Pub Date : 2024-01-01DOI: 10.1177/20101058241230181
Genevieve Min Lee, Soo Joang Kim, James Wei Ming Kwek, Ching Yee Chan
A 12-year-old girl with known bilateral enlarged vestibular aqueducts presented with vertigo and sudden profound hearing loss in her only hearing ear after COVID-19 infection. The hearing remained unchanged after systemic steroids, prompting treatment with salvage intratympanic dexamethasone and hyperbaric oxygen therapy with improvement in her hearing. This case report highlights the success of hyperbaric oxygen therapy in treating sudden sensorineural hearing loss and aims to raise awareness on its role in treating sudden hearing loss in patients with enlarged vestibular aqueduct.
{"title":"Hyperbaric oxygen therapy for sudden hearing loss in enlarged vestibular aqueduct syndrome: A case report and review of literature","authors":"Genevieve Min Lee, Soo Joang Kim, James Wei Ming Kwek, Ching Yee Chan","doi":"10.1177/20101058241230181","DOIUrl":"https://doi.org/10.1177/20101058241230181","url":null,"abstract":"A 12-year-old girl with known bilateral enlarged vestibular aqueducts presented with vertigo and sudden profound hearing loss in her only hearing ear after COVID-19 infection. The hearing remained unchanged after systemic steroids, prompting treatment with salvage intratympanic dexamethasone and hyperbaric oxygen therapy with improvement in her hearing. This case report highlights the success of hyperbaric oxygen therapy in treating sudden sensorineural hearing loss and aims to raise awareness on its role in treating sudden hearing loss in patients with enlarged vestibular aqueduct.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140526887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241241915
QinHao Jonathan Ye, Ganesh Kalyanasundaram, Hsiao Peng Toh, Qian Wen Leo, Linda Marie Nathan, Aubrey Cunanan, Han Ying Jessica Tan, Kiran Sharma
Late 2022, an ICU nurse discovered that Seretide™ (salmeterol/Fluticasone) Evohaler, a commonly used inhaler, did not change its dose counter when used with the inhaler connector 22M-22F. This was identified as a medication safety issue. Knowledge gaps of inhaler use in mechanically ventilated patients were identified as well. To effectively administer metered dose inhalers to ventilated patients and increase its accuracy and safety. We instituted education programs for healthcare professional in the ICU and introduced a new inhaler connector RTC 24-V. This was compared with the existing 22M-22F connector in a comparative study. The dose counter of Seretide™ recorded prior to initiation and extubation showed an obvious drop in doses ranging from 15 to 63 in patients randomized to use RTC 24-V, compared to 0 to 2 drop in doses for patients using 22M-22F. A total of 51 pre study and 33 post study questionnaires were completed. Confidence that the accurate dose of medications was administered rose from 58.8% to 84.8% after using the RTC 24-V. Responses that there was no issue compromising patient safety rose from 0% to 51.5% and fewer staff expressed concern about disconnections causing infections, dropping from 51% to 9.1%. 93.9% of respondents chose the new RTC 24-V as the preferred inhaler connector. The new inhaler connector RTC 24-V was assessed to have less medication errors. ICU healthcare professionals expressed greater confidence in its safety and accuracy. We will implement the use of this connector with continued medical education.
