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Article ; Online: Streamlining curriculum delivery within the regulatory framework during the COVID-19 pandemic: a medical school experience.

Hwang, Kai Yin / Ti, Lian Kah / Hwang, Nian Chih / Loh, May-Han

2023

Language	English
Publishing date	2023-10-03
Publishing country	India
Document type	Letter
ZDB-ID	604319-7
ISSN	2737-5935 ; 0037-5675
ISSN (online)	2737-5935
ISSN	0037-5675
DOI	10.4103/singaporemedj.SMJ-2021-421
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Article ; Online: The hospital difficult airway team: experience and implications for patient care.

Lean, Lyn Li / Chin, Benjamin Zhao Bin / Koh, Li Ying / Loh, Ne-Hooi Will / Loh, May-Han

Irish journal of medical science

2021 Volume 190, Issue 4, Page(s) 1561–1563

Abstract: The difficult airway involves the complex interaction between patient factors, the clinical setting and the practitioner's skills (Apfelbaum in Anesthesiology 118(2):251-70, 2013 and Mark et al. in Anesth Analg 121(1):127-139, 2015). It can also be a ... ...

Abstract	The difficult airway involves the complex interaction between patient factors, the clinical setting and the practitioner's skills (Apfelbaum in Anesthesiology 118(2):251-70, 2013 and Mark et al. in Anesth Analg 121(1):127-139, 2015). It can also be a result of preparedness and system failures. Our institution developed a protocol to enhance emergency airway management in settings outside of the operating theatre-the difficult airway (DA) team. The aims of this report are to perform a retrospective review to describe the patient profiles as well as our difficult airway code workflow, and to identify preliminary patterns within DAC activations over an 18-month period (September 2013 to November 2015) in a tertiary university hospital. We believe that these findings may aid institutions in establishing a difficult airway protocol or refining existing airway code workflows. Institutional board approval was granted for medical record review.
MeSH term(s)	Airway Management ; Emergency Service, Hospital ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Patient Care ; Retrospective Studies ; Tertiary Care Centers
Language	English
Publishing date	2021-01-22
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-020-02471-5
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Article: Labour epidural practice in a tertiary training centre.

Ashokka, Balakrishnan / Arora, Deepika / Niranjan Kumar, Shrividya / Chin, Rachel / Kannan, Rajesh / Ng, Bryan / Loh, May Han

Annals of the Academy of Medicine, Singapore

2022 Volume 51, Issue 1, Page(s) 49–52

MeSH term(s)	Analgesia, Epidural ; Female ; Humans ; Labor, Obstetric ; Pregnancy
Language	English
Publishing date	2022-01-29
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
DOI	10.47102/annals-acadmedsg.2021421
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Article ; Online: Use of GoPro point-of-view camera in intubation simulation-A randomized controlled trial.

Koh, Wenjun / Khoo, Deborah / Pan, Ling Te Terry / Lean, Lyn Li / Loh, May-Han / Chua, Tze Yuh Vanessa / Ti, Lian Kah

PloS one

2020 Volume 15, Issue 12, Page(s) e0243217

Abstract: Introduction: Teaching endotracheal intubation is uniquely challenging due to its technical, high-stakes, and highly time-sensitive nature. The GoPro is a small, lightweight, high-resolution action camera with a wide-angle field of view that can ... ...

