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Integrated care at the emergency department: an investment for better health. 急诊科的综合护理:改善健康的一项投资。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-05-12 DOI: 10.4103/singaporemedj.SMJ-2022-030
Steven Hoon Chin Lim, Colin Eng Choon Ong, Arron Seng Hock Ang, Khai Pin Lee, Jean Mui Hua Lee, Venkataraman Anantharaman

Abstract: It is crucial that policy makers, healthcare providers and relevant stakeholders understand how integrated care may be improved at our emergency departments (EDs) and what benefits that would bring. The potential that exists for right-siting care of special patient groups who could be managed in an ambulatory setting with the integration of a variety of hospital-based and community-based clinical support services is tremendous. This review describes the best practice and value of integrated care at the EDs. Local evidence is cited and compared with findings from overseas. The opportunities of care transition interventions among discharged patients are outlined, including that for paediatric patients, palliative care patients and patients with chronic diseases. This review also suggests ways to move forward to meet the aim of providing holistic care at EDs through integrated care programmes, innovation and research.

至关重要的是,政策制定者、医疗保健提供者和相关利益相关者了解如何在我们的急诊科(ed)改善综合护理,以及这会带来什么好处。对特殊患者群体进行正确定位护理的潜力是巨大的,这些患者群体可以在门诊环境中进行管理,并整合各种以医院为基础和以社区为基础的临床支持服务。这篇综述描述了综合护理在急诊科的最佳实践和价值。引用当地的证据,并与海外的研究结果进行比较。概述了对出院病人进行护理过渡干预的机会,包括对儿科病人、姑息治疗病人和慢性病病人的干预。本综述还提出了通过综合护理方案、创新和研究来实现在急诊科提供全面护理的目标的方法。
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引用次数: 0
Association of COVID-19 'circuit breaker' with higher rates of elderly trauma admissions. COVID-19“熔断机制”与老年创伤入院率较高的关联
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-05-11 DOI: 10.4103/singaporemedj.SMJ-2021-411
Yee Har Liew, Zhenghong Liu, Mian Jie Lim, Pei Leng Chong, Norhayati Bte Mohamed Jainodin, Teng Teng Peh, Jing Jing Chan, Sachin Mathur, Jeremy Choon Peng Wee

Introduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus emerged and caused a worldwide pandemic, leading to measures being imposed by many countries to reduce its transmission. Singapore implemented the 'circuit breaker', which restricted all movements except for access to necessities and healthcare services. We aimed to investigate the impact of lockdown measures on the pattern of trauma and its effects.

Methods: An observational, retrospective, single-centre descriptive study was conducted using the trauma registry in Singapore General Hospital. It included patients above 18 years old who presented to the emergency department with trauma and were subsequently admitted. Patients admitted from 1 February 2020 to 31 July 2020 and those admitted during the same timeframe in 2019 were studied. Subgroup analyses were performed for patients aged ≥65 years and those <65 years.

Results: A total of 1,037 patients were included for analysis. A 17.6% increase in trauma presentations was seen from 2019 to 2020. Patients aged ≥65 years accounted for the rise in admissions. The predominant mechanism of injury was falls at home for older patients and vehicular accidents in patients <65 years. There were no significant differences in injury severity score, intensive care/high-dependency unit admission rates, length of stay, mortality rate, and subsequent need for inpatient rehabilitation.

Conclusion: Our study provided information on differences in trauma presentations before and during the COVID-19 pandemic. Further studies are required to better inform on additional precautionary measures needed to reduce trauma and improve safety during future lockdowns and pandemics.

2019年12月,严重急性呼吸综合征冠状病毒2 (SARS-COV-2)出现并引起全球大流行,导致许多国家采取措施减少其传播。新加坡实施了"熔断机制",限制除获得必需品和医疗服务外的所有行动。我们的目的是调查封锁措施对创伤模式及其影响的影响。方法:一项观察性、回顾性、单中心描述性研究在新加坡综合医院创伤登记处进行。它包括18岁以上的患者,他们因创伤而到急诊室就诊,随后入院。研究了2020年2月1日至2020年7月31日入院的患者以及2019年同一时间段入院的患者。对年龄≥65岁的患者进行亚组分析。结果:共纳入1037例患者进行分析。从2019年到2020年,创伤病例增加了17.6%。入院人数增加的患者年龄≥65岁。结论:我们的研究提供了在COVID-19大流行之前和期间创伤表现的差异信息。需要进一步研究,以便更好地了解在未来封锁和大流行期间减少创伤和提高安全性所需的额外预防措施。
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引用次数: 0
Oncology-related emergencies discharged from the emergency department. 从急诊科出院的与肿瘤相关的急诊。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-05-02 DOI: 10.4103/singaporemedj.SMJ-2021-368
Si-Hua Yvonne Goh, Juin Jie Ng, Shi-En Joanna Chan, Wei-Lin Tallie Chua, Venkataraman Anantharaman

