114 research outputs found
Hospital design for better infection control
No full textThe physical design and infrastructure of a hospital or institution is an essential component of its infection control measure. Thus is must be a prerequisite to take these into consideration from the initial conception and planning stages of the building. The balance between designing a hospital to be an open, accessible and public place and the control to reduce the spread of infections diseases is a necessity. At Singapore General Hospital, many lessons were learnt during the SARS outbreak pertaining to this. During and subsequent to the SARS outbreak, many changes evolved in the hospital to enable us to handle and face any emerging infectious situation with calm, confidence and the knowledge that staff and patients will be in good stead. This paper will share some of our experiences as well as challenge
Grace under pressure: Leadership in emergency medicine
No full textPhysicians in general, including emergency physicians (EPs), are trained in the diagnostic, therapeutic, and administrative aspects of patient care but not so much in the theoretical and practical aspects of assuming and delivery of leadership. EPs are always taught to focus on their performance, to excel and achieve, to be accountable for their own clinical decisions, and to appreciate feedback and peer-to-peer review. Currently, if there are some semblances of formal or semi-formal leadership instruction, the organized theoretical curriculum often does not formally include very structured and planned departmental leadership and management elements. Leadership is a process for a person (≥the leader≥) to lead, influence, and engage a group or organization to accomplish their objectives and mission. To do this, the leader must understand a variety of issues of working, interacting, and integrating with people, the environment and both, the intrinsic and extrinsic factors, and elements that have an impact on the industry or area he/she is leading in. Leadership in emergency medicine (EM) is even more challenging, with its unique focus, issues, and trajectory, moving into the new century, with new considerations. No single strategy is sufficient to ace EM leadership and no single specific leadership model is complete. This paper shares some current views on medical/EM leadership. The author shares her views and some suggested proposals for more formal and structured leadership, implementation, and succession to help nurture and groom Eps who will become leaders in EM in the near future
Cyclone Nargis and Myanmar: A wake up call
No full textIn early May 2008, Cyclone Nargis (CN) tore across the southern coastal regions of Myanmar, pushing a tidal surge through villages and rice paddies. The almost 12 foot wall of water and wind speed of over 200 km/hr killed tens of thousands of people and left hundreds of thousands homeless and vulnerable to injury and disease. Out of the 7.35 million living in the affected townships of Labutta, Bogale, Pyinsalu, Yangon, and many more, approximately 2.4 million were affected. Overall, more than 50 townships were affected by this most devastating cyclone in Asia since 1991. The Delta region, Myanmar′s Rice Bowl, was severely damaged. The low-lying villages were submerged. There was widespread destruction of homes, critical infrastructure of the villages, roads, ferries, water, fuel, and electricity supplies. Our team from Singapore (called Team Singapore) reached out to at least 10 different villages during the time we were there. We ran mobile clinics daily at several locations and these operated from warehouses, temples, schools or any make shift buildings. The journey to the remote villages may take between 1 and 2 hours by road or by boat. We also ran mobile clinics at the township hospital, the rural healthcare centers, and an orphanage
Post exercise ice water immersion: Is it a form of active recovery?
No full textIce water immersion and contrast temperature water immersion therapy post exercise is fast becoming a common practice among athletes involved in a variety of sports. Several mechanisms have been put forth to explain the rationale for its use. However, there is still a lack of evidence from a sufficiently large-scale trial to support the routine practice and formal incorporation into certain sporting guidelines. We describe here two athletes who applied the therapy post exercise and presented to the Emergency Department with delayed onset muscle pain
Think muscle; Think rhabdomyolysis
No full textRhabdomyolysis is the breakdown of striated muscle cells resulting in leakage of cell matter into the extra-cellular space. It can present with myalgia, muscle weakness and swelling. Episodes of passing of dark tea-coloured urine have also been reported. Raised creatinine kinase is diagnostic of rhabdomyolysis. Raised serum myoglobin levels and presence of myoglobin in the urine (myoglobinuria) help to support the diagnosis. The aetiology for rhabdomyolysis can be both traumatic and non-traumatic. In the case of trauma, individuals with crush injuries trapped in cars or under collapsed buildings , struggling against restraints, immobilized and in the same position for hours due to injuries, comatosed states or positioning during prolonged surgeries and those with high voltage electrical injuries are at increased risk of rhabdomyolysis. Non-traumatic causes of rhabdomyolysis include hyperthermia, metabolic myopathies, drugs and toxins ingestions, electrolyte abnormalities and infections. The mechanism of rhabdomyolysis is often multifactorial. In the case of trauma, direct injury to cell membranes as well as hypoxia from direct compression leading to adenosine triphosphate depletion leads to breakdown of striated muscle cells.. The lysed cells release myoglobin, creatine kinase, urate and phosphate into the interstitium. Direct heme protein-induced toxicity on nephrons can result in acute kidney injury. We report a case of traumatic rhabdomyolysis and share the latest in the literature on the understanding of the subject as well as that of myoglobinuria, with which it is often associated with
Big data: applications in healthcare and medical education
No full textBig data is a hot topic these days, especially in academic circles. However, it is really a topic that goes
beyond the four walls of academia. It has got practical applications in day to day practice of medicine
and in medical education. What are these and are we ready to embark on the journey to continue to
enhance the way we practice, into the future
Use of social media in medicine: a double-edged sword?
No full textSocial Media (SM) is changing the way physicians and patients interact. SM is one of the drivers towards a more patient-centric model of healthcare. It offers a platform for health communications, empowerment and even possibly strengthening the physician-patient relationship. The use of SM in medicine has often brought on a lot of feedback, more negative than positive ones. The academic literature is commonly seen with articles on SM and how it poses dangers and risks to medical personnel. Many SM usage guidelines are also geared towards the expectations of misuse rather than positive considerations and constructive use. There is a need to assess its impact and utilisation in medicine, through processes such as consultation, education and creation of awareness, communications, interaction and sharing of information. The culture of medicine is one that values confidentiality, privacy, one to one interaction and very professional conduct. This is often thought to be contrasting to that of SM, which involves open sharing, connectivity and is thus, more informal. Despite the contrasting cultures, a significant proportion of medical personnel do use or are on SM platforms. Participation in SM networking and other similar internet sites can support physicians\u27 personal expression, enable individual physicians to have presence online, foster collegiality and camaraderie within the profession and provide opportunities to disseminate public health messages and other health communications. If properly and adequately used, within acceptable framework, SM can indeed be a boon, rather than a bane to medicine
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