Singapore medical journal最新文献

{"title":"Patient perceptions of emergency department versus GP visits and of GPFirst: a qualitative study.","authors":"Candyce Yi Ru Lee, Rebecca Hui Shan Ong, Chee Hsiang Liow, Priscilla Sook Kheng Goh, Atikah Ahmad, How Choon How, Hong Choon Oh, Steven Hoon Chin Lim","doi":"10.4103/singaporemedj.SMJ-2025-344","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-344","url":null,"abstract":"<p><strong>Introduction: </strong>Overcrowding in emergency departments (EDs) has long been a concern, contributing to adverse outcomes. To address inappropriate attendances, Changi General Hospital (CGH) introduced GPFirst, a programme that encourages patients with mild conditions to visit general practitioners (GPs) first. This study explored patients' perspectives on ED versus GP visits and their views on GPFirst to guide programme improvement.</p><p><strong>Methods: </strong>Purposive sampling was used to recruit patients who had inappropriately attended the CGH ED and were unaware of GPFirst. Sixteen in-depth interviews were conducted and analysed using thematic analysis.</p><p><strong>Results: </strong>Four main themes were identified: (1) determinants of health-seeking behaviour; (2) factors driving ED or GP preference; (3) motivations to participate in GPFirst; and (4) barriers to GPFirst uptake with suggestions for improvement. Emergency department visits were influenced by perceived severity or uncertainty of illness, trust in hospital resources, round-the-clock availability, social and financial considerations and prior GP experiences. General practitioners were valued for shorter waiting times, accessibility, personalised care, and lower out-of-pocket costs in some contexts. About half of the participants expressed willingness to use GPFirst, citing financial incentives and civic responsibility, whereas others remained hesitant due to difficulty in self-triaging, low awareness and unclear processes.</p><p><strong>Conclusion: </strong>This study revealed gaps between drivers of ED attendance and facilitators of GP use. Sustained, multi-pronged strategies, such as improving awareness, clarifying processes, aligning incentives and strengthening confidence in primary care, could help enhance GPFirst adoption and mitigate ED overcrowding.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198415","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":"Prevalence and risk factors of hearing impairment in older Singaporeans: a population-based study.","authors":"Jia Hui Ng, Johnny Cm Wong, Ryan Ek Man, Eva K Fenwick, Preeti Gupta, Neville Wy Teo, Ecosse L Lamoureux","doi":"10.4103/singaporemedj.SMJ-2025-270","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-270","url":null,"abstract":"<p><strong>Introduction: </strong>We investigated the prevalence and risk factors of hearing impairment (HI) and significant hearing impairment (SHI) in a multi-ethnic older Asian population.</p><p><strong>Methods: </strong>We included 2,494 adults aged ≥60 years from a population-based study. Hearing was evaluated using a SHOEBOX portable audiometer, with any HI defined as a pure-tone average hearing threshold >25 dB and SHI defined as >40 dB, based on the better-hearing ear. Sociodemographic, lifestyle and clinical characteristics were collected via a standardised clinical examination and validated questionnaires. Weighted prevalence rates were calculated using age-, gender- and ethnicity-specific sampling weights from the 2020 Singapore Census. Multivariable regression analysis was performed to identify risk factors for HI and SHI.</p><p><strong>Results: </strong>Of the 2494 participants (mean age ± SD, 73.4 ± 8.4 years; 55.2% female), the weighted prevalence of any HI was 67.9%, while that of SHI was 22.7%. The weighted prevalence of any HI increased with age, from 58.1% in individuals aged 60-69-years to 94.9% in those aged ≥80 years, while that for SHI increased from 9.8% in individuals aged 60-69 years to 64.5% in those aged ≥80 years. Risk factors for HI included older age (odds ratio [OR] 10.33, P < 0.001), male sex (OR 2.05, P < 0.001), Malay ethnicity (OR 1.43, P = 0.021 vs. Chinese ethnicity), lower socioeconomic status (OR 2.58, P < 0.029), living alone (OR 1.62, P = 0.032) and prior stroke (OR 2.72, P = 0.016). Similar risk factors were associated with SHI.</p><p><strong>Conclusion: </strong>Two in three community-living older Singaporeans live with HI, with one in five having SHI. Targeted community hearing screening programmes for older and vulnerable groups are essential to identify individuals requiring referral and treatment.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198411","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":"Community-based health screening in Singapore: eight-year follow-up data from the Eastern Community Health Outreach (ECHO) programme.","authors":"Linsey U Gani, Xuan Han Koh, Moi Kim Wee, Wan Leng Yap, Hong Choon Oh, Choon How How","doi":"10.4103/singaporemedj.SMJ-2025-062","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-062","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases (CVDs) account for 30% of deaths in Singapore. We described eight years of observational data from the Eastern Community Health Outreach (ECHO) screening programme and its impact on CVD risk, health care beliefs and behavioural changes.</p><p><strong>Methods: </strong>Demographic and health screening data of ECHO participants were collected over eight consecutive years from 20 February 2011 to 9 March 2019. We analysed the impact of ECHO participation on health care beliefs, behavioural changes, outcomes and utilisation, including changes in clinical variables and attendance at general practitioners (GPs) or primary care clinics for follow-up of abnormal results.