Ekokardiologiska undersökningar erbjuder en lätt, snabb och icke-invasiv metod för diagnostik av vänster förmaksvolym (LAV). I dagsläget är hjärt-magnetresonanstomografi (CMR) referensmetod för mätningen. Dock är CMR både tid- och kostnadskrävande, vilket leder till att tvådimensionell ekokardiografi (2DE) istället används. Den relativt nya metoden tredimensionell ekokardiografi (3DE) erbjuder en intressant valmöjlighet vid bedömning av förmaksvolym. Det är studiens syfte att ställa 2DE mot 3DE, gällande modaliteternas korrelation av vänster förmaksvolym, med CMR som referensmetod. Studien undersöker även förhållandet för modaliteternas intra- och inter-bedömar variation. Studien har använt databaserna Pubmed och Medline där systematiska litteratursökningar genomförts under april månad år 2020. Flera inklusions och exklusions kriterier har använts, studien har endast använt artiklar publicerade från 2010 och framåt. 3DE uppvisar en högre korrelation mot CMR vid volymbestämning av LAV. Resultatet visade även att 3DE har en lägre variation mellan både intra- och inter-bedömare än 2DE. 3DE har både en starkare korrelation mot CMR och en lägre bedömarvariation än 2DE, dock lider denna modalitet av begränsningar i dagsläget. Begränsningarna är: tid, personalens erfarenhet, brist på referensvärden samt kostnad för klinikerna. Författarna rekommenderar användning av 3DE för säkrare bedömning av LAV. Fortsatt kunskap som ger adekvata referensvärden och standardiserade mjukvarusystem behövs. / Echocardiological examinations offer an easy, quick, and non-invasive method for diagnosing the left atrium volume (LAV). Cardiac magnetic resonance imaging (CMR) is currently the golden-standard method. However, CMR is time-consuming and costly. Instead two-dimensional echocardiography (2DE) modality is used. The relatively new three-dimensional echocardiography (3DE) method offers an interesting choice when assessing LAV. It’s the purpose of this study to plot 2DE against 3DE regarding LAV correlation and with CMR as reference. The study will examine the relationship between modalities intra- and interobserver variation. Pubmed and Medline databases were used, and systematic literature searches were carried out during April 2020. Inclusion and exclusion criterias have been adopted; the study has only used articles published from 2010 onwards. 3DE shows a higher correlation with CMR in assessment of LAV. The result also showed that 3DE has a lower variation between both intra- and interobserver. 3DE has a stronger correlation to CMR and a lower variation than 2DE, however, 3DE suffers from limitations. These limitations are time, staff experience, lack of reference values and cost to clinics. The authors recommend 3DE for more accurate LAV assessment. Further research for more adequate reference-values and software systems is needed.

Work-related musculoskeletal disorders are associated with high costs and it is essential to prevent them. Occupational Health Services(OHS) provide expert services regarding work environment, health and rehabilitation of work related disorders. Risk assessments of the work environment can be an initial step for preventive measures, and ergonomists can be assigned by clients to assess exposures in the work environment. For such assignments different tools can be used. The aim of this thesis was to explore prerequisites, processes and practices of OHS consultants in Sweden within the domain of primary prevention of work-related musculoskeletal disorders. This was explored through the work of ergonomists in their role of assessing ergonomics risks. The research methodology was both quantitative and qualitative. Data collection includes a web questionnaire, semi-structured interviews and inter- and intra-observer reliability tests. The results shows that ergonomics risk assessments were most commonly initiated reactively and a systematic work methodology for the risk assessment process was often lacking. Swedish ergonomists used only a few standardized tools for risk assessment. The Ergonomics provision from the Swedish Work Environment Authority, AFS-98, was widely used, but other observation-based tools were used far less often. Ergonomics risks were often assessed solely by means of observation, based on ergonomists’ knowledge and experience. The results also pointed to that that the reliability was not acceptable when risk assessment was performed without any standardized tool. Furthermore, the results point to that support from the OHS organizations is an important prerequisite for ergonomists to work with primary prevention. Further, opportunities for specialization within a specific industry sector seem to facilitate ergonomic interventions. It is also important to have close relationships with clients and to make them aware about ergonomists competence. Conclusively, this thesis identifies a numbers of areas in which OHS must develop to improve primary preventive services regarding work environment. / <p>QC 20170127</p>