Bremer, Merri L.

Cardiac sonographers are frequently exposed to ergonomic risks such as postural stress and high levels of physical exertion while performing scanning tasks, contributing to work-related pain, and discomfort among cardiac sonographers. Passive exoskeletons are a potential ergonomic intervention with the potential to mitigate some of the risks associated with scanning. This study examined the effectiveness of a passive upper body exoskeleton in reducing the levels of work-related pain, discomfort, and workload in cardiac sonographers while performing transthoracic echocardiograms (TTE). Twelve cardiac sonographers were asked to use the HAPO FRONT exoskeleton while performing TTEs during a full workday. Participants were asked to rate their body part discomfort and workload throughout the day, both with and without the exoskeleton. The exoskeleton did not significantly decrease discomfort or workload associated with performing TTEs, except for a slight reduction in the discomfort at the left hand/wrist. This result indicates that the HAPO FRONT was not effective or appropriate for use by cardiac sonographers. Future development and study of purpose-designed exoskeletons for healthcare applications may provide greater benefits to cardiac sonographers.

Ames, IA Cardiac sonographers suffer from high prevalence of work-related upper extremity musculoskeletal pain due to awkward postures and fatigue accumulation. Sonographers can choose either left- or right-hand scanning, or alternate between both, however, the impact of each scanning technique on the upper extremity muscles remains unknown. Four ambidextrous cardiac sonographers performed between four to six cardiac scans using left- and right-hand while postural and muscle activity were collected from specific muscles on the upper extremities. A comparison of the posture showed that apart from forearm pitch and 90 th percentile upper arm deviation, upper extremity postures between the two scanning techniques did not differ significantly. Furthermore, while right-hand scanning (RHS) appeared to induce slightly higher muscle activity in the deltoids compared to left-hand scanning (LHS), the difference between the two techniques was not significant. We recommend alternating between these two techniques to distribute muscle stress evenly to prevent muscle overuse.

Background— It is presumed that echocardiographic laboratory accreditation leads to improved quality, but there are few data. We sought to compare the quality of echocardiographic examinations performed at accredited versus nonaccredited laboratories for the evaluation of valvular heart disease. Methods and Results— We enrolled 335 consecutive valvular heart disease subjects who underwent echocardiography at our institution and an external accredited or nonaccredited institution within 6 months. Completeness and quality of echocardiographic reports and images were assessed by investigators blinded to the external laboratory accreditation status and echocardiographic results. Compared with nonaccredited laboratories, accredited sites more frequently reported patient sex (94% versus 78%; P <0.001), height and weight (96% versus 63%; P <0.001), blood pressure (86% versus 39%; P <0.001), left ventricular size (96% versus 83%; P <0.001), right ventricular size (94% versus 80%; P =0.001), and right ventricular function (87% versus 73%; P =0.006). Accredited laboratories had higher rates of complete and diagnostic color (58% versus 35%; P =0.002) and spectral Doppler imaging (45% versus 21%; P <0.0001). Concordance between external and internal grading of external studies was improved when diagnostic quantification was performed (85% versus 69%; P =0.003), and in patients with mitral regurgitation, reproducibility was improved with higher quality color Doppler imaging. Conclusions— Accredited echocardiographic laboratories had more complete reporting and better image quality, while echocardiographic quantification and color Doppler image quality were associated with improved concordance in grading valvular heart disease. Future quality improvement initiatives should highlight the importance of high-quality color Doppler imaging and echocardiographic quantification to improve the accuracy, reproducibility, and quality of echocardiographic studies for valvular heart disease.

Background Atrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes. Methods and Results This retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF . We observed no significant differences in age, sex, vital signs, body mass index, or CHADS 2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P <0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P =0.48), hospitalization (18% versus 16%; P =0.22), or adverse events (2% versus 2%; P =0.95) within 30 days. Emergency department observation unit admissions were 40% ( P <0.001) less costly than inpatient hospital admissions of ≤1 day's duration. Conclusions Implementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.