Introduction: Cancer patients attending emergency departments (EDs) often present with acute symptoms and are frequently admitted. This study aimed to characterise the profile of oncology patients who were discharged from the ED.

Methods: This was a retrospective audit of patients with cancer-related diagnoses who presented to the ED at the Singapore General Hospital (SGH) over a 6-month period from 1 October 2018 to 31 March 2019 and were directly discharged from the ED. Data was extracted from the hospital's electronic medical record system.

Results: Of the 492 participants included in the study, the majority were triaged as Priority 2 (61.4%), while 30.7% were triaged as Priority 3, 6.9% as Priority 1 and 1.0% as Priority 4. There was no statistical difference between the National Early Warning scores across the different triage categories in these patients. The most common complaint was (44.3%), followed by genitourinary symptoms (19.5%) and those related to devices, catheters or stomas (17.3%). More investigations of all types were done for patients being managed in Priority 1 (57.6%) than in the other triage categories (40.1% for Priority 2, 23.2% for Priority 3 and 12.0% for Priority 4). Treatment procedures carried out were mainly symptomatic (analgesics, antiemetics, proton pump inhibitors) for 79.8% of the patients. There were no significant differences in the proportion of patients requiring various treatment modalities among the triage categories.

Conclusion: Selected oncological patients may potentially be managed in an ambulatory setting.

简介:急诊科(EDs)的癌症患者通常表现为急性症状,并且经常被收治。本研究旨在描述从急诊科出院的肿瘤患者的特征。方法:对2018年10月1日至2019年3月31日6个月期间在新加坡总医院(SGH)急诊科就诊并直接从急诊科出院的癌症相关诊断患者进行回顾性审计。数据提取自医院的电子病历系统。结果:纳入研究的492名参与者中,优先级2的占61.4%,优先级3的占30.7%,优先级1的占6.9%,优先级4的占1.0%。在这些患者的不同分类中,国家早期预警评分之间没有统计学差异。最常见的主诉是(44.3%),其次是泌尿生殖系统症状(19.5%)和与器械、导尿管或造口相关的症状(17.3%)。优先级1的患者(57.6%)比优先级2的40.1%、优先级3的23.2%和优先级4的12.0%进行了更多的所有类型的调查。对79.8%的患者进行的治疗主要是对症治疗(镇痛药、止吐药、质子泵抑制剂)。在分诊类别中,需要不同治疗方式的患者比例无显著差异。结论:选定的肿瘤患者可能在门诊环境中进行管理。
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引用次数: 0
Knowledge of COVID-19 and associated factors among kidney transplant recipients and donors in Singapore. 新加坡肾移植受者和供者对COVID-19及其相关因素的了解
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-05-30 DOI: 10.4103/singaporemedj.SMJ-2021-386
Ian Tatt Liew, Yeli Wang, Terence Kee, Ping Sing Tee, Rupesh Madhukar Shirore, Sobhana Thangaraju, Quan Yao Ho, York Moi Lu, Jin Hua Yong, Fiona Foo, Eleanor Ng, Xia He, Constance Lee, Shannon Baey, Marjorie Foo, Tazeen Hasan Jafar

Background: Effective interventions during the coronavirus disease 2019 (COVID-19) pandemic require an understanding of patients' knowledge and perceptions that influence their behaviour. Our study assessed knowledge of COVID-19 among kidney transplant recipients and donors, hitherto unevaluated.

Methods: We conducted a cross-sectional survey among 325 kidney transplant recipients and 172 donors between 1 May 2020 and 30 June 2020. The survey questionnaire assessed knowledge levels of COVID-19, sociodemographic data, health status, psychosocial impact of COVID-19 and precautionary behaviours during the pandemic.

