Ergonomía en cirugía laparoscópica ginecológica / Ergonomics and gynecologic laparoscopic surgery

INTRODUCCIÓN Y OBJETIVOS: Están demostradas las ventajas de la cirugía laparoscópica para el paciente en términos de dolor, rápida recuperación y precisión quirúrgica, sin embargo, no existen estudios nacionales respecto al impacto en los cirujanos. El objetivo de este trabajo es realizar un estudio prospectivo de evaluación ergonómica de ginecólogos que operan cirugía laparoscópica. MÉTODOS: Se utilizaron métodos de evaluación específica por ergónomo experto y percepción de los participantes. Se evaluaron, carga global de trabajo (NASA-tlx), carga bio-mecánica (REBA) y la percepción de molestias músculo-esqueléticas (Escala de Discomfort Corporal). Se recogieron datos personales y de la cirugía, para explorar la existencia de dificultades técnicas. RESULTADOS: 86,7% de los ginecólogos evidenciaron altos niveles de carga global de trabajo, siendo las variables esfuerzo y rendimiento, las de mayor puntaje. El nivel de riesgo bio-mecánico, fue catalogado como medio en la totalidad de la población. 60% manifestó discomfort corporal durante la cirugía. En cuanto a las dificultades técnicas, el efecto fulcrum estuvo presente en el 46% de los cirujanos, el mismo porcentaje tuvo síntomas de ojo seco. El 68% alguna vez accionó el pedal equivocado y ha sentido parestesia del pulgar. CONCLUSIONES: La cirugía laparoscópica ginecológica, presenta una elevada carga global de trabajo. El ginecólogo percibe un importante discomfort corporal y algunas dificultades técnicas. Es necesario incorporar medidas ergonómicas, para minimizar y/o disminuir los factores de riesgo mental y físicos, y así prevenir el desgaste precoz y lesiones a futuro en los cirujanos.

INTRODUCTION AND OBJECTIVES: Laparoscopic surgery had demonstrated advantages such as less pain, rapid recovery and surgical precision. There are no national data regarding the impact on surgeon's health. This is a prospective study on ergonomic evaluation and laparoscopic surgery performed by gynecologists. METHODS: Specific evaluation methods were used such as Global workload (NASA-tlx), bio-mechanical load (REBA) and the perception of musculoskeletal discomfort (Body Part Discomfort Scale). Personal opinions and surgery data were collected to explore the existence of technical difficulties. RESULTS: 86.7% of gynecologists cataloged surgery as high level of global workload. Effort and performance variables were most important. Bio-mechanical risk level was classified as medium in the entire population. 60% showed body discomfort during surgery. Regarding technical difficulties, fulcrum effect was present in 46% of surgeons, the same percentage had dry eye symptoms. 68% have a pedal error activation during surgery and felt paresthesia of the thumb. CONCLUSIONS: Gynecological laparoscopic surgery has a high overall workload. The gynecologist perceives an important body discomfort and some technical difficulties. It is necessary to incorporate ergonomic measures, to minimize and / or reduce mental and physical risk factors, and thus prevent early wear and future injuries in surgeons.

Validity And Inter-Rater Reliability Of Postural Analysis Among New Raters

@#Work posture analysis is crucial in observing and reducing work-related musculoskeletal symptoms in the workplace. However, in a developing country, new raters are commonly assigned to conduct postural analysis to save on cost. This study aims to observe the validity and inter-rater reliability (defined as the degree of agreement among different raters) among new raters of three different commonly used work posture analysis methods: Rapid Upper Limb Assessment (RULA), Rapid Entire Body Assessment (REBA), and Ovako Workload Assessment System (OWAS). Fifty industrial engineering students, divided into five groups, who received prior training about the use of the methods, participated voluntarily in this study by observing ten different working postures in five different industries: the tofu, military equipment manufacturing, automotive maintenance and service, cracker, and milk-processing industries. One ergonomics expert also observed the working postures. Validity was observed based on the correlation between new raters’ ratings and the rating of the ergonomics expert. Inter-rater reliability within one group was calculated using the percentage of agreement and kappa value. The result shows high validity of RULA, REBA, and OWAS among new raters. There are insignificant differences in the inter-rater reliability of new raters among RULA, REBA, and OWAS. The implications of the result are discussed.

