Return to Work after Traumatic Hand Injuries: Medical, Personal and Work-related Factors

PURPOSE This study aimed to examine the work-related impact of open hand injuries, specifically, the amount of lost work days subsequent to the injury and factors associated with work-related rehabilitation. PATIENTS AND METHODS We retrospectivley included consecutive patients with acute hand injuries who were operated between 2008 and 2009 in the Division of Hand Surgery (n=435) at the Department of Orthopaedic, Plastic and Hand Surgery. Information was obtained from the medical records and via a self-reported questionnaire sent out in 2011. Patients younger than 18 or older than 65 years, as well as the unemployed were excluded from the study. Descriptive group analysis was used to establish statistical relationships between time off work (TOW) and possible influencing variables. Multiple linear regression was applied to analyse the impact of injury, personal and/or work-related factors on TOW. RESULTS The sample included 290 patients with a mean age of 38.9 (SD 13.2) years of whom 98.6% returned to work after a median absence of 45.5 days. Univariate analysis demonstrated an association of length of absence from work with socio-demographic, clinical and work-related factors. Multiple regression analysis indicated that the location of injury, the number of injured regions, the need for secondary surgery, age, and the type of occupation were independently associated with TOW. CONCLUSION Most factors associated with TOW after traumatic hand injuries could not be influenced. Possible interventions should probably target improved injury prevention, optimal clinical treatment and rehabilitation starting early after injury. Whether improvements in communication and enhancement of cooperation between the treatment teams, the workplace and the insurance carrier may support a staged and earlier return to work remains to be investigated.

Transversal politics. Equality and difference in antiracist migrant protest

Transversale Politiken. Gleichheit und Differenz in antirassistischen migrantische Selbst-organisationen - Veronika Siegl Meine Arbeit beschäftigt sich mit transversalen Politiken in antirassistischen migrantischen Selbstorganisationen. Transversale Politik bezeichnet dabei eine Praxis der Zusammen-arbeit, die identitäre Kategorien zu überwinden versucht, aber Unterschiede zwischen einzelnen Personen oder Gruppen dennoch nicht negiert. Ausgangspunkt für meine Forschung ist insofern die Frage, wie MigrantInnen und MehrheitsösterreicherInnen gemeinsam über eine antirassistische Politik diskutieren und diese praktizieren können, ohne durch das Betonen von Differenz oder von Gleichheit rassistische Strukturen zu reproduzieren. Welche Strategien werden entwickelt? Wie wird mit Repräsentationsverhältnissen umgegangen? Gibt es ein kollektives „Wir“? Und: Was kann der Begriff MigrantIn für die politische Arbeit bedeuten? In Bezug auf die Fragen, die in der Ankündigung des Workshops aufgeworfen wurden, kann ich nach meinen Recherchen sagen, dass es in diesem Bereich noch relativ wenig Forschungen gibt. Schon allein zur antirassistischen Bewegung in Österreich gibt es sehr wenig Literatur, zu migrantischen Selbstorganisierungen noch weniger und zu Strategien transversaler Politik eigentlich gar nichts. Fragen der Differenz und Gleichheit werden im Allgemeinen oft nur auf einem sehr abstrakten Niveau geführt, empirische Erfahrungs-berichte, die einen Einblick geben, wie die Theorie in die Praxis umgesetzt werden kann, scheint es sehr wenig zu geben.

New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery.

Cystectomy and urinary diversion have high morbidity, and strategies to reduce complications are of utmost importance. Epidural analgesia and optimized fluid management are considered key factors contributing to successful enhanced recovery after surgery. In colorectal surgery, there is strong evidence that an intraoperative fluid management aiming for a postoperative zero fluid balance results in lower morbidity including a faster return of bowel function. Recently, a randomized clinical trial focusing on radical cystectomy demonstrated that a restrictive intraoperative hydration combined with a concomitant administration of norepinephrine reduced intraoperative blood loss, the need for blood transfusion and morbidity. The purpose of this review is to highlight specific anesthesiological aspects which have been shown to improve outcome after RC with urinary diversion.

CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.