1.The impact of malnutrition on health outcomes and healthcare cost among Chinese older adults
Junmin WEI ; Linlin FAN ; Yuhui ZHANG ; Partridge JAMIE ; Claytor LING ; Shirley LI ; Sulo SUELA
Chinese Journal of Geriatrics 2017;36(8):929-933
Objective This study used multivariate regression analysis to study the prevalence of malnutrition and the impact of malnutrition on independence in activities of daily living,health outcomes,chronic disease and healthcare cost among older Chinese adults.Methods This study was based on data from the 2013 China Health and Retirement Longitudinal Survey(CHARLS).The CHARLS data covers information on demographics,family,health status and functional limitations,health insurance,employment and earnings among mid-aged and older community-dwelling Chinese.This research focused on older Chinese adults aged 60 years and over.As a result,over 5,900 subjects were included.This study defined malnutrition based on body mass index,weight loss and reduced handgrip strength.Functional status was assessed via adapted versions of the Katz index of independence in basic activities of daily living (ADL)and the Lawton-Brody index of independence in instrumental activities of daily living (IADL).Health outcomes included self reported health status.Then multivariate regression analysis was used to investigate the relationship between malnutrition and various health outcomes.Results Thirty percent of older Chinese adults were malnourished.Malnutrition was associated with significantly lower IADL (OR =0.868,P < 0.05),poorer health status(OR =0.675,P<0.001),as well as higher probability of having stroke(OR =1.399,P<0.05)and chronic stomach disease(OR =1.241,P<0.001).As a significant contributor of poorer self-reported health status,malnutrition,in turn,increased hospital cost by ¥214 (14%increase,P<0.01)per person per year.Conclusions Malnutrition leads to functional limitations and worse health outcomes among community-dwelling older Chinese adults.These results imply that nutrition interventions such as nutrition screening and assessment,making scientific and personal nutrition support plans,and providing timely adequate nutrition support therapy can improve the health status and lower the healthcare cost of older adults living in the community.
5.Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study.
Amit KANSAL ; Shekhar DHANVIJAY ; Andrew LI ; Jason PHUA ; Matthew Edward COVE ; Wei Jun Dan ONG ; Ser Hon PUAH ; Vicky NG ; Qiao Li TAN ; Julipie Sumampong MANALANSAN ; Michael Sharey Nocon ZAMORA ; Michael Camba VIDANES ; Juliet Tolentino SAHAGUN ; Juvel TACULOD ; Addy Yong Hui TAN ; Chee Kiang TAY ; Yew Woon CHIA ; Duu Wen SEWA ; Meiying CHEW ; Sennen J W LEW ; Shirley GOH ; Jonathan Jit Ern TAN ; Kollengode RAMANATHAN ; Amartya MUKHOPADHYAY ; Kay Choong SEE
Annals of the Academy of Medicine, Singapore 2021;50(6):467-473
INTRODUCTION:
Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC.
METHODS:
We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC.
RESULTS:
Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days,
CONCLUSION
Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult
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Airway Extubation
;
Cannula
;
Critical Care
;
Female
;
Humans
;
Intensive Care Units
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Male
;
Middle Aged
;
Respiratory Insufficiency/therapy*
;
Singapore/epidemiology*
6.Evaluating the importation of yellow fever cases into China in 2016 and strategies used to prevent and control the spread of the disease
Chao Li ; Dan Li ; Shirley JoAnn Smart ; Lei Zhou ; Peng Yang ; Jianming ou ; Yi He ; Ruiqi Ren ; Tao Ma ; Nijuan Xiang ; Haitian Sui ; Yali Wang ; Jian Zhao ; Chaonan Wang ; Yeping Wag ; Daxin Ni ; Isaac Chun-Hai Fung ; Dexin Li ; Yangmu Huang ; Qun Li
Western Pacific Surveillance and Response 2020;11(2):5-10
Abstract
During the yellow fever epidemic in Angola in 2016, cases of yellow fever were reported in China for the first time. The
11 cases, all Chinese nationals returning from Angola, were identified in March and April 2016, one to two weeks after
the peak of the Angolan epidemic. One patient died; the other 10 cases recovered after treatment. This paper reviews the
epidemiological characteristics of the 11 yellow fever cases imported into China. It examines case detection and disease
control and surveillance, and presents recommendations for further action to prevent additional importation of yellow fever
into China.
7.CRISPR Screens Identify Essential Cell Growth Mediators in BRAF Inhibitor-resistant Melanoma.
Ziyi LI ; Binbin WANG ; Shengqing GU ; Peng JIANG ; Avinash SAHU ; Chen-Hao CHEN ; Tong HAN ; Sailing SHI ; Xiaoqing WANG ; Nicole TRAUGH ; Hailing LIU ; Yin LIU ; Qiu WU ; Myles BROWN ; Tengfei XIAO ; Genevieve M BOLAND ; X SHIRLEY LIU
Genomics, Proteomics & Bioinformatics 2020;18(1):26-40
BRAF is a serine/threonine kinase that harbors activating mutations in ∼7% of human malignancies and ∼60% of melanomas. Despite initial clinical responses to BRAF inhibitors, patients frequently develop drug resistance. To identify candidate therapeutic targets for BRAF inhibitor resistant melanoma, we conduct CRISPR screens in melanoma cells harboring an activating BRAF mutation that had also acquired resistance to BRAF inhibitors. To investigate the mechanisms and pathways enabling resistance to BRAF inhibitors in melanomas, we integrate expression, ATAC-seq, and CRISPR screen data. We identify the JUN family transcription factors and the ETS family transcription factor ETV5 as key regulators of CDK6, which together enable resistance to BRAF inhibitors in melanoma cells. Our findings reveal genes contributing to resistance to a selective BRAF inhibitor PLX4720, providing new insights into gene regulation in BRAF inhibitor resistant melanoma cells.
8.Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study.
Abhiram KANNEGANTI ; Benjamin Yong Qiang TAN ; Nik Hisamuddin NIK AB RAHMAN ; Aloysius Sheng-Ting LEOW ; Max DENNING ; Ee Teng GOH ; Lucas Jun HAO LIM ; Ching-Hui SIA ; Ying Xian CHUA ; James KINROSS ; Melanie TAN ; Li Feng TAN ; Yi Min WAN ; Arvind SHARMA ; Rivan DANUAJI ; R N KOMAL KUMAR ; Chew Keng SHENG ; Cheah Phee KHENG ; Sarah Shaikh ABDUL KARIM ; Mohd Najib ABDUL GHANI ; Suhaimi MAHMUD ; Yiong Huak CHAN ; Vijay Kumar SHARMA ; Kang SIM ; Shirley Beng SUAT OOI
Singapore medical journal 2023;64(11):667-676
INTRODUCTION:
The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.
METHODS:
A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).
RESULTS:
We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.
CONCLUSION
Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans
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Cross-Sectional Studies
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Pandemics
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COVID-19/epidemiology*
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Burnout, Psychological
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Health Personnel