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PubMed2004

Psychosocial and sexual concerns of patients with implantable left ventricular assist devices: a pilot study.

OBJECTIVE: We sought to determine the psychosocial and sexual concerns of patients discharged from the hospital with implantable left ventricular assist devices. METHODS: Bridge-to-transplant patients with the Heartmate left ventricular assist device received a psychosocial and sexual survey at 1 month after discharge from the hospital. The survey consisted of 3 parts, with 5 questions in each category. The patients were asked to complete the survey by circling the responses and to provide more detailed answers when necessary. RESULTS: There were 8 male patients who completed the questionnaire. Psychologically, all patients expressed a positive mood and found support from family or religious sources. The majority described a change in attitude and behavior. Socially, all patients described a change in lifestyle, as well as a change in the reaction of family and friends. No patient went back to work or had the desire to return to work until after transplantation. The minority of patients admitted to smoking or drinking. Sexually, the majority had the desire or participated in sexual activities. The majority of patients either used or were interested in using sexual stimulants. There were no mechanical problems with the left ventricular assist devices. CONCLUSIONS: Psychosocial and sexual conditions are altered in patients with heart failure who are discharged with implantable left ventricular assist devices. At 1 month's time interval, there is an improvement in mood, an adjustment in lifestyle, and a positive shift in relations with family and friends. There is sexual desire, with interest in sexual-enhancing medication. The most common concern is related to the pump, such as the durability of the device or damage to the components.

Adult↗
PubMed1986

Food poisoning in a hospital staff canteen.

Eighty-two confirmed cases of salmonella food poisoning arose among hospital staff due to consuming contaminated tartar sauce served in the staff canteen. Many key personnel were affected and the hospital was closed to non-urgent admissions. In order to maintain the accident and trauma services, the normal policy of excluding infected persons from work had to be modified. Staff returned to work 48 h after they had become asymptomatic provided that they did not have contact with patients' mouths, food or drink. There were no secondary cases. During the investigation of the outbreak, lack of national guidelines for the preparation and handling of mayonnaise-based food products became apparent.

Disease Outbreaks↗
PubMed2005

Impact of working status on breastfeeding in Singapore: evidence from the National Breastfeeding Survey 2001.

BACKGROUND: This study uses data from the 2001 Singapore National Breastfeeding Survey to examine factors, including working status, associated with breastfeeding duration. METHODS: All women who delivered in the eight hospitals with obstetric services in Singapore from 1 April to 31 May 2001 were invited to participate in a survey on infant feeding and nutrition at 2 and 6 months postpartum. A total of 2149 respondents were interviewed for variables that were known or suspected to be associated with breastfeeding initiation and duration. Cox proportional hazards model was used to determine the associated effect of working status on breastfeeding duration. Kaplan-Meier estimate and survival curves were compared between working and non-working mothers. RESULTS: Working status had no effect on initiation of breastfeeding, but had an effect on breastfeeding duration. The median breastfeeding duration for non-working and working mothers was 9 weeks and 8 weeks, respectively. This difference was significant by log rank test [hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.14-1.41, P value <0.001]. About 31% of non-working mothers breastfed for up to 6 months as compared to 20% of working mothers. Working mothers were more likely to stop breastfeeding than non-working mothers (HR = 1.61, 95% CI 1.43-1.85, P value = 0.001) after adjusting for potential confounders. The most important reason for working mothers stopping breastfeeding between 2 and 6 months was attributable to work. CONCLUSION: More breastfeeding-friendly initiatives need to be put in place at workplaces to encourage working mothers to continue breastfeeding upon returning to work.

Adolescent↗
PubMed2005

Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures.

