1) Innovation & Digital Strategies
Presenting author: Hazel Yeo Kai Hui, CGH
Developing an algorithm for automated classification of hearing loss and using artificial intelligence for predicting hearing improvement after myringoplasty: a pilot study
Presenting author: Kimberly Joseph, SIT
The integration of Virtual Reality in Radiation Therapy Clinical Training Curriculum
Radiation Therapy (RT) training in Singapore includes four years of undergraduate education in the Singapore Institute of Technology (SIT) and clinical placements at RT departments. Traditionally, academic teaching blocks provide the underpinning theoretical understanding and clinical placements facilitate integration of theory into clinical skills development, offering great value in education experience. However, clinical placements and opportunities for practice are limited, which are further reduced during the pandemic. Moreover, RT technology is expensive, and complex trainings with real patients and active clinical data risk errors. In this project, we aim to develop a RT Virtual Reality (VR) platform that supports training procedures and scenarios that leads to individualized learning. Adding advanced 3D immersive tools may enable understanding of concepts at a higher level than what is achievable in current training programs. While VR has been widely used in medicine, surgery and nursing, its use in RT education is limited and has not been fully explored. SIT RT undergraduates were recruited in this study. A mixed study method was used, including “checkpoints” to provide opportunities for self-testing, practicing and assessment which provide valuable feedback. The VARK questionnaire and Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaires were used to assess students’ learning preference and their acceptance for new technology. Pre- and post-program evaluation was conducted to determine the effectiveness of the VR systems in enhancing their clinical knowledge and skills. A significantly higher median score was found post-VR usage (p<0.02), showing higher VR acceptance than the traditional method. Additionally, no significant differences in VR acceptance were found between uni-modal and multi-modal learners (p>0.05). The VR group also showed a significantly higher score for the perceived knowledge and skills in performing a whole-brain RT (WBRT) procedure (p<0.03). Our studies have shown that VR can bridge the theory-practice gap in RT training through experiential and active learning. While providing a “physical” and protected environment, students can practice simulated clinical scenarios at their own convenience, without the fear of disruptions and the risk of making errors. Hence, integrating the VR system would benefit students’ clinical placements with increased preparedness and skills.
Presenting author: Dr Anthony Goff, SIT
How accurate, clear and accessible is web-based information about knee osteoarthritis in Singapore? A web-content evaluation
Introduction: Symptomatic knee osteoarthritis affects one in ten people over the age of 50 in Singapore, and is most prevalent in Indian and Malay populations. People with knee osteoarthritis are increasingly seeking information from web-based resources. Therefore, it is important that these align to key research evidence and clinical practice guidelines to inform decision making and facilitate engagement with guideline recommended care. This study assessed the accuracy and clarity of information, plus readability and accessibility (i.e. available in multiple languages) of web-based information about knee osteoarthritis included on Singapore-based websites.
Methods: A systematic appraisal of online information about knee osteoarthritis was performed. Searches (“knee arthritis Singapore” and “knee osteoarthritis Singapore”) were performed in July 2021 using google and Bing. The first 20 URLs from each search were screened for eligibility. For accuracy and clarity we matched website content against a 14-item rubric from previous research. The Flesch Kincaid Grade Level assessed readability. We also identified if information was available in the major languages spoken in Singapore (Chinese, Malay and Tamil).
Results: A total of 28 unique websites were included in this analysis. Very few websites provided accurate and clear information across all 14 content topics. Inaccurate information about the pathophysiology of osteoarthritis and surgery was present in 63% and 40% of websites respectively. Just over half of included websites (57%) met recommended readability levels, and very few (11%) provide information in alternate languages.
Conclusion: The poor accuracy, clarity, readability and accessibility of web-based information about knee osteoarthritis may act as a barrier to evidence-based decision-making and engagement in first-line care. Website owners in Singapore are encouraged to urgently review and upgrade the information about knee osteoarthritis that they provide.
2) Health Services Research
Presenting author: Ng Jia Wen Celeste, SIT
Does suspension of day care and day rehabilitation services during pandemic affect elderly's physical and cognitive functions?