Results: The mean COVID-19 knowledge score of the study population was 7.5 (standard deviation: 2.2) out of 10. The mean score was significantly higher among kidney recipients compared to kidney donors (7.9 [1.9] vs. 6.7 [2.6]; P <0.001). Younger age (21-49 vs. ≥50 years) and higher education (diploma and higher vs. secondary and lower) were associated with significantly higher knowledge scores in donors, but not among recipients ( P -interactions ≤0.01). In both kidney recipients and donors, financial concerns and/or social isolation were associated with lower knowledge levels.

Conclusions: Concerted efforts are needed to improve COVID-19 knowledge in kidney transplant recipients and donors, particularly older donors, donors with lower education and patients with financial concerns or feelings of social isolation. Intensive patient education may mitigate the impact of education levels on COVID-19 knowledge levels.

背景:在2019冠状病毒病(COVID-19)大流行期间,有效的干预措施需要了解影响患者行为的知识和观念。我们的研究评估了肾移植受者和供者对COVID-19的了解,迄今尚未进行评估。方法:我们在2020年5月1日至2020年6月30日期间对325名肾移植受者和172名供者进行了横断面调查。调查问卷评估了COVID-19的知识水平、社会人口数据、健康状况、COVID-19的心理社会影响以及大流行期间的预防行为。结果:研究人群的平均COVID-19知识得分为7.5分(标准差:2.2)。肾受体的平均评分明显高于肾供者(7.9 [1.9]vs. 6.7 [2.6];结论:需要共同努力提高肾移植受者和供者的COVID-19知识,特别是老年供者、受教育程度较低的供者和有经济问题或社会孤立感的患者。强化患者教育可减轻教育水平对COVID-19知识水平的影响。
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引用次数: 0
COVID-19 vaccine acceptance among kidney transplant recipients in Singapore. 新加坡肾移植受者的COVID-19疫苗接受度
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-04-26 DOI: 10.4103/singaporemedj.SMJ-2021-332
Ian Tatt Liew, Hanis Abdul Kadir, Sobhana Thangaraju, Quan Yao Ho, Eleanor Ng, Fiona Foo, Terence Kee

Introduction: A successful vaccination programme forms the cornerstone of controlling coronavirus disease 2019 (COVID-19). The unprecedented speed of COVID-19 vaccine development and lack of long-term data have raised fears regarding its safety and efficacy. Vaccine hesitancy can undermine the uptake, and hence success of the vaccination programme. Given the high complication rates of COVID-19 infections in kidney transplant recipients, it is particularly important to identify and address vaccine hesitancy in this population.

Methods: We conducted a cross-sectional survey among kidney transplant recipients attending transplant clinic between 5 April and 5 May 2021. The survey assessed attitudes towards COVID-19, willingness/hesitancy towards COVID-19 vaccination, vaccination concerns and prompts to vaccination. This was scored on a Likert scale with scores ranging from 'strongly disagree' - 1 point to 'strongly agree' - 5 points.

Results: One hundred and one completed responses were captured. Of these, 86% respondents reported to agree or strongly agree to vaccination. This was despite significant concerns of allograft rejection (mean score 4.12, standard deviation [SD] 0.97) and decreased immunosuppressant efficacy (mean score 4.14, SD 0.96) with vaccination. Multivariable model showed a positive association with transplant vintage of ≥ 5 years (median 2.41), lower educational levels of secondary school or less (median 5.82) and healthcare provider advocacy (median 1.88) in predicting vaccine acceptance.

Conclusions: Vaccine acceptance rate was high among kidney transplant recipients. Vaccine hesitancy remains a concern in those with a transplant vintage of less than 5 years and those with tertiary educational level. Healthcare provider advocacy is important in improving vaccine acceptance rates.

