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PubMed2004

[Appropriate evaluation of total workload in anesthesia].

Number of cases performed or total anesthesia time is usually used to evaluate workload anesthesiologists. However, each case is different in intensity of anesthetic management and these makes the evaluation difficult. We devised a total workload in anesthesia formula to account for technical, tactical, and physical factors in each case, as well as for number of cases and total anesthesia time. The present study evaluated reasonableness of this formula. We compared number of cases, hours of work, medical treatment fee and the total workload in anesthesia among anesthesiologists who had worked in our hospital in 2001. Each anesthesiologist answered questionnaires regarding number of cases, total anesthesia time, and total workload during 2001. Among anesthesiologists, we found significant differences in number of cases and total anesthesia time and medical treatment fee but no difference in total workload in anesthesia. The anesthesiologists indicated the same trend in their questionnaire responses. Evaluating only number of cases or total anesthetic time or medical treatment fee provides insufficient information to compare anesthesia workload. Our formula is a more appropriate index to quantify workload.

Anesthesia↗
PubMed1983

Effect of insulin and lack of effect of workload and hypoxia on protein degradation in the perfused working rat heart.

1. Protein degradation was studied in the glucose (5 mM)-perfused working rat heart preparation of Taegtmeyer, Hems & Krebs [(1980) Biochem. J. 186. 701-711]. 2. The effects of cardiac workload were investigated in three different preparations: (a) control (low workload), (b) increased pressure workload (simulating conditions of aortic pressure in vivo) and (c) increased volume workload. There was no effect of increased workload on protein degradation in preparation (b) or (c) when compared with preparation (a). Insulin inhibited protein degradation in all three preparations. Significantly greater inhibition by insulin was observed in the increased-pressure-workload preparation (b). 3. Hypoxia was induced by the partial replacement of O2 in the gaseous phase by N2. Hearts maintained their cardiac output when O2 content was decreased from 95% to 55% by volume, but the stability of the preparation was less at 50% O2. Lactate output was significantly increased at O2 contents of 65% or less. The rate of protein degradation was not different from control values (95% O2) in perfusions with 65, 55 or 50% O2. 4. We conclude that acutely increased workload or acute hypoxia does not affect protein degradation in the perfused working rat heart when cardiac output is relatively stable.

Animals↗
PubMed1998

The effect of maximum heart rate on oxygen kinetics and exercise performance at low and high workloads.

The normal heart rate is linearly related to oxygen consumption during exercise. The maximum heart rate of the normal sinus node is approximated by the formula: HRmax = (220-age) with a variance of approximately 15%. However, the nominal upper rate of most permanent pacemakers is 120 beats/min, a value that remains unchanged for many patients. As this nominal setting falls well below the maximum predicted heart rate for most patients, it is possible that the chronotropic response of rate adaptive pacemakers during moderate and maximal exercise workloads may be less than optimal. The purpose of this study was to determine the effect of the upper programmed rate on oxygen kinetics during submaximal exercise workloads and maximum exercise performance during symptom-limited treadmill exercise. Exercise performance with an upper rate programmed to 220-age was compared with an upper rate of 120 beats/min. Eleven patients (5 men and 6 women, mean age 54 +/- 10 years) with complete heart block following catheter ablation of the atrioventricular junction for refractory atrial fibrillation who were implanted with permanent, rate-modulating VVIR pacemakers comprised the study population. The rate adaptive sensors were based on activity in 8 patients, minute ventilation in 2 patients, and mixed venous oxygen saturation in 1 patient. After performing a symptom-limited treadmill exercise test to determine maximum exercise capacity and to optimized programming of the rate adaptive sensor, each subject performed two treadmill exercise tests in random sequence with a rest period of at least 1 hour between tests. During one of the tests the upper rate was programmed to a value calculated by the formula: HRmax = (220-age). During the other exercise test the upper rate was programmed to 120 beats/min. Patients were blinded as to their programmed values and to the hypothesis of the study. A novel treadmill exercise protocol was used that consisted of a 6 minute, constant-workload phase at approximately 50% of maximum workload followed immediately by incremental, symptom-limited exercise using a modified Chronotropic Assessment Exercise Protocol(CAEP) with 1 minute stages until; peak exertion. Breath-by-breath analysis of expired gases was performed with subjective scoring of exertional difficulty at the end of the constant workload phase and during each stage of incremental exercise using the Borg Perceived Exertion Scale. Exercise duration was significantly longer (637 +/- 47 vs 611 +/- 48 seconds, P < 0.005) with the higher programmed upper rate. Oxygen kinetics were also significantly improved with an age predicted upper rate with a lower O2 deficit (258 +/- 88 vs 395 +/- 155 mL, P = 0.002) and higher VO2 rate constant (3.6 +/- 1.0 vs 2.4 +/- 0.7, P < 0.001). The VO2max during peak exertion was higher with an age predicted upper rate than with an upper rate of 120 beats/min (1807 +/- 751 vs 1716 +/- 702 mL/min, P = 0.04). The mean Borg score was lower during the last common treadmill stage during maximum exercise with an age predicted upper rate than with an upper rate of 120 beats/min (15.7 +/- 2.0 vs 16.5 +/- 1.9, P = 0.04). The mean Borg score during submaximal, constant workload exercise was also lower with a higher upper rate (9.0 +/- 2.5 vs 9.6 +/- 2.2, P = 0.10). Programming the upper rate of rate adaptive pacemakers based on the age of the patient improves exercise performance and exertional symptoms during both low and high exercise workloads as compared with a standard nominal value of 120 beats/min.

