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1.
Front Artif Intell ; 4: 765210, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34765970

RESUMEN

Background: CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation. Objectives: This mini-review examines the literature and discusses the impediments to the success of AI application to CTG thus far. Prior randomised control trials (RCTs) of CTG decision support systems are reviewed from technical and clinical perspectives. A selection of novel engineering approaches, not yet validated in RCTs, are also reviewed. The review presents the key challenges that need to be addressed in order to develop a robust AI tool to identify fetal distress in a timely manner so that appropriate intervention can be made. Results: The decision support systems used in three RCTs were reviewed, summarising the algorithms, the outcomes of the trials and the limitations. Preliminary work suggests that the inclusion of clinical data can improve the performance of AI-assisted CTG. Combined with newer approaches to the classification of traces, this offers promise for rewarding future development.

2.
Ir Med J ; 111(4): 732, 2018 04 19.
Artículo en Inglés | MEDLINE | ID: mdl-30486643

RESUMEN

Introduction Following musculoskeletal injury patient education is essential to help patients understand their treatment. Many attend the orthopaedic fracture clinic with multiple questions related to their diagnosis and treatment. Aim To assess trauma patients' attitudes towards online health information and a specific orthopaedic patient information website. Methods A validated questionnaire was distributed over 5 consecutive clinics, with questions based on previous online experiences & www.myorthoclinic.com. Results One hundred six patients completed the survey. Seventy-one percent trusted the internet whereas 83% trusted the information provided by the website. Eighty-three percent felt encouraged to take action to benefit their health. Eighty-seven percent felt that there was a wide range of information provided. Seventy-two percent agreed that they learnt something new. Discussion Patients attending the trauma clinic have benefited from the 'prescribing' of a dedicated orthopaedic trauma website. This low-cost concept utilises minimal resources, requires little effort to implement and is applicable to all specialties.


Asunto(s)
Actitud Frente a la Salud , Educación a Distancia , Sistemas de Información en Salud , Sistema Musculoesquelético/lesiones , Educación del Paciente como Asunto , Heridas y Lesiones/psicología , Adolescente , Adulto , Niño , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/estadística & datos numéricos , Encuestas y Cuestionarios , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia , Adulto Joven
3.
J Hand Surg Asian Pac Vol ; 22(1): 83-87, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28205470

RESUMEN

BACKGROUND: Finger injuries are common in the sport of hurling. Injury to the little finger distal interphalangeal joint (DIPJ) often occurs when a high dropping ball impacts on the outstretched finger. The little finger contributes to approximately 15% of grip strength. Injury therefore results in reduced grip strength and may impair the ability of players to grip or catch a ball. METHODS: Six elite hurlers with post-traumatic arthritis of their non-dominant little finger DIPJ underwent arthrodesis in 30 degrees of flexion. Kirchner wires were inserted for up to 8 weeks to achieve fusion of the joint. Patients were evaluated after recovery using a dynamometer to assess grip strength, the DASH questionnaire and a sport specific questionnaire. RESULTS: All arthrodeses achieved bony union without complication. All patients reported a resolution of their pain and recovery in their ability to catch & retain a ball. Measurements of grip strengths were comparable between hands. DASH scores improved by up to 47 points. All scores were less than 5 at final follow-up. CONCLUSIONS: Grip strength decreases when fingers are immobilized in full extension. In sports that require catching or gripping a ball or a bat, arthrodesis of the DIP joint in flexion can improve grip strength and hand function. Fusion in 30 degrees of flexion for hurlers results in restoration of function and resolution of pain. Little finger DIPJ arthrodesis is a valid method of treating posttraumatic arthritis in ball and bat sports.


