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Results for “WORKMEN'S COMPENSATION”

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PubMed2003

Value of some clinical provocative tests in carpal tunnel syndrome: do we need electrophysiology and can we predict the outcome?

Despite the high incidence of CTS, there are no precise diagnostic criteria. The history is useful, but the value of so-called provocative tests is questionable. Electrophysiology is required in the atypical cases; however, it has no prognostic value. There is no good correlation between electrophysiology and symptoms. The outcome seems to be favorable in patients without workmen's compensation, with a mild to moderate impairment preoperatively, and with a favorable response to carpal tunnel infiltration. Postoperatively the electrophysiologic parameters ameliorate symptoms, but this is not correlated to the patient's satisfaction.

Carpal Tunnel Syndrome↗
PubMed1993

The Chow technique of endoscopic release of the carpal ligament for carpal tunnel syndrome: four years of clinical results.

This article represents a review of the clinical results of 650 consecutive cases of carpal tunnel decompression in 456 patients from the first 4 years of endoscopic carpal tunnel release: 38% returned to normal activities within 1 week, 59% within 2 weeks, 73% within 3 weeks, and 84% within 4 weeks. A total of 98% returned to their normal activities. Also included is an analysis of the workmen's compensation and pinch-and-grip studies. The results of these studies appear to indicate that endoscopic release of the carpal ligament accomplishes results similar to the standard procedure with a more rapid recovery.

Adolescent↗
PubMed2002

Latex allergy: historical perspective.

The widespread use of powdered latex gloves, following the institution of universal precautions in 1987, increased the occurrence of a host of adverse reactions to natural rubber latex (NRL). Although the most common reactions are irritant or allergic dermatitis reactions to manufacturing chemicals, a spectrum of type I IgE-mediated reactions to NRL proteins are of great concern. IgE-mediated reactions range from contact urticaria to occupational asthma and anaphylaxis, resulting in significant morbidity and potential mortality. At-risk populations include highly exposed groups like health care workers and certain patient groups requiring extensive medical treatment. A significant complicating factor is the association with clinically significant adverse reactions to certain foods because of allergen cross-reactivity. Institution of policies to use only low-protein, powder-free gloves, has resulted in a dramatic reduction of visits to occupational health departments and workmen's compensation claims due to occupational asthma.

Food Hypersensitivity↗
PubMedDate not supplied

Surgical resection of the distal clavicle.

Distal clavicle resection is frequently performed for persistent acromioclavicular pain. However, patient outcome after this procedure has not been well described. The results of subjective and objective retrospective analysis of 23 open distal clavicle resections in 21 patients are reported. Patients were evaluated with a questionnaire, roentgenographs, physical examination, and isokinetic muscle strength testing at an average of 30 months after surgery. Eighteen of 23 shoulders had good or excellent postoperative ratings. All patients had normal motion. No significant weakness of the operated shoulder was seen on objective muscle testing when compared with the unoperated shoulder. The average preoperative Hospital for Special Surgery score was 34, and the average postoperative score was 84. Age and hand dominance were unrelated to postoperative outcomes. Less predictable results were obtained in patients with workmen's compensation and in those patients involved in litigation. Open distal clavicle resection yields good to excellent results in properly selected patients and does not create significant subjective or objective weakness.

Acromioclavicular Joint↗
PubMed1978

First year hospitalisation costs for the spinal cord injured patient.

This retrospective, descriptive study presents the actual first year hospitalisation costs for a series of 85 spinal cord injured patients, covered by Workmen's Compensation Insurance and cared for in a variety of United States institutions. Mean first year hospital costs for all patients was $35,767. For quadriplegics, $42,240; and paraplegics, $32.619. During initial hospitalisation only, the average length of stay was 184 days and mean cost was $28.637. Room and board comprised 52 per cent of cots; special services, 36 per cent and professional services, 11 per cent. Major special service costs were private duty nursing, medications, medical supplies, respiratory and physical therapy. Major professional charges were centred in the surgical and physical medicine specialties. Home care costs averaged $4000 per patient or $37.00 per day. When compared with the other studies, the costs presented here are higher though the differential is reduced markedly when median rather than mean costs are presented. When compared with the one other known study based on actual and not estimated costs, the results are markedly similar. Differences in costs between this and other studies and the reasons for same are discussed.

Costs and Cost Analysis↗
PubMed2001

Quality of life and chronic nonmalignant pain.

Chronic nonmalignant pain is a prevalent and costly phenomenon. Chronic pain induces stressors that affect personal and work lives of sufferers. Because of this interference, quality of life is impacted. The purpose of this pilot study was to explore the impact of stressors on the quality of life of adult patients with chronic pain. The framework guiding this study was Neuman's Systems Model based on the concepts of stress and reaction to stress. A descriptive correlational research design was used to compare participants' quality of life according to their health and function; family, psychological, spiritual, and socioeconomic status; and the stressors of age, gender, income, marital and work status, occupation, monthly treatment costs, and type of insurance. Each participant was administered the Ferrans and Powers Quality-of-Life Index and a demographic survey. Results revealed that a higher quality of life was associated with participants who were older, female, and employed, whereas a lower quality of life was associated with participants with a low income, higher treatment costs, and a lack of workmen's compensation insurance. Based on Neuman's model, the implications of chronic pain sufferers' resistance to the negative impact of various stressors are discussed.

Adaptation, Psychological↗
PubMed1982

Adequacy of current industrial hygiene and occupational safety professional manpower.

