A pilot study of Korean Medical Examination

Objectives: This study aimed to evaluate the feasibility of the Korean medical examination protocol, which included 14 questionnaires and 20 medical examination devices.Methods: We conducted a pilot observational study of 90 subjects to measure the time required to fulfill each item of the Korean medical examination, to evaluate patient satisfaction, and to report improvements that can be made to the Korean medical examination protocol based on clinical coordinator and subject feedback.Results: Among the 90 subjects included in the study (59 women and 31 men; mean [standard deviation] age, 37.2 [12.3] years), over 80% intended to receive a Korean medical examination if hospitals provided it and would recommend a Korean medical examination to others. The average time spent on the overall Korean medical examination was approximately 88.0 (21.4) minutes. Three areas for improvements were reported: survey issues, including the number of items, understanding, and readability; error issues in device measurements; and environmental issues affecting the sequence of medical examinations and temperature.Conclusions: Most subjects were satisfied with the Korean medical examination. Future studies should be conducted with larger samples to collect data continuously.

La "clinical governance" č una prospettiva innovativa per le aziende ospedaliere?

In public health care organizations, the doctor is not only important as a provider of medical services but also as the individual that determines the demand of medical services; the doctor is both a participant in the definition of demand for services and the actual person representing the offer of them. Therefore health care organizations must guarantee the possibility for the doctor to act independently. On the other hand this autonomy is limited by the fact that doctors must act within the boundaries of structures that impose rules, hierarchies and adherence to organizational levels. This is the reason why in a hospital structure the doctor does not have the possibility to act in total autonomy. Within the hospital organization conflicts arise that must be either prevented and/or managed trough both coordination and integration of processes. The 2004 reform proposed by minister Sirchia constitutes an answer to the above conflict. It was inspired by the British experience with "clinical governance". Mr. Sirchia's law proposal creates the so called "clinical coordinator" and provides it with a position in the clinical organization's top management with the responsibility of definition of policies as well as coordination and controls. He will act as a medical director too. But the creation of the "clinical coordinator" position rather than solve the integration problems, would have generated permanent conflicts at top management level. Luckily the law proposal did not become an act of Parliament; but the problem of finding real solutions to the conflicts arising from the diversity of medical and economic cultures remains.

Ready for Our Children? Results From a Survey of Upstate New York Hospitals' Utilization of Pediatric Emergency Preparedness Toolkit Guidance

ABSTRACTObjective: This project evaluated New York (NY) hospitals outside of New York City (upstate) for their awareness and utilization of the NY State Department of Health Pediatric and Obstetric Emergency Preparedness Toolkit (toolkit) and presence of pediatric emergency preparedness planning elements.Methods: A survey assessing toolkit awareness and utilization was distributed to all 145 upstate NY hospitals. Quantitative survey data were analyzed using summary statistics, χ2 analysis, and odds ratios (OR) in aggregate, by hospital size, and by presence of pediatric medicine/surgery, pediatric intensive care unit (PICU), and/or neonatal ICU (NICU) beds (pediatric beds).Results: Of the 145 hospitals, 116 (80%) completed the survey; 86% of these had reviewed the toolkit. Most had staff clinicians with pediatric expertise, but fewer had appointed pediatric clinical (physician or nurse) coordinators. Hospitals with at least one pediatric bed were more than 2.5 times more likely to have an emergency management plan (EMP) for pediatric patients (P =. 0223) and nearly 8 times more likely to have appointed a pediatric physician coordinator (P <. 0001) than were hospitals without pediatric beds. Appointment of a pediatric clinical coordinator was significantly associated (P <. 001) with presence of various pediatric emergency plan elements (OR range: 3.06-15.13), while staff pediatric clinical expertise or toolkit review were not.Conclusions: Appointment of at least one pediatric clinical coordinator and the presence of one or more pediatric beds were significantly associated with having developed key EMP pediatric elements. Further research should examine barriers to pediatric clinical coordinator appointment and explore the awareness that pediatric patients may arrive at nonpediatric hospitals during a disaster with no option for transfer.(Disaster Med Public Health Preparedness. 2012;6:138–145)