Significant Increase In Workload Research Articles

Impact of lack of rehabilitation follow-up care on the functional level and autonomy of vascular hemiplegic patients at Kinshasa University clinics on homecoming

Objective: To evaluate the clinical and functional profile of vascular hemiplegia patients when deciding on their return home after hospitalization and evaluate its impact on their caregivers. Material and Methods: This prospective descriptive study involved 60 patients. It was devoted to the evaluation, on the one hand of the functional level and the autonomy of the patients at the entrance and the decision of the return home, and on the other hand of the social charge felt by the caregivers of these patients. Results: Out of 60 patients (66.7% of men and 33.3% of women, mean age of 62.93 ± 11.3 years), 93% of patients had a score of autonomy less than 60 at home , with no significant difference between the baseline score and the return to home score (p = 0.22), for an average length of stay of 25 ± 12 days. On the other hand, of 60 caregivers, between 72% and 73% of caregivers had a significant homework load, and this load was significant as function and independence levels were low (p = 0.001). Also, a significant increase in workload was observed at home compared to the hospital (p = 0.000). Conclusion: We have emphasized the importance of an acceptable level of autonomy and multidisciplinary cooperation to allow patients to return to their homes in order to ensure a good home care and reduce the heavy burden of caregivers who have also need a better quality of life.

Physical Test to Estimate Suitable Workloads for an Exercise Program in Breast Cancer Survivors.

Guillamó, E, Travier, N, Oviedo, GR, Fonseca-Nunes, A, Alamo, JM, Cos, F, Roca, A, Niño, O, Agudo, A, and Javierre, C. Physical test to estimate suitable workloads for an exercise program in breast cancer survivors. J Strength Cond Res 34(12): 3593-3599, 2020-Epidemiologic studies suggest that patients with breast cancer who gain weight after diagnosis have a higher risk of recurrence and death. Regular physical exercise can help minimize postdiagnosis weight gain. The objective of the study was to assess the effectiveness of a physical test for individualizing the workloads used during a fitness program. To continuously individualize the intensity of the training, a test was designed and integrated into the sessions. The test consisted in monitoring heart rate and workload during 2 bouts of cycling at moderate intensity. The workload parameters recorded during the tests were later used as reference values to plan the intensity of the next in-person training sessions. The 5 tests conducted during the 12 weeks of the intervention showed significant differences in intensity (F = 3.034, p = 0.047). Compared with the first evaluation, the intensities measured during the third, fourth, and fifth tests presented increases of 9.9% (p = 0.02), 13.2% (p = 0.019), and 17.5% (p = 0.002), respectively. A significant increase in workload with respect to body weight was observed in the physical assessment performed after the program (t = 13.2, p = 0.0001). The peak oxygen consumption with respect to body weight (peak V[Combining Dot Above]O2) achieved by the subjects during the assessment at the end of the program had also increased (t = 9.72, p = 0.0001). The intensity test, introduced in the training sessions along with the physical exercise program, was an easy-to-use, practical tool for monitoring intensity. It allows an adjustment of the workload over the program period that respects the individual progression of each patient.

A collaborative improvement project by an NHS Emergency Department and Scottish Ambulance Paramedics to improve the identification and delivery of sepsis 6.

Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department...

From engineer to manager, mastering the transition: effective delegation

Career progression is something all young professionals will experience. However, they can often find themselves facing major challenges for which they are underprepared. This type of role nominally comes with a significant increase in workload and responsibilities that elevate stress levels. Generally, their first attempt is to micromanage every activity, which results in an inefficient use of time. This becomes more evident as the team size and the complexity of the objectives grow and finally become impractical, leading to disastrous failures. An important aspect of leadership is the ability to effectively delegate tasks. Delegation involves handing over the authority, responsibility, and accountability for performing specific duties to others, so that they may act on your behalf. This article highlights six specific aspects of effective delegation for young professionals aspiring to become great managers and leaders.

