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

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

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

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

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 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

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

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

PURPOSE: The purposes of this study were to develop a PBL program for continuing nurse education and to evaluate the program after its implementation. METHODS: The PBL program was developed in the core cardio-pulmonary nursing concepts through a collaborative approach with a nursing school and a hospital. The PBL packages with simulation on ACLS were implemented to 40 clinical nurses. The entire PBL program consisted of six 3-hour weekly classes and was evaluated by the participants' subjective responses. RESULTS: Two PBL packages in cardio-pulmonary system including clinical cases and tutorial guidelines were developed. The 57.5% of the participants responded positively about the use of PBL as continuing nurse education in terms of self-motivated and cooperative learning, whereas 20.0% of the participants answered that the PBL method was not suitable for clinical nurses. Some modifications were suggested in grouping participants and program contents for PBL. CONCLUSION: The PBL method could be utilized to promote nurses' clinical competencies as well as self-learning abilities. Further research is needed in the implementation strategies of PBL-based continuing education in order to improve its effectiveness.
Adult ; Attitude of Health Personnel ; Cardiology/education ; *Clinical Competence ; Computer Simulation ; Curriculum ; Education, Nursing, Continuing/*organization & administration ; Health Services Needs and Demand ; Heart Diseases/nursing ; Hospitals, University ; Humans ; Lung Diseases/nursing ; Manikins ; Middle Aged ; Nursing Education Research ; Nursing Methodology Research ; Nursing Staff, Hospital/*education/psychology ; Organizational Objectives ; Pilot Projects ; Problem-Based Learning/*organization & administration ; Program Development ; Program Evaluation ; Pulmonary Medicine/education

PURPOSE: This study was designed to examine the effects of a bereavement intervention program on levels of depression and life satisfaction in middle aged widows in Korea. METHODS: A quasi-experimental design with non-equivalent control-group pretest-posttest was used. The subjects (control group, n = 10; intervention group, n = 17) were bereaved less than 6 months in G City and J Province, Korea. The bereavement intervention program consisted of Dan-jeon breathing, self-help group activities and a health examination. The experimental group attended 10 sessions of a bereavement intervention program. The control group had a health examination without the intervention program. For both groups, the level of depression and life satisfaction levels were measured before and after the experiment. RESULTS: The decrement of depression level in the experimental group was significantly greater than in the control group (p<.001). The increment in life satisfaction in the experimental group was significantly greater than in the control group (p<.001). CONCLUSION: The results suggested that the bereavement intervention program was effective in decreasing level of depression and in increasing the life satisfaction of widows. Accordingly, a bereavement intervention program can be applied as an intervention to help widows.
Adult ; Attitude to Health ; *Bereavement ; Breathing Exercises ; Depression/diagnosis/etiology/*prevention & control/psychology ; Exercise Therapy ; Female ; Health Services Needs and Demand ; Health Status ; Humans ; Korea ; Life Change Events ; Medicine, East Asian Traditional ; Middle Aged ; Nursing Evaluation Research ; *Personal Satisfaction ; Physical Examination ; Program Evaluation ; Psychiatric Status Rating Scales ; Quality of Life/psychology ; Questionnaires ; Self-Help Groups/*organization & administration ; Widowhood/*psychology