Singapore medical journal最新文献

{"title":"Breast cancer-related lymphoedema: approach and management.","authors":"Llewelyn Yi Chang Tan, Matthew Rong Jie Tay, Ishwarpal Singh Grewal, Chin Jung Wong","doi":"10.4103/singaporemedj.SMJ-2026-162","DOIUrl":"10.4103/singaporemedj.SMJ-2026-162","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 9","pages":"575-580"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019339","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":"Impact of value-driven care initiatives on clinical quality indicators in children admitted with community-acquired pneumonia in Singapore.","authors":"Biju Thomas, Meng Dao Jeremy Ho, Ching Yee Sim, Bee Keow Goh, Yi Hua Tan, Zi Xean Khoo, Yong Hong Ng, Kok Wee Chong, Yoke Hwee Chan, Koh Cheng Thoon, Alex T Sia, Kok Ann Amos Lim, Yeow Yang John Wong, Sashikumar Ganapathy, Xue Fen Valerie Seah, Chia Yin Chong","doi":"10.4103/singaporemedj.SMJ-2025-222","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-222","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare policymakers are focusing increasingly on value-driven care (VDC) models that aim to improve the quality of care and outcomes. We aimed to study the impact of community-acquired pneumonia (CAP) VDC initiatives on the trends in clinical quality indicators over a 7-year period (2018-2024).</p><p><strong>Methods: </strong>Children admitted with CAP from January 2018 to December 2024 to KK Women's and Children's Hospital, Singapore, were included. We adopted a multifaceted approach to improving clinical quality indicators (length of stay [LOS] ≤5 days, no 30-day complications, no 30-day readmissions and no inpatient mortality) and the Clinical Quality Index (CQI)-the proportion of patients who meet all four clinical quality indicators.</p><p><strong>Results: </strong>The total number of CAP admissions varied across the years (P < 0.05), with the highest number recorded in 2024 (n = 3197). The vast majority (68.7%) were of preschool age (<5 years). Viral CAP was the most common category, except in 2024 when a surge in CAP due to Mycoplasma pneumoniae was observed. The baseline CQI of 84% in 2018 (pre-VDC) increased to 90.3% in 2024 (P < 0.001). This was primarily driven by the improvement in LOS. The LOS (mean ± standard deviation) decreased from 3.65 ± 3.83 days in 2018 to 2.94 ± 2.00 days in 2024 (P < 0.001).</p><p><strong>Conclusion: </strong>This study highlights the positive impact of CAP VDC initiatives on key clinical quality indicators in children admitted with CAP over a 7-year period. The VDC model is scalable, and a similar multifaceted approach may be applied to VDC models for other acute and chronic conditions.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762379","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":"Diagnosis and analysis of plasma phosphorylated tau 217 in a memory clinic cohort: limitations of Generative Pre-trained Transformer-5.","authors":"Yat Fung Shea, Yi Ling Wong, Tsz King Wong, Pak Lam Chan, Ka Keung Yam, Felix Chi Kin Wong, King Pui Florence Chan, Yi Wah Eva Cheung, Henry Ka Fung Mak, Sau Man Mary Ip, Patrick Ka Chun Chiu, Ching Wan Lam","doi":"10.4103/singaporemedj.SMJ-2025-289","DOIUrl":"10.4103/singaporemedj.SMJ-2025-289","url":null,"abstract":"<p><strong>Introduction: </strong>No published studies have evaluated the application of Generative Pre-trained Transformer-5 (GPT-5) in the analysis of memory clinic patient clinical notes or the interpretation of plasma phosphorylated tau (P-tau) 217 values. We compared Alzheimer's disease (AD) probability estimates generated by GPT-5 before and after incorporating plasma P-tau 217 with pre- and posttest probabilities.</p><p><strong>Methods: </strong>This was a retrospective study comprising 74 patients from a memory clinic in Queen Mary Hospital, Hong Kong. Final diagnoses were made by physicians, supported by medical history, physical examination, neuroimaging and amyloid positron emission tomography. Extracted clinical data included cognitive, functional and neuropsychiatric assessments. Pretest AD probabilities were derived from a published meta-analysis, while posttest probabilities were calculated using a Bayesian approach. These values were compared with those estimated by GPT-5. The diagnostic performance of GPT-5 and physicians was assessed using accuracy and Kappa coefficient, with final diagnosis as reference.