Search

Abstract Background Little is known about stage 1 and 2 pressure injuries that are health care‐acquired. We report incidence rates of health care‐acquired stage 1 and stage 2 pressure injuries, and, estimate the excess length of stay using four competing analytic methods. We discuss the merits of the different approaches. Methods We calculated monthly incidence rates for stage 1 and 2 health care‐acquired pressure injuries occurring in a large Singapore acute care hospital. To estimate excess stay, we conducted unadjusted comparisons with a control cohort, performed linear regression and then generalized linear regression with a gamma distribution. Finally, we fitted a simple state‐based model. The design for the cost attribution work was a retrospective matched cohort study. Results Incidence rates in 2016 were 0.553% (95% confidence interval [CI] 0.55, 0.557) and 0.469% (95% CI 0.466, 0.472) in 2017. For data censored at 60 days’ maximum stay, the unadjusted comparisons showed the highest excess stay at 17.68 (16.43‐18.93) days and multi‐state models showed the lowest at 1.22 (0.19, 2.23) days. Conclusions Poor‐quality methods for attribution of excess length of stay to pressure injury generate inflated estimates that could mislead decision makers. The findings from the multi‐state model, which is an appropriate method, are plausible and illustrate the likely bed‐days saved from lowering the risk of these events. Stage 1 and 2 pressure injuries are common and increase costs by prolonging the length of stay. There will be economic value investing in prevention. Using biased estimates of excess length of stay will overstate the potential value of prevention.

Objective To estimate the ‘cost of illness’ arising from chronic wounds in Singapore.Design Incidence-based cost of illness study using evidence from a range of sources.Setting Singapore health services.Participants We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated.Results Total annual cost of illness was $350 million (range $72–$1779 million). With 168 503 acute bed days taken up annually (range 141 966–196 032) that incurred costs of $139 million (range 117–161 million). Total costs to health services were $184 million (range $120–$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range −2657 to 29 029) valued at $166 million (range −212 to 2399 million).Conclusions The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.

Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. Method A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). Results The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. Conclusions Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.

Aims: This study aimed to identify the prevalence and circumstances of the use of physical restraints, complications associated with its use and its association with patients’ characteristics. Methods: This is a prospective observational study design. A convenience sample of elderly patients (aged 65 and above) who were admitted to an acute care hospital from February 2012 to August 2012 were tracked daily to monitor the use of physical restraints during hospitalization. Patient-related variables and type of physical restraint used were gathered from the medical records and the Multi-Dimensional Dementia Assessment Scale was completed through interviews with nurses who had cared for the patients. Independent t -test or Chi-square (χ 2 ) tests were used to examine the effect of a single variable on the use of physical restraints. Multiple logistic regression was done to predict the patient-related variables to the likelihood of being placed on physical restraints. Results: Altogether, 998 patients accounting for 1048 admission episodes, were included in this study, of which 84 admission episodes involved the use of physical restraints (8%). Major reasons for restraints include ‘Behavioural/confused/violent’ ( n = 55; 65%) and to prevent falls ( n =53; 62%). Regression analysis indicated that male gender, behavioural changes, memory disturbance, impaired physical function, the use of anti-psychotic drugs and higher psychiatric workload predicted the likelihood of being put on physical restraints. The strongest predictor was memory disturbances with an odds ratio of 30. Conclusion: The prevalence of physical restraints used was higher than that in published literature for acute care hospitals. Preventive strategies would need to be targeted for the elderly, who suffered from memory disturbances upon admission.

Introduction: Nurses are encouraged to engage in research activities in order to stay abreast with the current nursing practice. However, limited knowledge about the research process may influence their level of involvement and utilisation of research in their daily nursing practices. This study examines Singapore nurses' perceived knowledge and educational needs in research as well as to explore their preferred mode and duration of education delivery. Methods: This is a multi-site, cross-sectional study that recruited 2248 registered nurses working in Singapore. A self-administered tool was used to examine nurses' perceived knowledge and educational needs in research. Descriptive statistics were used to present the nurses' demographic data; the Kruskal-Wallis and chi-square tests were used to examine the relationship between the nurses' education level and their perceived knowledge and educational needs in research. Results: Nurses in this study perceived low levels of knowledge in research. Majority of those who were involved in research activities had a bachelor's degree. There were statistically significant differences between education level and perceived knowledge (p=0.001). However, there was no significant difference between education level and perceived educational needs. Younger nurses (19–35 years old) preferred shorter duration when attending workshops compared to older nurses (36 years old and above). Skill-based workshop and tutorial or seminar that last no longer than a week was the most preferred educational mode and duration. Conclusion: Nurses with high level of education perceived a higher level of research knowledge and thus reported lower educational needs in research. The results showed the need for continual training programs, even for nurses with bachelor's and master's degrees, in order to better prepare them for evidence-based practice. Understanding the demographic of the nurses and their learning styles is important when devising strategies to teach research.

Introduction: The Internet is becoming increasingly important as a source of health information. In Singapore, two in three households have access to Internet at home and the proportion of Internet users is rising each year 1 . This study seeks to investigate the characteristic of patients who used the Internet to seek for health information before scheduled surgery and their preferred mode of education from the healthcare professionals. Methods: This study was carried out in a general surgical ward. Using convenience sampling, subjects were asked to fill up a standard set of closed-ended questionnaires, which consist of the patients' demographics data, their perception of using the Internet and their preferred mode of education from the health-care professionals. Results: A total of 107 subjects completed this study. The percentage of subjects who owned a computer and had access to the Internet were 90%. Higher level of education and income were more likely to search the Internet before their operation (p=0.03). There was no significance difference between age group and Internet search (p=0.574). The most preferred mode of education were Internet-based when discharge from the hospital (n=48). Conclusions: The findings showed that patients and their love ones are taking a pro-active approach in their health and are resourceful in acquiring information about their surgery. Nurses play a vital role in providing patient education and guiding them to a reliable and accurate websites. Hence, it is imperative to adopt an Internet-based education especially for the IT-literate population.