The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopaedics and general surgery: a nationwide study in Japan during 2015-2019.

BACKGROUND: Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan. METHODS: The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015-2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables. RESULTS: The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05). CONCLUSIONS: Inter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community. LEVEL OF EVIDENCE: III.

Health seeking behavior and associated factors among individuals with cough in Yiwu, China: a population-based study.

BACKGROUND: Previous studies have shown that a certain proportion of the population did not seek medical treatment after coughing, and understanding the potential reasons is crucial for disease prevention and control. METHOD: A population-based study was conducted with the probability proportional to population size sampling in Yiwu, Zhejiang, China. A total of 5855 individuals aged ≥15 years lived in Yiwu for more than 6 months were included. All participants completed a laptop-based questionnaire to collect detailed information by a face-to-face interview. Characteristics of individuals were described by categories of health seeking behavior using frequency and percentage. Univariate and multivariate logistic regression analyses were performed to estimate the associations of social-demographic and cough characteristics with health seeking behavior. RESULTS: 19.3% (1129/5855) of participants had a cough in the past month, 40% (452/1129) had sought medical treatment. Of these, 26.5% (120/452) chose hospitals at county level or above. Individuals aged ≥65 years old (OR = 2.25, 95% CI: 1.23, 4.12), female (OR = 1.57, 95% CI: 1.21, 2.06), living in rural areas (OR = 1.30, 95% CI: 1.003, 1.69), persistent cough for 3-8 weeks (OR = 2.91, 95% CI: 1.72, 4.92) and with more accompanying symptoms (P trend < 0.001) were more likely to seek medical treatment, but those coughed for > 8 weeks were not (p > 0.5). Female (OR = 0.33, 95% CI: 0.21, 0.54) and people living in rural areas (OR = 0.57, 95% CI: 0.36, 0.92) were less likely to choose hospitals at county level or above while the higher educated were more likely to (OR = 3.29, 95% CI: 1.35, 8.02). Those who coughed for more than 2 weeks were more likely to choose hospitals at or above the county level. But the number of accompanying symptoms does not show any significant relationship with the choice of medical facility. CONCLUSION: The present study found that age, sex, living areas and features of cough were associated with health seeking behavior. It is worth noting that those who coughed for too long (e.g. > 8 weeks) were less likely to seek medical treatment. Targeted measures should be developed based on the key factors found in this study to guide persons to seek medical treatment more scientifically.

Establishing mercury-free medical facilities: a Malaysian case study.

PURPOSE: Mercury is widely used in medical and healthcare facilities as dental amalgam, mercury-added medical devices, thiomersal-containing vaccines, laboratory analysis and for other general applications despite the hazards. Various agencies consistently promote mercury-free medical facilities through mercury-free alternatives and better management practices, which are in line with the Minamata Convention on Mercury that aims to protect human health and environment from anthropogenic mercury release. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: The authors conducted a gap analysis on recommended practices gathered from the literature and current practices gathered through semi-structured interviews with Malaysian medical personnel. A life cycle approach was adopted covering mercury use: input, storage, handling, accident, waste disposal and governance phases. FINDINGS: The authors found that there are significant gaps between recommended and current mercury management practices. Analysis indicates improper mercury management as the main contributor to these gaps. The authors found from recommended practices that core components needing improvement include: mercury management action plan, mercury use identification team, purchasing policy, proper guidelines and monitoring systems. PRACTICAL IMPLICATIONS: This study helps us to understand mercury management practices and suggests essential steps to establish a mercury-free medical facility. ORIGINALITY/VALUE: This study explored the gaps between recommended and current mercury management practices in a medical facility and contributes to the Minamata Convention on Mercury aspirations.

Public-private partnership as an investment and innovation tool for medical facilities: a case of ukrainian healthcare.

This paper summarizes the scientific discussion on the issue of public-private partnership in healthcare sector. The main purpose of research is to analyze the public-private partnership as the progressive form of innovative and investment mechanism in Ukrainian healthcare sector, taking into the consideration international experience in this sphere. The key methods used in the conducted research are data analysis, summarization and comparison. The data synthesis and analysis are the basic value-added elements of this research, which could help to find out the main prospective of PPP-model use in Ukrainian healthcare sector. The object of research is the group of countries such as USA, UK, Canada, and BRIC countries, because namely they are the most progressive in public-private partnership in health care. Practical importance of the scientific research results lies in defining the general principles of public-private partnerships and a set of criterion for its efficiency estimation. Also, the worldwide experience was analyzed in this research and main challenges for its implementation in Ukrainian healthcare practice were considered. It is important for the further development of the healthcare sphere, and improvement of the healthcare facilities' activity in Ukraine. Further research directions are aimed at study of the specific issue of public-private partnership, such as circumstances for creating alliances between private and public actors from a strategy perspective, explore the impact of incentive mechanisms and risk management procedures on health service performance throughout the extended project life-cycle, and to create conducive environments to foster inter-project learning.

