Significant Increase In Workload Research Articles

Data analysis of patients admitted to the emergency medicine clinic of Mersin City Training and Research Hospital after the Kahramanmaraş earthquake.

In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster's impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way. A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis. Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases. This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.

Teachers’ Perception of Some Effects of the COVID-19 Lockdown: The Case Study of Ludovika University of Public Service

The COVID-19 lockdown has had serious consequences, including rethinking higher education. The study aims to enhance the knowledge base of online education and academic integrity through a case study of the Ludovika University of Public Service (LUPS), Budapest, Hungary. The research aimed to assess the teachers’ experience with distance learning and examinations, including the change in workload, digital competencies, Moodle, Turnitin, and other software used during and after the lockdown. This paper summarizes the university-level policy changes induced during the lockdown, covering the introduction of emergency distance teaching and online examinations in academic integrity at the university. Two years after the first lockdown, the researchers made a survey (n = 145) about the continuation of the introduced solutions. The results show that a remarkable reordering started while the technical and technological backgrounds were available for the changes. The teachers could feel a significant increase in workload with distance education and have low trust in maintaining the standards of academic integrity. However, the research shows moderate and low levels of digital competencies in the majority of teachers, which clearly defines the most crucial task leading to success. Maintaining the monitoring system with objective indicators of the development and the opinions of the interested parties is essential for successful strategies in the field.

An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention.

Screening and brief interventions (SBI) can help identify opioid safety risks and healthcare professionals can accordingly intervene without a significant increase in workload. Pharmacists, one of the most accessible healthcare professionals, are uniquely positioned to offer SBI. To design an effective intervention with high potential for implementation, we explored pharmacist needs and barriers regarding SBI for opioid use disorders. Using the Consolidated Framework for Implementation Research (CFIR), we conducted 11 semi-structured 60-minute interviews with community pharmacists. We used a purposeful sample of English-speaking pharmacists practicing in varied pharmacies (small independent, large-chain, specialty-retail) and positions (managers, owners, full-time/part-time pharmacists). Transcriptions were analyzed using deductive content analysis based on CFIR constructs, followed by inductive open coding. Utilizing a theoretical framework for data collection and analysis, a diverse sample of pharmacist roles, peer debriefing, and 2 independent coders for each transcript, altogether increased the credibility and transferability of our research. Data collection and analysis continued until data saturation was achieved. Pharmacists described good working relationships with colleagues, organization cultures that were open to new initiatives, and believed the SBI to be compatible with their organization goals and pharmacy structure, which are facilitators for future SBI implementation. Pharmacists were motivated by improved patient outcomes, more patient interaction and clinical roles, representing facilitators at the individual level. They also described stigma toward patients, mixed need for change, and lack of knowledge regarding SBI, which are potential barriers to be addressed. Pharmacists believed that the SBI model was adaptable, not complicated, and benefits outweighed implementation costs. We addressed current SBI literature gaps-mainly lack of focus on implementation and contextual data, through rigorous implementation-focused qualitative research. Our exploratory findings have direct implications on future pharmacy-based SBI implementation.

Assessment of psychological and physical stressors among nurses in different functional areas before and during the COVID-19 pandemic: a cross-sectional study

BackgroundThe COVID-19 (coronavirus disease) pandemic placed a great burden on all health-care resources, especially nurses. The prevalence and underlying risk factors of affective symptoms related to the COVID-19 pandemic have been studied primarily among nurses in intensive care units (ICU) and emergency departments. The aim of this study was to identify at-risk nursing areas by examining the psychological and physical stress values of nurses in different functional areas.MethodsA questionnaire with standardized items was developed to assess psychological and physical stress values. At least 50 nurses with a minimum work experience of 3 years were recruited from the ward, outpatient clinic (OC), intermediate care (IMC) unit, and operating room (OR) of the University Hospital RWTH Aachen. The participants answered the questionnaire by referring to their perceptions before and during the COVID-19 pandemic. Absolute differences and relative trends in psychological and physical stress values were compared within and across functional areas.ResultsThe ward and OR nurses experienced significant increases in workload (p < 0.001 and p = 0.004, respectively) and time stressors (p < 0.001 and p = 0.043, respectively) during the COVID-19 pandemic. Regardless of functional area, the nurses showed strong tendencies toward increases in subclinical affective symptoms. After adjustments for age, sex, working in a shift system, the treatment of patients with COVID-19, and the impact of the COVID-19 pandemic on personal life, the values for working with pleasure decreased significantly among the ward (p = 0.001) and OR nurses (p = 0.009) compared with the OC nurses. In addition, the ward (p < 0.001) and OR nurses (p = 0.024) were significantly more likely to express intent to leave their profession than OC nurses.ConclusionsThe IMC nurses showed good adaptation to the exacerbated situation caused by the COVID-19 pandemic. The ward nurses, followed by the OR nurses, were the most vulnerable to mental and physical exhaustion, which threatened the nurses’ resilience and retention in the wake of the COVID-19 pandemic. Therefore, intervention programs must specifically address the professional and emotional needs of ward and OR nurses to prepare the health-care system for future crises.

