bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstruction of the Orbit
Authors: Ratanshi Imran , Nguyen Dennis C. , Yaremchuk Michael J.
Published: January 2021

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects.
This review contains 7 figures, 1 video, 2 tables, and 38 references.
Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning
Pathophysiology of the Diabetic Foot
Authors: Kim Paul J
Published: January 2021

The clinical manifestations of diabetes are evident in the foot. Peripheral neuropathy, peripheral vascular disease, dermatologic alterations, and musculoskeletal changes place the foot at high risk of ulceration. The diabetic foot ulcer (DFU) is the end result of these pathophysiologic changes, which increases the likelihood of infection, hospitalization, and amputation. There are treatment options available, but DFU imparts a tremendous toll on the patient’s quality of life and healthcare resources. Although there is a growing understanding of the pathophysiologic processes unique to the diabetic foot, much work is still needed. This chapter focuses on the assessment and management of the diabetic foot and its associated conditions.
 This review contains 7 figures, 3 tables and 62 references
Key Words:: Diabetic foot, Diabetic Foot Ulcer, Peripheral Neuropathy, Peripheral Vascular Disease, Foot Wound, Biomechanics, Deformity, Biomechanical Surgery, Infection
Health Economics: National Health Care Expenditures
Authors: Hall Bruce L
Published: January 2021

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform.

This review contains 3 tables and 20 references.
Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections
Intimate Partner Violence
Authors: Sillman Jane S.
Published: January 2021

Intimate-partner violence describes relationships characterized by intentional controlling or violent behavior by someone who is in an intimate relationship with the victim. The abuser’s controlling behavior may take many forms, including psychological abuse, physical abuse, sexual abuse, economic control, and social isolation. Abuse may ultimately lead to the death of the victim from homicide or suicide. Typically, an abusive relationship goes through cycles of violence. There are periods of calm, followed by increasing tension in the abuser, outbursts of violence, and return to periods of calm. These cycles often spiral toward increasing violence over time. The victims of intimate-partner violence are usually women, but intimate-partner violence is also a significant problem for gay couples and for the disabled and elderly of both sexes. This review discusses the epidemiology, diagnosis, treatment, outcomes, and prevention of intimate-partner violence. Risk factors for experiencing violence, risk factors for perpetrating violence, and consequences of abuse are also analyzed.
This review contains 5 figures, 14 tables, and 30 references.
Keywords: Domestic abuse, intimate-partner violence, elder abuse, child abuse, batterer, sexual abuse, physical abuse
Male Sexual Dysfunction
Authors: Eisenberg Michael , Hwang Kathleen
Published: January 2021

Normal male sexual function requires complex interactions among psychological, neurologic, hormonal, and vascular systems. Under the influence of proper stimulation, the acquisition and maintenance of a penile erection occur. Male sexual dysfunction includes erectile dysfunction (ED), impaired libido, and abnormal ejaculation, which occur due to aberrations in normal male sexual response. Estimates suggest a prevalence of approximately 10 to 20% in the adult male population. Thus, sexual dysfunction is a common problem in this country. This chapter focuses on several key, common components of male sexual dysfunction: namely, ED, premature ejaculation (PE), and Peyronie disease (PD). Figures include management algorithms, a graph depicting distribution of intravaginal ejaculation latency time values in a random cohort of men, and a Sexual Health Inventory for Men (SHIM). Tables list medications associated with ED, oral therapies for the treatment of PD, intralesional therapies for PD, indications for surgical correction of PD, recommended questions to establish the diagnosis of PE, treatment options for PE, and causes of delayed ejaculation, anejaculation, and anorgasmia.This chapter contains 5 highly rendered figures, 8 tables, 116 references, 1 teaching slide set, and 5 MCQs.
ECT: Physiology, Indications, and Treatment
Authors: Fink Max
Published: January 2021

