Public Hospital In Singapore Research Articles

Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection and the inflammatory response: an observational cohort study

SummaryBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) region of the genome have been detected in Singapore and other countries. We investigated the effect of this deletion on the clinical features of infection.MethodsWe retrospectively identified patients who had been screened for the ∆382 variant and recruited to the PROTECT study—a prospective observational cohort study conducted at seven public hospitals in Singapore. We collected clinical, laboratory, and radiological data from patients' electronic medical records and serial blood and respiratory samples taken during hospitalisation and after discharge. Individuals infected with the ∆382 variant were compared with those infected with wild-type SARS-CoV-2. Exact logistic regression was used to examine the association between the infection groups and the development of hypoxia requiring supplemental oxygen (an indicator of severe COVID-19, the primary endpoint). Follow-up for the study's primary endpoint is completed.FindingsBetween Jan 22 and March 21, 2020, 278 patients with PCR-confirmed SARS-CoV-2 infection were screened for the ∆382 deletion and 131 were enrolled onto the study, of whom 92 (70%) were infected with the wild-type virus, ten (8%) had a mix of wild-type and ∆382-variant viruses, and 29 (22%) had only the ∆382 variant. Development of hypoxia requiring supplemental oxygen was less frequent in the ∆382 variant group (0 [0%] of 29 patients) than in the wild-type only group (26 [28%] of 92; absolute difference 28% [95% CI 14–28]). After adjusting for age and presence of comorbidities, infection with the ∆382 variant only was associated with lower odds of developing hypoxia requiring supplemental oxygen (adjusted odds ratio 0·07 [95% CI 0·00–0·48]) compared with infection with wild-type virus only.InterpretationThe ∆382 variant of SARS-CoV-2 seems to be associated with a milder infection. The observed clinical effects of deletions in ORF8 could have implications for the development of treatments and vaccines.FundingNational Medical Research Council Singapore.

Development and validation of the incontinence associated dermatitis knowledge, attitude and practice questionnaire

AimThis study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses. MethodsA psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability. ResultsThe instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69–0.96, p < 0.001). ConclusionThe KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses’ KAP and associations between IAD knowledge, attitudes and practices.

Promotion of mobility among hospitalised older adults: An exploratory study on perceptions of patients, carers and nurses

BackgroundHospitalisation of an older adult due to acute medical illness can result in adverse events and accelerate loss of independence despite recovery from the illness. Promoting mobility during hospitalisation can help to mitigate the risks of functional decline. Understanding the perspectives on the barriers and the maintenance of mobility is essential in the development of effective strategies. AimsTo explore the perceptions of patients and their carers, as well as the nurses on promotion of mobility among hospitalised adult older patients. MethodsA qualitative descriptive study design with purposive and convenience sampling approach was undertaken. A total of fourteen patients, six carers and ten nurses from a general medical ward of an acute care tertiary public hospital in Singapore were recruited over the period of November 2017 to February 2018. Face to face semi-structured interviews were conducted and audio-recorded. The interview transcripts were coded and an inductive content analysis approach was adopted to generate categories of sub-themes and themes through the open coding process. ResultsFour main themes were generated: (1) perceived and induced fear of falling; (2) challenges in initiation of mobility; (3) influence of premorbid status and physical condition on activity level; and (4) strategies to promote mobility. ConclusionRecognition of the importance of mobility as well as the detrimental effects of prolonged bed rest during hospitalization is an essential first step toward developing successful interventions to promote mobility in the Asian context. Improvements need to be made to help overcome the various barriers and challenges in the mobilization of the older patients in the acute care settings. Nurses and other members of the care team can help to increase the confidence of patients and among family carers (in providing assistance during mobility) by role modelling and provision of walking aids as well as risk-based education.

Radiology Preparedness in the Ongoing Battle against COVID-19: Experiences from Large to Small Public Hospitals in Singapore.

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge to the health care systems of the world. In Singapore, early experiences of the radiology community on managing this pandemic was shaped by lessons learned from the severe acute respiratory syndrome outbreak in 2003. This article surveys the operational responses of radiology departments from six public hospitals in Singapore.© RSNA, 2020

Review of systems for recognising and responding to clinical deterioration in Singapore hospitals: a nationwide cross-sectional study.

