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BACKGROUND AND OBJECTIVES Despite the broad utilization of component-based transfusion strategies that aim to reconstitute whole blood during acute traumatic haemorrhage, data for haemorrhage occurring outside of trauma and surgery are limited. METHODS This is an observational cohort study of adults experiencing critical non-traumatic, non-intraoperative haemorrhage during hospitalization at an academic medical centre from 2011 to 2015. The primary goal was to evaluate differences in plasma and platelet to red blood cell (RBC) transfusion ratios across patient demographic, clinical and laboratory characteristics. Secondarily, associations between transfusion ratios and clinical outcomes were assessed. RESULTS Seven hundred nine patients were included: 498 (70.2%) medical and 211 (29.8%) post surgical. The gastrointestinal tract (36.7%) was the most common site of bleeding. Most patients received RBCs without plasma (35.5%) or platelets (54.2%). Among those receiving plasma, 82.3% received a plasma to RBC ratio

There is limited data comparing the outcomes of knee arthroplasty for arthritis secondary to meniscus root tear versus primary osteoarthritis. The aim of this 2:1 matched case control series was to compare outcomes in patients who underwent arthroplasty for arthritis following a meniscus root tear (root tear cohort—“RTC”) with a control group of patients with primary osteoarthritis (primary osteoarthritis—“controls”). The authors hypothesized that the meniscus root tear patients would have similar clinical outcomes, return to activity, complication and reoperation rates as their matched controls. A consecutive series of patients who had a clinically and radiographically confirmed meniscus root tear between 2002 and 2017 at a mean 4.8 year follow-up that developed secondary arthritis were matched 2:1 by laterality, surgery, age at surgery, date of surgery, sex, and surgeon to a control group of patients with primary osteoarthritis, without a root tear, who underwent arthroplasty. No patients were lost to follow-up. Patient demographics, Kellgren–Lawrence grades at the time of surgery, pre- and post-operative Knee Society Score pain and function scores, Tegner score, complications, and survival free of reoperation were analyzed between groups. A total of 225 subjects were identified, including 75 root tear cohort patients (13 UKA, 62 TKA) and 150 control patients. The root tear cohort had significantly lower Kellgren–Lawrence grades than the control group at the time of arthroplasty (p ≤ 0.001), but similar baseline pre-operative Knee Society Score pain, Knee Society Score function, and Tegner activity scale score. Post-operatively, Knee Society Score pain scores were comparable, and root tear cohort Knee Society Score function scores statistically significantly improved (p ≤ 0.007). Complication rates and survival free of reoperation at final follow-up were not statistically significantly different between groups. Patients treated with arthroplasty for secondary arthritis after a meniscus root tear demonstrated less severe radiographic arthritis, but similar pre-operative pain levels compared to matched controls with primary osteoarthritis. The root tear cohort patients demonstrated improved outcomes with respect to function, and similar outcomes with respect to pain, activity level, complication rates, and reoperation rates. The authors conclude that arthroplasty can be a reliable option for selected patients with an irreparable root tear and ongoing pain and dysfunction refractory to non-operative management, even in the setting of less advanced osteoarthritis on X-ray. III.

Epidural blood patch (EBP) is an accepted treatment modality for postdural puncture headache (PDPH) refractory to conservative approaches.[1–5][1] Despite the established efficacy of EBP, some patients require more than one EBP intervention to achieve symptom resolution. The rate of repeat image

Introduction The COVID-19 pandemic has placed great strain on blood resources. In an effort to extend platelet shelf-life and minimize waste, our institution transitioned room-temperature to cold-stored platelets for administration to bleeding patients. Study design and methods We describe the administrative and technical processes involved in transitioning room-temperature platelets to cold-storage in April 2020. Additionally, we describe the clinical utilization of cold-stored platelets in the first month of this practice change, with a focus on changes in platelet counts after transfusion, hemostasis, and safety outcomes. Results A total of 61 cold-stored platelet units were transfused to 40 bleeding patients, with a median (interquartile range) of 1 (1, 2) units per patient. The median age was 68 (59, 73) years; 58% male. Median pre-transfusion and post-transfusion platelets counts were 88 (67, 109) and 115 (93, 145). 95% of transfusions were administered in the operating room; 57% cardiac surgery, 20% vascular surgery, 8% general surgery, and 5% solid-organ transplantation. Hemostasis was deemed to be adequate in all cases after transfusion. There were no transfusion reactions. One patient (3%) experienced a fever and infection within 5 days of transfusion, which was unrelated to transfusion. Median hospital length of stay was 8.5 (6, 17) days. Two patients (5%) died in the hospital of complications not related to transfusion. Conclusion Cold-stored platelet utilization was associated with adequate hemostasis and no overt signal for patient harm. Conversion from room-temperature to cold-stored platelets may be one method of reducing waste in times of scarce blood inventories. This article is protected by copyright. All rights reserved.

