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PubMed2006

Reduction of musculoskeletal injuries in intensive care nurses using ceiling-mounted patient lifts.

The musculoskeletal injury (MSI) rate in the Richmond Hospital Intensive Care Unit (ICU) increased significantly in 2000 and 2001 by 130%. As part of a quality initiative program, the problem was identified, assessed, and a plan was developed that involved the installation of ceiling-mounted patient lifts (CMPL) and the incorporation of a patient positioning sling. The evaluation process included a survey given to the ICU nursing staff prior to the implementation of the CMPL and repeated three, six, and 18 months after implementation. The survey included questions about discomfort, fatigue, and frustration levels before and after a 12-hour shift, as well as any medical interventions such as use of medications, physician visits, physiotherapy, and massage therapy for work-related issues. The use of the lifts contributed to lower scores in fatigue, pain and frustration in addition to a reduction in medical visits. The results also demonstrated a significant reduction in work-related time loss claims while promoting a positive workplace environment.

Absenteeism↗
PubMed1991

Lumbar spine loads during the lifting of extremely heavy weights.

The reaction moments at the knee, hip, and L4/L5 joints, and the compressive and shearing forces on L4/L5 are documented in powerlifters competing in a national powerlifting championship. Analyses were made of 13 female and 44 male competitors. The joint moments and forces were estimated from a linked segment model (WATBAK) that incorporated functional low back extensor musculature with a moment arm of 6 cm and a line action that was oriented 5 degrees posteriorly to the L4/L5 compression axis. This oblique orientation of the extensor muscles reduced the anterior shearing load on the vertebral motion unit. Average compressive loads on L4/L5 were estimated up to 17,192 N while the highest average L4/L5 and hip moments were 988 and 1047 N.m, respectively. The sumo deadlift style resulted in a 10% reduction in the joint moment and 8% reduction in the load shear force at the L4/L5 level when compared with the conventional lifting style. Formulation of linear regression equations to predict the load lifted using reaction joint moments yielded substantial unexplained variability, though significant relationships were found. This analysis suggested that there is large variability in the pattern of loading joints among national class powerlifters.

Biomechanical Phenomena↗
PubMed1991

Weight lifting. Risks and injuries to the shoulder.

The weight lifter's desire to achieve higher limits of performance coupled with the rotator cuff's unfavorable position during lifting often leads to shoulder injury. Proper lifting techniques and training habits could reduce the risk of injury. When chronic symptoms occur, however, arthroscopy can help diagnose the injury, and arthroscopic procedures for injuries such as rotator cuff chronic tendinitis and incomplete tears, and biceps tenosynovitis can be performed.

Arthroscopy↗
PubMed1991

Relationship of heart rate to oxygen uptake during weight lifting exercise.

To define the relation of heart rate to oxygen uptake during weight lifting (WL), heart rate (HR) and oxygen uptake (VO2) were determined during bouts of WL at four intensities (40, 50, 60, and 70% of one-repetition maximum (1-RM)) in 15 males. The 11.5-min bouts of WL consisted of three circuits using four exercises (bench press, bent-over row, arm curl, and parallel squat), with each performed for ten repetitions over a 30-s period with a 1:1 work/rest ratio. During lifting at the four intensities, mean (+/- SE) VO2 values were 1.31 +/- 0.04, 1.50 +/- 0.07, 1.72 +/- 0.07, and 1.86 +/- 0.08 l.min-1, or 33-47% of treadmill-determined VO2max. Mean (+/- SE) HR values were 124 +/- 4, 134 +/- 4, 148 +/- 5, and 161 +/- 4 beats.min-1, or 63-82% of maximal HR. The slope of the linear regression equation predicting %VO2max from %HRmax (Y = 0.582X - 1.7911, r = 0.86, SEE = 3.4%) was approximately half that reported for dynamic low-resistance exercise such as running or cycling. At a given %HRmax, %VO2max was consistently lower than predicted for dynamic low-resistance exercise. It was concluded that the HR/VO2 relationship during dynamic high-resistance exercise for intensities between 40 and 70% of 1-RM is linear but is different from that reported for dynamic low-resistance exercise. The data are consistent with the conclusion in previous studies that using HR to prescribe the metabolic intensity of WL exercise results in a substantially lower level of aerobic metabolism than during dynamic low-resistance exercise.

Adult↗
PubMed1987

Plasma volume changes and cardiovascular responses associated with weight lifting.

