Physical job demands and related health complaints among surgeons

Prevalence of occupational injury and its associated factors among emergency department physicians in China: A large sample, cross-sectional study

BACKGROUND

Medical personnel, particularly emergency department (ED) physicians, face a variety of occupational hazards. However, the current state of occupational injuries among ED physicians remains unknown. This study aimed to assess the occupational injury of Chinese ED physicians and to identify its associated factors.

METHODS

From July to August 2018, a cross-sectional survey was conducted in Chinese emergency departments. A structured questionnaire covering sociodemographic characteristics, individual health behaviours, and work-related characteristics was completed by 10,457 ED physicians. Binary logistic regression was used to analyse the factors associated with occupational injuries.

RESULTS

In this study, 81.13% of ED physicians reported occupational injuries in the previous 12 months. All participants who had experienced occupational injuries had suffered verbal violence. Among physicians who experienced at least one injury, 76.57% and 71.30% reported injuries sustained while moving patients and from falls, slips, and sprains during office visits, respectively. Occupational injuries were significantly associated with gender, education level, drinking behaviour, sleep quality, the frequency of night shifts per month, self-perceived physician shortage, and work-family conflict. Physicians who experienced effort-reward imbalance were at a higher risk of occupational injury.

CONCLUSION

In China, occupational injuries are common among ED physicians. Individual factors as well as work-related factors are independently linked to occupational injuries. To reduce the rate of occupational injuries among ED physicians, health policymakers and healthcare facility managers should consider multi-injury interventions.

A timeline of surgical lighting - Is automated lighting the future?

High quality surgical lighting is central to successful performance in the operating room and therefore to both patient care and treatment. This article discusses the origins of surgical lighting from the 1800s to today, with a focus on the four main forms. Their uses, advantages, and disadvantages are evaluated in an effort to identify the improvements required to improve today's current state of surgical lighting. Whilst these four mainstream types have served well for the past thirty years, the literature exposes opportunities for improvement and can be used to guide the pathway to transition from manual conventional methods to a more automated lighting (AL) approach. The concept of AL has been proposed using established and known technical approaches such as artificial intelligence (AI), 3D sensor tracking algorithms and thermal imaging. Whilst AL seems incredibly promising, further focused research must be undertaken to maximise its' effectiveness and allow for successful integration of this new technology into operating rooms today.

Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis

Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I² statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.

How Much Stress Does a Surgeon Endure? The Effects of the Robotic Approach on the Autonomic Nervous System of a Surgeon in the Modern Era of Thoracic Surgery

(1) Objective: the purpose of this study was to evaluate and quantify the stress to which a surgeon is subjected during his/her surgical activity; we compared the individual clinical and psychological responses to stress of two surgeons during their surgical activities via robotic and open approaches. (2) Materials and methods: This was a prospective observational study in which we progressively collected data concerning the surgical performances of two different thoracic surgeons (October 2021-June 2022). We evaluated 20 lung resections performed via robot-assisted surgery and 20 lung resections performed via an open approach by each surgeon; in particular, we evaluated a panel of pre-, peri-, and postoperative data concerning the interventions, the patients, and other outcomes concerning the autonomic nervous system (ANS) and psychological responses to stress of the surgeons during their surgical activities. (3) Results: When analyzing data concerning the ANS activity of two surgeons, during robotic activity we found lower maximum, minimum, and mean heart rates; lower mean respiratory frequencies; lower body temperatures; and lower mean desaturations compared to the open approach activity for both surgeons. The psychological monitoring showed that the open approach created more physical fatigue and frustration but higher levels of satisfaction and performance evaluation. The robot-assisted surgeries showed higher levels of anxiety. (4) Conclusions: for different reasons, the robotic approach stimulated the ANS to a lesser degree, causing less stress for surgeons and ensuring greater comfort.

Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

OBJECTIVE

Our purpose is to define the learning curve for robot-assisted thoracoscopic surgery lobectomy by reporting the experience of a single surgeon.

MATERIAL AND METHODS

We progressively collected the data concerning the surgical performance of a single male thoracic surgeon, from the beginning of his robotic activity as first operator from January 2021 to June 2022. We evaluated several pre-, intra- and postoperative parameters concerning patients and intraoperative cardiovascular and respiratory outcomes of the surgeon, recorded during surgical interventions, in order to evaluate his cardiovascular stress. We used cumulative sum control charts (CUSUM) to analyze the learning curve.

