The prevalence of burnout amongst primary care physicians (PCPs) in Singapore is likely to be high. The resilient PCP is less likely to suffer from burnout and might recover faster from this condition. Mindfulness and self-compassionate practices are evidence-based skill sets that can enhance PCP resilience in the face of high work-stress. This article briefly explores the evidence base for mindfulness and self-compassionate practices, and details some simple examples of these practices that the reader can attempt.

The prevalence of burnout amongst primary care physicians (PCPs) in Singapore is likely to be high. Burnout has a negative impact on sleep quality, and poor sleep quality in turn feeds into burnout resulting in a vicious perpetuating cycle. Evidenced-based behavioural strategies can be useful to help improve sleep quality, which in turn contributes to the amelioration of burnout. This article details some of the evidence-based behavioural strategies that PCPs can use to improve their own sleep quality if used consistently.

Given the stressful demands of their work, primary care physicians are susceptible to experiencing burnout. Evidence-based strategies to effectively manage emotions at work are essential to preventing physician burnout. This article details the role of emotional regulation in a physician’s workplace, a model for understanding the processes underlying emotion regulation, and the theorised pathways to emotion dysregulation. Finally, this article provides strategies to assist the physician in practicing regular adaptive emotion regulation so as to reduce burnout.

Cardiac Tamponade/etiology* ; Female ; Humans ; Pericardial Effusion/etiology*

We describe a case of recurrent uterine rupture at the site of a previous rupture. Our patient had a history of right interstitial pregnancy with spontaneous uterine fundal rupture at 18 weeks of pregnancy. During her subsequent pregnancy, she was monitored closely by a senior consultant obstetrician. The patient presented at 34 weeks with right hypochondriac pain. She was clinically stable and fetal monitoring showed no signs of fetal distress. Ultrasonography revealed protrusion of the intact amniotic membranes in the abdominal cavity at the uterine fundus. Uterine rupture is a rare but hazardous obstetric complication. High levels of caution should be exercised in patients with a history of prior uterine rupture, as they may present with atypical symptoms. Ultrasonography could provide valuable information in such cases where there is an elevated risk of uterine rupture at the previous rupture site.
Abdominal Pain ; Adult ; Amnion ; diagnostic imaging ; pathology ; Female ; Humans ; Infant, Newborn ; Laparotomy ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy Complications ; diagnostic imaging ; Pregnancy Outcome ; Recurrence ; Ultrasonography ; Uterine Rupture ; diagnostic imaging ; Uterus ; diagnostic imaging ; pathology

COVID-19/epidemiology* ; Humans ; Singapore/epidemiology* ; Spinal Diseases/surgery* ; Spinal Injuries/surgery* ; Spine/surgery*

INTRODUCTION: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Conscious Sedation ; Endoscopy, Gastrointestinal ; Hospitals ; Humans ; Hypnotics and Sedatives ; Singapore

INTRODUCTION: There is worldwide concern over the psycho-emotional impact of COVID-19 on healthcare workers (HCWs). This study aimed to elicit HCWs' perceptions of the adequacy of protective measures in high-risk clinical areas and the factors associated with these perceptions. METHODS: This was a cross-sectional study conducted in April 2020. An anonymous electronic survey was sent via email to operating theatre (OT) and intensive care unit (ICU) staff of Sengkang General Hospital, Singapore. RESULTS: Of the 358 eligible participants, 292 (81.6%) responded to the survey. 93.2% of the participants felt that precautionary measures at work were sufficient and 94.9% acknowledged that adequate training was provided. More than 60% of the participants opined that their chances of contracting COVID-19 were moderate to high. Female gender, nursing occupation and duration of service <10 years were significantly associated with increased fear of contracting COVID-19, less control over occupational exposure and lower perceived need to care for COVID-19 patients. Having young children at home did not significantly affect these perceptions. The most important ICU precautions were availability of personal protective equipment outside the rooms of COVID-19 positive patients (95.3%) and having visitor restrictions (95.3%). The most important OT measures were having a dedicated OT for COVID-19 positive patients (91.2%) and having simulation as part of protocol familiarisation (91.7%). CONCLUSION Overall, there was high confidence in the adequacy of COVID-19 protective measures to prevent healthcare transmission in Singapore. The pandemic had a lower degree of psycho-emotional impact on HCWs here as compared to other countries.
Child ; Humans ; Female ; Child, Preschool ; COVID-19/epidemiology* ; Cross-Sectional Studies ; SARS-CoV-2 ; Singapore/epidemiology* ; Health Personnel/psychology* ; Hospitals