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

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

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

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

BACKGROUND: Unplanned intensive care unit admission (UIA) is associated with perioperative morbidity and mortality, and can be used as a surrogate marker for patient safety. This study aimed to compare the characteristics of planned and unplanned intensive care unit (ICU) admission groups. METHODS: We retrospectively reviewed the electronic medical records of adult patients admitted to the ICU after abdominal and thyroid surgery under general anesthesia between 2016 and 2017. Preoperative, intraoperative, and postoperative information of enrolled patients was recorded. We compared patients' characteristics and outcomes between the unplanned and planned admission groups. RESULTS: In the total cohort, the proportion of UIA was 82.8% (202/244). In the unplanned admission group, total hospital stay was significantly shorter and ICU stay longer than that in the planned admission group (19.0 and 3.0 days, respectively vs. 28.5 and 2.0 days, respectively). In-hospital mortality rates were 21.3% and 7.1% in the unplanned and planned groups, respectively (P = 0.055). Patients in the UIA group showed higher Acute Physiology And Chronic Health Evaluation II scores, higher American Society of Anesthesiologist physical status class, and more co-morbidities than those in the planned group. There were significant differences in the incidence of UIA among surgery types. CONCLUSIONS: The UIA group had a relatively high mortality rate and longer ICU stay. More critically ill patients tended to be admitted to the ICU without planning.
Adult ; Anesthesia ; Anesthesia, General ; APACHE ; Biomarkers ; Cohort Studies ; Critical Care ; Critical Illness ; Electronic Health Records ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Mortality ; Patient Safety ; Perioperative Care ; Retrospective Studies ; Thyroid Gland

BACKGROUND: This study aimed to systematically review the literature investigating the effect of intravenous (IV) tranexamic acid (TXA) on the perioperative blood loss and amount of transfused blood in patients who underwent spine surgery under general anesthesia. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched for studies published up to June 2017. Randomized controlled trials comparing the intervention of tranexamic acid use with a placebo in corrective spine fusion surgery were included. Outcome measures included intraoperative and postoperative blood loss and perioperative blood transfusion volume. We also conducted subgroup analyses according to the dose of administration of intervention drug. RESULTS: In total, 12 studies involving 875 patients were included in the final analysis. Blood loss decreased in patients treated with perioperative IV TXA by a mean volume of 189.58 ml intraoperatively (95% confidence interval [CI]: 135.82 to 243.34 ml, P < 0.001; I² = 74%), 121.04 ml postoperatively (95% CI: 84.92 to 157.17 ml, P < 0.001; I² = 0%), and 285.97 ml in total (95% CI: 190.70 to 381.23 ml, P < 0.001; I² = 0%). Perioperative transfusion volume also decreased by 162.10 ml in patients who received IV TXA (95% CI: 31.77 to 292.44 ml, P = 0.010; I² = 47%). CONCLUSIONS: Blood loss was reduced in patients who were administered TXA during spine surgery. Additionally, the perioperative volume of blood transfusion decreased in patients who received TXA. Further research is required to confirm the optimal dosage and timing of TXA usage.
Anesthesia ; Anesthesia, General ; Blood Transfusion ; Hemorrhage ; Humans ; Outcome Assessment (Health Care) ; Postoperative Hemorrhage ; Spine ; Tranexamic Acid

BACKGROUND: Antimicrobial resistant continues to pose a threat to public health. Therefore, rapid and accurate antimicrobial susceptibility testing is very important. The objectives of this study were to evaluate the performance of the MicroScan system (Beckman Coulter, USA) with newly developed Korean Antimicrobial Susceptibility Testing Panels (KSCM panels) for antimicrobial susceptibility testing (AST) against clinical isolates in South Korea. METHODS: Three KSCM panels were designed in this study. For the performance evaluation, a total of 1,325 clinical isolates including 1,027 of Gram-negative bacilli and 298 Gram-positive cocci collected from eight general hospitals in South Korea were used. The results by KSCM panels were compared with those by conventional methods. RESULTS: By KSCM-1 panel for Gram-positive cocci, the rates of categorical agreement (CA) were >90% in all the antimicrobials tested in this study. The rates of major error (ME) were also <3%, and only three very major error (VME) were identified; each of ampicillin, tetracycline, and quinupristin-dalfopristin in enterococcal isolates. By KSCM-2 panel for Enterobacteriaceae, the rates of CA were also above 90%, and those of ME and VME were less than 3% and 1.5%, respectively. KSCM-3 panels for glucose- non-fermenting Gram-negative bacilli, also showed good agreement rates, i.e., CA rates >90%, ME rates <3%, and VME rates <1.5%. CONCLUSION: The newly developed three KSCM panels for MicroScan system (Beckman Coulter) showed excellent performance in AST against a large number of clinical isolates, and they are applicable to clinical microbiology laboratories.
Ampicillin ; Enterobacteriaceae ; Gram-Positive Cocci ; Hospitals, General ; Hospitals, Teaching ; Korea ; Public Health ; Tetracycline

OBJECTIVES: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. METHODS: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. RESULTS: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. CONCLUSIONS: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.
Cannabis ; Cross-Sectional Studies ; Delivery of Health Care ; General Practitioners ; Health Personnel ; Health Promotion ; Humans ; Immunization ; Risk Factors ; Switzerland