Pub Date : 2023-01-02DOI: 10.1177/20101058221150078
S. Tay, C. Visperas, E. Zaw, M. M. Tan, Fathiah Samsudin, X. Koh
Objective To describe the functional outcomes of post COVID-19 patients after inpatient rehabilitation and determine if patients who underwent adjunct daily robotic therapy with Andago had better functional outcomes than those who did not and if patients who were frail had worse functional outcomes than those who were pre-frail or not frail. Design Retrospective study of COVID-19 patients transferred for acute inpatient rehabilitation from 1 November 2021 to 31 December 2021. Results Post COVID-19 patients who underwent inpatient rehabilitation had an improvement in the Functional Independence Measure (FIM) (median 109 vs 82), Functional Ambulation Category(FAC) (median 3 vs 2), distance walked with physiotherapist (mean 143.5 vs 18.7 m), and the Hospital Anxiety and Depression Scale(HADS) (mean 4.5 vs 7.8) from baseline. Robotic therapy may be associated with a shorter rehabilitation medicine length of stay (median 13 vs 19.5 days) and a higher FIM efficiency (mean 2.3 vs 1.2). Patients with a higher frailty score may have a slower 10 Meter Walk Test (10MWT) speed at discharge (Spearman’s rho −0.542). Conclusion Post COVID-19 patients benefit from inpatient rehabilitation with a comprehensive rehabilitation program, and adjunct robotic therapy may be offered to further improve functional outcomes. Frailty may also be considered when establishing rehabilitation goals, as meaningful functional gains can still be achieved.
目的描述新型冠状病毒感染后患者住院康复后的功能结局，并确定接受Andago辅助机器人日常治疗的患者是否比未接受治疗的患者功能结局更好，体弱患者的功能结局是否比体弱前或非体弱患者更差。设计对2021年11月1日至2021年12月31日转入急性住院康复的COVID-19患者进行回顾性研究。结果接受住院康复治疗的COVID-19患者在功能独立测量(FIM)(中位数109 vs 82)、功能活动类别(FAC)(中位数3 vs 2)、与物理治疗师步行距离(平均143.5 vs 18.7 m)和医院焦虑和抑郁量表(HADS)(平均4.5 vs 7.8)方面均较基线有所改善。机器人治疗可能与更短的康复药物停留时间(中位数13天对19.5天)和更高的FIM效率(平均2.3天对1.2天)相关。虚弱评分较高的患者出院时10米步行测试(10MWT)速度可能较慢(Spearman’s rho−0.542)。结论新型冠状病毒感染后患者可通过综合康复方案进行住院康复，辅助机器人治疗可进一步改善功能预后。在制定康复目标时也可以考虑到虚弱，因为仍然可以实现有意义的功能增益。
{"title":"Functional outcomes of COVID-19 patients who underwent acute inpatient rehabilitation and the exploration of the benefits of adjunct robotic therapy and the effects of frailty","authors":"S. Tay, C. Visperas, E. Zaw, M. M. Tan, Fathiah Samsudin, X. Koh","doi":"10.1177/20101058221150078","DOIUrl":"https://doi.org/10.1177/20101058221150078","url":null,"abstract":"Objective To describe the functional outcomes of post COVID-19 patients after inpatient rehabilitation and determine if patients who underwent adjunct daily robotic therapy with Andago had better functional outcomes than those who did not and if patients who were frail had worse functional outcomes than those who were pre-frail or not frail. Design Retrospective study of COVID-19 patients transferred for acute inpatient rehabilitation from 1 November 2021 to 31 December 2021. Results Post COVID-19 patients who underwent inpatient rehabilitation had an improvement in the Functional Independence Measure (FIM) (median 109 vs 82), Functional Ambulation Category(FAC) (median 3 vs 2), distance walked with physiotherapist (mean 143.5 vs 18.7 m), and the Hospital Anxiety and Depression Scale(HADS) (mean 4.5 vs 7.8) from baseline. Robotic therapy may be associated with a shorter rehabilitation medicine length of stay (median 13 vs 19.5 days) and a higher FIM efficiency (mean 2.3 vs 1.2). Patients with a higher frailty score may have a slower 10 Meter Walk Test (10MWT) speed at discharge (Spearman’s rho −0.542). Conclusion Post COVID-19 patients benefit from inpatient rehabilitation with a comprehensive rehabilitation program, and adjunct robotic therapy may be offered to further improve functional outcomes. Frailty may also be considered when establishing rehabilitation goals, as meaningful functional gains can still be achieved.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46146496","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 : 2023-01-02DOI: 10.1177/20101058221149579
Zeng Hao Joel Wong
