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Objective: The goal of this study was to compare factor concentrate (FC)-based and blood product-based hemostasis management of coagulopathy in cardiac surgical patients in terms of postoperative bleeding, required blood products, and outcome., Design: Retrospective, propensity score-matched analysis., Setting: Single, tertiary, academic medical center., Participants: One hundred eighteen matched pairs of 433 consecutive patients scheduled for cardiac surgery in two isolated periods with distinct strategies of hemostasis management., Interventions: Patients received either blood product-based (period I) or FC-based (period II) hemostasis management to treat perioperative coagulopathy., Measurements and Main Results: Patients treated with FC management experienced less postoperative blood loss (907 v 1,153 mL, p = 0.014) and required less red blood cell and fresh frozen plasma transfusion (2.3 v 3.7 units p < 0.0001, and 2.0 v 3.4 units p < 0.0001, respectively) compared with subjects in the blood product-based management group. The frequency of Stage 3 acute kidney injury and 30-day mortality rate were significantly higher in the blood product-based group than in the FC management group (6.8% v 0.8%, p = 0.016, and 7.2% v 0.8%, p = 0.022, respectively). FC management-related thromboembolic events were not registered. The FC strategy was associated with a 2.19-fold decrease in the odds of massive postoperative bleeding (p < 0.0001), a 2.56-fold decrease in the odds of polytransfusion (p < 0.0001), and a 13.16-fold decrease in the odds of early postoperative death (p = 0.003)., Conclusions: FC-based versus blood product-based management is associated with reduced blood product needs and fewer complications, and was not linked to a higher frequency of thromboembolic events or a decrease in long-term survival in cardiac surgical patients developing perioperative coagulopathy and bleeding., Competing Interests: Conflict of Interest Within the past five years, Endre Nemeth has received honoraria for lecturing from CSL Behring. All other authors declare that they have no competing financial or other interest in relation to their work., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the social and employment status of adults with cerebral palsy., Design: Detailed medical history, physical examination, and functional rating in the PULTIBEC system were performed on all study participants; they also responded to a standardized social adaptation questionnaire., Setting: Outpatient clinic., Subjects: Volunteer participants (n = 101), all with cerebral palsy, between the ages of 27 and 74 years, living independently in the community., Results: More than 80% wished that their physician knew more about cerebral palsy. The majority (84%) felt their parents overprotected them in childhood. More than 90% desired more sexual education. More than half (67%) lived independently, 34% with and 33% without attendant. Of the 53% who were competitively employed, 22% earned an income high enough that advancement would cause financial loss through termination of disability benefits. Speech deficits severely compromised functional verbal communication in 50%. Type of employment correlated more with adequate cognition than with physical or communicative impairments., Conclusions: Compared with earlier studies, the present study showed more adults with cerebral palsy achieving competitive employment and independent living, despite moderate to severe physical disability. Advances in rehabilitation technology, better home support services, and legal mandates in education and environmental access may have facilitated positive change for persons with cerebral palsy. Further studies are encouraged with emphasis on longitudinal designs.

This self-directed learning module presents pertinent information about rehabilitation management of specific joint and connective tissue diseases affecting children. This section highlights juvenile rheumatoid arthritis, Lyme disease, rheumatic fever, hemophilia, dermatomyositis, polymyositis, systemic lupus erythematosus, and other forms of arthritis. It is a section of the chapter of pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation.

This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of reflexes, and cognitive and personality development. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The rehabilitation perspective is emphasized, especially as it changes to accommodate the developing child, with a focus on specific chronic disorders such as respiratory disease, congenital heart disease, and malignancy. These types of disorders serve as a model for the management of problems that require special medical, rehabilitative, and psychosocial consideration.

In normal children, sex, age, height and weight account for approximately 50% to 70% of variance in the strength scores obtained by quantitative measurements. Although quantitative techniques accurately measure the forces generated by muscle contraction, technical and psychological variables may cause some inconsistency of scores and contribute to the variance observed. To explore the role of these factors, reliability of quantitative strength measurements was examined in children withe normal intelligence and with mild mental retardation using the isokinetic method. Results showed mean score deviations of 5.3% to 5.8% for different muscle groups within the same test. When testing was repeated by the same examiners 7 to 10 days apart, mean score deviations were 7.9% to 9.8% in various muscle groups. Repeated measurements by different examiners 7 to 10 days later yielded 8.7% to 10% mean score deviations for various muscles. Statistical analyses showed that these differences were not significant. Technical and behavioral aspects of test performance are not an important source of inaccuracy and, therefore, cannot contribute significantly to the variance of scores.

This self-directed learning module provides review and references for the basic concepts of, and highlights new advances in, disorders of the spinal cord in children. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. For spinal cord injury, only data pertinent to the pediatric age group are discussed. Myelodysplasia is presented in detail to include genetic implications, early intervention, long-term management planning, psychosocial impact, and quality-of-life considerations.

This self-directed learning module highlights advances in evaluation and treatment of congenital and acquired musculoskeletal disorders in the child. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains information on alterations of limb structure and gait, scoliosis, torticollis, sports injuries and overuse syndromes, and unexplained pain in children.

A prospective longitudinal study involving 233 children with cerebral palsy was carried out to select signs useful for early prognostication of ambulation. All patients were followed from the time they were 12 months old and their progress was observed until they reached the age of 3 to 11 years. The population consisted of 61 children having congenital hemiplegia, 37 having diplegia, 85 having spastic quadriparesis and 28 having the spastic-athetoid clinical type of cerebral palsy. In addition, there were 14 children with athetoid, 6 with ataxic and 2 with hypotonic cerebral palsy. Of the total population, 78.7% achieved some degree of functional walking. Findings indicated that the probability of ambulation was related to the clinical type of cerebral palsy. In some the ultimate functional outcome was rather uniform, as in those with congenital hemiplegic and ataxic types where the prognosis was consistently favorable or in those with hypotonic cerebral palsy in whom the outlook was poor. In spastic diplegic, quadriparetic, spastic-athetoid and athetoid types, on the other hand, expectations varied considerably. For this group of patients, sitting by two years was found to be a predictive sign of high reliability since all children who sat by this age eventually walked. For the group of patients not sitting by two years which included more than half of the eventual ambulators, suppression of obligatory primitive reflex activity between 18 and 24 months provided a sensitive indicator to distinguish the children who ultimately walked from those who would not be expected to do so. These data offer a possibility for predicting future ambulatory status by two years of age in those clinical types of cerebral palsy where difficulties of early accurate prognostication are most likely to be encountered. Observations also suggested that the presence of mental retardation adversely affects ambulation.

This self-directed learning module addresses rehabilitation issues in the child with brain damage. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. In addition to the motor manifestations, intellectual, social, and emotional impairment are addressed. Problems vary with developmental stage. Emphasis is on the etiology, severity, and combination of deficits in order to develop a plan of management, including physical, occupational, and speech therapy, recreational and social milieu, and family and community resources.

This self-directed learning module addresses diagnostic and rehabilitation issues in children with the most common disorders of the motor unit. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Conditions occurring only in infancy or childhood and differences in diagnostic and rehabilitation approaches as compared with those used in adults are highlighted.