Ten experienced weight lifters were studied to determine the influence of strenuous, free-weight, squat lift exercise on changes in plasma volume, mean arterial pressure, and the rate pressure product. After a 40-min postural adjustment prior to upright exercise, each subject completed eight sets of eight repetitions of the squat exercise at 55% of the one-repetition maximum. Electrocardiogram heart rate was monitored throughout the test, and blood pressure was determined at the completion of each exercise set. Arterialized capillary blood was drawn during sitting and standing pre-exercise and at the end of the second, fourth, sixth, and eighth sets for the measurement of hemoglobin, hematocrit, and plasma protein concentration, and after the last set for blood lactate. Five additional subjects participated in a postural control comparison. The results of the ANOVA showed a significant loss in plasma volume over the trials which was 2 1/2 times greater than for the control subjects (17.9 vs 7.7% loss) over the same period of time. Exercise rate pressure product increased by 2.85 times resting while only 1.1 times resting for the control subjects. An elevation in mean arterial pressure was found to be correlated to changes in plasma volume, r = -0.98. This study found that plasma volume is reduced while the rate pressure product is increased during the squat lift exercise.

Adult↗
PubMed1981

Response of type I fibers to weight lifting in rat plantaris.

The purpose of this histochemical study was to determine the effect of weight lifting exercise training on the muscle fibers in 2 muscle regions of the rat plantaris. Adult female Wistar rats were trained to carry weights up to 150 gm on their backs, up a 50 degrees incline, for a period of 6 weeks. A comparison between the exercised and control groups showed no significant muscle hypertrophy or change in the number of fibers. Only the smallest muscle fibers, which are located predominantly in the superficial region of the plantaris, showed a significant increase (19.6%, p less than 0.01) in diameter. The data suggest that the smallest muscle fibers, in the superficial region of the plantaris in this weight lifting training program, were exercised out of proportion to their usual activity and responded to the stress of the activity by enlarging.

Animals↗
PubMed1994

The revised NIOSH lifting guidelines. Application in a hospital setting.

1. Ergonomic interventions, which include the application of biomechanical models, are an integral part of a workplace injury control program. 2. The NIOSH 1991 Lifting Guide is an example of a biomechanical model. It is utilized as an assessment tool in the ergonomic analysis of a task performed by hospital nursing personnel. 3. The risk for musculoskeletal injury is quantified from the analysis. Economically feasible modifications to the task are outlined to reduce the associated lifting hazards.

Back Pain↗
PubMed1994

Rolling or lifting following hip replacement?

1. New minimum standards for manual load handling require nurses to rethink lifting strategies for patients. 2. The pelvic lift, used for skin inspection following hip replacement surgery, is particularly hazardous. 3. Safe methods of moving these patients are needed to protect the newly inserted hip from dislocation. 4. Rolling can be achieved without breaching the safe position range needed for protection against dislocation, and is safer for nurses.

Hip Prosthesis↗
PubMedDate not supplied

Minimal-incision endoscopic face-lift.

Ptosis of the midfacial tissues with resultant deepening of the melolabial folds, vertical lengthening of the lower eyelid, and depression of the oral commissure are generally only slightly improved with traditional superficial musculoaponeurotic system (SMAS) suspension or rhytidectomy techniques. Subperiosteal, deep plane, and composite rhytidectomies have evolved in an attempt to rejuvenate these areas. This article reviews a series of patients who underwent an endoscopic subperiosteal face-lift either as an isolated procedure or in conjunction with an SMAS rhytidectomy. Although all patients showed good initial improvement, patients with thin faces and well-defined facial bone structure maintained the best long-term result. Complications were minimal, with no permanent facial nerve injuries observed. The endoscopic subperiosteal face-lift is a useful technique as an isolated procedure or in conjunction with facial liposuction or SMAS suspension rhytidectomy. Arch Facial Plast Surg. 2000;2:274-278

Adult↗
PubMedDate not supplied

Techniques for creating inconspicuous face-lift scars: avoiding visible incisions and loss of temporal hair.

Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the price of signs that betray a face-lift, namely, visible incisions. We describe our face-lift incisional planning and the rationale behind specific surgical maneuvers for preventing unwanted sequelae. The telltale signs of poorly placed incisions include temporal hair loss, conspicuous scars, an unnatural appearance to the tragus, and a posterior hairline distorsion. Special considerations are given to the male patient and to the salvage of readily visible incision lines from previous surgery.

Alopecia↗
PubMedDate not supplied

Safety of face-lifts in the older patient.

