Annals of the Academy of Medicine, Singapore最新文献

{"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}

{"title":"Trends in healthcare costs and utilisation in SingHealth 2019-2024: The effects of an ageing population.","authors":"Joshua Kuan Tan, Yun Zhao, Zoey Hui Xian Lim, Boon Hwee Ang, Julian Thumboo, Ivan En-Howe Tan, Lian Leng Low, Marianne Kit Har Au","doi":"10.47102/annals-acadmedsg.202626","DOIUrl":"10.47102/annals-acadmedsg.202626","url":null,"abstract":"<p><strong>Introduction: </strong>Despite rising healthcare expenditure in Singapore, detailed utilisation patterns are not well characterised. We analyse utilisation within SingHealth, the country's largest public healthcare cluster.</p><p><strong>Method: </strong>We conducted a retrospective observational study using patient-level data from 2019 to 2024, across inpatient, outpatient specialist, and primary care settings. Patients were categorised using the Modified British Columbia (ModBC) Population Segmentation Framework, and inpatient diagnoses were classified using a locally adapted version of the Clinical Classifications Software Refined (CCSR). Healthcare costs were reported in inflation-adjusted 2024 Singapore dollars (SGD). Descriptive statistics and temporal trend analyses were performed.</p><p><strong>Results: </strong>The patient population increased from 1.21 million in 2019 to 1.37 million in 2024, while total healthcare expenditure rose from SGD 4.37 billion to SGD 6.05 billion. Inpatient care remained the dominant cost driver, accounting for 63.8% of total expenditure in 2024, with a stable relative share over time. Expenditure increased disproportionately among older adults, with the steepest per-user growth in those aged ≥80 years, consistent with age-related acceleration in healthcare spending. Absolute utilisation increased among adults aged ≥60 years, while utilisation rates within age groups remained stable, suggesting that growth was associated with changes in population composition rather than utilisation intensity. Patients in the ModBC high-complex chronic conditions and cancer segments accounted for 46.7% of total expenditure. Diagnosis-level analyses using CCSR revealed age-related differences in utilisation patterns within these segments.</p><p><strong>Conclusion: </strong>Rising healthcare expenditure appears consistent with population ageing and the increasing complexity of chronic diseases. Addressing these challenges will require a sustained shift towards preventive, community-based, and value-driven models of care to ensure long-term system sustainability.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 6","pages":"305-317"},"PeriodicalIF":2.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427847","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":"Novel insights on dementia care: Multidimensional benefits of doll therapy uncovered in cross-cultural meta-analysis.","authors":"Ying Qiu, Yujia Huo, Jiatian Ma, Yuling Wang, Haiying Ma, Tingting Liu, Man Yan, Qiao Xiao, Zhiling Sun, Han Sun","doi":"10.47102/annals-acadmedsg.2025470","DOIUrl":"10.47102/annals-acadmedsg.2025470","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"430-435"},"PeriodicalIF":2.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414583","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":"\"Gazing into the crystal ball of mortality prediction in conservative kidney care\": Correspondence.","authors":"Norhasyimah Tamin, Fazean Idris, Shin Bey Ho, Vui Heng Chong, Jackson Tan","doi":"10.47102/annals-acadmedsg.2026304","DOIUrl":"10.47102/annals-acadmedsg.2026304","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"398-401"},"PeriodicalIF":2.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298268","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":"Vascular stiffness and sepsis mortality: A promising signal in search of clinical relevance.","authors":"David M Allen","doi":"10.47102/annals-acadmedsg.2026333","DOIUrl":"10.47102/annals-acadmedsg.2026333","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"292-293"},"PeriodicalIF":2.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298314","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":"Feasibility of targeted tonsillectomy histology in Southeast Asia: A review of 4115 paediatric tonsillectomies.","authors":"Christopher Zx Chua, Sze Jet Aw, Julian Lee, Henry Kk Tan, Kenneth Te Chang","doi":"10.47102/annals-acadmedsg.2026142","DOIUrl":"10.47102/annals-acadmedsg.2026142","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"440-443"},"PeriodicalIF":2.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427687","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":"Strengthening infection control in Singapore's nursing homes: Lessons, limitations, and the road ahead.","authors":"Meng Ying Sim, Ray Junhao Lin","doi":"10.47102/annals-acadmedsg.2026362","DOIUrl":"10.47102/annals-acadmedsg.2026362","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"347-349"},"PeriodicalIF":2.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427695","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}