Ann Acad Med Singap
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Ann Acad Med Singap · May 1998
APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit.
This study seeks to determine if the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) model predictions are well calibrated in our adult Intensive Care Unit (ICU) patient population. 1064 successive ICU discharges were enrolled with 222 deaths at hospital discharge. APACHE II predicted 287.44 deaths, thus giving an APACHE II standardised mortality ratio (SMR) of 0.77 (95% confidence interval +/- 0.07). ⋯ The area under the Receiver Operating Characteristic plot for SAPS II risk of death was 0.87 (95% confidence interval +/- 0.028) while that for APACHE II risk of death was 0.88 (95% confidence interval +/- 0.026). Although the APACHE II and SAPS II models provide good discriminatory performance this study finds the APACHE II and SAPS II models to be poorly calibrated in that they over-predict mortality in our ICU population.
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Ann Acad Med Singap · May 1998
Audit of 2431 admissions to the Surgical Intensive Care Unit, Singapore General Hospital.
A prospective analysis of 2431 patients admitted to the Surgical Intensive Care Unit (SICU) of Singapore General Hospital was conducted between January 1994 and June 1997. All patients were followed up until hospital discharge. This ongoing project serves as both audit and quality assurance in the SICU. ⋯ Thirty (29%) died before the SICU discharge. SICU mortality was 9.46%, hospital mortality was 10.86% and standardised mortality ratio was 1.95. Computerised tools that analyse ICU utilisation patterns and outcomes have the potential to better target resources and so lower hospital costs, reducing futile medical care by selecting patients for appropriate expensive ICU care.
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Ann Acad Med Singap · Mar 1998
ReviewInterventional electrophysiology and its role in the treatment of cardiac arrhythmia.
Cardiac arrhythmias can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac death. Clinical cardiac electrophysiology is the study of the electrophysiology of the heart and all aspects of management of cardiac arrhythmias. The invasive electrophysiological study was initially purely diagnostic, but recent advances in technology has allowed us to intervene and hence the term interventional electrophysiology. ⋯ In conclusion, interventional electrophysiology represents a tremendous leap forward in the management of cardiac arrhythmias. With catheter ablation, it offers a safe curative therapy for patients with recurrent SVTs and VTs and with the ICD, prevents sudden cardiac death in patients who have been resuscitated from it or who are at risk for it. The future will see us improving our success in ablating patients with monomorphic ischaemic VT and even atrial fibrillation, and the role of prophylactic ICDs in high risk patients will be better defined.
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An ideal analgesic for labour would preferably be non-invasive, as effective as spinals and epidurals without their attendant complications and is safe to mother and child and should not complicate the labour process. Analgesia for labouring women ranges from the use of opioid injections to invasive methods, chiefly epidural injections. Each has its advantages and drawbacks. ⋯ They are known to improve maternal satisfaction because of preservation of motor power. Ambulation may help with cervical dilatation and engagement, and abolition of backpain, among other advantages. This article describes the methods of establishing mobile epidurals and offers guidelines on safe ambulation and contraindications to its use.