Medical Manpower Research Articles

Lack of skilled medical personnel as a structural problem

The healthcare system in Germany is characterized by a comprehensive local patient care. Nevertheless, due to the increasing lack of medical personnel bottlenecks are impending, which are not only of a temporary nature. The increasing demography-related needs for care, insufficient healthcare competence of many people and the inadequate prevention will strengthen the demand for medical and nursing personnel. At the same time, physicians and nursing personnel from the high birth rate baby boomer years are leaving the healthcare system. This age cohort must now be replaced by a younger workforce; however, in Germany too few physicians are being trained when measured against the requirements. A marked increase in the number of university study places in medicine will not be able to alleviate the deficit in the short term but prospectively there is no way past an expansion of capacities. The decline in panel physicians, especially in general practitioner care, is accompanied by a clear increase of employees in the outpatient sector. The desire for reduced working hours is clearly recognizable throughout all age cohorts. The part-time quota is increasing. The discrepancy between desired and actual working times is largely underestimated. The increased part-time quota already shows that something must fundamentally change to be able to provide sufficient medical manpower and working hours for the treatment of patients. The association between increased part-time quota and dissatisfaction with the working situation in hospitals is obvious and has repercussions for the medical care. In a multifactorial process the causes and sequelae of bottlenecks in skilled personnel are mutually strengthened in a negative spiral. In the short term, the deficit in medical personnel can only be counteracted by a better cooperation between the outpatient and inpatient fields of care and by a massive reduction in bureaucracy. The digitalization can without doubt contribute to the relief of the healthcare system. Telemedical applications can improve the treatment in rural and structurally weak regions.

Timely care for age-related macular degeneration: a qualitative study among retina specialists in Israel

BackgroundAge-related macular degeneration (AMD) affects quality of life and independence, and its incidence and prevalence are increasing due to ageing of the population. Access to effective timely treatment can improve vision and reduce incidence of blindness. This study aimed to explore the perspectives of ophthalmologists in the Israeli public healthcare system regarding timely treatment of AMD patients.MethodsQualitative semi-structured interviews were conducted in 2020-2021 with 22 senior ophthalmologists, from 10 general hospitals and from two HMOs, representing different geographic regions. All interviewees specialize in retinal diseases and work with AMD patients. Interviews discussed patient pathways involved in the diagnosis and treatment of AMD, access to care, and obstacles to timely care. Thematic analysis was conducted.ResultsBased on the interviews, we describe the usual referral and treatment pathways. Themes included regional disparities, long wait times in some areas, a lack of retina specialists, differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second-line treatment not fully covered by insurance, most affecting the weakest segments of the population.ConclusionsLoss of vision incurs high health and societal costs. In the context of insufficient medical manpower in Israel, the healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population. Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment. Awareness of AMD symptoms and the importance of early intervention could be highlighted by campaigns, particularly among high-risk groups.Highlights• Interviews with hospital-based and community ophthalmologists showed regional disparities in AMD treatment, with long wait times and a lack of retina specialists in some areas.• Differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second line treatment not fully covered by insurance were highlighted.• The healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population• Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment.• Awareness of AMD symptoms and the importance of early intervention should be emphasized in high-risk groups.

Ophthalmic primary care in Singapore: Considerations for review

Ophthalmic primary care (OPC) of Singapore residents is mainly provided for by trained specialists. This is due both to the current nature of the public healthcare system as well as societal perceptions and preferences, and it imposes a heavy burden on the country’s ophthalmologist resource. Changing population demographics, escalating costs as well limitations to medical manpower growth have necessitated a shift in Singapore’s healthcare strategy to focus on primary and preventive care. This national policy change further emphasizes the need to invest in OPC as a more structured service. Revisiting the principles of primary care and how they apply to ophthalmology will be an important first step in a timely review of the country’s OPC system.

