Evaluation of the effects of an ergonomic-educational programme

 Objectives: The objectives of this study were (i) To establish whether it is possible to assess by means of a check-list in a reliable way errors which violated biomechanical and ergonomical principles during nursing tasks, and (ii) to study the effectiveness of an ergonomic-educational course by using this check-list. Materials and methods: Trainees (n=12) and a control group of nurses (n=12) who did not attend the course, performed three nursing activities at three points in time under standardized conditions; once before and twice after the course had ended. Their performances were recorded on video. A check-list was developed to assess the number of ergonomic errors made during the test performances. Two observers completed the check-lists after having watched five videotapes, and one of them did this for a second time 3 weeks later, in order to assess inter- and intra-observer reliability. In addition the tapes of all nurses were scored and analysed on differences in the performance of the two groups at the three points in time. Percentage of agreement and kappa (κ) was used to express inter- and intra-observer reliability. Student’s t-test was used to analyse the differences in mean percentages of errors. Results: The inter- and intra-observer reliability were 92% with κ of 0.84, and 93% with κ of 0.86, respectively. Further results showed that the mean percentages of errors made by the control group remained the same at the three measurement times. However, in the trainee group a significant decrease in errors was found. The trainees made fewer errors at all three points in time than the controls did. Conclusion: It appears feasible to create a check-list to assess ergonomic errors in a reliable way. Trainees make fewer errors after an ergonomic-educational course. It is necessary, however, to evaluate whether trained nurses work more safely in their daily duties than during the study. Received: 17 July 1996/Accepted: 20 September 1996     

The Martin-Gruber innervated hand

Two patients with a complete ulnar nerve lesion at the elbow and a median nerve lesion at the wrist secondary to leprosy neuropathy retained good function of the first dorsal interosseous and flexor pollicis brevis muscles. One patient also lacked the typical finger clawing associated with ulnar and median paralyses. These findings were attributed to the presence of Martin-Gruber anastomoses that were confirmed by nerve-conduction studies.     

Application of infrared thermography for the analysis of rewarming in patients with cold intolerance

Cold intolerance is a serious long-term problem after injury to the ulnar and median nerves, and its pathophysiology is unclear. We investigated the use of infrared thermography for the analysis of thermoregulation after injury to peripheral nerves. Four patients with injuries to the ulnar nerve and four with injuries to the median nerve (4-12 years after injury) immersed their hands in water at 15 degrees C for 5 minutes, after which infrared pictures were taken at intervals of 2-4 minutes. The areas supplied by the injured nerves could be identified easily in the patients with symptoms of cold intolerance. At baseline temperature distribution of the hand was symmetrical, but after testing the injured side warmed up much slower. We concluded that the infrared profile of the temperature of the hand after immersion in cold water is helpful to assess thermoregulation after injury to peripheral nerves.     

Personality antecedents of burnout among middle-aged physicians

Utilizing a prospective design, this study addressed the question of whether vulnerability to burnout among physicians is associated with certain longstanding, maladaptive personality tendencies that predate entrance into medical training and subsequent exposure to the intrinsic stresses of medical practice. Subjects were 440 practicing physicians whose personality traits and psychological adjustment had been assessed with the Minnesota Multiphasic Personality Inventory (MMPI) shortly before entering medical school who were followed up by mail questionnaire an average of 25 years later to evaluate current symptoms of burnout with the Tedium scale. Results revealed that higher burnout scores were significantly correlated with a number of standard and special MMPI scales measuring low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others. In contrast, burnout scores exhibited no significant associations with demographic or practice characteristics, including sex, age, medical specialty, practice arrangement, hours worked per week, or percentage of work time spent in direct contact with patients. Alternative interpretations of these findings and their potential implications for reducing the risk of burnout among physicians are discussed.     

The clinical treatment of laryngeal papillomas with hematoporphyrin therapy

Photodynamic activation of hematoporphyrin derivative was originally developed for the treatment of cancer. This article demonstrates that it may also be an effective therapy for papillomavirus infections of the larynx. Seventy-two hours prior to surgery, hematoporphyrin derivative (6 mg/kg) was given intravenously to two patients with the adult-onset form of this disease. Three days later, endoscopic surgery was performed and 32 J/cm2 was delivered to the endolarynx via an argon pump dye laser with a red light output of 630 nm. No significant complications such as swelling or hemorrhage occurred. At follow-up (13 months) there has been no recurrence of the laryngeal papilloma in either of these patients. The surgical technique, molecular biology, and clinical implications of this work to control laryngeal papillomatosis are described.     

