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Biomedical subjects

L Dubs

Publications and source records attributed to L Dubs.

At least 19 recordsLinked to original sources
PubMed2004

Condition-specific outcome measures for low back pain. Part II: scale construction.

A literature review of the most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. In part I, technical issues such as validity, reliability, availability and comparability were analyzed for the nine most widely used outcome tools. This second part focuses on the content and wording of questions and answers in each of the nine questionnaires, and an analysis of the different score results is performed. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaires.

Disability Evaluation↗
PubMed1999

[Everything was done--patient still not satisfied: introduction to evidence-based surgery].

Although the best knowledge in academic medicine has been used, some patients are still unsatisfied. By reason of these experiences there is a certain need to reflect our patterns of thinking. The surgical act is based on the laws of causality from Newton and Galilei and it is determined by the principle of cause and effect. Therefore the healing process must be interpreted as a turning back of pathogenesis or the linear chain of causalities. Scientific knowledge of this century demonstrate, that biologic healing processes are connected with the laws of cybernetics and the principles of semiotics. There are functional relations between the level of the organ (impairments) of the individual (disabilities) and of the society (handicaps). This International Classification of Impairments, Disabilities and Handicaps (ICIDH) serves as the key for the management of chronic diseases. An independent and a separate classification of the severity in each level is necessary to identify the consequences of the disease to the patient. Surgical interventions occur on the organ level, benefit and evidence are reflected especially on the individual level (gain of abilities). The assessment and the integration of the so called "sensory impairment", influenced by the biographical events of the patient, an the evaluation of the psychosocial resistance are important factors to recognize a unfavourable conformity between the degree of impairment and the degree of disability. With this classification a more patient-oriented discussion of the indications regarding operative procedures can be realised. The MARA model (mean age related ability) serves as a pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve as ethical guideline. This model, which is derived on ICIDH, the hierarchy of needs and the salutogenesis (semiotics, cybernetics), facilitate the introduction of evidence based surgery. It helps to estimate the several predictive values and correlation factors influencing the manifestation of the disease. On this way astonishing results in evidence can be expected. Finally many misunderstandings in health care discussions are explained by the fact that the differences between pathology and illness are not clearly interpreted.

Adult↗
PubMed1998

Der Patient als Experte.

Patients as Experts: Determining Benefit by Using Assessments of Ability (ICIDH)When health economy and quality mangement are dealing with the cost-benefit relationship, to this day description, calculation, and assessment of the benefit are missing to a great extent. Deliberations in terms of cause and effect do not go beyond the model of pathogenesis (etiology - pathology - manifestation) and descriptions on the organ level (ICD). Only the international classification of impairments, disabilities, and handicaps (ICIDH) as a separate estimation of the resulting manifestations of illness on the levels of organ, individual, and society is capable to elucidate this benefit. It is the patient who is the expert to decide what he needs, what he wants, and what he can do, thus, evaluating on an individual level his loss of capability. The ICIDH is regarded as the key for the management of chronic diseases. The characteristics of being chronically ill require the integration of salutogenesis and the consideration of the hierarchy of needs. The specially developed MARA model serves as pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve (mean age-related ability) as ethical guideline. In quality circles the MARA model, which is based on ICIDH, hierarchy of needs and salutogenesis, can offer apatient-oriented basis of discussion for benefit assessments, and, in a pragmatical way, it can facilitate the introduction of evidence-based medicine. By the change of view from the organ level with multifactorial aspects to the individual level, in which the abilities can be understood as a monofactor, a high consensus potential between several participants of discussion in health service is possible.

Journal Article↗
PubMed1988

General joint laxity. Quantification and clinical relevance.

General joint laxity is measured with the hyperextensometer, and by analyzing the values obtained in a group of European subjects norm curves are drawn up related to age and sex. The values found in various orthopedic diseases are put into these curves, and the importance of general joint laxity is discussed.

Adolescent↗
PubMed1987

Changes in local bone density after knee arthroplasty. The use of quantitative computed tomography.

Loosening is a serious problem in total arthroplasty and early detection of bone loss in the vicinity of an implant would help in its investigation. We present a method for the objective evaluation of bone adjacent to metallic implants in which a modified technique of quantitative computed tomography (QCT) is used to reconstruct cross-sectional images with few artefacts. We have used this technique in 19 patients with knee arthroplasties to monitor the changes in bone density around the tibial stem of the prosthesis. In the first weeks after operation all patients showed a decrease in bone density ranging from 0.4% to 3.6% per month. One year after arthroplasty bone density had stabilised and only minor changes were observed. Our work indicates that modified QCT is a sensitive method for the long-term monitoring of the anchorage of implants and allows the early detection of osteolytic changes.

Aged↗
PubMed1986

Disuse osteoporosis in patients with total hip prostheses.

Aseptic loosening of total hip arthroplasty is still a serious problem. Bone quality might be one of the major factors influencing loosening. In a previous study, bone loss during the reparation phase was evaluated with modified computed tomography at the site of the implant. The present study documents the degree of disuse osteoporosis prior to and after surgery. Bone density of both tibiae of patients with unilateral artificial hip joints was evaluated longitudinally. Preoperatively a significant right-left difference was found, that has to be attributed to the preoperative unloading of the diseased leg. After surgery a slight but significant bone loss was found in both legs attributable to the immobilization following surgery and the reduced activity in the first 6 months. In successfully operated cases this loss is temporary. In one patient bone loss continued; after 1 year there are now clinical signs of implant loosening. Although the spectrum of physical activity in our group was wide, no correlation between activity and bone loss has been found so far.

Aged↗
PubMed1985

[Femoropatellar pain syndrome. Conservative treatment and results 7-10 years following Maquet operation].

Owing to the largely unsatisfactory results achieved to date following surgery for chondromalacia patellae, and owing to our greater knowledge of the functional relationships within the knee joint, the range of aetiological factors in femoropatellar pain needs to be expanded. Functional variants in the muscular and ligamentous system must be considered as well as anatomical variants. On the basis of symptomatology and the results of clinical examination, two extreme forms can be distinguished, depending on ligamentous laxity and muscular stabilisation capacity. Physiotherapy must be determined by these. There remain few cases in which surgery is indicated.

Adolescent↗