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Current Management and Treatment for Patients with Chronic Kidney Disease 慢性肾脏病患者的管理和治疗现状
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.u1
Chon Jun Jason Choo
{"title":"Current Management and Treatment for Patients with Chronic Kidney Disease","authors":"Chon Jun Jason Choo","doi":"10.33591/sfp.48.5.u1","DOIUrl":"https://doi.org/10.33591/sfp.48.5.u1","url":null,"abstract":"The incidence of chronic kidney disease (CKD) is rising in many parts of the world and primary care providers are poised to be the first point of contact for these patients. The optimal management of patients with CKD include early detection, cause identification, CKD progression retardation (including dietary support, blood pressure control, drug therapeutics), management of comorbid conditions, acute kidney injury prevention, and knowing when to refer for specialist care. In general, the concept of CKD progression retardation involves patient education on topics such as lifestyle modification measures, e.g., diet, to reduce burden on the kidneys and use of medications that can confer renoprotection while causing little if any side effects. The advent of SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and new potassium binders provides our patients with new hope to further lengthen the time to end-stage kidney failure. It is therefore necessary that stakeholders involved in the care of patients with CKD understand the latest evidence to optimise care and patient wellbeing.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48947982","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}
引用次数: 0
Complications of Chronic Kidney Disease: Therapeutic Approaches and What Can Be Done to Halt Disease Progression? 慢性肾脏疾病的并发症:治疗方法和如何阻止疾病进展?
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.u3
B. Khan
{"title":"Complications of Chronic Kidney Disease: Therapeutic Approaches and What Can Be Done to Halt Disease Progression?","authors":"B. Khan","doi":"10.33591/sfp.48.5.u3","DOIUrl":"https://doi.org/10.33591/sfp.48.5.u3","url":null,"abstract":"Singapore is one of the most rapidly ageing societies in the world. Currently, Singapore ranks first in the world for the incidence of diabetes-induced end-stage renal disease (ESRD) and seventh for the incidence of kidney failures per million population. It is estimated that nearly one-quarter of Singapore’s population will have chronic kidney disease (CKD) by 2035. Disease management of CKD has been identified as a critical issue due to the rapid increase in cases among the elderly in recent years. Chronic kidney disease is associated with adverse clinical outcomes, and metabolic complications such as anaemia, cardiovascular events, and CKD-associated metabolic bone diseases present treatment management complexities to healthcare professionals. Early detection and management of CKD can avert complications before symptoms occur and prevent the progressive loss of kidney function over time. Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) are recommended for hypertension and proteinuria management in CKD patients with and without diabetes. However, neither of these agents alone reduces the risk of all-cause mortality; furthermore, combinational therapy of ACEI plus ARB is associated with renal dysfunction, stroke, and/or hyperkalaemia. Recently, the use of sodium–glucose cotransporter 2 inhibitors (SGLT2i) has been shown to provide favourable effects on the kidney and cardiovascular outcomes in patients with or without type 2 diabetes mellitus. Studies have shown that early initiation of SGLT2i may slow or halt the progression of CKD in patients with the risk of CKD and ESRD. This review discusses the mechanisms underlying the progression of CKD, its associated risk factors and summarises the management strategies as per Kidney Disease Outcomes Quality Initiative clinical practice guideline recommendations. This article also summarises the evidence regarding the use of SGLT2i in slowing the progression of CKD and improvement of health-related quality of life.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47467583","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}
引用次数: 0
Sporadic Creutzfeldt-Jakob Disease Presenting with Rapidly Progressing Dementia – A Family Medicine Perspective of Two Case Reports 散发性克雅氏病伴快速发展性痴呆——两例病例的家庭医学观察
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.uc2
Lin Xin, S. J. Jiang
