Annals of the Academy of Medicine, Singapore最新文献

{"title":"Intrapleural fibrinolytic therapy: How low can we get?","authors":"Imran Bin Mohamed Noor, Sze Khen Tan","doi":"10.47102/annals-acadmedsg.2024358","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024358","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"707-709"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing care in nursing homes: Qualitative insights from the ENHANCE programme.","authors":"Yee Har Liew, Yingjia Yang, Sheryl Xin Yi Lim, Jean Mui Hua Lee, Chong Yau Ong","doi":"10.47102/annals-acadmedsg.2024268","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024268","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"758-761"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promise and challenges of pharmacogenomics in psychiatry.","authors":"Elaine Ah Gi Lo, Yi Min Wan, Cyrus Su Hui Ho","doi":"10.47102/annals-acadmedsg.2024367","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024367","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"710-712"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative emergency laparotomy pathway for patients undergoing emergency laparotomy: A propensity score matched study.","authors":"Joel Wen Liang Lau, Janardhan Baliga, Faheem Khan, Ying Xin Teo, Jonathan Ming Jie Yeo, Vincent Zhiwei Yeow, Christine Xia Wu, Stephanie Teo, Tracy Jia Hui Goh, Philip Iau","doi":"10.47102/annals-acadmedsg.2024311","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024311","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency laparotomy (EL) is associated with high morbidity and mortality, often exceeding 10%. This study evaluated the impact of the EMergency Laparotomy Audit (EMLA) interdisciplinary perioperative pathway on patient outcomes, hospital costs and length of stay (LOS) within a single centre.</p><p><strong>Method: </strong>A prospective cohort study was conducted from August 2020 to July 2023. The intervention team included specialist clinicians, hospital administrators and an in-hospital quality improvement team. Patients who underwent EL were divided into a pre-intervention control group (n=136) and a post-intervention group (n=293), and an 8-item bundle was implemented. Propensity scoring with a 1:1 matching method was utilised to reduce confounding and selection bias. The primary outcomes examined were LOS, hospitalis-ation costs and surgical morbidity, while secondary outcomes included 30-day mortality and adherence to the intervention protocol.</p><p><strong>Results: </strong>The utilisation of the EMLA perioperative care bundle led to a significant reduction in surgical complications (34.8% to 20.6%, <i>P</i><0.01), a decrease in LOS by 3.3 days (15.4 to 12.1 days, <i>P</i>=0.03) and lower hospitalisation costs (SGD 40,160 to 30,948, <i>P</i>=0.04). Compliance with key interventions also showed improvement. However, there was no difference in 30-day mortality.</p><p><strong>Conclusion: </strong>This study offers insights on how surgical units can implement systemic perioperative changes to improve outcomes for patients undergoing emergency laparotomy.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"713-723"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 residual symptoms and adverse drug reactions after oral antiviral therapy in the Singapore primary care setting.","authors":"Jia Qi Yeo, Poh Ching Tan, Cheryl Wei Yan Tan, Poay Sian Sabrina Lee","doi":"10.47102/annals-acadmedsg.2024200","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024200","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"762-764"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes and readiness of final-year medical students towards clinical goals-of-care discussion.","authors":"Isaac Kah Siang Ng, Wilson Guo Wei Goh, Christopher Zi Yi Thong, Li Feng Tan, Chong Han Peh, Ken Xingyu Chen, Pamela Goh, Desmond B Teo","doi":"10.47102/annals-acadmedsg.2024234","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024234","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"768-771"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacogenomics in psychiatry: Practice recommendations from an Asian perspective (2024).","authors":"Shih Ee Goh, Saumya Shekhar Jamuar, Siew Eng Chua, Derrick Chen Kuan Yeo, Jerome Hern Yee Goh, Chee Hon Chin, Mohamed Zakir Karuvetil, Ee Lian Lee, Daniel Shuen Sheng Fung, Giles Ming Yee Tan","doi":"10.47102/annals-acadmedsg.2024217","DOIUrl":"10.47102/annals-acadmedsg.2024217","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacogenomic testing in psychiatry is an emerging area with potential clinical application of guiding medication choice and dosing. Interest has been fanned by commercial pharmacogenomic providers who have commonly marketed combinatorial panels that are direct-to-consumer. However, this has not been adopted widely due to a combination of barriers that include a varying evidence base, clinician and patient familiarity and acceptance, uncertainty about cost-effectiveness, and regulatory requirements. This review aims to examine recent updates in this field and provide a contextualised summary and recom-mendations for Asian populations in order to guide healthcare professionals in psychiatric practice.</p><p><strong>Method: </strong>A review of recent literature about current evidence and guidelines surrounding pharmacoge-nomics in psychiatric practice was carried out with particular attention paid to literature evaluating Asian populations. The Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework was applied. Consensus meetings comprising workgroup psychiatrists from the public and private sectors were held prior to arriving at the key recommendations.</p><p><strong>Results: </strong>Pharmacogenomic testing should be mainly limited to drug-gene pairs with established clinical evidence, such as antidepressants and <i>CYP2C19/ CYP2D6</i>. Direct-to-consumer pharmacogenomic panels that assay multiple genes and analyse them via proprietary algorithms, are not presently recommended in Singapore's psychiatric setting due to inconclusive evidence on clinical outcomes.