Search

Aim: There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population., Methods: All eligible babies born at Kongsberg Hospital, Norway, from 1998 to 2006 (n = 4245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvres and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989 to 1997 prestudy period (n = 3594), including late diagnoses, were collected from hospital records., Results: Treatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the prestudy period. The follow-up rate did not change (11%). There were two (0.5/1000) and four (1.0/1000) cases detected late, respectively. No one underwent surgery during the first year of life and no avascular necrosis was seen., Conclusion: Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases., (©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

This study was designed to evaluate the potential of simultaneous communication (sign and speech together) to support classroom learning by college students who use cochlear implants (CIs). Metacognitive awareness of learning also was evaluated. A within-subjects design involving 40 implant users indicated that the student participants learned significantly more when material was presented via simultaneous communication than spoken language overall, but a statistical interaction indicated that the difference held only with more difficult material. Learning in the speech-only condition was positively related to the students' spoken language skills, their confidence with spoken language, and their receptive simultaneous communication skills. Learning in that condition was negatively related to the age at which the participants learned to sign. Findings were interpreted to indicate that simultaneous communication can be beneficial for classroom learning by college students with CIs, at least with more complex material or when information redundancy is otherwise important. Further research is needed to determine who is likely to benefit in what settings.

In the December issue of the Nederlands Tijdschrift voor Tandheelkunde (Dutch Journal of Dentistry) in 2014, an article was devoted to the use of light sedation with midazolam by dentists. A number of dentists who are active in the area of Special Dentistry (anxiety management, care of the disabled) and a anesthesiologist offer a response to the article and argue that the administration of intravenous sedation with midazolam by dentists is unsafe.

Background: Norwegian law requires all health institutions to have programmes in place for systematic surveillance of infections. Recording of wound infections is mandatory in surgical departments. We here present data from seven years of follow-up at a local hospital., Material and Methods: 2,421 patients, who comprised the study population, underwent orthopaedic procedures (acute or elective) from 1.2.1998 through 31.12.2004. Patients with orthopaedic implants were followed up for 12 months after the operation and other patients for four weeks. Quarterly reports were prepared and preventive measures undertaken., Results: One patient was lost to follow-up. 158 infections (mean: 6.5% of the patients, annual variation: 4.8-10.5%) were recorded; 56 of these were deep (2.3% of the patients) and 102 superficial. 28 of the deep infections occurred in primary hip replacement operations. The incidence of infections during three months varied from 1.6% to 8.9%. 72% of the infections were discovered after hospital discharge. Deep hip infections were detected from six days up to 18 months post-operatively. Multivariate analysis showed a positive correlation between surgeon and deep hip infection in primary hip replacement surgery., Discussion: Systematic recording of post-operative wound infections is a time-consuming, but important quality assurance measure. Recording should be carried out for one year in hip replacement surgery and for at least four weeks after other operations. The incidence of infections varies largely during three months and long-term recording is required to obtain valid data in a single hospital. Deep infections in primary hip replacement surgery may be operator-dependant.

Background: The prevailing strategy concerning ultrasound screening for DDH in newborns in Norway does not intercept all who should be treated. In recent years typical rates for hospital treatment of late hip dislocations in newborn have been 15-20 cases. By universal ultrasound examination, 10-20 % of the newborns present with "physiological immature" hips. By this we mean hips with subnormal ultrasound values that will normalise in the course of the neonatal period. An agreed basis of defined and standardised criteria in order to diagnose and treat physiological immature hips is required. We hope tat this study will contribute to the final solution to these questions., Material and Methods: Over the period 1 February 1998 through 2002 we had 2466 alive newborns at our hospital. 26 were directly transferred to another hospital, 130 were left out because of limited skills or inadequate training in ultrasound among temporary staff. The hips have been graduated morphologically in accordance with Graf's alpha angle. All newborns have been investigated by ultrasound and clinical examination with Ortolani/Barlow test 1-3 day after birth. Those with diagnosed dysplasia (alpha < 50 masculine) and those with positive clinic and physiological immature hip were immediately treated with Frejka pillow. Those with negative clinic and physiological immature hip were revaluated after 4 weeks by ultrasound, and those still immature were given Frejka pillow. Duration of pillow treatment was 4 months, followed by further clinically and radiological surveillance. All infants given the pillow treatment were clinically examined 2-3 months after they were able to walk without support, and again 1-5 years later radiologically., Results: Of the newborn, 31 (1.3%) had a positive Ortolani/Barlow test. Among them, 7 had dysplasia, 20 immature hip; 4 were normal. Among the 2275 infants with normal clinic, 9 had dysplasia and 232 (10.9%) had at least one physiological immature hip. After 4 weeks, 26 still had immature hip by ultrasound evaluation. A total of 62 infants (2.7%) were treated with Frejka pillow. At the "walk alone" control and the radiological control 1-5 years later, there were no pathological findings, specially no sign of aseptic necrosis. In the total material we had 2 girls with late subluxations, detected at the age of 8 and 10 months. Both had normal clinic with an ultrasound immature hip at birth. They should have been followed up, but were missed, for uncertain reasons. Both attained normal hips after treatment., Conclusion: Our study of universal ultrasound screening for DDH of the hips in newborns shows that 1 % of the infants born with normal hips clinically still have physiological immature hips at the age of 4 weeks. Taking those into account as potentially dysplastic, it gives an overall treatment rate of 2.7%. Today, the only possible way to intercept those physiological immature hips that will not normalise is by universal ultrasound examination. For these children, early treatment with Frejka pillow is effective, without any risk of iatrogenic injury.