bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Report: Induction of Immune Tolerance to Factor VIII Inhibitor after a Major Operation
Authors: Ho Liam-Pock , Ho Yoke-Kum , Tien Sim-Leng
Published: February 2023

Introduction: We report a successful case of immune tolerance to factor VIII (FVIII) inhibitor after a major operation. An attempt was made to induce immune tolerance with inhibitor in a haemophilia A patient, who was required to undergo an above-knee amputation. We opted to give high-dose FVIII infusion with no immunosuppression.

Outcome: The highest preoperative FVIII inhibitor level was 5 BU and the peak postoperative FVIII inhibitor level was 1.5 BU demonstrated on Day 9 post operation. High-dose FVIII support was provided during the perioperative period and continued with a low maintenance dose to achieve a FVIII level of 30% to 40%. The requirement of high-dose FVIII lasted from day 6 to 23 post operation and this was tailed down to a maintenance dose over the next 37 days. There were only 2 episodes of mild oozing from the wound at around Day 9, which coincided with the peak postoperative FVIII inhibitor level. Both bleeding episodes were arrested adequately by administering a single dose of FEIBA during each episode. Immune tolerance was demonstrated after around 3 months and a follow-up period of 233 days showed no recurrence of FVIII inhibitor with the normalisation of FVIII half-life study.

Conclusion: After immune tolerance, the patient suffered fewer episodes of joint haemorrhage and required a lower amount of FVIII infusion as well. The cost may be high initially but the longterm cost-effectiveness has to be carefully evaluated.

Key words: Factor VIII inhibitor, Haemophilia, Immune tolerance
POEMS Syndrome – A Case for More Aggressive Treatment
Authors: Rathakrishnan Rahul , Liu Te-Chih , Chan Yee-Cheun , Ong Benjamin KC
Published: February 2023

Introduction: Patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal or M-protein and skin changes) syndrome exhibit a wide range of clinical manifestations and are often seen by a variety of specialists prior to diagnosis.

Clinical Picture: We describe a case of POEMS syndrome that first presented with significant neuropathy but progressed to develop further manifestations of the condition, including marked gastrointestinal symptoms.

Treatment: The patient was commenced on localised radiotherapy and chemotherapy in addition to immunomodulatory therapy for the neuropathy.

437specialties. This case is also unique for its marked gastrointestinal manifestation. To our knowledge, this is the second reported case in the literature with this feature.

Key words: Demyelinating polyneuropathy, Gastrointestinal
Pharmacologic Treatment of SARS: Current Knowledge and Recommendations
Authors: Tai Dessmon YH
Published: February 2023

The severe acute respiratory syndrome (SARS) pandemic caught the world by surprise in 2003 and spread rapidly within a relatively short period of time. Hence, randomised placebocontrolled clinical trials on the treatment of SARS were not possible. Our understanding was obtained from observational, cohort studies, case series and reports. Nevertheless, such information is useful in providing clinical management guidelines and directing future research in case SARS recurs. Early in the pandemic, a combination of ribavirin and corticosteroids was adopted as the standard treatment in Hong Kong, Canada and elsewhere because of the apparent good results of the first few patients. Subsequent reports showed that ribavirin was associated with a high rate of toxicity and lacked in vitro antiviral effect on SARS-coronavirus (SAR-CoV). The timing and dosage regimens of steroid in the treatment of SARS are controversial. Pulse methylprednisolone 250 to 500 mg/day for 3 to 6 days has been reported to have some efficacy in a subset of patients with “critical SARS,” i.e., critically ill SARS patients with deteriorating radiographic consolidation, increasing oxygen requirement with PaO2 <10 kPa or SpO2 <90% on air, and respiratory distress (rate of 30/min). Prolonged therapy with high-dose steroids, in the absence of an effective antimicrobial agent, could predispose patients to complications such as disseminated fungal infection, and avascular necrosis. Kaletra (400 mg ritonavir and 100 mg lopinavir), a protease inhibitor used in the treatment of human immunodeficiency virus infection, may be considered for early treatment of SARS patients, preferably in a randomised double-blind placebocontrolled clinical trial setting. Interferon (IFN) is not recommended as standard therapy in SARS. However, there are enough data on in vitro activity of IFN preparations and a few clinical studies for these products to support a controlled trial if SARS recurs. Many other experimental treatments have been tried in an uncontrolled manner, and they should not be recommended as standard therapy.

