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PubMed1996

Alcohol and workload as factors affecting the detection of angular acceleration.

INTRODUCTION: Previous findings have demonstrated that a low blood alcohol concentration (BAC) decreases subjects' ability to detect changes in angular motion and that this effect persists after the BAC returns to zero. METHODS: Angular motion thresholds of six alcohol and six placebo subjects holding pilots' certificates were obtained under both low and high task load conditions. The alcohol subjects were tested under double blind conditions in an enclosed simulator apparatus prior to drinking, after drinking (mean BAC = 0.038%), and at a time when the alcohol subjects' BACs had reached zero. RESULTS: Alcohol subjects' mean threshold values for the three threshold test sessions were 0.361, 0.512, and 0.465 degree.s-2 and 0.292, 0.422, and 0.379 degree.s-2 for the high and low task conditions, respectively. Corresponding values for placebo subjects were 0.364, 0.37, and 0.356 degree.s-2 for the high task load condition and 0.311, 0.317, and 0.312 degree.s-2 for the low task load condition. Statistical analyses showed significant task load and sessions effects (p < 0.025). Significant alcohol by test sessions interactions were found for both high and low task load conditions (p < 0.01) with subsequent t-tests showing no alcohol-placebo differences for the pre-alcohol test session, but significant alcohol-placebo differences for the alcohol test session and the test session conducted after the subjects' BACs returned to zero. CONCLUSIONS: The results indicate that the increased threshold for detecting changes in angular motion found after alcohol ingestion is relatively insensitive to task workload and, thus, it is unlikely that attentional changes underlie the threshold increase. These data together with the finding that an elevated threshold can persist after BAC reaches zero suggest that the threshold increase after alcohol ingestion reflects changes in vestibular functioning.

Acceleration↗

PubMedDate not supplied

Validity and reliability of nursing workload measurement systems: strategies for nursing administrators.

In Part One, an overview of the theory related to validity and reliability of workload measurement systems (WMSs) was reviewed. In this article, the MEDICUS WMS is used to provide a concrete example of the type of comprehensive validity and reliability programs that can be established, in an inpatient setting, on the basis of this theory. Practical strategies for monitoring validity and reliability are identified. Administrators can adapt the approaches specified to fit the methodology underpinning other WMSs.

Humans↗

PubMed1996

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago hospital was done. It was found that of these 119 (36.1%) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was commoner in the age group 13-45 years compared to the age group 46-85 years. The older age group, 46-85 years, had a significantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process.

Adolescent↗

PubMed1998

A pilot study exploring the effect of discharging cancer survivors from hospital follow-up on the workload of general practitioners.

BACKGROUND: The tradition of routine, long-term follow-up of cancer patients in the outpatient clinic has led to busy clinics and long waiting times. Many cancer patients are anxious and have become dependent on the specialist clinic for reassurance. General practitioners (GPs) have been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonstrated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased demand on GP practices. AIM: To determine the consequences for GPs of discharging long-term cancer patients from a hospital outpatient follow-up clinic. METHOD: A consecutive sample of 65 patients under annual review in a hospital oncology clinic were offered a planned discharge in which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depression rates were assessed using the Hospital Anxiety and Depression Scale (HADS) at the time of discharge and four months later at a home interview. The GPs of all patients who were discharged were sent questionnaires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity. RESULTS: The results showed no significant increase in the consultation rates during the 12 months after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depression. GPs thought there was a need for more specialist Macmillan nurses working in the community and highlighted the importance of fast-track specialist referral. CONCLUSION: Discharging this group of long-term cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the community suggests that primary care services may find it difficult to cope adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training requirements of GPs in the routine follow-up of cancer patients.

England↗

PubMed1998

Nurse triage for house call requests in a Tyneside general practice: patients' views and effect on doctor workload.

BACKGROUND: Demand for consultations in primary care has risen recently, necessitating a change in working practices. As part of this process, the possible contribution of practice nurses in the telephone assessment of home visit requests merits attention. AIMS: To survey the views of our patients encountering our nurse triage system for home visit requests, set up in June 1995, and to plot its effect on the routine visiting workload of our doctors and thus their availability at the surgery. METHOD: The outcome of each request was categorized as: doctor to visit (DV), surgery consultation with doctor (SC), nurse advice given and accepted (NA), or call passed to doctor for advice (DA). Frequency data from September 1995 to December 1996 were recovered. Questionnaires for self-completion were sent to all those requesting a routine weekday house call during two four-week periods in 1995 and 1996. RESULTS: Analysable activity data revealed 1764 house call requests, with 41% DV, 18% SC, 24% NA, and 8% DA. In the first survey, 121 questionnaires were sent out and 84 returned (69% response rate) and, in the second, the corresponding figures were 113, 85, and 75%. About 80% of responders reported that they were satisfied with the help received from the nurse. CONCLUSIONS: Nurse triage of house call requests has led to more efficient care for our patients, as we have increased the availability of surgery consultations by reducing the number of house calls made by our general practitioners.