Medical facility statistics in Japan.

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

[Layer based epidemiological quality assessment of architecture of care security and geriatric wards]. / Warstwowa ocena epidemiologiczna architektury zakladów opiekunczo-leczniczych i oddzialów geriatrycznych.

BACKGROUND: The article describes the potential use of an original model called the layered epidemiological assessment (warstwowa ocena epidemiologiczna - WOE) for assessing the potential risk of infections in facilities intended for elderly individuals. MATERIAL AND METHODS: To verify the possibility of using the WOE method for assessing epidemiological safety hazards in the built environment, available literature sources related to the legal requirements in Poland regarding the assessment of medical facility ergonomics in terms of infection transmission were analyzed. The article also referred to the guidelines of the New European Bauhaus and the Baukultur Quality System as a standardized method for assessing the quality of the built environment. The article presents the fundamental assumption of the author's WOE method, which allows for the assessment of the risk of infection transmission separately for each component of a building. The effectiveness of the method was demonstrated by using it to assess the risk of infections in a geriatric ward room as an example. RESULTS: The article demonstrates that by employing the WOE, it is possible to clearly differentiate potential infection routes within the analyzed facilities and assign them to specific building components. Furthermore, by applying the presented method, it is possible to define necessary procedures and develop action plans to minimize the risk of infection spread within the analyzed properties. CONCLUSIONS: The application of the WOE for evaluating architectural solutions in facilities intended for the elderly offers several benefits. The WOE method presented in the article can serve as an expert tool for quick and precise assessment of potential epidemiological hazards. An important advantage of the WOE method is its ability to be used separately for different types of epidemiological hazards characterized by different routes of infection transmission. Med Pr Work Health Saf. 2024;75(3):199-209.

Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study.

BACKGROUND: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. OBJECTIVE: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. METHODS: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. RESULTS: In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. CONCLUSIONS: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR.

Research on urban country parks based on emergency medical facilities for public health emergencies-a case study of Guangzhou, China.

As COVID-19 has swept across the world, the escalating number of confirmed and suspected cases overwhelmed the admission capacity of the designated hospitals. Faced with such a grim situation, governments made a quick decision to build emergency medical facilities to address the outbreak. However, the emergency medical facilities faced a huge risk of epidemic spread and improper site could lead to serious secondary transmission. Using the disaster prevention and risk avoidance function of urban green space can solve the problem of selecting the location of emergency medical facilities to a certain extent, with country parks having a high degree of compatibility with the latter. Based on the location requirements of emergency medical facilities, using Analytic Hierarchy Process and Delphi method, through analyzing the type of country parks, effective risk avoidance area, spatial fragmentation, distance from water sources, wind direction, and distance from the city, quantification of 8 impact factors such as hydrogeology and traffic duration was conducted to comprehensively compare 30 country parks in Guangzhou. The results showed that the overall quality of country parks approximated a normal distribution, with Lianma Forest Country Park having the highest comprehensive score and the most balanced distribution of scores for various impact factors. Considering safety, expandability, rehabilitation, convenience, pollution prevention, and fecal isolation, it is a preferred destination for emergency medical facility construction.

The COVID-19 pandemic triggered a change in continuing education in nursing: From face-to-face to online education.

Prior to and up to 2019, the Training Center for Nursing Development, National College of Nursing, Japan (NCNJ) had provided education for nurses working at policy-based medical facilities in a face-to-face format. Since 2020 however, all on-campus courses have been cancelled due to the coronavirus disease (COVID-19) pandemic. The nursing directors of all participating facilities were subsequently surveyed; based on their responses, online education was implemented on a trial basis. As a result, all training since 2021 has been provided as online education. Online education has many advantages, such as there is no risk of contracting COVID-19 or other infectious diseases, no need for commuting or accommodations, courses can be attended remotely, and time can be used effectively. That said, there are some disadvantages. Potential improvements should be identified in the future.

The choice of medical facility and associated factors among Chinese advanced colorectal cancer patients: a cross-sectional multi-center study.

