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Altan E, Barmak E, Tatar EÇ, Saylam G, Korkmaz MH. Which Mask, N95 or Surgical Mask, Causes Hoarseness in Healthcare Workers? J Voice 2024:S0892-1997(24)00154-1. [PMID: 38902143 DOI: 10.1016/j.jvoice.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time during the pandemic period and had a healthy voice. METHODS Our research included 41 healthcare workers. The participants were separated into two groups: surgical (n = 21) and N95 mask users (n = 20). Healthcare workers evaluated masks before and after wearing them for at least 8 hours throughout the workday. All subjects had a videolaryngoscopic examination; the Voice Handicap Index-10 (VHI-10), GRBAS, acoustic voice analysis (F0, jitter%, shimmer%, noise/harmonic ratio, relative average perturbation [RAP]), aerodynamic measures (maximum phonation time, MPT), and blood oxygen saturation were evaluated. RESULTS Although both groups' VHI-10 scores increased after using the mask, this rise was not statistically significant in our research. According to the GRBAS classification, voice quality deterioration was identified in 9.6% (mild-moderate) of the group using surgical masks and 15% (mild) of the group wearing N95. Only the jitter and RAP values of individuals wearing both surgical and N95 masks were determined to be statistically significant. There was no significant change in MPT following mask wear in either group. Both the surgical and N95 mask-using groups showed a substantial drop in blood oxygen saturation before and after mask usage. CONCLUSION There was no change in voice quality between healthcare workers wearing surgical and N95 masks. It has been noticed that voice perception and quality are affected by the mask's barrier effect rather than the kind of mask.
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Affiliation(s)
- Esma Altan
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Elife Barmak
- Ankara Yıldırım Beyazıt University Department of Speech and Language Therapy, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
| | - Guleser Saylam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Lokman Hekim Hospital, Ankara, Turkiye
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
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Lackey TG, Rowley J, Pham TT, Portnuff CD, Ramos L, Friedman NR, Herrmann BW. Do Surgical Smoke Evacuators Increase the Risk of Hearing Loss for Operative Personnel During Routine Adenotonsillectomy Surgery? Cureus 2024; 16:e60214. [PMID: 38868294 PMCID: PMC11168719 DOI: 10.7759/cureus.60214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Aerosol mitigation equipment implemented due to COVID-19 has increased noise levels in the operating room (OR) during otolaryngological procedures. Intraoperative sound levels may potentially place personnel at risk for occupational hearing loss. This study hypothesized that cumulative intraoperative noise exposures with aerosol mitigation equipment exceed recommended occupational noise exposure levels. METHODS Sound levels generated by the surgical smoke evacuator (SSE) during adenotonsillectomy were measured using a sound level meter and compared to surgery without SSE. RESULTS Thirteen adenotonsillectomy surgeries were recorded. Mean sound levels with the SSE were greater than the control (72 ± 3 A-weighted decibels (dBA) vs. 68 ± 2 dBA; p=0.015). Maximum noise levels during surgery with SSE reached 82 ± 3 dBA. CONCLUSION Surgeons performing adenotonsillectomy with aerosol mitigation equipment are exposed to significant noise levels. Intraoperative sound levels exceeded international standards for work requiring concentration. Innovation is needed to reduce cumulative OR noise exposures.
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Affiliation(s)
- Taylor G Lackey
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Tiffany T Pham
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Cory D Portnuff
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
- UCHealth Hearing and Balance Clinic, UCHealth at University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Laylaa Ramos
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Norman R Friedman
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
- Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, USA
| | - Brian W Herrmann
- Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA
- Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, USA
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Rubbi I, Roveri A, Pasquinelli G, Cadas C, Carvello M, Lupo R, Vitale E, Di Lorenzo P, Sangiorgi N, Conte L, Cremonini V. Can Music Reduce Stress and Anxiety in the Operating Room Team? Insights from a Cross-Sectional Study in Northern Italy Healthcare Services. NURSING REPORTS 2024; 14:1079-1088. [PMID: 38804415 PMCID: PMC11130790 DOI: 10.3390/nursrep14020082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Music evokes positive emotions and reduces stress and anxiety. Operating room (OR) staff face various challenges which can lead to high levels of stress. The aim of the study is to assess whether listening to music during intraoperative phases improves the work environment by reducing anxiety and stress in the entire surgical team. METHODS A prospective observational study was conducted from February to September 2023, involving medical personnel, nursing staff, and nursing students. They were divided into two groups: Group 1 with music during surgical procedures, and Group 2 without music. Participants were administered two validated instruments: the Zung Anxiety Self-Assessment Scale (SAS) to measure anxiety, and the Positive and Negative Affect Schedule to assess emotions generating stress. Additional items were included for demographics, job satisfaction, and the organization method. RESULTS Music did not impact anxiety, but increased positive emotions while reducing negative ones. Music had an ancillary effect, highlighting the need for significant organizational interventions aimed at increasing operator satisfaction, including offering voluntary instead of mandatory assignments to nursing staff. CONCLUSIONS Music appears to reduce stress in the intraoperative team when supported by a positive work environment in which assigned operators have chosen to work in the OR.
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Affiliation(s)
- Ivan Rubbi
- School of Nursing, University of Bologna, 48018 Faenza, Italy; (I.R.); (A.R.); (C.C.); (V.C.)
| | - Anna Roveri
- School of Nursing, University of Bologna, 48018 Faenza, Italy; (I.R.); (A.R.); (C.C.); (V.C.)
| | - Gianandrea Pasquinelli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Claudia Cadas
- School of Nursing, University of Bologna, 48018 Faenza, Italy; (I.R.); (A.R.); (C.C.); (V.C.)
| | - Maicol Carvello
- “Community Hospital”, Local Health Authority (ASL) of Romagna, 48121 Ravenna, Italy;
| | - Roberto Lupo
- “San Giuseppe da Copertino” Hospital, Local Health Authority (ASL) of Lecce, 73043 Copertino, Italy;
| | - Elsa Vitale
- Local Health Authority (ASL) of Bari, 70126 Bari, Italy;
| | - Petia Di Lorenzo
- Multidisciplinar DH, Local Health Authority (AUSL) of Romagna, 48121 Ravenna, Italy; (P.D.L.); (N.S.)
| | - Nicola Sangiorgi
- Multidisciplinar DH, Local Health Authority (AUSL) of Romagna, 48121 Ravenna, Italy; (P.D.L.); (N.S.)
| | - Luana Conte
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics “E. De Giorgi”, University of Salento, 73100 Lecce, Italy
- Advanced Data Analysis in Medicine (ADAM), Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), Local Health Authority (ASL) Lecce and University of Salento, 73100 Lecce, Italy
| | - Valeria Cremonini
- School of Nursing, University of Bologna, 48018 Faenza, Italy; (I.R.); (A.R.); (C.C.); (V.C.)
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Narayanan A, Cavadino A, Fisher JP, Khashram M. The effect of music on the operating surgeon: a pilot randomized crossover trial (the MOSART study). ANZ J Surg 2024; 94:299-308. [PMID: 38263368 DOI: 10.1111/ans.18877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra-operative surgeon stress in the clinical environment. METHODS The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9-month period in a single-centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon-selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six-Item State-Trait Anxiety Inventory (STAI-6), and the Surgical Task-load Index (SURG-TLX). RESULTS Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG-TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra-operative music was not found to affect the psychological or physiological outcomes. CONCLUSIONS A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non-music conditions. Follow-up research in a simulated environment with intensive physiological monitoring could be considered.
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Affiliation(s)
- Anantha Narayanan
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Wellington Hospital, Wellington, New Zealand
| | - Alana Cavadino
- Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Soyer Er Ö, Yavuz van Giersbergen M. The Distraction Perceptions of Health Care Professionals in the Operating Room: The Disruptions in Surgery Index (DiSI). J Perianesth Nurs 2024; 39:109-115. [PMID: 37978972 DOI: 10.1016/j.jopan.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the psychometric properties of the Disruptions in Surgery Index (DiSI) in operating room health care professionals and to determine the frequency of distractions DESIGN: Methodological study. METHODS The sample consisted of 152 health care professionals. Data were collected online using the DiSI scale. The language validity was ensured, and the data were analyzed with the content validity index, Cronbach α coefficient, and item-total score correlation. Data on distractions of health care workers were given as percentages and averages. FINDINGS The mean age of health care professionals was 27.3 ± 6.0 years, and 77.0% of them were operating room nurses. The content validity index of the scale was found to be 0.95. The Cronbach α coefficient of the scale was 0.953 for frequency, 0.967 for contribution to error, and 0.971 for obstruction of goals. The correlation between the item and the total item was positive and significant (p < .001). Tiredness was determined as the most common distraction factor, causing errors and making it difficult to achieve goals. CONCLUSIONS The DiSI was found to be a valid and reliable tool. The most common distractions, contributing to errors and obstructing to goals, were related to individuals' skills, performance, and personality. Health care professionals perceived the distractions related to the surgical processes and the situations of the team members in the coordination and situational awareness subdimension as the least distracting factor.
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Affiliation(s)
- Özlem Soyer Er
- Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Surgical Nursing Department, Afyonkarahisar, Turkey.
