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Papers by Boon keng Tay

The influenza A (H1N1-2009) experience at the

The Journal of Arthroplasty, 2017

Background: This study aims to evaluate patient reported and functional outcomes following hybrid... more Background: This study aims to evaluate patient reported and functional outcomes following hybrid versus cemented total knee arthroplasty (TKA) in patients, stratified by body mass index (BMI). Methods: Registry data of patients undergoing primary TKA between January 2004 and January 2013 were collected. Baseline interviews were conducted preoperatively to assess sociodemographic characteristics, BMI and knee arthritis severity, using the Knee Society Score (KSS), which consists of the Knee Society Knee Score (KSKS) and the Knee Society Function Score (KSFS) and Oxford Knee Score (OKS). These scores were collected prospectively, preoperatively and postoperatively up to 2 years. 2-year outcomes and 5-year revision rates were then compared between (1) hybrid and cemented TKA groups and (2) BMI subclasses within the hybrid and cemented TKA groups. Results: Patients who underwent cemented TKA had marginally better flexion range, KSFS and OKS at 2-years postoperatively. In the overweight category, flexion range, KSFS and OKS were marginally lower for hybrid TKAs. There were no differences in outcomes between the two groups in Class I and II obesity. Within the cemented TKA group, there were no differences in the outcomes between BMI subclasses. There were significant differences in the KSFS (0.023) and OKS (0.030) between the BMI subclasses within the hybrid TKA group, with patients in Class II obesity faring the worst. There was no statistically significant difference in the revision rates. Conclusion: We conclude that obesity does not affect outcomes in hybrid versus cemented TKA.

Development in Practice, 2016

ABSTRACT Medical aid missions involve travel to conflict or danger zones, posing safety risks in ... more ABSTRACT Medical aid missions involve travel to conflict or danger zones, posing safety risks in addition to the usual occupational risks arising from daily medical work. The note reports on a volunteer mission, using personal reports, anecdotal experiences, and the formal annual report to undertake an assessment similar to worksite assessments for hazards and control measures. Hazards were found to be prevalent, including physical noise and heat, infectious exposure from patients and local vectors, poor water sanitation, and psychosocial stress from unfamiliar environments and large patient numbers with limited means. Implementable preventative measures include increasing awareness with appropriate protective equipment usage and safety guidelines. Mission planning and management should also involve occupational health input.

Singapore medical journal, 1988

Twenty-six (26) isoelastic cementless total hip replacement in 20 patients with a follow-up perio... more Twenty-six (26) isoelastic cementless total hip replacement in 20 patients with a follow-up period of 2 months to 2 years are presented. The indications for hip replacement were avascular necrosis and osteoarthritis secondary to rheumatoid arthritis, ankylosing spondylitis, degenerative arthritis and chronic renal failure except in two patients, one with fracture neck of femur and another with a loose cemented total arthroplasty. The duration of surgery ranged from 80 to 140 minutes and the average hospital stay 14 days. They were four intraoperative complications, one each with fracture of the greater trochanter and subtrochanteric femoral fracture and two perforations of the femoral shaft. All were managed conservatively with good results. Three patients had posterior hip dislocation in which in one it was associated with separation of the head from the endoprosthesis. The first two were managed by closed reduction and the last one by open reduction with satisfactory results. There was a marked improvement in the Harris score post-operatively. All patients were satisfied with the outcome of surgery with some bedridden patients returning to active independent life.

Singapore medical journal, 1992

The early post-operative results of wide versus selective decompression in a group of 64 patients... more The early post-operative results of wide versus selective decompression in a group of 64 patients with lumbar spinal stenosis were studied with the aim of ascertaining whether a more limited approach gives comparable results to the more traditional method of wide decompression. Wide decompression involved complete removal of a vertebral lamina at the stenotic level. Selective decompression refers to removal of the lower part of the superior lamina and the upper part of the inferior lamina at the stenotic level together with limited facetectomies. Patients were compared with respect to post-operative relief of back pain and sciatica/claudication as well as the ability to return to their pre-morbid level of functional activity. Follow up ranged from 4 months to 26 months. Results showed that both wide and selective decompression were able to achieve complete or considerable relief of symptoms and return to pre-morbid level of activity in 74% to 84% of patients. The results in the 2 gr...

