Latest Updates

Allergic Response

    • Radiofrequency ablation as a treatment modality has revolutionized therapy for many SVTs; acts as a first-line alternative to drug therapy in some circumstances, with a high acute success rate and relatively low complication rate.
    • Cryoablation therapy emerging as an alternative in ablative therapies. Investigation of this modality for SVTs is ongoing.
    • Detailed drug regimens optimized for acute and chronic management of specific SVTs; detailed in the 2015 ACC/AHA/HRS practice guidelines.

Antisocial Personality Disorder and Its Clinical Management

    • Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
    • Research has implicated brain regions that control judgment and impulse control.
    • Cognitive-behavioral therapy may be helpful in mild cases.

Injection Sclerotherapy and Ablation

    • Endovenous laser ablation (EVLA) has many similarities to radiofrequency ablation (RFA), with the primary differences related to the catheter and mechanism used to ablate the vein. EVLA uses a bare-tipped or jacket-tipped fiber to deliver laser energy to a target area.
    • The thermal energy generates heat and steam bubbles within the lumen of the target vessel, destroying the endothelial lining of the vessel. This causes an inflammatory and constricting reaction that leads to fibrosis and occlusion of the treated vein.
    • Of note, the incidence of severe postprocedure pain and bruising has been significantly decreased with the advent of the new-generation covered fibers and hemoglobin-targeted chromophore, such that these adverse events are now comparable to those seen with RFA.

Cervical Dysplasia and Human Papillomavirus

    • Large randomized trials of Pap and HPV cotesting found that after extended follow-up, the incidence of invasive cervical cancer was significantly lower in women initially screened with HPV-based testing compared with cytology alone.
    • Screening that includes assessment of HPV status provides 60 to 70% greater protection against invasive cervical carcinomas compared with cytology alone.
    • Vaccination rates for the HPV vaccine, approved in the United States since 2006, are well below national goals, and provider recommendation has been found to be the most important factor influencing a patient’s or parent’s decision as to whether or not to accept the HPV vaccine.

Epidemiology and Molecular Biology of Colorectal Cancer

    • Current data on the epidemiology of colorectal cancer in United States and globally
    • Classification and detailed description of the three major molecular pathways for colorectal cancer carcinogenesis
    • Modern classification of familial syndromes based on polyp type and description of newly discovered familial colorectal cancer syndromes

Reduction Mammaplasty

    • With heightened awareness of side effects associated with narcotics, there has been increased frequency of multimodal pain management for the management and reduction of postoperative pain, including intra-operative local anesthetic and postoperative nonsteroidal anti-inflammatory agents.
    • Current and future research that focuses on patient reported outcomes, using validated measures such as BREAST-Q, will further allow the evaluation of patient satisfaction and continue to improve the counseling and management plastic surgeons can provide reduction mammaplasty patients.
    • The use of acellular dermal matrix (ADM) “slings” as a soft tissue substitute can offer additional support for natural tissue and might offer beneficial results for larger, ptotic breasts.

Epidemiology and Molecular Biology of Colorectal Cancer

    • Current data on the epidemiology of colorectal cancer in United States and globally
    • Classification and detailed description of the three major molecular pathways for colorectal cancer carcinogenesis
    • Modern classification of familial syndromes based on polyp type and description of newly discovered familial colorectal cancer syndromes

Practicing Evidence-Based Medicine

    • Even the most competent physician can be prone to misusing epidemiologic concepts. An example of inaccurate decision making, resting on Bayes’s theorem, occurred in a recent study in which primary care physicians were given clinical scenarios. Although the clinicians confidently provided their estimates of the probabilities of given disorders, no consensus could be found among the estimates. Another study assessed the ability of medical students, residents, and attending physicians to correctly determine the positive predictive value of a hypothetical screening test. The vast majority of respondents not only got the question wrong but also had an answer that would have led to the opposite clinical conclusions, guessing an incorrect positive predictive value of 95% when the true answer was 2%.
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