Development and Implementation of a Violence Risk Assessment Tool

The purpose of this quality improvement project was to provide a means to effectively assess patients as they are admitted to the hospitals and to effectively communicate a patient’s violent tendencies within the healthcare setting. Workplace violence is a serious problem that affects all healthcare professionals. Although serious assaults and homicides attract more media attention, the majority of workplace violence consists of non-fatal assaults. Nurses, aides, and patient care technicians suffer the most non-fatal assaults resulting in injury. Due to the growing incidence of assault and injury among healthcare workers, some states are calling for additional study on workplace violence. Healthcare organizations are mandated to develop violence prevention programs and greater reporting of incidents. Healthcare organizations have workplace prevention programs in place but still fail to protect healthcare workers from injury. Additional measures are needed to cope up with the increasing incidence of workplace violence specifically related to assaults and injuries caused by patients in healthcare settings. Research shows that the use of a violence risk assessment tool has been proven effective in attempts to prevent workplace violence. This paper will examine patient initiated violence in the workplace, explore the use of a workplace violence risk assessment tool to identify patients with propensity for violence in hospitals, and analyze the implication of the use of a violence risk assessment tool to the nursing practice

Outcomes and Presurgical Correlates of Lumbar Fusion in Utah Workers\u27 Compensation Patients: A Replication Study

Lumbar fusion performed among injured workers has dramatically increased over the past two decades, coinciding with the increased use of more advanced surgical technology. Despite recent changes in how this surgery is performed, few outcome studies have been conducted, particularly among workers compensation populations. In prior studies, several biopsychosocial risk factors were found to be predictors of functional outcomes of lumbar fusion. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers, and whether a biopsychosocial model continues to be predictive of outcomes. The current study aimed to address multidimensional patient outcomes associated with lumbar fusion and examine the relationship between presurgical biopsychosocial variables and outcomes by testing the predictive efficacy of a multiple variable model. Injured workers (N = 245) who underwent their first lumbar fusion between 1998 and 2007 were included in a retrospective-cohort study performed in two phases that involved coding presurgical information documented in patient medical charts in the Worker\u27s Compensation Fund of Utah computer database (Phase 1) and administering a telephone outcome survey with patients at least 2 years post-surgery (Phase 2). Of the total sample, 45% (n = 110) of patients were contacted and completed follow-up outcome surveys on several measures of patient satisfaction, quality of life, fusion status, dysfunction level, disability status, pain, and general physical and mental health functioning. Results revealed injured workers reported a solid fusion rate of 89.0%, disability rate of 28.7%, and a poor outcome rate of 57.1%. Multiple linear regression analyses demonstrated an eight variable model was a statistically significant predictor of multiple patient outcomes. Involvement of a nurse case manger, vocational rehabilitation, and litigation at the time of fusion were the most prominent predictors across outcome measures, while age and depression history showed modest prediction of outcomes. Prior back operations, number of vertebral levels fused, and type of instrumentation showed no statistically significant prediction of outcomes. Results were evaluated and compared to prior lumber fusion studies on injured worker and fusion outcome literature, in general. Specific implications for our findings and limitations associated with this study were addressed

Predicting Lumbar Fusion Surgery Outcomes From Presurgical Patient Variables: The Utah Lumbar Fusion Outcome Study

Lumbar fusion surgery is a commonly used procedure to treat severe spinal pathology and associated chronic disabling low back and leg pain. Despite the common incidence of spinal fusion surgery, few studies have examined patient outcomes or predictive correlates of this procedure. The objectives of this study were to characterize Utah workers who received lumbar fusion surgery in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. An archival prospective research design was utilized consisting of a retrospective medical chart review and a postsurgical telephone outcome survey. Subjects were 203 workers\u27 compensation patients from the state of Utah who have undergone spinal fusion surgery and who were at least 2 years postsurgery at time of follow-up. Outcomes were assessed for 144 of the 203 patients (71%). Presurgical measures _included demographic, work, compensation, disability, health, surgical, and physiological variables. Outcome measures included solid arthrosis, patient satisfaction, work disability status, functional disability due to back pain, and multidimensional health. Analysis of patient outcome data revealed that solid arthrosis was achieved in 71.9% of patients. Forty-six percent of subjects felt their back/leg pain problems were worse than what they had expected following the surgery, and 42 % felt that their quality of life had not changed or worsened as a result of lumbar fusion. Twenty-eight percent of fusion patients were work disabled at follow-up. Fusion patient mean outcome scores on multidimensional health measures reflected poorer health than comparative medical patient and nonpatient norms. The most consistent presurgical correlates across outcomes were lawyer involvement, number of prior low back operations, age at injury, and household income at time of injury. Results are compared to data from previous lumbar fusion research studies and reasons for varying findings are offered. Implications of the findings are discussed in terms of inadequate patient selection and insufficient assessment of patient outcomes in low back research studies. Limitations of the present research are discussed, including how placebo, natural history, and regression to the mean can lead to erroneous conclusions about the efficacy of lumber fusion surgery. Suggestions for improvements in low back surgery outcome research are offered

