A Double-Blind, Randomised, Placebo-Controlled Trial of EMLA® Cream (Eutectic Lidocaine/Prilocaine Cream) for Analgesia Prior to Cryotherapy of Plantar Warts in Adults

<p><b>INTRODUCTION</b>Cryotherapy with liquid nitrogen is an effective, safe and convenient form of treatment for plantar warts. EMLA® cream (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) is a topical local anaesthetic agent that has proven to be effective and well tolerated in the relief of pain associated with various minor interventions in numerous clinical settings.</p><p><b>MATERIALS AND METHODS</b>In a single-centre, double-blind, randomised placebo-controlled study, 64 subjects were randomised into 2 groups. The subjects had a thick layer of EMLA® cream or placebo cream applied to pared plantar wart(s) and onto the surrounding margin of 1 mm to 2 mm under occlusion for 60 minutes prior to receiving cryotherapy. The pain of cryotherapy was evaluated by the subjects using a self-administered Visual Analogue Scale (VAS) immediately after the cryotherapy.</p><p><b>RESULTS</b>There was no statistical difference between the mean VAS score for EMLA® cream (47.0 ± 21.4 mm) and placebo (48.9 ± 22.0 mm). Those with more than 1 wart had a significantly higher VAS score than those with only 1 wart (59.1 ± 21.8 vs. 44.3 ± 20.4, P <0.05) but this did not affect the therapeutic effect of EMLA® cream prior to cryotherapy.</p><p><b>CONCLUSION</b>We conclude that the application of EMLA® cream prior to cryotherapy does not reduce the pain associated with cryotherapy.</p>

Understanding of diabetes mellitus and health-preventive behaviour among Singaporeans

<p><b>INTRODUCTION</b>To study the understanding and perceived vulnerability of diabetes mellitus among Singapore residents, and determine the predictors associated with screening for diabetes mellitus among the people without the condition.</p><p><b>MATERIALS AND METHODS</b>A population-based survey was conducted from December 2004 to October 2005 involving Singapore residents aged 15 to 69 years. Using a standard questionnaire, Health Survey Officers interviewed household members on their understanding and perceived vulnerability of diabetes mellitus and associated cardiovascular risk factors. Data were analysed using SPSS v13.</p><p><b>RESULTS</b>The response rate was 84.5%. Of 2,632 respondents, 291 (11.1%) have diabetes mellitus. Compared to respondents without diabetes, respondents with the disease had better understanding of diabetes and they had favourable health practice of screening for cardiovascular risk factors. Having diabetes mellitus was not associated with a healthier lifestyle. Among non-diabetics, those who had a family history of diabetes had better knowledge and health practices than those who had not. They were significantly more likely to recognise the symptoms and signs (61.5% vs 54.5%) and the causes of diabetes (70% vs 58.2%); and were more likely to have ever tested for diabetes (76.1% vs 60.4%), with P <0.001. Socio-demographic characteristics, family history, understanding and perception on the vulnerability of diabetes were identified as predictors associated with health screening for the disease.</p><p><b>CONCLUSION</b>Among all respondents, better understanding was found to be associated with favourable health-preventive behaviours. However, it did not translate into healthier lifestyle. Cultural and socio-demographic profiles must be factored in for any effort on lifestyle modifications.</p>

Development of a diabetes registry to improve quality of care in the National Healthcare Group in Singapore

In Singapore, chronic care is provided by both ambulatory primary care clinics and specialist clinics in hospitals. In 2005, the National Healthcare Group (NHG) embarked to build a diabetes registry to enhance the continuity of care for patients with diabetes and facilitate greater efficiency in outcome measurement. This Chronic Disease Management System (CDMS) links administrative and key clinical data of patients with diabetes mellitus across the healthcare cluster. At the point of patient care, clinicians view a summary of each patient's chronic disease records, consolidated chart with physical parameters, laboratory investigation results and the "patient reminders" listing the clinical decision support prompts when key laboratory and screening tests are due for each patient. The CDMS provides reports of clinical outcomes in a systematic and efficient manner for quality improvement and evidenced-based population management. These include process indicators consisting of the rates of glycated haemoglobin (HbA1c), low-density lipoprotein-cholesterol (LDL-c) and nephropathy tests; and intermediate outcome indicators of the proportion of patients with poor HbA1c (>9%) and optimal LDL-c (<2.6 mmol/L) control. From January 2007 to December 2008, the rates of the 3 process indicators were relatively unchanged and that of HbA1c and LDL-c tests were high. There was gradual improvement in the proportion of patients achieving target level of LDL-c in both primary care clinics and hospitals. Fewer patients at primary care clinics had poorly-controlled HbA1c. As a tool for chronic care delivery, the NHG diabetes registry has made clinical monitoring and outcome management for patients with diabetes mellitus more efficient.

Measuring the quality of care of diabetic patients at the specialist outpatient clinics in public hospitals in Singapore

<p><b>INTRODUCTION</b>This study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group.</p><p><b>MATERIALS AND METHODS</b>The cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those co-managed by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version 13.0.</p><p><b>RESULTS</b>A total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (P <0.001) in rates across the specialties for 8 process indicators; HbA1c, serum creatinine and lipid profile tests were over 75%, while the rest were below 50%. The mean HbA1c was 7.3% +/- 1.5%. "Optimal" control of HbA1c was achieved in 51.2% of patients, while 50.6% of the patients achieved "optimal" low-density lipoprotein (LDL)-cholesterol control. However, 47.3% of patients had "poor" blood pressure control. Adherence to process indicators was not associated with good intermediate outcomes.</p><p><b>CONCLUSIONS</b>There was large variance in the adherence rate of process and clinical outcome indicators across specialties, which could be improved further.</p>