Setting In Singapore Research Articles

General pain assessment among patients with cancer in an acute care setting

Aims This project sought to determine improve local practice in managing patients with cancer. It involved by: educating Registered Nurses on the importance of pain assessment, and ensuring this practice is done according to the current best available evidence and monitoring compliance with the audit criteria. Methods This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. It was implemented in three phases over a 6-month period, from September 2009 to February 2010. The audits utilised three out of 10 criteria recommended by The National Health Service Quality Improvement Scotland. The audits took place in a 24-bed oncology ward in a large acute care setting in Singapore involving a sample size of 24 patients and Registered Nurses. It involved going through the clinical charts and medical records of the cases, and educating Registered Nurses on pain assessment for patients with cancer. Results The post-implementation audit findings indicated a modest to significant improvement in all the three criteria: first, an improvement of 33% through using a pain assessment tool to assess pain in patients with cancer; second, a 75% increase in the number of Registered Nurses who received education on pain assessment; and third, a 46% increase in accuracy in the assessment and documentation of pain. Conclusion The project had shown that pre- and post-implementation audits represent a useful method for translating evidence into practice. The conduct of this project showed that achieving change in clinical practice was challenging. It also showed that positive audit results were achieved through the enthusiasm, commitment and dedication of every member of the project team, the use of champions who were involved in direct patient care and performance feedback.

General pain assessment among patients with cancer in an acute care setting: a best practice implementation project

This project sought to determine improve local practice in managing patients with cancer. It involved by: educating Registered Nurses on the importance of pain assessment, and ensuring this practice is done according to the current best available evidence and monitoring compliance with the audit criteria. This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. It was implemented in three phases over a 6-month period, from September 2009 to February 2010. The audits utilised three out of 10 criteria recommended by The National Health Service Quality Improvement Scotland. The audits took place in a 24-bed oncology ward in a large acute care setting in Singapore involving a sample size of 24 patients and Registered Nurses. It involved going through the clinical charts and medical records of the cases, and educating Registered Nurses on pain assessment for patients with cancer. The post-implementation audit findings indicated a modest to significant improvement in all the three criteria: first, an improvement of 33% through using a pain assessment tool to assess pain in patients with cancer; second, a 75% increase in the number of Registered Nurses who received education on pain assessment; and third, a 46% increase in accuracy in the assessment and documentation of pain. The project had shown that pre- and post-implementation audits represent a useful method for translating evidence into practice. The conduct of this project showed that achieving change in clinical practice was challenging. It also showed that positive audit results were achieved through the enthusiasm, commitment and dedication of every member of the project team, the use of champions who were involved in direct patient care and performance feedback.

Economic analysis of endobronchial ultrasound (EBUS) as a tool in the diagnosis and staging of lung cancer in Singapore

Endobronchial ultrasound (EBUS), encompassing endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) and Endobronchial ultrasound transbronchial lung biopsy (EBUS-TBLB) has been proven to be a useful modality in the staging and diagnosis of lung cancer. However, there are limited publications on the cost-effectiveness of EBUS and no economic evaluations relevant to the Singapore setting. An economic evaluation using our hospital's data was used to assess the cost implications of EBUS substituting where clinically appropriate: transthoracic needle aspiration; (TTNA), fluoroscopy-guided transbronchial lung biopsy (TBLB), and mediastinoscopy in the diagnosis and staging of lung cancer. Relationship between the clinical and economic implications of alternative modalities was modeled using data inputs that were relevant to the Singapore setting. Two decision analytic models were constructed to evaluate the cost of EBUS compared with TTNA, TBLB, and staging mediastinoscopy. Only direct costs were imputed. In the base-case analysis, TTNA was the most economical strategy (SGD3,335 = US$2,403) where clinically suitable for the diagnosis of lung cancer as compared to the other options: TBLB (SGD4,499) and EBUS-TBLB (SGD4,857). On the other hand, EBUS-TBNA resulted in expected cost savings of SGD1,214 per positive staging of lung cancer as compared to mediastinoscopy. The use of EBUS-TBNA could result in cost savings of SGD1,214 per positive staging of lung cancer as compared to mediastinoscopy. Whereas TTNA was the most economical intervention for the diagnosis of lung cancer as compared to the other options, its main limitation lies in its suitability only for peripheral lung lesions and high complication rate.

