Rasa Ruseckaite

Effect of temporal sparseness and dichoptic presentation on multifocal visual evoked potentials

Multifocal VEP (mfVEP) responses were obtained from 13 normal human subjects for nine test conditions, covering three viewing conditions (dichoptic and left and right monocular), and three different temporal stimulation forms (rapid contrast reversal, rapid pattern pulse presentation, and slow pattern pulse presentation). The rapid contrast reversal stimulus had pseudorandomized reversals of checkerboards in each visual field region at a mean rate of 25 reversals/s, similar to most mfVEP studies to date. The rapid pattern pulse presentation had pseudorandomized presentations of a checkerboard for one frame, interspersed with uniform grey frames, with a mean rate of 25 presentations/s per region per eye. The slow pattern pulse stimulus had six presentations/s per region per eye. Recording time was 5.3 min/condition. For dichoptic presentation slow pattern pulse responses were 4.6 times larger in amplitude than the contrast reversal responses. Binocular suppression was greatest for the contrast reversal stimulus. Consideration of the signal-to-noise ratios indicated that to achieve a given level of reliability, slow pattern pulse stimuli would require half the recording time of contrast reversal stimuli for monocular viewing, and 0.4 times the recording time for dichoptically presented stimuli. About half the responses to the slow pattern pulse stimuli had peak value exceeding five times their estimated standard error. Responses were about 20% smaller in the upper visual field locations. Space-time decomposition showed that responses to slow pattern pulse were more consistent across visual field locations. We conclude that the pattern pulse stimuli, which we term temporally sparse, maintain the visual system in a high contrast gain state. This more than compensates for the smaller number of presentations in the run, and provides signal-to-noise advantages that may be valuable in clinical application.

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Mental Health Claims Management and Return to Work: Qualitative Insights from Melbourne, Australia

Purpose Mental health conditions (MHC) are an increasing reason for claiming injury compensation in Australia; however little is known about how these claims are managed by different gatekeepers to injury entitlements. This study, drawing on the views of four stakeholders—general practitioners (GPs), injured persons, employers and compensation agents, aims to describe current management of MHC claims and to identify the current barriers to return to work (RTW) for injured persons with a MHC claim and/or mental illness. Methods Ninety-three in-depth interviews were undertaken with GPs, compensation agents, employers and injured persons. Data were collected in Melbourne, Australia. Thematic techniques were used to analyse data. Results MHC claims were complex to manage because of initial assessment and diagnostic difficulties related to the invisibility of the injury, conflicting medical opinions and the stigma associated with making a MHC claim. Mental illness also developed as a secondary issue in the recovery process. These factors made MHC difficult to manage and impeded timely RTW. Conclusions It is necessary to undertake further research (e.g. guideline development) to improve current practice in order to enable those with MHC claims to make a timely RTW. Further education and training interventions (e.g. on diagnosis and management of MHC) are also needed to enable GPs, employers and compensation agents to better assess and manage MHC claims.

Healthcare and disability service utilization in the 5-year period following transport-related traumatic brain injury.

Primary objective: To describe the type, intensity and direct cost of healthcare and disability services used following transport-related traumatic brain injury (TBI). Methods and procedures: Using the transport accident compensation regulator database, claims records were examined of 423 cases of adult (18–65 years of age) transport-related TBI occurring between 1 January 1995 and 31 December 2004. Claimants were stratified by TBI severity using the Glasgow Coma Scale (GCS) score. Service utilization and costs were examined by TBI severity in the 5-year period post-injury. Main outcomes and results: Claimants accessed a total of 409 740 services. Claimants with severe TBI accessed more medical (median 333 per claimant) and paramedical services (median 436 per claimant) than claimants with mild and moderate TBI. Almost 60% of claimants with severe TBI accessed attendant care services compared to 39% and 45% of claimants with moderate and mild TBI, respectively. Average total costs of services were highest among claimants with severe TBI (AUD

Health care utilisation following hospitalisation for transport-related injury

324 515 per claimant). Conclusions: Healthcare service utilization and the economic burden of TBI are substantial. Injury compensation data provides a unique opportunity to explore patterns of healthcare usage post-injury, which is important for the planning and management of resources.

The incidence and impact of recurrent workplace injury and disease: a cohort study of WorkSafe Victoria, Australia compensation claims

BACKGROUND Transport injuries are a substantial cause of disability and death internationally. There is little published information regarding patterns of healthcare utilisation following transport injury. AIMS To investigate patterns of in-hospital and post-discharge healthcare use following transport injury. METHODS Analysis of all accepted adult claims from the database of the transport accident compensation regulator in Victoria, Australia between 1995 and 2008. The analyses focused on injuries resulting in hospitalisation. Indicators of in-hospital and post-discharge healthcare utilisation (e.g. number of services per practitioner group) within the first 12-months were summarised. RESULTS More than a third (33.6%, n = 68,639) of all accepted compensable transport injuries resulted in admission to an acute care facility within 28 days of injury. In this group, the compensation authority paid for a total of 4.5 million healthcare services in the 12 months post-discharge (median of 19 services per claim). Services provided by medical practitioners were accessed by nearly all claimants (95.7%) at a median of 11 (5-26) per claimant. Less than half of claimants (46.7%) accessed paramedical or allied health services but the median number of services accessed was higher at 29 (9-82) per claimant. CONCLUSION Transport-related injury cases require a substantial interaction with multiple components of the healthcare system in the year following hospital discharge. Compensation system data may provide a detailed understanding of healthcare utilisation, a key element of injury burden.

