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Aims: This study aimed to (i) evaluate the effectiveness of mindfulness‐based interventions in improving self‐efficacy, reducing stress and anxiety among peritoneal dialysis patients, and (ii) compare the most effective method of mindfulness based interventions. Methods: This randomized three‐arm controlled trial recruited first‐time peritoneal dialysis patients from the peritoneal dialysis outpatient clinic in Singapore. Patients were randomly allocated to either video‐assisted mindfulness training, therapist‐assisted mindfulness training or treatment‐as‐usual. All groups received 4.5 days of structured peritoneal dialysis training at the peritoneal dialysis centre, while video‐assisted mindfulness training and therapist‐assisted mindfulness training groups were taught additional mindfulness‐based techniques. The perceived stress scale, self‐efficacy, and anxiety (State and Trait Anxiety Inventory) were measured at baseline, 4‐ and 12 weeks post‐randomization, using reliable and valid instruments. Results: Thirty‐nine patients were recruited (13 in each group). All the therapies showed a significant time trend in anxiety. Only therapist‐ and video‐assisted mindfulness training showed a significant trend in perceived stress scale scores but not treatment‐as‐usual. All Intervention X Time interactions were not significant. Patients in therapist‐ and video‐assisted mindfulness training groups had reduced perceived stress scale scores compared to treatment‐as‐usual at week 12. Conclusion: This study demonstrated the potential of mindfulness‐based interventions in reducing stress among first‐time PD patients. Summary Statement: What is already known about this topic? Mindfulness‐based interventions have been recommended to mediate stressful events.Mindfulness‐based interventions as complementary therapy can be taught to patients who are starting peritoneal dialysis for the first time; however, the best method to guide mindfulness‐based interventions is unknown. What this paper adds? The findings showed that mindfulness‐based interventions can potentially reduce stress and anxiety but have no statistically significant effect on self‐efficacy for patients undergoing peritoneal dialysis for the first time.Video‐ or therapist‐guided mindfulness training is just as effective in teaching mindfulness‐based interventions. The implications of this paper: Nurses hold an essential role in improving the experience of patients undergoing peritoneal dialysis by advocating and facilitating the use of MBI during dialysis, especially those who display high levels of stress and anxiety, as well as signs of coping issues. [ABSTRACT FROM AUTHOR]

Probation has been in existence in Singapore for more than 70 years. Given its long existence and vested interest in community-based sentencing, this paper calls for an effective measurement of probation officers training and supervision of the offenders measured against recidivism. First the paper focuses on the genesis and evolution of probation coupled with a brief description of programs conducted by probation officers since its introduction till its present iteration, along with its merits. The emphasis lies in the shift from a supervisory program to one which proactively seeks to transform behaviour, hence reaffirming remodelling character of probation. Second, it is recommended that effectiveness of training, supervision of offenders by Probation Officers be measured against the rate of recidivism. To this end, it is proposed that effectiveness of probation can only be measured against recidivism given that probation targets criminogenic needs of offenders. An evaluation of data presented on recidivism suggests that while the recidivism rate is decreasing, it does not maximize the potential role of Probation Officers. Third, training along the lines of Strategic Training Initiative in Community Supervision (STICs) program can be considered to enhance lower recidivism rates. Lastly, it is recommended that Randomized Controlled Trials (RCTs) be conducted for evidence-based policy making in criminal justice system, since RCTs can be useful in assessing the efficacy of probation as a community-based sentencing tool, particularly whether the policy orientation of probation meets the goal of reducing crime. [ABSTRACT FROM AUTHOR]

Background: Specialist palliative care is often provided late in the patient's disease trajectory in response to uncontrolled symptoms. Shifting from this reactionary illness-stress paradigm to a proactive health-wellness approach, the ENABLE (Educate, Nurture, Advise, Before Life Ends) telehealth model aims to enhance the coping, stress and symptom management, self-care, and advance care planning skills of patients with advanced cancers and their caregivers. The ENABLE model has been culturally adapted to Singapore (ENABLE-SG) and pilot-tested. A hybrid type 1 effectiveness-implementation design will be used to evaluate the effectiveness of ENABLE-SG while collecting real-world implementation data. Methods: This single-centre, assessor-blind, wait-list (immediately vs. 6 months) randomized controlled trial will recruit 300 adult patients within 60 days of an advanced cancer diagnosis and their family caregivers from the National Cancer Centre of Singapore. ENABLE-SG comprises structured psychoeducational sessions with a telehealth coach, covering essential topics of early palliative care. Participants will be assessed at baseline and every 3 months until patient's death, 12 months (caregivers), or end of study (patients). The primary outcome is patient quality of life 6 months after baseline. Secondary patient-reported outcomes include mood, coping, palliative care concerns, and health status. Secondary caregiver-reported outcomes include caregiver quality of life, mood, coping, and care satisfaction. Mixed-effects regression modelling for repeated measurements will be used. To assess the effectiveness of ENABLE-SG versus usual care, patient and caregiver outcomes at 6 months will be compared. To compare earlier versus delayed ENABLE-SG, patient and caregiver outcomes at 12 months will be compared. Within the hybrid type 1 effectiveness-implementation design, implementation outcomes will be evaluated in both the early and delayed groups. Acceptability, adoption, appropriateness, and feasibility will be assessed using a feedback survey and semi-structured interviews with a purposive sample of patients, caregivers, and healthcare providers. Transcribed interviews will be analysed thematically. Other implementation outcomes of penetration, fidelity, and cost will be assessed using records of study-related processes and summarized using descriptive statistics. A cost-effectiveness analysis will also be conducted. Discussion: This study will assess both effectiveness and implementation of ENABLE-SG. Insights into implementation processes can facilitate model expansion and upscaling. Trial registration: Registered prospectively on ClinicalTrials.gov, NCT06044441. Registered on 21/09/2023. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a debilitating disease. Adequate calcium consumption and physical activity are the two major modifiable risk factors. This paper describes the major outcomes and efficacy of a workplace-based targeted behaviour change intervention to improve the dietary and physical activity behaviours of working women in sedentary occupations in Singapore.Methods: A cluster-randomized design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the units of randomization and intervention. Sixteen workplaces were recruited from a pool of 97, and randomly assigned to intervention and control arms (eight workplaces in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organization-wide educational activities. Workplaces in the control/standard care arm received print resources. Outcome measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, 4 weeks and 6 months post intervention. Adjusted cluster-level analyses were conducted comparing changes in intervention versus control groups, following intention-to-treat principles and CONSORT guidelines.Results: Workplaces in the intervention group reported a significantly greater increase in calcium intake and duration of load-bearing moderate to vigorous physical activity (MVPA) compared with the standard care control group. Four weeks after intervention, the difference in adjusted mean calcium intake was 343.2 mg/day (95 % CI = 337.4 to 349.0, p < .0005) and the difference in adjusted mean load-bearing MVPA was 55.6 min/week (95 % CI = 54.5 to 56.6, p < .0005). Six months post intervention, the mean differences attenuated slightly to 290.5 mg/day (95 % CI = 285.3 to 295.7, p < .0005) and 50.9 min/week (95 % CI =49.3 to 52.6, p < .0005) respectively.Conclusion: This workplace-based intervention substantially improved calcium intake and load-bearing moderate to vigorous physical activity 6 months after the intervention began.Trial Registration: Australia New Zealand Clinical Trial Registry ACTRN12616000079448 . Registered 25 January 2016 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Past research shows that young adults have poor knowledge of age-related fertility decline and that the provision of information can improve fertility knowledge. We provide university students with information on age-related fertility and fertility-related policies and investigate whether the provision of such information affects their family formation and career expectations. Methods: A three-armed randomized controlled trial was conducted online in Singapore between September and October 2021. A total of 1000 undergraduate students were recruited through campus advertisements to complete a 30- to 45-minute online survey, which randomly exposed participants to one of three informational brochures on age-related fertility decline, fertility policies, or diabetes (control group). Participants answered questions on family formation and career expectations both before and after the information intervention. Analysis of covariance was used to assess the effects of the information intervention. Results: Exposure to age-related fertility information resulted in significant reductions in the ideal age at first childbirth, significant increases in the expected probability of marriage before age 30, and (among female participants) significant increases in the expected likelihood of undergoing social egg-freezing. No difference existed in child-number ideals, educational aspirations, and income expectations between groups after exposure. No difference existed between the fertility policy information group and the control group after exposure in any of the outcomes of interest. Conclusions: Information on age-related fertility decline brought forward university students' expected timing of childbearing and marriage without reducing their educational and career expectations. The provision of fertility information at early ages, such as during university, can help correct widespread inaccurate beliefs about fertility and promote realistic family formation planning without adversely affecting educational and career goals. Trial registration: ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tan T-C, Yan S, Chua T, Biswas A, Chong Y-S. A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG 2010;117:1270–1277. Objective We studied the efficacy of 25-μg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming. Design and setting A randomised controlled trial in Singapore. Population One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) ≤6 from 2003 to 2004. Method Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen. Main outcome measures Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome. Results More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) ( P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06–0.77). Conclusion Double-dose misoprostol 25 μg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction. [ABSTRACT FROM AUTHOR]