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Narayanan A, Naidoo M, Kong V, Pearson L, Mani K, Fisher JP, Khashram M. Broad Responses and Attitudes to Having Music in Surgery (The BRAHMS Study): An Australia and Aotearoa New Zealand Perspective. Surg Open Sci 2024; 17:30-34. [PMID: 38274239 PMCID: PMC10809093 DOI: 10.1016/j.sopen.2023.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background Surgery is a stressful exercise, and the experience of occupational stress may have impacts on surgical performance, and surgeon well-being. Music is played in operating theatres (OTs) throughout the world, and while it may improve surgical performance, and reduce clinician stress within the OT, concerns exist over its distracting and noise-creating properties. Methods In this prospective observational study, between May to August 2022, Vascular, General and Paediatric surgeons and registrars in Australia and Aotearoa New Zealand (AoNZ) responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. Binomial logistic regression and Chi squared tests of association were performed, accepting p < 0.05 as significant. Results In this cohort of 120 surgeons, 45 % were vascular specialists, 30 % were female and 59 % were consultant surgeons. The most commonly preferred music genres were easy listening and pop. Over 75 % of surgeons enjoyed having music in their OTs with the majority reporting it improved their temperament, how mentally fatiguing a procedure felt and how anxious or stressed they felt. Vascular surgeons were more likely to believe music had a positive influence on communication than their general and paediatric surgery colleagues (p < 0.01). Registrars had significantly higher odds of believing music had a positive effect on their temperament, and how stressed and anxious they felt when operating, when compared to consultants (p < 0.05). Conclusions This study provides a window into the surgeons' use of and attitudes towards intra-operative background music and its effect on stress and cognitive load in Australia and AoNZ. While overall, music is viewed positively by this cohort, there was some difference seen across specialties and level of experience. Further subjective and objective data in this field may provide useful information to guide hospital policy and inform pathways for clinician wellbeing.
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Affiliation(s)
- Anantha Narayanan
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
- Department of Surgery, University of Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - Maheshwar Naidoo
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Victor Kong
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
- Department of Surgery, University of Auckland, New Zealand
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Lydia Pearson
- Department of Paediatric Surgery, Waikato Hospital, New Zealand
| | - Kevin Mani
- Department of Vascular Surgery, Waikato Hospital, New Zealand
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - James P. Fisher
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - Manar Khashram
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
- Department of Surgery, University of Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, New Zealand
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Le Lous M, Beridot C, Baxter JSH, Huaulme A, Vasconcelos F, Stoyanov D, Siassakos D, Jannin P. Physical environment of the operating room during cesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 288:1-6. [PMID: 37406465 DOI: 10.1016/j.ejogrb.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Environmental factors in the operating room during cesarean sections are likely important for both women/birthing people and their babies but there is currently a lack of rigorous literature about their evaluation. The principal aim of this study was to systematically examine studies published on the physical environment in the obstetrical operating room during c-sections and its impact on mother and neonate outcomes. The secondary objective was to identify the sensors used to investigate the operating room environment during cesarean sections. METHODS In this literature review, we searched MEDLINE a database using the following keywords: Cesarean section AND (operating room environment OR Noise OR Music OR Video recording OR Light level OR Gentle OR Temperature OR Motion Data). Eligible studies had to be published in English or French within the past 10 years and had to investigate the operating room environment during cesarean sections in women. For each study we reported which aspects of the physical environment were investigated in the OR (i.e., noise, music, movement, light or temperature) and the involved sensors. RESULTS Of a total of 105 studies screened, we selected 8 articles from title and abstract in PubMed. This small number shows that the field is poorly investigated. The most evaluated environment factors to date are operating room noise and temperature, and the presence of music. Few studies used advanced sensors in the operating room to evaluate environmental factors in a more nuanced and complete way. Two studies concern the sound level, four concern music, one concerns temperature and one analyzed the number of entrances/exits into the OR. No study analyzed light level or more fine-grained movement data. CONCLUSIONS Main findings include increase of noise and motion at specific time-points, for example during delivery or anaesthesia; the positive impact of music on parents and staff alike; and that a warmer theatre is better for babies but more uncomfortable for surgeons.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France; Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom.
| | - Caroline Beridot
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - John S H Baxter
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
| | - Arnaud Huaulme
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
| | - Francisco Vasconcelos
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Danail Stoyanov
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Dimitrios Siassakos
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom; EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Pierre Jannin
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
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Choi EJ, Jee SR, Lee SH, Yoon JS, Yu SJ, Lee JH, Lee HB, Yi SW, Kim MP, Chung BC, Lee HS. Effect of music on colonoscopy performance: A propensity score-matched analysis. World J Gastrointest Endosc 2023; 15:397-406. [PMID: 37274560 PMCID: PMC10236976 DOI: 10.4253/wjge.v15.i5.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.
AIM To assess the effects of music on colonoscopy performance outcomes.
METHODS We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music. Colonoscopy performance outcomes, such as insertion time, adenoma detection rate (ADR), and polyp detection rate (PDR), were compared between the music and non-music groups. To reduce selection bias, propensity score matching was used.
RESULTS After one-to-one propensity score matching, 169 colonoscopies were selected from each group. No significant differences in insertion time (4.97 vs 5.17 min, P = 0.795) and ADR (39.1% vs 46.2%, P = 0.226) were found between the two groups. Subgroup analysis showed that the insertion time (3.6 vs 3.8 min, P = 0.852) and ADR (51.1% vs 44.7%, P = 0.488) did not significantly differ between the two groups in experts. However, in trainees, PDR (46.9% vs 66.7%, P = 0.016) and ADR (25.9% vs 47.6%, P = 0.006) were significantly lower in the music than in the non-music group.
CONCLUSION The current study found that listening to music during colonoscopy did not affect procedure performance. Moreover, it suggested that music may distract trainees from appropriately detecting adenomas and polyps.
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Affiliation(s)
- Eun Jeong Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Jun Sik Yoon
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Seung Jung Yu
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Jong Hyun Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Han Byul Lee
- Department of Public Health, Ajou University Graduate School of Public Health, Suwon 16499, South Korea
| | - Sang Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung 25601, South Korea
| | - Myeong Pyo Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Byung Cheol Chung
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
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Augmented reality during parotid surgery: real-life evaluation of voice control of a head mounted display. Eur Arch Otorhinolaryngol 2023; 280:2043-2049. [PMID: 36269364 PMCID: PMC9988782 DOI: 10.1007/s00405-022-07699-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Augmented Reality can improve surgical planning and performance in parotid surgery. For easier application we implemented a voice control manual for our augmented reality system. The aim of the study was to evaluate the feasibility of the voice control in real-life situations. METHODS We used the HoloLens 1® (Microsoft Corporation) with a special speech recognition software for parotid surgery. The evaluation took place in a audiometry cubicle and during real surgical procedures. Voice commands were used to display various 3D structures of the patient with the HoloLens 1®. Commands had different variations (male/female, 65 dB SPL)/louder, various structures). RESULTS In silence, 100% of commands were recognized. If the volume of the operation room (OR) background noise exceeds 42 dB, the recognition rate decreases significantly, and it drops below 40% at > 60 dB SPL. With constant speech volume at 65 dB SPL male speakers had a significant better recognition rate than female speakers (p = 0.046). Higher speech volumes can compensate this effect. The recognition rate depends on the type of background noise. Mixed OR noise (52 dB(A)) reduced the detection rate significantly compared to single suction noise at 52 dB(A) (p ≤ 0.00001). The recognition rate was significantly better in the OR than in the audio cubicle (p = 0.00013 both genders, 0.0086 female, and 0.0036 male). CONCLUSIONS The recognition rate of voice commands can be enhanced by increasing the speech volume and by singularizing ambient noises. The detection rate depends on the loudness of the OR noise. Male voices are understood significantly better than female voices.
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Krishnan T, Rudy P, Viswanathan N, Brommelsiek M, Bachar A, Sutkin G. The Impact of Facial Personal Protective Equipment on Speech Intensity. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:422-429. [PMID: 36730870 DOI: 10.1097/spv.0000000000001282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Facial personal protective equipment (FPPE) filters small particles in the operating room (OR) but also affects speech production, diminishing the effective transfer of information among OR team members. OBJECTIVE The aim of the study is to assess the attenuating effects of different combinations of layered FPPE on speech intensity, including potential differences in the effect of talkers with varying backgrounds and speaking volumes. STUDY DESIGN We recruited 30 speakers from health and nonhealth occupations with English as either their first or second language. All participants spoke unmasked, at varying voice levels into a portable Zoom H4n device 12 inches from the microphone. These no-mask recordings were played from a Styrofoam head, fitted with 7 combinations of FPPE commonly worn in the COVID-19 era, with the attenuated signals assessed for digital average signal levels. We submitted these attenuation values to an omnibus mixed analysis of variance and performed a spectral analysis on signal attenuation stratified by typical speech frequency bands. RESULTS Signal attenuation was strongly determined by FPPE combination, regardless of talker sex, first language, and occupation ( P < 0.01, η 2p = 0.881). The effects of vocal output were also significant ( P < 0.01, η 2p = 0.881). Soft talkers experienced particularly high attenuation at frequency bands higher than 2,000 Hz. The signal of the softest talkers, when asked to speak loudly, was similar to the loud talkers' signal. CONCLUSIONS Layered FPPE in the OR protects the surgical team from small particle exposure but may increase communication failures. Our data can help OR staff choose FPPE and alter their vocal volume accordingly.
