Pub Date : 2023-06-26DOI: 10.1177/20101058231186037
Nur Aniza Johari, Nur Diana Bte Zakaria, L. Tan, S. Ho
In Singapore General Hospital (SGH), patients with chronic obstructive pulmonary disease (COPD) are referred for advance care planning (ACP) at the specialist outpatient clinics with about 50 cases referred a year and a completion rate of 10%. One of the commonly cited reasons by patients is that they are feeling well currently and do not need to talk about ACP at that moment. The Emergency Department (ED) saw about 240 COPD patients of P2 or P3 acuity yearly and might be a strategic place for ACP advocacy to take place for COPD patients who are triaged as P2 or P3 acuity. While the memory of the recent exacerbation remains fresh, it could be an opportune moment to start an ACP conversation with such patients in the ED. A quality improvement project (QIP) led by both ED nurses and doctors was executed to increase the number of ACP referrals for COPD patients from the ED. A total of 16 COPD ACP referrals were made, up from the previous baseline of zero. Of note, two of the 16 referrals (12.5%) completed the ACP process. Four more (25%) are still in midst of ACP completion at time of project conclusion.
{"title":"Increasing advance care planning referrals for chronic obstructive pulmonary disease patients in the emergency department","authors":"Nur Aniza Johari, Nur Diana Bte Zakaria, L. Tan, S. Ho","doi":"10.1177/20101058231186037","DOIUrl":"https://doi.org/10.1177/20101058231186037","url":null,"abstract":"In Singapore General Hospital (SGH), patients with chronic obstructive pulmonary disease (COPD) are referred for advance care planning (ACP) at the specialist outpatient clinics with about 50 cases referred a year and a completion rate of 10%. One of the commonly cited reasons by patients is that they are feeling well currently and do not need to talk about ACP at that moment. The Emergency Department (ED) saw about 240 COPD patients of P2 or P3 acuity yearly and might be a strategic place for ACP advocacy to take place for COPD patients who are triaged as P2 or P3 acuity. While the memory of the recent exacerbation remains fresh, it could be an opportune moment to start an ACP conversation with such patients in the ED. A quality improvement project (QIP) led by both ED nurses and doctors was executed to increase the number of ACP referrals for COPD patients from the ED. A total of 16 COPD ACP referrals were made, up from the previous baseline of zero. Of note, two of the 16 referrals (12.5%) completed the ACP process. Four more (25%) are still in midst of ACP completion at time of project conclusion.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48974251","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 : 2023-06-22DOI: 10.1177/20101058231181478
Cia Sin Lee, N. Tan, Kuan Liang Shawn Goh, Zi Ying Chang, T. Liew
Potentially inappropriate prescribing (PIP) is common in primary care and is associated with adverse outcomes. Knowledge of the risk factors of PIP can be critical in designing PIP interventions, especially in guiding our understanding on how PIP occurs in primary care. This systematic review examined factors associated with PIP, specific to primary care. We searched PubMed, Embase, CINAHL, Web of Science, Scopus and PsycINFO for studies related to ‘older persons’, ‘primary care’ and ‘inappropriate prescribing’. Two reviewers conducted study selection, data extraction and quality appraisal. Factors associated with PIP were narratively synthesized. Of the 1017 articles identified, we included 25 articles and a total of 2,893,925 participants, with average age of 70.4–84.0 years. Risk factors of PIP could be classified into patient, physician and system factors. Patient factors were related to patient demographics (advanced age, lower education level and lower socioeconomic status), medical comorbidities (polypharmacy and multimorbidity) and lifestyle factors (unhealthy habits and use of over-the-counter medications). Physician and system factors included older, male, solo general practitioner (GP), higher number of visits of pharmaceutical sales representatives to GP, centrally located GP practice, and smaller number of older patients following up with GP, and medication source from public health system. The findings provide contextual information to guide our understanding of PIP in primary care. Factors identified in this review can inform the design of complex interventions for PIP, as well as be used to develop risk prediction tools to identify high-risk groups who may require further interventions related to PIP.