A 10 years old girl was referred with the complaints of “per vaginal bleeding and a mass after cycling”. During the first 2 weeks of symptoms, she had visited three different doctors with possible delayed recognition of her diagnosis. Clinical examination revealed an underweight, non-dysmorphic, prepubertal girl with vulvitis and an inflamed interlabial bleeding mass with ulceration. Imaging revealed a subcentimetre arteriovenous fistula and haematoma in the vagina. After one more week (total 3 weeks) of medical therapy, the indication for surgery was worsening of symptoms and failure of medical management. Examination under anaesthesia and cystoscopy revealed a complete urethra prolapse. Dilute adrenaline was injected into the prolapsed mucosa. The prolapse was excised in elliptical segments, and the edges closed with interrupted absorbable sutures. Sub-centimetre segments of mucosa were left between the excised specimens. Bipolar diathermy was used only for hemostasis and circumferential coagulation on the mucosa was avoided. These measures prevent an iatrogenic stenosis. The urethra prolapse was reduced, with no recurrence demonstrated on Valsalva maneuver. Post-operatively, her symptoms resolved. Oral antibiotics, sitz baths, antimicrobial cream and topical estrogen were administered. There was no recurrent urethra prolapse or stricture. The aim of this case report is to increase awareness of the urethral prolapse in the paediatric population and its management.
{"title":"Paediatric interlabial bleeding: More than vaginal pathology","authors":"Zeng Hao Joel Wong","doi":"10.1177/20101058221149579","DOIUrl":"https://doi.org/10.1177/20101058221149579","url":null,"abstract":"A 10 years old girl was referred with the complaints of “per vaginal bleeding and a mass after cycling”. During the first 2 weeks of symptoms, she had visited three different doctors with possible delayed recognition of her diagnosis. Clinical examination revealed an underweight, non-dysmorphic, prepubertal girl with vulvitis and an inflamed interlabial bleeding mass with ulceration. Imaging revealed a subcentimetre arteriovenous fistula and haematoma in the vagina. After one more week (total 3 weeks) of medical therapy, the indication for surgery was worsening of symptoms and failure of medical management. Examination under anaesthesia and cystoscopy revealed a complete urethra prolapse. Dilute adrenaline was injected into the prolapsed mucosa. The prolapse was excised in elliptical segments, and the edges closed with interrupted absorbable sutures. Sub-centimetre segments of mucosa were left between the excised specimens. Bipolar diathermy was used only for hemostasis and circumferential coagulation on the mucosa was avoided. These measures prevent an iatrogenic stenosis. The urethra prolapse was reduced, with no recurrence demonstrated on Valsalva maneuver. Post-operatively, her symptoms resolved. Oral antibiotics, sitz baths, antimicrobial cream and topical estrogen were administered. There was no recurrent urethra prolapse or stricture. The aim of this case report is to increase awareness of the urethral prolapse in the paediatric population and its management.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41601828","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 : 2022-06-01DOI: 10.1177/20101058221117390
Reanne Tang, Ou Feng, Jin Jian Chong, Aiwen Wang
Background Burnout has been prevalent among healthcare workers (HCWs). However, the effect of the Coronavirus Disease (COVID-19) pandemic on this phenomenon in HCWs is unclear. Objective This systematic review aims to evaluate the impact of COVID-19 on burnout of HCWs using Maslach Burnout Inventory (MBI). Methods A systematic search was performed on PubMed database for articles published between 1 December 2019 and 30 June 2021. Search strategy combined terms for HCWs, COVID-19, burnout, and MBI. The main outcome of interest was burnout, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalisation (DP) and low personal accomplishment (PA). Results Four cohort studies, 90 cross-sectional studies and one randomised-controlled trial were included for review. Only one cohort study compared burnout data among HCWs before and during COVID-19. It reported a statistically significant increase in mean EE and PA scores from 21.9 to 24.8 (p = .001), and 42.7 to 48.7 (p = .001), respectively. The remaining studies only evaluated burnout data during COVID-19 but were missing burnout data prior to the pandemic for comparison. Across these studies, the overall mean prevalence of burnout among HCWs was 39.95%, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Burnout outcomes were generally comparable across specific healthcare professions such as doctors and nurses. Conclusion Whilst quality research elucidating the effect of pandemic on burnout is lacking, current burnout prevalence among HCWs during COVID-19 is notable.
