Win Sen Kuan
Email Address
surkws@nus.edu.sg
Organizational Units
SURGERY
dept
YONG LOO LIN SCH OF MEDICINE
faculty
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Publication Search Results
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Publication Label-Free Biophysical Markers from Whole Blood Microfluidic Immune Profiling Reveal Severe Immune Response Signatures(WILEY-V C H VERLAG GMBH, 2021-02-16) Zeming, Kerwin Kwek; Vernekar, Rohan; Chua, Mui Teng; Quek, Kai Yun; Sutton, Greg; Kruger, Timm; Kuan, Win Sen; Han, Jongyoon; Dr Win Sen Kuan; BIOMEDICAL ENGINEERING; SURGERYDisease manifestation and severity from acute infections are often due to hyper-aggressive host immune responses which change within minutes. Current methods for early diagnosis of infections focus on detecting low abundance pathogens, which are time-consuming, of low sensitivity, and do not reflect the severity of the pathophysiology appropriately. The approach here focuses on profiling the rapidly changing host inflammatory response, which in its over-exuberant state, leads to sepsis and death. A 15-min label-free immune profiling assay from 20 µL of unprocessed blood using unconventional L and Inverse-L shaped pillars of deterministic lateral displacement microfluidic technology is developed. The hydrodynamic interactions of deformable immune cells enable simultaneous sorting and immune response profiling in whole blood. Preliminary clinical study of 85 donors in emergency department with a spectrum of immune response states from healthy to severe inflammatory response shows correlation with biophysical markers of immune cell size, deformability, distribution, and cell counts. The speed of patient stratification demonstrated here has promising impact in deployable point-of-care systems for acute infections triage, risk management, and resource allocation at emergency departments, where clinical manifestation of infection severity may not be clinically evident as compared to inpatients in the wards or intensive care units.Publication Pre- and Apnoeic high flow oxygenation for RApid sequence intubation in The Emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial(BMC, 2019-04-04) Chua, Mui Teng; Khan, Faheem Ahmed; Ng, Wei Ming; Lu, Qingshu; Low, Matthew Jian Wen; Yau, Ying Wei; Punyadasa, Amila; Kuan, Win Sen; Dr Kuan Win Sen; SURGERY© 2019 The Author(s). Background: Maintaining adequate oxygenation during rapid sequence intubation (RSI) is imperative to prevent peri-intubation adverse events that can lead to increased duration of hospital and intensive care unit stay, or a prolonged vegetative state requiring long-term institutionalisation. Despite employing current best practices during RSI, desaturation during intubation still occurs. High-flow nasal cannula (HFNC) oxygenation may potentially improve oxygenation during pre- and apnoeic oxygenation to allow a longer safe apnoeic time for RSI. Objective: We aim to test the hypothesis that the use of humidified high-flow oxygenation via nasal cannula at 60 L/min maintains higher oxygen saturation compared with current usual care of non-rebreather mask and standard nasal cannula at an oxygen flow rate of 15 L/min for pre- and apnoeic oxygenation. Methods: This is a multi-centre randomised controlled trial enrolling adult patients aged 21 years and older who require rapid sequence intubation due to medical, surgical, or traumatic conditions in the Emergency Departments (EDs) of the National University Hospital and the Ng Teng Fong General Hospital. Eligible patients will undergo randomisation at an equal ratio into intervention or control arms. The primary endpoint will be the lowest oxygen saturation achieved during the first intubation attempt from time of administration of paralytic agent until quantitative end-tidal carbon dioxide is detected if the first intubation attempt is successful, or until the start of the second attempt if it is not. Discussion: Prolongation of safe apnoea time through maintenance of oxygen saturation above 90% using HFNC oxygenation during RSI could potentially change current clinical practice, improve standard of care, and translate to better outcomes for patients. Trial registration: ClinicalTrials.gov, NCT03396094. Registered on 10 January 2018.Publication Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments(OXFORD UNIVERSITY PRESS, 2021-01-01) Kelly, Anne-Maree; Keijzers, Gerben; Klim, Sharon; Craig, Simon; Kuan, Win Sen; Holdgate, Anna; Graham, Colin A; Jones, Peter; Laribi, Said; Dr Win Sen Kuan; SURGERYObjectives: To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region. Methods: A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea. Results: 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days). Conclusion: Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.Publication Evaluation for occult sepsis incorporating NIRS and emergency sonography (EOSINE)(ELSEVIER SCIENCE INC, 2018-03-01) Ang, H; Tan, C; Ng, Y; Kuan, W; Chua, M; Dr Kuan Win Sen; SURGERYPublication Antibiotic expectation, behaviour, and receipt among patients presenting to emergency departments with uncomplicated upper respiratory tract infection during the COVID-19 pandemic.