The impact of intraoperative microbreaks with exercises on surgeons: A multi-center cohort study.

Recent literature has demonstrated ergonomic risk to surgeons in the operating room. One method used in other industries to mitigate these ergonomic risks is the incorporation of microbreaks. Thus, intraoperative microbreaks with exercises in a non-crossover design were studied. Fifty-six attending surgeons from 4 Medical Centers volunteered first in a day of their regular surgeries and then second day where there were microbreaks with exercises that could be performed in the sterile field, answering questions after each case, without significantly increasing the duration of their surgeries. Surgeons self-reported improvement or no change in their mental focus (88%) and physical performance (100%) for the surgical day incorporating microbreaks with exercises. Discomfort in the shoulders was significantly reduced while distractions and flow impact was minimal. Eighty-seven percent of the surgeons wanted to incorporate the microbreaks with exercises into their OR routine. Intraoperative microbreaks with exercises may be a way to mitigate work-related musculoskeletal fatigue, pain and injury.

Participatory ergonomics and new work: reducing neck complaints in assembling.

A participatory ergonomics approach is used to create a new work environment, which is aimed at reducing neck complaints in a cell phone assembly. The participatory ergonomics program included an initiative, problem identification, a selection of solutions, an implementation and evaluation. Twenty-eight women, all operators on an assembly line of cell phone boards, voluntarily participated in the design and evaluation of a device before implementing the device to all 215 employees performing that job. Prior to and after the intervention, RULA, comfort experiences and interviews were used. After introducing an adjustable angled small counter, these measurements showed both posture and comfort improvements. 90% of the 215 workers preferred the new work station and the neck complaints were reduced in 75% of the group. It also showed that the initial prototype needed to be modified as to reduce its sharp edges/compression points for the forearm. This project shows the importance of iterative testing and that an initiative by workers enlarges the chance of successful implementation.

Improving and analyzing signage within a healthcare setting.

Healthcare facilities are increasingly utilizing pictograms rather than text signs to help direct people. The purpose of this study was to analyze a wide variety of standardized healthcare pictograms and the effects of color contrasts and complexity for participants with both normal and impaired vision. Fifty (25 males, 25 females) participants completed a signage recognition questionnaire and identified pictograms while wearing vision simulators to represent specific visual impairment. The study showed that certain color contrasts, complexities and orientations can help or hinder comprehension of signage for people with and without visual impairment. High contrast signage with consistent pictograms involving human figures (not too detailed or too abstract) is most identifiable. Standardization of healthcare signage is recommended to speed up and aid the cognitive thought process in detecting signage and determining meaning. These fundamental signage principles are critical in producing an efficient, universal wayfinding system for healthcare facilities.

Evaluation of four cursor control devices during a target acquisition task for laparoscopic tool control.

Current laparoscopic surgery instruments create awkward postures which produce fatigue and pressure points in surgeons. In order to alleviate some of this discomfort a new laparoscopic tool had been developed with the inclusion of an articulating end-effector manipulated by a trackball. The current study was developed to access the performance of four input devices which could replace the manual trackball in a powered laparoscopic tool. A simple Fitts' law task was conducted and the devices' performance was evaluated with both subjective and objective measures. This article makes three main contributions to the scientific community. First, it provides a comparison of four control devices (TouchPad, Mouse Button Module, MiniJoystick Module and MicroJoystick) for use in a powered laparoscopic tool. Second, it provides an understanding of how the non-traditional measure of target re-entry can be utilized to compare control devices and how this relates to the more traditional measures of throughput and error rate. Finally, it contributes to the understanding of how a user's familiarity with a control device could affect the subjective and objective performance of the device. The main results indicate that the TouchPad and MicroJoystick are the best candidate-devices for use in a powered laparoscopic tool. The article also provides support for utilizing the new measure target re-entry when comparing control performance. Although studied in the application of laparoscopic surgery, the results can be generalized for the design of any hand-held device in which the speed and accuracy of the control device is critical.