Analysis of thermograms has often been subjective and has resulted in inconsistency in the diagnosis of breast diseases by thermography. The aim of this paper is to study the problem of subjective interpretation of breast thermograms and hence using thermography as an adjunct tool for breast cancer diagnosis. It ws proposed that the thermograms should be taken within the recommended screening period, classified and analysed in conjunction with an artificial neural network (ANN). Qualitative interpretation of thermal images can be carried out using an active contours algorithm. The 256 x 200 pixel image can be segmented as one of the inputs to the ANN. To achieve quantitative analysis of the breast thermograms, firstly the inputs of the ANN should be determined, so that the thermograms could be successfuly classified and based on the suggested inputs. [ABSTRACT FROM AUTHOR]

A cost-minimization analysis was conducted for Klebsiella pneumoniae liver abscess (KLA) patients enrolled in a randomized controlled trial which found oral ciprofloxacin to be non-inferior to intravenous (IV) ceftriaxone in terms of clinical outcomes. Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus IV ceftriaxone administered to 152 hospitalized adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer, and compared between oral and IV antibiotic groups over the trial period of 12 weeks. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was $16,378 (95% CI, $14,620–$18,136) for the oral ciprofloxacin group and $20,569 (95% CI, $18,296–$22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient service costs. Trial registration: ClinicalTrials.gov Identifier NCT01723150 (7/11/2012). [ABSTRACT FROM AUTHOR]

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general. [ABSTRACT FROM AUTHOR]

Background: The epidemic of non-communicable diseases (NCDs) is a growing concern worldwide and Singapore is no exception to this global trend. As part of measures to address this concern, the Singapore government will implement a mandatory color-coded front-of-package (FOP) nutrition label for beverages, called Nutri-Grade (NG), which will complement the existing FOP label, Healthier Choice Symbol (HCS) logos, currently displayed on select food and beverage items. NG grades beverages on a four-point scale, A (healthiest) to D (least healthy), in terms of sugar and saturated fat levels. This study aimed to evaluate the effectiveness of the NG label on nutritional quality of pre-packaged beverages using a fully functional online grocery store. Methods: We conducted a 2-arm crossover trial involving actual purchases with 138 participants randomly exposed to: 1) Control with HCS logos displayed on qualifying items; 2) Similar to Control except that all beverages displayed the NG label. The effects of the NG label were estimated using a linear mixed-effects model that addresses correlations between repeated measures and accommodates missing data. Results: We found that the NG label encouraged consumers to choose beverages with higher ratings. This led to a reduction in sugar from beverages purchased by 1.51 g [95% CI: − 2.68, − 0.34] per serving but was not effective at reducing saturated fat purchased (− 0.009 g [95% CI: − 0.22, 0.20]) per serving or improvements in overall diet quality, measured by the weighted (by the number of servings) average Nutri-Score value ranging from 1 to 5 (− 0.024 [95% CI: − 0.13, 0.08]). Conclusions: Results suggest that the Nutri-Grade label is likely to reduce sugar purchased from beverages. However, to improve overall diet quality in Singapore, additional measures will be needed. Trial registration: This trial was registered on ClinicalTrials.gov under the identifier: NCT05018026 on 24th August 2021. [ABSTRACT FROM AUTHOR]

