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:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; 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 to standard care.

Background The 2019 novel coronavirus disease (COVID-19) pandemic has impacted the globe dramatically. It has affected daily life noticeably and the teaching process is one of the significantly affected aspects as the learning approach has been shifted to distance learning (DL). These new changes may affect student performance and emotional well-being. This study aimed to assess the psychological impact of the COVID-19 pandemic and distance learning on healthcare students. Method An online self-administered cross-sectional survey was distributed to healthcare students for the period between April 2020 to June 2020. The study included students from different universities in Saudi Arabia. Knowledge and perception of COVID-19 and the experience of distance learning during the pandemic period were assessed using a 5-point Likert scale. Psychological effect was evaluated using Four-Item Patient Health Questionnaire for Anxiety and Depression (PHQ-4). Results A total of 721 students completed the survey with the majority being females. Around 25% of students had experienced anxiety, while 35% had depression. Severe anxiety and depression were noted in over 6% of the participants. Younger age and female gender were more affected psychologically. Students with higher scores in PHQ-4 were strongly disagreeing that hand gloves and surgical masks may help in preventing COVID-19 transmission. Students with normal psychological assessment were more likely to favor DL, while students with moderate to severe anxiety and depression disagreed. Conclusion Healthcare students have alarmingly high levels of anxiety and depression during the COVID-19 pandemic. General knowledge of the pandemic is not associated with the psychological impact. DL is a convenient approach for students with normal PHQ-4 scores. Programs to help students overcome the psychological impact of COVID-19 are highly recommended.

Background To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. Methods The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of “possible sepsis alert” to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. Discussion The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. Trial registration ClinicalTrials.gov NCT04078594. Registered on September 6, 2019