Adult↗
PubMed1996

Evaluation of NCRP Report No. 49 assumptions on workloads and use factors in diagnostic radiology facilities.

A survey of modern medical institutions has been performed to measure the workload and primary beam use factors used in diagnostic x-ray installations in comparison to those suggested in Report 49 of the NCRP. Seven types of radiology installations were investigated, namely general radiographic rooms, general fluoroscopic and radiographic rooms (fluoroscopic and radiographic tubes surveyed separately), chest radiographic rooms, mammographic suites, and cardiac and peripheral angiographic suites. The radiologic technique (kVp and mAs) for each exposure performed on a total of 2396 patients was recorded either manually or by a commercially-available invasive electronic sensing system. Additionally, the direction of the primary beam during the exposure was recorded. The kVp distribution of the workload data was determined and normalized per patient for each of the seven types of installations. The total average workload per patient surveyed in each type of installation is 2.5, 13, 1.5, 0.22, 6.7, 160, and 64 mA min per patient for the above installation types. For general radiographic rooms the primary beam was directed at the floor for 69% of the total workload, with the remaining 21.5%, 6.5% and 1.6% of the workload directed toward three walls. When multiplied by the average number of patients examined weekly in each type of installation, the mean weekly workloads observed are 270, 230, 35, 44, 320, 3100, and 1400 mA min for the above-listed types of installations. Additionally, a significant fraction of the observed workloads occur at potentials much less than the kVp values typically assumed for radiation shielding.

Biophysical Phenomena↗
PubMed1990

Measuring the workload of the anesthesiologist.

Workload is an important determinant of human performance during complex dynamic tasks. We indirectly measured the mental workload of nine anesthesia residents during 19 cases using a secondary (subsidiary) task paradigm in which performance on an extra task (problems in mathematical addition occurring approximately every 45 s) was used as a probe of a subject's "spare capacity." Excess response time (above baseline) correlated with activities like "manual task" and "speaking with the attending anesthesiologist." The addition problem was either skipped or had a high excess response time (greater than 30 s) in 40% of presentations. The complexity of a case and the experience level of the resident interacted in determining the workload. Subjective workload ratings confirmed that induction of and emergence from anesthesia were periods of highest workload, with "attention" as the dominant cognitive requirement. The anesthesiologist's spare capacity may often be limited during anesthesia. These types of workload measurement techniques should be applied in controlled studies to better define the factors that increase workload.

Anesthesiology↗
PubMed1979

Effect of different workloads varying in intensity and duration on resolution acuity.

