Related Articles

Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson’s disease in Singapore

Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disorder characterised by motor symptoms such as limb bradykinesia, rigidity and resting tremor.1 Non-motor symptoms, including mood disturbances, cognitive impairment, autonomic dysfunction, and sleep disorders, are also common. Disease progression often leads to motor fluctuations and dyskinesias, along with worsening...

A consensus survey of neurologists and clinical geneticists on spinal muscular atrophy treatment in Singapore

Dear Editor, Just a decade ago, spinal muscular atrophy (SMA) was considered a debilitating, progressive neuromuscular disease that inevitably led to chronic disability and a shortened lifespan. Now, it is treatable with nusinersen, onasemnogene abeparvovec (OAV) and risdiplam—the 3 disease-modifying drugs approved by the US Food and Drug Administration, the...

Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience

Dear Editor, Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan Tock Seng Hospital (TTSH), the TELE ACC service was established to enrol patients who (1) perform self-testing using a loaned point-of-care (POC) international normalised ratio...

HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?

Dear Editor, Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been  identified. Notably,  carriers  of  the HLA-B*5801  and  HLA-B*1502  alleles ...

Knowledge, attitudes and practices of doctors on constipation management in Singapore

Dear Editor, Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...

Value the patient as a person: Answering the call for a person-centred model of care

There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....

Script concordance test to assess diagnostic and management reasoning in acute medicine

Dear Editor,  Clinical reasoning, an essential skill for patient care, can be difficult to assess. We created and validated a script concordance test (SCT) to assess clinical reasoning in acute medicine. This tool was used to provide feedback and targeted remediation for Postgraduate-Year-1 (PGY1) doctors, guide teaching and learning, and...

Through the eyes into the brain, using artificial intelligence

Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...

The eye as a window to the brain

Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact hold more truth than previously thought. We are currently able to distinguish a variety of systemic diseases by funduscopic inspection. Following the dawn of high-resolution...

Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders

Dear Editor, Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1 We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...

Treating acutely ill patients at home: Data from Singapore

Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...

Neuralgic amyotrophy in COVID-19 infection and after vaccination

Dear Editor, Various neurological manifestations associated with coronavirus disease 2019 (COVID-19) have been described,1 conditions which left a significant proportion of patients with permanent disability. Continued vigilance is crucial with emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that cause the disease. Vaccination against COVID-19 remains the...

A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred speech. Physical examination revealed generalised weakness. Initial blood tests showed raised total white cell count, raised erythrocyte sedimentation rate at 35mm/h and fasting low-density lipoprotein...

Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant

The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific slowing in the background with stereotypical generalised periodic high-voltage slow and sharp wave complexes. This article is available only as a PDF. Please click on “Download...

The Profile of Hospitalised Patients with Parkinson’s Disease

Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude prevalence rates range from 10 to 450 per 100 000 population. This article is available only as a PDF. Please click on “Download PDF” on top...

Academic Medicine in Singapore

Academic medicine is currently grappling with the problem of whether the triple-threat academician is a species threatened with extinction in the 21st century, given the extraordinary growth of knowledge during the past decades. Academicians, by this definition, were expected to be original and productive investigators, inspiring teachers and outstanding...

The Alien Hand Sign–Case Report and Review of the Literature

The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is foreign, together with autonomous activity which is perceived as independent of voluntary control, as if the hand is driven by an external agent. This article is...

Electrophysiological Features in the Management of Meralgia Paraesthetica

Meralgia paraesthetica is a condition resulting from entrapment of the lateral femoral cutaneous nerve at the region of the anterior superior iliac spine, when the nerve angulates sharply over the inguinal ligament. It presents classically with pain, paraesthesia and sensory loss over the anterolateral surface of the thigh. This article...

Foregoing Life Support in Medically Futile Patients

The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the role of medicine was “to do away with the suffering of the sick, to lessen the violence of their diseases, and to refuse to treat...

Nitric Oxide in Septic Shock: Directions for Future Therapy?

In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated by a labile humoral substance termed endothelium-derived relaxing factor (EDRF). This article is available only as a PDF. Please click on “Download PDF” on top to...

Critical Care Medicine in the Western Pacific Region

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and medical traditions. The Western Pacific Association of Critical Care Medicine (WAPCCM) includes countries from Japan in the north to Australia and New Zealand in the...

Critical Care—The Worldwide Perspective

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s. Prolonged hand ventilation, and positive or negative pressure ventilation, enabled maintenance of oxygenation until some patients developed sufficient recovery or compensatory processes to enable separation...

Malaria Requiring Intensive Care

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Ergotism and Vascular Insufficiency: A Case Report and Review of Literature

Toxicity from ergot and its derivative is well known. Great epidemics occurred during the middle ages due to consumption of rye contaminated with the fungus, Claviceps purpurea, which elaborates the ergot alkaloids. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis

Genetic susceptibility and environmental factors influence the prevalence and clinical manifestations of multiple sclerosis (MS). Since MS is rare in Southeast Asia, descriptions of this disease particularly as it occurs in Singapore have been sparse. This article is available only as a PDF. Please click on “Download PDF” on top...

Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease. This article is...

Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic occlusion of a cerebral artery. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Palatal Myoclonus—A Case Report

Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and limb muscles. It usually develops secondary to brainstem or cerebellar disease (symptomatic palatal myoclonus) interrupting the central tegmental tract or dentato-olivary fibres. This article is available...

Intravital Microscopy for the Study of the Microcirculation in Various Disease States

It is more than 150 years ago when the first detailed description of intravital microscopy was given by Waller, demonstrating in the frog tongue the passage of leukocytes (at that time interpreted as “mucous and pus globules”) through microvessels. Later, the mesentery was acknowledged as the most suitable object...

Potentiation of Acetylcholine-induced Smooth Muscle Contraction in Rat Ileum by Lead

It is known that exposure of animals and humans to heavy metals such as lead can result in neurological dysfunction. Pharmacodynamic effects of lead (Pb++) on tension of smooth muscles, interaction with catecholaminergic function and neuromuscular transmission have been described. This article is available only as a PDF. Please click...

Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Role of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Patients with Hemifacial Spasm

Hemifacial spasm (HFS), characterized by intermittent twitching of muscles supplied by one facial nerve is commonly due to compression of the facial nerve by blood vessel(s) adjacent to its root exit zone (REZ). The facial nerve REZ refers to the part where facial nerve exits from the pons. This article...

The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s disease (AD). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Current State of Multiple Sclerosis Genetic Research

It was Charcot (1868) who first made the formal pathological correlation between lesions in the central nervous system (CNS) and a disorder termed, ‘la sclérose en plaques’. Today, a number of other immune-mediated, demyelinating CNS diseases have been recognised and hence, classical multiple sclerosis (MS) is now specified as...

The Genetics of Human Epilepsies

Epilepsies are one of the most common neurological disorders, affecting about 3% of individuals at least once in a lifetime. It thus represents a major health care problem. Socio-economical and educational issues are well known. This article is available only as a PDF. Please click on “Download PDF” on top...

Sleep/Wake Cycle and Circadian Disturbances in Shift Work: Strategies for Their Management—A Review

Humans have primarily been active/awake during the day and inactive/asleep at night. The discovery of artificial light and introduction of electric power generator have made available a continuous and reliable source of light throughout day and night. This article is available only as a PDF. Please click on “Download PDF”...

Incidence and risk factors of delirium in post-anaesthesia care unit

Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It has a strong association with postoperative delirium, which is present in up to 45% of patients after surgery.2-5 PACU is a wide-reaching problem, and especially...

Delirium in patients following general anaesthesia

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or a disorganised thinking, resulting in an impaired ability of the patient to receive, process, store and recall information. Delirium develops over a short period of...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in Singapore. This situation may change. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports

Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s pouch and are characteristically lined by a single layer of ciliated cuboidal or columnar epithelium with goblet cells. However, foci of squamous epithelium in Rathke’s...

Book Review

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore. This article is available only as a PDF. Please click on “Download PDF”...

Advances in Neurointensive Care

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper and Dan Hanley, have led in demonstrating the specialised expertise that neurointensivists offer to critically ill patients. This article is available only as a PDF. Please...

The Eye in Neurology: Evaluation of Sudden Visual Loss and Diplopia—Diagnostic Pointers and Pitfalls

The first step in the evaluation of sudden visual loss is to determine if the visual loss is monocular or binocular. The first diagnostic pitfall to avoid is the assumption that what is one-sided is one-eyed. This article is available only as a PDF. Please click on “Download PDF” on...

Neuroprotection in Acute Stroke

The neuronal cells of the central nervous system are especially susceptible to various forms of insult such as trauma and ischaemia. Once the ischaemic cascade is set into motion by the initiating injury, the resultant damage is traditionally considered to be unavoidable, untreatable and permanent. This article is available only...

Current and Emerging Treatments in Parkinson’s Disease

Parkinson’s disease (PD) affects 1% of adults above the age of 65 years. It is characterised histologically by the loss of neurons in the substantia nigra pars compacta and the presence of Lewy bodies within the degenerating neurons. This article is available only as a PDF. Please click on “Download...

Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore

Huntington’s disease (HD) is an autosomal dominantly inherited disease, affecting 1 in 10,000 individuals of European origin. The incidence in the Asian population is much lower, and the estimated prevalence in Singapore is 3 to 15 per million. This article is available only as a PDF. Please click on “Download...

Gemella Empyema Cured without Antibiotics: A Case Report

Gemella are gram-positive anaerobic bacteria that rarely produce serious human infections. We describe a case of thoracic empyema that occurred in an elderly Chinese male which, to our knowledge, is the first reported case out of Southeast Asia. This article is available only as a PDF. Please click on “Download...

Aseptic Meningitis in Children—The Singapore Experience

Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified, more than 90% were due to enteroviruses. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001. This article is available only as a PDF. Please click on “Download PDF”...

The Clinician Meets the Computer—Uneasy Bedfellows

Information technology has become a cornerstone of civilization as we know it. In its broadest definition, information technology encompasses all forms of technology required to create, archive, exchange and manipulate data. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Leveraging on Information Technology to Enhance Patient Care: A Doctor’s Perspective of Implementation in a Singapore Academic Hospital

Information technology (IT) has become truly pervasive in everyday life; however, in the field of medicine, we have yet to fully harness its full potential in the care of our patients. Most restructured hospitals in Singapore have been wired up with fast local area networks (LAN) and desktop personal...

Internal Medicine

It has taken a long time to plan for this November issue in Internal Medicine. The topic is so wide and often neglected as the specialties take prominence. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

General Medicine—Revisited, Rejuvenated, Revitalised and Reemphasised

“The irresistible swing towards medical specialisation has brought advantages for patients but arguably this has gone too far.” It is time to review the role of general medicine and general physicians in Singapore; with its own unique system of healthcare where patients can see any specialist and subspecialists without...

A Countrywide Approach to the Control of Non-communicable Diseases—The Singapore Experience

In the area of health, the last two decades has seen a decline or eradication of deadly diseases, such as smallpox and polio, the introduction of the fatal disease, such as acquired immunodeficiency syndrome (AIDS), and a marked rise in chronic diseases, making them the leading worldwide public health...

Causes for the Evolution of Case Management and the Development of a Working Model in an Acute Care Hospital in Singapore

In 1999, significant changes to the healthcare funding structure were introduced to public sector hospitals in Singapore. This was the advent of casemix-based funding for acute inpatient and day surgery episodes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Stroke Disease Management—A Framework for Comprehensive Stroke Care

Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a shift in focus from viewing patient care as discrete episodes or fragmentary encounters with different parts of the healthcare system, to provision of high-quality care...

Evidence-based Medicine: The Key to Guidelines, Disease and Care Management Programmes

Health care in America and the rest of the industrialised world continues to reinvent itself at an ever-accelerating rate. The societal pressures for high quality, high value care that produces measurable improvement in quality processes and outcomes is increasing from the government and private sectors. This article is available only...

Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery

Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling increase in healthcare expenditure in recent years, many countries have implemented cost-containing measures in healthcare financing. This article is available only as a PDF. Please click...

National Disease Management Plans for Key Chronic Non-communicable Diseases in Singapore

Like most other newly industrialised economies, Singapore has undergone a rapid epidemiological transition over the last 50 years. Chronic, non-communicable diseases have replaced infectious diseases as the dominant public health problems in Singapore today. This article is available only as a PDF. Please click on “Download PDF” on top to...

Chronic Disease Management: Challenges for Clinicians and the Way Forward

The healthcare, financial and social burden of chronic diseases, such as diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression, osteoporosis, end stage renal failure and stroke, are steadily on the rise. In the US alone, some 125 million people now suffer from at least...

Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey

Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...

Should Ethical Issues in Biotechnology Research be Decided by Physicians-Scientists or by Lawyers?

As with clinical practice, the practice of biomedical research is a moral activity. We have to think about what we should do, not just about what we can do, to modify life. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Seeing How We Think About Words Using BOLD Contrast fMR Imaging

Functional brain imaging refers to a set of non-invasive imaging techniques that are used to infer linkages between brain structure and function. In this review, blood flow functional magnetic resonance imaging (fMRI) is specifically discussed. This article is available only as a PDF. Please click on “Download PDF” on top...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...

Patterns and predictors of sound levels in hospital rooms

Dear Editor,      Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...

1st College of Physicians Lecture: The Role of Internal Medicine as a Specialty in the Era of Subspecialisation

It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled “The Role of Internal Medicine as a Specialty in the Era of Subspecialisation”. I believe I am given this honour as I am one of the few of a seemingly dying...

Standards and Revalidation or Recertification

In my Gordon Arthur Ransome Oration and other papers, I have described the nature and development of patient-centred professionalism, the key features of which are summarised in Figure 1. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Continuing Professional Development – a Surrogate for Recertification?

The Hong Kong Academy of Medicine is a statutory body set up in 1993 with the objectives of fostering the development of postgraduate medical education and continuing medical education, the study and practice of medicine and its specialties, and medical research. It is concerned with the standard of specialist...

Teaching and Learning of Professionalism in Medical Schools

There is now worldwide consensus that the elements of medical professionalism need to be enhanced and explicitly taught in medical schools. Medical schools in the United Kingdom (UK) have recently published a model for a core ethics curriculum. This article is available only as a PDF. Please click on “Download...

The Challenge of Teaching Professionalism

For the past 25 years, professionalisation, industrialisation, large-scale infusions of technology into the healthcare system and consumerism, to name a few factors, have definitely contributed to changes in the healthcare environment. At the same time, society has moved from modernity to post-modernity with the adoption of pluralism, relativism and...

2004 Runme Shaw Memorial Lecture: Professionalism – A Concept in Need of Nurturing

It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for their support of this lecture. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

17th Gordon Arthur Ransome Oration: Patient-centred Professionalism

When sickness strikes we all need doctors. People everywhere know that the quality of medical care can affect the outcome and possible consequences of illness, and at times mean the difference between life and death. This article is available only as a PDF. Please click on “Download PDF” on top...

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to 1.0 per million population. However, the incidence of CJD in the Singaporean population is not known. With a population of 4 million, an estimated 2...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that not only effects saltatory conduction but also protects and maintains the axonal structure. It is the last type of cells that appear in the CNS....

Refining Clinical Practice: Transforming Science Research into the Art of Medicine

I am humbled by the invitation given to me by Changi General Hospital to deliver this lecture at your 5th Annual Scientific Meeting with the theme “Frontiers of Medicine”. Thank you very much for the honour accorded me. Your CEO, Mr Udairam, and your CMB, Prof Fock Kwong Ming,...

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi, gradually spreading to involve the rest of the ipsilateral facial muscles. This article is available only as a PDF. Please click on “Download PDF” on top...

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is the most common cause of acute neuromuscular paralysis. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Extended-spectrum Beta-lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. in a Singapore Hospital: Clinical Spectrum

Extended-spectrum beta-lactamases (ESBLs) in gram-negative bacillary pathogens are a growing and important problem in hospital practice and it is tied to extensive use of broad-spectrum antibiotics. The emergence of ESBLs has increased the possibility that traditional, empiric antimicrobial regimens may be ineffective. This article is available only as a PDF....

Routine Microbiological Screening in Septic Patients in a Cardiac Surgical Intensive Care Unit

Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Medical Education in Asia: Is it a Time for Optimism?

Asia, the largest continent, is also an immensely diverse region with countries that vary in their socio-economic status, degree of urbanisation and health and disease profile. The objective of medical education is to create efficient and compassionate healers to serve indigenous society’s aspiration and priorities. This article is available only...

Issues and Priorities of Medical Education Research in Asia

Medical schools traditionally rest on the “three-legged stool” of research, education and service. Hence, medical teachers are sometimes referred to as “triple-threat academicians”. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Genital Herpes in a Sexually-transmitted Infection Clinic in Singapore: A 1-year Retrospective Study

Genital herpes simplex virus (HSV) infection is a commonly notified sexually transmitted infection (STI). Genital herpes can be caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2), with HSV-2 being the predominant infection in genital herpes. This article is available only as a...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications. This article is available...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide repeat expansions and 16 types of SCAs have been described. This article is available only as a PDF. Please click on “Download PDF” on top to...

Professionalism: Looking For Your Blind Spots

In 1996 a major breakthrough was reported in the medical literature. A 5-week ectopic pregnancy was re-implanted into the uterus via the cervix, and the fetus was successfully carried to term. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease

For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within the scientific community. The unraveling of the human genome project brings hope and great optimism that a verdict on such debates may be in the...

Neural Progenitor and Stem Cells in the Adult Central Nervous System

Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in the 1970s and 1980s confirmed that neurogenesis occurs in hippocampus and subventricular zone (SVZ) of rodents. This article is available only as a PDF. Please click...

Methodological Aspects of Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM) has a long history but its efficacy is not as well-documented as one would hope. Proof of efficacy has to come from clinical trials, i.e., prospective experiments for assessing the results of medical interventions. This article is available only as a PDF. Please click on “Download...

