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PubMed1999

Time off work due to scaphoid fractures and other carpal injuries in The Netherlands in the period 1990 to 1993.

This study assessed the epidemiology, treatment, disability and time off work due to carpal injuries in the Netherlands in the period from 1990 to 1993. Most injuries were scaphoid fractures and carpal instabilities were rare. The time off work was considerable (mean, 155 days; median, 105 days; range, 12-1708 days). Patients with non-scaphoid fractures had the shortest time off work, followed by those with scaphoid fractures; patients with carpal instabilities had the longest time off work. Despite the significant time off work, the prognosis for return to work was excellent.

Adult↗
PubMed1980

[The social destiny of operated patients with femoral and trochanteric fractures (author's transl)].

The social destiny of 54 patients with femoral neck and trochanteric fractures was analysed by interview three to five years after the operation and the results were compared with those of 48 control subjects of the same age. In addition to this 50 patients with a similar fracture not yet operated were asked the same questions and the results were compared with those of control subjects of the same age . The groups did not differ in terms of marital status, education and in state of health. The operated patients walked daily less than the control subjects. The capacity for self care of the not yet operated patients before the injury was more often reduced and they had to be helped in all daily activities more often than the control subjects. At follow up the ability to move of operated patients had deteriorated and every second patient had died. Of the operated patients, which were prior to the injury able to work, 40 per cent returned to work after the convalescent.

Activities of Daily Living↗
PubMed1998

Training future leaders of academic medicine: internal programs at three academic health centers.

The authors review the need for internal programs for leadership training at academic health centers and then describe in detail three programs of this type that have operated during the 1990s: (1) the Allegheny Leadership Institute, founded by the Allegheny Health, Education and Research Foundation, Pittsburgh, Pennsylvania; (2) the Physician Executive Management Development Program (PEMDP) of Saint Louis University School of Medicine; and (3) the University of Nebraska Medical Center Leadership Institute. Educational elements common to these programs include having a small class size and participants from many areas of academic medicine and health care, focusing on educational strategies that draw on participants' experiences and training, conducting the training away from the participants' institutions, having short sessions, using faculty from both within and outside the participants' institutions, and creating strategies to reinforce learning. Lessons learned reflect the unique context of each institution; the authors list the major lessons learned by each of the three programs they surveyed (e.g., leaders of the Saint Louis University PEMDP program believe that it is important to help participants implement desired changes in their work areas once they return to work, and are investigating how to do this). The authors conclude with an extensive list of recommendations to optimize the effects of leadership development training carried out in AHCs' internal programs (e.g., "Focus on specific skills that can be learned, and link the learning experiences to real work situations in health care and higher education") and explain why they think internal leadership institutes have at least three distinct advantages over external programs.

Academic Medical Centers↗
PubMed2004

Employment and work disability in rheumatoid arthritis.

PURPOSE OF REVIEW: The cost of work disability due to rheumatoid arthritis is substantial to both individuals and society. Approximately one third of people with rheumatoid arthritis will leave employment prematurely. Several studies over the past two decades have identified risk factors for work disability, and recent literature suggests increasing interest in ways to assess work limitations and offer interventions to prevent work loss. RECENT FINDINGS: Work disability results from a complex interaction of characteristics of individuals, the nature of their work, and their environment, including the physical workplace, policies related to work accommodation, and interpersonal relationships. Practitioners need tools to help identify patients experiencing limitations in the workplace and at risk for permanent work disability. Two new tools show promise in this area. Although there is general agreement that vocational assessment and intervention should occur early in the course of rheumatoid arthritis, evidence for vocational rehabilitation is sadly lacking. A recent systematic review identified only six studies, all uncontrolled, but suggestive of beneficial effects. SUMMARY: Assessment of possible work limitations and potential for vocational rehabilitation should be considered in the evaluation of employed patients and those wishing to work. Further development and evaluation of work retention and return-to-work programs for people with rheumatoid arthritis is required.

Arthritis, Rheumatoid↗
PubMed1987

Quality of life among long-term survivors of intensive care.