The impact of digital transformation on academic work

In recent years, the digital transformation of Higher Education (HE) has had a significant impact on educators and teaching practices across the sector. New ways of working have led to teachers experiencing more pressure to develop technical expertise while simultaneously supporting students through a labyrinth of change. This small-scale explorative study investigates educators’ experiences of working and teaching online in a teaching-focused institution through the lens of Leavitt’s Diamond Model (1964). The data collected consists of six semi-structured interviews with teachers working in a teaching-focused university. The study indicates that many participants have experienced a significant increase in workload since the Covid-19 pandemic, with some exhibiting signs of technostress associated with online working (Panisoara et al., 2021). This seemed especially prevalent with more senior academics as policies and digital infrastructure appear to have led to additional administrative burdens. Despite these findings, the research suggests that Information Communication Technology (ICT) may not be the sole cause for this, but rather, it is a symptom of a more complex phenomenon. It has been further suggested that as the HE landscape evolved, little emphasis has been placed on how organisational initiatives influenced the structure, work tasks, technology, and teachers’ experiences. Due to the limited scope of this study, it is unclear if this is an isolated situation within the school or a more extensive sector-wide issue. Nevertheless, Higher Education managers and policymakers may benefit from applying integrated change strategies if they are to better support teachers and adopt a more balanced work environment post Covid-19.Keywords: academic staff; digital transformation; Leavitt’s Diamond Model; organisational structures; post-pandemic; working and teaching onlinePart of the Special Issue Teaching practices in times of digital transformation <https://doi.org/10.21428/8c225f6e.ac86609b>

Female Endocrinologists May Be Disproportionately Burdened by Electronic Health Record Messaging

Since the institution of the electronic health record (EHR), there has been a significant change in healthcare delivery and the workflow of a physician; however, until recently, there was not recognition of this significant increase in workload that the EHR places on physicians. The EHR shifts many tasks to physicians and gives patients direct access to their physician through patient initiated messaging resulting in increased time spent facing the computer and a larger amount of EHR work that is completed outside of working hours 1 Muhiyaddin R. Elfadl A. Mohamed E. et al. Electronic Health Records and Physician Burnout: A Scoping Review. Stud Health Technol Inform. 2022; 289: 481-484 PubMed Google Scholar . Additional hours spent on the computer has increasingly caused physician dissatisfaction. 1 Muhiyaddin R. Elfadl A. Mohamed E. et al. Electronic Health Records and Physician Burnout: A Scoping Review. Stud Health Technol Inform. 2022; 289: 481-484 PubMed Google Scholar This combined with other increased administrative burdens such as prior authorizations have negatively impacted physician work satisfaction. 2 Sundarum P. Bhatt V. Feustel P. Mian B. Burden of Prior Authorization Requirements on Urology Practice and Patients. Urology. 2022; 169: 76-83 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar

The Instructors’ Competencies and Experiences in Online Teaching

This study aims to examine the online teaching processes of instructors in higher education in detail and reveal their online teaching competencies. The study employed a convergent parallel mixed method design, where the comparative method was used in the quantitative part of the research and the qualitative part was designed as a descriptive case study. The data were collected from 490 online instructors in various departments of a state university in Turkey. A questionnaire was used to reveal the instructors' practices, experiences, opinions, and online teaching competencies in the emergency remote teaching process. The results indicated that instructors mostly preferred Zoom for synchronous and Canvas for asynchronous applications in online education. The online teaching competencies of instructors in pedagogy, technology, and facilitation dimensions were found to be quite high, while course administration competencies were intermediate. According to the qualitative dimension of the research, most of the instructors reported a significant increase in workload due to online education. They also cited the advantages of online education as well as the pedagogical and technical difficulties encountered. Keywords: teaching competencies, online instructors, online higher education, covid-19 pandemic, online teaching

Early aortic valve replacement improves exercise capacity in truly asymptomatic patients with severe aortic stenosis

Abstract Background Exercise capacity is a strong predictor of morbidity and mortality overall. In severe aortic stenosis (AS) ustained pressure overload during watchful waiting is associated with LV structural and functional deterioration and impaired clinical outcome both pre- and post aortic valve replacement (AVR). The effect of early surgical aortic valve replacement (SAVR) in asymptomatic patients with severe AS and normal left ventricular function on exercise capacity in unknown. Aim We investigated whether the early surgical AVR in truly asymptomatic patients with severe aortic stenosis and normal LVEF improves the exercise capacity. Methods This is a sub-analysis or the AVATAR trial (NCT02436655), which is international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area ≤1 cm2 with aortic jet velocity &amp;gt;4 m/s or a mean transaortic gradient ≥40 mm Hg), and with normal left ventricular function. Patients underwent cardiopulmonary exercise testing (supine bicycle, ramp protocol, 15 W/min) at the baseline and 12 months following the randomization. Patients who had positive exercise testing at baseline visit were excluded. We compared the value of workload (in WATs), VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope at the inclusion and at 12 months. Results Total of 157 patients (mean age, 67 years; 57% men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79). Mean LVEF and Vmax in early surgery and conservative treatment group were 70% and 4.5m/s and 69% and 4.5m/s, respectively. After 12 months in patients with conservative treatment there was a slight decrease in the values of workload, VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope, but without statistical significance. However operated patients showed a significant increase in workload (115.4±38.4 watts at 12 months vs 104.8±42.2 at inclusion, p=0.038) and VO2 max (19.7±6.8 at 12 months vs 16.2±5.4 at the inclusion, p=0.048), while there was slight increase in the values of VO2 AT, VEVCO2 and PETCO2 but without statistical significance. Conclusion Early SAVR improve the functional capacity in asymptomatic patients with severe aortic stenosis and normal left ventricular ejection fraction Funding Acknowledgement Type of funding sources: None.

THE IMPACT OF COVID-19 PANDEMIC ON PERSONAL AND PROFESSIONAL LIFE OF KARACHI UNIVERSITY TEACHERS

The COVID-19 epidemic has posed substantial issues to the global higher education sector, particularly in Pakistan. The global academic community responded to the COVID-19 epidemic by shifting to distance learning, with the vast majority of courses being provided online throughout the outbreak. A large number of researchers have shared their work on online teaching and learning in a variety of various methods with the public. As a result of the global epidemic, several Schools, Colleges, and Universities have cancelled physical education programs. In this research report, we discovered that the COVID-19 pandemic, as well as social and emotional pressures, was the primary causes of the negative effects on Karachi University Faculty. These consequences reveal themselves in the participants' personal as well as professional lives. In terms of their professional role, participants reported that the additional time and attention that they dedicated to learning new technologies, implementing new teaching practices, receiving support from co-faculty members, and striving to meet their perceived obligations as scholars had an emotional impact. While conducting online classes during the COVID-19 epidemic, this study focuses on a number of concerns and challenges that University Faculty encountered. Faculty members are dealing with high levels of stress, hopelessness, rage, and grief. There is a significant increase in workload, and they claim that their work-life balance has deteriorated. They talked about the strategies, tools, and tactics they used to get out of this situation, whined about technology, and went back to their normal lives, emphasising the impact of trauma on both their personal and professional lives. They also talked about the impact of trauma on their personal and professional lives. There has been a substantial impact on the lives of faculty members as a result of the epidemic, with possibly important effects for the future. The findings imply that efforts should be made to improve assistance and professional training sessions should be held at the departmental and faculty levels to enable them to continue their research and other educational activities without experiencing stress or trauma in the future.

