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PubMed1988

A comparison of methods for increasing compliance within a general practitioner based screening project for colorectal cancer and the effect on practitioner workload.

Screening for colorectal cancer by testing for faecal occult blood (FOBT) is effective for early diagnosis, but the success of a screening programme also depends on compliance. The aims of this study were to assess the effect of health education on compliance and to assess any addition to general practitioner workload that resulted. Altogether 3860 patients were recruited and randomly allocated to test or control group. The test group was further divided into subgroups, some of which received health education. Compliance with FOBT was 54.7% (210/384) in the subgroup receiving only the doctor's letter, which fell to 48.1% (743/1544) in the group receiving health education. General practitioner consultation rates were similar in test and control groups.

Aged↗

PubMed1990

Will a breast screening programme change the workload and referral practice of general practitioners?

STUDY OBJECTIVE: The aim of the study was to consider possible changes in the clinical activities of general practitioners whose patients are registered in a breast cancer screening programme. DESIGN: The study was a survey based on completion of forms recording breast consultations carried out by participating general practitioners during a four week period. SETTING: One of three intervention centres and one of three comparison centres in the national trial of early detection of breast cancer was selected. The intervention centre was in Guildford; the comparison centre in Stoke on Trent. PARTICIPANTS: The participants were general practitioners in the selected centres. In Guildford, 64 of 99 general practitioners approached took part (65%); in Stoke on Trent, 81 of 177 took part (46%). The proportion of male and female participants in the two centres was similar. Doctors in Stoke on Trent were older and worked in smaller practices than in Guildford. RESULTS: A comparison of workloads showed that in the screening centre there was less demand for doctor consultations from those in the screened age group, but those excluded from screening made more use of the general practitioners' services. A difference in referral practice was also apparent, with doctors in the screening centre referring more frequently for specialist advice. CONCLUSIONS: The evidence suggests that no significant change in the overall use of general practice resources can be expected with the introduction of national screening, but there may be greater pressure on assessment services.

Adult↗

PubMed1995

Comparison of the workload of Dutch warmblood horses ridden normally and on a treadmill.

Six Dutch warmblood horses, ridden by an experienced rider, cantered 3320 m at a speed adapted to the individual horse's anaerobic threshold, under four different conditions: 1, on a firm shell track with the speed varying from 6.5 to 9.4 m/s; 2, on a horizontal treadmill at the same speeds and for the same duration as in test 1; 3, on a horizontal treadmill for the same duration as in tests 1 and 2, but at a 10 per cent higher speed; and 4, on a treadmill at the same speed and for the same duration as in test 1, but at an inclination of 1 to 2 per cent adjusted individually to obtain heart rates similar to those recorded in test 1. On the basis of the heart rates and plasma lactate concentrations, the workload of the horses was significantly greater in the normal exercise test (1) than in the first treadmill test (2). Increasing the speed of the test on the horizontal treadmill by 10 per cent (test 3) resulted in heart rates and plasma lactate concentrations similar to those recorded in test 1. Inclining the treadmill on the basis of the heart rates achieved in test 1 had a less consistent effect than increasing the speed, but imitated a normal exercise test better than the horizontal treadmill test 2.

Animals↗

PubMed2005

beta-Agonist stimulation produces changes in cardiac AMPK and coronary lumen LPL only during increased workload.

Given the importance of lipoprotein lipase (LPL) in cardiac and vascular pathology, the objective of the present study was to investigate whether the beta-agonist isoproterenol (Iso) influences cardiac LPL. Incubation of quiescent cardiomyocytes with Iso for 60 min had no effect on basal, intracellular, or heparin-releasable (HR)-LPL activity. Similarly, Iso did not change HR-LPL in Langendorff isolated hearts that do not beat against an afterload. In the intact animal, LPL activity at the vascular lumen increased significantly in the Iso-treated group, together with a substantial increase in rate-pressure product. This LPL increase was likely via mechanisms regulated by activation of AMP-activated protein kinase (AMPK) and inactivation of acetyl-CoA carboxylase (ACC280). In glucose-perfused hearts, simply switching from Langendorff to the isolated working heart (that beats against an afterload) induced increases in AMPK and ACC280 phosphorylation and enhanced HR-LPL activity. Provision of insulin and albumin-bound palmitic acid to the working heart was able to reverse these effects. In these hearts, introduction of Iso to the buffer perfusate duplicated the effects seen when this beta-agonist was given in vivo. Our data suggest that Iso can influence HR-LPL only during conditions of increased workload, mechanical performance and excessive energy expenditure, and likely in an AMPK-dependent manner.

