2.Role of community service as a curriculum delivery tool in the outcome-based curriculum of the International Medical University, Malaysia
Kwee Choy Koh ; Sheila Rani Kovil George ; Jun Wee Pak ; Ying Tian Liow ; Jie Xun
International e-Journal of Science, Medicine and Education 2014;8(1):24-31
Background:
The International Medical University
(IMU) has an outcome-based curriculum defined
by eight major curriculum outcome domains.
The attributes, qualities and competencies expected of a
health care professional form the basis for these outcome
domains. Community service is an effective curriculum
delivery tool widely practised by medical universities
around the world. We present the results of a survey
among IMU students to explore the effectiveness of
community service as a curriculum delivery tool in
enabling activities defined within the major curriculum
outcome domains of IMU.
Methods:
A self-administered 6-point Likert scale
questionnaire was used to survey student participants
of 20 community service events held in a rural village
between 2007 – 2012. The survey tool included
questions on demographic data as well as the perception
of the students on whether participation in the events
enabled them to experience activities defined under
the eight major curriculum outcome domains of IMU.
The one sample Student t-test was used to test for
statistical significance while regression analysis was done
to look for significant predictors.
Results:
A total of 255 students were surveyed, of
which 229 (90.5%) were medical students while the rest
were nursing students. Most of the students were in the
3
rd
(48.2%) and 4
th
(43.8%) year of their studies and
have completed the surgery, internal medicine and
family medicine posting. Six out of the 8 curriculum
outcomes domains were achieved through participation
in the community service programme.
Conclusion:
Community service is an effective
curriculum delivery tool for the outcome-based
curriculum of IMU where activities defined in six out of
eight outcome domains were achieved.
Education, Medical
3.A method in the madness in ultrasound evaluation of thyroid nodules.
Amogh HEGDE ; Anil GOPINATHAN ; Rafidah Abu BAKAR ; Chin Chin OOI ; Ying Ying KOH ; Richard Hoau Gong LO
Singapore medical journal 2012;53(11):766-quiz p.773
Around 50% of the population harbour thyroid nodules on ultrasonography, up to 7% of which may be malignant irrespective of size. While fine-needle aspiration biopsy is reliable, subjecting every thyroid nodule to this procedure is not cost-effective. Hence, ultrasonography is used primarily to characterise thyroid nodules, whereas nodules that have suspicious features are subject to a fine-needle aspiration biopsy. The presence of microcalcifications, macrocalcifications, irregular margins, 'taller-than-wide' shape, marked hypoechogenicity and intrinsic vascularity are features that render a thyroid nodule suspicious for malignancy. Spongiform appearance and the presence of colloid plugs or purely cystic nodules are considered features of benignity. In this article, these aforementioned sonographic features of malignancy and benignity are pictorially illustrated and a basic approach to dealing with solitary and multiple thyroid nodules is highlighted.
Humans
;
Predictive Value of Tests
;
Thyroid Neoplasms
;
diagnosis
;
diagnostic imaging
;
Thyroid Nodule
;
diagnosis
;
diagnostic imaging
;
Ultrasonography
4.Clinical evaluation of an in-house human immunodeficiency virus (HIV) genotyping assay for the detection of drug resistance mutations in HIV-1 infected patients in Singapore.
Kuan Kiat CHEW ; Kah Ying NG ; Wei Xin KHONG ; Palvinder KAUR ; Joe Kwan YAP ; Arlene CHUA ; Mei Ting TAN ; Yin Ling KOH ; Koh Cheng THOON ; Yee Sin LEO ; Oon Tek NG
Annals of the Academy of Medicine, Singapore 2012;41(12):553-558
INTRODUCTIONHuman immunodeficiency virus type 1 (HIV-1) genotyping resistance test (GRT) is essential for monitoring HIV-1 drug resistance mutations (DRMs). High cost and HIV-1 genetic variability are challenges to assay availability in Singapore. An in-house Sanger sequencing-based GRT method was developed at the Communicable Disease Centre (CDC), Singapore's HIV national treatment reference centre for both subtype B and non-subtype B HIV-1.
MATERIALS AND METHODSThe in-house GRT sequenced the fi rst 99 codons of protease (PR) and 244 codons of reverse transcriptase (RT) in the pol gene. The results were compared with the Food and Drug Administration (FDA)-approved ViroSeq™ HIV-1 Genotyping System.
RESULTSSubtype assignment for the 46 samples were as follows: 31 (67.4%) CRF01_AE, 14 (30.5%) subtype B and 1 (2.1%) subtype C. All 46 samples had viral load of ≥500 copies/mL, and were successfully amplified by the in-house primer sets. Compared to the ViroSeq™ test, our in-house assay showed drug-resistance conferring codon concordance of 99.9% at PR and 98.9% at RT, and partial concordance of 0.1% at PR and 1.1% at RT. No discordant result was observed.