Inducing grand mal seizures (electroshock, electroconvulsive therapy) developed as an effective treatment to alleviate the psychosis of dementia praecox. Clinicians quickly recognized that seizures also relieved depressed moods, suicide risk, catatonia, manic excitement, and delirium. It is an unheralded, often stigmatized, medical achievement. Seizures may be induced chemically or with electric or magnetic currents. Grand mal seizures must be repeated for persistent benefits. Not all seizures are equally effective. Effective seizures are marked by bilateral electroencephalographic brain wave changes and neuroendocrine discharges from hypothalamic-pituitary glands. Treatments are remarkably safe, with zero mortality. Immediate effects on memory are common but are almost always transient. They are not a practical deterrent to the treatments, although they are widely cited to reject its use. The stigmatization of induced seizures that places it as a “last resort” therapy is wasteful and unethical. It offers a remarkable opportunity for advancement in neuroscience. 
This review contains 4 figures, 3 tables, and 90 references.
Key words: anesthesia, bipolar disorder, catatonia, delirium, electroconvulsive therapy, electroencephalography, major depression, melancholia, neuroendocrine, seizures
Fibromyalgia as a Biopsychosocial Model for the Intersections of Physical and Emotional Pain
Authors: Proch Ronne J , Hasan Babar
Published: January 2021

The evaluation and treatment of pain and chronic pain conditions has been a dynamic and perpetually evolving area of focus as we strive towards a more standardized and comprehensive approach informed by ongoing research. The recent emergence of disorders focused on the recognition of the pain experience outside of a definitive physical lesion, specifically Fibromyalgia, has continued to challenge previously held beliefs about pain and our approach to its treatment. This article reviews the history of pain management through review of past and present guidelines and the unintended consequences of the interpretation of these guidelines. The biologic cause and function of pain, types of pain, and the neurologic basis of pain are presented with illustrative figures. Fibromyalgia as a syndrome, its evolving diagnostic criteria according to the American College of Rheumatology, and the insight this disorder gives us into the pharmacologic treatment of chronic pain are discussed.  Psychosocial considerations are also presented as they do play a significant role in both diagnosis and treatment of this order.  Overall the purpose of this article is to better inform treatment plans, recommendations, provider communication, and expectations for pain relief through the understanding that not all pain is the same and thus should not be treated as such. 
This review contains 6 figures, and 30 references.
Key Words: Dorsal Horn Neurons, Sensory/Discriminatory Pathways, Emotional/Motivation Pathways, Serotonin, Norepinephrine, Opioids, Endorphins, Peripheral Sensitization, Central Segmental Sensitization, Central Suprasegmental Sensitization, Fibromyalgia
Group Psychotherapy: Group Therapist Leadership Skills
Authors: Bowers Wayne A.
Published: January 2021

Conducting group psychotherapy is a complex yet fascinating endeavor. To be effective, a group therapist must be intentional in their approach and implementation of interventions. Some basic skills that must be mastered include confrontation of group members and behaviors, emotional stimulation of the group and individual members, and the development and enhancement of group cohesiveness. Practical skills involve the overall structure of the group, providing feedback to members and the group as a whole, modeling effective communication and interpersonal behavior, and self-disclosure in nonjudgmental manner. A group therapist also engages members to be open about themselves and with others and displays effective interpersonal communication by working with a cotherapist to model both interpersonal bonding as well as effective conflict resolution that can be generalized to the outside world.

This review contains 1 table and 16 references.

Key Words: cotherapy, emotional expression, executive function, feedback, group leader skills and values, male and female co-therapists, self-disclosure, skills and interventions
Psychopharmacology for Eating Disorder
Authors: Ruekert Laura , Wells Kimberlie
Published: January 2021

The treatment of eating disorders should include the utilization of nonpharmacologic therapy and, when appropriate, pharmacotherapy to address symptoms of the eating disorder and any psychiatric comorbidities present. Due to the complex nature of eating disorders, a multi-disciplinary team approach to care is an essential component for maximizing treatment outcomes. Currently there are no FDA approved medications for anorexia nervosa; however, SSRI antidepressants may help with comorbid symptoms. The SSRI, fluoxetine, is FDA approved for use in bulimia nervosa for symptoms associated with bulimia, also addressing psychiatric comorbidities. Lisdexamfetamine is an FDA approved treatment for use in binge-eating disorder, helping to reduce binge episodes. Other pharmacotherapeutic options have demonstrated efficacy benefits in eating disorders, such as topiramate treatment in bulimia and binge eating disorder; however, nonpharmacologic therapy remains an essential first-line treatment across eating disorders and should always be employed regardless of whether or not pharmacotherapy is also part of the treatment plan.
This review contains 3 tables, 4 figures, and 30 references.
Keywords : Anorexia, bulimia, binge-eating disorder, pharmacotherapy, treatment, psychopharmacology, serotonin, olanzapine, eating disorders
Embracing Uncertainty
Authors: Simpkin Arabella L.
Published: January 2021

