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Ang YTI, Gan SWS, Liow CH, Phang CC, Choong HLL, Liu P. Patients’ perspectives of home and self-assist haemodialysis and factors influencing dialysis choices in Singapore. Ren Replace Ther 2022. [DOI: 10.1186/s41100-022-00430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The rise in end stage kidney disease (ESKD) prevalence globally calls for a need to deliver quality and cost-effective dialysis. While most are familiar with centre-based haemodialysis (HD), there is a move to increase uptake of home-based modalities (peritoneal dialysis (PD) or home haemodialysis (HHD)) and self-assist haemodialysis (SAHD) due to the economic, clinical and lifestyle advantages they confer. However, HHD and SAHD are not yet widely adopted in Singapore with majority of patients receiving in-centre HD. Although much research has examined patient decision-making around dialysis modality selection, there is limited literature evaluating patient’s perspectives of HHD and SAHD in Asia where the prevalence of these alternative modalities remained low. With this background, we aimed to evaluate patient’s perspectives of HHD and SAHD and the factors influencing their choice of dialysis modality in Singapore to determine the challenges and facilitators to establishing these modalities locally.
Methods
Semi-structured interviews were conducted with 17 patients on dialysis from a tertiary hospital in Singapore in this exploratory qualitative study. Data collected from one-to-one interviews were analysed via thematic content analysis and reported via an interpretative approach.
Results
The findings were segregated into: (1) factors influencing choices of dialysis modality; (2) perspectives of HHD; and (3) perspectives of SAHD. Modality choices were affected by environmental, personal, social, financial, information and family-related factors. Most perceived HHD as providing greater autonomy, convenience and flexibility while SAHD was perceived as a safer option than HHD. For both modalities, patients were concerned about self-care and burdening their family.
Conclusions
The findings provided a framework for healthcare providers to understand the determinants affecting patients’ dialysis modality decisions and uncovered the facilitators and challenges to be addressed to establish HHD and SAHD modalities in Singapore.
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Zhang Z, Phang CC, Tan RY, Pang SC, Chandramohan S, Zhuang KD, Sulaiman MS, Tay KH, Chong TT, Tan CS. Corrigendum to "Re: does reducing radiation levels for procedures affect image quality and radiation to proceduralists? A double-blinded randomized study of two protocols" [76 (2) e1-e10]. Clin Radiol 2021; 76:552.e1. [PMID: 33975710 DOI: 10.1016/j.crad.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Z Zhang
- Duke-NUS Medical School, National University of Singapore, 169857, Singapore.
| | - C C Phang
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - R Y Tan
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - S C Pang
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - S Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore
| | - M S Sulaiman
- Department of Radiology, Singapore General Hospital, 169608, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore
| | - T T Chong
- Department of Vascular Surgery, Singapore General Hospital, 169608, Singapore
| | - C S Tan
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
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Tan HZ, Phang CC, Wu SY, Sim MH, Law MM, Foo MWY, Htay H. Improving influenza and pneumococcal vaccination uptake among incident peritoneal dialysis patients: a quality improvement initiative. Int Urol Nephrol 2021; 53:2167-2175. [PMID: 33675479 DOI: 10.1007/s11255-021-02817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Influenza and pneumococcal vaccination rates among peritoneal dialysis (PD) patients remain suboptimal, despite availability of vaccinations and health recommendations. AIM The primary aim was to improve influenza and pneumococcal vaccination rates among incident PD patients at our center to 80%. A secondary aim was to develop a sustainable workflow for vaccination in PD patients. DESIGN A quality improvement (QI) initiative to increase vaccination rate among incident PD patients was conducted in a tertiary care hospital in Singapore from Jul 2017 to Dec 2018. Key drivers and barriers to success were identified through root cause analysis. Change ideas focusing on improving opportunities, access and enhancement of reminder systems were implemented using Plan-Do-Study-Act methodology. Vaccination rates were monitored at 3-month intervals. RESULTS Total of 249 patients were eligible for vaccination. The baseline vaccination rate for influenza, pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) were 63%, 54% and 14%, respectively. Root-cause analyses revealed several practice-related barriers, including lack of physician recommendation, time constraints and ineffective reminder systems. Multifaceted interventions, such as the provision of vaccination at non-traditional clinical settings, physician audit and feedback, utilisation of reminder tools, successfully increased influenza, PCV13 and PPSV23 vaccination rates to 86%, 85% and 63%, respectively. CONCLUSION A robust influenza and pneumococcal vaccination program implemented using a standardized QI methodology and multidisciplinary approach is effective in improving and sustaining influenza and pneumococcal vaccination uptake among PD patients.
