Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers.

OBJECTIVES: To determine the lung cancer screening yield and stages in a union-sponsored low-dose computerized tomography scan program for nuclear weapons workers with diverse ages, smoking histories, and occupations. METHODS: We implemented a low-dose computerized tomography program among 7189 nuclear weapons workers in 9 nonmetropolitan US communities during 2000 to 2013. Eligibility criteria included age, smoking, occupation, radiographic asbestos-related fibrosis, and a positive beryllium lymphocyte proliferation test. RESULTS: The proportion with screen-detected lung cancer among smokers aged 50 years or older was 0.83% at baseline and 0.51% on annual scan. Of 80 lung cancers, 59% (n = 47) were stage I, and 10% (n = 8) were stage II. Screening yields of study subpopulations who met the National Lung Screening Trial or the National Comprehensive Cancer Network Group 2 eligibility criteria were similar to those found in the National Lung Screening Trial. CONCLUSIONS: Computerized tomography screening for lung cancer among high-risk workers leads to a favorable yield of early-stage lung cancers. Public Health Implications. Health equity and efficiency dictate that screening high-risk workers for lung cancer should be an important public health priority.

The benefits of data linkage for firefighter injury surveillance.

BACKGROUND: While survey data are available for national estimates of fire events and firefighter fatalities, data on firefighter injury at the national and local levels remain incomplete and unreliable. Data linkage provides a vehicle to maximise case detection and deepen injury description for the US fire service. METHODS: By linking departmental Human Resources records, despatch data, workers' compensation and first reports of injury, researchers were able to describe reported non-fatal injuries to 3063 uniformed members of the Philadelphia Fire Department (PFD), for the period of 2005 through 2013. RESULTS: Among all four databases, the overall linkage rate was 56%. Among three of the four databases, the linkage rate was 88%. Because there was duplication of some variables among the datasets, we were able to deeply describe all the linked injuries in the master database. 45.5% of uniformed PFD members reported at least one injury during the study period. Strains, falls, burns and struck-by injuries were the most common causes. Burns resulted in the highest lost time claim payout, and strains accounted for the highest medical claim cost. More than 70% of injuries occurred in the first 15 years of experience. DISCUSSION: Data linkage provided three new benefits: (1) creation of a new variable-years of experience, (2) reduction of misclassification bias when determining cause of injury, leading to more accurate estimates of cost and (3) visualisation of injury rates when controlling for the number of fire department responses, allowing for the generation of hypotheses to investigate injury hot spots.

Time Well Spent: Patient Industry and Occupation Data Collection in Emergency Departments.

OBJECTIVE: No comprehensive national system tracking work-related diseases and injuries exists in the United States. Industry and occupation (I/O) are the missing data elements that would make existing healthcare data useful for occupational health. The authors previously petitioned the National Uniform Billing Committee (NUBC) to adopt I/O standards for states to consider during their healthcare data rulemaking processes. METHODS: The NUBC asked for a pilot study to ascertain the potential burden. The time and cost to ask I/O questions in two hospital emergency departments was evaluated. RESULTS: Asking four I/O questions required 48 seconds on average and cost between $520 and $623 per Registrar per year. The annual cost for the two hospitals to gather I/O on every patient was $4160 and $15,000. CONCLUSIONS: We conclude no undue burden compared with the estimated $250 billion cost of occupational illnesses and injuries.

Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department.

BACKGROUND: Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence. METHODS: A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders. RESULTS: Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2-22.2, P < 0.001). Females reported increased odds of patient-initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8-10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94-2.85). Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention. CONCLUSIONS: Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.

Comparison of x-ray films and low-dose computed tomographic scans: demonstration of asbestos-related changes in 2760 nuclear weapons workers screened for lung cancer.

OBJECTIVE: Increased availability and technical improvements of computed tomographic (CT) scanning encourages its use for detecting asbestos-related disease. We compared low-dose scans and x-ray films in 2760 workers potentially exposed to asbestos, to assess their ability to detect interstitial lung disease (ILD) and pleural thickening (PT). METHODS: A total of 2760 nuclear workers received radiography and CT scanning (2006 to 2009). X-ray films were read by a B reader for ILD and PT and CT scans by a thoracic radiologist, using a protocol for nodules, ILD, and PT. RESULTS: Of the 2760 workers, 271 showed circumscribed PT on CT scans, and 73 on x-ray films, 54 (74%) of which were confirmed on CT scans; 76 showed ILD on CT scans, and 15 on x-ray film, 10 (67%) of which were confirmed on CT scans. CONCLUSIONS: Radiographic readings of PT and ILD were generally confirmed on CT scans. Computed tomographic scans detected three to five times more cases; the majority were minor.

