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

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

OBJECTIVES: This study was conducted to investigate the current status of outsourcing in Korean hospital information systems and the factors influencing its introduction. METHODS: The authors surveyed 136 hospitals located in Seoul and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and inhibitors to outsourcing in hospital information systems were derived from literature and expert reviews. Multiple logistic regression analysis was applied to identify the major influencing factors on outsourcing in hospital information systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which were mainly tertiary hospitals, responded to using outsourcing for their hospital information systems. "Hardware and software maintenance and support," "application development," and "management of service and staff" were the major areas of outsourcing. Outsourcing had been employed for 4~7 years by 45.5% of the hospitals and the proportion of the budget used for outsourcing was less than 20%. A need for an extension in outsourcing was agreed on by 76.5% of the hospitals. The multiple logistic regression analysis showed that both consumer satisfaction and security risk have an influence on hospital information system outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is expected to increase just as in other industries. One primary facilitator to outsourcing in other industries is consumer satisfaction. We found that this was also a facilitator to outsourcing in hospital information systems. Security risk, which is usually considered an inhibitor to information technology outsourcing, was proven to be an inhibitor here as well. The results of this study may help hospital information systems establish a strategy and management plan for outsourcing.
Security Measures ; Outsourced Services/economics/*utilization ; Maintenance ; Logistic Models ; Korea ; Hospital Information Systems/*organization & administration ; Health Services Research ; Decision Making, Organizational ; Consumer Satisfaction ; Computer Security

Chronic Disease ; Delivery of Health Care ; organization & administration ; trends ; Diffusion of Innovation ; Education, Medical, Continuing ; Forecasting ; Health Services Research ; Humans ; Public Health ; trends ; Singapore ; Societies, Medical

Computer Simulation ; Curriculum ; Education, Medical ; organization & administration ; trends ; Electronic Health Records ; Health Services Research ; Humans ; Interdisciplinary Communication ; Leadership ; Patient Care Team ; Public Health ; Schools, Medical ; Singapore

OBJECTIVES: This study was performed to evaluate the effectiveness of 'village health worker training program' which aimed to build community participatory health promotion capacity of community leaders in villages of low developed country and to develop methods for further development of the program. METHODS: The intervention group were 134 community leaders from 25 barangays (village). Control group were 149 form 4 barangays. Intervention group participated 3-day training program. Questionnaire was developed based on 'Health Promotion Capacity Checklist' which assessed capacity in 4 feathers; 'knowledge', 'skill', 'commitment', and 'resource'. Each feather was assessed in 4 point rating scale. Capacity scores between intervention group and control group were examined to identify changes between the pre- and post-intervention periods. A qualitative evaluation of the program was conducted to assess the appropriateness of the program. The program was conducted in Tuguegarao city, Philippine in January, 2009. RESULTS: The result showed significant increases in the total health promotion capacity and each feather of health promotion capacities between pre and post assessment of intervention group. But there was no significant change in that of control group. Participants marked high level of satisfaction for preparedness, selection of main subjects and education method. Qualitative evaluation revealed that training program facilitated community participatory health promotion capacity of participants. CONCLUSIONS: This study suggested that the Village health worker training program is effective for building health promotion capacity of community leaders and it can be a main method for helping low developed countries with further development.
Adolescent ; Adult ; Community Networks/*organization & administration ; Female ; Health Knowledge, Attitudes, Practice ; Health Personnel/*education ; *Health Promotion ; Humans ; Hygiene ; Male ; Middle Aged ; Philippines ; *Program Evaluation ; Public Health/manpower ; Qualitative Research ; Questionnaires ; Rural Health Services/*manpower ; Sanitation ; Water Supply ; Young Adult

PURPOSE: A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. METHODS: Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1week after the discharge by mail. RESULTS: The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. CONCLUSION: These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.
Adaptation, Psychological ; Adult ; Aftercare/organization & administration ; Attitude to Health ; Depression, Postpartum/diagnosis/etiology/*prevention & control ; *Family Health ; Female ; Home Care Services/*organization & administration ; Humans ; Infant, Newborn ; *Intensive Care Units, Neonatal ; Korea ; Male ; *Mother-Child Relations ; *Mothers/education/psychology ; Nursing Evaluation Research ; Patient Discharge ; Postnatal Care/organization & administration ; Program Evaluation ; Public Health Nursing/*organization & administration ; Questionnaires ; *Self Concept

Community-based rehabilitation for those people with a physical disability is a policy promoted by the World Health Organization. In order to assess whether such a program might be useful to the disabled people of the highlands of Papua New Guinea a survey was conducted which first identified those people with a severe physical disability and then investigated the degree that they were handicapped in terms of their social and physical environment. The survey was performed in the Tari area of the Southern Highlands Province in conjunction with the Papua New Guinea Institute of Medical Research (PNGIMR). By using the PNGIMR demographic surveillance system it was possible to calculate a prevalence level of physical disability (including walking disability, deafness and blindness) of 46 per 10,000 (0.46%). A significant physical disability was identified in 114 people, of whom 54 were given personal interviews to establish their quality of life. The survey found the social and economic situation of disabled people to be generally good although there is a lack of basic material aids for handicapped people. The disabled people and their families do not need extra knowledge about how to care for their disabilities and a formal community-based rehabilitation program would be inappropriate, but they would find mobility aids such as wheelchairs and artificial limbs of enormous help. The regular health care services are widely used although both people with a disability and health service staff are not always aware of the types of treatment which can usefully be provided.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent ; Adult ; Aged ; Altitude ; Attitude to Health ; Child ; Child, Preschool ; Community Health Services ; organization & administration ; utilization ; Disabled Persons ; rehabilitation ; statistics & numerical data ; Female ; Health Priorities ; Health Services Needs and Demand ; Health Services Research ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Papua New Guinea ; epidemiology ; Residence Characteristics ; Self-Help Devices ; supply & distribution ; Socioeconomic Factors

The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.
Critical Care ; trends ; Emergency Medicine ; trends ; Health Plan Implementation ; Health Services Research ; Hospitals ; Humans ; Models, Organizational ; Outcome Assessment (Health Care) ; Patient Admission ; Physicians ; Singapore ; Trauma Centers ; organization & administration ; Wounds and Injuries ; surgery

BACKGROUND: The need for a new healthcare system is growing due to the paradigm shift from health supervision to health maintenance. Previously, we performed a pilot study that examined the effectiveness of a ubiquitous healthcare (U-healthcare) diabetes management program which consists of self-monitoring of blood glucose (SMBG) and mobile phone services for elderly patients with type 2 diabetes mellitus. In this study, we investigated the effect of a diabetes management program using U-healthcare based on the self-care skills of elderly patients with diabetes mellitus. METHODS: From July to October 2005, 17 patients were recruited and provided with a blood glucometer with the ZigBee module and a mobile phone. In addition, the patients' understanding of diabetes self-care skills was examined at the beginning and end of the study. At the end of the study, we determined the level of patient satisfaction regarding U-healthcare services. RESULTS: The patients' test scores on their understanding of diabetes mellitus improved from 57.2 +/- 20.7 to 72.7 +/- 13.4%. Specifically, patient knowledge of the basic principles for a proper diabetic diet (52.9% vs. 82.4%, P = 0.046), foods that influence blood sugar level (41.2% vs. 76.5%, P = 0.007) and the influence of beverage choice (41.2% vs. 64.7%, P = 0.007), all increased. In addition, a significant increase in knowledge of living standards regarding diabetes mellitus was observed (64.7% vs. 88.2%, P = 0.0032). CONCLUSION: We conclude that the U-healthcare incorporating SMBG could be promising, as it improves self-management skills of diabetes mellitus patients, as well as their understanding of the disease.
Aged ; Beverages ; Blood Glucose ; Blood Glucose Self-Monitoring ; Cellular Phone ; Delivery of Health Care ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Health Services Research ; Humans ; Organization and Administration ; Patient Satisfaction ; Pilot Projects ; Self Care ; Socioeconomic Factors