{"title":"Quality improvement project to improve inhaler delivery in the intensive care unit","authors":"QinHao Jonathan Ye, Ganesh Kalyanasundaram, Hsiao Peng Toh, Qian Wen Leo, Linda Marie Nathan, Aubrey Cunanan, Han Ying Jessica Tan, Kiran Sharma","doi":"10.1177/20101058241241915","DOIUrl":"https://doi.org/10.1177/20101058241241915","url":null,"abstract":"Late 2022, an ICU nurse discovered that Seretide™ (salmeterol/Fluticasone) Evohaler, a commonly used inhaler, did not change its dose counter when used with the inhaler connector 22M-22F. This was identified as a medication safety issue. Knowledge gaps of inhaler use in mechanically ventilated patients were identified as well. To effectively administer metered dose inhalers to ventilated patients and increase its accuracy and safety. We instituted education programs for healthcare professional in the ICU and introduced a new inhaler connector RTC 24-V. This was compared with the existing 22M-22F connector in a comparative study. The dose counter of Seretide™ recorded prior to initiation and extubation showed an obvious drop in doses ranging from 15 to 63 in patients randomized to use RTC 24-V, compared to 0 to 2 drop in doses for patients using 22M-22F. A total of 51 pre study and 33 post study questionnaires were completed. Confidence that the accurate dose of medications was administered rose from 58.8% to 84.8% after using the RTC 24-V. Responses that there was no issue compromising patient safety rose from 0% to 51.5% and fewer staff expressed concern about disconnections causing infections, dropping from 51% to 9.1%. 93.9% of respondents chose the new RTC 24-V as the preferred inhaler connector. The new inhaler connector RTC 24-V was assessed to have less medication errors. ICU healthcare professionals expressed greater confidence in its safety and accuracy. We will implement the use of this connector with continued medical education.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140524402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241236988
Sudipta Roy Chowdhury, M. Chia, Christopher Ho Wen Wei
Nutrition education is one the essential components of any paediatric residency training. However, many paediatricians world-wide have suboptimal knowledge in core clinical nutritional topics. The purpose of our study is to assess the perceived effectiveness of nutrition training among physicians, including paediatric residents, paediatric trainees and paediatricians; identify areas of need for additional education resources and the preferred method of teaching for nutritional topics for medical education. A survey-questionnaire was sent to our physicians in our centre to assess general nutrition education via self-assessment of current nutritional knowledge across 12 distinct topics; importance of teaching amongst these topics and the preferred method of teaching. A total of 64 physicians completed the survey with an overall response rate of 88%. Most responders reported having average or above-average knowledge base in all nutritional topics except for nutritional aspects of special diets. Poorest knowledge base (either below average or poor) was reported in special diet ( n = 38, 59.4%), inflammatory bowel disease ( n = 17, 26.6%) and gastrointestinal allergy ( n = 16, 25.0%). There was strong interest in additional teaching needs for the topics of failure to thrive ( n = 38, 59.4%), nutritional assessment ( n = 34, 53.1%) and infant feeding ( n = 31, 48.4%). Most popular teaching methods were clinical case review (31.7%) followed by didactic lectures (29.8%) for overall clinical nutritional education. Physicians identified gaps in their nutrition knowledge base and multiple topics were identified for additional nutrition education. Preferred methods of teaching for nutritional education were clinical case reviews and didactic lectures.
{"title":"Assessment and evaluation of nutrition education among physicians in a tertiary paediatric specialist hospital: The need for improved clinical nutrition teaching","authors":"Sudipta Roy Chowdhury, M. Chia, Christopher Ho Wen Wei","doi":"10.1177/20101058241236988","DOIUrl":"https://doi.org/10.1177/20101058241236988","url":null,"abstract":"Nutrition education is one the essential components of any paediatric residency training. However, many paediatricians world-wide have suboptimal knowledge in core clinical nutritional topics. The purpose of our study is to assess the perceived effectiveness of nutrition training among physicians, including paediatric residents, paediatric trainees and paediatricians; identify areas of need for additional education resources and the preferred method of teaching for nutritional topics for medical education. A survey-questionnaire was sent to our physicians in our centre to assess general nutrition education via self-assessment of current nutritional knowledge across 12 distinct topics; importance of teaching amongst these topics and the preferred method of teaching. A total of 64 physicians completed the survey with an overall response rate of 88%. Most responders reported having average or above-average knowledge base in all nutritional topics except for nutritional aspects of special diets. Poorest knowledge base (either below average or poor) was reported in special diet ( n = 38, 59.4%), inflammatory bowel disease ( n = 17, 26.6%) and gastrointestinal allergy ( n = 16, 25.0%). There was strong interest in additional teaching needs for the topics of failure to thrive ( n = 38, 59.4%), nutritional assessment ( n = 34, 53.1%) and infant feeding ( n = 31, 48.4%). Most popular teaching methods were clinical case review (31.7%) followed by didactic lectures (29.8%) for overall clinical nutritional education. Physicians identified gaps in their nutrition knowledge base and multiple topics were identified for additional nutrition education. Preferred methods of teaching for nutritional education were clinical case reviews and didactic lectures.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140517733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241241914
Brianna Brianna, A. Masnammany, Yuan Seng Wu
Human cytomegalovirus (CMV) is a highly infectious virus that is prevalent among adults worldwide. In immunocompetent individuals, CMV infection rarely causes complications. Following initial infection, however, CMV remains latent in the body and can be reactivated especially in immunocompromised patients, such as those with autoimmune inflammatory rheumatic diseases (AIIRDs), leading to tissue-invasive, life-threatening diseases, such as colitis, vascular thrombosis, and pneumonitis. Although there are standard treatment recommendations for symptomatic CMV disease, there is paucity of consensus in the role of primary and secondary antiviral prophylaxis to prevent CMV reactivation, especially in AIIRDs patients undergoing immunosuppressive therapy. Therein, this review aimed to provide an overview of the prevalence, clinical disease, risk factors, and treatment for CMV infection, as well as on the role of primary and secondary antiviral prophylaxis in AIIRDs patients. The emerging novel techniques that measure CMV-specific T-cell immunity as a guide to initiate prophylaxis in high-risk patients were also discussed.
