Home care of high risk pregnant women by advanced practice nurses: nurse time consumed.
This study examined the time spent by advanced practice nurses (APNs) in providing prenatal care to women with high risk pregnancies. The results indicate that the overall mean APN time spent in providing prenatal care was 51.3 hours per woman. The greatest amount of time was spent in the clinic and women with pregestational diabetes consumed the most APN time and required the most contacts. Historically, home care services have been measured by number of visits or contacts. This study assists home care nurses and administrators to consider additional measurements including time spent. (+info)
Effect of working hours on cardiovascular-autonomic nervous functions in engineers in an electronics manufacturing company.
A field survey of 147 engineers (23-49 years) in an electronics manufacturing company was conducted to investigate the effect of working hours on cardiovascular-autonomic nervous functions (urinary catecholamines, heart rate variability and blood pressure). The subjects were divided into 3 groups by age: 23-29 (n = 49), 30-39 (n = 74) and 40-49 (n = 24) year groups. Subjects in each age group were further divided into shorter (SWH) and longer (LWH) working hour subgroups according to the median of weekly working hours. In the 30-39 year group, urinary noradrenaline in the afternoon for LWH was significantly lower than that for SWH and a similar tendency was found in the LF/HF ratio of heart rate variability at rest. Because these two autonomic nervous indices are related to sympathetic nervous activity, the findings suggested that sympathetic nervous activity for LWH was lower than that for SWH in the 30-39 year group. Furthermore, there were significant relationships both between long working hours and short sleeping hours, and between short sleeping hours and high complaint rates of "drowsiness and dullness" in the morning in this age group. Summarizing these results, it appeared that long working hours might lower sympathetic nervous activity due to chronic sleep deprivation. (+info)
Satisfaction with obstetric care. Patient survey in a family practice shared-call group.
OBJECTIVE: To examine patients' satisfaction with their obstetric care in a family medicine shared-call group. DESIGN: A survey was given to a convenience sample of patients who came to see their doctors over a 6-week period. SETTING: Brameast Family Practice in Brampton, Ont, where eight doctors participate in a shared obstetrics call group with 16 other physicians, each taking call 1 day in 23 days. PARTICIPANTS: Mothers in the practice who had delivered in the previous 8 months. MAIN OUTCOME MEASURES: Demographic data, interventions during delivery, and satisfaction ratings. RESULTS: Of the 70% of women who responded, 96% were delivered by a doctor other than their own. Eighty-eight percent of these women were satisfied with their medical care at delivery and 96% were satisfied with their prenatal care. Nearly 79% said they would choose this shared-call group again. CONCLUSIONS: This pilot study demonstrated a high level of patient satisfaction with obstetric care, despite the fact that most patients were delivered by a doctor other than their own. Family practice groups sharing obstetric call offer a feasible alternative for physicians who wish to avoid the interference with lifestyle and office appointments that practising obstetrics usually entails. (+info)
Gender, work and illness: the influence of a research unit on an agricultural community in The Gambia.
Changes in employment opportunities and medical services are exploited by men and women in different ways. This paper examines gender-based variation in the selective use of employment and health opportunities in a Gambian village which has been the subject of medical and nutritional research by the Medical Research Council (MRC) for 43 years. The seasonal workloads of 105 men and women in Keneba were compared during one calendar year. Women carried a heavier burden of agricultural labour, while men had a higher rate of waged employment. The impact of the MRC field station on the local economy was assessed and evidence of associated male dependence on MRC employment found. Illness reporting patterns and the treatment choices of men and women were examined. Women made greater use of the MRC medical service, while men resorted more frequently to local remedies and healers. Female dependence on the MRC medical services is suggested by the data, and may be linked to the greater attention paid to them by researchers and medical practitioners. (+info)
The effects of clonazepam on quality of life and work productivity in panic disorder.
Although panic disorder has been associated with impaired quality of life (QOL) and financial dependence, no prior study has examined whether a clinical intervention will improve these outcomes. This study examines the effects of clinically titrated doses of clonazepam versus placebo on QOL and work productivity (WP) in patients with panic disorder. QOL and WP were measured in conjunction with a randomized, double-blind, placebo-controlled trial. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment questionnaire were used to assess QOL and WP, respectively. Baseline assessments were obtained before randomizing patients to receive clinically titrated doses of clonazepam or placebo. Follow-up assessments were obtained after 6 weeks of therapy with the test drug or at premature termination from the study. Improvement on the SF-36 Mental Health Component Summary scale was more than twice as great with clonazepam than with placebo (P = 0.03). Clonazepam patients improved (P < 0.05) on all five measures of mental health-related QOL, and both measures of physical health-related QOL, and both measures of WP. Placebo patients improved on three of five measures of mental health-related QOL, but on no other measures. Patients with marked improvements on clinical measures of panic disorder severity, especially avoidance and fear of the main phobia, showed the greatest gains on the SF-36 Mental Health Component Summary scale. Clinically titrated doses of clonazepam significantly improved mental health-related QOL and WP in panic disorder patients. Lesser improvements were obtained with placebo. (+info)
Health human resource development in rural China.
China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas. (+info)
Provision of telephone advice from accident and emergency departments: a national survey.
This study sought to gain a national picture of the provision of telephone advice using a postal survey of senior nurses from accident and emergency (A&E) and minor injury units (MIUs). In all, 268/313 (85%) of hospitals/units responded. The average number of calls reported as received per day was 15.5 (median 12; quartiles 6, 20) for weekdays and 21.0 (median 17; quartiles 10, 29) for weekends. Most (89%) viewed the provision of telephone advice as an important component of their work, but few units offered staff training for this role or had implemented protocols or guidelines. Only 5.4% units included the number of calls received in their department in their workload figures, but 91.9% felt that they should be. Extrapolation of the data from this study to all 313 A&E and MIUs in the UK suggests that just under two million calls for telephone advice are currently made to units each year. Recognition and formalization of this aspect of work is likely to be of increasing importance given the constraints on services and the need to manage demand effectively. Future integration of A&E telephone advice calls with NHS Direct should be considered as a means of managing demand and avoiding duplication of service provision. (+info)
Doctor's assistants--do we need them?
OBJECTIVE: To investigate the potential for the doctor's assistant role within an accident and emergency (A&E) department in relation to consultant workload. METHODS: A time and motion evaluation of the activities of four A&E consultants before and after a doctor's assistant was established as a team member within our department. A review of the literature was undertaken to allow comparisons with the American model of the physician assistant within the emergency department. RESULTS: The initial evaluation indicated that over 20% of the consultant's time could have been saved if an assistant were available to perform a variety of non-medical tasks. The restudy performed once the assistant was in post indicated less time was spent by the doctors in "medical" clerical duties (6.7% v 11.5% time), telephone use (5.6% v 7.7%), and venepuncture/cannula insertion (0.4% v 2.1%), and more time was spent on consultation over cases (15.3% v 11.3%) and supervision of other staff (9.3% v 4.1%). These five areas changed significantly (p = 0.005 by paired t test). CONCLUSIONS: The doctor's assistant may have a role in reprofiling the workload of senior doctors in A&E departments in the UK. They may also have a role in reducing the pressure on junior doctors, though this effect was not evaluated. (+info)