Background For patients with cardiovascular disease (CVD), co-existence of peripheral artery disease (PAD) predicts increased mortality, and such patients are also more likely to benefit from aggressive therapy. Surveillance of PAD is often neglected at health clinics. Our aim is to highlight the importance and ease of surveillance of PAD in patients with CVD. Objective To determine the prevalence of symptomatic and asymptomatic PAD in a Malaysian patient population with documented CVD. Methods and Results A total of 393 subjects with established CVD were recruited from three centres (85 women and 308 men), as part of a larger international (AGATHA) survey. PAD, determined by presence of claudicant symptoms on interview and/or abnormal ankle-brachial index (ABI)score of less than 0.9, was present in 21.4% of patients - of whom 64% were asymptomatic. Abnormal ABI is associated with higher systolic blood pressure and number of arterial beds affected. Conclusions Concomitant PAD is prevalent among CVD patients in Malaysia. ABI screening is simple and yields a high proportion of patients with extensive atherosclerosis who may require more aggressive atherosclerotic risk management.

INTRODUCTION: The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore. METHODS: An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore. RESULTS: The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005). CONCLUSION There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.
Burnout, Professional/psychology* ; Delivery of Health Care ; Health Personnel/psychology* ; Humans ; Prevalence ; Singapore/epidemiology* ; Surveys and Questionnaires

INTRODUCTIONMycotic aneurysms are associated with high mortality rates and are managed in the local setting with extra-anatomical bypass followed by ligation, exclusion and debridement of the aneurysm. This is the first case of successful endovascular stenting in an immunocompromised patient with Salmonella mycotic aneurysm.

CLINICAL PICTUREA middle-aged man who was HIV positive had Salmonella septicaemia. He developed abdominal pain 5 days after admission and a computed tomography (CT) scan of the abdomen revealed infrarenal aortitis. He developed a mycotic aneurysm 3 weeks later.

TREATMENTHe opted for endovascular stenting and after prolonged antibiotic therapy and negative blood cultures, he underwent the procedure using a Talent stent, with an iliac extension.

OUTCOMEHe was discharged 1 week after stenting and maintained on oral bactrim based on sensitivity. At 1-year follow-up, he remains well symptomatically and CT scan showed no endoleak or collection.

CONCLUSIONEndovascular stenting, though a fairly new procedure, can be successfully deployed even in a mycotic aneurysm in the right setting.

Aneurysm, Infected ; drug therapy ; surgery ; therapy ; HIV Infections ; physiopathology ; Humans ; Male ; Middle Aged ; Salmonella Infections ; drug therapy ; microbiology ; surgery ; Salmonella enteritidis ; Stents ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

INTRODUCTIONCancer pain is one of the most frequently encountered pain syndromes. With the application of the World Health Organization analgesic ladder, adequate analgesia is achieved in 75% to 90% of patients. The remaining patients suffer from intractable pain requiring intrathecal analgesia. The aim of this study was to retrospectively analyse the pain intensity before and after intrathecal analgesia and review the complications associated with the implantation and the care of the intrathecal device.

MATERIALS AND METHODSWe reviewed medical records of all cancer patients whose pain were managed by intrathecal catheter implants in our centre from February 2005 to August 2008. The pain intensity, medication and complications related to intrathecal catheter insertion or drug delivery were reviewed at the time before starting the intrathecal analgesia (T0) and time of discharge from the hospital/time prior to death during their stay in the hospital (Tdsc).

RESULTSTwenty-nine patients were included. Out of these 29 patients, 86.2% had metastatic cancer. The most common indication was poor pain control. Pain intensity was reduced significantly at the time of discharge from hospital (P < 0.001). The number of patients with side effects from opioids decreased after intrathecal treatment. We found 4 patients with short-term catheter complications e.g. kinked or displaced catheter and catheter-related infection.

CONCLUSIONIntractable cancer pain could be managed effectively by intrathecal analgesia with a significant decrease in pain intensity and reduced opioid-related side effects. The side effects due to intrathecal opioids and complications from intrathecal catheter were minimal.

