Primary school teachers in Québec suffer psychological distress, as shown by the Québec Health Survey (M. Gervais, 1993; Santè Québec, 1995). The authors applied and extended the French model (F. Guérin, A. Laville, F. Daniellou, J. Duraffourg, & A. Kerguelen, 1991) of analysis of work activity to observing classroom teaching (14 women in 10 classrooms for a total of 48 hr 24 min) to identify stressful elements. The authors observed a rapid sequence of actions, eye fixations of short duration, little physical or mental relaxation, multiple simultaneous activities, and uncomfortable temperature and humidity levels. Teachers use many strategies to teach, to create a learning environment, and to maintain attention in classrooms under adverse conditions. Examination of these strategies led to recommendations to improve relations between the teachers and their supervisors and to make the classroom an easier place to teach.
OBJECTIVE: This long-term follow-up recorded the prevalence, aetiology and treatment of hard-to-heal leg and foot ulcers, and an estimated nurses' time spent providing care, for the years 1994-2005. METHOD: A questionnaire was sent to all district and community nurses in the county of Blekinge, Sweden, during one week in 1994, 1998, 2004 and 2005. Calculating the costs of hard-to-heal leg and foot ulcer care was not a primary aim, but the reduction in prevalence and time spent on wound management suggested it was important to illustrate the economic consequences of these changes over time. RESULTS: Estimated prevalence of hard-to-heal leg and foot ulcers reduced from 0.22% in 1994 to 0.15% in 2005. Treatment time decreased from 1.7 hours per patient per week in 1994 to 1.3 hours in 2005. Annual costs of leg and foot ulcer care reduced by SEK 6.96 million in the study area from 1994 to 2005. CONCLUSION: Improved wound management was demonstrated; leg and foot ulcer prevalence and treatment time were reduced. The results could be attributed to an increased interest in leg and foot ulcer care among staff, which was maintained by repeated questionnaires, continuous education, establishment of a wound healing centre in primary care and wound management recommendations from a multidisciplinary group. The improved ulcer care reduced considerably the annual costs of wound management in the area.
PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
The present study examined the activity profile, heart rate and metabolic response of small-sided football games for untrained males (UM, n=26) and females (UF, n=21) and investigated the influence of the number of players (UM: 1v1, 3v3, 7v7; UF: 2v2, 4v4 and 7v7). Moreover, heart rate response to small-sided games was studied for children aged 9 and 12 years (C9+C12, n=75), as well as homeless (HM, n=15), middle-aged (MM, n=9) and elderly (EM, n=11) men. During 7v7, muscle glycogen decreased more for UM than UF (28 +/- 6 vs 11 +/- 5%; P90% of HR(max) ranged from 147 +/- 4 (EM) to 162 +/- 2 (UM) b.p.m. and 10.8 +/- 1.5 (UF) to 47.8 +/- 5.8% (EM). Time >90% of HR(max) (UM: 16-17%; UF: 8-13%) and time spent with high speed running (4.1-5.1%) was similar for training with 2-14 players, but more high-intensity runs were performed with few players (UM 1v1: 140 +/- 17; UM 7v7: 97 +/- 5; P
INTRODUCTION: An important factor determining survival after out-of-hospital cardiac arrest is how fast the ambulance personnel can reach the patient. MATERIALS AND METHODS: In a two-year period between 1996 and 1998, all ambulance calls to patients with out-of-hospital cardiac arrest in Oslo were evaluated. Of 1,026 cardiac arrests, 130 were excluded because of missing data. RESULTS: The median ambulance response interval was 7.2 min (5.7-9.0 as 25-75% percentiles). There was a tendency to shorter response intervals to the central parts of Oslo with medians between 3 and 4 min, while 14 more peripheral boroughs had median response intervals over 8 min. Of the 627 cases where the ambulance starting point was registered, 76% were from the only ambulance station in Oslo, located downtown. INTERPRETATION: In our opinion, the median ambulance response interval is unsatisfactory in large parts of Oslo, as a long response time gives a dramatically lower survival rate after cardiac arrest. A reorganisation and decentralization of the Oslo Emergency Medical Service System seems necessary.
INTRODUCTION: The aim was to describe ambulance transportation and pre-hospital treatment in connection with admission for suspected acute myocardial infarction. MATERIAL AND METHODS: For all patients with suspected acute coronary syndrome who were urgently admitted to the Cardiological Department, Odense University Hospital between 3 August 1998 and 6 December 1998, information about ambulance transportation and pre-hospital treatment was collected through interviews with the patients and study of ambulance records, admission notes, and hospital medical records. In addition, details of the regarding response times were obtained from Falck's emergency service and from nurses' papers. RESULTS: Altogether 279 patients (83%) were transported by ambulance. Half the ambulances arrived at the hospital after 34 minutes (range 11-140 minutes), but every third ambulance took more than 40 minutes to reach the hospital. The pre-hospital treatment of all the patients was: oxygen 69%, nitroglycerin sublingually 46%, nitrous oxide 2%, defibrillation 1.4%, acetylsalicylic acid 9%, morphine injection 8%, and ECG monitoring 57%. CONCLUSION: The study showed that there were quality problems, as every third ambulance took more than 40 minutes to reach the hospital. It also showed that acetylsalicylic acid and morphine were used only to a limited extent in a pre-hospital situation.
Canada is considering the development of a new standard for infant/child life jackets. Eight currently available (approved and non-approved) infant/child life jackets were procured for evaluation. Fifty-six participants were chosen as a sample of convenience from the general public for testing. The life jackets were divided into two groups of four, which were donned on a soft infant manikin procured from the Red Cross. In 224 attempts at donning, only 43 (19%) attempts resulted in the life jacket being donned correctly in less than 1 min. Only one life jacket came close to a good design and passed the life jacket standard for donning time and accuracy. Failure rates were observed across all the participants irrespective of age, gender, experience with children and experience with recreational marine equipment. Accuracy and speed of donning the life jacket were hampered as the number of donning sub-tasks increased. It was concluded that it is possible to design a life jacket that can be donned correctly in under 1 min. The life jacket must be of simple, intuitive design and fall naturally into the anatomical shape of the child. A minimum number of ties, zips and clips should be used in the design, and if such connectors are used they should be color coded or of different shapes and sizes to avoid confusion.