Singapore medical journal最新文献

{"title":"Prevalence of polypharmacy: a cross-sectional study in Singapore public healthcare institutions","authors":"Jie Lin Soong, Hui Wen Ho, Leng Chuan Goh, Jiun Yu Christina Tan, Deborah Chia, Jun Long Marvin Sim","doi":"10.4103/singaporemedj.smj-2023-008","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-008","url":null,"abstract":"Polypharmacy is associated with increased prevalence of potentially inappropriate medications (PIMs), leading to higher risk of adverse drug events and medication errors. This study was the first multicentre cross-sectional study in Singapore that determined the prevalence of polypharmacy, its associated factors and the common drug classes involved, and evaluated prescribing appropriateness of drugs used by older adults. The prescriptions on two randomly selected days from five acute care hospitals and primary care polyclinics were retrospectively reviewed. Patients’ demographic characteristics, number of prescription line items and details of prescribed drugs were collected. Prescribing appropriateness was evaluated by identifying PIMs using the Beers Criteria. Logistic regression was used to assess the association of demographic characteristics and type of care setting with polypharmacy and PIM use. Prevalence of polypharmacy was significantly higher in hospitals than in polyclinics (66.6% vs. 35.0%, P < 0.001). On the contrary, prevalence of PIMs in older adults with polypharmacy was significantly higher in polyclinics than in hospitals (34.6% vs. 27.1%, P = 0.010). Patients aged ≥65 years and hospitalised patients had higher odds of having polypharmacy than patients aged 21–64 years and polyclinic patients, respectively. Drugs used for chronic conditions commonly contributed to polypharmacy in both care settings. The top PIMs in hospitals and polyclinics were drugs for functional gastrointestinal disorders and systemic antihistamines, respectively. With the ageing population and growing burden of chronic disease in Singapore, increase in prevalence of polypharmacy is expected. More focus should thus be placed on reducing inappropriate polypharmacy.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"12 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on: Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes","authors":"Efsun Somay, Busra Yilmaz, Erkan Topkan, Ugur Selek","doi":"10.4103/singaporemedj.smj-2023-227","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-227","url":null,"abstract":"Dear Sir, We found the article ‘Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes’ by Babu et al.[1] intriguing and informative.[1] The study shows that hypofractionated accelerated radiotherapy (HART) is effective in buccal mucosa carcinoma (BMC) patients. We wish to highlight two concerns, which we hope the authors can address and in so doing, contribute to future studies. First, although osteoradionecrosis of the jaw (ORNJ) is typically defined as exposed irradiated bone that fails to heal within 3–6 months without local tumour recurrence or proven metastasis,[2] the study by Babu et al.[1] had a follow-up period ranging from 1 to 134 months, emphasising that some patients require additional follow-up time to meet ORNJ definition since the lower margin was only 1 month. Hence, the presented data may have underrated ORNJ rates, which may be higher than 10.3%. Consequently, given the universally accepted definition of ORNJ,[2,3] it could be posited that implementing a time cut-off of no less than 6 months would likely result in the identification of substantially higher ORNJ rates. Second, despite radiation-induced trismus (RIT) being a more common complication of radiotherapy than ORNJ, no data is provided on its incidence in this high-risk patient population.[4,5] However, it is impossible to spare all the components of the masticatory apparatus when designing a two-dimensional radiotherapy for BMCs. Hence, most patients likely received high doses of radiation for the masticatory apparatus components. Concerning the potential of HART for severe complication risks, providing RIT-related outcomes may be valuable in determining the exact value of HART in such patients, which may aid in improving patient outcomes and future study designs in this field. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 98","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Savi Scout® wireless localisation of breast and axillary lesions: lessons learned from Singapore’s early experience","authors":"Hui Jun Lim, Lester Chee Hao Leong, Yah Yuen Tan, Eugene Mun Wai Ong, Veronique Kiak Mien Tan, Sue Zann Lim, Evan Kok Yen Woo, Yien Sien Lee, Yirong Sim, Preetha Madhukumar, Benita Kiat Tee Tan, Llewellyn Shao-jen Sim, Tammy Hui Lin Moey, Thida Win, Geok Hoon Lim","doi":"10.4103/singaporemedj.smj-2021-412","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-412","url":null,"abstract":"INTRODUCTION Hookwires are commonly deployed under imaging guidance to localise non-palpable breast lesions for excision. However, the use of hookwires has some disadvantages, including patient discomfort, wire migration, damage to surrounding anatomical structures, surgery scheduling inconveniences and limited access to axillary nodes. Novel, alternative, non-radioactive wireless localisation devices using technologies such as radiofrequency identification, magnetic seed and radar have been developed to address these shortcomings.