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

IntroductionAlthough the weightings to be summed in an early warning score (EWS) calculation are small, calculation and other errors occur frequently, potentially impacting on hospital efficiency and patient care. Use of a simpler EWS has the potential to reduce errors. MethodsWe truncated 36 published ‘standard’ EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. Using 1564,153 vital signs observation sets from 68,576 patient care episodes, we compared the discrimination (measured using the area under the receiver operator characteristic curve—AUROC) of each standard EWS and its truncated ‘binary’ equivalent. ResultsThe binary EWSs had lower AUROCs than the standard EWSs in most cases, although for some the difference was not significant. One system, the binary form of the National Early Warning System (NEWS), had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate. ConclusionsThe performance of Binary NEWS is only exceeded by that of standard NEWS. It may be that Binary NEWS, as a simplified system, can be used with fewer errors. However, its introduction could lead to significant increases in workload for ward and rapid response team staff. The balance between fewer errors and a potentially greater workload needs further investigation.

‘Writes a fair hand and appears to be well qualified’: the recruitment of Bank of England clerks, 1800–1815

The financial strains of the Revolutionary and Napoleonic Wars had a significant impact on the Bank of England. In its position as banker to the state and manager of the state's debt, it experienced a significant increase in workload and thus was forced rapidly to expand its workforce. From a complement of around 300 in the mid 1780s, the number of clerks employed had increased to over 900 in 1815. Using a unique set of records preserved in the Bank's archives, this article investigates the backgrounds and skills of the men recruited during the expansion of the early nineteenth century. It finds a significant gap between the skills required by the Bank and the skills possessed by its potential workforce.

Coping with Disaster: General Practitioners’ Perspectives on the Impact of the Canterbury Earthquakes

Aim – To explore the challenges for general practitioners (GPs) following the 2010/2011 Canterbury earthquakes and describe how these were met. Methods – Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring their experiences. Results – The interviews revealed that the GPs faced a range of challenges both in the immediate aftermath of the earthquakes and in the following months. These included dealing with an increased and changed workload, and managing personal concerns. The GPs reflected on their coping behaviour and how their professional practice had changed as a result. Conclusions – All GPs reported significant increases in workload raising questions about the need for coordination of locum support. GPs often found themselves working outside their area of accustomed expertise especially in relation to patients needing financial aid. GPs identified a number of coping behaviours though some only in hindsight. Greater awareness of self-care strategies would benefit GPs responding to disasters.

The impact of regional reconfiguration on the management of appendicitis

Reconfiguration of surgical services in the Mid-West in 2009 resulted in a large increase in numbers of patients undergoing emergency surgery for appendicitis in University Hospital Limerick (UHL). The aim of this study was to assess the impact of reconfiguration on the management of appendicitis in this area. Data on all patients who underwent appendicectomy between January and June 2007 were compared with the corresponding data from January to June 2011. The numbers of operations, types of operations, lengths of stay (LOS), operation start times, rates of negative histology specimens and readmissions within 30 days were compared. One hundred and twenty-five appendicectomies [48 laparoscopic (38.4 %)] were performed in the 2007 group of which 32 specimens (25.6 %) were histologically negative. Three hundred and nineteen appendicectomies [238 laparoscopic (74.6 %)] were performed in the 2011 group of which 62 specimens (19.4 %) were histologically negative. The increase in numbers of laparoscopic procedures was significant (p < 0.001). The reduction in the negative appendicectomy rate was not statistically significant (p = 0.16). There were 10 conversions (20.8 %) to open surgery in the 2007 period and 12 (5 %) in the 2011 period (p = 0.001). Mean LOS for the 2007 and 2011 groups was 4.45 and 3.16 days (p < 0.001). Six (4.8 %) readmissions within 30 days occurred in the 2007 group with 20 (6.3 %) in the 2011 group (p = 0.66). Though reconfiguration of surgical services has resulted in a significant increase in workload, LOS has decreased significantly while maintaining acceptably low negative appendicectomy, conversion and readmission rates.

270 Health and safety experience of commercial janitors

Commercial janitors are an important group of low wage, largely immigrant workers who face significant potential risks at work, and yet have only been minimally studied for occupational injury and...

