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PubMed1987

5-year results of a comprehensive rehabilitation programme after myocardial infarction.

A comprehensive cardiac rehabilitation programme has been offered to a non-selected consecutive group of patients who have survived an acute myocardial infarction (MI). The programme includes follow-up at a post-MI clinic, physical training in outpatient groups, the provision of information on smoking and diet, and psychological support to patients and their families. The intervention group, consisting of the 147 patients participating in the programme has been compared with a nonselected consecutive reference group of 158 patients receiving standard care. During the five-year follow-up there was no difference in cardiac mortality between the groups, but the recurrence rate of non-fatal MI (17.3 vs 33.3%. P = 0.02) and the rate of total cardiac events was lower in the intervention group (39.5 vs 53.2%, P = 0.05). There was an alteration of risk factors, as there were fewer smokers and uncontrolled hypertensives in the intervention group. Patients in the reference group used more sedatives and long-acting nitroglycerine and had a lower return-to-work rate during the study period. The programme proved to be particularly effective in the age group below 55 years, where a significantly lower rate of total cardiac events was observed and more patients returned to work than in the reference group. It is concluded that the combined effect of the comprehensive programme has contributed to the long-term results, and that the programme offers an effective and safe method of secondary prevention after MI.

Diet↗
PubMed1987

Neuropsychologic impairment in adults with brain tumors.

Neuropsychologic studies were performed in 49 adult patients with primary intracranial tumors following surgery and radiation therapy. In the absence of computed tomography (CT) scan evidence of tumor recurrence or neurologic disorders, patients' intellectual functioning was tested once (49 patients), twice (18 patients), or three times (5 patients) by the Wechsler Intelligence Scale (WAIS) between 1.5 and 110 months after the beginning of irradiation. Full scale IQ (FSIQ) and deterioration coefficient (DC) were evaluated. Time elapsed from treatment to initial evaluation (vertical study) determined three statistically different patient groups. During the first 4 months, DC and FSIQ did not differ from a normal population. From 5 to 30 months, there appeared a significant probability of intellectual deterioration (p = 0.01), whereas median FSIQ remained at a normal level. Beyond 30 months, deterioration disappeared in terms of DC, but median FSIQ fell (p = 0.01). Second and third evaluations (horizontal study) confirmed the initial evaluation. Nevertheless, later recovery from FSIQ impairment was seen in 4 of 5 patients who were less than 30 years old and in 2 patients between 30 and 50 years of age who returned to work early after treatment. We believe that early neuropsychologic testing to detect early psychologic impairment is needed in all adult patients treated for brain tumors, especially in younger patients. Psychologic assistance and an early return to work may be beneficial.

Adolescent↗
PubMedDate not supplied

Open versus laparoscopic appendectomy.

BACKGROUND/AIMS: To asses the role of laparoscopic appendectomy in the treatment of acute as well as chronic appendicitis on the basis of our own experiences. METHODOLOGY: From the set of 849 patients treated with appendectomy (from January 1993 to December 2000) 331 were singled out, i.e.; those unable to work for some time and thus being on sickness benefit who asked for a medical certificate. They were operated on for either acute or chronic appendicitis. RESULTS: In our set of 331 patients (158 males, 173 females, the average age 29.4) open appendectomy was performed on 179 patients and laparoscopic appendectomy on 152. Laparoscopic appendectomy was performed in 43 males (28%) and 109 females (72%); open appendectomy in 115 males (64%) and 64 females (36%). Laparoscopic appendectomy took 53.7 +/- 18.1 minutes, open appendectomy took 43.6 +/- 8.99 minutes. The time of work disablement is longer in open appendectomy (open appendectomy: 41.2 +/- 9.91 days; laparoscopic appendectomy; 29.1 +/- 15.11 days). A significant difference (p < 0.00001) can be seen in the length of hospitalization (laparoscopic appendectomy: 5.0 +/- 2.75 days, open appendectomy: 8.3 +/- 2.83 days). CONCLUSIONS: Patients who undergo laparoscopic appendectomy spent less time in hospital, and they can return to work rather earlier. On the other hand the time of surgery is longer. Higher cost is compensated for with shorter hospitalization and early return to work.

