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Lim KS, Fong SL, Yu X, Lim YH, Wong KY, Lai ST, Ng CG, Tan CT, Tan SB. The effect of 20-minute mindful breathing exercise on psychological well-being in epilepsy: A pilot randomized controlled trial. Epilepsy Behav 2024; 155:109778. [PMID: 38636139 DOI: 10.1016/j.yebeh.2024.109778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Depression and anxiety are prevalent in epilepsy patients, but psychiatric or psychological services may not be accessible to all patients. This study aimed to determine the effectiveness of the 20-minute mindful breathing on the psychological well-being of PWE using an instructional video. METHOD This was a pilot, assessor-blinded, randomized controlled trial. The intervention group received a guided video and was briefed to perform the exercise twice a week for two weeks while the waitlist control group only received the video upon completion of the study. The subjects were assessed at three-time points (T0: Baseline, T1: 2 weeks after the intervention, T2: 4 weeks after intervention), using the Neurological Disorders Depression Index (NDDI-E), General Anxiety Disorder (GAD-7), Quality of Life in Epilepsy Inventory (QOLIE-31) and Mindfulness Attention Awareness Scale (MAAS). RESULTS Twenty patients were recruited, with 10 in the intervention and waitlist-control groups. Compared with the waitlist-control group, participants in the intervention group showed significant improvement in NDDI-E at T1 (p = 0.022) but not at T2 (p = 0.056) and greater improvement in GAD-7 at T1 and T2 but not statistically significant. The QOLIE-31 overall score in the intervention group has significantly improved at T1 (p = 0.036) and T2 (p = 0.031) compared to the waitlist-control group. For MAAS, the intervention group also had an increased score at T2 (p = 0.025). CONCLUSION The 20-minute mindfulness breathing exercise has an immediate effect in improving depression and quality of life among people with epilepsy.
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Affiliation(s)
- Kheng-Seang Lim
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Xuen Yu
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ying-Huan Lim
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kian-Yong Wong
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siew-Tim Lai
- Department of Social Science, Faculty of Social Science and Humanities, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Chong-Guan Ng
- Department of Psychiatry, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong-Tin Tan
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Seng-Beng Tan
- Palliative Medicine, Subang Jaya Medical Centre, Kuala Lumpur, Malaysia
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Ng DLC, Bin Jamalludin MA, Gan XY, Ng SY, Bin Mohamad Rasidin MZ, Felix BA, Jagang NM, Sindeh W, Bin Mohd Abdul Rahim MAH, Tan SB, Chai CS. Public's Willingness to Perform COVID-19 Self-Testing During the Transition to the Endemic Phase in Malaysia - A Population-Based Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:2505-2519. [PMID: 38024502 PMCID: PMC10676112 DOI: 10.2147/rmhp.s439530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Malaysia entered the transition to the endemic phase of Coronavirus 2019 (COVID-19) on 1st April 2022. This study aims to determine the public's willingness to perform COVID-19 self-testing. Factors that influenced their willingness were also assessed. Methods A nationwide, cross-sectional, and population-based study was conducted online in Malaysia from 28th April 2023 to 4th June 2023. Individuals aged 18 years and above were enrolled through the snowball sampling method. Data were analyzed by using the Chi-Square test, independent t-test, and binary logistic regression. Results One thousand four hundred fifty-three responses were included in the analysis. Of these respondents, 89.3% were willing, 4.1% were reluctant, and 6.6% remained hesitant to perform COVID-19 self-testing, The common reasons given by those willing to perform COVID-19 self-testing included being able to self-isolate (99.0%) and seek treatment (96.3%) earlier if tested positive. The common reasons against COVID-19 self-testing included the belief that COVID-19 is equivalent to the common flu (91.7%) and having received the COVID-19 vaccine (78.3%). The isolation policy for COVID-19 was the most significant consideration for those who were still hesitant (85.4%). Women [adjusted odds ratios (OR): 2.1, 95% confidence intervals (95% CI): 1.44-3.00, p < 0.001], individuals with tertiary education (OR: 2.1, 95% CI: 1.32-3.26, p = 0.002), those vaccinated against COVID-19 (OR: 8.1, 95% CI: 2.63-24.82, p < 0.001), and individuals with prior experience of COVID-19 self-testing (OR: 4.2, 95% CI: 2.84-6.12, p < 0.001) showed a significantly higher willingness to engage in COVID-19 self-testing. Conclusion The public exhibited a high willingness to perform COVID-19 self-testing during the transition to the endemic phase in Malaysia. Future strategies to promote COVID-19 self-testing uptake in Malaysia should focus on vulnerable groups, address the common concerns among those hesitant and reluctant, and highlight the advantages of COVID-19 self-testing.
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Affiliation(s)
- Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | | | - Xhi-Yan Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew-Yoong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Beverlyn Anak Felix
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | | | - Woweham Sindeh
- Telupid Health Clinic, Ministry of Health, Beluran, Malaysia
| | | | - Seng-Beng Tan
- Palliative Care Unit, Subang Jaya Medical Center, Subang Jaya, Selangor, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Malaysia
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Chai CS, Ng DLC, Bt Mos S, Ibrahim MAB, Tan SB, Pang YK, Liam CK. COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV 1 - a post-hoc analysis of pooled data. BMC Pulm Med 2023; 23:150. [PMID: 37118725 PMCID: PMC10148499 DOI: 10.1186/s12890-023-02436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/15/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. METHODS This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. RESULTS Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121-0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). CONCLUSIONS In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Sumastika Bt Mos
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Muhammad Amin B Ibrahim
- Department of Medicine, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ng DLC, Gan GG, Chai CS, Anuar NAB, Sindeh W, Chua WJ, Said AB, Tan SB. The willingness of parents to vaccinate their children younger than 12 years against COVID-19: a cross-sectional study in Malaysia. BMC Public Health 2022; 22:1265. [PMID: 35768789 PMCID: PMC9241237 DOI: 10.1186/s12889-022-13682-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/22/2022] [Indexed: 12/23/2022] Open
Abstract
Background The initiation of a new drug, for instance, the coronavirus disease 2019 (COVID-19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID-19. Methods An online cross-sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method. Results The analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID-19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32–3.04; P = 0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21–1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34–2.26; P < 0.001), parents who had significant contact with COVID-19 (OR, 1.3; 95% CI, 1.09–1.63; P = 0.006), and parents who had been vaccinated against COVID-19 (OR, 15.4; 95% CI, 9.76–24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine information from physicians (82.3%), and the belief of vaccine was unsafe (79.8%). Conclusions In this study, nearly three-quarters of parents were willing to vaccinate their children younger than 12 years against COVID-19. The parents’ history of COVID-19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID-19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine’s benefits. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13682-z.
