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Are cloth masks useful?

Now that we have a shortage of masks, is a cloth mask any good at all? Does it offer any percenta...

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What is considered fever? Forehead, ear, oral all give different readings. If we go to a doctor, 37.5 ear temp is not considered a fever. So what are the readings we should take note for each devices?

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Hi @Mr_J, the sequence of symptoms you experienced is not uncommon. To go for a work-out with that neck ache, your body would typically use compensatory muscle groups of the...

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Hello @deliriousg">@deliriousg, very good question. In fact I was just speaking to a respiratory physician who brought up this topic. Cloth and water-repellent fabric masks are as helpful as...

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Orthopaedic & Sports

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Bunions: Symptoms, Causes, Treatments & Minimally Invasive Surgery What is a bunion?Bunions or hallux valgus are an extremely common condition. Typically, the big toe will deviate towards the lesser toes, resulting in a painful prominence or a bony bump over the inner side of the big toe. While they may not hurt too much to begin with, eventually they can become so painful that even walking is difficult.As the deformity progresses, the forefoot (front part of the foot) becomes broader. This broadening combined with the protruding bunion makes footwear painful, causing pain and redness over the bunion.Over time, bunions can affect the 2nd and 3rd toes too. These toes can start developing painful hammer toe and claw toe deformities.This can result in pain over the top of the 2nd and 3rd toe, or in some cases overload and a painful callosity or thickening of the skin at the sole underneath the 2nd or 3rd toes. How do I know if I have a bunion? A bunion can be identified by looking out for the following signs in your feet:• A bony bump on the side of your foot next to your big toe• Your big toe pointing at a pronounced angle towards the other toes• Hardened skin or callouses over the bump or side of the big toe• Redness or irritation over the bony bump• Warm, shiny skin on the bump• Pain when walking or moving the toesPossible causes of bunionsOften, bunions can be hereditary and can run in the family. For others their foot structure can predispose them to develop bunions. For example, flatfooted individuals are more prone. For people with a genetic predisposition, bunions can start developing in their teens, while in others it may only become more apparent later on. Bunions are also much more common in women than men, possibly to women's shoe styles tending to be tighter, and use of high heels which put the toes into unnatural positions during gait. Treatment options When symptoms from the bunion are minimal, your doctor may advise that surgery is not necessary. Also, if the bunion is very mild, non-surgical options can be used. This may include modification of footwear, such as avoiding heels or tight shoes and/or orthotic shoe inserts. When the bunions are painful, icing them or taking anti-inflammatory medication can help too. Although bunion spacers and splints can also be used there is little evidence that they help.Bunion surgeryIf symptoms are worse, or not getting better with footwear, surgery can be a good option. Also, when a bunion progresses past the mild stage it will tend to get worse with time so surgery can be useful to arrest the progression and correct the bunion earlier rather than later. There are many different methods to treat painful bunions.Types of bunion surgery may include:• Bunionectomy, where the part of the foot that is bulging is removed• Fusing the toe joint• Implanting an artificial joint• Realigning ligaments around the joint• Reshaping the big toe and metatarsal bones• Osteotomy, making cuts in the bones and adjusting their positionTypically a traditional open bunion surgery can be quite invasive, and so traditional bunion surgery can be quite painful and take a significant amount of time to recover from. Patients may not be able to walk on their foot for sometime, and may even need physical therapy to build strength again.However, as minimally invasive techniques are developing rapidly in all areas of clinical care, minimally invasive bunion surgery is emerging as a popular option for treating bunions.Minimally invasive bunion surgery Minimally invasive surgery (MIS) aims to correct the problem with a minimal amount of disruption to the skin and surrounding tissues. • Instead of one long incision, a few very small incisions are used in minimally invasive bunion correction.• The bunion is corrected through these smaller incisions, which require only 1 or 2 stitches to be closed.The benefits of minimally invasive bunion surgery include:• Shorter recovery time – patients are able to walk on their foot the same day of the procedure• Less pain involved with recovery• Minimal scarring and less post-operative swelling and stiffness Possible risks of bunion surgeryIf you choose to go for a bunion surgery, whether by traditional or minimally invasive techniques, you should be aware that there is a chance the bunion could reform. Overcorrection is also a possibility, where the toe is angled slightly the other way. There may still be pain in your joint, particularly if in addition to the bunion, your joint is also arthritic, or you have gout. There's also a chance you could lose mobility in your toes and develop some stiffness.If you think you have a bunion and want to explore more on treatment options it would be good to visit your doctor or foot surgeon to discuss more.