Presenting author: Soong Jie Lin, SGH
Prevalence of Polypharmacy: A Cross-Sectional Study in Singapore Public Healthcare Institutions
3) Basic/Clinical Research
Presenting author: Fiona Lim Yun Qian, SGH
Exploring the Relationship between Perceived Falls Risks and Falls Efficacy of Older Adults Admitted into an Acute Hospital in Singapore
Components of effective falls prevention interventions have been widely discussed but little is known about the psychological factors that affect their efficacy. Applying the Health Belief Model, perceived severity and susceptibility to falling may influence one’s receptivity levels towards addressing the risk of falling. A deeper understanding of perceived severity and susceptibility in the context of falling may better inform intervention designs. This study aimed to understand the relationship between self-perceived risk of falling and fall efficacy levels among older adults with higher independent activities of daily living performance in Singapore. Sixty-two participants were recruited from inpatient wards at a local acute hospital. Participants completed two self- report questionnaires, the Staying Independent Checklist (SIC) and the Falls Efficacy Scale – International (FES – I), measuring perceived susceptibility and severity respectively. Participant characteristics were summarized with descriptive statistics. To understand the relationship between self-perceived falls risk and fear of falling among older adults, a one-way ANOVA was used to determine the association between SIC and FES-I scores. To explore the factors associated with higher self-perceived falls risk and fear of falling, stepwise linear and logistic regression with backward elimination was conducted and the dependent variables were FES-I and SIC scores. One-way ANOVA analysis revealed a significant association between FES-I total scores and SIC score categories F(1,60) = 6.277, p = .015). Stepwise regression with backward elimination also found that falls history (β = .292, p = .033), sex (β= .269, p = .042), and FIM lower body dressing (β = -.286, p = .035) had significant associations with FES-I scores. Level of perceived susceptibility and severity of falling should be considered when determining if falls prevention interventions are relevant, regardless of one’s functional ability and physical health status. Future research on these factors to determine the underlying mechanisms which drives health behaviours related to falls prevention can be conducted to improve current intervention programs.
Presenting author: Eileen Lim Chay Ngun, NUH
Comparing the Repeatability and Sensitivity of the Manual Perimetry in Demonstrating the Functional Loss of the Superior Visual Field with a Supra-threshold and Threshold Stimuli
In 2018, the Health Ministry implemented a new guideline assessing the functional visual field loss due to ptosis. Automatic visual perimeter (HVF) testing of the peripheral 60 degree is a standard test to assess the visual loss, manual visual perimeter (GVF) which usually requires a shorter examiner time and can be sensitive in indicating the superior field loss, will be accepted when the patient has two unreliable HVF reports. The aim of this study is to compare the repeatability and sensitivity of a threshold and supra-threshold stimuli with GVF, in demonstrating the functional loss of the superior visual field and the repeatability of the stimuli between the examiners.
Method: Visual field (VF) of patients with unilateral and bilateral ptosis from dermatochalasis were mapped using GVF, those with known superior VF defects from glaucoma, neurologic disease and etc were excluded from the study. Supra-threshold and threshold stimuli were used to map the visual field, with their upper eyelid untapped and tapped. Another set of VF by another examiner were mapped within 2 months. The superior VF loss at were compared and analysed statistically.
Result: 18 Asian patients amounting to 34 visual fields were mapped, mainly Chinese with a mean age of 71.8. The mean VF loss at 12:00 meridian was 13.43o±7.42o using supra-threshold, and 12.81o±5.66o using threshold. VF loss from examiner 1 was 15.24o±7.26o using supra-threshold, and 13.89o±5.93o using threshold, and 13.20o±7.43o using supra-threshold, and 13.02o±5.88o using threshold for examiner 2. Intraclass correlation coefficient (ICC) for supra-threshold and threshold stimulus were 0.47 and 0.37 respectively; agreement between examiners was 0.43 at 95% confident interval.
Conclusion: Reliability was poor but supra-threshold stimulus had a higher reliability; agreement between examiners was low and the agreement was worst when using threshold stimulus. A supra-threshold stimulus for testing the VF loss in patient with ptosis is recommended. The mean VF loss vary depending upon the method of tapping the eyelids, patients’ response and learning curve.
Presenting author: Lee Yu Xian Merwyn, SIT
Effect of Guided Mindfulness Meditation on Novel Motor Learning in Healthy Young Adults
Motor learning is indispensable for fundamental human movement throughout life, from learning of new sports to post-stroke rehabilitation. Mindfulness Meditation (MM) is a promising cognitive strategy that can reduce anxiety and improve attention which may facilitate motor learning. This study aims to examine the acute effects of guided MM on novel motor learning and motor memory retention in healthy young adults. This study was conducted as randomised controlled trials where healthy participants between 18 to 35 years old were recruited. Participants underwent either a 10-minute session of MM or seated rest (Control) before performing 3 blocks of circle tracing tasks using their (1) dominant hand, (2) non-dominant hand, and (3) non-dominant hand with inverted screen display (novel motor task). This was followed by a 10-minute rest before participants underwent a Parametric Go/No-Go cognitive test. 24 hours later, they were reassessed on the same motor tasks. The level of anxiety was assessed via heart rate, State-Trait Anxiety Inventory (STAI) and Visual Analogue Scale-Anxiety (VAS-A). 24 participants were recruited (MM: n=12, Control: n=12). Main effect analysis showed that the heart rate was lowered during guided MM (p=0.03) with a reduction in VAS-A scores in meditators (p=0.01), relating to a lower level of anxiety. Learning effect for the dominant hand motor task was greater in MM group as compared to the Control group (MM=4.2±3.3%, Control=0.3±4.4%; p=0.02). However, no difference was observed in the learning effect for novel task learning between groups (p=0.13). Poorer motor memory retention for non-dominant hand task was observed in the Control group (Day 1= 1.0±0.1; Day 2= 0.9±0.1; p=0.03). For cognitive assessment, MM group showed higher accuracy in target detection in “Easy” level than Control group (76±9% vs. 65±14%; p=0.04) while no differences were detected for other levels (p>0.05). A single session of guided MM produced transient effects in reducing anxiety and promoted sustained attention in simpler motor and cognitive tasks. However, there were no carry-over benefits for novel motor learning. Future studies should explore potential benefits of long-term MM practice for motor learning as this may facilitate motor skills relearning in stroke survivors.
Presenting author: Chua Ningyi Fionn, CGH
Underdiagnosis of Chronic Metabolic Diseases in Patients with Newly Diagnosed Ischaemic Heart Disease
Programme Evaluation Presentations
Presenting author: Chan Hsin Yi Abigail, TTSH
Digitalised Exercise Brochure (DEB): Exercising Right With Digitalised Exercise Resources
Presenting author: Ng Kian Hong, CGH
Automated Batching and Collation of Data from Patient Input (ABCD PI) Sources for Efficient Medication Delivery Service
Presenting author: Tan Xiao Yen Joanna, SKH
Bariatric Nutrition Programme – The Person Beyond the Fats
Presenting author: Tan Shiyun Charmain, KKH
The Autism Primary School Readiness Workshop: Outcomes from pilot runs of a caregiver workshop for parents of autistic children
Presenting author: Dr Beron Tan, KKH
Enhancing the Early Detection of Psychological Distress in Paediatric Oncology Wards: A Quality Improvement Initiative
Presenting author: Lynette Goh, NUP
Impact of an interactive health corner in promoting long term dietary changes
An unhealthy diet is a major risk factors for chronic diseases. Although studies had shown that nutrition education and cooking demonstrations have resulted in favourable dietary changes, it is unclear whether this is sustainable for longer periods, especially among individuals with chronic diseases. This study aims to evaluate the long-term impact of a nutrition-led cooking programme on dietary behavioural patterns based on My Healthy Plate (MHP). This was a quasi-experimental study involving patients with chronic diseases in two polyclinics. A self-administered survey was done at baseline, 6 months and 1 year for both intervention and control group. Participants in the intervention group were exposed to the health corner which provides nutrition education and cooking demonstrations. 216 participants completed the study at one year with a follow-up rate of 86%. Adjusted risk ratio (aRR) were obtained from negative binomial regression. Participants in the intervention group were more likely to report knowing and adhering to the components of MHP at 6 months (aRR 1.83, 95% CI 1.12-2.99) and 1 year (aRR 1.54, 95% CI 1.10-2.16). Participants in intervention group were less likely to add salt or sauces to food at 6 months (aRR 0.29, 95% CI 0.12-0.75) and 1 year (aRR 0.21, 95% CI 0.07-0.61), and more likely to remove fat when eating meat at 1 year (aRR 0.30, 95% CI 0.13-0.67). The health corner had a positive impact of helping patients achieve MHP recommendations, not adding salt and sauces to their food, and removing animal fat before eating. There is potential for expanding this initiative to improve healthy eating practices in other polyclinics.