Constitutive integrin activation on tumor cells contributes to progression of leptomeningeal metastases

Leptomeningeal metastases are a serious neurological complication in cancer patients and associated with a dismal prognosis. Tumor cells that enter the subarachnoid space adhere to the leptomeninges and form tumor deposits. It is largely unknown which adhesion molecules mediate tumor cell adhesion to leptomeninges. We studied the role of integrin expression and activation in the progression of leptomeningeal metastases. For this study, we used a mouse acute lymphocytic leukemic cell line that was grown in suspension (L1210-S cell line) to develop an adherent L1210 cell line (L1210-A) by selectively culturing the few adherent cells in the cell culture. beta1, beta2, and beta3 integrins were in a constitutively high active state on L1210-A cells and in a low, but inducible, active state on L1210-S cells. Expression levels of these integrins were comparable in the two cell lines. Static adhesion levels of L1210-A cells on a leptomeningeal cell layer were significantly higher than those of L1210-S cells. All mice that were injected intrathecally with L1210-A cells died rapidly of leptomeningeal leukemia. In contrast, 45% long-term survival was seen after intrathecal injection of mice with L1210-S cells. Our data indicate that constitutive integrin activation on leukemic cells promotes progression of leptomeningeal leukemia by increased tumor cell adhesion to the leptomeninges. We argue that an aberrantly regulated inside-out signaling pathway underlies constitutive integrin activation on the adherent leukemic cell population.     

Perfluoroalkyl compounds in relation to life-history and reproductive parameters in bottlenose dolphins (Tursiops truncatus) from Sarasota Bay, Florida, U.S.A

Perfluoroalkyl compounds (PFCs) were determined in plasma, milk, and urine of free-ranging bottlenose dolphins (Tursiops truncatus) from Sarasota Bay (FL, USA) during three winter and two summer capture-and-release programs (2002-2005). Plasma and urine samples were extracted using an ion-pairing method. Perfluoroalkyl compounds were extracted from milk samples using acetonitrile, and extracts were cleaned with graphitized nonporous carbon. All extracts were analyzed by high-performance liquid chromatography-tandem mass spectrometry. Mean seasonal sum of PFCs (sigma PFCs) detected in dolphin plasma ranged from 530 to 927 ng/g wet weight. No significant differences (p > 0.05) were found in concentrations between seasons, suggesting a constant exposure to PFCs. Overall, blubber thickness of dolphins did not correlate with PFC concentrations in plasma, suggesting an absence of PFC sequestration in blubber. Sexually immature calves (age, <10 years; mean sigma PFCs, 1,410 +/- 780 ng/ g wet wt) were significantly more contaminated (p < 0.001) than their mothers (mean sigma PFCs, 366 +/- 351 ng/g wet wt). The reproductive history of females had a significant role in the burden of PFC contamination; PFC concentrations in nulliparous females (females that have not been observed with calves) were significantly greater than those detected in uniparous females (females that have been observed with one calf), suggesting an off-loading of PFCs during or after parturition. To investigate this hypothesis, PFCs were analyzed in milk samples (n=10; mean sigma PFCs, 134 +/- 76.1 ng/g wet wt), confirming a maternal transfer of PFCs through lactation in dolphins. Results from the present study showed that young and developing bottlenose dolphins are highly exposed to PFCs. These chemicals also were detected in urine (mean sigma PFCs, 26.6 +/- 79 ng/g wet wt), indicating that the urinary system is an important pathway of PFC depuration in dolphins.     

Visual assessment of segmental muscle ultrasound images in spina bifida aperta

In spina bifida aperta (SBA), spinal MRI provides a surrogate marker to estimate muscle damage caudal to the myelomeningocele (MMC). This muscle damage by the MMC can be quantified by intra-individual comparison of muscle ultrasound density (MUD) caudal versus cranial to the MMC (dMUD = [MUD(caudal-to-the-MMC)] - [MUD(cranial-to-the-MMC)]). Quantitative dMUD assessment requires time, equipment and expertise, whereas it could also be visually determined by differences in muscle echodensity caudal vs. cranial to the MMC (visual-dMUD). If visual and quantitative dMUD correspond, visual dMUD assessment could provide a clinical screening parameter. In 100 SBA muscle ultrasound recordings of patients with various MMC levels, we aimed to compare quantitative dMUD (dMUD = [MUD(calf-muscle/S1)] - [MUD(quadriceps-muscle/L2-L4)]) with visual dMUD assessments by 20 different observers. Results indicate that quantitative dMUD can be visually detected (sensitivity 86%; specificity 57%), implicating that visual dMUD screening could provide a quick, clinical screening tool for muscle impairment by the MMC.