Key points o Spend time taking a good history and performing a physical examination even though the majority of patients have “functional” symptoms. Exclude “non-dyspepsia” conditions and be careful in excluding a “surgical” abdomen. o Consider gastroscopy or an ultrasound or CT scan of the abdomen, if alarm symptoms are present. The threshold to investigate should be lower with older male patients as there is a higher chance of organic disease. o When patients’ symptoms are unclear, a close follow-up and review is useful. Symptoms persisting over many months or years are unlikely to have an organic basis. o Explore, understand and address patients’ concerns including psychological problems. Patients need to be reassured. o Sensible advice on food/meal and lifestyle modifications is useful. Antacids often give immediate relief to acute dyspeptic symptoms. Gastroesophageal reflux symptoms may be atypical − a trial of PPI therapy may be useful. Patients with wind, bloating and discomfort often benefit from a course of prokinetic agents.

Academies and Institutes ; History, 20th Century ; Singapore

The present study attempted to demonstrate an acquired immunity against Clonorchis sinensis in albino rat. Three separate experiments were carried out to determine acquired resistance developed by stimulating procedure followed by challenging infection with metacercariae. Acquired resistance was evaluated by the rate of recovery or the average number of flukes recovered from the liver of challenged albino rats, compared with the controls. In drder to demonstrate the rate of recovery of the fluke, three experimental groups of rats were challenged with 50 metacercariae per rat- 7,15 and 30 days after single injection of worm extract. The recovery rate was ranged from 33.2% to 38.0% in experimental group and their control group harbored from 37.8% to 42.6%. No significant difference was found on statistical analysis. In experimental groups received two immunizing injections with worm extract followed by challenging infection of metacercariae. Statistically significant difference was recovered between experimentals and controls. It was noted that reduction of the recovery rate was prominent in Group 5 and 6, which were challenged 15 and 30 days after two stimulating injections. From the third experiment which was consisted of single immunizing infection with 20 metacercariae followed by challenging infection with 30 metacercariae, no significant reduction was found between experimental rats and their controls. The number of recovered worms ranged from 16.2 to 18.5 worms in experimental group, while that of control group ranged from 18.9 to 19.8 worms. The evidence of delayed hypersensitivity reaction was observed in the groups with acquired immunity developed rats, by histopathological study of host hepatic tissue.
parasitology-helminth-trematoda ; Clonorchis sinensis ; immunology ; rat ; histology

The scope of health literacy demanded of the present day health services user is broad. Enhancing physician skills consists of improving on 6 things : Recognise and assist patients with low literacy to overcome their information handling problems ; Improve usability of health information ; Improve the usability of health services ; Build knowledge to improve health decision making ; Advocate for health literacy in your organisation ; and Learn more about health literacy.

Persons with disabilities (PWDs) form an integral part of our community. The Ministry of Social and Family Development (MSF) in Singapore has developed the Enabling Masterplan (EMIC) 2012 – 2016 with the vision of an inclusive society where PWDs are enabled to participate fully. A life course and integrated approach is adopted in caring for such persons with the 4 pillars of early intervention; education and healthy lifestyle; employment; and adult care. Five cross cutting issues need to be addressed: caregiver support and transition management; manpower and technology; Transport; Public education; and accessibility. Family Physicians being the medical practitioners in the frontline of medical care are touchpoints in accessibility to healthcare services and benefit schemes for this group of people.

A review was made of the current literature on cardiovascular diseases. The following key findings were found: (1) CVDs need to be reduced in Singapore and worldwide. (2) CVD risk assessment tools are population specific – use the FRS modified score for Singapore. (3) New ideas about therapeutic lifestyle change as primary prevention are to take note of the individuals who fail in lifestyle change early and to direct them to alternative strategies; educating patients to reduce sitting time, increasing physical activity, and cardio-respiratory fitness is beneficial; higher protein diets help in creating weight loss and reducing weight regain; trans fats are associated with all-cause mortality, total CHD, and CHD mortality. (4) Paradigm shifts in secondary prevention are: statin treatment intensity recommended in the 2013 ACC/AHA cholesterol treatment guidelines; setting the blood pressure targets for patients with diabetes mellitus to be less than 140/90 mmHg; and noting that the older patient (beyond 70 to 74 years) with diabetes mellitus need to be managed as one would do so with a middle-aged patient. (5) The iCVH model as the 2020 impactful strategy for cardiovascular disease reduction for Americans provides food for thought as a potential Singapore strategy -- Promote in each patient especially the young patient, the simultaneous presence of optimal levels of 4 health behaviours (body mass index, physical activity, nonsmoking status, and diet quality) and reduction of 3 disease factors (total cholesterol, blood pressure, and fasting blood glucose).

Under ElderShield, policyholders who are not able to perform at least 3 of the following ADLs, will be eligible for the insurance pay-outs. The conditions that result in disability in adults can be grouped into six: Disorders from childhood – sequelae of infections, injuries, and intellectual disorders reach adulthood and contribute to the pool of adults with disability; Injuries – spinal cord injuries in younger adults, traumatic brain injury in young and old, musculoskeletal injury in particular hip fractures in the older adult; Cardiovascular system disorders - strokes, ischaemic heart disease, peripheral vascular disease, retinopathy, nephropathy, and neuropathy; Degenerative musculoskeletal disorders – osteoarthritis of the knee, hip; cervical and lumbar spondylosis. Health conditions with a high potential to result in ADL disability are strokes, pelvic/femoral fractures, and osteoporosis. Prevention of strokes through attention to the high risk diseases (obesity, hypertension, diabetes, and hyperlipidemia). In the elderly, falls is an important cause of traumatic brain injury and musculoskeletal injury. Patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.

Emerging infections may be defined as infectious diseases whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future. They include: new infections resulting from changes or evolution of existing organisms; known infections spreading to new geographic areas or populations; previously unrecognised infections appearing in areas undergoing ecological transformation; and old infections re-emerging as a result of antimicrobial resistance in known agents. Emerging infections occur as the result of four groups of factors: novel zoonotic emergence factors; climate change; nonzoonotic emergence factors; and human practices. As frontline doctors, family physicians have at least five roles that they must perform well: participate in global and local surveillance of emerging infections; assist in societal learning; pandemic preparedness; legislation compliance; and antibiotic stewardship.

No abstract available.
Bone Conduction* ; Tympanoplasty*

No abstract available.
Bone Conduction* ; Otitis Media* ; Otitis*