Hands-free Technique Research Articles

Chamber shallowing technique for challenging DMEK cases: Tucking cellulose spears under the speculum to augment posterior pressure.

Some anterior chambers do not readily shallow because of insufficient posterior pressure and/or very deep anterior chamber anatomy, which can make unscrolling descemet membrane endothelial keratoplasty (DMEK) tissue more challenging with an unmodified tap technique. We present a hands-free method for augmenting posterior pressure by temporarily tucking cellulose sponges under the blades of the eyelid speculum. The sponges transfer some of the eyelid speculum's weight onto the bulbar surface posterior to the iris, thereby indenting the sclera and causing the iris diaphragm to bulge further forward. This hands-free technique can transform a potentially challenging DMEK case into a more straightforward one by facilitating both a shallow anterior chamber and a bimanual unscrolling technique. However, it only works in bicameral eyes with a vitreous body (e.g., an eye with penetrating keratoplasty, vitreous syneresis, and axial myopia) and will not work in unicameral eyes after vitrectomy (e.g., an eye with an Anterior Chamber Intraocular Lens (ACIOL)).

Cadaveric Analysis of Plantar Fascia Tension and Windlass Mechanism and Development of Plantar Fascia-Specific Stretching Device

Category:OtherIntroduction/Purpose:Plantar fasciitis is the most common cause of heel pain in adults, affecting 1 out of 10 of the population at some point during their lifetime. Plantar specific stretching programs are popularity among foot and ankle surgeons consisting of passively dorsiflexing foot and using thumb to apply pressure. This technique is not without limitations. Certain patients are unable to properly perform the stretching techniques, such as limited mobility from advanced age, disability, or simply from performing stretching exercises incorrectly. The aims of this study are; first, identify what configuration of plantar-specific stretching combined with applied pressure to the plantar aponeurosis generates the greatest tensional force in the plantar fascia. And second, to construct a prototype device that could simulate these forces in a hands-free technique.Methods:Six (will be 10) fresh-frozen, morphologically normal cadaver feet (Medcure, RI) were utilized. Plantar fascia was exposed, ankle was fixed at 90-degree dorsiflexion using Calcaneo-Tibial Schanz Pin, specimen was then inverted and potted in a custom-made box (Smooth-Cast 300q, PA). Using an electromagnetic motion tracking system (Liberty, Polhemus, VT), the motion of sensors was recorded at 120 Hz. Utilizing tissue adhesive glue (Vetbond, 3M, Minnesota), the first sensor was attached to medial calcaneal tuberosity, and the second sensor was placed 5 cm distal to the first sensor on the plantar aponeurosis. Custom- built testing apparatus was made for induction of MTP dorsiflexion application of pressure on the plantar aponeurosis to mimic current conservative treatments. Weights were added to the custom build stretcher device in 10Lb increments. Strain percentage was calculated as the change in length divided by the baseline length position (condition 1) using the formula: ([L − Lo]/Lo) × 100Results:Dorsiflexion of 2nd-5th MTPs increases strain percentage more in comparison with 1st MTP dorsiflexion (Condition 3>4>2). This might show that dorsiflexing of 1st metatarsal is less effective at straining the plantar fascia because of the midfoot motion. By adding thumb pressure, strain percentages go higher, up to a point that in condition 7 (dorsiflexing all MTPs in combination of thumb pressure) it is significantly higher than our baseline condition (P=0.0385). It is noteworthy that, stretcher device itself (condition 8), cannot replicate conditions 4 or 7 strain percentages. When adding direct pressure and weight to the stretcher device (conditions 12 and 13), strains are even higher than condition 7 and also are significantly higher than the baseline (P= 0.0090 and 0.0291 respectively).Conclusion:The stretcher device itself is insufficient for stretching the plantar fascia, supporting the hypothesis of this study that we need a direct forceful pressure on the plantar aponeurosis as well. Our customized plantar stretcher not only can replicate the conventional stretching program, but also can produce higher strains on the plantar aponeurosis than the current manual application of plantar specific stretching. This device may impact the rehabilitation process in patients with advanced age as well as patients with spine mobility limitation who cannot perform manual stretching programs.

Utility of a novel airway collar for electroconvulsive therapy: a hands-free technique.

