Usability Characteristics Assessment Protocol Applied to eTouch Ultrasound User-defined workflow Optimization Tool

AbstractThe Ultrasound (US) examination time reduction is an increasing compelling request in sonographer's everyday life. The increased number of patients and the cost reduction are two opposite forces, which can lead the sonographer to work faster without caring about scanning posture. The numerous repeated actions performed can easily lead to Work-related Musculoskeletal Disorders (WRMSD). The analysis of those problems has driven to the definition and implementation of eTouch tool: user-defined Macros appositively created, automatically and sequentially saved and performed in real time by pressing a button. The present work investigates ergonomics and usability performances of a portable US system (MyLabAlpha, Esaote S.p.A., Italy) by using eTouch as well as the classical manual interface in two clinical applications (Abdominal and Vascular). performed by a skilled sonographer on a healthy subject. is. Upper-body kinematic and muscle activation of the sonographer's left arm were recorded through an optoelectronic system (SmartDx400, BTS Spa, Italy) and a multi-channel Wireless Superficial Electromyography (SEMG, Freemg300, BTS Spa, Italy). The number of keystrokes used during the manual procedure was more than 3 times higher than the one with eTouch. This difference implied a reduction of US execution time when using eTouch in comparison with manual use of about 30%. Results of the upper-body kinematic showed that the arm was extended for less time intervals when using eTouch, whereas during the manual procedure there was a greater activation of the deltoid, responsible for the elevation of the shoulder and thus the extension of the arm. SEMG analysis showed that eTouch allowed a significant reduction of muscular activation, especially for the anterior deltoideus. Our findings showed that eTouch is recommendable for decreasing WRMSD risk

Ergonomics and Workflow Evaluation of Automatic Doppler Angle Technology Implemented in a Diagnostic Ultrasound System

AbstractCommonly available Pulsed Wave Doppler (PW) flow velocity measurements for Ultrasound (US) investigation require the operator to manually set the direction of the flow velocity vector along the blood vessel axis on the US image, in order to determine the Doppler angle and then to estimate the real flow velocity. The present work investigates the possibility to implement on a commercially available US system an innovative Automatic Doppler Angle (ADA) Technology by analyzing the best workflow in terms of higher execution speed, lower keystrokes/adjustments helping in the prevention of Work-related Musculoskeletal Disorders (WRMSD) and a Doppler angle correction precision, comparable to the one obtained manually by expert sonographer. Ergonomics and workflow tests, then accuracy and repeatability evaluations of the Doppler velocity measurement, were performed on a portable US system (MyLabAlpha, Esaote S.p.A., Florence, Italy) by an expert sonographer. Ergonomics and workflow Tests were performed to analyze the potential of ADA in terms of reduction of muscular activation applied (by SEMG), number of activations (by cameras optoelectronic system) and time needed using ADA, in comparison to manual procedure. Accuracy and intra-operator repeatability tests of the velocity measurement were performed to evaluate the precision of the obtained PW trace velocity measurements with ADA technology, compared to manual ones. Results provided evidence that ADA tool allowed: a reduction of muscular activation (from 12% for trapezius descendens, to 25% for deltoideus anterior) a lower total number of keystrokes and a reduction of the US scan time of about 56%. The maximal variation between PW Doppler trace velocity measurement set automatically by ADA and set manually by sonographer was 11%. ADA technology can provide a Doppler angle correction precision comparable to the manual one, while decreasing the risk of WRMSD

Diversity of the epidemiology of carbapenemase-producing Enterobacteriaceae in long-term acute care rehabilitation settings from an area of hyperendemicity, and evaluation of an intervention bundle

Background: Long-term acute care rehabilitation facilities (LTACRFs) are affected by carbapenem-resistant Enterobacteriaceae (CRE) in endemic areas. However, the contribution of different subpopulations of patients has not been investigated in these settings. Aim: To study the epidemiology of CRE in an LTACRF, and the effect of an infection control intervention. Methods: A surveillance programme was implemented in a large Italian LTACRF. The intervention included screening for CRE carriage at admission and weekly (for negative patients), and enforcement of contact precautions plus cohorting (in wards and rehabilitation areas) for presumed and confirmed carriers. Prevalence and incidence of CRE colonization and the number of CRE bacteraemias were monitored over one year. Findings: Overall, 1084 patients underwent screening (adherence 89.8%). At admission, 11.6% of patients were colonized, and 9.9% of those negative at admission subsequently became colonized. These percentages were significantly higher among patients with severe brain injuries (SBIs) who were exposed to a higher intensity of care (44.1% vs 8.6% and 63.5% vs 6.8%, respectively). The majority of CRE bacteraemias occurred in the SBI ward. The intervention was associated with a decline in the incidence of CRE colonization in the SBI ward (from 17.7 to 7.2 acquisitions/100 at-risk patient-weeks), but not in other wards. All CRE isolates were Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Conclusions: A peculiar CRE epidemiology was observed in a LTACRF from Italy, with very high rates of carriage and cross-transmission in SBI patients. A simplified infection control bundle was effective at reducing the incidence of CRE colonization in the SBI ward

AirExGlove — A novel pneumatic exoskeleton glove for adaptive hand rehabilitation in post-stroke patients

Stroke is one of the leading causes of disability worldwide: post-stroke disabilities affect the upper and lower limbs, significantly undermining a subject's autonomy in the Activities of Daily Living (ADLs). Among post-stroke disabilities, one of the most impairing and widespread conditions is the clenched fist deformity: the subject experiences a permanent contraction of the hand, resulting in a closed hand rest pose. In this paper, the authors propose a novel light-weight inflatable soft exoskeleton device, called the AirExGlove, to deliver high-dosage, adaptive and gradual rehabilitation therapy to patients affected by clenched fist deformity. Our system is lightweight, low-cost, adaptable to any hand size and unobtrusive. The system has been extensively tested to assess the hand-opening range in which it can operate according to the severity of the patient condition, which is typically ranked on the Modified Ashworth Scale (MAS) scale. Experimental analysis demonstrates the suitability of the glove for patients affected by post-stroke muscle spasticity scoring up to 3 out of 4 in the MAS scale. Preliminary testing with clenched-fist patient confirmed a higher level of ergonomics of the system in comparison with rigid-linked robotic systems