SEARCH · PubMed Health

Results for “Workload”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources

PubMed2005

Can urine dipstick testing for urinary tract infection at point of care reduce laboratory workload?

AIM: The University Hospitals of Leicester NHS Trust microbiology laboratory receives 150 000 urine samples each year, approximately 80% of which prove to be culture negative. The aim of this study was to reduce the proportion of culture negative urines arriving in the laboratory, by producing local evidence based guidelines for the use of urine dipstick testing at point of care within the trust's three acute hospitals. METHODS: One thousand and seventy six unborated urine samples were dipstick tested at the point of care using an automatic strip reader. Quantitative results for the four infection associated markers-leucocyte esterase, nitrite, blood, and protein-were compared with the results of conventional laboratory microscopy and culture. RESULTS: The performance of different marker combinations was calculated against the routine laboratory methods. One hundred and seventy five (16.3%) samples were negative for all four markers. Of these dipstick negative samples, only three (1.7% of all true positives) were positive by culture. The absence of all four infection associated markers was found to have a greater than 98% negative predictive value and a sensitivity and specificity of 98.3% and 19.2%, respectively. CONCLUSIONS: A urinary dipstick testing algorithm for infection associated markers was derived for use in hospital patients to screen out negative urines. Two years after distributing the algorithm and promoting access to reagent strips and strip readers, a reduction in the urine workload has been seen against an otherwise increasing laboratory specimen load.

Algorithms↗

PubMed1992

Implications on laboratory workload of breast cancer screening.

AIMS: To determine whether the recommended methods for the handling of breast excision biopsy specimens from screening patients cause more laboratory work than those used for non-screening patients. METHODS: All breast excision biopsy specimens from 1990 were identified. Ninety one came from patients identified during the prevalent round of breast screening. These were compared with 127 from non-screening patients operated on by the same surgeon. The workload in terms of initial blocks taken, cases which needed extra blocks or other additional work, and the time taken for delivery of slides to the pathologist were assessed. RESULTS: The screening cases required significantly more initial blocks than the non-screening cases (8.03 v 4.95; p = 0.000001). When looking at the malignant diagnoses this difference was maintained (7.74 v 6.02; p = 0.00014). CONCLUSIONS: Excision biopsy specimens from screening patients require more laboratory work per case than those from non-screening patients. The reasons for these differences lie in the nature of the specimens and their subsequent diagnoses, and in the initial indications for biopsy.

Biopsy↗

PubMed1996

The hidden increase in histopathologists' workload.

The informational content of histopathological reports generated between 1985 and 1995 was assessed. This showed an exponential rise over the past five years. It is postulated that this has arisen from developments in medical science and demands from clinical colleagues. This increase in workload is not addressed by present methods of measurement and has major resource implications.

Humans↗

PubMed2002

Workload and stress in consultant medical microbiologists and virologists: a questionnaire survey.

AIMS: To document demography, changing workload patterns, job satisfaction, morale, and prevalence of stress and psychological morbidity among UK consultant medical microbiologists and virologists. METHOD: A questionnaire survey of all identified UK practising consultant medical microbiologists and virologists (n= 464). RESULTS: Among 367 respondents (79%), there were 33 virologists and at least 89 single handed consultants. Over half the respondents (58%) were working a 1 : 1 or 1 : 2 on call rota during the week and a similar proportion (51%) at weekends. Of all consultants (including those working part time), 56% were working more than 48 hours weekly. Working more than 48 hours weekly, and being on call 1 : 1 or 1 : 2 at weekends, were both independently associated with increased psychological morbidity. Those on call 1 : 1 or 1 : 2 at weekends were also more likely to have low or very low morale. Female consultants were more likely to have higher stress scores. More than half of the respondents (208 of 363; 57%) were making active financial provision to retire early, and 198 of 363 (55%) did not intend to work beyond the age of 60. CONCLUSIONS: The long hours worked by many consultant microbiologists and virologists are in breach of the European Working Time Directive and are associated with a higher degree of psychological morbidity. For most consultants, the frequency of on call commitments is demanding and job satisfaction and morale have deteriorated. Urgent action is needed, particularly to support those working more than 48 hours each week and those on call at weekends 1 : 1 or 1 : 2. However, a major expansion of the consultant establishment cannot be achieved rapidly, and will be slowed further if early retirements become more frequent.

Adult↗

PubMed2005

A study of the workload and effectiveness of a comprehensive acute stroke service.

