Hip protectors to prevent hip fractures - a waste of time and money?

Abstract:
Background: An estimated 30-60% of older
adults fall every year and about 1% of falls result in a hip fracture. Hip fracture is a serious and growing problem, with a 3-10 fold rise in worldwide incidence predicted by 2050 (Gullberg, et al 1997). Hip protectors are underwear with built in protection for the greater trochanter. They are designed to prevent hip fractures by dispersing or absorbing the force of a fall. Trials
published to 2001 were broadly supportive of
the effectiveness of hip protectors, and this
was reflected in a Cochrane review in 2000.
However, earlier trials were methodologically
flawed and subsequent trials have not demonstrated effectiveness. The most recent Cochrane review describes only a marginal benefit (Parker et al, 2005).
Review and Discussion: This presentation
evaluates the current evidence for the use
of hip protectors and discusses the use of
that evidence by manufacturers, suppliers,
professional groups and guideline developers.
Interestingly, despite the limitations of the
evidence base, most advice has been broadly
supportive. Reasons for this are proposed
and discussed in the context of a critique of
evidence-based healthcare. protectors. However, the available evidence can be used in different ways and for different purposes by those with an interest in promoting
the use of hip protectors. A conservative
approach is warranted, where, if we cannot
demonstrate that hip protectors work, we
presume that they do not. This presentation will be of use to practitioners wanting to evaluate the evidence base for hip protectors (and other recommended interventions) on behalf of clients. It will also be of interest to policy makers who must assess the claims made for health care technologies as part of the decisionmaking process.
Recommended reading:
Gullberg B, Johnell O, Kanis JA (1997) Worldwide
projections for hip fracture. Osteoporos
Int. 7(5):407-13 .
Parker MJ, Gillespie WJ, Gillespie LD (2005) Hip
protectors for preventing hip fractures in older
people. The Cochrane Database of Systematic
Reviews Issue 3. Art. No.: CD001255.pub3. DOI:
10.1002/14651858.CD001255.pub3.

On Not Reading Fifty Shades:Feminism and the Fantasy of Romantic Immunity

This paper explores the politics of feminist criticism of the Fifty Shades novels as seen in both traditional media commentary and popular online news and cultural websites and blogs. I argue that much media commentary, in broadsheet and other ‘respectable’ outlets particularly, has featured avowedly feminist writers dismissing the books as ‘bad’, not only containing bad writing and bad sex but, ultimately, as being bad for their women readers. Situating these responses within a history of feminist discomfort with popular erotic and romantic fiction marketed to women I read these responses as a form of ‘anti-romantic’ fantasy in which the reader/critic is able to assert both her immunity from the romantic fantasy offered in the text and her cultural distance from those women who are subject to it. Further, this act of disavowal is often linked to a professed concern for the women who read the novel who the critic argues will, inevitably, replicate the abusive and harmful relationship dynamics that the novel represent. Such a move then positions the feminist critic as not only more culturally intelligent than women readers of the novel but enacts a fantasy of respectable, middle-class feminist cultural custodianship. Such a fantasy, I argue, is connected to the post-feminist era in which we live, which has produced a class of self-appointed ‘feminist’ cultural critics who seek to contest their own cultural marginalisation through enacting a governmental authority to worry about other women. This paper, therefore, is a critical investigation of the pleasures and politics of very publicly not reading Fifty Shades and its significance for analysing the contemporary politics of popular culture and feminism.

Peer tutoring in reading in Scotland:Thinking big

A large-scale randomised-controlled trial of reading tutoring in 80 schools in Scotland used the Paired Reading (PR) technique. On long-term evaluation, cross-age PR was significantly better than regular teaching, but same-age was not. On short-term evaluation, PR pupils did significantly better than control pupils in both years, and cross-age and same-age were similarly effective. Low socio-economic pupils, lower reading ability pupils, girls and reading with maths tutoring groups did significantly better. Implementation was good in parts, but some important aspects of technique were rare. Reading gains were significantly greater for those with mistakes about every 2 minutes and those who stopped reading to talk every 5 to 7 minutes. Significant gains in self-esteem were seen in same-age and cross-age groups, and for tutees and tutors, but not for controls. The relationship of achievement gain to quality of technique and socio-emotional gains is discussed, with implications for practice. Copyright © 2011 UKLA.