Background: Axial spondyloarthritis (AxSpA) is a chronic disease which results in fatigue, pain, and reduced quality of life (QoL). Traditional Chinese medicine (TCM), especially acupuncture, has shown promise in managing pain. Although a TCM collaborative model of care (TCMCMC) has been studied in cancer, there are no randomized controlled trials investigating TCM in AxSpA. Therefore, we will conduct a pragmatic trial to determine the clinical effectiveness, safety, and cost-effectiveness of TCMCMC for patients with AxSpA. We define TCMCMC as standard TCM history taking and physical examination, acupuncture, and TCM non-pharmacological advice and communications with rheumatologists in addition to usual rheumatologic care. The purpose of this paper is to describe the rationale for and methodology of this trial.Methods/design: This pragmatic randomized controlled trial will recruit 160 patients who are diagnosed with AxSpA and have inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs). Simple randomization to usual rheumatologic care or the intervention (TCMCMC) with a 1:1 allocation ratio will be used. Ten 30-min acupuncture sessions will be provided to patients assigned to the TCMCMC arm. All participants will continue to receive usual rheumatologic care. The primary endpoint - spinal pain - will be evaluated at week 6. Secondary endpoints include clinical, quality of life, and economic outcome measures. Patients will be followed up for up to 52 weeks, and adverse events will be documented.Discussion: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of a TCMCMC for patients with AxSpA.Trial Registration: ClinicalTrials.gov, NCT03420404 . Registered on 14 February 2018. [ABSTRACT FROM AUTHOR]

Assistive Technology (AT) has become a prevalent form of dyslexia intervention for addressing students' challenges in reading and learning. Besides improved reading and learning outcomes, AT use can also help to address students' psycho-social and behavioural needs. Lexicaid is a novel mobile application that was developed collaboratively based on input from various dyslexia stakeholders. To determine the efficacy of Lexicaid, a preliminary user study was conducted with students undergoing formal dyslexia remediation at the Dyslexia Association of Singapore. As part of a home-based study, a final number of 31 students (Mage=10.84 years, SD=1.39) participated in a user study involving Lexicaid over a period of six weeks whilst completing daily reading and learning activities. Participants were assessed on their reading motivation, self-perception, and reading and language skills before and after the intervention period. Although no significant effects were found between the experimental (n=18) and control (n=13) groups' pre and post scores on measures of reading and language, we found significant improvements in students' selfperception of writing and overall findings suggest that students saw improvements in their self-perception of writing and reading capabilities as well as a greater value in reading after the intervention using Lexicaid. [ABSTRACT FROM AUTHOR]

Previous research has shown that a Preschool Intervention Programme (PELP) designed and delivered in Singapore based on Orton Gillingham small group support led to significant improvements in early literacy with large effect sizes (Sim et al., 2015). However, it was unclear how much of this improvement was the result of maturation over time, because this earlier study did not include controls. Moreover, it was not clear whether or not satisfactory gains could be achieved with a shorter targeted programme. In order to address this, a controlled short-term study with a repeated measures design investigated the impact of this Programme on children who had been identified as struggling in the early years environment.. Participants (14 control group and 13 intervention group) completed a pre assessment battery followed by post assessment 10 weeks later. The intervention group underwent 20 hours of early literacy intervention over 10 weeks focusing on key aspects of early literacy, while the control group did not attend any form of intervention apart from normal kindergarten attendance. The results indicated that the experimental group outperformed the control group in phonogram knowledge, phonemic awareness, high frequency words, reading and spelling. The control group made significant improvements in spelling and sentence copying only, with all other measures largely unchanged over time. The implications of this study are that we cannot rely on the process of maturation to improve the skills of preschool children who are not keeping pace with their peers, and without explicit intervention they will continue to fall further behind and struggle with ongoing learning. Directions for policy and practice will be considered. [ABSTRACT FROM AUTHOR]

Background: We report long-term safety and immunogenicity of Takeda's tetravalent dengue vaccine candidate (TAK-003) in healthy children and adults living in dengue-endemic areas in Puerto Rico, Columbia, Singapore, and Thailand.Methods: In part 1 of this phase 2, randomized, placebo-controlled trial we sequentially enrolled 1.5-45 year olds (n = 148) into 4 age-descending groups, randomized 2:1 to receive 2 doses of TAK-003 or placebo 90 days apart. In part 2, 1-11 year olds (n = 212) were enrolled and randomized 3:1 to TAK-003 or placebo groups. We assessed neutralizing antibody titers for the 4 dengue serotypes (DENV) up to month 36 in part 1, and symptomatic dengue and serious adverse events (SAEs) up to month 36 in both parts.Results: At month 36, seropositivity rates were 97.3%, 98.7%, 88.0% and 56.0% for DENV-1, -2, -3 and -4, respectively. Seropositivity rates varied significantly for DENV-4 according to serostatus at baseline (89.5% in seropositives versus 21.6% in seronegatives). No vaccine-related SAEs were reported.Conclusions: The trial demonstrated persistence of neutralizing antibody titers against TAK-003 over 3 years in children and adults living in dengue-endemic countries, with limited contribution from natural infection. TAK-003 was well tolerated.Clinical Trials Registration: NCT01511250. [ABSTRACT FROM AUTHOR]

Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence‐associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open‐label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty‐four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P =.66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%‐14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care. [ABSTRACT FROM AUTHOR]

Background: Deprescribing is effective and safe in reducing polypharmacy among the elderly. However, the impact of deprescribing rounds remain unclear in Asian settings. Hence, we conducted this study.Methods: An open label randomised controlled trial was conducted on patients of 65 years and above, under rehabilitation or subacute care and with prespecified medications from a Singapore rehabilitation hospital. They were randomised using a computer generated sequence. The intervention consisted of weekly multidisciplinary team-led deprescribing rounds (using five steps of deprescribing) and usual care. The control had only usual care. The primary outcome is the percentage change in total daily dose (TDD) from baseline upon discharge, while the secondary outcomes are the total number of medicine, total daily cost and TDD up to day 28 postdischarge, overall side-effect rates, rounding time and the challenges. Efficacy outcomes were analysed using intention-to-treat while other outcomes were analysed as per protocol.Results: 260 patients were randomised and 253 were analysed after excluding dropouts (female: 57.3%; median age: 76 years). Baseline characteristics were largely similar in both groups. The intervention arm (n = 126) experienced a greater reduction of TDD on discharge [Median (IQR): - 19.62% (- 34.38, 0.00%) versus 0.00% (- 12.00, 6.82%); p < 0.001], more constipation (OR: 3.75, 95% CI:1.75-8.06, p < 0.001) and laxative re-prescriptions (OR: 2.82, 95% CI:1.30-6.12, p = 0.009) though death and hospitalisation rates were similar. The median rounding time was 7.09 min per patient and challenges include the inconvenience in assembling the multidisciplinary team.Conclusion: Deprescribing rounds can safely reduce TDD of medicine upon discharge compared to usual care in a Singaporean rehabilitation hospital.Trial Registration: This study is first registered at Clinicaltrials.gov (protocol number: NCT03713112 ) on 19/10/2018 and the protocol can be accessed on https://www.clinicaltrials.gov . [ABSTRACT FROM AUTHOR]

