Singapore medical journal最新文献

{"title":"Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.","authors":"Hong Jing Lee, Sheng Xu, Eric Xuan Liu, Jason Beng Teck Lim, Ming Han Lincoln Liow, Hee Nee Pang, Darren Keng-Jin Tay, Seng Jin Yeo, Jerry Yongqiang Chen","doi":"10.4103/singaporemedj.SMJ-2023-280","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-280","url":null,"abstract":"<p><strong>Introduction: </strong>The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge.</p><p><strong>Methods: </strong>All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h.</p><p><strong>Results: </strong>With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005).</p><p><strong>Conclusion: </strong>Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485003","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":"Association of psychological distress with health-related quality of life in Asian adolescents seeking obesity treatment.","authors":"Wang Chin Eileen Ng, Khairunisa Binte Khaider, Qiao Fan, Chu Shan Elaine Chew","doi":"10.4103/singaporemedj.SMJ-2024-006","DOIUrl":"10.4103/singaporemedj.SMJ-2024-006","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited research on the psychosocial health of Asian adolescents undergoing obesity treatment. Our study examined the predictors of psychological distress, disordered eating and poor health-related quality of life (HRQoL) in these adolescents and the associations between them.</p><p><strong>Methods: </strong>A total of 82 adolescents aged 11-17 years were recruited from the Weight Management Clinic in KK Women's and Children's Hospital between June 2022 and January 2023. Participants completed the following questionnaires: (a) Young Person's Clinical Outcomes in Routine Evaluation (YP-Core) assessing for psychological distress, (b) Children's Eating Attitude Test (ChEAT) evaluating for disordered eating behaviours, and (c) Pediatric Quality of Life Inventory (PedsQL) measuring HRQoL.</p><p><strong>Results: </strong>Participating adolescents had a mean body mass index of 31.9 ± 5.1 kg/m2. Of the participants, 40% reported significantly symptomatic psychological distress (YP-Core score ≥14) and 16% were at risk of eating disorders (ChEAT score ≥20). A higher YP-Core score was the only significant determinant of poorer HRQoL, after controlling for demographic variables and ChEAT scores. Malay (regression coefficient: 6.6, 95% confidence interval [CI]: 0.6-12.6, P = 0.031) and Indian (regression coefficient: 8.9, 95% CI: 3.8-14.0, P = 0.001) adolescents were more likely to report disordered eating and psychological distress, respectively, as compared to Chinese adolescents. Adolescents whose parent(s) had obesity (regression coefficient: 3.4, 95% CI: 0.1-6.7, P = 0.043) were also more likely to experience greater psychological distress.</p><p><strong>Conclusion: </strong>Understanding the determinants of psychological distress, disordered eating and HRQoL will facilitate targeted screening and management of the psychosocial complications of adolescent obesity.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484991","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 of diabetes mellitus-related complications and their impact on health-related quality of life in Singapore.","authors":"Bernard Chin Wee Tan, Edimansyah Abdin, Yen Sin Koh, P V Asharani, Fiona Devi, Kumarasan Roystonn, Chee Fang Sum, Tavintharan Subramaniam, Siow Ann Chong, Mythily Subramaniam","doi":"10.4103/singaporemedj.SMJ-2023-148","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-148","url":null,"abstract":"<p><strong>Introduction: </strong>One in three Singaporeans is at risk of developing DM (DM) in their lifetime. The majority of those with DM experience other comorbidities that often affect the course of their DM. This study explored: (a) the prevalence of DM-related complications, (b) their sociodemographic correlates, and (c) their association with health-related quality of life (HRQOL).</p><p><strong>Methods: </strong>Participants with DM (n = 387) were recruited from a population-based survey. Type 2 DM was self-reported as diagnosed by a doctor. The DM-related complications and comorbidities were assessed using the DM knowledge questionnaire and chronic conditions checklist. Short-Form health survey was used to examined HRQOL. Multiple logistic regressions were performed to examine the association between DM-related complications and sociodemographic factors and body mass index. Multiple linear regressions examined the association of complications with HRQOL.</p><p><strong>Results: </strong>Approximately 31.6% of the participants had DM-related complications. The top three complications were nephropathy (54.4%), neuropathy (42.2%) and retinopathy (40.8%). Younger participants (aged 18-49 years) and those with higher education were less likely to develop DM-related complications. Physical HRQOL was adversely affected in participants with any chronic condition, DM for 4-9 years, DM-related neuropathy, lower leg/foot ulcers and gangrene. Mental HRQOL was adversely affected by gangrene. Younger participants had better physical HRQOL.</p><p><strong>Conclusion: </strong>Physical HRQOL is adversely affected when individuals develop DM-related complications. Understanding the sociodemographic corelates of DM-related complications could aid clinicians in identifying and assisting at-risk populations to prevent adverse outcomes. Educating individuals on the risk of developing DM-related complications could encourage better DM management.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485002","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":"2021 NEDI-Singapore study: an updated inventory of emergency department characteristics.","authors":"Ivan Jinrong Low, En Ci Isaac Ong, Pin Pin Maeve Pek, Li Juan Joy Quah, Shu-Ling Chong, Jia Hao Lim, Krislyn M Boggs, Carlos A Jr Camargo, Venkataraman Anantharaman, Andrew Fu Wah Ho","doi":"10.4103/singaporemedj.SMJ-2023-271","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-271","url":null,"abstract":"<p><strong>Introduction: </strong>The last national emergency department (ED) inventory was performed in 2007, and major changes in population demographics, healthcare needs and infrastructure have since occurred. We sought to obtain an updated inventory of EDs in Singapore to identify and describe changes in their characteristics and capabilities across the years.