Acute Disease↗
PubMed1994

Laparoscopic antireflux surgery. What is real progress?

OBJECTIVE: The authors aim to substantiate, with objective arguments, potential advantages of laparoscopic versus open antireflux surgery in the light of the recent crude experience of the Louvain Medical School Hospital. METHODS: Seventy-two consecutive patients with disabling gastroesophageal reflux disease ([GERD], n = 56), symptomatic hiatal hernia without GERD (n = 5), or unsatisfactory outcome after unsuccessful antireflux procedure (n = 11) were operated on by laparotomy (n = 28), laparoscopy (n = 39), or thoracotomy (n = 5). The antireflux procedure was a subdiaphragmatic Nissen fundoplication (n = 60), an intrathoracic Nissen fundoplication (short esophagus, n = 3), a subdiaphragmatic 240 degrees fundoplication (severe motility disorders, n = 3), a Lortat-Jacob repair (hiatal hernia without GERD, n = 5), and a duodenal diversion (delayed gastric emptying, n = 1). RESULTS: Major postoperative morbidity included two pulmonary embolisms (one laparoscopy patient and one laparotomy patient), and one hemothorax (one thoracotomy patient). Mean hospital stay was 6.4 days for laparoscopy, 7.8 days for laparotomy, and 12.5 days for thoracotomy. Postoperative morphine consumption (patient-controlled analgesia) averaged 47 mg/48 hrs (laparoscopy) versus 46 mg/48 hrs (laparotomy with primary antireflux surgery) (p > 0.05). Although 93% of the laparoscopy patients returned to work within 3 weeks after surgery, 92% of the laparotomy and thoracotomy patients resumed their activity after more than 6 weeks. At follow-up, 87.5% of the patients were asymptomatic or had inconsequential symptoms, 9.8% had disabling side effects, and 2.7% had persistent or recurring esophageal symptoms. There were four parietal herniations, i.e., one incisional hernia and one recurrence of a repaired umbilical hernia in the laparotomy group, and two herniations of the wrap into the chest--probably related to a premature return to manual work--in the laparoscopy group. Three laparoscopy patients were dissatisfied with the esthetics of their scars. Lower esophageal sphincter pressure and esophageal acid exposure in the laparoscopy patients who were investigated were normal in 100% and 95%, respectively. CONCLUSIONS: Laparoscopy is a good approach for achieving successful antireflux surgery in selected cases. However, its fails to substantially reduce postoperative complication rate and discomfort, duration of the hospital stay, and the risk of esthetic sequela. Early return to work is questionable for manual workers. The subdiaphragmatic Nissen fundoplication is not an all-purpose antireflux procedure.

Adult↗
PubMed2006

Spatial working memory and inhibition of return.

Recently we showed that maintaining a location in spatial working memory affects saccadic eye movement trajectories, in that the eyes deviate away from the remembered location (Theeuwes, Olivers, and Chizk, 2005). Such saccade deviations are assumed to be the result of inhibitory processes within the oculomotor system. The present study investigated whether this inhibition is related to the phenomenon of inhibition of return (IOR), the relatively slow selection of previously attended locations as compared with new locations. The results show that the size of IOR to a location was not affected by whether or not the location was kept in working memory, but the size of the saccade trajectory deviation was affected. We conclude that inhibiting working memory-related eye movement activity is not the same as inhibiting a previously attended location in space.

Humans↗
PubMed1994

Decompression for lateral lumbar spinal stenosis. Results and impact on sick leave and working conditions.

