Pub Date : 2023-12-01DOI: 10.1177/20101058231224494
Xin Yu Adeline Leong, Z. Lim, Lydia Weiling Li, Jane Mary George, Raymond Wee Lip Goy, Diana Xin Hui Chan, Selene Yan Ling Tan, P. Tan, Xia Yu
In view of the opioid epidemic and increasing caution surrounding prescription of opioids, addressing the competence of opioid management is important. There is minimal structured opioid education in Singapore. Online opioid education modules are available but lack real-time input, concise objectives, and program evaluation. This pilot online, modular, blended program aimed to efficiently instruct novice doctors on safe and appropriate practical opioid prescribing, optimizing its role in multimodal pain management while minimizing risks to patients and public health. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used. A multidisciplinary team developed the interactive blended program, “Comprehensive Opioid Management in Pain (COMP)”, consisting of three online modules, one case-based discussion (CBD) session, pre- and post-program evaluations. The program was designed to be concise, clinically relevant and engaging to maximize application of knowledge in clinically deficient areas. All junior anesthetists across Singhealth were invited to participate. We analyzed all self-reported and objective scores, as well as program feedback. 33 participants completed the online modules. Despite the moderate to high level of baseline self-reported confidence and competency scores, median scores for all variables increased post-program from pre-program. There was unanimous agreement on the relevance and utility of the training program. This pilot achieved the aims of improving the knowledge and confidence levels of opioid management in novice doctors. Participants particularly enjoyed the succinct and interactive features of COMP. Further extension with modules focusing on opioid diversion and its use in high-risk populations would benefit intermediate learners.
{"title":"A blended learning program focusing on comprehensive opioid management in pain (COMP): A pilot program","authors":"Xin Yu Adeline Leong, Z. Lim, Lydia Weiling Li, Jane Mary George, Raymond Wee Lip Goy, Diana Xin Hui Chan, Selene Yan Ling Tan, P. Tan, Xia Yu","doi":"10.1177/20101058231224494","DOIUrl":"https://doi.org/10.1177/20101058231224494","url":null,"abstract":"In view of the opioid epidemic and increasing caution surrounding prescription of opioids, addressing the competence of opioid management is important. There is minimal structured opioid education in Singapore. Online opioid education modules are available but lack real-time input, concise objectives, and program evaluation. This pilot online, modular, blended program aimed to efficiently instruct novice doctors on safe and appropriate practical opioid prescribing, optimizing its role in multimodal pain management while minimizing risks to patients and public health. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used. A multidisciplinary team developed the interactive blended program, “Comprehensive Opioid Management in Pain (COMP)”, consisting of three online modules, one case-based discussion (CBD) session, pre- and post-program evaluations. The program was designed to be concise, clinically relevant and engaging to maximize application of knowledge in clinically deficient areas. All junior anesthetists across Singhealth were invited to participate. We analyzed all self-reported and objective scores, as well as program feedback. 33 participants completed the online modules. Despite the moderate to high level of baseline self-reported confidence and competency scores, median scores for all variables increased post-program from pre-program. There was unanimous agreement on the relevance and utility of the training program. This pilot achieved the aims of improving the knowledge and confidence levels of opioid management in novice doctors. Participants particularly enjoyed the succinct and interactive features of COMP. Further extension with modules focusing on opioid diversion and its use in high-risk populations would benefit intermediate learners.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"554 ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1177/20101058231221848
C. Pawa, Kexin Ang, Y. R. Chiew
Iatrogenic copper deficiency is rare in patients with Wilson’s disease. We present a case of iatrogenic copper deficiency myeloneuropathy secondary to zinc treatment for Wilson’s disease and compare the patient’s clinical features with existing cases. Our study highlights the importance of recognizing subtle clinical manifestations and counselling patients receiving copper-reducing treatment to watch for symptoms of myeloneuropathy. Early biochemical testing, including serum copper, caeruloplasmin and zinc levels, as well as magnetic resonance imaging of the spine and electrophysiological studies, may be helpful in diagnosing copper deficiency-related myeloneuropathy due to zinc treatment. Early detection and treatment of copper deficiency may lead to good recovery of neurological symptoms.
{"title":"A case report and literature review of iatrogenic copper deficiency myeloneuropathy due to zinc treatment in patients with Wilson’s disease","authors":"C. Pawa, Kexin Ang, Y. R. Chiew","doi":"10.1177/20101058231221848","DOIUrl":"https://doi.org/10.1177/20101058231221848","url":null,"abstract":"Iatrogenic copper deficiency is rare in patients with Wilson’s disease. We present a case of iatrogenic copper deficiency myeloneuropathy secondary to zinc treatment for Wilson’s disease and compare the patient’s clinical features with existing cases. Our study highlights the importance of recognizing subtle clinical manifestations and counselling patients receiving copper-reducing treatment to watch for symptoms of myeloneuropathy. Early biochemical testing, including serum copper, caeruloplasmin and zinc levels, as well as magnetic resonance imaging of the spine and electrophysiological studies, may be helpful in diagnosing copper deficiency-related myeloneuropathy due to zinc treatment. Early detection and treatment of copper deficiency may lead to good recovery of neurological symptoms.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"284 ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24DOI: 10.1177/20101058231218527
Jie Lin Soong, Lee Yi Ang, Jeremy Lin En Chan, S. Lie
Previous studies have deemed pharmacists essential in the intensive care units (ICU) to provide quality healthcare and ensure medication safety. As the impact of pharmacists in ICU varies according to different factors, our study aims to characterise and evaluate the impact of pharmacists’ interventions in ICUs in Singapore, to enable the identification of areas of improvement in our critical care pharmacy practice. We retrospectively evaluated 7 months of pharmacists’ interventions in five ICUs at Singapore General Hospital. Interventions were classified based on the medication-related problems (MRPs) addressed. The impact of pharmacists’ interventions was assessed by rating the severity of error in medication order, the clinical relevance of intervention, and the probability of adverse drug events (pADE) that would have occurred without pharmacists’ interventions. There were 619 interventions addressing 775 MRPs, of which 91.1% were accepted. The main MRP identified was inappropriate drug regimen (49.2%) and the medication class most frequently involved in MRPs was anti-infectives (56.9%). Majority of the interventions were rated as significant for both the severity of error (76.9%) and clinical relevance (72.4%). However, the pADE was deemed to be low (61.2%). The rating of pADE may be affected by the lack of information in patient profiles. This study demonstrated the crucial role of pharmacists in ensuring medication safety in ICUs. Possible areas of service improvement include educating medical residents on common medication errors and empowering pharmacists towards collaborative prescribing.
{"title":"Clinical impact of pharmacists’ interventions in intensive care units in a tertiary institution in Singapore – A retrospective cohort study","authors":"Jie Lin Soong, Lee Yi Ang, Jeremy Lin En Chan, S. Lie","doi":"10.1177/20101058231218527","DOIUrl":"https://doi.org/10.1177/20101058231218527","url":null,"abstract":"Previous studies have deemed pharmacists essential in the intensive care units (ICU) to provide quality healthcare and ensure medication safety. As the impact of pharmacists in ICU varies according to different factors, our study aims to characterise and evaluate the impact of pharmacists’ interventions in ICUs in Singapore, to enable the identification of areas of improvement in our critical care pharmacy practice. We retrospectively evaluated 7 months of pharmacists’ interventions in five ICUs at Singapore General Hospital. Interventions were classified based on the medication-related problems (MRPs) addressed. The impact of pharmacists’ interventions was assessed by rating the severity of error in medication order, the clinical relevance of intervention, and the probability of adverse drug events (pADE) that would have occurred without pharmacists’ interventions. There were 619 interventions addressing 775 MRPs, of which 91.1% were accepted. The main MRP identified was inappropriate drug regimen (49.2%) and the medication class most frequently involved in MRPs was anti-infectives (56.9%). Majority of the interventions were rated as significant for both the severity of error (76.9%) and clinical relevance (72.4%). However, the pADE was deemed to be low (61.2%). The rating of pADE may be affected by the lack of information in patient profiles. This study demonstrated the crucial role of pharmacists in ensuring medication safety in ICUs. Possible areas of service improvement include educating medical residents on common medication errors and empowering pharmacists towards collaborative prescribing.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"55 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139241734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The 29-item Frail-Physical, Psychological and Social (Frail-PPS) and the 14-item Frailty Assessment Measure (FAM) were developed in Singapore to identify risk of frailty among community dwelling older adults and validated for use among hospitalised older adults. Objectives This study aimed to establish the interrater reliability and feasibility of the two screening tools ‒ FAM and Frail-PPS, for assessing frailty among hospitalized older adults. Methods The FAM and Frail-PPS were administered during the initial nursing assessment by nurses to 62 patients aged 65 years and older within 24 h of admission. Interrater reliability, convergent validity and intraclass correlation coefficients (ICCs) were established. Feasibility was determined by the time of administration. Results ICCs for Frail-PPS and FAM were 0.95 and 0.95 respectively. A positive correlation was established (r = 0.97). The administration time for Frail-PPS averaged 6.7 min, and 3.3 min for FAM. Conclusions The FAM, with its high reliability and convergent validity, as well as shorter administration time, may be the preferred screening tool for use in acute care settings.
{"title":"Assessing the reliability and feasibility of frailty screening tools among hospitalised older adults","authors":"Siew Hoon Lim, Rahul Malhotra, Truls Østbye, Shin Yuh Ang, Xin Ping Ng, Nurliyana Agus, Raden Nurheryany Binte Sunari, Fazila Aloweni","doi":"10.1177/20101058231215167","DOIUrl":"https://doi.org/10.1177/20101058231215167","url":null,"abstract":"Background The 29-item Frail-Physical, Psychological and Social (Frail-PPS) and the 14-item Frailty Assessment Measure (FAM) were developed in Singapore to identify risk of frailty among community dwelling older adults and validated for use among hospitalised older adults. Objectives This study aimed to establish the interrater reliability and feasibility of the two screening tools ‒ FAM and Frail-PPS, for assessing frailty among hospitalized older adults. Methods The FAM and Frail-PPS were administered during the initial nursing assessment by nurses to 62 patients aged 65 years and older within 24 h of admission. Interrater reliability, convergent validity and intraclass correlation coefficients (ICCs) were established. Feasibility was determined by the time of administration. Results ICCs for Frail-PPS and FAM were 0.95 and 0.95 respectively. A positive correlation was established (r = 0.97). The administration time for Frail-PPS averaged 6.7 min, and 3.3 min for FAM. Conclusions The FAM, with its high reliability and convergent validity, as well as shorter administration time, may be the preferred screening tool for use in acute care settings.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135242491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-08DOI: 10.1177/20101058231215174
Kenneth HH Koh, Min-On Tan, Tyng Yu Chuah
Interstitial lung abnormalities (ILAs) are incidental findings on computed tomography (CT) scans in patients not suspected to have underlying interstitial lung disease (ILD). We report a case of a patient with ILAs who was subsequently diagnosed with lung cancer. We highlight the importance of following up on ILAs. We discuss about risk stratification, evaluation and uncertainties associated with ILAs. During evaluation, our patient tested positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5). Anti-MDA5 is a myositis-specific antibody (MSA) associated with dermatomyositis (DM). Anti-MDA5 DM is a heterogeneous condition. We highlight the known clinical phenotypes of anti-MDA5 DM. As we discover more about anti-MDA5, we highlight the importance of interpreting a laboratory result in the appropriate clinical context before a diagnosis and treatment decision is made.
{"title":"Do not dismiss interstitial lung abnormalities","authors":"Kenneth HH Koh, Min-On Tan, Tyng Yu Chuah","doi":"10.1177/20101058231215174","DOIUrl":"https://doi.org/10.1177/20101058231215174","url":null,"abstract":"Interstitial lung abnormalities (ILAs) are incidental findings on computed tomography (CT) scans in patients not suspected to have underlying interstitial lung disease (ILD). We report a case of a patient with ILAs who was subsequently diagnosed with lung cancer. We highlight the importance of following up on ILAs. We discuss about risk stratification, evaluation and uncertainties associated with ILAs. During evaluation, our patient tested positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5). Anti-MDA5 is a myositis-specific antibody (MSA) associated with dermatomyositis (DM). Anti-MDA5 DM is a heterogeneous condition. We highlight the known clinical phenotypes of anti-MDA5 DM. As we discover more about anti-MDA5, we highlight the importance of interpreting a laboratory result in the appropriate clinical context before a diagnosis and treatment decision is made.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"6 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135340722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.
{"title":"Enhancing the hospital at home experience","authors":"Rachel Marie Towle, Peijin Esther Monica Fan, Juweita Arba’in, Fazila Aloweni, Siew Hoon Lim, Shin Yuh Ang, Su-Fee Lim","doi":"10.1177/20101058231209200","DOIUrl":"https://doi.org/10.1177/20101058231209200","url":null,"abstract":"Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"33 20","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135819025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.1177/20101058231207691
Kaddie K Chen, Sandy Julianty Umboh, Tze-Ern Chua, Min S Chua, Chow M Yik, Ngar Y Poon, Ying Chia Ch’ng, Helen Chen
Postnatal depression is a critical public health issue with substantial impact on child development outcomes and family functioning. With the additional stressors that arose during the COVID-19 pandemic, the impact on global mental health has been marked. This study aims to examine the change in the prevalence of postnatal depression (PND) in Singaporean women before the onset of the pandemic and during the pandemic period. A single-center observational cross-sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital (KKH) where women were screened for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS). High scorers on EPDS (EPDS≥13) were considered probable cases of postnatal depression. The prevalence of high EPDS scorers increased from 4.9% in 2019 to 6.5% in 2021, which was statistically significant ( p = .028). The total number of women who received screening for postnatal depression at KKH increased by 42.6% in 2021 compared to 2019, whilst the numbers identified as probable cases increased by 91% over the same period. The prevalence of PND in Singapore significantly increased during the COVID-19 pandemic.
{"title":"Impact of the COVID-19 pandemic on the prevalence of postnatal depression in Singapore","authors":"Kaddie K Chen, Sandy Julianty Umboh, Tze-Ern Chua, Min S Chua, Chow M Yik, Ngar Y Poon, Ying Chia Ch’ng, Helen Chen","doi":"10.1177/20101058231207691","DOIUrl":"https://doi.org/10.1177/20101058231207691","url":null,"abstract":"Postnatal depression is a critical public health issue with substantial impact on child development outcomes and family functioning. With the additional stressors that arose during the COVID-19 pandemic, the impact on global mental health has been marked. This study aims to examine the change in the prevalence of postnatal depression (PND) in Singaporean women before the onset of the pandemic and during the pandemic period. A single-center observational cross-sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital (KKH) where women were screened for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS). High scorers on EPDS (EPDS≥13) were considered probable cases of postnatal depression. The prevalence of high EPDS scorers increased from 4.9% in 2019 to 6.5% in 2021, which was statistically significant ( p = .028). The total number of women who received screening for postnatal depression at KKH increased by 42.6% in 2021 compared to 2019, whilst the numbers identified as probable cases increased by 91% over the same period. The prevalence of PND in Singapore significantly increased during the COVID-19 pandemic.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"154 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135885035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.1177/20101058231209188
Vincent Tee, Ca W Ng, Ahmad A Ismail, Noor AH Che Hashim, Nik R Afendi
Foul-smelling vaginal discharge in adolescents often stems from infectious origin, foreign body insertion, neoplasm, congenital anomaly, and sexual abuse. Diagnosing the causes of the discharge remains challenging, especially in cases where sexual and reproductive health awareness is relatively low in the population from marginalized ethnographies and socio-cultural backgrounds. Suspicion of sexual abuse must be explored carefully and sensitively. A history of sexual exposure might not be forthcoming in adolescents where premarital sex is frowned upon. The process of eliciting the causation may be a challenge to healthcare professionals, delaying the diagnosis and subsequent management. In rare circumstances, imaging studies may help confirm the origin of the infection, giving insight into the presentation’s aetiology. We describe a case of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome presented with foul-smelling vaginal discharge in a newly attained menarche girl in the North-East region of Peninsular Malaysia. We also discussed the theories and reasons behind the occurrence of such a presentation, along with the diagnostic dilemma in this current case.