[1,2] While these devices have seen increasing usage in America and Europe, they were introduced to Asia only recently. One of these wireless techniques, the Savi Scout® (SS) surgical guidance system (Cianna Medical, Merit Medical Systems, Inc., South Jordan, UT, USA), was made available in Asia in 2019, and Singapore was the first Asian country to utilise it for breast and axillary localisations. Savi Scout employs radar technology, and it received the United States Food and Drug Administration clearance in 2014. The SS consists of a reflector implant, a needle introducer and an external check console. The reflector is a 12-mm metallic implant [Figure 1] consisting of thin nitinol antennae protruding from either end of a central transistor body. It is inserted percutaneously into the soft tissue via a single-use, preloaded, 16-gauge needle introducer and is deployed by uncovering the overlying sheath at the distal end of the introducer. This passive reflector delivery mechanism prevents damage to the thin antennae. The introducer is unsheathed by first unlocking the release button to either left or right and then retracting it along a sliding track [Figure 1]. Once the reflector is deployed, it cannot be repositioned. A handheld probe connected to the check console is used to locate the deployed reflector by transmitting a radio wave signal (radar), which is received and reflected back by the reflector. The signal capture and reflection mechanism of the reflector is multidirectional and is used to guide direction and distance to the target up to a depth of 6 cm. Unlike hookwires, SS does not have any components protruding from the skin. In addition, there is no placement expiry after deployment and it can be deployed at any time before surgery day, which provides flexibility in procedural scheduling.Figure 1: Photograph shows the parts and functions of the Savi Scout® needle introducer system and the 12-mm-long reflector (inset).Studies from America and Europe have evaluated SS to be a safe and convenient localisation technique for the breast and axilla.[3-8] However, to the best of our knowledge, there have been no published reports evaluating its performance in Asian women, and it is unclear if dense breast tissue, which is more prevalent in Asian women, may affect SS deployment and signal detection. We described our experience in the initial use of SS in Singapore women with the aims of providing an assessment on it","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 91","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comments on: Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes","authors":"Geethu Babu, Cessal Thommachan Kainickal","doi":"10.4103/singaporemedj.smj-2023-228","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-228","url":null,"abstract":"Dear Sir, This is in response to a letter to the editor[1] regarding our article, ‘Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes’.[2] Being a retrospective analysis, our study reported data on morbidity based on the information available in the case files, and this the main limitation of the study. Therefore, this data may have underrated the rates of osteoradionecrosis of the jaw (ORNJ). The minimum follow-up period was reported as 1 month as one patient was lost to follow-up and the data on toxicity of this patient were not captured. In addition, radiation-induced trismus (RIT) is a more common complication of radiotherapy than ORNJ, but no data was provided on its incidence in this high-risk patient population as the data have not been properly documented in the case files. The data regarding acute and late toxicity can be obtained only in a properly designed prospective trial where the patients are closely followed up by the investigator. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 99","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial toxicity among adult cancer survivors in Singapore: does it exist?","authors":"Weishan Ivy Ng, K. Yuen, Tian Meng, Chee Seong Jeremy Tey, Yu Yang Soon, Cho Hao Francis Ho, S. Yoong, Brent Gibbons, B. Vellayappan","doi":"10.4103/singaporemedj.smj-2021-341","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-341","url":null,"abstract":"Cancer survivors may experience financial toxicity (FT) arising from diagnosis, treatment and potential employment loss. The prevalence of FT in the context of Singapore healthcare model is unknown. We investigate whether higher out-of-pocket (OOP) expenditure correlates positively with FT, and whether higher FT correlates with a worse quality of life (QoL). In this pilot study, a cross-sectional survey was conducted on survivors of nasopharyngeal or breast cancer at the National University Hospital Singapore. Patients’ FT and QoL were measured using the COmprehensive Score on financial Toxicity (COST) and Functional Assessment of Cancer Therapy-General (FACT-G) questionnaires. Two multivariate regression models estimated (a) the association between FT and a range of variables, and (b) the association between FT and QoL. Sixty-three percent of our cohort of 76 patients experienced mild–moderate FT. Overall, the mean COST and FACT-G scores were 18.0 (out of 44) and 68.3 (out of 108), respectively. There was a positive correlation between COST and FACT-G scores (r = 0.45). We did not find any significant association between OOP expenditure and FT. Predictors for FT included government-subsidised housing, lower education levels, hire of a formal caregiver and the need for household members to take on extra employment. Greater FT correlated with a decline in QoL. Patients of lower socioeconomic status were at higher risk of FT. OOP expenditure was not directed related to FT, likely in view of the effective means-tested subsidies. Additional resources should be considered for this at-risk population. Based on this pilot study, our methodology to quantify FT and OOP expenditure can be scaled up to other cancer primaries.