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Compliance with face mask use during the COVID-19 pandemic: a community observational study in Singapore. COVID-19大流行期间口罩使用的依从性:新加坡社区观察性研究
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2023-04-28 DOI: 10.4103/singaporemedj.SMJ-2021-010
Sean Wei Xiang Ong, Ying Wei Tang, Kyaw Zaw Linn, Xiao Wei Huan, Allie Lim, Chu Ying Poon, Danielle Hui Ru Tan, Nur Hafizah Binte Hamed, Sharifah Farhanah Binte Syed Husen, Clara Chong Hui Ong, Monica Chan, Shawn Vasoo, Yee-Sin Leo, Oon-Tek Ng, Kalisvar Marimuthu

Introduction: Widespread mask use is an important intervention for control of the coronavirus disease 2019 pandemic. However, data on the factors affecting mask use are lacking. In this observational study, we evaluated the proportion of and factors influencing face mask use and related hygiene practices.

Methods: We observed randomly selected members from the public in 367 venues across Singapore, and recorded the proportion of individuals with full compliance with mask use and mask hygiene (hand hygiene before and after touching the mask or face). Logistic regression analyses were used to determine variables associated with mask and hand hygiene compliance.

Results: We made 3,821 observations - 2,149 (56.2%) females, 3,569 (93.4%) adults (≥21 years), 212 (5.5%) children (6-20 years) and 40 (1.0%) children (2-5 years). The overall full compliance rate (correct mask use), poor compliance rate (incorrect mask use) and absent mask use were 84.5%, 12.9% and 2.6%, respectively. The factors - male gender, fabric mask usage and crowded indoor venues - were associated with lower mask compliance. Face or mask touching behaviour was observed in 10.7% and 13.7% of individuals observed, respectively. Only one individual performed hand hygiene before and after touching the mask.

Conclusion: The rate of mask compliance was high, probably due to legislation mandating mask usage. However, specific factors and crowded indoor venues associated with lower mask compliance were identified. We also noted an issue with the absence of hand hygiene before and after face or mask touching. These issues may benefit from targeted public health messaging.

导语:广泛使用口罩是防控新冠肺炎疫情的重要举措。然而,缺乏影响口罩使用因素的数据。在这项观察性研究中,我们评估了影响口罩使用和相关卫生习惯的比例和因素。方法:我们从新加坡367个场所随机抽取公众进行观察,记录完全遵守口罩使用和口罩卫生(接触口罩或面部前后的手卫生)的个人比例。采用Logistic回归分析确定与口罩和手卫生依从性相关的变量。结果:共观察3821例,其中女性2149例(56.2%),成人(≥21岁)3569例(93.4%),儿童(6-20岁)212例(5.5%),儿童(2-5岁)40例(1.0%)。总体完全依从率(正确使用口罩)、不良依从率(不正确使用口罩)和未使用口罩的比例分别为84.5%、12.9%和2.6%。男性性别、使用织物口罩和拥挤的室内场所等因素与较低的口罩依从性有关。10.7%和13.7%的观察个体有接触面部或口罩的行为。只有一人在接触口罩前后进行了手部卫生。结论:口罩使用率较高,可能与法律规定口罩使用有关。然而,确定了与低口罩依从性相关的特定因素和拥挤的室内场所。我们还注意到在接触面部或口罩前后缺乏手部卫生的问题。这些问题可能受益于有针对性的公共卫生信息。
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引用次数: 0
Laryngeal mask airway in out-of-hospital cardiac arrest. 院外心脏骤停患者的喉罩通气。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2021-11-19 DOI: 10.11622/smedj.2021197
Yuet Nog Tang, Chun Tat Lui, Hin Tat Fung, Lap Yip Lee, Chu Leung Lau
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引用次数: 0
A year of COVID-19: effects of a global pandemic on a hip fracture bundled care protocol. 2019冠状病毒病之年:全球大流行对髋部骨折捆绑护理方案的影响
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2023-04-14 DOI: 10.4103/singaporemedj.SMJ-2021-351
Khai Cheong Wong, Kenny Xian Khing Tay, Suang Bee Koh, Tet Sen Howe

Introduction: Our aim was to analyse how the coronavirus disease 2019 (COVID-19) pandemic affects a hip fracture bundled care protocol. We hypothesised that key performance indicators, but not short-term outcomes, may be adversely affected.