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Affiliation(s)
- Tara Krishnan
- From the Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine
| | - Paul Rudy
- University of Missouri Kansas City Conservatory, Kansas City, MO
| | | | - Margaret Brommelsiek
- From the Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine
| | - Austin Bachar
- From the Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine
| | - Gary Sutkin
- From the Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine
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A distractions capture tool for cardiac surgery and lung transplantation: impact on outcomes. J Cardiothorac Surg 2023; 18:46. [PMID: 36691050 PMCID: PMC9872388 DOI: 10.1186/s13019-022-02065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Surgical distractions are associated with worse patient outcomes. Lung transplantation and cardiac surgery's multi-disciplinary nature, and their inherent complexities render them more vulnerable to distractions. We aim to use a novel distractions capture tool to evaluate the severity of distractions during cardiac surgery (CS) and lung transplantation (LTx) and assess its impact on post-operative complications. METHODS A prospective 'blinded' study was undertaken by direct observation of distractions during CS and LTx. Events were identified using the Imperial College Error Capture tool (ICECAP). Number and severity of distractions were correlated with post-operative outcomes (ICU & hospital stay, bleeding and anastomotic complications). RESULTS In LTx, we observed 2059 distractions within 287 h across 41 surgeries. In CS, we observed 1089 distractions within 192 h across 62 surgeries. Surgeons were consciously aware of 19.2% (LTx) and 21.3% (CS) of recorded events. Distractions consisted of procedure-independent pressures (61% LTx vs 56% CS), equipment problems (15% LTx vs 23%CS), communication (12% LTx vs 12% CS), technical problems or patient safety concerns (12% LTx vs 9% CS). In CS, 91% of procedure-independent pressures were non-operative distractions whilst LTx recorded 83%. Staff absences at a critical moment of surgery were recorded at 9% (LTx) and 7% (CS). The number and severity of distractions correlated with bleeding (CS p < 0.001, LTx p < 0.01), prolonged ICU stay (CS p = 0.002, LTx p = 0.002), hospital stay (CS p < 0.001) and anastomotic complications(LTx p < 0.03). CONCLUSIONS ICECAP as a novel surgical distractions capture tool was effective & applicable to both elective cardiac and urgent transplant surgeries. Surgeons were unaware of a large number of distractions & interruptions. Distractions were associated with longer ICU stay and higher rate of bleeding.
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Taaffe K, Ferrand YB, Khoshkenar A, Fredendall L, San D, Rosopa P, Joseph A. Operating room design using agent-based simulation to reduce room obstructions. Health Care Manag Sci 2022:10.1007/s10729-022-09622-3. [PMID: 36529790 PMCID: PMC10369668 DOI: 10.1007/s10729-022-09622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the procedure affect surgical team movement and contacts. We video recorded staff movements during a set of surgical procedures. Then we divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination through zones. This data was abstracted into a generalized, agent-based, discrete event simulation model to study how OR size and OR equipment layout affected surgical staff movement and total number of surgical team contacts during a procedure. A full factorial experiment with seven input factors - OR size, OR shape, operating table orientation, circulating nurse (CN) workstation location, team size, number of doors, and procedure type - was conducted. Results were analyzed using multiple linear regression with surgical team contacts as the dependent variable. The OR size, the CN workstation location, and team size significantly affected surgical team contacts. Also, two- and three-way interactions between staff, procedure type, table orientation, and CN workstation location significantly affected contacts. We discuss implications of these findings for OR managers and for future research about designing future ORs.
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13
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Hamad F, Moacdieh NM, Banat R, Lakissian Z, Al-Qaisi S, Zaytoun G, Sharara-Chami R. Perceptions on music and noise in the operating room: a cross-sectional study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 28:2168-2172. [PMID: 34496715 DOI: 10.1080/10803548.2021.1978729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Fadi Hamad
- Department of Industrial Engineering and Management, American University of Beirut, Lebanon
| | - Nadine Marie Moacdieh
- Department of Industrial Engineering and Management, American University of Beirut, Lebanon
| | - Rim Banat
- Dar Al-Wafaa Simulation in Medicine, American University of Beirut Medical Center, Lebanon
| | - Zavi Lakissian
- Dar Al-Wafaa Simulation in Medicine, American University of Beirut Medical Center, Lebanon
| | - Saif Al-Qaisi
- Department of Industrial Engineering and Management, American University of Beirut, Lebanon
| | - George Zaytoun
- Department of Otorhinolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Lebanon
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Lebanon
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14
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Narayanan A, Pearson L, Fisher JP, Khashram M. The effect of background music on stress in the operating surgeon: scoping review. BJS Open 2022; 6:6758525. [PMID: 36221189 PMCID: PMC9553852 DOI: 10.1093/bjsopen/zrac112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the ubiquitous sounds of music playing in operating theatres (OTs) around the world, the effect that music has on intraoperative clinician stress is ill-defined. In the present scoping review the aim was to map the available evidence for the effect of background music in the OT on the experience of stress in the operating surgeon. Methods The present review was conducted in accordance with the PRISMA Protocols for Scoping Reviews. Using Embase, MEDLINE, and the Cochrane databases, peer-reviewed research studies reporting the effect of intraoperative background music on an outcome measure of clinician stress or respondent perceptions on this effect were included. Results A total of 4342 studies were screened and 15 studies met the inclusion criteria, of which 10 were interventional studies, and five were observational survey-based studies. Of the 10 interventional studies, four showed reduced anxiety and mental workload scores with music, although only two demonstrated a significant improvement in a physiological outcome. The survey-based studies generally reported a positive perception among surgeons and theatre staff towards the effect of music on OT stress. Conclusion While there is generally a positive perception towards intraoperative music and surgeon stress, there are few objective physiological and psychological data to support this. Studies were varied in their design. The present review can be used to guide future experimental, observational, and mixed-method research on this topic.
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Affiliation(s)
- Anantha Narayanan
- Correspondence to: Anantha Narayanan, Department of Surgery, Auckland City Hospital Support Building, 2 Park Road, Grafton, Auckland, New Zealand (e-mail: )
| | - Lydia Pearson
- Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand,Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Effect of Background Music in the Operating Room on Surgical Outcomes: A Prospective Single-Blinded Case-Control Study. J Am Coll Surg 2022; 235:447-453. [PMID: 35972164 DOI: 10.1097/xcs.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of playing background music on surgical outcomes has been controversial. This prospective case-control study aims to evaluate the impact of music tempo in general surgical settings. STUDY DESIGN Six hundred consecutive patients with nonmetastatic breast cancer receiving breast cancer surgery have been recruited since April 2017. Patients were then assigned to 3 arms in consecutive order. The surgeon operated without music in study arm A; the surgeon operated with slow music in study arm B; and in study arm C, the surgeon operated with fast background music. Patients' clinical records were reviewed by an independent blinded assessor. RESULTS Baseline demographic data were comparable among the 3 study arms. Seven (3.5%) patients from study arm A developed minor complications (Clavien-Dindo class I and II); none developed major complications (Clavien-Dindo class III or above). Six (3.0%) patients from study arm B and C, respectively (slow/fast music groups), developed minor complications; none developed a major complication. Mean blood loss was also similar among the 3 study arms (5.1, 5.1, and 5.2 mL, respectively; p > 0.05). Operating time was significantly shorter in study arm C: 115 minutes (90-145), compared with 125 minutes (100-160) in study arm A (p < 0.0001) and 120 minutes (95-155) in study arm B (p = 0.0024). After a median follow-up of 40 months (3-56), 40 months (3-56), and 39.5 months (3-56), the local recurrence rates were 1.5%, 1%, and 1%, respectively (p > 0.05). CONCLUSION Playing music in the operating room is safe in general surgical settings in experienced hands.
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Effects of Auditory Pre-Stimulation on Cognitive Task Performance in a Noisy Environment. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The accident rate due to human errors in industrial fields has been consistently high over the past few decades, and noise has been emerging as one of the main causes of human errors. In recent years, auditory pre-stimulation has been considered as a means of preventing human errors by improving workers’ cognitive task performance. However, most previous studies demonstrated the effectiveness of the auditory pre-stimulation in a quiet environment. Accordingly, studies on the effects of pre-stimulation in a noisy environment are still lacking. Therefore, this study aimed to empirically investigate: (1) the effects of noisy environments on the performances of cognitive tasks related to different functions of working memory and (2) the effects of auditory pre-stimulation on the performances of cognitive tasks in a field-noise environment. To accomplish these research objectives, two major experiments were conducted. In the first experiment, a total of 24 participants performed each of three basic short-term/working memory (STM/WM) tasks under two different experimental conditions (quiet-noise environment and field-noise environment) depending on the presence or absence of field noise. In the second experiment, the participants performed each of the three basic STM/WM tasks in a field-noise environment after they were provided with one of four different auditory pre-stimulations (quiet noise, white noise, field noise, and mixed (white and field) noise). The three STM/WM tasks were the Corsi block-tapping, Digit span, and 3-back tasks, corresponding to the visuospatial sketchpad, the phonological loop, and the central executive of WM, respectively. The major findings were that: (1) the field-noise environment did not affect the scores of the Corsi block-tapping and 3-back tasks, significantly affecting only the Digit span task score (decreased by 15.2%, p < 0.01); and (2) the Digit span task performance in the field-noise environment was improved by 17.9% (p < 0.05) when mixed noise was provided as a type of auditory pre-stimulation. These findings may be useful for the work-space designs that prevent/minimize human errors and industrial accidents by improving the cognitive task performance of workers in field-noise environments.
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Han Y, Zheng B, Zhao L, Hu J, Zhang C, Xiao R, Wang C, Pu D. Impact of background music on the performance of laparoscopy teams. BMC MEDICAL EDUCATION 2022; 22:439. [PMID: 35672819 PMCID: PMC9172190 DOI: 10.1186/s12909-022-03503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acoustic conditions in the operating room have different impacts on surgeon's performance. Their effects on the performance of surgical teams are not well documented. We investigated if laparoscopic teams operating under pleasant acoustic conditions would perform better than under noisy conditions. METHODS We recruited 114 surgical residents and built 57 two-person teams. Each team was required to perform two laparoscopic tasks (object transportation and collaborative suturing) on a simulation training box under music, neutral, and noisy acoustic conditions. Data were extracted from video recordings of each performance for analysis. Task performance was measured by the duration of time to complete a task and the total number of errors, and objective performance scores. The measures were compared over the three acoustic conditions. RESULTS A music environment elicited higher performance scores than a noisy environment for both the object transportation (performance score: 66.3 ± 8.6 vs. 57.6 ± 11.2; p < 0.001) and collaborative suturing tasks (78.6 ± 5.4 vs. 67.2 ± 11.1; p < 0.001). Task times in the music and noisy environments was subtracted to produce a music-noisy difference time. Pearson correlation coefficient analysis showed a significant negative relationship between the team experience score and the music-noisy difference time on the object transportation (r = - 0.246, p = 0.046) and collaborative suturing tasks (r = - 0.248, p = 0.044). CONCLUSIONS As to individuals, music enhances the performance of a laparoscopy team while a noisy environment worsens performance. The negative correlation between team experience and music-noisy difference time suggests that laparoscopy teams composed of experienced surgeons are less likely affected by an acoustic distraction than the noisy teams. Team resistance to acoustic distraction may lead to a new way for assessing team skills.