Key words: Corticosteroid, Interferon, Protease inhibitor, Ribavirin, SARS
Academy of Medicine, Singapore – The Next Twenty-Five Years (1982-2007)
Authors: Nambiar Raj M. , Chee Yam-Cheng
Published: February 2023

The Academy of Medicine has been the foremost medical specialist organisation during the last 50 years. Its key roles in postgraduate education and training, specialist certification and continuing professional education have steadily increased. From a little over 500 members 25 years ago, it has now over 2000 specialists as Fellows. The Academy has acquired a permanent home, restructured the organisation, changed several Chapters into Colleges and is set to take on greater responsibility and leadership role in specialist training, examination and certification, accreditation and continuing professional development and maintenance of high standards of specialist practice. Key words: Academy of Medicine, Singapore, Postgraduate Medical Education, Specialist Training, Specialist Certification
From the Chapter of Anaesthetists to the College of Anaesthesiologists, Singapore
Authors: Khoo Siew Tuan
Published: February 2023

Sir Stamford Raffles introduced western medicine to Singapore in 1819 when he arrived with the East India Company. As the popularity of western medicine grew, more British doctors were sent here. The local medical school was started in 1905 and hospitals mushroomed to cope with increasing demands. Impetus for the development of anaesthesia was ignited by rapid advancements in surgery. Most of our early anaesthetists received their training and specialty degrees in Britain until 1971 when the local Master of Medicine (Anaesthesia) began. The College of Anaesthesiologists, Singapore, together with the Singapore Society of Anaesthesiologists, shoulders the responsibility of ensuring optimal training and continual upgrading for the anaesthesia fraternity so that patient safety is not compromised.

Key words: Anaesthesia, College of Anaesthesiologists, Singapore
Recent Development in Paediatrics: from Chapter to College
Authors: Quak Seng-Hock , Ho Nai-Kiong
Published: February 2023

Paediatrics is among one of the earliest specialties to develop in Singapore. At the end of the 1980s, there were some 100 practising paediatricians who were trained either locally or overseas. In 1989, there were 52 paediatricians registered as Fellows of Academy of Medicine, Singapore. The number was more than adequate for the formation of a chapter within the Academy. The inaugural meeting of the Chapter of Paediatricians was held on Friday, 31 March 1989 where a total of 24 members attended. The Chapter of Paediatricians functioned as a special group within the Academy, governed by its rules, regulations and by-laws. A number of academic activities such as lectures and scientific meetings were organised by the chapter. The formation of the Chapter of Paediatricians was to look after the interests of paediatricians in the Academy of Medicine. Over the years, it had functioned within the umbrella of the Academy and successfully organised many academic activities for its members. However, there were a number of restrictions for the Chapter. It was not financially independent and was not able to serve its members fully. Prof K Satku the Master of the Academy proposed that those Chapters with sufficient numbers could be transformed into Colleges so that the Colleges can be more independent. The main focus for the Colleges was to maintain professional standard and professional development. The Colleges would have their own rules and regulations and registered as a subsidiary company of Academy of Medicine, Singapore. The College of Paediatrics and Child Health, Singapore, was incorporated on 17 August 2004. This was indeed a milestone in the history of medicine in Singapore and the paediatric fraternity. Key words: College, History, Paediatricians
From the Chapter of Physicians, Academy of Medicine, Singapore to the College of Physicians, Singapore
Authors: Lim Shih-Hui , Ng Keng-Yeen , Chew Chin-Hin
Published: February 2023

Following the establishment of the Academy of Medicine in 1957, the Chapter of Physicians was formed within the Academy in 1966 when there was a sufficient number of physicians to warrant its formation. Over the 40 years, the Chapter played a major role in providing, promoting and enhancing Continuing Medical Education (CME) for the physician specialists in Singapore. The Chapter gradually grew in size and scope. In early 2000s, it had more than 450 members specialising in 14 Internal Medicine-related specialties. Because of the critical mass, specialization and sub-specialization in Singapore, the Chapter was no longer able to represent the diverse interests of physician specialists, as well as to further develop all these specialties and subspecialties. In 2004, the Chapter of Physicians transformed into the current College of Physicians, with its own 14 internal medicine-related specialty Chapters. Though an independent legal entity, the College and its 14 specialty Chapters continue to be affiliated to the Academy of Medicine. They will now provide and strengthen Continuing Professional Development (CPD) programme for specialists as well as augment physicians' training and certification in Singapore. The initiatives and effort of the College and its Chapters will further enhance the roles and functions of the Academy, the main professional body for all specialists in Singapore. This paper highlights the important milestones of the Chapter over the past 4 decades, describes the rationale and process of College formation, and outlines its strategy for the next decade.

Key words: Chapter, College, Physicians, Singapore
A Brief History of the College of Radiologists, From Chapter To College
Authors: Ong Chiou-Li , Khor Tong-Hong , Goh Anthony SW , Kaw Gregory , Tian Wen-Jie
Published: February 2023

Radiology has always been an enigma to the medical world. One of the younger medical specialties in the world, radiology has been in existence for just slightly more than a hundred years. Although relatively young, radiology has progressed so far since Dr Wilhelm Roentgen's discovery of X-ray in 1895. In order to fully realise the width and depth of the College of Radiologists, we must indulge ourselves in its progress and unravel its mystery and enigma. This article seeks to chronicle the development of the Chapter of Radiologists, from its wilderness nascent years to the present College comprising the three separate Chapters, of Diagnostic Radiology, Radiation Oncology and Nuclear Medicine. Key words: Chapter of Radiologists, College of Radiologists, History of Radiology in Singapore
A Brief History of the College of Surgeons, Singapore (Formerly known as Chapter of Surgeons), Academy of Medicine, Singapore
Authors: Heng Anthony
Published: February 2023

The Chapter of Surgeons was inaugurated in 1966 following the formation of the Academy of Medicine, Singapore in 1957. The formation of the Chapter of Surgeons was to look after the interest of surgeons in the Academy of Medicine. Over the years, it has successfully organized many academic activities for its members. In 2004, the Chapter of Surgeons transformed into the current College of Surgeons. The College continues to involve itself in training, continuing education and examination activities.

