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PubMed2005

The costs of care in general practice: patients compared by the council tax valuation band of their home address.

BACKGROUND: It is difficult to measure and compare workload in UK general practice. A GP/health economist team recently proposed a means of calculating the unit cost of a GP consulting. It is therefore now possible to extrapolate to the costs of other clinical tasks in a practice and then to compare the workloads of caring for different patients and compare between practices. OBJECTIVES: The study aims were: (i) to estimate the relative costs of daily clinical activities within a practice (implying workload); and (ii) to compare the costs of caring for different types of patients categorized by gender, by age, and by socio-economic status as marked by the Council Tax Valuation Band (CTVB) of home address. METHODS: The study design was a cross-sectional cost comparison of all clinical activity aggregated, by patient, over one year in an English semi-rural general practice. The subjects were 3339 practice patients, randomly selected. The main outcome measures were costs per clinical domain and overall costs per patient per year; both then compared by gender, age group and by CTVB. RESULTS: CTVB is as significant a predictor of patient care cost (workload) as is patient gender and age (both already known). CONCLUSIONS: It is now possible to estimate the cost of care of different patients in such a way that NHS planning and especially resource allocation to practices could be improved.

Catchment Area, Health↗

PubMed1998

Unplanned extubation: risk factors of development and predictive criteria for reintubation.

OBJECTIVES: To define patients at risk for unplanned extubation; to assess the influence of nursing workload on the incidence of unplanned extubation; and to determine predictive criteria for patients requiring reintubation. DESIGN: A prospective, case-control study, with 10 and 15 mos of data collection. SETTING: University medical intensive care department. PATIENTS: In the first study, which lasted 10 mos, unplanned extubation occurred in 40 (14%) of 281 ventilated and intubated patients; 36 cases were sufficiently documented to be compared with 74 intubated and ventilated controls. In the second study, which lasted 15 mos, the reintubated patients (n=23) of a series of 62 unplanned extubation patients were compared with those who were not reintubated (n=39). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following parameters were recorded: gender, age, main reason for admission, Simplified Acute Physiology Score II, route of intubation (oral or nasotracheal), tube diameter, ventilatory mode, FiO2, frequency and tidal volume delivered by the ventilator immediately before unplanned extubation, arterial blood gases performed 24 hrs before unplanned extubation, the presence of any sedation with, in this case, the last Ramsay score, the presence of hand restraints, the presence of weaning of ventilation, the accidental or deliberate nature of unplanned extubation, the Glasgow Coma Score at the time of unplanned extubation, the duration of ventilation before unplanned extubation, total duration of ventilation and stay in the intensive care unit, and the patient's survival or death. The nursing workload was evaluated using a score derived from the Projet de Recherche en Nursing and adapted to intensive care. Unplanned extubation patients were more frequently intubated orally than controls (33.3% vs. 14.9%, respectively; p< .05). In the population of sedated patients, unplanned extubation patients were more frequently agitated than controls (60% vs. 19%, respectively; p < .05). The nursing workload did not differ between days with and days without unplanned extubation. Twenty-three (37%) of the 62 cases of documented unplanned extubation were reintubated. Predictive factors of reintubation are, in decreasing order of importance: Glasgow Coma Score of <11, accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa). CONCLUSIONS: Patients at risk for unplanned extubation are characterized by oral intubation and insufficient sedation. In the department studied, and with the specific score used, we did not observe a relationship between the nursing workload and the incidence of unplanned extubation. A Glasgow Coma Score of <11, the accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa) are factors associated with a risk of reintubation.

Accidents↗

PubMed2006

On-call stress among Finnish anaesthetists.

We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.

Adult↗

PubMed2006

Workforce issues in nursing in Queensland: 2001 and 2004.

AIM AND OBJECTIVES: The aim of the study was to identify the factors having an impact upon nursing work and to use the results to inform strategic planning of the Queensland Nurses Union. BACKGROUND: In 2001 and 2004, a study was undertaken to gather data on the level of satisfaction of nurses with their working life. This paper reports the 2004 results on workload, skill mix, remuneration and morale. Where applicable, the results are compared with 2001 data. METHODS: A questionnaire was mailed to 3000 Assistants-in-Nursing, Enrolled and Registered Nurses in October 2004. All participants were members of the Queensland Nurses Union. The results are reported in three sectors - public, private and aged care. A total of 1349 nurses responded to the survey, a response rate of 45%. RESULTS: Nurses in the 2004 study believed: their workload was heavy; their skills and experience poorly rewarded; work stress was high; morale was perceived to be poor and, similar to 2001, deteriorating; the skill mix was often inadequate; and the majority of nurses were unable to complete their work in the time available. Nursing morale was found to be associated with autonomy, workplace equipment, workplace safety, teamwork, work stress, the physical demand of nursing work, workload, rewards for skills and experience, career prospects, status of nursing and remuneration. CONCLUSIONS: Overall the findings of the study are consistent with those determined by the 2001 survey. RELEVANCE TO CLINICAL PRACTICE: The findings of this study indicate the importance of factors such as workplace autonomy, teamwork, the levels of workplace stress, workload and remuneration on nursing morale. The data also indicate that workplace safety and workplace morale are linked. These findings provide information for policy makers and nurse managers on areas that need to be addressed to retain nurses within aged care, acute hospital and community nursing.

