Increasing risk of revision due to deep infection after hip arthroplasty: A study on 97,344 primary total hip replacements in the Norwegian Arthroplasty Register from 1987 to 2007

Background and purpose Over the decades, improvements in surgery and perioperative routines have reduced the incidence of deep infections after total hip arthroplasty (THA). There is, however, some evidence to suggest that the incidence of infection is increasing again. We assessed the risk of revision due to deep infection for primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 1987–2007

Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids

The aim of the study was to assess the total energy expenditure (TEE), resting energy expenditure (REE) and physical activity level (PAL) in home-living cachectic patients with advanced pancreatic cancer. The influence of an energy and protein dense oral supplement either enriched with or without the n-3 fatty acid eicosapentaenoic acid (EPA) and administered over an 8-week period was also determined. In total, 24 patients were studied at baseline. The total energy expenditure was measured using doubly labelled water and REE determined by indirect calorimetry. Patients were studied at baseline and then randomised to either oral nutritional supplement. Measurements were repeated at 8 weeks. At baseline, REE was increased compared with predicted values for healthy individuals (1387(42) vs 1268(32) kcal day-1, P=0.001), but TEE (1732(82) vs 1903(48) kcal day-1, P=0.023) and PAL (1.24(0.04) vs 1.50) were reduced. After 8 weeks, the REE, TEE and PAL of patients who received the control supplement did not change significantly. In contrast, although REE did not change, TEE and PAL increased significantly in those who received the n-3 (EPA) enriched supplement. In summary, patients with advanced pancreatic cancer were hypermetabolic. However, TEE was reduced and this was secondary to a reduction in physical activity. The control energy and protein dense oral supplement did not influence the physical activity component of TEE. In contrast, administration of the supplement enriched with EPA was associated with an increase in physical activity, which may reflect improved quality of life

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Active distributed temperature sensing to assess surface water–groundwater interaction and river loss in braided river systems

Braided river systems are continuously changing environments, comprising heterogeneous gravel-forming meandering channels and bars, and dynamic surface water–groundwater (SW–GW) interactions. In alluvial aquifers associated with braided rivers, river leakage is volumetrically the most important source of groundwater recharge, yet neither the leakage process or recharge rates are well understood. Insights into how braided river systems recharge underlying braidplain aquifers during different hydrological conditions, and how this can be measured, is of critical concern for river management practices. Innovative field techniques using heat as a tracer can be applied to spatially map and quantify the temporal changes of SW–GW interaction and the processes and mechanisms of groundwater recharge for different flow regimes. Horizontal directional drilling was used to construct two 100 m long drillholes at a depth of ∼ 5 m beneath and perpendicular to the river channel at a field site on the Waikirikiri Selwyn River, South Island, New Zealand. The two drillholes were completed with a hybrid fibre optic cable, containing four multi-mode fibres and 2x18AWG copper conductors. A Silixa XT-DTS™ distributed temperature sensor unit combined with a Silixa Heat Pulse System, was used to collect active distributed temperature sensing (A-DTS) measurements along both cables. Results from two A-DTS surveys showed distinct temperature changes across the active river channel indicating spatial variability in river loss and preferential groundwater recharge pathways to the shallow braidplain aquifer. The average groundwater velocity was 14 m d¯¹. The average calculated river loss at the survey sites was 21 m³ d¯¹ m¯¹ compared to 25 – 26 m³ d¯¹ m¯¹ that was measured using differential flow gauging conducted during the same time period. The horizontal installation of the fibre optic cable and the A-DTS method provided valuable insights into SW–GW exchange between the Waikirikiri Selwyn River and shallow braidplain aquifer and how the river leakage rates varied spatially across the river channel