Setting In Singapore Research Articles

From a learning to a smart nation: the rise of the digitalization megatrend and Singapore’s development

PurposeThe purpose of this article is to discuss the “learning nation” concept and examine the characteristics and implications of using the “learning” premodifier in this nation-building program.Design/methodology/approachThis article reviews how the “learning” aspect is inter-related to a series of national information and communication technology masterplans and includes a comparative analysis of the related premodifier “smart” as Singapore sets forth its ambition to become a “smart nation” as part of the digitalization megatrend. A print media indicator and Google Trends form part of the methodology to ascertain the rise of digital technology over a certain period. The former technique involves identifying relevant bibliographic databases and analyzing the volume of publications. The latter technique is a real time index of the volume of queries that users input into Google.FindingsIt is suggested that using the term “learning nation” previously and more recently “smart nation” is a consequence of the rise of the digitalization megatrend. The “smart-ness” involves learning about digital technologies, developing digital competencies and harnessing the benefits of these digital capabilities. From a public policy perspective, the article showcases how a city-state can transform itself through technology by riding on megatrends. Also, there is a need to be selective in developing specific areas for the application of digital technologies.Originality/valueThis article contributes to a better understanding on the frequent usage of the word “learning” as a premodifier and Singapore’s nation-building journey through human capital development and digitalization.

Hospitalised patients as stewards of their own antibiotic therapy: a qualitative analysis informing the strategic design of interventions to encourage shared decision-making in tertiary hospital settings in Singapore.

Shared decision-making (SDM) on antibiotic therapy may improve antibiotic use in tertiary hospitals, but hospitalised patients are apprehensive about being involved in it. Understanding the facilitators and barriers to SDM can inform the design and implementation of interventions to empower these patients to engage in SDM on their antibiotic therapies. We conducted qualitative interviews with 23 adult patients purposively sampled with maximum variation from the three largest tertiary-care hospitals in Singapore (April 2019─October 2020). Thematic analysis was conducted using the Theoretical Domains Framework and Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify areas for intervention. Hospitalised patients lacked comprehensive knowledge of their antibiotic therapies and the majority did not have the skills to actively query their doctors about them. There was a lack of opportunities to meet and interact with doctors, and patients were less motivated to engage in SDM if they had a self-perceived paternalistic relationship with doctors, trusted their doctors to provide the best treatment, and had self-perceived poor knowledge to engage in SDM. To empower these patients, they should first be educated with antibiotic knowledge. Highlighting potential side effects of antibiotics could motivate them to ask questions about their antibiotic therapies. Environment restructuring, as facilitated by nurses and visual cues to nudge conversations, could create opportunities for interactions and motivating patients into SDM on their antibiotic therapies. Education and environmental restructuring should be explored to empower hospitalised patients to engage in SDM on their antibiotic therapies.

The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting.

Background: Despite advances in technology, glycemic outcomes in people with type 1 diabetes (T1D) remain suboptimal. The MiniMed 780G (MM780G) advanced hybrid closed-loop (AHCL) system is the latest technology for T1D management with established safety and efficacy. This study explores the cost-effectiveness of MM780G AHCL compared against multiple daily injections (MDI) plus intermittently scanned continuous glucose monitor (isCGM). Methods: A cost-utility analysis was conducted, simulating lifetime outcomes for 1000 T1D individuals, with baseline hemoglobin A1c of 8.4%, using the IQVIA Core Diabetes Model (CDM) v9.5. A Singapore health care payer perspective was taken with 2023 costs applied. Treatment effects were taken from the ADAPT study and treatment-related events from a combination of sources. T1D complication costs were derived from local literature, and health state utilities and disutilities from published literature. Scenario analyses and probabilistic sensitivity analyses (PSAs) explored uncertainty. Cost-effectiveness was assessed based on willingness-to-pay (WTP) thresholds set to Singapore Dollars (SGD) 45,000 (United States Dollars [USD] 33,087) per quality-adjusted life year (QALY) and Singapore's gross domestic product (GDP) per capita of SGD 114,165 (USD 83,941) per QALY. Results: A switch from MDI plus isCGM to MM780G resulted in expected gains in life-years (+0.78) and QALYs (+1.45). Cost savings through reduction in T1D complications (SGD 25,465; USD 18,723) partially offset the higher treatment costs in the AHCL arm (+SGD 74,538; +USD 54,805), resulting in an estimated incremental cost-effectiveness ratio of SGD 33,797 (USD 24,850) per QALY gained. Findings were robust, with PSA outputs indicating 81% and 99% probabilities of cost-effectiveness at the stated WTP thresholds. Conclusion: MM780G is a cost-effective option for people with T1D managed in a Singapore setting.

