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Biomedical subjects

K B Yap

Publications and source records attributed to K B Yap.

17 recordsLinked to original sources
PubMed2001

Hyponatraemia in hospitalised elderly patients.

This study aims to investigate the incidence and causes of hyponatraemia in hospitalised elderly patients. There was a total of 407 new patients. 55 (13.5%) patients were found to have at least one episode of hyponatraemia during their hospitalization. There were 58 deaths. Fifteen out of 55 (27.3%) patients who had hyponatraemia died compared to 43 out of 352 (12.2%) normonatraemic patients (chi-square significant, p < 0.01). The three most common causes of hyponatraemia were syndrome of inappropriate antidiuretic hormone secretion (SIADH), poor oral intake and diuretics. The two most common causes of SIADH were lower respiratory tract infection and stroke.

Aged↗
PubMed2000

End-of-life issues--preferences and choices of a group of elderly Chinese subjects attending a day care centre in Singapore.

INTRODUCTION: This was an exploratory study that was intended to provide a descriptive analysis of the choices and preferences of a group of elderly Chinese subjects attending a day care centre in Singapore with regard to end-of-life issues. MATERIALS AND METHODS: A semi-structured one-to-one interview was conducted to collect data from the subjects. Qualitative techniques were used to analyse the data. RESULTS: Forty-three subjects were interviewed. The median age was 71 years. There were more women than men (58.1% vs. 41.9%). The predominant religion was Buddhism/Taoism. 83.7% and 76.7% of the subjects preferred to be told of the diagnosis and prognosis of a terminal illness, respectively. The person most preferred to reveal the diagnosis was the attending doctor (60.5%). About 83.7% of the subjects have never heard of the Advanced Medical Directive Act, while 37.2% agreed that making an advanced directive would be necessary. Twenty-three (53.5%) would choose the doctor, while 15 (34.9%) would choose a family member as a surrogate decision-maker. Twenty-two (51.2%) thought that euthanasia should be allowed, while 15 (34.9%) disagreed. With regard to supportive measures at the end of life, 67.4% wanted cardiopulmonary resuscitation, 62.8% wanted artificial ventilation, 55.8% wanted nasogastric feeding, 65.1% wanted intravenous hydration and 41.9% wanted renal dialysis. CONCLUSION: There is a need for closer communication between older persons and their carers with regard to end-of-life care. The attending doctor appears to have an important role in this respect.

Advance Directives↗
PubMed2000

Screening for hearing impairment in hospitalised elderly.

OBJECTIVES: The objective of this study was to determine the prevalence of hearing impairment in hospitalised elderly patients using the Welch Allyn Audioscope 3. PATIENTS AND METHOD: Consecutive geriatric patients admitted to an acute 38-bedded geriatric ward over a 4-week period in 1998 were screened for hearing impairment. The examination was conducted in a quiet side-room adjacent to the ward. Ability to hear normal conversation at arm's length and the whispered voice were noted. A conventional auroscopy was done. Screening using Welch Allyn Audioscope 3 was then conducted at 40 dB using speech frequencies of 500, 1000 and 2000 Hz. Individuals who failed to respond at any 2 frequencies in the better ear were deemed to have significant hearing impairment. Patients with impacted earwax had repeat audioscopic examination after wax was cleared. RESULTS: One hundred and twenty-four patients were enrolled. Fifty-four patients were excluded from the study: 37 patients had dementia, 11 were critically ill, 5 were dysphasic while 1 had acute confusion. The remaining 70 patients were included in the study. The median age of the study group was 81 years (range 72 to 96 years). There were equal number of males and females. Forty-seven (67.1%) patients had hearing impairment. Nineteen (40.4%) out of 47 hearing-impaired patients could not hear normal conversation at arm's length while 34 (72.3%) out of the same 47 patients failed the whispered voice test. Only 22 (46.8%) hearing-impaired patients complained of hearing difficulties. Four out of the 47 hearing-impaired patients possessed hearing aids. Majority (83.0%) of patients with hearing impairment did not want hearing aids and cited "no necessity" as the main reason for not wanting them. Five (7.1%) and 12 (17.1%) patients had bilateral and unilateral impacted ears respectively. Two out of 20 ears cleared of wax improved by one tone on repeat auroscopy. CONCLUSION: The prevalence of hearing impairment in hospitalised elderly patients was found to be very high during screening with an audioscope. However, identification of hearing impairment using the audioscope was not associated with keenness of wanting a hearing aid. The important factors associated with keenness for wanting a hearing aid were difficulty with hearing conversation at arm's and complaint about being handicapped socially by hearing difficulty. Screening for hearing impairment should be part of the routine in the examination of a hospitalised elderly as the prevalence of the disease is very high. Ability to hear normal conversation at arm's length alone was not a reliable method of screening for hearing impairment and it should be complemented by the whispered voice test. The audioscope is an expensive instrument and not widely available. Although the audioscope screening method was able to pick up more cases of hearing impairment, it did not result in more patients wanting hearing aid. Those detected to have hearing impairment will require further counselling regarding the usefulness of a hearing aid and detailed audiological assessment if they are keen for a hearing aid.

