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  1. Article ; Online: Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA)

    Yu Heng Kwan / Warren Fong / Stanley Angkodjojo / Deborah Xin Yi Chung / Ying Ern Loo / Jie Kie Phang / Ting Hui Woon / Wei Rui Goh

    BMJ Open, Vol 13, Iss

    a cross-sectional study

    2023  Volume 5

    Abstract: Objectives To evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA).Design Cross-sectional evaluation of baseline data from a prospective cohort study, with recruitment ... ...

    Abstract Objectives To evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA).Design Cross-sectional evaluation of baseline data from a prospective cohort study, with recruitment from January 2018 to March 2021.Setting Outpatient clinic in a tertiary hospital in Singapore.Participants Patients aged 21 years and above who were diagnosed with axSpA.Outcome measures The Hospital Anxiety and Depression Scale (HADS) was used for assessing anxiety and depression, 10-item Connor Davidson Resilience Scale (CD-RISC-10) for resilience, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional limitation and Assessment of SpondyloArthritis International Society Health Index (ASAS HI) for overall health and functioning. Univariable and multivariable linear regression analyses were performed to assess the association between anxiety, depression and resilience with health and functioning.Results We included 296 patients in this study. The median (IQR) score for HADS-Anxiety was 5.0 (2.0–8.0), with 13.5% and 13.9% having borderline abnormal and abnormal anxiety, respectively. The median (IQR) score for HADS-Depression was 3.0 (1.0–7.0), with 12.8% and 8.4% having borderline abnormal and abnormal depression, respectively. The median (IQR) CD-RISC-10 score was 29.0 (23.0–32.0) while the median (IQR) ASAS HI score was 4.0 (2.0–7.0). Apart from BASDAI, BASFI and disease duration, anxiety and depression were associated with overall health and functioning (β: 0.12, 95% CI 0.03, 0.20; β: 0.20, 95% CI 0.09, 0.31) in the multivariable linear regression. Level of resilience was not associated with health and functioning.Conclusion Anxiety and depression, but not resilience, were associated with poorer health and functioning. Clinicians could consider routinely screening for anxiety and depression in their patients, especially in patients with more severe symptoms.
    Keywords Medicine ; R
    Subject code 150
    Language English
    Publishing date 2023-05-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Assessment of medical professionalism using the Professionalism Mini-Evaluation Exercise (P-MEX)

    Warren Fong / Yu Heng Kwan / Sungwon Yoon / Jie Kie Phang / Julian Thumboo / Swee Cheng Ng

    The Asia Pacific Scholar, Vol 6, Iss 1, Pp 114-

    A survey of faculty perception of relevance, feasibility and comprehensiveness

    2021  Volume 118

    Abstract: Introduction: This study aimed to examine the perception of faculty on the relevance, feasibility and comprehensiveness of the Professionalism Mini Evaluation Exercise (P-MEX) in the assessment of medical professionalism in residency programmes in an ... ...

    Abstract Introduction: This study aimed to examine the perception of faculty on the relevance, feasibility and comprehensiveness of the Professionalism Mini Evaluation Exercise (P-MEX) in the assessment of medical professionalism in residency programmes in an Asian postgraduate training centre. Methods: Cross-sectional survey data was collected from faculty in 33 residency programmes. Items were deemed to be relevant to assessment of medical professionalism when at least 80% of the faculty gave a rating of ≥8 on a 0-10 numerical rating scale (0 representing not relevant, 10 representing very relevant). Feedback regarding the feasibility and comprehensiveness of the P-MEX assessment was also collected from the faculty through open-ended questions. Results: In total, 555 faculty from 33 residency programmes participated in the survey. Of the 21 items in the P-MEX, 17 items were deemed to be relevant. For the remaining four items ‘maintained appropriate appearance’, ‘extended his/herself to meet patient needs’, ‘solicited feedback’, and ‘advocated on behalf of a patient’, the percentage of faculty who gave a rating of ≥8 was 78%, 75%, 74%, and 69% respectively. Of the 333 respondents to the open-ended question on feasibility, 34% (n=113) felt that there were too many questions in the P-MEX. Faculty also reported that assessments about ‘collegiality’ and ‘communication with empathy’ were missing in the current P-MEX. Conclusion: The P-MEX is relevant and feasible for assessment of medical professionalism. There may be a need for greater emphasis on the assessment of collegiality and empathetic communication in the P-MEX.
    Keywords professionalism ; singapore ; survey ; assessment ; Education (General) ; L7-991 ; Medicine (General) ; R5-920
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher National University of Singapore
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Comparison of temperature readings using infrared thermometers at three different sites

    Warren Weng Seng Fong / Shuan Khiag Yeo / Stephanie Man Chung Fook-Chong / Jie Kie Phang / Eugene Sim

    Proceedings of Singapore Healthcare, Vol

    tympanic, forehead and temporal

    2021  Volume 30

    Abstract: The aim of this study was to compare the body temperature measurements at tympanic, forehead and temporal sites using infrared thermometers. A total of 1576 consecutive visitors to Singapore General Hospital at two entry locations were included in this ... ...

