scholarly journals A COMPARATIVE STUDY OF MIDDLE ONE THIRD OF FEMUR SHAFT FRACTURES MANAGED WITH INTERLOCKING NAILS AND KUNTSCHER INTRAMEDULLARY NAILS AT LEVEL 2 AND LEVEL 3 REFERRAL HOSPITALS IN TERMS OF HEALING TIME, FULL WEIGHT BEARING AND POST OPERATIVE COMPLICATIONS

2019 ◽  
Vol 8 (9) ◽  
pp. 640-643
Author(s):  
Rakesh Kumar Verma ◽  
Ahmer Hasmat ◽  
Hetandar Kumar Bhartiya
Keyword(s):  
Comparative Study ◽  
Weight Bearing ◽  
Healing Time ◽  
Full Weight Bearing ◽  
Intramedullary Nails ◽  
Operative Complications ◽  
Referral Hospitals ◽  
Level 3 ◽  
Femur Shaft ◽  
Level 2

scholarly journals Intramedullary nail versus locking plate for treatment of proximal humeral fractures: A meta-analysis based on 1384 individuals

2018 ◽  
Vol 46 (11) ◽  
pp. 4363-4376 ◽  
Author(s):  
Ming Li ◽  
Yanhua Wang ◽  
Yupeng Zhang ◽  
Ming Yang ◽  
Peixun Zhang ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Locking Plate ◽  
Meta Analysis ◽  
Operation Time ◽  
Healing Time ◽  
Locking Plates ◽  
Intramedullary Nails ◽  
Incision Length ◽  
Operative Complications ◽  
Evidence Quality

Objective The optimal surgical intervention on the treatment for proximal humeral fractures (PHFs) remains uncertain. The aim of this study was to evaluate clinical outcomes following fixation of PHFs by intramedullary nails or locking plates Methods The Cochrane Library, PubMed, EMBASE, China Knowledge Resource Integrated (CNKI), Chongqing VIP and Wanfang databases were systematically searched for studies published between January 01, 1996 and December 31, 2016 that investigated intramedullary nail vs. locking plate in the surgical treatment of PHFs. A meta-analysis examined incision length, blood loss, operation time, fracture healing time, Constant scores and post-operative complications. The methodological and evidence quality were also assessed by MINORS and GRADE system. Results From the original 1024 references, 20 studies involving 1384 patients met the eligibility criteria. Analyses showed that intramedullary nails were superior to locking plates in incision length, peri-operative bleeding time, operation time and fracture healing time. However, there were no differences between treatments in Constant score or post-operative complications. Conclusion Although the evidence quality was poor, the results suggest that compared with locking plates, intramedullary nails may be a better choice for the repair of PHFs.

scholarly journals Three different interlocking intramedullary nails for unstable reverse oblique inter-trochanteric fractures: a bio-mechanical comparative study

2016 ◽  
Vol 2 (4) ◽  
pp. 280
Author(s):  
Ujjwal K. Debnath ◽  
S. Naidu Maripuri ◽  
K. N. Subramanian ◽  
K. Mohanty
Keyword(s):  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Full Weight Bearing ◽  
Peak Strain ◽  
Intertrochanteric Fractures ◽  
Partial Weight Bearing ◽  
Intramedullary Nails ◽  
Significant Difference ◽  
Partial Weight

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Biomechanical testing, intramedullary devices have proven advantageous over the extramedullary devices in the management of unstable intertrochanteric fractures. Reverse oblique type of intertrochanteric fractures are highly unstable and intramedullary nails are currently the method of internal fixation. The currently available nails seems to provide rotational, axial and angular stability, but biomechanical analysis of the strain pattern in the bone and implant in this fractures are lacking. The aim of this experimental study was to analyse the strain in three different long femoral nail-bone units under physiological loading when implanted in Saw bone model after creating a reverse oblique intertrochanteric fracture.</span></p><p class="abstract"><strong>Methods:</strong> A total of 12 sawbones were divided in to 4 equal groups. Group 1 was intact saw bones and were used as controls. Group 2, Group 3 and Group 4 were implanted with Depuy, Stryker and Synthes nails respectively after creating a reverse oblique intertrochanteric fracture. All the four groups were axially loaded with 100 N increments until physiological loads. The strain patterns were measured at the posteromedial cortex and the peak strains were extracted at partial weight bearing i.e. 500 N and full weight bearing physiological loads i.e. 1000 N.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There was no significant difference in peak strains among the groups at partial loads. However at 1000 N loads the peak strain in the DePuy nail-bone unit was significantly high compared to the other two nail-bone units and the controls. </span></p><p class="abstract"><strong>Conclusions:</strong> These results question the safety of immediate full weight bearing following surgery when treating the reverse oblique unstable fractures with DePuy intramedullary nails. A period of partial weight bearing following fixation of reverse oblique fractures would be wise when using DePuy nails<span lang="EN-IN">.</span></p>

