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PubMed1983

Radiographic workload and use factors for orthopedic facilities.

Observations of technique factors at 9 radiographic installations dedicated to orthopedic radiography have been made. Monthly area radiation measurements with thermoluminescent dosimeters were made at three of these facilities. The results of these observations and measurements suggest that current NCRP recommended assumptions utilized in protective barrier computations result in considerably more shielding than is necessary. We observed an average workload of 224 mA min/wk and a maximum weekly average of 670 mA min/wk. The use factor for the chest wall averaged 5%. That for all other vertical barriers was less than 1%. The average operating potential was 75 kVp. Room radiation measurements confirm the suggestion that at least two of the walls and the control booth barrier in an orthopedic radiographic facility may be considered secondary barriers.

Ambulatory Care Facilities↗
PubMed1995

Workload and use factor of medical linear accelerators in radiotherapy.

An important factor in the design of primary protective barriers is the use factor. The present study was aimed at obtaining historical data on the use factor of two dual modality linear accelerators in a radiotherapy department. Gantry angle, field size, and beam modifiers were recorded for all radiation qualities in use at two medical linear accelerators with 6 MV and 18 MV x-rays and multiple electron energies ranging from 4 MeV to 20 MeV. The data for one year of clinical use was extracted from a record and verifying system and an estimate of the physics workload on the machines was obtained by going through the quality assurance records and machine log books. Of the total dose of approximately 37,000 Gy delivered in one year at isocenter on each unit 80% was given as 6 MV x-rays. As can be expected, most x-ray beams were directed at the four cardinal gantry angles with the angular distribution for 6 MV and 18 MV x-rays being very similar. Electron fields were broadly distributed around the gantry pointing down position. Less than 25% of all clinical x-ray treatment fields extended beyond a field size of 200 cm2.

Blood Component Transfusion↗
PubMed1991

Somatic versus nonsomatic shoulder and back pain experience in middle age in relation to body build, physical fitness, bone mineral content, gamma-glutamyltransferase, occupational workload, and psychosocial factors.

This study selected 205 subjects aged 55 years who had shoulder and/or back pain complaints to determine the relationship of somatic and nonsomatic pain experience to body build, physical fitness, bone mineral content, serum levels of gamma-glutamyltransferase, occupational workload and intelligence test, educational level, life success, social support, stress at work, monotonous work, and job decision latitude. Men with a somatic back pain drawing experienced more stress at work and had higher serum levels of gamma-glutamyltransferase, indicating a higher intake of alcohol and/or painkillers, but were more satisfied with their jobs compared with men who had a nonsomatic pain drawing. Women with obvious shoulder signs and symptoms and/or a somatic back pain drawing tended heavier than women without symptoms, had higher serum levels of gamma-glutamyltransferase, and found their jobs more mentally demanding than did women with shoulder and/or back pain experience but without obvious shoulder signs and symptoms and/or a nonsomatic back pain drawing.

Back Pain↗
PubMed2001

Young dyspeptic patients: with a test-and-treat policy, are the benefits of decreased symptom severity and oesophago-gastric-duodenoscopy workload sustained?

OBJECTIVES: To examine the symptom severity and requirement for oesophago-gastro-duodenoscopy (OGD) in young dyspeptic patients 2 years after serological testing for Helicobacter pylori, and to compare the outcomes of seronegative patients with those of seropositive patients. DESIGN: Long-term follow-up study of 232 participants from our previous trial. METHODS: Telephone assessment of patients' symptom severity, scored using a previously validated questionnaire; return of patients for OGD determined using local patient administration system (PAS); and review of medical case notes. RESULTS: Dyspepsia symptom severity of both seronegative and seropositive patients remained reduced compared with initial scores at time of trial recruitment. Symptom severity of seropositive patients was significantly lower than that of seronegative patients (P< 0.001). Seventeen additional patients returned for OGD between six months and two years after the start of the serological study. As 61 of the original 232 study patients returned for OGD within the first six month follow-up period, a total of 78 individuals (34%) had OGD during the two years following the study. Thus, 66% of the original participants avoided OGD. CONCLUSIONS: This study of non-invasive testing for H. pylori in young dyspeptic patients has demonstrated an improvement in symptom severity and a substantial reduction in OGD workload over a 2-year period.

Adult↗
PubMed1990

The initial effects on workload and outcome of a public education campaign on early diagnosis and treatment of malignant melanoma in Leicestershire.

We report our experience of the initial effects of a publicity campaign directed at early presentation of malignant melanoma in Leicestershire. The campaign resulted in a dramatic increase in workload and, at the pigmented lesion clinic, the numbers of new patients rose from 12.3 to 54.5 per clinic. There was a large rise in the number of new melanomas presenting in Leicestershire: from 1.02 per week before the campaign to 1.88 per week in the immediate post-publicity period. This was statistically significant (P less than 0.001). Although there was also an apparently encouraging rise in the percentage of thinner 'good prognosis' tumours, it was not possible to isolate this statistically from a pre-existing trend.

Dermatology↗
PubMed1982

A method of estimating nursing workload.

A real-time nursing computer system operational on six medical wards allows the automatic data capture of all nursing procedures carried out for all patients. Each nursing procedure has been graded by an experienced nurse on a 5-point scale (Ninewells Index I), with grade 5 representing the greatest workload. A Delphi type survey was carried out by a questionnaire involving 115 medical charge nurses in Scotland who graded the same procedures on a 5-point scale (Delphi Index I). Good agreement with the two indices was found. The Delphi Index I was transferred from the original scale to an interval scale (Delphi Index II) to facilitate statistical handling of data and conversion to timings. The conversion of Delphi Index II to timings (Ninewells Index II) was achieved by using data from three extensive work studies. It is suggested that Ninewells Index II is a practical problem of staff allocation in medical wards.

Abstracting and Indexing↗
PubMed2004

Introducing a baroreflex model for studying cardiovascular effects of mental workload.

A quantitative baroreflex control model is presented aimed at estimating differences in autonomic activation due to mental task performance. The model, which builds on earlier work of Wesseling and colleagues, is strongly supported by well-established knowledge of physiological control processes. Spectral measures of heart rate and blood pressure variability provide the information to estimate autonomic gain and tone parameters. The article gives a detailed model description as well as an evaluation in terms of spectral variability distributions, respiratory sinus arrhythmia, and vagal control mechanisms. The estimation procedure is outlined while presenting two studies that describe the effects of mental workload and vagal blockade, respectively. It is concluded that, using the model approach, cardiovascular effects of mental task performance can be interpreted in terms of specific changes in autonomic state. The model is implemented in a Matlab/Simulink environment and is available for other researchers in the field.

Adult↗
PubMed2005

Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.

The increase in the immunocompromised population and the incidence of invasive aspergillosis (IA) are leading to an overinterpretation of the potential clinical significance of many isolates of Aspergillus fumigatus. Our work prospectively assesses the workload of the isolation of A. fumigatus and its clinical significance in the microbiology laboratory of a large teaching hospital. During a 3-year period, all patients from whom A. fumigatus was isolated were prospectively monitored and classified as having IA or "nonsignificant" disease. A point score based on the prediction of five easily obtained laboratory and clinical parameters was applied. We found 404 A. fumigatus isolates in 260 patients (1/1,000 microbiology laboratory samples; 2.1 patients/10,000 admissions). A total of 90 isolates (22.3%) were from patients with IA. Of the 260 patients, 31 (12%) had invasive disease (IA), and the remaining 229 had "nonsignificant" disease. A score based on points for five parameters was applied to our population. It was constructed as follows: "sample obtained by invasive procedures" (1 point), "presence of two or more positive samples from the same patient" (1 point), "leukemia" (2 points), "neutropenia" (5 points), and "corticosteroid treatment" (2 points). Patients with a score of 0 had only a 2.5% probability of IA. Those with a score of 1 or 2 had an increased probability of 10.3%. The probabilities rose to 40% and 70%, respectively, for patients with a score of 3 or 4 or a score of > or = 5. A simple score based on five easily available parameters may be of help to microbiologists and clinicians to predict the risk of IA.

Analysis of Variance↗
PubMed1983

Changing workload in ophthalmology: some observations from routine statistics.

Children with squints and old people with cataracts account for most of the work of ophthalmologists. Recent demographic changes have led to fewer children and more elderly patients needing treatment. So far the increased workload has been met by shortening the time patients spend in hospital, but with striking variations between districts.

Adolescent↗
PubMed1983

General surgical workload in England and Wales.

An attempt was made to measure the workload of a typical general surgical firm (two part time consultants and their junior staff) serving a population of 100 000 in England and Wales. This provides a background against which to plan curricula for undergraduate and postgraduate teaching, as well as being a guide to the experience that a surgical trainee should get in a suitable training post. The effect of changes in surgical staffing on the number of operations done by a surgeon may also be estimated.

Bed Occupancy↗
PubMed1984

Night workload in one health district.

The night work (11 pm-7 am) in primary care in one health district (population 195 212 with 93 general practitioners) was studied over a three month period, starting 1 January 1983. The workload proved to be small (15% of all "out of hours" work for general practitioners). An average of three night visits was done a night in the whole health district, and 26 general practitioners were available for these. On average, over seven doctors were available each night for each patient who required a visit in primary care in the health district. It is concluded that there is only sufficient work for (at maximum) two doctors, and a system is proposed to make more efficient use of the general practitioner's time.

England↗
PubMed1985

Changing overall workload in neonatal units.

An epidemiological study was carried out in the current Nottingham health district to determine changes in both neonatal unit workload and in the infants requiring neonatal care during two study periods. All admissions for 1977 and again for the 12 months 1 April 1983 to 31 March 1984 were reviewed. Total numbers of admissions have shown roughly a 50% reduction because of a more rigorous admission policy locally. The admissions of infants of 33 weeks' gestation or less have shown a significant increase, while the overall survival of infants less than 33 weeks' gestation has improved.

Birth Weight↗
PubMed1989

Twenty four hour care in inner cities: two years' out of hours workload in east London general practice.

Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities.

Family Practice↗
PubMed1990

Preregistration house officers in the four Thames regions: I. Survey of education and workload.

OBJECTIVE: To assess the education and workload of preregistration house officers in the four Thames regions. DESIGN: Postal questionnaire. SETTING: Teaching and non-teaching hospitals in the four Thames regions. PARTICIPANTS: 1064 Preregistration house officers. RESULTS: Response rate was 70% (740 replies). Nine per cent of house officers (66/729) worked a rota of one in two. The average house officer had 20.4 inpatients under his or her care and admitted 23.2 patients per week. Sixty two per cent of house officers (459/740) felt that they spent an excessive amount of time on non-medical tasks of no educational merit; 75% (546/725) had never received adequate guidance on breaking bad news and 64% (467/729) had never received adequate guidance on pain control; 34% (249/731) did not feel confident that they could perform cardiopulmonary resuscitation unsupervised. House officers would tend to recommend their post to a friend. CONCLUSIONS: There are deficiencies in preregistration training in the four Thames regions. The General Medical Council's requirements are not being heeded.

Accreditation↗
PubMed1990

Preregistration house officers in the four Thames regions: II. Comparison of education and workload in teaching and non-teaching hospitals.

OBJECTIVE: To detect differences in the education and workload of preregistration house officers working in teaching and non-teaching hospitals. DESIGN: A postal questionnaire. SETTING: Teaching and non-teaching hospitals in the four Thames regions. PARTICIPANTS: 1064 Preregistration house officers. RESULTS: Response rate was 61% for teaching hospitals and 73% for non-teaching hospitals. House officers in teaching hospitals had significantly fewer inpatients under their care (house physicians 16.9 v 22.9, house surgeons 17.9 v 20.3) and admitted fewer emergency patients per week (house physicians 7.7 v 12.7, house surgeons 6.5 v 9.8). More house officers in teaching hospitals reported that they had too few patients to provide adequate clinical experience. More of their time was consumed by administrative activities devoid of educational value. CONCLUSION: Preregistration house officer posts at teaching hospitals provide less clinical activity and are perceived as less educationally satisfactory by their holders than those elsewhere.

Accreditation↗
PubMed1999

Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral.

OBJECTIVE: To examine the evolving role of specialised outpatient services for adult patients with congenital heart disease. DESIGN: A retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997. SETTING: A tertiary referral centre. MAIN OUTCOME MEASURES: Patient demographics, residence, medical and surgical history, type and source of referral, and investigations performed. RESULTS: In all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time. CONCLUSIONS: Over the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.

Adult↗
PubMed1990

Laboratory costing system based on number and type of test: its association with the Welcan workload measurement system.

A laboratory costing system which recovers all costs against tests, rather than using both test and request charges, was developed. Methods of recovering costs of routine and emergency services, of capital investment in equipment, of instrument maintenance costs and of general hospital overheads were considered. The Welcan unit system of workload measurement was applied to a range of test procedures. Both the Welcan unit value and unit value adjusted fro calibration and quality control (Welcan based weighting) correlated only moderately with locally derived analytical time per test and correlated poorly with direct analytical cost per test. The correlation of direct analytical cost per test with total cost per test was much stronger than that of analytical time per test with direct analytical cost per test. The data suggest that neither Welcan unit values, Welcan based weightings, nor locally derived analytical time per test can truly reflect total resource consumption for the provision of a range of test procedures. This factor should be borne in mind when applying operational or performance indicators based on Welcan units.

Clinical Laboratory Techniques↗