OBJECTIVE: Given the continued debate regarding syndesmotic screw fixation, we reviewed our institution's series of ankle syndesmotic screw insertions: 1) to examine technical aspects of syndesmotic screw fixation; and 2) to identify predictors of function and quality of life utilizing validated instruments. DESIGN: Retrospective observational study (level IV). SETTING: Three university hospitals. PATIENTS AND METHODS: All patients with ankle injuries who received syndesmotic screw fixation at 3 university-affiliated hospitals from 1998 to 2001. A combined hospital database for all 3 university affiliated hospitals was searched to identify all ankle fractures. Potentially eligible patients' charts were hand searched to determine the use of syndesmotic screw fixation. Radiographs from each patient were assessed for final eligibility for study inclusion. Baseline demographic information, fracture type (Lauge-Hansen, AO Weber), radiographic measurements of syndesmotic reduction, type of implants (number of screws, number of cortices, screw size), and screw removal at follow-up were determined. All radiographs were standardized for magnification. Patients also reported return to work, a visual analogue ankle pain score, and completed 2 functional outcomes instruments (Short Musculoskeletal Functional Assessment Index, Olerud and Molander Scale). MAIN OUTCOMES: Return to work, a visual analogue ankle pain score, and 3 functional outcomes instruments (Short Musculoskeletal Functional Assessment Index, Olerud and Molander Scale). RESULTS: Of 425 ankle fractures treated, 51 fractures had syndesmotic screw fixation. Patients were often males (67%), mean age 40.0 +/- 18.0 years, with sedentary occupations (88%), and twisting injuries (80%). Seventy percent of injuries were pronation external rotation injuries, and 30% were supination external rotation injuries. The ankle was dislocated in 45% of cases. The most common constructs for fixation included lateral plates with syndesmotic screws (45%). The majority of constructs included a single 3.5-mm cortical screw through 3 cortices of bone. Based upon postoperative x-rays, 16% of syndesmoses were not reduced. Additionally, 8 patients were deemed have inappropriate/lack of indications for syndesmotic screw insertion. At final follow-up (N = 39 patients, mean 18.1 months), patients achieved good function and quality of life (mean scores: Short Musculoskeletal Functional Assessment functional index = 11.4 +/- 10.6, Short Musculoskeletal Functional Assessment bother index = 13.5 +/- 13.1, Olerud and Molander = 74.1 +/- 23.4, visual analogue pain scale = 1.7 +/- 1.9). The only significant predictor of functional outcome was reduction of the syndesmosis (P = 0.04). This variable alone accounted for 18% of the variation in Short Musculoskeletal Functional Assessment Index physical function scores and 15% of the variance in the Olerud and Molander (running subscale) outcome measure. CONCLUSIONS/SIGNIFICANCE: Our findings suggest: 1) technical aspects of syndesmotic screw fixation vary between surgeons; 2) 16% of syndesmotic screws may have been unnecessary; and 3) despite variability in technique and indications, anatomic reduction of syndesmosis was significantly associated with improved Short Musculoskeletal Functional Assessment Index functional outcome. Larger, prospective studies are needed to further explore our findings.

Adult↗
PubMed1994

Validity of patient reporting and predictive value of industrial physical work demands.

STUDY DESIGN: This prospective study analyzed industrial physical work demands. The patients (n = 103), sick-listed 8 weeks because of low back pain, were industrial blue-collar workers in the car manufacturing industry. OBJECTIVES: This study described industrial physical work demands in a sample of patients with subacute low back pain (LBP), studied the agreement between reported and observed work postures, estimated compression load on the spine, and determined the predictive validity of industrial physical work demands and occupational LBP handicap. METHODS: The patients (n = 103), sick-listed 8 weeks because of low back pain, were industrial blue-collar workers in the car manufacturing industry. Industrial physical work demands were reported by the patients and also studied at the work place. The patients' work demands commonly included lifting, forward bending, standing and twisting, working with the hands above the shoulders, and a compression load on the spine of more than 2000 N, and more than 60% of the patients believed that work demands caused their LBP. RESULTS: Substantial or moderate agreement was found more often between the patients' reports and the physical therapists' observations of work postures. None of the studied industrial physical work demands predicted the rate of return to work or the sick-leave during the second follow-up year. CONCLUSION: The correlations between reported or observed physical work demands, individual physical capacity, individual psychological capacity, spare-time activities, other factors and LBP are not clear. A workplace visit made by a physical therapist may facilitate the rehabilitation process, especially since many patients believed that work factors caused their LBP.

