After the definition of Cushing's ulcer, it is well recognized that neurosurgical patients have the high risk of acute gastrointestinal bleeding, especially in severe head trauma. Acute gastrointestinal bleeding after burn, respiratory failure, hepatic failure, renal failure and sepsis as "stress ulcer" also were studied. The prevention and management of bleeding was discussed in medico-surgical field for several years. Despite of these regimen, the prognosis of the bleeding have not significantly improved and bleeding affected the patient's outcome more than initial neurosurgical intervention. The authors experienced 25 cases of acute gastrointestinal bleeding among our neurosurgical patients between January, 1984 to June, 1988. We analysed these patients respectively and concluded as follows: 1) The incidence of acute gastrointestinal bleeding was 0.61%. 2) The bleeding developed on 12th day, average, and clinical manifestation were anemia, hematemesis and melena in order of frequency within the first 4-week in almost all cases. 3) The initial neurological sign such Glasgow Coma Scale may well predict the hallmark to suspect the acute gastrointestinal bleeding. 4) The systemic insults such as shock, renal failure, hepatic failure, respiratory failure and sepsis significantly affected to re-bleeding chance and rendered the patient's outcome poorer. 5) The overall mortality due to gastrointestinal bleeding was 32% and the operative mortality was 50%.
Anemia ; Burns ; Craniocerebral Trauma ; Glasgow Coma Scale ; Hematemesis ; Hemorrhage* ; Humans ; Incidence ; Liver Failure ; Melena ; Mortality ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis ; Shock ; Ulcer

INTRODUCTION: Singapore has had three medical schools since 2013. We undertook a cross-sectional quantitative national survey to determine the financial impact of medical education on medical students in Singapore. METHODS: All 1,829 medical students in Singapore were invited to participate in this study. Information on demographics, financial aid utilisation and outside work was collected and analysed. RESULTS: 1,241 (67.9%) of 1,829 students participated in the survey. While the overall proportion of students from households with monthly incomes < SGD 3,000 was only 21.2% compared to the national figure of 31.4%, 85.4% of medical students expected to graduate with debts > SGD 75,000. There were significant differences in per capita incomes among the schools, with 54.5%, 23.3% and 7.8% of Duke-NUS Medical School (Duke-NUS), NUS Yong Loo Lin School of Medicine (NUS Medicine) and Lee Kong Chian School of Medicine (LKCMedicine) students, respectively, reporting a per capita income of < SGD 1,000 (p < 0.001). There were significant differences in financial support: 75.0%, 34.1% and 38.8% of Duke-NUS, NUS Medicine and LKCMedicine students, respectively, received financial aid (p < 0.001). The top reasons for not applying for aid included a troublesome application process (21.4%) and the perception that it would be too difficult to obtain (21.0%). CONCLUSION Students in the three medical schools in Singapore differ in their financial needs and levels of financial support received. A national approach to funding medical education may be needed to ensure that financial burdens do not hamper the optimal training of doctors for Singapore's future.
Cross-Sectional Studies ; Financial Stress ; Humans ; Schools, Medical ; Singapore ; Students, Medical ; Surveys and Questionnaires

INTRODUCTION: Medical school fees are rising globally. Student debt and financial background may affect residency choices, but few studies have been conducted in Asia. This study aimed to explore the relationship between financial background, student debt and postgraduate residency choices among medical students in Singapore. METHODS: An anonymised survey of all medical students in Singapore was conducted and had a response rate of 67.9%. RESULTS: 40.5% of our study population would graduate with debt. Medical students with monthly per capita household income < SGD 1,000 were more likely to graduate with debt (unadjusted odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.7; p < 0.001) and feel burdened by the cost of medical education (unadjusted OR 2.8, 95% CI 2.0-3.9; p < 0.001). Students with monthly per capita household income < SGD 1,000 (unadjusted OR 1.818, 95% CI 1.338-2.470, p < 0.001; adjusted OR 1.692, 95% CI 1.202-2.381, p = 0.003) and those with debt (unadjusted OR 1.623, 95% CI 1.261-2.090, p < 0.001; adjusted OR 1.393, 95% CI 1.048-1.851, p = 0.022) were more likely to rank at least one economic factor as 'very significant' in influencing their postgraduate training choices. CONCLUSION It is concerning that despite financial aid schemes, the cost of medical education remains a burden to students from lower-income households in Singapore. Student debt and financial background may distort postgraduate career choices, creating an undue push towards high-paying specialties.
Career Choice ; Choice Behavior ; Education, Medical ; economics ; Humans ; Internship and Residency ; economics ; Odds Ratio ; Schools, Medical ; economics ; Singapore ; Social Class ; Students, Medical ; statistics & numerical data ; Surveys and Questionnaires ; Training Support