PubMed Health⌕ Search

Biomedical subjects

Daniel G Becker

Publications and source records attributed to Daniel G Becker.

At least 19 recordsLinked to original sources
PubMed2005

Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting.

The purpose of this report is to describe a crisis in healthcare, disabling back injuries in US healthcare workers. In addition, outlined is the proven solution of safe, mechanized, patient lifting, which has been shown to prevent these injuries. A "Safe Patient Handling--No Manual Lift" policy must be immediately instituted throughout this country. Such a policy is essential to halt hazardous manual patient lifting, which promotes needless disability and loss of healthcare workers, pain and risk of severe injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from manually lifting patients. Back injury may be the single largest contributor to the nursing shortage. Reported injuries to certified nursing assistants are three to four times that of registered nurses. A national healthcare policy for "Safe Patient Handling--No Manual Lift" is urgently needed to address this crisis. Body mechanics training is ineffective in prevention of back injury with patient lifting. Mandated use of mechanical patient lift equipment has proven to prevent most back injury to nursing personnel and reduce pain and injury to patients associated with manual lifting. With the national epidemic of morbid obesity in our country, innovative devices are available for use in emergency medical systems and hospitals for patient lifting and transfer without injury to hospital personnel. The US healthcare industry has not voluntarily taken measures necessary to reduce patient handling injury by use of mechanical lift devices. US healthcare workers who suffer disabling work-related back injuries are limited to the fixed, and often inadequate, relief which they may obtain from workers' compensation. Under workers' compensation law, healthcare workers injured lifting patients may not sue their employer for not providing mechanical lift equipment. Discarding healthcare workers disabled by preventable back injuries is an abuse which legislators must remedy. In addition, Medicare reimbursement policies must also be updated to allow the disabled community to purchase electrically operated overhead ceiling lifts. The US lags far behind countries with legislated manual handling regulations and "No Lifting" nursing policies. England and Australia have had "No Lifting" nursing policies in place since 1996 and 1998, respectively. The National Occupational Research Agenda (NORA) recognized a model in 2003 for reduction of back injuries to nursing staff in US healthcare facilities. Also in 2003, the American Nurses Association called for elimination of manual patient handling because it is unsafe and causes musculoskeletal injuries to nurses. The first state legislation for safe patient handling passed both houses in California but was vetoed by the Governor in September 2004. California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting.

Adult↗
PubMed2005

A dedicated specialty center for nose and sinus care: an organized approach.

A specialty center focusing on a single, widespread medical problem and housing all treatment modalities is a revolutionary approach to medical treatment. Sinusitis, the most common chronic illness in the United States, is ideally suited to this approach. By housing the most advanced options for patients in a highly specialized treatment facility, attention is focused on the patient's problem, and treatment may be improved. In this article, an overview of the specialty center approach to sinus and nasal disorders is provided. State-of-the-art medical treatment, allergy evaluation and treatment, and surgical technology, including powered instrumentation and computerized image-guided surgery, are all employed in the treatment of functional nasal problems and cosmetic nasal requests. A subspecialty training program will allow for replication of this model for sinus and nasal care nationally. The Becker Nose and Sinus Center, LLC, is the first specialty center in New Jersey focused on diagnosing and treating patients who suffer from nasal and sinus disorders. The Nose and Sinus Center houses some of the most advanced options for patients in nose and sinus care in a highly specialized treatment facility and is a model for this organized approach to sinus and nasal care.

Academic Medical Centers↗
PubMed2004

Diagnostic and surgical endoscopy in functional septorhinoplasty.

Endoscopy has altered our ability to diagnose pathology accurately during the preoperative assessment, and it has also offered surgeons the ability to perform surgeries in a minimally invasive manner. In this article, we review the senior author's experience with diagnostic and surgical endoscopy in functional septorhinoplasty. A thorough examination of the nasal cavity in the patient seeking cosmetic rhinoplasty along with correction of nasal obstruction is enhanced by the performance of office nasal endoscopy. Endoscopically guided septoplasty is useful as a minimally invasive approach for isolated septal deformities, and it is an indispensable approach in difficult revision nasal surgeries in which obstructing septal deviation persists. Endoscopy is a critical diagnostic and surgical tool in patients seeking cosmetic nasal surgery who also have functional nasal complaints.

Endoscopy↗
PubMed2004

Revolutionary advances in sun-protective clothing--an essential step in eliminating skin cancer in our world.

