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Introduction The topic of healthcare human resource planning for diagnostic radiographers has received limited research attention to date. This research is concerned with developing a framework that can be used to determine diagnostic radiographer staffing requirements at a unit- or department level (i.e. at the micro-level). Methods An inductive approach is applied to formulate requirement specifications that inform the development of the framework. A number of verification and validation activities are performed, including theoretical verification and a case study application. Results The diagnostic radiographer staffing framework consists of seven steps that comprise a workload-based approach to determining the number of full time equivalent diagnostic radiographers that are required for each modality, or group of modalities. Both clinical and non-clinical activities are considered, and guidance is provided on calculating staffing requirements to cover leave allowances. A number of potential approaches to determining activity times are also discussed. Conclusion The framework represents a holistic approach to determining the required number of diagnostic radiographers at a practice-level, that is designed to remain relevant as technological advances are made in the field of diagnostic radiography. Implications for practice By providing a practical guideline, with accompanying examples, the framework is expected to hold value for individuals involved in the management of diagnostic radiography practices. The framework proposes an approach to a topic that affects every radiography practice in operation yet has received limited attention in literature to date.

Background Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Underrecognition of chronic wet cough by parents and clinicians and underdiagnosis of PBB by clinicians are known. Research Question We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodologic approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice. Study Design and Methods A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February 2017 to December 2019). Our KT strategy included the following: (1) culturally secure (ie, ensuring Aboriginal people are treated regarding their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children, and (2) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by physicians. Results Post-KT, health seeking for chronic wet cough increased by 184% (pre = eight of 630 children [1.3%], post = 23 of 636 children [3.6%]; P = .007; 95% CI, 0.7%-4.0%). Physician proficiency in management of chronic wet cough improved significantly as reflected by improved chronic cough-related quality of life (P Interpretation Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Physician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed.

Background The field of infection prevention is rapidly evolving and becoming increasingly complex, as resource-intensive responses to device-associated outbreaks, global epidemics, and regulatory requirements continue to grow. This increasing complexity coupled with changing health care systems present important challenges to infection prevention staffing and resources. We describe the development of a novel infection prevention and control (IPC) staffing structure that includes both infection preventionists (IPs) and role-specific support staff to meet the evolving IPC needs and challenges of an expanding health care network. Methods The IPC department at Children's Hospital of Philadelphia underwent iterative modifications to its staffing structure between 2014 and 2018, including the development of revised job descriptions and promotional criteria, career ladders, and supporting roles. Data on key infection prevention activities, including rounding frequency and performance of audits and observations, growth metrics and infection data was evaluated for trends before and after departmental restructuring. An overall health care associated infection (HAI) index was calculated based on existing surveillance data and used to monitor patient outcomes over time. In addition, departmental employee engagement was assessed via a standard survey instrument to evaluate improvements in teamwork and professional growth opportunities over time. Results Between 2014 and 2018, the number of unique job descriptions for IPs and support staff increased from 4 to 9, creating a 3-tier career ladder for IPs and increasing full time equivalents from 8.2 to 11.6. Additional support roles included a Hand Hygiene Program Manager, Infection Prevention Associates and a Clinical Practice Analyst; these roles, along with increased IP staffing, expanded the education and consultative range of the department, as measured by a 33% increase in environmental rounding and a 7-fold increase in performance of isolation audits. Team diversity also expanded, changing from a team with predominantly nursing backgrounds, to one with an equal distribution of nursing, public health, and laboratory scientists. Results from serial engagement surveys showed an increase in teamwork and professional growth by 7.4% and 5.4%, respectively. Over this time period, the total HAI index decreased by 23%, while patient days, central line days, and ventilator days increased each year, and there was a statistically significant reduction in rates of harm across 5 key HAI indicators. Conclusions Role diversity and varying professional backgrounds within IPC programs offer a complement of strengths and increase capacity to support patient care activities, improving patient outcomes. This strategy leads to a more cost-effective, robust IPC program that supports the growing needs and evolving challenges of the field.

Background Staffing ratios based on hospital beds and norms do not adequately address the requirement of infection preventionists (IP) in hospitals. We, therefore, aimed to determine staffing of IP (nursing category) based on actual workload involved. Methods The study design was quantitative and longitudinal conducted for 1 year. The study was structured around the steps of the World Health Organization's Workload Indicators of Staffing Need (WISN). Results We identified infection control activities, support activities and additional activities to be performed by 4 IP with a total available working time of 6,132 hours for an annual workload of 6,238.25 (±372) hours in an acute care hospital with 182 beds and 69,331 annual admissions. Core infection control activities consumed 78% time. Support and additional activities consumed the remaining 22% time. Active surveillance required 44% time and education consumed 32% time. WISN ratio of available staff and required staff was 0.75. Discussion A WISN ratio less than 1 suggests inadequate staffing. Therefore, the WISN method recommends 4 IP instead of 3 based on existing workload. We compared our results with the existing quantification-based staffing studies. Conclusions WISN is a valuable method to measure all infection control activities and translate workload into IP (nursing) full time equivalents.

Objective To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. Participants and Methods All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary. Results Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties. Conclusion A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.

Implementation of antimicrobial stewardship programs (ASPs) with multidisciplinary antimicrobial stewardship teams (ASTs) is critical for appropriate antimicrobial use at healthcare facilities. Although the Japanese medical reimbursement system was revised to allow fees for ASP implementation, several concerns remain, including understaffing and enforcement of the recommendations on ASTs and ASPs in practice. Furthermore, there are no recommendations on full-time equivalents (FTEs) of the core members in ASTs in Japan. This committee report presents our recommendations on ASTs based on an analysis of the nationwide survey on implemented ASPs and staff FTEs at 1358 healthcare facilities conducted by the Japanese Society of Chemotherapy. Our report provides a directive for structural and financial support of ASTs and should aid in planning for the enhancement of AST practices and the organization of new ASTs.

Background Administrative costs (AC) are a relevant spending category in health care, and several approaches exist on how to define and measure them. Based on available AC studies, this paper aims to provide a map for this multifaceted research topic. Methods A scoping review was conducted using the databases MEDLINE, EconLit, and Business Source Premier. Literature was screened focussing on the research question: What is known about the methodology of AC research from scientific publications? Results Definition concepts mostly rely on national cost documentations. The international cost reporting framework of the Systems of Health Accounts was a critical reference point in six studies. Indications on how to operationalise AC independently from periodical cost reports were suggested by ten publications. In this context, time and full time equivalents are the most common cost measurements. Conclusions The results indicate a lack of evidence regarding patients’ perceptions of administrative issues in health care. Also, research on administrative impact on working conditions for health care employees beyond hospitals and physicians’ offices is underrepresented. A systematic approach to reporting AC studies is needed. Reporting should include the appointment of entities actually empowered to change administrative resource usage. This would help to promote principles of a balanced administration.