An experiment was conducted to determine the effect of participation in physical activity on resolution acuity. In the experiment, 21 undergraduate males participated in exercise sessions with work loads of 300, 700, and 1100 kmp for durations of 3 and 6 min. and a non-exercise control session. Resolution acuity was then determined by finding thresholds of a 20-cpd sinusoid-wave grating using the method of adjustment. A repeated-measures analysis of variance compared the effects of different workloads, intensities, and durations of workloads, and the interaction of intensity and duration on resolution acuity. Significant improvement of resolution acuity was found for all workloads relative to the non-exercise control session, for all other workloads relative to the 300 kpm/3 min. workload, and for the 1100 kpm/6 min. workload relative to the 300 kpm/6 min. and the 700/3 min. workloads. Increases in duration or intensity of exercise significantly improved resolution acuity. There was no significant interaction of the variables of intensity and duration of work on resolution acuity.

Humans↗
PubMed1990

A 14-year investigation into the workload of oncology nurses in The Netherlands Cancer Institute.

In the Netherlands Cancer Institute, the daily workload of nurses has been measured since 1976. Each day the head nurse ranks the patients into one of the seven categories of care requirements. It can be inferred from the data that the percentage of patients who need intensive nursing care has doubled from 30% in 1976 to more than 60% in 1989. The increase in the nursing staff has only partially kept abreast of the increase in the workload. In addition to this simple technique, a more refined "factor evaluation system" has been developed. On the basis of this method, a more detailed check can be made as to what connection there is between the characteristics of the patient, the particular disease and treatment on the one hand, and the nursing workload on the other. Because of this it is possible to assess and to predict the consequences for nursing care when a new therapy is introduced. The correlation between both assessment methods is good: 0.72. A plea is made to use both methods of assessment in conjunction: the simple method for assessing the daily workload, and the refined and thus more laborious method to analyze the factors responsible for changes in the workload. In view of the rapid dissemination of new oncological therapies, it is essential that international consensus be reached with regard to a method for measuring the workload of nurses. In this way the consequences of these new therapies for the workload of nurses might be known more rapidly and proper measures could be taken.

Cancer Care Facilities↗
PubMed1987

Relationship between intensity of hospital services and pharmacy workload.

The relationship between hospital census variables and pharmacy department workload was studied; intensity, which measures services provided per hospitalized patient per day, was used as the workload indicator. Quarterly data on inpatient pharmacy workload and hospital census were statistically analyzed for 1981 through 1985. Number of patient days, number of admissions, average length of stay (LOS), and pharmacy work units were examined. A work unit was one unit of inpatient pharmacy activity, such as one order for oral medication or one i.v. admixture; clinical services were excluded. Intensity was defined as the number of work units per patient day. Intensity as a function of intensive-care-unit (ICU) patient days was also analyzed. The number of pharmacy work units per quarter more than doubled from 1981 to 1985, while the number of admissions remained relatively constant. The average LOS decreased from 8.4 days in 1981 to 6.3 days in 1985, and the number of patient days decreased 27%. Quarterly workload intensity increased from 1.4 to 4.37 over the five-year period. Statistical analysis showed a strong inverse relationship between intensity and average LOS; LOS accounted for 92% of the variability in intensity. The number of ICU patient days, which increased 21%, had a significant effect on pharmacy workload; 30% of the variation in pharmacy workload was explained by ICU days. Intensity measures are useful in predicting pharmacy department workload.

Critical Care↗
PubMed2007

House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service.

BACKGROUND: House staff work-hour regulations have required residency programs to reengineer inpatient services. However, few data describe how house staff workload on a patient's day of admission or on subsequent hospital days influences patient outcomes. METHODS: Retrospective cohort analysis of 5742 adults admitted to an academic general medical service between July 1, 1998, and June 30, 2001. RESULTS: After multivariate risk adjustment for patient severity and other structural factors, we found that 2 different measures of house staff workload significantly affected patient outcomes. House staff workload increases on the day of admission, defined as each additional team admission on a patient's admission day, increased length of stay (difference, 3.09%; 95% confidence interval [CI], 2.22%-3.96%), total costs (difference, 2.31%; 95% CI, 1.29%-3.33%), and risk of inpatient mortality (odds ratio, 1.09; 95% CI, 1.02-1.15). Patients had an even higher mortality risk when more than 9 patients were admitted to their team on their admission day. In contrast, house staff workload increases during the patient's entire stay, defined as every additional patient added to the team average census, reduced length of stay (difference, -5.30%; 95% CI, -4.54% to -6.07%) and total costs (difference, -5.11%; 95% CI, -4.20% to -6.00%). Reductions in length of stay and costs were most striking when the team average census exceeded 15 patients. CONCLUSIONS: Our findings suggest that higher house staff workload on admitting days-when fewer backup resources are available-increases resource use and may increase inpatient mortality. Conversely, a higher average team census was associated with reduced resource use, perhaps reflecting service-level adaptations to workload. Future studies should confirm these findings in larger trials.

Aged↗
PubMed1995

Physical workload and the aging worker: a review of the literature.

In the coming decades, demographic, economic and social changes will result in an increased proportion of elderly persons in the workforce in most industrialized countries. This trend is causing growing interest in the problems of the aging worker in current employment. The objective of this particular paper is to provide more insight into the impact of aging on the balance between physical work capacity and physical workload. To this end, the scientific literature in the field is reviewed and ordered by means of a specific conceptual model of "aging and physical workload". A progressive decline in physical work capacity, characterized by diminished aerobic capacity and muscular capacity, has consistently been reported. However, inter-individual differences appear to be considerable. The question of whether there are systematic differences in physical work demands between younger and older workers within occupations has been answered vaguely. Conflicting results in this matter bring into discussion the role of the actual working method as one of the determinants of the physical workload. An age-related imbalance between physical workload and physical work capacity is suggested to result in a chronic overload, increasing the risk of long-term health effects such as musculoskeletal complaints and disorders. For many aging workers in physically demanding occupations, extreme physical workloads, increasing the risk of disease or disablement, are still reported. The multiconceptual study of aging and physical workload in the present paper reveals several possibilities for preventive measures. However, as information is still lacking, additional research is needed, in particular on the onset and development of long-term effects on health in relation to age and work demands.

Adult↗
PubMed2004

Microgravity simulation: physical and psychological workload evaluation tests in an underwater environment.

As weightlessness is not completely reproducible on Earth, usability evaluation of space systems is often simulated through tests in an aquatic environment. A Neutral Buoyancy Facility test programme was organized in a special pool to simulate Extra-Vehicular Activities on the Columbus module of the future International Space Station with the aim of assessing various aspects of crew interface design. This study was designed to evaluate workload using visibility, accessibility and operability tests. Diving workload was determined through basic physiological measurements, such as pulmonary ventilation and heart rate during underwater operations. As anxiety can influence physiological processes, and consequently also the workload evaluation determined through these parameters, we developed an evaluation methodology to investigate the anxiety level based on a specific questionnaire submitted to all subjects before and after the dives. Heart rate increased in underwater work to a value approximately 50% larger than the value obtained in the resting condition while sitting outside the pool. This increase in heart rate was accompanied by an increase in pulmonary ventilation of 200% larger than the value recorded in the rest condition while sitting outside the water. The extent of these increases was notable in all the test subjects, who varied in age and stature. Recorded values of workload, heart rate and pulmonary ventilation were evaluated on the basis of Christensen's (Arbeitsphysiol. 14 (1950) 251) and Wells' (J. Appl. Physiol. 10 (1957) 51) classifications. Through this analysis it was possible to determine that the workload, indicated by performance on our neutral buoyancy tests, corresponds to moderate physiological work. For test subjects, anxiety related to underwater performance was light. Among the causes of anxiety all the subjects indicated the lack of confidence with neutral buoyancy tests and a feeling of lack of safety, typical of aquatic environments. We can conclude that context did not produce considerable psychological effects, and consequently that the psychological load did not influence heart rate and pulmonary ventilation values that can therefore be directly related to task workload.

Adult↗
PubMed2005

The relationship between protective and risk characteristics of acting and experienced workload, and musculoskeletal disorder cases among nurses.

