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PubMed1989

Workloads in genitourinary medicine clinics in England.

Work loads in venereal disease--sexually transmitted disease (STD)--genitourinary medicine (GUM) clinics have risen greatly in recent years. The increase in viral infections which are more difficult and time consuming to manage than those caused by bacteria and the higher expectations and demands of patients have combined to increase workloads more than the case figures indicate. This prompted the Department of Health and Social Security in 1988 to set up a survey of clinics in England with the following terms of reference: "To examine current and forecast workloads on GUM clinics, taking account of AIDS and other STDs, and to recommend any action which may need to be taken on manpower (including nursing manpower), training, resources and accommodation". The team concluded that the GUM service was ill equipped to meet the demands for its services, and made 36 recommendations. The priority recommendations included: the need to provide more resources; government ministers should give a lead in developing the service; all health districts should provide care for STD and HIV infection; all new patients should be seen on the day of presentation or failing that on the next occasion the clinic was open. Other recommendations included: location of all GUM clinics in the general outpatient department of general hospitals; accommodation of the same standard as other outpatient departments; review of the distribution of clinics; review of staffing levels and roles; and coordination of care of HIV infection. Many of these recommendations have already led to action including a lead from government ministers and provision of more funds. Many of the problems and recommendations will apply in other countries.

Data Collection↗

PubMed1991

Changing patterns in the workload of a district HIV/AIDS counselling unit 1987-90.

OBJECTIVES: To describe the changing workload of an HIV/AIDS counselling unit between 1987 and 1990. DESIGN: Retrospective examination of data collected by the HIV/AIDS counselling unit between 1987-90 on the number of counselling sessions with patients, family members and staff. SETTING: An HIV/AIDS counselling unit established in 1987 in a London teaching hospital. MAIN OUTCOME MEASURES: Number of new referrals to the HIV/AIDS counselling unit and the number of follow-up sessions. Number of counselling sessions with family members, hospital staff and people making telephone contact with the unit. RESULTS: New referrals to the HIV/AIDS counselling unit increased from 117 (1987-88) to 926 (1989-90). Follow-up appointments increased from 403 to 2016 in the same period. Telephone counselling sessions increased five-fold, and counselling sessions with family members nearly ten-fold over the three year period. Staff consultations doubled. CONCLUSION: The increase in the HIV/AIDS counselling unit's workload may be partly attributable to the rising incidence of AIDS in the community, reflecting earlier patterns of HIV infection. In addition, new HIV/AIDS services were developed in the hospital between 1987 and 1990. These included the establishment of a same-day HIV test and result clinic; integrated management of patients with HIV/AIDS, with an emphasis on early intervention in HIV infection; specialist services for families, antenatal clinic attenders and others affected by HIV; and the appointment of a designated HIV/AIDS consultant. New approaches to counselling and training health care providers in counselling skills will assume increasing importance in meeting future demand for HIV/AIDS counselling.

AIDS Serodiagnosis↗

PubMed1997

Mechanical workload-myocardial water content relationship in isolated rat hearts.

We tested the hypothesis that the mechanical workload of the heart inversely determines the rate of myocardial edema formation in an isolated, perfused rat heart preparation. Heart rate (HR) was varied in three groups by pacing at 125 (HR125), 250 (HR250), or 350 beats/min (HR350). Left ventricular pressure (LVP) was varied in two additional groups by pacing at 250 beats/min and with the addition of either epinephrine (Epi) or propranolol (Pro) to the perfusate. In five otherwise identical groups, variation of coronary vascular resistance was minimized by adenosine. Myocardial water content (MWC) varied significantly and inversely with HR in the HR125, HR250, and HR350 groups. MWC of the HR250 group was significantly less than that of the Pro group but did not differ from the Epi group. However, when adenosine was used, MWC had significant inverse relationships with HR and LVP. We concluded that the mechanical workload of the heart inversely determines the rate and degree of myocardial edema formation in this isolated heart preparation, and both HR and LVP are determinants of this relationship.

Adenosine↗

PubMed1999

CK inhibition accelerates transcytosolic energy signaling during rapid workload steps in isolated rabbit hearts.