5.4.2 Competencies Required for Successful Acquisition of Large, Highly Complex Systems of Systems

AbstractA generic competency model for acquiring large, highly complex Systems of Systems is presented. The model combines competencies of systems engineering, systems integration, and software engineering. The model is applied to the U.S. Federal Aviation Administration's (FAA) Next Generation Air Transportation System (NextGen). The FAA is facing the challenge of significant increases in workload for the air traffic control system. NextGen efforts are aimed at providing the changes to the system needed to meet that challenge. In order to be prepared, the FAA is looking at the competencies needed to develop and deploy those improvements.

Formes graves d’infection par le virus A(H1N1)v2009 à La Réunion en 2009 et en 2010

RésuméDans l’hémisphère sud, La Réunion est la sentinelle des infections survenant préférentiellement au cours de l’hiver austral, susceptibles de gagner quelques mois plus tard l’hémisphère nord, telle l’infection à A(H1N1)v2009. Nous rapportons les caractéristiques des patients admis en 2009 et 2010 dans notre service de réanimation principalement pour détresse respiratoire aiguë, à la suite d’une infection à A(H1N1)v2009. Les données démographiques, cliniques, biologiques, ainsi que les traitements et le devenir des patients admis pour infection virale à A(H1N1)v2009 exclusivement confirmée par RT-PCR ont été recueillis de façon prospective. Au cours des années 2009 et 2010, 25 patients ont répondu aux critères définis d’infection à A(H1N1)v2009. L’âge médian était de 40,4 (±17,4) ans. La plupart d’entre eux (22/25) présentaient des facteurs de comorbidité: pathologies chroniques, surpoids ou obésité, grossesse, trisomie. Les principaux motifs d’admission en réanimation ont été les pneumonies virales avec tableau de syndrome de détresse respiratoire aiguë. Le recours à la ventilation artificielle a été nécessaire chez 22 des 25 patients, avec recours à des méthodes sophistiquées et réservées à quelques centres au niveau national, telles que les techniques d’oxygénation extracorporelle (ECMO) ou ventilation à haute fréquence (HFO). Au cours des deux années, 12 décès (48 %) sont survenus essentiellement dans des tableaux de défaillance multiviscérale. Au cours des hivers et automnes australs 2009 et 2010 et pendant une période de plusieurs semaines, l’infection à A(H1N1) v2009 a entraîné une surcharge d’activité notable dans les services de réanimation de La Réunion. L’échec de la campagne de vaccination, notamment des personnes à risques, a eu pour conséquence la survenue de nouveaux cas graves en 2010, notamment parmi les personnes à risques. Le recueil de ces données peut aider à la planification et à l’anticipation de la prise en charge d’autres épidémies grippales.

"An Empirical Study on Occupational Stress in Women Academacians at Workplace"

Although high level of stress has been observed in teachers generally, the higher education sector is a relatively new focus of concern. It has been recognized that organizational change can be the significant cause of occupational stress. Over the past 10 - 20 years, our Indian Higher Education has undergone a more profound reorientation than any other system. The most obvious symptom of change in the sector has been the move towards mass higher education. There has not been corresponding increase in the numbers of academic teaching and support staff. Student staff ratio is now 15:1.There are a lot of colleges coming up. But the pay of the teaching staff member is not up to the mark and Administrative workload is more for the teaching staff members. The widespread changes in the policy and practices have led to a significant increase in workload and job related pressures for many academic staff. This has not been accompanied by a corresponding increase in human and technical resources.

