Search

BACKGROUND Psychosocial factors are known to play a key role in determining the progress of back pain patients. However, it is not known whether these factors are applicable to military personnel, who tend to be fitter than the general population. OBJECTIVE The aim was to identify physical and psychological predictors in a prospective study of the outcome of back pain rehabilitation over 6 months and a longer follow-up time of between 15 and 32 months. METHODS Two hundred and fifty military personnel reporting for a residential rehabilitation programme completed a battery of physical and psychological tests. The physical tests included 800 m run time and the Biering-Sorensen test. The psychological/psychosocial measures included items on fear avoidance, self efficacy, anxiety and depression and occupational psychosocial factors such as job satisfaction. RESULTS Self efficacy and 800 m run time predicted self-reported functional ability at 6 months and medical discharge/return to full fitness at 15–32 months. Patients with 800 m run times of more than 3 minutes 31 seconds had a four times greater chance of medical discharge from the Armed forces. CONCLUSIONS Eight hundred metre run time and self-efficacy were independent predictors of both self-reported functional ability at 6 months and return to full fitness/medical discharge at 15–32 months. Self-efficacy also predicted 40% of the variance in the intensity of back pain and 10% of other non-back pain. Rehabilitation should include greater emphasis on physical fitness and on improving self-efficacy.

What's known on the subject? and What does the study add? Over the last decade, the surgical treatment of prostate cancer has evolved towards minimal access surgery, particularly via a robot-assisted technique. However, there is still debate regarding the true benefit for patients with respect to a functional outcome such as erectile function. The present prediction model provides a reliable estimation of the likelihood of regaining erectile function after prostatectomy. OBJECTIVE • To identify the reported rates of potency after prostatectomy in the recent literature for men without preoperative erectile dysfunction (ED) and to develop a statistical model for predicting the expected potency after prostatectomy. MATERIALS AND METHODS • A Medline search was conducted with the keywords ‘potency’ and ‘prostatectomy’ from 2003 to 2009. • In total, 33 studies in the English language reporting pre- and postoperative erectile function were identified. • Data from studies reporting outcome after open, laparoscopic and robot-assisted prostatectomy were analyzed separately. • Only data obtained from potent men before surgery were included in the analysis. RESULTS • In potent men before surgery, the main predictors of post-treatment erectile function are age and time after treatment. • The cumulative range of potency rates at 48 months for all ages (45–75 years) was 49–74% for open, 58–74% for laparoscopic and 60–100% for robotic prostatectomy. • The predicted outcome differs by type of operation and patient age. CONCLUSIONS • Men aged

The Naval Service Stress Study (2007-2012) is investigating job strain, its characteristics, causes and distribution in the Service. Data from phases I, II and III of the study (January 2007, June 2007 and January 2008) were analysed to determine the relationship between General Health questionnaire scores and a score on the Cognitive Failures Questionnaire (CFQ) completed at phase III. Of 791 personnel who completed questionnaires at all phases, 43.6% had no job strain at any phase, whereas 9.9% had strain on all three occasions ('chronic strain'). 27% had strain at one of the three phases and 19% had strain at two of the three phases. The particular phase at which job strain was experienced was not related to CFQ score at phase III, whereas the total strain experienced over the period was related. High strain over the year was the strongest predictor of high CFQ score. A 'strain dose' variable, which combined both the amount of strain exposure and the timing of the exposure, explained little additional variance in CFQ score. The findings might be interpreted to indicate that a high CFQ score is a vulnerability factor for adverse reactions to work stress. The hypothesis that recent job strain elevates CFQ score was not supported. STATEMENT OF RELEVANCE: Current models of occupational stress focus on psychosocial factors and much of the advice about stress management in organisations is centred on the identification and control of psychosocial risk factors. The present paper provides evidence that cognitive factors are also important and suggests that support for those with poor executive function should be part of stress management in complex environments.

This study aimed to identify work-related and personal factors associated with occupational stress in submariners. Work and well-being questionnaires were distributed to 219 male submariners (mean age 34 years), as part of a larger cohort study involving a stratified sample of 4951 Royal Navy (RN) personnel. The stress rate in submariners was 40%; significantly higher than the stress rate in the general RN, although once demographic factors were controlled for in a matched control sample, this difference was no longer significant. A summary model accounted for 49% of the variance in submariner stress, with key differences emerging between the occupational factors associated with stress in submariners and in the general RN. The longitudinal nature of this study permits stress in submariners to be monitored over 5 years, which will provide valuable insights into the chronicity of stress in this specialised occupational group. STATEMENT OF RELEVANCE: This paper contributes to the current literature on the negative impact of working in isolated conditions. It is demonstrated that occupational stress in submarines can be partially explained using current theories of stress in the workplace. However, the constraints of a restricted environment introduce additional factors which can also be associated with occupational stress.

The decision to perform cardiopulmonary resuscitation (CPR) remains one of the most important and difficult decisions a physician must make. This study examined differences in CPR decision making among senior hospital clinicians. A questionnaire was sent out to consultants and specialist registrars in general medicine, elderly care and intensive care in a large UK district general hospital, with anonymous returns. Short clinical scenarios were presented, and participants stated their CPR decision and their confidence level. In total, 86 questionnaires were sent out and 54 replies (63%) were received. There were significant differences between specialties in making the decision to perform CPR and the confidence in doing so, with three cases producing polarised results within the specialties, despite equal confidence in the decision. There is lack of consensus with the CPR decisions made between specialties and within them. Formal training in recognition of futility should be encouraged for all clinicians.

• To identify the reported rates of potency after prostatectomy in the recent literature for men without preoperative erectile dysfunction (ED) and to develop a statistical model for predicting the expected potency after prostatectomy.• A Medline search was conducted with the keywords 'potency' and 'prostatectomy' from 2003 to 2009. • In total, 33 studies in the English language reporting pre- and postoperative erectile function were identified. • Data from studies reporting outcome after open, laparoscopic and robot-assisted prostatectomy were analyzed separately. • Only data obtained from potent men before surgery were included in the analysis.• In potent men before surgery, the main predictors of post-treatment erectile function are age and time after treatment. • The cumulative range of potency rates at 48 months for all ages (45-75 years) was 49-74% for open, 58-74% for laparoscopic and 60-100% for robotic prostatectomy. • The predicted outcome differs by type of operation and patient age.• Men aged60 years have a significant likelihood of regaining erectile function after radical prostatectomy. • The reported statistical model provides a reliable estimation of erectile function outcome after prostatectomy for men with localized prostate cancer and intact erectile function.

Background and Purpose —S-100 protein promises to be a valuable surrogate end point for cerebral injury. This is of particular interest within the context of cardiac surgery. We sought to explore the relationship between change in neurospychological performance attributable to cardiopulmonary bypass and the release of brain-specific S-100 protein. Methods —In an observational comparative study in a University Hospital Cardiac Surgical Unit, S-100 protein release during and 5 hours after the onset of cardiopulmonary bypass was compared with change (from preoperative to 6 to 8 weeks postoperative) in neuropsychological tests in 130 patients undergoing the full range of cardiac surgical procedures. Results —Neuropsychological performance usually improved, being significantly so in 10 of 25 parameters. S-100 area under the curve (AUC) protein release correlated with age ( r =0.24, P r =0.17, P r =0.29, P r =−0.21, P r =0.2. Multiple regression models showed that neuropsychological tests accounted for 23% of the variance associated with S-100 AUC release, after partialing out the effects of age and bypass time. Conclusions —The correlation between S-100 protein release and neuropsychological function supports the belief that it is a measure of brain injury, which may be useful in future studies of mechanisms and prevention.