For many years, individuals around the world have relied on sunscreen alone as their primary form of protection against ultraviolet rays (UV-R). Australia has shown that a multitactic approach to skin cancer prevention, combining sun-protective clothing with sunscreen, can be both highly effective and widely accepted by the general public. In the US, the aging baby boomer generation and rising skin cancer epidemic call for a fundamental behavioral shift toward this combination approach to sun protection. Sun-protective clothing, such as that manufactured by Coolibar and awarded the Seal of Recommendation by The Skin Cancer Foundation, offers millions of Americans the opportunity to significantly improve the quality of their lives and is an essential step in eliminating skin cancer in our world. All Coolibar clothing products carry a minimum ultraviolet protection factor (UPF) rating of 30, blocking 97% UV-R or greater. Each product in the Coolibar clothing line is individually tested and rated for its UV protection level; this process is explained in a thorough hangtag attached to the product. This tag specifies what UPF the product has received, how the UPF is figured, which testing procedures the individual product was submitted to, and if that product has received the Seal of Recommendation from The Skin Cancer Foundation. In addition to photoprotective clothing, The Skin Cancer Foundation recommends Rit Sun Guard, a photoprotective laundry additive. Rit Sun Guard washes into the clothing fibers and absorbs broadband UV-R. A single treatment of Rit Sun Guard sustains a UPF of 30 for approximately 20 launderings. The active ingredient in Rit Sun Guard is TINOSORB FD. In order to be certified by The Skin Cancer Foundation, the Coolibar clothing product must undergo extensive UPF testing to confirm the accuracy of the product labeling. Laundry additives evaluated by The Skin Cancer Foundation undergo similar tests to that of photoprotective clothing after a uniform laundering method is used to apply the product to the clothing fibers. Both of these certification processes confirm the UPF, UV-A and UV-B transmittance, and percentage blocking UV-A and UV-B. The certification process is reviewed on an annual basis.

Health Promotion↗
PubMed2004

Excisional biopsy of skin tumors.

The most frequently encountered neoplasm in the US is skin cancer. More than 600,000 new cases of malignant skin tumors are diagnosed in the US each year. One standard method of treatment of skin tumors is excisional biopsy. There are seven technical considerations involved in the excisional biopsy of skin tumors: (1) aseptic technique, (2) examination and demarcation of skin lesion, (3) skin biomechanical properties, (4) anesthesia, (5) excisional biopsy, (6) wound closure, and (7) postoperative care. The physician must use aseptic techniques and wear a cap, mask, and powder-free gloves. Hair is a source of wound contamination, and removal of hair prevents it from becoming entangled in suture and the wound during closure. Because surgical electric clippers cut hair close to the skin surface without nicking the skin, we now use only electric clippers to remove hair. The physician's visualization of the wound can be enhanced by magnification (2.5x) loupes. The physician's plan for excisional biopsy is dictated by the suspected pathology of the skin lesion. The ultimate appearance and function of a scar after closure of excisional biopsy can be predicted by the static and dynamic skin tensions on the surrounding skin. Infiltration anesthesia is preferred over regional nerve block because it does not interfere with the muscle movement that causes dynamic tensions, which elongate the configuration of the defect. Most skin lesions are amenable to a circular excision. In these instances, it is worthwhile to use circular-shaped excisions. The reusable metal trephines have been replaced by disposable trephines that have ribbed plastic handles attached to 316 stainless steel circular cutting blades. Wound closure is accomplished in the same direction as the long axis of the elliptical defect by first approximating the midportion of the defect with a 4-0 synthetic CAPROSYN* monofila-ment absorbable suture attached to the swage of the laser-drilled, compound-curved reverse cutting edge needle. Additional interrupted dermal (subcuticular) sutures are placed in each wound quadrant to approximate further the divided edges of the dermis. Compound-curved reverse cutting edge needles have been specifically designed for dermal closure. Reinforced Steri-Strips are then applied transversly across the incision to facilitate further skin edge approximation. Rigorous follow-up examination is essential for any patient with a history of a skin cancer to detect recurrence and prevent further actinic damage. The use of wide diameter trephine biopsy instruments are still not widely used by physicians because most physicians do not have the technical skills to approximate the defect with dermal sutures. Consequently, this need for a rapid dermal skin closure technique that can be used by a primary care physician must be devised before the trephine excisional biopsy technique is widely used by the primary care physician. This goal can be achieved by developing a disposable stapler for subcuticular closure of the skin.

Anesthesia, Local↗
PubMed2004

National health strategies to reduce sun exposure in Australia and the United States.