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Women’s Health

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Breast Itch & Nipple Discharge Breast Itch or RashBreast itch/rash is most commonly due to skin irritation (eg eczema, or mild allergic reaction to clothing/ dye/ detergent). Even lotions, perfumes, or sweat may irritate the skin over the breast area.Simple tips:Use a mild body soap and cool-tepid water for showing; gently pat dry. Apply a thin layer of moisturiserWash bras with a mild detergent, and rinse off thoroughlyConsider placing cotton pads in the bra cups to keep the area dry, and minimise contact with potential allergens (perfume, scented creams, etc)If you have eczema, you may consult your usual dermatologist to get advice on how to manage this acute flareIf the rash is bloody/”weeping” (having yellowish sticky discharge): please consult a doctor to check if a steroid ointment is suitableIf there is pus/fever: please consult a doctor as soon as possibleIf the rash if persistent after 2 weeks, consider seeing a specialist (skin or breast) for further evaluationAs a breast specialist, Dr Tan Yia Swam will assess the pattern of the itch/rash, and do the necessary tests to confirm that it is not due to cancer. This may involve a scan, and biopsy for certain patients.Nipple Discharge Nipple discharge may manifest in several ways: some ladies notice staining on the bra or pyjamas, some others notice it as part of their regular breast self-exam.There are many causes for nipple discharge: most commonly due to previous breastfeeding. Other causes include: benign duct changes/growth, thyroid problem, a hormone producing-type of brain tumour, or some forms of breast cancer.If you detect nipple discharge, it is good to consult a doctor for a full evaluation: these are some of the things to take note of and report to the doctor: Did the discharge come out by itself, or only when you press?Is it on one side, or both side?Is it always from the same spot, or from several areas on the nipple?What is the color? Transparent, yellow, green, brownish, red, milky?Do you notice any breast lumps?When was your most recent mammogram (if above 40 years old)?Have you ever had a breast ultrasound? if so- bring along the report to the doctor’sDr Tan Yia Swam will need to know the pattern of the discharge, and arrange for the relevant scans, and additional specialised tests such as sending the fluid for lab test (cytology). Sometimes, patients may need surgery to find out the cause (microdochectomy, or total duct excision).