(2023-03-09) Huang, Zhilian; Kuan, Win Sen; Tan, Hann Yee; Seow, Eillyne; Tiah, Ling; Peng, Li Lee; Weng, Yanyi; Chow, Angela; Dr Win Sen Kuan; SURGERY; DEAN'S OFFICE (SSH SCH OF PUBLIC HEALTH)OBJECTIVES: Pre-COVID-19 pandemic, patients who attended the emergency department (ED) for upper respiratory tract infection (URTI) were more likely to receive antibiotics if they expected them. These expectations could have changed with the change in health-seeking behaviour during the pandemic. We assessed the factors associated with antibiotics expectation and receipt for uncomplicated URTI patients in four Singapore EDs during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study on adult patients with URTI from March 2021 to March 2022 in four Singapore EDs and assessed the determinants of antibiotics expectation and receipt using multivariable logistic regression models. We also assessed the reasons patients expect antibiotics during their ED visit. RESULTS: Among 681 patients, 31.0% expected antibiotics while 8.7% received antibiotics during their ED visit. Factors [adjusted odds ratio (95% confidence interval)] that significantly influenced expectation for antibiotics include: 1) prior consultation for current illness with [6.56 (3.30-13.11)] or without [1.50 (1.01-2.23)] antibiotics prescribed; 2) anticipation for COVID-19 test [1.56 (1.01-2.41)]; and 3) poor [2.16 (1.26-3.68)] to moderate [2.26 (1.33-3.84)] knowledge on antibiotics use and resistance. Patients expecting antibiotics were 10.6 times [10.64 (5.34-21.17)] more likely to receive antibiotics. Those with tertiary education were twice [2.20 (1.09-4.43)] as likely to receive antibiotics. CONCLUSIONS: In conclusion, patients with URTI who expected antibiotics to be prescribed remained more likely to receive it during the COVID-19 pandemic. This highlights the need for more public education on the non-necessity for antibiotics for URTI and COVID-19 to address the problem of antibiotic resistance.Publication Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region.(Ovid Technologies (Wolters Kluwer Health), 2018-08-30) Laribi, Said; Keijzers, Gerben; van Meer, Oene; Klim, Sharon; Motiejunaite, Justina; Kuan, Win Sen; Body, Richard; Jones, Peter; Karamercan, Mehmet; Craig, Simon; Harjola, Veli-Pekka; Holdgate, Anna; Golea, Adela; Graham, Colin; Verschuren, Franck; Capsec, Jean; Christ, Michael; Grammatico-Guillon, Leslie; Barletta, Cinzia; Garcia-Castrillo, Luis; Kelly, Anne-Maree; AANZDEM and EURODEM study groups; Dr Kuan Win Sen; SURGERYOBJECTIVE: The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. PATIENTS AND METHODS: An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. RESULTS: A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. CONCLUSION: Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.Publication Superior performance of N-terminal pro brain natriuretic peptide for diagnosis of acute decompensated heart failure in an Asian compared with a Western setting(WILEY, 2017-02-01) Ibrahim, Irwani; Sen Kuan, Win; Frampton, Chris; Troughton, Richard; Liew, Oi Wah; Chong, Jenny Pek Ching; Chan, Siew Pang; Tan, Li Ling; Lin, Wei Qin; Pemberton, Chris J; Ooi, Shirley Beng Suat; Richards, A Mark; Dr Lin Weiqin; MEDICINE; SURGERY© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology Aims: This study was conducted to test the diagnostic performance of NT-proBNP for discrimination of acute decompensated heart failure (ADHF) among breathless patients presenting in an Asian compared with a Western centre. Methods and results: Patients with breathlessness were prospectively and contemporaneously recruited in Emergency Departments in Singapore and New Zealand (NZ). The diagnosis of ADHF was adjudicated by two clinician specialists. A total of 606 patients were recruited in Singapore and 500 in NZ. The discriminative power of NT-proBNP for ADHF was superior in Singapore compared with NZ [area under the curve (AUC) 0.926 vs. 0.866; P = 0.012] both overall and among selected subgroups stratified according to age, renal function, body mass index, and presence or absence of AF or diabetes. Previously established cut-off point values of plasma NT-proBNP yielded comparable sensitivity and negative predictive values, but superior specificity and accuracy in Singapore compared with NZ. The difference in test performance was driven by the younger age (median age 56 years vs. 73 years; P < 0.001), associated with better renal function (estimated glomerular filtration rate 89 vs. 62 mL/min/1.73 m2; P < 0.001), and lower prevalence of AF (9.7% vs. 25.7%; P < 0.001) in acutely breathless patients in Singapore. Conclusion: Considering emerging evidence of a lower average age of presentation with ADHF over