Pub Date : 2023-10-30DOI: 10.47102/annals-acadmedsg.v52n10p550
Weihan Tong, Hung Chew Wong, Maria Cecilia Aquino, Paul Chew, Dawn Lim
We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma.
我们提出了一个病例系列，描述了微脉冲光圈疗法治疗青光眼的效用。
{"title":"Treatment outcomes of micropulse cyclophototherapy in uveitic glaucoma","authors":"Weihan Tong, Hung Chew Wong, Maria Cecilia Aquino, Paul Chew, Dawn Lim","doi":"10.47102/annals-acadmedsg.v52n10p550","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.v52n10p550","url":null,"abstract":"We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"139 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136069774","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}
Taiwan Introduction: Hypervolemia is a prevalent comorbidity of chronic kidney disease (CKD) patients. Thiazide diuretics (THZ) are the most common treatment for volume overload and hypertension (HTN). This study examines the association between THZ usage and clinical outcomes among CKD patients in a nationwide cohort. Method: The total number of patients in the study was 24,312. After matching with one non-user randomly selected from the CKD population, we identified 8501 patients in the THZ and the comparison cohorts. Cox proportional hazards regression analysis was conducted to estimate the associations of THZ on the incidence of all-cause mortality, end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD), and stroke. Results: The all-cause mortality rate was significantly lower in THZ users than in non-users (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.60–0.71). The THZ usage was associated with a lower incidence of ESRD, AMI, PAOD, and stroke (P<0.05). In subgroup analysis, some significant clinical outcomes were related with CKD stages 3 and 4 (P<0.05); however, there were no clinical associations in CKD stage 5. In further THZ subtype analysis, there were clinical associations with fewer deaths, ESRD, AMI, and PAOD accompanying chlorthalidone treatment. Moreover, the indapamide prescription was linked to lower mortality, ESRD, AMI, and PAOD prevalence. However, there were significantly greater incidences of ESRD, CHF, and AMI in the metolazone users. Conclusion: THZ usage is associated with lower mortality and incidence of ESRD, AMI, PAOD, and stroke s in patients with CKD stages 3 and 4.
{"title":"Thiazide and thiazide-like diuretics associated with improved cardiovascular and renal outcomes for chronic kidney disease patients","authors":"Hugo Lin, Yu-Han Chang, Yu-Tsang Wang, Peir-In Liang, Chi-Chih Hung, Jer-Ming Chang, Dao-Fu Dai, Chang-Shen Lin, Kai-Ting Chang","doi":"10.47102/annals-acadmedsg.v52n10p510","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.v52n10p510","url":null,"abstract":"Taiwan Introduction: Hypervolemia is a prevalent comorbidity of chronic kidney disease (CKD) patients. Thiazide diuretics (THZ) are the most common treatment for volume overload and hypertension (HTN). This study examines the association between THZ usage and clinical outcomes among CKD patients in a nationwide cohort. Method: The total number of patients in the study was 24,312. After matching with one non-user randomly selected from the CKD population, we identified 8501 patients in the THZ and the comparison cohorts. Cox proportional hazards regression analysis was conducted to estimate the associations of THZ on the incidence of all-cause mortality, end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD), and stroke. Results: The all-cause mortality rate was significantly lower in THZ users than in non-users (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.60–0.71). The THZ usage was associated with a lower incidence of ESRD, AMI, PAOD, and stroke (P<0.05). In subgroup analysis, some significant clinical outcomes were related with CKD stages 3 and 4 (P<0.05); however, there were no clinical associations in CKD stage 5. In further THZ subtype analysis, there were clinical associations with fewer deaths, ESRD, AMI, and PAOD accompanying chlorthalidone treatment. Moreover, the indapamide prescription was linked to lower mortality, ESRD, AMI, and PAOD prevalence. However, there were significantly greater incidences of ESRD, CHF, and AMI in the metolazone users. Conclusion: THZ usage is associated with lower mortality and incidence of ESRD, AMI, PAOD, and stroke s in patients with CKD stages 3 and 4.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136069674","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2023294
Dujeepa D Samarasekera, Ardi Findyartini, Diantha Soemantri
Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting “industry” accepted standards than to remediate unprofessional behaviours of practitioners.1 Medical professionalism encompasses a commitment to providing high-quality patient care, maintaining ethical standards, and upholding the trust and respect of patients and the community. This is essential for ensuring patient safety, promoting effective healthcare delivery, and preserving the integrity of the medical profession. Systematic reviews published on unprofessional behaviours of medical students, such as failure to engage, dishonest and disrespectful behaviours, and lack of self-awareness have shown to have a negative impact on peers, teachers and patients leading to poor teamwork and provision of quality care.2
