2.Patient-Surrogate Agreement in Advance Care Planning: Who Are the Surrogates and Are They Making the Right Decisions?
Hui Jin TOH ; Laurence TAN ; Lai Kiow SIM ; James Alvin LOW
Annals of the Academy of Medicine, Singapore 2018;47(10):431-434
Advance Care Planning
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ethics
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legislation & jurisprudence
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Aged
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Aged, 80 and over
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Cross-Sectional Studies
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Decision Making
;
ethics
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Female
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Humans
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Male
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Middle Aged
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Patient Preference
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statistics & numerical data
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Risk Assessment
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Singapore
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Terminal Care
;
ethics
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methods
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Third-Party Consent
;
ethics
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legislation & jurisprudence
3.Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies.
Xinyu TAO ; Chou Chuen YU ; James Alvin LOW
Annals of the Academy of Medicine, Singapore 2022;51(10):619-628
INTRODUCTION:
The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families and healthcare professionals. Grief, which is the reaction to these losses, could cause strain on these individuals' physical and mental health if not identified and managed early. This scoping review analysed loss, grief and how they were managed among these groups during the pandemic.
METHOD:
This scoping review utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework for scoping reviews. Only qualitative studies relating to loss and grief and their management were included. Of 166 studies screened, 69 were included in the study. Qualitative analysis and data coding of each record were conducted through qualitative data analysis software.
RESULTS:
Losses included the death of family members, patients, colleagues and others. They also included the loss of usual routines, lifestyles and physical health. The grief experienced was multidimensional, affecting mainly the emotional, physical, social and existential realms. Anger, guilt and fear resulted from unsatisfactory farewells, issues with funerals, social isolation, financial strain and stigmatisation. Management strategies could be categorised into 5 themes: communication, finance, counselling, education and spiritual care.
CONCLUSION
Loss and grief identification and management among patients, family members and healthcare professionals are critically important during this COVID-19 pandemic. Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief. Nevertheless, further research is necessary to better understand the effectiveness of implemented policies.
Humans
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COVID-19
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Grief
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Health Personnel
;
Pandemics
;
Qualitative Research
4.International health regulations: lessons from the influenza pandemic in Singapore.
Chew Ling LOW ; Pei Pei CHAN ; Jeffery L CUTTER ; Bok Huay FOONG ; Lyn JAMES ; Peng Lim OOI
Annals of the Academy of Medicine, Singapore 2010;39(4):325-323
INTRODUCTIONSingapore's defense against imported novel influenza A (H1N1-2009) comprised public health measures in compliance with the World Health Organization's (WHO) International Health Regulations (IHR), 2005. We report herein on the epidemiology and control of the fi rst 350 cases notified between May and June 2009.
MATERIALS AND METHODSWe investigated the fi rst 350 laboratory-confirmed cases of novel influenza A (H1N1-2009) identified from the healthcare institutions between 27 May and 25 June 2009. Epidemiological details of these cases were retrieved and analysed. Contact tracing and active case finding were also instituted for each reported case, and relevant particulars including flight information were provided to WHO and overseas counterparts.
RESULTSThe fi rst 350 novel influenza A (H1N1-2009) cases comprised 221(63%) imported cases, 124 (35%) locally acquired cases and 5 (2%) cases with unknown source. The imported cases consisted of three waves involving the United States (US), Australia and Southeast Asia. In the fi rst wave, 11 (69%) of the 16 imported cases had visited the US within seven days prior to their onset of illness between 25 May and 4 June 2009. In the second wave, 20 (74%) of the 27 imported cases between 5 June and 12 June had travelled to Melbourne, Australia. In the third wave, 90 (51%) of the 178 imported cases between 13 June and 25 June were acquired from intra-regional travel in Southeast Asia. Specifically, 49 cases were from the Philippines and 40 (82%) of them had travelled to Manila. A total of 667 communications were effected through the IHR mechanism; a majority within 24 hours of disease notification.
CONCLUSIONSingapore experienced an unprecedented need for international cooperation in surveillance and response to this novel Influenza A (H1N1-2009) pandemic. The IHR mechanism served as a useful channel to engage in regional cooperation concerning disease surveillance and data sharing, but requires improvement.
