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PubMed1984

A study of the enquiry workload in a regional drug information centre.

In a study of the workload in a regional drug information centre, 65% of enquiries received were classed as urgent and required an answer on the day of receipt. The number varied considerably from day to day but no discernible pattern of either urgent or non-urgent enquiries was found. Manpower requirements are discussed on the basis of workload on the busiest days for urgent enquiries. It is calculated that with an annual workload of 1,106 enquiries the mean utilization of a full-time pharmacist on this work is 64% rising to 93% on the busiest days.

Drug Information Services↗

PubMed1985

Supine and sitting maximal workload difference and response to long-term enalapril therapy in congestive heart failure.

Maximal workloads in supine and sitting bicycle stress tests were compared in 12 patients with congestive heart failure during long-term therapy with the vasodilator enalapril. The response to the therapy was observed with the supine and sitting bicycle stress tests and gated equilibrium ventriculography. The maximal workload was 68 W in the supine position and 84 W in the sitting position; the mean difference was 15 W. The difference was highly significant (P less than 0.001). Both the supine and sitting workloads were significantly higher (P less than 0.02 and P less than 0.05) in the enalapril group than in the placebo group. The findings in the gated equilibrium ventriculography were not significantly different between the two groups.

Aged↗

PubMed1998

A software sensor using neural networks for detection of patient workload.

The morphology of intracardiac electrograms (IEGMs) was used for pacemaker patient workload estimation. The body posture also was studied as another characteristic. The IEGMs were obtained and recorded via temporary transcutaneous leads connected to the implanted pacemaker. IEGMs were recorded during exercise and at rest. Recordings at rest were performed in different body positions. The morphology was analyzed visually in order to observe changes due to workload and posture. The recordings were digitized and processed by a computer-simulated neural network. The network was used as an automatic IEGM classifier based on the morphology. Our results show that the morphology of the IEGM may be used as an indicator of patient workload and body posture. The necessary information is found mainly in the ST segment. We conclude that neural networks seem to be useful in an active cardiac device.

Aged↗

PubMed1996

Verification and correction of setup deviations in tangential breast irradiation using EPID: gain versus workload.

PURPOSE: When a deviation in the treatment setup is identified, when or how should it be corrected? With the aim of improving the precision and reducing the systematic errors while maintaining the workload to a minimum, a study was performed to define the proper set of actions for the correction of tangential breast setup deviations during the course of the treatment. PATIENTS AND METHODS: Clinical data were taken from a prospective study of more than 2200 on-line Electronic Portal Images (EPI) from 20 patients treated with tangential irradiation following a partial mastectomy for an early stage (I and II) breast cancer. The values of the central lung distance were then entered in the verification/correction procedure and modified to correct only the portion of the deviation most likely attributed to systematic errors according to the maximum likelihood. The verification/ correction procedure uses an action level equal to FML x alpha/square root of N, where alpha is proportional to the standard deviation (alpha = n sigma) and N is the number of consecutive fractions delivered after the start of the treatment. FML is the fraction of the deviation due to the systematic errors estimated from the maximum likelihood of the two distributions. In addition to n, one needs to specify Nmax, the maximum number of consecutive measurements without correction, to apply the procedure. The combination of these two parameters C(n,Nmax) will determine the reduction of systematic errors (gain) and the number of measurements and corrections (workload) associated to the procedure. RESULTS: The effects of three combinations, C(1,1), C(2,2), and C(3,4) were studied. Also, the analysis of the results after application of the procedure with and without the factor of maximum likelihood made individually for each patient demonstrates the importance of the FML. CONCLUSIONS: The verification/correction procedure with the inclusion of the FML can effectively improve the accuracy when applied to clinical data. With the specific workload related to measurements and corrections performed at our institution, we have found that in the case of the tangential breast treatment, the optimum combination uses an action level equal to 2 sigma and a maximum of two consecutive measurements without correction.

