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- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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| 3. |
- Onabolu, B., et al.
(författare)
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Integrating policy, system strengthening, research and harmonized services delivery for scaling up drinking water safety in Bangladesh
- 2018
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Ingår i: Environmental Arsenic in a ChangingWorld - 7th International Congress and Exhibition Arsenic in the Environment, 2018. - London : CRC Press/Balkema. - 9781138486096 ; , s. 535-537
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Konferensbidrag (refereegranskat)abstract
- The WASH Sector Development Plan (2011–2025) recognizes the absence of harmonized approaches as the root challenge to scaling up drinking water safety in Bangladesh. UNICEF is supporting the Government of Bangladesh (GoB) through the Department of Public Health Engineering (DPHE) and Policy Support Branch to re-engineer its approach to drinking water safety by integrating policy, systems strengthening & sustainable services delivery at national and sub-national levels. Some of the key contributions to the sector include the implementation of the UNICEF-DPHE Arsenic Safe Union model with the declaration of 106 Arsenic Safe Villages, reduction in arsenic contamination rates of new tubewells, a system for preventing elite capture of water points, and the adoption of the ASU model in a $240 million arsenic mitigation drinking water project using domestic resources. Relatedly, a Policy Support Branch has been established, the sector coordination mechanisms revised, WASH bottleneck analysis is ongoing & the National Implementation Plan on Arsenic has been reviewed: Next steps include the professionalisation of drilling by local drillers through a partnership with KTH, Sweden, the GoB and UNICEF.
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