The influence of work and treatment related factors on clinical status and disability in patients with non-specific work-related upper limb disorders

Objective: To assess the influence of work-and treatment-related factors on clinical status and functional disability in patients with non-specific work-related upper limb disorders (WRULD). Participants: 182 computer workers with non-specific WRULD, 18-50 years old, not having specific WRULD nor incomplete medical records. Methods: Retrospective cohort study among computer workers with non-specific WRULD; average follow-up 4 years. Medical records at time of diagnosis and during treatment period and a follow-up questionnaire were used. Setting: Outpatient department of Rehabilitation Medicine, University Hospital Maastricht. Outcome measures: Non-specific WRULD (clinical status) and Disabilities of Arm, Shoulder and Hand (DASH) at follow-up. Results: 103 patients (57%) returned the questionnaire. Of these, 14% developed a chronic pain syndrome, 9% recovered, 77% worsened slightly. None of the selected work-and treatment-related factors were significantly associated with clinical status. "Number of working hours per week before diagnosis" was negatively (b = -0.66, p = 0.00) and "other therapies during treatment" (b = 8.76, p = 0.02) positively associated with DASH. Conclusions: Computer workers with non-specific WRULD have a poor prognosis. Working more hours before diagnosis seems not predictive for disability while having undergone other therapies during treatment period does. Prospective cohort studies are recommended to unravel the associations found

Management of lung nodules detected by volume CT scanning

BACKGROUND The use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding on the best course of action when noncalcified pulmonary nodules are detected by CT. METHODS A total of 7557 participants underwent CT screening in years 1, 2, and 4 of a randomized trial of lung-cancer screening. We used software to evaluate a noncalcified nodule according to its volume or volume-doubling time. Growth was defined as an increase in volume of at least 25% between two scans. The first-round screening test was considered to be negative if the volume of a nodule was less than 50 mm(3), if it was 50 to 500 mm3 but had not grown by the time of the 3-month follow-up CT, or if, in the case of those that had grown, the volume-doubling time was 400 days or more. RESULTS In the first and second rounds of screening, 2.6% and 1.8% of the participants, respectively, had a positive test result. In round one, the sensitivity of the screen was 94.6% (95% confidence interval [CI], 86.5 to 98.0) and the negative predictive value 99.9% (95% CI, 99.9 to 100.0). In the 7361 subjects with a negative screening result in round one, 20 lung cancers were detected after 2 years of follow-up. CONCLUSIONS Among subjects at high risk for lung cancer who were screened in three rounds of CT scanning and in whom noncalcified pulmonary nodules were evaluated according to volume and volume-doubling time, the chances of finding lung cancer 1 and 2 years after a negative first-round test were 1 in 1000 and 3 in 1000, respectively. (Current Controlled Trials number, ISRCTN63545820.)