{"title":"Evaluating the impact of coronavirus disease on burnout among healthcare workers using maslach burnout inventory tool: A systematic review","authors":"Reanne Tang, Ou Feng, Jin Jian Chong, Aiwen Wang","doi":"10.1177/20101058221117390","DOIUrl":"https://doi.org/10.1177/20101058221117390","url":null,"abstract":"Background Burnout has been prevalent among healthcare workers (HCWs). However, the effect of the Coronavirus Disease (COVID-19) pandemic on this phenomenon in HCWs is unclear. Objective This systematic review aims to evaluate the impact of COVID-19 on burnout of HCWs using Maslach Burnout Inventory (MBI). Methods A systematic search was performed on PubMed database for articles published between 1 December 2019 and 30 June 2021. Search strategy combined terms for HCWs, COVID-19, burnout, and MBI. The main outcome of interest was burnout, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalisation (DP) and low personal accomplishment (PA). Results Four cohort studies, 90 cross-sectional studies and one randomised-controlled trial were included for review. Only one cohort study compared burnout data among HCWs before and during COVID-19. It reported a statistically significant increase in mean EE and PA scores from 21.9 to 24.8 (p = .001), and 42.7 to 48.7 (p = .001), respectively. The remaining studies only evaluated burnout data during COVID-19 but were missing burnout data prior to the pandemic for comparison. Across these studies, the overall mean prevalence of burnout among HCWs was 39.95%, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Burnout outcomes were generally comparable across specific healthcare professions such as doctors and nurses. Conclusion Whilst quality research elucidating the effect of pandemic on burnout is lacking, current burnout prevalence among HCWs during COVID-19 is notable.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43373013","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 : 2022-06-01DOI: 10.1177/20101058221147766
Thandar Oo, Wan Tin Lim
Hemichorea is one of the spectrums of involuntary, continuous, non-purposeful movement of one side of the body, a choreiform disorder. Hemichorea causes vary and include various inherited or acquired systemic conditions. There might be overlapping pathophysiology where the synergistic effects of uncontrolled hyperglycemia and vascular insufficiency cause an incomplete transient dysfunction of the striatum, leading to hemichorea. We herein describe a patient who presented with hemichorea triggered by hyperglycemia and was incidentally found to have an acute lacunar stroke. She was initiated on insulin with good glycemic control. Secondary stroke prevention therapy with aspirin and statin was also started. Her symptoms improved inpatient after stable glycemic control was achieved. After 3 months, her symptoms had completely resolved. Hemichorea is an unusual initial presentation for newly diagnosed diabetes mellitus or stroke. Hence, recognizing and diagnosing this uncommon disease entity is pertinent to make a timely and accurate diagnosis, which can lead to a rapid clinical response.