breast discharge breast itchy rash itchy rash nipple discharge

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The Ultimate Guide to Teeth Whitening in Singapore (2020) One of the most frequently discussed procedures with patients and friends is – “How do I whiten my teeth?” This article covers everything you would need to know if you are thinking about whitening your teeth. We will cover all the essential things that you would want to know about teeth whitening such as• how does teeth whitening work? • types of teeth whitening available in the Singapore market, • as well as debunk a few common myths that have been circulating around, for way too long now. If you are planning to get married or have a big occasion coming up, this article will also cover preparation timeline to make sure your pearly whites are sorted out punctually. So, let’s get started. How does teeth whitening work? Teeth whitening is a cosmetic dental procedure that involves lightening darkened teeth through physical and chemical means [4]. If you have external stains, a good polishing by your local dentist can help to remove these caffeine stains for example. However, this uncovers the original tooth colour, but does not actually whiten the tooth. What whitens my teeth in whitening products?The active ingredient in teeth whitening products is hydrogen peroxide [1], either in the form of carbamide or hydrogen peroxide. When hydrogen peroxide is exposed to the chromogens (the organic compounds within the tooth that gives teeth its colour), it causes oxidation to occur. This reaction causes an organic structural change that produces a lighter colour, producing whiter teeth! Usually, only the front 8 – 10 teeth are whitened as these are part of the smile aesthetic zone, meaning that these are the teeth visible when you smile. How do I know if I am suitable for teeth whitening? That depends on the type of stains you have. There are 2 main types of stains: internal and external. In general, if you have an internal stain, it is not possible to whiten your teeth the way you would see in most teeth whitening ads. However, if you are just an avid coffee drinker with external stains, you would stand a good chance of having whiter teeth, though perhaps cutting back on coffee may also help. What is an External Stain?An external stain is usually caused from the things we eat and drink, in general our lifestyle! Habits and lifestyle factors that can cause external stains include:● Plaque i.e. the build-up of biofilm from eating and drinking and the lack of brushing and flossing ● Any type of food and drink that is dark in colour such as coffees, teas, red wine, curries and ketchup! ● Smoking ● Tooth decayYellow teeth caused by external stains are an excellent candidate for teeth whitening! However, it is still important for you to have your teeth and gums checked by a dentist before starting on your whitening journey because any tooth cavities or gum issues should be sorted out first, to create a painless and pleasant whitening experience. More on that later. What is an Internal Stain?An internal stain is something that happened during childhood, that caused a disturbance in the development of your adult teeth! Teeth that are internally stained may appear bluish or brownish and are typically darkly coloured in appearance.Internal staining can be caused by a multitude of factors and some of these include [2]:● Taking certain antibiotics as a child (e.g. Tetracycline) ● Ingesting too much fluoride ● Genetic abnormalities ● Ageing● Post braces spots (Orthodontic white spot lesions) ● Old metal (amalgam) fillings Relevant mainly to people who have grown up in Singapore, fluorosis is a popular type of internal stain because our water supply contains fluoride! Though fluoride is meant to aid tooth mineralisation, too much fluoride during childhood can cause patchy teeth to develop. So kids, please do not swallow your toothpaste! What types of teeth whitening are available in Singapore? According to the American Academy of Cosmetic Dentistry [3] , these are the available products - Whitening Toothpastes - Over-The-Counter Whitening Strips and Gels (this includes online direct to consumer products) - Whitening Mouthwash - Tray based tooth whitening gel - In Office Whitening Whitening Toothpastes tend to be more abrasive as they contain extra ingredients that sometimes with long term use, can lead to a counterproductive effect due to stripping down the outer layer of teeth causing the inner layer of dentin which is yellow, to show through. This article will focus mainly on peroxide-based teeth whitening products available in Singapore which includes - Tray based tooth whitening gel i.e. Take Home Whitening Kit - In Office Whitening What is a take-home teeth-whitening kit? A take home whitening kit involves two things – A tray and gel. The gel is loaded into the tray and worn for 20 minutes – 8 hours, depending on the concentration of peroxide in the whitening gel you have purchased. It is really important to follow the manufacturer’s instructions to avoid experiencing unwanted teeth sensitivity or sore gums. Common brands on the market include - Opalescence (30 minutes / day – 35% carbamide peroxide) - Zenyum White (75 minutes / day – 17 %) - Philips NiteWhite (overnight gel – 16% carbamide peroxide) Brand & Market PriceOpalescence: $ 350 – 500 Philips NiteWhite: $ 350 – 500 Zenyum White: $ 99 - 289The unique nature about Zenyum White compared to other whitening gel companies, is that they are able to put you in touch with a dentist from their local partner network at discounted prices for consultation. This is a good option for those on a budget or do not have a regular dentist.My personal opinion is that if you have your own dentist then it’s good to go back to the one who knows everything that has been going on in your mouth, to determine if you are suitable for teeth whitening or not. What is In Office teeth whitening? It involves a higher concentration of peroxide based whitening gel that can only be done by a professional because if the gel were to go anywhere other than your teeth, it can burn really bad. Usually a 1-hour procedure that requires you to sit in the dental chair patiently while you would experience some teeth sensitivity due to the strong nature of the gel. However, you do come out with teeth that are generally 4 – 8 shades whiter, subject to prior teeth conditions. There are several brands on the market, some which require a light activated gel such as Philips ZOOM, though that may weigh heavy on your mouth which can be tiring. There are other brands such as Opalescence which provide light free options and basically all you have to do is sit and wait with the gel applied. Market price for this is $800 – 1000. Myths about teeth whitening Does it weaken my teeth? Long term studies have shown that peroxide-based teeth whitening gels do not have any long-term damage to your teeth.Why do some of my friends say teeth whitening is painful? It could be that the gel they are using is too strong, exposure time is too long or that there was untreated decay that needs to be addressed. Is peroxide damaging / toxic to my body? No, it is not toxic especially when ingested over a short period of time and in trace amounts. Tips and tricks to have super white teethGet an electric toothbrush to maintain good oral hygiene, like the Zenyum Sonic, Philips Sonicare or Oral B. Avoid drinking dark drinks and foods while whitening teeth!Choose calcium during the process to decrease any teeth sensitivity. The best combo of teeth whitening is to do chairside teeth whitening to jumpstart the base colour to a whiter shade, then maintain every 3 months with a take home whitening kit. Teeth Whitening Timeline If you have a big occasion coming up, think about whitening your teeth 3 months in advance. Just in case any pre-whitening needs have to be addressed such as fillings and dental cleaning. Teeth whitening if done chairside can be done instantly but it does take 2 weeks to see a colour stabilization. Take home whitening kits include trays that need to be fabricated so that also takes time. Lastly, while teeth whitening is a generally pleasant experience, it does take up to 48 hours for any tooth sensitivity to dissipate so that is worth taking into account. I hope that this article has proven to be a good way for you to find out more before you decide to begin your teeth whitening journey! Please note that this article is an opinion piece based on clinical practice backed with scientific evidence.

