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

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

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

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

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.

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.

The contribution of genetics to Parkinson disease (PD) is suggested by the increased risk of disease associated with a family history, and community-based studies that found a 1.5- to threefold increased risk of PD in persons with an affected first-degree relative. However, the most convincing evidence to date has come with the discovery of monogenic forms of PD. Highly penetrant mendelian forms of PD have now been associated with mutations in different genes but, in most populations, causative mutations in these genes have been found in fewer than 5% of patients. Nevertheless, different variants with incomplete penetrance in the LRRK2 and the GBA gene are strong risk factors for PD, and are especially prevalent in some populations. Mutations of the GBA gene are indeed the most important risk factor yet discovered for PD; the presence of a GBA mutation in homozygous or heterozygous form is associated with an approximately 20-fold increase in the risk for PD.

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.

Emergency Medicine