Community hospitals of the future: the role of community hospitals to mitigate health system burden in Singapore.

In Singapore, an ageing population with increasing chronic disease burden and complex social circumstances have strained the healthcare system. For the health system to run more efficiently, patients should be appropriately sited according to their medical needs. In Singapore, community hospitals serve as an intermediate inpatient facility managing patients with sub-acute and rehabilitation care needs.

Performance management of generalist care for hospitalised multimorbid patients-a scoping review for value-based care.

Objectives: Given the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients.

Design And Setting: A scoping review of published literature was conducted.

Distilling lessons from home hospital implementation: a narrative scoping review.

Introduction: Multiple Cochrane Reviews have demonstrated 'hospital at home' (HaH) as a promising healthcare model to be explored, with benefits such as higher care quality, reduced readmissions, shorter lengths of stay, lower cost and greater patient satisfaction. While there have been many reviews focusing on the quantitative clinical outcomes of HaH, there is generally a lack of collation of qualitative insights from stakeholders and lessons learnt from past HaH implementation.

Methods: We performed a systematic literature search on four databases and included 17 papers involving the provision of acute and/or subacute care by healthcare professionals in patients' homes.

Community hospitals of the future-challenges and opportunities.

Background: Medical training through specialization and even subspecialization has contributed significantly to clinical excellence in treating single acute conditions. However, the needs of complex patients go beyond single diseases, and there is a need to identify a group of generalists who are able to deliver cost-effective, holistic care to patients with multiple comorbidities and multi-faceted needs. Community hospitals (CHs) are a critical part of Singapore's shift toward a community-centric care model as the population ages.

Treating acutely ill patients at home: Data from Singapore.

Introduction: Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes.

Methods: We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021.

One-Bed-One-Team-Does an Integrated General Hospital Inpatient Model Improve Care Outcomes and Productivity: An Observational Study.

Introduction: With the increasing complexity of healthcare problems worldwide, the demand for better-coordinated care delivery is on the rise. However, current hospital-based practices remain largely disease-centric and specialist-driven, resulting in fragmented care. This study aimed to evaluate the effectiveness and feasibility of an integrated general hospital (IGH) inpatient care model.

Perceptions of Stakeholders Toward "Hospital at Home" Program in Singapore: A Descriptive Qualitative Study.

Objective: Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings.

Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study.

Hospital-at-Home (HaH) programmes are well-established in Australia, Europe, and the United States. However, there is limited experience in Asia, where the hospital is traditionally seen as a safe and trusted space for healing. This cross-sectional study aimed to explore attitudes and perceptions among patients and caregivers in Singapore toward this care model.

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis.

Background: Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH.

Attitudes and Perceptions Toward Healthcare Technology Adoption Among Older Adults in Singapore: A Qualitative Study.

Smart Nation is a key initiative of Singapore to move toward digitalization of its industries including healthcare. The complex negotiations of aging amid Smart Nation are addressed in this paper, where we study the challenges faced to adapt the elderly for the digital revolution while ensuring dignified aging. While the healthcare industry accelerates its study and use of health technologies to improve diagnostics, treatment, and the quality of life of those in the aging category, the elderly socially construct these technological insertions that challenge the dominant understandings of what these technologies can do for their health outcomes.

Comparison of Hospital-at-Home models: a systematic review of reviews.

Objectives: To provide an overview of the safety and effectiveness of Hospital-at-Home (HaH) according to programme type (early-supported discharge (ESD) vs admission avoidance (AA)), and identify the model with higher evidence for addressing clinical, length of stay (LOS) and cost outcomes.

Methods: A systematic review of reviews was conducted by performing a search on PubMed, EMBASE, Cochrane Database of Systematic Reviews, Web of Science and Scopus (January 2005 to June 2020) for English-language systematic reviews evaluating HaH. Data on primary outcomes (mortality, readmissions, costs, LOS), secondary outcomes (patient/caregiver outcomes) and process indicators were extracted.

Challenges and opportunities in pragmatic implementation of a holistic hospital care model in Singapore: A mixed-method case study.

Introduction: Hospital-based practices today remain predominantly disease-oriented, focusing on individual clinical specialties with less visibility on a comprehensive picture of each patient's health needs. To tackle the challenge of growing multimorbidity worldwide, practices without disease-specific focus have shown better integration of services. However, as we move away from the familiar disease-specific approaches of care delivery, many of us are still learning how to implement generalist care in a cost-effective manner.

Understanding and expectation towards pharmaceutical care among patients, caregivers and pharmacy service providers: a qualitative study.

