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1.
J Thromb Thrombolysis ; 50(3): 596-603, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32661758

RESUMEN

The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.


Asunto(s)
Atención Integral de Salud/organización & administración , Infecciones por Coronavirus/terapia , Prestación Integrada de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Neumonía Viral/terapia , Accidente Cerebrovascular/terapia , Anciano , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Grupo de Atención al Paciente/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Recuperación de la Función , Derivación y Consulta/organización & administración , Singapur/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Tiempo de Tratamiento/organización & administración , Resultado del Tratamiento , Flujo de Trabajo
7.
Singapore Med J ; 65(2): 61-67, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38343123

RESUMEN

INTRODUCTION: Modern magnetic resonance imaging (MRI) scanners utilise superconducting magnets that are permanently active. Patients and healthcare professionals have been known to unintentionally introduce ferromagnetic objects into the scanning room. In this study, we evaluated the projectile risk of Singapore coinage as well as some common healthcare equipment within a 3 T MRI scanner. METHODS: A rig termed 'Object eNtry Guidance and Linear Acceleration Instrument' (ONG LAI) was custom-built to facilitate safe trajectory of the putative ferromagnetic objects. A ballistic gel target was utilised as a human tissue surrogate to estimate tissue penetration. The point at which objects would self-propel towards the scanner was named 'Huge Unintended Acceleration Towards Actual Harm (HUAT AH)'. RESULTS: Singapore third-series coins (10-cent to 1-dollar coins) are highly ferromagnetic and would accelerate towards the MRI scanner from more than one metre away. Cannulas with their needles are ferromagnetic and would self-propel towards the scanner from a distance of 20 cm. Standard surgical masks are ferromagnetic and may lose their sealing efficacy when they are worn too close to the magnet. Among the tested objects, a can of pineapple drink (Lee Pineapple Juice) had the highest HUAT AH at a distance of more than 1.5 m. CONCLUSION: Some local coinage and commonly found objects within a healthcare setting demonstrate ferromagnetic activity with projectile potential from a distance of more than 1 m. Patients and healthcare professionals should be cognisant of the risk associated with introducing these objects into the MRI scanning room.


Asunto(s)
Equipos y Suministros de Hospitales , Imagen por Resonancia Magnética , Humanos , Singapur , Imagen por Resonancia Magnética/métodos , Diseño de Equipo
8.
Minerva Anestesiol ; 89(12): 1115-1126, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-38019175

RESUMEN

Human factors and non-technical skills (NTS) have been identified as essential contributors to both the propagation and prevention of medical errors in the operating room. Despite extensive study and interventions to nurture and enhance NTS in anesthesiologists, gaps to effective team practice and patient safety remain. Furthermore, the link between added NTS training and clinically significant improved outcomes has not yet been demonstrated. We performed a narrative review to summarize the literature on existing systems and initiatives used to measure and nurture NTS in the clinical operating room setting. Controlled interventions performed to nurture NTS (N.=13) were identified and compared. We comment on the body of current evidence and highlight the achievements and limitations of interventions published thus far. We then propose a novel education and training framework to further develop and enhance non-technical skills in both individual anesthesiologists and operating room teams. We use the cardiac anesthesiology environment as a starting point to illustrate its use, with clinical examples. NTS is a key component of enhancing patient safety. Effective framing of its concepts is central to apply individual characteristics and skills in team environments in the OR and achieve tangible, beneficial patient outcomes.


Asunto(s)
Anestesiólogos , Anestesiología , Humanos , Escolaridad , Corazón , Errores Médicos
9.
J Imaging ; 9(10)2023 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-37888332

RESUMEN

Ultrasound-guided techniques are increasingly prevalent and represent a gold standard of care. Skills such as needle visualisation, optimising the target image and directing the needle require deliberate practice. However, training opportunities remain limited by patient case load and safety considerations. Hence, there is a genuine and urgent need for trainees to attain accelerated skill acquisition in a time- and cost-efficient manner that minimises risk to patients. We propose a two-step solution: First, we have created an agar phantom model that simulates human tissue and structures like vessels and nerve bundles. Moreover, we have adopted deep learning techniques to provide trainees with live visualisation of target structures and automate assessment of their user speed and accuracy. Key structures like the needle tip, needle body, target blood vessels, and nerve bundles, are delineated in colour on the processed image, providing an opportunity for real-time guidance of needle positioning and target structure penetration. Quantitative feedback on user speed (time taken for target penetration), accuracy (penetration of correct target), and efficacy in needle positioning (percentage of frames where the full needle is visualised in a longitudinal plane) are also assessable using our model. Our program was able to demonstrate a sensitivity of 99.31%, specificity of 69.23%, accuracy of 91.33%, precision of 89.94%, recall of 99.31%, and F1 score of 0.94 in automated image labelling.

