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Stemming the tide of chronic kidney disease: A focus on primary care prevention. 遏制慢性肾病的蔓延:关注初级保健预防。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.47102/annals-acadmedsg.2024291
Sally Chih Wei Ho, Andrew Teck Wee Ang, Alvin Ren Kwang Tng
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引用次数: 0
Cost-effectiveness and clinical outcomes of artificial intelligence-enhanced screening for diabetic foot ulcers: A simulation study. 人工智能增强型糖尿病足溃疡筛查的成本效益和临床结果:模拟研究。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 10.47102/annals-acadmedsg.2024220
Yan Sun, Lixia Ge, Yee Gary Ang, Zhiwen Joseph Lo, Huiling Liew, Donna Ml Tan, Daniel Chew, John Arputhan Abisheganaden
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引用次数: 0
Journey towards a smoke-free nation. 迈向无烟国家。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 10.47102/annals-acadmedsg.2024301
Deshawn Chong Xuan Tan, Ken Cheah Hooi Lee
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引用次数: 0
Serum progesterone in the management of pregnancy of unknown location: A Singapore experience. 血清孕酮在不明位置妊娠管理中的应用:新加坡的经验。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 10.47102/annals-acadmedsg.2024146
Krystal Koh, Manisha Mathur, Rajeswari Kathirvel
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引用次数: 0
Five-year outcomes of a holistic programme for managing early chronic kidney disease in primary care. 基层医疗机构早期慢性肾病综合管理项目的五年成果。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-15 DOI: 10.47102/annals-acadmedsg.2023399
Sky Wei Chee Koh, Ping Young Ang, Hung Chew Wong, Hui Qi Koh, Nurfaziela Binti Zainal, Cynthia Sze Mun Wong

Introduction: Holistic Approach in Lowering and Tracking Chronic Kidney Disease (HALT-CKD) is a nationwide programme that was introduced in 2017 to combat CKD in Singapore. This study aims to evaluate outcomes of the HALT-CKD programme and identify factors influencing disease progression among early CKD patients.

Method: We conducted a retrospective cohort study involving adult patients aged 21 to 80 with CKD stages G1-G3A, recruited from 5 Singapore polyclinics between 2017 and 2018. The primary outcome-time to progression to advanced CKD (G3B-G5)-was tracked until March 2023, based on patients' last known serum creatinine levels. Descriptive statistics and Cox regression were used. Patients who followed up with other institutions, were deceased or defaulted without developing (or experiencing) the outcome were censored.

Results: We studied 3800 patients (mean age: 61.9 years) for a median of 4.7 years. Among them, 12.6% developed advanced CKD despite statistically significant improvements in HbA1c, blood pressure and albuminuria levels. Increasing age, female sex, clinic, baseline creatinine, diastolic blood pressure and HbA1c significantly shortened time to CKD progression. Macro-albuminuria at baseline (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.19- 2.61) and at analysis (HR 2.22, 95% CI 1.55-3.19) significantly accelerated advanced CKD progression. Patients who had their angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) dose reduced or discontinued progressed to advanced CKD earlier (HR 1.92, 95% CI 1.50-2.45). Counselling and sodium-glucose cotransporter-2 inhibitor (SGLT2i) use did not significantly delay CKD progression.

Conclusion: Maintaining optimal ACEi/ARB dosage is essential to delay CKD progression. Premature cessation or reduction of this dosage should be discouraged. Further research on counselling and SGLT2i use in early CKD is needed to address the growing burden of CKD.

