Avascular necrosis of bone (AVN) is increasingly being recognized as a complication of SLE and causes significant disability due to pain and mobility limitations. We studied the prevalence and factors associated with avascular necrosis (AVN) in a multiethnic SLE cohort. SLE patients who visited the outpatient clinic from October 2017 to April 2019 were considered eligible. Their medical records were reviewed to identify patients who developed symptomatic AVN, as confirmed by either magnetic resonance imaging or plain radiography. Subsequently, their SLE disease characteristics and treatment were compared with the characteristics of patients who did not have AVN. Multivariable logistic regression analyses were performed to determine the independent factors associated with AVN among the multiethnic SLE cohort. A total of 390 patients were recruited, and the majority of them were females (92.6%); the patients were predominantly of Malay ethnicity (59.5%), followed by Chinese (35.9%) and Indian (4.6%). The prevalence of symptomatic AVN was 14.1%, and the mean age of AVN diagnosis was 37.6 ± 14.4 years. Both univariate and multivariable logistic regression analyses revealed that a longer disease duration, high LDL-C (low density lipoprotein cholesterol), positive anti-cardiolipin (aCL) IgG and anti-dsDNA results, a history of an oral prednisolone dose of more than 30 mg daily for at least 4 weeks and osteoporotic fractures were significantly associated with AVN. On the other hand, hydroxychloroquin (HCQ), mycophenolate mofetil (MMF) and bisphosphonate use were associated with a lower risk of AVN. No associations with ethnicity were found. In conclusion, several modifiable risk factors were found to be associated with AVN, and these factors may be used to identify patients who are at high risk of developing such complications. The potential protective effects of HCQ, MMF and bisphosphonates warrant additional studies.

Background: Student attendance at teaching-learning sessions is traditionally registered using pen-and-paper. This method has many weaknesses: lost, hard to verify, attendance-by-proxy, late submission. The Quick-Response Code is a two-dimensional barcode that can be read with a QR reader on a smartphone that captures and instantly transmits information to a cloud storage. We describe the use of a QRC method to register medical students' attendance and assessed their perception of this method compared to PAP. Method:The attendance of 112 medical students in all teaching and learning sessions in internal medicine posting was registered either with QRC or PAP. A static QR code was generated using open source software online and linked to Google Document for storage of data registered. At the end of the posting, the students' perception was assessed using a 4-point Likert scale satisfaction survey.Results: 83 students participated in the survey (74% response rate). 100% owned a smart device and 91.6% had data connectivity. Compared to PAP, the QRC method was perceived to be more convenient, more accurate, more secure and more environment-friendly and preferred (all p < 0.05). The QRC method was not significantly faster than the PAP (p = 0.361). Conclusion:The QRC method was the preferred attendance record tool compared to the traditional PAP method. Its adoption in the closed and secure environment of a medical campus and hospital is feasible and should be explored.

The Neonatal Resuscitation Programme is a good example of an effective educational intervention that has improved perinatal mortality rates in many countries. This paper shares our experience of planning an undergraduate Neonatal Resuscitation Programme using basic principles of education theory of spiral curriculum, Bloom's taxonomy in planning learning outcomes, Kolb's learning model and Miller's model of clinical assessment. Engaging clinicians in pedagogical theories may not be well aligned with how clinicians traditionally thought they learnt best, yet it is key to improving learning concept and educational intervention outcomes in the healthcare professions. This article aims to illustrate the application of such educational theories into one example of practice. We structured this paper in the scope of content, delivery and assessment when planning a psychomotor learning activity.