Proceedings of Singapore Healthcare

To test the efficacy of green tea with that of conventional topical metronidazole powder by comparing the rate of malodorous score reduction using the verbal numeric scale (VNS).

This was a prospective randomised experimental study comparing two types of odour control agents used for treating malodorous fungating malignant wounds in a tertiary hospital in Singapore. Patients were randomised to either control (metronidazole power) or treatment (green tea) group and was follow-up with a daily dressing for a week by a designated nurse. Both patient and designated nurse would rate the malodorous score daily on a VNS of 0 (no smell) to 10 (worst smell that one can imagine).

Thirty cancer patients with malodorous fungating wounds were randomised into either treatment (n=15) or control group (n=15). The location of wounds were breast (n=24), neck (n=2), groin (n=2), spine (n=1) and anus (n=1). All patients in both groups showed improvement in odour control by Day 7. Treatment group was as effective as control group and there was no statistical significance (p>0.05) to demonstrate which treatment is more superior.

Green tea dressing is as effective as conventional topical metronidazole powder in controlling odour. Green tea is cheap, easily available and has no risk of drug resistance over long term use. Alternatively, it can also be used interchangeably with metronidazole powder to reduce the risk of drug resistance.

Singapore has one of the highest age-standardized incidence rates for colorectal cancer (CRC) at 35.1% in men and 29.9% in women which is almost double that of our neighboring Southeast Asian countries. Surgery is presently the mainstay in treatment of this cancer. This present study evaluates the clinical and prognostic characteristics of sporadic cancers treated by surgical resection in a single institution in an Asian population.

1814 consecutive patients with CRC from 1999–2005 treated in the Department of Colorectal Surgery in Singapore General Hospital were reviewed. The clinciopathological characteristics of these patients were collected from a prospectively collected database maintained in the department since 1987. Univariate analysis was performed, and survival curves were constructed using the Kaplan-Meier method. Multivariate analysis was carried out on independent prognostic factors that were positive on univariate analysis.

All patients had a minimum follow up duration of 5 years unless they were lost to follow up. There were 921 (50.8%) males and 893 (49.2%) females with a median age of 67 years (interquartile range 22–99). The predominant location of the tumour was left-sided ie distal to (and including) the splenic flexure (n=1272, 70%), and the majority presented at an advanced AJCC stage III and IV (n=1018, 56%). The most common site for solitary metastasis is in the liver (n=194, 49%) followed by the lungs (6%). Locoregional recurrence is low at 2.6% (n=46) and distant recurrence is noted at 16.8% (n=297). Disease recurrence are 5.7%, 18.1%, and 27.5% for Stages I, II and III respectively. The median five-year Cancer Specific Survival (CSS) is 58.7 % (95% CI 56.2%–61.2%). On multivariate analysis, a high pre-operative CEA, poorly-differentiated tumour grade, signet ring cell tumours, high tumour stage (T3/T4), nodal disease (N1/N2), presence of both perineural invasion and vascular emboli were all significant factors that worsened CSS.

Our dataset confirms the current favourable survival of colonic cancers in our country which is comparable to data from the West. Future challenges in management of patients involve improving staging, selection of high risk of recurrence of patients for closer monitoring and further adjuvant treatment to improve survival and reduce locoregional recurrence.

The incidence of mismatch repair (MMR) deficiency in young colorectal cancers (CRC) remains unknown in Asians. This preliminary study assessed the clinicopathological features and efficacy of screening for MMR protein deficiency in young Asian CRC patients.

From January 2006 to October 2009, patients under the age of 50 with immunohistochemical (IHC) staining for MMR proteins in resected CRC specimens were retrieved from a prospective computerised database.

Eighty unrelated patients comprising predominantly 80% Chinese (n = 64), with median age of diagnosis at 41 years (range 22–50 years) had IHC performed. Twenty-three per cent (n=18) of the patients had abnormal IHC staining. Loss of staining for MLH1, MSH2 and MSH6 proteins were observed in 18%, 2% and 6% of tumours respectively. Of the 15 patients who had abnormal staining of MLH1, three had concomitant equivocal staining for MSH6. One tumour specimen had abnormal staining in all 3 proteins. Multivariate analysis revealed that family history was the only significant predictive factor for defective MMR detection (OR 8.06, 95% CI 1.69–38.35, p=0.002). However if Amsterdam criteria alone were to be used, 72% (n=12) of the cohort would have not been detected for MMR gene defects.

The overall burden of germline MMR deficiency in the Singapore population may be as high as 23%. Amsterdam criteria alone are insufficient to detect hereditary non-polyposis colorectal cancer (HNPCC) related patients. The use of IHC staining of at least 3 MMR proteins is a useful screening strategy for HNPCC diagnosis and routine screening of mismatch repair deficiency may be recommended for all young Asian CRC patients.

Although technological advancements have improved the treatment outcomes of hearing-impaired patients, challenges still exist as caregivers are not able to fully appreciate patients' difficulties in communication. An effective education programme is deemed important, including an experiential learning component where people in contact with the patient could experience the sounds actually heard by the patient. This led to the setting up of the Hearing Education Arcade (HEAR), an interactive gallery which contains information about various aspects of hearing loss. This pilot study aims to assess the usefulness of HEAR as an educational tool for caregivers of hearing-impaired patients.