成功的疫苗接种规划是控制2019冠状病毒病(COVID-19)的基石。新型冠状病毒疫苗研发的空前速度和长期数据的缺乏引发了人们对其安全性和有效性的担忧。疫苗犹豫会影响疫苗接种计划的接受,从而影响疫苗接种计划的成功。鉴于肾移植受者中COVID-19感染的高并发症发生率,识别和解决这一人群的疫苗犹豫尤为重要。方法:我们对2021年4月5日至5月5日在移植诊所就诊的肾移植受者进行了横断面调查。该调查评估了对COVID-19的态度、对COVID-19疫苗接种的意愿/犹豫、疫苗接种问题和疫苗接种提示。这是用李克特量表打分的,得分范围从“非常不同意”(1分)到“非常同意”(5分)。结果:共获得101份完整的问卷。其中,86%的答复者报告同意或强烈同意接种疫苗。尽管接种疫苗后存在同种异体移植排斥反应(平均评分4.12,标准差[SD] 0.97)和免疫抑制效果下降(平均评分4.14,SD 0.96),但仍存在显著的担忧。多变量模型显示,移植年龄≥5年(中位数2.41)、中学或以下教育程度较低(中位数5.82)和卫生保健提供者宣传(中位数1.88)与预测疫苗接受度呈正相关。结论:肾移植受者疫苗接种率高。对于移植时间少于5年的患者和受过高等教育的患者,疫苗犹豫仍然是一个值得关注的问题。卫生保健提供者的宣传对提高疫苗接受率很重要。
{"title":"COVID-19 vaccine acceptance among kidney transplant recipients in Singapore.","authors":"Ian Tatt Liew, Hanis Abdul Kadir, Sobhana Thangaraju, Quan Yao Ho, Eleanor Ng, Fiona Foo, Terence Kee","doi":"10.4103/singaporemedj.SMJ-2021-332","DOIUrl":"10.4103/singaporemedj.SMJ-2021-332","url":null,"abstract":"<p><strong>Introduction: </strong>A successful vaccination programme forms the cornerstone of controlling coronavirus disease 2019 (COVID-19). The unprecedented speed of COVID-19 vaccine development and lack of long-term data have raised fears regarding its safety and efficacy. Vaccine hesitancy can undermine the uptake, and hence success of the vaccination programme. Given the high complication rates of COVID-19 infections in kidney transplant recipients, it is particularly important to identify and address vaccine hesitancy in this population.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey among kidney transplant recipients attending transplant clinic between 5 April and 5 May 2021. The survey assessed attitudes towards COVID-19, willingness/hesitancy towards COVID-19 vaccination, vaccination concerns and prompts to vaccination. This was scored on a Likert scale with scores ranging from 'strongly disagree' - 1 point to 'strongly agree' - 5 points.</p><p><strong>Results: </strong>One hundred and one completed responses were captured. Of these, 86% respondents reported to agree or strongly agree to vaccination. This was despite significant concerns of allograft rejection (mean score 4.12, standard deviation [SD] 0.97) and decreased immunosuppressant efficacy (mean score 4.14, SD 0.96) with vaccination. Multivariable model showed a positive association with transplant vintage of ≥ 5 years (median 2.41), lower educational levels of secondary school or less (median 5.82) and healthcare provider advocacy (median 1.88) in predicting vaccine acceptance.</p><p><strong>Conclusions: </strong>Vaccine acceptance rate was high among kidney transplant recipients. Vaccine hesitancy remains a concern in those with a transplant vintage of less than 5 years and those with tertiary educational level. Healthcare provider advocacy is important in improving vaccine acceptance rates.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"73-80"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9447025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department. 院外心脏骤停后自发性循环恢复患者在急诊的复苏后护理。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 Epub Date: 2023-04-28 DOI: 10.4103/singaporemedj.SMJ-2021-354
Jing Kai Jackie Lam, Jen Heng Pek

Introduction: Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insufficient well-established protocols for post-resuscitation care. We aimed to evaluate post-resuscitation care in the emergency department (ED) of adult (aged ≥16 years) OHCA patients with sustained ROSC and its associated neurologically intact survival.

Methods: A retrospective review of electronic medical records was conducted for OHCA patients with sustained ROSC at the ED. Data including demographics, pre-hospital resuscitation, ED resuscitation, post-resuscitation care and eventual outcomes were analysed.

