A Prospective Study of the Relationship Between Sleep Quality and Depression in Pregnancy

Objective Poor sleep and depression are common problems during pregnancy, but there has been little investigation into the association between them. This prospective study aims to examine the relationship between sleep quality and depression during pregnancy. Methods Pregnant women under 14 weeks’ gestation attending routine outpatient antenatal care in Singapore’s largest maternity hospital were recruited between 2012 and 2014. Women with multiple pregnancies and deemed at high risk of miscarriage were excluded. Six hundred and forty participants completed the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale (EPDS) at the three trimesters during pregnancy. Results Mean PSQI score was highest in the third visit, suggesting poorer quality sleep in the late third trimester compared to other trimesters. 15.6% of participants at each time point fulfilled the criteria for antenatal depression according to the EPDS cut-off score > 14. PSQI scores were significantly correlated with EPDS scores, and also prospectively predicted EPDS scores in all three trimesters. Conclusion Sleep quality in Singaporean pregnant women was poorest in the third trimester, and was associated with the development of depressive symptoms. With more than 1 in 10 women having antenatal depression, interventions targeting sleep quality might be particularly beneficial.

Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

Mucormycosis is an aggressive and potentially fatal fungal infection caused by fungi of the order Mucorales. There has been an increase in the number of cases of rhino-orbital mucormycosis in people with COVID-19, particularly in India. Rhino-orbital-cerebral mucormycosis is the most common manifestation of mucormycosis associated with COVID-19. We report the first case of rhino-orbital mucormycosis in a diabetic patient with SARS-CoV-2 infection in Malaysia. The diagnosis of mucormycosis was confirmed by histopathological examination, but the fungal culture and PCR results were negative. He was treated with antifungal therapy and had extensive debridement. Treatment of mucormycosis requires a multidisciplinary approach that includes addressing underlying risk factors, effective antifungal therapy, and surgical debridement.

Evaluating discrepancy rates of radiology resident provisional reports for cross-sectional body imaging studies at a tertiary hospital

Introduction Urgent radiological studies obtained during on-call hours are often preliminarily read by on-call residents before consultant radiologists finalise the reports at a later time. Such provisional radiology reports provide important information to guide initial patient management. This study aims to determine discrepancy rates between provisional reports and final interpretations, and to assess the clinical significance of such discrepancies. Methods This retrospective quality assurance project reviewed a total of 1218 cross-sectional imaging studies of the body (thorax, abdomen and pelvis) done between July 2015 and May 2016 during on-call hours. The studies included 1201 Computed tomography (CT) scans and 17 Magnetic Resonance Imaging (MRI) scans. Studies with incomplete or unavailable reports were excluded. Conclusions of both the provisional and final reports of each study were reviewed for concordance, with reference to the full report if needed. Discrepancies were graded according to the ACR 2016 RADPEER scoring system. Results There were 1210 studies with complete reports. Discrepant reports were noted in 183 (15.1%) studies. Of these, 89 (7.3%) were assessed to be clinically significant and the majority of these (55) were due to interpretations which should be made most of the time. CT of the abdomen and pelvis were the most prone to discrepant reports, accounting for 148 cases (80.9%). Conclusion The majority of preliminary reports for on-call body scans were concordant with final interpretations. The discrepancy rates for provisional body scan reports provided by residents while on call were comparable to those previously reported in literature.

How we implemented Continuous Interprofessional Education at a newly established public hospital in Singapore

Introduction To promote interprofessional collaboration (IPC), our newly established hospital implemented the Continuing Interprofessional Education (CIPE) initiatives, which included a half-day workshop and 15 sessions of Grand Rounds, with the content focusing on establishing interprofessional patient-centered care pathways, policies, and ultimately to build a community of IPC. Methods To evaluate the impact of the CIPE initiatives, 120 staff who attended at least 50% of the CIPE sessions were invited to complete the Interprofessional Attitudes Scale (IPAS). Results 67.5% of the invited participants completed the survey. The majority of the participants answered “agree” or “strongly agree” for the domains of Teamwork/Roles/Responsibilities, Patient-centeredness, Diversity and Ethics, and Community Centeredness after going through the CIPE initiatives. The Interprofessional Bias domain revealed mixed responses. Discussions and Implications of practice The significant contributing factors towards the success of the CIPE Grand Rounds included: (1) the topics were proposed by our staff and centered on clinical practice; (2) the delivery format was interactive, guided by adult learning principles. The mixed responses regarding the presence of biases among the participants suggested that interprofessional biases are deep-rooted in the healthcare setting, and attendance of these CIPE Grand Rounds made participants more acutely aware of these biases. However, more actions are needed to eradicate these biases.

Organophosphate poisoning from inappropriate topical use of malathion pesticide: A case report

A 43-year-old male with no past medical history presented to our emergency department with vomiting, diarrhea, and abdominal pain of 3 h’ duration. Upon further questioning, he revealed that he had been applying malathion pesticide over his body for the past 3 days for self-diagnosed scabies. He was otherwise afebrile and hemodynamically stable, and the physical examination was unremarkable. The patient was diagnosed with organophosphate poisoning and treated symptomatically due to the lack of worrying cardiorespiratory or neurologic sequelae. He was subsequently admitted to the general ward, where his symptoms abated within 4 h. Serum and red blood cell cholinesterase tests sent on admission returned on day three and were significantly decreased (serum cholinesterase 2131 U/L, reference range 4700–12000 U/L; red blood cell cholinesterase 3365 U/L, reference range 7700–14600 U/L). He was discharged home well and stable on day 5 of admission, with outpatient psychiatric follow-up for likely delusional parasitosis.

