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PubMed1977

Subjective stress assessment: a new, simple method to determine pilot workload.

Charged with the preparation of an expert opinion concerning psychophysical workload on pilots, the Aviation Psychology Branch of the GAF/IAM studied the "Subjective Stress Assessment" in which 217 Army, Air Force and Navy pilots filled in a standardized questionnaire. This questionnaire included 170 items to force the pilots into rating their on- and off-duty life; the answers of these people (117 jet, 41 multiple-prop, 14 single-engine, and 45 helicopter pilots) were evaluated quantitatively and qualitatively. It may be said--with all reservations towards subjectivity of pilots' opinions---that the pilots' image certainly requires some corrections, in particular as it relates to the ideal and material assessment of the activities of the separate groups of jet, helicopter, and prop pilots. It was the purpose of the study to show that the evaluation of pilots' workload by means of subjective interviews is a valuable method, aside from the assessment of difficulty of tasks by experts, aside from registration and evaluation of certain physiological parameters, and aside from the application of the Second-Task-Method-Registration.

Aerospace Medicine↗

PubMed2000

Part-time physicians. Physician workload and patient-based assessments of primary care performance.

OBJECTIVE: To examine the relationship between the number of hours physicians work and patients' assessment of the physician. DESIGN: Cross-sectional study with physician and patient surveys. SETTING: Primary care practices in Massachusetts. PARTICIPANTS: A random sample of 6810 Massachusetts state employees in 15 different health plans. MAIN OUTCOME MEASURES: Eleven summary scales measuring 7 essential elements of primary care. Information was derived from the Primary Care Assessment Survey, a validated patient-completed questionnaire. RESULTS: Physicians were classified into 3 groups according to their reported hours of work: "overtime" (> 65 h/wk), "full time" (40-65 h/wk), and "part time" (< 40 h/wk). There was no statistically significant difference between the 3 groups of physicians in 10 of the 11 measures of primary care performance. Physicians who worked more than 65 hours per week were found to score significantly higher in the visit-based continuity of care category than physicians working fewer hours. Physicians working more than 65 hours per week were also found to be significantly less satisfied with the amount of time they had for family and personal life than the other 2 groups. CONCLUSIONS: Part-time physicians perform as well as full-time physicians in most aspects of primary care, including all interpersonal aspects of care, as reported by patients. Patients of physicians working more than 65 hours per week experienced higher levels of visit-based continuity of care than patients of physicians working fewer hours, but this appears to carry a cost to those physicians in the area of personal and professional satisfaction. Subsequent research should examine the relationship between physician workload and technical aspects of care.

Adult↗

PubMed2004

Physical workload, ergonomic problems, and incidence of low back injury: a 7.5-year prospective study of San Francisco transit operators.

BACKGROUND: The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. METHODS: Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. RESULTS: An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-6.14) or reporting more ergonomic problems at baseline (HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. CONCLUSIONS: Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors.

Adult↗

PubMedDate not supplied

The revision of a workload measurement tool to reflect the nursing needs of patients with traumatic brain injury.

Rehabilitation for persons with head injuries is a multifaceted process that requires structure, consistency, and predictability. This article discusses the process followed by nurses on one rehabilitation unit to revise a standard nursing workload measurement tool to reflect the physical, cognitive, behavioral, and psychosocial needs of patients with traumatic brain injury (TBI). Family education and support, a critical component of care, was also addressed. The flexibility of the tool, known as GRASP, allowed the incorporation of neurobehavioral items based on the Rancho Los Amigos cognitive functioning scale and the inclusion of important therapeutic nursing interventions. The revised tool reflects the time required to deliver comprehensive nursing care to TBI patients and, thus, promotes the desired rehabilitation outcomes for patients and their families.

Brain Injuries↗

PubMedDate not supplied

A collaborative assessment of workload and patient care needs in four rehabilitation facilities.

This article describes the process used by nurse executives at four freestanding rehabilitation facilities to implement and validate an interactive patient classification system. The research process involved defining critical indicators, measuring workloads by level of staff, and validating the number of care hours for the levels of patient classification. The database enabled the four consortium members to share their knowledge, resources, and costs of implementing a patient classification system, and it provides a benchmark of rehabilitation services. The study data are being used in making staffing decisions, preparing and defending budgets, and identifying the cost of care by disability classification.

Attitude of Health Personnel↗

PubMed1992

Peripheral blood stem cell transplantation: impact on procedure load and workload in an apheresis unit.