10.
Cureus ; 15(10): e46345, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37920643

RESUMEN

Introduction Multiple barrier shields have been described since the start of the COVID-19 pandemic. Most of these are bulky and designed for use in the main anesthetic or radiology departments. We developed a portable, negative-pressure barrier shield designed specifically for portable ultrasound examinations. A novel supine cough generation model was developed together with a reverse qualitative fit test to simulate real-world aerosol droplet generation and dispersion for evaluating the effectiveness of the barrier shield. We report the technical specifications of this design, named "SIR Flat CAP" from Safety In Radiology - Flat-packed Compact Airborne Precaution, as well as its performance in reducing the spread of droplets and aerosols.  Methods The barrier shield was constructed using 1 mm acrylic panels, clear packing tape, foam double-sided tape, and surgical drapes. Negative pressure was provided via hospital wall suction. A supine cough generation model was developed to simulate cough droplet dispersal. A reverse qualitative fit test was used to assess for airborne transmission of microdroplets. Results The supine cough generation model was able to replicate similar results to previously reported supine human cough generation dispersion. The use of the barrier shield with negative-pressure suction prevented the escape of visible droplets, and no airborne microdroplets were detected by reverse qualitative fit testing from the containment area. Conclusions The barrier shield significantly reduces the escape of visible and airborne droplets from the containment area, providing an additional layer of protection to front-line sonographers.

11.
Br J Radiol ; 95(1129): 20210835, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34672690

RESUMEN

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.


Asunto(s)
Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Equipos de Seguridad , Radiología Intervencionista/instrumentación , Aerosoles y Gotitas Respiratorias , Adulto , COVID-19/transmisión , Tos , Diseño de Equipo , Fluorescencia , Humanos , Masculino , Fantasmas de Imagen , Dosis de Radiación , Relación Señal-Ruido , Posición Supina
12.
Tob Control ; 19(5): 355-60, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20876075

RESUMEN

As a contribution to worldwide efforts towards a tobacco-free society, this paper considers the possibility of a long-term phasing-in of a total ban, by proposing that individuals born in or after the year 2000 have their supply of tobacco restricted. In conjunction, a survey that we have conducted in Singapore indicates strong public support (even among current smokers) for the proposal.


Asunto(s)
Actitud Frente a la Salud , Prevención del Hábito de Fumar , Fumar/legislación & jurisprudencia , Adolescente , Niño , Encuestas Epidemiológicas , Humanos , Singapur
13.
J Surg Educ ; 77(2): 479-484, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31889691

RESUMEN

BACKGROUND: Delivering bad news is a difficult task for the clinician and one that is important to address and nurture in residency training. METHODS: Residents were assigned to receive communication training with either standardized patients (SP) or peer role play (RP). Anonymized pre- and post-questionnaires were filled by residents detailing their experience. Independent assessors blinded to the study hypothesis rated the residents' performance using a standardized plus-delta assessment form as a measure of effectiveness of either methods. In our study additionally, corresponding costs were assessed as man-hours resulting from the hours of work of SP, RP, and tutors in order to generate the incremental cost-effectiveness ratio for the use of SP against the use of RP. SETTING: The study took place in a tertiary academic hospital, National University Hospital, Singapore. PARTICIPANTS: A total of 15 junior residents in anesthetic training entered and completed the study and were evaluated during the 2017-2018 academic year. RESULTS: The mean performance scores were 63.3% (RP group) and 74.3% (SP group) attributing advantage to the SP group. Costs however were slighter greater in the SP group (14 man-hours) versus (10 man-hours) in the RP group. The resulting incremental cost-effectiveness ratio was 0.36 man-hours per 1-point increase in the performance score when comparing SP to peer RP. CONCLUSIONS: SPs proved to be the more cost-effective modality when employing communication training for delivering bad news. The successful experience and use of SPs should be balanced against the marginally lesser costs involved in peer RP in planning residency teaching sessions.