Communication Vulnerability within Singapore’s Healthcare Environment

Communication difficulties can, and often do, create barriers between patients and healthcare workers (HCWs). We examined the perceptual differences between patients and caregivers; and HCWs with regards to their perceived communication vulnerabilities and identified communication needs in a tertiary hospital. A survey was conducted in selected outpatient settings among patients, their caregivers and HCWs, in a cross-sectional study. Respondents rated the reasons and frequency of encountering the communication difficulties during a hospital visit. Fifty-four percent of patients and caregivers cited poor hearing in the presence of noise, while HCWs cited patient’s poor vision (87%) as their primary communication barrier that requires improvement. Majority of HCWs (90%) had encountered patients who presented multiple communication barriers a quarter of the time. A third of HCWs felt that such encounters were especially challenging during communication, with very limited strategies available to deal with such communication vulnerable individuals. Patients, caregivers and HCWs universally experience communication challenges, even if their perceived barriers to communication happen to differ. Such perceptual difference between patients and HCWs may lead to inconsistent use of communication strategies by HCWs, potentially compromising patient’s healthcare needs. Nonetheless, the onus is on healthcare providers to bridge this communication gap to improve patient care.

Planned discharge program effectiveness on cardiac self-efficacy and hope in patients undergoing coronary artery bypass graft surgery: A quasi-experimental study

Background Controlling risk factors and lifestyle modification in coronary artery bypass graft (CABG) patients plays an important role and leads to the empowerment of these patients to take care of themselves. One way to empower these patients is to improve their self-efficacy and hope. This study aimed to investigate the effect of the planned discharge on cardiac self-efficacy and hope of CABG patients. Methods In this quasi-experimental study, the sample consisted of 60 people (30 in the intervention group and 30 in the control group). Data were collected using the Miller Hope Questionnaire and Sullivan Cardiac Self-Efficacy Questionnaire. Data analysis was performed using central indices of mean and standard deviation and Chi-square, t-tests and one-way analysis of variance. The software used for data analysis was SPSS version 19. Results The mean age of participants in the control group was 91/9 ± 86/91 and in the intervention, group was 33/7 ± 7/58. There was no significant difference between the demographic characteristics, heart self-efficacy and hope scores of the participants in the control and intervention groups. After the intervention, there was a meaningful statistical difference between the two groups at discharge time and 1 month afterward in both hope and cardiac heart self-efficacy scores ( p = 0.001, 0.0001). Conclusion In this study, the implementation of the discharge program was effective in increasing the hope and cardiac self-efficacy of CABG patients and the use of the discharge plan is recommended to improve the outcomes of these patients.

Tricuspid valve endocarditis following over-the-counter intravenous injection of skin-whitening products

Intravenous drug use, central catheters and intracardiac devices are known predispositions to right-sided infective endocarditis (IE). We report a case of tricuspid IE caused by Acinetobacter seifertii and Enterobacter bugandensis as a result of intravenous use of skin-whitening products bought online. Clinical implications and pharmaceutical regulations are briefly discussed.

Endobronchial resection as a bridge to curative resection in patient with poor preoperative lung function secondary to an airway blocking endobronchial carcinoid tumour

We present a 70-year-old gentleman with chronic cough with haemoptysis found to have left lower zone collapse on imaging. The bronchoscopy showed an endobronchial mass histologically of a non-secreting atypical carcinoid. Poor baseline lung function excluded surgical resection, and instead, he successfully underwent a bronchoscopic debulking procedure which improved his FEV1 to 84% and DLCO 83% predicted. Unfortunately, the tumour regrew, but the calculated percentage predicted postoperative for FEV1 (64%), and DLCO (65%) enabled definitive surgical resection to take place. Surgical resection remains the definite curative option for localised endobronchial atypical carcinoid tumours. Achieving this in proximal endobronchial carcinoid tumour is a challenge. We described an endoscopic tumour debulking procedure as a bridge for curative surgical resection in a patient with an inoperable proximal atypical carcinoid tumour due to poor predicted postoperative lung function. We highlighted the need to assess predicted postoperative lung function with functional and quantitative perfusion methods to aid surgical planning. Debulking the tumour by endoscopy can be used as a conduit to curative surgical resection in bronchial carcinoid tumour. The choice of calculating the percentage predicted values by either or both methods must be individualised based on tumour location and the probability of converting a lobectomy to a pneumonectomy. This precautionary approach could evaluate the postoperative lung function and morbidity and mortality risk if considering a pneumonectomy. Endoscopic debulking can be a successful bridge to a curative surgical resection aided by comprehensive preoperative lung function tests to predict postoperative lung values

Understanding perspectives and choices for sedentary behaviour and physical activity in older adults’ post-acute exacerbation of chronic obstructive pulmonary disease

Background Individuals recovering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are most likely to exhibit sedentary behaviour (SB) and low levels of physical activity (PA). This study seeks to explore their choices for adopting current patterns of SB and PA post AECOPD and add to current literature on stable COPD. Method A semi-structured interview, based on the broad framework of the Behaviour Change Wheel, was conducted on patients post AECOPD. A phenomenological approach was utilised inductively. Results Six participants were interviewed at their homes. Four major themes were identified: (1) low perceived capabilities for engaging in PA; (2) limited understanding on COPD and PA; (3) lack of translation of health knowledge and intentions into actions; and (4) poor adherence to movement-advice from physiotherapist. Conclusion Our findings revealed largely psychological and behavioural deficits influencing SB and PA in people post AECOPD, similar to those in stable COPD.