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Presented are specific parameters of visual information intake in pilots on the job. The role of eye movements in the process of visual stimulus reception is discussed. Our own study on a MIG-23 flight simulator is presented. The method of oculographic testing of pilots performing professional assignments differing in workload is presented, and the practical implications of oculographic research are discussed.
Health care resources in Canada are limited, and there is tremendous pressure to reduce laboratory budgets. It is almost impossible to acquire new pathologist positions to adequately meet service demands. There is a need to determine objectively the appropriate pathologist workload. I looked at multiple indicators (total accessioned cases, number of specimens, slides, blocks, Royal College of Pathologists [London, England] model, population served, and level 4 equivalent [L4E]) that might reflect the pathologist's work and determine which indicators are the best. L4E is a calculated weighted value based on complexity levels of individual anatomic pathology consultation. Of all indicators analyzed, L4E is the best reflection of a pathologist's anatomic pathology work because it has the best statistical values, is a direct output measurement of pathologist consultations, and uses data routinely collected in many North American laboratories.
In 2 experiments, a 12-min computerized vigilance task was demonstrated to reproduce the vigilance decrement, high workload (NASA-TLX), and stressful character (Dundee Stress State Questionnaire) of vigilance tasks lasting 30 min or more. In Experiment 1, the abbreviated task was also shown to duplicate the signal salience effect, a major finding associated with long-duration vigilance tasks. Moreover, Experiment 2 showed that performance on the abbreviated task can be enhanced by caffeine - a drug that benefits long-duration tasks. This enhancement effect was limited to performance, however, suggesting that caffeine influences factors that control signal detection but not those that control task-induced stress. The results parallel those obtained with long-duration tasks and support a resource-depletion model of the vigilance decrement. The abbreviated task might be useful in situations in which long-duration tasks are precluded (e.g., performance assessment batteries, neuropsychological testing, and brain imaging).
Two experiments examined pilots' maneuver choice and visual workload in a free-flight simulation. In Experiment 1, 12 pilots flew a high-fidelity flight simulator with a cockpit display of traffic information and maneuvered to avoid traffic in a simulated free-flight environment. Pilots' choices reflected a preference to make vertical rather than lateral avoidance maneuvers and to climb rather than descend. Pilots avoided both complex maneuvers and airspeed maneuvers. The data were modeled in terms of how pilots traded off factors related to safety, efficiency, mental effort, and prior habits. In Experiment 2, 10 pilots flew the same maneuvers as the pilots in Experiment 1 but followed ATC instructions rather than using the CDTI. The CDTI in Experiment 1 occupied 25% of the pilots' visual attention. A comparison of scanning with Experiment 2 suggested that the CDTI pulled visual attention away from the outside world, but this attention diversion did not leave pilots vulnerable to missing traffic not annunciated on the CDTI. Actual or potential applications of the results include understanding the safety implications of presenting traffic displays in the cockpit, and the impact of pilot maneuver preferences on airspace procedures.
A free-address system is a new office layout in which a worker can freely sit in their favorite place with a computer and materials. Since this layout has recently been introduced in offices, we conducted a questionnaire survey which aimed to clarify the effects of the free-address system on visual display terminals (VDT) workers' posture and workload. A total of 203 male VDT workers who were system engineers aged 20 to 59 using a notebook computer were evaluated, of whom 150 used the free-address layout, and 53 used the fixed-address layout. The free-address layout was effective in the improvement of individual work space compared with the fixed-address layout. Also, in this layout the worker did not feel dissatisfaction with communication or support between workers. However, workers using the free-address layout assumed an unsuitable work posture, without adjusting the height of their chairs. Furthermore, this layout might have risk factors which increase neck/shoulder and low back stiffness and/or pain. Therefore, the free-address layout may have incipient problems, and it will be necessary to examine further the effects of this layout on VDT worker's health.
OBJECTIVES: In order to guarantee safety and health conditions in labor the maximum physical workload that can be supported by a worker during a labor day, without causing fatigue, must be determined. The objective of this study was to determine the relationship between the physical load, expressed as relative heart rate (RHR), and the maximum acceptable work time (MAWT) in a Colombian working population (n = 30) from a tropical environment. METHODS: An observational study was carried out during a typical labor day in the warehouses of a supermarket. Physiological, demographic, health and labor conditions data were collected. The resting heart rate level and the average heart rate during work were measured, and the RHR was estimated according to with the model described by Wu & Wang. RESULTS: Significant correlations between MAWT and RHR and other physiological variables were observed. 43% of workers didn't fulfill the MAWT. The only single variable that was associated with fulfillment was a body mass index under 18.5 Kg/m2; the other associated variables were some specific conditions of the occupational environment. Results showed a negative correlation between physiological variables and MAWT. The RHR showed its potential usefulness in the enterprise's occupational health practice. CONCLUSIONS: It is important for companies to diminish extended schedules and implement physical conditioning programs.
