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  1. Article ; Online: Acute Functional Outcomes in Critically Ill COVID-19 Patients

    Matthew Rong Jie Tay / Poo Lee Ong / Ser Hon Puah / Shuen Loong Tham

    Frontiers in Medicine, Vol

    2021  Volume 7

    Abstract: Background: COVID-19 (Coronavirus Disease 2019) is a global cause of morbidity and mortality currently. We aim to describe the acute functional outcomes of critically ill coronavirus disease 2019 (COVID-19) patients after transferring out of the ... ...

    Abstract Background: COVID-19 (Coronavirus Disease 2019) is a global cause of morbidity and mortality currently. We aim to describe the acute functional outcomes of critically ill coronavirus disease 2019 (COVID-19) patients after transferring out of the intensive care unit (ICU).Methods: 51 consecutive critically ill COVID-19 patients at a national designated center for COVID-19 were included in this exploratory, retrospective observational cohort study from January 1 to May 31, 2020. Demographic and clinical data were collected and analyzed. Functional outcomes were measured primarily with the Functional Ambulation Category (FAC), and divided into 2 categories: dependent ambulators (FAC 0–3) and independent ambulators (FAC 4–5). Multivariate analysis was performed to determine associations.Results: Many patients were dependent ambulators (47.1%) upon transferring out of ICU, although 92.2% regained independent ambulation at discharge. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (odds ratio 14.02, 95% CI 1.15–171.28, P = 0.039) and a longer length of ICU stay (odds ratio 1.50, 95% CI 1.04–2.16, P = 0.029) were associated with dependent ambulation upon discharge from ICU.Conclusions: Critically ill COVID-19 survivors have a high level of impairment following discharge from ICU. Such patients should be screened for impairment and managed appropriately by rehabilitation professionals, so as to achieve good functional outcomes on discharge.
    Keywords SARS-CoV-2 ; critical illness ; coronavirus ; acute respiratory distress syndrome ; dependent ambulation ; intensive care units ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Mobile device

    Ser Hon Puah / Chee Yen Goh / Chung Leung Chan / Amy Kui Jie Teoh / Hao Zhang / Zhiqi Shen / Lay Ping Neo

    BMC Medical Education, Vol 22, Iss 1, Pp 1-

    a useful tool to teach inhaler devices to healthcare professionals

    2022  Volume 8

    Abstract: Abstract Background Proper inhaler device usage is paramount for control of underlying obstructive airway disease. Hence, education to healthcare professionals who will eventually educate patients need to be done effectively. We developed an application ... ...

    Abstract Abstract Background Proper inhaler device usage is paramount for control of underlying obstructive airway disease. Hence, education to healthcare professionals who will eventually educate patients need to be done effectively. We developed an application for mobile devices for education on six medical inhaler devices, the metered-dose inhaler (MDI), Turbuhaler, Accuhaler, Breezhaler, Ellipta and Respimat, and studied if there were any difference between the application and the manufacturer’s instructions on inhaler technique. The aim of this study is to see if inhaler education via a mobile phone app is comparable to manual instruction for health care professions. Methods Participants, who were nursing students, were randomized to learn the inhaler devices via the manufacturer’s instruction guide or a mobile device app designed specifically for education on inhaler devices. Results There were 45 participants in each group. 78% of them were females with a median age of 21 (IQR 3). 67% used an Apple mobile device and the remainder used an Android device. The mobile device showed better total improvement points for the Turbuhaler device (262 vs 287 points; P = 0.02). Participants learning from the manufacturer’s guide had a significantly higher total improvement points in the Breezhaler (370 vs 327 points; P < 0.01) and Ellipta (214 vs 174 points; P < 0.01) device. Both interventions showed improvement in total scores for demonstrating the correct usage of all inhaler devices. MDI has the least number of correct steps for both interventions. The participants’ reported their mean (SD) self-rated knowledge was significantly higher for those using the app for all devices as compared to those that did not (4.33 (0.68) vs 4.73 (0.42); P = < 0.01). Self-reported confidence level was found to be higher in the mobile app group, but this was not statistically significant. The app was well received and scored of 4.42 of 5 with regards to its quality. Conclusion Using a mobile inhaler app is just as effective to teach ...
    Keywords Asthma ; Inhaler ; Mobile application ; Inhaler device ; Special aspects of education ; LC8-6691 ; Medicine ; R
    Subject code 600
    Language English
    Publishing date 2022-04-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Airway 'Resistotypes' and Clinical Outcomes in Bronchiectasis.

