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Seah S, Tan YK, Teh K, Loh WJ, Tan PT, Goh LC, Malakar RD, Aw TC, Lau CS, Dhalliwal T, Kui SL, Kam JW, Khoo J, Tay TL, Tan E, Au V, Soh SB, Zhang M, King TF, Gani L, Puar TH. Proton-pump inhibitor use amongst patients with severe hypomagnesemia. Front Pharmacol 2023; 14:1092476. [PMID: 36794273 PMCID: PMC9922884 DOI: 10.3389/fphar.2023.1092476] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: Long-term proton pump inhibitor (PPI) use has been associated with hypomagnesemia. It is unknown how frequently PPI use is implicated in patients with severe hypomagnesemia, and its clinical course or risk factors. Methods: All patients with severe hypomagnesemia from 2013 to 2016 in a tertiary center were assessed for likelihood of PPI-related hypomagnesemia using Naranjo algorithm, and we described the clinical course. The clinical characteristics of each case of PPI-related severe hypomagnesemia was compared with three controls on long-term PPI without hypomagnesemia, to assess for risk factors of developing severe hypomagnesemia. Results: Amongst 53,149 patients with serum magnesium measurements, 360 patients had severe hypomagnesemia (<0.4 mmol/L). 189 of 360 (52.5%) patients had at least possible PPI-related hypomagnesemia (128 possible, 59 probable, two definite). 49 of 189 (24.7%) patients had no other etiology for hypomagnesemia. PPI was stopped in 43 (22.8%) patients. Seventy (37.0%) patients had no indication for long-term PPI use. Hypomagnesemia resolved in most patients after supplementation, but recurrence was higher in patients who continued PPI, 69.7% versus 35.7%, p = 0.009. On multivariate analysis, risk factors for hypomagnesemia were female gender (OR 1.73; 95% CI: 1.17-2.57), diabetes mellitus (OR, 4.62; 95% CI: 3.05-7.00), low BMI (OR, 0.90; 95% CI: 0.86-0.94), high-dose PPI (OR, 1.96; 95% CI: 1.29-2.98), renal impairment (OR, 3.85; 95% CI: 2.58-5.75), and diuretic use (OR, 1.68; 95% CI: 1.09-2.61). Conclusion: In patients with severe hypomagnesemia, clinicians should consider the possibility of PPI-related hypomagnesemia and re-examine the indication for continued PPI use, or consider a lower dose.
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Affiliation(s)
- Sherry Seah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yen Kheng Tan
- Doctor of Medicine Programme, Duke-NUS (National University School) Medical School, Singapore, Singapore
| | - Kevin Teh
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Pei Ting Tan
- Department of Clinical Trial Research Unit, Changi General Hospital, Singapore, Singapore
| | - Leng Chuan Goh
- Department of Pharmacy, Changi General Hospital, Singapore, Singapore
| | | | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Chin Shern Lau
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Trishpal Dhalliwal
- Department of Internal Medicine, Changi General Hospital, Singapore, Singapore
| | - Swee Leng Kui
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Jia Wen Kam
- Department of Clinical Trial Research Unit, Changi General Hospital, Singapore, Singapore
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Eberta Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Vanessa Au
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Shui Boon Soh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Meifen Zhang
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Thomas F. King
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Linsey Gani
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Troy H. Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore,*Correspondence: Troy H. Puar,
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Ng WLS, Tan TJ, Kam JW, Mehta K. The Incidence and Anatomic Variation of Os Naviculare in a Multiethinic Asian Population. J Foot Ankle Surg 2022; 61:456-458. [PMID: 34750072 DOI: 10.1053/j.jfas.2021.05.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
The incidence of asymptomatic os naviculare ranges from 4% to 21%, varying between different ethnicities, with majority of studies performed in Caucasians. The aim of this study was to document the incidence of asymptomatic os naviculare in an Asian population stratified by ethnicity, and to characterize the features of each type. The records of all patients who underwent dorsoplantar and oblique foot radiographs between July and December 2017 were reviewed. We excluded patients with medial-sided foot pain. The radiographs of the remaining patients were reviewed and the incidence and type of os naviculare according to Coughlin's classification were recorded. About 439 patients were included. The overall incidence of asymptomatic os naviculare was 46.0%, of which 76.7% were bilateral. The prevalence of type Ia, Ib, and Ic os was 7.5%, 6.2%, and 5.9%, respectively. The prevalence of type IIAa, IIAb, IIAc, IIBa, IIBb, and IIBc was 2.7%, 0.7%, 0.2%, 16.6%, 5.9%, and 2.1%, respectively. The prevalence of type IIIa, IIIb, and IIIc was 1.1%, 8.4%, and 0.2%. Type IIBa had the highest prevalence of 16.6% out of 439 patients. The highest incidence of os naviculare was in the Chinese population (n = 145, p = .034) at 50.2%. There was no significant gender difference in the incidence of asymptomatic os naviculare. The incidence of asymptomatic os naviculare in a multiethnic Asian population is higher than that reported in other populations, and particularly in the Chinese. Type IIBa was the most prevalent type, which differs from previous reports. When treating patients of Chinse ethnicity who present with pain over the medial aspect of the foot, the diagnosis of a symptomatic os naviculare should be considered.
