Hospitals ; Humans ; Logistic Models ; Retrospective Studies ; Singapore ; Smoking Cessation ; methods ; statistics & numerical data

Absenteeism ; Emergency Service, Hospital ; Hospitals, General ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Personnel, Hospital ; Sentinel Surveillance ; Singapore ; epidemiology

Air Pollutants ; Dengue ; epidemiology ; transmission ; Disease Notification ; Humans ; Models, Theoretical ; Singapore ; epidemiology

INTRODUCTIONAsthma control varies in different clinical settings because of its multidimensional and heterogeneous nature, and variability over time. The revised asthma management guidelines indicate that the goal of treatment should be maintaining asthma control for long periods. The aims of this study were to explore: (i) difference in asthma control test scores in patients at different clinical practice settings; (ii) assess if patients were overestimating the level of their asthma control and (iii) assess the relationship of the derived Asthma Control Test (ACT) score to cost of inpatient stay and length of stay (LOS).

MATERIALS AND METHODSThe Asthma Control Test (ACT) is a 5-item questionnaire that assesses the multidimensional perspective of asthma control from activity limitation, shortness of breath, night symptoms, use of rescue medication and self-perception of asthma control. The score ranges on a scale from 1 (poorly controlled) to 5 (well controlled). ACT was administered to 447 patients diagnosed with asthma from the in-patient and out-patient settings (new and follow-up cases).

RESULTSThree hundred and ninety-nine (92%) patients completed the ACT questionnaire. The analysis only included patients who had completed the ACT questionnaire. The analysis showed that all the 5 items in the ACT questionnaire were significantly associated with different clinical settings (P <0.001). When we correlated the ACT question 5 (patients' self-rating of asthma control) in the ACT with Question 3 and Question 4 individually, it showed that most patients did not overestimate their asthma control (P <0.001). However, there was no correlation between the derived ACT score and cost (P = 0.419), LOS (P = 0.373), and the number of comorbid medical history (P = 0.055).

CONCLUSIONOur results reinforce the usefulness of ACT for clinicians to identify patients with poorly controlled asthma and to optimise their level of control in different clinical settings.

Adult ; Asthma ; physiopathology ; therapy ; Female ; Hospitalization ; Humans ; Length of Stay ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; classification ; Primary Health Care ; Prospective Studies ; Surveys and Questionnaires ; Young Adult

INTRODUCTIONDuplex ultrasonography is an excellent non-invasive screening tool for carotid artery stenosis. The aim of this study was to evaluate optimal ultrasonographic criteria for determination of internal carotid artery stenosis with reference to digital subtraction angiography.

MATERIALS AND METHODSFrom January 1995 to December 2003, 114 symptomatic patients underwent both duplex ultrasonography and angiography. Seven velocity criteria were compared with angiographic stenosis and receiver operating characteristic curves were used to determine the best cutoff for each criteria.

RESULTSInternal carotid artery/common carotid artery systolic velocity ratios (PSV ICA/PSV CCA) and systolic internal carotid artery/diastolic common carotid artery ratios (PSV ICA/EDV CCA) were superior to other criteria for diagnosing internal carotid artery stenosis. For 50% stenosis, the best criterion of PSV ICA/PSV CCA was 1.5 [sensitivity 100%, specificity 85%, area under the curve (AUC) 99%], and the best criterion of PSV ICA/EDV CCA was 3.5 (sensitivity 100%, specificity 58%, AUC 99%). For 60% stenosis, the best criterion of PSV ICA/PSV CCA was 2.6 (sensitivity 100%, specificity 94%, AUC 99%), and the best criterion of PSV ICA/EDV CCA was 10.3 (sensitivity 100%, specificity 96%, AUC 99%). For 70% stenosis, the best criterion of PSV ICA/PSV CCA was 3.1 (sensitivity 100%, specificity 91%, AUC 99%), and the best criterion of PSV ICA/EDV CCA was 10.3 (sensitivity 100%, specificity 91%, AUC 99%).

CONCLUSIONOur study showed that velocity ratios are superior to other criteria for detecting carotid stenosis. Each laboratory needs to validate its own results.

Aged ; Angiography, Digital Subtraction ; Area Under Curve ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; Carotid Stenosis ; classification ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography, Doppler, Duplex

INTRODUCTIONThe Asthma Control Test (ACT) is a 5-item self-administered tool designed to assess asthma control. It is said to be simple, easy and can be administered quickly by patients in the clinical practice setting. This stated benefit has yet to be demonstrated in our local clinical practice setting. The aim was to identify factors associated with difficulty in the administration of the ACT in different clinical practice settings in a tertiary hospital in Singapore.