STUDY DESIGN: One hundred patients underwent lumbar nerve root decompression without fusion. All patients were registered preoperatively in a computer-coded protocol and followed at regular intervals: 4, 12, and 24 months after surgery. A number of subjective and objective variables were investigated including data on preoperative and postoperative working conditions and sick listing. Patients' opinions on pain relief were assessed using a 4-grade scale. OBJECTIVES: Surgical results and impact on sick leave and working conditions in patients who underwent surgery for lateral spinal stenosis were evaluated in a prospective, consecutive study. SUMMARY OF BACKGROUND DATA: Preoperatively, 81 of the patients were employed, 21 in sedentary work, 36 in moderately heavy work, and 24 in heavy work. The majority of the patients (78%) were off work (sick listed) with a mean duration of 13 months. Mean preoperative duration of sciatic pain was 2.5 years. METHODS: Working conditions were classified into one of three categories: sedentary, moderately heavy, and heavy work. Distribution of working conditions preoperatively and postoperatively was assessed in conjunction with duration of sick leave. Change of work category postoperatively was evaluated and related to preoperative working conditions. RESULTS: The effect of decompression for sciatica due to lateral spinal stenosis was gratifying in most cases with excellent results in 65% and fair in 23% of the patients concerning leg pain. The majority of patients employed preoperatively (73%) returned to work after a postoperative sick leave of 5.5 months. Patients who received disability pension postoperatively had significantly inferior surgical result concerning back pain and were also sick listed significantly longer preoperatively. CONCLUSION: Thus, lateral spinal stenosis was improved in the majority of patients (88%) who underwent surgery, and the majority of patients who were employed before surgery returned to work after.

Adult↗
PubMed1996

Argon as Distending Medium in Laparoscopy Compared with Carbon Dioxide and Nitrous Oxide

The study investigated the inert gas argon as a distending medium during laparoscopic tubal sterilization under local anesthesia, and compared it with carbon dioxide (CO2) and nitrous oxide (N2O). Ninety women were assigned to three groups of 30 each, and one of three gases was randomly selected for abdominal distention. The chosen gas was blinded to surgeon, patient, and anesthetist. Induction and maintenance analgesia with midazolam and alfentanil were given by the anesthetist at a predetermined dosage as needed. Lidocaine 1% was given for paracervical block and in the subumbilical suprapubic areas for local anesthesia. A modified McGill pain assessment rating was used to record patients' pain at 1, 24, and 48 hours postoperatively. Postoperative analgesia requirement and time to return to work were also recorded. Intraoperatively, argon required similar analgesia as CO2 and N2O, but at 72 hours was associated with greater discomfort, probably relating to its lower solubility and retention in the abdomen. Time to return to work was not affected. Owing to its similar density (atomic weight 40) compared with molecular weight of 44 for CO2 and N2O, argon can be used interchangeably for distention in the standard insufflator machine. It should undergo further study for this purpose, however.

Journal Article↗
PubMed2001

Health and functional status of adult recipients 1 year after allogeneic haematopoietic stem cell transplantation.

Increasing numbers of patients are surviving after allogeneic haematopoietic stem cell transplantation (SCT). Among these patients, a number of late complications have been described but few data on the risk factors of these long-term effects of SCT are available. We report the analysis on 105 adult patients, surviving free of haematological disease at a median time of 15 months after SCT. At the time of screening, 52% had returned to work, general health status was normal in 67% and 47% were sexually active. Female patient gender odds ratio (OR) 2.9 (P = 0.01) and age > 25 years (OR = 3.2, P = 0.02) were associated with non-return to work. Decreased general status was associated with chronic graft-versus-host disease (GvHD) (OR = 3.2, P = 0.009) and irradiation (OR = 3.6, P = 0.004). Sexual inactivity was associated with younger age (OR = 7.0, P = 0.0002) and chronic GvHD (OR = 3.3, P = 0.006). Risk factors for altered pulmonary function tests included previous smoking habits, irradiation and chronic GvHD. Obstructive lung disease was associated with a previous history of asthma. Sicca syndrome and conjunctivitis were increased in patients with previous acute GvHD and cataracts were less frequent in patients with aplastic anaemia. Persistent impaired hair re-growth was less frequent in patients who received irradiation (OR = 0.18, P = 0.002) but increased in patients with previous acute GvHD (OR = 5.3, P = 0.007). Microalbuminuria was more frequent in irradiated patients (OR = 9.4, P = 0.05). Raised cholesterol was associated with age (OR = 20.8, P < 0.001), previous acute GvHD (OR = 4.7, P = 0.03), steroid use (OR = 6.3, P = 0.001) and familial hypercholesterolaemia (OR = 4.4, P = 0.04). Decreased bone density was associated with chronic GvHD (OR = 3.9, P = 0.001). Thus, using routine tests in adult patients we were able to detect significant numbers of-non-symptomatic complications enabling early treatment.

