Complementary and Alternative Medicine Use in the Last Year of Life: The COMPASS Cancer Cohort Study.

Context: There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.

Objectives: This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.

Methods: This study (N = 427) utilized data across 12 months (four time points) prior to patient death.

Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study.

Background: Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers.

Objective: We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called "My Voice," which is tailored for patients with heart failure and their caregivers.

Methods: This study's team and advisory board codeveloped the content for both patient and caregiver modules in "My Voice.

Clinical and molecular investigation of acute haemorrhagic conjunctivitis outbreak in North India (2023).

Purpose: The study aims to investigate an outbreak of acute haemorrhagic conjunctivitis (AHC) reported in North India.

Methods: All patients presenting to the outpatient clinic department with signs and symptoms (symptoms onset within 36 h) of AHC were enrolled in the study. The conjunctival swab samples were tested for the presence of enteroviruses and adenoviruses.

Inceptor binds to and directs insulin towards lysosomal degradation in β cells.

Blunted first-phase insulin secretion and insulin deficiency are indicators of β cell dysfunction and diabetes manifestation. Therefore, insights into molecular mechanisms that regulate insulin homeostasis might provide entry sites to replenish insulin content and restore β cell function. Here, we identify the insulin inhibitory receptor (inceptor; encoded by the gene IIR/ELAPOR1) as an insulin-binding receptor that regulates insulin stores by lysosomal degradation.

A Longitudinal Study of the Association of Awareness of Disease Incurability with Patient-Reported Outcomes in Heart Failure.

Objectives: To examine awareness of disease incurability among patients with heart failure over 24 mo and its associations with patient characteristics and patient-reported outcomes (distress, emotional, and spiritual well-being).

Methods: This study analyzed 24-mo data from a prospective cohort study of 251 patients with heart failure (New York Heart Association class III/IV) recruited from inpatient wards in Singapore General Hospital and National Heart Centre Singapore. Patients were asked to report if their doctor told them they were receiving treatment to cure their condition.

Awareness of Disease Incurability Moderates the Association between Patients' Health Status and Their Treatment Preferences.

Background: With advancing illness, some patients with heart failure (HF) opt to receive life-extending treatments despite their high costs, while others choose to forgo these treatments, emphasizing cost containment. We examined the association between patients' health status and their preferences for treatment cost containment versus life extension and whether their patients' awareness of disease incurability moderated this association.

Methods: In a prospective cohort of patients ( = 231) with advanced HF in Singapore, we assessed patients' awareness of disease incurability, health status, and treatment preferences every 4 mo for up to 4 y (up to 13 surveys).

Navigating dementia feeding decisions in Asia: a mixed methods study of caregivers.

Background: Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate.

Aim: This study aims to gain a comprehensive understanding of tube feeding among community-dwelling older adults with advanced dementia in Singapore and its relationship to older adult quality of life (QoL) and caregiver psychological distress.

Methods: We use a convergent mixed-methods design, synthesising analysis of qualitative caregiver interviews (n = 25) and two-year prospective, longitudinal cohort survey data (n = 215, 1018 observations).

Reimagining and rebranding advance care planning.

Advance care planning (ACP) has traditionally aimed at ensuring that patients' end-of-life (EOL) wishes are understood and respected. However, recent literature raises concerns about its effectiveness, with many trials indicating that ACP does not significantly improve goal-concordant care, enhance quality of life or reduce healthcare costs. This is because patients' future decisions are influenced by their transient preferences due to projection bias.

Prognostic understanding among caregivers of persons with dementia: A scoping review.

Introduction: Despite the influence of caregivers' prognostic understanding (PU) on the end-of-life care for persons with dementia (PwDs), the literature on PU of caregivers of PwDs is sparse. We conducted a scoping review to understand the variation in existing definitions and measurement of caregivers' PU for PwDs. We also aimed to synthesize the prevalence of caregivers' correct PU and the factors (caregiver, PwD and healthcare related) associated with it.

Corneal densitometry changes post-CXL for keratoconus: Comparative evaluation of epithelium-off, contact lens-assisted, and transepithelial techniques.

Purpose: To evaluate changes in corneal backscattering after collagen cross-linking (CXL) for progressive keratoconus and compare its course with different techniques - standard epithelium-off CXL (SCXL), contact lens-assisted CXL (CACXL), and transepithelial CXL (TECXL).