Breast Neoplasms↗

PubMed1990

Junior doctors' on call activities: differences in workload and work patterns among grades.

OBJECTIVE: To examine the workload and work patterns of junior doctors of all grades while on call. DESIGN: Pilot study of activity data self recorded by junior doctors, with the help of students during busy periods. SETTING: A general surgical firm and a general medical firm based at University Hospital, Nottingham. SUBJECTS: Four registrars, three senior house officers, and five preregistration house officers. RESULTS: Senior house officers and preregistration house officers spent nearly half of all their on call duty time working, but less than half of that time was spent in direct contact with patients. Registrars were on call more often than the house officers but spent less than one fifth of their on call duty time working, and almost two thirds of that time was spent in direct contact with patients. CONCLUSIONS: Workload while on duty is excessive for both senior and preregistration house officers. Changes in some administrative procedures and employment of more non-medical staff during on call periods might reduce the time spent on non-clinical activities, thereby reducing the overall workload and allowing more time for patient contact.

England↗

PubMed1991

Management importance of common treatments: contribution of top 20 procedures to surgical workload and cost.

OBJECTIVE: To assess the contribution of the most frequently performed procedures to surgical workload and to evaluate the financial implications. DESIGN: Analysis of data held on the department's computerised clinical information system. SETTING: Department of surgery in a district general hospital. PATIENTS: 4845 patients were treated by surgeons in three consultant firms over an 18 month period and 5346 patients by surgeons in a single firm over a five year period. MAIN OUTCOME MEASURES: Percentage and cumulative percentage contribution to workload in order of frequency by procedure. Costs of the commonest and costliest treatments. RESULTS: Half of the workload of the department was encompassed by eight procedures. Twenty procedures accounted for 70% of the work. For a single firm 20 procedures represented over 80% of all the surgical work. Transurethral prostatectomy was the treatment that consumed most resources (pounds 240,900 for 198 patients in 18 months). The costliest patients were those who had undergone complicated large bowel surgery, vascular reconstructions, or amputation. CONCLUSIONS: Clinicians and managers need to appreciate the importance of the most common surgical procedures. It is vital that performance and costing of these procedures are optimum as they contribute disproportionately to overall results and finance.

England↗

PubMed1991

Gastric cancer in Scotland: changing epidemiology, unchanging workload.

OBJECTIVE: To determine the changes in incidence of and mortality from gastric cancer in Scotland between 1978 and 1987 and in the operative workload in Lothian between 1979 and 1988. DESIGN: Analysis of national incidence statistics for gastric cancer derived from the Scottish national cancer registry, deaths from gastric cancer recorded by the registrar general for Scotland, and Lothian surgical audit data. SETTING: Scotland and Lothian Health Board area. PATIENTS: Patients in Scotland with gastric cancer during 1978 to 1987 inclusive; patients in Scotland with gastric cancer recorded on their death certificate as cause of death during 1978 to 1987; patients who had an operation in Lothian for gastric cancer during 1979 to 1988. MAIN OUTCOME MEASURES: Changes in incidence of and mortality from gastric cancer in Scotland from 1978 to 1987 and in the number of operations performed for gastric cancer in Lothian from 1979 to 1988. RESULTS: Mortality from gastric cancer in Scotland fell by about 25% over the 10 years. The incidence and standardised incidence of gastric cancer showed a marginal decline of about 9%. The differences in trends between incidence and mortality were significant (p less than 0.05). CONCLUSIONS: This study shows that the surgical workload associated with gastric cancer is not declining. This is because the incidence has remained almost static, which may be due to the relative increase in the numbers of older people in the population, who are at greater risk of developing gastric cancer. Gastric cancer should not be regarded as a disease in decline. Incidence and workload should determine resources allocated to this disease rather than mortality statistics.

Adult↗

PubMed2003

Effect of test interruptions on blood lactate during constant workload testing.

