Assessment of Musculoskeletal Disorder Risk with Hand and Syringe use in Chemotherapy Nurses and Pharmacy Assistants

Intravitreal Plungerless Injector Device (IPLID): An Innovative Intravitreal Injector Device

Purpose

To share our early experience with the novel intravitreal plungerless injector device (IPLID) for application in patients with various retinal diseases.

Patients and Methods

This study enrolled 300 eyes (300 patients) who had undergone at least 1 previous conventional intravitreal injection, for various indications, such as diabetic macular edema, venous occlusions, active choroidal neovascular membrane, wet AMD and neovascular glaucoma. Patients with systemic conditions that could affect pain tolerance were excluded. All patients underwent intravitreal injection with the IPLID. After the procedure the patients were asked to grade pain compared to conventional injections. Immediately after the procedure, surgeons completed a simple survey on various aspects of the device, including safety of the procedure. Data were also collected on the duration of the procedure.

Results

The study sample was comprised of 210 males and 90 females. The mean duration of the injection was 17.51 minutes (range, 15 minutes to 20 minutes). Post-IPLID injection, 155 (51.7%) patients reported less pain compared to previous injections, 128 (42.7) patients reported pain similar to previous injections and 5.7% (17) of patients reported more pain than previous procedures. The physician survey indicated that there was no difference between IPLID and conventional technique in 13.33% (40) of injections, and 86.67% (260) of the injections were comfortable to perform with the IPLID and size was not an issue in 91.67% (275) of injections. In all cases, the surgeons were comfortable with the delivery of medication with IPLID and there were no adverse events during or after IPLID injection.

Conclusion

The IPLID is a simple device for delivering intravitreal injection and may offer greater ergonomic advantages and that address the issue of musculoskeletal disorders in healthcare personnel due to repetitive procedures over time.

A generic approach to developing human factors-quality assessment tools exemplified by the warehouse error prevention tool

This study proposes a generic approach for creating human factors-based assessment tools to enhance operational system quality by reducing errors. The approach was driven by experiences and lessons learned in creating the warehouse error prevention (WEP) tool and other system engineering tools. The generic approach consists of 1) identifying tool objectives, 2) identifying system failure modes, 3) specifying design-related quality risk factors for each failure mode, 4) designing the tool, 5) conducting user evaluations, and 6) validating the tool. The WEP tool exemplifies this approach and identifies human factors related to design flaws associated with quality risk factors in warehouse operations. The WEP tool can be used at the initial stage of design or later for process improvement and training. While this process can be adapted for various contexts, further study is necessary to support the teams in creating tools to identify design-related human factors contributing to quality issues.

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.

Engineers in Medicine: Foster Innovation by Traversing Boundaries

Engineers play a critical role in the advancement of biomedical science and the development of diagnostic and therapeutic technologies for human well-being. The complexity of medical problems requires the synthesis of diverse knowledge systems and clinical experiences to develop solutions. Therefore, engineers in the healthcare and biomedical industries are interdisciplinary by nature to innovate technical tools in sophisticated clinical settings. In academia, engineering is usually divided into disciplines with dominant characteristics. Since biomedical engineering has been established as an independent curriculum, the term "biomedical engineers" often refers to the population from a specific discipline. In fact, engineers who contribute to medical and healthcare innovations cover a broad range of engineering majors, including electrical engineering, mechanical engineering, chemical engineering, industrial engineering, and computer sciences. This paper provides a comprehensive review of the contributions of different engineering professions to the development of innovative biomedical solutions. We use the term "engineers in medicine" to refer to all talents who integrate the body of engineering knowledge and biological sciences to advance healthcare systems.

