The American journal of orthopedics
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In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) established nationwide guidelines for resident working environments and duty hours. Following these guidelines became a requirement for all accredited residency programs. Two years after implementation, we conducted a national survey to assess the opinions and attitudes of orthopedic residents and program directors toward the ACGME work-hour regulations and the effects of these regulations on resident education, resident quality of life, and patient care. ⋯ There was overall agreement among the 3 groups that resident quality of life had improved as a result of work-hour regulations. For patient care, junior residents viewed the new regulations positively for surgical training and patient care, whereas senior residents and program directors disagreed. This survey showed meaningful differences in the attitudes and opinions of junior residents, senior residents, and program directors toward the new ACGME work-hour regulations.
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Bilateral knee dislocations seldom occur, and fewer than a dozen cases of bilateral luxatio erecta humeri (erect dislocation of the shoulder) have been reported. Here we present the case of a patient who sustained bilateral knee dislocations and bilateral luxatio erecta humeri in a motorcycle accident. Transient neurologic compromise resolved with closed reduction of the bilateral shoulder and left knee dislocations. To our knowledge, this is the first case report of a patient with this combination of injuries.
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Joint reconstruction surgery is associated with significant blood loss, and patients often require perioperative transfusions. Recombinant human erythropoietin (epoetin) can be used in anemic patients scheduled for elective, noncardiac, nonvascular surgery to reduce the need for transfusions. ⋯ Our analysis showed that transfusions were given to 3 (8%) of the 38 patients who received epoetin before surgery and 20 (57%) of the 35 historical controls (P<.001) and that length of hospital stay did not differ significantly between the 2 groups. Our results provide further support for use of epoetin as an effective strategy for reducing exposure to allogenic blood in orthopedic surgery.
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Review Case Reports
Retrofascial bilateral psoas abscess in a 6-year-old child.