Australia has developed a national health care policy that has made prevention of the occurrence of skin cancer a societal responsibility. Its strategies for skin cancer control have included careful documentation of the incidence of skin cancer over the last two decades. After realizing that the magnitude of sun exposure during childhood is a major risk factor in the development of skin cancer, Australia provides successful strategies to monitor and reduce the frequency of skin cancer. Early in the 1970s, education campaigns for the public as well as the healthcare worker were implemented that included booklets, posters, and teaching materials. This educational program allowed the public as well as healthcare workers to diagnose accurately the presence of skin cancer. In addition to identifying tumors at an early stage, Australia managed an exciting educational program on photodamage prevention. Australian standards governing ultraviolet radiation protection were incorporated into numerous comprehensive legislative bills that set standards for a wide variety of sun protective products to include sunscreens, photoprotective apparel, sunglasses, and occupational standards for sun exposure. On the basis of these comprehensive standards, the epidemic of skin cancer has been curbed, as documented. In contrast to Australia, the United States has relatively few comprehensive skin cancer prevention programs. These programs include the National Skin Cancer Prevention Educational Program, National Skin Cancer Prevention and Detection Month, The Skin Cancer Foundation's Self-Examination Program, and the State of California and US Food and Drug Administration Sunscreen legislation. It is difficult to measure the impact of these innovative efforts because there is not an accurate monitoring system for all skin cancers in the United States. However, the National Cancer Institute does determine the incidence of melanoma, which is reported annually by the American Cancer Society in their January/February issue of CA Journal for Clinicians. Statistics on other skin cancers are only projective. In the absence of an accurate, comprehensive statistical monitoring system for the frequency of skin cancer in the United States, as well as the limited legislative initiatives, it is difficult for organizations such as the American Academy of Dermatology, the American Cancer Society, the Centers for Disease Control and Prevention, and The Skin Cancer Foundation to ascertain the results of their efforts to prevent skin cancer. Consequently, the prevention of skin cancer in the United States is a personal rather than a societal responsibility.

Australia↗
PubMed2004

Photoprotection by sunscreens with topical antioxidants and systemic antioxidants to reduce sun exposure.

Skin cancer is the most common cancer diagnosed in the United States, and its incidence continues to rise. Epidemiological studies have documented that excessive sun exposure increases the risk of developing nonmelanoma skin cancer. Consequently, it is mandatory that the skin be protected from the damage that occurs from ultraviolet (UV) exposure. It is the purpose of this report to review the scientific basis for photoprotection by sunscreens, topical antioxidants, and systemic antioxidants to minimize the harmful effect of sun exposure. The US Food and Drug Administration regulates sunscreen products as over-the-counter drugs. Sunscreens are chemical or organic UV absorbers and nonchemical or inorganic UV absorbers. Other important sunscreen considerations include the sunscreen vehicle, sunscreen photostability, sunscreen preservatives, and sunscreen photoallergy and phototoxicity. Topical and systemic antioxidants have now been shown to supplement the photoprotective effects of sunscreen. The Skin Cancer Foundation, the only national and international nonprofit organization concerned exclusively with cancer of the skin, is playing a leadership role in eliminating skin cancer in our world.

Administration, Topical↗
PubMed2004

Use of UV-protective windows and window films to aid in the prevention of skin cancer.

People are exposed to ambient solar ultraviolet (UV) radiation throughout their daily routine, intentionally and unintentionally. Cumulative and excessive exposure to UV radiation is the behavioral cause to skin cancers, skin damage, premature skin aging, and sun-related eye disorders. More than one million new cases of skin cancer were diagnosed in the United States this year. UV radiates directly and diffusely scattered by the various environmental and atmospheric conditions and has access to the skin from all directions. Because of this diffuse UV radiation, a person situated under a covering, such as the roof of a car or house, is not completely protected from the sun's rays. Because shade structures do not protect effectively against UV radiation, there have been major advances in photoprotection of glass by the development of specially designed photoprotective windows and films. It is the purpose of this collective review to highlight the photoprotective windows and films that should be incorporated into residential, commercial, and school glass windows to reduce sun exposure. Low-emittence (low-E) coatings are microscopically thin, virtually invisible, metal or metallic oxide layers deposited on a window or skylight glazing surface to reduce the U-factor by suppressing radiative heat flow as well as to limit UV radiation. The exclusive Thermaflect coating uses the most advanced, double-layer soft coat technology to continue to deliver top performance for UV protection as well as prevent heat loss in the home. This product blocks 87% of UV radiation and has an Energy Star certification in all climate zones. Tints and films have been another important advance in glass photoprotection, especially in automobiles. Quality widow film products are high-tech laminates of polyester and metallized coatings bonded by distortion-free adhesives. The International Window Film Association provides members with accreditation in solar control films, safety films, and automotive films in an effort to increase consumer awareness and demand for all professionally installed film window products. The Skin Cancer Foundation has also played a leadership role in certifying window films that limit UV transmission. The Panorama Designer and Safety Films are currently recommended for UV photoprotection by The Skin Cancer Foundation. On the basis of these innovative scientific and industrial advances in window and film photoprotective products, we recommend that they be used in all residential, commercial, and school facilities to provide photoprotection in an effort to reduce skin cancer.