</p><p><strong>Results: </strong>There were 40 amyloid-positive (A+) and 34 amyloid-negative (A-) patients. In A+ patients, Bayesian posttest probabilities were higher than GPT-5 estimates (median 97.0% vs. 80.0%, P = 0.003), while those of A- patients were lower than GPT-5 estimates (median 3.0% vs. 27.5%, P < 0.001). With application of plasma P-tau 217, physicians achieved higher diagnostic accuracy than GPT-5 (81.1% vs. 45.9%, P < 0.001), while GPT-5 suggested mixed aetiologies more frequently (23.0% vs. 8.1%, P = 0.04) and inappropriate anti-amyloid therapy in 31% (11/36) of scenarios.</p><p><strong>Conclusion: </strong>Our findings show that GPT-5 has limitations in analysing clinical information of real-life memory clinic patients.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655536","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":"Effect of medial opening wedge high tibial osteotomy versus unicompartmental knee arthroplasty on mental health: a comparative study with propensity score-matched analysis.","authors":"Ashton Kai Shun Tan, Shaun Kai Kiat Chua, Shao Jin Teo, Xinyu Tao, Don Thong Siang Koh, Junwei Soong, Hamid Rahmatullah Bin Abd Razak, Kong Hwee Lee","doi":"10.4103/singaporemedj.SMJ-2025-291","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-291","url":null,"abstract":"<p><strong>Introduction: </strong>Medial opening wedge high tibial osteotomy (MOWHTO) and unicompartmental knee arthroplasty (UKA) are established treatments for knee osteoarthritis (KOA). This study compared their effects on mental health outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients who underwent MOWHTO or UKA between 2019 and 2023 at a single tertiary institution. The primary outcome measure, the Short Form-36 mental component score (SF-36 MCS), was recorded at baseline, six months and two years post-procedure. Secondary outcomes included the SF-36 physical component score (PCS) and the Oxford knee score (OKS). A total of 105 MOWHTO and 89 UKA procedures were performed. Propensity score matching accounted for preoperative scores, age, gender and body mass index, yielding 51 patients per group. Multivariable regression was used to examine associations between preoperative MCS and postoperative outcomes. Baseline predictors of postoperative MCS were analysed. The level of significance was set at P < 0.05.</p><p><strong>Results: </strong>At six months postoperatively, the UKA group demonstrated better PCS (MOWHTO 42.0 vs UKA 49.6, P < 0.001) and OKS (MOWHTO 23.0 vs UKA 18.8, P = 0.002). At two years, both groups achieved similar improvements in SF-36 MCS, SF-36 PCS and OKS. Preoperative MCS showed a moderate association with postoperative MCS and weak associations with postoperative PCS and OKS. Preoperative MCS was the only baseline factor independently associated with postoperative MCS.</p><p><strong>Conclusion: </strong>In patients with KOA, MOWHTO and UKA achieved similar improvements in mental health scores at two years. Preoperative mental health is an important determinant of postoperative mental health, highlighting its importance in preoperative assessment and counselling.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655538","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":"Unmet needs in autoimmune liver disease: epidemiology and clinical outcomes from a Southeast Asian cohort.","authors":"Shwetha Thiyagarajan, Jarell Jie-Rae Tan, Rahul Kumar, Jessica Yi-Lyn Tan, Kenneth Weicong Lin, Nicholas Chin Hock Tee, Chin Kimg Tan, Andrew Xia Huang Tan, Daphne Shih Wen Ang, Jeannie Peng Lan Ong, Tiing Leong Ang, Andrew Boon Eu Kwek, Kwong Ming Fock, Yu Jun Wong","doi":"10.4103/singaporemedj.SMJ-2025-211","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-211","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of autoimmune liver disease (AILD) is rising globally, yet data on its epidemiology and outcomes in Singapore remain limited. We aimed to characterise disease phenotype, treatment response and clinical outcomes among patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).