Occupational exposures and inpatient hospital care for lumbar intervertebral disc disorders among Finns

BACKGROUND: Low back disorders are among the most common health problems in industrialized societies. We examined the relationship between occupational exposures and severe lumbar intervertebral disc disorders (LIDD). METHODS: Information on inpatient care for LIDD (ICD-10: M51.1-51.9) in Finnish hospitals during 1996 was linked with the 1995 Population Census, and based on occupational title with the Finnish Job Exposure Matrix and the Occupational Lifestyle Matrix. There were 3,863 individuals hospitalized due to LIDD among occupationally active Finns. Poisson regression analyses were made with the total occupationally active population as reference. RESULTS: In a multivariate analysis in women, accident risk, job control, and three-shift work were associated with hospitalization, together with age, education, personal income, and average body mass index (BMI) by occupation. In men, accident risk and job control were associated with hospital admissions, allowing for age, education, and income. CONCLUSIONS: Accident risk and job control increased the risk of hospitalization for LIDD in both sexes. Three-shift work and BMI were also predictive of hospital admission among women.     

Private dental visits per dentist in Spain from 1987 to 1997. An analysis from the Spanish national Health Interview Surveys

OBJECTIVES: In view of the sharp increase in the number of dentists in Spain, the aim of the present study was to analyse changes in the private dentist workload in Spain over the period 1987-97. METHODS: Data were taken from censuses of the population and of dental practitioners, and from the Spanish National Health Interview Surveys. The percentage of people that had visited the dentist in the 3 months prior to the survey was calculated, and of these, the percentage whose last visit was private. The total number of visits made by those people was taken as the estimate of total private visits in Spain during 3 months. Total private activity in 1 year was derived by multiplying this estimate by four. Annual private activity was then divided by the number of dentists. RESULTS: From 1987 to 1997, the Spanish population grew 2.5% (from 38.7 to 39.7 million) and the number of dentists increased by 136.1% (from 6373 to 15,044). The total annual number of private dental visits (+/-SE) was 35.7 +/- 1.0 million in 1987, and 48.9 +/- 2.0 million in 1997 - a 36.8% increase. Thus, the mean number of private dental visits per dentist decreased 42.0% (from 5610 +/- 152 to 3251 +/- 133). CONCLUSION: A significant reduction in private dental visits per dentist is taking place in Spain.     

Introduction of night shift call system for surgical trainees: a prospective self-controlled trial

OBJECTIVE: The number of hours worked by specialty trainees has come under scrutiny recently. One approach aimed at decreasing the number of consecutive hours worked is the night shift call system (NSCS). This study aimed to determine the advantages and disadvantages of an NSCS compared with those of the conventional overnight call system (ONCS). SUBJECTS AND METHODS: Sixteen basic surgical trainees (BSTs) from our unit participated in this prospective, self-controlled trial. During April 2000, the conventional 1-in-4 ONCS with a post-call half-day off was instituted. From May to June 2000, each BST rotated to work 1 week of night duty (20.00-08.00) and 7 weeks of daytime duty. A battery of neuropsychological tests were administered to the group after call during the study period. RESULTS: On average the numbers of consecutive hours worked during the NSCS and ONCS periods were 12 and 28 hours, respectively. There was no difference in numbers of errors committed and no difference in discrepancy between diagnoses made on admission and discharge. Two of the simple neuropsychological tests (memory scanning and addition tests) showed a significant fall-off in performance during the ONCS period (P < 0.05). Most specialists preferred the ONCS, while the majority of the BSTs preferred the NSCS (P < 0.05). This was because without extra manpower, the overall workloads of senior staff were increased. CONCLUSIONS: The NSCS is 1 way of reducing work hours, and was associated with significantly less impaired cognition on the part of our BSTs. It is only feasible if extra relieving staff are available to cover daytime duties.     