潜在不当处方(PIP)在初级保健中很常见，并与不良后果相关。了解PIP的危险因素对设计PIP干预措施至关重要，特别是在指导我们理解PIP如何在初级保健中发生时。本系统综述检查了与PIP相关的因素，具体到初级保健。我们检索了PubMed、Embase、CINAHL、Web of Science、Scopus和PsycINFO等与“老年人”、“初级保健”和“不当处方”相关的研究。两名审稿人进行研究选择、数据提取和质量评价。叙述综合与PIP相关的因素。在纳入的1017篇文献中，我们纳入了25篇文献，共有2,893,925名参与者，平均年龄为70.4-84.0岁。PIP的危险因素可分为患者因素、医生因素和系统因素。患者因素与患者人口统计学(高龄、低教育水平和低社会经济地位)、医疗合并症(多种药物和多种疾病)和生活方式因素(不健康的习惯和使用非处方药)有关。医师和系统因素包括年龄较大、男性、全科医生、药品销售代表到全科医生就诊次数较多、全科医生诊所位于中心位置、全科医生随访的老年患者较少以及公共卫生系统的药物来源。研究结果提供了上下文信息来指导我们对初级保健中PIP的理解。本综述中确定的因素可以为PIP复杂干预措施的设计提供信息，也可用于开发风险预测工具，以确定可能需要进一步PIP相关干预措施的高危人群。
{"title":"Factors associated with potentially inappropriate prescribing among older persons in primary care settings: Systematic review","authors":"Cia Sin Lee, N. Tan, Kuan Liang Shawn Goh, Zi Ying Chang, T. Liew","doi":"10.1177/20101058231181478","DOIUrl":"https://doi.org/10.1177/20101058231181478","url":null,"abstract":"Potentially inappropriate prescribing (PIP) is common in primary care and is associated with adverse outcomes. Knowledge of the risk factors of PIP can be critical in designing PIP interventions, especially in guiding our understanding on how PIP occurs in primary care. This systematic review examined factors associated with PIP, specific to primary care. We searched PubMed, Embase, CINAHL, Web of Science, Scopus and PsycINFO for studies related to ‘older persons’, ‘primary care’ and ‘inappropriate prescribing’. Two reviewers conducted study selection, data extraction and quality appraisal. Factors associated with PIP were narratively synthesized. Of the 1017 articles identified, we included 25 articles and a total of 2,893,925 participants, with average age of 70.4–84.0 years. Risk factors of PIP could be classified into patient, physician and system factors. Patient factors were related to patient demographics (advanced age, lower education level and lower socioeconomic status), medical comorbidities (polypharmacy and multimorbidity) and lifestyle factors (unhealthy habits and use of over-the-counter medications). Physician and system factors included older, male, solo general practitioner (GP), higher number of visits of pharmaceutical sales representatives to GP, centrally located GP practice, and smaller number of older patients following up with GP, and medication source from public health system. The findings provide contextual information to guide our understanding of PIP in primary care. Factors identified in this review can inform the design of complex interventions for PIP, as well as be used to develop risk prediction tools to identify high-risk groups who may require further interventions related to PIP.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42255898","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 : 2023-06-20DOI: 10.1177/20101058231184955
S. Tay, C. Lim, Daphne Soo Chieng Tan, Maureen Seok Yee Tan, Jieying Chen, Wan Lin Oh, Shu Yuen Rachel Khoo, Boon Kwang Goh, W. Tang, Bandy Qiuling Goh
Though self-care is a critical component of diabetes management, it is unknown whether pharmacist-run medication review service (MRS) can be an additional intervention to enhance self-care in diabetic patients. Hence, this study aims to determine the effectiveness of MRS in addition to existing care protocol in improving self-care in diabetic patients. This randomised controlled study was conducted in five polyclinics from December 2014 to October 2016. Participants were 40 to 80 years of age and had been diagnosed with type 2 diabetes. These participants were prescribed with five or more chronic medications, of which at least one was an antidiabetic medication, by the primary healthcare centres’ doctors. The participants were randomly recruited into the intervention or control arm. A self-developed questionnaire which incorporated the validated Diabetes Self-Management Questionnaire (DSMQ) was administered face-to-face by the study team to the participants prior to and after MRS. MRS was not administered to participants in the control group. A total of 221 participants completed the follow up. There were 105 participants in the control arm and 116 in the intervention arm. The DSMQ Sum Scale score of the control group improved by 0.16 ± 1.11 ( p = 0.136) while the intervention group improved by 0.40 ± 0.99 ( p = 0.000). Participants in the intervention group reported a better improvement in their self-care of diabetes, specifically in glucose management ( p = 0.003), dietary control ( p = 0.096) and physical activity ( p = 0.003). Pharmacist-run MRS can be included in addition to existing care to improve self-care in patients with diabetes.
