INTRODUCTIONIn this study, the pathways patients followed to treatment in an Insomnia Clinic in a psychiatric hospital were compared over 2 periods. The time interval to specialist referrals and patient clinical presentations were also studied. The aim was to better understand referrers' knowledge, needs and accessibility to services.

MATERIALS AND METHODSA retrospective review of cases seen between 2002 and 2005 was compared with an earlier review of cases referred between 1997 and 2000. The information gathered from medical records was similar for the 2 periods.

RESULTSThere were no significant differences in the socio-demographic profiles of patients in the 2 periods. Primary Insomnia was diagnosed in 48.2% of the first period cohort and in 47.5% of the second period cohort. However, among the remaining patients there was a shift from more depressive disorders in the first period to neurosis in the second period. Significantly, there was no difference in alcohol or substance abuse or dependence between the 2 periods. More than three-quarters of the patients had received treatment prior to the referral and for 51.8% in both periods, the providers were family physicians. Treatment was mainly pharmacotherapy with an increase in the use of Sleep Hygiene measures in the second period.

CONCLUSIONThere is a need for continuing medical education on insomnia as well as a need to highlight the risks of untreated insomnia and assessment for other psychiatric disorders in this common complaint.

Adult ; Ambulatory Care Facilities ; Depressive Disorder ; complications ; diagnosis ; Female ; Hospitals, Psychiatric ; Humans ; Male ; Middle Aged ; Neurotic Disorders ; complications ; diagnosis ; Patient Acceptance of Health Care ; psychology ; Referral and Consultation ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; complications ; diagnosis ; therapy ; Young Adult

INTRODUCTIONThere is increasing evidence that second-generation antipsychotics are associated with weight gain. However almost all available literature has been for Caucasian populations.

MATERIALS AND METHODSA health quality improvement project was undertaken at the Institute of Mental Health/Woodbridge Hospital to monitor patients who were started on second-generation antipsychotics. This 2-year survey of 266 patients on second-generation antipsychotics closely tracked weight gain and other physical and biochemical parameters.

RESULTSOf the 222 patients regularly monitored, 78.4% had weight gain (mean weight gain 1.9 kg, maximum weight gain 20.1 kg). Weight gain group liability was highest for clozapine (72.4%), followed by olanzapine (66.7%) and risperidone (65%). Most of the weight gain occurred in the fi rst 4 weeks of treatment and 95.9% of those who gained weight had done so in the fi rst 6 months. The maximum weight gain was seen at 12 weeks for risperidone and 8 weeks for clozapine, quetiapine and olanzapine; the latter having another peak at 6 months.

CONCLUSIONThe survey confirms that weight gain is also a problem for Asian patients treated with second-generation antipsychotics. It reinforces the need for the regular monitoring of patients and the need for psychoeducation and advice on diet and a healthy lifestyle.

Adult ; Aged ; Antipsychotic Agents ; adverse effects ; Asia ; ethnology ; Female ; Health Surveys ; Humans ; Male ; Middle Aged ; Singapore ; Weight Gain ; drug effects ; ethnology ; Young Adult

Introduction: The accurate measurement of the height of bedridden patients is difficult. Height assessment is required for the calculation of body mass index, which is crucial for determining the nutrition status of a patient. This study aimed to validate recumbent length measurement against the standing height measurement using soft and firm mattresses and to derive predictive equations to calculate the actual height of bedridden patients on mattresses with different firmness. Methods: Ninety-nine hospitalised participants (mean age 48.9±13.9 years; range 21–80 years) (49 men, 50 women) and 100 healthy participants (mean age 36.8±13.6 years; range 21–77 years) (50 men, 50 women) were recruited. Standing height was measured using a stadiometer. Recumbent length was measured using a 2 metre long measuring tape. Hospitalised participants lay on soft mattress and healthy participants on firm mattress. Results: Using Bland–Altman plot, 96% of hospitalised participants using soft mattress were within 2.5±2.7 cm (mean±2SD) whereas 97% of healthy participants using firm mattress were within 2.1±2.1 cm. The regression equation developed using firm mattress was Standing height (cm) = 0.993 x Recumbent length – 0.943; (r2=0.982). The regression equation developed using soft mattress was Standing height (cm) = 1.012 x Recumbent length – 4.477; (r2=0.981). Conclusion: We concluded that recumbent length is a valid clinical tool to estimate standing height. Standing height can be estimated from the predictive equations developed for patients lying on soft or firm mattresses.

