Bibliometric analysis of the top 50 most cited publications of the Journal of Clinical Orthopaedics and Trauma

BackgroundThe Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus.MethodsWe looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords.ResultsTotal citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT.ConclusionsThere is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.     

Bibliometric analysis of orthopaedic related publications by Indian authors from the last decade

PurposeBibliometric studies have been established methods of analysing publications on a particular topic. These studies have been done on various orthopaedic topics and are increasing. The advantages of these studies have been highlighted in previous publications. Although some studies have been done on Indian publications from other specialties, those analysing Indian Orthopaedic Publications are lacking.MethodsWe performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopaedics) AND AFFIL(India)) AND PUBYEAR > 2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021. We analyzed the most publishing universities, city, state, specialty, authors, and anatomic location of these publications. We also mined the data to draw word clouds based on data obtained from the titles of articles, keywords and the affiliations of each of the articles published.ResultsTamil Nadu and New Delhi and their institutes appear to be the epicenter of publication activities in Orthopaedics in India. There has been a healthy trend of growth of articles in the orthopaedic specialty. Since there is a significant overlap of technology and engineering, it is not surprising to see engineering and technology institutes among the top 10 published institutes and even journals for the publications on orthopaedics.ConclusionThere has been a steady increase in the number of publications in the last decade. New Delhi and its Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.     

Last five years audit of Journal of Clinical Orthopaedics and Trauma (JCOT) - A scientometric analysis

BackgroundWe have studied the growth of Journal of Clinical Orthopaedics and Trauma (JCOT), the official journal of the Delhi Orthopaedic Association indexed in PubMed, Scopus and Embase, along with an analysis of citation trends and levels of evidence of published articles in the last five years.MethodsSCOPUS and PubMed databases (2015–19) were used to extract publication-related data for the last five years. The official website of the journal was also used to retrieve issue-specific data. An audit of recent publications in the JCOT was conducted focusing on number of issues and publications(year wise), types of articles published, review speed, level of evidence of publications, types of publication(speciality wise), number of publications in PubMed and SCOPUS, number of citations(year wise), national and international authorship and the Cite Scores.ResultsThe submissions were increased by 2.8 times and the citations rocketed to 16.6 times in 2019, compared to 2015. A total of 890 papers were there and the journal was cited 1702 times in the last five years. More articles with higher levels of evidence papers are now being published.ConclusionThere has been a significant increase in the numbers of submissions, publications, citations, Cite Score, h-index and contribution by the International authors. Its Editorial efficiency has also been outstanding with timely reviews and editorial decisions. The JCOT has become increasingly internationally relevant in the last five years, in the orthopaedic community. However, JCOT needs to publish more papers with a higher level of evidence like Systematic reviews, Meta-analyses, Randomized Controlled Trials and should only publish top-class lower hierarchy papers (like Case reports, Case-controlled and Retrospective studies).     

Time to publication for orthopaedic surgery peer-reviewed journals: A cross-sectional bibliometric analysis

BackgroundThe dissemination of research and evidence-based medicine is critical to advancing science and improving clinical practice. The purpose of this study was to evaluate the timing and associated factors of the publication process for the most influential orthopaedic surgery research journals.MethodsAfter analyzing 25 orthopaedic surgery journals with the highest impact factors, 14 journals provided the necessary information for data analysis. A minimum of three consecutive issues per journal from 2021 were collected for review. Within each issue, all articles were included except for reviews, commentaries, replies, letters to the editor, and invited articles. The publication times for received to accepted (RA), received to published in press (RP1), and received to published in print (RP2) were retrieved and compared. Journal impact factor, specialty, and article level of evidence were recorded.ResultsA total of 1040 articles were included with a mean number of 74.3 ± 38 (range, 35–182) articles analyzed per journal. The mean impact factor for the 14 journals was 3.6 ± 1 (range, 2.5–5.8). The overall median duration of time for RA, RP1, and RP2 were 119 (IQR, 78–165) days, 157 (IQR, 102–216) days, and 291 (IQR, 243–378) days across all 14 journals, respectively. Journal of Arthroplasty demonstrated the shortest median duration of time for RA and RP1, while International Orthopaedics demonstrated the shortest median duration of time for RP2. Clinical Journal of Sport Medicine demonstrated the longest median duration of time for RA and RP2, while the American Journal of Sports Medicine demonstrated the longest median duration of time for RP1. Level three studies, which included retrospective case-control and cohort study designs, demonstrated the shortest publication times, while sports medicine journals demonstrated the longest publication times for all periods.ConclusionThere was substantial variation in publication times across orthopaedic surgery journals which may impact accessibility to clinical insights.     

