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PubMed1988

Psychosocial and physical rehabilitation after heart transplantation: 1-year follow-up.

Experience on the rehabilitation of 62 heart-transplanted patients with a mean follow-up period of 15 months and a total survival rate of 79% is reported. From the present study we may conclude that: (a) One month after surgery, oxygen consumption of transplanted patients compared to coronary artery bypass-grafted patients was statistically lower (p less than 0.025). An excess ventilation was observed in transplanted patients in relation mainly to an excessive increase in blood lactates. (b) Improvement of maximal working capacity observed immediately after grafting was still enhanced after 1 year of a comprehensive rehabilitation program (p less than 0.001). This improvement was more related with an improvement of the respiratory function and of the peripheral factors than with a circulatory effect. (c) Four months after transplantation 71% of the patients still at work 6 months before operation returned to work. (d) The quality of life, well-being and heart acceptation demonstrated an immediate increase in physical items after transplantation while psychosocial items decreased postoperatively and normalized after weeks or months.

Adult↗
PubMed1987

Cancer patients and their co-workers: a study.

One way to gain a better understanding of cancer patients' experiences in the workplace is to study their relationships with their co-workers. A study of 61 cancer patients who continued to work during treatment or who returned to work following treatment found that, in general, these cancer patients believed that their co-workers had positive attitudes toward them. Nevertheless, some reported that they encountered changed and sometimes difficult interactions with their co-workers. Their experiences suggest ways in which social workers can help cancer patients prepare for their encounters with co-workers.

Adult↗
PubMed2002

Evidence-based medicine for occupational health.

OBJECTIVES: This study attempted to determine the feasibility and utility of methods used in evidence-based medicine for some common questions in the practice of occupational medicine. METHODS: The following clinical questions were generated that were representative of the type of problems encountered by occupational health physicians: is work a cause of health problems and is impaired health a cause of diminished work capacity for a specific job? Answers were generated according to the method used in evidence-based medicine by formulating an answerable question, searching the literature, critically appraising the results, and applying the results to the clinical question. RESULTS: Answers were found to all the questions in a reasonable amount of time. The searches revealed a need for more systematic reviews and studies that use work-related health outcomes like return to work. However, there is more evidence available in Medline than is generally assumed by occupational health physicians. Using this evidence led to better clinical decisions. Pitfalls during the literature search were typing mistakes, problems in using medical subject headings, and unreliable search strategies. With the use of the abstracts only, most clinical questions could be answered satisfactorily, but concrete risk estimates were often lacking. The lack of availability of full text journals decreased the reliability of the critical appraisal and risk estimation. CONCLUSIONS: Evidence-based medicine is a feasible and useful method for occupational medicine. Instruction and training is needed for most occupational health physicians to increase their searching and critical appraisal skills. More research is needed to determine the information needs of occupational health physicians and to develop tools that facilitate literature searches.

Adult↗
PubMed1992

Work-related toxic epidermal necrolysis?

A case of toxic epidermal necrolysis is described in an employee of a company that carries out plastic extrusion using various resins, including cellulose acetate, co-polyester, polyvinyl chloride, acrylonitrile-butadienestyrene, and polyethylene. Air sampling during normal operating conditions indicated only trace amounts of hydrogen chloride and the plasticizer diethylphthalate. However, pyrolysis products of resin plugs could include compounds such as formaldehyde, acrylonitrile, and chlorinated hydrocarbons that have been associated with previous case reports of either erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis. The development of toxic epidermal necrolysis in this worker was directly preceded by exposure to a vapor from a machine used to dry cellulose acetate. The problems in determining work relatedness and advising about return to work are discussed.

Adult↗
PubMed1984

Topical problems in rehabilitation following valve replacement.

The paper deals with fundamental aspects and phases of rehabilitation in patients who underwent cardiac surgery, and with problems of methodology of bicycle ergometric testing. The efficacy of rehabilitation programme is evaluated according to the results of comparison of a control group of patients without rehabilitation, and rehabilitated patients after mitral or aortic valve operation. As criteria there served the changes in the distribution of patients to functional classes, changes of physical working capacity and rate of return to work.

Aortic Valve↗
PubMed1995

[Occupational asthma].

