Comparing the Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire with technical measurements of physical workload in certified nursing assistants in a medical ward setting.

The Certified Nursing Assistant (CNA) is an important part of the workforce in hospitals and nursing homes, whose work includes heavy and repetitive work tasks including patient manual handling. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire is an Occupational Health Service method for evaluation of the work environment. The aim of this study is to compare the SMET questionnaire with technical measurements of physical workload in CNAs in a medical ward setting. 16 CNA's participated voluntarily to 8 h of measurements during one workday. Physical workload was measured with surface electromyography and inclinometers, and the work environment was evaluated with the SMET questionnaire during the same working day. Spearman's rho was used in the statistical correlation analysis between measurements. This study shows strong, statistically significant correlations between the items in the SMET questionnaire and measured physical workload, n CNAs.

Structured Multidisciplinary Work Evaluation Tool (SMET): Reliability testing of a multidisciplinary/multifactorial work questionnaire.

BACKGROUND: Occupational health services (OHS) are rarely involved in preventive issues and systematic work environment management. The Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire was created to address the lack of multidisciplinary/multifactorial OHS tools with the aim to be used in preventive issues and systematic work environment management. OBJECTIVES: The aim of this study was to evaluate trustworthiness of the inter-rater reliability in the qualitative analysis of the open-ended items and intra-rater reliability of the self-estimated items in the SMET questionnaire. METHODS: A qualitative comparison of the inter-rater reliability in the qualitative analysis of the open-ended items was performed to evaluate trustworthiness. The intra-rater reliability of the self-estimated items in the SMET questionnaire were analysed with Elisabet Svensson method. RESULTS: Qualitative analysis of the open-ended items showed good trustworthiness. The self-estimated items showed a high percent agreement (PA), 0.98-0.99 in the physically, 0.99 in the environmentally and 0.98-1.0 in the psychosocially demanding items. A low degree of systematic errors and individual variability were found. CONCLUSIONS: The SMET questionnaire shows good trustworthiness and intra-rater reliability and can be used to follow up and evaluate work environmental interventions.

Structured Multidisciplinary work Evaluation Tool: Development and validation of a multidisciplinary work questionnaire.

BACKGROUND: Important success factors for the Occupational Health Service (OHS) include services being based on active participation and risk identification from a multidisciplinary/multifactorial perspective. Despite an extensive search, no questionnaire with this approach was found so a new questionnaire was developed at the OHS. The aim of this study was to develop and validate the new questionnaire named Structured Multidisciplinary work Evaluation Tool (SMET) through action research. METHOD: Communicative and pragmatic validity were tested through the development of the questionnaire using action theory and presented in a descriptive portrayal. The Content Validity Index (CVI) was used to test content validity for each item as well as for the questionnaire as a whole. RESULT: Communicative and pragmatic validity were developed and tested over time in four different periods between 2008 and 2014, in 24 clinics (with a total of approximately 1000 employees) in Region Jönköping County.The content validity of the SMET questionnaire as a whole was close to excellent and the validity of the questions regarding physically and psychosocially demanding work factors were found to be excellent. The questions regarding environmentally demanding work factors were found to have a lower, but still good, validity. CONCLUSION: The SMET questionnaire has very good content validity. The pervasive work with the SMET questionnaire also shows good pragmatic and communicative validity.

Dose response evaluation of a low-density normoxic polymer gel dosimeter using MRI.

A low-density (approximately 0.6 g cm(-3)) normoxic polymer gel, containing the antioxidant tetrakis (hydroxymethyl) phosponium (THP), has been investigated with respect to basic absorbed dose response characteristics. The low density was obtained by mixing the gel with expanded polystyrene spheres. The depth dose data for 6 and 18 MV photons were compared with Monte Carlo calculations. A large volume phantom was irradiated in order to study the 3D dose distribution from a 6 MV field. Evaluation of the gel was carried out using magnetic resonance imaging. An approximately linear response was obtained for 1/T2 versus dose in the dose range of 2 to 8 Gy. A small decrease in the dose response was observed for increasing concentrations of THP. A good agreement between measured and Monte Carlo calculated data was obtained, both for test tubes and the larger 3D phantom. It was shown that a normoxic polymer gel with a reduced density could be obtained by adding expanded polystyrene spheres. In order to get reliable results, it is very important to have a uniform distribution of the gel and expanded polystyrene spheres in the phantom volume.

Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms.

No study to date has prospectively compared the results of uvulopalatopharyngoplasty (UPPP) and CO2 laser palatal surgery. This study investigates and compares outcomes in 121 consecutive patients suffering from rhonchopathy, the majority of whom reported apneas. Sixty-one patients underwent UPPP and 60 laser uvulopalatoplasty (LUPP). Patients were requested to assess the frequency of symptoms associated with obstructive sleep apnea syndrome prior to surgery, at 3-month follow-up and 5-8 years postoperatively. All symptoms were significantly improved for the two patient groups, both short and long term (p < 0.01) although short-term results were generally better. However, UPPP was superior to LUPP in terms of all clinical effect parameters. Although patients treated with UPPP had more severe symptoms preoperatively they also had a better long-term outcome. Side-effects such as minor swallowing disturbances were frequent, using either surgical modality, but few patients were bothered if surgery was successful.

Voice quality after radiofrequency volumetric tissue reduction of the soft palate in habitual snorers.

OBJECTIVE: To evaluate whether radiofrequency volumetric tissue reduction of the soft palate is causing voice changes as a result of velopharyngeal insufficiency in patients with heavy snoring. STUDY DESIGN: A prospective study of 16 habitual snorers (oxygen desaturation index, <6 in all cases) were investigated concerning nasopharyngeal competence before and, at minimum, 2 months after the procedure (mean period, 165 d). Speech evaluation was made objectively with a nasal-oral ratio meter and also was made subjectively by a trained speech-language pathologist. The patients received a mean of three Somnoplasty radiofrequency volumetric tissue reduction treatments of 1200 J each (600 J in the midline and 300 J on each side of the soft palate). RESULT: Comparison between preoperative and postoperative nasal-oral ratio meter analysis of hypernasality revealed no significant change. Neither did listener judgment of hypernasality, nasal escape, or pharyngeal snort reveal any influence on velopharyngeal function by the surgical procedures. Snoring was somewhat successfully treated, as evaluated by spouses; snoring score was reduced from 8.2 +/- 2.9 to 4.1 +/- 2.5 (P <.01) on a 10-grade rating scale. Maximum nocturnal decibel levels were also reduced in 79% of the cases. CONCLUSION: Radiofrequency volumetric tissue reduction in the soft palate as a treatment for snoring did not show any significant adverse effect on nasopharyngeal function.

[International consensus meeting on fatigue and the risk of traffic accidents. The significance of fatigue for transportation safety is underestimated]. / Internationellt konsensusmöte om trötthet och olycksrisk i trafiken. Trötthet har underskattad betydelse för transportsäkerheten.

Recently there has been a sizeable increase in research on fatigue and accidents in transportation. Therefore a meeting was convened last year to discuss prevalence, mechanisms and countermeasures, with the intention to produce an international consensus document. It was concluded that official statistics strongly underestimate prevalence, and that a reasonable estimate, based on research, lies between 10 and 20% for accidents on the road, in the air and at sea. The main causes are disturbed sleep and work at the circadian low, caused by night work, morning work, sleep/wake disorders (including sleep apnea) or social obstacles to sleep. Suggested countermeasures include information/education of the public and of transportation companies, as well as enforcement of existing work hour regulation. Additional countermeasures include strategic use of napping and caffeine, as well as implementation of rumble strips and--possibly--electronic devices for drowsiness detection.

[Drowsiness--greater traffic hazard than alcohol. Causes, risks and treatment]. / Vakenhetsstörning--en större trafikfara än alkohol. Orsaker, risker och behandling.