Absenteeism↗
PubMed2000

Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion.

STUDY DESIGN: A descriptive case review. OBJECTIVES: To assess the outcomes of anterior lumbar interbody fusion for painful discs within a solid posterolateral spinal fusion. SUMMARY OF BACKGROUND DATA: Some patients continue to have pain after posterolateral spinal fusion despite apparently solid arthrodesis. One potential etiology is pain that arises from a disc within the fused levels. METHOD: Retrospective review of 176 patients with anterior interbody fusion, which located 20 who had anterior interbody fusion levels of prior posterolateral spinal fusion. All had low back pain, solid posterolateral spinal fusion, and painful disc(s) at the posterolateral spinal fusion level(s) but not elsewhere. Pain was measured by the Numerical Rating Scale, function by Oswestry Disability Questionnaire, and patient satisfaction by the North American Spine Society Outcome Questionnaire. RESULTS: Follow-up data were available for 18 patients (90%). Mean follow-up was 58 months (25 to 102). There were 10 men and 8 women. Mean age was 45 years (26 to 72). Diagnoses were degenerative discs, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis. Eight patients had injuries after the previous posterolateral spinal fusion that precipitated new symptoms. Two patients had one level fusion, 14 had two levels, and 1 each had three and four levels. Four patients had one prior surgery, 5 had two, and 9 had three or more. All patients had solid anterior interbody fusion by radiograph. Mean Numerical Rating Scale improved from 7.9 before surgery to 4.7 after (P< 0.001). Mean Oswestry Disability Questionnaire improved from 56.3 before surgery to 47.9 after (P = 0.04). Of 15 patients unable to work before anterior interbody fusion, 5 returned to work. Sixteen patients (89%) were satisfied with their results. CONCLUSION: Low back pain that continues or recurs after apparently solid posterolateral spinal fusion may be caused by painful disc(s) at motion segment(s) within the fusion. A solid posterolateral spinal fusion may not protect the residual disc(s) from injury. Anterior interbody fusion can provide significant improvements in pain and function and a high degree of patient satisfaction in this clinical setting.

Disability Evaluation↗
PubMedDate not supplied

Treatment of varicose veins: proximal saphenofemoral ligation comparing adjunctive varicose phlebectomy with sclerotherapy at a military medical center.

There is no consensus as to the single best approach to the treatment of varicose veins. There has been a trend toward less invasive procedures to reduce the number of incisions and provide more selective ablation of varicosities. Ultimately, therapeutic decisions have depended on surgeon preference and the patient population. The active duty military population presents a unique challenge in the treatment of varicose veins. This mobile and active population requires a treatment method that provides maximum relief with the lowest possible morbidity and rapid recovery. The authors previously reported their experience with 104 patients who underwent saphenofemoral ligation combined with perforator point ligation and staged sclerotherapy. This group was compared to 103 patients who underwent saphenofemoral ligation, point perforator ligation, and stab avulsion phlebectomy as a single procedure. Follow-up for the sclerotherapy group included patient satisfaction surveys and documentation of recurrent varicosities. All ambulatory phlebectomy patients responded positively with respect to symptomatic and cosmetic results. Overall satisfaction was favorable and there was no significant difference in patient satisfaction between the ambulatory phlebectomy and sclerotherapy groups. Twelve per cent of the sclerotherapy patients developed true recurrences or new varicosities compared to 11% in the ambulatory phlebectomy group. The most common complication was superficial thrombophlebitis (20% ambulatory phlebectomy, 16% sclerotherapy) which was mild in all cases. All but three patients in the ambulatory phlebectomy group returned to work within 7 days and 75% returned to full duty within 72 hours. Completion of therapy was accomplished in a much shorter period for the ambulatory phlebectomy group. Overall patient satisfaction was achieved for both ambulatory phlebectomy and sclerotherapy patients. Completion of therapy was achieved in a shorter period with fewer clinic visits in the ambulatory phlebectomy group and this has become our procedure of choice for active duty military patients.

