Workload Pressures Research Articles

The Impact of Workload, Co-Worker Pressure and Supervisor Pressure on Employee Presenteeism: An Empirical Study on Sri Lankan Employees in Colombo District

Presenteeism is one of the major contemporary issues in Human Resource Management (HRM) as it negatively impacts on worker productivity and ultimately on organizational productivity and goal achievement. Objectives of the study were; (1) to find the degree of presenteeism of Sri Lankan employees in Colombo District who are under the study; (2) to find the impact of workload on employee presenteeism; (3) to find the impact of co-worker pressure on employee presenteeism; (4) to find the impact of supervisor pressure on employee presenteeism; (5) to find the overall impact of workload, co-worker pressure and supervisor pressure on employee presenteeism; and (6) to investigate whether there is any significant difference between male and female employees under study in terms of presenteeism. A theoretical framework was formulated based on some empirical evidences in literature review and logical beliefs of the authors. Three different instruments were developed by the authors to measure the degree of workload, co-worker pressure, and supervisor pressure while Stanford Presenteeism Scale (SPS) was utilized to measure employee presenteeism. Reliability and validity of the instruments are assured. Survey method was utilized and 72 employees responded to the questionnaire through the sampling technique of convenient sampling technique. The empirical findings revealed that the degree of employee presenteeism is between average and high and there is a significant positive impact from workload, co-worker pressure and supervisor pressure on employee presenteeism which means that higher the workload, co-worker pressure and supervisor pressure, higher the presenteeism will be. Further it was revealed that there is no significant difference between male and female employees who are under this study in terms of presenteeism.

Dönüşümcü liderliğin örgütsel güven üzerindeki etkisi: Havacılık sektöründe bir çalışma

This research focuses on the concept of organizational trust, which stands out in the activities of employees in different business lines of airline companies at airports in Turkey and directly affects expectations such as organizational communication, organizational efficiency, performance, and organizational commitment. In this context, the concept of trust is seen as the belief and expectation of the employee in the promises and actions of the organization. In the research, the relationship between the concept of trust and the transformational leadership skills expected from the responsible managers of the employees, who are effective in the complete and safe execution of the operations at the airports despite the pressure of time and workload, has been taken as the subject. The aim of the study was determined as the effect of transformational leadership on organizational trust. The field of this research consists of employees of 3 different private airline companies, operating at Ankara Esenboğa Airport. In this study, to measure transformational leadership, the method of “Transformational Leadership Scale” developed by Carless et al. was used which had carried out to investigate the effect of transformational leadership behavior on organizational trust [1]. Additionally, to measure organizational trust, the “Organizational Trust Scale” developed by Tokgöz and Seymen by making use of different scale factors with hospital staff, was used [2]. In the study, in which 270 survey data were evaluated, a positive and statistically significant relationship was found between transformational leadership and organizational trust (r=0.642, p

UK newspapers 'on the warpath': media analysis of general practice remote consulting in 2021.

Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting. To study media depictions of remote consultations in UK general practice at a time of system stress. Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13-26 May 2021, following an NHS England letter, and 14-27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis. In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an 'in-person by default' service (as it would further pressurise a system already close to breaking point). Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the 'war' on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice.

Correlation between Stress and Eating Behaviour in College Students: A Longitudinal Study

Stress is a process that involves the perception of and response to pressure and is often related to eating behaviour. For college students, academic stress could be one factor that affects eating behaviour. So far, no longitudinal study has directly compared the same respondents’ stress levels and eating behaviours in different years of study. Thus, this study aimed to examine changes in stress levels and eating behaviour during college students’ third and final years and determine the correlation between stress levels and eating behaviour. We asked 89 undergraduate students (27 males and 62 females) to complete a questionnaire on their stress levels using the Perceived Stress Scale (PSS-10) and their eating behaviour. Our results showed that students had significantly higher stress levels during the final year than in their third year. Our results also showed that during the student’s final year, there was a significant increase in eating when feeling stressed, overeating, eating fast food, and skipping meals compared to their third year. There was also a significant decrease in healthy food consumption during the final year compared to the third year. During the third year of study, stress levels were increased by academic workload pressure; meanwhile, during the final year of study, they were affected by sex and undergraduate thesis pressure. These results indicate that differences in academic pressure in different years of study can influence stress levels and eating behaviour in college students.