Stress and shortage of sleep may cause daytime somnolence and impaired vigilance at the wheel, especially among those suffering from sleep disturbances. According to the international consensus meeting in Stockholm in May of 2000 on "The sleepy driver and pilot--causes, risks and countermeasures", drowsy driving is an underestimated risk factor in official statistics, and as many as 15-30 percent of today's traffic accidents are related to drowsiness; thus it is an even greater risk factor than alcohol. Drowsy drivers suffer from inattention, impaired concentration and may even fall asleep at the wheel. Accidents during dozing result in three times as many fatalities as other accidents. There are a number of reasons for habitual drowsiness at the wheel aside from sleep deprivation, including rhonchopathy, shift work and jet lag, mental depression, insomnia, narcolepsy, endocrinological diseases, periodic limb movement disorder, medication, pain-disordered sleep, and heart disease. Among the most active drivers, i.e. middle aged men, obstructive sleep apnea syndrome (OSAS) has been found to be the most common reason for habitually drowsy driving. OSAS causes a 2-3 fold increased risk of traffic accidents, and it impairs simulated driving. Palatoplasty as well as nasal CPAP have been shown to improve vigilance and driving performance to an extent that the increase in risk is eliminated. Drivers suffering from habitual drowsiness and micro-sleep attacks forcing them to take repeated rests are at special risk. Even if they are as dangerous as drivers with unlawful blood alcohol levels they cannot be caught in a police checkpoint. However they often seek medial advice, and properly treated they may often return safely to traffic. If not, there could be a need to report them to the authorities so as to limit or prohibit their driving.

A randomized controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis.

BACKGROUND: Controlled prospective studies are needed to determine whether surgical treatment in fact has an effect additive to that of medical treatment of nasal polyposis. OBJECTIVE: We sought to compare the effect of medical treatment versus combined surgical and medical treatment on olfaction, polyp score, and symptoms in nasal polyposis. METHODS: Thirty-two patients with nasal polyposis and symmetrical nasal airways were randomized to unilateral endoscopic sinus surgery after pretreatment with oral prednisolone for 10 days and local nasal budesonide bilaterally for 1 month. Postoperatively, patients were given local nasal steroids (budesonide). Patients were evaluated with nasal endoscopy, symptom scores, and olfactory thresholds. They were followed for 12 months. RESULTS: The sense of smell was improved by the combination of local and oral steroids. Surgery had no additional effect. Symptom scores improved significantly with medical treatment alone, but surgery had additional beneficial effects on nasal obstruction and secretion. After surgery, the polyp score decreased significantly on the operated side but remained the same on the unoperated side. Twenty-five percent of the patients were willing to undergo an operation also on the unoperated side at the end of the study. CONCLUSIONS: Medical treatment seems to be sufficient to treat most symptoms of nasal polyposis. When hyposmia is the primary symptom, no additional benefit seems to be gained from surgical treatment. If nasal obstruction is the main problem after steroid treatment, surgical treatment is indicated. Selection of those who will benefit from surgery should be based on the patient's symptoms and not on the examiner's polyp score.

Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients.

BACKGROUND: Heavy snoring and the obstructive sleep apnea syndrome are associated with increased morbidity and mortality in patients with cardiovascular disease. The effect of uvulopalatopharyngoplasty on mortality has been questioned. OBJECTIVE: To investigate long-term survival after palatal surgery. DESIGN: An observational retrospective case-control study with a 5- to 9-year follow-up. SETTING: A university medical center. PATIENTS: Four hundred consecutive heavy snorers (median age, 47 years), 256 of whom had obstructive sleep apnea syndrome. The mean +/- SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of all included patients was 27.1+/-4.2. Comparison was made with 744 control patients (median age, 43 years) who underwent nasal surgery during the same period and a matched general control population. INTERVENTION: Uvulopalatopharyngoplasty or laser uvulopalatoplasty between 1986 and 1990. MAIN OUTCOME MEASURES: Mortality and causes of death up to 9 years after surgery. RESULTS: High blood pressure at the time of surgery and subsequent death due to cardiovascular disease were 3 times more frequent in the patients with obstructive sleep apnea syndrome than in both control groups (P<.01), but the overall long-term mortality was not increased either in snorers or in persons with sleep apnea. The cumulative survival rate was more than 96% for the 400 patients, the 744 controls, and the matched general population. CONCLUSIONS: No increased mortality was seen following palatal surgery in this long-term follow-up of 400 consecutive, on average, nonobese snorers, 256 of whom had obstructive sleep apnea syndrome. This might indicate a positive survival effect of surgery.

Dose response characteristics and basic dose distribution data for a polymerization-based dosemeter gel evaluated using MR.

