Ann Acad Med Singap
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Ann Acad Med Singap · Mar 2008
Case ReportsTreatment of cardiogenic pulmonary oedema by helmet-delivered non-invasive pressure support ventilation in children with scorpion sting envenomation.
The aim of this study was to evaluate the feasibility of non-invasive positive pressure ventilation through a new interface helmet in the treatment of cardiogenic pulmonary oedema due to scorpion sting envenomation in children. ⋯ This new approach of delivering NPSV through a helmet allows the successful treatment of cardiogenic pulmonary oedema in children with scorpion sting envenomation, assuring a good tolerance without complications. Future studies are needed before recommending the extensive application of this technique in all cases of cardiogenic pulmonary oedema due to scorpion sting envenomation.
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Ann Acad Med Singap · Feb 2008
Pattern and outcome of subsidised referrals to cardiology specialist outpatient clinics.
Increasing demand for public healthcare and access to specialist care has become a major concern. Characterising the referral pattern to a national centre's cardiology specialist outpatient clinics (SOCs) and the diagnostic outcomes may be useful in formulating referral guidelines to contain rising demand. ⋯ Referrals to cardiology outpatient specialist clinics should be based on the presence of patient symptoms, particularly that of typical chest pain. In asymptomatic patients, routine ECG screening did not appear to yield significant cardiac abnormalities.
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Ann Acad Med Singap · Feb 2008
Comparative StudyConcerns, perceived impact and preparedness in an avian influenza pandemic--a comparative study between healthcare workers in primary and tertiary care.
With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting. ⋯ HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.
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Ann Acad Med Singap · Feb 2008
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. Three typical "trajectories" or patterns of decline in the last year(s) of life have recently been described, and each of these may require different models of care to best meet the needs of patients. ⋯ In Singapore, the involvement of family physicians in end-of-life care is very low. A local survey is currently being conducted to identify the challenges in getting more family physicians involved. Given adequate time and resources, community professionals throughout the world can provide effective, equitable, and accessible primary palliative care, and form a solid bridge of communication and support between primary and secondary care.
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After hospital discharge, correct understanding and use of medications are key components of patient safety. The current discharge process does not provide adequate fail-safes to ensure quality post-discharge care. This often leads to preventable medication errors as well as nonadherence. ⋯ More timely communication with outpatient physicians in addition to a more comprehensive transfer of information further facilitates the transition home. Finally, a systematic process of medication reconciliation also aids in decreasing the incidence of medication errors. Hospital-based physicians who attend to key details in the process of discharging patients can have a profound impact on improving medication adherence, avoiding medication errors, and decreasing adverse outcomes in the post-discharge period.