AMP-Activated Protein Kinases↗

PubMed2002

Cardiovascular responses to static and dynamic contraction during comparable workloads in humans.

Previous studies suggest that the blood pressure response to static contraction is greater than that caused by dynamic exercise. In anesthetized cats, however, pressor responses to electrically induced static and dynamic contraction of the same muscle group are similar during equivalent workloads and peak tension development [i.e., similar tension-time index (TTI)]. To determine if the same relationship exists in humans, where contraction is voluntary and central command is present, dynamic (180 s; 1/s) and static (90 s) contractions at 30% of maximal voluntary contraction (MVC) were performed. Dynamic contraction also was repeated at the same TTI for 90 s at 60% MVC. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), MAP during postexercise arterial occlusion (an index of the metaboreceptor-induced activation of the exercise pressor reflex), and relative perceived exertion (RPE) (an index of central command) were assessed. No differences in these variables were found between static and dynamic contraction at a tension of 30% MVC. During dynamic contraction at 60% MVC, changes in MAP (16 +/- 3 vs. 19 +/- 4 mmHg) and absolute HR (92 +/- 6 vs. 69 +/- 5 beats/min), CO (7.9 +/- 0.4 vs. 6.3 +/- 0.3 l/min), RPE (16 +/- 1 vs. 13 +/- 1), and MAP during postexercise arterial occlusion (115 +/- 3 vs. 100 +/- 4 mmHg) were greater than during static contraction (P < 0.05). Thus increases in MAP and HR, activation of central command, and muscle metabolite-induced stimulation of the exercise pressor reflex during static and dynamic contraction in humans seem to be similar when peak tension and TTI are equal. Augmented responses to dynamic contraction at 60% MVC are likely related to greater activation of these two mechanisms.

Adult↗

PubMed2000

Hemodynamic responses to static and dynamic muscle contractions at equivalent workloads.

We tested the hypothesis that static contraction causes greater reflex cardiovascular responses than dynamic contraction at equivalent workloads [i.e., same tension-time index (TTI), holding either contraction time or peak tension constant] in chloralose-anesthetized cats. When time was held constant and tension was allowed to vary, dynamic contraction of the hindlimb muscles evoked greater increases (means +/- SE) in mean arterial pressure (MAP; 50 +/- 7 vs. 30 +/- 5 mmHg), popliteal blood velocity (15 +/- 3 vs. 5 +/- 1 cm/s), popliteal venous PCO(2) (15 +/- 3 vs. 3 +/- 1 mmHg), and a greater decrease in popliteal venous pH (0.07 +/- 0.01 vs. 0.03 +/- 0.01), suggesting greater metabolic stimulation during dynamic contraction. Similarly, when peak tension was held constant and time was allowed to vary, dynamic contraction evoked a greater increase in blood velocity (13 +/- 1 vs. -1 +/- 1 cm/s) without causing any differences in other variables. To investigate the reflex contribution of mechanoreceptors, we stretched the hindlimb dynamically and statically at the same TTI. A larger reflex increase in MAP during dynamic stretch (32 +/- 8 vs. 24 +/- 6 mmHg) was observed when time was held constant, indicating greater mechanoreceptor stimulation. However, when peak tension was held constant, there were no differences in the reflex cardiovascular response to static and dynamic stretch. In conclusion, at comparable TTI, when peak tension is variable, dynamic muscle contraction causes larger cardiovascular responses than static contraction because of greater chemical and mechanical stimulation. However, when peak tensions are equivalent, static and dynamic contraction or stretch produce similar cardiovascular responses.

Animals↗

PubMed1996

Peak blood lactate and blood lactate vs. workload during acclimatization to 5,050 m and in deacclimatization.