STUDY OF THE INFLUENCE OF DISTANCE FORM OF LEARNING ON THE LIFE ACTIVITIES OF STUDENTS OF PHARMACISTS IN THE CONVENTION OF THE COVID-19 PANDEMIC

Currently, the problem of distance learning covers almost all institutions of higher education in Ukraine. The Ministries of Education of all countries of the world, without exception, are forced to respond quickly to changes in everyday life caused by the pandemic, and make adaptive decisions on the organization of the educational process and the provision of distance learning. Distance education is now seen as the only form of education possible in a pandemic caused by COVID-19. As it is unknown how long we will be in quarantine zones, and the educational process must continue, therefore, it is important to study the impact of distance learning on the lives of higher education in Ukraine in a pandemic. To this end, we conducted a voluntary anonymous survey of 56 domestic full-time students of the Department of Pharmacy of Ivano-Frankivsk National Medical University. Theoretical, empirical and statistical research methods were used during the research.&#x0D; The article analyzes the results of online surveys of students on the impact of distance learning on their lives. The results show that half of the students surveyed said that nothing had changed for them in terms of workload during distance learning, more than a third said that the workload had increased significantly, and almost a fifth admitted that the workload during distance learning had become less.&#x0D; Most students noted that distance learning had a negative effect on their sleep, they could not organize the daily routine so as to go to bed on time. Almost a third of students said that distance learning had a positive effect on the quality and mode of sleep, due to increased time spent at home. One-fifth said that distance learning did not affect their sleep patterns.&#x0D; The majority of respondents noted that distance learning had a positive effect on eating due to being at home and increasing the time for healthy cooking. Instead, a third of respondents said that distance learning did not affect their diet.&#x0D; Most pharmacy students reported that their physical activity decreased due to reduced leisure time and limited mobility, and only a few students said that this form of study did not affect their activity. None of the respondents noted an increase in physical activity during distance learning.&#x0D; Most respondents voted to impair the ability to memorize all kinds of information, while about one-fifth said that distance learning did not affect the quality of memorization.&#x0D; More than half of the students surveyed said that it is much harder to focus on a class that is online than on a regular class. The students noted that they felt significant emotional stress when attending distance learning classes. One third of the students answered that they did not feel any stress.&#x0D; Almost half of the respondents consider full-time learning to be the best option, more than a third of students preferred blended learning, while the rest are satisfied with distance learning.&#x0D; Three-quarters of the pharmacy students surveyed want to return to their usual routine as soon as possible.&#x0D; So, summarizing the above, we can conclude that more than a third of students reported a significant increase in workload and emotional stress when attending distance learning. Most students noted the negative impact of distance learning on physical activity, sleep and memory. Most respondents noted the positive impact of distance learning on their diet. Half of the respondents think that the best way to master the material is full-time education and want to return to the usual mode of study as soon as possible.

Burnout and Health Issues among Prehospital Personnel in Taiwan Fire Departments during a Sudden Spike in Community COVID-19 Cases: A Cross-Sectional Study.

A spike in COVID-19 cases in Taiwan’s communities caused a significant increase in workload and infection concerns among prehospital personnel working in Taiwan fire departments. The present study was aimed at investigating their health status during this period. The target population was prehospital personnel who are from Taiwan fire departments, and who responded to COVID-19 patients during the community outbreak period. A questionnaire was employed to assess their physical and mental health status. The results showed that prehospital personnel suffered from moderate to severe degrees of burnout. Workload, body burden, and perceived pressure increased significantly during this period. Participants received more support from friends, family, and colleagues than they did from authorities. The paramedics reported higher scores for personal burnout than the emergency medical technicians (EMTs). Compared to non-COVID-19 response units, special COVID-19 response units reported higher scores for workload, body burden, and supportive environment. The results suggested that personal and work-related burnout were associated with higher perceived pressure. This study is the first investigation of physical and mental health burdens among prehospital personnel in Taiwan fire departments during the COVID-19 pandemic. The physical and mental health status of these personnel should be continuously monitored, and intervention provided as necessary.

Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project.

This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.