A Real-life Study of Brexpiprazole as an Adjunctive Treatment for Major Depressive Disorder in Asian Patients in Singapore (BADA).

: To investigate the effectiveness and safety of brexpiprazole as an adjunctive treatment to antidepressant therapy (ADT) in Asian adults with major depressive disorder (MDD) and inadequate response in a real-life clinical setting in Singapore. : This was a prospective, observational 3-month study of patients with MDD who had brexpiprazole added to their existing ADT. The study was conducted at two sites in Singapore between September 2020 and October 2021. The co-primary endpoints were Patient Health Questionnaire-9 (PHQ-9) and Clinical Global Impression-Severity (CGI-S). Other endpoints included Clinical Global Impression-Improvement (CGI-I), Sheehan Disability Scale (SDS), Generalized Anxiety Disorder 7-item scale (GAD-7), and safety. : Twenty patients were enrolled and 16 completed the study. There were improvements in PHQ-9, CGI-S, SDS, and GAD-7 scores from baseline at Week 12, with a mean difference of -4.8, -1.3, -8.5, and -6.2, respectively. The CGI-I score improved from baseline with a mean score of 2.3 at Week 12. One third achieved response and 25% achieved remission based on PHQ-9 scores at Week 12. Similar results were obtained using CGI-S scores (38% for both). The incidences of adverse events (AEs) and treatment-related AEs were 55% (11/20) and 50% (10/20), respectively. There were no deaths or severe AEs. Two patients withdrew brexpiprazole during the study. : The observed effects and safety of adjunctive brexpiprazole in Asian adults with MDD in the real-world setting in Singapore were consistent with those from clinical trials.

Health literacy and self-care among patients with chronic kidney disease in a primary care setting.

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD). This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33). The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001). Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.

Prevalence and factors associated with sarcopenia among older adults in a post-acute hospital in Singapore.

Sarcopenia is common in older adults worldwide, but its prevalence varies widely owing to differences in diagnostic criteria, population sampled, and care setting. We aimed to determine the prevalence and factors associated with sarcopenia in patients aged 65 and above admitted to a post-acute hospital in Singapore. This was a cross-sectional study of 400 patients recruited from a community hospital in Singapore. Data including socio-demographics, physical activity, nutritional status, cognition, clinical and functional status, as well as anthropometric measurements were collected. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria [AWGS2019]. Of the 383 patients with complete datasets, overall prevalence of sarcopenia was 54% while prevalence of severe sarcopenia was 38.9%. Participants with increased age, male gender and a low physical activity level were more likely to be sarcopenic, while those with higher hip circumference and higher BMI of ≥27.5m/kg2 were less likely to be sarcopenic. Other than the above-mentioned variables, cognitive impairment was also associated with severe sarcopenia. More than 1 in 2 older adults admitted to a post-acute hospital in Singapore are sarcopenic. There is an urgent need to address this important clinical syndrome burden and to identify patients at risk of sarcopenia in post-acute settings in Singapore for early intervention.

Performance of a preventive care programme for osteoporosis in primary care settings in Singapore during the COVID-19 pandemic

Background The Agency for Care Effectiveness of Singapore has advised primary care physicians to use osteoporosis screening tools to risk-stratify patients in the primary care setting. Objective This paper aims to report the uptake of a “Predict and Prevent” workflow for osteoporosis using risk scoring and BMD measurement in patients with chronic diseases seen in a network of primary care clinics in Singapore from 2020 to 2021. Methods A “Predict and Prevent” osteoporosis preventive care programme was implemented at a network of 11 primary care clinics. The programme included all adult patients that consulted at the clinic for a chronic condition. OSTA score was computed for each patient. All patients who consented to further fracture risk screening underwent FRAX scoring. Female patients with a high-risk OSTA score and females with diabetes with intermediate-risk OSTA score (per protocol), or those with high-risk FRAX score were recommended to undergo BMD measurement. Results Of the 6,332 adult patients with chronic diseases without baseline osteoporosis seen in the various clinics, 81.1% underwent OSTA scoring; 28.1% were intermediate risk and 7.0% were high risk. Among the per-protocol population ( n = 531), 38 (7.1%) underwent BMD testing. FRAX scoring (without BMD) was done on 939 patients (17.3%); 31.5% had a high hip fracture risk. Only 14 patients had FRAX with BMD; 57.1% had a high hip fracture risk. Conclusion A “Predict and Prevent” workflow could be implemented to screen, detect and potentially treat patients at high risk of osteoporosis. The rate of BMD measurement is low and needs to be improved.

Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore

ObjectivesManaging older adults with multimorbidity may be challenging due to the conflicting benefits and harms of multiple treatments. Thus, it is important to identify patients’ health outcome priorities to align...

#169 : The Use of PIEZO-ICSI Increases Fertilisation and Lowers Degeneration Rates when Compared to Conventional ICSI: In a Singapore Setting

Background and Aims: PIEZO-ICSI was first introduced by Kimura &amp; Yanagimachi in 1995 on mouse oocytes (1). It is a modified version of microinjection that uses piezoelectric pulses to enable fine movement of the needle. Further studies of PIEZO-ICSI on human oocytes showed improved outcomes in Japanese clinics (2-6) and similar findings were also reported by an Australian IVF group (7,8). In this study, we reflect on our experience using PIEZO-ICSI in a Singapore-based IVF clinic. Method: A retrospective study of 535 ICSI cycles was performed from January 2020 to December 2022, comprising of 157 cycles using Conventional ICSI and 378 cycles using PIEZO-ICSI. Primary outcomes were fertilisation, degeneration, blastulation and blastocyst usable rates. Secondary outcomes include clinical pregnancy, implantation and miscarriage rates. Patients who used donor gametes, surgically retrieved sperm or utilised cleavage-staged embryos were excluded. Two senior embryologists were responsible for the microinjections and had no prior experience with PIEZO-ICSI. Statistical significance for laboratory and clinical outcomes were determined using Mann-Whitney U Test and chi-square contingency tables, respectively. Results: The PIEZO-ICSI group showed significantly higher fertilisation (83.09% vs 69.62%, p&lt;0.0001) and lower degeneration rates (3.17% vs 7.33%, p&lt;0.0001) when compared to Conventional ICSI (Table 1). Blastulation (69.51% vs 64.86%, p=0.26) and blastocyst usable rates per 2PN (54.36% vs 51.26%, p=0.67) showed a higher trend in the PIEZO-ICSI group but did not meet statistical significance. The estimated time-to-competency for embryologists to achieve consistent outcomes with PIEZO-ICSI was three months (Figure 1). In terms of clinical outcomes, no significant differences were observed for clinical pregnancy (61.57% vs 56.97%, p=0.39), implantation (48.57% vs 43.59%, p=0.23) and miscarriage rates (23.70% vs 23.40%, p=0.96) between the PIEZO-ICSI and Conventional ICSI groups (Table 2). Conclusion: The use of PIEZO-ICSI improves fertilisation and degeneration outcomes when compared to Conventional ICSI in a Singapore-based IVF clinic.

