bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Influencing Decisions to Withdraw or Continue Life Support and Attitudes towards Treatment of the Critically Ill: A Survey of Registered Nurses in Intensive Care Units
Authors: Tai Clara Chia Chia , Li Li Ng Deborah 
Published: July 2015

Introduction: To examine the major determinants influencing the decision to withdraw or continue life support and the attitudes of registered nurses towards the treatments for the critically ill patients in intensive care units (ICUs). Methods: A self-administered questionnaire was distributed to a convenience sample of registered nurses working in 4 ICUs of a large teaching hospital in Singapore. The questionnaire consisted of 3 sections. The first section gathered details about the respondent's demographics; the second section required respondents to rate the importance of 18 different factors influencing the decision to withdraw or continue life support (1 = least important, 5 = most important) while the third section elicited responses about management strategy to 2 clinical scenarios from a possible pool of 6 different scenarios. Results: Eighty-three nurses responded (response rate: 70%). Patient advance directives (μ =3.63), likelihood of surviving current episode (μ = 3.52) and premorbid cognitive function (μ = 3.49) were the most important consideration factors for the withdrawal of life support. Across various clinical scenarios, the majority (82.6%) reported that “continue with current management” was most likely to be in the patients' best interests. Level of agreement between what the respondents believed to be in the patient's best interest and their responses on what they would do if they encountered a similar case was good (Kappa=0.78). Conclusion: Respondents regarded “Patient advanced directives” to be the most important factor in influencing decisions to withdraw or continue life support. In general, nurses were uncomfortable with complete withdrawal of life support. One way to minimise the impact of clinician's social, ethical, moral and religious values on medical decision making is to encourage more Singaporeans to make an Advance Medical Directive.
Vasopressin and Terlipressin in the Treatment of Vasodilatory Septic Shock: A Systematic Review
Authors: Soong Jie Lin , Lim Wai Hing 
Published: July 2015

Background: Vasodilatory septic shock unresponsive to fluid resuscitation requires the addition of vasopressors. Catecholamines remain the first line vasopressor therapy, but treatment failure is a potential problem. Vasopressin and its analogue, terlipressin, have been used for this indication. Objective: This systematic review aims to evaluate the effects of vasopressin and terlipressin on mortality and morbidity outcomes in patients with vasodilatory shock. Secondary outcomes include the effects of vasopressin and terlipressin on haemodynamic stability and organ function. Method: A computerised search of MEDLINE from January 1966 till June 2010 and screening of references of relevant articles were conducted. Only prospective, randomised controlled trials comparing vasopressin or terlipressin versus standard vasopressors or placebo were included. Results: Seven studies using vasopressin, three using terlipressin and one using both were identified. Four vasopressin trials assessing mortality and morbidity outcomes showed a trend towards benefit for mortality in adults but possibly adverse outcomes in a small paediatric study. No data was available on the long-term mortality and morbidity outcomes of terlipressin. Vasopressin and terlipressin were similar to standard vasopressors in maintaining haemodynamic parameters, while allowing a beneficial catecholamine-sparing effect. These agents also had a neutral to positive effect on organ function. Conclusion: Vasopressin and terlipressin was comparable to conventional agents in the maintenance of haemodynamic stability and organ function in vasodilatory shock. Since morbidity and mortality data do not differentiate vasopressin and terlipressin from catecholamines, their role remains unclear. More large studies evaluating the long-term outcomes in this group of patients are required.
A Retrospective Study of Temporomandibular Joint Internal Derangement Treated with Arthrocentesis and Arthroscopy
Authors: Tan Danny Ben Poon , Krishnaswamy Gita 
Published: July 2015

