scholarly journals LO95: A prospective evaluation of mild traumatic brain injuries in a working population in Edmonton, AB

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S61
Author(s):  
L. Gaudet ◽  
L. Eliyahu ◽  
J. Lowes ◽  
J. Beach ◽  
M. Mrazik ◽  
...  
Keyword(s):  
Return To Work ◽  
Attention Deficit Disorder ◽  
Brain Injuries ◽  
Work Outcomes ◽  
Continuous Variables ◽  
Chi Square ◽  
Work Related ◽  
Persistent Symptoms ◽  
History Of

Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergency department (ED); however, wide variation in diagnosis and management has been demonstrated in this setting. Sub-optimal mTBI management can contribute to post-concussion syndrome (PCS), affecting vocational outcomes like return to work. This study documented the work-related events, ED management, discharge advice, and outcomes for employed patients presenting to the ED with mTBI. Methods: Adult (>17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score ≥13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls ascertained outcomes, including symptoms and their severity, advice received in the ED, and adherence to discharge instructions, at 30 and 90 days after ED discharge. Dichotomous variables were analyzed using chi-square testing; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Work-related injury and return to work outcomes were modelled using logistic or linear regression, as appropriate. Results: Overall, 250 patents were enrolled; 172 (69%) were employed at the time of their injury and completed at least one follow-up. The median age was 37 years (interquartile range [IQR]: 24, 49.5), both sexes were equally represented (48% male), and work-related concussions were uncommon (16%). Work-related concussion was related to manual labor jobs and self-reported history of attention deficit disorder. Patients often received advice to avoid sports (81%) and/or work (71%); however, the duration of recommended time off varied. Most employed patients (80%) missed at least one day of work (median=7 days; IQR: 3, 14); 91% of employees returned to work by 90 days, despite 41% reporting persistent symptoms. Increased days of missed work were linked to divorce, history of sleep disorder, and physician’s advice to avoid work. Conclusion: While work-related concussions are uncommon, most employees who sustain a mTBI at any time miss some work. Many patients experience mTBI symptoms past 90 days, which has serious implications for workers’ abilities to fulfill their work duties and risk of subsequent injury. Workers, employers, and the workers compensation system should take the necessary precautions to ensure that workers return to work safely and successfully following a concussion.

scholarly journals Workers’ recovery from concussions presenting to the emergency department

2019 ◽  
Vol 69 (6) ◽  
pp. 419-427 ◽  
Author(s):  
L A Gaudet ◽  
L Eliyahu ◽  
J Beach ◽  
M Mrazik ◽  
G Cummings ◽  
...  
Keyword(s):  
Emergency Department ◽  
Return To Work ◽  
Patient Adherence ◽  
Point Of Care ◽  
Post Concussion Syndrome ◽  
Work Related ◽  
Hyperactivity Disorder ◽  
Persistent Symptoms ◽  
Modifiable Factors ◽  
History Of

AbstractBackgroundThe emergency department (ED) is the first point of care for many patients with concussion, and post-concussion syndrome can impact vocational outcomes like successful return to work. Evaluation of concussion in general adult populations is needed.AimsTo document the occurrence and outcomes of work-related concussion presenting to the ED for treatment.MethodsThis study enrolled adults presenting with concussion to three urban Canadian EDs. Baseline ED interviews, physician questionnaires and patient phone interviews at 30 and 90 days documented work-related events, ED management, discharge advice, patient adherence and symptom severity. Work-related injury and return to work were modelled using logistic or linear regression, as appropriate.ResultsOverall, 172 enrolled workers completed at least one follow-up. Work-related concussions were uncommon (n = 28). Most employees (80%) missed at least 1 day of work (median = 7; interquartile range: 3–14). Most (91%) employees returned to work within 90 days, while 41% reported persistent symptoms. Manual labour and self-reported history of attention deficit hyperactivity disorder were associated with work-related concussion, while days of missed work increased with marital status (divorced), history of sleep disorder and physician’s advice to avoid work.ConclusionWork-related concussions are infrequent; however, most workers who sustain a concussion will miss work, and many return while still experiencing symptoms. Work-related concussion and days of missed work are mainly affected by non-modifiable factors. Workers, employers and the workers’ compensation system should take necessary precautions to ensure that workers return to work safely and successfully following a concussion.

Malignant thyroid teratoma: an integrated analysis of case series and case reports

2021 ◽  
Author(s):  
Huy Gia Vuong ◽  
Truong P.x. Nguyen ◽  
Hanh T.t. Ngo ◽  
Lewis Hassell ◽  
Kennichi Kakudo
Keyword(s):  
Clinical Course ◽  
Case Reports ◽  
Case Series ◽  
Seer Program ◽  
Integrated Analysis ◽  
Continuous Variables ◽  
Chi Square ◽  
Large Tumor ◽  
Exact Test

Malignant thyroid teratoma (MTT) is a very rare thyroid malignancy. These neoplasms have been reported only in case reports and small-sized case series so far. In this study, we searched for MTTs in the Surveillance, Epidemiology, and End Result (SEER) program during 1975-2016. Subsequently, we incorporated the SEER data with published MTT cases in the literature to analyze the characteristics and prognostic factors of MTTs. Integrated data were analyzed using Chi-square or Fisher’s exact test for categorical covariates, and t-test or Mann-Whitney test for continuous variables. We included 28 studies with 36 MTT cases and found additional 8 cases from the SEER program for final analyses. Our results showed that MTT is typically seen in adult females. These neoplasms were associated with an aggressive clinical course with high rates of extrathyroidal extension (80%) and nodal involvement (62%). During follow-up, the development of recurrence and metastases were common (42% and 46%, respectively), and one-third of patients died at the last follow-up. Large tumor size (p = 0.022) and the presence of metastases during follow-up (p = 0.008) were associated with a higher mortality rate. In conclusion, our study demonstrated the characteristic features of MTT patients and outlined some parameters associated with a negative outcome which could help clinicians better predict the clinical course of these neoplasms.

scholarly journals 1313. Complementary Effects of Medical Follow-up and Virologic Suppression for Reincarcerated Inmates Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S474-S474
Author(s):  
Melissa E Badowski ◽  
R Kane Stafford ◽  
Brian W Drummond ◽  
Thomas D Chiampas ◽  
Sarah M Michienzi ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Management Support ◽  
Chi Square ◽  
History Of ◽  
Secondary Endpoints ◽  
Living With Hiv ◽  
Hiv 1

Abstract Background Although prison presents an opportunity to achieve virologic suppression (VS) among people living with HIV, continued success is not guaranteed upon release. Methods A retrospective cohort study was performed in reincarcerated Illinois prisoners from January 1, 2016 to July 31, 2018. Patients were included if they were age ≥18 years, carried a diagnosis of HIV/AIDS, on antiretroviral therapy (ART) at the time of release, and had CD4 and HIV-1 RNA labs drawn within 6 months of release and reincarceration. Potential subjects were excluded if reincarcerated within 30 days due to a technical violation and not receiving ART at the time of prison release. Primary and secondary endpoints were percent of patients achieving VS upon reincarceration and percent of patients following at an HIV clinic while released. Statistical analysis included descriptive statistics, chi-square, and paired t-tests. Results Among 505 patients released during the study period, 95 patients were reincarcerated and 80 were included (Figure 1). Demographic information can be found in Table 1. Fifty-one patients (64%) reported follow-up at an HIV clinic while released, whereas 29 (36%) did not. Patients who had VS at the time of prison release were more likely to make their follow-up appointment (90%) compared with those who did not (69%) (P < 0.001). In addition, patients making their follow-up appointment were also more likely to have VS at the time of reincarceration (86% vs. 10%, P < 0.001). Recidivist patients adherent to ART were less likely to experience decreases in mean CD4 count (P = 0.03) (Table 2). Subjects reporting a history of substance use were more likely not to re-engage in post-release HIV care (P = 0.001), but no difference was noted in patients with a documented psychiatric history (P = 0.2). Conclusion Patients failing to meet VS at the time of prison release should be targeted for more intensive re-entry medical and case management support to ensure adherence to follow-up and maintenance of immunologic function. Disclosures All authors: No reported disclosures.

scholarly journals Two-Month Follow-up of Persons with SARS-CoV-2 Infection: Zambia, September 2020

2021 ◽  
Author(s):  
James Exnobert Zulu ◽  
Dabwitso Banda ◽  
Jonas Z Hines ◽  
Musisye Luchembe ◽  
Suilanji Sivile ◽  
...  
Keyword(s):  
Symptom Duration ◽  
Upper Respiratory Tract ◽  
Chi Square ◽  
Duration Of Symptoms ◽  
Prevalence Studies ◽  
Persistent Symptoms ◽  
Contact Information ◽  
Upper Respiratory ◽  
Structured Questionnaire

Background COVID-19 is often characterized by an acute upper respiratory tract infection. However, information on longer-term clinical sequelae following acute COVID-19 is emerging. We followed a group of persons with COVID-19 in Zambia at two months to assess persistent symptoms. Methods In September 2020, we re-contacted participants from SARS-CoV-2 prevalence studies conducted in Zambia in July 2020 whose PCR tests were positive. Participants with valid contact information were interviewed using a structured questionnaire that captured demographics, pre-existing conditions, and types and duration of symptoms. We describe the frequency and duration of reported symptoms and used chi-square tests to explore variability of symptoms by age group, gender, and underlying conditions. Results Of 302 participants, 155 (51%) reported one or more acute COVID-19-related symptoms in July 2020. Cough (50%), rhinorrhoea (36%) and headache (34%) were the most frequently reported symptoms proximal to diagnosis. The median symptom duration was 7 days (IQR: 3-9 days). At a median follow up of 54 days (IQR: 46-59 day), 27 (17%) symptomatic participants had not yet returned to their pre-COVID-19 health status. These participants most commonly reported cough (37%), headache (26%) and chest pain (22%). Age, sex, and pre-existing health conditions were not associated with persistent symptoms. Conclusion A notable percentage of persons with SARS-CoV-2 infection in July still had symptoms nearly two months after their diagnosis. Zambia is implementing post-acute COVID-19 clinics to care for patients with prolonged symptoms of COVID-19, to address their needs and better understand how the disease will impact the population over time.

scholarly journals A Longitudinal SARS-CoV-2 Biorepository for COVID-19 Survivors with and without Post-Acute Sequelae

2021 ◽  
Author(s):  
Stephanie M LaVergne ◽  
Stromberg Sophia ◽  
Bridget A Baxter ◽  
Tracy L Webb ◽  
Taru S Dutt ◽  
...  
Keyword(s):  
Demographic Data ◽  
Acute Infection ◽  
Exercise Intolerance ◽  
Future Research ◽  
Clinical Trial Registration ◽  
Targeted Interventions ◽  
Persistent Symptoms ◽  
Northern Colorado ◽  
History Of

Abstract BackgroundSARS-CoV-2 has swept across the globe, causing millions of deaths worldwide. Though most survive, many experience symptoms of COVID-19 for months after acute infection. Successful prevention and treatment of acute COVID-19 infection and its associated sequelae is dependent on in-depth knowledge of viral pathology across the spectrum of patient phenotypes and physiologic responses. Longitudinal biobanking provides a valuable resource of clinically integrated, easily accessed, and quality-controlled samples for researchers to study differential multi-organ system responses to SARS-CoV-2 infection, post-acute sequelae of COVID-19 (PASC), and vaccination. MethodsAdults with a history of a positive SARS-CoV-2 nasopharyngeal PCR are actively recruited from the community or hospital settings to enroll in the Northern Colorado SARS-CoV-2 Biorepository (NoCo-COBIO). Blood, saliva, stool, nasopharyngeal specimens, and extensive clinical and demographic data are collected at 4 time points over 6 months. Patients are assessed for PASC during longitudinal follow-up by physician led symptom questionnaires and physical exams. This clinical trial registration is NCT05603677.ResultsWe have enrolled and collected samples from 119 adults since July 2020, with 66% follow-up rate. Forty-nine percent of participants assessed with a symptom surveillance questionnaire (N=37 of 75) had PASC at any time during follow-up (up to 8 months post infection). Ninety-three percent of hospitalized participants developed PASC, while 23% of those not requiring hospitalization developed PASC. At 90-174 days post SARS-CoV-2 diagnosis, 67% of all participants had persistent symptoms (N=37 of 55), and 85% percent of participants who required hospitalization during initial infection (N=20) still had symptoms. The most common symptoms reported after 15 days of infection were fatigue, loss of smell, loss of taste, exercise intolerance, and cognitive dysfunction. ConclusionsPatients who were hospitalized for COVID-19 were significantly more likely to have PASC than those not requiring hospitalization, however 23% of patients who were not hospitalized also developed PASC. This patient-matched, multi-matrix, longitudinal biorepository from COVID-19 survivors with and without PASC will allow for current and future research to better understand the pathophysiology of disease and to identify targeted interventions to reduce risk for PASC. Registered 27 October 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04603677.