Background: The benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown. Aim: To compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians. Design: An open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509. Setting/participants: Cancer patients admitted to the oncology inpatient service of an acute hospital in Singapore. Results: A total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI −0.04 to 1.45, p = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05–1.65, p = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63–4.61, p = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79–1.35, p = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90–1.58, p = 0.215) were similar between the consult and co-rounding models. Conclusions: The co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar. [ABSTRACT FROM AUTHOR]

Purpose: One of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water. Methods: A total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. Results: Comparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h. Conclusion: The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19. ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered [ABSTRACT FROM AUTHOR]

Background: Enhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore.Methods: This three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women's and Children's Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022.Discussion: This study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes.Trial Registration: ClinicalTrials.gov NCT04275765 . Registered on 19 February 2020. [ABSTRACT FROM AUTHOR]

Introduction: The SINGER pilot randomized controlled trial aims to examine the feasibility and acceptability of the Finnish Geriatric Intervention Study (FINGER) multidomain lifestyle interventions compared to Singaporean adaptations. Methods: Seventy elderly participants were recruited and randomized into FINGER (n = 36) or SINGER (n = 34) interventions; involving physical exercise, cognitive training, diet, and vascular risk factors management, for 6 months. Results: Both intervention groups were equally feasible and acceptable with participants completing at least 80% of the interventions. Body strength improved in both groups (Pupper body = .04, Plower body = .06, Pcore = .05). More participants in the SINGER group attained good blood pressure control at month-6 compared to FINGER (41% vs 19%; P = .06). Discussion: This study is the first to compare the feasibility of multi-domain interventions adapted to local culture with the FINGER interventions. The findings will be utilized for a larger study to provide evidence for the efficacy of multi-domain lifestyle interventions in preventing cognitive decline. [ABSTRACT FROM AUTHOR]

Background: The effectiveness and portability of the collaborative care model in the primary care treatment of depression has not been demonstrated in many randomized controlled trials in healthcare settings across the world. We determined the effectiveness of collaborative care management of elderly depression in the primary care setting in Singapore.Method: Eligible participants with depressive symptoms were randomized to 6-month duration usual care (UC, N = 112) or collaborative care (CC, N = 102). Outcome measures were HDRS-17, GDS, BDI and SF-12 MCS QOL measured at 3, 6, and 12-month, care satisfaction at 6-month, and also measured on 120 participants who refused referral (non-receipt of care, NC). Primary outcome was HDRS-17 measure of depression severity, response and remission at 6-month.Results: HDRS scores in CC group compared to UC group were reduced more at 6-month (1.5 points difference in change from baseline), and also at 3 and 12-month, with similar observations of differences for GDS and BDI. There was significantly greater improvement for both CC and UC groups compared to NC group. The CC group was about 1.5 times more likely to show HDRS treatment response and remission, and more than two times likely to show GDS treatment response and remission than the UC and NC groups, as well as better quality of life improvement (P < .001) and better care satisfaction (P < .001).Conclusion: Collaborative care is effective for primary care treatment of older persons with depression and is portable in diverse health care settings. [ABSTRACT FROM AUTHOR]

Background: Efforts to improve quality of end-of-life (EOL) care are increasingly focused on eliciting patients' EOL preference through advance care planning (ACP). However, if patients' EOL preference changes over time and their ACP documents are not updated, these documents may no longer be valid at the time EOL decisions are made. Objectives: To assess extent and correlates of changes in stated preference for aggressive EOL care over time. Design: Secondary analysis of data from a randomized controlled trial of a formal ACP program versus usual care in Singapore. Patients: Two hundred eighty-two patients with heart failure (HF) and New York Heart Association Classification III and IV symptoms were recruited and interviewed every 4 months for up to 2 years to assess their preference for EOL care. Analytic sample included 200 patients interviewed at least twice. Results: Nearly two thirds (64%) of patients changed their preferred type of EOL care at least once. Proportion of patients changing their stated preference for type of EOL care increased with time and the change was not unidirectional. Patients who understood their prognosis correctly were less likely to change their preference from non-aggressive to aggressive EOL care (OR 0.66, p value 0.07) or to prefer aggressive EOL care (OR 0.53; p value 0.001). On the other hand, patient-surrogate discussion of care preference was associated with a higher likelihood of change in patient preference from aggressive to non-aggressive EOL care (OR 1.83; p value 0.03). Conclusion: The study provides evidence of instability in HF patients' stated EOL care preference. This undermines the value of an ACP document recorded months before EOL decisions are made unless a strategy exists for easily updating this preference. Trial Registration: ClinicalTrials.gov: NCT02299180 [ABSTRACT FROM AUTHOR]

Background: Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore's National University Hospital. Methods: Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results: CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion: A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life. [ABSTRACT FROM AUTHOR]

We test and compare different incentives in motivating water conservation using a randomized controlled trial. In a field experiment carried out with Singaporean households, regular feedback was given, with informative, normative and monetary incentives provided to different groups. Evidence shows that all households saved an average of 4 Litres of water per person per day, with no difference in treatment effect found across various groups. Perhaps unsurprisingly, the water saving effect is also found to be more significant with high baseline users, who saved up to 5.9 Litres per person per day. High baseline households also respond more positively to the non-monetary incentives. [ABSTRACT FROM AUTHOR]