</p><p><strong>Methods: </strong>In 2021, the National Emergency Department Inventories (NEDI) instrument was administered to the leadership of Singapore EDs. Emergency departments in Singapore are opened round the clock, have no restrictions on who can access care and are equipped to handle general medical emergencies. The questionnaire comprises 16 items across three categories: (a) general characteristics, (b) patient volume and (c) medical capabilities.</p><p><strong>Results: </strong>We achieved 100% response rate from all 17 EDs - nine EDs in public hospitals and eight in private hospitals. In 2021, the EDs saw a total of 1,140,388 visits, an increase of 27% from 2007, with the median number of visits almost doubling (from 39,450 to 77,989); 41% and 59% of the EDs reported over 20% of visits arriving by ambulance and over 20% of visits resulting in inpatient admission, respectively. A clear distinction between public and private EDs across these metrics remained. Medical capabilities grew: 59% had access to a dedicated computed tomography scanner (up from 46%) and 82% had negative pressure isolation facilities (up from 54%). Overall, 41% of EDs self-assessed to be operating above their capacity.</p><p><strong>Conclusion: </strong>Singapore EDs have progressed in capabilities and capacity. Despite this, the increasing volume, complexity and acuity of patients are imposing strains on the emergency care system, signalling potential for systems improvement.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373981","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 symptomatic venous thromboembolism in distal femur fractures.","authors":"Wei Mao, Joel Xue Yi Lim, Jiong Hao Tan, Shi-Min Chang, Choon Chiet Hong","doi":"10.4103/singaporemedj.SMJ-2023-265","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-265","url":null,"abstract":"<p><strong>Introduction: </strong>There is a paucity of published research on symptomatic venous thromboembolism (sVTE) after distal femur fractures (DFFs). This study aimed to explore the prevalence and risk factors of sVTE in DFFs.</p><p><strong>Methods: </strong>We identified a total of 131 patients who underwent DFF surgeries without routine pharmacological thromboprophylaxis between October 2007 and November 2016. Cases of sVTE included symptomatic pulmonary embolism (sPE) and symptomatic deep vein thrombosis (sDVT). Patients with sVTE were compared to those without, and differences in demographics and fracture-related characteristics were explored. Multivariate logistic regression was used to eliminate confounding factors.</p><p><strong>Results: </strong>Of the 131 patients, 20 (15.3%) had sVTE, of whom 16 (12.2%) had sDVT and six (4.6%) had sPE (two patients had both sPE and sDVT). Notably, 17 (85.0%) sVTE patients were aged ≥60 years, while only 62 (55.9%) non-sVTE patients were aged ≥60 years (P = 0.014). Fourteen (82.4%) patients with sVTE had body mass index (BMI) ≥25 kg/m2, while 49 (53.3%) patients without sVTE had BMI ≥25 kg/m2 (P = 0.032). Multivariate logistic regression demonstrated that age ≥60 years (adjusted odds ratio [OR] 5.05; P = 0.040) and BMI ≥25 kg/m2 (adjusted OR 3.92; P = 0.045) were independently associated with a higher risk of sVTE after DFF.</p><p><strong>Conclusion: </strong>The prevalence of sVTE in DFFs is high at 15.3%. Advanced age (≥60 years) and being overweight (BMI ≥25 kg/m2) were two independent risk factors for sVTE in DFFs. The use of routine pharmacological thromboprophylaxis should be considered as a preventative measure.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373982","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":"Associations between parental bonding and health-related quality of life in a clinical sample of youths aged 14-35 years in Singapore.","authors":"Yoke Boon Tan, Eng Hong Tay, Shazana Shahwan, Yunjue Zhang, Rajeswari Sambasivam, Mythily Subramaniam","doi":"10.4103/singaporemedj.SMJ-2023-223","DOIUrl":"10.4103/singaporemedj.SMJ-2023-223","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with psychiatric disorders tend to report having poorer bonds with their parents during their early years. These individuals often experience lower quality of life as well. This study investigated the associations between aspects of parental bonding and health-related quality of life (HRQOL) in a clinical sample of youths. It was hypothesised that high parental care and low parental overprotectiveness would be associated with higher levels of HRQOL.</p><p><strong>Methods: </strong>Data were obtained from a larger cross-sectional study. The sample consisted of 400 psychiatric outpatients: 191 patients aged 14-21 (mean ± standard deviation 18.1 ± 2.22) years and 209 patients aged 22-35 (28.0 ± 4.33) years. The Parental Bonding Instrument was used to measure parental care and overprotectiveness. Short Form-12 measured physical health (physical component summary [PCS]) and mental health (mental component summary [MCS]) components of HRQOL, and the 8-item Patient Health Questionnaire assessed depressive symptoms. These scales and a sociodemographic form were self-administered. Multivariable linear regression was used for analysis.</p><p><strong>Results: </strong>About half of the sample reported affectionless control for mothers (46.6%) and fathers (45.9%). After controlling for sociodemographic variables, no significant relationship was found between aspects of parental bonding and PCS scores. Maternal care was associated with MCS scores (β = 0.32, P < 0.01) and PHQ-8 scores (β = -0.12, P < 0.05).</p><p><strong>Conclusion: </strong>Our results suggest that youths who experienced quality care from their mothers exhibit better mental health functioning despite their clinical diagnoses, which suggests that early maternal care exerts an overall long-term protective effect. Early parental education that promotes positive parenting practices could improve the overall HRQOL of individuals in adulthood despite their clinical diagnoses.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"579-585"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592489","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}

