"I noticed that when I have a good supervisor, it can make a Lot of difference." A Qualitative Study on Guidance of Employees with a Work Disability to Improve Sustainable Employability.

PURPOSE: For employees with a work disability adequate daily guidance from supervisors is key for sustainable employability. Supervisors often lack expertise to guide this group of employees. Mentorwijs (literal translation: Mentorwise) is a training for supervisors to improve the guidance of employees with a work disability. The aim of this study was to investigate the experiences of employees with a work disability regarding: (1) the guidance from their supervisors (who followed the Mentorwijs training), (2) which differences they notice in the guidance due to the Mentorwijs training, and (3) what kind of aspects they consider important in their guidance to achieve sustainable employability. METHODS: A qualitative study was performed with semi-structured (group) interviews among twenty-one employees with a work disability. Thematic analysis was performed to analyze the data. RESULTS: Themes that followed from the interviews were: (1) work tasks and conditions can facilitate or hinder sustainable employability: (2) relationships among employees and with supervisors can affect sustainable employability; (3) a desire for new opportunities and challenges; and (4) a need for supervisor skills to facilitate sustainable employability, i.e. appreciation, availability of help, dealing with problems, listening, attitude and communication. According to employees, changes were mainly noticed in supervisor skills. CONCLUSIONS: Employees with a work disability were very satisfied with the guidance of supervisors who followed the Mentorwijs training. To improve sustainable employability, training of supervisors should focus more on adequate work conditions, providing employees opportunities to learn new work tasks and improving supervisors' skills regarding appreciation, attitude and communication.

A Context Analysis with Stakeholders' Views for Future Implementation of Interventions to Prevent Health Problems Among Employees with a Lower Socioeconomic Position.

Purpose Health problems among employees with a lower socioeconomic position (SEP) often result from an interplay of problems on multiple life domains. Contextual factors greatly affect implementation of interventions that aim to solve these type of problems. The aim of this study was to gain insight into the organizational and socio-political context for implementation of preventive interventions that consider multiple life domains among employees with a lower SEP. Methods In total 16 semi-structured interviews were conducted with stakeholders at organizational level, occupational health service (OHS) level, and at socio-political macro level. Thematic analysis was performed to identify themes that describe the perceptions of stakeholders about the impact of contextual factors on implementation. Results The following themes were identified: (1) the importance of addressing problems on multiple life domains among employees with a lower SEP, (2) unclarity of responsibilities for solving problems on multiple life domains, (3) necessity of better collaboration between occupational and curative healthcare, (4) insufficient investments in prevention by employers, (5) difficulties in early identification of employees at risk for health problems, and (6) risk of conflicting role for supervisors in addressing problems on multiple life domains. Conclusions Implementation of preventive interventions considering multiple life domains among lower SEP employees is challenging, due to various contextual factors. To improve the feasibility, many different stakeholders both in- and outside occupational health practice need to be involved, collaborate, and need to be convinced of the added value to prevent problems on multiple life domains among employees with a lower SEP.

Improving the health of workers with a low socioeconomic position: Intervention Mapping as a useful method for adaptation of the Participatory Approach.

BACKGROUND: Workers with a low socioeconomic position (SEP) have a higher risk for health problems and premature dropout from the workforce. Unfavorable working conditions and unhealthy behaviors are more prevalent among this group of workers. The Participatory Approach (PA), is an evidence-based method to identify and solve problems at the workplace related to health issues of the worker. Health problems among workers with a low SEP are usually caused by an interplay of problems in and outside the workplace. To solve health problems on multiple life domains for workers with a low SEP we aim to adapt this approach to a broader perspective. METHODS: An Intervention Mapping (IM) protocol was used to adapt the PA. First, a needs assessment was conducted combining literature with data from interviews and focus groups with workers with a low SEP, employers and occupational health professionals (OHPs). Based on the needs assessment a program goal and performance and change objectives were defined, which resulted in methods and practical strategies to solve problems on multiple life domains. Based on the results of these steps, the PA was adapted and an implementation and evaluation plan were developed. RESULTS: The needs assessment confirmed that an interplay of problems on multiple life domains affect work functioning and health of workers with a low SEP. Moreover, they perceived difficulties with solving problems or used passive or avoidant coping styles towards these problems. The program goal is to identify and solve problems on multiple life domains that affect healthy functioning at work. To achieve this workers need support from OHPs to solve problems. The PA protocol and materials were adapted using theoretical concepts of the Self-Determination Theory (SDT), which resulted in the Grip on Health intervention. For OHPs a training was developed on how to implement this intervention in practice. The intervention will be evaluated in a pilot implementation study among workers with a low SEP and other relevant stakeholders. CONCLUSIONS: IM was a valuable tool for the adaptation of the PA to better support workers with a low SEP to improve their work functioning and health from a broader perspective.

Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey.

An international, multicenter, prospective survey has been conducted to determine the hospital survival rates of patients with potentially reversible acute respiratory failure (ARF) who are managed in sophisticated intensive care units by leading critical care specialists, using current (1991 to 1992) support and treatment techniques and protocols. Twenty-five clinical centers participated in the survey, 11 in the United States and 14 in Europe. A total of 1,426 patients with ARF were studied, all of whom had been receiving closed system positive pressure mechanical ventilation at an FIo2 of at least 0.50 for at least 24 h at the time of entry into the survey. Of the survey patients, 793 (55.6%) survived their hospitalization, while 633 (44.4%) died in the hospital. The 1,426 patients with ARF were prospectively divided into two groups: group A, containing 375 patients, who at the time of entry into the study were hypoxemic or hypercarbic while receiving mechanical ventilator assistance; and group B, containing 1,051 patients, who at the time of entry into the study were neither hypoxemic nor hypercarbic while receiving mechanical ventilator support at an FIo2 of 0.50 or greater. Hospital survival rate for group A patients was 33.3% and for group B patients it was 63.6%. Survival rates were higher in patients with ARF caused by pneumonia (63%) or post shock lung injury (67%) and lower in patients with ARF caused by sepsis (46%). Severity of lung injury at the time of entry into the survey was a major prognostic factor, varying from an 18% hospital survival rate for patients with ARF with far advanced lung injury to a survival rate of 67% for patients with ARF with less severe lung injury. Low survival rates (< 20%) were seen if mechanical ventilator FIo2 was 0.80 to 1.0, while 50% of the patients with ARF survived hospitalization whose FIo2 at entry was 0.50. Peak inspiratory pressure (PIP) > 50 cm H2O at entry into the survey was associated with survival rate of less than 20%, while PIP < 30 cm H2O was associated with survival rate of 60%. Shorter periods of mechanical ventilation (< 48 h) of group A patients before entering the survey were associated with higher survival rates (38%) than patients requiring mechanical ventilation for more than 2 weeks (30%). Patients with ARF with multiorgan failure had lower survival rates (10%) than those with pulmonary dysfunction alone (45%).(ABSTRACT TRUNCATED AT 400 WORDS)

Rate of thrombus accumulation on intravenacaval IVOX devices explanted from human clinical trial patients with acute respiratory failure.

The weight gain of IVOX devices removed from the first 49 human clinical trials patients after from 1 to 29 days of implantation into the venae caval blood stream has been assessed. Each patient had received sufficient systemic heparin to maintain activated clotting times between 150 and 200 s while the IVOX device was indwelling. The nature of the material accumulating on the IVOX device was documented histologically as being thrombus in various stages of development. The weight gain findings indicate that an average of 2.0 g of thrombus accumulates per 24 h on IVOX devices indwelling in the venous blood stream of moderately anticoagulated human acute respiratory failure patients. The rate of weight gain per 24 h of the IVOX device was more rapid during the first 96 h after its implantation than during its second, third, or fourth week of implantation. The accumulated thrombus on the IVOX hollow fibers was associated with a small but measurable decrease (approximately 1%/day) in gas transfer efficiency of the implanted device. The data support the conclusion that IVOX can function effectively and safely without major thrombus formation for up to 29 days in moderately anticoagulated human acute respiratory failure patients.