OBJECTIVE: To study the workload of and use of acute intervention within an established acute stroke service, the Calgary Stroke Programme (CSP). METHODS: Prospective record of all acute referrals, diagnoses, and management decisions over a 4 month period. RESULTS: The CSP received 572 referrals (median: 32 per week), 88% of which were made between 7 am and midnight. Of the 427 patients seen in person, 29% had not had an acute stroke or transient ischaemic attack (TIA). Fifty percent of patients with suspected acute stroke were referred within 3 h of symptom onset and 11% with acute ischaemic stroke (equating to 35% of those referred within 3 h of onset and seen in person) were treated with thrombolysis. CONCLUSION: Centralisation of services facilitates the rapid referral of, and use of acute interventions in, patients with acute stroke and TIA. Centralised services are likely to be busy (although less so at night), to attract large numbers of patients with disorders that mimic stroke and TIA, and yet still likely to treat only the minority of acute strokes using thrombolysis. These observations may help those planning similar services and underline the need to develop more widely applicable treatments for acute stroke.

Acute Disease↗

PubMed2004

Surgical workload from an integrated UK field hospital during the 2003 Gulf conflict.

AIMS: This paper reports the surgical experience of a UK reserve field surgical hospital during military operations in Iraq during March and April 2003. Particular reference is given to the integration of the surgical specialities, consultant led and multidisciplinary teamworking in the treatment of military and civilian casualties from all sources and of all causes. METHODS All surgical workload data was collected prospectively for the warfighting (Phase One) and specialist referral (Phase Two) phases of the operation. Standard military and Red Cross protocols were used for all injuries and microbiology studies were undertaken for penetrating ballistic injuries. Operations were classified by anatomical region; upper or lower limb; head and neck; thoracic; abdominal, including genitourinary; ophthalmic; and burns, and by whether they were primary; secondary planned or secondary unplanned. RESULTS: A wide range of patterns of wounding arising from combat and non-combat related military and civilian trauma and burns were seen and treated. 323 operations were performed. There were 116 operations in phase one and 207 operations in phase two. There were 160 primary procedures (new patients), 146 secondary planned and 17 unplanned procedures (range one to eight procedures per patient). Close integration of general, orthopaedic, plastic, maxillofacial, ophthalmic and neurological surgeons and general and ITU anaesthetists allowed the delivery of a range of specialist treatment to a heterogenous patient population, including children as young as 6 months and a lady in the advanced stages of pregnancy. CONCLUSIONS: Patterns of wounding in casualties surviving to reach specialist field hospital care were similar to those reported in other high intensity conflicts. A consultant led, multidisciplinary approach with field intensive care facilities allowed combined, staged and safe surgery for complex, multi-organ and multi-limb trauma in an austere environment.

Child↗

PubMed2004

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003.

BACKGROUND: During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle-injured extremities. METHOD: A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. RESULTS: Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle-injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). CONCLUSION: The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.

Abdominal Injuries↗

PubMed2005

Gender differences in the association of age with physical workload and functioning.

AIMS: To test whether (1) physically demanding work is less frequent for older than younger employees, and whether (2) the association of physically demanding work with decline of physical functioning is stronger for older employees than their younger counterparts. The gender differences in these associations were examined. METHODS: Subjects of the study were 40-60 year old employees of the City of Helsinki. Data (n = 5802) were collected with mail questionnaires in 2000 and 2001. Functioning was measured with the Role Limitations due to Physical Health Problems scale of the SF36 health questionnaire. Logistic regression models were used to analyse the data. RESULTS: There was a linear trend of less physically demanding work in older than in younger age groups. This trend was more marked for men than women. Age and physically demanding work were associated with poor functioning. In women the association of physically demanding work with poor functioning tended to be stronger for older than for younger age groups, while the opposite was observed in men. CONCLUSIONS: Results suggest that physically demanding work causes more ailments in women of high age than men. It is possible that less men than women are still employed in physically demanding occupations at high age, even though direct evidence of exit from physically demanding work cannot be obtained from cross-sectional data. In these data the physically demanding occupations for men and women were largely different. High physical workload among women working in social and health care is likely to contribute to the gender differences.

Activities of Daily Living↗

PubMed2000

Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses.