RESULTS

A total of 72 lung lobectomies were performed by a single surgeon in this period. Analyzing the CUSUM of several parameters, the inflection point identifying the transition beyond the surgeon learning phase was reached at cases 28, 22, 27 and 33 when considering operating time, mean heart rate, max heart rate and mean respiratory rate, respectively.

CONCLUSIONS

The learning curve for robotic lobectomy seems to be safe and feasible with a correct robotic training program. The analysis of a single surgeon from the beginning of his robotic activity demonstrates that confidence, competence, dexterity and security are achieved after about 20-30 procedures, without compromising efficiency and oncological radicality.

Social stressors and social resources at work and their association with self-reported health complaints among ready-made garment workers in Bangladesh: a cross-sectional study

BACKGROUND

Bangladesh is one of the world's largest garment exporters. Physical working conditions of garment workers are precarious and known to largely affect their health. Research on garment workers' psychosocial working conditions, however, is scarce. We aimed to quantify psychosocial working conditions of garment workers and possible associations with workers' health.

METHODS

We conducted a cross-sectional survey among 1,118 ready-made garment (RMG) workers in labor colonies in Dhaka, Bangladesh, in February 2021. Descriptive analyses were performed to characterize social stressors (e.g., being bullied at work, poor leadership) and social resources at work (e.g., receiving support at work, vertical trust between management and employees, beneficial leadership) and workers' health (self-reported overall health and 10 specific health complaints). To examine links of social stressors and social resources with self-reported health outcomes we ran multivariable Poisson regression models yielding prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

We found low to moderate levels of workplace bullying and high levels of poor leadership (i.e., supervisors not caring about workers' problems). We also found high levels of social support, vertical trust and beneficial leadership (i.e., supervisors taking decisions free of bias). Garment workers frequently suffered from health complaints, first and foremost headache (68.3%), cold (55.3%), and back pain (50.7%). Health outcomes were poorer among workers who reported to be bullied at work versus not bullied (e.g., PR 1.55 [95% CI 1.32-1.92] for poor self-reported health when bullied by colleagues) and health was better among those reporting to feel supported versus unsupported (e.g., PR 0.61 [0.52-0.71] for poor self-reported health when supported by supervisor). Perceived vertical trust between workers and management was weakly associated with better health. Leadership behavior did not display a consistent pattern.

CONCLUSIONS

Our findings suggest that working conditions of RMG workers are rather good (e.g., characterized by low levels of bullying and high levels of support, vertical trust and beneficial leadership). The majority of workers reported good or very good health, although health complaints were frequently mentioned, first and foremost headache, cold, and back pain. Associations between psychosocial working conditions and health indicate worse working conditions being associated with poorer health.

Will you choose neurosurgery as your career? An Indian female medical student perspective

OBJECTIVE

We aim at recognising the reasons that discourage female medical students to consider neurosurgery as a career, from an Indian perspective.

METHODOLOGY

An online survey was disseminated in various medical colleges of India. The study included female medical students (both cis and trans). The questionnaire consisted of objective questions on mentorship, opportunities and exposure. Their concerns on long working hours and the reasons for the same were recorded.

RESULTS

348 responses were included of which 79.9 % of students felt they didn't receive proper exposure to neurosurgery in their medical school. 87.4 % of the respondents faced a lack of opportunity and mentorship for research. 65.2 % of students felt that they would be more interested in neurosurgery if a female professor were to mentor them. Long working hours and Reduced Family and Personal time were identified as statistically significant factors (p < 0.001) that play a role in demotivating female medical students towards neurosurgery. Altered quality of life was the most frequent (79.49 %) and significant reason (p = 0.004) as to why long working hours were a concern for them. 65.07 % of participants did not consider physical strength to be a hurdle (p = 0.008). Approximately 37.6 % participants felt that maternity and neurosurgery could be incompatible (p = 0.005).

CONCLUSIONS

The study brings out the notions that female medical students have regarding the long working hours and decreased family and personal time, complicated by pregnancy and maternal leave in the life of female neurosurgeon.

Comparing the Efficiency of Tumescent Infiltration Techniques in Burn Surgery

Tangential excision and grafting of burn wounds result in significant intraoperative blood loss, and infiltration of a dilute epinephrine solution (tumescence) is routinely performed to reduce such bleeding. Tumescent infiltration has been described using both a manual technique (syringe) and a pump device. The purpose of this study is to compare the efficiency of these two methods in terms of time and economy of motion. Consecutive adult burn patients at a single center requiring excision and grafting were enrolled in the study and randomized into either the manual or pump technique. Excisions involving less than 2% TBSA were excluded, along with specific anatomic regions (eg, head and neck). Infiltration with epinephrine solution (1:500,000) was performed to the endpoint of tumescence by a single surgeon and filmed/coded for duration, number of maneuvers, and volume of tumescence injected. Fourteen patients were enrolled, and 16 cases were randomized to either manual (N = 8) or pump infiltration (N = 8). The pump method required less time (2.0 vs 1.1 cm2/s, P < .001) and fewer maneuvers (37.8 vs 1.1 cm2/move, P < .001) to reach the desired endpoint of tumescence. Use of the infiltration pump also resulted in a reduced volume of tumescent fluid required to reach this point of tumescence (1.7 vs 2.4 mL/cm2, P = .01). Compared to the manual technique, an infiltration pump was significantly more efficient in terms of both time and economy of motion. These reductions are potentially useful for improving operating room efficiency as well as minimizing operator fatigue.

Work-Related Musculoskeletal Complaints in Surgeons

The aim of the present study was to examine the prevalence of work-related musculoskeletal complaints and potential risk factors among Romanian surgeons. Ninety-five surgeons of different specialties (62.11% males) completed a questionnaire about work-related musculoskeletal complaints (WMSCs). Ninety-one surgeons (95.78%) experienced WMSCs at least in one body part in the last year. Most surgeons reported pain in four body parts (33.68%). The most common WMSCs were reported on the lower back (74.73%), followed by complaints in the neck region (55.79%), shoulder and upper back (46.32%), knee (31.58%), wrist-hand (16.84%), elbow (14.74%), hip (11.58%) and ankle-foot (4.21%). Surgeons rated their pain more severe on upper back, lower back and knees. A higher percentage of male surgeons reported upper back pain (χ²₍₁₎ = 5.818, p = 0.015). Significant age differences were found between the reported pain sites (F_8,278 = 2.666, p = 0.008); the surgeons reporting wrist-hand pain were younger than those reporting neck, shoulders, elbows, dorsal and lumbar pain. Surgeons with significantly less experience in years reported significantly more WMSCs in wrist-hand, hip and ankle-foot regions compared with those more experienced (p < 0.05). Surgeons are at high risk of developing work-related musculoskeletal complaints, which affects both their professional and personal life. Further studies are needed to identify all risk factors and ergonomic strategies to reduce the prevalence and the negative impact of WMSCs.

Ergonomics for surgeons - prototype of an external surgeon support system reduces muscular activity and fatigue

BACKGROUND

Since the unergonomic postures cannot be changed during a surgery, it seems reasonable to externally support the surgeon's posture in order to relieve the musculature. To evaluate this matter, we conducted a pilot study to investigate if a prototype of an external surgeon support system (S3) relieves the musculature in an objectively measurable manner.

METHODS

Simultaneous surface electromyography (EMG) was used alongside a combination of a laser Doppler flowmeter and a tissue spectrometer to record back and leg muscles during a simulated surgical situation.

FINDINGS

With S3, muscle activity was significantly lower (p < 0.05) and also fatigue decreased when compared to without S3. Muscle blood flow and oxygenation were relatively close to baseline with S3, but increased without S3.

INTERPRETATION

An ergonomic S3 is a possible approach to reduce muscle activity and fatigue and may therefore prevent chronic back pain amongst surgeons in the long term.

Comparison of Chief Surgeons' and Assistants' Feelings of Fatigue Between Laparoendoscopic Single-site and Conventional Laparoscopic Adrenalectomy

BACKGROUND

Our objective was to compare the surgical staff's feelings of fatigue between laparoendoscopic single-site adrenalectomy (LESS-A) and conventional laparoscopic adrenalectomy (CLA) before and after surgery.

METHOD

Data were collected for surgical procedures performed between June 2011 and September 2017 (57 LESS-A and 37 CLA). Each procedure in both groups was performed by the same chief surgeon. The subjective fatigue feelings of the key members of the surgical team (chief surgeon, scopist, assistant surgeon) were assessed using the "Jikaku-sho shirabe" questionnaire, which contained questions about work-related feelings of fatigue. It consisted of 25 subjective items for 5 factors drawn from factor analysis (drowsiness, instability, uneasiness, local pain or dullness, and eyestrain). For each item, the participants were requested to estimate the intensity of their feelings using a five-point rating scale before and after surgery.

RESULTS

There was no significant difference in operative time (p = 0.231) between the LESS-A and CLA procedure groups. For the chief surgeon, local pain or dullness (p = 0.603) and eyestrain (p = 0.086) were similar between the LESS-A and CLA procedures. The scopists and assistant surgeons in the LESS-A group did not suffer local pain or dullness (p = 0.793 and p = 0.240, respectively). They did, however, suffer more eyestrain than those in the CLA group (p = 0.001 and p = 0.001, respectively).

CONCLUSION

Although LESS-A is generally considered to be a technically difficult procedure, the results of this study demonstrate that the feelings of physical fatigue are roughly equivalent between LESS-A and CLA procedures.

Theory of heat stress management: Development and application in the operating room

AIM

The Theory of Heat Stress Management addresses the phenomenon of occupational heat stress and applies the theory to surgical staff wearing personal protective equipment while performing surgery. This discussion paper relates development of the prescriptive middle range theory of heat stress management to inform and advance research and provide evidence to support new standards of care in clinical nursing practice.

DESIGN

The prescriptive middle range theory was developed by summarizing essential elements of the theory, describing the linkages among the dimensions of the theory, enumerating nursing interventions and physiological, psychological and cognitive outcomes, stating relevant assumptions, defining and identifying relationships between the concepts of heat stress management in observable and measurable terms.

DATA SOURCES

This discussion paper is based on the first author's experiences with occupational heat stress, observed improvements in surgical personnel's thermal comfort by using a cooling intervention and knowledge gained from an extensive integrated literature review and ongoing clinical research.

IMPLICATIONS FOR NURSING

The middle range theory was developed to create awareness of the impact heat stress has on the health and well-being of all healthcare personnel at risk for heat stress due to wearing personal protective equipment. Nurses need to recognize individuals in thermally stressful environments, evaluate and monitor individuals' physiological and psychological responses and promote comfort by providing interventions to alleviate occupational heat stress.

CONCLUSION

The Theory of Heat Stress Management combines dimensions specific to heat stress affecting surgical staff and provides a perspective that facilitates knowledge development, can enhance nursing practice and support exploration of the linkages and prescriptions of the theory through research.

IMPACT

The predictive middle-range Theory of Heat Stress Management will guide nurses to promote the health and well-being of healthcare workers and influence and improve clinical nursing practice, education, and research related to heat stress management.

An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures

BACKGROUND

Work-related musculoskeletal injuries have been increasingly recognized to affect surgeons. It is unknown whether such injuries also affect surgical trainees. The purpose of this study was to assess the ergonomic risk of surgical trainees as compared with that of experienced surgeons.

METHODS

Ergonomic data were recorded from 9 surgeons and 11 trainees. Biomechanical loads during surgery were assessed using motion tracking sensors and electromyography sensors. Demanding and static positions of the trunk, neck, right/left shoulder, as well as activity from the deltoid and trapezius muscles bilaterally were recorded. In addition, participants reported their perceived discomfort on validated questionnaires.

RESULTS

A total of 87 laparoscopic general surgery cases (48 attendings and 39 trainees) were observed. Both trainees and attendings spent a similarly high percentage of each case in static (>60%) and demanding positions (>5%). Even though residents reported overall more discomfort, all participants shared similar ergonomic risk with the exception of trainees' trunk being more static (odds ratio: -11.42, P = .006).

CONCLUSION

Surgeons are prone to ergonomic risk. Trainees are exposed to similar postural ergonomic risk as surgeons but report more discomfort and, given that musculoskeletal injuries are cumulative over time, the focus should be on interventions to reduce ergonomic risk in the operating room.

Job stress among resident physicians in Tanta University Hospitals, Egypt

Resident physicians are the first-line health service providers, subjected to prolonged working hours, sleep deprivation and high job demands. Work stress causes reduction in productivity, suboptimal patient care and medical errors. To determine the level of stress among residents and associated factors and stressors. A cross-sectional study at Tanta University Hospitals recruited residents (n = 278), between December 2016 and February 2017. Job stress was assessed using a predesigned questionnaire. The mean age was 26.53 ± 1.35, and 46.4% were males. The majority reported they work more than 48 h/week, do not get a break during work and have a night shift periodically (87%, 83.1% and 94.2%, respectively). Only 4 (1.4%) had low stress while 169 (60.8%) had moderate and 105 (37.8%) had high stress. The study revealed a statistically significant association between high level of stress and being a single resident (p = 0.017), belonging to surgical departments (p = 0.001) and an absence of break during working hours (p = 0.001). The prime sources of stress were underpayment for the job (87.4%), serving to large number of patients (85.2%), disruption of home life due to long hours at work (83.9%), conflict of responsibilities (81.3) and complying with increasing bureaucratic procedures (78.8%) besides no available fund for research (74.8%). Medical residents experienced moderate to high level of job stress. Thus, there is a need for stress management programs during residency training period taking in consideration main sources of stress.