Results: Among 921 OHCA patients, 85 (9.2%) had sustained ROSC at the ED. Nineteen patients (19/85, 22.4%) survived, with 13 (13/85, 15.3%) having intact neurology at discharge. Electrocardiogram and chest X-ray were performed in all OHCA patients, whereas computed tomography (CT) was performed inconsistently, with CT brain being most common (74/85, 87.1%), while CT pulmonary angiogram (6/85, 7.1%), abdomen and pelvis (4/85, 4.7%) and aortogram (2/85, 2.4%) were done infrequently. Only four patients (4.7%) had all five neuroprotective goals of normoxia, normocarbia, normotension, normothermia and normoglycaemia achieved in the ED. The proportion of all five neuroprotective goals being met was significantly higher ( P = 0.01) among those with neurologically intact survival (3/13, 23.1%) than those without (1/72, 1.4%).

Conclusion: Post-resuscitation care at the ED showed great variability, indicating gaps between recommended guidelines and clinical practice. Good quality post-resuscitation care, centred around neuroprotection goals, must be initiated promptly to achieve meaningful survival with intact neurology.

院外心脏骤停(OHCA)是一项重大的公共卫生挑战,自然循环恢复后(ROSC)的目标已经从单纯的生存转移到神经系统完好的生存。虽然rosc后的护理对神经系统完好的患者的生存至关重要,但目前还没有完善的复苏后护理方案。我们的目的是评估急诊部门(ED)对持续ROSC的成年(年龄≥16岁)OHCA患者的复苏后护理及其相关的神经系统完整生存率。方法:回顾性分析在急诊科发生持续ROSC的OHCA患者的电子病历,分析人口统计学、院前复苏、急诊科复苏、复苏后护理和最终结局等数据。结果:921例OHCA患者中,85例(9.2%)在急诊科持续ROSC, 19例(19/ 85.22.4%)存活,13例(13/ 85.15.3%)出院时神经系统完整。所有OHCA患者均行心电图和胸部x线检查,CT检查不一致,以CT脑(74/85,87.1%)最为常见,CT肺血管造影(6/85,7.1%)、腹部和骨盆造影(4/85,4.7%)和主动脉造影(2/85,2.4%)较少见。只有4例患者(4.7%)在ED中达到了正常缺氧、正常碳氧、正常血压、正常体温和正常血糖这5个神经保护目标。神经功能完好的患者(3/13,23.1%)达到5个神经保护目标的比例显著高于未达到的患者(1/72,1.4%)(P = 0.01)。结论:急诊科的复苏后护理表现出很大的差异,表明推荐指南与临床实践之间存在差距。以神经保护目标为中心的高质量复苏后护理必须及时启动,以实现神经系统完整的有意义生存。
{"title":"Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department.","authors":"Jing Kai Jackie Lam, Jen Heng Pek","doi":"10.4103/singaporemedj.SMJ-2021-354","DOIUrl":"10.4103/singaporemedj.SMJ-2021-354","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insufficient well-established protocols for post-resuscitation care. We aimed to evaluate post-resuscitation care in the emergency department (ED) of adult (aged ≥16 years) OHCA patients with sustained ROSC and its associated neurologically intact survival.</p><p><strong>Methods: </strong>A retrospective review of electronic medical records was conducted for OHCA patients with sustained ROSC at the ED. Data including demographics, pre-hospital resuscitation, ED resuscitation, post-resuscitation care and eventual outcomes were analysed.</p><p><strong>Results: </strong>Among 921 OHCA patients, 85 (9.2%) had sustained ROSC at the ED. Nineteen patients (19/85, 22.4%) survived, with 13 (13/85, 15.3%) having intact neurology at discharge. Electrocardiogram and chest X-ray were performed in all OHCA patients, whereas computed tomography (CT) was performed inconsistently, with CT brain being most common (74/85, 87.1%), while CT pulmonary angiogram (6/85, 7.1%), abdomen and pelvis (4/85, 4.7%) and aortogram (2/85, 2.4%) were done infrequently. Only four patients (4.7%) had all five neuroprotective goals of normoxia, normocarbia, normotension, normothermia and normoglycaemia achieved in the ED. The proportion of all five neuroprotective goals being met was significantly higher ( P = 0.01) among those with neurologically intact survival (3/13, 23.1%) than those without (1/72, 1.4%).</p><p><strong>Conclusion: </strong>Post-resuscitation care at the ED showed great variability, indicating gaps between recommended guidelines and clinical practice. Good quality post-resuscitation care, centred around neuroprotection goals, must be initiated promptly to achieve meaningful survival with intact neurology.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"66-72"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9817074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of the modified Safety Attitude Questionnaire for the medical imaging department. 为医学影像科编制经修改的安全态度问卷。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-01 Epub Date: 2023-02-06 DOI: 10.4103/singaporemedj.SMJ-2021-254
Ravi Chanthriga Eturajulu, Maw Pin Tan, Mohd Idzwan Zakaria, Karuthan Chinna, Kwan Hoong Ng

