Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy Complications ; Pregnancy, Ectopic ; diagnostic imaging ; physiopathology ; surgery ; Pregnancy, Tubal ; surgery ; Radiography ; Treatment Outcome ; Uterus ; abnormalities ; Young Adult

Body Fluids ; physiology ; Dehydration ; metabolism ; prevention & control ; Fluid Therapy ; methods ; standards ; Humans ; Practice Guidelines as Topic

Humans ; Singapore ; Sports Medicine

Purpose: A novel and simple method to ensure accurate acetabular component anteversion and inclination intraoperatively with the use of a transparency template is described. Materials and Methods: Patients who underwent total hip arthroplasty (THA) via direct anterior approach (DAA) from June 2019 to January 2020 were included. A transparency template that can be placed over the image intensifier monitor to allow surgeons an accurate reading of the acetabular component position intraoperatively was designed, developed and utilized to determine effectiveness. The first template consists of two perpendicular lines indicating the “trans-ischial line” and the “pubic symphysis/coccyx”. The second template consist of a line indicating 45。inclination and parallel lines of corresponding distances apart required to achieve 20。anteversion based on Lewinnek’s formula: version=sin-1 (D1/D2), where D1: minor axis and D2: major axis of the component. This template was used throughout the acetabular part of the surgery, from reaming to impaction of component. Postoperative acetabular inclination, anteversion, surgical duration, length of stay, as well as complications were recorded. Results: Twenty-six patients were included in this study. Mean postoperative acetabular cup inclination was 43.46±3.09。and mean version was 19.98±2.89。. A total of 21 patients (80.8%) fell within the Callanan safe zone and all 26 patients (100%) were within the Lewinnek safe zone. Conclusion The transparency template is a simple, reproducible, and effective tool with a minimal learning curve and no requirement for expensive equipment. This template has the potential to assist surgeons, especially those who are less experienced with DAA THA, in obtaining better postoperative radiographic outcomes.

We present an unusual case of advanced ovarian carcinoma with postoperative complications of ischemia and perforation of the rectum as a result of tumor embolism. The interval progression from ischemia to infarction of the rectum was captured in repeated sigmoidoscopies. A brief discussion on tumor embolism and management of this case is also included.
Carcinoma* ; Infarction ; Ischemia* ; Neoplastic Cells, Circulating* ; Ovarian Neoplasms ; Postoperative Complications ; Rectum ; Sigmoidoscopy

INTRODUCTIONWe appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore.

MATERIALS AND METHODSA systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary.

RESULTSOverall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation.

CONCLUSIONEvidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.

Chronic Disease ; Delivery of Health Care ; methods ; organization & administration ; trends ; Disease Management ; Humans ; Internationality ; Patient Care Team ; organization & administration ; Pharmacists ; statistics & numerical data ; Professional Role ; Singapore

Haemangioma of the retroperitoneal space is a rare benign capillary malformation, which can grow significantly in pregnancy due to the multiple associated cardiovascular changes. We herein describe the case of a pregnant woman with an extensive right retroperitoneal haemangioma extending from the level of the renal hilum, across the lateral anterior abdominal wall and into the thigh. We also highlight the challenges faced in the management of the patient's delivery process. To the best of our knowledge, this is the first case of such nature and severity described in the English literature.
Adult ; Cesarean Section ; Female ; Gestational Age ; Hemangioma ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy Complications, Neoplastic ; Retroperitoneal Neoplasms ; diagnosis ; surgery

