Injury Compensation Research Articles

Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) in the United States: Development and Validation of a Natural Language Processing Method.

BackgroundShoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce.ObjectiveThe goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes.MethodsWe conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases.ResultsIn the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5% (278/291), 67.7% (84/124), and 17.3% (9/52), respectively.ConclusionsThe algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation.

Editor's Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration.

Editor's Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration.

Les préjudices professionnels des jeunes victimes de dommages corporels. La reconnaissance jurisprudentielle du préjudice professionnel des jeunes victimes. Partie 1

Compensation for professional damages in respect of young victims who remain disabled following an accident or assault remains problematic for personal injury compensation practitioners. However, such professional damages, recognized in principle by the Dintilhac group, were confirmed by the Court of Cassation in terms of full compensation for damages, both for loss of future earnings (PGPF), and professional incidence (IP). Though the burden of proof lies with the victim, experts have a major role to play in assessing these losses by setting out the foreseeable impact of the after-effects on the victim's professional activities, and on his or her professional potential before and after the injury, along with limitations in terms of the jobs the victim is subsequently able to do.

Validation of the Subgroups for Targeted Treatment for Back (STarT Back) screening tool at a tertiary care centre.

Background:The Subgroups for Targeted Treatment for Back (STarT Back) tool is a screening questionnaire developed to identify modifiable risk factors for back pain disability in primary care. Given the ability of this tool to assist with early identification of patients at high risk, we examined its concurrent convergent and known-group construct validity in tertiary care.Methods:This was a case–control study of adult (age > 18 yr) patients with and without an active work-related compensation claim recruited from an academic health centre between August 2017 and May 2019. Patients in the study group were assessed by a physiotherapist and an orthopedic surgeon in a spine specialty program designed to assess and treat workplace injuries. The control group included patients referred to an orthopedic spine surgeon in a publicly funded specialty clinic where an advanced practice physiotherapist determined the need for surgical consultation. We used the Roland–Morris Disability Questionnaire (RMDQ) and the Hospital Anxiety and Depression Scale (HADS) to determine the convergent and known-group construct validity of the STarT Back tool.Results:Fifty case and 50 control participants were included. We observed moderate to high association between the STarT Back total score, psychosocial subscore and risk categories and the RMDQ and HADS scores in the expected direction (p < 0.001). A significant association was observed between risk group allocation and depression (area under the curve values > 80), having a compensable injury and work status (p = 0.002–0.001).Conclusion:The STarT Back tool was able to differentiate between patients with and without a compensable injury and patients with different levels of work status. The tool has acceptable convergent and known-group construct validity and can assist in clinical decision-making in a tertiary care setting where adjunct psychologic management may be indicated.

A workplace wellness program at an academic health center influences employee health, satisfaction, productivity and the rate of workplace injury.

Workplace wellness (WP) programs are an employer strategy to improve employee health and satisfaction. Their impact on productivity and benefit expense remains unclear. This study examines the association of a voluntary WP at an academic health center with both employee metrics and employer costs. We retrospectively reviewed prospectively collected data from January 2016 to April 2018 for employees who voluntarily underwent screening for a WP at an academic medical center. We used their demographic, social, work, and clinical data to address the central research question. The primary outcomes included wellness measures from the Patient-Reported Outcomes Measurement Information System (PROMIS), secondary wellness outcomes such as body mass index, job-related outcomes such as job satisfaction, and workers' compensation metrics such as the claim amount. The key independent variables were whether an observation was from before or after the WP. For workers' compensation metrics, additional key independent variables were intervention/control group, and an interaction between the before/after and intervention/control variables. We conducted univariate and bivariate/unadjusted analyses, and estimated multivariable linear, logistic, and gamma regression models that also controlled for confounders. The study included 370 employees. Participation in the program was associated with significant improvements in the PROMIS pain interference, fatigue and sleep quality domains. Hip circumference diminished, and functional movement outcomes were improved. Job satisfaction improved by 4.4 percentage points (95% Confidence Interval [CI]: 0.3-8.5, p = 0.04) and self-reported productivity by 14.5 percentage points (95% Confidence Interval [CI]: 9.5-19.5, p < 0.001). The likelihood of a new compensation claim during the 12-month follow-up period fell by 10.1% (95% Confidence Interval [CI]: -15.5 to -4.7, p < 0.001). However, the value of a new claim was unchanged. Employees who completed a WP at an academic medical center demonstrated improvements in several recognized patient-reported outcome measures, in job satisfaction and self-reported productivity, a decrease in hip circumference, an improvement in functional motion and a decreased rate of compensable injury.