OBJECTIVE: To compare the surgical and anesthesia complications after rhytidectomy in patients 75 years and older vs those aged 45 to 61 years. DESIGN: Retrospective review of 107 patients of a single surgeon in private practice. All patients 75 and older who underwent rhytidectomy (using deep-plane and superficial musculoaponeurotic system plication techniques) from 1998 to 2002 were selected. This cohort was compared with a randomly selected group of rhytidectomy patients aged 45 to 61 from the same period. Complications related to the procedure or anesthesia were recorded, as well as American Society of Anesthesiologists (ASA) physical class, method of procedure, and patient age. RESULTS: The mean ages of the 2 groups were 79.0 years (33 patients) and 54.2 years (74 patients). Five patients in the older cohort had minor complications after surgery, compared with 7 in the younger group (P = .52). No major complications were reported. CONCLUSIONS: Patients 75 and older carry risks of postoperative complications from face-lift procedures that are similar to those of middle-aged patients, when matched for ASA class. Preoperative counseling should emphasize patient health status rather than age when considering the risk of postoperative complications. Face-lift surgery can be safely performed in patients 75 years and older with ASA class less than 3.

Aged↗
PubMed1998

Comparison of subperiosteal vs subgaleal elevation techniques used in forehead lifts.

OBJECTIVES: To compare eyebrow and forehead elevation and tension among the following 3 surgical techniques: subperiosteal dissection to the supraorbital rim, subperiosteal dissection with release (elevation, incision, and spread) of periosteum at the supraorbital rim, and subgaleal dissection to the supraorbital rim, and to determine the optimal method of elevation in an aesthetically accepted range for the endoscopic forehead lift. DESIGN: A randomized, self-controlled study using an open approach to the forehead in cadaver heads. Each half of head was compared with the other in the following 2 study groups: subperiosteal dissection without release vs subperiosteal dissection with release of periosteum (group 1) and subperiosteal dissection with release of periosteum vs subgaleal dissection. SETTING: Anatomy laboratory at a university medical center. SUBJECTS: Eight cadaver heads fixed with ethylene glycol in each group. INTERVENTION: Predissection distances in millimeters from fixed anatomic landmarks were measured. The forehead flaps were elevated using a coronal incision and divided with a midline incision for side-to-side comparison. Cadaver heads and side of surgical intervention were selected randomly. The flap tensions associated with incremental flap advancement of 0.5 and 1.0 cm were measured. Traction of 2.2 kg was then applied to each flap, and distances between the fixed landmarks were measured. MAIN OUTCOME MEASURES: Mean predissection and postdissection distance of brow and forehead elevation for each dissection type and mean distance and median tension of brow and forehead elevation within each group. RESULTS: The mean postdissection brow measurements at rest were significantly greater than the mean predissection measurements at most landmarks in all dissections for both groups (P<.05). The mean postdissection brow and forehead measurements with 2.2 kg of traction were significantly greater than the mean predissection measurements at all landmarks in all dissections for both groups (P<.05). The mean increase in distance from predissection to postdissection (at rest and with 2.2 kg of traction) did not significantly differ between the different dissection types (P>.05). For group 1, the median flap tension for subperiosteal dissection without release was greater than that for subperiosteal dissection with release (P>.05). For group 2, subperiosteal dissection with release had greater median flap tension than subgaleal dissection (P>.05). CONCLUSIONS: All 3 methods of dissection significantly elevated the brow at rest for most landmarks. All 3 methods of dissection significantly elevated the brow and forehead when traction was applied to the flap. Brow and forehead elevation at rest and with 2.2 kg of traction did not significantly differ between the dissections. Subgaleal dissection was associated with less flap tension compared with the subperiosteal dissection with or without release. The data support the use of all 3 methods of forehead dissection for brow elevation and subgaleal forehead dissection as the optimal approach for the forehead lift, whether performed endoscopically or open.

Aged↗
PubMed1978

The brow-lift operation in a man.

Various techniques of brow elevation, including their advantages and limitations, are discussed. Since there are no lines immediately above the eyebrow, the direct brow-lift operation results in a scar that cannot be camouflaged with makeup by a man. The approach via temporofrontal scalp produces limited and temporary brow elevation, and the scars may eventually become visible with hairline recession in men. A technique of the brow-lift operation in a man via the natural, horizontal forehead crease above the eyebrow has been found to be very effective. The complications have been minimal, the resulting scars have been unnoticeable.

Adult↗
PubMed1982

The frontalis nerve in the temporal brow lift.