{"title":"Hemichorea as initial presentation of newly diagnosed diabetes and acute lacunar stroke","authors":"Thandar Oo, Wan Tin Lim","doi":"10.1177/20101058221147766","DOIUrl":"https://doi.org/10.1177/20101058221147766","url":null,"abstract":"Hemichorea is one of the spectrums of involuntary, continuous, non-purposeful movement of one side of the body, a choreiform disorder. Hemichorea causes vary and include various inherited or acquired systemic conditions. There might be overlapping pathophysiology where the synergistic effects of uncontrolled hyperglycemia and vascular insufficiency cause an incomplete transient dysfunction of the striatum, leading to hemichorea. We herein describe a patient who presented with hemichorea triggered by hyperglycemia and was incidentally found to have an acute lacunar stroke. She was initiated on insulin with good glycemic control. Secondary stroke prevention therapy with aspirin and statin was also started. Her symptoms improved inpatient after stable glycemic control was achieved. After 3 months, her symptoms had completely resolved. Hemichorea is an unusual initial presentation for newly diagnosed diabetes mellitus or stroke. Hence, recognizing and diagnosing this uncommon disease entity is pertinent to make a timely and accurate diagnosis, which can lead to a rapid clinical response.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46366841","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 : 2022-06-01DOI: 10.1177/20101058221131656
Chee Yang Tan, Amelia Marie Theseira, Syukri Ahmad Zubaidi, N. Atiya, Anand Sanmugam, Srihari Singaravel, S. Nah
Aim The Coronavirus disease (COVID-19) pandemic has strained healthcare systems worldwide. Some institutions have implemented additional precautionary measures such as pre-procedural swabbing (PPS) to reduce transmission in patients and healthcare workers. We evaluate our experience with universal pre-procedural screening for COVID-19 in low-risk pediatric patients. Methods We performed a retrospective review of patients aged 18 years and below who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay swabs in our center over two waves (1st May 2020 to 31st July 2020 and 1st April 2021 to 30th June 2021). We included patients who underwent rRT-PCR for SARS-CoV-2 prior to any procedures requiring general anesthesia and were deemed low risk for COVID-19 according to our institutional screening criteria. All study patients were followed up for 14 days post-procedure. Results Of 2065 swabs done for patients aged 18 years and below during the study period, 645 (31.2%) were pre-procedural swabs. Patients were aged 4.2 years (median, interquartile range: 1.6 years–9.8 years). Two patients (0.3%) tested positive for COVID-19 by PPS, detected during Period 2 – both had risk criteria which were overlooked by healthcare workers. Within 14 days post-procedure, 10 patients had unscheduled readmissions and 15 required repeat rRT-PCR, all of which were negative. Conclusions In patients deemed low risk for COVID-19 infection according to our screening criteria, routine pre-procedural swabbing returns a low positive rate. Our findings can guide screening protocols at institutions that provide surgical services during the COVID-19 pandemic.
{"title":"Universal COVID-19 pre-procedural swabs in children in a developing country: A comparison of findings over two transmission waves","authors":"Chee Yang Tan, Amelia Marie Theseira, Syukri Ahmad Zubaidi, N. Atiya, Anand Sanmugam, Srihari Singaravel, S. Nah","doi":"10.1177/20101058221131656","DOIUrl":"https://doi.org/10.1177/20101058221131656","url":null,"abstract":"Aim The Coronavirus disease (COVID-19) pandemic has strained healthcare systems worldwide. Some institutions have implemented additional precautionary measures such as pre-procedural swabbing (PPS) to reduce transmission in patients and healthcare workers. We evaluate our experience with universal pre-procedural screening for COVID-19 in low-risk pediatric patients. Methods We performed a retrospective review of patients aged 18 years and below who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay swabs in our center over two waves (1st May 2020 to 31st July 2020 and 1st April 2021 to 30th June 2021). We included patients who underwent rRT-PCR for SARS-CoV-2 prior to any procedures requiring general anesthesia and were deemed low risk for COVID-19 according to our institutional screening criteria. All study patients were followed up for 14 days post-procedure. Results Of 2065 swabs done for patients aged 18 years and below during the study period, 645 (31.2%) were pre-procedural swabs. Patients were aged 4.2 years (median, interquartile range: 1.6 years–9.8 years). Two patients (0.3%) tested positive for COVID-19 by PPS, detected during Period 2 – both had risk criteria which were overlooked by healthcare workers. Within 14 days post-procedure, 10 patients had unscheduled readmissions and 15 required repeat rRT-PCR, all of which were negative. Conclusions In patients deemed low risk for COVID-19 infection according to our screening criteria, routine pre-procedural swabbing returns a low positive rate. Our findings can guide screening protocols at institutions that provide surgical services during the COVID-19 pandemic.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49574014","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 : 2022-06-01DOI: 10.1177/20101058221111579
