Profiles of women presenting for abortions in Singapore at the National University Hospital: focus on married women

INTRODUCTION@#In this study, we aimed to identify the differences in sociodemographic variables and reasons for termination of pregnancy (TOP) between married women and single/divorced women. We hope that this study can guide future policies and interventions to reduce the incidence of unsupported pregnancies in this profile group of women.@*METHODS@#We retrospectively evaluated the sociodemographic data of 802 women who underwent an abortion for social reasons at our institution in Singapore from January 2016 to September 2018. We compared the sociodemographic variables, reasons for and methods of TOP between married and single/divorced women.@*RESULTS@#We analysed data from 524 married women (65.3%) and 278 single/divorced women (34.7%). Married women were more likely to be of older age (29.5 years vs. 24.5 years, P < 0.001), had more living children and higher educational qualifications. The top two cited reason for abortions among married women were having enough children (42.0%) and the inability to afford another child (18.7%). Multivariate analysis showed that women aged >19 years and having more living children were independently associated with recurrent TOPs. Having a tertiary education was noted to be associated with less recurrent TOPs.@*CONCLUSION@#The most common reasons married women cited for having TOP include having enough children and the lack of financial capacity to afford another child. Recommendations to support women ought to be personalised and comprehensive in addressing their needs rather than offering a standardised support method. Greater emphasis should be placed on post-TOP family planning counselling to reduce repeated TOP.

Understanding cannabis use in Singapore: profile of users and drug progression

INTRODUCTION@#Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression.@*METHODS@#A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted.@*RESULTS@#The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug.@*CONCLUSION@#In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.

Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore

INTRODUCTION@#Studies of concordance between patients' self-report of diseases and a criterion standard (e.g. chart review) are usually conducted in epidemiological studies to evaluate the agreement of self-reported data for use in public health research. To our knowledge, there are no published studies on concordance for highly prevalent chronic diseases such as diabetes and pre-diabetes. The aims of this study were to evaluate the concordance between patients' self-report and their medical records of diabetes and pre-diabetes diagnoses, and to identify factors associated with diabetes concordance.@*METHOD@#A cross-sectional, interviewer-administered survey was conducted on patients with chronic diseases after obtaining written consent to assess their medical notes. Interviewers were blinded to the participants' profiles. Concordance was evaluated using Cohen's kappa (κ). A multivariable logistic regression model was used to identify factors associated with diabetes concordance.@*RESULTS@#There was substantial agreement between self-reported and medical records of diabetes diagnoses (κ=0.76) and fair agreement for pre-diabetes diagnoses (κ=0.36). The logistic regression model suggested that non-Chinese patients had higher odds of diabetes concordance than Chinese patients (odds ratio [OR]=4.10, 95% confidence interval [CI] 1.19-14.13, P=0.03). Patients with 3 or more chronic diseases (i.e. multimorbidity) had lower odds of diabetes concordance than patients without multimorbidity (OR=0.21, 95% CI 0.09-0.48, P<0.001).@*CONCLUSION@#Diabetes concordance was substantial, supporting the use of self-report of diabetes by patients with chronic diseases in the primary care setting for future research. Pre-diabetes concordance was fair and may have important clinical implications. Further studies to explore and improve health literacy and patient-physician communication are needed.

Frailty prevalence and its associations in a subacute geriatric ward in Singapore

INTRODUCTION@#Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward.@*METHODS@#This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected.@*RESULTS@#The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021).@*CONCLUSION@#Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions.

Prevalence of burnout among healthcare professionals in Singapore

INTRODUCTION@#The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore.@*METHODS@#An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore.@*RESULTS@#The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005).@*CONCLUSION@#There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.

Epidemiological trends and outcomes of children with aural foreign bodies in Singapore

INTRODUCTION@#Aural foreign bodies (FBs) are a common presenting complaint in emergency departments (EDs) worldwide. This study aims to describe trends and outcomes of aural FBs in the paediatric population, presenting to a tertiary hospital in Singapore.@*METHODS@#A retrospective review of medical records was conducted of all children 0-16 years old with aural FBs who presented to KK Women's and Children's Hospital ED from 2013 to 2017. Clinical data that were collected include patient demographics, type of FB, ear compartment and laterality of FB, symptoms, duration of impaction, mode of removal, outcome in ED, and final disposition.@*RESULTS@#There were a total of 1,003 cases. The largest age group consisted of 53.7% preschool children of 0-6 years. Males (61.7%) were more common than females (38.3%). FBs were predominantly organic materials (25.6%), followed by beads and stones (15.2%). Most FBs were found in the right ear (56.6%). The majority of patients were asymptomatic (62%). Symptoms observed included ear pain (20.1%), itch (4.8%) and bleeding (3.2%). FBs were removed by instruments (36.6%), suctioning (15.4%), syringing (8.2%), or a combination of methods (13.7%). In the ED, 73.9% of patients had an attempt at removal, among which 78.4% of FBs were successfully removed, 5.9% required specialist review, and 15.7% were unsuccessful.@*CONCLUSION@#The majority of paediatric aural FBs can be successfully removed in the ED. Emergency physicians should be trained and equipped with the relevant skills to remove aural FBs.

