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Preventing perioperative hypothermia in children through implementation of customised guidelines. 通过实施定制指南预防儿童围手术期体温过低。
Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-021
Shu Ying Lee, Rehena Sultana, John Carson Allen, Choon Looi Bong

Introduction: Perioperative hypothermia (PH) is common in children and associated with adverse clinical outcomes. Guidelines to prevent PH are mainly developed for adults and differ among institutions. We aimed to evaluate the effectiveness of customised guidelines in reducing PH in our paediatric population and the impact of cost considerations on physician practice.

Methods: Patients aged ≤16 years undergoing general anaesthesia in our tertiary paediatric hospital were prospectively recruited in this cohort study. Patient demographics, surgical procedures, anaesthesia details and temperature control measures were recorded. Data collection occurred over four phases: Phases 1 and 2 comprised standard management, while Phases 3 and 4 occurred following guidelines implementation. Sensors for continuous core temperature monitoring were provided free to patients during Phases 1 and 3, but were charged during Phases 2 and 4. The main outcome was occurrence of PH, defined as core temperature <36°C at any point from induction of anaesthesia to discharge from the postanaesthetic care unit. The impact of guidelines implementation and cost considerations influencing physician practice on PH outcomes was also analysed.

Results: Data from 3917 patients was analysed (1766 in Phase 1, 679 in Phase 2, 706 in Phase 3 and 766 in Phase 4). Guidelines implementation decreased PH incidence from 11.0% to 6.79% (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.50-0.80, P = 0.0002). Free sensors increased the odds of detecting PH (OR 1.48, 95% CI 1.17-1.88, P = 0.001). With guidelines implementation, there was greater reduction in PH with free sensors (OR 0.64, 95% CI 0.47-0.88, P = 0.0055) compared to chargeable sensors (OR 0.75, 95% CI 0.50-1.11, P = 0.1471).

Conclusions: Customised guidelines facilitated a sustained reduction of hypothermia in our paediatric surgical patients, although its impact was reduced by cost considerations.

导言:围手术期低温症(PH)在儿童中很常见,并与不良临床结果相关。预防 PH 的指南主要是针对成人制定的,不同机构的指南也不尽相同。我们旨在评估定制指南在减少儿童 PH 方面的有效性,以及成本因素对医生实践的影响:本队列研究前瞻性地招募了在我们的三级儿科医院接受全身麻醉的 16 岁以下患者。研究记录了患者的人口统计学特征、手术过程、麻醉细节和温度控制措施。数据收集分为四个阶段:第一和第二阶段为标准管理阶段,第三和第四阶段为指南实施阶段。第 1 和第 3 阶段免费向患者提供用于连续核心体温监测的传感器,但第 2 和第 4 阶段则收取费用。主要结果是 PH 的发生,即核心体温结果:分析了 3917 名患者的数据(第 1 阶段 1766 人、第 2 阶段 679 人、第 3 阶段 706 人、第 4 阶段 766 人)。指南的实施将 PH 发病率从 11.0% 降至 6.79%(几率比 [OR] 0.63,95% 置信区间 [CI] 0.50-0.80,P = 0.0002)。免费传感器提高了 PH 的检测几率(OR 1.48,95% 置信区间 [CI] 1.17-1.88,P = 0.001)。随着指南的实施,免费传感器(OR 0.64,95% CI 0.47-0.88,P = 0.0055)与收费传感器(OR 0.75,95% CI 0.50-1.11,P = 0.1471)相比,PH 下降幅度更大:结论:定制指南有助于持续减少儿科手术患者的低体温情况,但其影响因成本因素而有所减弱。
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引用次数: 0
Association of postpartum depression with child growth and developmental outcomes: a community-based study. 产后抑郁与儿童生长发育结果的关系:一项基于社区的研究。
Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-107
Moira Suyin Chia, Nur Adila Binte Ahmad Hatib, Elaine Chu Shan Chew, Shu-Ling Chong, Rehena Sultana, Ade Xin Ning Tan, Xiaoxuan Guo, David Chee Chin Ng, Padmini Sita Yeleswarapu, Pratibha Keshav Agarwal, Helen Yu Chen, Yoke Hwee Chan
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引用次数: 0
Disaster medicine in Singapore: past, present, future. 新加坡的灾难医学:过去、现在和未来。
Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-019
Li Juan Joy Quah, Jen Heng Pek, Lenard Cheng, Chan Yu Lee, David Kuan Peng Teng, Mathew Yi Wen Yeo, Venkataraman Anantharaman
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引用次数: 0
Diagnostic threshold and performance of anion gap in screening for high anion gap metabolic acidosis. 阴离子间隙在筛查高阴离子间隙代谢性酸中毒中的诊断阈值和性能。
Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-009
Chang Yin Chionh, Carolyn Shan-Yeu Tien, Wenxiang Yeon

Introduction: The anion gap (AG) is commonly used to screen for acid-base disorders. It was proposed that the cut-off for high anion gap metabolic acidosis (HAGMA) may be lower with current laboratory techniques, although modern laboratory equipment are still calibrated to familiar reference ranges established with earlier techniques. The appropriate cut-off for HAGMA is unclear. This study aimed to assess the performance of AG as a screening test for HAGMA and to determine the optimal diagnostic threshold of AG for HAGMA.