Outcomes of Rotator Cuff Surgery in Utah Workers’ Compensation Patients

Currently, rotator cuff injuries are the most common problem for the shoulder and accounted for 4.1 million physicians visits. Partial and full thickness tears are more common in people over the age of 50. The increased prevalence of rotator cuff injuries in the United States population certainly affects the working population and often represents a significant economic burden for employers. Few studies have examined outcomes in worker compensation patients or considered biopsychosocial predictive variables for rotator cuff repairs. The current study aimed to characterize injured workers who have undergone rotator cuff repairs across a number of pre- and postprocedural variables, evaluate multidimensional functional and quality of life outcomes, and examine biopsychosocial variables predictive of success and failure in this sample. The current study examined 93 injured workers who had undergone at least one rotator cuff repair within the past five years. Participants were solicited through the Worker’s Compensation Fund of Utah (WCF) computerized database. The current study used a retrospective cohort design, patients’ medical charts were reviewed, and various preprocedural variables were coded for analysis including age at the time of the rotator cuff repair, lawyer involvement in the claim, prior shoulder surgery history, and quantity of other compensation claims. Of the total sample, 47 patients (50.5%) were contacted and completed outcome surveys that assessed patient satisfaction, shoulder functional impairment, disability status, and general physical and mental health functioning. Findings revealed that approximately one third of the patients were totally disabled (29.8%), had poor shoulder specific functioning (36.2%), and were dissatisfied with their current shoulder condition (31.7%). A multivariate regression model was utilized in predicting patient outcomes. Specifically, the number of WCF claims of the patient was a robust predictor of multidimensional outcomes, while age and gender were less predictive of outcomes, and the presence of a prior shoulder surgery reflected no predictive power. Results of descriptive, correlational, and regression analyses are compared to existing data for rotator cuff repair patients when available or to other surgical procedures with similar populations. The study limitations are discussed, such as small sample size, the retrospective design, and lack of matched controls

Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

Data Science in Healthcare

Data science is an interdisciplinary field that applies numerous techniques, such as machine learning, neural networks, and deep learning, to create value based on extracting knowledge and insights from available data. Advances in data science have a significant impact on healthcare. While advances in the sharing of medical information result in better and earlier diagnoses as well as more patient-tailored treatments, information management is also affected by trends such as increased patient centricity (with shared decision making), self-care (e.g., using wearables), and integrated care delivery. The delivery of health services is being revolutionized through the sharing and integration of health data across organizational boundaries. Via data science, researchers can deliver new approaches to merge, analyze, and process complex data and gain more actionable insights, understanding, and knowledge at the individual and population levels. This Special Issue focuses on how data science is used in healthcare (e.g., through predictive modeling) and on related topics, such as data sharing and data management

Predictors of Outcome of Surgery for Carpal Tunnel Syndrome

Wrist surgery is a common method for treating carpal tunnel syndrome (CTS) although few studies have examined patient outcomes or predictive correlates of such procedures. The objectives of this study were to characterize Utah workers who received surgery for CTS in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. Participants were 75 Utah workers\u27 compensation patients who underwent surgery for CTS from 1999-2002 and were at least 6 months postsurgery at time of follow-up. A retrospective cohort design was utilized consisting of a review of presurgical medical records and a postsurgical telephone survey. Presurgical variables included: gender, age, history of depression, and litigation status. Correlational analyses revealed that age and lawyer involvement were consistent significant predictors of poorer outcomes. The importance of conceptualizing CTS surgery patient outcomes from a biopsychosocial perspective is discussed

An experimental approach for the characterization of prolonged sitting postures using pressure sensitive mats