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Affiliation(s)
- Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Nur Adila Bt Anuar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Woweham Sindeh
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei-Jing Chua
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Asri B Said
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Chai CS, Ng DLC, Chua WJ, Tung YZ, Sindeh W, Ibrahim MA, Badlishah Sham SF, Tan SB. Knowledge, Attitude, and Practices Among the General Population During the Later Stage of the COVID-19 Pandemic in Malaysia: A Cross-Sectional Study. Healthc Policy 2022; 15:389-401. [PMID: 35283653 PMCID: PMC8906877 DOI: 10.2147/rmhp.s349798] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/22/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science of University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science of University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
- Correspondence: Diana-Leh-Ching Ng, Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia, Tel +60 19-8198265, Email
| | - Wei-Jing Chua
- Department of Medicine, Faculty of Medicine of University of Malaya, Kuala Lumpur, Malaysia
| | - Yu-Zhen Tung
- Department of Medicine, Faculty of Medicine of University of Malaya, Kuala Lumpur, Malaysia
| | - Woweham Sindeh
- Department of Primary Care Medicine, Faculty of Medicine of University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Amin Ibrahim
- Department of Internal Medicine, Faculty of Medicine of University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Siti Fatimah Badlishah Sham
- Department of Primary Care Medicine, Faculty of Medicine of University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine of University of Malaya, Kuala Lumpur, Malaysia
- Seng-Beng Tan, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Tel +60 12-3263128, Email
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Ng DLC, Gan GG, Anuar NA, Tung YZ, Lai NZ, Tan YW, Said SNM, Madihie A, Chai CS, Tan SB. The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer - a randomised controlled trial. BMC Palliat Care 2021; 20:160. [PMID: 34649555 PMCID: PMC8518151 DOI: 10.1186/s12904-021-00855-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with haematological cancer had considerable symptom burden, in which fatigue was the most prevalent. Almost 70% of haematological cancer patients reported fatigue. METHODS We conducted a parallel-group, non-blinded, randomised control trial at the haemato-oncology unit of University Malaya Medical Centre, from 1st October 2019 to 31st May 2020. Patients included were ≥ 18 years, had histopathological diagnosis of haematological cancer, and fatigue score of ≥4 based on the fatigue subscale of Edmonton Symptom Assessment System (ESAS). Patients allocated to the intervention group received standard care plus a guided 30-min mindful breathing session, while those in control group received standard care. The study outcomes include fatigue severity according to the fatigue subscale of ESAS, visual analogue scale of 0 - 10, and Functional Assessment of Chronic Illness Therapy Fatigue Scale Version 4, at minute 0 and minute 30. RESULTS Of 197 patients screened, 80 were eligible and they were equally randomised into 30-min mindful breathing versus standard care. Lymphoma (58.9%) was the commonest haematological malignancy, followed by multiple myeloma (13.8%), acute leukaemia (11.3%), myeloproliferative neoplasm (6.3%), chronic leukaemia (5.0%) and myelodysplastic syndrome (5.0%). There was no difference in the demographic and clinical characteristics between the 2 groups. At minute 0, both arms of patients had similar ESAS-fatigue score (median, 5) and FACIT-fatigue score (mean ± SD, 24.7 ± 10.6 for intervention group versus 24.7 ± 9.7 for control group). At minute 30, intervention group had lower ESAS-fatigue score (median, 3 versus 5) and FACIT-fatigue score (mean ± SD, 17.1 ± 10.5 versus 24.8 ± 11.3) compared to control group. Both the ESAS-fatigue score reduction (median, - 2 versus 0, p = 0.002) and FACIT-fatigue score reduction (mean ± SD, - 6.7 versus + 0.8; p < 0.001) for the intervention group were statistically significant. The calculated effect size Cohen's d was 1.4 for between-group comparison of differences in total FACIT-fatigue score. CONCLUSIONS Our results provide evidence that a single session of 30-min mindful breathing was effective in reducing fatigue in haematological cancer patients. On top of all the currently available methods, 30-min mindful breathing can prove a valuable addition. TRIAL REGISTRATION NCT05029024 , date of registration 15th August 2021. (Retrospectively registered).
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Affiliation(s)
- Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Adila Anuar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu-Zhen Tung
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Natalie-Zi Lai
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi-Wen Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Norazilah Mohd Said
- Faculty of Cognitive Sciences and Human Development, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Amalia Madihie
- Faculty of Cognitive Sciences and Human Development, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Kadravello A, Tan SB, Ho GF, Kaur R, Yip CH. Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study. ACTA ACUST UNITED AC 2021; 57:medicina57070693. [PMID: 34356974 PMCID: PMC8305467 DOI: 10.3390/medicina57070693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.
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Affiliation(s)
- Aravinthan Kadravello
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Seng-Beng Tan
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Gwo-Fuang Ho
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Ranjit Kaur
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Cheng-Har Yip
- Breast Centre, Subang Jaya Medical Centre, Subang Jaya 47500, Malaysia
- Correspondence:
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Yee A, Hodori N'AM, Tung YZ, Ooi PL, Latif SABA, Isa HM, Ng DLC, Chai CS, Tan SB. Depression level and coping responses toward the movement control order and its impact on quality of life in the Malaysian community during the COVID-19 pandemic: a web-based cross-sectional study. Ann Gen Psychiatry 2021; 20:31. [PMID: 34030704 PMCID: PMC8142880 DOI: 10.1186/s12991-021-00352-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Coronavirus 2019 disease (COVID-19) is a highly infectious disease prompting extreme containment measures, including lockdown, travel restrictions, social distancing, and stringent personal hygiene. This study investigates the depression level and coping responses toward the lockdown, referred as the movement control order (MCO) during COVID-19 pandemic in Malaysia and its impact on quality of life. METHOD This cross-sectional study was conducted from April to May 2020. The outcomes were assessed using the Depression, Anxiety and Stress Scale-21, Coping Orientation to Problems Experienced Inventory, and World Health Organisation Quality of Life-BREF Scale (WHOQOL-BREF) in both English and validated Malay versions. RESULTS Mild-to-severe depression was found in 28.2% (n = 149) of the 528 respondents. Respondents with mild-to-severe depression were significantly younger (33.09 ± 10.08 versus 36.79 ± 12.47 years), without partner (71.8% versus 45.6%), lived in the red zone (85.9% versus 71.0%), and had lower household income as defined in the category of B40 (51.7% versus 39.3%) compared to those without depression (all p < 0.01). The avoidant coping score was significantly higher (25.43 ± 5.69 versus 20.78 ± 5.65), while the religious coping score was significantly lower (5.10 ± 2.07 versus 5.94 ± 2.11) among those with mild-to-severe depression compared to those without depression (both p < 0.001). Respondents with mild-to-severe depression also had significantly lower mean score in each domain of WHOQOL-BREF compare to those without depression [(physical health, 13.63 ± 2.66 versus 16.20 ± 2.11), (psychological, 12.5 ± 2.79 versus 16.10 ± 2.14), (social relationships, 12.17 ± 3.49 versus 15.28 ± 2.93), environment (14.50 ± 2.39 versus 16.21 ± 2.14), all p < 0.001] after controlling for age, marital status, zone, household income, and coping scores. CONCLUSION COVID-19 lockdown had adverse mental health effects. Our study highlighted that approximately one in three individual experienced mild-to-severe depression during the nationwide MCO. The varied impact of the pandemic on mental health could be due to different population characteristics and coping strategies used. Identifying those at higher risk to develop depression during MCO for COVID-19 pandemic could help mental healthcare service providers to plan services for those susceptible, thereby mitigating the pandemic's effect on quality of life.
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Affiliation(s)
- Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, University Malaya Medical Centre, 50600, Kuala Lumpur, Malaysia
| | - Nur 'Aqilah Mohd Hodori
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, University Malaya Medical Centre, 50600, Kuala Lumpur, Malaysia
| | - Yu-Zhen Tung
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Po-Lin Ooi
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Saiful Adni B Abdul Latif
- Department of Palliative and Supportive Therapy, National Cancer Institute, 62250, Putrajaya, Malaysia
| | - Husna Md Isa
- Faculty of Cognitive Sciences and Human Development, University Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Ng DLC, Malik NMBA, Chai CS, Goh GMKC, Tan SB, Bee PC, Gan GG, Said AB. Time in therapeutic range, quality of life and treatment satisfaction of patients on long-term warfarin for non-valvular atrial fibrillation: a cross-sectional study. Health Qual Life Outcomes 2020; 18:347. [PMID: 33081816 PMCID: PMC7576864 DOI: 10.1186/s12955-020-01600-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR. METHODS A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients' TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. RESULTS A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184-0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502-0.699). CONCLUSIONS Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.
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Affiliation(s)
- Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Natasya Marliana Bt Abdul Malik
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Greta-Miranda-Kim-Choo Goh
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Asri B Said
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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Chai CS, Mos SB, Ng DLC, Goh GMKC, Su AT, Ibrahim MAB, Musa ANB, Tan SB, Pang YK, Liam CK. Clinical phenotypes and heath-related quality of life of COPD patients in a rural setting in Malaysia - a cross-sectional study. BMC Pulm Med 2020; 20:254. [PMID: 32993591 PMCID: PMC7526228 DOI: 10.1186/s12890-020-01295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients’ health-related quality of life (HRQoL) according to their COPD phenotypes. Methods This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Results Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p < 0.001). There were significantly more patients with mMRC 2–4 among AE (68.6%) (p < 0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p < 0.001) and SGRQ-c (both p < 0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p < 0.001) scores than those with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p < 0.001), and ACO [(p = 0.003–0.016; p = < 0.001–0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001–0.040; p < 0.001) except CAT 2 and activity components of SGRQ-c. Conclusions The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Sumastika Bt Mos
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Greta-Miranda-Kim-Choo Goh
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Anselm-Ting Su
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Muhammad Amin B Ibrahim
- Department of Medicine, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Aisya Natasya Bt Musa
- Department of Medicine, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ng DLC, Chai CS, Tan KL, Chee KH, Tung YZ, Wai SY, Teo WTJ, Ang BT, Lim MA, Tan SB. The Efficacy of a Single Session of 20-Minute Mindful Breathing in Reducing Dyspnea Among Patients With Acute Decompensated Heart Failure: A Randomized Controlled Trial. Am J Hosp Palliat Care 2020; 38:246-252. [DOI: 10.1177/1049909120934743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Heart failure is the leading cause of morbidity and mortality worldwide. Standard treatment for heart failure includes pharmacotherapy and cardiac device implants. However, supportive approaches in managing dyspnea in heart failure are limited. This study aimed to test the efficacy of 20-minute mindful breathing in reducing dyspnea among patients admitted for acute decompensated heart failure. We conducted a parallel-group, non-blinded, randomized controlled trial of a single session of 20-minute mindful breathing plus standard care versus standard care alone among patients admitted for moderate to severe dyspnea due to acute decompensated heart failure, using the dyspnea score based on the Edmonton Symptom Assessment System (ESAS), at the Cardiology Unit of University Malaya Medical Centre in Malaysia. Thirty participants were randomly assigned to a single session of 20-minute mindful breathing plus standard care (n = 15) or standard care alone (n = 15), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the intervention group compared to the control group at minute 20 (U = 49.5, n1 = 15, n2 =15, median reduction in ESAS dyspnea score 1 = 2, median reduction in ESAS dyspnea score 2 = 0, mean rank 1 = 11.30, mean rank 2 = 19.70, z = −2.692, r = 0.4, P = 0.007). Our results provided evidence that a single session of 20-minute mindful breathing was efficacious in reducing dyspnea for patients admitted for acute decompensated heart failure.
