3 research outputs found
An Exploratory Study of the Factors that Promote, or Impede Sustainable EcoTourism Development in Saiful Muluk National Park Khyber Pakhtunkhwa
No full textDuring the last two decades tourism is considered as the building block of country overall growth. Pakistan tourism ranking among the world is at the lowest level. Despite the fact that Pakistan is considered as one of the top countries among the rest of the world for ecotourism and also other farms of tourism the overall purpose of this research study was to identify factors that impede and promote sustainable ecotourism development in Saiful Muluk National Park of Khyber Pakhtunkhwa. The main objectives of this study were to explore factors impeding sustainable tourism development in Khyber Pakhtunkhwa and to identify factors promoting sustainable tourism development in Khyber Pakhtunkhwa. Being qualitative in nature, data was collected by conducting in-depth interviews with key stakeholders (Wildlife Staff, Local business community and Tourists) of Saiful National Park. Thematic analysis was conducted to analyze data through NVivo software. The key findings in respect of impeding factors were identified as inadequate infrastructure, unbalanced power structure and communication gap among the key stakeholders while promoting factors includes uniqueness of the site, scenic beauty, precious wildlife species and hospitable local community culture
Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial
No full textInternational audienceBackgroundHip fractures carry a substantial risk of complications and death. This study aimed to report the 90-day incidence of mortality, major perioperative complications and in-hospital timelines after a hip fracture in the Spanish HIP ATTACK-1 trial cohort, comparing with the non-Spanish cohort.MethodsProspective cohort study of Spanish patients nested in the HIP ATTACK-1 trial. The HIP ATTACK-1 was an international, randomized, controlled trial (17 countries, 69 hospitals, 7 in Spain, highest recruiting country). Patients were randomized to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. Participants were ≥45 years of age who presented with a low-energy hip fracture requiring surgery.ResultsAmong 534 patients in the Spanish cohort, 69 (12.9 %) patients died at 90 days follow-up, compared to 225 (9.2 %) in the non-Spanish cohort (p = 0.009), mostly due to higher nonvascular related mortality. A composite of major postoperative complication occurred in 126 patients (23.6 %). The most common perioperative complications were myocardial injury (189 patients, 35.4 %), infection with no sepsis (86 patients, 16.1 %) and perioperative delirium (84 patients, 15.7 %); all these complication rates in Spain were significantly higher than the non-Spanish patients (29.2 % p = 0.005; 11.9 % p = 0.008 and 9.2 % p < 0.0001, respectively). Spanish cohort patients were older and had more comorbidities than the non-Spanish cohort, evidencing their greater frailty at baseline. Among Spanish patients, the median time from hip fracture diagnosis to surgery was 30.0 h (IQR 21.1–53.9) in the standard-care group, with 68.8 % of patients receiving surgery within 48 h of diagnosis. This median time was lower in the non-Spanish cohort (22.8 h, IQR 9.5–37.0), where 82.1 % of patients were operated within 48 h.ConclusionsIn the HIP ATTACK-1 trial, 1 in 8 patients died 90 days after a hip fracture in Spain. The most common complication after a hip fracture was myocardial injury, followed by infection and delirium. Spanish patients had worse outcomes than non-Spanish patients. Research needs to focus on new interventions such as accelerated surgery and perioperative troponin measurement with the appropriate investment of resources, to prevent and identify early these complications with a goal of improving mortality for this high-risk population.Level of evidence I