Role of bovine serum albumin-glutaraldehyde glue in the formation of anastomatic pseudoaneurysms.

BACKGROUND: Questions exist concerning the safety of bovine serum albumin-glutaraldehyde (BSAG) glue in thoracic aortic surgery, vis-à-vis embolization and pseudoaneurysm formation. We examined clinical experience with BSAG glue to determine if such problems were detected. METHODS: We studied 99 consecutive patients (25 female and 74 male, age range 27 to 86 years) in whom BSAG glue or similar product was used for reinforcement of thoracic aortic suture lines (n = 87 BSAG glue, 12 GRF [French] glue). BSAG glue was used selectively and sparingly for acute aortic dissection or tissue fragility. Cases included 81 ascending/arch procedures, 15 descending/thoracoabdominal procedures, and 3 combined. Clinical outcome and postoperative computed tomography (CT) scans were reviewed. Follow-up ranged from 1 to 90 months (mean: 15.1 months). We also examined the records of 78 controls in which BSAG glue was not used. The two groups were statistically similar except for rate of aneurysm versus dissection and percentage of emergent surgery. RESULTS: Perioperative survival was 95/99 (96.0%). Six patients (6.0%) required reexploration for bleeding. There were five early postoperative neurological events and no late strokes or peripheral embolic events. CT scan follow-up identified two pseudoansuerysms, both not perianastomic, which were likely unrelated to BSAG glue use. There was no statistically significant difference in the occurrence of pseudoaneurysms between the two groups. CONCLUSIONS: Isolated problems associated with BSAG glue have been reported. In this relatively large experience, we identified no obvious problems directly related to judicious use of BSAG glue. BSAG glue appears a safe and effective adjunct in thoracic aortic surgery.

Deep hypothermic circulatory arrest in patients with high cognitive needs: full preservation of cognitive abilities.

BACKGROUND: Owing to controversy regarding the efficacy and safety of deep hypothermic circulatory arrest (DHCA) during thoracic aortic surgery, we conducted a psychometric study in which high-cognitive patients and their informants were interviewed to determine whether DHCA had any adverse effect on their daily activities or work performance. METHODS: A total of 29 patients (18 males, 11 females; age, 26 to 75 years; mean 52.6 years) whose jobs require high cognitive capability and who had undergone aortic surgery using DHCA (range, 17 to 54 minutes; mean arrest time, 27.4 minutes) at Yale-New Haven Hospital were retrospectively studied. These 29 patients represented the responders among 45 such patients to whom questionnaires were mailed. A control group of 21 high-cognitive patients (20 males, 1 female; ages, 36 to 77 years; mean, 54.7 years) who underwent aortic surgery without DHCA were surveyed as well. During surgery, DHCA was used as the sole means of cerebral protection. The head was packed in ice, and carbon dioxide flooding of the field was used in all cases. The ascending aorta was resected with an open distal anastomosis and a hemiarch or total arch replacement. A 21-part questionnaire (adapted from A.F. Jorm's Short Form IQCODE and supplemented by our own questions) was distributed postoperatively to subjects and to their informants (generally a spouse). A value of 3 on the questionnaire indicated "not much change" from preoperative status (1 indicated much worse and 5 indicated much improved). RESULTS: There were no statistically significant differences in any functional outcomes by study group (by patient: DHCA 3.01, control 3.09; by informant: DHCA 3.00, control 3.03; p > 0.05). Mean values of the outcomes for study groups and control subjects were essentially identical and quite close to 3 (the value assigned to "not much change") for overall score, for occupational score, and for memory-related score. CONCLUSIONS: These data indicate that high-cognitive patients experienced very little cognitive change as a result of undergoing DHCA. Our assessment strongly supports the adequacy of straight DHCA as a cerebral protectant strategy during short- to moderate-duration circulatory arrest. We found excellent preservation of functional state and no difference from patients undergoing aortic surgery without DHCA.