Objective: Psychiatric case management was introduced in inpatient general psychiatry wards in a tertiary psychiatric hospital in late 2003. A brokerage model of case management is used espousing advocacy with case managers acting in their patient’s best interest to encourage and facilitate use of appropriate psychiatric care and reduce fragmentation and costs. Data on patients’ case managed in 2004 and 2005 was analysed to determine the effectiveness of the service in terms of clinical outcomes and service linkages provided. Methods: Psychiatric case managers maintained databases on the patients referred to them. There were 231 patients in 2004 and 375 patients in 2005. Analyses were performed by using SPSS 13.0 with statistical significance set at P <0.05. Descriptive statistics was used and differences between the 2 cohorts in outcome measures were assessed using Chi-square or Fisher’s Exact test. Results: The service developed with a 62.3% increase in the number of cases accepted for case management in the second year. There was improvement in clinical outcomes, such as reductions in unplanned re-admissions within 28 days from 4.8% in the first year to 2.1% in the second year. A reduction in suicide attempts and forensic complications was also found. There were significant reductions in re-hospitalisation in 2004, from 28.1% to just 6.9% after case management was provided (p<0.001). Conclusion: The brokerage model of case management used in this setting was effective in reducing re-hospitalisation, unplanned readmissions, suicide attempts and forensic complications for psychiatric patients

INTRODUCTIONMalnutrition is common among hospitalised patients, with poor follow up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients postdischarge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation.

MATERIALS AND METHODSConsecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results.

RESULTSIn 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5 kg to 46.3 ± 9.6 kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; P <0.001 for all. Seventy-four percent of patients improved in SGA score.

CONCLUSIONAmbulatory nutrition support resulted in significant improvements in followup rate, nutritional status and quality of life of malnourished patients post-discharge.

Body Weight ; Hand Strength ; Humans ; Nutritional Status ; Pilot Projects ; Quality of Life

INTRODUCTIONElevated levels of psychopathology have been described in various groups of obese patients. This study aimed to describe the presence of depressive and binge eating symptoms in patients presented for clinical weight management at a general hospital in Singapore, as well as their health-related quality of life (HRQOL). Correlations between these symptoms and other demographic and clinical variables were also sought.

MATERIALS AND METHODSPatients presented at a clinical weight management programme were asked to complete the Beck Depression Inventory (BDI), Binge Eating Scale (BES) and the Short Form-36 (SF-36). Clinical and demographic data were also collected.

RESULTSOf the group, 17.1% reported moderate or severe binge eating symptoms and 9.7% reported moderate or severe depressive symptoms. HRQOL, mostly in physical health domains, was lower in this sample compared to local norms. Within the group, binge eating and depressive symptoms, but not increasing obesity, predicted poorer HRQOL.

CONCLUSIONSPsychological symptoms are significantly present in patients presented for clinical weight management and these contribute to poorer quality of life. Addressing these symptoms will improve the overall well-beings of these patients and the total benefits gained will exceed the benefits of weight loss per se.

Adult ; Aged ; Depression ; complications ; diagnosis ; epidemiology ; Feeding and Eating Disorders ; complications ; epidemiology ; Female ; Health Status Indicators ; Humans ; Male ; Mental Disorders ; epidemiology ; physiopathology ; Middle Aged ; Obesity ; complications ; ethnology ; psychology ; therapy ; Psychiatric Status Rating Scales ; Quality of Life ; psychology ; Singapore ; epidemiology ; Young Adult

INTRODUCTIONHaemolysis of blood samples is a common problem encountered in the Emergency department (ED). It leads to inaccurate blood results and has cost implications as blood samples very often have to be retaken. The purpose of our study was to determine which factors in blood sampling were associated with higher rates of haemolysis.

MATERIALS AND METHODSAn observational convenience sample of all patients presenting to the ED requiring blood urea and electrolyte (UE) analysis were eligible for our study. Questionnaires were distributed to the doctors and nurses conducting blood sampling to determine the method used and outcome data were collected after the samples were processed.

RESULTSOut of 227 UE samples analysed, 45 (19.8%) were haemolysed. Various factors, including method (IV cannulation or venepuncture), system (syringe or vacutainer), operator, rate of blood flow, difficulty of cannulation/venepuncture and source of blood (arterial or venous), were analysed, but their effects on haemolysis were not statistically significant (P >0.05). However, the use of the vacutainer system was associated with the highest rates of haemolysis [adjusted odds ratio (OR), 6.0; 95% confidence interval (CI), 2.3 to 15.1].