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Background: Regular participation in moderate-to-vigorous physical activity (MVPA) is important to manage obesity. Physical education (PE) is considered to play an important role in promoting lifelong participation in physical activity (PA) because it provides an existing network where cost-effective interventions can be implemented to produce sustainable change in health behavior. However, the association between compulsory school PA (e.g., PE lessons) and body composition levels has received mixed support in the literature. Therefore, the present study aimed to investigate whether a school-based intervention targeting salient PA benefits and barriers grounded on the theory of planned behavior would promote young people's participation in MVPA during leisure time and reduce body mass index (BMI) of overweight students.Methods/design: A total of 171 students from 3 secondary schools in Singapore underwent the control condition followed by the intervention condition. Both the conditions consisted of PE lessons twice per week over 4 weeks. In the control condition, PE teachers encouraged students to participate in PA during leisure time without providing persuasive message. While in the intervention condition, PE teachers delivered persuasive messages that targeted the salient benefits and barriers associated with PA to the students at the last 5 to 10 min of each PE lesson. PA levels over a week were measured objectively with wrist-mounted GENEActiv Original accelerometers and subjectively with self-reporting questionnaires three times (Baseline, Post 1, and Post 2) in each condition. Student's self-reported PA level was measured using the Leisure-Time Physical Activity Participation Questionnaire and the International Physical Activity Questionnaire, and their attitudes, intentions, subjective norms and perceived behavior control towards leisure-time PA were measured with a questionnaire based on the theory of planned behavior. Furthermore, students' intention, determination and willingness to engage in leisure-time PA were compared with the other activity (e.g., doing homework, shopping).Discussion: This study will provide the evidence on the effectiveness of a cost-effective school-based intervention on reducing BMI of overweight students through promoting sustained participation in leisure-time PA. It will also address methodological issues on the gaps between objective and subjective measures of PA.Trial Registration: This trial is registered with the ISRCTN registry (ISRCTN73786157, 26/10/2017, retrospectively registered). [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore. Background: In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people. Design: A stratified randomized control trial with process evaluation is proposed. Methodology: The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme. Discussion: The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senioronly households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore.Methods: We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was used to characterize antibiotic resistance genes, MLST, plasmids and phylogenetic relationships. Antibiotic susceptibility was determined using disc diffusion and Etest.Results: A total of 70 3GC-R E. coli were included, of which the majority were ST131 (61.4%). BSI was most frequently from a urinary source (69.6%), community associated (62.9%) and in older patients (median age 71 years). The median Pitt score was 1 and ICU admission was infrequent (3.1%). ST131 possessed more acquired resistance genes than non-ST131 (P = 0.003). Clade C1/C2 ST131 predominated (30.2% and 53.5% of ST131, respectively) and these were all ciprofloxacin resistant. All clade A ST131 (n = 6) were community associated. The predominant ESBL types were blaCTX-M (80.0%) and were strongly associated with ST131 (95% carried blaCTX-M), with the majority blaCTX-M-15. Clade C1 was associated with blaCTX-M-14 and blaCTX-M-27, whereas blaCTX-M-15 predominated in clade C2. Plasmid-mediated AmpC genes (mainly blaCMY-2) were frequent (17.1%) but were more common in non-ST131 (P < 0.001) isolates from Singapore and Brisbane. Two strains carried both blaCMY-2 and blaCTX-M. The majority of plasmid replicon types were IncF.Conclusions: In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in association with blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2. [ABSTRACT FROM AUTHOR]

Aim To develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes for people with poorly controlled type 2 diabetes in Singapore. Background Over the past decades, Asia has emerged as the 'diabetes epicentre' in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective care management strategies in response to this rising diabetes epidemic. Design A randomized controlled trial with pre- and repeated posttests control group design. Methodology A total of 128 adults with poorly controlled type 2 diabetes will be recruited from the diabetes clinic of a public acute hospital in Singapore through convenience sampling. Study participants will be randomly allocated either to the experimental group or the control group. Outcome measures will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities and 19-item Diabetes-Dependent Quality of Life. Data will be collected at three time points: baseline, 3 and 6 months from the baseline. Discussion It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Furthermore, the self-supporting and less resource-intensive nature of this programme, using a smartphone application as the mode of intervention delivery, will greatly reduce nurses' direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with ClinicalTrials.gov. The trial registration number is NCT03088475. [ABSTRACT FROM AUTHOR]

Aims and Objectives To evaluate the effectiveness of the Illness Management and Recovery Program in comparison with the current standard of care in terms of reduction of symptoms, rehospitalisation rates and social functioning in Asia. Background Focus of treatment for Mental Health had been shifted from mere management of symptoms to that of achievement of recovery. In the recovery process, strategies to achieve higher level of functioning were used ( Psychiatric Services 2014, 65, 171). However, two main factors hindered clients from attaining recovery: first, the lack of Mental Health resources in the community and second the negative attitudes of healthcare professionals towards mental illness ( American Journal of Psychiatric Rehabilitation 2012, 15, 131). Hence, it is essential to implement an effective programme that will train mental health professionals to use more effective techniques and materials in helping the clients to better integrate into society by achieving skills in their attempt to work towards recovery. Design This study adopts a time series experimental quantitative design. Methods Fifty participants who consented to the study were randomly assigned to two groups. Participants in the experimental group received the experimental management and recovery programme, while the control group received standard care management by the community psychiatric nurses for a period of 12 months. Results Participants in the experimental group reported significantly lower number of admissions, shorter length of stay, lower Brief Psychiatric Rating Scale scores, and also reported significantly higher scores on both the Illness Management and Recovery Scale and the Global Assessment Scale. Conclusion This study demonstrated the effectiveness of IMR in helping Asian people with mental illness to not only reduce symptoms and hospitalisations but also improve social functioning. They have benefitted from the program although they are living in a different cultural setting from where IMR was developed. Relevance to Clinical Practice The success of this study has raised the standard of care in the community intervention and led more people to their recovery. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to describe a study protocol that evaluates the effectiveness of the 'Home-but not Alone' educational programme delivered via a mobile health application in improving parenting outcomes. Background The development in mobile-based technology gives us the opportunity to develop an accessible educational programme that can be potentially beneficial to new parents. However, there is a scarcity of theory-based educational programmes that have incorporated technology such as a mobile health application in the early postpartum period. Design A randomized controlled trial with a two-group pre-test and post-test design. Methods The data will be collected from 118 couples. Eligible parents will be randomly allocated to either a control group (receiving routine care) or an intervention group (routine care plus access to the 'Home-but not Alone' mobile health application. Outcome measures comprise of parenting self-efficacy, social support, parenting satisfaction and postnatal depression. Data will be collected at the baseline (on the day of discharge) and at four weeks postpartum. Discussion This will be an empirical study that evaluates a theory-based educational programme delivered via an innovative mobile health application on parental outcomes. Results from this study will enhance parenting self-efficacy, social support and parenting satisfaction, which may then reduce parental risks of postnatal depression. [ABSTRACT FROM AUTHOR]

