Re: consulting
From: Joan P Baker (jbakerbaker@comcast.net)
Mon Aug 15 00:15:50 2005
Thank you for this response because I agree it is important to question the rigors of any research or data collection.
The survey for the USA and Canada that I was referring to was done by the Health Care Benefit Trust (HCBT) of British Columbia. The reason they were doing this was to insure that the data was not collected by the profession itself. The team that perfromed the survey included a statistician and others experienced in medical surveying. Two sonographers advised them and looked at the questions before they were used.
The survey was 125 questions (23 pages) in length. We were also concerned that only those who were injured would fill it out. However, the survey was tested before being sent to the 3000 randomly selected sonographers from the ARDMS data base. The test group were all the sonographers in British Columbia and the response rate was an amazing 92%. (211 out of 232) The incidence figures for this group was 91%. The statistician then stated that the incidence percent going up when almost 100% respond made the question about whether only those injured would fill it out a mute point.
This large group (1,600+) were asked whether they thought that the symptoms they had were related to scanning and 96.5% said "yes" they believed their symptoms related to scanning patients.
Surveys have been done by many groups on this subject in other countries as well as the USA. The HCBT survey was the largest and national in scope, many of the other surveys were local or small in size. Here are some references to data on this subject for those interested
Vanderpool HE, Friis EA, Smith BS, Harms KL. Prevalence of carpal tunnel syndrome and other work-related musculoskeletal problems in cardiac sonographers. Journal Occupational Medicine 1993; 35(6): 604-10
Smith AC, Wolf JG, Xie GY, Smith MD. Musculoskeletal pain in cardiac ultrasonographers: results of a random survey. Journal American Society of Echocardiographers 1997; 10(4): 357-62.
Chapman-Jones D. Musculo-Skeletal Injury: is it a problem for sonographers? Synergy 2001; April: 14-15.
Habes DJ, Baron S. Health Hazard Evaluation Report, St. Peter's University Hospital, University of Medicine and Dentistry of New Jersey Piscataway, New Jersey. NIOSH report 1999; 99-0093-2749
Murphy C, Russo A. An Update on Ergonomic Issues in Sonography; Employee Health and Safety Services at Healthcare Benefit Trust, School of Kinesiology, Simon Fraser University, British Columbia 2000: 1-14
Gregory V. Occupational Health and Safety Update. Report on the results of the Australian Sonography Survey on the prevalence of musculoskeletal disorders amongst Sonographers. Sound Effects 1999; December: 42-43
Magnavita N, Bevilacqua L, Mirk P, Fileni A, Castellino N. Work-related musculoskeletal complaints in sonologists. Journal of Occupational Environmental Medicine 1999; 41(11): 981-8
Ogram D. May 1995. Ergonomic Evaluation of Work Performed By Sonographers While Conducting Ultrasound Examinations (Saskatchewan: Occupational Health & Safety Division, Saskatchewan Labour).
Pike I, Russo A, Berkowitz J, Baker J, Lessoway VA. September/October 1997. "The Prevalence of Musculoskeletal Disorders Among Diagnostic Medical Sonographers," Journal of Diagnostic Medical Sonography, 13: 219-227.
All these references and more can be found on http://www.soundergonomics.com click on icon for "publications"
> ----- Original Message -----
From: Philippe Jeanty, MD, PhD
To: Multiple recipients of list ULTRASOUND-HISTORY
Sent: Thursday, August 11, 2005 9:12 AM
Subject: RE: consulting
Hi Joan,
I have been unsuccessful in finding data about work-related injury in sonography that was not simply a study reporting self answered questionnaire by sonographer/logist and that included a control group.
When I receive a questionnaire, I only respond in 2 types of circumstances: 1) someone will go to great length to harass me until I provide the answer or 2) the subject has a compelling interest to me.
I suspect my reaction is not unique. The results from the second type of questionnaire have a very limited validity: they only represent the "opinion" of those "willing to respond". Extending the "result" to a broader group is likely to be a fallacy.
I have had bilateral carpal tunnel as well as cervical and lumbar spinal surgery. A questionnaire asking me if I have wrist/shoulder/back pain that is formulated as a simple [YES/NO] answer would likely have me answer YES although none of those 4 surgeries were work-related.