CONCLUSIONThe assay successfully identified DRMs in both subtype AE and B, making it suitable for the efficient treatment monitoring in genetically diverse population. At less than half of the running cost compared to the ViroSeq™ assay, the broadly sensitive in-house assay could serve as a useful addition to the currently limited HIV genotyping assay options for resource-limited settings, thereby enhancing the DRM surveillance and monitoring in the region.
Anti-Retroviral Agents ; pharmacology ; Drug Resistance, Viral ; genetics ; Genes, pol ; genetics ; Genotyping Techniques ; methods ; HIV Infections ; drug therapy ; virology ; HIV-1 ; drug effects ; genetics ; Humans ; Mutation ; Sequence Analysis, DNA ; methods ; Singapore
5.Medical and social domains of ageing research in Singapore (2008-2018): a scoping review.
Chen Hee TAM ; Elaine Qiao Ying HO ; Sumali Subhashini HEWAGE ; Shilpa TYAGI ; Gerald Choon Huat KOH
Singapore medical journal 2024;65(1):30-37
INTRODUCTION:
This scoping review examined the number, types and characteristics of journal publications on ageing in Singapore from 2008 to 2018 to determine how ageing research in medical and social domains in Singapore has transformed over time.
METHODS:
Using relevant search terms, articles were extracted from multiple databases and then screened and reviewed for eligibility and inclusion by independent reviewers. Data such as article title, authors, year of publication, name of journal, type of journal, study design and the kind of data used were charted from the included articles for evidence synthesis.
RESULTS:
Since 2008, there has been a steady increase in the number of publications on ageing in medical and social domains in Singapore. In the medical domain, publications on Ophthalmology (22%) made up the largest proportion of the existing medical literature on ageing in Singapore, followed by Physical Functioning (17%), which involved physiological measurements of physical well-being, and Geriatrics (16%). Non-medical publications comprised 38% of all the included publications, with publications on the social aspects of ageing (43%) forming the largest group in this cluster, followed by publications on Prevention (19%) and Healthcare services (18%). The study design was mostly observational (82%), with only 3% of interventional studies.
CONCLUSION
While ageing research had expanded in Singapore in the last decade, it was predominantly discipline specific and observational in design. As ageing issues are complex, with biology intersecting with psychology and sociology, we call for greater interdisciplinary collaboration, the conduct of more interventional studies, as well as more research in understudied and emerging areas.
Humans
;
Singapore
;
Aging
;
Geriatrics
;
Research Design
6.Prospective audit of febrile neutropenia management at a tertiary university hospital in Singapore.
Jing JIN ; Yee Mei LEE ; Ying DING ; Liang Piu KOH ; Siew Eng LIM ; Robert LIM ; Paul Ananth TAMBYAH ; Li Yang HSU
Annals of the Academy of Medicine, Singapore 2010;39(6):453-459
INTRODUCTIONFebrile neutropenia (FN) remains a major cause of morbidity and mortality in Oncology/Haematology units. We launched a new protocol for FN management that incorporates risk stratification at our institute from October 2008. An audit was performed concurrently to evaluate the protocol and to define the epidemiology of FN locally.
MATERIALS AND METHODSCase records of all inpatients with FN between October 2008 and June 2009 were reviewed prospectively. Clinical and microbiological characteristics were collated along with outcomes and programme adherence. Statistical testing was performed using Stata 10.1.
RESULTSThere were 178 FN episodes (50 in patients with solid cancers) from 131 patients. Forty-two (23.6%) episodes were classified as high-risk according to MASCC criteria. Initial blood cultures were positive in 49 (27.5%) episodes, of which gram-negative bacilli (GNB) predominated. Overall compliance to the protocol was 56.7%, with the main issue being disinclination to use oral antibiotics as fi rst-line empirical therapy for low-risk episodes. Overall mortality was 7.3% and infection-related mortality was 4.5%. High-risk FN and the presence of central venous catheters were independently associated with bacteraemia on multivariate analysis, but there were no independent predictors of infection-related mortality.
CONCLUSIONSGNB accounted for the majority of bloodstream infections at our institute, unlike data from developed countries. Uptake of the new FN protocol was satisfactory, although the use of oral antibiotics as fi rst-line empirical therapy can be improved. A better method for predicting infections caused by antibiotic-resistant GNB is urgently required, and antibiotic resistance trends should be monitored to enable the implementation of more appropriate antibiotic regimens over time.
Adult ; Aged ; Aged, 80 and over ; Drug Resistance, Microbial ; Female ; Fever ; drug therapy ; physiopathology ; Gram-Negative Bacteria ; Hospitals, University ; Humans ; Male ; Medical Audit ; Middle Aged ; Neutropenia ; drug therapy ; physiopathology ; Outcome Assessment (Health Care) ; Prospective Studies ; Severity of Illness Index ; Singapore ; Young Adult
7.Use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenopathy.