Singapore medical journal, 1987

Singapore medical journal, 1988

Journal of Spinal Disorders, 2000

Thirty-seven patients were studied for an average of 32.1 months after canal-expansive laminoplas... more Thirty-seven patients were studied for an average of 32.1 months after canal-expansive laminoplasty for the treatment of multiple-level cervical stenosis caused by spondylosis, ossification of posterior longitudinal ligament, prolapsed intervertebral disc, and other conditions. Short-term and medium-term results were recorded clinically, using the scoring system proposed by the Japanese Orthopedic Association. The canal expansion was also recorded with radiological studies. The improvement rate was good to excellent in 58.3% of the patients. Postoperative neurological deterioration occurred in only four patients. Poorer results were observed in female patients and in those in whom surgery was delayed. Surgery within 12 months of onset of symptoms gave good results. Serious complications occurred in only two patients. There were 12 patients who were treated with the single trap-door (unilateral) laminoplasty and 25 patients treated with the double trap-door (sagittal splitting of the spinous processes) laminoplasty; their results were compared. There was no significant difference in neurological outcome between the two methods.

Journal of orthopaedic surgery (Hong Kong), 2010

To determine whether continuous infiltration of local anaesthetic can reduce the pain score and m... more To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA). 11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intraarticular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hou...

The Journal of Trauma: Injury, Infection, and Critical Care, 1971

Emerging Infectious Diseases, 2004

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginnin... more An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute-care hospitals in Singapore. Critical factors in containing this outbreak were early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

Current Medical Research and Opinion, 2006

The number of hip fractures is expected to double in the next 20 years, with current estimates th... more The number of hip fractures is expected to double in the next 20 years, with current estimates that Asia will account for 37% of these cases. As bone mineral density (BMD) may be used as a measure of fracture risk, we sought to compare the effects of teriparatide with salmon calcitonin treatment on changes in BMD, biochemical bone markers, and safety in postmenopausal Asian women with osteoporosis. A total of 104 patients (n = 47 teriparatide [20 g/day subcutaneously] and n = 57 calcitonin [100 IU/day subcutaneously]) were enrolled in Hong Kong, Singapore, Philippines, Malaysia, and Thailand. Calcium (> or = 500 mg/day) and vitamin D (200-400 IU/day) supplements were taken throughout the 6-month controlled, randomized study. Teriparatide was associated with a 5.03 +/- 4.77% increase in lumbar spine BMD (p < 0.0001, mean +/- SD change from baseline), whereas changes in lumbar spine BMD for patients on calcitonin were not statistically significant (mean change of 0.36 +/- 4.12%, p = 0.16). Comparison of the two groups indicated that teriparatide treatment improved lumbar spine BMD statistically significantly more than calcitonin (p < 0.0001). No statistically significant changes were observed for total hip or femoral neck BMD. Serum bone-specific alkaline phosphatase (BSAP) increased by 55.9% (median change from baseline, p < 0.0001) in the teriparatide group, and remained stable with calcitonin (5.0% change, p = 0.24); osteocalcin increased by 156.15% (median change from baseline, p < 0.0001) with teriparatide, and decreased with calcitonin (-15.25%, p = 0.03). Similar rates of adverse events were observed, with nausea and dizziness the most commonly reported for both groups (teriparatide versus calcitonin, 13.0% versus 23.2% p = 0.21, 10.9% versus 21.4% p = 0.19, respectively). There were no clinically relevant changes observed in laboratory parameters. Both treatments were similarly tolerated, however teriparatide was associated with greater increases in lumbar spine BMD and bone formation markers, demonstrating the unique mechanism of action and safety of this treatment for osteoporosis in these Asian women.

British Journal of Sports Medicine, 2010

From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brough... more From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brought 1210 athletes and 810 offi cials from 43 participating countries. On 11 June, just 1 week before the Games Village Medical Centre started operations, the World Health Organization offi cially declared a global H1N1 2009 pandemic. Working in close partnership with the Olympic Council of Asia Medical Commission, Singapore AYG Organising Committee and other government agencies, the AYG Medical Services Committee was successful in preventing the local transmission of H1N1, which would have been a threat to the games, as it could have led to the cancellation of these games. This article describes the experience and valuable lessons learnt from managing a sports-related mass gathering during the developing pandemic.

Archives of Physical Medicine and Rehabilitation, 2004

Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in C... more Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

The Journal of Arthroplasty, 2004

Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Iso... more Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Isolated patellar revisions from April 1993 to April 2000 were assessed for complication rates, the Knee Society score (KSS), implant survival, and radiological loosening. Twenty-nine knees were revised in patients aged 71.0 years (range, 61-87; SD, 6.2). At 67.0 months (range, 24-98 months; SD, 22.0), no patient underwent further revision. Knee scores improved by 26.5 (range, 9.0-44.0; SD, 10.9) while function scores improved by 25.0 (range, 0-50.0; SD,14.5) over prerevision values. Early complications included 3 superficial wound infections, 1 hematoma, and a urinary tract infection in 1 patient. One patient had a subluxed patella. One patient had asymptomatic femoral osteolysis on radiological evaluation. Isolated patellar revisions can be performed in low-demand, elderly patients with minimal patellar maltracking.

