Background
Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting ...results on the physical and mental workload assessed.
Methods
Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures.
Results
Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median IQR: 40 28–47°) compared with laparoscopic surgeries (median IQR: 23 16–29°),
p
< 0.001) and torso (median IQR: 17 14–22° vs. 13 10–17°,
p
= 0.006).
Conclusion
Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.
Ag nanoparticles present good antimicrobial activity but with a potential toxicity to the cell, which limits the application. To address this issue, in this work, carbon-encapsulated sliver ...nanocapsules (Ag@C nanocapsules) were prepared by evaporating pure Ag ingot with the modified arc-discharge technique, and the Ag@C nanocapsules were acidified with nitric acid subsequently to facilitate the silver ion to release. Finally, Ag@C nanocapsules displayed a good and sustained antimicrobial activity against
E. coli
as a model of Gram-negative bacteria, due to the long-term release of sliver ions from Ag@C nanocapsules. The results obtained in this work indicate that the Ag@C nanocapsules may be a suitable nanomaterial for the bactericidal application.
Extensive atherosclerotic plaque burden in the lower extremities often leads to symptomatic peripheral artery disease (PAD) including impaired walking performance and claudication. Interleukin-1β ...(IL-1β) may play an important pro-inflammatory role in the pathogenesis of this disease. Interruption of IL-1β signaling was hypothesized to decrease plaque progression in the leg macrovasculature and improve the mobility of patients with PAD with intermittent claudication. Thirty-eight patients (mean age 65 years; 71% male) with symptomatic PAD (confirmed by ankle–brachial index) were randomized 1:1 to receive canakinumab (150 mg subcutaneously) or placebo monthly for up to 12 months. The mean vessel wall area (by 3.0 T black-blood magnetic resonance imaging (MRI)) of the superficial femoral artery (SFA) was used to measure plaque volume. Mobility was assessed using the 6-minute walk test. Canakinumab was safe and well tolerated. Markers of systemic inflammation (interleukin-6 and high-sensitivity C-reactive protein) fell as early as 1 month after treatment. MRI (32 patients at 3 months; 21 patients at 12 months) showed no evidence of plaque progression in the SFA in either placebo-treated or canakinumab-treated patients. Although an exploratory endpoint, placebo-adjusted maximum and pain-free walking distance (58 m) improved as early as 3 months after treatment with canakinumab when compared with placebo. Although canakinumab did not alter plaque progression in the SFA, there is an early signal that it may improve maximum and pain-free walking distance in patients with symptomatic PAD. Larger studies aimed at this endpoint will be required to definitively demonstrate this. ClinicalTrials.gov Identifier: NCT01731990
Degradation of amyloid-β (Aβ) aggregates has been considered as an attractive therapeutic and preventive strategy against Alzheimer's disease (AD). However, an in situ, real-time, and label-free ...technique is still lacking to understand the degradation process of Aβ aggregates. In this work, we developed a novel method to quantitatively evaluate the degradation of Aβ fibrils by photoactive meso-tetra(4-sulfonatophenyl)porphyrin under UV irradiation with quartz crystal microbalance (QCM).
During scanning, sonographers often assume significant awkward postures which may lead to musculoskeletal pain and disability. Two exoskeletons were tested as an ergonomic intervention by ...sonographers during transthoracic echocardiograms (TTE). Four sonographers each performed TTEs using right- and left-handed scanning techniques, with and without two different passive upper extremity exoskeletons in two two-by-two experimental designs. Posture, muscle activity, and subjective discomfort scores were recorded. Of the two exoskeletons tested, the updated FLEX® design significantly reduced 10th percentile upper trapezius muscle activity during left hand scanning, while the AIRFRAME® did not impact muscle activity across all the muscles of interest. Furthermore, there was a slight decrease in the self-reported discomfort levels in their wrist and hands associated with performing TTE when wearing Exos1 compared to baseline. However, participants experienced issues with comfort, limitations on their range of motion (ROM), and interference with tasks with both exoskeletons. Collectively, the results indicate that the tested exoskeleton designs provide minimal benefit for reducing upper extremity muscle workload during TTE ultrasonography tasks.