The Faculty of Family Planning and Reproductive Health Care (FFPRHC) has recently published Service Standards for Workload in Contraception, which state that a minimum of 20 minutes should be made available for intrauterine device/hormonal system (IUD/IUS) provision. This document acknowledges that there is currently little formal evidence relating to assessment of time taken for providing various contraceptive methods. The Abacus Clinics in Liverpool, UK provide an average of 1,300 IUD/IUS fittings in a year. We monitored the time taken for IUD/IUS provision over a 4-week period. Our study revealed that the average time taken for all types of IUD/IUS provision is significantly more than the minimum recommended by the FFPRHC.
Continuing pressure on tertiary hospitals to reduce expenses has inevitably meant a demand to reduce nursing staff. This has intensified the need to ensure that staffing allocation is appropriate. A method to calculate staffing needs based measurement of neonatal workload is explored.
OBJECTIVES: This study explored the association between biomarkers of type I collagen metabolism and exposure to physical workload. METHODS: In a prospective cohort study, serum concentrations of markers of type I collagen synthesis and degradation were assessed monthly for student nurses who worked as nurses for a period of 6 months and compared with those of a reference group. The number of patient-handling activities was estimated from observations at the workplace. Linear generalized estimating equations were used to analyze differences in the serum concentrations of the biomarkers between the exposed group and reference group, as well as to analyze whether the number of patient-handling activities was associated with serum concentrations of the biomarkers. RESULTS: Serum concentrations of the biomarkers were found to differ between the groups. The biomarkers reflected a higher anabolism of type I collagen in the exposed group when compared with that of the reference group. An analysis of the effect of the number of patient-handling activities revealed that a higher exposure was associated with higher effective type I collagen synthesis within the exposed group. CONCLUSIONS: These results indicate that serum concentrations of these biomarkers of type I collagen metabolism can reflect differences in exposure between contrasting groups, and also varying levels of exposure between persons within an occupation.
OBJECTIVE: To describe the workload profile in a network of Australian skin cancer clinics. DESIGN AND SETTING: Analysis of billing data for the first 6 months of 2005 in a primary-care skin cancer clinic network, consisting of seven clinics and staffed by 20 doctors, located in the Northern Territory, Queensland and New South Wales. MAIN OUTCOME MEASURES: Consultation to biopsy ratio (CBR); biopsy to treatment ratio (BTR); number of benign naevi excised per melanoma (number needed to treat [NNT]). RESULTS: Of 69 780 billed activities, 34 622 (49.6%) were consultations, 19 358 (27.7%) biopsies, 8055 (11.5%) surgical excisions, 2804 (4.0%) additional surgical repairs, 1613 (2.3%) non-surgical treatments of cancers and 3328 (4.8%) treatments of premalignant or non-malignant lesions. A total of 6438 cancers were treated (116 melanomas by excision, 4709 non-melanoma skin cancers [NMSCs] by excision, and 1613 NMSCs non-surgically); 5251 (65.2%) surgical wounds were repaired by direct suture, 2651 (32.9%) by a flap (of which 44.8% were simple flaps), 42 (0.5%) by wedge excision and 111 (1.4%) by grafts. The CBR was 1.79, the BTR was 3.1 and the NNT was 28.6. CONCLUSIONS: In this network of Australian skin cancer clinics, one in three biopsies identified a skin cancer (BTR, 3.1), and about 29 benign lesions were excised per melanoma (NNT, 28.6). The estimated NNT was similar to that reported previously in general practice. More data are needed on health outcomes, including effectiveness of treatment and surgical repair.
This article discusses the issues surrounding the measurement of nursing work. The authors highlight a Royal College of Nursing (RCN) survey of critical care units which identified the extent of the use of patient scoring systems. The authors also examine the implications of using scoring systems to determine nursing workload and estimate staffing requirements.
The importance of communication on the flightdeck is discussed and the application of a new computer-based linguistic method of text analysis is introduced. Preliminary results from a NASA B727 simulator study indicate that specific language variables are moderately to highly correlated with individual performance, individual error rates, and individual communication ratings. Also, language use was found to vary as a function of crew position and level of workload during the flight. Use of the first person plural (we, our, us) increases over the life of a flightcrew, and Captains speak more in the first person plural than First Officers or Flight Engineers. Language use in initial flights was associated with performance and error in subsequent flights. These are preliminary data, in that this method of linguistic analysis is currently being developed and integrated with a content-coding method of communication analysis and models of threat and error.
A study was conducted to collect work measurement data for pharmacokinetic drug consultation services. A stopwatch was used to measure the time required to perform pharmacokinetic consultations in the Ottawa General Hospital, a 530-bed tertiary care teaching hospital. Ten pharmacists provided 166 drug consults primarily for phenytoin, aminoglycosides, digoxin, and theophylline. The time required to obtain drug level measurements averaged 1.10 minutes. Consults required an average of 8.28 (SD = 4.72) minutes. Initial consults took 10.35 (SD = 5.07) minutes, while repeat consults took 6.62 (SD = 3.67) minutes. The difference was significant (t = 5.48, df = 164, P less than 0.001). No significant differences were found among consults for different drugs nor between primary and secondary patient coverage areas. There was a significant difference in the time required to perform a consult among pharmacists. Consult times were considerably less than those reported by the Canadian Hospital Pharmacy Workload Measurement Study.
