Usage of a Web-Based Workplace and Symptom Self-Management Intervention Tool to Improve Work Ability for Breast Cancer Survivors.

This work aimed to evaluate the usage of a web-based intervention (WISE: Work ability Improvement through Symptom and Ergonomic strategies) developed to improve work ability for women recently diagnosed with breast cancer. Twenty-two women undergoing adjuvant treatment for breast cancer were provided access to WISE. This website includes content pages (e.g., information on ergonomics, symptom management, and other work-related resources) and worksheets (e.g., journals to track symptoms or goals). It could be personalized based on individual work activities and symptoms. Measures assessed at 3 months included usage of the website and perceived usefulness. Thirteen of the 22 participants (60%) accessed WISE; 11 personalized their information. Content and worksheet pages had 97 and 79 visits, respectively. Most frequently visited pages were "setting goals" (i.e., prioritize and track symptoms; 45 visits) and "steps to creating your WISE plan" (i.e., incorporate symptom and ergonomic strategies; 16 visits). Median duration time was 11.05 (range 0.35-79.55) minutes. Usefulness of the content and worksheet pages assessed via a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree) was 5.08 (SD = 1.59) and 4.26 (SD = 2.03), respectively. Participants were likely to recommend WISE to other women undergoing cancer treatment (mean = 6.11; SD = 1.05). The majority of participants personalized WISE work and symptom strategies. Overall, participants agreed that WISE content pages were useful and would recommend WISE for other breast cancer survivors. Results support that majority of breast cancer survivors, undergoing treatment with curative intent, accessed a web-based intervention that provided personalized information on workplace and symptom strategies.

A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment.

BACKGROUND: Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed. METHODS: Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks. RESULTS: In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time. CONCLUSIONS: This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.

Evaluation of Simulated Clinical Breast Exam Motion Patterns Using Marker-Less Video Tracking.

OBJECTIVE: This study investigates using marker-less video tracking to evaluate hands-on clinical skills during simulated clinical breast examinations (CBEs). BACKGROUND: There are currently no standardized and widely accepted CBE screening techniques. METHODS: Experienced physicians attending a national conference conducted simulated CBEs presenting different pathologies with distinct tumorous lesions. Single hand exam motion was recorded and analyzed using marker-less video tracking. Four kinematic measures were developed to describe temporal (time pressing and time searching) and spatial (area covered and distance explored) patterns. RESULTS: Mean differences between time pressing, area covered, and distance explored varied across the simulated lesions. Exams were objectively categorized as either sporadic, localized, thorough, or efficient for both temporal and spatial categories based on spatiotemporal characteristics. The majority of trials were temporally or spatially thorough (78% and 91%), exhibiting proportionally greater time pressing and time searching (temporally thorough) and greater area probed with greater distance explored (spatially thorough). More efficient exams exhibited proportionally more time pressing with less time searching (temporally efficient) and greater area probed with less distance explored (spatially efficient). Just two (5.9 %) of the trials exhibited both high temporal and spatial efficiency. CONCLUSIONS: Marker-less video tracking was used to discriminate different examination techniques and measure when an exam changes from general searching to specific probing. The majority of participants exhibited more thorough than efficient patterns. APPLICATION: Marker-less video kinematic tracking may be useful for quantifying clinical skills for training and assessment.

Measuring elemental time and duty cycle using automated video processing.

A marker-less 2D video algorithm measured hand kinematics (location, velocity and acceleration) in a paced repetitive laboratory task for varying hand activity levels (HAL). The decision tree (DT) algorithm identified the trajectory of the hand using spatiotemporal relationships during the exertion and rest states. The feature vector training (FVT) method utilised the k-nearest neighbourhood classifier, trained using a set of samples or the first cycle. The average duty cycle (DC) error using the DT algorithm was 2.7%. The FVT algorithm had an average 3.3% error when trained using the first cycle sample of each repetitive task, and had a 2.8% average error when trained using several representative repetitive cycles. Error for HAL was 0.1 for both algorithms, which was considered negligible. Elemental time, stratified by task and subject, were not statistically different from ground truth (p < 0.05). Both algorithms performed well for automatically measuring elapsed time, DC and HAL. Practitioner Summary: A completely automated approach for measuring elapsed time and DC was developed using marker-less video tracking and the tracked kinematic record. Such an approach is automatic, repeatable, objective and unobtrusive, and is suitable for evaluating repetitive exertions, muscle fatigue and manual tasks.