Historical text archives and prosopography: the COEL database system

1998 ◽  
Vol 10 (1-3) ◽  
pp. 57-72 ◽  
Author(s):  
K. S. B. Keats-Rohan
Keyword(s):  
Research Tool ◽  
Direct Access ◽  
Specific Situation ◽  
Core Data ◽  
Secondary Sources ◽  
The Core ◽  
Level 3 ◽  
Full Discussion ◽  
Available Information ◽  
Level 2

The COEL database and database software, a combined reference and research tool created by historians for historians, is presented here through Screenshots illustrating the underlying theoretical model and the specific situation to which that has been applied. The key emphases are upon data integrity, and the historian's role in interpreting and manipulating what is often contentious data. From a corpus of sources (Level 1) certain core data are extracted for separate treatment at an interpretive level (Level 3), based upon a master list of the core data (Level 2). The core data are interdependent: each record in Level 2 is of interest in itself; and it either could or should be associated with an(other) record(s) as a specific entity. Sometimes the sources are ambiguous and the association is contentious, necessitating a probabilty-coding approach. The entities created by the association process can then be treated at a commentary level, introducing material external to the database, whether primary or secondary sources. A full discussion of the difficulties is provided within a synthesis of available information on the core data. Direct access to the source texts is only ever a mouse click away. Fully query able, COEL is formidable look-up and research tool for users of all levels, who remain free to exercise an alternative judgement on the associations of the core data. In principle, there is no limit on the type of text or core data that could be handled in such a system.

FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

2015 ◽  
Vol 21 (4.1) ◽  
pp. 638-642
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamosiunas ◽  
Janina Tutkuviene
Keyword(s):  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Full Extension ◽  
Low Degrees ◽  
Mri Study ◽  
Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

Variation in antibiotic use across intensive care units (ICU): A population-based cohort study in Ontario, Canada

2020 ◽  
Vol 41 (9) ◽  
pp. 1035-1041
Author(s):  
Erika Y. Lee ◽  
Michael E. Detsky ◽  
Jin Ma ◽  
Chaim M. Bell ◽  
Andrew M. Morris
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Ventilatory Support ◽  
Severity Of Illness ◽  
Antibiotic Use ◽  
Patient Factors ◽  
Days Of Therapy ◽  
Level 3 ◽  
Level 2

AbstractObjectives:Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation.Methods:We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use.Results:Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs.Conclusions:Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.

scholarly journals Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches?

2021 ◽  
pp. 219256822110223
Author(s):  
Fabio Cofano ◽  
Giuseppe Di Perna ◽  
Daria Bongiovanni ◽  
Vittoria Roscigno ◽  
Bianca Maria Baldassarre ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Clinical Results ◽  
Grading System ◽  
Obese Patients ◽  
Lumbar Surgery ◽  
Operative Care ◽  
Operative Complications ◽  
Proper Weight ◽  
Level 2

Study Design: Literature review. Objectives: An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. Methods: Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. Results: A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). Conclusion: Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals An Atmospheric Visibility Grading Method Based on Ensemble Learning and Stochastic Weight Average

Atmosphere ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 869
Author(s):  
Xiuguo Zou ◽  
Jiahong Wu ◽  
Zhibin Cao ◽  
Yan Qian ◽  
Shixiu Zhang ◽  
...  
Keyword(s):  
Ensemble Learning ◽  
Traffic Accidents ◽  
Feature Sets ◽  
Atmospheric Visibility ◽  
Average Accuracy ◽  
Level 3 ◽  
Visual Characteristics ◽  
Level 1 ◽  
Grading Model ◽  
Level 2

In order to adequately characterize the visual characteristics of atmospheric visibility and overcome the disadvantages of the traditional atmospheric visibility measurement method with significant dependence on preset reference objects, high cost, and complicated steps, this paper proposed an ensemble learning method for atmospheric visibility grading based on deep neural network and stochastic weight averaging. An experiment was conducted using the scene of an expressway, and three visibility levels were set, i.e., Level 1, Level 2, and Level 3. Firstly, the EfficientNet was transferred to extract the abstract features of the images. Then, training and grading were performed on the feature sets through the SoftMax regression model. Subsequently, the feature sets were ensembled using the method of stochastic weight averaging to obtain the atmospheric visibility grading model. The obtained datasets were input into the grading model and tested. The grading model classified the results into three categories, with the grading accuracy being 95.00%, 89.45%, and 90.91%, respectively, and the average accuracy of 91.79%. The results obtained by the proposed method were compared with those obtained by the existing methods, and the proposed method showed better performance than those of other methods. This method can be used to classify the atmospheric visibility of traffic and reduce the incidence of traffic accidents caused by atmospheric visibility.

scholarly journals Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Takahashi ◽  
Yoshihiro Noyama ◽  
Tsuyoshi Asano ◽  
Tomohiro Shimizu ◽  
Tohru Irie ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Full Weight Bearing ◽  
Loading Test ◽  
Lateral Plate ◽  
Element Analysis ◽  
Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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