Introduction: Medical errors commonly occur in medical imaging departments. These errors are frequently influenced by patient safety culture. This study aimed to develop a suitable patient safety culture assessment tool for medical imaging departments.

Methods: Staff members of a teaching hospital medical imaging department were invited to complete the generic short version of the Safety Attitude Questionnaire (SAQ). Internal consistency and reliability were evaluated using Cronbach's α. Confirmatory factor analysis (CFA) was conducted to examine model fit. A cut-off of 60% was used to define the percentage positive responses (PPR). PPR values were compared between occupational groups.

Results: A total of 300 complete responses were received and the response rate was 75.4%. In reliability analysis, the Cronbach's α for the original 32-item SAQ was 0.941. Six subscales did not demonstrate good fit with CFA. A modified five-subscale, 22-item model (SAQ-MI) showed better fit (goodness-to-fit index ≥0.9, comparative fit index ≥ 0.9, Tucker-Lewis index ≥0.9 and root mean square error of approximation ≤0.08). The Cronbach's α for the 22 items was 0.921. The final five subscales were safety and teamwork climate, job satisfaction, stress recognition, perception of management and working condition, with PPR of 62%, 68%, 57%, 61% and 60%, respectively. Statistically significant differences in PPR were observed between radiographers, doctors and others occupational groups.

Conclusion: The modified five-factor, 22-item SAQ-MI is a suitable tool for the evaluation of patient safety culture in a medical imaging department. Differences in patient safety culture exist between occupation groups, which will inform future intervention studies.

简介医学影像科经常发生医疗事故。这些错误经常受到患者安全文化的影响。本研究旨在为医学影像科室开发一种合适的患者安全文化评估工具:方法:邀请一家教学医院医学影像科的工作人员填写通用简版安全态度问卷(SAQ)。采用 Cronbach's α 评估内部一致性和可靠性。进行了确认性因子分析(CFA),以检查模型的拟合情况。正面回答百分比(PPR)的截止值为 60%。对不同职业组的 PPR 值进行了比较:共收到 300 份完整问卷,回复率为 75.4%。在信度分析中,最初的 32 项 SAQ 的 Cronbach's α 为 0.941。有六个分量表与 CFA 的拟合效果不佳。修改后的 5 个分量表、22 个项目的模型(SAQ-MI)显示出更好的拟合效果(拟合优度指数≥0.9,比较拟合指数≥0.9,塔克-刘易斯指数≥0.9,均方根近似误差≤0.08)。22 个项目的 Cronbach's α 为 0.921。最后五个分量表分别为安全和团队合作氛围、工作满意度、压力认可度、管理感知和工作条件,PPR 分别为 62%、68%、57%、61% 和 60%。据统计,放射技师、医生和其他职业群体之间的 PPR 存在明显差异:修改后的五因素 22 项 SAQ-MI 是评估医学影像科室患者安全文化的合适工具。不同职业群体在患者安全文化方面存在差异,这将为未来的干预研究提供参考。
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引用次数: 0
Immune thrombocytopenia in infants: a retrospective study with comparison to toddlers. 婴儿免疫性血小板减少症:一项与幼儿比较的回顾性研究。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-01 Epub Date: 2023-03-02 DOI: 10.4103/singaporemedj.SMJ-2021-184
Anselm Chi-Wai Lee

Introduction: Immune thrombocytopenia (ITP) is the most common cause of acquired bleeding in childhood, but little is known about the clinical course and outcomes in infants with ITP.

Methods: This is a retrospective study of all infants (1-12 months of age) and toddlers (13-47 months of age) diagnosed with ITP from a single centre during a 13-year period. The following data were compared between the two patients groups: demographics, severity of bleeding, platelet counts, duration of illness, development of chronic ITP, treatment and association with recent vaccination.