Quality of life was examined in 717 individuals 1 yr after their admission to a multidisciplinary ICU. Of these, 87% were able to live at home 6 months after their admission. Of patients 65 yr and older, 90% had been living independently before admission compared to 80% 1 yr afterward. Of those younger than 65 yr, most of the 65% who had been working before admission could return to work. The length of hospitalization during the first year after admission varied greatly; 10% of the patients stayed more than 145 days. The patients who needed mechanical ventilation or who stayed 1 wk or more in the ICU tended to have worse outcomes than others. These data indicate that there is no great deterioration in quality of life among long-term survivors of intensive care.

Adolescent↗
PubMed2001

Concurrent dorsal dislocations and fracture-dislocations of the index, long, ring, and small (second to fifth) carpometacarpal joints.

OBJECTIVE: To review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS: Between 1991 and 1997, twelve multiply injured patients with the described CMC injury complex (one open injury) were treated with ORIF (eleven patients) or percutaneous wire fixation (one patient) by the same surgeon. INTERVENTION: Treatment consisted of ORIF with Kirschner wires followed by splints and immediate metacarpophalangeal and interphalangeal joint range of motion exercises. MAIN OUTCOME MEASUREMENTS: Grip strength, wrist and finger range of motion, pain, need for additional surgery, and return to work. RESULTS: Of the ten patients available for follow-up (mean, three years), all had been treated with ORIF (eight within forty-eight hours of injury and two had treatment delayed for four weeks because of delayed diagnosis and management of more serious injuries). Three patients had additional surgery (planned secondary second and third CMC arthrodeses). Grip strength of the operated hand in the five patients with JAMAR testing was 50 percent (n = 3), 75 percent (n = 1), and 90 percent (n = 1) of that in their contralateral hands. Five patients were pain-free, and five reported occasional, activity-related pain. The five patients who worked before the injury returned to their previous occupations (one with slightly modified duties). CONCLUSION: This is the largest series of patients with this CMC injury complex and the first report of open CMC dorsal dislocations and fracture-dislocations. Although early ORIF is suggested, delay of up to four weeks did not adversely affect results.

Adult↗
PubMed1994

Nonsurgically treated carpal tunnel syndrome in the manual worker.

This study evaluates the course of carpal tunnel syndrome in a group of manual laborers who declined surgery for personal or social reasons. Thirty-five patients and 67 extremities with carpal tunnel syndrome were evaluated in a group of manual laborers. The carpal tunnel syndrome was classified as mild, moderate, or severe on the basis of initial evaluation data. Sensory batteries, motor and sensory conduction velocities, and electrical studies were performed on a scheduled basis. Follow-up ranged between 14 and 58 months, with an average of 34.3 months. Three patients became worse and one improved during the study period. All others remained unchanged. Six patients returned to work, but only three returned to their original jobs. Although carpal tunnel syndrome does not appear to be a progressive condition once the triggering cause is removed, nonsurgical treatment does not seem to be the treatment of choice for patients who must continue in a manual labor position.

Adult↗
PubMed2006

Lumbar total disc replacement using ProDisc II: a prospective study with a 2-year minimum follow-up.

A lumbar total disc replacement (TDR) is believed to be a promising substitute in the surgical treatment for lumbar degenerative disc disease. The purpose of this study is to report the clinical and radiographic outcomes of 36 consecutive patients who underwent lumbar TDR using ProDisc II, and the factors associated with a better clinical outcome after a 2-year minimum follow-up. At the time of the latest follow-up, the success rate was 94% of 36 patients according to the criteria of the US Food and Drug Administration. Of the 10 patients unable to work preoperatively, 7 patients returned to work. Moreover, mean score on the visual analog scale for low back and leg pain improved significantly from 7.5 and 4.7 to 3.0 and 1.2, respectively (P<0.001). In addition, mean Oswestry disability index scores improved significantly from 69.2 to 21.0 (P<0.001). Mean disc height at the operative level increased significantly from 9.0 to 17.6 mm, and mean range of motion increased significantly from 9.7 to 12.7 degrees (P<0.01). Statistical analysis showed that the factors associated with a better clinical outcome were single level, and a higher postoperative segmental ROM at the operative level. At a minimum follow-up of 2 years, the lumbar TDR using ProDisc II showed excellent clinical and radiographic outcomes without any significant complication. However, future efforts need to be directed toward the evaluation of a larger number of patients with longer follow-up.

