Rosemary Klein - Academia.edu (original) (raw)
Papers by Rosemary Klein
Building on the historical resolve of the World Health Organization (WHO) and World Health Associ... more Building on the historical resolve of the World Health Organization (WHO) and World Health Association (WHA) mandates, this chapter offers perspective on delivery, in its many varieties, of surgical education within low- and middle-income countries (LMICs).
Surgical Endoscopy, 2011
This study compares surgical techniques and surgeon&a... more This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize. Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.
Journal of the American College of Surgeons, 2007
The American surgeon, 2013
Virtual reality (VR) simulators may hold a role in the assessment of trainee abilities independen... more Virtual reality (VR) simulators may hold a role in the assessment of trainee abilities independent of their role as instructional instruments. Thus, we piloted a course in flexible endoscopy to surgical trainees who had met Accreditation Council for Graduate Medical Education endoscopy requirements to establish the relationship between metrics produced by a VR endoscopic simulator and trainee ability. After a didactic session, we provided faculty instruction to senior residents for Case 1 upper endoscopy and colonoscopy modules on the CAE EndoscopyVR. Course conclusion was defined as a trainee meeting all proficiency standards in basic endoscopic procedures on the simulator. Simulator metrics and course evaluation comprised data. Eleven and eight residents participated in the colonoscopy and upper endoscopy courses, respectively. Average time to reach proficiency standards for esophagogastroduodenoscopy was 6 and 13 minutes for colonoscopy after a median of one (range, one to two) a...
Surgical innovation, 2006
Radio frequency identification (RFID) is a technology that will have a profound impact on medicin... more Radio frequency identification (RFID) is a technology that will have a profound impact on medicine and the operating room of the future. The purpose of this article is to provide an introduction to this exciting technology and a description of the problems in the perioperative environment that RFID might address to improve safety and increase productivity. Although RFID is still a nascent technology, applications are likely to become much more visible in patient care and treatment areas and will raise questions for practitioners. We also address both the current limitations and what appear to be reasonable near-future possibilities.
Surgical innovation, 2007
Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, littl... more Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, little has been written regarding this field's tasks, models, and measurement systems. These 3 critical experimental components are crucial in objectively and accurately assessing joint and postural control as exhibited by expert laparoscopic surgeons. Such assessments will establish characteristic patterns important for surgical training. In addition, risk factors associated with both minimally invasive surgical instruments and the operating room environment can be identified and minimized. Our review focuses on evidence-based experimental ergonomic studies undertaken in the field of laparoscopic surgery. Publications were located through PubMed and other database and library searches. This article describes tasks, models, and measurement systems and considers their specific applications and the types of data obtainable with the use of each. Advantages and limitations, especially those o...
Archives of Surgery, 2009
... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclat... more ... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclature question: panniculus or pannus? answer: pannona. ... 14. Mish FC. Merriam-Webster OnLine Web site. http://www.merriam-webster.com. Accessed March 7, 2008. 15. ...
Surgical Endoscopy and Other Interventional Techniques, 2011
Background This study compares surgical techniques and surgeon’s standing position during laparos... more Background This study compares surgical techniques and surgeon’s standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons’ learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Methods Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. Results RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p p Conclusions Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.
Archives of Surgery, 2009
... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclat... more ... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclature question: panniculus or pannus? answer: pannona. ... 14. Mish FC. Merriam-Webster OnLine Web site. http://www.merriam-webster.com. Accessed March 7, 2008. 15. ...
Journal of The American College of Surgeons, 2007
Building on the historical resolve of the World Health Organization (WHO) and World Health Associ... more Building on the historical resolve of the World Health Organization (WHO) and World Health Association (WHA) mandates, this chapter offers perspective on delivery, in its many varieties, of surgical education within low- and middle-income countries (LMICs).
Surgical Endoscopy, 2011
This study compares surgical techniques and surgeon&a... more This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize. Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.
Journal of the American College of Surgeons, 2007
The American surgeon, 2013
Virtual reality (VR) simulators may hold a role in the assessment of trainee abilities independen... more Virtual reality (VR) simulators may hold a role in the assessment of trainee abilities independent of their role as instructional instruments. Thus, we piloted a course in flexible endoscopy to surgical trainees who had met Accreditation Council for Graduate Medical Education endoscopy requirements to establish the relationship between metrics produced by a VR endoscopic simulator and trainee ability. After a didactic session, we provided faculty instruction to senior residents for Case 1 upper endoscopy and colonoscopy modules on the CAE EndoscopyVR. Course conclusion was defined as a trainee meeting all proficiency standards in basic endoscopic procedures on the simulator. Simulator metrics and course evaluation comprised data. Eleven and eight residents participated in the colonoscopy and upper endoscopy courses, respectively. Average time to reach proficiency standards for esophagogastroduodenoscopy was 6 and 13 minutes for colonoscopy after a median of one (range, one to two) a...
Surgical innovation, 2006
Radio frequency identification (RFID) is a technology that will have a profound impact on medicin... more Radio frequency identification (RFID) is a technology that will have a profound impact on medicine and the operating room of the future. The purpose of this article is to provide an introduction to this exciting technology and a description of the problems in the perioperative environment that RFID might address to improve safety and increase productivity. Although RFID is still a nascent technology, applications are likely to become much more visible in patient care and treatment areas and will raise questions for practitioners. We also address both the current limitations and what appear to be reasonable near-future possibilities.
Surgical innovation, 2007
Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, littl... more Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, little has been written regarding this field's tasks, models, and measurement systems. These 3 critical experimental components are crucial in objectively and accurately assessing joint and postural control as exhibited by expert laparoscopic surgeons. Such assessments will establish characteristic patterns important for surgical training. In addition, risk factors associated with both minimally invasive surgical instruments and the operating room environment can be identified and minimized. Our review focuses on evidence-based experimental ergonomic studies undertaken in the field of laparoscopic surgery. Publications were located through PubMed and other database and library searches. This article describes tasks, models, and measurement systems and considers their specific applications and the types of data obtainable with the use of each. Advantages and limitations, especially those o...
Archives of Surgery, 2009
... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclat... more ... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclature question: panniculus or pannus? answer: pannona. ... 14. Mish FC. Merriam-Webster OnLine Web site. http://www.merriam-webster.com. Accessed March 7, 2008. 15. ...
Surgical Endoscopy and Other Interventional Techniques, 2011
Background This study compares surgical techniques and surgeon’s standing position during laparos... more Background This study compares surgical techniques and surgeon’s standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons’ learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Methods Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. Results RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p p Conclusions Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.
Archives of Surgery, 2009
... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclat... more ... 2006;203(1):82-93. FULL TEXT | WEB OF SCIENCE | PUBMED. 2. Cunningham SC, Klein RV. Nomenclature question: panniculus or pannus? answer: pannona. ... 14. Mish FC. Merriam-Webster OnLine Web site. http://www.merriam-webster.com. Accessed March 7, 2008. 15. ...
Journal of The American College of Surgeons, 2007