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How C.H.,Singhealth Polyclinics | Chan W.S.D.,Neurology Service
Singapore Medical Journal | Year: 2014

Headaches are common in children. Common primary headaches can also be experienced by children. The most common causes of innocent headaches among children are tiredness, shortsightedness, viral fever, sinusitis and psychosocial stressors. Consultation tasks include an attempt to diagnose the headache, the exclusion of sinister causes, and an effort to address any underlying concerns that the child and his/her family members may have. At a busy primary care consultation, the use of a headache symptom diary may provide important information for the evaluation of children presenting with chronic headaches. Source


Tan N.C.,Singhealth Polyclinics | Tan N.C.,National University of Singapore
Singapore Medical Journal | Year: 2014

Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore's primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the 'PAIR UP' approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore. Source


Chiou F.K.,Gastroenterology Service | How C.H.,Singhealth Polyclinics | Ong C.,Gastroenterology Service
Singapore Medical Journal | Year: 2013

Recurrent abdominal pain in childhood is common, and continues to be a diagnostic and therapeutic challenge. It is usually attributed to a functional gastrointestinal disorder rather than an organic disease. In most cases, a comprehensive history and physical examination should enable one to make a positive diagnosis of functional disorder. The presence of alarm symptoms and signs, such as weight loss, gastrointestinal bleeding and chronic severe diarrhoea, warrants further investigations and referral to a paediatric gastrointestinal specialist. The mainstay of therapy in functional abdominal pain is education, reassurance and avoidance of triggering factors. While symptom-based pharmacological therapy may be helpful in patients who do not respond to simple management, it is best used on a time-limited basis due to the lack of good evidence of its efficacy. The primary goal of therapy is a return to normal daily activities rather than complete elimination of pain. In recalcitrant cases, psychological interventions such as cognitive behaviour therapy and relaxation training have proven to be efficacious. Source


How C.H.,Singhealth Polyclinics
Proceedings of Singapore Healthcare | Year: 2011

Diabetes mellitus is a common chronic condition and an old friend to family physicians practising in the community. The long-standing practice had aimed to lower glucose levels in type 2 diabetes to prevent long-term complications. The recent evidence from some publications since June 2008 had suggested the possible harm to our patients when we adopt intensive treatment strategies with tight treatment control targets (below HbA1c of 6%) and many meta-analyses have been published. This review highlights the evidence from recent studies that shook the previous dogma and the new clinical equipoise. Source


Goh I.X.W.,National Healthcare Group Polyclinics | How C.H.,Singhealth Polyclinics | Tavintharan S.,Diabetes Center
Singapore Medical Journal | Year: 2013

Statins are commonly used in the treatment of hyperlipidaemia. Although the benefits of statins are well-documented, they have the potential to cause myopathy and rhabdomyolysis due to the complex interactions of drugs, comorbidities and genetics. The cytochrome P450 family consists of major enzymes involved in drug metabolism and bioactivation. This article aims to highlight drug interactions involving statins, as well as provide updated recommendations and approaches regarding the safe and appropriate use of statins in the primary care setting. Source

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