Peak blood lactate ([Labl]peak) and blood lactate concentration ([Labl]) vs. workload (W) relationships during acclimatization to altitude and in the deacclimatization were evaluated in 10 Caucasian lowlanders at sea level (SL0); after approximately 1 wk (Alt1wk), 3 wk (Alt3wk), and 5 wk (Alt5wk) at 5,050 m; and weekly during the first 5 wk after return to sea level (SL1wk-SL5wk). Incremental bicycle ergometer exercises (30 W added every 4 min up to exhaustion) were performed. At Alt1wk and at Alt5wk, the experiments were repeated in hypobaric normoxia (Alt1wk-O2 and Alt5wk-O2). [Labl] was determined at rest and during the last approximately 30 s of each W. [Labl]peak was taken as the highest [Labl] during recovery. Acid-base status (pH and concentration of HCO-3 in arterialized capillary blood) was determined at rest. Mean [Labl]peak values were 11.5 (SL0), 8.0 (Alt1wk), 6.4 (Alt3wk), 6.3 (Alt5wk), 8.0 (SL1wk), 9.4 (SL2wk), 10.8 (SL3wk), 11.3 (SL4wk), and 11.6 (SL5wk) mM. At Alt1wk-O2 and Alt5wk-O2, peak W increased, compared with Alt1wk and Alt5wk, whereas no changes were observed for [Labl]peak. [Labl] vs. W was shifted to the left (i.e., higher [Labl] values were found for the same W) at Alt1wk compared with SL0 and partially shifted back to the right (i.e., lower [Labl] values were found for the same W) at Alt3wk and Alt5wk. At Alt1wk-O2 and Alt5wk-O2, [Labl] vs. W values were superimposed on that at SL0. At SL1wk-SL5wk, [Labl] vs. W values were shifted to the right compared with that at SL0. At Alt1wk, a condition of respiratory alkalosis was found, which was only partially compensated for during acclimatization. At SL1wk, the acid-base status was back to normal. We conclude that 1) the reduced [Labl]peak at altitude is still present for 2-3 wk after return from altitude; is not attributable to reduced peak W nor to hypoxia per se, nor to a reduced buffer capacity; alternatively, it could be related to some central determinants of fatigue. 2) The [Labl] vs. W leftward shift at altitude was due to hypoxia per se. 3) The factor(s) responsible for the [Labl] vs. W partial rightward shift during acclimatization could still be effective during the first weeks after return to sea level.

Acclimatization↗

PubMed1999

Physiological response to moderate exercise workloads in a pulmonary rehabilitation program in patients with varying degrees of airflow obstruction.

STUDY OBJECTIVES: To investigate whether a 12-week pulmonary rehabilitation program that includes moderately intensive exercise training performed twice weekly can induce a training effect in patients with a wide variation of airflow limitation. PARTICIPANTS: Sixty patients with COPD (38 men) with a mean +/- SD FEV(1) % predicted of 55.1 +/- 19.8 (range, 0.51 to 2.99). All patients performed identical incremental symptom-limited cycle ergometer testing before and after a 12-week study period. MEASUREMENTS AND RESULTS: After 12 weeks, the patients demonstrated a significant (p < 0.05) increase in the peak values for work rate (WR; 77 +/- 30 vs 91 +/- 36 W) and oxygen uptake (1.14 +/- 0.45 vs 1.20 +/- 0.52 L/min). Furthermore, at a given WR during incremental symptom-limited cycle ergometer testing, there were significant (p < 0.05) reductions in minute ventilation (42.4 +/- 16.1 vs 37.0 +/- 13. 6 L/min), carbon dioxide output (1.13 +/- 0.49 vs 1.03 +/- 0.42 L/min), ventilatory equivalent for oxygen (37.6 +/- 8.1 vs 36.0 +/- 6.3), and heart rate (135 +/- 15 vs 128 +/- 16 beats/min). None of the observed physiologic changes correlated with FEV(1) % predicted. CONCLUSIONS: A pulmonary rehabilitation program performed twice weekly with moderate exercise workloads can lead to a physiologic training response irrespective of the degree of airflow limitation.

Exercise↗

PubMed1975

A general practitioner's study of his own workload and patient morbidity.

In 1972 a study of workload and morbidity was undertaken by a New South Wales general practitioner. The writer analysed 5,618 of his own face-to-face patient contacts and have been set out below. A comparison was also made between the writer's morbidity statistics and those of the Australian Morbidity Survey. Both surveys were conducted at the same time and it was interesting to note a marked similarity in the percentages of disease episodes when classified into broad groups (such as respiratory disease, for example). The results have been useful as a basis for future research, as an educational tool for undergraduates and graduates learning about general practice and as an aid in practice management planning.

Adolescent↗

PubMedDate not supplied

A new approach to workload recording. A contemporary approach to staffing analysis.

