ABSTRACT
BACKGROUND: The outcomes of treatment for work-related injuries and illnesses are multidimensional and complex, but have rarely been explored in detail. This study was intended to provide information on a sample of workers representing a range of jobs and employers typical of the workers compensation system. METHODS: A mailed, self-report survey measuring multiple dimensions was conducted. Identified through the New Hampshire Division of Workers' Compensation First Report of Injury database, a sample of workers with injuries to their lower back (60%) or upper extremities (40%) a year prior to the study were surveyed. Response rate was 80% (N=169; upper extremity cases=70; low back cases=99). RESULTS: Most (82.8%) were working one year post-injury. Over half reported residual effects of the injury on work or activities of daily living. Many working subjects reported persistent injury-related anxiety and pain at the end of the work day, worse in those with low back pain compared to those with upper extremity injuries. Almost 40% of those who returned to work suffered a reinjury. Forty-four percent of respondents suffered significant injury-related financial problems, which were worse in those who had been out of work for longer periods. CONCLUSIONS: Occupational musculoskeletal injuries do result in significant, long-term adverse physical, economic, and psychological consequences, as demonstrated in self-reported surveys.
Subject(s)
Arm Injuries/therapy , Back Injuries/therapy , Occupational Diseases/therapy , Outcome Assessment, Health Care , Absenteeism , Activities of Daily Living , Analysis of Variance , Anxiety/psychology , Arm Injuries/economics , Back Injuries/economics , Chi-Square Distribution , Cost of Illness , Databases as Topic , Employment , Female , Follow-Up Studies , Humans , Low Back Pain/physiopathology , Male , New Hampshire , Occupational Diseases/economics , Pain/physiopathology , Recurrence , Retrospective Studies , Surveys and Questionnaires , Workers' CompensationABSTRACT
The purpose of this study was to describe the demographic, vocational, medical, workplace, and psychosocial characteristics of patients treated for work-related upper-extremity disorders, to document treatment patterns in a community-practice setting, and to determine which of these factors predicts subsequent employment and functional status outcomes. A questionnaire was administered by mail or telephone to 112 patients seen at the University of Massachusetts Occupational Upper Extremities Disorders Clinic and included measures of disease-specific functional status, pain, reactions to pain, employer-employee relations, and number and type of interventions used to treat the disorder. Results were compared with baseline data obtained, on average, 16 months prior to follow-up. Of the original cohort (n = 124), 112 participated in the prospective study. Although most patients reported improvement in pain severity, fear of pain, life situation, and functional status, there was little change in employment status. Patients' self-reported intentions of return to work at baseline did not predict work status at follow-up. In general, those who were employed at baseline remained employed, had a greater reduction in symptom severity over time, and were significantly more likely to report improvement in their problem than those who were unemployed. The efficacy of various interventions was examined by type, mix, and intensity (number of different interventions undergone by the patient). No positive relationship was found between these measures and employment status, self-reported change in the problem, or self-reported improvement in functional status. Significant negative relationships were found between surgery, psychotherapeutic interventions, and outcomes. This was likely to have occurred because of a selection bias toward the more chronic and severely disabled patients for these treatments. However, the relative ineffectiveness of such intensive interventions as surgery in improving the work and health status of chronically symptomatic work-related upper-extremity patients cannot be overlooked. The findings suggest that more emphasis be placed on interventions aimed at resolving differences between employers and injured employees. More careful selection of patients for expensive and invasive procedures is recommended.
Subject(s)
Health Status , Musculoskeletal Diseases/therapy , Occupational Diseases/therapy , Outcome Assessment, Health Care , Adult , Aged , Analysis of Variance , Chi-Square Distribution , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Musculoskeletal Diseases/physiopathology , Occupational Diseases/physiopathology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The feasibility, reliability, and validity of a new instrument, the MacArthur Competence Assessment Tool-Treatment (MacCAT-T), which was developed for use by clinicians, was tested. The instrument assesses patients' competence to make treatment decisions by examining their capacities in four areas--understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. METHOD: The MacCAT-T and instruments to measure symptom severity were administered to 40 patients recently hospitalized with schizophrenia or schizoaffective disorder and 40 matched subjects in the community without mental illness. RESULTS: A high degree of ease of use and interrater reliability was found for the MacCAT-T. Overall, the hospitalized patients performed significantly more poorly than the community subjects on understanding and reasoning, although many patients performed as well as community subjects. Poor performance was related to higher levels of some psychiatric symptoms, such as conceptual disorganization, hallucinations, and disorientation. CONCLUSIONS: The MacCAT-T offers a flexible yet structured method with which caregivers can assess, rate, and report patients' abilities relevant for evaluating competence to consent to treatment.
Subject(s)
Informed Consent/legislation & jurisprudence , Mental Competency/legislation & jurisprudence , Neuropsychological Tests/statistics & numerical data , Patient Participation/legislation & jurisprudence , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Adolescent , Adult , Aged , Brief Psychiatric Rating Scale/statistics & numerical data , Feasibility Studies , Female , Humans , Legal Guardians , Male , Middle Aged , Observer Variation , Psychometrics , Reproducibility of Results , United StatesABSTRACT
Milwaukee Heart Surgery Associates, in affiliation with St. Mary's Medical Center, were asked to be clinical investigators for a comparison study of the current Hepcon System Four (HSF) and the next generation Hemostasis Management System (HMS) manufactured by HemoTec, Inc. The HSF has been in place at St. Mary's Medical Center for the past three years in a programme that performs approximately 900-1100 cardiac procedures a year. Heparin assays and high range activated clotting times (HR-ACTs) are performed routinely on all patients placed on cardiopulmonary bypass (CPB). This study will evaluate the results based upon the two systems run in tandem on a series of patients undergoing cardiac surgery with no exclusions, i.e. valve repair or replacement and myocardial revascularization. The study sets out to determine whether or not the new generation HMS has any distinct advantages over the HSF and whether it is or is not suitable for this clinical setting.