Adherence to National Burn Care Review referral criteria in a paediatric Emergency Department

Introduction The National Burn Care Review (NBCR) gives guidance on the recognition of potentially complex burns requiring assessment and management in a burn unit. This guidance provides a referral framework for those initiating assessment and management of burns. The effect of close adherence to NBCR guidance on workload is at present unknown. Objectives To audit referral patterns of burns in our paediatric Emergency Department (ED) in comparison to NBCR referral criteria. To identify the type of injuries not referred despite meeting criteria, and their outcomes, to assess whether these patients come to any harm short-term. To estimate the effect that closer adherence would have on workload and how our unit proposes to work with the ED to improve its distribution and our patients care. Methods A retrospective case-note audit of patients presenting to a paediatric ED with a triage diagnosis of “burn/scald” over a 6-month period between 1st April and 29th September 2008. Results 190 patients presented with burns during this period, of which 126 (66%) had potentially complex burns. Of these, 93 (74%) were not referred to the burns unit i.e. were “under-referred”. In this group burns to specialized areas in patients under 5 years of age were particularly prevalent. 78 (84%) were reviewed in the ED and received no specialist input. Seven patients suffered minor complications. Only three of these patients (3.2%) required subsequent referral to the burns unit for opinion. None required any further specialist intervention. Conclusion Strict adherence to NBCR referral criteria could result in a significant increase in workload for regional burn units with as yet unquantifiable benefit in patient outcomes. Many minor injuries appear to be safely managed in the ED with little adverse outcome. Even small improvements in practice could result in a considerable workload increase for a burns unit. Further prospective research is required, particularly looking at longer-term outcomes. We are hoping to improve educational and clinical links between our EDs and burn unit to improve patient care and distribution of clinical workload. Further national guidance maybe necessary.

Global vs. local decision support for multiple independent UAV schedule management

As unmanned aerial vehicles (UAVs) become increasingly autonomous, time-critical and complex single-operator systems will require advance prediction and mitigation of schedule conflicts. However, actions that mitigate a current schedule conflict may create future schedule problems. Decision support is needed allowing an operator to evaluate different mission schedule management options in real-time. This paper describes two decision support visualisations for single-operator supervisory control of four independent UAVs performing a time-critical targeting mission. A configural display common to both visualisations, called StarVis, graphically depicts current schedule problems, as well as projections of potential local and global schedule problems. Results from an experiment showed that subjects using the locally optimal StarVis implementation had better performance, higher situational awareness, and no significant increase in workload over a more globally optimal implementation of StarVis. This research effort highlights how the same decision support design applied at different abstraction levels can produce different performance results.

Day case adenoidectomy.

The Audit Commission recommends that more day surgery be undertaken in the Health Service. In a prospective study of 62 children undergoing adenoidectomy one major complication commenced within 2 hours of surgery. Of 15 minor complications, 78% occurred within 6 hours of surgery; they did not herald later major complications. Day adenoidectomy can safely be performed if patients remain in hospital for 6-8 hours post-operatively and then fulfil the following discharge criteria: they are apyrexial, eating, drinking and with no signs of haemorrhage. This will not result in a significant increase in workload for general practitioners. Day adenoidectomy for medically and socially appropriate patients increases our day surgery figures by 74% to 43% of the routine paediatric ENT caseload. There are immediate benefits to patients but the potential economic benefits to the Health Service will not be felt unless these children are treated in a designated Day Case Unit.

Automation and Aids: GPS Outage En-Route Simulation

This study was an initial examination of controllers' ability to manage Global Positioning System outage situations caused by intentional/unintentional radio frequency interference. Twenty-seven certified professional air traffic controllers staffed their on-the-job sectors that were emulated on a high fidelity platform. Three navigational system outage conditions were simulated: no outage, partial outage, and full outage. Three operational environments were also simulated: a current environment, a future avionics equipage environment, and a future avionics equipage environment with ground based navigation aid reductions. The research team collected coordination, task effectiveness measures, and real-time subjective workload ratings. Results indicated the controllers had significant increases in workload and coordination activities due to outages; however, no differences in task effectiveness measures emerged. The overall conclusion made in this study is that although there was a significant effect of outage on workload, controllers were generally able to compensate for the increase. The operational environment was inconsequential.

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.

Severity distribution of atopic dermatitis in the community and its relationship to secondary referral.