Adult↗
PubMed2006

The effectiveness of graded activity for low back pain in occupational healthcare.

BACKGROUND: Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce. OBJECTIVE: To determine the effectiveness of graded activity as part of a multistage RTW programme. DESIGN: Randomised controlled trial. SETTING: Occupational healthcare. SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57). INTERVENTION: Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles. MAIN OUTCOME MEASURES: The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks. RESULTS: Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly. CONCLUSIONS: Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.

Adolescent↗
PubMed2006

Chronic fatigue syndrome-like caseness as a predictor of work status in fatigued employees on sick leave: four year follow up study.

OBJECTIVE: To assess whether CFS-like caseness (meeting the criteria for chronic fatigue syndrome (CFS)) predicts work status in the long term. METHODS: Prospective study in a sample of fatigued employees absent from work. Data were collected at baseline and four years later, and included CFS-like caseness and work status (inactive work status and full work incapacity). RESULTS: CFS-like cases at baseline were three times more likely to be unable to work at follow up than fatigued employees who did not meet CFS criteria at baseline (ORs 3-3.3). These associations grew even stronger when demographic and clinical confounders were controlled for (ORs 3.4-4.4). CONCLUSION: A CFS-like status (compared to non-CFS fatigue) proved to be a strong predictor of an inactive work status and full work incapacity in the long term. Since little is known about effective interventions that prevent absenteeism and work incapacity or facilitate return to work in subjects with chronic fatigue, there is a great need for powerful early interventions that restore or preserve the ability to work, especially for workers who meet criteria for CFS.

Absenteeism↗
PubMed1999

Relation between indicators for quality of occupational rehabilitation of employees with low back pain.

OBJECTIVES: To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables. METHODS: The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome. RESULTS: Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better. CONCLUSION: Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial.

Adult↗
PubMed2001

The long term results of internal fixation of displaced intra-articular calcaneal fractures.

One hundred and fourteen displaced intra-articular fractures of the calcaneus (47 tongue type and 67 joint depression type) were treated by open reduction and internal fixation with multiple H plate and were followed-up for an average of 6.75 years. All the fractures healed radiographically in 3 months. Average time for bone healing was 2.25 months for the tongue type and 2.42 months for the joint depression type (p > 0.05). Average post operative Bohler tuber angle was 25.05 and 22.71 degrees in the tongue type and joint depression type respectively (p > 0.05). All patients could return to work in 8 months. The average time for returning to work was 3.42 months in the tongue type and 4.16 months in the joint depression type (p < 0.05). Three calcanei (2.6%) had wound infection. There were significant differences between the two types in degree of residual pain, walking activities and range of subtalar joint movement. There were no significant differences in the ability to work, change of footwear and hind foot swelling. The end functional result was rated as excellent in sixty one (53.5%), good in twenty (17.5%), fair in fourteen (12.3%) and poor in nineteen (16.7%) calcanei. There was significant difference in the satisfactory result (excellent to fair) between the tongue type (91.5%) and joint depression type (77.6%).

Adolescent↗
PubMed2006

Work-related factors contributing to chronic disability in low back pain.

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.

Adolescent↗
PubMed1987

A Canadian hospital's experience with the automatic implantable cardioverter/defibrillator.

The automatic implantable cardioverter/defibrillator is a device that can be implanted in patients for treatment of recurrent ventricular tachycardia and ventricular fibrillation. It was recently approved for clinical use in Canada. The authors describe their experience with 12 patients (mean age 51.3 years) who underwent implantation of a defibrillator. All 12 patients had a history of documented ventricular fibrillation, which was idiopathic in 3 and due to ischemic heart disease in 9. Electrophysiologic testing revealed inducible ventricular tachycardia or ventricular fibrillation in 8 of the 10 patients tested. An important criterion for selection for implantation was failure of pharmacologic therapy to suppress ventricular arrhythmias induced during electrophysiologic testing. Of the 12 patients, 1 died within 24 hours after implantation. During a mean follow-up period of 15.5 months there were no further deaths. All the surviving patients expressed satisfaction with the device; five of the seven under the age of 60 years have returned to work, and one has returned to school. This initial favourable experience with the automatic implantable cardioverter/defibrillator suggests that future increases in the availability of the device and improvements in its function will lead to much more widespread use, as the population of patients at risk of sudden cardiac death is large.

Adolescent↗
PubMed1987

Emergency coronary bypass for cardiogenic shock.

Emergency coronary bypass for cardiogenic shock has been associated with a high operative mortality. From January 1983 through March 1986, 69 patients at Crawford W. Long Hospital underwent emergency coronary artery bypass. Seventeen of 69 were in shock, 15 with hypotension requiring treatment (intra-aortic balloon pump in 10; catecholamines in six). The other two patients had a low cardiac index and a pulmonary capillary wedge pressure greater than 25 mm Hg. Of these patients, nine presented with acute infarction, four with failed angioplasty, and four with uncontrollable angina. Four patients required cardiopulmonary resuscitation. After operation, 94% of the patients required catecholamine support and 71% were treated with an intra-aortic balloon pump. There were two hospital deaths (12%). The median postoperative stay for survivors was 9 days. Major complications occurred in 47%. Follow-up (100%, mean 20.5 months) revealed no late deaths, a 3 year survival of 88 +/- 8%, and a functional class of I in six patients, II in seven patients, and III in two patients. The nine patients who were working before operation all returned to work. Of the 52 emergency coronary bypass patients without shock, one patient died in the hospital (2%), 52% required catecholamines (p less than .05 vs shock group by chi-square analysis), and 12% required an intra-aortic balloon pump after operation (p less than .05 vs shock group by chi-square analysis). Median stay was 8 days. Complications occurred in 13% (p less than .05 vs shock group by chi-square analysis). Three year survival was 91 +/- 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Age and late outcome of myocardial infarction].

Age-dependent differences in the clinical state, lethality, incidence of repeated infarction, frequency and duration of temporary disability were studied in 993 patients during 2 years after myocardial infarction. The stage of heart failure is the main factor responsible for the less favourable outcomes after myocardial infarction survived in middle and senile age. The incidence rate of repeated myocardial infarction during two years, and preservation of capacity for work in subjects, who returned to work, do not differ significantly in varying age groups.

Adult↗
PubMed1994

Lumbar diskectomy for recurrent disk herniation.

Eighty-two patients who underwent reoperation using a lumbar microdiskectomy approach for recurrent back and leg pain were evaluated retrospectively. Patients were entered consecutively except for exclusion of those who had a spinal fusion in addition to the diskectomy or those where a diskectomy was performed as an adjunct to decompression for spinal stenosis. As a percentage of all diskectomies performed by us over the 13 years of the study, the overall rate of reoperation (including all patients who underwent more than one diskectomy procedure regardless of vertebral level and side) was 7.4%, with those having a reoperation on the same level and either the same or contralateral side as the initial procedure representing 4.5%. Long-term outcomes obtained from 68 questionnaire responses (83% compliance) included 56% who had successful leg pain relief, 54% who had successful back pain relief, 44% who successfully returned to work, 51% who successfully returned to normal activity, and 73% who were satisfied with the results of surgery. Poor outcomes correlated most significantly with reoperation on the same vertebral level, same side, and short (< or = 1 year) time interval between consecutive diskectomies. A major conclusion was that workers' compensation patients presenting within 1 year with recurrent complaints after diskectomy and whose radiologic findings indicate a same-level, same-side recurrence represent extremely poor outcome risks for repeat diskectomy.

Adult↗