OBJECTIVES: To investigate the prevalence of neck, shoulder, and arm pain (NSAP) as well as low back pain (LBP) among hospital nurses, and to examine the association of work tasks and self estimated risk factors with NSAP and LBP. METHODS: A cross sectional study was carried out in a national university hospital in Japan. Full time registered nurses in the wards (n = 314) were selected for analysis. The questionnaire was composed of items on demographic conditions, severity of workloads in actual tasks, self estimated risk factors for fatigue, and musculoskeletal pain in the previous month. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were calculated by the Cox's proportional hazards model to study the association of pain with variables related to work and demographic conditions. RESULTS: The prevalences of low back, shoulder, neck, and arm pain in the previous month were 54.7%, 42.8%, 31.3%, and 18.6%, respectively. The prevalence of musculoskeletal symptoms among hospital nurses was higher than in previous studies. In the Cox's models for LBP and NSAP, there were no significant associations between musculoskeletal pain and the items related to work and demographic conditions. The RRs for LBP tended to be relatively higher for "accepting emergency patients" and some actual tasks. Some items of self estimated risk factors for fatigue tended to have relatively higher RRs for LBP and NSAP. CONCLUSIONS: It was suggested that musculoskeletal pain among hospital nurses may have associations with some actual tasks and items related to work postures, work control, and work organisation. Further studies, however, are necessary, as clear evidence of this potential association was not shown in the study.

Adult↗

PubMed2003

Effects of measurement strategy and statistical analysis on dose-response relations between physical workload and low back pain.

BACKGROUND: In epidemiological studies on physical workloads and back complaints, among the important features in modelling dose-response relations are the measurement strategy of the exposure and the nature of the dose-response relation that is assumed. AIM: To evaluate the effect of these two features on the strength of the dose-response relation between physical load and severe low back pain. METHODS: The study population consisted of 769 workers in nursing homes and homes for the elderly. Observations at the workplace were made of 212 subjects. These observations were analysed to determine exposure to physical load according to two measurement strategies: the individual approach and the group approach. The nature of the dose-response relation was evaluated with nested logistic regression models. RESULTS: The group approach resulted in higher odds ratios for the associations between physical load and low back pain than the individual approach. Spline logistic regression models appeared to describe the dose-response relation between physical load and low back pain best. The corresponding curve showed small changes in risk for small changes in exposure, whereas the categorical model only showed sudden large changes in risk at predefined exposure values. CONCLUSION: The choice for a particular measurement strategy of physical load influences the strength of the associations between physical load and severe low back pain. Spline models allow changes in risk over the whole exposure range and are therefore a promising approach to identify quantitative dose-response patterns between physical load and low back pain.

Health Surveys↗

PubMed1994

Possible role of Helicobacter pylori serology in reducing endoscopy workload.

We validated a commercial enzyme-linked immunosorbent assay (ELISA), Helico-G, in diagnosing H. pylori in 129 patients (mean age 50 years, range 15-86). We analysed the results of endoscopy against serology to see whether there was a possibility of adopting the strategy of not endoscoping dyspeptic subjects under the age of 45. H. pylori infection was considered present if either histology and/or culture were positive. The ELISA had a sensitivity of 88%, specificity of 72%, positive predictive value of 85%, negative predictive value of 77% and accuracy of 82% in detecting H. pylori. In a subgroup of 52 subjects aged 45 or less (mean age 35 years, range 15-45), 17 out of 25 patients with positive endoscopic findings were H. pylori seropositive while 16 out of 27 patients had normal endoscopic findings. Eighteen out of the 52 patients (35%) were H. pylori seronegative and normal endoscopically except for five patients (10%) who had mild to moderate oesophagitis and two who had non-erosive gastritis (4%). All patients with duodenal ulcer disease (7) were seropositive giving predictive values of positive and negative serology for a diagnosis of duodenal ulcer disease as 28% and 100%, respectively. Therefore adopting a strategy of endoscoping subjects under the age of 45 only if they were H. pylori seropositive would have saved 35% of endoscopies in this age group but missed oesophagitis in 10%. Negative serology would tend to exclude duodenal ulcer disease while positive serology discriminates poorly for it. Serology may be a useful adjunct in screening to reduce endoscopy workload provided that patients with gastro-oesophageal reflux symptoms are excluded.

Aged↗

PubMed1998

A staffing model based on workload in three VA mental health clinics.

In the era of managed care, agencies that provide mental health care can cope with the increasing volume of patients and the increasing severity of their conditions by having a variety of mental health professionals provide services. A model for determining workforce needs for outpatient mental health clinics is described. The model was used with workload data from three Veterans Affairs clinics to determine that two psychiatrists and five or six nonpsychiatrists should be able to evaluate 400 new patients a year and provide ongoing care for 2,300 patients a year in such settings. The method can be adapted to determine workforce needs for other outpatient clinical settings.