The Rapid Response System for recognising and responding to clinically deteriorating patients has been progressively implemented in acute care hospitals across the globe. This study sought to review the implementation of this system in acute public hospitals in Singapore. A cross-sectional study using a face-to-face survey questionnaire was conducted. Five out of seven invited hospitals completed the questionnaire and rated the Rapid Response System as either high priority or essential, and indicated its importance over other patient safety indicators. Sensitivity and specificity of the triggering criteria and non-adherence to the escalation protocol were highlighted issues. Only two hospitals had a dedicated response team for providing emergency help to deteriorating ward patients. Limited manpower resources, unclear roles between the primary and response teams, and the potential deskilling of ward staff were reported barriers that inhibited the uptake of a response team. All hospitals had a committee that oversaw its system operation, provided training to ward staff, and used information technology to support the implementation. A variety of approaches have been taken to support the system of recognising and responding to clinical deterioration. This calls for a national approach to enable the standardisation of clinical processes, sharing of educational resources and multi-site evaluation.

Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency Department Visits and Hospital Admissions in Singapore

Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995-1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996-1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011-1.036; P = 1.24 × 10-6 ) and hospital admissions (RR, 1.027; 99.2% CI, 1.010-1.043; P = 2.02 × 10-5 ) for respiratory conditions were found. Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore.

Analysis via Markov decision process to evaluate glycemic control strategies of a large retrospective cohort with type 2 diabetes: the ameliorate study.

Our aim was to explore optimal treatment decisions for HbA1c control for type 2 diabetes mellitus patients and assess the impact on potential improvements in quality of life compared with current guidelines. We analyzed a large dataset of HbA1c levels, diabetes-related key risk factors and medication dispensed to 70,069 patients with type 2 diabetes from polyclinics and a large public hospital in Singapore during January 1, 2008, to December 31, 2015. A Markov decision process (MDP) model was developed to determine the optimal treatment policy concerning medication management for glycemic control over a long-term treatment period. We assessed the model performance by comparing quality-adjusted life years (QALYs) gained by the model with those derived by a conventional Markov model informed by current clinical guidelines. Numerical results showed that optimal treatment strategies derived by the MDP model could increase the total expected QALYs by as much as 0.27years for patients at higher risk such as old age, high HbA1c levels and smokers. In particular, the improvements in QALYs gained for patients with HbA1c levels of 9% (75mmol/mol) and above were higher than those with lower HbA1c levels. However, the potential improvements appeared to be marginal for patients at lower risk compared with current guidelines. Use of data-driven prescriptive analytics would help clinicians make evidence-based treatment decisions for HbA1c control for patients with type 2 diabetes, in particular for those at high risk.

A cross-sectional survey on nurses' second victim experience and quality of support resources in Singapore.

The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore. The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked. A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources. The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable. Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon. Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.

The Impact of the COVID 19 Pandemic on Emergency Department Attendance: What Seems To Be Keeping the Patients Away?

During outbreaks such as severe acute respiratory syndrome and COVID 19, many Emergency Departments across the world had a reduction in the general attendance, including the attendance of more serious and critical diagnoses. Here, the author shares the numbers seen at Singapore General Hospital, the largest public hospital in Singapore during the period of February to June 2020. The reduction ranged from 13% to 28% compared to the same period in 2019, before the outbreak. Patient and healthcare system-related factors which may have caused these observations are discussed. The author also puts forth the Behavioral Immune System and Response mechanism as a possible explanation for patients staying away from the hospitals during the outbreak.

Association of SARS-CoV-2 Clades with Clinical, Inflammatory and Virologic Outcomes: An Observational Study