Automatic stent struts detection in optical coherence tomography based on a multiple attention convolutional model

Objective. Intravascular optical coherence tomography is a useful tool to assess stent adherence and dilation, thus guiding percutaneous coronary intervention and minimizing the risk of surgery. However, each pull-back OCT images may contain thousands of stent struts, which are tiny and dense, making manual stent labeling slow and costly for medical resources. Approach. This paper proposed a multiple attention convolutional model for automatic stent struts detection of OCT images. Multiple attention mechanisms were utilized to strengthen the feature extraction and feature fusion capabilities. In addition, to precisely detect tiny stent struts, the model integrated multiple anchor frames to predict targets in the output. Main results. The model was trained in 4625 frames OCT images of 37 patients and tested in 1156 frames OCT images of 9 patients, and achieved a precision of 0.9790 and a recall of 0.9541, which were significantly better than mainstream convolutional models. In terms of detection speed, the model achieved 25.2 ms per image. OCT images from different collection systems, collection times, and challenging scenarios were experimentally tested, and the model demonstrated stable robustness, achieving precision and recall higher than 0.9630. Meanwhile, clear 3D construction of the stent was achieved. Significance. In conclusion, the proposed model solves the problems of slow manual analysis and occupying a large amount of medical manpower resources. It enhances the detection efficiency of tiny and dense stent struts, thus facilitating the application of OCT quantitative analysis in real clinical scenarios.

Regional differences of individual and allocation efficiencies of health resources in China.

The existing health resources and services are difficult to meet the needs of rapid economic development and the aging population in China. This paper evaluates the regional differences of individual and allocation efficiencies of health resources in China to explore ways to change the current situation. The models of single-input single-output efficiency (SISOE), single-input multi-output efficiency (SIMOE), multi-input single-output efficiency (MISOE), and multi-input multi-output efficiency (MIMOE) were developed to calculate the individual and allocation efficiencies of health resources of China in this study. It was found that the efficiencies of the number of health institutions (NHI) in the eastern and western regions of China were relatively close, with values of 0.61 and 0.59, respectively, significantly higher than 0.49 in the middle region. The efficiencies of the number of health personnel (NHP) in the eastern, middle, and western regions were closer, with values of 0.77, 0.75, and 0.79, respectively. The efficiencies of the number of health institution beds (NHIB) in the eastern and western regions were very close, with values of 0.79 and 0.78, respectively, while that in the middle region was 0.72. The efficiencies of the total health expenditure (THE) were 0.72, 0.76, and 0.79 in the east, middle, and western regions, respectively. The efficiencies of the number of diagnosis and treatment persons (NDTP) were 0.81, 0.70, and 0.71 in the eastern, middle, and western regions, respectively, while the efficiencies of the number of inpatients (NI) were 0.75, 0.79, and 0.81, respectively. The efficiencies of the utilization rate of beds (URB) and the average days of hospitalization (ADH) in the three regions were below 0.51. The health resources allocation efficiencies (HRAEs) were 0.86, 0.83, and 0.87 in the eastern, middle, and western regions, respectively. There were obvious regional differences in HRAE in China with the situation of "Middle Collapse." The main direct reason for the low HRAE in the middle region was the lower efficiencies of NHI, NHIB, URB, and ADH. It revealed that there was relatively blind expansion of health institutions and beds with lower health service quality in the middle region. Governments should make strategic adjustments to public health resources and increase the investment in medical technology and manpower in the middle region. Hospitals in the eastern region should strengthen inter-regional medical and health technical cooperation with partners in the middle region by establishing a tele-medical network. The models of SISOE, SIMOE, MISOE, and MIMOE put forward in this study are simple, reasonable, and useful for resource efficiency analysis, which makes it convenient to adopt targeted measures to upgrade the efficiency of resource allocation. This study provides a new perspective and method to understand the mechanism of regional differences in China's health resource allocation efficiency.

Problems of past anticipations of the future: The case of medical manpower

AbstractThis commentary explores historical efforts to diagnose the present and project the future through the specific example of medical manpower planning. To situate this, it draws on work within and across geography exploring the concept of anticipation and considers the discipline's failure to adequately engage with healthcare workers, despite the vibrancy of health geography as a subdiscipline. As it explores, ensuring adequate numbers of staff in a healthcare system has been an issue for as long as there have been healthcare systems. Planning for healthcare system needs is thus a particularly fraught form of anticipation that seeks to project future needs from a contested and often incalculable present as a basis for political decision‐making and resource allocation. As this commentary explores, it is a problem that is global in scope, historically deep and thus rich in analytical possibility.