{"title":"Detection of soft tissue emphysema in emergency head and neck imaging.","authors":"Michael Che Hao Seng, Elena Tangtra, Chi Long Ho","doi":"10.4103/singaporemedj.SMJ-2021-453","DOIUrl":"10.4103/singaporemedj.SMJ-2021-453","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"65 10","pages":"591-598"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396546","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}

{"title":"No health without mental health: united we stand.","authors":"Kang Sim, Tiing Leong Ang","doi":"10.4103/singaporemedj.SMJ-2024-182","DOIUrl":"10.4103/singaporemedj.SMJ-2024-182","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"65 10","pages":"531-532"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396548","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}

{"title":"Stigma and mental health: overcoming barriers.","authors":"Mythily Subramaniam","doi":"10.4103/singaporemedj.SMJ-2024-166","DOIUrl":"10.4103/singaporemedj.SMJ-2024-166","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"65 10","pages":"533-535"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396551","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}

{"title":"Association between treatment resistance and cognitive function in schizophrenia.","authors":"Jiaqian Sun, Jie Yin Yee, Yuen Mei See, Charmaine Tang, Shushan Zheng, Boon Tat Ng, Jimmy Lee","doi":"10.4103/singaporemedj.SMJ-2024-143","DOIUrl":"10.4103/singaporemedj.SMJ-2024-143","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment-resistant schizophrenia (TRS) affects around 30% of individuals with schizophrenia. About half of the patients with TRS who are treated with clozapine do not show a meaningful clinical response, that is, clozapine resistance. To date, the relationship between cognitive function and treatment response categories is not entirely clear. This study evaluated the cognitive performance across subgroups stratified by treatment response, and we hypothesised that cognitive impairment increases with increased treatment resistance.</p><p><strong>Methods: </strong>This study was conducted at the Institute of Mental Health, Singapore, and included healthy controls and people with schizophrenia categorised into these groups: antipsychotic-responsive schizophrenia (ARS), clozapine-responsive TRS (TRS-CR) and clozapine-resistant TRS (ultra-treatment-resistant schizophrenia [UTRS]). Cognitive function was assessed using the Brief Assessment of Cognition-Short Form. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS). The planned statistical analyses included adjustments for covariates such as age, sex, PANSS scores and antipsychotic dose, which might affect cognitive function.</p><p><strong>Results: </strong>There were significant differences in overall cognitive performance between the groups: ARS had the least impairment, followed by TRS-CR and UTRS. Antipsychotic dose, and PANSS negative and disorganisation/cognitive factors were significant predictors of overall cognitive function in all patient groups.</p><p><strong>Conclusions: </strong>Our study found differences in cognitive function that aligned with levels of treatment resistance: the greater the degree of treatment resistance, the poorer the cognitive function. Interventions to improve negative and disorganisation symptoms might be effective to enhance the cognitive function and treatment outcomes in schizophrenia.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"65 10","pages":"552-557"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396544","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}