Inter-rater reliability of a composite health promotion scoring system developed in Singapore.

Introduction: In view of the important role of the environment in improving population health, implementation of health promotion programmes is recommended in living and working environments. Assessing the prevalence of such community health-promoting practices is important to identify gaps and make continuous and tangible improvements to health-promoting environments. We aimed to evaluate the inter-rater reliability of a composite scorecard used to assess the prevalence of community health-promoting practices in Singapore.

Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study.

Objective: To measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care.

Design: A retrospective cross-sectional study.

Setting: Specialist outpatient clinics (SOCs) in a Singapore regional hospital.

Prevalence of community health-promoting practices in Singapore.

Both living and working environments have a substantial influence on promoting healthy living habits. A holistic and accurate assessment of the community health-promoting practices is important to identify gaps and to make continuous, tangible improvements. The aim of the study is to assess the prevalence of the Singapore community health-promoting practices.

Risk factors for lower extremity amputation among patients with diabetes in Singapore.

Background: Among other risk factors, renal disease and ethnicity have been associated with diabetic lower extremity amputation (LEA) in Western populations. However, little is known about risk factors for LEA among Asian patients.

Objective: The objective was to assess the proportion of hospitalized patients with diabetes who have a LEA among all hospital patients with diabetes mellitus (DM) and to investigate risk factors for diabetic LEA (especially renal disease and ethnicity) using hospital discharge database.

Clinical characteristics and outcomes of hospitalized patients with 2009 H1N1 influenza in a large acute care tertiary hospital, Singapore.

This study describes the clinical characteristics and outcomes of hospitalized patients with 2009 H1N1 influenza in a large, acute care, tertiary hospital in Singapore. Of the 265 hospitalized patients with laboratory-confirmed 2009 influenza A (H1N1) during the height of the H1N1 flu pandemic, 13% (35) suffered severe outcomes including a mortality rate of 4.5% (12).

Bringing generalists into the hospital: outcomes of a family medicine hospitalist model in Singapore.

Purpose: The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database.

Methods: Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008.

Respiratory dysfunction in patients with sepsis: protective effect of diabetes mellitus.

Background: Sepsis is a common complication in patients with diabetes mellitus. In a Western population, risk of respiratory dysfunction was lower in diabetic patients with sepsis.

Objective: To compare organ dysfunction, particularly respiratory dysfunction, between sepsis patients with and without diabetes mellitus in an Asian population.

Severe infection with H1N1 requiring intensive care--lessons for preparedness programmes.

Introduction: The influenza pandemic has generated much interest in the press and the medical world. We report our experience with 15 cases of severe novel influenza A H1N1 (2009) infections requiring intensive care. The aim of this review is to improve our preparedness for epidemics and pandemics by studying the most severely affected patients.

The impact of portable high-efficiency particulate air filters on the incidence of invasive aspergillosis in a large acute tertiary-care hospital.

Background: Worldwide, the frequency of invasive fungal infections has been increasing, with a corresponding increase in the numbers of high-risk patients. Exposure reduction through the use of high-efficiency particulate air (HEPA) filters has been the preferred primary preventive strategy for these high-risk patients. Although the efficiency and benefits of fixed HEPA filters is well proven, the benefits of portable HEPA filters are still inconclusive.

The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis.

Purpose: Sepsis is believed to be responsible for substantial health care burden, but there is limited information about its magnitude and the factors affecting health outcomes in Asian population. The aim of the study was to assess the disease burden of sepsis and to test the usefulness of Charlson Comorbidity Index (CCI) and age as risk-adjusted hospital mortality predictors in patients with sepsis using hospital administrative database.

Methods: A retrospective cohort study of hospital discharge database from 2004 to 2007 to identify cases with sepsis, comorbidity, and organ failure using the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification codes was conducted.

High coverage of influenza vaccination among healthcare workers can be achieved during heightened awareness of impending threat.

Introduction: As preparation against a possible avian flu pandemic, international and local health authorities have recommended seasonal influenza vaccination for all healthcare workers at geographical risk. This strategy not only reduces "background noise", but also chance of genetic shifts in avian influenza viruses when co-infection occurs. We evaluate the response of healthcare workers, stratified by professional groups, to a non-compulsory annual vaccination call, and make international comparisons with countries not at geographical risk.

Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore.

Introduction: Until recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles.