Orthopedics
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This retrospective review analyzed and compared transfusion practices in patients undergoing orthopedic surgery in five Massachusetts hospitals with current practice guidelines; opportunities for improvement were identified. Patient-specific clinical information and data about transfusion practices were obtained from the medical records of 384 Medicare patients undergoing orthopedic surgery between January 1992 and December 1993. The number of patients who donated autologous blood preoperatively differed significantly among hospitals as did the number of autologous units that were unused. ⋯ Differences in intraoperative and postoperative blood salvage use also were noted. These findings indicate that significant variations in practice exist. Comparative data enabled hospitals to identify and target specific areas for improvement.
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Repetitive strain injuries are currently the leading cause of occupational illnesses. This report describes seven patients who presented with the sole symptom of hand pain and subsequently were diagnosed with intrinsic tendinitis. Six of the 7 patients were given injections of a local anesthetic and steroid solution into the region of the lumbrical tunnels for both diagnostic and therapeutic purposes. ⋯ Complete resolution of symptoms after both the injection and other treatment interventions occurred in 4 patients, and partial resolution of symptoms occurred in the remaining two patients. Follow-up ranged from 3 to 20 months for 6 patients, and the seventh patient was lost to follow-up. The clinical presentation, diagnostic work-up, and treatment of intrinsic tendinitis are described.