What's New | Decker

Microbiologic studies are critical for characterizing infections. Gram stains and cultures of wound tissue, pus, sputum, urine, and drainage effluent are generally very useful. Identification of not only the particular organism involved but also of its specific antimicrobial susceptibility has become common practice in most hospital clinical laboratories.
Treatment of CAUTI requires removal or change of the catheter along with systemic antimicrobial therapy. The predominant microorganisms causing CAUTI in the ICU are enteric gram-negative bacilli, Candida species, enterococci, staphylococci, and Pseudomonas aeruginosa. Multidrug resistance is a significant problem in urinary pathogens

We anticipate that the implementation of breast reconstruction-specific QoL evaluations and patient-reported outcomes measures to guide flap choice and design will continue to gain popularity and validity in the coming years.
Experience with pedicled perforator flaps such as the ICAP, SAAP, SEAP, and will continue to advance, making these flaps more reliable over time.
Multimodal pain control regimens, including acetaminophen, neuropathic pain agents, and novel local anesthetic blocks, may allow for significantly earlier discharge after pedicled breast reconstruction.

Pulmonary hypertension can be treated with single or combination therapy employing calcium channel blockers, phosphodiesterase inhibitors, guanylate cyclase stimulators, endothelin receptor antagonists, and prostanoids.
Levosimendan is a calcium sensitizer used to treat cardiogenic shock and right heart failure.
Clevidipine is an ultra-rapid acting calcium channel blocker used for perioperative hypertension management in cardiovascular and vascular diseases, neurosurgery, and surgery for pheochromocytoma.

Peripheral nerve and sphenopalatine ganglion blocks are a safe, effective treatment option for headache disorders, including migraine, although the evidence remains mixed for chronic migraine prophylaxis.
Neurostimulation has emerged as an effective treatment modality for migraine, with both noninvasive and minimally invasive options available.
Safe, effective, and noninvasive neurostimulation therapies available for migraine include transcutaneous supraorbital nerve stimulation for prophylaxis and single-pulse transcranial magnetic stimulation for the acute treatment of migraine with aura.
Occipital nerve stimulation may be effective for some patients with intractable chronic migraine, although the evidence is mixed and procedure-related complications are common.
Noninvasive vagus nerve stimulation and implanted sphenopalatine ganglion stimulation are emerging treatment options that may be useful for both acute and prophylactic treatment of episodic and chronic migraine.

The cholinesterase inhibitors donepezil, galantamine, and rivastigmine have been approved by the Food and Drug Administration (FDA) for the treatment of AD dementia.
Patients with mild to moderate AD dementia are the appropriate candidates for cholinesterase inhibitor therapy. These patients need a designated caregiver to supervise the use of the medication.
Support for and empowerment of the caregivers of dementia patients must be an integral part of management. The emotional and physical health of caregivers is critical to long-term outcomes.

2020 ATS and 2019 CTS practice guidelines delineating pharmacologic management of COPD.
Introduced the new Global Initiative for Chronic Obstructive Lung Disease (GOLD) Combined COPD Assessment using symptoms of breathlessness, spirometric classification, and risk of exacerbation to evaluate patients with chronic obstructive pulmonary disease (COPD) and guide treatment
Epidemiology section updated to reflect new data suggesting a decline in the age-adjusted prevalence of COPD, likely as a result of decreased smoking rates
Multiple new common genetic risk factors associated with COPD described, including a recently discovered functional genetic variant
Discussion about the long-term care of patients with COPD extensively revised to include the most recent trials assessing indications for long-acting inhaled bronchodilators and inhaled corticosteroids, among other therapies
Recent evidence supporting lung cancer screening in patients with COPD reviewed

The cholinesterase inhibitors donepezil, galantamine, and rivastigmine have been approved by the Food and Drug Administration (FDA) for the treatment of AD dementia.
Patients with mild to moderate AD dementia are the appropriate candidates for cholinesterase inhibitor therapy. These patients need a designated caregiver to supervise the use of the medication.
Support for and empowerment of the caregivers of dementia patients must be an integral part of management. The emotional and physical health of caregivers is critical to long-term outcomes.

Sepsis syndromes have been redefined (Sepsis-3 definitions) by international experts, based on sepsis mortality data extracted large administrative databases.
National focus has turned to early identification of sepsis as a key determinant of outcomes. International critical care experts have recommended using the qSOFA criteria in the Emergency Department setting to identify sepsis risk in patients prior to obtaining diagnostics.
The Center for Medicare and Medicaid Services (CMS) has added a sepsis quality measure (SEP-1) as a reporting requirement for all US hospital tied to Medicare & Medicaid reimbursement. This measure has increased awareness of sepsis performance and focused quality efforts on improvement.
2018 update to bundles to simplify to 1-hour bundle.

Scientific Foundations