To determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students’ write-ups.
The authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students’ clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means. Teachers in the portfolio group provided feedback directly on the student’s write-up using a web-based application. Teachers in the control group provided feedback directly on the student’s write-up by writing in the margins of the paper. Outcomes were teacher and student assessment of the frequency and quality of feedback on write-ups, expert assessment of the quality of student write-ups at the end of the clerkship, and participant assessment of the value of the electronic portfolio system.
Teachers reported giving more frequent and detailed feedback using the portfolio system (p = 0.01). Seventy percent of students who used the portfolio system, versus 39% of students in the control group (p = 0.001), reported receiving feedback on more than half of their write-ups. Write-ups of portfolio students were rated of similar quality to write-ups of control students. Teachers and students agreed that the system was a valuable teaching tool and easy to use.
An electronic clinical portfolio that automatically collects students’ clinical notes is associated with improved teacher feedback on write-ups and similar quality of write-ups.
portfolio; feedback; medical education
Sickness certification constitutes daily clinical practice for GPs. In April 2010, the UK sickness certification system changed to reflect the evidence that work is generally good for health and a new Statement of Fitness for Work — the ‘fit note’ — was introduced. Sickness certification is a contentious topic among GPs and the proposed fit note generated mixed reviews.
To explore GPs' views and use of the fit note during its first year of operation.
Design and setting
Qualitative interview study of GPs based in different geographical locations across the UK.
GPs (n = 15), who were recruited from a national sample, participated in semi-structured telephone interviews which were subject to constant comparative analysis.
Overall, the fit note was well received. GPs recognised that work is generally good for health and felt the fit note facilitated using an earlier return to work as a negotiation tool. GPs perceive employers as the major obstacle to early return to work. There were reports of scepticism towards the system that negatively impacted on some GPs' operation of sickness certification. Feedback over the fit note's impact on employer behaviour and the return of a mechanism that enables GPs to request early independent assessments would be welcomed.
A revised approach is needed to address the scepticism towards the sickness certification system that persists among some GPs. New strategies need to be designed to engage employers in facilitating an early return to work and to enable the objectives of the medical statement reforms to be achieved.
general practice; health policy; qualitative research; sick leave; sickness certification
The Department for Work and Pensions (DWP) has designed a trial medical statement.
To compare fitness for work assessment outcomes and written advice across current and trial medical statements. To examine the use of and suggestions to improve the trial medical statement.
Design of study
Comparative study with a two-way mixed design using questionnaire-based vignettes presenting GPs with three hypothetical sick leave cases (back pain, depression, combined back pain and depression) and medical statements (current or trial). The questionnaire also gathered GP views of using the trial Med 3.
Nine primary care organisations (PCOs) in England, Scotland, and Wales.
Five hundred and eighty-three GPs employed in PCOs in summer 2008 were randomised to receive a current or trial Med 3 postal questionnaire. GPs assessed vignette patients' fitness for work using the questionnaire medical statements.
GPs using the trial Med 3 were less likely to advise refraining from work and more likely to provide written fitness for work advice compared to GPs using the current Med 3 form. Date sections of the trial Med 3 were used inconsistently, and a return to work date was unclear. GPs wanted further clarification of the implications of assessing a case as ‘fit for some work’ and its relationship to employers' willingness to follow GP advice about work.
The study indicates a revised form may reduce the number of patients advised to refrain from work and increase the provision of written fitness for work information.
back pain; depression; family; employment; physicians; sick leave
Staying in work may benefit patients with chronic pain, but can be difficult for GPs to negotiate with patients and their employers. The new fit note is designed to help this process, but little is known of how it is operating.
To explore GPs' views on the fit note, with particular reference to sickness certification for patients with chronic pain.
Design and setting
Qualitative study using semi-structured interviews in eight primary care trusts in south-west England.
In-depth interviews with 13 GPs.