Adult↗

PubMed2005

Students' opinions about their preparation for clinical practice.

INTRODUCTION: There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre-clinical to clinical training causes problems. OBJECTIVES: To seek quantitative verification of qualitative findings from an earlier focus group study on problems medical students encounter when entering the clinical phase of undergraduate training. METHODS: At the start of the clinical phase, all Year 4 students at Maastricht Medical School were surveyed on the transition from pre-clinical to clinical training and its effects on workload, knowledge, skills and learning. RESULTS: The response rate was 67%. Students were uncertain as to how to behave and act, mainly because they did not know what was expected of them. They experienced a drastic increase in workload and a lack of time for studying. They considered themselves to be moderately prepared with regard to knowledge and they regarded their physical examination skills as satisfactory. Students reported having difficulty applying theoretical knowledge in clinical practice and perceived shortcomings in basic science knowledge. In addition, they felt compelled to change their learning strategies. DISCUSSION: The results of this study confirm the findings of the focus group study. The students experienced problems related to professional socialisation and workload and deficiencies in knowledge and the organisation of knowledge. A good starting point for improvement may involve exploring students' suggestions of an extensive introduction into the clerkships, a more gradual transition with regard to workload and closer integration of pre-clinical and clinical education.

Adult↗

PubMed2004

Renewal of the clinical-phase dental curriculum to promote better learning at the University of Oulu.

The degree awarded to a dentist in Finland is Licentiate of Dentistry, and it takes 5 years to achieve it. The old curriculum at the Institute of Dentistry, University of Oulu, Finland, was based on the departmental division, and there was minimal integration between the disciplines. According to student feedback, the old curriculum was overloaded. The amount of contact teaching was up to 40 h per week throughout the academic year. Based on the workload regulation model launched at the University of Oulu, the actual workload of students for three clinical years was found to exceed the confirmed curriculum (40 study weeks per year for 3 years, representing 180 European Credit Transfer System (ECTS) credits) by 68 ECTS credits (representing 45.3 study weeks). Because of the heavy workload, students did not have time actively to deepen their scientific reasoning. To tackle this problem and to maintain the high academic standards, the Institute of Dentistry, University of Oulu, Finland, decided to change the dental curriculum. The properties and qualities of the competent dentist were listed and arranged in the corners of an octagonal to provide the model of the key dental competencies. Based on this, a thorough core analysis of the courses was carried out by the departments. The new curriculum consists of 10 broader integrative entities, so called dental teaching strands (DTSs), wherein the teaching given by the different departments has been combined. The effort was successful. We managed to remove overlap in the substance of the courses to reduce the students' actual workload by about 45 ECTS credits (representing 30 study weeks and 1200 h of studying) and to promote better scientific reasoning and learning results. The authentic learning and comprehensive patient care comprise the core of the clinical practice.

Clinical Competence↗

PubMed1997

Neonatal intensive care provision in the United Kingdom 1992-3. British Association of Perinatal Medicine.

Medical neonatal units in the United Kingdom were surveyed in 1994 to determine for 1992-3 the number of cots, medical and nursing staff, workload, the ability of units to retrieve data and to assess any changes that might have occurred since the NHS reforms. There was an 84% response rate. Many units were unable to provide workload and birthweight specific information. Cot occupancy, and there-fore the exposure of individual neonatal nurses to babies requiring intensive care, increased in direct proportion to unit workload. In spite of this a third of all neonatal intensive care, even for babies of < 100 g, is provided by units with ventilator workloads of 50 or fewer babies a year. There was a 25% increase in intensive care level 1 (ICL1) cot provision between 1989 and 1993, but no change in the total number of cots. Consistent maintenance of a common dataset by all units undertaking neonatal intensive care would do much to assist future planning.

Health Care Surveys↗

PubMed2006

Gender differences in work-home interplay and symptom perception among Swedish white-collar employees.

