Latest Updates

ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

OVERVIEW OF ENTERAL NUTRITION

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Kevin K. Chang, MD, Sam S. Yoon, MD
    • The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
    • A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
    • Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.

Pathologic Evaluation of Soft Tissue Sarcoma

Narasimhan P. Agaram, MBBS
    • Concepts of pathologic examination and grading
    • Important diagnostic criteria for each soft tissue sarcoma
    • Latest molecular diagnostic methods used in the diagnosis of sarcomas

Nephrology: Hypertensive Disorders in Pregnancy

Susan Hou, MD, Kavitha Vellanki, MD
    • New diagnostic criteria for preeclampsia
    • Pathophysiology of preeclampsia
    • Role of serologic biomarkers for diagnosis of preeclampsia
    • Guidelines for target blood pressure in pregnancy

Nephrology: Drug Dosing in Acute Kidney Injury

Jamil Azzi, MD, Steven Gabardi, PharmD, BCPS, FAST, FCCP, Marjan Sadegh, PharmD, BCPS, Craig A Stevens, PharmD, BCPS
    • Full review of all available literature on the impact of acute kidney injury (AKI) on drug pharmacokinetic parameters
    • Recommendations for drug dosing strategies in patients with AKI, including loading doses, maintenance therapy, and therapeutic drug monitoring
    • Evaluation of specific medications that require special attention in patients with AKI

Nephrology: Management of Cardiovascular Disease in Dialysis Patients

John P. Middleton, John K. Roberts
    • Left ventricular hypertrophy is associated with cardiovascular outcomes, including sudden cardiac death. Efforts to mitigate left ventricular hypertrophy (blood pressure control, aggressive fluid management, and frequent hemodialysis) may improve outcomes.
    • Low potassium dialysate (< 2 mEq/L), low calcium dialysate (< 2.5 mEq/L), and high ultrafiltration rates (> 13 mL/kg/hr) have been associated with worse cardiovascular outcomes in hemodialysis patients.
    • End-stage renal disease (ESRD) patients with atrial fibrillation are at increased risk for both stroke and bleeding events. Routine anticoagulation is not recommended for stroke prophylaxis.
    • In two small randomized trials, use of spironolactone reduced cardiovascular events and left ventricular mass index compared with placebo in patients with ESRD.

Rheumatology: Osteoarthritis 

Christopher Wise, MD, FACP
    • 2016 Update on glucosamine for the management of osteoarthritis
    • 2014 NICE guidelines for osteoarthritis care and management
    • 2014 OARSI guidelines for non-surgical management knee osteoarthritis
    • 2013 AAOS guidelines for knee osteoarthritis
    • 2012 ACR recommendations for therapies in hand/hip/knee osteoarthritis
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