Further, any questionnaire that asks whether the user has pain/discomfort/inconvenience in a direct way is likely to elicit a biased response. A properly designed questionnaire should obtain the answer without suggesting the response, especially if the respondent is likely to perceive that the results of the study are likely to offer the respondent some benefits ("If I say 'I hurt' the study will prove I should work less").
Finally without a control group it is very difficult to segregate the problems observed from the background problems (aging workforce, stress due to other conditions, natural prevalence of the condition, etc etc).
Obtaining such clean data require a much sturdier study than those I have heard about, but clean data is what is needed in order to make evidence-based decisions.
This is not to say that work-related discomfort does not exist, but I would take with a healthy grain of skepticism the data that is currently available-unless I missed a better study.
Philippe Jeanty
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------------------------------------------------------------------------- From: ultrasound-history@medispecialty.com [mailto:ultrasound-history@medispecialty.com] On Behalf Of Joan P Baker
Sent: Wednesday, August 10, 2005 6:12 PM
To: Multiple recipients of list ULTRASOUND-HISTORY
Subject: Re: consulting
I have been out of town and just returned to this interesting set of emails. My perspective is one that relates to occupational injury.
quote from Dr Lancer
What is your opinion in the following issues:
1-How many studies are reasonable for each sonographer in one day?
2-How affect the excessive number of patients in the individual and department quality?
First some definitions since this is an international audience: Sonographer = the person (regardless of qualifications) who is holding the transducer and completing the protocol of the study.
The Sonologist (regardless of qualifications) is making the medical diagnosis from the scans. (non physicians in the UK, New Zealand and Australia do this)
I think it is important to point out that if you are the sonologist, referring physician and sonographer, the study will probably be shorter in length, and may be targeted or focused in scope. Those who are operating as sonographers only and do not have the benefit of having examined the patient or are not qualified to do so, must spend more time documenting everything and more time scanning to make sure they can convince the referring MD (who is usually not available) what they are seeing and the meaning of it.
The most important issue is the conditions that you perform ultrasound under, as far as tables, chairs, support cushions, type of equipment, its age and model. These factors are as important and in some cases more important and may have more to do with injury than the head count of patients. In other words it may be unwise to do 2 patients in poor ergonomic conditions and safe to do 10 in good ergonomic conditions. Also if you go from scanning in a poor environment to data entry and review of scans at an equally poor workstation, you might as well be scanning all the time. The injuries are the same. (A fixed height table with view boxes too high on the wall will produce the same injuries as the scanning monitor too high and the chair too low and table too high. (arm abduction leading to shoulder injury and neck extension leading to neck or cervical disc disease.
If you are a physician and have medical assistants/nurses etc putting patients in rooms for you and you are going from room to room in an assembly line fashion you will have issues of repetitive motion and static postures which are also risk factors. You also need to consider the type of studies you do and the amount of time allotted on the schedule for each type of study. Are you doing high risk OB or fetal cardiology both very high risk for injury as well as a lot of TV scans? These are long detailed studies (except TV) involving a lot of static positioning. Are you doing a lot of 2nd trimester fetal surveys or multiple pregnancy cases, back to back with little or no recovery time in between. How much time is allowed not only for the study but between the studies for muscle recovery. May be you are doing average OB patients (not high risk) this may make a difference if the other ergonomic conditions are good.
Due to the multifaceted nature of these injuries we were unable to determine what was the right number of studies to do per day to be SAFE. What we were able to determine in the USA was the number of studies sonographers were doing and what the incidence of injury was. In 1997 on a large survey involving USA and Canada rendered the following data. It is also important to note that the figures from the survey have produced a work force 84% of which is scanning in pain and 20% of those are career ending.This means that these numbers may be too high to prevent or reduce injury and would not be the recommended numbers.
If I can be of further assistance to you privately don't hesitate to contact me my email address is jbakerbaker@comcast.net
All responses: # of pts per day per sonographers
1-5 11.0%
6-10 51.2%
11-15 30.8%
16-20 5.9%
20+ 1.1%
Responses for Hospital Inpatient
1-5 9.0%
6-10 55.2%
11-15 30.9%
16-20 4.1%
20+ 0.8%
Responses for Physician Office
1-5 11.5%
6-10 45.6%
11-15 32.5%
16-20 8.8%
20+ 1.6%
Responses for Hospital Outpatient
1-5 10.9%
6-10 51.6%
11-15 31.0%
16-20 5.6%
20+ 0.9%
Responses for Ob/GYN
1-5 8.1%
6-10 45.3%
11-15 37.8%
16-20 7.5%
20+ 1.3%.
