What's New | Decker

Ahmed Reda Taha, MD, FRCP, FCCP, FCCM

New explanation for the pathogenesis of shock on the microvascular level, with detailed explanation of lethal corner and cellular death in different states of shock
The difference between systolic, diastolic, and mean blood pressure and their contribution to states of shock
Different vasopressors and their role in different types of shock

Sushanth Reddy, MD, FACS, Laura Stafman, MD

Advance directives such as a living will, a do not resuscitate order, and a designation of a power of attorney for health care are legally binding mechanisms to preserve patient autonomy when patients have lost decision-making capacity. Although these directives are frequently used to make decisions regarding life-supporting therapy, surgeons may also need to refer to these documents or to patients’ surrogates for surgical decision making to treat patients in accordance with their autonomous wishes. There is some information to suggest that surgeons value the utility of an advance directive as it can serve as a guide to patients’ preferences in the postoperative setting when life-supporting therapy has become ineffective or patient survival is unlikely.
The Physician Orders for Life-Sustaining Treatment (POLST) program was designed in Oregon in the 1990s to address the lack of advance directives in frail patients and those with chronic diseases. Although POLST is different from advance directives, both aim to address end-of-life care.
When patients do not have decision-making capacity, physicians are obliged to find someone who can make decisions for the patient. If the patient has previously designated a durable POAHC agent, this agent is the first person health care providers should turn to for decision making.

Preprocedure patient evaluation and appropriate patient selection as well as guidelines for procedure set-up
Vascular access site selection and access technique based on anatomic location as well as troubleshooting with difficult access sites
Appropriate guide-wire and catheter selection as well as basic instructions in their use
Appropriate use of angioplasty balloons, stents, and guide sheaths
Vascular closure devices and postoperative care

Preprocedure patient evaluation and appropriate patient selection as well as guidelines for procedure set-up
Vascular access site selection and access technique based on anatomic location as well as troubleshooting with difficult access sites
Appropriate guide-wire and catheter selection as well as basic instructions in their use
Appropriate use of angioplasty balloons, stents, and guide sheaths
Vascular closure devices and postoperative care

Preprocedure patient evaluation and appropriate patient selection as well as guidelines for procedure set-up
Vascular access site selection and access technique based on anatomic location as well as troubleshooting with difficult access sites
Appropriate guide-wire and catheter selection as well as basic instructions in their use
Appropriate use of angioplasty balloons, stents, and guide sheaths
Vascular closure devices and postoperative care

Bronchiolitis is a clinical diagnosis; supportive therapy including supplemental oxygen, hydration, and nutrition are key.
Prematurity, young age, and underlying medical comorbidities predispose patients to severe bronchiolitis.
Knowledge of the different pathogens affecting children of various ages paramount to best antibiotic choice
Thorough history on patients presenting to the emergency department with asthma symptoms should be obtained; children with significant respiratory distress, hypoxia, suboptimal response to therapy, or poor social situation should be admitted.
Current guidelines recommend increasing medical management in a stepwise fashion based on level of control.

Christopher Crowe, MD

There have not been substantial changes in microsurgical technique in recent decades
Vascularized composite allotransplantation (VCA) is a promising means of restoring form and function for those who have sustained unsalvageable amputations
Optimization of tissue storage continues to be a subject of study, allowing for better preservation of amputated parts prior to replantation

The first HIV treatment breakthrough came in 1987, with the early termination of a clinical trial of zidovudine because of significantly decreased mortality in patients receiving the drug compared with patients receiving placebo. Unfortunately, in longer-term follow-up, therapeutic benefit diminished as a result of rapid development of HIV escape mutants that conferred resistance to zidovudine.
Fortunately, ART has fundamentally altered the grim prognosis for most HIV-infected patients and has transformed AIDS from a fatal disease to a treatable chronic one. Before the development of ART, the estimated median time from the appearance of an AIDS-defining condition to death was approximately 1.5 years. ART has extended this to 14 years—and even this figure may underestimate survival in patients using current drug regimens who strictly adhere to their treatment protocols.
Novel research pertaining to three cured patients treated with allogeneic stem cell transplantation of CCR5Δ32/Δ32 donor cells resulting in lasting remission and viral elimination.

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