Introduction: Internal Derangement of the Temporomandibular Joint is an intra-articular condition in which there is a disruption in the normal relationship of the articular disc to the articular eminence and the condyle when the joint is at rest or in function. Patients may complain of pain and/or limitation of mouth opening. Treatment of internal derangement of temporomandibular joint includes arthrocentesis and arthroscopy. The aims of this retrospective study are to examine the efficacy of arthrocentesis and arthroscopy in the treatment of internal derangement of temporomandibular joint, specifically in relation to joint movement and pain. Methods: Twenty consecutive patients with internal derangement of temporomandibular joint seen in National Dental Centre of Singapore, from 2010 to 2011, were included in this study. Nine patients underwent arthrocentesis and 11 had arthroscopic lysis and lavage. The pre and postoperative pain score, in Visual Analogue Scale (0 to 10) and maximal inter-incisal opening were recorded to evaluate the effectiveness of both treatment modalities. The patients were reviewed one week and one month post-operation. The data obtained were statistically analysed. Results: Significant increase in postoperative mouth opening and reduction in pain were found in both groups of patients. In the arthrocentesis group, the mean increase in maximal inter-incisal opening was 13 ± 5mm and reduction of pain in VAS was 4.56 ± 1.74. For the arthroscopy group, the mean increase in maximal inter-incisal opening was 6.6mm ± 4.8mm and the reduction of pain was 2.5 ± 2.2. Duration of symptoms prior to treatment appeared to have influenced the treatment outcome of both treatments. Conclusion: Arthrocentesis and arthroscopy are effective in the treatment of internal derangement of temporomandibular joint. Factors that may influence treatment outcomes need to be investigated to provide more information on the predictability of arthrocentesis and arthroscopy.
Pathological Outcome in Men with Prostate Cancer Suitable for Active Surveillance after Radical Prostatectomy
Authors: Tan Grace , Ho Henry , Huang Hong g , Cheng Christopher Wai Sam , Lau Weber Kam On 
Published: July 2015

Background: Active surveillance (AS) as a treatment option for low risk prostate cancer is gaining recognition. We evaluate the validity of the AS protocol in our patient population, by defining the risk of undergrading and understaging in their pathology. We also aim to determine more accurate inclusion criteria, in order to improve the prediction of early low risk prostate cancer. Materials and Methods: Data was taken from our institutional prostate cancer registry for all men who underwent radical prostatectomy (RP) between Jan 2000 and June 2009. We determined if any of the patients would have met the University of Toronto's (UoT) AS inclusion criteria and examined their post-operative pathology. The primary end-point was pathological upgrading and upstaging. The individual inclusion factors i.e. preoperative PSA, were tested for statistical significance and better cutoffs. Univariate, multivariate and ROC curves were used in the statistical analysis. Results: 216 RPs were performed between January 2000 and June 2009. We identified 79 men who fulfilled the UoT AS criteria. 35% of patients had a Gleason score upgrade from biopsy to surgery, and 21.5% of patients had an upstage to T3 disease. Overall, 34 (43%) patients had an unfavourable change in the grade and/or stage of their prostate cancer. Conclusions: There is a significant risk of undergrading and understaging with the current criteria used for AS. There is a need to identify more discriminative AS criteria before it can be offered as an option to patients with clinically early prostate cancer.
The Singapore General Hospital Peritoneal Dialysis Programme from 2000–2008
Authors: Choo Jason Chon Jun , Ong Shin Yeu , Krishnasamy Thanaletchumi , Foo Marjorie Wai Yin 
Published: July 2015

Introduction: There is lack of data regarding outcomes of peritoneal dialysis (PD) in Singapore. The aim of this study is to retrospectively evaluate the patient characteristics, technique survival, and patient survival in a single centre. Methods: The retrospective review included 1,015 adults (47.3% female, 72.6% Chinese, mean age 58±12.4 years, mean follow-up 39.7±27.7 months) initiated on PD at the Singapore General Hospital from January 2000 to December 2008. Baseline characteristics, including cause of end-stage renal disease (ESRD), comorbid conditions, and endpoints (ie. death, transfer to HD or transplantation, renal recovery or until last follow-up on 31 December 2010) were collected. Demographic variables and patient and technique survival rates were analysed. Results: The main causes of ESRD were diabetes mellitus (DM) (58.0%), glomerulonephritis (GN) (23.3%) and hypertension (15.4%). The 1, 2, 5 and 10-year patient survival rates were 88.7%, 77.7%, 39.8% and 15.4%, respectively. Causes of death were related to infection (43.1%) and cardiac (37.8%). Patient survival rates were significantly better in PD patients with ESRD due to GN, compared with DM (5-year survival rates of 70.2% versus 22.3%, P <0.001). Patients aged 65 years and older had lower survival rates compared with those aged less than 65 years ( P <0.001). The 1, 2, 5 and 10-year technique survival rates were 92.9%, 85.0%, 64.8% and 32.9%, respectively. Peritonitis was the main cause of technique failure (63.5%), and caused 13.8% of deaths. Technique survival rates were better in patients with ESRD due to GN, compared with DM (5-year survival rates of 70.9% versus 62.0%, P <0.05). Conclusion: In our single-centre retrospective review, technique survival was comparable to other East Asian centres. The poorer patient survival observed in this study may be due to older age and higher comorbidity.
Preliminary Report on Efficacy of Acupuncture versus meToclopramide for Management of Post-Operative Gastroparesis (EAT POSTOP Trial)
Authors: Ho Vui Kian , Ong Sharon , Cui Shuli , Hwang Nian Chih 
Published: July 2015