The effect of graded creatine kinase (CK) inhibition on the response time of mitochondrial O2 consumption to dynamic workload jumps (tmito) was studied in isolated rabbit hearts. Tyrode-perfused hearts (n = 7/group) were exposed to 15 min of 0, 0.1, 0.2, or 0.4 mM iodoacetamide (IA) (CK activity = 100, 14, 6, and 3%, respectively). Pretreatment tmito was similar across groups at 6.5 +/- 0.5 s (mean +/- SE). The increase observed over time in control hearts (33 +/- 8%) was progressively reversed to 16 +/- 6, -20 +/- 6 (P < 0.01 vs. control), and -46 +/- 6 (P < 0.01 vs. control) % in the 0.1, 0.2 and 0.4 mM IA groups, respectively. The faster response times occurred without reductions in mitochondrial oxidative capacity (assessed in vitro) or myocardial O2 consumption of the whole heart during workload steps. Isovolumic contractile function assessed as rate-pressure product (RPP) and contractile reserve (increase in RPP during heart rate steps) were significantly reduced by IA. We conclude that CK in the myofibrils and/or cytosol does not speed up transfer of the energy-related signal to the mitochondria but rather acts as an energetic buffer, effectively slowing the stimulus between myofibrils/ion pumps and oxidative phosphorylation. This argues against the existence of an obligatory creatine phosphate energy shuttle, because CK is effectively bypassed.

Animals↗

PubMed2003

Modified exercise test in screening for mitochondrial myopathies--adjustment of workload in relation to muscle strength.

The aim of this study was to evaluate the usefulness of a modification of the bicycle ergometer test, the subanaerobic threshold exercise test (SATET), as a screening test for patients with mitochondrial myopathies. Since the original SATET is frequently found to be strenuous for weak patients, a new variable (relative muscle strength) was added to the workload formula. Plasma lactate levels were recorded at rest, then after 5 and 15 min of cycling on an ergometer, with constant workload. Nine patients with mitochondrial myopathy, 10 patients with other neuromuscular diseases and 9 healthy but sedentary volunteers undertook the test. An upper reference limit after exercise for plasma lactate was settled at 2.9 mmol/l. The modified SATET showed a sensitivity of 78% and a specificity compared to the healthy subjects of 100%. Compared to patients with other neuromuscular diseases, the specificity was lower (60%). All subjects completed the test without severe fatigue or pain.

Adult↗

PubMed1986

The inspiratory workload of patient-initiated mechanical ventilation.

We quantified inspiratory effort during patient-triggered ventilator cycles in 20 critically ill patients receiving assisted mechanical ventilation (AMV). An index of the patient's work per liter of ventilation (WP) was defined as the difference in the mechanical work done by the ventilator during controlled and assisted breathing cycles at similar settings of tidal volume and flow. WP was estimated graphically from plots of airway pressure against inflation volume for peak flow settings of 60 L/min and 100 L/min. During patient-initiated cycles, effort did not cease with the onset of gas delivery. Values for WP varied widely but at both flow settings frequently equalled or exceeded the total workload expected for a spontaneously breathing normal subject. Furthermore, the patient's component of the mechanical workload during AMV was often a large percentage of the work performed during spontaneous breathing 30 s after discontinuing ventilator support (at 60 L/min: mean 62.6%; range 30.3 to 116.3%). The addition of deadspace to the external circuit increased VE and WP significantly. Both the maximally negative pressure generated against an occluded airway and the deflection of esophageal pressure in the first 100 ms after the onset of inspiratory effort were highly correlated with WP, suggesting the importance of strength and ventilatory drive as determinants of patient effort. WP correlated poorly with measures of chest mechanics, and there was no separation of WP values for the two flow rates we studied, perhaps because both settings exceeded the patient's spontaneous demand for airflow (FD).(ABSTRACT TRUNCATED AT 250 WORDS)

Carbon Dioxide↗

PubMed1986

Effects of workload and analysis time on the cost of out-of-hours investigations.

In the UK, under present Whitley Council Regulations for payment for out-of-hours pathology services, there is a complex relationship between the number of requests received, the time taken to analyse each request, and the number of calls for which payment may be claimed for work done. At a fixed average analysis time, the rate of increase of remuneration slows down as workload increases until at higher workloads remuneration falls. The introduction of methods with a shorter average analysis time to improve the clinical service increases remuneration disproportionately. We suggest that a fixed sessional payment would be a better way of funding the service.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Analysing the workload from HIV inpatients: a 10-month retrospective study.