Acute Disease↗
PubMed1999

Diagnosis and prognosis in lumbar disc herniation.

In a prospective 2-year followup study of 160 consecutive patients undergoing primary surgery for suspected lumbar disc herniation, the authors studied the diagnostic and prognostic factors by using stepwise logistic regression analysis. When the different factors were entered in the same order as presented clinically, history and pain analysis contained most of the predictive information available. When all factors were entered simultaneously in the computations, the following factors (in order of relative importance) predicted relief of sciatica after 2 years: rupture of the anulus (as opposed to bulging disc or negative exploration), no preoperative comorbidity, and male gender. The following factors predicted return to work at 2 years: no preoperative comorbidity, duration of sciatica less than 7 months, education or vocational training in addition to compulsory school, age younger than 41 years, male gender, and no previous nonspinal surgery. Return to work does not seem to be a valid result parameter in lumbar disc surgery. The most important physical signs were root tension tests and lumbar range of motion, whereas neurologic signs were of secondary importance. Many people have asymptomatic herniations, and today supersensitive diagnostic imaging is widely available. Thus, the importance of clinical evaluation has increased, and most of the relevant information can be obtained by listening to the patient. A simple anamnesis apparently is a good alternative to psychologic tests in surgical triage.

Absenteeism↗
PubMed2005

Stapled hemorrhoidectomy: present status.

AIM: To evaluate cost-effectiveness of stapled hemorrhoidectomy comparing its results with conventional technique. SOURCE OF DATA: We retrospectively analyzed the MEDLINE data basis from 2000 to 2004 studying randomized clinical trials which compared pain intensity, recovery period, return to work and occurrence of anal incontinence, in addition to postoperative complications and costs evaluation between stapled and conventional hemorrhoidectomy during different periods of follow-up. CONCLUSIONS: Stapled hemorrhoidectomy provides lesser postoperative pain and earlier return to work than conventional hemorrhoidectomy. However, its efficacy could not be determined, since rigorous prospective and randomized clinical trials with long-term follow-up periods and large size samples are not available at this time.

Animals↗
PubMed2000

[Good results from a multidisciplinary and behavioral program for chronic back pain].

OBJECTIVE: To evaluate the results of a multidisciplinary and behavioral program for chronic back pain. DESIGN: Prospective cohort study. METHOD: In 1996, a total of 143 patients with chronic back pain participated in a 4-week multidisciplinary and behavioral treatment program in an outpatient centre for work reintegration (Rug AdviesCentrum) in Zeist, Eindhoven and Noordwijk, the Netherlands. At the start and six months after termination, data were collected on trunk muscle performance, pain intensity, disability and stress related physical complaints, and after 6 months about return to work, analgesics use, and health care utilization. Score differences between the first and the second measurements were tested on statistical significance using paired t-tests and on clinical relevance using the reliable change-index. RESULTS: The study group comprised 99 males and 44 females with a mean age of 41.6 years (range: 23-58). After 6 months the outcome variables were significantly improved statistically: depending on the outcome variable used, the improvement was clinically relevant in 44-91% of patients. The obtained percentage of full return to work at 6-months follow-up was 87%, while 80% had used no pain killers and 91% had made no use of health care facilities. CONCLUSION: The program resulted in important improvements in patients with chronic back pain.

Adult↗
PubMed1995

Outcomes analysis in cranial base surgery - preliminary results.

