Use of a violence risk assessment tool in an acute care hospital: effectiveness in identifying violent patients.

This study examined the use and effectiveness of the Alert assessment form. The form is part of the Alert system, used by one large acute care hospital to identify patients with a propensity for violence. All reported incidents of patient violence from August 1, 2003, through December 31, 2004, were included in patient charts. One hundred seventeen violent patient charts were reviewed and compared with 161 non-violent patient charts, randomly chosen from the same time period. Overall use of the Alert assessment form for violent and non-violent patients was 75.7% and 35.4%, respectively. The assessment form was found to have moderate sensitivity (71%) and high specificity (94%). It is reasonably effective in identifying potentially violent or aggressive patients when it is used according to protocol. Efforts to improve the tool are warranted, as is evaluation of its benefit in settings with low prevalence of violence. Also, greater effort must be taken to prevent violence once an aggressive patient has been identified.     

Effects of acetaminophen on adverse effects of influenza vaccination in health care workers.

OBJECTIVE: To evaluate the effects of acetaminophen on the incidence of adverse effects to, and the immunogenicity of, whole-virus influenza vaccine in health care workers. DESIGN: Prospective, randomized, double-blind placebo-controlled trial. SETTING: Health Sciences Centre, an acute care teaching hospital in Winnipeg. PARTICIPANTS: Of 474 hospital personnel who agreed to undergo influenza vaccination during the 1990-91 season 262 volunteered to participate in the study. INTERVENTIONS: A dose of 0.5 mL of inactivated trivalent whole-virus influenza vaccine was injected into the deltoid muscle. Volunteers were randomly assigned to ingest two capsules of acetaminophen in a half dose (162.5 mg per capsule) or a full dose (325 mg per capsule) or two identical placebo capsules. Capsules were to be taken at vaccination and at 4, 8 and 12 hours afterward. Subjects were asked to answer questions regarding six symptoms in a diary for the 3 days after vaccination and to record their ingestion of the study medication. MAIN OUTCOME MEASURES: Incidence of local (sore arm) and systemic (headache, fever, muscle ache, nausea and diarrhea) side effects as well as serum titres of hemagglutination inhibition (HAI) antibody to vaccine antigens before vaccination and 2 weeks and 6 months afterward. RESULTS: A total of 87, 87 and 88 subjects received the half dose, full dose and placebo respectively; 96% returned the diaries, 83% ingested all four doses of medication, and 87% volunteered all blood samples. Compared with the placebo group the incidence of sore arm was 25% to 28% lower in the half-dose and full-dose groups respectively at 24 hours after vaccination, and the rate of nausea was 90% lower in the full-dose group. The HAI titres were similar among the groups at the three test times. CONCLUSIONS: The full dose of acetaminophen significantly reduced the incidence of sore arm and nausea without affecting the antibody response. Acetaminophen use may increase the acceptance of influenza vaccine by health care workers in whom concern about side effects is an impediment to vaccination.     

The development of worker-controlled occupational health centers in Canada.

Over the past decade worker-controlled occupational health centers have been established in three Canadian provinces. This development has been a response to the slowness in recognizing occupational medicine in the Canadian medical community, the limited availability and questionable acceptability of existing services, as well as the growth of worker control in occupational health matters generally. The history, funding, organizational structure, personnel, resources, and programs of these worker-controlled centers are outlined, illustrating the extensive programs that can be provided despite small budgets of these operations. Advantages to workers include direct access to resources as well as expert professional advice with the focus on work place hazards. Furthermore, the centers provide for extensive interaction among workers on their common concerns. Disadvantages of the model include restricted access to work places associated with frequent distrust of employers. Employer-based and university-based models are compared to worker-controlled centers, and it is suggested that the latter may influence the pattern of practice of occupational health as well as the ability of workers and their unions to promote improved occupational health and safety conditions.     

