National Healthcare Group Polyclinics


National Healthcare Group Polyclinics

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Teo C.T.,National University of Singapore | Yeo Y.W.S.,National Healthcare Group Polyclinics | Lee S.-C.,National University of Singapore
American Journal of Health Behavior | Year: 2013

Objectives: To determine attitudes of Singaporean women toward screening mammography and its potential barriers. Methods: The study included 208 cancerfree Asian women. Data about mammogram knowledge, motivators, barriers, and adherence to surveillance mammography were obtained. Results: Only 37% underwent regular mammography. Lack of time (56.7%) and cost (54.3%) were the most commonly cited barriers. On multivariate analysis, being Chinese, having higher education, mammography knowledge, positive motivator scores, and receiving reminders were predictors to regular mammography. Participants were only willing to pay ~US$24 for mammogram compared to subsidized cost of ~US$40. Older Malays were less likely than Chinese and Indians to undergo regular mammography (p = .003). Conclusions: Surveillance adherence may be improved by lowering cost and increasing public education.

Gillard P.,Glaxosmithkline | Chu D.W.S.,Queen Mary Hospital Hong Kong | Hwang S.-J.,Taipei Veterans General Hospital | Yang P.-C.,National Taiwan University | And 5 more authors.
BMC Infectious Diseases | Year: 2014

Background: The pandemic potential of avian influenza A/H5N1 should not be overlooked, and the continued development of vaccines against these highly pathogenic viruses is a public health priority.Methods: This open-label extension booster study followed a Phase III study of 1206 adults who had received two 3.75 μg doses of primary AS03A-adjuvanted or non-adjuvanted H5N1 split-virus vaccine (A/Vietnam/1194/2004; clade 1) (NCT00449670). The aim of the extension study was to evaluate different timings for heterologous AS03A-adjuvanted booster vaccination (A/Indonesia/5/2005; clade 2.1) given at Month 6, 12, or 36 post-primary vaccination. Immunogenicity was assessed 21 days after each booster vaccination and the persistence of immune responses against the primary vaccine strain (A/Vietnam) and the booster strain (A/Indonesia) was evaluated up to Month 48 post-primary vaccination. Reactogenicity and safety were also assessed.Results: After booster vaccination given at Month 6, HI antibody responses to primary vaccine, and booster vaccine strains were markedly higher with one dose of AS03A-H5N1 booster vaccine in the AS03A-adjuvanted primary vaccine group compared with two doses of booster vaccine in the non-adjuvanted primary vaccine group. HI antibody responses were robust against the primary and booster vaccine strains 21 days after boosting at Month 12 or 36. At Month 48, in subjects boosted at Month 6, 12, or 36, HI antibody titers of ≥1:40 against the booster strain persisted in 39.2%, 61.2%, and 95.6% of subjects, respectively. Neutralizing antibody responses and cell-mediated immune responses also showed that AS03A-H5N1 heterologous booster vaccination elicited robust immune responses within 21 days of boosting at Month 6, 12, or 36 post-primary vaccination. The booster vaccine was well tolerated, and no safety concerns were raised.Conclusions: In Asian adults primed with two doses of AS03A-adjuvanted H5N1 pandemic influenza vaccine, strong cross-clade anamnestic antibody responses were observed after one dose of AS03A-H5N1 heterologous booster vaccine given at Month 6, 12, or 36 after priming, suggesting that AS03A-adjuvanted H5N1 vaccines may provide highly flexible prime-boost schedules. Although immunogenicity decreased with time, vaccinated populations could potentially be protected for up to three years after vaccination, which is likely to far exceed the peak of the a pandemic. © 2014 Gillard et al.; licensee BioMed Central Ltd.

Zheng R.M.,National Healthcare Group Polyclinics | Sim Y.F.,National Healthcare Group Polyclinics | Koh G.C.-H.,National University of Singapore
Journal of Interprofessional Care | Year: 2016

ABSTRACT: Interprofessional collaboration (IPC) has been shown to improve patient outcomes, cost efficiency, and health professional satisfaction, and enhance healthy workplaces. We determined the attitudes of primary care physicians and nurses towards IPC and factors facilitating IPC using a cross-sectional study design in Singapore. A self-administered anonymous questionnaire, based on the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), was distributed to primary healthcare physicians and nurses working in National Healthcare Group Polyclinics (N = 455). We found that the mean JSAPNC score for physicians was poorer than that for nurses (50.39 [SD = 4.67] vs. 51.61 [SD = 4.19], respectively, mean difference, MD = 1.22, CI = 0.35–2.09, p =.006). Nurses with advanced education had better mean JSAPNC score than nurses with basic education (52.28 [SD = 4.22] vs. 51.12 [SD = 4.11], respectively, MD = 1.16, CI = 0.12–2.20, p =.029). Male participants had poorer mean JSAPNC score compared to females (50.27 [SD = 5.02] vs. 51.38 [SD = 4.22], respectively MD = 1.11, CI = 0.07–2.14, p =.036). With regression analysis, only educational qualification among nurses was independently and positively associated with JSAPNC scores (p =.018). In conclusion, primary care nurses in Singapore had more positive attitudes towards IPC than physicians. Among nurses, those with advanced education had more positive attitudes than those with basic education. Greater emphasis on IPC education in training of physicians and nurses could help improve attitudes further. © 2016 Taylor & Francis.

Wong S.,National Healthcare Group Polyclinics | Lee J.,National University of Singapore | Lee J.,National Healthcare Group Pharmacy | Ko Y.,National University of Singapore | And 3 more authors.
Diabetic Medicine | Year: 2011

Aims The objective of this study was to determine the prevalence of insulin refusal amongst Singaporean patients with Type 2 diabetes mellitus, to compare perceptions regarding insulin therapy use between patients who were willing to use insulin and those who were not and to identify demographic factors that might predict insulin refusal.Methods A cross-sectional interviewer-administered survey incorporating demographic variables and 17 perceptions regarding insulin use (14 negative and three positive) was conducted among a sample of 265 patients attending a public primary healthcare centre.Results Seven of every 10 patients expressed unwillingness to use insulin therapy (70.6%). The greatest differences in perceptions between patients willing to use insulin therapy and those who were not included fear of not being able to inject insulin correctly (47.4 vs. 70.6%), fear of pain (44.9 vs. 65.8%), belief that insulin therapy would make it difficult to fulfil responsibilities at work and home (46.2 vs. 66.8%) and belief that insulin therapy improved diabetes control (82.1 vs. 58.3%). A tertiary level of education was associated with willingness to use insulin (odds ratio 3.3, confidence interval 1.8-6.1), and significant differences in perceptions were present in patients with different educational levels.Conclusions Insulin refusal is an important problem amongst our patients with Type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin therapy use should focus on injection-related concerns, perceived lifestyle adaptations and correction of misconceptions. Different interventions may also be required for patients of different educational groups. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Zhang X.,Khoo Teck Puat Hospital | Liu J.J.,Khoo Teck Puat Hospital | Sum C.F.,Khoo Teck Puat Hospital | Ying Y.L.,Khoo Teck Puat Hospital | And 6 more authors.
Atherosclerosis | Year: 2015

Objective: We previously reported ethnic disparity in adverse outcomes among Asians with type 2 diabetes (T2DM) in Singapore. Central arterial stiffness can aggravate systemic vasculopathy by propagating elevated systolic and pulse pressures forward, thereby accentuating global vascular injury. We aim to study ethnic disparity in central arterial stiffness and its determinants in a multi-ethnic T2DM Asian cohort. Methods: Arterial stiffness was estimated by carotid-femoral pulse wave velocity (PWV) and augmentation index (AI) using applanation tonometry method in Chinese (N=1045), Malays (N=458) and Indians (N=468). Linear regression model was used to evaluate predictors of PWV and AI. Results: PWV was higher in Malays (10.1±3.0m/s) than Chinese (9.7±2.8m/s) and Indians (9.6±3.1m/s) (P=0.018). AI was higher in Indians (28.1±10.8%) than Malays (25.9±10.1%) and Chinese (26.1±10.7%) (P<0.001). Malays remain associated with higher PWV (β=0.299, P=0.048) post-adjustment for age, gender, duration of diabetes, hemoglobin A1c, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), soluble receptor for advanced glycation end-products, urinary albumin-to-creatinine ratio, and insulin usage, which were all independent predictors of PWV. Indians remain associated with higher AI (β=2.776, P<0.001) post-adjustment for age, gender, BMI, SBP, DBP, and height, which were independent predictors of AI. These variables explained 27.7% and 33.4% of the variance in PWV and AI respectively. Conclusions: Malays and Indians with T2DM have higher central arterial stiffness, which may explain their higher risk for adverse outcomes. Modifying traditional major vascular risk factors may partially alleviate their excess cardiovascular risk through modulating arterial stiffness. © 2015 Elsevier Ireland Ltd.

Ang Y.G.,National Healthcare Services | Heng B.H.,National Healthcare Services | Saxena N.,National Healthcare Services | Liew S.T.A.,Tan Tock Seng Hospital | Chong P.-N.,National Healthcare Group Polyclinics
Journal of Clinical and Translational Endocrinology | Year: 2016

Background The prognosis of diabetic kidney disease is poor because epidemiological data have shown that all-cause mortality increases with declining renal function. This study aims to estimate the annual mortality rate of diabetic kidney disease stratified by chronic kidney disease (CKD) stages and to identify the predictors of mortality. Methods Patients with Stage 3-5 CKD (estimated glomerular filtration rate [eGFR] less than 60 mL/min per 1.73 m2) with diabetic kidney disease from the National Healthcare Group CKD Registry from 1 January 2007 to 31 December 2007 were included in this study. The patients were followed up till 30 November 2013. Cox's proportional hazards regression modelling was used to assess the factors associated with all-cause mortality. Results Over a median follow up period of 6.0 years, 985 out of 3008 patients (32.8%) died. Of those who died, 363 (36.9%) died from cardiovascular causes. The annual mortality rate was 64.1 per 1000 individuals (95% confidence interval [CI] 60.2-68.3) and the mortality rate increased with severity of CKD [Stage 3A (37.0), Stage 3B (57.5), Stage 4 (98.3) and Stage 5 (198.5)]. Predictors of mortality were age, male gender, CKD stages, albuminuria, comorbid conditions such as peripheral vascular disease, neuropathy, retinopathy and the use of antiplatelet agents. Conclusion Our study estimated the annual all-cause mortality rate for Singaporean patients with diabetic kidney disease by CKD stages and identified predictors of all-cause mortality. This study has affirmed the poor prognosis of these patients and an urgency to intervene early so as to retard the progression to later stages of CKD. © 2016 The Authors. Published by Elsevier Inc.

Bebakar W.M.W.,Universiti Sains Malaysia | Lim-Abrahan M.A.,University of the Philippines | Jain A.B.,Novo Nordisk AS | Seah D.,National Healthcare Group Polyclinics | Soewondo P.,University of Indonesia
Diabetes Research and Clinical Practice | Year: 2013

Aim: To examine the clinical safety and effectiveness of insulin aspart (IAsp) therapy in type 2 diabetes (T2D) patients from the ASEAN cohort of the international, 24-week, non-interventional A1chieve study. Methods: T2D patients from Indonesia, Malaysia, Philippines and Singapore, who started IAsp therapy with or without oral glucose-lowering drugs, were included. The primary endpoint was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemic events. Secondary endpoints included hypoglycaemia, glycated haemoglobin A1c [HbA1c], fasting plasma glucose [FPG], postprandial plasma glucose [PPPG], systolic blood pressure [SBP], body weight and lipids. Quality of life (QoL) was assessed using the EQ-5D questionnaire. Results: Overall, 312 T2D patients (222 insulin-naive and 90 insulin-experienced) with a mean±SD age of 56.6±11.2 years, BMI of 24.2±3.9 kg/m2 and diabetes duration of 7.0±5.7 years were included. The mean daily IAsp dose was 0.51±0.31U/kg at baseline titrated up to 0.60±0.29U/kg at Week 24. No SADRs or major hypoglycaemic events were reported in the entire subgroup. The proportion of patients who reported overall hypoglycaemia decreased from baseline to Week 24 (7.1% vs. 0.3%, p < 0.0001). The mean HbA1c improved from 9.5±1.6% at baseline to 7.6±1.3% after 24 weeks (p < 0.001). The mean FPG, post-breakfast PPPG and SBP also improved (p < 0.001). Health-related QoL scores increased in the entire subgroup (mean increase: 9.8±14.6 points, p < 0.001). Conclusions: Starting IAsp therapy was well-tolerated and was associated with significantly improved overall glycaemic control in the ASEAN cohort. © 2013 Elsevier Ireland Ltd.