Guang Xu David Lim, Siti Hamzah, Ricca Rocco Mae Bernardino, Patcharawan Sukhumalind, N. S. Ishak, Adiningrum Wiradidjaja Adiwoso
Background All member states in the Association of South East Asians (ASEAN) are ratified signatories of the UN Convention on the Rights of Persons with Disabilities. However, disability and oral health (DOH) can be an elusive ambition for developing nations. Objectives This survey aims to conceptualise ‘barriers’, ‘improvements’, ‘challenges in dental practice’, and ‘ways to collaborate’, to inform policy development for DOH within ASEAN. Methods The survey employed a novel quasi-qualitative design. It was electronically distributed to dentists with DOH specialty training in ASEAN within the International Association of Disability and Oral Health’s network from September 2018 to June 2020. The ‘barriers’ and ‘improvements’ would be categorised into five dimensions of healthcare - a framework by Levesque and colleagues (2013). Results 21 valid responses were received from Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand. From the care provider’s perspective, adequate training (appropriateness) was most prioritised. From the patient’s aspect, low oral health literacy (ability to perceive) was the most significant. ‘Social perception’ was collectively ranked as the key ‘challenge in dental practices’. Suggested ‘ways to collaborate’ could be categorised into five areas: engagement; advocacy; policies; specialty, and; upskilling. Conclusions The findings suggest an urgent need to address low oral health prioritisation, a drive to upskill providers, a challenge of ‘social perceptions’, and a consensual appeal for state-level support. A multi-sector collaboration is needed to align current strategies in order to achieve equity for DOH in ASEAN.
{"title":"Disability and oral health in association of south east Asians - A survey for conceptualisation and development","authors":"Guang Xu David Lim, Siti Hamzah, Ricca Rocco Mae Bernardino, Patcharawan Sukhumalind, N. S. Ishak, Adiningrum Wiradidjaja Adiwoso","doi":"10.1177/20101058221111579","DOIUrl":"https://doi.org/10.1177/20101058221111579","url":null,"abstract":"Background All member states in the Association of South East Asians (ASEAN) are ratified signatories of the UN Convention on the Rights of Persons with Disabilities. However, disability and oral health (DOH) can be an elusive ambition for developing nations. Objectives This survey aims to conceptualise ‘barriers’, ‘improvements’, ‘challenges in dental practice’, and ‘ways to collaborate’, to inform policy development for DOH within ASEAN. Methods The survey employed a novel quasi-qualitative design. It was electronically distributed to dentists with DOH specialty training in ASEAN within the International Association of Disability and Oral Health’s network from September 2018 to June 2020. The ‘barriers’ and ‘improvements’ would be categorised into five dimensions of healthcare - a framework by Levesque and colleagues (2013). Results 21 valid responses were received from Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand. From the care provider’s perspective, adequate training (appropriateness) was most prioritised. From the patient’s aspect, low oral health literacy (ability to perceive) was the most significant. ‘Social perception’ was collectively ranked as the key ‘challenge in dental practices’. Suggested ‘ways to collaborate’ could be categorised into five areas: engagement; advocacy; policies; specialty, and; upskilling. Conclusions The findings suggest an urgent need to address low oral health prioritisation, a drive to upskill providers, a challenge of ‘social perceptions’, and a consensual appeal for state-level support. A multi-sector collaboration is needed to align current strategies in order to achieve equity for DOH in ASEAN.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45357302","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 : 2022-06-01DOI: 10.1177/20101058221146323
J. Leow, Liyi Looi, Yixuan Lee, L. Chew
Background In line with zero-waste movement, there is a need for pharmacies to start reducing waste. There is no systematic waste minimization efforts by local pharmacies or studies to evaluate their effectiveness. Aim Assess behavioral change factors towards waste minimization at National Cancer Centre Singapore and evaluate effectiveness of recycling effort and patient education campaign. Methods Preliminary surveys were carried out among pharmacy staff, patients/caregivers to assess behavioral change factors. Recycling rate of staff and plastic bag consumption levels of patients/caregivers were measured. Results 46 staff members and 335 patients/caregivers were surveyed. Both populations were optimistic about the suggested green initiatives, 82.6% of staff members viewed recycling as a potential solution to reduce waste and 67.6% of patients and caregivers demonstrated willingness to participate in a Bring Your Own Bag (BYOB) campaign. Recycling efforts improved recycling rates by 53.4% while BYOB campaign resulted in no notable decrease in plastic bag consumption levels. Conclusion This study revealed the need for improvements in current waste management practices in local pharmacies, and demonstrated the effectiveness of implementing a recycling effort. BYOB campaign was not shown to be effective. Follow-up studies should be carried out to capture long-term sustainability data. Future efforts should include studies at other non-specialized local pharmacies.