{"title":"Diagnostic challenge in a case of foul-smelling vaginal discharge in a newly attained menarche girl","authors":"Vincent Tee, Ca W Ng, Ahmad A Ismail, Noor AH Che Hashim, Nik R Afendi","doi":"10.1177/20101058231209188","DOIUrl":"https://doi.org/10.1177/20101058231209188","url":null,"abstract":"Foul-smelling vaginal discharge in adolescents often stems from infectious origin, foreign body insertion, neoplasm, congenital anomaly, and sexual abuse. Diagnosing the causes of the discharge remains challenging, especially in cases where sexual and reproductive health awareness is relatively low in the population from marginalized ethnographies and socio-cultural backgrounds. Suspicion of sexual abuse must be explored carefully and sensitively. A history of sexual exposure might not be forthcoming in adolescents where premarital sex is frowned upon. The process of eliciting the causation may be a challenge to healthcare professionals, delaying the diagnosis and subsequent management. In rare circumstances, imaging studies may help confirm the origin of the infection, giving insight into the presentation’s aetiology. We describe a case of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome presented with foul-smelling vaginal discharge in a newly attained menarche girl in the North-East region of Peninsular Malaysia. We also discussed the theories and reasons behind the occurrence of such a presentation, along with the diagnostic dilemma in this current case.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135890046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.1177/20101058231204705
Yingjuan Mok, Jing Wen Foong, Hang Siang Wong, Amanda Soh, Shi Hua Tan, Poh Choo Tan, Bryan Peide Choo, Keith Keat Huat Wong
Introduction Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients experience difficulties participating in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR post-COPD exacerbation. Methods We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for COPD exacerbation were enrolled and randomized to either HFO or usual care during an early 6-weeks, outpatient PR program. Results Twenty two patients were randomized between May 2019 to Dec 2019 and 18 patients completed the study. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in 6-min walk distance (6MWD) being 30 m (95% CI: −23 m to 84 m), although this was not statistically significant. All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending ≥75% of exercise sessions). HFO was well tolerated with no adverse events reported. Conclusion This pilot RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early PR on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO’s benefits and has the potential to change PR practice.
{"title":"High flow nasal oxygen versus usual care in improving pulmonary rehabilitation outcomes of chronic obstructive pulmonary disease patients after an exacerbation - a pilot randomized controlled trial","authors":"Yingjuan Mok, Jing Wen Foong, Hang Siang Wong, Amanda Soh, Shi Hua Tan, Poh Choo Tan, Bryan Peide Choo, Keith Keat Huat Wong","doi":"10.1177/20101058231204705","DOIUrl":"https://doi.org/10.1177/20101058231204705","url":null,"abstract":"Introduction Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients experience difficulties participating in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR post-COPD exacerbation. Methods We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for COPD exacerbation were enrolled and randomized to either HFO or usual care during an early 6-weeks, outpatient PR program. Results Twenty two patients were randomized between May 2019 to Dec 2019 and 18 patients completed the study. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in 6-min walk distance (6MWD) being 30 m (95% CI: −23 m to 84 m), although this was not statistically significant. All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending ≥75% of exercise sessions). HFO was well tolerated with no adverse events reported. Conclusion This pilot RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early PR on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO’s benefits and has the potential to change PR practice.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135344914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.1177/20101058231204703
Geraldine Pei Yi Koo, Aliviya Dutta, Yuan Helen Zhang
Metformin-associated lactic acidosis (MALA) and euglycaemic diabetic ketoacidosis (EKA) are both life-threatening endocrine emergencies. MALA is a well-documented complication of anti-glycaemic therapy in diabetics while EKA is an increasingly recognized disease entity with the advent of use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. However, the occurrence of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis (MALKA) is uncommon and rarely reported in the literature. We report an unusual case of MALKA, in a 74-year-old gentleman with no previous history of chronic kidney disease and SGLT-2 inhibitor use, who presented with altered mental status, acute renal failure and profound high anion-gap metabolic acidosis (HAGMA) with lactaemia, ketonaemia and normoglycaemia (pH 6.965, bicarbonate 3.1, creatinine 522, glucose 6.6, lactate 17.5, ketones >8). The patient was initiated on intravenous insulin infusion with dextrose-containing drip and continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The patient had a prolonged hospital stay but was eventually discharged with a normalised renal function without need for long-term dialysis. The parallel occurrence of MALA and EKA suggest a metformin-associated inhibition of gluconeogenesis. This case highlights the importance of early recognition and investigation of concurrent diabetic ketoacidosis in the presence of MALA and vice versa as MALKA benefits from both prompt institution of parenteral glucose therapy and insulin infusion and consideration of initiation of haemodialysis.
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