Barriers and facilitators of cross-sectoral data linkage to inform healthy public policy and practice: lessons from three case study projects in Scotland.

ObjectivesWe sought to describe barriers and facilitators faced by three research projects aiming to link routinely-collected data across various sectors, to produce evidence to inform healthy public policy. We conducted these case studies as a part of a wider research project on cross-sectoral sharing and linkage of secondary data. ApproachWe selected the case studies to cover a range of target populations and datasets. The chosen projects investigated (1) the health of care-experienced children; (2) the intersection of homelessness, justice involvement, drug use, and severe mental illness; (3) multi-morbidity among adults receiving social care. Information about timelines and governance processes was collected from lead investigators, including specific barriers and facilitators encountered, using a standardised pro forma and follow-up interviews. Thematic analysis was carried out by the research team, informed by themes identified in a parallel scoping review of existing literature on evidence use for healthy public policy and practice. ResultsEach project involved between 6 and 11 agencies, with co-ordination across multiple institutions and geographies proving challenging. Due to challenges encountered, all projects had to amend their original geographical or demographic scope. Forty-four barriers and facilitators to sharing and linkage of cross-sectoral routinely-collected data for public health research were identified. These included but were not limited to: integration of current data in an ever-changing linkage landscape; the need for timely feedback in undertaking the study; standardisation of information governance processes; highlighting the resourcing and funding issues for data linkage projects; the need for data controllers to recognise the value of such projects; and issues relating to staff turnover and workload pressures. ConclusionThe interconnected nature of barriers and facilitators identified by the case studies suggests the importance of a whole-systems approach to cross-sectoral linkage. While literature offers relatively few case studies of cross-sectoral linkage for health research, the value of their insight into the linkage landscape derived from real-life experience is substantial.

Cohort Study on the Effect of Psychological Education for Nurses in Psychiatric Department.

With the deepening of the medical and health system, high-quality nursing service with the reform of nursing service model and the provision of holistic nursing care for patients as the core connotation is being comprehensively carried out. With the continuous improvement of medical quality, people's awareness of health has gradually increased. They have put forward higher requirements for medical quality, nursing service quality, and medical care safety. Under the influence of these conditions, the workload and work pressure of clinical nurses continue to increase, and mental health problems become increasingly prominent. According to relevant data, the detection rate of occupational stress among nurses was 100%, and the proportion of nurses who perceived considerable stress was 60.9%, which seriously affected their work efficiency and quality of life. However, the physical and mental health of the frontline nurses working in psychiatric hospitals is not optimistic. This study explored the effects of psychological education among nurses in the department of psychiatry. The results showed that psychological education intervention among nurses in the department of psychiatry could alleviate their professional tiredness, effectively improve their psychological elasticity and happiness index, and thus improve sleep quality and promote their physical and mental health development.

Real Estate Tax Base Assessment by Deep Learning Neural Network in the Context of the Digital Economy.