The potential impact of undiagnosed vision impairment on reading development in the early years of school

This paper presents a critical review of the literature surrounding the potential impact of undiagnosed and untreated vision impairment on reading development in the early years of primary school. Despite pre-school screening programmes, it is still possible for children to enter school with undiagnosed, uncorrected vision impairments. This can be due to health care access issues for children. Data reviewed indicated correlations between hyperopic vision impairment and poor reading development. However, the relationships reported remain complex, with myopic vision impairment being reported to correlate to high reading ability in some studies. In addition, correlation does not necessarily imply causation. Previous research in the field is reported. Deficiencies in the current literature base are discussed. Finally, recommendations for teaching practice and the nature of research that explores whether vision impairment is the cause of poor reading development for some children in school is suggested.

What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).

Methods/Findings

We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.

Conclusions

EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

Mathematics background of engineering students in Northern Ireland and Finland

The Organisation for Economic Co-operation and Development investigated numeracy proficiency among adults of working age in 23 countries across the world. Finland had the highest mean numeracy proficiency for people in the 16 – 24 age group while Northern Ireland’s score was below the mean for all the countries. An international collaboration has been undertaken to investigate the prevalence of mathematics within the secondary education systems in Northern Ireland and Finland, to highlight particular issues associated with transition into university and consider whether aspects of the Finnish experience are applicable elsewhere. In both Northern Ireland and Finland, at age 16, about half of school students continue into upper secondary level following their compulsory education. The upper secondary curriculum in Northern Ireland involves a focus on three subjects while Finnish students study a very wide range of subjects with about two-thirds of the courses being compulsory. The number of compulsory courses in maths is proportionally large; this means that all upper secondary pupils in Finland (about 55% of the population) follow a curriculum which has a formal maths content of 8%, at the very minimum. In contrast, recent data have indicated that only about 13% of Northern Ireland school leavers studied mathematics in upper secondary school. The compulsory courses of the advanced maths syllabus in Finland are largely composed of pure maths with a small amount of statistics but no mechanics. They lack some topics (for example, in advanced calculus and numerical methods for integration) which are core in Northern Ireland. This is not surprising given the much broader curriculum within upper secondary education in Finland. In both countries, there is a wide variation in the mathematical skills of school leavers. However, given the prevalence of maths within upper secondary education in Finland, it is to be expected that young adults in that country demonstrate high numeracy proficiency.

Discursive Control, Non-Domination and Hegelian Recognition Theory: Marrying Pettit’s Account(s) of Freedom with a Pippinian/Brandomian Reading of Hegelian Agency

The aim of this article is to combine Pettit’s account(s) of freedom, both his work on discursive control and on non-domination, with Pippin’s and Brandom’s reinterpretation of Hegelian rational agency and the role of recognition theory within it. The benefits of combining these two theories lie, as the article hopes to show, in three findings: first, re-examining Hegelian agency in the spirit of Brandom and Pippin in combination with Pettit’s views on freedom shows clearly why and in which way a Hegelian account of rational agency can ground an attractive socio-political account of freedom; second, the reconciling of discursive control and non-domination with Hegelian agency shows how the force and scope of recognition become finally tangible, without either falling into the trap of overburdening the concept, or merely reducing it to the idea of simple respect; third, the arguments from this article also highlight the importance of freedom as non-domination and how this notion is, indeed, as Pettit himself claims, an agency-freedom which aims at successfully securing the social, political, economic and even (some) psychological conditions for free and autonomous agency.

How much do you need: a randomised experiment of whether readers can understand the key messages from summaries of Cochrane Reviews, without reading the full review?

Objective: We explored whether readers can understand key messages without having to read the full review, and if there were differences in understanding between various types of summary.
Design: A randomised experiment of review summaries which compared understanding of a key outcome.
Participants: Members of university staff (n = 36).
Setting: Universities on the island of Ireland.
Method: The Cochrane Review chosen examines the health impacts of the use of electric fans during heat waves. Participants were asked their expectation of the effect these would have on mortality. They were then randomly assigned a summary of the review (i.e. abstract, plain language summary, podcast or podcast transcription) and asked to spend a short time reading/listening to the summary. After this they were again asked about the effects of electric fans on mortality and to indicate if they would want to read the full Review.
Main outcome measure: Correct identification of a key review outcome.
Results: Just over half (53%) of the participants identified its key message on mortality after engaging with their summary. The figures were 33% for the abstract group, 50% for both the plain language and transcript groups and 78% for the podcast group.
Conclusions: The differences between the groups were not statistically significant but suggest that the audio summary might improve knowledge transfer compared to written summaries. These findings should be explored further using a larger sample size and with other reviews.