Singapore medical journal最新文献

{"title":"Empowering primary care in the management of toe fractures: a quality improvement project","authors":"Valerie Huali Tan, Amaris Shu Min Lim, Sky Wei Chee Koh, Jun Hao Tan, Choon Chiet Hong","doi":"10.4103/singaporemedj.smj-2022-019","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-019","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"14 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of deep learning model for paediatric elbow radiograph binomial classification: initial experience, performance and lessons learnt","authors":"M. Tan, R. Y. Chua, Qiao Fan, M. Fortier, P. P. Chang","doi":"10.4103/singaporemedj.smj-2022-078","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-078","url":null,"abstract":"In this study, we aimed to compare the performance of a convolutional neural network (CNN)-based deep learning model that was trained on a dataset of normal and abnormal paediatric elbow radiographs with that of paediatric emergency department (ED) physicians on a binomial classification task. A total of 1,314 paediatric elbow lateral radiographs (patient mean age 8.2 years) were retrospectively retrieved and classified based on annotation as normal or abnormal (with pathology). They were then randomly partitioned to a development set (993 images); first and second tuning (validation) sets (109 and 100 images, respectively); and a test set (112 images). An artificial intelligence (AI) model was trained on the development set using the EfficientNet B1 network architecture. Its performance on the test set was compared to that of five physicians (inter-rater agreement: fair). Performance of the AI model and the physician group was tested using McNemar test. The accuracy of the AI model on the test set was 80.4% (95% confidence interval [CI] 71.8%–87.3%), and the area under the receiver operating characteristic curve (AUROC) was 0.872 (95% CI 0.831–0.947). The performance of the AI model vs. the physician group on the test set was: sensitivity 79.0% (95% CI: 68.4%–89.5%) vs. 64.9% (95% CI: 52.5%–77.3%; P = 0.088); and specificity 81.8% (95% CI: 71.6%–92.0%) vs. 87.3% (95% CI: 78.5%–96.1%; P = 0.439). The AI model showed good AUROC values and higher sensitivity, with the P-value at nominal significance when compared to the clinician group.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"1 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic myonecrosis in haemodialysis patients: importance of early recognition, noninvasive diagnosis and treatment","authors":"Jin Wen Rachael Nai, Jingyin Sophia Ng, Eng Kuang Lim, Claude Jeffrey Renaud, Fams Renal Medicine","doi":"10.4103/singaporemedj.smj-2021-431","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-431","url":null,"abstract":"","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"24 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139213230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcome of patients with anorexia nervosa on medical nutritional therapy: an institutional study with review of literature","authors":"Denise Elizabeth Shi Yun Teo, Valerie Wei Ling Teong, R. Ramachandran, Su Lin Lim, Charlotte Xianghui Lin","doi":"10.4103/singaporemedj.smj-2022-062","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2022-062","url":null,"abstract":"Eating disorders (EDs) are debilitating mental illnesses that can lead to significant medical complications from malnutrition. Eating disorders are on the rise in Asia and the prevalence is expected to increase. The aim of this study was to understand the characteristics of local patients and evaluate our current inpatient nutritional rehabilitation protocol for anorexia nervosa (AN). Retrospective descriptive data were gathered from 47 patients diagnosed with AN. Patients with admissions were further stratified according to their nutritional management based on whether they were on the AN protocol or standard hospital care. Data on their rate of weight gain, length of stay and calorie prescription were collected. Similar to previous studies, the majority of AN patients were female (96.7%). However, the age at presentation of AN in this study, as compared with previous local studies, had decreased (14 vs. 16 years). We also found that patients on the AN protocol were prescribed a higher amount of calories than those given standard care (2,700 vs. 2,317 calories). Patients on the AN protocol achieved a higher rate of weight gain per week (1.15 vs. 0.29 kg) and had a shorter length of hospital stay (23 vs. 36 days). Patients with AN appear to be presenting at a younger age. Medical stabilisation of AN patients can be achieved more quickly through a higher calorie inpatient AN treatment protocol. Future local studies examining actual calorie consumption, its effect on weight gain trajectory, severity of refeeding syndrome and time to remission will be beneficial.