Proceedings of Singapore Healthcare

Obesity is a global public health problem. A systematic review showed that intensive behavioural counselling is effective in weight management amongst patients with obesity, but little is known if primary care physicians (PCPs) are involved in delivering such counselling. Studies revealed that patients had weight reduction if they were counselled by PCPs who used the 5As (Ask, Assess, Advise, Agree and Assist) method, but PCPs varied in their use of this tool. We aimed to explore the local PCP modalities of obesity counselling and if their approaches and methods corresponded to the 5As tool.

Qualitative data were obtained from interviews with 50 PCPs from public and private primary care practices during six focus group discussions and seven in-depth interviews. The interviews were audio-recorded, transcribed, audited and analysed iteratively based on the grounded theory. Emergent themes were first externally validated, and then finalized after rounds of deliberations amongst the investigators.

PCPs varied in their approach in obesity counselling, focusing predominantly on “Ask”, “Assess” and “Advise” in the 5As tool. “Asking” was indirect and “Assessment” rarely covered the effects of obesity on psychosocial functioning. Dietary and lifestyle modifications were the main foci in “Advise”. “Agree” was least performed. Polyclinic doctors tended to “Assist” patients with referral to other healthcare workers for further weight management, but few deliberately “Arrange” to review progress in weight management, citing barriers.

PCPs varied in their method of obesity counselling, pending on context and setting of their practices. In contrast to “Ask’, “Assess” and “Advise”, the use of “Agree” and “Arrange” was uncommon.

Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care.

To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore.

An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis.

Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients.

This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.

Men differ from women in their cardiovascular mortality and morbidity globally, possibly due to their varying dietary and lifestyle behavior and usage of medications in dyslipidemia control.

The study aimed to compare the gender differences among community-dwelling Asians in their dietary habits, physical activity, their perception and use of lipid-lowering medications towards achieving their LDL-Cholesterol goals.

A cross-sectional study was conducted, which included patients with physician-diagnosed dyslipidemia, aged 31–80 years in two public primary care clinics in Singapore. They were administered a questionnaire survey on their diet, exercise and lipid-lowering medication. Their latest laboratory fasting lipid tests, retrieved from their electronic health records, defined their treatment goals based on adapted Framingham risk scores.

Amongst 1093 patients, 61.9% were female. Fewer men (65.9%) achieved LDL-C treatment goals compared with women (75.2%). Comparing with their counterpart, more women were willing to change their diet (75.8% vs. 46.2%) and exercise (78.4% vs. 70.9%) to achieve their LDL treatment goals. However, men who were treated with lipid medication were more likely to reach LDL-C treatment goals.

Fewer Asian men in Singapore attained their LDL-C treatment goals than women, which appeared to be associated with greater reluctance to embark on dietary and lifestyle changes. Gender-specific interventions should be considered to address these differences.

Unplanned readmission incurs additional cost to patients and contributes to the rising healthcare cost of our nation. Although numerous studies have investigated the predicting factors that contribute to hospital readmission, the majority of the studies focused on clinical and patient-related factors, and were not from the perspectives of clinicians such as patient navigators (PNs).

To understand factors that predict patients’ readmission risks from the PNs’ perspectives.

Using purposive sampling, PNs with a minimum of 10 years of clinical experience in the adult acute-care setting participated in the focus group interviews. Thematic analysis was adopted.

All 10 PNs agreed that the readmission risk assessment tool was useful as a guide to assess patients’ risk of readmission; however, they also mentioned the use of clinical judgement and experience while assessing their patients. Three themes emerged from this study: (1) looking beyond medical-related issues; (2) social and community support; (3) functional status of patients.

Predicting patients’ risk of readmission is closely tied to the patients’ current medical conditions and caregiving needs. Ensuring individualised readmission risk assessment and identifying social issues early are key in ensuring a holistic discharge planning.

Public primary healthcare clinics in Singapore manage a large proportion of elderly patients with chronic diseases. Inappropriate prescribing of medications and polypharmacy in the elderly are associated with adverse outcomes. It is hence important to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centred process of optimising medication regimens. The study aimed to elucidate patients’ attitudes towards the number of medications they were taking and identify factors that might influence acceptance of deprescription.

A cross-sectional study using the validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was performed at two public primary healthcare institutions in Singapore. Participants were on regular follow-up at the clinics for chronic disease management and had at least five regular prescription medications.

The study found that participants (with a mean age of 68) had an average of four medical conditions and six prescription medications, with the majority (60.3%) expressing that they were taking a large number of medications. Of note, 93.4% of participants were willing to stop one of their medications if advised by the doctor. This was associated with a younger age (<65 years old), not having a discount card for medications and having a higher physician trust score (Wake Forest Physician Trust Score).

This study showed that majority of the participants were willing to cease a medication that their physician thought was no longer required. Factors were also identified which potentially may be targeted to facilitate deprescription.

Insertion of a tube via the nasal passage is a common procedure which has been practiced for many years. There are various ways to assess the position of the nasogastric tube (NGT).

The objective of this study was to discuss the advantages and limitations of each method of NGT placement confirmation, to identify gaps in literature, and provide suggestions for future research.

A search was performed with Pubmed, CINAHL, and Embase. The following keywords were used: “nasogastric,” “tube,” “placement,” “insertion,” and “measurement.” The results were narrowed down to those with full text available, published in the English language, those published within the last 10 years, and those studies done in the adult population. The reference lists of those articles were also referred to and relevant articles were retrieved. A final 26 relevant articles were included in this review, including six that were published more than 10 years ago but still relevant in this review.

A method to confirm NGT placement that is accurate, affordable, does not require gastric aspirates, and is able to be used not only upon insertion but also at regular intervals is lacking.

This article provides a summary of the different methods of NGT placement confirmation and discusses their advantages and limitations. Gaps in literature and suggestions for future research were also deliberated.