The receptiveness of patients towards involving medical trainees in their care is essential to clinical education. Data on patients’ attitude towards trainees and reasons for their attitude is ...currently lacking. Hence the aim was to explore the attitudes and factors influencing the attitudes of patients towards trainees at a tertiary centre for cardiovascular care. A cross-sectional survey was performed among consecutive patients from the cardiac clinics at our tertiary institution in 2014. Of the 723 patients included, nearly all (97.9%) believe that senior doctors make the final decision for their care, and the majority (94.1%) are willing to interact with trainees under supervision of senior doctors. However, less than 60% of patients have actually allowed trainees to participate in their care most or all of the time, with the most important reason for this being fear that care would be compromised (n = 172). Top reasons why trainees were allowed include belief that it is important for trainees to get experience (n = 538), that trainees obtained permission politely (n = 360) and that trainees were professional (n = 284). Multivariate analysis revealed that better education (odds ratio (OR) 2.055, 95% confidence interval (CI) 1.393–3.033, p < 0.01), male gender (OR 1.556, 95% CI 1.058–2.338, p = 0.03) and less worry about cost of treatment (OR 1.605, 95% CI 1.058–2.433, p = 0.03) increased receptiveness towards trainees. The study demonstrated largely positive attitudes towards trainees being involved in one’s care. The trainee’s politeness and professionalism, as well as the patient’s perceived importance of trainee education, were important in determining such receptiveness.
Erectile dysfunction is commonly faced by men with cardiovascular disease. We aimed to determine the prevalence of erectile dysfunction in patients with cardiovascular disease risk factors in ...Singapore. We conducted a cross-sectional survey on patients with cardiovascular disease risk factors from June 2014 to July 2014 at the outpatient cardiology clinics of our tertiary institution. The survey included patient demographics, comorbidities and an abridged version of the International Index of Erectile Function (IIEF-5). Erectile dysfunction severity was categorized as absent (IIEF-5 score: 22–25), mild (IIEF-5 score: 17–21), moderate (IIEF-5 score: 8–16) and severe (IIEF-5 score: <8). Independent variables were demographic factors (i.e. age, race, occupation, etc.) and comorbidities (i.e. diabetes, hypertension, etc.). Primary dependent variable was the presence of erectile dysfunction and secondary dependent variable was the severity of erectile dysfunction. A total of 468 male respondents (mean age 57±11.2 years) were included. Sixty-nine per cent of respondents reported the presence of erectile dysfunction, with further breakdown into 29% with mild, 30% with moderate and 10% with severe erectile dysfunction. Multivariate analysis revealed that significant predictive risk factors of erectile dysfunction were old age (odds ratio (OR) 1.073, 95% confidence interval (CI) 1.050–1.097, p<0.001), the presence of diabetes (OR 2.127, 95% CI 1.186–3.81, p=0.001) and a lower level of education (OR 2.392, 95% CI 1.387–4.125, p=0.002). These three factors were significant predictors for severity of erectile dysfunction (p-values of 0.000). Prevalence of erectile dysfunction is high in patients with cardiovascular disease risk factors. Cardiologists should screen for erectile dysfunction particularly in patients with older age, diabetes and lower education levels.
Increasing time spent on Electronic Health Records (EHR) for delivery of patient care is often cited as an important cause of healthcare provider burnout.1 During COVID-19, the pressure to lower bed ...occupancy rates led to new models of care to deliver healthcare in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model. We aim to see if these alternative models of care can reduce time spent on EHR.
Using published methods of time-driven activity-based costing in healthcare, we created a process map for the journey of a typical patient with uncomplicated rhabdomyolysis and hypertensive urgency using different models of care. The amount of time each healthcare provider spent on delivering care and its breakdown was estimated in consultation with experienced clinicians, nurses, and allied health professionals. We confirmed these times by observing the actual care processes.
In all conditions across all models, residents spend about 4 times more time on patients in total compared to consultants (Table 1). Residents spend a higher proportion of time (40% to 63.1%) on EHR compared to consultants (12.5% to 22.6%). Compared to conventional inpatient ward based care, residents spent a lesser proportion of time on EHR in alterative models (65% and 90% in HaH and ACT respectively). However, consultants spend a larger proportion of time on EHR in alternative models (1.5 and 1.3 times in HaH and ACT respectively).
In the HaH model, both consultants and residents spend more time on EHR (12 mins vs 4 mins and 86 mins vs 65 mins) but a lesser proportion of time on EHR in the HaH model. This is likely due to the influence of commute time and extra time taken to screen for safety concerns in a new service model.
In the ACT model, the total physician time spent on the patient is about half of that of the conventional model (61 min vs 127 min). The absolute time spent on EHR is reduced by 2.3 times in residents and 1.5 times in consultants compared to conventional care. The proportion of time spent on EHR for residents compared to conventional care is reduced (57.1% vs 63.1%).
Alternative models of care influence physician time spent on EHR and overall time spent delivering care to a patient differently. The ACT reduces overall physician time and time spent on EHR, demonstrating its potential to increase the efficiency and cost-effectiveness of care and contribute to reducing physician burnout in the global context of a shrinking health workforce.
: Knowledge, attitudes and practices (KAP) impact on cardiac disease outcomes, with noted cultural and gender differences. In this Asian cohort, we aimed to analyse the KAP of patients towards ...cardiac diseases and pertinent factors that influence such behaviour, focusing on gender differences.
: A cross-sectional survey was performed among consecutive outpatients from a cardiac clinic over 2 months in 2014.