Utility of a novel airway collar for electroconvulsive therapy: a hands-free technique.

Hands Free Technique: New Tool Possibility for Image Capture of Sublingual Microcirculation with Handheld Vital Microscopy - HVM

Hands Free Technique: New Tool Possibility for Image Capture of Sublingual Microcirculation with Handheld Vital Microscopy - HVM

Developing a Novel Hands-Free Interaction Technique Based on Nose and Teeth Movements for Using Mobile Devices

Human-mobile interaction is aimed at facilitating interaction with the smartphone devices. The conventional way to interact with mobile devices is through manual input where most of the applications are made assuming that the end user has full control over their hand movements. However, this assumption excludes people who are unable to use their hands or have suffered limb damage. In this paper, we proposed a nose and teeth based interaction system, which allows the users to control their mobile devices completely hands free. The proposed system uses the front facing camera of the smartphone to track the position of the nose for cursor control on the smartphone screen. The system detects teeth for performing the touch screen events such as tap, scroll, long press, and drag. Viola-Jones algorithm is used to detect the face and teeth based on the Haar features. After detecting the face, the nose position is calculated and tracked continuously using Lucas Kanade’s method for optical flow estimation. All the touch screen events have been implemented in the system so that the user can execute all the operations of the smartphone. To evaluate the performance and the effect of (smartphone) device type on the execution time, the proposed system was installed in 3 smartphone devices and 7 trials for each device were performed by 3 different able-bodied elderly persons. The result shows a significant success rate for the detection of nose and teeth, and for the execution of the operations. The execution time of each operation slightly varies by 0.72s on average because of the configuration of the smartphones.

Acetabular Exposure Is Enhanced With Self-Retaining Retractors During Direct Anterior Total Hip Arthroplasty.

Acetabular exposure for direct anterior (DA) total hip arthroplasty (THA) can be performed using hands-free, self-retaining retractors. No current study quantitatively compares this self-retaining technique with the traditional manual technique. In 65 consecutive DA THA hips, two "best-view" digital photographs were taken of the exposure-one using Charnley/self-retaining retractors and one using a traditional three-retractor manual technique. Percent exposure of the polyethylene liner was calculated. Percent acetabular exposure averaged 80.0% using the Charnley/self-retaining technique, compared with 73.1% using the manual technique (P=.0002). A hands-free technique provides superior acetabular exposure compared with the manual technique. Increasing body mass index predicts decreasing exposure with both techniques. [Orthopedics. 2021;44(2):e309-e313.].

Sharp injuries in the operative room among residents in surgical specialties: A cross-sectional study

Background and Objective: Surgical residents are at high risk of sustaining sharp injuries. Our aim is to identify predisposing factors of sustaining sharp injuries in operating rooms among surgical residents and their attitudes and behaviors in dealing with sharp injuries. Methods: In this cross-sectional study, a random sampling technique was adopted to recruit a representative sample of surgical residents who were involved in operative procedures in King Abdulaziz University Hospital. Data were collected between September and December 2016 by completing a self-administered questionnaire on attitude toward the most recent sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures. Results: Among the 78 recruited residents, 46 (58.9%) had sharp injuries during surgical procedures. Most of the injuries (60%) were self-induced, and (72.9%) of the injuries took place while suturing. Twenty (43.5%) of those who had injuries did not report any injury, 15 (32.6%) reported some, and 11 (23.9%) claim that they reported all their sharp injuries. 44.9% of the participants are fully aware of sharp injuries local policy and procedures in the hospital. Most of the injured participants during surgeries did not follow each step of the local sharp injury policy. The perceived causes of sharp injuries among the participants were due to rushed (61.1%), fatigue (43%), lack of skills (19.4%), lack of assistance (15.3%), lack of sleep (13.9%) and (16.7%) though it is not preventable. 55.1% of all participants have never participated in any sharp-related safety training. 10.2% practiced all three universal precautions of double-gloving, face shields, and hands-free technique. Conclusions: Sharp injuries are common among the surgical residents but are not reported by most of them. Target training about sharp injuries during residency may improve their attitude and behavior toward prevention of sharp injuries in the operative room.