Journal of Bone and Mineral Metabolism, 2007

We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postme... more We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postmenopausal women at increased risk of osteoporotic fractures. In this 12-month observational study conducted in Asia (Hong Kong, Malaysia, Pakistan, Philippines, Singapore, Taiwan), 984 postmenopausal women (aged 55 years or older) were treated with raloxifene 60 mg/day (n = 707; 72%) or daily bisphosphonate (alendronate 10 mg/day; n = 206; 21%, or risedronate 5 mg/day; n = 71; 7%) during their normal course of care. Patients were assessed at baseline, 6, and 12 months. Baseline characteristics (including age, race, education, menopausal status, and baseline fractures) were comparable between the raloxifene and bisphosphonate groups. More women on raloxifene completed the study compared with those on bisphosphonate (50.2% versus 37.5%; P < 0.001). Patients also took raloxifene for a longer period than bisphosphonate (median, 356 versus 348 days; P = 0.011). Compared with those taking bisphosphonate, significantly fewer patients taking raloxifene discontinued the study because of stopping treatment (5.7% versus 10.1%, P = 0.017) or changing treatment (2.8% versus 9.7%, P < 0.001). Inconvenient dosing was reported as a primary reason for discontinuation due to stopping or changing treatment in 19 (6.9%) bisphosphonate patients compared with 0 raloxifene patients. The percentage of patients who had consumed 80% or more of their study medication was similar for raloxifene patients (48-56 weeks; 95.2%) and bisphosphonate patients (48-56 weeks; 93.3%). More raloxifene patients responded that they were satisfied with their medication than bisphosphonate patients at 48-56 weeks (P = 0.002). We concluded that Asian postmenopausal women at increased risk of osteoporotic fractures showed a greater propensity to remain on raloxifene compared with bisphosphonate. The women on raloxifene exhibited lower discontinuation rates and higher treatment satisfaction.

The influenza A (H1N1-2009) experience at the

The Journal of Arthroplasty, 2017

Background: This study aims to evaluate patient reported and functional outcomes following hybrid... more Background: This study aims to evaluate patient reported and functional outcomes following hybrid versus cemented total knee arthroplasty (TKA) in patients, stratified by body mass index (BMI). Methods: Registry data of patients undergoing primary TKA between January 2004 and January 2013 were collected. Baseline interviews were conducted preoperatively to assess sociodemographic characteristics, BMI and knee arthritis severity, using the Knee Society Score (KSS), which consists of the Knee Society Knee Score (KSKS) and the Knee Society Function Score (KSFS) and Oxford Knee Score (OKS). These scores were collected prospectively, preoperatively and postoperatively up to 2 years. 2-year outcomes and 5-year revision rates were then compared between (1) hybrid and cemented TKA groups and (2) BMI subclasses within the hybrid and cemented TKA groups. Results: Patients who underwent cemented TKA had marginally better flexion range, KSFS and OKS at 2-years postoperatively. In the overweight category, flexion range, KSFS and OKS were marginally lower for hybrid TKAs. There were no differences in outcomes between the two groups in Class I and II obesity. Within the cemented TKA group, there were no differences in the outcomes between BMI subclasses. There were significant differences in the KSFS (0.023) and OKS (0.030) between the BMI subclasses within the hybrid TKA group, with patients in Class II obesity faring the worst. There was no statistically significant difference in the revision rates. Conclusion: We conclude that obesity does not affect outcomes in hybrid versus cemented TKA.

Development in Practice, 2016

ABSTRACT Medical aid missions involve travel to conflict or danger zones, posing safety risks in ... more ABSTRACT Medical aid missions involve travel to conflict or danger zones, posing safety risks in addition to the usual occupational risks arising from daily medical work. The note reports on a volunteer mission, using personal reports, anecdotal experiences, and the formal annual report to undertake an assessment similar to worksite assessments for hazards and control measures. Hazards were found to be prevalent, including physical noise and heat, infectious exposure from patients and local vectors, poor water sanitation, and psychosocial stress from unfamiliar environments and large patient numbers with limited means. Implementable preventative measures include increasing awareness with appropriate protective equipment usage and safety guidelines. Mission planning and management should also involve occupational health input.