To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician. During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS). Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour, chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions. Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below). Neurological complications of AIDS were associated with the longest admissions. Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services. Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations. Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.

HIV Infections↗

PubMed1992

Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure.

This study reports the preliminary clinical evaluation of a new mode of ventilation--volume-assured pressure support ventilation (VAPSV)--which incorporates inspiratory pressure support (PSV) with conventional volume-assisted cycles (VAV). This combination optimizes the inspiratory flow during assisted/controlled cycles, reducing the patient's respiratory burden commonly observed during VAV. Different from conventional PSV, VAPSV assures precise control of tidal volume (VT) in unstable patients. Eight patients with acute respiratory failure (ARF) were submitted to assisted ventilation under VAV and VAPSV. Patient's ventilatory workload (evaluated through the pressure-time product, mechanical work per liter of ventilation, and work per minute) and patient's ventilatory drive (occlusion pressure--P0.1) were significantly reduced during VAPSV. This "relief" was more evident among the most distressed patients (p < 0.001), allowing a reduction of more than 60 percent in muscle load, without the need of increasing peak tracheal pressure. Mean inspiratory flow (VT/TI), VT, and effective dynamic compliance were significantly increased during VAPSV, whereas the effective inspiratory impedance decreased. These mechanical advantages of VAPSV allowed a reduction of intrinsic PEEP, whenever it was present. Blood gas values were similar in both periods. We concluded that VAPSV is a promising form of ventilatory support. At the same time that it was able to safely assure a minimum preset VT, VAPSV reduced patient workload and improved synchrony between the patient and the ventilator during ARF.

Acute Disease↗

PubMed2005

Automation in future air traffic management: effects of decision aid reliability on controller performance and mental workload.

Future air traffic management concepts envisage shared decision-making responsibilities between controllers and pilots, necessitating that controllers be supported by automated decision aids. Even as automation tools are being introduced, however, their impact on the air traffic controller is not well understood. The present experiments examined the effects of an aircraft-to-aircraft conflict decision aid on performance and mental workload of experienced, full-performance level controllers in a simulated Free Flight environment. Performance was examined with both reliable (Experiment 1) and inaccurate automation (Experiment 2). The aid improved controller performance and reduced mental workload when it functioned reliably. However, detection of a particular conflict was better under manual conditions than under automated conditions when the automation was imperfect. Potential or actual applications of the results include the design of automation and procedures for future air traffic control systems.

Accidents, Aviation↗

PubMed2004

Effects of sensory modality and task duration on performance, workload, and stress in sustained attention.

The workload and stress associated with a 40-min vigilance task were examined under conditions wherein observers monitored an auditory or a visual display for changes in signal duration. Global workload scores fell in the midrange of the NASA Task Load Index, with scores on the Frustration subscale increasing linearly over time. These effects were unrelated to the sensory modality of signals. However, sensory modality was a significant moderator variable for stress. Observers became more stressed over time as indexed by responses to the Dundee Stress State Questionnaire, with evidence of recovery in the auditory but not the visual condition toward the end of the watch. This result and the finding that signal detection accuracy - although equated for difficulty under alerted conditions - favored the auditory mode, indicate that display modality and time on task should be considered carefully in the design of operations requiring sustained attention in order to enhance performance and reduce stress. Actual or potential applications of this research include domains in which monitoring is a crucial part, such as baggage screening, security operations, medical monitoring, and power plant operations.

Adolescent↗

PubMed1982

A model for dental workload measurement.

The primary purpose of the study was to develop a model that would provide an efficient and standardized approach to workload reporting in a non-fee (HMO-like) dental care system. The model was also designed to predict the dental personnel resource requirements in the system as the overall dental needs of the population were already known. To accomplish this, a set of 246 task/procedures representing the broad scope of dental practice was developed. For each task/procedure, a Best Time-weighted Estimate (BTE) in terms of average expected man-minutes of work required for accomplishment was developed from over 35,000 actual time measurements on patient visits to 29 US Army dental clinics located throughout the United States. Because of the nature of the specific task/procedure data, it was necessary to use four different mathematical models to produce statistically optimal BTEs. It was concluded that, cumulatively the BTEs developed for each task/procedure evaluated could be used as a basis for both the development of a Dental Care Composite Unit workload measure and the determination of overall dental personnel resource requirements in a non-free dental care system.

