Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023306
Vivien Teo, Benny Kaihui Li, Suat Fern Low, Jing Wen Oh, Kwok Foong Lam, Eng Sing Lee, Cheryl Wei Yan Tan, Poh Ching Tan, Hui Shan Chia, Su Yin Pang, Fu Xun Marcus Heng, Sin Hui Neo, Tat Ming Ng
Medication nonadherence is a prevalent public health problem that compromises patients’ health outcomes and increases healthcare expenditures.1 Studies in Singapore showed that 25.7%–38.9% of patients are nonadherent.2,3 Studies investigating the association between patients’ reasons for nonadherence and their preferences towards adherence enablers are limited. We aimed to (1) examine the prevalence and reasons of medication nonadherence among patients with different clinical conditions and settings and (2) investigate possible associations with their preferred intervention for improving adherence.
{"title":"Patient’s degree of adherence, challenges & preferences towards medicine taking (PACT) in Singapore","authors":"Vivien Teo, Benny Kaihui Li, Suat Fern Low, Jing Wen Oh, Kwok Foong Lam, Eng Sing Lee, Cheryl Wei Yan Tan, Poh Ching Tan, Hui Shan Chia, Su Yin Pang, Fu Xun Marcus Heng, Sin Hui Neo, Tat Ming Ng","doi":"10.47102/annals-acadmedsg.2023306","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023306","url":null,"abstract":"Medication nonadherence is a prevalent public health problem that compromises patients’ health outcomes and increases healthcare expenditures.1 Studies in Singapore showed that 25.7%–38.9% of patients are nonadherent.2,3 Studies investigating the association between patients’ reasons for nonadherence and their preferences towards adherence enablers are limited. We aimed to (1) examine the prevalence and reasons of medication nonadherence among patients with different clinical conditions and settings and (2) investigate possible associations with their preferred intervention for improving adherence.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375535","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}
Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023237
P. Asharani, Yen Sin Koh, Rachel Hsiao Shen Tan, Yoke Boon Tan, Savita Gunasekaran, Benedict Lim, Lorainne Tudor Car, Mythily Subramaniam
Introduction: This systematic review is aimed at (1) evaluating the association between media portrayals of suicides and subsequent copycat suicides or attempts among the general public in Asia, (2) understanding the factors associated with copycat suicides and (3) determining the positive impacts of the media reporting of suicides (e.g. increased help-seeking, coping). Method: A systematic review and narrative synthesis of English and Chinese articles from 8 electronic databases (i.e. PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, Ariti, China National Knowledge Infrastructure and OpenGrey) from January 2000 to May 2023 was conducted. Observational studies were included, and the data were analysed through narrative synthesis. The protocol was registered with PROSPERO (CRD42021281535). Results: Among the 32 studies included (n=29 for evidence synthesis) in the review, there is good-quality evidence to show that copycat suicides and suicide attempts increase after media reports of a suicide, regardless of country, celebrity status, study design, type of media, mode of suicide or follow-up period. Females, younger age groups and those sharing similar characteristics as the deceased in publicised suicides (age, gender) were more susceptible to negative impact. Reporting of the mode of death of the deceased increased suicides by the same method among the public. Conclusion: Media portrayals of suicide appear to have a negative impact on copycat suicides at the population level in Asia. Thus, in addition to tighter media control, healthcare systems, professional medical bodies and community outreach services should work collaboratively to promote early help-seeking in those with psychological distress.
