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PubMed1993

Mission challenge, mental workload and performance in military aviation.

In modern military aircraft, complexity of information combined with time stress creates difficulties for the pilot under combat conditions. The first step to mitigate this problem is to measure mental workload. Several methods for doing so have been proposed. In this paper we develop an analysis of mental workload as distinguished from its prior flight mission parameters (risk, challenge) and subsequent effects (mission performance). A model is developed on the basis of extensive mission data, both ground attack and fighter missions, which exhibits a dual coping process as a response to challenge and risk: emotion coping, leading to tension and decreased performance, and problem solving, leading to increased mental energy and improved performance. The model implies a selection of optimal measures for constructing an index of mental workload which is demonstrated to yield a sensitive measure of the pilot's changing mental status over the course of a period of training.

Aerospace Medicine↗
PubMed1993

A 10-year analysis of "revenues," costs, staffing, and workload in an academic medical center clinical chemistry laboratory.

From 1980 to 1990 we found progressive increases in workload (number of billable tests; 12.1% per year), staffing [number of full-time equivalents (FTEs); 5.6% per year], "revenues" (gross billings; 25.8% per year), and direct cost (12.9% per year) in the clinical chemistry laboratory of a large tertiary-care university medical center. The increase in direct cost was mainly attributable to an increase in salary cost (23.7% per year), whereas the impact of increasing "consumable" cost was relatively small (5.3% per year). In fact, after adjustment for inflation, the consumable cost was virtually unchanged or decreased during the 10-year study period. Initially, consumables represented about 60% of the direct cost, and the remaining 40% was for salaries. After 1982/83, however, the relative contribution of consumables and salaries to direct cost gradually reversed. Because the workload grew at a higher rate than staffing, the workload per FTE increased from 1980 to 1990. This was paralleled by gradual increases in both "revenue" per FTE and salary per FTE in actual dollars, but by lesser increases to no increases in inflation-corrected dollars. After adjusting for inflation with different indices, the direct cost per test, the consumable cost per test, and the salary cost per test either remained unchanged or decreased in the 1980s. The findings are discussed in the context of technical advancements in laboratory testing, nationwide shortages of medical technologists, and implementation of prospective fixed-fee reimbursement practices during the study period.

Academic Medical Centers↗
PubMedDate not supplied

Forecasting ambulatory clinic workload to facilitate budgeting.

Concern about controlling health care costs is a driving force in forecasting workload. The availability of computers and spreadsheet software now makes it possible for middle managers to forecast future workload using past workload data.

Ambulatory Care Facilities↗
PubMed1996

Carpal tunnel syndrome. Effects of litigation on utilization of health care and physician workload.

We performed a study consisting of two parts to investigate the impact of litigation on patient recovery and physician workload. We received 556 replies from a questionnaire sent to hand surgeons and discovered that 98.20% of them felt that litigation increased the subjective complaints of patients. Most of these physicians (89.75%) also felt that litigation led to a worse result from treatment. Second, we undertook a retrospective chart review of 447 patients to see if there was a correlation between litigation, patient utilization of health care and physician workload. We found that workers' compensation patients with pending litigation went to the doctor's office more. They also had more letters, phone calls, and forms associated with their care, had more nerve conduction studies performed, and took longer to be discharged from care than patients with non-work-related carpal tunnel syndrome as well as workers' compensation patients who did not have pending litigation. These results indicated that litigation does affect patient utilization of health care and increases the workload on the physician.

Adult↗
PubMed1996

Analysis of workload predictions generated by multiple resource theory.

BACKGROUND: During the design process, operator workload assessments sometimes require subject matter experts (SME's) to predict the amount of physical and mental demands they expect during system employment. Often, these subjective estimates are considered within the context of models that partition human capabilities into discrete resources. Such models require the SME's to rate tasks on how they affect resource consumption. This type of assessment technique is based upon the premise that raters can effectively discriminate their own resources. METHODS: Subjective workload ratings based on multiple resource theory were collected independently from two highly experienced pilots for 225 different tasks of an anticipated mission for a future advanced strike aircraft. The data were examined using a factor analytic approach. RESULTS: Factor analysis of their responses suggest that while such ratings have high face validity and even high inter-rater reliabilities, the ratings could have little validity in terms of efforts required to use the seven postulated resource channels (i.e., visual or auditory input, spatial, verbal or analytical cognition, and manual or speech output). Ratings of efforts required for the cognitive resource channels were particularly suspect. We identified four independent factors for each pilot that accounted for virtually all of the intercorrelations among the 7 resource channels. Three factors (i.e., visual-spatial, verbal communications, and manual and speech output) were identical for both pilots and accounted for most of the explainable variance. CONCLUSION: Given these results, this analysis challenges the utility of a multiple resource framework for predictive workload assessments.

