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OBJECTIVE: Dimethylsulfoxide-cryopreserved platelets are being evaluated for treatment of acute hemorrhage in patients with thrombocytopenia or platelet dysfunction when liquid stored platelets are unavailable. Patients undergoing cardiac surgery with cardiopulmonary bypass with risk factors for significant bleeding represent a population for which determining efficacy and safety of cryopreserved platelets is ideal in the clinical trial setting. The primary objective is to compare blood loss in cardiopulmonary bypass patients receiving cryopreserved platelets or liquid stored platelets. METHODS: In patients undergoing cardiac surgery utilizing cardiopulmonary bypass, a standardized algorithm with transfusion triggers will be used to guide the intra- and postoperative administration of study platelets, either cryopreserved platelets or liquid stored platelets, based on the clinical presentation. The primary efficacy end point was the volume of blood loss from completion of chest closure (time 0) until the time chest tubes were removed or 24 hours after chest closure, whichever is earlier. RESULTS: This design article describes an ongoing multicenter, randomized, blinded trial to evaluate noninferiority or superiority of cryopreserved platelets with liquid stored platelets in controlling blood loss in patients undergoing cardiopulmonary bypass surgery. CONCLUSIONS: Frozen storage could substantially safely extend the shelf life of stored platelets. If efficacy and safety were demonstrated in this trial, current constraints on platelet use in low resource military and civilian settings would be relieved.

Supplemental Digital Content is available in the text., Introduction: Overutilization of point-of-care (POC) testing may reduce the overall value of care due to high-cost cartridges, need for staff training, and quality assurance requirements. Methods: The Diagnostic Stewardship group at Cincinnati Children’s Hospital Medical Center assembled a multidisciplinary team to reduce the use of POC blood gas testing by 20% in the pediatric intensive care unit (PICU). Key drivers of test overutilization included poor knowledge of cost, concern with testing turnaround time, and a lack of a standard definition of when a POC test was appropriate. We calculated weekly the outcome measure of POC blood gas tests per PICU patient-day and a balancing measure of blood gas result turnaround time using data extracted from the electronic medical record. Interventions focused on staff education, the establishment of a standard practice guideline for the use of POC testing, and improving turnaround time for laboratory blood gas testing. Results: Over the baseline period starting July 2016, a median of 0.94 POC blood gas tests per PICU patient-day was ordered. After initial staff training, the rate was reduced to 0.60 tests per PICU patient-day and further reduced to 0.41 tests per PICU patient-day after a formal policy change was adopted. We have sustained this rate for 15 months through June 2018. Institutional direct cost savings were estimated to be $19,000 per year. Conclusions: Our improvement initiative was associated with a significant and rapid reduction in the use of POC testing in the PICU. Interventions focused on cost awareness, and a formal guideline helped establish a consensus around appropriate utilization.

Introduction: The purpose of this study was to compare the following three treatments of upper limb motor impairment in chronic moderate/severely impaired stroke survivors: 1) Customized whole limb motor learning (Whole ML), including shoulder/elbow robotics (ROB) and functional electrical stimulation (FES); 2) prescribed shoulder/elbow ROB + motor learning (S/E ROB ML); and 3) prescribed wrist/hand FES + ML (W/H FES ML). Methods: Subjects with chronic stroke were stratified according to relative level of impairment (Fugl-Meyer coordination Test) in wrist/hand versus shoulder/elbow. Their stratification category dictated the treatment group to which they were allocated, as follows: 1) WHOLE ML (n=18), equal distal and proximal impairment; 2) S/E ROB ML (n=10 ), greater shoulder/elbow impairment; and 3) FES ML (n=8), greater wrist/hand impairment. Treatment was 5 days/wk, 5 hrs/day, 60 sessions. Primary measure was the Arm Motor Assessment Tool, 13 complex tasks, Functional Scale (AMAT-F), acquired at baseline and at follow-up, 3 months after last treatment. Secondary measures were subscales, AMAT-F Shoulder/Elbow (AMAT-F S/E) and AMAT Wrist/Hand (AMAT-F W/H). Statistical analyses were Kruskal Wallace model to account for group size differences; group comparisons and within-group pre-/follow-up comparisons were analyzed (and multiple comparisons corrections). Results: All three groups had significant within-group gain for AMAT-F (p=.0007; p=.039; p=.047, respectively; similar results were shown for AMAT S/E subscale. Only the Whole ML group had significant gain in AMAT W/H (p=.007). Gain for all three groups exceeded the threshold for clinically significant gain in AMAT-F (.21 points), as follows: Whole ML (.66 points, 3 x’s the threshold); S/E ROB ML (.53 points, 2.5 x’s); W/H FES ML (.46 points, 2 x’s). Conclusion: For the customized whole limb motor learning group there was greater improvement in upper limb function versus the two groups that received prescribed, focused training for either shoulder/elbow or wrist/hand, according to the AMAT-F clinically significant threshold and according to the AMAT-F W/H subscale.