Common Codes for Billing: Contraceptive Management Visits
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Lactational Amenorrhea Method
Lactational Amenorrhea Method Dr. Raqibat Idris [email protected] From Research to Practice: Training in Sexual and Reproductive Health Research 2017 Objectives of presentation • Define Lactational Amenorrhea Method (LAM) • Understand the mechanism of action of LAM • Know the efficacy of LAM • Know and describe the 3 criteria for LAM • Know the indication and contraindications for LAM • Know the focus and timing of counselling for LAM • List the advantages, disadvantages and health benefits of LAM • Know the elements of programming necessary for the provision of quality LAM services Introduction Breastfeeding delays the return of a woman’s fertility in the first few months following childbirth. Women who breastfeed are less likely to ovulate in this period. When compared with women who breastfeed partially or who do not breastfeed at all, women who breastfeed more intensively are less likely to have a normal ovulation before their first menstrual bleed postpartum (Berens et al., 2015). In a consensus meeting in Bellagio, Italy in 1998, scientists proposed that women who breastfeed fully or nearly fully while they remain amenorrhoeic in the first 6 months postpartum experience up to 98% protection from pregnancy. This formed the basis for the Lactational Amenorrhea Method and has since then been tested and confirmed by other studies (Berens et al., 2015; Van der Wijden et al., 2003; WHO, 1999). Berens P, Labbok M, The Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeeding Medicine. 2015 Feb;10(1):3-12. The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. -
Endometriosis for Dummies.Pdf
01_050470 ffirs.qxp 9/26/06 7:36 AM Page i Endometriosis FOR DUMmIES‰ by Joseph W. Krotec, MD Former Director of Endoscopic Surgery at Cooper Institute for Reproductive Hormonal Disorders and Sharon Perkins, RN Coauthor of Osteoporosis For Dummies 01_050470 ffirs.qxp 9/26/06 7:36 AM Page ii Endometriosis For Dummies® Published by Wiley Publishing, Inc. 111 River St. Hoboken, NJ 07030-5774 www.wiley.com Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permit- ted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600. Requests to the Publisher for permission should be addressed to the Legal Department, Wiley Publishing, Inc., 10475 Crosspoint Blvd., Indianapolis, IN 46256, 317-572-3447, fax 317-572-4355, or online at http:// www.wiley.com/go/permissions. Trademarks: Wiley, the Wiley Publishing logo, For Dummies, the Dummies Man logo, A Reference for the Rest of Us!, The Dummies Way, Dummies Daily, The Fun and Easy Way, Dummies.com, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and/or its affiliates in the United States and other countries, and may not be used without written permission. -
Practice-Based Competencies for Genetic Counselors © 2015
Practice-Based Competencies for Genetic Counselors © 2015 Accreditation Council for Genetic Counseling 7918 Jones Branch Drive, Suite 300, McLean, VA 22102 (703) 506-7667 www.gceducation.org Practice-Based Competencies for Genetic Counselors This document defines and describes the twenty two practice-based competencies that an entry-level provider must dem- onstrate to successfully practice as a genetic counselor. It provides guidance for the training of genetic counselors and an assessment for maintenance of competency of practicing genetic counselors. The didactic and experiential components of a genetic counseling training curriculum and maintenance of competency for providers must support the development of competencies categorized in the following domains: (I) Genetics Expertise and Analysis; (II) Interpersonal, Psychosocial and Counseling Skills; (III) Education; and (IV) Professional Development & Practice. These domains describe the minimal skill set of a genetic counselor, which should be applied across practice settings. Some competencies may be relevant to more than one domain. Italicized words are defined in the glossary. Domain I: Genetics Expertise and Analysis 12. Understand how to adapt genetic counseling skills for varied service delivery models. 1. Demonstrate and utilize a depth and breadth of understanding and knowledge of genetics 13. Apply genetic counseling skills in a cultur- and genomics core concepts and principles. ally responsive and respectful manner to all clients. 2. Integrate knowledge of psychosocial aspects of conditions with a genetic component to Domain III: Education promote client well-being. 14. Effectively educate clients about a wide range 3. Construct relevant, targeted and compre- of genetics and genomics information based hensive personal and family histories and on their needs, their characteristics and the pedigrees. -
