Ergonomic Assessment of Surgeon Characteristics and Laparoscopic Device Strain in Gynecologic Surgery.

STUDY OBJECTIVE: To evaluate whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with laparoscopic advanced energy devices. DESIGN: Prospective cohort study. SETTING: Ergonomic simulation at an academic tertiary care site and the Society of Gynecologic Surgeons 47th Annual Meeting. PATIENTS: Thirty-eight participants (19 women and 19 men) were recruited. INTERVENTIONS: Surgeon anthropometric measurements were collected. Each participant completed a 120-second trial of maximum voluntary effort with 3 laparoscopic advanced energy devices (LigaSure, HALO PKS, and ENSEAL). Grip strength was measured using a handheld dynamometer. Subjects completed the NASA Raw Task Load Index scale after each device trial. Grip strengths and ergonomic workload scores were compared using Student t tests and Wilcoxon rank sum tests where appropriate. Univariate and multivariate models analyzed hand size and ergonomic workload. MEASUREMENTS AND MAIN RESULTS: Women had lower baseline grip strength (288 vs 451 N) than men, as did participants with glove size <7 compared with ≥7 (231 vs 397 N). Normalized grip strength was not associated with surgeon sex (p = .08), whereas it was significantly associated with surgeon glove size (p <.01). Grip strength decline was significantly greater for smaller compared to larger handed surgeons for LigaSure (p = .02) and HALO PKS devices (p <.01). The ergonomic workload of device use was significantly greater for smaller compared to larger handed surgeons (p <.01). Surgeon handspan significantly predicted grip strength decline with device use, even after accounting for potential confounders (R2 = .23, ß = .8, p <.01). CONCLUSION: Surgeons with smaller hand size experienced a greater grip strength decline and greater ergonomic workload during repetitive laparoscopic device use. No relationship was found between surgeon sex and grip strength decline or ergonomic workload. Laparoscopic device type was also identified as a significant main effect contributing to grip strength decline. These findings point toward ergonomic strain stemming from an improper fit between the laparoscopic device and the surgeon's hand during device use.

Evaluating preceptors: a methodological study.

The purpose of this study was to develop and test the Baptist Health Lexington Performance and Proficiency Assessment for validity and reliability. Twelve expert nurse educators evaluated the instrument for content validity. The sample for test-retest included nurse administrators (5), preceptors (9), and new graduates (10). To evaluate internal consistency, administrators (12), preceptors (66), and new graduates (43) responded. Strong validity and reliability were found for all subscales on the preceptor and new graduate versions.

Analysis of ambient, precipitation-weighted, and lake sulfate concentrations in the Adirondack region of New York.

AbstractIt is well known that many ecosystems in the eastern United States, including the Adirondack Mountain region of New York, are particularly sensitive to acidic deposition because the soils and lakes in the region tend to have low values of base saturation and acid neutralizing capacity, respectively [e.g. Environ Sci Policy, 1 (1998), 185]. To facilitate tracking the impacts of anthropogenic emissions on air quality, acidic deposition, and surface water quality, the National Atmospheric Deposition Program, New York State Department of Environmental Conservation, and Adirondack Lake Survey Corporation have been monitoring ambient sulfur dioxide and aerosol sulfate levels, and anion and cation concentrations in wet deposition and lake water over the past few decades. In this paper, we discuss the seasonality and year-to-year variability, and illustrate some of the complexities in estimating temporal trends in these data. The periods of analysis extended through 2000, beginning in 1991 for the ambient air quality data, 1978 for the wet deposition data, and 1982 for the lake water quality data. While the lake water SO4(2-) concentrations appear to be decreasing gradually, the air concentration data appear to have changed abruptly in the 1990s and the precipitation-weighted concentrations exhibited both gradual and sharp decreases during the same period.