Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance

Objective: To determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals. Design/setting A national (UK) research priority setting partnership. Participants: People who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures. The scope includes open fractures, fractures to joints broken into multiple pieces, multiple concomitant fractures and fractures involving the pelvis and acetabulum. Methods: A multiphase priority setting exercise was conducted in partnership with the James Lind Alliance over 21 months (October 2019 to June 2021). A national survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 18 questions was taken to a stakeholder workshop, where a consensus was reached on the top 10 priorities. Results: A total of 532 uncertainties, submitted by 158 respondents (including 33 patients/carers) were received during the initial survey. These were refined into 58 unique indicative questions, of which all 58 were judged to be true uncertainties after review of the existing evidence. 136 people (including 56 patients/carers) responded to the interim prioritisation survey and 18 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions. Conclusions: The top 10 research priorities for complex fracture include questions regarding rehabilitation, complications, psychological support and return to life-roles. These shared priorities will now be used to guide funders and teams wishing to research complex fractures over the coming decade

A review of the Late Permian – Early Triassic conodont record and its significance for the end-Permian mass extinction

As a marine microfossil with a long-lasting fossil record stretching from the Cambrian to the Triassic, the tiny conodont plays an important role for the study of the end-Permian mass extinction. In the past few decades, numerous studies on Permian-Triassic conodonts have been published. This paper summarizes the progress made on high-resolution conodont biostratigraphy, timing of the mass extinction across the Permian-Triassic Boundary, conodont apparatus and phylogeny, conodont size variation, conodont oxygen isotope as well as other isotopes and chemical elements. Finally, future perspectives are also discussed

Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews

This is a protocol for a Cochrane Review (overview). The objectives are as follows:To summarise the evidence from Cochrane Reviews and other systematic reviews of randomised or quasi‐randomised trials evaluating the effects of pharmacological and non‐pharmacological interventions, administered perioperatively, on reducing blood loss, anaemia, and the need for allogeneic blood transfusion in adults undergoing hip fracture surgery

Geochemical zonation across a Neoproterozoic orogenic belt: Isotopic evidence from granitoids and metasedimentary rocks of the Jiangnan orogen, China

In order to understand how Late Mesoproterozoic to Early Neoproterozoic orogenic belts evolved during the assembly and rifting of the supercontinent Rodinia, we have carried out detailed studies on the geochemical compositions of Early Neoproterozoic crust across the Jiangnan orogen (JO) which connects the Yangtze and Cathaysia blocks on the northwestern margin of Rodinia. A gradual geochemical variation is recognized from east to west, based on comparisons of whole-rock Nd isotopes, U-Pb age spectra of detrital zircons, and Hf isotopes in magmatic zircons and detrital zircons from the Neoproterozoic granitoids and metasedimentary basement sequences in the JO. LA-ICP-MS U-Pb dating of detrital zircons from the sediments and magmatic zircons from interlayered volcanic rocks suggests that the folded basement sequences formed within the span 860-825Ma, implying the final amalgamation of the Yangtze and Cathaysia blocks occurred no older than ca 825Ma. The 950-820Ma detrital zircons strongly dominate in the eastern basement sequences, and most of them show moderately to highly positive εHf(t). In contrast, many of the Early Neoproterozoic detrital zircons in the western JO have moderately negative εHf(t) and more older (>1.0Ga) detrital zircons were found in this area. We suggest that the metasedimentary basement sequences in the JO were deposited in retro-arc foreland basins which originally evolved from back-arc basins, and the change of provenance controlled the variation in crustal geochemistry of crust across the JO. Sediments in the eastern basement sequences have been sourced mainly from the juvenile subduction-related igneous rocks to the east, with a few from the central Yangtze Block, whereas those in the western JO may have been located far from arc terranes to the east and thus received more older recycled detritus from the southern part of the South China Block. Moreover, the Hf isotopes of the detrital zircons imply episodic crustal growth in the provenance of the JO metasedimentary basement sequences, with age peaks at 1.0-0.8Ga, 1.75-1.50Ga and 2.60-2.45Ga. The early crust in South China may have been formed mainly at around 3.8Ga ago, and contains some Hadean components (ca 4.1Ga).18 page(s

Decision-analysis modelling of effectiveness and cost-effectiveness of pharmacological thromboprophylaxis for surgical inpatients, using variable risk assessment models or other strategies

Background Surgical inpatients are at risk of venous thromboembolism (VTE) which can be life-threatening or result in chronic complications. Thromboprophylaxis reduces VTE risk but incurs costs and may increase bleeding risk. Risk assessment models (RAMs) are currently used to target thromboprophylaxis at high-risk patients. Objective To determine the balance of cost, risk, and benefit for different thromboprophylaxis strategies in adult surgical inpatients, excluding major orthopaedic surgery, critical care and pregnant women. Methods Decision analytic modelling to estimate the following outcomes for alternative thromboprophylaxis strategies: thromboprophylaxis usage; VTE incidence and treatment; major bleeding; chronic thromboembolic complications; and overall survival. Strategies compared were: no thromboprophylaxis; thromboprophylaxis for all; and thromboprophylaxis given according to RAMs (Caprini and Pannucci). Thromboprophylaxis is assumed to be given for the duration of hospitalisation. The model evaluates life-time costs and quality-adjusted life-years (QALYs) within England’s health and social care services. Results Thromboprophylaxis for all surgical inpatients had a 70% probability of being the most cost-effective strategy (at a £20,000 per QALY threshold). RAM-based prophylaxis would be the most cost-effective strategy if a RAM with higher sensitivity (99.9%) were available for surgical inpatients. QALY gains were mainly due to reduced post-thrombotic complications. The optimal strategy was sensitive to several other factors including: risk of VTE, bleeding and post thrombotic syndrome; duration of prophylaxis and patient age. Conclusions Thromboprophylaxis for all eligible surgical inpatients appeared to be the most cost-effective strategy. Default recommendations for pharmacological thromboprophylaxis, with the potential to ‘opt-out’, may be superior to a complex risk-based ‘opt-in’ approach