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Chowdhury S.,Post Graduate Institute of Medical Education and Research | Ji L.,Peking University | Suwanwalaikorn S.,Chulalongkorn University | Yu N.-C.,Yu Neng Chun Diabetes Clinic | Tan E.K.,Mount Elizabeth Medical Center
Current Medical Research and Opinion | Year: 2015

Comprehensive glycemic control is necessary to improve outcomes and avoid complications in individuals with diabetes. Self-monitoring of blood glucose (SMBG) is a key enabler of glycemic assessment, providing real-time information that complements HbA1c monitoring and supports treatment optimization. However, SMBG is under-utilized by patients and physicians within the Asia-Pacific region, because of barriers such as the cost of monitoring supplies, lack of diabetes self-management skills, or concerns about the reliability of blood glucose readings. Practice recommendations in international and regional guidelines vary widely, and may not be detailed or specific enough to guide SMBG use effectively. This contributes to uncertainty among patients and physicians about how best to utilize this tool: when and how often to test, and what action(s) to take in response to high or low readings. In developing a practical SMBG regimen, the first step is to determine the recommended SMBG frequency and intensity needed to support the chosen treatment regimen. If there are practical obstacles to monitoring, such as affordability or access, physicians should identify the most important aspects of glycemic control to target for individual patients, and modify monitoring patterns accordingly. This consensus paper proposes a selection of structured, flexible SMBG patterns that can be tailored to the clinical, educational, behavioral, and financial requirements of individuals with diabetes. © 2015 Informa UK Ltd.

Zhu M.,National University of Singapore | Chen J.Y.,0 College Road | Chong H.C.,0 College Road | Yew A.K.S.,0 College Road | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: A 24-month prospective follow-up study was carried out to compare perioperative clinical outcomes, radiographic limb alignment, component positioning, as well as functional outcomes following total knee arthroplasty (TKA) between patient-specific instrumentation (PSI) and conventional instrumentation (CI). Methods: Ninety consecutive patients, satisfying the inclusion and exclusion criteria, were scheduled to undergo TKA with either PSI or CI. A CT-based PSI was used in this study, and a senior surgeon performed all surgeries. Patients were clinically and functionally assessed preoperatively, 6 and 24 months post-operatively. Perioperative outcomes were also analysed, including operating time, haemoglobin loss, the need for blood transfusion, length of hospitalisation, and radiographic features.Results: At 24-month follow-up, clinical and functional outcomes were comparable between the two groups. PSI performed no better than CI in restoring lower limb mechanical alignment or improving component positioning. There were no differences in operating time, haemoglobin loss, transfusion rate, or length of hospitalisation between PSI and CI. Conclusion: No significant clinical benefit could be demonstrated in using PSI over CI after 24 months, and routine use of PSI is not recommended in non-complicated TKA. Level of evidence: II. © 2015 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)

Chiang C.-E.,Taipei Veterans General Hospital | Chiang C.-E.,National Yang Ming University | Zhang S.,Chinese Academy of Sciences | Zhang S.,Peking Union Medical College | And 4 more authors.
International Journal of Cardiology | Year: 2013

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with increased morbidity and mortality. AF has a slightly lower incidence and prevalence in Asian populations than in Western populations, but the associated relative risk of stroke and mortality is similar. Patients with AF in Asia have similar disease profiles and CHADS2 score distributions compared to those in the West, with the exception of a slightly higher prevalence of valvular heart diseases in Asia. Acute ventricular rate control should be the initial consideration in patients with AF and rapid ventricular rate. Anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and clinical trials in both the West and the East show that chronic rhythm control is not superior to chronic rate control in terms of cardiovascular outcomes, most likely because the benefit of anti-arrhythmic drugs in these trials was often offset by proarrhythmic effects. ECG-driven trials for AF should be replaced by outcome-driven ones. ATHENA is the largest outcome trial to confirm the superiority of a new anti-arrhythmic drug in improving cardiovascular outcomes. The choice of anti-arrhythmic drugs for AF should be based on both safety and efficacy in improving cardiovascular outcomes. For long-term rate control, a lenient strategy with a ventricular rate of less than 110 bpm may be adequate, but more strict rate control may be required if patients continue to complain of symptoms. Catheter ablation should be reserved for patients who remain symptomatic despite optimal medical therapy. © 2011 Elsevier Ireland Ltd.

Kamaldin N.,National University of Singapore | Liang W.,National University of Singapore | Tan K.K.,National University of Singapore | Gan C.W.,National University of Singapore | And 2 more authors.
IEEE Sensors Journal | Year: 2015

Otitis media with effusion is a prevalent condition affecting people of all age groups worldwide. When medication fails, a surgical procedure called myringotomy is done and a ventilation tube (grommet) is inserted. A novel all-in-one device that allows office-based myringotomy was conceptualized and realized, but there exists constraints with respect to contact sensing. This paper will discuss the challenges with contact sensing within the confines of the ear canal in the context of the applicator. A capacitive sensing approach is then proposed to circumvent these difficulties and experimental results are furnished to show the relative performance of capacitive sensing over force sensing for contact detection. © 2001-2012 IEEE.

Aung T.H.,National Heart Center Singapore | Go Y.Y.,National Heart Center Singapore | Low L.P.,Mount Elizabeth Medical Center | Chua T.,National Heart Center Singapore
Singapore Medical Journal | Year: 2013

Introduction Hyperlipidaemia is a major risk factor for coronary artery disease (CAD). Its effective treatment has been shown to reduce the incidence of cardiovascular events, both in secondary and primary prevention. An essential component of risk factor management at the community level is public awareness and knowledge of treatment benefits. However, this data is limited in Singapore. Methods A cross-sectional survey questionnaire of public perception and knowledge on cholesterol treatment among adult Singaporeans aged 30-69 years was commissioned by the Singapore Heart Foundation and conducted by a professional market survey company. Regional quota sampling was performed to ensure that the sample was representative of the Singapore population. This was followed by random sampling of households and respondents. Results Of the 365 respondents, 40.9% were male, 70.3% were Chinese, 18.8% Malay and 10.9% Indian. The mean age was 47.5 years. Although 81.9% of respondents had medical check-ups involving blood tests, only 11.0% knew their actual cholesterol levels. A third of the respondents saw herbal medicine as healthier and safer than Western medication. More than 80% of respondents believed that diet and exercise were equally effective at lowering cholesterol as medication. About half of the respondents associated long-term use of statins with damage to the liver and kidney, while a third associated chronic statin use with the development of cancer. Conclusion There are gaps in the level of public awareness and understanding of cholesterol treatment in Singapore. Common misconceptions should be addressed, as they could potentially impair effective management or treatment compliance.

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