Background: Host determinants of severe coronavirus disease 2019 include advanced age, comorbidities and male sex. Virologic factors may also be important in determining clinical outcome and transmission rates, but limited patient-level data is available. Methods: We conducted an observational cohort study at seven public hospitals in Singapore. Clinical and laboratory data were collected and compared between individuals infected with different SARS-CoV-2 clades. Firth’s logistic regression was used to examine the association between SARS-CoV-2 clade and development of hypoxia, and quasi-Poisson regression to compare transmission rates. Plasma samples were tested for immune mediator levels and the kinetics of viral replication in cell culture were compared. Findings: 319 patients with PCR-confirmed SARS-CoV-2 infection had clinical and virologic data available for analysis. 29 (9%) were infected with clade S, 90 (28%) with clade L/V, 96 (30%) with clade G (containing D614G variant), and 104 (33%) with other clades ‘O’ were assigned to lineage B.6. After adjusting for age and other covariates, infections with clade S (adjusted odds ratio (aOR) 0·030 (95% confidence intervals (CI): 0·0002-0·29)) or clade O (B·6) (aOR 0·26 (95% CI 0·064-0·93)) were associated with lower odds of developing hypoxia requiring supplemental oxygen compared with clade L/V. Patients infected with clade L/V had more pronounced systemic inflammation with higher concentrations of pro-inflammatory cytokines, chemokines and growth factors. No significant difference in the severity of clade G infections was observed (aOR 0·95 (95% CI: 0·35-2·52). Though viral loads were significantly higher, there was no evidence of increased transmissibility of clade G, and replicative fitness in cell culture was similar for all clades. Interpretation: Infection with clades L/V was associated with increased severity and more systemic release of pro-inflammatory cytokines. Infection with clade G was not associated with changes in severity, and despite higher viral loads there was no evidence of increased transmissibility.Funding Statement: This study was funded by grants from the Singapore National Medical Research Council (COVID19RF- 001, COVID19RF2-0001, COVID19RF-007, and COVID19RF-60) and Biomedical Research Council (project number H20/04/g1/006).Declaration of Interests: No conflicts of interest declared.Ethics Approval Statement: The epidemiological investigation was conducted under the Infectious Diseases Act (Singapore). Study protocols were approved by ethics committees of the National Healthcare Group and SingHealth. Written informed consent was obtained from participants for clinical data and biological sample collection as part of the PROTECT study (2012/00917; 2018/3045). A waiver of informed consent for retrospective data collection only was granted for individuals admitted to the National Centre of Infectious Diseases (2020/01122). Healthy donor samples were collected under study numbers 2017/2806 and NUS IRB 04-140.

Singapore SPICE: sedation practices in intensive care evaluation in Singapore - a prospective cohort study of the public healthcare system.

A study was conducted to describe the sedation practices of intensive care units (ICUs) in Singapore in terms of drug use, sedation depth and the incidence of delirium in both early (< 48 hours) and late (> 48 hours) periods of ICU admission. A prospective multicentre cohort study was conducted on patients who were expected to be sedated and ventilated for over 24 hours in seven ICUs (surgical ICU, n = 4; medical ICU, n = 3) of four major public hospitals in Singapore. Patients were followed up to 28 days or until ICU discharge, with four-hourly sedation monitoring and daily delirium assessment by trained nurses. The Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) were used. We enrolled 198 patients over a five-month period. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25.3 ± 9.2, and 90.9% were emergency hospital admissions. Patients were followed up for 1,417 ICU patient days, of which 396 days were in the early period and 1,021 days were in the late period. 7,354 RASS assessments were performed. Propofol and fentanyl were the sedative agents of choice in the early and late periods, respectively. Patients were mostly in the light sedation range, especially in the late period. At least one episode of delirium was seen in 23.7% of patients. Sedation practices in Singapore ICUs are characterised by light sedation depth and low incidence of delirium, possibly due to the drugs used.

Experiences and Needs of Perimenopausal Women With Climacteric Symptoms in Singapore: A Qualitative Study.

Introduction: Women in the perimenopause stage may face climacteric symptoms where physical and mental challenges are experienced. The purpose of this study was to increase the understanding of the experiences and needs of perimenopausal women with climacteric symptoms in Singapore. Method: This is a descriptive qualitative study. Purposive sampling was used to recruit 20 perimenopausal women with climacteric symptoms from a tertiary public hospital in Singapore. Semistructured face-to-face interviews and thematic analysis were used for data collection and analysis, respectively. Results: Participants lacked knowledge resulting in misconceptions of the condition. Experiencing climacteric symptoms led to mixed feelings. The availability of support varied in different sources and forms. Participants seek for more information, understanding, compassion, and empathy from family members and health care professionals. Discussion: Health care professionals should provide adequate support to cater to the diverse experiences and needs of multiracial perimenopausal women with climacteric symptoms. Future research should include the perspectives of health care professionals and family members.