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Affiliation(s)
- Wei Ling Stacy Ng
- Singhealth Orthopaedic Residency, Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore.
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Jia Wen Kam
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Kinjal Mehta
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
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Tan S, Foong JW, Kam JW, Foo CWS, Ong KXK. Development and validation of a predictive model for early functional recovery in the post-hip fracture surgery population. Singapore Med J 2021; 64:276-281. [PMID: 34911184 PMCID: PMC10144448 DOI: 10.11622/smedj.2021184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shumei Tan
- Rehabilitative Services, Changi General Hospital, Singapore
| | - Jing Wen Foong
- Rehabilitative Services, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
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Huang C, Seah JJ, Tan CK, Kam JW, Tan J, Teo EK, Kwek A, Wong YJ, Tan M, Ang TL, Kumar R. Modified AST to platelet ratio index improves APRI and better predicts advanced fibrosis and liver cirrhosis in patients with non-alcoholic fatty liver disease. Clin Res Hepatol Gastroenterol 2021; 45:101528. [PMID: 33268036 DOI: 10.1016/j.clinre.2020.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
AIMS Advanced fibrosis (AF) and liver cirrhosis (LC) are important milestones in non-alcoholic fatty liver disease (NAFLD). FIB-4, NFS and BARD are validated scores with good accuracy in detecting AF and LC. APRI does not have similar predictive accuracy. While a modification (m-APRI) improves its use in viral hepatitis, this has yet to be evaluated in NAFLD. This study compares diagnostic performance of aforementioned scores in predicting AF and LC in NAFLD. METHODS Consecutive NAFLD patients undergoing Transient Elastography (TE) using Echosens® Fibroscan® for fibrosis staging were included. Cut-off liver stiffness measurements for AF and LC were 7.9 kPa and 11.5 kPa respectively. Anthropometric and laboratory tests done within 3 months were used. Diagnostic performances of scores were analyzed by standard statistical tests. RESULTS 161 patients qualified for the study. Mean age was 60.2 ± 14 years, BMI 26.8 ± 4.6 kg/m2. M-probe was used in 113, XL in 48. Optimal cut-offs of m-APRI for AF and LC were 5.84 and 9 respectively. Area under receiver operator characteristic curves (AUROC) for prediction of AF at optimal cut-off points were m-APRI 0.84, APRI 0.80, FIB-4: 0.77, NFS 0.77 and BARD 0.65. For prediction of LC, AUROC were m-APRI: 0.83, APRI: 0.76, FIB-4: 0.81, NFS: 0.77 and BARD: 0.66. m-APRI was significantly superior to all scores compared in detecting AF (p < 0.05 for all) and superior to APRI (p = 0.008) and BARD (p = 0.007) in predicting LC. There was no significant difference between m-APRI and FIB-4 or NFS in prediction of LC. CONCLUSIONS For prediction of AF in NAFLD, m-APRI outperforms BARD, APRI, NFS and FIB-4, while for the prediction of cirrhosis, m-APRI is superior to APRI and BARD but comparable to NFS and FIB-4.
