Physician staffing pattern in intensive care units:Have we cracked the code?

Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.

Testing Reliability and Validity of the Oulu Patient Classification Instrument—The First Step in Evaluating the RAFAELA System in Norway

Objective: To study reliability and validity of the Finnish Oulu Patient Classification instrument in Norway. Background: The Finnish patient classification system RAFAELA consists of three parts: 1) daily patient classification of nursing intensity using the Oulu Patient Classification instrument, 2) calculation of nursing resources providing bed side care per 24 hours, and 3) Professional Assessment of Optimal Nursing Care Intensity Level. The RAFAELA system has not been tested outside of Finland. Methods: A prospective, descriptive study was performed at 5 clinical units at Oslo University Hospital during 2011-2012. The interrater reliability of the Oulu Patient Classification instrument was tested by parallel classification including 100-167 patient classifications pr. unit, and analyzed by consensus in % and using Cohen’s Kappa. Convergent validity was tested by using the average Oulu Patient Classification instrument value to predict the average Professional Assessment of Optimal Nursing Care Intensity Level for the same calendar day by linear regression analysis. Results: The Oulu Patient Classification instrument consensus of parallel classifications varied between 70.1%-89%. Cohen’s Kappa within patient classes varied between 0.57 and 0.81, representing substantial interrater reliability. The Oulu Patient Classification instrument was valid as the instrument in average explained about 38% of the variation of the Professional Assessment of Optimal Nursing Care Intensity Level. Conclusions: Patient classification systems tested for psychometric properties are needed and this study provides evidence of satisfactory reliability and validity of the Oulu Patient Classification instrument as tested outside Finland, demonstrating that this instrument has international relevance within nursing.

A Qualitative Study of Manager Experiences Using the RAFAELA System

Objective: The objective was to explore manager experiences using the RAFAELA system. Background: The RAFAELA system was developed in Finland during the 1990s to create a work situation where patients’ care needs were balanced with personnel resources. The system is used in almost all hospitals in Finland and is implemented in several European countries. However, the system has never been evaluated outside Finland. This study, focusing on the managers’ perspective, represents the second report from a larger Norwegian evaluation project of the RAFAELA system. Methods: An explorative qualitative design was chosen. Data were collected by individual in-depth interviews at a university hospital in Norway during 2012-2013. A total of 10 informants in various management positions were interviewed. The tape-recorded interviews were transcribed verbatim, and the transcripts were analysed using Kvale’s method for content analysis. Results: Four main themes emerged from the qualitative data: making the invisible visible;a common language;a system for prospective planning;and a resource-demanding tool. Conclusions: The study indicated that the RAFAELA system provided useful information about the patients’ care needs and nursing activities. Also the system provided a common reference frame for discussing nursing, staffing and allocation. Although the managers considered the RAFAELA to be time consuming in the implementation phase, they considered the system to be an important tool.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

Empirical study on the antecedents of multinational enterprises’ oversea subsidiaries staffing

Based on probing into the literature on multinational enterprise (MNE) staffing, we set up a concept model for MNEs’ subsidiary staffing by two groups of influencing factors: the national differences bwteen the parent country and the host country, and the strategies employed by MNEs. We also tested the model and proposed propositions by a sample evaluation method, specifically with 1 000 copies of questionnaires given out to managers or directors of MNEs’ subsidiaries in China Mainland and resulting in 151 sets of valid answers. The empirical study supports that national differences between the parent country and the host country and the strategies employed by MNEs do have impact on the subsidiary staffing, and MNE headquarters should make different staffing plans according to the difference of nations and strategies. We welcome testing our model by peer researchers in other country.

Professional Staffing Practice of Academic Anesthesia Departments in the United States

Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.

Unfavorable staffing and resources adequacy impact on patient outcomes and quality of care in the three university hospitals in Malaysia

The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcomes, adequate staffing, high-quality care, nurses’ job satisfaction and hence their retention. The aim of this study was to explore the staffing and resource adequacy in NPE and the association with POs (adverse events). A descriptive correlational study was conducted and participated 395 staff nurses (94.3%) from three university hospitals in Malaysia over two months, from January to February 2011. In this paper, the results showed that 344 (87.1%) staff nurses rated that was unfavorable (

Analysis of Staffing and Training Needs for Effective Delivery of Extension Service in Sustainable Land Management in Kilimanjaro Region, Tanzania

An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

我国铅物质流分析研究

从铅的生产、铅制品的加工制造、铅制品的使用和废杂铅的处理等阶段详细地阐述了铅循环的'STAF(stocks and flows)'物质流分析模型.运用此模型分析了2006年我国铅的社会存量变化及其流动状况,并且计算出2000—2006年几项重要指标的平均值分别为:生产阶段的原料自给率PZ=79.28%;生产阶段使用废杂铅的比例PS=19.08%;加工制造阶段的原料自给率MZ=148.91%;加工制造阶段使用废杂铅的比例MS=30.25%;矿石指数R=0.834 9;废铅指数S=0.194 9.在此基础上总结了我国在铅资源循环利用方面的不足,并对铅工业的发展和资源的循环利用提出建议.

STAF评分在缺血性卒中患者心房颤动筛查的应用

目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患者,收集其基本临床特征、入院首次美国国立卒中卫生院卒中评分量表(the Na tional Institute of Health stroke scale,NIHSS)评分、心脏彩超结果、经典TOAST(Trial of Org 10172 in Acute Stroke Treatment)分型、既往史、12导联心电图(electrocardiogram,ECG)、24小时动态心电图(24h-Holter)、心电监护结果并进行STAF评分。绘制受试者工作特征(receiver operator characteristic,ROC)曲线确定STAF诊断房颤的界值,分析其诊断价值。结果共收集患者219例,STAF评分诊断房颠的ROC曲线下面积(area under the curve,AUC)为0.901。以STAF≥5分作为界值,STAF评分的灵敏度为97.37%,特异度为70.72%。结论初步发现STAF评分对缺血性卒中患者具有较好的诊断价值,仍需进一步研究验证。

我国铜资源物质流分析研究

铜是我国应用最为广泛的有色金属，研究铜资源利用和循环状态对我国经济可持续发展具有重要的战略意义。论文从铜的生产、加工制造、使用和废铜处理4个阶段详细阐述了铜循环的“STAF”物质流分析模型，并以此模型分析了2004年我国铜的流动状况和社会存量变化，得出结论：1998～2004年，我国铜工业的Pz、Ps、Mz和Ms平均值分别为49．08％、25．98％、57．14％和21．45％，远低于欧洲发达国家水平。对比1994年与2004年我国铜物质流图可知，10年来我国铜循环的各阶段中所有流入量和流出量都有较大提高，废铜再资源化程度虽有提高，但较之快速增长的铜需求量仍显不足。因此在资源危机面前，加强政策引导与科研力度，大力提高一次铜的资源生产率和二次铜的再资源化效率是我国铜工业可持续发展的工作重点。

STAF评分联合病灶分布对脑梗死患者心房纤颤的诊断价值

目的评价STAF评分及联合磁共振弥散加权成像(DWI)病灶空间分布特征对脑梗死患者心房纤颤(房颤)的诊断价值。方法收集我院一年的住院脑梗死患者的连续性病例资料,分为房颤组和非房颤组,比较两组患者的基本临床特征,并以STAF评分及STAF评分+DWI病灶空间分布特征对房颤诊断与否分别绘制受试者工作特征(ROC)曲线。结果房颤组的年龄及冠心病发生率高于非房颤组,三酰甘油水平低于非房颤组,房颤组STAF评分≥5分的发生率明显高于非房颤组,差异有统计学意义(P<0.05);而两组在性别、高血压、糖尿病等方面差异均无统计学意义(P>0.05)。STAF评分及病灶空间分布特征均为脑梗死患者发生房颤的独立预测因素。STAF评分诊断房颤的ROC曲线下面积为0.809[95%CI(0.729,0.890),P=0.000];STAF评分+病灶空间分布特征诊断房颤的ROC曲线下面积为0.846[95%CI(0.783,0.909),P=0.000]。结论 STAF评分对脑梗死患者的房颤具有诊断价值,联合DWI病灶空间分布特征可改善诊断。

基于STAF的软件自动化测试系统的研究和实现

设计并实现了一种基于STAF的软件自动化测试系统,能够较好地对自动化测试过程进行管理,并且支持多平台测试网络环境下对自动化测试任务的执行和监控。通过该系统的实施,能够提高软件测试环节中的自动化程度,从而提高测试效率,缩短测试周期,同时增加测试结果的可信赖程度。

STAF评分对房颤导致心源性脑梗死的诊断价值

目的评价房颤鉴别(STAF)评分在房颤导致心源性脑梗死中的应用价值。方法收集首次脑梗死患者180例,根据STAF评分分为≥5分组80例和STAF评分<5分组100例,比较两组患者的基本临床特征、房颤的发生率。结果两组年龄、NIHSS评分、左房直径及房颤发生率比较差异均有统计学意义(P均<0.05)。结论应用STAF评分能提高房颤导致心源性脑梗死的诊断率。

核动力蒸汽发生器三维热工水力分析程序STAF的发展与应用

蒸汽发生器(SG)作为核动力系统一、二次侧能量转换枢纽,保证其安全运行至关重要。为对标国外先进SG三维热工水力分析程序,西安交通大学核反应堆热工水力团队(NuTHeL)基于多孔介质方法和漂移流模型自主开发了SG三维热工分析程序——STAF系列。初始程序STAF1.0将SG一次侧简化为一维流动,与采用多孔介质模型的二次侧实现耦合换热。为实现蒸汽发生器一、二次侧全三维高精度耦合分析,团队基于局部精细化建模结合重叠网格方法,进一步开发了一、二次侧全三维耦合瞬态分析程序STAF-CT(STAF2.0)。近些年,团队基于开源CFD平台OpenFOAM开发了STAF3.0版本,在原有计算功能基础上实现了并行计算,大幅提高了计算效率。本文详细介绍STAF系列程序数学物理模型、开发验证过程,并重点介绍STAF系列程序在核工程领域典型应用,包括SG三维稳态及瞬态热工水力特性分析、带轴流式预热器强化换热、堵管运行、二次侧^(16)N迁移、腐蚀沉积和海洋条件下SG热工水力响应特性等。

基于STAF的故障注入自动化测试平台

为提高高端容错计算机故障注入自动化测试的执行效率,基于开源的自动化测试工具STAF,设计一个可集成多种故障注入工具的分布式自动化测试平台。论述分布式运行环境与平台软件架构,给出任务控制算法的流程,对故障注入模块进行分析。实验结果表明,该平台可提高测试任务的复用性,缩短测试时间。

基于STAF的自动化测试工具的研究和设计

以软件的回归测试自动化作为研究的重点,首先针对回归测试的特点,选择开源的自动化测试工具STAF,然后基于这个工具,提出一个可适用回归测试的自动化测试工具模型ATT.该自动化测试工具提高了自动化测试的开发和执行效率.同时,该工具也提供了标准、易用的扩展接口,其良好的可扩展性能够让测试人员方便的添加测试组和测试用例.

STAF评分筛查急性脑梗死患者合并心房颤动的临床研究

目的探讨STAF评分对急性脑梗死患者合并心房颤动(AF)的筛查价值。方法 225例临床诊断为急性脑梗死并完成STAF评分患者,收集患者人口学信息、入院后首次美国国立卫生研究院卒中量表(NIHSS)评分、常规心电图(ECG)、心脏彩超、24 h动态心电图组合、头颈部血管评估等检查结果。对所有患者进行STAF评分,绘制受试者工作特征(ROC)曲线,确定STAF诊断AF的最佳界值,计算其灵敏度与特异度,分析其诊断价值。结果 225例患者中男143例,女82例,年龄37~90岁,平均年龄(65.0±9.5)岁。STAF评分诊断AF的ROC曲线下面积为0.912,以STAF评分≥5分作为最佳截断点,此时灵敏度为92.68%,特异度为86.41%,阳性预测值为60.31%,阴性预测值为99.22%,假阴性率7.32%,假阳性率13.59%,阳性似然比6.82,阴性似然比0.08,约登指数为0.79。结论 STAF评分对急性缺血性卒中患者合并AF具有较好的筛查价值。

基于STAF自动化测试框架的研究与应用

随着软件功能实现技术越来越复杂,软件测试领域迫切需要具有自动化、多平台、开销小的自动化测试框架,STAF的出现很好地解决了这个问题;提出一种基于STAF的自动化测试框架,并进行模拟实践,采用ATT工具设计自动测试引擎,通过模拟实验测试,构建基于STAF的自动化测试框架;测试结果显示:在不同环境下,该框架均具有软件测试自动化程度高,测试效率高,易于管理、维护和可扩展等优点。