OBJECTIVE: To determine whether repetitive test interruptions (TI) during constant load testing influence blood lactate concentration (BLC), maximal lactate steady state (MLSS), MLSS workload (P-MLSS), and relative MLSS intensity (Int-MLSS). METHODS: Nineteen males participated in this study. In experiment A, 10 subjects (27.5 +/- 2.9 yr; 183.7 +/- 5.2 cm; 77.4 +/- 3.7 kg) performed 30-min constant load tests: one without TI, one with TI of 30 s, and one with TI of 90 s after every 5 min of cycling at a given workload. In experiment B, nine subjects (28.0 +/- 2.7 yr; 182.9 +/- 6.8 cm; 76.2 +/- 4.5 kg) performed 30-min constant load tests at different workloads until MLSS had been determined for all three TI protocols. RESULTS: In experiment A, the BLC after 30 min net working time (BLC30) was higher (P < 0.001) without TI (6.0 +/- 1.3 mmol.l(-1)) than with TI of 30 s (4.9 +/- 1.4 mmol.l(-1)) or 90 s (4.5 +/- 1.1 mmol.l(-1)). The change in BLC during the final 20 min (DeltaBLC10-30) was greater (P < 0.01) without TI (1.2 +/- 1.0 mmol.l(-1)) than with TI of 30 s (0.2 +/- 0.7 mmol.l(-1)) or 90 s (-0.3 +/- 0.7 mmol.l(-1)). In experiment B, the MLSS was not affected, but P-MLSS and Int-MLSS were lower (P < 0.01) without TI (277.8 +/- 24.4W and 73.7 +/- 7.6%) than with TI of 30 s (300.4 +/- 30.4W and 79.2 +/- 8.0%) or 90 s (310.0 +/- 31.2W and 81.5 +/- 7.1%). Approximately 35% of the variance of BLC30 and DeltaBLC10-30, and 70% of the variance of P-MLSS and Int-MLSS were explained by TI duration (P < 0.001). CONCLUSIONS: TI decreased BLC30 and DeltaBLC10-30 but has no effect on MLSS. Consequently, with TI, the MLSS is achieved at higher P-MLSS and Int-MLSS.

Adult↗

PubMed1988

Multifactor prediction of hospital service workload.

Prediction of workload for hospital departments is a forecasting problem. Most forecasting techniques use time series methods. However, the unpredictability of hospital utilization which occurs because of environmental turbulence requires that predictions be based on strategic plans. Regression models developed from cross-sectional data can provide a methodology for linking predictions of service workload to strategic plans. The methodology is illustrated and evaluated in a pilot study, which produced models predicting measures of workload such as laboratory tests (R2 = .85), doses of medication given to inpatients (R2 = .43), outpatient prescriptions (R2 = .79), and x-rays (R2 = .86).

Forecasting↗

PubMed2001

Cardiopulmonary exercise testing in children: an individualized protocol for workload increase.

OBJECTIVES: To investigate the feasibility of individualized workload increments, as used in adults, for exercise testing in children; and to investigate whether this individualized protocol makes it possible to satisfy the usual criteria for maximal exercise (clinical exhaustion, predicted maximum heart rate [HRmax], oxygen uptake [O(2)] plateau, maximal respiratory exchange ratio > 1.1). DESIGN: Prospective clinical study. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Ninety-two children aged 5 to 17 years with various cardiac and respiratory diseases (33 with asthma, 11 with bronchopulmonary dysplasia, 6 with cystic fibrosis, 10 with congenital heart disease, and 32 miscellaneous). INTERVENTIONS: Individualized maximal incremental exercise testing. The increase in workload was adapted to the individual and was calculated from predicted maximal oxygen uptake (O(2)max) for each child. The test lasted 10 to 12 min. RESULTS: The exercise test was well tolerated by all children and was maximal in all but seven patients. A total of 65.7% of children reached the predicted O(2)max and 68.4% satisfied the criteria for a O(2) plateau at peak exercise. The predicted HRmax was achieved in all but two children. The mean maximal respiratory exchange ratio was 1.06. CONCLUSION: The individualized protocol for increasing workload, based on O(2) rather than power, was well tolerated by children. In our view, the best two criteria for assessing the maximality of the tests were clinical exhaustion and HRmax, especially if the O(2) plateau was not reached. These results suggest that individualized protocols could be used instead of standardized tests for exercise testing in children.