With the continuous development of China's digital economy and the continuous heating of the real estate market, real estate tax base assessment occupies an important position in the real estate market. The purpose is to improve the work efficiency of relevant personnel of real estate tax base assessment, reduce workload pressure, and improve the evaluation level. Real estate tax base assessment and real estate appraisal are studied in detail, and the factors of the real estate tax base assessment index are analyzed. Different real estate tax base assessment methods are compared, and the difference and connection between different methods are explored. The theory of batch assessment of real estate tax base is analyzed in depth, and the procedures for batch assessment implementation are summarized. On this basis, a deep learning neural network (DLNN) theory is proposed, and a real estate tax base assessment model based on DLNN is constructed. The reliability, accuracy, and relative superiority of the model are analyzed in detail, and the model is used to test the sample data and analyze the error. The results reveal that the DLNN model has better data fit and good reliability. Compared with other algorithms, it has certain advantages and smaller error values. In the sample test, the test value is closer to the actual value, the error is controllable, and it has high accuracy. Through training, it shows that the DL model has an excellent performance in tax base assessment, can meet the requirements of efficient batch assessment, and is expected to achieve the goal of completing a huge workload in a limited time and improve work efficiency. The real estate tax base assessment model by DLNN can bring some help to the real estate finance and taxation work and provide a reference for the batch assessment of tax base in the real estate industry.

What promotes or prevents greater use of appropriate compression in people with venous leg ulcers? A qualitative interview study with nurses in the north of England using the Theoretical Domains Framework

ObjectivesTo investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers.DesignQualitative interview study with nurses using the Theoretical Domains Framework (TDF).SettingThree National Health...

The Impact of the COVID-19 Pandemic on the Healthcare System and on the Mental Health of Primary Health Care Providers

The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks. Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied. There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans. The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.

Enhancing opportunistic recruitment and retention in primary care trials: lessons learned from a qualitative study embedded in the Cranberry for Urinary Tract Infection (CUTI) feasibility trial

BackgroundOpportunistic recruitment in primary care is challenging due to the inherent unpredictability of incident conditions, and workload and time pressures. Many clinical trials do not recruit to target, leading to equivocal answers to research questions. Learning from the experiences of patients and recruiters to trials of incident conditions has the potential to improve recruitment and retention to future trials, thereby enhancing the quality and impact of research findings. The aim of this research was to learn from the trial experiences of UTI patients and recruiters to the Cranberry for UTI (CUTI) trial, to help plan an adequately powered trial of similar design.MethodsOne-to-one semi-structured interviews were embedded within the CUTI feasibility trial, an open-label, randomised feasibility trial of cranberry extract for symptoms of acute, uncomplicated Urinary Tract Infection (UTI) in primary care. Interviews were conducted with a sample of: CUTI trial participants; non-CUTI trial UTI patients; and, recruiters to the CUTI trial. Verbatim transcripts were analysed thematically.ResultsTwenty-six patients with UTI and eight recruiters (nurses and GPs) to the CUTI trial were interviewed. Three themes were developed around: reasons for participating in research; barriers to opportunistic recruitment; and, UTI patients’ experiences of trial procedures. Recruiters found that targeted electronic prompts directed at healthcare practitioners based in clinics where patients with incident conditions were likely to present (e.g. minor illness clinic) were more effective than generic prompts (e.g. desk prompts) at filtering patients from their usual clinical pathway to research clinics. Using a script to explain the delayed antibiotic trial group to patients was found to be helpful, and may have served to boost recruitment. For UTI patients, using an electronic diary to rate their symptoms was considered an acceptable medium, and often preferable to using a paper diary or mobile phone application.ConclusionsThe use of targeted prompts directed at clinicians, a script to explain trial groups that may be deemed less desirable, and an appropriate diary format for patient-reported outcomes, may help to improve trial recruitment and retention.

Enhancing Sustainable Development: Examining Factors That Foster Creativity and Productivity in Organizations

Innovation and creativity in organizations are becoming imperative to their advancement. These two categories are shaping the new culture of innovation, which managers should take into account when trying to maintain the sustainable development of their organizations. This paper examines the contribution of management practice, organizational motivation and resources as the important factors for fostering creativity and innovation in organizations and their effects on productivity. Empirical research using the KEYS methodology was conducted on a sample of employees from innovation-driven organizations. The research results show a positive and significant effect of creativity on organizational productivity. At the same time, the research reveals that challenging tasks, as an element of management practice, and realistic workload pressure, as a resource, strongly contribute to organizational productivity. The paper extends current knowledge on the contribution of management practice, organizational motivation, and resources as factors important for fostering creativity in organizations. Furthermore, the paper contributes by providing a deeper theoretical insight into the concept of the culture of innovation and creativity in an organizational environment.

