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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,...

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...

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...

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...

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,...

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...

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%...

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...

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...

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...

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...

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...

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,...

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)...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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%...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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...

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...

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,...

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...

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,...

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...

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...

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...

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...

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...

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...

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)...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...