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Affiliation(s)
- Ying Han
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Zheng
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Linyong Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Jiankun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Chao Zhang
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Ran Xiao
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Chunyan Wang
- West China Academic Exchange Center of Health and Medicine, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Dan Pu
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Mcleod RWJ, Gallagher M, Hall A, Bant SP, Culling JF. Acoustic analysis of the effect of personal protective equipment on speech understanding: lessons for clinical environments. Int J Audiol 2022:1-6. [DOI: 10.1080/14992027.2022.2070780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Andy Hall
- ENT Department, University Hospital of Wales, Cardiff, UK
| | - Sarah P. Bant
- Audiology Department, Betsi Cadwaladr University Health Board, Bangor, UK
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19
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Brommelsiek M, Krishnan T, Rudy P, Viswanathan N, Sutkin G. Human-Caused Sound Distractors and their Impact on Operating Room Team Function. World J Surg 2022; 46:1376-1382. [PMID: 35347392 DOI: 10.1007/s00268-022-06526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient safety in the Operating Room (OR) depends on unobstructed team communication. Yet the typical OR is loud, containing numerous sounds from surgical machinery overlayed with human-caused sounds. Our objective was to compare machine vs human-caused sounds for their loudness and distraction, and potential impact on team communication. METHODS After surveying OR staff about sounds that interfere with job performance and team communication, we recorded 19 machine and 48 human-caused sounds measuring their acoustical intensity. We compared peak measures of machine vs human-caused sound loudness, using Student's t-test. We observed the effect of these sounds on OR staff in 59 live surgeries, rating level of interference with team function. We visually depicted competing sounds through a spectral analysis. RESULTS The survey response rate was 62.8%. 93% of respondents indicated that OR noise, especially human-caused sounds such as irrelevant conversations, interfere with team communication, hearing, and focus. OR peak decibel levels ranged from 56.8 dB (surgical packaging) to 105.0 dB (kicked metal stepstool). Human-caused sounds were comparable to machine-caused sounds in terms of mean peak dB levels (77.0 versus 73.8 dB, p = 0.32), yet were rated as more interfering with surgical team function. The spectral analysis illustrated both machine and human-caused sound sources obscuring the surgeon's instructions. CONCLUSIONS Avoidable human-caused sounds are a major source of disruption in the OR and interfere with communication and job performance. We recommend surgical team training to minimize these distractions.
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Affiliation(s)
- Margaret Brommelsiek
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64112, USA
| | - Tara Krishnan
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64112, USA
| | - Paul Rudy
- University of Missouri Kansas City Conservatory, 439 PAC, Kansas City, MO, 64110, USA
| | - Navin Viswanathan
- The Pennsylvania State University, 301 Ford Building, University Park, PA, 16802, USA
| | - Gary Sutkin
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64112, USA.
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Suresha PB, Hegde C, Jiang Z, Clifford GD. An Edge Computing and Ambient Data Capture System for Clinical and Home Environments. SENSORS (BASEL, SWITZERLAND) 2022; 22:2511. [PMID: 35408127 PMCID: PMC9003543 DOI: 10.3390/s22072511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
The non-contact patient monitoring paradigm moves patient care into their homes and enables long-term patient studies. The challenge, however, is to make the system non-intrusive, privacy-preserving, and low-cost. To this end, we describe an open-source edge computing and ambient data capture system, developed using low-cost and readily available hardware. We describe five applications of our ambient data capture system. Namely: (1) Estimating occupancy and human activity phenotyping; (2) Medical equipment alarm classification; (3) Geolocation of humans in a built environment; (4) Ambient light logging; and (5) Ambient temperature and humidity logging. We obtained an accuracy of 94% for estimating occupancy from video. We stress-tested the alarm note classification in the absence and presence of speech and obtained micro averaged F1 scores of 0.98 and 0.93, respectively. The geolocation tracking provided a room-level accuracy of 98.7%. The root mean square error in the temperature sensor validation task was 0.3°C and for the humidity sensor, it was 1% Relative Humidity. The low-cost edge computing system presented here demonstrated the ability to capture and analyze a wide range of activities in a privacy-preserving manner in clinical and home environments and is able to provide key insights into the healthcare practices and patient behaviors.
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Affiliation(s)
- Pradyumna Byappanahalli Suresha
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (P.B.S.); (C.H.)
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | - Chaitra Hegde
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (P.B.S.); (C.H.)
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | - Zifan Jiang
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA;
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA;
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Yang C, Möttig F, Weitz J, Reissfelder C, Mees ST. Effect of Genre and amplitude of music during laparoscopic surgery. Langenbecks Arch Surg 2022; 407:2115-2121. [PMID: 35332368 DOI: 10.1007/s00423-022-02490-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Music is often played in operating theaters. In the literature, the effects of music on surgeons are controversial. We aimed to investigate the effect of different music genres and amplitudes on laparoscopic performance. METHODS Novice surgeons underwent a proficiency-based laparoscopic training curriculum. Participants were required to perform these tasks under three conditions: no music, with music in medium volume (45-50 dB) and in high volume (65-70 dB). Soft rock by the Beatles and hard rock by AC/DC were played. Task performance was evaluated by analyzing speed and accuracy. RESULTS With soft rock in medium volume, participants were faster in peg transfer (60.3 vs. 56.7 s, P = 0.012) and more accurate in suture with intracorporeal knot (79.2 vs. 54.0, P = 0.011) compared to without music. The total score was improved (383.4 vs. 337.9, P = 0.0076) by enhancing accuracy (79.5 vs. 54.0, P = 0.011). This positive effect was lost if the soft rock was played in high volume. With hard rock in medium volume, participants were faster performing precision cutting (139.4 vs. 235.8, P = 0.0009) compared to without music. Both balloon preparation and precision cutting were performed more rapidly (227.3 vs. 181.4, P = 0.003, 139.4 vs. 114.0, P < 0.0001) and the accuracy was maintained. Hard rock in high volume also resulted in increased speed (366.7 vs. 295.5, P < 0.0001) compared to without music. Thereby, the total scores of participants were enhanced (516.5 vs. 437.1, P = 0.002). CONCLUSION Our data reveal that the effect of music on laparoscopic performance might depend on the combination of music genre and amplitude. A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries. TRIAL REGISTRATION DRKS00026759, register date: 18.10.2021 (retrospectively registered).
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Affiliation(s)
- Cui Yang
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.
| | - Franziska Möttig
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Juergen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christoph Reissfelder
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Soeren Torge Mees
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Klinik Für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden, Dresden, Germany
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22
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Cass ND, Perkins EL, Bennett ML, Ricketts TA. Evaluating Risk of Noise-Induced Hearing Loss in Otologic Surgery. Ann Otol Rhinol Laryngol 2022; 132:35-40. [PMID: 35109716 DOI: 10.1177/00034894221075422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate risk for noise-induced hearing damage from otologic surgery-related noise exposure, given recent research indicating that noise levels previously believed to be safe and without long-term consequence may result in cochlear synaptopathy with subsequent degeneration of spiral ganglion neurons, degradation of neural transmission in response to suprathreshold acoustic stimuli, and difficulty understanding in background noise. METHODS A prospective observational study of surgeon noise exposure during otologic and neurotologic procedures was performed in a tertiary care center. Surgeon noise exposure was recorded in A- and C-weighted decibel scales (dBA, dBC), including average equivalent (LAeq) and peak (LApeak, LCpeak) levels and noise dose. RESULTS Sound measurements taken at the ear with continuous recording equipment during cadaveric otologic surgery demonstrated LAeq 80-83 dBA, LApeaks of 105 dBA, LCpeaks of 127 dBC, with noise doses of 0.9% to 6.7%. Sound level measurements during live surgery translabyrinthine approaches yielded lower LAeq of 72 to 74 dBA and lower noise doses compared with temporal bone lab measurements. Raw sound recordings during live surgery demonstrated narrow band, high frequency, high amplitude spikes between 4 and 12 kHz. CONCLUSION Noise exposure to surgeons, staff, and patients in the operating room is acceptable per NIOSH recommendations. Temporal bone lab noise exposures are greater, possibly due to poorly maintained drill systems and lack of noise shielding from microscope bulk, yet are also within NIOSH recommended levels.
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Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth L Perkins
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marc L Bennett
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd A Ricketts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Tseng LP, Chuang MT, Liu YC. Effects of noise and music on situation awareness, anxiety, and the mental workload of nurses during operations. APPLIED ERGONOMICS 2022; 99:103633. [PMID: 34740074 DOI: 10.1016/j.apergo.2021.103633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
This study aims to explore the effects of noise and music types on nurses' anxiety, mental workload and situation awareness during an operation. Participants included 20 circulating nurses (CNs) and 16 nurse anesthetists (NAs) who completed a total of 70 operations in which each operation required one CN and one NA. The experiment was separated into a control group (operating noise only) vs. an experimental group (3 different music types-between subjects and 2 music volume levels-within-subjects). Results showed that all participants had excellent situation awareness performance despite their mental workload showing significant differences in various phases of the surgery. Music at 55-60 dB caused lower mental workloads and anxiousness for nurses than those exposed to levels of 75-80 dB. When Mozart's music was played, the participants' mental workload and situation anxiety were lower than when exposed to other music types. Music played at 60 dB during an operation may be a feasible solution to mitigate the negative effects of extra noise and thus improve the nurses' performance.
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Affiliation(s)
- Li-Ping Tseng
- Department of Management Center, Sisters of our Lady of China Catholic Medical Foundation, St. Martin De Porres Hospital, Chiayi City, 60069, Taiwan; Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliu, Yunlin, 640301, Taiwan
| | - Mao-Te Chuang
- Department of Surgery, Sisters of our Lady of China Catholic Medical Foundation, St. Martin De Porres Hospital, Chiayi City, 60069, Taiwan
| | - Yung-Ching Liu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliu, Yunlin, 640301, Taiwan.
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Yu CV, Foglia J, Yen P, Montemurro T, Schwarz SKW, MacDonell SY. Noise in the operating room during induction of anesthesia: impact of a quality improvement initiative. Can J Anaesth 2022; 69:494-503. [PMID: 35014000 DOI: 10.1007/s12630-021-02187-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Noise in the operating room (OR) is common and associated with negative effects on anesthesiologists, surgeons, and patient outcomes. Induction of anesthesia is among the loudest perioperative periods. Despite its critical nature, there is little data on noise levels during induction, associated patient and anesthesiologist satisfaction, and the effects of noise reduction strategies. METHODS We conducted a two-part prospective interventional quality improvement project on the care of adult patients receiving general anesthesia for elective noncardiac surgery. For part A, we measured average and peak noise (dB[A]) levels during anesthesia induction in N = 100 cases and administered a satisfaction questionnaire to anesthesiologists. We then applied a multidisciplinary educational program to OR personnel on active noise reduction strategies and subsequently collected data during N = 109 cases in a post-intervention phase. For part B, we administered satisfaction questionnaires to N = 100 patients pre- vs postintervention, respectively. RESULTS Median [interquartile range] noise levels throughout induction were 66.0 [62.5-68.6] dB(A) preintervention vs 63.5 [60.1-65.4] dB[A] post-intervention (Hodges-Lehmann estimator of the difference, - 2.7 dB[A]; 95% confidence interval [CI], - 4.0 to - 1.5; P < 0.001). Peak noise levels during induction were 87.3 [84.0-90.5] dB(A) preintervention and 86.2 [81.8-89.3] dB(A) postintervention (Hodges-Lehmann estimator of the difference, - 1.8 dB[A]; 95% CI, - 3.3 to - 0.3; P = 0.02). Noise-related anesthesiologist satisfaction postintervention was significantly improved in multiple domains, including assessment of noise having distracted anesthesiologists. Patient satisfaction was high pre-intervention and did not significantly improve further. CONCLUSION In this quality improvement project, average noise levels during induction of anesthesia, anesthesiologist satisfaction, and anesthesiologists' perceived ability to perform were improved following a multidisciplinary educational program on noise reduction in the OR. STUDY REGISTRATION www.ClinicalTrials.gov (NCT04204785); registered 19 December 2019.
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Affiliation(s)
- Charles V Yu
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Julena Foglia
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Paul Yen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Trina Montemurro
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - Su-Yin MacDonell
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada. .,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada.
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Hughes MA, Swan L, Taylor CL, Ilin R, Partridge R, Brennan PM. The Impact of Novel Nontechnical Stressors (Visual and Auditory) on Simulated Laparoscopic Task Performance Among Surgeons and Students. J Laparoendosc Adv Surg Tech A 2021; 32:189-196. [PMID: 34860611 DOI: 10.1089/lap.2021.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical training emphasizes technical competence. Growing evidence indicates that nontechnical skills are also significant in determining performance. Critically, surgeons should be aware how performance is affected by pressure or distraction. We assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We hypothesized that the stressors would worsen performance, and that stress-induced diminution in performance would be inversely related to surgical experience. Methods: Twenty participants (10 surgeons and 10 medical students) completed a peg-threading task using a laparoscopic simulator: three times under control conditions, next with a visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance), and then with an auditory distraction overlay (operating theater environment noise). Task completion time and instrument tracking metrics (instrument tip distance traveled and instrument smoothness) were measured. Results: Under control conditions, surgeons completed the task significantly faster, with greater economy of movement, and improved instrument smoothness-compared with students. When exposed to distracting stimuli, the groups behaved differently. Surgeons completed the task more slowly, instrument movements became less smooth (significantly so under audio distraction conditions), but total distance traveled by instruments was unchanged. By contrast, student performance was not impaired and, in some ways, improved. Conclusion: The impact of visual and auditory distraction on surgical performance can be modeled in a laparoscopic simulation environment. The effect of distraction varies according to expertise. This environment may be an effective setting within which to learn to mitigate stress-induced diminution in performance.
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Affiliation(s)
- Mark A Hughes
- Department of Clinical Neurosciences, Edinburgh, United Kingdom
| | - Lewis Swan
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Caitlyn L Taylor
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Razvan Ilin
- Software Development team, eoSurgical Ltd., Edinburgh, United Kingdom
| | - Roland Partridge
- Department of Surgery, Alder Hey Hospital, Liverpool, United Kingdom
| | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Noise reduction in the operating room: another leadership opportunity for anesthesiologists? Int J Obstet Anesth 2021; 49:103231. [PMID: 34774398 DOI: 10.1016/j.ijoa.2021.103231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
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Sheridan H, Plaza E, Hendren G, Hu J, Ortman AJ. Noise levels during cesarean delivery: a prospective observational study. Int J Obstet Anesth 2021; 48:103211. [PMID: 34534867 DOI: 10.1016/j.ijoa.2021.103211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Excessive noise has negative implications for both clinicians and patients. Emergency cesarean deliveries require rapid co-ordination and communication, possibly increasing noise pollution. We aimed to determine if noise levels in the Labor and Delivery operating room were higher during emergency cesarean deliveries than during non-emergency cesarean deliveries. METHODS We conducted a prospective observational study measuring noise levels in Labor and Delivery operating rooms at a single academic medical center. Sound meters placed on anesthesia machines and events charted in the electronic medical record were used to correlate noise levels to clinical activity. Noise levels in all cesarean deliveries were recorded for one year. Deliveries were classified into two groups: non-emergency (routine or urgent) and emergency. We compared noise levels of the groups at eight time points of interest: anesthesia provider enters operating room (T1), induction (T2), five minutes before incision (T3), three minutes before incision (T4), one minute before incision (T5), time of incision (T6), delivery (T7), and five minutes before initiating emergence (T8). RESULTS Noise levels were measured for 440 cesarean deliveries. Forty were classified emergency and 400 non-emergency (304 routine, 96 urgent) procedures. Emergency cesarean deliveries were noisier at all eight time points, although the absolute difference in decibels between the two groups was modest. The difference in noise level reached statistical significance at five time points (T1, T2, T5, T6, and T7). CONCLUSION Noise levels were higher during emergency than during non-emergency cesarean deliveries.
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Affiliation(s)
- H Sheridan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - E Plaza
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - G Hendren
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - J Hu
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - A J Ortman
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA.
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Role Identity During the Resuscitation of Trauma Patients. J Trauma Nurs 2021; 27:374-377. [PMID: 33156255 DOI: 10.1097/jtn.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Full trauma team activations (TTAs) are initiated for patients meeting criteria that are indicative of life-threatening injuries. This influx of medical personnel causes crowding, as well as increased noise. Both adverse effects create an environment that is prone to medical errors, miscommunication, and physical limitations reaching the patient. METHODS A perception survey was issued to all members of the trauma-resuscitation team. The survey focused on the perception of organization, role identity, communication, crowding, and noise during the resuscitation. Following the conclusions of the survey, a role identity process was initiated. The roles of each team member were preprinted on neon stickers and kept at the door of the trauma bay. Team members were required to don a sticker to be in the resuscitation room. Seven months after the initiation of this process, the original survey was reissued. RESULTS A total of 141 team members completed the preimplementation survey, and 96 completed the postimplementation survey. A significant difference was found in the perception of less noise (p = .009) and improved communication (p =.005) during the trauma resuscitation. No significant difference was determined regarding the perception of organization (p = .175) or improvement in knowing the roles of all the team members (p = .090). CONCLUSION Having a mechanism to identify the members of the trauma team during a full TTA resuscitation has shown to limit overcrowding, improve communication, and decrease noise during trauma resuscitation. This mechanism ensures appropriate personnel are present during this phase of the critically injured patient.
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Montiel V, Pérez-Prieto D, Perelli S, Monllau JC. Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers. Trop Med Infect Dis 2021; 6:43. [PMID: 33807317 PMCID: PMC8103268 DOI: 10.3390/tropicalmed6020043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. MATERIALS AND METHODS This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. RESULTS A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. DISCUSSION The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior.
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Affiliation(s)
- Verónica Montiel
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra, Spain;
| | - Daniel Pérez-Prieto
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Simone Perelli
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Joan Carles Monllau
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
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Fu VX, Oomens P, Merkus N, Jeekel J. The Perception and Attitude Toward Noise and Music in the Operating Room: A Systematic Review. J Surg Res 2021; 263:193-206. [PMID: 33677147 DOI: 10.1016/j.jss.2021.01.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/22/2020] [Accepted: 01/18/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Environmental noise pollution is regarded as a general stressor. Noise levels frequently exceed recommended noise levels by the World Health Organization in hospitals, especially in the operation room. The aim of this systematic review was to assess the effects of noise pollution on patient outcome and performance by operation room staff. In addition, the perception and attitude toward playing music in the operation room, which can increase noise levels, were assessed as well. MATERIALS AND METHODS A systematic literature search of the databases Embase, Medline Ovid, and Cochrane from date of database inception until October 16th, 2020 using the exhaustive literature search method was performed. Prospective studies evaluating the effect of noise on the patient, surgeons, anesthesiologists, nurses, and other operation room staff, or perception and attitude toward playing music in the operation room, were included. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and was registered with PROSPERO (ID: 208282). RESULTS The literature search generated 4758 articles, and 22 prospective studies (3507 participants) were included. Three of the four studies that investigated the effect of noise on patient outcome reported a significant reduction of complication rate in surgical patients, when noise levels were lower. Six studies assessed the effect of noise in the operation room on the staff (1383 participants). Over half of the surveyed staff found noise levels to be a disturbing stressor and negatively impact performance. Although music increased decibel levels in the operation room, most surveyed staff was positively predisposed toward playing music during surgery, believing it to improve both individual and team performance. In general, music was not considered to be distracting or impairing communication. CONCLUSIONS Higher noise levels seem to have a negative effect on patient outcome and adversely affect performance by members in the operation room. Further research is needed to assess whether this knowledge can benefit patient outcome and surgical performance. Notably, attitude of surgical team members toward music during surgery is generally regarded favorable.