A Practical Way of Research in Chinese Medicine

Chinese medicine individualises its treatment plan and practice and refutes any general law. Therefore, Chinese medicine practitioners do not have the tradition of research. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Complementary and Alternative Medicine, and Traditional Chinese Medicine: Time for Critical Engagement

Practice outside of mainstream or conventional medicine has always been an important part of public healthcare in some countries, particularly in the developing world. Recently the use of complementary-alternative medicine (CAM) has grown in popularity worldwide. This article is available only as a PDF. Please click on “Download PDF” on...

Student Academic Committees: An Approach to Obtain Students’ Feedback

The shift of medical curricula from a traditional subject based to an integrated module-based system can be seen in many medical schools worldwide. The change in curricular design was introduced to encourage student-centred learning and equip students with essential skills for future practice. This article is available only as a...

Curricular Trends in Malaysian Medical Schools: Innovations Within

Medical educators continue to evaluate and introduce innovations into their curriculum with the objective of achieving appropriate outcomes for their graduates so that they can meet the healthcare needs of the society locally and globally. They sought to develop approaches to teaching and learning that would address the goals...

A Problem-Based Learning Pathway for Medical Students: Improving the Process Through Action Research

Problem-based learning (PBL) is a student-centred, self-directed, integrated and contextual mode of learning. It has been widely perceived by many to confer advantages in promoting critical thinking, retention of knowledge, independent learning and interpersonal skills. This article is available only as a PDF. Please click on “Download PDF” on top...

A Simple Instrument for the Assessment of Student Performance in Problem-based Learning Tutorials

Assessment can be done in a variety of ways, for many purposes, and for different populations. It can occur at the classroom level, programme level, college level or even national level. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

An Online Evaluation of Problem-based Learning (PBL) in Chung Shan Medical University, Taiwan – A Pilot Study

The goal of problem-based learning (PBL) is to motivate students to develop self-learning skills in a small group. PBL embraces principles of good learning and teaching. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Evidence-based Medicine in Clinical Curriculum

Evidence-based medicine (EBM) is “the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.” Considering the vast amount of medical knowledge available today through various media outlets with almost no boundaries, it is essential that our medical graduates should have...

Leadership and Professionalism Curriculum in the Gross Anatomy Course

Healthcare delivery systems worldwide are currently undergoing significant changes to create resilient learning organisations that are able to adapt with ever-increasing speed to shifting business, regulatory, and competitive environments. The delivery of healthcare is no longer a single-provider responsibility; modern group practice organisations require a physician to be not...

Constructing Multiple Choice Questions as a Method for Learning

Students in general and medical students in particular are often described as “strategic learners”, but in reality many become superficial learners out of necessity when faced with the seemingly boundless volume of material in today’s curriculum. The apparent enormity of the task might encourage rote learning and much of...

Computer-based Versus Pen-and-paper Testing: Students’ Perception

Computer-based testing (CBT) has gained popularity as a testing modality, with large-scale professional examinations such as the United States Medical Licensing Examination (USMLE) adopting a CBT format since 1999, replacing the written pen-and-paper (PNP) format. Studies have found that testing format does not affect test scores, and that CBT...

Curriculum TIPS For All of Us

Medical education is a lifelong learning process. Just as we remind our students and ourselves that the practice of medicine is a lifelong process in which we continually seek to improve our knowledge so that we give our patients the most effective care, so too with medical education. This article...

Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation

The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...

Translational Research – A Multidisciplinary Approach

Translational research aims to convert laboratory discoveries into therapeutic gains for patients – in oncology, drug development is a prime example. This multifaceted process is often complicated and requires huge investments in time, money and expertise. This article is available only as a PDF. Please click on “Download PDF” on...

A Complex, Contagious, Evolutionary Habit

Yawning is often noted in medical seminars and conferences – be they surgical, orthopaedic, gastroenterological, endocrinological or neurological. Yet, this condition receives little coverage by professors in medical schools. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Amendment of the Human Organ Transplant Act

Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July 1970. However, prior to the commencement of the Human Organ Transplant Act (HOTA) in 1988, there was only a small number of kidney transplants; between...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes and non-caseating epithelioid granulomas in affected organs. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St Mungo’s Hospital for Magical Maladies

With the return of “You Know Who” (YKW) and the rise of Death Eaters, injuries amongst both muggle and wizarding folk (MF and WF) have escalated. Muggle medicine, with its quaint dependence on potions and “technology”, is inadequate to deal with magical injuries, and has much to learn from...

The Doctor’s Multi-instrument Tool of the Future?

It is just another day in 2020, except that the eyes of the medical world are eagerly awaiting the latest invention to be revealed: the ingenious multi-instrument pocket tool. Precision, quality, functionality and versatility are what this invention promises to deliver. This article is available only as a PDF. Please...

