What's New | Decker

Bariatric surgery is the most effective therapy for obesity and associated metabolic diseases
200,000 bariatric procedures are performed annually in the US with an overall low complication rate
Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed procedures and each have unique complication profiles

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

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.

Bactericidal antibiotics are used parenterally in high doses. With the exception of PVE caused by staphylococci, antimicrobial therapy for PVE caused by a specific organism uses the same drugs recommended for native valve endocarditis.
Endocarditis caused by relatively penicillin-resistant (MIC = 0.2 to 0.5 µg/mL) viridans or other nonenterococcal streptococci is treated with a higher dose of penicillin G combined with gentamicin. If the strain is even more resistant to penicillin (MIC > 0.5 µg/mL), the infection is treated with one of the standard regimens for enterococcal endocarditis.
Operative intervention to débride infected perivalvular tissue or to replace or reconstruct a dysfunctioning valve is important in the management of complicated infective endocarditis that involves either a native or a prosthetic valve. Overall, surgery is indicated in 25 to 40% of patients with infective endocarditis, and up to 45% of patients undergo surgery during the active phase of their disease.

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.

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

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

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.

Gastrointestinal Diseases