{"title":"Nurturing professional behaviours and ethical practice: From students to professionals","authors":"Dujeepa D Samarasekera, Ardi Findyartini, Diantha Soemantri","doi":"10.47102/annals-acadmedsg.2023294","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023294","url":null,"abstract":"Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting “industry” accepted standards than to remediate unprofessional behaviours of practitioners.1 Medical professionalism encompasses a commitment to providing high-quality patient care, maintaining ethical standards, and upholding the trust and respect of patients and the community. This is essential for ensuring patient safety, promoting effective healthcare delivery, and preserving the integrity of the medical profession. Systematic reviews published on unprofessional behaviours of medical students, such as failure to engage, dishonest and disrespectful behaviours, and lack of self-awareness have shown to have a negative impact on peers, teachers and patients leading to poor teamwork and provision of quality care.2","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579615","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2022457
Jin Yang Ho, Valerie Tuang, Desmond B Teo, Gominda Ponnamperuma
Introduction: Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assessment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students. Method: A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach’s alpha, respectively. Results: There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire, titled “Medical Professionalism: A Self-assessment Tool” (MPAST), with a 5-component solution was obtained. The 5 components were commitment to: (1) patient’s best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach’s alpha value ranged from 0.540 to 0.714, with an overall Cronbach’s alpha value of 0.777. Conclusion: MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.
{"title":"Development and validation of a new self-assessment tool to measure professionalism among medical students","authors":"Jin Yang Ho, Valerie Tuang, Desmond B Teo, Gominda Ponnamperuma","doi":"10.47102/annals-acadmedsg.2022457","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022457","url":null,"abstract":"Introduction: Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assessment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students. Method: A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach’s alpha, respectively. Results: There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire, titled “Medical Professionalism: A Self-assessment Tool” (MPAST), with a 5-component solution was obtained. The 5 components were commitment to: (1) patient’s best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach’s alpha value ranged from 0.540 to 0.714, with an overall Cronbach’s alpha value of 0.777. Conclusion: MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579618","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2023296
Eric Chen
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a consensus process consisting of a literature review and consensus meetings involving a range of related professionals in family medicine, paediatrics, psychiatry, social services and the Health Promotion Board in Singapore. Ten consensus statements were developed with particular consideration for adolescent mothers, women with special needs, and women who suffered severe maternity events.
{"title":"Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening","authors":"Eric Chen","doi":"10.47102/annals-acadmedsg.2023296","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023296","url":null,"abstract":"In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a consensus process consisting of a literature review and consensus meetings involving a range of related professionals in family medicine, paediatrics, psychiatry, social services and the Health Promotion Board in Singapore. Ten consensus statements were developed with particular consideration for adolescent mothers, women with special needs, and women who suffered severe maternity events.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579623","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2023291
Kai Siang Chan, Kok Yang Tan, Jerry Tiong Thye Goo
Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict higher post-operative complications and mortality following MAES.2 Pre-operative risk stratification scores, such as the Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) and National Emergency Laparotomy Audit (NELA) score, have also been developed to assist clinicians and/or surgeons in decision making and patient counselling. While these scoring systems have been widely studied and validated in patients of various demographics,3 they require input of multiple variables which may be cumbersome, especially in the emergency setting. Simple bedside scoring systems remain attractive for quick risk stratification and guidance of subsequent management.
