Hyponatremia in orthopaedic patients is associated with longer, costlier hospitalizations. The factors that significantly increased the risk of developing postoperative hyponatremia were an older age, spine fusion, hip arthroplasty, and the amount of lactated Ringer solution used.

Background: In the past decade, internal medicine residencies have undergone major changes in competency-based assessments, work-hour restrictions and the implementation of the electronic medical record. The aim of this study is to compare a typical day of a first year post-graduate (PGY1) to that of a third year post-graduate (PGY3) internal medicine resident and examine if the differences in their days demonstrate the American Board of Internal Medicine's (ABIM) desired progression towards competency-based milestones and unsupervised practice. Methods: We conducted an observational time study documenting 14,103 minutes, 9 major categories, and 17 subcategories while shadowing 10 internal medicine PGY1s and 10 PGY3s during inpatient, non-call days. The following day, house staff completed surveys of their perceived time allocation of the previous 24 hours. Results: PGY1s spent an average of 12.5 hours managing an average of 6 patients. Thirtyeight percent of their time was spent on the computer, 21% discussing patients and 18% directly with patients. PGY3s, overseeing an average of 12 patients, worked 1.5 hours less per day (p<0.001), had 1.5 hours less computer time (p=0.001), 24 minutes less direct patient contact (p=0.045), and 36 minutes more patient care discussions (p=0.011). Conclusion: The difference between PGY1s' and PGY3s' daily time allocations is minimal. Whereas a PGY3 spends 1.5 hours less than a PGY1 on writing computer notes and discharges, they also work 1.5 hours less per day. The additional 36 minutes of patient care discussions was the only significant time quantity difference that would be considered a higher level of practice for the PGY3 compared to the PGY1. With residents now caring for fewer patients, there has been a marked increase in computer time per patient for both PGY1s and PGY3s.

Introduction Waterproof lining in casting in the pediatric population is becoming more commonplace due to the improved quality of life for the child by providing patients with a higher physical functional level when compared to those with non-waterproof lining. The objective of this study is to compare patient satisfaction and outcomes of two commonly used waterproof liners. Methods A prospective, randomized-controlled trial of children with stable forearm fractures not requiring reduction was conducted. Of those who chose a waterproof lining, patients were randomized to one of two products: Delta Dry® or Aquacast®. At the time of cast removal, each patient and medical assistant who applied and removed the cast completed surveys about their satisfaction with the cast. A two-sample T-test for independent samples was used to compare the two cast liners. Results Both liners were well liked by patients with no statistically significant difference in satisfaction scores nor were there differences in water exposure between the two groups (pool use, showering, or lake swimming). The medical assistants scored Aquacast® higher in three out of four domains but again there was no statistical difference. There were no fracture complications nor problems from cast application or removal. Conclusion Both waterproof cast liners were safe and efficacious. No significant differences were detected in any measured parameter including overall high patient satisfaction.

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