{"title":"The impact of media reporting of suicides on subsequent suicides in Asia: A systematic review","authors":"P. Asharani, Yen Sin Koh, Rachel Hsiao Shen Tan, Yoke Boon Tan, Savita Gunasekaran, Benedict Lim, Lorainne Tudor Car, Mythily Subramaniam","doi":"10.47102/annals-acadmedsg.2023237","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023237","url":null,"abstract":"Introduction: This systematic review is aimed at (1) evaluating the association between media portrayals of suicides and subsequent copycat suicides or attempts among the general public in Asia, (2) understanding the factors associated with copycat suicides and (3) determining the positive impacts of the media reporting of suicides (e.g. increased help-seeking, coping).\u0000\u0000Method: A systematic review and narrative synthesis of English and Chinese articles from 8 electronic databases (i.e. PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, Ariti, China National Knowledge Infrastructure and OpenGrey) from January 2000 to May 2023 was conducted. Observational studies were included, and the data were analysed through narrative synthesis. The protocol was registered with PROSPERO (CRD42021281535).\u0000\u0000Results: Among the 32 studies included (n=29 for evidence synthesis) in the review, there is good-quality evidence to show that copycat suicides and suicide attempts increase after media reports of a suicide, regardless of country, celebrity status, study design, type of media, mode of suicide or follow-up period. Females, younger age groups and those sharing similar characteristics as the deceased in publicised suicides (age, gender) were more susceptible to negative impact. Reporting of the mode of death of the deceased increased suicides by the same method among the public.\u0000\u0000Conclusion: Media portrayals of suicide appear to have a negative impact on copycat suicides at the population level in Asia. Thus, in addition to tighter media control, healthcare systems, professional medical bodies and community outreach services should work collaboratively to promote early help-seeking in those with psychological distress.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"16 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375780","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}
Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023357
Felicia Li Ling Ong, S. Pang
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles have an increased risk of SJS/TEN with the use of allopurinol and carbamazepine, respectively.2 Consequently, much debate has arisen over the utility of pharmacogenomics in preventing SJS/ TEN. We will discuss the evidence surrounding genetic testing in the prevention of allopurinol- induced SJS/TEN, with the aim of highlighting the potential value of pre-testing.
{"title":"HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?","authors":"Felicia Li Ling Ong, S. Pang","doi":"10.47102/annals-acadmedsg.2023357","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023357","url":null,"abstract":"Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles have an increased risk of SJS/TEN with the use of allopurinol and carbamazepine, respectively.2 Consequently, much debate has arisen over the utility of pharmacogenomics in preventing SJS/ TEN. We will discuss the evidence surrounding genetic testing in the prevention of allopurinol- induced SJS/TEN, with the aim of highlighting the potential value of pre-testing.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"76 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375958","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}
Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023119
Kevin Wei Hao Liang, Keith Wei Han Liang, Qing Rong Chan, Winnie Hwee Suat Goh
Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women’s and Children’s Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.
导言：低收入家庭面临着影响儿童发展的不良童年经历和社会心理风险。在新加坡KK妇女儿童医院，儿童综合发展服务（KIDS0-3）是一项家访计划，旨在优化低收入家庭儿童的发展：方法：通过对2014年6月至2022年10月期间登记的469对母子进行病历审查，整理了包括家庭人口统计学、母亲社会心理风险和儿童发展结果在内的数据。结果根据家庭和成人支持工具，312 个家庭（67%）被确定为中度或高风险家庭。与低风险组相比，中度和高风险家庭的儿童在24个月大时的Bayley认知（平均值95.88 [SD 8.25] vs [vs] 98.44 [SD 8.72]，P=0.014）和语言（平均值87.38 [SD 10.35] vs 90.43 [SD 9.61]，P=0.016）得分较低。少龄母亲的子女的 Bayley 认知得分较低（平均值 95.16 [SD 8.42] vs 97.76 [SD 8.55]，P=0.037），而遭受过性虐待的母亲的子女的 Bayley 认知得分较低（平均值 93.1 [SD 5.68] vs 99.7 [SD 8.17]，P=0.013），语言得分也较低（平均值 82.3 [SD 12.87] vs 91.3 [SD 10.86]，P=0.021）。与产后入学相比，产前入学的儿童语言成绩（平均 90.1 [SD 9.37] vs 87.13 [SD 10.79]，P=0.04）和运动成绩（平均 99.62 [SD 9.45] vs 94.72 [SD 9.51]，P=0.001）更好。结论社会心理风险影响着新加坡低收入家庭儿童的成长。研究结果强调了对弱势家庭进行早期综合干预的重要性。
{"title":"Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme","authors":"Kevin Wei Hao Liang, Keith Wei Han Liang, Qing Rong Chan, Winnie Hwee Suat Goh","doi":"10.47102/annals-acadmedsg.2023119","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023119","url":null,"abstract":"Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women’s and Children’s Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families.\u0000\u0000Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. \u0000\u0000Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. \u0000\u0000Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"64 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376582","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}
Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023168
Shang Chee Chong, Ramkumar Aishworiya, Woon Li Seo, Yee Keow Chiong, Gerald Choon-Huat Koh, Jeremy Bingyuan Lin, Lynn Heng, Thahirah Habib Mohd, Young Ern Saw, Yiong Huak Chan, Jing Shi Chua, S. Shorey
Introduction: Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG). Method: Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children’s HRQoL using PedsQL 4.0 Generic Core Scales. Results: Majority of the children were aged 4–6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4+12.2 vs 84.3+15.3, P<0.001) and emotional (mean 85.2+15.1 vs 76.6+17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG. Conclusion: Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.