MATERIALS AND METHODSThis is a prospective study performed from April to June 2008. All patients diagnosed with asthma and referred to an asthma nurse from the in-patient and out-patient clinical practice setting in Tan Tock Seng Hospital were enrolled.

RESULTSFour hundred and thirty-four patients were asked to complete the ACT tool. In the univariate model, we found that age, clinical setting and medical history to be significantly associated with the completion of the ACT. The odds of completion decreased by a factor of 0.92 (95% CI, 0.89 to 0.94) for every year's increase in age, and this was statistically significant (P <0.001). Similarly, the odds ratio of completion for those with more than 3 medical conditions by history were 0.59 (95% CI, 0.48 to 0.71) as compared to those with less than 3 medical conditions by history, and this was also significant (P <0.001). In the multivariate model, we only found age to be an independent and significant factor. After adjusting for age, none of the other variables initially significant in the univariate model remained significant.

CONCLUSIONThe results show that the ACT was simple and easy to be administered in younger-aged patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma ; diagnosis ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Prospective Studies ; Singapore ; Surveys and Questionnaires ; Young Adult

INTRODUCTIONPatients with suspected deep vein thrombosis (DVT) pose a diagnostic dilemma to the Emergency Department (ED) clinician. This study aimed to implement a known algorithm incorporating the modified Wells criteria and D-dimer testing to guide the ED clinician, thus reducing unnecessary ultrasound scans (USS).

METHODSPatients who presented to the ED between August 2008 and April 2009 with suspected DVT underwent Wells scoring. Those with scores < 2 were deemed unlikely to have DVT and underwent D-dimer testing first. Patients with scores ≥ 2 were regarded as likely to have DVT and underwent urgent USS. USS findings were tabulated as positive or negative/indeterminate for DVT. The latter group was followed up for one year to check whether DVT was missed during the initial USS.

RESULTS75 patients presented with suspected DVT and underwent USS. Of these, 14 results were positive and 61 were negative. 37 patients had Wells scores < 2, with three (8.1%) having DVT. Another 38 patients had Wells scores ≥ 2, with 11 (28.9%) having DVT. D-dimer testing was performed on 27 of the 75 patients. Those with DVT had higher average values compared to those without DVT (1.305 vs. 0.595 µg/ml). The majority of patients with raised D-dimer values had cellulitis, although three also had DVT (with values ≥ 0.99 µg/ml).

CONCLUSIONWe managed to reduce the number of unnecessary USS and increase the pick-up rate of DVT. A cut-off score ≥ 2 in our algorithm is suitable for use in the ED setting.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Biomarkers ; metabolism ; Cost-Benefit Analysis ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Health Status Indicators ; Humans ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Singapore ; Ultrasonography ; Unnecessary Procedures ; economics ; Venous Thrombosis ; diagnosis ; diagnostic imaging

INTRODUCTIONThis study objectively evaluates the effectiveness of a 6-week Preparatory Training Phase (PTP) programme prior to Basic Military Training (BMT) for less physically conditioned conscripts in the Singapore Armed Forces.

MATERIALS AND METHODSWe compared exercise test results of a group of less fi t recruits who underwent a 16-week modified-BMT (mBMT) programme (consisting of a 6-week PTP and 10-week BMT phase) with their 'fitter' counterparts enlisted in the traditional 10-week direct-intake BMT (dBMT) programme in this prospective cohort study consisting of 36 subjects. The main outcome measures included cardiopulmonary responses parameters (VO(2)max and V(O2AT)) with clinical exercise testing and distance run timings.

RESULTSAlthough starting off at a lower baseline in terms of physical fitness [VO(2)max 1.73 +/- 0.27 L/min (mBMT group) vs 1.97 +/- 0.43 L/min (dBMT), P = 0.032; V(O2AT) 1.02 +/- 0.19 vs 1.14 +/- 0.32 L/min respectively, P = 0.147], the mBMT group had greater improvement in cardiopulmonary indices and physical performance profiles than the dBMT cohort as determined by cardiopulmonary exercise testing [VO(2)max 2.34 +/- 0.24 (mBMT) vs 2.36 +/- 0.36 L/min (dBMT), P = 0.085; V(O2AT) 1.22 +/- 0.17 vs 1.21 +/- 0.24 L/min respectively, P = 0.303] and 2.4 kilometres timed-run [mBMT group 816.1 sec (pre-BMT) vs 611.1 sec (post-BMT), dBMT group 703.8 sec vs 577.7 sec, respectively; overall P value 0.613] at the end of the training period. Initial mean difference in fitness between mBMT and dBMT groups on enlistment was negated upon graduation from BMT.