Family Practice↗

PubMed1998

Workload implications of community psychiatric nurse employment by a general practice: a pilot study.

This study examines the impact of the employment of a community psychiatric nurse (CPN), dedicated to the care of patients with chronic mental illness, on general practice workload. Although the consultation rate with general practitioners for mental health reasons was significantly lower after CPN intervention, no differences were found in the total consultation rate.

Community Mental Health Services↗

PubMed1998

[How much is the workload of surgeons in Scandinavia?].

According to figures presented at the Bianniul General Meeting of the Scandinavian Surgical Society, the mean number of operations performed per surgeon at some clinics of different sizes in Denmark, Finland, Iceland, Norway and Sweden ranged from 90 to 240 in 1996. This corresponds to 2.6 to 8.5 hours actual operating time, though figures are misleading since time spent assisting at operations, or on endoscopies, minor diagnostics and outpatient procedures, and essential pre- and post-operative tasks is not included. This level of operative activity is considered barely sufficient for training surgeons or for maintaining surgical skills. Surgeons could devote more time to surgery if a greater proportion of their non-surgical workload was taken over by other hospital staff, which would also reduce the number of surgeons required.

General Surgery↗

PubMed1997

Protein synthesis under conditions of anoxia and changing workload in ventricle strips from turtle heart.

An earlier study determined that protein synthesis in isolated perfused turtle (Trachemys [= Pseudemys] scripta elegans) hearts was three-fold lower under conditions of anoxia than under conditions of normoxia. However, the earlier study did not attempt to define the role of work in the isolated perfused preparation. In this study, the effects of varying workload, as defined by changing frequency of contraction, and anoxia on protein synthesis were examined. The ventricle strip preparation allows for comparison of multiple strips from a single heart, which aids in eliminating the variability found between individuals chosen from wild populations. Ventricle strips forced to contract at 24 contractions.min-1 under anoxic conditions failed more rapidly than strips forced to contract at 24 contractions.min-1 under normoxic conditions. Protein synthesis decreased by 32% when compared to normoxic controls. When stimulation was terminated after 2 hr of contraction, the rate of protein synthesis in strips under anoxic conditions was similar to that in strips under normoxic conditions. Also, returning strips to normoxic conditions after 2 hr of anoxia restored protein synthesis to the level of the normoxic controls. A significant correlation between pacing rate and protein synthesis was found under normoxic conditions but not under anoxic conditions when strips were paced at 12, 18 and 24 contractions.min-1. Protein synthesis increased by 30% at the 18 contractions.min-1 frequency and 45% at the 24 contractions.min-1 frequency over the rate at 12 contractions.min-1 frequency. Force-frequency studies revealed that under normoxic conditions force generation did not change until above 24 contractions.min-1, but under anoxic conditions there was a significant negative inotropic effect (20% decrease in force) at 24 contractions.min-1 and fell to 50% of initial at 36 contractions.min-1. These studies indicate that, in the turtle heart, anoxia per se is not the only determinant of protein synthesis but rather that work plays an important role in protein synthesis, as in the mammalian heart.

Animals↗

PubMed1987

Assessment of hospital workload in war surgery.

The aim of treatment of casualties in war time is to offer a chance of survival to the greatest number of patients. This goal can be approached by selecting for treatment patients who have a real chance of survival and by reducing the duration of operations as much as possible. Should the operative time be limited to an assessed predetermined duration as proposed in certain armies? Conditions for the observation of war wounded were particularly favourable in the ICRC (International Committee of the Red Cross) Hospital in Peshawar (Pakistan) because all treatments were started and completed in the same place. During the summer of 1985, a major battle took place near the Pakistan border. Analysis of 212 operated patients, of whom 68 per cent arrived at the hospital less than 48 h after the injury, showed that the operations lasted 90 min on average. Abdominal procedures were the longest. Patients stayed in the hospital for an average of 4 weeks; those with lesions of the extremities stayed longer (5.8 weeks) than those with abdominal or thoracic lesions (4.3 and 3 weeks). The results show that the long duration of an operation has not been correlated either with an unfavourable outcome or with an increased postoperative workload. As far as possible, accelerating the turnover of operations by increasing the number of operating teams should be the objective rather than the selection of patients who require short operations. Such selection would have resulted in the death of most seriously wounded patients in this series.

Adolescent↗

PubMed1987

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 2. The effect of time and shift on the nursing workload.

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined, and the nurse's bedside activities logged at 1 min intervals throughout the 24 h immediately following the patient's return from the operating theatre. It is possible to identify three broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and the balance of the nurse's time, largely concerned with observation and liaison with other staff--learning activities (Type 3). The time devoted to technical nursing care reduces significantly over the patient's first 24 h in the ward. On the other hand the time devoted to intermittent nursing care and learning activities is shown to be shift dependent. The effect of the efficient utilisation of computer technology is estimated, and it is demonstrated that the implementation of such technology would result in the expansion of the time available for the nurse to observe the patient. The potential benefits and drawbacks of this are discussed.

Adult↗

PubMed1984

Aerobic capacities and blood pressure responses of five different groups in North Sumatra and Aceh at different workloads.

In five different groups consisting of athletes (TPG), high school students, men and women (HS), rural group (Arun), and a professional football group (Galatama), the VO2max was determined indirectly, using the cycle ergometer exercise test and Astrand's nomogram. Systolic and diastolic blood pressure was determined using a sphygnomanometer and measured after steady state was reached at each load. The aerobic capacities of the group below 20 years differ significantly between the TPG and all the other groups compared (P less than 0.01). Between the other groups there is a difference in VO2max, though significant differences were only found between the HS (men), Arun group and the HS (women) (P less than 0.01). In the group above 20 years the TPG group have the highest VO2max, and the differences when compared with the HS (men) and Arun groups were significant (P less than 0.01). In the Arun group above 30 years, though a lower values was found in the older age group, significant differences in VO2max were only found between the 30-39 years and the 40-49 years age group (P less than 0.01). Blood pressure responses to different workloads successfully confirmed the results reported by Astrand and Rodahl (1970) and Barnard et al. (1973), but no consistent relationship was found between aerobic capacities and systolic blood pressures.

Adolescent↗

PubMed1979

Influence of physical workload on freerunning circadian rhythms of man.

While living under constant conditions and complete isolation from environmental time cues for about 4 weeks, 9 male subjects exercised on a bicycle ergometer seven times per 'day' during two weeks and refrained from physical activities during the other 2 weeks. The freerunning circadian rhythms of wakefulness and sleep and of rectal temperature showed, on the average, no difference between the two sections with regard to the autonomous period and the tendency towards internal desynchronization. Even in the one experiment in which the two rhythms became internally desynchronized, the periods of the rhythms remained unchanged during the time the subject worked on the bicycle. Only in one out of the nine subjects, the autonomous period was considerably longer under the influence of work than without it. The hypothesis is advanced that the period of an autonomous rhythm becomes normally independent of physical workload by way of a compensation mechanism.

Adult↗

PubMed2003

Respiratory muscle workload in intubated, spontaneously breathing patients without COPD: pressure support vs proportional assist ventilation.

OBJECTIVE: To compare the respiratory muscle workload associated with pressure support ventilation (PSV) and proportional assist ventilation (PAV) in intubated and spontaneously breathing patients without COPD. DESIGN AND SETTING: Prospective study, intensive care unit university hospital. INTERVENTIONS: Twenty intubated patients, during early weaning, PSV settings made by clinician in charge of the patient, and two levels of PAV, set to counterbalance 80% (PAV 80) and 50% (PAV 50) of both elastic and resistive loads, respectively. The patients were ventilated in the following order: 1) PSV; 2) PAV 50 or PAV 80; 3) PSV; 4) PAV 80 or PAV 50; 5) PSV. PSV settings were kept constant. MEASUREMENTS: Arterial blood gases, breathing pattern and respiratory effort parameters at the end of each of the five steps. MAIN RESULTS: PSV and PAV 80 had the same effects on work of breathing (WOB). The pressure-time product (PTP) was significantly higher during PAV 80 than during PSV (90+/-76 and 61+/-56 cmH(2)O.s.min(-1), respectively, P <0.05). Tidal volume was comparable, albeit more variable with PAV 80 than with PSV (variation coefficient, 43% vs 25%, respectively, P <0.05). PAV 50 entailed a higher respiratory rate, lower tidal volume, and higher WOB and PTP than PSV and PAV 80. PaO(2)/FiO(2) and SaO(2) were lower with PAV 50 than with PSV and PAV 80. CONCLUSION: In a group of intubated spontaneously breathing non-COPD patients, PAV 80 and PSV were associated with comparable levels WOB, whereas PTP was higher during PAV 80. PAV 50 provided insufficient respiratory assistance.

