Efficacy of Red Cell Salvage Systems in Open Acetabular Surgery.

Over the past 50 years, treatment of displaced acetabular fractures has moved away from conservative treatment with bedrest to operative intervention to achieve anatomic reduction, stable fixation, and allow early range of motion of the hip. However, operative fixation is not without complications. Internal fixation of traumatic acetabular fractures has been coupled with large volume of blood loss both at the time of injury and surgery. This often results in the need for allogenic blood products, which has been linked to increase morbidity (Vamvakas and Blajchman, 2009). In an attempt to avoid the risk associated with allogenic blood transfusion numerous techniques and methods have been devised. Red blood cell salvage (CS) is an intraoperative blood salvage tool where blood is harvested from the operative field. It is washed to remove the plasma, white blood cells, and platelets. The red cells are resuspended in a crystalloid solution. If the hematocrit of the resuspended red blood cells is sufficient, it is transfused to the patient intravenously. The benefits of CS in major spine surgery, bilateral knee replacement, and revision hip surgery are well established (Goulet et al. 1989, Gee et al. 2011, Canan et al. 2013). However, literature reviewing the use of cell saver in orthopedic trauma surgery, specifically acetabular surgery is limited. Our institute performed a retrospective review of 63 consecutive operative acetabular fractures at a level one trauma center. Our study revealed that patients with blood loss of less than 400 mL were 13 times less likely to receive autologous blood, and patients with hemoglobin less than 10.5 were 5 times less likely to receive autologous transfusion (p < 0.05). We also found that no patients with a hemoglobin level less than 10.5 and EBL less than 400 mL received autologous blood return. Autologous blood transfusion had no effect on volume or rate of allogenic blood transfusion. We believed that if a patient's preoperative hemoglobin is less than 10.5 or expected blood loss is less than 400 mL, then CS should have a very limited role, if any, in the preoperative blood conservation strategy. We found ASA greater than 2, BMI greater than 24 and associated fracture type to be a risk factor for high blood loss.

Skin cancer knowledge, attitudes, beliefs, and prevention practices among medical students: A systematic search and literature review.

BACKGROUND: As future physicians, medical students will play an important role in the prevention of skin cancers by becoming directly involved in skin cancer prevention education and counseling patients about the hazards of ultraviolet light. OBJECTIVE: We assessed the skin cancer-related knowledge, attitudes, beliefs, and prevention practices reported in previous studies of medical students. METHODS: The search for relevant articles was performed in four electronic databases: PubMed (Medline), Cumulative Index to Nursing and Allied Health, ERIC, and PsycINFO. Studies were included if they met the following criteria: 1) targeted medical students; 2) assessed sun avoidance, sun protection, skin self-examination, and/or indoor tanning behaviors; 3) were published in peer-reviewed journals; and 4) complete data were available for extraction. RESULTS: A total of 21 studies are included in this review. Important findings include moderate-to-high levels of skin cancer knowledge and low levels of both sunscreen and ultraviolet light knowledge. The attitudes and knowledge of medical students reflect a low level of concern with regard to the perceived importance of skin cancer compared with other forms of cancer despite a high level of concern for the importance of skin cancer prevention. Furthermore, this review demonstrated that medical students fail to protect themselves routinely from the sun and have a high interest in tanning bed use. CONCLUSION: This review demonstrates the need to educate medical students about skin cancer and skin cancer preventive behaviors. New strategies and educational campaigns should be developed to communicate better information on skin cancer morbidity, mortality, and prevention to medical students. This will pay dividends by improving the practice of these future physicians in all specialties.

Promoting physical activity in upper elementary children using multi-theory model (MTM) of health behavior change.

BACKGROUND: Physical activity and exercise offer numerous benefits to children and Centers for Disease Control and Prevention guidelines require that school children engage in at least 60 minutes of moderate to vigorous physical activity every day. Unfortunately, up to 30% elementary students do not meet these requirements and 79% elementary schools do not provide students with physical education classes every day. The transition from elementary to secondary school is particularly deleterious for levels of physical activity. Therefore, there is a need to develop educational interventions for upper elementary school children to promote physical activity. A new theory multi-theory model (MTM) of health behavior change can be utilized to develop such interventions. OBJECTIVES: The purpose of this article was to develop and introduce an instrument based on MTM for physical activity change in upper elementary school children and propose an approach for changing this behavior among sedentary students. METHODS: A review of literature in MEDLINE, CINAHL, Google Scholar, and ERIC databases was conducted for physical activity in upper elementary children and multi-theory model of health behavior change to prepare this article. RESULTS: An instrument with Flesch-Kincaid Grade level of 5.4 and the Flesch Reading Ease of 68 making it suitable for administration with upper elementary school children was developed. An approach utilizing the constructs of participatory dialogue, behavioral confidence and changes in physical environment to initiate physical activity and reifying the constructs of emotional transformation, practice for change and changes in social environment to sustain physical activity in upper elementary school children is presented. CONCLUSIONS: MTM offers potential to augment current educational efforts to promote physical activity in upper elementary school children.

Site-specific associations of muscle thickness with bone mineral density in middle-aged and older men and women.

It is unknown whether age-related site-specific muscle loss is associated with areal bone mineral density (aBMD) in older adults. To examine the relationships between aBMD and whole-body muscle thickness distribution, 97 healthy adults (46 women and 51 men) aged 50-78 years volunteered. Total and appendicular lean soft tissue mass, aBMD of the lumbar spine (LS-aBMD) and femoral neck (FN-aBMD) were determined using dual-energy X-ray absorptiometry. Muscle thickness (MT) was measured by ultrasound at nine sites of the body (forearm, upper arm, trunk, upper leg, and lower leg). Relationships of each co-variate with aBMD were tested partialling out the effect of age. aBMD was not correlated with either MT of the trunk or anterior lower leg in either sex. In men, significant and relatively strong correlations were observed between anterior and posterior upper arms, posterior lower leg, and anterior upper leg MT and LS-aBMD or FN-aBMD. In women, significant correlations were observed between anterior and posterior upper legs, posterior lower leg, and anterior upper arm MT and FN-aBMD. LS-aBMD was only correlated with forearm and posterior upper leg MT in women. In conclusion, the site-specific association of MT and aBMD differs between sexes and may be associated with the participants' daily physical activity profile.