Background The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity was formed in 2011 to study institutional factors that could influence the clinical productivity of physicians and sonographers in academic pediatric echocardiography laboratories. In the previous two surveys, staff clinical productivity remained stable while total echocardiography volumes increased. This third survey was designed to assess how clinical productivity is associated with laboratory infrastructure elements such as training, administrative tasks, quality improvement, research, and use of focused cardiac ultrasound (FCU). Methods Survey questions were sent by e-mail to North American laboratories. The aims were to assess (1) educational and training obligations, (2) academic productivity and research, (3) laboratory medical director satisfaction, (4) quality improvement, (5) laboratory leadership roles, and (6) impact and use of FCU. Survey responses were compared with clinical productivity metrics defined in the first two surveys. Results There were 38 responses. Academic productivity was higher at institutions with more dedicated imaging personnel, personnel with dedicated protected academic time, and advanced imaging fellows. Academic productivity did not correlate with clinical productivity and was not significantly affected by the presence of dedicated research sonographers. The satisfaction level of laboratory medical directors was related to dedicated administrative time and an administrative stipend. The majority of administrative roles were tasked to the laboratory medical director with support of the technical director. FCU was listed as a hospital privilege at four institutions (13%). Twenty-two (58%) were training FCU providers in one or more subspecialties. FCU was not associated with clinical or academic productivity. Conclusion This third survey gathered supplemental data to complement the clinical productivity data collected from the first two surveys. Together, the results of these surveys further describe the range of factors that can affect North American academic pediatric echocardiography laboratories.

Purpose A survey was created by NRG to assess a medical physicists' percent full time equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 American Society for Radiation Oncology report, "Safety Is No Accident," quantified medical physics staffing contributions in FTE factors for clinical departments. No quantification of FTE effort associated with clinical trials was included. Methods To address this lack of information, the NRG Medical Physics Subcommittee decided to obtain manpower data from the medical physics community to quantify the amount of time medical physicists spent supporting clinical trials. A survey, consisting of 16 questions, was designed to obtain information regarding physicists' time spent supporting clinical trials. The survey was distributed to medical physicists at 1996 radiation therapy institutions included on the membership rosters of the 5 National Clinical Trials Network clinical trial groups. Results Of the 451 institutions who responded, 50% (226) reported currently participating in radiation therapy trials. On average, the designated physicist at each institution spent 2.4 hours (standard deviation [SD], 5.5) per week supervising or interacting with clinical trial staff. On average, 1.2 hours (SD, 3.1), 1.8 hours (SD, 3.9), and 0.6 hours (SD, 1.1) per week were spent on trial patient simulations, treatment plan reviews, and maintaining a Digital Imaging and Communications in Medicine server, respectively. For all trial credentialing activities, physicists spent an average of 32 hours (SD, 57.2) yearly. Reading protocols and supporting dosimetrists, clinicians, and therapists took an average of 2.1 hours (SD, 3.4) per week. Physicists also attended clinical trial meetings, on average, 1.2 hours (SD, 1.9) per month. Conclusion On average, physicist spent a nontrivial total of 9 hours per week (0.21 FTE) supporting an average of 10 active clinical trials. This time commitment indicates the complexity of radiation therapy clinical trials and should be taken into account when staffing radiation therapy institutions.

COVID-19 pandemic has severely affected regular public health interventions including population-based cancer screening. Impacts of such screening delays on the changes in structure and screening process and the resultant long-term outcomes are unknown. It is therefore necessary to develop a systematic framework to assess theses impacts related to these components of quality. Using population-based cancer screening with fecal immunochemical test (FIT) as an illustration, the main analysis was to assess how various scenarios of screening delays were associated with the capacity for primary screening and full time equivalent (FTE) for colonoscopy and impact long-term outcomes based on a Markov decision tree model on population level. The second analysis was to quantify how the extent of COVID-19 epidemic measured by social distancing index affected capacity and FTE that were translated to delays with an exponential relationship. COVID-19 epidemic led to 25%, 29%, 34%, and 39% statistically significantly incremental risks of late cancer for the delays of 0.5-year, 1-year,1.5-year, and 2-year, respectively compared with regular biennial FIT screening. The corresponding statistically findings of four delayed schedules for death from colorectal cancer (CRC) were 26%, 28%, 29%, and 30%, respectively. The higher social distancing index led to a lower capacity of uptake screening and a larger reduction of FTE, resulting in longer screening delay and longer waiting time, which further impacted long-term outcomes as above. In summary, a systematic modelling approach was developed for demonstrating the strong impact of screening delays caused by COVID-19 epidemic on long-term outcomes illustrated with a Taiwan population-based FIT screening of CRC.

Objective This study was conducted to compare human resource requirement among manual, automated, and modified automated dispensing systems. Methods Data were collected from the pharmacy department at the 2100-bed university hospital (Siriraj Hospital, Bangkok, Thailand). Data regarding the duration of the medication distribution process were collected by using self-reported forms for 1 month. The data on the automated dispensing machine (ADM) system were obtained from 1 piloted inpatient ward, whereas those on the manual system were the average of other wards. Data on dispensing, returned unused medication, and stock management processes under the traditional manual system and the ADM system were from actual activities, whereas the modified ADM system was modeled. The full-time equivalent (FTE) of each model was estimated for comparison. Results The result showed that the manual system required 46.84 FTEs of pharmacists and 132.66 FTEs of pharmacy technicians. By adding pharmacist roles on screening and verification under the ADM system, the ADM system required 117.61 FTEs of pharmacists. Replacing counting and filling medication functions by ADM has decreased the number of pharmacy technicians to 55.38 FTEs. After the modified ADM system canceled the return unused medication process, FTEs requirement for pharmacists and pharmacy technicians decreased to 69.78 and 51.90 FTEs, respectively. Conclusions The ADM system decreased the workload of pharmacy technicians, whereas it required more time from pharmacists. However, the increased workload of pharmacists was associated with more comprehensive patient care functions, which resulted from the redesigned work process.

