Singapore medical journal最新文献

{"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":null,"pages":null},"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}

{"title":"Routine preoperative screening computed tomography of the thorax for cardiac surgery","authors":"Jai Ajitchandra Sule, Xue Wei Chan, Hari Kumar Sampath, Hai Dong Luo, Mofassel Uddin Ahmed, Giap Swee Kang","doi":"10.4103/singaporemedj.smj-2021-416","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-416","url":null,"abstract":"Abstract Introduction: This study aimed to evaluate the role of screening computed tomography (CT) of the thorax in cardiac surgery by analysing the presence of CT aortic calcifications in association with changes in operative strategy and postoperative stroke, and the CT features of emphysema with development of pneumonia. Methods: All patients who underwent cardiac surgery from January 2013 to October 2017 by a single surgeon were retrospectively studied. Patients who underwent screening CT thorax before cardiac surgery (CT group) were compared to those who did not (no CT group). Multivariate subgroup analyses were performed to determine significant association with postoperative outcomes. Results: A total of 392 patients were included, of which 156 patients underwent preoperative screening CT thorax. Patients in the CT group were older (63.9 vs. 59.0 years, P = 0.001), had fewer recent myocardial infarctions preoperatively (41% vs. 56.4%, P = 0.003) and had better ejection fraction (>30%; P = 0.02). Operative strategy was changed in 4.3% of patients, and 4.9% of patients suffered stroke postoperatively. The presence of CT aortic calcifications was significantly associated with change in operative strategy ( P = 0.016) but not with postoperative stroke ( P = 0.33). Age was an independent risk factor for change in operative strategy among patients with CT thorax ( P = 0.02). Multivariate age-adjusted analysis showed only palpable plaque to be significantly associated with change in operative strategy ( P < 0.001). None of the patients with CT emphysema features developed pneumonia. Conclusion: The results of this study do not support routine use of preoperative screening CT thorax. Contrasted CT may be advisable in older patients and for other operative planning purposes.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135873122","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":"Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study.","authors":"Abhiram Kanneganti, Benjamin Yong Qiang Tan, Nik Hisamuddin Nik Ab Rahman, Aloysius Sheng-Ting Leow, Max Denning, Ee Teng Goh, Lucas Jun Hao Lim, Ching-Hui Sia, Ying Xian Chua, James Kinross, Melanie Tan, Li Feng Tan, Yi Min Wan, Arvind Sharma, Rivan Danuaji, R N Komal Kumar, Chew Keng Sheng, Cheah Phee Kheng, Sarah Shaikh Abdul Karim, Mohd Najib Abdul Ghani, Suhaimi Mahmud, Yiong Huak Chan, Vijay Kumar Sharma, Kang Sim, Shirley Beng Suat Ooi","doi":"10.11622/smedj.2022014","DOIUrl":"10.11622/smedj.2022014","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.</p><p><strong>Methods: </strong>A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).</p><p><strong>Results: </strong>We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.</p><p><strong>Conclusion: </strong>Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39903327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide complex tachycardias detected by smartwatch: what is the diagnosis?","authors":"Weien Chow, Colin Yeo, Vern Hsen Tan","doi":"10.4103/singaporemedj.smj-2021-302","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-302","url":null,"abstract":"CASE 1 Clinical presentation A 64-year old woman with no significant past medical history presented to our cardiology clinic for recurrent intermittent palpitations at rest for the past 7 years. She also had an episode of left-sided chest pain. Her symptoms occurred about once a month, lasted 2–3 h with sudden onset and offset and were irregular in nature. The symptoms were associated with giddiness, and she complained of lethargy after the palpitations stopped. She did not have any near-syncopal or syncopal episodes. The patient is a non-smoker and non-drinker, and does brisk walking twice a week (30–45 min each session). Her electrocardiogram (ECG) at the clinic showed normal sinus rhythm with normal PR, QRS and QTc interval [Figure 1]. Serial event monitors (including 24-h monitoring, 14 days of transtelephonic ECG monitoring) showed intermittent rate-related left bundle branch block (LBBB), no significant pause and infrequent premature atrial (<1%) and ventricular (<1%) ectopics. No symptom was recorded while she was on the event monitors.Figure 1: Case 1. 