Biomedical subjects

W S Pang

Publications and source records attributed to W S Pang.

11 recordsLinked to original sources

PubMed2000

Wegener's granulomatosis in the elderly.

Wegener's granulomatosis classically involves the upper respiratory tract, lungs and kidneys. Rarely, it also affects the skin and heart. Cardiac involvement is uncommon in Wegener's granulomatosis and myocardial infarction is seldom highlighted. It can be a difficult diagnosis to make in the elderly who often have multiple co-existing illnesses. We present a case of a 75-year-old Chinese woman with interesting cardiac and dermatological manifestations of Wegener's granulomatosis.

Aged↗

PubMed1999

Is euthanasia compatible with palliative care?

There has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for care of the terminally ill and dying. There have also been calls by certain groups to actually legalize voluntary euthanasia and physician-assisted suicide for patients who meet certain conditions, some of which are as follows: that the patient be of a sound mind, suffering from an incurable or terminal illness, experiencing unbearable suffering and uncontrollable pain. The rationale for legalizing euthanasia is based on the principle of the patient's right of self-determination and the duty of doctors to relieve pain and suffering at all times. A few within the medical community quickly saw certain similarities in terms of goals and aims between euthanasia and palliative care and, thus, proposed that euthanasia be an option or choice for difficult palliative care cases. Some even went as far as to suggest that euthanasia and palliative care be part of the continuum of care for terminally ill patients. When palliative medicine fails to fully control pain and suffering for the patient, euthanasia can be the logical next step in the continuum of care. This article seeks to discuss why the rationale for legalizing euthanasia is flawed, why euthanasia goes against the fundamental principles of Medicine in general and why it is incompatible with the practice of palliative medicine.

Ethics, Medical↗

PubMed1999

Functional status of the elderly in Singapore.

BACKGROUND: This study was done to look at prevalence and factors affecting functional dependence. The data in this paper were part of the 'Community Study on State of Health, Function, Cognitive and Social State of Elderly People in Singapore' conducted in Singapore between September 1992 and December 1993. PATIENTS: Four hundred and one elderly, aged 60 years and above were studied. Sixty-eight subjects (17%) were dependent in at least one function of Activities of Daily Living (ADL) as measured by the Barthel's Index (BI). RESULTS: The most common problem identified using this index was urinary incontinence. Forty subjects (10.4%) were dependent in at least one Instrumental Activities of Daily Living (IADL) function. The most common mode of transportation was by public transport, of which travelling by bus was the most common (59.9%) and mass rapid transit (MRT) was the least common (4%). Female gender and age > or = 75 were significant factors associated with dependence measured on Barthel's index but not on IADL. CONCLUSION: Results of this study were also compared with two previous surveys done in Singapore. Discrepancies in results noted could be attributed to different definitions in which the functions were assessed. We should aim to standardise the definition and measures of function in the local context in order to measure changes in the elderly population.

Activities of Daily Living↗

PubMed1998

A descriptive study of the demography, symptomology, management and outcome of the first 300 patients admitted to an independent hospice in Singapore.

The aims of this study were: 1) to describe the demography, symptomology, investigations conducted, non-pharmacological interventions and outcome of patients admitted to an inpatient hospice and 2) to identify the nursing and medical needs of terminally ill patients. Case-notes of the first 300 patients admitted to Dover Park Hospice were studied retrospectively. There were 159 men and 141 women making up 325 admissions. The racial distribution was: Chinese 95.0%, Malays 3.0%, Indians 1.3% and Others 0.6%. Two-thirds of the men (64.2%) had spouses while 44.7% of the women were widowed. The mean age was 64.7 years. The 3 most common cancers were lung (21.7%), colorectal (14.6%) and hepatobiliary (12.5%). A proportion of patients (39.5%) were not known to have any metastases. Most patients were referred from hospitals and the home-care based Hospice Care Association. The commonest reason for admission was for "terminal care" (57.2%). At admission, only 38% of the patients were aware of their diagnoses and prognosis while 30% did not know either. The average length of stay was 25 days with 7.7% of patients having more than one admission. The most common symptoms were pain, anorexia, breathlessness, insomnia, constipation and dry skin. Non-pharmacological interventions ranged from manual evacuation of the rectum to transfers to tertiary hospitals for surgery and other more invasive interventions. Many patients also attended day-care activities (23.1%). Outcome of the 325 admissions were as follows: went home 20%, died in the hospice 73.2%, went home to die 4.9% and others 1.8%.

Adult↗

PubMed1998

Self-perception of health among elderly community dwellers in Singapore.

Majority (90.5%) of the elderly living in the community in Singapore had a positive (satisfactory to good) perception of their health. This study found that age (70 years or older), recent hospitalisation, regular medical follow-up, hearing impairment, presence of chronic medical conditions (like musculo-skeletal problems, hypertension, ischaemic heart disease and chronic obstructive lung disease), impairment in activities of daily living, history of falls, those on regular medications and those with financial difficulties all adversely influenced perception of health. Those able to participate in regular outdoor leisure activities have a positive influence. Factors that did not significantly influence perception of health were gender, health-promoting activities, work, poor eyesight, cognitive impairment, urinary incontinence, diabetes, history of stroke and the ability to use public transport.