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Women’s Health

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Am I suffering from chronic constipation? Our bowel movement and adventures in toilet are not commonly discussed topics among family and friends. Do you know that it is quite common for some people not to pass stools once a day? In the medical literature, we define a normal stool passage as once in 3 days to three times a day, so long as the person does not have any pain during stool passage or need to strain very hard to pass the stools. However, if someone has infrequent passage of stools associated with abdominal bloating, pain or a need to strain excessively to pass stools, he/she is likely to have constipation. Are there different types of constipation?While there are many causes of constipation, your doctor should firstly decide whether you are suffering from primary or secondary constipation. Primary constipation is when the cause of the constipation is directly related to the colon (large intestine). Secondary constipation happens when you are suffering from a disease that causes your colon to slow down, leading to constipation. Secondary constipation can usually be excluded by some simple blood tests. One example of secondary constipation is hypothyroidism (a condition when your body produces too little thyroid hormone). Replacement of the thyroid hormone will quickly resolve the constipation.After excluding secondary constipation, your doctor will try to determine if you have chronic constipation. Patients suffering from at least two of the following symptoms over a period of three months or more are considered to have chronic constipation:Symptoms• Frequency of less than 3 bowel movements per week• Excessive straining during defaecation for at least 25 % of bowel movement• Lumpy or hard stools• Sensation of anorectal obstruction• Sensation of incomplete defecation• Manual maneuvering required to defecateCan my chronic constipation be cured?Chronic constipation can be readily controlled and some patients can be cured of the condition. It is important to know that the aim of treatment is to normalize your stool passage so that you do not suffer any discomfort/pain from going to toilet. A normal person’s bowel movement is affected by the following factors:• Diet content – diet low in fruit and vegetable fiber tends to cause constipation• Psychological stress – the more stressed you feel, the more constipated you become• Physical stress – if you are sick or have trouble sleeping (insomnia), you become constipated• Medications – some medications for other health conditions may cause constipation• Hormones – your general hormone levels can affect your bowel movement• Physical activity – low general physical activity is associated with constipation• Brain/ nerve control – nerves stimulate the colonic muscle which lead to bowel movementOn average, an adult will pass stools roughly once a day. A change in any of the factors can lead to constipation. Your doctor can identify which factors are abnormal and this can help treat your constipation. What are the treatment options?While further investigation and assessment are required to determine the best suited treatment option for each patient, the options below are widely accepted as reasonable first-line therapy:• Dietary modification• Lifestyle modification• Regular exercise • Oral medicationIs laxative use bad for me? Will I become dependent on laxatives?It is a myth that laxative use will damage your colon. Your doctor can use one or more laxative to regulate your bowel movement. Many patients can gradually reduce or stop their laxatives when their lifestyle/ diet modifications have improved to control their bowel movement. Unfortunately, some patients have more severe constipation and require long term use of laxatives. You should not worry if this happens because the aim is to regulate your bowel movement to avoid complications of constipation. Most of the common laxatives have very few risks with long term use.Can surgery cure me of constipation?Surgery is very rarely used today in treatment of constipation as dietary modifications, exercise and medications have been very effective in treatment of chronic constipation. If your doctor recommends surgery before exhausting all the non-surgical options, you should seek a second opinion.