OVESTIN PESSARY (0.5Mg)
NEW ZEALAND DATA SHEET 1. OVESTIN PESSARY (0.5mg) 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each pessary contains 0.5 mg Estriol. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Pessary 0.5 mg - white, torpedo formed pessary. One pessary (2.5 g weight) contains 0.5 mg oestriol. Length 26.5 mm; largest diameter 14 mm. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Atrophy of the lower urogenital tract related to oestrogen deficiency, notably • for the treatment of vaginal complaints such as dyspareunia, dryness and itching. • for the prevention of recurrent infections of the vagina and lower urinary tract. • in the management of micturition complaints (such as frequency and dysuria) and mild urinary incontinence. Pre- and postoperative therapy in postmenopausal women undergoing vaginal surgery. A diagnostic aid in case of a doubtful atrophic cervical smear. 4.2 Dose and method of administration Dosage OVESTIN is an oestrogen-only product that may be given to women with or without a uterus. Atrophy of the lower urogenital tract 1 pessary per day for the first weeks, followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage (e.g. 1 pessary twice a week) is reached. Pre- and post-operative therapy in postmenopausal women undergoing vaginal surgery 1 pessary per day in the 2 weeks before surgery; 1 pessary twice a week in the 2 weeks after surgery. A diagnostic aid in case of a doubtful atrophic cervical smear 1 pessary on alternate days in the week before taking the next smear. Administration OVESTIN pessaries should be inserted intravaginally before retiring at night. -
NFP Related Research ……………………………………………
1 Winter/Spring 2000 ● Vol. 11, Nos. 1 and 2 Richard J. Fehring, DNSc, RN, Marquette University College of Nursing In this issue NFP Related Research ……………………………………………. 2 Pregnancy and Breastfeeding …………………………………….. 8 Contraception ……………………………………………………… 11 Research Briefs …………………………………………………….. 14 Under the Microscope ……………………………………………... 19 The Effectiveness of Natural Family Planning, Robert T. Kambic, MSH Current Medical Research is a publication of the Natural Family Planning Program of the United States Conference of Catholic Bishops.© Washington, DC: USCCB, 2011. The managing editor is Theresa Notare, PhD, Assistant Director. Permission is granted to reproduce in whole or in part, in print and/or electronically, with the following statement: Current Medical Research, NFPP/US Conference of Catholic Bishops, Washington, DC, volume # (year): page#. Used with permission. 2 Natural Family Planning United States Physicians Underestimate Effectiveness of Natural Family Planning A recent study conducted by researchers at the University of Missouri-Columbia, found that 79% of physicians in Missouri estimated the best possible effectiveness of natural family planning for avoiding pregnancy to be less than 91%. Sixty-five percent of those surveyed ranked the actual effectiveness of NFP to be 70% or less.1 The purpose of the study was to determine physicians' knowledge and practices of modern methods of NFP. The researchers assumed that modern methods of NFP are important for medical practice in order to help women and couples avoid or achieve pregnancy. A one page questionnaire on knowledge and practice of NFP was created by the researchers and mailed to 840 randomly selected physicians in Missouri. While 69% of the 547 respondents saw women for reproductive needs, only 46% mentioned NFP to at least some women when discussing family planning issues. -
UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ Prolapse
UK Clinical Guideline for best practice in the use of vaginal pessaries for pelvic organ prolapse March 2021 Developed by members of the UK Clinical Guideline Group for the use of pessaries in vaginal prolapse representing: the United Kingdom Continence Society (UKCS); the Pelvic Obstetric and Gynaecological Physiotherapy (POGP); the British Society of Urogynaecology (BSUG); the Association for Continence Advice (ACA); the Scottish Pelvic Floor Network (SPFN); The Pelvic Floor Society (TPFS); the Royal College of Obstetricians and Gynaecologists (RCOG); the Royal College of Nursing (RCN); and pessary users. Funded by grants awarded by UKCS and the Chartered Society of Physiotherapy (CSP). This guideline was completed in December 2020, and following stakeholder review, has been given official endorsement and approval by: • British Association of Urological Nurses (BAUN) • International Urogynecological Association (IUGA) • Pelvic Obstetric and Gynaecological Physiotherapy (POGP) • Scottish Pelvic Floor Network (SPFN) • The Association of Continence Advice (ACA) • The British Society of Urogynaecology (BSUG) • The Pelvic Floor Society (TPFS) • The Royal College of Nursing (RCN) • The Royal College of Obstetricians and Gynaecologists (RCOG) • The United Kingdom Continence Society (UKCS) Review This guideline will be due for full review in 2024. All comments received on the POGP and UKCS websites or submitted here: [email protected] will be included in the review process. 2 Table of Contents Table of Contents ................................................................................................................................ -
