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Biomedical subjects

J M Melhorn

Publications and source records attributed to J M Melhorn.

At least 19 recordsLinked to original sources
PubMed2001

Occupational orthopaedics in this millennium.

Treatment of musculoskeletal pain in the workplace by early return to work and prevention is the future of occupational orthopaedics. Patients who receive workers' compensation comprise 20% of the general orthopaedist's practice, 65% of a hand surgeon's practice, and 90% of the independent medical examiner's practice. To improve the treatment outcomes for patients who receive workers' compensation, orthopaedists in this millennium will need knowledge about how individual and job risk factors can combine to result in musculoskeletal pain in the workplace. This knowledge will promote the safe return of their patients to the workplace after injury. With the prediction that more than 50% of the workforce in the United States will have experienced an occupational injury or illness, it is important for orthopaedists who are treating patients with work-related injuries to understand how management of these workplace risk prevention programs will impact their patients and practice of orthopaedics. In this millennium, orthopaedists will need to know how to talk the language, interpret the information, and understand the benefits of early return to work and prevention of injuries in the workplace. The future will be about legislated prevention and healthcare in the workplace.

Disability Evaluation↗
PubMed2001

Management of musculoskeletal pain in the workplace.

Occupational Safety and Health Administration recordable upper-extremity musculoskeletal pains or disorders account for a significant number of work-related illnesses in the US workforce. Although the concept of musculoskeletal disorder prevention is appealing, little has been done to demonstrate the successful application and benefit of these programs. In 1995, an aircraft manufacturer established a unique risk-management program for new employees based on the CtdMAP individual risk assessment instrument. In 1998, a subgroup was prospectively studied for medical management on the basis of individual risk scores. Outcome measures were compared for the risk assessment group, the matched control group, and the total company. Employer-estimated savings in direct workers compensation costs were $2.42 million, and estimated indirect savings were over $13.5 million during the study.

Cost Savings↗
PubMed1999

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Adult↗
PubMed1999

An outcomes study of an occupational medicine intervention program for the reduction of musculoskeletal disorders and cumulative trauma disorders in the workplace.

Upper-extremity musculoskeletal pains or disorders (MSDs) account for a significant number of work-related illnesses in the US workforce. Although the concept of MSD prevention is appealing, little has been done to demonstrate the successful application and benefit of these programs. In 1995, an aircraft manufacturer established a unique risk-management program based on the individual risk assessment (CtdMAP) for new hires. The MSD intervention program was designed to prospectively evaluate each new employee for their individual risk of developing MSDs in the workplace. Before job placement, individuals at higher risk were assigned to a period of transitional work. Workers' compensation costs decreases per year were 16%, 3%, 24%, and 12%, while work hours increased by 56%. Employer-estimated savings in direct workers' compensation costs per year were $469,990, $678,337, $1,936,105, and $1,995,759.

Algorithms↗
PubMed1998

Cumulative trauma disorders and repetitive strain injuries. The future.

Cumulative trauma disorders account for 56% of all occupational injuries. Currently, occupational injuries affect 15% to 20% of all Americans. The United States government predicts that by the year 2000, 50% of the American workforce will have occupational injuries annually and 50 cents of every dollar will be spent on cumulative trauma disorders. There is common agreement on the need for reduction of cumulative trauma disorders in the workplace. However, there is little agreement on the appropriate definition for musculoskeletal pain that occurs in the workplace, or the ergonomic and epidemiologic model for cumulative trauma disorders, or on the specific exposure relationships of the individual, by the job, and occurring in the workplace. The previous treatments for, and the natural history of, cumulative trauma disorders in other countries gives some insight into the possible future of cumulative trauma disorders for the United States. Until research can provide specific dose and exposure relationships for the individual, prevention remains the best treatment for cumulative trauma disorders in the workplace.

Cumulative Trauma Disorders↗
PubMed1996

A prospective study for upper-extremity cumulative trauma disorders of workers in aircraft manufacturing.

Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates were analyzed in conjunction with the four experimental groups, a positive benefit from ergonomic posture training and exercise training was demonstrated for the following groups: the dominant han, time spend in an awkward position, number of standard rivets bucked, number of parts routed, number of parts ground, number of vibration-dampening rivets bucked, and newly hired individuals. A negative effect (increase in individual risk level) for current employees using a vibration-dampening rivet gun was demonstrated. This prospective study helps to identify the possible benefit of education and training for controlling CTDs and demonstrates the usefulness of being able to evaluate materials, methods, machines, and environments as they relate to the individual's risk level for the development of upper-extremity CTDs.

Adult↗
PubMed1996

Inflammatory large bowel disease in immunodeficient mice naturally infected with Helicobacter hepaticus.

Large bowel disease detected clinically by rectal prolapse was studied in 64 immunodeficient mice (37 athymic NCr-nu/nu, 12 BALB/c AnNCr-nu/nu, 9 C57BL/6NCr-nu/nu, and 6 C.B17/Icr-scid/NCr) naturally infected with Helicobacter hepaticus. Rectal prolapse was found in approximately 5% of immunodeficient mice maintained in a research facility over a period of 3.5 years. All mice had various degrees of chronic proliferative typhlitis, colitis, and proctitis, usually without concomitant hepatitis. Some mice had severe proliferative proctitis with cystic hyperplasia. Histologic study of the large bowel of 48 athymic NCr-nu/nu mice without H. hepaticus infection and housed in another clean facility revealed only 12% of the mice with minimal-to-mild large bowel inflammation. Helicobacter hepaticus infection is associated with large bowel disease in immunodeficient mice but is not seen in H. hepaticus-infected immunocompetent mice. This new pathogenic bacterial infection should be considered as another potential cause or co-factor for rectal prolapse and large bowel disease in mice.

Animals↗
PubMed1996

Carpal tunnel syndrome. Effects of litigation on utilization of health care and physician workload.

We performed a study consisting of two parts to investigate the impact of litigation on patient recovery and physician workload. We received 556 replies from a questionnaire sent to hand surgeons and discovered that 98.20% of them felt that litigation increased the subjective complaints of patients. Most of these physicians (89.75%) also felt that litigation led to a worse result from treatment. Second, we undertook a retrospective chart review of 447 patients to see if there was a correlation between litigation, patient utilization of health care and physician workload. We found that workers' compensation patients with pending litigation went to the doctor's office more. They also had more letters, phone calls, and forms associated with their care, had more nerve conduction studies performed, and took longer to be discharged from care than patients with non-work-related carpal tunnel syndrome as well as workers' compensation patients who did not have pending litigation. These results indicated that litigation does affect patient utilization of health care and increases the workload on the physician.

Adult↗
PubMed1994

CTD: carpal tunnel syndrome, the facts and myths.

Recognition of the need for risk control of occupational injuries and prevention programs has led to many new studies demonstrating that occupational diseases are multifactorial in etiology, and that a specific job may not be the primary cause for occurrence. As a result of the many causes, myths about work-related injuries have developed. CTDs are the majority of occupational injuries. Individual risk factors are a better predictor of development of CTD and CTS than are job-related factors. Risk for carpal tunnel syndrome is closely related to general physical condition. Improved general health and health prevention programs may reduce an individual's risk level for developing a cumulative trauma injury. Risk measurement systems now allow employers to establish programs with measurable results. Since assessing the individual risk factors provides the best opportunity to attain the goal of prevention, the next step is for employee, employers, insurance carriers and the medical profession to establish concurrent prevention programs based on human risk factor evaluation systems.

Adult↗
PubMed1985

Dose-responsive increase in sister-chromatid exchanges in bone-marrow cells of mice exposed nose-only to whole cigarette smoke.

The effect of whole cigarette smoke exposure on bone-marrow sister-chromatid exchanges (SCEs) was studied in B6C3F1 mice. Animals were exposed nose-only to 10% (v/v) cigarette smoke 5 days/week for 2 weeks. Four dose levels of cigarette smoke (1, 4, 9 and 18 exposures/day) were studied using 2 cigarette types, Kentucky reference 3A1 (3A1) and American Blend (AB). A single exposure represented approximately 1 cigarette. A dose-dependent increase in SCEs was observed for both the 3A1 and AB cigarettes at dose levels which had no effect on bone-marrow cell-replication kinetics. These findings represent the first demonstration of a dose-responsive increase in cigarette smoke-induced SCEs in a rodent model system.

Animals↗