Biometric Analysis of Surgeons' Physiologic Responses During Surgery

BACKGROUND

Much has been written from the social science perspective surrounding surgeons' stress and burn out. The literature is sparse in reference to scientific investigations of the hemodynamic effect of that stress. This prospective clinical study quantifies the physiologic impact of performing surgery upon the acute care surgeon.

METHODS

Over 2.5 years, monitoring devices were affixed to surgeons prior to entering the operating room, and physiologic variables were documented every 30 minutes. Qualifying cases were projected as being greater than 2 hours with a baseline preoperative measurement obtained. Variables recorded included blood pressure (BP), heart rate (HR), rate pressure product (RPP), oxygen saturation (O₂ sat), and end-tidal carbon dioxide (ET CO₂).

RESULTS

Statistically significant differences (P < .05) were found between baseline data to the maximum recording during the surgical operation for: BP (min 101 ± 6.6 (mmHg)-max 117 ± 5.1 (mmHg)), HR (min 70.5 ± 6.2 (bpm)-max 83.7 ± 9.0 (bpm)), O₂ sat (min 97 ± 2.0 (%)-max 100 ± 0.22(%)), and ET CO₂ (min 34.1 ± 1.15 mmHg-max 38 ± 1.7 mmHg) (P < .0001). The RPP ranged from 10.49 mmHg/min to 15.88 mmHg/min with a mean of 14.00 mmHg/min.

DISCUSSION

The practice of surgery is considered demanding in training and lifestyle in comparison to other medical specialties. This data is among the first to demonstrate the negative physiological impact of surgery upon the metabolic demand of the surgeon. The longitudinal implications of increased physiologic demand over time may have cardiovascular and cerebrovascular consequences.

Risk factors for musculoskeletal disorders in an obstetrician-gynecologist and orthopedic surgeon

BACKGROUND

Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks.

OBJECTIVE

The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon.

METHODS

A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data.

RESULTS

Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks.

CONCLUSIONS

Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.

Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort

BACKGROUND

Surgeons are at high risk of developing musculoskeletal disorders.

STUDY DESIGN

This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed.

RESULTS

Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures.

CONCLUSIONS

This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Background

It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.

Methods

Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.

Results

The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.

Conclusion

Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture.

Techniques for Patient Positioning During Burn Surgery: A Systematic Review

INTRODUCTION

Patient positioning in the operating room remains a challenge for burn surgeons; burn surgery involves critically ill patients who require close monitoring, difficult exposures, and careful handling of grafted areas. Various techniques to optimize intraoperative positioning during burn surgery have been described in the literature. The aim of this review was to outline these positioning techniques and report on their complications.

METHODS

A systematic review was performed by 2 independent reviewers using PubMed, Scopus, and OvidSP MEDLINE databases. Articles were included if they described intraoperative techniques to position patients undergoing burn surgery. The primary variable of interest was complications related to positioning during surgery.

RESULTS

The search identified 1855 nonduplicate citations, of which 29 underwent full-text review, and 10 met inclusion criteria. Three studies described overhead suspension techniques, including a hook-and-pulley system, ceiling chains, weighted IV poles, and mounted crossbars; no complications were reported. Six studies described limb fixation techniques, including Steinmann pins, finger traps, wrist/ankle wraps, towel clips through eschar or distal phalanges, and external fixators. Complications included one case of hardware failure of external fixation and several pin site infections. Four studies described table modification techniques, including a modified Stryker frame, a fracture table, the Mayfield headrest, and the recliner position; no complications were reported.

DISCUSSION

Numerous techniques have been described to improve patient positioning during burn surgery. No major complications were identified in this systematic review. Most techniques use standard operating room equipment and can aid in safe and easier operations.

Medical students' resilience: a protective role on stress and quality of life in clerkship

BACKGROUND

Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students' resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships.

METHODS

This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students' resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed.

RESULTS

This study verified the negative effects of medical students' perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students' professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R²) values of the hierarchical regression building, our study found that medical students' perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction.

CONCLUSIONS

Medical students' resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students' professional quality of life such as burnout and compassion satisfaction warrant additional studies.

