An innovative model of delivering cancer care in the community: the experience of a tertiary cancer centre in Singapore.

BACKGROUND: Cancer care has evolved rapidly, increasing the demand on healthcare resources. While many non-oral cancer treatments are administered in the hospital, not all necessitate complex medical care. Treatments that can be administered subcutaneously, intramuscularly, or as short intravenous infusions with a low risk of extravasation can be safely administered in the community. PATIENTS AND METHODS: Since 2017, the National University Cancer Institute, Singapore (NCIS) has operated a program called NCIS on-the-go (NOTG) comprising a network of community cancer treatment clinics located within 20 km of the hospital. NOTG provides 17 low-risk treatments and nursing services run by oncology-trained nurses without on-site physicians. Patients who receive their first dose of cancer treatment uneventfully in the cancer centre can opt-in to receive subsequent doses at any NOTG clinic. RESULTS: Treatment at NOTG has become more mainstream over the years, with its workload increasing by over sevenfold since 2017, and is now responsible for ∼10% of the total main cancer centre workload. The program is sustainable and financially viable to operate. A survey of 155 patients revealed a 96.8% user satisfaction rate, with the majority reporting tangible savings in travelling time, waiting time, and travelling costs. The diversion of low-risk treatments to NOTG has indirectly increased capacity and reduced waiting times at the main cancer centre for patients requiring complex cancer treatments, resulting in a win-win situation. CONCLUSIONS: NOTG represents an innovative model of care to deliver low-risk cancer treatments safely in the community and can be easily replicated in other countries.

Laser-induced onset of electrospinning.

We present a method to start electrospinning from a polymeric drop. This method uses a pulsed laser which is focused inside the drop close to the liquid surface. The pulse cavitates the liquid and produces a protrusion from the tip of the drop. The protrusion narrows by drainage and vertical stretching, thus concentrating the electric field and increasing the charge density until it overcomes the surface tension and produces the electrified jet. This approach can reduce the required value of applied electric field to half of its value required to start convectional electrospinning from a stationary drop.

Seroprevalence of hepatitis B and C viral markers in patients with primary hepatocellular carcinoma in Singapore.

The prevalence of hepatitis B and C serological markers were studied in 55 patients (45 males and 10 females) with primary hepatocellular carcinoma (PHC). Their ages ranged from 28 years to 79 years (mean age: 56 years). Fifty-five other patients with non-hepatic diseases were used as age and sex matched controls. Forty-one PHC patients (74%) had chronic hepatitis B infection alone, 5 patients (9%) had chronic hepatitis C infection alone, 6 patients (11%) had chronic hepatitis B and C co-infection, 2 patients (4%) had evidence of previous exposure to HBV and one patient (2%) had no hepatitis B and C serological markers. Among those patients with chronic HBV infection alone, the commonest serological pattern was HBsAg and anti-HBe positive (66%; 27/41) followed by HBsAg and HBeAg positive (i.e. highly HBV infectious group) (24%; 10/41). All the positivity rate for HBsAg (including co-infection with HBV and HCV) was 85% and all the positivity rate for anti-HCV (including co-infection with HBV and HCV) was 20%. In the control group, positivity rate for HBsAg was 13%(7/55). None of the control sera was positive for anti-HCV. Positivity rates for HBsAg and anti-HCV were significantly higher in the 55 PHC cases than in controls. The odds ratio for HBsAg was 40.3 (p value: < 0.001) (95% CI limits: 12.1 to 143.3) and for anti-HCV was indeterminate.

Immunogenicity and safety of an inactivated hepatitis A vaccine amongst Singaporeans.

The immunogenicity and reactogenicity of an inactivated hepatitis A virus (HAV) vaccine was studied in healthy Singaporean adult volunteers. One hundred and forty healthy volunteers with normal alanine (ALT) and aspartate (AST) transaminases and no previous exposure to HAV, received three 1 ml doses (720 ELISA units) of an inactivated HAV vaccine (Smithkline Beechams Biologicals) following a 0, 1, 6 months vaccination schedule. All subjects were asked to record and grade the severity of any reactions for three consecutive days after each dose. Serum ALT and AST as well as anti-HAV were measured at 0, 1, 2, 6 and 7 months after the first vaccine dose. Anti-HAV seroconversion occurred when levels rose above 40 mIU/ml. Eighty-five percent of vaccinees seroconverted after the first innoculation and 99% after the second injection. All vaccinees seroconverted after the third dose. Geometric mean anti-HAV titers (GMTs) were, respectively, 119, 391, 4406 mIU/ml one month after each of the three doses. The most common side effect was transient pain and tenderness at the vaccination site. No elevation of ALT or AST levels were noted during the study period. The inactivated hepatitis A vaccine used in this study is safe and highly immunogenic in the local adult population. Two doses one month apart appeared to give adequate protection.