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Preventing perioperative hypothermia in children through implementation of customised guidelines. 通过实施定制指南预防儿童围手术期体温过低。
Singapore medical journal Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-021
Shu Ying Lee, Rehena Sultana, John Carson Allen, Choon Looi Bong
{"title":"Preventing perioperative hypothermia in children through implementation of customised guidelines.","authors":"Shu Ying Lee, Rehena Sultana, John Carson Allen, Choon Looi Bong","doi":"10.4103/singaporemedj.SMJ-2023-021","DOIUrl":"10.4103/singaporemedj.SMJ-2023-021","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative hypothermia (PH) is common in children and associated with adverse clinical outcomes. Guidelines to prevent PH are mainly developed for adults and differ among institutions. We aimed to evaluate the effectiveness of customised guidelines in reducing PH in our paediatric population and the impact of cost considerations on physician practice.</p><p><strong>Methods: </strong>Patients aged ≤16 years undergoing general anaesthesia in our tertiary paediatric hospital were prospectively recruited in this cohort study. Patient demographics, surgical procedures, anaesthesia details and temperature control measures were recorded. Data collection occurred over four phases: Phases 1 and 2 comprised standard management, while Phases 3 and 4 occurred following guidelines implementation. Sensors for continuous core temperature monitoring were provided free to patients during Phases 1 and 3, but were charged during Phases 2 and 4. The main outcome was occurrence of PH, defined as core temperature <36°C at any point from induction of anaesthesia to discharge from the postanaesthetic care unit. The impact of guidelines implementation and cost considerations influencing physician practice on PH outcomes was also analysed.</p><p><strong>Results: </strong>Data from 3917 patients was analysed (1766 in Phase 1, 679 in Phase 2, 706 in Phase 3 and 766 in Phase 4). Guidelines implementation decreased PH incidence from 11.0% to 6.79% (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.50-0.80, P = 0.0002). Free sensors increased the odds of detecting PH (OR 1.48, 95% CI 1.17-1.88, P = 0.001). With guidelines implementation, there was greater reduction in PH with free sensors (OR 0.64, 95% CI 0.47-0.88, P = 0.0055) compared to chargeable sensors (OR 0.75, 95% CI 0.50-1.11, P = 0.1471).</p><p><strong>Conclusions: </strong>Customised guidelines facilitated a sustained reduction of hypothermia in our paediatric surgical patients, although its impact was reduced by cost considerations.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121769","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
Association of postpartum depression with child growth and developmental outcomes: a community-based study. 产后抑郁与儿童生长发育结果的关系：一项基于社区的研究。
Singapore medical journal Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-107
Moira Suyin Chia, Nur Adila Binte Ahmad Hatib, Elaine Chu Shan Chew, Shu-Ling Chong, Rehena Sultana, Ade Xin Ning Tan, Xiaoxuan Guo, David Chee Chin Ng, Padmini Sita Yeleswarapu, Pratibha Keshav Agarwal, Helen Yu Chen, Yoke Hwee Chan
{"title":"Association of postpartum depression with child growth and developmental outcomes: a community-based study.","authors":"Moira Suyin Chia, Nur Adila Binte Ahmad Hatib, Elaine Chu Shan Chew, Shu-Ling Chong, Rehena Sultana, Ade Xin Ning Tan, Xiaoxuan Guo, David Chee Chin Ng, Padmini Sita Yeleswarapu, Pratibha Keshav Agarwal, Helen Yu Chen, Yoke Hwee Chan","doi":"10.4103/singaporemedj.SMJ-2023-107","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-107","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121765","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
Disaster medicine in Singapore: past, present, future. 新加坡的灾难医学：过去、现在和未来。
Singapore medical journal Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-019
Li Juan Joy Quah, Jen Heng Pek, Lenard Cheng, Chan Yu Lee, David Kuan Peng Teng, Mathew Yi Wen Yeo, Venkataraman Anantharaman
{"title":"Disaster medicine in Singapore: past, present, future.","authors":"Li Juan Joy Quah, Jen Heng Pek, Lenard Cheng, Chan Yu Lee, David Kuan Peng Teng, Mathew Yi Wen Yeo, Venkataraman Anantharaman","doi":"10.4103/singaporemedj.SMJ-2023-019","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-019","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121767","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
