Latest Updates

Human Trafficking 2: Approach To The Patient

Wendy Macias-Konstantopoulos, MD, MPH
    • The trauma-informed approach to care has been likened to ethics of care, a philosophy that emphasizes fostering attentive, holistic, and competent patient care that is simultaneously responsive to the unique and continually changing needs, wishes, goals, priorities, risks, and vulnerabilities of the individual patient.
    • ED clinicians should inform patients about their rights to privacy and the limits of confidentiality with respect to mandatory reporting laws.
    • Preliminary data analysis from one clinic for trafficking victims and survivors found that 57% of trafficked persons accessed care while trafficked and 76% of them accessed care through the ED.

Pediatric Renal Trauma

Douglas A Husmann, MD
    • New renal staging criteria
    • AUA and EUA trauma guidelines
    • Differences in etiology and management between adult and pediatric renal trauma

Evaluating the Quality of Evidence

Zach W Brown, DO, CDR, MC, USN, Herb A. Phelan, MD, MSCS
    • Well-written articles must identify a clear and novel hypothesis, a relevant topic, valid study methods, and the overall importance of the research.
    • Baseline level of quality is established by the hierarchy of study designs.
    • Overall quality of research can be downgraded based on five criteria identified in the GRADE guidelines: imprecision, inconsistency, indirectness, publication bias, and lack of internal validity.
    • Overall quality of research can be upgraded based on three criteria identified in the GRADE guidelines: when the size of the effect observed is very large, when a dose-response relationship exists, or when plausible confounders or other biases paradoxically increase confidence in the direction or magnitude of the signal.
    • A basic understanding of statistics is helpful for the reader to determine if the author has applied the appropriate statistical tools to interpret and analyze the data correctly. Otherwise, the conclusions may not be valid.

Role of Radiotherapy in Localized Prostate Cancer

Joelle Helou, MD, MSc, Andrew Loblaw, MD, MSc, FRCPC
    • The current AUA/ASTRO consensus guidelines recommend adjuvant RT in postoperative patients with high-risk pathologic features (pT3 or positive margins).
    • PSA monitoring could be an alternative; however, early administration of radiation is warranted if there is a sign of progression.
    • The prognostic value of preradiation PSA is well established.
    • Doses above 65 Gy to the prostate bed are recommended in the postoperative setting.
    • The role of pelvic radiation is being investigated; currently, the decision is based on clinical judgment.
    • Short-term ADT should be discussed with patients starting postoperative RT.

Postoperative Management of Liver Transplant Patients

Aleah L. Brubaker, MD, PhD, Marianne Chen, MD, Amy Gallo, MD
    • Donor and operative considerations: In an era of major donor shortage, advancing the use of marginal livers is imperative. Extended criteria donors can be successful if careful management and operative skills are implemented.
    • Cardiovascular hemodynamics in liver transplant recipients: Liver transplant patients’ cardiovascular needs can vastly differ from those of standard postoperative patients, and addressing differences can improve care.
    • Intensive care unit (ICU) and transplant team communication: Create standardization between ICU and transplant team communication can lead to increased graft and patient survival, allowing for both teams’ expertise to be maximally used.

Vascular Disorders of the Hand

Christian E Sampson, MD, Matthew Treiser, MD
    • The use of botulinum toxin for the management of digital ulcerations and ischemia associated with Raynaud disease is becoming more widely accepted as results have been positive.  
    • Magnetic resonance angiography is improving at a rapid rate and may supplant standard angiography as image quality and resolution improve.

Stress Urinary Incontinence Assessment and Conservative Treatments

Benjamin M Brucker, MD, Sidhartha Kalra, MD
    • Clinicians may perform a multichannel urodynamic study in patients with both symptoms and physical findings of stress urinary incontinence (SUI) who are considering invasive, potentially morbid, or irreversible treatments.
    • Clinicians should perform repeat stress testing with the urethral catheter removed in patients suspected of having SUI who do not demonstrate this finding with the catheter in place during urodynamic testing.

    • New mechanical device for SUI

Male-to-Female Gender-Confirming Surgery

Shane D Morrison, MD, MS, Marcelina G Perez, Medical Student, Thomas Satterwhite, MD, Stelios C Wilson, MD
    • Approaches to breast augmentation in the male-to-female transgender patient require special attention outside of conventional breast augmentations.
    • Understanding the differences in the nipple-areola complex (NAC) between females and males when undertaking gender-confirming breast augmentations
    • Special consideration is needed for the clitoral and urethral anatomy in gender-confirming vaginoplasty.
    • Postoperative care and complications in gender-confirming vaginoplasty require close follow-up and consideration. 
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