Kwok B.C.,National Healthcare Group Polyclinics | Pua Y.H.,Singapore General Hospital
Age and Ageing | Year: 2016

Background: the study compares the effects of a Nintendo Wii exercise programme and a standard Gym-based exercise intervention on fear of falling, knee strength, physical function and falls rate in older adults.Methods: eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5-9 points and modified falls efficacy scale (MFES) score of ≤9 points participated in the parallel-group randomised trial. Each intervention arm involved an hour of intervention per week, totalling 12 sessions over 12 weeks. Besides 1-year fall incidence, the participants were evaluated on MFES, knee extensor strength (KES), timed-up-and-go test, gait speed, 6-minute walk test and narrow corridor walk test at weeks 13 and 24.Results: at week 13, between interventions, the effect of MFES changes did not reach statistical significance (difference = -0.07 point, 95% CI -0.56 to 0.42, P = 0.78); at week 24, the Wii group showed statistically significant effects over the Gym group (difference = 0.8 point, 95% CI 0.27 to 1.29, P < 0.01). For KES, the two groups did not differ statistically at week 13 (difference = -2.0%, 95% CI -5.6 to -1.7, P = 0.29); at week 24, the Gym group had greater strength gains than the Wii group (difference = -5.1%, 95% CI -8.7 to -1.5, P < 0.01). No between-group differences were observed for other outcome measures.Conclusion: on completion of a 12-week Nintendo Wii exercise programme, there was no significant benefit seen on fear of falling when compared to a standard Gym-based exercise intervention; however, post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training, despite knee strength apparently improving more in those allocated to the Gym. It is possible that long-term gains after using the Wii might be due to a carry-over effect. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Goh I.X.W.,National Healthcare Group Polyclinics | How C.H.,SingHealth Polyclinics | Tavintharan S.,Khoo Teck Puat Hospital
Singapore Medical Journal | Year: 2013

Statins are commonly used in the treatment of hyperlipidaemia. Although the benefits of statins are well-documented, they have the potential to cause myopathy and rhabdomyolysis due to the complex interactions of drugs, comorbidities and genetics. The cytochrome P450 family consists of major enzymes involved in drug metabolism and bioactivation. This article aims to highlight drug interactions involving statins, as well as provide updated recommendations and approaches regarding the safe and appropriate use of statins in the primary care setting.

Heng B.H.,National Healthcare Services | Sun Y.,National Healthcare Services | Cheah J.T.S.,National Healthcare Group Polyclinics | Jong M.,Tan Tock Seng Hospital
Annals of the Academy of Medicine Singapore | Year: 2010

Introduction: The National Healthcare Group (NHG) launched an enterprise-wide diabetes registry in 2007. We describe the epidemiology of type 2 diabetes mellitus from 2005 to 2008. Materials and Methods: Patients with encounters in NHG from 2005 were identified for inclusion into the Diabetes Registry from existing stand-alone diabetes registries, ICD9CM diagnosis codes, anti-hyperglycaemic medication and laboratory confirmation. Variables extracted for analysis were demographics (age, gender, ethnicity), diabetes-related comorbidities and complications, most recent anti-hyperglycaemic agents dispensed, and the most recent glycated haemoglobin (HbA1C) measurement. Results: The diabetes registry grew 32% from 129,183 patients in 2005 to 170,513 patients in 2008, making up 12% to 15% of all patients in NHG. About half of the type 2 diabetes patients were aged 45 to 64 years. Females were generally older with a median age of 63 to 64 years vs 59 to 61 years in males. The Indian ethnic group accounted a disproportionately higher 13% of patients. Over 95% of type 2 patients had at least one diabetes-related comorbid condition, and diabetes-related complications were principally renal and cardiovascular complications. The majority (86.2% to 89.2%) of primary care patients were on oral anti-hyperglycaemic agents; however, the rate of insulin treatment increased from 10.8% to 13.8%. HbA1C levels in 2008 improved over that in 2005, with the percentage of patients with good glycaemic control improving with age. Conclusion: The registry has enabled a baseline assessment of the burden and the care of type 2 diabetes patients in NHG, which will provide critical evidence for planning future programmes.

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