Methods: This was a retrospective analysis of a large, anonymised dataset extracted by computerised protocol from 2017 to 2019. All inpatients with blood samples taken for organic acids (lactate, ketone or salicylate) paired with a metabolic panel were included. The target condition was HAGMA secondary to elevated blood lactate, ketone and/or salicylate. Sensitivity for HAGMA was explored at various AG cut-off levels.

Results: Of 16,475 patients, 2,621 had organic acidosis. Median age was 65 years, and median estimated glomerular filtration rate was 70 mL/min/1.73 m2. With organic acidosis, the median AG was 23 (interquartile range [IQR] 20-29) mEq/L, while without organic acidosis, the median AG was 16 (IQR 14-19) mEq/L. The area under the curve-receiver operating characteristic of AG for HAGMA was 0.873. Desired sensitivity for HAGMA was set at ≥95%, and this was found with an AG threshold of ≥15 mEq/L (sensitivity 98.1%, specificity 34.0%).

Conclusion: The recommended AG threshold value is ≥15 mEq/L with a high sensitivity for HAGMA. The AG should always be interpreted with the clinical context, and it should be repeated as the clinical picture evolves.

简介阴离子间隙(AG)通常用于筛查酸碱紊乱。尽管现代实验室设备仍根据早期技术建立的熟悉的参考范围进行校准,但有人提出,高阴离子间隙代谢性酸中毒(HAGMA)的临界值在目前的实验室技术下可能会更低。HAGMA的合适临界值尚不明确。本研究旨在评估 AG 作为 HAGMA 筛查试验的性能,并确定 AG 对 HAGMA 的最佳诊断阈值:这是对2017年至2019年期间通过计算机协议提取的大型匿名数据集进行的回顾性分析。纳入了所有抽取血液样本检测有机酸(乳酸、酮或水杨酸)并配以代谢面板的住院患者。目标条件是继发于血液乳酸、酮和/或水杨酸升高的 HAGMA。结果显示,在 16,475 名患者中,2,3,4,5 名患者的血液中乳酸和/或水杨酸含量升高:在 16,475 名患者中,2,621 人患有器质性酸中毒。中位年龄为 65 岁,估计肾小球滤过率中位数为 70 mL/min/1.73 m2。有机性酸中毒患者的AG中位数为23(四分位距[IQR] 20-29)毫微克/升,而无有机性酸中毒患者的AG中位数为16(四分位距[IQR] 14-19)毫微克/升。HAGMA 的 AG 曲线下面积-接收器操作特征为 0.873。HAGMA 的预期灵敏度设定为≥95%,AG 阈值≥15 mEq/L(灵敏度 98.1%,特异性 34.0%):推荐的 AG 临界值为≥15 mEq/L,对 HAGMA 具有较高的灵敏度。在解释 AG 时应始终结合临床情况,并随着临床情况的变化而重复进行。
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引用次数: 0
HER2-low breast cancers: challenges in the interpretation of immunohistochemistry. 低 HER2 乳腺癌:解读免疫组化的挑战。
Pub Date : 2024-03-13 DOI: 10.4103/singaporemedj.SMJ-2023-037
Noel Chia, Mihir Ananta Gudi, Emad Rakha, Puay Hoon Tan

Abstract: Overexpression of human epidermal growth factor receptor 2 (HER2) protein in breast cancers carries significant prognostic and therapeutic implications. Anti-HER2 blockade has shown to be a useful adjunct to surgery in treating HER2-positive tumours. Up till today, the HER2 immunohistochemistry (IHC) and in situ hybridisation (ISH) scoring algorithms are geared towards identifying HER2-positive cases. A recently published Phase III clinical trial (DESTINY-Breast04) has demonstrated that an antibody-drug conjugate (trastuzumab-deruxtecan) significantly reduced disease progression and death in patients with metastatic disease with IHC score 1+ or 2+ and without ISH amplification, defining a new category of cases known as HER2 low. At present, IHC scores 0, 1+ and 2+ show significant interobserver variability, and identifying HER2-low breast cancers may pose significant challenges with the current algorithms. More work is needed in this area to better define HER2-low breast cancers, target the appropriate group of patients and assess treatment efficacy.

