Journal Reviews
October 1, 1998 7 minutes read
Journal Reviews
Atcheson SG, Ward JR, Lowe W. Concurrent medical disease in work-related carpal tunnel syndrome. Arch Intern Med 1998; 158:1,506-1,512.
Many studies published in the past 20 years conclude that carpal tunnel syndrome (CTS) is caused by repetitive or forceful hand use in the workplace, but this new report states that those studies are of questionable validity unless they prospectively account for confounding disease and obesity. Unrecognized medical diseases capable of causing CTS are common, the authors say.
The 297 patients involved in the study had a chief complaint of discomfort involving the elbow, forearm, wrist, or hand. All were referred by workers' compensation administrators and had at least one previous medical exam certifying that their symptoms were incurred on the job. A physician reviewed each patient's medical records and performed physical examinations. Patients were evaluated for CTS using four criteria: 1) one prior CTS diagnosis; 2) the NIOSH diagnostic criteria for work-related CTS; 3) the examiner's assessment after a comprehensive evaluation; 4) a positive Phalen test or Tinel sign and a classic or probable median nerve distribution of neuropathic symptoms.
Pre-existing or concurrent medical conditions were diagnosed and noted. Patients were placed into job categories descriptive of tasks performed or industry in which employed.
Overall, patients had made more than 1,425 physician visits for industrial injuries; 125 had at least one nerve conduction velocity study, but only 37 had any blood testing performed. Some 198 patients had been diagnosed with CTS 420 times in 1,005 office visits. In these, 137 nerve conduction velocity studies were completed, nearly six times more often than diagnostic blood tests such as thyroid function, glucose, or a simple blood count. Wrist radiography was not done in nearly half the patients, including some who were scheduled for carpal tunnel surgery.
Concurrent medical conditions were common among all patients, including illnesses capable of causing arm pain, CTS, or median neuropathy. Hypothyroidism and diabetes mellitus were the most prevalent medical conditions, with either or both present in 33 patients. Other conditions included rheumatoid arthritis, lupus, spondyloarthropathy, and unclassified inflammatory disease.
The researchers found that medical diseases and obesity were significantly correlated with CTS diagnoses. Of 213 patients fitting at least one of the four CTS definitions, 40% were found to have a metabolic, inflammatory, or degenerative condition that might have caused the symptoms.
"This study confirmed our hypothesis that patients diagnosed as having work-related CTS have a high prevalence of concurrent medical conditions capable of causing CTS without respect to any particular occupation," the report states.
The authors also call for physicians to determine if a claimant's hand or wrist numbness could result from a treatable medical condition and to first consider known nonworkplace factors before ordering electrodiagnostic studies. t
Arnetz JE, Arnetz BB, Soderman E. Violence toward health care workers: Prevalence and incidence at a large, regional hospital in Sweden. AAOHN J 1998; 107-114.
Applying traditional epidemiological methods to the description and analysis of violence as an occupational hazard for health care workers, researchers show that nursing personnel and physicians are at considerable risk for workplace violence, with one-year incidence rates highest for practical nurses.
Researchers investigated the career prevalence and one-year incidence of workplace violence toward all categories of general (non-psychiatric) hospital staff, including physicians. Violence was broadly defined, including verbal threats and aggression. The study aimed to:
· compile standardized data and establish prevalence ratios for violence;
· compile standardized incidence rates and ratios;
· compare profession-based prevalence data with incidence data for possible associations.
Data were gathered through work environment questionnaires distributed to hospital staff in 1993, 1994, and 1995. Medical staff categories examined in the study were practical nurses (n=738), registered nurses (n=1,093), nurses' aides (n=31), and physicians (n=357). Paramedical staff included orderlies (n=21), social workers (n=36), occupational therapists (n=40), laboratory technicians (n=163), and physical therapists (n=61). A total of 2,540 staff were included in the study.
Results showed that compared to a representative sample of Swedish nurses, standardized prevalence ratios for violence at work were significantly increased for all four medical staff categories. The risk was greatest for practical nurses. None of the paramedical staff had significant increased risks for violence.
For medical staff, one-year incidence rates of violence ranged from 18/100 person-years for physicians to 31/100 person-years for practical nurses. A significantly higher standardized incidence rate ratio for violence at work over a one-year period was found only for practical nurses.
When standardized for age and gender, practical nurses reported the highest prevalence and one-year incidence rates of violence among medical staff, while physicians reported the lowest rates. Among paramedical staff, orderlies accounted for the highest rates for both prevalence and incidence of violence.
The authors note that the data serve as a base measurement for future studies in Sweden and other countries.
"This study indicates substantial risks for violence for health care personnel in a general hospital setting," they state. "Data that quantify the prevalence and incidence of violent or threatening events toward health care workers is of importance to health care staff, administrators, and occupational health professionals."
