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Biomedical subjects

N C Tan

Publications and source records attributed to N C Tan.

At least 19 recordsLinked to original sources
PubMed2006

Family physicians' experiences, behaviour, and use of personal protection equipment during the SARS outbreak in Singapore: do they fit the Becker Health Belief Model?

Singapore experienced the SARS outbreak in 2003. The study aimed to describe the experience and behaviour of family physicians and the use of personal protection equipment (PPE) in their encounters with SARS patients. 8 such participants were interviewed and the content was analysed using qualitative research method. They highlighted the difficulties in procuring PPE due to severe shortage, the discomfort and inconvenience associated with its use. Despite the increasing operating cost, declining patient attendance and high price of the PPE, they persist in using PPE and change their behaviour in order to reduce the perceived threat to their lives. It fits into the Becker Health Belief Model, which explains that behaviour change depends on the balance of perceived vulnerability, severity, effectiveness, and barriers. The vulnerability and severity of SARS to healthcare workers were verified by the hospital experience. Perceived effectiveness of PPE amongst the family physicians outweighed the barriers of shortage, cost and discomfort of the PPE.

Disease Outbreaks↗
PubMed2005

Home blood-pressure monitoring among hypertensive patients in an Asian population.

Hypertension is a principal cause of mortality and morbidity in Singapore. The use of home blood-pressure monitoring (HBPM) to assess hypertensive control with digital devices in the local multi-racial population is unknown. The study determined the factors associated with hypertensive patients' use of HBPM in primary care in a multi-racial Asian population. Randomized cross-sectional questionnaire survey of hypertensive patients managed in a district polyclinic. A model predicting use of HBPM was constructed by univariate and multivariate logistic regression. A total of 224 eligible subjects were randomly selected from 1943 patients. Response rate was 78.1% (n = 175). In all, 61.7% of them were aware of HBPM but only 24% used HBPM. Using multivariate analysis by stepwise backward regression, the final fitted model showed that HBPM was associated with higher patients' socioeconomic status: (adjusted OR for middle-income status = 2.85, 95% CI: 1.2-6.78, P = 0.018; adjusted OR for high-income status = 3.46, 95% CI: 1.22-9.87, P = 0.020) and their documented diastolic BP (adjusted OR for diastolic BP > 80 mmHg = 2.26, 95% CI: 1.06-4.82, P = 0.034). Nonusers cited failure to recognize benefits (54.1%), lack of HBPM awareness (29.3%), understanding of device operation (18.8%) and perception of inaccuracy (10.5%) as deterrents. 76.2% of users were satisfied with HBPM but lacked knowledge in maintenance of devices. In conclusion, 61.7% of the study population were aware of HBPM but only 24% used it. Patients' failure to recognize benefits, lack of awareness, cost and perception of inaccuracy were barriers. Higher socioeconomic status and patient's documented diastolic BP correlated with HBPM usage.

Adult↗
PubMed2005

A qualitative study of health-seeking behavior of Hepatitis B carriers.

INTRODUCTION: Asymptomatic Hepatitis virus (HBV) carriers are often followed up at primary and secondary care centres in Singapore. Compliance to disease monitoring is perceived to be a barrier in their management. The study used qualitative methods to determine the health-seeking behavior of HBV carriers. Understanding such behavior will enable the attending physicians to optimise their care and promote regular disease surveillance. METHODS: Data were collected from 39 HBV carriers from primary and secondary healthcare centres, with different demographic profiles in eight respective focus group discussions (FGD). A nurse conducted the FGDs using a semi-structured guideline. The qualitative data were analysed using standard content analysis technique. RESULTS: There was evidence of doctor hopping among the HBV carriers in seeking the follow-up of their disease. Cost of review and investigations and preference for specialists' care appeared to be determinants of the sites of disease monitoring. Compliance to follow-up seemed to be sub-optimal, arising from apathy, denial, perceived inconvenience and cost of review. A significant proportion of the carriers had tried alternate therapy, took liver supplements but most found them to be ineffective. Most carriers had adopted healthier lifestyle after their diagnosis with regular exercise, smoking cessation and alcohol abstinence. CONCLUSION: Many HBV carriers' inadequate understanding of the disease resulted in indifferent or inappropriate health-seeking behavior towards their disease management. There is room for health education for these carriers to enhance their awareness of the disease and improve compliance to disease monitoring.

