Dit briefadvies maakt eerst kort de balans op van twee jaar oorlog. Vervolgens constateert de Raad dat de westerse consensus brozer wordt, dat er kantelpunten in zicht zijn en dat een langdurige... Show moreDit briefadvies maakt eerst kort de balans op van twee jaar oorlog. Vervolgens constateert de Raad dat de westerse consensus brozer wordt, dat er kantelpunten in zicht zijn en dat een langdurige patstelling dreigt. De vraag naar een adequate Nederlandse opstelling dient zich aan, ook voor de nieuw aan te treden regering. Het adviesrapport benadrukt de noodzaak van onverminderde Nederlandse en Europese steun aan Oekraïne en geeft aan dat Nederland zich proactiever moet voorbereiden op verschillende scenario’s voor de oorlog in Oekraïne en actief dient te streven naar de meest wenselijke uitkomsten, waaronder een overwinning voor Oekraïne of een sterke onderhandelingspositie voor het land.Het advies bespreekt daarna zes thema’s in meer detail: 1) de Europese veiligheidsarchitectuur; 2) de Europese defensie-industrie; 3) het perspectief op Oekraïens EU-lidmaatschap; 4) Oekraïne’s wederopbouw; 5) de gevolgen van de oorlog voor het mondiale Zuiden; en 6) weerbaarheid en draagvlak. Deze bespreking leidt tot een korte conclusie en een zestal aanbevelingen. Show less
Purpose: Effects of clockwise torque rotation onto proximal femoral fracture fixation have been subject of ongoing debate: fixated right-sided trochanteric fractures seem more rotationally stable... Show morePurpose: Effects of clockwise torque rotation onto proximal femoral fracture fixation have been subject of ongoing debate: fixated right-sided trochanteric fractures seem more rotationally stable than left-sided fractures in the biomechanical setting, but this theoretical advantage has not been demonstrated in the clinical setting to date. The purpose of this study was to identify a difference in early reoperation rate between patients undergoing surgery for left-versus right-sided proximal femur fractures using cephalomedullary nailing (CMN). Materials and methods: The American College of Surgeons National Surgical Quality Improvement Program was queried from 2016-2019 to identify patients aged 50 years and older undergoing CMN for a proximal femoral fracture. The primary outcome was any unplanned reoperation within 30 days following surgery. The difference was calculated using a Chi-square test, and observed power calculated using post-hoc power analysis. Results: In total, of 20,122 patients undergoing CMN for proximal femoral fracture management, 1.8% (n=371) had to undergo an unplanned reoperation within 30 days after surgery. Overall, 208 (2.0%) were left-sided and 163 (1.7%) right-sided fractures (p=0.052, risk ratio [RR] 1.22, 95% confidence interval [CI] 1.00-1.50), odds ratio [OR] 1.23 (95%CI 1.00-1.51), power 49.2% (& alpha;=0.05). Conclusion: This study shows a higher risk of reoperation for left-sided compared to right-sided proximal femur fractures after CMN in a large sample size. Although results may be underpowered and statistically insignificant, this finding might substantiate the hypothesis that clockwise rotation during implant insertion and (post-operative) weightbearing may lead to higher reoperation rates. Level of evidence: Therapeutic level II. Show less
Dijkstra, H.; Oosterhoff, J.H.F.; Kuit, A. van de; Ijpma, F.F.A.; Schwab, J.H.; Poolman, R.W.; ... ; Hendrickx, L.A.M. 2023
Aims To develop prediction models using machine-learning (ML) algorithms for 90 -day and oneyear mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip... Show moreAims To develop prediction models using machine-learning (ML) algorithms for 90 -day and oneyear mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip fracture Evaluation with Alternatives of Total Hip arthroplasty versus Hemiarthroplasty (HEALTH) and Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trials.Methods This study included 2,388 patients from the HEALTH and FAITH trials, with 90 -day and oneyear mortality proportions of 3.0% (71/2,388) and 6.4% (153/2,388), respectively. The mean age was 75.9 years (SD 10.8) and 65.9% of patients (1,574/2,388) were female. The algorithms included patient and injury characteristics. Six algorithms were developed, internally validated and evaluated across discrimination (c-statistic; discriminative ability between those with risk of mortality and those without), calibration (observed outcome compared to the predicted probability), and the Brier score (composite of discrimination and calibration).Results The developed algorithms distinguished between patients at high and low risk for 90 -day and one -year mortality. The penalized logistic regression algorithm had the best performance metrics for both 90 -day (c-statistic 0.80, calibration slope 0.95, calibration intercept-0.06, and Brier score 0.039) and one -year (c-statistic 0.76, calibration slope 0.86, calibration intercept-0.20, and Brier score 0.074) mortality prediction in the hold -out set.Conclusion Using high-quality data, the ML -based prediction models accurately predicted 90 -day and one -year mortality in patients aged 50 years or older with a FNF. The final models must be externally validated to assess generalizability to other populations, and prospectively evaluated in the process of shared decision-making. Show less
Pelupessy, I.; Werkhoven, B. van.; Elteren, A.K. van.; Viebahn, J.; Candy, A.; Portegies Zwart, S.F.; Dijkstra, H. 2016
