Coronavirus disease (COVID-19) and tuberculosis (TB) developed in 4 foreign workers living in dormitories in Singapore during April–May 2020. Clinical manifestations and atypical radiographic features of COVID-19 led to the diagnosis of TB through positive interferon-gamma release assay and culture results. During the COVID-19 pandemic, TB should not be overlooked.
Obstructive sleep apnea (OSA) is a highly prevalent condition worldwide. Untreated, it is associated with multiple medical complications as well as a reduced quality of life. Home sleep apnea tests are increasingly used for its diagnosis and evaluation of severity, but using total bed time rather than total sleep time may underestimate OSA severity. We aim to uncover the extent and predictors of OSA misclassification when using total bed time. A retrospective observational study was conducted using data from the sleep laboratory of the National University Hospital, Singapore, a tertiary hospital with 1200 beds. Misclassification of OSA was defined as any OSA severity that was less severe using total bed time versus total sleep time. Logistic regression was used to identify predictors of OSA misclassification. A total of 1621 patients were studied (mean age 45.6 ± 15.9 years; 73.4% male). 300 (18.5%) patients were misclassified. Risk factors for OSA misclassification included age (OR 1.02, 95% CI 1.01–1.03, P = 0.001) and body-mass index (BMI) (OR 0.97, 95% CI 0.95–0.99, P = 0.015). Risk for misclassification was significant in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2. Using total bed time rather than total sleep time to quantify OSA severity was associated with a significant risk of misclassification, particularly in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2.
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study LETTER TO THE EDITOR Dear Editor,The COVID-19 pandemic has disrupted medical education 1,2 and distressed clinicians. 3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents' experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response.We present our qualitative study, guided by a theoretical framework underpinned by empirical evidence, which explicitly explored residents' experiences of stress during the pandemic, important and modifiable underlying factors, and how this can guide prioritisation of limited resources to aid residents. Ethics approval was obtained (DSRB reference number 2020/00523).We framed our study using the Lazarus and Folkman transactional model of stress, 5 given its strong empirical foundations. In this model, stress is a relationship between the individual and the environment that is cognitively appraised as exceeding the individual's resources and threatening well-being.Cognitive appraisal comprises 2 parts. Primary appraisal determines what is at stake, i.e. whether it is irrelevant, beneficial or threatening to the individual. Commitments influence primary appraisal, with deeper commitments increasing potential threat and driving coping efforts. Secondary appraisal evaluates coping options based on availability, and ability to accomplish the intended outcome and apply them effectively. Coping is the process of managing the demands of the personenvironment relationship and the emotions generated.The study was conducted according to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist 6 and a phenomenological paradigm. Purposive sampling was employed to ensure representation across sites and levels of training. Sampling was deemed complete when thematic saturation was achieved, i.e. no new themes emerged. There were 92 EM residents in Singapore during the study period (October-November 2020); all were eligible and invited for recruitment via email. Twenty-six residents were recruited, and 4 focus group discussions (FGDs) were conducted. FGDs lasted 49-65 minutes. No residents dropped out after recruitment. Written informed consent was obtained from all participants. Participation was voluntary and none received compensation.
Point of Care Ultrasound is an increasingly popular modality in the emergency department as well as in the critical care unit. Its applications are varied, centered on its role in diagnosis, thereby minimizing the time taken for the appropriate diagnosis to be made and hence incorporate definitive treatment. There are currently no international guidelines published with regards for point of care ultrasound in the context of cardiac arrest. We propose to delineate the impact of the role of point of care ultrasound in a patient with cardiac arrest, in the evaluation of the cause, its prognostic role, as well as possible implications for therapies based on a case report.
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