Using Electronic Health Records and Clinical Decision Support to Provide Return-to-Work Guidance for Primary Care Practitioners for Patients With Low Back Pain.

OBJECTIVE: The aim of this study was to describe the process by which a group of subject matter experts in the area of return to work developed a resource tool to provide clinical decision support (CDS) for primary care clinicians. METHODS: A common musculoskeletal disorder, low back pain (LBP), was selected, pertinent literature reviewed, and specific recommendations for action in the clinical setting developed. RESULTS: Primary care practitioners (PCPs) are routinely expected to create work activity prescriptions. The knowledge base for a CDS tool that could be embedded in electronic health records has been developed. CONCLUSION: Improved clinical support should help prevent and manage work limitations associated with LBP not caused by work. The proposed decision support should reduce administrative burden and stimulate PCPs to explore the role of occupation and its demands on patients.

Latent health effects in firefighters.

Firefighter mortality studies that used standardized mortality ratio (SMR) as a summary measure are reviewed and an overview of time-dependent mortality effects for all causes, CAD, cancer, and respiratory deaths is provided. Of 17 studies reporting SMRs for firefighters, three overlapped with larger studies and six did not contain time-dependent data, leaving eight for inclusion. The time effects showed no increased mortality with increasing time employed and time since first employment (latency) for all-cause mortality or any specific cause. There were many causes of death for which firefighters' SMRs were below one through all durations of employment and latency. There was no convincing evidence that employment as a firefighter is associated with increased all-cause, CAD, cancer, or respiratory disease mortality.

A patient with postoperative mercury contamination of the peritoneum.

CASE REPORT: Peritoneal exposure to mercury has been rarely reported and long-term consequences of this type of exposure have not been documented. We report the clinical course of a patient who has survived almost eight years with a massive intraperitoneal load of mercury. She has suffered formication, pruritus, fatigue, irritiability, insomnia, alopecia, dizziness, a gait disturbance, loss of balance and multiple falls, abdominal pain, choking, and headaches. Two courses of chelation with dimercaptosuccinic acid using the standard protocol were undertaken, resulting in increased daily excretion, but without demonstrable objective or subjective benefit or lasting effect. She had multiple medical problems before the mercury intoxication, which complicates the attribution of all her problems to mercury intoxication. It is of particular interest that the patient survived and did not suffer any marked cognitive deterioration. She died in 2002 shortly after being diagnosed with lung cancer and declaring that she would fight it. Phasing out of mercury-weighted tubes is recommended.