Medical work Assessment in German hospitals: a Real-time Observation study (MAGRO) – the study protocol

Background: The increasing economic pressure characterizes the current situation in health care and the need to justify medical decisions and organizational processes due to limited financial resources is omnipresent. Physicians tend to interpret this development as a decimation of their own medical influence. This becomes even more obvious after a change in hospital ownership i.e. from a public to a private profit oriented organization. In this case each work procedure is revised. To date, most research studies have focused mainly on differences between hospitals of different ownership regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Little attention has been devoted to the effects of hospital ownership on physicians' working routines. The aim of this observational real time study is to deliver exact data about physicians' work at hospitals of different ownership. Methods: The consequences of different management types on the organizational structures of the physicians' work situation and on job satisfaction in the ward situation are monitored by objective real time studies and multi-level psycho diagnostic measurements. Discussion: This study is unique in its focus. To date no results have been found for computer-based real time studies on work activity in the clinical field in order to objectively evaluate a physician's work-related stress. After a complete documentation of the physicians' work processes the daily work flow can be estimated and systematically optimized. This can stimulate an overall improvement of health care services in Germany

A TEMPORAL AND KINETIC COMPARISON OF THE KETTLEBELL SWING AND MAXIMAL VERTICAL JUMP

The purpose of this study was to compare the temporal and kinetic characteristics of the kettlebell swing to those of the maximal vertical jump in an attempt to understand how the kettlebell swing could potentially enhance vertical jump performance from the kinetic perspective. Twenty-five recreational athletes completed five two handed kettlebell swings and 5 maximal vertical jumps while ground reaction force data was sampled at 1200 Hz using two force plates. Variables related to power such as time to peak rate of force development (RFD), peak RFD, and average RFD were smaller in the kettlebell swing than the vertical jump. The lack of similarity between the kettlebell swing and vertical jump indicates the kettlebell swing may not be an appropriate training method for eliciting improvements in vertical jump performance at the 20% body weight load examined in this study

STUDENTS’ LEARNING OF SPECIFIC BIOMECHANICAL COMPETENCIES

The purpose of this study was to examine student learning in various competency areas of undergraduate biomechanical concepts based on the North American guidelines. A total of 173 students were recruited from introductory biomechanics classes from two state universities. The third version of Biomechanics Concept Inventory (BCI3) was given during the first and last two weeks of the sessions to measure student learning in six competency areas. Data from the 162 students who completed the study protocol showed that performance on items requiring prerequisite skills remained consistent between pre- and post-test. Overall, post-test scores significantly improved by 17 percent from pre-test values. Furthermore, the students demonstrated significant learning progress on neuromuscular and kinetics competencies

EFFECTS OF KINEMATIC FEEDBACK ON VERTICAL JUMP PERFORMANCE

The purpose of this study was to examine the immediate effects of kinematic feedback on vertical jump performance. Twenty recreationally active women were randomly assigned to the treatment or control group. Participants performed five maximal countermovement jumps pre-feedback and five jumps post-feedback. Visual and verbal feedback based on the mover’s pre-feedback jumps was provided to the treatment group. All participants were also allowed to view their jump performance on video. Treatment participants made reductions in maximal knee flexion (p=0.003) and depth of descent (p=0.003) but no significant changes in jump height (p=0.07), pre- to post-feedback. These findings suggest kinematic feedback is an effective means of modifying movement, however, the feedback in the present study did not result in improvement in jump height

a cross-sectional study of differences among medical residents with various specialties working in German hospitals

Objectives This study aimed to analyse and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties. Methods 435 German hospital residents in medical training working in 6 different medical specialties participated in a cross-sectional survey study. Physicians were asked about their working conditions and aspects of mental health and work ability. The Copenhagen Psychosocial Questionnaire, the Work Ability Index, the ICD-10 Symptom Rating and the Perceived Stress Questionnaire were used to measure working conditions, mental health and work ability. Results Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anaesthesiologists. Significant associations between physicians’ working conditions, occupational distress and mental health- related aspects are illustrated. Conclusions Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians' health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians' health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimisation and work process improvements should be focused by hospital managemen

EFFECT OF MODE OF LOAD CARRIAGE ON POSTURAL SWAY

People commonly carry external loads for sport and recreational purposes; recently the safety of such practice has come into question. The purpose of this study was to evaluate balance under different load carriage conditions. Fifteen college-age individuals completed three blocks of quiet standing trials: unloaded, wearing a backpack, and wearing a shoulder bag. A-P sway amplitude was greater under the backpack condition than the unloaded condition (P = 0.013); however, A-P sway amplitude did not differ between the backpack and shoulder bag condition, nor did it differ between the unloaded and shoulder bag condition. M-L sway amplitude, sway area, peak sway velocity, and stance width were not dependent on load condition. This evidence suggests a backpack and shoulder bag are equally safe means of load carriage in college-age individuals

Effects of decision making on landing neuromechanics as a function of task and sex

Although the incidence of non-contact anterior cruciate ligament (ACL) injuries is greater among women than men athletes, the factors that contribute to this greater risk of injury are not well understood. One relevant question is whether decision making during landing influences the biomechanical and neuromuscular factors thought to contribute to ACL injury, and whether these effects differ as a function of task and sex. The purpose of this study was thus to examine the effects of decision making on the neuromechanics of two-footed landing tasks in women and men. Twenty-nine healthy young adults (13 women; 16 men) completed a series of two-footed drop landing and drop-jump tasks under preplanned and decision-making conditions. Biomechanical and electromyographic data were collected. Repeated measures ANOVA was used to determine the effect of decision making on hip, knee, and ankle kinematics and kinetics, and on proactive and reactive muscle activity, as a function of task and sex. Multiple linear regression was used to assess the relationship between select knee biomechanical variables and proactive muscle activity. Decision making had numerous effects on lower extremity kinematics, kinetics, and neuromuscular control, many of which were task-specific. Under decision-making conditions, individuals exhibited similar joint postures at initial ground contact and similar amounts of reactive muscle activity across tasks. The majority of the observed modifications in neuromechanics suggested a default towards the preplanned drop landing strategy under decision-making conditions. Some effects of decision making on joint mechanics and reactive muscle activity varied with sex, although the extent to which these dissimilar effects modified relative ACL loading is not known. Knee flexion at initial contact, peak knee abduction, and peak knee adduction moment were significantly related to the proactive activity of several, primarily lateral, muscles of the lower extremity, independent of task and decision-making condition. These results indicate that decision making influences landing mechanics and neuromuscular control and that these effects are generally task-dependent and, in some cases, sex-dependent. The results also suggest that, in both women and men, drop landings and drop-jumps performed under decision-making conditions are no more dangerous, with respect to ACL loading, than preplanned drop landings

Psychotrauma and effective treatment of post-traumatic stress disorder in soldiers and peacekeepers

Psychotrauma occurs as a result to a traumatic event, which may involve witnessing someone's actual death or personally experiencing serious physical injury, assault, rape and sexual abuse, being held as a hostage, or a threat to physical or psychological integrity. Post-traumatic stress disorder (PTSD) is an anxiety disorder and was defined in the past as railway spine, traumatic war neurosis, stress syndrome, shell shock, battle fatigue, combat fatigue, or post-traumatic stress syndrome (PTSS). If untreated, post-traumatic stress disorder can impair relationships of those affected and strain their families and society. Deployed soldiers are especially at a high risk to be affected by PTSD but often receive inadequate treatment. Reviews to date have focused only on a single type of treatment or groups of soldiers from only one country. The aim of the current review was to evaluate characteristics of therapeutic methods used internationally to treat male soldiers' PTSD after peacekeeping operations in South Eastern Europe and the Gulf wars

working conditions and individual resources as related factors

Objectives This study developed and tested a research model that examined the effects of working conditions and individual resources on work–family conflict (WFC) using data collected from physicians working at German clinics. Material and methods This is a cross-sectional study of 727 physicians working in German hospitals. The work environment, WFC and individual resources were measured by the Copenhagen Psychosocial Questionnaire, the WFC Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism. Descriptive, correlation and linear regression analyses were applied. Results Clinical doctors working in German hospitals perceived high levels of WFC (mean=76). Sociodemographic differences were found for age, marital status and presence of children with regard to WFC. No significant gender differences were found. WFCs were positively related to high workloads and quantitative job demands. Job resources (eg, influence at work, social support) and personal resources (eg, resilient coping behaviour and self- efficacy) were negatively associated with physicians’ WFCs. Interaction terms suggest that job and personal resources buffer the effects of job demands on WFC. Conclusions In this study, WFC was prevalent among German clinicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WFC. Our results give a strong indication that both individual and organisational factors are related to WFC. Results may play an important role in optimising clinical care. Practical implications for physicians’ career planning and recommendations for future research are discussed

Bidirectional Assessment of Stress, job satisfaction and work ability of Educators in day care centres: a real-time observation study - the study protocol (BASE)

Background: Occupational demands of educators are not very well researched. Nevertheless their work is subject to several requirements. Whether these demands have an effect on the work ability and the health status of employees has also not been examined. Furthermore it is unclear if the ownership type of day care centres have an influence on job satisfaction and work ability of the pedagogical staff and what kind of resources do exist. Previous studies were mainly based on questionnaire data. Objective data does not exist. Therefore the aim of this investigation is to collect precise data relating to work of educators. Methods: Effects of different types of ownership of day care centres on job satisfaction and work ability of educators will be assessed with the help of objective real time studies in combination with multi-level psycho diagnostic measurements. Discussion: The present study is the first of its kind. Up to now there are no computer-based real time studies on workflow of pedagogical staff with regard to assess their work-related stress. Following an exhaustive documentation of educators work processes the day-to-day task can be estimated and approaches for prevention can be developed. This can substantially contribute to an overall improvement of child care in Germany