ObjectiveClinician educators (CEs) frequently report tensions in their professional identities as... more ObjectiveClinician educators (CEs) frequently report tensions in their professional identities as clinicians and educators, although some perceive a reciprocal relationship between clinical and teaching roles. However, it is unknown if the shared meanings of clinicians’ multiple job roles translate to identity verification. We sought to examine CEs’ perceptions of their clinician and educator roles and the influence of their perceptions on the salience of their professional identities.DesignQualitative individual interviews and focus groups, analysed using framework analytic approach.Setting and participants23 occupational therapy (OT) and 16 physiotherapy (PT) educators from two acute hospitals and one rehabilitation unit in Singapore.ResultsPT and OT CEs constructed shared meanings of their clinician and educator roles through overcoming feelings of unease and inadequacy, discovering commonalities and establishing relevance. However, shared meanings between clinician and educator ...
ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers i... more ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers in Singapore and compare them to a decade ago. Secondary aim to analyse usefulness of selected trauma scores in this context.DesignRetrospective review of trauma registry of a single centre, from 1 April to 30 June 2015. Data compared with those from similar study performed at same centre in 2004.SettingEmergency department (ED) of 1500-bedded acute urban public hospital in Singapore.Participants1094 foreign workers with work-related injuries were included. Tourists, foreign students, non-work-related injuries, re-attendances for the same condition were excluded.ResultsMean age of participants was 32.8 years (SD 7.8), 90.0% were men. ED attendance was lowest on Sundays. Mechanism of injury: blunt (78.2%), penetrating (19.2%), burns (2.6%). Compared to 2004, 5% of foreign workers required admission (vs 19.6% in 2004, p≤0.0001), 8.0% underwent day or inpatient surgical procedures (vs 13.2% ...
The need for incorporation of biomedical ethics and professionalism into the formal undergraduate... more The need for incorporation of biomedical ethics and professionalism into the formal undergraduate and postgraduate curriculum has been increasingly recognised in the last twenty years.1-4 Parallel to changes in the
Introduction Peer assessments are increasingly prevalent in medical education, including student-... more Introduction Peer assessments are increasingly prevalent in medical education, including student-led mock Objective Structured Clinical Examinations (OSCE). While there is some evidence to suggest that examiner training may improve OSCE assessments, few students undergo training before becoming examiners. We sought to evaluate an examiner training programme in the setting of a student-led mock OSCE. Methods A year‑2 mock OSCE comprised of history taking (Hx) and physical examination (PE) stations was conducted involving 35 year‑3 (Y3) student examiners and 21 year‑5 (Y5) student examiners who acted as reference examiners. Twelve Y3 student-examiners attended an OSCE examiner training programme conducted by senior faculty. During the OSCE, Y3 and Y5 student examiners were randomly paired to grade the same candidates and scores were compared. Scores for checklist rating (CR) and global rating (GR) domains were assigned for both Hx and PE stations. Results There was moderate to excelle...
Background (1) To compare the characteristics of female and male trauma patients seen in the Emer... more Background (1) To compare the characteristics of female and male trauma patients seen in the Emergency Department (ED) and (2) to determine if injury prevention programmes for women should be different. Methods A prospective survey was conducted for 11544 trauma patients, aged 15 years and above, who presented to the ED of an urban public hospital in Singapore over 6 months. The following data were collected: demography, place, type and mechanism of injury and subsequent disposition from the ED. Results Almost half (49.5%) the injuries sustained by females occurred at home, with low falls of less than 2 metres being the most common mechanism of injury (52.7%). Victims of domestic violence were predominantly female at p<0.0001. Conclusion Injury prevention programs for women should focus on home safety and low falls. Special assistance programs for the victims of domestic violence should be available in the ED as the latter may be their only access to safety.