Inter-hospital trends of post-resuscitation interventions and outcomes of out-of-hospital cardiac arrest in Singapore

INTRODUCTION@#Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated post-resuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period.@*METHODS@#This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome.@*RESULTS@#The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO (P<0.001) in hospitals, and a positive trend of survival outcomes (P<0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P<0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P<0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status.@*CONCLUSION@#Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.

Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore

INTRODUCTION@#To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations.@*METHODS@#This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020.@*RESULTS@#Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25-35.99; 6.30, 95% CI 1.15-34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively.@*CONCLUSION@#The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease.

Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore

INTRODUCTION@#The COVID-19 pandemic has affected almost all populations, with frontline workers experiencing a higher risk of mental health effects compared to other groups. Although there are several research studies focusing on the mental health effects of the pandemic on healthcare workers, there is little research about its impact on workers in outsourced hospital essential services. This study aims to examine the prevalence and correlates of psychological distress and coronavirus anxiety among staff working in 3 outsourced hospital essential services-housekeeping, porter service and maintenance services.@*METHODS@#A cross-sectional study was conducted among outsourced hospital essential services workers in a tertiary hospital. Data on demographics, medical history, lifestyle factors, psychosocial factors and mental well-being were collected using self-administered questionnaires. Robust logistic regression was used to determine risk factors associated with psychological distress and dysfunctional anxiety related to COVID-19.@*RESULTS@#A total of 246 hospital essential services workers participated in the study. The prevalence of psychological distress was 24.7%, and dysfunctional anxiety related to COVID-19 was 13.4%. Social support and workplace support were found to be independently associated with a lower risk of psychological distress, and social connectivity was associated with a lower risk of dysfunctional anxiety related to COVID-19.@*CONCLUSION@#These findings highlight the crucial roles of communities and workplaces in combating the mental health consequences of the pandemic. Public health programmes that aim to tackle the emerging mental health crisis in hospital essential services workers should incorporate strategies to address psychosocial factors, in addition to traditional self-care approaches.

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

INTRODUCTION@#Infant gastroesophageal reflux disease (GERD) is a significant cause of concern to parents. This study seeks to describe GERD prevalence in infants, evaluate possible risk factors and assess common beliefs influencing management of GERD among Asian parents.@*METHODS@#Mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort were prospectively followed from preconception to 12 months post-delivery. GERD diagnosis was ascertained through the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) administered at 4 time points during infancy. Data on parental perceptions and lifestyle modifications were also collected.@*RESULTS@#The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. Infants exclusively breastfed at 3 weeks of life had reduced odds of GERD by 1 year (adjusted odds ratio 0.43, 95% confidence interval 0.19-0.97, P=0.04). Elimination of "cold or heaty food" and "gas producing" vegetables, massaging the infant's abdomen and application of medicated oil to the infant's abdomen were quoted as major lifestyle modifications in response to GERD symptoms.@*CONCLUSION@#Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. Infants exclusively breastfed at 3 weeks had reduced odds of GERD. Cultural-based changes such as elimination of "heaty or cold" food influence parental perceptions in GERD, which are unique to the Asian population. Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD.

Health economics of kidney replacement therapy in Singapore: Taking stock and looking ahead

The prevalence of end-stage kidney disease (ESKD) in Singapore remains high and continues to rise. We continue to face major challenges in containing the rising incidence of ESKD and providing sustainable kidney replacement therapy. Our cost projections provide an insight into the present and future, urging a call to action to augment existing initiatives to address the emergent issues.

