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Article ; Online: Beyond the self: a novel framework to enhance non-technical team skills for anesthesiologists.

Khoo, Deborah W / Roscoe, Andrew J / Hwang, Nian C

2023 Volume 89, Issue 12, Page(s) 1115–1126

Abstract: Human factors and non-technical skills (NTS) have been identified as essential contributors to both the propagation and prevention of medical errors in the operating room. Despite extensive study and interventions to nurture and enhance NTS in ... ...

Abstract	Human factors and non-technical skills (NTS) have been identified as essential contributors to both the propagation and prevention of medical errors in the operating room. Despite extensive study and interventions to nurture and enhance NTS in anesthesiologists, gaps to effective team practice and patient safety remain. Furthermore, the link between added NTS training and clinically significant improved outcomes has not yet been demonstrated. We performed a narrative review to summarize the literature on existing systems and initiatives used to measure and nurture NTS in the clinical operating room setting. Controlled interventions performed to nurture NTS (N.=13) were identified and compared. We comment on the body of current evidence and highlight the achievements and limitations of interventions published thus far. We then propose a novel education and training framework to further develop and enhance non-technical skills in both individual anesthesiologists and operating room teams. We use the cardiac anesthesiology environment as a starting point to illustrate its use, with clinical examples. NTS is a key component of enhancing patient safety. Effective framing of its concepts is central to apply individual characteristics and skills in team environments in the OR and achieve tangible, beneficial patient outcomes.
MeSH term(s)	Humans ; Anesthesiologists ; Anesthesiology ; Educational Status ; Heart ; Medical Errors
Language	English
Publishing date	2023-11-09
Publishing country	Italy
Document type	Review ; Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.23.16729-0
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Article ; Online: Faster improvement in outcome scores in posterior stabilised total knee arthroplasty compared to medial congruent system with posterior cruciate ligament retained.

Lee, W C / Foong, C M B / Khoo, K M S / Kwan, Y H / Kunnasegaran, R

Musculoskeletal surgery

2023 Volume 108, Issue 1, Page(s) 87–92

Abstract: Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A ... ...

Abstract	Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A retrospective review of a single-surgeon's registry data comparing 44 PS and 26 MC with PCL retained (MC-PCLR) TKAs was performed. Both groups had similar baseline demographics. The PS and MC-PCLR groups had similar pre-operative range of motion (ROM) (PS:104º ± 20º vs. MC-PCLR: 101º ± 19º, p = 0.70), Oxford Knee Score (OKS) (PS: 27 ± 6 vs. MC-PCLR: 26 ± 7, p = 0.62), and Knee Society Scoring System (KS) Function Score (KS-FS) (PS: 52 ± 24 vs. MC-PCLR: 56 ± 23, p = 0.49). The pre-operative KS Knee Score (KS-KS) was significantly lower in the PS group (PS: 44 ± 14 vs. MC-PLR: 53 ± 18, p < 0.05). At 12-months post-operation, there was significant improvement in all parameters (p < 0.01). Both groups had similar ROM (PS: 115º ± 13º vs. MC-PCLR: 114º ± 10º, p = 0.98), OKS (PS: 41 ± 5 vs. MC-PCLR: 40 ± 4, p = 0.50), KS-FS (PS: 74 ± 22 vs. MC-PCLR: 77 ± 16, p = 0.78), and KS-KS (PS: 89 ± 10 vs. MC-PCLR: 89 ± 10, p = 0.89). The PS group had significant improvement in all parameters from preoperation to 3-month postoperation (p < 0.05), but not from 3-month to 1-year postoperation (p ≥ 0.05). The MC-PCLR group continued to have significant improvement from 3-month to 1-year postoperation (p < 0.05). Preserving the PCL when using MC may paradoxically cause an undesired additional restrain that slows the recovery process of the patients after TKA. Compared to MC-PCLR, a PS TKA may expect significantly faster improvement at 3 months post operation, although they will achieve similar outcomes at 1-year post operation.
MeSH term(s)	Humans ; Posterior Cruciate Ligament/surgery ; Arthroplasty, Replacement, Knee ; Knee Joint/surgery ; Knee Prosthesis ; Osteoarthritis, Knee/surgery ; Range of Motion, Articular
Language	English
Publishing date	2023-08-29
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2495458-5
ISSN	2035-5114 ; 2035-5106
ISSN (online)	2035-5114
ISSN	2035-5106
DOI	10.1007/s12306-023-00797-8
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Article ; Online: Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report.