CRITICAL UNDERSTANDING OF THE EXPERIENCE OF UNIVERSITY TEACHERS FOR USING ONLINE TECHNOLOGIES IN EDUCATIONAL PROCESS ON THE EXAMPLE OF KALININGRAD, TYUMEN OBLASTS AND PRIMORSKY KRAI

The experience of using online technologies in the educational process of higher education institutions in Kaliningrad, Tyumen and Vladivostok is summarized. The main positive and negative aspects of transferring education to the information environment are analyzed. The results of a survey conducted among students of the Institute of recreation, tourism and physical culture of the Kant Baltic Federal University (BFU), teachers and students of the Tyumen State Medical University (TSMU, Tyumen SMU) and teachers of the far Eastern Federal University (FEFU) are presented. The research findings are presented and discussed at the round table of the Moscow international salon of education (MISE). The article contains general conclusions made by the interregional public organization "League of Higher School Teachers" about the existing problems of teachers' work. Teachers note a significant increase in workload due to the transition to distance learning, technical problems, imperfect communication means, lack of equipment and software, difficulties when working with University electronic educational resources. Students note insufficient quality of distance learning, lack of practice, lack of contact with the teacher and communication with classmates. However, all participants in the educational process believe that e-learning is possible as an additional tool that expands the traditional forms of teaching at the University, for some disciplines that are more theoretical in nature, the distance option is acceptable. In addition, experts of the League of Higher School Teachers draw conclusions about the need to reform the archaic system of higher education regulation in the direction of increasing confidence in the competence of teachers, simplifying the control function, reducing bureaucratization, etc.

Effect of high-intensity interval training on cardiorespiratory fitness, physical activity and body composition in people with schizophrenia: a randomized controlled trial

BackgroundExercise may improve cardiorespiratory fitness in people with schizophrenia, however, possible condition-specific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group. The primary aim of this study, therefore, was to investigate the effect of high-intensity interval training on VO2max in people with schizophrenia. Second, we sought to determine whether the intervention would have an effect on general physical activity (PA) level and body composition.MethodsEighty-two patients with schizophrenia were randomly assigned to supervised high-intensity interval training or computer gaming skills training, performed twice a week for 12 weeks. Oxygen uptake was measured directly, during a maximum exercise session on a treadmill. PA level were assessed using ActiGraph accelerometer, and body composition was assessed by bioelectrical impedance. Differences between groups were assessed by analysis of variance using a univariate general linear model.ResultsThere were no significant differences between the groups on any of the cardiorespiratory variables neither at baseline nor after the program. There were also no significant within-group differences in any of the cardiorespiratory fitness variables between the baseline and post-program time points, despite that 61% of the participants performing high-intensity interval training showed a significant increase in workload on the treadmill. However, 47% of the participants in the high-intensity interval training group had a ≥ 5% increase in VO2max. Participants supervised by mental health care providers with PA competence (e.g. rehabilitation center staff, sport scientist, physical trainer) had a much larger increase in VO2max compared to participants supervised by mental health workers without such competence, and when adding PA competence to the model, the intervention group increased VO2max significantly compared to the comparison group. The intervention had no significant effect on PA level or body composition.ConclusionsThe intervention did not improve VO2max, PA level or body composition but succeeded in increasing workload on the treadmill. With regard to VO2max, approximately half of the patients may be considered responders.Trial registrationClinicalTrials.gov; NCT02205684, registered July 2014,

The impact of the COVID-19 pandemic on cardiology services

ObjectiveThe COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking...

Impact of COVID-19 Pandemic on Laboratory Utilization.

BackgroundCoronavirus Disease 2019 (COVID-19) was formally characterized as a pandemic on March 11, 2020. Since that time, the COVID-19 pandemic has led to unprecedented demand for healthcare resources. The purpose of this study was to identify changes in laboratory test utilization in the setting of increasing local incidence of COVID-19.MethodsWe performed a retrospective assessment of laboratory test order and specimen container utilization at a single, urban tertiary care medical center. Data were extracted from the laboratory information system database over a 10-week period, spanning the primordial inflection of COVID-19 incidence in our region. Total testing volumes were calculated during the first and last two-weeks of the observation period and used as reference points to examine the absolute and relative differences in test order volume between the pre-pandemic and COVID-19 surge periods.ResultsBetween February 2, 2020 and April 11, 2020, there were 873,397 tests ordered and final verified. The in-house SARS-CoV-2 PCR positivity rate for admitted patients in the last week of the observation period was 30.8%. Significant increases in workload were observed in the send-out laboratory section and for COVID-19 diagnosis (PCR) and management-related testing. Otherwise, there was a net decrease in overall demand across nearly all laboratory sections. Increases in testing were noted for tests related to COVID-19 management. Viral transport media and citrated blue top containers demonstrated increases in utilization.ConclusionIncreasing local incidence of COVID-19 had a profound impact on laboratory operations. While volume increases were seen for laboratory tests related to COVID-19 diagnostics and management, including some with limited evidence to support their use, overall testing volumes decreased substantially. During events such as COVID-19, monitoring of such patterns can help inform laboratory management, staffing, and test stewardship recommendations for managing resource and supply availability.