Abstract	Introduction: Teaching endotracheal intubation is uniquely challenging due to its technical, high-stakes, and highly time-sensitive nature. The GoPro is a small, lightweight, high-resolution action camera with a wide-angle field of view that can encompass both the airway as well as the procedurist's hands and positioning technique when worn with a head mount. We aimed to evaluate its effectiveness in improving intubation teaching for novice learners in a simulated setting, via a two-arm, parallel group, randomized controlled superiority trial with 1:1 allocation ratio. Methods: We recruited Year 4 medical students at the start of their compulsory 2-week Anesthesia posting. Participants underwent a standardized intubation curriculum and a formative assessment, then randomized to receive GoPro or non-GoPro led feedback. After a span of three months, participants were re-assessed in a summative assessment by blinded accessors. Participants were also surveyed on their learning experience for a qualitative thematic perspective. The primary outcomes were successful intubation and successful first-pass intubation. Results: Seventy-one participants were recruited with no dropouts, and all were included in the analysis. 36 participants received GoPro led feedback, and 35 participants received non-GoPro led feedback. All participants successfully intubated the manikin. No statistically significant differences were found between the GoPro group and the non-GoPro group at summative assessment (85.3% vs 90.0%, p = 0.572). Almost all participants surveyed found the GoPro effective for their learning (98.5%). Common themes in the qualitative analysis were: the ability for an improved assessment, greater identification of small details that would otherwise be missed, and usefulness of the unique point-of-view footage in improving understanding. Conclusions: The GoPro is a promising tool for simulation-based intubation teaching. There are considerations in its implementation to maximize the learning experience and yield from GoPro led feedback and training.
MeSH term(s)	Anesthesiology/education ; Clinical Competence ; Computer Simulation ; Computer-Assisted Instruction/methods ; Curriculum ; Education, Medical, Undergraduate/methods ; Feedback ; Female ; Humans ; Intubation, Intratracheal/methods ; Male ; Photography/instrumentation ; Problem-Based Learning/methods ; Singapore ; Students, Medical ; Young Adult
Language	English
Publishing date	2020-12-01
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0243217
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Article ; Online: Inadvertent spinal injection of ondansetron.

Loh, May-Han / Lean, Lyn Li / Ng, Bryan Su Wei / Loh, Will Ne-Hooi

Journal of anesthesia

2016 Volume 30, Issue 6, Page(s) 1071–1073

Abstract: Cesarean sections under spinal anesthesia are now a daily occurrence in most tertiary hospitals. We report the first published case of inadvertent spinal injection of ondansetron without any neurological sequelae in a patient undergoing elective Cesarean ...

Abstract	Cesarean sections under spinal anesthesia are now a daily occurrence in most tertiary hospitals. We report the first published case of inadvertent spinal injection of ondansetron without any neurological sequelae in a patient undergoing elective Cesarean section under spinal anesthesia. She did not experience any permanent neurological sequelae, and also did not exhibit any central neuraxial opioid side effects-nausea, vomiting or pruritus. Vigilance is essential to reduce the risk of wrong route delivery of drugs, especially when presented in very similar-looking 2 mL ampules as in our institution.
MeSH term(s)	Adult ; Analgesics, Opioid/administration & dosage ; Anesthesia, Spinal/methods ; Cesarean Section/methods ; Female ; Humans ; Injections, Spinal ; Ondansetron/administration & dosage ; Ondansetron/adverse effects ; Pregnancy
Chemical Substances	Analgesics, Opioid ; Ondansetron (4AF302ESOS)
Language	English
Publishing date	2016-09-27
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	1107821-2
ISSN	1438-8359 ; 0913-8668
ISSN (online)	1438-8359
ISSN	0913-8668
DOI	10.1007/s00540-016-2254-6
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Article ; Online: Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel.

Ashokka, Balakrishnan / Loh, May-Han / Tan, Cher Heng / Su, Lin Lin / Young, Barnaby Edward / Lye, David Chien / Biswas, Arijit / Illanes, Sebastian E / Choolani, Mahesh

American journal of obstetrics and gynecology

2020 Volume 223, Issue 1, Page(s) 66–74.e3

Abstract: Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as ... ...

