Purpose: To evaluate whether using flexible and navigable suction ureteral access sheath can obviate insertion of double J stent and establish the safety of overnight ureteric catheter placement as alternative following flexible ureteroscopy for kidney stones. Materials and Methods: Five hundred forty adults were prospectively enrolled across 25 centers (from April 2023 to January 2024). Patients were divided into group 1 (overnight ureteric catheter), and group 2 (double J stent). Surgeons could choose either modality as per their discretion. One-to-one propensity score-matching for age, sex, pre-stenting, Hounsfield units, stone volume and location was performed. Thirty-day computed tomography scan was done to estimate stone-free status. Results: After matching, 120 patients were included in each group. Group 1 had significantly shorter lasing, ureteroscopy, surgical time. Median day 1 loin pain score was similar (1 [1, 2] in both groups). Median postoperative stay was shorter in group 1 (0 days [0, 1] vs. 1 day [0, 2], p<0.001). One patient in group 2 required a blood transfusion. Incidence of fever was similar (5.0% vs. 0.8%).Loin/abdominal pain requiring medication occurred in one patient in group 2. Stent-related symptoms occurred in 2 patients in group 1. Three patients (2.5%) in group 1 and 2 patients (1.7%) in group 2 required readmission. Thirty-day stone-free status was higher in group 1 patients (79.2% vs. 56.7%). Conclusions In selected patients after thorough inspection to ensure no injury or residual fragments remain, placing an overnight ureteric catheter can be a safe alternative to a double J stent.

It is crucial that policy makers, healthcare providers and relevant stakeholders understand how integrated care may be improved at our emergency departments (EDs) and what benefits that would bring. The potential that exists for right-siting care of special patient groups who could be managed in an ambulatory setting with the integration of a variety of hospital-based and community-based clinical support services is tremendous. This review describes the best practice and value of integrated care at the EDs. Local evidence is cited and compared with findings from overseas. The opportunities of care transition interventions among discharged patients are outlined, including that for paediatric patients, palliative care patients and patients with chronic diseases. This review also suggests ways to move forward to meet the aim of providing holistic care at EDs through integrated care programmes, innovation and research.
Humans ; Emergency Service, Hospital/organization & administration* ; Delivery of Health Care, Integrated ; Palliative Care ; Chronic Disease

Aviation medicine safeguards flight safety by addressing three critical areas: managing physiological challenges of the aviation environment, preventing in-flight medical incapacitation and ensuring psychological fitness for flight. The field adopts occupational medicine's hierarchy of risk control to mitigate physiological risks in the operating environment, while employing systematic medical screening with tailored standards based on operational requirements to reduce the likelihood of in-flight incapacitation. A comprehensive approach incorporating mental health education, support systems and regular monitoring helps prevent psychological incapacitation. Recent data from the Singapore Changi Aeromedical Centre reveal that ophthalmological, otolaryngological and respiratory conditions are the primary causes of medical disqualification during air force pilot screening, reflecting the unique physiological demands of military aviation. This review emphasises the ongoing challenge of balancing rigorous medical standards with maintaining an adequate pilot recruitment pool, while highlighting the need for evidence-based approaches to aeromedical assessment and certification.
Humans ; Aerospace Medicine/methods* ; Singapore ; Aviation ; Pilots ; Accidents, Aviation/prevention & control* ; Occupational Health ; Safety ; Occupational Medicine ; Military Personnel

Purinergic P2Y Receptor Antagonists ; Consensus ; Cardiovascular System ; Cardiology ; Asia

Pregnancy ; Female ; Humans ; Mosaicism ; Prenatal Diagnosis ; Prenatal Care ; Aneuploidy

Humans ; Urology ; Pandemics ; COVID-19/epidemiology* ; SARS-CoV-2

INTRODUCTION: To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations. METHODS: This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020. RESULTS: Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25-35.99; 6.30, 95% CI 1.15-34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively. CONCLUSION The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease.
COVID-19/therapy* ; Critical Illness/therapy* ; Humans ; Nutritional Support ; SARS-CoV-2 ; Singapore/epidemiology* ; United States

COVID-19 ; Health Personnel ; Humans ; Masks ; N95 Respirators ; Pandemics ; SARS-CoV-2

INTRODUCTION: Haze is a recurrent problem in Southeast Asia. Exposure to haze is linked to ophthalmic, respiratory and cardiovascular diseases, and mortality. In this study, we investigated the role of demographic factors, knowledge and perceived risk in influencing protective behaviours during the 2013 haze in Singapore. METHODS: We evaluated 696 adults in a cross-sectional study. Participants were sampled via a 2-stage simple random sampling without replacement from a large residential district in Singapore in 2015. The questionnaire measured the participant's knowledge, perceived risk and behaviours during the Southeast Asian haze crisis in 2013. Reliability and validity of the questionnaire were assessed using comparative fit index (≥0.96) and root mean square error of approximation (≤0.05). We performed structural equation modelling to examine the relationship between the hypothesised factors and protective behaviours. RESULTS: More than 95% of the individuals engaged in at least 1 form of protective behaviour. Knowledge was strongly associated with protective behaviours via direct effect (β=0.45, 95% CI 0.19-0.69, CONCLUSION Knowledge was associated with protective behaviours, suggesting the importance of public education. Efforts should target those of lower education level and smokers. The wearing of N95 masks correlates with uptake of other protective behaviours.
Adult ; Asia, Southeastern ; Cross-Sectional Studies ; Ethnic Groups ; Humans ; Minority Groups ; Reproducibility of Results ; Singapore/epidemiology*