{"title":"Effectiveness of medication review services on diabetes self-care in primary care patients-A randomised controlled study","authors":"S. Tay, C. Lim, Daphne Soo Chieng Tan, Maureen Seok Yee Tan, Jieying Chen, Wan Lin Oh, Shu Yuen Rachel Khoo, Boon Kwang Goh, W. Tang, Bandy Qiuling Goh","doi":"10.1177/20101058231184955","DOIUrl":"https://doi.org/10.1177/20101058231184955","url":null,"abstract":"Though self-care is a critical component of diabetes management, it is unknown whether pharmacist-run medication review service (MRS) can be an additional intervention to enhance self-care in diabetic patients. Hence, this study aims to determine the effectiveness of MRS in addition to existing care protocol in improving self-care in diabetic patients. This randomised controlled study was conducted in five polyclinics from December 2014 to October 2016. Participants were 40 to 80 years of age and had been diagnosed with type 2 diabetes. These participants were prescribed with five or more chronic medications, of which at least one was an antidiabetic medication, by the primary healthcare centres’ doctors. The participants were randomly recruited into the intervention or control arm. A self-developed questionnaire which incorporated the validated Diabetes Self-Management Questionnaire (DSMQ) was administered face-to-face by the study team to the participants prior to and after MRS. MRS was not administered to participants in the control group. A total of 221 participants completed the follow up. There were 105 participants in the control arm and 116 in the intervention arm. The DSMQ Sum Scale score of the control group improved by 0.16 ± 1.11 ( p = 0.136) while the intervention group improved by 0.40 ± 0.99 ( p = 0.000). Participants in the intervention group reported a better improvement in their self-care of diabetes, specifically in glucose management ( p = 0.003), dietary control ( p = 0.096) and physical activity ( p = 0.003). Pharmacist-run MRS can be included in addition to existing care to improve self-care in patients with diabetes.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45499086","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 : 2023-06-19DOI: 10.1177/20101058231184953
Raylynn Teo, S. Thilarajah, Liu Jiale, Favian Lim Fang Yu, Kwah Li Khim
Physical activity (PA) levels of stroke survivors are far from recommended levels. To develop specific interventions targeted at improving PA after stroke, there is a need to consider the barriers to PA faced by stroke survivors. To use the comprehensive Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to identify intrapersonal, interpersonal, organizational and community barriers to PA faced by stroke survivors in Singapore. We conducted a face-to-face survey with stroke survivors recruited from Singapore National Stroke Association platforms. Participants were eligible for the study if they were 21 years old and above, had a medical diagnosis of stroke, and had a weak arm or leg. 38 stroke survivors participated in the survey. More than half had moderate or moderately severe disability, and needed assistance for activities of daily living or walking. Of the 63 barriers spanning across intrapersonal, interpersonal, organizational and community domains, the top three most commonly reported barriers include lack of accessible classes/programs at fitness centre (21/38; 55%), lack of assistance from fitness centre staff (19/38; 50%) and feelings of tiredness/fatigue (18/38; 47%). Of the top 10 most commonly reported barriers, four were organizational barriers, four were intrapersonal barriers and two were community barriers. Stroke survivors in Singapore want to participate in PA, but are often limited by barriers associated with fitness centres, self and the environment in the wider community.
{"title":"Barriers to physical activity of stroke survivors in Singapore: A face-to-face cross-sectional survey","authors":"Raylynn Teo, S. Thilarajah, Liu Jiale, Favian Lim Fang Yu, Kwah Li Khim","doi":"10.1177/20101058231184953","DOIUrl":"https://doi.org/10.1177/20101058231184953","url":null,"abstract":"Physical activity (PA) levels of stroke survivors are far from recommended levels. To develop specific interventions targeted at improving PA after stroke, there is a need to consider the barriers to PA faced by stroke survivors. To use the comprehensive Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to identify intrapersonal, interpersonal, organizational and community barriers to PA faced by stroke survivors in Singapore. We conducted a face-to-face survey with stroke survivors recruited from Singapore National Stroke Association platforms. Participants were eligible for the study if they were 21 years old and above, had a medical diagnosis of stroke, and had a weak arm or leg. 38 stroke survivors participated in the survey. More than half had moderate or moderately severe disability, and needed assistance for activities of daily living or walking. Of the 63 barriers spanning across intrapersonal, interpersonal, organizational and community domains, the top three most commonly reported barriers include lack of accessible classes/programs at fitness centre (21/38; 55%), lack of assistance from fitness centre staff (19/38; 50%) and feelings of tiredness/fatigue (18/38; 47%). Of the top 10 most commonly reported barriers, four were organizational barriers, four were intrapersonal barriers and two were community barriers. Stroke survivors in Singapore want to participate in PA, but are often limited by barriers associated with fitness centres, self and the environment in the wider community.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44204567","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 : 2023-06-07DOI: 10.1177/20101058231182004
J. J. Wong, Fiona Wei Ling Loke, H. L. Tan, J. Quah, Wai Chye Cheong, Shariq Ali Khan, Biju Thomas, G. Phua, Derrick Wei Shih Chan
Background In the COVID-19 pandemic, ventilators vital to keeping infected patients alive, were in short supply globally. Our aim was to rapidly prototype and implement production of basic ventilators to serve the local and regional needs in this emergency situation. Methods We adopted a supply-to-design approach, estimating the potential demand for ventilator units and sourcing for common off-the-shelf components available in the estimated quantities, to assemble ventilator units which met the essential requirements for clinical use. We determined the minimum requirements of a basic ventilator based on published specifications and clinician input. Building the ventilator involved interdisciplinary collaboration (between clinicians, industry, hospital innovation engineers and government partners), prototyping and repeated iterations, bench testing, animal testing, regulatory processes, ISO13485 quality management processes, licensing and user acceptability testing. Results We prototyped a limited feature ventilator to supplement hospital ventilators which could be manufactured in sufficient numbers within a short span of time from easily available component parts. Developed with close attention to clinician user input with compliance to ISO standards and quality management processes where possible, this ventilator system was composed of coupled resuscitation bags, motor systems, and pressure and flow sensors capable of delivering ventilator breaths within safe and clinically important targets. This system is functional on ambient air with or without low pressure oxygen supplementation. User feedback cited size, alarms and intuitiveness of controls as potential areas for improvement. Conclusions Further modification based on user acceptability testing results are needed to refine the usability of this limited feature ventilator.
{"title":"Real-world considerations for the rapid prototyping and manufacture of a ventilator for the COVID-19 pandemic","authors":"J. J. Wong, Fiona Wei Ling Loke, H. L. Tan, J. Quah, Wai Chye Cheong, Shariq Ali Khan, Biju Thomas, G. Phua, Derrick Wei Shih Chan","doi":"10.1177/20101058231182004","DOIUrl":"https://doi.org/10.1177/20101058231182004","url":null,"abstract":"Background In the COVID-19 pandemic, ventilators vital to keeping infected patients alive, were in short supply globally. Our aim was to rapidly prototype and implement production of basic ventilators to serve the local and regional needs in this emergency situation. Methods We adopted a supply-to-design approach, estimating the potential demand for ventilator units and sourcing for common off-the-shelf components available in the estimated quantities, to assemble ventilator units which met the essential requirements for clinical use. We determined the minimum requirements of a basic ventilator based on published specifications and clinician input. Building the ventilator involved interdisciplinary collaboration (between clinicians, industry, hospital innovation engineers and government partners), prototyping and repeated iterations, bench testing, animal testing, regulatory processes, ISO13485 quality management processes, licensing and user acceptability testing. Results We prototyped a limited feature ventilator to supplement hospital ventilators which could be manufactured in sufficient numbers within a short span of time from easily available component parts. Developed with close attention to clinician user input with compliance to ISO standards and quality management processes where possible, this ventilator system was composed of coupled resuscitation bags, motor systems, and pressure and flow sensors capable of delivering ventilator breaths within safe and clinically important targets. This system is functional on ambient air with or without low pressure oxygen supplementation. User feedback cited size, alarms and intuitiveness of controls as potential areas for improvement. Conclusions Further modification based on user acceptability testing results are needed to refine the usability of this limited feature ventilator.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44651293","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 : 2023-05-25DOI: 10.1177/20101058231178397