Asunto(s)
Artritis/cirugía , Artrodesis/métodos , Traumatismos en Atletas/complicaciones , Traumatismos de los Dedos/complicaciones , Articulaciones de los Dedos/cirugía , Fracturas no Consolidadas/complicaciones , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Artritis/diagnóstico , Artritis/etiología , Traumatismos en Atletas/diagnóstico , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/fisiopatología , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/fisiopatología , Fracturas no Consolidadas/diagnóstico , Fuerza de la Mano , Humanos , Masculino , Radiografía , Encuestas y Cuestionarios , Adulto Joven
4.
Hand Surg ; 19(1): 145-9, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24641760

RESUMEN

The aim of this study was to determine the path of screw placement to avoid breaching the articular surface of both lunate and scaphoid bones at the radiocarpal and midcarpal joints. An Acutrak screw was inserted into the right scapholunate joint of ten cadavers starting immediately distal to the tip of the radial styloid and aiming for the tip of the ulnar styloid. The articular surfaces of the scaphoid and lunate bones in all ten cadavers were exposed and examined. A computed tomography (CT) scan of four wrists was performed. Eight of the ten cadavers had no perforation or destruction of the articular surfaces. Screw stabilization of the scapholunate joint can be performed without perforation or destruction of the lunate or scaphoid surfaces. We recommend that if this form of fixation is being used then the screw should be inserted commencing at the radial styloid tip and aiming for ulnar styloid tip, under radiological guidance.


Asunto(s)
Inestabilidad de la Articulación/prevención & control , Articulación de la Muñeca/cirugía , Tornillos Óseos , Humanos , Hueso Semilunar , Hueso Escafoides , Tomografía Computarizada por Rayos X , Articulación de la Muñeca/diagnóstico por imagen
6.
Ir J Med Sci ; 180(3): 691-5, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21286843

RESUMEN

BACKGROUND: The academic productivity of trainees, consultants and institutions is frequently judged by the quantity of articles published in peer-reviewed medical journals. AIM: To assess the publication history of Irish orthopaedic units over a 5-year period, and to identify patterns of publication. METHODS: A PubMed search was performed of each consultant affiliated with each orthopaedic unit in the country for between 2004 and 2008. Publications were classified by individual, institution, publication type and impact factor. RESULTS: Over the 5 years of the study, 239 papers were published from 19 orthopaedic units, in 69 different journals. Fifty-six consultants had at least one senior author publication, with seven consultants having more than ten. Impact factors of the journals targeted varied considerably and reveals an interesting duality among authors when opting for profile or prestige. CONCLUSION: We feel this study represents a comprehensive and novel review of the state of publishing in a surgical specialty.


Asunto(s)
Eficiencia Organizacional , Ortopedia/estadística & datos numéricos , Edición/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Irlanda , Factor de Impacto de la Revista
7.
J Bone Joint Surg Br ; 92(8): 1165-70, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20675766

RESUMEN

We split 100 porcine flexor tendons into five groups of 20 tendons for repair. Three groups were repaired using the Pennington modified Kessler technique, the cruciate or the Savage technique, one using one new device per tendon and the other with two new devices per tendon. Half of the tendons received supplemental circumferential Silfverskiöld type B cross-stitch. The repairs were loaded to failure and a record made of their bulk, the force required to produce a 3 mm gap, the maximum force applied before failure and the stiffness. When only one device was used repairs were equivalent to the Pennington modified Kessler for all parameters except the force to produce a 3 mm gap when supplemented with a circumferential repair, which was equivalent to the cruciate. When two devices were used the repair strength was equivalent to the cruciate repair, and when the two-device repair was supplemented with a circumferential suture the force to produce a 3 mm gap was equivalent to that of the Savage six-strand technique.


Asunto(s)
Técnicas de Sutura/instrumentación , Traumatismos de los Tendones/cirugía , Animales , Elasticidad , Diseño de Equipo , Estrés Mecánico , Sus scrofa , Tendones/fisiopatología
8.
J Bone Joint Surg Br ; 89(10): 1396-401, 2007 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17957085

RESUMEN

We compared the bulking and tensile strength of the Pennington modified Kessler, Cruciate and the Savage repairs in an ex vivo model. A total of 60 porcine tendons were randomised to three groups, half repaired using a core suture alone and the remainder employing a core and peripheral technique. The tendons were distracted to failure. The force required to produce a 3 mm gap, the ultimate strength, the mode of failure and bulking for each repair were assessed. We found that there was a significant increase in strength without an increase in bulk as the number of strands increased. The Cruciate repair was significantly more likely to fail by suture pullout than the Pennington modified Kessler or Savage repairs. We advise the use of the Savage repair, especially in the thumb, and a Cruciate when a Savage is not possible. The Pennington modified Kessler repair should be reserved for multiple tendon injuries.


