Annals of the Academy of Medicine, Singapore最新文献

Striving for our most vulnerable children: Buffering against the impact of child maltreatment. 为我们最脆弱的儿童奋斗：缓冲儿童虐待的影响。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-23 DOI: 10.47102/annals-acadmedsg.202563

Ramkumar Aishworiya, Ying Qi Kang

引用次数: 0

Machine learning to risk stratify chest pain patients with non-diagnostic electrocardiogram in an Asian emergency department. 机器学习对亚洲急诊科胸痛患者的非诊断性心电图进行风险分层

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-22 DOI: 10.47102/annals-acadmedsg.2024232

Ziwei Lin, Tar Choon Aw, Laurel Jackson, Cheryl Shumin Kow, Gillian Murtagh, Siang Jin Terrance Chua, Arthur Mark Richards, Swee Han Lim

{"title":"Machine learning to risk stratify chest pain patients with non-diagnostic electrocardiogram in an Asian emergency department.","authors":"Ziwei Lin, Tar Choon Aw, Laurel Jackson, Cheryl Shumin Kow, Gillian Murtagh, Siang Jin Terrance Chua, Arthur Mark Richards, Swee Han Lim","doi":"10.47102/annals-acadmedsg.2024232","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024232","url":null,"abstract":"Introduction: Elevated troponin, while essential for diagnosing myocardial infarction, can also be present in non-myocardial infarction conditions. The myocardial-ischaemic-injury-index (MI3) algorithm is a machine learning algorithm that considers age, sex and cardiac troponin I (TnI) results to risk-stratify patients for type 1 myocardial infarction.Method: Patients aged ≥25 years who presented to the emergency department (ED) of Singapore General Hospital with symptoms suggestive of acute coronary syndrome with no diagnostic 12-lead electrocardiogram (ECG) changes were included. Participants had serial ECGs and high-sensitivity troponin assays performed at 0, 2 and 7 hours. The primary outcome was the adjudicated diagnosis of type 1 myocardial infarction at 30 days. We compared the performance of MI3 in predicting the primary outcome with the European Society of Cardiology (ESC) 0/2-hour algorithm as well as the 99th percentile upper reference limit (URL) for TnI.Results: There were 1351 patients included (66.7% male, mean age 56 years), 902 (66.8%) of whom had only 0-hour troponin results and 449 (33.2%) with serial (both 0 and 2-hour) troponin results available. MI3 ruled out type 1 myocardial infarction with a higher sensitivity (98.9, 95% confidence interval [CI] 93.4-99.9%) and similar negative predictive value (NPV) 99.8% (95% CI 98.6-100%) as compared to the ESC strategy. The 99th percentile cut-off strategy had the lowest sensitivity, specificity, positive predictive value and NPV.Conclusion: The MI3 algorithm was accurate in risk stratifying ED patients for myocardial infarction. The 99th percentile URL cut-off was the least accurate in ruling in and out myocardial infarction compared to the other strategies.","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 4","pages":"219-226"},"PeriodicalIF":2.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056674","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}

引用次数: 0

Optical coherence tomography and acetylcholine provocation for diagnosing coronary vasospasm in MINOCA patients. 光学相干断层扫描和乙酰胆碱激发诊断MINOCA患者冠状血管痉挛。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-21 DOI: 10.47102/annals-acadmedsg.2024313

Madeleine Perocho Su, Chee Yang Chin, Yann Shan Keh, Kay Woon Ho

引用次数: 0

Acute respiratory tract infections management in private primary healthcare in Singapore. 新加坡私人初级保健机构的急性呼吸道感染管理。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-21 DOI: 10.47102/annals-acadmedsg.2024321

Tim Hart, Xin Hui Sam, Helen Elizabeth Smith

引用次数: 0

Re-evaluating adjuvant systemic therapy in cancer treatment: Scientific rigour to guide policy and practice. 重新评估辅助全身治疗在癌症治疗：科学的严谨性指导政策和实践。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-15 DOI: 10.47102/annals-acadmedsg.2024305

Daniel Jm Ang, Mohamad Farid

引用次数: 0

The impact of Anchor, a home visitation programme for maltreated children, on child developmental and behavioural outcomes. 针对受虐待儿童的家访计划Anchor对儿童发展和行为结果的影响。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-15 DOI: 10.47102/annals-acadmedsg.2024281

Shi Hua Chan, Jean Yin Oh, Li Ming Ong, Wen Hann Chow, Oh Moh Chay, Salam Soliman, Lourdes Mary Daniel, Pratibha Agarwal, Charmain Samantha Tan, Jun Lin Sai, Joanne Ferriol Especkerman, Rehena Sultana, Cong Jin Wilson Low, Sita Padmini Yeleswarapu

{"title":"The impact of Anchor, a home visitation programme for maltreated children, on child developmental and behavioural outcomes.","authors":"Shi Hua Chan, Jean Yin Oh, Li Ming Ong, Wen Hann Chow, Oh Moh Chay, Salam Soliman, Lourdes Mary Daniel, Pratibha Agarwal, Charmain Samantha Tan, Jun Lin Sai, Joanne Ferriol Especkerman, Rehena Sultana, Cong Jin Wilson Low, Sita Padmini Yeleswarapu","doi":"10.47102/annals-acadmedsg.2024281","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024281","url":null,"abstract":"Introduction: Adverse childhood experiences (ACEs) are associated with significant long-term impacts, yet few interventions specifically target ACE exposure, especially in Asian populations. Anchor, Singapore's first home visitation programme, addresses maltreat-ment among preschool children. This study evaluated Anchor's impact on children's developmental and behavioural outcomes.Method: We conducted a prospective evaluation of children under 4 years assessed for maltreatment from November 2019 to July 2023. Developmental and behavioural progress was measured every 6 months using the Ages and Stages Questionnaires (ASQ-3) and ASQ:Social-Emotional (ASQ:SE-2), and annually using the Child Behaviour Checklist (CBCL).Results: The results of 125 children (mean age 20.0 months, 48% female) were analysed. The mean length of stay in programme was 21.2 (7.3) months. At baseline, 92 (73.6%) children were at risk of develop-mental delay and 25 (31.7%) children aged ≥18 months had behavioural concerns. The programme was associated with significant improvements in gross motor (P=0.002) and fine motor (P=0.001) domains of the ASQ-3 and internalising problem scale (P=0.001) of the CBCL.Conclusion: Anchor effectively enhances develop-mental and behavioural outcomes for children exposed to maltreatment. Targeted early intervention through such programmes can mitigate adverse impacts, optimising developmental trajectories and potentially reducing the long-term clinical and economic burdens associated with ACEs.","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 4","pages":"208-218"},"PeriodicalIF":2.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049726","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}

引用次数: 0

Pregnancy-associated breast cancer: Management of the mother, fetus and tumour. 妊娠相关乳腺癌：母亲、胎儿和肿瘤的处理。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-10 DOI: 10.47102/annals-acadmedsg.2024320

Andrea Tan, Weining Wang, Cheryl Long, Zewen Zhang, Joanne Ngeow, Citra Mattar

{"title":"Pregnancy-associated breast cancer: Management of the mother, fetus and tumour.","authors":"Andrea Tan, Weining Wang, Cheryl Long, Zewen Zhang, Joanne Ngeow, Citra Mattar","doi":"10.47102/annals-acadmedsg.2024320","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024320","url":null,"abstract":"Introduction: Pregnancy-associated breast cancer (PABC) is described as breast cancer diagnosed within pregnancy or within 1 year postpartum. PABC is becoming more common due to delayed childbearing, with older maternal age increasing the likelihood of tumorigenesis coinciding with pregnancy. Our review aims to outline the important principles of managing PABC, and discusses future fertility implications, genetic testing and postnatal considera-tions that are not often considered in other existing reviews.Method: A literature search was conducted using PubMed, Cochrane and Google Scholar databases.Results: A persistent breast mass in pregnant women should be evaluated with a breast ultrasound. Total mastectomy is the standard treatment in the first trimester. Chemotherapy is contraindicated in the first trimesters, but can be given in the second and third trimester, and stopped before 35 weeks. Radiotherapy should be delayed until delivery, and hormone receptor therapy is contraindicated in pregnancy. A multidisciplinary team involving an obstetrician, medical oncologist and other allied health professionals is crucial. Delivery should be planned as close to 37 weeks as possible, and at least 3 weeks after the last chemotherapy cycle. Vaginal delivery is preferred, and breastfeeding can resume 14 days after the last chemotherapy regime.Conclusion: A breast mass in a pregnant woman should not be dismissed. PABC must be managed by multidisciplinary teams at tertiary medical centres with access to surgery and chemoradiation therapies. Management strategies must include safe manage-ment and delivery of the fetus, contraception and future fertility planning.","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 4","pages":"235-246"},"PeriodicalIF":2.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047905","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}

