Proceedings of Singapore Healthcare

The purpose of this study was to evaluate the performance of three severity scoring tools and procalcitonin (PCT) in severity stratification and mortality prediction among patients with community-acquired pneumonia (CAP) in Singapore.

The method used was a retrospective observational study of all the consecutive patients with CAP admitted through the emergency department of Singapore General Hospital between 2012–2013.

Among 1902 study subjects, the overall 30-day mortality was 15.7%. The mortality rates for Pneumonia Severity Index (PSI) class I–III were 0, 0, and 3.7%, which were comparable to the original published data. CURB-65 and CRB-65 had higher mortality rates in all severity levels. In three levels of risk stratification, the low risk group of PSI (class I–III) included 42.6% of the patients with mortality rate of 1.9%, whereas the low risk group defined by CURB-65 (score 0–1) and CRB-65 (score 0) included 52.0% and 24.4% of the patients with higher mortality rates (7.3% and 4.5% respectively). PSI was the most sensitive in mortality prediction with area under receiver operating characteristic (ROC) curve of 0.82, higher than CURB-65 (0.71), CRB-65 (0.67), and PCT (0.63) (p<0.001). The initial level of PCT was higher in non-survivors and intensive care unit (ICU)-admitted patients compared to survivors (0.91 vs 0.36 ng/ml, p<0.001) and non-ICU patients (3.70 vs 0.38 ng/ml, p<0.001). Incorporating PCT did not improve the discriminatory power of the scoring tools for mortality prediction.

PSI was a reliable tool for severity stratification and morality prediction among the patients with CAP in Singapore.

The polymorphisms of the angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) genes have been demonstrated to be involved in some cardiovascular diseases. We hypothesised that the polymorphisms of ACE and ACE2 relate to the formation of thoracic aortic diseases and coronary heart disease.

A total of 86 patients (four groups: thoracic aortic dissection; thoracic aortic aneurysm; coronary heart disease; and control group) were recruited. The ACE I/D polymorphism and the ACE2 (A8790G) polymorphism were measured in all patient samples.

There were no significant differences in groups with regard to either the ACE I/D polymorphism or the ACE2 (A8790G) polymorphism.

The polymorphisms of the ACE and ACE2 genes are not associated with thoracic aortic dissection, thoracic aortic aneurysm and coronary heart disease.

It has been suggested that bispectral index (BIS) can be indicative of cerebral perfusion during advanced cardiac life support (ACLS) resuscitation of cardiac arrest patients. Our aim was to determine whether BIS monitoring during resuscitation in the emergency department (ED) can predict survival or neurological outcomes of patients with cardiac arrest.

This was a prospective, single-centre, observational cohort study in the ED of a tertiary hospital, where we included 100 patients whom received resuscitation in the ED between December 2010 and March 2014. We recorded BIS values, suppression ratio, electromyography and signal quality index; throughout the resuscitation. A research coordinator set up the monitoring apparatus at the earliest time possible.

Out of the 100 patients recruited, 22 had a sustained return of spontaneous circulation (ROSC) and were admitted to the intensive care unit (ICU). Of these, 19 patients subsequently died in the ICU, two were discharged with good neurological recovery (cerebral performance category (CPC) 1) and one was discharged with poor neurological recovery (CPC4). By comparing the groups of patients who died in the ICU and were discharged, we found there was no significant difference in the initial BIS score (p = 0.64), the score upon ROSC (p = 0.36), the average BIS score 10 minutes post-ROSC (p = 0.35), nor the BIS score upon admission to the ICU (p = 0.22).

Very early monitoring of BIS before admission to the ICU predicts neither survival nor neurological recovery in patients with cardiac arrest. Very low BIS scores in the ED may not indicate a poor prognosis, especially in patients undergoing therapeutic hypothermia.

The National Dental Centre Singapore (NDCS) has been educating learners since the late 1980s. However, in this time, no formal feedback about these educational activities has been garnered from education stakeholders (comprising learners and faculty). Furthermore, no formal faculty development efforts to improve the educational activities have been done.

The aim of the study was to collect data from learners about the NDCS’s educational activities and the faculty’s attitude towards teaching.

A survey was administered to 239 education stakeholders from May to July 2015. The survey on learners focused on learners’ perceptions on the importance and frequency of the One-Minute Preceptor (OMP) five-step microskills model of clinical teaching, and the quality and quantity of teaching overall. For faculty, the survey focused on their attitudes around teaching.

A total of 92 responses were received from learners. Learners perceived the OMP elements to be important (mean Likert scores ranged from 4.13–4.44 out of 5). However, they reported infrequent use of this teaching model by the faculty (range 3.06–3.50 out of 5). While learners reported quality and content of teaching to be adequate, they felt the number of clinical hours for teaching could be increased. The faculty reported positive attitudes towards teaching.

This study provided educators with valuable feedback on the NDCS’s educational activities, identifying strengths and weaknesses of the programmes that they can work towards improving.

Singapore’s postgraduate medical education underwent a transition in 2010, moving away from the House staff model to the American Residency model. Teaching was defined as a core competency for SingHealth Residency programs. This study sought to determine how this transition impacted medical students’ perception of Residents as teachers.

A 19-item Likert-type questionnaire comprising three domains—(1) quality, (2) frequency and (3) engagement—was given to all Duke-NUS medical students at the end of each clerkship from the academic year (AY) 2009–10 through 2013–14. The first two academic years were classified as the pre-initiation stage of the Residency, and the latter three, the post-initiation stage. Students rated Residents they encountered in their most recent clerkship.

Student ratings have gradually improved, with the largest improvement occurring after the initiation of Residency, and after the introduction of Residents as Future Teachers courses. Student ratings in the post-initiation Residency years combined were significantly higher than the pre-initiation of Residency years combined, for all three domains. Analysis of individual items revealed significant improvement in student ratings on all items in all domains, except for the quality of teaching in performing procedural skills.

Findings from this study indicate a positive shift in the teaching culture with the transition of Singapore’s postgraduate medical education from the House staff model to the Residency program.

Optimal hand function recovery is the key to the successful management of hand burns. It starts with a timely burns coverage in the acute setting. A new hand burns protocol has been introduced to cover hand burn wounds within 24 hours after admission. Biobrane^TM and split skin graft (SSG) are the coverage methods for partial-thickness burns. A three-year prospective study is being carried out to evaluate the short- and long-term clinical and functional outcomes of the two treatment modalities. This paper reports the preliminary short-term results of the first 34 hand burns of the study.

This report includes consecutive hand burns patients admitted between September 2014 and May 2015. The recruited hand burns patients underwent clinical and functional assessments seven days after the coverage with either SSG or Biobrane^TM. Statistical analysis was performed to evaluate the outcomes.

Eleven burnt hands were treated with SSG and 23 with Biobrane^TM. The clinical and functional outcomes, including range of motion, power and sensitivity, were similar in both treatment groups. Further study to recruit more patients is necessary to ascertain the significance of the above findings. More importantly, long-term functional outcomes have to be assessed to conclude the treatment efficacy of early hand burns coverage with Biobrane^TM or SSG.