Results: Twenty-two infants and 30 toddlers were diagnosed and followed up for ITP during the study period. Infants with ITP generally had minor or mild bleeding (19, 86.4%) and seldom required treatment (7, 31.8%), and their thrombocytopenia resolved at a mean of 1.90 months after diagnosis. Besides age, the sex ratio, severity of bleeding, platelet counts and proportion that required treatment were comparable between infants and toddlers. Fewer infants developed chronic ITP (1/22 vs. 9/30, P = 0.032), but more infants had a history of vaccination in the preceding 6 weeks prior to diagnosis of ITP (13/22 vs. 1/30, P < 0.001).

Conclusion: ITP in infants is almost always a self-limiting and transient illness, and the majority of cases do not require treatment.

免疫性血小板减少症(ITP)是儿童期获得性出血的最常见原因,但对ITP患儿的临床病程和结局知之甚少。方法:这是一项回顾性研究,对13年间来自单一中心诊断为ITP的所有婴儿(1-12个月大)和幼儿(13-47个月大)进行研究。比较两组患者的以下数据:人口统计学、出血严重程度、血小板计数、病程、慢性ITP的发展、治疗以及与近期疫苗接种的关系。结果:22名婴儿和30名幼儿在研究期间被诊断并随访ITP。ITP患儿一般有轻微或轻度出血(19.86.4%),很少需要治疗(7.31.8%),其血小板减少症在诊断后平均1.90个月消退。除了年龄,性别比例、出血严重程度、血小板计数和需要治疗的比例在婴幼儿之间是相似的。发生慢性ITP的婴儿较少(1/22比9/30,P = 0.032),但更多的婴儿在ITP诊断前6周有疫苗接种史(13/22比1/30,P < 0.001)。结论:婴幼儿ITP多为一过性自限性疾病,多数不需要治疗。
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引用次数: 0
Risk and protective factors associated with adolescent depression in Singapore: a systematic review. 新加坡青少年抑郁症的相关风险和保护因素:系统回顾。
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-01 Epub Date: 2023-04-26 DOI: 10.4103/singaporemedj.SMJ-2021-192
Wei Sheng Goh, Jun Hao Norman Tan, Yang Luo, Sok Hui Ng, Mohamed Sufyan Bin Mohamed Sulaiman, John Chee Meng Wong, Victor Weng Keong Loh

Introduction: Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore.

Methods: A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis.

Results: In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming).

Conclusion: The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.

青少年抑郁症很普遍,青少年自杀率在当地呈上升趋势。系统性回顾了解相关的风险和保护因素对于加强新加坡青少年抑郁症和自杀的预防和早期发现措施非常重要。本系统综述旨在确定新加坡青少年抑郁症的相关因素。方法:于2020年5月21日对PubMed、EMBASE和PsycINFO数据库进行系统检索。对全文进行审查以确定其合格性,并使用纽卡斯尔渥太华量表对纳入的研究进行质量评价。通过主题分析对定稿文章进行叙事综合。结果:本综述共纳入8项研究。与青少年抑郁相关的四个因素是:(1)社会人口因素(性别、种族);(2)心理因素,包括童年虐待暴露和心理构念(希望、乐观);(3)患有慢性疾病(哮喘)的;(4)生活方式因素(睡眠不足、过度上网、病态游戏)。结论:所确定的因素与国际文献报道的基本相似,除了睡眠不足,以及明显缺失的因素,如学业压力和严格的父母教育,这些因素应促使这些领域的进一步研究。进一步的研究应侧重于当前和未来的干预措施,以提高心理健康素养,针对睡眠时间、互联网使用和游戏,并在初级保健和社区环境中减轻慢性疾病患者的抑郁风险。
{"title":"Risk and protective factors associated with adolescent depression in Singapore: a systematic review.","authors":"Wei Sheng Goh, Jun Hao Norman Tan, Yang Luo, Sok Hui Ng, Mohamed Sufyan Bin Mohamed Sulaiman, John Chee Meng Wong, Victor Weng Keong Loh","doi":"10.4103/singaporemedj.SMJ-2021-192","DOIUrl":"10.4103/singaporemedj.SMJ-2021-192","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore.</p><p><strong>Methods: </strong>A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis.</p><p><strong>Results: </strong>In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming).</p><p><strong>Conclusion: </strong>The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"2-14"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9447018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Paediatric one-day admission: why and is it necessary? 儿科一日入院:为什么需要?
IF 1.7 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-01 Epub Date: 2023-02-15 DOI: 10.4103/singaporemedj.SMJ-2021-117
Jing Zhan Lock, Zi Xean Khoo, Jen Heng Pek

Introduction: Paediatric patients admitted to the inpatient units from the emergency department (ED) are increasing, but the mean length of stay has fallen significantly. We aimed to determine the reasons behind paediatric one-day admissions in Singapore and to assess their necessity.