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Physical Health and Fitness

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Overuse Injuries in Cycling and How To Prevent Them Cycling — Too Much of a Good Thing Can Sometimes Be BadIn 2010, the government (LTA, URA and NParks) announced the National Cycling Plan, aiming to make cycling a feasible transport option for Singaporeans. As cycling networks are being developed and improving connectivity between towns, it can be expected that more of us may consider cycling as a healthier, eco-friendly way of transport. With the development of park connecting trails like the Coast-to-Coast trail, Round Island Route Park Connector, and the Rail Corridor, it also seems like a good time to pick up cycling as a leisure or sporting activity.This all sounds great, with the increasing prevalence of non-communicable diseases amidst an aging population, these initiatives provide us with more options to fulfil our need for moderate intensity aerobic exercise to maintain our cardiovascular health. As a relatively low-impact sport, it is also less likely for us to sustain injuries like stress fractures or muscle tears.However, as the title suggests, cycling as a sporting activity does present with its own unique set of injuries, categorised mainly into traumatic injuries and overuse injuries. The former can largely be avoided with a good sense of traffic safety and caution. It is the latter that will be discussed further in this article. It is interesting to note that it is not just elite, professional cyclists who suffer from overuse injuries. In terms of prevalence, 85% of recreational cyclists in an epidemiological study (Wilber CA et al., 1995) experience an overuse injury. Whereas in elite professionals, 62% of all injuries are also due to overuse (Barrios C et al., 1997).What then are overuse injuries, and why do they occur? Overuse injuries are due to repetitive stress to the skin, tendons, joints and nerves that are involved during cycling. They present when tissue breakdown in these structures occur faster than repair. This is compounded by biomechanical factors such as a poor bike fit. Let us now assess systematically the different types of overuse injuries in cycling by anatomical region from head to toe.Neck and Lower backThe neck and lower back are two areas that experience a considerable amount of strain in cycling. This is largely attributed to the posture adopted by cyclists (demonstrated in the left image below) where the lower back (lumbar spine) is flexed, while the neck (cervical spine) is extended so that the cyclist can look ahead. This could be due to poor flexibility of the hamstrings, as well as handlebars that are too short. Ways to prevent strain to the paraspinal muscles in these two areas include: raising the handlebars to shorten the reach, and stretching the hamstrings to prevent excessive rounding of the lower back. http://www.cyclingweekly.co.uk/fitness/bike-fit/cycling-neck-pain-prevent-treat-145063 Wrists and HandsNext, nerve compression injuries at the hands and wrists are also common in cycling. Two major nerves run their course through the wrist to the hand, namely the ulnar nerve which runs along the side of the wrist of the little finger, and the median nerve which runs down the middle of the wrist and branches out at the palm. Compression of these nerves can occur from prolonged gripping of the handlebar via the mechanisms illustrated below. The pressure exerted on these nerves can lead to temporary ischemia of the nerves, causing sensory and motor deficits to the areas of the hand supplied by the nerve. Such injuries can be avoided by using padded gloves and handlebars, changing your hand position frequently when cycling, and also by raising the handlebars to shorten the reach required. http://www.hughston.com/hha/a_15_3_2.htm Owing to the prolonged periods of sitting in the bicycle seat, tissues in the buttock and groin are also prone to overuse injuries. Skin chafing and ulceration is common, owing to the constant friction and pressure, coupled with the moisture frown sweating. Preventive measures include wearing padded chamois shorts, using a more cushioned saddle, as well as applying petroleum jelly to areas prone to chafing. In cases where mild chafing of the skin has occurred, it can be treated with antiseptic cream, whereas ulcerations will require wound dressings coupled with topical and oral antibiotics. In both cases, it is important to