Annals of the Academy of Medicine, Singapore最新文献

{"title":"Singapore expert consensus on optimising lipid-lowering strategies in acute coronary syndrome: A modified Delphi study.","authors":"Ru San Tan, Jonathan Yap, Colin Yeo, Kian Keong Poh, Peter Chee Hong Yan, Pow Li Chia, Michael Chun Leng Lim, David Foo, Fahim Haider Jafary, Natalie Si Ya Koh","doi":"10.47102/annals-acadmedsg.2025459","DOIUrl":"10.47102/annals-acadmedsg.2025459","url":null,"abstract":"<p><strong>Introduction: </strong>Acute coronary syndrome (ACS) carries a high early risk of recurrent events, yet time-to-target low-density lipoprotein cholesterol (LDL-C) is often prolonged, and goal attainment is suboptimal in real-world practice. The authors aimed to develop expert consensus recommendations for post-ACS lipid management in Singapore, focusing on LDL-C targets, pharmacotherapy, escalation strategies, and implementation tools to improve adherence and reduce therapeutic inertia.</p><p><strong>Method: </strong>A modified Delphi methodology was employed with a panel of 10 members. Evidence was synthesised from guidelines, randomised trials, metaanalyses, and observational studies. Thirty-two statements were drafted across 5 domains (LDL-C targets; timing/ monitoring; pharmacotherapy; special populations; implementation/adherence/health-system strategies) and rated anonymously on a 5-point Likert scale. Consensus thresholds were defined as high (≥75% concordant), moderate (55-74%), and low (<55%).</p><p><strong>Results: </strong>After the final round, 30 of 32 statements achieved high consensus, and 2 received low consensus. Key agreements included measuring lipids within 24 hours of admission and retesting at 4-6 weeks, early initiation of high-intensity statins, and upfront combination therapy with statin + ezetimibe when monotherapy is unlikely to achieve the goals. Consideration of a proprotein convertase subtilisin/kexin type 9 inhibitor at discharge was recommended if LDL-C remained >1.4 mmol/L. Special considerations included older adults, familial hypercholesterolaemia, lower statin adherence among women, and the role of lipoprotein(a). The panel recommended adopting objective metrics, integrating electronic health record prompts, and developing localised pathways to harmonise care transitions.</p><p><strong>Conclusion: </strong>The consensus recommendations provide a tailored approach for Singapore, emphasising early action, proactive escalation, and systems-level interventions to improve post-ACS outcomes.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"318-331"},"PeriodicalIF":2.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177528","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":"Association of estimated pulse wave velocity with 28-day mortality in sepsis: A MIMIC-IV study.","authors":"Xiuxiu Ding, Chaochao Wei, Shuang Cai, Bingli Zhan, Jiwei Li, Dajia Fu","doi":"10.47102/annals-acadmedsg.2025400","DOIUrl":"10.47102/annals-acadmedsg.2025400","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the association between sepsis and carotid-femoral pulse wave velocity, the relationship between estimated pulse wave velocity (ePWV) and sepsis remains unclear. This study investigated the correlation between ePWV and 28-day mortality in patients with sepsis.</p><p><strong>Method: </strong>Using data from the Medical Information Mart for Intensive Care IV database between 2008 and 2019, the association between ePWV and 28-day mortality was analysed with Kaplan-Meier curves, Cox models, and res-tricted cubic splines (RCS). Subgroup analysis was performed to validate the findings. A combined model was constructed by screening variables via Cox-least absolute shrinkage and selection operator (LASSO), with its incremental predictive value evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).</p><p><strong>Results: </strong>Survival analysis showed an inverse association between ePWV and survival rates (log-rank test P<0.001). Cox analysis demonstrated that each increase in ePWV was associated with a significantly higher risk of 28-day mortality in patients with sepsis (hazard ratio 1.905, 95% confidence interval 1.672-2.169, P<0.001), with linearity confirmed by RCS analysis (P-nonlinear=0.3313). Subgroup analysis indicated significant interaction effects of invasive ventilation (P-interaction <0.001) and a history of malignant tumours (P-interaction =0.005) on mortality. The combined model optimised by LASSO demonstrated the best discriminative performance (ROC=0.823) and an improved net clinical benefit with the inclusion of ePWV, as confirmed by DCA.</p><p><strong>Conclusion: </strong>ePWV was linearly and positively correlated with the risk of 28-day mortality in patients with sepsis.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"294-304"},"PeriodicalIF":2.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177529","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":"Transcatheter aortic valve implantation for severe aortic regurgitation with Trilogy system: Initial Southeast Asia experience.","authors":"Jonathan Yap, Samuel Ji Quan Koh, Zameer Abdul Aziz, Sivaraj Govindasamy, Victor Tar Toong Chao, Mohammed Rizwan Amanullah, See Hooi Ewe, Kay Woon Ho","doi":"10.47102/annals-acadmedsg.2026159","DOIUrl":"10.47102/annals-acadmedsg.2026159","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"388-391"},"PeriodicalIF":2.