Shared medical appointments in English primary care for long-term conditions: a qualitative study of the views and experiences of patients, primary care staff and other stakeholders

BackgroundShared medical appointments (SMAs) or group consultations have been promoted in primary care to improve workload pressures, resource-use efficiency and patient self-management of long-term conditions (LTCs). However, few studies have explored stakeholders’ perspectives of this novel care delivery model in the English NHS context, particularly patients’ views and experiences of SMAs.MethodSemi-structured interviews were used to explore the perspectives of stakeholders (21 patients, 17 primary care staff, 2 commissioners and 2 SMA training providers) with and without SMA experience from a range of geographical and socio-economic backgrounds in the North East and North Cumbrian region of England. Thematic analysis was conducted to examine perceptions around impact on patient care and outcomes and barriers and facilitators to implementation.ResultsThree main themes were identified: ‘Value of sharing’, ‘Appropriateness of group setting’, ‘Implementation processes’. Patients experiences and perceptions of SMAs were largely positive yet several reported reservations about sharing personal information, particularly in close-knit communities where the risk of breaching confidentiality was perceived to be greater. SMAs were considered by patients and staff to be inappropriate for certain personal conditions or for some patient groups. Staff reported difficulties engaging sufficient numbers of patients to make them viable and having the resources to plan and set them up in practice. Whilst patients and staff anticipated that SMAs could deliver high quality care more efficiently than 1:1 appointments, none of the practices had evaluated the impact SMAs had on patient health outcomes or staff time.ConclusionStakeholder experiences of SMA use in English primary care are largely similar to those reported in other countries. However, several important cultural barriers were identified in this setting. Further work is needed to better understand how patient and staff perceptions, experiences and engagement with SMAs change with regular use over time. Concerns regarding staff capacity, additional resource requirements and numbers of eligible patients per practice suggest SMAs may only be feasible in some smaller practices if facilitated by primary care networks. Further mixed-method evaluations of SMAs are needed to inform the evidence base regarding the effectiveness, efficiency and feasibility of SMAs long-term and subsequently their wider roll-out in English primary care.

“One of those things the student is left to do”. Student midwives' experience of infant feeding education. A phenomenological study

Aim/ObjectiveTo explore final year student midwives’ experiences of breastfeeding education and clinical experience during their three year pre-registration midwifery degree course. BackgroundDespite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first six weeks of birth. Breastfeeding support and education have been identified as influencing factors associated with breastfeeding prevalence, yet there is a paucity of evidence exploring infant feeding education for pre-registration student midwives. DesignQualitative data was gathered using semi-structured interviews with seventeen final year midwifery students in a Higher Education Institution in the North of England. MethodsInterviews were audio recorded, transcribed verbatim, and analysed using thematic analysis. ResultsThree core themes were identified: The Mentor-Student Relationship, Midwives and student midwives’ attitudes towards breastfeeding and Theory-Practice Disassociation. University-based input provided them with underpinning knowledge but provided little opportunity to develop skills. Attitudes towards breastfeeding were predominantly negative, and these negative descriptions were frequently linked by students to time constraints and workload pressures. The relationship between students and mentors had a direct impact on students’ development of breastfeeding support skills and confidence: students who had mentors who were enthusiastic about their role in facilitating learning in clinical practice were confident in supporting women with infant feeding. However, many students described the hospital environment as too busy for infant feeding skills teaching and guidance. ConclusionsAlthough few participants were dissatisfied with how their pre-registration midwifery education prepared them for clinical practice in general, the majority would have liked more opportunities to support women with infant feeding in complex and challenging cases, both in University and in clinical practice. There is a need for midwifery students to be provided with a variety of educational experiences such as theoretical classroom-based learning, simulation-based learning, peer learning, clinical care practice and direct service user engagement. These learning experiences need to include artificial feeding and breastfeeding.

The Workload Pressures Experienced by Nurses at Public Sector Hospitals, Peshawar

OBJECTIVE The study's objective was to assess that nurses working in in-patient wards were under workload stress. METHODOLOGY Descriptive observational research on nurses working in the in-patient ward of a public sector hospital in Peshawar was undertaken in November 2020. Workload Indicators of Staffing Need (WISN), a tool established by the World Health Organization (WHO) to anticipate the number of health staff needed to cope with workload pressure, was used to determine nurses' workload. To ensure the successful implementation of the WISN methodology, three tiers of committees were developed, including steering, technical, and expert committees. Data were also analyzed using the tool. RESULTS Nurses in the hospital's in-patient unit work 1966 hours per year. Health service activities, support, and other activities account for 47.92%, 33.33%, and 18.75% of all nurses' time, respectively, during this time. Four nurses were working in the hospital during the research study; however, WISN estimated that three nurses were needed to cope with the ward's workload pressure, and one nurse was overstaffed at the time. The WISN ratio calculated was 1.33. CONCLUSIONS The study concluded that there was no workload pressure on nurses (negative), and the ward had an extra nurse who could be accommodated in any other department with greater demand.

Promoting Student Teachers’ Well-Being

Abstract. Student teachers’ well-being is particularly important in times of teacher shortage. To prevent student dropout and promote students’ well-being, demands and resources within university teacher education need to be identified. Demands like workload or time pressure can lead to emotional exhaustion in the long-term, while resources like emotional support may foster well-being. By conducting a quantitative, longitudinal study on 903 student teachers from German universities, we investigate the relationship between the emotional support of peers (as a resource) and emotional exhaustion (an indicator of well-being). In addition, we conducted a qualitative study to analyze demands as possible reasons for dropout during teacher education. Latent change score models indicate that emotional exhaustion first increases and then slightly decreases over the course of three semesters. Emotional support by peers remains stable over time. The bivariate latent change model suggests that social support is not a predictor of later emotional exhaustion. The qualitative study analyzed three main dropout intentions: performance problems, lack of study motivation, and study conditions. Especially study conditions at university can be adjusted and act as a resource to increase students’ well-being.

O-102 Comparing the efficacy of two commercially available AI-based embryo assessment tools in a large clinical laboratory

