An image-based eyelid lesion management service-evaluation of a pilot.

BACKGROUND/AIMS: Oculoplastics is a predominantly visual specialty and many of the pathologies can be diagnosed based on external appearance. An image-based eyelid lesion management service was piloted to reduce the number of patients who would require outpatient clinic review. The aim of this study was to determine its accuracy and feasibility, both as a hospital-based and community optometrist-based service. If successful, the service was envisaged to significantly reduce the number of patients that require face-to-face (F2F) review, in accordance with current post-COVID-19 principles of social distancing. METHODS: Patients with lid lesions attending an oculoplastics clinic were assessed by consultant oculoplastic surgeons in an F2F consultation (Arm A). The lesions were photographed by a professional clinical photographer (Arm B) and by an optometrist with a handheld digital camera (Arm C). These images were reviewed by independent consultants masked to the outcome of the F2F clinical encounter. Data were collected prospectively including patient demographics, diagnosis, suspicion of malignancy and management. The image-based clinic results were compared to the F2F clinic results. RESULTS: Ninety-five patients were included. Clinical diagnoses were compared for intra-observer variability and substantial agreement was demonstrated between gold-standard F2F clinic visit (Arm A) and Arm B (Ƙ = 0.708) and C (Ƙ = 0.776). There was no statistically significant difference in the rate of discharge and all cases of malignancy were either identified or flagged for F2F review in the image-based arms. CONCLUSION: This pilot demonstrated substantial diagnostic agreement of image-based diagnoses with F2F consultation and image review alone did not miss any cases of malignancy.

Task selection for increased mechanical exposure variation: relevance to job rotation.

It is generally considered that variation in mechanical exposure is beneficial from the viewpoint of preventing musculoskeletal disorders. An approach to quantifying the functional similarity of manual tasks was developed and tested by using three handgrips: power grip (PG); pulp pinch (PP); lateral pinch (LP). Changes in maximal voluntary contraction (MVC) forces were measured during 15 combinations of 2-min duration, 30% MVC isometric contraction in 25 participants. Strength changes in PG were found to be substantially different from LP; when the two grips were alternated, strength dropped to 85.1% MVC whereas after PG alone, strength dropped to 59.3% MVC. The findings suggest that PG and LP are functionally different enough for their alternating use to contribute to increased exposure variation during manual activities. STATEMENT OF RELEVANCE: The paper describes how to determine if two tasks, when performed alternately, are different enough to reduce fatigue, increase work capacity and potentially prevent musculoskeletal disorders. Better understanding of the differences between tasks has the potential to improve job design by allowing better choice of tasks that combine to define a job.

A notable anniversary in the history of medical illustration.

The author argues that medical illustration is not a cross-cultural phenomenon known since ancient times, but a modern tradition born out of the intellectual climate of 18th century Europe. In this climate, photography was always desirable in theory, and medical illustrators grasped photographic technology as soon as it became available in the 1840s, quickly adapting it to their own purposes. The earliest surviving clinical photograph can be identified as that of a woman with a goitre taken by Hill and Adamson ca. 1847, in which case medical photography has this year reached its 150th anniversary. The author also offers a revised account of the speed and enthusiasm with which early medical illustrators recognized the opportunities afforded by new forms of technology.

Photography of dermatological conditions using polarized light.

The author set up a photographic trial in order to determine the practicality of using photography with parallel- and cross-polarized light alongside routine clinical photography, and the usefulness of the resultant images in comparison with conventional photographs. It was found that the technique added no more than 5 min to patient contact time, and that the attendant cost was minimal. Parallel-polarization has proved relatively valueless, but cross-polarization significantly enhanced the definition of pigmented lesions, and has considerable potential as a technique for documenting specific conditions, and as a teaching aid.