: Of 1406 patients approached, 1000 (71.1%) responded (mean age 57.0 ± 12.7 years, 713 71.3% males). There was significant correlation between knowledge and attitude scores (r = 0.224,
<0.001), and knowledge and practice scores (r = 0.114,
<0.001). There was no correlation between attitude and practice scores. Multivariate predictors of higher knowledge scores included female sex, higher education, higher attitude and practice scores and prior coronary artery disease. Multivariate predictors of higher attitude scores included higher education, higher knowledge scores and non-Indian ethnicity. Multivariate predictors of higher practice scores included male sex, Indian ethnicity, older age, higher knowledge score and hypertension. Males had lower knowledge scores (85.8 ± 8.0% vs 88.0 ± 8.2%,
<0.001), lower attitude scores (91.4 ± 9.4% vs 93.2 ± 8.3%,
= 0.005) and higher practice scores (58.4 ± 18.7% vs 55.1 ± 19.3%,
= 0.013) than females.
: In our Asian cohort, knowledge of cardiovascular health plays a significant role in influencing attitudes and practices. There exists significant gender differences in KAP. Adopting gender-specific strategies for future public health campaigns could address the above gender differences.
Importance
During COVID-19, Singapore simultaneously experienced a dengue outbreak, and acute hospitals were under pressure to lower bed occupancy rates. This led to new models of care to treat ...patients with acute, low-severity medical conditions either at home, in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model, but a reliable cost analysis for these models is lacking.
Objective
To compare personnel costs of HaH and ACT with inpatient care.
Design, Setting, and Participants
In this economic evaluation study, time-driven activity-based costing was used to compare the personnel cost of inpatient care with treating dengue via HaH and treating chest pain via ACT. Participants were patients with nonsevere dengue and chest pain unrelated to a coronary event admitted via the emergency department to the internal medicine service of a tertiary hospital in Singapore.
Exposures
HaH for dengue and ACT for chest pain.
Main Outcomes and Measures
A process map was created for the patient journey for a typical patient with each condition. The amount of time personnel spent on delivering care was estimated and the cost per minute determined based on their wages in 2022. The total cost of care was calculated by multiplying the time spent by the per-minute cost of the personnel resource and summing all costs.
Results
Compared with inpatient care, HaH used 50% less nursing time (418 minutes, 95% uncertainty interval UI, 370 to 465 minutes) but 80% more medical time (303 minutes, 95% UI, 270 to 338 minutes) per case of dengue. If implemented nationally, HaH would save an estimated 56 828 SGD per year (95% UI, −169 497 to 281 412 SGD US $41 856; 95% UI, −$124 839 to $207 268). The probability that HaH is cost saving was 69.2%. Compared with inpatient care, ACT used 15% less nursing time (296 minutes, 95% UI, 257 to 335 minutes) and 50% less medical time (57 minutes, 95% UI, 46 to 69 minutes) per case of chest pain. If implemented nationally, ACT would save an estimated 1 561 185 SGD per year (95% UI, 1 040 666 to 2 086 518 SGD US $1 149 862; 95% UI, $766 483 to $1 536 786). The probability that ACT is cost saving was 100%.
Conclusions and Relevance
This economic evaluation found that the HaH and ACT models decreased the overall personnel cost of care. Reorganizing hospital resources may help hospitals reap the benefits of reduced hospital-acquired infections, improved patient recovery, and reduced hospital bed occupancy rates.
Black bone disease refers to the hyperpigmentation of bone secondary to prolonged usage of minocycline. We present a report of a 34-year-old man who underwent femoral shaft fracture fixation ...complicated by deep infection requiring debridement. The implants were removed 10 months later after long-term treatment with minocycline and fracture union. A refracture of the femoral shaft occurred 2 days after implant removal and repeat fixation was required. Intraoperatively, abundant heavily pigmented and dark brown bone callus was noted over the old fracture site. There was no evidence of other bony pathology and the appearance was consistent with minocycline-associated pigmentation. As far as we are aware, this is the first case of black bone disease affecting callus within the interval period of bone healing. We also discuss the relevant literature on black bone disease to bring light on this rare entity that is an unwelcomed surprise to operating orthopaedic surgeons.
Data on complementary and alternative medicine (CAM) use in patients with cardiovascular disease (CVD) are lacking. We aim to investigate the prevalence of CAM use among patients with CVD attending a ...tertiary centre for cardiovascular care, their attitudes and beliefs towards CAM, and factors associated with CAM usage.
A cross-sectional, self-administered written survey was conducted on consecutive patients attending outpatient cardiovascular clinics at our tertiary institution over 2 months from June to July 2014. Information gathered included demographic data and various aspects of CAM use.
A total of 768 responses (562 males, mean age 57 ± 13 years, 74 % Chinese, 6 % Malay, 14 % Indian) were included. The prevalence of CAM use in the cohort was 43.4 % (333/768). Biologically-based systems (29.4 %) was the most common type of CAM used. Some patients (19.0 %) used multiple types of CAM simultaneously. External influences (78.1 %) were cited more than internal influences (47.8 %) to affect CAM use. Malay ethnicity (compared to Chinese) was the only significant negative multivariate predictor of CAM use (OR = 0.531 (95 % CI 0.147 to 0.838), p = 0.018). A significantly higher proportion of CAM users compared to non-CAM users were non-compliant to medications (35.6 %, n = 114 vs. 20.5 %, n = 84, p < 0.001) and consults (41.4 %, n = 130 vs. 28.1 %, n = 112, p < 0.001) respectively.
The usage of CAM is prevalent amongst our patients with CVD. CAM use was associated with poorer reported compliance to medications and consults. Understanding the factors influencing CAM use amongst CVD patients provides medical professionals with an opportunity to better discuss CAM use and potentially enhance the patient-physician interaction.
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