Wearing lead aprons in surgical operating rooms: ergonomic injuries evidenced by infrared thermography.

BACKGROUND: The purpose of this study is to quantify the impact of the weight of radiation protection lead aprons on the discomfort and the fatigue of the medical staff within an operating room of interventional gastroenterology. To quantify this fatigue, we analyzed variations of the physiological parameters, including heart rate, blood pressure, and cutaneous temperature; we compared two situations: the first within the classic endoscopy department (without apron) and the second within the operating room with apron. A follow-up study with lighter lead aprons was also conducted. METHODS: We used infrared thermography as the principal method of analysis in our study. This technique permits us to obtain data, without body contact, of the spatial and temporal orientation of temperatures on subject skin. This method proves to be beneficial in the evaluation of the posture of users. The symmetry of the temperature evolution among the different body zones can contribute to the body balance analysis. RESULTS: Our results of the cutaneous temperatures obtained by infrared camera show significant differences in the muscular activity. All the muscular groups studied were revealed significant temperature increases. The temperature curve T2-T1 reveals the actual influence of carrying heavy apron loads. Regardless of the muscular group, this temperature increase varies on the range between 0.55°C and 0.95°C. The muscular groups most recruited are the trapezoids and pectorals. The muscles least recruited are those of the lower limbs. CONCLUSIONS: The study shows the impact of load bearing on the body mechanics of medical staff during work. It will be beneficial to develop this study to predict changes in skin temperature because of the various types of aprons and to determine the possible correlation between the thermal distribution and users' sense of comfort.

Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial.

Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1-4) and Rockall score was 5 (IQR 3-6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04-2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31-2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39-2.80), being an inpatient (OR 2.45; 95 %CI 1.76-3.41) and rebleeding (OR 2.6; 95 %CI 1.85-3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.