INTRODUCTIONThis study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD).

MATERIALS AND METHODSA community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratifi ed random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD suffi ciently were further evaluated on their knowledge, attitudes and practices.

RESULTSA total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish "for an artifi cially prolonged life", "to be kept alive indefi nitely on a life-support machine", wished to "lessen the fi nancial burden of loved ones", "avoid prolonged suffering" and accepted the "imminence of death" were more willing to sign an AMD. However, "religious beliefs", "personal ethical views", "dissuasion by family members" and "unclear terminology in the AMD" discouraged the participants from signing an AMD. After adjusting for signifi cant factors, participants who did not wish "to be kept alive indefi nitely on a life-support machine" and accepted the "imminence of death" were found to correlate signifi cantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively].

CONCLUSIONSThere is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD.

Adult ; Advance Care Planning ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Decision Making ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Singapore ; Surveys and Questionnaires ; Young Adult

Methods: A retrospective review was conducted, involving all patients who underwent ultrasound-guided lumbar spine injection therapy at a single institution over 1 year. Patients were evaluated by two interventionists, who then performed standardized ultrasound-guided lumbar facet joint and pararadicular spinal injections. Results: There were 42 patients treated at our Sports Medicine Centre; with 27 patients (64.3%) receiving facet joint injections and 18 patients (42.9%) receiving nerve root injections. The majority (90.5%) of patients experienced an improvement of >30% in pain intensity at 3 months post-injection, using the Numerical Rating Scale pain score (p<0.001); with 40 patients (95.2%) reporting a reduction in Oswestry Disability Index score (p<0.001). No complications were reported. Conclusions Our initial experience confirms the safety, feasibility, and effectiveness of ultrasound-guided lumbar spinal injection for the treatment of axial and radicular pain in an Asian multiethnic cohort.

Methods: A retrospective review was conducted, involving all patients who underwent ultrasound-guided lumbar spine injection therapy at a single institution over 1 year. Patients were evaluated by two interventionists, who then performed standardized ultrasound-guided lumbar facet joint and pararadicular spinal injections. Results: There were 42 patients treated at our Sports Medicine Centre; with 27 patients (64.3%) receiving facet joint injections and 18 patients (42.9%) receiving nerve root injections. The majority (90.5%) of patients experienced an improvement of >30% in pain intensity at 3 months post-injection, using the Numerical Rating Scale pain score (p<0.001); with 40 patients (95.2%) reporting a reduction in Oswestry Disability Index score (p<0.001). No complications were reported. Conclusions Our initial experience confirms the safety, feasibility, and effectiveness of ultrasound-guided lumbar spinal injection for the treatment of axial and radicular pain in an Asian multiethnic cohort.

Humans ; Encephalomyelitis, Acute Disseminated/complications* ; COVID-19/complications* ; SARS-CoV-2 ; Brain

INTRODUCTIONFrequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore.

METHODSAn observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions.

RESULTSA total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions.

CONCLUSIONOur study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk.

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*