Ann Acad Med Singap
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Ann Acad Med Singap · Jul 2002
ReviewEvidence-based medicine: the key to guidelines, disease and care management programmes.
Evidence-based medicine (EBM) is based on the concept of applying best practice to the diagnosis or treatment of a single patient or clinical question, one patient at one time. Although this is useful as a practitioner seeing patients one at a time, it is limited in its application to populations or to single patients with multiple diseases. I will review how to apply EBM to the structure and implementation of population-based care management programmes. ⋯ To optimally improve the health of a population, chronic collaborative care programmes must be built and implemented that utilise best practice as defined by evidence in the literature.
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Ann Acad Med Singap · Jul 2002
Emergency department asthma: compliance with an evidence-based management algorithm.
Recent surveys in emergency medicine departments show inadequacies in many aspects of acute asthma management. ⋯ In the management of acute asthma, we found excellent compliance with specific treatment steps based upon clinical evidence. However, adherence to second-line treatment was less satisfactory. Nevertheless, whenever second-line treatment was complied with, reasonable outcomes were achieved. It may be more appropriate to emphasise evidence-based treatment rather than extensive documentation.
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Ann Acad Med Singap · Jul 2002
Problems related to epidural analgesia for postoperative pain control.
Epidural analgesia provides excellent analgesia after major surgery but it is not without adverse effects. This retrospective study aims to evaluate the efficacy of analgesia and the problems commonly encountered postoperatively. ⋯ Although the incidence of serious complications was low, there was a high incidence of minor adverse effects especially during the first 48 hours. This emphasises the importance of close monitoring during the early postoperative period and the APS in the management of side effects, especially inadequate analgesia.
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Ann Acad Med Singap · Jul 2002
Audit of total parenteral nutrition in an adult surgical intensive care.
A preliminary one-year review of total parenteral nutrition (TPN) in the adult surgical intensive care unit (SICU) in view of its complications, cost and lack of consistent benefits in the critically ill. ⋯ This audit highlights the shortcomings in TPN prescription and characteristics of the attendant complications. Efforts must be directed towards encouraging uniformity and level of practice standards.
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Multicompartmental blocks are commonly described in epidurals but not spinals. We describe a case of subarachnoid block performed in an obese patient which resulted in a clinical presentation resembling that of a subdural block. ⋯ The diagnosis of subdural block must be considered in patients with unusual presentations after a spinal anaesthetic. Factors affecting spread of hyperbaric bupivacaine are also highlighted.