Singapore medical journal最新文献

{"title":"Safety and efficacy of ambulatory total knee arthroplasty with enhanced recovery after surgery protocols in well-selected patients aged 80 years and older.","authors":"Carol Xiaoshu Zhao, Kelvin Guoping Tan","doi":"10.4103/singaporemedj.SMJ-2024-157","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-157","url":null,"abstract":"<p><strong>Introduction: </strong>An enhanced recovery after surgery protocol following total knee arthroplasty (TKA) offers multiple benefits. However, there are concerns about whether old age should be a criterion for exclusion from this protocol. This study aimed to determine the safety and outcomes of ambulatory TKA for patients aged ≥80 years.</p><p><strong>Methods: </strong>A retrospective study was conducted using data from our hospital knee registry database (2021-2024). We compared the length of hospital stay, complication rate, readmission rate, three-month postoperative functional outcomes and overall experiences of patients (aged ≥80 years) who underwent ambulatory TKA with patients (aged ≥80 years) who underwent non-ambulatory TKA and younger patients who underwent ambulatory TKA. Functional outcomes were evaluated using Oxford Knee Score (OKS), Knee Society Clinical Score (KSS) and Knee Society Functional Score (KSFS). The minimal clinically important difference cutoffs for OKS, KSFS and KSS were 5.0, 6.4 and 5.9, respectively.</p><p><strong>Results: </strong>There were clinically significant improvements in the three-month postoperative functional scores compared to preoperative scores in all patient groups. Patients aged ≥80 years who underwent ambulatory TKA had lower complication and readmission rates compared to the other patient groups. They also had better three-month postoperative functional scores than patients who underwent non-ambulatory TKA ( P = 0.004 for OKS, P = 0.003 for KSFS), and similar outcomes as younger patients ( P > 0.050 for OKS, KSFS). Length of hospital stay, satisfaction rates and rates of expectation met were comparable between patients aged ≥80 years and younger patients who underwent ambulatory TKA.</p><p><strong>Conclusion: </strong>In carefully selected patients aged ≥80 years, ambulatory TKA is safe and yields outcomes comparable to those of younger patients.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001481","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":"Implementing appropriateness criteria for use of imaging technology (Project ACUITY) in magnetic resonance imaging of the lumbar spine: a Singapore experience.","authors":"Hiok Yang Chan, Gita Yashwantrao Karande, Cher Heng Tan, Yeong Huei Ng, Meng Ai Png, Valentina Ricci, Adelina Young, Lai Peng Chan","doi":"10.4103/singaporemedj.SMJ-2024-096","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-096","url":null,"abstract":"<p><strong>Introduction: </strong>Uncomplicated acute low back pain is usually self-limiting and does not warrant imaging. However, despite current recommendations, many patients continue to receive spinal imaging, increasing healthcare costs. The Ministry of Health, Singapore, convened a multidisciplinary workgroup to develop a consensus guideline on magnetic resonance imaging (MRI) of the lumbar spine (Agency for Care Effectiveness [ACE] guideline) for low back pain that was incorporated into electronic radiology order forms. We analysed the MRI orders following implementation of the guideline.</p><p><strong>Methods: </strong>A list of 'appropriate' and 'inappropriate' indications was developed based on existing literature. These indications were inserted into the MRI of the lumbar spine request form within the electronic system. It was mandatory for clinicians to specify on a drop-down list of indications. For 'inappropriate' indications, clinicians are required to fill out a free-text 'pop up' elaborating on their clinical reasoning for the MRI request.</p><p><strong>Results: </strong>Baseline pre-intervention data were collected over 3 months. A total of 492 MRI scans were performed with 64 (13.0%) inappropriate orders. Post-intervention, we retrospectively analysed two sets of data over 3 months each in 2021 and 2022. In 2021, there were 86 (9.1%) inappropriate orders out of 940 scans performed. In 2022, there were 38 (7.3%) inappropriate studies out of 521 scans performed. There was a statistically significant overall decrease in inappropriate scans from 13.0% pre-intervention to 7.3% post-intervention ( P = 0.01). Among all the 124 inappropriate studies post-intervention, only one patient eventually required surgery.</p><p><strong>Conclusion: </strong>Our study demonstrates the positive impact of implementing a local guideline through electronic medical records in reducing inappropriate MRI of the lumbar spine for low back pain. Further studies on the impact of other behavioural nudges are recommended.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045725","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":"Comparison of clinical and cost outcomes between primary and interval debulking surgery in ovarian cancer.","authors":"Abhiram Kanneganti, Benedict Jia Da Loh, Joseph S Ng","doi":"10.4103/singaporemedj.SMJ-2024-077","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-077","url":null,"abstract":"<p><strong>Introduction: </strong>While neoadjuvant chemotherapy with interval debulking surgery (IDS) has comparable clinical outcomes to primary debulking surgery (PDS) for advanced epithelial ovarian cancer, their economic dimension remains understudied.</p><p><strong>Methods: </strong>This retrospective chart review examined Stage IIIC-IV epithelial ovarian cancer patients who underwent IDS or PDS between 2011 and 2014. We compared the demographics, disease-specific, intraoperative, thirty-day clinical outcome and billing, and ten-year survival data.</p><p><strong>Results: </strong>Patients who underwent PDS (n = 36) and IDS (n = 43) had similar characteristics, including age, comorbidity, cancer stage, cell type, nationality, and 30-day median bill sizes (SGD 31,649.69 vs. SGD 35,326.02). The IDS group had lower postoperative sepsis (2.3% vs. 16.7%), gastrointestinal complications (0.0% vs. 11.1%) and suboptimal debulking (14.0% vs. 33.3%) rates, shorter median hospital stay (5 vs. 8 days) and higher rates of complete gross resection (CGR) (62.8% vs. 36.1%) (all P < 0.05). There were significant associations between thirty-day complications and mucinous adenocarcinomas (odds ratio [OR] 10.8), packed cell transfusion (OR 1.87 per unit), and suboptimal debulking (OR 6.33). Thirty-day readmission or death was significantly associated with Clavien-Dindo Grade I-II complications (OR 46.8) and suboptimal debulking (OR 8.24). While PDS and IDS groups had similar ten-year survival (37.0% vs. 16.2%), PDS conferred a significantly lower recurrence rate (66.7% vs. 83.7%, P = 0.003).</p><p><strong>Conclusion: </strong>The thirty-day cost and ten-year survival of IDS and PDS are comparable. Although IDS offers lower postoperative sepsis and gastrointestinal complications, shorter hospital stays and higher CGR rates, the ten-year recurrence is higher.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015472","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":"22q11.2 deletion syndrome in children with palatal anomaly: who and when to test?","authors":"Man Yee Paula Tang, Siu Yan Bess Tsui, Sih Yin Nicholas Chao, Kin Wai Edwin Chan, Kim Hung Lee","doi":"10.4103/singaporemedj.SMJ-2024-131","DOIUrl":"10.4103/singaporemedj.SMJ-2024-131","url":null,"abstract":"<p><strong>Introduction: </strong>22q11.2 deletion syndrome (22q11.2DS) is associated with palatal abnormalities. It remains controversial as to when and how children with palatal abnormalities should undergo specific diagnostic 22q11.2DS testing. There is also a lack of local data on the prevalence and clinical features associated with 22q11.2DS in children with cleft anomalies. We aimed to review the data on children diagnosed with 22q11.2DS who attended the cleft clinic at the Hong Kong Children's hospital.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of children who attended the cleft clinic at the Hong Kong Children's Hospital from January 2020 to April 2024 and had been tested for or diagnosed with 22q11.2DS. The age at genetic diagnosis, clinical features and details of palatal operation were reviewed.</p><p><strong>Results: </strong>Based on clinical suspicions, 31 children were tested for 22q11.2DS, and of these, eight (26%) children were confirmed to have the 22q11.2DS. The majority (75%) of those tested and diagnosed received their genetic diagnosis after their palatal operations. Additionally, ten other children with 22q11.2DS were identified from hospital records, having received their genetic diagnosis elsewhere.</p><p><strong>Conclusion: </strong>A notable number of children who attended the cleft clinic suffered from 22q11.2DS. Clinicians managing children with cleft anomalies should maintain a high index of suspicion and consider early specific 22q11.2DS genetic investigations in accordance with locally available resource and disease prevalence.