Introduction: Gastroparesis is common in intensive care patients and may increase the incidence of malnutrition and nosocomial pneumonia, leading to poorer patient outcomes. Current pharmacotherapy has shown only modest efficacy. Acupuncture without pharmacotherapy has been shown to improve gastroparesis in animal studies and in recent clinical trials. However, no trials studying the efficacy of acupuncture as an adjunctive therapy for surgical intensive care patients have been done. This study aims to evaluate the effectiveness of adding electro-acupuncture therapy to pharmacotherapy in the management of gastroparesis in these patients. Methods: For this prospective block randomised controlled trial, we aim to recruit 200 adult surgical intensive care patients who require gastric enteral nutrition, and mechanical-assisted ventilation, and who have gastroparesis (gastric residual volumes more than 120 mL twice four hours apart). Patients will receive either metoclopramide 20 mg intravenously thrice daily (Group M) or electro-acupuncture comprising four sessions of 30-minute electro-acupuncture at specific sites over 48 hours in addition to intravenous metoclopramide 20 mg thrice daily (Group A). Gastroparesis resolution is defined as 24-hour cumulative gastric residual volumes less than 200 mL. Patients are followed-up for 48 hours from the commencement of therapy. Results: Three patients have been recruited in a four-month period thus far. Two are in Group A and one in Group M. All have met the study definition of gastroparesis resolution. The incidence of gastroparesis in this period among longer stayers in the unit (n = 92) is 8.7%. Conclusions: The trial is on-going. Reasons for the low incidence of gastroparesis are discussed. The study of the use of acupuncture in the treatment of intensive care patients with gastroparesis is worthwhile due to its excellent side-effect profile and if successful, will be a tool to improve nutritional support.
Nosocomial Infections (Late Onset Sepsis) in the Neonatal Intensive Care Unit (NICU)
Authors: Joseph Carolin Jeyanthi , Lian Wee Bin , Yeo Cheo Lian 
Published: July 2015

Objective: Neonates admitted to the Neonatal Intensive Care Unit (NICU) are at high-risk of developing nosocomial infection. Ongoing infectious disease surveillance is essential to minimise the occurrence of nosocomial infection. To determine the incidence of nosocomial infection, distribution of pathogens, associated risk factors and outcomes, we evaluated a cohort of 263 neonates who were admitted to NICU from May 2005 to May 2007. Methods: The Singapore General Hospital neonatal database was tapped into to obtain information on all nosocomial infections that occurred during the review period. The inpatient case notes of these infants were reviewed, detailed data on epidemiology of infection, results of blood and cerebral spinal fluid culture were collected; associated risk factors and outcomes were evaluated. Results: Out of 255 neonates who were analysed, 20 infants (7.8%) developed nosocomial infection. The vast majority of infections (85%) were caused by Gram-positive organisms with coaugulase-negative Staphylococci accounting for 55% infection. Birth weight and gestational age were inversely related to rate of infection (13% of very low birth weight infants [VLBW] versus 4.1% of non-VLBW infants). Among VLBW infants, prolonged mechanical ventilation, central line insertion and chest tube insertion were associated with an increased rate of late-onset sepsis (LOS). Neonates with LOS had a significantly prolonged hospital stay (mean length of stay 84 days versus 54 days). The mortality rate for nosocomial sepsis was 5%. Conclusion: This study documents the high prevalence of nosocomial infection in neonates admitted to NICU, particularly VLBW infants. Identification of VLBW infants who are at high-risk for LOS and early detection of LOS remain the keys to successful management of this condition.
Paediatrics Rheumatology Clinic Population in Singapore: The KKH Experience
Authors: Tan Justin Hung Tiong , Fun Hoh Sook , Arkachaisri Thaschawee 
Published: July 2015

