Return to work after coronary angioplasty or heart surgery: a 5-year experience with the "CardioWork" protocol.

OBJECTIVE: The "CardioWork" protocol, for work resumption after invasive heart procedures and subsequent cardiac rehabilitation, is presented. METHODS: Over 5 years, 107 consecutive patients of working age were enrolled. Jobs were classified as multiples of basal metabolism according to the entity of physical strain. These data were integrated with instrumental evaluations to provide indications regarding time and modality of work resumption. RESULTS: A total of 89.7% of patients resumed working. Other relevant findings include the correlation of time for work resumption with the kind of treatment and the task energy requirement; the earliness of return to work, even for older people and those performing heavy tasks; and the difficulty of work resumption for those who failed to restart work within 6 months. CONCLUSIONS: This study highlights the importance of a multidisciplinary rehabilitative approach to facilitate work resumption, adapting the work tasks to the changed psychophysical capabilities.

Conventional versus digital mammography in the analysis of screen-detected lesions with low positive predictive value.

PURPOSE: To compare the performance of screen-film and digital mammography in the assessment of screen-detected breast lesions. MATERIALS AND METHODS: A series of 100 consecutive mammographic screen-detected lesions (65 masses, 6 architectural distortions, 29 microcalcifications) deserving diagnostic assessment and judged to have a low positive predictive value underwent screen-film mammography (SFM) and digital mammography by a Fuji computed radiography system (FCR) (double exposure, same view, without removing compression) of the corresponding breast. Three sets of images (SFM, hard copy and soft copy FCR) were read, blind of assessment outcome, by three experienced radiologists. For the three different imaging modalities a contrast-detail analysis, dose evaluation and diagnostic accuracy by means of ROC analysis were performed. At the end of the diagnostic workup all suspicious cases (20) underwent surgical biopsy and were histologically confirmed as cancers and the cases which were negative or benign at assessment (80) were followed up for a period of 12-20 months. During the follow-up period two more cases proved to be cancers at subsequent examinations. RESULTS: Contrast-detail analysis gives better image quality for FCR compared to SFM at the same delivered dose, whilst in ROC analysis the SFM (AUC 0.7158), hard copy FCR (AUC 0.7404) and soft copy FCR (AUC 0.7501) (chi(2)=1.30, p=0.5220) are equivalent. CONCLUSION: FCR has a diagnostic performance equivalent to SFM in the assessment of screen-detected lesions with a low positive predictive value for cancer and it may be safely included in routine screening practice.