Nicole Stigall-Weikle

Objective: The aim of these analyses was to determine the potential development of increased carotid intima-media thickness (cIMT) and spectral Doppler velocity in a cohort of children who were eligible for federal nutrition support services. Materials and Methods: A secondary data analysis was conducted based on data collected during a larger randomized clinical trial. Data were pulled on 108 children, ages 8 to 11 years, who had both cIMT measures, as well as spectral Doppler data, at the level of measured intimae. Additional data such as vessel geometry, body mass index (BMI), and blood pressure (BP) were added to the analysis to provide additional descriptive data. Results: The posterior cIMT data provided the best visualization and measurements to assess the presence of early risk for atherosclerosis. In this cohort of 8- to 11-year-olds, the median spectral Doppler values did not exceed the published values for these ages, nor did their systolic blood pressure. In this group, 77 (71%) were classified as having a healthy BMI. However, the posterior cIMT data were compared to published measures of pediatric cIMT values and 60 children (55%) exceeded the expected mean thickness of 0.38 mm + 0.04 on the right and 58 (53%) on the left. Conclusion: The use of spectral Doppler to assess the risk of developing atherosclerosis may not be the best diagnostic tool, based on this cohort. The measurement of cIMT has the most promise to proper classify healthy appearing 8- to 11-year-olds, for early signs of diminished cardiovascular health.

Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists. Materials and Methods: A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings. Results: A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes. Conclusion: Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.

Objective: Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort. Materials and Methods: An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort. Results: A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort. Conclusion: This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.

Objective: This discipline-based educational research (DBER) project was designed to longitudinally study the influence of high-fidelity computer-based sonography simulators (HFCBSSs) on student learning. The research question was: Can the implementation of HFCBSS improve clinical skills for sonography students, beyond traditional methods? Materials and Methods: HFCBSSs were shipped to three educational sites for implementation. A quasi-experimental design was utilized across the three educational sites. Educational materials, simulator guides, and assessment templates were developed for implementation. The educational sites revised their standard curricula to allow for students to develop skills with HFCBSS, low-fidelity simulation (e.g. phantoms), and sonographic evaluation of peer classmates. A control group of graduating sonography students was assessed having no HFCBSS experience. Those assessment scores were used as an educational threshold. Successive cohorts of students across the educational sites were assessed as they progressed through their first year. Results: First-year sonography students, exposed to the revised simulation curricula, demonstrated higher median assessment scores, on most sonographic examinations, than the control-group student scores. Those student cohorts that were exposed to the revised simulation curricula but demonstrated a lower median assessment score were remediated to make sure they were ready for clinical placement. Students, across all three educational sites, rated their experience with the HFCBSS as second only to gaining patient examinations in their sonography clinical placements. Conclusion: This educational research project spanned three educational sites, with varied curricula, but it did demonstrate HFCBSS is a useful and effective educational tool. It also demonstrated how preclinical sonographic skill assessments can ensure students get lab-based remediation prior to clinical placement. These results are exclusive to this cohort and should be replicated at other sites, for concurrence.

Objective: The Centers for Disease Control and Prevention (CDC) has documented that the leading cause of death in the United States is cardiovascular disease (CVD). Specifically, CVD is responsible for the death of one out of every five women in the United States. Therefore, the research question was, “What specific diagnostic tests, including a novel approach to detecting abdominal aortic calcifications (AAC), could be added to screening women for CVD?” Materials and Methods: A prospective cohort of 14 female volunteers, between the ages of 40 and 60 years, were consented to sonography of the aorta, collection of demographic data, as well as contributing biometric data. Each volunteer gave informed consent in compliance with the university’s Institutional Review Board. Volunteers also were provided with a Health Insurance Portability and Accountability Act (HIPAA) release that was signed prior to the collection of any data. All sonographic images were analyzed post-examination and aortic calcifications were graded using a modified scoring system derived from a dual-energy x-ray absorptiometry (DXA)-based grading system. Results: In this cohort of 14 females, their AAC category scores ranged from I to IIIB (grades: normal to multiple calcified atheroma). Descriptive statistics demonstrate that it is possible to document AAC on this cohort of women using sonography. Correlational statistics showed a statistically significant association between a volunteer’s posterior aortic-intimal media thickness (a-IMT) and their atherosclerotic cardiovascular disease (ASCVD) 10-year risk score. Conclusion: This pilot study suggests the need for further research on screening techniques to determine women’s specific CVD risk in this age group. Although the preliminary results allude to sonographic measures of a-IMT being a possible CVD screening method in the future, more research data are needed.

Objective: As the global pandemic resulting from this virus continues, surviving patients continue to report chronic symptoms long after a diagnosis of coronavirus disease (COVID-19). A pilot study was conducted with a convenient sample to ascertain the proper diagnostic testing for detecting chronic disease. Materials and Methods: A convenient group of nine patients were directed by their primary care physician to be evaluated based on a variety of symptoms being reported by those surviving the acute phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patients who volunteered provided sonographic imaging data of the lungs, kidney, and heart. This modified sonographic assessment was completed in a Family Practice office, with a laptop ultrasound equipment system, a blood draw, as well as completion of the EuroQol (EQ-5D) questionnaire. The data were collected as part of the patients 3- to 4-month follow-up primary care visit. Results: In this cohort, six patients were diagnosed and were able to recover at home. The other three patients chose to undergo monoclonal antibody therapy. The two subgroups’ data are provided and describe the types of residual effects that some individuals continue to suffer. Conclusion: Those patients with residual symptoms of SARS-CoV-2 have been dubbed “COVID long-haulers.” This combination of diagnostic tests, specifically renal sonography, flow cytometry, and dynamic sonographic assessment, may hold promise for guiding the treatment and surveillance of these patients.

This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study . The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.

Objective: Atherosclerosis is a chronic inflammatory disease that can be undetected in middle-aged patients. Abdominal aortic calcifications (AACs) are one form of cardiovascular disease (CVD), and these can go undetected during a routine physician visit. Sonography has the potential to assess CVD progression, quantify plaque in the aorta, and help to quantify risk in asymptomatic patients. Methodology: This pilot study modified a current AAC grading system to create a scoring method for sonographic images among a small cohort of asymptomatic participants. A traditional portable ultrasound unit was used to image participants, and a subset underwent the same imaging with a handheld transducer and tablet. Results: In this cohort, six males and five females, it was possible to adequately visualize and assess plaque, utilizing both types of ultrasound equipment. The abdominal aorta was divided into segments on the sonogram for quality of grading. Ten participants were categorized with a grade II and one participant was given a grade IIIA. Conclusion: Replication of this modified grading system is needed to better understand the clinical utilization of sonography as a risk assessment tool. The risk assessment scoring was not dependent on the type of device used.