Articles: cations.
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Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited. ⋯ IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.
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In 2015, the American College of Surgeons (ACS) created a new hospital improvement program to enhance the performance of pediatric care in US hospitals. The Children's Surgery Verification (CSV) Quality Improvement Program is predicated on the idea that pediatric surgical patients have improved outcomes when treated at children's hospitals with optimal resources. Achieving ACS level I CSV designation at pediatric trauma centers may lead to greater benefits for pediatric trauma patients; however, the specific benefits have yet to be identified. We hypothesize that achieving the additional designation of ACS level I CSV is associated with decreased narcotic use perioperatively and improved efficiency when managing pediatric patients with femur fractures. ⋯ Achieving ACS level I CSV designation is associated with increased efficiency and decreased preoperative and postoperative narcotic use when treating pediatric trauma patients.
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Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and acceptability of these methods in spine surgery patients. ⋯ Spine fusion candidates successfully completed a preoperative multimodal mHealth assessment with high acceptability. The intensive longitudinal data collected may provide new insights that improve patient selection and treatment guidance.
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Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Although POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others. ⋯ Spinal anesthesia is associated with a significant decrease in perioperative medications and may confer superior intraoperative hemodynamic stability, which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs, although this requires further study.