The IMPACT of Agent Transparency on Human Performance

The primary purpose of this article is to determine the impact of a simulated agent's transparency on human performance and related variables, such as response time, workload, and trust calibration. The agent supports participants as they complete a base defense task by managing a team of heterogeneous unmanned vehicles and serves as a decision aid to the human. Three conditions of transparency are explored. In condition 1, the agent displays only the basic information (map of vehicle location and proposed routes). In condition 2, the agent displays the basic information and an explanation of its reasoning. In condition 3, the agent displays the basic information, reasoning, and uncertainties involved in the plans. Results show that participants exhibit better performance and trust calibration in the high-transparency conditions without perceiving a significant increase in workload. However, response time also increased, likely due to the additional processing time needed for conditions with more information. Overall, our findings indicate that the increased agent transparency can improve human-agent decision making and performance, but with a small cost of the efficiency (timeliness) of task completion.

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study.

BackgroundInitiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach.ObjectiveThis study aimed to evaluate the clinical effectiveness and feasibility and the patients’ and health care providers’ experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment.MethodsAn observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16).ResultsOf 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] −17.13; P<.001) and T1 and T3 (MD −18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD −0.64; P=.002) and T1 and T3 (MD −0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team.ConclusionsThis intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

Surgical management of head and neck tumours during the SARS-CoV (COVID-19) pandemic

The health emergency caused by the SARS-CoV (Covid-19) pandemic calls for the utmost commitment on the part of every member of the healthcare team and involves a reorganization of the health system to meet exceptional care needs efficiently and effectively. In Lombardy – one of the Italian regions most affected by this pandemic – many public and private hospitals have been wholly reconverted to ensure the treatment of Covid-19 patients. At the same time, other “Covid-free” hospitals have been identified and designated to treat all other diseases and conditions safely. As a consequence of this reorganization, specific cancer centres, including the European Institute of Oncology, have become regional reference “hubs” for the treatment of cancer patients. A series of organisational and clinical problems has therefore to be addressed as the number of patients to be evaluated and treated increases, while at the same time, it is necessary to ensure that the “hub” remains as“COVID-19-free” as possible over time. These dedicated centres are employed in the treatment of patients referring from different areas, with a significant increase in workload, where, alongside the complexity of oncological disease, there is the overlapping problem of coronavirus infection. Download full article in PDF

Single mission workload and influencing factors in German prehospital emergency medicine - a nationwide prospective survey of 1361emergency missions

BackgroundWorkload is a major determinant of system performance and human well-being. This study aims to evaluate workload in prehospital emergency medicine on a single mission level and investigates influencing factors originating from medical scenarios, patient-provider interaction, EMS logistics and teamwork.MethodsIn a nationwide study, German paramedics were asked to evaluate single missions for perceived workload by completing the NASA Task-Load-Index (TLX). A variety of candidate variables were documented and tested for influence on the TLX through multivariate regression analysis.ResultsOne thousand three hundred sixty-one emergency missions were analysed. Global workload scored in medium ranges (Median TLX 41.00/100; IQR 24.25–57.50). 263 missions achieved very low (< 20/100) and 52 missions achieved very high (> 80/100) levels of workload. Severity of distress as indicated by the NACA score (delta TLX 2.71 per 1 NACA point), execution of invasive procedures (e.g. delta TLX 8.20 for intravenous access), obese patients (delta TLX 0.05 per 1 kg of weight) and aggression incidences (e.g. delta TLX 10.54 for physical aggression), amongst others, resulted in significant increases in workload. Good teamwork decreased workload by 2.18 points per 1 point on the Weller-Teamwork Measurement Tool.ConclusionDistinct factors result in significant increases in workload for EMS paramedics. Improvements in training for certain medical scenarios, strategies against aggression events and enhancements in EMS logistics - especially for the transfer of obese patients – should be implemented and tested for their presumably positive effect on workload, EMS performance and paramedics’ well-being.