PROBLEMS: Limited research is available on the acting (work characteristics) and experienced (perceived stress) workload of nurses. The relationship between risk and protective characteristics of work-related factors and the prevalence of musculoskletal symptoms in different body regions is also unclear. METHODS: The study was a cross-sectional design with 97 female registered nurses working in a hospital setting. Two surveys were used to document the workload exposure of the nurses. One survey consisted of 148 items aimed to measure the acting workload variables from the environment; the other survey included 33 items that were aimed to measure the nurses' experienced workload. The musculoskeletal outcomes were documented with a modified version of the Nordic Musculoskeletal Symptom Survey. RESULTS: Factor analyses revealed three factors that accounted for 56% of the total variance. Factor 1 (i.e., integrated experienced energy replenishment/expenditure) represented the psychological effects of work characteristics, effort, perceived risk, and performance. Factor 2 (i.e., acting energy replenishment/expenditure) consisted of non-physical variables of the work characteristics, while Factor 3 (i.e., acting energy expenditure) included both acting and experienced workload. Logistic regression analyses indicated that Factor 3 was significantly associated with the musculoskeletal symptoms of lower and upper back, hands/wrists, and knees/lower legs (odds ratios > 1.0). Factor 2 was significantly associated with the musculoskeletal symptoms of the upper back and knees/lower legs (odds ratios < 1.0). SUMMARY: Both the acting and experienced workloads exhibited associations with musculoskeletal outcomes in the lower back, upper back, hands/wrists, and knees/lower legs in terms of risk and protective effects.

Adult↗
PubMed2001

The impact of draught related to air velocity, air temperature and workload.

This experimental study was designed to test the hypotheses that the effects of draught increase with higher air velocity, with lower air temperature, and with lower workload. Thirty healthy young males were exposed to horizontal draught during 55 min while they operated an arm ergometer in a standing posture. Air velocity, air temperature, and workload were varied in 3 steps each, between 11 and 23 degrees C, 0.1 and 0.3 m/s, and 104 to 156 W/m2, respectively. The 27 combinations were distributed over subjects in a fractional factorial 3(3)-design. The participants were clothed for thermal neutrality. Workload was measured at the end of the sessions by respirometry. Draught-induced annoyance was determined every 5 min, separately for 10 body sites. Corresponding skin temperature was also recorded. The hypotheses were verified for the influence of air velocity and air temperature. Regarding workload, local heat production is probably decisive, meaning that draft-induced local annoyance is inversely related to workload in active but independent from workload in non-active body areas. To improve the situation for the workers concerned it is suggested to apply protective gloves that cover an as great area of the forearms as possible and to limit airflows to mean velocities of less than 0.2 m/s (with turbulence intensities of 50%).

Adult↗
PubMed2003

A method of predicting workload and staffing level for radiotherapy treatment planning as plan complexity changes.

When assessing the impact on workload from an expanding number of new patients and increasing treatment complexity, radiotherapy clinics find that oversimplified workload parameters, such as number of patients or number of fields, are not suitable for managing and predicting workload and organisational dimension. Although the basic treatment equivalent concept is available for predicting linear accelerator utilisation, no corresponding parameter has been available for radiotherapy treatment planning. In this study, we derive a simple workload indicator for treatment planning. The dose plan unit (DPU) takes the complexity of the treatment plan into account. Categorising plans according to complexity in their production, and measuring corresponding time for completing the plans in these categories, leads to the following baseline values for workload prediction: 1 DPU (non-computed tomography [CT]), 3 DPU (CT-contour) and 6 DPU (full-CT). The measured average productivity of 0.65 DPU per hour (1 standard deviation, SD = 0.08 DPU), or alternatively 1 DPU = 92 min, for a dosimetrist in this clinic indicates that 79.0 DPU can be produced by each dosimetrist per month within normal working hours. The predictive power of the DPU is shown in terms of using it to quantify the impact on workload in treatment planning of changing treatment protocols for a particular anatomic treatment site.

Analysis of Variance↗
PubMed2003

Bowling workload and the risk of injury in elite cricket fast bowlers.

This study examined the relationship between the bowling workload of first-class cricket fast bowlers and injury with the aim of identifying a workload threshold at which point the risk of injury increases. Ninety male fast bowlers (mean age 27 years, range 18-38 years) from six Australian state squads were observed for the 2000-2001 and/or 2001-2002 cricket seasons. Workload was quantified by examining fixture scorecards and conducting surveillance at training sessions. Injury data was obtained from the Cricket Australia's Injury Surveillance System. Compared to bowlers with an average of 3-3.99 days between bowling sessions, bowlers with an average of less than 2 days (risk ratio (RR) = 2.4, 95% confidence interval (CI) 1.6 to 3.5) or 5 or more days between sessions (RR = 1.8, 95% CI 1.1 to 2.9) were at a significantly increased risk of injury. Compared to those bowlers with an average of 123-188 deliveries per week, bowlers with an average of fewer than 123 deliveries per week (RR = 1.4, 95% CI 1.0 to 2.0) or more than 188 deliveries per week (RR= 1.4, 95% CI 0.9 to 1.6) may also be at an increased risk of injury. There appears to be a dual fast bowling workload threshold beyond which the risk of injury increases and maintaining a workload that is too low or infrequent is an equally significant risk factor for injury as maintaining a high bowling workload. Further study is required to determine the reason why players who bowl infrequently suffer more injuries.

