Singapore medical journal最新文献

{"title":"Key factors for successful 24-h discharge following Enhanced Recovery After Surgery protocols in total knee arthroplasty.","authors":"Ee Chern Ng, Sheng Xu, Xuan Eric 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-2024-103","DOIUrl":"10.4103/singaporemedj.SMJ-2024-103","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) remains the gold standard treatment for end-stage knee osteoarthritis. With rising TKA numbers, effective resource management, such as reducing length of stay, is crucial. While prior studies have focused on patient characteristics, this study aimed to investigate the influence of demographics and pre- and immediate postoperative patient-reported outcome measures (PROMs) on successful 24-h discharge using Enhanced Recovery After Surgery (ERAS) protocols.</p><p><strong>Methods: </strong>Patients who underwent TKA with ERAS from August 2020 to July 2021 were followed up. Successful protocol completion was defined as discharge within 24 hours of surgery. Baseline characteristics and PROMs were recorded. Outcomes measures were compared between patients who successfully completed or failed the ERAS protocol, and variables were imputed into a binary logistic regression.</p><p><strong>Results: </strong>Of 342 patients, 315 (92.1%) completed the ERAS protocol for TKA. Logistic regression analysis showed that higher postoperative pain scores and American Society of Anesthesiology (ASA) class > 2 significantly reduced the likelihood of passing the ERAS protocol (postoperative visual analogue scale odds ratio 0.742, P = 0.004; ASA > 2 odds ratio 0.196, P = 0.02). The model demonstrated satisfactory goodness of fit and accurately classified 80.1% of patients at the optimal cut-off. Receiver operating characteristic curve analysis showed good probability of discriminating between patients (area under the curve = 0.741).</p><p><strong>Conclusion: </strong>Immediate postoperative pain scores and ASA class may be useful adjuncts in predicting successful 24-h discharge after TKA using ERAS protocol.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746699","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":"Advances, reception and potential of ChatGPT as a tool for healthcare delivery and research: a systematic review.","authors":"Navkaran Singh, Samantha Neubronner, Suren Kanayan, Sebastian Illanes, Mahesh Choolani, Matthew Warren Kemp","doi":"10.4103/singaporemedj.SMJ-2024-173","DOIUrl":"10.4103/singaporemedj.SMJ-2024-173","url":null,"abstract":"<p><strong>Abstract: </strong>ChatGPT gained widespread attention for its capabilities in natural language processing, enabling machines to assess human language inputs and generate complex, yet evolving answers. As large language models (LLMs) continue to develop, clear guidelines are needed to help healthcare providers and educators maximise their benefits while mitigating potential risks. This review assessed the utility and accuracy of applying ChatGPT in healthcare assistance, specifically in understanding clinical knowledge and guiding clinical practice and research. A search on PubMed/MEDLINE for ChatGPT-related articles from 30 November 2022 (ChatGPT's release date) to 14 March 2024 yielded 2690 articles. After screening and reviewing, 2141 articles were deemed relevant to the clinical and research domains. Of the articles, 60.3% were supportive of ChatGPT, highlighting its immense potential for automating routine tasks, enhancing decision-making processes and addressing complex challenges in health care. However, 0.9% were not supportive of ChatGPT's utilisation in its current form, given the unresolved ethical implications and concerns regarding accuracy, bias, privacy and legal. Additionally, 38.8% had an equivocal stance, suggesting for further research to fully understand the rapidly evolving capabilities and potential impacts of ChatGPT in healthcare. This review presents a newly created conceptual framework, the 'ABCD model', to facilitate a systematic approach for researchers and healthcare practitioners to navigate ChatGPT's strengths and limitations. The model aims to align the development and deployment of ChatGPT by providing guiding principles, which ChatGPT and other emerging LLMs should incorporate into further developments to ensure their suitable application in health care.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746696","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":"Autoimmune rheumatic diseases and manifestations for population screening: a consensus development study.","authors":"Ling Xiang, Andrea Hsiu Ling Low, Ying Ying Leung, Warren Weng Seng Fong, Tang Ching Lau, Dow Rhoon Koh, Sungwon Yoon, Julian Thumboo","doi":"10.4103/singaporemedj.SMJ-2024-257","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-257","url":null,"abstract":"<p><strong>Introduction: </strong>Self-administered screening questionnaires are one of the key strategies to shorten diagnostic delay among patients with autoimmune rheumatic diseases (ARDs). However, most existing screening questionnaires for ARDs were developed to screen for one or a limited number of ARDs, and thus have limited utility when the goal is to screen for common ARDs. We aimed to develop a list of ARDs for population screening, and based on this, a list of manifestations to be assessed in a screening questionnaire for ARDs.