Glass↗
PubMed2004

Strategies to reduce hyperthermia in ambulatory multiple sclerosis patients.

Approximately 400,000 Americans have multiple sclerosis. Worldwide, multiple sclerosis affects 2.5 million individuals. Multiple sclerosis affects two to three times as many women as men. The adverse effects of hyperthermia in patients with multiple sclerosis have been known since 1890. While most patients with multiple sclerosis experience reversible worsening of their neurologic deficits, some patients experience irreversible neurologic deficits. In fact, heat-induced fatalities have been encountered in multiple sclerosis patients subjected to hyperthermia. Hyperthermia can be caused through sun exposure, exercise, and infection. During the last 50 years, numerous strategies have evolved to reduce hyperthermia in individuals with multiple sclerosis, such as photoprotective clothing, sunglasses, sunscreens, hydrotherapy, and prevention of urinary tract infections. Hydrotherapy has become an essential component of rehabilitation for multiple sclerosis patients in hospitals throughout the world. On the basis of this positive hospital experience, hydrotherapy has been expanded through the use of compact aquatic exercise pools at home along with personal cooling devices that promote local and systemic hypothermia in multiple sclerosis patients. The Multiple Sclerosis Association of America and NASA have played leadership roles in developing and recommending technology that will prevent hyperthermia in multiple sclerosis patients and should be consulted for new technological advances that will benefit the multiple sclerosis patient. In addition, products recommended for photoprotection by The Skin Cancer Foundation may also be helpful to the multiple sclerosis patient's defense against hyperthermia. Infections in the urinary tract, especially detrusor-external sphincter dyssynergia, are initially managed conservatively with intermittent self-catheterization and pharmacologic therapy. In those cases, refractory to conservative therapy, transurethral external sphincterotomy followed by condom catheter drainage is recommended. However, if external urethral sphincterotomy fails to reduce residual urine and detrusor pressure, urinary diversion or bladder reconstruction may be necessary.

Body Temperature↗
PubMed2003

Auricular cartilage in revision rhinoplasty.

Revision rhinoplasty is a challenge in reconstruction to the rhinoplasty surgeon, both in the techniques of repair and the choice of implant material for augmentation grafting. Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for a decision about the material that will be used for structural grafting. The senior author follows the time-tested approach of generations of surgeons who have used exclusively autogenous material for nasal reconstruction because of its superior long-term survival characteristics, its ready availability in the head and neck region, its resistance to infection and resorption, and its bendability and flexibility when implanted in the nose. With this in mind, the subject of this article is the use of auricular cartilage in revision rhinoplasty. Careful strategic planning must be undertaken to get the maximal and ideal benefit from the auricular cartilage. The revision rhinoplasty surgeon must understand the anatomy of the external ear and must be able to manage the precious cartilage supply to get the maximum use of it in reconstructive rhinoplasty.

Ear Cartilage↗
PubMed2003

Treatment of nasal obstruction from nasal valve collapse with alar batten grafts.

Nasal obstruction may require treatment with rhinoplasty techniques. One cause of nasal obstruction is known as nasal valve collapse. This refers to narrowness and weakness at the nasal valve, the narrowest part of the nasal airway. There are a number of surgical approaches available to treat nasal valve collapse. Selection of the appropriate surgical intervention depends on proper identification of the anatomic cause of the collapse. Alar batten grafts are especially useful for addressing nasal valve collapse caused by a weak nasal sidewall. In this report, we review the senior author's experience with the use of alar batten grafts for nasal valve collapse. Twenty-one patients had septoplasty with placement of alar batten grafts; all patients noted improvement in their nasal breathing. Seven patients underwent ear cartilage harvest with alar batten grafts, and five of them noted improvement, one noted partial improvement, one noted no improvement. Six patients underwent revision septorhinoplasty with alar batten grafting, and ten patients underwent revision septorhinoplasty with ear cartilage harvest and alar batten grafting. These patients all reported improvement in their nasal breathing postoperatively. Six patients underwent revision rhinoplasty (no septoplasty) with ear cartilage and battens. These patients hold special interest because no other intranasal procedures were performed that affected nasal breathing. All six of these patients reported significant improvement of their nasal breathing and all patients were satisfied with their postsurgical cosmetic appearance. The nasal valve area is considered to be the location of the least cross-sectional area in the nose. When narrowing of the nasal valve is a result of collapse of the nasal sidewall, alar batten grafts are a useful technique to address the patient's nasal obstruction.