OBJECTIVE: Description of three cases of work-related asthma. DESIGN: Retrospective clinical observations. SETTING: Primary care clinics in the centre of the metropolitan health area of Madrid. PATIENTS: A 19-year old male who worked in the manufacture of Psyllium and reported one month's evolution of an irritative cough on getting up in the morning. A 33-year-old male who worked as a car mechanic and reported episodes of respiratory difficulty while at work. A 17-year-old male employed by a bread manufacturer who attended because of a catarrhal condition accompanied by respiratory difficulty. MEASUREMENTS AND MAIN RESULTS: The maximum expiratory flow monitor (MEFM) was used to measure maximum expiratory flow (MEF) in two patients. The third was temporarily separated from his work environment. The monitoring of the MEF showed a slow fall of 25% in the patient who worked with Psyllium and a rapid fall of 36% in the mechanic, which coincided with the symptoms. The patient with asthma probably caused by flour evolved favourably while off work and deteriorated again on returning to work. The allergological study showed sensitivity to Psyllium, Isocyanate and flour, respectively. The three patients stayed asymptomatic on being separated from the catalysing substances. CONCLUSIONS: The early diagnosis of work-related asthma requires a high level of diagnostic awareness. It is extremely important to separate the patient from the catalysing agent. The MEFM is a very useful instrument of diagnosis for the primary care doctor.

Adolescent↗
PubMed1995

Initial functional and economic status of patients with multivessel coronary artery disease randomized in the Bypass Angioplasty Revascularization Investigation (BARI).

Randomized trials of coronary angioplasty and bypass surgery have hypothesized that these procedures will have equivalent long-term rates of death and myocardial infarction. Functional status, quality of life, employment, and healthcare cost will therefore be critical measures of the efficacy of these alternative revascularization procedures. Patients at 7 sites in the Bypass Angioplasty Revascularization Investigation (BARI) were enrolled in an ancillary Study of Economics and Quality of Life (SEQOL). Physical function was assessed by the Duke Activity Status Index and emotional status by the Mental Health Inventory. Employment patterns and health care utilization were also measured at study entry and at 3-month intervals in follow-up. The 934 patients enrolled in SEQOL were similar to the 895 remaining BARI randomized patients. Most patients (63%) aged < or = 64 years were working, and almost all working patients (96%) intended to return to work. Patients aged > or = 65 years had lower household incomes but better health insurance coverage. Overall health ratings were significantly correlated with both physical and emotional status (p < 0.001). Patients enrolled in SEQOL are representative of the overall BARI population. Data collected in SEQOL will provide a detailed picture of the physical, emotional, and economic well-being after coronary angioplasty and bypass surgery.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Coronary bypass surgery in the elderly: characteristics and quality of life].

From November 1991 to December 1996, 66 patients aged 70 years or more underwent coronary artery bypass grafting (CABG). They were compared with a group of 200 consecutive patients aged less than 70 years of age who underwent CABG during the same period. The elderly patients had a higher incidence of female gender, smaller body structure, left main trunk disease, calcification of ascending aorta and emergency operation. However, there were no significant differences between two groups in hospital mortality, IABP insertion or length of stay in intensive care unit. Quality of life (QOL) of the elderly patients was evaluated for all the 58 survivors by means of Specific Activity Scale Questionnaires. Forty of the 58 patients (69%) had functional capacity of 5 METs or more. All the 43 patients who worked before CABG were able return to work, although some patients reduced their workload. We conclude that CABG in elderly patients can be performed with mortality and morbidity similar to those in younger patients. QOL is generally maintained.

Age Factors↗
PubMed1997

[Endoscopic decompression of carpal tunnel syndrome with the "Agee one-portal system"].

The aim of the present study was to present the results after endoscopic carpal tunnel release in the first 30 hands operated in our department. Over a five month period we used the Agee one-portal system for endoscopic carpal tunnel release in all patients operated with a carpal tunnel release in our department. All patients were operated by one surgeon, who recorded all data and results prospectively. The patients were evaluated preoperatively and after two and eight weeks. A total of 30 hands in 25 patients were operated. There were 19 females and six males with a mean age of 50.1 years (23-80). There were no haematomas, injuries to the arcade vessels, nerve lesions or infections. All patients but one stated a good clinical result of the operation, and all patients had regained normal movement of all fingers at the two-week postoperative check-up. All patients, who were working preoperatively, were able to return to work after two to three weeks except for three patients. In conclusion, we have not experienced any complications in our series, and all patients but one had a good clinical results. We feel that the Agee one-portal system ensures carpal tunnel release with a minimum of discomfort, and we find the preliminary results in our department so promising, that we now use this technique as a routine in uncomplicated cases of carpal tunnel syndrome.

