Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Computer-assisted word reading intervention effects throughout the primary grades: A meta-analysis

This meta-analysis focused on the effects of computer-supported word reading interventions (foundational reading instruction, supplementary alphabetics, reading fluency, remedial reading) on reading related outcome measures (letter knowledge, phonological awareness, word and pseudoword reading, sentence and text reading, and spelling, as well as transfer to reading comprehension) across different languages in primary school children starting from 1995. We identified 67 studies with a total number of 10734 children throughout the primary grades from which 694 effect sizes were derived. Following a multilevel approach, the average effect size across interventions and outcome measures was 0.36 with 95% CI (0.28, 0.43). There was also evidence of transfer to reading comprehension, 69 effect sizes with an average of 0.21 (95% CI 0.13-0.29). Large variation in effect sizes was observed between studies and especially between comparisons within studies. The effect sizes were moderated by treatment length, subword level as criterion variable and speeded tests. The effect sizes were dependent on the control group condition in that the effect sizes were higher in the case of a control condition with education as usual and lower in cases of a reading treatment control condition. It is concluded that technology enhanced word reading interventions on average yield moderate positive effects on both accuracy and speed of word learning across program types and across languages

Computer-supported early literacy intervention effects in preschool and kindergarten: A meta-analysis

Contains fulltext : 217239.pdf (publisher's version ) (Open Access)A meta-analysis was conducted on the effects of computer-supported early literacy interventions (strict phonological awareness training, combined phonological awareness and letter training, and use of e-books) on phonological-awareness (syllabic awareness, word blending, rhyme, phoneme awareness) and reading-related skills (concept about print, letter knowledge, decoding, spelling) across different languages in preschool and kindergarten since 1995. A total of 59 studies were identified with a total amount of 339 effect sizes, involving 6786 preschool and kindergarten students. A multilevel approach was followed to estimate the average effect size and to examine the moderation of effects. On average, a small positive effect size of 0.28 with 95% CI (0.21, 0.35), was evidenced across treatments and across outcome measures. Large variation in effect sizes was observed between studies and especially between comparisons within studies. If the intervention was part of an integrated learning system in the classroom, the effects were better. The present analysis also shows the importance of methodological rigor of study designs being used in that effect sizes were higher in cases of absence of randomization and comparisons with classroom teaching as usual instead of an active control group.22 p

Therapieontrouw HIV-geinfecteerde kinderen.

Contains fulltext : 59267.pdf (publisher's version ) (Open Access

Modelling of Capacitive Couplers through Frequency Response Analysis for PD On-line Detection in HV Cables

ABSTRACT: BACKGROUND: Posttraumatic osteoarthritis can develop after an intra-articular extremity fracture, leading to pain and loss of function. According to international guidelines, anatomical reduction and fixation are the basis for an optimal functional result. In order to achieve this during fracture surgery, an optimal view on the position of the bone fragments and fixation material is a necessity. The currently used 2D-fluoroscopy does not provide sufficient insight, in particular in cases with complex anatomy or subtle injury, and even an 18-26% suboptimal fracture reduction is reported for the ankle and foot. More intra-operative information is therefore needed. Recently the 3D-RX-system was developed, which provides conventional 2D-fluoroscopic images as well as a 3D-reconstruction of bony structures. This modality provides more information which consequently leads to extra corrections in 18-30% of the fracture operations. However, the effect of the extra corrections on the quality of the anatomical fracture reduction and fixation as well as on patient relevant outcomes has never been investigated. The objective of this study protocol is to investigate the effectiveness of the the intra-operative use of the 3D-RX-system as compared to the conventional 2D-fluoroscopy in patients with traumatic intra-articular fractures of the wrist, ankle and calcaneus. The effectiveness will be assessed in two different areas: 1) the quality of fracture reduction and fixation, based on the current golden standard, Computed Tomography. 2) The patient-relevant outcomes like functional outcome range of motion and pain. In addition, the diagnostic accuracy of the 3D-RX-scan will be determined in a clinical setting and a cost-effectiveness as well as a cost-utility analysis will be performed. Methods/design In this protocol for an international multicenter randomized clinical trial, adult patients (age > 17 years) with a traumatic intra-articular fracture of the wrist, ankle or calcaneus eligible for surgery will be subjected to additional intra-operative 3D-RX. In half of the patients the surgeon will be blinded to these results, in the other half the surgeon may use the 3D-RX results to further optimize fracture reduction. In both randomization groups a CT-scan will be performed postoperatively. Based on these CT-scans the quality of fracture reduction and fixation will be determined. During the follow-up visits after hospital discharge at 6 and 12 weeks and 1 year postoperatively the patient relevant outcomes will be determined by joint specific, health economic and quality of life questionnaires. In addition a follow up study will be performed to determine the patient relevant outcomes and prevalence of posttraumatic osteoarthritis at 2 and 5 years postoperatively. DISCUSSION: The results of the study will provide more information on the effectiveness of the intra-operative use of 3D-imaging during surgical treatment of intra-articular fractures of the wrist, ankle and calcaneus. A randomized design in which patients will be allocated to a treatment arm during surgery will be used because of its high methodological quality and the ability to detect incongruences in the reduction and/or fixation that occur intra-operatively in the blinded arm of the 3D-RX. An alternative, pragmatic design could be to randomize before the start of the surgery, then two surgical strategies would be compared. This resembles clinical practice better, but introduces more bias and does not allow the assessment of incongruences that would have been detected by 3D-RX in the blinded arm. Trial registration Dutch Trial Register NTR 190