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Perioperative and frailty outcomes after total knee arthroplasty: a retrospective cohort study. 全膝关节置换术后的围手术期和虚弱结果:一项回顾性队列研究。
Pub Date : 2024-10-22 DOI: 10.4103/singaporemedj.SMJ-2023-144
Boon Hian Tan, Kein Boon Poon

Background: Total knee arthroplasty (TKA) is a common procedure with an increasing demand, especially among the elderly. Frailty is known to be associated with adverse perioperative outcomes in the older population. In this article, we aimed to understand the associations of preoperative frailty status and comorbid conditions in relation to their clinical and healthcare outcomes after TKA, and to describe the perioperative factors leading to improvement in a patient's frailty status after TKA.

Methods: This is a retrospective cohort study, and the outcomes were assessed over 2 years. Frailty is defined by the Clinical Frailty Score.

Results: A total of 96 patient records were assessed, of which 13 (13.5%) patients were robust and 83 (86.5%) patients were prefrail or frail. Two years after TKA, the number of robust patients increased to 58 (61.7%) patients, showing a reversal of frailty in 48.2% of patients.

Conclusion: Total knee arthroplasty in prefrail and frail patients is a safe procedure that leads to improvement of frailty status, with an increase in the proportion of patients becoming robust within 2 years after the operation.

背景:全膝关节置换术(TKA)是一种常见的手术,其需求量越来越大,尤其是在老年人中。众所周知,虚弱与老年人围手术期的不良预后有关。本文旨在了解术前虚弱状态和合并症与 TKA 术后临床和保健结果的关系,并描述导致 TKA 术后患者虚弱状态改善的围手术期因素:这是一项回顾性队列研究,对两年内的结果进行了评估。虚弱以临床虚弱评分来定义:共评估了96份病历,其中13名(13.5%)患者体格健壮,83名(86.5%)患者为前期或后期体弱。全膝关节置换术两年后,体格健壮的患者增至58人(61.7%),48.2%的患者体弱状况得到逆转:结论:对体弱多病的患者进行全膝关节置换术是一种安全的手术,可改善患者的体弱状况,术后两年内体格健壮的患者比例会增加。
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引用次数: 0
Predictive factors for interstitial lung disease progression in a Singapore systemic sclerosis cohort: a multicentre study. 新加坡系统性硬化症队列中间质性肺病进展的预测因素:一项多中心研究。
Pub Date : 2024-10-22 DOI: 10.4103/singaporemedj.SMJ-2023-225
Maria Noviani, Seyed Ehsan Saffari, Gim Gee Teng, Xin Rong Lim, Grace Yin Lai Chan, Amelia Santosa, Cassandra Hong, Sue-Ann Ng, Andrea Hsiu Ling Low

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.

导言:系统性硬化症(SSc)患者的间质性肺病(ILD)具有异质性,其进展速度各不相同。本研究旨在确定在确诊 ILD 后 1、3 和 5 年内与 ILD 进展相关的基线临床特征:这是一项前瞻性多中心研究--新加坡系统性硬化队列研究--于2008年1月至2021年2月进行,研究对象包括经高分辨率计算机断层扫描确诊患有ILD的SSc患者。强迫生命容量(FVC)下降≥10%(预测值)或FVC下降5%-9%(预测值),一氧化碳肺弥散容量下降≥15%(诊断为ILD时),即为ILD进展。在对恶性肿瘤和治疗进行调整后,进行了多变量逻辑分析和 Cox 回归分析,以确定 ILD 进展的独立风险因素:在124名患有ILD的SSc患者中,47.6%患有局限性皮肤SSc,33.9%患有弥漫性SSc,18.5%患有SSc-重叠性SSc。分别有6%、15%和23%的患者在1年、3年和5年内出现ILD进展。调整恶性肿瘤和治疗因素后,抗La与1年内(几率比[OR]6.94,95% 置信区间[CI]:1.14-42.2;P = 0.04)和3年内(OR 5.98,95% CI:1.31-27.4;P = 0.02)的ILD进展相关,抗Scl-70与5年内的ILD进展相关(OR 2.54,95% CI:1.05-6.12;P = 0.04)。将 ILD 进展时间作为一项结果进行分析,抗-La 与较高的 ILD 进展风险显著相关(危险比 3.47,95% CI:1.18-10.2;P = 0.02)。抗La患者的ILD进展时间为1.4年,而无抗La患者为6.9年(P = 0.02);抗Scl-70患者的ILD进展时间为4.7年,而无抗Scl-70患者为8.9年(P = 0.12):结论:在这批亚洲 SSc 患者中,自身抗体有助于预测 ILD 的进展率。
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引用次数: 0
Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol. 全膝关节置换术后 24 小时成功出院:手术时机和物理治疗在术后恢复强化方案中的重要性。
Pub Date : 2024-10-22 DOI: 10.4103/singaporemedj.SMJ-2023-280
Hong Jing Lee, Sheng Xu, Eric Xuan Liu, Jason Beng Teck Lim, Ming Han Lincoln Liow, Hee Nee Pang, Darren Keng-Jin Tay, Seng Jin Yeo, Jerry Yongqiang Chen

