BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.
Cities/statistics & numerical data* ; Geography ; Hospitals, Teaching/statistics & numerical data* ; Japan ; Physicians/statistics & numerical data* ; Population Density ; Salaries and Fringe Benefits/statistics & numerical data* ; Students, Medical/psychology* ; Workload/statistics & numerical data*

Clinical laboratories for in vitro diagnostics are facing pressure to preserve cost control while providing better services through new initiatives. Laboratory automation is a partial answer to this problem, having come a long way from the early days of clinical laboratory testing. The journey and implementation of automation in the Singapore General Hospital's Clinical Biochemistry Laboratory has allowed for sustained performance in the light of increasing workload and service commitments amid an evolving healthcare environment. Key to realising predicted outcomes is the optimisation of workflow processes, reduction of errors, and spatial placement of specimen reception and analytical areas. This paper gives an overview of our experience with automation in the clinical laboratory and its subsequent impact on service standards.
Aged ; Automation, Laboratory ; Clinical Laboratory Information Systems ; organization & administration ; Clinical Laboratory Techniques ; Efficiency, Organizational ; statistics & numerical data ; Hospitals, General ; Humans ; Laboratories, Hospital ; organization & administration ; Middle Aged ; Quality of Health Care ; Singapore ; Tertiary Healthcare ; organization & administration ; User-Computer Interface ; Workload

PURPOSEIran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors.

METHODS2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012-2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality.

RESULTSMean working (driving) time was (9.3±2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality.

CONCLUSIONResults obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

Accidents, Traffic ; statistics & numerical data ; Adult ; Aged ; Automobile Driving ; Educational Status ; Humans ; Iran ; Logistic Models ; Male ; Middle Aged ; Sleep ; Workload

PURPOSE: Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. MATERIALS AND METHODS: The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. RESULTS: A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. CONCLUSIONS: Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.
Adolescent ; Adult ; Age Distribution ; Child ; Child, Preschool ; Hospitalization/statistics & numerical data/*trends ; Humans ; Hypospadias/epidemiology/*surgery ; Infant ; Length of Stay/statistics & numerical data/trends ; Male ; Outcome Assessment (Health Care) ; Postoperative Complications/epidemiology ; United States/epidemiology ; Workload/statistics & numerical data ; Young Adult

OBJECTIVETo investigate the change pattern of primary and secondary school teachers' work ability with the changes in their mental workload.

METHODSA total of 901 primary and secondary school teachers were selected by random cluster sampling, and then their mental workload and work ability were assessed by National Aeronautics and Space Administration-Task Load Index (NASA-TLX) and Work Ability Index (WAI) questionnaires, whose reliability and validity had been tested. The effects of their mental workload on the work ability were analyzed.

RESULTSPrimary and secondary school teachers' work ability reached the highest level at a certain level of mental workload (55.73< mental workload ≤ 64.10). When their mental workload was lower than the level, their work ability had a positive correlation with the mental workload. Their work ability increased or maintained stable with the increasing mental workload. Moreover, the percentage of teachers with good work ability increased, while that of teachers with moderate work ability decreased. But when their mental workload was higher than the level, their work ability had a negative correlation with the mental workload. Their work ability significantly decreased with the increasing mental workload (P < 0.01). Furthermore, the percentage of teachers with good work ability decreased, while that of teachers with moderate work ability increased (P < 0.001).

CONCLUSIONToo high or low mental workload will result in the decline of primary and secondary school teachers' work ability. Moderate mental workload (55.73∼64.10) will benefit the maintaining and stabilization of their work ability.

Faculty ; statistics & numerical data ; Humans ; Occupational Health ; Reproducibility of Results ; Sampling Studies ; Schools ; Stress, Psychological ; psychology ; Surveys and Questionnaires ; Work ; psychology ; Workload ; psychology

The change of compressing personnel will inevitably accompany hands off time when cardiopulmonary resuscitation (CPR) is performed by two or more rescuers. The present study assessed whether changing compression by a second rescuer located on the opposite side (OS) of the first rescuer can reduce hands-off time compared to CPR on the same side (SS) when CPR is performed by two rescuers. The scenario of this randomized, controlled, parallel simulation study was compression-only CPR by two laypersons in a pre-hospital situation. Considering sex ratio, 64 participants were matched up in 32 teams equally divided into two gender groups, i.e. , homogenous or heterogeneous. Each team was finally allocated to one of two study groups according to the position of changing compression (SS or OS). Every team performed chest compression for 8 min and 10 sec, with chest compression changed every 2 min. The primary endpoint was cumulative hands-off time. Cumulative hands-off time of the SS group was about 2 sec longer than the OS group, and was significant (6.6 +/- 2.6 sec vs. 4.5 +/- 1.5 sec, P = 0.005). The range of hands off time of the SS group was wider than for the OS group. The mean hands-off times of each rescuer turn significantly shortened with increasing number of turns (P = 0.005). A subgroup analysis in which cumulative hands-off time was divided into three subgroups in 5-sec intervals revealed that about 70% of the SS group was included in subgroups with delayed hands-off time > or = 5 sec, with only 25% of the OS group included in these subgroups (P = 0.033). Changing compression at the OS of each rescuer reduced hands-off time compared to the SS in prehospital hands-only CPR provided by two bystanders.
Cardiopulmonary Resuscitation/methods/*statistics & numerical data ; Clinical Competence/*statistics & numerical data ; Emergency Medical Services/*statistics & numerical data ; Female ; Heart Arrest/epidemiology/*prevention & control ; Heart Massage/methods/*statistics & numerical data ; Humans ; Male ; Republic of Korea/epidemiology ; Treatment Outcome ; Workload/*statistics & numerical data ; Young Adult

PURPOSE: This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation. METHODS: Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model. RESULTS: Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients). CONCLUSION: Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.
Age Factors ; Aged ; Consciousness ; Device Removal ; Female ; Humans ; Hypnotics and Sedatives/therapeutic use ; Intensive Care Units ; Intubation, Intratracheal/mortality/*nursing/psychology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Nurses/statistics & numerical data/supply & distribution ; Proportional Hazards Models ; Psychomotor Agitation ; Retrospective Studies ; Risk Factors ; Workload

Education, Medical, Graduate ; standards ; General Surgery ; education ; Humans ; Singapore ; Workload ; statistics & numerical data

This study intended to identify the need for the legalization and development of a systematic program for physician assistants (PAs) by understanding the actual state of PA operation in hospitals. In 114 hospitals assigned as resident training hospitals for surgery, a survey was conducted on the personnel working as PAs in those hospitals; the survey included general personal information, working conditions, training time, and satisfaction. A total of 192 PAs in surgery at 35 hospitals responded to the survey. The types of PAs are Surgical Assistant, Clinical Physician Assistant, Wound Ostomy Care Nurse, Coordinator, and Clinical Research Coordinator. Types of work PAs preformed are surgical assistance, wound dressing, educating patients, overlooking consultation, doing paper works, writing operation records, and confirming examination results which were ordered. The satisfaction level for the position which PAs hold were 29.1% and and satisfaction level which doctors see towards PA was 15%. The role and the job descriptions of PAs are not clear cut, there are many discrepancies among hospitals we studied. As a result, legalization and the implementation of standardized role of PAs will lead to increase level of satisfactions in the work force and the quality of work which PAs perform will be greater.
Adult ; Female ; General Surgery ; Humans ; Job Description ; Male ; Physician Assistants/*statistics & numerical data ; Questionnaires ; Republic of Korea ; Task Performance and Analysis ; Workload

PURPOSE: This study was done to analyze variations in unit staffing and recommend policies to improve nursing staffing levels in intensive care units (ICUs). METHOD: A cross-sectional study design was used, employing survey data from the Health Insurance Review Agency conducted from June-July, 2003. Unitstaffing was measured using two indicators; bed-to-nurse (B/N) ratio (number of beds per nurse), and patient-to-nurse (P/N)ratio (number of average daily patients per nurse). Staffing levels were compared according to hospital and ICU characteristics. RESULT: A total of 414 institutions were operating 569 adult and 86 neonatal ICUs. Tertiary hospitals (n=42) had the lowest mean B/N (0.82) and P/N (0.76) ratios in adult ICUs, followed by general hospitals (B/N: 1.34, P/N: 0.97). Those ratios indicated that a nurse took care of 3 to 5 patients per shift. Neonatal ICUs had worse staffing and had greater variations in staffing ratios than adult ICUs. About 17% of adult and 26% of neonatal ICUs were staffed only by adjunct nurses who had responsibility for a general ward as well as the ICU. CONCLUSION: Stratification of nurse staffing levels and differentiation of ICU utilization fees based on staffing grades are recommended as a policy tool to improve nurse staffing in ICUs.
Analysis of Variance ; Female ; Humans ; Intensive Care Units/economics/*manpower/statistics & numerical data ; Intensive Care Units, Neonatal/economics/*manpower/statistics & numerical data ; Nursing Staff, Hospital/economics/*supply & distribution ; Personnel Staffing and Scheduling/*economics ; Workload