Although atopic dermatitis is the most common inflammatory dermatosis affecting children, no previous studies have evaluated the relationship between disease severity and the referral pattern to secondary health care services. We carried out a cross-sectional survey of 1760 children aged 1-5 years selected from the age-sex registers of four urban and semiurban general practices in Nottingham. Atopic dermatitis was diagnosed by a dermatologist on the basis of symptoms and signs of a flexural itchy rash that had been present in the previous 12 months. The severity of atopic dermatitis was assessed clinically by the same dermatologist on the basis of reported symptoms over the previous 12 months and clinical signs, and was graded on a three-point scale as mild, moderate or severe. Information on the use of primary and secondary health care services was recorded at the time of the interview. The 1-year period prevalence of atopic dermatitis was 16.5% (95% confidence interval 14.7-18.2%). The severity distribution of atopic dermatitis was: mild 84% (n = 242), moderate 14% (n = 41) and severe 2% (n = 7). Of those children with atopic dermatitis, 96% (n = 278) had consulted their general practitioner in the previous 12 months and 6% (n = 17) had been seen in secondary care. Overall, 4% (n = 11) of those children with atopic dermatitis had a consultation with a dermatologist. Other sources of secondary care referral included the paediatric department (n = 2) and accident and emergency department (n = 6). Referral to secondary care was found to be positively related to disease severity, with referral occurring in 3% of mild cases, 15% of moderate cases and 43% of severe cases. Although the relative referral rate of mild and moderately severe disease was low, these cases were found to represent a significant proportion (82%) of the total numbers of children seen in secondary care. This study has shown that: (i) most cases of atopic dermatitis in the community are mild in severity; (ii) referral to secondary health care services by general practitioners is infrequent; (iii) disease severity is an important determinant of referral to secondary care; and (iv) any potential change in the referral pattern of mild/moderate cases of atopic dermatitis to secondary care is likely to produce a significant increase in workload for dermatology departments.

Exercise hypoxemia and the effects of increased inspiratory oxygen concentration in severe chronic obstructive pulmonary disease.

Exercise-associated oxygen desaturation in severe chronic obstructive pulmonary disease (COPD) remains a topic of unknown prognostic and clinical relevance and of unknown therapeutic importance. Furthermore, exercise limitation in these patients is due to multifactorial interaction of respiratory, cardiac, circulatory and 'peripheral' mechanisms. For the evaluation of the role of the oxygen-dependent mechanisms of exercise limitation we studied 14 stable patients with severe COPD (FEV1 32% pred., FEV1/VC 41%, thoracic gas volume of 180% pred.) and mean Pa O2 64 mm Hg by a stage 1 cycle exercise test during breathing room air (FiO2 0.21) and hyperoxic (FiO2 0.35) air. The measurements were performed by an open system using a low dead space valve (55 ml) measuring real-time breath by breath oxygen consumption (VO2) via a differential oxygen sensor, expired carbon dioxide (VCO2), ventilation (VE), oxygen pulse and oxygen saturation in both conditions. With FiO2 0.21 the mean exercise limitation was restricted to 37 (+/- 14) W and the VO2 to 11.7 (+/- 2.4) ml/kg/min with peak oxygen desaturation of 86.4 (+/- 3.2). With FiO2 0.35 the patients achieved a significant increase of workload to 55 (+/- 12.4) W and of VO2 to 14.9 (+/- 2.9) ml/kg/min. Despite the complete abolition of exercise desaturation by FIO2 0.35 the mean peak ventilation of 261/min (+/- 5.1) vs. 27 l/min (+/- 4.1) remained unaltered and therefore the restriction of the ventilatory pump limited the exercise ability. The effects of FiO2 0.35 occurred in these patients at submaximum exercise and may be related to reduction of ventilatory cost of energy and delayed onset of metabolic acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Future child and adolescent psychiatrists: a further survey of senior registrar training

Child and adolescent psychiatry is a growing speciality. Significant increases in workload, the reasons for which have been described elsewhere (Black, 1989), have led to an expansion in consultant posts across the UK. Recently the Joint Planning and Advisory Committee (JPAC) reviewed senior registrar numbers and recommended an increase in the establishment by 38 whole-time equivalents in England and Wales, a rise of 38%, to meet the expected shortfall. How existing senior registrars, as well as this large number of new recruits, are trained is clearly a matter of some importance.