{"title":"A review on cytomegalovirus in patients with autoimmune inflammatory rheumatic diseases: Prevalence, clinical spectrum, treatment, and antiviral prophylaxis","authors":"Brianna Brianna, A. Masnammany, Yuan Seng Wu","doi":"10.1177/20101058241241914","DOIUrl":"https://doi.org/10.1177/20101058241241914","url":null,"abstract":"Human cytomegalovirus (CMV) is a highly infectious virus that is prevalent among adults worldwide. In immunocompetent individuals, CMV infection rarely causes complications. Following initial infection, however, CMV remains latent in the body and can be reactivated especially in immunocompromised patients, such as those with autoimmune inflammatory rheumatic diseases (AIIRDs), leading to tissue-invasive, life-threatening diseases, such as colitis, vascular thrombosis, and pneumonitis. Although there are standard treatment recommendations for symptomatic CMV disease, there is paucity of consensus in the role of primary and secondary antiviral prophylaxis to prevent CMV reactivation, especially in AIIRDs patients undergoing immunosuppressive therapy. Therein, this review aimed to provide an overview of the prevalence, clinical disease, risk factors, and treatment for CMV infection, as well as on the role of primary and secondary antiviral prophylaxis in AIIRDs patients. The emerging novel techniques that measure CMV-specific T-cell immunity as a guide to initiate prophylaxis in high-risk patients were also discussed.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140518655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241232182
Y. Okada, Joel Aik, A. Ho, Yilin Ning, M. Ong
This study aimed to describe the clinical characteristics and epidemiology of heat-related illnesses presented at a tertiary hospital in Singapore. This retrospective observational study utilized electronic health records from the emergency department (ED) of Singapore General Hospital. Patients primarily diagnosed with heat-related illnesses from 2008 to 2020, were analyzed. The annual number of cases and the temporal trend of heat-related illnesses were described, along with the characteristics of patients. Among the 1,833,908 patients registered at the ED, 426 patients had diagnoses of heat-related illnesses. The median age (interquartile range [IQR]) was 32 (22, 43) years, with 303 (71%) being male and 201 (47%) not being Singapore citizens. The annual number of cases ranged from a minimum of 21 in 2019 to a maximum of 49 cases in 2015, except for four cases in 2020. Heat-related illnesses occurred most commonly on Sundays (233, 55%) and in December (97, 23%). A significant number of cases in December coincided with the day of an annually organized marathon (91, 21%). Approximately half of the total cases required hospitalization, with 183 (43%) admitted to the general ward and 31 (7%) admitted to the intensive care unit. The 30-day mortality was 2 (0.5%). This descriptive study indicated the unique characteristics of heat-related illness in a tertiary care hospital in Singapore. These local contexts may be valuable to consider preventative measures for heat-related illness, in preparation for future extreme weather events related to climate change.