Singapore medical journal, 1988

Twenty-six (26) isoelastic cementless total hip replacement in 20 patients with a follow-up perio... more Twenty-six (26) isoelastic cementless total hip replacement in 20 patients with a follow-up period of 2 months to 2 years are presented. The indications for hip replacement were avascular necrosis and osteoarthritis secondary to rheumatoid arthritis, ankylosing spondylitis, degenerative arthritis and chronic renal failure except in two patients, one with fracture neck of femur and another with a loose cemented total arthroplasty. The duration of surgery ranged from 80 to 140 minutes and the average hospital stay 14 days. They were four intraoperative complications, one each with fracture of the greater trochanter and subtrochanteric femoral fracture and two perforations of the femoral shaft. All were managed conservatively with good results. Three patients had posterior hip dislocation in which in one it was associated with separation of the head from the endoprosthesis. The first two were managed by closed reduction and the last one by open reduction with satisfactory results. There was a marked improvement in the Harris score post-operatively. All patients were satisfied with the outcome of surgery with some bedridden patients returning to active independent life.

Singapore medical journal, 1992

The early post-operative results of wide versus selective decompression in a group of 64 patients... more The early post-operative results of wide versus selective decompression in a group of 64 patients with lumbar spinal stenosis were studied with the aim of ascertaining whether a more limited approach gives comparable results to the more traditional method of wide decompression. Wide decompression involved complete removal of a vertebral lamina at the stenotic level. Selective decompression refers to removal of the lower part of the superior lamina and the upper part of the inferior lamina at the stenotic level together with limited facetectomies. Patients were compared with respect to post-operative relief of back pain and sciatica/claudication as well as the ability to return to their pre-morbid level of functional activity. Follow up ranged from 4 months to 26 months. Results showed that both wide and selective decompression were able to achieve complete or considerable relief of symptoms and return to pre-morbid level of activity in 74% to 84% of patients. The results in the 2 gr...

Singapore medical journal, 1987

Singapore medical journal, 1988

Journal of Spinal Disorders, 2000

Thirty-seven patients were studied for an average of 32.1 months after canal-expansive laminoplas... more Thirty-seven patients were studied for an average of 32.1 months after canal-expansive laminoplasty for the treatment of multiple-level cervical stenosis caused by spondylosis, ossification of posterior longitudinal ligament, prolapsed intervertebral disc, and other conditions. Short-term and medium-term results were recorded clinically, using the scoring system proposed by the Japanese Orthopedic Association. The canal expansion was also recorded with radiological studies. The improvement rate was good to excellent in 58.3% of the patients. Postoperative neurological deterioration occurred in only four patients. Poorer results were observed in female patients and in those in whom surgery was delayed. Surgery within 12 months of onset of symptoms gave good results. Serious complications occurred in only two patients. There were 12 patients who were treated with the single trap-door (unilateral) laminoplasty and 25 patients treated with the double trap-door (sagittal splitting of the spinous processes) laminoplasty; their results were compared. There was no significant difference in neurological outcome between the two methods.

Journal of orthopaedic surgery (Hong Kong), 2010

To determine whether continuous infiltration of local anaesthetic can reduce the pain score and m... more To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA). 11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intraarticular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hou...

The Journal of Trauma: Injury, Infection, and Critical Care, 1971

Emerging Infectious Diseases, 2004

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginnin... more An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute-care hospitals in Singapore. Critical factors in containing this outbreak were early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

