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PubMed2003

Food intake and circadian rhythms in shift workers with a high workload.

Shift work is associated with nutritional and health problems. In the present study, the food intake of garbage collectors of the city of Florianopolis (Brazil) was investigated using a dietary survey method based on meal recording during 24 h and adapted for the Brazilian food context. Three different shifts (morning, afternoon, and night) were compared (n=22 per shift). Age, body weight and body mass index (BMI) were similar for all groups. Daily energy expenditure was high in all three shifts, especially in morning shift workers. No difference in daily energy intake was found, in spite of differences in food choices and circadian ingestion rhythms. Energy intake was high and close to levels previously reported in athletes. Several factors not associated with shifts had significant impact on ingestion: hour of the day, time since the last meal, age, and BMI. Ingested foods were analyzed in groups based on nutrient content. Shifts significantly influenced intake of starches, alcoholic drinks, and sweets. In different periods of the day, food and nutrient intake were considerably affected by shifts. The analysis of circadian distribution of food choices and nutrient intake is important in shift workers, because total daily intake may not reveal shift-associated differences.

Adult↗
PubMed2004

[Workload].

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed2003

An economic evaluation of the optimal workload in treating surgical patients in a breast unit.

A breast unit is a cancer centre specialised in the diagnosis and treatment of patients with breast cancer. The high level of specialised skills involved in running a breast unit makes it an expensive pattern of care. The European Society of Mastology (EUSOMA) recommends a minimum caseload of 150 cases sufficient to maintain expertise for each team member and to ensure cost-effective working of the breast unit. Specific economic analysis evaluating main diagnostic services (radiology and pathology) and treatment are needed. The present study assesses the activity level at which the breast unit represents good value for money in surgically-treated patients. Cost assessment is realised by defining a cost function according to the following assumptions: cost function input is personnel costs and technical equipment and output is the number of newly diagnosed cases of primary breast cancer admitted to the breast care unit each year. The increase from 50 new cancer cases per year to 100 will reduce average costs by almost 50%. Cost reduction is important up to a volume of 200 new cases per year. For economic investment to be justified, it is desirable that intake rises to at least 200 new cases per year. Our result is in-line with the EUSOMA recommendation.

Ambulatory Care↗
PubMed2005

New outpatient referrals to a tertiary paediatric cardiac centre: evidence of increasing workload and evolving patterns of referral.

OBJECTIVES: To assess the volume and range of diagnosis in new patients referred to paediatric cardiac outpatient clinics. METHODS: Data was collected prospectively, using a proforma completed at all outpatient clinics over a period of three months. RESULTS: There were 526 new referrals, representing an increase of almost one-fifth compared to 5 years ago. Of the referrals, 78 percent came from hospital doctors, and 22 percent from general practitioners, with 221 of those referred being infants. A heart murmur was the most common reason for referral, representing almost two-thirds of cases. In 372 patients referred (71 percent), the heart was discovered to be structurally normal. The proportion of patients with normal hearts referred by general practitioners and hospital doctors were 81 percent, and 68 percent, respectively (p less than 0.004). There was considerable variation in the pattern of referral between doctors working in different hospitals. CONCLUSION: New referrals to centres dealing with congenital cardiac malformations are increasing alarmingly, with the majority of the children referred having normal hearts. This increase in demand for specialist services has important implications for resources and training.

Adolescent↗
PubMed1999

An overhead specimen handling system for variable workloads.

This unique overhead specimen handling system requires virtually no floor space and only a minimal amount of bench space. It uses state-of-the-art conveyors suspended near the ceiling to transport, log-in and sort blood specimens in standard specimen containers. Specimens placed into the system at bench-level bins are automatically singulated and loaded onto cleated conveyors and lifted to the main conveyor belt near the ceiling. The barcoded labels are then read as the containers are rotated under an optical scanner. The specimens are then diverted to the appropriate branch conveyor and lowered back to the bench level by cleated conveyors. The specimen handling system is rapid and accurate, requires no special containers, allows laboratorians to move unimpeded below it, and is inexpensive by automation standards. Studies show no adverse effect upon the specimens.

Automation↗
PubMed1999

Definitions in obstetric anaesthesia: how should we measure anaesthetic workload and what is 'epidural rate'?

