This is a prevalence study of patients seeking IVF treatment cycle for the second time and includes patients seen from 1996 to 2009. Patients were grouped into two based on the time period of treatment. The first 100 were seen from 1996- 2002 and the second 100 were seen from 2003 to 2009. Of the 200 seen, 11% opted for a second cycle of treatment (5% coming from the first batch increasing to 17% from the second batch). Using chi-square with a P value of 0.007, this 12% difference is significant. Comparing the two groups based on age (regardless of number of IVF procedures administered), there is no significant difference between the two groups (P=0.28). The mean age in both groups was 35 years. Ages of patients ranged from 22-47, most frequent occurring age was 32 years. Of those who had second cycles, there was no significant difference in the mean age of patients in batches 1 & 2 (P=0.29) with the mean age of 35 years and ages ranged from 28-41. In terms of outcome (pregnancy rate), out of the 22 (total from both batches) who received second treatment, 8 achieved pregnancy (36.4% pregnancy rate; 3 from batch 1 and 5 from batch 2). Comparing outcomes between batches, there was no significant difference (P=0.30). Given the small number of subject who had obtained IVF treatment in the Philippines in a span of thirteen years since the first center was put up, the paper then explores the possible reasons for these. Such reasons ranged from economic concerns, government prioritization of national health issues, public awareness and personal biases. Despite the small number of patients seeking IVF, there was a significant rise in number of couples obtaining a second cycle in the second (later) group of subjects studied. Reasons for this also explored and may involve physician-patient rapport, better lay knowledge of the techniques, lesser apprehension and improved facilities and techniques.

Human ; Female ; Adult ; Pregnancy ; Pregnancy Rate ; Philippines ; Bias ; Government ; Knowledge ; Research ; Fertilization In Vitro

INTRODUCTION: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. METHODS: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). RESULTS Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
Aged ; Anesthesia ; Anesthesia Recovery Period ; Delirium/etiology* ; Humans ; Incidence ; Postoperative Complications/etiology* ; Prospective Studies ; Risk Factors

INTRODUCTION: Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. METHODS: We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium. RESULTS: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium. CONCLUSION In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.
Female ; Humans ; Delirium/epidemiology* ; Postoperative Complications/etiology* ; Singapore/epidemiology* ; Prospective Studies ; Anesthesia/adverse effects* ; Risk Factors ; Neoplasms