CONCLUSIONPre-enlistment fitness stratification with training modification in a progressive albeit longer BMT programme for less-conditioned conscripts appears efficacious when measured by resultant physical fitness.

Adolescent ; Asian Continental Ancestry Group ; Body Mass Index ; Cohort Studies ; Exercise Test ; statistics & numerical data ; Humans ; Male ; Military Personnel ; statistics & numerical data ; Oxygen Consumption ; Physical Education and Training ; methods ; standards ; Physical Fitness ; Program Evaluation ; Prospective Studies ; Risk Assessment ; Running ; physiology ; Singapore ; Time Factors ; Young Adult

INTRODUCTIONPertussis is a highly communicable, vaccine-preventable respiratory disease and a frequent but often underestimated cause of prolonged cough illness in adults. Protection after childhood vaccination is minimal after 10 years without boosting. The need for adult booster depends on the national epidemiology.

MATERIALS AND METHODSWe did a seroepidemiological survey amongst the adult population (aged 18 to 45 years) of Singapore. None had received pertussis booster vaccine in the preceding 10 years. We measured IgG antibodies to pertussis whole cell antigen.

RESULTSTwo hundred and seventy subjects with the median age of 30 years were enrolled. We found positive IgG antibody levels in 97% of the population. Seropositivity was not associated with age, gender or race.

CONCLUSIONThe seroprevalence in adults was much higher than the previously documented seroprevalence of around 50% in the adolescent age group in Singapore. The increase is most likely due to natural infection with B. pertussis. Pertussis booster vaccine for adolescents/young adults in Singapore would be indicated.

Adolescent ; Adult ; Antibodies, Anti-Idiotypic ; immunology ; Antibodies, Bacterial ; blood ; Bordetella pertussis ; immunology ; Cross-Sectional Studies ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; pharmacology ; Female ; Humans ; Immunoglobulin G ; immunology ; Male ; Middle Aged ; Population Surveillance ; methods ; Prevalence ; Prognosis ; Retrospective Studies ; Seroepidemiologic Studies ; Singapore ; epidemiology ; Whooping Cough ; epidemiology ; immunology ; prevention & control

INTRODUCTIONMultidrug-resistant (MDR) Gram-negative healthcare-associated infections are prevalent in Singaporean hospitals. An accurate assessment of the socioeconomic impact of these infections is necessary in order to facilitate appropriate resource allocation, and to judge the costeffectiveness of targeted interventions.

MATERIALS AND METHODSA retrospective cohort study involving inpatients with healthcare-associated Gram-negative bacteraemia at 2 large Singaporean hospitals was conducted to determine the hospitalisation costs attributed to multidrug resistance, and to elucidate factors affecting the financial impact of these infections. Data were obtained from hospital administrative, clinical and financial records, and analysed using a multivariate linear regression model.

RESULTSThere were 525 survivors of healthcare-associated Gram-negative bacteraemia in the study cohort, with 224 MDR cases. MDR bacteraemia, concomitant skin and soft tissue infection, higher APACHE II score, ICU stay, and appropriate definitive antibiotic therapy were independently associated with higher total hospitalisation costs, whereas higher Charlson comorbidity index and concomitant urinary tract infection were associated with lower costs. The excess hospitalisation costs attributed to MDR infection was $8638.58. In the study cohort, on average, 62.3% of the excess cost attributed to MDR infection was paid for by government subvention.

CONCLUSIONMultidrug resistance in healthcare-associated Gram-negative bacteraemia is associated with higher financial costs--a significant proportion of which are subsidised by public funding in the form of governmental subvention. More active interventions aimed at controlling antimicrobial resistance are warranted, and the results of our study also provide possible benchmarks against which the cost-effectiveness of such interventions can be assessed.

Aged ; Anti-Bacterial Agents ; economics ; therapeutic use ; Bacteremia ; drug therapy ; economics ; Cohort Studies ; Cost of Illness ; Cross Infection ; drug therapy ; economics ; Drug Resistance, Multiple, Bacterial ; Female ; Gram-Negative Bacterial Infections ; drug therapy ; economics ; Hospitalization ; economics ; Humans ; Intensive Care Units ; economics ; Linear Models ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Severity of Illness Index ; Singapore