Introduction: The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge.

Methods: All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h.

Results: With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005).

Conclusion: Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

导言:关于哪些患者因素(如果有的话)可预测术后恢复增强型全膝关节置换术(ERAS)24小时内的成功出院率,目前的文献说法不一。本研究旨在探讨手术和物理治疗的时机对 24 小时内成功出院率的影响:对2020年8月至2021年7月期间接受ERAS日间手术TKA的342名患者进行了前瞻性随访。记录患者特征和术后结果,如出院前所需的物理治疗次数、术后步行大于10米所需的时间和住院时间(LOS)。根据手术结束时间(上午/下午/傍晚)和物理治疗复查时间(上午/下午/傍晚/术后上午)对患者进行分组。如果患者在24小时内出院,则成功通过ERAS日间手术方案:在手术时间方面,上午组患者的 LOS 最短(P = 0.001),ERAS 日间手术通过率高于下午组(P = 0.016)。在物理治疗时间方面,与上午手术后组相比,下午手术后组患者步行>10米所需时间最短(P < 0.001),LOS时间最短(P < 0.001),ERAS日间手术通过率更高(P = 0.005):结论:上午结束手术并在当天下午接受物理治疗复查的患者最有可能在24小时内出院,因为他们可以尽早下床活动,脊髓麻醉也有足够的时间消退。
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引用次数: 0
Association of psychological distress with health-related quality of life in Asian adolescents seeking obesity treatment. 寻求肥胖症治疗的亚洲青少年的心理困扰与健康相关生活质量的关系。
Pub Date : 2024-10-22 DOI: 10.4103/singaporemedj.SMJ-2024-006
Wang Chin Eileen Ng, Khairunisa Binte Khaider, Qiao Fan, Chu Shan Elaine Chew

Introduction: There is limited research on the psychosocial health of Asian adolescents undergoing obesity treatment. Our study examined the predictors of psychological distress, disordered eating and poor health-related quality of life (HRQoL) in these adolescents and the associations between them.

Methods: A total of 82 adolescents aged 11-17 years were recruited from the Weight Management Clinic in KK Women's and Children's Hospital between June 2022 and January 2023. Participants completed the following questionnaires: (a) Young Person's Clinical Outcomes in Routine Evaluation (YP-Core) assessing for psychological distress, (b) Children's Eating Attitude Test (ChEAT) evaluating for disordered eating behaviours, and (c) Pediatric Quality of Life Inventory (PedsQL) measuring HRQoL.

Results: Participating adolescents had a mean body mass index of 31.9 ± 5.1 kg/m2. Of the participants, 40% reported significantly symptomatic psychological distress (YP-Core score ≥14) and 16% were at risk of eating disorders (ChEAT score ≥20). A higher YP-Core score was the only significant determinant of poorer HRQoL, after controlling for demographic variables and ChEAT scores. Malay (regression coefficient: 6.6, 95% confidence interval [CI]: 0.6-12.6, P = 0.031) and Indian (regression coefficient: 8.9, 95% CI: 3.8-14.0, P = 0.001) adolescents were more likely to report disordered eating and psychological distress, respectively, as compared to Chinese adolescents. Adolescents whose parent(s) had obesity (regression coefficient: 3.4, 95% CI: 0.1-6.7, P = 0.043) were also more likely to experience greater psychological distress.