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"77 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139214997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of polypharmacy: a cross-sectional study in Singapore public healthcare institutions","authors":"Jie Lin Soong, Hui Wen Ho, Leng Chuan Goh, Jiun Yu Christina Tan, Deborah Chia, Jun Long Marvin Sim","doi":"10.4103/singaporemedj.smj-2023-008","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-008","url":null,"abstract":"Polypharmacy is associated with increased prevalence of potentially inappropriate medications (PIMs), leading to higher risk of adverse drug events and medication errors. This study was the first multicentre cross-sectional study in Singapore that determined the prevalence of polypharmacy, its associated factors and the common drug classes involved, and evaluated prescribing appropriateness of drugs used by older adults. The prescriptions on two randomly selected days from five acute care hospitals and primary care polyclinics were retrospectively reviewed. Patients’ demographic characteristics, number of prescription line items and details of prescribed drugs were collected. Prescribing appropriateness was evaluated by identifying PIMs using the Beers Criteria. Logistic regression was used to assess the association of demographic characteristics and type of care setting with polypharmacy and PIM use. Prevalence of polypharmacy was significantly higher in hospitals than in polyclinics (66.6% vs. 35.0%, P < 0.001). On the contrary, prevalence of PIMs in older adults with polypharmacy was significantly higher in polyclinics than in hospitals (34.6% vs. 27.1%, P = 0.010). Patients aged ≥65 years and hospitalised patients had higher odds of having polypharmacy than patients aged 21–64 years and polyclinic patients, respectively. Drugs used for chronic conditions commonly contributed to polypharmacy in both care settings. The top PIMs in hospitals and polyclinics were drugs for functional gastrointestinal disorders and systemic antihistamines, respectively. With the ageing population and growing burden of chronic disease in Singapore, increase in prevalence of polypharmacy is expected. More focus should thus be placed on reducing inappropriate polypharmacy.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"12 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on: Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes","authors":"Efsun Somay, Busra Yilmaz, Erkan Topkan, Ugur Selek","doi":"10.4103/singaporemedj.smj-2023-227","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-227","url":null,"abstract":"Dear Sir, We found the article ‘Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes’ by Babu et al.[1] intriguing and informative.[1] The study shows that hypofractionated accelerated radiotherapy (HART) is effective in buccal mucosa carcinoma (BMC) patients. We wish to highlight two concerns, which we hope the authors can address and in so doing, contribute to future studies. First, although osteoradionecrosis of the jaw (ORNJ) is typically defined as exposed irradiated bone that fails to heal within 3–6 months without local tumour recurrence or proven metastasis,[2] the study by Babu et al.[1] had a follow-up period ranging from 1 to 134 months, emphasising that some patients require additional follow-up time to meet ORNJ definition since the lower margin was only 1 month. Hence, the presented data may have underrated ORNJ rates, which may be higher than 10.3%. Consequently, given the universally accepted definition of ORNJ,[2,3] it could be posited that implementing a time cut-off of no less than 6 months would likely result in the identification of substantially higher ORNJ rates. Second, despite radiation-induced trismus (RIT) being a more common complication of radiotherapy than ORNJ, no data is provided on its incidence in this high-risk patient population.[4,5] However, it is impossible to spare all the components of the masticatory apparatus when designing a two-dimensional radiotherapy for BMCs. Hence, most patients likely received high doses of radiation for the masticatory apparatus components. Concerning the potential of HART for severe complication risks, providing RIT-related outcomes may be valuable in determining the exact value of HART in such patients, which may aid in improving patient outcomes and future study designs in this field. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 98","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Savi Scout® wireless localisation of breast and axillary lesions: lessons learned from Singapore’s early experience","authors":"Hui Jun Lim, Lester Chee Hao Leong, Yah Yuen Tan, Eugene Mun Wai Ong, Veronique Kiak Mien Tan, Sue Zann Lim, Evan Kok Yen Woo, Yien Sien Lee, Yirong Sim, Preetha Madhukumar, Benita Kiat Tee Tan, Llewellyn Shao-jen Sim, Tammy Hui Lin Moey, Thida Win, Geok Hoon Lim","doi":"10.4103/singaporemedj.smj-2021-412","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-412","url":null,"abstract":"INTRODUCTION Hookwires are commonly deployed under imaging guidance to localise non-palpable breast lesions for excision. However, the use of hookwires has some disadvantages, including patient discomfort, wire migration, damage to surrounding anatomical structures, surgery scheduling inconveniences and limited access to axillary nodes. Novel, alternative, non-radioactive wireless localisation devices using technologies such as radiofrequency identification, magnetic seed and radar have been developed to address these shortcomings.[1,2] While these devices have seen increasing usage in America and Europe, they were introduced to Asia only recently. One of these wireless techniques, the Savi Scout® (SS) surgical guidance system (Cianna Medical, Merit Medical Systems, Inc., South Jordan, UT, USA), was made available in Asia in 2019, and Singapore was the first Asian country to utilise it for breast and axillary localisations. Savi Scout employs radar technology, and it received the United States Food and Drug Administration clearance in 2014. The SS consists of a reflector implant, a needle introducer and an external check console. The reflector is a 12-mm metallic implant [Figure 1] consisting of thin nitinol antennae protruding from either end of a central transistor body. It is inserted percutaneously into the soft tissue via a single-use, preloaded, 16-gauge needle introducer and is deployed by uncovering the overlying sheath at the distal end of the introducer. This passive reflector delivery mechanism prevents damage to the thin antennae. The introducer is unsheathed by first unlocking the release button to either left or right and then retracting it along a sliding track [Figure 1]. Once the reflector is deployed, it cannot be repositioned. A handheld probe connected to the check console is used to locate the deployed reflector by transmitting a radio wave signal (radar), which is received and reflected back by the reflector. The signal capture and reflection mechanism of the reflector is multidirectional and is used to guide direction and distance to the target up to a depth of 6 cm. Unlike hookwires, SS does not have any components protruding from the skin. In addition, there is no placement expiry after deployment and it can be deployed at any time before surgery day, which provides flexibility in procedural scheduling.Figure 1: Photograph shows the parts and functions of the Savi Scout® needle introducer system and the 12-mm-long reflector (inset).Studies from America and Europe have evaluated SS to be a safe and convenient localisation technique for the breast and axilla.[3-8] However, to the best of our knowledge, there have been no published reports evaluating its performance in Asian women, and it is unclear if dense breast tissue, which is more prevalent in Asian women, may affect SS deployment and signal detection. We described our experience in the initial use of SS in Singapore women with the aims of providing an assessment on it","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 91","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comments on: Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes","authors":"Geethu Babu, Cessal Thommachan Kainickal","doi":"10.4103/singaporemedj.smj-2023-228","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2023-228","url":null,"abstract":"Dear Sir, This is in response to a letter to the editor[1] regarding our article, ‘Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes’.[2] Being a retrospective analysis, our study reported data on morbidity based on the information available in the case files, and this the main limitation of the study. Therefore, this data may have underrated the rates of osteoradionecrosis of the jaw (ORNJ). The minimum follow-up period was reported as 1 month as one patient was lost to follow-up and the data on toxicity of this patient were not captured. In addition, radiation-induced trismus (RIT) is a more common complication of radiotherapy than ORNJ, but no data was provided on its incidence in this high-risk patient population as the data have not been properly documented in the case files. The data regarding acute and late toxicity can be obtained only in a properly designed prospective trial where the patients are closely followed up by the investigator. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":" 99","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial toxicity among adult cancer survivors in Singapore: does it exist?","authors":"Weishan Ivy Ng, K. Yuen, Tian Meng, Chee Seong Jeremy Tey, Yu Yang Soon, Cho Hao Francis Ho, S. Yoong, Brent Gibbons, B. Vellayappan","doi":"10.4103/singaporemedj.smj-2021-341","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-341","url":null,"abstract":"Cancer survivors may experience financial toxicity (FT) arising from diagnosis, treatment and potential employment loss. The prevalence of FT in the context of Singapore healthcare model is unknown. We investigate whether higher out-of-pocket (OOP) expenditure correlates positively with FT, and whether higher FT correlates with a worse quality of life (QoL). In this pilot study, a cross-sectional survey was conducted on survivors of nasopharyngeal or breast cancer at the National University Hospital Singapore. Patients’ FT and QoL were measured using the COmprehensive Score on financial Toxicity (COST) and Functional Assessment of Cancer Therapy-General (FACT-G) questionnaires. Two multivariate regression models estimated (a) the association between FT and a range of variables, and (b) the association between FT and QoL. Sixty-three percent of our cohort of 76 patients experienced mild–moderate FT. Overall, the mean COST and FACT-G scores were 18.0 (out of 44) and 68.3 (out of 108), respectively. There was a positive correlation between COST and FACT-G scores (r = 0.45). We did not find any significant association between OOP expenditure and FT. Predictors for FT included government-subsidised housing, lower education levels, hire of a formal caregiver and the need for household members to take on extra employment. Greater FT correlated with a decline in QoL. Patients of lower socioeconomic status were at higher risk of FT. OOP expenditure was not directed related to FT, likely in view of the effective means-tested subsidies. Additional resources should be considered for this at-risk population. Based on this pilot study, our methodology to quantify FT and OOP expenditure can be scaled up to other cancer primaries.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"18 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139281379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic classification of dermatomyositis with and without electrodiagnostic study: real-world clinical practice","authors":"Presaad Pillai, Mazliha Mashor, Min Moon Tang, F. Hiew","doi":"10.4103/singaporemedj.smj-2021-392","DOIUrl":"https://doi.org/10.4103/singaporemedj.smj-2021-392","url":null,"abstract":"The revised European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2017 criteria and European Neuromuscular Centre’s (ENMC) 2018 criteria have improved diagnostic accuracy for dermatomyositis (DM). However, electromyography (EMG) was not included in the diagnostic criteria. We evaluated the usefulness of EMG under both criteria in the classification of DM and its amyopathic subtypes for patients who had rash with or without muscle weakness. In this retrospective study, 20 patients who were classified into DM and alternative diagnoses groups based on the Bohan and Peter (BP) criteria and histopathological findings of muscle and/or skin were included. We then compared the diagnostic accuracy to that of the EULAR/ACR and ENMC criteria. Differences in proportion were determined using Fisher’s exact test. Two patients who had weakness with elevated creatine kinase but no typical DM features on muscle biopsies were incorrectly excluded as alternative diagnoses using BP criteria. Both EMGs demonstrated presence of myopathic recruitment pattern and spontaneous activity in the proximal and distal muscles, consistent with the clinical phenotype. Two patients with a final diagnosis of systemic lupus erythematosus were incorrectly classified as DM by EULAR/ACR and ENMC criteria, but EMG demonstrated no evidence of muscle inflammation. Electromyography is valuable in identifying mild myopathy among DM patients with subtle clinical muscle weakness, allowing better classification of DM subtypes. Absence of EMG signs indicating muscle involvement provides clues for alternative diagnosis. In addition, EMG aids in interpretation of inconclusive muscle biopsy results. Therefore, EMG should be performed for every suspected DM patient.","PeriodicalId":21752,"journal":{"name":"Singapore medical journal","volume":"209 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139280993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}