Background Singapore is an affluent small nation-state with a high per capita gross domestic prod... more Background Singapore is an affluent small nation-state with a high per capita gross domestic product. Objective To determine the prevalence of hunger and poverty among elderly patients attending an emergency department (ED). Methods All patients aged 65 years and above who sought treatment at the ED of an urban acute care hospital over one week between 0900 and 1700 hours were surveyed. Two trained interviewers administered a face-to-face close-ended questionnaire. Data collected were demographics, health status and surrogate indicators of poverty and hunger. Results Of the 210 non-critically ill patients approached, data was available for 194 (92.4%), of which 51% were men. The mean age was 76.7 (SD 7.4) years. Majority of the patients were well taken care of but a minority were not coping: 0.5% was homeless, 3.1% had skipped medical appointments in the last year due to lack of money, 1% did not have enough to eat and were not receiving any food aid and 1.5% borrowed money to buy f...
Introduction Junior students making the transition from pre-clinical to clinical years often stru... more Introduction Junior students making the transition from pre-clinical to clinical years often struggle to integrate into ward teams during ward-round activities. The SimRound is a novel approach to facilitate embedding of junior medical students into incumbent ward teams through simulation rounds specially designed to replicate actual ward-round proceedings. Using the situated learning and cognitive load theories, this study aims to describe the rationale, processes and lessons learnt from our experience in developing the SimRound. Methods Third-year students undergo two SimRound sessions at weeks two and six during the eight-week General Medicine clerkship. There are four phases in each SimRound: Prioritisation and triage; pre-round; consultant round; and evaluation and feedback. Using framework analysis, we compared open-ended survey data from pre-SimRound and SimRound cohorts to develop descriptive and explanatory accounts of identified themes. Results Despite the benefits to learning from being embedded in the ward team, students reported challenges to learning arising from engagement and team identity; increased intrinsic load; and increased extraneous load. SimRound addresses this by enabling deliberate learning in a controlled and authentic setting with inter-professional participation. The reduction of cognitive load enabled students to assimilate the necessary knowledge and skills.
INTRODUCTION With Singapore’s ageing population, there are increasing numbers of elderly cyclists... more INTRODUCTION With Singapore’s ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre. METHODS Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital’s trauma registry and reviewed. RESULTS Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries ...
Background: During clinical rotations, the learning environment of medical students becomes more ... more Background: During clinical rotations, the learning environment of medical students becomes more complex as they transit from lecture- to patient-based learning. Such complexity can emanate from tensions, a phenomenon according to Activity Theory (AT). Through the perspectives of medical students and healthcare professionals, this study aimed to delineate the tensions that students encounter in the clinical environment. Summary of work: Thirty one semi-structured in-depth interviews were conducted with doctors (n = 12), nurses (n = 8), and medical students (n = 11). AT was used as the analytical framework. Interviews were recorded, transcribed and analysed for unifying themes to identify systemic tensions, known as contradictions in AT. Summary of results: Seven themes were identified to be relevant to two contradictions – role contradiction in faculty members, and differing perceptions in the relationship between theory and practice. For the first contradiction, faculty members fac...
Most patients presenting to the emergency department (ED) with minor head injury (HI) can be disc... more Most patients presenting to the emergency department (ED) with minor head injury (HI) can be discharged, provided a caregiver is present and careful discharge instructions are given. The study ED uses an advice leaflet with verbal reinforcement to patients and caregivers detailing post-discharge instructions and warning symptoms of worsening HI. We aim to evaluate local patients' and caregivers' compliance to discharge instructions and their ability to recall HI advice. A prospective study was conducted in an adult ED between April 10, 2006 and May 1, 2006. All patients with minor HI discharged from the ED or its 24-hour observation ward were included in the study. A telephone survey was conducted within 48 hours of discharge using a standardised questionnaire. During the study period, 292 patients had HI, of which 182 were eligible for the study. 71 were uncontactable and one refused to participate, leaving 110 patients in the study. Patients' age ranged between 7 and 1...
To describe the relationship between bicycle helmet use and injury pattern sustained by patients ... more To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05)...