Conclusion: Understanding the determinants of psychological distress, disordered eating and HRQoL will facilitate targeted screening and management of the psychosocial complications of adolescent obesity.

简介有关接受肥胖症治疗的亚洲青少年社会心理健康的研究十分有限。我们的研究探讨了这些青少年的心理困扰、饮食紊乱和健康相关生活质量(HRQoL)低下的预测因素以及它们之间的关联:2022 年 6 月至 2023 年 1 月期间,我们从 KK 妇女儿童医院体重管理门诊共招募了 82 名 11-17 岁的青少年。参与者填写了以下问卷:(a)评估心理困扰的《青少年常规临床结果评估》(YP-Core);(b)评估饮食行为紊乱的《儿童饮食态度测试》(ChEAT);以及(c)测量 HRQoL 的《儿童生活质量量表》(Pediatric Quality of Life Inventory):参与调查的青少年的平均体重指数为 31.9 ± 5.1 kg/m2。其中 40% 的参与者有明显的心理困扰症状(YP-Core 评分≥14 分),16% 的参与者有饮食失调的风险(ChEAT 评分≥20 分)。在控制了人口统计学变量和 ChEAT 分数后,较高的 YP-Core 分数是决定较差 HRQoL 的唯一重要因素。马来人(回归系数:6.6,95% 置信区间 [CI]:0.6-12.6,P<0.05):与华裔青少年相比,马来裔(回归系数:6.6,95% 置信区间[CI]:0.6-12.6,P = 0.031)和印度裔(回归系数:8.9,95% 置信区间:3.8-14.0,P = 0.001)青少年更有可能报告饮食失调和心理困扰。父母患有肥胖症的青少年(回归系数:3.4,95% CI:0.1-6.7,P = 0.043)也更有可能经历更大的心理压力:了解心理困扰、饮食失调和 HRQoL 的决定因素将有助于对青少年肥胖症的心理并发症进行有针对性的筛查和管理。
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引用次数: 0
Prevalence of diabetes mellitus-related complications and their impact on health-related quality of life in Singapore. 新加坡糖尿病相关并发症的发病率及其对健康相关生活质量的影响。
Pub Date : 2024-10-16 DOI: 10.4103/singaporemedj.SMJ-2023-148
Bernard Chin Wee Tan, Edimansyah Abdin, Yen Sin Koh, P V Asharani, Fiona Devi, Kumarasan Roystonn, Chee Fang Sum, Tavintharan Subramaniam, Siow Ann Chong, Mythily Subramaniam

Introduction: One in three Singaporeans is at risk of developing DM (DM) in their lifetime. The majority of those with DM experience other comorbidities that often affect the course of their DM. This study explored: (a) the prevalence of DM-related complications, (b) their sociodemographic correlates, and (c) their association with health-related quality of life (HRQOL).

Methods: Participants with DM (n = 387) were recruited from a population-based survey. Type 2 DM was self-reported as diagnosed by a doctor. The DM-related complications and comorbidities were assessed using the DM knowledge questionnaire and chronic conditions checklist. Short-Form health survey was used to examined HRQOL. Multiple logistic regressions were performed to examine the association between DM-related complications and sociodemographic factors and body mass index. Multiple linear regressions examined the association of complications with HRQOL.

Results: Approximately 31.6% of the participants had DM-related complications. The top three complications were nephropathy (54.4%), neuropathy (42.2%) and retinopathy (40.8%). Younger participants (aged 18-49 years) and those with higher education were less likely to develop DM-related complications. Physical HRQOL was adversely affected in participants with any chronic condition, DM for 4-9 years, DM-related neuropathy, lower leg/foot ulcers and gangrene. Mental HRQOL was adversely affected by gangrene. Younger participants had better physical HRQOL.