BACKGROUND: The authors have developed a Digital image chart(DIC) and digital Radiotherapy Record System (DRRS). We have evaluated the DIC and DRRS for reliability, usefulness, ease of use, and efficiency. METHOD AND MATERIALS: The basic design o f the DIC and DRRS was to build an digital image database of radiation therapy patient records for a more efficient and timely flow of critical image in formation throughout the department. This system is a subunit of comprehensive radiation oncology managemert system (C-ROMS) and composed of a picture archiving and communication system (PACS), radiotherapy information database, and a radiotherapy imaging database. The DIC and DRRS were programmed using Delphi under a Windows 95 environment and is capable of displaying the digital images of patients identification photos, simulation films, radiotherapy setup, diagnostic radiology image... Gross lesion photos, and radiotherapy planning isodose charts with beam arrangements. Twenty-three clients in the department are connected by Ethernet (10 Mbps) to the central image server (Sun Ultra-sparc 1 workstation). RESULTS: From the introduction of this system in February 1998 through December 1999, we have accumulated a total of 15,732 individual images for 2,556 patients. We can organize radiation therapy in; paperless environment in 120 patients with breast cancer. Using this system, we have succeeded in the prompt, accurate, and simultaneous access to patient care information from multiple locations throughout the department. This coordination has resulted in improved operational efficiency within the department. CONCLUSION: The authors believe that the DIC and DRRS has contributed to the improvement of radiation oncology department efficacy as well as to time and resource savings by providing necessary visual information throughout the department conveniently and simultaneously. As a result, we can also achieve the paperless and filmless practice of radiation oncology with this system.
Breast Neoplasms ; Dacarbazine ; Hospital Information Systems ; Humans ; Income ; Patient Care ; Radiation Oncology* ; Radiotherapy*

INTRODUCTIONManagement guidelines emphasise the importance of prompt therapeutic intervention for sepsis as well as stroke, both of which are common causes of death. Unfortunately, a rate-limiting step may be delayed presentation to the emergency department by patients themselves. The aim of this study was to assess public awareness of sepsis and stroke in Singapore.

MATERIALS AND METHODSThis was a population-based, structured telephone survey of adults in Singapore.

RESULTSThere were 1067 completed surveys (response rate 50.3%). The survey population was mostly comparable with the actual Singapore population. Fifty-three respondents (5.0%) had heard of the term sepsis. Of these, 45 respondents (4.2%) could provide at least one accepted definition of sepsis, the commonest being that of an unspecified infection. Respondents mostly heard about sepsis from school, the Internet, and newspapers. On the other hand, 963 respondents (90.3%) had heard of the term stroke. Of these, 818 respondents (76.7%) could name at least one accepted warning sign of stroke, the commonest being that of numbness, while 806 respondents (75.5%) could name at least one accepted risk factor for stroke, the commonest being hypertension. Respondents mostly heard about stroke from television, newspapers, a relative, a friend, media (unspecified), and the Internet.

CONCLUSIONOur findings reflect the differences in the public profile of sepsis versus stroke in Singapore. More concerted efforts involving healthcare professionals, medical societies, statutory boards, and the mass media are required to improve public awareness of these 2 conditions -especially sepsis.

Adult ; Female ; Health Education ; methods ; Health Surveys ; Humans ; Internet ; Male ; Mass Media ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Stroke ; epidemiology ; Telephone ; Young Adult

This review discusses human thermoregulation during exercise and the measurement of body temperature in clinical and exercise settings. The thermoregulatory mechanisms play important roles in maintaining physiological homeostasis during rest and physical exercise. Physical exertion poses a challenge to thermoregulation by causing a substantial increase in metabolic heat production. However, within a non-thermolytic range, the thermoregulatory mechanisms are capable of adapting to sustain physiological functions under these conditions. The central nervous system may also rely on hyperthermia to protect the body from "overheating." Hyperthermia may serve as a self-limiting signal that triggers central inhibition of exercise performance when a temperature threshold is achieved. Exposure to sub-lethal heat stress may also confer tolerance against higher doses of heat stress by inducing the production of heat shock proteins, which protect cells against the thermolytic effects of heat. Advances in body temperature measurement also contribute to research in thermoregulation. Current evidence supports the use of oral temperature measurement in the clinical setting, although it may not be as convenient as tympanic temperature measurement using the infrared temperature scanner. Rectal and oesophagus temperatures are widely accepted surrogate measurements of core temperature (Tc), but they cause discomfort and are less likely to be accepted by users. Gastrointestinal temperature measurement using the ingestible temperature sensor provides an acceptable level of accuracy as a surrogate measure of Tc without causing discomfort to the user. This form of Tc measurement also allows Tc to be measured continuously in the field and has gained wider acceptance in the last decade.
Body Temperature ; physiology ; Body Temperature Regulation ; physiology ; Exercise ; physiology ; Humans ; Monitoring, Physiologic ; methods