Relationship Between Item Difficulty and Discrimination Indices in True/False-Type Multiple Choice Questions of a Para-clinical Multidisciplinary Paper

Multiple-choice questions (MCQs) are used more and more in departmental examinations or as comprehensive examinations at the end of an academic session. They may be used to determine progress or to make decisions regarding the certification of a candidate. This article is available only as a PDF. Please click on...

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation of the practice of good clinical medicine. This is particularly so in Neurology, in which the detection of an absent reflex or of focal weakness...

Towards a Global Educational Matrix for Tomorrow’s Health Systems

Society supports medical schools expecting them to produce physicians who can improve both the health of the population as well as the health system itself. This goal has not been achieved yet; deaths from tuberculosis (1.7 million, 2006) are but one of many examples that points to that failure...

Harnessing the IT Factor in Medical Education

In this digital age, we are constantly inundated with breathtaking images worthy of an Ansel Adams photograph or a Zhang Yimou film. Is it any wonder, then, that we educationists feel compelled to “wow” our students, who may have become jaded by this daily barrage of digital wizardry to...

A Systems Approach to Teach Core Topics across Graduate Medical Education Programmes

Core curricula including Ethics, Medico-legal issues, Socioeconomics, and Quality Improvement (QI) are relevant and significant for graduate medical education programmes, regardless of specialty. A lack of faculty expertise in these content areas is a frequently cited concern among specialty programmes in graduate medical education. This article is available only as...

World Federation for Medical Education Policy on International Recognition of Medical Schools’ Programme

There is an increasing need for international quality assurance of medical education. However, there are no present mechanisms for international recognition of medical educational institutions and programmes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Quality Management of Medical Education at the Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany

In Germany, medical education is an undergraduate programme for which the students applying at the “Zentralstelle für die Vergabe von Studienplätzen” (ZVS); the final admission is primarily based on the grades of the “Gymnasium”. The number of applying students is about 4 times higher than the number of university...

Supporting Learners who are Studying or Training Using a Second Language: Preventing Problems and Maximising Potential

Travel and immigration are vibrant aspects of the international medical and educational field. Patients are increasingly mobile and finding healthcare professionals in a foreign country who can bring additional insights to help address their cultural and language needs can only benefit their care. This article is available only as a...

Development of a Tool to Evaluate Health Science Students’ Experiences of an Interprofessional Education (IPE) Programme

A shortage of healthcare professionals and resources in rural areas is well documented. These workforce shortages necessitate new models of healthcare in rural areas that focus on increased collaboration and communication to optimise patient care. This article is available only as a PDF. Please click on “Download PDF” on top...

Step-2 Thai Medical Licensing Examination Result: A Follow-up Study

The Center for Evaluating and Accrediting Medical Competency of the Thai Medical Council has established the regulation that Thai medical graduates matriculated as of 2003 have to pass the Medical Licensing Examination of Thailand (MLET) to qualify for medical practice. There are 3 steps in this national test. This article...

Does Team Learning Motivate Students’ Engagement in an Evidence-based Medicine Course?

Team-based learning (TBL) is a well-defined instructional strategy that has generated considerable interest within the medical education community because of its potential to promote active learning with a limited number of faculty facilitators. This mode of learning was originally developed more than 20 years ago for college business and...

A Survey of Medical Students’ Perceptions of the Quality of their Medical Education upon Graduation

Founded in 1934, Tehran University of Medical Sciences School of Medicine (TUMS-SoM) is the oldest modern medical school in Iran. It has the most number of academic staff and research productivity in the country, as well as the highest number of both undergraduate and postgraduate students enrolment per year. This...

The Learning of 7th Year Medical Students at Internal Medical – Evaluation by Logbooks

In 1945, Taihoku (Taipei) Imperial University was renamed the National Taiwan University and the Japanese teaching system was replaced with a system implemented by the Ministry of Education of the Republic of China. The 7-year curriculum in the School of Medicine, College of Medicine and the National Taiwan University...

Use of Knowledge-sharing Web-based Portal in Gross and Microscopic Anatomy

The extensive use of and the rate at which medical technology is becoming an integral force in medicine has impacted on the way in which physicians are being trained to practise within this new environment. Medical informatics and the era of interacting over web-based systems require competencies that need...

Assessment of Psychometric Properties of a Modified PHEEM Questionnaire

In Sri Lanka, after a 5-year medical undergraduate curriculum, graduates from the medical faculties undergo a one year mandatory internship or housemanship, 6 months each in 2 selected disciplines of clinical medicine, surgery, paediatrics, obstetrics & gynaecology and paediatric surgery in a recognised government hospital. After successful completion of...