12-lead ECG shows normal sinus rhythm with normal PR, QRS and QTc interval.Other investigations included computed tomography (CT) coronary angiogram, which showed minor coronary artery disease. The patient’s myocardial perfusion imaging was negative for ischaemia, and 2D echocardiography showed a normal left ventricular ejection fraction (LVEF) of 57%, normal left atrium (LA) size (LA volume 29.9 mL/m2) and mild to moderate mitral regurgitation. The patient continued to have intermittent symptoms despite being started on beta-blocker empirically. Due to her recurrent symptoms, her son decided to use his Apple Watch to record the ECG tracing for her whenever she was symptomatic. ECG interpretation The smartwatch ECG tracing (correlates to lead I) showed an irregularly irregular wide complex tachycardia [Figure 2]. The differential diagnosis included the following the: (a) atrial fibrillation (AF) with rate-related bundle branch block; (b) pre-excited AF; and (c) polymorphic ventricular tachycardia (VT) (torsades de pointes).Figure 2: Case 1. Smartwatch ECG tracing (represents lead I) shows an irregularly irregular wide complex tachycardia.Clinical course The patient was counselled on AF due to her symptoms and tracing from her smartwatch. In the later part of the day, she was admitted to the hospital for sudden onset of palpitations associated with shortness of breath when climbing the stairs. On examination, her pulse was irregularly irregular. The rest of the physical examination was unremarkable. The patient’s ECG showed an irregularly irregular wide complex (left bundle branch block pattern) tachycardia [Figure 3], similar to that shown by the smartwatch ECG tracing. The patient was diagnosed with AF with aberrancy and rapid ventricular rate of 160 bpm. Her troponin T level was normal at 5 ng/L and electrolytes were normal.Figure 3: Case 1. 12-lead ECG shows an irregularly irregular wide","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515129","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":"Malignant arrhythmia in a COVID-19 patient with a structurally normal heart.","authors":"Clare Anne Yoke Kum Fong, Benjamin Wei Liang Tung, Weiqin Lin, Kay Choong See","doi":"10.11622/smedj.2021191","DOIUrl":"10.11622/smedj.2021191","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39854520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges.","authors":"Sukhee Park, Ja Eun Lee, Gyu Sung Choi, Jong Man Kim, Justin Sangwook Ko, Duck Hwan Choi, Gaab Soo Kim","doi":"10.11622/smedj.2021143","DOIUrl":"10.11622/smedj.2021143","url":null,"abstract":"<p><strong>Introduction: </strong>Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery.</p><p><strong>Methods: </strong>Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO₂), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO₂), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared.</p><p><strong>Results: </strong>The values of ETCO₂, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO₂ at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar.</p><p><strong>Conclusion: </strong>During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39494805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic inflammatory disease with obstructive complications: two cases and a literature review.","authors":"Grace Ming Fen Chan, Lionel Hon Wai Lum, Pearl Shuang Ye Tong","doi":"10.11622/smedj.2022021","DOIUrl":"10.11622/smedj.2022021","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39903325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of nationwide COVID-19 lockdown on workload and injury patterns of major trauma cases in a regional trauma centre in Singapore.","authors":"Min Li Kang, Woan Wui Lim, Daniel Jin Keat Lee, Jerry Tiong Thye Goo","doi":"10.11622/smedj.2021131","DOIUrl":"10.11622/smedj.2021131","url":null,"abstract":"<p><strong>Introduction: </strong>Singapore instituted lockdown measures from 7 February 2020 to 1 June 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Methods: </strong>A retrospective analysis of cases from the national trauma registry was carried out comparing the lockdown period (from 7 February 2020 to 1 June 2020) to the pre-lockdown period (from 7 February 2019 to 1 June 2019). Data extracted included the volume of Tier 1 (injury severity score [ISS] >15) and Tier 2 (ISS 9-15) cases and epidemiology. Subgroup analysis was performed for Tier 1 patient outcomes.</p><p><strong>Results: </strong>Trauma volume decreased by 19.5%, with a 32% drop in Tier 1 cases. Road traffic and workplace accidents decreased by 50% (P < 0.01), while interpersonal violence showed an increase of 37.5% (P = 0.34). There was an 18.1% decrease in usage of trauma workflows (P = 0.01), with an increase in time to intervention for Tier 1 patients from 88 to 124 min (P = 0.22). Discharge to community facilities decreased from 31.4% to 17.1% (P < 0.05). There was no increase in inpatient mortality, length of stay in critical care or length of stay overall.