Key words: College, History, Surgeons
A Brief History of the Chapter of Dental Surgeons
Authors: Yeo Jin-Fei
Published: February 2023

ABSTRACT When the Academy of Medicine was formed in 1957, Dr J A Jansen was as one of its dental founding members. As the membership strength of dental surgeons increases in the ensuing years, the Chapter of Dental Surgeons was officially formed within the Academy of Medicine, Singapore in 1979 with Dr Edmund Tay Mai Hiong as the first Chairman of the Dental Chapter Committee 1979-1980. Following upon the footsteps of Dr Edmund Tay, many prominent Dental Academicians from both Institutions and Private Sector had come forth to lead the Dental Chapter since then. The membership strength in the Dental chapter had grown steadily from 37 members in 1982 to the current number at 179 Fellows. Over the years, the Dental Chapter has continued to play a significant role in the continuing education of dental surgeons in general as well as influencing and contributing to the nurturing and development of dental specialties in Singapore. Key words: Chapter of Dental Surgeons, Dentistry, History
A Brief History of Pathology and the Chapter of Pathologists
Authors: Teo Cuthbert ES
Published: February 2023

Pathology was the first specialty practiced in Singapore, and celebrated its centenary 2 years ago. A brief history of the discipline and the Chapter of Pathologists are presented here. Significant milestones especially inaugural events are recounted. Key words: Biochemistry, Forensic pathology, Histopathology, History, Inaugural events, Microbiology, Pathology, Chapter of Pathologists, Singapore
A Brief History of the Chapter of Psychiatrists
Authors: Ng Beng-Yeong , Yap Hwa-Ling , Chee Kuan-Tsee
Published: February 2023

The Inaugural Meeting of the Chapter of Psychiatrists and Chapter of Pathologists, Academy of Medicine, was held on 5 December 1986 at King’s Hotel, Singapore. Though the Academy of Medicine was duly founded in 1957, the Chapter of Psychiatrists has been in existence only since 1986. Over the last 20 years, the Chapter is very much involved in organising activities, symposia and workshops for doctors and psychiatrists. In 1998, the Guidelines on the Practice of Electroconvulsive Therapy (ECT) were issued by the Academy of Medicine, Singapore. The challenges ahead of us include: membership growth and formation of College, communication with members, and close liaison with other psychiatric associations. Key words: College, Education, Electroconvulsive therapy, Research, Stigma, Training
A History of the Chapter of Public Health and Occupational Physicians
Authors: Koh David , Lee Hin-Peng
Published: February 2023

The Chapter of Public Health and Occupational Physicians was formed in 1980, 23 years after the founding of the Academy of Medicine in Singapore. From a modest beginning with 12 foundation Fellows, the Chapter has provided professional leadership and continuing education in public health and occupational medicine. It has organised numerous talks, conferences, seminars and symposia, and a very successful series of annual scientific meetings. The content of these activities reflect the concerns and developments of public health and occupational medicine in Singapore throughout the last quarter century. Fellows of the Chapter serve on national specialist training committees and on academic programme committees of both specialities. The Chapter also provides recommendations to the Academy on specialist qualification and training. With an active current membership of 100 Fellows, which is still growing, the Chapter is poised to further raise the professional standards and practice of public health and occupational medicine in Singapore. Key words: Academy of Medicine Singapore, Occupational Medicine, Public Health
The Annals: Inspection & Projection
Authors: Oh Vernon MS
Published: February 2023

The Annals of the Academy of Medicine has a short history with a steep learning graph. Five chief editors have nudged an in-house publication into a respectable general journal catering to the major specialties of Medicine. Its editors share an interest in Nature and humankind with its readership, consisting of specialists of all kinds. The Annals invests intellectual energy in the growth of biomedical knowledge and institutions in Singapore. Its editors believe that the journal’s forum for research and debate is an integral part of the infrastructure of Singapore’s biomedical science enterprise. The editors appeal to the enlarging community of bioscientists and clinician investigators to contribute more actively to the peer review of submitted articles. The rigour of peer review of new medical information reflects the quality of the experts’ skeptical thinking. This journal hopes, as a partner, to provide opportunities for authors to present their discoveries and thoughts in an exciting chapter of the nation’s history.

