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Decompressive hemicraniectomy (DHC) is a procedure performed in the setting of malignant cerebral edema after a large middle cerebral artery stroke. The decision to proceed with surgical decompression is one that must be made judiciously and rapidly. Although this can be a life-saving surgery, it does not necessarily improve the patient's quality of life. Box5 clinical trial The neurosurgical team must thoroughly discuss the patient's comorbidities, age, dominant versus nondominant hemispheric injury, and neurological expectations, and the procedure itself (ie, risks, benefits, expected postoperative course, goals of care) with the patient and his or her family before DHC. This article briefly reviews the anatomy of the brain and stroke presentation and provides an overview of DHC and the perioperative course. The article concludes with a case study of a patient with a medical history of hypertension and prediabetes who presents to the emergency department after a fall and undergoes an emergent DHC.Debris in sterilized instrument sets Key words organic debris, inorganic debris, instrument sets, sterile processing, sterilizing agent. Preventing debris in sterilized instrument sets Key words debris, instrument sets, sterile processing equipment, instructions for use (IFU), quality assurance. Bone cement precautions during pregnancy Key words bone cement, exposure, methyl methacrylate (MMA), pregnant. Using a bed sheet or blanket for positioning Key words patient positioning devices, improvised positioning device, pressure distribution, skin shear, pressure injury. Laundering of cloth head coverings Key words laundering, head covering, reusable cloth hat, surgical attire, disposable bouffant.Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.The perioperative setting is a complex, high-risk working environment. Ensuring adequate staffing with highly competent nurses remains a top priority to sustain safe patient care. However, there are barriers to individual professional advancement in hospitals, including costs and lack of support or time, which can lead to decreased nurse satisfaction. After the mandated cancellation of elective surgery in March 2020 resulting from the coronavirus disease 2019 pandemic, leaders at a medical center decided to turn this difficult situation into an opportunity to re-engage their perioperative personnel in professional development. More than 70 staff members participated in activities related to certification, continuing education, clinical advancement, and cross-training. Elective surgery has since resumed, and as a result of the pursuit of professional development opportunities, staff member turnover did not increase throughout the transition at the medical center. Interest in professional growth has been reignited and staff members are excited about future development opportunities.

In the setting of suspected septic transfusion reactions, bacterial culture of both the transfused patient and the residual blood component is recommended. Primary bacterial contamination can occur at the time of component collection. Clinically insignificant "secondary contamination" can occur during post-transfusion component discard, retrieval for culture, or manipulation of the bag at the time of culture sampling.

This retrospective, multi-center study analyzes positive residual component culture results and companion patient blood cultures from 15 hospitals, 1 blood center, and all cultured transfusion reactions within the province of Quebec, Canada, over a 5-year period. Imputability was assigned as "definite" (concordant growth), "possible" (discordant growth or lack of growth in patient culture), or "unable to assess" (patient not cultured).

There were 373 positive component cultures from 360 unique transfusion reactions, with 276 (76.7%) companion patient blood cultures performed, of which 10 (lood components, the positive predictive value of a positive component culture result is very low.Inflorescence movements in response to natural gradients of sunlight are frequently observed in the plant kingdom and are suggested to contribute to reproductive success. Although the physiological and molecular bases of light-mediated tropisms in vegetative organs have been thoroughly investigated, the mechanisms that control inflorescence orientation in response to light gradients under natural conditions are not well understood. In this work, we have used a combination of laboratory and field experiments to investigate light-mediated re-orientation of Arabidopsis thaliana inflorescences. We show that inflorescence phototropism is promoted by photons in the UV and blue spectral range (≤500 nm) and depends on multiple photoreceptor families. Experiments under controlled conditions show that UVR8 is the main photoreceptor mediating the phototropic response to narrowband UV-B radiation, and phototropins and cryptochromes control the response to narrowband blue light. Interestingly, whereas phototropins mediate bending in response to low irradiances of blue, cryptochromes are the principal photoreceptors acting at high irradiances. Moreover, phototropins negatively regulate the action of cryptochromes at high irradiances of blue light. Experiments under natural field conditions demonstrate that cryptochromes are the principal photoreceptors acting in the promotion of the heliotropic response of inflorescences under full sunlight.