We are constantly faced with uncertainty, which can instill a sense of vulnerability and fear. Prior studies link intolerance of uncertainty to burnout, ineffective communication strategies, cognitive biases and inappropriate resource use. Paradoxically, uncertainty is the driver of curiosity and progress, and is an important part of the practice of medicine. Indeed, the only certainty is in uncertainty. Unfortunately, we Western culture too often equates uncertainty with ignorance or failure, viewing it as a threat rather than a surmountable challenge, thus encouraging denial of this fundamental state for both physicians and patients. The time is ripe for a renewed perspective. Changing our culture to acknowledge, celebrate and embrace uncertainty could have positive downstream ramifications: decreasing physician burnout by reducing stress from uncertainty and altering our perspective on this state; and lightening physician’s burdens by absolving responsibility for implicitly having promised more than a physician or even medicine can deliver. Indeed, understanding and embracing uncertainty could be the most significant contribution of 21st century science to the human intellect.

This review contains 29 references.
Multiple Sclerosis and Related Disorders
Authors: Lindsey J William
Published: January 2021

Multiple sclerosis (MS) is a relatively common cause of neurologic symptoms and disability in young adults. The distinguishing pathologic features of MS are loss of myelin and inflammation in the central nervous system (CNS). The myelin sheath is essential for rapid conduction of nerve signals along large-diameter axons. Oligodendrocytes produce and maintain myelin in the CNS, and Schwann cells produce and maintain myelin in the peripheral nerves. In addition to MS, there are a number of related disorders causing demyelination, inflammation, or both in the CNS. This chapter discusses MS and related disorders, including neuromyelitis optica, optic neuritis, acute disseminated encephalomyelitis, transverse myelitis, Behçet syndrome, neurosarcoidosis, inherited demyelinating diseases (leukodystrophies, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL]), and virus-induced demyelination (progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis). The section on MS covers epidemiology, etiology/genetics, pathogenesis, diagnosis, differential diagnosis, management, and prognosis. Figures include organization of the microenvironment of larger-diameter axons, typical magnetic resonance imaging findings in MS and neuromyelitis optica, postgadolinium images of the cervical spine in MS, and an approach to treatment of relapsing-remitting MS. Tables list MS and related disorders, distribution of neurologic deficits at the onset of MS, differential diagnosis of MS, disease-modifying therapies for relapsing-remitting MS, and selected leukodystrophies, as well as diagnostic criteria and selected symptomatic therapies for MS.
 
This chapter contains 3 highly rendered figures, 7 tables, 82 references, 1 teaching slide set, and 5 MCQs.
Nerve Blocks and Neurostimulation in the Treatment of Migraine
Authors: Robbins Matthew S
Published: January 2021

Peripheral nerve and sphenopalatine ganglion blocks are a safe, effective treatment option for headache disorders, although, despite a wealth of anecdotal experience, the evidence is conflicting for efficacy in chronic migraine prophylaxis. Neurostimulation has emerged as an effective treatment modality for migraine with both noninvasive and minimally invasive options available. Such options include transcutaneous supraorbital nerve stimulation for prophylaxis and single-pulse transcranial magnetic stimulation for the acute treatment of migraine with aura. Although occipital nerve stimulation may be effective for some patients with intractable chronic migraine, the evidence is mixed and procedure-related complications are common. Emerging treatment modalities for acute and preventive treatment of migraine include noninvasive vagus nerve stimulation and implanted sphenopalatine ganglion stimulation.
This review contains 5 highly rendered figures, 2 tables, and 106 references.
Tension-Type Headache: Acute and Preventive Therapies
Authors: Rayhill Melissa
Published: January 2021