Industry Watch

Research Institute and CSL to Develop New Treatments for Inflammatory Diseases. QRxPharma in Strategic Alliance with Liaoning Nuokang Medicines for the Development of Venomics Assets. Mesoblast's Treatment for Damaged Intervertebral Disc Cartilage may be a Product Breakthrough. Device Technologies Australia in Strategic Partnership with Health Robotics for Robot-Assisted Cancer Surgery. Agilent Technologies Co-Establishes Center for Systems Biology with Chinese Academy of Sciences. Zhejiang Hisun Pharmaceutical Granted License to Develop Hematopoietic Stem Cell Stimulator. HUYA Establishes Partnership with GIBH. China Biologic Products Enters into a Strategic R&D on Blood Plasma. India's First Stem Cell Therapy Laboratory Launched. Biocon and Amylin to Jointly Make Drug for Diabetes. Singapore Sets up First Cell Therapy Facility. Smart Information Technology Integration for Bangkok Hospital Group.

Association between painful physical symptoms and clinical outcomes in East Asian patients with major depressive disorder: a 3-month prospective observational study

Reports from non-Asian populations indicate that painful physical symptoms (PPS) are associated with poorer clinical and functional outcomes in major depressive disorder (MDD). The purpose of this study is to report comparative changes in disease severity, treatment patterns and quality of life observed in East Asian patients with MDD, with and without PPS, as assessed prospectively over a 3-month observation period. This observational study enrolled 909 patients with MDD in psychiatric care settings in China, Hong Kong, Korea, Malaysia, Singapore and Taiwan. Patients were classified as PPS positive (PPS+) or negative (PPS-) based on mean modified Somatic Symptom Inventory scores of >or= 2 or < 2 respectively. The Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD(17)) determined depression severity; a visual analogue scale (VAS) determined pain severity; and the EuroQoL (EQ-5D) assessed well-being after 3 months observation. Of the 909 enrollees, 355/471 (75.4%) of PPS+ patients and 363/438 (82.9%) of PPS- patients completed the study (p = 0.006). PPS+ patients improved less than PPS- patients on depression, pain and quality of life measures during the study (HAMD(17) p < 0.001, CGI-S p < 0.001, VAS p = 0.008 and EQ-5D p = 0.004). Fewer PPS+ patients (46.5%) achieved remission compared with PPS- patients (69.4%, p < 0.001). As the presence of PPS is associated with poorer outcomes in East Asian MDD patients, clinical management should aim to address both the mental and PPS associated with MDD.

Diabetes Outcomes in Specialist and General Practitioner Settings in Singapore: Challenges of Right-Siting