Abstract Study question Are artificial intelligence (AI) systems an effective tool to aid in assessment of embryo viability, that can be implemented in a busy clinical laboratory setting? Summary answer LW and iDA scores both have value in predicting embryo potential, however iDA was a significantly stronger indicator of clinical pregnancy and live birth rates. What is known already Embryologist assessment of blastocysts can be variable, influenced by a range of factors including fatigue, experience, emotional bias, workload, and time pressures. An advantage of AI technologies is the consistent and objective assessment of embryos, along with the potential to observe variations not detectable by the human eye. Both AI systems have been demonstrated by their developers to have a degree of effectiveness, however there is less data to show how this translates to routine clinical use in a laboratory not involved in the development of either system. Study design, size, duration Embryos were cultured in EmbryoScope+ using Vitrolife sequential media at 6% CO2 and 5% O2. All single embryo transfers of blastocyst stage embryos during 2020 (n = 806) were assessed by two independent commercially available AI-based systems, Life Whisperer (LW) by Presagen and Intelligent Data Analysis (iDA) by Vitrolife. Both systems assessed embryos independently of embryologist assessment. Scores from LW and iDA were analysed against clinical pregnancy and birth outcomes. Participants/materials, setting, methods LW and iDA independently assigned each embryo a score from 0-10 based on prediction of embryo viability. LW scores were calculated by analysing a static 2D image of a blastocyst, input by the embryologist. iDA scores were generated from Embryoscope+ timelapse footage after a minimum of 112 hours in culture. Clinical pregnancy was defined as presence of a gestational sac, and pregnancy loss as any clinical pregnancy that did not result in live birth. Main results and the role of chance This cohort had a mean patient age of 36.9 years and had undertaken a mean of 3.2 prior cycles. The overall clinical pregnancy rate was 45.3%. Of these pregnancies, 79.2% resulted in live birth, thus the pregnancy loss rate was 20.8%. Scores at the extremes of each scale, &amp;lt;5 and ≥9, resulted in a statistically significant difference in clinical pregnancy rates from both iDA scores (24.0% and 59.3% respectively, p = 0.0001) and LW scores (38.0% and 53.1% respectively, p = 0.0031), with this difference being more pronounced in iDA assessments. When stratifying scores into five categories, a linear relationship was observed between increasing score and pregnancy rate. This relationship was consistent whether assessing by raw score, as generated by the AI program, or by allocating a designated proportion of the cohort to each category. Interestingly, pregnancy loss significantly decreased with increasing iDA scores (iDA&amp;lt;5: 50% and iDA≥9: 13.7%, p = 0.0066). Although a similar trend was seen with LW scores, this was less pronounced and not statistically significant (LW &amp;lt; 5: 28.6% and LW ≥ 9: 18.3%, p = 0.1124). This demonstrates that iDA score was both more representative of the chance of establishing a clinical pregnancy and of that pregnancy resulting in a live birth. Limitations, reasons for caution This study was conducted at a single clinical laboratory and results may not necessarily be applicable to all settings. Variables such as differing culture conditions, the transfer of multiple embryos, or transfer of embryos prior to the blastocyst stage, may impact these findings. Wider implications of the findings AI technologies may aid embryologists in the selection of embryos and reduce variability between scientists. More effective ranking of embryos may reduce the number of cycles required to achieve a pregnancy and potentially reduce pregnancy loss. This is particularly valuable to patients who have many embryos available for transfer. Trial registration number NA

Dealing with Unwanted Donations: A Content Analysis of Small Academic Canadian Library Webpages

While archives and special collections continue to welcome unique and valuable resources, small academic libraries can struggle with how to manage donation offers intended for their main collections. There is a need to be selective considering falling print circulation, workload pressures on library personnel, and space restrictions. Additionally, limited collections funds needed for more current and higher-demand resources can be strained by the higher processing costs of donated materials. These pressures are compounded by prospective donors seeking a home for items they no longer want, a perception that small academic libraries need all donations, and a lack of understanding about the qualifications and expertise of academic library workers. Clearly communicated and regularly reviewed guidelines can help discourage unwanted donations in ways that lessen alienating our patrons. This article provides a content analysis of donations webpages from small academic libraries in Canada to identify trends and provide support for libraries reviewing their own policies and procedures in an effort to manage donor expectations.

Redistribution of Doctors and Decentralization of Clinics Improved Utilization of Services, Demand, and Capacity of Hamad Medical Corporation's Staff Clinic.

Background: The Staff Medical Clinic (SMC) of the Hamad Medical Corporation (HMC) serves the staff members who require healthcare services, but in a crowded environment, the SMC can only meet 75% of that demand. Overcrowding reduces productivity and service quality and increases waiting time. Furthermore, overcrowding in healthcare facilities decreases the experience and satisfaction of patients and healthcare providers.Aim: The main objective of this study was to use simulation modeling to evaluate interventions that could improve SMC waiting time and efficiency.Method: Eighteen months of data on SMC patient flow, staffing, and clinical sessions were collected (January 2018 to June 2019). The patient's journey through the SMC was modeled as a series of processes with assigned durations defined mathematically using the appropriate probability distribution. A simulation flow model was developed considering the locations of the staff and nearby main hospital facilities. An intervention was proposed and evaluated through a simulation. The intervention involved redistributing 25% of the SMC staff into three main satellite clinics located at the facilities where most of the SMC patients came. Results: The proposed intervention decreased crowding by 37%, reduced staffing requirements by 28%, and increased the number of patient slots by 22%, resulting in a net increase in the number of patients served by an average of 1250 monthly, without the need for hiring new additional staffing.Conclusion: Redistribution of the available medical staff to three new satellite clinics reduces workload pressure at all sites and increases clinic capacity without additional costs.