Methods: Patients admitted under a hip fracture bundled care protocol were divided into two arms: 'COVID' group included patients admitted in 2020 during the COVID-19 pandemic and 'PRE-COVID' group included patients admitted in 2019. We retrospectively analysed time to admission, time to surgery, length of stay, discharge disposition, as well as rates of 30-day revision surgery, 30-day readmission and inpatient mortality.

Results: There were 307 patients in the PRE-COVID group and 350 patients in the COVID group. There was no significant difference in terms of gender, age and type of hip fracture. The COVID group had a higher proportion of American Society of Anesthesiologists classification III and IV patients (61.4% vs. 50.2% in the PRE-COVID group; P = 0.004). In the COVID group, similar proportion of patients were admitted to the ward within 4 h, but the mean time to surgery was longer (71.8 ± 73.0 h vs. 60.4 ± 72.8 h in the PRE-COVID group; P = 0.046) and few patients underwent operations within 48 h (41.7% vs. 60.3% in the PRE-COVID group; P < 0.001). Mean postoperative length of stay, discharge disposition, as well as rates of inpatient mortality, 30-day revision surgery and 30-day readmission were similar.

Conclusion: The volume of hip fractures during the COVID-19 pandemic remained unchanged, although patients admitted during the COVID-19 pandemic appeared to be more deconditioned. Nevertheless, having robust protocols and staff familiar with hip fracture treatment can preserve short-term outcomes for this group of patients, even with strict isolation measures in place during a pandemic.

我们的目的是分析2019冠状病毒病(COVID-19)大流行如何影响髋部骨折捆绑护理方案。我们假设关键绩效指标,而非短期结果,可能受到不利影响。方法:根据髋部骨折捆绑护理方案入院的患者分为两组:“COVID”组包括2020年COVID-19大流行期间入院的患者,“PRE-COVID”组包括2019年入院的患者。我们回顾性分析了入院时间、手术时间、住院时间、出院处理、30天翻修手术率、30天再入院率和住院死亡率。结果:PRE-COVID组307例,COVID组350例。性别、年龄、髋部骨折类型差异无统计学意义。COVID组美国麻醉师学会III和IV级患者比例更高(61.4% vs. PRE-COVID组50.2%;P = 0.004)。COVID组患者在4 h内入院的比例相似,但平均手术时间更长(71.8±73.0 h vs. PRE-COVID组60.4±72.8 h);P = 0.046),很少患者在48 h内接受手术(41.7% vs. PRE-COVID组60.3%;P < 0.001)。术后平均住院时间、出院处置、住院死亡率、30天翻修手术和30天再入院率相似。结论:新冠肺炎大流行期间髋部骨折的数量保持不变,尽管新冠肺炎大流行期间入院的患者似乎更健康。然而,拥有健全的方案和熟悉髋部骨折治疗的工作人员,即使在大流行期间采取严格的隔离措施,也可以保持这组患者的短期疗效。
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引用次数: 0
Behavioural sleep problems in children. 儿童的睡眠行为问题。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2023-01-06 DOI: 10.4103/singaporemedj.SMJ-2021-102
Chun Yi Ting, Biju Thomas

Abstract: Behavioural sleep problems are very common in children and are concerns for many parents. This review discusses normal sleep physiology and sleep development and focuses on common behavioural sleep problems in childhood, including behavioural insomnia of childhood, parasomnias and sleep-related movement disorders, highlighting their clinical features and management. Behavioural insomnia of childhood is characterised by learned difficulties in falling asleep and/or staying asleep. Management includes establishing bedtime routines and behavioural techniques. Parasomnias include confusional arousals, sleepwalking, sleep terrors and nightmares, and these usually resolve with time. Management includes parental reassurance and behavioural interventions such as scheduled awakening. With regards to sleep enuresis, management includes behavioural modifications, enuresis alarm and desmopressin. Sleep-related movement disorders include sleep-related bruxism and sleep-related rhythmic movements, of which body rocking is the most common. Early identification and management of behavioural sleep problems may prevent their negative impact on children as well as their families.

行为性睡眠问题在儿童中非常常见,也是许多家长关心的问题。本综述将讨论正常的睡眠生理学和睡眠发育,并重点介绍儿童期常见的行为性睡眠问题,包括儿童行为性失眠症、寄生虫病和睡眠相关运动障碍,强调其临床特征和处理方法。儿童行为性失眠的特点是难以入睡和/或保持睡眠。治疗方法包括建立睡前常规和行为技巧。副失眠症包括困惑性唤醒、梦游、梦惊和噩梦,这些症状通常会随着时间的推移而缓解。处理方法包括父母安抚和行为干预,如定时唤醒。至于睡眠遗尿症,治疗方法包括行为矫正、遗尿报警器和去氨加压素。与睡眠有关的运动障碍包括与睡眠有关的磨牙症和与睡眠有关的节律性运动,其中身体摇摆最为常见。及早发现和处理睡眠行为问题可避免对儿童及其家庭造成负面影响。
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引用次数: 0
Factors associated with readmission after long-term administration of tolvaptan in patients with congestive heart failure. 充血性心力衰竭患者长期服用托伐普坦后再次入院的相关因素。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2023-02-06 DOI: 10.4103/singaporemedj.SMJ-2021-348
Shoko Yamashita, Miki Takenaka, Masayuki Ohbayashi, Noriko Kohyama, Tatsuya Kurihara, Tomiko Sunaga, Hisaaki Ishiguro, Mari Kogo

Introduction: We investigated the factors associated with readmission in patients with congestive heart failure (HF) receiving long-term administration of tolvaptan (TLV) to support treatment decisions for HF.

Methods: This retrospective cohort study included 181 patients with congestive HF who received long-term administration of TLV. Long-term administration of TLV was defined as the administration of TLV for 60 days or longer. The outcome was a readmission event for worsening HF within 1 year after discharge. Significant factors associated with readmission were selected using multivariate analysis. To compare the time to readmission using significant factors extracted in a multivariate analysis, readmission curves were constructed using the Kaplan-Meier method and analysed using the log-rank test.

Results: The median age was 78 years (range, 38-96 years), 117 patients (64.6%) were males, and 77 patients (42.5%) had a hospitalisation history of HF. Readmission for worsening HF within 1 year after long-term TLV treatment occurred in 62 patients (34.3%). In the multivariate analysis, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 (odds ratio, 3.22; 95% confidence interval, 1.661-6.249; P = 0.001) was an independent significant factor. When eGFR at discharge was divided into two groups (eGFR < 30 vs. eGFR ≥ 30), readmission rates within 1 year were 53.3% vs. 25.4%, respectively ( P = 0.001).

Conclusion: We revealed that eGFR was strongly associated with readmission in patients with HF who received long-term administration of TLV. Furthermore, we showed that eGFR is an important indicator in guiding treatment of HF in patients receiving TLV.

简介我们调查了长期服用托伐普坦(TLV)以支持高血压治疗决策的充血性心力衰竭(HF)患者再入院的相关因素:这项回顾性队列研究纳入了181名长期服用托伐普坦的充血性心力衰竭患者。长期服用 TLV 的定义是服用 TLV 60 天或更长时间。研究结果为出院后 1 年内因心房颤动恶化而再次入院。通过多变量分析筛选出与再入院相关的重要因素。为了比较使用多变量分析中提取的重要因素进行再入院治疗的时间,使用 Kaplan-Meier 法构建了再入院治疗曲线,并使用对数秩检验进行分析:中位年龄为 78 岁(38-96 岁),117 名患者(64.6%)为男性,77 名患者(42.5%)有心房颤动住院史。62名患者(34.3%)在长期TLV治疗后1年内因心房颤动恶化而再次入院。在多变量分析中,估计肾小球滤过率(eGFR)2(几率比,3.22;95% 置信区间,1.661-6.249;P = 0.001)是一个独立的重要因素。当出院时的 eGFR 被分为两组(eGFR < 30 vs. eGFR ≥ 30)时,1 年内再入院率分别为 53.3% vs. 25.4%(P = 0.001):我们发现,在长期服用 TLV 的心房颤动患者中,eGFR 与再入院率密切相关。此外,我们还发现 eGFR 是指导接受 TLV 治疗的 HF 患者治疗的重要指标。
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引用次数: 0
The use of protocolised sedation to reduce benzodiazepine use and improve sedation practices in a medical intensive care unit in Singapore. 在新加坡的一家医疗重症监护病房中,使用协议镇静法来减少苯二氮卓类药物的使用并改进镇静方法。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2023-02-09 DOI: 10.4103/singaporemedj.SMJ-2021-060
Roshni Sadashiv Gokhale, Ian Wee, Tan Poh Choo, Michelle See, Siau Chuin
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引用次数: 0
Rehabilitation outcome after acute subarachnoid haemorrhage: the role of early functional predictors and complications. 急性蛛网膜下腔出血后的康复效果:早期功能预测和并发症的作用。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2021-11-19 DOI: 10.11622/smedj.2021198
Karen Sui Geok Chua, Jonathan Jin Yuan Loke, Chien Joo Lim, Jocelyn Mei Lin Thio, Rathi Ratha Krishnan
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引用次数: 0
Clinical profile and outcomes in patients with moderate to severe aortic stenosis with or without concomitant chronic kidney disease. 伴有或不伴有慢性肾病的中重度主动脉瓣狭窄患者的临床概况和疗效。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2023-03-24 DOI: 10.4103/singaporemedj.SMJ-2021-427
Jinghao Nicholas Ngiam, Ching-Hui Sia, Nicholas Wen Sheng Chew, Tze Sian Liong, Zi Yun Chang, Chi Hang Lee, Wen Ruan, Edgar Lik-Wui Tay, William Kok-Fai Kong, Huay Cheem Tan, Tiong-Cheng Yeo, Kian Keong Poh