The accuracy of conventional 2D video for quantifying upper limb kinematics in repetitive motion occupational tasks.

Marker-less 2D video tracking was studied as a practical means to measure upper limb kinematics for ergonomics evaluations. Hand activity level (HAL) can be estimated from speed and duty cycle. Accuracy was measured using a cross-correlation template-matching algorithm for tracking a region of interest on the upper extremities. Ten participants performed a paced load transfer task while varying HAL (2, 4, and 5) and load (2.2 N, 8.9 N and 17.8 N). Speed and acceleration measured from 2D video were compared against ground truth measurements using 3D infrared motion capture. The median absolute difference between 2D video and 3D motion capture was 86.5 mm/s for speed, and 591 mm/s(2) for acceleration, and less than 93 mm/s for speed and 656 mm/s(2) for acceleration when camera pan and tilt were within ± 30 degrees. Single-camera 2D video had sufficient accuracy (< 100 mm/s) for evaluating HAL. Practitioner Summary: This study demonstrated that 2D video tracking had sufficient accuracy to measure HAL for ascertaining the American Conference of Government Industrial Hygienists Threshold Limit Value(®) for repetitive motion when the camera is located within ± 30 degrees off the plane of motion when compared against 3D motion capture for a simulated repetitive motion task.

Reducing thumb extensor risk in laboratory rat gavage.

Gavage is a common technique for orally administering compounds to small laboratory animals using a syringe. It involves highly repetitive thumb extensor exertions for filling the syringe, a risk factor for DeQuervain's tenosynovitis. As an intervention, a series of bench tests were performed varying fluid viscosity, syringe size and needle size to determine the forces required for drawing fluid. Forces up to 28 N were observed for a viscosity of 0.29 Pa s. A guide is presented to minimize thumb forces for a particular combination of syringe (3 mL, 5 mL and 10 mL), fluid viscosity (0.001 Pa s, 0.065 Pa s, 0.21 and 0.29 Pa s), and needle length (52 mm, 78 mm and 100 mm) based on maximum acceptable exertion levels. In general, a small syringe and large needle size had a greater number of acceptable rat gavages per day due to the lower forces experienced as compared to all other syringe and needle combinations.

Predicting tool operator capacity to react against torque within acceptable handle deflection limits in automotive assembly.

The proportion of tool operators capable of maintaining published psychophysically derived threaded fastener tool handle deflection limits were predicted using a biodynamic tool operator model, interacting with the tool, task and workstation. Tool parameters, including geometry, speed and torque were obtained from the specifications for 35 tools used in an auto assembly plant. Tool mass moments of inertia were measured for these tools using a novel device that engages the tool in a rotating system of known inertia. Task parameters, including fastener target torque and joint properties (soft, medium or hard), were ascertained from the vehicle design specifications. Workstation parameters, including vertical and horizontal distances from the operator were measured using a laser rangefinder for 69 tool installations in the plant. These parameters were entered into the model and tool handle deflection was predicted for each job. While handle deflection for most jobs did not exceed the capacity of 75% females and 99% males, six jobs exceeded the deflection criterion. Those tool installations were examined and modifications in tool speed and operator position improved those jobs within the deflection limits, as predicted by the model. We conclude that biodynamic tool operator models may be useful for identifying stressful tool installations and interventions that bring them within the capacity of most operators.

Proximal forearm extensor muscle strain is reduced when driving nails using a shock-controlled hammer.

BACKGROUND: Repetitive hammer use has been associated with strain and musculoskeletal injuries. This study investigated if using a shock-control hammer reduces forearm muscle strain by observing adverse physiological responses (i.e. inflammation and localized edema) after use. METHODS: Three matched framing hammers were studied, including a wood-handle, steel-handle, and shock-control hammer. Fifty volunteers were randomly assigned to use one of these hammers at a fatiguing pace of one strike every second, to seat 20 nails in a wood beam. Magnetic resonance imaging was used to scan the forearm muscles for inflammation before the task, immediately after hammering, and one to two days after. Electromyogram signals were measured to estimate grip exertions and localized muscle fatigue. High-speed video was used to calculate the energy of nail strikes. FINDINGS: While estimated grip force was similar across the three hammers, the shock-control hammer had 40% greater kinetic energy upon impact and markedly less proximal extensor muscle edema than the wood-handle and steel-handle hammers, immediately after use (p<.05). INTERPRETATION: Less edema observed for the shock-control hammer suggests that isolating handle shock can mitigate strain in proximal forearm extensor muscles.