Surgeons' muscle load during robotic-assisted laparoscopy performed with a regular office chair and the preferred of two ergonomic chairs: A pilot study

Surgeons work in awkward work postures and have high precision demands - well-known risk factors for musculoskeletal pain. Robotic-assisted laparoscopy is expected to be less demanding compared to conventional laparoscopy; however, studies indicate that robotic-assisted laparoscopy is also associated with poor ergonomics and musculoskeletal pain. The ergonomic condition in the robotic console is partially dependent upon the chair provided, which often is a regular office chair. Our study quantified and compared the muscular load during robotic-assisted laparoscopy using one of two custom built ergonomic chairs and a regular office chair. The results demonstrated no differences that could be considered clinically relevant. Overall, the study showed high levels of static and mean muscular activity, increased perceived physical exertion from pre-to-post surgery, and moderate to high risk for musculoskeletal injuries measured by the Rapid Upper Limb Assessment worksheet. Authors advocate for further investigation in surgeons' ergonomics and physical work demands in robotic surgery.

Using an intervention mapping approach to develop prevention and rehabilitation strategies for musculoskeletal pain among surgeons

BACKGROUND

The aim of the present study was to describe the development of strategies to prevent and rehabilitate musculoskeletal pain among surgeons. Musculoskeletal pain affects surgeons' life, and evidence on interventions for effective prevention and rehabilitation is lacking for this occupational group.

METHODS

An Intervention Mapping approach was used to develop intervention strategies specifically tailored to surgeons. This approach entailed conducting a systematic scoping literature search and semi-structured interviews with six surgeons.

RESULTS

The first step was to develop a logic model of the problem of musculoskeletal pain among surgeons. Step two was to formulate health-enhancing outcomes and performance objectives for the intervention, while in step three theory-based methods and practical strategies for the intervention were identified.

CONCLUSION

The present Intervention Mapping study demonstrated that musculoskeletal pain among surgeons is a complex area that needs attention. Our findings highlight a need for individual behavioural changes as well as organisational, attitudinal, and management changes.

The non-monetary costs of surgical training

Could addressing these issues improve patient outcomes?

The prevalence of musculoskeletal injuries in bariatric surgeons

OBJECTIVE

To investigate the prevalence of musculoskeletal (MSK) injuries in bariatric surgeons around the world.

BACKGROUND

As the popularity of bariatric surgery increases, efforts into improving its patient safety and decreasing its invasiveness have also been on the rise. However, with this shift towards minimal invasiveness, surgeon ergonomic constraints have been imposed, with a recent report showing a 73-88% prevalence of physical complaints in surgeons performing laparoscopic surgeries.

METHODS

A web-based survey was designed and sent out to bariatric surgeons around the world. Participants were queried about professional background, primary practice setting, and various issues related to bariatric surgeries and MSK injuries.

RESULTS

There were 113 responses returned from surgeons from 34 countries around the world. 68.5% of the surgeons have had more than 10 years of experience in laparoscopic surgery, 65.8% in open, and 0.9% in robotic surgery. 66% of participants reported that they have experienced some level of discomfort/pain attributed to surgical reasons, causing the case load to decrease in 27.2% of the surgeons. It was seen that the back was the most affected area in those performing open surgery, while shoulders and back were equally as affected in those performing laparoscopic, and the neck for those performing robotic, with 29.4% of the surgeons reporting that this pain has affected their task accuracy/surgical performance. A higher percentage of females than males reported pain in the neck, back, and shoulder area when performing laparoscopic procedures. Supine positioning of patients evoked more discomfort in the wrists, while the French position caused more discomfort in the back region. A higher percentage of surgeons who did not exercise experienced more issues in the neck and back region, while those that exercised more than 3 h a week experienced issues in their shoulders and wrists in both open and laparoscopic approaches. Only 57.7% sought medical treatment for their MSK problem, of which 6.35% had to undergo surgery for their issue, of which 55.6% of those felt that the treatment resolved their problem.

CONCLUSION

MSK injuries and pain are a common occurrence among the population of bariatric surgeons (66%), and has the ability to hinder performance at work. Therefore, it is of importance to investigate ways in which to improve ergonomics for these surgeons as to improve quality of life.

Ergonomics in microsurgery

There is a growing body of evidence to suggest that surgeon posture while operating contributes to cervical musculoskeletal strain, discomfort, and chronic pain. Microsurgeons may be particularly susceptible to this risk due to persistent neck flexion, long periods of static posture, and the use of heavy, high-power loupe magnification. Several techniques are thus presented that may help in obviating the cervicospinal repercussions of performing microsurgery.

