bluuebunny/crossref_metadata_2025_split huggingface dataset:
Threatening Airway Obstruction by Mediastinal Masses: The Experience of a Medical Intensive Care Unit
Authors: Hsu Anne Ann Ling , Phua Ghee Chee 
Published: July 2015

Objective: Life-threatening airway obstruction is a dreaded complication of mediastinal masses. The acute management is difficult and catastrophic outcomes have been reported. We describe our experience in a Medical Intensive Care Unit (ICU) and discuss the management options. Design: Retrospective observational study. Setting: 1,600-bed tertiary-care hospital. Patients and Participants: 13 patients were treated between January 1996 and February 2010. Interventions: All patients were mechanically ventilated. Three received emergent chemotherapy, 10 underwent airway stenting and 2 underwent surgery. Measurements and Results: The median age was 51 years (range 13 to 64). In 5 patients (36%), the diagnosis was only made after ICU admission. Two had benign pathologies (retrosternal goitre and bronchogenic cyst) and 3 had lymphoma. The remaining 8 had metastatic mediastinal lymphadenopathy. All were successfully weaned off the ventilator (range 0 to 5 days). All patients with benign pathologies and lymphoma were still alive with a mean follow-up of 2.8 years (range 1 to 7 years). All patients with metastatic disease died, with a mean survival of 3.8 months (range 1 to 9 months). Conclusion: In the management of life-threatening airway obstruction by mediastinal masses, we reported the heterogeneous nature of this group of conditions. Therefore in the intensive care setting, a definitive diagnosis needs to be established urgently, as treatment and prognosis are highly dependent on the underlying etiology. We propose categorising patients into subgroups and combining various therapeutic modalities.
A Pilot Study of the Effects of Music Listening for Pain Relief among Burns Patients
Authors: Kahar Noor Ahsikin Binte Ab , Kanageswari  , Tay Yong Bee , Koh Khee Xuan 
Published: July 2015

Introduction: The aim of this pilot study was to assess the effects of music listening for pain relief among burns patients during the change of dressings. Methods: Quasi-experimental study was conducted to evaluate if music helps in reducing the intensity of pain experienced by burns patients during wound dressing procedures. A convenience sample of 30 dressing changes were involved. Each dressing change was alternatively assigned to control (not listening to music) and treatment (listening to music) groups. Three assessment tools were used, namely: numeric pain scale, pain behavioural tool, and physiological monitoring. Patients who were given music to listen to were also asked about their experience at the end of the dressing change. Results: Most of the patients experienced little or no pain before dressing change, moderate pain during dressing change and lesser pain thereafter. There were no statistically significant differences in the pain experienced between wound dressing changed with no music listening and wound dressing changed with music listening. Despite a greater proportion of patients being distressed during wound dressing changes without music listening, there was no statistical evidence that music listening had an effect on the patient's distressed status. For wound dressing changes with music listening, patients experienced a lesser degree of change in mean blood pressure and heart rate (not statistically significant) as compared to wound dressing changes without music listening. Conclusion: Preliminary results from this pilot study demonstrated that listening to music might have a positive effect on patient's experience of pain. Large studies are needed to evaluate the impact of music. However many patients verbalised that the soothing music helped to distract them from the pain experience during the dressing changes.
The Use of Individual Performance Metrics to Reduce Prescription Errors in the Emergency Department
Authors: Tiah Ling , Lee Wee Yee , Tiruchittampalam Mohan 
Published: July 2015

