Annals of the Academy of Medicine, Singapore最新文献

{"title":"Achieving restraint-free care for frail older patients with cognitive impairment in the acute hospital.","authors":"Wen Qi Mok, Thuy Anh Giang, Li Cheng Heng, Philip Lin Kiat Yap","doi":"10.47102/annals-acadmedsg.2026125","DOIUrl":"10.47102/annals-acadmedsg.2026125","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"485-487"},"PeriodicalIF":2.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979086","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":"Body roundness index, frailty, and prevalent self-reported stroke: An exploratory cross-sectional decomposition analysis.","authors":"Desheng Zhu, Fuqiang Li, Kai Zhou, Wentao Fan, Min Ma, Ting Huang, Min Xu","doi":"10.47102/annals-acadmedsg.2025312","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2025312","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the clinical outcomes of endoscopic combined intrarenal surgery (ECIRS) in the prone hip-flexed split-leg position with conventional percutaneous nephrolithotomy (PCNL) for the treatment of complex renal calculi.</p><p><strong>Method: </strong>We retrospectively analysed 168 patients with complex renal calculi, including 82 who underwent ECIRS and 86 who underwent conventional PCNL. Baseline demographic and stone characteristics, perioperative outcomes, initial stone-free rate (SFR) within 1-3 days after surgery, final SFR after completion of all planned treatments, auxiliary procedures, double-J stent indwelling duration, length of hospital stay, and postoperative complications were compared between groups. Logistic regression analyses were performed to evaluate factors associated with residual stones after the initial procedure, with additional clinically informed sensitivity analysis using prespecified covariates.</p><p><strong>Results: </strong>Baseline demographic characteristics, stone features, and postoperative outcomes, including intraoperative ureteral catheterization time, complication rates, Clavien-Dindo classification, and final SFR after completion of all planned treatments, were comparable between the two groups (all P>0.05). In this retrospective cohort, ECIRS in the prone hip-flexed split-leg position was associated with earlier stone clearance after the index procedure, reflected by a higher initial SFR (74.39% versus [vs] 50.00%, P=0.001) and a lower requirement for auxiliary procedures (29.27% vs 46.51%, P=0.021). These findings were accompanied by a shorter hospital stay (6.44 vs 8.61 days, P<0.001), shorter double-J stent indwelling duration (2.81 vs 4.79 weeks, P=0.002), and shorter operative time (P=0.012). Multivariable and sensitivity analyses further demonstrated that ECIRS was independently associated with lower odds of residual stones after the initial procedure (odds ratio 0.40, 95% confidence interval 0.20-0.80, P=0.009).</p><p><strong>Conclusion: </strong>Single-position ECIRS in the prone hipflexed split-leg configuration was feasible for selected patients with complex renal calculi and was associated with earlier stone clearance and shorter perioperative recovery metrics. However, the final SFR after completion of all planned treatments was comparable between groups, and whether this positional configuration confers benefit beyond ECIRS in alternative positions could not be determined from this comparison. Further prospective studies are required to validate these findings.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 9","pages":"404-414"},"PeriodicalIF":2.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122006","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":"Body roundness index, frailty, and stroke.","authors":"Laura Bee Gek Tay","doi":"10.47102/annals-acadmedsg.2026531","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2026531","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 8","pages":"402-403"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868807","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":"Evaluation of China's \"1146\" school-based myopia control programme in primary school children: A 12-month study.","authors":"Liuying Wang, Mengke Tian, Weiquan Guo, Jialong Wang, Xiangxing Duan, Lina Yun","doi":"10.47102/annals-acadmedsg.2026147","DOIUrl":"10.47102/annals-acadmedsg.2026147","url":null,"abstract":"<p><strong>Introduction: </strong>Structured school-based myopia prevention programmes are increasingly promoted, but real-world evidence supporting multicomponent models remains limited. This study evaluated the 12-month effectiveness of the \"1146\" programme in China in a routine primary school setting.</p><p><strong>Method: </strong>This prospective, non-randomised controlled study included 24 classes from a single primary school, assigned to intervention or control groups according to teaching schedule. After follow-up, 100 children from the intervention group and 98 children from the control group were analysed. Intervention classes received the multicomponent \"1146\" programme, which integrated education, visual behaviour, environmental measures, outdoor activity promotion, monitoring, and adjunctive professional components. Control classes followed standard teaching. Routine refractive correction was provided to myopic children in both groups when indicated. Continuous outcomes were analysed using linear mixed-effects models adjusted for baseline value, age, and sex, with class included as a random effect.</p><p><strong>Results: </strong>At 12 months, axial length increased less in the intervention group than in controls (0.01 ± 0.11 mm versus [vs] 0.29 ± 0.37 mm; adjusted mean difference -0.288 mm; 95% confidence interval -0.363 to -0.213). Spherical equivalent changed by 0.20 ± 0.61 D vs -0.45 ± 0.77 D, and uncorrected visual acuity changed by 0.37 ± 0.30 vs -0.27 ± 0.25 (all adjusted P<0.001). Improvement of ≥2 lines in uncorrected visual acuity (UCVA) occurred in 53.0% vs 1.0%, indicating meaningful functional gain. No subgroup interaction was significant.</p><p><strong>Conclusion: </strong>The \"1146\" programme was associated with less axial elongation and more favourable refractive and UCVA changes over 12 months. The single-school, non-randomised design limited causal inference and generalisability. Larger randomised multicentre studies with longer follow-up are needed.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"415-425"},"PeriodicalIF":2.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809645","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":"Body roundness index, frailty, and prevalent self-reported stroke: An exploratory cross-sectional decomposition analysis.","authors":"Zekai Hu, Jie Zhuang, Jinyan Wang, Xieyun Jin, Lei Fang, Jun Hu","doi":"10.47102/annals-acadmedsg.2025411","DOIUrl":"10.47102/annals-acadmedsg.2025411","url":null,"abstract":"<p><strong>Introduction: </strong>Prior NHANES studies have reported nonlinear associations of the body roundness index (BRI) with prevalent stroke and frailty. The authors updated these observations using NHANES 1999-2023 and examined the additional contribution of frailty to the BRI-prevalent self-reported stroke association.</p><p><strong>Method: </strong>This cross-sectional study included 36,324 adults. Stroke was defined by self-reported physician diagnosis. Survey-weighted logistic regression and restricted cubic splines were used to assess BRI associations. Expanded models were fitted with and without the frailty index (FI). A post hoc 2-piecewise model estimated a potential BRI breakpoint using 1000 bootstrap resamples. Incremental discrimination was evaluated across nested age-sex, age-sex-BRI, and age-sex-BRI-FI models. Analyses were interpreted as cross-sectional associations.</p><p><strong>Results: </strong>In the primary adjusted model, higher BRI was associated with prevalent self-reported stroke (odds ratio [OR]=1.08, 95% confidence interval [CI] 1.05-1.12). The spline showed increasing odds across lower-to-middle BRI values, followed by attenuation at higher values. The exploratory breakpoint was 6.34 (bootstrap 95% CI 6.14-7.65). In expanded sensitivity analyses, the BRI estimate was attenuated without FI (OR=1.01, 95% CI 0.98-1.04) and became inverse after FI was included (OR=0.91, 95% CI 0.88-0.95). FI remained strongly associated with prevalent self-reported stroke (OR=2.38 per 0.1-unit increase, 95% CI 2.23-2.54). Adding BRI to age and sex increased area under the curve (AUC) from 0.763 to 0.769, while adding FI increased AUC to 0.868.</p><p><strong>Conclusion: </strong>BRI showed a nonlinear, model-dependent association with prevalent self-reported stroke, and frailty provided additional cross-sectional information. These findings support prospective evaluation of BRI and frailty as complementary markers in stroke-related assessment.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"404-414"},"PeriodicalIF":2.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820834","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":"Stroke publications in Southeast Asia: A bibliometric analysis.","authors":"Dawn Lim Se Teng, Siti Rohaida Binte Rahmat, Daniel Hong Zhihao, Deidre Anne De Silva","doi":"10.47102/annals-acadmedsg.2026151","DOIUrl":"10.47102/annals-acadmedsg.2026151","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"444-446"},"PeriodicalIF":2.