Dental Care↗

PubMed1982

Changes in the Workload Recording Method? What they mean and how to cope.

The 1982 edition of the Laboratory Workload Recording Method manual will reflect a reduction in unit values assigned to some clinical chemistry procedures. In this article, the author explains why the changes have been made, what they mean, and offers guidelines on coping with the ever changing but valuable Workload Recording Method.

Autoanalysis↗

PubMed1982

Characterization of pharmacy workload and pharmacist activities in a Canadian community pharmacy.

The present study was undertaken to obtain data which would characterize pharmacist activities and prescription workload in a community pharmacy. Data on pharmacist activities were obtained by using a work sampling methodology. The proportion of time spent on each of 44 activities was obtained, and it was found that the proportion of time spent on professional activities (17.6 percent) was notably less than the time spent on nonprofessional activities (82.4 percent). Data on prescription workload were obtained by the design of a data sheet which was to be completed by each pharmacist for every prescription dispensed. The collected data characterized the number of prescriptions dispensed, which were related to the time of day and day of the week; they also provided information on the types of prescriptions dispensed, the age of patients (e.g., pediatric, geriatric), and the methods of payment.

Canada↗

PubMed1984

Philosophy and quality control. Workload recording--why your laboratory should be in the data bank.

The CAP Workload Recording (WLR) Method is the only widely accepted and validated method for recording laboratory workload. Here, the author details how unit values are assigned, how and by whom the data are used, how to quality control the data, and why an adequate comparative data base, such as the CAP Computer Assisted WLR Program, is so important to laboratories.

Hospital Departments↗

PubMed1990

Analysis of workload and staffing requirements for a critical-care satellite pharmacy.

A study to determine the workload and the staffing requirements of a proposed critical-care satellite pharmacy is reported. Data for all patients admitted to the adult surgical intensive-care units (SICUs) of an acute-care teaching hospital were recorded for 30 days. Both clinical and distributive data were collected, such as the number and times of patient admissions to the SICUs, the times medication orders were written and their nature, the number and types of drugs administered per patient per day, the number of medication profile reviews per day, and the number and types of interventions. Productivity standards were determined for specific clinical and distributive tasks and used to project the staffing requirements of the new satellite pharmacy. It was determined that proposed changes in distributive services, including expansion of the i.v. admixture program and implementation of a syringe-pump infusion system, would increase the pharmacist and technician staffing requirements by 1.91 and 6.77 hours per day, respectively. Expansion of clinical services, such as pharmacokinetic monitoring, would increase the pharmacist staffing requirements by 8.68 hours per day. It was estimated that the SICU satellite pharmacy could save the hospital more than $200,000 per year. Hospital administration approved a request to increase staffing by 3 full-time-equivalent (FTE) pharmacists and 1.6 FTE technicians. Workload analyses and projections of staffing requirements must incorporate measurements for clinical as well as distributive services.

California↗

PubMed1990

Model workload agreement for DGH general surgeon: discussion paper.

A guideline programme for a Consultant General Surgeon includes three operating lists, and two outpatient sessions per week. A General Surgical Consultant working with a 'standard' surgical team should expect to see approximately 1,000 new patients per year, and undertake an elective operative workload of 15 'hernia equivalent' procedures per week. A model workload such as this might assist surgical service planners to estimate the need for surgical staff in their Districts.

England↗

PubMed1989

Comparison of the workload of a trainer and trainee.

A general practitioner trainee's workload over one year was compared with a sample of his trainer's workload in order to identify and explain any differences. In line with previous studies the trainee saw relatively fewer patients with chronic diseases, fewer women of child-bearing age and fewer elderly patients but more children, more men and more acute problems. However, the trainee saw a marked excess of ear, nose and throat conditions and asthma which is explained by his special interest in these two subjects. Over the first six months the number of doctor-initiated consultations seen by the trainee increased steadily and remained fairly constant over the second six months. Periodic study throughout the year enabled the provision of extra experience in areas where the trainee had seen few cases.

Family Practice↗