A system of analysis addressing predictors of management outcomes in Cranial Base Surgery has yet to be published. We therefore report data on seventy-nine consecutive patients undergoing surgery for tumors involving the cranial base, excluding patients with the diagnosis of pituitary microadenoma. Outcomes were defined prospectively in terms of completeness of tumor resection, complications of treatment with emphasis on neurological morbidity, and return to work or independent living. Also, preoperative features are analyzed as influencing cost of treatment, estimated in terms of the number of surgical procedures required, duration of hospital and Intensive Care Unit stay, and time taken to return to work. Preliminary analysis of data reveals that severe brainstem compression, large tumor size (average diameter > 3 cm), high cavernous sinus grade, and tumor encasement of major cerebral arteries are associated with incomplete tumor resection (p < 0.05). Patient age greater than 65, preoperative Karnofsky Performance Score (KPS) less than 80, and severe brainstem compression are associated with increased risk of stroke (p < 0.05). Age greater than 65 and preoperative KPS less than 80 are associated with an increased length of stay (p < 0.05). Other untoward events did not occur with sufficient frequency to reach statistical significance. A model of outcomes analysis in Cranial Base Surgery is proposed utilizing a database to incorporate a group of non-operated patients and include quality of life measurements in long-term patient follow-up.

Brain Neoplasms↗
PubMed1984

Coronary artery bypass surgery following thrombolytic therapy for acute coronary thrombosis.

One hundred thirty-six patients underwent thrombolytic therapy for acute evolving myocardial infarction from June, 1981, through December, 1982. Of these patients, 51 underwent coronary bypass procedures from two hours to 90 days (average, 16 days) following thrombolytic therapy. Six (12%) had single-vessel disease, 15 (29%) had double-vessel disease, and 30 (59%) had triple-vessel involvement. Ejection fraction values ranged from 21 to 60%. The average number of grafts performed per patient was 3.4. There were no operative deaths in this series. Postoperative hemorrhagic problems were minimal, and the incidences were no different from those for other coronary bypass patients. In follow-up ranging from 2 to 18 months, there was no recurrence of severe angina or other clinical evidence of saphenous graft occlusion in the thrombolysed vessels. Of the 45 patients eligible to return to work, 40 (89%) have done so. The data from this series suggest that surgical myocardial revascularization after intracoronary thrombolytic infusion for acute myocardial infarction can be performed safely and that complete recovery and a high return-to-work ratio can be anticipated.

Adult↗
PubMed2000

Tourniquet versus no tourniquet use in routine knee arthroscopy: a prospective, double-blind, randomized clinical trial.

PURPOSE: The purpose of this study was to determine the effects of tourniquet use for routine knee arthroscopy based on both subjective and objective functional outcome measures. TYPE OF STUDY: The study was a prospective, double-blind, randomized clinical trial. MATERIALS AND METHODS: There were 120 patients randomized to tourniquet inflation (300 mm Hg) or no tourniquet inflation during routine knee arthroscopy. Patients recorded their average pain on a visual analog scale and their narcotic use for the previous 24 hours, for the first 5 postoperative days. Patients also completed a preoperative and postoperative (2 week, 6 week, 3 month) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk, 30-second stair climb, 1-leg standing vertical leap, range of motion, and isokinetic strength testing. Time to return to work and sport was documented. RESULTS: No statistically significant difference was found between tourniquet-up and tourniquet-down groups for the WOMAC quality of life measure, functional tests, isokinetic muscle strengthening, or time to return to work or sport (t test/repeated measures analysis of variance). However, there was a trend for less early postoperative pain and slightly better isokinetic strength testing at 2 weeks in the tourniquet-down group. Visualization was rated by surgeons to be 3 times better in the tourniquet-up group, although mean operative time did not differ between the groups. CONCLUSION: The use of a pneumatic tourniquet at 300 mm Hg does not significantly effect overall patient quality of life or functional outcome following routine knee arthroscopy.

Adult↗
PubMed1995

Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy of physical therapy.