GPs reported that the rationale behind the fit note is sound and that it may help patients with chronic pain to return to work earlier. However, GPs also reported barriers to successful fit note use, including the need to preserve doctor–patient relationships, inconsistent engagement from employers, GPs' lack of specialist occupational health knowledge, issues with fit note training, and whether a new form can achieve cultural shift.
While doctors agree that good work improves health outcomes, they do not think that fit notes will greatly alter sickness-certification rates without more concerted initiatives to manage the tripartite negotiation between doctor, patient, and employer.
chronic disease; general practice; pain; sick leave
One of the best opportunities that undergraduates have to learn to write like a scientist is to write a thesis after participating in faculty-mentored undergraduate research. But developing writing skills doesn't happen automatically, and there are significant challenges associated with offering writing courses and with individualized mentoring. We present a hybrid model in which students have the structural support of a course plus the personalized benefits of working one-on-one with faculty. To optimize these one-on-one interactions, the course uses BioTAP, the Biology Thesis Assessment Protocol, to structure engagement in scientific peer review. By assessing theses written by students who took this course and comparable students who did not, we found that our approach not only improved student writing but also helped faculty members across the department—not only those teaching the course—to work more effectively and efficiently with student writers. Students who enrolled in this course were more likely to earn highest honors than students who only worked one-on-one with faculty. Further, students in the course scored significantly better on all higher-order writing and critical-thinking skills assessed.
Idiosyncrasies are the expression of abnormal mental or physical reaction towards “agents.” An attempt is made to indicate the position of idiosyncrasies in a classified scheme of all abnormalities; but bodily idiosyncrasies due to an “allergic” or hypersensitive response to agents are mainly considered in the present paper. Migraine and mucous colic (“colitis mucosa”) are discussed in connexion with Freeman's view of food idiosyncrasies, hay fever, asthma, urticaria, angioneurotic œdema, &c., as manifestations of an “immunological abnormality or defect.”
The hypothesis that idiosyncratic hypersensitiveness towards physical agents, such as light, heat, cold and mechanical trauma, may in reality be the expression of reaction towards a histamine-like body, or protein of some kind (virtually a “foreign protein”) liberated in the tissues by the physical agent in question, is referred to, according to the works of W. W. Duke and Sir Thomas Lewis and his co-workers, and the writings of Sir Humphry Rolleston on the subject. A somewhat analogous explanation is suggested for the following conditions: an abnormally hypersensitive (eczema-like) reaction towards formalin lotions; epidermolysis bullosa; constitutional factitious urticaria in otherwise healthy individuals not suffering from ordinary urticaria; excessive liability to chilblains; so-called “erythrocyanosis” of the lower parts of the legs in girls and young women, and some cases of Raynaud's disease.
The significance of eosinophilia in cases of dermatitis herpetiformis and pemphigus is also alluded to.
Laparoscopic cholecystectomy (LC) is the most performed minimal invasive surgical procedure and has a relatively high complication rate. As complications are often revealed postoperatively, clear, accurate, and timely written operative notes are important in order to recall the procedure and start follow-up treatment as soon as possible. In addition, the surgeon’s operative notes are important to assure surgical quality and communication with other healthcare providers. The aim of the present study was to assess compliance with the Dutch guidelines for writing operative notes for LC.
Nine hospitals were asked to send 20 successive LC operative notes. All notes were compared to the Dutch guideline by two reviewers and double-checked by a third reviewer. Statistical analyses on the “not described” items were performed.
All hospitals participated. Most notes complied with the Dutch guideline (52–69%); 19–30% of items did not comply. Negative scores for all hospitals were found, mainly for lacking a description of the patient’s posture (average 69%), bandage (94%), blood loss (98%), name of the scrub nurse (87%), postoperative conclusion (65%), and postoperative instructions (78%). Furthermore, notes from one community hospital and two teaching hospitals complied significantly less with the guidelines.
Operative notes do not always fully comply with the standards set forth in the guidelines published in the Netherlands. This could influence adjuvant treatment and future patient treatment, and it may make operative notes less suitable background for other purposes. Therefore operative note writing should be taught as part of surgical training, definitions should be provided, and procedure-specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.