导言:降低和跟踪慢性肾脏病的整体方法(HALT-CKD)是新加坡于 2017 年推出的一项全国性计划,旨在防治慢性肾脏病。本研究旨在评估 HALT-CKD 计划的成果,并确定影响早期 CKD 患者疾病进展的因素:我们开展了一项回顾性队列研究,研究对象是 2017 年至 2018 年期间从新加坡 5 家综合医院招募的 21 至 80 岁 CKD 分期 G1-G3A 的成年患者。根据患者最后一次已知的血清肌酐水平,对其进展为晚期 CKD(G3B-G5)的主要结果时间进行了追踪,直至 2023 年 3 月。研究采用了描述性统计和 Cox 回归方法。在其他机构随访的患者、死亡的患者或未出现(或经历)结果而违约的患者均被剔除:我们对 3800 名患者(平均年龄:61.9 岁)进行了中位数为 4.7 年的研究。其中,尽管 HbA1c、血压和白蛋白尿水平有了统计学意义上的显著改善,但仍有 12.6% 的患者发展为晚期 CKD。年龄、女性性别、门诊、基线血肌酐、舒张压和 HbA1c 的增加明显缩短了 CKD 进展的时间。基线时的巨蛋白尿(危险比 [HR] 1.77,95% 置信区间 [CI] 1.19-2.61)和分析时的巨蛋白尿(HR 2.22,95% 置信区间 [CI] 1.55-3.19)明显加快了晚期 CKD 的进展。血管紧张素转换酶抑制剂(ACEi)/血管紧张素受体阻滞剂(ARB)剂量减少或停用的患者更早进展为晚期 CKD(HR 1.92,95% CI 1.50-2.45)。咨询和钠-葡萄糖共转运体-2抑制剂(SGLT2i)的使用并不能显著延缓CKD的进展:结论:保持最佳的 ACEi/ARB 剂量对延缓 CKD 进展至关重要。结论:保持最佳 ACEi/ARB 剂量是延缓 CKD 进展的关键,应避免过早停药或减少剂量。为应对日益加重的慢性肾脏病负担,需要进一步研究早期慢性肾脏病患者的咨询和 SGLT2i 的使用。
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引用次数: 0
Factors influencing smoking cessation: Insights from Singapore's nationwide health and lifestyle survey. 影响戒烟的因素:新加坡全国健康与生活方式调查的启示。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-15 DOI: 10.47102/annals-acadmedsg.2024177
Yen Sin Koh, Rajeswari Sambasivam, P V AshaRani, Edimansyah Abdin, Saleha Shafie, Stefan Ma, Wai Leng Chow, Siow Ann Chong, Yvette van der Eijk, Mythily Subramaniam

Introduction: Singapore has implemented an evidence-based smoking cessation framework to support smokers in quitting. Our study investigated the prevalence and correlates of (1) quit attempts (QA) and quit intentions (QI) among current smokers, and (2) smoking cessation (SC) among ever-smokers in Singapore.

Method: Data was collected from a nationwide survey conducted between 2020 and 2022. QA was defined as attempting to stop smoking at least once in the past 12 months, while QI was defined as planning to quit smoking within the next 30 days or the next 6 months. SC referred to individuals who quit smoking over 6 months ago. Sociodemographic factors, doctor's advice to quit and perceived harm from smoking were assessed using logistic regression among current smokers (n=1024) and ever-smokers (n=1457).

Results: Among current smokers, 31.3% and 41.2% reported QI and QA, respectively. Smokers with secondary or pre-tertiary education were less likely to report QI compared to those with a degree or higher. Doctor's advice to quit was associated with a higher likelihood of QA. Among ever-smokers, 25.3% reported SC, and this was more likely when they perceived smoking 1 or more packs of cigarettes daily as posing a moderate or high health risk.

Conclusion: Educational campaigns should focus on simplifying messages for individuals with lower literacy levels. Smoking cessation training can be incorporated into medical education, and graphic health warnings on cigarette packs can help effectively communicate the dangers of smoking.

导言:新加坡实施了以证据为基础的戒烟框架,以支持吸烟者戒烟。我们的研究调查了新加坡当前吸烟者中(1)戒烟尝试(QA)和戒烟意向(QI)以及(2)曾经吸烟者中(SC)的戒烟率及其相关因素:数据收集自 2020 年至 2022 年期间开展的一项全国性调查。QA的定义是在过去12个月内至少尝试戒烟一次,而QI的定义是计划在未来30天或未来6个月内戒烟。SC指的是6个月前戒烟的人。我们使用逻辑回归法对当前吸烟者(1024 人)和曾经吸烟者(1457 人)的社会人口因素、医生的戒烟建议和吸烟危害感知进行了评估:在目前吸烟者中,分别有 31.3% 和 41.2% 的人报告了 QI 和 QA。与拥有学位或更高学历的吸烟者相比,拥有中学或大学预科学历的吸烟者较少报告QI。医生的戒烟建议与较高的 "合格 "可能性相关。在曾经吸烟的人群中,25.3%的人报告了SC,当他们认为每天吸烟1包或1包以上会带来中度或高度健康风险时,报告SC的可能性更大:结论:教育活动应侧重于简化针对文化水平较低人群的信息。戒烟培训可纳入医学教育,烟盒上的图形健康警示可帮助有效传达吸烟的危害。
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引用次数: 0
Intravenous epoprostenol therapy in the treatment of pulmonary arterial hypertension in Singapore. 新加坡治疗肺动脉高压的静脉注射表前列腺素疗法。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-09 DOI: 10.47102/annals-acadmedsg.2024223
Jack Choo, Jonathan Yap, Aidila Ismail, Jin Shing Hon, Wen Ruan, Andrea Low, Soo Teik Lim, Ju Le Tan
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引用次数: 0
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening. 脊柱侧弯X光片中的自动Cobb角测量:用于筛查的深度学习方法
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-07 DOI: 10.47102/annals-acadmedsg.2023300
Xi Zhen Low, Mohammad Shaheryar Furqan, Andrew Makmur, Desmond Shi Wei Lim, Ren Wei Liu, Xinyi Lim, Yiong Huak Chan, Jiong Hao Tan, Leok Lim Lau, James Thomas Patrick Decourcy Hallinan
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引用次数: 0
Enhancing guidelines for managing cognitively impaired drivers: Insights from Western evidence for Asian adaptation. 加强认知障碍驾驶员管理指南:从西方证据中获得的启示,以适应亚洲的情况。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-03 DOI: 10.47102/annals-acadmedsg.2024141
Mei Leng Chan, Dwee Wee Lim, Khin Khin Win, Helen Smith