    Abstract The aim of this study was to compare the body temperature measurements at tympanic, forehead and temporal sites using infrared thermometers. A total of 1576 consecutive visitors to Singapore General Hospital at two entry locations were included in this study. Pearson correlation and Bland–Altman mean difference between sites (95% confidence interval for limits of agreement) were calculated for the relationship between the three different sites of temperatures recorded (i.e. temporal, forehead and tympanic). Of all the visitors, 27 (1.7%) had fever. Moderate positive correlation was found between temporal and forehead temperature readings ( r =0.602, mean difference (temporal – forehead), (95% limits of agreement) = 0.1 (−0.8, 0.7)), and there was very weak positive correlation between tympanic and temporal temperature readings ( r =0.177, mean difference (temporal – tympanic), (95% limits of agreement) = −0.3 (−1.7, 1.1)). Sensitivity for temporal temperature readings (⩾37.5°C) to detect febrile visitors was 3.7%, specificity was 99.6%, positive predictive value was 14.3% and negative predictive value was 98.3%. Our results demonstrate that tympanic temperature readings should be used for fever screening instead of temporal or forehead readings.
    Keywords Medicine ; R
    Subject code 551
    Language English
    Publishing date 2021-03-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Assessment of medical professionalism

    Warren Fong / Yu Heng Kwan / Sungwon Yoon / Jie Kie Phang / Julian Thumboo / Ying Ying Leung / Swee Cheng Ng

    BMC Medical Education, Vol 20, Iss 1, Pp 1-

    preliminary results of a qualitative study

    2020  Volume 12

    Abstract: Abstract Background The importance of medical professionalism has been well documented in the literature. Cultural background affects the constituents of professionalism. However, few studies have explored the domains of medical professionalism in an ... ...

    Abstract Abstract Background The importance of medical professionalism has been well documented in the literature. Cultural background affects the constituents of professionalism. However, few studies have explored the domains of medical professionalism in an Asian context. We aim to describe the views and experiences of both patients and faculty on medical professionalism in an urban Asian city state. Methods Data for this qualitative study were collected through focus group discussions (FGDs) with patients and in-depth interviews (IDIs) with faculty members. The IDIs and FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted by two independent coders using a priori framework derived from Professionalism Mini Evaluation Exercise (P-MEX). Sociodemographic data of faculty members and patients were obtained through brief questionnaires. Results A total of 31 patients (58.1% male, all had visited healthcare facilities within the past year) and 26 faculty members (42.3% male, 38.5% from medical disciplines, median years as faculty is 11) participated in this study. The results supported the four domains of medical professionalism - Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills. Two new sub-domains which emerged from data were (1) communicated effectively with patient and (2) demonstrated collegiality. Conclusions The domains of professionalism in Singapore were similar to previous studies. This study allows a better understanding of medical professionalism to enhance the assessment and ultimately, the teaching of medical professionalism in an urban multi-ethnic Asian city.
    Keywords Professionalism ; Singapore ; Qualitative ; Assessment ; Special aspects of education ; LC8-6691 ; Medicine ; R
    Subject code 001
    Language English
    Publishing date 2020-01-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Assessment of medical professionalism using the Professionalism Mini Evaluation Exercise (P-MEX) in a multi-ethnic society

    Warren Fong / Yu Heng Kwan / Sungwon Yoon / Jie Kie Phang / Julian Thumboo / Ying Ying Leung / Swee Cheng Ng

    BMC Medical Education, Vol 20, Iss 1, Pp 1-

    a Delphi study

    2020  Volume 9

    Abstract: Abstract Background The importance of medical professionalism and its assessment has been well documented in the literature. However, there is currently no culturally-adapted tool to assess medical professionalism in Singapore. This study sets out to ... ...

