What's New | Decker

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

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.

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.

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.

Cultural sensitivity and openness is more important than cultural ‘competence’ when treating migrants from diverse backgrounds
Guidelines are available for effective and appropriate use of qualified medical interpreters
Mental health screening is not only to assess effects of prior trauma but to determine challenges in acculturation
There is increasing recognition of the need for preventive counseling and chronic care in migrant women

Cultural sensitivity and openness is more important than cultural ‘competence’ when treating migrants from diverse backgrounds
Guidelines are available for effective and appropriate use of qualified medical interpreters
Mental health screening is not only to assess effects of prior trauma but to determine challenges in acculturation
There is increasing recognition of the need for preventive counseling and chronic care in migrant women

Pulmonary