</p><p><strong>Results: </strong>The ECHO programme screened 28,565 participants over eight years. Of these, 12,762 participants attended their initial screening, with 5977 (46.8%) having abnormal results requiring GP referral, and 56% attended their GP referral within a year. Participants living in lower-cost housing had a significantly higher attendance rate at the GPs than those living in housing and development board four- to five-room units or condominiums (74% vs. 52.5%, P < 0.001). In a multivariable mixed-effects proportional odds model, increased ECHO participation over five years was associated with more positive self-reported healthcare beliefs, behaviours and clinical indicators. Regular health screening attendance was associated with increasing odds of improvement in chronic disease indicators, despite only modest changes in healthcare beliefs.</p><p><strong>Conclusion: </strong>Participation in the community-based ECHO screening programme was associated with sustained improvements in cardiometabolic risk factors and positive health behaviours, despite modest changes in health care beliefs. Repeated community engagement may translate small shifts in beliefs into sustained behavioural change.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198445","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":"Severe hypotonic hyponatraemia in an ovolactovegetarian: balancing the benefits and perils of solute repletion.","authors":"Chun Hui Sharmaine Wong, Claude Renaud","doi":"10.4103/singaporemedj.SMJ-2025-119","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-119","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170599","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":"Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on bacterial skin and soft tissue infections - diagnosis and antibiotic prescribing.","authors":"Johanan D Ponniah, Rujia Xu, Ye Sun, Valentina Ricci, Phyllis Al Kim","doi":"10.4103/singaporemedj.SMJ-2026-494","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-494","url":null,"abstract":"<p><strong>Abstract: </strong>This evidence-to-recommendation (EtR) framework underpins the Agency for Care Effectiveness Clinical Guideline (ACG) for bacterial skin and soft tissue infections (SSTIs), providing rationale and justifications for its recommendations on diagnosis and antibiotic prescribing in primary and community care. Based on the Grading of Recommendations Assessment, Development and Evaluation framework, five evidence-based recommendations were developed to guide practitioners in making appropriate decisions on the diagnosis, assessment and management of SSTIs, including cellulitis, erysipelas, impetigo, folliculitis, ecthyma, furuncles, carbuncles and skin abscesses. As SSTIs are a leading indication for use of oral antibiotics in primary care, recommendations focus on principles for prescribing antibiotics for specific bacterial SSTIs, including whether antibiotics are indicated and when to prescribe topical, oral or intravenous formulations. The EtR framework consolidates the evidence and considerations that informed the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability. The ACG can be found at https://go.gov.sg/acg-ssti.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140126","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":"Breaking out of the mould-recent developments in 3D-printed ankle-foot orthoses and strategies to improve clinical practicality: a systematic review.","authors":"Joel Yeh Siang Chen, Michael Gui Jie Yam","doi":"10.4103/singaporemedj.SMJ-2025-031","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-031","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional ankle-foot orthoses (C-AFOs) are commonly used to improve patient mobility. The traditional handmade process offers limited design flexibility and personalisation. In the last decade, 3D-printed AFOs (3D-AFOs) have emerged as a promising alternative. While numerous biomechanical benefits over C-AFOs have been suggested, their clinical application and real-world feasibility remain underexplored. This study aims to evaluate recent developments in 3D-AFOs and identify strategies to improve their clinical relevance and integration.</p><p><strong>Methods: </strong>A systematic review was conducted on 3 October 2024. Five electronic databases (PubMed, Cochrane, Scopus, CINAHL and EMBASE) were searched for studies published between 2022 and 2024. The inclusion criteria focused on physically tested 3D-AFOs modelled from leg scans or commercial templates. Data were categorised into design, mechanical properties, walking ability and participant satisfaction.</p><p><strong>Results: </strong>Of the 69 studies identified, 11 met the eligibility criteria and 36 participants were included. 3D-AFOs were designed with reduced weight and demonstrated improved gait symmetry and ankle range of motion. The modifiable material composition of 3D-AFOs influenced stiffness and durability. 3D-AFOs also demonstrated improved walking speed and muscle efficiency, although performance varied across terrains. Although superior in comfort, support and effectiveness, 3D-AFOs were comparable or inferior in social participation, perceived weight and convenience of use.</p><p><strong>Conclusion: </strong>While 3D-AFOs demonstrate strong biomechanical promise, current research falls short of translating these benefits into clinically meaningful outcomes. Future studies can consider targeting patients with relevant comorbidities, extend follow-up duration, and incorporate compliance and usability metrics to promote further integration of 3D-AFOs into routine clinical practice.