Two separate surveys were carried out. The first survey sought to find out if HEAR had been informative and educational. The second, a focus-group survey on caregivers of hearing impaired children and adults, gauged knowledge levels before and after experiencing HEAR.

Most respondents found HEAR to be very informative (86.4%) and highly educational (75.8%). The respondents in both focus groups recorded improvement in knowledge scores after going through HEAR.

This study supports the belief that HEAR is a useful tool in the education of caregivers of hearing-impaired patients about hearing, its disorders, the treatment and the needs of the hearing-impaired. When the family and caregivers are properly educated on matters of hearing loss, it can have a positive effect on management outcomes.

A sound understanding of pelvic anatomy is essential for training in obstetrics and gynaecology (OBGYN) and for practising in the field post-qualification. There is a growing concern that surgery residents have an inadequate knowledge of anatomy and little confidence in their approach to the subject.

This study aims to explain the use of an anatomy workshop to deliver a unique and self-designed innovative instruction method that employs cutting-edge resources to enhance OBGYN residents’ comprehension of clinical anatomy and to discuss why this approach works.

The workshop emphasised the clinical and surgical anatomy of the female pelvis using 3-D virtual dissections, relevant plastinated specimens and also bony pelvic models that had been developed in house. Anatomists and OBGYN consultants facilitated the workshop. The students’ knowledge of anatomy and their perceptions of the subject were evaluated by pre- and post-tests and a five-point Likert scale, respectively. A mixed methods analysis was applied.

Of the 42 participants, 26 (61.9%) completed both the pre- and post-test. The overall difference (mean percentage) between the pre- and post-test performance was 25.41%. There was a significant difference in the residents’ knowledge of anatomy between the pre- and post-workshop (p<0.05). Participants (n=10) provided positive feedback on the workshop content, teaching tools, learning activities and educators. They recommended that the workshop should be held at least once a year (70%), and particularly during the first year of residency (90%).

The active learning workshop enabled by multidisciplinary teaching and the innovative tools employed resulted in improved outcomes in knowledge of anatomy, confidence and learning satisfaction. Reintroduction of anatomy concepts during OBGYN residency training is needed to improve surgical training and patient care.

Although cervical cancer is the 10th most common cancer among females in Singapore, it is a vaccine-preventable cancer. Human papillomavirus vaccines combined with regular Pap (papillomavirus) smears have been shown to reduce the mortality and morbidity associated with cervical cancer. We assessed the knowledge and attitudes towards cervical cancer, human papillomavirus and its vaccination amongst pre-university female students and assessed if a short educational presentation can improve this knowledge and acceptability of the vaccine.

A cohort survey was carried out amongst 150 female students at Hwa Chong Junior College via questionnaires administered anonymously. Standardized educational presentations were carried out followed by post intervention questionnaires.

Almost all the students were aged between 15 and 19 years old (99.3%). At baseline, only 29% and 27% of the students had ever heard of human papillomavirus and its vaccines respectively. The most common source of information cited was from a family member or a friend (22.5%). Only 4% had been administered the human papillomavirus vaccine. Mean knowledge scores significantly improved from 4.95 to 8.61 out of 10 after the intervention. Of those who did not have the vaccine, only 31.3% were willing to consider the human papillomavirus vaccine pre-intervention, with a statistically significant improvement to 51.4% post intervention.

Low awareness about human papillomavirus, its relationship to cervical cancer and its prevention is common, even amongst well-educated students. Most of them obtained the information from family and/or friends. A short educational presentation was able to improve the knowledge scores, and improve the acceptability of the human papillomavirus vaccine.

The exclusive breastfeeding rate (for the first 6 months of a baby’s life) remained low in Singapore despite active promotion of breastfeeding by government bodies and hospitals. The aim of this study was to explore the breastfeeding experiences of first time mothers and the difficulties they faced during their breastfeeding period.

A qualitative descriptive study design was adopted. Participants were chosen from a purposive sampling technique and data were collected from 10 semi-structured in-depth interviews. All interviews conducted were audio-taped and transcribed verbatim. Interview transcriptions were analysed using the qualitative content analysis approach.

The breastfeeding period of the 10 first time mothers in this study ranged from 3 days to 10 months, and four participants were still breastfeeding at the time of interview (4–12 months after delivery). The interview transcriptions generated 54 nodes, 12 sub-themes and four key themes. The four key themes identified were: (a) challenges and support for breastfeeding in the initial period after birth; (b) low degree of support for breastfeeding in the workplace; (c) unease at breastfeeding in front of others; and (d) emotional and psychological aspects of breastfeeding.

This study provided a better understanding of the breastfeeding experiences of first time mothers in Singapore. Initiating and sustaining breastfeeding is still challenging for first time mothers. Greater public awareness, laws that support breastfeeding in public and the workplace, as well as support of family members could be fundamental to successful breastfeeding.