A marker-less technique for measuring kinematics in the operating room.

BACKGROUND: Often in simulated settings, quantitative analysis of technical skill relies largely on specially tagged instruments or tracers on surgeons' hands. We investigated a novel, marker-less technique for evaluating technical skill during open operations and for differentiating tasks and surgeon experience level. METHODS: We recorded the operative field via in-light camera for open operations. Sixteen cases yielded 138 video clips of suturing and tying tasks ≥5 seconds in duration. Video clips were categorized based on surgeon role (attending, resident) and task subtype (suturing tasks: body wall, bowel anastomosis, complex anastomosis; tying tasks: body wall, superficial tying, deep tying). We tracked a region of interest on the hand to generate kinematic data. Nested, multilevel modeling addressed the nonindependence of clips obtained from the same surgeon. RESULTS: Interaction effects for suturing tasks were seen between role and task categories for average speed (P = .04), standard deviation of speed (P = .05), and average acceleration (P = .03). There were significant differences across task categories for standard deviation of acceleration (P = .02). Significant differences for tying tasks across task categories were observed for maximum speed (P = .02); standard deviation of speed (P = .04); and average (P = .02), maximum (P < .01), and standard deviation (P = .03) of acceleration. CONCLUSION: We demonstrated the ability to detect kinematic differences in performance using marker-less tracking during open operative cases. Suturing task evaluation was most sensitive to differences in surgeon role and task category and may represent a scalable approach for providing quantitative feedback to surgeons about technical skill.

Cavernous hemangioma of the external ear canal.

OBJECTIVE: To document the occurrence of a cavernous hemangioma of the external ear canal and to review the relevant literature. STUDY DESIGN Case report and literature review. METHODS: Review of a patient chart, imaging studies, operative report, and histologic findings. RESULTS: A cavernous hemangioma of the external ear canal not involving the tympanic membrane was surgically excised without complication. This is the third documented cavernous hemangioma of the external ear canal without tympanic membrane involvement in the English literature. Computed tomography scan is invaluable to narrow the differential diagnosis. Complete removal is curative. CONCLUSIONS: Cavernous hemangioma of the external ear canal with or without tympanic membrane involvement is a rare otologic entity amenable to surgical treatment. Temporal bone computed tomography scan imaging is an important preoperative diagnostic tool.

Role of cytomegalovirus, Epstein-Barr virus, and human herpes virus-8 in benign lymphoepithelial cysts of the parotid gland.

OBJECTIVE: To provide background and evaluate the role of herpesviruses in benign lymphoepithelial cysts (BLC) of the parotid gland. STUDY DESIGN: Case series derived from review of pathology specimens. METHODS: Radiolabeled polymerase chain reaction (PCR) analysis was used to detect for the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 8 (HHV-8) DNA sequences in 14 paraffin embedded specimens and 1 freshly aspirated BLC specimen. Thirteen normal parotid tissue specimens obtained from paraffin embedded blocks were used as a control group. RESULTS: CMV was detected with nearly equal frequency between the two groups (23% of normal vs. 20% in BLC). HHV-8 was found in 13% of the BLC group and in none of the normal group (P =.4841). There was significant difference in EBV detection between the normal (0%) and the BLC (33%) groups (P =.0437). CONCLUSION: CMV and HHV-8 does not appear to be associated with BLCs. Although EBV is found more frequently in BLC than in normal parotid controls, further studies are needed to elucidate the role of this virus in BLC pathogenesis.

Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function.