{"title":"Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?","authors":"Kai Siang Chan, Kok Yang Tan, Jerry Tiong Thye Goo","doi":"10.47102/annals-acadmedsg.2023291","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023291","url":null,"abstract":"Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict higher post-operative complications and mortality following MAES.2 Pre-operative risk stratification scores, such as the Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) and National Emergency Laparotomy Audit (NELA) score, have also been developed to assist clinicians and/or surgeons in decision making and patient counselling. While these scoring systems have been widely studied and validated in patients of various demographics,3 they require input of multiple variables which may be cumbersome, especially in the emergency setting. Simple bedside scoring systems remain attractive for quick risk stratification and guidance of subsequent management.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579622","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.202360
Peter Zhi Qing Choo, Tchoyoson Choie Cheio Lim, Cher Heng Tan
This commentary highlights key areas in which diagnostic radiological services in Singapore will need to evolve in order to address the needs of Healthier SG and population health. Policymakers should focus on “doing the right thing” by improving access to radiological expertise and services to support community and primary care and “doing the thing right” by establishing robust frameworks to support value-based care.
{"title":"Transforming radiology to support population health","authors":"Peter Zhi Qing Choo, Tchoyoson Choie Cheio Lim, Cher Heng Tan","doi":"10.47102/annals-acadmedsg.202360","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202360","url":null,"abstract":"This commentary highlights key areas in which diagnostic radiological services in Singapore will need to evolve in order to address the needs of Healthier SG and population health. Policymakers should focus on “doing the right thing” by improving access to radiological expertise and services to support community and primary care and “doing the thing right” by establishing robust frameworks to support value-based care.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579621","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.202345
Lakshmi V Dhevi, Sarah Wei Ling Li, Lin Lin Su, Arundhati Gosavi, Arijit Biswas
Delayed childbearing and increased use of assisted reproduction technology (ART) have resulted in a dramatic rise in the incidence of multifetal pregnancies. In 2022, the incidence of twin birth was 1 in 38.2 (932 live births) and triplet birth 1 in 1978 (18 live births) in Singapore.1 Preterm birth and its associated complications remain the most significant risks of multifetal pregnancies—60.5% of twins and 100% of triplets were born <37 weeks in Singapore in 2019. The relative risks of cerebral palsy in triplets and twins compared with singletons are 12.7 and 4.9, respectively.2
{"title":"A case series of higher-order multifetal pregnancies managed at a tertiary maternity unit","authors":"Lakshmi V Dhevi, Sarah Wei Ling Li, Lin Lin Su, Arundhati Gosavi, Arijit Biswas","doi":"10.47102/annals-acadmedsg.202345","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202345","url":null,"abstract":"Delayed childbearing and increased use of assisted reproduction technology (ART) have resulted in a dramatic rise in the incidence of multifetal pregnancies. In 2022, the incidence of twin birth was 1 in 38.2 (932 live births) and triplet birth 1 in 1978 (18 live births) in Singapore.1 Preterm birth and its associated complications remain the most significant risks of multifetal pregnancies—60.5% of twins and 100% of triplets were born <37 weeks in Singapore in 2019. The relative risks of cerebral palsy in triplets and twins compared with singletons are 12.7 and 4.9, respectively.2","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579619","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2023143
Celestine Jia Ling Loh, Ming Hua Cheng, Yuqing Shang, Nicholas Brian Shannon, Hairil Rizal Abdullah, Ke Yuhe
Introduction: Major abdominal emergency surgery (MAES) patients have a high risk of mortality and complications. The time-sensitive nature of MAES necessitates an easily calculable risk-scoring tool. Shock index (SI) is obtained by dividing heart rate (HR) by systolic blood pressure (SBP) and provides insight into a patient’s haemodynamic status. We aimed to evaluate SI’s usefulness in predicting postoperative mortality, acute kidney injury (AKI), requirements for intensive care unit (ICU) and high-dependency monitoring, and the ICU length of stay (LOS). Method: We retrospectively reviewed 212,089 MAES patients from January 2013 to December 2020. The cohort was propensity matched, and 3960 patients were included. The first HR and SBP recorded in the anaesthesia chart were used to calculate SI. Regression models were used to investigate the association between SI and outcomes. The relationship between SI and survival was explored with Kaplan-Meier curves. Results: There were significant associations between SI and mortality at 1 month (odds ratio [OR] 2.40 [1.67–3.39], P<0.001), 3 months (OR 2.13 [1.56–2.88], P<0.001), and at 2 years (OR 1.77 [1.38–2.25], P<0.001). Multivariate analysis revealed significant relationships between SI and mortality at 1 month (OR 3.51 [1.20–10.3], P=0.021) and at 3 months (OR 3.05 [1.07–8.54], P=0.034). Univariate and multivariate analysis also revealed significant relationships between SI and AKI (P<0.001), postoperative ICU admission (P<0.005) and ICU LOS (P<0.001). SI does not significantly affect 2-year mortality. Conclusion: SI is useful in predicting postopera-tive mortality at 1 month, 3 months, AKI, postoperative ICU admission and ICU LOS.