Adolescent↗

PubMed2005

High-workload endurance training may increase serum ischemia-modified albumin concentrations.

The measurement of cardiac troponins has emerged as the biochemical "gold standard" for the diagnosis and management of patients with acute chest pain. However, earlier markers should support investigation strategies, as several patients with acute coronary syndrome might present with non-diagnostic concentrations. Ischemia-modified albumin (IMA), measured by the albumin cobalt binding (ACB) assay, was recently proposed for early detection of myocardial ischemia. To establish the potential influence of endurance training on the diagnostic approach to patients with suspected myocardial injury, cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK-MB), myoglobin and IMA were evaluated in healthy individuals subjected to different aerobic workloads. The concentrations of both IMA and CK-MB were significantly increased in athletes subjected to high-workload endurance training, whereas the concentration of cTnT and myoglobin was not influenced by physical exercise in the medium term. Taken together, our results demonstrate that demanding aerobic physical activity might influence the generation of IMA, which might be increased in the medium term following high-workload endurance training, while the concentration of other conventional markers of myocardial injury remains non-diagnostic.

Adult↗

PubMed2006

[Maximal workload prediction models in the clinical cardio-pulmonary effort test].

OBJECTIVE: This study sought to derive generalized equations for predicting maximal workload for young men and women. METHODS: Direct ergospirometry (Aerosport TEEM 100, USA) was used to determine VO2máx and the maximal work load (Wmax) on the cycle ergometer test (Monark,Brazil) of thirty men (25 +/- 5 years, 75.0 +/- 10.7 kg; 48.4 +/- 8.8 mL x kg(-1) x min(-1) and 243 +/- 51 Watts) and thirty women (26 +/- 5 years, 56.7 +/- 5.9 kg, 39.8 +/- 7.6 mL x kg(-1) x min(-1) and 172 +/- 37 Watts). Age and body mass were used as independent variables. For all statistic tests, a p < 0.05 significance level was adopted. RESULTS: In the multiple linear adjustment, the maximal workload was explained by age and body mass as 54% (r = 0.73) for men, and as 76% (r = 0.87) for women, with standard errors of 0.66 W x kg(-1) and 25 Watts. The proposed equations were cross-validated using another sample with similar age and VO2máx characteristics comprised of fifteen men and fifteen women. The intraclass correlation between the predicted Wmax values and those measures by ergospirometry were 0.70 and 0.69, with standard errors of 28.4 and 15.8 Watts, respectively, for men and women. CONCLUSIONS: This study exhibits valid generalized equations for determining the maximal cycle ergonometer workload for men and women.

Adult↗

PubMed1999

Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of insensate foot and workload requirements.

OBJECTIVE: The purpose of this study was to evaluate the effects of different testing sites and buckling strengths on the sensitivity and specificity of using the Semmes-Weinstein monofilament to detect patients with insensate foot. The impact on workload required to educate and follow up these high-risk individuals was estimated by modeling in our patient population with a documented status of neuropathy. RESEARCH DESIGN AND METHODS: Using the 5.07/10-g monofilament, one observer tested 132 randomly selected subjects with diabetes at five sites on the right foot. The sensitivity and specificity of each site and combinations of sites in detecting vibration perception threshold > 40 was calculated. In addition, two monofilaments, one with a buckling force of 5 g and the other with a force of 15 g, were compared by testing 200 randomly selected patients. An estimate of the prevalence of insensate foot and workload was made by modeling the findings to the 5,270 patients with neuropathy status registered on our computerized database. RESULTS: Specificity of the 5.07/10-g monofilament to detect insensate foot at each of the five sites is high, at approximately 90%, but there is considerably more variation and lower sensitivity, ranging from 44-71%. Data derived from the use of different combinations of sites showed that more stringent criteria are associated with lower sensitivity but higher specificity. If the foot is considered insensate when either of sites 3 and 4 (plantar aspect of the first and fifth metatarsal heads, respectively) cannot feel the monofilament, there is reasonable sensitivity and specificity (80-86%, respectively). By modeling on our diabetes center population, it can be demonstrated that the choice of different methodologies leads to different conclusions about the prevalence of severe neuropathy, ranging from 3.4 to 29.3%. CONCLUSIONS: Using a combination of sites 3 and 4 for monofilament testing gives a reasonable compromise for time, sensitivity, and specificity. Minor changes in sensitivity and specificity can lead to major changes in the prevalence of neuropathy, with implications for workload.