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Affiliation(s)
- Cheryl Huang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; NUS Yong Loo Lin School of Medicine, Singapore
| | - Jun Jie Seah
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; NUS Yong Loo Lin School of Medicine, Singapore
| | - Chin Kimg Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Jessica Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Andrew Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Yu Jun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Malcolm Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
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Chionh CY, Poh CB, Roy DM, Koduri S, Chow BL, Tan PT, Tin AS, Kam JW, Lau CS, Hoo SP, Phua SK, Tar Choon AW. The Serum Anion Gap Revisited: A Verified Reference Interval for Contemporary Use. Intern Med J 2021; 52:1531-1537. [PMID: 34028972 DOI: 10.1111/imj.15396] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/12/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anion gap (AG) is often used to evaluate acid-base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non-gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation. AIMS To determine the reference interval for AG based on current laboratory techniques. METHODS During a health-screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally-accredited clinical laboratory. AG was calculated by (Na+ ) - (Cl- ) - (HCO3- ) and AGK by (Na+ ) + (K+ ) - (Cl- ) - (HCO3 - ). The reference interval was determined at 2.5th-97.5th percentiles. Analysis was further undertaken for a sub-cohort of 156 individuals with no sub-optimal health indicators. RESULTS Median age was 35 years, BMI 23.4 kg/m2 and glomerular filtration rate 106 mL/min/1.73m2 . Median AG was 13 mmol/L and the reference interval for normal AG is 10-18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub-cohort of 156 individuals. Median AGK was 17.7 mmol/L and reference interval was 14.6-22.5 mmol/L. CONCLUSIONS The AG reference interval of 10-18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non-gap acidosis or mixed acid-base disorders. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chang Yin Chionh
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Cheng Boon Poh
- Department of Renal Medicine, Changi General Hospital, Singapore
| | | | - Sreekanth Koduri
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Bing Lun Chow
- University of Aberdeen, United Kingdom; Department of Renal Medicine, Changi General Hospital, Singapore
| | - Pei Ting Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Aung Soe Tin
- Health Services Research, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Chin Shern Lau
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - See Ping Hoo
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Soon Kieng Phua
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - A W Tar Choon
- Department of Renal Medicine, Changi General Hospital, Singapore
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Koh WP, Mok Y, Poh Y, Kam JW, Wong HS. Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore. Singapore Med J 2020; 61:665-666. [DOI: 10.11622/smedj.2020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koh WP, Mok Y, Poh Y, Kam JW, Wong HS. Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore. Singapore Med J 2020; 61:613. [PMID: 33415342 DOI: 10.11622/smedj.2020153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Yvonne Poh
- Sleep Technology, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore.
| | - Hang Siang Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Balasundaram B, Yoon PS, Rosario BH, Kam JW, Tan LMY, Varman S. Geriatric psychiatry liaison programme in a Singapore public hospital geriatric ward setting: descriptive and evaluation study on delirium and dementia. Proceedings of Singapore Healthcare 2019. [DOI: 10.1177/2010105819869031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Comprehensive geriatric psychiatry liaison services are in early and evolving stages in Singapore. A description and evaluation of a geriatric psychiatry liaison programme in geriatric wards was undertaken describing programme activity and clinical outcomes in patients with neurocognitive disorders. Dementia training and staff upskilling are also discussed. Methods: This study included all referred patients by the geriatric team in Changi General Hospital over a one-year period from 15 June 2017 to 14 June 2018. As measures of good clinical practice, diagnosis of delirium and new diagnosis of dementia made during the inpatient admission following liaison consultation were included in the study. Patient-related outcomes that included length of stay (LOS), institutionalisation rates and in-hospital mortality were evaluated. Results: Dementia (53%), delirium (49%) and depression (28%) were the commonest diagnoses in this study. Dementia was newly diagnosed in 30% of cases. The median LOS in those with delirium was 19 days; 19% with a delirium diagnosis had new institutionalisation rates. In-hospital mortality in this study was 2%. Conclusions: The geriatric psychiatry liaison programme in geriatric wards in Changi General Hospital improved detection rates of delirium and new diagnoses of dementia. It also reports increased LOS and new institutionalisation rates in those with a diagnosis of delirium. Nursing staff education in neurocognitive disorders is enhanced. This article has outlined the importance of team-based care, joint specialist care and staff training in recognition of delirium and dementia in an acute hospital setting to improve outcomes for older patients.
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Affiliation(s)
- Bharathi Balasundaram
- Medical Centre Department of Psychological Medicine, Changi General Hospital, Singapore
| | | | | | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
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Raghuraman R, Kam JW, Chua DTC. Predictors of failure following fixation of intertrochanteric fractures with proximal femoral nail antirotation. Singapore Med J 2019; 60:463-467. [PMID: 31570952 DOI: 10.11622/smedj.2019114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This retrospective matched case-control study aimed to identify predictors of cut-out following intramedullary nailing of intertrochanteric fractures with the 200-mm Synthes proximal femoral nail antirotation (PFNA). METHODS 609 patients underwent intramedullary nailing for intertrochanteric fractures at our institution between January 2011 and December 2014. 370 patients satisfied the inclusion criteria. There were 20 cases of implant cut-out. Cases and controls were matched using a propensity score-matching method with an m:n ratio, matching the criteria of gender, age and side of operation. Radiographs were assessed to determine fracture classification, fracture reduction quality, tip-apex distance, calcar referenced tip-apex distance (CalTAD), anteroposterior (AP) Parker's ratio index, lateral Parker's ratio index and cervical angle difference. Conditional logistic regression analysis was performed to determine any association between potential predictors and cut-outs. RESULTS The cut-out incidence was 5.4%. Of the 20 cut-outs, 16 were superior and four were cut-throughs. Univariate analysis only showed a significant association between unsatisfactory fracture reduction quality and cut-outs (odds ratio [OR] 10.1, 95% confidence interval [CI] 1.31-77.6, p = 0.027). This association remained significant with multivariate logistic regression analysis (OR 16.4, 95% CI 1.9-140.4, p = 0.011). Cut-throughs had significantly lower CalTAD (16.2 vs. 27.5, p = 0.016) and AP Parker's ratio index values (38.7 vs. 50.7, p = 0.007) than superior cut-outs. CONCLUSION Unsatisfactory fracture reduction quality was a significant predictor of cut-out in intertrochanteric fractures treated with the 200-mm PFNA. Cut-outs had two distinct modes, with cut-throughs having a deeper and more inferior helical blade position in the femoral head compared to superior cut-outs.