Key words: Clinician investigator, Medical publishing, Peer review, Research forum
Adult Living Donor Liver Transplantation in Singapore: The Asian Centre for Liver Diseases and Transplantation Experience
Authors: Jr Wilfredo T Polido , Lee Kang-Hoe , Tay Khoon-Hean , Wong Sin-Yew , Singh Ranjodh , Leong See-Odd , Tan Kai-Chah
Published: February 2023

Introduction: Living donor liver transplantation (LDLT) has progressed dramatically in Asia due to the scarcity of cadaver donors and is increasingly performed in Singapore. The authors present their experience with adult LDLT.

Materials and Methods: Adult LDLTs performed at the Asian Centre for Liver Diseases and Transplantation, Singapore from 20 April 2002 until 20 March 2006 were reviewed. All patients received right lobe grafts and were managed by the same team throughout this period. Data were obtained by chart review. This study presents both recipient and donor outcomes in a single centre.

Results: A total of 65 patients underwent LDLT. Forty-three were genetically related while 22 were from emotionally-related donors. The majority were chronic liver failure while 14% were acute. The most common indication for LDLT was end-stage liver disease due to hepatitis B virus. A total of 22 patients with hepatoma were transplanted and overall 1-year disease specific survival was 94.4%. The mean model for end-stage liver disease (MELD) score was 17.4 ± 9.4 (range, 6 to 40). Six patients had preoperative molecular adsorbent recycling system (MARS) dialysis with 83% transplant success rate. The mean follow-up was 479.2 days with a median of 356 days. One-year overall survival was 80.5%. There was 1 donor mortality and morbidity rate was 17%. Our series is in its early stage with good perioperative survival outcome with 1-month and 3-month actuarial survival rates of 95.4% and 87.3% respectively.

Conclusion: The study demonstrates that LDLT can be done safely with good results for a variety of liver diseases. However, with dynamically evolving criteria and management strategies, further studies are needed to maximise treatment outcome.

Key words: Donor and recipient outcome, End-stage liver disease, Hepatitis, Hepatocellular carcinoma, Living donor liver transplantation
Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy
Authors: Lim Kok-Ren , Ibrahim Salleh , Tan Ngian-Chye , Lim Swee-Ho , Tay Khoon-Hean
Published: February 2023

Introduction: Laparoscopic cholecystectomy for acute cholecystitis is associated with higher rate of conversion to laparotomy. The value of several factors that might influence the rate of conversion is analysed.

Materials and Methods: In a retrospective analysis of a prospective database, the medical records of patients who underwent laparoscopic cholecystectomy from May 1998 to June 2004 were reviewed. Patients who had acute cholecystitis and had undergone interval laparoscopic cholecystectomy were included in this study.

Results: Out of 1000 laparoscopic cholecystectomies, 201 were operated on for acute cholecystitis. One hundred and forty-five patients (72.3%) underwent succesful laparoscopic cholecystectomy and 56 patients (27.7%) needed conversion to open cholecystectomy. Patient’s age (P = 0.031), total white cell count (P = 0.014), total bilirubin (P = 0.002), alkaline phosphatase (P = 0.003) and presence of common bile duct stone (P = 0.001) were found to be independently associated with conversion.

Conclusion: Laparoscopic cholecystectomy can be performed safely for acute cholecystitis. Predictors of conversion will be helpful when planning the laparoscopic approach and for counselling patients preoperatively.

Key words: Acute cholecystitis, Laparoscopic cholecystectomy, Risk factors
Seroepidemiology of Varicella and the Reliability of a Self-reported History of Varicella Infection in Singapore Military Recruits
Authors: Dashraath P , Ong Eng-Seng , Lee Vernon J
Published: February 2023

Introduction: Varicella is an acute disease with significant morbidity. However, there is little knowledge on the seroepidemiology of the disease in Singapore. The objective of this study was to assess the seroprevalence of varicella zoster virus (VZV) antibodies in military recruits in Singapore and to ascertain the predictive value of a self-reported history of varicella. The latter is a possible proxy for seroprevalence, and may be used to provide efficient identification of candidates for vaccination.

Materials and Methods: From September 2000 to October 2005, 2189 servicemen were selected during their pre-enlistment medical check-up. Blood samples were obtained to determine the varicella IgG levels via enzyme-linked immunosorbent assay (ELISA). Information about the participant’s race, history of varicella and vaccination, and other clinical variables were obtained through a questionnaire.

Results: The overall prevalence of VZV seropositivity in military recruits was 76.0% (75.8% in the 16 years to 20 years age group). For the reported history, 73.7% of Chinese participants, 73.0% of Malays, and 63.6% of Indians reported having had varicella infection and/or vaccination. Overall, the sensitivity, specificity, positive and negative predictive values of a self-reported history of varicella for serologically confirmed immunity were 87.2%, 83.2%, 94.3% and 67.1% respectively.

Conclusions: The prevalence of VZV antibodies in pre-enlistees to the Singapore Armed Forces (SAF) is high. Incidence of varicella in the SAF is on the wane, indicating an increase in herd immunity against VZV. A recalled history of varicella infection was also a good predictor of serological immunity and may be used for selection for vaccination.

