1.DYSPNOEA IN PALLIATIVE CARE THE WHY, WHAT AND HOW FOR PRIMARY CARE PHYSICIANS
The Singapore Family Physician 2016;42(3):42-44
Dyspnoea is the subjective experience of breathing
discomfort, made up of distinct sensations varying in
intensity. It is caused by multiple factors in palliative
patients, such as infections, anaemia or anxiety. Tools
like the Visual Analogue Scale (VAS), Numerical Rating
Scale (NRS) and the Modified Borg scale, together with
Functional Assessment Scales like the Medical Research
Council Dyspnoea Scale and Baseline Dyspnoea Index
(BDI) are used to measure the severity of Dyspnoea.
Oxygen therapy can provide comfort for patients and
can increase survival in selected COPD patients. An
N=1 trial of supplemental oxygen is encouraged for
patients with dyspnoea.Other non-pharmacological
interventions such as breathing training and walking
aids have been proven to be effective in managing
dyspnoea. Studieshave shown that oral or parenteral
opioids are useful for relieving dyspnoea. They are safe
to use in titrated doses. However, morphine should be
used cautiously in patients with impaired renal and
liver functions. Benzodiazepines are not recommended
for first-line treatment, and should be administered
after consult with a palliative physician. Effort should
always be made to correct reversible causes.Family
education is important to alleviate the stress of caring
for patients with dyspnoea.
2.What Can We Do for Chronic Scrotal Content Pain?.
Wei Phin TAN ; Laurence A LEVINE
The World Journal of Men's Health 2017;35(3):146-155
Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.
Chronic Pain
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Epididymis
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Epididymitis
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Humans
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Male
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Pelvic Pain
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Vasovasostomy
3.Comparative study of the auditory steady-state response (ASSR) and click auditory brainstem-evoked response (ABR) thresholds among filipino infants and young children
Charlotte M. Chong ; Maria Leah C. Tantoco ; Maria Rina T. Reyes-Quintos ; Laurence Ian C. Tan
Philippine Journal of Otolaryngology Head and Neck Surgery 2009;24(1):9-12
Objective: To compare the results of auditory steady-state response (ASSR) and click auditory brainstem response (click ABR) among infants and young children tested at the Ear Unit of a Tertiary General Hospital. Methods: Design: Cross-sectional Study Setting: Tertiary General Hospital Population: Within-subject comparisons of click auditory brainstem response (click ABR) thresholds and auditory steady-state response (ASSR) thresholds among 55 infants and young children, 2 months to 35 months of age referred to the Ear Unit for electrophysiologic hearing assessment. Results: Click ABR showed strong positive correlation to all frequencies and averages of ASSR. Highest correlation was noted with the average of 1-4 kHz ASSR results with Pearson r = 0.89 (Spearman r=0.80), the average of 2-4 kHz had strong positive correlation r = 0.88 (0.79). Correlation was consistently strong through all ASSR frequencies (0.5 kHz at r=0.86 (0.74), 1 kHz at r=0.88 (0.78), 2 kHz at r=0. 87 (0.79), 4 kHz at r=0.85 (0.76)). Average differences of click ABR and ASSR thresholds were 8.2±12.9dB at 0.5 kHz, 8.6±12.6dB at 1 kHz, 5.3±11.8dB at 2 kHz and 7.8±13.4dB at 4 kHz. Among patients with no demonstrable waveforms by click ABR with maximal click stimulus, a large percentage presented with ASSR thresholds. Of these, 80.5% (33 of 41) had measurable results at 0.5 kHz with an average of 107.3±11.1dB, 85.4% (35 of 41) at 1 kHz with an average of 110.5±11.8dB, 73.2% (30 of 41) at 2 kHz with an average of 111.2±11.1dB and 63.4% (26 of 41) at 4 kHz with average of 112.2±8.21dB. Auditory steady-state response results were comparable to auditory brainstem response results in normal to severe hearing loss and provided additional information necessary for complete audiologic assessment especially among patients with severe to profound hearing loss wherein click ABR showed no responses. Up to 85.4% of patients that would have been noted to have no waveforms by click ABR still demonstrated measurable thresholds by ASSR. Conclusion: Our study suggests that ASSR may be the best available tool for assessing children with severe to profound hearing loss, and is a comparably effective tool in overall hearing assessment for patients requiring electrophysiological testing. The advantages of ASSR over click ABR include: 1) detection of frequency-specific thresholds and; 2) the detection of hearing loss thresholds beyond the limits of click ABR.
5.Patient-Surrogate Agreement in Advance Care Planning: Who Are the Surrogates and Are They Making the Right Decisions?
Hui Jin TOH ; Laurence TAN ; Lai Kiow SIM ; James Alvin LOW
Annals of the Academy of Medicine, Singapore 2018;47(10):431-434
Advance Care Planning
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ethics
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legislation & jurisprudence
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Aged
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Aged, 80 and over
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Cross-Sectional Studies
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Decision Making
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ethics
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Female
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Humans
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Male
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Middle Aged
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Patient Preference
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statistics & numerical data
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Risk Assessment
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Singapore
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Terminal Care
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ethics
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methods
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Third-Party Consent
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ethics
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legislation & jurisprudence