Utilizing Tranexamic Acid To Reduce Blood Transfusion In Hip Fractures

Minimizing perioperative blood loss during orthopedic surgery has proven challenging for providers. Perioperative utilization of antifibrinolytic pharmacologic interventions, such as tranexamic acid (TXA), has been demonstrated as a safe and effective technique for decreasing blood loss and allogenic blood transfusion rates. Currently, the Food and Drug Administration (FDA) approved on-label indications of TXA are for use in short-term treatment of hemophilia patients undergoing dental extractions and in management of patients experiencing menorrhagia (Mayeux, Alwon, Collins, & Hewer, 2016). Despite the current limited scope of FDA approval for TXA, use in elective surgery with otherwise clotting-uncompromised patients is not a new concept. Perioperative TXA administration in elective joint replacement surgery, cardiopulmonary bypass, spinal fusions, and hysterectomies has been well studied (Duncan et al., 2015). Numerous studies have acknowledged TXA use decreases perioperative blood loss, decreases perioperative blood transfusions, and shortens length of hospital stay. Additionally, research exists that demonstrates safety and efficacy of TXA use in patients presenting with traumatic injury (Roberts et al., 2013). Despite this vast body of knowledge, little research exists evaluating TXA use in hip fractures. Over 325,000 traumatic hip fractures occur every year (Neuman, Rosenbaum, Ludwig, Zubizarreta, & Silber, 2014). This patient population is generally frail and typically lacks optimization prior to urgent surgery. Based on the extensive body of prior research conducted to date, it is reasonable to postulate that TXA use in these instances would yield a decreased blood loss and therefore contribute to lower rates of allogenic blood transfusion in hip fracture patients

What are the experiences of external executive coaches working with coachees’ assigned goals?

The notion of goals as central to the coaching process is reflected in practice literature, popular coaching models and research, with an emphasis placed on the effectiveness of coachee-led goal-setting. In executive coaching however, the organisation may assign goals to determine outcomes for both business and individual. How this dynamic impacts on the external executive coach's experience was explored in a study using Interpretative Phenomenological Analysis, a qualitative method involving in-depth interviews. This article explains the methodological and analytic approaches, and describes the key findings, including the significance of coaches’ beliefs about goals, and the complex nature of multi-stakeholder contracting

Spatialities: The Geographies of Art and Architecture

Book Review of Spatialities: The Geographies of Art and Architecture, ed. by Judith Rugg and Craig Martin. ISBN 9781841504681. Reviewed by Katherine Cowan

Does funded research reflect the priorities of people living with type 1 diabetes? A secondary analysis of research questions

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. Objectives This study explored the divergence and convergence between funded research about type 1 diabetes and the research agenda of people living with the condition and their carers. Design, method, setting A secondary analysis was undertaken of existing data from two UK organisations who regularly work with patients and carers to identify research priorities. The research ideas of people with diabetes were identified in two ways: in 15 research question generation workshops involving approximately 100 patients and carers, and in a James Lind Alliance Type 1 Diabetes Priority Setting Partnership with approximately 580 patients, carers and clinicians (clinician question submissions were excluded from analysis). A total of 859 individual research questions were collected from patients and carers. Diabetes research funding activity was identified through extensive online searches which provided a total of 172 relevant research projects for analysis. Results The data were thematically analysed and areas of priority for research identified and compared between the patient and funded research agendas. The overall finding of this study is that there is substantial convergence between the two research agendas, alongside some important areas of divergence. The key areas of divergence were found in care delivery, injection issues, psychosocial impacts and women's health. We also demonstrate how an apparently convergent priority can host significant differences in emphasis between patientgenerated and funded research agendas. Conclusions We offer a comparison of a funded research agenda with one that has been derived directly from people with type 1 diabetes without initial framing by researchers. This provided a rare opportunity to explore the viewpoints of the end-users of research and compare them to realised research as determined by researchers and research organisations

The Role of Group Psychotherapy in Psychiatric Residency Training

Group psychotherapy has become a well-recognized treatment modality in the mental health field. Educationally, however, group psychotherapy has not reached the priority level it deserves. We described our experiences in using group psychotherapy as a training tool at the University of Texas at Houston. In describing our program, we used case illustrations to better demonstrate the richness of our training experiences. Group psychotherapy should be more extensively used in the training of tomorrow’s mental health professionals

Double-negative-2 B cells are the major synovial plasma cell precursor in rheumatoid arthritis

B cells are key pathogenic drivers of chronic inflammation in rheumatoid arthritis (RA). There is limited understanding of the relationship between synovial B cell subsets and pathogenic antibody secreting cells (ASCs). This knowledge is crucial for the development of more targeted B-cell depleting therapies. While CD11c+ double-negative 2 (DN2) B cells have been suggested as an ASC precursor in lupus, to date there is no proven link between the two subsets in RA. We have used both single-cell gene expression and BCR sequencing to study synovial B cells from patients with established RA, in addition to flow cytometry of circulating B cells. To better understand the differentiation patterns within the diseased tissue, a combination of RNA-based trajectory inference and clonal lineage analysis of BCR relationships were used. Both forms of analysis indicated that DN2 B cells serve as a major precursors to synovial ASCs. This study advances our understanding of B cells in RA and reveals the origin of pathogenic ASCs in the RA synovium. Given the significant role of DN2 B cells as a progenitor to pathogenic B cells in RA, it is important to conduct additional research to investigate the origins of DN2 B cells in RA and explore their potential as therapeutic targets in place of the less specific pan-B cells depletion therapies currently in use