The Role of Music Therapy for Children Undergoing Cancer Treatment in Singapore.

The aim of this study was to explore the benefits of music therapy (MT) for children with cancer over the course of their treatment in an acute paediatric hospital setting in Singapore. Twenty-five children undergoing cancer treatment received MT sessions as part of a multidisciplinary team rehabilitation intervention from March 2017 to January 2020. A total of 37 individualised goals were developed by the music therapist for the cohort. Goals were scored via the Goal Attainment Scale at 3-month intervals up to 1 year. Descriptive statistics and correlation analysis were used to evaluate the findings. The rate of goal achievement was 89.2% over 180 MT sessions (M = 7.20, SD = 6.45). Children diagnosed with brain tumours had the highest frequency of MT sessions (M = 9.11, SD = 7.79). Most of the goals targeted the regulation of mood and morale through music. There was a positive correlation found between goals and sessions (rs = 0.56, p = 0.004). Age of the children was not correlated with the number of sessions received (rs= -0.19, p = 0.354). MT has been found to be an accessible and effective intervention in addressing functional and emotional goals for children across all ages who are undergoing cancer treatment.

Implementation of a nutrition screening tool to improve nutritional status of children with cancer in Singapore's largest paediatric hospital.

Poor nutritional status in children with cancer can impact treatment outcomes and mortality. Nutrition screening is a simple yet effective approach to identify malnutrition risk for early intervention. We aim to improve the identification of children with cancer at high risk of malnutrition, so that nutritional intervention and rehabilitation can commence early for these children. Our multidisciplinary team conducted a root cause analysis and concluded that the generic screening tool did not differentiate malnutrition risk for different cancer types, stage and intensity of treatment. Hence, a screening tool that considered the identified factors was tested for reliability and validity first. Subsequently, we used the Plan, Do, Study, Act model with two improvement cycles to put in place a systematic process to facilitate the implementation. The interventions included (1) instituting the tool in the electronic medical records and (2) direct referral to dietitian based on screening score.We compared pre- and post-implementation cohorts and demonstrated better identification of nutritionally at-risk patients (36.4%-85.7%, p<0.001) with the new tool as well as improved timeliness of nutritional intervention (3 days to 1 day from admission, p=0.010). A lower malnutrition rate (17.4%-6.5%, p<0.001) in the postimplementation cohort was also demonstrated. Nutritional intervention within 48 hours of admission led to an overall positive weight change at 3 months (+2.68%, IQR: -1.14 to 9.09 vs -0.43%, -6.60 to 2.29; p=0.036) in the malnourished patients from both cohorts. Further studies will be conducted to evaluate the scale of the effectiveness of early intervention and close nutritional monitoring, in improving the nutritional status of children with cancer. The collaborative partnership among the doctors, nurses and dietitians has helped to streamline and simplify nutrition screening, making it an efficient and sustainable system in our hospital.

Computer aided diagnosis of diabetic foot using infrared thermography: A review.

Diabetes mellitus (DM) is a chronic metabolic disorder that requires regular medical care to prevent severe complications. The elevated blood glucose level affects the eyes, blood vessels, nerves, heart, and kidneys after the onset. The affected blood vessels (usually due to atherosclerosis) may lead to insufficient blood circulation particularly in the lower extremities and nerve damage (neuropathy), which can result in serious foot complications. Hence, an early detection and treatment can prevent foot complications such as ulcerations and amputations. Clinicians often assess the diabetic foot for sensory deficits with clinical tools, and the resulting foot severity is often manually evaluated. The infrared thermography is a fast, nonintrusive and non-contact method which allows the visualization of foot plantar temperature distribution. Several studies have proposed infrared thermography-based computer aided diagnosis (CAD) methods for diabetic foot. Among them, the asymmetric temperature analysis method is more superior, as it is easy to implement, and yielded satisfactory results in most of the studies. In this paper, the diabetic foot, its pathophysiology, conventional assessments methods, infrared thermography and the different infrared thermography-based CAD analysis methods are reviewed.

Medial Longitudinal Arch Development of Children Aged 7 to 9 Years: Longitudinal Investigation.