{"title":"Sporadic Creutzfeldt-Jakob Disease Presenting with Rapidly Progressing Dementia – A Family Medicine Perspective of Two Case Reports","authors":"Lin Xin, S. J. Jiang","doi":"10.33591/sfp.48.5.uc2","DOIUrl":"https://doi.org/10.33591/sfp.48.5.uc2","url":null,"abstract":"Dementia is an increasing problem in Singapore’s ageing population with the most common being Alzheimer’s disease, vascular dementia, and mixed dementia. Creutzfeldt-Jakob Disease (CJD) is a fatal neurodegenerative condition that causes rapidly progressive dementia. It is a rare human transmissible prion disease with limited literature in Southeast Asia. In this article, we report 2 patients diagnosed with CJD who presented to primary care with rapidly progressive dementia, behavioral changes, and rapid functional decline. Deterioration of their clinical condition was relentless, and treatment remained palliative and supportive. It is important for family physicians to be cognisant of the clinical manifestations of CJD. We will outline the role of family physicians in the management of patients with CJD in different healthcare settings – general practice, tertiary hospital, community hospital and hospice home care.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42578345","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}
引用次数: 0
HALT-ing CKD Progression in Patients with Diabetes Mellitus 糖尿病患者CKD进展的HALT
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.u2
A. Ang
{"title":"HALT-ing CKD Progression in Patients with Diabetes Mellitus","authors":"A. Ang","doi":"10.33591/sfp.48.5.u2","DOIUrl":"https://doi.org/10.33591/sfp.48.5.u2","url":null,"abstract":"Up to 16 percent of the world’s population has chronic kidney disease, the leading causes of which are diabetes mellitus, hypertension, and ageing. Diabetic kidney disease (DKD) is classified by severity, like any CKD into five GFR categories (G1-G5) and three albuminuria categories (A1-A3).","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44805093","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}
引用次数: 0
Putting A Stop To CKD 制止慢性肾病
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.e
Shu Hui Grace
{"title":"Putting A Stop To CKD","authors":"Shu Hui Grace","doi":"10.33591/sfp.48.5.e","DOIUrl":"https://doi.org/10.33591/sfp.48.5.e","url":null,"abstract":"Chronic kidney disease (CKD), defined as kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for three months or more, irrespective of cause, is a major global public health problem.1 CKD is an incurable progressive disease that has become one of the most rapidly rising causes of death worldwide.2,3 CKD is associated with adverse outcomes of kidney failure, cardiovascular disease, and premature death, especially in people with diabetes mellitus and hypertension.2,3 In Singapore, CKD has become an increasingly prevalent and alarming disease in recent years. Singapore is ranked first in the world for diabetes-induced kidney failure, and fourth and seventh in the world for prevalence of kidney failure and incidence of kidney failure respectively.4 There are currently more than 8,500 dialysis patients in Singapore and it is estimated that 5.7 new patients are diagnosed with end-stage kidney failure in Singapore daily.4 Given that CKD is not only associated with a higher burden of complications, morbidity, and mortality, but also significant economic burden and poorer quality of life, it is imperative that kidney function be preserved. Preservation of kidney function results in improved health outcomes and can be achieved through a combination of non-pharmacological strategies (i.e., lifestyle and dietary modifications) and CKD-targeted and kidney disease-specific pharmacological interventions.2 This issue will provide an update on the latest evidence-based treatment options in CKD management. The College is pleased to partner with AstraZeneca to conduct this Family Practice Skills Course for our doctors.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46487139","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}
引用次数: 0
Approach to the Management of Pain in a Patient With Cancer in the Community Hospital 社区医院癌症患者疼痛管理探讨
The Singapore family physician Pub Date : 2022-05-01 DOI: 10.33591/sfp.48.5.uc1
Ami Nagashima, Hwei May Victoria Wong, Bangyu Xu
{"title":"Approach to the Management of Pain in a Patient With Cancer in the Community Hospital","authors":"Ami Nagashima, Hwei May Victoria Wong, Bangyu Xu","doi":"10.33591/sfp.48.5.uc1","DOIUrl":"https://doi.org/10.33591/sfp.48.5.uc1","url":null,"abstract":"Pain is a common symptom in patients with cancer. Up to two thirds of patients with cancer experience pain that requires a strong opioid for pain relief. Cancer pain management can be challenging as the pain experience differs among patients. A patient’s response to opioids and other analgesia depends on several factors such as the character and cause of pain, and the pharmacodynamics and pharmacokinetics of the drug. Optimizing pain control is important, as pain can impact negatively on many aspects of a patient’s life such as mood, sleep, social interactions, cognition and physical function, resulting in physical, emotional and existential suffering. We will use the following case study to illustrate the process of pain assessment and the importance of understanding the aetiology of the pain in a patient with cancer. We will also discuss the pharmacological and non-pharmacological management of cancer pain.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46912912","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}
引用次数: 0
The Role Of GPs In Supporting Caregivers Of Persons With Dementia In Singapore 全科医生在支持新加坡痴呆症患者护理中的作用
The Singapore family physician Pub Date : 2022-03-30 DOI: 10.33591/sfp.47.4.u6
D. S. Chai, Philip Yap Lin Kiat
{"title":"The Role Of GPs In Supporting Caregivers Of Persons With Dementia In Singapore","authors":"D. S. Chai, Philip Yap Lin Kiat","doi":"10.33591/sfp.47.4.u6","DOIUrl":"https://doi.org/10.33591/sfp.47.4.u6","url":null,"abstract":"Dennis Seow Chuen Chai Senior Consultant Department of Geriatric Medicine Singapore General Hospital MENTAL HEALTH 2021 UPDATE https://doi.org/10.33591/sfp.47.4.u6 UNIT NO. 6 THE ROLE OF GPS IN SUPPORTING CAREGIVERS OF PERSONS WITH DEMENTIA IN SINGAPORE Dr Dennis Seow Chuen Chai, Dr Philip Yap Lin Kiat Caregiver interventions have been shown to reduce caregiver depression, the burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers need caring too. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from dealing with behavioural problems can lessen as the burden from coping with physical and functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to create a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community. The role of the GP in supporting the caregiver is more important than ever amid the current COVID-19 pandemic.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46679956","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}
引用次数: 0
Mental Health 2022 2022年心理健康
The Singapore family physician Pub Date : 2022-03-30 DOI: 10.33591/sfp.48.4.e
{"title":"Mental Health 2022","authors":"","doi":"10.33591/sfp.48.4.e","DOIUrl":"https://doi.org/10.33591/sfp.48.4.e","url":null,"abstract":"","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43753895","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}
引用次数: 3
The Ecosystem of Community Mental Health in Singapore 新加坡社区心理健康生态系统
The Singapore family physician Pub Date : 2022-03-30 DOI: 10.33591/sfp.48.4.up1
D. Teo, Jared Ng, S. Soo, S. C. Kwan, W. Tan, Chih Wei Sally Ho, L. H. Peh
{"title":"The Ecosystem of Community Mental Health in Singapore","authors":"D. Teo, Jared Ng, S. Soo, S. C. Kwan, W. Tan, Chih Wei Sally Ho, L. H. Peh","doi":"10.33591/sfp.48.4.up1","DOIUrl":"https://doi.org/10.33591/sfp.48.4.up1","url":null,"abstract":"Community psychiatry focuses on the delivery of a coordinated programme of mental healthcare to a specified population. Mental illness is prevalent and a significant cause of morbidity in Singapore. In line with Singapore’s drive toward right siting of care, community psychiatry will play a pivotal role in providing timely access to effective and affordable mental healthcare in the community. This paper provides an overview of the community mental health ecosystem and range of services that seek to integrate mental and physical healthcare with social and community support in Singapore. We discuss systemic challenges such as financing issues and patient confidentiality in relation to the important role primary care physicians play in enhancing community mental health. Finally, we propose solutions and future directions to develop an effective and sustainable ecosystem for community mental health in Singapore.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44286294","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}
引用次数: 1
Continuity of Care of the Schizophrenia Patients in the Community 精神分裂症患者社区护理的连续性
The Singapore family physician Pub Date : 2022-03-30 DOI: 10.33591/sfp.48.4.u4
{"title":"Continuity of Care of the Schizophrenia Patients in the Community","authors":"","doi":"10.33591/sfp.48.4.u4","DOIUrl":"https://doi.org/10.33591/sfp.48.4.u4","url":null,"abstract":"","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46636666","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}
引用次数: 0
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