ARAUSv2: An Expanded Dataset and Multimodal Models of Affective Responses to Augmented Urban Soundscapes

The ARAUS (Affective Responses to Augmented Urban Soundscapes) dataset consists of a five-fold cross-validation set and independent test set of subjective perceptual responses to augmented soundscapes presented as audio-visual stimuli. However, key limitations in its original release included a disproportionate number of participants being young university students and a relatively small test set. We aim to address this by publishing ARAUSv2, which adds responses from participants to the cross-validation set from an older, non-student population, as well as responses from additional participants in a substantially larger test set consisting of new urban soundscapes recorded in a variety of settings in Singapore. The additional responses were collected in a similar fashion as the initial release, with participants rating augmented soundscapes (made by digitally adding maskers to urban soundscape recordings) on how pleasant, annoying, eventful, uneventful, vibrant, monotonous, chaotic, calm, and appropriate they were. We also present a sample of multimodal prediction models for the ISO Pleasantness and Eventfulness of the augmented soundscapes in ARAUSv2. The multimodal models use participant-linked information such as demographics and responses to psychological questionnaires, as well as visual information from the stimuli, which the baseline models presented in the initial ARAUS dataset did not utilize.

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers.

Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.

Adult dysphagia services in acute and subacute settings in Singapore

ABSTRACT International studies examining dysphagia management have identified that a degree of practice variability exists globally, with multiple factors within the local health service context influencing the nature of services. Understanding current practices and service inefficiencies is a foundational step for service optimization. Thus, this study aimed to understand service characteristics and issues associated with adult dysphagia service provision within acute and subacute settings in Singapore. Two online anonymous surveys were conducted with: (a) managers to explore practice documents used to guide dysphagia services, and (b) speech-language pathologists (SLPs) to understand dysphagia practices and service issues. Data were analyzed using descriptive statistics and content analysis. Responses from 12 managers and 68 SLPs working in acute and subacute settings were analyzed. There was a lack of national practice documents to guide dysphagia clinical training and service provision, and services were generally guided by internal documents. Despite this, dysphagia services were similar across acute and subacute settings. However, differences between settings were identified in screening and instrumental assessments services, perceived rehabilitation intensity, perceived rehabilitation adherence among patients, and extent of challenges with onward referrals. Whilst Singapore’s dysphagia services were largely aligned with other countries, challenges unique to the Singapore context was found relating to enteral feeding management, language barrier, financing framework, and care transitions. These findings build on the knowledge of dysphagia practices internationally, and provide direction for service optimization in Singapore.

Talking leadership into practice: the enactment of teacher leadership in a networked learning community

ABSTRACT The literature suggests that professional learning networks contribute to teacher learning, school, and system improvement. This paper examines the enactment of teacher leadership in a networked learning community (NLC) setting in Singapore, specifically how teacher leadership is enacted through the artifact of talk. In this case study, teacher talk was transcribed and analysed using an interactional approach, which views talk as social practice. The findings show that teachers enact leadership by engaging in pedagogically productive talk, deconstructing their practice, supporting their peers’ learning, and engaging in professional learning themselves. Although there is distribution of leadership, the close examination of talk highlighted differences in leadership practices due to differences in the roles that teachers play or the context of the talk. In addition, the focus on talk prompts a critical reflection of what leadership entails, in that what is not said could be as important as what is said and can constitute demonstration of leadership. The study suggests there is value in integrating research on teacher leadership with research on teacher facilitation of learning in networks and communities. Facilitating learning communities might be a promising in-situ approach to develop teacher leadership.

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals—A Qualitative Analysis

Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders' perspectives and experiences regarding end-of-life care in the ED. Materials and Methods: A descriptive qualitative study was conducted from November 2019 to January 2020. Study participants were recruited from the EDs of three tertiary hospitals and community care settings in Singapore through purposive sampling. Data collection included focus group discussions with 36 ED staff, 16 community healthcare professionals, and one-on-one semi-structured interviews with seven family members. Results: Three main themes and several subthemes emerged from the data analysis. (1) Reasons for ED visits were attributed to patients' preferences, families' decisions, limited services and capabilities in the community, and ease of access. (2) Barriers to providing end-of-life management in the ED included: conflicting priorities of staff, cramped environment, low confidence, ineffective communication, and lack of standardised workflows. (3) Discussion about continuity of end-of-life care beyond the ED uncovered issues related to delayed transfer to inpatient wards, challenging coordination of terminal discharge from the ED, and limited resources for end-of-life care in the community. Conclusions: Key stakeholders reported challenges and shared expectations in the provision of end-of-life care in the ED, which could be optimised by multidisciplinary collaborations addressing environmental factors and workflows in the ED. Equipping ED physicians and nurses with the necessary knowledge and skills is important to increase competency and confidence in managing patients attending the ED at the end of their lives.