摘要:人表皮生长因子受体 2(HER2)蛋白在乳腺癌中的过度表达对预后和治疗具有重要影响。抗 HER2 阻断剂已被证明是治疗 HER2 阳性肿瘤手术的有效辅助手段。迄今为止,HER2 免疫组化(IHC)和原位杂交(ISH)评分算法主要用于识别 HER2 阳性病例。最近发表的一项 III 期临床试验(DESTINY-Breast04)表明,对于 IHC 评分为 1+ 或 2+、无 ISH 扩增的转移性疾病患者,抗体药物共轭物(曲妥珠单抗-德鲁司坦)可显著减少疾病进展和死亡,从而定义了一类新的 HER2 低病例。目前,IHC评分为0、1+和2+的病例在观察者之间存在很大的差异,用目前的算法识别HER2低的乳腺癌可能会带来很大的挑战。要更好地定义 HER2 低乳腺癌、锁定合适的患者群体并评估治疗效果,还需要在这一领域开展更多的工作。
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引用次数: 0
Clinical outcomes of variceal and non-variceal upper gastrointestinal bleeding in cirrhosis patients in Singapore. 新加坡肝硬化患者静脉曲张性和非静脉曲张性上消化道出血的临床结果。
Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2023-046
Garrett Kang, Le Shaun Ang, Wen Hui Leia Teo, Yu Wei Cheryl Huang, Venkataraman Narayan, Andrew Boon Eu Kwek, Tiing Leong Ang, Yu Jun Wong
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引用次数: 0
Prehospital stroke care in Singapore. 新加坡的院前中风护理。
Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2023-066
Timothy Jia Rong Lam, Zhenghong Liu, Benjamin Yong-Qiang Tan, Yih Ying Ng, Colin Kaihui Tan, Xiang Yi Wong, Narayanaswamy Venketasubramanian, Leonard Leong Litt Yeo, Andrew Fu Wah Ho, Marcus Eng Hock Ong

Abstract: Due to the narrow window of opportunity for stroke therapeutics to be employed, effectiveness of stroke care systems is predicated on the efficiency of prehospital stroke systems. A robust prehospital stroke system of care that provides a rapid and well-coordinated response maximises favourable poststroke outcomes, but achieving this presents a unique set of challenges dependent on demographic and geographical circumstances. Set in the context of a highly urbanised first-world nation with a rising burden of stroke, Singapore's prehospital stroke system has evolved to reflect the environment in which it operates. This review aims to characterise the current state of prehospital stroke care in Singapore, covering prehospital aspects of the stroke survival chain from symptom onset till arrival at the emergency department. We identify areas for improvement and innovation, as well as provide insights into the possible future of prehospital stroke care in Singapore.

摘要:由于卒中治疗的机会窗口很窄,卒中救治系统的有效性取决于院前卒中系统的效率。强大的院前卒中救治系统能提供快速、协调的响应,最大限度地改善卒中后的预后,但要实现这一目标却面临一系列独特的挑战,这取决于人口和地理环境。新加坡是高度城市化的第一世界国家,脑卒中发病率不断上升,在此背景下,新加坡的院前卒中系统也在不断发展,以反映其所处的环境。本综述旨在描述新加坡院前卒中救治的现状,涵盖从症状出现到到达急诊科的卒中存活链的院前环节。我们确定了需要改进和创新的领域,并对新加坡院前卒中救治可能的未来提出了见解。
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引用次数: 0
Fitness to drive after trigger or carpal tunnel release surgery: perceptions of patients versus clinicians. 扳机或腕管松解手术后的驾驶能力:患者与临床医生的看法。
Pub Date : 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2021-424
Camelia Qian Ying Tang, Sean Han Sheng Lai, Ellen Yutan Lee, Anthony Foo, Alphonsus Khin Sze Chong
{"title":"Fitness to drive after trigger or carpal tunnel release surgery: perceptions of patients versus clinicians.","authors":"Camelia Qian Ying Tang, Sean Han Sheng Lai, Ellen Yutan Lee, Anthony Foo, Alphonsus Khin Sze Chong","doi":"10.4103/singaporemedj.SMJ-2021-424","DOIUrl":"10.4103/singaporemedj.SMJ-2021-424","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051434","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
Clinical use cases in artificial intelligence: current trends and future opportunities. 人工智能的临床应用案例:当前趋势与未来机遇。
Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.4103/singaporemedj.SMJ-2023-193
Cher Heng Tan, Wilson Wen Bin Goh, Jimmy Bok Yan So, Joseph J Y Sung
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引用次数: 0
Introduction to artificial intelligence in medicine. 医学人工智能入门。
Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.4103/singaporemedj.SMJ-2024-060
Joseph J Y Sung
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引用次数: 0
期刊
Singapore medical journal
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