OBJECTIVE: To analyse gender differences in paid and unpaid workload and symptoms in matched groups of Swedish white-collar workers with children. DESIGN AND SETTING: Paid and unpaid workload and perceived stress from paid work, conflict between demands and control over household work were measured by a total workload (TWL) questionnaire. Some symptoms were rated with regard to frequency and severity as a measure of health. Cross-sectional analyses were performed. PARTICIPANTS: Matched groups of male (n = 440) and female (n = 529) well-educated white-collar workers in full-time employment, aged 32-58 years and living with children in the home. RESULTS: Women in higher positions in Sweden are healthier than the average population of women, but report more symptoms than men in the same position as well as more stress from paid work, more conflict between demands and a greater TWL. However, women also reported more control over household duties and TWL was not associated with more symptoms. The men were mainly focused on their paid work role and perhaps even more so than men in the general population as they were fairly resistant to feelings of conflicting demands. CONCLUSION: Even among matched groups of full-time employed, well-educated men and women, traditional gender differences in division of responsibilities and time allocation were found. Even though the women were healthy at this stage, they might risk future ill health, owing to high workload, stress and feelings of conflicting demands.

Adult↗

PubMed1994

Cervical screening: the optimum visit plan for contacting users and non-users in Scotland.

OBJECTIVE: To investigate the numbers of visits required to obtain interviews with users and non-users of cervical screening, and to determine the workload involved to enable an optimum visit plan to be developed. DESIGN: Case-control study of users and non-users of cervical screening using a flexible visit plan that involved up to eight attempts at contact. Visits were made in mornings, afternoons, and evenings, the visit pattern being determined by information gained from local sources. PATIENTS: Altogether 660 non-users of cervical screening (cases), aged 20-64 and registered with 23 randomly selected general practitioners (GPs), were identified from the Tayside computerised register of cervical smears. These women were selected from the computerised lists of 18 GPs in Dundee and five in Perth. A total of 417 women recorded as having a smear within the previous three years (controls), matched by age and GP, were also identified from the computerised register. RESULTS: Altogether 1834 attempts were made to contact the cases, of whom 339 were interviewed, giving a workload of 18 interviews per 100 attempts. For the controls 1359 attempts were made at contact to yield 339 interviews, a workload of 25 interviews per 100 attempts. Refusals (19%) and incorrect addresses (23%) were the two major reasons for failing to achieve interview. Only for four (0.6%) of the cases and one (0.2%) of the controls was no information gained. The proportion of attempts which led to interview remained constant with increasing numbers of call-backs (up to six for the cases and eight for the controls). CONCLUSIONS: A flexible approach to visit scheduling that takes account of local knowledge can lead to interviews with 66% of non-users of health screening, when incorrect addresses are removed. It is preferable to plan for many (up to six) visits to achieve interview. This will minimise non-response bias without increasing the workload per successful interview.

Adult↗

PubMed1998

Epicondylitis among cooks in nursery schools.

OBJECTIVES: To investigate the prevalence and risk factors of epicondylitis among cooks in nursery schools in a cross sectional study because they are suspected to have strenuous workloads on the hands and arms. METHODS: Prevalence of epicondylitis among 209 nursery school cooks and 366 control workers aged 40-59 were studied. Both groups consisted of women workers chosen from 1299 subjects who agreed to participate from 1329 social welfare employees in a city. All workers were interviewed with a questionnaire and had a clinical examination of the tenderness to palpation of epicondyles and epicondylar pain provoked by resisted extension and flexion of the wrist. RESULTS: Nursery school cooks had a significantly higher prevalence of epicondylitis (11.5%) than the controls (2.5%). In a logistic regression model, job title of the cook was also found to have a strong association with epicondylitis (odds ratio (OR) 5.4, 95% confidence interval (95% CI) 2.4 to 11.9) after adjustment for age, body length, and body mass index. Weaker associations were also found between epicondylitis and suspected job stress or workload scores for mechanical workload and psychosocial stressors based on factor analysis. CONCLUSIONS: This study supported the hypothesis that nursery school cooks had a higher prevalence of epicondylitis than other workers with less strenuous hand and arm tasks. It was suggested that risk factors of epicondylitis would be multifactorial, including mechanical workload and psychosocial factors.

Adult↗

PubMed2002

Job stress, fatigue, and job dissatisfaction in Dutch lorry drivers: towards an occupation specific model of job demands and control.