Palliative Care Awareness Among Advanced Cancer Patients and Their Family Caregivers in Singapore

We investigated the awareness of palliative care (PC) services in advanced cancer patients and their family caregivers and whether negative perceptions was a possible barrier to PC utilisation in Singapore. Patients with stage 4 solid cancer and their caregivers were interviewed between July 2016 and March 2018 at outpatient clinics located in the medical oncology departments of 2 major public hospitals in Singapore. Patients and caregivers were asked whether they were aware of PC services, how they first learned about them, who first recommended PC to the patient, whether the patient had received PC, and reasons for not receiving PC. Awareness of PC was lower in patients compared to caregivers (43% vs 53%; P <0.01). The odds of being aware in patients was higher if they had higher education (odds ratio [OR] = 2.927; P <0.001) and higher income (OR = 1.798; P = 0.005). Compared to patients, more caregivers reported that a healthcare provider recommended PC to the patient (10% vs 20%; P <0.012). Furthermore, 7% of patients and 15% of caregivers reported that the patient received PC (P = 0.031). The most common reasons for not receiving PC reported by patients and caregivers (respectively) were that the patient was still receiving treatment (68% and 78%), it is not time for PC (76% and 59%) and PC would not be of help (18% and 19%). Less than half of patients indicated an awareness of PC. Our findings suggest that efforts should be made to increase awareness of PC and promote its acceptance in cancer patients and their family caregivers in Singapore.

Blood eosinophil count correlates with severity of respiratory failure in life-threatening asthma and predicts risk of subsequent exacerbations.

An elevated blood eosinophil count when asthma is stable predicts exacerbations and therapeutic response to corticosteroids or biologics targeting eosinophils. Few studies have examined the prognostic value of blood eosinophils measured at exacerbation. To elucidate the relationship between a spot blood eosinophil count-measured at the onset of a life-threatening asthma exacerbation-with indices of exacerbation severity and risk of subsequent exacerbations. Real-world, retrospective review of all life-threatening asthma cases admitted at 4 public hospitals in Singapore between 2011-2015. We assessed the trends and correlations between blood eosinophil count on admission with arterial blood gas values, duration of mechanical ventilation, and risk of death, hypoxic ischemic encephalopathy or respiratory arrest. Risk of future exacerbations among survivors was modelled using Cox regression and survival curves. There were 376 index life-threatening exacerbations with median blood eosinophil count (5-95th percentiles) of 0.270×109 /L (0-1.410×109 /L). Arterial pH decreased and PCO2 increased with increasing eosinophil count. Duration of mechanical ventilation and risk of death, hypoxic ischaemic encephalopathy or respiratory arrest did not vary with eosinophils. Among 329 survivors who were followed-up over a median of 52months, blood eosinophils ≥1.200×109 /L was associated with an increased hazard of emergency visits and/or admissions for asthma (hazard ratio 1.8, 95% confidence interval 1.1-2.9, P=.02). In this study of life-threatening asthma, we found that a spot blood eosinophil count correlates with severity of respiratory failure and predicts risk of subsequent exacerbations.

Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study

BackgroundPregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore.MethodsBetween September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants’ influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake.ResultsResponse rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3–12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92–12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54–4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43–3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30–2.01).ConclusionsInfluenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines.

A Cross-sectional Study of Knowledge, Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors.

Introduction:Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods:Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results:Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion:The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.

Patterns of relapse after neoadjuvant chemotherapy in breast cancer: implications for surveillance in clinical practice.

This study aimed to identify patterns of relapse after neoadjuvant chemotherapy (NAC) for breast cancer to refine follow-up recommendations. Retrospective analysis on 523 breast cancer patients treated with NAC at two public hospitals in Singapore between 2000 and 2014. Majority of patients (71.9%) had locally advanced disease. Median follow-up was 55months. 5-year recurrence rate was significantly higher in triple negative breast cancer (TNBC) than non-TNBC subtypes (38.4% vs. 29.5%; p = 0.042); 85% of recurrences involved distant sites. Among TNBC and HR (hormone receptor)-/HER2+ subtypes, 97.0% and 95.0% of relapses occurred within 3years from diagnosis respectively while 10.6% of relapses among HR+ subgroup occurred beyond 5years. Recurrence risk in high-grade tumours decreased with time. Stage III at diagnosis (hazard ratio = 2.94; p < 0.001), grade 3 tumours (hazard ratio = 2.87; p = 0.018), not achieving pathologic complete response (pCR) (hazard ratio = 8.77; p = 0.003) and not receiving adjuvant radiotherapy (hazard ratio = 3.19; p < 0.001) were independent predictors of inferior recurrence-free survival. Serum CA 15-3 was raised in 49% of patients upon relapse; it correlated with inferior post-relapse survival (median 11months vs. 22months; p = 0.019). While more intensive follow-up during the first 3years may be required for patients who do not achieve pCR, especially those with TNBC and HR-/HER2+ tumours, the benefit from blood tests such as CA 15-3 appears limited, and the benefit from intensification of surveillance remains to be addressed in prospective studies on high-risk patients.

Fathers' Involvement in Their Wives'/Partners' Breastfeeding: A Descriptive Correlational Study.

Fathers' involvement has been identified as a significant predictor in maternal breastfeeding outcomes. Its benefits have been well-documented, but limited studies have examined its influencing factors. To investigate factors influencing fathers' involvement in their partners' breastfeeding. A descriptive correlational design was used. Data were collected from 151 fathers from four obstetrics wards of a public hospital in Singapore from October 2016 to December 2016. Self-administered questionnaires were used to examine factors such as fathers' knowledge and involvement in breastfeeding, attitudes towards breastfeeding, and perceived improvements of knowledge and attitudes for fathers' involvement in breastfeeding on the discharge day of their partners' and 2 weeks post-birth. Data were analyzed using IBMSPSS24.0. Fathers' involvement in their partners' breastfeeding yielded a moderate to high mean score. The multiple linear regression analysis showed that five independent factors significantly influenced fathers' involvement in their partners' breastfeeding: (1) perceived approval of family members and friends in fathers' breastfeeding involvement; (2) knowledge regarding breastfeeding and their involvement; (3) perceived behavioral control for fathers' breastfeeding involvement; (4)marital relationship; and (5) perceived improvements of knowledge and attitudes 2 weeks post-birth. The study provided evidence on the significant factors that influenced fathers' involvement in their partners' breastfeeding, which can be used to guide healthcare professionals when providing appropriate support to facilitate fathers' involvement. Future studies should continue to evaluate fathers' involvement in breastfeeding longitudinally so that relevant support can be rendered.

Perspectives of women experiencing Menorrhagia: A descriptive qualitative study.

To describe the perspectives and support needs of women experiencing menorrhagia in Singapore. Women with menorrhagia lack awareness regarding the severity of menorrhagia. There is a dearth of literature understanding the support needs of women with menorrhagia. A descriptive qualitative study design was adopted. The Consolidated crieteria for Reportig Qualitative Research (COREQ) was used to report the findings of this study. The study was conducted at a tertiary public hospital in Singapore from July 2017-October 2017. Semi-structured interviews were used to collect data from 16 women who were diagnosed with menorrhagia. The total number of interviews was concluded based on data saturation. The interviews were transcribed verbatim, and thematic analysis was used to analyse the interview transcripts. The COREQ was used to report the findings of this study. Participants reported that they were unaware about menorrhagia and its severity. Various internal and external factors influenced the participants' awareness and understanding of menorrhagia. Although the participants received support to cope with menorrhagia, the support was deemed insufficient. The women shared that menorrhagia had affected their lives physically, emotionally, socially and financially. They used both external and internal coping mechanisms to cope with their conditions and looked for information through close contacts and the Internet. They longed to learn more about their conditions. Multiethnic Singaporean women with menorrhagia lacked awareness about their conditions and the severity, which affected their lives negatively. There should be greater efforts to raise the public's awareness of menorrhagia so that women can seek medical help early and minimise its negative influence on their lives. Healthcare providers need to pay greater attention to menorrhagia in order to provide more holistic care and support for those experiencing this condition. Healthcare professionals should understand their patients' experiences with menorrhagia and evaluate their current support resources in order to create a strong support system.

Lost in transition-Newly qualified registered nurses and their transition to practice journey in the first six months: A qualitative descriptive study

Background and objective: Poor transition to practice during the first year of graduate nurses' employment causes compromised patient care and a high staff turnover. Globally, as the world grapples with an ageing population and increasing healthcare demands, it is imperative to retain newly qualified Registered Nurses to sustain the nursing workforce. Objectives: To explore newly qualified Registered Nurses on their transition to practice journey during their first six months of employment.Methods: Design: A qualitative descriptive design. Settings: A large metropolitan public hospital in Singapore. Participants: A purposive sample of eleven newly qualified Registered Nurses with six months of graduate working experience. Methods: One-to-one semi-structured interviews were conducted, audio-taped and transcribed verbatim. Thematic analysis was employed in this study.Results: Three themes emerged from the data analysis: personal adaptations, professional adaptations and organisational adaptations. Subthemes of personal adaptations include a new experience, seeking help and coping with transition. Under professional adaptations, the subthemes are accountability, coordination, interprofessional relationships and knowledge. Subthemes of organisational adaptations are staff support, working environment and transition to practice programme.Conclusions: The findings emphasized the importance of establishing responsibilities, performance expectations and appropriate workplace behaviors guidelines, and to bridge the gap between transition to practice programme and preceptorship is also necessary.