Assessment of willingness to Tele-monitoring interventions in patients with type 2 diabetes and/or hypertension in the public primary healthcare setting.

BACKGROUND: Tele-monitoring (TM) is remote monitoring of individuals via info-communication technology, enabling them and their relatives or care-providers to recognize their health status conveniently. TM will be successful only if the individuals, often patients with medical conditions, are willing to accept and adopt it in their daily lives. This study aimed to determine the prevalence of willingness of patients with type 2 diabetes mellitus (T2DM) and/or hypertension towards the use of TM, and the factors influencing their uptake. METHODS: A cross-sectional survey was conducted at two public primary care clinics (polyclinics) in north-eastern Singapore, where TM had not been implemented. After the patients with T2DM and/or hypertension consented after fulfilling the eligibility criteria, they were first introduced to the concept of TM using pictogram and explanation by the investigators. Data on their demography, clinical parameters, technological literacy and acceptance of TM based on the Health Information Technology Acceptance Model (HITAM) were subsequently collected, computed, analyzed, followed by regression analyses to identify the factors associated with their willingness to use TM. RESULTS: Among 1125 eligible multi-ethnic Asian patients approached, 899 of them completed the assisted questionnaire survey, yielding a response rate of 79.9%. Their mean age was 58 ± 8 years, females 51.3% and Chinese 69.3%. Overall, 53.0% of the patients were willing to use TM. Personal beliefs on technology (OR = 3.54, 95%CI = 2.50-4.50, p < 0.001), prior technology utility (OR = 3.18, 95%CI = 1.57-6.42, p = 0.001), Patient's requirements to be accompanied (OR = 1.48, 95% CI = 1.054-2.082, P = 0.03) Cost considerations (OR = 2.96, 95% CI = 2.257-3.388, P < 0.01) and technological literacy (OR = 2.77, 95%CI = 2.05-3.38, p < 0.001) were associated with willingness to use TM. CONCLUSION: Slightly over half of the patients were willing to use TM. Factors such as age, ethnicity, technological literacy, beliefs and previous utility of technology of the patients have to be addressed before implementing TM in primary care.

Chronic Pain in a Low Socioeconomic Status Population in Singapore: A Cross-Sectional Study.

PURPOSE: . The authors sought to determine the prevalence of chronic pain in a low socioeconomic-status rental-flat community in Singapore and its associations. In Singapore, ≥85% own homes; public rental flats are reserved for the low-income. METHODS: . Chronic pain was defined as pain ≥3 months. From 2009-2014, residents aged ≥ 40 years in five public rental-flat enclaves were surveyed for chronic pain, as well as sociodemographic factors. Subsequently, the authors conducted an additional study among elderly (aged ≥60) in two public rental-flat enclaves in 2012. The authors compared against residents staying in adjacent owner-occupied public housing. RESULTS: . Prevalence of chronic pain in the rental-flat population was 14.2% (133/936) compared with 14.4% (158/1101) in the owner-occupied population (p = 0.949). On multivariate analysis, among those aged 40-59 years, staying in the rental flat community was independently associated with higher prevalence of leg/ankle/foot pain, compared to staying in the owner-occupied flat community (aOR = 2.35, CI = 1.24-7.35, p = 0.008). In the rental-flat population, unemployment was associated with chronic pain (aOR = 1.92, 95%, CI = 1.05-2.78, p = 0.030); among the elderly, dependency in instrumental-activities-of-daily-living (iADLs) was associated with chronic pain (aOR = 2.38, CI = 1.11-5.00, p = 0.025), as well as female gender, being single, and having higher education (all p > 0.05). CONCLUSIONS: . In this low socioeconomic-status population, chronic pain associated with unemployment and functional limitation. There was no difference in pain prevalence between the rental-flat population and adjacent owner-occupied precincts.

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study.

BACKGROUND: In Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore. METHODS: From 2009-2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology. RESULTS: In the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12-2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10-3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82-47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04-8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17-0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10-0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01-0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment. CONCLUSIONS: Regular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.

Unusual painful pelvic masses: Extramedullary hematopoiesis with extramedullary multiple myeloma.

The coexistence of extramedullary hematopoiesis and extramedullary multiple myeloma can occur and present as painful pelvic masses. In such a case, normal hematopoietic cells may outnumber clonal plasma cells, posing a diagnostic challenge.

Unexpected coccidioidomycosis presenting as lung nodules with presumptive diagnosis of malignancy.

Coccidioidomycosis can present as fluorodeoxyglucose (FDG) avid lung nodules which may be mistaken as relapse in patients with a history of malignancy. Detailed clinical history, relevant laboratory testing, and/or tissue biopsy with histologic evaluation are necessary for correct diagnosis.

Acute pulmonary embolism multimodality imaging prior to endovascular therapy.

The manuscript discusses the application of CT pulmonary angiography, ventilation-perfusion scan, and magnetic resonance angiography to detect acute pulmonary embolism and to plan endovascular therapy. CT pulmonary angiography offers high accuracy, speed of acquisition, and widespread availability when applied to acute pulmonary embolism detection. This imaging modality also aids the planning of endovascular therapy by visualizing the number and distribution of emboli, determining ideal intra-procedural catheter position for treatment, and signs of right heart strain. Ventilation-perfusion scan and magnetic resonance angiography with and without contrast enhancement can also aid in the detection and pre-procedural planning of endovascular therapy in patients who are not candidates for CT pulmonary angiography.

Fast MRI breast cancer screening - Ready for prime time.

OBJECTIVE: The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described. CONCLUSION: Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.

Diary of an astronaut: examination of the remains of the late Israeli astronaut Colonel Ilan Ramon's Crew Notebook recovered after the loss of NASA's space shuttle Columbia.

Two months after the fatal re-entering into the Earth's atmosphere of Columbia flight STS-107, the remains of Israeli astronaut Colonel Ilan Ramon's Crew Notebook were found strewn in a field in San Augustine County, TX. The random pile of papers was found to have survived the calamity of the Shuttle's disintegration remarkably well. Most of the papers recovered were torn and/or washed out to varying degrees but only mildly charred around the edges. The sheets of paper could be categorized into four groups: Group I: eight sides of paper written while in space in black ink and in pencil--Ramon's personal diary; the writing on these eight sides of paper survived well and is only missing where the pages were torn. Small fragments found in the field were physically matched to holes in the pages thus locating their original positions in the text. Group II: six sides of technical preparation notes written by Ramon before the mission. The writing on these pages was washed out entirely, but much of it was visualized using infrared luminescence. Group III: eight sides of personal notes prepared by Ramon before the mission written in blue ink. The writing on these pages was barely visible to the naked eye and not visualized by infrared luminescence, but was made largely legible by digital enhancement imaging. Group IV: a few sides of printed technical information. These pages were mostly intact and were not examined at length as they contained standard printed material. After completion of examinations at the Questioned Document Laboratory of the Israel Police, the diary was transferred to the Paper Conservation Department of the Israel Museum for preservation and strengthening treatments.

"I'm healthy, I don't have pain"- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population.

BACKGROUND: We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income. METHODS: Chronic pain was defined as pain ≥ 3 months. From 2009-2014, residents aged 40-60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves. RESULTS: In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36-3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25-3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18-4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34-5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94-6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of "major illness"; screening as a search for answers to pain; and labelling pain as an end in itself. CONCLUSIONS: Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.