Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p\u3c0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (−1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (−2 to 4; p=0·71). Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Funding: Canadian Institutes of Health Research

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial : a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewedPublisher PD

Paul A. Cibis, MD: A St. Louis pioneer of modern vitreoretinal surgery

Poster for the 38th Historia Medica lecture.https://digitalcommons.wustl.edu/historyofmedicine_historia_medica_posters/1019/thumbnail.jp

Simon Pollak and ophthalmology in St. Louis during the Civil War

Poster for the 24th Historia Medica lecture.https://digitalcommons.wustl.edu/historyofmedicine_historia_medica_posters/1006/thumbnail.jp

Classroom Technologies-How Tablet PCs and Presentation Remotes Can Change Our Teaching

Be prepared to learn, share, and discuss some of the exciting uses and potential limitations of incorporating the new Tablet PC Convertibles into your courses and the classroom. There are a number of methods of using the tablets in drawing and editing modes to highlight important points, add graphic elements in a presentation, or do examples of “pen and ink” mark-up edits of papers. There are some issues with loss of mobility that we will look at, as well as ways in which that might be overcome in the future. Also, come see a quick demonstration of remote presentations tools as one of those ways in which we might be able to free ourselves from the instructor’s station in the front of the room. Please come prepared to give us some feedback at the session on how you see these technologies being good – or bad – for your classroom

Breaking Free From the Chains: Using Tablet PCs and Wireless Projection Systems to Foster Better Student Engagement

This session will look at the use of the TabletPC as replacement for the electronic whiteboard, with the advantage that it is portable, and can be used to create a more student interaction with its onscreen drawing technology. Recent improvements in wireless technology and presentation software also allow a broader range of activity than prior classroom applications such as Classroom Presenter (from the University of Washington). At the end, I will discuss what the future may hold towards overcoming some of the current limitations to this promising technology