The adoption of prolonged sitting posture,which is a condition commonly encountered in several working tasks,is known to induce a wide range of negative effects,including discomfort,which has been recognized as an early predictor for musculoskeletal disorders (particularly low back pain).In this regard,the continuous monitoring of worker’s psychophysical state while sitting for long periods of time, may result useful in to preventing and managing potentially risky situations and to promote ergonomics and macroergonomics interventions,aimed to better organize work shifts and workplaces.The aim of this dissertation is to provide and test the reliability of a set of monitoring parameters,based on the use of quantitative information derived from body-seat contact pressure sensors.In particular, he study was focused on the assessment of trunk postural sway (the small oscillations resulting from the stabilization control system) and the number of In Chair Movements (ICM) or postural shifts performed while sitting, proven as a reliable tool for discomfort prediction. This thesis is articulated into four experimental campaigns.The first is a pilot study which aimed to define the most reliable algorithm and the set of parameters useful to assess the performed postural shifts or In chair Movements (ICM), which result useful to characterize postural strategies in the long term-monitoring. In this regard, a pilot study was conducted in which two different algorithms for the ICM computing were tested, based on different parameters and having different thresholds. The chosen algorithm was used, together with trunk sway parameters, to evaluate postural strategies in the other three experiments of this thesis. The second and the third studies evaluated sitting postural strategies among bus drivers during regular, long-term work shifts performed on urban and extra-urban routes. The results, in this case, showed that, all drivers reported a constant increase in perceived discomfort levels and a correspondent increase in trunk sway and overall number of ICM performed. This may indicate the adoption of specific strategies in order to cope with discomfort onset, a fatigue-induced alteration of postural features, or both simultaneously. However, it was interesting to observe differences in ICM vs trunk sway trend considering the single point-to-point route in the case of urban drivers. This difference between may indicate that these parameters refer to different aspects of sitting postural strategies: ICM may be more related to discomfort while sway may be more representative of task-induced fatigue. Trunk sway monitoring, as well as the count of ICM performed by bus drivers may thus be a useful tool in detecting postural behaviors potentially associated with deteriorating performance and onset of discomfort. Finally, the last experiment aimed to characterize modifications in sitting behavior, in terms of trunk sway and ICM among office workers during actual shifts. Surprisingly, results showed a decreasing trend in trunk sway parameters and ICM performed over time, with significant modifications in sitting posture in terms of trunk flexion-extension. Subjects were also stratified basing on their working behavior (staying seated or making short breaks during the trial) and significant differences were identified among these two groups in terms of postural sway and perceived discomfort. This may indicate that the adoption of specific working strategies can significantly influence sitting behavior and discomfort onset. In conclusion, the trunk sway monitoring and the ICM assessment in actual working environments may represent a useful tool to detect specific postural behaviors potentially associated with deteriorating performance and onset of discomfort, both among professional drivers and office workers.They might effectively support the evaluation of specific working strategies,as well as the set-up of macroergonomics interventions

Outcomes and Presurgical Correlates of Lumbar Interbody Cage Fusion

Rates of lumbar fusion surgery have been increasing with an estimated 192,000 procedures performed annually. However, satisfactory outcomes of lumbar fusion vary considerably and often emphasize technical success, such as arthrodesis, rather than Ill functional and quality of life outcomes. Interbody cage fusion was recently developed and touted as a superior alternative to existing lumbar fusion procedures. There is, however, a paucity of research to support these claims, particularly with regards to functional and quality of life outcomes. Moreover, predictive correlates of outcomes for interbody cage fusion have not been given adequate attention in the literature. The aims of this study were to characterize patients undergoing this new procedure, examine functional and multidimensional outcomes, and investigate the predictive efficacy of presurgical variables. A retrospective cohort research design was employed and entailed medical record reviews for presurgical data and telephone outcome surveys at least 18 months following surgery. Seventy-three patients who had undergone lumbar interbody cage fusion were identified from the private practice of an orthopedic surgeon and the Workers\u27 Compensation Fund of Utah. Presurgical variables coded for analysis included age at the time of surgery, severity rating of presurgical spinal pathology, smoking tobacco, depression, and pursuing litigation at the time of surgery. Of the total sample, 56 patients (76.7%) completed outcome surveys that assessed patient satisfaction, back-specific functioning, disability status, and physical and mental health functioning. While arthrodesis was achieved for most patients (84%), almost half were dissatisfied with their current back condition. Outcomes regarding disability and functioning were mixed. Arthrodesis was only moderately associated with better outcome and for a quite limited set of measure s. Three of the five presurgical variables (tobacco use, depression, and litigation) were consistently predictive of patient outcomes. Findings are discussed and compared to existing data on lumbar fusion procedures , and clinical implications for improved patient selection and possible interventions are highlighted. Consideration is given to the limitations of this study, such as retrospective design, no matched controls , and sample size. Directions for future research are suggested

The content of acoustic signals and biological effects of noise in conditions of high level of work intensity

BACKGROUND. Biological effects of noise depend on its physical parameters, combination with other hazards, the content of acoustic signals. This article aimed to analyze the difference in biological effects caused by the selection of nonverbal and verbal signals in conditions of a high level of work intensity. METHODS. Work conditions, physical characteristics of noise, levels of work intensity were studied among 75 telephone operators and 96 geophone operators. Levels of permanent hearing thresholds, evaluated by pure-tone audiometry, and results of self-estimation of operators' health were compared. The contribution of the content of acoustic signals in the shifting of hearing thresholds was evaluated by the one-way analysis of variance. RESULTS. Selection of acoustic signals in the noise background (&lt;65 dB), in conditions of high work intensity, causes a significant increase of permanent hearing thresholds in both studied groups comparing to the non-noise exposed population. Combination of the high level of work intensity and distinguishing of nonverbal acoustic messages leads to significant deterioration of health resulting in decreasing of hearing sensitivity and number of complaints on the state of health (p&lt;0.05). The content of acoustic signals significantly contributes to the biological effects of the nose. CONCLUSION. Obtained results testify necessity to revise safe criteria of noise levels for workers, engaged in selection, recognition and distinguishing of acoustic messages in the noise background combined with a high level of work intensity. In case when the energy of the acoustic field cannot be reduced, occupational safety measures should focus on decreasing of work intensity