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Affiliation(s)
- Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kok-Leng Tan
- Department of Medicine, Faculty of Medicine, University Sains Malaysia, Kelantan, Malaysia
| | - Kok-Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu-Zhen Tung
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suet-Yen Wai
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei-Ting Joyce Teo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin-Ting Ang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Min-Ai Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan SB, Liam CK, Pang YK, Leh-Ching Ng D, Wong TS, Wei-Shen Khoo K, Ooi CY, Chai CS. The Effect of 20-Minute Mindful Breathing on the Rapid Reduction of Dyspnea at Rest in Patients With Lung Diseases: A Randomized Controlled Trial. J Pain Symptom Manage 2019; 57:802-808. [PMID: 30684635 DOI: 10.1016/j.jpainsymman.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT Dyspnea is a common and distressing symptom in respiratory diseases. Despite advances in the treatment of various lung diseases, the treatment modalities for dyspnea remain limited. OBJECTIVES This study aims to examine the effect of 20-minute mindful breathing on the rapid reduction of dyspnea at rest in patients with lung cancer, chronic obstructive pulmonary disease, and asthma. METHODS We conducted a parallel-group, nonblinded, randomized controlled trial of standard care plus 20-minute mindful breathing vs. standard care alone for patients with moderate to severe dyspnea due to lung disease, named previously, at the respiratory unit of University Malaya Medical Centre in Malaysia, from August 1, 2017, to March 31, 2018. RESULTS Sixty-three participants were randomly assigned to standard care plus a 20-minute mindful breathing session (n = 32) or standard care alone (n = 31), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the mindful breathing group compared with the control group at minute 5 (U = 233.5, n1 = 32, n2 = 31, mean rank1 = 23.28, mean rank2 = 37.72, z = -3.574, P < 0.001) and minute 20 (U = 232.0, n1 = 32, n2 = 31, mean rank1 = 23.00, mean rank2 = 36.77, z = -3.285, P = 0.001). CONCLUSION Our results provide evidence that a single session of 20-minute mindful breathing is effective in reducing dyspnea rapidly for patients with lung cancer, chronic obstructive pulmonary disease, and asthma.
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Affiliation(s)
- Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Tat-Seng Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kelvin Wei-Shen Khoo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chieh-Yin Ooi
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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Chai CS, Liam CK, Pang YK, Ng DLC, Tan SB, Wong TS, Sia JE. Clinical phenotypes of COPD and health-related quality of life: a cross-sectional study. Int J Chron Obstruct Pulmon Dis 2019; 14:565-573. [PMID: 30880946 PMCID: PMC6402617 DOI: 10.2147/copd.s196109] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction The Spanish COPD guideline (GesEPOC) classifies COPD into four clinical phenotypes based on the exacerbation frequency and dominant clinical manifestations. In this study, we compared the disease-specific health-related quality of life (HRQoL) of patients with different clinical phenotypes. Methods This was a cross-sectional study of patients with COPD attending the respiratory medicine clinic of University of Malaya Medical Centre from 1 June 2017 to 31 May 2018. Disease-specific HRQoL was assessed by using the COPD Assessment Test (CAT) and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Results Of 189 patients, 28.6% were of non-exacerbator phenotype (NON-AE), 18.5% were of exacerbator with emphysema phenotype (AE NON-CB), 39.7% were of exacerbator with chronic bronchitis phenotype (AE CB), and 13.2% had asthma-COPD overlap syndrome phenotype (ACOS). The total CAT and SGRQ-c scores were significantly different between the clinical phenotypes (P<0.001). Patients who were AE CB had significantly higher total CAT score than those with ACOS (P=0.033), AE NON-CB (P=0.001), and NON-AE (P<0.001). Concerning SGRQ-c, patients who were AE CB also had a significantly higher total score than those with AE NON-CB (P=0.001) and NON-AE (P<0.001). However, the total SGRQ-c score of AE CB patients was only marginally higher than those who had ACOS (P=0.187). There was a significant difference in the score of each CAT item (except CAT 7) and SGRQ-c components between clinical phenotypes, with AE CB patients recording the highest score in each of them. Conclusion Patients who were AE CB had significantly poorer HRQoL than other clinical phenotypes and recorded the worst score in each of the CAT items and SGRQ-c components. Therefore, AE CB patients may warrant a different treatment approach that focuses on the exacerbation and chronic bronchitis components.
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Tat-Seng Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Jo-Ee Sia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
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Ng DLC, Gan GG, Chai CS, Chee KH, Tan KL, Tan SB, Bee PC. Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants: a cross-sectional study. Patient Prefer Adherence 2019; 13:1363-1373. [PMID: 31616136 PMCID: PMC6698611 DOI: 10.2147/ppa.s204246] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION AND AIM Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). METHODS This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). RESULTS A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069). CONCLUSION Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.
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Affiliation(s)
- Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Gin-Gin GanDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, MalaysiaTel +60 37 949 2741Fax +60 37 955 6936Email
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kok-Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok-Leng Tan
- Department of Medicine, Faculty of Medicine, University Science Malaysia, Penang, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan SB, Nazni WA, Misni S, Zuraini Z, Lee HL. Effects of vitamin B fortified sucrose solution on the longevity and reproductive potentials of laboratory-bred Culex quinquefasciatus Say adult. Trop Biomed 2016; 33:141-148. [PMID: 33579151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Laboratory colonised mosquitoes are usually maintained on vitamin B complex fortified sucrose solution, however only few studies were conducted to evaluate the effects of such practice. This study aimed to determine the effects of different concentrations of sucrose solution fortified with and without 1% vitamin B complex on the longevity and reproductive potential of adult female of a local strain of Culex quinquefasciatus Say. Two arms of studies were carried out separately and each arm was triplicated. In one arm, concentrations of sucrose solution at 0%, 1%, 3%, 5% and 10% fortified with 1% Vitamin B complex were fed to the mosquitoes, while in the other arm, similar sucrose concentrations were used but without 1% vitamin B complex. Adult Cx. quinquefasciatus maintained on 5% sucrose solution fortified with 1% vitamin B complex exhibited significant extended vitality and longevity in stimulating ovarian development, compared with other vitamin fortified sucrose concentrations (p<0.05). The vitality and longevity of F0 and F1 males were 76.67±2.19 days and 57.67±8.19 days respectively. The F0 females survived the longest duration of 107.67±5.61 days and the F1 females survived 90.67±12.47 days with higher number of eggs laid, i.e. 1427.67±62.89 eggs at a higher hatchability rate of 57.05±8.39% or 814.49 eggs hatched. Thus, 5% sucrose solution fortified with 1% Vitamin B complex should be used to produce colonies of homogenous mosquitoes as this exerts positive biological effects on laboratory-bred Cx. quinquefasciatus.