Heated current political discussions of proper staffing and conduct of industrial hygiene and safety programs raise the questions of the numbers and adequacy of available professional manpower. Data from several studies of such professional manpower in the U.S. during the past decade were critically reviewed and compared. Their projected growth rates for industrial hygiene were far short of the actual recent 15%/year growth rate of AIHA membership and of ABIH diplomates, and 27% year for ABIH trainees. From these studies and census data, it was calculated that in 1977 the ratio of employees to IH professionals was 17 100, and to safety professionals 2200. Also the ratio of professional costs to the value of lost workdays plus workmen's compensation was 1.4% for industrial hygiene and 10.6% for safety. It appears likely that more IH professionals would be cost effective. Data on outputs of university training programs indicate that the majority of individuals on current staffs were not specifically trained as IH or safety professionals. Although employment demands may be affected by the outcome of ongoing political discussions, there are obvious unsatisfied needs for services. These require professional training of greater numbers than current capacities of university programs permit.

Humans↗
PubMed2001

Bloodborne pathogen exposures in a developmental center: 1993-2000.

In a developmental center, 257 potential bloodborne pathogen exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks) occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of the residents, 9% were hepatitis B virus (HBV) surface antigen carriers. Serological follow-up of exposed, susceptible employees and residents identified no transmission of HBV, hepatitis C virus (HCV), or human immunodeficiency (HIV) virus. This outcome has been due primarily to hepatitis B immunization and low prevalences of HCV or HIV infections among the subjects. Proper follow-up of all potential exposures is crucial to identify transmission promptly, allay anxiety, and prevent unwarranted workmen's compensation claims. Measures are suggested to reduce exposure further.

Blood-Borne Pathogens↗
PubMed1978

Psittacosis outbreak in employees of a turkey-processing plant.

In June 1976, 28 employees of a Nebraska poultry processing plant had clinical onset of an illness compatible with psittacosis. The diagnosis was serologically confirmed in 22 patients by fourfold or greater changes in their complement fixation antibody titers, using a Chlamydia group antigen. Lack of serologic response in the remaining patients could not be readily explained by therapy differences, timing of serologic evaluation, or severity of clinical illness. The comparable attack rates in the various processing departments were consistent with an airborne infection. However, results of the investigation also suggested that workers having both frequent contact with turkey tissues and skin injuries were more likely to be infected than other processing workers. The cost of the outbreak for reimbursed medical costs, workmen's compensation, and lost wages was $19,000. A single turkey flock was implicated as the source of infection. This flock had been screened on a voluntary basis for evidence of infection prior to slaughter, using criteria developed by the United States Department of Agriculture. Although the preslaughter screening failed to detect psittacosis infection, two turkeys from the same flock which inadvertently had not been sent to slaught were subsequently found to be infected.

Adolescent↗
PubMed1989

Diagnostic epidural opioid technique.

Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response group--pain relief with placebo solutions; fentanyl response group--pain relief with epidural fentanyl; lidocaine response group (LRG)--pain relief with lidocaine but not fentanyl; and no response group--no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. The comparisons resulted in the conclusion that LRG patients had a much longer average duration of pain than the other groups. On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.

Adult↗
PubMed1993

Anterior lumbar interbody fusion for discogram concordant pain.

Twenty-two patients undergoing anterior lumbar interbody fusion (ALIF) for discogram concordant low-back pain were retrospectively evaluated by objective criteria. Results were poor in all two-level fusions. Among single-level fusions, there were 35% good, 18% fair, and 47% poor results. Patients with previous surgery or workmen's compensation did poorly as a group despite positive discography. Subjective results were difficult to assess.

Adult↗
PubMedDate not supplied

Factors relating to return to work after burn injury.

This study examined the influence of various factors on the probability that 225 persons with severe burns would return to work 12 months after being discharged from the acute care setting. By use of multivariate analysis, 4 out of 15 variables significantly increased the probability of being employed: (1) being white, (2) not blaming oneself, (3) receiving workmen's compensation, and (4) being employed before the injury. With controls for burn severity and other variables, premorbid employment accounted for a person being 171 times more likely to return to work than one who was not employed before injury. Our findings suggest that some traditionally held impressions regarding factors related to return to work after a severe burn should be revisited. Moreover, despite earlier reports concluding that burn severity was the primary predictor of return to work, we found no factors in the acute care environment or patient characteristics that were statistically significant. Instead, findings from this series underscore the importance of the preinjury environment--especially being employed at the time of injury--as the strongest predictor of return to work after a severe burn.

Absenteeism↗
PubMed1995

Treatment charges, payment sources, and disability from alcohol-related trauma.

We examined treatment charges and who paid them and disability for work, school, household activities, and activities of daily living according to identified use of alcohol before injury among 2,416 patients age 15 years or older from 22 northwestern Vermont communities. Over 90% received emergency department treatment only. Among patients reported to have consumed this drug mean hospital and physician charges, respectively, were $2,482 and $565; 31.7% did not pay any portion of their hospital bills, and 27.8% of their total bills were unpaid. Among patients not known to have consumed alcohol, mean hospital and physician charges were $601 and $158, respectively; 10.7% made no payments and 11.3% of their bills were unpaid. Bills of alcohol users more often were paid by Medicaid and less often by Workmen's Compensation or commercial insurance than were those of patients without alcohol. Users also were less likely than the nonalcohol group to pay physicians' bills for hospital care. Alcohol users experienced longer postinjury disability than did persons not known to have been drinking.

Academic Medical Centers↗
PubMed1986

Hospital utilization by health maintenance organizations. Separating apples from oranges.

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary "leakage," or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

Adolescent↗