Introduction Cancer registration is an important activity for informing cancer control activities. Cancer registries in Sub-Saharan Africa have limited resources to effectively operate because of competing priorities. To date, there has not been an assessment of the resources and funding needed to perform all the activities essential for cancer registration in Kenya. Evidence will help registries to quantify and advocate for the funds needed to sustain, enhance, and expand high quality cancer registration in Kenya. Methods In this study, we used the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool ( IntRegCosting Tool ) to evaluate the funding, cost, and labor resources used to perform the cancer registry operations in Nairobi County for two annual periods between July 2012 and June 2014. Results Funding from grants, research studies, and international organizations provided 70% of the registry operations' cost. For both time periods, the most-costly registry activities were related to administration, management, and training, along with data acquisition activities such as data abstraction, entry, and validation. Even among these core registry activities, however, substantial variations existed. Conclusions Stable funding for cancer registry operations is necessary to sustain core registry activities in other to deliver high-quality data, which in turn is necessary to foster evidence-based policies to improve cancer outcomes. As stakeholders look into expanding the Nairobi Cancer Registry into a national program, the cost data provided in this study will help justify the funding required for sustaining and expanding registry activities.

Objectives Australians are among the world's highest consumers of complementary medicine. Research is vital to ensure the safe and effective use of complementary medicines and practices and their appropriate integration into mainstream healthcare. In 2014, the National Institute of Complementary Medicine (NICM) undertook a survey to determine the extent of complementary medicine academic research in Australia from 2008 to 2013. This survey builds upon aspects of previous research undertaken by NICM in 2005 and 2008. Methods The surveys were conducted using the Survey Monkey™ program and distributed electronically by email, made available on the NICM website, provided in the NICM newsletter and sent to industry associations, who agreed to promulgate the link. The survey included 20 items assessing the size and scope of the industry in Australia in terms of the research workforce, the nature of research activities, funding mechanisms and quantum of research funds and resources and facilities available to researchers. Results Based on survey responses reporting on the 6 year period 2008–2013, 160 respondents provided information on 295 active CM research projects employing a total quantum of $31.3 million. The greatest quantum provided for active projects came from NHMRC (36%) while universities supported the greatest number of projects (27%). 238 of the 296 projects reported on their workforce, this represented 429 academic researchers and 167 full time equivalent (FTE) research students. $29.5M in new funding was awarded to new projects over this period. Conclusions Whilst the total reported quantum of research funding for expenditure on CM projects in the period January 2008–December 2013 was $31.3M, the annual funding of new CM research projects decreased considerably in the latter part of the survey period. Australia has a well-developed CM research sector; however it is insufficiently supported given the size of the Australian industry and the level of consumer use.

The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents.Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]).Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia.This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings.

Background Maintaining population-based registries requires adequate and sustained resources; however, to date there has been no systematic evaluation to identify the resource needs for cancer registration in most countries, including Colombia. A systematic assessment of the costs can quantify the funding required and identify processes to improve efficiency of cancer registries. Methods The Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool ( IntRegCosting Tool) was tailored specifically for the Colombian registries and was used to collect resource use data from five regional population-based cancer registries: Barranquilla, Bucaramanga, Cali, Manizales, and Pasto. The registries provided cost data for the year 2013 and cancer cases corresponding to the year 2010. Results We identified an almost threefold variation in the average cost per case (77,932 to 214,082 Colombian pesos or US $41 to US $113 in 2013) across the registries, but there were also substantial differences in data collection approaches, types of data collected, and activities performed. Cost per inhabitant varied between 95 and 415 Colombian pesos (US $0.05 to US $0.22). Between 20% and 45% of the total cost was due to fixed cost activities. Conclusions The detailed economic information presented in this study constitutes a valuable source of activity-based cost data that registries can use to compare operations, assess key factors that lead to differences in cost per case, and identify potential approaches to improve efficiencies. Furthermore, the knowledge gained from studying the Colombian registries can help inform the planning and operations of other registries in the region.

Ensuring a balance of conservation and human activities within the marine environment requires complex decisions on how to achieve conservation objectives whilst considering the likely economic and social costs and benefits of such decisions. We assessed the risk of adverse effects from abrasion caused by bottom fishing, as a case study, to demonstrate an integrated spatial management methodology. Risk was quantified in the Galway Bay, Ireland region using a 1 km grid, as the ratio between mortality and recovery of benthic infauna exposed to abrasion effects estimated from fishing data. Risk was considered high if annual mortality exceeded recovery. A Bayesian network model, incorporating ecological and economic data, compared three management scenarios: i) business as usual (BAU), ii) exclusion of fishing vessels over 18 m within 6 nautical miles (68% of study area) (Length) and iii) a network of marine protected areas (MPAs) closed to all fishing vessels (11% of study area) (MPA). The BAU scenario indicated that risk was high for 85.6% of the study area. The length scenario resulted in a 14.6% reduction in high risk cells, affecting €0.9 M of landings, €0.7 M of indirect output and 19 full time equivalent (FTE) employees. The MPA scenario resulted in a 1.7% reduction of high risk cells. This scenario affected €0.17M in landings, €0.13M in indirect outputs and 3 FTE employees. We present a method which provides a quantitative, spatial, risk and economic impact assessment of the effects of human activities and pressures on the marine environment that assesses potential costs and benefits of management options to mitigate against these pressures. Future development of a mortality-recovery ratio for defined time periods would enable application across multiple habitats, human activities and pressures.

Background A pressing international concern is the issue of mental health workforce capacity, which is also of concern in England where staff attrition rates are significantly higher than in physical health services. Increasing demand for mental health services has led to severe financial pressures resulting in staff shortages, increased workloads, and work-related stress, with health care providers testing new models of care to reduce cost. Previous evidence suggests shift work can negatively affect health and wellbeing (increased accidents, fatigue, absenteeism) but can be perceived as beneficial by both employers and employees (fewer handovers, less overtime, cost savings). Objective This study reports an evaluation of the impact of extending the shifts of nurses and health care assistants from 8 to 12 hours. Using data before and after the policy change, the effect of extended working hours on short term sickness ( Setting The setting is six inpatient wards within a large mental health hospital in England where the shift extension took place between June and October 2017. The Data come from wards administrative records and the analysis is performed using weekly data (N=463). Methods Causal inference methods (Interrupted Time Series and Difference-in-Difference) are used to compare staff sickness rates before and after the implementation, where the outcome variable is defined as the ratio of total sickness hours over the total scheduled working hours (full time equivalents) in a given week. Patient casemix, staff demographics, ward and time variables are included as controls. Results Estimation results establish that the extended shifts are associated with an increased percentage of sickness hours per week of between 0.73% and 0.98%, the equivalent of a complete shift per week per ward. Conclusion This is the first study to use causal inference to measure the impact of longer shifts on sickness absences for mental health workforce. The analysis is relevant to other providers which may increasingly look towards these shift patterns as a means of cost saving.

Background The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity aimed to study factors that could influence the clinical productivity of physicians and sonographers and assess longitudinal trends for the same. The first survey results indicated that productivity correlated with the total volume of echocardiograms. Methods Survey questions were designed to assess productivity for (1) physician full-time equivalent (FTE) allocated to echocardiography reading (echocardiograms per physician FTE per day), (2) sonographer FTE (echocardiograms per sonographer FTE per year), and (3) machine utilization (echocardiograms per machine per year). Questions were also posed to assess work flow and workforce. Results For fiscal year 2013 or academic year 2012–2013, the mean number of total echocardiograms—including outreach, transthoracic, fetal, and transesophageal echocardiograms—per physician FTE per day was 14.3 ± 5.9, the mean number of echocardiograms per sonographer FTE per year was 1,056 ± 441, and the mean number of echocardiograms per machine per year was 778 ± 303. Both physician and sonographer productivity was higher at high-volume surgical centers and with echocardiography slots scheduled concordantly with clinic visits. Having an advanced imaging fellow and outpatient sedation correlated negatively with clinical laboratory productivity. Machine utilization was greater in laboratories with higher sonographer and physician productivity and lower for machines obtained before 2009. Conclusion Measures of pediatric echocardiography laboratory staff productivity and machine utilization were shown to correlate positively with surgical volume, total echocardiography volumes, and concordant echocardiography scheduling; the same measures correlated negatively with having an advanced imaging fellow and outpatient sedation. There has been no significant change in staff productivity noted over two Committee on Pediatric Echocardiography Laboratory Productivity survey cycles, suggesting that hiring practices have matched laboratory volume increases.

To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort.Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction.Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months.Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.

Egypt faces multiple interlinked challenges such as unemployment, poverty and gender inequality that pose tremendous barriers in the current efforts to achieve sustainable development. Aquaculture is a primary sector of the economy that has high potential to not only for provide nutritious food, but also to contribute to the national economy. The aquaculture value chain provides substantial employment generation opportunities, including for females and the youth. This paper assesses employment generation along the different stages of the aquaculture value chain in the main governorates that are responsible for about 80% of the Egyptian aquaculture production. In particular it analyses data from surveys in hatcheries (N=40), feed mills (N=14), fish farms (N=234), and fish trading and retailing (N=182) as a proxy of employment generation patterns for the entire sector. We estimated that aquaculture generates 19.56 Full Time Equivalent (FTE) jobs per 100t of produced fish along the entire value chain. However most of these jobs are generated for males over 30 years of age, with few jobs for females or younger people. Most jobs for female are currently generated at the retailing stage. Boosting employment generation across the entire value chain, especially for females and the youth, can contribute to the attainment of multiple Sustainable Development Goals (SDGs) such as SDG 8 and SDG 5.

Background In 2016, our institution implemented a 5 + 2 year vascular surgery fellowship program, providing graduates of general surgery residencies two years of advanced training in open vascular and endovascular surgery. In this study, we use statistical process control to evaluate the clinical performance of the vascular surgery service, before and after implementation of the fellowship program, within an operating room (OR) block utilization framework. Study Design Using WiseOR, we extracted monthly vascular surgery operating room utilization data for the fifteen months before and after the implementation of the fellowship. Monthly block productivity was calculated: Productivity = (workload)/(allocated hours + 1.75 * over-utilized time). From financial reports, we obtained monthly work Relative Value Units (wRVUs) and clinical Full Time Equivalents (FTEs) for faculty of the vascular surgery service for the same 30-month study period. I-control charts were used to analyze changes in productivity and wRVU/FTE ratio across implementation of the fellowship. We visualized changes in block utilization and productivity by constructing a novel three-dimensional chart plotting under-utilized time vs. over-utilized time for each month of the study, while representing productivity via a color gradient based on Delaunay triangulation. Results The vascular surgery service saw a significant increase in both normal-hours and after-hours case time after implementation of the fellowship. Under-utilized OR block time decreased (p = 0.002) and over-utilized time increased (p Conclusion Implementation of the fellowship training program marked an upward shift in block productivity and revenue generation of the vascular surgery service, with the additional workload compensating for an increase in over-utilized block time.

Background In 2016, our institution implemented a 5+2 year vascular surgery fellowship program, providing graduates of general surgery residencies two years of advanced training in open vascular and endovascular surgery. In this study, we use statistical process control to evaluate the clinical performance of the vascular surgery service, before and after implementation of the fellowship program, within an operating room (OR) block utilization framework. Study Design Using WiseOR, we extracted monthly vascular surgery operating room utilization data for the fifteen months before and after the implementation of the fellowship. Monthly block productivity was calculated: Productivity = (workload) / (allocated hours + 1.75 * over-utilized time). From financial reports, we obtained monthly work Relative Value Units (wRVUs) and clinical Full Time Equivalents (FTEs) for faculty of the vascular surgery service for the same 30-month study period. I-control charts were used to analyze changes in productivity and wRVU/FTE ratio across implementation of the fellowship. We visualized changes in block utilization and productivity by constructing a novel bubble chart plotting under-utilized time vs. overutilized time for each month of the study, with the size of each point representing monthly productivity. Results The vascular surgery service saw a significant increase in both normal-hours and after-hours case time after implementation of the fellowship. Under-utilized OR block time decreased (p = 0.002) and over-utilized time increased (p Conclusion Implementation of the fellowship training program marked an upward shift in block productivity and revenue generation of the vascular surgery service, with the additional workload compensating for an increase in over-utilized block time.

Background Non-adherence to medication represents an important barrier to achieving optimum patient outcomes. Community pharmacists are well placed to deliver interventions to support adherence. Aims To investigate community pharmacists' activities in supporting patient adherence; and identify factors influencing pharmacists' provision of adherence support. Method A random sample of 2020 Australian community pharmacies was mailed a questionnaire investigating their provision of adherence support. The self-completed, structured questionnaire consisted of eight sections, five of which were relevant to this study: strategies used to identify non-adherent patients, strategies used to support patients' adherence to medications, pharmacists' attitudes toward provision of adherence support, perceived barriers to provision of adherence support, and demographics. Structural equation modeling (SEM) was used to determine potential influencing factors. Results A response rate of 31% was achieved ( n = 627). Pharmacists reported using strategies to identify non-adherent patients for less than half (45%) of the prescriptions dispensed. A mean of 8.4 ± 14.9 (mean ± SD) strategies was used by respondents in the 7 days prior to survey completion. Dose administration aids was the most commonly used strategy (provided by 96.5% of respondents). Time pressure for patients (68%) was perceived by pharmacists as the main barrier to adherence support. SEM identified "stakeholders/skills" and " number of full time equivalent staff" as influencing provision of adherence support strategies. Conclusion Provision of adherence support by pharmacists was episodic and infrequent, impeded by a number of barriers. By addressing barriers, it is possible to enable pharmacists to become more proactive and effective in supporting patient adherence.

Lung transplantation is an effective therapy for many patients with end-stage lung disease. Few centers across the United States offer this therapy, as a successful lung transplant program requires significant institutional resources and specialized personnel. Analysis of the United Network of Organ Sharing database reveals that the failure rate of new programs exceeds 40%. These data suggest that an accurate assessment of program viability as well as a strategy to continuously assess defined quality measures is needed. As part of strategic planning, regional availability of recipient and donors should be assessed. Additionally, analysis of institutional expertise at the physician, support staff, financial, and administrative levels is necessary. In May of 2007, we started a new lung transplant program at the University of Iowa Hospitals and Clinics and have performed 101 transplants with an average recipient 1-year survival of 91%, placing our program among the top in the country for the past 5 years. Herein, we review internal and external factors that impact the viability of a new lung transplant program. We discuss the use of four prospectively identified quality measures: volume, recipient outcomes, financial solvency, and academic contribution as one approach to achieve programmatic excellence.

The question of whether and how research quality should be measured, and the consequences of research audits such as the UK's Research Excellence Framework (REF) – formerly the RAE – are considered in relation to the role of journal ratings such as the Association of Business Schools Academic Journal Quality Guide (the ABS Guide). Criticism of the ABS Guide has distracted attention from the results of successive RAEs, where the panel for Business and Management has been one of the most selective in its allocation of the highest grades, especially when compared with the neighbouring field of Economics. If the ABS Guide had been used to grade outputs submitted for Business and Management in the RAE 2008 then many more outputs would have received the highest grades, especially in accounting where outputs from journals such as Critical Perspectives on Accounting, which are highly rated in the ABS Guide, appear to have been downgraded by the RAE panel. The alleged bias against accounting in the ABS Guide rests on a particular interpretation of citation impact factors for journals, and a narrow definition of subject fields. Critics of the ABS Guide would be better advised to direct their attention to scrutinizing the results of the REF and considering whether it provides an adequate research ranking for UK business schools. 15% of all full time students in the UK study business and management, including accounting and finance, but only 6.7% of the full time equivalent research active staff submitted in the RAE 2008 were in business and management, or accounting and finance. Research audits are therefore forcing the separation of teaching from research in UK business schools. With an estimated ratio of 71 full time students per research active faculty member in UK business schools, it may be time to consider a more appropriate, inclusive, and economical form of ranking for research in business and management.

The issue of cost management within State Organisational Units (SOU) is still left to the subjective decisions of managers who nevertheless usually do not have a sufficient scope to adopt effective decisions. The reason is a constant effort of political representation to set new rules for the exercise of competence and financial and cost management within SOU. The result of these, often unprofessional, interventions is a fundamental over-regulation of the whole segment of SOU cost management. One of the possible ways is to introduce modern management methods based on the causation of activities and costs in SOU, notably including the ABC/ABM methodology. A specific cost domain represents overhead expenditure on IT. With this respect there stands a general assumption that IT leads to boosted efficiency of activities, which fact may also mean a displacement of labour force. The performed regression analysis revealed that IT overheads are not dependent upon the number of workers. These overheads are subject primarily to technical and technological development. As a result, neither number of workers nor any indicators derived from it, such as full time equivalent, can be used for the construction of cost drivers for causal cost allocation methodology according to the ABC/ABM methodology.

Background Childhood caries is a major oral and general health problem, particularly in certain populations. In this study, the authors aimed to evaluate the adequacy of the supply of pediatric dentists. Methods The authors collected baseline practice information from 2,546 pediatric dentists through an online survey (39.1% response rate) in 2017. The authors used a workforce simulation model by using data from the survey and other sources to produce estimates under several scenarios to anticipate future supply and demand for pediatric dentists. Results If production of new pediatric dentists and use and delivery of oral health care continue at current rates, the pediatric dentist supply will increase by 4,030 full-time equivalent (FTE) dentists by 2030, whereas demand will increase by 140 FTE dentists by 2030. Supply growth was higher under hypothetical scenarios with an increased number of graduates (4,690 FTEs) and delayed retirement (4,320 FTEs). If children who are underserved experience greater access to care or if pediatric dentists provide a larger portion of services for children, demand could grow by 2,100 FTE dentists or by 10,470 FTE dentists, respectively. Conclusions The study results suggest that the supply of pediatric dentists is growing more rapidly than is the demand. Growth in demand could increase if pediatric dentists captured a larger share of pediatric dental services or if children who are underserved had oral health care use patterns similar to those of the population with fewer access barriers. Practical Implications It is important to encourage policy changes to reduce barriers to accessing oral health care, to continue pediatric dentists’ participation with Medicaid programs, and to urge early dental services for children.

Background The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Problem Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Goals Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Strategy Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Results Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. Implication • TDABC can be applied in a health care setting. • TDABC allows for quantification of value in process improvements. • TDABC allows one to evaluate the value of identified process improvements.

Introduction How does safety pharmacology operate in large pharmaceutical companies today? By understanding our current position, can we prepare safety pharmacology to successfully navigate the complex process of drug discovery and development? Methods A short anonymous survey was conducted, by invitation, to safety pharmacology representatives of the top 12 pharmaceutical companies, as defined by 2009 revenue figures. A series of multiple choice questions was designed to explore group size, accountabilities, roles and responsibilities of group members, outsourcing policy and publication record. Results A 92% response rate was obtained. Six out of 11 companies have 10 to 30 full time equivalents in safety pharmacology, who hold similar roles and responsibilities; although the majority of members are not qualified at PhD level or equivalent. Accountabilities were similar across companies and all groups have accountability for core battery in vivo studies and problem solving activities but differences do exist for example with in vitro safety screening and pharmacodynamic/pharmokinetic modeling (PK/PD). The majority of companies outsource less than 25% of studies, with in vitro profiling being the most commonly outsourced activity. Finally, safety pharmacology groups are publishing 1 to 4 articles each year. Conclusion This short survey has highlighted areas of similarity and differences in the way large pharmaceutical companies operate safety pharmacology.

BACKGROUND: Inpatient geriatric consultation teams are multidisciplinary teams that advice and sensitize health care professionals in the hospital for the care of older patients. Despite the lack of clear evidence that these teams are effective, they were rated highly relevant and introduced in Belgian hospitals in 2007. OBJECTIVES: To evaluate the implementation and performance of geriatric consultation teams and geriatric resource nurses (GRNs) in Belgium. DESIGN: A cross-sectional survey was performed in March and April 2010. SETTING: Acute hospitals. PARTICIPANTS: Sixty-six hospitals completed the questionnaire (response rate of 68.8%); 63 geriatric consultation teams were included. METHODS: A newly developed questionnaire was sent to all hospitals. The head of the geriatric department completed the general parts of the questionnaire. The other parts, covering the organization of the consultation teams and geriatric resource nurses, respectively, were completed by the geriatrician or the head nurse of the geriatric consultation team. All data were analysed in a descriptive manner. RESULTS: The mean number of full time equivalents (FTE) per consultation team was 4.3 (SD±1.3; range 1.9-10.1). The nurse, represented by a mean of 1.7 FTE (SD±0.8), was a core member in almost all teams (n=60; 98.4%). The occupational therapist, geriatrician, dietician, psychologist and speech therapist were core members in more than 59% of the teams. Twenty-seven teams (42.9%) estimated that more than 75% of the patients (≥75 years) were screened for having a geriatric profile. This screening was mostly performed using the Triage Risk Screening Tool (n=23) or the Identification of Seniors At Risk (n=20). A positive screening automatically resulted in a request for a geriatric consultation team intervention in 45 teams (71.4%). Thirty-five teams (55.5%) had an advisory role only, while the other 28 teams (44.5%) had both advisory and executive roles. The median number of patients for whom recommendations were formulated per year, was 423 (Q1=230; Q3=633). Most participants rated the function of GRNs as 'poor' or 'bad'. CONCLUSION: To increase their impact, inpatient geriatric consultation teams focus on frail older persons using screening tools for detection of high-risk patients. More intense collaboration with GRNs is essential, and the function of GRNs needs further improvement.

To determine the effect of a hospitalist-developed, continuity-centered hospitalist staffing model on patient outcomes and resource use.The Creating Incentives and Continuity Leading to Efficiency (CICLE) staffing model was conceived by a group of hospitalists who sought to improve continuity of inpatient care. Using a retrospective, observational, pre-post study design, we compared patient-level data for all discharges from our hospitalist service from 6 months after implementation of the CICLE staffing model (September 1, 2009, through February 28, 2010; n=1585) with data from those same months in the prior year (September 1, 2008, through February 28, 2009; n=1808). We used the number of unique hospitalists who documented an encounter during the admission as a measure of continuity of care. Length of stay and hospital charges per admission constituted the measures of resource use.The odds of having a single hospitalist for the entire hospitalization nearly doubled under the CICLE model (odds ratio, 1.87; 95% confidence interval, 1.60-2.2; P.001). Mean length of stay decreased 7.5% (from 2.92 before to 2.70 days after initiation of the model; P.001). Mean hospital charge per admission decreased 8.5% (from $7224.33 before to $6607.79 after initiation of the model; P.001). Thirty-day readmission rates were not substantially affected by the CICLE model (15.0% before to 17.3% after initiation of the model; P=.08).Improved continuity of care among hospitalists was associated with reductions in length of stay and lower health care costs. These benefits were realized without substantially affecting readmission rates. The staffing model can be achieved by reorganizing existing hospitalists and may not require the hiring of additional personnel. The CICLE staffing model is a viable option for hospitalist groups that are aiming to diminish resource use and improve quality of care.

This paper uses the Jobs and Economic Development Impacts (JEDI) model to estimate economic impacts from 1398 MW of wind power development in four counties in west Texas. Project-specific impacts are estimated at the local level (i.e., within a 100-mile radius around the wind farms) and at the state level. The primary economic policy question addressed is how investment in wind energy affects the state and local communities where the wind farms are built. During the four-year construction phase approximately 4100 FTE (full time equivalents) jobs were supported with turbine and supply chain impacts accounting for 58% of all jobs generated. Total lifetime economic activity to the state from the projects equated to more than $1.8 billion, or $1.3 million per MW of installed capacity. The total economic activity to the local communities was also substantial, equating to nearly $730 million over the assumed 20-year life cycle of the farms, or $0.52 million per MW of installed capacity. Given the current level of impacts observed, and the potential for increased impacts via greater utilization of instate manufacturing capacity and the development of trained wind industry specific laborers, Texas appears to be well positioned to see increasing impacts from continued wind development.

With rapid social development and large-scale construction of infrastructure in China, construction projects have become one of the driving forces for the national economy, whose energy consumption, environmental emissions, and social impacts are significant. To completely understand the role of construction projects in Chinese society, this study developed input–output life-cycle assessment models based on 2002, 2005, and 2007 economic benchmarks. Inventory indicators included 10 types of energy, 7 kinds of environmental emissions, and 7 kinds of social impacts. Results show that embodied energy of construction projects in China accounts for 25–30% of total energy consumption; embodied SO2 emissions are being controlled, and the intensities of embodied NOx and CO2 have been reduced. However, given that the construction sector related employment is 17% of the total employment in China, the accidents and fatalities related to the construction sector are significant and represent approximately 50% of the national total. The embodied human and capital investments in science and technology (ST) increased from 2002 to 2007. The embodied full time equivalent (FTE) of each ST person also increased while the personal ST funding and intramural expenditures decreased. This might result from the time lag between RD activities and large-scale implementation.

The realisation that the world’s oceans play an important role in climate regulation and many territory activities, notably food production, coupled with economic changes and the rapid advancement in ocean technology have seen a shift in the perception of the importance of marine resources. This increased focus on marine resources means that governments and policy-makers require accessible and reliable information regarding the role of the marine sector. This information may then be used to formulate new environmental and economic policy measures. The aim of this paper is to define, describe and quantify the value of the marine sector in Ireland. This paper outlines a methodology that provides a robust analysis of the Irish marine sector for 2007. It was found that in 2007 the Irish marine sector contributed €1.44 billion in GVA to the wider Irish economy and employed over 17,000 individuals in full time equivalents.

Objective To assess the contribution of organizational factors to implementation of 3 asthma quality measures: enrollment in a disease management program, development of a written treatment plan, and prescription of severity-appropriate anti-inflammatory therapy. Study design A total of 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 nonurban private practices completed questionnaires about their practice's organizational characteristics (eg, leadership, communication, perceived effectiveness, job satisfaction). Results 94% of the clinicians and 92% of the office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs were associated with higher rates of enrollment in the Easy Breathing program, whereas higher scores for 3 organizational characteristics—communication timeliness, decision authority, and job satisfaction—were associated with both higher enrollment and a greater number of written treatment plans. None of the organizational characteristics was associated with greater use of anti-inflammatory therapy. Conclusions Three organizational characteristics predicted 2 quality asthma measures: use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics were amenable to change, then our findings could help focus interventions in areas of effective and acceptable organizational change.

Background. Gastrointestinal (GI) disorders account for 10% of all consultations in primary care. Little is known about the management. of GI disorders by general practitioners (GP) across different European countries. Aim and methods. We undertook a postal survey of randomly selected samples of GPs in six European countries (UK, Holland, Spain, Greece, Poland, Czech Republic) to determine patterns of diagnosis, management and service use in GI disorders. Results. We received 939 responses, response rate 32%. Over 80% of GPs were aware of at least three national guidelines for gastrointestinal disease. The availability of open access endoscopy ranged from 28% (Poland) to over 80% (Holland, Czech and UK). For uninvestigated dyspepsia the preferred first line management was proton pump inhibitor therapy (33-82%), Helicobacter pylori test and treat (19-47%), early endoscopy (5-32%), specialist referral (2-21%). Regarding irritable bowel syndrome, 23% of respondents were familiar with one or more diagnostic criteria, but between 7% (Netherlands) and 32% (Poland) would ask for a specialist opinion before making the diagnosis. Conclusion. The wide variation between GPs both between and within countries partly reflects variations in health care systems but also differing levels of knowledge and awareness, factors which are relevant to educational and research policy. (C) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Background Little has been reported in the literature about the time it takes nursing faculty to become comfortable utilizing technologically advanced equipment for teaching in the curriculum. The purpose of this survey was to determine the amount of time faculty members in an undergraduate nursing program perceived it would take for them to plan, implement, and evaluate the use of the Laerdal Medical Corporation's SimMan to teach clinical nursing skills in courses they were involved in. Method This was a small descriptive study conducted at a Midwestern college of nursing. The choices for full time equivalent (FTE) release for one semester were .25, .50, .75, and 1.0. Results The majority (55.2%) of the faculty members perceived it would require .50 FTE release time to plan for the utilization of simulation, and a near majority (44.8%) of the faculty members perceived it would require .50 FTE release time to implement high-fidelity simulation into nursing courses. Finally, the majority (60.7%) of the faculty members perceived it would require .25 FTE release time to evaluate the use of high-fidelity simulation in nursing courses.

OBJECTIVE To evaluate patients' expectations of hospital chaplains. PATIENTS AND METHODS From April 6, 2006, through April 25, 2006, we surveyed by mail 1500 consecutive medical and surgical patients within 3 weeks of their discharge from the hospital. The survey included questions related to demographics, duration and area of hospitalization, awareness of chaplain availability, expectations regarding chaplain visits, and reasons for wanting to see a chaplain. Measured characteristics were summarized by calculating means and SDs for continuous variables and proportions for categorical variables. Proportions were statistically compared via Fisher exact tests or Monte Carlo estimates. RESULTS Surveys were returned by 535 of the 1500 patients to whom they were sent. Most of those who returned surveys had been hospitalized for less than 1 week (398/514 [77.4%]) and were male (265/510 [52.0%]), married (396/528 [75.0%]), 56 years or older (382/532 [71.8%]), or affiliated with either the Lutheran (177 [33.3%]) or Catholic (133 [25.0%]) churches. Most (78.9%) were aware of the availability of chaplains, and 62.3% would have appreciated chaplain visitation at least every few days. More than half (52.9%) reported that they were visited, and 86.4% reported that this visit was important to them. The primary reason selected for wanting to see a chaplain was "to be reminded of God's care and presence." Items related to ritual, prayer, and pastoral support were also highly endorsed. Some results were dependent on sex, age, religious affiliation, or duration of stay. CONCLUSION Hospitalized patients value visitation by chaplains and appreciate both religious and supportive interventions. Opportunities for patient care, education, and research are apparent.

Background The duties of infection control professionals (ICPs) have increased over time, but resources have not increased substantially. Numerous states have passed or have considered mandatory reporting laws for health care–associated infections. Such laws would increase ICPs' work further. Methods We conducted two surveys of ICPs in Iowa to determine their current responsibilities and resources and to estimate the resources they would need if they were required to report all nosocomial infections to the state. Results Most hospitals had less than 1 full time equivalent performing infection control (mean = 0.64). Many respondents had several roles within the hospital. Surveillance methods and scope varied by hospital size. Most ICPs did not use catheter days as the denominator for rates of bloodstream infections. Over 50% of Iowa's hospitals are critical access hospitals, most of which did not have intensive care units, and most had very few patients with central venous catheters. Conclusions Hospitals in Iowa have limited resources for infection control. “One size fits all” public reporting systems are not appropriate for states like Iowa that have a few large hospitals and many small hospitals.

Background A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue. Methods The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions. Results On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum. Conclusions Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.

The availability of tax-based payroll data has proved a blessing to labour and business economists wishing to understand workers, their jobs and their employers. Unfortunately, administrative data do not always include key variables of interest. In the case of New Zealand, linked employer-employee data do not include any information on hours worked. We implement a set of complementary methods to patch this gap, deriving an approximate measure of full-time equivalent labour input. In addition, and more specific to the New Zealand data environment, we describe a method for identifying working proprietors using annual tax-filed information, thus providing a more complete picture of total firm labour input.

OBJECTIVES To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs). METHODS Data were collected on total staff composition and number of beds in ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site. Medicare medical education reimbursements were also taken into account. RESULTS Costs per ICU bed for physician staffing were $18,630 in Rochester, $37,515 in Jacksonville, and $38,010 in Scottsdale. When NPPs were substituted for house staff, the costs per bed were $72,466 in Rochester, $61,291 in Jacksonville, and $49,909 in Scottsdale. Incremental costs per ICU bed using NPPs were $53,836 in Rochester, $23,776 in Jacksonville, and $11,899 in Scottsdale. CONCLUSION Use of residents and fellows in ICU staffing at a major tertiary health center is more cost-efficient than use of NPPs. This finding could have implications for the cost of physician services in nonteaching community hospitals and the methods by which care is provided.