Introduction: Management of aortic stenosis (AS) in patients with chronic kidney disease (CKD) may often be overlooked, and this could confer poorer outcomes.

Methods: Consecutive patients ( n = 727) with index echocardiographic diagnosis of moderate to severe AS (aortic valve area <1.5 cm 2 ) were examined. They were divided into those with CKD (estimated glomerular filtration rate < 60 mL/min) and those without. Baseline clinical and echocardiographic parameters were compared, and a multivariate Cox regression model was constructed. Clinical outcomes were compared using Kaplan-Meier curves.

Results: There were 270 (37.1%) patients with concomitant CKD. The CKD group was older (78.0 ± 10.3 vs. 72.1 ± 12.9 years, P < 0.001), with a higher prevalence of hypertension, diabetes mellitus, hyperlipidaemia and ischaemic heart disease. AS severity did not differ significantly, but left ventricular (LV) mass index (119.4 ± 43.7 vs. 112.3 ± 40.6 g/m 2 , P = 0.027) and Doppler mitral inflow E to annular tissue Doppler e' ratio (E: e' 21.5 ± 14.6 vs. 17.8 ± 12.2, P = 0.001) were higher in the CKD group. There was higher mortality (log-rank 51.5, P < 0.001) and more frequent admissions for cardiac failure (log-rank 25.9, P < 0.001) in the CKD group, with a lower incidence of aortic valve replacement (log-rank 7.12, P = 0.008). On multivariate analyses, after adjusting for aortic valve area, age, left ventricular ejection fraction and clinical comorbidities, CKD remained independently associated with mortality (hazard ratio 1.96, 95% confidence interval 1.50-2.57, P < 0.001).

Conclusion: Concomitant CKD in patients with moderate to severe AS was associated with increased mortality, more frequent admissions for cardiac failure and a lower incidence of aortic valve replacement.