    Abstract Abstract Background The importance of medical professionalism and its assessment has been well documented in the literature. However, there is currently no culturally-adapted tool to assess medical professionalism in Singapore. This study sets out to find consensus on relevance of the items from the Professionalism Mini Evaluation Exercise (P-MEX) for assessing medical professionalism in Singapore. Methods A two-round Delphi survey was completed by an expert panel consisting of program directors, associate designated institutional officials, and designated institutional official (n = 15) from residency programs in Singapore. Round 1 comprised of 23 items from the P-MEX rated on a 5-point scale (1 = Definitely include, 2 = Possibly include, 3 = Neutral, 4 = Possibly exclude, 5 = Definitely exclude). In round 2, the experts received feedback from the previous round, and were asked to re-rate the items which did not achieve consensus in the previous round. The threshold for consensus in the study was defined as 70% or greater agreement among experts. Results Completed questionnaires for both rounds were received from all 15 experts. In round 1, 18 items (78%) achieved consensus to be included. In round 2, 1 (4%) item achieved consensus to be included. However, none of the remaining items achieved consensus to be removed, and they exhibited stability in responses. A list of 19 items covering four domains of medical professionalism (Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills) was obtained during the two-rounds of Delphi survey. Conclusions Nineteen items in the P-MEX had garnered consensus and is suitable for assessing medical professionalism in Singapore. The findings of this study can provide guidance for faculty and institutions who want to assess medical professionalism of their medical trainees.
    Keywords Professionalism ; Singapore ; Delphi ; Assessment ; Special aspects of education ; LC8-6691 ; Medicine ; R
    Subject code 005
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Professionalism in traditional Chinese medicine (TCM) practitioners

    Yu Heng Kwan / Sarah Chooi / Sungwon Yoon / Xiang Ling Ang / Jie Kie Phang / Hwee Ling Koh / Julian Thumboo / Swee Cheng Ng / Warren Fong

    BMC Complementary Medicine and Therapies, Vol 20, Iss 1, Pp 1-

    a qualitative study

    2020  Volume 10

    Abstract: Abstract Background Medical professionalism is important for establishing public trust in doctors. Its definition is culture-sensitive. However, no research has explored medical professionalism in Traditional Chinese Medicine (TCM) practitioners. This ... ...

    Abstract Abstract Background Medical professionalism is important for establishing public trust in doctors. Its definition is culture-sensitive. However, no research has explored medical professionalism in Traditional Chinese Medicine (TCM) practitioners. This study aims to (a) establish the domains of professionalism in TCM practitioners in Singapore, and to (b) compare the domains of professionalism of practitioners trained in TCM and practitioners trained in conventional medicine. Methods Data for this qualitative study was collected through in-depth interviews (IDIs) with TCM practitioners. IDIs were audio-recorded and transcribed verbatim. Thematic analysis was conducted by two independent coders using the Professionalism Mini-Evaluation Exercise (P-MEX) as a framework. The domains of professionalism in TCM and conventional medicine were then compared, using data from a similar study on professionalism in practitioners trained in conventional medicine. Results A total of 27 TCM practitioners (40.7% male) participated in this study. The four domains of professionalism in the P-MEX, namely doctor-patient relationship skills, reflective skills, time management and inter-professional relationship skills, and two new sub-domains, “communicated effectively with patient” and “demonstrated understanding and integrated with conventional medicine”, were relevant to TCM practitioners. This is largely similar to that of practitioners trained in conventional medicine, with a few differences, including “ensured continuity of care” and “used health resources appropriately”. Conclusion The domains of professionalism in TCM practitioners were established and they are similar to that of practitioners trained in conventional medicine. This study is the first to define medical professionalism in TCM practitioners. Findings will provide guidance on the education of professionalism in TCM practitioners.
    Keywords Professionalism ; Traditional Chinese medicine ; TCM practitioners ; Singapore ; Qualitative ; Assessment ; Other systems of medicine ; RZ201-999
    Subject code 001
    Language English
    Publishing date 2020-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Protocol for a randomized controlled trial of electroacupuncture in the management of patients with axial spondyloarthritis in Singapore (E‐AcuSpA)

    Warren Fong / Yu Heng Kwan / Su‐An Quek / Ader Lim / Chiah Yuen Wong / Shin Yoong Chua / Hui Chin Tan / Clara Eng / Choy Tip Tan / Bao Qiang Dong / Youyi Huang / Chuen Seng Tan / Bee Choo Tai / Ting Hui Woon / Jie Kie Phang / Hwee Ling Koh / Ying Ying Leung / Julian Thumboo / Truls Østbye

    Rheumatology & Autoimmunity, Vol 1, Iss 2, Pp 104-

    2021  Volume 114

    Abstract: Abstract Background Despite therapeutic advances, treatment of patients with axial spondyloarthritis (axSpA) continue to pose as a challenge as many do not respond well to conventional Western medications, such as nonsteroidal anti‐inflammatory drugs ( ... ...