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809688","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":"Training for constraint in Southeast Asia: Rethinking adaptive expertise in a region of contrasts.","authors":"Jacquilyne Kharlukhi, Celest Yee Suan So, Arun-Kumar Kaliya-Perumal","doi":"10.47102/annals-acadmedsg.2026299","DOIUrl":"10.47102/annals-acadmedsg.2026299","url":null,"abstract":"<p><p>Modern clinical training is increasingly conducted in technology-rich environments supported by advanced diagnostics, automated systems, and structured workflows. These environments support efficient learning but may offer fewer opportunities for trainees to develop adaptive expertise, particularly when familiar resources, technologies, or processes are unavailable. Resource availability, however, exists on a spectrum, and even well-resourced systems can become stretched during pandemics, supply-chain disruptions, workforce shortages, or service overload. In such situations, clinicians need to prioritise, communicate clearly, reason with incomplete information, and adapt to changing conditions. For this reason, exposure to settings where resources are stretched, variable, or constrained can complement modern training by strengthening clinical judgement, observation, teamwork, and confidence in core clinical skills. Evidence on elective placements has described self-reported improvements in clinical examination skills, reduced reliance on extensive investigations and greater cultural awareness. However, such experiences must also be ethically and feasibly structured, with attention to host-institution needs, supervision, scope of practice, financing, and equity of access. Since external placements may not be available to all trainees, adaptive expertise should also be cultivated within existing training programmes through history-and-examination-first teaching, no-investigation case discussions, simulation under constraint, and structured reflection. The aim is not to privilege 1 training environment over another, but to prepare clinicians to practise safely and thoughtfully across the full spectrum of resource availability by intentionally building adaptive expertise.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"426-429"},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715065","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":"Interpreting multivariable regression coefficients in observational clinical research: The Table 2 fallacy.","authors":"John Rong Hao Tay, Nasir Z Bashir, Upul Cooray","doi":"10.47102/annals-acadmedsg.2026420","DOIUrl":"10.47102/annals-acadmedsg.2026420","url":null,"abstract":"<p><p>Multivariable regression tables are common in observational clinical research, but their coefficients are often over-interpreted. A model built to estimate the effect of 1 exposure may also report coefficients for age, sex, comorbidities, behaviours, and other adjustment variables. These additional rows are frequently read as independent risk factors, even when the analysis was not designed to estimate their effects. This is the Table 2 fallacy. The problem is not the use of adjustment, but the interpretation of adjustment terms as if each were a separate causal estimate. In this commentary, we use a directed acyclic graph and a single worked example to show why the coefficient for the exposure of interest can answer the intended clinical question, while coefficients for adjustment variables may not represent clinically actionable effects. We also show how similar errors arise when interaction terms are interpreted as causal. Authors should specify the target estimand (the causal effect the analysis is designed to estimate) and exposure, choose adjustment variables from the assumed causal structure, interpret only the exposure coefficient, and fit a separate model for each further question. We set out red flags, recurring pitfalls, and questions to ask of any risk-factor table. A regression table is not a menu of modifiable risks. An association is clinically actionable only when the study was designed to support that interpretation.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"383-387"},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633496","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":"Burden trends of Alzheimer's disease and other dementias in China, 1990-2023: Sex, age, and risk-attributable patterns.","authors":"Yao Li, Shuai Wang, Kaiyue Xie, Siyv Qian, Mingyue Ma, Haining Zhang","doi":"10.47102/annals-acadmedsg.2026146","DOIUrl":"10.47102/annals-acadmedsg.2026146","url":null,"abstract":"<p><strong>Introduction: </strong>China's population has aged rapidly in recent decades, accompanied by a steady rise in Alzheimer's disease and other dementias (ADOD). Understanding long-term national trends is important for anticipating future healthcare needs.</p><p><strong>Method: </strong>The authors analysed Global Burden of Disease (GBD) 2023 estimates for China from 1990 to 2023, following the Guidelines for Accurate and Transparent Health Estimates Reporting, with STROBE used as a secondary reporting reference. Deaths, disability-adjusted life years (DALYs), incidence, and prevalence were examined together with crude rates, age-standardised rates (ASRs), and average annual percentage changes. Results were evaluated and stratified by sex and broad age group. Modelled risk-attributable burden was assessed for selected GBD risk factors-ambient particulate matter pollution, high fasting plasma glucose, smoking, and household air pollution from solid fuels.</p><p><strong>Results: </strong>Over the study period, the number of people affected increased markedly. Deaths rose from 122,411 in 1990 to 586,002 in 2023, while DALYs and prevalent cases more than tripled. In contrast, ASR showed only modest upward changes. Women had higher ASRs in 2023, although mortality- and DALY-related rates increased more quickly among men. The burden remained concentrated in those aged 75 years and older. Among the selected exposures, ambient particulate matter pollution accounted for the largest attributable share in 2023, whereas household air pollution declined over time.</p><p><strong>Conclusion: </strong>The marked increase in absolute ADOD burden, together with smaller changes in ASR, is consistent with demographic ageing being an important contributor to rising dementia-related service needs in China. The risk-attributable estimates suggest changing population-level patterns for selected environmental and metabolic exposures, but they should not be interpreted as individual-level causal effects.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"358-369"},"PeriodicalIF":2.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633445","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":"Artificial intelligence tools in dermatology education: A scoping review on their application, efficacy, and limitations.","authors":"Chun Hian John Yap, Ziying Vanessa Lim","doi":"10.47102/annals-acadmedsg.2026346","DOIUrl":"10.47102/annals-acadmedsg.2026346","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial Intelligence (AI) is increasingly explored for medical education, and dermatology, with its visual diagnostic focus, holds promise for AIenhanced learning. However, evidence on its educational effectiveness remains limited and fragmented. This scoping review aimed to assess the evidence base for applications and limitations of AI-based educational tools in dermatology.</p><p><strong>Method: </strong>A systematic search of PubMed, Embase, Web of Science, Scopus, and PsycINFO up to July 2025 was conducted. Data were synthesised narratively, considering types of AI interventions and their assessed outcomes. These were analysed with the Cost, Usability, Credibility, Fairness, Accountability, Transparency, Explainability (CUC-FATE) framework. Study quality was assessed with ROBINS-I and a COSMIN-informed checklist.</p><p><strong>Results: </strong>A total of 827 records were screened, with 360 duplicates removed, yielding 467 studies. Six full-length studies and 1 conference abstract met inclusion criteria, mostly from 2023 to 2025. These explored AI-generated clinical images, Large Language Model-generated vignettes, intelligent tutoring systems, and clinical decision support tools. Content validation studies generally reported favourable ratings for accuracy, clarity, and educational utility, while intervention studies suggested possible benefits for learning performance and diagnostic accuracy. Usability and credibility were commonly assessed, whereas cost, accountability, fairness, transparency, and explainability were rarely examined.</p><p><strong>Conclusion: </strong>Most of the studies reviewed had high risk of bias, small sample sizes, and limited methodological rigour, with significant heterogeneity in examined educational outcomes limiting synthesis. While current initial studies on AI hold promise, this scoping review underscores the need for more robust studies with standardised evaluation frameworks, prioritising ethical principles such as fairness, explainability, and accountability for safe integration in training.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"370-382"},"PeriodicalIF":2.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633491","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}