Age Distribution↗
PubMed1999

The prescribing pattern of outpatient polyclinic doctors.

OBJECTIVE: This study aims to analyse the prescribing pattern of doctors working in a government outpatient polyclinic in Singapore. DESIGN: Retrospective study of 1 week of prescription scripts in 1996. MAIN OUTCOME MEASURES: Number, types and duration of drugs prescribed; combination of drugs; age distribution; bad handwriting. RESULTS: Two thousand six hundred and seventy-nine scripts were analysed. The age of patients ranged from 1 to 93 years with a mean of 43.8 years. There were 44.0% males and 56.0% females. The overall mean of 'total number of drugs prescribed' was 2.8 items. The means of 'number of drug items prescribed for more than 1 week' by age-group were: < 20 years = 0.2, 20 to < 40 years = 0.5, 40 to < 60 years = 1.3 and > 60 years = 2.4. One way analysis of variance showed significant difference between the means of each age-group. Post hoc analysis revealed that the oldest age group accounted for most of this significant result. The top 10 drugs prescribed in descending order were: antihistamines, paracetamol, throat medications (eg. lozenges, gargles, etc), nifedipine, beta-blockers, antacids, mist benadryl expectorant, Procodin cough syrup (containing codeine and promethazine), amoxycillin and vitamin B. Nifedipine and beta-blockers were the most commonly prescribed anti-hypertensives. Non-steroidal anti-inflammatory drugs were usually prescribed with antacids. One hundred and twenty (4.5%) scripts were illegible. CONCLUSION: This study provides a baseline data for monitoring future prescribing trends. There may be a need to re-evaluate the appropriateness of nifedipine as the first line anti-hypertensive drug and the usefulness of NSAID-antacid and amoxycillin-cloxacillin combinations. The prevalence of illegible handwriting was high.

Adolescent↗
PubMed1999

Interaction of fluvoxamine with warfarin in an elderly woman.

An 80-year-old woman presented with an embolic stroke secondary to atrial fibrillation and mitral stenosis. She was initially on intravenous heparin and was subsequently maintained on oral warfarin. She was also given digoxin for atrial fibrillation and colchicine for gouty arthritis as well as fluvoxamine in her fourth week in hospital, to treat her depression. However, her INR (international normalised ratio) became markedly elevated within a week. Fluvoxamine and warfarin were stopped immediately. When warfarin was reintroduced 6 days later, her INR value increased again. The coagulation profile only became stable after 2 weeks of cessation of fluvoxamine. Low dose fluvoxamine can interact significantly with warfarin in the elderly and the effect may persist for up to 2 weeks of stopping the antidepressant.

Aged↗
PubMed1999

Bilateral caudate infarct--a case report.