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Affiliation(s)
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
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Tan C, Tai MM, Kam JW. Emergency department asthma guideline adherence, 72-h return rates and disposition trends: Comparing data 10 years apart. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919878336] [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] [Indexed: 11/17/2022] Open
Abstract
Objective: (1) To compare adherence of Ministry of Health Singapore Guidelines of Acute Asthma in the emergency department, in data 10 years apart, and ascertain if any difference observed impacted 72-h return rates and (2) to describe enhancement in hospital and community medical services for asthma, and its effect on disposition trends. Methods: A retrospective comparison in guideline adherence with regard to systemic steroids administration, anti-cholinergic administration in moderately severe exacerbations and patient education in discharged patients was done. Rates of unscheduled 72-h returns were compared. A description of new community and hospital services was described, and disposition trends were compared. Results In total, 630 patients 10 years ago and 635 patients in the current year were studied, after exclusions and systematic sampling applied. Steroid administration improved by 29% (adjusted p < 0.001). Steroids started in the emergency department improved by 43% (adjusted p < 0.001). Ipratropium addition to second nebulizer improved by 63% (adjusted p < 0.001). Patient education improved by 66% (adjusted p < 0.001). Unscheduled 72-h returns rate were unchanged at 4.2% (adjusted p = 0.912). Although there was no significant difference in the admission and discharge disposition (adjusted p = 0.173), there was a trend towards admission to the short stay unit as an admission option and referral to the primary healthcare provider for discharged patients. Conclusion: Although guideline adherence improved in the current year, rates of 72-h unscheduled returns were similar. Disposition trends reflected emphasis and availability of healthcare services in the community and hospital.
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Affiliation(s)
- Camlyn Tan
- Department of Emergency Medicine, Changi General Hospital, Singapore
| | | | - Jia Wen Kam
- Clinical Trials & Research Unit, Changi General Hospital, Singapore
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Poh CB, Tan PC, Kam JW, Siau C, Lim NL, Yeon W, Cui HH, Ding HT, Song XY, Yan P, Chea KL, Liu JS, Chionh CY. Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy - A Safe and Effective Low-Dose Protocol. Nephrology (Carlton) 2019; 25:305-313. [PMID: 31469465 DOI: 10.1111/nep.13656] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 01/20/2023]
Abstract
AIMS Regional citrate anticoagulation (RCA) is the preferred mode of anticoagulation for continuous renal replacement therapy (CRRT). Conventional RCA-CRRT citrate dose ranges from 3 to 5 mmol/L of blood. This study explored the effectiveness of an RCA protocol with lower citrate dose and its impact on citrate-related complications. METHODS This prospective observational study compared two RCA-CRRT protocols in the intensive care unit. RCA Protocol 1 used an initial citrate dose of 3.0 mmol/L while Protocol 2 started with 2.5 mmol/L. The citrate dose was titrated by sliding scale to target circuit-iCa 0.26-0.40 mmol/L. Calcium was re-infused post-dialyzer and titrated by protocol to target systemic-iCa 1.01-1.20 mmol/L. RESULTS Two hundred RCA-CRRT sessions were performed (81 Protocol 1; 119 Protocol 2). The median age was 65.4 years and median APACHE-II score was 23. Citrate dose for Protocol 1 was significantly higher than Protocol 2 in the first 12 h. The circuit clotting rate was similar in both arms (Protocol 1: 9.9%; Protocol 2: 9.2%; P = 0.881). With Protocol 2, circuit-iCa levels were 2.42 times more likely to be on target (P = 0.003) while the odds of hypocalcaemia was 4.67 times higher with Protocol 1 (P < 0.001). There was a wider anion gap was noted with Protocol 1, which suggests a propensity for citrate accumulation with higher citrate exposure. CONCLUSION The RCA protocol with a lower initial citrate dose of 2.5 mmol/L blood had less citrate-related complications with no loss of efficacy. A more precise RCA prescription at the start of treatment avoids unnecessary citrate exposure and improves safety.
