Related Articles

Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore

Persons living with dementia experience chronic and progressive cognitive decline in 1 or more cognitive domains, affecting their everyday activities.1 Globally, the number of persons living with dementia is expected to rise from 55 million in 2019 to 139 million in 2050, with an estimated two-thirds in lower- and...

Unplanned hospitalisations among subsidised nursing home residents in Singapore: Insights from a data linkage study

Hospitalisations pose hazards and safety risks to nursing home (NH) residents who may be frail, cognitively impaired, suffering from multi-morbidities and physically dependent,1 with propensity to develop adverse outcomes such as functional, psychological or cognitive decline, iatrogenic complications, and be subjected to over-investigation.2 There is an imperative for health...

Optimising paediatric urinary tract infection diagnosis

Urinary tract infection (UTI) is the most common cause of serious bacterial illness among children and infants.1 Up to 2% of boys and 8% of girls will develop at least 1 episode of UTI by the age of 7 years.1,2 Of these, it is estimated that 12% to 30%...

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study

Urinary tract infection (UTI) is a common diagnosis in the paediatric emergency department (ED). It accounts for an estimated 5–14% of paediatric ED visits yearly in the US.1-3 It is a common cause of serious bacterial infections in children, and the most common microorganism is Escherichia coli (65–75%), followed...

Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease

Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...

Factors affecting outcomes among older trauma patients in Singapore: A retrospective observational study

Dear Editor, Singapore faces a rapidly ageing population with its median age projected to be above 45 years by 2030. Our greying demographics is accompanied by a rise in chronic diseases and medication use, including polypharmacy.1 Longer life expectancy and increased activity levels have contributed to higher incidence of geriatric...

Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study

Young infants ≤90 days old are at risk of serious bacterial infections (SBIs) due to their immature immune systems and may develop severe complications resulting in neurocognitive deficits, hearing loss and even mortality.1,2 The diagnosis of SBIs remains challenging as fever may be the only symptom of SBIs in...

Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients

Frailty is a clinically recognisable state of vulnerability in older people, resulting from age-associated decline in physiological reserves and function across multiple organ systems, such that the ability to cope with acute stressors is compromised.1 Frailty is prevalent among older people2 and is associated with higher rates of utilisation...

Anti-osteoporosis drugs reduce mortality in cancer patients: A national cohort study of elderly with vertebral fractures

Osteoporotic vertebral fractures (OVFs) are the most prevalent type of fragility fractures, affecting 25% of adults in their early 70s and 43% of those over the age of 80.1,2 Following an OVF, persistence of the vertebral deformity may lead to spinal kyphosis, which is associated with chronic lower back...

Anti-osteoporosis drugs and reduction of mortality in cancer patients

Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs,...

Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground

In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....

Impact of an ageing population on the intensive care unit

Dear Editor, Intensive care unit (ICU) resources are scarce and expensive, and deciding if intensive care is suitable for older patients involves complex clinical reasoning, ethical challenges and cost considerations. Although some studies show that ICU mortality increases with age, others suggest that age alone is not predictive of poor...

Clinical outcomes of hospitalised individuals with spin-induced exertional rhabdomyolysis

Rhabdomyolysis is a clinical and biochemical syndrome caused by the breakdown of myocytes and release of intracellular components into the bloodstream.1 A subset of rhabdomyolysis is exertional rhabdomyolysis (ER), which is caused by strenuous physical activity. Risk factors for ER include lack of physical endurance, increased duration and intensity...

Emergency department falls interventions improve osteoporosis management in frail older adults

Dear Editor, Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40% of emergency department (ED) users and proportionally are the highest users of ED services.2 One-third of community dwellers over 65 years of age fall each year,...

Transitional care strategies at emergency department for elderly patients: A multicentre study in Singapore

In Singapore, greater efforts are being directed towards developing an integrated health and social ecosystem under the new Healthier SG strategy announced by the Ministry of Health. This life-course approach aims to promote overall healthier living in collaboration with key community partners (e.g. intermediate and long-term care service providers)...

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Dear Editor, Nitrous oxide (N2O) produces dissociative euphoria, amnesia and analgesia, and is a common sedative for procedural sedation in paediatric emergency departments (EDs) due to its non-parenteral administration and good safety profile.1-3 Suitable procedures include fracture reduction, toilet and suturing, incision and drainage, and application of burn dressings. The...