Background: Over the past decades, the pharmacist's role has changed from being 'compounders and dispensers' to one of 'medication therapy manager' providing pharmaceutical care (PC). The transformation of pharmacy practice and its benefits, however, seem to be poorly understood by patients and caregivers (consumers) even in advanced health systems.

Objective: This study aims to assess the comprehension of consumers in Singapore towards PC and expectations on the scope of pharmacy services today.

Approaches to outpatient pharmacy automation: a systematic review.

Purpose: To systematically review, summarise and evaluate the evidence on the effectiveness of automation systems in the outpatient and community settings.

Methods: A literature search was performed using PubMed, Embase, Cochrane Library and CINAHL databases. A pre-defined search strategy focusing on the context of implementation, function and automation was used to identify articles published over the past decade.

Patient-provider disconnect: A qualitative exploration of understanding and perceptions to care integration.

Background: Integrated care has been well-recognized as a solution to improve quality of care for patients with complex needs. As Singapore increasingly develops and promotes integrated models of care, it is unclear if providers, patients, and caregivers share similar understanding of changes in the healthcare system.

Objectives: This study aims at exploring three dimensions of care integration: a) understanding of integration; b) challenges and c) changes perceived as essential among three distinct stakeholder groups: providers, patients and caregivers.

Comparison of Medication Adherence and Treatment Persistence between New Oral Anticoagulant and Warfarin among Patients.

Introduction: This study aimed to compare medication adherence and treatment persistence of patients on warfarin versus rivaroxaban in Singapore. A secondary objective was to identify significant covariates influencing adherence.

Materials And Methods: A retrospective cohort study was conducted where data from September 2009 to October 2014 was retrieved from the hospital electronic databases.

Real-World Impact of Setting a Narrow International Normalized Ratio Target Range in the Management of Older Adult Patients on Warfarin.

Introduction: Elderly patients intrinsically have higher bleeding risks, deterring clinicians from prescribing them oral anticoagulants. Setting a narrow international normalized ratio (INR) target range might potentially mitigate some of these risks. This study sought to compare the outcomes of elderly patients who were assigned to either a narrow INR target range or the conventional INR target range in a real-world environment.

[Study on mechanism of inducing apoptosis in human hepatoma SMMC-7721 cells by DMC, a chalcone from buds of Cleistocalyx operculatus].

Objective: To study the in-vitro inducing apoptosis mechanism of human hepatoma SMMC-7721 cells by 2',4'-di- hydroxy-6'-methoxy-3',5'-dimethylchalcone (DMC), a chalcone compound from Cleistocalyx operculatus.

Method: Quantitative DNA fragmentation assay was carried out to detect the effect of DMC of different concentrations on SMMC-7721 cells, according to the method of Sellins and Cohen with some modifications. Telomerase activities of the cells were determined by PCR-ELISA methods.

2',4'-Dihydroxy-6'-methoxy-3',5'-dimethylchalcone, from buds of Cleistocalyx operculatus, induces apoptosis in human hepatoma SMMC-7721 cells through a reactive oxygen species-dependent mechanism.

Nowadays, much effort is being devoted to detect new substances that not only significantly induce the death of tumor cells, but also have little side effect on normal cells. Our previous study showed that 2',4'-dihydroxy-6'-methoxy-3',5'-dimethylchalcone (DMC) exhibited significant cytotoxic potential with an IC50 value of 32.3 ± 1.

Multi-source/component spray coating for polymer solar cells.

A multi-source/component spray coating process to fabricate the photoactive layers in polymer solar cells is demonstrated. Well-defined domains consisting of polymer:fullerene heterojunctions are constructed in ambient conditions using an alternating spray deposition method. This approach preserves the integrity of the layer morphology while forming an interpenetrating donor (D)/acceptor (A) network to facilitate charge transport.

Oxide mediated liquid-solid growth of high aspect ratio aligned gold silicide nanowires on Si(110) substrates.

Silicon nanowires grown using the vapor-liquid-solid method are promising candidates for nanoelectronics applications. The nanowires grow from an Au-Si catalyst during silicon chemical vapor deposition. In this paper, the effect of temperature, oxide at the interface and substrate orientation on the nucleation and growth kinetics during formation of nanogold silicide structures is explained using an oxide mediated liquid-solid growth mechanism.

ZnO nanorods with two spatially distinct light emissions.

Single-crystalline ZnO nanorods emitting two characteristic optical emissions from opposite halves of the nanorods were synthesized by thermal chemical vapor deposition using Zn/Al mixed powders. Energy dispersive x-ray spectra with transmission electron microscopy show a gradually decreasing Zn:O atomic ratio from the root to the top of a nanorod, and the averaged ratios at the two ends are ≈57.2:42.