What's New | Decker

With heightened awareness of side effects associated with narcotics, there has been increased frequency of multimodal pain management for the management and reduction of postoperative pain, including intra-operative local anesthetic and postoperative nonsteroidal anti-inflammatory agents.
Current and future research that focuses on patient reported outcomes, using validated measures such as BREAST-Q, will further allow the evaluation of patient satisfaction and continue to improve the counseling and management plastic surgeons can provide reduction mammaplasty patients.
The use of acellular dermal matrix (ADM) “slings” as a soft tissue substitute can offer additional support for natural tissue and might offer beneficial results for larger, ptotic breasts.

Large randomized trials of Pap and HPV cotesting found that after extended follow-up, the incidence of invasive cervical cancer was significantly lower in women initially screened with HPV-based testing compared with cytology alone.
Screening that includes assessment of HPV status provides 60 to 70% greater protection against invasive cervical carcinomas compared with cytology alone.
Vaccination rates for the HPV vaccine, approved in the United States since 2006, are well below national goals, and provider recommendation has been found to be the most important factor influencing a patient’s or parent’s decision as to whether or not to accept the HPV vaccine.

Even the most competent physician can be prone to misusing epidemiologic concepts. An example of inaccurate decision making, resting on Bayes’s theorem, occurred in a recent study in which primary care physicians were given clinical scenarios. Although the clinicians confidently provided their estimates of the probabilities of given disorders, no consensus could be found among the estimates. Another study assessed the ability of medical students, residents, and attending physicians to correctly determine the positive predictive value of a hypothetical screening test. The vast majority of respondents not only got the question wrong but also had an answer that would have led to the opposite clinical conclusions, guessing an incorrect positive predictive value of 95% when the true answer was 2%.

Current data on the epidemiology of colorectal cancer in United States and globally
Classification and detailed description of the three major molecular pathways for colorectal cancer carcinogenesis
Modern classification of familial syndromes based on polyp type and description of newly discovered familial colorectal cancer syndromes

Cognitive-behavioral therapy (CBT) is typically more structured and shorter duration and centers on identifying thoughts and beliefs and how they impact feelings and behaviors. The therapist helps individuals label and challenge these thoughts and beliefs, and often homework is assigned to identify and counter these as they occur in their daily life.
All guidelines agree that an antidepressant trial should be a minimum of 4 weeks and up to 8 to 12 weeks at an adequate duration and dose. Even with dozens of antidepressant therapies on the market, overall response rates are still suboptimal, and remission rates remain low.
There are few data on long-term use of antidepressants. Studying relapse and prevention therapies is challenging because of the heterogeneity of the disease and difficulty retaining subjects in long-term antidepressant studies.

Imaging studies for the initial evaluation of Hodgkin lymphoma should include a screening chest radiograph and computed tomography (CT) of the chest, abdomen, and pelvis (with intravenous contrast if possible). CT is the gold-standard imaging modality. Positron emission tomography (PET) is an important adjunct to CT for initial staging.
An improved histopathologic classification, accurate staging, improved radiotherapy, and effective chemotherapeutic agents contribute to the high cure rate for Hodgkin lymphoma. For therapeutic success, care should be given by a multidisciplinary team with expertise in histopathology, diagnostic radiology, medical oncology, and radiation therapy.
Because of the high cure rate of Hodgkin lymphoma, long-term toxicity of therapy is becoming increasingly important as the follow-up time for patients increases. The full toxicity profile of radiation is only now becoming apparent. The risk of several types of solid tumors is dramatically increased in patients who receive radiation therapy for Hodgkin lymphoma.

Imaging studies for the initial evaluation of Hodgkin lymphoma should include a screening chest radiograph and computed tomography (CT) of the chest, abdomen, and pelvis (with intravenous contrast if possible). CT is the gold-standard imaging modality. Positron emission tomography (PET) is an important adjunct to CT for initial staging.
An improved histopathologic classification, accurate staging, improved radiotherapy, and effective chemotherapeutic agents contribute to the high cure rate for Hodgkin lymphoma. For therapeutic success, care should be given by a multidisciplinary team with expertise in histopathology, diagnostic radiology, medical oncology, and radiation therapy.
Because of the high cure rate of Hodgkin lymphoma, long-term toxicity of therapy is becoming increasingly important as the follow-up time for patients increases. The full toxicity profile of radiation is only now becoming apparent. The risk of several types of solid tumors is dramatically increased in patients who receive radiation therapy for Hodgkin lymphoma.

Microbiologic studies are critical for characterizing infections. Gram stains and cultures of wound tissue, pus, sputum, urine, and drainage effluent are generally very useful. Identification of not only the particular organism involved but also of its specific antimicrobial susceptibility has become common practice in most hospital clinical laboratories.
Treatment of CAUTI requires removal or change of the catheter along with systemic antimicrobial therapy. The predominant microorganisms causing CAUTI in the ICU are enteric gram-negative bacilli, Candida species, enterococci, staphylococci, and Pseudomonas aeruginosa. Multidrug resistance is a significant problem in urinary pathogens

Surgery of the Lower Extremity