Classification of heterotopic ossification about the elbow.
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Adult↗
Biomedical subjects
J B Bennett
Publications and source records attributed to J B Bennett.
Workplace substance abuse prevention and help seeking: comparing team-oriented and informational training.
Employees fail to seek help for alcohol or drug (AOD) abuse because of unhealthy work climates, stigma, and distrust in Employee Assistance Programs (EAPs). To address such problems, the authors randomly assigned groups of municipal employees (N = 260) to 2 types of training: a 4-hr informational review of EAPs and policy and an 8-hr training that embedded messages about AOD reduction in the context of team building and stress management. Pre- and posttraining and 6-month follow-up surveys assessed change. Group privacy regulation, EAP trust, help seeking, and peer encouragement increased for team training. Stigma of substance users decreased for information training. EAP/policy knowledge increased for both groups. A control group showed little change. Help seeking and peer encouragement also predicted EAP utilization. Integrating both team and informational training may be the most effective for improving help seeking and EAP utilization.
Adult↗
Team awareness for workplace substance abuse prevention: the empirical and conceptual development of a training program.
This paper describes the empirical and theoretical development of a workplace training program to help reduce/prevent employee alcohol and drug abuse and enhance aspects of the work group environment that support ongoing prevention. The paper (1) examines the changing social context of the workplace (e.g., teamwork, privacy issues) as relevant for prevention, (2) reviews studies that assess risks and protective factors in employee substance abuse (work environment, group processes, and employee attitudes), (3) provides a conceptual model that focuses on work group processes (enabling, neutralization of deviance) as the locus of prevention efforts, (4) describes an enhanced team-oriented training that was derived from previous research and the conceptual model, and (5) describes potential applications of the program. It is suggested that the research and conceptual model may help prevention scientists to assess the organizational context of any workplace prevention strategy. The need for this team-oriented approach may be greater among employees who experience psychosocial risks such as workplace drinking climates, social alienation, and policies that emphasize deterrence (drug testing) over educative prevention. Limitations of the model are also discussed.
Attitude to Health↗
Reliability of the Lichtman classification of Kienböck's disease.
The purpose of this study was to establish the interobserver reliability and intraobserver reproducibility of the staging of Kienböck's disease according to Lichtman's classification. Posteroanterior and lateral wrist radiographs of 64 patients with a diagnosis of Kienböck's disease and 10 control subjects were reviewed independently by 4 observers on 2 separate occasions. The reviewers included 3 hand fellowship-trained surgeons and 1 orthopedist who was not fellowship-trained in hand surgery. A stage was assigned to each set of radiographs according to the Lichtman classification. Paired comparisons for reliability among the 4 observers showed an average absolute percentage agreement of 74% and an average paired weighted kappa coefficient of 0.71. Furthermore, all the controls were correctly classified as stage I, which is in accordance with the Lichtman system. With regard to reproducibility, observers duplicated their initial readings 79% of the time with an average weighted kappa coefficient of 0.77. These results indicate substantial reliability and reproducibility of the Lichtman classification for Kienböck's disease.
Carpal Bones↗
Tendon transfers about the shoulder and elbow in obstetrical brachial plexus palsy.
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Adolescent↗
Employee exposure to coworker substance use and negative consequences: the moderating effects of work group membership.
The current study assesses: (1) whether the relationship between individual exposure to coworker substance use and negative consequences resulting from exposure depends on work group membership, and (2) whether group-level characteristics moderate the relationship between exposure and consequences. At the group-level, we assessed occupations involving safety risk or high mobility and social factors of drinking climate and group cohesiveness. We conducted Hierarchical Linear Modeling (HLM) across two samples of municipal employees (ns = 650, 878; n of groups = 50, 49). Our results revealed that groups with higher proportions of jobs involving risk (e.g., machine work) and, to a lesser extent, groups with a higher level of drinking climate were those most vulnerable to consequences under conditions of exposure. Importantly, our findings controlled for individual risk factors (e.g., personal drinking, job stress). Our discussion examines the implications of this study for theory and policy related to workplace substance abuse.
Adult↗
Workplace drinking climate, stress, and problem indicators: assessing the influence of teamwork (group cohesion).
