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Substance use disorder (SUD), including alcohol use disorder (AUD), is a complex issue for lawyers and judges in many kinds of cases, including civil, probate, criminal, juvenile, and family. Its [...]

AimsThe aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients.MethodsA retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes.ResultsA total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay.ConclusionBlood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction.Cite this article: Bone Joint J2022;104-B(11):1266–1272.

MY POSITION ON THIS ISSUE DEVELOPED FROM MY EXPERIENCE IN BOTH THE JUVENILE AND FAMILY COURT SYSTEMS. In 1997, after serving at juvenile court for nine years, I was transferred [...]

What do judges want? As a judge, I want a child's attorney in every family law case in which custody, parenting time, or relocation is at issue. I want a [...]

Reports that when taken orally as prescribed, psychostimulant drugs are an effective course of treatment for adolescents diagnosed with attention-deficit disorder/attention-deficit/hyperactivity disorder (ADD/ADHD). Estimated number of children diagnosed with ADD/ADHD; Prescribed medications; Misuse of psychostimulants on high school and college campuses.