Effect of mycophenolate mofetil dose on antibody response following initial SARS-CoV-2 vaccination in patients with systemic sclerosis.

Effect of mycophenolate mofetil dose on antibody response following initial SARS-CoV-2 vaccination in patients with systemic sclerosis.

Systematic Review of Incidence, Prevalence, and Trends in Health Outcomes for Australian and New Zealand Paramedics

Introduction The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organizations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this article was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context. Methods A systematic search of key databases and gray literature was conducted to identify all available studies reporting on quantitative health outcomes for paramedics working in Australia or New Zealand. The review was conducted using the JBI methodology for prevalence studies and uses a narrative synthesis approach to reporting. Results There were k = 20 studies that met inclusion criteria, and most used Australian samples. Results indicated between 57.3–66.5% of paramedics studied were classified as overweight or obese, while up to 80% reported poor sleep, and 55.6% reported fatigue. Incidence rates per 100,000 full-time equivalent (FTE) included 26.62 for completed suicide, 5.46 for drug-caused death, and 9.3 for workplace fatalities. The most recent incidence per 1,000 FTE for injury compensation claims was 141.4. Conclusions Australian and New Zealand paramedics demonstrate poor health according to several metrics. Our sample demonstrated considerably worse health than the general population or similar occupations. There is a minimal amount of trend data available; therefore, it was difficult to ascertain if rates are changing. The range of health outcomes studied was limited, and correlations between different health outcomes were rarely considered by authors. Data relating to specific rates for gender and sexuality, location of work, and First Nations status or ethnicity was often not available. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO) CRD42021232196

Effects of patient transfer devices on the risk of work-related musculoskeletal disorders: a systematic review

Objectives. This study aimed to evaluate the efficacy of patient transfer assistive devices in reducing the risk of work-related musculoskeletal disorders (WMSDs) among nurses. Methods. PubMed, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews were searched to identify studies with a quantitative assessment of the efficacy of patient transfer assistive devices on the incidence and injury claims of WMSDs as compared to the manual lifting of patients. A health impact analysis of the pre–post intervention of assistive device implementation was performed. The percentage of the reduction of forces, incidence of WMSDs, number of missed workdays and injury compensation claims were calculated, pooled and presented as boxplots. Results. A total of 25 studies met the inclusion criteria. The best post-intervention outcomes of assistive devices deployment in the healthcare setting included a reduction in WMSD incidence by 59.8%, missed workdays by 90.0% and workers’ compensation claims by 95.0%. Additionally, hand force declined by 71% (p < 0.05) and 70% (p < 0.05) with the use of air-assisted devices and ceiling lifts respectively. Conclusions. Overall, the evidence suggests that patient transfer assistive devices, notably ceiling lifts and air-assisted devices, are effective in reducing the risk of WMSDs among nurses.

When ‘ideal victim’ meets ‘criminalised other’: Criminal records and the denial of victimisation

This article critically examines the restrictions on access to statutory compensation in Great Britain for victims of serious crime with criminal records. Drawing on original analysis of Criminal Injuries Compensation Authority transparency data it reveals the scale of the denial of victimisation as a so-called ‘collateral consequence of a criminal record’. The policy is then critiqued on the basis that it reproduces the problematic social construction of the ‘ideal victim’, delineates people with criminal records as subaltern citizens and gives rise to harmful secondary victimisation of applicants whose criminal records are often unrelated to their victimisation event.

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

Murphy and the Sixteenth Amendment in Relation to the Taxation of Non-Excludable Personal Injury Awards

A recent panel decision of the U. S. Court of Appeals for the District of Columbia, Murphy v. Internal Revenue Service, shocked the tax community by holding that Internal Revenue Code section 104(a)(2) was unconstitutional by failing to exclude from gross income revenue (damages for emotional distress and injury to professional reputation) that is not “income” under the Sixteenth Amendment to the U.S. Constitution.A petition for rehearing en banc was filed, but, in a highly unusual move, the D.C. Circuit panel that decided the case, on its own motion, vacated its judgment and set the case for re-argument.Before 1996, section 104(a)(2) had excluded from gross income compensatory damages on account of personal injuries, including non-physical personal injuries of the type suffered by plaintiff Murphy. In 1996, Congress narrowed the exclusion so that it only applied to damages on account of physical personal injuries, thereby removing the exclusion for non-physical injuries. The panel stated its constitutional holding as follows:Insofar as § 104(a)(2) permits the taxation of compensation for a personal injury, which compensation is unrelated to lost wages or earnings, that provision is unconstitutional.Part I contains a brief description of the federal constitutional provisions concerning taxation and how they are related to each other. Part II discusses the issue of how to interpret the Sixteenth Amendment. Part III considers the on-the-merits exclusionary theories offered by the Murphy panel.

Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools.

STarT Back Screening Tool and OSPRO-YF scales have been reported to be accurate tools for estimating risk for the development of persistent pain or prolonged disability in primary care settings. We performed a comparison of construct convergent and known-group validity and ceiling floor effect (CFE) of these tools using a common sample of patients seen at a tertiary care spine centre. This was a cross-sectional study of patients with and without a work-related back injury. The Hospital Anxiety and Depression Scale (HADS) was used as the reference outcome measure for convergent validity. For known-group validity, we examined the ability of the scales to differentiate between different levels of compensation, presence of non-organic signs, and work status. The CFE values were calculated. Fifty consecutive injured workers were included along with 50 patients without an active compensation claim related to their low back pain. STarTBack and OSPRO-YF had moderate to high associations with the depression component of the HADS (0.69 to 0.77 respectively) with a statistically significant difference in favour of the OSPRO-YF. STarTBack's risk stratification categories were able to differentiate patients with a compensable injury, non-organic signs, and inability to work (p values ranging from 0.002 to < 0.001). The physical activity and work fear-avoidance beliefs constructs of the OSPRO-YF consistently outperformed other yellow flag constructs (p values ranging from 0.008 to < 0.001). The psychological sub-score of STarTBack showed a ceiling effect. There was a floor effect for the negative affect domain of OSPRO-YF. Neither total score had a floor or ceiling effect. STarTBack and OSPRO-YF are short screening tools with acceptable convergent and known-group construct validity and no floor or ceiling effect of their total score. Both tools could assist with the identification, evaluation, and management of psychological distress in patients presenting to tertiary care spine centres.

Care Workers in the Covid-19 Pandemic: Questions of Injury Compensation from a Gender Perspective

Care Workers in the Covid-19 Pandemic: Questions of Injury Compensation from a Gender Perspective

Experimenting with modifications to consent forms in comparative effectiveness research: understanding the impact of language about financial implications and key information

BackgroundInformed consent forms are intended to facilitate research enrollment decisions. However, the technical language in institutional templates can be unfamiliar and confusing for decision-makers. Standardized language describing financial implications of participation, namely compensation for injury and costs of care associated with participating, can be complex and could be a deterrent for potential participants. This standardized language may also be misleading in the context of comparative effectiveness trials of standard care interventions, in which costs and risk of injury associated with participating may not differ from regular medical care. In addition, the revised U.S. Common Rule contains a new requirement to present key information upfront; the impact of how this requirement is operationalized on comprehension and likelihood of enrollment for a given study is unknown.MethodsTwo online surveys assessed the impact of (1) changes to compensation for injury language (standard vs. tailored language form) and (2) changes to the key information page (using the tailored compensation language form with standard key information vs. modified key information vs. modified key information plus financial information) on both likelihood of enrollment in and understanding of a hypothetical comparative effectiveness trial.ResultsLikelihood of enrolling was not observed to be different between the standard and tailored language forms in Study 1 (73 vs. 75%; p = 0.6); however, the tailored language group had a higher frequency of understanding the compensation for injury process specific to the trial (25 vs. 51%; p < 0.0001). Modifications to the key information sheet in Study 2 did not affect likelihood of enrolling (88 vs. 85 vs. 85%; p = 0.6); however, understanding of randomization differed by form (44 vs. 59 vs. 46%; p = 0.002).ConclusionsThese findings suggest that refining consent forms to clarify key information and tailoring compensation for injury language to the nature of the study, especially in the context of comparative effectiveness trials, may help to improve study comprehension but may not impact enrollment.

Persistent Shoulder Pain After Vaccine Administration Is Associated with Common Incidental Pathology: A Systematic Review.

Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine. Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve? In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively. A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period. The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology. Level IV, therapeutic study.

Financial professionals and the formation of proprietarian ideology

Financial professionals and the formation of proprietarian ideology

Vaccine damage schemes in the US and UK reappraised: making them fit for purpose in the light of Covid-19

AbstractVaccines have continued to play a crucial global role in preventing infectious diseases in the twenty-first century. The Covid-19 pandemic has underlined their importance, with vaccines seen as the best way to protect the public from coronavirus. A longstanding problem of governments has been the extent to which they should assume responsibility for the compensation of those injured by vaccines. This paper reappraises the vaccine damage schemes currently available in the US and UK in the light of the Covid-19 pandemic. It argues that any improvements to both US and UK schemes should be included in a revised national vaccine policy which takes into consideration their respective long-term national vaccine strategies to prepare for future pandemics. It supports the adoption of a UK-wide National Vaccine Injury Compensation Programme, similar to the one in the US, to be administered by the Secretary of State for Health and Social Care. To balance the need for rigorous criteria to determine causation with the need for fairness, the programme should adopt the US practice of allowing negotiated settlements between parties in circumstances where review of the evidence has not concluded that the vaccine(s) caused the alleged injury but there are close calls concerning causation.