California↗

PubMed1999

Setting benchmarks and determining psychiatric workloads in community mental health programs.

Administrators and clinicians must find ways to effectively and efficiently use psychiatric resources without compromising the quality of care. The author outlines a model for setting benchmarks for allocating psychiatrists' time in a community mental health service setting. After the percentage of time for direct-care activities is agreed on (for example, 60 percent), the amounts of time necessary for three direct-care clinical activities-assessment of new patients, follow-up of stable patients, and follow-up of unstable patients and emergencies--are established. Time for documentation should be included in each task. At the end of six months, workloads are evaluated, and benchmarks are reset as appropriate.

Benchmarking↗

PubMed2001

Consultants workload due to alcohol related conditions in acute medical receiving gastroenterology and endocrinology.

A four-week survey was performed into the incidence of alcohol related problems in the acute medical receiving unit, and the prevalence of alcohol related cases in a ward shared between two gastroenterologists and an endocrinologist. Alcohol related conditions were the commonest reason for acute admission (19%). Gastroenterologists, in contrast to their colleagues have a substantial workload related to alcohol, especially chronic liver disease. These patients have longer lengths of stay with higher morbidity and mortality than those without alcohol related conditions. The reason for these differences and the implications for service planning are discussed.

Acute Disease↗

PubMed1993

Measuring hospital workload in general medicine.

The study described here used routine data sources to consider three aspects of hospital workload-volume and case-mix of inpatients; volume of outpatients; and volume of procedures.

Age Distribution↗

PubMed1995

Workload in trauma and orthopaedic surgery: use of linked statistics to profile a specialty.

We have used linked hospital morbidity statistics to construct a basic profile of the demographic and epidemiological features of trauma and orthopaedic surgery in a defined population. This paper reports on this profile and illustrates trends in the specialty between 1976-86. During this period episode-based inpatient admission rates rose by about 20%. Multiple admissions per person varied with age but did not increase over time. Thus the increase in admission rates in this specialty represented an increase in numbers of people who received treatment. Average length of stay per episode of inpatient care and the total time spent in hospital per person declined over time. New outpatient attendance rates increased by 19% in the 11-year period. The ratio of follow-up outpatient appointments to new appointments fell from 2.68:1 to 2.24:1; the number of inpatient beds fell by about 13% and bed occupancy remained stable at about 80%. We describe some of the major components of clinical workload in the specialty, with emphasis on conditions for which admission rates changed over time, relating the data to numbers of people treated as well as to episodes of care.

Adolescent↗

PubMedDate not supplied

Increasing workload of an HIV/AIDS counselling service in a London teaching hospital, 1990-91.

The number of new patients referred to the HIV/AIDS Counselling Unit at the Royal Free Hospital, London, increased from 926 in 1989-90 to 1450 in 1990-91. Follow-up contacts nearly doubled during the same period of time. Growing demand for HIV testing as well as the shift to the treatment of HIV as a chronic condition increased the workload of the HIV/AIDS counsellors.

AIDS Serodiagnosis↗

PubMed1996

Predicting activity and workload in general practice from the demographic structure of the practice population.

OBJECTIVES: The managerial requirements of budget-setting and performance monitoring in general practice (primary care) in the UK require an understanding of the causal relationship between practice activities and the characteristics of both the practice and its patients. This study sought to model the determinants of three major components of general practice activities (consultations, prescribing costs and referrals to secondary care), paying particular attention to the influence of the demographic structure of the patient list. METHODS: Stepwise regression analysis was carried out on data for 98 practices in the county of Lincolnshire using 12 independent variables pertaining to patient and practice characteristics plus 14 statistical measures derived from the demographic structure of the patients registered with the practice. RESULTS: Robust statistical models were estimated for the three dependent variables, of which list size emerged as the most significant independent variable. In addition, six other independent variables, including the patients' unemployment rate, fundholding status and single-handed status, were statistically significant in one or more of the equations. Variables based on the demographic structure of the practice population also appeared in each model. The Jarman score and degree of urbanization did not achieve statistical significance. CONCLUSIONS: Activity and workload in general practice can be predicted from routine data. Such models are of particular value for planning and financial management when demographic change in practice populations is anticipated.

Budgets↗