Latest Updates

Overview Of Schizophrenia And Other Psychotic Disorders

Donald W. Black, MD, James A Wilcox, DO, PhD
    • Psychotic disorders have been reclassified by grouping together those considered to fall within a schizophrenia spectrum.
    • Delusional disorder no longer requires the presence of nonbizarre delusions.
    • Schizophrenic subtypes (paranoid, disorganized, catatonic) were discontinued in the DSM-5. 2020 APA practice guidelines to be published.

Overview Of Schizophrenia And Other Psychotic Disorders

Donald W. Black, MD, James A Wilcox, DO, PhD
    • Psychotic disorders have been reclassified by grouping together those considered to fall within a schizophrenia spectrum.
    • Delusional disorder no longer requires the presence of nonbizarre delusions.
    • Schizophrenic subtypes (paranoid, disorganized, catatonic) were discontinued in the DSM-5. 2020 APA practice guidelines to be published.

Open Rhinoplasty

Paul Hwang, MD, Samuel J. Lin, MD, Nargiz Seyidova, MD, Ginger Xu, MD
    • Cartilage grafting helps to restore nasal architecture, provides support, refinement, contouring and visual enhancement
    • Functional preservation maintains nasal skeletal framework and reduces complex revisions by destabilisation of these structures
    • Open approach allows for the ability to have total exposure, accurately diagnose the nasal deformities and meticulously shape the cartilaginous and bony framework

Pharmacologic Differences in Children

Raymond Park, MD, Lauren Kelly Ugarte, MA, MD
    • There is increasing focus on the impact of anesthetic medication effects on the developing brain with a goal to improve patient safety.
    • Dexmedetomidine is one particular medication found to confer protection to the developing brain in the anesthesia setting and will likely have increasing clinical applications for the pediatric anesthesiologist.
    • Technology and innovative engineering have led to the development and application of tools to improve pediatric patient compliance with anesthesia-related procedures such as needleless medication delivery systems to aid in painless IV placement and the use of small electronics as distraction for mask induction.

Acute Kidney Injury and Renal Replacement Therapy

    • Acute tubular necrosis, immune-mediated dysfunction and renal hibernation are all mechanisms underlying AKI
    • Volume expansion with supraphysiologic chloride may induce hyperchloremia and precipitate AKI
    • Regional citrate anticoagulation should be used as anticoagulation for CRRT preferentially over systemic heparin

Diagnosis and Management of Barrett Esophagus 

Arianna Barbetta, MD, Daniela Molena, MD, Francisco Schlottmann, MD
    • The diagnostic accuracy of BE increases when the Seattle protocol is applied.
    • Chromoendoscopy, narrow-band imaging, autofluorescence imaging, and confocal laser endomicroscopy can increase lesion identification and decrease the number of biopsies needed for BE surveillance.
    • Surveillance is encouraged to monitor for progression and deliver early treatment. 
    • In the presence of high-grade dysplasia or multifocal or recurrent low-grade dysplasia, endoscopic treatment should be preferred over surveillance.
    • Treatment of dysplastic BE can reduce the risk of progression to esophageal adenocarcinoma. 

Feeding and Eating Disorders

Phillip S Mehler, MD, Patricia Westmoreland, MD
    • With the DSM-5, rumination and pica are now placed in the same chapter as bulimia nervosa and anorexia nervosa.
    • In the DSM-5, diagnoses were modified and expanded to better describe patient diversity, especially with respect to age.
    • According to a recent study, implementation of the DSM-5 criteria may dramatically reduce residual eating disorder diagnoses within clinical settings.

Septic Shock

Allison Dalton, MD , Mark Nunnally, MD, FCCM
    • Enhanced awareness is driving diagnosis and therapy sooner. We are more accurate and faster at diagnosing sepsis, which improves outcomes.
    • Prompt aggressive resuscitation is important for outcomes. The recipe for resuscitation does not matter as much as getting started promptly and then slowing fluid therapies in response to physiologic end points.
    • Sepsis changes immune, endocrine, and neurologic function, leading to immunosuppression and metabolic changes. Depending on severity and duration, suppression and changes produce long-term disabilities or death.
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