The influence of the patient's health-state compared with time to surgery on the outcomes following hip fracture surgery: a longitudinal study of 4,791 patients.

INTRODUCTION: This study investigated whether the health-state of hip fracture patients or the time to surgery had a greater effect on outcomes. METHODS: Of the 5,120 patients admitted with a fragility hip fracture, 4,791 (93.6%) were included in the analysis. Patients operated after 36 hours were initially group by length of delay (36-48 hours and >48 hours) and then regrouped by delay cause (medical and administrative). Patients operated within 36 hours were the comparative group. Data were collected at admission, discharge, 120 days and 365 days post discharge. RESULTS: Multivariate logistic regression analysis revealed that the patients who were delayed over 36 hours, owing to medical causes, had a higher mortality at all studied time points, but the patients who were delayed owing to administrative causes had no increase in mortality. Analysis by time to surgery revealed that patients operated after 36 and 48 hours had a higher mortality at discharge only. Medically delayed patients were less likely to return to their premorbid level of residence at discharge. Older, male patients had a higher risk of inferior outcomes. Postoperative length of stay was significantly greater in the >48-hour delay group and the medical delay group. All delay groups had a significantly higher rate of reoperation within 30 days compared with the no-delay group. CONCLUSIONS: The health-state of the hip fracture patient had a greater impact on the outcome in contrast to time to surgery. This study concurs that hip fracture patients should receive surgery within the timeframe of current guidelines, but medically unwell patients have relatively worse outcomes and should receive enhanced clinical attention.

Life on a knife edge: using simulation to engage young people in issues surrounding knife crime.

BACKGROUND: Knife-related behaviour among young people is an increasing social concern with a total of 35 teenagers killed by knife attacks in England in 2017. Distributed simulation has been shown to be a valid method of portable simulation for medical professionals; however, its role in delivering a socially educational message to members of the public has not been previously studied. This paper explores how the novel use of simulation could be used to address a serious social issue amongst young people at risk of criminal knife behaviour. METHODS: A qualitative approach was used to study a two-part workshop attended by two groups of young people vulnerable to knife crime. Based on the concepts of sequential simulation and distributed simulation previously developed at the Imperial College Centre for Engagement and Simulation Science, the first part of the workshop showed the patient journey of a young man stabbed in the abdomen, attended by policemen and paramedics, followed by the participants witnessing a simulated emergency abdominal operation on a silicone model and concluded with a dialogue between the surgeon, the victim (who required an intestinal stoma as a result of the knife injury) and his mother. The second part of the workshop involved further discussion with the participants regarding the role of knives from the personal and community perspective. Visual data was recorded during the workshops and qualitative data obtained from group and individual interviews were thematically analysed. RESULTS: A total of sixty teenagers aged 13-19 took part in the two workshops. The participant feedback suggested that the workshops provided a safe environment where young people could learn about and explore the consequences surrounding knife crime. Furthermore, participant recollection of key points was assessed between 4 and 6 weeks after the second workshop and the data suggested that the workshop could promote learning and a change in the participants' knife-related behaviour in the future. CONCLUSIONS: The findings support further exploration of simulation as a modality for engaging young people about the issues surrounding criminal knife behaviour in a safe and cooperative environment. Moreover, the findings suggest that the workshop could be used as an educational tool that may facilitate behavioural change.