A Clinical Applicable Smartwatch Application for Measuring Hyperkinetic Movement Disorder Severity

Measuring the severity of hyperkinetic movement disorders like tremor and myoclonus is challenging. Although many accelerometers are available to quantify movements, the vast majority lacks real-time analysis and an interface that makes it possible to real-time adjust therapy like deep brain stimulation (DBS). Here, we developed a smartwatch / smartphone application that is capable of real-time analysing movement disorder severity. Movement analysis was realised by integrating acceleration values, to velocity and subsequently to distance. Measured distances were compared with a validated accelerometer already applied for quantifying movement disorders. Further validation was done by quantitative assessment of simulated movement disorders in 10 healthy volunteers. Finally, the approach was tested in two patients treated with DBS to quantify the effect of different DBS settings on myoclonus and tremor severity, respectively. The distance measured with the application had a 96% accuracy. This was non-inferior (p = 0.76) compared to accelerometers already clinically applied. Furthermore, (simulated) movement disorder severity could be classified correctly in 93% of the cases. Finally, the method was capable of distinguishing effective from non-effective DBS parameters in two patients. In summary, with our approach we realised an instantaneous and reliable estimation of the severity of movement disorders which can assist in real time titrating therapy like DBS.</p

Determinants of outcome in hip fracture patient care

In this thesis, clinical and functional outcomes of a large cohort of hip fracture patients are described, with regards to anemia, blood transfusion, concomitant fractures, loss of mobility and place of residence. Secondly, risk factors for poor outcome, both in a clinical and a functional perspective were identified. Finally, specific risk scores for delirium and discharge to an alternative location have been developed and validated.Orthopedisch Centrum Oost-Nederland Ziekenhuis Groep Twente Stichting Research Orthopedie Delft Nederlandse Orthopaedische Vereniging Nederlandse Vereniging voor Orthopaedische Traumatologie Anna Fonds NOREF Arthrex dePuy-Synthes Chipsoft B.V. BIS Life Pro-Motion Medical Biomet B&CoUBL - phd migration 201

Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients

Purpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005 and June 2009. Fractures were scored retrospectively for 2005-2008 and prospectively for 2008-2009. Rates of a contralateral hip and other osteoporosis- related fractures were compared between patients with and without a history of a fracture. Previous fractures, gender, age and ASA classification were analysed as possible risk factors. Results: The absolute risk for a contralateral hip fracture was 13.8 %, for one or more osteoporosis-related fracture( s) 28.6 %. First-, second- and third-year risk for a second hip fracture was 2, 1 and 0 %. Median (IQR) interval between both hip fractures was 18.5 (26.6) months. One-year incidence of other fractures was 6 %. Only age was a risk factor for a contralateral hip fracture, hazard ratio (HR) 1.02 (1.006-1.042, p = 0.008). Patients with a history of a fracture (33.1 %) did not have a higher incidence of fractures during follow-up (16.7 %) than patients without fractures in their history (14 %). HR for a contralateral hip fracture for the fracture versus the non-fracture group was 1.29 (0.75-2.23, p = 0.360). Conclusion: The absolute risk of a contralateral hip fracture after a hip fracture is 13.8 %, the 1-year risk was 2 %, with a short interval between the 2 hip fractures. Age was a risk factor for sustaining a contralateral hip fracture; a fracture in history was not

Predicting discharge location of hip fracture patients; the new discharge of hip fracture patients score

Purpose This paper reports on the development and validity of a new instrument, called the discharge of hip fracture patients score (DHP), that predicts at admission the discharge location in patients living in their own home prior to hip fracture surgery. Methods A total of 310 patients aged 50 years and above were included. Risk factors for discharge to an alternative location (DAL) were analysed with a multivariable regression analysis taking the admission variables into account with different weights based on the estimates. The score ranged from 0-100 points. The cut-off point for DAL was calculated using a ROC analysis. Reliability of the DHP was evaluated. Results Risk factors for DAL were higher age, female gender, dementia, absence of a partner and a limited level of mobility. The cut-off point was set at 30 points, with a sensitivity of 83.8%, a specificity of 64.7% and positive predictive value of 79.2%. Conclusion The DHP is a valid, simple and short instrument to be used at admission to predict discharge location of hip fracture patients