The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative

INTRODUCTION@#Proton pump inhibitors (PPIs) are effective treatments for upper gastrointestinal pathologies and short-term courses are well-tolerated. However, indiscriminate use of PPIs is undesirable due to its potential harms. We implemented a series of deprescribing interventions between 2016 and 2017 to curb PPI overutilisation in our institution. The aim of this study was to evaluate the effectiveness and safety of these interventions.@*METHODS@#An institutional PPI deprescribing guide was disseminated by email and educational roadshows were conducted to prescribers. Interrupted time series analysis was used to evaluate the effectiveness of the deprescribing interventions over a 7-year period from 2013 to 2019. To ascertain the safety of PPI deprescribing, we analysed the peptic ulcer disease incidence from 2015 to 2018 and conducted a retrospective chart review of 262 inpatients who were deprescribed PPIs.@*RESULTS@#Following the first intervention, there was a significant decrease in mean oral PPI utilisation by 2,324.46 defined daily doses (DDD) per 1,000 prescriptions (95% confidence interval [CI] -3,542.66, -1,106.26) per month, followed by a month-to-month decrease of 302.61 DDD per 1,000 prescriptions per month thereafter (95% CI -473.95, -131.27). A second targeted educational intervention was only effective in sustaining the decline in the outpatient, but not in the inpatient setting. There were no significant changes in incidence of peptic ulcer disease. In the retrospective chart review, a majority (62.6%) of patients remained deprescribed at 6 months.@*CONCLUSION@#We observed a sustained decrease in PPI utilisation in our institution for more than 12 months following our educational interventions. Cautious deprescribing of PPIs in eligible candidates was found to be safe with low recurrence rates of upper gastrointestinal events.

Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016

INTRODUCTION@#Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016.@*METHODS@#We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses.@*RESULTS@#The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status.@*CONCLUSION@#The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.

Vulnerability to rumours during the COVID-19 pandemic in Singapore

INTRODUCTION@#Amid the COVID-19 pandemic, many rumours have emerged. Given prior research linking rumour exposure to mental well-being, we conducted a nationwide survey to document the base rate of rumour exposure and factors associated with rumour vulnerability.@*METHODS@#Between March and July 2020, 1,237 participants were surveyed on 5 widely disseminated COVID-19 rumours (drinking water frequently could be preventive, eating garlic could be preventive, the outbreak arose because of bat soup consumption, the virus was created in an American lab, and the virus was created in a Chinese lab). For each rumour, participants reported whether they had heard, shared or believed each rumour.@*RESULTS@#Although most participants had been exposed to COVID-19 rumours, few shared or believed these. Sharing behaviours sometimes occurred in the absence of belief; however, education emerged as a protective factor for both sharing and belief.@*CONCLUSION@#Our results suggest that campaigns targeting skills associated with higher education (e.g. epistemology) may prove more effective than counter-rumour messages.

Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore

INTRODUCTION@#As part of infection control measures for COVID-19, individuals have been encouraged to adopt both preventive (such as handwashing) and avoidant behavioural changes (e.g. avoiding crowds). In this study, we examined whether demographics predicted the likelihood that a person would adopt these behaviours in Singapore.@*METHODS@#A total of 1,145 participants responded to an online survey conducted between 7 March and 21 April 2020. We collected demographic information and asked participants to report which of 17 behaviour changes they had undertaken because of the COVID-19 outbreak. Regression analyses were performed to predict the number of behavioural changes (preventive, avoidant, and total) as a function of demographics. Finally, we sought to identify predictors of persons who declared that they had not undertaken any of these measures following the outbreak.@*RESULTS@#Most participants (97%) reported at least one behavioural change on account of the pandemic, with changes increasing with the number of local COVID-19 cases (@*CONCLUSION@#Our characterisation of behavioural changes provides a baseline for public health advisories. Moving forward, health authorities can focus their efforts on encouraging segments of the population who do not readily adopt infection control measures against COVID-19.

Psychosocial impact of the COVID-19 pandemic on paediatric healthcare workers

INTRODUCTION@#Frontline healthcare workers (HCWs) exposed to coronavirus disease 2019 (COVID-19) are at risk of psychological distress. This study evaluates the psychological impact of COVID-19 pandemic on HCWs in a national paediatric referral centre.@*METHODS@#This was a survey-based study that collected demographic, work environment and mental health data from paediatric HCWs in the emergency, intensive care and infectious disease units. Psychological impact was measured using the Depression, Anxiety, Stress Scale-21. Multivariate regression analysis was performed to identify risk factors associated with psychological distress.@*RESULTS@#The survey achieved a response rate of 93.9% (430 of 458). Of the 430 respondents, symptoms of depression, anxiety and stress were reported in 168 (39.1%), 205 (47.7%) and 106 (24.7%), respectively. Depression was reported in the mild (47, 10.9%), moderate (76, 17.7%), severe (23, 5.3%) and extremely severe (22, 5.1%) categories. Anxiety (205, 47.7%) and stress (106, 24.7%) were reported in the mild category only. Collectively, regression analysis identified female sex, a perceived lack of choice in work scope/environment, lack of protection from COVID-19, lack of access to physical activities and rest, the need to perform additional tasks, and the experience of stigma from the community as risk factors for poor psychological outcome.@*CONCLUSION@#A high prevalence of depression, anxiety and stress was reported among frontline paediatric HCWs during the COVID-19 pandemic. Personal psychoneuroimmunity and organisational prevention measures can be implemented to lessen psychiatric symptoms. At the national level, involving mental health professionals to plan and coordinate psychological intervention for the country should be considered.

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

INTRODUCTION@#We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore.@*METHODS@#Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004).@*RESULTS@#Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020.@*CONCLUSION@#Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.

COVID-19 in Singapore - a case series from primary care

As the COVID-19 pandemic worsens, early case detection is vital to limiting community spread. We describe our experiences with four COVID-19 cases at the polyclinics in January and February 2020. This retrospective case series highlights the challenges primary care clinicians face in the early identification of suspect cases based on clinical criteria only. To improve case detection, clinicians can sharpen their clinical acumen by keeping abreast with the latest COVID-19 developments and by maintaining a high state of vigilance.

Safety and side effect profile of Pfizer-BioNTech COVID-19 vaccination among healthcare workers: A tertiary hospital experience in Singapore

INTRODUCTION@#Vaccination remains a key strategy to living endemically with COVID-19. The Pfizer-BioNTech COVID-19 vaccine was first granted interim authorisation for use in Singapore in December 2020. With overseas studies published about the safety and side effect profiles of mRNA COVID-19 vaccines focusing mainly on non-Asian populations, we described the side effects of Pfizer-BioNTech COVID-19 vaccination experienced by the healthcare workers (HCWs) in a tertiary hospital in Singapore.@*METHODS@#Data were obtained from the Occupational Health Clinic (OHC) at the National University Hospital in Singapore, which monitored staff for any adverse effects within 30 minutes post vaccination on-site and any adverse effects after that. A cross-sectional study among the vaccinated HCWs was conducted using an online survey, which established basic demographics, histories of allergies or atopic disorders, and adverse events encountered after dose 1 and dose 2 of vaccination.@*RESULTS@#No anaphylaxis was reported. Most common symptom was giddiness (32.7%) experienced by HCWs within 30 minutes. Adverse events attended post-vaccination by OHC were generally mild and self-limiting. From the survey, odds of experiencing an adverse event after dose 2 was significantly higher than after the first dose, especially for fever/chills (odds ratio [OR] 22.5). Fever/chills, injection site reactions, headache, aches and pains, and feeling unwell were significantly more common in HCWs below 60 years compared to those ≥60 years. An allergy to food (adjusted OR 2.7) and a history of eczema/sensitive skin (adjusted OR 2.6) were associated with a skin reaction not at injection site.@*CONCLUSION@#The side effects experienced after Pfizer-BioNTech COVID-19 vaccines are generally self-limiting and mild, with no anaphylaxis reported.

Learning during the pandemic: Perspectives of medical students in Singapore

The COVID-19 pandemic has significantly disrupted medical education, particularly affecting clinical-year students. Educational institutions often had to halt, shorten or impose significant restrictions on their hospital rotations due to strict infection control and social-distancing guidelines implemented in tertiary healthcare institutions, as well as manpower and logistical constraints amid the pandemic. Thus, distance-based learning platforms such as online lectures and case-based teaching were increasingly adopted in place of bedside and face-to-face tutorials. While interactive virtual case-based discussions are generally useful in imparting clinical reasoning skills to medical students, they are unfortunately not able to fully replicate the experience of clerking, examining and managing real patients in the wards, which is a quintessential process towards building clinical acumen and attaining core clinical competencies. Therefore, for final year medical students who are preparing for their Bachelor of Medicine and Bachelor of Surgery (MBBS) examinations, many are naturally concerned by how learning in this "new normal" may affect their ability to make the transition to become competent junior doctors. As such, we seek to share our learning experiences as the first batch of medical students to have completed our entire final year of clinical education amid the COVID-19 pandemic, and offer 4 practical suggestions to future batches of students on how to adapt and optimise clinical learning under these circumstances: actively engaging in virtual learning, making the most of every clinical encounter, learning how to construct peer teaching/practice sessions, and maintaining physical and psychological well-being.