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177530","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 inflammation and nutritional status: Monocyte-to-albumin ratio as a novel prognostic marker in nasopharyngeal cancer.","authors":"Mark Kit Lim, Tze Choong Charn, Boon Huat Bay","doi":"10.47102/annals-acadmedsg.2026340","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2026340","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 5","pages":"229-230"},"PeriodicalIF":2.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145866","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":"Percutaneous electrosurgical leaflet laceration to prevent coronary obstruction during TAVI for severe aortic regurgitation.","authors":"Paul Toon Lim Chiam, Choon Pin Lim, Yean Teng Lim, Cumaraswamy Sivathasan","doi":"10.47102/annals-acadmedsg.2026232","DOIUrl":"10.47102/annals-acadmedsg.2026232","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"436-439"},"PeriodicalIF":2.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145861","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":"Prognostic value of the monocyte-to-albumin ratio in nasopharyngeal carcinoma: A retrospective cohort study.","authors":"Wei-Qiong Ni, Fei Xu, Yong-Miao Lin, Zhi-Qing Long, Fang-Fang Duan, Xin Huang, Wen Xia, De-Huan Xie, Ao-Qiang Chen, Sha-Sha Du, Xin Hua","doi":"10.47102/annals-acadmedsg.2025469","DOIUrl":"10.47102/annals-acadmedsg.2025469","url":null,"abstract":"<p><strong>Introduction: </strong>Although monocyte and albumin levels have been associated with survival in various malignant tumours, their specific prognostic significance in nasopharyngeal carcinoma (NPC) remains under-explored. This study seeks to examine the relationship between the monocyte-to-albumin ratio (MAR) and overall survival (OS) in NPC patients to create a precise prediction model.</p><p><strong>Method: </strong>The authors retrospectively analysed data from 860 NPC patients who underwent concurrent chemoradiotherapy. The optimal cut-off for MAR was determined using the maximum selection log-rank method. Univariate and multivariate Cox proportional hazards models were applied to identify factors significantly related to OS. A predictive nomogram was then developed and rigorously validated for its accuracy.</p><p><strong>Results: </strong>The optimal MAR threshold was determined to be 11.63, effectively categorising the 860 NPC patients into 2 prognostic subgroups (hazard ratio 0.56; 95% confidence interval [CI] 0.41-0.77, P<0.001). The predictive nomogram exhibited strong predictive capability for OS, factoring in T stage, N stage, MAR value, body mass index, and age over 45 years. The concordance index (C-index) of the traditional tumour- node-metastasis staging system was found to be 0.64 (95% CI 0.57-0.70), which was less than the C-index of the nomogram (0.68; 95% CI 0.64-0.72) for OS.</p><p><strong>Conclusion: </strong>MAR was identified as an innovative and independent prognostic factor in NPC patients, presenting a potential biomarker for personalised treatment strategies.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 5","pages":"231-239"},"PeriodicalIF":2.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145904","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 multicomponent control programme in nursing homes in Singapore.","authors":"Louisa Sun, Nares Smitasin, Brenda Mae Alferez Salada, Cathrine Teo, Garvi Pandya, Xin Hu, Dale Andrew Fisher","doi":"10.47102/annals-acadmedsg.2026237","DOIUrl":"10.47102/annals-acadmedsg.2026237","url":null,"abstract":"<p><strong>Introduction: </strong>Nursing home (NH) residents are vulnerable to infections and avoidable hospital transfers. The Infectious Diseases Community Program was developed as a multicomponent intervention to strengthen infection prevention and control (IPC), improve vaccination uptake, and support clinical decisionmaking in NHs.</p><p><strong>Method: </strong>The authors conducted a retrospective cohort study in 6 NHs in western Singapore with pre- and post-implementation data, in collaboration with an acute hospital. A total of 4801 admissions were screened, of which 2045 fever-related admissions were included. The intervention comprised IPC training, policy and process reviews, vaccination support, antimicrobial guidance, and implementation of a structured fever and desaturation pathway to standardise hospital transfer decisions.</p><p><strong>Results: </strong>New methicillin-resistant Staphylococcus aureus (MRSA) acquisitions declined from 14.6% to 9.7% (relative reduction 33.6%, 95% confidence interval [CI] -6.8 to -3.1, P<0.001). Inappropriate fever-related transfers decreased from 12.0% (108/898) to 7.3% (61/839), a relative reduction of 39.2% (absolute reduction 4.8%, 95% CI -7.5 to -2.0, P<0.001). Influenza vaccination coverage exceeded 90% by 2022. Staff surveys indicated sustained adoption, with 84% reporting regular use of the pathway.</p><p><strong>Conclusion: </strong>A collaborative model integrating acute hospital expertise with NH teams was associated with improved IPC outcomes, increased vaccination coverage, and reduced inappropriate transfers, supporting safer care delivery in long-term care.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"350-357"},"PeriodicalIF":2.