Introduction: The mode and speed of transportation to the Accident and Emergency Department (AED) of hospitals is very important for critically ill patients. This study looked at the mode of transportation to the AED at the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. Materials and Methods: Three different time periods: Period A from 15th May to 31st May 2004, (17 days, n=2,170 without prioritising), Period B from 1st January 2004 to 31st July 2006 (31 months, n=235 dead on arrival and resuscitation cases), and Period C from 20th to 26th November 2006 (7 days, all Priority Cases 1 to 3) were reviewed. Data on mode of transportation and triage categories were extracted from the ambulance response sheets. Results: During Period A, the main mode of transportation to the AED was private vehicles (90.7%) followed by ambulance (7.9%), and other transportation (1.4%). During study Period B, the main mode of transportation was also private transports (50.2%) followed closely by ambulance (48.5%) and other transportation (1.3%). During Period C, Priority 1 cases (life-threatening conditions, n=7(, most were transported with private transport (71.4%) followed by ambulance (28.6%); Priority 2 (n=232) cases, majority were transported with private transport (89.2%), followed by ambulance (10.3%), and one case used police transportation; and in Priority 3 cases (non-life threatening conditions, n=1,010), almost all were transported with private transport (98.7%), followed by police (0.9%) and ambulance (0.4%) respectively. Conclusion: Utilisation of designated emergency transportation is low especially for the moderate to seriously ill (Priority 1 and 2) patients when compared to other well developed countries. More needs to be done to improve the usage of emergency transportations especially for the seriously ill cases.
Emergencies ; Transportation ; Resource Allocation

OBJECTIVE: To investigate the postural control factors influencing the automatic (reflex-controlled) and attentional (high cortical) factors on dual task. METHODS: We used a dual task model to examine the attentional factors affecting the control of posture, subjecting test subjects to vibration stimulation, one-leg standing and verbal or nonverbal task trials. Twenty-three young, healthy participants were asked to stand on force plates and their centers of pressure were measured during dual task trials. We acquired 15 seconds of data for each volunteer during six dual task trials involving varying task combinations. RESULTS: We observed significantly different sway patterns between the early and late phases of dual task trials, which probably reflect the attentional demands. Vibration stimulation perturbed sway more during the early than the late phases; with or without vibration stimulation, the addition of secondary tasks decreased sway in all phases, and greater decreases in sway were observed in the late phases, when subjects were assigned nonverbal tasks. Less sway was observed during the nonverbal task in a sequential study. CONCLUSION: The attentional and automatic factors were analyzed during a sequential study. By controlling the postural control factors, optimal parameters and training methods might be used in clinical applications.
Postural Balance ; Posture ; Resource Allocation ; Task Performance and Analysis ; Vibration

BACKGROUND: Selecting priority occupational carcinogens is important for cancer prevention efforts; however, standardized selection methods are not available. The objective of this paper was to describe the methods used by CAREX Canada in 2015 to establish priorities for preventing occupational cancer, with a focus on exposure estimation and descriptive profiles. METHODS: Four criteria were used in an expert assessment process to guide carcinogen prioritization: (1) the likelihood of presence and/or use in Canadian workplaces; (2) toxicity of the substance (strength of evidence for carcinogenicity and other health effects); (3) feasibility of producing a carcinogen profile and/or an occupational estimate; and (4) special interest from the public/scientific community. Carcinogens were ranked as high, medium or low priority based on specific conditions regarding these criteria, and stakeholder input was incorporated. Priorities were set separately for the creation of new carcinogen profiles and for new occupational exposure estimates. RESULTS: Overall, 246 agents were reviewed for inclusion in the occupational priorities list. For carcinogen profile generation, 103 were prioritized (11 high, 33 medium, and 59 low priority), and 36 carcinogens were deemed priorities for occupational exposure estimation (13 high, 17 medium, and 6 low priority). CONCLUSION: Prioritizing and ranking occupational carcinogens is required for a variety of purposes, including research, resource allocation at different jurisdictional levels, calculations of occupational cancer burden, and planning of CAREX-type projects in different countries. This paper outlines how this process was achieved in Canada; this may provide a model for other countries and jurisdictions as a part of occupational cancer prevention efforts.
Canada ; Carcinogens ; Occupational Exposure ; Occupational Health ; Resource Allocation

OBJECTIVES: This study was conducted to estimate health service weight for resource allocation and performance monitoring using Basic Priority Rating System. METHODS: The Health service would be classified according to New Health Plan 2010, and Burden of disease collected from preceding studies. The data of severity of health problem and effectiveness of intervention were collected through the survey of experts' suggestion. The health service weight was estimated in the formula which is Basic Priority Rating System. RESULTS: In the result of analysis, the health service weight of Infectious disease was ranked highest at 58.97% followed by Anti-smoking campaign(14.07%), Hypertension(3.87%), Diabetes mellitus(3.40%), Cancer(2.90%), Cardiovascular-Cerebrovascular diseases(2.86%), Physical activity(2.10%), Moderate drinking(2.07%), Medical examination(1.92%), Mental health promotion(1.72%), Serious mental illnesses(1.62%), Nutrition(1.52%), Oral health promotion(1.15%), Oral diseases(1.10%), Addiction(0.73%). CONCLUSIONS: We think the result of this study provides a rational basis for resource allocation and performance monitoring of health service.
Communicable Diseases ; Health Services ; Mental Health ; Oral Health ; Resource Allocation

Objective: To analyze the equity of national stomatologist resource allocation from 2016 to 2020, providing relevantly referenced basis for further stomatologist resource allocation. Methods: Collect data of domestic and international stomatologist resources in 2016, 2018 and 2020, and analyze the relevant data by using the health resources agglomeration degree and population agglomeration degree. Results: At present, at the international level, the number of dentists per 10 000 people ranks 46th in 2010-2019. The quantity of domestic dental resources is on the rise, with a balanced gender distribution and a concentrated age distribution mainly in 25-44 years old. At the specialized technical level, the proportion of junior titles can reach 79.5%-83.0%. The ratio of resource agglomeration of dental practitioners and assistants calculated based on geographical area and population density shows that the ratio of HRAD to PAD in the eastern provinces is greater than 1, while the ratios of most provinces in the central and western regions are less than 1. The eastern regions have excessive allocations, while ones in the central and western regions are insufficient. Conclusions: Unfairness still exists in the allocation of resources for dentists in China. At the national level, it is necessary to continue to cultivate high-quality stomatologists and intensify efforts to support the grass-roots and remote areas. The ability, quality and work competence of on-the-job personnel should be comprehensively improved. Multi-point practice of stomatologists should be standardized and popularized, promoting the rational flow of oral health personnel.
Humans ; Adult ; Dentists ; Professional Role ; Health Resources ; Resource Allocation ; China

OBJECTIVES: This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.
Classification ; Cost of Illness ; Group Processes ; Humans ; Korea* ; Methods ; Resource Allocation ; Weights and Measures*

Acute-phase rehabilitation hospitals focus on managing disabilities, reducing sequelae and symptoms, and enhancing social reintegration, to provide patients with the highest possible independence and the best quality of life. In order to achieve these goals, it is necessary to ensure the appropriate length of hospital stays based on a consideration of disease severity and patients' potential for rehabilitation, as well as to provide multidisciplinary rehabilitation. Multidisciplinary rehabilitation has been shown to be effective in the management of complex or severe conditions. Hospitals should include rehabilitation centers (specialized rehabilitation units) for patients with complex or severe needs. Starting in acute settings, specialized rehabilitation wards provide intensive, highly specialized interventions to restore function to patients with complex rehabilitation needs. Financial resources should be allocated to rehabilitation services to implement recommendations for the delivery of medical services In Korea, the appropriate allocation of resources for rehabilitation could increase both the availability and the quality of rehabilitation services by facilitating the establishment of specialized rehabilitation units in acute settings.
Delivery of Health Care ; Humans ; Korea ; Length of Stay ; Quality of Life ; Rehabilitation Centers ; Rehabilitation* ; Resource Allocation

PURPOSE: This study was designed to identify current status of the subspecialist training programs and related factors affecting subspecialists' job selection. METHODS: The study subjects were 5,569 subspecialist trainees in 61 hospitals between 1989 and 1999. Among them, 1,260 subjects were selected to identify employment status after training. Also we analysed factors affecting career selection for 863 subspecialists on which basic information was available. RESULTS: About 26.6% of all subspecialist trainees trained in 1999 was for subspecialties in internal medicine, the largest majority, and 89.3% was in metropolitan areas. Also 91.1% were trained in teaching hospitals. Among subspecialists completed training, 79.5% selected career to work at general or teaching hospitals as of 1999, but 13.5% practised at clinics. The factors affecting career selection after training were gender, ownership of medical school, and specialty. CONCLUSION: The fact that not a few subspecialists work at primary care clinics means there are unreasonable human resource allocation and planning, with probable poor quality of primary care. Therefore, it is necessary to have a human resource plan at the national level for appropriate number of subspecialists, based on each specialty, in particular. Any structural factors affecting destination of subspecialist trainees, such as gender and graduated medical school, etc, should be dealt with in the long run.
Education* ; Employment ; Hospitals, Teaching ; Humans ; Internal Medicine ; Ownership ; Primary Health Care ; Resource Allocation ; Schools, Medical

PURPOSE: The prehospital ambulance run report function's as a legal and billing document, a unit of database for emergency medical service system quality improvement and community resources allocation. We examined how much ambulance run report is collected, contents are checked and whether there is a hospital-wise difference. METHODS: Prehospital run report of patients who visited the emergency department of Severance hospital, YongDong Severance hospital and Ilsan hospital by ambulance during the month of August in 2003 were collected. The items in run report were grouped according to relevancy in 11categories including 6 essential cetegories. The scores of each item was calculated as follows; 1 point if completed, 0 point if not checked and 0.5 point if incomplete. The categorical score, total score and essential score was consisted of corresponding scores. RESULTS: There was 1,339 (13.5%) 119 ambulance transportation in 9,946 total visit and 783 (58.5%) reports were collected with no statistical difference among hospitals. Overall score completed 100 point scale was in total 54.43 in total score, 70.61 in essential score. In essential categories, transportation category score (78.26) was higher than EMS information (73.04), rand & signature category (72.73) and patient condition & care category (45.20) scores. Among hospitals, YongDong Severance hospital showed significantly higher total and essential score than others. In essential categories, YongDong Severance hospital in EMS information, patient condition & care, rank & signature categories and Ilsan hospital in transportation category had higher score than others with significant differences. CONCLUSION: In this study, the collection rate and completion score of prehospital 119 run report were disappointedly low and differed among hospitals. To improve present status, we prepare urgent need redesign of run report, was of uniform data set and proper education of emergency medical personnel.
Ambulances* ; Dataset ; Education ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Quality Improvement ; Resource Allocation ; Transportation

PURPOSE: High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS: This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. RESULTS: Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. CONCLUSION: With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
Anesthesiology ; Canada* ; Cost-Benefit Analysis* ; Curriculum ; Education ; Learning ; Resource Allocation ; Simulation Training ; Uncertainty