Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.
Ambulatory Care/methods* ; COVID-19/prevention & control* ; Home Care Services ; Hospitalization ; Humans ; Infection Control/methods* ; Pandemics ; Peritoneal Dialysis/methods* ; Self Care/methods* ; Singapore/epidemiology*

The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.

Hoarding refers to an excessive acquisition of objects and inability to part with apparently valueless possessions. While it can lead to excessive clutter, distress and disability, it is important to note that not all cases of hoarding are pathological. This article aims to suggest how one can make recommendations to patients and families when they encounter someone exhibiting hoarding behaviour. It also introduces the Hoarding Task Force and relevant legislation in Singapore to address the issue of hoarding in the community.
Government Agencies ; Hoarding Disorder ; diagnosis ; epidemiology ; Humans ; Referral and Consultation ; Residence Characteristics ; Safety ; Singapore

Dysphagia is a common problem among the elderly either as a result of age-related loss of musculature and function involved in the act of swallowing, and/or because of neurological, degenerative, respiratory and musculoskeletal diseases that cause decreased swallowing function. Assessment for dysphagia is important to prevent serious complications such as aspiration pneumonia. Referral to the speech-language therapist for comprehensive assessment paves the way for proper management. The management may include diet modification, compensatory swallowing techniques, swallowing exercises or use of feeding tubes and facilitative devices.

The elderly have complex bio-psycho-social needs which are best met by a multidisciplinary team approach. In a multidisciplinary team, diverse perspectives are gathered to make a unified decision to solve a complex problem. Having a clear vision with common goals and ensuring an organised framework with good collaboration among team members are some of many factors needed to build a strong team. Benefits include the ability to provide comprehensive and personalised care to the patient during care transition, henceforth reducing overall hospitalisation and healthcare costs.

Advance Care Planning (ACP) is increasingly recognised as part of holistic patient-centred care. The goal of ACP is to help the patient explore and express his preferences regarding options and goal of care before the event of a catastrophic illness. Family physicians are well sited to conduct ACP in the community with their patients. It should be offered, with discernment and empathy, to individuals, ranging from the well healthy patient to those with organ complications from chronic diseases, who are ready to participate in such dialogue. It should always be paced at the patient’s pace.

INTRODUCTIONHip arthroplasty is commonly performed worldwide. The objective of this study was to determine the diameter of the femoral head in the Malaysian population in relation to gender and race (i.e. among Malay, Chinese and Indian patients).

METHODSThis was a retrospective cross-sectional study performed between January 1995 and December 2006, evaluating the femoral head diameters of all patients aged 50 years and above who underwent hemiarthroplasty at two major hospitals in Malaysia.

RESULTSA total of 945 femoral heads (663 women, 282 men) were evaluated. The mean age of the patients in our cohort was 75.2 ± 9.4 (range 50-101) years. The mean femoral head diameter (with intact articular cartilage) was 44.9 ± 3.2 (range 38-54) mm. In our study, men had a significantly larger mean femoral head diameter than women (47.7 ± 2.8 mm vs. 43.7 ± 2.4 mm; p < 0.05). Patients of Chinese ethnicity were also found to have significantly larger femoral head diameters, when compared among the three races studied (p < 0.05).

CONCLUSIONMalaysians have a mean femoral head diameter of 44.9 ± 3.2 mm. Among our patients, Chinese patients had a significantly larger femoral head size than Malay and Indian patients. We also found that, in our cohort, men had significantly larger femoral head diameters than women.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Asian Continental Ancestry Group ; Cross-Sectional Studies ; Female ; Femur Head ; anatomy & histology ; pathology ; Humans ; Malaysia ; Male ; Middle Aged ; Reference Values ; Retrospective Studies

To highlight the diagnostic challenges in diagnosing a patient with schizoaffective disorder under DSM-IV-TR and to evaluate the effectiveness of changes in DSM-V in addressing these issues. Methods: We present the evolution of the diagnosis from its inception, outline its complex nosology, review the diagnostic difficulties under DSM-IV-TR and critique the proposed changes made in DSM-V. Results: A complex nosology, varied thresholds of diagnosis under DSM-IV-TR, and the inherent difficulty in obtaining a detailed longitudinal history from a patient contribute to the challenge of diagnosing a patient with schizoaffective disorder. Changes in DSM-V attempt to increase the reliability of the diagnosis by specifying and raising temporal thresholds, moving the time of disease observation away from a single episode but towards the lifetime of illness. Conclusion: Changes made in DSM-V only address a small part of the difficulties raised and clinicians will continue to face challenges in diagnosing schizoaffective disorder under DSM-V. However, there might still be value in the proposed changes under DSM-V

Health Knowledge, Attitudes, Practice ; Humans ; Mental Disorders ; diagnosis ; rehabilitation ; therapy ; Psychiatry