Litière et al. (2007) presented the results of simulation studies that they claimed showed that misspecification of the shape of the random effects distribution can produce marked increases in Type II error (decreases in power) of tests based on fits of generalized linear mixed models. However, the paper contains a logical fallacy that invalidates this claim. We present logically correct simulation studies that demonstrate little increase in Type II error, consistent with the earlier work that shows little effect due to misspecification.
Conditional likelihood; generalized linear mixed models; misspecified random effect distributions; power
Reflective practice may help physicians identify and connect with what they value and find meaningful in their work. There are many practical obstacles in teaching narrative skills and reflection to residents in surgical subspecialties. We aimed to assess the feasibility of designing and implementing a writing workshop series within an obstetrics and gynecology curriculum.
Materials and Methods
Between 2008 and 2009, a reflective writing workshop series was introduced into the didactic curriculum of an obstetrics and gynecology residency program. The course included reading fiction and creative writing. Workshops focused on topics residents identified. Residents answered a subjective questionnaire and also completed the Maslach Burnout Inventory and Interpersonal Reactivity Index to assess burnout and empathy.
Six 1-hour reflective writing workshops took place within the dedicated didactic time for residents. Of the 20 residents in the program, 10 junior residents and 8 senior residents evaluated the workshops. Ten residents participated in more than one workshop, an average of 3.6 workshops. Residents felt that the workshops were enjoyable, and some felt that they influenced their experience of residency, but few felt that it affected their work with patients. Trends in Maslach Burnout Inventory and Interpersonal Reactivity Index scores did not show statistical significance.
A practical curriculum for introducing reflective practice to obstetrics and gynecology residents is described. This model may be useful to educators looking to incorporate reflective practice into residency curricula and lead to collaborative work that may assess the impact of this work on the experience of residents and their patients.
Mental fitness for work is the ability of workers to perform their work without risks for themselves or others. Mental fitness was a neglected area of practice and research. Mental ill health at work seems to be rising as a cause of disablement. Psychiatrists who may have had no experience in relating mental health to working conditions are increasingly being asked to undertake these examinations. This research was done to explore the relationship of mental ill health and fitness to work and to recognize the differences between fit and unfit mentally ill patients.
This study was cross sectional one. All cases referred to Al-Amal complex for assessment of mental fitness during a period of 12 months were included. Data collected included demographic and clinical characteristics, characteristics of the work environment and data about performance at work. All data was subjected to statistical analysis.
Total number of cases was 116, the mean age was 34.5 ± 1.4. Females were 35.3% of cases. The highly educated patients constitute 50.8% of cases. The decision of the committee was fit for regular work for 52.5%, unfit for 19.8% and modified work for 27.7%. The decision was appreciated only by 29.3% of cases. There were significant differences between fit, unfit and modified work groups. The fit group had higher level of education, less duration of illness, and better performance at work. Patients of the modified work group had more physical hazards in work environment and had more work shift and more frequent diagnosis of substance abuse. The unfit group had more duration of illness, more frequent hospitalizations, less productivity, and more diagnosis of schizophrenia.
There are many factors affecting the mental fitness the most important are the characteristics of work environment and the most serious is the overall safety of patient to self and others. A lot of ethical and legal issues should be kept in mind during such assessment as patient's rights, society's rights, and the laws applied to unfit people.
A description of the fitness, physical activity of lifestyle, and some aspects of health status and attitudes in a population of male factory workers aged 35-60 is presented as the first part of a report on a study of morbidity in this population. A total of 1394 subjects were included, undergoing medical examination, fitness testing by bicycle ergometry, assessment of body fat, and interview questionnaire. The inter-relation of fitness, body composition, habitual exertion, health risk factors, and attitudes to exercise are discussed. Fitness levels are compared with those reported in other studies and discussed in terms of capacity for walking and running and in relation to criteria for health benefit. In these two latter respects fitness appears to be inadequate among the great majority of those tested, although it is comparable with that reported by several other recent studies. Fitness is associated with physical activity of leisure but not that of work. Only relatively strenuous physical activity in leisure time appears to be related to fitness, and is only participated in by some 28% of the sample. Cycling has the strongest association with fitness of all the physical activity variables. Blood pressure and percentage body fat are also associated, inversely, with fitness, the latter not unexpectedly because of the weight related measure of fitness.
