Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore.

In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

Development of a measure of the concerns held by people with implanted cardioverter defibrillators: the ICDC.

OBJECTIVES: To develop a questionnaire to measure the extent and severity of the concerns of people with an implanted cardioverter defibrillator. DESIGN: Items were generated from patient interviews, expert review and the research literature on patients' worries and concerns. A pilot version was administered to a series of ICD patients and repeated for test-retest reliability 6 weeks later. Psychometric tests including the screen test, factor analysis and various reliability assessments were undertaken. It was predicted that the greater the extent and severity of concerns, the greater the anxiety experienced by the ICD patient. Scores were compared with a validated measure of anxiety and depression administered at the same time. RESULTS: Fifty-seven (64%) patients completed and returned the questionnaire and a further 22 (100% of those asked) completed the 6-week retest. Reliability and validity appeared to be good and two factors were identified. Both total score and the individual factor scores correlated moderately with anxiety. CONCLUSIONS: The questionnaire appears to reflect patients' concerns and, as predicted, these were associated with the patients' anxiety level. The scale requires further testing to reveal if it is of use both clinically and for research purposes.

Basilar artery and vertigo.

Our goal was to identify by magnetic resonance angiography the specific vascular abnormalities of the basilar artery that can be related to hypoperfusion disorders and produce symptoms of vertebrobasilar insufficiency. A classification of regional vascular perfusion disorders based on developmental malformations and intrinsic and extrinsic angiopathies was formulated from an analysis of individuals with these disorders. Specific angiographic abnormalities such as tortuosity, stenosis, thrombosis, and dolichoectasia were identified in subjects with vestibulocerebellar dysfunction. Charts and radiographic images were examined with respect to the history, physical evidence, and vascular configuration, and the data were integrated for comprehensive analysis. We found that abnormalities identified by magnetic resonance angiography could be correlated with symptoms due to vascular insufficiency. Cases are presented that document the developmental and acquired arterial disorders that may be considered the etiologic factors for regional perfusion deficits.

Vertigo: analysis by magnetic resonance imaging and angiography.

The relationship of vascular disease of the vertebrobasilar artery system to isolated vertigo was examined by magnetic resonance imaging and angiography. Eighty-nine individuals complaining of vertigo were evaluated by standard otoneurologic investigations, and the data were correlated with the vascular patterns of the cervical region and posterior fossa. The age distribution extended from the fourth decade to the ninth decade; the peak occurrence was observed in the eighth. Approximately 85% of the group experienced numerous episodes of vestibular dysfunction from months to years before examination; the remaining segment was examined following the first episode due to severity or persistence of symptoms. The criteria for vascular abnormality proposed by the authors are based upon comparison with previous normal findings. Approximately 52% of the cohort demonstrated abnormal configurations or evidence of diminished flow within the vertebrobasilar artery system. Of this segment, a vertebral artery was most frequently abnormal, in 76%; the basilar artery was judged pathological in 32%, and combined disease of several arteries was evident in 20%.

Attitudes among adolescents in a Swedish city toward some sexual crimes.

Using data from a representative sample of adolescents in grade ten in Uppsala, the fourth largest city in Sweden, attitudes toward a number of (criminal) sexual acts are studied. These data are contrasted with those from a sample of patients at a school gynecological clinic. It is found that for both samples, only a very limited number of the eight discussed acts are considered to be criminal by the adolescents. Although at least seven or eight acts are criminal in Swedish law, only two acts are considered criminal by about half of the respondents. These acts are pedophilia and rape after petting. The same questions were used by Kutchinsky in 1969 when on behalf of the U.S. Congress Commission on Obscenity and Pornography he studied inhabitants in Copenhagen, Denmark. When comparing data from Uppsala Sweden 1978 with data from Copenhagen, Denmark 1969 we find that Swedish adolescents in the late seventies, on the whole are much less likely to call the discussed acts criminal. The only exception is rape after petting, which in Copenhagen in the late sixties was the act least often seen as criminal but in the Uppsala study in the late seventies it was one of the two acts most often claimed to be criminal. Finally, the effects of coital experience and the effect of sexual knowledge on the percieved criminality of the acts are considered.