Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden - A prospective observational study.

BACKGROUND: Little is known about accuracy of common risk prediction scores in elderly patients suffering from hip fractures. The objective of this study was to investigate accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, Portsmouth-POSSUM (P-POSSUM) score and the Nottingham Hip Fracture Score (NHFS) for prediction of mortality and morbidity in this patient group. METHODS: This was a prospective single centre observational study on 997 patients suffering out-of-hospital cervical, trochanteric or subtrochanteric fracture of the neck of the femur. Calibration and discrimination was assessed by calculating the ratio of observed to expected events (O:E) and areas under receiver operating characteristics curves (ROC). RESULTS: The 30-day mortality was 6.2% and complications, as defined by POSSUM, occurred in 41% of the patients. Overall O:E ratios for POSSUM, P-POSSUM and NHFS scores for 30-day mortality were 0.90, 0.98, and 0.79 respectively. The models underestimated mortality in the lower risk bands and overestimated mortality in the higher risk bands. In contrast, POSSUM predicted morbidity well with O:E ratios close to unity in most risk bands. The areas under the ROC curves for the scoring systems was 0.60-0.67. CONCLUSION: The POSSUM score and NHFS show moderate calibration and poor discrimination in this cohort. The results suggest that mortality and morbidity in hip fracture patients are largely dependent on factors that are not included in these scores.

Cochlear implantation of Danish prelingually deaf children.

The aim of the study was to review the indications, techniques and results of cochlear implant (CI) treatment with the Nucleus CI multi-channel electrode for the first children operated on in Denmark. The study material comprised 16 children (5 girls, 11 boys). Their median age at the time of CI operation was 27 months. Anacusis was caused by pneumococcal meningitis in 31% of the children in this relatively young prelingual material. Obliteration of the cochlea was found in two children, indicating the need for surgery as soon as possible after the verification of post-meningitis, total deafness. There were no technical difficulties with operating on the youngest children in the congenital group and the age of 2 years is optimal for implantation. These preliminary results have contributed definitively to an increase in the number of cochlear implantations being carried out in young prelingually deaf Danish children.

[Cochlear implantation in children. The first Danish results]. / Cochleaimplantation hos børn. De første danske resultater.

The aim of this study is to review indication, technique and results of cochlear implant (CI) treatment with Nucleus CI-multi-electrode of the first ten children operated in Denmark (five children with congenital deafness and five with acquired prelingual deafness due to meningitis). In the literature, the importance of early referral and operation at the age 2-3 (4) years for congenital deafness and as soon as possible on suspicion of acquired deafness (meningitis) is stressed. A short survey of our indications, technique and rehabilitation is presented. The results of treatment after 11-44 months' use of CI are that one child has language almost matching age, four use words and short sentences accompanied by support signing, three have sound reaction and say single words without sentence building, but of these two children have only used CI for a very short time and are improving. Two meningitis sequelae cases had cochlear ossification, which made the implantation difficult. Both patients had to be operated, and one of them is not using the processor.

The bone-anchored hearing aid. Osseointegration and audiological effect.

The results of treatment of the first 12 Danish patients with the Brånemark titanium implant system and the bone-anchored hearing aid (BAHA) are reported. All implants were osseointegrated, judged by 99mTC-scintigraphy, X-ray examination and clinical examination. Skin reactions were few, transient and short lasting. The patients experienced the BAHA to be superior to both conventional BC hearing aids and AC hearing aids in practically all respects. Speech discrimination scores in quiet and in noise were similar for the 3 types of hearing aids.

[Bone-anchored hearing aids. Preliminary results]. / Det knogleforankrede høreapparat (bone-anchored hearing aid). Praeliminaere resultater.

The bone conduction hearing aid is employed for patients who cannot tolerate treatment with air conduction hearing aids and for whom operation cannot offer permanent improvement of hearing. Conventional bone conduction hearing aids are, however, uncomfortable to wear, amplification is frequently less effective and sounds are often distorted. A new type of bone conduction hearing aid, the bone-anchored hearing aid (BAHA) is presented. In this, sound is transferred directly to the cranium via a percutaneous titanium implant. The results of treatment of the first six Danish patients are presented after a therapeutic period of 8-24 months. The subjective effect of treatment was satisfactory in all of the patients. They all employed their BAHA all day and found that the effect was better than the effect of air conduction hearing aids and conventional bone conduction hearing aids on practically all points. Speech discrimination investigations in quiet and noisy surroundings confirmed the subjective assessment although the differences between BAHA and the two other types of hearing aids were not as great as the patients subjective impressions. The bone-anchored hearing aid, BAHA, should, in our opinion, become the bone conduction hearing aid of the future for patients who have a permanent need for this. It represents considerable progress in treatment of a group of patients for whom treatment has hitherto been difficult and unsatisfactory.

Strategies for treatment of the hearing impaired child.

The goal of medical, educational and social intervention in the hearing impaired child is outlined. The results and suitability of the present available strategies are evaluated and it is stressed that a coordinated individualized effort must be planned according to audiological personal and social resources.

Psychological impact of amniocentesis on low-risk women.

The study comprised 85 young (25-34 years old) women who underwent genetic amniocentesis, 80 comparable young women who had an ultrasoundscan at the same gestational age and 74 women (35-40 years old) who had amniocentesis. The State-Trait Anxiety Inventory and Visual Analogue Scales concerning anxiety and worry were used on four occasions to evaluate psychological changes during pregnancy. The anxiety level in the younger women decreased after amniocentesis and a further decrease was observed after the results were communicated to them. However, similar changes were seen in the group of younger women after ultrasonography, and there was no difference in anxiety level between the two groups of younger women in the 16th or in the 35th week of pregnancy. Thus, in younger women at low genetic risk amniocentesis was neither anxiety-relieving, nor anxiety-creating. The level of anxiety before amniocentesis was not higher in the older than in the younger women having amniocentesis. However, in the younger women a significant decrease in anxiety was seen as soon as amniocentesis had been performed, while in the older women this decrease was delayed until after the results were known.