Adult↗
PubMed2005

What barriers do primary care physicians face in the management of patients with chronic hepatitis B infection in primary care?

INTRODUCTION: Asymptomatic chronic hepatitis B virus (HBV) carriers, followed-up in primary care, present a challenge to primary care physicians as they encounter problems in monitoring this group of patients. The study aims to explore the barriers faced by primary care physicians in the management of patients with chronic hepatitis B infection in primary care. METHODS: Qualitative analysis of eight focus group discussions with 43 primary care physicians in Singapore was conducted. RESULTS: Primary care physicians highlighted the HBV carriers' poor compliance to disease monitoring as a major hurdle, attributing to their lack of understanding of the disease, state of denial, fear of stigmatisation in society, failure to perceive benefits, costs and reluctance of investigations due to physical discomfort. The carriers' health-seeking behaviour, such as doctor hopping and the use of traditional medication, were other barriers. The investigators noted that the physicians placed emphasis on passive disease monitoring, focusing on the investigation results when they reviewed the carriers. They were less proactive in explaining the disease's natural history nor discussing the possibility of definitive anti-viral treatment for suitable carriers. These physicians varied in their approaches in disease monitoring of chronic HBV infection. The fees-for-service healthcare system allowed the carrier to seek consultation from different doctors, which could result in disruption of disease surveillance. This was further compounded by the differential cost of investigations in private practices and government-aided polyclinics. The absence of a national HBV registry and recall system and waiting time for referral to specialist clinics in restructured hospitals, were other barriers. CONCLUSION: The management of HBV carriers in primary care could be enhanced by measures that eliminate the barriers involving the patient, doctor and healthcare system.

Adolescent↗
PubMed2005

Successful management of a bleeding duodenal varix by endoscopic banding.

Endoscopic treatment of bleeding duodenal varices is less invasive than the usual surgical options. However, there is limited experience with endoscopic treatment of bleeding duodenal varices, especially with that of endoscopic ligation. We report a 55-year-old man with a bleeding duodenal varix that was successfully ligated endoscopically. He has been followed up for nine months with no recurrence of bleeding. Endoscopic ligation may offer a new and effective treatment modality for bleeding duodenal varix.

Duodenoscopy↗
PubMed2004

Diagnosis and misdiagnosis of hemifacial spasm: a clinical and video study.

Early recognition of hemifacial spasm (HFS) is important as it can be effectively treated. 203 family physicians participated in a video "test" on HFS. Only 9.4% (19/203) were able to diagnose HFS. 94 (46.3%) of them did not know how to manage the condition. Twenty-two (10.8%) would use steroids as a treatment and 13 (6.4%) felt no treatment was needed. Only 27 (13.3%) indicated that botulinum toxin could be employed to treat HFS. The year of graduation of the doctors significantly correlated with a correct diagnosis (P<0.05). The low positive diagnostic rate (25.7%) of HFS from referrals to the movement disorder clinic corroborated findings from the video test.

Adult↗
PubMed2004

The role of general practitioners in the management of erectile dysfunction-a qualitative study.

The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.

Adult↗
PubMed2004

Effectiveness of nurse counselling in discouraging the use of the infant walkers.

Infant walkers are widely used by caregivers in Singapore despite being recognized as a household hazard. The study determined the effectiveness of nurse counselling in dissuading caregivers from using the walker. Caregivers of children 4 months of age were recruited and divided into the intervention group (nurse's advice and illustrated pamphlets), a conventional group (questionnaire alone) and a control group (without any intervention in separate polyclinic). The percentage of the caregivers, who used the walkers in each group when their child was 9 months old, was taken as a surrogate indicator of effectiveness of nurse's intervention. The study analyzed 708 caregivers. Fewer caregivers (62.7% intervention vs. 80.4% questionnaire alone vs. 83.0% control) used the walker after nurse's advice with illustrated pamphlets. 8% of the users reported walker-related injuries (n=43). Nurses' counselling could be a simple yet effective method to discourage the use of walkers.

Accident Prevention↗
PubMed2002

Primary care doctors' practice in the management of adult asthma patients.

