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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physicians are exposed to a series of occupational risk factors&#44; of which musculoskeletal problems are among the most noteworthy&#46; Musculoskeletal problems can lead to both acute and chronic neck and low back pain&#46; They can also become disabling&#44; are one of the main reasons for sick leave&#44; and account for considerable consumption of health care resources&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> A high percentage of physicians and surgeons may be affected by symptoms&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a> mainly chronic neck and low back pain&#46; While data on prevalence of these conditions among dermatologists are scarce&#44; the prevalence of musculoskeletal symptoms has been reported to be between 30&#37; and 50&#37;&#44; especially those associated with poor posture&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4&#44;5</span></a> We were unable to find recommendations on appropriate posture for dermatologists performing clinical examinations and dermatoscopy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various studies have shown how repetition and maintenance of some postures and body movements lead to degeneration of the joints responsible for stabilizing the spinal column&#44; and often additional complications such as chronic bone and muscle pain&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Some of these movements can damage the intervertebral discs&#44; cause ligament strain&#44; and reduce the diameter of the intervertebral foramina&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Joint movements that are advised against include any posture or gesture that requires unvarying&#44; forced movements that overload joint structures and are systematically repeated&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Some of these movements are observed daily in dermatologists who perform physical examinations&#46; They take the form of trunk hyperflexion that may involve rotation&#44; as well as cervical hyperextension or hyperflexion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Therefore&#44; the risk of lesions is not only associated with weight or sudden effort&#44; but also with the adoption of specific postures&#46; Given the high caseloads in our health centers&#44; it is not uncommon for a dermatologist to perform 10-15 physical examinations per day in patients with a high number of pigmented lesions or a history of multiple skin tumors&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Education about posture should play a key role in preventing the development of lesions in daily clinical practice&#46; Therefore&#44; we should try to ensure a neutral&#44; well-balanced posture with the muscles relaxed&#46; Postures that do not respect the natural curves of the spinal column overload its joint structures&#46; We should also adapt our workplace furniture and fittings to prevent forced postures&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In this article&#44; we propose a routine for performing clinical examinations and dermatoscopy based on good posture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Furthermore&#44; carrying out a physical examination systematically and meticulously can help to prevent omissions and delays in the diagnosis of lesions in areas that are difficult to examine&#44; such as the scalp or the soles&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our proposal for clinical examination and dermatoscopy in adult patients requires few specific items of furniture&#44; since we have a stool &#40;preferably a swivel chair with wheels and a backrest&#41; and a stretcher&#46; We can summarize our algorithm in the following successive steps&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient standing&#58; The upper third of the trunk is examined &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46; If the patient is of a similar height to the dermatologist&#44; then we can also examine facial and cervical lesions&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patient standing&#58; The doctor sits on a stool and can therefore examine the abdominal and suprapubic areas more comfortably&#46; The patient is then asked to turn his&#47;her trunk towards the doctor so that the flanks&#44; lower back&#44; and buttocks can be examined &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a><span class="elsevierStyleSmallCaps">C</span> and D&#41;&#46; We believe that examination in this position is more comfortable than the alternative&#44; ie&#44; the patient in supine decubitus&#44; since we can comfortably examine the lower back and buttocks through 360&#176;&#44; thus obviating the need for the doctor to bend over too far&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patient sitting on the stretcher&#58; If the patient is tall&#44; we can explore facial lesions&#44; since the patient is in our line of vision&#44; and we can perform the examination comfortably &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; We can take advantage of this position to perform a full examination of the scalp and pinnae &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patient in supine decubitus on the stretcher&#58; While the doctor remains seated on the stool&#44; the anterior surface of the thighs&#44; legs&#44; and dorsum of the feet are examined &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>C&#41;&#46; It is better if the stretcher is situated in such a way that the doctor can move around it and thus examine both sides of the patient more comfortably&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patient in prone decubitus on the stretcher&#58; With the patient in this condition&#44; the doctor can examine the posterior surface of the thighs&#44; legs&#44; and the soles of the feet &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D&#41;&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">While these simple steps for a full examination may seem no more than common sense&#44; incorrect gestures and movements are not infrequent among dermatologists in daily practice&#46; Therefore&#44; we believe that our suggestions could pave the way toward greater awareness of the importance of posture and thus help prevent the acquisition of inappropriate gestures and movements&#46; Similarly&#44; following these steps in an orderly fashion allows us to perform a systematic examination that covers the whole body surface&#44; without missing areas that are difficult to examine&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Ergonomics in Dermatology: Good Posture During Physical Examinations
Posturas ergonómicas para la exploración en dermatología
I. Hernández Aragüésb,
Corresponding author
ignaciohdezaragues@gmail.com

Corresponding author.