Key words: Antibody, Chickenpox, Cost-effective, Military, Seroprevalence, Varicella zoster virus
Adverse Hospital Outcomes Associated With the Choice of Empiric Antibiotics in Klebsiella pneumoniae Pneumonia: A Retrospective Observational Study
Authors: Loh Li-Cher , Sani Rosdara Masayuni Mohd , Samad Nor Izran Hanim Abdul , Raman Sree , Thayaparan Tarmizi , Kumar Shalini
Published: February 2023

Introduction: In Malaysia, Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalisation.

Patients and Methods: With concern over its rising microbial resistance, we explored the association of empiric antibiotics choices with the hospital outcomes of patients treated for microbial proven K. pneumoniae pneumonia in an urban-based teaching hospital.

Results: In 313 eligible cases reviewed retrospectively, hospital mortality and requirement for ventilation were 14.3% and 10.8% respectively. Empiric regimes that had in vitro resistance to at least one empiric antibiotic (n = 90) were associated with higher hospital mortality (23.3% vs. 10.8%, P = 0.004) with risk increased by about two-fold [Odds ratio (OR), 2.5; 95% confidence interval (CI), 1.3 to 4.8]. Regimes (n = 84) other than the commonly recommended “standard” regimes (a β-lactam stable antibiotic with or without a macrolide) were associated with higher ventilation rates (16.7% vs. 8.8%, P = 0.047) with similar increased risk [OR, 2.0; 95% CI, 1.0 to 4.3].

Conclusions: Our findings reiterate the clinical relevance of in vitro microbial resistance in adult K. pneumoniae pneumonia and support empiric regimes that contain β-lactam stable antibiotics.

Key words: In vitro resistance, Malaysia
Application of the McDonald MRI Criteria in Multiple Sclerosis
Authors: Chan Ling-Ling , Sitoh Yih-Yian , Chong June , See Siew-Ju , Umapathi Thirugnanam N , Lim Shih-Hui , Ong Benjamin
Published: February 2023

Introduction: The aim of this study was to assess the sensitivity of McDonald’s magnetic resonance imaging (MRI) criteria for the diagnosis of multiple sclerosis (MS) in a group of Asian patients diagnosed with clinically definite MS, based on lesion characterisation on MRI scans.

Materials and Methods: Forty-nine patients from 3 major neurological institutions were classified as having Asian- or Western-type MS based on clinical assessment. Each MRI scan was reviewed by 2 neuroradiologists for the presence and characteristics of brain and spinal lesions. The McDonald’s MRI criteria were then applied and its sensitivity evaluated.

Results: Nine patients were excluded, leaving 34 females and 6 males who were dominantly Chinese (90%), with a mean age of 36.2 years. The MRI brain and spinal findings were detailed and tabulated. Statistically significant differences (P <0.01) in MRI brain findings and sensitivity of McDonald’s MRI criteria were found between our Asian- and Western-type MS patients. The diagnostic yield of McDonald’s MRI criteria increased by 20% when we substituted a cord for a brain lesion, and applied the substitution for enhancing cord lesions as well.

Conclusion: The diagnosis is more likely to be made when using McDonald MRI criteria based on brain findings, in a patient who presents clinically with Western-type MS. The provision for substitution of “one brain for a spinal lesion” is helpful in Asian-type MS, where there is preponderance of spinal lesion load. Our findings suggest that minor modifications in the interpretation of McDonald’s MRI criteria have significant impact on the diagnosis in patients clinically presenting as Asian-type MS, with potential bearing on their subsequent management.

Key words: Asian, Brain, Spinal cord, Western
Public Trust in Primary Care Doctors, the Medical Profession and the Healthcare System among Redhill Residents in Singapore
Authors: Lee Yi-Yong , Ng Choon-Ta , Ghazalie Siti Aishah M , Ngiam Ju-Zheng , Tai Bee-Choo , Lim Meng-Kin , Hughes Kenneth
Published: February 2023

Introduction: There have been few studies on public trust in doctors and healthcare systems and this is the first in Singapore.

Materials and Methods: A cross-sectional survey was carried out in Redhill in January 2005. Citizens or Permanent Residents aged ≥18 years were randomly selected, one per household to avoid cluster bias, and 361 participated (response rate 68.7%). An interview administered questionnaire included 3 questionnaires measuring public trust: “Interpersonal Trust in Physicians Scale” for primary care doctors; “Trust in Physicians Generally Scale” for the medical profession; and “Trust in Healthcare System Scale” for the Healthcare System. Questions were answered on a Likert scale: 1. Strongly Disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly Agree. Individual transformed scores of trust (range, 0 to 100) were equally divided into 5 categories with their average being the transformed mean.