OBJECTIVES: Building on Karasek's model of job demands and control (JD-C model), this study examined the effects of job control, quantitative workload, and two occupation specific job demands (physical demands and supervisor demands) on fatigue and job dissatisfaction in Dutch lorry drivers. METHODS: From 1181 lorry drivers (adjusted response 63%) self reported information was gathered by questionnaire on the independent variables (job control, quantitative workload, physical demands, and supervisor demands) and the dependent variables (fatigue and job dissatisfaction). Stepwise multiple regression analyses were performed to examine the main effects of job demands and job control and the interaction effect between job control and job demands on fatigue and job dissatisfaction. RESULTS: The inclusion of physical and supervisor demands in the JD-C model explained a significant amount of variance in fatigue (3%) and job dissatisfaction (7%) over and above job control and quantitative workload. Moreover, in accordance with Karasek's interaction hypothesis, job control buffered the positive relation between quantitative workload and job dissatisfaction. CONCLUSIONS: Despite methodological limitations, the results suggest that the inclusion of (occupation) specific job control and job demand measures is a fruitful elaboration of the JD-C model. The occupation specific JD-C model gives occupational stress researchers better insight into the relation between the psychosocial work environment and wellbeing. Moreover, the occupation specific JD-C model may give practitioners more concrete and useful information about risk factors in the psychosocial work environment. Therefore, this model may provide points of departure for effective stress reducing interventions at work.

Adult↗

PubMed1994

Physicians' perceived value of international AIDS conferences and attitudes towards patient attendance.

OBJECTIVE: To determine the perceived value of attendance at an International AIDS Conference and attitudes towards the effect of patient attendance on the conference. DESIGN: A confidential, self-administered questionnaire. PARTICIPANTS: 102 physicians from the United Kingdom who attended the VIII International AIDS Conference in Amsterdam. RESULTS: There was an 84% response rate. 50% reported increased motivation for clinical work and 57% for research. Physicians with a lower HIV positive patient workload found the conference more valuable for finding out the latest information on HIV, compared with those with a higher workload (p = 0.04). Those with a higher patient workload found the conference more useful for increasing motivation for research than those with a lower HIV workload (p = 0.047). Conference attendance was felt to reduce burnout by 48% of respondents. The majority (55%) would prefer a more traditional meeting. Patient attendance was seen as improving the standard of discussion of ethical and political issues but not on medical or scientific issues. CONCLUSIONS: The International AIDS Conferences are perceived as useful by those UK physicians who attend, but most would prefer a more "traditional" scientific meeting. Whilst patient participation was not seen as useful for medical or scientific discussions, it was felt to improve discussion of ethical and political issues. A smaller more focused conference may be equally useful to UK physicians.

Acquired Immunodeficiency Syndrome↗

PubMed2004

[A study of interconsultations requested to an Internal Medicine Department].

BASIS: The medical interconsultation contributes knowledge of a speciality to another one, but implies an important workload. The objective is to define de characteristics of medical interconsultation requested to an Internal Medicine Department and to assess the workload that they involve. PATIENTS AND METHOD: Medical interconsultations requested during 6 months were included. Sex and age of the patient, petitioner department, reason for the interconsultation, follow-up length and referring to other departments were evaluated. RESULTS: 181 medical interconsultation were requested, 53.6% were women. Median age was 68.5 years (17-98), and median follow-up was 6 days (1-76). Surgical departments requested 86.7%. The reason was long pathology in 19.7% and cardiac pathology in 18.9%. There was more than one reason in 53 medical interconsultations. Twelve patients were referred to other departments. CONCLUSIONS: Most of medical interconsultations come from the surgical area. The differences among the petitioner departments are due to their different kind of organization and staffing of to the different types of formation or criteria of requestion physicians. Cardiopulmonary pathology predominates, possibly because of high prevalence of this pathology in the hospital. The workload due to medical interconsultation is similar to workload internists endure in their hospitalization area.

Adolescent↗

PubMed1998

Automation, task difficulty, and aircrew performance.

The effects of an automated system on team processes and performance were assessed in a laboratory simulation. Two-person crews were required to fly a complex emergency-response scenario under conditions of low and high workload. These flights were completed with or without the aid of an autopilot. The results indicated that the autopilot was effective in reducing subjective workload. However, the automation was associated with improved performance on only 1 of 4 performance measures. Furthermore, it was observed that problem-solving performance was worse in the autopilot condition during the high-workload flights. Investigation of crew process data indicated that workload savings afforded by the autopilot might have been invested in more explicit coordination. The results are discussed in terms of their implications for military aviators' performance, system design, and team training.

Adult↗

PubMed2000

Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands.

