Singapore medical journal最新文献

Abstract: Post-intensive care syndrome (PICS) refers to a constellation of chronic symptoms and deficits experienced by both adult and paediatric survivors of critical illness. These may include impairment in physical, cognitive and mental domains several months after admission to the intensive care unit. Affected patients may experience chronic pain, sleep disturbances and swallowing dysfunction, which may impact their quality of life. Beyond the medical consequences, PICS poses psychological and financial challenges to both patients and their caregivers. This state-of-the-art review provides a comprehensive overview of current evidence on PICS, including key risk factors, screening instruments and potential treatment strategies. Future efforts should prioritise standardised data collection, family-centred care and restoration of health-related quality of life.

Introduction: Interstitial lung disease (ILD) in systemic sclerosis (SSc) is heterogeneous with varied progression rate. This study aimed to identify the baseline clinical characteristics associated with ILD progression within 1, 3 and 5 years of the diagnosis of ILD.

Methods: This was a prospective, multicentre study - Systematic Sclerosis Cohort Singapore - conducted from January 2008 to February 2021, which included SSc patients with ILD diagnosed by high-resolution computed tomography. Progression of ILD was defined by forced vital capacity (FVC) decline ≥10% predicted or FVC decline 5%-9% predicted, with diffusing lung capacity of carbon monoxide decline ≥15% from the time of ILD diagnosis. Multivariable logistic and Cox regression analyses, adjusting for malignancy and treatment, were performed to determine independent risk factors of ILD progression.

Results: Of 124 SSc patients with ILD, 47.6% had limited cutaneous SSc, 33.9% had diffuse SSc and 18.5% had SSc-overlap. Progression of ILD was seen in 6%, 15% and 23% of patients within 1, 3 and 5 years, respectively. After adjusting for malignancy and treatment, anti-La was associated with ILD progression within 1 year (odds ratio [OR] 6.94, 95% confidence interval [CI]: 1.14-42.2; P = 0.04) and 3 years (OR 5.98, 95% CI: 1.31-27.4; P = 0.02), and anti-Scl-70 was associated with ILD progression within 5 years (OR 2.54, 95% CI: 1.05-6.12; P = 0.04). Analysing time to ILD progression as an outcome, anti-La was significantly associated with higher risk of ILD progression (hazard ratio 3.47, 95% CI: 1.18-10.2; P = 0.02). Time to ILD progression was 1.4 years in patients with anti-La versus 6.9 years in patients without anti-La ( P = 0.02), and 4.7 years in patients with anti-Scl-70 versus 8.9 years in patients without anti-Scl-70 ( P = 0.12).

Conclusion: In this Asian cohort of SSc patients, autoantibodies may help to predict ILD progression rates.

Abstract: Screening for lung cancer using low-dose computed tomography is an established means for early lung cancer detection in smokers, but the role of screening for never smokers is unclear. In the 13 lung cancer screening studies involving unselected never smokers, detection rates ranged from 0.1% to 1.1% and positive predictive values ranged from 0.4% to 4.5%. In three lung cancer screening studies involving selected never smokers, selection was based primarily on occupational asbestos exposure, environmental radon exposure and family history of lung cancer in first-degree relatives. Detection rates ranged from 0.3% to 2.6%, and positive predictive values ranged from 0.7% to 15%. Also, 80%-100% of lung cancer cases discovered by screening were early stage, with limited data suggesting survival benefit. Lung cancer screening for never smokers with selected risk factors may achieve detection rates similar to those of screening for high-risk ever smokers. However, further research on optimal subject selection, alternative screening methods and clinical/economic outcomes is needed.

Introduction: Rapid response teams (RRTs) are prevalent in healthcare institutions worldwide. Repeated activations are associated with increased morbidity and higher resource utilisation, and represent a heterogeneous population that may benefit from early identification. To date, there are no published data on repeat RRT activations in Singapore. We aimed to compare the characteristics and outcomes between patients who required single versus multiple RRT activations.

Methods: We conducted a prospective cohort study of daytime RRT activations from February 2018 to June 2020 in Singapore General Hospital. Repeat activations were defined as patients who had two or more activations during their admission. Patient demographics, clinical characteristics, RRT interventions, patient disposition after activation and hospital length of stay were recorded. The primary outcome of interest was in-hospital mortality.

Results: A total of 1055 patients were included, with 85 requiring repeat RRT activations. There was no significant difference in comorbidities and functional performance status at the time of first activation between patients with single versus repeated activations. Patients with repeat activations had more days in hospital before their index activation, a longer hospital length of stay and higher in-hospital mortality. Repeat activations had the strongest association with mortality on multivariate analysis.

Conclusion: Our study found that repeat RRT activations were significantly associated with higher in-hospital mortality rates and increased hospital length of stay, independent of age, performance status and comorbidities. The results of our study highlight the need for early recognition and intervention in this patient group and discussion on goals of care when appropriate.