Biomedical subjects

P Krueger

Publications and source records attributed to P Krueger.

At least 19 recordsLinked to original sources

PubMed1997

Detecting and managing elder abuse: challenges in primary care. The Research Subcommittee of the Elder Abuse and Self-Neglect Task Force of Hamilton-Wentworth.

OBJECTIVE: To determine family physicians' perceptions of barriers and strategies in the effective detection and appropriate management of abused elderly people. DESIGN: Questionnaire survey; the protocol included an advance notification letter and 3 follow-up mailings. SETTING: Regional Municipality of Hamilton-Wentworth, Ont. PARTICIPANTS: All active nonspecialist physicians who reported seeing elderly patients in their practices were eligible for inclusion. Fifty health service organization (HSO) physicians were randomly selected from among those listed with the HSO Mental Health Program, and 200 fee-for-service physicians were randomly selected from the Canadian Medical Directory. Of the 189 eligible physicians 122 returned completed questionnaires, a response rate of 65%. OUTCOME MEASURES: Physicians' ratings of the importance of potential barriers in assisting older people experiencing abuse and of the usefulness of strategies for dealing with elder abuse. RESULTS: Physicians identified the following barriers as fairly or very important: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. Strategies deemed to be helpful included a single agency to call, a directory of services, a list of resource people, an educational package, guidelines for detection and management, reimbursement for time spent on legal matters, continuing education, revision of fee structure and a central library of resources on elder abuse. CONCLUSION: Although the physicians perceived numerous barriers to their detection and management of elder abuse, they identified many strategies that could be implemented at a local level. Preparation of an algorithm to help physicians is the next phase of this work.

Aged↗

PubMed1997

A review of risk factors for child pedestrian injuries: are they modifiable?

PURPOSE: To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES: (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION: All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT: Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION: Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS: A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS: Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.

Accidents, Traffic↗

PubMed1993

Locomotion of aged rats: relationship to neurochemical but not morphological changes in nigrostriatal dopaminergic neurons.

Spontaneous locomotion and motor coordination was evaluated in young (5-6 month old) and aged (24-25 month old) rats. Animals were tested for spontaneous locomotor activity in Digiscan Animal Activity Monitors during the nocturnal cycle. Aged animals exhibited a significant hypoactivity compared to their young counterparts. Evaluation of the time course of activity revealed that the young animals had a cyclical pattern of activity during the 12-hour testing period with clear peaks at 2-4 hours after the initiation of testing and at 8- to 10-hour intervals thereafter. In contrast, the aged animals exhibited a blunted initial activity peak. During the remainder of the test period the aged animals activity was stable with no further peaks in activity. Compared to the young animals the aged animals also (a) remained suspended from a horizontal wire for less time, (b) were unable to descend a wooden pole covered with wire mesh in a coordinated manner, (c) fell more rapidly from a rotating rod and (d) were unable to maintain their balance on a series of wooden beams with either a square or rounded top of varying widths. Histological analysis demonstrated that there was no reduction in the number, area, or length of tyrosine hydroxylase-immunoreactive neurons within the A8, A9, or A10 region of the aged animals. Neurochemical analysis revealed that while DA and HVA levels were not decreased in the aged rats, DOPAC levels, as well as the ratios of DA/DOPAC and DA/HVA, were decreased. These results indicate that neurochemical but not morphological changes within the nigrostriatal dopaminergic system underlie the deficits in motor behavior observed in aged rats.

Aging↗

PubMed1992

[Pelvic girdle fractures--must they be stabilized?].

Osteosynthesis can only be successful in the pelvis if one has a biomechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function here. For assessing stability and classifying the traumatic patterns it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern one can distinguish three subtypes. Type 1 is treated conservatively while types 2 and 3 require surgical treatment. The traumatic patterns and treatment techniques applied are described clearly and with good illustrations.

Biomechanical Phenomena↗

PubMed1991

[Knee joint hemarthrosis. An absolute indication for operation?].

The degree of severity of an injury of the knee joint is estimated mainly on the basis of the history given by the patient, stability testing and hemarthrosis. Once these are known the surgeon usually decides whether an arthroscopy should be done or not. In a group of 365 patients who had undergone arthroscopy after acute knee injury, we made a retrospective check of the indications. The purpose of the study was to evaluate the sensitivity of hemarthrosis as an indicator of severe injury of the knee joint necessitating operative treatment. For stability testing we used the varus and valgus stress test, the Lachman test, the Anterior drawer test, the pivot shift test and the anterior drawer test with medial and lateral rotation. The Lachman test was repeated under general anesthesia in the majority of patients just before the arthroscopy. The results were evaluated retrospectively with the aid of electronic data processing. In nearly 70% of cases the arthroscopy was indicated because of positive signs of instability together with a typical history provided by the patient or hemarthrosis. In another 27%, the hemarthrosis was the sole reason for the surgeon's decision to perform an arthroscopic investigation of the injured knee joint. In 80.5% of all cases the clinical diagnosis of lesion of the anterior cruciate ligament (ACL) or combined injury to ligaments and menisci was confirmed by the arthroscopy. In addition to this group, in another 10.8% we found other severe lesions necessitating by operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Arthroscopic cruciate ligament reinsertion and augmentation. Indications--surgical technic].

