Singapore medical journal最新文献

{"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}

{"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":" ","pages":"728-731"},"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: 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":" ","pages":"739-741"},"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}

{"title":"Approach to clinically significant vascular anomalies in children.","authors":"Raymond Reinaldo Tanugroho, Lynette Wei Yi Wee, Mark Jean Aan Koh, Jin Ho Chong","doi":"10.11622/smedj.2021209","DOIUrl":"10.11622/smedj.2021209","url":null,"abstract":"<p><p>Vascular anomalies consist of tumours or malformations made up of abnormal growth or collections of blood vessels that can result in functional or cosmetic problems. While many vascular anomalies are present at birth, some do not appear until later in life, making diagnosis more challenging. Although many vascular anomalies are benign, some are associated with serious complications and may involve multiple organ systems. This article highlights the important features of clinically significant vascular anomalies to help physicians promptly identify and refer these cases to a specialised multidisciplinary team for evaluation and management. The discussion includes the various presenting complaints of vascular anomalies in children, namely, rapidly growing birthmarks, painful lesions, seizures/neurological manifestations, bleeding diathesis, cardiac/airway abnormalities and part of an overgrowth syndrome.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"714-720"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39758901","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":"Early mobilisation following fragility hip fracture surgery: current trends and association with discharge outcomes in a local tertiary hospital.","authors":"Shumei Tan, Aswinkumar Vasireddy","doi":"10.11622/smedj.2021132","DOIUrl":"10.11622/smedj.2021132","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative day 1 (POD 1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD 1 mobilisation at our institution and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination.</p><p><strong>Methods: </strong>In this preliminary observational study, data pertaining to demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD 1 ambulation formed the early ambulation (EA) group, while the remaining patients formed the delayed ambulation (DA) group. Data were analysed for any significant difference between the groups.</p><p><strong>Results: </strong>One hundred and fifteen patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD 1 was 80.0% (n=92), which was comparable to the data available from international hip fracture audit databases. There were 55 (47.8%) patients in the EA group and 60 (52.5%) patients in the DA group. The EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20, 95% confidence interval 1.50-56.45; P = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to the DA group (P > 0.05).</p><p><strong>Conclusion: </strong>This is the first local study to offer benchmark of the POD 1 mobilisation status for this population. Patients who attained POD 1 ambulation had better early functional recovery.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"721-727"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39494808","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":"Mindfulness and reflective practice pilot programme of Postgraduate Year 1 doctors: perceptions on impact and sustainability","authors":"Mae Yue Tan, Shuh Shing Lee, Marion Margaret Aw, Nasyitah Binte Abd Aziz, Yih Lin Lim, Suan Peen Foo, Ze Lei Tan, Andrew Anjian Sng, Yu Han Chee, Nicholas Beng Hui Ng, Jeremy Bingyuan Lin","doi":"10.4103/singaporemedj.smj-2021-419","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-419","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"66 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200150","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":"Burnout among COVID-19 hospital-based contact tracers in Singapore: results of a mixed-method, cross-sectional multicentre study","authors":"Ian Matthias Ng, Tzu-Jung Wong, Yong Yang, I. Venkatachalam, J. Sim, L. Wee, T. Liew, Evelyn Boon, Tong Yong Ng, Hwi Kwang Han, Diana Yuen Lan Tan","doi":"10.4103/singaporemedj.smj-2021-458","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-458","url":null,"abstract":"During the coronavirus disease 2019 (COVID-19) pandemic, contact tracers were under immense pressure to deliver effective and timely contact tracing, raising concerns of higher susceptibility to burnout. Our study aimed to determine burnout prevalence among hospital-based contact tracers and associated risk factors, so that interventions to reduce burnout risk could be formulated. One hundred and ninety-six active contact tracers across three hospitals within a healthcare cluster were invited to complete an anonymous online survey. To identify burntout, data such as demographics, work-related variables and contact tracing-related variables were collected using the Copenhagen Burnout Inventory. Associated factors were identified using multivariate statistics. Open-ended questions were included to understand the challenges and potential improvements through qualitative analysis. A total of 126 participants completed the survey, giving a completion rate of 64%, and almost half of these participants (42.9%) reported burnout. Protective factors included being on work-from-home arrangements (adjusted odds ratio [OR] 0.22, 95% confidence interval [CI] 0.08–0.56), perception of being well supported by their institution (adjusted OR 0.25, 95% CI 0.08–0.80) and being married (adjusted OR 0.28, 95% CI 0.12–0.64). Risk factors included having an administrative role pre–COVID-19 (adjusted OR 3.62, 95% CI 1.33–9.83). Work-related burnout was related to being activated for more than 1 day in the preceding week (unadjusted OR 3.25, 95% CI 1.33–7.94) and multiple activations in a day (unadjusted OR 3.54, 95% CI 1.44–4.41). Biggest challenges identified by participants were language barrier (62.7%), followed by workflow-related issues (42.1%). Our study demonstrated burnout and other challenges faced by a team of mostly hospital-based administrative staff redeployed on a part-time basis to ensure timely contact tracing. To mitigate burnout, we recommend choosing staff on work-from-home arrangements and ensuring adequate manpower and rostering arrangements.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"18 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139199265","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}