There is limited data comparing the outcomes of knee arthroplasty for arthritis secondary to meniscus root tear versus primary osteoarthritis. The aim of this 2:1 matched case control series was to compare outcomes in patients who underwent arthroplasty for arthritis following a meniscus root tear (root tear cohort-"RTC") with a control group of patients with primary osteoarthritis (primary osteoarthritis-"controls"). The authors hypothesized that the meniscus root tear patients would have similar clinical outcomes, return to activity, complication and reoperation rates as their matched controls.A consecutive series of patients who had a clinically and radiographically confirmed meniscus root tear between 2002 and 2017 at a mean 4.8 year follow-up that developed secondary arthritis were matched 2:1 by laterality, surgery, age at surgery, date of surgery, sex, and surgeon to a control group of patients with primary osteoarthritis, without a root tear, who underwent arthroplasty. No patients were lost to follow-up. Patient demographics, Kellgren-Lawrence grades at the time of surgery, pre- and post-operative Knee Society Score pain and function scores, Tegner score, complications, and survival free of reoperation were analyzed between groups.A total of 225 subjects were identified, including 75 root tear cohort patients (13 UKA, 62 TKA) and 150 control patients. The root tear cohort had significantly lower Kellgren-Lawrence grades than the control group at the time of arthroplasty (p ≤ 0.001), but similar baseline pre-operative Knee Society Score pain, Knee Society Score function, and Tegner activity scale score. Post-operatively, Knee Society Score pain scores were comparable, and root tear cohort Knee Society Score function scores statistically significantly improved (p ≤ 0.007). Complication rates and survival free of reoperation at final follow-up were not statistically significantly different between groups.Patients treated with arthroplasty for secondary arthritis after a meniscus root tear demonstrated less severe radiographic arthritis, but similar pre-operative pain levels compared to matched controls with primary osteoarthritis. The root tear cohort patients demonstrated improved outcomes with respect to function, and similar outcomes with respect to pain, activity level, complication rates, and reoperation rates. The authors conclude that arthroplasty can be a reliable option for selected patients with an irreparable root tear and ongoing pain and dysfunction refractory to non-operative management, even in the setting of less advanced osteoarthritis on X-ray.III.

Objective The purpose of this study was to determine overall levels of grit, self-control, and conscientiousness among orthopedic surgery residents, to compare levels of grit across orthopedic resident training levels, and to identify common applicant variables which may correlate with these valuable noncognitive attributes. Design A cross-sectional study composed of a confidential electronic survey consisting of a 17-item Grit scale, 10-item Self-control scale, and 9-item Conscientiousness scale was completed by Orthopedic residents and fellows. Setting Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; a tertiary medical center. Participants Grit, ambition, consistency of interest, perseverance of effort, self-control, and conscientiousness were assessed in orthopedic surgery residents and fellows. The survey was distributed to program coordinators of ACGME accredited Orthopedic Surgery residency programs and fellowship. 431 (431 out of 621, 69.4%) respondents completed the assessment. Results Orthopedic residents demonstrated high baseline levels of grit (4.0 of 5.0), self-control (3.8 of 5.0), and conscientiousness (4.4 of 5.0). The grit score of 4.0 places them in the 65th percentile of the general adult population. There were no significant differences in scores between training levels of orthopedic residents and fellows. Significantly higher self-control scores were seen in female trainees (p = 0.042), inductees of Alpha Omega Alpha honor society (p = 0.008), and those with higher numbers of publications (p = 0.037). Orthopedic trainees with more publications scored higher in the ambition sub-score (0 publications: 4.0 ± 0.7; 1-3 publications: 4.2 ± 0.5, 3 or more publications: 4.3 ± 0.5; p Conclusions Orthopedic surgery residents demonstrated high levels of grit compared to the general population. Key objective variables utilized in the residency application process including Alpha Omega Alpha status and volume of research publications were predictive of these qualities.