Significant Reduction In Workload Research Articles

The Experience of Family Medicine Residents during the Early Phase of COVID-19 Pandemic in Tunisia

The COVID-19 pandemic has overwhelmed healthcare systems particularly the training curriculum for post-graduate medical students. Our aim was to assess family medicine residents’ perceived impact of the COVID-19 pandemic on training and medical education in Tunisia. Methods: We conducted a cross-sectional survey among all Tunisian family medicine residents who were in training during the year 2020. Residents starting their first-year residency studies in 2021 were excluded. A structured questionnaire was created and shared via Google Forms. Residents' anonymity and consent were respected. Results: We included 107 residents (85% females). During the first semester of 2020, a significant reduction in workload was reported including working hours (58.9%), patient's flow (65.1%) and elective admission (83%). The workload tended to partially normalize during the second half of the year. The restriction of academic activities (staff, grand rounds, and congresses) was considered the major obstacle (73.8%) hindering residents’ training. About 72% benefited from E-learning during the second period. By the end of 2020, 48.6% of participants reported being infected by the virus. The majority (97.2%) reported feeling anxious, irritable and/or depressed. The pandemic significantly decreased residents' satisfaction with their medical training (4.22±2.15 before the crisis versus 2.78±1.18 during COVID-19) (p<10-3). Conclusion: The COVID-19 pandemic had decreased residents' level of satisfaction with their training and had negatively affected their mental health. The key findings of the present research can be a starting point to provide high quality residency training and to avoid bypassing their weaknesses in the upcoming outbreaks.

Improving Work Attitudes And Assistive Devices Can Reduce Subjective Complaints And Increase The Productivity Of Weavers

Gringsing weaving products is a part of handicraft or home industry. They are still confessed at present and produced by simple technology with hand in hand. This activity as a business of income from the most of women in Tenganan Pegringsingan Village of Manggis Sub District, Karangasem Regency. A work attitude with no planned well and they do not use a tool instruments for helping then working correctly, it is caused a subjective complaints of the workers so the production is not maximally and will cause the productivity of the workers come down. Woven products workers is required a carefulness and neatness of the workers, with long sitting posture on the flour covered by something material. It is not aware of this problem in to the anatomy and physiology of the workers and they will have a lot of complaint, sick, or pain on their next, hand, low back, anus, thigh, eyes. It is caused static work load frequently, so that they will be to come a decrease activity and low motivations, it’is activity and the work is not done efficient and effective. The variable that is measured in this study is decrease workload, subjective complaint, work efficiency (long work), and work productivity. The research has been studied to the sixteen weaving workers that were chosen without rules with treatment by subject program with cross over design, its analyses unit considering group variance. It has been intervened by work attitude with supporting tool for instant ‘peliper, tingklik, por (supported by sponge), barble, and using eyes glasses and group workers. This study is analyzed by t-paired, and there is a significant work load reduction (p<0.005), which is the pulse of the workers come down from 89,62 beats per minutes to be 82,56 beats per minutes (±5,60) in the same of the light work load category. The subjective complaints of the work load come down showed significant value (p<0.005) that is from Nordic Body Map score 56,92 (16.14) to be 28.86 (7.32). By the efficient work 7 hours a day with support tools, it is to be come the productivity increase (0,34%) and work productivity (7,9%) significantly (p<0.005).

Enhanced Teleoperation Interfaces for Multi-Second Latency Conditions: System Design and Evaluation

Adding human cognitive skills to planetary exploration through remote teleoperation can lead to more valuable scientific data acquisition. Still, even small amounts of latency can significantly affect real-time operations, often leading to compromised robot safety, goal overshoot, and high levels of cognitive workload. Thus, novel operational strategies are necessary to cope with these effects. This paper proposes three augmented teleoperation interfaces that allow the user to operate a robot subject to 3 seconds of latency: (1) Avatar-Aided Interface (AAI), a semi-autonomous approach based on a virtual element; (2) Predictive Interface (PI), an approach with direct control and predictive elements; and (3) Hybrid Interface (HI), where operators can easily switch between PI and AAI. We conducted a systematic within-subject experiment to evaluate the proposed interfaces in a realistic virtual environment with frequent traction losses. The user study compared AAI and PI to a Control Interface (CI), which did not display any augmented elements. The main results of this comparison showed that: (1) AAI led to a significant reduction in workload and a significant increase in usability and robot safety; (2) the use of the PI caused a significant increase in path length, indicating that operators overshoot their goals more often with this approach; (3) PI and AAI had lower reported effort; and (4) AAI is more flexible and effortless than PI and CI. Finally, during traction loss periods, PI and AAI had shortcomings that led to confusion from the operator, showing the need to integrate uncertainty measures in future interface design.