Y. Aoki, Amane Niitsu, Hitomi Baba, Yui Nishizawa
We have reported that age-specific incidence rates of breast cancer among Japanese women increased from 2005 to 2015 in a bimodal distribution pattern, with two peaks in the pre- and postmenopausal age groups. The present study aimed to assess the associations of the increasing age-specific breast cancer incidence or mortality with the prevalence of obesity and drinking and smoking habits, compared with those in uterine body, female and male colon and lung cancers. Linear correlations of annual rates from 2005 to 2015 of the 10-year age-specific cancer incidence and mortality with the prevalence of obesity (body mass index, 25 and over) and drinking (alcohol, 20 g and over 3 times or more a week) and smoking habits were assessed by Pearson’s correlation coefficients during the same 10-year period (from 2005 to 2015) or the 10-year period 10 years before the cancer incidence and mortality were noted (from 1995 to 2005). Positive correlations (r>0.640) were found between the increasing breast cancer incidence and the drinking habit during the same period or the smoking habit during the period 10 years before. Similar but weaker correlations were found for the breast cancer mortality rate increasing with age. Positive correlations were found between the decreasing male lung cancer mortality rate and the smoking habit rate during the period 10 years before. The present ecological study indicated that the breast cancer incidence was associated with the current drinking habits and the past smoking habits among Japanese women.
{"title":"Associations of increasing breast cancer incidence with the current drinking habits and the past smoking habits among Japanese women","authors":"Y. Aoki, Amane Niitsu, Hitomi Baba, Yui Nishizawa","doi":"10.1177/20101058231178397","DOIUrl":"https://doi.org/10.1177/20101058231178397","url":null,"abstract":"We have reported that age-specific incidence rates of breast cancer among Japanese women increased from 2005 to 2015 in a bimodal distribution pattern, with two peaks in the pre- and postmenopausal age groups. The present study aimed to assess the associations of the increasing age-specific breast cancer incidence or mortality with the prevalence of obesity and drinking and smoking habits, compared with those in uterine body, female and male colon and lung cancers. Linear correlations of annual rates from 2005 to 2015 of the 10-year age-specific cancer incidence and mortality with the prevalence of obesity (body mass index, 25 and over) and drinking (alcohol, 20 g and over 3 times or more a week) and smoking habits were assessed by Pearson’s correlation coefficients during the same 10-year period (from 2005 to 2015) or the 10-year period 10 years before the cancer incidence and mortality were noted (from 1995 to 2005). Positive correlations (r>0.640) were found between the increasing breast cancer incidence and the drinking habit during the same period or the smoking habit during the period 10 years before. Similar but weaker correlations were found for the breast cancer mortality rate increasing with age. Positive correlations were found between the decreasing male lung cancer mortality rate and the smoking habit rate during the period 10 years before. The present ecological study indicated that the breast cancer incidence was associated with the current drinking habits and the past smoking habits among Japanese women.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47587192","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 : 2023-05-23DOI: 10.1177/20101058231178398
J. S. Chuah, J. Tan, Tharveen Nair Chandrasekaran, Jun Loong Chiew, R. Alwi
A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.
{"title":"Strangulated giant inguinal scrotal hernia with traction perforation at lesser curve of the stomach","authors":"J. S. Chuah, J. Tan, Tharveen Nair Chandrasekaran, Jun Loong Chiew, R. Alwi","doi":"10.1177/20101058231178398","DOIUrl":"https://doi.org/10.1177/20101058231178398","url":null,"abstract":"A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48708236","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 : 2023-05-22DOI: 10.1177/20101058231178380
C. H. Sim, Elizabeth Jing Yng Heah, X. Zhan, Nur Aqilah Muzini, D. Koh, K. C. Wong, T. Howe, J. Koh
Background and aims Majority of elective orthopaedic operations are postponed to accommodate the reallocation of healthcare resources to combat the pandemic. The aim of this paper is to evaluate the mental state of orthopaedic patients amidst limited orthopaedic management options. The secondary aim of this paper is to identify areas of significant stressors and to provide avenues for improvements. Methods A survey was administered on patients in outpatient clinics within a tertiary institution from 31 May to 13 June 2021 where government interventions prevented elective orthopaedic surgeries from being performed. Individuals' fatigue level were assessed with Chalder fatigue scale (CFS) and they were surveyed on their areas of stressors. Results A total of 160 orthopaedic patients (67 males and 93 females) were surveyed with an average age of 48.3 years old (range 17–88). 65 out of 160 (40.6%) were deemed to be severely fatigued (CFS > 4) with a higher prevalence amongst females than males (47.3% vs 31.3% respectively.) The top three areas identified as stressors included transmitting to family/friends, travel restrictions/quarantine orders and limitation on recreational/social activities (67.5%, 45.6% and 57.5% respectively). 25.6% of the patients indicated that the increased difficulty in accessing healthcare was a stress factor. Discussion and conclusion There is a high proportion of severe fatigue amongst orthopaedic patients. Combined with postponement of orthopaedic care and treatment, the detrimental effects of a prolong pandemic can be more pronounced on orthopaedic patients. Identified areas of stressors provide avenues for improvements to safeguard the mental health of orthopaedic patients.
