Singhealth Polyclinics

Singapore

Singhealth Polyclinics

Singapore
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Lee C.S.,SingHealth Polyclinics | Liew T.M.,National University of Singapore | Liew T.M.,Institute of Mental Health
BMJ Open | Year: 2017

Introduction Inappropriate prescribing has a significant impact on older persons in primary care. Previous reviews on inappropriate prescribing included a heterogeneous range of populations and may not be generalisable to primary care. In this study we aim to conduct a comprehensive systematic review and meta-analysis of the prevalence, risk factors and adverse outcome associated with inappropriate prescribing, specifically among older persons in primary care. Methods and analysis We will search PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO and references of other review articles for observational studies related to the keywords older persons', primary care' and inappropriate prescribing'. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Newcastle-Ottawa Scale. If appropriate, meta-analyses will be performed to pool the data across all the studies. In the presence of heterogeneity, meta-regression and subgroup analyses will also be performed. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ethics and dissemination The results will be disseminated through conference presentations and peer-reviewed publications. They will provide consolidated evidence to support informed actions by policymakers to address inappropriate prescribing in primary care, thus reducing preventable and iatrogenic risk to older persons in primary care. Trial registration number CRD42016048874. © Published by the BMJ Publishing Group Limited.


Lew Q.-L.J.,Singhealth Polyclinics | Jafar T.H.,National University of Singapore | Jafar T.H.,Singapore General Hospital | Koh H.W.,National University of Singapore | And 4 more authors.
Journal of the American Society of Nephrology : JASN | Year: 2017

Randomized controlled trials suggest that protein restriction may retard the progression of CKD toward ESRD. However, the effects of dietary protein intake level and the food sources of dietary protein on the risk of ESRD in the general population remain unclear. We investigated these effects in the Singapore Chinese Health Study, a prospective population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. We collected habitual diet information via a validated semiquantitative food frequency questionnaire and identified ESRD via record linkage with a nationwide registry. In all, 951 cases of ESRD occurred over a mean follow-up of 15.5 years. Regarding total protein intake, compared with the lowest quartile, the three higher quartiles combined had a hazard ratio for ESRD of 1.24 (95% confidence interval [95% CI], 1.05 to 1.46), but the dose-dependent association across the quartiles was not statistically significant (Ptrend=0.16). Red meat intake strongly associated with ESRD risk in a dose-dependent manner (hazard ratio for highest quartile versus lowest quartile,1.40 [95% CI, 1.15 to 1.71; Ptrend<0.001]). Intake of poultry, fish, eggs, or dairy products did not associate with risk of ESRD. In substitution analysis, replacing one serving of red meat with other food sources of protein associated with a maximum relative risk reduction of 62.4% (95% CI, 33.1 to 78.9; P<0.01). Our study shows that red meat intake may increase the risk of ESRD in the general population and substituting alternative sources of protein may reduce the incidence of ESRD. Copyright © 2016 by the American Society of Nephrology.


Tan N.C.,SingHealth Polyclinics | Tan N.C.,National University of Singapore
Singapore Medical Journal | Year: 2014

Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore's primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the 'PAIR UP' approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore.


How C.H.,SingHealth Polyclinics | Chan W.S.D.,KK Womens and Childrens Hospital
Singapore Medical Journal | Year: 2014

Headaches are common in children. Common primary headaches can also be experienced by children. The most common causes of innocent headaches among children are tiredness, shortsightedness, viral fever, sinusitis and psychosocial stressors. Consultation tasks include an attempt to diagnose the headache, the exclusion of sinister causes, and an effort to address any underlying concerns that the child and his/her family members may have. At a busy primary care consultation, the use of a headache symptom diary may provide important information for the evaluation of children presenting with chronic headaches.


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.