</p><p><strong>Conclusion: </strong>Pharmacogenomic testing in psychiatry is not recommended as standard clinical practice. Exceptions may include concerns about drug concentrations or potential severe adverse drug reactions. Studies investigating newly identified drug-gene associations, and clinical effectiveness and cost-effectiveness of utilising pharmacogenomic testing in psychiatry is encouraged.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"734-741"},"PeriodicalIF":2.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and causes of rifampicin-resistance genotypic/phenotypic discrepancy detected on Xpert MTB/RIF in Singapore.","authors":"Caroline Victoria Choong, Lovel Galamay, Jerlyn Huixian Woo, Angeline Jie-Yin Tey, Cynthia Bin Eng Chee","doi":"10.47102/annals-acadmedsg.2024271","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024271","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"765-767"},"PeriodicalIF":2.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapleural fibrinolytic therapy for pleural infections: Outcomes from a cohort study.","authors":"Glenn Khai Wern Yong, Jonathan Jia Jun Wong, Xiaoe Zhang, Carmen Pei Sze Tan, Xiao Na Wang, Poh Seo Quek, Kim Hoong Yap","doi":"10.47102/annals-acadmedsg.2024276","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024276","url":null,"abstract":"<p><strong>Introduction: </strong>Pleural infections are a significant cause of mortality. Intrapleural fibrinolytic therapy (IPFT) utilising alteplase and dornase is a treatment option for patients unsuitable for surgery. The optimal dose of alteplase is unknown, and factors affecting treatment success in an Asian population are unclear. We sought to determine the factors affecting treatment success in Tan Tock Seng Hospital, Singapore and evaluate the efficacy of lower doses of IPFT.</p><p><strong>Method: </strong>A retrospective analysis of patients with pleural infections treated with IPFT between July 2016 and November 2023 was performed. Treatment success was defined as survival without surgery at 3 months. Data, including patient demographics; comorbidities; RAPID (renal, age, purulence, infection source and dietary factor) scores; and radiological characteristics, were extracted from medical records and analysed. Linear mixed effects model and logistic regression were performed to determine factors affecting treatment success.</p><p><strong>Results: </strong>A total of 131 cases were analysed. Of these, 51 (38.9%) reported positive pleural fluid culture, and the most common organism was <i>Streptoccocus anginosus</i>. Mean age was 65 years (standard deviation [SD] 15.5). Mean time from chest tube insertion to first dose of IPFT was 10.2 days (SD 11.5). Median starting dose of alteplase was 5 mg. Treatment success was reported in 112 cases (85.5%). There were no significant differences between the alteplase dose and radiological clearance. Patient age (odds ratio [OR] 0.94, confidence interval [CI] 0.89-0.98) and interval between chest tube insertion to first dose (OR 0.95, CI 0.91-0.99) were statistically significant variables for the treatment success.</p><p><strong>Conclusion: </strong>Lower starting doses of alteplase remain effective in the treatment of pleural infection. Early IPFT may result in better outcomes.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"724-733"},"PeriodicalIF":2.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore.","authors":"Jun Pei Lim, Sabrina Lau, Penny Lun, Jia Ying Tang, Edwin Shih-Yen Chan, Luming Shi, Liang Guo, Yew Yoong Ding, Laura Tay, Reshma A Merchant, Wee Shiong Lim","doi":"10.47102/annals-acadmedsg.2024163","DOIUrl":"10.47102/annals-acadmedsg.2024163","url":null,"abstract":"<p><strong>Introduction: </strong>Timely detection of dementia enables early access to dementia-specific care services and interventions. Various stakeholders brought together to refine Singapore's dementia care strategy identified a lack of a standardised cognitive screening tool and the absence of a comparative review of existing tools. We hence conducted a rapid review to evaluate the diagnostic performance of brief cognitive screening tools in identifying possible dementia among community-dwelling older adults in Singapore.</p><p><strong>Method: </strong>Brief cognitive screening tools were defined as interviews or tests administered in ≤5 minutes. Studies performed in Singapore on older adults ≥60 years, which used locally-validated comparators and reported outcomes of clinician-diagnosed dementia were included. Rapid review methodology was used in study screening and selection. Quality Assessment of Diagnostic Accuracy Studies version 2 tool was used for risk-of-bias assessment. A negative likelihood ratio (LR-) of ≤0.2 was defined a priori as having a moderate effect in shifting post-test probability.</p><p><strong>Results: </strong>Fourteen studies were included in qualitative synthesis: 3 studies evaluated self-/informant-based tools only, 4 evaluated performance-based measures only and 7 evaluated combination approaches. Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) was the most studied self-/ informant-based tool. One study found informant AD8 (iAD8) superior to self-rated AD8. Another study found iAD8 superior to Mini-Mental State Examination. Among performance-based measures, Abbreviated Mental Test, Visual Cognitive Assessment Test-Short form version 1 (VCAT-S1), VCAT-S2 and Mini-Cog had LR- <0.2. Minimal improvement of combination approaches compared to iAD8 alone was demonstrated.</p><p><strong>Conclusion: </strong>Our review suggests the limited utility of dementia screening in communities with low dementia prevalence and supports a case-finding approach instead. With a reliable informant, iAD8 alone has sufficient discriminant ability. Further research is needed to specifically assess the diagnostic ability of performance-based tools in community settings.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"742-753"},"PeriodicalIF":2.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}