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Aims International diabetes guidelines have not established the frequencies of self‐monitoring of blood glucose in patients with type 2 diabetes (T2D) who do not use insulin. The present study aimed to assess the impact of self‐monitoring of blood glucose (SMBG) frequencies on the glucose control and other outcomes in non‐insulin‐treated patients with T2D. Methods A literature search was performed in four databases. Randomised controlled trials with ≥6‐month follow‐up duration that compared the impact of different frequencies of SMBG on glycated haemoglobin A1c (HbA1c) were included. Studies with abstract only or reported effects of SMBG as a secondary outcome were excluded. Results Of the 1557 studies identified, 12 RCTs with a total of 3350 patients were analysed. Overall, performing SMBG for 8 to 14 times per week was correlated with a better HbA1c control at 6 months (MD −0.46%, 95% CI −0.54 to −0.39) and 12 months (MD −0.20%, 95% CI −0.29 to −0.11). However, up to seven measurements of SMBG per week did not significantly affect glycaemic control. In addition, performing SMBG between 8 and 14 times per week was also associated with improved BMI (MD −0.46, 95% CI −0.84 to −0.08). When the results of SMBG were applied to adjust diabetes medication, a significant reduction in HbA1c levels was observed in the intervention arm compared to the control arm. Conclusions Eight to 14 measurements of SMBG per week were associated with an improved glycaemic control and a reduced BMI in patients with T2D not using insulin.

Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

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IntroductionEpidemiological studies have reported that diabetes‐related complications increase after 5 years of uncontrolled/suboptimal metabolic control. The risk of experiencing diabetes‐related microvascular diseases usually spike after 10 years of uncontrolled diabetes.ObjectivesThe objective of this study was to evaluate the impact of team‐based pharmaceutical care on glycemic control, self‐care, diabetes‐dependent quality of life, and productivity loss in patients with long‐standing diabetes (≥5 years).MethodsThis was a prospective, multicenter, randomized, controlled study. Patients with a glycosylated hemoglobin (HbA1c) > 7%, long‐standing diabetes defined as having a disease duration of at least 5 years, and polypharmacy defined as taking 5 or more chronic medications were included in the study. Patients in the intervention arm received team‐based pharmaceutical care regularly while patients in the control arm received physician‐centered care. Patients' humanistic outcomes were followed for 6 months.ResultsA total of 248 patients (126 intervention and 122 control) were included in the study. In addition to improved glycemic control observed in the intervention arm (mean difference: 0.44%, P = .003, 95% confidence interval: [0.15, 0.73]), the intervention arm showed significant improvements in overall self‐care level (+0.36, 95% confidence interval: [0.01, 0.72], P = .045) and self‐monitoring of blood glucose (+1.87, 95% confidence interval: [1.00, 2.99], P < .001) compared with the control arm. There were no significant differences in the changes in diabetes‐associated quality of life and overall work impairment between the two arms. A significant difference in activity impairment (affected productivity in regular unpaid activity) between the two arms was found, with 43.3% impairment having occurred in the control group vs 27.9% in the intervention group (P = .047).ConclusionTeam‐based pharmaceutical care significantly improved overall self‐care and glycemia without deteriorating quality of life and incurring productivity loss. Our findings highlighted the value of team‐based pharmaceutical care in managing diabetes‐experienced patients.

Breast cancer is the number one cancer amongst females in Singapore. From 2015 to 2019, 11,805 new cases were diagnosed. Correspondingly over the same period, 1107 new cases of cervical cancer were diagnosed, contributing to a significant burden as well (Ministry of Health, 2020). The age-standardised incidence rate of breast and cervical cancer in Singapore is 73.8 and 6.7 per 100, 000 population respectively in 2020 (Singapore Cancer Registry Annual Report, 2020). Notably, both these cancers are among the few where early screening has shown to be associated with superior oncological outcomes if detected early. Likewise in Singapore, women aged 40 and above are advised to undergo mammography

Pyomyositis is a purulent infection of striated muscle and postoperative management remains the mainstay. If delayed primary wound closure is not managed in a timely manner, it often results in recurrent infection and sinus tract creation. Cavity wounds with sinus formation are known to complicate treatment, are problematic to manage and persist for long periods of time. The aim of this case report is to present the challenges in the assessment and management of a sinus tract with deep cavity wound, between the vastus lateralis and biceps femoris muscles, originating from liquefaction of a haematoma. Our review of the literature revealed limited research evidence in the management of deep cavity wounds. This is a rare case where the sinus tract route which leads to the rim-shaped cavity is embedded deep between the muscles, posing a high risk of recurrent infection from the premature closure of the wound tract. Successful management was attributed to: the accuracy in the initial wound assessment; appropriate dressing plans; the rationale for each action; and an outcome goal as each treatment progressed. Daily dressing change and reassessment of the wound was required to ensure progress and to address any complications in a timely manner. Finally, concerns of the patient and their family and regular discussions on the treatment plans are important to encourage adherence with management goals.