Impact of an interstitial lung disease service in the diagnosis and management of interstitial lung disease in Singapore.

INTRODUCTION: The current gold standard for diagnosing interstitial lung disease (ILD) involves an ILD clinic evaluation, followed by discussion in a multidisciplinary meeting (MDM). However, there is a paucity of data on the impact of ILD MDMs on the diagnosis and management of ILDs in Southeast Asia. We studied the clinical impact of the ILD service on the diagnosis and management of ILDs at a university-affiliated tertiary hospital in Singapore. METHODS: A single-centre retrospective review was done on 97 consecutive patients referred for evaluation to the ILD service from March 2016 to August 2017. RESULTS: Mean age of the patients was 67 ± 11 years. Gender distribution was almost equal (52% male), with a majority of never-smokers (63%). Mean forced vital capacity (FVC) was 1.81 ± 0.66 L (66% ± 20% predicted). The three commonest referral diagnoses were ILD of uncertain classification (n = 38, 39%), connective tissue disease-associated ILD (CTD-ILD) (n = 24, 25%) and idiopathic pulmonary fibrosis (IPF) (n = 16, 17%). Following evaluation by the ILD service, there was a change of diagnosis in 60 (62%) patients and a change of management in 71 (73%) patients. The majority of consensus MDM diagnoses were IPF (n = 35, 36%), CTD-ILD (n = 30, 30%) and others (n = 15, 15%). There was a significant prognostic separation between the IPF and non-IPF diagnoses made following evaluation by the ILD service. CONCLUSION: The ILD service allowed for more precise subtyping of various ILDs. This is particularly useful for IPF patients, who can benefit from antifibrotic therapies.

Stigma and health-related quality of life in Asian adults with epilepsy.

This study aims to (1) review the impact of epilepsy on the health-related quality of life (HRQoL) of Asian adult persons with epilepsy (PWE), and (2) identify the extent of stigma they experience and the associated factors. The electronic databases Medline, PsycINFO, ISI Web of Science, and the International Pharmaceutical Abstracts were searched using a combination of keywords to identify relevant journal articles published before October 2007, and supplemental manual searches of article bibliographies and the journal Neurology Asia were conducted. Thirty-six articles that met the predetermined inclusion criteria were selected and reviewed. The HRQoL of Asian adult PWE was lower than that of the general population. These PWE had difficulties in both physical and psychosocial functioning. Psychosocial factors appeared to have a more significant impact on PWE's HRQoL than physical factors. Stigma and negative attitudes towards marriage and employment of PWE was prevalent in many Asian countries, and the stigma's associated factors were multifaceted. Given the prevalent negative attitudes towards epilepsy, public education campaigns targeting misconceptions and associated factors may help reduce stigma and, together with psychosocial support, the HRQoL of Asian adult PWE can be improved.