基于某样本区的门诊医生工作负荷研究

目的:界定当前门诊医生标准工作负荷,明确门诊医生工作负荷现状,了解"看病难"的实质性问题。方法:分析门诊患者数据库,门诊医生问卷调查。结果:(1)当前门诊医生标准工作负荷应为21～25人次/d;(2)门诊医生每年大约有25%的工作日处于超负荷工作状态;(3)"看病难"问题实质上与百姓看门诊"扎堆儿"现象有关。结论:医院管理活动中应根据病人流量科学安排门诊医生上岗与轮休,以提高工作效率及医生、病人综合满意度,缓解"看病难"问题。     

Effect of order of exercise intensity upon cardiorespiratory,metabolic, and perceptual responses during exercise of mixed intensity

Exercise of mixed intensities can be of benefit in many different ways. However, whether physiological interaction exists between exercises of different intensity is questionable. As such, the primary aim of this study was to examine the effect of order of exercise intensity upon cardiorespiratory, metabolic, and perceptual responses during exercise of mixed intensity. Eight males and four females volunteered to serve as subjects for the study. They were informed of the purpose of the experiment and gave their written consent to participate. Each subject completed a peak oxygen uptake (O_2peak) test and two submaximal exercises of mixed intensity on three separate laboratory visits. During each submaximal exercise trial, subjects performed a 15-min (high intensity) exercise at 70%O_2peak that was followed by another 15-min (low intensity) exercise at 50%O_2peak (high/low, H/L), or a 15-min exercise at 50%O_2peak that was followed by another 15-min exercise at 70%O_2peak (low/high, L/H). Oxygen uptake (O₂), respiratory exchange ratio (R), expired ventilation (_E), heart rate (HR) and ratings of perceived exertion (RPE) were measured every 5 min throughout exercise. Energy expenditure and carbohydrate and fat oxidation were calculated from O₂ adjusted for substrate metabolism using R and then accumulated for each phase of exercise intensity as well as for the entire exercise session. O₂ and HR were higher (P<0.05), while R was lower (P<0.05) at the lower intensity in H/L than in L/H. _E and RPE were lower (P<0.05) at the higher intensity in H/L than in L/H. While no differences in caloric expenditure and carbohydrate oxidation between the two trials were observed, fat oxidation was higher (P<0.05) both at the lower intensity and for the entire trial in H/L than in L/H. It appears that during exercise of mixed intensity, placing some periods of moderate intensity exercise prior to a milder one is a more favorable sequence in that it can elicit a greater fat oxidation while being felt less stressful.     

中文版主观负荷评估法量表和美国国家航空航天任务负荷指数量表评估三级医院内科医生脑力负荷的信效度研究

目的　检验中文版主观负荷评估法（SWAT）、美国国家航空航天任务负荷指数（NASA-TLX）量表评估三级医院内科医生脑力负荷的信度和效度,并分析不同内科医生之间的脑力负荷差异,为以后评估国内三级医院内科医生的脑力负荷提供一种可行的工具。方法　2014年11月—2015年1月采用方便抽样法选取复旦大学附属中山医院内科临床执业医生107例为调查对象。采用医生一般情况调查表及中文版SWAT、NASA-TLX量表对其进行调查。采用内部一致性信度、分半信度、条目与总分的相关性进行信度评价,采用结构效度、区分效度进行效度评价。采用多个独立样本的非参数检验比较不同科室医生脑力负荷水平的差异。结果　共发放调查问卷107份,回收有效问卷105份（2例拒绝调查）,有效回收率为98.1%。中文版SWAT、NASA-TLX量表的Cronbach's α系数分别为0.504、0.516,分半信度系数分别为0.360、0.634,中文版SWAT量表各条目得分与其总分的相关系数均>0.3（P值均<0.05）,中文版NASA-TLX量表心智需求、体力需求、时间需求、努力程度、受挫程度条目得分与其总分的相关系数均>0.3（P值均<0.05）,由于中文版NASA-TLX量表自我绩效条目得分与其总分的相关系数<0.3,故将此条目删除,形成C-NASA-TLX量表,其Cronbach's α系数为0.645,分半信度系数为0.690,各条目得分与其总分的相关系数均>0.3（P值均<0.05）。中文版SWAT量表的KMO值为0.552,Bartlett's球形检验χ2=24.711,P<0.001,说明适合进行因子分析;共提1个公因子,累积方差贡献率为51.343%,各条目载荷值为0.573~0.817。中文版NASA-TLX量表的KMO值为0.590,Bartlett's球形检验χ2=117.010,P<0.001,说明适合进行因子分析;共提取3个公因子,累积方差贡献率为76.508%,各条目载荷值为0.602~0.827。C-NASA-TLX量表的KMO值为0.607,Bartlett's球形检验χ2=96.658,P<0.001,说明适合进行因子分析;共提取2个公因子,累积方差贡献率为67.037%,各条目载荷值为0.542~0.810。根据中文版SWAT、NASA-TLX量表总分及C-NASA-TLX量表总分,分别采用极端组法将医生分为A高分组、A低分组和B高分组、B低分组及C高分组、C低分组,各28例;A高分组中文版SWAT量表时间负荷、努力负荷、心理紧张负荷条目得分高于A低分组（P<0.05）;B高分组中文版NASA-TLX量表仅心智需求、体力需求、努力程度条目得分高于B低分组（P<0.05）;C高分组C-NASA-TLX量表心智需求、体力需求、时间需求、努力程度、受挫程度条目得分高于C低分组（P<0.05）。不同科室医生中文版SWAT量表总分及其各条目得分比较,差异无统计学意义（P>0.05）。不同科室医生中文版NASA-TLX量表总分及其心智需求、体力需求、时间需求、自我绩效条目得分比较,差异无统计学意义（P>0.05）;不同科室医生中文版NASA-TLX量表努力程度、受挫程度条目得分比较,差异有统计学意义（P<0.05）。结论　中文版SWAT量表虽结构效度及项目区分度较好,但内部一致性信度较差,仍不适合用于评估三级医院内科医生脑力负荷;中文版NASA-TLX量表与中文版SWAT量表信效度相似,但删除自我绩效条目后的C-NASA-TLX量表信效度较好,可以用于三级医院内科医生的脑力负荷研究。三级医院不同科室医生总脑力负荷无差异。     

