Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis

Background The management of hip fracture patients has been challenging across the UK in the wake of emergency coronavirus disease 2019 guidelines. Aims This retrospective, observational cohort study analyses the impact of the first lockdown during the early part of the coronavirus disease 2019 pandemic on the management of hip fracture patients at a district general hospital in the UK. Methods Comparative analysis to assess hip fracture patients treated at this Trust between 1 April to 31 May 2019 and 1 April to 31 May 2020 was undertaken. The primary outcome measures appraised were 30 and 60-day mortality and the secondary outcome measure included time to surgery. Results There was a higher 30 and 60-day mortality rate in the first lockdown period at 8.1% and 13.5%, respectively, compared to 1.96% and 5.88% in 2019. A significantly lower proportion of hip fracture patients at 59.46% were operated within the 36h target time frame during the first lockdown. Conclusion In our Trust, hip fractures were treated as obligatory injuries. However, the mortality was higher in the 2020 cohort with a significant reduction in patients achieving the recommended ‘36 hours’ time to surgery target and accruement of Best Practice Tariff. Enhanced infection control strategies have prepared us for the future.

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Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2021-048772 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048772

Author(s):

Toby O Smith ◽

Pippa Belderson ◽

Jack R Dainty ◽

Linda Birt ◽

Karen Durrant ◽

...

Keyword(s):

Mixed Methods ◽

Qualitative Study ◽

Online Survey ◽

Musculoskeletal Diseases ◽

Community Dwelling ◽

Secondary Outcome ◽

Healthcare Provision ◽

Social Restriction ◽

The Uk ◽

The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank

BMJ Open ◽

10.1136/bmjopen-2020-046931 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046931

Author(s):

Junren Wang ◽

Jianwei Zhu ◽

Huazhen Yang ◽

Yao Hu ◽

Yajing Sun ◽

...

Keyword(s):

Primary Diagnosis ◽

Secondary Outcome ◽

Hospital Inpatient ◽

Reference Period ◽

Stress Reactions ◽

Uk Biobank ◽

The Uk ◽

The Impact ◽

Distinct Increase ◽

Related Mortality

ObjectiveTo assess the impact of the COVID-19 outbreak on cardiovascular disease (CVD) related mortality and hospitalisation.DesignCommunity-based prospective cohort study.SettingThe UK Biobank.Participants421 372 UK Biobank participants who were registered in England and alive as of 1 January 2020.Primary and secondary outcome measuresThe primary outcome of interest was CVD-related death, which was defined as death with CVD as a cause in the death register. We retrieved information on hospitalisations with CVD as the primary diagnosis from the UK Biobank hospital inpatient data. The study period was 1 January 2020 to June 30 2020, and we used the same calendar period of the three preceding years as the reference period. In order to control for seasonal variations and ageing of the study population, standardised mortality/incidence ratios (SMRs/SIRs) with 95% CIs were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period.ResultsWe observed a distinct increase in CVD-related deaths in March and April 2020, compared with the corresponding months of the three preceding years. The observed number of CVD-related deaths (n=218) was almost double in April, compared with the expected number (n=120) (SMR=1.82, 95% CI 1.58 to 2.07). In addition, we observed a significant decline in CVD-related hospitalisations from March onwards, with the lowest SIR observed in April (0.45, 95% CI 0.41 to 0.49).ConclusionsThere was a distinct increase in the number of CVD-related deaths in the UK Biobank population at the beginning of the COVID-19 outbreak. The shortage of medical resources for hospital care and stress reactions to the pandemic might have partially contributed to the excess CVD-related mortality, underscoring the need of sufficient healthcare resources and improved instructions to the public about seeking healthcare in a timely way.

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Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03705-x ◽

2021 ◽

Author(s):

Valeri Borger ◽

Motaz Hamed ◽

Inja Ilic ◽

Anna-Laura Potthoff ◽

Attila Racz ◽

...