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Affiliation(s)
- S B Tan
- Medical Entomology Unit/WHO Collaborating Centre for Vectors, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - W A Nazni
- Medical Entomology Unit/WHO Collaborating Centre for Vectors, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - S Misni
- School of Distance Education, Universiti Sains Malaysia, Penang, Malaysia
| | - Z Zuraini
- School of Distance Education, Universiti Sains Malaysia, Penang, Malaysia
| | - H L Lee
- Medical Entomology Unit/WHO Collaborating Centre for Vectors, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
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Chung AYF, Ooi LLPJ, Machin D, Tan SB, Goh BKP, Wong JS, Chen YM, Li PCN, Gandhi M, Thng CH, Yu SWK, Tan BS, Lo RHG, Htoo AMM, Tay KH, Sundram FX, Goh ASW, Chew SP, Liau KH, Chow PKH, Tay KH, Tan YM, Cheow PC, Ho CK, Soo KC. Adjuvant hepatic intra-arterial iodine-131-lipiodol following curative resection of hepatocellular carcinoma: a prospective randomized trial. World J Surg 2014; 37:1356-61. [PMID: 23463394 DOI: 10.1007/s00268-013-1970-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). METHODS From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan-Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong. RESULTS The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46-1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51-1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by (131)I-lipiodol and hepatic artery dissection during angiography. CONCLUSIONS The randomized trial provides insufficient evidence to recommend the routine use of (131)I-lipiodol in these patients.
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Affiliation(s)
- A Y F Chung
- General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Teh CH, Nazni WA, Lee HL, Fairuz A, Tan SB, Sofian-Azirun M. In vitro antibacterial activity and physicochemical properties of a crude methanol extract of the larvae of the blow fly Lucilia cuprina. Med Vet Entomol 2013; 27:414-420. [PMID: 23650928 DOI: 10.1111/mve.12012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 09/27/2012] [Accepted: 10/12/2012] [Indexed: 06/02/2023]
Abstract
The emergence of multidrug-resistant bacterial strains has prompted the reintroduction of maggot therapy in the treatment of chronic, infected wounds. Many previous studies have demonstrated the potent antibacterial activity of larval excretions/secretions of the blowfly Lucilia sericata (Meigen) (Diptera:Calliphoridae) against bacteria. However, the antibacterial activity of its sibling species, Lucilia cuprina (Wiedemann) (Diptera:Calliphoridae) against a wide range of pathogenic bacteria has never been determined. The aim of this study was to develop a new procedure to produce whole body extract of larvae of L. cuprina via methanol extraction as well as to demonstrate the in vitro antibacterial activity of this extract against seven selected wound pathogens (Staphylococcus aureus, methicillin-resistant S. aureus, S. epidermidis, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli). The turbidimetric assay demonstrated that L. cuprina larval extract was significantly potent against all bacteria tested (P < 0.001). Additionally, colony-forming unit (CFU), agar well diffusion and minimum inhibitory concentration assays have confirmed the apparent potency of larval extract against P. aeruginosa. The reconstituted larval extract was highly robust and thermally stable. These observations substantiated the feasibility of the methanol extraction method in the production of larval extract.
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Affiliation(s)
- C H Teh
- Method and Statistics Section, Institute for Public Health, Kuala Lumpur, Malaysia
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Chandran M, Tan MZW, Cheen M, Tan SB, Leong M, Lau TC. Secondary prevention of osteoporotic fractures--an "OPTIMAL" model of care from Singapore. Osteoporos Int 2013; 24:2809-17. [PMID: 23615816 DOI: 10.1007/s00198-013-2368-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED A significant care gap exists in the management of osteoporotic fractures. Osteoporosis Patient Targeted and Integrated Management for Active Living (OPTIMAL) is a secondary fracture prevention program instituted in the public hospitals of Singapore. We aim to describe the operational characteristics of OPTIMAL and initial audit data of patients who were recruited into the program at Singapore General Hospital. INTRODUCTION Fractures often represent the first opportunity for care of osteoporosis. However, a significant care gap still exists in the management of these sentinel events and underdiagnosis and undertreatment of osteoporotic fractures are prevalent worldwide. Fracture liaison services run by care coordinators have been shown to reduce the fracture care gap. OPTIMAL is a clinician champion-driven, case manager-run secondary fracture prevention program set up in the public hospitals of Singapore in 2008. METHODS We present the operational characteristics and initial audit data of OPTIMAL from the largest tertiary teaching hospital in Singapore. RESULTS One thousand and fourteen patients have been recruited into OPTIMAL at our hospital since 2008, and 476 patients are currently in active follow-up. Two hundred and eighty-seven patients had completed a 2-year follow-up at the hospital as of August 2012 and were evaluated; 97.5% of these patients had DXA evaluation upon enrollment into the program, and 62% of the patients reported compliance with an exercise program over the 2-year follow-up. Compliance to osteoporosis medications as estimated by the medication possession ratio (MPR) was 72.8 ± 34.5% at 2 years with patients maintaining good compliance (MPR ≥ 80%) for an average of 20.2 months (95% CI 19.3-21.1). CONCLUSION Our report provides the first compelling evidence of the potential success of a secondary fracture prevention program from an Asian country. The ultimate success of the program will be determined by fracture outcomes and cost effectiveness, but in the interim, clear evidence of enhanced assessment and treatment rates has been demonstrated.
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Affiliation(s)
- M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore,
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Wang XL, Tan SB, Ganderton D. The Influence of Binding Agent on the Drug Release Rate of Granules and Tablets. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1990.tb14455.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- XL Wang
- Department of Pharmacy, King's College London, Manresa Road, London SW3 6LX
| | - SB Tan
- Department of Pharmacy, King's College London, Manresa Road, London SW3 6LX
| | - D Ganderton
- Department of Pharmacy, King's College London, Manresa Road, London SW3 6LX
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20
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Venketasubramanian N, Chen CLH, Gan RN, Chan BPL, Chang HM, Tan SB, Picard D, Navarro JC, Baroque AC, Poungvarin N, Donnan GA, Bousser MG. A double-blind, placebo-controlled, randomized, multicenter study to investigate CHInese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES Study). Int J Stroke 2009; 4:54-60. [PMID: 19236501 DOI: 10.1111/j.1747-4949.2009.00237.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Rationale Traditional Chinese Medications(TCM) have been reported to have beneficial effects in stroke patients, but were not rigorously evaluated by GCP standards. Aim This study tests the hypothesis that Neuroaid, a TCM widely used in China post-stroke, is superior to placebo in reducing neurological deficit and improving functional outcome in patients with acute cerebral infarction of an intermediate severity. Design This is a multicenter, randomised, double-blind, placebo-controlled study of Neuroaid in ischemic stroke patients with National Institute of Health Stroke Scale(NIHSS) 6-14 treated within 48 h of stroke onset. Neuroaid or placebo is taken (4 capsules) 3 times daily for 3 months. Treatments are assigned using block randomization, stratified for centers, via a central web-randomization system. With a power of 90% and two-sided test of 5% type I error, a sample size is 874. Allowing for a drop-out rate of up to 20%, 1100 individuals should be enrolled in this study. Study Outcomes The primary efficacy endpoint is the modified Rankin Scale(mRS) grades at 3 months. Secondary efficacy endpoints are the NIHSS score at 3 months; difference of NIHSS scores between baseline and 10 days, and between baseline and 3 months; difference of NIHSS sub-scores between baseline and 10 days, and between baseline and 3 months; mRS at 10 days, 1 month, and 3 months; Barthel index at 3 months; Mini Mental State Examination at 10 days and 3 months. Safety outcomes include complete blood count, renal and liver panels, and electrocardiogram. STUDY REGISTRATION ClinicalTrials.gov identifier: NCT00554723.
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Lo YL, Dan YF, Teo A, Tan YE, Yue WM, Raman S, Tan SB. The value of bilateral ipsilateral and contralateral motor evoked potential monitoring in scoliosis surgery. Eur Spine J 2007; 17 Suppl 2:S236-8. [PMID: 17874145 PMCID: PMC2525889 DOI: 10.1007/s00586-007-0498-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
Intraoperative monitoring (IOM) of the motor pathways is a routine procedure for ensuring integrity of corticospinal tracts during scoliosis surgery. We have previously demonstrated presence of ipsilateral motor evoked potentials (MEPs) during IOM for scoliosis surgery, but its significance was uncertain. In this case series, we show concurrent ipsilateral and contralateral MEP amplitude changes obtained with cortical stimulation are of value in reducing false positive observations during IOM. The use of this easily recordable MEP is thus advocated as a diagnostic adjunct to contralateral MEPs for scoliosis and spinal surgery.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, Singapore 169608.
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22
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Teo HEL, Peh WCG, Akhilesh M, Tan SB, Ishida T. Congenital osteofibrous dysplasia associated with pseudoarthrosis of the tibia and fibula. Skeletal Radiol 2007; 36 Suppl 1:S7-14. [PMID: 16944141 DOI: 10.1007/s00256-006-0177-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 06/08/2006] [Indexed: 02/02/2023]
Abstract
The association between congenital pseudoarthrosis and osteofibrous dysplasia of the tibia and fibula is a rare entity that has been recently recognized. We report a male newborn who was found to have swelling and deformity of the left lower leg. Radiographs and magnetic resonance imaging showed an extensive destructive lesion of the tibial shaft, with dysplastic congenital pseudoarthrosis of the lower fibula. Histopathological examination confirmed the diagnosis of congenital pseudoarthrosis of the tibia and fibula with underlying osteofibrous dysplasia involving both bones. Immunohistochemical stains showed cytokeratin positivity.