The average age of the sonographers answering these questions was 42 years and they had been in ultrasound an average of 11 years. They had also been in pain and discomfort while scanning for a little more than 5 years. Data collected this year the average age of sonographers in the USA has increased to 45 years and the average number of cases per day per sonographers is 10. There has also been an increase in through put of 55.5% between 1992 and 2000 with 2,740 pts per year per sonographer in an average 300 bed hospital in USA. The incidence of scanning in pain in Canada is 87%, Italy 80% (all MD's) UK is 89%, Australia is 95% and New Zealand is 93%
> ----- Original Message -----
From: Terry DuBose
To: Multiple recipients of list ULTRASOUND-HISTORY
Sent: Tuesday, August 09, 2005 7:27 PM
Subject: Re: consulting
Dr. De Lancer, you ask a question that many have asked. In general sonography (Abdomen and OB/GYN) usually no more than two an hour in peak rush times. It depends on how detailed the studies are, but at bottom line, two an hour average is too much if it is all day every day. This is based on my experience of 29 years and not on any scientific study.
For you second question I would say anytime the sonographer is rushed enough to not be able to focus on the diagnosis, that is too many. There needs to be a bit of flexibility to allow for the unexpected twins or other detailed study.
Also do not forget that over work, continuously over a period of months or years can injure the sonographer. Repeated Stress Injuries are well documented now. See:
http://www.sdms.org/msi/default.asp
Hope this helps. Terry
jose de lancer <josedelancer@yahoo.com> wrote:
Hi, i am Dr. Jose De Lancer from Dominican Republic.
I am obstetrician, gynecologist and sonologist.
We have troubles in our hospital sonografy department for the "overdemand" in ultrasound studies.
What is your opinion in the following isues:
1-How many studies are reasonable for each sonographer in one day?
2-How afect the excesive number of patients in the individual and department quality?
Thanks for your cooperation!!
"DuBose, Terry" <DuboseTerryJ@uams.edu> escribió:
Congratulations to everyone on another landmark event. Good work. Terry
Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
Associate Professor & Director
Diagnostic Medical Sonography Program
University of Arkansas for Medical Sciences, CHRP
4301 West Markham St. Mail Slot #563
Little Rock, Arkansas, 72205 USA
501-686-6510
DuBoseTerryJ@UAMS.edu
http://www.io.com/~dubose/
http://www.uams.edu/chrp/dms/default.asp
http://www.obgyn.net/us/panel/panel.htm
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From: Dale R. Cyr [mailto:cyr@ardms.org]
Sent: Tuesday, August 09, 2005 7:18 AM
To: ALL STAFF; BOARD MEMBERS; All EDTF Committees
Cc: Thomas Magallanes; steve_tapp@promissor.com
Subject: Success in Hong Kong ARDMS Exam Delivery
Hello Everyone:
ARDMS began delivering examinations at the University of Hong Kong on August 8th. Two candidates sat for ARDMS examinations (Neuro and CPI), which were routinely and securely delivered with all data safely transmitted back to Promissor as per normal procedure. The ARDMS Hong Kong examinations and processes are exactly the same as here in the United States and Canada. Several other Candidates are scheduled to sit for ARDMS examinations in Hong Kong over the next couple of weeks.
Congratulations everyone as ARDMS continues to increase the number of credentialed individuals to promote quality and patient safety through credentialing and continuing competency of ultrasound professionals.
Also, a big thank you to Promissor who has been a great partner in assisting ARDMS in meeting our strategic initiatives, particularly in the global expansion program.
Regards,
Dale
Dale R. Cyr, MBA, CAE
Chief Executive Officer/Executive Director
ARDMS and the Breast Ultrasound Foundation
51 Monroe St., Plaza East One
Rockville, Maryland 20850-2400
301-738-8406, x223
cyr@ardms.org, cyr@breastultrasound.org
http://www.ardms.org http://www.breastultrasound.org
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