Aim To develop and examine the effectiveness of an advanced practice nurse-led telehealth rehabilitative programme as a transitional nursing therapeutic on readmission rates and health-related outcomes among patients with acute myocardial infarction postdischarge. Background Patients suffering from acute myocardial infarction are experiencing an increasing trend of frequent readmissions. This implicates both the effectiveness of healthcare services and patient's quality of life. Advanced Practice Nurse-led telehealth rehabilitative programme has yet to be explored as a strategy to minimize preventable readmissions and improve patient's self-efficacy so as to enhance quality of life after a heart attack. Design Randomized controlled trial with repeated measures. Methodology A consecutive sampling of 172 patients with acute myocardial infarction will be recruited from a tertiary acute hospital in Singapore. Participants will be randomized into two groups. The experimental group ( ALTRA) will receive Advanced Practice Nurse-led telehealth rehabilitative programme on discharge. The control group will receive only standard follow-up care. The outcome measures include readmissions, cardiac self-efficacy, cardiovascular risk factors, quality of life, anxiety and depression. The data will be collected at the baseline, 1 and 6 month postdischarge. A postprogramme evaluation will be conducted among the participants to assess its acceptability, strengths and weakness. Discussion ALTRA aims to engage and support patients with acute myocardial infarction by increasing self-care management through education and telehealth contacts with Advanced Practices Nurses. This provides a smoother transition of illness to health and ultimately, reduces preventable costly readmissions. Trial registration The study has been registered with clinicaltrials.gov. The trial registration number is NCT02483494. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20-50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia.Methods/design: We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint.Discussion: Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability.Trial Registration: ClinicalTrials.gov Identifier: NCT02365493 . Registered 24 February 2015. [ABSTRACT FROM AUTHOR]

Aim To examine the effects of a therapeutic play intervention for children on parents' perioperative anxiety, the relationship between parents' and their children's anxiety and to explore parents' perceptions of the intervention. Background Therapeutic play intervention was found to reduce children's perioperative anxiety. Little is known about how such an intervention for children affects their parents' anxiety. Design A mixed method of randomized controlled trial with qualitative process evaluation was used. Methods Ninety-five pairs of parents and children were recruited between November 2011-August 2013 and randomized into a control or an intervention group. The State Anxiety Scale for Children and the State Anxiety Scale for Adults were used to measure children's and parents' anxiety, respectively, at baseline, on surgery day and around 24 hours after surgery. Parents were interviewed about their perceptions of the intervention. Data were analysed using SPSS version 22·0 and thematic analysis. Results There was no difference in parents' anxiety after participating with their child in the intervention compared with usual care. There were significantly positive relationships between parents' and their children's baseline anxiety and parents' postoperative anxiety and their children's pre-operative anxiety. Four themes were identified: reducing anxiety, increasing knowledge and understanding about anaesthetic procedure, the worthiness of attending the intervention and suggestions for improvement of the intervention. Conclusions Therapeutic play intervention had no significant effect on parents' perioperative anxiety. Parents' and their children's perioperative anxiety are correlated. Parents perceived the intervention as helpful preparation for themselves and for their children undergoing elective surgery. [ABSTRACT FROM AUTHOR]

Aim To examine the effectiveness of a postnatal psychoeducation programme in enhancing maternal self-efficacy and social support and reducing postnatal depression among primiparas. Background Primiparas experience various challenges during the early postnatal period with low self-efficacy, depression and lack of social support. Support in the form of postnatal educational programmes is needed to improve these outcomes of primiparas. Design A randomized controlled two-group pre-test-post-test design was adopted. Methods Data were collected from June-December 2012 in a public hospital in Singapore from 122 primiparas, who were randomly assigned to the intervention ( n = 61) or control group ( n = 61). The intervention group received postnatal psychoeducation programme and routine care while the control group received routine care only. The Maternal Parental Self-Efficacy scale, Perinatal Infant Care Social Support scale and Edinburgh Postnatal Depression Scale were used to measure outcomes of maternal parental self-efficacy, social support and postnatal depression. The mean percentage changes of all three outcome variables from baseline to 6 and 12 weeks postpartum between groups were used when performing repeated measures multivariate analysis of covariance. Results The intervention group had significantly higher scores of maternal parental self-efficacy and social support and lower scores of postnatal depression at 6 and 12 weeks postpartum when compared with the control group. Conclusion The postnatal psychoeducation programme was effective in improving maternal outcomes and hence could be introduced as routine care with ongoing evaluation in the postnatal period. Future studies could focus on the effects of this programme on other populations. Trial registration no: ISRCTN15886353. [ABSTRACT FROM AUTHOR]

Aim To report a study protocol of a randomized controlled trial examining if a symptom self-management programme helps patients with acute myocardial infarction self-manage their physical and psychological symptoms. Background In addition to physical conditions, people with acute myocardial infarction often experience psychological symptoms. However, there is limited empirical evidence on how to help individuals self-manage these psychological symptoms. Design A single-blinded, randomized controlled trial is proposed. Methods A convenience sample of 90 will be recruited. Eligible participants will be adult patients with acute myocardial infarction hospitalized at a tertiary hospital in Singapore. Participants will be randomly assigned to one of the three treatment groups: Intervention 1 and standard care ( n = 30), Intervention 2 and standard care ( n = 30) and standard care alone ( n = 30). Data will be collected by self-reported questionnaires, physiological measures and open-ended questions. Quantitative data will be analysed by descriptive statistics, t-test, analysis of covariance and repeated measures analysis of variance. Open-ended questions will be analysed by content analysis. Discussion This study will identify a potentially efficacious symptom self-management programme for patients with acute myocardial infarction. If the efficacy of the programme is demonstrated, the programme can be integrated into hospital services to improve patient care. A new teaching method (virtual reality-based teaching) and new teaching materials (virtual reality videos and relaxation videos) derived from this study can be offered to patients. Future research with larger samples and multi-centre recruitment can be undertaken to further test the efficacy of the interventions. [ABSTRACT FROM AUTHOR]