High fatigue and its associations with health and work related factors among female medical personnel at 54 hospitals in Zhuhai, China

The present study aimed to investigate the prevalence of fatigue and determine factors associated with fatigue in female medical personnel. Based on a cross-sectional study, a total of 1608 female medical personnel at 54 hospitals in Zhuhai, China were recruited by a multistage stratified cluster sampling method. The Symptoms Checklist-90-Revised and Chalder Fatigue Scale were used to assess psychiatric symptoms and fatigue, respectively. Data regarding demographic, health, and work related variables were also collected. Multivariate logistic regression model was constructed to determine the influencing factors of fatigue. Approximately 83% of participants had experienced fatigue in the past week. The risk of fatigue was higher in aged 30-39 years old than older or younger participants; Longer sleeping time predicted a lower prevalence of fatigue (OR = .35), while tense physician-patient relationship predicted a higher prevalence of fatigue (OR = 1.77). Depression (OR = 1.76) and anxiety (OR = 1.96) were found related to fatigue. Additionally, fatigue was associated with marital status, occupation, health related factors (exercise, regular diet, and health status), and work related factors (hospital rank and turnover intention). These study findings might facilitate development and implementation of targeted interventions and preventive measures.

Ergonomic risk factors and musculoskeletal symptoms in surgeons with three types of surgery: Open, laparoscopic, and microsurgery

Background: Musculoskeletal symptoms are the main cause of loss of working time, and increase in labor costs. Poor posture is the most important risk factor for work-related musculoskeletal symptoms. This study aimed at evaluating the role of ergonomic risk factors in different surgical (open surgery, laparoscopy, and microsurgery) in the frequency or resonance frequency of musculoskeletal symptoms. Methods: This descriptive-analytic study was conducted on 81 surgeons in a hospital in Tehran. In this study, the prevalence of musculoskeletal symptoms was evaluated using the Nordic Questionnaire. Moreover, Workplace ergonomic risk assessment method (WERA) was used to evaluate ergonomic risk factors in 3 types of open surgery, laparoscopy, and microsurgery. Results: The results revealed that the prevalence of musculoskeletal symptoms of the neck, back, shoulder, and arm is high in surgeons (over 75%). The mean final score of WERA was 40.11, representing the high risk of the 3 types of surgery for the prevalence of musculoskeletal symptoms. Results revealed that the prevalence of musculoskeletal symptoms in the neck, waist and wrists had a significant relationship with the body posture in the 3 types of open surgery, laparoscopy, and microsurgery (p<0.05). Conclusion: In the present study, the prevalence of musculoskeletal symptoms was high in the neck, waist, and hands surgeries. Depending on the type of surgery, teaching correct working methods, using proper seats and ergonomic equipment are the best strategies to reduce musculoskeletal symptoms in the surgical profession.

A saúde física e mental do profissional médico: uma revisão sistemática

RESUMO O objetivo desta revisão sistemática da literatura foi de identificar as principais doenças que acometem os médicos em todo o mundo, mediante uma pesquisa eletrônica na base de dados Biblioteca Virtual em Saúde (BVS) baseada na metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma). Foram analisados 57 dos 374 artigos científicos encontrados sobre o tema em inglês, português e espanhol, publicados entre 2005 e 2015. Os resultados encontrados apontaram que os acometimentos mentais prevaleceram, destacando-se o esgotamento profissional (síndrome de burnout). Entre as doenças físicas, predominaram os acometimentos musculoesqueléticos.

Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals

OBJECTIVES

This study aimed to analyse and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties.

METHODS

435 German hospital residents in medical training working in 6 different medical specialties participated in a cross-sectional survey study. Physicians were asked about their working conditions and aspects of mental health and work ability. The Copenhagen Psychosocial Questionnaire, the Work Ability Index, the ICD-10 Symptom Rating and the Perceived Stress Questionnaire were used to measure working conditions, mental health and work ability.

RESULTS

Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anaesthesiologists. Significant associations between physicians' working conditions, occupational distress and mental health-related aspects are illustrated.

CONCLUSIONS

Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians' health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians' health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimisation and work process improvements should be focused by hospital management.

Current and future healthcare needs of future hospital physicians

BACKGROUND

Work-related health problems can impair the work ability of hospital physicians and pose a threat to patient safety. Understanding the health status and care needs of young hospital physicians is therefore essential to providing job-specific health services and ensuring good future quality of care.

AIMS

To investigate the current health status of future hospital physicians and their current and future care needs and to explore their preferences regarding occupational health services.

METHODS

We gathered data concerning worries about current health, current and future care needs and preferred ways of receiving feedback and interventions when using occupational health services from the 2013 wave of a cohort study of Dutch medical students (original population: n = 4961). We also calculated the relationship between current health status and future care needs.

RESULTS

We obtained data from 647 future physicians. Irrespective of their stage of training, most (73%) had few worries about their current health. However, two-fifths felt in need of care for psychological (42%) or physical (40%) complaints. More than half (52%) anticipated future care needs by indicating they would consider using occupational health services when offered in the future. General health status was not significantly related to feeling in need of future care. Preferences regarding feedback on health results were to receive this by email (54%) or from an occupational physician (51%) and in their own teaching hospital (68%).

CONCLUSIONS

Future hospital physicians expressed a need for current and future occupational healthcare, irrespective of current worries about health.

How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

Background

A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content.

Methods

Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications.

Results

Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness.

Conclusion

The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

The effect of work location on urolithiasis in health care professionals

The objective of this study is to compare the prevalence and risks factors for urolithiasis among health care professionals who work in the operating room (OR) versus other locations. Electronic surveys, focusing on a history of urolithiasis, were sent to 3,921 randomly selected employees at our institution, 34 % (1,340) of which worked in an OR. Additional information regarding potential risk factors such as quantity of daily fluid intake, stress level, activity level, body mass index, relevant medical conditions and family history of urolithiasis were obtained and analyzed. Of those surveyed, 46 % (1,802/3,921) responded. The prevalence of urolithiasis for all responders was 10.9 % (196/1,802). Those individuals working in an OR had a higher prevalence of stone disease compared to those who work elsewhere [14.6 % (64/439) versus 9.7 % (132/1,363); p = 0.004]. Specifically, physicians that work in an OR had the highest prevalence of urolithiasis [17.4 % (20/115) versus 9.7 % (132/1,363); p = 0.009). Additionally, physicians that work in an OR reported significantly less fluid intake (p = 0.04) and higher stress levels (p < 0.0001) compared to employees not working in an OR. On multivariate analysis, working in an OR remained associated with a significantly increased risk stone formation (HR 1.43; p = 0.04). Our survey found that health care professionals working in an OR setting, and physicians in particular, are at higher risk of urolithiasis.

Musculoskeletal disorders among construction workers: a one-year follow-up study

Background

Work-related musculoskeletal disorders (MSDs) are an important cause of functional impairments and disability among construction workers. An improved understanding of MSDs in different construction occupations is likely to be of value for selecting preventive measures. This study aimed to survey the prevalence of symptoms of MSDs, the work-relatedness of the symptoms and the problems experienced during work among two construction occupations: bricklayers and supervisors.

Methods

We randomly selected 750 bricklayers and 750 supervisors resident in the Netherlands in December 2009. This sample was surveyed by means of a baseline questionnaire and a follow-up questionnaire one year later. The participants were asked about complaints of the musculoskeletal system during the last six months, the perceived work-relatedness of the symptoms, the problems that occurred during work and the occupational tasks that were perceived as causes or aggravating factors of the MSD.

Results

Baseline response rate was 37%, follow-up response was 80%. The prevalence of MSDs among 267 bricklayers and 232 supervisors was 67% and 57%, respectively. Complaints of the back, knee and shoulder/upper arm were the most prevalent among both occupations. Irrespective of the body region, most of the bricklayers and supervisors reported that their complaints were work-related. Complaints of the back and elbow were the most often reported among the bricklayers during work, whereas lower arm/wrist and upper leg complaints were the most often reported among the supervisors. In both occupations, a majority of the participants perceived several occupational physical tasks and activities as causes or aggravating factors for their MSD. Recurrent complaints at follow-up were reported by both bricklayers (47% of the complaints) and supervisors (31% of the complaints). Participants in both occupations report that mainly back and knee complaints result in additional problems during work, at the time of follow-up.

Conclusions

A substantial number of the bricklayers and the supervisors report musculoskeletal disorders, mainly back, knee and shoulder/upper arm complaints. The majority of the bricklayers and half of the supervisors believe that their complaints are work-related. Irrespective of occupation, participants with MSDs report substantial problems during work. Workplace intervention measures aimed at occupational physical tasks and activities seem justified for both occupations.