Annals of the Academy of Medicine, Singapore最新文献

{"title":"Knowledge, attitudes and practices of doctors on constipation management in Singapore.","authors":"Chun En Chua, Ni Yin Lau, V Vien Lee, Agata Blasiak, Christopher Tze Wei Chia, Andrew Ming-Liang Ong, Tze Lee Tan, Yi Kang Ng, Wai Mun Loo, En Xian Sarah Low, Kenny Ching Pan Sze, Daphne Ang, Alex Yu Sen Soh, Dean Ho, Kewin Tien Ho Siah","doi":"10.47102/annals-acadmedsg.2023270","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023270","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452675","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 systematic review and meta-analysis on the effect of goal-directed fluid therapy on postoperative outcomes in renal transplantation surgeries.","authors":"Caitlin Lmc Choo, Lawrence Sc Law, Wen Jie How, Benjamin Ys Goh, Balakrishnan Ashokka","doi":"10.47102/annals-acadmedsg.202367","DOIUrl":"10.47102/annals-acadmedsg.202367","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature.</p><p><strong>Method: </strong>A systematic search of patients aged ≥18 years who have undergone single-organ primary renal transplantations up to June 2022 in PubMed, Embase, Scopus and CINAHL Plus was performed. Primary outcome examined was postoperative renal function. Secondary outcomes assessed were mean arterial pressure at graft reperfusion, intraoperative fluid volume and other postoperative complications. Heterogeneity was tested using I² test. The study protocol was registered on PROSPERO.</p><p><strong>Results: </strong>A total of 2459 studies were identified. Seven eligible studies on 607 patients were included. Subgroup assessments revealed potential renal protective benefits of GDT, with patients receiving cadaveric grafts showing lower serum creatinine on postoperative days 1 and 3, and patients monitored with arterial waveform analysis devices experiencing lower incidences of postoperative haemodialysis. Overall analysis found GDT resulted in lower incidence of tissue oedema (risk ratio [RR] 0.34, 95% CI 0.15-0.78, P=0.01) and respiratory complications (RR 0.39, 95% CI 0.17-0.90, P=0.03). However, quality of data was deemed low given inclusion of non-randomised studies, presence of heterogeneities and inconsistencies in defining outcomes measures.</p><p><strong>Conclusion: </strong>While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452669","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":"Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit.","authors":"Jie Ming Nigel Fong, Maria Erika Gapas Ramirez, Yi Shern Terence Kee, Shien Wen Sheryl Gan, Marjorie Wai Yin Foo, Manish Kaushik, Chieh-Suai Tan","doi":"10.47102/annals-acadmedsg.2023272","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023272","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452676","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 in medicine: Ethical, social and legal perspectives.","authors":"Joseph Sung","doi":"10.47102/annals-acadmedsg.2023272","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023272","url":null,"abstract":"<p><p>Artificial intelligence (AI) has permeated into every aspect of medicine and promises to provide accurate diagnosis, better management decision and improved outcome for patients and healthcare system. However, ethical, social and legal issues need to be resolved for successful implementation of AI tools in clinical practice. In order to gain trust and acceptance, AI algorithms should offer maximum explainability and inclusiveness. Robust evidence of benefit to patients and healthcare services has to be provided to gain justification of using these tools. Doctor-patient relationship needs to be maintained in order to gain trust and acceptance of users. Autonomy of decisions and dignity of patients need to be preserved while using machine in healthcare. Responsibility and accountability in the use of AI in medicine should be deliberated and defined before mishaps and damage occur. A new role of healthcare providers will emerge with the advancement of technology and changes are inevitable. This manuscript is based on the Gordon Arthur Ransome Lecture 2022 entitled \"Artificial Intelligence in Medicine: Ethical, Social and Legal Perspective\". It represents the opinion of the orator.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452671","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":"Understanding the use of evidence-based medical therapy in patients with peripheral artery disease: A qualitative study using the Tailored Implementation for Chronic Diseases Framework.","authors":"Yingqi Xu, Candelyn Yu Pong, Charyl Jia Qi Yap, Vanessa Khoo, Nicholas Graves, Tze Tec Chong, Tjun Yip Tang, Sze Ling Chan","doi":"10.47102/annals-acadmedsg.2023146","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023146","url":null,"abstract":"<p><strong>Introduction: </strong>The global burden of peripheral artery disease (PAD) has been increasing. Guidelines for PAD recommend evidence-based medical therapy (EBMT) to reduce the risks of cardiovascular events and death but the implementation of this is highly variable. This study aimed to understand the current practices regarding EBMT prescription in PAD patients and the key barriers and facilitators for implementing PAD guidelines.</p><p><strong>Method: </strong>A qualitative study was conducted in the largest tertiary hospital in Singapore from December 2021 to March 2023. The participants included healthcare professionals and in-patient pharmacists involved in the care of PAD patients, as well as patients with PAD who had undergone a lower limb angioplasty revascularisation procedure. Data were collected through in-depth, individual semi-structured interviews conducted face-to-face or remotely by a trained research assistant. Interviews were audio-recorded, transcribed and systematically coded using data management software NVivo 12.0. The Tailored Implementation for Chronic Diseases (TICD) framework was used to guide the interviews and analysis.</p><p><strong>Results: </strong>Twelve healthcare professionals (4 junior consultants, 7 senior consultants, and 1 senior in-patient pharmacist) and 4 patients were recruited. Nine themes in 7 domains emerged. Only a small proportion of doctors were aware of the relevant guidelines, and the generalisability of guidelines to patients with complicated conditions was the doctors' main concern. Other barriers included cost, frequent referrals, lack of interprofessional collaboration, not being the patients' long-term care providers, short consultation time and patients' limited medication knowledge.