Caudate strokes comprise only a small proportion of all subtypes of strokes. Bilateral caudate infarcts are even rarer and only a few cases have been reported in the literature. We report an 86-year-old woman with bilateral caudate infarcts. She had no past medical history of note. She presented with headache for several days and drowsiness on day of admission. Clinical examination revealed abulia, inability to comprehend or verbalize (acute mutism), right-sided neglect and right-sided hemiparesis. Computed tomographic (CT) scan brain revealed decreased attenuation in both heads of both caudate nuclei with extension across the anterior limb of both internal capsules to involve the lentiform nuclei. Echocardiography showed aortic valve sclerosis, mild mitral and aortic regurgitation and normal left ventricular function. Carotid ultrasound revealed mild stenosis of proximal right internal carotid and left distal common carotid and adjacent proximal internal carotid arteries. She showed initial improvement in the first week, but subsequently had a progressive downward course despite rehabilitation and died 44 days after her stroke. A patient with bilateral caudate infarcts is likely to have poor prognosis for rehabilitation and survival.

Aged↗
PubMed1999

Ischaemic hepatitis in an elderly woman.

An elderly woman presented with very high levels of transaminases and lactic dehydrogenase in her liver function tests. Viral and drug-induced hepatitis were considered unlikely because of the absence of risk factors. Sepsis was suspected and antibiotic treatment was started with clinical improvement. A retrospective diagnosis of ischaemic hepatitis due to septicaemia was made. Markedly raised liver transaminases need not always be drug-induced or viral-related, especially in the elderly. It could be ischaemic in origin and the serious underlying condition needs to be sought and treated urgently.

Aged↗
PubMed1999

Posterior cerebral artery territory infarct presenting as acute psychosis.

An 82-year-old man with a past medical history of hypertension was admitted to a psychiatric hospital for sudden onset of acute psychosis. He was then transferred to an acute geriatric unit for further evaluation. During the admission the patient was noted to be very restless, agitated and noisy and was shouting and screaming incessantly. This was interspersed with occasional short periods of calm and quiet. Clinically, no obvious focal neurological deficits were detected. A CT scan of the brain was performed and it revealed an acute infarct involving the area supplied by the left posterior cerebral artery. This was a rather atypical presentation for an infarct involving this area.

Aged↗
PubMed1999

The presentation of elderly people at an emergency department in Singapore.

OBJECTIVE: This study aims to provide demographic and clinical data of elderly people attending one of the hospital emergency departments in Singapore. DESIGN: Patients aged 60 years and above who attended the Emergency Department (ED) at Alexandra Hospital, Singapore, during 4 randomly selected one-week periods in 1996 were retrospectively studied. MAIN OUTCOME MEASURES: Patient profile; presenting symptoms; diagnoses; types of investigations done, and outcome following attendance. RESULTS: A total of 455 ED attendance cards were analysed. The age of patients ranged from 60 to 102 years with a mean age of 72.8 years. Two hundred and sixty-one (57.4%) were males and 194 (42.6%) were females. Four hundred and twenty-seven (93.9%) were emergencies, 25 (5.5%) were non-emergencies and in 3 (0.6%) the priority rating was unknown. Two hundred and ninety (63.7%) were admitted, of whom 166 (57.2%) were males. One (0.2%) was admitted for social reason. The 3 most common symptoms were abnormalities of breathing (10.6%), falls (9.4%) and musculoskeletal pain (8.2%). Majority had 1 (40.4%) or 2 (41.6%) symptoms. The symptoms were mainly acute (1 day, 45.2%) or less than a week (25.7%). The 3 most common diagnoses were chest infection or pneumonia (8.2%), non-fracture head injury (7.2%) and heart failure (6.6%). Most patients (90.5%) had only 1 diagnosis. The 3 most common tests done were chest X-ray (172 patients, 37.8%), electrocardiography (119 patients, 26.2%) and blood glucose (86 patients, 19.0%). One hundred and twenty (26.4%) patients did not require any investigation. CONCLUSION: The elderly constituted 12.4% of attendance at the ED but formed 34.5% of admissions. They were more likely to have emergency problems. Understanding the common presenting symptoms and diagnoses of the elderly will help doctors at the ED provide better care. Elderly patients with complex problems who are not hospitalised would probably benefit from further geriatric assessment.

