Letter to the Editor
A review on adverse airway events during anaesthesia over six years in a tertiary referral hospital
Dear Editor,
Comprehensive reviews of perioperative critical airway events (CAE) have been conducted through audits and closed claims analyses. However, there is currently limited published data specific to the local setting. Our study aims to analyse CAE at a tertiary hospital in Singapore, ascertain their frequency, identify risk factors, and...
Letter to the Editor
Physician sentiments on low-value investigations in Singapore: Part of Choosing Wisely campaign
Dear Editor,
Low-value investigations provide marginal benefit and may result in harm to the patient or disproportionate healthcare costs.1 The introduction of Singapore’s Choosing Wisely (CW) campaign in 2012 aims to reduce such investigations.2 CW was designed to encourage conversations between physicians and patients to weigh the risk-benefit ratio behind...
Letter to the Editor
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 ...
Letter to the Editor
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...
Commentary
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....
Letter to the Editor
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...
Letter to the Editor
Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial
Dear Editor,
Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of unsafe recovery include sudden unpredictable emergence or delayed return of airway tone and reflex with risk of airway obstruction.1 Agitation includes straining, sitting up, screaming...
Letter to the Editor
Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
Dear Editor,
The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an accompanying editorial were published in the January 2022 issue of the Annals.1,2 An evidence-based approach was used with reference made to relevant published literature. The...
Letter to the Editor
Sedation in gastrointestinal endoscopy in Singapore
Dear Editor,
I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during endoscopy in the hospital setting”2 in your journal in January 2022.
The American Society of Gastrointestinal Endoscopy (ASGE) and the European...
Letter to the Editor
Non-anaesthesiologists administering propofol in the Singapore context
Dear Editor,
Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid onset of action and fast post-procedural recovery.1 Nonetheless, propofol depresses cardiorespiratory function and could result in life-threatening adverse effects.
A workgroup, mainly consisting of gastroenterologists and...
Letter to the Editor
Sedation by non-anaesthesiologists in gastrointestinal endoscopy
Dear Editor,
We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. We are especially intrigued by Statement 6, stating that propofol sedation for endoscopy can be safely and effectively administered by trained...
Original Article
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...
Others
Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring
The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are many factors which may affect the accuracy of this technique such as the volume, temperature and timing of the injectate.
This article is available only as...
Review Article
An Overview of Anaesthetic Issues in Phaeochromocytoma
New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the pathophysiology and clinical features of phaeochromocytoma.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?
Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant technique in oral and maxillofacial surgery aimed at reducing blood loss and improving the surgical field. Deliberate hypotension was reported as the fourth commonest cause...
Editorial
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...
Others
Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol
The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500% and accompanied by increases in minute ventilation and cardiac output to maintain aerobic metabolism.
This article is available only as a PDF. Please click on “Download...
Others
Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report
Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (% HbO2) that is less than 90%. The immediate response in acute situations is to rapidly exclude or treat common conditions such as airway obstruction, pneumothorax...
Commentary
Planning and Design of a Surgical Intensive Care Unit in a New Regional Hospital
The Changi General Hospital is a new regional hospital in the eastern part of Singapore catering to a population of about 750 000. Planning of the hospital started since 1987 and construction began in 1992.
This article is available only as a PDF. Please click on “Download PDF” on top...
Commentary
Management Training in Critical Care Medicine
Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence has been awarded to graduates of the critical care medicine fellowship programmes since 1987.
This article is available only as a PDF. Please click on “Download...
Others
A Case of Pseudohyperkalaemia and Thrombocytosis
Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular ionic shift from acid-base anomalies and tissue trauma. We report a rare and erstwhile unencountered cause of serum hyperkalaemia in our intensive care unit (ICU),...
Others
Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report
The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...
Review 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...
Review Article
Continuous Renal Replacement Therapy: Continuous Blood Purification in the Intensive Care Unit
The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the use of renal replacement therapy) as well as in the epidemiology of this condition. Severe acute renal failure (SARF) is now most commonly seen in...
Review Article
Contributions of Respiratory Care Practitioners to Intensive Care: A Review
The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability of full-time intensivists has been associated with improved survival.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
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...
