IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

AIMS: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. METHODS: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1(st) March-31(st) May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. RESULTS: A total of 7090 patients were included, with a mean age of 82.2 (range 50-104) years and 4959 (70%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) became positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p=0.001), residential care (OR 2.15, p<0.001), inpatient fall (OR 2.23, p=0.003), cancer (OR 0.63, p=0.009), ASA grade 4-5 (OR 1.59, p=0.008; OR 8.28, p<0.001), and longer admission (OR 1.06 for each increasing day, p<0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p<0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p<0.001). Increasing age (HR 1.03, p=0.028), male sex (HR 2.35, p<0.001), renal disease (HR 1.53, p=0.017), and pulmonary disease (HR 1.45, p=0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. CONCLUSION: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher mortality risk

Dust mite allergens, indoor humidity and asthma

This presentation looks at dust mite allergens, indoor humidity and asthm

Fuel poverty and asthma

This speech discusses fuel poverty and asthma. It was presented at the Health, Housing and Affordable Warmth Symposium in 1999

Unicompartmental knee replacement in the elderly: a systematic review

Unicompartmental knee replacement in the elderly may be associated with a better outcome than total knee replacement. The purpose of this review was to assess the clinical outcome in patients over the age of 70. A computerised search was performed using Pubmed and Embase. Quality assessment was performed using the Newcastle-Ottawa Scale. Eligible studies were identified according to defined criteria and reviewed in terms of peri-operative events, functional outcome and long-term results. 20 studies, representing a minimum of 2956 knees were included. There was a significant increase in the knee society score in the majority of studies to 89.5 (objective) and 80 (function) and the median range of motion (ROM) achieved was 115 degrees. There was no peri-operative mortality and the 10 year prosthesis survival rate was 87.5 -98% Revision for periprosthetic infection was low at 0.13 -0.30%

A retrospective review of the assessment of current perioperative management of diabetes in patients undergoing knee replacement surgery

Objectives The prevalence of diabetes mellitus is increasing. Previous work has shown that suboptimal glycaemic control is associated with poor perioperative outcomes with increased rates of postoperative morbidity and mortality in several surgical specialities. Recently published UK guidelines have laid out the standards of perioperative care for patients with diabetes. Because an increasing number of patients with diabetes undergo surgery, it is important that these nationally agreed standards of care are adhered to. Design A retrospective review of the standard of care of patients against existing audit standards laid down in national guidelines, and a comparison of outcomes with people without diabetes. Setting A single major orthopaedic department. Participants Fifty consecutive patients undergoing knee arthroplasty between July 2010 and June 2011. Main outcome measures Postoperative complications; pre, peri and postoperative glucose control; hospital length of stay. Results Although there were no serious postoperative complications, the pre, peri and postoperative management was found to be suboptimal, particularly with reference to optimization of blood glucose control, both in terms of HbA1c preoperatively and blood glucose monitoring perioperatively. The average length of hospital stay was not different between groups; however, 36 patients with diabetes had at least one documented hyperglycaemic episode and four at least one hypoglycaemic episode. Conclusions Perioperative care of diabetes in patients undergoing knee arthroplasty could be improved. Several changes have been made since this audit was carried out, in particular adoption of the comprehensive Joint British Diabetes Societies Guideline on the perioperative management of adult patients with diabetes. </jats:sec

The change in energy absorbed post removal of metalwork in a simulated paediatric long bone fracture

Purpose: The surgical treatment of paediatric fractures is increasing. Open reduction and internal fixation (ORIF) with plates and screws is long established, whilst the use of elastic stable intramedullary nailing (ESIN) has become increasingly popular. This study quantifies, in terms of the energy required to produce a fracture, the biomechanical sequelae of both techniques post removal of metalwork, to provide clinicians with evidence to guide post-operative advice. Methods: An immature bovine model was adopted to ascertain whether these techniques exposed the bone to a greater re-fracture risk following removal of the device. Bones were prepared to reflect ORIF or ESIN techniques, or prepared intact for the acquisition of control data. Each bone was tested to failure at 90 °/s, with the absorbed energy then being calculated to determine the relative difference between each technique and versus control data. Data describing peak shear stress and torque were recorded. Results: Absorbed energy was reduced by 47 % in the ORIF group compared to both the control (p = 0.011) and ESIN (p = 0.018) groups. The peak shear stress and torque were also significantly different. All ORIF bones failed through drill holes, suggesting stress localisation around the defects. Conclusion: This study suggests that there is a significantly higher re-fracture risk following the removal of ORIF plates when compared to both ESIN and the control environment. Whilst this may reflect the intuitive view of many clinicians, this study provides a quantitative value of the reduction in strength and should help clinicians to appropriately caution patients and parents prior to surgery

Domestic ventilation rates, poor humidity and dust mite allergens - are our homes causing the asthma pandemic?

This chapter discusses if our homes are causing the asthma pandemic

Optimizing the shipbuilding layout of Damex Shipbuilding and Engineering for cost efficiency

In this master thesis the shipyard layout of Damex Shipbuilding and Engineering is optimized for cost efficiency.Ship ProductionDPOMechanical, Maritime and Materials Engineerin