A safe and reproducible mixing procedure for the manufacture of a polymerization-based dosemeter gel evaluated using MRI (PoMRI) is presented. The dose response, obtained by irradiating gel-filled vials with absorbed doses in the interval 0-20 Gy and evaluated with respect to 1/T2, was found to be linear in the interval 0-8 Gy, with a sensitivity of 0.211 s-1Gy-1 (r2 = 0.998) at 1.5 T. Evaluation of the same set of vials with respect to 1/T1 gave a sensitivity of 0.018 s-1Gy-1 (r2 = 0.960). PoMRI and diode data were compared for standard photon and electron treatment beams. A deviation of less than 3% was found between the two methods for central depth dose curves as well as dose profiles (2 mm for electrons in the steep dose gradient regions). The importance of the method used for background correction for the reliability of the results was also evaluated. Barex (with a wall thickness of 1.5 mm) was investigated for use as phantom material and found to be favourable compared with glass. The results obtained in this study show that PoMRI has excellent potential as a 3D detector.

Psychosocial impact of cosmetic rhinoplasty.

The psychosocial impact of cosmetic rhinoplasty in Scandinavia is poorly investigated. Therefore a study was undertaken utilizing a mailed audit covering self-percepted experiences before, during, and after surgery. A total of 67 of 80 patients responded to the questionnaire (84%), on average 18 months after surgery. The mean age was 31 years (range, 16-63 years) and the M/F ratio was 20/44 among the 64 patients analyzed, half of whom were of foreign extraction. The self-report disclosed that a majority of the patients had been preoccupied with their noses since puberty and that the mental awareness of nasal stigmatization was given mainly by the mirror (58%), not by others. Despite the early exclusion of patients with possible body dysmorphic disorder, almost one-fourth had a severe complex, and one-third felt socially inhibited by their noses and avoided being looked at from certain angles. Surgery was not a significant problem even though it was performed under local anesthesia and i.v. sedation. The great majority (91%) were satisfied with the result and 89% would recommend the procedure to others. More than 60% felt more self-confident and perceived life as being easier. To conclude, successful rhinoplasty may change preoccupied patients' lives, because the majority simply stopped thinking about their noses.

Ethnic profile of patients undergoing aesthetic rhinoplasty in Stockholm.

During 1985-1995 we performed 640 rhinoplasties in 578 patients. Five hundred eighteen of them were inhabitants of the Province of Stockholm, with a population of 1,708,502. The patients from the Stockholm area were analyzed and divided into subgroups depending on their ethnic origin. It was found that 272 (52%) of them were of Nordic descent, while 248 (48%) were born in and immigrated from non-Scandinavian countries. Among the latter, the largest group were 166 people of Middle Eastern extraction, who generally strived to reduce the size of their noses to the size similar to the average nose of the native Swedes. Middle Easterners were 17 times more prone to undergo aesthetic rhinoplasty than the ethnic Swedes (p < 0.001), whereas immigrants from the other Scandinavian countries had the same rhinoplasty frequency pattern as the natives. In the Slavic group females outnumbered males by the ratio 17:1. The large prevalence of patients of foreign extraction desiring alteration of their noses may reflect the assimilation difficulties and low tolerance of the society in accepting people with a foreign look or name, both in the private sector and in the job market. Psychological aspects of decision making by patients and medico-ethical aspects of decision making by surgeons are discussed.

Two methods of anesthesia for rhinoplasty in outpatient setting.

This retrospective study was designed with the aim to evaluate suitability of two methods of anesthesia: local anesthesia combined with sedation (midazolam + pethidine) or dissociative (midazolam + ketamine hydrochloride) anesthesia for performing rhinoplasties in an outpatient setting. During 1985-1994, we performed 516 rhinoplasties in 464 patients. Sedation and local anesthesia was used in 263, and dissociative and local anesthesia in 253 procedures. Both methods were well tolerated by the patients, no serious anesthetic complications were seen, and the clinical problems in connection with anesthesia were acceptably low. The use of sedation technique and dissociative anesthesia in combination with local anesthesia have both proved to be safe and effective anesthetic methods for performing rhinoplasty.

Laser-uvulopalatoplasty (LUPP) under local anesthesia: effective, safe and comfortable.