Asunto(s)
Internado y Residencia , Comunicación , Análisis Costo-Beneficio , Humanos , Grupo Paritario , Relaciones Médico-Paciente , Revelación de la Verdad
14.
Simul Healthc ; 15(6): 422-426, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32842075

RESUMEN

STATEMENT: Healthcare simulation training can be significantly disrupted by infectious disease outbreaks, yet it is a key component in several important medical education activities, such as resuscitation refresher training and high-stakes prelicensure healthcare examinations. This article details the strategic and tactical considerations for continuing simulation training during infectious disease outbreaks. A framework of graded responses, titrated to outbreak severity, is provided from the perspective of an academic medical center managing simulation training during the early stage of the now global coronavirus disease 2019 outbreak.


Asunto(s)
COVID-19/epidemiología , Entrenamiento Simulado/organización & administración , Centros Médicos Académicos , Humanos , Control de Infecciones/normas , Pandemias , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Entrenamiento Simulado/normas
15.
PLoS One ; 15(12): e0243217, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33259536

RESUMEN

INTRODUCTION: Teaching endotracheal intubation is uniquely challenging due to its technical, high-stakes, and highly time-sensitive nature. The GoPro is a small, lightweight, high-resolution action camera with a wide-angle field of view that can encompass both the airway as well as the procedurist's hands and positioning technique when worn with a head mount. We aimed to evaluate its effectiveness in improving intubation teaching for novice learners in a simulated setting, via a two-arm, parallel group, randomized controlled superiority trial with 1:1 allocation ratio. METHODS: We recruited Year 4 medical students at the start of their compulsory 2-week Anesthesia posting. Participants underwent a standardized intubation curriculum and a formative assessment, then randomized to receive GoPro or non-GoPro led feedback. After a span of three months, participants were re-assessed in a summative assessment by blinded accessors. Participants were also surveyed on their learning experience for a qualitative thematic perspective. The primary outcomes were successful intubation and successful first-pass intubation. RESULTS: Seventy-one participants were recruited with no dropouts, and all were included in the analysis. 36 participants received GoPro led feedback, and 35 participants received non-GoPro led feedback. All participants successfully intubated the manikin. No statistically significant differences were found between the GoPro group and the non-GoPro group at summative assessment (85.3% vs 90.0%, p = 0.572). Almost all participants surveyed found the GoPro effective for their learning (98.5%). Common themes in the qualitative analysis were: the ability for an improved assessment, greater identification of small details that would otherwise be missed, and usefulness of the unique point-of-view footage in improving understanding. CONCLUSIONS: The GoPro is a promising tool for simulation-based intubation teaching. There are considerations in its implementation to maximize the learning experience and yield from GoPro led feedback and training.


Asunto(s)
Anestesiología/educación , Educación de Pregrado en Medicina/métodos , Intubación Intratraqueal/métodos , Fotograbar/instrumentación , Competencia Clínica , Simulación por Computador , Instrucción por Computador/métodos , Curriculum , Retroalimentación , Femenino , Humanos , Masculino , Aprendizaje Basado en Problemas/métodos , Singapur , Estudiantes de Medicina , Adulto Joven
16.
J Neurol Sci ; 417: 117078, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-32768718

RESUMEN

BACKGROUND AND AIM: COVID-19 pandemic has resulted in an unprecedented increased usage of Personal protective equipment (PPE) by healthcare-workers. PPE usage causes headache in majority of users. We evaluated changes in cerebral hemodynamics among healthcare-workers using PPE. METHODS: Frontline healthcare-workers donning PPE at our tertiary center were included. Demographics, co-morbidities and blood-pressure were recorded. Transcranial Doppler (TCD) monitoring of middle cerebral artery was performed with 2-MHz probe. Mean flow velocity (MFV) and pulsatility index (PI) were recorded at baseline, after donning N95 respirator-mask, and after donning powered air-purifying respirator (PAPR), when indicated. End-tidal carbon-dioxide (ET-CO2) pressure was recorded for participants donning PAPR in addition to the N95 respirator-mask. RESULTS: A total of 154 healthcare-workers (mean age 29 ± 12 years, 67% women) were included. Migraine was the commonest co-morbidity in 38 (25%) individuals while 123 (80%) developed de-novo headache due to N95 mask. Donning of N95 respirator-mask resulted in significant increase in MFV (4.4 ± 10.4 cm/s, p < 0.001) and decrease in PI (0.13 ± 0.12; p < 0.001) while ET-CO2 increased by 3.1 ± 1.2 mmHg (p < 0.001). TCD monitoring in 24 (16%) participants donning PAPR and N95 respirator mask together showed normalization of PI, accompanied by normalization of ET-CO2 values within 5-min. Combined use of N95 respirator-mask and PAPR was more comfortable as compared to N95 respirator-mask alone. CONCLUSION: Use of N95 respirator-mask results in significant alterations in cerebral hemodynamics. However, these effects are mitigated by the use of additional PAPR. We recommend the use of PAPR together with the N95 mask for healthcare-workers doing longer duties in the hospital wards.