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Affiliation(s)
- Harvey E L Teo
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
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Abstract
PURPOSE To evaluate the treatment outcome of skin traction followed by spica casting for closed femoral shaft fractures in children. METHODS Between September 1997 and December 2001 inclusive, outcomes of 63 children aged one month to 15 (mean, 5.3) years with closed femoral shaft fractures managed with skin traction and spica casting were reviewed. Depending on age, patients were kept in traction from 2 to 15 (median, 9) days, then in spica casts for 2 to 8 (median, 5) weeks. RESULTS Bony union took 3 to 12 (median, 6) weeks. There were no malunion, nonunion, or rotational deformities. Nor were there any significant limb length discrepancies, pressure sores, or nerve palsies. On no occasion was a spica cast removed and reapplied for loss of fracture reduction. At final follow-up, limb length discrepancy was noted in 14 (22%) of the patients, but none had a discrepancy of greater than 1.5 cm or a short-legged gait. CONCLUSION Skin traction followed by spica casting for closed femoral shaft fractures in children is safe, cost-effective and associated with a low complication rate. It is effective in children below 5 years of age and no less effective in older children, except in instances of open fracture, multiple fractures, or older children with large statures, which conditions render them intolerant to spica casts.
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Affiliation(s)
- Y H D Lee
- Department of Pediatric Orthopedic Surgery, Kandang Kerbau Womens' and Childrens' Hospital, Singapore.
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Lo YL, Tan YE, Dan YF, Leoh TH, Tan SB, Tan CT, Chan LL. Cutaneous silent periods in the evaluation of cord compression in cervical spondylosis. J Neurol 2007; 254:14-9. [PMID: 17508136 DOI: 10.1007/s00415-007-0142-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The clinical diagnosis of cervical spondylotic myelopathy (CSM) may be challenging in patients with cervical spondylosis (CS). Routine nerve conduction studies (NCS) may not evaluate cord compression adequately. METHODS We obtained cutaneous silent periods (CSP) in 26 consecutive patients presenting with clinical features of CS, in comparison with 30 normal controls. The results were also compared with transcranial magnetic stimulation (TMS) findings, and magnetic resonance imaging of the cervical cord as the gold standard. RESULTS CSP findings showed similarly high sensitivity of up to 96% with TMS in evaluating cervical cord dysfunction. CONCLUSION In specific clinical settings, CSP is of value for the diagnosis of CSM in CS. CSP measurement is advocated as a simple and rapid diagnostic adjunct to NCS in evaluating CS patients with possible cord compromise.
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Affiliation(s)
- Y L Lo
- Dept. of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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25
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Machin D, Tan SB. Biometrical aspects of drug development. Ernst Schering Res Found Workshop 2007:195-207. [PMID: 17117725 DOI: 10.1007/978-3-540-49529-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Once the activity of a compound has been established in the laboratory (usually by use of experimental animals) the next stage of development is to bring this forward to humans in early-phase clinical trials. A pharmacokinetic study aims to establish an effective dosing regimen for the compound in order to reach concentrations within the therapeutic window as quickly as possible. The aim of the phase I trials is typically to determine a maximal safe dose with which more rigorous investigation of activity in a phase II trial can be conducted. This chapter deals with statistical issues related to the design of phase I studies.
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Affiliation(s)
- D Machin
- UKCCSG-Data Centre, University of Leicester, Hearts of Oak Hous, UK.
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Lo YL, Dan YF, Tan YE, Fook-Chong S, Tan SB, Tan CT, Raman S. Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery. Eur Spine J 2006; 15 Suppl 5:656-60. [PMID: 16858594 PMCID: PMC1602201 DOI: 10.1007/s00586-006-0190-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 06/15/2006] [Accepted: 07/02/2006] [Indexed: 12/02/2022]
Abstract
Ipsilateral motor evoked potentials (MEPs) in spinal cord surgery intraoperative monitoring is not well studied. We show that ipsilateral MEPs have significantly larger amplitudes and were elicited with lower stimulation intensities than contralateral MEPs. The possible underlying mechanisms are discussed based on current knowledge of corticospinal pathways. Ipsilateral MEPs may provide additional information on the integrity of descending motor tracts during spinal surgery monitoring.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore.
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27
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Lo YL, Chan LL, Lim W, Tan SB, Tan CT, Chen JLT, Fook-Chong S, Ratnagopal P. Transcranial magnetic stimulation screening for cord compression in cervical spondylosis. J Neurol Sci 2006; 244:17-21. [PMID: 16478626 DOI: 10.1016/j.jns.2005.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 10/28/2005] [Accepted: 12/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cervical spondylosis (CS) often results in various degrees of cord compression, which can be evaluated functionally with transcranial magnetic stimulation (TMS). We investigate the use of TMS as a screening tool for myelopathy in CS. METHODS We prospectively studied 231 patients classified into Groups 1 to 4 based on MRI grading of severity of cord compromise. TMS elicited central motor conduction times and motor evoked potential (MEP) amplitudes in all 4 limbs. The results were compared with those from 45 healthy controls. RESULTS TMS showed 98% sensitivity and 98% specificity for cord abnormality using MRI as reference standard. CONCLUSIONS MEP abnormalities are useful for electrophysiological evaluation of cord compression in CS. While TMS is not a substitute for MRI, it is of value as a rapid, inexpensive and non-invasive technique for screening patients before MRI studies.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore 169608, Singapore.
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28
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Busmanis I, Ho TH, Tan SB, Khoo KS. p53 and bcl-2 expression in invasive and pre-invasive uterine papillary serous carcinoma and atrophic endometrium. Ann Acad Med Singap 2005; 34:421-5. [PMID: 16123814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Uterine papillary serous carcinoma (UPSC), a high-grade tumour, is known to be associated in some cases with an identifiable intraepithelial neoplasia (IEN) component. Biomarker studies incorporating this latter component are not well documented. One aim of the present study was to compare levels of immunohistochemical (IHC) expression of p53 tumour suppressor gene and bcl-2 oncoprotein between UPSC and IEN, as well as normal endometrium to determine its biologic significance. The other major aim was to determine if these IHC results have any bearing on survival data in this tumour. MATERIALS AND METHODS An immunoreactivity score was assigned for examination of p53 and bcl-2 expression in a total of 21 cases of UPSC, 9 with an evaluable IEN component and 11 with associated non-neoplastic endometrium. Statistical analysis of IHC results was performed, in addition to correlation with survival data and disease stage. RESULTS p53 was identified in 16/21 cases of UPSC (76%) and 8/9 cases of IEN (89%), and no cases of normal endometrium. By contrast, bcl-2 was positive in all normal endometria with less expression in UPSC leaving 15/21 (71%) cases positive, and in IEN, leaving 5/9 (55%) of cases positive. Differences in immunoreactive scores for both p53 and bcl-2 between UPSC and benign glands, as well as between IEN and benign glands reached statistical significance with P values of 0.006 and 0.014 for p53, and 0.003 and 0.027 for bcl-2 respectively. There was no statistical significance between values for UPSC and IEN. Cox regression analysis found no statistically significant relationship between patient survival time in early and late stages of disease, and p53 and bcl-2 immunoscores. CONCLUSIONS The lack of a significant difference between the bcl-2 and p53 values for both UPSC and IEN suggests that these molecular alterations occur at an early stage of tumour pathogenesis. A potential advantage of the use of immunohistochemical markers is their application to routinely processed surgical specimens. In this case, bcl-2 and p53 were applied in UPSC to determine any potential significance, but neither marker proved to be a useful predictor of survival time or disease stage.
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Affiliation(s)
- I Busmanis
- Department of Pathology, Singapore General Hospital, Singapore.
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Lo YL, Chan LL, Tan CT, Chen JLT, Tan SB. Pectoralis major motor evoked potentials in cervical spondylosis. J Neurol Sci 2005; 235:55-9. [PMID: 15939436 DOI: 10.1016/j.jns.2005.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 03/09/2005] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
Myelopathy is a severe complication of cervical spondylosis (CS). We studied 27 consecutive patients with CS referred for evaluation for possible myelopathy using transcranial magnetic stimulation. The findings were compared with those from 20 normal controls. Magnetic resonance imaging was utilized to assess the degree of cord compromise. Central motor conduction time (CMCT) abnormalities showed equivalent diagnostic yield with pectoralis major (PM) recordings, as compared with combined first dorsal interossei and abductor hallucis recordings. Our findings show that CMCT measurement with PM recordings is of value as a diagnostic adjunct in the electrophysiological evaluation of myelopathy in CS.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
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Chia SL, Tan BH, Tan CT, Tan SB. Candida spondylodiscitis and epidural abscess: management with shorter courses of anti-fungal therapy in combination with surgical debridement. J Infect 2005; 51:17-23. [PMID: 15979485 DOI: 10.1016/j.jinf.2004.08.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2004] [Indexed: 11/30/2022]
Abstract
Epidural abscess associated with candidal spondylodiscitis is rarely seen, particularly when it involves the cervical and thoracic spine. We report two such cases that were successfully managed with early surgical debridement, as well as medical therapy with intravenous amphotericin followed by oral fluconazole. The literature related to candidal spinal infection is reviewed, and a rational approach to the management of this uncommon condition is proposed. A good outcome may generally be expected with early diagnosis as well as appropriate surgical and pharmacological treatment. Oral fluconazole appears to be useful in the management of candida spondylodiscitis complicated by epidural abscess formation. Treatment until a normal ESR is attained is ideal, and this may be as short as 3 months when surgical drainage has been adequately performed.
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Affiliation(s)
- S L Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
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Nazni WA, Luke H, Wan Rozita WM, Abdullah AG, Sa'diyah I, Azahari AH, Zamree I, Tan SB, Lee HL, Sofian MA. Determination of the flight range and dispersal of the house fly, Musca domestica (L.) using mark release recapture technique. Trop Biomed 2005; 22:53-61. [PMID: 16880754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In order to control any pest it is essential to study the life cycle, biology and bionomics of the target pest under control. With this respect, we have studied the flight range of the house fly Musca domestica (L.). The flight range of the house fly from two sites i.e, the poultry farm and a stable farm has been studied. The flight range study was conducted using a mark release technique. The approach we used in this study was that the flies collected from the respective farms were marked and released at different distances from the farms. The flies were then re-captured from the poultry farm and the stable farm. Studies conducted elsewhere use the technique of releasing the insect species at one spot and recapturing the insect species with the help of baited traps placed at various locations from the release point. The advantage of the approach used in this study was that the flight range as well as the homing effect was determined. From this study, the flight range of house flies released at the poultry farm was 7 km whereas flight range for flies release from stable farm was 5 km. The recovery rate of house flies at the poultry and stable farm was 0.05% and 0.016%, In this study, marked specimens has been detected up to 8 days in field conditions indicating that under field condition the life expectancy could be in the range of 1-2 weeks.
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Affiliation(s)
- W A Nazni
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
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Tan SB, Goh C, Thumboo J, Che W, Chowbay B, Cheung YB. Risk perception is affected by modes of risk presentation among Singaporeans. Ann Acad Med Singap 2005; 34:184-7. [PMID: 15827666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Not much is known about how Singaporeans perceive and react to risk presentation. There is no consensus on whether the European Union guidelines for describing the risk of side effects are valid. This study investigated the effect of different modes of risk presentation on how Singaporeans perceive and react to medical risk. Furthermore, we investigated the practical usage of qualitative phrases, the European Union's adjectives in particular, in describing levels of risk. MATERIALS AND METHODS A hypothetical situation about the risk of side effects of an influenza vaccine was presented in either a probability format (i.e., 5%; n = 42) or a frequency format (i.e., 1 out of 20; n = 43). The 2 versions of questionnaire were handed out in an alternate order to a convenience sample of 47 healthcare professionals and 38 university students. RESULTS Respondents presented with a "5% risk" were more likely to describe the risk as "uncommon" or "rare", as compared to respondents presented with a risk of "one out of twenty" (P <0.01). Furthermore, the former showed more willingness to accept the influenza vaccine described in the hypothetical situation than in the latter, but this was not statistically different (67% versus 54%; P >0.1). CONCLUSIONS Modes of risk presentation affect how people perceive risk, even among people who are highly educated.
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Affiliation(s)
- S B Tan
- Division of Clinical Trials and Epidemiological Sciences, Hong Kong Baptist University
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Lin K, Tan SB, Kolatkar PR, Epstein RJ. Nonrandom intragenic variations in patterns of codon bias implicate a sequential interplay between transitional genetic drift and functional amino acid selection. J Mol Evol 2004; 57:538-45. [PMID: 14738312 DOI: 10.1007/s00239-003-2507-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Accepted: 05/20/2003] [Indexed: 11/28/2022]
Abstract
Although most codon third bases appear to be functionless, the synonymous codons so defined exhibit a strikingly nonrandom distribution (codon bias) within human and other genes. To examine this phenomenon further, we generated a database of DNA sequences encoding human transmembrane cell-surface receptor proteins. Using this database we show here that the guanine and cytosine content of codon third bases (GC3) varies intragenically with the nature of the specified receptor domains (transmembrane > extracellular > intracellular domains; p < 0.001), the phenotype of the encoded amino acids (hydrophobic > hydrophilic > neutral amino acids; p < 0.001), and the receptor affiliation of the transmembrane (G-protein-coupled receptors > receptor tyrosine kinases; p < 0.001). Within gene regions specifying transmembrane domains, GC3 declines as domain functionality becomes redundant with increasing hydrophobicity (p < 0.001). Codons containing the second-base cytosine (XCZ, which encodes neutral amino acids) are selectively depleted of third-base adenine content (A3: XCA codons) when encoding transmembrane domain residues, consistent with positive selection for transitional mutation of XCG to XTG (which encodes hydrophobic amino acids) rather than to the synonymous XCA. Supporting this XCG --> XTG mechanism of codon bias, the G3:A3 ratio of codons specifying the transmembrane amino acid glycine (GGZ) is intermediate between that of its functional homolog alanine (GCZ) and that of hydrophobic valine (GTZ), even though the C3:T3 ratios are similar. Conversely, nearest-neighbor analysis of third bases 5' to codons specifying valine and leucine (CTZ) confirms a significant difference in C3:T3 but not G3:A3 ratios (i.e., C3/G1 --> T3/G1 > C3/A1; p < 0.001), consistent with the functionally advantageous retention of hydrophobic residues. These data raise the possibility that patterns of intragenic codon bias reflect a balance between negative and positive selection, suggesting in turn that analysis of codon third-base usage may help to predict the functional significance of encoded products.
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Affiliation(s)
- K Lin
- Institute of Molecular and Cell Biology, Bioinformatics Centre, National University of Singapore, 117609, Singapore
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Lo YL, Chan LL, Lim W, Tan SB, Tan CT, Chen JLT, Fook-Chong S, Ratnagopal P. Systematic correlation of transcranial magnetic stimulation and magnetic resonance imaging in cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2004; 29:1137-45. [PMID: 15131444 DOI: 10.1097/00007632-200405150-00017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study over a 3.5-year period involving transcranial magnetic stimulation and magnetic resonance imaging. OBJECTIVES To assess the correlation of transcranial magnetic stimulation and magnetic resonance imaging in cervical spondylotic myelopathy qualitatively and statistically. SUMMARY OF BACKGROUND DATA Cervical spondylotic myelopathy presents with different degrees of cord compression, which can be assessed by magnetic resonance imaging. There are no large studies correlating transcranial magnetic stimulation and magnetic resonance imaging findings in this condition. METHODS A total of 141 patients with a clinical diagnosis of cervical spondylotic myelopathy were prospectively studied over a 3.5-year period. They were classified into Groups 1 to 4 based on severity of cervical cord changes on magnetic resonance imaging. All had transcranial magnetic stimulation and central motor conduction time measurements within 2 months of the magnetic resonance imaging study. RESULTS Twenty-eight, 49, 28, and 36 patients were classified into Groups 1 to 4, respectively. Mean upper limb and lower limb central motor conduction times correlated with the severity of magnetic resonance cord compression. The absence of central motor conduction time abnormalities correlated reliably with the absence of cervical cord impingement as in Group 1. Statistically significant right left difference in central motor conduction time in the lower limbs was seen between Groups 1 (no cord changes) and Group 2 (mild cord impingement). Eight other patients with diagnoses other than cervical spondylotic myelopathy all showed central motor conduction time abnormalities. The sensitivity and specificity for transcranial magnetic stimulation for differentiating the presence from absence of magnetic resonance imaging cord abnormality were 100% and 84.8%, respectively. CONCLUSIONS Transcranial magnetic stimulation showed excellent correlation with magnetic resonance imaging findings and can be considered as an effective technique for screening patients for cervical cord abnormalities before magnetic resonance imaging in the clinical setting. The findings in this study have relevant implications in the pathophysiology, management, and health costs of cervical spondylotic myelopathy.
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Affiliation(s)
- Y L Lo
- Department of Neurology, Singapore General Hospital, Singapore.
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35
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Lo YL, Dan YF, Tan YE, Nurjannah S, Tan SB, Tan CT, Raman S. Intra-operative monitoring in scoliosis surgery with multi-pulse cortical stimuli and desflurane anesthesia. Spinal Cord 2004; 42:342-5. [PMID: 15007378 DOI: 10.1038/sj.sc.3101605] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective, observational study. SETTING Country General Hospital, Singapore. OBJECTIVE Intraoperative monitoring (IOM) with motor-evoked potentials (MEPs) assesses the integrity of cortical spinal tracts during scoliosis surgery. MEPs are sensitive to the effects of inhalational anesthetic agents. We evaluate the use of desflurane in combination with multipulse cortical stimulation in this study. METHODS In all, 10 consecutive neurologically normal subjects underwent scoliosis surgery with desflurane anesthesia (0.5 maximum alveolar concentration) and five pulse cortical stimulation (250 Hz) from two stimulators in parallel configuration, delivering a maximum intensity of 160 mA. RESULTS Consistent MEPs were obtained from the abductor hallucis and tibialis anterior in nine of ten and five of five of subjects, respectively. Baseline coefficients of variations were below 16% for both muscles. CONCLUSION This combination of anesthetic and stimulation protocols is efficacious for IOM during spinal cord surgery. Our findings support the use of desflurane for successful acquisition of MEPs during scoliois surgery as an alternative anesthetic regime.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital
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Cheung YB, Ng GY, Wong LC, Koo WH, Tan EH, Tay MH, Lim D, Poon D, Goh C, Tan SB. Measuring quality of life in Chinese cancer patients: a new version of the Functional Living Index for Cancer (Chinese). Ann Acad Med Singap 2003; 32:376-80. [PMID: 12854381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Since its translation into Chinese, the Functional Living Index for Cancer (FLIC) has not been widely received due to some of its difficulties. We modified its visual analogue scale (VAS) to an ordered categorical scale and changed some of the wording in the instrument. This study examined the measurement properties of the modified FLIC. MATERIALS AND METHODS The modified version of FLIC and the Functional Assessment of Cancer Therapy (FACT-G Chinese version 4) were filled in by 140 patients recruited from the National Cancer Centre Singapore. The patients' FLIC scores were compared with their clinical characteristics to establish known-group validity. Convergent and divergent validity of FLIC were examined by correlation analysis with FACT-G and its sub-scales. Cronbach's alpha and relative efficiency were also examined. RESULTS FLIC and most of its sub-scales could indicate a clear and statistically significant difference of quality of life (QOL) according to patients' performance status and treatment status. FLIC strongly correlated with FACT-G. The Physical, Psychological, and Symptoms sub-scales of FLIC converged to and diverged from FACT-G sub-scales as conceptually expected. Cronbach's alpha indicated a satisfactory level of reliability. FLIC appeared to be more efficient than FACT-G, meaning that a smaller sample size will be required for FLIC than for FACT-G to achieve the same research purpose. CONCLUSIONS The modified version of FLIC was found to have achieved satisfactory measurement properties. This is a user-friendly alternative to the original FLIC.
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Affiliation(s)
- Y B Cheung
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, 11 Hospital Drive, Singapore 169610.
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Tan SB. Spinal canal stenosis. Singapore Med J 2003; 44:168-9. [PMID: 12952026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Goh LHH, Tan SB, Liaw JSC. Advances in surgical treatment of osteoporotic fractures of the spine. Ann Acad Med Singap 2002; 31:623-30. [PMID: 12395650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
INTRODUCTION To highlight recent advances in the management of osteoporotic compression fractures of the spine. METHODS A MEDLINE search was conducted from January 1975 to October 2001. Keywords included osteoporotic compression fractures, osteoporosis and spine fractures. RESULTS Osteoporotic fractures of the spine often cause significant morbidity to the elderly individual. Diagnosis requires a detailed history and physical examination and investigations are usually required to exclude other causes of back pain. Magnetic resonance imaging (MRI) is often helpful in excluding other causes of pathologic fracture but may not be confirmatory. Conservative treatment was the traditional approach, but newer percutaneous treatments, such as vertebroplasty and kyphoplasty, are safe and simple day surgery procedures which allow for rapid recovery of symptoms and prevention of increasing spinal deformity. Neurological deficit as a result of spinal canal compromise from retropulsed fragments, though relatively uncommon, is well recognised as a cause of significant morbidity and is a major indication for open spinal surgery. Various spinal approaches including anterior or posterior decompression combined with a variety of stabilisation techniques have been reported in the literature. Rehabilitation is often required to improve physical function. CONCLUSIONS Osteoporotic fractures of the spine are a common cause of morbidity in the elderly. Patients who have persistent pain despite conservative treatment require investigation to exclude other pathological causes of fracture. Percutaneous vertebroplasty and kyphoplasty are new techniques that offer much promise in the treatment of these elderly patients. Open surgery may still be required where there is significant neurologic compromise.
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Affiliation(s)
- L H H Goh
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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Abstract
The susceptibility of Culex sitiens to Japanese Encephalitis (JE) virus was examined in the laboratory. Cx. sitiens became infected with JE virus on day 8 and subsequently it is able to transmit the virus when it takes a blood meal. Both parts of the experiment were carried out using artificial membrane feeding technique.
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Affiliation(s)
- I Vythilingam
- Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia.
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Tan SB, Wee SB, Cheung YB. Agreement or prediction: asking and answering the right question. Ann Acad Med Singap 2002; 31:405-7. [PMID: 12061305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Measuring agreement and measuring predictive ability are similar but distinct problems. Failure to appreciate the conceptual and practical differences may lead clinical researchers to give the right answer to the wrong question. METHODS We illustrate the relation and difference between measuring agreement and predictive ability in a non-technical way. We provide a real example investigating the feasibility of using preoperative breast cancer tumour size measurements to estimate postoperative histological size. The intraclass correlation and R-squared are calculated to ascertain the level of agreement and predictive ability respectively. RESULTS Analysis of agreement and analysis of predictive ability serve different purposes. The optimal solution found in terms of agreement may be different from that found for prediction. CONCLUSIONS A careful clarification of the goal of an investigation is important. Using an inappropriate analysis can lead to misleading results, or to results that do not really answer the research question of interest.
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Affiliation(s)
- S B Tan
- Department of Surgical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610
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Tan SB, Machin D, Cheung YB, Chung YFA, Tai BC, Machin D. Following a trial that stopped early: what next for adjuvant hepatic intra-arterial iodine-131 lipiodol in resectable hepatocellular carcinoma? J Clin Oncol 2002; 20:1709. [PMID: 11896125 DOI: 10.1200/jco.2002.20.6.1709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sheah K, Peh WCG, Tan SB. A 16-year-old boy with back pain. Am J Orthop (Belle Mead NJ) 2002; 31:101-4. [PMID: 11878315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
This case is presented to illustrate the imaging and clinical findings of a condition of interest to orthopaedic surgeons. The initial findings are noted on this page. The clinical and imaging diagnoses are presented on the following pages.
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Affiliation(s)
- Kenneth Sheah
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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Cheung YB, Tan SB, Khoo KS. The need for collaboration between clinicians and statisticians: some experience and examples. Ann Acad Med Singap 2001; 30:552-5. [PMID: 11603146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Very often we see poor communication and collaboration between clinicians and statisticians. Both sides may fail to realise the importance of a truly collaborative effort. In this paper we give examples to illustrate some problems clinicians and statisticians may encounter when they do not have the full support of each other. The aim is to convince both parties the importance of a truly collaborative effort. METHODS Real examples in various medical research areas are drawn from the authors' practical experience for illustration. The examples cover various research aspects such as the use of computer software, regression analysis and interpretation of findings. RESULTS Superficial collaboration between clinicians and statisticians may lead to serious problems and sub-optimal research practice that may not be obvious in the first sight. Some of the barriers to effective communication and collaboration are discussed. CONCLUSIONS On the one hand, robust statistical practice is vital in many medical research projects. On the other hand, medical thinking is important in the formulation and application of statistical strategies. Statistical inputs should be integrated into medical research projects throughout the whole research process. Sporadic contacts between clinicians and statisticians are not enough. Both parties must learn to communicate more effectively and to be willing to collaborate with each other.