Adult ; Aged ; Analgesics ; administration & dosage ; adverse effects ; pharmacology ; Catheterization ; Female ; Humans ; Injections, Spinal ; Male ; Medical Audit ; Middle Aged ; Neoplasms ; physiopathology ; Pain Measurement ; Pain, Intractable ; drug therapy ; Retrospective Studies

INTRODUCTIONThis study aimed to investigate secular trends in the prevalence of myopia over 6 decades (from the 1920s to 1980s) in Chinese adults in Singapore.

MATERIALS AND METHODSParental myopia prevalence was estimated using a parent-completed questionnaire in paediatric cohorts that included: 1) The Singapore Cohort Of Risk factors for Myopia (SCORM), 2) The Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS), and 3) The Growing Up in Singapore Towards healthy Outcomes (GUSTO). Published estimates for myopia prevalence from 5 adult studies in Singapore were reviewed. Secular trends in the prevalence of myopia were correlated with changes in the education system.

RESULTSThe prevalence of parental myopia in SCORM (n = 2943), STARS (n = 4938), and GUSTO (n = 1072) was 47.8%, 53.4%, and 73.4%, respectively; corresponding calendar years these parents might have started schooling were 1966, 1973, and 1983 (born in 1960, 1967, and 1977), respectively. Mean age of parents was 41.3, 40.1, and 33.4 years, respectively. Prevalence of myopia in adult studies in persons who started elementary school in 1928, 1934, 1938, 1939, 1942, 1948, 1952, 1958, 1962, 1972, 1982, and 1995 were 36.4%, 39.7%, 30.0%, 31.5%, 33.0%, 26.4%, 32.5%, 48.7%, 39.4%, 52.0%, 82.2%, and 85.9%, respectively.

CONCLUSIONDuring the past few decades, the prevalence of myopia increased rapidly, especially in persons who started elementary school after the 1980s (born after 1970). The education system was expanded after Singapore's independence in 1965, and the new education system was introduced in 1978. These changes, together with increasing intensive schooling, may have contributed to the increase in myopia prevalence.

INTRODUCTIONWe aimed to investigate the epidemiology, diagnosis, prognostication, follow-up care and outcomes of antenatally diagnosed congenital diaphragmatic hernia (CDH) in KK Women's and Children's Hospital (KKH), Singapore. The objective of this study was to identify trends in current practice, and evaluate and improve the management of CDH.

METHODSWe retrospectively reviewed cases of antenatally diagnosed CDH from 2006 to 2010.

RESULTSA total of 22 cases of CDH were found, bringing its incidence in KKH to 3.6 per 10,000 live births. The mean gestational age at diagnosis was 22.7 weeks, with 14 (63.6%) cases diagnosed at < 22 weeks and 8 (36.4%) diagnosed at ≥ 22 weeks. All cases were left-sided - 15 (68.2%) were isolated CDH and 7 (31.8%) were associated with other anomalies. Of the 22 cases, counselling about the prognosis of pregnancy based on the lung-to-head ratio was provided in 9 (40.9%). Overall, 10 (45.5%) cases resulted in termination of pregnancy (TOP), 9 (40.9%) resulted in live birth and 1 (4.5%) in stillbirth; 2 (9.1%) cases were lost to follow-up prior to delivery. Of the 9 live births, 3 (33.3%) resulted in neonatal death. In the 10 births, 5 (50.0%) were delivered by normal vaginal delivery, 4 (40.0%) by emergency Caesarean section and 1 (10.0%) by elective Caesarean section.

CONCLUSIONCDH is a challenging perinatal problem with a low overall survival rate. Almost half of the cases opt for TOP. The data in this study can help clinicians better undertake the task of adequately counselling parents with qualitative and quantitative prognostic factors, using an evidence-based approach.