Bunzel, Eli W / Khoo, Kevin / Zhou, Haitao

AME case reports

2023 Volume 7, Page(s) 24

Abstract: ... C-collar) after traction testing revealed no dynamic instability.: Case description: A 19-year ... on dynamic traction testing, and the patient was treated non-operatively in a C-collar. At 12 weeks post ...

Abstract	Background: Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries, and delayed diagnosis and management is a well-known risk factor for poor outcomes in high energy trauma. Early surgical stabilization has been shown to improve outcomes and neurologic recovery in these patients. We present a case of incongruent atlanto-occipital (O-C1) joints found on post-operative computed tomography (CT) imaging following C1-C2 fusion. This patient was treated non-operatively in a cervical collar (C-collar) after traction testing revealed no dynamic instability. Case description: A 19-year-old male with history of obesity was involved in a high-speed motor vehicle collision (MVC). On arrival, he had elevated troponins but otherwise normal laboratory workup and electrocardiogram (EKG). He remained hypotensive throughout his initial presentation. A reliable neurologic exam could not be obtained due to the patient's intubated and sedated status, however, bulbocavernosus reflex was intact, reflexes were normal and the patient did not demonstrate evidence of spinal or neurogenic shock. CT of the full spine revealed distraction of the C1-C2 articulation without associated fracture, and without clear disruption or distraction of the O-C1 joint. He was taken to the operating room for C1-C2 posterior instrumentation and fusion. Post-operative cervical spine CT revealed further distraction and subluxation of the occipitocervical junction bilaterally, with condyle to C1 interval (CCI) of 4-mm bilaterally, a basion-dens interval (BDI) of 10 mm, and a Power's Ratio of 1.1. The patient was brought back urgently to the operating room for traction testing to rule out OCD. There was no distraction noted on dynamic traction testing, and the patient was treated non-operatively in a C-collar. At 12 weeks post-injury, the patient experienced no neck pain, and flexion/extension radiographs showed no evidence of subluxation or distraction at the O-C1 joints. Conclusions: Incongruity of the O-C1 joint may not be synonymous with instability as previously thought, and in cases of O-C1 incongruity with stable traction testing, non-operative treatment with external immobilization can be considered as a viable treatment option even in the polytraumatized patient.
Language	English
Publishing date	2023-07-18
Publishing country	China
Document type	Case Reports
ISSN	2523-1995
ISSN (online)	2523-1995
DOI	10.21037/acr-23-23
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Article ; Online: Differences in Femoral Neck and Trochanteric Structure in Elderly Women Prior to Hip Fracture: Role in Hip Fracture Prediction.

Prince, Richard / Khoo, Benjamin / Brown, Keenan / Lewis, Joshua

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

2023 Volume 38, Issue 6, Page(s) 869–875

Abstract: ... W), were Sigma (distribution of bone within scanned area) and Delta (distance between center ... of THaBMD and age improved the C statistic from 0.62 to 0.69, p = 0.01. At baseline, TRF cases had a 15 ... of Sigma nor Width improved the model that included age and THaBMD as predictors and did not alter the C ...

Abstract	We examine the hypothesis that internal dual-energy X-ray absorptiometry (DXA) structural variables measured at the femoral neck and trochanter cross sections will improve prediction of fractures at these sites in addition to areal BMD (aBMD). We present an analysis of the internal distribution of bone at the site of these fractures using baseline hip DXA measurement of 1151 participants, mean age (SD) 75 (3) years, in the 14.5-year Perth Longitudinal Study of Aging in Women. Structural differences at the femoral neck (FN) and trochanter (TR) cross sections were compared in 69 participants who went on to sustain femoral neck fracture (FNF) and 59 participants who went on to sustain trochanter fracture (TRF), on average 10 years later, to those who did not fracture. The new structural variables, in addition to aBMD and bone width (W), were Sigma (distribution of bone within scanned area) and Delta (distance between center-of-mineral mass and geometric center), which can be assessed by current DXA programs. At baseline, compared with nonfracture cases, FNF cases had a FNaBMD 7% lower, a FNWidth 3% higher and a FNDelta 29% higher, associated with reduced bone in the superior segment. In FNF Cox proportional hazard analysis, age (hazard ratio [HR 1.39]), total hip aBMD (THaBMD; 0.79), and Delta (1.70) were significant. Addition of FN Delta to the base case of THaBMD and age improved the C statistic from 0.62 to 0.69, p = 0.01. At baseline, TRF cases had a 15% lower TRaBMD with minor differences in Sigma (1%) and Width (2%). In TRF Cox analysis, neither addition of Sigma nor Width improved the model that included age and THaBMD as predictors and did not alter the C-statistic of 0.81. In conclusion, adding measurement of FN Delta, an assessment of superior sector bone loss, to hip aBMD and age substantially improved clinical FNF prediction in older women. © 2023 American Society for Bone and Mineral Research (ASBMR).
MeSH term(s)	Humans ; Female ; Aged ; Femur Neck/diagnostic imaging ; Longitudinal Studies ; Bone Density ; Hip Fractures/diagnostic imaging ; Femur ; Absorptiometry, Photon
Language	English
Publishing date	2023-04-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	632783-7
ISSN	1523-4681 ; 0884-0431
ISSN (online)	1523-4681
ISSN	0884-0431
DOI	10.1002/jbmr.4789
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Article: Efficacy and safety of adjunctive treatment with perampanel in epilepsy patients.