Introduction: The study emergency department (ED) receives a new cohort of junior doctors every 6 months as part of the national manpower allocation to meet health service needs. An approach to effect a consistent reduction in prescribing errors by these doctors during their 6-month postings at the study ED was introduced in May 2009. Methods: Monthly broadcasting of prescribing error counts by individual doctors allowed performances to be openly benchmarked against one another while providing a reference for self-improvement. The monthly tally of absolute counts were computed into a pre-determined formula and translated into monetary rewards for the junior doctors. Control charts of total count per month, mean count per doctor per month and highest individual count per month were plotted based on a total of 48 data points for 8 cohorts over 4 years from May 2007 to April 2011. Results: There was a shift towards fewer absolute counts and lower mean count of prescribing errors per month in the post-intervention phase, suggesting a positive impact of the intervention on the doctors as a cohort. The intervention's impact on individual performances, however, was less convincing with minimal change in variation in the highest individual count per month over the 4 years. Conclusion: The use of metrics has helped to drive and sustain a reduction in prescribing errors among junior doctors as a cohort during their 6-month postings in the study ED.
Heparinised Saline versus Normal Saline in Maintaining Patency of Arterial and Central Venous Catheters
Authors: Goh Ling Jia , Teo Hui Sin , Masagoes Masayu 
Published: July 2015

Introduction: Heparin has been used in flush solutions in attempts to prolong the patency of arterial and central venous pressure monitoring lines. Its use however is not without risks such as hypersensitivity reactions and heparin-induced thrombocytopenia. Recent studies suggest that non-heparinised solutions may be as effective in maintaining catheter patency. Our aim is to determine if there is any difference in maintaining patency of arterial and central venous pressure monitoring lines using normal saline as compared to heparinised saline. Methods: In this randomised controlled trial, patients were randomised to receive either heparinised saline or normal saline flush solutions. Randomisation was achieved using sealed opaque envelopes. Only nurses who had been specially trained in the care of catheters cared for the lines. Data was collected at 8-hour intervals for up to 120 hours post-insertion on acceptability of arterial waveform and presence of backflow of blood in the arterial and central venous lines. Results: A total of 70 patients were enrolled, with 36 in the normal saline group and 34 in the heparinised saline group. There were no differences between the groups in functionality of the arterial catheters as determined by waveform and backflow at 72 hours (p=0.578) and 120 hours (p=0.328) as well as for the venous catheters at 72 hours (p=0.063) and at 120 hours (p=0.173) based on presence of backflow. Conclusion: Normal saline is as effective as heparinised saline as flush solutions. Eliminating heparin use in flush solutions will result in fewer potential adverse events and cost savings.
Ten-Year Outcomes of Kidney Transplants at the Singapore General Hospital
Authors: Mok Irene Yanjia , Kee Terence , Goh Angeline 
Published: July 2015

Renal transplantation is the treatment of choice for kidney failure. This study analyses the outcomes of kidney transplant recipients whose transplant was performed at the Singapore General Hospital from January 2000 to 31 December 2010, and who have had at least a year of follow-up in the hospital. Patient demographics, recipient and donor characteristics, graft and patient outcomes were extracted from patients' electronic and hard copy medical records. Graft and patient survival were calculated by Kaplan-Meier analysis until return to dialysis or patient death. There are 332 deceased donor (DD) and 118 live donor (LD) kidney transplants included in this study. Majority of our transplant recipients were Chinese males, and the most common etiology of renal failure was chronic glomerulonephritis. DD recipients were significantly older than LD recipients (45.3+8.2 years vs. 36.9+11.7 years, respectively, P <0.001), and also had a significantly longer duration of dialysis (8.6+2.6 years vs. 2.3+3.5 years, respectively, P <0.001). Majority were on haemodialysis prior to transplantation. DD were significantly older than LD (45.7+8.2 years vs. 37.1+11.8 years, respectively, P <0.001); 73.2% of our DD were standard criteria donors. Graft survival at 5 years was 80.8% and 96.5%, and 65.9% and 79.4% at 10 years for DD and LD transplants, respectively. Patient survival at 5 years was 91.5% and 82.7%, and 99.1% and 84.7% at 10 years for DD and LD transplants, respectively. LD recipients had improved graft and patient survival compared to DD recipients, reinforcing LD kidney transplantation as the treatment of choice for patients with end-stage renal failure.
Knowledge and Attitudes of Junior Medical Doctors towards Gastric Cancer
Authors: Goh Boon Bee George , Tan Meng Yew Damien , Ling Khoon Lin 
Published: July 2015