导言:慢性肾脏病(CKD)患者主动脉瓣狭窄(AS)的治疗可能经常被忽视,这可能导致治疗效果较差:方法:超声心动图诊断为中重度主动脉瓣狭窄(主动脉瓣面积)的连续患者(n = 727):270名患者(37.1%)同时患有慢性肾脏病。慢性肾脏病组年龄较大(78.0 ± 10.3 岁 vs. 72.1 ± 12.9 岁,P < 0.001),高血压、糖尿病、高脂血症和缺血性心脏病发病率较高。强直性脊柱炎的严重程度无明显差异,但左心室(LV)质量指数(119.4 ± 43.7 vs 112.3 ± 40.6 g/m 2,P = 0.027)和多普勒二尖瓣流入量E与瓣环组织多普勒e'比值(E:e' 21.5 ± 14.6 vs 17.8 ± 12.2,P = 0.001)在慢性肾脏病组较高。CKD 组死亡率更高(对数秩 51.5,P<0.001),因心力衰竭入院的次数更多(对数秩 25.9,P<0.001),但主动脉瓣置换术的发生率较低(对数秩 7.12,P=0.008)。多变量分析显示,在调整了主动脉瓣面积、年龄、左室射血分数和临床合并症后,慢性肾脏病仍与死亡率独立相关(危险比 1.96,95% 置信区间 1.50-2.57,P <0.001):结论:中重度强直性脊柱炎患者合并慢性肾脏疾病与死亡率升高、因心力衰竭入院次数增多以及主动脉瓣置换术发生率降低有关。
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引用次数: 0
Are surgical fees between specialties fair? 各专科之间的手术费是否公平?
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2024-11-08 DOI: 10.11622/smedj.2021186
Arshvin Kesavan, Priya Tiwari, Sanjeev Shanker, Kesavan Esuvaranathan
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引用次数: 0
Use of testosterone replacement therapy in the rehabilitation of patients with intensive care unit-associated weakness and hospital-associated deconditioning: the Singapore General Hospital rehabilitation experience. 睾酮替代疗法在重症监护室相关虚弱和医院相关衰竭患者康复中的应用:新加坡中央医院的康复经验。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 Epub Date: 2023-01-19 DOI: 10.4103/singaporemedj.SMJ-2021-307
Geoffrey Sithamparapillai Samuel, Du Soon Swee

Introduction: Rehabilitation medicine in a tertiary care hospital involves attending to many patients affected by intensive care unit (ICU)-associated weakness (ICU-AW) and hospital-associated deconditioning (HAD). These conditions contribute to poor long-term functional outcomes and increased mortality. We explored the role of short-term adjunctive androgen therapy in this group of patients in improving the rehabilitative outcomes.

Methods: This was a retrospective analysis of five patients with either ICU-AW or HAD who were given testosterone replacement therapy (TRT) or oxandrolone for a total of 2 weeks during the period from April to November 2020 was undertaken. During the 2-week trial period, the subjects underwent standard rehabilitation therapy.

Results: Grip strength was used as the primary outcome measure, and the mean improvement was 4.2 kg (+24.9%), which is encouraging in a 2-week timeframe. This was matched with good functional recovery in terms of distance ambulated and less assistance needed for ambulation. Sex hormone analysis was also done before initiation of TRT, and it showed that four out of five of the subjects were biochemically hypogonadal. None of the subjects dropped out or experienced any significant adverse events over the 2-week trial period. All the subjects except one improved to full independence at 3 months post-discharge.

Conclusion: TRT has the potential to be used as a useful adjunct to standard rehabilitation in enhancing functional recovery in critically ill patients. A multidisciplinary approach would ensure that suitable patients benefit from optimal nutrition, optimal rehabilitation and synergistic testosterone therapy in a clinically sound and resource-efficient fashion.

简介:三级护理医院的康复医疗工作涉及到许多受重症监护病房(ICU)相关虚弱(ICU-AW)和医院相关衰弱(HAD)影响的患者。这些情况会导致长期功能不良和死亡率升高。我们探讨了短期雄激素辅助疗法在改善这类患者康复效果方面的作用:这是一项回顾性分析,研究对象是在 2020 年 4 月至 11 月期间接受了睾酮替代疗法(TRT)或奥雄酮治疗的 5 名 ICU-AW 或 HAD 患者,他们共接受了 2 周的治疗。在为期两周的试验期间,受试者接受了标准康复治疗:结果:握力是主要的结果测量指标,平均改善幅度为 4.2 公斤(+24.9%),在两周的时间内取得了令人鼓舞的改善。同时,在行走距离和行走所需协助减少方面,功能恢复情况良好。在开始 TRT 之前,还进行了性激素分析,结果显示五名受试者中有四名生化性腺功能低下。在为期两周的试验期间,没有任何受试者退出试验或出现任何重大不良反应。除一名受试者外,其他所有受试者在出院后 3 个月都已完全自立:TRT有可能作为标准康复治疗的一种有效辅助手段,促进重症患者的功能恢复。多学科方法将确保合适的患者从最佳营养、最佳康复和协同睾酮疗法中获益,从而实现临床合理化和资源节约型。
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引用次数: 0
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