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Affiliation(s)
- Victor X Fu
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Neuroscience, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
| | - Pim Oomens
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Neuroscience, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Niek Merkus
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Neuroscience, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Shover A, Holloway J, Dauphine C, Benharash P, Xing H, Kansal N, Bowens N, Archie M, Kaji AH, de Virgilio C. A Randomized Prospective Blinded Study Evaluating the Effect of Music on Novice Surgical Trainees' Ability to Perform a Simulated Surgical Task. JOURNAL OF SURGICAL EDUCATION 2021; 78:638-648. [PMID: 32917540 DOI: 10.1016/j.jsurg.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine if playing music would affect novice surgical trainees' ability to perform a complex surgical task. BACKGROUND The effect of music in the operating room (OR) is controversial. Some studies from the anesthesiology literature suggest that OR music is distracting and should be banned. Other nonblinded studies have indicated that music improves surgeons' efficiency with simple tasks. DESIGN/METHODS A prospective, blinded, randomized trial of 19 novice surgical trainees was conducted using an in vitro model. Each trainee performed a baseline vascular anastomosis (VA) without music. Subsequently, they performed one VA with music (song validated to reduce anxiety) and one without, in random order and without prior knowledge of the study's purpose. The primary endpoint was a difference in differences from baseline with and without music with respect to time to completion, acceleration/deceleration (using a previously validated hand-tracking motion device), and video performance scoring (3 blinded experts using a validated scale). The participants completed a poststudy survey to gauge their opinions regarding music during tasks. RESULTS Overall, 57 VAs by 19 trainees were evaluated. Average time to completion was 11.6 minutes. When compared to baseline, time to completion improved for both the music group (p = 0.01) and no-music group (p = 0.001). When comparing music to no music, there was no difference in time to completion (p = 0.7), acceleration/deceleration (p = 0.3), or video performance scorings (p = NS). Among participants, 89% responded that they enjoy listening to music while performing tasks. CONCLUSIONS Using three outcome measures, relaxing music did not improve the performance of novice surgical trainees performing a complex surgical task, and the music did not make their performance worse. However, nearly all trainees reported enjoying listening to music while performing tasks.
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Affiliation(s)
- Andrew Shover
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Janell Holloway
- David Geffen School of Medicine at University of California, Los Angeles, California; Charles R. Drew University of Medicine and Science College of Medicine, Los Angeles, California
| | - Christine Dauphine
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California
| | - Peyman Benharash
- Division of Cardiac Surgery at University of California Los Angeles, Los Angeles, California
| | - Hanning Xing
- David Geffen School of Medicine at University of California, Los Angeles, California
| | - Nikhil Kansal
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California
| | - Nina Bowens
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California
| | - Mark Archie
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California
| | - Christian de Virgilio
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; The Lundquist Institute, Torrance, California.
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Sampieri G, Namavarian A, Levin M, Philteos J, Lee JW, Koskinen A, Lin V, Lee J. Noise in Otolaryngology - Head and Neck Surgery operating rooms: a systematic review. J Otolaryngol Head Neck Surg 2021; 50:8. [PMID: 33573705 PMCID: PMC7879658 DOI: 10.1186/s40463-020-00487-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. METHODS Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. RESULTS This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. CONCLUSIONS This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs.
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Affiliation(s)
| | | | - Marc Levin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jong Wook Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Anni Koskinen
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Lin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Mcleod RWJ, Myint-Wilks L, Davies SE, Elhassan HA. The impact of noise in the operating theatre: a review of the evidence. Ann R Coll Surg Engl 2021; 103:83-87. [PMID: 33559553 PMCID: PMC9773860 DOI: 10.1308/rcsann.2020.7001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51dB and 79dB in operating theatres. Despite these levels of noise, there is little research investigating their effect on surgical team functioning. METHODS A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE, which included the search terms 'noise' OR 'distraction' AND 'technical skill' OR 'Surgical skill' OR 'Operating Room'. Only 10 of 307 articles identified were deemed relevant. FINDINGS Eight of ten studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case-irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. CONCLUSION Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning.
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Affiliation(s)
- RWJ Mcleod
- University Hospital of Wales, Cardiff, UK
| | | | - SE Davies
- University Hospital of Wales, Cardiff, UK
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Gülşen M, Aydıngülü N, Arslan S. Physiological and psychological effects of ambient noise in operating room on medical staff. ANZ J Surg 2021; 91:847-853. [PMID: 33459517 DOI: 10.1111/ans.16582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The study was conducted to assess operating room noise levels and to investigate its effects on medical staff. METHODS Single-blind study. This study was conducted with 92 medical staff working in 11 operating rooms of a university hospital. Data was collected using a personal information form and sound level measuring devices. Sound measurements were made 3 days a week in the morning and in the afternoon, twice a day and lasted 15 min each. Mean values of the measurements in each room were collected and recommended maximum values for operating rooms (35 dB during daytime) by the World Health Organization were set as a reference point. RESULTS The highest noise level was measured in orthopaedic (67.5 dB), and the lowest in gynaecology room (55.5 dB). Daily mean noise level of all operating rooms was 60.90 dB. Noise disturbance score measured with Visual Analogue Scale was 6.66 ± 1.84. Of the medical staff, 84.8% were physiologically, 93.5% psychologically, and 82.6% both physiologically and psychologically affected. Of those affected physiologically, 51.1% experienced fatigue, and 33.7% headache, and of those affected psychologically, 43.5% experienced inattentiveness, 34.8% agitation and 15.2% restlessness. Only 4.34% reported not being affected by the noise. CONCLUSION Operating room noise levels were higher than normal limits set by the World Health Organization, which affected the medical staff both physiologically and psychologically. Since experienced negativities may reduce medical staff's motivation and increase error making, making arrangements to control noise levels is recommended.
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Affiliation(s)
- Muaz Gülşen
- Faculty of Health Sciences, Department of Surgical Nursing, Çukurova University, Adana, Turkey
| | - Nursevim Aydıngülü
- Faculty of Health Sciences, Department of Surgical Nursing, Çukurova University, Adana, Turkey
| | - Sevban Arslan
- Faculty of Health Sciences, Department of Surgical Nursing, Çukurova University, Adana, Turkey
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Safer Surgical Practice: a Guide for Surgeons (not just for pandemics). Br J Oral Maxillofac Surg 2021. [PMCID: PMC7833066 DOI: 10.1016/j.bjoms.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The surgical working environment has changed considerably since the World Health Organisation (WHO) declared the coronavirus outbreak, COVID-19 (SARS-CoV-2), a pandemic on 11 March 2020. Measures remain in place to reduce the risk of spread from patients to surgeons, nosocomial infection and amongst healthcare workers. However, despite these protective measures, healthcare staff are at risk with the number of health workforce deaths increasing worldwide. This article sets out to explore the roles and responsibilities of the surgeon during these extraordinary times and discuss how we can improve our practice to reduce the risk of harm to patients, surgical staff, and ourselves.
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Levin M, Zhou K, Sommer EC, Purohit H, Wells J, Pugi J, Sommer DD. Noise in Endoscopic Sinus and Skull Base Surgery Operating Rooms. Am J Rhinol Allergy 2020; 35:541-547. [PMID: 33236663 DOI: 10.1177/1945892420976523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Noise in the operating room (OR) contributes to miscommunication among team members and may negatively impact patient outcomes. OBJECTIVES This study aimed to quantify noise levels during endoscopic sinus and skull base surgery. The secondary aim was to understand how OR team members perceive noise during endoscopic sinus and skull base surgery. METHODS Noise levels were measured using the validated phone application SoundMeter X 10.0.4 (r1865) (Faber Acoustical, Utah, USA) at the ear-level of the surgeon, scrub nurse, circulating nurse, and anesthesiologist. At the end of each surgery, OR team members were asked to complete a six-question questionnaire about noise during that surgery. RESULTS One thousand four hundred and two noise measurements were recorded across 353 trials. The loudest mean noise measurement was 84.51 dB and maximum noise measurement was 96.21 dB at the ear-level of the surgeon. Noise was significantly higher at the ear-level of the surgeon and scrub nurse in comparison to the circulating nurse (p = .000) and anesthesiologist (p = .000). Forty percent of questionnaire respondents believed noise was a problem and 38% stated that noise caused communication issues during surgery. CONCLUSION Surgeons and scrub nurses have significantly higher noise exposure in comparison to circulating nurses and anesthesiologists during endoscopic sinus and skull base surgery. For these members of the OR team, noise is also identified as problematic and causing issues with communication. Mechanisms to reduce potential noise may be implemented to improve communication and patient outcomes in endoscopic sinus and skull base surgery.
