Low Self-Reported Physical Function Status Was an Excellent Predictor of Adverse Postoperative Course in Older Veterans Having Knee and Hip Surgery

Objectives: To measure the association between functional status and an adverse postoperative course. Design: Retrospective cohort study. Setting: Veterans Affairs Medical Center. Participants: Older adults who underwent total hip and knee replacement (THR and TKR) at a VA facility from 2002-2009. To be included, subjects must have completed the Veteran Rand-12 (VR-12) within six months of surgery. VR-12 is a general purpose 12 item health quality survey nearly identical to the SF-12 for which the summary score of physical health called physical component score (PCS) is normed to a value of 50 for US adults with standard deviation of 10. Measurements: We measured the association of PCS split into quartiles with the outcomes major complication (cardiac arrest, myocardial infarction, stoke, respiratory failure, pneumonia, pulmonary embolism, sepsis, and renal failure), discharge to nursing home, and readmission. We checked our association for confounding by age, race, surgery type, facility volume, duration of time between collection of PCS and surgery, and clustering by facility. Results: We identified 3,542 THR and TKR surgeries for which PCS information was available. The very lowest quartile of PCS (values 4.9-24.2) predicted a 2.7 fold increase in odds of major complications, 2.1 fold increase in odds of discharge to nursing home, and a 1.9 fold increase in odds of readmission compared with highest quartile (PCS 38.9-61). The next lowest quartile (PCS 24.3-31.8) also predicted elevated rates of major complication and readmission. Conclusions: Very low PCS predicts greater than a 2 fold increase in major complication and readmission after total hip and knee replacement. Future research should re-measure the effect of very low PCS in populations not addressed by our study including women, patients having non-orthopedic surgery, and nonveterans

Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015 : findings from the Global Burden of Disease 2015 study

To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.Peer reviewe

RETURN OF THE 'OLD-TIMERS': AN EXPLORATORY STUDY ON THE INVOLVEMENT OF PERSONS WITH YOUTH DELINQUENCY EXPERIENCES IN COMMUNITY-BASED YOUTH WORK

Bachelor'sBachelor of Social Sciences (Honours

Orthodontic-surgical management of an unusual dilacerated maxillary incisor

Orthodontic traction of an impacted dilacerated maxillary central incisor is clinically challenging and often results in a long treatment duration. A case of an unusual dilacerated central incisor with a 90° crown-root angulation and palatally displaced crown is presented herein. Using a single stage open window exposure of the crown on the palatal aspect with light orthodontic traction force, the impacted dilacerated central incisor crown was successfully positioned in alignment with the contralateral incisor

Emergence of Starhub and its impact on SingTel mobile and Mobileone.

The entry of StarHub has lead to wild excitement from the consumers. This research aims to examine the impacts of this new gaint and consumers' reaction. We examine the strengths and weaknesses of the 3 telecommunication incumbents and gave recommendations

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

10.11622/smedj.2015195SINGAPORE MEDICAL JOURNAL5711603-60

A Study of Mental Health and the Coping Strategies of College Students in a Hispanic-Serving Institution During the COVID-19 Pandemic

Mental health conditions were seen to rise during the COVID-19 pandemic as individuals lost loved ones due to the pandemic, lost jobs, and in many cases had to care for elderly and other loved ones. For students, the pandemic also brought the additional challenge of having to transition to online learning. In this study, we investigated the depression and anxiety levels of students in a Hispanic-serving institution and the coping strategies they used to deal with the stress during the pandemic, and the relationship of students’ depression and anxiety levels to their preference of learning and their other demographic characteristics. A survey was administered online via Qualtrics to the students. The depression and anxiety faced by the students in this study could have been attributed to them being majority Latino and economically disadvantaged, which studies have shown to be more disproportionately affected by the pandemic. Students who have taken online courses before were associated with lower depression levels, which may indicate that those who have not taken online courses may have been experiencing more stress with this transition. Students employed approach- based coping strategies instead of avoidance strategies which are known as more positive forms of coping

Using the consolidated framework for implementation research to guide a pilot of implementing an institution level patient informed consent process for clinical research at an outpatient setting

Abstract Background In Singapore, research teams seek informed patient consent on an ad hoc basis for specific clinical studies and there is typically a role separation between operational and research staff. With the enactment of the Human Biomedical Research Act, there is increased emphasis on compliance with consent-taking processes and research documentation. To optimize resource use and facilitate long-term research sustainability at our institution, this study aimed to design and pilot an institution level informed consent workflow (the “intervention”) that is integrated with clinic operations. Methods We used the Consolidated Framework for Implementation Research (CFIR) as the underpinning theoretical framework and conducted the study in three stages: Stage 1, CFIR constructs were used to systematically identify barriers and facilitators of intervention implementation, and a simple time-and-motion study of the patient journey was used to inform the design of the intervention; Stage 2, implementation strategies were selected and mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy; Stage 3, we piloted and adapted the implementation process at two outpatient clinics and evaluated implementation effectiveness through patient participation rates. Results We identified 15 relevant CFIR constructs. Implementation strategies selected to address these constructs were targeted at three groups of stakeholders: institution leadership (develop relationships, involve executive boards, identify and prepare champions), clinic management team (develop relationships, identify and prepare champions, obtain support and commitment, educate stakeholders), and clinic operations staff (develop relationships, assess readiness, conduct training, cyclical tests of change, model and simulate change, capture and share local knowledge, obtain and use feedback). Time-and-motion study in clinics identified the pre-consultation timepoint as the most appropriate for the intervention. The implementation process was adapted according to clinic operations staff and service needs. At the conclusion of the pilot, 78.3% of eligible patients provided institution level informed consent via the integrated workflow implemented. Conclusions Our findings support the feasibility of implementing an institution level informed consent workflow that integrates with service operations at the outpatient setting to optimize healthcare resources for research. The CFIR provided a useful framework to identify barriers and facilitators in the design of the intervention and its implementation process