{"title":"Preoperative shock index in major abdominal emergency surgery","authors":"Celestine Jia Ling Loh, Ming Hua Cheng, Yuqing Shang, Nicholas Brian Shannon, Hairil Rizal Abdullah, Ke Yuhe","doi":"10.47102/annals-acadmedsg.2023143","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023143","url":null,"abstract":"Introduction: Major abdominal emergency surgery (MAES) patients have a high risk of mortality and complications. The time-sensitive nature of MAES necessitates an easily calculable risk-scoring tool. Shock index (SI) is obtained by dividing heart rate (HR) by systolic blood pressure (SBP) and provides insight into a patient’s haemodynamic status. We aimed to evaluate SI’s usefulness in predicting postoperative mortality, acute kidney injury (AKI), requirements for intensive care unit (ICU) and high-dependency monitoring, and the ICU length of stay (LOS). Method: We retrospectively reviewed 212,089 MAES patients from January 2013 to December 2020. The cohort was propensity matched, and 3960 patients were included. The first HR and SBP recorded in the anaesthesia chart were used to calculate SI. Regression models were used to investigate the association between SI and outcomes. The relationship between SI and survival was explored with Kaplan-Meier curves. Results: There were significant associations between SI and mortality at 1 month (odds ratio [OR] 2.40 [1.67–3.39], P<0.001), 3 months (OR 2.13 [1.56–2.88], P<0.001), and at 2 years (OR 1.77 [1.38–2.25], P<0.001). Multivariate analysis revealed significant relationships between SI and mortality at 1 month (OR 3.51 [1.20–10.3], P=0.021) and at 3 months (OR 3.05 [1.07–8.54], P=0.034). Univariate and multivariate analysis also revealed significant relationships between SI and AKI (P<0.001), postoperative ICU admission (P<0.005) and ICU LOS (P<0.001). SI does not significantly affect 2-year mortality. Conclusion: SI is useful in predicting postopera-tive mortality at 1 month, 3 months, AKI, postoperative ICU admission and ICU LOS.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579620","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}
Pub Date : 2023-09-27DOI: 10.47102/annals-acadmedsg.2023148
Helen Chen, Tze-Ern Chua, Theresa Mei Ying Lee, Elizabeth Junpei Siak, Lin Feng Hong, Ying Chia Ch’ng, Hassan Yasmin, Cornelia Yin-Ing Chee, Yee Ming Mok, Say How Ong, Victor Samuel Rajadurai, Tiong Ghee Teoh, Vasuki Utravathy, Kok Hian Tan, Lay Kok Tan
Introduction: Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women. Method: The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members—comprising experts in the field of perinatal mental health and obstetric medicine—deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods. Results: A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore. Conclusion: Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.
{"title":"Consensus statement on Singapore perinatal mental health guidelines on depression and anxiety","authors":"Helen Chen, Tze-Ern Chua, Theresa Mei Ying Lee, Elizabeth Junpei Siak, Lin Feng Hong, Ying Chia Ch’ng, Hassan Yasmin, Cornelia Yin-Ing Chee, Yee Ming Mok, Say How Ong, Victor Samuel Rajadurai, Tiong Ghee Teoh, Vasuki Utravathy, Kok Hian Tan, Lay Kok Tan","doi":"10.47102/annals-acadmedsg.2023148","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023148","url":null,"abstract":"Introduction: Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women. Method: The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members—comprising experts in the field of perinatal mental health and obstetric medicine—deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods. Results: A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore. Conclusion: Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579617","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}
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