</p><p><strong>Methods: </strong>This study comprised two phases: Phase 1 involved the development of a list of ARDs through a modified Delphi study with accredited rheumatologists and Phase 2 involved the development of a list of manifestations through a modified nominal group technique with accredited rheumatologists, other healthcare professionals caring for patients with ARDs, and patients with ARDs.</p><p><strong>Results: </strong>In Phase 1, 14 candidate ARDs were identified using a multipronged approach, ten of which were deemed necessary to be screened for in the general population, through three rounds of Delphi exercise. In Phase 2, 80 candidate manifestations of these ten ARDs were identified from a literature review. Of these, 59 manifestations were deemed necessary to be assessed in a screening questionnaire through one round of prenominal group dialogue and two rounds of nominal group discussion.</p><p><strong>Conclusion: </strong>Consensus-based lists of ARDs and their manifestations were developed in this study. They provide a basis for developing new ARD screening questionnaires to facilitate early diagnosis of ARDs in the general population.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746698","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":"Attitudes toward medications among frail older adults and their caregivers in Singapore: a qualitative study.","authors":"Rebecca Siew Yan Teng, Yingqi Xu, Candelyn Yu Pong, Sze Ling Chan, Bharathi Balasundaram, Wendy Swee Tee Ang, Manjit Kaur D/O Charan Singh, Rakhi Vashishtha, Barbara Helen Rosario","doi":"10.4103/singaporemedj.SMJ-2024-142","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-142","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746697","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":"Trichophyton indotineae: timely recognition of an emerging pathogen causing persistent dermatophytosis.","authors":"Xue Ling Ang, Pei Ming Yeo, Yen Ee Tan, Shiu Ming Pang, Chia Chun Ang","doi":"10.4103/singaporemedj.SMJ-2024-243","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-243","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700807","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":"Effects of music therapy on intravitreal injections: a randomised clinical trial.","authors":"Kai En Chan, Hannah Jia Hwee Tan, Kwan Yi Yap, Ruochen Du, Zhongzheng Lan, Blanche Xiao Hong Lim, Chris Hong Long Lim","doi":"10.4103/singaporemedj.SMJ-2024-156","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-156","url":null,"abstract":"<p><strong>Introduction: </strong>Procedures are frequently performed under regional or local anaesthesia, where patients maintain a level of consciousness. This has been associated with heightened pre- and intraprocedural anxiety levels, which may increase the risk of emotional distress and worsen patient outcomes. Music therapy has been proposed as an effective non-pharmacological intervention to reduce anxiety levels. This is a pilot study aimed at evaluating the effect of music therapy on anxiety and perceived pain during intravitreal injections (IVI) in the Singaporean context.</p><p><strong>Methods: </strong>Study participants were randomised into groups with and without music therapy. Anxiety levels were assessed using the Spielberger State-Trait Anxiety Inventory (state subscale) before and after IVI. The patients' perceptions of pain and discomfort were rated on a visual analogue scale.</p><p><strong>Results: </strong>Fifty and 51 patients were assigned to the music therapy and control groups, respectively. After IVI, anxiety levels were lower in the music therapy group than the control group (-5.94 ± 10.81 vs. -5.02 ± 7.59; P = 0.62), although the difference was not statistically significant. The levels of pain and discomfort reported by patients in both groups were comparable.</p><p><strong>Conclusion: </strong>In the setting of IVIs, anxiety levels among patients receiving music therapy were reduced compared to those who had no music therapy, although the difference in anxiety levels was not statistically significant. Future studies should evaluate the impact of patient autonomy over the choice of music on the effectiveness of music therapy.