Uncomfortable Bedfellows: Employer Perspectives on General Practitioners’ Role in the Return-to-Work Process

Objective To determine the incidence and impact of recurrent workplace injury and disease over the period 1995–2008. Design Population-based cohort study using data from the state workers’ compensation system database. Setting State of Victoria, Australia. Participants A total of 448 868 workers with an accepted workers’ compensation claim between 1 January 1995 and 31 December 2008 were included into this study. Of them, 135 349 had at least one subsequent claim accepted for a recurrent injury or disease during this period. Main outcome measures Incidence of initial and recurrent injury and disease claims and time lost from work for initial and recurrent injury and disease. Results Over the study period, 448 868 workers lodged 972 281 claims for discrete occurrences of work-related injury or disease. 53.4% of these claims were for recurrent injury or disease. On average, the rates of initial claims dropped by 5.6%, 95% CI (−5.8% to −5.7%) per annum, while the rates of recurrent injuries decreased by 4.1%, 95% CI (−4.2% to −0.4%). In total, workplace injury and disease resulted in 188 978 years of loss in full-time work, with 104 556 of them being for the recurrent injury. Conclusions Recurrent work-related injury and disease is associated with a substantial social and economic impact. There is an opportunity to reduce the social, health and economic burden of workplace injury by enacting secondary prevention programmes targeted at workers who have incurred an initial occupational injury or disease.

Is clinician refusal to treat an emerging problem in injury compensation systems

Abstract Workers’ compensation authorities expect that various stakeholders — insurers, employers, injured workers and healthcare providers — work together to help return an injured worker to early, safe and sustainable employment. To date, research examining interactions between employers and healthcare providers, in the context of return to work, is limited. Based on data gathered via qualitative, in-depth interviews with employers, our paper addresses this gap. We examine the perspectives of a group of employers from Melbourne, Australia who have had experience with return to work and, specifically, their interactions with general practitioners during this process. Our findings indicate that while employers view general practitioners as important decision-makers in the return-to-work process, they often have difficulty making contact with general practitioners and working collaboratively on a return-to-work plan. They feel that general practitioners’ lack of engagement in the return-to-work process is due to the administrative complexity of the workers’ compensation system, limited remuneration and lack of knowledge of the workplace. Employers’ feelings of exclusion, along with a view that some injured workers will ‘cheat the system’, make some employers suspicious of the doctor-patient relationship, making collaboration more difficult. Including employers in an employee’s return to work can signify that they have influence over processes that can profoundly affect their workplaces and provide decision-makers with important information about available duties and workplace organisation. Streamlined administrative processes, higher remuneration for general practitioners and the engagement of return-to-work coordinators can also facilitate the return-to-work process.

Dark adaptation recovery of human rod bipolar cell response kinetics estimated from scotopic b‐wave measurements

Objective The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Design Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Setting Compensable injury management in general practice in Melbourne, Australia. Participants 25 GPs who were treating, or had treated a patient with compensable injury. Results The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. Conclusions In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries.

Examining the epidemiology of work-related traumatic brain injury through a sex/gender lens: analysis of workers’ compensation claims in Victoria, Australia

We recorded ganzfeld scotopic ERGs to examine the responses of human rod bipolar cells in vivo, during dark adaptation recovery following bleaching exposures, as well as during adaptation to steady background lights. In order to be able to record responses at relatively early times in recovery, we utilized a ‘criterion response amplitude’ protocol in which the test flash strength was adjusted to elicit responses of nearly constant amplitude. In order to provide accurate and unbiased measures of response kinetics, we utilized a curve‐fitting procedure to fit a smooth function to the measured responses in the vicinity of the peak, thereby extracting both the time‐to‐peak and the amplitude of the responses. Following bleaching exposures, the responses exhibited both desensitization and accelerated kinetics. During early post‐bleach recovery, the flash sensitivity and time‐to‐peak varied according to a power‐law expression (with an exponent of 6), as found in the presence of steady background light. This light‐like phenomenon, however, appeared to be set against the backdrop of a second, more slowly recovering ‘pure’ desensitization, most clearly evident at late post‐bleach times. The post‐bleach ‘equivalent background intensity’ derived from measurements of flash sensitivity faded initially with an S2 slope of ∼0.24 decades min−1, and later as a gentle S3 tail. When calculated from kinetics, the results displayed only the S2 slope. While the recovery of rod bipolar cell response kinetics can be described accurately by a declining level of opsin in the rods, the sensitivity of these cells is reduced further than expected by this mechanism alone.