Annals of the Academy of Medicine, Singapore最新文献

Introduction: Human papillomavirus (HPV) causes over 95% of cervical cancers. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines support a risk-based approach using the most informative test, which may include high-risk (HR) or extended genotyping. Most laboratories perform partial genotyping. This study reports findings from the comprehensive genotyping of all 14 HR HPV genotypes in cervical samples from the Singapore population.

Method: A total of 2497 cervical specimens collected in ThinPrep PreservCyt vials underwent full HPV genotyping using real-time polymerase chain reaction TOCE technology (Seegene Inc, Seoul, South Korea). Among these, 327 (13.1%) tested positive for HPV. Cytology results were available for 275 (84.1%) of these HPV-positive cases. The authors examined genotype prevalence and cytology correlations, and compared follow-up management under the Society for Colposcopy & Cervical Pathology of Singapore (SCCPS) guidelines versus ASCCP 2019 guidelines.

Results: HPV52 and 58 were the most prevalent genotypes, accounting for 32.2% of all detected HPV genotypes. Co-infections were seen in 20.2% of samples. Among 31 (9.5%) HPV16/18 cases, most had normal cytology, though some showed atypical or low-grade changes. Under the ASCCP guidelines for primary screening, 16.8% of cases could defer to repeat HPV testing in 1 year instead of immediate cytology triage under SCCPS. In co-testing, ASCCP-guided management reduced colposcopy referrals by 7.4% since these cases would only require repeat HPV testing in 1 year.

Conclusion: Comprehensive HPV genotyping enhances risk stratification and enables more efficient patient management. Compared to SCCPS, the ASCCP guidelines reduce unnecessary procedures while preserving safety, supporting broader adoption of full genotyping and risk-based triage in cervical screening programmes in Singapore.

Introduction: Singapore's Active Ageing Centres (AACs) are central to the national strategy to enable older adults to age in place through preventive, community-based services. Under the Healthier SG and Age Well SG reforms, AACs are being transformed from targeted social support points for vulnerable seniors into population-wide health-social hubs, with a goal of reaching 80% of seniors by 2025.

Method: This policy commentary draws on national policy documents, programme reports and practitioner insights to examine the evolution and implementation of AAC 2.0, and to identify emerging opportunities and system-level challenges.

Results: We highlight governance shifts, regional coordination mechanisms and health-social integration strategies. Innovations such as thematic centres, peer-led programmes and extended operating hours aim to engage diverse senior populations. Key challenges include centralised policy design, limited community voice, workforce constraints and fragmented coordination. Promising pilots, such as integrated wellness hubs, are underway but require greater alignment, relationship-building and local adaptation to scale.

Conclusion: We propose strategies to strengthen community partnerships, invest in trust-based engagement and embed robust evaluation frameworks informed by implementation science. Singapore's experience offers actionable insights for health systems seeking to design scalable, community-rooted models for healthy ageing that integrate social and healthcare services.

Introduction: Cardiovascular disease remains a leading cause of morbidity and mortality in Singapore, with rising demand for longitudinal cardiovascular care driven by ageing and metabolic risk factors. Cardiology pharmacists support medication optimisation, transitions of care and patient education across hospital, ambulatory and community settings. However, limited specialist accreditation pathways, uneven service distribution and emerging digital requirements constrain scalable delivery to match national needs.

Methods: This position paper was developed by the Pharmaceutical Society of Singapore Cardiology Pharmacy Working Group. A multidisciplinary consensus approach was adopted, guided by RIGHT and AGREE II principles to ensure transparency, applicability and editorial independence. Evidence synthesis drew from published literature, national epidemiology and institutional experience, contextualised within governance under the Healthcare Services Act and Collaborative Prescribing Agreement.

Results: Cardiology pharmacists are essential to medication safety, adherence support and protocol-guided dose optimisation under physician oversight. Key gaps include delayed post-discharge follow-up, fragmented hospital-primary care alignment, telehealth implementation challenges and a limited pipeline of accredited specialists, restricting capacity to achieve guideline-directed therapy targets and sustained continuity of care.

Conclusion: Five priorities were endorsed: strengthening specialist workforce capability; enhancing early postdischarge reviews; integrating pharmacists across care settings; leveraging digital-enabled care; and expanding medication-focused roles in prevention, atrial fibrillation, palliative heart failure and precision medicine. Cardiology pharmacists are critical contributors to a safe, coordinated and future-ready cardiovascular care ecosystem. A physician-led, pharmacist-enabled model supports national goals under Healthier SG.

Introduction: Knowledge of late effects after oncological treatment in Southeast Asia remains limited. This study is among the first comprehensive audits of late effects experienced by paediatric cancer survivors from the long-term follow-up (LTFU) clinic at KK Women's and Children's Hospital in Singapore, between September 2017 and December 2023.

Method: A total of 485 survivors were examined, all of whom had at least 2 years of treatment and 5 years of remission. Data on cancer diagnoses, treatments and late effects were analysed, with severity classified by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results: The analysis showed 394 survivors (81%) experienced at least 1 late effect. Body mass index ≥23 kg/m2 or ≥90th percentile, low bone mineral density (e.g. Z-score ≤-2.0 standard deviation score) and hearing difficulties were observed in 149 (30.7%), 87 (17.9%) and 73 (15.1%) survivors, respectively. Leukaemia survivors' detection of their first late effect was 10-14 years postdiagnosis, while central nervous system (CNS) and solid tumour survivors detected their first late effect within ≤5 years. Majority of late effects were of mild CTCAE severity. The odd ratio of developing late effects in the first 5 years post-diagnosis was 4.88 (95% confidence interval 2.98-7.71, P<0.001) in survivors treated with both chemotherapy and radiotherapy (with and without surgery) compared to chemotherapy (with and without surgery).

Conclusion: Despite risk-adapted protocols, timely screening is recommended to improve early detection of metabolic health, bone health and hearing impairment. Radiotherapy-treated survivors and survivors of CNS tumours and solid tumours would benefit from earlier and frequent screening. Adopting an exposure-based approach to proactively screen for late effects, coupled with survivor education, can help mitigate the biopsychosocial impacts.

Introduction: Oesophago-gastro-duodenoscopy (OGD) is the gold standard for evaluating upper gastrointestinal (UGI) symptoms. However, the quality of endoscopic examinations varies widely. This paper, initiated by the Gastroenterological Society of Singapore (GESS), aims to standardise best practices and enhance OGD procedure quality in Singapore.

Method: A core group of 6 experienced gastroenterologists conducted a comprehensive literature review, referencing established international guidelines. They developed preliminary statements, which underwent 2 rounds of formal voting by a broader group of consultant-level gastroenterologists. Statements were reviewed, modified and re-evaluated using the Delphi process, and assigned levels of evidence and recommendation using the US Preventive Services Task Force model. The threshold for acceptance of statements was agreed to be 80% or higher.

Results: Twenty consensus statements were finalised, covering pre-requisite, pre-procedure, intra-procedure and post-procedure quality indicators.

Conclusion: The GESS consensus statements provide recommendations for institutions in Singapore to establish quality standards for white light UGI endoscopy, facilitating high-quality, safe and accurate endoscopic care.