Writing a meaningful and valuable letter of reference is not an easy task. Several factors influence the quality of any letter of reference. First, the accuracy and reliability of the writer's impressions and judgment depend on how well he knows the individual being described. Second, the writer's frame of reference, which is determined by the number of persons at the same level that he has worked with, will impact the context and significance of his beliefs and estimations. Third, the letter-writing skills of the person composing the letter will naturally affect the letter. To support the other components of a candidate's application, a letter of reference should provide specific examples of how an individual's behavior or attitude compares to a reference group and should assess “intangibles” that are hard to glean from a curriculum vitae or from test scores. This report offers suggestions that should help physicians write more informative letters of reference.
references; letter of reference; evaluation; writing
Scholars have not fully theorized the multifaceted, interdependent dimensions within the work-family “black box.” Taking an ecology of the life course approach, we theorize common work-family and adequacy constructs as capturing different components of employees' cognitive appraisals of fit between their demands and resources at the interface between home and work. Employees' appraisals of their work-family linkages and of their relative resource adequacy are not made independently but, rather, co-occur as identifiable constellations of fit. The life course approach hypothesizes that shifts in objective demands/ resources at work and at home over the life course result in employees experiencing cycles of control, that is, corresponding shifts in their cognitive assessments of fit. We further theorize patterned appraisals of fit are key mediators between objective work-family conditions and employees' health, well-being and strategic adaptations. As a case example, we examine whether employees' assessments on ten dimensions cluster together as patterned fit constellations, using data from a middle-class sample of 753 employees working at Best Buy's corporate headquarters. We find no single linear construct of fit that captures the complexity within the work-family black box. Instead, respondents experience six distinctive constellations of fit: one optimal, two poor, and three moderate fit constellations.
The Nintendo Wii Fit was released just over five years ago as a means of improving basic fitness and overall well-being. Despite this broad mission, the Wii Fit has generated specific interest in the domain of neurorehabilitation as a biobehavioral measurement and training device for balance ability. Growing interest in Wii Fit technology is likely due to the ubiquitous nature of poor balance and catastrophic falls, which are commonly seen in older adults and various disability conditions. The present review provides the first comprehensive summary of Wii Fit balance research, giving specific insight into the system’s use for the assessment and training of balance. Overall, at the time of the fifth anniversary, work in the field showed that custom applications using the Wii Balance Board as a proxy for a force platform have great promise as a low cost and portable way to assess balance. On the other hand, use of Wii Fit software-based balance metrics has been far less effective in determining balance status. As an intervention tool, positive balance outcomes have typically been obtained using Wii Fit balance games, advocating their use for neurorehabilitative training. Despite this, limited sample sizes and few randomized control designs indicate that research regarding use of the Wii Fit system for balance intervention remains subject to improvement. Future work aimed at conducting studies with larger scale randomized control designs and a greater mechanistic focus is recommended to further advance the efficacy of this impactful neurorehabilitation tool.
Postural control; Interventions; Training; Virtual reality; Evaluation
The anterior cruciate ligament (ACL) consists of two bundles, the anteromedial (AM) and posterolateral bundle (PM). Double bundle reconstructions appear to give better rotational stability. The usual technique is to make two tunnels in the femur and two in the tibia. This is difficult and in small knees may not even be possible. We have developed a foreign material free press fit fixation for double bundle ACL reconstruction using a single femoral tunnel (R). This is based on the ALL PRESS FIT ACL reconstruction. It is suitable for the most common medium and, otherwise difficult, small sizes of knees.
Using diamond edged wet grinding hollow reamers, bone cylinders in different diameters are harvested from the implantation tunnels of the tibia and femur and used for the press fit fixation. Using the press fit technique the graft is first fixed in tibia. It is then similarly fixed under tension in the femoral side with the knee in 120 degree flexion. This is called Bottom To Top Fixation (BTT). On extending the knee the graft tension is self adapting. Depending on the size of the individual knee, the diameter of the femoral bone plug is varied from 8 to 13 mm to achieve an anatomic spread with a double bundle-like insertion. The tibia tunnel can be applied with two 7 or 8 mm diameter tunnels overlapping to a semi oval tunnel between 10 to 13 mm.
Since May 2003 we have carried out ACL-reconstructions with Hamstring grafts without foreign material using the ALL PRESS FIT technique. Initially, an 8 mm press fit fixation was used proximally with good results. Since April 2008, the range of diameters was increased up to 13 mm. The results of the Lachman tests have been good to excellent. Results of the Pivot shift test suggested more stability with femoral broader diameters of 9,5 to 13 mm.
The foreign material free fixation of ham-string in the ALL PRESS FIT Bottom To Top Fixation is a successful method for ACL Reconstruction. The Diamond Instruments and tubed guiding devices are precise, reliable and easy to manage. On this basis a double bundle reconstruction is achieved using a single tunnel. A broad anatomic femoral insertion with autogenous bone plugs inserted near the cortex seems to improve rotational stability.
ACL; press fit; double bundle; single tunnel; foreign material free; bottom to top
Nmrglue, an open source Python package for working with multidimensional NMR data, is described. When used in combination with other Python scientific libraries, nmrglue provides a highly flexible and robust environment for spectral processing, analysis and visualization and includes a number of common utilities such as linear prediction, peak picking and lineshape fitting. The package also enables existing NMR software programs to be readily tied together, currently facilitating the reading, writing and conversion of data stored in Bruker, Agilent/Varian, NMRPipe, Sparky, SIMPSON, and Rowland NMR Toolkit file formats. In addition to standard applications, the versatility offered by nmrglue makes the package particularly suitable for tasks that include manipulating raw spectrometer data files, automated quantitative analysis of multidimensional NMR spectra with irregular lineshapes such as those frequently encountered in the context of biomacromolecular solid-state NMR, and rapid implementation and development of unconventional data processing methods such as covariance NMR and other non-Fourier approaches. Detailed documentation, install files and source code for nmrglue are freely available at http://nmrglue.com. The source code can be redistributed and modified under the New BSD license.
Nuclear magnetic resonance; Solid-state NMR; Data processing; Data analysis; Data visualization; Python; Open source
This study moves from “work-family” to a multi-dimensional “life-course fit” construct (employees’ cognitive assessments of resources, resource deficits, and resource demands), using a combined work-family, demands-control and ecology of the life course framing. It examined (1) impacts of job and home ecological systems on fit dimensions, and (2) whether control over work time predicted and mediated life-course fit outcomes. Using cluster analysis of survey data on a sample of 917 white-collar employees from Best Buy headquarters, we identified four job ecologies (corresponding to the job demands-job control model) and five home ecologies (theorizing an analogous home demands-home control model). Job and home ecologies predicted fit dimensions in an additive, not interactive, fashion. Employees’ work-time control predicted every life-course fit dimension and partially mediated effects of job ecologies, organizational tenure, and job category.
Work-family; Job and home ecologies; Life-course fit; Job strain; Role train/enhancement; Demand-control; Work time control; Control over work time; Job and home systems
The purpose of this study was to extend our earlier work to determine the extent to which cardiorespiratory fitness is associated with the frequency of memory problems via its effects on the hippocampus and spatial working memory. We hypothesized that age, sex, education, body composition, and physical activity were direct determinants of fitness which, in turn, influenced frequency of forgetting indirectly through hippocampal volume and spatial working memory.
We conducted assessments of hippocampal volume, spatial working memory, frequency of forgetting, BMI, physical activity, demographic characteristics, and cardiorespiratory fitness in 158 older adults (M age = 66.49). Path analyses within a covariance modeling framework were used to examine relationships among these constructs.