scholarly journals Liposuction in Cancer‐Related Lower Extremity Lymphedema: An Investigative Study For Clinical Applications

2021 ◽  
Author(s):  
Jianfeng Xin ◽  
Yuguang Sun ◽  
Song Xia ◽  
Kun Chang ◽  
Chao Dong ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Subcutaneous Fat ◽  
Operation Time ◽  
Chi Square ◽  
Patients With Cancer ◽  
Therapeutic Outcomes ◽  
Lower Volume ◽  
History Of ◽  
Hemorrhage Volume

Abstract Background: Lymphedema is a progressive, noncurable condition consisting of increases in subcutaneous fat and interstitial fluid in the limbs and fibrosis during later stages. The disease most commonly affects the limbs because of injury to or removal of lymph nodes. The aim of this study was to investigate therapeutic outcomes of liposuction for cancer-related lower extremity lymphedema.Methods: 62 patients with cancer-related lymphedema in unilateral lower extremity were recruited in this study, and all the patients underwent liposuction. The volume of hemorrhage and lipid, the operation time, and the volume changes of the affected extremity were compared by applying t-test, and the subjective feelings of patients were also assessed by applying Chi-square. Results: Total lipid volume is (2539±1253.5) ml, and the hemorrhage volume is (828±311.8) ml during liposuction. For the comparison of objective indexes, (1) Percent volume differences(PVDs) before surgery, in-operation and 3-month follow-up were (5.5±12.2 Vs. 11.6±18.4 Vs. 43.2±23.7, P＜0.05) respectively. (2) Higher lipid volume and liposuction rate for female patients, with a lower volume of hemorrhage. (3) Higher volume of hemorrhage in patients with a history of recurrent erysipelas. (4) Higher lipid volume and liposuction rate(LR), with lower hemorrhage for stage II than stage III patients. Conclusions: Liposuction is an effective therapy for cancer-related lower extremity lymphedema. Gender, stage and recurrent erysipelas history influence the course and effect of liposuction.

scholarly journals The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

2021 ◽  
Vol 18 (21) ◽  
pp. 11504
Author(s):  
Elise M. Gane ◽  
Melanie L. Plinsinga ◽  
Charlotte L. Brakenridge ◽  
Esther J. Smits ◽  
Tammy Aplin ◽  
...  
Keyword(s):  
Sick Leave ◽  
Road Traffic ◽  
Musculoskeletal Injury ◽  
Musculoskeletal Injuries ◽  
Work Outcomes ◽  
Traffic Crashes ◽  
Road Traffic Crashes ◽  
Work Related ◽  
The Impact

Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.