Adult↗
PubMed1997

The skin cancer workload in Australian general practice.

OBJECTIVE: Skin cancer is common in Australia. It is managed in large portion within general practice, and early excision usually affords cure, therefore, it may form a much greater workload for general practitioners (GPs) than incidence figures would imply. The aim of this study was to describe the skin cancer workload in Australian general practice. METHOD: Analysis of data recorded by 495 randomly selected GPs relating to 113,468 consultations (98,796 weighted for State size), which were collected as part of a national descriptive study. Medicare and census data were used to calculate rates at which GPs were consulted for different conditions. RESULTS: Skin tumours accounted for 2,083 (1.5%) of all 145,799 problems managed in 98,796 encounters. Annual rates at which GPs were consulted were: 13/1,000 people for 'malignant' tumours of the skin; 23/1,000 for 'naevus/mole; and 13/1,000 for 'other benign' lesions. The rates of diagnoses of 'malignant skin neoplasms' increased with age to a maximum among women and men aged 65 years or more of > 80/1,000 and > 100/1,000, respectively. For 'naevus/mole' the rates of maximum diagnoses were 40/1,000 for women and 351/1,000 for men aged 15-24 years. There was no sex difference for the maximal rate (15/1,000) among the 45-64 age groups for 'other benign skin lesions'. The main form of management was procedural for malignant skin lesions (90% of consultations) and naevi/moles (50%). Referral to specialist services was most common during consultations for malignant disease (22% of consultations), in comparison to naevi/moles (15%) and other benign skin neoplasms (9%). Procedures (cryotherapy, diathermy and excision) and referrals were more common for malignant lesions and naevi/moles. CONCLUSIONS: There were important differences in age distribution for rates of management of benign and malignant skin tumours and naevi. Skin tumours usually were managed in conjunction with other problems. Most were managed procedurally. Only a minority were referred. Skin cancer represents a greater workload for Australian GPs than suggested by previous incidence reports.

Adolescent↗
PubMed1997

[The workload in Pathological Anatomy measured on the basis of categories of services].

Workload measurement is one of the most reliable tools in perspective payment systems, to evaluate clerk and technical personnel needs in a Surgical Pathology Department. In 1992 Italian Government began a full-comprehensive modification of financial support in National Health Care System, and during the last four years Public Hospitals and Local Health Units modified their financial organization with the introduction of workload measurement for the personnel needs. We propose a synthetic method for the workload measurement in Surgical Pathology Departments, similar to that proposed for perspective payment of surgical pathology services. The method is reliable and simple representing the full performance to obtain pathological report.

Autopsy↗
PubMed1990

Transmural high energy phosphate distribution and response to alterations in workload in the normal canine myocardium as studied with spatially localized 31P NMR spectroscopy.

Spatially localized phosphorus-31 nuclear magnetic resonance (31P NMR) spectroscopy has been applied to the study of the normal canine myocardium to measure the relative content of high energy phosphates across the left ventricular wall. Transmural NMR data were acquired in five voxels spanning the wall of the left ventricle using the FLAX-ISIS technique. The validity of the FLAX-ISIS approach in acquiring localized spectra for transmural studies and in providing quantitative information from the localized spectra was examined rigorously by studies involving phantoms, intact rats, and the canine myocardium in vivo. The results indicated that (1) this technique yields spatially resolved spectra with partial overlap between adjacent voxels and virtually no overlap between every other voxel; (2) in the canine heart, signals from subepicardium, midwall, and subendocardium can be detected separately without cross contamination; and (3) relative metabolite contents within a voxel and among voxels can be quantitated. Transmural 31P NMR spectra were acquired with cardiac gating on 29 separate animals either at early systole or late diastole, and at three different workloads with the heart rate peak systolic pressure product (RPP) increasing from 6000 mmHg/min to 35,000 mmHg/min. The data revealed that in the normal canine myocardium, the creatine phosphate (CP) content and the CP/ATP ratio was significantly lower in the subendocardium than in the subepicardium. ATP levels were transmurally constant. Both the CP content and the CP/ATP ratio measured for each voxel remained unaltered in relation to either the phase of the cardiac cycle or approximately fourfold increase in workload. Free ADP levels calculated for each voxel showed that ADP was relatively higher in the subendocardium than the subepicardium, and in all transmural layers was higher than its apparent Km for oxidative phosphorylation. In this domain changes in ADP content with workload and MVO2 are not expected and were not observed.

Adenosine Diphosphate↗
PubMed1987

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 1: Analysis of the elements of activity in the nursing workload, and its variation with patient age group and pathology.

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined. It was possible to identify 3 broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and learning activities (Type 3). The latter is the balance of the nurses time which is largely concerned with observation and liaison with other staff. The 17 patients comprised 4 groups of pathologies, 2 each representative of the adult and paediatric workload. The primary bedside nurse performs virtually all of the Type 1 activities, recruiting the assistance of a secondary nurse principally to change the patients' posture (a Type 2 activity). The only practically significant period of time spent by the secondary nurse is in clinical discussion with the bedside nurse, largely at change of shift. Statistically significant differences in bedside nursing activities between age groups can be explained by the relative physical size of the patients and equipment. However the nurse maintains a higher level of awareness with shorter periods of inattention when nursing children. A greater number of significant differences between pathologies were found within the paediatric group of patients; this may indicate that a broader spectrum of such differences is to be found in this age group. An estimate was made of the impact of computer technology on the nurse's bedside workload.

Age Factors↗
PubMed1988

Heart glucose transport and transporters in rat heart: regulation by insulin, workload and glucose.

Aspects of the regulation of the glucose transport by perfused hearts of normal rats have been studied by measuring glucose transport (via the efflux of labelled 3-O-methyl-D-glucose) and glucose transporters (via the labelled cytochalasin B binding assay). Similarly to what is observed with insulin, increasing workload (by raising perfusion pressure from 50 to 100 mm Hg) stimulated glucose transport 7 to 8-fold. Glucose (via its analog 3-O-methylglucose, used at 15 mmol/l) stimulated its own transport 4-fold. The three stimuli favored the translocation of glucose transporters from an intracellular pool (microsomes) to the plasma membrane. Insulin increased the apparent affinity (decreased dissociation constant values) of plasma membrane transporters for cytochalasin, as well as the Hill coefficient, indicating the occurrence of a positive cooperativity amongst plasma membrane transporters. Workload increased only the Hill coefficient, glucose only the apparent affinity for cytochalasin of plasma membrane transporters. This study shows that insulin, workload and glucose itself stimulate glucose transport by favouring the translocation process of glucose transporter as well as by changing, albeit by a different mechanism, the functional properties of the transporters once translocated to the plasma membrane.

3-O-Methylglucose↗
PubMed1985

Haemodynamic effects of indenolol at rest and after a submaximal workload in essential hypertension.

The effect of indenolol on heart rate and blood pressure at rest and after submaximal workload has been studied in 19 patients with established essential hypertension. A stepwise increase from moderate to submaximal exercise was chosen to mimic challenges normally occurring in daily life. After 4 weeks of once a day indenolol therapy a significant, gradual reduction in the following cardiovascular parameters was observed: heart rate at rest fell by 20%, 30% after exercise and 31% after recovery; systolic blood pressure showed a fall of 15% at rest, 19% after workload and 14% after recovery; the reduction in diastolic blood pressure was 15% at rest, 11% after exercise and 12% after recovery. The rate-pressure product was decreased by 32% at rest, 43% after exercise and 42% after recovery. It is concluded that the most important pharmacological effect of indenolol is the significant decrease in myocardial oxygen demand. In patients with essential hypertension indenolol not only produces a definite antihypertensive effect, but it also increases workload tolerance and decreases subjective symptoms during physical activity. Compliance was good and no severe side effects were observed.

Adult↗
PubMed2004

Surgical workload and cost of postoperative adhesion-related intestinal obstruction: importance of previous surgery.

Postoperative intraabdominal adhesions cause morbidity of varying degree. Intestinal obstruction is the most severe complication of adhesions. This study examined the importance of previous surgery on clinical and economic workloads caused by intestinal obstruction due to postoperative intraabdominal adhesions. All emergency hospitalizations due to adhesion-related intestinal obstruction from January 1, 1999 to December 31, 1999 in a hospital district serving roughly 450,000 inhabitants was reviewed retrospectively. The patient population was divided into six groups according to the site of previous surgery, and the total as well as group-related surgical workload and direct costs of inpatient care were analyzed. There were 123 hospitalizations due to postoperative adhesion-related intestinal obstruction during the study period. A total of 101 patients had experienced 176 operations. The most prevalent operations were colorectal (with or without other operations), upper abdominal, and female reproductive system procedures. Colorectal surgery preceded 40% and 38% of inpatient episodes and inpatient days, respectively. Altogether, 40 operations were performed because of adhesion-related intestinal obstruction. No differences between groups were seen in terms of the mean operating or theater time. Total annual inpatient costs due to emergency hospitalizations for intestinal adhesion-related obstruction related to colorectal surgery in a hospital district serving roughly 450,000 inhabitants was 72,520.60 (U.S. dollars) which accounted for 35.3% of all annual costs caused by postoperative adhesion-related intestinal obstructions. There were no significant differences between groups regarding the total mean inpatient episode costs. Intestinal obstruction due to postoperative adhesions poses substantial costs for the society. Colorectal operations are the most important procedures preceding adhesion-related intestinal obstruction, accounting for 35.3% to 46.8% of the total clinical workload or costs attributable to postoperative adhesion-related obstruction.

Adult↗
PubMed2004

The most economical cadence increases with increasing workload.

Several studies have suggested that the most economical cadence in cycling increases with increasing workload. However, none of these studies have been able to demonstrate this relationship with experimental data. The purpose of this study was to test the hypothesis that the most economical cadence in elite cyclists increases with increasing workload and to explore the effect of cadence on performance. Six elite road cyclists performed submaximal and maximal tests at four different cadences (60, 80, 100 and 120 rpm) on separate days. Respiratory data was measured at 0, 50, 125, 200, 275 and 350 W during the submaximal test and at the end of the maximal test. The maximal test was carried out as an incremental test, conducted to reveal differences in maximal oxygen uptake and time to exhaustion (short-term performance) between cadences. The results showed that the lowest oxygen uptake, i.e. the best work economy, shifted from 60 rpm at 0 W to 80 rpm at 350 W ( P<0.05). No difference was found in maximal oxygen uptake among cadences ( P>0.05), while the best performance was attained at the same cadence that elicited the best work economy (80 rpm) at 350 W ( P<0.05). This study demonstrated that the most economical cadence increases with increasing workload in elite cyclists. It was further shown that work economy and performance are related during short efforts (approximately 5 min) over a wide range of cadences.

Adult↗
PubMed1985

An approach to assessing motor workload in assembly tasks by the use of predetermined-motion-time systems.

Starting from the problem of how to identify 'motor workload' in assembly tasks, it is pointed out that the concept of assessing workload can be understood axiomatically. Indices for rating motor workload can be pragmatically derived from predetermined-motion-time systems like 'methods-time measurement' or 'work factor'. The practicability of such indices is exemplified. A computer-aided procedure to apply this method is introduced. First experiences in practice are reported. The results demonstrate the utility of that approach to differentiate not only various tasks but also between manufacturing departments within a plant or enterprise. The current boundaries for the validation permit an absolute but limited rating. The application therefore concentrates at present on identifying the state of different designs of manual operations, workplaces and working conditions for assembly tasks.

Journal Article↗
PubMed1986

Measuring pilot workload in a motion base trainer. A comparison of four techniques.

Various techniques have been developed to predict and measure pilot workload. This simulation was conducted in order to compare four widely used methods: a visual two-and four-choice reaction time task, time production, retrospective multi-dimensional subjective ratings and in-flight verbal workload estimates. Two scenarios with different levels of difficulty determined by preliminary research were designed to test these techniques. The insertion of the secondary tasks did not significantly affect flight performance. All four techniques were able to distinguish between the overall levels of scenario complexity. In addition, the three secondary tasks and workload ratings obtained in-flight were generally able to distinguish among levels of difficulty for different segments within the scenarios.

Journal Article↗
PubMed1986

Causes of dissociation between subjective workload measures and performance ; Caveats for the use of subjective assessments.

Dissociations between subjective workload assessments and performance were investigated. The difficulty of a Sternberg memory search task was manipulated by varying stimulus presentation rate, stimulus discernibility, value of good performance, and automaticity of performance. All Sternberg task conditions were performed both alone and concurrently with a tracking task. Bipolar subjective workload assessments were collected. Dissociations between workload and performance were found related to automaticity, presentation rate and motivation. The results were interpreted as supporting the hypothesis that the specific cognitive processes responsible for subjective assessments can differ from those responsible for performance. The potential contamination these dissociations could inflict on operational assessments was discussed.

Journal Article↗
PubMed1991

General practitioners' subjective experience of surgery workload.

General practitioners (GPs) in the U.K. frequently cite heavy workload as a major source of work-related stress. However, there is little direct evidence either to support this claim or to suggest whether the source of this stress lies in the amount, or rather the type, of work undertaken. The present paper uses a within-subjects design to address these issues in the surgery context. Over a two-week period three GPs gave ratings of subjective workload following each of their surgeries (N = 20-23). Correlational analysis showed a wide range of surgery characteristics to predict the GPs' reactions, including the length of surgeries, the number of consultations, the number of re-presentations, and the number of follow-ups and investigations requested. The GPs' perceptions of their patients (e.g. in terms of their health status and the appropriateness of the consultation), in contrast, did not emerge as significant predictors. The results of multiple regression analyses, however, revealed that most of the first-order effects could be accounted for by surgery length. Thus while the study supported the hypothesised link between the overall level of surgery work demands and the subjective experience of workload, it failed to confirm any consistent additional effects of the type of work involved. It was also found that as the length of surgeries increased, the GPs were more likely to arrange follow-up appointments. The implications of the present findings are therefore two-fold.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