INTRODUCTION: This scoping review examined the number, types and characteristics of journal publications on ageing in Singapore from 2008 to 2018 to determine how ageing research in medical and social domains in Singapore has transformed over time. METHODS: Using relevant search terms, articles were extracted from multiple databases and then screened and reviewed for eligibility and inclusion by independent reviewers. Data such as article title, authors, year of publication, name of journal, type of journal, study design and the kind of data used were charted from the included articles for evidence synthesis. RESULTS: Since 2008, there has been a steady increase in the number of publications on ageing in medical and social domains in Singapore. In the medical domain, publications on Ophthalmology (22%) made up the largest proportion of the existing medical literature on ageing in Singapore, followed by Physical Functioning (17%), which involved physiological measurements of physical well-being, and Geriatrics (16%). Non-medical publications comprised 38% of all the included publications, with publications on the social aspects of ageing (43%) forming the largest group in this cluster, followed by publications on Prevention (19%) and Healthcare services (18%). The study design was mostly observational (82%), with only 3% of interventional studies. CONCLUSION While ageing research had expanded in Singapore in the last decade, it was predominantly discipline specific and observational in design. As ageing issues are complex, with biology intersecting with psychology and sociology, we call for greater interdisciplinary collaboration, the conduct of more interventional studies, as well as more research in understudied and emerging areas.
Humans ; Singapore ; Aging ; Geriatrics ; Research Design

Background Historically, physicians routinely delivered medical care to sick patients in patients' homes. While house calls accounted for 40% of all doctor-patient encounters In the 1940s, the rate has since dwindled to less than 1%. Based on some studies done overseas, the reasons for the unpopularity of house calls were the lack of time and unsatisfactory remuneration. The aim of this study was to explore the attitudes of general practitioners (GPs) currently practicing in Singapore towards house calls. Design A qualitative study using phenomenological methodology was done by conducting one-to-one in-depth interviews with 12 GPs. Results All the GPs interviewed were aware of the benefits of house calls in the healthcare scene of Singapore. The commonest barrier was concern about the limitations perceived to be present during a house call and their possible medicolegal implications. GPs also struggled with charging appropriately for house calls and found them disruptive to their practices. Conclusion: The study shows that GPs recognize the value of making house calls but at the same time struggle with perceived limitations in the home setting as well as remuneration issues.

BACKGROUND: We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income. METHODS: Chronic pain was defined as pain ≥ 3 months. From 2009−2014, residents aged 40−60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves. RESULTS: In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36−3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25−3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18−4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34−5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94−6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of “major illness”; screening as a search for answers to pain; and labelling pain as an end in itself. CONCLUSIONS: Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.
Asian Continental Ancestry Group ; Breast Neoplasms ; Chronic Pain* ; Colorectal Neoplasms ; Dyslipidemias ; Early Detection of Cancer ; Humans ; Mass Screening* ; Pain Management ; Public Housing ; Singapore ; Social Class* ; Uterine Cervical Neoplasms

Introduction: The rising cost of healthcare in Singapore has resulted in calls for greater price transparency. With the GP (General Practitioner's) fees surveys done in 1996 and 2006, we undertook a similar survey in 2013 to investigate the change in GP fees and GP operating costs over the years. Methods: The 2013 GP Fee Survey involved 992 GPs and solo clinic practitioners. Results from the 2013 GP Fee Survey were compared against the 1996 and 2006 GP Fees Surveys. Compound Annual Growth Rate (CAGR) was used to reflect the change in price data over the years and compared against the CAGR of the Consumer Price Index (CPI) and CPI-Health over the same periods. Results: 113 participants (11.5%) responded. Between 1996 and 2013, the CAGR for CPI was 1.84% and CPI-Health was 2.97%. In comparison, the CAGR for the median patient fee was 3.12%; staff salary was 1.95%; property cost was 2.47%; and total monthly practice cost was 9.21%. Conclusion: Between 1996 and 2013, the rise in the patient fee matched the rise in CPI-Health but the rise in practice cost outpaced CPI-Health by more than three-fold. However, the low response rate limits the generalizability of the data.

INTRODUCTIONThe poststroke acute and rehabilitation length of stay (LOS) are key markers of stroke care efficiency. This study aimed to describe the characteristics and identify the predictors of poststroke acute, rehabilitation and total LOS. This study also defined a subgroup of patients as "short" LOS and compared its complication rates and functional outcomes in rehabilitation with a "long" acute LOS group.

MATERIALS AND METHODSA prospective cohort study (n = 1277) was conducted in a dedicated rehabilitation unit within a tertiary academic acute hospital over a 5-year period between 2004 and 2009. The functional independence measure (FIM) was the primary functional outcome measure in the rehabilitation phase. A group with an acute LOS of less than 7 days was defined as "short" acute LOS.

RESULTSIschaemic strokes comprised 1019 (80%) of the cohort while the rest were haemorrhagic strokes. The mean acute and rehabilitation LOS were 9 ± 7 days and 18 ± 10 days, respectively. Haemorrhagic strokes and anterior circulation infarcts had significantly longer acute, rehabilitation and total LOS compared to posterior circulation and lacunar infarcts. The acute, rehabilitation and total LOS were significantly shorter for stroke admissions after 2007. There was poor correlation (r = 0.12) between the acute and rehabilitation LOS. In multivariate analyses, stroke type was strongly associated with acute LOS, while rehabilitation admission FIM scores were significantly associated with rehabilitation LOS. Patients in the short acute LOS group had fewer medical complications and similar FIM efficacies compared to the longer acute LOS group.

CONCLUSIONConsideration for stroke type and initial functional status will facilitate programme planning that has a better estimation of the LOS duration, allowing for more equitable resource distribution across the inpatient stroke continuum. We advocate earlier transfers of appropriate patients to rehabilitation units as this ensures rehabilitation efficacy is maintained while the development of medical complications is potentially minimised.

Activities of Daily Living ; Acute Disease ; Brain Ischemia ; rehabilitation ; therapy ; Humans ; Intracranial Hemorrhages ; rehabilitation ; therapy ; Length of Stay ; statistics & numerical data ; Prospective Studies ; Stroke ; therapy ; Stroke Rehabilitation ; statistics & numerical data ; Treatment Outcome

This study assessed the effectiveness of education reforms on student-reported learning outcomes at the end of the 5-year medical school (M5) and 1-year internship (HO) in 2006, 2007 and 2008. A self-administered anonymous survey with 17 learning outcomes assessed, derived from Harden's Three-Circle Outcomes Model for outcomes-based education, was administered to 683 students at the end of medical school (M5) and internship (HO) from 2006, 2007 and 2008. We identified learning outcomes which changed significantly for internship (Cohorts A, B and C) and medical school (Cohorts B, C and D) between cohorts from 2006 to 2008, and compared learning outcomes between medical school and internship within cohorts (i.e. Cohort B which was M5 in 2006 and HO in 2007; Cohort C which was M5 in 2007 and HO in 2008). The proportion of students who agreed that medical school helped them achieve learning outcomes increased significantly from 2006 to 2008 for 15 out of 17 learning outcomes assessed. The proportion of students who agreed that internship helped them achieve learning outcomes increased significantly from 2006 to 2008 for 6 learning outcomes assessed. For Cohorts B and C, internship was more effective than medical school in achieving 8 learning outcomes. Cohort C reported that internship was more effective than medical school in 3 additional learning outcomes than Cohort B: patient management, humility and dedication. We conclude that a successful journey of education reform is an ongoing process that needs to comprehensively address multifaceted components such as faculty, administration and curriculum.
Clinical Competence ; Curriculum ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Humans ; Internship and Residency ; Schools, Medical ; Singapore ; Surveys and Questionnaires

INTRODUCTIONThe study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.

METHODSA single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.

RESULTSA total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.

CONCLUSIONThe prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

Aged ; Cognition ; physiology ; Delirium ; diagnosis ; epidemiology ; physiopathology ; Diagnostic Errors ; Female ; Follow-Up Studies ; Humans ; Inpatients ; Male ; Middle Aged ; Neuropsychological Tests ; Pilot Projects ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Singapore ; epidemiology

Purpose: There are relatively few student-led medical conferences worldwide. A group of medical and nursing students from Yong Loo Lin School of Medicine, National University of Singapore, organized an annual student-led faculty-supported inter-professional Student Medical-Nursing Education Conference (SMEC), which consisted of plenary talks, lectures and workshops, and a scientific competition. This research focused on the evaluation of workshops conducted during the 8th SMEC 2012. Method: The authors used various process variables to survey the conference participants on the educational value of the 4 plenary lectures and 20 workshops, half of which were run by experienced healthcare professionals and the other half by current seniors or recent graduates. Results: A total of 270 medical and nursing students completed the survey. Good to excellent educational value was reported for most of the workshops. Higher educational value was associated with use of props (correlation coefficient, r=0.733 and 0.568), adherence to workshop topic/focus (r=0.608 and 0.815) and openness of presenter to questions (r=0.555 and 0.453). Conclusion: A student-led, faculty-supported interprofessional conference organized by medical and nursing students had good to excellent self-reported education value in helping their fellow medical and nursing students learn about various healthcare disciplines and prepare for medical and nursing school.

Caregivers are important in post-stroke rehabilitation, but little work has been done on the caregivers of stroke survivors in Asian cultures. We examined the association between patient profile (age, gender, socioeconomic status, functional level, religion, and ethnicity) and caregiver availability, number of potential caregivers and primary caregiver identity amongst Singaporean community hospitals' stroke patients. Data was obtained from all Singaporean community hospitals from 1996-2005. 3796 patients fulfilled inclusion criteria. Mixed logistic regression identified independent predictors of caregiver availability and primary caregiver identity. Mixed Poisson modelling identified independent predictors of the number of caregiver(s). Among recent stroke survivors, 95.8% (3640/3796) had potential caregivers, of which 94.2% (3429/3640) had identified primary caregivers. Of the latter, 41.2% relied on live-in hired help (foreign domestic workers-FDWs), 27.6% on spouses and 21.6% on first-degree relatives. Independent patient factors associated with caregiver availability and number were older, female, married, higher socioeconomic status, having a religion and lower functional level at admission. Independent patient factors associated with FDW caregivers were older age, female, Chinese compared to Malay, with higher socioeconomic class and lower functional level at admission. Caregiver availability for post-stroke patients in Singapore community hospitals is relatively high, with heavy dependence on FDWs.