Is performing joint arthroplasty surgery during the COVID-19 pandemic safe?: A retrospective,cohort analysis from a tertiary centre in NCR,Delhi, India

PurposeResuming joint replacement arthroplasty amidst the COVID-19 pandemic and lockdown has come with various challenges that had to be dealt with utmost caution. Patients with severe arthritis experiencing a state of intolerable pain, could not be left unaddressed. Guidelines published by surgical associations, collaborative surgical author groups including public health organisations had to be modified to suit the Indian scenario and obtain optimal functional outcomes in these patients.MethodsA retrospective cohort analysis of 147 patients who underwent arthroplasty during the pandemic (March 2020 to April 2021), for either primary or secondary arthritis, was performed. We assess the efficacy and safety of the newly established Institutional surgical peri-operative protocol at our tertiary care centre in the National Capital Region, India in response to COVID-19 guidelines. The primary outcome measures appraised was 30-day mortality and the secondary outcome measures included length of stay, peri-operative complications and COVID-19 infection.ResultThe most common indication for arthroplasty during the pandemic was neglected trauma. One patient died, due to myocardial infarction during the follow-up period. About 67% of patients were discharged to their usual residence within 7 days of admission. Two patients tested positive for COVID-19 postoperatively, but none required Intensive Care Unit admission.ConclusionJoint replacement arthroplasty can be undertaken safely with diligent patient selection, application of a stringent COVID appropriate behaviour and a ‘ring-fenced’ peri-operative pathway.     

IMPACT of COVID-19 on hip fracture services: A global survey by the International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics

IntroductionThe Coronavirus Disease 2019 (COVID-19) pandemic resulted in major disruption to hip fracture services. This frail patient group requires specialist care, and disruption to services is likely to result in increases in morbidity, mortality and long-term healthcare costs.AimsTo assess disruption to hip fracture services during the COVID-19 pandemic.MethodsA questionnaire was designed for completion by a senior clinician or service manager in each participating unit between April–September 2020. The survey was incorporated into existing national-level audits in Germany (n = 71), Scotland (n = 16), and Ireland (n = 16). Responses from a further 82 units in 11 nations were obtained via an online survey.ResultsThere were 185 units from 14 countries that returned the survey. 102/160 (63.7%) units reported a worsening of overall service quality, which was attributed predominantly to staff redistribution, reallocation of inpatient areas, and reduced access to surgical facilities. There was a high rate of redeployment of staff to other services: two thirds lost specialist orthopaedic nurses, a third lost orthogeriatrics services, and a quarter lost physiotherapists. Reallocation of inpatient areas resulted in patients being managed by non-specialised teams in generic wards, which increased transit of patients and staff between clinical areas. There was reduced operating department access, with 74/160 (46.2%) centres reporting a >50% reduction. Reduced theatre efficiency was reported by 135/160 (84.4%) and was attributed to staff and resource redistribution, longer anaesthetic and transfer times, and delays for preoperative COVID-19 testing and using personal protective equipment (PPE).ConclusionHip fracture services were disrupted during the COVID-19 pandemic and this may have a sustained impact on health and social care. Protection of hip fracture services is essential to ensure satisfactory outcomes for this vulnerable patient group.     

2005至2009年《中华骨科杂志》载文被引分析

目的 从文献引证的角度透视<中华骨科杂志>的学术水平和期刊质量.方法 利用<中国生物医学期刊引文数据库>(chinese medical citation index,CMCI),采用文献计量方法对<中华骨科杂志>载文被CMCI来源期刊引用的情况进行统计分析,主要文献计量学统计指标包括各年度发文被引率、篇均论文被引次数、单篇论文被引情况、作者被引情况、被引作者的地区和高产机构分布、主要引用期刊和自引率及被引论文年代分布等.结果 2005至2009年<中华骨科杂志>发表论文1182篇,被引用了663篇(3728次),平均发文被引比例为56.09%,单篇论文平均被引5.62次,单篇论文最高被引为104次.单篇被引5次以上论文210篇,共被引2835次,占总被引篇数的31.68%,占被引总频次的76.04%.663篇被引论文中,共有国内外作者485人,作者最高被引篇数为12篇,被引1篇的作者386人,占作者总数的79.58%.被引作者群的地域分布30个省(自治区)、直辖市和香港、台湾地区及美国、加拿大、法国.北京、上海和天津在骨科学研究领域居于国内前列,其中北京居第一位,占32.16%.有445种期刊引用<中华骨科杂志>.<中华骨科杂志>自引217条,自引率为0.058.结论 <中华骨科杂志>所载文献质量高,在我国医学研究领域已具有较强的影响力,是骨科先进科研成果交流的平台.     