Aim To examine if therapeutic play intervention could reduce perioperative anxiety, negative emotional manifestation and postoperative pain in children undergoing inpatient elective surgery. Background Children undergoing surgery commonly experience anxiety and postoperative pain and exhibit negative emotional manifestations. Previous studies have shown inconsistent conclusions about the influence of therapeutic play on children's perioperative anxiety, negative emotional manifestation and postoperative pain. Design A randomized controlled trial was used. Methods Suitable children were recruited from November 2011-August 2013. They were randomized to receive either routine care (control group, n = 47) or a 1-hour therapeutic play intervention (experimental group, n = 48). Children's state anxiety, negative emotional manifestations and postoperative pain were measured at baseline, on the day of surgery and around 24 hours after surgery. Repeated measures analysis of covariance ( ancova) and univariate ancova adjusting for all possible confounding factors were used in the data analysis. Results The time effect of state anxiety was significant, but no group and interaction (group x time) effects between the control and experimental groups were found. Compared with the control group, children in the experimental group demonstrated significantly lower scores of negative emotional manifestations prior to anaesthesia induction and postoperative pain. Conclusions Therapeutic play intervention is effective in reducing negative emotional manifestations before anaesthesia induction and in reducing postoperative pain in children undergoing inpatient elective surgery. These results suggest that it is useful to give children with therapeutic play intervention prior to inpatient elective surgery. [ABSTRACT FROM AUTHOR]

Aim To report a study protocol that tests the effectiveness of an educational intervention on outcomes of parents and their children who undergo inpatient elective surgery. Background Inadequate children's postoperative pain management remains a global problem. Parents are required to be involved in their child's pain assessment and management, yet they often lack relevant knowledge and skills. Education is an effective strategy for enhancing a person's knowledge, attitudes and behaviour. However, few studies have examined its effectiveness in parents and their children undergoing inpatient elective surgery. Design Randomized controlled trial and embedded qualitative process evaluation. Methods One hundred and sixty-two pairs of participants (each comprised of one parent and his/her child undergoing inpatient elective surgery) will be recruited (protocol approved in January 2013). Participants will be randomized to either a Control group (routine care), an Intervention group 1 (routine care and an educational intervention with face-to-face teaching), or an Intervention group 2 (routine care and an educational intervention without face-to-face teaching). Outcome measures will include parents' knowledge, attitude and behaviour related to postoperative pain management; their child's postoperative pain; and parents' satisfaction with their child's pain management at baseline and around 6, 12 and 24 hours after the operation. Discussion A standardized educational intervention protocol and detailed study procedure have been developed in this study to improve parents' knowledge, attitude and behaviour related to postoperative pain management and reduce their child's postoperative pain. [ABSTRACT FROM AUTHOR]

Aim: To report a trial protocol to determine if a self-care program enhances quality of life and sense of coherence in community-dwellers aged 65 years or over. Design: A randomized controlled trial with a two-group pretest and posttest will be conducted in a community activity center involving a sample of 64 community-dwellers who are 65 years or over. Methods: The intervention group will receive Resource Enhancement and Activation Program, a structured 12-week self-care program comprising 24 activities based on a salutogenic framework. The control group will receive the routine service. Both outcome and process evaluations will be used. Outcomes will be measured using standardized tools and these include quality of life, sense of coherence, satisfaction with life, activation measure, well-being, depression, loneliness and resilience. Focus group interviews will be conducted to explore participants’ views on the program. Conclusion: This study will provide evidence on the feasibility and effectiveness of a self-care program that is based on a salutogenic framework to promote quality of life and sense of coherence among older community-dwellers. [ABSTRACT FROM AUTHOR]

Background Lower urinary tract symptoms ( LUTS) in men are associated with obesity, particularly central obesity as measured by waist circumference ( WC), and may improve with weight loss. We aimed to compare effects of a meal-replacement based diet with isocaloric reduced-fat plan on LUTS and nutrient intake in obese Asian men. Methods Obese Asian [mean (range) body mass index of 32.9 (30.5-42.3) kg m-2] men [mean (range) age 40.2 (30-61) years] were randomised to a reduced-fat (< 30% of energy) diet [conventional reduced-fat diet (CD) group; n = 23] or meal-replacement-based plan [meal replacement (MR) group; n = 23], to reduce daily intake by 2000 kJ for 12 weeks. Results CD and MR groups had statistically significant and similar reductions in weight (−2.6 ± 1.9 kg versus −4.2 ± 3.8 kg), overall LUTS severity measured with International Prostate Symptom Scale ( IPSS) scores (−1.71 ± 1.93 points versus −2.42 ± 2.12 points) and insulin resistance [homeostasis model assessment ( HOMA) calculated from plasma glucose and insulin]. The MR group had significantly greater decreases in WC (−4.8 ± 3.3 cm versus −2.5 ± 2.3 cm), fat mass (−2.47 ± 3.63 kg versus −1.59 ± 2.32 kg), fat intake, plasma C-reactive protein, and in storage LUTS score (−1.59 ± 1.33 points versus −1.00 ± 0.87 points), which was associated with a decreased fat intake ( r = 0.48, P = 0.03). A decrease in overall IPSS score was associated with reductions in weight, WC and HOMA. Conclusions Weight loss as a result of CD or MR had similar efficacy in relieving LUTS. MR produced greater reductions in fat intake, adiposity and storage LUTS. [ABSTRACT FROM AUTHOR]

Aim To determine the effectiveness of a peer-led self-management programme for people with schizophrenia in reducing psychotic symptom severity, hospital readmission and psychiatric consultation and in enhancing cognition, empowerment, functioning level, medication adherence, perceived recovery, quality of life and social support. Background Several self-management programmes have been developed to empower patients with severe mental illness in achieving recovery. Research suggests that peer-led self-management programmes have positive effects on patient recovery. However, the existing evidence is inconclusive, due to a lack of credible evidence and long-term follow-up evaluations. Design A stratified randomized controlled trial will be conducted at six community mental health rehabilitation centres Methods A sample of 242 adults with schizophrenia will be recruited. A peer-led self-management programme, comprising six 2-hour sessions, will be implemented in the intervention group and a standard rehabilitation programme in the control group. Outcomes will be measured at baseline, postintervention and at the 6- and 12-month follow-ups. The measures will include cognition, empowerment, functioning level, medication adherence, perceived recovery, quality of life, social support, symptom severity, hospital readmission and psychiatric consultation. A mixed effects model will be used to analyse the results. Semi-structured interviews will be conducted to explore the peer-trainers' and participants' perspectives on the programme. Research Ethics Committee approval was obtained in December 2011 and funding was obtained in January 2012. Conclusion This study will provide evidence on the effectiveness of a peer-led self-management programme for patient recovery. It will identify a clinically useful and potentially effective intervention that incorporates empowerment concept. [ABSTRACT FROM AUTHOR]