Low skeletal muscle mass predicts poor prognosis of elderly patients after emergency laparotomy: A single Asian institution experience

Emergency laparotomy (ELAP) for elderly patients is associated with higher mortality and increased postoperative complications compared with those undergoing elective surgery.1-3 Elderly patients, who are more likely to have comorbidities, have lower functional reserves to cope with the increased physiological demand due to their acute illness and eventual surgical...

A strategy to make COVID-19 vaccination more accessible to the elderly

Dear Editor, Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services. While the...

ICU nutrition: Bracing for the silver tsunami

The global population’s life expectancy is growing with a steady increase in the proportion of older patients admitted to the intensive care unit (ICU).1 Up to 13% of the ICU patients are above the age of 80.2 Older critically ill patients have lower physiological reserves of the various organ...

Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore

The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...

Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore

Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED) with blunt or penetrating major trauma. “Trauma team activation” is initiated by the ED specialist through the hospital call-centre, and is a process that mobilises...

Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns

Emergency department (ED) overcrowding is a growing issue that threatens public health in various parts of the world,1 including the US,2 UK,3 Australia,4 Japan5 and Taiwan.6 Individuals who visit the ED repeatedly, known as frequent attenders (FAs), have been identified as a possible driver of ED overcrowding. While the...

Frequent attenders to multiple emergency departments in Singapore

The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...

Epidemiological trends and outcomes of children with aural foreign bodies in Singapore

Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...

Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial

Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and reduced pulmonary reserves.1 Hypoxia is a commonly encountered adverse event during rapid sequence intubation (RSI)2 and is associated with cardiac arrest, neurological injury and death.3...

A Review of Pedestrian Fatalities in Singapore from 1990 to 1994

Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by the Traffic Police Department show that, although the accident fatality rate had fallen sharply from 13.4 per 100,000 population in 1984, to 8.0 per 100,000...

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...

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...

Perceived Need for Community Geriatric Services: A Survey at a Regional Hospital in Singapore in an Inpatient Setting

Singapore has one of the most rapidly ageing populations in the wor1d. The number of the very aged (>75 years old) has already increased from 42,700 in 1985 to 75,500 in 1995. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Swallowing Impairment and Feeding Dependency in the Hospitalised Elderly

Loss of ability to feed independently and swallowing impairment are common problems in the elderly and will be an increasing cause of disability as the population ages. A study in Europe suggested that up to 10% of people older than 50 experience troublesome dysphagia. This article is available only as...

Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore

Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it is not surprising that public services like the health service feel the impact of their presence. This article is available only as a PDF. Please click...

Drowning and Near-drowning—Some Lessons Learnt

Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at least temporarily, or that the victim has survived over twenty-four hours. This article is available only as a PDF. Please click on “Download PDF” on top...

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.

Preparing for the silver boom: A falls prevention tool for older adults in the emergency department

Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls also account for 85% of all geriatric trauma presenting to the emergency department (ED) in Singapore,3 with the crude incidence rate of unintentional falls at...

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...

Critical Role of Functional Decline in Delayed Discharge from an Acute Geriatric Unit

In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment of the population. Owing to their generally poorer health status in terms of chronic illnesses and long-term disability, the elderly consume a disproportionate amount of...

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”...

The Practice of Foregoing Life Support in the Critically Ill “Old Old”: A Singapore Perspective

Studies on the foregoing of life support (FLS) in North America, Europe and Australia have shown diversity in terms of the incidence, decision-making process and outcome. However, they have not specifically looked into such practice in the elderly. This article is available only as a PDF. Please click on “Download...

Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review

Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur suddenly, outside of a hospital. The mechanism of death is usually a fatal arrhythmia, most often ventricular tachycardia or fibrillation. This article is available only as...

Early Unplanned Readmission of Elderly in Singapore: A Retrospective Study

The number of elderly people in Singapore is expected to increase over the next 2 decades. The proportion of those 60 years and above is estimated to increase from the present 11% to 27% by the year 2030. This article is available only as a PDF. Please click on “Download...

Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care

Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to simple starvation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department

Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from acute myocardial infarction (AMI) have seen a worldwide decline in recent years. This article is available only as a PDF. Please click on “Download PDF” on...

The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint

Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition has been sporadic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)

Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause a range of serious infections. These included infective endocarditis which had been emphasised in older reports1 but was found to be uncommon in later studies. This...

Nursing Home Falls: A Local Perspective

Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done on falls in community-dwelling elderly, relatively few studies have focused on the problem in institutionalised elderly. This article is available only as a PDF. Please click...

The Development of Geriatric Psychiatry Services in Singapore

The population of Singapore is ageing. In 2002, it was estimated that there were 252,700 persons aged >65 years, forming 7.5% of the population. By 2030, there will be 794,000, forming 18.4% of the population. This article is available only as a PDF. Please click on “Download PDF” on top...

Aged Care Issues and Services in Australia

In Australia, the number of elderly people is increasing rapidly. In 2001, the population of Australia was approximately 19 million people and about 12.6% of this population were >65 years old. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Aged Care Services in Singapore – An Overview

The last century has witnessed the establishment of geriatric medicine as a well-recognised medical specialty supported by a respectable body of evidence, which shows that it is able to improve the health outcomes of frail older persons. Since the pioneering work of Marjory Warren in the 1930s, different models...

Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in nursing homes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030. This article is available only as a PDF....

Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study

Dear Editor, The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response. We present our qualitative study, guided by...

Work-related Injury Sustained by Foreign Workers in Singapore

Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders, typically working in lower skill industries and blue-collar sectors, e.g. construction industry. This article is available only as a PDF. Please click on “Download PDF” on...

Polypharmacy and Inappropriate Medication Use in Singapore Nursing Homes

The elderly usually have multiple medical problems, requiring prescription drugs to treat diseases and to prevent complications arising from them. Currently, in the United States, those who are 65 years and older (geriatric age group) make up 13% of the total population but consume 33% of all prescription drugs. This...

Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report

Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in a patient can be life threatening. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective

Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health care system often gets disrupted and the health and well-being of the survivors may depend on disaster relief organisations from within the country as well...

When the Stork Arrives Unannounced – Seven Years of Emergency Deliveries in a Non-obstetric General Hospital

Emergency department (ED) deliveries are uncommon in the Singapore setting, as patients presenting with labour to the ED are sent to the obstetric suites in Kandang Kerbau Women’s and Children’s Hospital (KKH), National University Hospital (NUH) and Singapore General Hospital upon arrival. The same applies to the various private...

Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department

Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in many Emergency departments (EDs), where many conditions have time-dependent outcomes, and accurate and quick blood results are thus important. This article is available only as a...

The Prevalence of Psychological and Psychiatric Sequelae of Cancer in the Elderly – How Much Do We Know?

Across the globe, there has been a rapid increase in the absolute and relative numbers of older persons. According to the 1993 World Bank report, the number of people aged 65 and above will form 1 in 4 of the population in 2025.1 The projected percentage increase in the...

Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms of its ability to achieve higher patency rates, minimise infarct size, improve left ventricular function and improve long-term survival, as well as lower rates of...

Renal Artery Embolism in a Patient with Vague Abdominal Pain

Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that is easily missed due to its infrequent and non-specific presentations. This article is available only as a PDF. Please click on “Download PDF” on top to...

Clinical Characteristics of Renal Infarction in an Asian Population

Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Hip Fractures in the Elderly: The Impact of Comorbid Illnesses on Hospitalisation Costs

Management of hip fractures is costly and continues to generate significant costs throughout the one-year period after discharge.1 They demand considerable resources from a country’s health care system.2,3 Hip fractures are the commonest cause for admission in the acute orthopaedics setting in the elderly.4 As a result of an...

A Review of Geriatric Education in Singapore

The United Nations International Plan of Action on Ageing (IPA), formulated during the First World Assembly on Ageing in Vienna in 1982, listed gerontological education at all levels as a priority in order to meet the challenges of global population ageing.1 The Second World Assembly on Ageing held in...

Multimodal prehabilitation before major abdominal surgery: A retrospective study

Ageing is one of the biggest public health concerns of the 21st century, presenting a challenge to the practice of medicine globally. As the Singapore population ages, research is needed to refine our knowledge in the care of older persons and the frail, so that better methods of care...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care. There is little literature detailing emergency department (ED)...