Results: Trust in primary care doctors (mean 59.7) had proportions (prevalence rates) of: very low 0.3%, low 2.5%, neutral 40.4%, high 54.0%, and very high 2.8%. Trust in the medical profession (mean
61.8) had proportions of: very low 1.0%, low 7.7%, neutral 33.7%, high 47.0%, and very high 10.5%. Trust in the healthcare system (mean 61.5) had proportions of: very low 0.5%, low 4.1%, neutral 40.0%, high 48.7%, and very high 6.7%. For areas of the healthcare system, proportions of high/very high trust were: “Healthcare Providers’ Expertise” (70.8%), “Quality of Care” (61.5%), “Patient Focus of Providers” (58.7%), “Information Supply and Communication by Care Providers” (52.3%), “Quality of Cooperation” (43.3%), and “Policies of the Healthcare System” (24.6%).

Conclusions: While low proportions had low/very low trust, the high proportions with neutral trust and the rather low level of trust in “Policies of the Healthcare System” are causes for concern.

Key words: Doctor-patient relationship, General practitioners, Physicians, Satisfaction
Clinically Compressed Digital Echocardiography: A Patient-safe Alternative to Videotape Review
Authors: Poh Kian-Keong , Yang Hong , Omar Abdul Razakjr , Yip James WL , Chan Yiong-Huak , Ling Lieng-Hsi
Published: February 2023

Introduction: Digital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.

Materials and Methods: Transthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.

Results: From an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.

Conclusions: The potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.

Key words: Clinical implications, Digital echocardiography, Patient safety, Videotape
Oral Hypoglycaemic Agents for Diabetes in Pregnancy – An Appraisal of the
Current Evidence for Oral Anti-diabetic Drug Use in Pregnancy
Authors: Ho Francis LW , Liew Choon-Fong , Cunanan Elaine C , Lee Kok-Onn
Published: February 2023

Introduction: The use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically.

Methods: Literature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy.

Results: In two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy.

Conclusions: Recent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.

Key words: Acarbose, Gestational diabetes, Glyburide, Metformin
Happenings in Histopathology – A Post-World War II Perspective
Authors: Shanmugaratnam K
Published: February 2023

There have been several important developments in the practice of histopathology since World War II; those reviewed in this lecture are grouped under 4 headings: new techniques (cytopathology, electron microscopy, immunohistochemistry and molecular pathology), organisational issues (recruitment, training and certification, subspecialties, quality control and consultations), ethical and legal issues (service costs, and the ownership and uses of biopsy tissues) and globalisation (international associations, standardised classification and nomenclature, and telepathology). Advances in the fields of molecular pathology and telepathology are expected to have the greatest impact on the practice of pathology in the next decade.

Key words: Anatomic pathology, Organisation, Globalisation, Telepathology
Demands and Challenges of Modern Medicine
Authors: Lim Pin
Published: February 2023

Modern medicine, characterised by the enormous impact of rapid advances in science and technology, has vastly enhanced the doctor’s professional capabilities and has made the practice of medicine more intellectually challenging as well as professionally satisfying. It has also made medicine more complex and demanding. In addition to having to keep pace with rapid medical advances, the doctor has to deal with 1) the issue of sorting the wheat from the chaff out of the deluge of new drugs and equipment presented to him, 2) the issue of rationing and determining priorities within the limits of finite resources, 3) the issue of appropriate response to new ethical challenges presented by the application of new technologies and 4) the issue of maintaining the human face of medicine in the context of growing presence and impact of technology. As doctors, we have the responsibility to ensure that through steadfast commitment to professionalism, through wisdom and insight we can harvest and maximise the vast potential of technology in caring for our patients. This is a challenge we must accept in the cause of our patients’ welfare, the paramount concern of our professional creed.

Key words: Opportunities, Professional response, Technology
Justification Theory of Internalism VS Externalism
Authors:   UIN Prof. K.H. Saifuddin Zuhri Purwokerto, Supriyanto Supriyanto
Published: February 2023

Claims about the truth are often still based on each person's point of view. Thus, the question arises what makes a belief true? Belief (belief) is an attitude towards a certain statement, as a relationship between the subject and the prepoisisi. There are several types of beliefs, (1) Dispositional belief, which is a preposition that we can but not accept or consider, (2) occurent belief, an acceptance of that proposition. In this study, two patterns of belief were found, namely internalist and externalism. The two stand in dichotomously different spaces. The debate between the two in contemporary epistemology appears focused on adequate explanations of epistemic justification. Internalists can provide justification for danya's beliefs by corresponding to their perspectives and views. Contrary to that, Externalism allows at least some justification factor of a belief to be outside the cognitive perspective of the agent.
Paradigm Changes in Patterns of Islamic Religious Education during the Covid-19 Pandemic
Authors:   SMP Negeri 1 Krangkeng, Indramayu, Indonesia, Darmawan Asep
Published: February 2023

