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An absolute bilirubin level where preoperative biliary decompression (PBD) is indicated before pancreaticoduodenectomy has been elusive. Our goal was to identify a total bilirubin level whereby biliary decompression provides clear benefit, despite associated expenses and potential complications.
We reviewed a prospectively collected database of patients undergoing pancreaticoduodenectomy at the Vidant Medical Center between 2007 and 2016. Patients were arbitrarily subdivided into 3 groups based on presenting bilirubin level (≤10mg/dL, 10.1-14.9mg/dL, and ≥15mg/dL) to determine the presence of overall complications, severe complications (Clavien-Dindo classification ≥3), prolonged length of stay (>1 SD), readmissions, or mortality.
Common bile duct stenting independently predicted a higher incidence of complications in patients presenting with bilirubin ≤10mg/dL (
= .03) vs. those patients going directly to surgery. No differences were observed for patients with bilirubin between 10.1mg/dL and 14.9mnd timeliness to definitive cancer treatment.
This study explores how aspects of lighting in patient rooms are experienced and evaluated by nurses while performing simulated work under various lighting conditions. The lighting conditions studied represent design standards consistent with different environments of care-traditional, contemporary, and future.
Recent advances in lighting research and technology create opportunities to use lighting in hospital rooms to improve everyday experience and provide researchers with opportunities to explore a new set of research questions about the effects of lighting on patients, guests, and staff. Ridaforolimus mTOR inhibitor This study focuses on the experience of nurses delivering simulated patient care.
Perceptions of each of the 13 lighting conditions were evaluated by nurses using rating scales for difficulty of task completion, comfort, intensity, appropriateness of the lighting color, and naturalness of the lighting during the task. The nurses' ratings were analyzed alongside qualitative reflections to provide insight into their responses.
Significant differences were found for several a priori hypotheses. Interesting findings provide insight into lighting to support circadian synchronization, lighting at night, the distribution of light in the patient room and the use of multiple lighting zones, and the use of colored lighting.
The results of this study provide insight into potential benefits and concerns of these new features for patient room lighting systems and reveal gaps in the existing evidence base that can inform future investigations.
The results of this study provide insight into potential benefits and concerns of these new features for patient room lighting systems and reveal gaps in the existing evidence base that can inform future investigations.Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Although most patients with advanced GISTs benefit from imatinib mesylate (IM) as standard targeted therapy, the optimal duration of adjuvant IM for GIST patients with high risk of recurrence who underwent surgical resection remains unknown. In this article, we present a case of a ruptured GIST of the small intestine accompanied by peritoneal metastases, which was effectively treated by surgical procedure followed by long-term adjuvant therapy with IM. Surgical resection was performed for the ruptured small intestinal GIST, and multitude of peritoneal metastases were cauterized. The patient received adjuvant therapy with IM (400 mg/day) for 12 years without an interruption or a dose change. Peritoneal metastatic recurrence was observed by the follow-up computed tomography scan obtained 12 years after surgery, and surgical resection of the recurrent GIST was performed. The molecular examination indicated a KIT exon 11 deletion mutation in both the primary GIST and recurrent GIST. An additional point mutation was observed in the recurrent GIST in exon 17 that caused resistance to IM. The present case might indicate that extensive removal of the tumor cells through surgery and long-term administration of IM without an interruption or a dose change were important for achieving improved recurrence-free survival in patients with ruptured GISTs of the small intestine with peritoneal metastases.Background and Objectives Although anxiety consists of multiple components, including cognitive, affective, motivational, and physiological, and some findings suggest that there might be differences regarding their control antecedents and effects on performance, previous studies have largely neglected to examine these components separately and for reasons of convenience often assessed test anxiety as a unified construct using a single-item. Therefore, this study investigated the different test anxiety components with the goal to (1) examine the relative impact of the anxiety components in the mediating mechanism that connects control and performance - as proposed by Pekrun's control-value theory, and (2) determine which specific anxiety component is underlying common single-item anxiety measures. Methods The research questions were investigated using an intra-individual approach in a sample of N = 137 German 8th graders during a mathematics exam. Results As expected, control was negatively related to all anxiety components, but associations varied in strength. Additionally, the components differed in their relative impact on performance, with the cognitive component being central for this outcome. Furthermore, common single-item measures seem to specifically assess the affective component, and thus not the component most relevant for test performance. Conclusion Consequently, our study strongly recommends to distinguish between the anxiety components depending on the research question at hand.Sphingobacterium multivorum is a gram-negative rod found in the environment and rarely associated with human infections. Sphingobacterium is the causative agent of infections in an immunocompromised host in most cases. We report a rare case of cellulitis in an immunocompromised host by Sphingobacterium multivorum.
