Singapore medical journal最新文献

{"title":"Characteristics of patients who received Sinopharm BIPB vaccine in Singapore general practice","authors":"E. Chng, Aloysius Chow, Helen Elizabeth Smith","doi":"10.4103/singaporemedj.smj-2022-082","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-082","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"13 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139389837","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":"Potential hurdles to prescribing COVID-19 oral antivirals in primary and community care","authors":"Martin Yong Kwong Lee, Deanna Xiuting Koh, S. Chong, R. Chua","doi":"10.4103/singaporemedj.smj-2023-054","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-054","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"116 35","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139390816","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":"Medical and social domains of ageing research in Singapore (2008-2018): a scoping review.","authors":"Chen Hee Tam, Elaine Qiao Ying Ho, Sumali Subhashini Hewage, Shilpa Tyagi, Gerald Choon Huat Koh","doi":"10.11622/smedj.2021172","DOIUrl":"10.11622/smedj.2021172","url":null,"abstract":"<p><strong>Introduction: </strong>This scoping review examined the number, types and characteristics of journal publications on ageing in Singapore from 2008 to 2018 to determine how ageing research in medical and social domains in Singapore has transformed over time.</p><p><strong>Methods: </strong>Using relevant search terms, articles were extracted from multiple databases and then screened and reviewed for eligibility and inclusion by independent reviewers. Data such as article title, authors, year of publication, name of journal, type of journal, study design and the kind of data used were charted from the included articles for evidence synthesis.</p><p><strong>Results: </strong>Since 2008, there has been a steady increase in the number of publications on ageing in medical and social domains in Singapore. In the medical domain, publications on Ophthalmology (22%) made up the largest proportion of the existing medical literature on ageing in Singapore, followed by Physical Functioning (17%), which involved physiological measurements of physical well-being, and Geriatrics (16%). Non-medical publications comprised 38% of all the included publications, with publications on the social aspects of ageing (43%) forming the largest group in this cluster, followed by publications on Prevention (19%) and Healthcare services (18%). The study design was mostly observational (82%), with only 3% of interventional studies.</p><p><strong>Conclusion: </strong>While ageing research had expanded in Singapore in the last decade, it was predominantly discipline specific and observational in design. As ageing issues are complex, with biology intersecting with psychology and sociology, we call for greater interdisciplinary collaboration, the conduct of more interventional studies, as well as more research in understudied and emerging areas.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"30-37"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39575951","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":"Improving children's cooperativeness during magnetic resonance imaging using interactive educational animated videos: a prospective, randomised, non-inferiority trial.","authors":"Evelyn Gabriela Utama, Seyed Ehsan Saffari, Phua Hwee Tang","doi":"10.11622/smedj.2021141","DOIUrl":"10.11622/smedj.2021141","url":null,"abstract":"<p><strong>Introduction: </strong>A previous prospective, randomised controlled trial showed that animated videos shown to children before magnetic resonance imaging (MRI) scan reduced the proportion of children needing repeated MRI sequences and improved confidence of the children staying still for at least 30 min. Children preferred the interactive video. We hypothesised that the interactive video is non-inferior to showing two videos (regular and interactive) in improving children's cooperativeness during MRI scans.</p><p><strong>Methods: </strong>In this Institutional Review Board-approved prospective, randomised, non-inferiority trial, 558 children aged 3-20 years scheduled for elective MRI scan from June 2017 to March 2019 were randomised into the interactive video only group and combined (regular and interactive) videos group. Children were shown the videos before their scan. Repeated MRI sequences, general anaesthesia (GA) requirement and improvement in confidence of staying still for at least 30 min were assessed.</p><p><strong>Results: </strong>In the interactive video group ( n = 277), 86 (31.0%) children needed repeated MRI sequences, two (0.7%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 22.1% after the video. In the combined videos group ( n = 281), 102 (36.3%) children needed repeated MRI sequences, six (2.1%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 23.2% after the videos; the results were not significantly different between the two groups.</p><p><strong>Conclusion: </strong>The interactive video group demonstrated non-inferiority to the combined videos group.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"9-15"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517433","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":"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":" ","pages":"23-29"},"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":" ","pages":"2-8"},"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":"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":" ","pages":"16-22"},"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":"127 28","pages":""},"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":"118 12","pages":""},"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":"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":" ","pages":"742-744"},"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}