Pessary for Management of Pelvic Organ Prolapse
Pessary for management of Pelvic Organ Prolapse Cathy Davis Clinical Nurse Specialist Department of Urogynaecology King’s College Hospital, London Definition of Prolapse The descent of one or more of the anterior vaginal wall, posterior vaginal wall, uterus (cervix) or vaginal vault (cuff scar after hysterectomy). The presence of any such sign should be correlated with relevant POP symptoms. (Haylen et al 2016) Risk Factors • Increased intra-abdominal pressure • Chronic cough • Chronic constipation • Weight lifting • Presence of abdominal tumours - fibroids & ovarian cysts • High impact exercise • Age/ Menopause • Obesity Risk Factors contd.... • Smoking • Multiparity • Congenital weakness – rare; due to deficiency in collagen metabolism • Injury to pelvic floor muscles • Iatrogenic/ pelvic surgery - hysterectomy Symptoms of POP • May be asymptomatic – a small amount of prolapse can often be normal • Sensation of a lump or bulge " coming down" - most common • Backache • Heaviness • Dragging or discomfort inside the vagina – often worse on standing /sitting for prolonged periods • Seeing a lump or bulge Symptoms of POP contd.... • Bladder / Urinary symptoms -Frequency -Difficulty initiating voids, low-flow, incomplete bladder emptying -Leakage on certain movements or when lifting heavy objects -Recurrent urinary tract infections • Bowel symptoms -Constipation - Incomplete bowel emptying - May have to digitate to defecate/use aides • Symptoms related to Sex – uncomfortable, lack of sensation Diagnosis of Prolapse • Vaginal examination • -
Combi Soft Gel Pessary & External Cream
Combi Soft Gel Pessary Canesten & External Cream 500mg vaginal capsule & 2% w/w cream Clotrimazole Read all of this leaflet carefully because it contains important To treat internal thrush, your doctor may recommend that you use the information for you. pessary without the help of an applicator. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. HOW TO USE CANESTEN® COMBI • This medicine has been prescribed for you. Do not give it to anyone else 3. under any circumstances. The Soft Gel Pessary: • If you have any unusual effects after using this product, tell your doctor. Unless directed otherwise by your doctor, the Soft Gel Pessary should be inserted as high as possible into the vagina, preferably before going to sleep IN THIS LEAFLET at night for convenient and comfortable treatment. Wash your hands before removing the foil from the blister pack and again 1. What is Canesten Combi and what is it used for? afterwards when you have used the applicator. 2. Before you use Canesten Combi 3. How to use Canesten Combi 1. Remove the applicator from the packaging. Pull out the plunger A until it 4. Possible side effects stops. Remove the pessary from the foil blister pack and place firmly into the 5. How to store Canesten Combi applicator B. 6. Further information 1. WHAT IS CANESTEN® COMBI AND WHAT IS IT USED FOR? Canesten Combi Soft Gel Pessary & External Cream is a full course of treatment for vaginal thrush (candidiasis) because it treats both the internal cause and external symptoms. -
American Family Physician Web Site At
Diagnosis and Management of Adnexal Masses VANESSA GIVENS, MD; GREGG MITCHELL, MD; CAROLYN HARRAWAY-SMITH, MD; AVINASH REDDY, MD; and DAVID L. MANESS, DO, MSS, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate labo- ratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Fam- ily physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks. -
Intermenstrual Bleeding (Bleeding Between Periods)