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057176","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":"Management of anaemia in critically ill adults.","authors":"Isaac Kah Siang Ng, Clarice Choong, Shir Lynn Lim, Kay Choong See","doi":"10.4103/singaporemedj.SMJ-2024-005","DOIUrl":"10.4103/singaporemedj.SMJ-2024-005","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 5","pages":"283-290"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096729","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 person-centred Healthier SG outcomes framework.","authors":"Simon Jian Chong Ong, Grace Shu Hui Chiang, Chirk Jenn Ng, Wei Mon Wong, Eng Sing Lee, Kheng Hock Lee, Sabrina Kw Wong, José M Valderas, Boon Yeow Tan","doi":"10.4103/singaporemedj.SMJ-2025-074","DOIUrl":"10.4103/singaporemedj.SMJ-2025-074","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 5","pages":"232-234"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096726","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":"Physical activity and sedentary time distribution among adult residents during COVID-19 circuit breaker movement restrictions in Singapore: a public health perspective.","authors":"Swarup Mukherjee, Kang Jin Tan","doi":"10.4103/singaporemedj.SMJ-2022-113","DOIUrl":"10.4103/singaporemedj.SMJ-2022-113","url":null,"abstract":"<p><strong>Introduction: </strong>Social lockdowns and quarantines have been enforced in various populations to mitigate the spread of coronavirus disease 2019 (COVID-19) in the community. This study investigated the impact of COVID-19 lockdown, known as circuit breaker movement restrictions (CBMR), on physical activity (PA) and sedentary time (ST) distribution patterns among Singapore residents aged 21-65 years.</p><p><strong>Methods: </strong>This was a cross-sectional retrospective study that utilised a 44-item questionnaire that included sections to determine PA and ST distribution patterns before and during CBMR. It also included information on sleep duration, PA preference and routine, awareness of local initiatives and perceptions on barriers towards PA during the CBMR period.</p><p><strong>Results: </strong>There was an overall decrease in PA and a significant increase in physical inactivity and ST during the CBMR period. A greater proportion of participants reported sleeping for longer hours, suggesting positive adaptations in sleep habits during CBMR. Majority were unaware of online exercise initiatives and programmes offered during the CBMR period, and >50% of the respondents never used an online resource for exercise. Singapore residents seemed to prefer outdoor and facility-based venues for exercise and PA, and closure of facilities was the primary barrier for PA during the CBMR period.</p><p><strong>Conclusion: </strong>Reduced PA and increased ST during CBMR reflect negative lifestyle adaptations and may have adverse public health implications. Increased sleep duration suggests successful coping, which may consequently lead to physical and mental health benefits. While Singapore adult residents may be flexible with certain aspects of being physically active, they seemed less adaptive to changes in type of exercise, facility and environment.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"265-270"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695736","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":"World Family Doctor's Day reflection: how family medicine is building a sustainable healthcare system in Singapore.","authors":"Yang Luo, Kai Ping Sze, Chirk Jenn Ng, Andrew Fu Wah Ho","doi":"10.4103/singaporemedj.SMJ-2025-093","DOIUrl":"10.4103/singaporemedj.SMJ-2025-093","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 5","pages":"228-229"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096159","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 skinny on 'keto': the low-carb, high-fat diet everyone is talking about.","authors":"Wan Xing Michelle Ch'ng, Mark Chung Wai Ng","doi":"10.4103/singaporemedj.SMJ-2022-146","DOIUrl":"10.4103/singaporemedj.SMJ-2022-146","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 5","pages":"278-282"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096740","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 comparative analysis on the latest international and local guidelines for the management of hypertension.","authors":"Aloysius Sheng-Ting Leow, Ashish Anil Sule, Jam Chin Tay, Hui Hwang Teong, Wai Lun Moy, Pankaj Kumar Handa, Yik Tian Wu, Veerendra Melagireppa Chadachan, Vernon Min Sen Oh, Ching-Hui Sia, Kian-Keong Poh, Boon Wee Teo, Troy H Puar","doi":"10.4103/singaporemedj.SMJ-2025-094","DOIUrl":"10.4103/singaporemedj.SMJ-2025-094","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 5","pages":"240-243"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096722","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}