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Affiliation(s)
- Cheng Boon Poh
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Poh Choo Tan
- Medical Intensive Care Unit, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Chuin Siau
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Noelle L Lim
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Wenxiang Yeon
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Hai Hua Cui
- Medical Intensive Care Unit, Changi General Hospital, Singapore
| | - Hai Ting Ding
- Medical Intensive Care Unit, Changi General Hospital, Singapore
| | - Xiao Ying Song
- Surgical Intensive Care Unit, Changi General Hospital, Singapore
| | - Peng Yan
- Surgical Intensive Care Unit, Changi General Hospital, Singapore
| | - Kai Li Chea
- Surgical Intensive Care Unit, Changi General Hospital, Singapore
| | - Jin Shu Liu
- Surgical Intensive Care Unit, Changi General Hospital, Singapore
| | - Chang Yin Chionh
- Department of Renal Medicine, Changi General Hospital, Singapore
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De Roza MA, Kai L, Kam JW, Chan YH, Kwek A, Ang TL, Hsiang JC. Proton pump inhibitor use increases mortality and hepatic decompensation in liver cirrhosis. World J Gastroenterol 2019; 25:4933-4944. [PMID: 31543684 PMCID: PMC6737311 DOI: 10.3748/wjg.v25.i33.4933] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are widely prescribed, often without clear indications. There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients. Furthermore, PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.
AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.
METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017. PPI users were defined as cumulative defined daily dose (cDDD) ≥ 28 within a landmark period, after hospitalisation for hepatic decompensation. Cox regression analysis for comparison was done after propensity score adjustment. Further risk of hepatic decompensation was analysed by Poisson regression.
RESULTS Among 295 decompensated cirrhosis patients, 238 were PPI users and 57 were non-users. PPI users had higher mortality compared to non-users [adjusted HR = 2.10, (1.20-3.67); P = 0.009]. Longer PPI use with cDDD > 90 was associated with higher mortality, compared to non-users [aHR = 2.27, (1.10-5.14); P = 0.038]. PPI users had a higher incidence of hospitalization for hepatic decompensation [aRR = 1.61, (1.30-2.11); P < 0.001].
CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation. Longer PPI exposure with cDDD > 90 increases the risk of mortality.
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Affiliation(s)
| | - Lim Kai
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth 529889, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singhealth 529889, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 160608, Singapore
| | - Andrew Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth 529889, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth 529889, Singapore
| | - John Chen Hsiang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth 529889, Singapore
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Tan E, Khoo J, Gani LU, Malakar RD, Tay TL, Tirukonda PS, Kam JW, Tin AS, Tang TY. Effect of multidisciplinary intensive targeted care in improving diabetes mellitus outcomes: a randomized controlled pilot study - the Integrated Diabetes Education, Awareness and Lifestyle modification in Singapore (IDEALS) Program. Trials 2019; 20:549. [PMID: 31477163 PMCID: PMC6720083 DOI: 10.1186/s13063-019-3601-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 11/11/2022] Open
Abstract
Background There is a global pandemic of type 2 diabetes mellitus (T2DM), especially in Asia. Singapore has a prevalence of T2DM at 10.5%, which is higher than the world average of 8.8%. Multiple studies have shown that multidisciplinary, team-based, coordinated care has been associated with improved measures of quality care and reduced healthcare utilization. Patients with poor glycemic control and nephropathy are at the highest risk of developing cardiovascular complications and renal failure. In this study, we aimed to investigate the impact of intensive multidisciplinary diabetes mellitus care with patient empowerment versus routine clinical care on the rate of progression of micro and macrovascular complications and peripheral atherosclerotic burden, as measured by changes in femoral intima-media thickness (IMT) in patients with persistently elevated HbA1c and nephropathy. Methods The study is a single-center randomized controlled trial (RCT) with two study arms - intensive diabetes mellitus care versus routine clinical care. Patients in the intensive arm will receive care from a multidisciplinary team consisting of an endocrinologist, diabetes nurse educator, dietitian, renal pharmacist and medical social worker for counselling. In addition, patients will be provided with tools for self-care empowerment such as glucometers, blood pressure monitors and android tablets to facilitate care, monitoring and education. Patients in the routine clinical care arm will receive standard clinical care. Follow up (FU) will be for 3 years. Primary outcomes include cardiovascular events, rate of progression of nephropathy and development of end-stage renal disease. Secondary endpoints include the proportions of patients with documented improved control of cardiovascular risk factors (HbA1c, blood pressure, low density lipoprotein-C (LDL-C), reduction in body weight), frequency of hypoglycemia, hospitalization days and changes in femoral IMT. We will also examine the prevalence of peripheral atherosclerosis and the predictive value and usability of lower extremity arterial ultrasound to predict cardio-cerebrovascular events, amputation and peripheral intervention. Discussion Diabetes mellitus carries significant healthcare costs. Patients with poor glycemic control and nephropathy are at highest risk of developing cardiovascular complications and renal failure. Intensive diabetes mellitus care with patient empowerment may lead to sustained glycemic control, reduction of clinical complications and progression of nephropathy, and incidence of cardiovascular complications. Trial registration ClinicalTrials.gov, NCT03413215. Registered on 29 January 2019. Electronic supplementary material The online version of this article (10.1186/s13063-019-3601-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eberta Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore.
