Cardiac Catheterization ; instrumentation ; methods ; Cardiac Output ; Confidence Intervals ; Female ; Hemodynamics ; Humans ; Middle Aged ; Mitral Valve Stenosis ; pathology ; Pulmonary Artery ; physiology ; Statistics as Topic

INTRODUCTIONThe objective of the study is to compare the efficacy of fl at insoles, bone spur pads, pre-fabricated orthotics and customised orthotics in reducing plantar contact pressure of subjects with plantar fasciitis.

MATERIALS AND METHODSThis is a controlled non-blinded comparative study conducted in a tertiary medical institute. Thirty subjects with unilateral plantar fasciitis between the ages of 20 and 65 years were recruited at the sports medicine clinic. The contact pressures and pressure distribution patterns in both feet for each subject were measured with sensor pressure mats while standing. Repeat measurements were made with the subjects wearing shoes, fl at insoles, bone spur heel pads, pre-fabricated insoles and customised orthotics on both feet. The asymptomatic side was used as the control. Contact pressure measurements of the symptomatic and asymptomatic feet and power ratio of the pressure distribution pattern of the rearfoot were then compared.

RESULTSContact pressure was higher on the asymptomatic side due to unequal distribution of weight. Bone spur heel pads were ineffective in reducing rearfoot pressure while formthotics and customised orthotics reduced peak rearfoot pressures significantly. The power ratio of the rearfoot region decreased with the use of formthotics and customised orthotics.

CONCLUSIONPre-fabricated orthotics and customised orthotics reduced rearfoot peak forces on both sides while bone spurs heel pad increase rearfoot peak pressures. Pre-fabricated and customised orthotics are useful in distributing pressure uniformly over the rearfoot region.

Adult ; Aged ; Analysis of Variance ; Biomechanical Phenomena ; Body Mass Index ; Chronic Disease ; Fasciitis, Plantar ; therapy ; Female ; Foot ; physiology ; Heel ; Heel Spur ; prevention & control ; Humans ; Male ; Middle Aged ; Orthotic Devices ; Pain ; prevention & control ; Pain Measurement ; Pressure ; Young Adult

Adult ; Age Factors ; Burnout, Professional ; epidemiology ; psychology ; Cross-Sectional Studies ; Exercise ; Female ; Humans ; Internal Medicine ; education ; Internship and Residency ; Interprofessional Relations ; Male ; Physicians ; psychology ; statistics & numerical data ; Prevalence ; Risk Factors ; Singapore ; epidemiology ; Stress, Psychological ; epidemiology ; psychology ; Surveys and Questionnaires

INTRODUCTIONManagement guidelines emphasise the importance of prompt therapeutic intervention for sepsis as well as stroke, both of which are common causes of death. Unfortunately, a rate-limiting step may be delayed presentation to the emergency department by patients themselves. The aim of this study was to assess public awareness of sepsis and stroke in Singapore.

MATERIALS AND METHODSThis was a population-based, structured telephone survey of adults in Singapore.

RESULTSThere were 1067 completed surveys (response rate 50.3%). The survey population was mostly comparable with the actual Singapore population. Fifty-three respondents (5.0%) had heard of the term sepsis. Of these, 45 respondents (4.2%) could provide at least one accepted definition of sepsis, the commonest being that of an unspecified infection. Respondents mostly heard about sepsis from school, the Internet, and newspapers. On the other hand, 963 respondents (90.3%) had heard of the term stroke. Of these, 818 respondents (76.7%) could name at least one accepted warning sign of stroke, the commonest being that of numbness, while 806 respondents (75.5%) could name at least one accepted risk factor for stroke, the commonest being hypertension. Respondents mostly heard about stroke from television, newspapers, a relative, a friend, media (unspecified), and the Internet.

CONCLUSIONOur findings reflect the differences in the public profile of sepsis versus stroke in Singapore. More concerted efforts involving healthcare professionals, medical societies, statutory boards, and the mass media are required to improve public awareness of these 2 conditions -especially sepsis.

Adult ; Female ; Health Education ; methods ; Health Surveys ; Humans ; Internet ; Male ; Mass Media ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Stroke ; epidemiology ; Telephone ; Young Adult

INTRODUCTIONDistractions and interruptions of doctor's work, although common and potentially deleterious in the intensive care unit (ICU), are not well studied.

METHODSWe used a simple observational method to describe the frequency, sources and severity of such distractions, and explore at-risk situations in the ICU. Independent paired observers separately shadowed eight residents and three fellows for 38 sessions (over 100 hrs) in a 20-bed medical ICU.