Expansion of the CT-scans image set based on the pretrained DCGAN for improving the performance of the CNN

Diagnosis of COVID-19 based on CT scans images using artificial intelligence can massively reduce medical manpower, time, and resources and reduce misdiagnosis rate. However, there are few relevant image sets publicly available at present, which is not conducive to the training of models such as classification. Transfer learning has been extensively considered in image classification, but less utilized in image generation. This work attempts to expand this dataset with discriminators using Deep Convolutional Generative Adversarial Network (DCGAN) models of Imagenet pre-training models and verify the significance of pre-training models for generating image veracity. A DCGAN model using the Imagenet pre-training model (i.e. resnet18) and a DCGAN network without the pre-train model generated 100 positive and 100 negative images to extend the original dataset, respectively. These images were classified using a Convolutional Neural Network (CNN) binary classifier, and the accuracy improved from 82.67% to 85.33% after adding the pre-training model. Furthermore, the comparison shown by the Gradcam visualization shows that the discriminator with the pre-training model can better capture the key details of the images. This experiment shows that even though Imagenet and lung images are totally uncorrelated, there are still some features that can be transferred. It also demonstrates that Imagenet pre-training models can improve the quality of GAN-generated images, extending the application of migration transfer learning.

The ‘health workforce crisis’ and ‘the medical manpower problem’: New term, old problems.

The recent, but overdue, publication of the NHS Long Term Workforce Plan marks a welcome investment in the future sustainability of the service. The Plan includes a near doubling of medical and nursing school places, a proposed shortening of medical degrees, growth in ‘new roles’ including associates and apprentices, reduced overseas recruitment of staff and efforts to boost productivity and retention. While the plan was greeted with enthusiasm by many, criticisms were also numerous. This short opinion piece does not aim to add to the critique, but instead presents an argument for why, in trying to understand the persistence of the ‘health workforce crisis’ across the world, we might usefully think back seven decades to international efforts to address the ‘medical manpower problem’. Here, the manpower concept offers a hugely useful heuristic to think through the contours of time, space and resources that characterise(d) efforts to forecast and anticipate future health needs and, therefore, staff and resourcing. Geographers, I argue, should have far more to say about these conceptual continuities in modes and means of problematisation, as well as their consequences.

The telemedicine and digital technologies in education programs of training medical personnel of higher qualification

The article considers application of telemedicine and digital technologies in educational programs of training medical personnel in residency and graduate school for the Russian health care system. The possibilities of telemedicine and digital technologies that currently are in use for remote medical care, consultations of medical workers by qualified medical specialists and for training and re-training of medical personnel are investigated. The key topics of modern health care are improvement of system of training medical manpower, personalization of medical care in health care, individualization of professional orientation in the process of continuing medical education and current methods of information environment management in health care sector. The conclusion is made that owing to new technologies,such innovations as telemedicine, artificial intelligence, medical decision-making systems, remote platforms of patient health monitoring and other modern inventions are implemented into health care. The purpose of the study is to examine impact of transformational processes in higher medical education in epoch of digitization.

Manual single lumen alternating micro-batch dialysis achieves reliable clearance via diffusion.