Adult↗
PubMed1998

Dissection tonsillectomy: pattern of post-operative pain, medication and resumption of normal activity.

A prospective study of 99 adults undergoing tonsillectomy was carried out to determine the pattern of post-operative pain, intake of medication and timing of return to work and normal swallowing. The differences in the pain scores, as measured by a visual analogue scale, between every third consecutive day following post-operative day four were found to be highly significant (p < 0.001). Sixty-six patients (66.6 per cent) required medication in the form of analgesics and/or antibiotics after the first post-operative day. Sixty-four out of a total of 82 patients (78.2 per cent) returned to work within 14 days of surgery. Ninety-six patients (97 per cent) reported normal swallowing within 14 days of surgery. These results suggest that the majority of adult patients undergoing tonsillectomy can be appropriately advised pre-operatively regarding the probable pattern and duration of post-operative pain and the timescales they can expect to return to work and normal swallowing.

Adolescent↗
PubMed2003

Family-friendly policies: general nurses' preferences and experiences.

While European Union policy emphasises that one of the aims of family-friendly working arrangements is to increasing gender equality, in the UK the focus has been primarily on workforce retention. Drawing on a study of Registered General Nurses who returned to work after breaks for maternity leave, this paper considers their preferences and experiences in light of current UK family-friendly policies and the implications of the findings for increasing gender equality. Questionnaires were completed by respondents in three regional health authorities and focused on the four to eight year period after qualification. The following topics were investigated: views about length of maternity break and reasons for returning to work sooner than preferred; hours sought after a return and hours obtained; the availability of preferred patterns of work and of flexible hours; retention of grade on return; the availability and use of workplace crèches, and childcare arrangements when children were unwell.

Child Day Care Centers↗
PubMed2005

Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy.

BACKGROUND: The new technique of circular stapler for the treatment of hemorrhoids has shown early promise in terms of minimal or no postoperative pain, early discharge from hospital, and quick return to work. This study was designed to compare stapled technique with the well-accepted conventional Milligan Morgan hemorrhoidectomy. METHODS: After fulfilling the selection criteria, 84 patients were randomly allocated to the stapled (n = 42) or open group (n = 42). All patients were operated on under spinal anesthesia. The 2 techniques were evaluated with respect to the operative time, pain scores, complications, day of discharge, return to work, and level of satisfaction. RESULTS: The mean age of patients was 46.02 years (SD, 12.33) in the stapled group and 48.64 years (14.57) in the open group. Grade III or IV hemorrhoids were more common in men (ie, 80.9% and 85.7% in the stapled and open group, respectively). The mean operative time was shorter in the stapled group 24.28 minutes (4.25) versus 45.21 minutes (5.36) in the Milligan-Morgan group (P < .001). The blood loss, pain scores and requirement of analgesics was significantly less in the stapled group. Mean hospital stay was 1.24 days (0.62) and 2.76 days (1.01) (P < .001) in the stapled and open group, respectively. The patients in the stapled group returned to work or routine activities earlier (ie, within 8.12 days [2.48]) as compared with 17.62 (5.59) in the open group. Only 88.1% of patients were satisfied by the open method compared with 97.6% after the stapled technique. The median follow-up period was 11 months with a maximum follow-up of 19 months (range 2-19 months). CONCLUSIONS: Stapled hemorrhoidectomy is a safe and effective day-care procedure for the treatment of grade III and grade IV hemorrhoids. It ensures lesser postoperative pain, early discharge, less time off work, complications similar to the open technique, and in the end a more satisfied patient with no perianal wound. However, more such randomized trials are essential to deny any long-term complication.

Adult↗
PubMed2005

Assessment of traumatic brain injury patients by WAIS-R, P300, and performance on oddball task.