Recommended Adult Immunization Schedule, United States, 2022.

Recommended Adult Immunization Schedule, United States, 2022.

PROFESSIONAL LIABILITY INSURANCE AND INCREASED CIVIL PROTECTION OF MEDICAL STAFF

Compensation for injuries caused by medical accidents is one of the main branches of insurance under the title of doctors' civil liability insurance. In the present article, we have decided to collect information on the income and expenses of doctors' professional liability insurances to obtain a community view of the coverage of this insurance and to explain the advantages and disadvantages of stakeholders and to propose practical solutions to expand coverage and increase insurance coverage.&#x0D; In this study, information was collected from the Forensic Medicine Organization of Tehran Province about the amount of complaints and convictions of the medical staff in 1396 by a counting method in a researcher-made checklist and the amount of ransom that various medical professionals were required to pay in 1396 was estimated. Quality was calculated based on percentage and frequency and quantitative information was calculated based on mean and standard deviation.&#x0D; Out of 4079 complaints, 3343 (52.5%) were acquitted and 1731 (425%) were convicted. The highest number of convictions was related to general surgery, general practitioners and dentists and the lowest convictions were related to traditional medicine, poisoning, nursing and pathology. Complaints from female patients were 2430 cases (59.6%) and the rate of men complaints over time was 3076 cases (75.5%). Between the two groups of medical staff who were required to pay ransom to patients and the group who were not negligent. There was no statistically significant difference in terms of gender. The highest amount of negligence was related to the complaints convicted in the Plastic Surgery Commission in the amount of 924,900,000 Tomans (Iranian currency) and the lowest amount of negligence was related to the complaints condemned in the Traditional Medicine Commission in the amount of 35,700,000 Tomans. Considering the approximate number of 630/269 staff members and considering that if the insurer has spent on average 375/743 Tomans for each limited liability insurance, a significant figure of 250/839/705/200 can be calculated.&#x0D; As a result, the obligation to insure medical staff requires a determinative. Therefore it is appropriate for the Medical System organization, as the custodian and pioneer of supporting and providing services to the medical staff, to take action in this regard and to achieve this coverage.

Die Toepassing van die Wet op Beroepsgesondheid en -Veiligheid en ander Veiligheidsmaatreëls by Skole se Tegnologiewerkswinkels / The Application of the Occupational Health and Safety Act and other Safety Measures at Schools' Technology Workshops

Empirical research conducted by education researchers over a period of approximately 20 years confirms that uncertainty exists whether the provisions of the Occupational Health and Safety Act (OHSA) apply to technology workshops at academic, technical and special schools; whether compliance with the safety provisions of the OHSA is lacking; and whether serious injuries at technology workshops at schools occur from time to time. A comparative study of foreign law regarding occupational safety at technology workshops at high schools confirms that many countries have national or federal occupational safety and health statutes that apply to workplaces as well as public schools, although some have specific statutes or regulations addressing occupational safety at public schools. Countries like Germany, the Netherlands and some states of the United States of America define school-going children and students as "workers" in terms of their occupational safety legislation. Germany includes all school-going children in its statutory accident insurance scheme to provide for faultless compensation in case of injury. In determining whether the OHSA applies to technical workshops at high schools, the fundamental rights, as well as its spirit and purport, must be considered through the prism of the Constitution of the Republic of South Africa. Applying the traditional literalist-cum-intentionalist approach to the interpretation of the OHSA, the conclusion is that this Act does indeed apply to technology workshops at schools. In terms of section 60(1)(a) of the South African Schools Act state liability for damages occurring as a result of school activities does provide essential legal protection. However, the South African Schools Act, school safety policies and school infrastructure regulations do not make explicit provision for the application of health and safety standards at school premises that use potentially dangerous machinery and equipment in places such as technical workshops and science laboratories. It is therefore recommended that the OHSA, the Compensation for Occupational Injuries and Diseases Act, the Schools Act and the School Infrastructure Regulations be amended to provide legal certainty in respect of the application of occupational safety to technical workshops at high schools.