{"title":"Heat-related illness in Singapore: Descriptive analysis of a tertiary care center from 2008 to 2020","authors":"Y. Okada, Joel Aik, A. Ho, Yilin Ning, M. Ong","doi":"10.1177/20101058241232182","DOIUrl":"https://doi.org/10.1177/20101058241232182","url":null,"abstract":"This study aimed to describe the clinical characteristics and epidemiology of heat-related illnesses presented at a tertiary hospital in Singapore. This retrospective observational study utilized electronic health records from the emergency department (ED) of Singapore General Hospital. Patients primarily diagnosed with heat-related illnesses from 2008 to 2020, were analyzed. The annual number of cases and the temporal trend of heat-related illnesses were described, along with the characteristics of patients. Among the 1,833,908 patients registered at the ED, 426 patients had diagnoses of heat-related illnesses. The median age (interquartile range [IQR]) was 32 (22, 43) years, with 303 (71%) being male and 201 (47%) not being Singapore citizens. The annual number of cases ranged from a minimum of 21 in 2019 to a maximum of 49 cases in 2015, except for four cases in 2020. Heat-related illnesses occurred most commonly on Sundays (233, 55%) and in December (97, 23%). A significant number of cases in December coincided with the day of an annually organized marathon (91, 21%). Approximately half of the total cases required hospitalization, with 183 (43%) admitted to the general ward and 31 (7%) admitted to the intensive care unit. The 30-day mortality was 2 (0.5%). This descriptive study indicated the unique characteristics of heat-related illness in a tertiary care hospital in Singapore. These local contexts may be valuable to consider preventative measures for heat-related illness, in preparation for future extreme weather events related to climate change.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140518485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241236987
Georgina Kwek, Zi Yang Wong, P. Salkade, J. Pek, Chinmaya Shrikant Joshi
The differential diagnoses of a patient presenting with motor weakness is broad and requires a systematic approach at the Emergency Department when evaluating its underlying cause. While nitrous oxide neurotoxicity is uncommon, it is important to consider it as a possible differential in patients with preceding exposure, as treatment is readily available. We present a case report with magnetic resonance imaging images of subacute combined degeneration of the spinal cord due to nitrous oxide induced vitamin B12 deficiency.
{"title":"Nitrous oxide-induced subacute combined degeneration of the spinal cord","authors":"Georgina Kwek, Zi Yang Wong, P. Salkade, J. Pek, Chinmaya Shrikant Joshi","doi":"10.1177/20101058241236987","DOIUrl":"https://doi.org/10.1177/20101058241236987","url":null,"abstract":"The differential diagnoses of a patient presenting with motor weakness is broad and requires a systematic approach at the Emergency Department when evaluating its underlying cause. While nitrous oxide neurotoxicity is uncommon, it is important to consider it as a possible differential in patients with preceding exposure, as treatment is readily available. We present a case report with magnetic resonance imaging images of subacute combined degeneration of the spinal cord due to nitrous oxide induced vitamin B12 deficiency.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140524925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241230182
Natesha Eusoof Angullia, Elizabeth Sein Jieh Tan
Background: Hip fractures are associated with significant morbidity and mortality in the elderly and optimal pain control is essential in improving postoperative outcomes. The sensory innervation of the hip is complex, and blocking the hip branches of the femoral, obturator and sciatic nerves is necessary to provide full sensory coverage of the hip joint. Objectives: This case report describes the use of a combination of three regional anesthesia techniques – caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve block – in hip fracture surgery, and demonstrates its efficacy in minimizing pain and opioid requirements in a high cardiac risk geriatric patient. Results: Caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve blocks were performed in a patient presenting for hip fracture surgery prior to general anaesthesia successfully without the need for further doses of opioids post operatively
{"title":"Caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve block in hip fracture surgery: A case report","authors":"Natesha Eusoof Angullia, Elizabeth Sein Jieh Tan","doi":"10.1177/20101058241230182","DOIUrl":"https://doi.org/10.1177/20101058241230182","url":null,"abstract":"Background: Hip fractures are associated with significant morbidity and mortality in the elderly and optimal pain control is essential in improving postoperative outcomes. The sensory innervation of the hip is complex, and blocking the hip branches of the femoral, obturator and sciatic nerves is necessary to provide full sensory coverage of the hip joint. Objectives: This case report describes the use of a combination of three regional anesthesia techniques – caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve block – in hip fracture surgery, and demonstrates its efficacy in minimizing pain and opioid requirements in a high cardiac risk geriatric patient. Results: Caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve blocks were performed in a patient presenting for hip fracture surgery prior to general anaesthesia successfully without the need for further doses of opioids post operatively","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140516239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241245239
