Sitting versus standing work postures during simulated laparoscopic surgery: in terms of user preferences, comfort, performance and biomechanics.

Prolonged standing in surgery has been linked to an increased risk of musculoskeletal disorders. The aim of this study was to determine whether sitting could serve as an alternative work posture in laparoscopic procedures. Twenty medical students in their third and fourth years were recruited. Sitting and standing were compared at two task complexity levels on a laparoscopic surgery simulator. Measured variables included user posture preferences, perceived discomfort, performance and biomechanics. Electromyography data from the upper trapezius and erector spinae muscles were analysed. Results showed that posture did not affect surgical performance and erector spinae muscle activation. Sitting showed higher muscle activation at the trapezius muscles; however, perceived discomfort was unaffected. Most participants preferred sitting for the difficult task and standing for the easy task. Findings showed that sitting, with appropriate seat design considerations, could serve as an alternative or even as a preferred work posture for simulated laparoscopic procedures.

Prolonged standing in surgery has been linked to increased musculoskeletal disorder risks. This study investigated sitting as a potential alternative work posture to standing. Both postures were tested during simulated laparoscopic procedures. Results showed that sitting can serve as an alternative or even preferred work posture for simulated laparoscopic surgery.

Perceptions on music and noise in the operating room: a cross-sectional study.

Objectives. Noise in operating rooms (ORs) during surgery may affect OR personnel and pose a threat to patient safety. The sources of noise vary depending on the operation. This study aimed to investigate how OR staff perceived noise, whether music was considered noise and what its perceived effects were. Methods. Surgeons, anaesthesiologists, residents and nurses were interviewed. iPads were placed in the ORs to gather noise-level data. Results. Ninety-one interviews were conducted. Most participants (60.5%) reported the presence of noise and 25% the presence of music in the OR. Noise data from iPads registered levels ranging between 59.52 and 85.60 dB(A). χ2 analyses yielded significant results between participants' role and the perceived effects of noise (p = 0.02). Responses to open-ended questions were thematically categorized. Conclusions. Surgeons generally chose the music played in ORs and were likely positively inclined to its effects, while anaesthesiologists and nurses minded the lack of choice and were more likely to consider it as noise.

A review of prenatal HIV screening practices among physicians at a tertiary care center in Lebanon: is it culture?

HIV remains one of the major causes of mortality and morbidity among women of reproductive age; given the risk of vertical transmission to the fetus, timely prevention, monitoring and management are imperative (Melaku et al. [2014]. Causes of death among females-investigating beyond maternal causes: A community-based longitudinal study. BMC Research Notes, 7(1), 629. https://doi.org/10.1186/1756-0500-7-629). Most HIV studies in Lebanon focus on men who have sex with men, people diagnosed with sexually transmitted infections, intravenous (IV) drug users, and people infected by blood transfusion products Ministry of Public Health [2017]. National AIDS Control Program in Lebanon. https://www.moph.gov.lb/en/Pages/2/4000/aids#/en/Pages/2/4000/aids; Shaheen [2014]. Around 3,750 HIV/AIDS cases in Lebanon. The Daily Star. https://www.dailystar.com.lb/News/Lebanon-News/2014/Dec-02/279570-around-3750-hivaidscases-in-lebanon.ashx). We conducted a retrospective review of women who delivered at a tertiary academic hospital in Beirut between January 2016-Decemeber 2017 to assess prenatal HIV screening practices. In total, 1500 charts were randomly selected and reviewed: 137 (9%) women were screened for HIV, 2 (1.5%) tested positive. Odds rations were calculated for screening in relation to religion, parity, previous abortions, and mode of delivery: none were significant. No one was tested for Gonorrhoea and Chlamydia; 1250 (93.8%) were tested for Hepatitis B, 27 (1.9%) for Hepatitis C, 7 (0.5%) for HSV and, 74(5.3%) for Syphilis. Barriers to screening may include: Lack of consensus on mandated screening policy, HIV stigma, physician and patient prejudice and misconception of risk and, financial barriers as health insurance does not cover HIV screening.

In Situ Simulation: An Essential Tool for Safe Preparedness for the COVID-19 Pandemic.

INTRODUCTION: Working under extreme stress can cause medical professionals to deviate from clinical guidelines even if they know of their existence, let alone in situations such as COVID-19 where guidelines are unclear, fluid, and resources limited. In situ simulation has been proven an effective tool for training medical professionals during previous healthcare crises, eg, Ebola, influenza, as well as for assessing the preparedness of centers by identifying potential latent safety threats. In this article, we describe our ongoing simulation activities to ensure that our staff is best prepared to adapt to the challenges of COVID-19. METHODS: This is a prospective preparedness assessment and training intervention at a tertiary care academic center in Lebanon during the COVID-19 pandemic. In situ simulations followed by debriefing with good judgment occur daily involving native teams of 3 to 5 professionals in the newly established COVID intensive care unit and wards, the adult and pediatric intensive care unit and wards, and the emergency department. The simulations are assessed by the instructor using the Simulation Team Assessment Tool and by the participants using the Simulation Effectiveness Tool. Transcripts of recorded simulation debriefings are analyzed for content for latent safety threats using the SHELL Framework (Software-Hardware-Equipment-Liveware). RESULTS: In 2 weeks, we conducted 15 simulations with 106 participants and 47 observers. Simulation Team Assessment Tool scores show an overall improvement across the hospital over time [101.5 ± 13 (80-134)]. Participants' feedback on the Simulation Effectiveness Tool has been predominantly positive on the educational and practical benefits of the simulation activity. Data from debriefings and observations demonstrated the following categories of latent safety threats: inadequate preparedness on infection control, uncertainty of guidelines on oxygen supplementation and intubation protocols, lack of leadership and communication, overall panic, and others. CONCLUSIONS: Our single-center preparedness intervention demonstrated multiple latent safety threats in relation to COVID-19, which can be recognized through simulation before translating into actual patient care.

In-situ simulations for COVID-19: a safety II approach towards resilient performance.

BACKGROUND: COVID-19 has taken the world by surprise; even the most sophisticated healthcare systems have been unable to cope with the volume of patients and lack of resources. Yet the gradual spread of the virus in Lebanon has allowed healthcare facilities critical time to prepare. Simulation is the most practical avenue not only for preparing the staff but also for troubleshooting system's latent safety threats (LSTs) and for understanding these challenges via Hollnagel's safety I-II approaches. METHODS: This is a quality improvement initiative: daily in situ simulations were conducted across various departments at the American University of Beirut Medical Center (AUBMC), a tertiary medical care center in Beirut, Lebanon. These simulations took place in the hospital with native multidisciplinary teams of 3-5 members followed by debriefing with good judgment using the modified PEARLS (Promoting Excellence and Reflective Learning in Simulation) for systems integration. All participants completed the simulation effectiveness tool (SET-M) to assess the simulation. Debriefings were analyzed qualitatively for content based on the Safety Model and LST identification, and the SET-Ms were analyzed quantitatively. RESULTS: Twenty-two simulations have been conducted with 131 participants. SET-M results showed that the majority (78-87%) strongly agreed to the effectiveness of the intervention. We were able to glean several clinical and human factor safety I-II components and LSTs such as overall lack of preparedness and awareness of donning/doffing of personal protective equipment (PPE), delayed response time, lack of experience in rapid sequence intubation, inability to timely and effectively assign roles, and lack of situational awareness. On the other hand, teams quickly recognized the patient's clinical status and often communicated effectively. CONCLUSION: This intervention allowed us to detect previously unrecognized LSTs, prepare our personnel, and offer crucial practical hands-on experience for an unprecedented healthcare crisis.