- Randomized trials of treatments (tamoxifen plus radiation versus tamoxifen alone) showed no difference in survival rates.
- Randomized trials of quadrantectomy with axillary lymph node dissection versus quadrantectomy alone showed that overall survival, distant metastases, and breast cancer mortality were no different.
Latest Updates
Child Abuse and Nonaccidental Trauma
- Abusive injuries account for over 1% of pediatric emergency department visits.
- Skeletal survey should now be obtained in any child under age 3 with concern for abusive injury.
- Cardiopulmonary resuscitation does not lead to significant rib fractures or retinal hemorrhages, and these conditions should be considered highly concerning for abusive injury.
Biomechanics of the Diabetic Foot
- Identifying unique and important aspects foot and ankle anatomy that are pivotal to normal and abnormal ambulation.
- Forces involved in the biomechanics of the diabetic foot and ankle which lead to ulcer development and chronicity.
- Options that include conservative and surgical offloading approaches to prevent and treat diabetic foot ulcers.
Improving Patient Safety in Surgical Care
- Use of sophisticated nonmedical systems approaches to improving surgical patient safety
- Recognition and implementation of standardization across surgical practices and integrated health systems to improve surgical patient safety
- National programs aimed at developing grassroots efforts to improve surgical safety at the individual, practice, and health system levels
Improving Patient Safety in Surgical Care
- Use of sophisticated nonmedical systems approaches to improving surgical patient safety
- Recognition and implementation of standardization across surgical practices and integrated health systems to improve surgical patient safety
- National programs aimed at developing grassroots efforts to improve surgical safety at the individual, practice, and health system levels
Improving Patient Safety in Surgical Care
- Use of sophisticated nonmedical systems approaches to improving surgical patient safety
- Recognition and implementation of standardization across surgical practices and integrated health systems to improve surgical patient safety
- National programs aimed at developing grassroots efforts to improve surgical safety at the individual, practice, and health system levels
- The causes of gastrointestinal bleeding are protean and reflect the fact that many different kinds of lesions can bleed, many of which can be found in multiple locations in the gastrointestinal tract.
- Patients with gastrointestinal bleeding are critically ill. It is imperative to obtain early expert consultation and definitive care while resuscitation and stabilization begin; consults may include Gastroenterology, Surgery, and Interventional Radiology.
- Appropriate, early intensive resuscitation has been shown to significantly reduce mortality in patients with upper gastrointestinal bleeding; a mean arterial pressure > 65 mm Hg is the goal.
- Aggressive airway management is prudent, with early intubation if indicated.
- Blood transfusions are indicated for patients with hemoglobin < 7 g/dL or < 9 g/dL if there is evidence of end-organ ischemia.
- Based on the history, physical examination, bedside testing, and laboratory studies, it is usually possible to distinguish between upper and lower gastrointestinal bleeding, and treatments should be initiated accordingly.
- Endoscopy is the mainstay of diagnosis and treatment for both upper and lower gastrointestinal bleeding.
- Treatment for variceal bleeding includes octreotide administered as a 50 µg bolus followed by continuous infusion at 50 µg/hr for 72 hours; an appropriate antibiotic (such as ceftriaxone 1 g intravenously four times a day for 7 days) and a promotility agent (such as erythromycin 250 mg IV) should be given prior to endoscopy.
- Treatment for nonvariceal upper gastrointestinal bleeding includes an intravenous proton pump inhibitor (such as omeprazole 80 mg) and endoscopy.
- Evidence-based clinical risk scores such as the Blatchford and Rockall scores can guide disposition decisions.
- Children with gastrointestinal bleeding can have subtle signs of severe illness; serious disease entities such as intussusception and necrotizing enterocolitis must be considered.
- Both intrinsic and extrinsic factors contribute to patients’ anticoagulation status, and some of these mechanisms can be managed with pharmacologic therapy.
Stroke and Other Cerebrovascular Diseases
- Recent advances in endovascular therapy for acute ischemic stroke
- Updated guidelines for administration of intravenous recombinant tissue plasminogen activator
- Recent advances in antithrombotic choice for directed secondary stroke prevention
- Current recommendations for the management of acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage
