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Establishing an integrated gastroenterology service between a medical center and the community

World Journal of Gastroenterology 2015年第7期21卷 2152-2158页

作者： Yaron Niv Ram Dickman Zohar Levi Gadi Neumann Dorit Ehrlich Haim Bitterman Jacob Dreiher Arnon Cohen Doron Comaneshter Eyran Halpern Rabin Medical Center Clalit Health Services Tel Aviv University Dan-Petach Tikva District Clalit Health Services general management Clalit Health Services

AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was ***:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were *** education,guidelines and agreed instructions for referral were promoted by the *** quality indicators were developed by the Delphi method,rigorously designed and regularly *** was assessed by comparing 2010,2011 and 2012 ***:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of *** this paper we describe a new integrated gastroenterology service established in April *** time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th *** cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal ***:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.

关键词： Gastroenterology Direct referral Endoscopy Communi

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Relationship between the use of smart medical services and mental health status

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World Journal of Psychiatry 2025年第1期15卷 21-25页

作者： Elif Sarac Ministry of National Defense General Directorate of Management ServicesAnkara 06000Türkiye

In this editorial,I comment on the article by Zhang et *** emphasize the importance of the topic,I discuss the relationship between the use of smart medical devices and mental *** medical services have the potential to positively influence mental health by providing monitoring,insights,and ***,they also come with challenges that need to be *** the primary purpose for which individuals use these smart tech-nologies is essential to tailoring them to specific mental health needs and prefe-rences.

关键词： Smart devices Medical service Usage People Relationship Mental health status

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Mobile technology:Usage and perspective of patients and caregivers presenting to a tertiary care emergency department

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World Journal of Emergency Medicine 2020年第1期11卷 5-11页

作者： Zhenghong Liu Mingwei Ng Dinesh V.Gunasekeran Huihua Li Kishanti Ponampalam R Ponampalam Singhealth Emergency Medicine Residency Programme Singapore Health ServicesSingapore Ministry of health Holdings Singapore health services Research Unit Singapore General HospitalSingapore University of Newcastle Australia Department of Emergency Medicine Singapore General HospitalSingapore

BACKGROUND:Developments in information technology(IT)have driven a push in healthcare innovation in the emergency department(ED).Many of these applications rely on mobile technology(MT)such as smartphones but not everyone is comfortable with MT *** study aims to characterize the technology usage behavior of users in the ED so as to guide the implementation of IT interventions in the ***:A cross-sectional survey was conducted in the emergency department of a tertiary *** and their caregivers aged 21 and above were *** survey collected demographic information,technology usage patterns,and participant reported comfort level in the usage of *** performed descriptive statistics and multivariate logistic regression to identify factors differentially associated with comfort in usage of ***:A total of 498 participants were recruited,and 299(60%)were *** was the most commonly written and read language(66.9%)and 64.2%reported a comfort level of 3/5 or more in using *** that were associated with being comfortable in using MT include having a tertiary education,being able to read and write English,as well as being a frequent user of *** were more likely to display these ***:A large proportion of ED patients are not comfortable in the usage of *** that predicted comfort level in the usage of MT were common amongst *** interventions should take this into consideration in the design of MT interventions.

关键词： Mobile health technology Information technology Emergency department

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World Journal of Gastroenterology 2014年第44期20卷 16782-16785页

作者： James Frydman Shahar Grunner Yoram Kluger Department of general Surgery Rambam Health Care Campus

Ig G4-related disease is a recently recognized entity linked initially to autoimmune pancreatitis and has been subsequently described in nearly every organ system. Men over the age of 50 represent the most affected demographic group and a comprehensive set of diagnostic criteria has been developed to aid treating clinicians. Though elevated levels of Ig G4 in the serum are suggestive of the disease, definitive diagnosis is made on histopathology. Treatment is tailored to the clinical presentation with corticosteroid therapy known to have proven efficacy. Gastric manifestations of the Ig G4-related disease primarily come in two varieties, notably chronic ulceration or pseudotumor formation. Autoimmune pancreatitis conveys increased risk for Ig G4-related disease of the stomach, which is independent of Helicobacter pylori status. In this case report, we present an acute gastric-pericardial fistula secondary to Ig G4-related disease that required urgent operative management. To our knowledge, this is the first report in the medical literature describing this complication of Ig G4-related disease.

关键词： IgG4-related disease Autoimmune pancreatitis Gastric ulcer

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Assessing healthcare workers’knowledge and confidence in the diagnosis,management and prevention of Monkeypox

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World Journal of Clinical Cases 2025年第1期13卷 38-47页

作者： Epipode Ntawuyamara Thierry Ingabire Innocent Yandemye Polycarpe Ndayikeza Bina Bhandari Yan-Hua Liang Department of Dermatology Cosmetology and VenereologyShenzhen Hospital of Southern Medical UniversityShenzhen 518101Guangdong ProvinceChina Department of Dermatology and Venereology Kamenge Teaching HospitalUniversity of BurundiBujumbura 1020Burundi Department of Infectious Diseases Kamenge Teaching HospitalUniversity of BurundiBujumbura 1020Burundi general Directorate of healthcare Supply Modern and Traditional MedicineNutrition and RegistrationMinistry of Public Health and Fight Against HIV/AIDSBujumbura 1055Burundi Department of Epidemiology National Institute of Public HealthBujumbura 350Burundi general Directorate of Planification Ministry of Public Health and Fight Against HIV/AIDSBujumbura 1055Burundi

BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central *** To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of *** We conducted a cross-sectional study via an online survey designed mainly from the World health Organization course distributed among Burundi HCWs from June-July *** questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and *** data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical *** The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a *** confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among *** confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent *** is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi *** encourage future researchers to assess potential hesitancy toward Mpox vaccination and its asso

关键词： Monkeypox Public health emergency of international concern healthcare workers Epidemic Preparedness Knowledge Confidence

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World Journal of Emergency Medicine 2024年第4期15卷 256-262页

作者： Jie Er Janice Soo Yuan Helen Zhang Gek Hsiang Lim Fatimah Lateef Department of Emergency Medicine Singapore General HospitalSingapore 168753Singapore health services Research Unit Singapore General HospitalSingapore168753Singapore

BACKGROUND:This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury ***:This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore general Hospital from January to June *** records were reviewed and *** analyses were used to summarize patient characteristics,and differences in characteristics subgrouped by triage acuity and discharge status were ***:The study included 272 patients with a mean age of 43 years and a male predominance(71.7%).Most presented without referrals(88.2%)and were not conveyed by ambulances(70.6%).Based on acuity category,there were 24(8.8%)Priority 1(P1)patients with 7 trauma activations,174(64.0%)and 74(27.2%)P2 and P3 patients *** most common injuries were fractures(34.2%),followed by superficial abrasion/contusion(29.4%)and laceration/wound(19.1%).Thirteen(4.8%)patients experienced head injury and 85 patients(31.3%)were documented to be wearing a *** majority occurred on the roads as traffic accidents(32.7%).Forty-two patients(15.4%)were admitted with a mean length of stay of 4.1 d and 17(6.3%)undergone surgical *** of 214(78.7%)discharged patients,no re-attendances or mortality were *** the subgroup analysis,higher acuity patients were generally older,with higher proportions of head injuries leading to ***:Our study highlights significant morbidities in bicycle-related *** is also a high proportion of fractures in the young healthy male *** prevention is paramount and we propose emphasizing helmet use and road user safety.

关键词： Cycling Injuries Emergency department

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Development of a heart rate variability and complexity model in predicting the need for life-saving interventions amongst trauma patients

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Burns & Trauma 2019年第1期7卷 107-117页

作者： Aravin Kumar Nan Liu Zhi Xiong Koh Jayne Jie Yi Chiang Yuda Soh Ting Hway Wong Andrew Fu Wah Ho Takashi Tagami Stephanie Fook-Chong Marcus Eng Hock Ong Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore health services Research Centre Singapore Health ServicesAcademia20 College RoadSingapore 169856Singapore Duke-NUS Medical School National University of SingaporeSingaporeSingapore Department of Emergency Medicine Singapore General HospitalSingaporeSingapore Department of general Surgery Singapore General HospitalSingaporeSingapore Department of Emergency and Critical care Medicine Nippon Medical SchoolTokyoJapan health services Research Unit Singapore General HospitalSingaporeSingapore

Background:Triage trauma scores are utilised to determine patient disposition,interventions and prognostication in the care of trauma *** rate variability(HRV)and heart rate complexity(HRC)reflect the autonomic nervous system and are derived from electrocardiogram(ECG)*** this study,we aimed to develop a model incorporating HRV and HRC,to predict the need for life-saving interventions(LSI)in trauma patients,within 24 h of emergency department ***:We included adult trauma patients(≥18 years of age)presenting at the emergency department of Singapore general Hospital between October 2014 and October *** excluded patients who had non-sinus rhythms and larger proportions of artefacts and/or ectopics in ECG *** obtained patient demographics,laboratory results,vital signs and outcomes from electronic health *** conducted univariate and multivariate analyses for predictive model ***:Two hundred and twenty-five patients met inclusion criteria,in which 49 patients required *** LSI group had a higher proportion of deaths(10,20.41%vs 1,0.57%,p<0.001).In the LSI group,the mean of detrended fluctuation analysis(DFA)-α1(1.24 vs 1.12,p=0.045)and the median of DFA-α2(1.09 vs 1.00,p=0.027)were significantly *** stepwise logistic regression analysis determined that a lower Glasgow Coma Scale,a higher DFA-α1 and higher DFA-α2 were independent predictors of requiring *** area under the curve(AUC)for our model(0.75,95%confidence interval,0.66–0.83)was higher than other scoring systems and selected vital ***:An HRV/HRC model outperforms other triage trauma scores and selected vital signs in predicting the need for LSIs but needs to be validated in larger patient populations.

关键词： Triage trauma score Hear trate variability Heart rate complexity Life-saving interventions

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Economic and medical benefits of ultrasound screenings for gallstone disease

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World Journal of Gastroenterology 2015年第11期21卷 3337-3343页

作者： Hung-Ju Shen Chung-Te Hsu Tao-Hsin Tung Cheng Hsin general Hospital Faculty of Public health School of MedicineFu-Jen Catholic University Department of Nursing Kang-Ning Junior College of Medical Care and Management

AIM:To investigate whether screening for gallstone disease was economically feasible and clinically ***:This clinical study was initially conducted in2002 in Taipei,*** study cohort total included2386 healthy adults who were voluntarily admitted to a regional teaching hospital for a physical *** follow-up screening with ultrasound sonography for gallstone disease continued until December 31,2007.A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone *** economic evaluation included estimates of both the cost-effectiveness and cost-utility of screening for gallstone ***:Direct costs included the cost of screening,regular clinical fees,laparoscopic cholecystectomy,and *** costs represent the loss of productivity attributable to the patient’s disease state,and were estimated using the gross domestic product for 2011 in *** time intervals in screening for gallstone disease were associated with the reduced efficacy and utility of screening and with increased *** cost per life-year gained(average cost-effectiveness ratio)for annual screening,biennial screening,3-year screening,4-year screening,5-year screening,and no-screening was new Taiwan dollars(NTD)39076,NTD 58059,NTD 72168,NTD 104488,NTD 126941,and NTD 197473,respectively(P<0.05).The cost per quality-adjusted life-year gained by annual screening was NTD 40725;biennial screening,NTD64868;3-year screening,NTD 84532;4-year screening,NTD 110962;5-year screening,NTD 142053;and for the control group,NTD 202979(P<0.05).The threshold values indicated that the ultrasound sonography screening programs were highly sensitive to screening costs in a plausible ***:Routine screening regime for gallstone disease is both medically and economically *** screening for gallstone disease should be recommended.

关键词： Decision analysis Gallstone disease Economic evalu

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On sustaining the ecology and livestock industry of the Bayanbuluk Grasslands

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Journal of Arid Land 2010年第1期2卷 57-63页

作者： Adrian R WILLIAMS Pendragon Dryland management services

A short visit to the Bayanbuluk Grassland in the Tianshan Mountains, Xinjiang, PRC, revealed a number of environmental and livestock production problems, including grassland degradation, loss of grassland biodiversity, soil erosion and flash flooding downstream, decreased pasture productivity, and poor livestock nutrition (especially in winter) leading to stock losses and flocks and herds of low productivity. This paper describes those problems and then suggests some solutions. Short duration, high intensity grazing could be one of the solutions to both improving grassland condition and improving livestock nutrition. Local production of fodder crops for feeding in winter and spring deserves testing, using adapted strains of Alfalfa (Medicago sativa) and trialling fodder root crop production. It is important to realise that the land management objectives of scientists, administrators, herders and farmers may be similar, and that there are opportunities for land improvement through working together.

关键词： Bayanbuluk Grasslands Tianshan Mountains reversing grassland degradation improving livestock productivity

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Investigation of the working conditions of nurses in public hospitals on the basis of nurse-friendly hospital criteria

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International Journal of Nursing Sciences 2018年第2期5卷 206-212页

作者： Fatma Er Serap Sokmen Vocational School of health services Department of Health Care ServicesBingol UniversityBingolTurkey Faculty of health Sciences Department of NursingErzincan UniversityErzincanTurkey

Objective:This descriptive study reveals how nurses working in public hospitals rated their practice environments with respect to nurse-friendly hospital ***:This study was conducted on 460 nurses volunteering to participate this study among 735 nurses working in inpatient wards of three public *** were collected using a personal information form and the Adapted Nursing Work ***,percentages,means and standard deviations,t-test and one-way variance analysis were used to evaluate the ***:Among the nurse-friendly hospital criteria,‘control of nursing practice’,‘middle management accountability’and‘quality initiatives’had the highest mean scores,and‘competitive wages’had the lowest mean *** assessments of the nurses presented statistically significant differences with respect to personal and occupational ***:The nurses found most of the nurse-friendly hospital criteria adequate,but they believed that several areas needed improvement.

关键词： Nurses Nurse-friendly hospital criteria Positive work environment

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