Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at a university hospital from January 2008 to January 2010 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.

Aims: To determine the prevalence and predictors of medication non-adherence among older community-dwelling people with at least one chronic disease in Singapore.Design: A single-centre cross-sectional study. Methods:The study was conducted in the largest tertiary public hospital in Singapore between May 2019 and December 2019. The community nurses of the hospital recruited a total of 400 community-dwelling older people aged ≥60 years old, who were diagnosed with at least one chronic disease and prescribed with at least one long-term medication. Medication non-adherence was assessed using the self-report 5-item Medication Adherence Report Scale, operationalized as a score of <25. A list of potential factors of medication non-adherence was structured based on the World Health Organization five-domain framework and collected using a self-report questionnaire.Results: Sixty percent (n = 240) of our participants were non-adherent to their medication regime. Older people who smoked (OR 2.89, 95% CI 1.14-7.33), perceived their medication regime as being complicated (OR 2.54, 95% CI 1.26-5.13), felt dissatisfied with their regime (OR 2.50, 95% CI 1.17-5.31), did not know the purpose of all their medications (OR 2.56, 95% CI 1.42-4.63) and experienced side effects (OR 3.32, 95% CI 1.14-9.67) were found to be predictive of medication non-adherence. Conclusion:Medication adherence was found to be poor in community-dwelling older people in Singapore. The predictors identified in this study can help guide healthcare professionals in identifying older people who are at risk of medication non-adherence and inform the development of interventions to improve adherence. Impact: Medication non-adherence, especially in the older population with chronic diseases, constitutes a serious problem as it undermines the efforts to reduce morbidity and mortality associated with the underlying chronic diseases. To improve adherence, our findings propose the importance of assessing the older person's treatment satisfaction, which includes examining the aspects of side effects, effectiveness and convenience. Additionally, we highlight the need to address the older person's medication knowledge deficit.