</p><p><strong>Conclusion: </strong>There was an overall decrease in major trauma cases during the lockdown period, particularly road traffic accidents and worksite injuries, and a relative increase in interpersonal violence. Redeployment of manpower and hospital resources may have contributed to decreased usage of trauma workflows and community facilities. In the event of further lockdowns, it is necessary to plan for trauma coverage and maintain the use of workflows to facilitate early intervention.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39494807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine administration during COVID-19 pandemic: an overview of safe injection technique and local complications","authors":"Wen Loong Paul Yuen, Yuen Khong Keith Chong, Choon How How, Sir Young James Loh","doi":"10.4103/singaporemedj.smj-2022-059","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-059","url":null,"abstract":"Opening Vignette Madam Tan, a 65-year-old housewife, visited your clinic for left shoulder pain. The pain started 1 day after she was vaccinated in her left shoulder at a vaccination drive. Your initial assessment was that of postinjection site pain. You prescribed her with a course of nonsteroidal anti-inflammatory drugs (NSAIDs) and advised rest. She returned a week later with worsening and severe pain over her left shoulder, which affected her daily activities. Clinical examination showed generalised tenderness and effusion over her left shoulder joint with limited range of motion. Madam Tan recollected that she felt the injection had been given ‘too high and too deep’. Due to the temporal nature of the symptoms, you suspected that her shoulder pain could be related to vaccine administration. Due to the progressing severity of the symptoms, you referred her to a tertiary hospital for orthopaedic evaluation.HOW RELEVANT IS THIS TO MY PRACTICE? Vaccination is a procedure routinely performed by doctors and nurses in the primary healthcare setting. In the adult population, the most common site for vaccination is the deltoid muscle. The deltoid muscle is preferred due to its size and ease of exposure and administration on a seated patient in the clinic setting. The vaccine needs to be administered with the proper technique to maximise its efficacy and minimise the risk of an adverse event at the injection site. During the coronavirus disease 2019 (COVID-19) pandemic, large-scale vaccination programmes were held, and a potential rise in complications from vaccinations is expected. Therefore, it is important to have in place safe and competent vaccination practices. WHAT TO EXPECT AT THE INJECTION SITE? Common symptoms postinjection include induration, erythema and pain at the injection side. These symptoms are usually self-limiting and resolve spontaneously over a week. More serious complications, such as shoulder injury related to vaccine administration (SIRVA), are rare. There is a spectrum of shoulder pathologies contributed by poor injection techniques. It includes traumatic injury or inappropriate administration of vaccine material into the subdeltoid bursa or shoulder joint, leading to an inflammatory cascade and damage to the surrounding structures. The first local case of SIRVA complication following COVID-19 vaccination was reported in 2021.[1] WHAT CAN I DO IN MY PRACTICE? It is important that the family physician or nursing practitioner perform safe vaccination for each patient. To achieve this, good working knowledge of the following is necessary: (a) shoulder anatomy and surface landmarking; (b) appropriate needle selection; (c) safe injection technique; (d) alternate injection site; and (e) approach to postvaccination injection site and shoulder pain. It is recommended to counsel the patient about common local site reactions, such as induration, pain and erythema, and red flags suggestive of more serious complications. Shoulder anatomy","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510333","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":"Atypical presentation of COVID-19 with abdominal pain and no respiratory symptoms: a case series.","authors":"Pei Hua Lee, Stephanie Sutjipto, Hock Foong Lui, Kalisvar Marimuthu, Mona Manghani, Serene Si Ning Goh, Huimin Liu, Shawn Vasoo","doi":"10.11622/smedj.2021196","DOIUrl":"10.11622/smedj.2021196","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39854521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}