What's New | Decker

CT of the chest has taken a greater role in determining injury severity in inhalation injury.
Airway control and ventilator management remain the mainstays of treatment in those with severe injury.
Volumetric diffusive respiration is a mode specifically developed for inhalation injury that has been shown to decrease use of other rescue modes of ventilation.

Many iatrogenic withdrawal syndromes have been identified, the most common of which is opioid or benzodiazepine withdrawal. Generally speaking, the approach to treating opioid and/or benzodiazepine withdrawal is to provide enough medication to saturate target receptors, followed by a period of gradual dose reduction to allow the body to return to a state of homeostasis.
The Neonatal Abstinence Score (NAS) was designed to assess withdrawal symptoms in infants with multiple drug exposure during pregnancy. Because the NAS was validated in infants, it is not applicable in older children with iatrogenic withdrawal. In recent years, withdrawal assessment tools for pediatrics have been developed for iatrogenic withdrawal to provide an objective assessment of withdrawal.
There have been no randomized clinical trials that have compared the efficacy of various weaning strategies. However, a recent multicenter clinical trial, named the RESTORE trial, examined the effects of a standardized sedation protocol in pediatric intensive care units.

Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.

Many iatrogenic withdrawal syndromes have been identified, the most common of which is opioid or benzodiazepine withdrawal. Generally speaking, the approach to treating opioid and/or benzodiazepine withdrawal is to provide enough medication to saturate target receptors, followed by a period of gradual dose reduction to allow the body to return to a state of homeostasis.
The Neonatal Abstinence Score (NAS) was designed to assess withdrawal symptoms in infants with multiple drug exposure during pregnancy. Because the NAS was validated in infants, it is not applicable in older children with iatrogenic withdrawal. In recent years, withdrawal assessment tools for pediatrics have been developed for iatrogenic withdrawal to provide an objective assessment of withdrawal.
There have been no randomized clinical trials that have compared the efficacy of various weaning strategies. However, a recent multicenter clinical trial, named the RESTORE trial, examined the effects of a standardized sedation protocol in pediatric intensive care units.

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

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%.

Lip Taping and nasoalveolar molding pre-operatively can greatly improve surgical outcomes.
3-Dimensional printing used to make nasoalveolar molding appliances

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.

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