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Linsey Utami Gani
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Aung Soe Tin
- Health Services Research Department, Changi General Hospital, Singapore, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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Balasundaram B, Loh SY, Nadkarni P, Jiang LN, Jayaram M, Kam JW, Yap HL, Shashu Ayengar K, Bai JY. Effect of an educational training intervention on rapid tranquillisation usage – a pilot nursing study in a public hospital in Singapore. Proceedings of Singapore Healthcare 2019. [DOI: 10.1177/2010105818795941] [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] [Indexed: 11/15/2022] Open
Abstract
Background: Studies evaluating nursing educational initiatives in rapid tranquillisation procedures are lacking. Objective: This pilot study in a public hospital in Singapore evaluated the effect of an educational training intervention on knowledge and confidence of nurses using rapid tranquillisation in two medical wards. Method: The study design was a pilot pre- and post-test single-group design on a voluntary sample of 75 nurses. The educational training intervention comprised of a 60 min interactive presentation followed by a small-group-based case discussion conducted by an advanced nurse practitioner. Knowledge was measured using a ‘test the knowledge’ questionnaire; a Likert scale measured perceived level of confidence. Results: The knowledge score (overall score = 11) was significantly improved from pre-training (average score: 5.1 (standard deviation, 1.3)) to post-training (average score: 8.1 (standard deviation, 1.8)), t = −12.61, p < 0.001. The participants were more confident after training ( p < 0.001). Conclusion: This study has shown that a classroom training intervention of nurses in rapid tranquillisation procedures improved knowledge and confidence in dealing with patient violence in hospitals and added to the safe practice of rapid tranquillisation. Further studies evaluating the long-term and clinical impact of training with more rigorous study designs are needed to replicate these promising findings.
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Affiliation(s)
| | - Soak Yee Loh
- Department of Pharmacy, Changi General Hospital, Singapore
| | | | - Li Na Jiang
- Department of Nursing, Changi General Hospital, Singapore
| | - Mahesh Jayaram
- Department of Psychiatry, University of Melbourne, Australia
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Hwa Ling Yap
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | | | - Jing Yuan Bai
- Department of Nursing, Changi General Hospital, Singapore
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Koh WLE, Low F, Kam JW, Rahim S, Ng WF, Ng LL. Person-centred creative dance intervention for persons with dementia living in the community in Singapore. Dementia (London) 2019; 19:2430-2443. [PMID: 30634864 DOI: 10.1177/1471301218823439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This paper examines the efficacy of the use of creative dance intervention for persons with mild to moderate dementia, living in the community. Pre- and post-intervention data were collected on the sample of 35 older people to track the impact of the intervention on the domains of function, quality of life and well-being and caregiving stress through the use of the gait speed test, CONFbal scale, Functional Independence Measure, Quality of Life-AD, Dementia Care Mapping and Zarit Burden Interview. There was an overall improvement in all the domains. Statistically significant improvement was found in the Quality of Life reports (p = 0.002) and well-being as measured by Dementia Care Mapping (p < 0.001). The findings assert the positive contributions of person-centred creative dance towards an approach and environment that promotes dementia care. Future studies on determining sustainability of such intervention are recommended.