Background: Old age and diabetes mellitus are risk factors for vitamin deficiencies, weakness and falls. Deficiencies of Vitamin D, and possibly vitamin B12 and folate (which are associated with hyperhomocysteinaemia), contribute to sarcopenia. Determination of the physical effects of vitamin deficiencies in specific groups of people can help to guide public health policy with regard to vitamin supplementation. Methods: A pilot cross-sectional study was conducted to determine the association of levels of Vitamin D, vitamin B12, folate and homocysteine with muscle strength, gait and fall history in 56 patients >65 years old with diabetes mellitus in primary care in Singapore. Hand-grip and leg-quadriceps strength measures were obtained and divided by body mass index (BMI). The timed up-and-go and Tinetti tests were used to measure gait. A history of "at least one fall in the preceding year" was obtained. Results: Vitamin B12 deficiency (<150 pmol/l) was present in 43 % of patients, folate deficiency (<13.5 mmol/l) in 20 %, hyperhomocysteinaemia (≥15.0 μmol/l) in 52 % and Vitamin D deficiency (<49.9 nmol/l) in 25 %. Levels of Vitamin D, vitamin B12 and homocysteine did not significantly predict muscle strength in regression analyses. Folate (B = 0.010, P < 0.01) and gender (B = 0.356, P < 0.001) predicted average grip strength corrected for BMI (F(2,53) = 17.74, P < 0.001, R 2 = 0.40) Folate (B = 0.011, P < 0.05) and gender (B = 0.367, P < 0.001) also predicted average leg quadriceps strength corrected for BMI (F(2,53) = 9.79, P < 0.001, R 2 = 0.27). Average leg strength and average leg strength corrected for BMI were both negatively associated with the risk of having fallen in the preceding year (odds ratio (OR) = 0.89, 95 % CI 0.80-0.98, P < 0.05 and OR = 0.12, 95 % CI 0.02-0.92, P < 0.05, respectively). Conclusions: The prevalence of vitamin deficiency was very high in our sample of patients >65 years old with diabetes mellitus. Folate levels were significantly correlated with grip and leg strength (with correction for BMI). Leg strength was positively correlated with gait measures and negatively correlated with a history of falls. The role of folate in muscle weakness and falls warrants further study. © 2016 The Author(s).


How C.H.,SingHealth Polyclinics
Proceedings of Singapore Healthcare | Year: 2011

Health literacy is an important concept that is increasingly being recognised internationally worldwide as a fundamental skill required in maintaining health and accessing the local healthcare system. Not recognising low health literacy can be serious and costly as Singapore's population ages and chronic disease becomes more prevalent. As there are few local studies available, this clinical review highlights the current known prevalence and problem of health literacy in other countries; the assessment tools available; and some useful lessons we can draw from published interventions. This review may be useful in promoting awareness of health literacy, generating interest in this area among clinicians and inspiring more local work into this emerging field.


How C.H.,SingHealth Polyclinics | Quah H.M.J.,SingHealth Polyclinics
Singapore Medical Journal | Year: 2014

Hypertension is the most common chronic condition seen in primary care. It is a potentially modifiable risk factor for cardiovascular and renal complications. The latest Joint National Committee recommendations in 2014 address common clinical questions from the best available science with regard to managing patients with hypertension. We review some of these recommendations and discuss how they may be applied in our practice.


How C.H.,SingHealth Polyclinics
Proceedings of Singapore Healthcare | Year: 2011

Diabetes mellitus is a common chronic condition and an old friend to family physicians practising in the community. The long-standing practice had aimed to lower glucose levels in type 2 diabetes to prevent long-term complications. The recent evidence from some publications since June 2008 had suggested the possible harm to our patients when we adopt intensive treatment strategies with tight treatment control targets (below HbA1c of 6%) and many meta-analyses have been published. This review highlights the evidence from recent studies that shook the previous dogma and the new clinical equipoise.


Ng L.P.,SingHealth Polyclinics | Goh P.S.C.,SingHealth Polyclinics
Singapore Medical Journal | Year: 2014

Introduction The incidence of cough induced by angiotensin-converting enzyme (ACE) inhibitors has been reported to be 5%-20%, with less than half of affected patients requiring discontinuation due to persistent cough. However, the incidence in the local Asian population has not been studied. This study aimed to objectively evaluate the incidence of discontinuation of ACE inhibitors due to cough, in a primary healthcare centre in Singapore. Methods We retrospectively reviewed the medical records, both electronic and written, of patients who attended Tampines Polyclinic to identify those who were newly prescribed ACE inhibitors. The written medical records were analysed to identify patients who discontinued the use of ACE inhibitors and to find out the reasons for discontinuation. Results A total of 424 patients were identified during the study period. Out of the 424 patients, 129 (30.4%) discontinued the use of ACE inhibitors due to cough. Overall, 90 (21.2%) patients who were initially started on ACE inhibitors were eventually switched to angiotensin receptor blockers (ARBs). Conclusion In our cohort, the incidence of discontinuation of ACE inhibitors due to cough is higher than most other studies. The relationship between ethnicity and tolerance of medications should not be underestimated. As there is a high incidence of discontinuation of ACE inhibitors due to cough in the local population, ARBs may be a reasonable substitute as a first-line medication, if clinically indicated.

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