Review Article
Ventilatory Strategies for Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased respiratory compliance, bilateral pulmonary infiltrates and reported a survival rate of 42%.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
The Oxygen Delivery Debate—A Review
Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients. The mechanisms responsible for the development of multisystem organ failure in the critically ill patient are unknown.
This article is available only as a PDF. Please...
Review Article
Severity Scoring Systems in the Modern Intensive Care Unit
The first major general severity adjustment system, the Acute Physiology and Chronic Health Evaluation (APACHE) system, was published in 1981. Since then, APACHE, the Mortality Prediction Model (MPM), and the Simplified Acute Physiology Score (SAPS) systems have dominated the literature as general outcome prediction models.
This article is available only...
Review Article
Controlled Observations in Critical Care Medicine: The Therapeutic Trial
Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its subsequent change over time consequent to a therapeutic intervention.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
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...
Original Article
Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery
The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have reviewed its use for inguinal and genital surgery in children.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)
Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO).
This article is available only as a PDF. Please click on...
Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...
Original Article
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.
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...
Original 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.
Original Article
Diabetes Insipidus in Neurosurgical Patients
Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but is an important complication.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Outcome of Patients with Traumatic Brain Injury Managed on a Standardised Head Injury Protocol
Trauma is the fifth commonest cause of death in Singapore. In 1996, trauma contributed to 5.4% of mortality.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Predictors of Long-term Outcome in Severe Head Injury
Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute myocardial infarction, to save those with “hearts too good to die”.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
APACHE II and SAPS II are Poorly Calibrated in a Hong Kong Intensive Care Unit
The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) scoring systems are widely used prognostic tools in Intensive Care Units (ICUs). These scoring systems calculate a “risk of death” (ROD) for ICU patients while adjusting for case-mix with severity...
Original Article
Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital
The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU, Burns ICU, Medical ICU, Coronary Care Unit and Neonatal ICU. The SICU receives patients from various surgical disciplines (Table I).
This article is available only as...
Original Article
Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation
Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs) use about 15% of the total hospital cost or about 1% of the gross national product.
This article is available only as a PDF. Please click...
Editorial
Intensivists for the Intensive Care Unit—Do They Make a Difference?
Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have arrived at different paradigms—open versus closed models, specialty-based intensive care units (ICUs) versus general ICUs, internist versus pulmonologist or anaesthetist, and so forth.
This article is...
Others
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...
Review Article
Epidural Analgesia in Obstetrics
Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types of drugs used in labour epidurals.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
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...
Original Article
An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking
In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural catheter breakage can result in the inconvenience of surgical extraction of catheter fragments, while kinking can lead to impairment or failure of drug delivery to...
Others
The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus
A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed severe tenderness in the lumbar region, limited straight leg raising but no neurological deficit.
This article is available only as a PDF. Please click on “Download...
Others
Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report
A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior release approach and posterior instrumentation. Preoperative assessment revealed good effort tolerance.
This article is available only as a PDF. Please click on “Download PDF” on top...
Review Article
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...
Original Article
Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation
In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists have, whenever possible, adopted the practice of early extubation after cardiac surgery to improve the patient’s level of comfort and to allow an early return...
Review Article
Controversies in Anaesthesia—Designer Drugs
The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of different teams looking for effects of interest to their own area.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report
A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™) was first attempted on the dorso-lateral aspect of the right wrist at the base of the anatomical snuffbox.
This article is available only as a PDF....
Original Article
Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit
Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with potential spread of respiratory tract microorganisms from one patient to another.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Perioperative Wheezing—A Report of Three Cases
Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration, whereas those of lower airway obstruction are worse in expiration.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Others
The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report
A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...
Others
A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma
Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in varying proportions.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes associated with intubation, the frequency and magnitude of the changes associated with extubation are less well documented.
This article is available only as a PDF. Please...
Commentary
Transurethral Surgery and the Adductor Spasm
Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of these tumours that direct electrical stimulation of the obturator nerve occurs.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia
Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium
Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous (IV) route without the use of inhalation agents. The main advantages of TIVA are avoidance of both volatile agent and nitrous oxide exposure and reduction...
