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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. Methods This mixed-method case study, which centred on a specialist-led General Medicine model implemented at an acute hospital in Singapore, aimed to (1) quantitatively summarise its clinical outcomes, and (2) qualitatively describe the challenges and lessons gathered from the pragmatic implementation of the care model. Quantitative hospital data were extracted from databases and summarised. Qualitative staff-reported experiences and insights were gathered through semi-structured interviews and analysed using thematic analysis. Results Quantitative findings revealed that the generalist care model was implemented with high fidelity, where more than 75% of patients admitted were placed under General Medicine’s or General Surgery’s care. The mean length of stay was 2.6 days, and the 30-day post-discharge readmission rate was 15%. Inpatient mortality rate was found to be 2.8%, and the average gross hospitalisation bill amounted to SGD3,085.30. For qualitative findings, themes concerning feasibility and operational aspects of the implementation were grouped into categories- (1) Feasibility of ‘One Care Team’ approach, (2) Enablers required for meaningful generalist care, (3) Challenges surrounding information sharing, (4) Lack of integration with the community to facilitate care transition, and (5) Evolving roles of self-management. The findings were rich, with some being identified as barriers that could benefit from system-level de-constraining. Discussion This case study was an illustration of our pursuit for an integrated solution to rising prevalence of multimorbidity. While quantitative findings indicated that a pivot towards General Medicine might be possible, data also revealed gaps in clinical outcomes, especially in readmission rates. These findings corroborated with much of the lessons and challenges gathered from qualitative interviews, specifically surrounding the lack of receptacles in the community to facilitate care transition, training, and competency of generalists in holistic management of complex multimorbid cases, as well as inadequate infrastructure to allow information sharing between providers. Thus, a multi-pronged approach might be required to develop a new and sustainable care model for patients with multimorbidity in the long run. In the short to medium transitional period, nonetheless, the specialist-led General Medicine care model demonstrated might be a viable interim approach, especially in circumstances where trained medical generalists remained limited.

Pressure retarded osmosis (PRO) is a promising technology to harvest renewable osmotic energy using a semipermeable membrane. However, a significant flux reduction has been always observed that severely shrinks the harvestable power to a level only marginally higher or even lower than the economically feasible value. This work focuses on the elucidation of various underlying mechanisms responsible for the flux reduction. First, both inner-selective and outer-selective thin film composite (TFC) hollow fiber membranes are employed to examine how the fundamental internal factors (such as the surface salinity of the selective layer at the feed side (C F,m) and its components) interact with one another under the fixed bulk salinity gradient, resulting in various behaviours of external performance indexes such as water flux, reverse salt flux, and power density. Then, the research is extended to investigate the effects of the growing bulk feed salinity due to the accumulated reverse salt flux along PRO modules. Finally, the insights obtained from the prior two stationary conditions are combined with the advanced nucleation theory to elucidate the dynamic scaling process by visualizing how the multiple fundamental factors (such as local supersaturation, nucleation rate and nuclei size) evolve and interplay with one another in various membrane regimes during the whole scaling process. To our best knowledge, it is the first time that the advanced nucleation theory is applied to study the PRO scaling kinetics in order to provide subtle and clear pictures of the events occurring inside the membrane. This study may provide useful insights to design more suitable TFC hollow fiber membranes and to operate them with enhanced water flux so that the PRO process may become more promising in the near future.

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