Sex, age, BMI, and education were all significant determinants of cardiorespiratory fitness. The hypothesized path models testing the effects of fitness on frequency of forgetting through hippocampal volume and accuracy and speed of spatial working memory all fit the data well.
Our findings suggest that older adults with higher levels of fitness show greater preservation of hippocampal volume which, in turn, is associated with more accurate and faster spatial memory and fewer episodes of forgetting. Given the proportion of older adults reporting memory problems, it is necessary to determine whether improvements in fitness brought about by physical activity interventions can result in subsequent attenuation of memory problems or potentially improvements in memory.
Frequency of Forgetting; Hippocampus Volume; Cardiorespiratory Fitness; Spatial Memory; Older Adults
If physicians do not write notes for employers and disability insurers carefully, patients may lose employment and/or disability benefits. Employers want to know whether workers can perform the job adequately and safely under reasonable conditions. Whether the inability to do the job is due to a legitimate medical problem is irrelevant for protecting jobs. The physician should therefore be careful to distinguish between ‘hurt’, which may cause workers pain, but allow them to do a job, and ‘harm’, which means a particular job may worsen the patient's condition. The physician must also be well informed about eligibility for disability payment. When writing a note, doctors should ask themselves several questions: Is there a definite diagnosis? Is the patient receiving optimal medical therapy? What are the irreducible limitations imposed by the patient's disease? What are the contraindications? Is the disability temporary or permanent?
Doctors' notes; disability benefits; occupational health
The ability to copy and paste text within computerized physician documentation facilitates electronic note writing, but may affect the quality of physician notes and patient care. Little is known about physicians’ collective experience with the copy and paste function (CPF).
To determine physicians’ CPF use, perceptions of its impact on notes and patient care, and opinions regarding its future use.
Resident and faculty physicians within two affiliated academic medical centers currently using a computerized documentation system.
Responses on a self-administered survey.
A total of 315 (70%) of 451 eligible physicians responded to the survey. Of the 253 (80%) physicians who wrote inpatient notes electronically, 226 (90%) used CPF, and 177 (70%) used it almost always or most of the time when writing daily progress notes. While noting that inconsistencies (71%) and outdated information (71%) were more common in notes containing copy and pasted text, few physicians felt that CPF had a negative impact on patient documentation (19%) or led to mistakes in patient care (24%). The majority of physicians (80%) wanted to continue to use CPF.
Although recognizing deficits in notes written using CPF, the majority of physicians used CPF to write notes and did not perceive an overall negative impact on physician documentation or patient care. Further studies of the effects of electronic note writing on the quality and safety of patient care are required.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-008-0843-2) contains supplementary material, which is available to authorized users.
medical records system, computerized; documentation/mt [methods]; attitude of health personnel; medical staff, hospital; user-computer interface
Reflective writing is being introduced in many medical schools in the United States and abroad for a variety of reasons and with a variety of goals in mind. As Wald and colleagues write, multiple methods, including the rubric introduced in their study, have been proposed for rating or grading this writing to quantify the gains obtained. The authors of this commentary detail the assumptions both about reflection and about writing implied in Wald and colleagues’ work. They then describe a reciprocal model of writing as discovery, suggesting that the writing itself is what teaches the skills of reflection. Equipping medical students with a sense of story may well be the active ingredient in whatever gains are observed in teaching reflective writing.
The ability to write clearly and effectively is of central importance to the scientific enterprise. Encouraged by the success of simulation environments in other biomedical sciences, we developed WriteSim TCExam, an open-source, Web-based, textual simulation environment for teaching effective writing techniques to novice researchers. We shortlisted and modified an existing open source application - TCExam to serve as a textual simulation environment. After testing usability internally in our team, we conducted formal field usability studies with novice researchers. These were followed by formal surveys with researchers fitting the role of administrators and users (novice researchers)
The development process was guided by feedback from usability tests within our research team. Online surveys and formal studies, involving members of the Research on Research group and selected novice researchers, show that the application is user-friendly. Additionally it has been used to train 25 novice researchers in scientific writing to date and has generated encouraging results.