Peripheral blood stem cells (PBSC) reinfusion appears to hasten hematologic reconstitution following myeloablative therapy. While procurement of PBSC adds apheresis procedures, rapid engraftment could decrease the demand for platelet transfusions. To determine the impact of PBSC collection on workload in our apheresis unit, we studied 3 consecutive groups of patients with metastatic breast cancer given comparable high-dose chemotherapy and autologous bone marrow transplant, with or without PBSC or granulocyte-colony stimulating factor (G-CSF). Forty-one transplants were performed with bone marrow cells only: 31 patients (Group A) did not receive G-CSF, while the following 10 patients (group B) received daily G-CSF until neutrophil engraftment. Bone marrow cells and PBSC were used for the most recent 11 transplants (group C), followed by daily G-CSF until engraftment. PBSC were mobilized with cyclophosphamide (4 g/m2) and etoposide (1 g/m2), followed by G-CSF, 8 micrograms/kg/day. PBSC collection was carried out on a Fenwal CS3000+ cell collector, using modified procedure 1, to obtain a minimum of 5 x 10(8) mononuclear cells/kg. The times to neutrophil count over 500/microL, platelet count over 20,000/microL, and discharge from the hospital after transplant were significantly shorter for patients in group C (medians of 8, 8, and 21 days, respectively) compared to group A (medians of 14, 14, and 29 days; P = 0.001) or group B (medians of 11, 24, and 32 days; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Preliminary results on nursing workload in a dedicated weaning center.

OBJECTIVE: To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center (WC) and to examine the correlation of the nursing time with nursing workload (NW) scores and with clinical severity and dependency. SETTING: Four-bed WC of a pulmonary rehabilitation department. INTERVENTION: None. DESIGN AND MEASUREMENT: Prospective, observational study of 46 consecutive patients admitted to a long-term WC. Time required by items of the Time Oriented Score System (TOSS) and other tasks specific to respiratory intermediate intensive care units were evaluated for all the activities performed on each patient in the first 2 days after admission. Patient dependency and level of nursing care at admission were measured using the Dependence Nursing Scale (DNS) and the Intermediate Therapeutic Intervention Score System (TISS-int). The Acute Physiology and Chronic Health Evaluation (APACHE) II score was also recorded at admission. RESULTS: On the first day each patient needed 45 +/- 15% (63 +/- 23%, 45 +/- 22%, and 29 +/- 14% for the three nursing shifts) of allocated single nursing time. On the TOSS on the first day patients required a daily mean 28 +/- 10% of total available nursing time; on the second day the results did not change. Time of care in the first 24 h was only weakly related to DNS, APACHE II score, and TISS-int; only DNS was able (although weakly; r = 0.45) to predict minutes of nursing care. CONCLUSIONS: In difficult-to-wean patients from mechanical ventilation the nursing time in the first 2 days after admission is high. The use of TOSS may underestimate NW by about 38%. Although only DNS showed the ability to predict minutes of care, the weak relationship limits its value in clinical practice.

Aged↗

PubMed2001

The effect of laparoscopic instrument working angle on surgeons' upper extremity workload.

BACKGROUND: Laparoscopic surgery may be kinder to the patient, but it is more demanding on the surgeon. Fixed trocar positions often require the surgeon to work with instruments at awkward angles to their body. We studied the effect of horizontal and vertical laparoscopic instrument working angle on the surgeon's thumb, forearm, and shoulder muscle work. METHODS: Electronyographic (EMG) signals were collected from the thenar compartment (TH), flexor digitorum superficialis (FDS), and deltoid (DEL) muscles of the dominant arm of eighth surgeons while they were closing a standard pistol-grip disposable laparoscopic grasper against a fixed resistance of 3 N. With the aid of a special testing bench, the instruments' position was randomly changed among 15 degrees, 45 degrees, and 75 degrees of horizontal angulation relative to the surgeons' sagital plane, and 15 degrees, 45 degrees, and 75 degrees degrees of vertical angulation relative to a horizontal plane. EMG signals were rectified and smoothed using analogue circuitry and digitally sampled at l0 Hz using a National Instruments DAQCard-700 connected to a Macintosh PowerBook 5300c running LabVIEW software. Statistical analysis was carried out by analysis of variance (ANOVA). RESULTS: The effects of vertical and horizontal working angles on the muscle effort were as follows: TH (horizontal, N.S.; vertical, N.S.), FDS (horizontal, p 45 degrees to the surgeon's sagital plane significantly increases the workload of the flexor digitorium superficialis and deltoid muscles. The deltoid muscle is also adversely affected by vertical angulation of the instrument. The instrument working angle has no effect on the thenar muscles. Whenever possible, laparoscopic surgeons should strive to place their instruments and trocars so as to minimize extreme horizontal or vertical displacement of their hands away from a resting position of comfort.

Arm↗

PubMed1994

Translocation of two glucose transporters in heart: effects of rotenone, uncouplers, workload, palmitate, insulin and anoxia.

Our previous studies on the acute regulation of glucose transport in perfused rat hearts were extended to explore further the mechanism of regulation by anoxia; to test the effects of palmitate, a transport inhibitor; and to compare the translocation of two glucose transporter isoforms (GLUT1 and GLUT4). Following heart perfusions under various conditions, glucose transporters in intracellular membranes were quantitated by reconstitution of transport activity and by Western blotting. Rotenone stimulated glucose uptake and decreased the intracellular contents of glucose transporters. This indicates that it activates glucose transport via net outward translocation, similarly to anoxia. However, two uncouplers of oxidative phosphorylation produced little or no effect. Increased workload (which stimulates glucose transport) reduced the intracellular contents of transporters, while palmitate increased the contents, indicating that these factors cause net translocation from or to the intracellular pool, respectively. Relative changes in GLUT1 were similar to those in GLUT4 for most factors tested. A plot of changes in total intracellular transporter content vs. changes in glucose uptake was roughly linear, with a slope of -0.18. This indicates that translocation accounts for most of the changes in glucose transport, and the basal pool of intracellular transporters is five times as large as the plasma membrane pool.

Animals↗

PubMed1992

Workload in oral and maxillofacial surgery: analysis of time trends from linked statistics in a defined population.

Data from the Oxford Region were used to study trends in hospital admission rates and demographic profiles of hospital care in the National Health Service in oral and maxillofacial surgery. In a defined population of 1.9 million people, admission rates for inpatient care, day case care, and outpatient attendance rates all almost doubled between 1975-1985. Population-based age-specific admission rates were much higher in teenagers and young adults than in other age-groups. In these age-groups admission rates for females were about double those for males. Whilst perhaps not surprising to the oral and maxillofacial surgeon, these demographic profiles of workload are strikingly different from those found in most other hospital specialties.

Adolescent↗

PubMed2005

Physiological workload evaluation of carrying soft drink beverage boxes on the back.

Soft drink manufacturing has become one of the largest food industries in Korea, now competing in a 2.5-billion dollar market, with more than 20,000 people employed. Deliveries of a broad line of soft drink products involve the use of a hand truck and, in many cases, a backpack mode of carriage. Workers usually prefer the backpack mode, because they feel safer by carrying beverage boxes on the back on stairs. In this study, the physiological workload involved in backpack-mode carrying was investigated, especially focusing on the effects of load weight and stairway transport. To measure heart rate and oxygen uptake while carrying on the back, a laboratory experiment was conducted and safety guidelines for such tasks were proposed, based on the experimental results. Eight healthy male subjects performed backpack-mode carrying, weight between 40 and 60 kg: (1) on level ground, (2) upstairs and (3) downstairs. The results showed that stairways involved an increased physiological burden, and that a load of 60 kg entailed a significantly higher physiological cost than carrying a load of 40 kg. Although backpack-mode carrying has some biomechanical advantages, the worker should be advised to carry a load of less than 40 kg, to avoid a high physiological load. During backpack-mode carrying, it is also recommended that a delivery person makes more trips with a light load rather than fewer trips with a heavier load per trip.

Adult↗

PubMed2004

Secretory immunoglobulin A reactivity to acute and cumulative acute multi-tasking stress: relationships between reactivity and perceived workload.

The effects of an acute stressor upon secretory immunoglobulin A (S-IgA) were assessed using a task that requires participants to attend and respond to several stimuli simultaneously and is therefore analogous to a variety of working environments. In two studies, the task was administered for periods of 5 min to healthy samples of men and women at two sessions 24 h apart (n = 49) and three times in succession within one session (n = 20). Multi-tasking stress was, at all sessions, associated with increases in S-IgA secretion. Inter and intra-session reliability of pre and post-stress S-IgA measures was observed, although the reliability of stress reactivity data was reduced. Classification of participants as either high or low S-IgA reactors revealed differences in their perceptions of task workload. Low S-IgA reactors consistently perceived the task to be more demanding and frustrating than did those who demonstrated high S-IgA reactivity. We conclude that S-IgA reactivity to stressful situations depends not just upon the task, but also upon individual perceptions of the stressor.

Acute Disease↗

PubMed2006

Diagnostic and interventional radiology workload in acute pancreatitis in an ITU/HDU setting.