{"title":"Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore","authors":"Shang Chee Chong, Ramkumar Aishworiya, Woon Li Seo, Yee Keow Chiong, Gerald Choon-Huat Koh, Jeremy Bingyuan Lin, Lynn Heng, Thahirah Habib Mohd, Young Ern Saw, Yiong Huak Chan, Jing Shi Chua, S. Shorey","doi":"10.47102/annals-acadmedsg.2023168","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023168","url":null,"abstract":"Introduction: Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG).\u0000\u0000Method: Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children’s HRQoL using PedsQL 4.0 Generic Core Scales.\u0000\u0000Results: Majority of the children were aged 4–6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4+12.2 vs 84.3+15.3, P<0.001) and emotional (mean 85.2+15.1 vs 76.6+17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG.\u0000\u0000Conclusion: Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"100 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377609","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}
Pub Date : 2024-03-27DOI: 10.47102/https://doi.org/10.47102/annals-acadmedsg.202481
Chien-Chang Lee, James Yeongjun Park, W. Hsu
In this issue of the Annals, Thirunavukarasu et al.’s systematic review on the clinical performance of automated machine learning (autoML) highlights its extensive applicability across 22 clinical specialties, showcasing its potential to redefine healthcare by making artificial intelligence (AI) technologies accessible to those without advanced computational skills.1 This enables the development of effective AI models that could rival or exceed the accuracy of traditional machine learning (ML) approaches and human diagnostic methods.
{"title":"Bridging expertise with machine learning and automated machine learning in clinical medicine","authors":"Chien-Chang Lee, James Yeongjun Park, W. Hsu","doi":"10.47102/https://doi.org/10.47102/annals-acadmedsg.202481","DOIUrl":"https://doi.org/10.47102/https://doi.org/10.47102/annals-acadmedsg.202481","url":null,"abstract":"In this issue of the Annals, Thirunavukarasu et al.’s systematic review on the clinical performance of automated machine learning (autoML) highlights its extensive applicability across 22 clinical specialties, showcasing its potential to redefine healthcare by making artificial intelligence (AI) technologies accessible to those without advanced computational skills.1 This enables the development of effective AI models that could rival or exceed the accuracy of traditional machine learning (ML) approaches and human diagnostic methods.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"10 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374839","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}
Pub Date : 2024-03-27DOI: 10.47102/annals-acadmedsg.2023186
Stephanie Pei Yun Soh, Wei Yann See Toh, Wei Qing Ten, Khai Pang Leong, L. Goh
Predicting optimal warfarin dosing is difficult due to complex pharmacodynamics and pharmacokinetics, narrow therapeutic index and susceptibility to many factors.1 Genetic variations of the CYP2C9 and VKORC1 enzymes, occurring in different frequencies in different populations, play a significant role in determining warfarin dosing.1-4 Using pharmacogenetic dosing algorithms to predict warfarin doses may shorten the time to achieve target International Normalised Ratio (INR) and stable dose.2,5 The Clinical Pharmacogenetics Implementation Consortium Guidelines 2017 Update4 recommends the Gage (WarfarinDosing.org7) and International Warfarin Pharmacogenetics Consortium (IWPC)8 pharmacogenetic algorithms.