BACKGROUND: It is unclear at what age the medial longitudinal arch (MLA) of the foot becomes stable in children. The influence of footwear on MLA development also is unknown. OBJECTIVE: The purpose of this study was to examine the MLA development of children using a longitudinal approach. The relationship between wearing different types of footwear and MLA development also was explored longitudinally. DESIGN: This was a longitudinal cohort observational study. METHODS: The MLA of 111 healthy children (mean age=6.9 years, SD=0.3) was evaluated using 3 parameters (arch index [AI], midfoot peak pressure [PP], and maximum force [MF]) extracted from dynamic foot loading measurements at baseline (t0), 10-month follow-up (t1), and 22-month follow-up (t2). Information on footwear usage was surveyed. Linear mixed modeling was used to test for differences in MLA over time. RESULTS: The MLA of the children remained stable over time (AI: t0/t1/t2=0.25 [95% confidence interval (CI)=0.24, 0.26]/0.25 [95% CI=0.24, 0.26]/0.25 [95% CI=0.24, 0.26]; P=.95). When the children's sex was considered, the AI of boys decreased (higher arch) with age (0.26 [95% CI=0.24, 0.27]/0.25 [95% CI=0.24, 0.27]/0.25 [95% CI=0.23, 0.27]; P=.02). Boys also displayed a flatter MLA than girls at age 6.9 years (AI: mean difference=0.02 [95% CI=0.01, 0.04]; P=.02). At baseline, children who wore closed-toe shoes displayed the lowest MLA overall (AI: closed-toe shoes/sandals/slippers=0.26 [95% CI=0.24, 0.28]/0.24 [95% CI=0.23, 0.25]/0.25 [95% CI=0.24, 0.26]; P<.01). Children who used slippers at toddlers' age experienced a higher PP (flatter arch) in later childhood than those who wore sandals (mean difference=31.60 kPa [95% CI=1.44, 61.75]; post hoc P=.04). LIMITATIONS: Information on the type of footwear worn was self-reported and, therefore, may be subjected to recall bias. CONCLUSIONS: The MLA of children remained stable from 7 to 9 years of age. The child's sex and the type of footwear worn during childhood may influence MLA development.

Association between foot type and lower extremity injuries: systematic literature review with meta-analysis.

STUDY DESIGN: Systematic literature review with meta-analysis. OBJECTIVES: To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. METHODS: A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case-control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. RESULTS: Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries. For foot-assessment methods using a continuous scale, measurements of lateral calcaneal pitch angle (SMD, 1.92; 95% CI: 1.44, 2.39; P<.00001), lateral talocalcaneal angle (SMD, 1.36; 95% CI: 0.93, 1.80; P<.00001), and navicular height (SMD, 0.34; 95% CI: 0.16, 0.52; P<.001) showed significant effect sizes in identifying high-arch foot, whereas the navicular drop test (SMD, 0.45; 95% CI: 0.03, 0.87; P<.05) and relaxed calcaneal stance position (SMD, 0.49; 95% CI: 0.01, 0.97; P<.05) displayed significant effect sizes in identifying flatfoot. Subgroup analyses revealed no significant associations for children with flatfoot, cross-sectional studies, or prospective studies on high arch. CONCLUSIONS: High-arch and flatfoot foot types are associated with lower extremity injuries, but the strength of this relationship is low. Although the foot posture index and visual/physical examination showed significance, they are qualitative measures. Radiographic and navicular height measurements can delineate high-arch foot effectively, with only anthropometric measures accurately classifying flatfoot. LEVEL OF EVIDENCE: Prognosis, level 2a.

Reliability of footprint geometric and plantar loading measurements in children using the Emed(®) M system.

This study investigated the between-day reliability of footprint geometric and plantar loading measurements on children utilising the Emed(®) M pressure measurement device. Bilateral footprints (static and dynamic) and foot loading measurements using the two-step gait method were collected on 21 children two days apart (age = 9.9 ± 1.8 years; mass = 34.6 ± 8.9 kg; height = 1.38 ± 0.12 m). Static and dynamic footprint geometric (lengths, widths and angles) and dynamic loading (pressures, forces, contact areas and contact time) parameters were compared. Intraclass correlation coefficients of static geometric parameters were varied (0.19-0.96), while superior results were achieved with dynamic geometric (0.66-0.98) and loading variables (0.52-0.94), with the exception of left contact time (0.37). Standard error of measurement recorded small absolute disparity for all geometric (length = 0.1-0.3 cm; arch index = 0.00-0.01; subarch angle = 0.6-6.2°; left/right foot progression angle = 0.5°/0.7°) and loading (peak pressure = 2.3-16.2 kPa; maximum force = 0.3-3.0%; total contact area = 0.28-0.49 cm(2); % contact area = 0.1-0.6%; contact time = 32-79 ms) variables. Coefficient of variation displayed widest spread for static geometry (1.1-27.6%) followed by dynamic geometry (0.8-22.5%) and smallest spread for loading (1.3-16.8%) parameters. Limits of agreement (95%) were narrower in dynamic than static geometric parameters. Overall, the reliability of most dynamic geometric and loading parameters was good and excellent. Static electronic footprint measurements on children are not recommended due to their light body mass which results in incomplete footprints.

Computer-based identification of type 2 diabetic subjects with and without neuropathy using dynamic planter pressure and principal component analysis.