Lim, K Y / Khoo, C S / Rajah, R / Tan, H J / Tajurudin, F W

The Medical journal of Malaysia

2023 Volume 78, Issue 5, Page(s) 635–638

Abstract: Introduction: Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy ... ...

Abstract	Introduction: Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy for both generalized and focal seizures. Owing to its high cost, the use of perampanel is limited in our country. Materials and methods: We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital. Results and conclusions: From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects. Conclusion: Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.
MeSH term(s)	Humans ; Retrospective Studies ; Anticonvulsants/therapeutic use ; Anticonvulsants/adverse effects ; Treatment Outcome ; Drug Therapy, Combination ; Epilepsy/drug therapy ; Epilepsy/chemically induced
Chemical Substances	perampanel (H821664NPK) ; Anticonvulsants
Language	English
Publishing date	2023-09-29
Publishing country	Malaysia
Document type	Journal Article
ZDB-ID	604286-7
ISSN	0300-5283
ISSN	0300-5283
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Article: Feasible non-surgical options for management of knee osteoarthritis during the COVID-19 pandemic and beyond.

Khoo, J R / Chan, P K / Wen, C / Lau, L C M / Leung, T K C / Luk, M H / Chan, V W K / Cheung, A / Cheung, M H / Fu, H / Chiu, K Y

Hong Kong medical journal = Xianggang yi xue za zhi

2024 Volume 30, Issue 1, Page(s) 56–61

MeSH term(s)	Humans ; Osteoarthritis, Knee/surgery ; Pandemics ; COVID-19 ; Exercise Therapy
Language	English
Publishing date	2024-02-19
Publishing country	China
Document type	Journal Article
ZDB-ID	1239255-8
ISSN	1024-2708
ISSN	1024-2708
DOI	10.12809/hkmj2210209
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Article: McDAPS: A multi-channel physiological signals display and analysis system for clinical researchers.

Thuptimdang, Wanwara / Chalacheva, Patjanaporn / Coates, Thomas D / Khoo, Michael C K

SoftwareX

2023 Volume 23

Abstract: We introduce McDAPS, an interactive software for assessing autonomic imbalance from non-invasive multi-channel physiological recordings. McDAPS provides a graphical user interface for data visualization, beat-to-beat processing and interactive analyses. ... ...

Abstract	We introduce McDAPS, an interactive software for assessing autonomic imbalance from non-invasive multi-channel physiological recordings. McDAPS provides a graphical user interface for data visualization, beat-to-beat processing and interactive analyses. The software extracts beat-to-beat RR interval systolic blood pressure, diastolic blood pressure, the pulse amplitude of photoplethysmogram and the pulse-to-pulse interval. The analysis modules include stationary and time-varying power spectral analyses, moving-correlation analysis and univariate analyses. Analyses can also be performed in batch mode if multiple datasets have to be processed in the same way. The program exports results in standard CSV format. McDAPS runs in MATLAB, and is supported on MS Windows and MAC OS systems. The MATLAB source code is available at https://github.com/thuptimd/McDAPS.git.
Language	English
Publishing date	2023-07-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2819369-6
ISSN	2352-7110
ISSN	2352-7110
DOI	10.1016/j.softx.2023.101482
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Article ; Online: Promoting Collaboration of Regulators and Patients in Improving Drug Safety and Regulatory Decision Making.

Khoo, Yoong Khean / Lim, John C W / Tan-Koi, Wei Chuen / Kitikiti, Nokuthula Sikhethiwe / Sim-Devadas, Ai Ling

Drug safety

2023 Volume 47, Issue 3, Page(s) 217–225

Abstract: Pharmacovigilance involves a continuous process of evaluating, monitoring and communicating the safety profile of a medicine throughout its life cycle. This process involves a range of stakeholders, including national regulatory authorities, industry, ... ...

Abstract	Pharmacovigilance involves a continuous process of evaluating, monitoring and communicating the safety profile of a medicine throughout its life cycle. This process involves a range of stakeholders, including national regulatory authorities, industry, health organisations, healthcare providers and patients. Although patients are the end users of medicines and experts in their medical conditions, patient involvement is still nascent in the Asia-Pacific region. While there are positive examples and encouraging trends, several key challenges currently hinder systemic patient involvement in drug safety and regulatory decision making. Systemic issues such as a lack of formalised frameworks or platforms, underdeveloped communication and information exchange channels, and paternalistic health systems constrain greater patient involvement and collaborative regulator-patient activities. Addressing these challenges will greatly advance collaboration among regulators, patients, and patient advocates to enhance drug safety and regulatory decision making.
MeSH term(s)	Humans ; Pharmacovigilance ; Patients ; Communication ; Decision Making ; Asia
Language	English
Publishing date	2023-12-11
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1018059-x
ISSN	1179-1942 ; 0114-5916
ISSN (online)	1179-1942
ISSN	0114-5916
DOI	10.1007/s40264-023-01385-2
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Article ; Online: Magnetic resonance imaging of disorders with white matter changes in children and adolescents: a pictorial essay.

Kwok, Po Lam / Lai, Alta Y T / Lai, Billy M H / Luk, Shiobhon Y / Tang, Kendrick Y K / Wong, Wendy W C / Khoo, Jennifer L S

Pediatric radiology

2023 Volume 53, Issue 6, Page(s) 1188–1206

Abstract: White matter changes are seen in a spectrum of disorders in children and adolescents. Understanding their distribution and appearance helps to reach diagnoses in daily radiologic practice. This pictorial essay will outline the magnetic resonance imaging ( ...

Abstract	White matter changes are seen in a spectrum of disorders in children and adolescents. Understanding their distribution and appearance helps to reach diagnoses in daily radiologic practice. This pictorial essay will outline the magnetic resonance imaging (MRI) appearances of diseases with white matter changes including demyelinating diseases, dysmyelinating disorders/leukodystrophies, infections, autoimmune diseases, vascular causes, mitochondrial disorders and neurocutaneous syndromes, along with a brief overview of clinical aspects of the diseases such as typical age of presentation, etiology, symptoms and signs and treatment options. This article highlights important features in common white matter diseases in children and adolescents.
MeSH term(s)	Adolescent ; Child ; Humans ; Demyelinating Diseases/diagnosis ; Demyelinating Diseases/pathology ; Leukoencephalopathies/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Neurocutaneous Syndromes ; White Matter/diagnostic imaging ; White Matter/pathology
Language	English
Publishing date	2023-01-10
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-022-05580-8
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Article ; Online: Cranberry Juice Polyphenols Inhibited the Formation of Advanced Glycation End Products in Collagens, Inhibited Advanced Glycation End Product-Induced Collagen Crosslinking, and Cleaved the Formed Crosslinks.

Chang, Haotian / Johnson, Elizabeth / Khoo, Christina / Wang, Weixin / Gu, Liwei

Journal of agricultural and food chemistry

2022

Abstract: Collagens in the human skin are susceptible to glycation due to their long half-life of about 15 years, accumulating advanced glycation end products (AGEs). The formation of AGEs and the subsequent AGE-induced collagen crosslinking are major factors for ... ...

Abstract	Collagens in the human skin are susceptible to glycation due to their long half-life of about 15 years, accumulating advanced glycation end products (AGEs). The formation of AGEs and the subsequent AGE-induced collagen crosslinking are major factors for skin aging. The objective of this study was to determine the capacity of cranberry juice polyphenols (CJPs) and their fractions to inhibit collagen glycation and to break AGE-induced crosslinks in collagens. Concentrated cranberry juice was extracted to obtain the CJP, which was further fractionated into an ethyl acetate fraction, water fraction, 30% methanol (MeOH) fraction, 60% MeOH fraction, MeOH fraction, and acetone fraction. CJPs and their fractions contained different ratios of anthocyanins, procyanidins, and flavonols. All the fractions significantly inhibited collagen glycation assessed with the collagen-methylglyoxal (MGO) or collagen-dehydroascorbic acid (DHAA) assays. The ethyl acetate fraction and 60% MeOH had the lowest IC
Language	English
Publishing date	2022-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	241619-0
ISSN	1520-5118 ; 0021-8561
ISSN (online)	1520-5118
ISSN	0021-8561
DOI	10.1021/acs.jafc.2c06502
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