Introduction: Gastric cancer (GC) has considerable morbidity and mortality in Singapore. As doctors play an important part in persuading patients to undergo screening, and as screening may have an important role in diagnosing early GC, we sought to determine the knowledge and attitudes of doctors towards GC and GC screening. Methods: Self-administered questionnaires were distributed to a cohort of junior doctors in Singapore General Hospital. Results: There were a total of 104 respondents; 82.5% of respondents felt that GC is common in Singapore. While most risk factors (RF) were identified correctly, knowledge of dietary RF was deficient, with only 34.3% and 36.5% realising that a high salt diet and low vegetable/fruit intake were RF, respectively. 95.1% knew that GC can be asymptomatic, but if detected early, is potentially curable (97.1%). Majority of respondents felt that GC was best diagnosed by endoscopy and the best time to diagnose it was when asymptomatic. However, only 52% of the respondents felt that screening gastroscopy was worthwhile. For those willing to pay for screening gastroscopy, the mean cost they were willing to pay was S$243. Conclusion: Our results show that while most RF of GC are well recognised, knowledge of dietary factors is deficient. There is ambivalence towards screening gastroscopy despite knowing that GC is common in Singapore and can be asymptomatic. This may be a barrier to tackling the problem of GC in Singapore. Before we recommend any GC screening programmes in the future, it may be important to optimise knowledge and change the mindsets of doctors in Singapore towards GC.
Evaluation of the Hanen it Takes Two to Talk Intervention Programme
Authors: Fong Nikki Wen Yan , Ho Selina Kah Ying , So Brian Jian Wei , Lian Wee Bin 
Published: July 2015

Introduction: It Takes Two to Talk (ITTT) – The Hanen Programme is a family-focused programme for parents of young children with speech and language delays (SLD). It aims to equip parents with the skills to help their child learn to communicate and use language. This programme is widely used overseas, but there is little evidence about its effect on the Singapore population. The aim of this study was to investigate the effectiveness of ITTT in improving a child's speech and language abilities, and in equipping parents with the skills necessary to teach their children. Methods: Parents of four children aged 26–41 months with a diagnosis of SLD participated in the study. The child's language was evaluated pre- and post-ITTT by a parent report communicative development inventory. Parental perceptions were evaluated with a knowledge, attitudes and perceptions questionnaire. Results: Improvement was seen post-program in expressive vocabulary for all participating children, with an increase in the median vocabulary age-equivalence of the child, beyond that of the chronological time that had elapsed. All parents achieved a pass rate in scores on knowledge-based questions. While 2/3 of parents felt ill-equipped to handle their child's SLD, all were interested to attend training in this area as they saw a need to implement changes in the way they helped their children. Conclusion: Results suggest that ITTT may be a useful tool in helping children with SLD. However, more research needs to be done on a larger population locally to determine the effectiveness of the programme.
Knowledge, Attitudes, and Practices regarding Chickenpox Disease and its Prevention in Singapore: Comparison between Parents and Medical Students
Authors: Ho Ernest Weisheng , Ereno Imelda Lustestica , Ibrahim Masitah , Yeo Cheo Lian 
Published: July 2015

Introduction: The incidence of chickenpox in Singapore is steadily increasing despite the availability of effective preventive measures. To address the need for improvement in public education, a survey was conducted to establish if differences exist amongst parents and medical students with regards to their knowledge, attitudes, and practices regarding chickenpox and its prevention. Methods: Over a six-week period in 2010, an online survey involving parents who attended a paediatric clinic, and medical students from the National University of Singapore, was conducted. Results: Parents had a significantly greater lack of knowledge compared to medical students ( P <0.001). Family and friends were the main source of information for parents and junior medical students, unlike senior medical students who learnt more from physicians. A large majority of responders (85.2%) favoured vaccination for varying reasons, with parents and junior students being more concerned about the spread of disease and favouring its avoidance, and senior students fearing life-threatening complications. Parents who would not recommend the vaccine considered chickenpox a rite of passage and believed the vaccine lacks long-term benefits, while a perception that the disease is mild was more prevalent among medical students. A better understanding of the disease and vaccine was the most influential factor for changing decisions against vaccination. Conclusion: Greater efforts to disseminate information about chickenpox disease and its prevention are needed to address important deficits in public health and medical school education. Being aware that chickenpox can be more than just a mild disease with serious complications may increase the uptake of chickenpox vaccination.
Therapeutic Hypothermia for Hypoxic Ischaemic Encephalopathy in Singapore General Hospital: Two Patient Case Series and Review of Literature
Authors: Arunachalam Sridhar , Poon Woei Bing 
Published: July 2015