Diagnostic threshold and performance of anion gap in screening for high anion gap metabolic acidosis. 阴离子间隙在筛查高阴离子间隙代谢性酸中毒中的诊断阈值和性能。
Singapore medical journal Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-009
Chang Yin Chionh, Carolyn Shan-Yeu Tien, Wenxiang Yeon
{"title":"Diagnostic threshold and performance of anion gap in screening for high anion gap metabolic acidosis.","authors":"Chang Yin Chionh, Carolyn Shan-Yeu Tien, Wenxiang Yeon","doi":"10.4103/singaporemedj.SMJ-2023-009","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-009","url":null,"abstract":"<p><strong>Introduction: </strong>The anion gap (AG) is commonly used to screen for acid-base disorders. It was proposed that the cut-off for high anion gap metabolic acidosis (HAGMA) may be lower with current laboratory techniques, although modern laboratory equipment are still calibrated to familiar reference ranges established with earlier techniques. The appropriate cut-off for HAGMA is unclear. This study aimed to assess the performance of AG as a screening test for HAGMA and to determine the optimal diagnostic threshold of AG for HAGMA.</p><p><strong>Methods: </strong>This was a retrospective analysis of a large, anonymised dataset extracted by computerised protocol from 2017 to 2019. All inpatients with blood samples taken for organic acids (lactate, ketone or salicylate) paired with a metabolic panel were included. The target condition was HAGMA secondary to elevated blood lactate, ketone and/or salicylate. Sensitivity for HAGMA was explored at various AG cut-off levels.</p><p><strong>Results: </strong>Of 16,475 patients, 2,621 had organic acidosis. Median age was 65 years, and median estimated glomerular filtration rate was 70 mL/min/1.73 m2. With organic acidosis, the median AG was 23 (interquartile range [IQR] 20-29) mEq/L, while without organic acidosis, the median AG was 16 (IQR 14-19) mEq/L. The area under the curve-receiver operating characteristic of AG for HAGMA was 0.873. Desired sensitivity for HAGMA was set at ≥95%, and this was found with an AG threshold of ≥15 mEq/L (sensitivity 98.1%, specificity 34.0%).</p><p><strong>Conclusion: </strong>The recommended AG threshold value is ≥15 mEq/L with a high sensitivity for HAGMA. The AG should always be interpreted with the clinical context, and it should be repeated as the clinical picture evolves.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121766","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
HER2-low breast cancers: challenges in the interpretation of immunohistochemistry. 低 HER2 乳腺癌：解读免疫组化的挑战。
Singapore medical journal Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-037
Noel Chia, Mihir Ananta Gudi, Emad Rakha, Puay Hoon Tan
{"title":"HER2-low breast cancers: challenges in the interpretation of immunohistochemistry.","authors":"Noel Chia, Mihir Ananta Gudi, Emad Rakha, Puay Hoon Tan","doi":"10.4103/singaporemedj.SMJ-2023-037","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-037","url":null,"abstract":"<p><strong>Abstract: </strong>Overexpression of human epidermal growth factor receptor 2 (HER2) protein in breast cancers carries significant prognostic and therapeutic implications. Anti-HER2 blockade has shown to be a useful adjunct to surgery in treating HER2-positive tumours. Up till today, the HER2 immunohistochemistry (IHC) and in situ hybridisation (ISH) scoring algorithms are geared towards identifying HER2-positive cases. A recently published Phase III clinical trial (DESTINY-Breast04) has demonstrated that an antibody-drug conjugate (trastuzumab-deruxtecan) significantly reduced disease progression and death in patients with metastatic disease with IHC score 1+ or 2+ and without ISH amplification, defining a new category of cases known as HER2 low. At present, IHC scores 0, 1+ and 2+ show significant interobserver variability, and identifying HER2-low breast cancers may pose significant challenges with the current algorithms. More work is needed in this area to better define HER2-low breast cancers, target the appropriate group of patients and assess treatment efficacy.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121768","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
Clinical outcomes of variceal and non-variceal upper gastrointestinal bleeding in cirrhosis patients in Singapore. 新加坡肝硬化患者静脉曲张性和非静脉曲张性上消化道出血的临床结果。
Singapore medical journal Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2023-046