WriteSim TCExam is the first Web-based, open-source textual simulation environment designed to complement traditional scientific writing instruction. While initial reviews by students and educators have been positive, a formal study is needed to measure its benefits in comparison to standard instructional methods.
Injuries to working age adults are common and place a considerable burden on health services accounting for more than 10% of GP sick notes and 14% of those claiming benefits because they are unable to work in the UK. General practitioners (GPs) currently assess fitness to work and provide care and referral to other services to facilitate return to work (RTW). Recent UK recommendations suggest replacing GP sickness certification with independent assessments of fitness to work after four weeks sick leave. The impact of a wide range of injuries on RTW and subsequent need for independent fitness to work assessments has not been well studied in the UK. The aim of this study was to quantify RTW and factors predicting RTW following a wide range of injuries.
We used a multicentre longitudinal study, set in four acute NHS Trusts in the UK which recruited emergency department (ED) attenders and hospital admissions for injury and included those aged 16–65years that were employed or self-employed before the injury. Participants were followed up by postal questionnaire at 1, 4 and 12 months post injury to measure health status (EQ-5D), recovery, use of health and social services, time off work in the preceding month and work problems amongst those who had RTW. Multivariable Poisson regression with a robust variance estimator was used to estimate relative risks for factors associated with RTW.
One month after injury 35% of ED attenders had fully RTW. The self employed were more likely (RR 1.70, 95% CI 1.17 to 2.47 compared with employed) and the moderate/severely injured less likely to RTW (RR 0.48, 95% CI 0.32 to 0.72 compared with minor injuries). At four months, 83% of ED attenders had RTW and self employment and injury severity remained significant predictors of RTW (self employment RR 1.15, 95% CI 1.03 to 1.30; moderate/severe injury RR 0.79, 95% CI 0.68 to 0.92). At four months 57% of hospital admissions had RTW. Men were more likely than women to RTW (RR 1.94, 95% CI 1.34 to 2.82), whilst those injured at work (RR 0.49, 95% CI 0.27 to 0.87 compared with at home) and those living in deprived areas (most deprived tertile RR 0.59, 95% CI 0.40 to 0.85 and middle tertile RR 0.61, 95% CI 0.40 to 0.93) were less likely to RTW. Health status was significantly poorer at one and four months after injury than before the injury and was significantly poorer amongst those that had not RTW compared to those that had. Problems with pain control, undertaking usual activities, mobility and anxiety and depression were common and persisted in a considerable proportion of participants up to four months post injury.
Injuries have a large impact on time off work, including amongst those whose injuries did not warrant hospital admission. The majority of injured people would require an in-depth fitness for work assessment if recent UK recommendations are implemented. Many people will have on-going pain, mobility problems, anxiety and depression at the point of assessment and it is important that patients are encouraged to use primary care services to address these problems. A range of factors may be useful for identifying those at risk of a slower recovery and a delayed RTW so that appropriate interventions can be provided to this group.
The purpose of this study was to concurrently examine the development of written language across several writing tasks and to investigate how writing features develop in preschool children. Emergent written language knowledge of 372 preschoolers was assessed using numerous writing tasks. The findings from this study indicate that children possess a great deal of writing knowledge before beginning school. Children appear to progress along a continuum from scribbling to conventional spelling, and this progression is linear and task dependent. There was clear evidence to support the claim that universal writing features develop before language-specific features. Children as young as 3 years possess knowledge regarding universal and language-specific writing features. There is substantial developmental continuity in literacy skills from the preschool period into early elementary grades. Implications of these findings on writing development are discussed.
emergent literacy; emergent writing; language development; preschool; writing; written language
The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966–2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre‐offer or post‐offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost‐effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from “fit” to “unfit”, with other possible intermediate categories such as “fit subject to work modifications”, “fit with restrictions” or “conditionally fit (temporarily, permanently)”. Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision‐making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.