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The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors associated with change resistance and acceptance from both patients’ and medical staff’s perspectives.

A survey design study, with two questionnaires developed and distributed to patients and medical staff. Convenience and stratified random sampling methods were applied to patient and medical staff samples.

A 5-dimension, 21-item patient questionnaire and a 4-dimension, 16-item staff questionnaire were identified and confirmed, with 1020 patients (91.07 percent) and 202 staff (90.18 percent) as effective survey participants. The results revealed that patient resistance mainly stems from a lack of personal experiences with visiting general practice (GP) and being educated or having lived overseas; while staff resistance came from occupation, education, GP training certificate, and knowledge and experience with specialists. Living in overseas and knowledge of GP concepts, gender and education are associated with resistance of accepting the new practice model for both patients and staff.

There are few Chinese studies on process reengineering in the medical sector; this is the first study to adopt this medical consultation model and change in patients’ consultation culture in Mainland China. Applying organizational change and process reengineering theories to medical and healthcare services not only extends and expands hospital management theory but also allows investigation of modern hospital management practice. The experience from this study can serve as a reference to promote this new consultation model in Chinese healthcare reform.

This study aims to summarize the critical issues in medical federated learning and applicable solutions. Also, detailed explanations of how federated learning techniques can be applied to the medical field are presented. About 80 reference studies described in the field were reviewed, and the federated learning framework currently being developed by the research team is provided. This paper will help researchers to build an actual medical federated learning environment.

Since machine learning techniques emerged, more efficient analysis was possible with a large amount of data. However, data regulations have been tightened worldwide, and the usage of centralized machine learning methods has become almost infeasible. Federated learning techniques have been introduced as a solution. Even with its powerful structural advantages, there still exist unsolved challenges in federated learning in a real medical data environment. This paper aims to summarize those by category and presents possible solutions.

This paper provides four critical categorized issues to be aware of when applying the federated learning technique to the actual medical data environment, then provides general guidelines for building a federated learning environment as a solution.

Existing studies have dealt with issues such as heterogeneity problems in the federated learning environment itself, but those were lacking on how these issues incur problems in actual working tasks. Therefore, this paper helps researchers understand the federated learning issues through examples of actual medical machine learning environments.

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Is humanity heading to immortal living? If so, what areas of society are playing an active role in achieving this? In order to understand this, the study explores the relationship between immortality and the wellness and medical tourism industry to seek potential relationships between them and ultimately, asks difficult questions about the growth of these tourism sectors and the potential need for greater regulation of them.

Taking a pragmatic philosophical approach and through the examination of refined information from secondary sources and published material and reports, the study presents original theoretical knowledge and a model exploring tourism and human immortality.

This paper argues that continued growth in the wellness and medical markets today could lead to a world where transhumanists and cyborgs are present in our world, even taking over from Homo sapiens. The study presents a model highlighting the potential role of wellness and medical tourism markets, illustrating the potential for future consumer services that could further fuel the search for immortality. Thus, how such markets and consumer desires are (in)directly supporting humanities desire for (non-human) immortal existence.

Today, individuals are driven by wellness practices and medical and cosmetic desires and are willing to travel the globe in search of companies who are either capable of carrying out the desired procedures or seeking prices more affordable to them. This research offers novel insights into these complex relationships and maps the affiliation between wellness and medical practices and the concept of immortality.

The purpose of this paper is to present the results of a critical analysis of the disability models developed to date and of how they function in practice. Furthermore, it aims to answer the following question: which model of disability (MD) will provide the most suitable foundation for any course of action undertaken in the process of planning accessible tourism development in the future?

In the first stage of the study a critical analysis of the MDs described in the literature as well as in selected reports and expert opinions relating to people with disability (PwD) was performer. These findings then became the basis for the second stage of the study which focuses on identifying attitudes within society towards the types of tourism on offer connected to the analysed MDs. The applied research methods include an analysis of a survey (2013, 2014) carried out face-to-face and on the SurveyMonkey web site. The study group consisted of 619 people (from Poland, Russia, Germany, Portugal, Slovakia, Canada, Tunisia and Great Britain).

The great diversity of disabilities makes finding a universal solution in the creation of accessible tourism supply a complex task. This supports the need for a flexible “mix of various models” aimed at finding optimal solutions and the personalisation of tourism. In this context the greatest potential in the development of accessible tourism are models which are a synthesis of many determiners of disability such as the biopsychosocial or the geographical model of disability. The dynamics of accessible tourism development is likely to be increasingly influenced by the economic model, reflecting current trends for the personalisation of tourism supply.

The survey was carried out mainly within the European Community, the exception being respondents from Irkutsk in eastern (Asian) Russia. In order to gain a global view of the development of accessible tourism, research should be performed in countries representing all continents or tourist regions. Additionally, reflecting the definition of accessible tourism its beneficiaries – PwD – should participate in decision-making processes. Tourism service providers who are directly engaged in tourism supply also have a role to play. Their opinions and attitudes towards the development of accessible tourism determine its very nature in reality.

The survey on attitudes in society regarding the organisation of tourist trips for PwD confirmed conclusions from the analysis of the practical implications of various disability models in the creation of tourism supply that a single universal, optimal solution does not exist. All of the described MD can be applied in the development of a diverse tourism supply. The proposed model “diversification of supply […]” is the theoretical basis for the conscious development of accessible tourism in practice which in accordance with changes observed in the tourism market is undergoing increasing diversification and personalisation.

In each of the tourism supply for PwD types the economic model of disability based on the identification of PwD needs and surrounding society is important. The number of PwD and the scope of necessary services, social support (PwD often travel accompanied by one to three people) is determined by income in all the sectors identified in the structure of tourism supply. From the economic point of view, awareness of different types of disability and the diverse models describing it are significant aids in the segmentation of tourism supply and placement of products accessible to PwD on the tourism market.

The paper presents a new, critical perspective on the selected MD, the key to which is the search for optimal solutions in the development of accessible tourism. The analysis performed indicated the need for a synthesis of paradigms at the core of the conceptualisation of particular models, including those often regarded as being contrary (medical and social). The results of studies would give tourism providers important data on an increasingly competitive tourism market, and also affect changes in how PwD, the elderly, are viewed, from the category of “relatively poor” to “attractive, using a wide range of services”.

Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA).

Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996).

The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped.

The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency.

Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

The past decade has witnessed a tremendous and progressive growth in the number of Nigerians who engage in medical tourism from Nigeria to India. Various commentators have advanced diverse reasons for this trend. However, there is a dearth of research that has sought to provide empirical insights. This paper aims to investigate the decision-making process of Nigerian medical tourists and why they prefer medical tourism to India to medical care locally.

Eight Nigerian medical tourists are interviewed on a one-on-one basis with open-ended questions using purposive criterion sampling technique from an interpretivist mind-set.

The paper identifies two major motivators, namely, inadequate medical infrastructure and poor medical, and customer service from health workers in Nigeria, which spurred medical tourism from Nigeria to India. Further, it finds that first timers premise their decisions on advice from reference groups, while previous personal experiences guide decisions on subsequent medical travels. Findings are explained using the template provided by the theory of planned behaviour.

This exploratory nature of this research provides a useful basis to elucidate the course of decision-making of Nigerian patients so that appropriate marketing communication channels can be applied. It improves the process of recruiting and engaging Nigerian patients and nurturing wholesome relationships between Nigerian patients and hospitals.

The purpose of this study is to describe the design and validation of a three-dimensional (3D)-printed phantom of a uterus to support the development of uterine balloon tamponade devices conceived to stop post-partum haemorrhages (PPHs).

The phantom 3D model is generated by analysing the main requirements for validating uterine balloon tamponade devices. A modular approach is implemented to guarantee that the phantom allows testing these devices under multiple working conditions. Once finalised the design, the phantom effectiveness is validated experimentally.

The modular phantom allows performing the required measurements for testing the performance of devices designed to stop PPH.

PPH is the leading obstetric cause of maternal death worldwide, mainly in low- and middle-income countries. The proposed phantom could speed up and optimise the design and validation of devices for PPH treatment, reducing the maternal mortality ratio.

To the best of the authors’ knowledge, the 3D-printed phantom represents the first example of a modular, flexible and transparent uterus model. It can be used to validate and perform usability tests of medical devices.

The purpose of this paper is to investigate US noncombatant evacuation operations (NEO) in South Korea and devise planning and management procedures that improve the efficiency of those missions.

It formulates a time-staged network model of the South Korean noncombatant evacuation system as a mixed integer linear program to determine an optimal flow configuration that minimizes the time required to complete an evacuation. This solution considers the capacity and resource constraints of multiple transportation modes and effectively allocates the limited assets across a time-staged network to create a feasible evacuation plan. That solution is post-processed and a vehicle routing procedure then produces a high resolution schedule for each individual asset throughout the entire duration of the NEO.

This work makes a clear improvement in the decision-making and resource allocation methodology currently used in a NEO on the Korea peninsula. It immediately provides previously unidentifiable information regarding the scope and requirements of a particular evacuation scenario and then produces an executable schedule for assets to facilitate mission accomplishment.

The significance of this work is not relegated only to evacuation operations on the Korean peninsula; there are numerous other NEO and natural disaster related scenarios that can benefit from this approach.

The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health environment.

This paper reviews the current literature on this topic.

Hospitals have evolved from being professional bureaucracies to being managed professional business with clinical directorates in place that are medically led.

Limitations include the difficulty doctors have balancing clinical duties and management, restricted profession-specific view and the lack of management competencies and/or training.

The benefits of having doctors in health management include bottom-up leadership, specialised knowledge of the profession, expert knowledge of clinical care, greater political influence, effective change champions to have on-side, frontline leadership and management, improved communication between doctors and senior management, advocacy for patient safety and quality, greater credibility with public and peers and the perception that doctors have more power and influence compared to other health professionals can be leveraged.

Overall, there are more benefits than there are limitations to having doctors in health management but there is a need for more management training for doctors.