The present research investigates factors that prevent traumatic brain injury patients from returning to work. Participants included 40 patients and 40 healthy individuals. Participants' intelligence quotients and the P300 component of event-related potentials elicited during an auditory oddball task were compared. The patients' mean intelligence quotient was significantly lower than that of the control group. However, some patients had normative intelligence, suggesting that the WAIS-R test results could not fully explain their inability to return to work. The peak of the P300 component could not be determined from recordings of 9 patients. When compared to the control group, the mean latency and amplitude for the remaining 31 patients were significantly longer and smaller, respectively. The mean reaction time of the patients was significantly longer than that of the controls. Omission errors were significantly more frequent in the patient group than among controls, suggesting that the patients were suffering from deficits in the allocation and maintenance of attention. Based on the number of omission errors, patients were divided into a group comprising individuals who committed fewer than two omissions (n=26) and a group comprised of individuals who committed more than three omissions (n=14). The frequent omission errors observed among individuals in the latter group may indicate their inability to sustain an adequate level of vigilance. This deficit would be a factor preventing the patients' return to work.

Adult↗
PubMedDate not supplied

[Length of work disability and associated factors].

OBJECTIVE: To estimate the mean length of temporary work disability (TD) and to assess some of its possible determinants. METHODS: During 1995, we registered 12,570 cases of TD among people from the Inspection Area of Alcala of Henares. We obtained a random sample of 600 cases. In addition to TD length, we obtained information about patients' sociodemographic characteristics, social security group, diagnosis, and type of primary care. Analysis of variance was used to compare means and Cox regression models were used to estimate risk ratios for factors influencing return to work. RESULTS: The mean and the median of the TD were 44.5 and 11 days respectively. The TD length was less than one month in 72.9% of the cases. The TD length was similar in both sexes and showed a positive association with age (p=0.0002). The General group had higher TD length than the Insalud group and lower than the Autonomous and Housework groups. The Insalud personnel showed an adjusted relative effect (and 95% confidence intervals) in the probability of returning to work of 2 (1.07-3.73) compared to the General group. The adjusted relative risk was 0.89 (0.88-0.90) for an increase of 5 years of age. CONCLUSIONS: The most important factors in the TD length were age and social security group. The improvement in the health system accessibility is one of the factors that may positively affect the probability of returning to work.

Absenteeism↗
PubMed1997

Return to employment after burn.

The increase in the survival rate of burned patients has stressed the need to study their rehabilitation. The purpose of our study was to characterize the factors influencing such patients' return to work. We conducted a mail survey among 316 patients aged 15-65 years, treated at Töölö Hospital Burns Unit between 11 November 1988 and 31 December 1994. Of 175 participants, 130 (74 per cent) were men and 45 (26 per cent) women. The mean TBSA was 14.0 per cent, mean FT 6.4 per cent and the mean time of hospital treatment (TOT) 17.5 days. Statistical significance was calculated by Mann-Whitney U test, Kruskall-Wallis one-way analysis of variance and Chi-square test as appropriate, with a probability level of 0.05. In the study, 54 per cent of patients whose burn area was 1-10 per cent, returned to work within 2 months. No difference was found between patients who had hand burns and those who had burn injuries in other parts of the body. Patients who did not return to work were significantly older (mean age 45 years) than those who did (mean ages varying from 33 to 36 years; P < 0.05). Total body surface area burned (TBSA), FT, TOT, age and employment status at the time of injury were the factors predicting the resumption of working ability after burn injury.

Adolescent↗
PubMed2002

Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial.