Conventional uvulopalatopharyngoplasty has in the last years to an increasing extent been succeeded by a variety of laser procedures for snorers obstructed by lax palates only. These surgical techniques have the advantages of being less traumatic and therefore more suitable for local anesthesia and outpatient surgery. However, to the authors' knowledge, there are no studies on degree of patient discomfort during this type of surgery as well as the value of anticholinergic component in premedication in preventing bradycardia and hypersalivation during the operation. We studied 53 consecutive patients undergoing laser-uvulopalatoplasty (LUPP) under local anesthesia at our day care unit. LUPP is a one-stage operation for rhonchopathy which has been developed at our department. Twenty-five patients received morphine and scopolamine, and 28 morphine alone as premedication. Peroperative salivation, bradycardia and nausea was estimated and recorded for each group. Later the patients were asked to assess mouth dryness both before and after surgery, as well as satisfaction with sedation and pain relief. The great majority of the patients (> 80%) described only insignificant pain, which when occurring was related to subliminal premedication or to the injection of local anesthesia or both. Morphine-scopolamine was significantly better in preventing hypersalivation (p < 0.01) during surgery and also improved sedation and analgesia when compared to morphine alone (p < 0.05). The efficacy of LUPP is compared with various laser procedures for snoring.

Does uvulopalatopharyngoplasty inhibit automobile accidents?

Patients with rhonchopathy, which includes obstructive sleep apnea syndrome (OSAS), who report sleepy spells at the wheel do poorly on simulated monotonous driving tests and have a twofold to threefold increase in traffic accidents. To assess whether drivers with rhonchopathy (heavy snoring, sleep disturbances, and daytime sleepiness) cause fewer automobile accidents after uvulopalatopharyngoplasty (UPPP), the car accident rate for the first 5 years after surgery was compared to the rate of the 5 years immediately before the operation. Data were collected by means of a self-report questionnaire. Fifty-six patients with rhonchopathy were compared to 142 controls without rhonchopathy who had been subjected to nasal surgery. The response rates were 96% and 94%, respectively. The reported habitual sleepiness while driving had disappeared in 87% (P < .001) of drivers who had the problem preoperatively. The accident risk reduction (corrected for mileage) in patients was almost four times greater than the reduction in controls (P < .001) after surgery. The relative rate of patients involved in any single-car accident fell by 77% (P < .05), and the relative rate of single-car accidents fell by 83% (P < .001). It is concluded that drivers with rhonchopathy have an increased risk for car accidents, especially single-car accidents, but that this risk returns to normal after UPPP.

Long-term effect of uvulopalatopharyngoplasty on driving performance.

OBJECTIVE: It has been questioned whether the effect of uvulopalatopharyngoplasty lasts as years go by. From a previous study it is known that patients with severe rhonchopathy, complaining of sleepiness at the wheel, improve their vigilance and driving performance immediately following uvulopalatopharyngoplasty, but is this effect persisting? DESIGN: In a cohort study, the long-term effect of surgical treatment on driving vigilance was evaluated on 13 middle-aged (median, 52 years) male patients and five matched controls. Three to 4 years postoperatively, they were subjected to a boring 90-minute-long retest in an advanced driving simulator and daytime polysomnography, identical to those performed preoperatively. Factors measured were brake reaction time, lateral position deviation, and off-road incidents. The patients were also asked to assess their driving skills on a self-report and their vigilance on a visual analogue scale. RESULTS: All but one patient reported themselves as being more vigilant and safe drivers following surgery. Objective results showed that the initial improvement in brake reaction time, lateral position deviation, and number of off-road incidents was sustained, but not always in concordance with the apnea index. CONCLUSION: The positive effect of uvulopalatopharyngoplasty on vigilance and driving performance remains after 4 years. This may have a substantial impact on traffic safety.

Sleep apnea syndrome symptoms and automobile driving in a general population.

Automobile accidents are reported as being overrepresented in those suffering from the obstructive sleep apnea syndrome (SAS), evident by snoring, sleep disturbances and diurnal hypersomnia. An estimation of the prevalence of these symptoms amongst an adult population, predominantly automobile drivers, was assessed by using a one-stage questionnaire procedure. From a national random sample of 1214 persons a weighted reply rate of 76% was achieved. Snoring, breath cessations, mid-sleep awakenings, and diurnal hypersomnia were reported in 24, 3.8, 27 and 9.1%, respectively. The maximum prevalence of SAS was estimated as 2.8-5.5% among men, aged 30-69 years, depending on definition used. Driving frequency in potential sleep apneics was similar to that of the entire population studied. Diurnal hypersomnia, considered a consequence of SAS, was reported as an overall 2.2%, corresponding to 100,000 automobile drivers in Sweden.

Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea.

The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms--snoring, sleep disturbances and diurnal hypersomnia--if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) greater than 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from -23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 +/- 18.4; p less than 0.01). The positive predictive value of DPSG was 63% (10/16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.