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145914","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":"2025 Singapore consensus statements on the management of osteoporosis.","authors":"Linsey Gani, Siok Bee Chionh, Nur Azizah Allameen, Elizabeth Jiahui Chan, Manju Chandran, Bertrand Chew, Ivan Chua, Swee Sen Foo, Intekhab Islam, Tang Ching Lau, Vivien Lim, Wen Yi Lim, Alvin Ng, Rani Ramason, Donovan Tay, Jason Shau Khng Lim, Eu-Leong Yong, Seng Bin Ang","doi":"10.47102/annals-acadmedsg.202658","DOIUrl":"10.47102/annals-acadmedsg.202658","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis is a progressive disease characterised by changes in bone structure leading to fragility fractures. In Singapore, it is a significant health concern with a high prevalence, and is expected to increase as the population ages. These consensus statements aim to provide scientifically grounded recommendations for the management of osteoporosis, to standardise its management in Singapore and promote multidisciplinary collaboration.</p><p><strong>Method: </strong>An expert panel comprising 18 representatives from 10 Singapore medical bodies developed consensus statements based on current evidence and through multiple online meetings. Each panellist voted on each statement independently using a 3-point Likert scale (Agree, Neutral, Disagree). Consensus (total ratings of \"Agree\") was set a priori at ≥80%, with statements not reaching this threshold excluded for lacking consensus.</p><p><strong>Results: </strong>The expert panel reached consensus on 80 consensus statements. These include 10 statements on screening, risk factors, and fracture risk assessment; 7 statements on initial bone mineral density testing; 5 on the indications for pharmacotherapy; 20 on osteoporosis pharmacotherapy; 24 on treatment targets, treatment monitoring, and follow-up bone mineral density testing; and 14 statements on the prevention and management of medication-related osteonecrosis of the jaw.</p><p><strong>Conclusion: </strong>The consensus statements in this paper guide clinicians in using the latest evidence and expert opinion to inform appropriate diagnostic and therapeutic approaches for the management of osteoporosis. These statements are not intended to replace current guidelines, but rather to support clinical decision-making and help develop individualised, patient-centred management plans based on the patient's demographics, clinical characteristics, and preferences.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"55 5","pages":"252-268"},"PeriodicalIF":2.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145886","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 primary care perspective on gender-focused mental health services in Singapore: Correspondence.","authors":"Jeremiah Pereira","doi":"10.47102/annals-acadmedsg.2026285","DOIUrl":"10.47102/annals-acadmedsg.2026285","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"396-397"},"PeriodicalIF":2.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960438","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":"The effect of pulse steroid therapy on bone density and turnover: A systematic review and meta-analysis.","authors":"Lawrence Siu-Chun Law, Fatima Siddiqui, Amal Al-Aamri, Siok Bee Chionh, Pei Chia Eng, Chin Meng Khoo","doi":"10.47102/annals-acadmedsg.2026123","DOIUrl":"10.47102/annals-acadmedsg.2026123","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic exposure to glucocorticoids (GC) is a leading cause of secondary osteoporosis and fractures. While the skeletal effects of long-term oral GC are wellestablished, the bone effects of intermittent high-dose intravenous pulse methylprednisolone therapy remain less clearly defined. This study aimed to evaluate its impact on skeletal health in adults not receiving antiosteoporosis treatment.</p><p><strong>Method: </strong>This meta-analysis was conducted according to PRISMA guidelines and prospectively registered. PubMed, Scopus, Embase, and Google Scholar were searched up to September 2025. Studies included longitudinal cohort and case-control studies with appropriate comparators and randomised controlled trials reporting pre- and post-intravenous methylprednisolone bone outcomes.</p><p><strong>Results: </strong>Eight studies (n=192, 72% females) were included. Pulse intravenous methylprednisolone did not significantly reduce bone mineral density (BMD) at the lumbar spine (mean difference [MD] 0.01 g/cm2; 95% confidence interval [CI] -0.02 to 0.03), femoral neck (MD -0.01 g/cm2; 95% CI -0.03 to 0.01), or total hip (MD -0.03 g/cm2; 95% CI -0.06 to 0.01) over a mean followup period of 5.5 months. Trabecular bone score showed no significant pooled change (MD -0.01 g/cm2). In contrast, procollagen type-1 N-terminal propeptide (MD -36.95 ng/mL; 95% CI -56.86 to -17.03) and C-terminal telopeptide (MD -0.19 ng/dL; 95% CI -0.32 to -0.07) significantly decreased. Serum 25-hydroxyvitamin D increased modestly, while serum calcium and parathyroid hormone remained unchanged.</p><p><strong>Conclusion: </strong>Pulse intravenous methylprednisolone does not cause short-term BMD loss, though it is associated with measurable suppression of bone turnover markers. Larger controlled studies with standardised sampling, peripheral site assessment, and fracture outcomes are needed to determine long-term skeletal risk from pulse regimens.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":" ","pages":"189-200"},"PeriodicalIF":2.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960418","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}