Dear Editor, During the Ministry of Health workplan seminar held on 2 June 2022, Minister Ong Ye Kung expounded the notion of a good death and outlined the Ministry’s vision and strategy for better care (and experience) for all near the end of life.1 Specifically, he aimed to reduce the...

Dear Editor, End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life.1 However, many of them (82%) prioritise minimising suffering over life prolongation. Although twice as many patients prefer dying at home and inpatient hospice (65%) compared to hospital (27%), hospice utilisation...

Dear Editor, Mok et al. gave hope for cautious optimism for the acceptance of telemedicine for palliative care—which will be referred to as “telepalliative care” in this article—during the COVID-19 pandemic.1 Properly organised, telepalliative care can save time, provide flexibility, improve access for patients2,3 and possibly reduce the need for...

Modern society views death as an aberration which has to be postponed and, if possible, prevented at all cost. Death is just unacceptable and cannot be regarded as a natural process of life. This article is available only as a PDF. Please click on “Download PDF” on top to view...

A patient with recurrent stroke disease and severe pneumonia did not respond to the previous courses of antibiotics. The medical team decided to switch to another broad-spectrum antibiotic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A syndrome of total functional dependence, poor mobility, lack of meaningful communication and incontinence of bowels and bladder appears to be the final common pathway for many neurodegenerative conditions such as the dementias, Parkinson’s disease (PD) and motor neurone disease (MND). In the United States, the National Hospice Organisation...

Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese. This article is available only as a PDF. Please...

Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the defect in the thoracic enclosure. According to aetiology, pulmonary hernias can be congenital (due to rib or intercostal hypoplasia or agenesis) or acquired (traumatic, pathological...

Around two-thirds of people with incurable diseases in economically developed countries wish to die at home, but less than one third succeed in doing so. Developing primary care-based services for the dying in the community is essential to reach and serve the whole population, and to provide care where...

Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...

A hiccup is a result of an involuntary, intermittent spasmodic contraction of the diaphragm and the inspiratory intercostal muscles, resulting in a sudden inspiration and ends with an abrupt closure of the glottis. This article is available only as a PDF. Please click on “Download PDF” on top to view...

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients. This article is available only...

The concept of medical futility has been present since antiquity, and traditionally marked the shift in the primary goal of care to providing physical and emotional comfort. Only by following the declaration of futility could interventions be designed to relieve distress and pain for the patient, and bringing a...

Dear Editor, We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19 in Pakistan: Lessons, legislation challenges and future perspective”.1 We would like to share our perspectives on using telemedicine to deliver palliative care during the COVID-19...

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...

The management of schizophrenia has advanced considerably since the term was first coined in 1911, with Kraepelin’s early pessimism tempered by more recent evidence examining outcome. The discovery of antipsychotics represented a major breakthrough in the treatment of schizophrenia, while more recently we have witnessed promising initiatives such as...

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in Singapore and from around the world. Between 2010–12, local OHCA patients with a witnessed arrest and shockable rhythm had a survival-to-hospital discharge rate of 11.0%. Treatment of OHCA patients is resource-intensive since it requires invasive interventions and potentially...