There is little evidence to support the efficacy of the life storybook creation process, which incorporates the use of narratives, in mediating depression levels. The study aimed to examine the effects of the life storybook creation process on depressive symptoms among older community-dwelling Chinese adults in Singapore. A randomised controlled trial was conducted from January 2011 to March 2012. Twenty-six Chinese aged over 60 years, who were able to communicate in Chinese and/or English, and with mild to severe depression were randomly allocated to either the life storybook (intervention) group ( n = 14) or the non-life storybook (control) group ( n = 12). Subjects in the intervention group were interviewed on a one to one basis on five sessions over 8 weeks. Depressive symptoms were measured using the Geriatric Depression Scale. Generalised estimating equations were used to examine the effects of the intervention on the elderly peoples' depression level. Significant reductions in depression scores were found in the intervention group from baseline (mean 7.9 [SD 3.0]) to week 8 (2.5 [1.7], χ2 = 15.25, P < 0.001). At week 8, the intervention group showed a lower level of depression than the control (χ2 = 4.33, P = 0.037). This study supports the life storybook creation process as an effective intervention for depressed older Chinese adults living in the community. The findings suggest that this intervention may enhance the quality of care provided by healthcare providers as the therapeutic relationship between provider and client is being established. [ABSTRACT FROM AUTHOR]

Four studies examined whether thought suppression could enhance attitude accessibility and whether behaviours that are consistent with the more accessible attitudes would follow. Thinness was examined as the attitude object. Experiments 1 and 2 showed that suppression of positive thoughts about thinness increased the accessibility of the positive attitudes associated with thinness. Experiments 3 and 4 showed that suppression of positive thinness thoughts also elicited more health-promoting behaviours. The implications of the findings for attitude accessibility and the practical consequences of thought suppression are discussed. [ABSTRACT FROM AUTHOR]

Aim. To determine the effect of music on depression levels in older adults. Background. Depression is a common psychiatric disorder in older adults, and its impacts on this group of people, along with its conventional treatment, merit our attention. Conventional pharmacological methods might result in dependence and impairment in psychomotor and cognitive functioning. Listening to music, which is a non-pharmacological method, might reduce depression. Design. A randomised controlled study. Method. The study was conducted from July 2009-June 2010 at participants' home in Singapore. In total, 50 older adults (24 using music and 26 control) completed the study after being recruited. Participants listened to their choice of music for 30 minutes per week for eight weeks. Outcome measures. Depression scores were collected once a week for eight weeks. Results. Depression levels reduced weekly in the music group, indicating a cumulative dose effect, and a statistically significant reduction in depression levels was found over time in the music group compared with non-music group. Conclusions. Listening to music can help older people to reduce their depression level. Relevance to clinical practice. Music is a non-invasive, simple and inexpensive therapeutic method of improving life quality in community-dwelling older people. [ABSTRACT FROM AUTHOR]

ang e., mordiffi s.z. & wong h.b. (2011) Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal of Advanced Nursing 67(9), 1984-1992. Abstract Aim. This article is a report of a randomized controlled trial to examine the effectiveness of a targeted multiple intervention strategy in reducing the number of patient falls in an acute care hospital. Background. Prevention of patient falls remains a challenge that has eluded healthcare institutions. The effectiveness of targeted multiple fall prevention interventions in reducing the incidences of falling has not been established. Methods. Patients who scored 5 and above on the Hendrich II Fall Risk Model, a fall assessment tool, were recruited in 2006. Patients who were randomized to the intervention group received targeted multiple interventions. Both the research groups received the standard fall prevention interventions from the ward nurses. The rates of fall incidences for both groups were reported with 95% CI, calculated using Wilson method and compared using the Chi-square test. The relative risk was estimated and 95% CI was calculated using the methods described by Armitage and Berry. The times to first fall events were constructed using the Kaplan-Meier method. The hazard ratio was reported at 95% CI and the comparison was made using the log-rank test. Results. There were 912 and 910 participants in the control and intervention groups, respectively. The fall incidence rates were 1·5% (95% CI: 0·9-2·6) and 0·4% (95% CI: 0·2-1·1) in the control and intervention groups, respectively. The relative risk estimate of 0·29 (95% CI: 0·1-0·87) favours the intervention group. Conclusion. This study showed that targeted multiple interventions were effective in reducing the incidences of falls in patients in the acute care setting. [ABSTRACT FROM AUTHOR]

The article assesses the effectiveness of using a case-based video animation to educate ward nurses regarding physiological compensatory mechanisms and improve their ability to recognize patient deterioration via early changes in vital signs. Topics discussed include the nurses' misconception of changes in vital sign which may be due to a lack of knowledge of the effect of physiological compensatory mechanisms underlying vital signs changes.

Objective. The objective of our study was to test the hypothesis that the availability and selective use of STAN® in conjunction with cardiotocography for intrapartum monitoring, lowers the incidence of operative deliveries for fetal distress. Design. Observational study. Setting. Delivery suite of the National University Hospital, Singapore. Methods. The data regarding intrapartum cesarean sections and instrumental vaginal deliveries for presumed fetal distress and the condition of the neonate at birth (Apgar scores at one and five minutes and admission to neonatal intensive care unit (NICU) were collected over two consecutive three-year periods. In the first triennium, only external cardiotocography was used for intrapartum fetal surveillance and in the second triennium STAN® monitoring was available for use in the delivery suite. Results. With the availability and selective use of STAN® monitoring, there was a significant decrease in the number of instrumental deliveries for fetal distress (from 66 out of 520 (0.9%) to 36 out of 474 (0.5%), p<0.025), the number of admissions to the NICU (from 418 (5.6%) to 311 (4.6%), p<0.01) and the number of neonates with Apgar score of seven or less at five minutes (from 192 (2.6%), p<0.001 to 113 (1.7%), p<0.001). There was no significant difference in the incidence of emergency cesarean sections for fetal distress during the two time periods. Conclusion. Intrapartum monitoring of term fetuses with cardiotocography combined with selective use of ST analysis leads to a significant reduction in the number of operative deliveries for suspected fetal distress with no adverse effect on neonatal outcome. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children's incentives to both their and their parent's physical activity levels can increase parent's physical activity. Methods: We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child's physical activity (child-based) or (2) rewards to child contingent on both child's and parent's physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25–65 years, and with a participating child aged 7–11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent's mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint). Results: Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54–1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: − 88–1114) and was no longer statistically significant. Conclusions: Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent's physical activity was not sustained through one year. Trial registration: NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015. [ABSTRACT FROM AUTHOR]