    Abstract Abstract Background Despite therapeutic advances, treatment of patients with axial spondyloarthritis (axSpA) continue to pose as a challenge as many do not respond well to conventional Western medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDs) and biologic disease‐modifying antirheumatic drugs (bDMARDs). Hence, acupuncture is a possible alternative. Some studies found electroacupuncture to be better than manual acupuncture, though no trials have been conducted in patients with axSpA. This clinical trial aims to evaluate the clinical efficacy, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA. Methods/Design This randomized controlled trial will recruit 100 patients diagnosed with axSpA, who have active disease despite NSAIDs and bDMARDs. Eligible patients will be randomized to receive either electroacupuncture or manual acupuncture in a 1:1 ratio. All participants will receive standard rheumatologic care in addition to 20 acupuncture sessions. The mean difference in Bath Ankylosing Spondylitis Disease Activity Index score between the 2 groups over 12 weeks will serve as the primary outcome. Secondary outcomes include improvements in other clinical, quality of life, and economic outcomes over 24 weeks. All adverse events will be recorded. Discussion Results from this trial may provide evidence regarding the clinical effectiveness, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA, and guide implementation into clinical practice. Limitations of this trial include the lack of patient blinding, use of a repeated measures design, and possible variation in acupuncture technique amongst the various Traditional Chinese Medicine practitioners.
    Keywords axial spondyloarthritis ; complementary and alternative medicine ; electroacupuncture ; randomized controlled trial ; Traditional Chinese Medicine ; Immunologic diseases. Allergy ; RC581-607 ; Diseases of the musculoskeletal system ; RC925-935
    Subject code 610
    Language English
    Publishing date 2021-12-01T00:00:00Z
    Publisher Wiley
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Traditional Chinese medicine (TCM) collaborative care for patients with axial spondyloarthritis (AcuSpA)

    Yu Heng Kwan / Warren Fong / Xiang Ling Ang / Chuen Seng Tan / Bee Choo Tai / Youyi Huang / Marcel Bilger / Jie Kie Phang / Hui Chin Tan / Jia Ven Lee / Limin Sun / Choy Tip Tan / Bao Qiang Dong / Hwee Ling Koh / Ying Ying Leung / Nai Lee Lui / Siaw Ing Yeo / Swee Cheng Ng / Kok Yong Fong /
    Julian Thumboo / Truls Østbye

    Trials, Vol 20, Iss 1, Pp 1-

    protocol for a pragmatic randomized controlled trial

    2019  Volume 11

    Abstract: Abstract Background Axial spondyloarthritis (AxSpA) is a chronic disease which results in fatigue, pain, and reduced quality of life (QoL). Traditional Chinese medicine (TCM), especially acupuncture, has shown promise in managing pain. Although a TCM ... ...

    Abstract Abstract Background Axial spondyloarthritis (AxSpA) is a chronic disease which results in fatigue, pain, and reduced quality of life (QoL). Traditional Chinese medicine (TCM), especially acupuncture, has shown promise in managing pain. Although a TCM collaborative model of care (TCMCMC) has been studied in cancer, there are no randomized controlled trials investigating TCM in AxSpA. Therefore, we will conduct a pragmatic trial to determine the clinical effectiveness, safety, and cost-effectiveness of TCMCMC for patients with AxSpA. We define TCMCMC as standard TCM history taking and physical examination, acupuncture, and TCM non-pharmacological advice and communications with rheumatologists in addition to usual rheumatologic care. The purpose of this paper is to describe the rationale for and methodology of this trial. Methods/design This pragmatic randomized controlled trial will recruit 160 patients who are diagnosed with AxSpA and have inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs). Simple randomization to usual rheumatologic care or the intervention (TCMCMC) with a 1:1 allocation ratio will be used. Ten 30-min acupuncture sessions will be provided to patients assigned to the TCMCMC arm. All participants will continue to receive usual rheumatologic care. The primary endpoint — spinal pain — will be evaluated at week 6. Secondary endpoints include clinical, quality of life, and economic outcome measures. Patients will be followed up for up to 52 weeks, and adverse events will be documented. Discussion This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of a TCMCMC for patients with AxSpA. Trial registration ClinicalTrials.gov, NCT03420404. Registered on 14 February 2018.
    Keywords Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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