Crude delivery rate is used to calculate requirements for consultant anaesthetic sessions in the UK, but this calculation is arbitrary and ignores differences in case-mix between units. The term 'epidural rate' is commonly used to indicate regional anaesthetic activity but has never been defined. We challenge both these concepts and illustrate our argument by applying different definitions of obstetric anaesthetic activity to prospectively collected maternity data from 31 211 deliveries over 5 years in two hospitals. Number of anaesthetic interventions is a more accurate reflection of obstetric anaesthetic activity than number of deliveries, with Northwick Park Hospital having about 200-600 more deliveries per year than Chelsea & Westminster Hospital but about 300-400 fewer anaesthetic interventions per year. 'Epidural rate' varied by up to 30% according to the definition used. We conclude that number of anaesthetic interventions should replace crude number of deliveries as a measure of obstetric anaesthetic activity, and that the term 'regional anaesthesia rate' should replace 'epidural rate'.

Anesthesia, Epidural↗
PubMed2003

Nursing workloads: the results of a study of Queensland Nurses.

This paper reports the findings of a survey undertaken in Queensland, Australia in October 2001. The participants were registered and enrolled nurses and assistants in nursing who were members of the industrial body - the Queensland Nursing Union (QNU), and who were in paid employment in nursing in Queensland. Participants were selected by random sampling from each of the three major employment groups - the aged care, public and private acute sectors. Of the 2800 invited participants, 1477 responded resulting in an overall response rate of 53%. The findings indicate that over 50% of nurses in the aged-care sector, 32% of nurses in the public and 30% of nurses in the private acute sector experience difficulties in meeting patient needs because of insufficient staffing levels. The nurses in this study also believed that there was poor skills-mix, mostly caused by lack of funding, too few experienced staff or too many inexperienced staff. Many nurses in this study expressed their anger and frustration about their inability to complete their work to their professional satisfaction in the paid time available. Further, many nurses also expressed the view that because of this inability they were planning to leave the nursing profession. These findings are consistent with other research into the nursing workforce both within Australia and internationally.

Acute Disease↗
PubMed1999

Nurses' workload associated with 16-h night shifts. II: Effects of a nap taken during the shifts.

This study aimed at examining the effects on the subjective symptoms in nurses of both timing and length of a 2-h nap during a 16-h night shift. Compared to pre-nap levels, sleepiness, fatigue, and dullness increased immediately after napping. Afterwards, sleepiness decreased significantly, and the other symptoms returned to the pre-nap values. The nurses' subjective symptoms after napping were not associated with the timing of the nap and post-nap fatigue lasted longer as the nap time increased (> 1.5 h). These results suggest that for effective napping during long night shifts, the nap length should be determined carefully to avoid persistent sleep inertia.

Adult↗
PubMed2002

Evolution of the anaesthetic workload--the French experience.

The use of anaesthesia has shown major growth during the period 1975-1985. Increases safety in anaesthesia safety have permitted its use in surgery and in other exploratory procedures involving older patients and those with more severe clinical conditions. A survey, designed by the French Society of Anaesthesiologists, collected and analysed data relating to anaesthesia performed in France in 1996 from a representative sample collected in all French hospitals and clinics; the results of this survey were compared with an earlier survey performed in 1980. The participation rate of hospitals was 98%. The results of this survey showed that, between 1980 and 1996, the number of anaesthetic procedures had increased by 120% and the annual rate had increased from 6.6 to 13.5 anaesthetic procedures per 100 population. The annual rate varied between 5.4 per 100 in girls 5-14 years of age and 30.2 per 100 in men 75-84 years of age. The second important phenomenon which occurred between 1980 and 1996 was a marked increase in regional anaesthesia--from 4 to 23% of all cases. This represents a 14-fold increase in the number of cases involving regional anaesthesia. Anaesthesia for obstetric procedures represented 9% of all cases. Seventy-six per cent of all anaesthetics which were started between midnight and 7.00 a.m. were related to obstetric activities. Changes that occurred in the practice of anaesthesia could be explained by changes in the types of procedure requiring anaesthesia: in 1980, 88% of anaesthetics were required for surgical procedures, while in 1996 surgery accounted for 71% of all cases, obstetrics for 9%, and other procedures for the remaining 20%. The practice of epidural anaesthesia for deliveries has developed markedly in France during recent years, increasing from 1.5 to 51% of all deliveries between 1980 and 1996. This survey has offered an interesting overview of recent developments in anaesthesia--which are probably representative of the evolutionary trends in most industrialized countries. These changes can be summarized in three major points: (i) a global increase in the use of anaesthesia related to improvements in its safety; (ii) a significantly increased use of anaesthesia in elderly patients; and (iii) a marked increase in regional anaesthesia.

Adolescent↗