Female↗
PubMed2003

Treatment of sinus and nasal disorders in the 21st century.

In the modern history of the surgical treatment of sinus and nasal problems, there have been three revolutionary changes. The first was the introduction and refinement of endoscopic techniques in the 1980s. The second important development in the modern history of rhinology was the introduction of powered instrumentation in the 1990s. Now in the 21st Century we see a third turning point, which is the use of intraoperative image guidance in endoscopic sinus surgery. These three advances are being integrated to provide a new level of care for problems of the nose and sinuses and are the subject of this special section. In the first articles, the author provides an overview of sinusitis and reviews many of the medical treatments available for the management of sinusitis. When anatomic abnormalities of the nose and sinuses contribute to sinusitis, and when medical therapy has failed, these anatomic or structural abnormalities can be surgically corrected. In the article entitled "Minimally Invasive Approach to Endoscopic Sinus Surgery," we review this modern approach to the sinuses and discuss recent advances. We also provide an overview of rhinoplasty--surgery to reshape the nose--with special emphasis on the surgical anatomy and preoperative analysis of appearance. We conclude by reviewing some of the more common adjunctive cosmetic procedures performed with surgery of the nose and sinuses.

Humans↗
PubMed2003

Sinusitis.

Sinusitis is one of the most common health care complaints in the United States. Approximately one in eight people in the US will have sinusitis at one time in their lives. Until recently, sinusitis has been an undertreated disease. The drastic negative effect of sinusitis on patients' quality of life has been generally underappreciated and unrecognized. Recent studies show that patients score the effects of chronic sinus disease in areas such as bodily pain and social functioning as more debilitating than diseases such as angina, congestive heart failure, emphysema, chronic bronchitis, and lower back pain, to name a few. In the past, many patients were told they would just have to "live with" their sinus problem. However, there have been enormous advances in the past 15 years in the ability to diagnose and treat these problems. This is largely because of technological advances in nasal endoscopy and X-ray imaging. Also, the development of newer, more powerful medications and significant advances in surgical treatment have played a major role in improved patient care. In this article, we provide an overview of sinusitis. We describe the modern definition of sinusitis and the normal physiology of the sinuses. We discuss the causes of sinusitis with attention to the role of allergies, acid reflux, and other related disorders. Finally, we review the current approach to the diagnosis of sinusitis.

Humans↗
PubMed2003

Medical treatment of sinusitis.

Treatment of sinusitis is aimed at eliminating causative factors and controlling the inflammatory and infectious components. Ideal management includes preventative measures, including the use of specific medications in proper dose and duration. In this article, we review many of the medical treatments available for the management of sinusitis.

Anti-Bacterial Agents↗
PubMed2003

The minimally invasive, endoscopic approach to sinus surgery.

When anatomic abnormalities of the nose and sinuses contribute to sinusitis, and when medical therapy has failed, these anatomic or structural abnormalities can be surgically corrected. Examples of anatomic problems include nasal polyps, nasal septal deviations, and blockage of the osteomeatal complex--the "crossroads" of the sinuses. Endoscopic techniques allow sinus specialists to diagnose and treat these problems more easily than in the past, allowing them to be more proactive in the management of anatomic nasal abnormalities. In this article we review the minimally invasive, endoscopic approach to sinus surgery and discuss recent advances in sinus surgery. Specifically, we discuss the utility of powered instrumentation and image guidance in endoscopic sinus surgery.

Adult↗
PubMed2003

Rhinoplasty.

Rhinoplasty--surgery to reshape the nose--is a common procedure for both cosmetic and functional requests. In this article, the author provides an overview of rhinoplasty, with special emphasis on the surgical anatomy and preoperative analysis of appearance. A review of some of the surgical techniques at the disposal of the rhinoplasty surgeon is also provided and illustrated with patient examples.

Adult↗