Keyword(s):

Tumor Resection ◽

Temporal Lobectomy ◽

Secondary Outcome ◽

Seizure Outcome ◽

Seizure Freedom ◽

Secondary Outcome Measure ◽

Total Resection ◽

Class 1 ◽

Postoperative Seizure ◽

The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

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Modelling the impact of the tier system on SARS-CoV-2 transmission in the UK between the first and second national lockdowns

BMJ Open ◽

10.1136/bmjopen-2021-050346 ◽

2021 ◽

Vol 11 (4) ◽

pp. e050346

Author(s):

Daniel J Laydon ◽

Swapnil Mishra ◽

Wes R Hinsley ◽

Pantelis Samartsidis ◽

Seth Flaxman ◽

...

Keyword(s):

Real Time ◽

Reproduction Number ◽

Secondary Outcome ◽

Bayesian Hierarchical ◽

Time Reproduction ◽

Tier System ◽

The Uk ◽

National Trends ◽

Tier 3 ◽

The Impact

ObjectiveTo measure the effects of the tier system on the COVID-19 pandemic in the UK between the first and second national lockdowns, before the emergence of the B.1.1.7 variant of concern.DesignThis is a modelling study combining estimates of real-time reproduction number Rt (derived from UK case, death and serological survey data) with publicly available data on regional non-pharmaceutical interventions. We fit a Bayesian hierarchical model with latent factors using these quantities to account for broader national trends in addition to subnational effects from tiers.SettingThe UK at lower tier local authority (LTLA) level. 310 LTLAs were included in the analysis.Primary and secondary outcome measuresReduction in real-time reproduction number Rt.ResultsNationally, transmission increased between July and late September, regional differences notwithstanding. Immediately prior to the introduction of the tier system, Rt averaged 1.3 (0.9–1.6) across LTLAs, but declined to an average of 1.1 (0.86–1.42) 2 weeks later. Decline in transmission was not solely attributable to tiers. Tier 1 had negligible effects. Tiers 2 and 3, respectively, reduced transmission by 6% (5%–7%) and 23% (21%–25%). 288 LTLAs (93%) would have begun to suppress their epidemics if every LTLA had gone into tier 3 by the second national lockdown, whereas only 90 (29%) did so in reality.ConclusionsThe relatively small effect sizes found in this analysis demonstrate that interventions at least as stringent as tier 3 are required to suppress transmission, especially considering more transmissible variants, at least until effective vaccination is widespread or much greater population immunity has amassed.

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Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

Geriatrics ◽

10.3390/geriatrics3030055 ◽

2018 ◽

Vol 3 (3) ◽

pp. 55 ◽

Cited By ~ 2

Author(s):

Mark Middleton

Keyword(s):

Hip Fracture ◽

Financial Incentives ◽

Models Of Care ◽

Social Needs ◽

Medical Rehabilitation ◽

Integrated Models ◽

National Guidelines ◽

Fracture Care ◽

The Uk ◽

The Impact

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics.

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The impact of oral anticoagulation on time to surgery in patients hospitalized with hip fracture

Thrombosis Research ◽

10.1016/j.thromres.2015.09.017 ◽

2015 ◽

Vol 136 (5) ◽

pp. 962-965 ◽

Cited By ~ 42

Author(s):

Thomas Tran ◽

Aurélien Delluc ◽

Carine de Wit ◽

William Petrcich ◽

Grégoire Le Gal ◽

...

Keyword(s):

Hip Fracture ◽

Oral Anticoagulation ◽

Time To Surgery ◽

The Impact

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Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517722104 ◽

2017 ◽

Vol 8 (3) ◽

pp. 161-165 ◽

Cited By ~ 6

Author(s):

Alastair G. Dick ◽

Dominic Davenport ◽

Mohit Bansal ◽

Therese S. Burch ◽

Max R. Edwards

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

District General Hospital ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Retrospective Case ◽

Time To Surgery ◽

Surgery Mortality ◽

Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

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Infection control: current status. risks, research, rules and recycling

Orthodontic Update ◽

10.12968/ortu.2021.14.2.59 ◽

2021 ◽

Vol 14 (2) ◽

pp. 59-66

Author(s):

Jennifer Haworth ◽

Jonathan Sandy ◽

Anthony J Ireland

Keyword(s):