They charge occupational health professionals with helping to assess and control violence toward HCWs by monitoring trends in violent behavior with the aim of developing effective coping strategies and intervention programs. n
Respond! software for Windows is now available for employee/occupational health in single-user or network platforms. The software is available in six modules that can be purchased in any combination. Modules are: tests/exams, vaccinations, exposures, work-related injuries/illnesses, absences, and demographic download. Respond! includes hundreds of reports, including the OSHA 200 log and incidence/severity report, cost analyses, PPD conversion rate, cross tables, frequencies, line listings, and complete health histories. More than 40 built-in letters are available. Three months' technical support are included free. For more information and a free demo disk, call Infection Control and Prevention Analysts Inc., (800) 856-4594, fax (512) 892-4598, or send an e-mail request to [email protected].
Infection control tear sheets support staff training on the CDC's isolation precautions guidelines. Topics include an introduction to standard precautions, airborne precautions, droplet precautions, contact precautions, hand washing, cleaning up contamination, handling needles and other sharps, and gloves and other personal protective equipment. Each tear sheet presents specific guidelines, along with illustrated instructions, and includes a signature line for employees to confirm that they have read and understood the material. Can be ordered with personalized information (i.e., hotline numbers, exposure instructions) printed on the back. Cost is $12.50 per pad of 50 sheets, with discounts for large orders. Contact Krames Communications, Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821; telephone: (800) 333-3032; fax: (650) 244-4512.
Women: Work and Health is the Department of Health and Human Services' first comprehensive report on the health and well-being of America's working women. The report includes information on job-related injuries (most frequent are back injuries) and illnesses, workplace health education and health promotion, work-related fatalities, the effect of health status on work, knowledge of health risks and behaviors, and health-related employee benefits. The report was produced with information from NIOSH, the National Center for Health Statistics, the U.S. Department of Labor, the CDC's Office of Women's Health, and the U.S. Bureau of the Census. Copies are available by calling (800) 35-NIOSH, or on the NCHS home page on the World Wide Web at http://www.cdc.gov/nchswww/. n
"AOHP Salutes the New Millennium" - Oct. 21-24, 1998, Orlando, FL. The 18th annual national conference of the Association of Occupational Health Professionals in Healthcare includes presentations on ergonomics, latex allergy, wellness promotion, substance abuse, OSHA's proposed TB standard, professional certification, and surfing the Internet. Preconference workshops are offered in physical assessments and getting started in occupational health. Contact AOHP, 11250 Roger Bacon Drive, Suite 8, Reston, VA 22090-5202; telephone: (800) 362-4347 or (703) 437-4377; fax: (703) 435-4390; Web site: http://www.aohp.org/aohp.
"Bridging Canyons to the 21st Century" - Oct. 18-22, Phoenix. The 50th annual state-of- the-art conference sponsored by the American College of Occupational and Environmental Medicine (ACOEM) focuses on integrating old and new delivery systems, practice settings, technologies, and treatment modalities. Features postgraduate seminars, scientific sessions, technical exhibits, and preconference professional development courses. Contact ACOEM, 55 W. Seegers Road, Arlington Heights, IL 60005-3919; telephone: (847) 228-6850, ext. 184; fax: (847) 228-1856; Web site: http://www.acoem.org.
Latex Allergy: Understanding Implications and Interventions - Nov. 4-5, New York City. Sessions include: "Making your hospital safe: policies, procedures, glove purchasing, and product selection"; "Epidemiology/diagnosis"; "Infection control"; "Limiting your institution's liability"; "So you have a latex allergy: What do you do now?"; and "In-depth diagnosis for physicians, NPs/PAs, and employee health practitioners." Another session will discuss workers' compensation, disability, and the ADA as they apply to health care workers. Contact: Compass Medical Education Network, 820 W. Jackson Blvd., Chicago, IL 60607; telephone: (800) 818-9128.
"The Power of Partnership: A Force for Global Change" - Nov. 11-13, Eastbourne, England. This conference is sponsored by the American Association of Occupational Health Nurses (AAOHN), the Royal College of Nursing, the Federation of Occupational Health Nurses in the European Union, and the Scientific Committee of Occupa tional Health Nurses. Goals are to build international partnerships; strengthen leadership; develop strategies to integrate research into practice; and promote occupational and environmental health nursing, education, and networking. Contact AAOHN, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341; telephone: (770) 455-7757; fax: (770) 455-7271; Web site: http://www.aaohn.org.
Fourth International Conference on Occupational Health for Health Care Workers - Fall 1999. Sponsored by the International Commission on Occupational Health. Contact: Pierre Robillard, MD, Montreal Public Health Department, Occupational and Environmental Health Unit, 75 Port-Royal East, Room 240, Montreal, Quebec, Canada H3L 3T1. Telephone: (514) 858-7510, ext. 245. Fax: (514) 858-5993. E-mail: [email protected].
(To submit calendar items of interest to hospital employee health professionals in the United States or Canada, send the information to: Calendar Editor, Hospital Employee Health, P.O. Box 740056, Atlanta, GA 30374. Items must be submitted at least three months prior to the event date or event registration deadline. Please include a contact person's telephone number.) n
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