Australia↗

PubMed1989

Assessment of mental workload on older workers during performance of a calculating task.

Twenty-four healthy male clerical workers (50-59 years of age) in an automobile manufacturing plant performed as accurately as they could a calculating task consisting of the addition or subtraction of two 2-digit numbers at five grades of task load for 5 min each. The workers' work capacities were inferior in speed but not in precision to those of male students determined previously. The resting levels of occipital midline beta-2 (Oz beta 2) amplitude were significantly lower for the workers than for the students. The workers' mental workloads were objectively shown to be lighter than the students' based on a significant difference between the percent increases in Oz beta 2 amplitude over resting levels. The workers' subjective mental workloads assessed by subjective rating of task difficulty (SRTD) were lighter than the students' at higher task loads. From the trend that there was no undue rise in either SRTD or percent increase in Oz beta 2 amplitude, it was judged that no task load could induce excessive mental workload on workers.

Adult↗

PubMed1977

Assessment of workload in the microbiology laboratory.

Workload measurement is necessary for laboratory management and planning. Adaptation of the College of American Pathologists' scheme to the requirements of a large clinical microbiology laboratory is described. Our method of applying basic work values is simpler and the calculation of workload is easily adapted to take account of alterations in laboratory method. The resulting system of workload measurement can be instituted without undue effort.

Australia↗

PubMed1986

Faculty workload: myths and realities.

This survey was done to determine the current workload policies and practices in collegiate schools of nursing. A 40-item questionnaire was mailed to all schools holding membership in the American Association of Colleges of Nursing. Seventy-two percent of the schools responded. Analysis of the data shows that quantifiable factors which relate directly to teaching are of considerable importance to deans in determining faculty workload while less quantifiable factors such as student advisement, research, publication and involvement in direct client care are of little or no importance in determining workload.

Education, Nursing, Baccalaureate↗

PubMed1990

Unit dose pharmacy workload forecasting: validation of the pharmacy service unit model.

Departmental efficiency is a priority issue for hospital administration as third party payers maintain or reduce the level of reimbursement. This study validates the PHASU (PHArmacy Service Unit) model, which predicts the workload and productivity of a unit dose pharmacy. A PHASU equivalency system enabled the authors to develop a comparative standard for all pharmacy procedures. The procedure most reflective of workload is unit dose orders. Predicted productivity and staff requirements compare favorably to management engineering determinations. The PHASU model represents a reliable workload forecasting instrument that pharmacy managers can prospectively incorporate in the support of current and future pharmacy services.

Efficiency↗

PubMed1990

Clinical pharmacy workload measurement: pharmacokinetic and drug information services.

Clinical workload measurement statistics have not been completely documented or related to service characteristics. The Clinical Hospital Pharmacy Administrative Group of British Columbia measured the time required for provision of clinical pharmacokinetic and drug information services utilizing standard definitions of component activities. Pharmacists in 10 participating hospitals independently recorded the time required for the various components of these services. The data collected allows for an estimation of workload requirements by similar institutions and allows for comparison of the impact of differences in methods of organization of the services on workload measurement.

British Columbia↗