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Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Mui Hian Sim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Zhang Z, Phang CC, Tan RY, Pang SC, Chandramohan S, Zhuang KD, Sulaiman MS, Tay KH, Chong TT, Tan CS. Does reducing radiation levels for procedures affect image quality and radiation to proceduralists? A double-blinded randomised study of two protocols. Clin Radiol 2020; 76:157.e1-157.e10. [PMID: 32993879 DOI: 10.1016/j.crad.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the ultra-lose dose imaging protocol (ULDP), compared to the standard low-dose imaging protocol (LDP), which are used for haemodialysis access, in terms of radiation exposure and image quality. MATERIAL AND METHODS This was a single-centre, institutional review board-approved, prospective, double-blinded randomised controlled study to compare radiation exposure and image quality of the ULDP and LDP. Ten proceduralists, two radiographers, and 11 nurses were enrolled. Radiation exposure during 80 procedures (40 angioplasties and 40 thrombolysis) was recorded (direct radiation to patients from protocol report and scattered radiation to participants from the RaySafe i2 real-time dosimetry system). Baseline characteristics of procedure were recorded. Image quality was assessed subjectively using questionnaires based on the five-point Likert scale after each procedure. RESULTS Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses (0.506±0.430 versus 0.847±0.965 μSv/s, p=0.044; 0.571±1.284 versus 1.284±1.007 mGy/s, p<0.001; and 0.052±0.071 versus 0.141±0.185 μSv/s, p=0.005, respectively). No significant difference in image quality or duration of procedure was observed (all p values >0.05). CONCLUSION Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses without compromising the image quality or duration of procedure.
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Affiliation(s)
- Z Zhang
- Duke-NUS Medical School, National University of Singapore, 169857, Singapore.
| | - C C Phang
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - R Y Tan
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - S C Pang
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
| | - S Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore.
| | - M S Sulaiman
- Department of Radiology, Singapore General Hospital, 169608, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, 169608, Singapore
| | - T T Chong
- Department of Vascular Surgery, Singapore General Hospital, 169608, Singapore
| | - C S Tan
- Department of Renal Medicine, Singapore General Hospital, 169608, Singapore
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Phang CC, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Koniman R, Chan CM, Oei EL, Chong TT, Htay H. Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience. Int Urol Nephrol 2020; 53:583-590. [PMID: 32895864 DOI: 10.1007/s11255-020-02630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD. METHODS This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival. RESULTS A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups. CONCLUSION Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.
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Affiliation(s)
- Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan City, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Health Services Research Centre (HSRC), Singapore Health Services (SingHealth), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Tze Tec Chong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
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Koniman R, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Phang CC, Oei EL, Htay H. Early technique failure in peritoneal dialysis patients in a multi-ethnic Asian country. Int Urol Nephrol 2020; 52:1987-1994. [PMID: 32729098 DOI: 10.1007/s11255-020-02570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Early technique failure is a serious complication for peritoneal dialysis (PD) patients. The study aimed to examine the incidence, causes, and risk factors associated with early technique failure. METHODS: This retrospective study included all incident PD patients in a hospital in Singapore from 2013 to 2017. The primary outcome was early technique failure, which was defined as transfer to hemodialysis for ≥ 30 days or death, within the first year of PD initiation. Secondary outcomes were death, technique failure due to PD infection, and death-censored technique failure. RESULTS Overall, 517 patients were included in the study. Of these, 98 patients (19.0%) developed early technique failure. The common causes of early technique failure were death (41.8%) and infection (40.8%). Peripheral vascular disease was significantly associated with a higher hazard of early technique failure [hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.04-3.63] and death (HR 3.75, 95% CI 1.71-8.21), whilst glomerulonephritis as a cause of end-stage kidney disease (compared with hypertension) was associated with a lower hazard of early technique failure (HR 0.38, 95% CI 0.18-0.77) and death (HR 0.08, 95% CI 0.02-0.37). Male gender was associated with early technique failure due to PD infection (HR 2.55, 95% CI 1.32-4.95). No specific factor was associated with death-censored early technique failure. CONCLUSION Technique failure in the first year of PD initiation occurs in one-fifth of PD patients and is associated with peripheral vascular disease and cause of end-stage kidney disease.
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Affiliation(s)
- Riece Koniman
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Brisbane, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Singapore Health Services, Health Services Research Centre (HSRC), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Chee Chin Phang
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Htay Htay
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore.
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Koniman R, Htay H, Wu SY, Ng P, Ng LC, Oei LE, Phang CC, Foo WYM. SP494EARLY TECHNIQUE FAILURE IN PERITONEAL DIALYSIS: A SINGLE CENTER EXPERIENCE IN SINGAPORE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Htay Htay
- Singapore General Hospital, Singapore, Singapore
| | - Sin Yan Wu
- Singapore General Hospital, Singapore, Singapore
| | - Peishi Ng
- Singapore General Hospital, Singapore, Singapore
| | - Li Choo Ng
- Singapore General Hospital, Singapore, Singapore
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Phang CC, Tan RY, Pang SC, Tan CW, Teh SP, Cheng R, Kho YX, Chong TT, Gogna A, Foo WY, Tan CS. Paclitaxel‐coated balloon in the treatment of recurrent dysfunctional arteriovenous access, real‐world experience and longitudinal follow up. Nephrology (Carlton) 2019; 24:1290-1295. [DOI: 10.1111/nep.13591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Chee Chin Phang
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Ru Yu Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Suh Chien Pang
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Chee Wooi Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Swee Ping Teh
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | | | - Yu Xuan Kho
- NUS Yong Loo Lin School of Medicine Singapore Singapore
| | - Tze Tec Chong
- Department of Vascular SurgerySingapore General Hospital Singapore Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional RadiologySingapore General Hospital Singapore Singapore
| | - Wai Yin Foo
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Chieh Suai Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
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