Population-based lifetime health services rely on health management practice. Collection, management and analysis of big data are highly suitable for the huge population base in China. Nowadays, more and more research focus on the methods, security and ethnicity of health management and big data, and a plenty of instructive results have been made, which could be used to guide the future practice and development. Yichang mode has set a precedent for construction and use of big data for health management.
Big Data ; China ; Delivery of Health Care ; Health Services Research ; Population Health Management ; Population Surveillance/methods*

PURPOSE: This study was conducted to design and implement a fundamental nursing practice based on flipped learning and to examine the effects. METHODS: Participants were 57 students who were taking the fundamental nursing practice course at D university in N city. The study included processes of instructional design, action/effects and reflection. Data were analyzed using paired t-test with the SPSS/WIN 23.0. RESULTS: In the instructional design stage, the class consisted of 3 parts: outside class (pre-learning), inside class (assessment, collaborative practice, peer review, reflection), after-class (self-directed practice, feedback). In the action/effects stage, the flipped learning was applied for 15 weeks according to the instructional design and then the effects of flipped learning were evaluated. Students showed a significant improvement in self-directed learning ability (t=−3.56, p=.001) and critical thinking disposition after the class (t=−3.72, p<.001). Finally, in the reflection stage, the researchers examined whether the four pillars of flipped learning occurred. CONCLUSION: Findings indicate that flipped learning applied in fundamental nursing practice is effective in improving self-directed learning ability and critical thinking disposition. The action research method was a useful way to foster professor's educational competency as well as to verify effects of a new nursing education method.
Education, Nursing ; Health Services Research* ; Humans ; Learning* ; Methods ; Nursing* ; Peer Review ; Thinking

General internal medicine is now an essential service, and may in time be the main vehicle of delivery of healthcare to an ageing population, since resources are finite. One model for an equitable system of healthcare delivery may be the integration of General Internal Medicine as the core matrix, around which the various subspecialties deliver quality care. This is now a reality in many hospitals, where all subspecialists serve for varying periods in general medical wards, some even achieving dual accreditation. This promotes integration rather than fragmentation of services. Subspecialties will thrive, for the general workload will also be shared by internists in an equitable fashion. The obvious beneficiaries are the patients, and the health economics will also benefit the funding bodies. The services provided by internists must also be expanded into new fields, e.g. medicine for disasters, so as to promote cost-effective medical care, research and teaching, and also to achieve right-siting of patient care. It must also be emphasised that the specialties remain integral parts of the matrix, so that all departments complement one another, rather than compete with each other. The collegiality engendered is essential for a more congenial workplace, so as to promote staff retention.
Delivery of Health Care ; organization & administration ; Health Expenditures ; trends ; Health Services Research ; methods ; Humans ; Internal Medicine ; manpower ; Physician's Role ; Singapore

OBJECTIVES: This article reviews an evaluation vector model driven from a participatory action research leveraging a collective inquiry system named SMILE (Stanford Mobile Inquiry-based Learning Environment). METHODS: SMILE has been implemented in a diverse set of collective inquiry generation and analysis scenarios including community health care-specific professional development sessions and community-based participatory action research projects. In each scenario, participants are given opportunities to construct inquiries around physical and emotional health-related phenomena in their own community. RESULTS: Participants formulated inquiries as well as potential clinical treatments and hypothetical scenarios to address health concerns or clarify misunderstandings or misdiagnoses often found in their community practices. From medical universities to rural village health promotion organizations, all participatory inquiries and potential solutions can be collected and analyzed. The inquiry and solution sets represent an evaluation vector which helps educators better understand community health issues at a much deeper level. CONCLUSIONS: SMILE helps collect problems that are most important and central to their community health concerns. The evaluation vector, consisting participatory and collective inquiries and potential solutions, helps the researchers assess the participants' level of understanding on issues around health concerns and practices while helping the community adequately formulate follow-up action plans. The method used in SMILE requires much further enhancement with machine learning and advanced data visualization.
Community-Based Participatory Research ; Diagnostic Errors ; Follow-Up Studies ; Health Promotion ; Health Services Research* ; Learning* ; Machine Learning ; Methods ; Public Health ; Public Health Informatics ; Social Learning ; Telemedicine

PURPOSE: Although medical curricula are now better structured for integration of biomedical sciences and clinical training, most teaching and learning activities still follow the older teacher-centric discipline-specific formats. A newer pedagogical approach, known as Collaborative Learning Cases (CLCs), was adopted in the medical school to facilitate integration and collaborative learning. Before incorporating CLCs into the curriculum of year 1 students, two pilot runs using the action research method was carried out to improve the design of CLCs. METHODS: We employed the four-phase Kemmis and McTaggart's action research spiral in two cycles to improve the design of CLCs. A class of 300 first-year medical students (for both cycles), 11 tutors (first cycle), and 16 tutors (second cycle) were involved in this research. Data was collected using the 5-points Likert scale survey, open-ended questionnaire, and observation. RESULTS: From the data collected, we learned that more effort was required to train the tutors to understand the principles of CLCs and their role in the CLCs sessions. Although action research enables the faculty to improve the design of CLCs, finding the right technology tools to support collaboration and enhance learning during the CLCs remains a challenge. CONCLUSION: The two cycles of action research was effective in helping us design a better learning environment during the CLCs by clarifying tutors' roles, improving group and time management, and meaningful use of technology.
Cooperative Behavior ; Curriculum ; Education ; Health Services Research* ; Humans ; Learning* ; Meaningful Use ; Methods ; Schools, Medical ; Students, Medical ; Time Management

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

OBJECTIVES: This study attempts to show how studies using non-experimental data can strengthen causal inferences by applying propensity score and instrumental variable methods based on the counterfactual framework. For illustrative purposes, we examine the effect of having private health insurance on the probability of experiencing at least one hospital admission in the previous year. METHODS: Using data from the 4th wave of the Korea Labor and Income Panel Study, we compared the results obtained using propensity score and instrumental variable methods with those from conventional logistic and linear regression models, respectively. RESULTS: While conventional multiple regression analyses fail to identify the effect, the results estimated using propensity score and instrumental variable methods suggest that having private health insurance has positive and statistically significant effects on hospital admission. CONCLUSIONS: This study demonstrates that propensity score and instrumental variable methods provide potentially useful alternatives to conventional regression approaches in making causal inferences using non-experimental data.
Adult ; *Data Interpretation, Statistical ; *Epidemiologic Methods ; Female ; Health Services Research/*methods ; Humans ; Insurance, Health/*statistics & numerical data ; Korea ; Male ; Middle Aged ; Patient Admission/*statistics & numerical data ; Regression Analysis ; Research Design ; Selection Bias

PURPOSE: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. METHODS: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. RESULTS: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p > .05), the mean differences for all dimensions were statistically significant. CONCLUSIONS: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.
Attitude of Health Personnel ; Education, Nursing/*organization & administration ; Educational Measurement/methods ; Health Services Research/organization & administration ; Humans ; Iran ; Midwifery/*education ; Nurse's Role ; Nursing Education Research/organization & administration ; Personal Satisfaction ; Reproducibility of Results ; Students, Nursing/psychology ; Teaching ; Trust

PURPOSE: The purpose of this study was to identify the effects of a nurse presence program on suicide prevention for elders with chronic disease. METHOD: The subjects were recruited from two different elderly institutions located in D city and K province, Korea. Twenty subjects in the control group received no intervention and nineteen subjects in the experimental group received a nurse presence program. RESULT: There were more significant decreases in suicide ideation, and the cortisol level and increases in life satisfaction in the experimental group compared to the control group. CONCLUSION: According to the above results, a nurse presence program for elders with a chronic disease decreased stressful events like suicide ideation and increased self esteem through therapeutic interaction. These findings suggest that this program can be used as an efficient independent nursing intervention for elders in a critical situation.
Aged ; *Chronic Disease ; Female ; Frail Elderly ; Geriatric Assessment ; Geriatric Nursing ; Health Services ; Humans ; Interpersonal Relations ; Nursing Methodology Research/*methods ; Personal Satisfaction ; Self Concept ; Social Support ; Suicide/*prevention & control

PURPOSE: This study was conducted to examine the experience of nurse in comprehensive nursing care. METHODS: Experiential data collected from 9 nurses through in-depth interviews. Participants were selected from nurses working in the comprehensive nursing care unit at general hospital. The main question was “Can you describe your experience in the comprehensive nursing care unit?” All interviews were recorded and transcribed, then analyzed using Colaizzi's method. RESULTS: Nine themes were derived from the analysis: 'Practice nursing care', 'Feel thankful of the client', 'Difficulty in nursing due to absence of patients' guardian', 'Tired of over-demanding patient and distrust of guardian', 'Confusion regarding one's identity as a nurse', 'Not enough to support system','Insufficient pre-training for nurse and client', 'Requirement of work establishment for nurse and nurse aid', 'Concerns about low rewards and high safety accidents'. CONCLUSION: As a comprehensive nursing service, the nurses provided total patient care, and patient satisfaction and expression of appreciation increased. However, disadvantages were identified, such as patients' excessive needs, communication difficulties, lack of support systems, low compensation, and a high number of safety accidents. Therefore, systematic comprehensive nursing will be achieved if these shortcomings are addressed.
Compensation and Redress ; Health Policy ; Hospitals, General ; Humans ; Methods ; Nursing Care* ; Nursing Services ; Nursing* ; Patient Care ; Patient Satisfaction ; Primary Nursing ; Qualitative Research ; Reward