Short Paper: Risk Factors for Long-Term Persistent Symptoms in COVID-19 in an Outpatient Cohort (Preprint)

2020 ◽  
Author(s):  
James O'Keefe ◽  
Ghazala A Datoo O’Keefe ◽  
Anthony Mufarreh
Keyword(s):  
Risk Factors ◽  
Categorical Variables ◽  
Short Paper ◽  
Symptom Duration ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Persistent Symptoms ◽  
Long Term Follow Up

BACKGROUND Symptom descriptions in outpatients with COVID-19 are limited to cross-sectional surveys and longitudinal follow-up of long term symptoms has not been reported. Symptom duration is important for patient and provider knowledge in managing outpatient COVID-19. OBJECTIVE Describe the presence of symptoms at long term follow-up of patients managed in an outpatient telemedicine program for acute COVID-19. METHODS Chart review of clinical notes for acute COVID-19 and long term follow-up calls. Descriptive analysis were conducted using Wilcoxon rank-sum for continuous variables and chi-square or Fisher’s Exact as appropriate for categorical variables. RESULTS Minor symptoms were reported by 55 patients (34.8%) and 7 (4.4%) reported major ongoing symptoms at follow-up call. Factors associated with prolonged symptoms include older age, provider reported higher symptom severity at intake visit, and BMI >30. Symptoms which persisted include shortness of breath on exertion, wheeze, nausea, and joint pain. CONCLUSIONS Persistence of symptoms after acute COVID-19 in outpatients is common. Risk factors may help predict which patients are more likely to have prolonged symptoms.

Prognostic implication of KIT mutations in melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9049-9049
Author(s):  
Katherine G. Roth ◽  
Emily C. Zabor ◽  
Marta N. Colgan ◽  
Jedd D. Wolchok ◽  
Paul B. Chapman ◽  
...  
Keyword(s):  
Cox Regression ◽  
Chi Square ◽  
Risk Of Death ◽  
Disease Characteristics ◽  
Kaplan Meier ◽  
Increased Risk ◽  
History Of ◽  
Genetic Subgroup ◽  
Prognostic Implications

9049 Background: The natural history of BRAF and NRAS mutant (mut) melanoma (mel) has been described, but prognostic implications of KIT mut mel have not. Methods: We performed a single-center retrospective review of 180 patients (pts) enriched for mucosal, acral or chronic sun-damaged skin (CSD) mel and screened for KIT, BRAF, and NRAS mut from 4/07 - 4/10 as a part of a phase II imatinib study. Pt/disease characteristics were compared using the Kruskal-Wallis or Chi-square tests. Factors associated with outcomes were assessed by Kaplan-Meier methods and multivariable Cox regression. Results: Median age, 63.7 years; 54.4% male. Primary site: 40% mucosal, 29% acral, 22% CSD, 9% others. Mut rate: 18% KIT, 16% BRAF, 14% NRAS, 52% wild-type (wt). Pathologic subtype differed by genetic subgroup (p<.001) while age, gender, and stage did not (all p>0.05). 18/26 (69%) KIT mut pts received imatinib in the metastatic (met) setting; 6/18 received > 1 other KIT inhibitor. 3/25 (12%) BRAF mut pts received vemurafenib. 8/27 (30%) KIT mut, 4/27 (15%) BRAF mut, 6/20 (30%) NRAS mut, and 6/20 (30%) wt pts received ipilimumab. 149/180 (83%) pts developed mets at a median of 2.15 years (95% CI: 1.72, 2.72). Median follow-up (FU) of pts not developing mets was 3.91 yrs (range: 0.25, 14.34). Older age (HR: 1.02, 95% CI: 1.00, 1.03) and pathologic subtype (mucosal vs CSD HR: 1.70, 95% CI: 1.02, 2.84; non-CSD/unknown vs CSD HR: 2.05, 95% CI: 1.00, 4.21) were associated with increased risk of mets but not with time from mets to death. Of 149 pts who progressed, 123 (83%) died during FU. Median time from met to death was 1.21 years (95% CI: 0.91, 1.67). Median FU from time of mets among those alive at last FU was 2.53 yrs (range: 0.06, 6.85). Mut status including KIT mut was not associated with time to first met or time from met to death. Pts who received ipilimumab from time of first distant met had reduced risk of death (HR: 0.55, 95% CI: 0.36, 0.87) independent of mut status. No impact was observed with KIT inhibition. Conclusions: KIT mut status is not an independent predictor of time to mets or survival in pts with mets. Ipilimumab improved pt outcomes regardless of mut status. The lack of impact of KIT inhibitors is likely due to the heterogeneity of KIT mut in mel but does not preclude efficacy in appropriately selected pts.

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