Acute kidney injury is a cause of preventable deaths in low resource settings due to lack of dialysis access and cost. A manual single lumen alternating micro-batch (mSLAMB) dialysis technique performs kidney replacement therapy using single lumen access, low-cost bags/tubing, intravenous fluids, anda filter without electricity, a battery, or a pump. We propose a protocol whereby mSLAMB can perform diffusive clearance simply and efficiently to bring dialysis to underserved populations. Expired packed red blood cells mixed with crystalloid solution were spiked with urea and anticoagulated with heparin. A Static diffusion Technique (with short flushes of fluid before each filter pass) was compared to a Dynamic diffusion Technique (with fluid running through the filter during the forward pass) to assess urea and potassium clearance. Passive ultrafiltration was the difference between the 200 mL batch volume and volume returned to the blood bag per cycle. Five cycles achieved urea reduction ratios (URR) between 17-67% and potassium clearance of 18-60%, with higher percentagesachieved from higher proportions of batch volume dialyzed to patient volume. Dynamic Technique increased clearance over the Static Technique. Passive ultrafiltration volumes were 2.5-10% of batch volume. mSLAMB dialysis performs diffusive clearance and passive ultrafiltration efficiently, while preserving resources and available manpower. mSLAMB is a dialysis technique that can perform efficient diffusive clearance and passive ultrafiltration without electricity, batteries, or a pump. With basic medical supplies and limited manpower, mSLAMB is a cost-effective means of providing emergency dialysis in low resource areas. We propose a basic algorithm for safe and cost-effective dialysis for people of different ages and sizes.

Two Years of COVID-19: Analysis of Global and India's Pandemic Response

Introduction: We are currently amid a COVID-19 pandemic which had its epicenter in Hubei Province of the People's Republic of China. The present study is conducted to understand the various factors influencing pandemic response, policies adopted by different countries, and lessons learned. Materials and Methods: This is a descriptive study conducted across countries of different WHO regions covering period from January 2020 to December 2021. Data included parameters like case fatality rate, R0, human development index, vaccination coverage, medical manpower. Other key epidemiological parameters assessed and analyzed like sociodemographic and health related indicators. Results: A range of strategies has been adopted worldwide based on the population structure as well as the health-care infrastructure of each country. Rich countries such as the US and the UK were susceptible to COVID because of international air travel but also had more financial resources to fight the pandemic but have been repeatedly overwhelmed by infections and face a return to costly lockdowns. These countries had high prevalence of comorbidities such as diabetes and obesity with large elderly population. Case fatality and death per million had no relation with vaccination coverage. Countries with high population density like India and Israel shown to have high reproduction number for COVID-19. Country like New Zealand revealed best pandemic response thanks to timely and aggressive lockdown containment strategy alogwith strongpolitical will. Conclusion: COVID-19 vaccine seems to be the single most important weapon that needs global focus. Pediatric vaccination, booster coverage, containment strategies with strict lockdowns amid delta, and omicron variants are some of the public health dilemmas offered by the pandemic to the public health specialist and policymakers which needs to be urgently addressed.

Current situation and tasks for public health and medical cooperation between South Korea and Central Asia: Focusing on Kazakhstan and Uzbekistan

2022 marks the 30th anniversary of diplomatic ties between Korea and Central Asia. Since the establishment of diplomatic ties, Korea and Central Asia have expanded exchanges in various fields, including politics, economy, and diplomacy. Cooperation between Korea and Central Asia utilizing the abundant medical manpower of Central Asia and Korea’s excellent medical and pharmaceutical technology was also selected as a promising area of cooperation between the two sides. Korea and Central Asia have continued to cooperate in the field of health and medical care, but there were limits to deepening cooperation. Recently, the importance of health and medical cooperation around the world has been highlighted again due to COVID-19. This thesis examines the status and problems of health care in Central Asia, and analyzes the achievements and limitations of health care cooperation between Korea and Central Asia. The purpose of this is to suggest directions for strengthening health care cooperation between Korea and Central Asia. This will help the new government, which aims to become a global center of bio-digital health, explore strategies and policies for preemptive health care cooperation in Central Asian countries.

