Latest Updates

Medical Futility

Jacob A Blythe, MA, MD, Stephanie Harman, MD
    • Medical futility has developed as an ethical construct to approach patient/family requests for clinical interventions that are not medically effective in achieving their intended goal and creates recourse for clinicians to address these requests.
    • Several states now have legislation that govern medical futility that offers protections for both clinicians and patients and families.
    • A process-based approach incorporating the concept of “potentially inappropriate” care has now been established in society guidelines promoting a shared decision-making approach and aligning the goals of clinicians and patients and families.

Microsurgical Reconstruction of the Upper Extremity

Nikolas H Kazmers, MD, MSE, L. Scott Levin, MD, FACS, Zvi Steinberger, MD, Stephanie Thibaudeau, MD
    • Recent literature highlighting considerations for surgical timing of microsurgical reconstruction is reviewed and summarized.
    • Recent literature highlighting risk factors for failure of free flaps is reviewed and summarized.
    • Newer concepts, including perforator freestyle flaps, have been introduced.

Diagnosis, Etiology, and Treatment of Premenstrual Dysphoric Disorder

Marlene P. Freeman, MD, Edwin Raffi, MD, MPH
    • Diagnosing PMDD only formally achieved after ruling out other underlying mood or anxiety disorder, and if the symptoms persist for two consecutive months, in a cyclic fashion.
    • Differential Diagnosis for PMDD include any mood or anxiety disorder, or PTSD. Providers should rule out PME of one of these disorders first.
    • The etiology of PMDD is likely multifactorial and includes the interplay between genetics, neurosteroids, neurotransmitters, brains structure and function, and the pathophysiology that connects these factors.
    • Of the pharmacologic approaches, serotonergic reuptake inhibitors and oral contraceptives should initially be considered for treatment of PMDD.

Erectile Dysfunction: Evaluation, Including Diagnostic Studies

Sevann Helo, MD, Kevin T McVary, MD, Nicholas Tadros, MD MCR
    • Risk assessment in patients with cardiovascular disease
    • Penile Doppler ultrasonography
    • Cavernosometry and cavernosography

Immunosuppression

Steven Gabardi, PharmD, BCPS, FAST, FCCP, Miae Kim, MS, PharmD, BCPS
    • Full review of all available literature on transplant immunosuppression use in renal transplantation
    • Recommendations for strategies to manage common adverse reactions from transplant immunosuppressants
    • Evaluation of specific medications that are used for the management of antibody-mediated rejection

Head and Neck Melanoma: An Overview

Samuel Kim, MD, Deepak Narayan, MD
    • A recently discovered gain-of-function mutation in the RAC1 gene in melanomas may provide a potential target for pharmacologic treatment.
    • Adoptive cell therapy has been refined and advanced to become an effective form of personalized cancer therapy, but the search continues to generalize its use.
    • Expanding our knowledge of and targeting the tumor microenvironment, which provides several means of tumor protection, may unlock the full potential of immunotherapy.

Surgical Management of the Breast

Anees B Chagpar, MD, MSc, MPH, MA, MBA
    • Diagnosis of breast cancer: from open biopsy of palpable lesions to minimally invasive image-guided core-needle biopsy
    • Extirpation of primary breast cancer: from mastectomy to breast conservation and oncoplastics
    • Lymph node evaluation: from axillary dissection to sentinel node biopsy
    • Integration with multidisciplinary management of breast cancer

Chemotherapy for Gynecologic Malignancies

Lauren E Dockery, MD, MS, Laura L Holman, MD, MS
    • Targeted therapies such as antiangiogenesis agents improve outcomes in ovarian and metastatic cervical cancer. 
    • Poly(ADP)ribose polymerase (PARP) inhibitors improve outcomes as treatment and maintenance therapies in recurrent epithelial ovarian cancer. 
    • Intraperitoneal administration of chemotherapy can be considered for a select group of patients with ovarian cancer in the front-line setting. 
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