Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our contry is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty. To improve CCM in Korea, reimbursement of the government must be amended such that referral hospitals can hire sufficient number of qualified intensivists and nurses. For the government to address these urgent issues, public awareness of the role of CCM is also required.
Critical Care/*organization & administration ; *Forecasting ; Intensive Care Units/*organization & administration ; Needs Assessment/*organization & administration ; Republic of Korea

Based on the results of three national health surveys and relevant statistical data, this article reviews the main problems existed in the providers and demanders of rural health service in China and tries to provide evidences for health decision-makers.
China ; Humans ; Needs Assessment ; economics ; organization & administration ; Rural Health Services ; economics ; organization & administration

INTRODUCTIONThe Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth), is a newly formed health professions education academy designed to cultivate best education practices and create a community of health professions educators. To achieve the aims of AM∙EI, the needs of SingHealth educators have to be understood. Therefore, this study was carried out to assess educators' perceptions towards the current education climate and their academic needs.

MATERIALS AND METHODSA 28-item questionnaire consisting of free-response, Likert-type and ranking questions was developed. The questionnaire was electronically distributed to 200 medical and nursing educators, and made available to attendees of the 2012 Singhealth Duke-NUS Scientific Congress through hardcopies.

RESULTSA total of 150 completed questionnaires were received (94 from electronic survey and 56 from Congress). Five themes emerged from the analysis of responses to free-response questions: 1) faculty development, 2) development of a community of educators, 3) recognition for educational efforts, 4) institutional support, and 5) better communication about SingHealth educational activities. Respondents were in highest agreement with the statements (rating of 3.7 out of 5): "The SingHealth education programmes are high quality", "New learning or teaching methods are welcomed in this institution/hospital", and "An academic appointment is important to me". The competencies that respondents felt to be the most important were facilitating discussions, presentation skills, and providing feedback (respective means = 5.1, 5, 5 of 7).

CONCLUSIONThis needs assessment provided us with important insights regarding SingHealth medical educators' perceptions of their education environment and established key priorities for the AM∙EI's programming efforts.

Academies and Institutes ; Attitude of Health Personnel ; Education, Medical ; organization & administration ; Education, Nursing ; organization & administration ; Faculty, Medical ; organization & administration ; Faculty, Nursing ; organization & administration ; Humans ; International Cooperation ; Needs Assessment ; North Carolina ; Organizational Culture ; Schools, Medical ; organization & administration ; Singapore ; Surveys and Questionnaires

PURPOSE: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX(R), http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. MATERIALS AND METHODS: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of < or =-2.5 points, or the FRAX(R) criteria, defined as the 10-year probability of a major osteoporotic fracture and hip fracture of > or =20% or > or =3%, respectively. RESULTS: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX(R) criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX(R) criteria. CONCLUSION: A combination of the HIRA and FRAX(R) criteria is required to improve the current guidelines for osteoporosis treatment.
Aged ; Arthroplasty ; Bone Diseases, Metabolic ; Health Services Needs and Demand ; Hip ; Humans ; Insurance, Health ; Knee ; Knee Joint ; Osteoarthritis ; Osteoporosis ; Osteoporotic Fractures ; Risk Assessment ; World Health Organization

PURPOSE: The purpose of this study is to identify the role adaptation process experienced by head nurses. METHODS: Data were collected from 10 head nurses with in-depth interviews about their actual experiences. All the interviews were recorded and transcribed. The collected data were analyzed by the grounded theory methodology of Strauss and Corbin. RESULTS: The core category was identified as "weighing and balancing," and the role adaptation process was divided into six stages by time sequence: inquiring, approaching to others, bringing people into their fold, working with conviction, avoiding conflicts, and settling. CONCLUSION: The results of this study yield useful information for top mangers of nursing to identify, by stages, the demands of the head nurses in their role adaptation process. The findings of this study contributes to developing programs that facilitates the head nurses' role adaptation.
*Adaptation, Psychological ; Adult ; *Attitude of Health Personnel/ethnology ; Avoidance Learning ; Conflict (Psychology) ; Female ; *Hospitals, General/organization & administration ; Humans ; Interprofessional Relations ; Korea ; Leadership ; Models, Nursing ; Models, Psychological ; Needs Assessment ; Nurse Administrators/education/organization & administration/*psychology ; *Nurse's Role ; Nursing Methodology Research ; Nursing Staff, Hospital/organization & administration/psychology ; Nursing, Supervisory/organization & administration ; Philosophy, Nursing ; Power (Psychology) ; Professional Competence/standards ; Qualitative Research ; Questionnaires ; Self Efficacy

Commerce ; Delivery of Health Care ; economics ; Economics ; Health Services Accessibility ; economics ; Health Services Needs and Demand ; Health Status ; Humans ; Models, Economic ; National Health Programs ; organization & administration ; Outcome Assessment (Health Care) ; Singapore

PURPOSE: This study developed a web-based wound care course for undergraduate nursing students and evaluated the course's content, system, and student-satisfaction. METHODS: This study was done in three stages, the development of the web-based wound care course, the implementation and evaluation of the course. The course was developed based on the ARCS model. 80 undergraduate nursing students to Y University in Korea used the web-based wound care program during four weeks. After that, they completed questionnaires, evaluating the contents, system, and their satisfaction. RESULTS: Eighteen learning objectives were used to create the web-based wound care course and the course was developed with 7 chapters and 20 subsections. The analysis of the questionnaires showed a mean score for content and system-related items of 3.04 each, out of a possible 4 points. Student satisfaction items had a mean score of 2.89. CONCLUSIONS: The web-based course allowed students access to the course anytime and anywhere, and according to their own learning abilities. However this advantage would only be possible when nurse educators develop qualitative web-based course to meet the demand of a complex health care system as well as the needs of the students and the effectively incorporate it into traditional lectures.
*Attitude of Health Personnel ; Attitude to Computers ; Causality ; Computer-Assisted Instruction/*methods ; Curriculum ; Education, Nursing, Baccalaureate/*organization & administration ; Humans ; Internet/*organization & administration ; Korea ; Models, Educational ; Needs Assessment ; Nursing Assessment ; Nursing Diagnosis ; Nursing Education Research ; Patient Care Planning ; Practice Guidelines as Topic ; Program Development ; Program Evaluation ; Questionnaires ; Skin Care/nursing ; Students, Nursing/*psychology ; Wound Healing ; Wounds and Injuries/etiology/*nursing

PURPOSE: The purpose of this study was to test the effectiveness of a comprehensive smoking cessation program for Korean adolescents. METHOD: The study design was quasi-experimental with one pre and three post-tests. The three posttests were done immediately after, three months later, and six months after the completion of the program. A total of 43 high school students who smoked participated in the study with 22 in the experimental group and 21 in the control group. The smoking cessation program consisted of 9 sessions with content on enhancement of self-efficacy, stress management, correction of distorted thoughts, consciousness raising, and assertiveness training. The study variables were urine cotinine levels, self-efficacy, stress, and stages of changed behavior. RESULTS: Urine cotinine levels significantly decreased in the experimental group after the program (F=3.02, p=.06) but significantly increased in the control group (F=6.32, p=.004). Self-efficacy and the degree of stress did not change in either group. The stages of smoking cessation behavior tended to change when compared with raw data for the experimental group. For most participants, the stages of change had been precontemplation and contemplation, but changed to action and maintenance stage among the experimental group. CONCLUSION: The program was effective in smoking cessation and influencing stages of change but did not change psychosocial factors such as self-efficacy and stress. It is suggested a program should be developed to change psychosocial variables on a long-term basis. It is also desirable to involve peers and families of adolescents who smoke when planning programs to enhance social support.
Adolescent ; Adolescent Behavior ; Adolescent Health Services/*organization & administration ; Adolescent Psychology ; Analysis of Variance ; Attitude to Health ; Cotinine/urine ; Educational Status ; Health Knowledge, Attitudes, Practice ; Humans ; Korea ; Longitudinal Studies ; Needs Assessment ; Patient Education as Topic/*organization & administration ; Personality Inventory ; Program Development ; Program Evaluation ; Questionnaires ; School Health Services/*organization & administration ; Self Efficacy ; Smoking/*prevention & control/psychology/urine ; Smoking Cessation/*methods/psychology ; Stress, Psychological/complications/psychology

The involvement of health-care professionals in tobacco-control activities is essential to prevent smoking-related morbidity and mortality. The purposes of this predictive correlational study were to examine tobacco-control activities and to identify the predictors of such activities of community health practitioners (CHPs). Of the 1,813 members of the Korean Association of CHP, 1,247 participated in this study. A mailed survey was conducted to collect data. The majority of CHPs supported tobacco-control policies and recognized tobacco-control activities as an important role for them. Only 44.3% of CHPs were confident in their knowledge and skills regarding tobacco-control activities, and only 30.8% had received professional tobacco-control education. While the majority of the CHPs "asked, advised, and assessed"their clients, only a small number "assisted or arranged". The tobacco-control activities of CHPs were predicted by their attitude toward it, age, experience of tobacco-control education, educational level, and general perception of the risk of smoking; these variables accounted 13.5% of variance in the tobacco-control activities of CHPs. These findings provide the basis for developing a continuing education program for CHPs. CHPs should be encouraged to integrate tobacco-control activities into their routine practice, and CHP education programs should be adjusted to increase the time spent on the tobacco-control intervention techniques.
Adult ; Aged ; Analysis of Variance ; *Attitude of Health Personnel ; Clinical Competence/standards ; Community Health Nursing/education/*organization & administration ; Cross-Sectional Studies ; Education, Nursing, Continuing/standards ; Educational Status ; Health Knowledge, Attitudes, Practice ; Humans ; Korea ; Middle Aged ; Needs Assessment ; *Nurse's Role ; Nursing Methodology Research ; Nursing Staff/education/organization & administration/*psychology ; Predictive Value of Tests ; Questionnaires ; Regression Analysis ; Risk Factors ; Self Efficacy ; Smoking/*prevention & control ; Smoking Cessation

PURPOSE: With a sample of cognitively impaired nursing home residents and nursing staff, the following were examined 1) the proportion and nature of aggressive behavior, 2) the frequency and types of aggressive behavior, 3) the difference between the residents who demonstrate aggressive behavior and those who do not demonstrate aggressive behavior (age, mental status, functional status, and pain, length of nursing home stay), and 4) nursing staff responses to aggressive behavior by residents. METHODS: A cross-sectional descriptive study design was used. Data were collected from cognitively impaired nursing home residents (N=205) and nursing staff (N=60) at two nursing homes using Ryden Aggression Scale I and II, Mini-Mental State Exam, Modified Barthel Index, Verbal Descriptor Scale, and aggressive behavior management questionnaire. Data were analyzed using descriptive statistics including t-test. RESULTS: About 62.9% residents were found to be aggressive and 38.5% were both physically and verbally aggressive. Pushing, making threatening gestures, hitting, slapping, cursing/obscene/vulgar languages, making verbal threats were occurred frequently. Aggressive residents were significantly older, had more cognitive impairment, had more pain, and stayed longer in the nursing home when compared with non-aggressive residents. Considerable proportion of nursing staff responded to aggressive behaviors inadequately. CONCLUSION: Aggressive behavior among cognitively impaired nursing home residents is prevalent thus needs to be prevented and reduced. Along with environmental modification, educational programs for nursing staff and family caregivers need to be developed and implemented so that they can have extensive knowledge and skills to manage aggressive behaviors.
Aged ; Aged, 80 and over ; *Aggression/psychology ; Attitude of Health Personnel ; Case-Control Studies ; Clinical Competence/standards ; Cognition Disorders/*complications/nursing ; Cross-Sectional Studies ; Education, Nursing, Continuing ; Female ; Geriatric Assessment ; Geriatric Nursing/education/organization & administration ; Health Services Needs and Demand ; Humans ; Inservice Training ; Korea/epidemiology ; Male ; Mental Competency ; *Nursing Homes ; Nursing Staff/education/psychology ; Prevalence ; Psychomotor Agitation/epidemiology/*etiology/prevention & control/psychology ; Questionnaires ; Risk Factors