Infection Control ◽

Best Practice ◽

Mainland China ◽

Current Status ◽

Infectious Agents ◽

Emerging Infections ◽

Healthcare Waste ◽

Control Procedures ◽

The Uk ◽

The Impact

We are living through a period of immense change following the outbreak of the COVID-19 pandemic in mainland China in December 2019. Even before the pandemic, the cost of managing healthcare-associated infections in the UK was considerable. The risk of acquiring any infection from the dental environment must be reduced to a minimum. As we have observed in recent years, new infectious agents emerge frequently, and the dental profession must be ready to respond appropriately and quickly. Orthodontic practice presents unique challenges in relation to infection control procedures. The impact of healthcare waste on the environment must also be considered. CPD/Clinical Relevance: This paper describes the range of infectious agents posing a risk to dental team members and patients. The aim is to place the recent coronavirus pandemic in the context of other recent emerging infections. Some of the latest research regarding infection control procedures is reviewed. Current best practice is described.

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Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care

BMJ Open ◽

10.1136/bmjopen-2016-015574 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015574 ◽

Cited By ~ 12

Author(s):

Kristin Haugan ◽

Lars G Johnsen ◽

Trude Basso ◽

Olav A Foss

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Fast Track ◽

Conventional Care ◽

University Hospital ◽

Secondary Outcome ◽

Charlson Comorbidity Index Score ◽

Care Group ◽

Time To Surgery ◽

Significant Difference

ObjectiveTo compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.DesignRetrospective single-centre study.SettingUniversity hospital in middle Norway.Participants1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).Interventions788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013.Primary and secondary outcomePrimary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay.ResultsWe found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways.ConclusionsThere was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased.Trial registration numberNCT00667914; results

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Strong governance: a result of evolutionary and revolutionary processes

Journal of Family Business Management ◽

10.1108/jfbm-08-2014-0020 ◽

2014 ◽

Vol 4 (2) ◽

pp. 99-109 ◽

Cited By ~ 1

Author(s):

Lorna Collins ◽

Ken McCracken ◽

Barbara Murray ◽

Martin Stepek

Keyword(s):

Family Business ◽

Best Practice ◽

Family Dynamics ◽

Family Businesses ◽

Formal Structure ◽

Governance Mechanisms ◽

Content Type ◽

The Family ◽

The Uk ◽

The Impact

Purpose – This paper is the first in a regular series of articles in JFBM that will share “a conversation with” thought leaders who are active in the family business space. The world of family business is, like many other arenas, constantly evolving and as the authors learn more about how and why families “do business” the approaches and tools for working with them also evolve. The purpose of this paper is to stimulate further new research in areas that practically affect family businesses and to “open the door” to practical insights that will excite researchers and provide impetus for new and exciting study. The specific purpose of this paper is to explore “what is strong governance.” There has been much interest in governance lately yet there is a tendency to treat governance in a formulaic way such that, at the moment, the notion that every family business must have a family council or a formal structure in order to be considered “effective” and “successful” predominates. The authors’ panel challenges and discusses this notion drawing on the experience and knowledge as family business advisors, consultants and owners. Design/methodology/approach – The impetus for this particular conversation is a result of a brainstorming conversation that Lorna Collins and Barbara Murray held in February 2014 where they focussed on “how JFBM can encourage and stimulate researchers to engage in aspects of research that makes a difference to the family business in a practical way.” This paper reports a conversation between Barbara Murray (Barbara), Ken McCracken (Ken) and Martin Stepek (Martin), three leading lights in the UK family business advising space, all of whom have been involved in running or advising family businesses for more than three decades, held in August 2015. The conversation was held via telephone and lasted just over 60 minutes. Lorna Collins acted as moderator. Findings – Strong governance is not just about instituting a “family council” or embedding formal governance mechanisms in a family business. Evolutionary adaption by family members usually prevails such that any mechanism is changed and adapted over time to suit and fit the needs of the family business. Many successful family businesses do not have recognized “formal” governance mechanisms but, it is contended, they are still highly successful and effective. Future areas of research in governance are also suggested. Originality/value – This paper contributes to the family business discourse because the debate it reports challenges the basic assumptions upon which much consulting and advisory practice is conducted. It also challenges the notion of “best practice” and what is “new best practice” and how is it that any “best practice” is determined to be “best.” Furthermore, the panel provides insights in to the “impact of family dynamics on governance” and “the impact of family dynamics on advisors.” The paper content is original in that it provides an authentic and timely narrative between active family business practitioners who are also scholars and owners.

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