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Affiliation(s)
- Y B Cheung
- Clinical Trials and Epidemiological Sciences, National Cancer Centre, 11 Hospital Drive, Singapore 169610.
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Yue WM, Tan SB, Tan MH, Koh DC, Tan CT. The Torg--Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. Spine (Phila Pa 1976) 2001; 26:1760-4. [PMID: 11493847 DOI: 10.1097/00007632-200108150-00006] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A radiologic study to compare the Torg--Pavlov ratios between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. OBJECTIVES To determine and compare the Torg--Pavlov ratios between the two groups of patients. SUMMARY OF BACKGROUND DATA Patients with congenital cervical spinal canal stenosis are more likely to develop cervical spondylotic myelopathy. The Torg--Pavlov ratio eliminates errors related to magnification, a problem with determination of spinal canal stenosis from direct measurements of plain cervical spine radiographs. There has only been one other study that directly compares the Torg--Pavlov ratio between patients with cervical spondylotic myelopathy and a normal control population. METHODS The preoperative plain lateral cervical spine radiographs of 28 patients with cervical spondylotic myelopathy requiring surgical decompression were compared with radiographs of 88 nonspondylotic, nonmyelopathic patients. The Torg--Pavlov ratio was computed for each level from C3 to C7. RESULTS The study showed that the Torg--Pavlov ratio is significantly smaller (P < 0.001) in myelopathic patients (mean 0.72 +/- 0.08) compared with the control patients (mean 0.95 +/- 0.14). This was so when individual levels and the mean values were compared. Age was also found to be a significant factor (P = 0.002), although lesser in magnitude when compared with the Torg--Pavlov ratio (P = 0.0001). CONCLUSIONS The Torg--Pavlov ratio is significantly lower in patients with cervical spondylotic myelopathy compared with a nonspondylotic, nonmyelopathic population. It could possibly be used to predict the likelihood of developing cervical spondylotic myelopathy.
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Affiliation(s)
- W M Yue
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Tan SB. Introduction to Bayesian methods for medical research. Ann Acad Med Singap 2001; 30:444-6. [PMID: 11503556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Bayesian statistical methods provide a credible alternative to traditional statistical approaches used in medical research. In this article, the author gives a brief introduction to the key concepts involved in Bayesian methods and compares them with some commonly used non-Bayesian statistical techniques.
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Affiliation(s)
- S B Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, 11 Hospital Drive, Singapore 169610.
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Yue WM, Tan CT, Tan SB, Tan SK, Tay BK. Results of cervical laminoplasty and a comparison between single and double trap-door techniques. J Spinal Disord 2000; 13:329-35. [PMID: 10941893 DOI: 10.1097/00002517-200008000-00010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thirty-seven patients were studied for an average of 32.1 months after canal-expansive laminoplasty for the treatment of multiple-level cervical stenosis caused by spondylosis, ossification of posterior longitudinal ligament, prolapsed intervertebral disc, and other conditions. Short-term and medium-term results were recorded clinically, using the scoring system proposed by the Japanese Orthopedic Association. The canal expansion was also recorded with radiological studies. The improvement rate was good to excellent in 58.3% of the patients. Postoperative neurological deterioration occurred in only four patients. Poorer results were observed in female patients and in those in whom surgery was delayed. Surgery within 12 months of onset of symptoms gave good results. Serious complications occurred in only two patients. There were 12 patients who were treated with the single trap-door (unilateral) laminoplasty and 25 patients treated with the double trap-door (sagittal splitting of the spinous processes) laminoplasty; their results were compared. There was no significant difference in neurological outcome between the two methods.
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Affiliation(s)
- W M Yue
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Chok B, Lee R, Latimer J, Tan SB. Endurance training of the trunk extensor muscles in people with subacute low back pain. Phys Ther 1999; 79:1032-42. [PMID: 10534796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Clinicians treating patients with low back pain often use exercise to reduce pain and improve function. The aim of this study was to evaluate the effectiveness of trunk extensor endurance training in reducing pain and decreasing disability in subjects with subacute low back pain (ie, onset of back pain within 7 days to 7 weeks). SUBJECTS AND METHODS Patients were randomly assigned to either an experimental group or a control group. A visual analog scale and the pain rating index (PRI) of the McGill Pain Questionnaire (MPQ) were used to obtain baseline measurements of pain. The Roland Morris Disability Questionnaire (RMDQ) was used to measure disability, and the Sorensen Test was used to measure trunk extensor endurance. Subjects in the experimental group attended exercise sessions 3 times a week for 6 weeks. Subjects in the control group did not do exercises. Both groups were given back care advice and hot packs for 15 minutes, 3 to 5 times per week. Reassessments were carried out at 3 and 6 weeks. RESULTS There were differences between the 2 groups at 3 weeks in regard to pain intensity during the evaluation session and pain experienced over the preceding 24 hours, the total MPQ PRI, the sensory component of the MPQ PRI, and the RMDQ. At 6 weeks, no differences were found for pain measurements, disability scores, and holding time on the Sorensen Test. CONCLUSION AND DISCUSSION Trunk extensor endurance training reduced pain and improved function at 3 weeks but resulted in no improvement at 6 weeks when compared with the control group. Endurance exercise is considered to expedite the recovery process for patients with an acute episode of low back pain.
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Affiliation(s)
- B Chok
- Physiotherapy Department, Singapore General Hospital, Outram Rd, Singapore 169608.
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Abstract
We consider problems of choice of sample size and allocation in the clinical trials context when utilities are explicitly taken into account. In particular, we consider utilities of benefits and side-effects (and their trade-offs), as well as utility functions that trade-off scientific and ethical concerns.
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Affiliation(s)
- S B Tan
- Department of Mathematics, Imperial College of Science, Technology & Medicine, London, U.K
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Chew JT, Tan SB, Sivathasan C, Pavanni R, Tan SK. Vascular assessment in the neuropathic diabetic foot. Clin Orthop Relat Res 1995:95-100. [PMID: 7586848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diabetic foot infections, a common source of morbidity and mortality, often have been related to vasculopathy and neuropathy in its etiopathogenesis, especially in the elderly person with diabetes. However, blood flow in the neuropathic diabetic foot has not been evaluated extensively, and there is evidence of abnormal blood flow patterns in the neuropathic diabetic foot unrelated to ischemia. The authors studied young persons with diabetes, with varying degrees of neuropathy, to assess the extent of vasculopathy in their lower limbs. Twelve young persons with insulin-dependent (Type I) diabetes (mean age, 36.1 +/- 1.975 years) and peripheral neuropathy, all of whom had previous surgery for diabetic foot infections, were identified. Confirmatory evidence of neuropathy was made using electromyographic studies and clinical tests that showed severe peripheral neuropathy. The results of vascular assessment of both lower limbs did not reveal any change in the pulse wave velocities from the popliteal to the digital vessels of the big toe as compared with correspondingly matched controls. There also was no significant stenosis in any of the vessels studied as far as the level of the dorsalis pedis and posterior tibial vessels. The normal triphasic pattern of arterial blood flow was lost. A monophasic pattern was present in all patients with prolonged diastolic flow at the level of the dorsalis pedis and posterior tibial arteries and distally. The pulsatility index was 3.14 +/- 0.81 as compared with 9.85 +/- 4.2. Mean toe pressures in the patient with diabetes was 64.17 +/- 20.87 mm Hg as compared with 98.23 +/- 10.12 mm Hg in controls. A linear correlation of decreasing toe pressures with increasing severity of neuropathy was seen (R = 0.7). The data suggest that changes exist in the blood flow patterns in young patients with diabetes and neuropathy, even in the absence of lower limb ischemia.
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Affiliation(s)
- J T Chew
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
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Abstract
A variety of techniques and frames are used for positioning patients during posterior lumbar spinal instrumentation and fusion. Little information is available on the relationship of lumbar lordosis and the various positioning options, so it was felt that further investigation was warranted. Ten volunteers with no history of back pain were positioned and radiographed in the standing position followed by four lateral radiographs with the patient positioned on chest rolls, Andrew's frame, the Hasting's frame, and a four-poster spinal frame. Total lumbar lordosis from L1 to S1 as well as intervertebral body angles at each of the lumbar interspaces using standardized techniques were computed. No significant difference was found in lumbar lordosis between the standing and chest roll position. However, there was approximately a 50% reduction in lumbar lordosis when using the Hasting's, Andrew's, and four-poster frame as compared to the standing and chest roll configuration. The clinical implications are discussed.
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Affiliation(s)
- S B Tan
- Center for Spinal Disorders, Baylor College of Medicine, Houston, Texas
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