The Singapore public healthcare system has increasingly used the term “right-siting” to describe the principle that stable chronic disease patients should be managed in primary care rather than specialist settings. The majority of primary healthcare providers in Singapore are general practitioners (GPs). The aims of this paper were to measure the quality of diabetes care in specialist and GP settings, and assess right-siting efforts in a tertiary centre in Singapore. Three hundred eighty-three consecutive patients with type 2 diabetes referred to the Singapore General Hospital Diabetes Centre (SGH DBC) between January and March 2005 were analysed. At the first visit, 51 patients (13.3%) were classified as inappropriate referrals and discharged back to the referral source or to primary care. After 12 months, 136 patients (group A = 35.5%) remained on follow-up at SGH DBC. In these patients, significant improvements were seen in mean HbA1c but not blood pressure (BP) or low density lipoprotein-cholesterol (LDL-C). One hundred twenty-eight (group B = 33.4%) patients were discharged from DBC within the 12 months of the study period. Mean follow-up duration in group B was 5.5 months and HbA1c, blood pressure and LDL-cholesterol had improved significantly in these patients. Glycaemic control of group B patients at the time of discharge was significantly better than group A at 12 months (mean HbA1c = 7.15% vs 8.16%; P &lt;0.001). More than half (55.6%) of group B patients achieved HbA1c targets compared to 32.4% from group A (P &lt;0.001). Although mean BP and LDL-C levels fell in group B patients, the percentage of patients achieving BP and LDL-C targets did not improve significantly in both groups. From August 2005 to January 2008, GPs participating in SingHealth’s Delivering on Target (DOT) programme enrolled 579 patients under their care for additional diabetic counselling by community nurse educators. Pre- and postprogramme HbA1c results were submitted for 370 patients (64%). Mean HbA1c levels of these patients decreased from 8.23% to 7.32% (P &lt;0.001). The proportion of patients who achieved HbA1c &lt;7% increased from 26% to 51% (P &lt;0.01). However, BP and LDL-C levels did not improve. It is difficult to base referral or discharge decisions solely on these indicators. Our studies show that both in the specialist and GP settings, significant improvements in HbA1c are seen. Results for BP and LDL-C, however, showed little improvement. Some degree of rightsiting was seen at SGH DBC with discharged patients showing greater improvements than patients who were retained. However, &gt;30% of patients remained in SGH DBC despite achieving HbA1C targets. Our results indicate the need for better strategies to address the underlying obstacles to right-siting. Of greater concern, the lack of improvement in BP and LDL-C indicates a high degree of clinical inertia to these issues among specialists and GPs treating diabetes in Singapore. Key words: Clinical outcomes, Clinical quality, Glycaemic control, Integration and transfer of care

General News

Singapore Sets Up Four New Translational Research Initiatives.

When the Stork Arrives Unannounced – Seven Years of Emergency Deliveries in a Non-obstetric General Hospital

Introduction: Emergency department deliveries are uncommon in the Singapore setting, but when they do occur, the emergency physician has to be able to deliver the child safely, perform neonatal resuscitation if needed, and try to prevent any birth trauma to the child or complications of delivery in the mother. We present our experience of emergency room deliveries spanning 7 years in a community hospital without obstetric or neonatal backup. Materials and Methods: This is a retrospective case series. A search was made through our electronic medical records system for patients presenting in labour or with deliveries from March 1997 to October 2004. They were studied for demographic and social factors, gravidity and parity, as well as any complications (during birth and in the immediate post-delivery period) in both parent and child. Results: Twenty-three patients presented to our emergency department with labour contractions, and 14 progressed to vaginal deliveries. Twelve were single mothers who had hidden their pregnancies, while another 2 married patients had unsuspected pregnancies. No neonate needed resuscitation or airway support, but there were 4 patients without episiotomy who sustained perineal tears, and another 2 patients in whom the placenta could not be delivered. A child (born to a single mother without antenatal care) had a low Apgar score, but improved with oxygen and suctioning. Conclusions: An emergency department in a non-obstetric hospital should have in place adequate preparations to cater for the occasional unexpected emergency delivery and the associated need for neonatal resuscitation. In our series, there was a high proportion of concealed (hidden) and “unaware” pregnancies presenting in labour. Prompt referral to a maternity hospital with neonatal care should be made for any complications.

SARS Risk Perception and Preventive Measures, Singapore and Japan

To the Editor: Healthcare workers accounted for 21% of all cases of severe acute respiratory syndrome (SARS) during the 2002–2003 outbreak (1). We studied perceptions of risk for SARS infection and preventive measures among healthcare workers in Singapore, who handled cases of SARS and where >41% of the cases occurred among healthcare workers, and in Japan, a SARS-free country. A self-administered questionnaire was distributed to healthcare workers in various healthcare settings in Singapore (n = 15,025) and Japan (n = 9,978) from May to September 2003. Healthcare workers in Singapore were from 9 primary healthcare hospitals and 9 major institutional healthcare settings, including 3 tertiary hospitals where cases of SARS occurred among healthcare workers, 1 specialized women and children's hospital, 2 community hospitals, and 2 tertiary dental centers. In Japan, study participants were healthcare workers at 7 tertiary-level hospitals distributed throughout Japan. Four of these are university-attached, 2 are municipal hospitals, and 1 is a private hospital. A total of 10,511 (70% response) and 7,282 (73% response) valid questionnaires were returned in Singapore and Japan, respectively. A total of 43% and 45% of the healthcare workers in Singapore and Japan were nurses; others were doctors, physiotherapists, pharmacists, attendants, cleaning staff, and administrative or clerical staff. In terms of sociodemographic characteristics, the mean ages of the healthcare workers were 36.6 years in Singapore and 35.6 years in Japan, while the gender distribution was 82% female in Singapore and 70% female in Japan, respectively. Approximately half (57% and 45%, respectively) of healthcare workers in Singapore and Japan were married. A similar proportion (about two thirds) of healthcare workers in both countries felt at great risk of exposure to SARS. However, a higher proportion (76%) was afraid of contracting SARS in Singapore as compared to Japan (55%). Nearly all healthcare workers (96%) in Singapore felt that implementation of protective measures at work was generally effective, and 95% were satisfied with the explanation of their necessity and importance. Slightly fewer (93%) agreed that clear policies and protocols for everyone to follow were in place. In contrast, among Japanese healthcare workers, only 65% agreed that clear policies and protocols were in place, and many fewer (31%) felt that protective measures at work were generally effective (Table). Table Singaporean and Japanese healthcare workers' risk perceptions about severe acute respiratory syndrome (SARS) As to the national experiences with the SARS outbreak, healthcare workers in Singapore managed 238 cases of SARS, while those in Japan did not encounter any cases. Furthermore, preventive measures were strictly enforced and effective in Singapore, and the outbreak was contained successfully. In contrast, preventive measures were in place in Japan, but workers lacked confidence in an untested system (2). These differences are probable explanations for the varying responses in the Singaporean and Japanese healthcare workers. The perceived need for adherence to prescribed measures and willingness to follow protocols were quite different, given the difference in perceived risks. In SARS-free Japan, most healthcare workers were aware that institutional policies and protocols existed, but less than a third were confident of their effectiveness. The degree of implementation and adherence endorsed by healthcare workers was also lower in Japan. Infections of healthcare workers at the onset of an outbreak may be due to perceptions that recommended policies and measures are unnecessary or excessive. Thus, efforts to educate and communicate the rationale and importance of protective measures may be especially important when outbreaks seem distant and perceived danger is low. Healthcare workers in both Singapore and Japan perceived a risk for exposure to SARS at work, which reflected the global reach of the illness. However, in Singapore, where cases existed and where the disease was eventually contained, the perceived danger of contracting the illness was higher, and most healthcare workers were reassured by the preventive measures taken, which they viewed as effective. This situation was in contrast to the healthcare workers' perceptions of infection risk and confidence in preventive measures against SARS in Japan, where the measures for infection control were untested.

Cutaneous lymphomas other than mycosis fungoides in Singapore: a clinicopathological analysis using recent classification systems

Cutaneous lymphomas other than mycosis fungoides (MF) are a heterogeneous group with wide variations in clinical presentation, biological behaviour and prognosis. New classification systems have been designed or proposed in recent years, with well-defined disease entities and emphasis on the importance of site. This study aims to analyse a series of non-MF lymphomas in an institution-based dermatological setting in Singapore, based on the European Organization for Research and Treatment of Cancer (EORTC) classification and the World Health Organization (WHO) classification. A secondary objective is to highlight the clinical utility of both classification systems. Forty cases diagnosed over a 12-year period were examined by immunohistochemistry with antibodies targeting CD3, CD4, CD5, CD8, CD20, CD30, CD43, CD45RO, CD56 and CD68 in paraffin-embedded specimens. The immunohistological diagnosis was correlated with the clinical presentation and staging investigations for the final diagnosis and the course of disease recorded. Non-MF T-cell lymphomas presenting in the skin comprised 31 cases (78%) and were 3(1/2) times more common than B-cell lymphomas, which comprised nine cases (22%). The common subtypes were lymphomatoid papulosis, CD30+ large cell cutaneous T-cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma. The commonly ascribed B-cell pattern with infiltrates in the mid and deep dermis and perivascular spaces was seen in 60% of T-cell lymphomas. Overall, there were equal numbers of primary cutaneous T-cell lymphomas and those due to concurrent or secondary cutaneous lymphoma. Five of six cases of subcutaneous panniculitis-like T-cell lymphoma had concurrent cutaneous and systemic involvement and their median survival was 7 months. The predominance of cutaneous T-cell lymphomas in this case series closely matched that reported from east Asia; cutaneous B-cell lymphomas are much less common than in Europe. The EORTC classification, which is designed only for primary cutaneous lymphomas, should be used in conjunction with the WHO classification because of the high prevalence of cutaneous lymphomas as the secondary site of disease from systemic lymphoma. In addition, subcutaneous panniculitis-like T-cell lymphoma is a primary cutaneous lymphoma where systemic involvement is common at initial presentation. We propose full immunophenotyping and complete clinical evaluation with staging investigations for all patients presenting with cutaneous lymphomas other than MF.

General Information &amp; Statistics

Innovative Food Center Launched. China Sets up National Stem Cell Base in Tianjin. Sino-US Collaboration on Drug Screening. Study Shows Insufficient Breast Cancer Awareness. Call for India to Modernize Farming Sector. Indian Biotech Sector Lacks Funding. Biotech Solutions Available Online. Local Governments Subsidize Fertility Treatment. Low Blood Selenium Levels in New Zealanders. NZ Biotech Should Focus on Environment. Singapore Sets up National Tissue Repository. Singapore Research Agency Appoints New Leaders. Institute to Use Nanoscience to Treat Diseases. Taiwan Establishes Botanical Drug Products Plant. Fatality Rate in Childbirth at High Level.

General Information &amp; Statistics

Australian Scientists in Real-time Virtual Surgery. China Invests US$36 Million to Set up Plant Gene Banks. India, Germany to Jointly Promote Biotech Research. Firms Urged to Lower Costs of Anti-HIV Drugs. Japanese Private Sector May Stop Funds to AIDS Body. Malaysian Institute Collaborates with Drug Firm. Parkinson’s Disease Research Gets NZ$1.2 Million Funding. Online Food Composition Database Available. NZ Recalls Blood Pressure Medicine. Conference on Biotechnology Awareness in the Philippines. Singapore Sets up New Cancer Research Body. Singapore Attracts Attention of Life Sciences Firms. Thailand Ponders Adopting GM Crops.

General Information &amp; Statistics

Major Health Research Institutes to Receive Funding. Record Number of Hepatitis C Infections in Australia. Needle Schemes Prevents HIV and HCV Infections. Sino-French Life Sciences Center Established. Ten Percent of HK Students Have High Mercury Exposure. India Emerges as Biotech R&amp;D Hub. Adult Smoking Rate at All-time Low. Japan’s Nobel Laureates Hope to Inspire Science Boom. NZ Lays out Biotechnology Strategy. IRRI Sets up Rice Knowledge Bank. Students to Learn Life Sciences through BioCamp. Singapore Sets Up Oncology Research Institute. Agrobiology Scientists Move into New Institution. Survey Shows Singapore Biomed Industry Highly Rated. Biological and Medical Engineering Conference in Singapore. Taiwan Shares Malaria Experience.

Rules &amp; Regulations

GM Poppy License Granted. New Guidelines on Foreign Investment in Healthcare Industries. GM Experiment Dodges New Ethics Council. Singapore Sets Stricter Rules for Chinese Medicines.

On the Cost of Adverse Selection in Individual Annuity Markets: Evidence From Singapore

AbstractNew evidence is presented on the cost of adverse selection in individual annuity markets using Singapore data. The Singapore annuity market is an interesting setting to examine the cost of adverse selection for three reasons. First, unlike many Western countries, the Singapore government provides very limited public financial assistance for retirees. Second, while social security contributions mandated under the Central Provident Fund (CPF) result in a high forced savings rate, a large proportion of CPF savings, are used up for housing. Third, to ensure that retirees have sufficient funds to meet basic needs, individuals who reach age 55 are required to set aside a minimum amount of their CPF savings, which can be withdrawn at age 62. The CPF Board allows various options for investing the minimum sum, but the most attractive option is to purchase an annuity. The institutional setting in Singapore in effect provides insurers with a large captive market for annuities. It is conjectured that this should be reflected in a significantly lower cost of adverse selection for annuities sold in Singapore as compared with other countries. The results herein, using data for CPF‐approved insurers, are strongly consistent with this conjecture. On average, money's worth of annuities is higher than annuities sold to a similar age‐gender mix in the United States, United Kingdom, and Australia. Adverse selection accounts for less than 13 percent of the cost of longevity insurance compared to 30–50 per‐ cent documented in many previous studies. These results suggest that one way to resolve the adverse selection problem is to adopt a universal individual defined contribution pension scheme that mandates or provides strong incentives for retirees to purchase annuities.

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China Made Great Stride in Biotechnology Over Last 15 Years. First Asian Biotech Summit to be Held in China. International Biotechnology Exhibition to Kick off in Beijing. Sino-Canadian Bioscience Lab Set up in Xinjiang. China Join Hands with Russia, Belarus and Ukraine in Science and Technology. Hong Kong, Taiwan and Mainland China Urged to Cooperate in Bio-Pharmaceutical Development. India Seeks More US Funds for Farm R&amp;D. Incidence of Pulmonary Disease Diagnosed as Asthma High in India. Japanese Biotech Industry Seeking to Establish Ties with Europe. Korea Spends Half the Agriculture Budget to Subsidize Farming Sector. NZ Biotech Sector to Overtake Meat Industry in Eight Years. Singapore and Japan Strengthen R&amp;D Ties. Biotechnology in Asia 2002 to be Held in Singapore. Singapore Sets up New Infectious Diseases Center.

General Information &amp; Statistics

China's Imitation Generic Drugs See Less Profit. Pharmaceutical Firms Vie for China's Cephalosporin Market. China to Hold Investment Conference in Frankfurt. Korean Adults Suffer Deteriorating Mental Health. Singapore Sets up Young Investigators Award to Boost Biomedical Research. Singapore Turns to Supercomputers to Process Life Science Data. Review Panel Calls for Overhaul to Singapore's Medical Education System. Neuroscience Symposium in Singapore. International Firms Invest in Taiwan's Biotech Market. Thailand Funds Six Genome Projects. Thailand to Hold Pharmaceutical Conference.

General Information and Statistics

HK University Gets Funding of US$12.8 Million to Establish Genome Center. HK Grants US$99.8 Million for Academic Research Projects. Singapore Sets Up Tissue Network to Boost Biomedical Research. Biomedical Grid to Share Biomedical Information in Singapore. Elderly in Singapore to Get Free Eye Tests. Taiwan Allocates NT$10 Billion to Nanotech Research. Thailand Launches New Health Scheme. Neurosurgeons in Singapore Use 3D Virtual Simulator to Rehearse Surgical Procedures. Singapore's Two Top Institutes to Merge.

The politics of problem definition and agenda setting in Singapore

(1995). The politics of problem definition and agenda setting in Singapore. Asian Journal of Political Science: Vol. 3, No. 2, pp. 66-89.

Leadership Attributes in a Cultural Setting in Singapore

Deals with one aspect of cultural leadership – leadership attributes. Based on recent research on cultural aspects in educational leadership in Singapore, attempts to identify essential attributes possessed by school principals that are found to be an indispensible yardstick for measuring leadership effectiveness. The leader, e.g. a school principal, has the responsibility to design and maintain a school culture as a framework with its unique environment and atmosphere in which teachers and administrators work. Attempts to search for some answers to: what are the personal characteristics that one possesses to be a school leader?; what leadership attributes are essential for leadership effectiveness?; how do these characteristics and attributes help a leader build up the strengths of the school culture? Presents the results of interviews and discussions with around 200 heads of departments of schools in Singapore.