{"title":"Towards zero waste in pharmacy: Challenges and opportunities in Singapore","authors":"J. Leow, Liyi Looi, Yixuan Lee, L. Chew","doi":"10.1177/20101058221146323","DOIUrl":"https://doi.org/10.1177/20101058221146323","url":null,"abstract":"Background In line with zero-waste movement, there is a need for pharmacies to start reducing waste. There is no systematic waste minimization efforts by local pharmacies or studies to evaluate their effectiveness. Aim Assess behavioral change factors towards waste minimization at National Cancer Centre Singapore and evaluate effectiveness of recycling effort and patient education campaign. Methods Preliminary surveys were carried out among pharmacy staff, patients/caregivers to assess behavioral change factors. Recycling rate of staff and plastic bag consumption levels of patients/caregivers were measured. Results 46 staff members and 335 patients/caregivers were surveyed. Both populations were optimistic about the suggested green initiatives, 82.6% of staff members viewed recycling as a potential solution to reduce waste and 67.6% of patients and caregivers demonstrated willingness to participate in a Bring Your Own Bag (BYOB) campaign. Recycling efforts improved recycling rates by 53.4% while BYOB campaign resulted in no notable decrease in plastic bag consumption levels. Conclusion This study revealed the need for improvements in current waste management practices in local pharmacies, and demonstrated the effectiveness of implementing a recycling effort. BYOB campaign was not shown to be effective. Follow-up studies should be carried out to capture long-term sustainability data. Future efforts should include studies at other non-specialized local pharmacies.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43776182","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 : 2022-06-01DOI: 10.1177/20101058221114743
Yeong Y Yik, Arvindran A/L Alaga, H. S. Hin
Osimertinib is a third-generation thyroxine kinase inhibitor (TKI) used in treating advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. Osimertinib is used as a second line treatment for patients who develop EGFR T790 M resistance mutation rather than first line due to financial constraints. We present a case of a 60-year-old Chinese gentleman who diagnosed as stage 4 adenocarcinoma with EGFR Exon 19 deletion. His disease progressed after a year of treatment with afatinib. His plasma T790 M was negative and due to delay in tissue biopsy, he was empirically started on osimertinib. However, in view of financial concerns, he opted a dose reduction of 80 mg every alternate day rather than the conventional dose of 80 mg daily. Serial CT Thorax showed partial response based on RECIST 1.1 criteria and he has 9 months of progression free survival. This case report shows that Osimertinib in reduced dose may achieve good partial response and progression free survival in patients.