Adolescent↗
PubMed2004

Psychological workload is associated with weight gain between 1993 and 1999: analyses based on the Danish Nurse Cohort Study.

AIMS: To examine associations between psychological workload and subsequent 6-y weight changes. METHODS: In total, 6704 Danish nurses, aged 45-65 y and employed both in 1993 and 1999, answered questionnaires about psychological workload, including busyness in job, job speed and job influence, and lifestyle, as well as body weight and height at both examinations. RESULTS: Danish nurses who reported being almost always busy, or never busy, gained significantly more weight (3.1 and 3.5 kg, respectively) than nurses who reported being sometimes busy, who gained 2.5 kg in weight (P=0.04, 0.002). Job speed was not associated with subsequent weight gain. Job influence was inversely associated with subsequent weight changes after 6 y. The mean weight gain for nurses with no job influence was 4.1 kg, whereas those having major job influence had a mean weight gain of 2.6 kg (P=0.002). Nurses who stated they felt almost always busy in their jobs and who had no job influence gained significantly more weight than those who were never busy and those with major influence in their jobs (P=0.007). All results were essentially similar before and after adjustment for confounders for nurses reporting both high and low workload. Nurses whose workload remained stable (for instance, being sometimes busy) both in 1993 and 1999 gained less weight than nurses who changed their workload. Nurses who experienced minor/no influence in job, in both 1993 and in 1999, experienced a greater weight gain as compared to nurses who attained influence in job over the 6-y period. CONCLUSION: : Psychological workload, particularly both low and high busyness in job and low influence in job, was associated with higher 6-y weight gain among female Danish nurses.

Cohort Studies↗
PubMed1997

Case mix type as a predictor of nursing workload.

In the current health care service, the need to measure nursing workload has become the subject of major debate. Attempts have been made to relate workload and nurse staffing, however, despite there being systems for this there appears to be no single recognized formula. Case mix groups have been advocated as a useful tool for measuring nursing workload, particularly in Canada where work continues. Case mix groups work on the basis that patients who are clinically similar and use equivalent resources are grouped using procedure and diagnostic codes. The retrospective study examines the relationship between case mix, resource utilization and nursing effort to determine whether future workload could be predicted using these parameters. The sample included 798 patients and 30 nurses over the period 1993-1994 with analysis of data from the Patient Administration System (PAS) and TEAMWORK, which purports to measure nurse workload. Results showed that there was little relationship between nursing workload and case mix grouping and recommendations are made for future research.

Diagnosis-Related Groups↗
PubMed1997

Accuracy in workload measurement: a fact or fallacy?

As the drive within a market-led National Health Service is towards cost-efficiency and through-put, nurses are now more than ever having to 'prove their worth'. This has led to various workload measurement systems being used throughout nursing. Before examining the accuracy of these measurement tools this paper attempts to define workload and investigates how measurement is limited by an unclear definition of what 'nursing' actually is. There is little argument as to some of the beneficial effects of monitoring workload where changes in practice, rostering, skill mix and establishments have occurred. It is, however, necessary to examine the accuracy of workload measurement within the current framework of nursing to see if it is the promised panacea. The issues surrounding patient dependency and professional judgement are discussed and the seeming unacceptability of such 'soft data' to non-nursing personnel. Both the 'bottom-up' and 'top-down' approaches of workload measurement are explored within the context of equity, neutrality and bias. The conclusion is drawn that accuracy in nursing workload measurement is not possible in the current economic climate and that a compromise solution that uses patient dependency as an assessment tool is the best that can be hoped for without limiting nursing to inflexible and restrictive practices.

Activities of Daily Living↗