, A. Neyra Castañedab, E. Fernández Vilariñoa, G. Simala
a Servicio de Dermatología, Hospital San Pedro, Logroño, La Rioja, España
b Servicio de Prevención de Riesgos Laborales, Hospital General Universitario Gregorio Marañón, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physicians are exposed to a series of occupational risk factors&#44; of which musculoskeletal problems are among the most noteworthy&#46; Musculoskeletal problems can lead to both acute and chronic neck and low back pain&#46; They can also become disabling&#44; are one of the main reasons for sick leave&#44; and account for considerable consumption of health care resources&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> A high percentage of physicians and surgeons may be affected by symptoms&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a> mainly chronic neck and low back pain&#46; While data on prevalence of these conditions among dermatologists are scarce&#44; the prevalence of musculoskeletal symptoms has been reported to be between 30&#37; and 50&#37;&#44; especially those associated with poor posture&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4&#44;5</span></a> We were unable to find recommendations on appropriate posture for dermatologists performing clinical examinations and dermatoscopy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various studies have shown how repetition and maintenance of some postures and body movements lead to degeneration of the joints responsible for stabilizing the spinal column&#44; and often additional complications such as chronic bone and muscle pain&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Some of these movements can damage the intervertebral discs&#44; cause ligament strain&#44; and reduce the diameter of the intervertebral foramina&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Joint movements that are advised against include any posture or gesture that requires unvarying&#44; forced movements that overload joint structures and are systematically repeated&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Some of these movements are observed daily in dermatologists who perform physical examinations&#46; They take the form of trunk hyperflexion that may involve rotation&#44; as well as cervical hyperextension or hyperflexion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Therefore&#44; the risk of lesions is not only associated with weight or sudden effort&#44; but also with the adoption of specific postures&#46; Given the high caseloads in our health centers&#44; it is not uncommon for a dermatologist to perform 10-15 physical examinations per day in patients with a high number of pigmented lesions or a history of multiple skin tumors&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Education about posture should play a key role in preventing the development of lesions in daily clinical practice&#46; Therefore&#44; we should try to ensure a neutral&#44; well-balanced posture with the muscles relaxed&#46; Postures that do not respect the natural curves of the spinal column overload its joint structures&#46; We should also adapt our workplace furniture and fittings to prevent forced postures&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In this article&#44; we propose a routine for performing clinical examinations and dermatoscopy based on good posture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Furthermore&#44; carrying out a physical examination systematically and meticulously can help to prevent omissions and delays in the diagnosis of lesions in areas that are difficult to examine&#44; such as the scalp or the soles&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our proposal for clinical examination and dermatoscopy in adult patients requires few specific items of furniture&#44; since we have a stool &#40;preferably a swivel chair with wheels and a backrest&#41; and a stretcher&#46; We can summarize our algorithm in the following successive steps&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient standing&#58; The upper third of the trunk is examined &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46; If the patient is of a similar height to the dermatologist&#44; then we can also examine facial and cervical lesions&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patient standing&#58; The doctor sits on a stool and can therefore examine the abdominal and suprapubic areas more comfortably&#46; The patient is then asked to turn his&#47;her trunk towards the doctor so that the flanks&#44; lower back&#44; and buttocks can be examined &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a><span class="elsevierStyleSmallCaps">C</span> and D&#41;&#46; We believe that examination in this position is more comfortable than the alternative&#44; ie&#44; the patient in supine decubitus&#44; since we can comfortably examine the lower back and buttocks through 360&#176;&#44; thus obviating the need for the doctor to bend over too far&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patient sitting on the stretcher&#58; If the patient is tall&#44; we can explore facial lesions&#44; since the patient is in our line of vision&#44; and we can perform the examination comfortably &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; We can take advantage of this position to perform a full examination of the scalp and pinnae &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patient in supine decubitus on the stretcher&#58; While the doctor remains seated on the stool&#44; the anterior surface of the thighs&#44; legs&#44; and dorsum of the feet are examined &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>C&#41;&#46; It is better if the stretcher is situated in such a way that the doctor can move around it and thus examine both sides of the patient more comfortably&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patient in prone decubitus on the stretcher&#58; With the patient in this condition&#44; the doctor can examine the posterior surface of the thighs&#44; legs&#44; and the soles of the feet &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D&#41;&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">While these simple steps for a full examination may seem no more than common sense&#44; incorrect gestures and movements are not infrequent among dermatologists in daily practice&#46; Therefore&#44; we believe that our suggestions could pave the way toward greater awareness of the importance of posture and thus help prevent the acquisition of inappropriate gestures and movements&#46; Similarly&#44; following these steps in an orderly fashion allows us to perform a systematic examination that covers the whole body surface&#44; without missing areas that are difficult to examine&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Idiomas
Actas Dermo-Sifiliográficas
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