Neonatal encephalopathy affects 2–5/1000 live births and hypoxic ischaemic encephalopathy (HIE) is the major cause1. Therapeutic hypothermia reduces brain injury and improves the neurodevelopmental outcome. We are sharing our local experience in therapeutic hypothermia in the form of a case series of two patients. Our incidence of moderate to severe HIE is 0.6/1000 live births. Both patients were cooled for 72 hours. The challenges faced were mainly in the time taken for achieving the target temperature and the time needed for re-warming, which varied from one to six hours and 4–24 hours, respectively. Complications like hyponatremia, hypokalemia, sinus bradycardia and thrombocytopenia were noted. Amplitude integrated electroencephalogram (aEEG) remained abnormal post cooling for both babies. Clinical markers, aEEG and MRI head findings combine to prognosticate well for the neurodevelopmental outcomes. We need to be familiar with the protocol for timely implementation of cooling, whichever the cooling method. Concentrating these high-risk cases in selected tertiary centres capable of instituting cooling as well as long-term follow-up will ensure better outcomes.
A Peri-Operative Audit of the Paediatric Cochlear Implantation Programme at the Singapore General Hospital
Authors: Phoon HYP , Kan AD , Yam PC Ip 
Published: July 2015

Introduction: Paediatric cochlear implantation has become an established procedure for treating irreversible hearing loss. The aim of this survey was to review the peri-operative anaesthetic management of this programme since its inception. Methods: We conducted a retrospective clinical audit of 184 paediatric (age <12) cochlear implantation cases by reviewing clinical records. The surgery was performed by the same surgeon at the Singapore General Hospital (SGH) from 1997 to 2010. Results: A total of 184 procedures (including five bilateral cases) were performed on 173 patients. The average age (mean [standard deviation, range]) at the time of surgery was 3.7 (±2.6, 0.7–11) years. The mean duration of the unilateral and bilateral implantation procedures were 3.2 (±1.0, 1.2–6.5) hours and 4.7 (±0.8, 4–6) hours respectively. Inhalational anaesthesia (66.3%) was the most popular choice for induction. 15 (8.1%) patients required additional analgesia in the post-anaesthetic care unit. In the ward, 14 patients (7.6%) required stronger analgesia in addition to paracetamol. Peak paracetamol requirement (22.9 [±16.6] mg/kg) was on the first postoperative day. Nausea and vomiting was reported in 19 (10.3%) procedures. The correlation between increasing age and post-operative nausea and vomiting was statistically significant (p<0.05) as was the association between age and analgesic requirements. The average duration of hospital stay was 3.2 (±1.0, 1–6) days. Mean age at time of surgery as well as duration of unilateral implantation procedures decreased over time. A trend towards same day admission (SDA) was also noted. Conclusion: Cochlear implantation in paediatric patients is a relatively safe procedure involving few complications.
Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort
Authors: Ng Yee Sien , Astrid Suantio , De Silva Deidre Anne , Tan May Leng Dawn , Tan Yeow Leng , Chew Effie 
Published: July 2015