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121145","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":"Dealing with the dialysis tsunami: a peritoneal dialysis-preferred strategy for Singapore.","authors":"Sye Nee Tan, Wei Zhen Ivan Lee, Pei Shan Lee, Jie Ming Nigel Fong","doi":"10.4103/singaporemedj.SMJ-2026-041","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-041","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121213","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":"Propensity score-matched comparison of robotic and laparoscopic right hemicolectomies with intracorporeal anastomosis.","authors":"James Chi-Yong Ngu, Neng Wei Wong, Nan Zun Teo","doi":"10.4103/singaporemedj.SMJ-2026-072","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-072","url":null,"abstract":"<p><strong>Introduction: </strong>Comparisons between robotic and laparoscopic right hemicolectomy have largely been based on older robotic systems, early case series or unmatched retrospective studies. This study aimed to provide propensity score-matched data from surgeons proficient in both minimally invasive approaches.</p><p><strong>Methods: </strong>Audit data from patients who underwent elective robotic right-sided hemicolectomies between November 2015 and November 2025 were reviewed. The operative technique was standardised to include only cases with intracorporeal anastomosis, with other patient and operative variables matched to a laparoscopic group. Perioperative management was in accordance with an enhanced recovery after surgery protocol. Outcomes and histopathological data were compared.</p><p><strong>Results: </strong>Ninety patients were available for analysis after matching. The median operative time was comparable between the robotic-assisted surgery and laparoscopy groups (210 vs. 215 min, P = 0.997). The use of robotic assistance was associated with a reduction in postoperative complication rates (20.0% vs. 40.0%, P = 0.038) and a significantly earlier discharge from hospital (4 vs. 6 days, P = 0.003). There was no significant difference in short-term oncological outcomes.</p><p><strong>Conclusion: </strong>While many outcomes were comparable with conventional laparoscopic right hemicolectomy, robotic assistance appeared to provide certain benefits that could be clinically significant for both patients and the healthcare system. Further studies are required to evaluate the cost-effectiveness of these benefits.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121585","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":"Navigating medical management in chronic coronary syndrome: evidence, controversies and guideline updates.","authors":"Rodney Yu-Hang Soh, Aaron Kwun-Hang Ho, Gavin Yeow-Peng Ng, Ching-Hui Sia, William Kok-Fai Kong, Kwan Seung Lee, Poay-Huan Loh, Tiong-Cheng Yeo, Swee-Chye Quek, Huay-Cheem Tan, Kian-Keong Poh","doi":"10.4103/singaporemedj.SMJ-2025-234","DOIUrl":"10.4103/singaporemedj.SMJ-2025-234","url":null,"abstract":"<p><strong>Abstract: </strong>Chronic coronary syndrome (CCS), one of the top contributors to mortality and morbidity worldwide, is an emerging entity that moves beyond the traditional view of fixed, flow-limiting epicardial stenoses as the sole cause of ischaemia to encompass a broader and more heterogeneous group of conditions. This heterogeneity underscores the importance of individualised management, guided by an assessment of each patient's future cardiovascular risk. Despite recent international guidelines for the management of CCS, significant gaps and controversies remain. Our review, with a focus on the Asia-Pacific population, aims to highlight key updates from the latest international guidelines and explore potential directions for addressing these persistent challenges in CCS care.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121516","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":"Impact of primary care accessibility and availability on inappropriate emergency department attendance in Singapore.","authors":"Jemima Jia En Koh, Yan Gao, Hong Choon Oh, Priscilla Sook Kheng Goh, Hoon Chin Lim","doi":"10.4103/singaporemedj.SMJ-2025-154","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-154","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care providers (PCPs) can safely manage non-emergency acute medical cases, reducing emergency department (ED) visits. This study examined how proximity and availability of PCPs affect inappropriate attendance (IA) at a tertiary hospital ED in eastern Singapore.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of eligible ED visits between 1 January 2023 and 31 December 2023. Reporting followed STROBE guidelines. Multivariable logistic regression assessed the association between IA and (a) travel time to an available PCP, (b) travel distance to an available PCP, and (c) number of available PCPs. An IA was defined by investigations, procedures and discharge type. Models were adjusted for demographics, visit characteristics and prior healthcare utilisation.</p><p><strong>Results: </strong>In 2023, there were 135,838 eligible ED visits, of which 12.5% were IAs. A travel time of >5 min to a PCP was associated with a 13%-24% higher likelihood of inappropriate ED attendance compared with a travel time of ≤5 min. Similarly, a travel distance of >1 km from a PCP increased the likelihood by 10%-33% compared with a distance of ≤1 km. Conversely, having more than three PCPs within a 1-km radius of the attendee's home was associated with at least a 12% lower likelihood of IA.</p><p><strong>Conclusion: </strong>Longer travel time and distance to a PCP and limited PCP availability were associated with higher risk of IA. Our findings underscore the importance of accessible primary care services, particularly during non-operating hours, in shaping health-seeking behaviour and reducing inappropriate ED visits.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121263","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}