1.Timing of arrival to a tertiary hospital after acute ischaemic stroke - A follow-up survey 5 years later.
Deidre Anne De SILVA ; Norazieda YASSIN ; April J P TOH ; Dao Juan LIM ; Wan Xin WONG ; Fung Peng WOON ; Hui Meng CHANG
Annals of the Academy of Medicine, Singapore 2010;39(7):513-515
INTRODUCTIONIntravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset. We aimed to determine whether the problem of delayed hospital arrival persists in 2009 and to establish the impact of widening the time window for intravenous tPA to 4.5 hours.
MATERIALS AND METHODSWe prospectively surveyed consecutive ischaemic stroke patients admitted to the SGH from 9th March to 30th April 2009. Patients and/or relatives were interviewed with a standardised form similar to the 2004 survey.
RESULTSAmong the 146 ischaemic stroke patients surveyed (median age 67 years, 59% male, median NIHSS score 2), 6% presented to SGH within 2 hours and 15% within 3.5 hours of onset. Median time from stroke onset to hospital arrival was 1245 minutes (20.75 hours). Pre-hospital consultation was significantly associated with hospital arrival after 2 hours from onset. Main reasons cited for delay were not realising the gravity of symptoms (31%) and not recognising them as stroke (27%).
CONCLUSIONDelayed arrival to SGH following acute ischaemic stroke remains a problem in 2009. This confirms the lack of stroke awareness in Singapore and highlights the need for public stroke education. Furthermore, these data confirm that widening the time window for intravenous tPA treatment to 4.5 hours at SGH will increase its utilisation.
Acute Disease ; therapy ; Aged ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitalization ; trends ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care ; statistics & numerical data ; Prospective Studies ; Stroke ; therapy ; Time Factors
2.Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors.
Rochelle Melina KINSON ; Song GUO ; Yi Min WAN ; Victoria MANNING ; Hui Chin TEOH ; Kim Eng WONG
Singapore medical journal 2015;56(2):87-91
INTRODUCTIONThere is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs.
METHODSWe conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010.
RESULTSMajority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs.
CONCLUSIONA large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.
Adult ; Analgesics, Opioid ; therapeutic use ; Female ; HIV Infections ; blood ; complications ; Hepatitis B ; blood ; complications ; Hepatitis C ; blood ; complications ; Humans ; Inpatients ; Male ; Middle Aged ; Needle Sharing ; Odds Ratio ; Prevalence ; Prognosis ; Retrospective Studies ; Singapore ; Substance Abuse, Intravenous ; blood ; complications ; epidemiology
3.A Practical Guide to Ordering and Interpreting Coagulation Tests for Patients on Direct Oral Anticoagulants in Singapore.
Wan Hui WONG ; Christina Yc YIP ; Christina Ll SUM ; Chuen Wen TAN ; Lai Heng LEE ; Eng Soo YAP ; Ponnudurai KUPERAN ; Wen Chang TING ; Heng Joo NG
Annals of the Academy of Medicine, Singapore 2016;45(3):98-105
INTRODUCTIONDirect oral anticoagulants (DOACs) are establishing themselves as principle choices for the treatment of a variety of thrombotic disorders. DOACs are also known to affect common coagulation tests which are routinely performed for patients in clinical practice. An understanding of their varied effects is crucial for the appropriate ordering of coagulation tests and their interpretation.
MATERIALS AND METHODSLaboratories in public and private healthcare institutions and commercial sectors were surveyed on coagulation tests offered and their methods. A Medline and bibliography search, including a search on search engines, was performed for publications reporting the effects of dabigatran, apixaban and rivaroxaban on these coagulation tests. These papers were reviewed and summarised for consensus recommendations.
RESULTSProthrombin time (PT) and activated partial thromboplastin time (aPTT) are variably affected by the DOACs and dependent of the coagulation assays used. Clinicians must know which laboratory has performed these tests to logically interpret test results. A normal PT or aPTT does not exclude the presence of residual DOACs effect. The thrombin time is sensitive to dabigatran but not apixaban or rivaroxaban. Specialised coagulation tests such as thrombophilia tests are also variably affected by the DOACs. All laboratories in Singapore however, employ similar test methods permitting a common set of recommendations for specialised coagulation testing.
CONCLUSIONKnowledge of the effects of DOACs on coagulation testing is essential to determine the appropriateness of performing such tests and interpreting them coherently. Practical recommendations which are tests and location-specific are set out in this paper.
Antithrombins ; therapeutic use ; Blood Coagulation Tests ; Dabigatran ; therapeutic use ; Factor Xa Inhibitors ; therapeutic use ; Humans ; Partial Thromboplastin Time ; Practice Guidelines as Topic ; Prothrombin Time ; Pyrazoles ; therapeutic use ; Pyridones ; therapeutic use ; Rivaroxaban ; therapeutic use ; Singapore
4.Barriers to implementing a national health screening program for men in Malaysia: An online survey of healthcare providers
Chirk Jenn Ng ; Chin Hai Teo ; Kar Mun Ang ; Yong Leng Kok ; Khalid Ashraf ; Hui Ling Leong ; Sri Wahyu Taher ; Zakiah Mohd Said ; Zainal Fitri Zakaria ; Ping Foo Wong ; Chee Peng Hor ; Teng Aik Ong ; Husni Hussain ; V Paranthaman P Vengadasalam ; Chiu Wan Ng ; Kavitha Agamutu ; Mohamad Aznuddin Abd Razak
Malaysian Family Physician 2020;15(1):6-14
Introduction: This study aimed to determine the views and practices of healthcare providers and
barriers they encountered when implementing the national health screening program for men in a
public primary care setting in Malaysia.
Methods: An online survey was conducted among healthcare providers across public health clinics in
Malaysia. All family medicine specialists, medical officers, nurses and assistant medical officers involved in the screening program for adult men were invited to answer a 51-item questionnaire via email or WhatsApp. The questionnaire comprised five sections: participants’ socio-demographic information, current screening practices, barriers and facilitators to using the screening tool, and views on the content and format of the screening tool.
Results: A total of 231 healthcare providers from 129 health clinics participated in this survey.
Among them, 37.44% perceived the implementation of the screening program as a “top-down
decision.” Although 37.44% found the screening tool for adult men “useful,” some felt that it was
“time consuming” to fill out (38.2%) and “lengthy” (28.3%). In addition, ‘adult men refuse to answer’
(24.1%) was cited as the most common patient-related barrier.
Conclusions: This study provided useful insights into the challenges encountered by the public
healthcare providers when implementing a national screening program for men. The screening tool for
adult men should be revised to make it more user-friendly. Further studies should explore the reasons
why men were reluctant to participate in health screenings, thus enhancing the implementation of
screening programs in primary care.