There is extensive literature to support the notion that the increase in occupational back and upper extremity injuries has become a major socioeconomic problem. To prevent these disabling and costly conditions successfully, more research is needed in all professions to determine where environmental risks exist, and more effort must be put into implementing preventive strategies. Best quality drugs cheap: find diabetes drugs and discover best deals online.
Our results indicate that ERCP endoscopists may be at considerable risk for the development of occupational musculoskeletal injuries. The preventive measures discussed in this paper should be implemented to minimize risk. The survey used in this study was sent only to ERCP endoscopists practising in Canada. A limitation of our study is that musculoskeletal complaints among ERCP endoscopists were not compared with those of endoscopists who do not perform ERCP. Further studies are needed in Canada and other countries to investigate this issue, which may lead to improved working conditions for ERCP endoscopists.
Ergonomic considerations are very important. The majority of respondents performed ERCP in areas with poor ergonomic design. Early endoscopy literature recommended using a fluoroscopy table with an adjustable height and the ability to tilt laterally. We agree with this recommendation and also suggest that video and fluoroscopy monitors should be placed side by side at a height such that the operators’ eyes are three-quarters of the way up the screen (Figure 3) to minimize eye strain and unnecessary neck torsion. Similar recommendations have been validated by the Health and Safety Guidelines for Computer Use developed by the Massachusetts Institute of Technology. Also, ERCPs are often performed in cramped radiology facilities. Improved ergonomic design maximizes space and promotes proper posture. Finally, antifatigue matting should be used when endoscopists perform several ERCPs in succession. This floor padding reduces pressure on the spine during prolonged standing and delays the fatigue process of muscles.
Our data indicate that performing more procedures over time is positively correlated with musculoskeletal injury. Due to the vasoelastic nature of all biological tissues, the spine and other joints may develop residual deformation under static loads. Repeated load can result in cumulative fatigue, which decreases the ability of the joints — especially the spine — to bear future stress. Prolonged standing and bent-over postures increase the likelihood of developing low back pain, and are both characteristics of physicians who perform ERCP. Twisting and bending motions drastically increase forces throughout the spine. Facilities that are designed to promote natural postures and limit the amount of twisting and bending protect operators from the development of cumulative trauma disorders. The risk factors involved in performing ERCP, the survey results and the appropriate modification strategies are summarized in Table 3. Cheapest online shopping – find cialis professional at best fully-licensed pharmacy.
A comparison of physicians with musculoskeletal injuries and those without musculoskeletal injuries revealed a higher proportion of injured physicians among those who had been practising ERCP longer. This variable was significant. This finding is consistent with the finding that 56% of injured respondents had experienced their symptoms only within the past five years and that 88% had experienced their symptoms only within the past 10 years. Because the majority of the noninjured physicians had been practising ERCP for less than 10 years, they may not yet have developed symptoms. These types of injuries are cumulative trauma disorders, and a higher percentage of ERCP endoscopists may be afflicted over time (Figure 1). A higher proportion of injured physicians was also seen among those who performed more ERCPs per year (Figure 2). There were more injured physicians in every frequency category, but this was only statistically significant in those performing more than 150 ERCPs per year. Shop with best online pharmacy and find birth control yasmin getting the most out of it.
Since 1992, the Occupational Safety and Health Administration has been preparing federal legislation in the United States concerning ergonomic hazards in at-risk workplaces. We are unaware of such legislation in Canada. Sufficient evidence and documentation of the association between several health care professions and musculoskeletal disorders of the back and upper extremities have led to the implementation of various ergonomic considerations for such professions. Similar considerations need to be implemented for endoscopists who perform ERCP and other procedures on a repetitive basis. Until sufficient evidence and documentation demonstrate a need for risk management among endoscopists, no action will be taken to implement preventive strategies to protect the profession at large. Efficient treatment has got less costly: find asthma inhalers at best online pharmacy.
Back, neck and hand pain, respectively, were the most frequently reported symptoms and are all consistent with the physical risk factors involved in performing ERCPs leading to RSIs. A total of 79% of injured respondents were bothered by their symptoms while performing ERCP, and 74% felt that their conditions were attributable to endoscopy and ERCP, suggesting the potential cause and effect relationship between ERCP and musculoskeletal injuries.