Prevalence Of Work Related Musculoskeletal Disorders In Fire Fighters

Introduction: Firefighters having high risk for occupational injuries, perform many hazardous job tasks at the scene of fire. The objective of this cross sectional study is to find the prevalence of self reported musculoskeletal disorders in firefighters at various Fire brigade centres in Mumbai. Method: Total number of 70 active duty firefighters ,both male and females ,were recruited in the study from various fire brigade centres in Mumbai. A validated questionnaire was administered to them consisting information about their demographics, their job profile and self reported measures of their health and co morbidities. The participants also completed a Body Diagram to indicate the location of pain for their musculoskeletal problems. Their working postures was analysed by using REBA after doing a pilot study .The three tasks were lifting the ladder up and down ,folding the hose and lifting the dummy .The data was collected and analysed. Result: The study participants comprised both male and females active duty firefighters, 59 males, mean age (27-45 years ),SD (3.5) and 11 females ,mean age (25-30 years), SD (1.6). The prevalence of neck, shoulder, elbow ,upper back and lower back complaints was 24%, 23%, 13%, 7% and 6 % respectively. 27% participants reported no complaints related to musculoskeletal problems. REBA (Rapid Entire Body Assessment) indicated that 40 out of 70 firefighters have medium risk of cumulative trauma disorders while 30 have high risk in the task of lifting the ladder up and down on shoulders. For folding the hose, all 70 participants had medium risk of injuries and for lifting the dummy, 29 out of 70 had high risk and 41 firefighters had very high risk of musculoskeletal injuries. Conclusion- This study reveals that there is high prevalence of musculoskeletal injuries especially in neck and shoulder among firefighters at various fire brigade centres in Mumbai .REBA assessment for the risk analysis for cumulative trauma disorders shows medium to high risk in all three tasks of lifting the ladder, folding the hose and lifting the dummy which warrants immediate preventive measures and remedial treatment among the study population.

Clinical Usefulness of PCR-REBA for Diagnosis of Onychomycosis / 대한의진균학회지

BACKGROUND: PCR-based reverse blot hybridization assay (PCR-REBA) has high sensitivity and specificity, can be performed directly on nail samples, is relatively cheaper than other molecular biologic methods, and is useful for diagnosing onychomycosis. OBJECTIVE: This study aims to compare the diagnostic efficacy of fungal culture and REBA Fungus-ID® which is a commercial PCR-REBA-based kit used for onychomycosis diagnosis. METHODS: Fifty nail samples were collected from 50 patients diagnosed with onychomycosis via direct microscopic examination using KOH preparation, and subjected to fungal culture and REBA Fungus-ID® test. RESULTS: The sensitivity of conventional fungal culture and REBA Fungus-ID® was 56% and 100%, respectively. In REBA Fungus-ID®, 43 of 50 samples were found to be infected with Trichophyton rubrum. Four of the remaining 7 samples were identified as infected with Trichophyton spp., one with Trichophyton mentagrophytes, and two revealed a panfungal DNA sequence. In fungal culture, 28 of 50 samples showed growth, of which 18 samples were identified as T. rubrum, 3 as Rhodotorula mucilaginosa, 3 as Cladosporium spp., 1 as Cyphellophora europaea, 1 as Penicillium cvjetkovicii, 1 as Lachnum soppittii, and 1 as non-dermatophytic mold. REBA Fungus-ID® and fungal culture were identical in 20 cases (40%). The non-dermatophytic fungi identified in fungal culture were considered contaminants. CONCLUSION: Nail specimens can be used directly for REBA Fungus-ID®, which has a high sensitivity for onychomycosis diagnosis. Therefore, it can be considered useful for diagnosis and identification of the causative organism in mixed infections like onychomycosis.