change out of wet clothing as soon as possible.Buttocks and GroinLike in the hands and wrists, the neurovascular structures running in the buttocks are also prone to compression injuries by being compressed between the pubic bone and saddle of the bicycle. The structures at risk are the pudendal nerve and pudendal artery, which supplies various structures at the perineum and perianal region. Symptoms from the nerve compression can last a few days after long rides and may include genital pain, a burning sensation, as well as numbness in the areas supplied by the nerve. The compression of the artery can lead to reduced blood flow to the genitalia, and in the long run, may lead to complications like erectile dysfunction. In studies conducted, it was found that erectile dysfunction presented in 24% of cyclists with a weekly mileage of more than 400km (Summer F et al, 2001), and also in 4% of amateur cyclists (Schwarzer et al, 1999). Preventive measures would involve reducing the amount of pressure that is exerted on the perianal region. This can be achieved by alternating between standing and sitting, taking frequent breaks, avoiding excess upward saddle tilt, as well as investing in ergonomic saddles. http://www.johnpolson.com.au/2011/11/05/something-every-male-cyclist-should-read/ KneeInjuries to the knee can be classified into those of the outer knee, and those at the front of the knee. In the outer knee, iliotibial band syndrome can occur. The iliotibial band is a thick band of fascia originating from the gluteus maximus and the tensor fascia lata connective tissue, extending from the pelvis to the Gerdy’s tubercle (a bony prominence below and outside the knee). With repeated flexion and extension of the knee during cycling, there can be excessive friction of the iliotibial band against the lower outer part of the thigh bone (the lateral femoral epicondyle), causing irritation and inflammation of the band. This can be attributed to a rapid increase in training volume and intensity, inward-pointing toes when cycling, and a tight iliotibial band. Treating iliotibial band syndrome can be approached firstly by reducing training volume, pointing the toes straight forward whilst cycling, and also by stretching and foam rolling the iliotibial band to improve its flexibility (see images below). http://www.fix-knee-pain.com/knee- exercises/stretches/itb-stretches Pain at the front of the knee can be due to patellofemoral pain syndrome. This describes a misalignment between the kneecap (patella) and the thigh bone (femur), causing excessive pressure on the kneecap during knee movements such as the repetitive flexion and extension during cycling. Patellofemoral pain syndrome can occur in cycling due to reasons such as a low saddle height, weak thigh (quadricep) muscles, as well as a tight iliotibial band. Treatment of this pain would involve addressing the above mentioned factors by raising the saddle height, stretching the iliotibial band, and strengthening the quadriceps and core.FootLast but not least, foot pain and numbness is also one of the many symptoms in overuse injuries related to cycling. This is known as metatarsalgia, and is caused by irritation and compression of nerves and tissues around the ball of the foot. This can stem from faulty weight distribution on areas of the foot, and is exacerbated by poorly cushioned insoles as well as wearing shoes with narrow toe boxes or excessively tight straps. It is advisable for cyclists to use metatarsal pads, wear shoes with a wider toe box, and/or loosen the shoe straps.In light of the Covid-19 pandemic, we would also like to remind cyclists to cycle alone if possible and maintain safe distancing guidelines. Do also maintain personal hygiene by wiping perspiration on your face with a towel rather than your hands, wearing a mask if possible, and washing your hands after cycling. Lastly, avoid touching public objects and cycling itself if you are feeling unwell.This article has explored, by anatomical regions, common overuse injuries related to cycling, as well as ways to prevent or treat these injuries. Whilst cycling is a great form of exercise, it is important to understand them so that we can continue enjoying this activity without having to give it up to such preventable overuse injuries. To sum up, to avoid and prevent cycling related injuries, it is crucial to have a proper bike fit, increase mileage and intensity gradually, and have adequate rest. Happy cycling and cycle safely!

