Biomedical subjects
Michael J Hodgson
Publications and source records attributed to Michael J Hodgson.
Effects of cigarette smoking on diagnostic tests for work-related hypersensitivity pneumonitis: data from an outbreak of lung disease in metalworkers.
BACKGROUND: It is widely believed that development of hypersensitivity pneumonitis (HP) is forestalled in cigarette smokers. We encountered the largest outbreak of HP in metalworkers yet reported [Hodgson et al. (2001): Am J Ind Med 39:616-628] and subsequently did a chart review of the 61 patients seen in connection with the outbreak [Dangman et al. (2002a): Am J Resp Crit Care Med 165(8):A528; Dangman et al. (2002b): Am J Ind Med 42:150-162], developing a diagnostic index for this disease. METHODS: A re-examination of data from the chart review was carried out to explore possible effects of cigarette smoking on the clinical tests used to diagnose HP [Hodgson et al. (2001): Am J Ind Med 39:616-628]. RESULTS: Cigarette smokers with HP were less likely than non-smokers with HP to develop crackles in the lungs, elevated erythrocyte sedimentation rates (ESRs), and restrictive spirometry. Smoking habits had little effect on diffusion capacity and alveolar-arterial oxygen gradients in the patients with HP. Smokers were more likely to have abnormal gallium scans than non-smokers. CONCLUSIONS: It appears that cigarette smoking can affect the physical examination findings, spirometry, and ESR changes associated with HP, making these tests less sensitive and specific, and potentially obscuring the diagnosis. Such changes may contribute to the apparent "protective" effect of smoking on the development of HP.
Emergency management program operational responses to weapons of mass destruction: Veterans Health Administration, 2001-2004.
BACKGROUND: Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities. METHODS: An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered. RESULTS: Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews). CONCLUSIONS: Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge.
Violence in healthcare facilities: lessons from the Veterans Health Administration.
GOALS: The authors examined assault frequency and risk factors in health care. METHODS: The authors conducted a cross-sectional questionnaire survey in 142 hospitals. Analyses are presented at the level of the individual and aggregated by facility. RESULTS: Thirteen percent of employees described at least 1 assault in the last year; the proportion assaulted per facility ranged from 1% to 26%. Patients were the most common assaulters. Working in geriatrics, mental health, and rehabilitation or in nursing represented a high risk for assault. Hours of work and work patterns represented major risk factors for assault, as were higher measures of organizational stress. The penetration of training in alternate dispute resolution strategies was associated with lower rates of assaults. CONCLUSIONS: Although work in health care is associated with high rates of assaults, closer scrutiny suggests specific possible intervention strategies.
Respiratory protection for mold remediation.
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An outbreak of hypersensitivity pneumonitis at a metalworking plant: a longitudinal assessment of intervention effectiveness.
The authors describe a longitudinal assessment of intervention effectiveness in response to an outbreak of hypersensitivity pneumonitis (HP) at a metalworking facility. Thirty-five (29%) of the plant's 120 production workers were given a clinical diagnosis of HP during the two years of the investigation. Although quantitative exposure assessment tools were of limited utility, the investigators successfully used qualitative observations and the patients' return-to-work experiences to iteratively evaluate their exposure control recommendations. Recommended interventions included improving metalworking fluid management practices, enclosing selected metalworking fluid machining operations, eliminating mist cooling, exhausting two additional water-based industrial processes, increasing general dilution ventilation, and worker training. As of November 1999, 26 months into the outbreak, 51 percent (18) of the employees with a clinical diagnosis of hypersensitivity pneumonitis had been able to return to work. The symptom onset of the 35 workers who were given a clinical diagnosis of hypersensitivity pneumonitis during the two-year study period predated the implementation of the interventions. The collaboration of a multidisciplinary team appears to have allowed for successful intervention in this setting. A specific etiological agent(s) associated with the outbreak was not confirmed during the investigation. An acid fast isolate identified as being in the Mycobacterium chelonae group was detected in only one of the submitted metalworking fluid (MWF) sump samples. Longitudinally, there was a statistically significant difference in MWF sump bacteria (X(2) = 286.4, df = 17, p <.0001) and MWF sump fungi (X(2) = 28.1, df = 7, p <.0002). Measured oil mist air levels did not exceed the Occupational Safety and Health Administration's (OSHA's) permissible exposure limit (PEL), and in fact, did not exceed 0.5 mg/m(3).
The hypersensitivity pneumonitis diagnostic index: use of non-invasive testing to diagnose hypersensitivity pneumonitis in metalworkers.
BACKGROUND: Since 1993, several outbreaks of hypersensitivity pneumonitis (HP) have been reported in metalworkers. We report the largest outbreak of HP in metalworkers yet known. It occurred in a Connecticut factory that produces precision parts for the aerospace industry. The workers typically presented with systemic and respiratory problems ("sick fatigue," myalgias, cough, dyspnea, wheezing, and chest tightness). They had variable findings on clinical tests, which complicated diagnosis. An HP diagnostic index was developed to help reduce the uncertainties in case identification. METHODS: Data from 16 biopsy-confirmed cases and 14 non-HP patients were compared, and the HP diagnostic index was derived using variables that best discriminated between the two groups. The index is based on (a) work-related symptoms, (b) dry crackles on auscultation, (c) restrictive spirometry, (d) decreased diffusion capacity and/or increased A-a oxygen gradient, (e) elevated erythrocyte sedimentation rate, (f) abnormal radiographic images, and (g) abnormal gallium scans. We then applied the HP diagnostic index and, for comparison, the "Kenosha epidemiological case criteria" (developed during a recent HP outbreak in an automobile factory) to our data set. RESULTS: The HP diagnostic index and the Kenosha criteria confirmed HP in overlapping sets of 36 and 34 patients, respectively, that were both in good agreement with the clinical diagnoses. CONCLUSIONS: The HP diagnostic index relies less heavily on symptoms, subjective evaluations, and invasive tests than the Kenosha criteria, but both identified similar subsets of the 61 patients as having HP. The HP diagnostic index could provide a useful tool in future HP outbreaks, which are increasingly being recognized in metalworking facilities.