What's New | Decker

Peripheral nerve and sphenopalatine ganglion blocks are a safe, effective treatment option for headache disorders, including migraine, although the evidence remains mixed for chronic migraine prophylaxis.
Neurostimulation has emerged as an effective treatment modality for migraine, with both noninvasive and minimally invasive options available.
Safe, effective, and noninvasive neurostimulation therapies available for migraine include transcutaneous supraorbital nerve stimulation for prophylaxis and single-pulse transcranial magnetic stimulation for the acute treatment of migraine with aura.
Occipital nerve stimulation may be effective for some patients with intractable chronic migraine, although the evidence is mixed and procedure-related complications are common.
Noninvasive vagus nerve stimulation and implanted sphenopalatine ganglion stimulation are emerging treatment options that may be useful for both acute and prophylactic treatment of episodic and chronic migraine.

Cognitive therapy groups address understanding and changing cognitive processes that interact with behavioral, affective, environmental, physiologic, and developmental processes.
Group therapy with eating disorders yielded similar effectiveness individual psychotherapy, self-help, behavioral weight-loss, and pharmacotherapy.
Group therapy for social anxiety disorder also obtained large positive effects compared to waitlist control groups and demonstrated equivalence to alternative treatment options.

Detailed physiology of acid-base homeostasis to provide a clearer understanding of the pathophysiology of acid-base disorders
Updated information on the treatment of metabolic acidosis, including the use of tromethamine and bicarbonate

Detailed physiology of acid-base homeostasis to provide a clearer understanding of the pathophysiology of acid-base disorders
Updated information on the treatment of metabolic acidosis, including the use of tromethamine and bicarbonate

Detailed physiology of acid-base homeostasis to provide a clearer understanding of the pathophysiology of acid-base disorders
Updated information on the treatment of metabolic acidosis, including the use of tromethamine and bicarbonate

The resistance by extended-spectrum β-lactamases (ESBLs) is mediated by plasmids that spread microbial resistance across bacterial species and confer additional resistance to fourth-generation cephalosporins.
Current guidelines from the IDSA provide a comprehensive approach for the clinician evaluating and managing a bacteremic patient with short-term venous catheters, arterial catheters, long-term central venous catheters, or ports, taking into consideration the patient’s clinical status and the organism recovered.
Vancomycin is the first-line antibiotic for MRSA pneumonia; however, adequate dosing, monitored by drug levels, is required to ensure both efficacy and safety, especially in patients with renal insufficiency. Linezolid, although not superior to vancomycin, may be preferable for patients with renal insufficiency.

The Committee on Trauma of the American College of Surgeons (ACS-COT) mandates that high-level trauma centers develop a predefined MTP that can be activated to quickly transfuse rapidly hemorrhaging patients. Early activation of a predefined MTP is associated with more efficient use of blood products (reducing waste) and improved patient outcomes. However, early identification of the bleeding patient remains a challenge.
Viscoelastic assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) assess the coagulation profile of a whole blood sample. Significantly, different parameters derived from the TEG and ROTEM tracings are related to different components of coagulation, enabling targeted correction of abnormalities.
Although it seems natural and intuitive to follow the same protocol to treat patients with substantial nontraumatic hemorrhage, there is little scientific evidence to support this practice. Of the few studies investigating optimal blood product ratios of nontraumatic hemorrhage available in the literature, MT was unfortunately defined using the outdated criterion of 10 RBC units or more in 24 hours, which, as we have previously stated, is fraught with survivor bias.

The mortality for severe acute pancreatitis is 15 to 30%; however, the overall mortality for all patients with acute pancreatitis is less than 5%. Over the last several decades, mortality related to acute pancreatitis has decreased substantially, which likely reflects improved critical care and better strategies for operative management.
Recent guidelines identify the SIRS criteria as the best and most pragmatic predictor of severe acute pancreatitis at admission and at 48 hours. A 1991 consensus committee first coined the term SIRS as the clinical manifestation of the hypermetabolic response to infection or a noninfectious insult. SIRS criteria include (1) temperature greater than 38°C (100.4°F) or less than 36°C (96.8°F); (2) heart rate greater than 90 beats/min; (3) tachypnea with a respiratory rate greater than 20 breaths/min or hyperventilation with arterial carbon dioxide tension (PaCO2) less than 32 mm Hg; and (4) a white blood cell count greater than 12,000/µL or less than 4,000/µL or greater than 10% immature neutrophils (“bands”).
The optimal strategy for intervention in patients with confirmed infected necrotizing pancreatitis is initial image-guided percutaneous retroperitoneal catheter drainage or endoscopic transluminal drainage, followed, when necessary, by minimally invasive endoscopic or surgical necrosectomy.

Neurological Symptoms