Singapore medical journal最新文献

Introduction: We aimed to describe the clinical course of bacterial exogenous endophthalmitis (EE) in a Singapore tertiery hospital and identify the risk factors associated with poor visual outcomes.

Methods: This was a retrospective chart review of patients diagnosed with EE between 1 January 2014 and 31 December 2021. Microbiological data, aetiologies, treatment and visual acuities (VAs) were assessed. Poor visual outcome was defined as final VA poorer than 6/60.

Results: Overall, 18 eyes of 18 patients were identified (postoperative endophthalmitis [POE]: n = 11, 61.1%; postinjection endophthalmitis [PIE]: n = 3, 17.7%; posttraumatic endophthalmitis: n = 2, 11.1% and keratitis-induced endophthalmitis: n = 2, 11.1%). Among the 11 POE patients, cataract surgery was the most common cause (n = 8, 72.7%). The median VA was hand movement (HM) (range from 6/30 to no light perception [NLP]) at presentation and HM (range from 6/6 to NLP) at final review. Patients with presenting VA of 6/60 or better were significantly less likely to have poor visual outcomes (0% vs. 78.6%, P = 0.01, Fisher's exact test). Coagulase-negative Staphylococcus (CoNS) was the most common organism (n = 6), followed by Enterococcus spp. (n = 3), Bacillus spp. and Pseudomonas spp. (n = 2 each). Compared to Gram-positive endophthalmitis, a greater proportion of patients with Gram-negative endophthalmitis had poor visual outcomes (100% vs. 33.5%, P = 0.06).

Conclusion: Between 2014 and 2021, POE was the most common cause of bacterial EE, followed by PIE. The most common organism isolated was CoNS. Patients with better presenting VA may have better visual prognosis after treatment.

Introduction: Boarders refer to patients who have been admitted to the hospital but remain in the emergency department (ED) while waiting for an available inpatient bed. We aimed to examine the correlations between the number of boarders and outcome measures, including effectiveness of patient care, patient safety, efficiency of patient care, patient experience and staff well-being in the ED.

Methods: A retrospective study was carried out. Correlations between the number of boarders and outcome measures were assessed using Pearson's correlation (r) or Spearman's rho (ρ).

Results: The average number of boarders correlated strongly with these outcomes: wait times for triage (r = 0.883, P < 0.001); consult among P2 (urgent) (r = 0.829, P < 0.001) and P3 (ambulatory) patients (r = 0.825, P < 0.001); urinary test (r = 0.562, P < 0.001) and computed tomography (r = 0.733, P < 0.001); time taken for administration of analgesia (r = 0.960, P < 0.001), antibiotics (r = 0.828, P < 0.001) and intravenous fluids (r = 0.872, P < 0.001); and the length of stay for admitted patients (r = 0.995, P < 0.001) and discharged patients (r = 0.797, P < 0.001). Additionally, medical errors (ρ = 0.646, P < 0.001), compliments (ρ = 0.520, P = 0.006), patients who were triaged but did not go through consult (ρ = 0.848, P < 0.001), as well as medical leave taken by doctors (r = 0.626, P = 0.001) and nurses (r = 0.815, P < 0.001) strongly correlated with the average number of boarders in the ED.

Conclusion: Boarders lead to insufficient space and inefficient work processes, which compromise the delivery of emergency care in a timely and safe manner for patients in EDs.

Abstract: Aviation medicine safeguards flight safety by addressing three critical areas: managing physiological challenges of the aviation environment, preventing in-flight medical incapacitation and ensuring psychological fitness for flight. The field adopts occupational medicine's hierarchy of risk control to mitigate physiological risks in the operating environment, while employing systematic medical screening with tailored standards based on operational requirements to reduce the likelihood of in-flight incapacitation. A comprehensive approach incorporating mental health education, support systems and regular monitoring helps prevent psychological incapacitation. Recent data from the Singapore Changi Aeromedical Centre reveal that ophthalmological, otolaryngological and respiratory conditions are the primary causes of medical disqualification during air force pilot screening, reflecting the unique physiological demands of military aviation. This review emphasises the ongoing challenge of balancing rigorous medical standards with maintaining an adequate pilot recruitment pool, while highlighting the need for evidence-based approaches to aeromedical assessment and certification.

Abstract: Correctional facilities are a major hub of hepatitis C virus (HCV), with rates far higher than those observed in the general population. Once considered an intractable crisis, the current situation offers a unique opportunity. The advent of direct-acting antivirals has changed the HCV treatment landscape, making its elimination possible. This review summarises the scientific evidence and progress towards HCV elimination in correctional health systems. It outlines the evolution of 'test-and-treat' models, assesses micro-elimination success worldwide, especially in Singapore, and highlights collaborative efforts between Changi General Hospital and Singapore Prison Services. Their implementation of HCV treatment guidelines serves as a key case study in this context. This review also analyses the various barriers - structural, financial, clinical and logistical - that hinder progress. It consolidates strong evidence that prison-based HCV treatment is cost-effective, promotes health equity, supports the World Health Organization 2030 goals and reduces the societal burden of HCV.