The advantages of arthroscopic refixation and augmentation of the cruciate ligament in comparison to open methods are conserving innervation of the most important structures of the knee joint, a clear-cut reduction in morbidity, and more rapid rehabilitation of the knee joint. In principle, however, as far as ligament replacement and fixation of the augmented ligament parts are concerned, the technique corresponds to the open method. As the early results refer to a period of 2 years at most, however, it is too soon to report them. Nevertheless, the results of follow-up in our present study are identical to those previously reported by other authors.

Arthroscopes↗

PubMed1990

[Cervical transverse spinal cord injury caused by knife stab injury].

This clinical report refers to a case of quadriplegia caused by a knife stab wound in the cervical spine. Open removal of the knife made it possible to avoid such complications as bleeding and infection. Nevertheless, the tetraplegic signs and symptoms were the result of complete severance of the cervical spinal cord and therefore persisted.

Adult↗

PubMed1990

[Expanded trans-pedicular spongiosa grafting--dorsal approach to filling of the intervertebral spaces with cancellous bone].

Internal fixation of dorsolumbar spinal fractures can be accomplished by dorsal plating or internal fixator. So far, the technique of transpedicular grafting has been applied to fill the vertebral body with cancellous bone. In this paper, we present a new technique of extended transpedicular bone grafting to fill the intervertebral space also. By this means, the disadvantage of secondary loss of height after removal of the metal implants can be prevented.

Bone Plates↗

PubMed1989

[Fractures of the spine].

The standard treatment for stable fractures of the spine is functional. Owing to the improvement of surgical methods and special implants, the percentage of operatively treated spine fractures has increased from 10% to 20%. In contrast to the necessity for multisegmental fixation with the rod instruments used formerly, the recently developed implants (plates, fixators) allow stable, brief, and therefore functionally more favourable immobilization.

Fracture Fixation, Internal↗

PubMed1989

[Changes and progress in surgical treatment of fractures of the pelvic ring and acetabulum].

The diagnosis and treatment of pelvic fractures and dislocations demand that the pelvic girdle and the acetabulum be examined separately. Fractures of the pelvic girdle are present in more than 60% of cases but have to be stabilized only in 9%, in contrast to acetabular fractures, which need to be reduced and internally fixated in 55%. Combined fractures need surgical management in 66% of cases. Fractures of the pelvic girdle are best diagnosed by means of plain radiograms and computed tomograms to distinguish posterior instability. These techniques are the basis of the treatment plan for external or internal fixation. External fixation is an effective method from the aspect of hemorrhage control but not sufficient to avoid postoperative pain. Early open reduction and internal anterior and posterior fixation is the treatment of choice if good rehabilitation is to be achieved. Acetabular fractures occur mostly in young patients. Only accurate articular reduction of displaced fractures can bring about a good functional result, as this minimizes posttraumatic arthritis. Radiological evaluation is done with three standard views: 1. A. P. X-ray of the pelvis; 2. oblique view of the obturator; 3. oblique view of the ilium. When those are considered in combination with a CT scan, acetabular fractures can be classified. The Letournel classification is extremely important for reduction and fixation, as no one surgical approach has been found that is satisfactory for all acetabular fractures. Internal stabilization is provided with single screws and plates.

Acetabulum↗

PubMed1989

[Changes and progress in the treatment of fractures of the coxal end of the femur].

Consideration of technical developments, a review of the literature and of our own experience with 535 patients compared with nearly 20,000 patients of an ASIF population treated during the same period show that the indications for treatment of extra- and intracapsular fractures of the proximal femur have become much simpler. (1) Extracapsular fractures of the proximal femur fall into two groups: pertrochanteric fractures are fixed by means of the dynamic hip screw and intratrochanteric unstable fractures by means of either the dynamic hip screw (valgus type) or a 95 degrees condylar plate. (2) Intracapsular fractures are treated according to the patient's age group. In patients younger than 70 years femoral head preservation is achieved by compressing screw osteosyntheses, while in patients over 70 years head resection is performed an a total endoprothesis inserted. In patients with life expectation shorter than 3-5 years a femoral head prothesis is inserted.

Aged↗

PubMed1988