Adolescent ; Adult ; Child ; Disease Notification ; Disease Outbreaks ; prevention & control ; Female ; Guideline Adherence ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; International Cooperation ; Male ; Singapore ; epidemiology ; Travel ; World Health Organization ; Young Adult
5.Sex and Gender Influence Urinary Symptoms and Management in Multiple System Atrophy
Elke Schipani BAILEY ; Sara J. HOOSHMAND ; Negin BADIHIAN ; Paola SANDRONI ; Eduardo E. BENARROCH ; James H. BOWER ; Phillip A. LOW ; Wolfgang SINGER ; Elizabeth A. COON
Journal of Movement Disorders 2023;16(2):196-201
Objective:
Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on urinary symptoms and treatment is unclear. We sought to characterize sex and gender differences in the symptomatology, evaluation, and management of urinary dysfunction in patients with MSA.
Methods:
Patients with MSA evaluated at our institution were reviewed and stratified by sex.
Results:
While the prevalence of urinary symptoms was similar in male and female patients, incontinence was more common in females. Despite this, males and females underwent postvoid residual (PVR) measurement at similar rates. While catheterization rates were similar when PVR was measured, males were more than twice as likely to be catheterized than females in the absence of PVR measurement.
Conclusion
Urinary symptoms are common in MSA, but their presentation differs between males and females. The difference in catheterization rates may be driven by a gender disparity in referrals for PVR, which can guide treatment.
6.Help-seeking patterns and funding strategies in patients with pulmonary arterial hypertension on phosphodiesterase-5 inhibitors: an orphan disease with effective but costly treatment.
Yinghao LIM ; Siti Munawarah Bte MAAROOF ; Ting Ting LOW ; Ivandito KUNTJORO ; James Wl YIP ; Edgar TAY
Singapore medical journal 2021;62(4):199-203
INTRODUCTION:
Pulmonary arterial hypertension (PAH) is associated with high medical and pharmaceutical costs. Phosphodiesterase type 5 (PDE5) inhibitors have been found to be beneficial but costly. They are not subsidised in Singapore except via the Medication Assistance Fund (MAF) Plus scheme. In this study, we described the help-seeking behaviour of patients and funding strategies for Singaporean patients on PDE5 inhibitors in our registry.
METHODS:
We consecutively recruited all patients with PAH who presented to our pulmonary hypertension specialty centre between 1 January 2003 and 29 December 2016. Singaporean patients on PDE5 inhibitors were included. Data recorded and analysed for this study included baseline demographics, whether the patients received MAF Plus funding, percentage of funding, and any additional source of subsidies.
RESULTS:
114 (77.0%) of 148 patients in the registry were Singapore citizens on PDE5 inhibitors. 75 (65.8%) of these 114 patients had been seen by a medical social worker, of whom 16 were on MAF Plus funding. 14 of the remaining 59 patients were subsidised by MediFund, whereas the remainder were self-paying. 30 (26.3%) patients in total were on some form of subsidy, and 28 (24.6%) patients were on combination therapy. Of this group, nine were receiving MAF Plus subsidies.
CONCLUSION
Fewer than expected patients were found to be receiving drug subsidies for PAH. This was partly due to insufficient referrals and lack of requests for financial assistance. Patients on combination therapy had greater financial challenges. This study should spur us on to study funding gaps further and address them.
7.Percutaneous pulmonary valve implantation as an alternative to repeat open-heart surgery for patients with pulmonary outflow obstruction: a reality in Singapore.
Lik Wui Edgar TAY ; Wei Luen James YIP ; Ting Ting LOW ; Chin Ling William YIP ; Kok Fai William KONG ; Tiong Cheng YEO ; Huay Cheem TAN ; Shakeel Ahmed QUERESHI ; Swee Chye QUEK
Singapore medical journal 2019;60(5):260-264
Right ventricle to pulmonary artery (RV-PA) conduits have been used for the surgical repair of congenital heart defects. These conduits frequently become stenosed or develop insufficiency with time, necessitating reoperations. Percutanous pulmonary valve implantation (PPVI) can delay the need for repeated surgeries in patients with congenital heart defects and degenerated RV-PA conduits. We presented our first experience with PPVI and described in detail the procedural methods and the considerations that are needed for this intervention to be successful. Immediate and short-term clinical outcomes of our patients were reported. Good haemodynamic results were obtained, both angiographically and on echocardiography. PPVI provides an excellent alternative to repeat open-heart surgery for patients with congenital heart defects and degenerated RV-PA conduits. This represents a paradigm shift in the management of congenital heart disease, which is traditionally managed by open-heart surgery.