There is apparent disparity between the international guidelines on asthma management and the current practice in reality. This can be attributed to both patient's and doctor's factors. This study examines the practice of asthma management by a group of family physicians using a self-administered questionnaire. This comprises questions relating to the main principles of asthma management set by international guidelines. The results showed that majority of the doctors (>90%) in the study reviewed patient's asthma status based on symptoms, educate their patients on types of asthma medications and advised them on allergen avoidance including smoking. Fewer of them (50 to <90%) check trigger factors or inhaled device technique, nocturnal symptoms or ER visits. Even fewer doctors (<50%) bothered to check the patient's peak expiratory flow rate (PEFR) or used spirometry.

Asthma↗
PubMed2001

Advances in high-rate anaerobic treatment: staging of reactor systems.

Anaerobic wastewater treatment (AnWT) is considered as the most cost-effective solution for organically polluted industrial waste streams. Particularly the development of high-rate systems, in which hydraulic retention times are uncoupled from solids retention times, has led to a world-wide acceptance of AnWT. In the last decade up to the present, the application potentials of AnWT are further explored. Research shows the feasibility of anaerobic reactors under extreme conditions, such as low and high temperatures. Also toxic and/or recalcitrant wastewaters, that were previously believed not to be suitable for anaerobic processes, are now effectively treated. The recent advances are made possible by adapting the conventional anaerobic high-rate concept to the more extreme conditions. Staged anaerobic reactor concepts show advantages under non-optimal temperature conditions as well as during the treatment of chemical wastewater. In other situations, a staged anaerobic-aerobic approach is required for biodegradation of specific pollutants, e.g. the removal of dyes from textile processing wastewaters. The current paper illustrates the benefits of reactor staging and the yet un-exploited potentials of high-rate AnWT.

Bacteria, Aerobic↗
PubMed2000

Relation between morbidity and current treatment in patients who present with acute asthma to polyclinics.

BACKGROUND: It has been suggested that resources for asthma intervention should be focused mainly on patients in the community who experience a high burden of disease. These are who patients who have acute exacerbations which require urgent treatment. AIM: To assess the morbidity and identify deficiencies in the treatment of patients who present for urgent treatment of acute exacerbations to primary care clinics. PATIENTS: Adult patients who received urgent treatment for acute exacerbation of bronchial asthma SETTING: 4 primary care polyclinics. METHODS: A cross-sectional survey of consecutive patients which related regular preventive treatment to current asthma activity. Poor asthma control was defined as step 2 or higher (American National Asthma Education and Prevention Program, report II, 1997) or > or = 2 emergency room visits in 6 months. RESULTS: There were 116 patients of whom 53% were women. The mean (SD) age was 45(15) years and duration of current exacerbation 3 (3) days. The acute symptoms were successfully treated in 93% of patients. Quick relief medication was used regularly in 91% and inhaled corticosteroids (ICS) in 55%. Oral salbutamol was prescribed in 14% of patients. The asthma was poorly controlled in 54%. In the poorly controlled group 33% were not on regular ICS treatment and 64% were not receiving "add on" medication. CONCLUSIONS: Patients treated for acute asthma in primary care clinics: (1) were older and had less acutely severe exacerbations than those who presented to emergency rooms, (2) over half had poorly controlled asthma and (3) a third of patients with poor asthma control were inadequately treated.

Acute Disease↗
PubMed2000

Myelodysplastic syndrome with monosomy 7 and pulmonary aspergillosis.

A 43-year-old man with no past history presented with symptoms of fever, cough and dyspnoea arising from invasive pulmonary aspergillosis and was found to have myelodysplastic syndrome with monosomy 7. Before initiation of chemotherapy, he deteriorated rapidly, developing multi-organ failure requiring mechanical ventilation, and he eventually succumbed despite amphotericin B treatment. The importance of monosomy 7 in determining immune function in patients with myelodysplastic syndrome is emphasised.

Adult↗
PubMed1999

Biodegradation of azo dyes in cocultures of anaerobic granular sludge with aerobic aromatic amine degrading enrichment cultures.

