Annals of the Academy of Medicine, Singapore最新文献

{"title":"Trastuzumab-deruxtecan in breast cancer treatment: Balancing the triad of efficacy, safety and accessibility.","authors":"Victor Guan Hui Lee, Joline Si Jing Lim","doi":"10.47102/annals-acadmedsg.2025229","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2025229","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"455-457"},"PeriodicalIF":2.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034816","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":"Factors associated with persistent high healthcare service utilisers in Singapore: A population health analysis.","authors":"Jemima Jia En Koh, Yin Zhien Tan, Hong Choon Oh, Beng Hoong Poon","doi":"10.47102/annals-acadmedsg.202543","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202543","url":null,"abstract":"<p><strong>Introduction: </strong>Albeit comprising a small portion of the hospital population, persistent high utilisers (PHUs) contribute disproportionately to healthcare expenditures. Amid rising healthcare costs and an ageing population, this study examines factors associated with PHUs among residents in eastern Singapore.</p><p><strong>Method: </strong>This is a retrospective study of eligible patients at Changi General Hospital in Singapore between 1 January 2020 and 31 December 2022. The study included Singapore citizens who utilised any services offered by CGH. Patients were classified as PHUs if their annual healthcare expenditure exceeded SGD3700 for 3 consecutive years. Demographics, healthcare utilisation patterns and clinical profiles were compared, and multivariable analyses were conducted to identify factors associated with PHUs.</p><p><strong>Results: </strong>There were 267,838 eligible patients identified, with 5316 (2%) classified as PHUs. PHUs accounted for 18.4% of the total healthcare expenditure, with the highest costs attributed to inpatient services, followed by outpatient services. PHUs were more likely to be older, male, non-Chinese and of lower socioeconomic status. Conditions with the strongest association with PHUs were mental health disorders, chronic obstructive pulmonary disease, osteoporosis, asthma and renal diseases. Inpatient discharges from renal medicine, psychological medicine and general/geriatric medicine wards had the strongest association with PHUs. Utilisation of allied health services had the highest odds of being a PHU in outpatient care.</p><p><strong>Conclusion: </strong>This study identified key factors associated with PHUs, providing invaluable insights into the planning of population health services within the hospital's geographical region. Targeted service development and process improvements of medical care can help mitigate persistent high utilisation.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"476-490"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034779","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":"Automatic brain segmentation in cognitive impairment: Validation of AI-based AQUA software in the Southeast Asian BIOCIS cohort.","authors":"Ashwati Vipin, Rasyiqah Binte Shaik Mohamed Salim, Regina Ey Kim, Minho Lee, Hye Weon Kim, ZunHyan Rieu, Nagaendran Kandiah","doi":"10.47102/annals-acadmedsg.2024317","DOIUrl":"10.47102/annals-acadmedsg.2024317","url":null,"abstract":"<p><strong>Introduction: </strong>Interpretation and analysis of magnetic resonance imaging (MRI) scans in clinical settings comprise time-consuming visual ratings and complex neuroimage processing that require trained professionals. To combat these challenges, artificial intelligence (AI) techniques can aid clinicians in interpreting brain MRI for accurate diagnosis of neurodegenerative diseases but they require extensive validation. Thus, the aim of this study was to validate the use of AI-based AQUA (Neurophet Inc., Seoul, Republic of Korea) segmentation software in a Southeast Asian community-based cohort with normal cognition, mild cognitive impairment (MCI) and dementia.</p><p><strong>Method: </strong>Study participants belonged to the community-based Biomarker and Cognition Study in Singapore. Participants aged between 30 and 95 years, having cognitive concerns, with no diagnosis of major psychiatric, neurological or systemic disorders who were recruited consecutively between April 2022 and July 2023 were included. Participants underwent neuropsychological assessments and structural MRI, and were classified as cognitively normal, with MCI or with dementia. MRI pre-processing using automated pipelines, along with human-based visual ratings, were compared against AI-based automated AQUA output. Default mode network grey matter (GM) volumes were compared between cognitively normal, MCI and dementia groups.</p><p><strong>Results: </strong>A total of 90 participants (mean age at visit was 63.32±10.96 years) were included in the study (30 cognitively normal, 40 MCI and 20 dementia). Non-parametric Spearman correlation analysis indicated that AQUA-based and human-based visual ratings were correlated with total (ρ=0.66; P<0.0001), periventricular (ρ=0.50; P<0.0001) and deep (ρ=0.57; P<0.0001) white matter hyperintensities (WMH). Additionally, volumetric WMH obtained from AQUA and automated pipelines was also strongly correlated (ρ=0.84; P<0.0001) and these correlations remained after controlling for age at visit, sex and diagnosis. Linear regression analyses illustrated significantly different AQUA-derived default mode network GM volumes between cognitively normal, MCI and dementia groups. Dementia participants had significant atrophy in the posterior cingulate cortex compared to cognitively normal participants (P=0.021; 95% confidence interval [CI] -1.25 to -0.08) and in the hippocampus compared to cognitively normal (P=0.0049; 95% CI -1.05 to -0.16) and MCI participants (P=0.0036; 95% CI -1.02 to -0.17).</p><p><strong>Conclusion: </strong>Our findings demonstrate high concordance between human-based visual ratings and AQUA-based ratings of WMH. Additionally, the AQUA GM segmentation pipeline showed good differentiation in key regions between cognitively normal, MCI and dementia participants. Based on these findings, the automated AQUA software could aid clinicians in examining MRI scans of patients with cognitive impairment.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"467-475"},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034754","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":"Integrating traditional Chinese medicine into disease management in Singapore.","authors":"Hui Ping Ng, Linda Ld Zhong, William Wei Liang Peh, Wai Ching Lam, Kenneth Mak, Shih-Hui Lim","doi":"10.47102/annals-acadmedsg.202560","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202560","url":null,"abstract":"<p><strong>Introduction: </strong>While traditional Chinese medicine (TCM) has a long history and continues to be widely practised, its overall clinical efficacy according to conventional scientific standards remains the topic of ongoing research and exploration. This review focuses on the potential use of acupuncture and Chinese herbal medicine (CHM) in combination with Western medicine in Singapore, based on recently published data on the clinical effectiveness and cost-effectiveness of these TCM treatments.</p><p><strong>Method: </strong>We collated and summarised 71 research papers published in the past decade, focusing on randomised controlled trials, systematic reviews and population-based cohort studies that had a total sample size (treatment and control arms) exceeding 60. English-language articles published between 2015 and 2025 were identified by searching PubMed/MEDLINE, the Cochrane Library and the China National Knowledge Infrastructure. The search strategy included intervention terms like \"acupuncture\", \"Chinese medicine\", \"TCM\", \"traditional Chinese medicine\", \"RCT\" and \"randomized controlled trial\"; economic evaluation terms like \"cost\" and \"cost-effectiveness\"; and disease conditions of concern. We narrowed our research to the clinical effectiveness and cost-effectiveness of CHM in which either the individual ingredients or the products were listed as Chinese Proprietary Medicines (CPMs).</p><p><strong>Results: </strong>The summary tables demonstrate that the integration of acupuncture and/or CPMs with conventional Western medicine can enhance treatment outcomes across various chronic and non-chronic diseases. Their affordability and preventive focus can contribute to long-term healthcare cost savings, benefiting both patients and the healthcare system as a whole.</p><p><strong>Conclusion: </strong>With a robust regulatory framework, scientific validation and government support, acupunc-ture and CPMs have an important role in the management of various diseases, especially chronic ones, in Singapore.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"491-497"},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034748","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":"Postpartum urinary incontinence: Longitudinal risk factors and trajectories in Singapore.","authors":"Amanda Wei Mun Tan, Wan Hui Yip, Yong Hao Pua, Shau Khng Jason Lim","doi":"10.47102/annals-acadmedsg.2024298","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2024298","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"515-517"},"PeriodicalIF":2.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034904","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":"Advancing breast cancer and lung cancer screening: Expert perspectives to advance programmes in Singapore.","authors":"Clive Tan, Ern Yu Tan, Geak Poh Tan, Ravindran Kanesvaran","doi":"10.47102/annals-acadmedsg.202567","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202567","url":null,"abstract":"<p><strong>Introduction: </strong>The high prevalence and mortality rates of breast cancer and lung cancer in Singapore necessitate robust screening programmes to enable early detection and intervention for improved patient outcomes, yet 2024 uptake and coverage remain suboptimal. This narrative review synthesises expert perspectives from a recent roundtable discussion and proposes strategies to advance breast cancer and lung cancer screening programmes.</p><p><strong>Method: </strong>A 2024 roundtable convened clinical practitioners, health policymakers, researchers and patient advocates discussed current challenges and opportunities for improving cancer screening in Singapore. Perspectives and insights were analysed to identify themes related to existing programme gaps, opportunities for innovation and implementation challenges.</p><p><strong>Discussion: </strong>Singapore's national breast cancer screening programme has been in place for over 2 decades, yet screening uptake remains suboptimal. A national lung cancer screening programme, in contrast, is still in its early stages of implementation. Regardless, employment of risk stratification approaches that integrate genetic, demographic and lifestyle factors could enhance screening effectiveness by identifying high-risk indivi-duals, while also taking local epidemiological trends into consideration. Integration of digital health technologies, artificial intelligence and behavioural change models can enhance cancer screening uptake and accuracy to overcome barriers such as low awareness, cultural beliefs and socioeconomic factors that contribute to low participation rates.</p><p><strong>Conclusion: </strong>Key recommendations include enhancing public awareness, refining screening guidelines, expanding access and applying innovative technologies. A coordinated effort among stakeholders is crucial to continually assess and enhance screening programmes to narrow the practice-policy gap and ultimately reduce breast cancer and lung cancer burden in Singapore.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"498-504"},"PeriodicalIF":2.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034792","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":"\"Machine learning to risk stratify chest pain patients with non-diagnostic electrocardiogram in an Asian emergency department\": Correspondence.","authors":"Erkan Boða","doi":"10.47102/annals-acadmedsg.2025131","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2025131","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 9","pages":"601-602"},"PeriodicalIF":2.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240627","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":"Patients' preferences for nutrition care from health professionals in public primary care setting: A cross-sectional study in Singapore.","authors":"Zhi Ying Chie, Xin Ying Shannon Lee, Xinyao Ng, Shu Yun Tan","doi":"10.47102/annals-acadmedsg.2025105","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2025105","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"508-511"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034763","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":"A review of fertility preservation in women in Singapore from 2010 to 2019.","authors":"Toon Wen Tang, Shu Ying Charissa Goh, Jessie Wai Leng Phoon","doi":"10.47102/annals-acadmedsg.202559","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202559","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"512-514"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034733","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":"Evaluating the impact of relative dose intensity on efficacy of trastuzumab deruxtecan for metastatic breast cancer in the real-world clinical setting.","authors":"Han Yi Lee, Vivianne Shih, Jack Junjie Chan, Shun Zi Liong, Ryan Shea Ying Cong Tan, Jun Ma, Bernard Ji Guang Chua, Joshua Zhi Chien Tan, Chuan Yaw Lee, Wei Ling Teo, Su-Ming Tan, Phyu Nitar, Yoon Sim Yap, Mabel Wong, Rebecca Dent, Fuh Yong Wong, Tira J Tan","doi":"10.47102/annals-acadmedsg.202576","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202576","url":null,"abstract":"<p><strong>Introduction: </strong>Trastuzumab deruxtecan (T-DXd) has revolutionised treatment for metastatic breast cancer (MBC). While effective, its high cost and toxicities, such as fatigue and nausea, pose challenges.</p><p><strong>Method: </strong>Medical records from the Joint Breast Cancer Registry in Singapore were used to study MBC patients treated with T-DXd (February 2021-June 2024). This study was conducted to address whether reducing dose intensity and density may have an adverse effect on treatment outcomes.</p><p><strong>Results: </strong>Eighty-seven MBC patients were treated with T-DXd, with a median age of 59 years. At the time of data cutoff, 32.1% of patients were still receiving T-DXd. Over half (54%) of the patients received treatment with an initial relative dose intensity (RDI) of <;85%. Overall median real-world progression-free survival (rwPFS) was 8.1 months. rwPFS was similar between RDI groups (<85%: 8.7 months, <85%: 8.1 months, P=0.62). However, human epidermal growth receptor 2 (HER2)-positive patients showed significantly better rwPFS outcomes compared to HER2-low patients (8.8 versus 2.5 months, P<0.001). Only 16% with central nervous system (CNS) involvement had CNS progressive disease on treatment. No significant progression-free survival (PFS) differences were found between patients with or without CNS disease, regardless of RDI groups. Five patients (5.7%) developed interstitial lung disease (ILD), with 3 (3.4%) having grade 3 events. Two required high-dose steroids and none were rechallenged after ILD. There were no fatalities.</p><p><strong>Conclusion: </strong>Our study demonstrated that reduced dose intensity and density had no significant impact on rwPFS or treatment-related toxicities. Furthermore, only 5.7% of patients developed ILD. T-Dxd provided good control of CNS disease, with 82% of patients achieving CNS disease control.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"54 8","pages":"458-466"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034759","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}