What's New | Decker

Timothy Ando, MD, Emily Morse, DO, Alexander Thompson, MD, MBA, MPH

Discussion of the evolution of DSM substance use disorder diagnoses over time
Overview of the biological, environmental, and personal factors implicated in the development of substance use disorders
Critical reviews of the current diagnostic criteria, epidemiology, and clinical presentation of the major substances of misuse

Timothy Ando, MD, Emily Morse, DO, Alexander Thompson, MD, MBA, MPH

Discussion of the evolution of DSM substance use disorder diagnoses over time
Overview of the biological, environmental, and personal factors implicated in the development of substance use disorders
Critical reviews of the current diagnostic criteria, epidemiology, and clinical presentation of the major substances of misuse

The International Society for Sexual Medicine agreed on a definition of premature ejaculation in 2014.
Premature ejaculation (PE) classification has been expanded to include natural variable (variable PE) and premature-like ejaculatory dysfunction (subjective PE).
There is now well-established pharmacotherapy mainly with SSRIs with differing levels of efficacy as well as potential adjunctive therapy with topical or local anesthetics.

Lightning strikes may also cause myocardial injury,
which may be evident through ECG changes, biomarker elevations, and echocardiographic ventricular wall motion abnormalities.
Pericarditis and pericardial effusion may also occur. These abnormalities tend to resolve within several weeks.

Lightning strikes may also cause myocardial injury,
which may be evident through ECG changes, biomarker elevations, and echocardiographic ventricular wall motion abnormalities.
Pericarditis and pericardial effusion may also occur. These abnormalities tend to resolve within several weeks.

The majority of patients with iCCA present with locally advanced or metastatic disease.
Surgery for patients iCCA involves margin-negative resection with porta hepatis lymphadenectomy including at least six lymph nodes.
Formal volumetry should be considered for patients requiring extended hepatectomy to ensure adequatefuture liver remnant size
Adjuvant chemotherapy should be considered after resection, particularly for high-risk features such as lymph node involvement or positive margins.

The majority of patients with iCCA present with locally advanced or metastatic disease.
Surgery for patients iCCA involves margin-negative resection with porta hepatis lymphadenectomy including at least six lymph nodes.
Formal volumetry should be considered for patients requiring extended hepatectomy to ensure adequatefuture liver remnant size
Adjuvant chemotherapy should be considered after resection, particularly for high-risk features such as lymph node involvement or positive margins.

Michael R. Filbin, MD

Sepsis syndromes have been redefined (Sepsis-3 definitions) by international experts, based on sepsis mortality data extracted large administrative databases.
National focus has turned to early identification of sepsis as a key determinant of outcomes. International critical care experts have recommended using the qSOFA criteria in the Emergency Department setting to identify sepsis risk in patients prior to obtaining diagnostics.
The Center for Medicare and Medicaid Services (CMS) has added a sepsis quality measure (SEP-1) as a reporting requirement for all US hospital tied to Medicare & Medicaid reimbursement. This measure has increased awareness of sepsis performance and focused quality efforts on improvement.
There have been new studies investigating the effect of time-to-antibiotics on mortality with focus on elements of the 3 h and 6 h sepsis treatment bundles. A large retrospective study in New York state showed that timely delivery of the 3-hour bundle (lactate measurement, blood cultures, antibiotics) lead to improved outcomes, whereas timely delivery of the 6-hour bundle (30 mL/kg fluid bolus, timely vasopressor therapy) did not.

IM Psychiatry