Introduction: The global incidence of dementia is increasing, and cognitively impaired drivers are at a higher risk of crashes compared to healthy drivers. Doctors face challenges in assessing these at-risk drivers, with questionable adherence to existing guidelines. This study aimed to review and compare guidelines for managing cognitively impaired drivers from various countries.

Method: A scoping review was conducted to identify relevant guidelines, which were then descriptively compared with Singapore's guideline.

Results: Eleven guidelines from 8 countries: US (n=2), Canada (n=2), UK (n=2), Ireland, Belgium, Australia, New Zealand and Singapore were reviewed. All guidelines support driving assessments and conditional licensing in ordinary (i.e. non-professional) drivers with dementia. Canada stands out for not allowing co-piloting and geographical restrictions in conditional licensing practice. Few guidelines provide indemnity for doctors reporting to licensing authorities, and communication about the impact of dementia on car insurance is rarely addressed. Most Western guidelines include evidence-based approaches, provisions for drivers with mild cognitive impairment and early discussions on transitioning from driving. A clinic-based functional screening toolbox and 2 clinical algorithms (1 with and 1 without the Clinical Dementia Rating scale) were identified as having universal applicability. Singapore's guideline, by comparison, is outdated and lacks both developmental rigour and guidance on managing mild cognitive impairment and transitioning drivers out of driving.

Conclusion: Comprehensive, evidence-based guidelines from Western countries provide valuable resources that can help Singapore design or update its guideline.

导言:全球痴呆症的发病率正在上升,与健康驾驶员相比,认知能力受损的驾驶员发生车祸的风险更高。医生在评估这些高风险驾驶员时面临挑战,现有指南的遵守情况也值得商榷。本研究旨在回顾和比较各国认知障碍驾驶员管理指南:方法:进行范围审查以确定相关指南,然后将其与新加坡的指南进行描述性比较:结果:来自 8 个国家的 11 份指南:结果:审查了来自 8 个国家的 11 份指南:美国(2 份)、加拿大(2 份)、英国(2 份)、爱尔兰、比利时、澳大利亚、新西兰和新加坡。所有指南都支持对患有痴呆症的普通(即非专业)驾驶员进行驾驶评估和有条件许可。加拿大在有条件许可实践中不允许共同驾驶和地域限制,这一点比较突出。很少有指南为向发证机构报告的医生提供赔偿,也很少涉及痴呆症对汽车保险影响的沟通问题。大多数西方指南都包括循证方法、针对轻度认知障碍驾驶者的规定,以及关于从驾驶过渡的早期讨论。以诊所为基础的功能筛查工具箱和两个临床算法(一个有临床痴呆评级量表,一个没有)被认为具有普遍适用性。相比之下,新加坡的指南已经过时,在管理轻度认知障碍和驾驶员退出驾驶的过渡方面缺乏严谨的发展和指导:结论:西方国家以证据为基础的综合指南提供了宝贵的资源,可帮助新加坡设计或更新其指南。
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引用次数: 0
Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort. 因不耐受而提前移除胃内球囊的预测因素:来自多种族亚洲队列的启示。
IF 2.5 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-27 DOI: 10.47102/annals-acadmedsg.2023257
Amadora Choo, Eugene Lim, Alvin Eng, Weng Hoong Chan, Ravishankar Asokkumar, Jeremy Tan, Ai Shan Tan, Agnes Chong, Yumni Binte Md Shahrin, Xuan Wang, Phong Ching Lee, Chin Hong Lim

Introduction: Intolerance frequently limits the use of intragastric balloons (IGBs) in the treatment of obesity. This includes refractory nausea, vomiting and abdominal discomfort. Our study aims to identify predictors of balloon intolerance and early removal, which will help to guide patient selection for this intervention and peri-procedure care.