The workload performed by three hospital pharmacy residents during typical clinical rotations was quantified then subjected to cost-benefit analysis. Daily activities and interventions were recorded on standardized forms for a four-week period. The cost of a resident to provide direct patient care services was compared to that of a staff pharmacist. In addition, the balance of the residents' salary and partial salaries of any pharmacists spending time with the residents were included in the cost analysis. The interventions were analyzed for their impact on patient care and potential cost avoidance by an external review committee. Collectively, more than 660 hours were recorded. Fifty-two percent of hospital time was spent on education-related activities and 32 percent on the provision of clinical services. Thirty interventions were submitted to a review panel of three physicians. Of the 90 evaluations, 76 percent were considered to have a positive impact on patient care, 22 percent no effect, and two percent a potentially detrimental effect. In one case, reviewers thought that hospitalization could have been prolonged had the intervention not occurred. Cost-benefit analysis yielded a ratio of 1.4 to 1 in favour of the residents. While the major benefit of a residency program is the perceived long-term benefit to the profession and patients, this study suggests that even during their residency year, hospital pharmacy residents provide cost-beneficial clinical services.
A small proportion of patients use a disproportionate amount of general practitioners' (GPs') time. We demonstrate here that such frequent attending behaviour tends to persist through five-year follow-up, suggesting the need for the development of specific management strategies. We also show that, at any rate in one practice, total workload is increasing dramatically, and that frequent consulters make up a large part of the increase.
Workload implications of upper gastrointestinal (UGI) subspecialisation within the district general hospital (DGH) have been assessed by prospective data collection over a 12-month period in a DGH with six general surgeons serving a population of 320,000. The single UGI surgeon (UGIS) performed all ten oesophageal resections, ten of 11 gastric resections for malignancy and all eight pancreatic operations. He also performed 91 of the 182 cholecystectomies, 164 of the 250 endoscopic retrograde cholangiopancreatograms (ERCP) and all endoscopic procedures for the palliation of unresected oesophageal tumours. The UGIS was responsible for the management of all patients with severe pancreatitis, yet he also performed 51 colorectal resections over the 12-month period. Successful management of severely ill patients with upper GI disease requires consultant supervision on a day-to-day basis. If such UGI disease is to be managed in the DGH, two surgeons with UGI experience will be required if high quality care and reasonable working conditions are to be achieved. Such UGIS will continue to perform some colorectal surgery.
A prospective census of patients attending the casualty room of Wicklow District Hospital (a general practitioner operated service) for one year was performed. A total of 1564 attendances were recorded, of which 904 (58%) were male and 953 (61%) were eligible for free medical care. Almost half, 735 (47%) attended outside daytime hours. Concerning type of presentation, 637 (41%) attended with acute trauma, 450 (29%) attended with acute medical and 477 (30%) attended with elective problems. Repeat visits accounted for 5% of the total. Concerning outcome of consultation, 409 (26%) were given a prescription, 307 (20%) had blood tests, 263 (17%) received dressings, 183 (12%) were referred to secondary care, 168 (11%) were followed up by their GP, 146 (9%) had minor surgery, and 86 (5%) had no intervention. This study indicates that the hospital is responsible for a considerable workload, with a significant out of hours component.
OBJECTIVE: Serological screening for Helicobacter pylori (H. pylori) in young (< or = 45 years) dyspeptic patients has been used to avoid oesophago-gastro-duodenoscopy (OGD). We used serology to identify seronegative and seropositive patients without sinister symptoms and combined approaches of avoiding OGD in both groups. We aimed to determine the reduction of OGD in this group. DESIGN: Prospective study on the treatment of 232 patients with dyspepsia. SETTING: Six hundred and fifty bed district general hospital serving rural Northamptonshire, UK. INTERVENTIONS: Two hundred and thirty-two patients referred by local general practitioners for OGD were offered serology. Symptom severity was scored using a questionnaire. One hundred and eleven seronegative patients received symptomatic treatment, 105 seropositive patients received triple therapy for 1 week. Sixteen patients with equivocal results were offered OGD. Patients were followed up after 6 months. MAIN OUTCOME MEASURES: Severity of dyspepsia symptoms and proportion of patients returning for OGD. RESULTS: Fifteen equivocal patients underwent OGD, one refused. Forty-six patients (33 seronegative, 13 seropositive) had persisting symptoms and underwent OGD. Mean symptom severity was reduced significantly in equivocal (P<0.01), seronegative (P<0.001) and seropositive (P<0.001) patients. Fewer seronegative patients were symptom-free at follow up compared to seropositive patients (n = 15 (16%) vs n = 48 (51%); P<0.001), 171 patients avoided OGD, a 74% reduction. CONCLUSIONS: Use of H. pylori serology in the management of young dyspeptic patients without sinister symptoms can reduce the OGD workload by 74%, decreasing the length of time that older patients, who are at greater risk of malignant disease, may have to wait for OGD.