Brow elevations via the indirect temporal lift approach was carried out on a series of 26 cadaver half heads. The purpose of the dissection was to identify the course and depth of plane of the frontalis branch of the facial nerve. Of particular interest was the area superolateral to the brow. Histologic sections were taken along the course of the nerve to determine its exact depth. It was determined that the nerve lay in the superficial musculoaponeurotic system layer of superficial fascia lying above the level of the temporalis fascia. Utilizing this information, a method of dissection in the temporal lift operation is described that safely avoids the frontalis branch of the facial nerve.

Cadaver↗
PubMed1983

Midforehead lift.

Ptosis of the brow-glabellar tissues with or without vertical and horizontal wrinkling accompanies aging in other areas of the face. The direct browlift is effective in elevating and shaping brow tissues, but leaves a scar at the brow-forehead juncture and does little for glabellar deformity. The coronal forehead lift allows the correction of brow-glabellar ptosis and wrinkling with camouflage of the scar in the scalp. Male pattern hairline, thinning hair, or a high hairline may contraindicate this approach. Our technique for treating these patients is the midforehead lift. We review the anatomical considerations, patient selection, and surgical technique, showing representative cases.

Aged↗
PubMed1995

The anterior extension face-lift.

OBJECTIVE: To describe a face-lift technique with emphasis on extension of the temporal incision into the lateral orbital area. This modification serves several beneficial ends but must be used only in carefully selected patients. Gathering of excess skin in the lateral orbital area is prevented, eliminating the typical disparity between relatively tight lower and middle facial skin and flaccid upper facial skin, which is commonly seen after rhytidectomy. The anterior extension also helps to support the lower eyelid, which is helpful when lid laxity exists or when concomitant blepharoplasty is performed. SETTING: A private cosmetic surgery center. PARTICIPANTS: Thirty-five patients undergoing rhytidectomy (15 primary and 20 revision procedures). OUTCOME MEASURE: Patient satisfaction at 3 months after surgery. RESULTS: Thirty-four (97%) of 35 patients were pleased with their results. CONCLUSIONS: The anterior extension face-lift can provide excellent results in carefully selected patients. We have found this procedure to be especially helpful in patients undergoing revision surgery and in older patients with facial skin laxity.

Female↗
PubMed1998

M. levator ani in the rat: does it really lift the anus?

BACKGROUND: There is a good deal of confusion about the denomination of the pelvic floor muscles of the rat in the literature. By carefully dissecting and observing tail and visceral movements and pressure measurements in the vagina, rectum, and urethra during electrical stimulation, we studied the anatomy and function of the different muscles and searched for similarities with the human anatomy. RESULTS: We found some degree of similarity between the M. pubococcygeus and M. iliococcygeus muscles in both species. The M. levator ani in the rat resembles in gross anatomy the M. puborectalis in man, but the insertion and function are different. More specifically, stimulation of the M. levator ani led to only a negligible pressure rise in the rectum and no lifting of the rectum or anus. CONCLUSIONS: The M. pubococcygeus and the M. iliococcygeus share similarities with their homologues in the human. The M. levator ani, which is present only in the male rat, reveals some anatomical resemblance with the human M. puborectalis but has a different insertion and function. Because it does not lift the anus during contraction, its denomination as M. levator ani seems unjustified. Because of its principal sexual function, its fixation to the bulbus, and its sensitivity to testosterone, naming this muscle M. bulbocavernosus dorsalis would indeed seem more logical.

Anal Canal↗
PubMed2003

Microalgae cultivation in air-lift reactors: modeling biomass yield and growth rate as a function of mixing frequency.

The slow development of microalgal biotechnology stems from the failure in the design of large-scale photobioreactors where light energy is efficiently utilized. Due to the light gradient inside the reactor and depending on the mixing properties, algae are subjected to certain light/dark cycles where the light period is characterized by a light gradient. These light/dark cycles will determine productivity and biomass yield on light energy. Air-lift reactors can be used for microalgae cultivation and medium-frequency light/dark cycles will be found in these systems. Light/dark cycles are associated with two basic parameters: first, the light fraction, i.e., the ratio between the light period and the cycle time and second, the frequency of the light/dark cycle. In the present work, light/dark cycles found in air-lift reactors were simulated taking into account the light gradient during the light period. The effect of medium-frequency cycle time (10-100 s) and light fraction (0.1-1) on growth rate and biomass yield on light energy of the microalgae Dunaliella tertiolecta was studied. The biomass yield and growth rates were mainly affected by the light fraction, while cycle time had little influence. Response surface methodology was used and a statistical model describing the effect of light fraction and cycle time on growth rate and biomass yield on light energy was developed. The use of the model as a reactor design criterion is discussed.

Biomass↗