Ann Acad Med Singap
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For decades, warfighters have been putting in place a sophisticated "digital battlefield", an electronic communication and information system to support advanced technology. Medicine is now in a position to leverage these technologies to produce a fundamental revolution, and the keystone is the digital physician. Today nearly all information about a patient can be acquired electronically, and with the new technologies of teleoperation and telesurgery we can provide remote treatment and even surgery through telemedicine. ⋯ Also, the expertise from any specialist will be available from the rear echelons as far back as the home country. For education and training in combat casualty care, virtual reality simulators are being implemented. This same scenario can be utilised in civilian health care, especially in providing care to patients in remote areas who do not currently have access to simple, let alone sophisticated, health care.
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Ann Acad Med Singap · Nov 1996
Comparative Study Clinical TrialAbnormal thyroid and adrenocortical function test results in intensive care patients.
A prospective, cohort study of 75 consecutive patients requiring management in the medical intensive care unit (MICU) of the Singapore General Hospital was carried out over a five-month period to determine thyroid and adrenocortical profiles and evaluate their use in predicting patient outcome. Up to 88% of patients had at least one abnormal thyroid function and 77% had abnormal adrenocortical function test results. There were significantly lower triiodothyronine, thyroxine and free thyroxine, but not thyrotropin levels, and higher cortisol levels in non-survivors compared to survivors (all P < 0.01). ⋯ The APACHE II (acute physiology and chronic health evaluation II) score alone predicted outcome with 71% accuracy, and in combination with triiodothyronine and cortisol levels improved accuracy to 84%. The use of dopamine alone predicted outcome with 74% accuracy, and in combination with triiodothyronine and cortisol levels, improved accuracy to 84%. Measurements of total triiodothyronine and cortisol concentrations on admission to the MICU, and consideration of the use of dopamine improve on the APACHE II score in outcome prediction.
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Ann Acad Med Singap · Nov 1996
Noninvasive positive-pressure ventilation for acute respiratory failure in a medical intensive care unit in Singapore.
The main advantage of noninvasive ventilation over conventional mechanical ventilation is in the avoidance of endotracheal intubation and its related complications. Currently, the role of noninvasive ventilation in the management of patients with acute respiratory failure is still not firmly established. We conducted a prospective study to evaluate the efficacy of nasal positive pressure ventilation in patients with acute respiratory failure. ⋯ Successfully supported patients tolerated the device with improved gas exchange, hence avoiding endotracheal intubation. The mean duration of support was 19.2 hours. There were major associated complications, e.g. gastric distention or aspiration.
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Ann Acad Med Singap · Sep 1996
Review Case ReportsCystic nodal metastasis in occult tonsil carcinoma--a case report.
A "branchial cyst" in a patient above 40 years old may turn out to be a malignant cystic nodal metastasis from a primary tumour in the tonsil. We present a case of a 45-year-old woman in whom an initial mistaken diagnosis of branchial cyst was made. The neck mass was discovered to be malignant and the left tonsil was subsequently implicated as the primary source. Older patients with cystic neck masses should be managed on the presumption that these may possibly be metastatic lesions from a primary oropharyngeal tumour.
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Ann Acad Med Singap · Sep 1996
Biography Historical ArticleHow I developed laparoscopic cholecystectomy.