Acute Disease↗
PubMed1998

The prescribing pattern of hospital doctors.

OBJECTIVE: There has been no local data on the prescribing habits of doctors over the last 25 years. This is a retrospective study done to examine the outpatient prescribing pattern of doctors at Alexandra Hospital over a one month period in 1995. METHOD: Six-thousand five-hundred and three scripts were analysed. A total of 16,642 items were prescribed. The distribution of prescription scripts by departments included Accident & Emergency 39.0%; Medical 23.5%; Orthopaedics 10.3%; Surgery 18.5%; Paediatrics 4.4%, and Geriatrics 4.3%. The overall mean number of drugs prescribed was 2.6 (median = 2, mode = 2, range = 14). RESULTS: Analysis of the overall results by age groups showed the following means for "total number of drugs prescribed": (> 0 to 20 years) = 2.23, (> 20 to 40 years) = 2.42, (> 40 to 60 years) = 2.61 and (> 60 years) = 3.18. Analysis of variance showed highly significant results between the means of each age-group. Post-hoc analysis revealed that the oldest age group (> 60 years) accounted for most of this significant result. The top 10 drugs used by the hospital were (in descending order): NSAIDs, antacids, analgesics (other than NSAID), antibiotics, topical medications, anti-diarrhoeal agents, anti-histamines, vitamins, anti-emetics and promethazine cough syrup. There was a high usage of NSAID-antacid combination. Similarly, amoxycillin was often given with cloxacillin. There was an underuse of anti-depressants. There were very few (0.15%) illegible prescriptions. Only one prescription had an adverse combination of drugs. CONCLUSION: This is the first local study of prescribing pattern of a hospital. While this data may vary from hospital to hospital, depending on the patient mix, it does provide some useful baseline data which hitherto never existed. Our findings suggested that the elderly do receive more medications.

Adolescent↗
PubMed1998

Day hospital rehabilitation for the elderly: a retrospective study.

Alexandra Hospital has the first day hospital for rehabilitation of the elderly in Singapore. To determine if functional skills and mobility improved significantly with a Day Hospital rehabilitation programme, and the factors influencing the outcome, a pre-test/post-test study was conducted on 30 male and 34 female patients discharged from the programme between 1 October 1995 and 30 June 1996. The Barthel Index was used to assess functional status and the Elderly Mobility Scale was used to assess mobility. All patients were assessed by trained therapists and scored on admission to and at discharge from the programme. We found a significant difference in the mean Barthel Index scores of 59.7 (SD 18.7) on admission and 71.4 (SD 20.5) at discharge (P < 0.001). The difference in the mean Elderly Mobility Scale of 7.1 (SD 4.3) on admission and 11.8 (SD 4.7) at discharge was also significant (P < 0.001). Improvement in functional skills and mobility were both inversely correlated with age. Multiple linear regression analysis showed that age and Barthel Index on admission were significant independent determinants of the Barthel Index at discharge, while age, Barthel Index and Elderly Mobility Score on admission significantly determined the Elderly Mobility Scale at discharge. This study showed that functional skills and mobility improved with rehabilitation in the elderly population, but younger and less severely disabled individuals tended to fare better.

Activities of Daily Living↗
PubMed1998

Care of elderly patients with DNR orders in Singapore--a descriptive study.