{"title":"A prolonged pandemic impacts the mental health of orthopaedic patients","authors":"C. H. Sim, Elizabeth Jing Yng Heah, X. Zhan, Nur Aqilah Muzini, D. Koh, K. C. Wong, T. Howe, J. Koh","doi":"10.1177/20101058231178380","DOIUrl":"https://doi.org/10.1177/20101058231178380","url":null,"abstract":"Background and aims Majority of elective orthopaedic operations are postponed to accommodate the reallocation of healthcare resources to combat the pandemic. The aim of this paper is to evaluate the mental state of orthopaedic patients amidst limited orthopaedic management options. The secondary aim of this paper is to identify areas of significant stressors and to provide avenues for improvements. Methods A survey was administered on patients in outpatient clinics within a tertiary institution from 31 May to 13 June 2021 where government interventions prevented elective orthopaedic surgeries from being performed. Individuals' fatigue level were assessed with Chalder fatigue scale (CFS) and they were surveyed on their areas of stressors. Results A total of 160 orthopaedic patients (67 males and 93 females) were surveyed with an average age of 48.3 years old (range 17–88). 65 out of 160 (40.6%) were deemed to be severely fatigued (CFS > 4) with a higher prevalence amongst females than males (47.3% vs 31.3% respectively.) The top three areas identified as stressors included transmitting to family/friends, travel restrictions/quarantine orders and limitation on recreational/social activities (67.5%, 45.6% and 57.5% respectively). 25.6% of the patients indicated that the increased difficulty in accessing healthcare was a stress factor. Discussion and conclusion There is a high proportion of severe fatigue amongst orthopaedic patients. Combined with postponement of orthopaedic care and treatment, the detrimental effects of a prolong pandemic can be more pronounced on orthopaedic patients. Identified areas of stressors provide avenues for improvements to safeguard the mental health of orthopaedic patients.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43181655","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 : 2023-05-22DOI: 10.1177/20101058231178402
Kimberly Wanxian Soh, J. Loo
Word recognition tests must be conducted in the native language of the listener to obtain valid word recognition scores. Existing Singapore Mandarin speech audiometry test materials that are disyllabic lack in sensitivity and are not phonologically balanced. The purpose of this study was to address those limitations and develop a set of word lists for testing speakers of Singapore Mandarin. The word lists were developed over three phases. (1) Frequently occurring words were chosen from a database consisting of subtitles from local Mandarin programmes, and subjected to familiarity rating by 50 native Singapore Mandarin speakers. (2) Phonologically balanced word lists were created and professionally recorded using words rated as familiar in phase 1. (3) Psychometric curves of words were obtained from 20 normal-hearing native speakers and word lists were analysed for perceptual equivalence. Sixteen phonologically balanced word lists consisting of 25 monosyllables each were created in phase 2. Eight of the 16 lists were found to be perceptually equivalent. Word lists developed in this study addressed the limitations of existing Singapore Mandarin speech audiometry materials. The word lists need to be validated with normal-hearing and hearing-impaired Singapore Mandarin speakers before they can be used clinically.