{"title":"Osimertinib 80 mg EOD? Does this work?","authors":"Yeong Y Yik, Arvindran A/L Alaga, H. S. Hin","doi":"10.1177/20101058221114743","DOIUrl":"https://doi.org/10.1177/20101058221114743","url":null,"abstract":"Osimertinib is a third-generation thyroxine kinase inhibitor (TKI) used in treating advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. Osimertinib is used as a second line treatment for patients who develop EGFR T790 M resistance mutation rather than first line due to financial constraints. We present a case of a 60-year-old Chinese gentleman who diagnosed as stage 4 adenocarcinoma with EGFR Exon 19 deletion. His disease progressed after a year of treatment with afatinib. His plasma T790 M was negative and due to delay in tissue biopsy, he was empirically started on osimertinib. However, in view of financial concerns, he opted a dose reduction of 80 mg every alternate day rather than the conventional dose of 80 mg daily. Serial CT Thorax showed partial response based on RECIST 1.1 criteria and he has 9 months of progression free survival. This case report shows that Osimertinib in reduced dose may achieve good partial response and progression free survival in patients.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43799288","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 : 2022-06-01DOI: 10.1177/20101058221147755
A. Masnammany, Wendy Lau, P. Wong, N. Manolios
Tumour necrosis factor inhibitors (TNFis) can trigger autoantibody formation and, in a small proportion of patients, result in symptomatic autoimmune diseases, including polymyositis and dermatomyositis. Focal myositis presents with localized muscle pain and is diagnosed based on magnetic resonance imaging (MRI), electromyography (EMG) and muscle histopathology. We report the first case of TNFi-induced focal myositis in the left thigh of a patient with ulcerative colitis on infliximab. A 30-year-old lady presented with left thigh pain with no other systemic manifestation or muscle weakness. The immunology profile showed positivity of antinuclear antibody (ANA), high titre of anti-ds-DNA, and anti-Mi-2 without any features of systemic lupus erythematosus or dermatomyositis. Discontinuation of the TNFi and commencement of glucocorticoids resulted in the resolution of the myositis.
{"title":"Anti tumor necrosis factor induced focal myositis","authors":"A. Masnammany, Wendy Lau, P. Wong, N. Manolios","doi":"10.1177/20101058221147755","DOIUrl":"https://doi.org/10.1177/20101058221147755","url":null,"abstract":"Tumour necrosis factor inhibitors (TNFis) can trigger autoantibody formation and, in a small proportion of patients, result in symptomatic autoimmune diseases, including polymyositis and dermatomyositis. Focal myositis presents with localized muscle pain and is diagnosed based on magnetic resonance imaging (MRI), electromyography (EMG) and muscle histopathology. We report the first case of TNFi-induced focal myositis in the left thigh of a patient with ulcerative colitis on infliximab. A 30-year-old lady presented with left thigh pain with no other systemic manifestation or muscle weakness. The immunology profile showed positivity of antinuclear antibody (ANA), high titre of anti-ds-DNA, and anti-Mi-2 without any features of systemic lupus erythematosus or dermatomyositis. Discontinuation of the TNFi and commencement of glucocorticoids resulted in the resolution of the myositis.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48276889","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 : 2022-06-01DOI: 10.1177/20101058221117891
Tomoki Nakagawa, R. Masuda, Hiraiwa Shinichiro, S. Yamada, M. Iwazaki
An 81-year-old man was admitted for resection of an asymptomatic left anterior mediastinal tumor. Chest computed tomography showed that a small, homogeneous lesion had grown to a large, cystic lesion (80 mm) over a 5-year period. The cystic tumor was removed with adherent structures such as the left upper pulmonary parenchyma and lower part of the left innominate vein via median sternotomy with assistance from a left thoracoscopic procedure. Macroscopically, a solid tumor was located within the large multilocular cyst. The pathological diagnosis was cystic squamous cell carcinoma (12 mm), which had not infiltrated any surrounding organs. The patient has remained well without recurrence as of 4 years postoperatively.
{"title":"Thymic squamous cell carcinoma lurking in a growing large cyst: A case report","authors":"Tomoki Nakagawa, R. Masuda, Hiraiwa Shinichiro, S. Yamada, M. Iwazaki","doi":"10.1177/20101058221117891","DOIUrl":"https://doi.org/10.1177/20101058221117891","url":null,"abstract":"An 81-year-old man was admitted for resection of an asymptomatic left anterior mediastinal tumor. Chest computed tomography showed that a small, homogeneous lesion had grown to a large, cystic lesion (80 mm) over a 5-year period. The cystic tumor was removed with adherent structures such as the left upper pulmonary parenchyma and lower part of the left innominate vein via median sternotomy with assistance from a left thoracoscopic procedure. Macroscopically, a solid tumor was located within the large multilocular cyst. The pathological diagnosis was cystic squamous cell carcinoma (12 mm), which had not infiltrated any surrounding organs. The patient has remained well without recurrence as of 4 years postoperatively.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45278142","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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