Medical Education in a Flat World

In 2005 Thomas Friedman published the international best-seller The World is Flat: A Brief History of the Twenty-First Century. He asserted that as the world becomes more connected, it becomes a level playing field, in which all players have equal opportunities. This article is available only as a PDF. Please...

Objective Structured Clinical Evaluation Should Not Only Be a Test of Clinical Skill

The Objective Structured Clinical Examination (OSCE) was originally a test (or summative assessment) specifically of clinical skills, using standardised patients (SP), anatomical models and itemised checklists3 for scoring medical students. However, if OSCE was restricted to a test, as with any other test, many students would learn tricks for...

5th College of Physicians Lecture – A Physician’s Odyssey: Recollections and Reflections

Allow me to thank you Mr President and your Council for asking me to deliver the 5th College of Physicians Lecture. Your President has suggested that with over 50 years of association with Medicine, the title be “In the Service of the Medical Profession”. This article is available only as...

Standard Setting in Student Assessment: Is a Defensible Method Yet to Come?

To validate any “adjective”, be it for living or non-living, a criteria or standard is needed. Globalisation, mobility of doctors and the rising number of medical institutions make it imperative to have comparable standards in medical teaching learning and assessment. This article is available only as a PDF. Please click...

Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses

In Asia, the challenges facing medical education are similar across different countries. The learning process is still problematic with large classes, and most of the curriculum time being spent on traditional lectures. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Assessment of Medical Graduates Competencies

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...

Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for ischaemic stroke within 3 hours from symptom onset. This article is available only as a PDF. Please click on “Download...

Evidence-based Medicine (EBM) for Undergraduate Medical Students

The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence. This article is available only as a PDF. Please click on “Download PDF” on...

Transudates in Malignancy: Still a Role for Pleural Fluid

According to Light’s criteria, an exudate is defined by at least one of the following: a total protein pleural fluid to serum ratio greater than 0.5, an lactate dehydrogenase (LDH) pleural fluid to serum ratio greater than 0.6, or an absolute pleural fluid LDH greater than 2/3 of the...

Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review

Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation can be both total, taking place over 1 to 2 nights, or chronic partial, as characterised by insufficient restorative sleep over days, months and even...

Treatment of Circadian Rhythm Sleep Disorders with Light

In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the absence of environmental time cues, cycles of sleep-wake, physiology, and gene expression continue to exhibit a near-24-hour circadian rhythm (derived from the Latin phrase “circa...

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the prototypical example of a behaviour that demonstrates a circadian rhythm. Circadian (from the Latin “circa diem” – “about a day”) rhythms are also discernible in...

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly consumed ethanol in moderation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler

We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as evidenced by impaired cerebrovascular reactivity. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind. In more practical terms, it often, though not necessarily, narrows down to psychiatric comorbidities of neurologic diseases (e.g. depression in a patient with stroke) and...

Self-directed Learning in Health Professions Education

More than 600,000 new citations were published in MEDLINE in 2005; this raised the total number of indexed citations to more than 14 million citations. In a study be Williamson et al, 2 out of 3 primary care physicians described the volume of literature as unmanageable, and 1 out...

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in Tübingen. The patient, Auguste Deter, suffered memory loss, disorientation, hallucinations and died at an early age of 55. This article is available only as a PDF....

Translating the Family Medicine Vision into Educational Programmes in Singapore

The core of the Family Medicine (FM) vision is patient-centred care, requiring specific education and vocational training. Modern day FM began its existence as a “counterculture” to the disease-and-body-part focus of the hospital specialties in the 1960s. This article is available only as a PDF. Please click on “Download PDF”...

Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor unit number estimation are useful for the evaluation of lower motor neuron (LMN) damage, there is at present no objective and quantitative technique to detect...

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its earlier stages, no disease-modifying strategies are currently known. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore

Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics. TCD can aid in the diagnostic work-up by detecting, localising and grading the severity of intracranial arterial obstruction. This article is available only as a PDF....

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may suffer significant morbidity such as seizures or neurological deficits. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Erysipelothrix rhuseopathiae Septicaemia with Prolonged Hypotension: A Case Report

Erysipelothrix sp. is a gram-positive, non-spore forming bacterium that was first isolated by Robert Koch. It has the unusual ability to infect a large variety of vertebrate and invertebrate animals, including various species of domestic and wild animals, mainly swine, cattle, fish and birds. This article is available only as...

Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy

Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an agenda for many clinicians and scientists alike. Amongst others, restorative cell therapies are considered a potential treatment for this debilitating disease. This article is available only...