Conclusion: Physical HRQOL is adversely affected when individuals develop DM-related complications. Understanding the sociodemographic corelates of DM-related complications could aid clinicians in identifying and assisting at-risk populations to prevent adverse outcomes. Educating individuals on the risk of developing DM-related complications could encourage better DM management.

导言:每三名新加坡人中就有一人有可能在一生中罹患糖尿病(DM)。大多数糖尿病患者还伴有其他并发症,这些并发症往往会影响糖尿病的病程。本研究探讨了:(a)糖尿病相关并发症的发病率;(b)这些并发症的社会人口学相关因素;以及(c)这些并发症与健康相关生活质量(HRQOL)之间的关系:方法:从一项基于人口的调查中招募了 DM 患者(n = 387)。2 型糖尿病是由医生诊断的自我报告。使用 DM 知识问卷和慢性病检查表对 DM 相关并发症和合并症进行评估。短表健康调查用于检查 HRQOL。多重逻辑回归研究了DM相关并发症与社会人口学因素和体重指数之间的关系。多重线性回归检验了并发症与 HRQOL 的关系:结果:约 31.6% 的参与者患有糖尿病相关并发症。结果:约有 31.6% 的参与者患有糖尿病相关并发症,前三位并发症分别是肾病(54.4%)、神经病变(42.2%)和视网膜病变(40.8%)。较年轻的参与者(18-49 岁)和受教育程度较高的参与者较少出现糖尿病相关并发症。患有任何慢性疾病、糖尿病持续 4-9 年、糖尿病相关神经病变、小腿/足部溃疡和坏疽的参与者,其身体的 HRQOL 均受到不利影响。坏疽则对心理的 HRQOL 有不利影响。结论:身体的 HRQOL 受到坏疽的不利影响:结论:当出现糖尿病相关并发症时,身体的 HRQOL 会受到不利影响。了解糖尿病相关并发症的社会人口学核心因素有助于临床医生识别并帮助高危人群预防不良后果。对个人进行有关糖尿病相关并发症的风险教育,可以促进更好的糖尿病管理。
{"title":"Prevalence of diabetes mellitus-related complications and their impact on health-related quality of life in Singapore.","authors":"Bernard Chin Wee Tan, Edimansyah Abdin, Yen Sin Koh, P V Asharani, Fiona Devi, Kumarasan Roystonn, Chee Fang Sum, Tavintharan Subramaniam, Siow Ann Chong, Mythily Subramaniam","doi":"10.4103/singaporemedj.SMJ-2023-148","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-148","url":null,"abstract":"<p><strong>Introduction: </strong>One in three Singaporeans is at risk of developing DM (DM) in their lifetime. The majority of those with DM experience other comorbidities that often affect the course of their DM. This study explored: (a) the prevalence of DM-related complications, (b) their sociodemographic correlates, and (c) their association with health-related quality of life (HRQOL).</p><p><strong>Methods: </strong>Participants with DM (n = 387) were recruited from a population-based survey. Type 2 DM was self-reported as diagnosed by a doctor. The DM-related complications and comorbidities were assessed using the DM knowledge questionnaire and chronic conditions checklist. Short-Form health survey was used to examined HRQOL. Multiple logistic regressions were performed to examine the association between DM-related complications and sociodemographic factors and body mass index. Multiple linear regressions examined the association of complications with HRQOL.</p><p><strong>Results: </strong>Approximately 31.6% of the participants had DM-related complications. The top three complications were nephropathy (54.4%), neuropathy (42.2%) and retinopathy (40.8%). Younger participants (aged 18-49 years) and those with higher education were less likely to develop DM-related complications. Physical HRQOL was adversely affected in participants with any chronic condition, DM for 4-9 years, DM-related neuropathy, lower leg/foot ulcers and gangrene. Mental HRQOL was adversely affected by gangrene. Younger participants had better physical HRQOL.</p><p><strong>Conclusion: </strong>Physical HRQOL is adversely affected when individuals develop DM-related complications. Understanding the sociodemographic corelates of DM-related complications could aid clinicians in identifying and assisting at-risk populations to prevent adverse outcomes. Educating individuals on the risk of developing DM-related complications could encourage better DM management.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485002","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
2021 NEDI-Singapore study: an updated inventory of emergency department characteristics. 2021 NEDI-新加坡研究:急诊科特点的最新清单。
Pub Date : 2024-10-04 DOI: 10.4103/singaporemedj.SMJ-2023-271
Ivan Jinrong Low, En Ci Isaac Ong, Pin Pin Maeve Pek, Li Juan Joy Quah, Shu-Ling Chong, Jia Hao Lim, Krislyn M Boggs, Carlos A Jr Camargo, Venkataraman Anantharaman, Andrew Fu Wah Ho