Memories of nursing in Singapore - an oral history approach.

Documentation of the voices of nurses provided valuable insight and a greater understanding of the nursing experience in Singapore. To record nurses' experiences of journey of nursing profession in the acute care setting in Singapore from the early days of formalisation of nursing education to today's practice as a profession with various specialisation and career tracks. An oral history research approach was adopted, with purposive and snowball sampling to recruit nurses (both current and retired) who had trained in Singapore from 1956 which marked the beginning of the founding of the School of Nursing to current. Interviews were conducted with an interview guide. Thematic analysis was utilised to analyse the audio-recorded data. The 54 participants with a range of 10-54 years of nursing experience were interviewed and they completed their nursing training between 1952 and 2006. Four themes were generated: essence of nursing, inevitable changes across nursing profession, resilience and future outlook in nursing. Understanding the experiences of these nurses generated an in-depth understanding of the personal, social and historical events that were at play in fostering today's nursing practice. With the evolution of the roles in nursing, compassion in current practice needs to be re-evaluated. Continuous learning is essential to meet the needs of the changing healthcare landscape.

Exploring ethical challenges in Singapore physiotherapy practice: Implications for ethics education

Introduction: Workplace contexts, including political and sociocultural systems influence health professions’ perception and experience of ethical issues. Although established health ethics principles are relevant guiding values, they may be experienced and interpreted differently within different health contexts. How should ethics education account for this? This paper presents ethical dilemmas and concerns encountered by physiotherapists practicing in Singapore and discusses the implications for ethics education. Methods: Qualitative methods informed by interpretivism and phenomenology were employed. In-depth interviews with 42 physiotherapists from different workplace settings in Singapore were conducted. Participants described everyday ethical challenges they encountered. Inductive content analysis was used to analyse the interview transcript data. Results: Ethical issues occurred within and across three spheres of ethics: micro, meso and macro. Ethical issues at the micro sphere centered around physiotherapist-patient relationships, interactions with colleagues, and therapists’ feelings of moral distress. In the meso sphere, ethical challenges related to influences arising from the organizational resources or systems. In the macro sphere, ethical challenges developed or were influenced by sociocultural, religious, economic, and political factors. Conclusion: The findings reflect current literature indicating that context can influence ethical situations, as experienced and perceived by physiotherapists in their unique settings. Such empirical data might inform the development of ethics curricula to ensure that universal ethical principles are situated within the realities of clinical practice. Locally relevant and realistic ethical case studies will better enable students to recognise and address these situations.

Meeting today’s healthcare needs: Medicine at the interface

The demographic of Singapore has undergone dramatic change. Historically, younger patients with communicable diseases predominated, whereas patients are now older with chronic multimorbidity and functional impairment. This shift challenges existing health and social care systems in Singapore, which must pivot to meet the changing need. The consequences of mismatched health and social care to patient needs are the fragmentation of care, dysfunctional acute care utilisation and increasing care costs. In Singapore and internationally, there is an inexorable rise in acute care utilisation, with patients facing the greatest point of vulnerability at transitions between acute and chronic care. Recently, innovative care models have developed to work across the boundaries of traditional care interfaces. These "Interface Medicine" models aim to provide a comprehensive and integrated approach to meet the healthcare needs of today and optimise value with our finite resources. These models include Acute Medical Units, Ambulatory Emergency Care, Extensivist-Comprehensivist Care, Virtual Wards, Hospital-at-Home and Acute Frailty Units. We describe these models of care across the acute care chain and explore how they may apply to the Singapore setting. We discuss how these models have evolved, appraise the evidence for clinical effectiveness, point out gaps in knowledge for further study and make recommendations for future progress.