Sex and central obesity in heart failure with preserved ejection fraction.

Obesity is a risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. The present study aimed to investigate the impact of central adiposity in patients with HFpEF and explore potential sex differences. A total of 124 women and 105 men with HFpEF underwent invasive haemodynamic exercise testing and rest echocardiography. Central obesity was defined as a waist circumference (WC) ≥88 cm for women and ≥102 cm for men. Exercise-normalized pulmonary capillary wedge pressure (PCWP) responses were evaluated by the ratio of PCWP to workload (PCWP/W) and after normalizing to body weight (PCWL). The prevalence of central obesity (77%) exceeded that of general obesity (62%) defined by body mass index ≥30 kg/m2 . Compared to patients without central adiposity, patients with HFpEF and central obesity displayed greater prevalence of diabetes and dyslipidaemia, higher right and left heart filling pressures and pulmonary artery pressures during exertion, and more severely reduced aerobic capacity. Associations between WC and fasting glucose, low-density lipoprotein (LDL) cholesterol, peak workload, and pulmonary artery pressures were observed in women but not in men with HFpEF. Although increased WC was associated with elevated PCWP in both sexes, the association with PCWP/W was observed in women but not in men. The strength of correlation between PCWP/W and WC was more robust in women with HFpEF as compared to men (Meng's test p= 0.0008), and a significant sex interaction was observed in the relationship between PCWL and WC (p for interaction=0.02). Central obesity is even more common than general obesity in HFpEF, and there appear to be important sexual dimorphisms in its relationships with metabolic abnormalities and haemodynamic perturbations, with greater impact in women.

Evaluating Completeness of Admissions Clerking Procedure for Patients Admitted to an Acute Psychiatric Inpatient Unit

AimsThere is a well-known bidirectional relationship between mental and physical health. A thorough mental and physical health assessment of new inpatients on admission is crucial to assess possible organic causes of psychiatric presentations and enable appropriate treatment to be commenced in a timely manner. We noted a pattern of incomplete clerking, leading to delays in commencing treatment and increased workload pressure on the ward medical team. Our audit aims to assess how thoroughly and in what time frame patients' admission assessments are being completed on an acute psychiatric inpatient unit.MethodsA sample of 20 patients was used for each cycle. Eight components were identified from the Trust clerking procedure. These were a full psychiatric history, capacity assessment, prescription chart, physical health systems review, physical examination, blood tests, ECG and VTE assessment. The expected standard was completion of all of the above at the point of admission or, if applicable, adequate documentation of patient refusal with documented reattempt within 24 hours.Electronic patient records were retrospectively reviewed to identify whether each component was completed, the number of days from admission to completion and if completed by the clerking doctor. Evidence of documented patient refusals and the number of incomplete draft entries were noted.ResultsInitial results showed only 20% of patients (n = 4) had the full expected clerking procedure completed at admission. Physical health assessments (ECG, blood test, physical examination) had the lowest completion rates. When components were not completed by the clerking doctor, there was often a delay of several days from admission to completion of by the ward day team. For 50% of patients, some assessments were never completed (without adequate refusal documented). Eight patients did not have a completed VTE assessment by the point of discharge.ConclusionReasons were identified for the poor completion rates of clerking assessments. These included a lack of understanding by on-call doctors about the importance of completing all assessments, unfamiliarity with ward equipment, lack of adequate handover to the ward medical team and staffing pressures. A new handover checklist was introduced for clerking doctors to use and enable better communication with the ward team. Clerking procedure summaries were displayed in on-call rooms and additional teaching was organised.