Asunto(s)
Técnicas de Sutura , Traumatismos de los Tendones/cirugía , Cicatrización de Heridas/fisiología , Animales , Distribución Aleatoria , Suturas , Porcinos , Resistencia a la Tracción
9.
J Cancer Educ ; 15(2): 86-90, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-10879897

RESUMEN

BACKGROUND: Assessment of smoking status and identification of those most likely to continue smoking are important in the management of patients who have bladder cancer, because continued smoking following diagnosis and treatment increases the likelihood of treatment-related complications, recurrence, second primary malignancies, and morbidity and mortality. METHODS: Patients (n = 224) receiving follow-up care of previously treated bladder cancers completed a brief written survey assessing their post-diagnosis smoking patterns. RESULTS: Despite the risks of continued smoking, 69% of the patients who had been active smokers at the time of diagnosis (n = 84) reported smoking at some point following the diagnosis and 45% reported smoking at the time of assessment. Patients diagnosed at earlier stages were more likely to continue smoking. Patients diagnosed at later stages were 2.80 times more likely to be continuous abstainers than those diagnosed sooner (95% CI, 1.08-7.25). CONCLUSIONS: The findings underscore the need to assess smoking status and provide smoking-cessation advice and counseling within routine comprehensive care of bladder cancer patients.


Asunto(s)
Actitud Frente a la Salud , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/terapia , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Encuestas y Cuestionarios , Neoplasias de la Vejiga Urinaria/diagnóstico
10.
Injury ; 30(7): 467-70, 1999 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-10707213

RESUMEN

The aim of our study is to determine the incidence and extent of torsional malalignment in patients with tibial diaphyseal fractures treated with closed antegrade intramedullary (IM) nailing. We measured torsion using CT scanning in 22 patients. A difference of 8 degrees or more was found in 8 cases (36%) as compared with the uninjured side. Only 2 of these cases could be clinically detected and only one patient noted the problem. We also describe a method of directly calculating torsion from CT images captured on a single film that is easy and does not require any special equipment.


Asunto(s)
Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Estudios de Cohortes , Humanos , Fracturas de la Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía
11.
J Pediatr Orthop ; 15(3): 342-5, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7790492

RESUMEN

Salter innominate osteotomy is a widely used operative procedure to redirect the acetabulum in cases of acetabular dysplasia. The effectiveness of this redirection is indicated by the change in the appearance of the obturator foramen after the procedure. This is usually accompanied by an increase in the center edge (CE) angle with an effective decrease in the forces transmitted across the hip joint. In a prospective study of 20 Salter innominate osteotomies performed on two different age groups, one mature and one immature, we studied the change in the deformity of the obturator foramen with time after this procedure. In the immature pelvis, the asymmetric appearance of the obturator foramen remodeled gradually during the 6 months after the procedure. However, in the mature patient, no such remodeling potential was demonstrable during the study period. This finding has clinical implications regarding the advice for performing Salter innominate osteotomies in mature and immature patients.


Asunto(s)
Acetábulo/anomalías , Remodelación Ósea , Osteotomía , Huesos Pélvicos/fisiología , Acetábulo/cirugía , Adolescente , Adulto , Factores de Edad , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Osteotomía/métodos , Huesos Pélvicos/anatomía & histología , Huesos Pélvicos/diagnóstico por imagen , Radiografía
12.
Clin Orthop Relat Res ; (302): 273-83, 1994 May.
Artículo en Inglés | MEDLINE | ID: mdl-8168314

RESUMEN

The authors compared the effects of decreased loading, increased loading, and baseline loading on the early (six weeks) and intermediate (12 weeks) healing of tibial fractures treated with an external fixator in adult dogs. The different loading conditions were verified by gait studies. Periosteal bone in the increased-loading fracture site was significantly increased compared with the decreased-loading site at both time intervals, and with the baseline-loading site at six weeks. The mechanical variables of energy absorption and angle of rotation at six weeks were significantly increased in the increased-loading fracture site compared with the decreased-loading site and baseline-loading site. Blood flow to the increased-loading fracture site was significantly higher than that to the decreased-loading fracture site at six weeks. Five dogs were studied at 12 weeks to compare the effects of decreased loading to increased loading. The increased-loading fracture showed significantly increased rotation, torque, and energy absorption to failure. Blood flow was not measured in the 12-week animals.


