Education, Professional ; trends ; Humans ; Internship and Residency ; organization & administration ; Singapore

INTRODUCTIONAssertive Community Treatment (ACT) provides community-based treatment to patients with severe and persistent psychiatric illnesses, so that they may continue to live and function in the community as they receive psychiatric care. This study aimed to examine the effects of ACT on the outcome of patients over a 1-year period in an Asian population.

MATERIALS AND METHODSThis naturalistic and retrospective cohort study examined the effects of ACT on 100 patients who had completed 1 year of ACT. Parameters used to measure primary outcome were i) number of admissions (NOA) and ii) total length of stay (LOS) in days. Secondary outcome compared the employment status of patients before and after ACT. Paired sample analyses were performed using SPSS.

RESULTS AND DISCUSSIONThe mean reduction in NOA 1 year post-ACT was 57.1%. The mean reduction in LOS 1 year post-ACT was 61.9%. The median reduction for NOA and LOS were both statistically significant (P <0.01). Thirty-seven patients were employed compared to 6 before the programme, a statistically significant effect on employment (odds ratio 9.69, P <0.01).

CONCLUSIONSACT appears effective in reducing the frequency and duration of admissions for patients in Singapore. The employment status of patients also showed improvement over the course of study.

Adult ; Cohort Studies ; Community Mental Health Services ; methods ; standards ; Community Psychiatry ; standards ; Female ; Follow-Up Studies ; Humans ; Male ; Mental Disorders ; therapy ; Middle Aged ; Outcome Assessment (Health Care) ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Social Adjustment

INTRODUCTIONAssertive Community Treatment (ACT) was introduced in the 1970s as a comprehensive and assertive approach to community-based case management of patients with chronic and serious mental illness. Launched in Singapore in 2003, the Assertive Community Management (ACM) was modelled after the ACT, but with the main difference of 24 hour availability for the latter only. In line with the move towards de-institutionalisation of psychiatric patients, ACM was introduced to provide a mobile community-based multidisciplinary team approach to manage patients with severe chronic psychiatric illness. This article aims to evaluate and provide an update on this service programme in Singapore following an earlier study by Fam Johnson in 2007.

MATERIALS AND METHODSA naturalistic and retrospective study was conducted. One hundred and fifty-five patients recruited into ACM from 1 September 2008 to 1 September 2009 and had completed 1 year of ACM were included in our study. Outcomes were defined as number of admissions (NOA) and length of stay (LOS) one year before and one year following induction into the programme. Baseline socio-demographic factors were also investigated to see if they predicted outcome with ACM.

RESULTSThe mean NOA was 1.9 pre-ACM and 0.6 post-ACM, with mean reduction in NOA of 1.3 (P <0.01). The mean LOS was 72.2 days pre-ACM and 17.1 days post ACM, mean reduction in LOS 55.1 days (P <0.01). In addition, it was found that gender, diagnoses and ethnicity were not predictive of the outcome measures of NOA or LOS.

CONCLUSIONACM in Singapore had been well established since its inception and continued to show effectiveness in reducing inpatient hospitalisation among the chronically mentally ill.

Adult ; Bipolar Disorder ; therapy ; Case Management ; Community Mental Health Services ; Female ; Humans ; Length of Stay ; Male ; Mental Disorders ; therapy ; Outcome Assessment (Health Care) ; Patient Admission ; Psychotic Disorders ; therapy ; Schizophrenia ; therapy ; Singapore

INTRODUCTION: The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore. METHODS: An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore. RESULTS: The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005). CONCLUSION There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.
Burnout, Professional/psychology* ; Delivery of Health Care ; Health Personnel/psychology* ; Humans ; Prevalence ; Singapore/epidemiology* ; Surveys and Questionnaires

Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore.
Adult ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; statistics & numerical data ; Electrophysiology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Safety ; Prosthesis Implantation ; Singapore ; Tachycardia, Ventricular ; Ventricular Fibrillation

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

INTRODUCTIONRemote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.

METHODSPatients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.

RESULTSA total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.

CONCLUSIONRemote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.

Aged ; Arrhythmias, Cardiac ; diagnosis ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Pacemaker, Artificial ; Patient Safety ; Pilot Projects ; Prospective Studies ; Quality of Life ; Remote Consultation ; methods ; Singapore ; Surveys and Questionnaires

INTRODUCTIONThe use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time.

METHODSWe prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported.

RESULTSA total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups.

CONCLUSIONThe use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; methods ; Child ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiation Dosage ; Radiation, Ionizing ; Tachycardia, Atrioventricular Nodal Reentry ; therapy ; Tachycardia, Supraventricular ; therapy ; Treatment Outcome ; Young Adult

INTRODUCTIONThis study aimed to describe the planning, development and evaluation of the success of the first nationwide, resident-led, large-group teaching programme for medical students - the Singapore Health Services Student Internship Programme (SIP) Bootcamp.

METHODSThis was an initial feasibility study evaluating a half-day teaching boot camp initiated, developed and conducted by the resident educators. A three-month preparation period was required to set up an education subcommittee, liaise with medical student leaders, recruit resident educators, meet all the stakeholders and conduct the boot camp. During the SIP Bootcamp, resident educators conducted clinical case presentations using a question-and-answer format. Audience participation was strongly encouraged. A 15-item questionnaire was distributed to assess the participants' learning experience and the resident educators' teaching performance using a five-point Likert scale.

RESULTSOverall, 94.8% (n = 110) of the 116 respondents agreed that the teaching sessions were of high quality and content was relevant to their training. The resident educators appeared well-informed (96.6%, n = 112) and enthusiastic about their respective topics (98.3%, n = 114). However, a few students (9.5%, n = 11) felt that the audio-visual aids and handouts could be improved to better aid their learning process.

CONCLUSIONThis teaching boot camp for medical students was the first of its kind in Singapore and feedback from medical students showed that it was well-received. Further research using different teaching methods, including small-group discussions and surgical practical sessions by resident educators from different specialties, would be of great value to students.

Clinical Competence ; Curriculum ; Education, Medical ; methods ; organization & administration ; Feasibility Studies ; Humans ; Internship and Residency ; Schools, Medical ; Singapore ; Students, Medical ; Surveys and Questionnaires

In this paper, we aim to provide professional guidance to clinicians who are managing patients with chronic liver disease during the current coronavirus disease 2019 (COVID-19) pandemic in Singapore. We reviewed and summarised the available relevant published data on liver disease in COVID-19 and the advisory statements that were issued by major professional bodies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, contextualising the recommendations to our local situation.
COVID-19/epidemiology* ; Carcinoma, Hepatocellular/therapy* ; Chronic Disease ; Hepatitis B, Chronic/therapy* ; Hepatitis C, Chronic/therapy* ; Humans ; Liver Cirrhosis/therapy* ; Liver Diseases/therapy* ; Liver Neoplasms/therapy* ; Liver Transplantation ; Singapore/epidemiology*