Setting: Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Design: Retrospective comparative study.

Visual and clinical outcomes after bilateral implantation of a novel extended depth of focus lens post cataract surgery.

Purpose: To assess the visual and clinical outcomes after bilateral implantation of the novel extended depth of focus (EDOF) (AcrySof IQ Vivity) intraocular lens (IOL) using a micromonovision strategy.

Methods: This was a prospective interventional study at a tertiary care center. Twenty patients (40 eyes) underwent bilateral implantation of AcrySof IQ Vivity IOL.

Caregiving Experiences as Mediators Between Caregiving Stressors and Anticipatory Grief in Severe Dementia: Findings From Longitudinal Path Analysis.

Objectives: Family caregivers of older adults with severe dementia often experience anticipatory grief. We aimed to investigate the temporal association of caregiving stressors (older adults' behavioral symptoms, and caregiver-older adult co-residence and emotional closeness) and caregivers' anticipatory grief, and its mediation by positive and negative caregiving experiences.

Design: Prospective cohort.

Evaluation of Meibomian Gland Structure and Function in Patients with Vernal Keratoconjunctivitis Using Non Contact Meibography and Lipid Layer Interferometry.

Purpose: This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry.

Methods: In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids.

Caregiver coping mediates the relationship between caregivers' understanding of dementia as terminal and their distress.

We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation.

Opioid Access among Advanced Cancer Patients in Low- and Middle-Income Countries in Asia.

Context: Most cancer-associated pain is experienced in low- and middle-income countries (LMICs) due to inequitable access to opioids.

Objective: To determine opioid access as estimated by both patients and providers and to understand patient and facility-level factors influencing access among patients with advanced cancer in LMICs in Asia using the Behavioral Model of Health Services Use.

Methods: The APPROACH cross-sectional study was conducted in seven LMICs in Asia, involving in-depth surveys with providers and advanced cancer patients.

Prognostic understanding among advanced heart failure patients and their caregivers: A longitudinal dyadic study.

Objectives: To examine heart failure patients' and caregivers' prognostic understanding (PU) over time, and patient and caregiver factors associated with their own and each other's PU.

Methods: We used longitudinal dyadic data from Singapore, involving surveys with 95 heart failure patient-caregiver dyads every 4 months for up to 4 years. We assessed the association of PU with patient health status, caregiver psychological distress and caregiving hours using random effects multinomial logistic models, controlling for patient and caregiver characteristics.

More competent informal caregivers reduce advanced cancer patients' unplanned healthcare use and costs.

Background: Patients with metastatic cancer experience high healthcare use and costs, most of which are unplanned. We aimed to assess whether patients with more competent informal caregivers have lower unplanned healthcare use and costs.

Methods: This study used data from a prospective cohort of patients with solid metastatic cancer.

'I secretly wish. . .' Caregivers' expression of wish for death of persons with severe dementia.

Background: Qualitative evidence suggests that caregivers may express a wish for death of persons with severe dementia (PwSD). No study has assessed the extent to which it happens, stability of this wish over time and the factors associated with it.

Objectives: We examined caregivers' wish for death of PwSDs overtime and the factors associated with this wish.

Do advanced cancer patients and their caregivers agree on preferred place of patient's death?-a prospective cohort study of patient-caregiver dyads.

Background: Greater patient-caregiver concordance for preferred place of death can increase the chances of patients dying at their preferred place, thus improving quality of life at end-of-life (EOL). We aimed to assess changes in and predictors of patient-caregiver concordance in preference for home death at EOL during the last 3 years of life of patients with advanced cancer.

Methods: We used data from the Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) cohort study of patients with stage IV solid cancer.

Goals of Care Among Patients With Advanced Cancer and Their Family Caregivers in the Last Years of Life.

Importance: Understanding goals of care for terminally ill patients at the end of life is crucial to ensure that patients receive care consistent with their preferences.

Objectives: To investigate the patterns of goals of care among patient-caregiver dyads over the last years of the patient's life and the associations of the goals of care with patient-caregiver characteristics.

Design, Setting, And Participants: This prospective cohort study of 210 patient-caregiver dyads involved surveys every 3 months from July 8, 2016, until the patient's death or February 28, 2022.