Method: We conducted a retrospective cohort study of 54 consecutive patients who underwent IGB insertion from July 2017 to July 2022 in a single tertiary institution in Singapore. Forty-seven (87.0%) patients completed therapy, while 7 patients (13.0%) had early removal of the balloon due to intolerance. Characteristics of both groups were compared.

Results: Multivariate analysis revealed significant associations between early balloon removal and both depression (P=0.012) and anxiety (P=0.001) after adjusting for age, sex, ethnicity, height, nulliparity, balloon type and volume. Univariate analysis revealed that anxiety was the main risk factor (P=0.004, odds ratio 9.111, 95% confidence interval 1.624-51.124), while depression was no longer a significant predictor.

Conclusion: Identifying predictors of balloon intolerance and early removal can enhance patient selection and improve peri-procedural care. In patients with a history of depression or anxiety, it is important to ensure adequate counselling and preparation prior to balloon insertion.

导言:在治疗肥胖症的过程中,胃内气球(IGBs)的不耐受性经常会限制其使用。这包括难治性恶心、呕吐和腹部不适。我们的研究旨在确定球囊不耐受和早期移除的预测因素,这将有助于指导患者选择这种干预措施和术前护理:我们对 2017 年 7 月至 2022 年 7 月期间在新加坡一家三级医疗机构接受 IGB 植入术的 54 名连续患者进行了回顾性队列研究。47名患者(87.0%)完成了治疗,7名患者(13.0%)因不耐受而提前移除球囊。对两组患者的特征进行了比较:多变量分析显示,在调整了年龄、性别、种族、身高、无阴道、球囊类型和容量后,早期球囊移除与抑郁(P=0.012)和焦虑(P=0.001)之间存在显著关联。单变量分析显示,焦虑是主要的风险因素(P=0.004,几率比9.111,95%置信区间1.624-51.124),而抑郁不再是重要的预测因素:结论:识别球囊不耐受和早期移除的预测因素可以提高患者选择率,改善围手术期护理。对于有抑郁或焦虑病史的患者,必须确保在球囊插入前进行充分的咨询和准备。
{"title":"Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort.","authors":"Amadora Choo, Eugene Lim, Alvin Eng, Weng Hoong Chan, Ravishankar Asokkumar, Jeremy Tan, Ai Shan Tan, Agnes Chong, Yumni Binte Md Shahrin, Xuan Wang, Phong Ching Lee, Chin Hong Lim","doi":"10.47102/annals-acadmedsg.2023257","DOIUrl":"10.47102/annals-acadmedsg.2023257","url":null,"abstract":"<p><strong>Introduction: </strong>Intolerance frequently limits the use of intragastric balloons (IGBs) in the treatment of obesity. This includes refractory nausea, vomiting and abdominal discomfort. Our study aims to identify predictors of balloon intolerance and early removal, which will help to guide patient selection for this intervention and peri-procedure care.</p><p><strong>Method: </strong>We conducted a retrospective cohort study of 54 consecutive patients who underwent IGB insertion from July 2017 to July 2022 in a single tertiary institution in Singapore. Forty-seven (87.0%) patients completed therapy, while 7 patients (13.0%) had early removal of the balloon due to intolerance. Characteristics of both groups were compared.</p><p><strong>Results: </strong>Multivariate analysis revealed significant associations between early balloon removal and both depression (P=0.012) and anxiety (P=0.001) after adjusting for age, sex, ethnicity, height, nulliparity, balloon type and volume. Univariate analysis revealed that anxiety was the main risk factor (P=0.004, odds ratio 9.111, 95% confidence interval 1.624-51.124), while depression was no longer a significant predictor.</p><p><strong>Conclusion: </strong>Identifying predictors of balloon intolerance and early removal can enhance patient selection and improve peri-procedural care. In patients with a history of depression or anxiety, it is important to ensure adequate counselling and preparation prior to balloon insertion.</p>","PeriodicalId":502093,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"53 9","pages":"551-561"},"PeriodicalIF":2.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383199","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}
引用次数: 0
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Annals of the Academy of Medicine, Singapore
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