HYPOTHESIS: Stapled hemorrhoidectomy offers several advantages over excision hemorrhoidectomy, including reduced postoperative pain, a reduced hospital stay, and an earlier recovery time. Furthermore, stapled hemorrhoidectomy is associated with lower hemorrhoidal recurrence on long-term follow-up. DESIGN: A randomized prospective trial. Patients were blinded to the operation technique used. Follow-up occurred at 1 and 3 weeks and 12 months postoperatively. SETTING: A university hospital providing primary, secondary, and tertiary care. PATIENTS: Forty patients with second- and third-degree hemorrhoid disease were randomized to undergo either stapled or excision hemorrhoidectomy. Two patients were excluded. All patients were subject to a follow-up examination. INTERVENTIONS: Stapled hemorrhoidectomy (Longo technique) vs excision hemorrhoidectomy (Ferguson technique). MAIN OUTCOME MEASURES: Operating time, postoperative pain (measured by the visual analog scale), hospital stay, histologic features, morbidity, defecation habit, continence, recovery time (return to work), and hemorrhoid recurrence at 1 year. RESULTS: Stapled vs excision hemorrhoidectomy was associated with a significantly reduced operating time (30 vs 43.25 minutes; P<.001), reduced postoperative pain scores (visual analog score) on the first 4 postoperative days (day 1: 2.7 vs 6.3; day 2: 1.7 vs 6.3; day 3: 0.8 vs 5.4; and day 4: 0.5 vs 4.8, where 0 indicates no pain, and 10, maximum pain; P < or = .001), and an earlier return to work (6.7 vs 20.7 days;P =.001). There were no differences for stapled vs excision hemorrhoidectomy in length of hospital stay (2.4 vs 2.1 days), complications (3 [15%] of 20 patients vs 5 [25%] of 20 patients), and recurrence rate (1 [5%] of 20 patients vs 1 [5%] of 20 patients). CONCLUSIONS: Stapled hemorrhoidectomy is associated with reduced postoperative pain, earlier recovery time and return to work, and a similar recurrence rate compared with the excision technique. Provided further clinical trials confirm these findings, stapled hemorrhoidectomy may become a future gold standard.

Adult↗
PubMedDate not supplied

Changes in health-related quality of life and depression in heart transplant recipients.

BACKGROUND: The intent of this study was to measure health-related quality of life and depression in 94 heart transplant recipients. METHODS: Changes in health-related quality of life and depression were examined by administering the Sickness Impact Profile and the Beck Depression Inventory before heart transplantation, as well as 4, 8, 12, 24, 36, 48, and 60 months after surgery. RESULTS: Sickness Impact Profile scores obtained before heart transplantation highlighted the greatest health-related quality of life dysfunction in work, sleep and rest, home management, and recreation and pastimes. Posttransplantation measures suggested improvement (p < 0.05) in emotional behavior, home management, mobility, ambulation, depression, eating behavior, social interaction, body care and movement, sleep and rest, recreation and pastimes, depression, and physical, overall, and psychosocial functioning. Continued improvement was noted up to 5 years after transplantation although patients continued to have marked work-related dysfunction. Age, medication regimen, rejection episodes, and a variety of preoperative medical variables were not related to health-related quality of life. Actuarial survival rates at 1, 2, 3, 4, and 5 years were 89%, 87%, 80%, 79%, and 79%, respectively. CONCLUSIONS: Our results suggest that as early as 4 months after heart transplantation, patients show excellent functioning in most health-related quality of life areas. Survival rates are encouraging. Patients did not generally experience problems with depression within the first 4 months after heart transplantation. Notable problems remain after transplantation in rate of return to work where only 53% returned to work by 5 years after heart transplantation.

Actuarial Analysis↗
PubMed1998

[Mesh-plug operation: a simple, rapid and complication-free technique for managing inguinal hernia].

INTRODUCTION: The optimal inguinal hernia repair technique is a matter of debate. The Shouldice operation has long been regarded as the gold standard. While specialized hernia clinics have reproduced good results, a recurrence rate for trainees and non-specialized surgeons of between 10% and 15% seems to be more common. Laparoscopic hernia surgery has brought decreasing postoperative morbidity, low post-operative disability and early return to work. These advantages of a tension-free technique are due to the use of a prosthetic mesh. It is largely the efforts of Gilbert, Lichtenstein and Rutkow/Robbins which have popularized the use of prosthetic mesh by an open anterior approach in the USA. METHODS: Since January 1997 we have prospectively evaluated the open mesh plug repair described by Rutkow/Robbins in Basel and Lugano. We have operated on 110 patients (103 male, 7 female). All patients were interviewed 4 weeks postoperatively at our clinic. RESULTS: There were no major complications. Two patients underwent reoperation for drainage of a haematoma. There was no early recurrence or infection. After 4 weeks 82% of all patients were back to normal activity. An early return to work has been noted (10 days on average for sedentary workers). CONCLUSION: The main advantages of this technique are simplicity, low cost, reduced post-operative disability and early return to work. It is much too early to say anything concerning recurrence in this series.

Adult↗