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Background: Potentially inappropriate prescribing is common among older adults with multimorbidity due to various reasons, from concurrent application of multiple single-disease clinical guidelines to fragmentation of care. Interventions such as medication review have been implemented worldwide to reduce inappropriate prescribing for older adults. However, the implementability of such interventions are underexplored in the outpatient clinics in Singapore's public hospitals. Hence, the Pro-M study aims to assess the feasibility of implementing a physician-pharmacist collaborative care intervention in geriatric medicine outpatient clinics to facilitate appropriate prescribing for older adults in Singapore. Methods: This is a single-arm, non-randomised feasibility study using a pre-post evaluation design. This study consists of two parts: (1) implementation phase of the intervention (6 months) and an (2) evaluation phase (3 months). Eligible patients will be recruited from geriatric medicine outpatient clinics at two public hospitals in Singapore through convenience sampling. The main components of the Pro-M intervention are: (1) pharmacist-facilitated medication reviews with feedback on any medication issues and potential recommendations to physicians, and (2) physicians communicating changes to other relevant prescribers. The evaluation phase will involve surveying and interviewing physicians and pharmacists involved in the implementation of the intervention. A mixed-method approach will be employed for data collection and analysis. The quantitative and qualitative findings will be triangulated and reported using Proctor's implementation outcomes: appropriateness, penetration, acceptability, fidelity, feasibility, and sustainability. A basic cost analysis will be conducted alongside the study. Discussion: This is a phase 2 study to test the feasibility of implementing an intervention that was co-created with stakeholders during phase 1 development of an intervention to optimise prescribing for older adults with multimorbidity. The implementation will be assessed using Proctor's implementation outcomes to provide insights on the process and the feasibility of implementing medication reviews for older adults with multimorbidity as a routine practice in outpatient clinics. Data collected from this study will inform a subsequent scale-up study. Trial registration: ClinicalTrials.gov Identifier: NCT05756478. Registered on 06 March 2023. [ABSTRACT FROM AUTHOR]

Background. Hospitalised older patients with coronavirus disease 2019 (COVID-19) have an increased risk of poor health outcomes. We aimed to determine the associations of length of stay (LOS) with frailty status and disease severity among older patients admitted to a community treatment facility (CTF) in Singapore. Methods. Medical records of consecutive patients admitted to the CTF were retrospectively reviewed. Data retrieved included demographics, frailty, LOS, 30-day readmission, disease severity, and functional statuses on admission and at discharge. Results. In total, 96 older patients (mean age, 80.3 years) were included. According to the Clinical Frailty Scale (CFS), 26.0% were robust (CFS 1-3), 27.1% were mildly frail (CFS 4-5), and 46.9% were moderately/ severely frail (CFS 6-9). Compared with the robust and mildly frail groups, the moderately/severely frail group had more severe COVID-19 cases (p=0.033), longer LOS at the CTF (p=0.005), and fewer patients discharged home (p=0.01). Greater disease severity was associated with poorer frailty status (p=0.033), worsening of functional status at discharge (p=0.02), higher International Severe Acute Respiratory and emerging Infection Consortium score (p=0.031), and receipt of <2 doses of COVID-19 vaccine (p=0.005). Risk factors for longer LOS at the CTF and overall LOS were basic ADL–assisted status on admission (p=0.09 and p=0.017, respectively), fully dependent status on admission (p=0.043 and p=0.002, respectively), presence of infective changes on chest X-ray (p=0.027 and p=0.003, respectively), and receipt of <2 doses of COVID-19 vaccine (p=0.007 and p=0.005, respectively). Conclusions. Risk factors for longer LOS in older patients with COVID-19 were basic ADL–assisted status and fully dependent status on admission, presence of infective changes on chest X-ray, and receipt of <2 doses of COVID-19 vaccine. High-risk patients should be identified through assessments of these characteristics. Identification of risk factors for longer LOS can help guide medical decisions and optimise healthcare resource utilisation. [ABSTRACT FROM AUTHOR]

Leadership research in early childhood education and care (ECEC) is a relatively new undertaking. It combines leadership concepts from school research as well as from business. There are common aspects in the leadership profession, but the context and the mission define the content of leadership tasks and responsibilities. Data in this cross-cultural study were collected in Finland, Japan, and Singapore from 2012 to 2014. Questionnaires were used as the data collection method and content analysis as the method to explore how leadership tasks define leadership in the different countries. The project included 100 participants in each country. Analysis in this article focuses on leadership tasks in ECEC settings in Finland, Japan, and Singapore. The study revealed that the tasks of ECEC leaders in all three countries are similar--the two most important leadership tasks are pedagogical leadership and human resource management--though implementation of tasks varied based on cultural context. In practice, leaders in Finland spend most of their time in line with the two issues considered most important, leaders in Japan spend their time on service and human resource management, and leaders in Singapore spend their time on pedagogical leadership and service management.

This study investigates in-service early childhood teachers' "practical knowledge" (Elbaz, 1981) in implementing changes in the classroom in the Republic of Singapore. In Singapore, many early childhood classrooms are teacher-directed where learning takes place in large groups. As part of the in-service teacher education program, a learner-centered practicum required teachers to visualize how they can include children's choice through designing learning corners and implementing small group learning. This investigation unveils how teachers used their "practical knowledge" to implement change and documents evidences of the change after 3 to 5 years of its initial implementation. It also highlights conditions for change and offers suggestions to policy makers, curriculum designers, and teacher educators in educating for change.

Introduction: Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward. Methods: This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected. Results: The prevalence of pre-frailty (CFS 4) and frailty (CFS≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021). Conclusion: Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions. [ABSTRACT FROM AUTHOR]

This study investigates in-service early childhood teachers' "practical knowledge" (Elbaz, 1981) in implementing changes in the classroom in the Republic of Singapore. In Singapore, many early childhood classrooms are teacher directed, where learning takes place in large groups. As part of the in-service teacher education program, a learner-centered practicum required teachers to visualize how they can include children's choice through designing learning corners and implementing small group learning. This investigation unveils how teachers used their "practical knowledge" to implement change and documents evidences of the change after 3 to 5 years of its initial implementation. It also highlights conditions for change and offers suggestions to policymakers, curriculum designers, and teacher educators in educating for change. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward., Methods: This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected., Results: The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021)., Conclusion: Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions., Competing Interests: None