The nurse's workload in care situations

AIM: The aim of this study was to describe the nurse's workload in care situations and on different work shifts on surgical and medical wards. Changes in heart rate, shoulder-neck muscle tension and perceived exertion were measured in these care situations. DESIGN: Nurses' physical fitness was tested using a clinical exercise test. RESULTS: Transportation of a patient to the operating theatre was the most strenuous care situation on morning and evening shifts. Primary care, and situations related to practical nursing procedures were the second most strenuous situations regardless of the shift. Workload in primary care situations and in transporting the patient can be classified as medium heavy based on heart rate and relative workload, whereas in other situations it can be classified on average as moderate or light. The nurse's good physical fitness was reflected in relative workload in care situations so that in primary care and practical nursing procedures there was a statistically significant difference between those who scored high on a fitness test and those who scored low. Transferring tasks and practical nursing procedures involved more shoulder-neck muscle tension than other care situations.     

Emergency department workload — A transatlantic comparison

This paper compares the workload of the emergency department of a Level One trauma center in the United States and a large city hospital in the United Kingdom. The referral pattern and diagnostic classification of 5,000 patients presenting to both departments were compared, as were the transportation systems at the two sites. It was shown that similarities existed in many areas. Major trauma formed only a small proportion of the overall workload of both departments. The conclusion is that althofugh the two emergency care systems have fundamental differences in terms of organization and finance, the workloads are remarkably similar. Interesting differences arose in areas such as use of helicopter transport, psychiatric and drug and alcohol related admissions, and in the number of patients brought to hospital under police escort.     

AUSTRALIA’S BREAST SURGERY WORKLOAD IS CHANGING: COMPARISON OF A METROPOLITAN AND A RURAL HOSPITAL

Background : Breast cancer is a common disease in our community and its incidence is increasing. As a result of the improvements in community awareness and introduction of screening, patients are being diagnosed with earlier breast cancer and with a higher incidence of pre-invasive disease. Improvements in radiology, often coupled with minimally invasive diagnostic modalities, have lessened the requirement for open diagnostic biopsies and also reduced the number of operations for benign breast disease. Methods : An audit of the surgical workload at Prince of Wales/Prince Henry Hospitals and Tamworth Base Hospital was conducted to document and compare the above changes in the metropolitan and rural settings. This study was conducted between 1987 and 1996 to assess the effect of screening and improved technology over a 10-year period. Results : The study found that a high percentage of malignant lesions are being diagnosed by fine-needle aspiration biopsy (FNAB) with a corresponding reduction in open biopsy rate at the Prince of Wales Hospital. There is a smaller percentage of benign operations in both settings with a reduction of equal proportion. The reporting of the pathology specimens has markedly improved at both institutions. There has been a reduction in the number of patients having modified radical mastectomy and there has been a corresponding increase in breast conservation surgery especially at the Prince of Wales/Prince Henry Hospitals, although there was an unexpectedly high incidence of breast conservation surgery at Tamworth Base Hospital in 1987. In 1996 the rates of breast conservation surgery were the same in both hospitals. Conclusions : There are minimal differences in the quality of surgical care being offered to patients at the Tamworth Base Hospital compared with the Prince of Wales Hospital and both institutions are within reach of the accepted best management practices available.     

应用作业管理法进行医生工作量的测算

目的:通过科学测量医生工作量为合理配置医生人力资源提供评价依据。方法:选择病种相对单一、手术操作较为统一、临床过程较为明确的乳腺外科作为研究对象,运用作业管理法进行医生工作量的测算。结果:通过作业管理我们可以得到医生的人力配置模型。结论:通过作业管理得出的医生人力配置的作业模型可以作为医院科学配置人力资源的评价办法,但还有待于进一步完善。     

What degree of work overload is likely to cause increased sickness absenteeism among nurses? Evidence from the RAFAELA patient classification system

AIM: This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload. BACKGROUND: The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care. METHOD: An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers. FINDINGS: The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year. CONCLUSION: Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.     

医院业务收入与医疗工作量的回归分析

目的了解医疗工作量对医院业务收入的影响及其程度,为管理层的决策提供参考依据。方法采用SPSS13.0软件,运用线性回归统计方法对某院2001年至2008年医疗业务主要指标进行研究,分析医疗工作量与业务收入的密切程度。结果医院业务收入的变异99%以上可由医疗业务工作量变化来解释,其中住院中心手术量对业务收入影响最大,其次分别是住院病人量、急诊量、专家门诊量和普通门诊量。结论应注重手术病人对医院收入的巨大拉动作用;进一步合理调配专家在夜间、双休日、节假日坐诊,提升收治病人质量,提高医疗工作量。