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Practicing Evidence-Based Medicine

    • 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%.

Rare Tumors of the Colorectal Region

    • Immunotherapy and targeted therapy represent innovative medical therapies to improve survival in anorectal melanoma.
    • Clinical trials are under way examining medical therapy options in imatinib-resistant GISTs.
    • Safety and effectiveness of transanal minimally invasive surgery are being studied for rectal GISTs.

Rare Tumors of the Colorectal Region

    • Immunotherapy and targeted therapy represent innovative medical therapies to improve survival in anorectal melanoma. Pembrolizumab is a PD-1 inhibitor used as immunotherapy in melanoma.
    • Clinical trials are under way examining medical therapy options in imatinib-resistant GISTs.
    • Safety and effectiveness of transanal minimally invasive surgery are being studied for rectal GISTs.

Overview of Substance Use Disorders

    • Discussion of the evolution of DSM substance use disorder diagnoses over time
    • Overview of the biological, environmental, and personal factors implicated in the development of substance use disorders
    • Critical reviews of the current diagnostic criteria, epidemiology, and clinical presentation of the major substances of misuse

Injuries to the Upper Urogenital Tract

    • Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
    • Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
    • A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy

Part 1: Borderline Personality Disorder and Its Clinical Features

    • Diagnosing borderline personality disorder (BPD) is  focused on identifying patterns of symptoms that are consistent over time across several domains.
    • Development of BPD depends on an interactive combination of temperamental factors and environment stresses.
    • Distinguishing BPD from other psychiatric disorders, such as bipolar disorder, is essential in providing effective treatment.
    • Patients with BPD are highly stigmatized in the mental health system and receive poorer quality of care than patients with some other disorders.
    • BPD has a positive prognosis, with improvements typically seen within several years.

Overview of Substance Use Disorders

    • Discussion of the evolution of DSM substance use disorder diagnoses over time
    • Overview of the biological, environmental, and personal factors implicated in the development of substance use disorders
    • Critical reviews of the current diagnostic criteria, epidemiology, and clinical presentation of the major substances of misuse

Breast Cancer

    • There has been much interest in the development of breast cancer prevention strategies. Pharmacologic approaches are the most developed at this time. The nonsteroidal selective estrogen receptor modulator (SERM) tamoxifen, a mainstay in the management of breast cancer, has also been tested as a chemopreventive agent. 
    • Screening strategies for breast cancer include the triad of breast self-examination (BSE), clinical breast examination by a health care professional, and screening mammography. Although widely touted as an important component of early detection, BSE is of uncertain value.
    • Increased understanding of growth pathways of breast cancer has led to the identification of crucial nonendocrine pathways that are potential targets for therapy. One such target is the HER-2 protein, a transmembrane protein that is overexpressed in about 20% of breast cancers, generally because of gene amplification. 
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