H. Tan, J. Yek, Terrence K Allen, R. Sultana, C. Tan, B. Sng
Prediction of severe obstetric haemorrhage may facilitate timely interventions and reduce maternal morbidity and mortality. Rotational thromboelastometry (ROTEM) provides point-of-care coagulation parameters that may identify patients at risk of severe haemorrhage. Our aim was to determine the correlation of ROTEM-derived parameters at early stages of postpartum haemorrhage. Retrospective cohort study. Patients who utilised ROTEM during postpartum haemorrhage from 2013 to 2021. Severe harmorrhage was defined as: (1) decrease in haemogoblin concentration >4g.dL-1 within 48 h; (2) packed red blood cell transfusion of >1000 mL; (3) haemostatic intervention such as angiographic embolisation, arterial ligration, or hysterectomy; or (4) death. ROTEM-derived parameters were collected accordingly. Data from 36 patients were analysed, of whom 29 (80.6%) developed severe haemorrhage. FIBTEM A5, A10, and A20 were highly correlated (r > +/−0.7) with severe haemorrhage. There were moderate correlations (r = +/− 0.5 to 0.7) between EXTEM A5, A10, A20, maximum clot firmness, maximum lysis, and lysis index-30 with severe haemorrhage. These findings are consistent with prior studies reporting associations between fibrinogen concentration, EXTEM A10, and FIBTEM A10 with severe haemorrhage. In conjunction with these studies, our results support the use of FIBTEM A5 and A10 as early biomarkers to predict progression to severe haemorrhage and facilitate timely implementation of appropriate medical or surgical interventions.
{"title":"The correlation of Rotational Thromboelastometry (ROTEM) derived parameters with severe obstetric haemorrhage","authors":"H. Tan, J. Yek, Terrence K Allen, R. Sultana, C. Tan, B. Sng","doi":"10.1177/20101058241245239","DOIUrl":"https://doi.org/10.1177/20101058241245239","url":null,"abstract":"Prediction of severe obstetric haemorrhage may facilitate timely interventions and reduce maternal morbidity and mortality. Rotational thromboelastometry (ROTEM) provides point-of-care coagulation parameters that may identify patients at risk of severe haemorrhage. Our aim was to determine the correlation of ROTEM-derived parameters at early stages of postpartum haemorrhage. Retrospective cohort study. Patients who utilised ROTEM during postpartum haemorrhage from 2013 to 2021. Severe harmorrhage was defined as: (1) decrease in haemogoblin concentration >4g.dL-1 within 48 h; (2) packed red blood cell transfusion of >1000 mL; (3) haemostatic intervention such as angiographic embolisation, arterial ligration, or hysterectomy; or (4) death. ROTEM-derived parameters were collected accordingly. Data from 36 patients were analysed, of whom 29 (80.6%) developed severe haemorrhage. FIBTEM A5, A10, and A20 were highly correlated (r > +/−0.7) with severe haemorrhage. There were moderate correlations (r = +/− 0.5 to 0.7) between EXTEM A5, A10, A20, maximum clot firmness, maximum lysis, and lysis index-30 with severe haemorrhage. These findings are consistent with prior studies reporting associations between fibrinogen concentration, EXTEM A10, and FIBTEM A10 with severe haemorrhage. In conjunction with these studies, our results support the use of FIBTEM A5 and A10 as early biomarkers to predict progression to severe haemorrhage and facilitate timely implementation of appropriate medical or surgical interventions.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140523703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241236991
Abhay Kant, Yi-En Clara Seah
Background: There is lack of uniformity and consensus amongst the emergency physicians about an appropriate duration of cardiopulmonary resuscitation (CPR) and resuscitative efforts before deciding about termination of resuscitation (TOR) in patients with either out-of-hospital or in the emergency department (ED) non-traumatic cardiac arrests. An ideal duration of resuscitation for those with persistent cardiac arrest has not been determined yet. This study aims to evaluate the resuscitative interventions, patient factors and outcomes associated with prolonged duration of resuscitation in these patients. Methods: A retrospective study conducted in the Emergency Department (ED) of Changi General Hospital, Singapore and included 15 non-consecutive and randomly selected adult patients who either had an out-hospital cardiac arrest (OHCA) or suffered a witnessed cardiac arrest soon after arrival in the ED and were resuscitated further. Results: The median age was 58 years (IQR 51.5–70.5 years), and the median total CPR and resuscitation duration was 46 min (IQR 40–62.5 min). 12 patients sustained ROSC and one had transient ROSC. Ten (10) patients survived to hospital admission from ED and 5 of them underwent emergency angiography from ED. Three patients were discharged from hospital eventually with mRS scores of 0–1. Conclusion: Patients with sustained ROSC were older, had more prevalence of co-morbidities and lesser prevalence of shockable rhythms, received bystander CPR and pre-hospital adrenaline more frequently, had longer total duration of CPR and a larger proportion were administered intravenous calcium gluconate during ED resuscitation.