Adult ; Counseling ; Delivery, Obstetric ; methods ; Female ; Gestational Age ; Hernia, Diaphragmatic ; diagnostic imaging ; epidemiology ; Hernias, Diaphragmatic, Congenital ; Humans ; Incidence ; Pregnancy ; Pregnancy Outcome ; Prognosis ; Retrospective Studies ; Singapore ; epidemiology ; Survival Rate ; Treatment Outcome ; Ultrasonography, Prenatal

INTRODUCTIONThe Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth), is a newly formed health professions education academy designed to cultivate best education practices and create a community of health professions educators. To achieve the aims of AM∙EI, the needs of SingHealth educators have to be understood. Therefore, this study was carried out to assess educators' perceptions towards the current education climate and their academic needs.

MATERIALS AND METHODSA 28-item questionnaire consisting of free-response, Likert-type and ranking questions was developed. The questionnaire was electronically distributed to 200 medical and nursing educators, and made available to attendees of the 2012 Singhealth Duke-NUS Scientific Congress through hardcopies.

RESULTSA total of 150 completed questionnaires were received (94 from electronic survey and 56 from Congress). Five themes emerged from the analysis of responses to free-response questions: 1) faculty development, 2) development of a community of educators, 3) recognition for educational efforts, 4) institutional support, and 5) better communication about SingHealth educational activities. Respondents were in highest agreement with the statements (rating of 3.7 out of 5): "The SingHealth education programmes are high quality", "New learning or teaching methods are welcomed in this institution/hospital", and "An academic appointment is important to me". The competencies that respondents felt to be the most important were facilitating discussions, presentation skills, and providing feedback (respective means = 5.1, 5, 5 of 7).

CONCLUSIONThis needs assessment provided us with important insights regarding SingHealth medical educators' perceptions of their education environment and established key priorities for the AM∙EI's programming efforts.

Academies and Institutes ; Attitude of Health Personnel ; Education, Medical ; organization & administration ; Education, Nursing ; organization & administration ; Faculty, Medical ; organization & administration ; Faculty, Nursing ; organization & administration ; Humans ; International Cooperation ; Needs Assessment ; North Carolina ; Organizational Culture ; Schools, Medical ; organization & administration ; Singapore ; Surveys and Questionnaires

INTRODUCTIONLow birth weight (LBW, <2500 g) is an important risk factor for perinatal mortality and morbidity. We performed the first geospatial study of LBW in Singapore, with focus on the public sector and analysis of the national planning areas.

MATERIALS AND METHODSA dataset of 24,615 singleton deliveries from 2012 to 2014 was obtained from the largest maternity hospital in Singapore. Maternal residences were identified with 28 planning areas according to postal code. Multiple logistic regression was used to examine associations between LBW rates and planning areas. Moran's I statistic was used to test for geospatial clustering of LBW rates among planning areas.

RESULTSThe LBW rate across planning areas ranged from 5.3 to 11.5 per 100 live births (median, 8.4). High LBW rates were associated with: 1) a lower individual socioeconomic status, 2) non-compliance to antenatal visits, and 3) biological factors such as maternal hypertension, low body mass index and Indian race. Moran's statistic indicated no geospatial clustering of LBW rates among the 28 planning areas ( = 0.12). LBW rates were moderately correlated with the Socioeconomic Disadvantage Index (r = 0.58) but uncorrelated with distance travelled to hospital (r = -0.08).

CONCLUSIONThere was no evidence of clustering of LBW rates among planning areas in Singapore that would indicate inequitable distribution of health resources among planning areas. The 2 areas showing the highest rates of LBW infants were Outram and Bukit Merah. We recommend targeted health interventions and outreach programmes to encourage antenatal visits in these areas.

INTRODUCTION: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. MATERIALS AND METHODS: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. RESULTS: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. CONCLUSION Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; Cohort Studies ; Confidence Intervals ; Depressive Disorder ; diagnosis ; epidemiology ; Female ; Humans ; Odds Ratio ; Pregnancy ; Pregnancy Complications ; diagnosis ; epidemiology ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Prevalence ; Prospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore