Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore.

In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

Development of a measure of the concerns held by people with implanted cardioverter defibrillators: the ICDC.

OBJECTIVES: To develop a questionnaire to measure the extent and severity of the concerns of people with an implanted cardioverter defibrillator. DESIGN: Items were generated from patient interviews, expert review and the research literature on patients' worries and concerns. A pilot version was administered to a series of ICD patients and repeated for test-retest reliability 6 weeks later. Psychometric tests including the screen test, factor analysis and various reliability assessments were undertaken. It was predicted that the greater the extent and severity of concerns, the greater the anxiety experienced by the ICD patient. Scores were compared with a validated measure of anxiety and depression administered at the same time. RESULTS: Fifty-seven (64%) patients completed and returned the questionnaire and a further 22 (100% of those asked) completed the 6-week retest. Reliability and validity appeared to be good and two factors were identified. Both total score and the individual factor scores correlated moderately with anxiety. CONCLUSIONS: The questionnaire appears to reflect patients' concerns and, as predicted, these were associated with the patients' anxiety level. The scale requires further testing to reveal if it is of use both clinically and for research purposes.

The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred.

The aims of the study were to investigate self-reported physical, sexual, emotional and economical abuse in Swedish female users of psychiatric services, who the perpetrators were and in which places abuse occurred. An anonymous self-administrated questionnaire was answered in the waiting room of the services. The drop-out rate was 21% and n=1382 women completed the questionnaire. Fifty-three per cent of the women had been abused during childhood, 63% during adulthood and 31% during past year. Seventy-four per cent of those exposed during childhood were also exposed later in life. Women subjected to abuse reported longer contact with psychiatric care. Regardless of life period, the majority reported multiple and frequent abuse. Emotional abuse was most frequent reported in both childhood and adulthood followed by physical and sexual abuse. The reported perpetrators were mainly male persons to whom the woman had an intimate relationship. Mostly the abuse occurred in the women's own home. However, other women, strangers, acquaintances and relatives were also stated as perpetrator and abusive acts also took place in other homes, outdoors or down town. The high prevalence of abuse and its multiplicity point to the necessity for the care and support system to prioritize abuse against women with psychiatric illness.

Basilar artery and vertigo.

Our goal was to identify by magnetic resonance angiography the specific vascular abnormalities of the basilar artery that can be related to hypoperfusion disorders and produce symptoms of vertebrobasilar insufficiency. A classification of regional vascular perfusion disorders based on developmental malformations and intrinsic and extrinsic angiopathies was formulated from an analysis of individuals with these disorders. Specific angiographic abnormalities such as tortuosity, stenosis, thrombosis, and dolichoectasia were identified in subjects with vestibulocerebellar dysfunction. Charts and radiographic images were examined with respect to the history, physical evidence, and vascular configuration, and the data were integrated for comprehensive analysis. We found that abnormalities identified by magnetic resonance angiography could be correlated with symptoms due to vascular insufficiency. Cases are presented that document the developmental and acquired arterial disorders that may be considered the etiologic factors for regional perfusion deficits.

Vertigo: analysis by magnetic resonance imaging and angiography.

The relationship of vascular disease of the vertebrobasilar artery system to isolated vertigo was examined by magnetic resonance imaging and angiography. Eighty-nine individuals complaining of vertigo were evaluated by standard otoneurologic investigations, and the data were correlated with the vascular patterns of the cervical region and posterior fossa. The age distribution extended from the fourth decade to the ninth decade; the peak occurrence was observed in the eighth. Approximately 85% of the group experienced numerous episodes of vestibular dysfunction from months to years before examination; the remaining segment was examined following the first episode due to severity or persistence of symptoms. The criteria for vascular abnormality proposed by the authors are based upon comparison with previous normal findings. Approximately 52% of the cohort demonstrated abnormal configurations or evidence of diminished flow within the vertebrobasilar artery system. Of this segment, a vertebral artery was most frequently abnormal, in 76%; the basilar artery was judged pathological in 32%, and combined disease of several arteries was evident in 20%.

3 regimens of topical metronidazole compared with subgingival scaling on periodontal pathology in adults.

This report presents the findings from an open randomized multicentre clinical trial designed to compare the clinical efficacy of scaling with application of 3 different preparations/dose frequencies of topical metronidazole in the treatment of adult periodontitis. The 4 treatments were: (A) metronidazole 25% dental gel administered 1 x a week for 2 weeks; (B) metronidazole 15% dental gel applied 1 x a week for 2 weeks; (C) metronidazole 15% dental gel applied 2 x a week for 2 weeks; (D) subgingival scaling, performed 1 x only. A split mouth design was used. Patients were included in the study if they had at least 1 tooth in each quadrant with a pocket depth > or = 5 mm in at least 1 of 4 sites. A total of 61 patients from 4 centres were entered into the study. The efficacy parameters were probing pocket depth and bleeding on probing. Follow-up visits for recording of clinical efficacy were made at 2, 4, 6 and 12 weeks after the end of metronidazole treatment. All 3 antibiotic treatments (A, B, C) reduced the symptoms of periodontal pathology and yielded results comparable to those seen after subgingival scaling (D). When using a topical drug therapy, it seems important to use a preparation that requires as few applications as possible. The best candidate for drug therapy would therefore be treatment (A) metronidazole 25% applied 1 x a week for 2 weeks.