Ambulatory Surgical Procedures↗
PubMed2002

Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients.

OBJECT: The need for interbody fusion or stabilization after anterior cervical microdiscectomy is still debated. The objectives of this prospective randomized study were 1) to examine whether combined interbody fusion and stabilization is more beneficial than microdiscectomy only (MDO) and 2) if fusion is found to be more beneficial than MDO, to determine which is the best method of fusion by comparing the results achieved using autologous bone graft (ABG), polymethylmethacrylate (PMMA) interposition, and threaded titanium cage (TTC). METHODS: A total of 125 patients with a single-level cervical disc disease were included in this prospective study. All patients were randomized and assigned to one of the four following groups: Group 1 (33 patients), MDO; Group 2 (30 patients), microdiscectomy followed by ABG; Group 3 (26 patients), microdiscectomy followed by injection of PMMA; and Group 4 (36 patients), microdiscectomy followed by placement of a TTC. Clinical outcome according to Odom criteria was summarized as 1) excellent and good or 2) satisfactory and poor. One-year follow-up examination was performed in 123 patients. Patients in the TTC group experienced a significantly better outcome 6 months after surgery (92% excellent and good results) compared with those in the MDO and ABG groups (72.7 and 66.6% excellent and good results, respectively). Twelve months after surgery there was still a significant difference in outcomes between the TTC group (94.4% excellent and good results) and the MDO group (75.5% excellent and good results). Outcome in patients treated with PMMA was comparable with that in those treated with TCC after 6 (91.6%) and 12 months (87.5%), but no segmental fusion was achieved. Differences compared with MDO and ABG were, however, not significant, which may be related to the smaller number of patients in the PMMA group. CONCLUSIONS: Interbody cage-assisted fusion yields a significantly better short- and intermediate-term outcome than MDO in terms of return to work, radicular pain, Odom criteria, and earlier fusion. In addition, the advantages of interbody cages over ABG fusion included better results in terms of return to work, Odom criteria, and earlier fusion after 6 months. These results suggest that interbody cage-assisted fusion is a promising therapeutic option in patients with single-level disc disease. Polymethylmethacrylate seems to be a good alternative to interbody cage fusion but is hindered by the absence of immediate fusion.

Adult↗
PubMed1999

Posterior lumbar interbody fusion with cages: an independent review of 71 cases.

OBJECT: The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. METHODS: In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). CONCLUSIONS: This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

Analysis of Variance↗
PubMedDate not supplied

Occupational health services for municipal employees.

Most municipalities have departments responsible for fire, policing, public works, parks, sanitation, health, water, administration, and communications. A comprehensive occupational medicine program must address the potential and actual health hazards associated with each of these fields, as well as pre-employment/placement medical evaluations, medical surveillance, wellness programs, work-related injury, case management, return-to-work accommodations, and drug and alcohol testing. While no standard for municipal occupational heath services exists, a comprehensive approach to the variety of work settings that are inherent even in small municipalities is important for the service provider.

Accidents, Occupational↗
PubMed1992

[Myocardial infarct in motor transport drivers and the results of long-term observations].

As many as 283 drivers with a history of acute myocardial infarction were examined. In the long-term postinfarction period, the number of the able-bodied accounted for 22.8%, the number of persons with restricted work fitness was 43.3%, that of the disabled amounted to 33.9%. It should be noted that about 60% of the able-bodied and those with restricted work fitness returned to the driving-related work. However, in some cases, the type of the trucking was either changed of the work scope was to be minimized. Criteria forming the basis for predicting the recovery of work fitness of the drivers were as follows: non-transmural character of myocardial infarction for the most part, the effective staged rehabilitation program, positive dynamics and smoothing of the ECG signs of myocardial infarction, the lack of areas of regional hypo- and akinesia of the myocardium, normalization of the ejection fraction, high and mean indicators of physical work fitness, exercise tolerance, coronary reserves, functional class I and II angina pectoris of effort, either the lack or initial clinical signs of circulatory failure, psychological readaptation, high occupational class, and labour orientation.