Reply from Author: Putting the Wedge under Pressure

We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous pressure and pulmonary artery wedge pressures are inaccurate in predicting cardiac output or fluid responsiveness. This article is available only as a PDF. Please click on...

Putting the Wedge under Pressure

We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler Ultrasound in the Assessment of Haemodynamic Status of Patients Admitted to the Medical Intensive Care Unit with Septic Shock”. In their paper, Dr Chew and...

Profiling Acute Presenting Symptoms of Geriatric Patients Attending an Urban Hospital Emergency Department

Singapore’s population is ageing rapidly. Today 1 out of every 12 Singaporeans is aged 65 or above. In 2030, it is expected to be 1 out of 5.1 This poses a challenge to our healthcare system especially our emergency departments. This article is available only as a PDF. Please click...

Predicting Positive Blood Cultures in Patients presenting with Pneumonia at an Emergency Department in Singapore

Pneumonia is the fourth leading cause for hospitalisation, and the third leading cause of death in Singapore.1 Overall, it is consistently one of the most expensive diseases to treat among elderly persons with multiple co-morbid conditions,2 a challenge to our healthcare system with a rapidly ageing population. Treatment guidelines...

Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)

Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can be fatal. In many countries with a large agricultural base, it poses a significant economic burden. This article is available only as a PDF. Please click...

Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital

Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have better outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

An Eight Year Review of Exercise-related Cardiac Arrests

Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac arrest in those affected by silent congenital cardiovascular conditions. In older adults, sudden vigorous physical exercise increases the incidence of acute coronary events in those...

Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients

The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in which there are pathologies in the vessels nourishing the brain. Besides being a serious health problem due to its high mortality and morbidity, stroke is...

A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore

Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has its own dedicated Cardio-Thoracic Intensive Care Unit). This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Herpes Zoster as a Useful Clinical Marker of Underlying Cell-mediated Immune Disorders

Herpes zoster (HZ) occurs when latent virus in the dorsal-root ganglia becomes reactivated and causes a vesicular and often painful rash with a dermatomal distribution. The rash may be followed by severe neuralgia that lasts for weeks or even months. An unknown triggering mechanism possibly caused by declining or...

Junior Doctors’ Attitudes Towards Older Adults and its Correlates in a Tertiary-care Public Hospital

Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8% of the population in 1995 and is projected to increase to 20% by the year 2030. The medical community is also faced with a similar problem in caring for an ageing...

An Observational, Prospective Study to Determine the Ease of Vascular Access in Adults Using a Novel Intraosseous Access Device

Intravascular access is a vital component of emergency care and resuscitation. There is nothing more frustrating for the emergency physician than the inability to administer fluids or medications just because of the inability to obtain intravascular access. Rapidly securing vascular access will allow for the administration of fluids, pressor...

Clinical Outcome Following Treatment of Stable and Unstable Intertrochanteric Fractures with Dynamic Hip Screw

Intertrochanteric (IT) fracture is among the most common orthopedic injuries in the elderly population, and is associated with osteoporosis. It usually occurs as a result of low energy trauma e.g. trivial falls. It carries considerable morbidity and mortality. In Singapore, there has been an increase in the incidence of...

Older Age at Initial Presentation to Human Immunodeficiency Virus (HIV) Care and Treatment at the Communicable Disease Centre (CDC) in Singapore, 2006 to 2011

Since the first case of human immunodeficiency virus (HIV) in Singapore was identified in 1985, the incidence of HIV/acquired immunodeficiency syndrome (AIDS) has steadily increased, reaching a peak rate of 125.2 cases per million population in 2008. From 2006 to 2011, 28.3% of newly diagnosed HIV/AIDS cases in Singapore...

A Subacute Model of Geriatric Care for Frail Older Persons: The Tan Tock Seng Hospital Experience

The number of persons aged over 65 will increase from 8.4% in 2005 to 18.7% in 2030, which translates to absolute numbers of 296,900 in 2005 to 873,300 of older persons in Singapore by 2030. The life expectancy at birth has also increased from 79.1 years (2003) to 80.6...