Adult↗

PubMed1992

Eye movement and pupillary response indices of mental workload during visual search of symbolic displays.

Eye movement and pupillary response measures (in addition to search time and accuracy) were collected as indices of visual workload during two experiments designed to evaluate the addition of colour coding to a symbolic tactical display. Displays also varied with regard to symbol density and the type of information participants were required to abstract from the display. These variables were factorially manipulated to examine the effects of colour coding in conditions of varying difficulty. In Experiment 1 (n = 8), search time and the number of eye fixations were affected by all variables and in a similar manner; fixation dwell time and the pupillary response dissociated from the other measures. Compared to monochrome displays, colour coding facilitated search (reduced search time, but not accuracy) during exhaustive search, but had no effect during self-terminating search. Experiment 2 (n = 8) was a replication of Experiment 1 with a pseudo-search control condition added to examine further the pupillary response measures: in particular, to assess the effects of the physical parameters of the displays, and to verify the findings of Experiment 1. Pupillary response measures were sensitive to the information processing demands of the search task, not merely to the physical parameters of the display. Further, the search time, accuracy, and eye movement results from the active search condition generally replicated Experiment 1, but the fixation dwell time data did not. These between-study differences were interpreted as indicating the importance of participant search strategy.

Journal Article↗

PubMed1995

Standards for ergonomics principles relating to the design of work systems and to mental workload.

Starting with some recent developments in standardization in the field of ergonomics principles relating to the design of work systems, an overview is given on standards and ongoing activities in this field, pointing to problems and perspectives, especially in the context of the activities of the different standardization committees. Existing international standards relating to mental workload are described, together with possible future developments in this area.

Journal Article↗

PubMed1985

Accident and emergency content of general surgical workload.

In a 12-month period from 1 January to 31 December 1982, 1064 patients were admitted under the care of one consultant general surgeon. Of these, 485 came through the Accident and Emergency (A & E) Department; details of their management are presented. All the data were collected prospectively, stored on microcomputer discs and later analysed. The surgical cases provided adequate material for training but the planning of curricula did not allow all the A & E trainees to be adequately exposed to it. Head injuries accounted for nearly one-third of the emergency workload and were well managed, but more children with this diagnosis were admitted than was necessary. About one-quarter of the investigations performed did not contribute usefully to management; adequate discussion between the laboratories and clinicians and the laying-down of written guidelines may reduce the number of unnecessary investigations. A system which enables casualty officers to follow up the patients whom they admit will help trainees to confirm or refute their initial diagnostic impressions, and should be encouraged. A knowledge of the number, type and outcome of treatment of general surgical cases passing through the A & E Department is important in planning curricula and also for allocating resources.

Accidents↗

PubMed1995

Rheoencephalographic and electroencephalographic measures of cognitive workload: analytical procedures.

This investigation demonstrates the feasibility of mental workload assessment by rheoencephalographic (REG) and multichannel electroencephalographic (EEG) monitoring. During the performance of this research, unique testing, analytical and display procedures were developed for REG and EEG monitoring that extend the current state of the art and provide valuable tools for the study of cerebral circulatory and neural activity during cognition. REG records are analyzed to provide indices of the right and left hemisphere hemodynamic changes that take place during each test sequence. The EEG data are modeled using regression techniques and mathematically transformed to provide energy-density distributions of the scalp electrostatic field. These procedures permit concurrent REG/EEG cognitive testing not possible with current techniques. The introduction of a system for recording and analysis of cognitive REG/EEG test sequences facilitates the study of learning and memory disorders, dementia and other encephalopathies.

Adult↗

PubMed1987

Predictable adaptations by skeletal muscle mitochondria to different exercise training workloads.

1. Mitochondria were isolated according to their cellular location within the fibers of pooled gastrocnemius and plantaris muscle of the rat. This procedure yields two populations of mitochondria which display different biochemical properties. 2. The adaptive response of these mitochondria populations to the chronic exposure to different elevated energy demands (different modes of exercise training) was investigated. 3. The observed changes in mitochondrial protein content and cytochrome oxidase activity in the respective mitochondria population suggests that each population is capable of independent adaptations. 4. The adaptive response of each mitochondria population, furthermore, was predictable with respect to the metabolic energy demand of the exercise training workload.

Acclimatization↗