Pro/con debate: In patients who are potential candidates for organ donation after cardiac death, starting medications and/or interventions for the sole purpose of making the organs more viable is an acceptable practice

Several hospitals have been developing programmes for organ donation after cardiac death. Such programmes offer options for organ donation to patients who do not meet brain-death criteria but wish to donate their organs after withdrawal of life-support. These programmes also increase the available organ pool at a time when demand exceeds supply. Given that potential donors are managed in intensive care units, intensivists will be key components of these programmes. Donation after cardiac death clearly carries a number of important ethical issues with it. In the present issue of Critical Care two established groups debate the ethical acceptability of using medications/interventions in potential organ donors for the sole purpose of making the organs more viable. Such debates will be an increasingly common component of intensivists' future practice

Lung cancer in Chinese women: Evidence for an interaction between tobacco smoking and exposure to inhalants in the indoor environment

10.1289/ehp.0901587Environmental Health Perspectives11891257-126

How residents and interns utilise and perceive the personal digital assistant and UpToDate

<p>Abstract</p> <p>Background</p> <p>In this era of evidence-based medicine, doctors are increasingly using information technology to acquire medical knowledge. This study evaluates how residents and interns utilise and perceive the personal digital assistant (PDA) and the online resource UpToDate.</p> <p>Methods</p> <p>This is a questionnaire survey of all residents and interns in a tertiary teaching hospital.</p> <p>Results</p> <p>Out of 168 doctors, 134 (79.8%) responded to the questionnaire. Only 54 doctors (40.3%) owned a PDA. Although these owners perceived that the PDA was most useful for providing drug information, followed by medical references, scheduling and medical calculators, the majority of them did not actually have medical software applications downloaded on their PDAs. The greatest concerns highlighted for the PDA were the fear of loss and breakage, and the preference for working with desktop computers and paper. Meanwhile, only 76 doctors (56.7%) used UpToDate, even though the hospital had an institutional subscription for it. Although 93.4% of these users would recommend UpToDate to a colleague, only 57.9% stated that the use of UpToDate had led to a change in their management of patients.</p> <p>Conclusion</p> <p>Although UpToDate and various PDA software applications were deemed useful by some of the residents and interns in our study, both digital tools were under-utilised. More should be done to facilitate the use of medical software applications on PDAs, to promote awareness of tools for evidence-based medicine such as UpToDate, and to facilitate the application of evidence-based medicine in daily clinical practice.</p

Management of severe community acquired pneumonia in the emergency department

10.21037/jeccm.2017.12.12Journal of Emergency and Critical Care Medicine22021-02-0

Living with the virus: Singapore’s 2021 endemic strategy in the COVID-19 pandemic

SMU Faculty/Staff can download the case and teaching note with your SMU login ID and Password via the following links: The Case (SMU-22-0019) Teaching Note (SMU-22-0019TN) For purchase of the case and supplementary materials via The CMP Shop, please access the following link: The Case (SMU-22-0019) For purchase of the case and supplementary materials via The Case Centre, please access the following links: The Case (SMU-22-0019) Teaching Note (SMU-22-0019TN) For purchase of the case and supplementary materials via Harvard Business Publishing, please access the following links: The Case (SMU-22-0019) Teaching Note (SMU-22-0019TN) </ul

Diagnosing pulmonary tuberculosis by pooling induced sputum

Introduction: Early diagnosis and treatment of pulmonary tuberculosis (PTB) remains fundamental in reducing transmissions and death. Sputum induction is recommended for the diagnosis of pulmonary tuberculosis (PTB) in patients who are unable to expectorate or smear negative. Objective: The aim of this study was to evaluate the diagnostic accuracy of pooling two induced sputum specimens into one microbiological test over a single day for the diagnosis of PTB. Methods: We prospectively enrolled consecutive hospitalized adults with suspected PTB from 2009–2016. Two induced sputum specimens were obtained on the same day and pooled together for AFB smear, culture and Xpert MTB/RIF testing. The final diagnosis of PTB was based on a positive culture from any respiratory specimen. All patients were followed up for 3 months. Results: Of 420 patients, 86(20.5%) were diagnosed with PTB based on a positive respiratory culture. The sensitivity, specificity, positive and negative predictive values for pooled induced sputum were 98.8% (CI 93.7–100%), 100% (CI 98.9–100%) and 100% (94.6–100%) and 99.7% (CI 98.1–100%) respectively. Xpert MTB/RIF in pooled induced sputum was positive in 88.4% of the PTB patients. Conclusion: In the diagnosis of PTB, testing two induced sputum specimens which were pooled together for one microbiological testing process may be comparable to repeat testing. Keywords: Detection, Reduce transmissions, Smear negative, Induced sputu