ABSTRACT
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.
Subject(s)
Ambulatory Surgical Procedures , Ergonomics/methods , Headache/prevention & control , Mohs Surgery/methods , Musculoskeletal Diseases/prevention & control , Occupational Diseases/prevention & control , Physicians , Adult , Asthenopia/prevention & control , Edema/prevention & control , Female , Humans , Low Back Pain/prevention & control , Male , Minnesota , Neck Pain/prevention & control , Physicians' Offices , Population Surveillance , Posture , Shoulder Pain/prevention & control , Videotape RecordingSubject(s)
Adjuvants, Immunologic/administration & dosage , Aminoquinolines/administration & dosage , Kidney Transplantation/adverse effects , Papillomaviridae/isolation & purification , Papillomavirus Infections/drug therapy , Porokeratosis/drug therapy , Adjuvants, Immunologic/therapeutic use , Administration, Topical , Aged , Aminoquinolines/therapeutic use , Biopsy , DNA, Viral/analysis , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Imiquimod , Male , Middle Aged , Ointments , Papillomaviridae/genetics , Papillomavirus Infections/pathology , Papillomavirus Infections/virology , Polymerase Chain Reaction , Porokeratosis/pathology , Porokeratosis/virologyABSTRACT
Infliximab, a chimeric mouse-human monoclonal antibody, blocks the action of tumor necrosis factor-alpha and is a highly effective treatment for several inflammatory disorders, including inflammatory bowel disease and rheumatoid arthritis. Although safety data are encouraging, immunosuppressive sequelae may result. We report the acute development of multiple squamous cell carcinomas and keratoacanthomas in a patient receiving infliximab for rheumatoid arthritis.