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Roy D, Chowdhury AR, Pande S, Kam JW. Evaluation of unplanned dialysis as a predictor of mortality in elderly dialysis patients: a retrospective data analysis. BMC Nephrol 2017; 18:364. [PMID: 29258464 PMCID: PMC5738183 DOI: 10.1186/s12882-017-0778-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Increasing numbers of elderly patients are undergoing long-term dialysis. However, the role of dialysis in survival and quality of life is unclear, and poor outcomes may be associated with comorbidities rather than with age only. The initiation of unplanned dialysis in elderly patients with chronic kidney disease (CKD) has been reported to be associated with poor survival. We evaluated patient and practice factors associated with poor survival. Methods We performed a retrospective analysis of 90 consecutive elderly patients (≥75 years) with CKD initiated on long-term dialysis at our renal unit between October 2010 and February 2014. Six patients were excluded; data from 84 remaining patients (≥75 years) with end-stage renal disease undergoing planned or unplanned dialysis were analyzed. Patients were followed up until death or January 2015. Patient factors such as age at initiation of dialysis and comorbidities (i.e., diabetes mellitus, ischemic heart disease [IHD], peripheral vascular disease, cancer, chronic obstructive pulmonary disease, and cognitive dysfunction) were analyzed. Practice factors such as planned or unplanned initiation of dialysis were compared in relation to survival outcomes. “Unplanned dialysis” was defined as a patient with known CKD stage 4 or 5 who had not been evaluated by a nephrologist in the 3 months before dialysis initiation. Results The average age at dialysis initiation was 81.5 ± 4.5 years), serum albumin level was 24.8 ± 6 g/L, body mass index was 22.5 ± 4.8 kg/m2, and glycated hemoglobin A1c level was 6.3 ± 1.3. Overall, 51 (61%) and 33 (39%) patients underwent unplanned and planned dialysis, respectively. On univariate analysis, the presence of IHD, peripheral vascular disease, ≥3 comorbidities, and unplanned initiation of dialysis were significantly related to death. On multivariate analysis, unplanned start of dialysis, ischemic heart diseases and peripheral vascular disease remained significant. Survival rates at 3 and 12 months were 38.6% vs. 90.9% and 14.4% vs. 73.6% for unplanned vs. planned dialysis, respectively (p < 0.001). Unplanned dialysis was significantly associated with greater mortality. Conclusions In elderly dialysis patients, unplanned start of dialysis was associated with poor survival. Patient characteristics such as associated peripheral vascular disease and IHD were associated with poor survival.
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Affiliation(s)
- Debajyoti Roy
- Changi General Hospital, 2 Simei St. 3, Singapore, 528889, Singapore.
| | | | - Shrikant Pande
- Changi General Hospital, 2 Simei St. 3, Singapore, 528889, Singapore
| | - Jia Wen Kam
- Changi General Hospital, 2 Simei St. 3, Singapore, 528889, Singapore
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Li JW, Ang TL, Kam JW, Kwek ABE, Teo EK. The learning curve for needle knife precut sphincterotomy revisited. United European Gastroenterol J 2017; 5:1116-1122. [PMID: 29238590 DOI: 10.1177/2050640617701808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background There is no consensus on what constitutes adequate training for needle knife precut sphincterotomy. Objective The purpose of this study was to determine the number of procedures required before effective and safe precut sphincterotomy can be achieved. Methods This retrospective study examined the cumulative experience of a single endoscopist from January 2006-December 2015. Precut sphincterotomy success and complication rates were analyzed as a function of number of procedures performed. Acceptable success and complication rates were defined as 85% and 10% respectively. A one-sided binomial test was used to test success and complication rates of every 25 precut sphincterotomies performed. Results The index endoscopic retrograde cholangiopancreatography was successful in 141/158 (89.2%) patients who underwent precut sphincterotomy. This increased to 148/158 (93.7%) when endoscopic retrograde cholangiopancreatography was repeated on another day. Six precut sphincterotomies were required to achieve an 85% success probability. This was maintained consistently above 85% after 13 precuts, and was significantly higher (91.2%; p = 0.029) than 85% at the 125th precut. Bleeding and pancreatitis developed in 2/158 (1.3%) and 5/158 (3.2%). Probability of either complications remained below 5% after 50 precuts. No perforation occurred. Conclusion At least 13 precut sphincterotomies were required to achieve a sustained success rate greater than 85%. The probability of bleeding or pancreatitis was less than 5% after 50 precut sphincterotomies.
