A virtual reality cognitive screening tool based on the six cognitive domains.

Introduction: Early detection of cognitive impairment enables interventions to slow cognitive decline. Existing neuropsychological paper-and-pencil tests may not adequately assess cognition in real-life environments. A fully-immersive and automated virtual reality (VR) system-Cognitive Assessment using VIrtual REality (CAVIRE)-was developed to assess all six cognitive domains.

Investigating the determinants of iridolenticular contact area: a novel parameter for angle closure.

Background/aims: To identify ocular determinants of iridolenticular contact area (ILCA), a recently introduced swept-source optical coherence tomography (SSOCT) derived parameter, and assess the association between ILCA and angle closure.

Methods: In this population-based cross-sectional study, right eyes of 464 subjects underwent SSOCT (SS-1000, CASIA, Tomey Corporation, Nagoya, Japan) imaging in the dark. Eight out of 128 cross-sectional images (evenly spaced 22.

Role of Alternative Medical Systems in Adult Chronic Kidney Disease Patients: A Systematic Review of Literature.

There is a growing interest in the use of alternative medical systems (AMS), such as traditional Chinese medicine (TCM), ayurveda, homeopathy, and naturopathy, among chronic kidney disease patients. This review summarizes the efficacy and safety of AMS interventions in chronic kidney disease (CKD) patients. A systematic review was conducted in MEDLINE, Embase, Scopus, CINAHL, CENTRAL, and PsycINFO in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.

Manipulative and body-based methods in chronic kidney disease patients: A systematic review of randomized controlled trials.

Background: and purpose: Among chronic kidney disease (CKD) patients, manipulative and body-based methods (MBM) have demonstrated efficacy in improving symptoms such as fatigue. This review aims to summarize the efficacy and safety of MBM among CKD patients.

Methods: A systematic review was performed in PubMed, Embase, Scopus, CINAHL, CENTRAL and PsycInfo.

Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners.

Background: The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners' (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore.

Methods: Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice.

Age-Related Performance in Using a Fully Immersive and Automated Virtual Reality System to Assess Cognitive Function.

Introduction: Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language). Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment (MoCA) has limitations and is influenced by age.

Comparison of Time Taken to Assess Cognitive Function Using a Fully Immersive and Automated Virtual Reality System vs. the Montreal Cognitive Assessment.

Dementia is increasingly prevalent globally. Existing questionnaire-based cognitive assessment tools may not comprehensively assess cognitive function and real-time task-performance across all cognitive domains. CAVIRE (Cognitive Assessment by VIrtual REality), a fully immersive virtual reality system incorporating automated audio-visual instructions and a scoring matrix was developed to assess the six cognitive domains, with potential to maintain consistency in execution of the testing environment and possibly time-saving in busy primary care practice.

Experiences of doctors working in Singapore's public primary healthcare clinics.

Despite providing 20 percent of primary healthcare and a larger proportion of care for patients with chronic conditions, little is documented about working in public primary healthcare clinics in Singapore. While previous studies of primary care physicians' occupational stress focused on burnout, this study explores broader personal, professional and organisational factors affecting their experiences. It examines factors influencing doctors working in such clinics to leave or remain in this setting, and the initiatives that would retain and encourage re-entry in the public sector.

A Fully-Immersive and Automated Virtual Reality System to Assess the Six Domains of Cognition: Protocol for a Feasibility Study.

Dementia is increasing in prevalence in aging populations. Current questionnaire-based cognitive assessments may not comprehensively assess cognitive function and real-time task-performance. Virtual reality (VR) technology has been used in cognitive assessments but existing systems have limited scope in evaluating all cognitive domains.

Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study.

Background: The prevalence of dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing worldwide. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and, to a lesser extent, on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older persons is promising, but evidence for its use is sparse.

Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality - a retrospective cohort study.

Background: Heterogeneity of population health needs and the resultant difficulty in health care resources planning are challenges faced by primary care systems globally. To address this challenge in population health management, it is critical to have a better understanding of primary care utilizers' heterogeneous health profiles. We aimed to segment a population of primary care utilizers into classes with unique disease patterns, and to report the 1 year follow up healthcare utilizations and all-cause mortality across the classes.

Assessment of Circumferential Angle Closure with Swept-Source Optical Coherence Tomography: a Community Based Study.