Programme Development Presentations
Presenting author: Neo Zhi Yang, SGH
Gamifying Pharmacy Resource Management Training through PRISM – PhaRmacy Interactive SiMulator
Presenting author: Karishma J Surtani, Yishun Health
eLEARN Nutrition Programme – Development of an Online Nutrition Training Programme for Healthcare Workers
Nutrition is an important part of care for hospitalised patients and residents living in the community. Training in nutrition was offered to Community Nurses within the Population Health and Community Transformation (PHCT) Team to support them in caring for their residents. As the training was opportunistic and fragmented, it resulted in inconsistent and varied nutrition knowledge levels. It is also a challenge to gather teams for training, especially with safe distancing measures and split teams in effect during the COVID-19 pandemic. Hence, there is a need to review the nutrition training programme to better support the team. The eLEARN Nutrition Programme aims to educate and empower healthcare workers with evidence-based nutrition knowledge and strategies to reinforce nutrition messages in their interactions with patients and residents. This aligns with the move towards transforming the healthcare workforce through upskilling and providing transdisciplinary learning opportunities. The nutrition training framework and content was developed by the Nutrition & Dietetics (N&D) Department and supported by the Allied Health Services & Pharmacy (AHS&P) Office. PHCT provided input on the common nutrition issues and challenges faced by the residents they cared for, which was key to the development of the topics. An online learning platform was identified as the most feasible and effective way to ensure access to the nutrition information. The programme is asynchronous and designed in two parts: Core Course featuring the basic foundational concepts in nutrition and Continuous Courses featuring elective, advanced topics. Topics are co-created with learners to ensure relevant and useful content. Each course is bite-sized and include pre and post quizzes, and additional reading materials on the NHG eLEARN platform. We piloted the programme with PHCT, Allied Health Professionals (AHP) and Nursing Leads in 2021. 97 learners completed the Core Course and 97% provided positive feedback. We were able to identify the needs of different groups of healthcare workers, prioritise the topics for development, and improve the work processes. We are currently working to roll out the programme to include nurses within the hospital and community setting and relevant AHP.
Presenting author: Julia Wang Xinyi, KKH
Pretend Play Workshop goes Online
Pretend Play is important for a child’s development but caregivers in Singapore may overlook it. There tends to be insufficient time in typical individual outpatient therapy sessions to fully address the breadth and depth of play knowledge. Thankfully, research suggests that workshop-based caregiver training is a cost and time-efficient option. As in-person workshops were suspended during the Covid-19 outbreak, it was imperative that the Pretend Play workshops be delivered online while still maintaining effectiveness. The Pretend Play workshop is a three-hour program designed to empower caregivers on play development. Caregivers learn to identify their child’s play skills, create a personalised play plan, and practice Facilitating Strategies (FS). The outcomes are to increase caregivers’ self-efficacy and facilitation skills in engaging their child in Pretend Play. Caregivers are offered a one-on-one session with their Occupational Therapist within one to two months after the workshop for continued support. The workshop was redesigned to be conducted via Zoom. Caregivers utilized screen annotations to identify FS in videos of parent-child interaction. Additional visuals were included to improve understanding of handouts and attention to slides. Experiential learning methods such as role-playing, live modeling, and toy exploration were more difficult to adapt. Group discussions of new video depicting both ideal and less ideal FS application replaced role-playing. One video was paused at various points to allow for discussion about how caregivers would use the FS if they played the role of the parent. Outcomes were measured using pre, post, and review surveys. So far, four runs have been completed with 30 caregivers and 28 responded to the surveys. According to the post-survey results, all the caregiver respondents were satisfied or very satisfied with the workshop and would recommend it to other parents. Immediately following the workshop, caregivers' self-efficacy in engaging and facilitating their child's pretend play increased significantly. While the implementation is in its early stages, the ongoing discussion helps to refine the instructional method and content. Some areas to improve for online delivery include identifying participants who need more support during the session and accurately identifying the profile of parents who will benefit from online training.
Presenting author: Jessica Lim Pei Ying, SKH
Continuum of Care - Inpatient to Outpatient Speech Therapy Referrals
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