Risk of surgical site infection in 401 consecutive patients with glioblastoma with and without carmustine wafer implantation

OBJECTIVES

Patients with glioblastoma (GBM) have an inherently shortened survival because of their disease. It has been recently shown that carmustine wafers in addition to other therapies (surgery, temozolomide, and radiation) can further extend survival. There is concern, however, that these therapies may increase infection risk. The goals of this study were to calculate the incidence of postoperative infection, evaluate if carmustine wafers changes the risk of infection and identify factors independently associated with an infection following GBM surgery.

METHODS

All patients who underwent non-biopsy, surgical resection of an intracranial GBM from 2007 to 2011 at a single institution were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection, including the use of carmustine wafers. Variables with P < 0.05 were considered statistically significant.

RESULTS

Four hundred and one patients underwent resection of an intracranial GBM during the reviewed period, and 21 (5%) patients developed an infection at a median time of 40 [28-286] days following surgery. The incidence of infection was not higher in patients who had carmustine wafers, and this remained true in multivariate analyses to account for differences in treatment cohorts. The factors that remained significantly associated with an increased risk of infection were prior surgery [RR (95% CI); 2.026 (1.473-4.428), P = 0.01], diabetes mellitus [RR (95% CI); 6.090 (1.380-9.354)], P = 0.02], and increasing duration of hospital stay [RR (95% CI); 1.048 (1.006-1.078); P = 0.02], where the greatest risk occurred with hospital stays > 5 days [RR (95% CI); 3.904 (1.003-11.620), P = 0.05].

DISCUSSION

These findings may help guide treatment regimens aimed at minimizing infection for patients with GBM.

The evaluation of ergonomic risk factors among meat cutters working in Jabalpur, India

BACKGROUND

Manual meat cutters in India are at high risk of work-related musculoskeletal disorders (WMSDs) for a variety of reasons including holding awkward postures, repetitive forceful exertions, and inadequate rest. This is the first study of its kind to investigate the nature and magnitude of WMSDs among manual meat cutters in India.

OBJECTIVE

The aim of this study was to measure the ergonomic risk factors for WMSDs among adult male manual meat cutters working in Jabalpur, India.

METHODS

We used direct observation, activity analysis, questionnaires, interviews, photography, and video to measure the quantitative ergonomic risk factors.

RESULTS

Ovako working posture analysis indicated high scores (four for the back in peeling, six for the arms in cutting, and six for the arms during mincing tasks). Rapid entire body assessment method (REBA) scores were also high at 10/10 for deboning and mincing tasks, all associated with repetitive movements of the arms and awkward posture of the upper part of the body.

CONCLUSIONS

The study indicates that most tasks for meat cutters fall in the high-risk category for occupational injury. Results suggest that ergonomic interventions that address retooling and workstation and process redesign would be useful in reducing the number of injuries.