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Many Specialties (many + specialty)
Selected AbstractsErgonomics in Office-Based Surgery: A Survey-Guided Observational StudyDERMATOLOGIC SURGERY, Issue 11 2007ADAM C. ESSER MD BACKGROUND The practice of office-based surgery is increasing in many specialties. OBJECTIVE Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders. METHODS All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders. RESULTS All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures. CONCLUSION Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery. [source] Soft tissue augmentation 2006: filler fantasyDERMATOLOGIC THERAPY, Issue 3 2006Arnold William Klein ABSTRACT:, As an increasing number of patients seek esthetic improvement through minimally invasive procedures, interest in soft tissue augmentation and filling agents is at an all-time high. One reason for this interest is the availability of botulinum toxin type A, which works superbly in the upper face. The rejuvenation of the upper face has created much interest in injectable filling agents and implant techniques that work equally well in the restoration of the lower face. One of the central tenets of soft tissue augmentation is the concept of the three-dimensional face. The youthful face has a soft, full appearance, as opposed to the flat, pulled, two-dimensional look often achieved by more traditional surgical approaches. Injectable filling agents can augment and even at times, replace pulling. Additionally, with the lip as the focal center of the lower face, subtle lip enhancement is here to stay, and is in fact, the number one indication for injectable fillers. Moreover, minimally invasive soft tissue augmentation offers cosmetic enhancement without the cost and recovery time associated with more invasive procedures. As more and more physicians take interest in minimally invasive surgery, courses in cosmetic surgery techniques are becoming increasingly popular at the medical meetings of many specialties. Today, physicians have a much larger armamentarium of techniques and materials with which to improve facial contours, ameliorate wrinkles, and provide esthetic rejuvenation to the face. For a substance or device to be amenable for soft tissue augmentation in the medical community, it must meet certain criteria. It must have both a high "use" potential, producing cosmetically pleasing results with a minimum undesirable reactions, and have a low abuse potential in that widespread or incorrect or indiscriminate use would not result in significant morbidity. It must be nonteratogenic, noncarcinogenic, and nonmigratory. In addition, the agent must provide predictable, persistent correction through reproducible implantation techniques. Finally, the substance, agent or device must be approved by the U.S. Food and Drug Administration, which assures purity, safety, and accessibility, as well as much-needed information regarding use. Having a thorough understanding of the filling agents available, their indications and contraindications, as well as having thorough knowledge of implant technique are vital in providing the patient with an esthetically pleasing result. [source] Prospects for progress in diagnostic imagingJOURNAL OF INTERNAL MEDICINE, Issue 4 2000E. J. Potchen Abstract. Potchen EJ (Michigan State University, Michigan, USA). Prospects for progress in diagnostic imaging (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 411,424. New fast-imaging MRI systems designed specifically for cardiac magnetic resonance enable new applications of noninvasive vascular imaging. The use of functional MRI and diffusion tensor imaging to map brain function and structure offers a new dimension to an understanding of the human condition. Clinical applications of functional MRI will influence many specialties including surgery, education, and rehabilitation. Functional imaging has the potential to visualize the regional concentration of specific proteins. This imaging at the level of molecules may be possible by use of a contrast material whose signal is changed by local enzymatic activity. The three-dimensional digital data collected in modern imaging techniques allow for virtual endoscopy in the respiratory, alimentary, and cardiovascular systems. Virtual endoscopy may replace many of the more invasive diagnostic methods in the near future. The measurement of clinical decision-making through observer performance studies better informs both the physician and the patient on how to improve upon the quality of clinical practice. These prospects for progress reinforce diagnostic imaging as a cornerstone in medical informatics. The history of creating images used in medicine reveals the invention of diagnostic tools which may provide new information but premature use can result in improper application of a poorly understood technology. Research into the use of new technology may be as important as the technology itself in improving the human condition. [source] Emergency Medicine Residents Do Not Document Detailed Neurologic ExaminationsACADEMIC EMERGENCY MEDICINE, Issue 12 2009John Sarko MD Abstract Objectives:, Physical examinations performed by residents in many specialties are often incomplete and inaccurate. This report assessed the documentation of the neurologic examination performed by emergency medicine (EM) residents when examining patients with potential psychiatric or neurologic chief complaints. Methods:, A retrospective chart review of neurologic examinations documented by EM residents was performed. An eight-item neurologic examination score was created and analyzed by resident postgraduate year. A linear mixed model was used to determine if differences in neurologic examination scores existed between resident year, type of complaint, and resident year and type of complaint. A one-point difference in scores was considered clinically important. Results:, A total of 384 charts were reviewed. An average of 4.26 items (95% confidence interval [CI] = 3.91 to 4.62) out of a possible eight were documented that did not vary by resident year of training (p = 0.08). An effect was found for type of complaint. Documentation was lower for psychiatric than for neurologic complaints: mean score for psychiatric complaints 3.97 vs. mean score for neurologic complaints 4.55 (difference ,0.58, 95% CI = ,1.02 to ,0.14). No interaction was found for type of complaint and resident year. A clustering effect was identified for individual residents. Conclusions:, Emergency medicine residents do not document detailed neurologic examinations on patients with neurologic or psychiatric complaints. Individual resident variation contributes to this documentation. [source] | ||||||||||