Exploring long-term volunteerism in a community family service centre in Singapore: A Focused Ethnographic Study.

Volunteerism contributes significantly to the social development of a country. Although the rate of volunteerism has steadily increased over the years, the numbers of regular volunteers remains small. While the existing literature has elucidated individuals' motivations for volunteerism, research is lacking on their motivations and challenges in sustaining long-term volunteerism. A focused ethnographic approach was adopted in this study to explore 20 participants' motivations and challenges towards long-term volunteerism. Purposive sampling was used to recruit participants in one single-family service centre in Singapore from October to December 2018. Data were collected through covert observations and semi-structured interviews. Field notes, observational data and findings from the interviews were triangulated and analysed through thematic analysis. In this study, a central exhaustive description of the volunteers 'providing help while receiving good deeds' is established. This was supported with three main themes revolving around the volunteers: fulfilling life goals, deriving meaning from experiences and striking a balance in the life. These themes characterised the motivations and challenges faced by them amidst their voluntary works. They reported that the satisfaction and fulfilment through volunteering had brought personal growth, well-being and happiness to them. The sense of purpose through volunteering further enhanced their experiences. Finally, some volunteers reported that volunteering enabled them to strike a balance in their own life by engaging it as a form of solace. The findings suggest that sustained volunteerism is a multidimensional construct involving the interplay of different factors in the individual's life. By understanding motivations underlying long-term volunteerism, voluntary organisations can create volunteering opportunities that dovetail with volunteers' personal goals, thus boosting their satisfaction and incentivising their sustained engagement. Additionally, the organisations can hold regular bonding activities to promote rapport among their volunteers, beneficiaries and staff, thus encouraging the volunteers to persevere on their volunteering journey.

Primary percutaneous coronary intervention for acute myocardial infarction secondary to acute left main coronary occlusion in an institution without on-site cardiothoracic surgical support.

AIMS: There is no consensus on the optimal management of acute myocardial infarction due to acute left main coronary occlusion (LMCO). We evaluated the feasibility of primary percutaneous coronary intervention (PCI) for acute LMCO in an institution without on-site cardiothoracic surgical (CTS) support. METHODS AND RESULTS: We retrospectively identified 20 patients, median age 67 years (range 38 to 81). Sixteen patients presented with cardiogenic shock. All patients required intra-aortic balloon pump counterpulsation and inotropic support. Sixteen patients underwent stenting and four had balloon angioplasty only. Thrombolysis In Myocardial Infarction 3 flow was restored in 13 patients. Post-PCI, six patients were transferred to a tertiary institution for further care: three underwent extracorporeal membrane oxygenation (ECMO), one underwent both ECMO and coronary artery bypass grafting (CABG), one died before ECMO initiation and one stabilised without further intervention. Thirteen patients died in-hospital. There was one subsequent death out of the seven hospital survivors, with median follow-up 390 days (range 60 to 660 days). There was a trend towards survival with a shorter door-to-balloon time (p = 0.07). CONCLUSIONS: Primary PCI may be a feasible initial revascularisation strategy for acute LMCO in centres without on-site CTS support.

Acute neurological events in a patient with secondary polycythaemia and arteriovenous malformations.

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations (AVMs) who presents with a transient ischaemic attack (TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient.

Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study.

BACKGROUND: The prognostic importance of various hemodynamic responses to adenosine infusion in patients undergoing adenosine stress myocardial perfusion stress (MPS) has not been defined. METHODS AND RESULTS: We identified 3444 unique patients (53.5% women, mean age 74.0+/-8.4 years) who underwent adenosine (with no additional exercise) stress myocardial perfusion single photon emission computed tomography (MPS) and were followed up for 2.0+/-0.8 years. Multivariable Cox proportional hazards analysis was used to assess the prognostic value of hemodynamic variables in predicting cardiac death (CD). Two hundred twenty-four CDs (6.5%) occurred during follow-up. By multivariable analysis, higher rest heart rate (HR) and to a lesser extent lower peak HR were markers of CD. When added to the multivariable model in place of peak and rest HR, the peak/rest HR ratio was an independent predictor of CD. Peak/rest HR ratio additionally risk-stratified patients within each MPS category. A significant interaction was found between gender and peak systolic blood pressure (SBP), in which there was an increased risk associated with a low peak SBP (<90 mm Hg at end of adenosine infusion) in men but not in women. CONCLUSIONS: Patients undergoing adenosine stress MPS with high rest HR and low peak/rest HR ratio have increased risk of CD, as do male patients with a low peak SBP. Assessment of the hemodynamic response to adenosine adds incremental prognostic value to MPS results and enhances identification of patients at risk for CD.