Compensating occupationally related tenosynovitis and epicondylitis: a literature review

OBJECTIVES: To assess occupational associations with tenosynovitis and epicondylitis, we conducted a systematic literature review. We focused particularly on evidence that might support compensation of these disorders 'on the balance of probabilities'. METHODS: We searched the MEDLINE and EMBASE electronic biomedical databases to 1 January 2005 using combinations of keyword and medical subject headings, and also the references cited in two state-of-the-art reviews from the 1990s. Primary research reports were retrieved and checked for further relevant citations. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. RESULTS: We found and summarized 18 papers. In the main, these based analysis on job titles rather than on directly assessed physical activities. Few occupations were studied more than once, however, and there was little consistent evidence of jobs or work activities that carried more than a doubling of risk for either disorder. CONCLUSION: Compensation of occupational illness can be problematic for disorders that are not specific to work and for which there are no distinctive clinical features in occupationally related cases. Attribution can, however, be made on the balance of probabilities if there is convincing evidence that risk is at least doubled in an occupational group. Our review highlights the relative lack of data to support such attribution for tenosynovitis and epicondylitis, and discusses the difficulty of compensating upper limb disorders.     

Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England

Introduction

In the UK, primary varicella is usually a mild infection in children, but can cause serious illness in susceptible pregnant women and adults. The UK Joint Committee on Vaccination and Immunisation is considering an adolescent varicella vaccination programme. Cost-effectiveness depends upon identifying susceptibles and minimising vaccine wastage, and chickenpox history is one method to screen for eligibility. To inform this approach, we estimated the proportion of adolescents with varicella antibodies by reported chickenpox history.

Methods

Recruitment occurred through secondary schools in England from February to September 2012. Parents were asked about their child's history of chickenpox, explicitly setting the context in terms of the implications for vaccination. 247 adolescents, whose parents reported positive (120), negative (77) or uncertain (50) chickenpox history provided oral fluid for varicella zoster virus-specific immunoglobulin-G (VZV-IgG) testing.

Results

109 (90.8% [85.6–96.0%]) adolescents with a positive chickenpox history, 52 (67.5% [57.0–78.1%]) with a negative history and 42 (84.0% [73.7–94.3%]) with an uncertain history had VZV-IgG suggesting prior infection. Combining negative and uncertain histories, 74% had VZV-IgG (best-case). When discounting low total-IgG samples and counting equivocals as positive (worst-case), 84% had VZV-IgG. We also modelled outcomes by varying the negative predictive value (NPV) for the antibody assay, and found 74–87% under the best-case and 84–92% under the worst-case scenario would receive vaccine unnecessarily as NPV falls to 50%.

Conclusion

Reported chickenpox history discriminates between varicella immunity and susceptibility in adolescents, but significant vaccine wastage would occur if this approach alone were used to determine vaccine eligibility. A small but important proportion of those with positive chickenpox history would remain susceptible. These data are needed to determine whether reported history, with or without oral fluid testing in those with negative and uncertain history, is sufficiently discriminatory to underpin a cost-effective adolescent varicella vaccination programme.     

Impact and costs of varicella prevention in a university hospital.

Information regarding all patient and staff exposures to varicella-zoster virus (VZV) was prospectively accumulated from 1/1/86 to 12/31/86 at North Carolina Memorial Hospital. During this period of time 37 sources of exposure to VZV were reported: 10 outside and 27 within the hospital. Index cases for nosocomial exposure included: 12 patients with zoster, 9 patients with varicella, two staff with varicella, three visitors with varicella, and one staff with zoster. One hundred and twenty patients received nosocomial exposures; 28 had no history of VZV infection (23 per cent), of whom 11 were serosusceptible (39 per cent). Sources of nosocomial patient exposure included: other patients (85 per cent), staff (14 per cent), and a single visitor (1 per cent). More than 300 employees received nosocomial exposure; 158 had no history of VZV infection, of whom 49 were serosusceptible (31 per cent). Only a single employee and no patients developed clinical varicella as a result of nosocomial exposure. Costs associated with VZV control during 1986 totaled $55,934: $39,658 for work furloughs, $9,800 for serologies, $4,293 for patient isolation, $155 for varicella-zoster immune globulin, and $2,028 for infection control personnel time. These costs should be considered as part of any benefit-cost analysis of varicella immunization of health care personnel.     

The CQI paradigm: a pathway to nurse empowerment in a community hospital

Anderson Area Medical Center instituted continuous quality improvement (CQI) hospitalwide two years ago. Three teams were challenged with identifying and improving processes related to accounts receivable. X-ray report turn-around-time, and emergency department patient satisfaction. Nursing participation was sought for all three teams. An eight-step CQI process was used to identify, analyze, and improve these three processes. Substantial nursing participation in these pilot CQI teams led to further participation in many other CQI teams optimizing clinical processes. Nursing personnel gained opportunities to make significant contributions to the enhancement of clinical and administrative processes in a large hospital. Nurses learned to work with other members of the health care team outside of their traditional domains, and this, combined with formalized training in the team process, is empowering.     

浅谈做一名合格的基层医院护士应具备的素质

目的:探讨基层医院护士应具备的素质.方法:分析基层医院的护士面对的工作环境和思想表现;结论:基层医院的护士通过提高思想素质,加强学习和各方面的锻炼,成为一名适应基层工作的合格的护士.     

Case report: silicatosis in a carpet installer

CONTEXT: Chronic exposure to talc in the course of carpet installation can result in pneumoconiosis. CASE PRESENTATION: We present a case of a young carpet installer who was diagnosed with silicatosis of the lung. Review of occupational history revealed that the patient had been working as a carpet installer for approximately 15 years, since he was 15 years of age. The patient was exposed to talc in the course of his work. DISCUSSION: Exposure to talc in the course of carpet installation has not been reported as a possible cause of pneumoconiosis. In this article we review different causes of silicatosis and discuss chronic exposure in the course of carpet installation and development of pneumoconiosis. In addition, we also review the relevance of mycobacterial infection in cases of silicosis and silicatosis. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: Exposure to talc in the course of carpet installation should be added to conditions that can cause pneumoconioses, specifically silicatosis of the lung.     

The epidemiology of varicella in staff and students of a hospital in the tropics

A five-year retrospective survey of the epidemiology of varicella in staff and students at our hospital revealed a high incidence of 0.72 cases per 100 per year. The incidence was highest among 17-24 year-olds, especially among student nurses (3.22 cases per 100 per year). Most cases of varicella occurred in the cooler and more humid months of the year. Among 102 candidate student nurses aged 17-20 years, only 29.7% had complement-fixing antibodies to varicella-zoster virus. Thus our hospital personnel are at high risk of contracting and transmitting nosocomial varicella. These results corroborate existing evidence that the epidemiology of varicella in the tropics is different from that in temperate regions.     

Making the grade: a status report on hospital report cards

Hospital report cards that document patients' medical outcomes are attracting increasing attention for their role in guiding health care decisions by employers, consumers and providers. Significant questions remain, however, regarding the validity and utility of this information. This Issue Brief is based on a seminar held by the Center for Studying Health System Change at which two expert panels discussed whether report cards make the grade. The first panel approached this subject through a Socratic dialogue that focused on the release of a hypothetical community hospital report card. The second panel weighed in on two research presentations related to report cards. The panelists agreed that efforts to collect and report clinical outcomes data are flawed. Even so, release of the data can help improve clinical quality and foster an environment in which health care quality information ultimately has an impact on health care decision making.     

Epidemiology of hospital admissions for paediatric varicella infections: a one-year prospective survey in the pre-vaccine era

To evaluate the epidemiology of hospital admissions for varicella in children, a 1-year prospective multicentre study was done in Northern France in the pre-varicella vaccine era. The 405 children aged <16 years seen at local hospitals for varicella or herpes zoster were included. Among them, 143 who had varicella and resided in the district were admitted. Admission incidence rates were 28/100000 children aged <16 years (149/100000 infants aged <1 year, 69/100000 children aged 1-4 years, and 2/100000 children aged 5-15 years). Most admissions (57%) were related to complications, usually skin infection (47%). Independent risk factors for admission were place of residence outside the district [adjusted odds ratio (aOR) 8.7], complication at admission (aOR 5.8), recurrent fever (aOR 4.5), recent varicella in a sibling (aOR 4.0), and previous physician visit for the same condition (aOR 2.0).     

Neurological complications of varicella in childhood: Case series and a systematic review of the literature

Although varicella has usually an uncomplicated course in early childhood, several neurological complications may occur. We conducted a study to review the type and the rate of varicella neurological complications in a case series of hospitalized immunologically healthy children over nearly a 8 year period. We also systematically reviewed data from the literature to estimate the rate of varicella neurological complications. In our case reports, the proportion of neurological complications among all those hospitalized for varicella was of 21.7% (CI 17.9-26%). The pooled prevalence of neurological complications resulting from the systematic review of the literature identifies the likelihood of such complications in the range of 13.9-20.4%. Although neurological complications of chickenpox do not frequently result in permanent sequelae, they represent significant determinants of prolonged hospital stay and of other indirect costs. The obtained results may be useful for estimating costs associated with hospitalization from varicella in cost-benefit analysis for immunization.     

Diphenhydramine toxicity in a child with varicella. A case report.

Varicella may be associated with serious complications including encephalitis, Reye's syndrome, and drug toxicity. In this case, a 19-month-old child with varicella was brought to the family practice clinic by her parents when she began behaving abnormally. At the time of presentation the child exhibited dilated pupils, ataxia, urinary retention, and facial grimacing. The child's parents had treated her with acetaminophen, diphenhydramine syrup, colloidal oatmeal baths, and frequent applications of Caladryl lotion. The results of her immediate laboratory tests were within normal limits, and she was admitted to the hospital for observation. She recovered without therapeutic intervention. Although not available at the time of admission to the hospital, her diphenhydramine serum level was 1948 ng/mL. Diphenhydramine levels above 100 ng/mL have been associated with toxicity.     

Determination and importance of varicella immune status of nursing staff in a children''s hospital

A survey of nurses at the Prince of Wales Children's Hospital was conducted to determine the prevalence of immunity to varicella-zoster virus (VZ) as defined by enzyme immunoassay (EIA), and to establish the value of history as a predictor of immunity. Of the 209 nurses surveyed, 51% could recall suffering VZ infection, and with a single exception, all of this group were immune. However, despite a 95% prevalence of immunity among all nurses, 46% of those found to be immune by EIA could not recollect having VZ infection. In the event of a hospital VZ outbreak, the latter group, without serological testing, would thus need to be regarded as susceptible, and this would create a major logistical problem in staffing the affected areas. We suggest, to minimize this cause of disruption to services, that all paediatric staff with patient contact should be asked at the time of recruitment if they recall suffering VZ infection. Those who give a positive response may be considered immune, but all other staff should have their immune status assessed by EIA at the earliest opportunity.     

Optimizing nurse capacity in a teaching hospital neonatal intensive care unit

Patients in intensive care units need special attention. Therefore, nurses are one of the most important resources in a neonatal intensive care unit. These nurses are required to have highly specialized training. The random number of patient arrivals, rejections, or transfers due to lack of capacity (such as nurse, equipment, bed etc.) and the random length of stays, make advanced knowledge of the optimal nurse a requirement, for levels of the unit behave as a stochastic process. This stochastic nature creates difficulties in finding optimal nurse staffing levels. In this paper, a stochastic approximation which is based on the required nurse: patient ratio and the number of patients in a neonatal intensive care unit of a teaching hospital, has been developed. First, a meta-model was built to generate simulation results under various numbers of nurses. Then, those experimented data were used to obtain the mathematical relationship between inputs (number of nurses at each level) and performance measures (admission number, occupation rate, and satisfaction rate) using statistical regression analysis. Finally, several integer nonlinear mathematical models were proposed to find optimal nurse capacity subject to the targeted levels on multiple performance measures. The proposed approximation was applied to a Neonatal Intensive Care Unit of a large hospital and the obtained results were investigated.     

Mortality in an European cohort occupationally exposed to Epichlorohydrin (ECH)

A study was undertaken on the mortality of workers exposed to ECH at four European sites with plants producing epichlorohydrin (ECH), epoxy resins, glycerin, and other specialty chemicals derived from ECH. The vital status of 606 individuals with at least one year of exposure to ECH, starting at least 10 years before the final date of the study on 31 December, 1978, were collected. Mortality was analysed for a subgroup with 10 or fewer years of exposure, and another subgroup with more than 10 years of exposure. Four deaths from different cancers were observed against five expected. No excess mortality from cancer was observed in either subgroup or the complete cohort, which could be related to ECH exposure. The small size of the cohort and the limited number of deaths due to low average age (42 years), as well as the short duration of the observation period, do not allow a firm conclusion to be reached regarding the potential carcinogenicity of ECH in man. Current exposure levels are low, but exposure in the early days of production occasionally reached levels high enough to be irritating. We recommend updating the study 5 years from the final date of the present study, i.e. on 31 December, 1983. Within their limitations this and other epidemiological studies so far provide no evidence for an association between occupational exposure to ECH and the occurrence of malignant neoplasms in man.     

Case report of a perforated appendix in the sac of inguinal hernia (Amyand's hernia)

This case is a rare aspect of inguinal hernia. The patient was admitted with a 10-day pain of right groin and a past history of an inguinal hernia which was irreducible at the time of admission. In the operating room, the hernia sac was opened which included a perforated and gangrenous appendix that is called Amyand's hernia. The patient underwent appendectomy and herniorrhaphy at the same operation.