Abstract	Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO
MeSH term(s)	Acute Disease ; Algorithms ; Anesthesia ; Betacoronavirus ; COVID-19 ; Cesarean Section ; Coronavirus Infections/diagnosis ; Coronavirus Infections/prevention & control ; Diagnosis, Differential ; Female ; Health Personnel ; Humans ; Infant, Newborn ; Infection Control ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Labor, Obstetric ; Obstetrics/methods ; Pandemics/prevention & control ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/prevention & control ; Pregnancy ; Pregnancy Complications, Infectious/virology ; Radiography, Thoracic ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2020.04.005
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Article: Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel

Ashokka, Balakrishnan / Loh, May-Han / Tan, Cher Heng / Su, Lin Lin / Young, Barnaby Edward / Lye, David Chien / Biswas, Arijit / Illanes, Sebastian E / Choolani, Mahesh

Am J Obstet Gynecol

Abstract	Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #47913
Database	COVID19

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Article ; Online: Rapid initiation of fetal therapy services with a system of learner-centred training under proctorship: the National University Hospital (Singapore) experience.

Gosavi, Arundhati / Vijayakumar, Pradip D / Ng, Bryan Sw / Loh, May-Han / Tan, Lay Geok / Johana, Nuryanti / Tan, Yi Wan / Sandikin, Dedy / Su, Lin Lin / Wataganara, Tuangsit / Biswas, Arijit / Choolani, Mahesh A / Mattar, Citra Nz

Singapore medical journal

2016 Volume 58, Issue 6, Page(s) 311–320

Abstract: Introduction: Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using ...

Abstract	Introduction: Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units. Methods: Five pregnancies with fetal complications were identified for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision. Results: All co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise. Discussion: Proctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefit other small units committed to providing these services.
MeSH term(s)	Catheter Ablation/methods ; Education, Medical, Continuing/methods ; Education, Medical, Continuing/organization & administration ; Female ; Fetal Therapies ; Fetofetal Transfusion/therapy ; Fetoscopy/education ; Hospitals, University/organization & administration ; Humans ; Laser Therapy/methods ; Pregnancy ; Pregnancy, Twin ; Singapore
Language	English
Publishing date	2016-07-21
Publishing country	India
Document type	Journal Article
ZDB-ID	604319-7
ISSN	2737-5935 ; 0037-5675
ISSN (online)	2737-5935
ISSN	0037-5675
DOI	10.11622/smedj.2016127
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Article ; Online: Omental infarction--a mimicker of acute appendicitis in children.

Loh, May Han / Chui, Hon Chan / Yap, Te-Lu / Sundfor, Anette / Tan, Carolyn Eng Looi

Journal of pediatric surgery

2005 Volume 40, Issue 8, Page(s) 1224–1226

Abstract: Purpose: The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery.: Methods: A retrospective review was conducted of all patients with surgically proven ... ...

Abstract	Purpose: The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery. Methods: A retrospective review was conducted of all patients with surgically proven omental infarction treated at KK Women's and Children's Hospital between May 1997 and January 2004. Results: Twelve children (10 boys and 2 girls) were treated for primary omental infarction. The mean age was 9.0 +/- 1.42 years. The mean weight was 41.3 +/- 9.65 kg, with 6 (50%) above the 97th percentile and the remainder were between the 50th and 97th percentile. All 12 children presented with right-sided abdominal pain. At presentation, 9 had low-grade fever of 37.3 degrees C or higher, with the maximum temperature recorded at 37.9 degrees C. The mean total white blood cell count was 13.3 +/- 2.66. Significant neutrophilia (relative percentage, > 70%; absolute neutrophils, > 8000) was noted in 9 children. Eight children underwent radiological imaging, which included ultrasonography (n = 3) and/or computed tomography (CT) (n = 7) of the abdomen. Preoperative diagnosis was made on 4 CT scans. Surgical resection resulted in immediate resolution of symptoms. Conclusion: Omental infarction often mimics acute appendicitis preoperatively, although CT may be diagnostic. Surgical resection of the affected omentum expedites clinical recovery.
MeSH term(s)	Abdomen, Acute/diagnosis ; Appendicitis/diagnosis ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Infarction/diagnosis ; Male ; Omentum/blood supply ; Peritoneal Diseases/diagnosis ; Retrospective Studies
Language	English
Publishing date	2005-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2005.05.002
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