OBJECTIVE: While job-related alcohol use may be associated with problems for drinkers, less is known about the effects of employee drinking on co-workers. We hypothesized that either exposure to co-worker drinking or the presence of a drinking climate would positively correlate with reports of stress and other problems. Following previous research, we also predicted that work group cohesion (or team orientation) would buffer against such problems. METHOD: Two random samples of municipal employees (Ns = 909 and 1,068) completed anonymous surveys. These assessed individual drinking, co-worker drinking, task-oriented group cohesion, the direct reports of negative consequences due to co-worker substance use, and five problem indicators: job stress, job withdrawal, health problems, and performance (work accidents and absences). RESULTS: In each sample, drinking climate correlated with stress and withdrawal more so than did reports of individual drinking. Drinking climate and individual job stress were negatively associated with cohesion. ANCOVA results indicated that drinking climate combined with low cohesion resulted in increased vulnerability for all five problems. Moreover, cohesion appeared to attenuate the negative impact of exposure to drinking norms. CONCLUSIONS: As many as 40% of employees report at least one negative consequence associated with co-worker substance use (alcohol and drugs). Because teamwork may buffer negative effects of drinking climate on co-workers, workplace prevention efforts might be enhanced through a focus on the social environment. These efforts would include team-building and discussions of the impact of co-worker drinking on employee productivity.
Adult↗
Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients.
BACKGROUND: Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy. PATIENTS AND METHODS: A simplified extracorporeal cardiopulmonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy. RESULTS: While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived. CONCLUSIONS: ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.
Cardiopulmonary Resuscitation↗
The winner's group: a self-help group for homeless chemically dependent persons.
The homeless chemically addicted person presents many unique problems that cannot be addressed in standard treatment programs. Homeless clients are difficult to track and are not consistent in follow-up care. The health and mental health conditions found in this population are straining the resources of drug treatment programs, hospitals, the criminal justice system, and social agencies that serve the homeless (Bassuck, 1991). The Winner's Group located in an inner city soup kitchen demonstrates the adaptability and flexibility of nursing practice. The nurses exhibited creativity in developing methods to meet the diverse needs of homeless chemically addicted persons. The goals and objective that were achieved were neither successes nor failures, they were reflections of efforts to make lifestyle changes. Some of those persons responded in a very positive manner, while others continued to deteriorate. An overall desire was to instill a seed of hope and knowledge that there is always a potential for change and that recovery from chemical dependency is possible. Nurses who work with the homeless must be knowledgeable and realistic about the impact and importance of substance abuse. Nontraditional programs that meet the unique needs of a particular setting and a particular population can provide an opportunity to gain access to health care providers.
Adult↗
Interhospital transport of the patient on extracorporeal cardiopulmonary support.
Portable extracorporeal cardiopulmonary support systems have enhanced the resuscitation and support of moribund patients outside of the operating room environment. The literature documents the successful application of emergency cardiopulmonary support within the hospital setting. Clinicians have reported the use of helicopter and ground ambulance to transport patients requiring intraaortic balloon counterpulsation and fixed-wing transport of neonates requiring extracorporeal membrane oxygenation. As medical transport capabilities extend the sphere of tertiary care to outlying medical facilities, there is a role for extracorporeal cardiopulmonary support in the initial stabilization and safe transport of critically ill patients, via air or ground ambulance. Potentially, the early application of life-sustaining technology can lower mortality and morbidity in patients with a survivable pathology. This is a report on the experience with the resuscitation and interhospital transport of patients on extracorporeal cardiopulmonary support.
Adult↗
Considerations for inter-hospital extracorporeal cardiopulmonary support resuscitation and transport.
The availability of commercial, pre-packaged extracorporeal cardiopulmonary support (ECPS) circuits, which are simplified for rapid set-up and priming, has made the intra-hospital resuscitation of moribund patients routine. The successful utilization of this technology in the emergent setting requires planning and the coordination of personnel familiar with the technology. Many issues must be addressed when a patient requiring life-sustaining support utilizing this technology at an outlying hospital, must be transported while on ECPS. After reducing the size and weight of the ECPS cart and obtaining Federal Aviation Administration approval for use during aeromedical transport, the Emanuel Hospital Mobile Surgical Transport Team (MSTT) was able to extend the use of emergency cardiopulmonary bypass to outlying medical facilities. The patients selected for transport, using ECPS, are a group of patients with a potentially survivable pathology unlikely to survive inter-hospital transport without such measures. This report describes our experience with inter-hospital transport of patients on ECPS with special emphasis on transport considerations.
Adolescent↗
Lateral and medial epicondylitis.
Lateral and medial epicondylitis (tennis elbow) are common pain complaints about the elbow in the adult. Disability from persistent pain and weakness at the elbow lead to surgical correction of the disorder. Complications of surgery arise from the improper diagnosis of the origin of the pain, failure to correct the pathology with the surgical procedure, and resultant profound forearm weakness or elbow instability. Rehabilitation during the postoperative period is critical for successful return to work or sports activity.
Diagnosis, Differential↗
Power staple fixation in trapeziometacarpal arthrodesis.
