Predictors of rate of return to work after surgery for carpal tunnel syndrome

Objective . To evaluate the impact of patient demographics, clinical features, and job-related factors on the time until return to work after carpal tunnel release surgery. Methods . We employed a cross-sectional community-based study of 59 patients who had undergone carpal tunnel release surgery. Sociodemographic, clinical, and job-related characteristics and time to return to work were obtained by interview and from medical records. Exposure to ergonomic risk was derived from an independently validated job matrix. Time to return to work after surgery was analyzed by survival techniques. Results . Median time to return to work was 5 weeks. After adjustment, the relative rate (RR) of return to work per week after surgery was most strongly decreased by the receipt of workers' compensation, RR 0.2 (95% confidence interval [CI] 0.1–0.5), and by the exposure to bending and twisting of the hand prior to surgery, RR 0.7 (95% CI 0.5–0.9) per hour. Female gender was another predictor of decreased return to work, RR 0.5 (95% CI 0.3–0.8). Conclusions . Patients receiving workers' compensation, those exposed to higher levels of bending and twisting of their hands and wrists, and women were slower to return to work after carpal tunnel release surgery.     

Return to work after myocardial infarction: results of a longitudinal population based study

Return to work was studied in all men who had entered the infarctregister in the city of Ghent between 1983 and 1988 becauseof a first myocardial infarction before the age of 60 years.Information on work resumption was collected in 1991 using apostal survey; 78% of the 295 eligible subjects participatedSixty-nine percent of all responders and 85% of all those whowere at work before the infarct returned to work. Age, the perceivedimportance of the job, support from friends and the participationin a comprehensive cardiac rehabilitation programme were significantlyrelated to work resumption.     

Return to work after thoracic organ transplantation in a clinically-stable population

PURPOSE: To evaluate the rate of return to work after transplantation and its determinants in a clinically-stable population of patients transplanted and followed-up at a single institution in Italy. METHODS: 151 thoracic organ transplant recipients (72 lung, 79 heart) were examined. Patients were asked about daily activities, level of education, employment and clinical condition. A six-minute walking test was performed with measurement of dyspnoea using the Borg scale. Quality of Life was evaluated with the SF-36 and GHQ questionnaires. RESULTS: Before transplantation 131 patients (87%), (70 heart and 61 lung) worked. After transplantation, 51 patients (39%) went back to work and 3 more started working. We found that younger age, a better quality of life (mainly in the mental domain), having had an occupation previously (particularly as an entrepreneur/freelancer), and having been off work for less than 24 months, were independent predictors of return to work. CONCLUSIONS: Considering their good, objective and subjective, functional status, some patients who could have returned to work, chose not to. Identifying factors which affect return to work might help health professionals to adopt the best course of treatment and psychological support in order to fulfil this goal; however, return to work should not be considered as the only expression of a patient's real psychophysical condition.     

Long-term survivors with adult acute leukemia in complete remission: complications and return to work

For addressing, and eventually being able to predict and prevent, both disease-related complications and changes in social status in long-term acute leukemia survivors, the follow-up is the most important factor after treatment. To this end, we assessed the complications following the attainment of complete remission in adult acute leukemia patients and the changes in social status of patients surviving more than 5 years after disease onset. In our study population of 42 survivors, 24 (57.1%) suffered from various combinations of 18 types of identified complications including posttransfusion hepatitis, diabetes mellitus, and idiopathic osteonecrosis. Regarding fertility, 9 live births were recorded in this cohort, from 2 female patients and the partner of a male patient. Of these 42 long-term survivors, at the time of this report 48.5% were working full- or part-time, 9.0% were unemployed, 30.3% were homemakers, and 12.2% were retired.     

Psychological and clinical predictors of return to work after acute coronary syndrome.

AIMS: Resumption of paid employment following acute coronary syndrome (ACS) is an important indicator of recovery, but has not been studied extensively in the modern era of acute patient care. METHODS AND RESULTS: A total of 126 patients who had worked before hospitalization for ACS were studied with measures of previous clinical history, ACS type and severity, clinical management, and sociodemographic characteristics. Depressed mood (Beck Depression Inventory) and type D personality were measured 7-10 days following admission. Among them, 101 (80.2%) had returned to work 12-13 months later. Failure to resume work was associated with cardiac factors on admission (heart failure, arrhythmia), cardiac complications during the intervening months, and depression scores during hospitalization. It was not related to age, gender, socioeconomic status, type of ACS, cardiac history, acute clinical management, or type D personality. In multivariate analysis, the likelihood of returning to work was negatively associated with depression, independently of clinical and demographic factors [adjusted odds ratio 0.90, CI 0.82-0.99, P=0.032]. CONCLUSION: Depressed mood measured soon after admission is a predictor of returning to work following ACS. The management of early depressed mood might promote the resumption of economic activity and enhance the quality of life of cardiac patients.     

Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

BackgroundThe rate of unplanned return to the operation room (UROR) is an important index for the quality of surgeries. Study of the features and causes of patients who have suffered UROR is key to reduce the risk of it.MethodsA retrospective, observational study was conducted among lung cancer patients who have received lung resections and UROR over a 5-year period. The causes, findings, procedures of UROR and recovery of patients were examined.ResultsAmong the 23,345 lung cancer surgeries, 64 underwent UROR with the rate being 0.27%. Lobectomy was performed in 78.1% of the patients. The most common indication was post-operative bleeding, responsible for 82.8% (53/64) of the cases. The median length of stay after the second surgery was 7 days and over 90% of the patients were discharged with proper recovery. The death rate within 90 days after return to operation room (OR) was 1.6% (1/64). In the 53 cases caused by bleeding, 27 (50.9%) occurred in surgical sites, with the raw surface of lymph node dissection being most frequently affected. Bleedings on incisions and unknown origin took up 11.3% and 37.7%, respectively.ConclusionsBleeding is the most common indication which causes over 80% of UROR for lung cancer surgeries. Careful examination and complete hemostasis in surgery is key to reduce the risk of this unwanted complication.     

左心室心肌做功预测心脏再同步化治疗的效果

目的 利用二维斑点追踪成像(2D-STI)技术新参数左心室心肌做功预测心脏再同步化治疗(CRT)的效果.方法 选取2017年12月至2019年10月在苏北人民医院接受CRT治疗的75例心力衰竭患者为研究对象,于CRT术前及术后6个月测量常规超声心动图参数以及利用2D-STI技术分析整体心肌做功参数.将术后左心室收缩末期...     

Return to work after coronary artery bypass surgery in a population of long-term survivors

BACKGROUND: Return to paid employment may be facilitated by coronary artery bypass graft (CABG) surgery. We assessed work status in a population-based study of long-term outcomes of CABG. AIM: To determine the association between returning to work after CABG and clinical and socio-demographic factors. METHODS: A postal survey of 2,500 randomly selected patients 6-20 years post-CABG. The outcomes assessed were work status in the year before and after CABG and health-related quality of life (HRQOL) measured with SF-36. RESULTS: Response was 82% (n = 2,061). Employment fell from 56% in the year prior to CABG to 42% in the year after. Workers in 'blue-collar' occupations were more likely to reduce their work status than those in 'white collar' occupations (46% versus 29%, p < 0.001). Independent predictors of reducing employment were increasing age (9% per year, 99% CI: 1.06-1.11, p < 0.001), 'blue-collar' versus 'white collar' occupation (OR: 2.1, 99% CI: 1.4-3.1) and female sex (OR: 2.1, 99% CI: 1.1-3.6). HRQOL among participants under 60 years of age at follow-up was better for those who returned to work after CABG surgery. CONCLUSION: CABG surgery is followed by a net loss to paid employment of working age patients which increases with age, and is more likely for those in blue-collar occupations and women.     

Predictors of Successful Return to Work from HIV-Related Disability

ABSTRACT

This study examines factors distinguishing HIV-infected persons who successfully return to work (RTW) from those who do not. Records were obtained from 135 participants in a return to work program; these were matched with the records of 135 persons who did not return to work. Matching was made on the basis of age, gender, race, CD4 counts, and length of time in treatment. The return to work group had a greater total number of mental health diagnoses than the non-return group; however, when type of diagnosis was controlled for, the non-return group had greater number of substance use disorders. It appears that substance use disorders preclude a successful return to the workforce, while accessing the mental health treatment system may actually facilitate a return to work. Careful psychosocial assessment of clients on entry into the primary care clinic can aid referrals directly into a RTW program or into services that would facilitate an eventual return to work.     

Healthcare workers' willingness to work during an influenza pandemic: a systematic review and meta‐analysis

To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta‐analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random‐effects meta‐analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I² statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta‐analyses were not possible. Forty‐three studies met our inclusion criteria. Meta‐analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I² = 99·2%). Narrative synthesis showed study estimates ranged from 23·1% to 95·8% willingness to work, depending on context. Meta‐analyses of specific factors showed that male HCWs, physicians and nurses, full‐time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role‐specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.     