{"title":"Characteristics and outcomes of cardiac arrest patients with prolonged resuscitation","authors":"Abhay Kant, Yi-En Clara Seah","doi":"10.1177/20101058241236991","DOIUrl":"https://doi.org/10.1177/20101058241236991","url":null,"abstract":"Background: There is lack of uniformity and consensus amongst the emergency physicians about an appropriate duration of cardiopulmonary resuscitation (CPR) and resuscitative efforts before deciding about termination of resuscitation (TOR) in patients with either out-of-hospital or in the emergency department (ED) non-traumatic cardiac arrests. An ideal duration of resuscitation for those with persistent cardiac arrest has not been determined yet. This study aims to evaluate the resuscitative interventions, patient factors and outcomes associated with prolonged duration of resuscitation in these patients. Methods: A retrospective study conducted in the Emergency Department (ED) of Changi General Hospital, Singapore and included 15 non-consecutive and randomly selected adult patients who either had an out-hospital cardiac arrest (OHCA) or suffered a witnessed cardiac arrest soon after arrival in the ED and were resuscitated further. Results: The median age was 58 years (IQR 51.5–70.5 years), and the median total CPR and resuscitation duration was 46 min (IQR 40–62.5 min). 12 patients sustained ROSC and one had transient ROSC. Ten (10) patients survived to hospital admission from ED and 5 of them underwent emergency angiography from ED. Three patients were discharged from hospital eventually with mRS scores of 0–1. Conclusion: Patients with sustained ROSC were older, had more prevalence of co-morbidities and lesser prevalence of shockable rhythms, received bystander CPR and pre-hospital adrenaline more frequently, had longer total duration of CPR and a larger proportion were administered intravenous calcium gluconate during ED resuscitation.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140521890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/20101058241239442
Hou Boon Lim, Tin Aung
Ophthalmic primary care (OPC) of Singapore residents is mainly provided for by trained specialists. This is due both to the current nature of the public healthcare system as well as societal perceptions and preferences, and it imposes a heavy burden on the country’s ophthalmologist resource. Changing population demographics, escalating costs as well limitations to medical manpower growth have necessitated a shift in Singapore’s healthcare strategy to focus on primary and preventive care. This national policy change further emphasizes the need to invest in OPC as a more structured service. Revisiting the principles of primary care and how they apply to ophthalmology will be an important first step in a timely review of the country’s OPC system.
{"title":"Ophthalmic primary care in Singapore: Considerations for review","authors":"Hou Boon Lim, Tin Aung","doi":"10.1177/20101058241239442","DOIUrl":"https://doi.org/10.1177/20101058241239442","url":null,"abstract":"Ophthalmic primary care (OPC) of Singapore residents is mainly provided for by trained specialists. This is due both to the current nature of the public healthcare system as well as societal perceptions and preferences, and it imposes a heavy burden on the country’s ophthalmologist resource. Changing population demographics, escalating costs as well limitations to medical manpower growth have necessitated a shift in Singapore’s healthcare strategy to focus on primary and preventive care. This national policy change further emphasizes the need to invest in OPC as a more structured service. Revisiting the principles of primary care and how they apply to ophthalmology will be an important first step in a timely review of the country’s OPC system.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140521571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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