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"18 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139281379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic classification of dermatomyositis with and without electrodiagnostic study: real-world clinical practice","authors":"Presaad Pillai, Mazliha Mashor, Min Moon Tang, F. Hiew","doi":"10.4103/singaporemedj.smj-2021-392","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-392","url":null,"abstract":"The revised European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2017 criteria and European Neuromuscular Centre’s (ENMC) 2018 criteria have improved diagnostic accuracy for dermatomyositis (DM). However, electromyography (EMG) was not included in the diagnostic criteria. We evaluated the usefulness of EMG under both criteria in the classification of DM and its amyopathic subtypes for patients who had rash with or without muscle weakness. In this retrospective study, 20 patients who were classified into DM and alternative diagnoses groups based on the Bohan and Peter (BP) criteria and histopathological findings of muscle and/or skin were included. We then compared the diagnostic accuracy to that of the EULAR/ACR and ENMC criteria. Differences in proportion were determined using Fisher’s exact test. Two patients who had weakness with elevated creatine kinase but no typical DM features on muscle biopsies were incorrectly excluded as alternative diagnoses using BP criteria. Both EMGs demonstrated presence of myopathic recruitment pattern and spontaneous activity in the proximal and distal muscles, consistent with the clinical phenotype. Two patients with a final diagnosis of systemic lupus erythematosus were incorrectly classified as DM by EULAR/ACR and ENMC criteria, but EMG demonstrated no evidence of muscle inflammation. Electromyography is valuable in identifying mild myopathy among DM patients with subtle clinical muscle weakness, allowing better classification of DM subtypes. Absence of EMG signs indicating muscle involvement provides clues for alternative diagnosis. In addition, EMG aids in interpretation of inconclusive muscle biopsy results. Therefore, EMG should be performed for every suspected DM patient.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"209 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139280993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral abducens nerve avulsion injury following trauma","authors":"Rugaiyah Fuad Alkhatib, Robert Chun Chen, CAQ Neuroradiology, Benjamin Wei Heng Sing, Sarat Kumar Sanamandra","doi":"10.4103/singaporemedj.smj-2022-222","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-222","url":null,"abstract":"Dear Sir, While abducens nerve palsy is commonly seen in clinical practice, abducens nerve palsy secondary to an avulsion injury is uncommon. In a retrospective study documenting the causes of abducens nerve palsy, only up to 3.1% were attributed to trauma; the most common cause in adults was related to vascular ischaemia.[1] Unilateral abducens nerve palsy is found in only 1%–2.7% of all head traumas.[2] Here, we present a case of unilateral abducens nerve injury following trauma. A 60-year-old woman with no significant medical history was involved in a road traffic accident. Initial computed tomography (CT) of the brain revealed bilateral acute subarachnoid haemorrhage, as well as an acute subdural haemorrhage along the posterior interhemispheric falx. Multiple facial bone fractures were identified [Figure 1], including fractures of both orbital floors and lateral walls, lamina papyracea, maxilla and left zygomatic process. No fracture was identified along the course of the left abducens nerve. Of note, the left petrous apex in the region of Dorello’s canal, cavernous sinus and lateral rectus muscle appeared unremarkable.Figure 1: Axial CT images in the bone windows. (a) Acute fractures of both lateral orbital walls, lamina papyracea and left zygomatic process (circles). (b) There is also an acute fracture of the left lateral sphenoid wall (circle). Of note, the left petrous apex appears unremarkable, with no acute fracture.The patient subsequently underwent open reduction internal fixation of both zygomaticomaxillary complex fractures with left orbital floor reconstruction 26 days after the accident. Intraoperatively, forced duction test did not reveal any restriction on eye movement. Postoperatively, it was noted that the patient possessed signs of left abducens nerve palsy, with persistent medial deviation and failure of abduction of the left eye. These were likely not detected during the initial few weeks in view of extensive periorbital soft tissue swelling from the facial and orbital fractures, which resolved after surgical fixation. Contrast-enhanced CT of the brain did not demonstrate any new finding to explain the left abducens nerve palsy. Magnetic resonance imaging of the brain and orbits, including a three-dimensional constructive interference in steady-state (3D CISS) sequence of the cranial nerves was performed 35 days after the accident. This showed a discontinuous left abducens nerve in the prepontine cistern, with subtle linear enhancement corresponding to its root exit zone [Figure 2]. Findings pointed towards a traumatic unilateral left abducens nerve avulsion injury resulting from the road traffic accident. An iatrogenic aetiology of the left abducens nerve avulsion was deemed less likely, as the surgery was mainly focused on facial and orbital fracture repairs, with no surgical intervention performed along the course of the left abducens nerve. The patient was subsequently referred to ophthalmology and managed conservativel","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 13","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135291099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular vortex formation time: emerging clinical applications and limitations","authors":"Jinghao Nicholas Ngiam, Tze Sian Liong, Thanawin Pramotedham, Ching-Hui Sia, Eric Jou, William Kok-Fai Kong, Kian-Keong Poh","doi":"10.4103/singaporemedj.smj-2022-132","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-132","url":null,"abstract":"Abstract Vortex formation during left ventricular diastolic filling may provide clinically useful insights into cardiac health. In recent years, there has been growing interest in the measurement of vortex formation time (VFT), especially because it is derived noninvasively. There are important applications of VFT in valvular heart disease, athletic physiology, heart failure and hypertrophic cardiomyopathy. The formation of the vortex as fluid propagates into the left ventricle from the left atrium is important for efficient fluid transport. Quantifying VFT may thus help in evaluating and understanding disease and pathophysiological processes.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 43","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profiles and predictors of survival in severe dengue cases","authors":"Zainura Che Isa, Jo Anne Lim, Amelia Mohamed Ain, Fatin Aliaa Othman, Yee Cheng Kueh, Mei Mei Tew, Maz Jamilah Masnan, Aznita Ibrahim","doi":"10.4103/singaporemedj.smj-2022-072","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-072","url":null,"abstract":"Abstract Introduction: Dengue is endemic in tropical countries. Severe dengue has a high risk of morbidity and mortality. We aimed to identify factors associated with dengue survival among our intensive care unit (ICU) patients. Methods: A retrospective study was conducted among dengue cases admitted to the ICU of Hospital Sultan Abdul Halim, Kedah, Malaysia from 2016 to 2019. Results: Out of 1,852 dengue cases admitted to the hospital, 7.2% of patients required ICU admission. Survival rate was 88.6% among severe dengue cases. The majority of severe dengue patients were obese, while other notable comorbidities included hypertension and diabetes mellitus. Also, 73% of patients presented in the critical phase, at a median of Day 4 of illness. All patients admitted to the ICU had a history of fever. The predominant warning signs were lethargy, fluid accumulation and haemoconcentration with rapid platelet reduction. Among nonsurvivors, 69.2% had fulminant hepatitis, 53.8% had massive bleeding or disseminated intravascular coagulation, 38.5% had haemophagocytic lymphohistiocytosis and 30.8% had myocarditis. The predominant serotypes were DENV-3 and DENV-1. The least number of cases was seen in 2017, when all serotypes were equally presented. Multiple logistic regression showed that Sequential Organ Failure Assessment (SOFA) score, peak international normalised ratio, peak partial thromboplastin time and aspartate aminotransferase on admission were independent risk factors for survival. This model had an area under the curve of 0.98, giving an overall 98.2% accuracy. Conclusions: Specific warning signs and blood investigations in dengue patients may aid in early decision for ICU admission. Monitoring of SOFA scores plus coagulation and liver enzyme profiles could improve dengue survival rates.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"29 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135873724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on: Return to work after surgically treated pelvic ring fractures in Singapore","authors":"Anne HY Goei, Alvin KW Tan, David Koh","doi":"10.4103/singaporemedj.smj-2023-226","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-226","url":null,"abstract":"Dear Sir, We read with interest the article ‘Return to work after surgically treated pelvic ring fractures in Singapore’ by Ng et al.[1] The authors have commendably explored perioperative factors affecting return to work (RTW) and underscored the importance of early rehabilitation and work reintegration. However, only one job-related factor — a dichotomous classification of job sedentariness — was analysed. Given the heterogeneity of work, we propose several suggestions to generate meaningful insights on RTW evaluations. First, RTW involves a comprehensive evaluation of patents’ functional capabilities relating to the nature and demands of their current work. This can only be achieved through a detailed occupational history. Often forgotten,[2,3] an occupational history allows the clinician to ascertain what the patient actually does at work (e.g., the need to lift loads, use of machinery, working hours, presence of shift work) to better quantify the risk of reinjury, delayed recovery and to what extent the patient can function at work. Second, the ability to RTW is multifactorial, comprising psychosocial and workplace factors like self-efficacy, workplace support, work satisfaction, RTW coordination programmes and availability of job accommodations.[4] These were not evaluated or adjusted for, and may be potential confounders affecting the ability to detect significant associations. Return to work is a multidisciplinary and multisectoral collaboration, and involvement of the employer is critical. Ideally, patients should not be on medical leave till complete recovery. Instead, early reintegration using stepwise assimilation, with appropriate job restrictions and accommodations provided by the employer are crucial in early RTW and creating a healthier workforce.[5] Editor’s note: The authors, Ng et al., did not respond to the above letter. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"29 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135873726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}