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore.

To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting. We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention. We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore. We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.

The perspectives of healthcare professionals in mental health settings on stigma and recovery - A qualitative inquiry

BackgroundMental health stigma is one of the most prominent barriers to recovery, and it is widely known that stigma may manifest differentially in different cultures. Healthcare professionals working closely with persons with mental illnesses (PMI) may provide important insights towards stigma that are otherwise unattainable from caregivers and consumers. However, there is a dearth of literature on healthcare professionals’ perspectives on this topic. Thus, this study uses a multilevel approach to explore how stigma affects recovery from the perspectives of healthcare professionals that work closely with PMI in Singapore.MethodsSemi-structured interviews were conducted with a total of 17 healthcare professionals who were working in mental health settings in Singapore. Participants were recruited via direct email invitation or through snowball sampling. Data collected was analysed with the inductive thematic analysis method. All coding and inter-rater analyses were performed with NVivo.ResultsThe current study themes identified stigma-related factors that influence PMI’s recovery from the perspectives of healthcare professionals working closely with PMI. These factors were organised into three overarching themes in a multilevel structure. The three themes were classified as Micro Factors (e.g., internalised stigma), Meso Factors (e.g., discrimination of people associated with the stigmatised group), and Macro Factors (e.g., structural stigma and stigma within healthcare settings).ConclusionsThe findings of this study gave us a greater understanding of how stigma influences recovery in Singapore, which could be used to guide the development and implementation of future policies and strategies to promote recovery. Importantly, our results suggest that improving mental health literacy, addressing cultural misgivings towards mental illness, implementing recovery-oriented practices, and making insurance more accessible for PMI could mitigate the deleterious impact that stigma has on recovery.

Characteristics of Patients with Chronic Obstructive Pulmonary Disease Treated with Long-Acting Bronchodilators in a Real-World Setting in Singapore: A Single-Center Observational Study.

IntroductionThere is limited real-world evidence regarding clinical practice for chronic obstructive pulmonary disease (COPD) in Singapore. We compared baseline clinical characteristics and evaluated outcomes in patients with COPD who initiated treatment with either a long-acting muscarinic antagonist (LAMA) or a LAMA and a long-acting β2-agonist (LAMA+LABA).MethodsThis was a single-center observational study at Changi General Hospital, Singapore. Routine clinical data (hospital visits, case management, lung function, laboratory/imaging results, medication orders) were collected and compiled into a data warehouse. Eligible patients with COPD were ≥40 years old and newly prescribed LAMA or LAMA+LABA during the enrollment period. Patient characteristics in the baseline period (6 months) were compared between treatments. Clinical worsening was measured as a composite endpoint, defined as the first of a change in maintenance treatment class or a moderate-to-severe exacerbation during follow-up (12 months).ResultsIn total, 261 patients were included in the baseline period (LAMA: 73; LAMA+LABA: 188). In the baseline period, patients receiving LAMA+LABA versus LAMA had significantly lower body mass index, higher COPD Assessment Test score and worse lung function, and numerically higher exacerbation history. Prevalence of comorbidities was similar between treatment groups. In follow-up, high rates of clinical worsening were observed regardless of treatment regimen (LAMA: 38/73 [52%]; LAMA+LABA: 86/188 [46%]). Median time-to-clinical worsening was 340 days for the LAMA cohort and the raw median 154 days (interquartile range: 44–225) for the LAMA+LABA cohort. Median medication dispensation rate (0.86; interquartile range: 0.56–1.00) was similar between treatments.ConclusionPatients initiating treatment with LAMA+LABA had more severe COPD than patients prescribed LAMA. The proportion of patients experiencing clinical worsening was similarly high in both cohorts, suggesting that early identification and treatment optimization are necessary.