What's New | Decker

Bryan Hierlmeier, MD, Vanetta Levesque, MD, Henrique Vale, MD

Newer lung isolation devices may increase the success of placement with decreased difficulty.
Bronchial blockers can be used for lung isolation in a suspected difficult airway.
Stepwise ways to predict and manage hypoxia during one-lung ventilation.

Walter P Maksymowych, MB, ChB, FRCP (UK), FRCPC, FACP

The combined use of T₁-weighted MRI with a water-sensitive MRI sequence significantly enhances early detection of spondyloarthritis, identifies patients responsive to therapeutic intervention with tumor necrosis factor inhibitors (TNFIs), and constitutes a key prognostic factor for structural progression.
Treatment of patients with TNFI early in the disease course when radiographic sacroiliitis is not yet evident is highly effective, especially in patients with an elevated C-reactive protein and/or features of inflammation on MRI.
Treatment targeting interleukin-17 is an effective new treatment option for patients with spondyloarthritis, especially in the setting of concomitant psoriasis.
Imaging recommendations that allow for precision in diagnosis.

Sylvia Botros-Brey, MD, MSCI, K. Christopher McMains, MD, PhD, MS, Jo Shapiro, MD, FACS

The central feature of medical ethics is the primacy of the patient’s interests.
The ethical obligations of a for-profit corporation include maximizing profit and growth.
The rise of entrepreneurialism and the growing corporatization of medicine also challenge the traditions of virtue-based medical care. When these processes are allowed to dominate medicine, health care becomes a commodity.
The different obligations of business and medical ethics call the appropriateness of applying industrial models to provision of health care into question. It is no less than each of our professional duties to address these tensions where they exist.

Use of molecular testing of non-diagnostic thyroid nodule FNAs to increase the ability to obtain a diagnosis, decrease the need for repeated biopsies, and improve patient care
Refining the indications for total or complete thyroidectomy
Decreasing the use of radioactive iodine ablation based on risk stratification
Indications for lymphadenectomy approach in selected patients
Improving molecular targeted agents for iodine-refractory metastatic disease with improvements shown in progression free survival
Targeted therapy for recurrent, unresectable, iodine-refractory lesions

Antihistamines to block the binding of histamine at target sites, aspirin and NSAIDs to block the synthesis of prostaglandin D2, and leukotriene antagonists blocking it’s downstream effects
Allergen immunotherapy to induce long-lasting clinical tolerance in sensitized patients in an antigen-specific approach
Monoclonal antibodies against IL-5 (mepolizumab, reslizumab), and IL-5 receptor (benralizumab) for treatment of hypereosinphilia and proposed for allergy diseases

Novel treatment modalities include Negative Pressure Wound Therapy, bioengineered skin substitutes and placental derived constructs
Advances in microsurgical techniques including perforator flaps and understanding angiosomes
Improvements in management of vascular disease including advances in diagnostic methods and new non-invasive stenting techniques

Lance Griffin, MD, Cathline Layba, MD

Sarah Culbreth, PharmD, BCPS, Jessica Rimsans, PharmD, BCPS, Dirk Varelmann, MD

As the direct acting oral anticoagulants (DOACs) have short half-lives, they are able to be continued throughout low bleeding risk procedures, or for high bleeding risk procedures, they may be held 1 to 4 days depending on renal function.
Idarucizumab (Praxbind) is a new FDA-approved targeted reversal agent to reverse the effects of dabigatran (Pradaxa) in those with life-threatening bleeding or requiring urgent or emergent surgery.
Andexanet alfa is a modified decoy protein newly FDA approved for reversal of apixaban and rivaroxaban, based on results of the ANNEXA-4 trial.

Thoracic Anesthesia