</p><p><strong>Conclusion: </strong>Findings from this study may inform strategies for improving healthcare professionals' adherence to guidelines and patients' medication adherence.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452678","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":"Four cases of HIV infection in men taking pre-exposure prophylaxis in Singapore.","authors":"Woo Chiao Tay, Martin Tze-Wei Chio, Benjamin Wen Yang Ho, Sophia Archuleta, Dariusz Piotr Olszyna","doi":"10.47102/annals-acadmedsg.2023228","DOIUrl":"10.47102/annals-acadmedsg.2023228","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452674","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":"Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea.","authors":"Sung Hwan Yoo, Ju-Young Park, Hye Sun Lee, Hyun Woong Lee, Jung Il Lee","doi":"10.47102/annals-acadmedsg.202379","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202379","url":null,"abstract":"<p><strong>Introduction: </strong>Non-alcoholic fatty liver disease (NAFLD) is known to be associated with metabolic syndrome of which diabetes is an important component. Although diabetes is a known risk factor for dementia, studies on the association between NAFLD and dementia still produce conflicting results. This study aimed to determine whether NAFLD would be a risk factor for the development of dementia in an elderly population.</p><p><strong>Method: </strong>This study included 107,369 subjects aged ≥60 years in the Korean National Health Insurance Service-Senior cohort, entered in 2009 and followed up until 2015. NAFLD was diagnosed by calculating fatty liver index (FLI). Subjects were screened for dementia at baseline using a Korean Dementia Screening Questionnaire, and dementia was diagnosed using ICD-10 codes. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection.</p><p><strong>Results: </strong>From 107,369 subjects, 65,690 stroke- and dementia-free subjects without chronic hepatitis B or C or excessive alcohol drinking were selected for evaluation. Having NAFLD, determined by FLI, was associated with increased risk of dementia development (adjusted odds ratio [AOR] 1.493; 95% confidence interval [CI] 1.214-1.836). The increased risk of dementia in NAFLD subjects was independent of type 2 diabetes (AOR 1.421; 95% CI 1.013-1.994, in subjects with diabetes: AOR 1.540; 95% CI 1.179- 2.010, in subjects without diabetes).</p><p><strong>Conclusion: </strong>In this population-based nested case-control study, having NAFLD increased the risk of dementia in elderly individuals, independent of accompanying diabetes.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452666","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":"Clinical utility of PET/MRI in multiple myeloma.","authors":"Cinnie Soekojo, Lenith Tai Jit Cheng, Wee Ming Peh, Sanjay de Mel, Melissa Ooi, Ying-Hwey Nai, Anthonin Reilhac, Lih Kin Khor, Wee Joo Chng","doi":"10.47102/annals-acadmedsg.2022414","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022414","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the clinical utility of positron emission tomography/magnetic resonance imaging (PET/MRI), especially in comparison with PET/computed tomography (CT), which has been widely used in clinical practice in multiple myeloma.</p><p><strong>Method: </strong>F-18 fluorodeoxyglucose PET/MRI and PET/ CT studies were done at baseline and when at least a partial response to treatment was achieved. These were done for newly-diagnosed myeloma patients who have not had more than 1 cycle of anti-myeloma treatment, or for relapsed and/or refractory myeloma patients before the start of next line of therapy.</p><p><strong>Results: </strong>PET/MRI correlated significantly with PET/CT, in terms of number of lesions detected, standardised uptake value (SUVmean and SUVmax, both at baseline and post-treatment. PET/MRI and PET/CT correlated with survival at baseline, but not post-treatment.</p><p><strong>Conclusion: </strong>In this study, PET/MRI was more sensitive in detecting early disease and disease resolution post-treatment, compared with PET/CT. However, PET/MRI was less sensitive in detecting lesions in the ribs, clavicle and skull.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452644","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":"Improving visual outcomes in patients with rare paediatric eye diseases.","authors":"Faye Yu Ci Ng, Poh Lin Tan, Gangadhara Sundar","doi":"10.47102/annals-acadmedsg.202323","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202323","url":null,"abstract":"<p><strong>Introduction: </strong>Rare paediatric eye diseases (RPEDs) threaten both vision and life. Recently, rare diseases were recognised as a global public health agenda, with children specified as a priority in the World Health Organization's VISION 2020 against avoidable visual loss.</p><p><strong>Method: </strong>We conducted a review through a query of online databases (PubMed, Embase and Cochrane Library). Articles related to RPEDs were selected based on relevance by 2 authors, with any disagreements adjudicated by the third author.</p><p><strong>Results: </strong>We synthesise the current state of knowledge regarding RPEDs, barriers to their care, and recommendations for the future. RPEDs often result in significant visual loss, profoundly impacting the way children comprehend and participate in the world. These diseases may also reduce life expectancy and even be life-threatening. Barriers to the care of RPEDs include an unclear definition of \"rare diseases\", missed or delayed diagnosis, inadequate knowledge and expertise in management, and challenging research environments.</p><p><strong>Conclusion: </strong>Our findings provide an update on the diagnosis and management of RPEDs, which is of relevance to ophthalmologists, paediatricians, healthcare policymakers and social workers. We propose supportive policies and adequate resource allocation to these diseases, comprehensive and patient-centred care, alongside improved education and training, enhanced research capabilities and continued collaboration across institutions.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452646","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":"Improving management of AL amyloidosis.","authors":"Yuh Shan Lee, Jeffrey Huang","doi":"10.47102/annals-acadmedsg.2023370","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023370","url":null,"abstract":"","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452645","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}