Ergonomic risk assessment of manual handling tools by oil palm collectors and loaders

Oil palm workers are exposed to ergonomics problems in their routine works. Although many technological advances have been developed, a large number of workers are still using manual handling tools in their daily work. A study was done to identify and solve the problems or issues of material handling effect on oil palm collectors and loaders during their daily work activities. A cross sectional study was done in an oil palm plantation in Negeri Sembilan, Malaysia. Twenty five workers were selected randomly to participate in this study. Musculoskeletal symptoms were recorded using Modified Nordic Questionnaires and awkward postures of the workers were assessed using Rapid Entire Body Assessment (REBA). Result showed that 61% of workers were exposed to high risk level and 39% to very high risk level of working posture problems. In conclusion, majority of oil palm collectors and loaders need to correct their working posture as soon as possible. The manual handling activities need to be improved with respect to correct procedure for health and safety concerns.

A Case Study On Manual Handling At An Electronic Component Manufacturing Company

This An Ergonomic hazard often exists in any industry. However, majority of the employees are not aware of practicing good body posture until the MSDs symptoms become permanent and chronic. The main objective of this study is to determine the manual handling problems among workers at an electronic component manufacturing company. The scope of this study focused on the study entire body disorders among workers on electronic manufacturing company using the Rapid Entire Body Assessment (REBA). A cross sectional study involving observation of the workplace, the work task and the working environment, photographs and videos taken during the observation. Later, a survey questionnaire was given to the respondents to obtain their socio-demography information, work activity and health problems. Rapid Entire Body Assessment (REBA) was conducted on all respondents to determined REBA scores in different work positions. The study was conducted at an electronic component manufacturing company located in Klang Valley, Selangor. A total of 124 workers were surveyed and REBA assessment was performed on 20 workers at Company X production area. It includes 5 categories of position at Company X, such as:loading steel bar into casing; pushing the steel bar, turning movement while adjusting the steel bar, adjusting steel bar into the loading area, unloading steel bar from casing into the machine. The study found that turning section has the highest MSDs problems regarding manual handling because majority of the respondents in the turning department felt the pain while performing their work. This is due to their job demand, which they need to handle with tools weighing from 200 to 400 kg. The REBA scores showed that17 out of 20 respondents performing turning operations, moving and pushing the steel bar recorded the highest score of 11 or more which are categorize in the very high risk group. The position of pushing and turning steel bar while moving the steel bar has higher risk that contributed to the ergonomics risk factor, which in-turn can contribute to Muscular Skeletal Disorders (MSDs). More detailed investigation and remedial measures should be taken immediately, especially for the workers performing the manual handlings activities.

Prevalence Of Musculoskeletal Problems And Awkward Posture In A Pakistani Garments Manufacturing Industry

This cross-sectional study aimed to serve as a pilot investigation to identify the level of discomfort and awkward posture among the workers of a garments manufacturing industry. The study was conducted for both male (54) and female (26) workers working in two different departments - stitching and finishing. Data were collected using both questionnaire and direct observation. As discomfort cannot be measured directly, a questionnaire was used to measure it based on subjective ratings by the workers. For analyzing posture, two objective assessment tools were used – rapid upper limb assessment (RULA) to analyze sitting posture and rapid entire body assessment (REBA) for standing posture. The cumulative scores of discomfort for different body parts were measured. The lower back was found to be at the highest risk as compared to other body parts. Female workers had higher score of discomfort (mean = 2.9615, S.D. = 1.3931) as compared to their male counterparts (mean = 1.2693, S.D. = 0.6538). Similarly, standing workers suffered more discomfort (mean = 2.7272, S.D. = 1.3090) as compared to sitting workers (mean = 1.0909, S.D. = 0.3784). No worker received ergonomically acceptable score for both of postural assessment tools. The mean RULA score was 5.25 and mean REBA score was 5. The results of this study necessitate a company-wide ergonomic assessment immediately.

