The results of this study are very reassuring concerning the acceptability to patients of consulting with medical students and are more favourable than those reported for studies of students being present in consultations by GPs.

Background and Aims: Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal complication of liver cirrhosis. This study aims to analyze the prevalence of SBP among liver cirrhotic patients according to geographical location and income level, and risk factors and outcomes of SBP.Methods: A systematic search for articles describing prevalence, risk factors and outcomes of SBP was conducted. A single-arm meta-analysis was performed using generalized linear mix model (GLMM) with Clopper-Pearson intervals.Results: Ninety-Nine articles, comprising a total of 5,861,142 individuals with cirrhosis were included. Pooled prevalence of SBP was found to be 17.12% globally (CI: 13.63–21.30%), highest in Africa (68.20%; CI: 12.17–97.08%), and lowest in North America (10.81%; CI: 5.32–20.73%). Prevalence of community-acquired SBP was 6.05% (CI: 4.32–8.40%), and 11.11% (CI: 5.84–20.11%,) for healthcare-associated SBP. Antibiotic-resistant microorganisms were found in 11.77% (CI: 7.63–17.73%) of SBP patients. Of which, methicillin-resistant Staphylococcus aureus was most common (6.23%; CI: 3.83–9.97%), followed by extended-spectrum beta-lactamase producing organisms (6.19%; CI: 3.32–11.26%), and lastly vancomycin-resistant enterococci (1.91%; CI: 0.41–8.46%). Subgroup analysis comparing prevalence, antibiotic resistance, and outcomes between income groups was conducted to explore a link between socioeconomic status and SBP, which revealed decreased risk of SBP and negative outcomes in high-income countries.Conclusion: SBP remains a frequent complication of liver cirrhosis worldwide. The drawn link between income level and SBP in liver cirrhosis may enable further insight on actions necessary to tackle the disease on a global scale.

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LEGISLATION FOR ORGAN TRANSPLANTATION Singapore, located in Southeast Asia, has a developed economy, a multiethnic population of 5.7 million, and spends 2.1% of its gross domestic product on health care. The Medical Therapy, Education and Research Act passed in 1972 allows people to pledge their organs for transplant, research, or education upon death. A low sign-up rate despite an extensive campaign led to the Human Organ Transplant Act in 1987, essentially an opt-out system that presumes consent to procure organs for transplantation upon death. Initially, Human Organ Transplant Act applied only to traumatic causes of death among Singapore permanent residents and citizens (21-60 y), non-Muslims, restricted to the procurement kidneys. This Act was amended in 2004 to include all causes of death and retrieval of heart, liver, cornea while also covering the regulation of living donor transplants. The amendment in 2008 included Muslims, and in 2009, the upper age limit was removed and paired matching was permitted. 1 OVERALL LIVER TRANSPLANT ACTIVITYThe first deceased donor liver transplantation (DDLT) in Singapore was performed in 1990 and the first living donor liver transplant (LDLT) in 1996 at the National University Hospital (NUH) Singapore.Since then, >500 LDLT and DDLT have been completed in Singapore. At present, there are 4 liver transplantation centers in Singapore, with 2 centers in the public sector-National University Centre for Organ Transplantation at NUH and the SingHealth Transplant Center at the Singapore General Hospital that was commissioned for liver transplants in 2005; 2 additional centers are in the private sector. National University Centre for Organ Transplantation accounted for the majority of liver transplants in Singapore. Figure 1 shows the timelines of key

Objectives: This is a first-of-its-kind cross-country collaboration between medical students from Singapore and Vietnam in conducting a cardiopulmonary resuscitation (CPR) workshop for Vietnamese high school students. Our objective was to assess the effectiveness of CPR training in improving students’ knowledge and attitudes towards CPR. Methods: The CPR workshop was conducted using active learning methods, including interactive lecture session, games, small group demonstration and hands-on practice on the mannequin. Knowledge and attitudes towards CPR were studied using a standardised questionnaire administered at three time points: before the workshop (TP1), immediately after the workshop (TP2) and three months after the workshop (TP3). Results: There was an improvement in the median knowledge score from 6.5/14 at TP1 to 13/14 at TP2 ( p<0.001) which was sustained at TP3 (10/14). Willingness and confidence in performing CPR on strangers increased from TP1 to TP2. From TP2 to TP3, however, there was a decrease in willingness to perform CPR on all groups, though confidence in performing CPR remained high at TP3. The most-cited concern about performing CPR was a lack of skills and knowledge. Most participants picked formal training courses to increase confidence in performing CPR. Conclusions: The CPR training was effective in improving the knowledge and attitudes of high school students towards CPR. Our study supports expanding this workshop to train more students in basic cardiac life support in the community and further collaboration internationally between medical schools in order to increase the number of students in the community competent in performing CPR.