引用次数: 0

A person-centred approach to decision-making and care for persons living with dementia. 对痴呆症患者采取以人为本的决策和护理方法。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-08 DOI: 10.47102/annals-acadmedsg.2024377

Gabriel Hong Zhe Wong, Philip Lin Kiat Yap

引用次数: 0

Implementing a fantasy space-themed video distraction programme to reduce sedation in paediatric MRI. 实施幻想空间主题的视频分散程序，以减少小儿MRI中的镇静作用。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-07 DOI: 10.47102/annals-acadmedsg.2024323

Bernice Oh, Eileen Oh, Vivian Shan Hui Lee, Krista Lea Fernandez Francisco, Regine Teo, Desmond Hoon, Ryan Taylor

引用次数: 0

Clinical and echocardiographic differences between rheumatic and degenerative mitral stenosis. 风湿性二尖瓣狭窄与退行性二尖瓣狭窄的临床及超声心动图差异。

IF 2.5

Annals of the Academy of Medicine, Singapore Pub Date : 2025-04-04 DOI: 10.47102/annals-acadmedsg.2024351

Ryan Leow, Ching-Hui Sia, Tony Yi-Wei Li, Meei Wah Chan, Eng How Lim, Li Min Julia Ng, Tiong-Cheng Yeo, Kian-Keong Poh, Huay Cheem Tan, William Kf Kong

{"title":"Clinical and echocardiographic differences between rheumatic and degenerative mitral stenosis.","authors":"Ryan Leow, Ching-Hui Sia, Tony Yi-Wei Li, Meei Wah Chan, Eng How Lim, Li Min Julia Ng, Tiong-Cheng Yeo, Kian-Keong Poh, Huay Cheem Tan, William Kf Kong","doi":"10.47102/annals-acadmedsg.2024351","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024351","url":null,"abstract":"Introduction: Degenerative mitral stenosis (DMS) is frequently cited as increasing in prevalence in the developed world, although comparatively little is known about DMS in comparison to rheumatic mitral stenosis (RMS).Method: A retrospective observational study was conducted on 745 cases of native-valve mitral stenosis (MS) with median follow-up time of 7.25 years. Clinical and echocardiographic parameters were compared. Univariate and multivariate Cox regression analyses were performed for a composite of all-cause mortality and heart failure hospitalisation.Results: Patients with DMS compared to RMS were older (age, mean ± standard deviation: 69.6 ± 12.3 versus [vs] 51.6 ± 14.3 years, respectively; P<0.001) and a greater proportion had medical comorbidities such as diabetes mellitus (78 [41.9%] vs 112 [20.0%], P<0.001). The proportion of cases of degenerative aetiology increased from 1.1% in 1991-1995 to 41.0% in 2016-2017. In multivariate analysis for the composite outcome, age (hazard ratio [HR] 95% confidence interval [CI] of 1.032 [1.020-1.044]; P<0.001), diabetes mellitus (HR 1.443, 95% CI 1.068-1.948; P=0.017), chronic kidney disease (HR 2.043, 95% CI 1.470-2.841; P<0.001) and pulmonary artery systolic pressure (HR 1.019, 95% CI 1.010- 1.027; P<0.001) demonstrated significant indepen-dent associations. The aetiology of MS was not independently associated with the composite outcome.Conclusion: DMS is becoming an increasingly common cause of native-valve MS. Despite numerous clinical differences between RMS and DMS, the aetiology of MS did not independently influence a composite of mortality or heart failure hospitalisation.","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 4","pages":"227-234"},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036003","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}

引用次数: 0