Asunto(s)
Betacoronavirus , Personal de Salud , Máscaras/efectos adversos , Enfermedades Profesionales/prevención & control , Pandemias , Dispositivos de Protección Respiratoria , Adulto , Velocidad del Flujo Sanguíneo , COVID-19 , Dióxido de Carbono/análisis , Circulación Cerebrovascular , Infecciones por Coronavirus/prevención & control , Estudios Transversales , Femenino , Cefalea/etiología , Hemodinámica , Humanos , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiopatología , Enfermedades Profesionales/etiología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Flujo Pulsátil , SARS-CoV-2 , Ultrasonografía Doppler Transcraneal , Adulto Joven
18.
Head Neck ; 36(6): 873-81, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23733717

RESUMEN

BACKGROUND: The vacuum-assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas. METHODS: A retrospective study was performed on 10 patients treated at the National Cancer Centre, Singapore, who developed postoperative orocutaneous fistulas. Hydrogum dental paste was used as a sealant together with the VAC system to close the fistulas. We used either the RENASYS or VAC ATS system with 50 mm Hg to 125 mm Hg continuous suction. RESULTS: The 10 patients developed 11 fistulas. The median age of this cohort was 67 years (range, 33-80 years). Nine patients had successful closure of their fistulas with VAC therapy whereas 1 patient had unsuccessful VAC therapy and required flap reconstruction. The median time to fistula closure was 19 days (range, 6-36 days). The median time to radiotherapy after surgery was 46 days (range, 26-62 days). CONCLUSION: VAC therapy is an effective treatment option for orocutaneous fistulas.


Asunto(s)
Fístula Cutánea/terapia , Cementos Dentales/uso terapéutico , Terapia de Presión Negativa para Heridas , Fístula Oral/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Fístula Cutánea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Fístula Oral/etiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Cicatrización de Heridas
19.
Ann Acad Med Singap ; 38(3): 202-6, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19347072

RESUMEN

INTRODUCTION: A local study completed in Singapore, which was part of an international multi-country study that aims to develop a global assessment of exposure to second-hand smoke in indoor workplaces, gathered data regarding the indoor air quality of public areas. It was hypothesised that air would be less polluted in non-smoking venues compared to places where smoking occurred. MATERIALS AND METHODS: A TSI SidePak AM510 Personal Aerosol Monitor was used to sample and record the levels of respirable suspended particles (RSP) in the air. A broad range of venues were sampled in Singapore. The primary goal of data analysis was to assess the difference in the average levels of RSP in smoke-free and non smoke-free venues. Data was assessed at 3 levels: (a) the mean RSP across all venues sampled compared with the mean levels of smoke-free and non smoke-free venues, (b) levels in venues where smoking occurred compared with similar venues in Ireland, and (c) comparison between smoke-free and non smoke-free areas according to the type of venue. Statistical significance was assessed using the Mann-Whitney U-test. RESULTS: The level of indoor air pollution was 96% lower in smoke-free venues compared to non smoke-free venues. Averaged across each type of venue, the lowest levels of indoor air pollution were found in restaurants (17 microg/m3) and the highest in bars (622 microg/m3); both well above the US EPA Air Quality Index hazardous level of >or=251 ug/m3. CONCLUSIONS: This study demonstrates that workers and patrons are exposed to harmful levels of a known carcinogen and toxin. Policies that prohibit smoking in public areas dramatically reduce exposure and improve worker and patron health.


Asunto(s)
Contaminación del Aire Interior/análisis , Lugar de Trabajo , Contaminación del Aire Interior/legislación & jurisprudencia , Monitoreo del Ambiente , Irlanda , Restaurantes , Singapur , Fumar
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