PubMed · 11198840
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H E Ganley, M Ward. 2001. Program logic. A planning and evaluation method.. https://doi.org/10.1097/00005110-200101000-00001
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Isolated sternal fractures are seen with increasing frequency in road accidents, especially since the introduction of seatbelt legislation. The medical records of all our patients who were treated with a diagnosis of sternal fracture (SF) over the past two decades were retrospectively reviewed to determine the incidence, morbidity, and mortality of this entity. Between 1984 and 1998, 100 consecutive patients were admitted to the Department of Surge Surgery, General Hospital of Nikea-Piraeus, Greece, for SF. There were 72 men and 28 women ranging in age between 17 and 84 years. Sixty-seven patients sustained an isolated SF and the remaining 33 had a SF in combination with multiple injuries such as flail chest (n = 19), head injury (n = 18), limb fractures (n = 10), spinal fractures (n = 4), hear contusion (n = 1), hemo-pneumothorax (n = 9), pneumothorax (n = 6), hemomediastinum (n = 5), and pericarditis (n = 2), among others. All patients with a radiological diagnosis were admitted for cardiac monitoring for at least 24 hours. Electrocardiogram (ECG), determinations of cardiac enzyme levels such as lactic dehydrogenase, creatine kinase, and creatine kinase-MB, and evaluation by a cardiologist were routinely performed. An echocardiogram was performed as indicated by the cardiologist. Seven patients underwent operation, two for abdominal bleeding, two for chest wall and sternal stabilization, two for open pneumothorax, and one for massive hemothorax. Eight of our patients needed ventilatory support. Four of them died from respiratory insufficiency, myocardial infarction, and heart and lung contusion. Although an isolated SF carries a good prognosis, careful evaluation and clinical observation are essential.
OBJECTIVE: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. DESIGN: A randomised controlled trial with a full factorial design. SETTING: Urban community in Melbourne, Australia. PARTICIPANTS: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. INTERVENTIONS: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. MAIN OUTCOME MEASURE: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. RESULTS: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. CONCLUSIONS: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.
We tested the hypothesis that anxiety regarding the potential consequences of a possible fall would alter gait patterns differently between younger and older adults. Sixteen younger and fifteen older adults participated in this study. Participants walked at a self-determined velocity along a 7.2-m walkway under 4 different conditions of postural threat; the walking conditions varied depending on the width constraints of the walkway (0.60 m vs 0.15 m) and the height of the walking surface (floor vs elevated: 0 m vs 0.60 m). Results indicated that although both younger and older adults altered their gait patterns under conditions of increased postural threat, the movement adaptations observed among older adults were substantially different to those adopted by younger adults. These age-dependent differences were strongly evidenced in the joint kinematics and the variability of the gait pattern within each condition. Our findings also indicated that when postural threat increased, the level of muscle activation throughout the gait cycle was altered in the distal musculature (gastrocnemius m. and tibialis anterior m.) among older adults only. Based on the age-related differences observed, we believe that the gait pattern alterations observed among younger and older adults reflect central set modifications to postural control that are mediated by a heightened anxiety imposed by the constraints of the testing conditions. Based on the age-dependent differences in the observed gait pattern modifications, it appears that the effects of anxiety on the control of locomotion are more pervasive for older adults than for younger adults.