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*

The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review aimed to update the understanding of epilepsy management in this region over the past 23 years. There has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per 1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas, and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However, HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is questionable. Stigma and its psychosocial consequences are still a major concern despite enormous efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries. The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many SEA countries, related to cost, cultural perception and lack of facilities. More resources should also be channelled in training adequate number of epileptologists who can spearhead epilepsy care around the region, as well as public education and research in epilepsy. In conclusion, there is an increase in epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.

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.

Sleep disorder is common among the general population. A nutritional supplement containing alpha-s1-casein tryptic hydrolysate and L-theanine was evaluated for its effects in improving sleep quality. The study was conducted using a double-blind randomized trial. Intervention group received once-daily capsules of 150 mg alpha s1 casein tryptic hydrolysate and 50 mg L-theanine, and the control group were given placebo (150 mg skimmed milk powder) for four weeks. The outcome measurements were assessed on weekly basis using PSQI, DASS-21, clinical and biochemical parameters. ANOVA test were used to assess within group differences and ANCOVA were used to check for differences between groups. Significantly lower (better) sleep latency score, sleep disturbances score and daytime dysfunction score were demonstrated on week-4 in intervention group compared to placebo group. Profound differences were observed between the two groups for anxiety and stress scores from week-3 onwards, in which lower anxiety and stress scores were observed in intervention group compared to placebo group. In addition, significantly lower depression score in intervention group compared to placebo group on week-4 was observed. Intervention supplement has demonstrated potent effects in relieving anxiety, stress, depression and sleep quality

Aged, 80 and over ; Axilla ; Breast Neoplasms ; epidemiology ; surgery ; Comorbidity ; Diabetes Mellitus ; epidemiology ; Dyslipidemias ; epidemiology ; Female ; Humans ; Hypertension ; epidemiology ; Length of Stay ; Lymph Node Excision ; Mastectomy ; Myocardial Infarction ; epidemiology ; Myocardial Ischemia ; epidemiology ; Operative Time ; Postoperative Complications ; epidemiology ; Postoperative Hemorrhage ; epidemiology ; Seroma ; epidemiology ; Singapore ; epidemiology ; Surgical Wound Dehiscence ; epidemiology ; Surgical Wound Infection ; epidemiology ; Venous Thrombosis ; epidemiology

Background: Human Immunodeficiency Virus (HIV) can be transmitted through blood, vaginal secretion, infected semen, breast milk as well as blood containing saliva, vomitus and urine. Health care workers (HCWs) are at risk of HIV infection; and standard precautions is a guideline to be followed by HCWs to prevent it. Objective: This study was aimed to evaluate the level of knowledge, attitude and practice on standard precautions for prevention of HIV infection; and its associated factors. Materials and Methods: This cross-sectional study was conducted among 200 clinical year medical students from a public university in Malaysia. The clinical year medical students were arranged into strata according to year of study and were randomly selected via stratified random sampling. Each respondent were provided a selfadministered questionnaire. There were four sections in the questionnaire to obtain information on socio-demographic characteristics, knowledge, attitude and practice on standard precautions. Both descriptive and analytical analyses such as Chi-squared test were performed. Results: A total of 162 respondents participated in this study, contributed to the response rate of 81%. The study demonstrated that there was no significant association between level of practice with socio-demographic characteristics such as gender, ethnicity, age, religion, year of study and total family income. However, there was a significant association between level of practice with level of knowledge and attitude (p<0.05). For every one year increase in age, the respondents were 1.7 times (p=0.001) and 1.5 times (p=0.012) more likely to have knowledge score between 50th and 75th percentile and above 75th percentile compared to below 50th percentile, respectively. Conclusion: It could be interpreted from the findings, that there is a need for further improvement in the knowledge and attitude level among the respondents; which will eventually improve their practice.

AIMThis study aims to evaluate the prescription patterns and side effects of oxycodone in a local hospital setting.

MATERIALS AND METHODSThis is a retrospective analysis of all patients who were prescribed oxycodone for acute or chronic pain from June to November 2007. Patients' names were obtained from the hospital pharmacy and data were collected with a set of questionnaire after review of their casenotes. Prescription was compared with other recommended opioid prescription guidelines. Side effects to oxycodone use were documented.

RESULTSOne hundred and thirty patients were prescribed oxycodone for the 6-month study period. Prescription by the orthopaedic surgeons was the highest, followed by the pain service. Most patients had a clear indication for use of oxycodone and appropriate dosing regimes. However, two thirds of the patients prescribed oxycodone were not reviewed with regard to their analgesia within 24 hours and one third did not have titration of the drug to their pain symptoms. Majority of the patients had outpatient follow-up within 4 weeks of discharge. Common side effects included nausea, vomiting and constipation.

CONCLUSIONThis is the first local audit that profiles oxycodone prescription patterns and its side effects. Prescription of oxycodone was appropriate for the majority of the study population. Patient assessment upon initiation of oxycodone therapy and titration of the drug to patients' pain symptoms was suboptimal. Oxycodone was well tolerated by the study population with minimal side effects. Further quality measures and ongoing education of clinicians will ensure future patients obtain safe and effective analgesia.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid ; therapeutic use ; Drug Prescriptions ; Female ; Humans ; Male ; Middle Aged ; Oxycodone ; therapeutic use ; Pain, Intractable ; drug therapy ; Practice Patterns, Physicians' ; Retrospective Studies ; Singapore ; Surveys and Questionnaires ; Young Adult