Surveillance and return to work of healthcare workers following SARS-CoV-2 Omicron variant infection,Sheffield, England, 17 January to 7 February 2022

The SARS-CoV-2 Omicron variant has challenged demands to minimise workplace transmission in healthcare settings while maintaining adequate staffing. Policymakers have shortened COVID-19 isolation periods, although little real-world data have evaluated the utility. Our findings from surveillance of 240 healthcare workers from Sheffield Teaching Hospitals, England, show that 55% of affected staff could return before day 10 of isolation with over 25% eligible on day 6, pending two successive negative antigen tests. This outcome is favourable for continuity of healthcare services.     

Fear for CoViD-19 and reluctance to work among health care workers during the epidemic,a prospective monocentric cohort study

BackgroundHealth care workers (HCW) are facing the Coronavirus disease 2019 (CoViD-19) epidemic. Consequently, psychological impairments have been reported. However, literature showed controversial results on the relationship between gender, frontline HCW, and psychological impairments. This study aims to investigate CoViD-19 fear and reluctance to work in HCW.MethodsEmployees who worked between April and October 2020 at the UZ Brussel were included. Data were prospectively collected in 2 phases through a survey together with serological tests. Sampling strategy was convenience sampling.ResultsAbout 2,336 employees completed the study and response rate was 70%. The prevalence of severe CoViD-19 fear in participants increased from 9% to 15%. Employees showing way less motivation rose from 9% to 14%. The seroprevalence was 7.4% and 7.9%. Multivariable analysis found a relation between reluctance to work, study phase, female gender, shortage of personal protective equipment, and poor education on CoViD-19. Furthermore, CoViD-19 fear was related to the study phase, older age, female gender, being second-line HCW, reported exposure to CoViD-19 during work, and insufficient education on CoViD-19.DiscussionSeroprevalence remained rather stable, but fear and reluctance to work significantly increased. Differences in time of data collection together with epidemiological setting might be responsible for conflicting data reported in literature.ConclusionsThe evolution of the epidemiological setting might influence the results of studies investigating psychological impairments in HCW.     

Insulin resistance and hyperinsulinaemia in mild to moderate progressive chronic renal failure and its association with aerobic work capacity

Summary Tissue sensitivity to insulin and aerobic work capacity was measured in patients with mild to moderate progressive chronic renal failure. Twenty-nine non-diabetic patients with a glomerular filtration rate of 25 ml·min^–1·1.73 m^–2 (11–43) (median, range) and 15 sex, age, and body mass index matched control subjects with normal renal function were studied. Fasting blood glucose was comparable and in the non-diabetic range in the two groups as was the oral glucose tolerance test. Patients demonstrated hyperinsulinaemia both during fasting (p<0.01) and during the test (p<0.02). The tissue sensitivity to insulin, expressed by the amount of glucose infused during the last 60 min of a 120-min hyperinsulinaemia euglycaemic clamp (M-value) and the M/I ratio, was significantly lower in the patients than in the control subjects (M-value 404±118 vs 494±85 mg glucose/kg body weight, p<0.02) (M/I ratio 1.77±0.71 vs 2.57±0.70 (mg/(kgBW·min) per pmol/l·100, p<0.001). The maximal aerobic work capacity was significantly lower in the patients than in the control subjects (24±8 vs 32±11 ml O₂/(kg body weight·min), p<0.02) and positively correlated to the M-value and the M/I ratio in both groups. In conclusion, not only patients with end-stage chronic renal failure but also those with mild to moderate progressive chronic renal failure are insulin resistant and hyperinsulinaemic. The tissue sensitivity to insulin is correlated to the maximal aerobic work capacity suggesting that these patients might benefit from physical training programmes.Abbreviations CRF Chronic renal failure - GFR glomerular filtration rate - NEFA non-esterified fatty acids - CO cardiac output - GH growth hormone - OGTT oral glucose tolerance test     

Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients

BackgroundSince most hip fractures occur in fragile patients, an important step forward in the treatment may be a co-managed, multidisciplinary treatment approach with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with the usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon.The primary aim of this study was to assess the effect of the MCM on 30-day mortality, compared with the UCM.MethodsA retrospective study was conducted on patients with main diagnosis of hip fracture, as reported in the hospital admission discharge reports, aged 65 years and older, who underwent surgery in Tuscan hospitals from 2010 to 2013. A multilevel logistic regression model was performed to assess the effect of the MCM vs the UCM. The Charlson Comorbidity Index (CCI) was used as a proxy for case mix complexity.Results23,973 patients were included: 23% men and 77% women; the mean age was 83.5 years. The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR = 1.32; 95% CI 1.09–1.59; p = 0.004). Surgical delay was not significantly associated with higher mortality rates.ConclusionsA co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to a reduction in mortality after hip fracture surgery.