Hidden Giant: Medium Vessel Vasculitis as a Cause for Unresolving Fever

10.1016/j.amjmed.2017.12.022AMERICAN JOURNAL OF MEDICINE1315E179-E18

Behind the Curve: Late-Onset Axial Spondyloarthritis

10.1016/j.amjmed.2018.09.019AMERICAN JOURNAL OF MEDICINE1323325-32

Method for fabricating semiconductor devices with reduced junction diffusion

US8053340Granted Paten

Effect of a multidisciplinary ward-based intervention on end-of-life care for general medicine patients.

10.1017/S1478951521001723Palliat Support Care1-

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

10.1186/s12877-020-01894-0BMC GERIATRICS20

Method for fabricating semiconductor devices with shallow diffusion regions

US8101487Granted Paten

Sustainability and impact of the implementation of a frailty checklist for the acute medical unit: experience from a tertiary public hospital in Singapore

Background Accelerated population ageing is associated with an increasing prevalence of frailty. International guidelines call for systematic assessment and timely interventions for older persons requiring acute care. Checklists have been applied successfully in healthcare settings.Objective This study describes the implementation of a safety checklist for frailty in the acute medical unit (AMU) of a tertiary public hospital in Singapore. We explored the sustainability of processes up to 6 months after initial implementation. Additionally, we investigated process and system outcome benefits following the implementation of the checklist.Methods This retrospective observational study used case notes review of patients admitted to the AMU of a tertiary public hospital in Singapore from February to August 2019. Process outcomes measured to include compliance with AMU frailty checklist assessments and interventions at 24 hours of hospital admission. System and patient outcomes studied to include the length of hospital stay; 30-day emergency department reattendance rate; 30-day hospital readmission rate and inpatient mortality. Propensity scores were used to create balanced cohorts for comparison between those with complete and incomplete compliance with the checklist. Logistic regression was used to adjust for known confounders.Results Average weekly (all-or-nothing) compliance with the frailty checklist (14.7%) was sustained for 6 months. Where assessments detected high risk, appropriate interventions were appropriately triggered (44%–97.4%). While trends to benefit systems and patient outcomes were present, these were not statistically significant. Contextual patterns are discussed.Conclusion A safety checklist for frailty was feasibly implemented in the AMU. The checklist was a complex intervention. Full compliance with the checklist was challenging to achieve. Further research assessing optimal patient selection criteria and how checklists may shift team behaviour is a priority

Remote monitoring of marginalised populations affected by COVID-19: a retrospective review

Objectives The COVID-19 outbreak in Singapore has largely centred around migrant worker dormitories, comprising over 90% of all cases in the country. Dormitories are home to a culturally and linguistically distinct, low-income population, without on-site healthcare after-hours. The primary objective of this study was to assess the engagement and utilisation of a simple, low-cost, accessible, mobile health solution for remote self-reporting of vital parameters in dormitory residents with COVID-19.Design Retrospective review of medical care.Setting Two large migrant worker dormitories with a combined population of 31 546.Participants All COVID-19-affected residents housed in dormitories during the study period.Intervention All residents were taught to use a chat assistant to self-report their temperature, heart rate and oxygen saturations. Results flowed into a dashboard, which alerted clinicians of abnormal results.Outcomes The primary outcome measure was engagement rate. This was derived from the total number of residents who registered on the platform over the total number of COVID-19-affected residents in the dormitories during the study period. Secondary outcome measures included outcomes of the alerts and subsequent escalations of care.Results 800 of the 931 COVID-19-affected residents (85.9%) engaged with the platform to log a total of 12 511 discrete episodes of vital signs. Among 372 abnormal readings, 96 teleconsultations were initiated, of which 7 (1.8%) were escalated to emergency services and 18 (4.9%) were triaged to earlier physical medical review on-site.Conclusions A chat-assistant-based self-reporting platform is an effective and safe community-based intervention to monitor marginalised populations with distinct cultural and linguistic backgrounds, living communally and affected by COVID-19. Lessons learnt from this approach may be applied to develop safe and cost-effective telemedicine solutions across similar settings

Remote monitoring of marginalised populations affected by COVID-19: a retrospective review

10.1136/bmjopen-2020-042647BMJ OPEN101

Treating acutely ill patients at home: Data from Singapore.

10.47102/annals-acadmedsg.2021465Ann Acad Med Singap517392-39