진료지원인력의 양성화 및 합법화 고찰

Every year, South Korean medical field is undergoing significant shortage of residents, especially in the field of surgery. Therefore, hospitals hire physician assistants(PA) to cover for short-staffed physicians and increase the quality of medical care. PA’s perform medical checkups, surgery assistance, prescription, anesthesia, and directing nurses to aid physicians. Foreign nations like the United States and Canada produce highly skilled PA’s via official PA training programs and standardized license exams, and PA’s are allowed to perform limited medical practice. However in South Korea, lack of legal basis for PA’s eligibility, training program, and range of allowed medical practice causes social problems like unlicensed medical care and medical accident. South Korea’s objective for PA program is significantly different from that of the United States and Canada. In those countries, purpose of PA is to aid and cover for primary care, whereas South Korean PA program is used for remedying surgeon shortage problem and hospitals’ business purposes, such as cost reduction and treatment time saving. This study criticizes implementing a new occupational field based on foreign PA policy will cause numerous problems and limits due to the difference of purpose. Therefore, establishing a new management& operating system for medical support persons considering patient safety, supply of health medical manpower, medical field requirements and characteristics of different medical institutions will be a realistic solution. Tasks for PA’s should be categorized and trained accordingly so that PA’s quality increases. Also, appropriate reward system, athority, and eligibility of PA’s are required according to their experience and ability. Registered nurse(RN) in South Korea is recognized as professional medical personnels that went through systematic education. This study suggests improvising RN program and utilizing it will be a efficient and realistic alternative solution for this problem.

Establishing the role and desirable relationship between the government and medical personnel in the post-corona era in Korea

This study aims to analyse academic papers on the topic of coronavirus published in Korea, and, on that basis, to select important topics that should be addressed by policymakers. The study constructs an eco-network that includes two keywords, ‘government’ and ‘medical manpower’, and analyses it. The research results thus obtained may contribute to deriving policy information with which to respond to situations similar to the corona pandemic that may occur in the future. For this purpose, we analyse academic papers published during the two-year period from January 2020, when the first corona patient was first identified in Korea, to December 2021. As research methods, text network analysis and ego network analysis methods were applied. As a result, seven important policy tasks were derived. Among these policy themes, in particular the topic relating to citizen participation in medical law revision and quarantine processes was selected as representing the task to be resolved first.

Assessment of Services at Primary Health Center of Jaipur District as Per Indian Public Health Standards

Background:. These standards are to underpin the delivery of quality services which are fair and responsive to client’s needs, which should be provided equitably and which deliver improvements in the health and well-being of the population. Aim and Objectives: to identify the existing gap with respect to Indian Public Health Standards (IPHS) for availability of infrastructure, human resources, investigative services and emergency services at 24 × 7 primary health centers (PHCs) of Jaipur district of Rajasthan state. Methods: It is a cross-sectional quantitative study was conducted from March 2018 – March 2019 in Jaipur district of Rajasthan state. Jaipur is divided into 7 blocks,73 PHC and 18 CHC. Out of these 7 blocks 3blocks were selected by simple random sampling. From these 3 blocks 3 PHC from each block was selected by simple random sampling. 3 sub center from each PHC was selected by simple random sampling and then 30 households were selected from each Sub-centre by systematic random sampling. Results: In terms of staff availability found critical status, Essential services were adequate, but not at all PHCs, Infrastructure and facilities was satisfactory. Conclusion: Even after more than a decade of Indian Public Health Standards (IPHS) in place for the Public Health Facilities this study reveals a huge gap in the availability of the manpower (Medical, Para medical and support manpower), Services, Drugs, equipment, infrastructure and Quality control measure

A Systematic Implementation of Telemedicine in Singapore's COVID-19 Community Recovery Facilities.

Introduction: This article describes the experience of the Singapore Armed Forces (SAF) implementing telemedicine consultations for COVID-19-positive patients recovering within community recovery facilities (CRFs) in a semi-inpatient setting. Materials and Methods: The SAF adopted a systematic approach to telemedicine implementation and scaling up, with Phase 1 being the deployment of medical teams operating on-site clinics daily at six CRFs and telemedicine only provided for after-hours medical consultations on an ad hoc basis. Subsequently in Phase 2, most clinical consultations in the CRFs were conducted virtually. Results: Phases 1 and 2 recorded 1,902 and 449 clinical consultations, respectively. The mean number of clinical encounters was 33 per 1,000 occupants per day in Phase 1, and 12 per 1,000 occupants per day in Phase 2 (p < 0.001). Acute respiratory illness (52.3% in Phase 1 and 46.7% in Phase 2) was the most common reason for consultations. With full telemedicine in Phase 2, there was reduction in the mean number of clinical encounters per 1,000 occupants per day (p = 0.001), lower man-hours in personal protective equipment (PPE) (p < 0.001), and rise in escalation of care (p < 0.001) but without adverse events reported. Conclusions: Telemedicine for patients was safe, improved medical manpower efficiency, and reduced man-hours in PPE. The increased escalation of care in Phase 2 due to the lack of physical examination capabilities was to be expected to ensure patients' safety. Overall, it is recommended that for stable and mild medical conditions, telemedicine is a viable, safe, and efficient health care delivery tool in crisis situations similar to COVID-19.