Asunto(s)
Curación de Fractura , Fracturas de la Tibia/fisiopatología , Soporte de Peso , Animales , Fenómenos Biomecánicos , Desarrollo Óseo , Perros , Fijadores Externos , Marcha , Flujo Sanguíneo Regional , Tibia/irrigación sanguínea , Fracturas de la Tibia/cirugía
13.
J Pediatr Orthop ; 14(1): 13-5, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-8113363

RESUMEN

Eleven hips in nine children were identified with acetabular dysplasia, which presented as developmental dislocation of the hip. The clinical signs of dislocation--tight abductors and a limp, associated with a plain radiograph showing the femoral head protruding from the pelvis--were not evident among this group. Arthrography showed acetabular dysplasia but no dislocation. Accurate grading of hip dysplasia can help to avoid such misdiagnoses, which have presented a recurring problem in the management tof this condition.


Asunto(s)
Acetábulo/patología , Enfermedades del Desarrollo Óseo/diagnóstico , Luxación Congénita de la Cadera/diagnóstico , Enfermedades del Desarrollo Óseo/patología , Preescolar , Diagnóstico Diferencial , Femenino , Luxación Congénita de la Cadera/clasificación , Luxación Congénita de la Cadera/patología , Humanos , Lactante , Masculino
14.
Clin Orthop Relat Res ; (295): 264-9, 1993 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8403659

RESUMEN

Sixteen dogs and 14 anatomic tibiae were studied to determine the effect of a pressurized brace on a canine tibial fracture model. Bilateral tibial fractures were treated with an external fixator for 48 days. At 48 days, the pressurized brace was applied to one tibia, and a conventional cast was applied to the opposite tibia. The dogs were allowed unrestricted weight bearing until 88 days. Postmortem biomechanical studies indicated that tibiae were stronger on the side treated by the pressurized brace. This was reflected in torque values, energy, and degrees of rotation. The histomorphometry of the periosteal bone of the fracture sites disclosed a more dense periosteal callus on the side treated with a pressurized brace. In vitro mechanical studies in cadaveric tibias at 30 degrees rotation indicated that the pressurized brace provided significantly more stability.


Asunto(s)
Tirantes , Fijadores Externos , Fijación de Fractura/métodos , Curación de Fractura , Fracturas de la Tibia/cirugía , Animales , Moldes Quirúrgicos , Perros , Presión
15.
J Hand Surg Br ; 18(3): 395-8, 1993 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-8345277

RESUMEN

The socio-economic effect of 156 hand injuries was studied prospectively. The average cost per injury was IR 474.28 pounds of the more serious injuries utilized two-thirds of the resources and resulted in 83% of the days lost from work. In the working population approximately 50% of hand injuries occurred at work. In assessing the economic impact of hand injuries, labour costs account for 55 to 65% of costs. Amputation and complicated laceration were the most costly and resulted in more days lost at work. Injuries at work result in greater costs because they involve more serious injuries, and because workers requiring manual skills need a higher level of hand rehabilitation to return to work. Unless the labour costs are taken into account, the true impact of hand injuries is greatly underestimated.


Asunto(s)
Traumatismos de la Mano/economía , Accidentes/economía , Accidentes/estadística & datos numéricos , Adolescente , Adulto , Evaluación de la Discapacidad , Femenino , Traumatismos de la Mano/etiología , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Estudios Prospectivos
17.
J Pediatr Orthop ; 10(4): 549-50, 1990.
Artículo en Inglés | MEDLINE | ID: mdl-2358499

RESUMEN

Two cases of meningococcal septicemia are presented. Distal tibial physeal arrest occurred in both cases due to hypotension and disseminated intravascular coagulation. To our knowledge, this is the first report of distal tibial physeal arrest with resultant varus deformity at the ankle subsequent to meningococcal septicemia.


Asunto(s)
Enfermedades del Desarrollo Óseo/etiología , Placa de Crecimiento/fisiopatología , Infecciones Meningocócicas/complicaciones , Sepsis/complicaciones , Tibia , Enfermedades del Desarrollo Óseo/diagnóstico por imagen , Enfermedades del Desarrollo Óseo/fisiopatología , Placa de Crecimiento/irrigación sanguínea , Humanos , Lactante , Masculino , Infecciones Meningocócicas/fisiopatología , Radiografía , Sepsis/fisiopatología
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