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Affiliation(s)
- Marc Levin
- Michael G. DeGroote School of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Kelvin Zhou
- Michael G. DeGroote School of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Ethan C Sommer
- Bachelor of Health Sciences Program, 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | - Hitansh Purohit
- Bachelor of Health Sciences Program, 3710McMaster University, Hamilton, ON, Canada
| | - Jeffery Wells
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Jakob Pugi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
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Gil K, Jones M, Mouw T, Al-Kasspooles M, Brahmbhatt T, DiPasco PJ. Satisfaction or Distraction: Exposure to Nonpreferred Music May Alter the Learning Curve for Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2020; 77:1370-1376. [PMID: 32532698 DOI: 10.1016/j.jsurg.2020.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There is growing evidence supporting the benefits of preferred music on task performance, however there is a paucity of data regarding the potential impact on surgical and procedural learners. This study aims to assess the effects of nonpreferred music on surgical and procedural learners. DESIGN This was a single-blinded, randomized crossover trial in which each participant completed a survey regarding their demographic information and music preferences. Each participant then completed 3 training tasks, and 2 repetitions of the evaluative task while listen to music. Tasks were completed using a Da Vinci Skills Simulator Si. SETTING All tasks were completed in a live operating room at the University of Kansas Hospital, a tertiary care center. PARTICIPANTS Medical students at the University of Kansas Medical Center were recruited by email to participate. In total, 31 medical students completed the experience. RESULTS Thirty-one participants participated in this study. Group 2 (preferred music first, nonpreferred music second) showed no significant change in their test scores (72.73 vs 74.33, p = 0.34). However, Group 1 (nonpreferred music first, then preferred music) showed significant improvement between trial runs (70.31 vs 81.88, p < 0.001). There was no significant difference between the initial runs for each group. When analyzed irrespective of group assignment, there was a significant increase in scores for preferred music vs nonpreferred music (77.45 vs 72.26 p = 0.025). CONCLUSIONS Participants showed expected improvement with task repetition. This improvement may have been offset by exposure to nonpreferred music during repeat runs. Our findings suggest that the impact of music was nearly as large as the impact of prior exposure to the task. This may have implications for environmental conditions during resident procedural training, especially early in residency training when new tasks are being introduced and the skill level of the learner is still low.
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Affiliation(s)
- Kellen Gil
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas.
| | - Maddie Jones
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Tyler Mouw
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Mazin Al-Kasspooles
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Tejal Brahmbhatt
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter J DiPasco
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Heider CA, Álvarez ML, Fuentes-López E, González CA, León NI, Verástegui DC, Badía PI, Napolitano CA. Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID-19 Era. Laryngoscope 2020; 131:E1227-E1233. [PMID: 33009672 PMCID: PMC7675517 DOI: 10.1002/lary.29172] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022]
Abstract
Objectives/Hypothesis To determine the prevalence and associated risk factors of voice disorders in healthcare workers of high‐risk hospital care units during the 2019 coronavirus disease (COVID‐19) pandemic. Study Design Cross‐sectional study. Methods Questionnaire survey to healthcare personnel of COVID‐19 high‐risk hospital units was conducted, regarding demographic data, clinical activity, the pattern of usage of personal protective equipment, medical and vocal history, vocal symptoms, and Spanish validated Voice Handicap Index (VHI)‐10 questionnaire. Results A total of 221 healthcare workers answered the survey. Nearly 33% of them reported having trouble with their voice during the last month, and 26.24% had an abnormal score in the Spanish validated VHI‐10 questionnaire. The mean VHI‐10 score was 7.92 (95% confidence interval 6.98–8.85). The number of working hours, the number of hours of mask daily use, simultaneous surgical and self‐filtering mask use, and working in intermediate or intensive care units were independent variables significantly associated with a higher VHI‐10 score. Conclusions Healthcare workers of high‐risk hospital care units during the universal masking COVID‐19 pandemic are at risk of voice disorders. Level of Evidence 3 Laryngoscope, 131:E1227–E1233, 2021
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Affiliation(s)
- Claudia A Heider
- Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Matías L Álvarez
- Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Speech Language Therapy Program, Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A González
- Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Norma I León
- Speech Language Therapy Program, Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniela C Verástegui
- Speech Language Therapy Program, Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro I Badía
- Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carla A Napolitano
- Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Fu VX, Oomens P, Kleinrensink VEE, Sleurink KJ, Borst WM, Wessels PE, Lange JF, Kleinrensink GJ, Jeekel J. The effect of preferred music on mental workload and laparoscopic surgical performance in a simulated setting (OPTIMISE): a randomized controlled crossover study. Surg Endosc 2020; 35:5051-5061. [PMID: 33026515 PMCID: PMC8346395 DOI: 10.1007/s00464-020-07987-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Worldwide, music is commonly played in the operation room. The effect of music on surgical performance reportedly has varying results, while its effect on mental workload and key surgical stressor domains has only sparingly been investigated. Therefore, the aim is to assess the effect of recorded preferred music versus operating room noise on laparoscopic task performance and mental workload in a simulated setting. METHODS A four-sequence, four-period, two-treatment, randomized controlled crossover study design was used. Medical students, novices to laparoscopy, were eligible for inclusion. Participants were randomly allocated to one of four sequences, which decided the exposure order to music and operation room noise during the four periods. Laparoscopic task performance was assessed through motion analysis with a laparoscopic box simulator. Each period consisted of ten alternating peg transfer tasks. To account for the learning curve, a preparation phase was employed. Mental workload was assessed using the Surgery Task Load Index. This study was registered with the Netherlands Trial Register (NL7961). RESULTS From October 29, 2019 until March 12, 2020, 107 participants completed the study, with 97 included for analyzation. Laparoscopic task performance increased significantly during the preparation phase. No significant beneficial effect of music versus operating room noise was observed on time to task completion, path length, speed, or motion smoothness. Music significantly decreased mental workload, reflected by a lower score of the total weighted Surgery Task Load Index in all but one of the six workload dimensions. CONCLUSION Music significantly reduced mental workload overall and of several previously identified key surgical stressor domains, and its use in the operating room is reportedly viewed favorably. Music did not significantly improve laparoscopic task performance of novice laparoscopists in a simulated setting. Although varying results have been reported previously, it seems that surgical experience and task demand are more determinative.
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Affiliation(s)
- Victor X Fu
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Pim Oomens
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Vincent E E Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Karel J Sleurink
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Willemijn M Borst
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Pascale E Wessels
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Silverman MJ, Gooding LF, Yinger O. It’s...Complicated: A Theoretical Model of Music-Induced Harm. J Music Ther 2020; 57:251-281. [DOI: 10.1093/jmt/thaa008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractWhile literature exists supporting the use of music for health promotion, scholars have also noted the potential for music-induced harm and other maladaptive effects of music. Harm is a multifaceted construct that can include affective, behavioral, cognitive, identity, interpersonal, physical, and spiritual aspects. As music also represents a multifaceted experience, the relationship between music and harm is complex and can include numerous contextual-, deliverer-, music-, and recipient-based factors. Music-induced harm (MIH) also needs to be clearly defined to understand and protect against it. Therefore, the purpose of this article was to explore the numerous factors influencing how music can result in harm and develop a theoretical model that could be used to inform safe music practices. Drawing from existing models of emotional responses to music, music intervention reporting guidelines, therapeutic functions of music, and holistic wellness, we explored how the interplay between the deliverer, music, and recipient can result in various types of MIH in diverse contexts. We then developed the MIH model to integrate these factors and connect the model with the existing literature. The MIH model highlights the relevance of academic and clinical training, credentialing, occupational regulation, continuing education, and professional organizations that provide accredited curricular oversight to protect people from MIH. Implications for clinical application, limitations, and suggestions for future research are provided.
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Mellum ML, Vestergaard AH, Grauslund J, Vergmann AS. Virtual vitreoretinal surgery: effect of distracting factors on surgical performance in medical students. Acta Ophthalmol 2020; 98:378-383. [PMID: 31580012 DOI: 10.1111/aos.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to investigate the effect of four distracting factors on surgical performance in virtual vitreoretinal surgery. METHODS Nineteen novice surgeons completed a validated training programme on the Eyesi surgical simulator (VRmagic GmbH, Manheim, Germany; software version 2.9.2) until a calculated target score was reached. The training programme consisted of four modules: navigation level 2 (Nav2), bimanual training level 3 (BimT3), posterior hyaloid level 3 (PostH3) and internal limiting membrane peeling level 3 (ILMP3). When properly trained, the participants completed the training programme once without distraction to generate reference scores and times. Next, they conducted the training programme under the influence of each of the following: auditory distraction, 12 hr of fasting, interrupted sleep and 24 hr of sleep deprivation. Wilcoxon signed-rank test was used to compare the distraction-induced results to the participants' reference scores and times. RESULTS As compared to reference score (328), a lower performance was found for all four distractions: auditory distraction (289, p = 0.0012), fasting (302, p = 0.02), sleep interruption (304, p = 0.02) and sleep deprivation (300, p = 0.0006). In particular, PostH3 performance was influenced by all four interventions. (86 versus 50, p = 0,0012, 65, p = 0.05, 72, p = 0.05, 54, p = 0.0007 respectively). CONCLUSIONS Virtual vitreoretinal surgery is an important tool for practicing complex surgical skills without compromising patient safety. In this study, deleterious effects on surgical performance were induced by four independent distracting factors. This knowledge is useful to optimize surgeons' work conditions and ensuring the best possible treatment of patients.
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Affiliation(s)
- Marie Leonora Mellum
- Department of Ophthalmology Odense University Hospital Odense C Denmark
- Faculty of Health Science Department of Clinical Research Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Regional Center for Technical Simulation Region of Southern Denmark Odense Denmark
| | - Anders Højslet Vestergaard
- Department of Ophthalmology Odense University Hospital Odense C Denmark
- Faculty of Health Science Department of Clinical Research Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense C Denmark
- Faculty of Health Science Department of Clinical Research Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Steno Diabetes Center Odense Odense University Hospital and Svendborg Hospital Odense Denmark
| | - Anna Stage Vergmann
- Department of Ophthalmology Odense University Hospital Odense C Denmark
- Faculty of Health Science Department of Clinical Research Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Regional Center for Technical Simulation Region of Southern Denmark Odense Denmark
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Abstract
Background Noise exposure in hospitals can negatively impact both patients and doctors. It can make patients feel more anxious or depressive and can impair doctors' concentration or judgment, potentially leading to poor decision-making or performance. In China, an increasing number of outpatient operating rooms have emerged in recent years for the convenience of patients planning to undergo minor surgery. In this study, we aimed to investigate the impact of noise exposure in the outpatient operating room and ways to deal with it. Methods By monitoring noise at different locations in three hospitals, we analyzed the average noise exposure intensity affecting outpatient operative procedures. After noise monitoring, we made some constructive suggestions and other adjustments to reduce and lower the noise exposure in one outpatient operating room [the experimental operating room (EOR)] to observe the feasibility and effectiveness of noise control in and out of the outpatient operating room. Results Noise intensity in the outpatient operating room was significantly higher than that in the inpatient operating room (68.3±14.7 vs. 45.7±9.6, P<0.05). After noise control, the noise intensity in the EOR decreased significantly (74.5±16.6 vs. 59.2±13.4, P<0.05) but was still higher than that in the inpatient operating room (59.2±13.4 vs. 46.0±9.3, P<0.05) of the same hospital. Further analysis revealed that noise affecting outpatient operating room mainly originates from vehicles outside, medical machines, ambulances, crowds in the outpatient main hall, and communication devices. Conclusions Noise exposure is a common and serious problem, but measures can be taken to deal with it effectively.