BACKGROUND AND PURPOSE: The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers' compensation was examined. The primary purpose of the study was to describe the level of disability, physical impairment, and rate of return to work for compensated patients. SUBJECTS: One hundred thirty-eight patients (84 male, 54 female), aged 17 to 63 years (mean = 38, SD = 10), were evaluated prospectively. METHODS: Subjects were assessed initially (INA) and were reevaluated 1 month later (1MO) and again at the time of discharge (DC). The Oswestry disability score, fingertip-to-floor distance during forward bending, maximal isometric lift, and work status were described as outcomes. Subjects were grouped based on compliance, chronicity, and leg symptoms. Each disability/impairment outcome was analyzed with paired t tests (INA versus 1MO and INA versus DC). The frequency of subjects returning to work across groups was evaluated with a chi-square analysis corrected for unequal group sizes. RESULTS: Overall, there was improvement in each dependent measure at 1MO and DC compared with the INA. Subjects with high compliance had a 10% reduction in mean disability at 1MO and a 12% reduction in mean disability at DC compared with the INA. The low-compliance group, in contrast, showed less than a 5% reduction in mean disability at both the 1MO and DC assessments compared with the INA. The magnitude of improvement in disability status, forward bending, and maximal lift was approximately two to three times greater for subjects with acute symptoms compared with those with chronic symptoms. The increase in mean forward bending for subjects without leg symptoms was over twice as large as the increase in forward bending for subjects with leg symptoms. Seventy-five percent of the subjects followed at DC (30 out of 40) were released to work in some capacity. There was no association between compliance or presence of leg symptoms and work status at DC. Eighty percent of the subjects with acute symptoms, however, were working at the time of DC compared with 44% of those with chronic symptoms. CONCLUSION AND DISCUSSION: Compliance, chronicity, and leg symptoms are all factors that can affect the outcome of physical therapy. The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment.

Adolescent↗
PubMed2002

Back Performance Scale for the assessment of mobility-related activities in people with back pain.

BACKGROUND AND PURPOSE: Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. SUBJECTS: The participants were 288 patients with long-lasting musculoskeletal pain. METHODS: The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. RESULTS: Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. DISCUSSION AND CONCLUSION: The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.

Adult↗
PubMed1998

Conservative inhospital management of low back pain patients. Factors predicting two-year outcomes.

OBJECTIVE: To evaluate the course of symptoms and occupational outcomes in low back pain patients two years after conservative inhospital therapy. METHODS: Retrospective medical chart study of all patients admitted to a rheumatology department in Geneva in 1993, and telephone interview two years after the admission. RESULTS: Eighty of the 99 patients (81%) identified by the chart review were interviewed by telephone. The course of symptoms (evaluated based on subjective assessments and on the number of subsequent admissions) was similar in the patients who had acute (n = 33) and chronic (n = 47) low back pain at the index admission. Patients who had not returned to work were significantly more likely to report persistent pain (P < 0.001). As many as 61% of patients had not resumed work. Sick leave duration and symptom duration at admission were the factors that had the largest effects on prognosis. Over 90% of patients who were put on sick leave for more than four weeks did not return to work. Permanent cessation of work was recorded in 82% of manual laborers versus 27% of patients in sedentary jobs (P < 0.001). CONCLUSION: Our results are ascribable, at least in part, to the fact that our population included large numbers of patients with persistent pain and of blue collar workers with physically-challenging jobs. Sick leave duration and occupation were the best predictors of the course of symptoms and work status.

Acute Disease↗
PubMed1986

The predictive validity of the functional capacities evaluation.

This study tested the predictive validity of the Functional Capacities Evaluation (FCE), which included the following three components: a Medical History Review, a Client Activity Interview, and the Smith Physical Capacities Evaluation (SMITH-PCE) as the performance component. The FCE is used in conjunction with the Physical Demands and Environmental Conditions specified by the U.S. Department of Labor to predict a subject's ability to return to work. The study used a random sample of 52 subjects. An employment questionnaire served as a criterion measure of predictive validity. The data from the questionnaires were compared with predictions from the evaluations, and a lambdab test was applied to the data. Results suggested that for the sample analyzed, trained registered occupational therapists could use the FCE to predict a client's ability to return to work more accurately. The study was limited in that the sample used was drawn from clients seen in only one private practice and that only 42% of the questionnaires were returned.

Adult↗