Annals of the Academy of Medicine, Singapore最新文献

{"title":"Transforming medical education in the AI era: Balancing technological expertise with humanistic care in tomorrow's doctors.","authors":"Michelle Jong","doi":"10.47102/annals-acadmedsg.2024163","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024163","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 12","pages":"754-757"},"PeriodicalIF":2.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924328","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":"Towards a unified approach: Standardising radiological diagnosis and grading of vertebral compression fractures.","authors":"Russell O Kosik, Xiaoguang Cheng, James F Griffith, Wing P Chan","doi":"10.47102/annals-acadmedsg.2024186","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024186","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"694-696"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788380","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":"Evolving therapies for atopic dermatitis: Bridging guidelines and practice.","authors":"Pawinee Rerknimitr","doi":"10.47102/annals-acadmedsg.2024355","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024355","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"641-643"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788376","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":"Interdisciplinary approach of conservative kidney management with a community nurse-led programme.","authors":"Swee Ping Teh, Hui Boon Tay, Ivan Wei Zhen Lee, Shashidhar Baikunje, Sing Ping Loh, Edwin Lim, Mee Horng Lai, Lee Ying Yeoh","doi":"10.47102/annals-acadmedsg.2024256","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024256","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"703-706"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788378","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":"Unplanned hospitalisations among subsidised nursing home residents in Singapore: Insights from a data linkage study.","authors":"Weiren Charles Quah, Chin Jong Leong, Edward Chong, James Alvin Low, Heidi Rafman","doi":"10.47102/annals-acadmedsg.2024118","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024118","url":null,"abstract":"<p><strong>Introduction: </strong>Hospitalisations can pose hazards and may not be an appropriate care setting for frail nursing home (NH) residents. Few studies have quantified the extent of NH resident hospitalisations in Singapore, hence we aimed to address this knowledge gap by studying characteristics of unplanned hospitalisations over a 1-year period.</p><p><strong>Method: </strong>This was a retrospective cohort study of 9922 subsidised residents across 59 NHs in Singapore, with analysis using administrative healthcare data. Key measures included inpatient admission and emergency department visit rates, final discharge diagnoses and estimated costs. We examined correlates of inpatient admissions with a multivariable zero-inflated negative binomial regression model incorporating demogra-phics, institutional characteristics and Charlson Comorbidity Index.</p><p><strong>Results: </strong>There were 6620 inpatient admissions in 2015, equivalent to 2.23 admissions per 1000 resident days, and the majority were repeat admissions (4504 admissions or 68.0%). Male sex (incidence rate ratio [IRR] 1.23), approaching end-of-life (IRR 2.14), hospitalisations in the past year (IRR 2.73) and recent NH admission within the last 6 months (IRR 1.31-1.99) were significantly associated with inpatient admission rate. Top 5 discharge diagnoses were lower respiratory tract infections (27.3%), urinary tract infection (9.3%), sepsis (3.1%), cellulitis (1.9%) and gastroenteritis (1.1%). We estimated the total system cost of admissions of subsidised residents to be SGD40.2 million (USD29.1 million) in 2015.</p><p><strong>Conclusion: </strong>We anticipate that unplanned hospitali-sation rate will increase over time, especially with an increasing number of residents who will be cared for in NHs. Our findings provide a baseline to inform stakeholders and develop strategies to address this growing problem.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"657-669"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788382","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":"Updated consensus guidelines for management of moderate-to-severe atopic dermatitis in Singapore: Integrating biologics, Janus kinase inhibitors and conventional therapies.","authors":"Yik Weng Yew, Uma Alagappan, Derrick Aw, Nisha Suyien Chandran, Karen Jl Choo, Roland Chu, Hong Yi Koh, Mark Jean Aan Koh, Shan Xian Lee, Ching Yin Neoh, Siyun Lucinda Tan, Mark Tang, Yong-Kwang Tay, Seth Francis-Graham, Andrew Lim, Haur Yueh Lee","doi":"10.47102/annals-acadmedsg.2024158","DOIUrl":"10.47102/annals-acadmedsg.2024158","url":null,"abstract":"<p><strong>Introduction: </strong>Since 2016, several therapies have been approved for treating atopic dermatitis (AD) in Singapore, including biologics, oral Janus kinase (JAK) inhibitors and topical crisaborole. This study supplements the 2016 Singapore treatment guidelines for AD, focusing on newer therapies for moderate-to-severe disease, while revisiting older treatment regimens to accommodate changes in knowledge and practice.</p><p><strong>Method: </strong>A modified Delphi panel was held, led by 2 co-chairs. The voting expert panel consisted of 12 dermatologists experienced in managing AD in Singapore. Delphi survey rounds were conducted between 24 July and 27 October 2023. Panellists indicated their agreement with drafted statements using a 5-point Likert scale. Consensus was defined as ≥80% agreement. An expert meeting was held to facilitate the consensus process between rounds 1 and 2 of voting.</p><p><strong>Results: </strong>All expert panellists participated in both survey rounds, with a 100% response rate. Thirty-nine statements, classified into general principles, conventional treatments, biologics and JAK inhibitors, were proposed. Of these, 27 statements reached consensus at the end of round 1. After the expert meeting, 17 statements were included in round 2, of which 16 statements reached consensus. One statement did not reach consensus. Key updates are the inclusion of dupilumab and JAK inhibitors as potential first-line treatments for moderate-to-severe AD, in certain populations.</p><p><strong>Conclusion: </strong>This modified Delphi study generated consensus among Singapore dermatology experts, to update treatment guidelines in moderate-to-severe atopic dermatitis. The consensus statements developed are intended to supplement the 2016 Singapore treatment guidelines for AD. Further revisions may be required when new evidence and/or treatments become available.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"670-682"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788383","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":"Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?","authors":"Wesley Teck Wee Loo, Kendra Jing Ying Tang, Si Yuan Chew","doi":"10.47102/annals-acadmedsg.2024335","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024335","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"644-646"},"PeriodicalIF":2.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788374","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":"Natural Language Processing for serious illness communications in palliative surgical oncology.","authors":"Louis Choon Kit Wong, Nicholas Brian Shannon, Qingyuan Zhuang, Hairil Rizal Abdullah, Wei Jing Fong, Claramae Shulyn Chia, Jolene Si Min Wong","doi":"10.47102/annals-acadmedsg.202450","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202450","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"697-699"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788379","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":"Corticosteroids in critically ill patients with community-acquired pneumonia: A systematic review and Bayesian meta-analysis.","authors":"Wei Yu Chua, Natalie Chew, Shruthi C Iyer, Rachel Goh, Wei Ren Ryanna Koh, Hong Lien Vu, Qai Ven Yap, Miny Samuel, John Soong, Matthew Edward Cove","doi":"10.47102/annals-acadmedsg.2024159","DOIUrl":"10.47102/annals-acadmedsg.2024159","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of adjunct systemic corticosteroid therapy in patients admitted to the intensive care unit (ICU) with bacterial community-acquired pneumonia (CAP).</p><p><strong>Method: </strong>We searched MEDLINE, Embase and the Cochrane Library to identify randomised controlled trials (RCTs) published from the databases' inception to February 2024. All RCTs evaluating the effect of systemic corticosteroids on mortality, compared to standard of care among adult bacterial CAP patients admitted to ICU were included. Bayesian meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Independent authors reviewed each study for eligibility, extracted data and assessed risk of bias in duplicate, with discrepancies referred to senior reviewers.</p><p><strong>Results: </strong>A total of 6 RCTs comprising 1585 patients were included for analysis. In ICU patients with severe CAP who were treated with corticosteroids, there was no significant reduction in hospital mortality (risk ratio [RR] 0.70, 95% confidence interval [CI] 0.39-1.14, certainty of evidence: ⊕⊕⊝⊝ low) or all-cause mortality (RR 0.68, 95% CI 0.34-1.22, ⊕⊕⊝⊝ low) compared with placebo. The use of corticosteroids showed a significant reduction in mechanical ventilation post-intervention (RR 0.58, 95% CI 0.37-0.86, ⊕⊕⊕⊕ high) compared with placebo. In a subgroup analysis of patients treated with hydrocortisone, hospital mortality was significantly reduced (RR 0.45, 95% CI 0.20-0.88, ⊕⊕⊝⊝ low) compared with placebo. There was no significant increase in gastrointestinal bleeding, secondary infections or hyperglycaemia in patients treated with corticosteroids.</p><p><strong>Conclusion: </strong>Corticosteroids significantly reduced mechanical ventilation requirements, and hydrocor-tisone significantly reduced hospital mortality. Further work is required to determine whether other corticosteroids reduce mortality among ICU patients with CAP.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"683-693"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788375","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":"Gender dysphoria in children and adolescents: A retrospective analysis of cases in Singapore.","authors":"Tze Jui Goh, Dana Kaitlyn Chua, Kirthana Vasudevan, Daniel Shuen Sheng Fung","doi":"10.47102/annals-acadmedsg.2024198","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024198","url":null,"abstract":"<p><strong>Introduction: </strong>The understanding of gender dysphoria (GD) in children and adolescents is limited in Singapore. This study aims to review the presentation of GD in an outpatient psychiatric clinic, to gain insights into its prevalence and associated factors.</p><p><strong>Method: </strong>We conducted a retrospective review of medical records for patients diagnosed with GD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth editions, at the clinic between 1 January 2017 and 31 December 2021. We collected and analysed demographic, medical and other GD-specific clinical variables.</p><p><strong>Results: </strong>The study included 107 participants (mean age 16.6 years), comprising 47 natal males and 60 natal females. The prevalence of GD was found to be 1:5434 (0.019%). Incidence rates increased from 2.17 to 5.85 per 100,000 population between 2017 and 2021. The mean age of diagnosis was 15.6 years, with an average delay of 5 years between experiencing gender identity-related concerns and seeking formal assistance. Approximately 45% of participants reported social and physical transitions, and 20.6% reported self-harm or suicidal thoughts.</p><p><strong>Conclusion: </strong>The study highlights the presentation of GD in an under-researched Asian setting. Supporting individuals with GD in Asia requires sensitivity to cultural and societal factors with a holistic approach to individual well-being.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 11","pages":"647-656"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788377","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}