{"title":"Validating two international warfarin pharmacogenetic dosing algorithms for estimating the maintenance dose for patients in Singapore","authors":"Stephanie Pei Yun Soh, Wei Yann See Toh, Wei Qing Ten, Khai Pang Leong, L. Goh","doi":"10.47102/annals-acadmedsg.2023186","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023186","url":null,"abstract":"Predicting optimal warfarin dosing is difficult due to complex pharmacodynamics and pharmacokinetics, narrow therapeutic index and susceptibility to many factors.1 Genetic variations of the CYP2C9 and VKORC1 enzymes, occurring in different frequencies in different populations, play a significant role in determining warfarin dosing.1-4 Using pharmacogenetic dosing algorithms to predict warfarin doses may shorten the time to achieve target International Normalised Ratio (INR) and stable dose.2,5 The Clinical Pharmacogenetics Implementation Consortium Guidelines 2017 Update4 recommends the Gage (WarfarinDosing.org7) and International Warfarin Pharmacogenetics Consortium (IWPC)8 pharmacogenetic algorithms.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"82 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376225","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}
Pub Date : 2024-02-28DOI: 10.47102/annals-acadmedsg.2023264
J. X. Hing, Yen Nee Chua, Pei Ting Tan, Meliza Su Ling Tan, C. Mok, Melissa Yert Li Seet, Zar Chi Lin, C. Seah, Wai Peng Lee, Su-Ming Tan
Introduction: We presented the key findings from Singapore’s Changi General Hospital Breast Centre’s lymphedema surveillance strategy that used patients’ reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research. Method: We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients’ self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging. Results: The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity. Conclusion: Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.
{"title":"Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance","authors":"J. X. Hing, Yen Nee Chua, Pei Ting Tan, Meliza Su Ling Tan, C. Mok, Melissa Yert Li Seet, Zar Chi Lin, C. Seah, Wai Peng Lee, Su-Ming Tan","doi":"10.47102/annals-acadmedsg.2023264","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023264","url":null,"abstract":"Introduction: We presented the key findings from Singapore’s Changi General Hospital Breast Centre’s lymphedema surveillance strategy that used patients’ reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research. \u0000\u0000Method: We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients’ self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging. \u0000\u0000Results: The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity. \u0000\u0000Conclusion: Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419324","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}
Pub Date : 2024-02-28DOI: 10.47102/annals-acadmedsg.2023314
J. N. Ngiam, Chelsea Chia, Yihui Goh, Amy Quek, Lin Cui, Nancy Tee, Raymond Tzer Pin Lin, P. Tambyah, Lionel HW Lum
We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore and Ipoh, Malaysia. In Ipoh, he lived in a village with domesticated cows and would frequently drink cow urine as part of his religious and cultural practice. His last travel to Ipoh had been approximately 2 weeks prior to presentation. At presentation, he was febrile (39 °C), with a blood pressure of 100/82 mmHg, and narrowed pulse pressure. He had an unsteady gait, but did not have any other physical signs of cerebellar dysfunction or neurological deficits.
{"title":"Hantavirus haemorrhagic fever and renal syndrome, caused by the Hantaan virus in Singapore: A case report","authors":"J. N. Ngiam, Chelsea Chia, Yihui Goh, Amy Quek, Lin Cui, Nancy Tee, Raymond Tzer Pin Lin, P. Tambyah, Lionel HW Lum","doi":"10.47102/annals-acadmedsg.2023314","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023314","url":null,"abstract":"We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore and Ipoh, Malaysia. In Ipoh, he lived in a village with domesticated cows and would frequently drink cow urine as part of his religious and cultural practice. His last travel to Ipoh had been approximately 2 weeks prior to presentation. At presentation, he was febrile (39 °C), with a blood pressure of 100/82 mmHg, and narrowed pulse pressure. He had an unsteady gait, but did not have any other physical signs of cerebellar dysfunction or neurological deficits.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"205 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140421826","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}
Despite significant progress in tobacco control measures and stringent smoking policies, cigarette smoking remains one of the largest preventable causes of death and disability worldwide. The World Health Organization estimates that over 8 million global deaths are attributed to smoking yearly, and in Singapore, more than 2,000 Singaporeans die prematurely due to smoking-related diseases each year.1,2
{"title":"Challenges to smoking cessation in patients with substance use disorders","authors":"Zaakira Shahul Hameed Mareen, Kiranjeet Kaur Harjit Singh, Charis Wei Ling Ng, L. Low","doi":"10.47102/annals-acadmedsg.2023213","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023213","url":null,"abstract":"Despite significant progress in tobacco control measures and stringent smoking policies, cigarette smoking remains one of the largest preventable causes of death and disability worldwide. The World Health Organization estimates that over 8 million global deaths are attributed to smoking yearly, and in Singapore, more than 2,000 Singaporeans die prematurely due to smoking-related diseases each year.1,2","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"26 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140422994","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}
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