Singapore medical journal最新文献

{"title":"Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma?","authors":"Genevieve Jingwen Tan, Chau Hung Lee, Yan Sun, Cher Heng Tan","doi":"10.11622/smedj.2021153","DOIUrl":"10.11622/smedj.2021153","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasonography (US) is the current standard of care for imaging surveillance in patients at risk of hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We performed a cost-effective analysis comparing US and dual-sequence non-contrast-enhanced MRI (NCEMRI) for HCC surveillance in the local setting.</p><p><strong>Methods: </strong>Cost-effectiveness analysis of no surveillance, US surveillance and NCEMRI surveillance was performed using Markov modelling and microsimulation. At-risk patient cohort was simulated and followed up for 40 years to estimate the patients' disease status, direct medical costs and effectiveness. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio were calculated.</p><p><strong>Results: </strong>Exactly 482,000 patients with an average age of 40 years were simulated and followed up for 40 years. The average total costs and QALYs for the three scenarios - no surveillance, US surveillance and NCEMRI surveillance - were SGD 1,193/7.460 QALYs, SGD 8,099/11.195 QALYs and SGD 9,720/11.366 QALYs, respectively.</p><p><strong>Conclusion: </strong>Despite NCEMRI having a superior diagnostic accuracy, it is a less cost-effective strategy than US for HCC surveillance in the general at-risk population. Future local cost-effectiveness analyses should include stratifying surveillance methods with a variety of imaging techniques (US, NCEMRI, contrast-enhanced MRI) based on patients' risk profiles.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39503921","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":"Time to intubation with McGrath ™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial.","authors":"Qing Yuan Goh, Sui An Lie, Zihui Tan, Pei Yi Brenda Tan, Shin Yi Ng, Hairil Rizal Abdullah","doi":"10.11622/smedj.2021165","DOIUrl":"10.11622/smedj.2021165","url":null,"abstract":"<p><strong>Introduction: </strong>During the coronavirus disease 2019 (COVID-19) pandemic, multiple guidelines have recommended videolaryngoscope (VL) for tracheal intubation. However, there is no evidence that VL reduces time to tracheal intubation, and this is important for COVID-19 patients with respiratory failure.</p><p><strong>Methods: </strong>To simulate intubation of COVID-19 patients, we randomly assigned 28 elective surgical patients to be intubated with either McGrath™ MAC VL or direct laryngoscope (DL) by specialist anaesthetists who donned 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. The primary outcome was time to intubation.</p><p><strong>Results: </strong>The median time to intubation was 61 s (interquartile range [IQR] 37-63 s) and 41.5 s (IQR 37-56 s) in the VL and DL groups, respectively ( P = 0.35). The closest mean distance between the anaesthetist and patient during intubation was 21.6 ± 4.8 cm and 17.6 ± 5.3 cm in the VL and DL groups, respectively ( P = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubations at the first laryngoscopic attempt and proportion of intubations requiring adjuncts. All the patients underwent successful intubation with no adverse event.</p><p><strong>Conclusion: </strong>There was no significant difference in the time to intubation of elective surgical patients with either McGrath™ VL or DL by specialist anaesthetists who donned PAPR and N95 masks. The distance between the anaesthetist and patient was significantly greater with VL. When resources are limited or disrupted during a pandemic, DL could be a viable alternative to VL for specialist anaesthetists.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39550053","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":"An unusual case of itchy subcutaneous nodules secondary to aluminium allergy from vaccination.","authors":"Nicholas Ann Hong Teo, Mark Jean-Aan Koh, Lynette Wei Yi Wee","doi":"10.11622/smedj.2022015","DOIUrl":"10.11622/smedj.2022015","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39903326","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":"Effects of local infiltration of analgesia and tranexamic acid in total knee replacements: safety and efficacy in reducing blood loss and comparability to intra-articular tranexamic acid.","authors":"Harish Sivasubramanian, Cheryl Marise Peilin Tan, Lushun Wang","doi":"10.11622/smedj.2021130","DOIUrl":"10.11622/smedj.2021130","url":null,"abstract":"<p><strong>Introduction: </strong>The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured.</p><p><strong>Results: </strong>Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups.</p><p><strong>Conclusion: </strong>Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39494806","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":"Perceptions of mistreatment: a comparison of students at two geographically and culturally distinct graduate medical schools","authors":"Sulochana Naidoo, Jennifer M Carbrey, Nancy Weigle, Deborah Lynn Engle, S. Goh, Mara McAdams, Chai Rick Soh","doi":"10.4103/singaporemedj.smj-2022-157","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-157","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138599174","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":"Moving from specialist-led to generalist-led hospital care: propensity-matched analyses of clinical outcomes and survey of patient care experiences","authors":"Yee Wei Lim, Sin Hui Neo, Ee Lin Kimberly Teo, Cherylanne Tan, Lin Siew Chong, Anjali Bundele, Jennifer Sumner","doi":"10.4103/singaporemedj.smj-2023-092","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-092","url":null,"abstract":"\u0000 \u0000 \u0000 In this study, we aimed to compare the clinical outcomes of patients who received care under a new generalist-led hospital care model — the Integrated General Hospital (IGH) — with those receiving care under the usual specialist-led hospital model, and to examine patients’ care experiences of the IGH model.\u0000 \u0000 \u0000 \u0000 A retrospective propensity-matched analysis comparing attendees of IGH (n = 2,127) and usual care attendees at a different hospital (n = 2,127) was conducted between 1 January 2019 and 31 August 2019. Clinical outcomes included length of stay, 30-day readmission, inpatient mortality and mortality within 30 days of discharge. In addition, a patient survey on IGH care experiences (n = 270) was conducted between 7 October 2019 and 12 April 2021. A two-sample t-test or chi-square test was used to compare the matched samples. For time-to-event variables, a Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence intervals.\u0000 \u0000 \u0000 \u0000 After propensity-matching, statistically significant differences were found between the IGH and usual care groups for length of stay (P = 0.003), inpatient mortality (P = 0.007) and mortality within 30 days of discharge (P = 0.014), but not for 30 day readmission (P = 0.456). The hazard ratio for 30-day readmission was 0.94 (P = 0.46) and for mortality within 30 days of discharge was 0.51 (P = 0.01). Survey responses on IGH care found the care experiences were generally positive, particularly in terms of provider–patient communication and perceived staff teamwork.\u0000 \u0000 \u0000 \u0000 Initial analysis of the IGH model was associated with better clinical outcomes in some respects compared with the usual care model. Patient care experiences of IGH were also favourable. An ongoing prospective study will explore the longer-term clinical impact of the IGH care model, including the effect on postdischarge care and care continuity.\u0000","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138599400","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":"Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore.","authors":"Yuhe Ke, Sophia Chew, Edwin Seet, Wan Yi Wong, Vera Lim, Nelson Chua, Jinbin Zhang, Beatrice Lim, Vanessa Chua, Ne-Hooi Will Loh, Lian Kah Ti","doi":"10.11622/smedj.2021129","DOIUrl":"10.11622/smedj.2021129","url":null,"abstract":"<p><strong>Introduction: </strong>Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population.</p><p><strong>Methods: </strong>We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium.</p><p><strong>Results: </strong>A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium.</p><p><strong>Conclusion: </strong>In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39501476","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":"Lessons from the Lim Lian Arn case (II): professional misconduct.","authors":"Thamotharampillai Thirumoorthy, Jiaying Shen, Jing Yan Seah","doi":"10.11622/smedj.2021176","DOIUrl":"10.11622/smedj.2021176","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39664104","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":"Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore.","authors":"Joel Yong Hao Tan, Jiong Hao Tan, Si Heng Sharon Tan, Liang Shen, Lynette Mee-Ann Loo, Philip Iau, Diarmuid Paul Murphy, Gavin Kane O'Neill","doi":"10.11622/smedj.2022081","DOIUrl":"10.11622/smedj.2022081","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.</p><p><strong>Methods: </strong>This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.</p><p><strong>Results: </strong>560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.</p><p><strong>Conclusion: </strong>Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40333801","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":"Lessons from the Lim Lian Arn case: duty to advise and consent taking.","authors":"Thamotharampillai Thirumoorthy, Jiaying Shen, Jing Yan Seah","doi":"10.11622/smedj.2021175","DOIUrl":"10.11622/smedj.2021175","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39664103","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}