The question of "How productive is our laboratory?" is one with which we wrestle constantly. The College of American Pathologists (CAP) Workload Recording Method (WLR) is somewhat familiar to most laboratorians. It is a system that could be better used in most laboratories. The recent introduction of a new approach to productivity analysis and of code numbers for nonworkloaded activities makes the system easier to use and more meaningful in analyzing staff productivity. Laboratory managers strive constantly to answer the question, "How do I show administration my real staffing needs?" Personnel productivity analysis is a benefit of using the CAP WLR method.

Blood Banks↗

PubMed1983

Workload measurement study to develop staffing guidelines for the clinical inpatient dietitian.

A study was done to develop staffing guidelines for the inpatient clinical dietitian based on the Victoria General Hospital Dietary Department's philosophy of nutritional care. The objectives were to identify the major activities being performed by the dietitian, estimate the average amount of time spent on each activity, determine the number of dietitian consults, determine the time required per patient consult, and establish indicators for workload, performance and productivity. All activities were coded for easy record keeping and tabulation, and the D-unit (5 minutes of a dietitian's time) was used as the unit of time measurement. The results showed that the dietitians were spending 44% of time on direct patient care, 20% on patient care support activities, 1% intradepartmental activities, 6% teaching (other than patients), 4% community, 3% on research and special projects, and 7% doing other tasks. Using the % of direct patient care time available, the % of patients requiring nutritional support, and the patient turnover rate, it was possible to develop a formula for the number of dietitians required to provide nutritional care based on the department's philosophy.

Food Service, Hospital↗

PubMed1986

The Canadian hospital pharmacy workload measurement study.

"One pharmacist for every 100 beds" has been the traditional rule of thumb used in determining hospital pharmacy staffing requirements in North America. Hospital pharmacy practice has undergone profound changes over the past 20 years. Staffing requirements for contemporary hospital pharmacy practice determined by the traditional guideline are outdated and of limited value. The Canadian government, through its National Health Research and Development Program, funded a $225,000 study to develop a Canadian Hospital Pharmacy Workload Measurement System which would provide a data base for a more accurate determination of staffing requirements for hospital pharmacies. Time studies were carried out to measure the personnel time required to perform defined activities that collectively formed a pharmacy service or function.

Canada↗

PubMed1983

Graphic analysis of pharmacy workload as a management tool.

As pharmacy planners implement modern services and cost containment measures, a graphic analysis of pharmacy workload can assist the planner in better utilizing personnel time and assuring adequate time for the completion of additional functions by depicting the peak-trough relationship of workflow. Such analysis can be an effective tool to communicate to both peers and superiors.

Hospital Bed Capacity, 300 to 499↗

PubMed1987

PHARMIS: a national pharmacy workload and productivity reporting system.

PHARMIS represents the first easily usable database for review of pharmacy workload and productivity. While many large institutions have been successful in developing and using their own programs for reviewing this type of information, PHARMIS represents a desirable alternative for those hospitals that lack the ability to develop their own system. While the current version of PHARMIS lacks the flexibility to address separation and categorization of activities within the pharmacy, it represents the current state of the art. As an experience base develops and changes and trends in indicator values become explainable, PHARMIS will become a valuable tool for all hospital pharmacy managers. It is an excellent starting point for the collection and review of management information. When used in tandem with a sound quality assurance program and DRG-based review of resource utilization, PHARMIS will allow the pharmacy manager and his or her institution to review and develop excellent, cost-effective pharmacy services. The imprimatur of ASHP and the potential for a national reporting program should make PHARMIS a part of every pharmacy manager's analysis of department activities.

Efficiency↗

PubMed2000

[The studies of hemodynamic changes and liver uptake in a combination of ATP stress test and low workload exercise test on myocardial scintigraphy].

A pharmacological adenosine-tri-phosphoric acid (ATP) stress test has been used in patients who can not perform an enough exercise stress test. However, falling blood pressure during the stress test and increased liver uptake of the tracer are often found in patients undergoing the ATP test. To prevent these phenomena, a combination of ATP stress test and low workload exercise test (ATP & EX) is proposed. The usefulness of this newly developed stress test was elucidated from two viewpoints. Firstly, the changes of hemodynamic parameters were measured in 34 patients: 17 undergoing ATP alone and 17 undergoing ATP & EX. Systolic blood pressure fell from 150 +/- 20 mmHg to 126 +/- 16 mmHg (p < 0.05) for ATP alone. However, it changed from 141 +/- 19 mmHg to 149 +/- 31 mmHg (ns) for ATP & EX. There was a significant fall in systolic blood pressure (> 30 mmHg) in 58.8% for ATP alone and 5.9% for ATP & EX (p < 0.01). Secondly, the ROI count in the liver and heart on an anterior projection image were measured in 38 patients: 11 undergoing ATP alone, 13 undergoing ATP & EX, and 14 undergoing an ergometer exercise test (EX). The ROI count in the liver at 60 minutes after tracer injection were 29.0 +/- 10.7 count/pixel, 21.4 +/- 5.2 count/pixel, 18.3 +/- 4.5 count/pixel for ATP alone, ATP & EX and EX, respectively. The activities for ATP & EX and EX were lower than that for ATP alone (p < 0.05 and p < 0.01). Thus, ATP & EX decreased the rates of the fall of systolic blood pressure and decreased liver uptake of the tracer compared with ATP alone. In conclusion, ATP & EX is a useful stress method for myocardial perfusion scintigraphy in patients who can not perform the enough exercise stress test.

Adenosine Triphosphate↗

PubMed1997

[Computer fuzzy control of physiological workload intensity of human body during sports training].

The real-time control of physiological workload intensity of human being during sports training was carried out by means of the Fuzzy Control with the pattern of double input and single output, the Mean of Maximum Method (MOMM) for making fuzzy judgment, the List Method, etc. The fuzzy control system processes the advantages of high-velocity control, small-quantity over modulation and high stability.

Exercise Tolerance↗

PubMed2001

Physical workload on upper extremities in various operations during machine milking.

The aim of the study was to quantify the workload on the upper extremity for fundamental work tasks during machine milking. Eleven milkers working in a loose-housing system with a milking parlour participated in the study. Muscle activity for the biceps and the forearm flexors, as well as positions and movements of the wrists were simultaneously measured by electromyography and electrogoniometry while video-recording the work. The milking work was broken up in three main tasks "Drying (the cow's udder)", "Pre-milking (the first milk)" and "Attaching (the milking unit to the udder)" and three supplementary tasks. All three main tasks show high muscle load values and almost no time for rest. The highest load values for the biceps and flexor muscles were found during the tasks "Attaching, holding the milking unit" and "Drying", respectively. For 10% of the recording time, the milkers held active hands in 42 degrees dorsal flexion during the milking tasks "Pre-milking" and "Attaching" and in deviated positions exceeding 50% of their maximum values during "Attaching" and "Drying". The high muscle loads in combination with extreme positions and movements of the hand and forearm might contribute to the development of injuries among milkers. The result from the study aims to form a basis for technical improvements of the milking equipment to decrease the risk for arm wrist and hand disorders.

Adult↗

PubMedDate not supplied

Comparison of certain biochemical changes during exercise tests on treadmill and bicycle-ergometer with equal workload intensity.

Ergometrics, using both treadmill (T) and bicycle-ergometer (B), plays an important role in assessing physical work capacity. In addition to the other important parameters (blood pressure, heart rate, oxygen consumption, oxygen and carbon dioxyde-partial pressure in blood, etc.), it is of interest to follow, measure and compare values of certain metabolic products immediately after completion of exercise on T and B. The aim of this study was to define which test develops the most significant changes in metabolic parameters when the same workload intensity is maintained. The metabolic parameters measured were: lactate, pyruvate, 2.3-diphosphoglycerate (2.3-DPG), lactate dehydrogenase (LDH) and aldolase activity. The mean values obtained at the end of both tests were: lactate 3.17 mmol/l +/- 1.017 mmol/l (T) and 4.28 mmol/l +/- 1.2 mmol/l (B); pyruvate 78.17 mumol/l +/- 30.32 mumol/l (T) and 92.16 mumol/l +/- 32.73 mumol/l (B); 2.3-DPG 3.58 mmol/l +/- 1.31 mmol/l (T) and 3.93 mmol/l +/- 1.44 mmol/l (B); LDH activity 239.22 U/I +/- 38.24 U/I (T) and 260.5 U/I +/- 61.27 U/I (B); aldolase activity 4.93 U/I +/- 1.45 U/I (T) and 5.88 U/I +/- 2.31 U/I (B). The results obtained indicate that a much higher production and/or lower elimination of acid metabolic products occurs during the test on B. This is most likely due to increased muscle pressure in big muscle groups in the legs which, by compressing the local blood vessels, diminish oxygen supply and the elimination of acid metabolic products. According to the results of the study, the use of T can be recommended as a more appropriate method for physical work capacity assessment of untrained individuals in occupational medicine.

2,3-Diphosphoglycerate↗