This article aims to discover the new educational paradigm regarding parental participation as an aspect of student assessment in the pandemic era, especially at SMPN 1 Krangeng, Indramayu, Indonesia. The Covid-19 pandemic has significantly impacted all aspects of life, including the Islamic education system. Changes in the education system, especially in learning, are required to make changes so that students do not experience difficulties in the learning process. The Work from Home (WFH) policy, social and physical distancing, and the Teaching and Learning Activities process using an online system (online) have also enlivened the dynamics of Islamic Religious education. This article examines the learning conditions during the Covid-19 pandemic and the education challenges during the Covid-19 pandemic, especially at SMPN 1 Krangeng, Indramayu, Indonesia. This research is phenomenological research, with descriptive-analytical. The results and conclusions in this writing show that learning changes during the Covid-19 pandemic are very much needed and are a solution in education, especially in junior high schools. Technology is a medium for interacting between educators (teachers) and students in implementing online learning. In addition, technology also plays a role in facilitating educators to convey learning material so that learning continues even though it is not carried out face-to-face (offline).
The Religion of Love Ibn 'Arabi in the Perspective of PsychoHistorical Hermeneutics
Authors:   Doctoral Program UIN Prof. KH. Saifuddin Zuhri Purwokerto, Indonesia, Idrus Afifuddin , Rakhman Muhammad Zainur ,   Magister Pascasarjana UIN Walisongo Semarang, Indonesia
Published: February 2023

The religion of love is a term expressed by Ibn ‘Arabi in a unity of ideas about the concept of Wahdatul Wujud. As a node that summarizes the overall ideas of Ibn ‘Arabi about love and religion, it certainly does not just arise from empty space. There is the influence of the spirit of the era that lies behind the presence of the idea. The presence of the term 'religion of love', expressed by Ibn ‘Arabi, will not be separated from the influence of social and cultural backgrounds, the locus of the times in which Ibn‘ Arabi lived and gave birth to his thoughts. This becomes an interesting problem to study, about how the concept of the religion of love arises, and how it influences the spirit of the times that surround it. Using the psycho-historical hermeneutics approach, this paper aims to examine the concept of the religion of love, and the influence of the spirit of the times that surround it. The results of the discussion show that the context of the age of Ibn 'Arabi gave a major influence on the birth of Ibn' Arabi's view of the religion of love, namely in the aspect: the city where Ibn 'Arabi was educated, and the teachers and people whom Ibn' Arabi met along his intellectual and spiritual odyssey.
The Influence of Transparent Internal Communication on Employees' Adaptation to Firm Changes in the Context of the Covid-19 Pandemic
Authors:   University of Labour and Social Affairs, Vietnam, Hien Luc Manh , Thi Thuy Van Pham ,   University of Labour and Social Affairs, Vietnam
Published: February 2023

This study investigates the impact levels of transparent internal communication on employees' adaptation to firm changes in the context of the covid-19 pandemic. This study uses data of employees of enterprises in Hanoi City, Vietnam during 2021-2022. The data used for analysis and regression consists of 618 observations. We use Cronbach’s Alpha, EFA and regression model to learn the effect of different variables on employee uncertainty about organizational change. The results show that (i) transparent internal communication has a negative effect on the control coping strategy of employees; (ii) transparent internal communication has a positive effect on the escape strategy of employees; (iii) transparent internal communication has a negative effect on the employee uncertainty about organizational change; (iv) control coping strategy has a negative effect on employee uncertainty about organizational change; and (v) Escape Strategy has a positive effect on employee uncertainty about organizational change. Based on the findings, recommendations are given for improving the enterprises maintain a good quality of relationship with their employees.
METHODS OF INCREASING LABOR EFFICIENCY INDICATORS
Authors:   Doctoral student, Tashkent State University of Economics., SUVANOV BEKNIYOZ BAKHTIYAR UGLI
Published: February 2023

This article talks about proposals and problems for increasing labor efficiency indicators in economic entities. In the conditions of the modern market economy, the development and competitiveness of the organization directly depends on labor efficiency. The greater the labor efficiency, the more products are created per unit of time, and as a result, the total output of the enterprise increases. Therefore, increasing labor productivity is one of the most important tasks of any enterprise.
Research on differences and influencing factors of inclusive green development in Beijing-Tianjin-Hebei region
Authors: Dai Tiejun , Shi Fubin
Published: February 2023

Abstract

Inclusive green development (IGD), adhering to harmonious between human and nature, is a sustainable approach pursuing economic growth, social equity, achievement sharing and ecological environment. This study takes the Beijing-Tianjin-Hebei (BTH) region as an example. After systematically sorting out the connotation of IGD, more comprehensive resource and environmental indicators are added to build an evaluation system. The entropy weight and material flow analysis method are used to study the time series characteristics of the level of IGD in BTH from 1992 to 2021, and the differences and the influencing factors among the three places are analyzed by the Theil index. The results show that: (1) The level of IGD in BTH showed a steady upward trend. (2) The Theil index curve of BTH has undergone an inverted "U"-shaped change, and has initially reached regional coordination in recent years. (3) Issues of social life as well as resource and environment, having surpassed economic issues, become main causes of differences in BTH. (4) The gaps in indicators such as industrial structure and scale, social security, information and technology popularization, natural resources, and ecological restoration ability fluctuate greatly. The gaps in population development, information popularization and environmental governance are decreasing rapidly, while industrial structure, urbanization and natural resources are increasing rapidly, deserving more concentration.