The epidemiology of back injuries in nurses at a large Canadian tertiary care hospital: implications for prevention

Two years of prospective data on 416 back injuries were gatheredat a 1100-bed acute and tertiary care hospital to assist targetprevention efforts. The rate of injury among 1645 nurses wasfound to be highest for those working on orthopaedic, medicine,neurology, spinal and surgery wards, indicating priorities forprevention. In fact, 51% of the orthopaedic nurses sustained at least oneback injury during the two-year period. Gender did not significantlyaffect the risk for back injury; however, injuries were slightlymore common in nurses with less seniority and younger nurseswere found to be at significantly increased risk of back injury.Almost 63% of the back injuries which occurred in nurses working8 h shifts on the high-risk wards occurred during the firsttwo hours of the shift. Lifting and transferring patients withassistance were the two most common mechanisms for back injury(22.6% and 23.3%, respectively). In total, injured nurses attributed52.3% of their injuries to inadequate training; inadequate staffingwas given as the primary reason for 13.8% of the injuries. Theresults suggest that training in the indications for and useof mechanical devices for lifting/transferring patients requiresintensification, and a ‘warm-up’ period should alsobe considered in the face of injuries occurring early in theshift if work activities cannot be evenly planned.     

Is public health training in Canada meeting current needs? Defrosting the paradigm freeze to respond to the post-truth era

Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of public health researchers and practitioners are being prepared with the knowledge, attitudes, and skills needed for the tasks ahead. We found that of the 76 graduate level programs listed by the Public Health Agency of Canada, 65% required at least one quantitative methods course, but only 26% required qualitative methods and only 16% required a course in community engagement. While 25% had at least one required course related to social theory or social determinants of health, only 3% required a course on the ecological determinants. Our examination suggests that the majority of schools of public health may still be frozen in old paradigms wherein interdisciplinary inquiry and the development of skills to work with communities to implement and evaluate interventions to promote and protect collective health are still only peripheral considerations. With the intensification of public distrust in experts in this post-truth era, greater emphasis is needed now more than ever to develop skills in understanding and engaging the public in addressing the underlying issues threatening health. We argue that as the challenges of the Anthropocene are upon us, it is urgent that we rethink the skills we are teaching and prepare ourselves to radically adjust our approach.     

Upper limb repetitive strain injuries in Manitoba

A review of workers' compensation board (WCB) claims in Manitoba, Canada identified an estimated 382 upper limb repetitive strain injury (RSI) claims or 9.3% of all upper limb WCB claims accepted in 1991. Tendonitis and carpal tunnel syndrome (CTS) were the most frequent diagnoses (27.5% and 19.3%, respectively). Rates of RSI were not significantly different by gender and age. RSI claimants had been experiencing symptoms for an average of 8 months prior to filing a compensation claim. While clerical occupations accounted for 13.6% of all upper limb RSI claims, the rates for RSIs in these occupations were low (0.67/1,000 workers), in contrast to occupations with the highest RSI rates: food, beverage, and related processing occupations (14.68/1,000 workers) and fabricating, assembling, and repairing of metal products (9.32/1,000). The highest risk industries were meat and poultry processing-related (23.48/1,000) and the manufacturing of airplanes (9.06/1,000). RSI claims were significantly more costly ($5,569 vs. $2,480, p <0.0001) and required more time loss (71.4 vs. 33.6 d. p <0.0001) than similar musculoskeletal non-RSI claims. Similarly, RSI claimants were less likely to return to the same job (67.3% vs. 81.0%, p <0.0001) than non-RSI claimants. It was concluded that the cost and severity of RSI claims militate for intensified preventive measures. © 1996 Wiley-Liss, Inc.     

Trends in injuries, illnesses, and policies in Canadian healthcare workplaces

BACKGROUND: Analysis of workers' compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector. METHODS: Timeloss claims data were collected for 1992-2002 from the Association of Workers' Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions. RESULTS: The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 person-years since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces. DISCUSSION: Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.     

Preventing disability from occupational musculoskeletal injuries in an urban, acute and tertiary care hospital: results from a prevention and early active return-to-work safely program

OBJECTIVE: Healthcare workers are at high risk for musculoskeletal injuries. A program was developed to decrease the incidence of musculoskeletal injuries and the duration of associated time loss. METHODS: A program combining primary prevention and on-site early intervention was implemented at a large, urban hospital. Incidence rates were compared using Poisson regression. Cox regression was used to analyze the time to return to regular duties. RESULTS: Although there was no reduction in incidence, the program was effective in returning injured employees to work more promptly for registered nurses and health science professionals (therapists, technicians), although not for facility support staff. CONCLUSIONS: Overall savings in time loss and compensation payments were realized. However, better integration of prevention and follow-up efforts are needed, and greater attention to the sociopolitical environment is required to improve outcomes for facility support staff.