Background: Colorectal cancer (CRC) poses a significant public health burden worldwide. The investigation of the choice of medical facility among CRC patients is helpful for understanding access to health services and improving quality of oncology services to optimize health outcomes. However, there are limited studies on the topic. The objective of this study was to investigate the choice of medical facility and its associated factors among advanced CRC patients. Methods: This cross-sectional multi-center study included a total of 4,589 individuals with advanced CRC from 19 hospitals in 7 geographic regions in China. Participants were recruited by multi-stage stratified sampling. In the first stage, two cities in each geographic region were selected through simple random sampling. In the second stage, one tertiary cancer hospital and/or one general hospital were selected in each city. Data on medical experience and demographics were collected via a questionnaire during face-to-face interviews. Explanatory variables were selected based on the Andersen behavioral model. Multinomial logistic regression analyses were performed to explore the factors associated with the level of medical facility for the first treatment. Results: Hospitals at the prefecture level were the most common medical facility sought by advanced CRC patients for initial medical care (44.9%), the first definite diagnosis (46.3%), the first treatment (39.5%), and regular follow-up (38.9%). However, the first priority was changed to hospitals at the national level for the second treatment (38.0%) and after recurrence and metastasis (45.9%). Female {odds ratios (ORs) ranged from 1.31 [95% confidence interval (CI): 1.01-1.71] to 1.41 (95% CI: 1.07-1.87)} and relatively well-educated individuals [ORs ranged from 1.74 (95% CI: 1.20-2.53) to 7.26 (95% CI: 4.18-12.60)] preferred to seek higher-level health facilities. Individuals with metastatic CRC at diagnosis were more likely to visit hospitals in provincial capitals versus hospitals at the county level (OR =1.68, 95% CI: 1.27-2.22). Individuals with "good" health-related quality of life (HRQOL) (OR =0.63, 95% CI: 0.49-0.81) were less likely to seek hospitals at the prefecture level compared with hospitals at the county level. Conclusions: There is a need to improve the oncology services for CRC patients, including the optimization of referral reform policy and the promotion of quality of primary healthcare service. The results may provide evidence to fill the policy-implementation gap and potentially contribute to the improvement of the efficiency of the healthcare system.

Dynamic Demand Evaluation of COVID-19 Medical Facilities in Wuhan Based on Public Sentiment.

Medical facilities are an important part of urban public facilities and a vital pillar for the survival of citizens at critical times. During the rapid spread of coronavirus disease (COVID-19), Wuhan was forced into lockdown with a severe shortage of medical resources and high public tension. Adequate allocation of medical facilities is significant to stabilize citizens' emotions and ensure their living standards. This paper combines text sentiment analysis techniques with geographic information system (GIS) technology and uses a coordination degree model to evaluate the dynamic demand for medical facilities in Wuhan based on social media data and medical facility data. This study divided the epidemic into three phases: latent, outbreak and stable, from which the following findings arise: Public sentiment changed from negative to positive. Over half of the subdistricts in three phases were in a dysfunctional state, with a circular distribution of coordination levels decreasing from the city center to the outer. Thus, when facing major public health emergencies, Wuhan revealed problems of uneven distribution of medical facilities and unreasonable distribution of grades. This study aims to provide a basis and suggestions for the city to respond to major public health emergencies and optimize the allocation of urban medical facilities.

An Improved Genetic Algorithm for Location Allocation Problem with Grey Theory in Public Health Emergencies.

The demand for emergency medical facilities (EMFs) has witnessed an explosive growth recently due to the COVID-19 pandemic and the rapid spread of the virus. To expedite the location of EMFs and the allocation of patients to these facilities at times of disaster, a location-allocation problem (LAP) model that can help EMFs cope with major public health emergencies was proposed in this study. Given the influence of the number of COVID-19-infected persons on the demand for EMFs, a grey forecasting model was also utilized to predict the accumulative COVID-19 cases during the pandemic and to calculate the demand for EMFs. A serial-number-coded genetic algorithm (SNCGA) was proposed, and dynamic variation was used to accelerate the convergence. This algorithm was programmed using MATLAB, and the emergency medical facility LAP (EMFLAP) model was solved using the simple (standard) genetic algorithm (SGA) and SNCGA. Results show that the EMFLAP plan based on SNCGA consumes 8.34% less time than that based on SGA, and the calculation time of SNCGA is 20.25% shorter than that of SGA. Therefore, SNCGA is proven convenient for processing the model constraint conditions, for naturally describing the available solutions to a problem, for improving the complexity of algorithms, and for reducing the total time consumed by EMFLAP plans. The proposed method can guide emergency management personnel in designing an EMFLAP decision scheme.