Garrett Kang, Le Shaun Ang, Wen Hui Leia Teo, Yu Wei Cheryl Huang, Venkataraman Narayan, Andrew Boon Eu Kwek, Tiing Leong Ang, Yu Jun Wong
{"title":"Clinical outcomes of variceal and non-variceal upper gastrointestinal bleeding in cirrhosis patients in Singapore.","authors":"Garrett Kang, Le Shaun Ang, Wen Hui Leia Teo, Yu Wei Cheryl Huang, Venkataraman Narayan, Andrew Boon Eu Kwek, Tiing Leong Ang, Yu Jun Wong","doi":"10.4103/singaporemedj.SMJ-2023-046","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-046","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041275","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
Prehospital stroke care in Singapore. 新加坡的院前中风护理。
Singapore medical journal Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2023-066
Timothy Jia Rong Lam, Zhenghong Liu, Benjamin Yong-Qiang Tan, Yih Ying Ng, Colin Kaihui Tan, Xiang Yi Wong, Narayanaswamy Venketasubramanian, Leonard Leong Litt Yeo, Andrew Fu Wah Ho, Marcus Eng Hock Ong
{"title":"Prehospital stroke care in Singapore.","authors":"Timothy Jia Rong Lam, Zhenghong Liu, Benjamin Yong-Qiang Tan, Yih Ying Ng, Colin Kaihui Tan, Xiang Yi Wong, Narayanaswamy Venketasubramanian, Leonard Leong Litt Yeo, Andrew Fu Wah Ho, Marcus Eng Hock Ong","doi":"10.4103/singaporemedj.SMJ-2023-066","DOIUrl":"10.4103/singaporemedj.SMJ-2023-066","url":null,"abstract":"<p><strong>Abstract: </strong>Due to the narrow window of opportunity for stroke therapeutics to be employed, effectiveness of stroke care systems is predicated on the efficiency of prehospital stroke systems. A robust prehospital stroke system of care that provides a rapid and well-coordinated response maximises favourable poststroke outcomes, but achieving this presents a unique set of challenges dependent on demographic and geographical circumstances. Set in the context of a highly urbanised first-world nation with a rising burden of stroke, Singapore's prehospital stroke system has evolved to reflect the environment in which it operates. This review aims to characterise the current state of prehospital stroke care in Singapore, covering prehospital aspects of the stroke survival chain from symptom onset till arrival at the emergency department. We identify areas for improvement and innovation, as well as provide insights into the possible future of prehospital stroke care in Singapore.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051435","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
Fitness to drive after trigger or carpal tunnel release surgery: perceptions of patients versus clinicians. 扳机或腕管松解手术后的驾驶能力：患者与临床医生的看法。
Singapore medical journal Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2021-424
Camelia Qian Ying Tang, Sean Han Sheng Lai, Ellen Yutan Lee, Anthony Foo, Alphonsus Khin Sze Chong
{"title":"Fitness to drive after trigger or carpal tunnel release surgery: perceptions of patients versus clinicians.","authors":"Camelia Qian Ying Tang, Sean Han Sheng Lai, Ellen Yutan Lee, Anthony Foo, Alphonsus Khin Sze Chong","doi":"10.4103/singaporemedj.SMJ-2021-424","DOIUrl":"10.4103/singaporemedj.SMJ-2021-424","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051434","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
Clinical use cases in artificial intelligence: current trends and future opportunities. 人工智能的临床应用案例：当前趋势与未来机遇。
Singapore medical journal Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.4103/singaporemedj.SMJ-2023-193
Cher Heng Tan, Wilson Wen Bin Goh, Jimmy Bok Yan So, Joseph J Y Sung
{"title":"Clinical use cases in artificial intelligence: current trends and future opportunities.","authors":"Cher Heng Tan, Wilson Wen Bin Goh, Jimmy Bok Yan So, Joseph J Y Sung","doi":"10.4103/singaporemedj.SMJ-2023-193","DOIUrl":"10.4103/singaporemedj.SMJ-2023-193","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140290113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Introduction to artificial intelligence in medicine. 医学人工智能入门。
Singapore medical journal Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.4103/singaporemedj.SMJ-2024-060
Joseph J Y Sung
{"title":"Introduction to artificial intelligence in medicine.","authors":"Joseph J Y Sung","doi":"10.4103/singaporemedj.SMJ-2024-060","DOIUrl":"10.4103/singaporemedj.SMJ-2024-060","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140290119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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