Introduction: The subspecialty of paediatric rheumatology (PR) is the newest discipline established at KK Women's and Children's Hospital, in 2009. The service provides tertiary care for children with rheumatic diseases in Singapore. Referral population to this subspecialty has not been described in this region. Methods: Using the Registry for Childhood Onset Rheumatic Diseases (RECORD), a dedicated web-based data entering system, case descriptions and diagnoses were captured. Standardised descriptions of diagnoses were used. Results: Data from January 1, 2009 to March 31, 2012 included 1158 referrals which were analysed. Almost half (42.2%) were diagnosed as non-rheumatic conditions. Systemic vasculitides (28.4%) with Henoch-schonlein purpura (HSP) and Kawasaki disease (KD) were the most common rheumatic diseases. Enthesitis related juvenile idiopathic arthritis (JIA) was common but JIA associated uveitis was rare, so as to antinuclear antibody (ANA) positivity (25.4%). The remaining 36.4% of patients with rheumatic disease had a variety of other conditions. Primary angiitis of the central nervous system (CNS) and recurrent aphthous stomatitis were seen more commonly in local patient than in patients from the west. Of the patients with non-rheumatic disease, 66.3% had orthopaedic/mechanical related conditions, 7.4% had a fever of unknown causes and 4.9% had infections. Mechanical joint pain (67.6%) and hypermobility syndrome (18.5%) were the most frequent referrals. Conclusion: Our report described, for the first time, a large single centre cohort of a PR clinic population. Local frequencies or burden of paediatric rheumatic diseases and unique findings were delineated. Targeted education and awareness to both healthcare professionals and members of the public were made possible. However, continuous prospective longitudinal data collection is on-going in order to confirm our initial observation.
Disease Characteristics of the Singapore Systemic Sclerosis Cohort
Authors: Ling Andrea Low Hsiu , Gee Teng Gim , Giap Law Weng , Cheng Ng Swee , Santosa Amelia , Chan Grace , Lim Anita , Ee Png May , Qing Teo Huan , Ting Lee Ping , Thumboo Julian 
Published: July 2015

Introduction: Systemic sclerosis (SSc) has one of the worst prognoses among autoimmune diseases. Multi-ethnic Western cohorts have shown ethnic differences in disease characteristics. Due to a paucity of data in Asia, we aimed to describe the disease characteristics and autoantibody profile of Asian SSc patients. Methods: The Singapore SSc database consists of prevalent and incident cases from four institutions. Data were recorded annually according to a standardised protocol. Cumulative disease characteristics were analysed using descriptive statistics. Results: From 2008 to 2012, 200 patients (85.5% females; Chinese 78%, Malays 10.5%, Indians 6%) diagnosed at a mean age of 46 years, fulfilled the American College of Rheumatology (ACR) (88.0%) or the Very Early Diagnosis of SSc (VEDOSS) (12%) criteria. SSc subtypes include limited cutaneous SSc (LcSSc) (32%) or diffuse cutaneous SSc (DcSSc) (37.6%), SSc-overlap syndromes (27.4%) and sine scleroderma (3%). Predominant disease manifestations were Raynaud's phenomenon (n=161, 80.5%), gastrointestinal (GI) (n=125, 62.5%), joint pain (n=116, 58%) and interstitial lung disease (ILD) (n=99, 51.8%). Pulmonary arterial hypertension (PAH) by echocardiography was present in 23.2% (39/168) of patients (mean systolic pulmonary arterial pressure 55.0+19.7mmHg). Renal crisis was rare (n=4, 2%). Anti-nuclear antibodies (ANA) tested positive in 78.7% (155/197), with anti-Scl-70 (69/197, 35.0%), anti-ribonucleoprotein (RNP) (56/192, 29.2%) and anti-Ro60 (40/193, 20.7%) most frequently detected. Anti-centromere antibodies were infrequent (23/190, 12.1%). Treatment included corticosteroids (80.7%), for peripheral vasculopathy (61.4%), GI (68%), PAH (11.2%) and immunosuppression (62.9%). Conclusion: Compared to Caucasian patients, our predominantly Chinese Asian SSc patients were diagnosed at an earlier age, with more severe PAH, less frequent Raynaud's phenomenon, an autoantibody profile characterised by anti-Scl70, anti-RNP and anti-Ro60, infrequently anti-centromere and more patients had DcSSc.
A Preliminary Review of the Medication Management Service Conducted by Pharmacists in Haemodialysis Patients of Singapore General Hospital
Authors: Li Li Chen 
Published: July 2015