Web-Questionnaire-Based Corpus Creation Under Assumption of Human as Speech Targets

This paper presents a method that uses a web questionnaire to create a corpus containing spontaneous utterances of natural ideas, which may contain grammatical mistakes. In an experimental implementation of the method, the subjects were informed that they were receiving nursing care from a person, and they were required to answer a web-based questionnaire in which their responses were recorded as speech utterances. Compared to the Wizard of Oz approach and interview-based corpus-creation methods, the presented method simplifies the collection of utterances. Furthermore, we conducted a two-fold assessment to verify the effectiveness of the presented method. First, the approach exhibited a significant reduction in workload compared to interview-style utterance collection. Second, we compared the variety of expressions collected when subjects were informed that they were talking to a person with those collected when they were informed that they were communicating with a nursing robot. The results indicate that, although the number of utterances was larger for a robot than for a person, in terms of other metrics such as time efficiency index, the total number of morphemes, the average number of morphemes per utterance, the number of unique morphemes, and coefficient of variation, the utterances were larger for a human speech target than for a robot.

The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study.

BackgroundAt the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice.ObjectiveThe aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume.MethodsWe performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265).ResultsThe elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01).ConclusionsThe reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x

Impact of COVID-19 on Workload and Workflow in Echocardiography Unit in a Tertiary Care University Hospital: A Monocentric Observational Study.

Background:The COVID-19 pandemic is a new unexpected worldwide condition with a heavy burden on health-care institutions and health-care workers.Objective:We sought to examine the impact of COVID-19 on workload and workflow in the echocardiography unit in a tertiary care university hospital.Methods:We conducted a monocentric observational study, evaluating workload and workflow during the COVID-19 year relative to the previous year.Results:The findings show a substantial reduction in workload (55.20%) along with significant changes in workflow in the echocardiography unit during the pandemic. Changes in workflow involved measures implemented for protection, changes in echo indications which became more selective, changes in echo pattern, reduction in human flow in echocardiography laboratory, delays in reporting and archiving, and changes in training and teaching.Conclusion:COVID-19 pandemic had a substantial impact on the echocardiography unit, with a significant reduction in workload and considerable changes in workflow. In the future, it is essential to be better prepared as individuals, health-care workers, health-care institutions, and the general community, to deal better with any potential “invisible enemy.”

Human vs. Machine – or with Machine?

In their study, Adam et al.1 eloquently demonstrate that artificial intelligence (AI) through training of a neural networks pipeline can automatically segment and measure the outer to outer diameter of the whole length of the aorta in computed tomography (CT) angiography (CTA). Their Augmented Radiology for Vascular Aneurysms (ARVA) software is a glimpse into the future of AI for vascular surgery as, conceptually, it promises a significant reduction in workload when measuring maximum aortic diameter (ADmax) in high volume centres.

Toward Workable and Cost-Efficient Monitoring of Unstable Rock Compartments with Ambient Noise

Ambient Vibration-Based Structural Health Monitoring (AVB–SHM) studies on prone-to-fall rock compartments have recently succeeded in detecting both pre-failure damaging processes and reinforcement provided by bolting. The current AVB–SHM instrumentation layout is yet generally an overkill, creating cost and power issues and sometimes requiring advanced signal processing techniques. In this article, we paved the way toward an innovative edge-computing approach tested on ambient vibration records made during the bolting of a ~760 m3 limestone rock column (Vercors, France). First, we established some guidelines for prone-to-fall rock column AVB–SHM by comparing several basic, computing-efficient, seismic parameters (i.e., Fast Fourier Transform, Horizontal to Vertical and Horizontal to Horizontal Spectral Ratios). All three parameters performed well in revealing the unstable compartment’s fundamental resonance frequency. HHSR appeared as the most consistent spectral estimator, succeeding in revealing both the fundamental and higher modes. Only the fundamental mode should be trustfully monitored with HVSR since higher peaks may be artifacts. Then, the first application of a novelty detection algorithm on an unstable rock column AVB–SHM case study showed the following: the feasibility of automatic removing the adverse thermomechanical fluctuations in column’s dynamic parameters based on machine learning, as well as the systematic detection of clear, permanent change in column’s dynamic behavior after grout injection and hardening around the bolts (i1 and i2). This implementation represents a significant workload reduction, compared to physical-based algorithms or numerical twin modeling, and shows better robustness with regard to instrumentation gaps. We believe that edge-computing monitoring systems combining basic seismic signal processing techniques and automatic detection algorithms could help facilitate AVB–SHM of remote natural structures such as prone-to-fall rock compartments.