Keywords: Inclusive green development, Beijing-Tianjin-Hebei coordination, Entropy weight method, Theil index, Obstacle analysis, Regional differences analysis.
Condition of the house physical environment on the incidence of acute respiratory infections in toddlers in Sumbawa, Indonesia
Authors:   S1 Nursing Study Program, STIKES Griya Husada Sumbawa, Sumbawa, Indonesia, Maliga Iga
Published: February 2023

Objective: The objective was to examine the relationship between the state of the home’s physical environment and the incidence of acute respiratory tract infections (ARI) in toddlers in the working area of the North Moyo Health Center in Sumbawa Regency, Indonesia. Methods: The research design employed is a case-control design with an analytic survey method and a retrospective methodology
Bullying among nursing students during clinical practice
Authors:   Nursing Study Program, STIKes Payung Negeri Pekanbaru, Riau, Indonesia, Malfasari Eka , Febtrina Rizka
Published: February 2023

Objective: Bullying behavior that occurs in the educational environment, such as insulting, giving a bad nickname, slandering, terrorizing, and others. Bullying is disturbing behavior that causes mental damage to its victims. This study aims to describe the occurrences of bullying among nursing students in Pekanbaru, Indonesia.
Effect of Yoga on Anxiety of Pregnant Women in Bali
Authors:   Faculty of Medicine and Health Science, Universitas Warmadewa, Bali, Indonesia, Kasih Permatananda Pande Ayu Naya , Asih Primatanti Putu , Litha Satyarini Puteri
Published: February 2023

Objective: Anxiety is an obscure and pervasive concern, related to feelings of uncertainty and helplessness. Anxiety can be caused by certain circumstances. One condition that can cause anxiety is pregnancy. During pregnancy, mothers will experience changes in physical and psychological. Anxiety in pregnancy will have adversely affected the physical and psychological state of the mother and fetus. Yoga is one of the recommended exercises for reducing anxiety during pregnancy. The purpose of this study was to determine the effect of yoga on anxiety levels of third-trimester pregnant women at the Bumi Sehat Foundation Clinic.
Nurses’ Turnover Intentions in Private Hospitals: A Narrative Study
Authors:   Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Novia Sabatini Monika Steffi , Dwiantoro Luky , Setiawati Dewi Nur
Published: February 2023

Objective: This study aims to analyze the problems often faced by nurses with a holistic approach to identifying the main motivations or reasons why nursing staff intends to move from the hospital where they work. Methods: This research was conducted by using a qualitative method with a narrative study approach using semi-structured interviews where one participant will be given guideline questions and 8 responsive assessments that will be given to respondents where the assessment has previously gone through the expert test stage.
Smartphone Effect Against Students Psychosocial Changes in Kebumen Regency, Central Java, Indonesia
Authors:   Universitas Muhammadiyah Gombong, Kebumen, Indonesia, Agustin Ike Mardiati , Pangestu Anton Aji
Published: February 2023

Objective: The purpose of this study was to understand the psychosocial changes in students due to smartphone use in Kebumen Regency, Central Java, Indonesia in 2021. Methods: This study was qualitative research with a phenomenological approach. The sampling technique was purposive sampling, with a total of 5 participants who used smartphones. Data analysis was conducted using qualitative analysis. Demographic data was performed descriptively. Quantitative data was obtained through dept interviews with respondents.
Implementation of nurse knowledge about handover with situation, background, assessment, and recommendation technique
Authors:   Poltekkes Kemenkes Mataram, Indonesia, . Zulkifli , Sulastien Herni
Published: February 2023

Introduction: Error due to the conveyance of handover during shift change will result in a decrease in service quality indicators, especially patient safety in a hospital. Poor communication is a contributing factor to the cause of injury. One form of nurse communication is a handover. Handover is a technique of conveying and receiving information related to the conditions of patients. Gaps in communication in the handover process were found. It is considered that around 45.5 % of the implementing nurses at the Regional General Hospital of Mataram do not maximize the form of handover implementation with the SBAR technique.
Measuring the Learning Model’s Effectiveness in the Medical Surgical Nursing course
Authors:   Doctoral Student, Educational Technology, Jakarta State University, Indonesia, Juliani Enni , . Rusmono , Winarsih Murni
Published: February 2023

Objective: Learning process activities should be carried out in a deliberate and systematic effort to achieve learning goals in the cognitive, affective, and psychomotor domains by changes in attitudes and behavior. When the learning process is well-executed, good learning objectives can be achieved. It is vital to have a good learning design to achieve a good learning process. The aim of this study was to create a detailed, methodical, and accurate description of the facts, qualities, and relationships between the phenomena being studied.