Respondents were subdivided into two groups – ‘injured’ and ‘noninjured’. Nonparametric tests of significance were performed. Z-tests were performed to determine the statistical significance of number of years performing ERCP, number of ERCPs performed per year and number of ERCPs performed in succession; the corresponding Z-scores were 2.442, 0.525 and 0.655, respectively. Therefore, the only significant variable (Z-score greater than 1.654) was number of years performing ERCP. Cheapest drugs online – buy birth control for you to spend less money every time.
X2 tests were performed to determine the statistical significance of having adjustable tables and ergonomic room design between injured and noninjured respondents on developing an injury. Of these two factors, only ergonomic room design had a statistically significant effect on injury, with a calculated value of 2.534, which was greater than the critical value for x.
Of the treatments used, the most common was medication (36%), followed by physiotherapy (15%) and massage therapy (13%). Thirty-three per cent of respondents used more than one form of treatment (Table 2). Respondents who had an injury were asked whether they had modified the way in which they performed ERCP to prevent further injury or to alleviate pain symptoms while performing ERCP. Of the 76 injured respondents, 14 (18%) had modified how they performed ERCP, three stated that conditions could not be modified and the remaining 59 had not attempted to change their working conditions. The majority of respondents (61%) wore a one-piece lead apron while performing ERCP. Seventy-nine per cent of respondents currently used a videoscope, while 11% currently used fibre optic scopes. Eighty-nine per cent of respondents had used fibre optic scopes in the past. More than one-half of the respondents did not take regular breaks between procedures (Table 2).
Of the 162 surveys sent, 122 responses were received, with five respondents indicating that they no longer performed ERCP and three indicating that they were not interested in participating. This is a total response rate of 74% (114 of 154). You have a great opportunity to find birth control pills to feel one lucky customer.
Sixty-seven per cent of respondents reported at least one musculoskeletal complaint, 58% of whom reported two or more complaints. Back pain (57%), neck pain (46%) and hand pain (36%) were the complaints reported most frequently, followed by elbow pain (8%), shoulder pain (16%) and other complaints (two wrist pain, one heel pain and one latex allergy) (5%). Forty-one per cent of the affected respondents experienced their symptoms while performing ERCP and during other activities, and another 38% of the affected respondents were bothered by their symptoms only when performing ERCP. Three-quarters (74%) of affected respondents felt that their conditions were attributable to endoscopy and ERCP. Seventeen per cent thought that their injury was due to sports, 4% thought that their condition was due to their operating table, 4% thought that their injury was due to a pre-existing condition and 1% thought that their condition was simply a factor of age.
The majority of respondents had been afflicted with their pain symptoms within the past five years. Almost one-half (45%) of the respondents who had an injury or pain symptoms did not use any form of treatment.
Physicians practising ERCP in Ontario were identified from a pre-existing database obtained by calling all hospitals with 100 or more beds. Physicians practising ERCP outside of Ontario were identified by calling ERCP endoscopists at each medical school in Canada, who then identified their local academic and community peers. A study package containing a cover letter, a two-page self-administered questionnaire and a stamped return envelope was mailed to the identified physicians. The return envelopes were numbered to keep track of who participated in the study. The results were kept anonymous. Nonrespondents were sent a second study package, with the same contents as the first mailing, approximately six weeks later.
Occupationally induced musculoskeletal injuries have become a widespread problem among many health care professionals. The two areas of the body that are most frequently affected by these occupational injuries are the lower back and the upper extremities. Repetitive movements, static muscle loading and awkward body posture are the most common causes of musculoskeletal injury. Evidence suggests that physicians incur occupational injuries by performing procedures on a repetitive basis. In addition, a positive correlation between wearing lead aprons and developing low back injury has been shown. Despite this evidence, very little has been reported regarding musculoskeletal injuries to endoscopists, and there is no literature specific to the injuries incurred by those who perform endoscopic retrograde cholangiopancreatography (ERCP). ‘Endoscopist’s thumb’, ‘endoscopist’s tendonitis’, ‘endoscopist’s neck’ and ‘biliary endoscopist’s knuckle’ are all conditions that have been attributed specifically to the performance of endoscopy procedures, but no studies have been conducted to determine the prevalence of such conditions.