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Affiliation(s)
- James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Leong D, Tan B, Pardal CV, Lin C, Kam JW. INJURY AND ILLNESS SURVEILLANCE DURING THE INTERNATIONAL SAILING FEDERATION SAILING WORLD CHAMPIONSHIPS 2014. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leong D, Tan B, Pardal CV, Lin C, Kam JW. INJURY AND ILLNESS PATTERNS IN COMPETITIVE SAILORS OF THE INTERNATIONAL SAILING FEDERATION SAILING WORLD CHAMPIONSHIPS 2014 – A 12-MONTH RETROSPECTIVE STUDY. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mok Y, Tan TY, Tay TR, Wong HS, Tiew PY, Kam JW, Siao C. Do we need transbronchial lung biopsy if we have bronchoalveolar lavage Xpert® MTB/RIF? Int J Tuberc Lung Dis 2017; 20:619-24. [PMID: 27084815 DOI: 10.5588/ijtld.15.0463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies evaluating the role of transbronchial lung biopsy (TBLB) in diagnosing pulmonary tuberculosis (PTB) date back decades and have shaped current practice. However, with the recent advent of bronchoalveolar lavage (BAL) Xpert® MTB/RIF, it is time to re-evaluate the role of TBLB. OBJECTIVE To assess the impact of BAL and TBLB with the addition of BAL Xpert on diagnostic PTB yields and time to treatment initiation in sputum-scarce or acid-fast bacilli (AFB) smear-negative PTB patients. METHODS We retrospectively reviewed all sputum-scarce or AFB smear-negative patients who underwent both BAL and TBLB for suspected PTB between March 2011 and October 2013. Xpert was performed on all BAL specimens. RESULTS Of 158 patients included in our analysis, 44 were culture-proven PTB. Ninety-four per cent of the patients had AFB smear-negative BAL samples. The sensitivity and specificity of Xpert in AFB smear-negative BAL samples were respectively 60% and 98%. The addition of BAL Xpert expedited the institution of PTB treatment while having diagnostic yields comparable to those of conventional BAL with TBLB. CONCLUSIONS The use of BAL Xpert may obviate the need for TBLB in increasing the diagnostic yield of PTB in sputum-scarce or AFB smear-negative patients.
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Affiliation(s)
- Y Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - T Y Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - T R Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - H S Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - P Y Tiew
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - J W Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - C Siao
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Abstract
Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.
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Affiliation(s)
- T Y Tang
- 1 Vascular Unit, Changi General Hospital, Singapore, Singapore
| | - J W Kam
- 2 Clinical Trials & Research Unit, Changi General Hospital, Singapore, Singapore
| | - M E Gaunt
- 3 Spire Cambridge Lea Hospital, Cambridge, UK
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Tan B, Leong D, Vaz Pardal C, Lin CY, Kam JW. Injury and illness surveillance at the International Sailing Federation Sailing World Championships 2014. Br J Sports Med 2016; 50:673-981. [DOI: 10.1136/bjsports-2015-095748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/04/2022]
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Tang TY, Kam JW, Gaunt ME. ClariVein® - Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins. Phlebology 2016. [PMID: 26908638 DOI: 10.1177/0268355516630154.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks' follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0-10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in-walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.
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Affiliation(s)
- T Y Tang
- 1 Vascular Unit, Changi General Hospital, Singapore, Singapore
| | - J W Kam
- 2 Clinical Trials & Research Unit, Changi General Hospital, Singapore, Singapore
| | - M E Gaunt
- 3 Spire Cambridge Lea Hospital, Cambridge, UK
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Mok Y, Tan TY, Tay TR, Wong HS, Tiew PY, Kam JW, Siau C. The Accuracy of Xpert MTB/RIF Assay in Bronchoalveolar Specimens and Its Impact on Pulmonary Tuberculosis (PTB) Management. Chest 2014. [DOI: 10.1378/chest.1992976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Hepatobiliary studies were performed over a three-year period on 139 patients suspected of having cystic duct obstruction. Each patient was infused intravenously with sincalide, a C-terminal octapeptide of CCK, 15 minutes prior to the administration of the hepatobiliary imaging agent Tc-99m paraisopropyl iminodiacetic acid (PIPIDA). Analysis of the results demonstrated significant advantages in pretreating patients with sincalide in hepatobiliary studies in a small facility with a relatively large patient load. Most of our studies were completed within 2 hours without jeopardizing the sensitivity (97%) or accuracy (96%) of the test. The specificity (88%) was comparable to percentages reported by others. Most investigators have reported that chronic cholecystitis contributed to the majority of false-positive cases. In addition, inconsistency in the documentation of criteria for the determination of acute cholecystitis (surgical, radiologic, or histologic also could be a cause for such a discrepancy. Knowledge of some important variables may help improve the specificity of the test: an awareness of the following factors during scan interpretation: 1) the effectiveness of the sincalide pretreatment dose, 2) the patient's pretest status (fasting or nonfasting, postanalgesic medication or no analgesics), and 3) time limit for gallbladder visualization. With these variables in mind, the hepatobiliary imaging using pretreatment with sincalide is proven to be a practical procedure protocol with good sensitivity and accuracy as well as specificity.
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