Tension-type headache (TTH) is an incredibly common condition. The clinician should be careful to distinguish TTH from migraine and from causes of secondary headache. The importance of regular sleep, nutrition, hydration, and appropriate management of life stressors cannot be overemphasized. The mainstays of abortive pharmacologic therapy for TTH are the nonsteroidal antiinflammatory drugs. Most of these drugs are thought to have roughly equivalent efficacies based on many older clinical trials and more recent meta-analyses. The side effects of this drug class can be severe and include renal toxicity and gastrointestinal bleeding; these drugs may also increase cardiovascular risk. Tricyclic antidepressants are thought to be the most effective preventive therapy for TTH, particularly amitriptyline. Other antidepressant medications as well as muscle relaxants may also be beneficial in some patients. A number of other nonpharmacologic and procedural therapies exist, although the evidence supporting the use of these treatments is variable. However, in many patients, these other modalities can be helpful therapeutic adjuncts. In this review, we also discuss the evidence base for physical therapy, acupuncture, trigger-point injections, massage therapy, and psychological therapy.
Stroke and Other Cerebrovascular Diseases
Authors: Kasner Scott E. , Wilson Christina A
Published: January 2021

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. 
This review contains 7 figures, 9 tables, and 84 references.
Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy
Erectile Dysfunction: Evaluation, Including Diagnostic Studies (Doppler Ultrasound, Cavernosography/Cavenosometry)
Authors: Helo Sevann , Tadros Nicholas , McVary Kevin T
Published: January 2021

Erectile dysfunction (ED) is a common condition in the aging population that can be broadly classified as organic, psychogenic, or mixed. A thorough evaluation of a patient with ED begins with acknowledging that it is intimately related to a host of medical, neurologic, and psychological conditions. Providers should be confident in their ability to obtain a relevant history, perform a targeted physical exam, and, when indicated, select appropriate diagnostic testing. Patients should also be evaluated for associated urologic conditions, including male hypogonadism and lower urinary tract symptoms, the treatment of which may improve ED symptoms. It is also important that clinicians be aware that ED may be a “sentinel event” for undiagnosed cardiovascular disease as the implications of intervention can potentially be lifesaving.
This review contains 7 figures, 10 tables and 138 references
Key words: cardiovascular disease, Doppler ultrasonography, erectile dysfunction, hypogonadism, lower urinary tract symptoms, male impotence, metabolic syndrome, penile tumescence, Peyronie disease, premature ejaculation, sexual desire, testosterone
Cancer Epidemiology and Prevention
Authors: Neugut Alfred I. , Wu David P
Published: January 2021

Recently surpassing heart disease, cancer is now the leading cause of death (one in four) in the United States. Worldwide, cancer control is becoming increasingly important as life expectancy improves because of lower infant mortality and fewer deaths from infectious diseases. Morbidity and mortality from many forms of cancer can be controlled through primary or secondary prevention. Primary prevention can be defined as risk modification to lower cancer occurrence. Secondary prevention refers to the use of screening tests to detect cancers at early stages. Environmental carcinogens, inherited factors that predispose to cancer, and screening and early detection are covered in major sections. Also included are discussions of infectious agents, occupational carcinogens, iatrogenic causes, carcinogens affecting the reproductive system, and miscellaneous environmental causes. Tables outline established causes of human cancer, common hereditary cancers and syndromes attributable to germline mutations in predisposing genes, and the American Cancer Society’s recommendations for early detection of cancer. This chapter contains 138 references.
Kidney Biopsy
Authors: Voiculescu Adina , McMahon Gearoid
Published: January 2021

The introduction of renal biopsies has transformed practice in nephrology, particularly with regard to glomerular disease and the care of kidney transplant recipients. A biopsy can provide information about the diagnosis and prognosis of kidney disease while most importantly often leading to changes in therapy that can be life saving. Four groups of patients benefit most from renal biopsy: those with nephrotic syndrome, those with acute nephritic syndromes with rapid deterioration of renal function, those with unexplained acute kidney injury and renal transplant recipients. Non-nephrotic range proteinuria and/or hematuria or unexplained chronic kidney disease represent indications in selected cases. The evaluation of patients prior to undergoing a kidney biopsy requires a careful assessment that includes a detailed history to confirm the relative benefit of a biopsy in making an accurate diagnosis compared with individual’s risk of bleeding. The use of real-time ultrasound or CT-guidance with gun-mounted biopsy needles is paramount for the successful performance of the biopsy and reduction of risks. renal biopsies are mostly done as an inpatient but can be performed on an outpatient basis in selected cases. A renal biopsy has a bleeding risk of up to 5% and is considered a “high bleeding risk procedure”. For patients receiving -antithrombotic therapy, the approach to periprocedural use of antithrombotic agents needs to be individualized. Because it is a high-risk procedure, all efforts must be undertaken to minimize the risk including a careful assessment of the patient's specific situation, and only experienced operators at institutions that can care for post-biopsy complications should perform the procedure.
This review contains 7 tables, 7 figures and 83 references
Key words: kidney biopsy, native kidney, transplant kidney, indications, preparation, performing biopsy, ultrasound guidance, transjugular, CT-guided, complications
Kidney Neoplasia
Authors: Fay Andre P , Barrios Pablo M , Schutz Fábio A B , Barrios Carlos H
Published: January 2021

The incidence of kidney cancer is rising. Due to the widespread use of abdominal imaging for unrelated indications, small renal masses have been increasingly detected incidentally. A better understanding of the biology underlying the different tumor types arising from the kidney cortex has opened new avenues to define diagnosis, prognosis, and treatment strategies. Complete surgical resection remains the standard approach to treat renal neoplasms, and no systemic treatments have proven to be effective after a curative intent surgery. Approximately 30 to 40% of patients with kidney cancer will experience recurrence after a definitive treatment and will ultimately succumb to their disease. Drugs targeting the vascular endothelial growth factor and mammalian target of rapamycin pathways have significantly changed the outcome of patients with metastatic renal cell carcinoma (mRCC). Recently, the new era of immunotherapy has brought a new breath to the treatment of mRCC and will integrate into the landscape of treatment, improving clinical outcome.
 
This review contains 3 figures, 7 tables and 129 references
Key words: benign kidney tumors, cystic renal mass, kidney cancer, kidney neoplasms, metastatic renal cell carcinoma, renal cell carcinoma, small renal masses
Ethical and Social Issues in Medicine
Authors: Loewy Roberta Springer , Loewy Erich H. , Fitzgerald Faith T.
Published: January 2021

So rapidly has the field of health care ethics continued to grow that, when recently “googled,” the term produced 28.2 million hits. The challenge is to address the ethical and social issues in medicine in this very limited article space. It remains an impossible task to present more than a superficial discussion of these complex issues and the complicated cases in which they are to be found. Like good medicine, good ethics cannot be practiced by algorithm. The authors have opted to provide an operational guide to help clinicians sort through the ethical and social quandaries they must face on a daily basis. To that end, the authors have chosen to divide this chapter into the following sections: 1. A brief description of the biopsychosocial nature of ethics and how it differs from personal morality 2. A method for identifying and dealing with ethical issues 3. A discussion of the role of bioethicists and ethics committees 4. The professional fiduciary role of clinicians 5. Listings of some of the common key bioethical and legal terms (online access only) 6. A very brief discussion of the terms cited in the above listings (online access only)
This reviews contains 4 tables, 8 references, 1 appendix, and 20 additional readings.
Keywords: Ethical, social, right, wrong, good, bad, obligation, moral authority, critically reflective, and multiperspectival activity, Curiosity, Honesty, Patience, Open-mindedness
Practicing Evidence-Based Medicine
Authors: Barnett Michael , Choudhry Niteesh
Published: January 2021

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies.
This review contains 6 highly rendered figures, 9 tables, and 28 references.
Heart Failure
Authors: Shah Sachin P , Mehra Mandeep R.
Published: January 2021

Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure.
This review contains 3 highly rendered figures, 7 tables, and 113 references.
Reproductive Health in LGBTQ Populations
Authors: Meservey Marybeth , Gomez-Carrion Yvonne
Published: January 2021

The healthcare community and lay public have become more aware of transgender (TG) people in the past decade as celebrities have publicly transitioned and activists have pushed back against restrictive laws. Movies, television, nonfiction books, and novels increasingly represent the experience of people who are TG. News organizations and entertainment outlets have given attention to the lives, needs, and challenges of TG and gender-nonconforming individuals. Nonetheless, TG individuals are often fearful when seeking healthcare. Experiences of shame, judgment, and rejection with providers lead to anxiety in future encounters. The number of clinical providers who feel prepared to offer care for TG individuals is limited. Many TG individuals have been denied basic primary and preventive healthcare as a result of their TG status. Understanding the concepts of TG and gender nonconformance expands the skill set of the healthcare professional for providing culturally competent care to all patients and their family members.

