Ann Acad Med Singap
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The hospice movement in Singapore was started in 1985 when St Joseph's Home opened its doors to terminally ill patients by setting aside 16 beds for hospice care. A newspaper article about this work brought together a group of volunteers who started a hospice home care service under the auspices of the Singapore Cancer Society in 1987. This service was originally entirely staffed by volunteers until a charitable foundation made possible the employment of a nurse coordinator in 1988. ⋯ With charitable funding from the community, the new organization built on the experience of the volunteer-run hospice home care service and developed it into one in which professionals provide most of the care, supported by volunteers. Full-time staff were responsible for the day-to-day running of the service, providing for reliability and setting and maintaining of standards, while the role of volunteers changed to that of supporting, supplementing and enhancing the quality of the care given to patients. This paper chronicles the evolution of this service and describes its present functioning.
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Ann Acad Med Singap · Nov 1993
Pulmonary function in healthy Chinese, Malay and Indian adults in Singapore.
Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), single-breath diffusion capacity measurements (effective alveolar volume (VA), carbon monoxide transfer factor (DLCO) and transfer coefficient (KCO)) were determined in 452 healthy Singaporean adults (277 males and 175 females) aged 20-70 years. The ratio of Chinese, Malay and Indian subjects was 5:2:3 in both sexes. Age, height and weight in the males were all significantly correlated with FEV1, FVC, DLCO, VA and PEFR. ⋯ Regression equations, with age and height as independent variables, were derived for males and females in each ethnic group to predict normal pulmonary function for the Singapore Chinese, Malay and Indian populations. The predicted values of various pulmonary function measurements obtained from these regression equations for subjects of specified age (30 years) and height (165 cm for men, 155 cm for women) were compared with those reported in other studies. Differences were observed among the different races.
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Ann Acad Med Singap · May 1993
Case ReportsPedicle fixation: an adjuvant for the treatment of thoracolumbar metastases.
For a long time, radiotherapy was considered as the best treatment for spinal metastases. However, radiotherapy alone could not resolve the problem of pathological fracture which is an important complication of spinal metastases. ⋯ The operation time was short and none of the patients required a blood transfusion. Tissue diagnosis was possible through this approach.
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Ann Acad Med Singap · May 1993
ReviewCritical care medicine--a review of the outcome prediction in critical care.
Predicting the outcome of critically ill patients has undergone considerable evolution over the last two decades. Economic constraints require the channelling of resources and efforts to patients with reasonable chances of survival. ⋯ The issues surrounding the use of the APACHE score from the literature are discussed. Estimation of specific individual mortality risks have not been as successful as that for large groups of critical care patients in general using the available prognostic scores and until better systems are available, clinical decisions on any individual outcome should not be based on any prognostic score alone.
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Several basic and fundamental principles remain prime considerations in lumbar spine surgery, so a review of these is appropriate in view of the current headlong rush into the use of new and developing technology for lumbar spine surgery. Eighteen hundred and sixty-one laminectomy procedures are reviewed, the majority of these for simple lumbar disc protrusion and spinal canal stenosis but also 204 cases where patients required a surgical procedure for failed back surgery syndrome. Surgical technique and technology will fail when an inappropriate patient is selected for surgical intervention; failure also occurs particularly in lumbar disc protrusion if lateral recess stenosis is undiagnosed and untreated at the time of surgery. The patient's motivation status also has a significant effect on surgical outcome and the optimum patient to submit to surgery for failed back surgery syndrome has sciatica, more severe than backache, a recurrent or residual disc protrusion associated with the stenosis and excellent motivation which is not affected by workers' compensation or other insurance claims or benefit.