Intermenstrual Bleeding (Bleeding between periods) What is Intermenstrual bleeding? This is unscheduled bleeding that can occur in between periods. There are many different causes of bleeding between periods but seek medical advice if you are experiencing this, even if it is for reassurance in many situations. What is the nature of bleeding? Bleeding that occurs randomly without any relation to your monthly period should not be ignored, unless the cause is known. The bleeding may be light blood, spotting, a bloody or dark brown vaginal loss or heavy bleeding mimicking a period. Mid cycle pain and bleeding Mittelschmerz is one-sided, lower abdominal pain associated with ovulation, about 14 days before your next menstrual period. In most cases, mittelschmerz does not require medical attention and may be associated with light vaginal bleeding for a day or so. It may not occur every month. If you are concerned, seek advice. Spotting in the lead up to or at the end of the period Usually, this just suggests that levels of progesterone fall slightly more slowly in some cycles and can lead to spotting seen in the lead up to the proper menstrual flow. This is usually not a concern. Spotting or a brown vaginal loss as the period finishes is also not abnormal, unless lasting for days or associated with other symptoms. (See information on a normal menstrual cycle under the leaflet on Irregular Periods) What are the possible causes of bleeding between periods? (not an exhaustive list) Hormonal contraceptives, such as the combined or progesterone only pill, implant, injection, intrauterine system, patch, ring can all cause bleeding between cycles, especially in the first few months of starting them. -
Efficacy of Genetic Testing in Cases of Ambiguous Genitalia
EFFICACY OF GENETIC TESTING IN CASES OF AMBIGUOUS GENITALIA DETECTED ON PRENATAL! ULTRASOUND ! ! ! by! EVELYN ROSE! CRAWFORD ! ! Submitted in partial fulfillment of !the requirements for the degree of Master of! Science ! ! ! Thesis Advisor: Larisa! Baumanis, MS ! ! Genetic Counseling! Department !of Genetics CASE WESTERN RESERVE! UNIVERSITY ! ! ! ! ! ! ! August, 2014 ! ! CASE WESTERN RESERVE! UNIVERSITY SCHOOL OF GRADUATE! STUDIES We hereby approve! the thesis of: Evelyn Rose! Crawford candidate for the degree of !Master of Science degree.* ! ! Larisa Baumanis, MS (Committee Chair) ! Anne Matthews, RN, PhD ! Noam Lazebnik, MD ! Aditi Parikh, MD ! Sara Debanne, PhD ! ! ! ! Date of Defense June 20, 2014 ! ! ! ! ! *We also certify that written approval has been obtained for any proprietary material contained therein !2 ! ! ! TABLE OF CONTENTS List of Tables 4 List of Figures 5 Acknowledgements 6 Abstract 7 Introduction 8 Purpose of Study & Specific Aims 10 Background 11 Detection of Ambiguous Genitalia on Prenatal Ultrasound 11 Current use of Genetic testing in determining a specific diagnosis 13 The Importance of Prenatal Diagnosis in Cases of Ambiguous Genitalia 18 Significance for genetic counselors 19 Conclusions 20 Methodology 22 Systematic Review of the Literature 22 Chart Review 27 Algorithm & Analysis 29 Results 31 Analysis 52 Discussion 55 Appendix I: First Review Matrix Organization and summary of literature review articles 62 Appendix II: Second Review Matrix Organization and summary of case studies from the literature review 78 Appendix III: Third Review Matrix Organization and summary of chart review cases 94 References 102 !3 LIST OF TABLES ! !Table 1: Keyword Combinations for Literature Search 22 !Table 2: Example First Review Matrix 25 !Table 3: Example Second Review Matrix 25 !Table 4: Protocol Key 26 !Table 5: Example Third Review Matrix 29 Table 6: Imaging characteristics to differentiate cloacal exstrophy, bladder !exstrophy and cloacal malformation (Calvo-Garcia et al. -
Genetic Counseling
Genetic Counseling Brook Croke, MS, MPH Genetic Counselor [email protected] 618-581-9098 (cell) Overview Genetics – a Growing Field Genetic Counseling Applying to Programs Northwestern University Overview Genetics – a Growing Field Genetic Counseling Applying to Programs Northwestern University Cancer Genetics There are more than 50 well described genetic cancer susceptibility syndromes (Lindor NM et al., 2008, JNCI) Genetic counseling and testing shortly after cancer diagnosis can help guide patients’ surgical and treatment decisions. (Weitzel JN et al., 2003, Arch Surg; Schwartz MD et al., 2004, JCO) (Ashworth A, 2008, JCO; Ribic CM et al., 2003, NEJM; Sargent DJ et al., 2010, JCO) Personalized Med. 34% reduction in chemotherapy use would occur if women with breast cancer receive a genetic test prior to treatment. 17,000 strokes could be prevented each year if a genetic test is used to properly dose the blood thinner warfarin. Neurogenetics Ten neurogenetics tests in 1995, several hundred today (Charcot-Marie-Tooth neuropathy, hereditary ataxia, spas7c paraplegia, muscular dystrophy and early-onset demen7a) (Jayadev S, Smith CO, Bird TD. NeurogeneCcs: Five new things. Neurol Clin Pract 2011;1;41) Lifetime risk of developing Alzheimer disease (AD) is 10-12%. Few clinicians are prepared to address the genetic risks of Alzheimer disease with their patients (Goldman et al. Genetic counseling and testing for Alzheimer disease: Joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors. Genet Med 2011:13(6):597-605) Prenatal Genetics ACOG currently recommends that Down syndrome screening and invasive testing be offered to all women, regardless of age.