Purpose: To evaluate the diagnostic performance of swept-source optical coherence tomography (SS-OCT, CASIA SS-1000; Tomey Corporation, Nagoya, Japan) for angle closure detection, in comparison with gonioscopy, in a community setting.

Design: Reliability analysis.

Methods: A total of 2027 phakic subjects aged ≥50 years, with no previous history of glaucoma, laser (including peripheral iridotomy), intraocular surgery, or ocular trauma, were consecutively recruited from a community polyclinic in Singapore.

Determinants of poor sleep quality in elderly patients with diabetes mellitus, hyperlipidemia and hypertension in Singapore.

AimThe objective of this study was to assess determinants of poor sleep quality which is an under-diagnosed and under-treated problem in elderly patients with diabetes mellitus, hyperlipidemia and hypertension. BACKGROUND: Poor sleep quality is linked to decreased quality of life, increased morbidity and mortality. Poor sleep quality is common in the elderly population with associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension.

Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial.

Background: Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics.

Methods/design: The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care.

Automated Detection of Iris Furrows and their Influence on Dynamic Iris Volume Change.

We introduced a new method for detecting iris surface furrows and identify its associations with dynamic changes in iris volume in healthy eyes. Swept-source optical coherence tomography was performed on 65 subjects with open angle under light and dark conditions. Iris boundaries were identified and a reconstruction of the anterior iris surface was obtained.

Health-related quality of life of older Asian patients with multimorbidity in primary care in a developed nation.

Aim: Older adults are susceptible to two or more chronic ailments or multimorbidity. The present study aimed to establish the relationship between multimorbidity and health-related quality of life (HRQoL) amongst Asian elderly patients in primary care in a developed nation. It also assessed how functional disability and chronic musculoskeletal pain are associated with HRQoL.

Iris Crypts Influence Dynamic Changes of Iris Volume.

Purpose: To determine the association of iris surface features with iris volume change after physiologic pupil dilation in adults.

Design: Cross-sectional observational study.

Participants: Chinese adults aged ≥ 50 years without ocular diseases.

Association of iris surface features with iris parameters assessed by swept-source optical coherence tomography in Asian eyes.

Background/aims: To characterise the association of iris surface features (crypts, furrows and colour) with iris volume and curvature assessed by swept-source optical coherence tomography (SSOCT) in Asian eyes.

Methods: Iris crypts (by number and size) and furrows (by number and circumferential extent) were graded from iris photographs. Iris colour was measured by a customised algorithm written on MATLAB (MathWorks, Natick, Massachusetts, USA).

Academy of Medicine-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level.

The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.

Patient acceptability of tear collection in the primary healthcare setting.

Purpose: The primary healthcare setting is well placed for health screening. Tear fluid composition gives valuable information about the eye and systemic health, and there is now significant interest in the potential application of tears as a tool for health screening; however, the acceptability of tear collection in the primary healthcare setting as compared with other methods of human sample collection has not been previously addressed. The objective of this study was to evaluate the patient acceptability of tear collection in a primary healthcare setting.

Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore.

Background: The aim was to study the glycaemic control of type 2 diabetic patients, and to identify factors associated with unacceptable glycaemic control (defined as HbA1c >8.0%).

Methods: Analysis of data collected in a cross-sectional survey of type 2 diabetic patients in eight SingHealth Polyclinics in January 2009.

Simply eczema.

Atopic eczema is a commonly encountered chronic skin condition in primary care. In this article, we share a holistic, structured approach, which is grounded on the chronic and atopic nature of the condition - planned reviews, patient empowerment, a written action plan for chronic and fare management, and trigger avoidance. Common pitfalls in management are insufficient emphases on scheduled reviews and patient empowerment, as well as neglect in the care of the loss of the epidermal barrier during acute flares.

Approach to hand dermatitis in primary care.

Hand dermatitis is commonly seen in primary care, although it is often underdiagnosed. Exogenous causes should always be considered and a detailed environmental and occupational history taken, especially in patients presenting in adulthood. Although not life-threatening, the condition may have significant impact on the patient's quality of life and employment.

Health-related quality of life is associated with diabetic complications, but not with short-term diabetic control in primary care.

Introduction: Type 2 diabetes mellitus is of increasing healthcare concern worldwide, with incidence rising, complications leading to significant morbidity and mortality, posing strain on public healthcare funding. Health-related quality of life of diabetic patients is increasingly being recognised as "the ultimate goal of all health interventions". The aim of our study was to identify the quality of life predictors of diabetic patients in primary care.