•Upper extremity pain is predominant in cardiac sonographers.•Two commercially available exoskeletons provided minimal benefit for shoulder muscles of cardiac sonographers performing TTEs.•Upper extremity exoskeletons for cardiac sonography applications need to be designed with shallow abduction engagement angles.
Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services.
In this ...prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX.
Seventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty – 62%, residents – 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected.
Higher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance.
•Faculty physician workload was increased when shifts were more difficult than expected.•Physician workload was increased after shifts with a higher patient care volume.•Subjective fatigue level was associated with increased physician workload.
Clear cell renal cell carcinoma (CCRCC) metastasis to pancreas is clinically rare. Misdiagnosis for these cases is frequently due to the low incidence, lack of specific clinical symptoms, and ...laboratory results.
Three female patients aged 47 years, 69 years, and 76 years, respectively, were admitted to hospital for routine examination after resection of clear cell carcinoma of kidney for 69 months, 57 months, and 123 months, respectively. All 3 cases had no specific clinical symptoms. Routine laboratory tests and common tumor markers including CEA, AFP, CA19-9, and CA125 showed no obvious abnormality.
All 3 cases were finally diagnosed with CCRCC metastasis to pancreas on the basis of CT and pathological findings. On unenhanced CT, foci of the pancreas showed single or multiple nodules or masses with mildly low or equal density and obscure boundary. On enhanced CT, the enhanced mode of foci was similar to CCRCC and showed "fast in fast out." The main body was confined in the pancreas. The peripheral structure was clear relatively. Obstruction of common bile duct, main pancreatic duct, and local infringement of foci cannot be seen. Additional metastases of right adrenal gland can be seen in one case.
All 3 cases underwent CT examination and surgical treatment, with complete removal of metastatic tumors.
All 3 cases underwent surgical treatment successfully, and recovered successfully after operation.
The manifestations of pancreatic metastases from CCRCC on CT show certain characteristics, which may be useful to assess the histological features of pancreatic metastases from CCRCC and facilitate the preoperative diagnosis.
Degradation of amyloid-β (Aβ) aggregates has been considered as an attractive therapeutic and preventive strategy against Alzheimer's disease (AD). However, an
in situ
, real-time, and label-free ...technique is still lacking to understand the degradation process of Aβ aggregates. In this work, we developed a novel method to quantitatively evaluate the degradation of Aβ fibrils by photoactive
meso
-tetra(4-sulfonatophenyl)porphyrin under UV irradiation with quartz crystal microbalance (QCM).
Quartz crystal microbalance is a useful method to quantitatively evaluate the degradation of Aβ fibrils by porphyrin under UV irradiation.
The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is ...still uncommon.
The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons.
A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed.
The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.
•Lack of ergonomics training likely plays a role in the high rates of work-related musculoskeletal disorders among surgeons.•Proper intraoperative ergonomics includes posture, operating room set-up, selection and use of surgical instruments and adjuncts.•Illustrations of good and bad intraoperative ergonomics can be used in education.
This study investigated vascular surgeon workload and its association with specific procedural drivers over different procedure types. Thirteen attending vascular surgeons (two females) were emailed ...a survey over a 3-month period. Data from 253 surgical procedures (118 open, 85 endovascular, 18 hybrid, and 32 venous) revealed high physical and cognitive workload among vascular surgeons. Based on the statistically significant findings and similar non-significant trends in the data (significance level of 0.01), open and hybrid vascular procedures showed higher levels of physical and cognitive workload compared to venous cases, while endovascular procedures were relatively more moderate. Additionally, the workload subscales for five subcategories of open procedures (e.g., arteriovenous access) as well as three subcategories of endovascular procedures (e.g., aortic) were compared. The granularity of the intraoperative workload drivers across various vascular procedure types and adjunct equipment could be the key to create targeted ergonomic interventions to reduce workload during vascular surgeries.
•High physical and cognitive workload among vascular surgeons was found.•Longer procedures showed more effort and higher self-perceived performance.•Workload by surgery modality (open, endovascular, hybrid, and venous) was studied.•Intraoperative ergonomic interventions can be created based on these data.
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