Evaluation of a two cursor control device for development of a powered laparoscopic surgical tool.

The current study was performed to test two electronic cursor control devices (a Touchpad and a MicroJoystick) for use in an articulating powered laparoscopic tool. A simple target acquisition test was conducted to test how well the cursor control devices could be manipulated and how accurate they were (including endpoint and movement path). The study varied the width (0.27, 0.54 and 1.07 cm) of the target as well as the hand position used (thumb and index finger control). Additionally, each participant was able to choose their ideal operating cursor speed for each cursor control device. The MicroJoystick had a higher throughput and movement variability than the Touchpad. In all other categories tested, the cursor control devices did not differ significantly. The speed of the cursor control devices did not affect the performance of the devices; therefore, the ideal cursor speed could be chosen by the participant. Finally, the hand position did not affect the performance of the devices. This experiment found both hand positions, cursor control devices and all speeds could be used to effectively manipulate an articulating end-effector in a powered, cauterising, laparoscopic tool. This article addresses the advantages and limitations of two control mechanisms for laparoscopic tool controls considering both the subjective and objective data. The controls are tested in two hand positions to test how well the participants can manipulate the device while minimising perceived fatigue.

Ergonomic usability testing of operating room devices.

Medical errors in the operating room due to design, technological factors and poor human factors engineering are common. Determining the factors which facilitate or hinder successful performance during the use of medical systems is critical to the creation of standardized metrics for usability of medical devices in the operating room. Creation of a standardized evaluation for usability based on international standards and user-centered design principles can help determine what role these factors have in medical errors. In addition, device design can be evaluated to promote safety, measured objectively by metrics such as reduction in medical errors with a decrease in performance time.

The development and evaluation of an ergonomic glove.

The primary intent of this study was to determine if a hand glove could be designed on a criterion of selective protection. Force distribution patterns on the palmar side of hand were obtained from various studies to develop zones of hand that needed protection. A new design for gloves was developed based on the principle of selective protection, where protective material is introduced in varying levels over different parts of the glove, in order to provide protection where it is most needed, and at the same time preserve the desirable dexterity and strength capabilities of the barehand, optimizing the trade-off between protection and performance. Two pairs of prototype gloves incorporating different levels of protection were fabricated and tested using a battery of performance tests and an algometer test for pressure sensitivity. The test battery comprising four dexterity tasks and a maximal voluntary grip strength task was used to assess a number of glove conditions, including the two prototype gloves developed. The results indicate that the performance of the prototype gloves are comparable, and that the performance times for the double glove and the two prototype gloves tested were not significantly different. For the grip strength, the two prototype gloves were better than the double glove. The assembly task performance for the prototype II (laminar glove) was significantly lower than that of the other glove types tested. It appears that gloves of variable thickness can be developed to afford adequate protection at zones of most need. Glove manufacturers are recommended to use an ergonomic approach in the design of gloves. Such an approach, besides protecting the safety objective of gloves, could enhance productivity considerably.

Flexion and extension forces generated by wrist-dedicated muscles over the range of motion.

An experiment was performed to evaluate the relationships among active range of motion (ROM), gender, wrist position and direction of force exertion in their effects on the magnitude of static force exerted by the wrist-dedicated muscles in wrist flexion and extension. This study employed 60 right-hand-dominant subjects (30 male, 30 female) between 20 and 30 years of age, all reporting no prior wrist injury and good to excellent overall physical condition. The ROM of each subject was used to determine the number of wrist positions evaluated for static maximal voluntary forces generated in wrist flexion and extension while they were instructed to relax their fingers; thus only the six wrist-dedicated muscles were employed in the exertion. The ANOVA procedure showed gender, wrist position, direction of force exertion, and the wrist position interaction with direction to have significant effects upon maximal force exertion. Females averaged 76.3% of the mean male flexion force and 72.4% for extension. On average, extension forces were found to be 83.4% of those generated by flexing the wrist-dedicated muscles.