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Classification Systems for Lower Extremity Occlusive Disease

    • The SVS runoff score provides a method for giving weight to those vessels contributing to the runoff. It was developed to anatomically stratify patients when designing studies to compare the outcome of lower extremity arterial bypass.
    • The TASC classification system guides the clinical management of a patient by providing vascular specialists with a basic framework for determining whether the patient’s vascular disease pattern is best treated with endovascular intervention or with surgical revascularization. The TASC classification is also used to stratify cohorts in research studies evaluating treatment modalities.
    • The Finnvasc score, Project of Ex-Vivo graft Engineering via Transfection (PREVENT) III (PIII) score, and BASIL Mortality Index are three tools designed to aid in decision making between open surgical revascularization and endovascular intervention. These tools stratify the risk of periprocedural morbidity and/or predict a patient’s probability for short-term, medium-term, and long-term survival.

Classification Systems for Lower Extremity Occlusive Disease

    • The SVS runoff score provides a method for giving weight to those vessels contributing to the runoff. It was developed to anatomically stratify patients when designing studies to compare the outcome of lower extremity arterial bypass.
    • The TASC classification system guides the clinical management of a patient by providing vascular specialists with a basic framework for determining whether the patient’s vascular disease pattern is best treated with endovascular intervention or with surgical revascularization. The TASC classification is also used to stratify cohorts in research studies evaluating treatment modalities.
    • The Finnvasc score, Project of Ex-Vivo graft Engineering via Transfection (PREVENT) III (PIII) score, and BASIL Mortality Index are three tools designed to aid in decision making between open surgical revascularization and endovascular intervention. These tools stratify the risk of periprocedural morbidity and/or predict a patient’s probability for short-term, medium-term, and long-term survival.

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability

Neck Dissection

    • The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
    • Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter. 

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability

Clinical Trial Design and Statistics

    • Because of the complex nature of clinical trial design, significant resources and infrastructure are invested in drug development. Many drugs fail to progress beyond the phase I/II stage, and many phase III trials take years to accrue and publish results, leading to a delay in Food and Drug Administration (FDA) approval for diseases that desperately need better therapeutic options. The relatively recent FDA Safety and Innovation Act has allowed for the creation of priority and expedited review for drugs and biologics in serious conditions and where there is an unmet medical need. The designation of fast-track or breakthrough therapy may be granted when there is preclinical or clinical evidence to suggest that the intervention may result in a substantial improvement over currently available therapies. 
    • Prior to embarking on a clinical trial, data entry, editing (“cleaning”), and analysis should be anticipated. Planning for data management begins with developing rules for coding the variables for computer entry. The appropriate hardware and software programs should be selected and standardized across study sites.
    • A type I error (false positive) occurs if an investigator rejects a null hypothesis that is true in the population. A type II error (false negative) occurs if the investigator fails to reject a null hypothesis that is false in the population. Neither of these errors can be avoided entirely.

Bipolar Disorders and Their Clinical Management, Part I: Epidemiology, Etiology, Genetics, and Neurobiology

    • Review of emerging genetics and etiologic theories of bipolar disorders
    • Correlation between recent neurobiologic findings and clinical manifestations of bipolar disorders
    • Discussion of the role of endocrine and immune alterations in metabolic derangements associated with bipolar disorders
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