A prerequisite for the mineralization (complete biodegradation) of many azo dyes is a combination of reductive and oxidative steps. In this study, the biodegradation of two azo dyes, 4-phenylazophenol (4-PAP) and Mordant Yellow 10 (4-sulfophenylazo-salicylic acid; MY10), was evaluated in batch experiments where anaerobic and aerobic conditions were integrated by exposing anaerobic granular sludge to oxygen. Under these conditions, the azo dyes were reduced, resulting in a temporal accumulation of aromatic amines. 4-Aminophenol (4-AP) and aniline were detected from the reduction of 4-PAP. 5-Aminosalicylic acid (5-ASA) and sulfanilic acid (SA) were detected from the reduction of MY10. Subsequently, aniline was degraded further in the presence of oxygen by the facultative aerobic bacteria present in the anaerobic granular sludge. 5-ASA and SA were also degraded, if inocula from aerobic enrichment cultures were added to the batch experiments. Due to rapid autoxidation of 4-AP, no enrichment culture could be established for this compound. The results of this study indicate that aerobic enrichment cultures developed on aromatic amines combined with oxygen-tolerant anaerobic granular sludge can potentially be used to completely biodegrade azo dyes under integrated anaerobic/aerobic conditions.

Aerobiosis↗
PubMed1999

Assessment of metered dose inhaler technique in family health service patients in Singapore.

OBJECTIVE: To assess the metered-dose inhaler technique in polyclinic patients with chronic lung disease. METHOD: A cross-sectional study was conducted in three polyclinics. The inhalation technique was assessed in six steps. RESULTS: Only 7.1% of patients could perform all six steps correctly. Percentage of patients performing each of the following steps correctly were: preparation (89.1%), exhalation (53.8%), lip closure (69.2%), inhalation (57.7%), breath-holding (32.1%) and puff interval (35.4%). CONCLUSION: This study showed a high incidence of incorrect usage of metered dose inhaler amongst polyclinic patients.

Adolescent↗
PubMed1999

Video-assisted thoracoscopy: role in the management of intrathoracic pathology.

A retrospective study was done from October 1992 to December 1996 of 48 patients who underwent video-assisted thoracoscopy. A male to female ratio of 3.7:1 was seen, with a mean age of 50 +/- 19 years. The underlying diagnoses included spontaneous pneumothorax (n = 23), malignant pleural effusion (n = 16), lung disease (n = 4), trauma (n = 2), empyema (n = 2) and oesophageal carcinoma (n = 1). The use of this modality is discussed in the treatment of various intrathoracic pathologies.

Adolescent↗
PubMed1996

Massive chylothorax after anterior fusion of the thoracic spine.

We report a case of massive chylothorax occurring postoperatively in a patient with Potts paraplegia who underwent transthoracic anterior debridement and fusion of the T7 and T8 vertebrae. This is an uncommon complication of anterior spinal surgery but has a significant morbidity and mortality. Diagnosis of the condition and the institution of the appropriate therapy will reduce this significantly. The treatment principles are continuous tube drainage, nutritional support and reduction of chyle production. In 50% of cases a surgical procedure will be required. There are a variety of techniques available. We describe a technique that uses a pedicled intercostal muscle flap, which to our knowledge, has not been described previously. Among the other techniques, video-assisted thoracoscopic surgery is the most promising because of its low morbidity.

Adult↗
PubMed1992

A prevalence study of dysmenorrhoea in female residents aged 15-54 years in Clementi Town, Singapore.

A community-based questionnaire survey to study the prevalence of dysmenorrhoea, its associated risk factors and impact on daily living was carried out on a random sample of 415 female persons aged 15 to 54 residing in Housing Development Board flats in Clementi Town. The overall prevalence of dysmenorrhoea, defined as one or more episodes of menstrual cramp or pain in the previous year, not due to a diagnosed gynaecological disease, was 51.3%. The condition was less prevalent and less severe in older women and in women with later menarche. It was also less prevalent in women who were parous, with the greatest number of parous women reporting improvement in severity after the first child. Among those with dysmenorrhoea, about 52% of students, 42% of working women, and 30% of housewives reported that their ability to perform work was affected. About 6% of all women consulted a doctor for their problem, and 10% of all employed women reported having been sick-absent because of dysmenorrhoea.

Adolescent↗