Casual sex among Norwegian adolescents.

The issue of casual sex and amount of sexual experience was studied using data from a representative sample of 2997 Norwegians, 17-19 years old. Data were collected by anonymous self-administered questionnaires, and the response rate was 62.8%. Results showed that among adolescents, experience of casual sex to a large extent was a function of the time the individual had been coitally active. The amount of sexual experience was poorly related to social background and strongly related to life-style factors such as smoking and drinking of alcohol. A small minority of adolescents was found to have a sexual behavior deviating from that of the majority, and thus containing elements of potentially high risk for contracting HIV or other STDs. This minority of adolescents had the identifying characteristic of low self-reported intimacy with their first coital partner.

Effects of self-help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services.

A home-based exercise programme has been found to be as useful as a hospital-based one in improving cardiovascular fitness after an acute myocardial infarction. To find out whether a comprehensive home-based programme would reduce psychological distress, 176 patients with an acute myocardial infarction were randomly allocated to a self-help rehabilitation programme based on a heart manual or to receive standard care plus a placebo package of information and informal counselling. Psychological adjustment, as assessed by the Hospital Anxiety and Depression Scale, was better in the rehabilitation group at 1 year. They also had significantly less contact with their general practitioners during the following year and significantly fewer were readmitted to hospital in the first 6 months. The improvement was greatest among patients who were clinically anxious or depressed at discharge from hospital. The cost-effectiveness of the home-based programme has yet to be compared with that of a hospital-based programme, but the findings of this study indicate that it might be worth offering such a package to all patients with acute myocardial infarction.

Use of birth control pills and condoms among 17-19-year-old adolescents in Norway: contraceptive versus protective behaviour?

This article addresses the relationship between sexual risk behaviour and contraceptive behaviour, and considers whether adolescents who use condoms are practising birth control or STD protective behaviour. The material comprised a representative sample of 3000 Norwegians aged 17-19 years. Data were collected by anonymous self-administered questionnaires. The response-rate was 63%. At the first sexual intercourse 51% of the adolescents used condoms and 7% birth control pills. At the most recent intercourse 31% used condoms and 38% the pill. Use of the pill was widespread among adolescents with high coital frequency and few coital partners. Use of condoms was not particularly widespread among adolescents who reported a relatively large number of coital partners. Irrespective of the number of years they had been coitally active there was no significant difference between those who intended to use condoms at the next sexual intercourse and those who did not as regards their beliefs about condoms as protection against STDs, HIV and unintended pregnancies. The results from this study indicate that the majority of adolescents who use contraception do this for protection against unintended pregnancy and not for protection against STDs. The preference for the pill may make teenagers less prepared to practise STD protective behaviour in specific situations.

PIP: A study was conducted to examine the relationship between coital frequency and risk behavior in relation to the number of coital partners and contraceptive/protective behavior and to study changes in contraceptive/protective techniques from 1st to most recent sexual intercourse. Data were gathered from 3000 Norwegians aged 17-19 years in anonymous self-administered questionnaires. A 63% response rate was achieved. 51% reported having used condoms at 1st intercourse, while 7% used contraceptive pills. 31%, however, used condoms most recently, while 38% employed the pill. Contraceptive pills were used most commonly among respondents with high coital frequency and few partners. Condom use was not particularly widespread among those with relatively large numbers of coital partners. Concerning beliefs about the ability of condoms to protect against sexually transmitted diseases (STD), HIV, and pregnancy, no significant differences were observed between those planning to use condoms and those not planning to use them at next coitus. In sum, results indicate that the majority of youths use condoms to protect against pregnancy, not STDs. The tendency toward serial monogamous relationships increases dependence upon the pill at the expense of the condom and makes sexually active teens less prepared to protect themselves against STDs in certain situations. Teens need to be taught about the protective value of condoms, with greater condom availability ensured where youths congregate.

The effects of physical exercise training and cardiac education on levels of anxiety and depression in the rehabilitation of coronary artery bypass graft patients.

OBJECTIVE: to evaluate whether an exercise and education-based rehabilitation programme is sufficient treatment for individuals with clinically significant levels of anxiety or depression following coronary artery bypass graft (CABG) surgery. DESIGN: follow-up and repeated assessment after surgery. SETTING: outpatient cardiac rehabilitation programme. PATIENTS: all 88 attenders after CABG surgery. ASSESSMENTS: structured interview and Hospital Anxiety and Depression (HAD) scale (using 8 as the cut-off) administered by rehabilitation nurses at start of course and HAD repeated at 12 weeks and 6 and 12 months (by post after discharge). RESULTS: return rates of 76 and 80% at 6- and 12-month assessments, respectively; statistically significant reductions in levels of anxiety and depression found between first and all subsequent assessments; subdividing into groups revealed significant reduction in anxiety and depression in the anxious and depressed groups at 12 weeks and 6 months, respectively, but at 12 months there was no significant reduction. CONCLUSIONS: there is a need to address the problems of anxiety and depression directly by screening and treatment, and to provide more psychologically-orientated cardiac rehabilitation programmes.