Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1997
Preoperative prediction of intra and postoperative red blood cell transfusion in surgical patients.
Anaesthetists were asked to predict the need for intra and postoperative red blood cell transfusion in 1706 patients before surgery. Each prediction was made using only the individual patient's medical history and physical examination, the results of routine preoperative laboratory investigations, and knowledge of the proposed surgical procedure. ⋯ Using a stepwise logistic regression model, preoperative haemoglobin concentration, Surgical Table of the procedure, and age of patients were found to significantly determine the need for intra and postoperative red blood cell transfusion. It is recommended that type and screen should replace group and crossmatch procedures in surgical patients where no intra and postoperative red blood cell transfusion is predicted as necessary.
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Ann Acad Med Singap · Jul 1997
ReviewJoint lectureship of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore--accurate long-term documentation in surgical audit and evaluation of outcomes.
The purpose of a surgical audit is to allow a critical assessment of patient care, carried out among peers and in an atmosphere of learning, open discussion, free of recriminations. The results of a surgical unit will hopefully lead to improvement in the quality of care of our patients by reducing the preventable causes of mortality and morbidity. Data from surgical audit can also be used to monitor the teaching programme in a department. It may even allow us to study the cost effectiveness of certain procedures which is obviously very important in this era of diminishing resources and cost containment.
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Ann Acad Med Singap · Jul 1997
Usefulness of bacteriologic cultures in choice of antibiotics in patients with chemotherapy-induced neutropenic sepsis.
Neutropenic sepsis is a potential problem in cancer patients undergoing cytotoxic chemotherapy. Septic work-up including cultures from various sites is routinely done for these patients. To assess the usefulness of these cultures, a retrospective review of all patients admitted for neutropenic sepsis in the period from June 1994 to August 1995 was conducted. ⋯ Of the patients with positive cultures, the results of drug sensitivity made a difference to treatment. None of the patients with negative cultures died from sepsis. It appears that even though the rate of positive culture is low (27%), it is still useful as a guide when change of antibiotics is required.
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Monumental advances in the field of lipid metabolism and its relationship to atherosclerotic cardiovascular disease have been achieved during the last half century. Epidemiologic studies have defined lipid disorders as highly significant independent risk factors for coronary heart disease, along with diabetes mellitus, hypertension and smoking. Primary and secondary prevention studies including the Coronary Primary Prevention Trial, Helsinki Heart Study, and the Coronary Drug Project have shown that lowering the atherogenic low density lipoproteins (LDL) and very low density lipoproteins (VLDL) whilst raising the high density lipoproteins (HDL) significantly decreases the risk for coronary disease. ⋯ Such patients merit individualized treatment. The prevalence of this syndrome may be more common in Singapore and requires further investigation. Current therapeutic guidelines emphasize the need for weight loss and dietary restriction of total and especially saturated fat (< 7% to 10% total calories), cholesterol (< 200 to 300 mg/day), and exercise. (ABSTRACT TRUNCATED)