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661432","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":"Inhaler adherence, associated factors and outcomes among adult asthma patients in Singapore.","authors":"Tingfeng Lee, Kui Jie Amy Teoh, Sanchalika Acharyya, Shu Yi Lee, Sze Min Tan, Cheila May Dizon Coliat, Lathy Prabhakaran, Chee Yen Goh, Nurul Shahida Binte Azman, Ping Hou, Esther Pee Hwee Pang","doi":"10.4103/singaporemedj.SMJ-2024-155","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-155","url":null,"abstract":"<p><strong>Introduction: </strong>Inhaler therapy is paramount in asthma management, yet non-adherence poses a significant challenge. This study investigates inhaler adherence patterns among adult asthma patients, employing the Test of Adherence to Inhalers (TAIs) questionnaire.</p><p><strong>Methods: </strong>This cross-sectional study recruited 99 eligible patients from a specialist outpatient clinic over six months. The TAI questionnaire was administered to the patients. Data on asthma control test scores, medication possession ratio, and healthcare utilisation were collected. Statistical analyses were performed to examine the associations between adherence, patient characteristics, and clinical outcomes.</p><p><strong>Results: </strong>More than half of the patients (68.7%) exhibited intermediate (n = 23) or poor (n = 45) adherence, with younger age associated with poorer adherence. Different patterns of non-compliance were identified; 38.8% (n = 19) of patients with poor adherence showed deliberate non-compliance, whereas only 7.3% (n = 3) with good adherence showed unconscious non-compliance. Surprisingly, patients with intermediate and poor adherence often achieved good asthma control, revealing potential challenges in outcome-based adherence assessments. A relatively higher but statistically non-significant proportion of patients with poor adherence had at least one hospitalisation or emergency department attendance due to asthma (42.2% with poor adherence vs. 35.5% with good adherence) or at least one asthma exacerbation requiring oral corticosteroid (64.4% with poor adherence vs. 48.4% with good adherence) in the past 12 months.</p><p><strong>Conclusion: </strong>This study provides insights into inhaler adherence among local adult asthma patients, identifying distinct adherence patterns and recognising potential complacency issues associated with traditional adherence assessments. Despite these limitations, our findings contribute to the optimisation of asthma care through a nuanced understanding of inhaler adherence.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661433","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":"Adopting a consensus on the dose of antenatal steroids used by obstetric and neonatal services in Singapore in anticipation of imminent preterm birth.","authors":"Matthew Warren Kemp, Zubair Amin, Agnihotri Biswas, Mei Chien Chua, Bin Huey Quek, Lay Kok Tan, Victor Samuel Rajadurai, Devendra Kanagalingam, Woei Bing Poon, Lin Lin Su, Arjit Biswas, Shwetha Shanmugam, Navkaran Singh, Tak Yein Lim, Tiong Ghee Teoh, Sebastian Enrique Illanes, Alan Hall Jobe, Sean William David Carter, Mahesh Arjandas Choolani","doi":"10.4103/singaporemedj.SMJ-2025-040","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-040","url":null,"abstract":"<p><strong>Abstract: </strong>In Singapore, glucocorticoids are administered to pregnant women at risk of imminent preterm delivery. The primary desired benefit is maturation of the preterm fetal lung. The commonly used antenatal steroid regimen in Singapore, two doses of 12 mg dexamethasone phosphate at a 12-h interval, is not widely used in other jurisdictions. There are important pharmacokinetic and pharmacodynamic differences between the glucocorticoids used to elicit fetal lung maturation. Acknowledging the range of society-endorsed clinical guidelines in worldwide use, we recommend that obstetric and neonatal services in Singapore work towards adopting a more widely accepted antenatal steroid dosing regimen: either two 11.4 mg maternal intramuscular injections of betamethasone (as betamethasone phosphate and betamethasone acetate), spaced by 24 h, or four 6 mg maternal intramuscular injections of dexamethasone phosphate spaced by 12 h.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577505","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":"Status of hepatitis B virus and hepatitis C elimination in Singapore: a call for action.","authors":"Yu Jun Wong, Daniel Huang","doi":"10.4103/singaporemedj.SMJ-2025-142","DOIUrl":"10.4103/singaporemedj.SMJ-2025-142","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 7","pages":"376-378"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700811","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":"Advancing precision medicine: the case for monogenic diabetes mellitus in Singapore.","authors":"Jeannette Lay Kuan Goh, Saumya Shekhar Jamuar, Joan Khoo","doi":"10.4103/singaporemedj.SMJ-2025-115","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-115","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556365","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}