Methods: A retrospective study involving paediatric patients who were admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital between 1 August 2018 and 30 April 2020. One-day admission was defined as an inpatient stay of less than 24 h from the time of admission to discharge. An unnecessary admission was defined as one with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit. Data were captured in a standardised form and analysed.

Results: There were 13,944 paediatric attendances - 1,160 (8.3%) paediatric patients were admitted. Among these, 481 (41.4%) were one-day admissions. Upper respiratory tract infection (62, 12.9%), gastroenteritis (60, 12.5%) and head injury (52, 10.8%) were the three most common conditions. The three most common reasons for ED admissions were inpatient treatment (203, 42.2%), inpatient monitoring (185, 38.5%) and inpatient diagnostic investigations (32, 12.3%). Ninety-six (20.0%) one-day admissions were unnecessary.

Conclusion: Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the paediatric patient and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions.

简介从急诊科(ED)转入住院部的儿科病人越来越多,但平均住院时间却大幅缩短。我们旨在确定新加坡儿科一日入院的原因,并评估其必要性:这是一项回顾性研究,涉及 2018 年 8 月 1 日至 2020 年 4 月 30 日期间从成人三级医院普通急诊室收治到儿科三级医院的儿科患者。入院一天定义为从入院到出院的住院时间少于24小时。不必要的入院定义为在住院部未开具诊断检测单、未进行静脉用药、未执行治疗程序或未进行专科复查的入院。数据以标准化表格采集并进行分析:共有 13,944 名儿科就诊者,其中 1,160 名(8.3%)儿科患者入院。其中,481 人(41.4%)住院一天。上呼吸道感染(62 人,12.9%)、肠胃炎(60 人,12.5%)和头部受伤(52 人,10.8%)是最常见的三种疾病。急诊室收治病人的三个最常见原因是住院治疗(203 人,42.2%)、住院监测(185 人,38.5%)和住院诊断检查(32 人,12.3%)。96人(20.0%)的单日入院是不必要的:儿科单日入院为制定和实施针对医疗系统、急诊室、儿科患者及其护理人员的干预措施提供了机会,从而安全地减缓甚至扭转入院人数增加的趋势。
{"title":"Paediatric one-day admission: why and is it necessary?","authors":"Jing Zhan Lock, Zi Xean Khoo, Jen Heng Pek","doi":"10.4103/singaporemedj.SMJ-2021-117","DOIUrl":"10.4103/singaporemedj.SMJ-2021-117","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric patients admitted to the inpatient units from the emergency department (ED) are increasing, but the mean length of stay has fallen significantly. We aimed to determine the reasons behind paediatric one-day admissions in Singapore and to assess their necessity.</p><p><strong>Methods: </strong>A retrospective study involving paediatric patients who were admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital between 1 August 2018 and 30 April 2020. One-day admission was defined as an inpatient stay of less than 24 h from the time of admission to discharge. An unnecessary admission was defined as one with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit. Data were captured in a standardised form and analysed.</p><p><strong>Results: </strong>There were 13,944 paediatric attendances - 1,160 (8.3%) paediatric patients were admitted. Among these, 481 (41.4%) were one-day admissions. Upper respiratory tract infection (62, 12.9%), gastroenteritis (60, 12.5%) and head injury (52, 10.8%) were the three most common conditions. The three most common reasons for ED admissions were inpatient treatment (203, 42.2%), inpatient monitoring (185, 38.5%) and inpatient diagnostic investigations (32, 12.3%). Ninety-six (20.0%) one-day admissions were unnecessary.</p><p><strong>Conclusion: </strong>Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the paediatric patient and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions.</p>","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" ","pages":"15-19"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9363620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","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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