    Mac Aogáin, Micheál / Xaverius Ivan, Fransiskus / Jaggi, Tavleen K / Richardson, Hollian / Shoemark, Amelia / Narayana, Jayanth Kumar / Dicker, Alison J / Koh, Mariko Siyue / Lee, Ken Cheah Hooi / Thun How, Ong / Poh, Mau Ern / Chin, Ka Kiat / Hou, Albert Lim Yick / Ser Hon, Puah / Low, Teck Boon / Abisheganaden, John Arputhan / Dimakou, Katerina / Digalaki, Antonia / Kosti, Chrysavgi /
    Gkousiou, Anna / Hansbro, Philip M / Blasi, Francesco / Aliberti, Stefano / Chalmers, James D / Chotirmall, Sanjay H

    American journal of respiratory and critical care medicine

    2024  

    Abstract: Introduction: Application of whole-genome shotgun metagenomics to the airway microbiome in bronchiectasis highlights a diverse pool of antimicrobial resistance genes: the 'resistome', the clinical significance of which remains unclear.: Methods: ... ...

    Abstract Introduction: Application of whole-genome shotgun metagenomics to the airway microbiome in bronchiectasis highlights a diverse pool of antimicrobial resistance genes: the 'resistome', the clinical significance of which remains unclear.
    Methods: Individuals with bronchiectasis were prospectively recruited into cross-sectional and longitudinal cohorts (n=280) including the international multicentre cross-sectional Cohort of Asian and Matched European Bronchiectasis 2 study (CAMEB 2; n=251) and two independent cohorts, one describing patients experiencing acute exacerbation and a further cohort of patients undergoing
    Results: The bronchiectasis resistome features a unique resistance gene profile and elevated counts of aminoglycoside, bicyclomycin, phenicol, triclosan and multi-drug resistance genes. Longitudinally, it exhibits within-patient stability over time and during exacerbations despite between-patient heterogeneity. Proportional differences in baseline resistome profiles including increased macrolide and multi-drug resistance genes associate with shorter intervals to next exacerbation, while distinct resistome archetypes associate with frequent exacerbations, poorer lung function, geographic origin, and the host microbiome. Unsupervised analysis of resistome profiles identified two clinically relevant 'resistotypes' RT1 and RT2, the latter characterized by poor clinical outcomes, increased multi-drug resistance and
    Conclusion: The bronchiectasis resistome associates with clinical outcomes, geographic origin, and the underlying host microbiome. Bronchiectasis 'resistotypes' link to clinical disease and are modifiable through targeted antimicrobial therapy. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
    Language English
    Publishing date 2024-01-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202306-1059OC
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Perceived Stress, Stigma, Traumatic Stress Levels and Coping Responses amongst Residents in Training across Multiple Specialties during COVID-19 Pandemic—A Longitudinal Study

    Qian Hui Chew / Faith Li-Ann Chia / Wee Khoon Ng / Wan Cheong Ivan Lee / Pei Lin Lynnette Tan / Chen Seong Wong / Ser Hon Puah / Vishalkumar G Shelat / Ee-Jin Darren Seah / Cheong Wei Terence Huey / Eng Joo Phua / Kang Sim

    International Journal of Environmental Research and Public Health, Vol 17, Iss 6572, p

    2020  Volume 6572

    Abstract: This study aimed to explore changes in psychological responses (perceived stress, traumatic stress, stigma, coping) over time in residents, as well as their predictors. The level of perceived stress, traumatic stress, stigma, and coping responses were ... ...

    Abstract This study aimed to explore changes in psychological responses (perceived stress, traumatic stress, stigma, coping) over time in residents, as well as their predictors. The level of perceived stress, traumatic stress, stigma, and coping responses were assessed using the Perceived Stress Scale, Impact of Event-Revised, Healthcare Workers Stigma Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory, respectively. We collected responses from 274 residents at baseline and 221 residents at 3 months follow-up (timepoint 2) from the National Healthcare Group (NHG) residency programs in Singapore. All residents reported lower perceived stress and lower perceived stigma compared to baseline. Use of avoidance coping was associated with all three psychological responses (perceived stress, traumatic stress, and stigma) across the two timepoints. Compared to baseline, specific factors associated with perceived stress and traumatic stress at timepoint 2 were living alone, less problem solving, and seeking social support. Residency programs should encourage active coping strategies (e.g., seeking social support, positive thinking, problem solving) among residents, and proactively identify residents who may be at higher risk of psychological sequelae due to circumstances that contribute to isolation.
    Keywords COVID-19 ; residency ; psychological responses ; healthcare workers ; Medicine ; R ; covid19
    Subject code 150 ; 360
    Language English
    Publishing date 2020-09-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Expanding the utility of the ROX index among patients with acute hypoxemic respiratory failure.

    Andrew Li / Matthew Edward Cove / Jason Phua / Ser Hon Puah / Vicky Ng / Amit Kansal / Qiao Li Tan / Juliet Tolentino Sahagun / Juvel Taculod / Addy Yong-Hui Tan / Amartya Mukhopadhyay / Chee Kiang Tay / Kollengode Ramanathan / Yew Woon Chia / Duu Wen Sewa / Meiying Chew / Sennen J W Lew / Shirley Goh / Shekhar Dhanvijay /
    Jonathan Jit-Ern Tan / Kay Choong See / SICM-NICER Group

    PLoS ONE, Vol 17, Iss 4, p e

    2022  Volume 0261234

    Abstract: Background Delaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but ... ...

    Abstract Background Delaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but little information is available for non-pneumonia causes. In this study, we validate the ROX index among AHRF patients due to both pneumonia or non-pneumonia causes, focusing on early prediction. Methods This was a retrospective observational study in eight Singapore intensive care units from 1 January 2015 to 30 September 2017. All patients >18 years who were treated with HFNC for AHRF were eligible and recruited. Clinical parameters and arterial blood gas values at HFNC initiation and one hour were recorded. HFNC failure was defined as requiring intubation post-HFNC initiation. Results HFNC was used in 483 patients with 185 (38.3%) failing HFNC. Among pneumonia patients, the ROX index was most discriminatory in pneumonia patients one hour after HFNC initiation [AUC 0.71 (95% CI 0.64-0.79)], with a threshold value of <6.06 at one hour predicting HFNC failure (sensitivity 51%, specificity 80%, positive predictive value 61%, negative predictive value 73%). The discriminatory power remained moderate among pneumonia patients upon HFNC initiation [AUC 0.65 (95% CI 0.57-0.72)], non-pneumonia patients at HFNC initiation [AUC 0.62 (95% CI 0.55-0.69)] and one hour later [AUC 0.63 (95% CI 0.56-0.70)]. Conclusion The ROX index demonstrated moderate discriminatory power among patients with either pneumonia or non-pneumonia-related AHRF at HFNC initiation and one hour later.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Expanding the utility of the ROX index among patients with acute hypoxemic respiratory failure

    Andrew Li / Matthew Edward Cove / Jason Phua / Ser Hon Puah / Vicky Ng / Amit Kansal / Qiao Li Tan / Juliet Tolentino Sahagun / Juvel Taculod / Addy Yong-Hui Tan / Amartya Mukhopadhyay / Chee Kiang Tay / Kollengode Ramanathan / Yew Woon Chia / Duu Wen Sewa / Meiying Chew / Sennen J. W. Lew / Shirley Goh / Shekhar Dhanvijay /
    Jonathan Jit-Ern Tan / Kay Choong See FCCP / on behalf of SICM-NICER Group

    PLoS ONE, Vol 17, Iss

    2022  Volume 4

    Abstract: Background Delaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but ... ...

    Abstract Background Delaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but little information is available for non-pneumonia causes. In this study, we validate the ROX index among AHRF patients due to both pneumonia or non-pneumonia causes, focusing on early prediction. Methods This was a retrospective observational study in eight Singapore intensive care units from 1 January 2015 to 30 September 2017. All patients >18 years who were treated with HFNC for AHRF were eligible and recruited. Clinical parameters and arterial blood gas values at HFNC initiation and one hour were recorded. HFNC failure was defined as requiring intubation post-HFNC initiation. Results HFNC was used in 483 patients with 185 (38.3%) failing HFNC. Among pneumonia patients, the ROX index was most discriminatory in pneumonia patients one hour after HFNC initiation [AUC 0.71 (95% CI 0.64–0.79)], with a threshold value of <6.06 at one hour predicting HFNC failure (sensitivity 51%, specificity 80%, positive predictive value 61%, negative predictive value 73%). The discriminatory power remained moderate among pneumonia patients upon HFNC initiation [AUC 0.65 (95% CI 0.57–0.72)], non-pneumonia patients at HFNC initiation [AUC 0.62 (95% CI 0.55–0.69)] and one hour later [AUC 0.63 (95% CI 0.56–0.70)]. Conclusion The ROX index demonstrated moderate discriminatory power among patients with either pneumonia or non-pneumonia-related AHRF at HFNC initiation and one hour later.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

    Ser Hon Puah / Barnaby Edward Young / Po Ying Chia / Vui Kian Ho / Jiashen Loh / Roshni Sadashiv Gokhale / Seow Yen Tan / Duu Wen Sewa / Shirin Kalimuddin / Chee Keat Tan / Surinder K. M. S. Pada / Matthew Edward Cove / Louis Yi Ann Chai / Purnima Parthasarathy / Benjamin Choon Heng Ho / Jensen Jiansheng Ng / Li Min Ling / John A. Abisheganaden / Vernon J. M. Lee /
    Cher Heng Tan / Raymond T. P. Lin / Yee Sin Leo / David C. Lye / Tsin Wen Yeo / Singapore 2019 novel coronavirus outbreak research team

    Scientific Reports, Vol 11, Iss 1, Pp 1-

    2021  Volume 11

    Abstract: Abstract We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who ... ...

    Abstract Abstract We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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