AIM: To determine the impact on diagnostic and interventional radiology services when imaging patients with severe pancreatitis on intensive therapy (ITU) and high-dependency units (HDU) in a tertiary referral centre. MATERIAL AND METHODS: One hundred and sixty-nine patients admitted to ITU/HDU over a 9-year period (1996-2004) with severe acute pancreatitis were reviewed. There were 109 admissions to the ITU with length of stay of 0.2-81.6 days (mean 19.7 days) and 92 admissions to the HDU with length of stay of 0.4-12.8 days (mean 4.9 days). RESULTS: One hundred and seventy-nine computed tomography (CT) and 199 ultrasound (US) examinations were performed on the ITU patients in whom interventional procedures were required in 24% of patients undergoing CT examinations and in 32% of patients undergoing US. Sixty-two CT and 60 US examinations were performed in the HDU patients. The percentage of interventional procedures performed in HDU patients was similar to that in ITU patients, i.e., 18% CT-guided and 35% US-guided. The proportion of patients that underwent investigations and interventions has gradually increased over the period of the study. Inpatient mortalities were 29% and 5.4%, respectively, in ITU and HDU patients. CONCLUSIONS: This study demonstrates the huge input and increasing workload undertaken by radiologists when managing patients with severe acute pancreatitis in an ITU/HDU setting. We believe this is partly due to the implementation of the British Society of Gastroenterology (BSG) guidelines on management of acute pancreatitis and partly due to the more intensive non-surgical management offered to patients being referred into a specialist tertiary referral unit.

Acute Disease↗

PubMed2005

Impact of referral for gastro-oesophageal reflux disease on the workload of an academic Gastroenterology Unit.

BACKGROUND: Gastro-oesophageal reflux disease is known to be a frequent cause of patients' referral to hospital gastroenterologists. AIM: To increase knowledge on referral for reflux disease, in an Italian academic setting. PATIENTS AND METHODS: The impact of gastro-oesophageal reflux disease on 1 year's workload, comprising upper endoscopy, outpatients' consultations in the general clinic, oesophageal pH monitoring and oesophageal manometry was retrospectively assessed. Appropriateness of oesophageal pH monitoring and oesophageal manometry was also evaluated. RESULTS: Endoscopy: Out of 2269 upper endoscopies reflux symptoms comprised 16.9% (n=386) of referrals; 19.1% only of these 386 patients had erosive oesophagitis at endoscopy and none had oesophagogastric malignancies (68% of the patients were >45 years). Consultations: Thirty-three percent out of 553 patients were referred for reflux symptoms. Upper endoscopy had already been performed before consultation in 64% of them. pH monitoring and oesophageal manometry: Two hundred and sixteen oesophageal pH monitorings and 160 oesophageal manometries were performed and 29% and 28%, respectively, were inappropriate, being performed in the diagnostic work-up of patients with typical reflux symptoms. CONCLUSIONS: At an academic Gastroenterology Unit, (a) gastro-oesophageal reflux disease is a frequent referral for upper endoscopy and consultations, (b) prevalence of oesophagitis is low, (c) consultation is preceded by endoscopy in the majority of patients and (d) oesophageal pH monitoring and oesophageal manometry are often inappropriately used.

Academic Medical Centers↗

PubMed2004

Moving on from 'patient dependency' and 'nursing workload' to managing risk in critical care.

The contribution nurses make to the management of critically ill patients is usually appraised through the use of concepts such as 'patient dependency' or 'nursing workload'. These concepts fail to address the knowledge, skills and experience of nurses and consequently fail to acknowledge the risk presented by critically ill patients. This paper describes the development of a tool that attempts to measure risk and the process of risk management undertaken by nurses who coordinate the shifts and lead the nursing team. The results of this pilot study indicated that the tool was valid, but reliability has not yet been demonstrated. Thus the tool requires further refinement and testing. We chose to publish at this time because we feel the paper offers a new way of examining the contribution of nurses working in critical care.

Activities of Daily Living↗

PubMed2005

"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.

BACKGROUND: Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia. METHODS: Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (n=30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625% + sufentanil 0.35 microg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout. RESULTS: In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%. CONCLUSIONS: These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.

Adult↗

PubMed2006

Orthopaedic trauma workload in the former homeland of the Transkei, South Africa.

The Bedford Orthopaedic Centre is situated in Umtata at the heart of the former homeland of the Transkei in the Eastern Cape of South Africa. It acts as an orthopaedic and trauma referral hospital for a mainly rural population approaching 4 million. This article focuses on the workload of the hospital over a 4-month period and like many hospitals in South Africa we highlight the difficulties it faces with the trauma epidemic.

Accidents, Traffic↗

PubMed1998

An assessment of workload in the Thai steel industry.

In this study three different types of industrial activities in a steel plant have been studied in Thailand. Workload has been described and assessed by means of an ergonomics approach, encompassing task, organisation and environment as well as the physiological reactions and the subjective appreciation of the exposed workforce. The results are evaluated by means of the ISO Standard on Heat Stress (WBGT-Index) and by the cardiovascular load. Strain results reveal important basic physiological differences between Thai workers and Western data. The use of the ISO-Standard for the studied activities in Thailand is questioned and a proposal for adaptation of the WBGT-Index is formulated. Before implementing the proposals the results should be confirmed by a larger sample of workers and for other less demanding work.

Adult↗