On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that be... more On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that became known as severe acute respiratory syndrome (SARS). We now describe a series of patients that did not fit World Health Organisation (WHO) case definitions for SARS at initial assessment. The Ministry of Health, Singapore centralised SARS cases in the study hospital and its emergency department (ED) became the national screening centre. A screening questionnaire and a set of admission criteria based on WHO case definitions were applied. Patients discharged from ED were tracked via telephone surveillance and recalled if necessary. A retrospective review was done of patients who did not fit WHO definitions initially, were discharged and had re-attended. During the outbreak, 11,461 people were screened for SARS. Among 10,075 (87.9 percent) discharged from the ED, there were 28 re-attendees diagnosed to have SARS later, giving an undertriage rate of 0.3 percent. Among the 28, six (21.4 pe...
On 22 March 2003, the Ministry of Health, Singapore, designated Tan Tock Seng Hospital as the nat... more On 22 March 2003, the Ministry of Health, Singapore, designated Tan Tock Seng Hospital as the nationwide severe acute respiratory syndrome (SARS) hospital and its Emergency Department (ED) took over the role as the screening center for SARS on 26 March 2003. We describe the initial clinical characteristics of probable or suspect SARS patients that presented to the ED. A retrospective study of patients who were admitted through the ED and subsequently diagnosed to have probable SARS and suspect SARS was done. The data of these patients from the ED log were reviewed and analysed. From 13 March 2003 to 31 May 2003, 11,461 patients were screened for SARS and 1,386 patients were admitted. Of these, 117 patients were diagnosed to have probable SARS and 146 suspect SARS. Their mean age was 36.7 years (range 1-80). Among these patients, there were 122 men (46.4 percent), and 205 were Singaporeans (77.9 percent). 13 patients had no initial contact history upon presentation to the ED. The mea...
Annals of the Academy of Medicine, Singapore, 2004
A Singapore study reported that 99% of diabetics had received some diabetes mellitus (DM) educati... more A Singapore study reported that 99% of diabetics had received some diabetes mellitus (DM) education. Another study reported that the Singapore public is generally well-informed about DM but whether diabetics are well-informed is not known. The objectives of this study were to determine DM knowledge of diabetics visiting the Emergency Department (ED) and to determine the diabetics' knowledge versus practice gap. A pretested questionnaire was used to survey a convenient sample of ED patients and visitors. The respondents were required to answer 43 questions on areas including "Risk Factors", "Treatment and Management" and "Monitoring". A point was awarded for each correct response. Diabetics were asked if they practised the items described in "Treatment and Management" and "Monitoring" sections. There were 95 diabetics and 91 non-diabetics surveyed, with no difference in the mean age or the proportion of men. There was no differenc...
Annals of the Academy of Medicine, Singapore, 2004
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objecti... more Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of fore...
A study of senior house officers' daytime work activities was conducted in the accident and emerg... more A study of senior house officers' daytime work activities was conducted in the accident and emergency department of the Cardiff Royal Infirmary. Activities were timed every 15 seconds by a single observer and were subdivided into working periods, meal periods and periods when no patient was waiting to be seen. A total of 96.1 h was analysed. The SHOs were found to be working for 78% of their time, of which 18.5% was taken up by nondoctor tasks. The SHOs took an average of 10.4 min for each walking wounded patient, 10.6 min for each paediatric patient and 27.3 min for a trolley patient. Each patient required an average of 14.2 min for assessment and treatment, which meant that 3.3 patients were seen each hour. However, considering that SHOs worked for 78% of their time, the actual rate of work was 4.2 patients for each working hour. The implications for staffing are discussed.
To determine if emergency physicians (EPs) are ready to accept 360˚feedback, and agreement betwee... more To determine if emergency physicians (EPs) are ready to accept 360˚feedback, and agreement between self and colleagues' assessment in a 360˚feedback for EPs. Methods: Self-administered questionnaire to determine acceptability of 360˚feedback (n = 43). Each EP completed the Physician Achievement Review self-assessment and approached five colleagues to complete an assessment for him/her. Results: Thirty-one responded: 77.4% preferred to select their appraisers, 90.3% wanted feedback to be confidential, 58.1% would share feedback with supervisors, but only 35.5% would link feedback to remuneration. Colleagues rated EPs' holistic management, humanistic aspects and patient communication, and professional relationship with colleagues as weak domains, weaknesses which EPs were only partially aware. Conclusions: EPs would accept 360˚feedback provided that they selected their appraisers and results were confidential. Colleagues reported that EPs were weak in ''soft'' and system skills.
for trainees to acquire the necessary skills. It remains to be seen if the proficiency in resusci... more for trainees to acquire the necessary skills. It remains to be seen if the proficiency in resuscitation skills among those taking anaesthetic examinations is higher than that among candidates taking the examination for membership of the Royal College of Physicians. The resuscitation training officer has a valuable role in ensuring that these skills are retained.
