Articles: cations.
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The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature. ⋯ The lack of evidence on ICU patients with IE highlights the critical importance of multidisciplinary decision-making and the need for further research.
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An understanding of nurse characteristics that influence pain management, which are potentially amenable to change, can help to refine and improve nurse education and practice, resulting in better patient outcomes. The purpose of this review was to identify nurse characteristics that influence their assessment of and intention to treat postoperative pain. ⋯ More studies are needed to investigate the influence of cultural characteristics on pain assessment and management. There is a need for further quantitative studies that explore the relationship between nurse characteristics and their pain management practice. Intervention studies using innovative educational approaches that change attitudes and biases, and improve practice are needed.
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Intraoperative molecular imaging (IMI) using tumor-targeted optical contrast agents can improve cancer resections. The optimal wavelength of the IMI tracer fluorophore has never been studied in humans and has major implications for the field. To address this question, we investigated 2 spectroscopically distinct fluorophores conjugated to the same targeting ligand. ⋯ Long-wavelength near-infrared fluorophores are superior to short-wavelength IMI fluorophores in human tissues. Therefore, future efforts in all human cancers should likely focus on long-wavelength agents.
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Both gastric bypass and sleeve gastrectomy can induce diabetes remission. However, deciding which procedure to perform is challenging, because remission rates and morbidity can vary, depending on patient factors as well as disease severity. ⋯ Patients requiring insulin experience higher rates of insulin discontinuation after gastric bypass, but also have significantly higher complication rates when compared to sleeve gastrectomy. However, if patients are on oral diabetic medication alone, rates of medication discontinuation at 1 year are greater than 85% and procedure type is not predictive. Disease severity is an important factor when deciding on the optimal procedure for diabetes.
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A new repair for gastroesophageal reflux and hiatal hernia, the Nissen-Hill hybrid repair, was developed to combine the relative strengths of its component repairs with the aim of improved durability. In several small series, it has been shown to be safe, effective, and durable for paraesophageal hernia, Barrett esophagus, and gastroesophageal reflux disease. This study represents our experience with the first 500 consecutive repairs for all indications. ⋯ The combined Nissen-Hill hybrid repair is safe and effective in achieving excellent symptomatic and objective outcomes and low recurrence rates beyond 5 years.