Objective: To explore and evaluate the most common factors causing therapeutic noncompliance. Methods: A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results: A total of 102 articles was retrieved and used in the review from the 2095 articles identifi ed by the literature review process. From the literature review, it would appear that the defi nition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion: There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as "soft" and "hard" factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.

This study aimed to test these hypotheses: cystathionine ␥-lyase (CSE) is expressed in a human artery, it generates hydrogen sulfide (H 2 S), and H 2 S relaxes a human artery. H 2 S is produced endogenously in rat arteries from cysteine by CSE. Endogenously produced H 2 S dilates rat resistance arteries. Although CSE is expressed in rat arteries, its presence in human blood vessels has not been described. In this study, we showed that both CSE mRNA, determined by reverse transcription-polymerase chain reaction, and CSE protein, determined by Western blotting, apparently occur in the human internal mammary artery (internal thoracic artery). Artery homogenates converted cysteine to H 2 S, and the H 2 S production was inhibited by DL-propargylglycine, an inhibitor of CSE. We also showed that H 2 S relaxes phenylephrine-precontracted human internal mammary artery at higher concentrations but produces contraction at low concentrations. The latter contractions are stronger in acetylcholine-prerelaxed arteries, suggesting inhibition of nitric oxide action. The relaxation is partially blocked by glibenclamide, an inhibitor of K ATP channels. The present results indicate that CSE protein is expressed in human arteries, that human arteries synthesize H 2 S, and that higher concentrations of H 2 S relax human arteries, in part by opening K ATP channels. Low concentrations of H 2 S contract the human internal mammary artery, possibly by reacting with nitric oxide to form an inactive nitrosothiol. The possibility that CSE, and the H 2 S it generates, together play a physiological role in regulating the diameter of arteries in humans, as has been demonstrated in rats, should be considered.

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The second edition of the MOH clinical practice guidelines on hypertension for Singapore was published in 2005. Since then, more facts about this important condition have emerged, particularly those recommending home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) as key procedures in diagnosing suspected hypertension. Target groupThe main aim of these guidelines is to help physicians make sound clinical decisions about hypertension by presenting up-to-date information about diagnosis, classification, treatment, outcomes and follow-up. These guidelines are developed for all healthcare professionals in Singapore. Guideline developmentThese guidelines have been produced by an MOH-appointed committee of cardiologists, internists, general medicine practitioners, renal physicians, family physicians, and a neurologist. They were developed by adaptation of existing guidelines, critical review of relevant literature and expert clinical consensus taking local practice into consideration. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or his guardian or carer. Review of guidelinesEvidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review five years after publication, or earlier if new evidence appears that requires substantive changes to the recommendations. EXECUTIVE SUMMARY OF RECOMMENDATIONS IntroductionThis is the executive summary of the MOH Clinical Practice Guidelines (CPG) on Hypertension. It is intended to be used with reference to the full version of the CPG, which is freely available on the MOH website at this link: https://www.moh.gov.sg/ content/moh_web/healthprofessionalsportal/doctors/guidelines/ cpg_medical.html.Hypertension is the leading associated risk factor for cardiovascular disease. It is prevalent and increasing in many developing and developed countries. The Singapore National Health Survey (NHS) 2010 showed that the crude prevalence of hypertension (defined as BP of ≥ 140/90 mmHg) among Singapore residents aged 30 to 69 years was 23.5%, compared to 24.9% in 2004 and 27.3% in 1998. However, the age-specific prevalence for hypertension rises markedly from age 40 years onward and, with our ageing population, we continue to face challenges in the prevention and control of hypertension. Target audienceThese guidelines are developed for all healthcare professionals in Singapore as an evidence-based resource to provide up-to date information and guidance on diagnosis, classification, treatment, outcomes and follow-up. CMEArticle Ministry of Health Clinical Practice Guidelines: HypertensionJam Chin Tay, Ashish Anil Sule, Daniel Chew, Jeannie Tey, Titus Lau, Simon Lee, Sze Haur Lee, Choon Kit Leong, Soo Teik L...

Closure of medical schools or the barring of “live patient” contact during an epidemic or pandemic is potentially disruptive to medical education. During the SARS epidemic, the use of web-based learning, role play, video vignettes and both live and mannequin-based simulated patients minimised disruptions to medical education. This article examines the pedagogical innovations that allow clinical teaching to continue without medical students examining actual patients, and proposes a contingency plan in the event of future outbreaks that may necessitate similar containment measures. Key words: Infection control, Medical education, Pandemic, Strategies