Background: Patients with end-stage renal disease (ESRD) are at risk of developing drug-related problems (DRPs) due to polypharmacy, multiple co-morbidities and frequent medication changes. Objective: To evaluate the prevalence of DRPs identified and the types of interventions made by Medication Management Service (MMS) pharmacists. Methodology: Renal MMS was set up to conduct comprehensive medication review and medication reconciliation in haemodialysis patients. A pharmacist review was arranged for selected patients prior to the renal physician's appointment. A written report on the findings and proposed recommendations after the pharmacist's review was submitted to the referring physician to aid clinical decision making. This acted as a method of communication between the patient's dialysis centre, pharmacist and attending renal physician. Results: A total of 30 patients were enrolled into the service within a period of five months. Each patient had, on average, 3.1 DRPs. The three most common DRPs were non-adherence (41.5%), untreated indications (14.9%) and adverse drug reactions (11.7%). A total of 54 interventions were performed and almost half of them involved suggestions to modify dosing regimens (51.9%), followed by suggestions to add new drugs (16.7%) and to discontinue drugs (13.0%). Conclusion: The high prevalence of DRPs in renal patients warranted a multidisciplinary team approach. MMS conducted by pharmacists may help to address the gap in information when patients transfer between healthcare settings.
The Use of Single-Injection Thoracic Paravertebral Block in Breast Cancer Surgeries in Our Asian Population: The Singapore General Hospital Experience
Authors: Khai Darren Koh Liang 
Published: July 2015

Background: This series of cases describe the experience of using the single-injection thoracic paravertebral block of ropivacaine 1% to provide analgesia in breast cancer surgery in Asian patients within the Singapore General Hospital. Cases: Over these eight years, we documented 32 cases scheduled for elective breast cancer surgery with axillary dissection. These patients received 20 ml ropivacaine 1% with adrenaline (5 ug/ml) injected into the paravertebral space prior to surgery. All patients received a standardised regime of general anaesthesia, using fentanyl (if intra-operative supplemental analgesia was required). Patient-controlled analgesia (PCA) of morphine was used for post-operative analgesia. Assessments included peri-operative analgesic requirement, pain score, and shoulder movement limitation, incidence of nausea or vomiting, and adverse effects of the block. Observations: Parathesia using the loss of pinprick sensation was elicited in all patients after the institution of the block. A median of seven (range 4–11) dermatomes were recorded in this series. Seventy-five percent of the patients underwent surgery without supplemental analgesia. In the immediate post-operative period, 87.5% of patients reported none-mild pain. Over 90% responded with none-mild pain in the 24-hour post-operative period. No local anaesthetic toxicity or severe adverse effects of paravertebral block was observed. Conclusion: The single-injection of ropivacaine 1% into the thoracic paravertebral space is a useful alternate analgesia strategy for breast cancer surgery in our Asian population.
Relationship between Sperm Hyaluronan-Binding Assay (HBA) Scores on Embryo Development, Fertilisation, and Pregnancy Rate in Patients Undergoing Intra-Cytoplasmic Sperm Injection (ICSI)
Authors: Fen Carine To Chiou , Lee Shaw Ni , Lim Mui Nee , Yu Su Ling 
Published: July 2015

Introduction: The novel development of the sperm hyaluronan-binding assay (HBA) has now been routinely used in some laboratories worldwide to predict sperm maturity and functionality. Hence, the purpose of this study is to evaluate if embryo development, quality, fertilisation and pregnancy rates are affected by low HBA values. Methods: A total of192 female patients who underwent intra-cytoplasmic sperm injection (ICSI) were compared retrospectively in terms of embryo development, fertilisation, and pregnancy rates with their husbands' HBA score. Patients' husbands were required to undergo a HBA test before the start of their stimulation cycle to determine if their semen was suitable to undergo ICSI or in-vitro fertilisation (IVF). P-value < 0.05 was considered significant. Results: Patients were divided into four groups, group A (HBA ≤ 15%), group B (HBA > 15% < 35%), group C (HBA ≥ 35% < 60%), and group D (HBA ≥ 60%). The fertilisation rate for groups A, B, C, and D were 67.9%, 73.1%, 72.5%, and 77.1% respectively. Group D had a fertilisation rate significantly higher than the rest of the groups ( p = 0.016). The pregnancy rate for group D was also significantly higher amongst the four groups ( p = 0.041), whereas the pregnancy rate for groups B and C was similar (42.4% versus 41.1% respectively). Day three cleavage rate (the ability to reach six cells and beyond) was highest for group D compared to the other groups ( p = 0.002). Conclusion: The higher the HBA score, the better the fertilisation, pregnancy, and cleavage rates. This shows that HBA does have the ability to select mature sperms with normal chromosome development and oocyte-binding capability.