Diabetes is a chronic disease that is characterized by an increased blood glucose level due to insulin resistance. Type 2 diabetes is common in middle aged and old people. In this work, we present a technique to analyze dynamic foot pressures images and classify them into normal, diabetes type 2 with and without neuropathy classes. Plantar pressure images were obtained using the F-Scan (Tekscan, USA) in-shoe measurement system. We used Principal Component Analysis (PCA) and extracted the eigenvalues from different regions of the foot image. The features extracted from region 1 of the foot pressure image, which were found to be clinically significant, were fed into the Fuzzy classifier (Sugeno model) for automatic classification. Our results show that the proposed method is able to identify the unknown class with an accuracy of 93.7%, sensitivity of 100%, and specificity of 83.3%. Moreover, in this work, we have proposed an integrated index using the eigenvalues to differentiate the normal subjects from diabetes with and without neuropathy subjects using just one number. This index will help the clinicians in easy and objective daily screening, and it can also be used as an adjunct tool to cross check their diagnosis.

In-shoe Plantar Pressure Distribution in Nonneuropathic Type 2 Diabetic Patients in Singapore.

BACKGROUND: We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy. METHODS: Thirty-five patients with type 2 diabetes mellitus without loss of tactile sensation and foot deformities and 38 nondiabetic individuals in a control group had in-shoe plantar pressures collected. Maximum peak pressure and peak pressure-time integral of each foot were analyzed as separate variables and were masked into 13 areas. Differences in pressure variables were assessed by analysis of covariance, adjusting for relevant covariates at the 95% confidence interval. RESULTS: No significant differences were noted in maximum peak pressures after adjusting for sex, race, age, height, and body mass. However, patients with diabetes mellitus had significantly higher mean ± SD pressure-time integrals at the right whole foot (309.50 ± 144.17 kPa versus 224.06 ± 141.70 kPa, P < .05) and first metatarsal (198.65 ± 138.27 kPa versus 121.54 ± 135.91 kPa, P < .05) masked areas than did those in the control group after adjustment. CONCLUSIONS: Patients without clinical observable signs of foot deformity (implying absence of motor neuropathy) and sensory neuropathy had similar in-shoe maximum peak pressures as controls. This finding supported the notion that either component of neuropathy needs to be present before plantar pressures are elevated. Patients with diabetes mellitus demonstrated greater pressure-time integrals, implying that this variable might be the first clinical sign observable even before peripheral neuropathy could be tested.

Preliminary investigation on the reduction of plantar loading pressure with different insole materials (SRP--Slow Recovery Poron, P--Poron, PPF--Poron +Plastazote, firm and PPS--Poron+Plastazote, soft).

BACKGROUND: The aim of this study is to investigate the amount of pressure reduction for different padding and insole materials commonly used in the podiatry clinic. METHODS: Plantar pressure were taken for 5 subjects without insoles fitted (BF) in their daily sports shoes, and thereafter with 4 pairs of simple insoles (6.4 mm thick) each as follow: SRP - Slow Recovery Poron, P - Poron, PPF - Poron+Plastazote (firm) and PPS - Poron+Plastazote (soft). In addition, subjects were also tested with semi-compressed felt (SCF) padding with a 1st metatarsophalangeal joint (MTPJ) aperture cut-out bilaterally. Minimum, maximum, mean pressure and peak pressure at the hallux, 1st, 2nd, 3rd/4th and 5th MTPJ across both feet were analysed. Repeated measures ANOVA with post hoc Bonferroni paired wise comparison was used to test for any statistical significance at the 95% confidence level for all pressure data. RESULTS: PPF was significant in reducing the minimum (p<0.005) and mean pressure (p<0.03) when compared to BF. This accounted for approximately 28% and 27% pressure reduction in minimum and mean pressure respectively. Peak pressure on the 1st MTPJ locality showed significant reduction of 37% and 29% with the use of SCF (p<0.004) and PPF (p<0.004), respectively. CONCLUSIONS: All 4 commonly used insole materials were able to reduce pressure across the whole foot with PPF achieving significance. Off-loading the 1st MTPJ would still be best achieved with the commonly used plantar metatarsal pad of SCF with the aperture cut-out design.

Case reports on the use of antimicrobial (silver impregnated) soft silicone foam dressing on infected diabetic foot ulcers.

This article described four patients who had an episode of an infected foot ulcer, and subsequently treated with a novel antimicrobial soft silicone foam dressing together with standard off-loading and antibiotic therapy. Qualitative description of the ulcer-healing process was documented. All four ulcers showed positive wound contraction and reduction in size throughout the follow-up period ranging from 3 to 16 weeks. In addition, clinical signs of infection were absent at the end of the follow-up period. Moreover, surrounding skin maceration and trauma were absent in all wounds. Adequate moisture control was also achieved with the evidence of a healthy red granulating base, and a thin layer of clear light exudate in three out of the four cases. However, these reports had very little evidence to show the dressing's effectiveness in combating wound infection, but there might be some possible clinical efficacies of the dressing to control infection. Appropriate antibiotic therapy and off-loading are still essential components when treating diabetic foot infection.