An Integrative Review of the Hands-Free Technique in the OR

Sharps injury rates are proportionally higher in perioperative areas than in other practice settings. The hands-free technique (HFT) has been shown to decrease the hazards of sharps injuries when passing sharps during surgery. We reviewed and synthesized research studies regarding compliance with the HFT and factors facilitating its use using a key word search of online databases and a secondary search of references. We reviewed English language studies published since 2001 regarding HFT compliance rates or related factors using the Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. We found 14 articles reporting a wide range of HFT compliance rates (ie, 5% to 84%), which identified that a number of organizational factors and health care workers’ perceptions of infection risks influenced the use of the HFT.

Hang Them High: A Hands-Free Technique for Upper Extremity Limb Holding During Surgical Preparation.

Lifting and holding upper and lower limbs during the "prep and drape" portion of certain orthopaedic procedures exert strong forces on the holder and may lead to musculoskeletal disorders. To address these challenges during upper extremity procedures, this article describes a hand-free elevation and traction technique of the upper limbs during preoperative skin preparation with the use of items readily available within the operating room (OR). This technique is particularly useful for heavy or fractured limbs that may impose a physical challenge to lift and maintain in a stable position. Implementation of this technique reduces the risk to nurses, OR personnel, and caregivers of developing work-related musculoskeletal injuries while lifting and holding limbs in the orthopaedic OR.

Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance

This study was performed to compare self-report and observation methods for measuring compliance with double gloving (DG) and the hands-free technique (HFT). The participants were 81 health care professionals (29 nurses, 52 doctors) working in 22 operating rooms in a tertiary hospital in Busan (South Korea). All participants were asked to complete a self-report questionnaire. Additionally, compliance with DG and the HFT was observed from March-May 2014. Data were analyzed using descriptive statistics, χ(2) test, and κ statistic using SPSS version 18.0 (SPSS, Chicago, IL). The participants who always complied with DG and the HFT were 30.9% and 7.7% according to the self-report method, respectively, and 30.9% and 0.0% according to direct observation, respectively. The κ value comparing the self-report and observation methods was 0.557 for all study participants, 0.259 for nurses, and 0.668 for doctors for DG. The κ value was 0.027 for all participants, 0.131 for nurses, and 0.020 for doctors for the HFT. DG compliance and HFT compliance showed moderate and low levels of agreement between the 2 methods, respectively. Doctors showed higher agreement than nurses between the 2 methods for DG compliance but similar to nurses for HFT compliance. Therefore, the levels of compliance with DG may be measured by either the self-report or observation methods for doctors.

Hands-off preparation of monodisperse emulsion droplets using a poly(dimethylsiloxane) microfluidic chip for droplet digital PCR.

A fully autonomous method of creating highly monodispersed emulsion droplets with a low sample dead volume was realized using a degassed poly(dimethylsiloxane) (PDMS) microfluidic chip possessing a simple T-junction channel geometry with two inlet reservoirs for oil and water to be loaded and one outlet reservoir for the collection of generated droplets. Autonomous transport of oil and water phases in the channel was executed by permeation of air confined inside the outlet reservoir into the degassed PDMS. The only operation required for droplet creation was simple pipetting of oil and aqueous solutions into the inlet reservoirs. Long-lasting fluid transport in the current system enabled us to create ca. 51,000 monodispersed droplets (with a coefficient of variation of <3% for the droplet diameter) in 80 min with a maximum droplet generation rate of ca. 12 Hz using a PDMS chip that had been degassed overnight. With multiple time-course measurements, the reproducibility in the current method of droplet preparation was confirmed, with tunable droplet sizes achieved simply by changing the cross-sectional dimensions of the microchannel. Furthermore, it was verified that the resultant droplets could serve as microreactors for digital polymerase chain reactions. This hands-free technique for preparing monodispersed droplets in a very facile and inexpensive fashion is intended for, but not limited to, bioanalytical applications and is also applicable to material syntheses.