As women have become more assimilated into the work-force over recent decades, they have realized considerable changes in their work roles which may contribute to health problems and other negative outcomes such as marital strain and diminished job status. The purpose of this review was threefold: (1) to synthesize data on the distribution of women's work efforts in the areas of paid employment, household chores, and childcare; (2) to outline research which addresses the impact of women's workload on their well-being and careers; and (3) to make international and gender comparisons regarding women's work responsibilities. Our findings showed that women from each of the three countries examined--the United States, Sweden, and The Netherlands--contribute more effort to household chores and childcare and less to the workplace than men do. As a result, their total workloads appear to be somewhat greater and more diffusely distributed than those of men. Heavy workloads may adversely affect women's health, especially in the presence of certain role characteristics (e.g., having a clerical, managerial, professional, or executive position, or caring for young children). Heavy work responsibilities may also undermine marital happiness, particularly if there is perceived inequity in the way partners share household work. Finally, women's total work responsibilities often impact their careers due to compensatory reductions in work commitment and job status. These observations point to the need for further research on women's workload and work roles, on the relationship of work to well-being, and on methods of preventing or alleviating adverse effects on overburdened workers.

Adult↗

PubMed2002

Malleable attentional resources theory: a new explanation for the effects of mental underload on performance.

This paper proposes a new theory to account for the effects of underload on performance. Malleable attentional resources theory posits that attentional capacity can change size in response to changes in task demands. As such, the performance decrements associated with mental underload can be explained by a lack of appropriate attentional resources. These proposals were explored in a driving simulator experiment. Vehicle automation was manipulated at 4 levels, and mental workload was assessed with a secondary task. Eye movements were also recorded to determine whether attentional capacity varied with mental workload. The results showed a clear decrease in mental workload associated with some levels of automation. Most striking, though, were the results derived from the eye movement recordings, which demonstrated that attentional capacity varies directly with level of mental workload. These data fully supported the predictions of the new theory. Malleable attentional resources theory suggests that future vehicle designers should employ their technology in driver support systems rather than in automation to replace the driver. The implications of this theory are discussed with regard to capacity models of attention as well as to the design of future vehicle systems.

Adult↗

PubMed1997

Combining time and intensity effects in assessing operator information-processing load.

A quantitative description of the human information processor is required for predicting operator workload and performance from the simulated task time line data generated by task network models and related methods. Although many models of workload exist, few appear to be well founded in theory or to provide a satisfactory basis for a quantitative representation of operator load. Adherents of both time- and intensity-based models of operator load individually claim success for their methods, which might suggest that both factors are operating in determining operator workload and performance. This paper describes a study that explicitly investigates the relationship between a time-based factor and an intensity-based factor (amount of information to be processed) within a simulated air traffic control environment. A model is developed that posits that the load on the human information-processing system results directly from the ratio of the time necessary to process the required information to the time allowable for making a decision. This ratio, which can be identified with time pressure, determines subjective estimates of workload as well as operator performance. The model is tested against the data from the air traffic control simulation.

Adult↗

PubMed1999

[Evaluation of Japanese school lunch cooks' work by foreign researchers: an attempt to promote an effective discussion by presenting a video tape record].

The aim of this study was to collect and examine foreign researchers' evaluations of Japanese school lunch cooks' workload, risk of musculoskeletal disorders, and some related issues by means of video tape discussion method at international conferences. The author reported work-related musculoskeletal disorders of Japanese school lunch cooks' at three international conferences. Together with the presentation a video tape recorded at one school kitchen during working hours was shown and the participants at the conferences were asked to evaluate the workload and risks of the Japanese school lunch cooks in the form of a questionnaire. Out of 151 participants from 21 countries at three conferences, 86 participants from 18 countries answered the questionnaire. The median of the values for Japanese school cooks' workload, derived by the Visual Analogue Scale method ranging from 0 (easy) to 10 (severe), was 8.5. Concerning the possibility of occurrence of musculoskeletal problems, 83% of the respondents pointed out that the occurrence of musculoskeletal disorders was certain, and 17% of them estimated that it was probable. Out of 18 countries from which participants came from, 12 countries were serving meals at school, and school lunch cooks in these 12 countries had similar occupational problems to those in Japan, such as musculoskeletal disorders, skin disorders and injuries, etc. The participants also pointed out that Japanese school lunch cooks were exposed to various problems, i.e., excessive workloads for women, and too few replacements of manual work by machinery. On the other hand, the cleanliness of the school kitchen, quality of meals, and conscientious cooking work were evaluated as very high. There were 36 researchers who asked for a copy of the video tape in order to use it in the education of industrial health personnel, medical students, and so on. These results showed the same tendency as Japanese researchers have found over the past 16 years. The video tape discussion method is proved to be useful in deepening mutual understanding at international conferences.

Bone Diseases↗