RESULTSIn total, 444 distractions were noted. Interobserver agreement was excellent at 99.1%. The mean number of distractions/doctor/hr was 4.36 ± 2.27. Median duration of each distraction was 2 mins (interquartile range 2-4 mins; range 1-20 mins). The top three initiators of distractions were other doctors (35.1%), nurses (30.4%) and oneself (18.7%). Of the 444 distractions, 107 (24.1%) were prolonged (lasting ≥ 5 mins), 210 (47.3%) led to a complete pause of current activity and 85 (19.1%) led to complete abandonment of the current activity. On multivariate analysis, physician seniority, time of session and day of week did not predict frequency of distraction. After adjusting for time of session, day of week and type of current activity, urgent distractions (to see another patient, perform immediate procedures or administer medications) and physician juniority were associated with major distractions (complete interruption or termination of current activity), while only urgent distractions were associated with prolonged distractions.

CONCLUSIONDistractions are common in the ICU and junior doctors are particularly susceptible to major distractions.

Adult ; Attention ; Attitude of Health Personnel ; Continuity of Patient Care ; Critical Care ; methods ; organization & administration ; Female ; Humans ; Intensive Care Units ; Internship and Residency ; Linear Models ; Male ; Medical Staff, Hospital ; Nurses ; Observer Variation ; Physicians ; Risk Factors ; Time Factors

INTRODUCTIONThe presence of trigger factors may help to distinguish asthma from chronic obstructive pulmonary disease (COPD). Knowing and avoiding trigger factors for both asthma and COPD can facilitate the design of comprehensive management programmes that can aid disease control. This study aimed to describe the relative frequency and range of various trigger factors in asthma and COPD.

METHODSWe conducted a telephone-based survey involving asthma and COPD patients on follow-up at a university hospital in Singapore.

RESULTSA total of 779 asthma patients and 129 COPD patients participated in this study. Among these patients, 93.8% of those with asthma and 42.6% of those with COPD had trigger factors (p < 0.001). The median number of trigger factors was greater among asthma patients than among those with COPD (3 vs. 0, p < 0.001). Trigger factors found to be significantly more prevalent among asthma patients compared to those with COPD include tobacco smoke, alcohol, upper respiratory tract infections, incense smoke, perfume, laughter, a dusty environment, air-conditioning, heavy rain, heavy traffic fumes, citrus fruits, gastro-oesophageal reflux, household pets, flowers/pollen, medications and psychological triggers. Trigger factors that were not previously described, such as bathing, fatigue, insufficient sleep, crowded places and overeating, were also reported.

CONCLUSIONTrigger factors, although found in both groups of patients, were more common among asthma patients. Knowledge of these trigger factors may be useful in distinguishing between the two diseases and optimising disease management.

Adult ; Aged ; Allergens ; Asthma ; epidemiology ; etiology ; Chronic Disease ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Male ; Middle Aged ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; epidemiology ; etiology ; Singapore ; Telephone

INTRODUCTION: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS. METHODS: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H RESULTS: A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67-75 versus median 61 years, IQR 52-66; CONCLUSION COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.
COVID-19 ; Humans ; Lung Compliance ; Phenotype ; Respiratory Distress Syndrome/therapy* ; SARS-CoV-2

INTRODUCTIONAlthough research is widely considered to be a relevant and essential skill to resident development, the actual participation rate of residents in research remains low, and the factors associated with participation are unclear.

METHODSWe examined the participation rate of junior residents in research, and their attitudes and perceived barriers toward research, via an anonymised survey carried out from October to November 2013. The residents were from an established Accreditation Council for Graduate Medical Education-accredited internal medicine residency training programme in Singapore.

RESULTSThe overall response rate was 64.1% (82/128 residents). The most frequently cited barrier was lack of time. Only a third of the residents surveyed were actively participating in research. Those with postgraduate qualifications were more likely to be involved in research (odds ratio 4.71, p = 0.015). Among the 82 residents, 40.2% reported an interest in research as part of their career; these were mainly graduates from overseas universities or postgraduates. A belief that research is an intrinsically valuable activity distinguished residents who chose research as a career path from those who were undecided (p = 0.004). The belief that research is a means to better clinical practice also divided those who chose research from those who rejected it (p = 0.02).

CONCLUSIONOur findings suggest that specific beliefs determine the level of research activity and career interest among residents. Novel strategies may be incorporated in training programmes to improve the interest and participation of residents in research, and to facilitate the development of academic clinicians.

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 ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*