Impact of the COVID-19 pandemic on pathology and cytology practice in University Hospital Centre Rijeka

Aim: To determine the impact of the COVID-19 pandemic on the overall practice of the histopathological and cytological laboratory at the University Hospital Centre Rijeka, and on the diagnosis of the most common cancers. Methods: The numbers of histopathological and cytological reports, newly diagnosed cancers of breast, lung, colon, endometrium, and prostate, molecular tests for EGFR mutations and HPV were extracted. Two periods, from March 1 to September 30 in 2019 and 2020 were analysed and compared, as the periods before and during the COVID-19 pandemic. Results: The total number of reports was statistically significantly lower during the COVID-19 pandemic in 2020, compared to the same period in 2019 (p<0.000), histopathology by 24%, non-gynecological cytology by 20%, gynecological cytology by 13%, and Pap tests by 11%. During COVID-19 compared to the same period in 2019 the number of newly diagnosed malignant tumors was significantly reduced for colon cancers (–25%, p <0.0001). The decrease in the new cases of breast (–3%) and prostate cancer (–4%) was less pronounced while the increase was recorded for lung (+ 2%) and endometrial cancer (+ 53%). The number of HPV tests dropped significantly during the COVID-19 pandemic, by 40% (p <0.0001). Conclusions: This study confirmed the expected significant reduction in workload during the first wave of the COVID-19 pandemic in 2020, from 11% to 40%, although the number of patients with newly diagnosed cancers, except for colon, did not fall significantly. It would be important to form a joint national registry that would collect diagnostic and also therapeutic procedures, especially for oncology patients, in order to gain a more objective insight into the problems of the health system during pandemics. These data can be used to consider measures and strategies for the most adequate care, not only for COVID-19 but also for all other patients. © 2021 Hrvatski Lijecnicki Zbor. All rights reserved.

Lateral Tyre Force Distribution for Four-Wheel Steer-by-Wire Vehicles

In a four-wheel independent steering vehicle, all the tyres have the capability of being steered independently. The traditional steering assemblies are mechanically limited because their inner and outer wheel’s steering angles are interrelated which makes it difficult to extract the maximum possible traction from the ground. Such steering systems are unable to take the advantage of the load transfer which occurs during the cornering. This work proposes a novel method of lateral tyre force distribution between the inner and outer wheels by making use of load transfer during the cornering of the vehicle. The distribution is obtained by using a function which maps the lateral acceleration of the vehicle to the distribution of the forces between the wheels. The function can be tailored according to the requirements of the driving. The control strategy involves simple equations to allow for an easy hardware implementation. The simulations performed through numerical solution of vehicle dynamics model using the computer program in MATLAB/Simulink show an improvement in the cornering performance of the vehicle and a significant reduction in workload of tyres.

Stand-alone artificial intelligence - The future of breast cancer screening?

Although computers have had a role in interpretation of mammograms for at least two decades, their impact on performance has not lived up to expectations. However, in the last five years, the field of medical image analysis has undergone a revolution due to the introduction of deep learning convolutional neural networks – a form of artificial intelligence (AI). Because of their considerably higher performance compared to conventional computer aided detection methods, these AI algorithms have resulted in renewed interest in their potential for interpreting breast images in stand-alone mode. For this, first the actual capability of the algorithms, compared to breast radiologists, needs to be well understood. Although early studies have pointed to the comparable performance between AI systems and breast radiologists in interpreting mammograms, these comparisons have been performed in laboratory conditions with limited, enriched datasets. AI algorithms with performance comparable to breast radiologists could be used in a number of different ways, the most impactful being pre-selection, or triaging, of normal screening mammograms that would not need human interpretation. Initial studies evaluating this proposed use have shown very promising results, with the resulting accuracy of the complete screening process not being affected, but with a significant reduction in workload. There is a need to perform additional studies, especially prospective ones, with large screening data sets, to both gauge the actual stand-alone performance of these new algorithms, and the impact of the different implementation possibilities on screening programs.

Oriented mentalization-based treatment for borderline personality disorder patients: preliminary results at Camposampiero Mental Health Center.

This contribution presents two brief reports about preliminary results of 18 months of oriented Mentalization-Based Treatment (MBT), with Borderline Personality Disorder patients, recruited at the Camposampiero Mental Health Center. Following in large part Bateman and Fonagy guidelines for MBT in institutional settings, this paper presents preliminary results in two brief reports related to two cohorts of patient underwent to the oriented MBT in Camposampiero Mental Health Center (MHC). In the first study, we analyzed a group of 9 patients: an anamnestic schedule was administered; then, symptoms (SCL-90-R), psychodiagnostic scale and global health functioning (Health of the Nation Outcome Scale, Structured Clinical Interview for DSM-IV Axis II Disorder [SCID-II], Global Assessment of Functioning, [GAF]), data on service impact and service costs (Cassel Community Adjustment Questionnaire, Patient Evaluation Schedule and folder data) were provided at the beginning (T0), at the end of the treatment (T2) and 1 year after the end of the MBT project. The second study showed a micro-analytical change on a second patient cohort (n=6) at T0, 3, 6 and 9 months (T1) were presented considering specifically mentalization (Comparative Psychotherapy Process Scale, Modes of Mentalization Scale, Mentalization Imbalances Scale) and patienttherapist session evaluation trends (Session Evaluation Questionnaire) and patient reflective functioning at T0 and T2 (Reflective Functioning Questionnaire). Aims and hypotheses of the two studies pointed out how the oriented MBT bring to an improvement of the overall functioning of the patients, a reduction of the symptoms, a decrease of the diagnostic criteria for the Borderline Personality Disorder (BPD) and the other Axis II disorders, a reduction of the workload hours for the MHC staff and of the costs of the assistance. The analyses of both the studies were carried out using non-parametric statistics (Friedman test, Spearman correlation, Chi-square). Preliminary results confirmed the improvement in the overall functioning of patients (GAF), the reduction in BPD-related symptoms and in diagnostic criteria for BPD (SCID-II), the improvement of patients’ mentalization skills, and a significant reduction in workload for health staff. Standing the limits and the preliminary results, the two brief reports demonstrate the feasibility of an oriented MBT within an Italian Public Service and the effectiveness of this treatment pathway for patients with BPD, leaving some open questions to stimulate a fruitful clinical discussion.

Novel Thoracoscopic Navigation System With Augmented Real-Time Image Guidance for Chest Wall Tumors

We developed a thoracoscopic surgical navigation system with real-time augmented image guidance to assess the potential benefits for minimally invasive resection of chest wall tumors. The accuracy of localization of tumor and resection margin and the effect on task workload and confidence were evaluated in a chest wall tumor phantom. After scanning a realistic tumor phantom by cone-beam computed tomography and registering the data into the system, three-dimensional contoured tumor and resection margin was displayed. Fifteen surgeons were asked to localize the tumor margin and surgical margins with the thoracoscope alone. The same procedure was performed with the surgical navigation system activated, and results were compared between each attempt. A questionnaire and National Aeronautics and Space Administration Task Load Index were completed after. The surgical navigation system significantly reduced localization error for the medial (p= 0.002) and superior tumor margin (p < 0.001), which was difficult to visualize by thoracoscopy alone. All surgical resection margins were improved circumferentially, including margins that were readily visible by thoracoscopy. National Aeronautics and Space Administration Task Load Index response scores showed a statistically significant reduction in workload in all subscales. There was a more than 50% mean reduction in workload for performance (10.1 vs 4.4, p= 0.001) and frustration (13.0 vs 5.4, p= 0.001). This study showed that the thoracoscopic surgical navigation system providing augmented image guidance decreased tumor localization error for regions difficult to visualize thoracoscopically and also reduced surgical margin error circumferentially, regardless of thoracoscopic visibility. This system also reduced workload and increased surgeon's confidence in localizing challenging chest wall tumors.

Use of a self-reported psychosocial distress screening tool as a predictor of need for psychosocial intervention in a general medical setting

ABSTRACTThis study describes the development of a self-reported psychosocial distress screening tool for a general medical population and criteria to predict the need for psychosocial intervention. The objectives were to develop criteria to determine which patients need in-person screening and establish criteria identifying patients who are more likely to require psychosocial interventions. The outcomes have bearing on reducing initial psychosocial screening workload for medical social workers in high volume medical settings. Furthermore, a criterion for scoring the self-reported tool can predict which patients will need further social work intervention. The results suggest criteria are a score on the adapted Distress Thermometer of five or greater, at least two negative emotions, and a lack of health insurance. The optimal criterion identified 36% (446/1228) of patients in need of in-person screening with the remaining 64% (782/1228) screened low risk through the tool, representing a significant workload reduction.

INDOOR SMARTPHONE NAVIGATION USING A COMBINATION OF WI-FI AND INERTIAL NAVIGATION WITH INTELLIGENT CHECKPOINTS

Abstract. For Wi-Fi positioning location fingerprinting is one of the most commonly employed localization technique. To achieve an acceptable level of positioning accuracy on the few meter level, i.e., to provide at least room resolution in buildings, such an approach is very labour consuming as it requires a high density of reference points. Thus, the novel approach developed aims at a significant reduction of workload for the training phase. The basic idea is to intelligently choose waypoints along possible users’ trajectories in the indoor environment. These waypoints are termed intelligent checkpoints (iCPs) and serve as reference points for the fingerprinting localization approach. They are selected along the trajectories in such a way that they define a logical sequence with their ascending order. Thereby, the iCPs are located, for instance, at doors at entrances to buildings, rooms, along corridors, etc., or in low density along the trajectory to provide a suitable absolute user localization. Continuous positioning between these iCPs is obtained with the help of the smartphones’ inertial sensors. While walking along a selected trajectory to the destination a dynamic recognition of the iCPs is performed and the drift of the inertial sensors is reduced as the iCP recognition serves as absolute position update. Conducted experiments in a multi-storey office building have shown that positioning accuracy of around 2.0 m are achievable which goes along with a reduction of workload by three quarter using this novel approach. The iCP concept and performance are presented and demonstrated in this paper.

Do non-targeted gastric biopsies affect the management of patients, and can a simple protocol and education reduce the rate?

ObjectiveTo determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions.DesignRetrospective analysis of patient records...

Simplified protocol for clinical-grade tumor-infiltrating lymphocyte manufacturing with use of the Wave bioreactor

Background aimsThe high level of complexity of current Good Manufacturing Practice–compliant methods of manufacturing hampers rapid and broad application of treatment with tumor-infiltrating lymphocytes (TILs). MethodsTo ensure higher applicability of TIL production to laboratory routine, a practical and simple protocol of TIL manufacturing with the use of a closed-system bioreactor was developed and implemented at our institution. ResultsThis protocol enabled significant work load reduction during the most labor-intense step of TIL expansion, and allowed generation of high-quality TIL products, which mediated clinical regression in patients with metastatic melanoma. ConclusionsImplementation of simplified methods of TIL expansion will speed up dissemination of TIL methods worldwide and will increase patient access to this highly effective treatment.

Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation

To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p=0.024). Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.

Virtual surgical planning in endoscopic skull base surgery

Skull base surgery (SBS) involves operative tasks in close proximity to critical structures in a complex three-dimensional (3D) anatomy. The aim was to investigate the value of virtual planning (VP) based on preoperative magnetic resonance imaging (MRI) for surgical planning in SBS and to compare the effects of virtual planning with 3D contours between the expert and the surgeon in training. Retrospective analysis. Twelve patients with manually segmented anatomical structures based on preoperative MRI were evaluated by eight surgeons in a randomized order using a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Multivariate analysis revealed significant reduction of workload when using VP (P<.0001) compared to standard planning. Further, it showed that the experience level of the surgeon had a significant effect on the NASA-TLX differences (P<.05). Additional subanalysis did not reveal any significant findings regarding which type of surgeon benefits the most (P>.05). Preoperative anatomical segmentation with virtual surgical planning using contours in endoscopic SBS significantly reduces the workload for the expert and the surgeon in training.

Addressing drop-out and sustained effort issues with large practical groups using an automated delivery and assessment system

The acquisition of programming skills specially in introductory programming courses poses an important challenge for freshmen students of engineering programs. These courses require students to devote a sustained effort during the whole course and a failure to do so may contribute to not passing the course. However, it is difficult for the teaching staff to deploy measures to enforce a pattern of continuous work without significantly increasing the required management tasks. A significant reduction of this workload can be achieved with the automation of time consuming tasks such as the delivery of activities or submission grading. This paper presents a case of study where a technology based orchestration of learning scripts was applied in a large enrollment course to promote student sustained effort through the course and keep the workload on teaching staff within reasonable margins. The orchestration system, based on IMS Learning Design and Generic Service Integration, automatically evaluated the student submissions and gradually unlocked the following activities depending on the received results. Such system was used during a semester supporting 425 students and 8 instructors. The analysis of the case of study followed a mixed method based on qualitative and quantitative data, and revealed a significant reduction of the orchestration workload on the teaching staff, allowing the strategy of continuous work to be applied in a course with high enrollment. Additionally, the application of these techniques show statistically significant differences in the drop out rate with respect to previous editions of the course. ► High enrolment courses poses a high workload to the teaching staff. ► The effects of an orchestration system is evaluated with a case study. ► The experimental setting was formed by 425 students and 8 teachers. ► Studied parameters are workload, drop out, course results and engagement. ► A significant decrease in the attrition rate is shown, having students acceptance.