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Latest developments in Hypertension and optimising Blood Pressure control Hypertension is an established risk factor for cardiovascular disease. The 3 main vascular beds involved include cerebral, coronary and peripheral regions. Complications in any of these areas could result in significant morbidity and mortality.Will good hypertension control mitigate these cardiovascular complications? How do we do surveillance for those at risk. All these will be discussed together with several larger than life cases.

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Updates in the management of Hyperlipidemia & tackling Statin Myths Hyperlipidaemia is a very common problem in primary care and is also a significant chronic disease. Many GPs faced the challenges to start their patients on treatment due to many patient factors. Through this webinar, I would like to dispel some of the statin myths so that GPs are better equipped to educate their patients. I will also share the updated reference target in different patient groups and discuss my management approach using different classes of drugs including the new PCSK9 inhibitors for different types of patient profiles.

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Moving towards better patient outcomes in chronic disease management with the help of pharmacogenomics Primary care provides patients with immediate care at the first line of treatment. GPs prescribe medications based on standard therapy and dosing guidelines and medication change or dose modification takes place if the patient is unresponsive or experiences side effects. This conventional “trial-and-error” process of drug optimization is associated with increased cost, and subjects patients to risk of adverse drug reactions (ADRs). Pharmacogenetics offers personalized medicine based on genetic profile for optimal medication choice, reducing unnecessary healthcare utilization, ADRs and polypharmacy. We have conducted a study in private GP practices in Singapore, exploring of feasibility of using pharmacogenetic testing and clinical decision support software (CDSS) in the management of patients with ≥1 common chronic diseases. The primary outcomes were adequacy of DNA in the samples collected by GPs and the number of clinically actionable variants among participants. The pharmacogenetic test panel was selected based on accuracy, speed of delivery and cost. Testing of the DNA was provided by the Genome Institute of Singapore using an Illumina array. Data on the selected single nucleotide polymorphisms were incorporated into the CDSS. Seven GPs from six private practices took part in the study. In my presentation I will discuss our findings and the next steps.

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Latest developments in the Management of Obesity in Primary care Obesity is now very prevalent in many parts of the world. Yet, the management of the patient with obesity (PwO) is often challenging for many reasons. Failure of PwO and healthcare professionals (HCPs) to recognise obesity as a chronic disease, the physiologic adaptive responses to weight loss, phenotypic features, co-existing metabolic problems, psychosocial factors including weight bias and stigma are among some of the barriers to effective weight loss. Layering upon these challenges is the recent COVID-19 pandemic.How can we as HCPs institute treatment for our PwO or continue to engage them in weight loss interventions in this era of constant change where other medical conditions seem to take precedence? In this talk, we shall discuss some of the myths and hurdles in obesity management and the innovative approaches required to tackle one of the most challenging yet one of the most common chronic diseases of our time.

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Digitisation of Mental Health care during COVID-19 and beyond: practice tips for Primary care and support services in the community Digitisation of Mental Health care during COVID-19 and beyond: practice tips for Primary care and support services in the communityCOVID-19 has pushed connections and communications online beyond the physical constraints of consultation in the clinic. What are some of these challenges amidst the COVID-19 crisis ? How do we make better connections and communications? Dr Joseph Leong will share from his personal journey and introduce community support services which might be useful for Primary Care such as MindLine.sg, Mental Connect, SOS, Caregiver Alliance, Caring for Life and others.

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