{"title":"Development of phonologically-balanced and perceptually equivalent Singapore Mandarin word lists for word recognition test","authors":"Kimberly Wanxian Soh, J. Loo","doi":"10.1177/20101058231178402","DOIUrl":"https://doi.org/10.1177/20101058231178402","url":null,"abstract":"Word recognition tests must be conducted in the native language of the listener to obtain valid word recognition scores. Existing Singapore Mandarin speech audiometry test materials that are disyllabic lack in sensitivity and are not phonologically balanced. The purpose of this study was to address those limitations and develop a set of word lists for testing speakers of Singapore Mandarin. The word lists were developed over three phases. (1) Frequently occurring words were chosen from a database consisting of subtitles from local Mandarin programmes, and subjected to familiarity rating by 50 native Singapore Mandarin speakers. (2) Phonologically balanced word lists were created and professionally recorded using words rated as familiar in phase 1. (3) Psychometric curves of words were obtained from 20 normal-hearing native speakers and word lists were analysed for perceptual equivalence. Sixteen phonologically balanced word lists consisting of 25 monosyllables each were created in phase 2. Eight of the 16 lists were found to be perceptually equivalent. Word lists developed in this study addressed the limitations of existing Singapore Mandarin speech audiometry materials. The word lists need to be validated with normal-hearing and hearing-impaired Singapore Mandarin speakers before they can be used clinically.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48738233","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 : 2023-05-04DOI: 10.1177/20101058231172235
A. Yap, Trishpal Kaur Dhaliwal, S. Varman
Paracetamol is a commonly used analgesic among older adults. There have been reports of adverse events with chronic paracetamol use even at therapeutic doses. The objective of this clinical audit is twofold – 1. To evaluate the prevalence of inappropriate paracetamol prescription in the elderly admitted for falls; 2. To introduce strategies to reduce the rate of inappropriate paracetamol prescription in this population. A clinical audit was performed on 100 patients aged 75 years and older who were admitted to the Geriatric Medicine department of a tertiary hospital between July 2019 and October 2019 with a primary diagnosis of a fall. Data collected included demographic data, relevant medical history of cirrhosis, cognitive impairment, alcohol use and weight <50 kg, prescription pattern of paracetamol on day 1 or two of admission and on discharge as well as clinical data on the documented indications for paracetamol use. Paracetamol was prescribed in 84 patients. Out of these 84 patients, 56 were prescribed round-the-clock paracetamol with a median duration of 9 (IQR = 10) days. In this group, paracetamol use was inappropriate in 32 (57%) of them and 32 (57%) patients were discharged with round-the-clock paracetamol for a median duration of 17.5 (IQR = 46) days. This clinical audit revealed a high prevalence of round-the-clock and inappropriate paracetamol prescription in elderly patients admitted for a fall. Moving forward, we hope that the implementation of a paracetamol prescribing algorithm may reduce the rates of inappropriate paracetamol prescribing in this population.
{"title":"Is paracetamol prescribed appropriately in elderly patients admitted for a fall? – A Geriatrician’s perspective","authors":"A. Yap, Trishpal Kaur Dhaliwal, S. Varman","doi":"10.1177/20101058231172235","DOIUrl":"https://doi.org/10.1177/20101058231172235","url":null,"abstract":"Paracetamol is a commonly used analgesic among older adults. There have been reports of adverse events with chronic paracetamol use even at therapeutic doses. The objective of this clinical audit is twofold – 1. To evaluate the prevalence of inappropriate paracetamol prescription in the elderly admitted for falls; 2. To introduce strategies to reduce the rate of inappropriate paracetamol prescription in this population. A clinical audit was performed on 100 patients aged 75 years and older who were admitted to the Geriatric Medicine department of a tertiary hospital between July 2019 and October 2019 with a primary diagnosis of a fall. Data collected included demographic data, relevant medical history of cirrhosis, cognitive impairment, alcohol use and weight <50 kg, prescription pattern of paracetamol on day 1 or two of admission and on discharge as well as clinical data on the documented indications for paracetamol use. Paracetamol was prescribed in 84 patients. Out of these 84 patients, 56 were prescribed round-the-clock paracetamol with a median duration of 9 (IQR = 10) days. In this group, paracetamol use was inappropriate in 32 (57%) of them and 32 (57%) patients were discharged with round-the-clock paracetamol for a median duration of 17.5 (IQR = 46) days. This clinical audit revealed a high prevalence of round-the-clock and inappropriate paracetamol prescription in elderly patients admitted for a fall. Moving forward, we hope that the implementation of a paracetamol prescribing algorithm may reduce the rates of inappropriate paracetamol prescribing in this population.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43915813","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}
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