Rationale: The provision of surgical services in the Philippines is an essential component of our healthcare system. Despite an increasing number of accredited training programs, geographic maldistribution remains a key factor in access to surgical care in the country. This study aimed to describe the geographic distribution of surgeons and anesthesiologists in the Philippines and factors that affect their practice to provide insights into the country's surgical capabilities. Additionally, demographic factors such as workforce density, professional mobility, and economic indicators were explored. The ultimate goal was to establish an updated database for continuous monitoring of surgical manpower, facilitated through the collaboration of the Philippine College of Surgeons (PCS) and the Philippine Society of Anesthesiologists (PSA). Methods: This cross-sectional study, sponsored by the World Surgical Foundation (WSF) and the Philippine College of Surgeons Foundation (PCSF), received exemption from review by the Single Joint Research Ethics Board (SJREB) of the Department of Health. An online survey was distributed to surgeons and anesthesiologists across the Philippines from July 1 to December 31, 2020. Active practitioners in relevant specialties were eligible, excluding retirees. Procedures adhered to ICH-GCP principles, National Ethical Guidelines, and the Data Privacy Act. Additional data, sourced from various outlets, was consolidated, verified and subsequently entered into an electronic data sheet (Google Sheets, Google LLC, Palo Alto CA) to extract descriptive statistics of the surgical and anesthesia workforce at the national and regional levels. Results: Analysis of the data indicates male dominance with a noticeable trend of increasing female participation in surgical training programs, while anesthesiologist gender distribution showed a female preponderance. Maldistribution in manpower persists, influenced by factors such as training programs, medical education, and the availability of secondary and tertiary hospitals, and other socio-economic conditions in the country. The study reveals regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a notable concentration in urban centers, the highest being in Luzon, particularly in the National Capital Region (NCR). Conclusion The study highlights gender disparities and regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a significant concentration in Luzon, particularly in the National Capital Region (NCR). Disparities in subspecialty distribution are exacerbated by healthcare education discrepancies and inadequate healthcare infrastructure especially in rural areas. Addressing these challenges requires focused efforts on expanding training programs, recruiting specialists, and ensuring equitable access to surgical care nationwide. Establishing a comprehensive surgical workforce database is essential for informed policymaking, monitoring workforce distribution, and assess service quality to enhance access to surgical services.
Workforce ; Health Resources ; General Surgery ; Anesthesiology

COVID-19/prevention & control* ; Communicable Disease Control ; General Surgery/organization & administration* ; Guidelines as Topic ; Health Care Rationing ; Health Services Needs and Demand ; Health Workforce ; Humans ; Practice Guidelines as Topic ; SARS-CoV-2 ; Singapore/epidemiology* ; Surgical Procedures, Operative ; Triage

OBJECTIVES: To investigate the status and the related factors of nursing behaviors for pressure injury, and to provide the evidence for standardizing pressure injury management. METHODS: A total of 1 039 clinical nursing staff from 4 general hospitals in Changsha from December 1 to 30, 2017 were selected by a stratified random sampling procedure. Nurses' demographic information such as age, gender, title, educational attainment, and department were collected. We investigated the status of nursing behaviors on pressure injury by a self-designed questionnaire, assessed nurses' knowledge of pressure injury and nurses' attitude of pressure injury using the Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, compared the nursing behaviors on pressure injury with different backgrounds, used multiple linear regression to analyze the influential factors for nursing behaviors on pressure injury, and conducted the Pearson correlation analysis for nurses' knowledge, attitude, and behaviors on the pressure injury. RESULTS: The overall nursing behaviors score on pressure injury was 155.96±17.29. The 5 dimensional scores from high to low were: risk assessment (4.42±0.49), prevention actions (4.40±0.50), risk understanding (4.35±0.52), injury assessment and interventions (4.27±0.55), and health education (4.25±0.63). A significant difference was found in the nursing behavior scores of pressure injury among ages, lengths of service, education, and training times (all ˂0.05). There was no correlation between nurses' knowledge and behaviors (=0.606). The nurses' attitude was positively correlated with their behaviors (=0.307, ˂0.001), and the nurses' knowledge was also positively correlated with their attitudes (=0.212, ˂0.001). The results of multiple linear regression showed that the length of service (≤5 years), training times (1-2 times), education (diploma or below), the scores of nurses' knowledge, and the scores of nurses' attitude were independent influencial factors of nurses' behaviors on pressure injury. CONCLUSIONS The nursing staff in the general hospital of Changsha has a high level of nursing behaviors on pressure injury, and they has good sense of responsibility and confidence. However, personal competence in pressure injury is insufficient and still needs to be improved. The nursing managers should focus on the nurses' attitude and training frequency, increasing the experience in nursing the pressure injury and practical level, and arouse the highly educated nurses' enthusiasm and sense of accomplishment to prevent pressure injury, thus reducing the incidence of pressure injury.
Attitude of Health Personnel ; China ; epidemiology ; Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Hospitals, General ; Humans ; Nursing Staff, Hospital ; Pressure Ulcer ; epidemiology ; etiology ; Surveys and Questionnaires

OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.
Betacoronavirus ; Coronavirus Infections ; epidemiology ; prevention & control ; Cross Infection ; prevention & control ; Emergency Medical Services ; organization & administration ; Health Services Needs and Demand ; Hospitals, General ; organization & administration ; Humans ; Outpatients ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control

To propose the architectural layout for the big general hospital in the face of public health emergencies, we analyzed the conditions, methods, problems and countermeasures for the reconstruction of the isolation ward from the existing medical building layout of a general hospital. The affected areas met the requirements of isolation ward in the reconstruction, and realized the corresponding partition and separation of people. But the cost of occupying the medical room should be concerned. General hospital should be alerted to potential risks of public health emergencies. The characteristics of different construction types, defects, and the function of the hospital should be considered in the construction, rebuilding, and expansion of the hospital, which shouldnot only meet the needs of the development of the hospital daily usage but also consider dealing with emergent public health events. We can adopt the reasonable layout, including setting up a firewall-like device between the channel and the floor, an ordinary ward at ordinary times, and an independent space for emergency by pulling down the gate. This strategy can not only avoid the problem of low utilization rate of the space occupied by the corresponding area in the ward for diseases spread by air and droplets, maximizing the efficiency of the medical site, but also avoid the problem of emergency response to the temporary reconstruction.
Emergencies ; Emergency Service, Hospital ; Facility Design and Construction ; Hospitals, General ; Humans ; Public Health

BACKGROUND: Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality. METHODS: To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics. RESULTS: The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01). CONCLUSION: This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.
Adult ; Hospitalization ; Hospitals, General ; Hospitals, Private ; Hospitals, Public ; Humans ; Logistic Models ; Mortality ; National Health Programs

On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.
Crime ; Hand ; Health Personnel ; Hospitals, General ; Humans ; Mentally Ill Persons ; Mood Disorders ; Violence ; Waiting Lists ; Weapons

The effectiveness of dental implants in patients with disability, who are non-compliant during treatment, is controversial because of their poor oral health. Thus, oral health-care and management in such patients is concerning. Moreover, limited information is available on prognosis after implant placement. Herein, we describe a patient with schizophrenia who underwent dental implantation under multiple inductions of general anesthesia (5 times) and required conservative treatment and tooth extraction for multiple dental caries and retained roots because of inadequate oral health-care. Postoperatively, fracture of the prosthodontics and progression of dental caries were observed, and with 3 additional inductions of general anesthesia, conservative treatment, implant surgery, and prosthesis implantation were conducted. Postoperative 12-month follow-up since the last prosthesis implantation showed successful results. For patients with schizophrenia, multiple implantation can reduce horizontal bone loss and achieve aesthetic results compared to treatment with removable prosthodontics and could serve as an alternative treatment modality.
Anesthesia, General ; Dental Caries ; Dental Implantation ; Dental Implants ; Follow-Up Studies ; Humans ; Oral Health ; Prognosis ; Prosthesis Implantation ; Prosthodontics ; Schizophrenia ; Tooth Extraction

BACKGROUND: Patients with special health care needs are more likely to develop health problems, including dental problems. Dental treatments require a good level of communication with the patient. Therefore, in these patients, sedation and general anesthesia are an extremely humanistic approach for comfortable and successful treatment. In patients with special needs, there is no standard anesthetic approach due to varying clinical conditions. The aim of this study was to provide literature content about the anesthetic approaches used by us in patients with special needs. METHODS: The medical records of 710 patients with special health care needs treated under general anesthesia or sedation were reviewed retrospectively. Demographic data, the American Society of Anesthesiologists classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and analgesic agents used, dental treatment performed, secondary diseases, and complications in the perioperative period were recorded. Patients were evaluated under five groups: Down syndrome, other syndromes, psychiatric disorders, physical disabilities, and complicated medical story. RESULTS: Among the patients evaluated, 47.5% were females and 52.5% were males (mean age 15.76 ± 11.17 years), and general anesthesia and sedation were administered in 72.9% and 22.1% patients, respectively. The mean duration of anesthesia was 43.20 ± 35.85 min. Simple dental treatments were performed in all groups, and the most common complications were observed in the other syndromes group. CONCLUSION: Complications can be reduced by utilizing the appropriate anesthetic approach and taking serious precautions in patients with special needs.
Analgesics ; Anesthesia ; Anesthesia, General ; Classification ; Delivery of Health Care ; Dental Care ; Down Syndrome ; Female ; Humans ; Male ; Medical Records ; Perioperative Period ; Retrospective Studies

PURPOSE: This study aimed to investigate the factors affecting general hospital nurses' intention to stay in their jobs. METHODS: A descriptive research design was used with a convenience sample of 286 nurses. Data were collected from March 15 to April 14, 2017using self-reported questionnaires and analyzed by descriptive statistics, t-test, analysis of variance, Pearson's correlation coefficient, and multiple regression analysis using the SPSS/WIN 21.0 program. RESULTS: The mean scores for intention to stay, resilience, and emotional labor were 5.28 out of 8, 57.40 out of 100, and 3.23 out of 5, respectively. Intention to stay was positively correlated with overall career (r=.30), workplace (r=.18), shift work (r=−.20), position (r=.28), salary (r=.13), job satisfaction (r=.51), hospital satisfaction (r=.46), and resilience (r=.41). Factors influencing the intention to stay were job satisfaction and resilience, which explained 28% of the variance. CONCLUSION: Overall career, job satisfaction, and resilience are critical factors affecting general hospital nurses' intention to stay. Based on the findings of this study, efforts to improve nurses' job satisfaction and resilience should be implemented to mitigate the loss of this expert group among healthcare professionals.
Delivery of Health Care ; Hospitals, General ; Intention ; Job Satisfaction ; Research Design ; Salaries and Fringe Benefits