Latest Updates

Clinical Management of Drug Use Disorders

Timothy Ando, MD, James Jackson, MD, Alexander Thompson, MD, MBA, MPH
    • Outlines updated DSM-5 classifications of substance use disorders
    • Synthesizes current heritable and genetic factors in substance use disorders
    • Reviews current treatment options with the strongest evidence base
    • Updated with 2020 ASAM Practice Guidelines: Opioid Use Disorder

Constipation: Diagnosis and Management

Renee Bassaly, DO, Lennox Hoyte, MD, MSEECS
    • Updated with 2019 CAG Practice Guidelines for IBS
    • Added 2016 ASCRS Practice Guidelines for Constipation

Preventing Cesarean Delivery

Toni Huebscher Golen, MD, Scott A. Shainker, DO, MS
    • Cesarean delivery is a significant contributor to maternal morbidity and mortality. The rise in cesarean delivery has not been associated with a decrease in cerebral palsy in offspring.
    • A multi-strategy quality improvement approach that accounts for fetal heart tracing assessment, progress in labor, and environmental stress may lead to a reduction in cesarean delivery rates.
    • Many cesarean deliveries occur because of subjective interpretation of fetal heart rate tracings. Standardization of interpretation of fetal heart rate tracings using NICHD-endorsed terminology may help to decrease the incidence of cesarean for “nonreassuring” fetal heart tracings
    • Allowing patience with the labor curve may achieve increased numbers of safe vaginal deliveries. Redefining arrest and protraction could potentially decrease the cesarean rate and the resultant morbidity. Of particular importance for clinicians, active labor may not begin until 6cm of cervical dilation, and before diagnosing arrest of labor in the second stage, providers should allow for at least 2 hours of pushing in multiparous women and 3 hours in nulliparous women.  ACOG and SMFM also endorse longer second stages on an individualized basis.

Drugs of Abuse

Kavita Babu, MD, FACEP, FACMT, Matthew D Zuckerman , MD
    • In the last decade, dozens of novel agents of abuse have emerged, many of them chemical variants of the naturally occurring cathinone found in the plant Catha edulis. 
    • Synthetic cathinones may be sold under the name of bath salts or plant food to subvert legal restrictions on their use. Their beta-ketone amphetamine structure results in their amphetamine-like sympathomimetic effects. However, synthetic cathinones also seem to modulate serotonin release, resulting in various psychoactive effects.
    • Toxicity in patients using synthetic cathinones varies from euphoria and intoxication, to florid violent hallucinations, hyperthermia, rhabdomyolysis, seizures, and death. Unlike many other street drugs, synthetic cathinones are often known more commonly by their street name (e.g., bath salts), with the exact chemical composition changing over time in response to legal pressures. 

Viral Hepatitis C: Epidemiology, ­Pathogenesis, Transmission, And ­Natural History

Raymond T. Chung, MD, Jacinta A Holmes, MBBS, PhD, Anna Lidofsky, BS
    • Changing incidence and prevalence of HCV
    • Increasing burden of HCV-related liver disease

Radiation Injury

Maryann Mazer-Amirshahi, PharmD, MD, MPH
    • Advances are being made in the realm of treatment, including new short acting Granulocyte Colony Stimulating Factor medications, such as Neupogen (Filgrastim), Zarxio (Filgrastim-sndz), Fulphila (Pegfilgrastim-jmdb), and Leukine (Sargramostim) which have been FDA approved for treatment of severe neutropenia. 
    • Previously accepted policies due to "radiation phobia" by those in the scientific community were based on a linear-no threshold scale for radiation dose and the link to cancers such as leukemia. These scales continue to be discredited as being magnitudes lower than the observed rates of incidence. In current literature, scientists are challenging the idea that the dose threshold for exposure is as low as we accept right now (~ 100 mSV) and in fact are demonstrating that the increased risk for cancer development amongst individuals exposed to similar doses does not exist until a much higher radiation dose. Scientists will continue to follow this and establish an acceptable recommendations because of the ubiquitous nature of radiation exposure in our medical and industrial lives.
    • Patients developing hematopoietic syndrome, or even simply anemia, after significant exposure to radiation requiring blood transfusion are at increased risk of developing Graft-versus-Host disease. Current guidelines state that, when possible, cellular transfusion products (i.e, whole blood, pRBCs) should be irradiated with at least 25 Gy prior to administration. The samples should also undergo leukocyte reduction as well. In situations of mass casualty incidents, guideline therapy may be adjusted based on the supply of blood available against the anticipated need for blood on mass scale.

Neurobiology of Addiction

Alex Gogliettino, Program in Neuroscience, Marc Potenza, MD, PhD, Sarah Yip, MSc, PhD, Yasmin Zakiniaeiz, MSc, Zu Wei Zhai, PhD
    • Epidemiology of and heritable risk factors for developing addictive disorders
    • Dysregulated brain networks and neurochemical systems in several substance and nonsubstance addictions
    • Treatment options for substance and nonsubstance addictions
    • Updated with 2020 ASAM Practice Guidelines: Opioid Use Disorders

Osteoarthritis

    • Nonpharmacologic measures that have the potential to improve outcomes in osteoarthritis include patient education, physical and occupational therapy assessment and interventions, exercise, weight loss, and dietary measures.
    • Therapies with potential to prevent or retard the progression of articular cartilage breakdown have received a great deal of attention in recent years, including tetracyclines, protease inhibitors, antiresorptive agents (i.e., bis­phosphonates, calcitonin), glycosaminoglycan compounds, growth factors, and cytokine inhibitors.
    • In patients with badly damaged knees and hips, total joint replacement is an effective option. Almost all patients experience significant pain relief, and some have improved range of motion. Joint loosening and infection are potential late complications in prosthetic joints but are uncommon.
    • 2019 ACR/AF Practice Guidelines: Osteoarthritis of the Hand, Knee, and Hip

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