Original Article
The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury
Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1 Goldman et al2 formulated the “cardiac risk index”, implicating previous myocardial infarction (MI), heart failure and unstable angina as major determinants of postoperative cardiac events.
This...
Original Article
Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation
Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised in the UK and USA. It is the simplest method, effective for all grade 2 laryngoscopies, where at least the arytenoids are visible and most...
Others
Casemix Reimbursement: A Singapore Children’s Hospital Perspective
Supplement on Casemix Conference Singapore 2001 held on 17-19 August 2001 in Singapore
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix
Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Intravenous Regional Anaesthesia Using Lignocaine and Tramadol
Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the quality of intraoperative anaesthesia, tourniquet pain and lack of adequate postoperative analgesia.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Catheter-related Infection: Diagnosis, Prevention and Treatment
Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
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”...
Others
Book Review
This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions in Singapore.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Intra-abdominal Hypertension—Implications for the Intensive Care Physician
Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that the clinical importance of these changes are being recognised.1-7 This coincides with the increasing availability of intensive care, which allows many more patients to survive...
Review Article
Anaemia in the Critically Ill—The Optimal Haematocrit
The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported dissolved in the plasma.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Quality of Life in Long-Term Survivors of Intensive Care
Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying their acute medical problems. New interventions have been introduced with success determined by their ability to save lives.
This article is available only as a PDF....
Review Article
Limitation of Life Support in the Critically Ill: The Hong Kong Perspective
Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly so in the specialty of intensive care where intensivists possess the necessary knowledge and tools to prolong life in many situations where patients would previously...
Review Article
Simulation-based Training at the University of Pittsburgh
In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred on training issues and technologies. Since the introduction of external cardiopulmonary resuscitation in 1960 through to the establishment of International Guidelines for Cardiopulmonary Resuscitation and...
Original Article
Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock
Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of endotoxin, which is chemically composed of lipopolysaccharide, and is extremely biologically active.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume
The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored and uncorrected, can result in tissue ischaemia, acidosis and systemic inflammatory response syndrome.
This article is available only as a PDF. Please click on “Download PDF”...
Others
Case Report: Catheter-Related Epidural Abscess
Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to 12% and about 0.7% are reported to have central nervous system infection e.g. epidural abscess or meningitis.
This article is available only as a PDF. Please...
Others
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...
Review Article
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...
Review Article
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...
Editorial
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.
Commentary
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...
Others
A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery
Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of laryngospasm on extubation of a Benjamin jet tube resulting in pulmonary haemorrhage.
This article is available only as a PDF. Please click on “Download PDF” on...
Others
Subdural Block—From a Spinal? A Case Report
There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an epidural gone astray, and the lowest reported volume of local anaesthetic used was 3.5 mL.
This article is available only as a PDF. Please click on...
Original Article
Problems Related to Epidural Analgesia for Postoperative Pain Control
Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with epidural analgesia; and effective postoperative pain relief is a prerequisite to attain improved postoperative outcome.
This article is available only as a PDF. Please click on...
Others
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...
Others
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...
Others
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...
Others
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...
Editorial
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...
Original Article
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...
Others
Clinical Update on Managing the Obstructed Airway
Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians and intensivists.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report
Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems of rejection, infection, immunosuppression and declining donor pools.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Editorial
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...
Others
Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports
The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to control the haemodynamic fluctuations during phaeochromocytoma resection.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Original Article
A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital
Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and medicolegal considerations may limit any comprehensive study of anaesthetic mishaps.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Letter to the Editor
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...
Review Article
Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase in the breadth and complexity of procedures. Routine endoscopies have increased due to a growth in population size, and the introduction of guidelines is needed...
Editorial
Ensuring safe sedation during gastroendoscopy
Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were introduced later. Most of these procedures were performed then without sedation. The patients needed to cooperate with the endoscopists and inability to complete the endoscopic...
Others
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...
Others
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.
Others
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...
Others
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...
Others
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...
Others
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.
Others
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...
Others
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,...
Review Article
Marijuana in Pregnancy
Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include a unique blend of effects of alcohol, opioids, tranquilisers and hallucinogens, the clinical picture could be very unpredictable and the diagnosis is often difficult.
This article...
Original Article
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....
Original Article
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...
Commentary
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...
Review Article
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.
Original 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...
Others
Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context
Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44 per 100,000 in the year 2001.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Severe Adult Chickenpox Infection Requiring Intensive Care
Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Editorial
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...
Review Article
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...
Review Article
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.
Editorial
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...
Letter to the Editor
An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics
Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion of central venous lines despite the advances made in the design, material of the catheter and the technique of insertion.
This article is available only as...
Commentary
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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.
Original Article
The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation
The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style is mismatched with the teaching style or the teaching environment, the student may spend considerable effort to adapt, and this may negatively impact the student’s...
Original 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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Review 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...
Letter to the Editor
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...
Others
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.
Commentary
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...
Others
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...
Others
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...
Original Article
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...
Letter to the Editor
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...
Commentary
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...
Commentary
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...
Commentary
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.
Original 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...
Original Article
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...
Original Article
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...
Original Article
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...
Original 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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Letter to the Editor
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...
Others
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...
Review Article
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...
Original Article
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...
Letter to the Editor
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...
Original Article
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...
Original Article
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...
Review Article
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...
Commentary
Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy
Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for 33 years before his retirement in 1971.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Commentary
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”...
Letter to the Editor
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...
Commentary
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.
Commentary
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...
Commentary
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...
Editorial
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...
Original Article
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.
Letter to the Editor
Reply from Author: Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters
We thank Dr Nicholas Chua et al for their interest in our review article. We agree and appreciate the experience and comments by the authors regarding the usage of externalised intrathecal catheter for analgesia in cancer pain.
This article is available only as a PDF. Please click on “Download PDF”...
Letter to the Editor
Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters
We thank the authors for a comprehensive review on the role of interventional pain therapies used in cancer pain as well as a informative local audit using the intrathecal catheter (PORT-A-CATH® IT) implantable system (Deltec Inc, USA).
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
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...
Editorial
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.
Letter to the Editor
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...
Letter to the Editor
Recommendations for standards of neuromuscular monitoring during anaesthesia
Dear Editor,
We presented recommendations for neuromuscular monitoring during anaesthesia, which were approved by the Council of the College of Anaesthesiologists, Singapore in September 2019 and the Council of the Academy of Medicine, Singapore in May 2021. Neuromuscular blocking drugs (NMBDs) are used to facilitate tracheal intubation and mechanical ventilation;...
Original Article
Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force
Studies show that the incidence of chronic pain is approximately 18% in Australia and developed countries in Europe. In Asia, data from Hong Kong and Singapore indicate that chronic pain is experienced by about 10% of adults, with chronic pain being more common in women and older adults. In...
Original Article
The Use of Complementary and Alternative Medicine in Chronic Pain Patients in Singapore: A Single-Centre Study
Chronic pain is a prevalent disease that is often diffi cult to manage. According to a World Health Organisation survey, the worldwide prevalence of chronic pain is in the range of 20% to 30%.
Chronic pain disease has an impact not only on the individuals’ general health and psychological health,...
Original Article
Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography
A significant proportion of patients with underlying obstructive sleepapnoea (OSA) remain undiagnosed when they present for surgery. Epidemiologic data have placed
the prevalence in the general adult Western populations with a diagnosis of OSA at up to 5%,3 with a higher incidence in certain subpopulations such as males and obese...
Commentary
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...
Review Article
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...
Original Article
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...
Letter to the Editor
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...
Original Article
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...
Editorial
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...
Letter to the Editor
A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients
Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range, but this is impaired during general and/or neuraxial anaesthesia. Inadvertent peri-operative hypothermia is defined as a core temperature of <36C, the prevalence of which can...
Review Article
Controversies in Sepsis Management—What is the Way Forward?
Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...
Original Article
Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks
Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good operating conditions, with the facial nerve block preventing blepharospasm and providing lid akinesia.
This article is available only as a PDF. Please click on “Download PDF”...