Clinical Competence ; standards ; Education, Medical ; standards ; Humans ; Physicians ; standards

Female ; Gynecology ; Health Care Surveys ; Humans ; Male ; Physical Examination ; ethics ; methods ; standards ; Sex Factors ; Sexual Harassment ; legislation & jurisprudence ; prevention & control ; statistics & numerical data ; Singapore ; Students, Medical

Colorectal Neoplasms ; diagnosis ; Directive Counseling ; Early Detection of Cancer ; methods ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Occult Blood ; Patient Acceptance of Health Care ; statistics & numerical data ; Patient Education as Topic

Aged ; Dental Health Services ; standards ; Health Services for the Aged ; standards ; Humans ; Nursing Homes ; Oral Health ; Singapore

The United Nations has identified the training and education of healthcare professionals and care providers involved in the care of older persons as a global priority. Singapore is no exception as it faces a rapidly ageing population. Older people have many medical needs of varying dimensions and their care requires a multidisciplinary healthcare team. The current status of geriatric education of health professionals involved in elderly care in Singapore is discussed in this paper. Important issues raised include the disparity between professions in the stages of development of geriatric education, questions on the adequacy of numbers and training of healthcare professionals providing geriatric care, as well as the need for geriatric education of caregivers.
Aged ; Geriatric Nursing ; education ; Health Personnel ; education ; Humans ; Singapore

Attitude to Health ; Civil Defense ; ethics ; Communicable Disease Control ; Communication ; Ethics, Medical ; Freedom ; Health Personnel ; ethics ; Health Planning ; ethics ; Health Priorities ; ethics ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; epidemiology ; Mandatory Programs ; ethics ; Moral Obligations ; Pandemics ; ethics ; Patient Rights ; ethics ; Primary Health Care ; ethics ; Public Health ; ethics ; Public Health Administration ; ethics ; Resource Allocation ; ethics ; Singapore ; Trust

INTRODUCTIONThis study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later.

MATERIALS AND METHODSA retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy.

RESULTSThe mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later.

CONCLUSIONCH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.

Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Hip Fractures ; rehabilitation ; Hospitalization ; Hospitals, Community ; Humans ; Male ; Middle Aged ; Postoperative Complications ; rehabilitation ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONPrevious studies on patient acceptance of medical student teaching were from Western populations and in one setting only. However, there has been no prospective study comparing patient acceptability before and after an actual experience. We studied patient acceptability of medical student teaching in private and public family practices and public hospital specialist outpatient clinics in Singapore, and before and after an actual medical student teaching consultation.

MATERIALS AND METHODSWe conducted an anonymous cross-sectional survey from March through October 2007 of Singaporean or permanent resident patients attending 76 teaching private family practices, 9 teaching public family practices and 8 specialty clinics in a teaching public hospital. We used pre-consultation cross-sectional patient surveys in all three settings. For private family practice setting only, post-consultation patient survey was conducted after an actual experience with medical student presence.

RESULTSOut of 5123 patients, 4142 participated in the cross-sectional survey (80.9%) and 1235 of 1519 patients in the prospective cohort study (81.3%). Eighty percent were comfortable with medical students present, 79% being interviewed and 60% being examined. Regarding being examined by medical students, parents of children were least comfortable while patients between 41 to 60 years were most comfortable (adjusted OR = 1.99 [1.55-2.57]). Females were less comfortable with medical student teaching than males. Chinese patients were the least comfortable about being interviewed or examined by medical students among the ethnic groups. Indians were most comfortable with being interviewed by medical students (adjusted OR = 1.38 [1.02-1.86]) but Malays were the most comfortable being examined by them (adjusted OR = 1.32 [1.07-1.62]). Family practice patients were more receptive to medical student teaching than the hospital's specialist outpatients. Common barriers to patient acceptance were lack of assurance of patient privacy, dignity and confidentiality. Actual exposure to medical student teaching did not change levels of patient acceptance.

CONCLUSIONSCompared to similar studies from Western countries, Asian patients appear to be less receptive to medical student teaching than Western patients. Family practice settings offer medical students a more receptive learning environment.

Adult ; Cross-Sectional Studies ; Education, Medical, Undergraduate ; Family Practice ; Female ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Odds Ratio ; Outpatient Clinics, Hospital ; Patient Satisfaction ; Physician-Patient Relations ; Private Practice ; Students, Medical ; Young Adult

INTRODUCTIONWe were interested to determine the participation rates for health screening in a multi-ethnic urban low-income community. We assessed the health screening rates at baseline, collected data on reasons for non-participation and assessed the impact that a 5-month intervention had on health screening in this community.

MATERIALS AND METHODSThe study population involved all residents aged ≥40 years, living in heavily subsidised public rental flats in Taman Jurong Constituency, Singapore. From January 2009 to May 2009, we collected baseline information and offered eligible residents free blood pressure, fasting blood glucose and lipid measurements, fecal occult blood testing and Pap smears. Screenings were conducted either at or near the residents' homes.

RESULTSThe participation rate was 60.9% (213/350). At baseline, 18.9% (24/127), 26.4% (42/159) and 18.7% (31/166) had gone for regular hypertension, diabetes and hyperlipidaemia screening, respectively; 3.8% (6/157) and 2.9% (2/70) had had regular colorectal and cervical cancer screening, respectively. Post-intervention, rates for hypertension screening increased to 97.6% but increases for other modalities were marginal. High cost, lack of time, not at risk, too old, or unnecessary for healthy people were commonly-cited reasons for skipping regular health screening. Being unemployed was associated with missing regular hypertension screening (adjusted OR = 2.48, CI = 1.12-5.53, P = 0.026); those who did not need financial aid were less likely to miss regular hyperlipidaemia screening (adjusted OR = 0.27, CI = 0.10-0.72, P = 0.008).

CONCLUSIONThe participation rates for health screening were poor in this low-income community. More can be done to encourage regular health screening participation amongst this segment of the populace, both by reducing costs as well as addressing misperceptions.

Adult ; Aged ; Female ; Health Services Research ; Humans ; Male ; Mass Screening ; methods ; utilization ; Middle Aged ; Patient Acceptance of Health Care ; ethnology ; Poverty Areas ; Singapore

INTRODUCTIONWe assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore's Yong Loo Lin School of Medicine (NUS YLLSoM).

MATERIALS AND METHODSWe conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS.

RESULTSThe participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score.

CONCLUSIONPHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students.

Attitude of Health Personnel ; Community Health Services ; organization & administration ; Confidence Intervals ; Cross-Sectional Studies ; Data Collection ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Learning ; Logistic Models ; Male ; Mass Screening ; Models, Educational ; Odds Ratio ; Program Development ; Program Evaluation ; Public Health Practice ; Schools, Medical ; Singapore ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Teaching ; Volunteers