Impact of COVID-19 on Orthopaedic Care and Practice: A Rapid Review

IntroductionThe COVID-19 pandemic has led to a large body of literature regarding the impact of COVID-19 on orthopaedic care and practice. This rapid review aims to synthesize this published literature to give the orthopaedic fraternity an overview about the best practices that need to be followed during this period.MethodologyA rapid review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for rapid reviews on the impact of COVID-19 on orthopaedic care and practice. A Pubmed search was done to identify all literature related to the impact of COVID-19 on orthopaedic care and practice, published between December 2019 and October 2020 using a predefined search strategy. The final review included 375 peer-reviewed articles addressing the objectives.ResultsThe majority of articles were expert opinions ( 37.1%) and narrative reviews (13.1%). There were 17.3% retrospective studies and 2.1% prospective studies with only one randomized control trial and ten systematic reviews.  83.8% of articles had levels of evidence IV and V, 79.5% of the articles were published in core-orthopaedic journals. Maximum publications were from the United States of America (31.7%), followed by India (11.5%). European countries together contributed to  32.0% of all publications.ConclusionCOVID-19 has had a significant impact on all aspects of orthopaedic care and practice. The pandemic has affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialities of orthopaedics. Orthopaedic practice will require the incorporation of new technologies, restructuring of health systems and reorganizing of training programs for optimal patient care. There would also be a need for frequent review of emerging literature to provide evidence-based guidelines to the orthopaedic fraternity which will not only help in mitigation of transmission of disease but also ensure continuity of optimum patient care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00354-0.     

Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: A multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study

IntroductionThe COVID-19 lockdown resulted in decreased vehicle use and an increased uptake in cycling. This study investigated the trends in cycling-related injuries requiring orthopaedic intervention during the COVID-19 lockdown period compared with similar time periods in 2018 and 2019.MethodsData were collected prospectively for patients in 2020 and collected retrospectively for 2019 and 2018, from hospitals within four NHS Scotland Health Boards encompassing three major trauma centres. All patients who sustained an injury as a result of cycling requiring orthopaedic intervention were included. Patient age, sex, mechanism of injury, diagnosis and treatment outcome from electronic patient records.ResultsNumber of injuries requiring surgery 2020: 77 (mean age/years – 42.7); 2019: 47 (mean age/years - 42.7); 2018: 32 (mean age/years – 31.3). Overall incidence of cycling injuries 2020: 6.7%; 2019: 3.0%; 2018: 2.1%. Commonest mechanism of injury: fall from bike 2020 n = 54 (70.1%); 2019 n = 41 (65.1%); 2018 n = 25 (67.6%). Commonest injury type: fracture 2020 n = 68 (79.1%); 2019 n = 33 (70.2%); 2018 n = 20 (62.5%). Commonest areas affected: Upper extremity: 2020 n = 45 (58.5%); 2019 n = 25 (53.2%); 2018 n = 25 (78.1%). Lower extremity: 2020 n = 23 (29.9%); 2019 n = 14 (29.7%); 2018 n = 7 (21.8%).ConclusionA significant increase in the number of cycling related injuries requiring orthopaedic intervention, a greater proportion of female cyclists and an older mean age of patients affected was observed during the COVID-19 lockdown period compared with previous years. The most common types of injury were fractures followed by lacerations and fracture-dislocations. The upper extremity was the commonest area affected.     

Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

BackgroundLimited data exist on the incidence and outcome of early coronavirus disease 2019 (COVID-19) in kidney transplantation recipients (KTR).MethodsA retrospective multicenter research study was conducted across 12 centers in India. We explored the symptomatology, demographic, laboratory findings, and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19.ResultsThe incidence of early COVID-19 was 2.6% (n = 22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 until May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43 (31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%), and severe (13.6%). Among clinical symptoms, dyspnea and anosmia were frequent, and in laboratory parameters, neutrophil lymphocyte ratio, high-sensitivity C-reactive protein, and D-dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; P = 1). COVID-19 severity (23.9% vs 15.7%; P = .0001) and mortality (15.5% vs 8.5%; P = .001) among waitlisted patients (n = 1703) were higher compared with overall KTR.ConclusionsWe report higher burden of COVID-19 in waitlisted patients compared with KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.     

