Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes

IntroductionDissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales.MethodsA 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications.ResultsA total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively.ConclusionsFunnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications.     

Analysis of the risk factors of musculoskeletal disease among dentists induced by work posture

[Purpose] The purpose of this study was to ergonomically evaluate the work posture of dentists to examine their subsequent risk of developing musculoskeletal diseases. [Subjects and Methods] Scenes in which the three dentists performed procedures at their dental clinics were videotaped. The videotapes of the dentists’ work postures were evaluated and analyzed by using the Rapid Upper Limb Assessment (RULA) and Quick Exposure Check (QEC). [Results] The RULA analysis of the dentists’ work posture indicated, “improvement required” in the posture used to treat the anterior and “instant improvement required” in the posture used to treat the maxillary second molar. Of all the work postures studied, the risk was considered particularly high in the lower back and neck, implying prominent problems in these body parts. The QEC analysis showed that the worst work posture was that required to treat the maxillary second molar, which led to a high risk of neck problems and vibrations. [Conclusion] The neck area has the highest risk of developing musculoskeletal disease. Hence, regular rests and the provision of information regarding muscle strengthening exercise for the neck are necessary.Key words: Dentists, Ergonomic evaluation, Musculoskeletal diseases     

Immediate effects of the activation of the affected lower limb on the balance and trunk mobility of hemiplegic stroke patients

[Purpose] The purpose of this study was to determine the effects of the activation of the affected lower limb on balance and the trunk hemiplegic mobility of stroke patients. [Subjects] The gait group (GG) consisted of 6 subjects with hemiplegia and the non-gait group (NGG) consisted of 6 hemiplegic subjects. [Methods] The subjects in both groups were given foot facilitation training once for 30 min. The Spinal Mouse was used to measure the spinal alignment and the Berg balance scale (BBS) and sensory tests were also performed. [Results] In the GG, the sacral hip in upright to flexion, the lumbar spine in upright to extension, and the sacral hip and lumbar spine in flexion to extension showed significant increases in their angles after the intervention. In addition, there was a significant increase in the angle of the lumbar spine during extension from an upright position in the NGG. The BBS scores of both groups also increased significantly. [Conclusion] The intervention resulted in improvements in the angle of anterior pelvic tilt in the GG, and subjects in the NGG showed more extension of the thorax, which was regarded as compensation to avoid falling forward when flexing from an upright position. However, when extending backward from an upright position, both groups tended to control balance by using more lumbar flexion to keep the center of mass (COM) within the base of support (BOS). Both groups had better BBS scores.Key words: Balance, Stroke, Trunk