Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance

Objective: To determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals. Design/setting A national (UK) research priority setting partnership. Participants: People who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures. The scope includes open fractures, fractures to joints broken into multiple pieces, multiple concomitant fractures and fractures involving the pelvis and acetabulum. Methods: A multiphase priority setting exercise was conducted in partnership with the James Lind Alliance over 21 months (October 2019 to June 2021). A national survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 18 questions was taken to a stakeholder workshop, where a consensus was reached on the top 10 priorities. Results: A total of 532 uncertainties, submitted by 158 respondents (including 33 patients/carers) were received during the initial survey. These were refined into 58 unique indicative questions, of which all 58 were judged to be true uncertainties after review of the existing evidence. 136 people (including 56 patients/carers) responded to the interim prioritisation survey and 18 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions. Conclusions: The top 10 research priorities for complex fracture include questions regarding rehabilitation, complications, psychological support and return to life-roles. These shared priorities will now be used to guide funders and teams wishing to research complex fractures over the coming decade

Research priorities for the management of major trauma: an international priority setting partnership with the James Lind Alliance

Objective The objective of this study is to determine research priorities for the management of major trauma, representing the shared priorities of patients, their families, carers and healthcare professionals. Design/setting An international research priority-setting partnership. Participants People who have experienced major trauma, their carers and relatives, and healthcare professionals involved in treating patients after major trauma. The scope included chest, abdominal and pelvic injuries as well as major bleeding, multiple injuries and those that threaten life or limb. Methods A multiphase priority-setting exercise was conducted in partnership with the James Lind Alliance over 24 months (November 2021–October 2023). An international survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second international survey asked respondents to prioritise the research questions. A final shortlist of 19 questions was taken to a stakeholder workshop, where consensus was reached on the top 10 priorities. Results A total of 1572 uncertainties, submitted by 417 respondents (including 132 patients and carers), were received during the initial survey. These were refined into 53 unique indicative questions, of which all 53 were judged to be true uncertainties after reviewing the existing evidence. 373 people (including 115 patients and carers) responded to the interim prioritisation survey and 19 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions. Conclusions The top 10 research priorities for major trauma include patient-centred questions regarding pain relief and prehospital management, multidisciplinary working, novel technologies, rehabilitation and holistic support. These shared priorities will now be used to guide funders and teams wishing to research major trauma around the globe

Pinos transcorticais e gesso associados à aplicação local de plasma rico em plaquetas no tratamento de fratura do III metatarsiano em potro

In horses less than one year of age fractures of the third metacarpal bone (McIII) or metatarsal bone III (MtIII) are mainly attributed to trauma. Open reduction and internal fixation are the most common treatment method. A Quarter Horse filly with three months of age, which weighed 150kg presented a diaphyseal multifragmentar wedge fracture of right MtIII which was treated with transcortical pins and cast, associated with intralesional application of platelet rich plasma (PRP). After two years of surgery, the animal initiated a training program for racing, and six months later, the patient ran its first official match. The choice of therapeutic methods for treating fractures in horses should be one that provides an earlier repair and minor possibility of complications. Thus, the therapy association which was adopted was considered favorable, since allowed full reestablishment of locomotion of the patient and made possible its return to race.Em potros até um ano de idade, as fraturas do III osso metacarpiano (McIII) ou III metatarsiano (MtIII) são principalmente atribuídas ao trauma. A redução aberta e a imobilização do foco com implantes constituem o tratamento cirúrgico recomendado. Uma potra com três meses de idade e 150kg, da raça Quarto de Milha, que apresentava umafratura diafisária multifragmentar em cunha do MtIII direito foi submetida à osteossíntese através datransfixação externa e gesso, associada com a aplicação intralesional deplasma rico em plaquetas (PRP). Após dois anos do tratamento, o animal iniciou programa de treinamento para corrida e, após seis meses do treinamento, correu o primeiro páreo oficial. A escolha dos métodos terapêuticos para o tratamento de fraturas em equinos deve ser baseada naquela que promova reparação precoce e de melhor qualidade, com menores riscos de complicações. Sendo assim, a associação terapêutica adotada foi considerada favorável, já que possibilitou o completo reestabelecimento da locomoção da paciente, podendo inclusive competir na sua modalidade esportiva.Univ Estadual Paulista Julio Mesquita Filho UNESP, Fac Med Vet &Zootecnia, Dept Cirurgia &Anestesiol Vet, BR-18618970 Botucatu, SP, BrazilMed Vet Autonoma, Brotas, SP, BrazilUniv Estadual Paulista Julio Mesquita Filho UNESP, Fac Med Vet &Zootecnia, Dept Cirurgia &Anestesiol Vet, BR-18618970 Botucatu, SP, Brazi

Using healthcare systems data for outcomes in clinical trials: Issues to consider at the design stage

Background Healthcare system data (HSD) are increasingly used in clinical trials, augmenting or replacing traditional methods of collecting outcome data. The PRIMORANT study set out to determine when HSD are of sufficient quality and utility to replace bespoke outcome data collection, a methodological question prioritised by the clinical trials community. Methods The PRIMORANT study had three phases. First, an initial workshop was held to scope the issues faced by trialists when considering whether to use HSDs for trial outcomes. Second, a consultation exercise was undertaken with clinical trials unit (CTU) staff, trialists, methodologists, clinicians, funding panels and data providers. Third, a final discussion workshop was held, at which the results of the consultation were fed back, case studies presented, and issues considered in small breakout groups. Results Key topics included in the consultation process were validity of outcome data, timeliness of data capture, internal pilots, data-sharing, practical issues, and decision-making. A majority of respondents (n = 78, 95%) considered the development of guidance for trialists to be feasible. Guidance was developed following the discussion workshop, for the five broad areas of terminology, feasibility, internal pilots, onward data sharing, and data archiving. Conclusions We provide guidance to inform decisions about whether or not to use HSDs for outcomes, and if so, to assist trialists in working with registries and other HSD-providers to improve the design and delivery of trials

A review of the Late Permian – Early Triassic conodont record and its significance for the end-Permian mass extinction

As a marine microfossil with a long-lasting fossil record stretching from the Cambrian to the Triassic, the tiny conodont plays an important role for the study of the end-Permian mass extinction. In the past few decades, numerous studies on Permian-Triassic conodonts have been published. This paper summarizes the progress made on high-resolution conodont biostratigraphy, timing of the mass extinction across the Permian-Triassic Boundary, conodont apparatus and phylogeny, conodont size variation, conodont oxygen isotope as well as other isotopes and chemical elements. Finally, future perspectives are also discussed

Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews

This is a protocol for a Cochrane Review (overview). The objectives are as follows:To summarise the evidence from Cochrane Reviews and other systematic reviews of randomised or quasi‐randomised trials evaluating the effects of pharmacological and non‐pharmacological interventions, administered perioperatively, on reducing blood loss, anaemia, and the need for allogeneic blood transfusion in adults undergoing hip fracture surgery