2000至2004年《中华骨科杂志》载文被引分析

目的从文献引证的角度了解《中华骨科杂志》的学术水平和期刊质量。方法以《中华骨科杂志》2000至2004年共60期刊载的论文和被引用的论文为研究对象。依据中国生物医学期刊引文数据库(ChineseMedicalCitationIndex,CMCI),采用文献计量学方法对载文被CMCI来源期刊引用的情况进行统计分析及评价。主要文献计量学统计指标为各年度发文被引比例、单篇论文平均被引次数、单篇论文被引情况、作者发文被引情况、被引论文的地区分布、高被引作者机构、被引论文年代分布、主要引用期刊和自引率。结果《中华骨科杂志》2000至2004年发表论文1184篇,被CMCI来源期刊引用了749篇(4213次),被引率分别为76.43%、75.20%、71.49%、57.46%和30.19%,平均被引率为63.26%,单篇论文被引次数分别为7.86、6.54、5.48、2.98和1.78次,平均被引次数为5.62次,单篇被引最高次数为68次。被引作者群的地域分布30个省(自治区)、直辖市和特区。北京、上海和天津在骨科学研究领域居于国内前列。CMCI来源期刊中有461种期刊引用《中华骨科杂志》。《中华骨科杂志》自引191条,自引率为0.045。结论《中华骨科杂志》所载文献质量较高,是我国骨科学研究领域最重要的信息源之一,也是我国医学领域的主要核心期刊。     

2005至2009年《中华骨科杂志》载文被引分析

目的 从文献引证的角度透视<中华骨科杂志>的学术水平和期刊质量.方法 利用<中国生物医学期刊引文数据库>(chinese medical citation index,CMCI),采用文献计量方法对<中华骨科杂志>载文被CMCI来源期刊引用的情况进行统计分析,主要文献计量学统计指标包括各年度发文被引率、篇均论文被引次数、单篇论文被引情况、作者被引情况、被引作者的地区和高产机构分布、主要引用期刊和自引率及被引论文年代分布等.结果 2005至2009年<中华骨科杂志>发表论文1182篇,被引用了663篇(3728次),平均发文被引比例为56.09%,单篇论文平均被引5.62次,单篇论文最高被引为104次.单篇被引5次以上论文210篇,共被引2835次,占总被引篇数的31.68%,占被引总频次的76.04%.663篇被引论文中,共有国内外作者485人,作者最高被引篇数为12篇,被引1篇的作者386人,占作者总数的79.58%.被引作者群的地域分布30个省(自治区)、直辖市和香港、台湾地区及美国、加拿大、法国.北京、上海和天津在骨科学研究领域居于国内前列,其中北京居第一位,占32.16%.有445种期刊引用<中华骨科杂志>.<中华骨科杂志>自引217条,自引率为0.058.结论 <中华骨科杂志>所载文献质量高,在我国医学研究领域已具有较强的影响力,是骨科先进科研成果交流的平台.     

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

BackgroundCOVID-19 has drastically affected transplant services, but there is limited understanding of the discrepancy of COVID-19 effects on various regions of the world.MethodsWe have explored the Global Observatory for Organ Donation and Transplantation data for assessing the transplant number changes between the calendar year 2019 (n = 157,301) and 2020 (129,681).ResultsThere was a disproportionate impact of COVID-19 on different areas of the world. Globally, there was a decline of 17.5%, in which deceased donation, kidney (20.9%), pancreas (16.2%), lung (12.7%), liver (11.3%), and heart (8%) transplant declined disproportionally in different regions of the world. The pandemic affected almost all geographic regions and nations, but China and the United States were mostly able to recover from the initial halt of the transplant practices by the pandemic so that there was a cumulative increase in transplant numbers.ConclusionsOur data show that developing nations lagged behind, whereas developed nations have been able to recover their transplantation programs during the pandemic. Further policy making and preparedness is required to safeguard the most vulnerable areas of the world to minimize the impact of any future pandemic on transplantation practices.     

The impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado

BackgroundIn 2019 firearm injuries surpassed automobile-related injuries as the leading cause of pediatric death in Colorado. In the spring of 2020, the COVID-19 pandemic led to community-level social, economic, and health impacts as well as changes to injury epidemiology. Thus, we sought to determine the impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado.MethodsWe conducted a retrospective review of pediatric firearm injured patients (≤ 18-years-old) evaluated at three trauma centers in Colorado from 2018–2021. Patients were stratified into two groups based on the time of their firearm injury: pre- COVID injuries and post- COVID injuries. Group differences were examined using t-tests for continuous variables and Chi Squared or Fisher's exact tests for categorical variables.ResultsOverall, 343 firearm injuries occurred during the study period. There was a significant increase in firearm injuries as a proportion of overall pediatric ED trauma evaluations following the onset of the COVID-19 pandemic (pre COVID: 5.18/100 trauma evaluations; post COVID: 8.61/100 trauma evaluations, p<0.0001). Assaults were the most common injury intent seen both pre and post COVID (70.3% vs. 56.7%, respectively); however, unintentional injuries increased significantly from 10.3% to 22.5% (p = 0.004) following the onset of the pandemic. Additionally, the COVID-19 pandemic was associated with a 177% increase in unintentional injuries in adolescents.ConclusionPediatric firearm injuries, particularly unintentional injuries, increased significantly in Colorado following the onset of the COVID-19 pandemic. The substantial increase in unintentional injuries among adolescents highlights the necessity of multi-disciplinary approaches to limit or regulate their access to firearms.Level of EvidenceLevel III.Study TypeRetrospective.     

Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic – An observational cohort study in the UK

AimThis study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery.MethodsThe study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19.ResultsThere were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years.ConclusionThis study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.     

Adult kitchen-related burn injuries: The impact of COVID-19

IntroductionKitchen-related burn injuries are common and preventable. To limit the spread of COVID-19, public health orders encouraged the public to stay at home which may have led to an increase in kitchen-related burn injuries.ObjectiveTo assess adult kitchen-related burns treated in an outpatient setting in general, and especially looking at the impact of the COVID-19 pandemic on the incidence and epidemiology of these burns.MethodsFor this retrospective, population-based study, data were obtained for adult patients who suffered burn injuries resulting in a visit to a Canadian tertiary Burn Clinic between April 2016 and March 2021 specifically looking at demographics, burn etiology, severity and anatomical location and the need for surgery. Separately, we compared the patients before and after the beginning of the COVID-19 pandemic (April 1, 2020).ResultsA total of 1380 burn patients were identified. Of these, 38 % (N = 521) sustained a kitchen-related burn. The median patient age was 40 years (range 18–95) and 282 (54.1 %) were female. The most common etiology and location were scald (76.8 %) and anterior arm (28.5 %), respectively. Thirty-two (6.1 %) patients required admission to the Burn Unit and 26 of these had surgeries. Additionally, 72 (13.8 %) patients had surgery as an outpatient. During the COVID-19 pandemic, East Asian patients saw a significant increase in kitchen burns (p < 0.01).ConclusionOver 1/3 of burns at the outpatient burn clinic were kitchen-related. About 94 % of these were treated as outpatient only. The incidence of kitchen-related burns did not change during the COVID-19 pandemic, but we found significant differences in ethnic distribution. These results provide a unique opportunity to focus on communication and education and set up preventative measures.     

Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

BackgroundThe Coronavirus disease (COVID-19) pandemic has contributed to over 1,000,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England.MethodsData were extrapolated retrospectively from two separate 6-week periods in 2019 and 2020 (1st April–13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods.ResultsThere were fewer attendances to hospital in 2020 compared with 2019 (178 vs. 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs. 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs. 11/88, p < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status.ConclusionsRestructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.     

Immunosuppressive Medication Adherence in Kidney Transplant Recipients During the COVID-19 Pandemic: A Cross-Sectional Study in Hong Kong

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has put an enormous burden on health care systems worldwide. Limited access to medical care and fear of increased infective risks due to the use of immunosuppressive medication (IM) have increased concerns about IM adherence in kidney transplant recipients (KTRs). The aim of this study was to determine the various dimensions of IM nonadherence in KTRs during the COVID-19 pandemic.MethodsThis was a single-center, cross-sectional study using a convenient sampling approach. KTRs with follow-up in Queen Elizabeth Hospital, Hong Kong between May 1, 2020 and September 30, 2020, were invited to complete a self-reported questionnaire on IM adherence. The sociodemographic factors associated with IM adherence were extracted from medical records.ResultsOverall, 210 patients completed the questionnaires. The overall IM nonadherence rate was 35.2% in the 4 weeks before survey completion. None of the patients stopped taking IMs without instructions from their health care providers. The most common pattern of IM nonadherence was timing adherence (n = 63; 30.1%), followed by dose-skipping item. Among the different sociodemographic factors studied, only marital status was an independent risk factor of IM nonadherence (odds ratio, 1.97; 95% confidence interval, 1.04-3.72; P = .03).ConclusionsThe impact of COVID-19 on IM adherence in KTRs was not significant. All the patients continued their IM despite of the pandemic. Good family support can have a positive influence on treatment adherence in KTRs during the COVID-19 pandemic.