This project evaluated the roles and workload of Registered Nurses (RNs) within an outpatient Cancer Care Centre (CCC) of a tertiary referral hospital in Sydney, Australia. The research incorporated the two distinct areas of radiation oncology and haematology oncology. Patient throughput (incorporating clinic attendance and treatments) was known to have increased substantially since the centre opened in 1994. The nursing Full Time Equivalents (FTEs) for the CCC were determined when the centre opened with minimal change to the nursing establishment since then. Nursing staff perceived that their workload had increased substantially and that their roles had become more complex. Work sampling was conducted over a 3-month period and identified the range of nursing activities performed by the oncology outpatient nurse. The nurses were found to have a large administrative role while their nursing activities ranged from basic nursing tasks to more specialist activities including patient counseling and complex chemotherapy regimes.

Objectives To develop a cost model for hospitalization costs of surgery among children with Chiari malformation type 1 (CM-1) and to examine risk factors for increased costs. Study design Data were extracted from the US National Healthcare Cost and Utilization Project 2009 Kids' Inpatient Database. The study cohort was comprised of patients aged 0-20 years who underwent CM-1 surgery. Patient charges were converted to costs by cost-to-charge ratios. Simple and multivariable generalized linear models were used to construct cost models and to determine factors associated with increased hospital costs of CM-1 surgery. Results A total of 1075 patients were included. Median age was 11 years (IQR 5-16 years). Payers included public (32.9%) and private (61.5%) insurers. Median wage-adjusted cost and length-of-stay for CM-1 surgery were US $13 598 (IQR $10 475-$18 266) and 3 days (IQR 3-4 days). Higher costs were found at freestanding children's hospitals: average incremental-increased cost (AIIC) was US $5155 (95% CI $2067-$8749). Factors most associated with increased hospitalization costs were patients with device-dependent complex chronic conditions (AIIC $20 617, 95% CI $13 721-$29 026) and medical complications (AIIC $13 632, 95% CI $7163-$21 845). Neurologic and neuromuscular, metabolic, gastrointestinal, and other congenital genetic defect complex chronic conditions were also associated with higher hospital costs. Conclusions This study examined cost drivers for surgery for CM-1; the results may serve as a starting point in informing the development of financial risk models, such as bundled payments or prospective payment systems for these procedures. Beyond financial implications, the study identified specific risk factors associated with increased costs.

This paper empirically assesses the economic size (in terms of full time equivalent employees (FTEs)) of postponed manufacturing applications and related activities. Based on a survey among 782 companies, the differences in size and scope of applications between manufacturers, wholesalers and logistics service providers are assessed. Currently, relatively simple postponement applications are practiced in wholesale and logistics services as supplementary services. More complex, high value adding manufacturing activities are still the primary domain of manufacturers and these are not often outsourced to logistics service providers. Based on future expectations of respondents this need not stay this way.

Purpose: Automation of pharmacy workflow can reduce medication errors as well as improve efficiency of the medication picking, packing and labeling process. Since September 2012, two drug dispensing systems (DDS) began operations in the Singapore General Hospital Specialist Outpatient Clinic Pharmacy. This study sought to evaluate the impact of the DDS on safety and efficiency in the pharmacy. Methods: The primary outcome was the rate of prevented dispensing incidents contributed by DDS or manual picking of medications defined as the number of prevented dispensing incidents per 1000 medications picked. The secondary outcome was the productivity of each full time equivalent (FTE) when assigned to either the DDS or manual picking stations. Data pertaining to the primary and secondary outcomes between January and December 2013 were collected and analyzed. The rate of prevented dispensing incidents was expressed in median (interquartile range) and compared using Mann-Whitney U test. Other continuous variables were expressed in mean ± standard deviation and compared using independent samples t-test. Results: An average of 59494 medications was picked every month in the pharmacy. DDS accounted for 21.1 percent while manual picking accounted for 78.9 percent of all the medications picked. The median rate of prevented dispensing incidents per month committed by manual picking (2.73) was significantly higher than the DDS (0.00). DDS had greater productivity with each FTE in the DDS having an average of 6175 picks per month which was significantly higher than each FTE in the manual picking stations which had an average of 4867 picks per month. Conclusion: Installation of DDS in an outpatient pharmacy improved safety of the pharmacy workflow by automating the medication picking, packing and labeling process and minimizing human errors. Efficiency of the medication picking, packing and labeling process was also improved by the DDS as there were continuous efforts to boost their productivity as well as being more reliable and better able to handle fluctuations in patient load.

Conclusions in the 2006 annual video competition report released by the Federal Communications Commission undercut the rationale for additional regulation of cable providers. Although the data used in the report is 30 months out-of-date, it illustrates a steady trend of increasing competition among video service providers and increasing sources of diverse information and video programming.The most important finding of the recently released Thirteenth Annual Video Competition Report is the continuation of trends discussed in previous reports: cable competition is growing, consumer choice of diverse sources of video programming and information is increasing and cable operators are offering an ever-increasing array of video and non-video services. These results undermine the arguments for both increased regulation and sustaining the current level of regulation of cable in two ways. First, the report indicates even as of June 2006, cable penetration is unlikely to have surpassed 70% of the market, the threshold in which cable would be open to further regulation. Second, the report reveals that as of that date, the vertical integration of video programming and distribution channels was decreasing, and the video market was successfully providing consumers with a diversity of information sources, including new distribution methods, such as the Internet. Especially lamentable is the 14 month delay in the release of the report, keeping vital statistics about the video marketplace out of the hands of both Congress and consumers. Had the FCC been up to date with its annual video competition reports, it might have discovered that the answer to [the perceived twin problems of] cable pricing and the inability of consumers to buy programming on a per-channel basis - are already being addressed through technological innovation and market forces without the expenditure of a single "full time equivalent" federal employee man or woman hour.

s / Can J Diabetes 39 (2015) S38eS74 S72 (N1⁄424) were allocation concealed and randomized. The implementation process and context was evaluated by a qualitative study (interviews, field notes) analyzed by thematic analysis. The quantitative outcome measure of the number of weight management visits per full time equivalent RN/NP was blinded and collected over 1 year. Results: Qualitative results have revealed interacting contextual factors influencing the implementation of the intervention. These include the complexity and embedded nature of obesity, multidisciplinary team factors, provider relationship with patients, individual ability and work environment. These factors will enhance understanding of the primary outcome. Qualitative results have identified changes in provider behavior such as a reduction of patient weight bias, improved use of 5As of Obesity Management tools, and efficient obesity assessment. Summary: Tailoring weight interventions to primary care context may be a necessary step in overcoming barriers to implementation and effective change.