The “Syringe” Technique: A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department

BackgroundThe traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation. ObjectivesWe describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED). MethodsThis study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique. Demographics, mechanism, duration of dislocation, and reduction time were collected. Briefly, the “syringe” technique is a hands-free technique that requires a syringe to be placed between the posterior molars as they slide over the syringe to glide the anteriorly displaced condyle back into its normal anatomical position. Procedural sedation or intravenous analgesia is not required. ResultsOf the 31 patients, the mean age was 38 years. Thirty patients had a successful reduction (97%). The majority of dislocations were reduced in <1 min (77%). The two most common mechanisms for acute TMJ dislocations were due to chewing (n = 19; 61%) and yawning (n = 8; 29%). There were no recurrent dislocations at 3-day follow-up. ConclusionWe describe a novel technique for the reduction of the acutely nontraumatic TMJ dislocation in the ED. It is simple, fast, safe, and effective.

Real-time transrectal ultrasonography-guided hands-free technique for focal cryoablation of the prostate.

To describe, step-by-step, our hands-free technique for focal cryoablation of prostate cancer. After detailed discussion of its limitations and benefits, consent was obtained to perform focal cryoablation in patients with biopsy-proven unilateral low- to intermediate-risk prostate cancer. The procedure was performed transperineally, using a hands-free technique (without an external grid template) under real-time bi-plane transrectal ultrasonography (TRUS) guidance, using an argon/helium-gas-based third generation cryoablation system. Follow-up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy. The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands-free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands-free bi-plane TRUS probe manipulation to facilitate real-time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real-time TRUS monitoring of ice-ball size, control of the energy delivered and the use of a warming urethral catheter. We have described step-by-step the focal cryoablation of prostate cancer using a hands-free technique. This technique facilitates the effective delivery of cryoprobes and the intra-operative real-time quick manipulation of the TRUS probe.

Archie Brain: celebrating 30 years of development in laryngeal mask airways

The practice of anaesthesia was revolutionised by the ideas of Archie Brain. The routine use of a facemask to manage the airway was not a hands-free technique, despite the development of various harnesses, and made adequate record-keeping difficult. The tracheal tube was associated with some morbidity, which some felt was unsuitable for day surgery. Brain developed an airway management device that was less stressful to the patient than tracheal intubation, and was, however, as safe as using a facemask and airway. Brain also hoped his device would function for cases where mask ventilation was particularly difficult and thus give anaesthetists a safer alternative to a complex intubation, especially in emergency scenarios.

Hang Them High: A Hands-Free Technique for Limb-Holding During Surgical Preparation

Hang Them High: A Hands-Free Technique for Limb-Holding During Surgical Preparation

Hang Them High: A Hands-Free Technique for Limb-Holding During Surgical Preparation

Journal of Orthopaedic Trauma: September 2011 - Volume 25 - Issue 9 - p e97-e97 doi: 10.1097/01.bot.0000405081.02941.d8

Hang Them High: A Hands-Free Technique for Limb-Holding During Surgical Preparation

We describe the use of a suspension system to provide hands-free elevation and traction of lower limbs during preoperative skin preparation. The technique is particularly useful for fractured limbs that are often both awkward to elevate by hand and present a physical challenge to lift and hold. Furthermore, limb-lifting and holding has been identified by the National Association of Orthopaedic Nurses as a commonly performed task associated with high risk of work-related musculoskeletal disorders. The National Association of Orthopaedic Nurses Task Force has recommended the use of assisted lifting and holding devices if the task of limb elevation and or holding exceeds its recommended limits. The principal determinants of these limits are the weight of the leg, the height it is elevated above the chest, and the time for which it is held. The maximal weight recommended for a two hand lift is 35 pounds, which is often less than the weight of a patient's leg whose total body weight is over 190 pounds. The maximal limit is below 35 pounds for lifts above chest height and for holds over 1 minute. Because the average size and weight of American citizens is increasing, so has the need for devices to assist with lifting and holding in the operating room. This technique also can improve operating room efficiency because a member of the operating team is not engaged in holding the limb during the skin preparation and draping. The limb is also held reliably with constant in-line traction by this technique. This reduces the chance for accidental decontamination of the skin or further movement of the fracture and potential secondary soft tissue damage if the limb holder loses or changes their grip.