Residential elbow joint rehabilitation system by smart phone with cloud database.

Physical therapy treatment has gradually become important in hospitals. This paper focused on elbow joint rehabilitation, as this form of rehabilitation is used most often. Moreover, most elbow joint rehabilitation programs could be conducted at home without going to a medical institution, which will economize medical manpower. How to judge the correct rehabilitation motion becomes an issue for elbow joint rehabilitation at home. Therefore, this study proposed a residential elbow joint rehabilitation system (REJRS) by smartphone with a cloud database to address these issues. REJRS has the ability to judge the correct motions and times of rehabilitation in real time. When the rehabilitation motions are incorrect, the number of rehabilitation repetitions is insufficient, or a timed rehabilitation session is insufficient, the patient will receive a warning text and light alert by REJRS. Then, the data of rehabilitation sessions are uploaded to the cloud database immediately. Patients can query their rehabilitation data at all times. Moreover, medical staff can track the status of each patient's rehabilitation at any time and any place by downloading the data from the cloud database via the Internet. In our experimental results, the rate for detecting the correct elbow joint rehabilitation motion was up to 90%. The results show that REJRS could be applied for residential elbow joint rehabilitation. In the future, REJRS will be verified by the Institutional Review Board (IRB) for application to clinical treatment.

Responses to COVID-19 in South Asian Association for Regional Cooperation (SAARC) countries in 2020, a data analysis during a world of crises

Coronavirus disease (COVID-19) caused by SARS-CoV-2 was notified from Wuhan city, Hubei province, China in the mid of December 2019. The disease is showing dynamic change in the pattern of confirmed cases and death toll in these low and middle-income countries (LMICs). In this study, exponential growth (EG) method was used to calculate the real-time reproductive number (Rt) for initial and later stage of epidemic in South Asian Association for Regional Cooperation (SAARC) member countries (April 2020 – December 2020). Time dependent (TD) method was used to calculate the weekly real-time reproduction number (Rt). We also presented the observations on COVID-19 epidemiology in relation with the health expenditure, poverty, BCG vaccination, literacy population density and Rt for understanding the current scenario, trends, and expected outcome of the disease in SAARC countries. A significant positive correlation was noticed between COVID-19 deaths and health expenditure (% GDP) (r = 0.58, P < 0.05). The other factors such as population density/sq km, literacy %, adult population %, and poverty % were not significantly correlated with number of COVID-19 cases and deaths. Among SAARC countries, the highest Rt was observed in India (Rt = 2.10; 95% CI 2.04–2.17) followed by Bangladesh (Rt = 1.62; 95% CI 1.59–1.64) in initial state of epidemic. A continuous monitoring is necessitated in all countries looking at the medical facilities, available infrastructure and healthcare manpower, constraints which may appear with increased number of critically ill patients if the situation persists longer.

International Medical Graduates - Asset or Liability?

One of the gains of globalisation is its osmotic effect of equalisation motivating all the countries to reach their potential. Human resource especially, medical manpower, determines the health of the nation. Developing countries are becoming increasingly aware, of using their scarce resources to train a doctor, only to lose it to the Western world. The article highlights the exploitation, and possible wastage of highly qualified medical workforce who, are accommodated to suit the needs of the host country irrespective of their previous qualifications and experience. The article also makes suggestions to recover and retain the talents of the country.

Coping with COVID-19 in United Nations peacekeeping field hospitals: increased workload and mental stress for military healthcare providers

IntroductionThis study aimed to explore the impact of COVID-19 on the United Nations peacekeeping field hospitals where medical supply and manpower are extremely insufficient.MethodsA level II hospital was deployed in...