This review contains 26 figures, and 59 references.
Key Words: cis-sexual, gender binary, gender confirmation surgery, gender dysphoria, gender nonconforming, intersex, LGBTQ, queer, transgender, WPATH
The Puerperium
Authors: Kleinman Sarah , Ricciotti Hope A
Published: January 2021

The puerperium starts after the birth of a baby and continues until 6 to 8 weeks postpartum. Several recent interventions in management have been shown to improve outcomes. Delayed cord clamping, the practice of waiting for a period of time after a baby is born before clamping and cutting the umbilical cord, can increase hemoglobin levels, improve iron stores, and increase birth weight in newborns. Rooming in, the practice of mothers and newborns staying together, improves infant sleep and breast-feeding without affecting maternal sleep. Immediately after birth, significant physiologic and anatomic changes occur. Thromboembolic events are more common in the postpartum state than during pregnancy, but the majority of women do not require specific thromboprophylaxis but should be encouraged to walk after birth. Women who have not been previously immunized for influenza; tetanus, diphtheria, pertussis (Tdap); and rubella should be offered these immunizations. Women with uncomplicated pregnancies may engage in exercise within days after delivery. Pelvic floor physical therapy performed during pregnancy and postpartum may assist in maintaining or regaining muscle tone of the pelvic floor and may prevent or treat urinary incontinence. Perinatal depression affects one in seven women. Baby blues, which include mood swings, anxiety, tearfulness, and insomnia, should resolve by 2 weeks after delivery. Patients should be screened for depression using a standardized, validated tool and appropriate treatment initiated. All women should undergo a comprehensive postpartum visit within 6 weeks of delivery.
 
This review contains 2 figures, 1 table and 32 references
Key words: delayed cord clamping, hemodynamic changes, perinatal depression, postpartum, puerperium, rooming in, skin-to-skin contact
Fecal Incontinence: Nonsurgical Management
Authors: Blank Madeleine , Chen Lilian
Published: January 2021

Fecal incontinence is the uncontrolled passage of feces or flatus. It is a debilitating and often unrecognized condition whose prevalence is increasing with our aging population and often carries significant stigmata associated with decreased quality of life. It is also one of the leading causes of nursing home admissions in the United States. The etiology of fecal incontinence is multifactorial, with many risk factors contributing to this disease process. Treatment may be challenging and needs to be individualized. In this review, we discuss the initial evaluation of the patient presenting with fecal incontinence, adjunctive testing modalities, and nonoperative management.

This review contains 6 figures, 2 tables and 50 references
Key words: accidental bowel leakage, biofeedback, bowel incontinence, fecal incontinence, pelvic floor physical therapy, pelvic floor retraining
Drug Allergies
Authors: Hooker Edmond A. , Kreitzer Natalie P. , Ventura Amanda
Published: January 2021

Adverse drug reactions (ADRs) are very common, causing approximately 2% of emergency department visits. It is estimated that approximately one-half of these ADRs are preventable. Although most ADRs and allergic reactions are minor, some may be severe, and the emergency physician's first priority should be the identification of anaphylactic or life-threatening reactions. This review examines the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of ADRs and drug allergies. Figures show the Gell and Coombs system, the four basic immunologic mechanisms for drug reactions, drugs as haptens and prohaptens, chemical structure of different β-lactam antibiotics, and management of the patient with possible drug allergy. Tables list the types of adverse drug reactions, drugs frequently implicated in allergic reactions in the emergency department, classification of allergic reactions, pretreatment protocol for radiocontrast allergy, and important parts of a history and physical examination of a patient with a suspected or confirmed drug hypersensitivity reaction.
This review contains 5 figures, 5 tables, and 128 references.
Keywords: drug allergies, Adverse Drug Reactions (ADRs), Gell and Coombs system, allergic reactions, anaphylactic reactions, radiocontrast allergy, drug hypersensitivity, drug withdrawal
Viral Upper Respiratory Infection
Authors: Creswell Simpson James , Dwyer Kristin H.
Published: January 2021