most of Asia compared with Western countries, NT-proBNP is likely to be more accurate when applied in Asian centres than in the West.Publication Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study(WILEY, 2019-10-01) Craig, Simon; Kuan, Win Sen; Kelly, Anne-Maree; Van Meer, Oene; Motiejunaite, Justina; Keijzers, Gerben; Jones, Peter; Body, Richard; Karamercan, Mehmet A; Klim, Sharon; Harjola, Veli-Pekka; Verschuren, Franck; Holdgate, Anna; Christ, Michael; Golea, Adela; Graham, Colin A; Capsec, Jean; Barletta, Cinzia; Garcia-Castrillo, Luis; Laribi, Said; Dr Win Sen Kuan; SURGERYObjective: Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. Methods: In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub-study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in-hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. Results: Five hundred and eighty-four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co-morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients – inhaled beta-agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. Conclusion: The data suggests that compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is sub-optimal. It also suggests over-use of antibiotics.Publication Early predictors for the diagnosis of liver abscess in the emergency department(Springer Nature, 2019-01-01) Chia, DWJ; Kuan, WS; Ho, WH; Sim, TB; Chua, MT; Dr Kuan Win Sen; SURGERY© 2019, Società Italiana di Medicina Interna (SIMI). Diagnosing pyogenic liver abscess (PLA) in the emergency department (ED) is challenging due to its non-specific clinical presentation. We aim to identify predictors that aid in diagnosis of PLA in ED patients. This retrospective chart review included patients diagnosed with PLA in a tertiary hospital between January 2008 and December 2012. We compared the demographics, clinical characteristics, investigations and outcomes between patients with PLA diagnosed and missed in the ED. During the study period, 155 patients were admitted via the ED with a cause of death or discharge diagnosis of PLA. Mean age was 58.1 (standard deviation [SD] 15.8) years, with male predominance of 69.7%. There were 79.4% of patients with diagnosis of PLA missed in the ED. Fulfillment of SIRS criteria was associated with increased odds of diagnosing PLA in the ED (adjusted OR 3.20, 95% CI 1.03–9.92), while a higher SpO 2 /FiO 2 ratio was associated with decreased odds of a timely ED diagnosis (adjusted OR 0.993, 95% CI 0.988–0.998). Missed ED diagnosis of PLA did not result in significant differences in mortality or treatment failure (p = 0.939), and median length of stay (11 days [IQR 8–16] vs. 11 days [IQR 7–17], p = 0.48). Non-fulfillment of the SIRS criteria and a higher SpO 2 /FiO 2 ratio at ED presentation were associated with higher likelihood of missed diagnosis. Despite that, a missed diagnosis of PLA in the ED did not appear to affect outcomes.Publication Virtual reality mobile application to improve videoscopic airway training: A randomised trial(ACAD MEDICINE SINGAPORE, 2021-02-01) Yau, Ying Wei; Li, Zisheng; Chua, Mui Teng; Sen Kuan, Win; Chan, Gene Wai Han; Dr Win Sen Kuan; SURGERYINTRODUCTION: Flexible bronchoscopic intubation (FBI) is an important technique in managing an anticipated difficult airway, yet it is rarely performed and has a steep learning curve. We aim to evaluate if the integration of virtual reality gaming application into routine FBI training for emergency department doctors would be more effective than traditional teaching methods. METHODS: We conducted a randomised controlled trial to compare self-directed learning using the mobile application, Airway Ex* in the intervention group versus the control group without use of the mobile application. All participants underwent conventional didactic teaching and low-fidelity simulation with trainer's demonstration and hands-on practice on a manikin for FBI. Participants randomised to the intervention arm received an additional 30 minutes of self-directed learning using Airway Ex, preloaded on electronic devices while the control arm did not. The primary outcome was time taken to successful intubation. RESULTS: Forty-five physicians (20 junior and 25 senior physicians) were enrolled, with male predominance (57.8%, 26/45). There was no difference in time taken to successful intubation (median 48 seconds [interquartile range, IQR 41-69] versus 44 seconds [IQR 37-60], P=0.23) between the control and intervention groups, respectively. However, the intervention group received better ratings (median 4 [IQR 4-5]) for the quality of scope manipulation skills compared to control (median 4 [IQR 3-4], adjusted P=0.03). This difference remains significant among junior physicians in stratified analysis. CONCLUSION: Incorporating virtual reality with traditional teaching methods allows learners to be trained on FBI safely without compromising patient care. Junior physicians appear to benefit more compared to senior physicians.