OBJECTIVE: To describe the demographic profile of a cohort of elderly patients with a 'do-not-resuscitate' (DNR) order at death and to study the specific supportive measures instituted or withdrawn during the DNR period and those in force at the time of death. METHODS: The case notes of patients who died between October 1996 and March 1997 in the Department of Geriatrics, Alexandra Hospital were studied retrospectively by a single observer. RESULTS: Only 95 out of an eligible 102 patients' case notes could be retrieved. Seventy-two (75.8%) patients had a DNR status at death. The racial distribution was as follows: 90.3% Chinese, 5.6% Indians, 2.8% Malays and 1.4% Others while their pre-admission domicile were: own home 79.2%, nursing home 19.4% others 1.4%. Those bedbound constituted 48.6% of the cohort while 29.2% had dementia and 43.1% were totally dependent for their activities of daily living. The commonest cause of death was pneumonia while the average duration patients were on the DNR status was 5.1 days before death. The commonest measures instituted during DNR period were as follows: oxygen therapy (38.9%), nasogastric tube insertion and feeding (30.6% and 33.3% respectively), intravenous fluid administration (33.3%), blood investigations (33.3%), opioid use (33.3%) and antibiotic use (29.2%). Measures withdrawn were intravenous fluid administration (36.1%), hourly monitoring of parameters (22.2%), antibiotics (13.9%), high dependency care (12.5%) and nasogastric tube feeding (6.9%). CONCLUSION: The DNR status is decided late in the course of a patient's illness when he may have been too ill to partake in the decision making process. Even if a DNR status was ordered, a patient might still be subjected to CPR at death.

Aged↗
PubMed1995

Atypical presentation in the elderly--case report of an acute abdomen.

An elderly woman with an acute abdomen due to a perforated peptic ulcer is discussed to illustrate the problem of atypical presentation of illness in the elderly. The importance of not dismissing non-specific symptoms and signs such as confusion, restlessness, abdominal distention and non-localising abdominal tenderness in the elderly, is highlighted. In addition, the useful radiological features of pneumoperitoneum are described. The need for functional assessment and rehabilitation are emphasised as important components in the practice of geriatric medicine.

Abdomen, Acute↗
PubMed1994

Pattern of skin diseases in the elderly seen at the National Skin Centre (Singapore) 1990.

A retrospective study was conducted at the National Skin Centre (Singapore) for the period 1st January 1990 to 31st December 1990 to determine the pattern of skin disorders in the elderly. A total of 2,571 patients aged 65 years and above were studied. This constituted 6.4% (2,571/39,941) of patients seen at the Centre for that year. 38.1% of the elderly patients were aged 75 years or older. The male to female ratio was 1.3 to 1. There were differences in the pattern of skin problems when compared with the young. Xerosis and asteatotic eczema were distinctly common in the elderly. The most common dermatosis in the elderly was eczema. Endogenous eczema (including seborrhoeic dermatitis, lichen simplex chronicus, hand/feet eczema, stasis eczema, generalised exfoliative dermatitis), exogenous eczema (ie contact dermatitis) and dermatitis (not otherwise specified) formed 35.3% (907/2,571) of the skin disorders encountered at the National Skin Centre. Eczema, fungal, viral infections and psoriasis were on the whole less common in the elderly compared with the general population. Common skin infestations and infections were scabies, viral warts, monilial and bacterial intertrigo and tinea corporis. Urticaria, alopecia, insect bite reactions and post-inflammatory pigmentation were uncommon referral problems in the elderly.

Aged↗
PubMed1993

Outcome of patients with cervical spondylotic myelopathy seen at a rehabilitation centre.

A retrospective study was conducted on 21 patients with cervical spondylotic myelopathy to study the clinical characteristics of these patients and the influence of surgery and rehabilitation on their outcome. All the patients were 50 years and above, with a mean age of 63.6 years. The most common presenting feature was weakness of all the limbs. Neckache was not a prominent finding. Although only 2 patients complained of bladder disturbance, 6 other patients were found to have bladder dysfunction after urodynamic assessment. Clinical outcome after surgery was 50% improved, 28% unchanged and 22% worsened. Fifty percent of the patients with voiding problems recovered after bladder training. Rehabilitation was significant in assisting in the recovery of patients after surgery. One patient had a disabling stroke 4 days after cervical surgery while another died of urinary tract infection while undergoing rehabilitation.

Activities of Daily Living↗