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, and is susceptible to a variety of pathogens including many viruses.  Although other pathogens can also cause infections of the upper respiratory tract, we are focusing on viral illnesses for the purposes of this review.  Upper respiratory tract infections (URIs) include sinusitis, nasopharyngitis (common cold), pharyngitis, epiglottitis, and tracheitis.  URI’s are one of the most frequent causes for visits to see a physician in the United States. Despite the fact that many URIs are caused by viral pathogens, more than half of patients in both the clinic and the emergency department setting with a diagnosis of URI received antibiotics. URIs are generally mild, and self-limited illnesses; however, it is important to recognize clinical entities that may be severe and warrant more extensive diagnostic workup and treatment such as epiglottitis and tracheitis. This review covers the pathophysiology, diagnosis, treatment, disposition and outcome for multiple viral URIs seen commonly in the emergency department setting.
This review contains 3 figures, 8 tables, and 87 references.
Key words: Common cold, epiglottitis, nasopharyngitis, pharyngitis, sinusitis, tracheitis, upper respiratory tract infection
Child Abuse and Nonaccidental Trauma
Authors: Malka S Terez
Published: January 2021

Child abuse accounts for over 1% of visits to pediatric emergency departments (EDs), and injuries related to abuse have higher morbidity and mortality than accidental injuries. Recognizing child abuse and neglect in the ED is challenging but critical to prevent recurrent episodes of abuse and long-term physical and emotional sequelae. This review defines child abuse and neglect and explores historical and physical examination findings, assessment and diagnosis, treatment, disposition, and outcomes for victims of child abuse. Figures show x-rays demonstrating common fracture patterns associated with abusive injury and an algorithm for evaluation of nonaccidental trauma in the ED. Tables list key historical elements in the evaluation for abuse or neglect, bruising characteristics suggestive of abuse, fractures that are specific for abuse, and recommended laboratory evaluation for suspected abuse. 
This review contains 4 figures, 4 tables, and 37 references.
Key words: child abuse, child neglect, nonaccidental trauma, sexual abuse
Acute Respiratory Failure And ­Mechanical Ventilation
Authors: DeLuca, Jr Lawrence A.
Published: January 2021

Patients with acute respiratory failure present to the emergency department (ED) on a regular basis, and emergency physicians (EPs) are expected to be skilled in endotracheal intubation. Historically, although a significant portion of emergency medicine residency training focuses on airway management, extended management of the ventilated patient has received relatively short shrift. Recent data indicate that not only is endotracheal intubation one of the most commonly performed ED procedures, but also that in the initial hours of care, it is also often the EP rather than the intensivist who provides the bulk of critical care to the patient. It is therefore critical that EPs are skilled in ongoing management of the ventilated patient in the early hours as inappropriate management of the ventilator or sedation/analgesia can have a significant impact on complications such as ventilator-induced lung injury, ventilator-associated pneumonia (VAP), ventilator weaning, and delirium. This review outlines basic strategies for the physiologic management of respiratory failure patients to reduce periintubation complications and discuss ventilation strategies, appropriate use of analgesia/sedation, and prevention of secondary complications such as VAP and delirium. Basic troubleshooting of common ventilator problems is also reviewed. Although it is not expected that the EP will replace the intensivist, the goal of this review is to optimize patient management early in the ED stay, to facilitate the transition between the ED and the intensive care unit, and to reduce preventable complications by optimizing the care of ventilated patients in the ED.

This review contains 9 figures, 4 tables and 46 references
Key words: acute respiratory distress syndrome, analgesia, chronic obstructive pulmonary disease, delirium, hypercapnia, hyperventilation, hypoxia, patient-ventilator dyssynchrony, pulmonary edema, respiratory failure, sedation, ventilator-associated pneumonia
Cardiac Arrest And Resuscitation
Authors: Hughes Patrick , Mechanic Oren , Grossman Shamai A.
Published: January 2021

The ultimate goal of cardiac resuscitation is full neurologic recovery; however, the probability of achieving this goal deteriorates rapidly with each minute of cardiac arrest. The most essential steps are rapid recognition of cardiac arrest, early high-quality chest compressions with minimal interruptions, and early defibrillation. Additional key components include effective leadership and followership, appropriate airway management, and effectual investigation for possible reversible causes of the arrest. This review discusses the role of and evidence for using pharmacologic agents. Additional discussion evaluates the use of ultrasonography and end-tidal CO2 in cardiac arrest resuscitation. Lastly, this review discusses cardiac arrest in special circumstances, such as patients who are pregnant, have left ventricular assist devices, or are subjects of trauma.

This review contains 6 figures, 3 tables and 101 references
Key words: advanced cardiovascular life support, antidysrhythmics, asystole, cardiac arrest, basic life support, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, pulseless electrical activity, resuscitation, ventricular fibrillation, ventricular tachycardia
Extracorporeal Membrane Oxygenation
Authors: Villar Julian , Ruoss Stephen , HA Richard , Hsu Joe
Published: January 2021

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is the practice of using circulatory assist devices and a gas exchange system to maintain sufficient tissue oxygen delivery, supplementing pulmonary and/or cardiac function in patients whose native physiology is too severely altered to be successfully supported solely by conventional life support techniques (eg, mechanical ventilation and inotropic and vasopressor drugs). ECMO should be considered in patients who are at a high risk of death due to a potentially reversible etiology of cardiopulmonary collapse. Indications for ECMO can be broadly divided into profound respiratory failure and/or cardiogenic shock. The indications include acute respiratory distress syndrome, heart failure, postoperative cardiogenic shock, and as an adjunct to cardiopulmonary resuscitation in patients with cardiac arrest. ECMO is currently experiencing a renaissance, and familiarity with its concepts is important for all critical care practitioners.

This review contains 8 figures, 8 tables and 34 references
Key Words: complications, equipment, indications, management basics, outcomes
Medications and Botulinum Toxin for Overactive Bladder
Authors: Syed Kirin K , Gousse Angelo E
Published: January 2021

Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB).
This review contains 11 figures, 7 tables, and 90 references.
Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention
Quality of Life Following Management of Localized Prostate Cancer
Authors: Aliperti Louis A , Sanda Martin G , Filson Christopher P
Published: January 2021

With a long survivorship phase after diagnosis and treatment of prostate cancer, consideration of the impact of treatment on health-related quality of life (HRQOL) is critical. For men considering treatment of prostate cancer, the domains that are impacted include urinary, sexual, and bowel-related qualities of life. This review identifies aspects of tools measuring HRQOL and covers instruments used to measure quality of life following a diagnosis and treatment of prostate cancer. We review the impact associated with radical prostatectomy, radiation and brachytherapy, and observation on men diagnosed with prostate cancer and compare the effects that each management strategy has on sexual and urinary function.

This review contains 3 figures, 5 tables, 44 references.
Key Words: erectile dysfunction, expectant management, lower urinary tract symptoms, prostate cancer, radical prostatectomy, radiation therapy, quality of life, urinary incontinence
Genetic Vascular Disorders
Authors: Fairman Alexander S. , Damrauer Scott M.
Published: January 2021

This review describes the clinical presentation, disease biology, and treatment (both medical and surgical) of genetically predisposed vascular diseases including Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, neurofibromatosis, and pseudoxanthoma elasticum. This study briefly evaluates the progress in understanding the genetic causes of nonsyndromic thoracic aortic aneurysms and dissections and recommendations for working up these patients and their family members. This study then discusses the historical context, current efforts, and future direction of understanding the genetic underpinnings of peripheral arterial disease and abdominal aortic aneurysms through linkage gene studies, candidate gene studies, genome-wide association studies, and epigenetics.
This review contains 4 figures, 6 tables, and 68 references. 
Key Words: candidate genes, complex traits, Ehlers-Danlos syndrome (EDS), geneme-wide association studies (GWASs), inherited nonsyndromic arteriopathies, linkage studies, Loeys-Dietz syndrome (LDS), Marfan syndrome (MFS), syndromic arteriopathies