OBJECTIVE: To determine the clinical significance of the House-Brackmann facial nerve grading scale (HBFNGS) in the setting of differential function along the branches of the facial nerve. STUDY DESIGN: Prospective study of 38 patients with facial palsy who demonstrated differential facial function. SETTING: Tertiary referral center. PATIENTS: Patients with facial nerve dysfunction from any cause. Patients with complete facial nerve paralysis (House-Brackmann Grade 6) were excluded. INTERVENTION: Physicians were provided with printed description of the HBFNGS and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the forehead, eye, nose, and mouth. This was reported as F(w) E(x) N(y) M(z), where w, x, y, and z ranged from 1 to 6 based on the HBFNGS. Synkinesis was graded as none, mild, or severe. MAIN OUTCOME MEASURES: The traditional HBFNGS score was compared with a regional grading facial nerve grading system based on the HBFNGS for the forehead, eye, nose, and mouth. Agreement between the traditional global score and the regional scores was analyzed. RESULTS: In patients with variable facial weakness, the single House-Brackmann score did not fully communicate their facial function. Further, the single grade did not always correlate with the best or worst function along the four facial regions. The single House-Brackmann score most strongly correlated with the regional scoring of the eye (61%), followed by the nose/midface (40%), mouth (32%), and forehead (18%). The global score did not correlate with the worst regional score in 30 patients (79%). In 3 of 5 patients with synkinesis and an obligatory Grade 3 or higher in the global House-Brackmann grading system, the regional facial function was Grade 2 or better at one or more areas of the face. CONCLUSIONS: In patients with differential facial function, a single global number is inadequate to describe facial function and primarily reflects the function of the eye. Regional assessment using the HBFNGS and reported as F(w) E(x) N(y) M(z) more fully communicates facial function.

A comparison between analysis time and inter-analyst reliability using spectral analysis of kinematic data and posture classification.

This study compares the time needed to analyze data and the inter-analyst variability using observational posture classification vs. spectral analysis of upper limb kinematic measurements made using an electrogoniometer for selected industrial jobs. Eight trained analysts studied four jobs using both methods. An incomplete fixed block experimental design was used, whereby each analyst used one method for each job. The four jobs included (1) punch press operation, (2) packaging, (3) parts hanging, and (4) construction vehicle operation. The posture classification analysis method involved visually classifying tipper extremity joint angles into specific zones relative to the range of motion for every one-third second (10 frames) of videotape. Spectral analysis required the analysts to identify cycle break points. The electrogoniometer signals were synchronized with each cycle, and power spectra for each joint were computed. The average difference in RMS joint deviation among analysts was 0.9 (SD = 0.61 degrees) for spectral analysis and 7.1 (SD = 2.53 degrees) for posture classification. The average difference in mean joint angle was 0.8 (SD = 0.59 degrees) for spectral analysis and 11.4 (SD = 1.58 degrees) for posture classification. Repetition frequency differed an average of 0.05 Hz (SD = 0.054 Hz) for spectral analysis and 0.07 Hz (SD = 0.058 Hz) for posture classification. Posture classification took a factor of 6.3 more time than cycle break point assignment for spectral analysis. Even considering the additional time needed for sensor attachment for direct measurement, posture classification took an average factor of 1.29 more time than spectral analysis using electrogoniometer data.

Evaluation of Hands-On Clinical Exam Performance Using Marker-less Video Tracking.

This study investigates the potential of using marker-less video tracking of the hands for evaluating hands-on clinical skills. Experienced family practitioners attending a national conference were recruited and asked to conduct a breast examination on a simulator that simulates different clinical presentations. Videos were made of the clinician's hands during the exam and video processing software for tracking hand motion to quantify hand motion kinematics was used. Practitioner motion patterns indicated consistent behavior of participants across multiple pathologies. Different pathologies exhibited characteristic motion patterns in the aggregate at specific parts of an exam, indicating consistent inter-participant behavior. Marker-less video kinematic tracking therefore shows promise in discriminating between different examination procedures, clinicians, and pathologies.

Factors influencing power hand tool fastening accuracy and reaction forces.

OBJECTIVE: A laboratory study investigated the relationship between power hand tool and task-related factors affecting threaded fastener torque accuracy and associated handle reaction force. BACKGROUND: We previously developed a biodynamic model to predict handle reaction forces. We hypothesized that torque accuracy was related to the same factors that affect operator capacity to react against impulsive tool forces, as predicted by the model. METHOD: The independent variables included tool (pistol grip on a vertical surface, right angle on a horizontal surface), fastener torque rate (hard, soft), horizontal distance (30 cm and 60 cm), and vertical distance (80 cm, 110 cm, and 140 cm). Ten participants (five male and five female) fastened 12 similar bolts for each experimental condition. RESULTS: Average torque error (audited - target torque) was affected by fastener torque rate and operator position. Torque error decreased 33% for soft torque rates, whereas handle forces greatly increased (170%). Torque error also decreased for the far horizontal distance 7% to 14%, when vertical distance was in the middle or high, but handle force decreased slightly 3% to 5%. CONCLUSION: The evidence suggests that although both tool and task factors affect fastening accuracy, they each influence handle reaction forces differently. We conclude that these differences are attributed to different parameters each factor influences affecting the dynamics of threaded faster tool operation. Fastener torque rate affects the tool dynamics, whereas posture affects the spring-mass-damping biodynamic properties of the human operator. APPLICATION: The prediction of handle reaction force using an operator biodynamic model may be useful for codifying complex and unobvious relationships between tool and task factors for minimizing torque error while controlling handle force.

Leveraging electronic health record systems to create and provide electronic cancer survivorship care plans: a pilot study.

PURPOSE: The Institute of Medicine (IOM) recommends cancer survivors receive survivorship care plans after completing active cancer treatment. However, care plan creation requires significant time and effort, contributing to diminished adoption of this recommendation. Electronic health record (EHR) systems have been proposed as a solution. We assessed the feasibility of creating and delivering care plans within an EHR system. METHODS: Thirty-eight breast cancer survivors without existing care plans were recruited during a follow-up visit to their primary oncologist. Using an EHR template, an oncologist created an individualized care plan for each participant. Time spent creating each plan was recorded. Participant use and feedback were collected. RESULTS: Participants enrolled a median of 19.7 months after diagnosis (range, 4.3 to 57 months). A minority of IOM-recommended plan elements could be automatically imported without any manual entry. The majority of elements required interpretation and manual import by the clinician. However, with an established infrastructure for importing elements, the time needed to create a care plan electronically was short (median, 3 minutes; range 2 to 12 minutes). Most survivors (n = 36; 95%) successfully accessed their care plans online and spent a median of 12 minutes (range, 0.5 to 61.9 minutes) reviewing them. Survivors perceived the plans as useful and did not generally report difficulty in accessing them online or understanding content. CONCLUSION: Rapid care plan creation and delivery within an EHR is possible. Plans were available to all (survivors, oncologists, primary care physicians) via the EHR. Further research is required to explore the barriers to automating data importation into plans as well as the impact of EHR-integrated plans.

Automated video exposure assessment of repetitive hand activity level for a load transfer task.

OBJECTIVE: A new method is described for automatically quantifying repetitive hand activity with the use of digital video processing. BACKGROUND: The hand activity level (HAL) is widely used for evaluating repetitive hand work. Conventional methods involving either a trained observer on- or off-site or manual off-site video analysis are often considered inaccurate, cumbersome, or impractical for routine work assessment METHOD: A cross-correlation-based template-matching algorithm was programmed to track the motion trajectory of a selected region of interest across successive video frames for a single camera to measure repetition frequency, duty cycle, and HAL. A simple, paced, load transfer task was used to simulate a repetitive industrial activity. A total of 12 participants were videoed performing the task for varying HAL conditions. The automatically predicted HAL was compared with the manually measured HAL with the use of frame-by-frame video analysis. RESULTS: Predicted frequency, duty cycle, and HAL were in concert with the manually measured HAL conditions. The linear regression slopes of the automatically predicted values with respect to the manually measured values were 0.98 (R2 = .79), 1.27 (R2 = .63), and 1.06 (R2 = .77) for frequency, duty cycle, and HAL, respectively. CONCLUSION: A proof-of-concept for automatic video-based direct exposure assessment was demonstrated. APPLICATION: The video assessment method for repetitive motion is promising for automatic, unobtrusive, and objective exposure assessment, which may offer broad availability with the use of a camera-enabled mobile device for helping evaluate, prevent, and control exposure to repetitive motions related to upper-extremity injuries in the workplace.