Aim: Rehabilitation is proven to improve function following a stroke. The functional outcomes of stroke patients and benefits from rehabilitation are highly variable. We aim to describe functional outcomes and gains following inpatient rehabilitation post-stroke and identify factors associated with improved outcomes. Methods: In this five-years prospective study, data for 1332 consecutive stroke patients admitted to the Singapore General Hospital inpatient rehabilitation unit were charted into a custom-designed rehabilitation database. The primary outcome measure was the Functional Independence Measure (AFIM) and discharge (DFIM). The functional gain was defined as the DFIM-AFIM. Results: The mean age was 64.1±12.5 years, 58.9% were male patients and 78.9% consisted of ischaemic (versus haemorrhagic) strokes. The average rehabilitation length of stay (RLOS) was 18.7±13.9 days and the majority (87.7%) were discharged home. The most common risk factor was hypertension (78.4%) and urinary tract infection (21.2%) was the commonest post-stroke complication. The mean AFIM and DFIM scores were 67.9±23.0 and 83.2±23.5 respectively with a mean functional gain of 15.4±12.3 FIM points. Younger, male, and haemorrhagic stroke patients had better functional outcomes. Multiple regression analysis results revealed that higher DFIM score was associated with higher admission motor and cognitive FIM scores, younger age, male gender, employment at admission, single patients, presence of a caregiver, haemorrhagic stroke, right-sided motor impairments, absence of urinary tract infection or depression, acupunction treatment, and a longer RLOS. The regression model on functional gain was associated with similar independent predictors on DFIM scores except that a higher AFIM was associated with lower functional gains. Conclusion: In this large cohort study, stroke patients make significant functional gains and should be offered rehabilitation to improve outcomes. A comprehensive set of multiple interacting demographic, clinical, cultural, and social factors significanctly impact on stroke functional outcomes after inpatient rehabilitation. The identification of these factors allows optimising rehabilitation for individual patients, and is important for discharge and resource planning.
Advocating for the Best Interests of Critically Ill Newborn Infants
Authors: Ho Lai Yun , Tan Tong Khee , Goh Pheck Suan June 
Published: July 2015

This bioethics article deals with the conflict and difficulty in quality of life judgements. The importance and roles of the various stakeholders in determining the management of critically ill infants are described. This is an in-depth insider perspective of one of the most difficult medical decision making processes when dealing with infants with poor prognoses. The complex treatment options often fraught with ethical dilemmas and conflict are discussed from the viewpoints of patient, family, and physician. The role of the ethics committee and legislation in the decision making process is discussed.
A Pilot Study to Evaluate the Role of Therapeutic Drug Monitoring of Pegfilgrastim in Lymphoma Patients Receiving Chemotherapy
Authors: See Michelle , Shih Vivianne Lee Chuen , Ho Han Kiat , Tang Tiffany Pooi Ling , Farid Mohamad , Quek Richard Hong Hui , Tao Miriam , Lim Soon Thye , Chan Alexandre 
Published: July 2015

Background: Despite primary prophylaxis of febrile neutropenia (FN) with pegfilgrastim, studies have demonstrated a significant number of breakthrough FN events among Asian lymphoma patients receiving chemotherapy. This study was designed to investigate the association of pegfilgrastim concentrations during the lowest point of absolute neutrophil count (ANC nadir) after chemotherapy administration and the occurrence of breakthrough FN, to evaluate whether Therapeutic drug monitoring of pegfilgrastim can guide management of FN. Methods: This was a single-centre, prospective cohort study of Asian lymphoma patients who received prophylactic pegfilgrastim after completion of their chemotherapy. Pegfilgrastim serum concentrations were measured from blood samples taken during ANC nadir and at development of breakthrough FN using an enzyme-linked immunosorbent assay. Descriptive statistics, t-tests and correlation curves were used in the statistical analyses. Results: Nineteen patients were recruited from May to August 2012 and received 21 cycles of pegfilgrastim. Three (15.8%) developed breakthrough FN. The median pegfilgrastim concentration among patients who developed breakthrough FN was 0.257 (0.231–0.631) ng/ml, compared to 0.299 (0.001–0.829) ng/ml in patients who did not (p=0.740). Baseline ANC levels were significantly lower in patients with breakthrough FN (3.59 × 109/L, range 2.71–3.87) versus those who did not (5.36 × 109/L, range 2.80–16.48; p=0.014). Conclusion: There was no difference in pegfilgrastim levels during ANC nadir between patients who developed breakthrough FN and those who did not, but the study was underpowered. Therapeutic drug monitoring of pegfilgrastim cannot be recommended at this time.