Background: Singapore has a mandatory helmet law for motorcyclists. This study aimed to determine... more Background: Singapore has a mandatory helmet law for motorcyclists. This study aimed to determine the injuries sustained by helmeted motorcyclists presenting to the emergency Department (ED). Methods: Adult victims of motor vehicular incidents (MVI) who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. Results: Motorcyclists formed 49.1% (1018) of all MVI victims, of whom 96.1% were men. The mean age was 32.5 years (SD 13.1), significantly younger (p,0.0001) than the mean age of 36.4 years (SD 16.4) among other MVI victims. The proportions of motorcyclists and other MVI patients admitted to the hospital were not different. Among those admitted, significantly fewer (p = 0.001) motorcyclists (32.2%) sustained head injury compared with other MVI victims (46.8%) but among the motorcyclists with head injury, more than one third (34.2%) had severe head injury. The proportion of patients with thoracic injury was not different (p = 0.93) between motorcyclists (10.2%) and other MVI victims (9.9%). However, among those with thoracic injury, 79.2% of motorcyclists had severe thoracic injury, significantly more (p = 0.04) than 50% of other MVI patients. Wounds, fractures, and/or dislocations of the limbs (p,0.001) were significantly more among motorcyclists compared with other MVI patients. Conclusion: Compared with other MVI victims, fewer helmeted motorcyclists sustained head injury. When head injury occurs in helmeted motorcyclists, it tends to be more severe. Motorcyclists remain vulnerable to extremity injury and to severe chest injury.
ObjectiveClinician educators (CEs) frequently report tensions in their professional identities as... more ObjectiveClinician educators (CEs) frequently report tensions in their professional identities as clinicians and educators, although some perceive a reciprocal relationship between clinical and teaching roles. However, it is unknown if the shared meanings of clinicians’ multiple job roles translate to identity verification. We sought to examine CEs’ perceptions of their clinician and educator roles and the influence of their perceptions on the salience of their professional identities.DesignQualitative individual interviews and focus groups, analysed using framework analytic approach.Setting and participants23 occupational therapy (OT) and 16 physiotherapy (PT) educators from two acute hospitals and one rehabilitation unit in Singapore.ResultsPT and OT CEs constructed shared meanings of their clinician and educator roles through overcoming feelings of unease and inadequacy, discovering commonalities and establishing relevance. However, shared meanings between clinician and educator ...
ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers i... more ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers in Singapore and compare them to a decade ago. Secondary aim to analyse usefulness of selected trauma scores in this context.DesignRetrospective review of trauma registry of a single centre, from 1 April to 30 June 2015. Data compared with those from similar study performed at same centre in 2004.SettingEmergency department (ED) of 1500-bedded acute urban public hospital in Singapore.Participants1094 foreign workers with work-related injuries were included. Tourists, foreign students, non-work-related injuries, re-attendances for the same condition were excluded.ResultsMean age of participants was 32.8 years (SD 7.8), 90.0% were men. ED attendance was lowest on Sundays. Mechanism of injury: blunt (78.2%), penetrating (19.2%), burns (2.6%). Compared to 2004, 5% of foreign workers required admission (vs 19.6% in 2004, p≤0.0001), 8.0% underwent day or inpatient surgical procedures (vs 13.2% ...
