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1.
BMC Musculoskelet Disord ; 15: 39, 2014 Feb 11.
Article de Anglais | MEDLINE | ID: mdl-24517194

RÉSUMÉ

BACKGROUND: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery. METHODS/DESIGN: The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION: Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture. TRIAL REGISTRATION: The trial is registered at the Netherlands Trial Register (NTR3617).


Sujet(s)
Ostéosynthèse/méthodes , Consolidation de fracture , Fractures de l'humérus/thérapie , Plan de recherche , Activités de la vie quotidienne , Protocoles cliniques , Analyse coût-bénéfice , Évaluation de l'invalidité , Ostéosynthèse/économie , Coûts des soins de santé , Humains , Fractures de l'humérus/diagnostic , Fractures de l'humérus/économie , Fractures de l'humérus/physiopathologie , Fractures de l'humérus/chirurgie , Pays-Bas , Mesure de la douleur , Études prospectives , Récupération fonctionnelle , Reprise du travail , Enquêtes et questionnaires , Facteurs temps , Résultat thérapeutique
2.
Am Ann Deaf ; 151(3): 336-44, 2006.
Article de Anglais | MEDLINE | ID: mdl-17087444

RÉSUMÉ

Empirical data on the development of interaction, communication, and language in deafblind children is very rare. To fill this gap, a case study was conducted in which the interaction between a teacher and a deafblind boy age 3 years 4 months was analyzed. Sequential analysis of their interaction confirmed some general clinical impressions about interaction with deafblind children, and provided the basis for suggestions on how the interaction pattern might be changed.


Sujet(s)
Surdité-cécité/psychologie , Corps enseignant , Relations interpersonnelles , Personnes malentendantes/psychologie , Personnes malvoyantes/psychologie , Enfant d'âge préscolaire , Surdité-cécité/physiopathologie , Humains , Mâle , Analyse multifactorielle , Enregistrement sur magnétoscope
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