CONCLUSIONWe found blood sampling with the vacutainer system to have increased rates of haemolysis. This could potentially change attitudes towards equipment used for blood sampling in the ED.

Catheters, Indwelling ; Data Collection ; Emergency Service, Hospital ; Hemolysis ; Humans ; Nurses ; Phlebotomy ; instrumentation ; methods ; Physicians ; Professional Competence ; Singapore ; Syringes ; utilization

AIMMental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital.

MATERIALS AND METHODSSelf-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing.

RESULTS93.8% respondents perceived "contribution to medical knowledge/public health" to be a major benefit of conducting research. 86.7% respondents felt that "learning experience" was important. "Prestige/publication" (52.7%) and "financial gain" (76%) were perceived to be unimportant. "Clinical load of patients", "lack of skilled personnel to assist in research" and "insufficient funding" were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. "Time constraints", "patient and family readiness to research participation", "insufficient training" and "concerns about patient welfare" are major concerns while conducting research.

CONCLUSIONTo the study team's best knowledge, this is the only study of mental health professionals' perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.

Adult ; Attitude of Health Personnel ; Behavioral Medicine ; Behavioral Research ; Cohort Studies ; Data Collection ; Female ; Hospitals, Psychiatric ; Humans ; Male ; Middle Aged ; Personnel, Hospital ; Singapore ; Young Adult

Objective: To describe the prevalence of food allergy in Asian patients with allergic rhinitis. Study Design: A non-randomized prospectively collected patients over a three year period, with complaints of nose congestion, rhinorrhea and/or nasal discharge. Results: There were 435 patients enrolled, 213 children and 222 adults. The children group had a high prevalence of allergen specific IgE to Dermatophagoides pteryonysinus (70%), Dermatophagoides farina (69%), and Blomia tropicalis (55%); followed by dogs (32%), cats (19%) and cockroaches (19%). In the children food allergy category, the top three allergens were egg white (54%), milk (31%) and soya bean (13%). The adult group had results of Dermatophagoides pteryonysinus (71%), Dermatophagoides farina (72%), and Blomia tropicalis (59%); the adult food allergy category, the top 3 allergens were egg white (13%), milk (6%) and soya bean (5%). There was a statistically significant difference in the child and adult group for Dust, D. pteryonysinus, D. farina, B.tropicalis, egg white, wheat, gluten and soya bean. In the age specific child groups, there was an increased in egg food allergy levels, with a peak at the age of five-nine years old and decreasing thereafter (p=0.04). In the children group, the mean Total Nasal Symptom Score (TNSS) was 10.3 (range of 7 to 13); the adult group was similar, with a mean TNSS of 9.8 (range 5 to 12). Conclusion: The prevalence of food allergy in paediatric patients with allergic rhinitis is fairly high and should be considered when treating these children.

INTRODUCTIONMany alcohol-related problems often go undetected and untreated. In Singapore, no epidemiological studies have been done in general hospitals on alcohol use disorders (AUD), i.e. alcohol dependence and abuse (DSM-IV-TR). Such findings are useful in planning AUD liaison services. In this study, we aim to estimate the prevalence of AUD among non-psychiatric inpatients and to determine the rates of identification and intervention rendered by medical staff.

MATERIALS AND METHODSNon-psychiatric medical and surgical wards inpatients aged 21 years and above were recruited over a 3-month period. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for AUD and the MINI International Neuropsychiatric Interview (MINI English Version 5.0.0) was administered to diagnose AUD if the AUDIT score was 8 or above. Case notes were independently reviewed for AUD identification and if interventions were offered during admissions.

RESULTSA total of 5599 inpatients were screened, of which 673 (12%) completed the screening using the AUDIT, and of these, 154 (2.8% of total sample) were positive for AUDIT. In this group, 107 were diagnosed with AUD. The estimated prevalence was 1.9% (approximately 400 cases per year per hospital). The medical staff identified only 25 (23.4%) cases of AUD, out of which, majority of them (76%) were rendered interventions.

CONCLUSIONThe rate of AUD identification by medical staff was low. Of those identified, majority were given interventions. Thus, the training of health care staff to identify AUD together with the implementation of brief interventions should be considered.

Adult ; Aged ; Alcoholism ; diagnosis ; epidemiology ; therapy ; Female ; Hospitalization ; Hospitals, General ; Humans ; Male ; Mass Screening ; utilization ; Mental Health Services ; Middle Aged ; Prevalence ; Referral and Consultation ; Singapore ; epidemiology ; Young Adult