The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals

Healthcare systems are complex adaptive systems. They are capable of self organisation through interacting agents that adapt to changes to the internal and external environment. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Medication Use in the Transition from Hospital to Home

Hospital discharge can be a complex and challenging time for physicians and patients alike. Patients are being discharged sooner, often in the process of convalescence rather than at baseline health status. This requires physicians to more effectively communicate instructions for post discharge care to patients, family members, and outpatient...

Family Medicine Education in Singapore: A Long-standing Collaboration between Specialists and Family Physicians

In the US, Canada and Australia, the postgraduate training of family physicians (FPs) involves the attachment of family medicine (FM) trainees to specialist departments, similar to the model currently employed in Singapore. Unlike Singapore, however, FM training outside these hospital attachments is largely administered by senior FPs with minimal...

Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke

Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and sex-standardised prevalence of 3.65% among adults aged ≥50 years, and an incidence of 1.8/1000 patient-years. It is among our top 10 causes of hospitalisation. With...

Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead

The strong guiding hand and deep pockets of the state have brought about the growth of hospitals and national specialist centres while leaving the primary care sector largely to free market forces. Thus, it is not surprising that the evolution of Singapore’s healthcare system has largely favoured specialisation and...

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic drugs, this syndrome may also occur in patients with Parkinson’s disease (PD) during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy and...

Clinical Skills in Final-year Medical Students: The Relationship between Self-reported Confidence and Direct Observation by Faculty or Residents

In clinical medical education, instructors train students in their medical knowledge and clinical skills. Medical educators also aspire to develop students’ self-confidence in medical practice. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring

Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according to the current guidelines. However, significantly low recanalisation rates have been demonstrated with intravenous thrombolysis alone. This article is available only as a PDF. Please click...

Chewing-induced Facial Dystonia

Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and legs. Classification of this condition may be based on topography, age at onset, cause, or by the presence of genetic markers. This article is available only...

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom onset, utilisation is limited by delayed arrival of most patients to hospital. This article is available only as a PDF. Please click on “Download PDF” on...

Alzheimer’s disease–The Inexorable Epidemic

Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive domains such as language, praxis and executive function. More than 70 million people worldwide have dementia currently and AD accounts for over 50% of all...

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly understood condition with the pain described as a persistent facial pain that does not have the characteristics of cranial neuralgias and which is not attributable...

Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore

Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%. This article is available only as a...

Medical Professionalism in the Internet Age

Medical professionalism encompasses the conduct and practices of physicians, both as individuals and as a collective organisation. Professionalism enhances the trust and confidence of patients and society in doctors. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Developing the “NUS Tummy Dummy”, A Low-Cost Simulator to Teach Medical Students to Perform the Abdominal Examination

Simulators may be used to provide adequate exposure to learning experiences that allow clinical skills to develop, that is, allow medical students and trainees to perform the steps of clinical examinations and to acquire diagnostic skills. To date, simulators have been developed for trainees to perform cardiac and respiratory...

Genome-wide Association Studies: Promises and Pitfalls

Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with the disease need to be identified. Hunting for the genes that cause or are associated with a particular disease is a challenging task. This article is...

Epilepsy: Looking Beyond Seizures

World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step back to review epilepsy as a disease, to reflect on progress made, and as yet unresolved challenges. Epilepsy is a fairly common disease affecting 5 to...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of city dwellers can implement to reduce their risk of accidents, coronary artery disease, diabetes, cancer and all-cause mortality while improving their cognitive performance. Unlike costly supplements...

Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?

Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values. —Louis D Brandeis As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...

Cognitive Aspect of Diagnostic Errors

It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...

Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...

Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...

Diagnosing Bacteraemia Early in Older Adults

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

Dear Editor, Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting with chorea, which affected her left lower limb and both upper limbs after phototherapy. Chorea is an extrapyramidal movement disorder characterised by non-repetitive, abrupt, involuntary jerky...

Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...

Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions

Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...

Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore

The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...

Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson’s disease

Little is known about the genetics of Parkinson’s disease (PD) in Southeast Asian populations.1 We extended knowledge of the Southeast Asian monogenic PD landscape by describing a Malaysian Malay family with early-onset PD (EOPD), defined as onset at <50 years of age and a rarely reported homozygous PRKN exon...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases (95% UI 93.2–111 million) and 143 million disability adjusted life years lost (DALYs) (95% UI 133–153 million) in 2019. The impact is even higher in...

The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research

Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement disorders of CP are often accompanied by other associated sensory and cognitive impairments. For the majority of children (about 95% in high income countries), the...

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though uncommon, can affect both central and peripheral nervous system; producing parenchymal, non-parenchymal and mixed forms of the disease. Ophthalmic findings include ocular inflammation and other...