Resuscitation in hip fractures:A systematic review

To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality.DesignWe searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies.Outcome measuresMortality at 1 week, 30 days and 1 year following surgery.ResultsTwo hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture.ConclusionsPatients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients

A comparison of 3-D CT and 2-D plain radiograph measurements of the wrist in extra-articular malunited fractures of the distal radius

Two-dimensional (2-D) plain radiographs may be insufficient for the evaluation of distal radial malunion, as it is a three-dimensional (3-D) deformity. This study introduced a 3-D measuring method that outputs radial inclination, ulnar variance, palmar tilt and axial rotation. To this end, a standardized and clearly defined coordinate system was constructed that allowed 3-D measurements closely resembling the conventional 2-D method in 35 patients. Mean differences between 3-D and 2-D measurements in affected wrists were 1.8° for radial inclination, 0.8 mm for ulnar variance and 3.7° for palmar tilt. In addition, inter- and intra-observer reproducibility of all 3-D and 2-D measurements were good or excellent (intraclass correlation coefficient &gt;0.75), with 3-D reproducibility always better than 2-D. Axial rotation was present in all patients with a mean of 7.9° (SD 6.9). Although the differences between 2-D and 3-D measurements were small, 3-D evaluation enables the assessment of axial rotation and brings us closer to a routine 3-D evaluation of malunion.</p

Metal artefacts severely hamper magnetic resonance imaging of the rotator cuff tendons after rotator cuff repair with titanium suture anchors

BackgroundThe rate of retear after rotator cuff surgery is 17%. Magnetic resonance imaging (MRI) scans are used for confirmative diagnosis of retear. However, because of the presence of titanium suture anchors, metal artefacts on the MRI are common. The present study evaluated the diagnostic value of MRI after rotator cuff tendon surgery with respect to assessing the integrity as well as the degeneration and atrophy of the rotator cuff tendons when titanium anchors are in place.MethodsTwenty patients who underwent revision surgery of the rotator cuff as a result of a clinically suspected retear between 2013 and 2015 were included. The MRI scans of these patients were retrospectively analyzed by four specialized shoulder surgeons and compared with intra-operative findings (gold standard). Sensitivity and interobserver agreement among the surgeons in assessing retears as well as the Goutallier and Warner classification were examined.ResultsIn 36% (range 15% to 50%) of the pre-operative MRI scans, the observers could not review the rotator cuff tendons. When the rotator cuff tendons were assessable, a diagnostic accuracy with a mean sensitivity of 0.84 (0.70 to 1.0) across the surgeons was found, with poor interobserver agreement (kappa = 0.12).ConclusionsMetal artefacts prevented accurate diagnosis from MRI scans of rotator cuff retear in 36% of the patients studied.</jats:sec

A shape completion model for corrective osteotomy of distal radius malunion

Purpose When performing 3D planning for osteotomies in patients with distal radius malunion, the contralateral radius iscommonly used as a template for reconstruction. However, in approximately 10% of the cases, the contralateral radius is notsuitable for use. A shape completion model may provide an alternative by generating a healthy radius model based on theproximal part of the malunited bone. The aim of this study is to develop and clinically evaluate such a shape completionmodel.Method A total of 100 segmented CT scans of healthy radii were used, with 80 scans used to train a statistical shape model(SSM). This SSM formed the base for a shape completion model capable of predicting the distal 12% based on the proximal88%. Hyperparameters were optimized using 10 segmented 3D models, and the remaining 10 models were reserved for testingthe performance of the shape completion model.Results The shape completion model consistently produced clinically viable 3D reconstructions. The mean absolute errorsbetween the predicted and corresponding reference models in the rotational errors were 2.6 ± 1.7° for radial inclination, 3.6± 2.2° for volar tilt, and 2.6 ± 2.8° for axial rotation. Translational errors were 0.7 ± 0.6 mm in dorsal shift, 0.8 ± 0.5 mmin radial shift, and 1.7 ± 1.1 mm in lengthening.Conclusion This study successfully developed a shape completion model capable of reconstructing healthy 3D radius modelsbased on the proximal bone. The observed errors indicate that the model is viable for use in 3D planning for patients lackinga healthy contralateral radius. However, routine use in patients with a healthy contralateral radius is not yet advised, as errormargins exceed bilateral differences observed in healthy populations. The most clinically relevant error found in the model,length mismatch, can be easily corrected during 3D planning if the ipsilateral ulna remains intact