Twenty-seven trapeziometacarpal arthrodeses were performed in 26 patients for basilar thumb joint arthritis utilizing power staple fixation. Short arm thumb spica cast immobilization was maintained for an average of 8 weeks, followed by part-time splintage for 6-12 weeks. Twenty patients were available for evaluation an average of 19 months after the operation. All of the patients were satisfied with the procedure. Thirteen had complete relief of pain, four had mild pain, and three had moderate pain after surgery. The two nonunions that occurred were in patients that refused postoperative casting and both had complete pain relief. There were no fixation-related complications in the remaining 18 patients that were casted postoperatively, and all developed a solid fusion. Power staple fixation in trapeziometacarpal arthrodesis has a 90% union rate with no long-term fixation related complications.
Arthrodesis↗
In vitro validation of color velocity imaging and spectral Doppler for velocity determination.
Color velocity imaging (CVI) is a new non-Doppler ultrasound technique for vascular color flow imaging. Using information contained in the two-dimensional B-mode, gray-scale image to determine velocity, CVI offers potential advantages over Doppler color flow imaging methods. In order to be used clinically, velocity determination with CVI must be validated by other current methods. A Doppler string phantom was studied with a Philips CVI ultrasound system. Velocity measurements were obtained by both CVI and duplex Doppler spectral analysis for constant string speeds from 10 to 200 cm/sec, at intervals of 10 cm/sec. Twenty separate estimates were obtained with each method, at each string speed. Linear regression assessed the relationship between estimated and actual string velocities, with CVI and spectral Doppler analysis yielding highly valid results (CVI = -0.713 + 1.000997 x phantom; r 2 = 0.9979). At all string speeds tested, the averaged estimated and the actual velocities for both methods were within the 95% confidence estimates. The range for the CVI 95% confidence limits from the regression line varied from +/-1.07 cm/sec at the lowest speed of 10 cm/sec (11.6%) to +/-7.72 cm/sec at 200 cm/sec (3.87%). Based on in vitro testing, CVI is as accurate as Doppler spectral analysis for the estimation of flow velocity.
Blood Flow Velocity↗
A team approach to emergency portable cardiopulmonary support.
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Accidental Falls↗
Capitellum osteochondral injury in a football lineman.
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Adult↗
Surgical management of chronic medial elbow instability.
Chronic medial elbow instability in the active adult working population is a rarely diagnosed entity. Although it is recognized in the professional athlete as a cause of disability, reports in the general population do not exist. Fourteen adult patients with symptomatic chronic medial instability were evaluated from 1982 to 1986. Surgical reconstruction of the medial collateral ligaments was performed with follow-up evaluation averaging two years. Symptomatic complaints, physical examination, and roentgenographic evaluation were recorded preoperatively. Range of motion, postoperative stability, ulnar nerve symptomatology, and activity level were recorded postoperatively. All but one patient reported improved stability of the elbow.
Adolescent↗
Factors relating to the development of respiratory symptoms in coffee process workers.
After several cases of occupational asthma had been reported in a coffee processing factory in England, 197 coffee workers representing 80% of the production workforce were studied to determine the factors affecting the development of work related respiratory symptoms of wheeze, cough, and dyspnoea. Two computer administered questionnaires concerning the presence of respiratory symptoms and the occurrence of work related respiratory symptoms were used. Workers underwent skin prick testing to green coffee bean extract (GCB) and 11 common inhalant allergen extracts and bronchial provocation testing with methacholine. The presence of specific immunoglobulin E (IgE) antibodies to GCB and castor bean extract (CAB) were determined by a radioallergosorbent test (RAST). The prevalence of work related respiratory symptoms was 12.7%, bronchial hyperresponsiveness 30%, atopy 54%, positive GCB skin prick test 14.7%, positive GCB RAST 14%, and positive CAB RAST 14.7%. None of the workers was sensitised to fungi present in the factory and the numbers of certain species of fungi, despite being greater than may be found out of doors or in an uncontaminated indoor environment, were fewer than are generally associated with the presence of work related respiratory symptoms among agricultural workers. Storage mites were not isolated. Green coffee bean extract and CAB RAST were significantly correlated using the McNemar test but there was limited allergenic cross reactivity in RAST inhibition studies of the two extracts. The only factors that were significantly and independently associated with work related symptoms were CAB RAST and duration of employment. Bronchial hyperresponsiveness was not independently associated with work related respiratory symptoms. The significant independent associations of bronchial hyperresponsiveness included GCB RAST, duration of employment, and resting forced expiratory volume in one second. Exposure to CAB, a highly potent antigen, may be overriding the effects of other factors such a GCB, atopy, bronchial hyperresponsiveness, and smoking. This study suggests that CAB contamination remains a potential problem in the coffee processing industry and all efforts to eliminate it from the working environment should continue.
Adolescent↗