Absenteeism↗
PubMed2004

Preliminary assessment of a prototype advanced mobility device in the work environment of veterans with spinal cord injury.

The INDEPENDENCE 3000 IBOT Transporter (IBOT) is an electronically stabilizing device for people with disabilities. The purpose of this study was to collect qualitative data on the potential for the IBOT to improve employment satisfaction of veterans who use wheelchairs to work. This study was based upon observations by trained clinicians, and responses to a survey completed by four men with traumatic spinal cord injury, who worked in an office environment. The mean age of the subjects was 52 +/- 8.8 years. The subjects used the devices to hold eye-level discussions with colleagues, climb stairs, ascend steep ramps, and negotiate curbs. When subjects were asked to rate the ease of getting around in the IBOT compared to their personal wheelchairs, they responded with a mean of 6.7 +/- 1.8 on a 10-point visual analog scale. The response to rating the overall function of the IBOT within their working environment yielded a rating of 6.0 +/- 2.8. Half of the users felt that the IBOT would help them at work and all thought it should be made available to veterans who use wheelchairs. A larger study should be conducted to determine if the IBOT affects work performance and the ability to return to work.

Employment↗
PubMed2005

[The duration of disability pensions in Iceland].

OBJECTIVE: To analyze the long-term outcome for recipients of disability pension in Iceland. MATERIAL AND METHODS: The study includes all those receiving disability pension for the first time in 1992 in Iceland. Their status in the disability register at the State Social Security Institute of Iceland November 30th 2004 was examined as to whether they were still receiving disability pension, had died, had reached the age of retirement or were not receiving disability pension any more for some other reasons. RESULTS: In 1992 there were 725 new recipients of disability pension in Iceland, 428 females and 297 males. Twelve years later 434 from this group were no longer receiving disability pension, 240 females and 194 males. In most cases this was because they had reached the age of retirement or died (on average 88% of the females and 91% of the males each year). Only 12% of the females and 9% of the males ceased to receive disability pension (and probably went back to work). CONCLUSION: In Iceland few people return to work once they have started receiving disability pension.

Adult↗
PubMed1986

[10-year outcome of patients with isolated anterior interventricular stenosis technically accessible to coronary angioplasty].

Between April 1972 and March 1976, 70 patients were found to have an isolated stenosis of the left anterior descending artery at coronary angiography which could have been treated by coronary angioplasty, had the technique been available at that time. A questionnaire was sent to these patients and 65 (93 p. 100) replies were received 9 to 13 years after initial coronary angiography. They provided information about 61 men and 4 women with an average age of 48.1 +/- 8.4 years. Thirty eight patients had undergone surgery and 27 were treated medically, each group having distinct clinical characteristics. The 10 year survival rate was excellent (91 p. 100) and was high in both groups. The quality of life was good: 56 p. 100 claimed to be in good or very good health and 67 p. 100 were improved with respect to their functional state at the time of coronary angiography; only one quarter of these patients had been readmitted to hospital for cardiac problems during the follow up period, and 76 p. 100 of patients in work before the coronary angiography had returned to work. This date illustrates the excellent results of classical medical and surgical management of potential candidates for coronary angioplasty for isolated left anterior descending artery stenosis.

Adult↗
PubMed1986

Shoulder-muscle strength and range of motion following surgical repair of full-thickness rotator-cuff tears.