Country Parks as Sites of Emergency Medical Facility: A Case of COVID-19 in Hangzhou, China.

City parks are suitable sites for the construction of emergency medical facilities. A comparison of various types of city parks revealed that country parks fit closely with site selection conditions for emergency medical facilities. Based on the latter site selection requirements, eight impact factors such as park type, effective avoidance area, spatial fragmentation degree, water source protection area, wind direction, distance from city center, impermeability, and transport duration were quantified, and then 29 country parks in the Hangzhou Urban Area were compared using Principal Component Analysis (PCA). The calculation results showed that Linglong Country Park has the highest score, taking into account the characteristics of safety, scalability, rehabilitation, convenience, pollution prevention, and isolation. Linglong can be given priority selection as a target location for emergency medical facilities. In addition, Silver Lake Country Park, Dongqiao Country Park, Taihuyuan Country Park, and Tuankou Country Park have higher scores and can be used as alternative targets for emergency plans. The scoring results prove that the evaluation method has a high degree of rigor, a significant degree of discrimination, and a high degree of consistency between the validity and weight assignment of each impact factor. In view of the different geographical conditions in each region, the weight assignment of each impact factor can be adjusted according to local conditions and can help make effective use of existing conditions and avoid disadvantages.

Effects of family planning service utilization determinants on unmet need incidents with generalized structural equation modeling.

BACKGROUND: One of the reasons for the lack of optimal achievement in terms of contraceptive use in Indonesia is the unmet need for family planning that has not been fully addressed. OBJECTIVE: This study aimed to determine the direct, indirect, and total effect of the determinants of family planning services utilization on the incidence of unmet need spacing and limiting in Indonesia to provide a basis for appropriate and effective program recommendations. STUDY DESIGN: This study used secondary data from the 2017 Indonesian Demographic and Health Survey with a cross-sectional design with 33,635 respondents who were married women aged 14 to 49 years. RESULTS: The results of the generalized structural equation modeling showed that the incidence of unmet need in Indonesia was 11.68%, consisting of unmet need spacing (4.86%) and unmet need limiting (6.82%). The quality of family planning services had a positive indirect effect on the incidence of unmet need spacing. The quality of family planning services also had a positive direct, indirect, and total effect on the incidence of unmet need limiting. Socioeconomic and demographic status variables had a negative direct effect on the incidence of unmet need spacing, whereas the indirect and the total effect were positive. The direct and total effect of socioeconomic and demographic status variables on the incidence of unmet need limiting were positive. The women's autonomy variable had a positive direct, indirect, and total effect on the incidence of unmet need spacing. Women's autonomy had positive indirect and total effect on the incidence of unmet needs limiting. The variable of access problems did not have a significant effect on the incidence of unmet need spacing and unmet need limiting. The ideal number of children had a negative direct and total effect on the incidence of unmet need spacing and unmet need limiting in Indonesia. CONCLUSION: The variables that have been shown to have a significant effect on the incidence of unmet needs were the quality of family planning services, socioeconomic and demographic status, women's autonomy, and the ideal number of children.

A Community-Based Management of COVID-19 in a Mobile Container Unit.

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

Knowledge and Training of Primary School Teachers in First Aid - A Questionnaire Based Study.

BACKGROUND: Students at schools may need first aid due to illness or accident. Therefore, teachers at school should know first aid measures and be able to put them into practice. The aim of this study is to assess awareness regarding first aid training among primary school teachers. METHODS: Subjects were 150 primary school teachers from nine schools in the Udupi district of Karnataka. They were assessed by predesigned questionnaire proforma, after which each teacher was interviewed and responses were discussed separately in smaller groups. RESULTS: Of the subjects, 11.3% felt that first aid is important and 87.7% said that it is very important and wanted to learn first aid. About a third (30.2%) of the teachers knew some basic treatments for minor emergencies but they didn't recognize such treatments were called first aid. Most of the subjects (69.8%) were unfamiliar with the expression "first aid". CONCLUSION: First aid training should be included in the teacher training curriculum, and such training should be updated regularly.

Using virtual reality as a replacement for hospital tours during residency interviews.

