Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome

Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure–response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure–response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed

A US hospital budget impact analysis of a skin closure system compared with standard of care in hip and knee arthroplasty

Kay Sadik,1 Jana Flener,2 Jeanine Gargiulo,3 Zachary Post,4 Steven Wurzelbacher,5 Andrew Hogan,6 Sarah Hollmann,6 Nicole Ferko6 1Ethicon Inc., Health Economics Market Access, Somerville, NJ, USA; 2Proliance Orthopedic Associates, Renton, WA, USA; 3Anderson Orthopaedic Clinic, Arlington, VA, USA; 4Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; 5Trihealth Orthopaedic and Sports Institute, Cincinnati, OH, USA; 6Cornerstone Research Group Inc., Burlington, ON, Canada Background: Medicare’s mandatory bundle for hip and knee arthroplasty necessitates provider accountability for quality and cost of care to 90 days, and wound closure may be a key area of consideration. The DERMABOND® PRINEO® Skin Closure System (22 cm) combines a topical skin adhesive with a self-adhering mesh without the need for dressing changes or suture or staple removal. This study estimated the budget impact of the Skin Closure System compared to other wound closure methods for hip and knee arthroplasty. Methods: A 90-day economic model was developed assuming 500 annual hip/knee arthroplasties for a typical US hospital setting. In current practice, wound closure methods for the final skin layer were set to 50% sutures and 50% staples. In future practice, this distribution shifted to 20% sutures, 20% staples, and 60% Skin Closure System. Health care resources included materials (eg, staplers, steri-strips, and traditional/barbed sutures), standard or premium dressings, outpatient visits, and home care visits. An Expert Panel, comprised of three orthopedic physician assistants, two orthopedic surgeons, and a home health representative, was used to inform several model parameters. Other inputs were informed by national data or literature. Unit costs were based on list prices in 2016 US dollars. Uncertainty in the model was explored through one-way sensitivity and alternative scenario analyses. Results: The analysis predicted that use of Skin Closure System in the future practice could achieve cost savings of $56.70 to$79.62 per patient, when standard or premium wound dressings are used, respectively. This translated to an annual hospital budgetary savings ranging from $28,349 to$39,809 when assuming 500 arthroplasties. Dressing materials and postoperative health care visits were key model drivers. Conclusions: Use of the Skin Closure System may provide cost savings within hip and knee arthroplasties due to decreases in resource utilization in the postacute care setting. Keywords: budget impact analysis, wound closure, knee arthroplasty, hip arthroplasty, hospital, economic, wound dressings, costs, postacute car

Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers

<p>Despite substantial financial and personnel resources being devoted to occupational exposure monitoring (OEM) by employers, workers' compensation insurers, and other organizations, the United States (U.S.) lacks comprehensive occupational exposure databases to use for research and surveillance activities. OEM data are necessary for determining the levels of workers' exposures; compliance with regulations; developing control measures; establishing worker exposure profiles; and improving preventive and responsive exposure surveillance and policy efforts. Workers' compensation insurers as a group may have particular potential for understanding exposures in various industries, especially among small employers. This is the first study to determine how selected state-based and private workers' compensation insurers collect, store, and use OEM data related specifically to air and noise sampling.</p> <p> Of 50 insurers contacted to participate in this study, 28 completed an online survey. All of the responding private and the majority of state-based insurers offered industrial hygiene (IH) services to policyholders and employed 1 to 3 certified industrial hygienists on average. Many, but not all, insurers used standardized forms for data collection, but the data were not commonly stored in centralized databases. Data were most often used to provide recommendations for improvement to policyholders. Although not representative of all insurers, the survey was completed by insurers that cover a substantial number of employers and workers. The 20 participating state-based insurers on average provided 48% of the workers' compensation insurance benefits in their respective states or provinces. These results provide insight into potential next steps for improving the access to and usability of existing data as well as ways researchers can help organizations improve data collection strategies. This effort represents an opportunity for collaboration among insurers, researchers, and others that can help insurers and employers while advancing the exposure assessment field in the U.S.</p

The Working Class Promise: A Communicative Account of Mobility-Based Ambivalences

In-depth interviews with 62 people with working class ties (blue-collar workers and adult sons and daughters of blue-collar workers) reveal a social construction of working class that imbues it with four core, positively valenced values: strong work ethic, provider orientation, the dignity of all work and workers, and humility. This constellation of values is communicated through a ubiquitous macrolevel discourse—which I coin the Working Class Promise—that elevates working class to the highest position in the social class hierarchy and fosters a strong commitment to maintain a working class value system and identity. However, this social construction is only a partial social construction. That is, these individuals do not question material, socioeconomic-based delineations of class boundaries (e.g., income, education level, occupational prestige). Consequently, their acceptance of structural class boundaries, combined with their high regard of working class values, positions social classes in ways that make the goals of the American Dream (i.e., class mobility) and the Working Class Promise (i.e., class maintenance) paradoxical. I argue that the paradox of social mobility that results from this partial social construction is the root of mobility-based ambivalences