The Hands-Free Technique: An Effective and Easily Implemented Work Practice

A series of prospective United States operating room studies published between 1990 and 2002, in which dedicated observers or circulating nurses recorded blood and body-fluid exposures, found that percutaneous injuries occurred in 1.1% to 15% of all surgeries, and mucocutaneous contaminations occurred in 1.4% to 32.1% of all surgeries. In these studies, surgeons and residents usually sustained the greatest number of percutaneous and other exposures during surgery. However, in one operating room study, scrubbed personnel sustained as many percutaneous injuries as surgeons and, in another, circulating nurses sustained the greatest total number of contaminations, although surgeons sustained the greatest number of percutaneous injuries. Two of these studies, in addition to measuring occupational exposures, also measured patient wound recontact rates. One study found a patient wound recontact rate of 32%, and the other found a patient wound recontact rate of 11%. Since these studies were conducted, operating room risk has not decreased, according to blood and body-fluid exposure surveillance data from 87 United States hospitals participating in the Exposure Prevention Information Network (EPINet). More specifically, after passage of the US Needlestick Safety and Prevention Act in 2000, which strengthened the requirement to use reengineered sharp safety devices, percutaneous injuries decreased by 34% from 2000 to 2004 in hospital departments

Comparison of tissue heating between manual and hands-free ultrasound techniques

ABSTRACTThe objective of this single-factor repeated-measures design was to examine the effectiveness of tissue heating with a hands-free ultrasound (US) technique compared to a hand-held US transducer using the Rich-Mar AutoSoundTM unit. US is a therapeutic modality often used to provide deep tissue heating. Recently, a “hands-free” US unit was introduced by Rich-Mar Incorporated. This unit allows the clinician to choose the mode of US delivery, using either a handheld (manual) transducer or a hands-free device that pulses the US beam through the transducer. However, the Center for Medicare and Medicaid Services has deemed delivery of US via a hands-free unit to be investigational. Forty volunteers over 18 years of age participated. Treatment was provided at a 3-MHz US frequency. Muscle temperature was measured with 26-gauge, 4-cm Physiotemp thermistors placed in the triceps surae muscle. The depth of thermistor placement was at 1 - and 2-cm deep. One calf was treated with a manual transducer (5-cm2 US head at three times the effective radiating area [ERA]), and one calf was treated with the hands-free transducer (14-cm2 [ERA]). Both methods used a 1.5 W/cm2 intensity for 10 minutes. The manual technique used an overlapping circular method at 4 cm/sec, and the hands-free method used a sequential pulsing at 4 cm/sec. Tissue temperatures were recorded at baseline and every 30 seconds. The hands-free technique resulted in a tissue temperature increase from 33.68 to 38.7°C and an increase from 33.45 to 40.1°C using the manual technique at 1-cm depth. The tissue temperature increase at the 2-cm depth was from 34.95 to 35.44°C for the hands-free device and 34.44 to 38.42°C for the manual device. Thus, there was a significant difference between the hands-free and the manual mode of US delivery for the 3-MHz frequency (5.02°C vs. 6.65°C at 1 cm and 1.49°C vs. 3.98°C at 2 cm). In this study, the “hands-free” device did not result in the same level of tissue heating as the manual technique. The hands-free device has the advantage of not needing a clinician present to deliver the modality but a therapeutic level of heating was not achieved at the 2-cm tissue depth. Thus, the efficacy of the “hands-free” treatment is in question.

Is use of the hands-free technique during surgery, a safe work practice, associated with safety climate?

A better safety climate has been linked to better compliance with safety behaviors. This study assessed whether "management support," the most commonly measured safety climate dimension, was associated with greater use of the hands-free technique (HFT), a work practice recommended for use during surgery to prevent exposure to blood and body fluids. Questionnaires from operating room nurses participating in a test retest reliability study and in training sessions for an intervention study, from 9 hospitals in 3 Canadian provinces, were analyzed. Response rates in the hospitals varied from 61% to 97%. Four hundred forty-two operating room nurses responded; 16% reported using the HFT approximately 75% or more of the time in surgery, and 39% had received HFT training. Management support and HFT training were each associated with increased HFT use: odds ratio (OR), 6.63; 95% confidence interval (CI): 1.89-23.30 and OR, 6.36; 95% CI: 1.97-20.51, respectively. When training occurred in a context of management support, HFT use was further increased: OR, 9.12; 95% CI: 2.71-30.72. Consistent with previous research linking management support for health and safety to uptake of safety practices, management support and HFT training acted synergistically to increase HFT use most of the time in surgery.