Latest Updates

Estrogen Receptor–Positive, HER-2 Nonamplified Breast Cancer

Leisha C Elmore, MD, MPHS, Julie A. Margenthaler, MD
    • • Estrogen receptor (ER)-positive tumors represent 70% of all breast cancers and generally have a good prognosis but are heterogeneous, and biological behavior can be more closely predicted by luminal subtype.
    • • Endocrine therapy reduces locoregional and distant failure in ER-positive tumors, with tamoxifen being the drug of choice in premenopausal women and tamoxifen or an aromatase inhibitor alone or in sequence being used in postmenopausal women.
    • • Although clinicopathologic features, such as patient risk factors, pathologic stage, and lymphovascular invasion, guide therapy selection, genomic profiling of the tumor provides insight into the risk of recurrence and is a commonly used tool to determine the need for adjuvant chemotherapy. Oncotype DX is the most broadly used molecular profiling tool.
    • • Ovarian suppression, either reversibly or irreversibly, in addition to hormone therapy reduces the risk of recurrence in premenopausal women who are at high risk for recurrence indicated by the need for chemotherapy.
    • • Neoadjuvant and adjuvant chemotherapy have equivalent long-term outcomes, but neoadjuvant therapy can be used to downstage a tumor to make it amenable to breast-conserving therapy or to evaluate tumor response to systemic therapy and provide prognostic information.

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Antiepileptic and Antidepressant Drugs Used in the Treatment of Pain

Lucia Daiana Voiculescu, MD
    • Gabapentinoids
    • Antiepileptic and antidepressant drugs used in pain therapy: approved indications and off-label use
    • Antiepileptic drugs used as adjuvant analgesics in the perioperative period

ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

Child Abuse and Nonaccidental Trauma

S Terez Malka, MD
    • 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.

Nutritional Management of Celiac Disease

Ciarán P Kelly, MD, Satya Kurada, MD, Mariana Urquiaga, MD
    • Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
    • Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
    • IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.

OVERVIEW OF ENTERAL NUTRITION

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.
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