Letter to the Editor
Knowledge, attitudes and readiness of final-year medical students towards clinical goals-of-care discussion
Dear Editor,
In a rapidly ageing global population,1 there is increasing recognition of the importance of clinical goals-of-care (GOC) discussions aimed at understanding patients’ goals, wishes and care preferences in the event of serious illness or end-of-life situations,2 in order to affirm patient-centred decision-making, improve quality of life and facilitate...
Editorial
Nurturing professional behaviours and ethical practice: From students to professionals
Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting...
Letter to the Editor
Telepalliative care during the pandemic: Lessons for the future
Dear Editor,
Mok et al. gave hope for cautious optimism for the acceptance of telemedicine for palliative care—which will be referred to as “telepalliative care” in this article—during the COVID-19 pandemic.1 Properly organised, telepalliative care can save time, provide flexibility, improve access for patients2,3 and possibly reduce the need for...
Original Article
Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance haemodialysis were discharged to skilled nursing facilities.2 Despite that, haemodialysis patients still preferred CPR during cardiac arrest3 and there are lower do-not-resuscitate orders for the...
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...
Original Article
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...
Original Article
Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery
Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling increase in healthcare expenditure in recent years, many countries have implemented cost-containing measures in healthcare financing.
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Review Article
A Palliative Care Approach to End-stage Neurodegenerative Conditions
A syndrome of total functional dependence, poor mobility, lack of meaningful communication and incontinence of bowels and bladder appears to be the final common pathway for many neurodegenerative conditions such as the dementias, Parkinson’s disease (PD) and motor neurone disease (MND). In the United States, the National Hospice Organisation...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
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Original Article
Factors Causing Delay in Discharge of Elderly Patients in an Acute Care Hospital
With the introduction of block budget for acute care hospitals, cost containment is an important issue for all secondary and tertiary hospitals. Though health care cost was rising at a rate of 31.2% between the year 2002 and 2003, it is important to keep the cost of health care...
Commentary
Internationally, it is Time to Bridge the Gap between Primary and Secondary Healthcare Services for the Dying
Around two-thirds of people with incurable diseases in economically developed countries wish to die at home, but less than one third succeed in doing so. Developing primary care-based services for the dying in the community is essential to reach and serve the whole population, and to provide care where...
Original Article
Opioid Use amongst Cancer Patients at the End of Life
Opioid use in terminally ill cancer patients at the end of life has been a source of concern amongst many for fear of its perceived life shortening effects, despite evidence to the contrary. This fear has, in fact, contributed to the reluctance in utilising these drugs to provide adequate...
Original Article
The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms
Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...
Original Article
Factors Associated with Delayed Discharges after Inpatient Stroke Rehabilitation in Singapore
Persisting disabilities from stroke lead to partial or total dependence for up to two-thirds of survivors. To improve mobility and to enable the recommencement of self-care activities, rehabilitation is essential.
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Letter to the Editor
Novel Use of Baclofen in Cancer Patients for the Treatment of Hiccups
A hiccup is a result of an involuntary, intermittent spasmodic contraction of the diaphragm and the inspiratory intercostal muscles, resulting in a sudden inspiration and ends with an abrupt closure of the glottis.
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Original Article
Profile of Hospitalisation and Death in the First Year after Diagnosis of End-stage Renal Disease in a Multi-ethnic Asian Population
End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients.
This article is available only...
Original Article
How do English-speaking Cancer Patients Conceptualise Personhood?
Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...
Commentary
Schizophrenia as a Lifelong Illness: Implications for Care
The management of schizophrenia has advanced considerably since the term was first coined in 1911, with Kraepelin’s early pessimism tempered by more recent evidence examining outcome. The discovery of antipsychotics represented a major breakthrough in the treatment of schizophrenia, while more recently we have witnessed promising initiatives such as...