Most orthopaedic surgeons have met patients with poor shoulder function after a proximal humerus fracture, and many of us have thought: if I’ve only done the other thing I was thinking of…. Unfortunately the outcome seems to be independent of what we do, at least according to Launonen et al’s meta-analysis and Rangan et al’s recent RCT on 250 patients. Continue reading
In a recent RCT by Gregersen et al. they manage to complicate blood transfusions in orthopaedic patients even further. They suggest that orthopaedic patients from nursing homes fare better with liberal blood transfusions (> 113 g/L compared to >97 g/L). The concept is interesting, although the paper has some issues. Continue reading
Continuing on the theme of #2MuchMed (see BMJ’s campaign) I figured it may be worth highlighting two recent studies on stable compression fractures of the spine. Both failed to show any benefit with standard bracing treatment. As some patients experience the brace as claustrophobic and uncomfortable (from my own patients’ experience), I’m thrilled to have this option available. Continue reading
As I have a weakness for studies that challenge the dogma, I was ecstatic when I stumbled upon Carson et al.’s bold study on blood transfusions. In their study they selected 2000 patients with cardiovascular disease that were undergoing surgery due to hip fracture. Interestingly, there was no difference in 3-year mortality when randomizing between transfusion Hemoglobin thresholds of 100 g/L or 80 g/L! Continue reading
One of the successful insights to training neural networks has been the rectified linear unit, or short the ReLU, as a fast alternative to the traditional activation functions such as the sigmoid or the tanh. One of the major advantages of the simle ReLu is that it does not saturate at the upper end, thus the network is able to distinguish a poor answer from a really poor answer and correct accordingly.
A modification to the ReLU, the Leaky ReLU, that would not saturate in the opposite direction has been tested but did not help. Interestingly in a recent paper by the Microsoft© deep learning team, He et al. revisited the subject and introduced a Parametric ReLU, the PReLU, achieving superhuman performance on the imagenet. The PReLU learns the parameter α (alpha) and adjusts it through basic gradient descent.
In this tutorial I will benchmark a few different implementations of the ReLU and PReLU together with Theano. The benchmark test will be on the MNIST database, mostly for convenience. Continue reading
I recently e-mailed Freakonomics asking them to look into the economic incentives that govern health-care. Guess if I was thrilled when I found these two recent gems (although I can’t take any credit):
- How Do We Know What Really Works in Healthcare?
- How Many Doctors Does It Take to Start a Healthcare Revolution?
Freakonomics delivers as always with a fresh, interesting scientific perspective. As a supporter since a few years I want to recommend these to anyone interested in the topic. As I have written earlier, I find it perplexing that so many arthroscopies are being performed while so much evidence is pointing against this. There is probably a vast combination of incentives that result in this, these podcasts provide some nice insights.
htmlTable-function has perhaps been one of my most successful projects. I developed it in order to get tables matching those available in top medical journals. As the function has grown I’ve decided to separate it from my Gmisc-package into a separate package, and at the time of writing this I’ve just released the 1.3 version. While
htmlTable allows for creating plain tables without any fancy formatting (see usage vignette) it is primarily aimed at complex tables. In this post I’ll try to show you what you can do and how to tame some of the more advanced features. Continue reading
Costa et. al. performed recently a multi-center study including 18 trauma centers throughout the United Kingdom. They randomized patients with distal radius fractures to volar locking plates or Kirschner wires. They managed to randomize 461 patients and follow-up 90% after 1 year using self-reported scores. They could not find any difference after 1 year regarding their primary outcome, PRWE-score (−1.3 points, 95% CI -4.5 to 1.8). This was well below their stipulated minimally clinically important difference of 6 points. Could this be the end of the volar locking plate era? Continue reading
Today is a good day to start parallelizing your code. I’ve been using the parallel package since its integration with R (v. 2.14.0) and its much easier than it at first seems. In this post I’ll go through the basics for implementing parallel computations in R, cover a few common pitfalls, and give tips on how to avoid them. Continue reading
One, never-ending thread on this blog seems to be the degenerative meniscus. Gauffin et al. recently published a randomized controlled trial comparing surgery vs physiotherapy with favorable results for surgery regarding pain. Could this be the turnaround for one of the most controversial, but common orthopaedic procedures? Continue reading