Major findings from the clinical trials of the intravascular oxygenator.

Major clinically relevant findings have been extracted and summarized from the database developed from the international multicenter clinical trials of the intravascular oxygenator (IVOX) as a means for augmenting the deficient blood gas transfer of patients in advanced acute respiratory failure (ARF). Between February 1990 and May 1993, a total of 164 IVOX devices were utilized in 160 clinical trial patients who were hypoxemic and/or hypercarbic while receiving closed system positive pressure mechanical ventilator support at or exceeding generally accepted minimum safe levels of intensity. The average rates of oxygen and carbon dioxide transfer into and out of circulating venous blood by means of the IVOX device varied from 40-70 ml/min. Evidence of patient benefit during IVOX utilization includes improvement in blood gas partial pressures associated with decreased intensity of mechanical ventilation, improved hemodynamics in patients with mechanical ventilator depressed cardiovascular function, and decreased indices of lung dysfunction. Clinically recognized IVOX-related complications or adverse events were reported in 24.5% of the clinical trials patients. At necropsy examination of 68 clinical trials patients who died during or after IVOX utilization, forensic pathologists reported 4 cases in which IVOX utilization could have been a primary or contributing cause of death. Significant IVOX device mechanical and/or performance malfunction problems were recognized in 29 (17.7%) of the IVOX devices utilized in clinical trials. IVOX clinical trials data collected and analyzed to date indicate IVOX utilization has a favorable risk/benefit ratio in patients in severe, acute, potentially reversible ARF.

In vivo biocompatibility of catheter materials.

The inflammatory response to four different catheter materials was quantitatively characterized using an in vivo cage implant system over a 21 d implantation period. The greatest differences between materials were observed at day 4, where the total leucocyte concentration in the exudate decreased in the following order: AE-PVC greater than A-PU greater than D-PU1 greater than D-PU2. Similar trends were observed for the polymorphonuclear leucocyte (PMN) and macrophage concentrations at day 4. At day 7, this trend continued, but by day 21 the total leucocyte concentration, PMN concentration and macrophage concentration had decreased to comparable values for all materials. The extracellular alkaline phosphatase activity at day 4 was lowest for the AE-PVC exudate samples. Similar results were observed for the extracellular acid phosphatase activity but after that time point no significant differences were observed. From these results, it appears that AE-PVC is least biocompatible compared with the other three catheter materials, which were polyurethanes.

A numerical identification system for airways in the lung.

A numerical system for identifying airways at any level in the tracheobronchial tree has been developed which appears to be simple, logical, and accurate. The system has been successfully used in the authors' laboratory to expedite morphometric studies of the conducting airways in the tracheobronchial tree. Three simple and direct criteria or rules have been formulated for assignment of an airway identification number (AIN) to any specific pulmonary airway, according to this identification system. Some specific applications of this AIN system have been enumerated and several limitations that the authors have recognized have been described. Workers in the fields of bronchial morphometry and anatomy are invited to consider the possible theoretic and practical utility of this airway identification system.

Immediate mucosal effects of short-term, soft-cuff, endotracheal intubation. A light and scanning electron microscopic study.

Little is known regarding the early pathogenesis of intubation-induced laryngotracheal damage or the effects of presently used soft-cuff endotracheal tubes. We have examined the pathological changes of short-term intubation (four hours) in six mongrel dogs. Interaction of the endotracheal tube with the mucosa produced a variety of lesions ranging from superficial abrasions to ulcerations with the most severe lesions in the respiratory epithelium. Changes are present at the free surfaces of ciliated cells that include flattening, fusion, and erosion of cilia of sufficient extent to compromise ciliary function. The ischemic and mechanical modes of injury are compared; the latter is considered causal with modern soft-cuff tubes. These studies reveal tube-induced mucosal damage of an extent and nature not previously appreciated.