Postoperative measurements of the range of motion and muscle strength of the shoulder and ratings of pain and the ability to perform daily activities were made in fifty-eight patients (sixty-three shoulders) who had a repair of a full-thickness rotator-cuff tear. Postoperatively, the patients had an average of 126 degrees of active flexion of the shoulder and an average of 130 degrees of active abduction. Passive motion averaged 21 degrees more than active motion. The strength of the abductor muscles of the shoulder averaged approximately 86 per cent of normal. Most patients reported marked relief of pain and rated themselves as having mild or no deficits in their ability to perform daily activities. The length of the cuff tear significantly affected the functional results. Short tears (less than 2.5 centimeters) were associated with greater strength and range of motion than were long tears. Fifteen of the nineteen patients who were unable to work preoperatively because of the shoulder returned to work after surgery, but not necessarily to the same type of work that they had done before the onset of the problem with the shoulder.

Acromion↗
PubMed1976

Resumption of work after acute myocardial infarction.

A total of 644 patients, admitted to the Coronary Care Unit of a district hospital on account of acute myocardial infarction, have been discharged during a 3-year period. Of these patients, 71% had been employed at the time of the infarction and more than 80% of this group returned to work. Among the long-term survivors (LTS) aged less than 65 years who had been employed at the time of infarction, 87% of the male and 74% of the female patients had resumed work some time afterwards. Among 347 LTS age was found to be the main factor to determine whether or not patients would be able to resume work, whereas the number of experienced infarctions as well as signs and/or symptoms of heart failure during the acute phase were of no consequence. The occurrence of additional symptoms of ischaemic heart diseases (recurrences of infarction, presence of angina pectoris, demand for drugs) was of prognostic importance for whether or not patients would have to abandon work. The ability of patients to resume their previous work. The ability of patients to resume their previous work depended on the character of the latter, i.e. its type and the physical strain involved. About 80% of the LTS resumed work within three months. Patients in whom heart failure had occurred during the acute phase tended to return to work later than those without this complication. No more than half of the LTS who had abandoned work declared that cardiac symptoms had been the reason.

Acute Disease↗
PubMed2002

Endoscopic carpal tunnel release: thirteen years' experience with the Chow technique.

The purpose of this single-center study was to evaluate the results of endoscopic carpal tunnel release (ECTR) by using the dual portal Chow technique in a large series of patients. A total of 2,675 procedures in 1,886 patients were performed during a 13-year period. Follow-up evaluation was performed in 2,402 (90%) cases or 1,698 (90%) patients. The success rate was 95% and the recurrence rate was 0.5%. A total of 106 cases (4.5%) were considered failures or had unsatisfactory results. The overall complication rate was 1.1% but no serious complications occurred in this series. The return-to-work status was followed-up in 1,156 patients; 90% of non-worker's compensation patients and 60% of worker's compensation patients returned to work within 4 weeks. This study suggests that ECTR for carpal tunnel syndrome (CTR) is a reliable procedure with a high success rate. Based on our 13 years of experience, we believe that the technique is safe and iatrogenic complications can be avoided with meticulous surgical technique.

Adolescent↗
PubMed1986

Minimal incision techniques for digital deformities.

We have presented basic minimal incision approaches to the more common digital deformities. We feel that with proper evaluation of the deformity and the patient, minimal incision surgery techniques give excellent long-term results with several advantages. These advantages include: Less discomfort due to less surgical dissection. Less need for internal fixation by careful use of compression dressings in the immediate postoperative period along with early ambulation. Less disability. Compression dressings allow immediate ambulation in normal footgear. In most instances, the patient is able to return to work sooner and with less discomfort. Better patient acceptance. Procedures may be performed under local anesthesia in the office environment and the patient may usually return to work in normal footgear within 1 to 3 days. Cost containment. Not all digital deformities may be addressed through a minimal incision approach. Internal fixation, multiple procedures with special postoperative shoes, syndactylisms, fusions, transpositional osteotomies, and skin plasties may be necessary in more severe conditions. However, it is equally important to point out that not all digital deformities must be approached in the "traditional" manner, employing large incisions with deep structure dissection, retraction, and visualization. It is up to the podiatric surgeon to develop his skills, and, after carefully evaluating the abnormality, the patient, and his goals, to perform the surgical procedure that will result in the best long-term results with the minimal amount of discomfort, disability, and cost to the patient.

Callosities↗