Cytological Evaluation and REBA HPV-ID HPV Testing of Newly Developed Liquid-Based Cytology, EASYPREP: Comparison with SurePath

BACKGROUND: The objective of this study was to evaluate a newly-developed EASYPREP liquid-based cytology method in cervicovaginal specimens and compare it with SurePath. METHODS: Cervicovaginal specimens were prospectively collected from 1,000 patients with EASYPREP and SurePath. The specimens were first collected by brushing for SurePath and second for EASYPREP. The specimens of both methods were diagnosed according to the Bethesda System. Additionally, we performed to REBA HPV-ID genotyping and sequencing analysis for human papillomavirus (HPV) on 249 specimens. RESULTS: EASYPREP and SurePath showed even distribution of cells and were equal in cellularity and staining quality. The diagnostic agreement between the two methods was 96.5%. Based on the standard of SurePath, the sensitivity, specificity, positive predictive value, and negative predictive value of EASYPREP were 90.7%, 99.2%, 94.8%, and 98.5%, respectively. The positivity of REBA HPV-ID was 49.4% and 95.1% in normal and abnormal cytological samples, respectively. The result of REBA HPV-ID had high concordance with sequencing analysis. CONCLUSIONS: EASYPREP provided comparable results to SurePath in the diagnosis and staining quality of cytology examinations and in HPV testing with REBA HPV-ID. EASYPREP could be another LBC method choice for the cervicovaginal specimens. Additionally, REBA HPV-ID may be a useful method for HPV genotyping.

Demanda biomecánica en el ensamblaje de un vehículo camioneta deportiva / Biomechanical demand in a sport truck assembly process

En este estudio se realizó la valoración de la demanda biomecánica de las actividades ejecutadas en el proceso de ensamblaje de un vehículo camioneta deportiva; este análisis es de corte transversal y utiliza las metodologías Suzanne Rodgers y REBA para identificar las situaciones críticas y, paralelamente, establecer cuál de estas herramientas resulta más apropiada para valorar la situación de los puestos de trabajo estudiados. La evaluación multitarea de la carga física se emplea para estimar el nivel de riesgo ponderado del conjunto de actividades que ejecutan los trabajadores. Se evaluaron 3177 actividades distribuidas en 318 puestos. Los resultados muestran que la mayoría de las operaciones tienen un nivel de riesgo medio a lesiones del sistema osteomuscular. Se obtuvo evidencia estadística, con la cual se puede afirmar con una significancia del 1 por ciento que el método REBA tiene una valoración mayor (más severa) en cuanto al nivel de exigencias requerido para la ejecución de una actividad, en contraste con el método Rodgers, por lo que se concluye que para la evaluación biomecánica debe utilizarse el método REBA, por ser más sensible a los factores de riesgo presentes en la ejecución de las tareas. Finalmente se plantean oportunidades de mejora de tipo técnicas y administrativas en aquellos casos donde el nivel de riesgo fue medio y alto. En total se presentaron 1307 recomendaciones, a través de las cuales se pretende disminuir los niveles de riesgo encontrados.

This study assessed the biomechanical demand of activities performed during a sport truck assembly process of. This is a cross-sectional analysis and uses the Suzanne Rodgers and REBA methodologies for identifying critical situations and concurrently establishes which of these tools is more appropriate for assessing the situation of jobs studied. Multitask evaluation of physical load is used to estimate the weighted risk level of the group of activities performed by the workers. 3177 activities, distributed in 318 jobs, were evaluated. Results show that most of the operations have a medium risk level of osteomuscular system lesions. Statistical evidence was obtained which allows stating with a significance of a 1 percent that the REBA method has a higher evaluation (more stringent) regarding the level of requirements for the performance of the activity, as compared with the Rodgers method. For this reason it is concluded that the REBA method should be used for biomechanical evaluation since it is more sensitive to risk factors present in tasks performance. Finally, a proposal is made about opportunities of technical and administrative improvement in those cases where the risk level was medium to high. A total of 1307 recommendations were submitted to try to diminish risk levels found.