The need for incorporation of biomedical ethics and professionalism into the formal undergraduate... more The need for incorporation of biomedical ethics and professionalism into the formal undergraduate and postgraduate curriculum has been increasingly recognised in the last twenty years.1-4 Parallel to changes in the
Introduction Peer assessments are increasingly prevalent in medical education, including student-... more Introduction Peer assessments are increasingly prevalent in medical education, including student-led mock Objective Structured Clinical Examinations (OSCE). While there is some evidence to suggest that examiner training may improve OSCE assessments, few students undergo training before becoming examiners. We sought to evaluate an examiner training programme in the setting of a student-led mock OSCE. Methods A year‑2 mock OSCE comprised of history taking (Hx) and physical examination (PE) stations was conducted involving 35 year‑3 (Y3) student examiners and 21 year‑5 (Y5) student examiners who acted as reference examiners. Twelve Y3 student-examiners attended an OSCE examiner training programme conducted by senior faculty. During the OSCE, Y3 and Y5 student examiners were randomly paired to grade the same candidates and scores were compared. Scores for checklist rating (CR) and global rating (GR) domains were assigned for both Hx and PE stations. Results There was moderate to excelle...
Background (1) To compare the characteristics of female and male trauma patients seen in the Emer... more Background (1) To compare the characteristics of female and male trauma patients seen in the Emergency Department (ED) and (2) to determine if injury prevention programmes for women should be different. Methods A prospective survey was conducted for 11544 trauma patients, aged 15 years and above, who presented to the ED of an urban public hospital in Singapore over 6 months. The following data were collected: demography, place, type and mechanism of injury and subsequent disposition from the ED. Results Almost half (49.5%) the injuries sustained by females occurred at home, with low falls of less than 2 metres being the most common mechanism of injury (52.7%). Victims of domestic violence were predominantly female at p<0.0001. Conclusion Injury prevention programs for women should focus on home safety and low falls. Special assistance programs for the victims of domestic violence should be available in the ED as the latter may be their only access to safety.
Background Singapore is an affluent small nation-state with a high per capita gross domestic prod... more Background Singapore is an affluent small nation-state with a high per capita gross domestic product. Objective To determine the prevalence of hunger and poverty among elderly patients attending an emergency department (ED). Methods All patients aged 65 years and above who sought treatment at the ED of an urban acute care hospital over one week between 0900 and 1700 hours were surveyed. Two trained interviewers administered a face-to-face close-ended questionnaire. Data collected were demographics, health status and surrogate indicators of poverty and hunger. Results Of the 210 non-critically ill patients approached, data was available for 194 (92.4%), of which 51% were men. The mean age was 76.7 (SD 7.4) years. Majority of the patients were well taken care of but a minority were not coping: 0.5% was homeless, 3.1% had skipped medical appointments in the last year due to lack of money, 1% did not have enough to eat and were not receiving any food aid and 1.5% borrowed money to buy f...
Introduction Junior students making the transition from pre-clinical to clinical years often stru... more Introduction Junior students making the transition from pre-clinical to clinical years often struggle to integrate into ward teams during ward-round activities. The SimRound is a novel approach to facilitate embedding of junior medical students into incumbent ward teams through simulation rounds specially designed to replicate actual ward-round proceedings. Using the situated learning and cognitive load theories, this study aims to describe the rationale, processes and lessons learnt from our experience in developing the SimRound. Methods Third-year students undergo two SimRound sessions at weeks two and six during the eight-week General Medicine clerkship. There are four phases in each SimRound: Prioritisation and triage; pre-round; consultant round; and evaluation and feedback. Using framework analysis, we compared open-ended survey data from pre-SimRound and SimRound cohorts to develop descriptive and explanatory accounts of identified themes. Results Despite the benefits to learning from being embedded in the ward team, students reported challenges to learning arising from engagement and team identity; increased intrinsic load; and increased extraneous load. SimRound addresses this by enabling deliberate learning in a controlled and authentic setting with inter-professional participation. The reduction of cognitive load enabled students to assimilate the necessary knowledge and skills.
INTRODUCTION With Singapore’s ageing population, there are increasing numbers of elderly cyclists... more INTRODUCTION With Singapore’s ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre. METHODS Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital’s trauma registry and reviewed. RESULTS Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries ...
Background: During clinical rotations, the learning environment of medical students becomes more ... more Background: During clinical rotations, the learning environment of medical students becomes more complex as they transit from lecture- to patient-based learning. Such complexity can emanate from tensions, a phenomenon according to Activity Theory (AT). Through the perspectives of medical students and healthcare professionals, this study aimed to delineate the tensions that students encounter in the clinical environment. Summary of work: Thirty one semi-structured in-depth interviews were conducted with doctors (n = 12), nurses (n = 8), and medical students (n = 11). AT was used as the analytical framework. Interviews were recorded, transcribed and analysed for unifying themes to identify systemic tensions, known as contradictions in AT. Summary of results: Seven themes were identified to be relevant to two contradictions – role contradiction in faculty members, and differing perceptions in the relationship between theory and practice. For the first contradiction, faculty members fac...
Most patients presenting to the emergency department (ED) with minor head injury (HI) can be disc... more Most patients presenting to the emergency department (ED) with minor head injury (HI) can be discharged, provided a caregiver is present and careful discharge instructions are given. The study ED uses an advice leaflet with verbal reinforcement to patients and caregivers detailing post-discharge instructions and warning symptoms of worsening HI. We aim to evaluate local patients' and caregivers' compliance to discharge instructions and their ability to recall HI advice. A prospective study was conducted in an adult ED between April 10, 2006 and May 1, 2006. All patients with minor HI discharged from the ED or its 24-hour observation ward were included in the study. A telephone survey was conducted within 48 hours of discharge using a standardised questionnaire. During the study period, 292 patients had HI, of which 182 were eligible for the study. 71 were uncontactable and one refused to participate, leaving 110 patients in the study. Patients' age ranged between 7 and 1...
To describe the relationship between bicycle helmet use and injury pattern sustained by patients ... more To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05)...
On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that be... more On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that became known as severe acute respiratory syndrome (SARS). We now describe a series of patients that did not fit World Health Organisation (WHO) case definitions for SARS at initial assessment. The Ministry of Health, Singapore centralised SARS cases in the study hospital and its emergency department (ED) became the national screening centre. A screening questionnaire and a set of admission criteria based on WHO case definitions were applied. Patients discharged from ED were tracked via telephone surveillance and recalled if necessary. A retrospective review was done of patients who did not fit WHO definitions initially, were discharged and had re-attended. During the outbreak, 11,461 people were screened for SARS. Among 10,075 (87.9 percent) discharged from the ED, there were 28 re-attendees diagnosed to have SARS later, giving an undertriage rate of 0.3 percent. Among the 28, six (21.4 pe...
On 22 March 2003, the Ministry of Health, Singapore, designated Tan Tock Seng Hospital as the nat... more On 22 March 2003, the Ministry of Health, Singapore, designated Tan Tock Seng Hospital as the nationwide severe acute respiratory syndrome (SARS) hospital and its Emergency Department (ED) took over the role as the screening center for SARS on 26 March 2003. We describe the initial clinical characteristics of probable or suspect SARS patients that presented to the ED. A retrospective study of patients who were admitted through the ED and subsequently diagnosed to have probable SARS and suspect SARS was done. The data of these patients from the ED log were reviewed and analysed. From 13 March 2003 to 31 May 2003, 11,461 patients were screened for SARS and 1,386 patients were admitted. Of these, 117 patients were diagnosed to have probable SARS and 146 suspect SARS. Their mean age was 36.7 years (range 1-80). Among these patients, there were 122 men (46.4 percent), and 205 were Singaporeans (77.9 percent). 13 patients had no initial contact history upon presentation to the ED. The mea...
Annals of the Academy of Medicine, Singapore, 2004
A Singapore study reported that 99% of diabetics had received some diabetes mellitus (DM) educati... more A Singapore study reported that 99% of diabetics had received some diabetes mellitus (DM) education. Another study reported that the Singapore public is generally well-informed about DM but whether diabetics are well-informed is not known. The objectives of this study were to determine DM knowledge of diabetics visiting the Emergency Department (ED) and to determine the diabetics' knowledge versus practice gap. A pretested questionnaire was used to survey a convenient sample of ED patients and visitors. The respondents were required to answer 43 questions on areas including "Risk Factors", "Treatment and Management" and "Monitoring". A point was awarded for each correct response. Diabetics were asked if they practised the items described in "Treatment and Management" and "Monitoring" sections. There were 95 diabetics and 91 non-diabetics surveyed, with no difference in the mean age or the proportion of men. There was no differenc...