BACKGROUND: Residency programs invest a significant amount of time and resources on the recruitment process, and maintaining efficiency and cost-effectiveness are very important. Virtual Reality (VR) has become an adaptive substitute for 'real life' experiences and its use during the interview season could help save time and resources. OBJECTIVE: With the intention to maximize the interview day and provide a cost-effective alternative to facility tours, a Med-Peds residency training program introduced a VR tour of their children's hospital during recruitment. DESIGN: The Med-Peds program replaced an in-person facility tour of the children's hospital with a VR tour. Applicants were asked to complete an anonymous, voluntary survey on their VR experience at the end of the interview season, and rank features of the interview day in order of importance. RESULTS: There were 33 respondents out of 54 interviewees. Approximately two thirds (63-66%) agreed that VR was non-inferior and superior to in-person facility tours, and that the use of VR had a favorable impact on their perception of the program. However, almost 50% of the applicants had some difficulty using VR technology. CONCLUSION: Use of VR facility tours as an alternative to in-person tours of affiliate training facilities during a residency interview day is a viable and innovative option that can save time and money and favorably impact the applicant's impression of the program. More research is necessary to assess whether VR tours can replace in-person tours at the main teaching site, however, while social distancing measures are in place, VR tours may become necessary for programs moving forward. ABBREVIATIONS: Med-Peds: Internal Medicine-Pediatrics; VR: Virtual Reality; AAMC: Association of American Medical Colleges; IRB: Institutional Review Board.

[Questionnaire Survey on Collaboration with Medical Facilities/Nursing Home Care Facilities at Community Pharmacies].

Construction of regional inclusive care system is being promoted and pharmacists are required to implement multidisciplinary collaboration in order to provide appropriate pharmaceutical care to patients. However, there are few studies on collaboration between medical facilities and community pharmacies. In this study, we conducted a questionnaire survey of community pharmacies in Gifu City, which assessed the experience and attitudes regarding collaboration with other medical facilities. The survey items are: I. Participation in regional care meetings, II. Case discussion conferences, III. Joint workshops/study conferences, IV. Community service, V. Sharing information through medical cooperation network, and VI. Accompanying community pharmacists at home medical care. For the implementation of collaboration, the percentage of "not implemented" were as high as 70% or more in II, IV, V and VI. Regarding the attitudes toward collaboration, more than half of pharmacies answered that they wanted to implement in all items. In the comparison by the number of pharmacists, pharmacies with two or more pharmacists had significantly higher implementation ratios than pharmacies with one pharmacist in IV and V. Regarding the attitudes toward collaboration, pharmacies with two or more pharmacists had significantly higher ratios of considering implementation than pharmacies with one pharmacist in I and VI. Based on the results of this survey, there were many items that were not implemented as collaboration with other medical facilities at community pharmacies. However, many community pharmacies are planning to collaborate with other medical facilities in the future.

Effect of Facilitated Discharge in Pediatric Orthopedic Patients at an Academic Medical Facility.

INTRODUCTION: Because health care reimbursement is being linked to discharge quality and patient satisfaction, this quality improvement initiative reviewed the outcomes of embedding a pediatric nurse practitioner within the resident team at an academic medical facility. METHODS: The project was completed at a pediatric orthopedic unit at a large Southeastern U.S. academic medical facility. During the intervention, the pediatric nurse practitioner student completed daily rounds, communicated with the resident team, assessed readiness for discharge, provided patient education, and ensured that comprehensive discharge materials were completed. RESULTS: Analyses were completed for 219 patients (pre-intervention, n = 116; post-intervention, n = 103). Patient satisfaction was measured for provider communication and discharge. All areas experienced improvement, with provider communication benchmarks obtained. Ambulatory call volume decreased from 97 to 45 calls/100 patients. DISCUSSION: This study shows that embedding a pediatric nurse practitioner into the resident team helped improve patient satisfaction and reduce ambulatory workload by decreasing call volume.

Electrostatic hazards of charging of bedclothes and ignition in medical facilities.

We investigated the charge generated on bedclothes (cotton and polyester) during bedding exchange with different humidities and the ignitability of an alcohol-based hand sanitizer (72.3 mass% ethanol) due to static spark with different temperatures to identify the hazards of electrostatic shocks and ignitions occurring previously in medical facilities. The results indicated that charging of the polyester bedclothes may induce a human body potential of over about 10 kV, resulting in shocks even at a relative humidity of 50%, and a human body potential of higher than about 8 kV can cause a risk for the ignition of the hand sanitizer. The grounding of human bodies via footwear and flooring, therefore, is essential to avoid such hazards (or to reduce such risks).