Workers’ subjective discomfort, muscle fatigue, and kinematics during a manual packaging task

BACKGROUND: Due to the prevalence and increased demand for manual packaging tasks, the concern for worker health and safety has grown. OBJECTIVE: This study aims to assess the effects of gender and work postures on subjective discomfort, muscle fatigue, and kinematics during a manual packaging task. METHODS: Twenty participants, including 10 males and 10 females, were recruited to perform a 60-minute manual packaging task in sitting and standing postures. RESULTS: Discomfort was evidenced by increased the rating of perceived exertion (RPE) values (sit: from 6 to 14.55; stand: from 6 to 17.15) and muscle fatigue was supported by decreased median power frequency (MPF) values for right brachioradialis (RB) (sit: –23.68% ; stand: –16.20%), right upper trapezius (RUT) (sit: –20.14% ; stand: 11.79%), and right erector spinae (RES) (sit: 8.64% ; stand: 11.21%) muscles. Women were more likely to bend forward in a relaxed upper body position, especially while sitting, which may increase the risk of low back pain and women also reported greater discomfort than men, but not in the hands and back. Compared with sitting, the back showed greater muscle fatigue in standing, while muscle fatigue for the shoulders and hands was the opposite. CONCLUSION: These findings suggest that work posture should be considered to prevent fatigue in manual packaging tasks. Given the impact of gender on muscle fatigue, work performed by women and men should both be considered. The results can help to develop action strategies and work posture design to prevent musculoskeletal disorders in the manual packaging industry.

Median nerve travel and deformation in the transverse carpal tunnel increases with chuck grip force and deviated wrist position

Background

We assessed median nerve travel and deformation concurrently to better understand the influence of occupational risk factors on carpal tunnel dynamics, including forceful chuck gripping and deviated wrist positions.

Methods

Fourteen healthy right-hand dominant participants performed a chuck grip in 6 experimental conditions: two relative force levels (10% and 40% of maximum voluntary effort); three wrist positions (15° radial deviation, 0° neutral, 30° ulnar deviation). Chuck grip forces were measured with a load cell while the transverse cross-section of the carpal tunnel was imaged via ultrasound at the distal wrist crease. Images of the median nerve were analyzed in ImageJ to assess cross-sectional area, circularity, width, and height as well as travel in the anterior-posterior and medial-lateral axes.

Results

We found a main effect of deviated wrist position on both anterior-posterior and medial-lateral travel, with the greatest nerve travel occurring in 30° ulnar deviation. There was also a significant interaction between chuck grip force and deviated wrist position on cross-sectional area. Specifically, the area decreased with 40% vs. 10% chuck grip force when the wrist was in 30° ulnar deviation; however, there were no changes in 0° neutral and 15° radial deviation.

Discussion

Overall, we demonstrated that forceful chuck gripping in deviated wrist positions influenced carpal tunnel dynamics, resulting in both migratory and morphological changes to the median nerve. These changes may, in turn, increase local strain and stress with adjacent structures in the carpal tunnel. Future studies mapping contact stress between structures may further elucidate injury development of work-related carpal tunnel syndrome.

Occupational Health and Safety Risk Assessment based on Combination Weighting and Uncertain Linguistic Information: Method Development and Application to a Construction Project

OCCUPATIONAL APPLICATIONSOccupational hazards and work-related accidents are a substantial problem in countries around the world. Therefore, it is of great importance to develop appropriate techniques to assess and reduce the risk of occupational hazards. In many situations, however, exact data are inadequate to model real-life scenarios, because of the complexity of occupational health and safety (OHS) risk assessment problems. We present a new OHS risk assessment model to assess and rank the risk of occupational hazards based on combination weighting and uncertain linguistic information. Moreover, a practical example of a shopping mall construction project is given to illustrate the effectiveness of the proposed model. The new model was found to provide a useful, practical, and flexible way for risk evaluation in OHS. In particular, it offered a new method for capturing domain expert opinions and prioritizing potential occupational hazards to improve the health and safety of workers.

A syringe adapter for reduced muscular strain and fatigue

Workers in hospitals, clinics, and contract research organizations who repetitively use syringes have an increased risk for musculoskeletal disorders. This study developed and tested a novel syringe adapter designed to reduce muscle strain associated with repetitive fluid draws. Three syringe plunger extension methods (ring-finger, middle-finger, and syringe adapter) were studied across twenty participants. Electromyogram signals for the flexor digitorum superficialis and extensor digitorum muscles were recorded. The syringe adapter required 31% of the 90th percentile flexor muscle activity as compared to the ring-finger syringe extension method, and 45% the 90th percentile flexor muscle activity as compared to the middle-finger method (p < 0.001). The greatest differences were observed when the syringe was near full extension. Although the syringe adapter took more time than the other syringe extension methods (1.5 times greater), it greatly helped reduce physical stress associated with repetitive, awkward syringe procedures.