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Affiliation(s)
- Min Liu
- Department of Operation, The Central Hospital of Wuhan & Affiliated Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
| | - Chen Yi
- Department of Operation, The Central Hospital of Wuhan & Affiliated Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
| | - Fei Yin
- Department of Operation, The Central Hospital of Wuhan & Affiliated Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yu Dai
- Department of Operation, The Central Hospital of Wuhan & Affiliated Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
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Baltin CT, Wilhelm H, Wittland M, Hoelscher AH, Stippel D, Astvatsatourov A. Noise patterns in visceral surgical procedures: Analysis of second-by-second dBA data of 599 procedures over the course of one year. Sci Rep 2020; 10:3030. [PMID: 32080239 PMCID: PMC7033177 DOI: 10.1038/s41598-020-59816-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/04/2020] [Indexed: 11/12/2022] Open
Abstract
The objective of this study is to analyze noise patterns during 599 visceral surgical procedures. Considering work-safety regulations, we will identify immanent noise patterns during major visceral surgeries. Increased levels of noise are known to have negative health impacts. Based on a very fine-grained data collection over a year, this study will introduce a new procedure for visual representation of intra-surgery noise progression and pave new paths for future research on noise reduction in visceral surgery. Digital decibel sound-level meters were used to record the total noise in three operating theatres in one-second cycles over a year. These data were matched to archival data on surgery characteristics. Because surgeries inherently vary in length, we developed a new procedure to normalize surgery times to run cross-surgery comparisons. Based on this procedure, dBA values were adjusted to each normalized time point. Noise-level patterns are presented for surgeries contingent on important surgery characteristics: 16 different surgery types, operation method, day/night time point and operation complexity (complexity levels 1–3). This serves to cover a wide spectrum of day-to-day surgeries. The noise patterns reveal significant sound level differences of about 1 dBA, with the most-common noise level being spread between 55 and 60 dBA. This indicates a sound situation in many of the surgeries studied likely to cause stress in patients and staff. Absolute and relative risks of meeting or exceeding 60 dBA differ considerably across operation types. In conclusion, the study reveals that maximum noise levels of 55 dBA are frequently exceeded during visceral surgical procedures. Especially complex surgeries show, on average, a higher noise exposure. Our findings warrant active noise management for visceral surgery to reduce potential negative impacts of noise on surgical performance and outcome.
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Affiliation(s)
- C T Baltin
- Department of Orthopaedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
| | - H Wilhelm
- Faculty of Management and Economics, Witten/Herdecke University, Witten, Germany
| | - M Wittland
- Department of Nursing and Health Care, Faculty V, University of Applied Sciences and Arts, Hannover, Germany
| | - A H Hoelscher
- Contilia Centre for Diseases of the Oesophagus, Elisabeth Hospital Essen, Essen, Germany
| | - D Stippel
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - A Astvatsatourov
- Clinical Trials Centre Cologne, University Hospital of Cologne, Cologne, Germany
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El Boghdady M, Ewalds-Kvist BM. The influence of music on the surgical task performance: A systematic review. Int J Surg 2019; 73:101-112. [PMID: 31760139 DOI: 10.1016/j.ijsu.2019.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/26/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Music is commonly played in operating theatres. Music was shown to diminish stress of the surgical team along with reducing the patient's anxiety before surgery. On the other hand, it has been revealed that music might give rise to negative effects of divided attention causing distraction in surgical routines. Therefore, we aimed to systematically review the effect of music on the surgeon's task performance. METHODS A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. A literature search using PubMed/Medline, ScienceDirect and Google Scholar, was performed by means of the search terms: "music and operating theatre", as well as "music and surgery". The search was limited to citations in English from year 2009-2018. Search items were considered from the nature of the articles, date of publication, forum of publication, aims and main findings in relation to use of music in operating theatres. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied. Studies were included based on predetermined inclusion criteria where after the papers' quality assessments and evidence grading were completed by two independent reviewers. The protocol was registered with the PROSPERO register of systematic reviews. RESULTS Out of 18 studies that formed the base for evidence evaluations, 6 studies were assessed as having high quality and 8 studies of moderate quality. Five studies, provided both strong and moderate scientific evidence for a positive effect of music on surgeon's task performance. In contrast, strong scientific evidence for a negative effect of music on surgeon's task performance also was revealed in 2 high-quality studies. Nevertheless, the positive effect of music on the surgical task performance was significantly higher when compared to its negative effect (p < 0.0001). CONCLUSION Certain music elements affect the surgical task performance in a positive or negative way. The total and significant outcome of the present study was that the positive effect of music on surgeon's task performance, overrides its negative effect. Classic music when played with a low to medium volume can improve the surgical task performance by increasing both accuracy and speed. The distracting effect of music should also be put in consideration when playing a loud or high-beat type of music in the operating theatres.
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Rastipisheh P, Choobineh A, Razeghi M, Kazemi R, Ghaem H, Taheri S, Maghsoudi A. The effects of playing music during surgery on the performance of the surgical team: A systematic review. Work 2019; 64:407-412. [PMID: 31524187 DOI: 10.3233/wor-192984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Music is an economical, advantageous and reliable means of reducing stress or stress-related problems. OBJECTIVE The present study aims to evaluate the effects of playing music during surgery on the performance of the surgical team through a systematic review of published studies. METHODS The relevant databases of Medline/PubMed, Scopus and Science Direct were searched up to July 2018 to find related articles. The comprehensive literature search was reduced to 19 articles that met inclusion criteria. RESULTS The articles comprised 13 studies and reported on the positive effects of music on the performance of the surgical team. The effects included a more relaxing and pleasant environment, more accurate and precise performance of tasks, a decrease in the mental workload and task completion time, increased situation awareness, a reduction in stress and anxiety and improved memory consolidation. Five studies reported on the negative effects of music during surgery as being a negative impact on task completion, poor auditory performance and increased likelihood of having to repeat requests. The remaining article reported no significant differences between groups compared. CONCLUSIONS Most studies reported positive effects of music on the surgical team during surgery. These results indicate that it may be possible to improve the performance of the surgical team during surgery while playing controlled music.
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Affiliation(s)
- Pegah Rastipisheh
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Physiotherapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Kazemi
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Taheri
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Maghsoudi
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Oomens P, Fu VX, Kleinrensink GJ, Jeekel J. The effect of music on simulated surgical performance: a systematic review. Surg Endosc 2019; 33:2774-2784. [PMID: 31140001 PMCID: PMC6684803 DOI: 10.1007/s00464-019-06868-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/18/2019] [Indexed: 02/02/2023]
Abstract
Introduction Beneficial effects of music have been described on several cognitive domains, task performance, stress, anxiety and pain. Greater surgical skill is a factor that has been associated with improved patient outcome. The aim of this systematic review is to assess the effect of music on surgical performance. Methods An exhaustive literature search was performed. The following databases were searched: Embase, Medline Ovid, Web of Science, Cochrane CENTAL, PsycINFO Ovid, CINAHL EBSCOhost, ERIC EBSCOhost and Google Scholar. All prospective studies that assessed the effect of a music intervention compared to either another auditory condition or silence on surgical performance were included in a qualitative synthesis. The study was registered in the PROSPERO-database (CRD42018092021). Results The literature search identified 3492 articles of which 9 studies (212 participants) were included. Beneficial effects of music were reported on time to task completion, instrument handling, quality of surgical task performance and general surgical performance. Furthermore, a beneficial effect of music on muscle activation was observed. Conclusion Although beneficial effects of music on surgical performance have been observed, there is insufficient evidence to definitively conclude that music has a beneficial effect on surgical performance in the simulated setting. Future studies should be conducted using greater numbers of participants focusing on a more limited range of tasks, as well as validation in the live operating environment.
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Affiliation(s)
- Pim Oomens
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands. .,Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands.
| | - Victor Xing Fu
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands.,Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands
| | - Gert Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands.,Department of Surgery, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, Rotterdam, The Netherlands
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Aalirezaie A, Akkaya M, Barnes CL, Bengoa F, Bozkurt M, Cichos KH, Ghanem E, Darouiche RO, Dzerins A, Gursoy S, Illiger S, Karam JA, Klaber I, Komnos G, Lohmann C, Merida E, Mitt P, Nelson C, Paner N, Perez-Atanasio JM, Reed M, Sangster M, Schweitzer D, Simsek ME, Smith BM, Stocks G, Studers P, Talevski D, Teuber J, Travers C, Vince K, Wolf M, Yamada K, Vince K. General Assembly, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S105-S115. [PMID: 30348570 DOI: 10.1016/j.arth.2018.09.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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50
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Carillo L, Devic A, Soulié M, Gamé X. Évaluation du niveau sonore dans un bloc opératoire d’urologie. Prog Urol 2019; 29:45-49. [DOI: 10.1016/j.purol.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/01/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
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