Su Ying LOW ; Mariko S KOH ; Thun How ONG ; Ghee Chee PHUA ; Devanand ANANTHAM
Annals of the Academy of Medicine, Singapore 2014;43(5):250-254
INTRODUCTIONThis study assessed the clinical utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of suspected granulomatous mediastinal lymphadenopathy.
MATERIALS AND METHODSRetrospective chart review of all patients who underwent EBUS-TBNA for suspected granulomatous mediastinal lymphadenopathy at Singapore General Hospital between December 2008 and December 2011 inclusive.
RESULTSOver a period of 3 years, a total of 371 patients underwent EBUS-TBNA of whom 33 (9%) had the procedure performed for evaluation of suspected granulomatous mediastinal lymphadenopathy - 18 for suspected tuberculosis (TB) and non-tuberculous mycobacterial (NTM) lymphadenitis, and 15 for suspected sarcoidosis. EBUS-TBNA was diagnostic in 9 of the 13 patients with a final diagnosis of TB/NTM. EBUS-TBNA cultures were positive in 6 of them (46%), 1 showed acid-fast bacilli (AFB) although cultures were negative, and 2 had necrotising granulomatous inflammation from EBUS-TBNA biopsies and sputum cultures grew TB. EBUS-TBNA was diagnostic in 9 of the 14 patients with a final diagnosis of sarcoidosis through histology showing non-caseating granulomatous inflammation. The sensitivities of EBUS-TBNA for diagnosis of TB/NTM, sarcoidosis and overall granulomatous mediastinal lymphadenopathy were 69%, 64%, 64%; the negative predictive values were 56%, 17%, 33%; and accuracies were 78%, 67%, 70%, respectively.
CONCLUSIONEBUS-TBNA can be useful in the diagnosis of suspected granulomatous mediastinal lymphadenopathy with sensitivities and accuracies of >60%.
Bronchoscopy ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Female ; Granuloma ; pathology ; Humans ; Lymphatic Diseases ; pathology ; Male ; Mediastinal Diseases ; pathology ; Middle Aged ; Retrospective Studies
8.An initial experience with laser haemorrhoidoplasty in addition to mucopexy for symptomatic haemorrhoids.
Ying Xin LOW ; Frederick Hong Xiang KOH ; Winson Jianhong TAN ; Sharmini Su A SIVARAJAH ; Leonard Ming Li HO ; Min Hoe CHEW ; Fung Joon FOO
Annals of the Academy of Medicine, Singapore 2022;51(4):253-254
9.Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting.
Shu Yun TAN ; Kaiwei Jeremy LEW ; Ying XIE ; Poay Sian Sabrina LEE ; Hui Li KOH ; Yew Yoong DING ; Eng Sing LEE
Annals of the Academy of Medicine, Singapore 2021;50(11):809-817
INTRODUCTION:
The rising prevalence of multiple chronic diseases is an important public health issue as it is associated with increased healthcare utilisation. This paper aimed to explore the annual per capita healthcare cost in primary care for patients with multiple chronic diseases (multimorbidity).
METHODS:
This was a retrospective cohort study conducted in a cluster of public primary care clinics in Singapore. De-identified data from electronic medical records were extracted from July 2015 to June 2017. Only patients with at least 1 chronic disease were included in the study. Basic demographic data and healthcare cost were extracted. A list of 20 chronic diseases was considered for multimorbidity.
RESULTS:
There were 254,377 patients in our study population, of whom 52.8% were female. The prevalence of multimorbidity was 62.4%. The median annual healthcare cost per capita for patients with multimorbidity was about twice the amount compared to those without multimorbidity (SGD683 versus SGD344). The greatest percentage increment in cost was when the number of chronic diseases increased from 2 to 3 (43.0%).
CONCLUSION
Multimorbidity is associated with higher healthcare cost in primary care. Since evidence for the optimal management of multimorbidity is still elusive, prevention or delay in the onset of multimorbidity in the general population is paramount.
Chronic Disease
;
Comorbidity
;
Cross-Sectional Studies
;
Female
;
Health Care Costs
;
Humans
;
Prevalence
;
Primary Health Care
;
Retrospective Studies
;
Singapore/epidemiology*
10.Multimodal prehabilitation before major abdominal surgery: A retrospective study.
Ning Qi PANG ; Stephanie Shengjie HE ; Joel Qi Xuan FOO ; Natalie Hui Ying KOH ; Tin Wei YUEN ; Ming Na LIEW ; John Peter RAMYA ; Yijun LOY ; Glenn Kunnath BONNEY ; Wai Kit CHEONG ; Shridhar Ganpathi IYER ; Ker Kan TAN ; Wan Chin LIM ; Alfred Wei Chieh KOW
Annals of the Academy of Medicine, Singapore 2021;50(12):892-902
INTRODUCTION:
Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.
METHODS:
Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.
RESULTS:
There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (
CONCLUSION
The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.
Humans
;
Postoperative Complications/prevention & control*
;
Preoperative Care
;
Preoperative Exercise
;
Prospective Studies
;
Retrospective Studies