</p><p><strong>Methods: </strong>We retrospectively analysed patients diagnosed with AILD between 1995 and 2025 at a tertiary centre. Diagnoses and treatment responses for AILD were defined according to international guidelines. Clinical outcomes between AIH and PBC were compared using logistic regression, adjusted for baseline Model for End-stage Liver Disease score.</p><p><strong>Results: </strong>Among 260 patients included, 71.2% had PBC, 22.0% had AIH, 3.8% had AIH/PBC overlap syndrome and 3.1% had PSC. The prevalence of AIH and PBC was 8.0 and 26.1 per 100,000 persons, respectively. Autoimmune hepatitis was independently associated with a higher risk of de novo steatotic liver disease (SLD) (adjusted odds ratio [OR] 5.90, 95% confidence interval [CI] 2.39-14.58). Compared with PBC, patients with AIH had a higher treatment response rate at 1 year (57.4% vs. 34.6%, P < 0.01) and a lower risk of overall mortality (OR 0.28, 95% CI 0.11-0.69). In patients with PBC, achieving a treatment response by the Toronto criteria was associated with improved transplant-free survival.</p><p><strong>Conclusion: </strong>The prevalence of AIH and PBC in our cohort mirrors that of East Asian populations. Despite a superior biochemical response, AIH was associated with a higher risk of hepatic steatosis. Underutilisation of second-line treatment in PBC represents an important gap for future improvement.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655586","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 upper respiratory tract infections - rational antimicrobial use.","authors":"Bin Lim, Sonja Cjh Chua, Rujia Xu, Valentina Ricci, Phyllis Al Kim","doi":"10.4103/singaporemedj.SMJ-2026-181","DOIUrl":"10.4103/singaporemedj.SMJ-2026-181","url":null,"abstract":"<p><strong>Abstract: </strong>This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for rational antimicrobial use in upper respiratory tract infections (URTIs). Upper respiratory tract infections are one of the most frequent presentations in primary healthcare settings, and they offer a critical opportunity for clinicians to promote antimicrobial stewardship through evidence-based prescribing practices. Utilising Grading of Recommendations Assessment, Development and Evaluation methodology, four evidence-informed recommendations have been formulated to support clinicians in assessing URTIs and making appropriate antimicrobial treatment decisions. This EtR framework synthesises the available evidence base alongside expert consensus to inform the recommendations presented in the ACG, thereby enabling clinicians to better understand the underlying rationale and effectively implement these recommendations within their clinical practice when managing URTIs and considering antimicrobial therapy. The ACG can be found at https://go.gov.sg/acg-urti .</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"479-486"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427914","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":"Clinics in diagnostic imaging (226).","authors":"Hong Wan Yap, Jeremy Jia Hong Lam, Felicia Teo","doi":"10.4103/singaporemedj.SMJ-2024-119","DOIUrl":"10.4103/singaporemedj.SMJ-2024-119","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 8","pages":"529-534"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835662","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":"Morbidity and treatment costs of cystic fibrosis in a middle-income country.","authors":"Shih Ying Hng, Agnes Suganthi Thinakaran, Chiou Jia Ooi, Kah Peng Eg, Meow Keong Thong, Sok Kun Tae, Saw Huan Goh, Kee Seang Chew, Lay Teng Tan, Mia Tuang Koh, Li Ai Chong, Farah Khalid, Ruey Teng Ng, Anna Marie Nathan, Jessie Anne de Bruyne","doi":"10.4103/singaporemedj.SMJ-2022-093","DOIUrl":"10.4103/singaporemedj.SMJ-2022-093","url":null,"abstract":"<p><strong>Introduction: </strong>Asian children with cystic fibrosis (CF) managed in Malaysia have significant morbidity with limited access to life-sustaining treatments. We determined the morbidity and treatment cost of CF in a resource-limited country.</p><p><strong>Methods: </strong>This cross-sectional study included all children diagnosed with CF in our centre. Data on clinical presentation, genetic mutation, serial spirometry results and complications were collected. Out-of-pocket (OOP) and healthcare costs over 1 year were retrieved for patients who were alive. Cohen's d and odds ratio (OR) were used to determine the effect size.</p><p><strong>Results: </strong>Twenty-four patients were diagnosed with CF. Five patients died at a median (range) age of 18 (0.3-22) years. F508deletion (c. 1521_1523delCTT) was found in 20% of the alleles, while 89% of the variants were detected in nine patients. Body mass index (BMI) Z score was >-1.96 in 70.6% of patients. Two thirds (68%) were colonised with Pseudomonas aeruginosa , and this was associated with lower weight ( P = 0.009) and BMI ( P = 0.02) Z scores. Only 18% had FEV 1 Z scores >-1.96. Early symptom onset ( d = 0.74), delayed diagnosis ( d = 2.07), a low FEF 25-75 Z score ( d = 0.82) and a high sweat conductance ( d = 1.19) were associated with death. Inpatient cost was mainly from diagnostic tests, while medications contributed to half of the outpatient cost. Healthcare utilisation cost was catastrophic, amounting to 20% of the total income.</p><p><strong>Conclusion: </strong>Asian children with CF suffer significant complications such as low weight, low lung function and shortened lifespan. P. aeruginosa colonisation was frequent and associated with poor growth. Healthcare cost to parents was catastrophic.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"487-496"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695734","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":"Perceptions and practices of primary care physicians in the management of resistant hypertension.","authors":"Clement Wai Kit Wong, Rui Lee, James Lee, Eugene Kwong Fei Leong, N V Ramani, Ngiap Chuan Tan, Troy Puar, Rajeev Parameswaran","doi":"10.4103/singaporemedj.SMJ-2025-248","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-248","url":null,"abstract":"<p><strong>Introduction: </strong>Resistant hypertension poses significant management challenges in primary care, with varying practices influencing patient outcomes. We evaluated current practices of primary care physicians in Singapore in managing resistant hypertension and examined their concordance with local and international guidelines.</p><p><strong>Methods: </strong>An anonymised cross-sectional survey was conducted from July 2021 to October 2023, using a 26-item questionnaire distributed to primary care physicians across Singapore. The survey included physicians from both the public and private healthcare sectors, while specialists were excluded. The survey assessed their knowledge of the definitions, diagnostic criteria, treatment preferences and referral patterns for resistant hypertension.</p><p><strong>Results: </strong>A total of 85 respondents participated in the survey. Only 74% (n = 63) of respondents correctly defined resistant hypertension as uncontrolled blood pressure (BP) (above 140/90 mmHg) despite concurrent use of three or more antihypertensives, including a diuretic. In addition, 53% (n = 45) correctly defined uncontrolled hypertension as home BP exceeding 135/85 mmHg. The majority (69%, n = 59) of primary care physicians would consider referral to a specialist after a trial of three antihypertensives, whereas 13% (n = 14) chose to continue management in primary care. Referrals were made mainly to Endocrinology (43%, n = 47) and Cardiology (35%, n = 39). Notably, few primary care physicians (27%, n = 23) considered the necessary work-up for secondary causes such as primary aldosteronism.</p><p><strong>Conclusion: </strong>This study identifies discrepancies between clinical practice and guidelines. The findings highlight a need to improve education on accurate definitions and guideline-based diagnosis of resistant hypertension, and develop clear national referral pathways for suspected secondary hypertension in primary care.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655555","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":"Advancing quality and impact: a mid-year update from SMJ.","authors":"Tiing Leong Ang","doi":"10.4103/singaporemedj.SMJ-2026-495","DOIUrl":"10.4103/singaporemedj.SMJ-2026-495","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 8","pages":"478"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835524","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}