Delphi consensus on the American Society of Anesthesiologists’ physical status classification in an Asian tertiary women’s hospital / 대한마취과학회지

Background@#The American Society of Anesthesiologists (ASA) score is generated based on patients’ clinical status. Accurate ASA classification is essential for the communication of perioperative risks and resource planning. Literature suggests that ASA classification can be automated for consistency and time-efficiency. To develop a rule-based algorithm for automated ASA classification, this study seeks to establish consensus in ASA classification for clinical conditions encountered at a tertiary women’s hospital. @*Methods@#Thirty-seven anesthesia providers rated their agreement on a 4-point Likert scale to ASA scores assigned to items via the Delphi technique. After Round 1, the group’s collective responses and individual item scores were shared with participants to improve their responses for Round 2. For each item, the percentage agreement (‘agree’ and ‘strongly agree’ responses combined), median (interquartile range/IQR), and SD were calculated. Consensus for each item was defined as a percentage agreement ≥ 70%, IQR  1.0, and SD < 1.0. @*Results@#All participants completed the study and none had missing data. The number of items that reached consensus increased from 25 (51.0%) to 37 (75.5%) in the second Delphi round, particularly for items assigned ASA scores of III and IV. Nine items, which pertained to alcohol intake, asthma, thyroid disease, limited exercise tolerance, and stable angina, did not reach consensus even after two Delphi rounds. @*Conclusions@#Delphi consensus was attained for 37 of the 49 study items (75.5%), facilitating their incorporation into a rule-based clinical support system designed to automate the prediction of ASA classification.

Fear of cancer recurrence among cancer survivors in Singapore

INTRODUCTION@#Fear of cancer recurrence (FCR) among cancer survivors is a persistent and distressing psychosocial concern that affects recovery and quality of life. The prevalence of FCR in Singapore is unknown. This cross-sectional study was designed to examine FCR and identify factors associated with FCR in mixed-cancer survivors locally.@*METHODS@#Cancer survivors in remission (n = 404) were assessed for: FCR using the Fear of Cancer Recurrence Inventory (FCRI); emotional distress using the Hospital Anxiety and Depression Scale; and quality of life using the World Health Organization Quality of Life-BREF. Clinical and severe/pathological FCR was determined based on the severity scale of FCRI, known as FCRI-Short Form. Multivariate logistic regression was performed to examine factors associated with FCR.@*RESULTS@#The mean score on the FCRI was 59.5 ± 30.4. 43.6% of cancer survivors had clinical FCR and 32.1% had severe/pathological FCR. Younger age (odds ratio [OR] 0.952, 95% confidence interval [CI] 0.911-0.995, p < 0.05), higher educational status (OR 2.55, 95% CI 1.15-5.65, p < 0.05) and higher levels of emotional distress (OR 1.17, 95% CI 1.10-1.24, p < 0.001) were significantly associated with severe/pathological levels of FCR.@*CONCLUSION@#The present study is the first to determine levels of FCR among cancer survivors in Singapore. While the total FCR scores were similar to those of international studies, severe/pathological levels of FCR were found to be four times higher. These findings highlight a problem that is not widely recognised or acknowledged, but which deserves greater attention.

Diabetes Health Profile-18 is Reliable, Valid and Sensitive in Singapore

<p><b>INTRODUCTION</b>The Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.</p><p><b>MATERIALS AND METHODS</b>Patients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.</p><p><b>RESULTS</b>A total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).</p><p><b>CONCLUSION</b>The DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.</p>

WHOQOL-BREF among Singaporean Patients with Type II Diabetes Mellitus: What Does It Measure.

Aims: Health-related quality of life (HRQoL) of Type 2 diabetes mellitus (T2DM) is a growing concern globally given the increase in T2DM prevalence. Generic HRQoL instruments are important to allow cross-cultural, cross-population and cross-study comparisons. The short version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire is a widely used generic questionnaire. Hence, we aimed to evaluate the psychometric properties of the WHOQOL-BREF among patients with T2DM in Singapore. Study Design: Patients at a diabetes outpatient specialist clinic in Singapore were recruited via convenience sampling. Classical Test Theory methods were used to evaluate data quality, scaling assumptions, targeting, internal consistency reliability and construct validity (structural, convergent and discriminant) and criterion validity using HbA1c control (good versus poor). Principal Component Analyses (PCA) and Confirmatory Factory Analyses (CFA) were performed to assess unidimensionality (domain-level) as well as conformity with the original four-factor structure. Exploratory Factor Analysis (EFA) was done if CFA indicated lack of fit. Results: 212 subjects were analyzed of whom 50% were Chinese, 28% Indians, 11% Malays and 10% others. 63% were males with mean (SD) age 45.8 (11.9) years. Data quality was superior, scaling assumptions were met, targeting was satisfactory and internal consistency was achieved. PCAs were compatible with unidimensionality, except in the Physical domain. Domain level CFA indicated that unidimensionality had poor fit and overall CFA did not support the original 4-factor structure. EFA runs showed that the Physical and Environment domains overlapped while the Social and Psychological domains could not be recovered. Therefore construct (structural) validity was not established. Criterion validity was not achieved as all domains could not discriminate between those with good versus poor HbA1c control. Conclusion: Construct and criterion validity of WHOQOL-BREF posed some concerns. Thus, we recommend that an adequately-powered random sample of T2DM patients in Singapore be studied to confirm the findings of our study.

Evaluation of adherence and depression among patients on peritoneal dialysis

<p><b>INTRODUCTION</b>It is challenging for dialysis patients to maintain adherence to their medical regimen, and symptoms of depression are prevalent among them. Limited data is available about adherence and depression among patients receiving peritoneal dialysis (PD). This study aimed to examine the rates of treatment non-adherence and depression in PD patients.</p><p><b>METHODS</b>A total of 20 PD patients (response rate 71.4%; mean age 64.4 ± 11.6 years) were assessed using the Beliefs about Medicines Questionnaire, Self Efficacy for Managing Chronic Disease Scale, Hospital Anxiety and Depression Scale (HAD) and Kidney Disease Quality of Life-Short Form. A self-reported adherence (PD exchanges, medication and diet) scale developed for the study was also included. Medical information (e.g. most recent biochemistry results) was obtained from chart review.</p><p><b>RESULTS</b>The mean self-reported scores indicated an overall high level of adherence, although a significant proportion of patients were non-adherent. Among the latter, 20% of patients were non-adherent to medication and 26% to diet due to forgetfulness, while 15% and 26% of patients admitted to deliberate non-adherence to medication and diet, respectively. Treatment modality, employment, self-care status and self-efficacy were associated with overall adherence. Using a cutoff point of 8 for HAD depression and anxiety subscales, 40% of patients were found to be depressed and 30% had symptoms of anxiety.</p><p><b>CONCLUSION</b>This is the first study to document treatment adherence and depression among PD patients in Singapore. Findings of high prevalence of depression and anxiety, and reports of poor adherence warrant development of intervention programmes.</p>