Current Medical Research and Opinion, 2006

The number of hip fractures is expected to double in the next 20 years, with current estimates th... more The number of hip fractures is expected to double in the next 20 years, with current estimates that Asia will account for 37% of these cases. As bone mineral density (BMD) may be used as a measure of fracture risk, we sought to compare the effects of teriparatide with salmon calcitonin treatment on changes in BMD, biochemical bone markers, and safety in postmenopausal Asian women with osteoporosis. A total of 104 patients (n = 47 teriparatide [20 g/day subcutaneously] and n = 57 calcitonin [100 IU/day subcutaneously]) were enrolled in Hong Kong, Singapore, Philippines, Malaysia, and Thailand. Calcium (> or = 500 mg/day) and vitamin D (200-400 IU/day) supplements were taken throughout the 6-month controlled, randomized study. Teriparatide was associated with a 5.03 +/- 4.77% increase in lumbar spine BMD (p < 0.0001, mean +/- SD change from baseline), whereas changes in lumbar spine BMD for patients on calcitonin were not statistically significant (mean change of 0.36 +/- 4.12%, p = 0.16). Comparison of the two groups indicated that teriparatide treatment improved lumbar spine BMD statistically significantly more than calcitonin (p < 0.0001). No statistically significant changes were observed for total hip or femoral neck BMD. Serum bone-specific alkaline phosphatase (BSAP) increased by 55.9% (median change from baseline, p < 0.0001) in the teriparatide group, and remained stable with calcitonin (5.0% change, p = 0.24); osteocalcin increased by 156.15% (median change from baseline, p < 0.0001) with teriparatide, and decreased with calcitonin (-15.25%, p = 0.03). Similar rates of adverse events were observed, with nausea and dizziness the most commonly reported for both groups (teriparatide versus calcitonin, 13.0% versus 23.2% p = 0.21, 10.9% versus 21.4% p = 0.19, respectively). There were no clinically relevant changes observed in laboratory parameters. Both treatments were similarly tolerated, however teriparatide was associated with greater increases in lumbar spine BMD and bone formation markers, demonstrating the unique mechanism of action and safety of this treatment for osteoporosis in these Asian women.

British Journal of Sports Medicine, 2010

From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brough... more From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brought 1210 athletes and 810 offi cials from 43 participating countries. On 11 June, just 1 week before the Games Village Medical Centre started operations, the World Health Organization offi cially declared a global H1N1 2009 pandemic. Working in close partnership with the Olympic Council of Asia Medical Commission, Singapore AYG Organising Committee and other government agencies, the AYG Medical Services Committee was successful in preventing the local transmission of H1N1, which would have been a threat to the games, as it could have led to the cancellation of these games. This article describes the experience and valuable lessons learnt from managing a sports-related mass gathering during the developing pandemic.

Archives of Physical Medicine and Rehabilitation, 2004

Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in C... more Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

The Journal of Arthroplasty, 2004

Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Iso... more Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Isolated patellar revisions from April 1993 to April 2000 were assessed for complication rates, the Knee Society score (KSS), implant survival, and radiological loosening. Twenty-nine knees were revised in patients aged 71.0 years (range, 61-87; SD, 6.2). At 67.0 months (range, 24-98 months; SD, 22.0), no patient underwent further revision. Knee scores improved by 26.5 (range, 9.0-44.0; SD, 10.9) while function scores improved by 25.0 (range, 0-50.0; SD,14.5) over prerevision values. Early complications included 3 superficial wound infections, 1 hematoma, and a urinary tract infection in 1 patient. One patient had a subluxed patella. One patient had asymptomatic femoral osteolysis on radiological evaluation. Isolated patellar revisions can be performed in low-demand, elderly patients with minimal patellar maltracking.

Journal of Bone and Mineral Metabolism, 2007

We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postme... more We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postmenopausal women at increased risk of osteoporotic fractures. In this 12-month observational study conducted in Asia (Hong Kong, Malaysia, Pakistan, Philippines, Singapore, Taiwan), 984 postmenopausal women (aged 55 years or older) were treated with raloxifene 60 mg/day (n = 707; 72%) or daily bisphosphonate (alendronate 10 mg/day; n = 206; 21%, or risedronate 5 mg/day; n = 71; 7%) during their normal course of care. Patients were assessed at baseline, 6, and 12 months. Baseline characteristics (including age, race, education, menopausal status, and baseline fractures) were comparable between the raloxifene and bisphosphonate groups. More women on raloxifene completed the study compared with those on bisphosphonate (50.2% versus 37.5%; P < 0.001). Patients also took raloxifene for a longer period than bisphosphonate (median, 356 versus 348 days; P = 0.011). Compared with those taking bisphosphonate, significantly fewer patients taking raloxifene discontinued the study because of stopping treatment (5.7% versus 10.1%, P = 0.017) or changing treatment (2.8% versus 9.7%, P < 0.001). Inconvenient dosing was reported as a primary reason for discontinuation due to stopping or changing treatment in 19 (6.9%) bisphosphonate patients compared with 0 raloxifene patients. The percentage of patients who had consumed 80% or more of their study medication was similar for raloxifene patients (48-56 weeks; 95.2%) and bisphosphonate patients (48-56 weeks; 93.3%). More raloxifene patients responded that they were satisfied with their medication than bisphosphonate patients at 48-56 weeks (P = 0.002). We concluded that Asian postmenopausal women at increased risk of osteoporotic fractures showed a greater propensity to remain on raloxifene compared with bisphosphonate. The women on raloxifene exhibited lower discontinuation rates and higher treatment satisfaction.