Work and workload of Dutch primary care midwives in 2010

Objective

to re-assess the work and workload of primary care midwives in the Netherlands.

Background

in the Netherlands most midwives work in primary care as independent practitioners in a midwifery practice with two or more colleagues. Each practice provides 24/7 care coverage through office hours and on-call hours of the midwives. In 2006 the results of a time registration project of primary care midwives were published as part of a 4-year monitor study. This time the registration project was repeated, albeit on a smaller scale, in 2010.

Method

as part of a larger study (the Deliver study) all midwives working in 20 midwifery practices kept a time register 24 hours a day, for one week. They also filled out questionnaires about their background, work schedules and experiences of workload. A second component of this study collected data from all midwifery practices in the Netherlands and included questions about practice size (number of midwives and number of clients in the previous year).

Findings

in 2010, primary care midwives actually worked on an average 32.6 hours per week and approximately 67% of their working time (almost 22 hours per week) was spent on client-related activities. On an average a midwife was on-call for 39 hours a week and almost 13 of the 32.6 hours of work took place during on-call-hours. This means that the total hours that an average midwife was involved in her work (either actually working or on-call) was almost 59 hours a week. Compared to 2004 the number of hours an average midwife was actually working increased by 4 hours (from 29 to 32.6 hours) whereas the total number of hours an average midwife was involved with her work decreased by 6 hours (from 65 to 59 hours). In 2010, compared to 2001–2004, the midwives spent proportionally less time on direct client care (67% versus 73%), although in actual number of hours this did not change much (22 versus 21). In 2009 the average workload of a midwife was 99 clients at booking, 56 at the start of labour, 33 at childbirth, and 90 clients in post partum care.

Conclusion

the midwives worked on an average more hours in 2010 than they did in 2004 or 2001, but spent these extra hours increasingly on non-client-related activities.     

30 Years of Radiotherapy Service in Southern Thailand: Workload vs Resources

Background: To study the pattern of patient load, personnel and equipment resources from 30-yearsexperience in Southern Thailand. Materials and Methods: This retrospective study collected secondary datafrom the Division of Therapeutic Radiology and Oncology and the Songklanagarind Hospital Tumor Registrydatabase, Faculty of Medicine, Prince of Songkla University, during the period of 1982-2012. Results: The numberof new patients who had radiation treatment gradually increased from 121 in 1982 to 2,178 in 2011. Shortagesof all kinds of personnel were demonstrated as compared to the recommendations, especially in radiotherapytechnicians. In 2011, Southern Thailand, with two radiotherapy centers, had 0.44 megavoltage radiotherapymachines (cobalt or linear accelerator) per million of population. This number is suboptimal, but could bemanaged cost-effectively by prolonging machine operating times during personnel shortages. Conclusions: Thisstudy identified a discrepancy between workload and resources in one medical school radiotherapy center inSouthern Thailand. This information is crucial for future strategic planning both regionally and nationally.     

Radiologist supply and workload: international comparison--Working Group of Japanese College of Radiology

Purpose  The aim of this study was to compare radiology statistics and procedures across the world with an eye to lightening the workload of radiologists in Japan. Methods  Literature and data in the public domain were obtained for Organization for Economic Cooperation and Development (OECD) member countries. This study collected and analyzed the number of (diagnostic) radiologists and physicians, computed tomography/magnetic resonance (CT/MR) units, CT/MR examinations, and workload of radiologists. Results  Data for the number of radiologists and CT/MR units were obtained from 26 countries and, among them, data for the number of CT/MR examinations for 17 countries. The study found that in 2004 Japan had only 36 radiologists per million population, which is one-third the national average of the 26 countries surveyed, making Japan one of the lowest ranked countries. The workload of a radiologist (CT/MR examinations/year) in Japan was calculated at 6130. This is 4.3 times the global average (1440 for the 17 countries). Conclusions  This comparison showed that the number of radiologists in Japan is the lowest among the 26 countries, and the workload is the highest. The study also showed that for Japan to provide sustainable and quality health care 8614 diagnostic radiologists—2.5 times the present number—would be required.     

Should previous mammograms be digitised in the transition to digital mammography?

Breast screening specificity is improved if previous mammograms are available, which presents a challenge when converting to digital mammography. Two display options were investigated: mounting previous film mammograms on a multiviewer adjacent to the workstation, or digitising them for soft copy display. Eight qualified screen readers were videotaped undertaking routine screen reading for two 45-min sessions in each scenario. Analysis of gross eye and head movements showed that when digitised, previous mammograms were examined a greater number of times per case (p = 0.03), due to a combination of being used in 19% more cases (p = 0.04) and where used, looked at a greater number of times (28% increase, p = 0.04). Digitising previous mammograms reduced both the average time taken per case by 18% (p = 0.04) and the participants’ perceptions of workload (p < 0.05). Digitising previous analogue mammograms may be advantageous, in particular in increasing their level of use.