What's New | Decker

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.

In a 2015 population-based, cross-sectional study conducted by the United Kingdom Obstetric Surveillance System on women requiring massive postpartum transfusion for PPH, uterine atony was found to be responsible 40% of the time. Atony represents a large proportion of cases of PPH, and its incidence is on the rise. Over recent years, we have observed a significant rise in the rate of PPH attributed to uterine atony not only in the United States but also worldwide.
Originally described in 1997, the B-Lynch compression suture is an effective and easily used tool for the management of PPH. This technique involves placing brace sutures over the fundus of the uterus to apply ongoing compression of the uterus.
The correct ratio of packed red blood cells to fresh frozen plasma to platelets in the setting of obstetrical hemorrhage remains controversial. Most experts advocate for a 1:1:1 ratio in the setting of active bleeding, whereas others advocate for 6:4:1 or 2:1 (with platelets to be given after the first 4:2).

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

In an attempt to minimize postoperative discomfort while maintaining the benefits of saphenous vein ablation, RF alternating current has been employed to effect rapid thermic electrocoagulation of the vein wall and its valves.
Ligation of the GSV at the saphenofemoral junction has been widely practiced in the belief that it would control gravitational reflux while preserving the vein for subsequent arterial bypass.
Over the years, surgical treatises have devoted a great deal of space to clinical examination of the patient with varicose veins. Numerous clinical tests have been described, many of which carry the names of famous persons interested in venous pathophysiology.

Patients with colorectal cancer, due to increased age and exposure to neoadjuvant therapy, are likely to have or obtain functional deficits prior to surgery. Optimizing patients is crucial for minimizing postoperative complications after radical resections. It has been established that patients with poor physical fitness experience a greater number of complications after surgery, are at greater risk for death, and have a significant delay in regaining their baseline functional status. Prehabilitation is an increasingly studied novel approach to patient optimization through a process of increasing functional capacity prior to colorectal surgery. Several small studies have shown beneficial functional outcomes, although the clinical impact, as far as decreased morbidity and mortality, has not been clearly demonstrated.
With an aggressive multidisciplinary approach, the overall 5-year survival rate of LRRC is 25 to 67%. The quality of the surgery has a large impact on patient survival; therefore, an aggressive surgical strategy to gain a negative resection margin is vital to patient outcomes

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.

Internal Medicine