Activities of Daily Living↗

PubMed1998

Preferred place of death--a local study of cancer patients and their relatives.

BACKGROUND: Knowing the preferred place of terminal care is helpful in the provision of services for the terminally ill. We carried out a survey of cancer in-patients and their relatives to determine the local preference for place of terminal care as well as the factors that affected their choice. METHODS: The study was conducted in the form of an interview survey on patients admitted to a general medical unit and a geriatric medicine unit. Relatives approached were the nearest kin (first degree relatives), or relatives living with the patients. Patients who were not aware of their diagnosis, who were unable to comprehend the questionnaire, or were too ill to participate were not interviewed. RESULTS: Fifty-two percent (23/44) of interviewed patients preferred to die at home if possible (compared to 34%, 15/44, who preferred the hospital). This is particularly so in the elderly and if there is assurance of domiciliary care. Relatives have an almost equal preference for the patient to be at home (45%, 35/77) or in the hospital (42%, 32/77) terminally. Given the support, more (37.5%, 12/32) of those who initially wanted their sick relatives to be in hospital would prefer them to spend their last days at home. CONCLUSION: There is a greater preference in cancer patients for terminal care at home. This is especially so for the elderly and if there is assurance of domiciliary care. This is an impetus for greater support of home care services.

Adult↗

PubMed1997

Neuroimaging guidelines in cognitive impairment: lessons from 3 cases of meningiomas presenting as isolated dementia.

We report three cases of large intracranial meningiomas who presented with dementia alone and no accompanying focal neurological deficits. The meningiomas were detected solely as a result of a policy of routinely scanning the brains of patients presenting with early dementia. Dramatic improvements in the cognitive functions were noted following the excision of the tumours in two of the patients (the third passed away in the perioperative period). The implications of these cases with regard to deciding when to order a brain scan for patients presenting with isolated dementia are discussed in this article and a brief review of the relevant medical literature on this topic is also presented.

Aged↗

PubMed1997

Epidemiology of falls among the elderly community dwellers in Singapore.

AIM: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore. METHOD: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience. RESULTS: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93). CONCLUSION: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

Accidental Falls↗

PubMed1996

Clinical utility of a portable ultrasound scanner in the measurement of residual urine volume.

BACKGROUND: Post-voiding residual urine volume is an important investigation in the management of voiding dysfunction. Catheterisation is widely regarded as the "gold" standard method of measurement. We investigated the performance of a portable ultrasound scanner (Bladder Scan BVI-2500), as an alternative method of measurement. METHODS: This study was prospective in nature. One hundred measurements of post-voiding residual urine volume by ultrasound were compared with measurements by catheterisation. RESULTS: The mean absolute error of the scanner was 52 mL. For volumes below 200 mL and 100 mL, this was 36 mL and 24 mL respectively. A decision regarding whether to decompress the bladder by catheterisation would have also been correct in 86% to 89% of instances, depending on the cut-off value of the residual volume used. In other words, the ultrasound measurement would have been correct in 9 out of 10 clinical cases. CONCLUSION: We recommend the routine use of portable ultrasound scanners of similar accuracy in the measurement of post-voiding residual urine volume.

Adult↗

PubMed1995

Do-not-resuscitate orders: towards a policy in Singapore.

Despite the fact that the pioneers of cardio-pulmonary resuscitation (CPR) designed the techniques for victims who were meant to be "salvable", currently CPR is largely applied to anyone who collapses, regardless of their underlying illness. However, the central fact is that CPR (and all its related complex and expensive technology) has a very low success rate (in terms of eventual hospital discharge) and the most important determinant of survival has always been the nature and stage of the underlying illnesses. All these bespeak of a need to have do-not-resuscitate (DNR) orders which will incorporate the pertinent medical, ethical, socio-cultural and legal components. In this discussion paper some guidelines for DNR orders relevant to Singapore are proposed, the main rationale of the guidelines are explained and some challenges and needed changes associated with its implementation are addressed.

Attitude to Health↗

PubMed1994

Dyspnoea in advanced malignancies: a palliative care approach.

The incidence of dyspnoea in advanced malignancies varies from 48-78.6% in different studies. A systematic approach enables the clinician to separate non-malignant causes from those due to complications of malignancy. Specific treatment should be considered for airway obstruction, secondary chest infection, pleural effusions and superior vena cava obstruction. Morphine remains the most effective drug and may be delivered either orally or by inhalation. Nebulised anaesthetics are alternatives, while the value of other drugs is uncertain. Oxygen therapy and treatment of anxiety are important components.

Combined Modality Therapy↗