Association of Socioeconomic Status (SES) and Social Support with Depressive Symptoms among the Elderly in Singapore

Depression in the elderly is a major public health issue. Associated morbidities such as higher risk of impairment in physical, mental and social functioning can be substantial, with the most serious complication being suicide. In the elderly, depression can often be undiagnosed and untreated because it may be related...

Can Preoperative Scoring Systems be Applied to Asian Hip Fracture Populations? Validation of the Nottingham Hip Fracture Score (NHFS) and Identification of Preoperative Risk Factors in Hip Fractures

Osteoporotic hip fractures are common and have significant consequences on mortality and functional capability which indirectly has familial, social and economic repercussions. The inpatient mortality rates approach 4% to 12%, while 1-year mortality is between 12% to 37%.2, Studies from Denmark, Italy, the United Kingdom (UK), and the United...

Anticoagulation Needs in Asians with Atrial Fibrillation: A Mythbuster

Atrial fibrillation (AF) increases the risk of stroke 5-fold in Caucasians. While the relative risk for stroke is somewhat lower in Asia, estimated at 3.6% in Singapore, total AF and stroke-associated mortality rates are reported to be similar. This article is available only as a PDF. Please click on “Download...

External Validation of the Cham Score for Ordering of Blood Cultures in Emergency Department Patients with Non-Hospital Acquired Pneumonia

Some guidelines currently promote the taking of blood cultures in patients admitted to hospital with non-hospital acquired pneumonia in order to identify pathogens and guide therapy. Previous studies have reported that the proportion of patients returning a true positive blood culture is between 2.1% and 9%. False positive cultures...

Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study

Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world, with the World Health Organization (WHO) reporting over 206 million cases and over 4 million deaths globally as of 15 August 2021.1 To contain the...

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...

Changing Landscape of Nursing Homes in Singapore: Challenges in the 21st Century

Nursing homes trace their evolution to American alms-houses in the 1930s where retired nurses welcomed the elderly and ill into their homes. In Singapore, community-based charitable organisations pioneered the earliest sheltered accommodations for homeless and destitute elderly immigrants. For instance, the local chapter of the Little Sisters of the...

Determinants of Health-Related Quality of Life Among Community Dwelling Elderly

Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65 and above, and these numbers are estimated to go up to 600,000 by 2020. These growing elderly population have multiple coexisting medical conditions which are...

Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma

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...

Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?

It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July 2010 in Singapore. The transit from a time-based curriculum to a competency-based curriculum, which centres on the 6 ACGME-I core competencies of ‘medical knowledge’, ‘patient...

Prehabilitation and Its Role in Geriatric Surgery

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...

A review of child sexual abuse cases presenting to a paediatric emergency department

Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for defining children differ around the world. In Singapore, CSA refers to any act where a child or young person below 16 years old is used...

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...

Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB) in the elderly is rare. We report a case of a 63-year-old man who presented with acute-on-chronic intestinal obstruction due to CAB, which caused pseudointestinal...

Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits

Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...

Estimating the impact of COVID-19-induced coagulopathy

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...

Tackling osteoporosis and fragility fractures in Singapore

A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young nation which gained its independence only in 1965, but has one of the fastest growing ageing populations in the world. It is estimated that by...

Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there are variations in the reported survival-to-hospital discharge rates among different regions in the world. In Singapore, OHCA incidence rate was 27.2 per 100,000 person-years, with...

Community-level interventions for out-of-hospital cardiac arrests in Singapore: Yay or nay?

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between 2011 and 2016. Despite multiple pre-hospital and hospital-based interventions, survival rates remain low. Initiation of time-sensitive cardiopulmonary resuscitation (CPR) while waiting for emergency services arrival...

Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore

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

Decrease in emergency department attendances during COVID-19 especially in school-going children

Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. This...

Virtual reality mobile application to improve videoscopic airway training: A randomised trial

Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle difficult airways that may present unexpectedly with expertise. Flexible bronchoscopic intubation (FBI) technique is considered an important option in the management of predicted difficult airways....

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...

Epidemiology and risk stratification of minor head injuries in school-going children

Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...

Emergency airway management in a Singapore centre: A registry study

Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...

Circulatory collapse from rupture of splenic artery aneurysm: A case study

Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted the management challenges faced in the emergency department (ED). This article is available only as a PDF. Please click on "Download PDF" on top to view...