Annals of the Academy of Medicine, Singapore, 2004
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objecti... more Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of fore...
A study of senior house officers' daytime work activities was conducted in the accident and emerg... more A study of senior house officers' daytime work activities was conducted in the accident and emergency department of the Cardiff Royal Infirmary. Activities were timed every 15 seconds by a single observer and were subdivided into working periods, meal periods and periods when no patient was waiting to be seen. A total of 96.1 h was analysed. The SHOs were found to be working for 78% of their time, of which 18.5% was taken up by nondoctor tasks. The SHOs took an average of 10.4 min for each walking wounded patient, 10.6 min for each paediatric patient and 27.3 min for a trolley patient. Each patient required an average of 14.2 min for assessment and treatment, which meant that 3.3 patients were seen each hour. However, considering that SHOs worked for 78% of their time, the actual rate of work was 4.2 patients for each working hour. The implications for staffing are discussed.
To determine if emergency physicians (EPs) are ready to accept 360˚feedback, and agreement betwee... more To determine if emergency physicians (EPs) are ready to accept 360˚feedback, and agreement between self and colleagues' assessment in a 360˚feedback for EPs. Methods: Self-administered questionnaire to determine acceptability of 360˚feedback (n = 43). Each EP completed the Physician Achievement Review self-assessment and approached five colleagues to complete an assessment for him/her. Results: Thirty-one responded: 77.4% preferred to select their appraisers, 90.3% wanted feedback to be confidential, 58.1% would share feedback with supervisors, but only 35.5% would link feedback to remuneration. Colleagues rated EPs' holistic management, humanistic aspects and patient communication, and professional relationship with colleagues as weak domains, weaknesses which EPs were only partially aware. Conclusions: EPs would accept 360˚feedback provided that they selected their appraisers and results were confidential. Colleagues reported that EPs were weak in ''soft'' and system skills.
for trainees to acquire the necessary skills. It remains to be seen if the proficiency in resusci... more for trainees to acquire the necessary skills. It remains to be seen if the proficiency in resuscitation skills among those taking anaesthetic examinations is higher than that among candidates taking the examination for membership of the Royal College of Physicians. The resuscitation training officer has a valuable role in ensuring that these skills are retained.
Background: Singapore has a mandatory helmet law for motorcyclists. This study aimed to determine... more Background: Singapore has a mandatory helmet law for motorcyclists. This study aimed to determine the injuries sustained by helmeted motorcyclists presenting to the emergency Department (ED). Methods: Adult victims of motor vehicular incidents (MVI) who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. Results: Motorcyclists formed 49.1% (1018) of all MVI victims, of whom 96.1% were men. The mean age was 32.5 years (SD 13.1), significantly younger (p,0.0001) than the mean age of 36.4 years (SD 16.4) among other MVI victims. The proportions of motorcyclists and other MVI patients admitted to the hospital were not different. Among those admitted, significantly fewer (p = 0.001) motorcyclists (32.2%) sustained head injury compared with other MVI victims (46.8%) but among the motorcyclists with head injury, more than one third (34.2%) had severe head injury. The proportion of patients with thoracic injury was not different (p = 0.93) between motorcyclists (10.2%) and other MVI victims (9.9%). However, among those with thoracic injury, 79.2% of motorcyclists had severe thoracic injury, significantly more (p = 0.04) than 50% of other MVI patients. Wounds, fractures, and/or dislocations of the limbs (p,0.001) were significantly more among motorcyclists compared with other MVI patients. Conclusion: Compared with other MVI victims, fewer helmeted motorcyclists sustained head injury. When head injury occurs in helmeted motorcyclists, it tends to be more severe. Motorcyclists remain vulnerable to extremity injury and to severe chest injury.
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