Introduction: The last national emergency department (ED) inventory was performed in 2007, and major changes in population demographics, healthcare needs and infrastructure have since occurred. We sought to obtain an updated inventory of EDs in Singapore to identify and describe changes in their characteristics and capabilities across the years.

Methods: In 2021, the National Emergency Department Inventories (NEDI) instrument was administered to the leadership of Singapore EDs. Emergency departments in Singapore are opened round the clock, have no restrictions on who can access care and are equipped to handle general medical emergencies. The questionnaire comprises 16 items across three categories: (a) general characteristics, (b) patient volume and (c) medical capabilities.

Results: We achieved 100% response rate from all 17 EDs - nine EDs in public hospitals and eight in private hospitals. In 2021, the EDs saw a total of 1,140,388 visits, an increase of 27% from 2007, with the median number of visits almost doubling (from 39,450 to 77,989); 41% and 59% of the EDs reported over 20% of visits arriving by ambulance and over 20% of visits resulting in inpatient admission, respectively. A clear distinction between public and private EDs across these metrics remained. Medical capabilities grew: 59% had access to a dedicated computed tomography scanner (up from 46%) and 82% had negative pressure isolation facilities (up from 54%). Overall, 41% of EDs self-assessed to be operating above their capacity.

Conclusion: Singapore EDs have progressed in capabilities and capacity. Despite this, the increasing volume, complexity and acuity of patients are imposing strains on the emergency care system, signalling potential for systems improvement.

导言:上一次全国急诊室(ED)清查是在 2007 年,此后人口统计、医疗保健需求和基础设施都发生了重大变化。我们试图获得新加坡急诊室的最新清单,以确定并描述这些年来急诊室的特点和能力的变化:方法:2021 年,我们对新加坡急诊室的领导层使用了国家急诊室清单(NEDI)工具。新加坡的急诊室全天候开放,对就诊者没有任何限制,并具备处理一般医疗紧急情况的能力。问卷包括三个类别的 16 个项目:(a) 一般特征、(b) 病人数量和 (c) 医疗能力:所有 17 家急诊室的回复率均为 100%,其中 9 家为公立医院急诊室,8 家为私立医院急诊室。2021 年,这些急诊室共接待了 1,140,388 人次,比 2007 年增加了 27%,中位数几乎翻了一番(从 39,450 人次增加到 77,989 人次);分别有 41% 和 59% 的急诊室报告说,超过 20% 的病人是乘坐救护车来就诊的,超过 20% 的病人是住院治疗的。在这些指标上,公立和私立急诊室仍有明显区别。医疗能力有所提高:59%的急诊室配备了专用的计算机断层扫描仪(高于 46%),82%的急诊室配备了负压隔离设施(高于 54%)。总体而言,41%的急诊室自我评估为超负荷运转:新加坡急诊室在能力和容量方面都取得了进步。结论:新加坡急诊室在能力和容量方面都有进步,尽管如此,病人数量、复杂性和严重程度的增加给急诊护理系统带来了压力,预示着系统改进的潜力。
{"title":"2021 NEDI-Singapore study: an updated inventory of emergency department characteristics.","authors":"Ivan Jinrong Low, En Ci Isaac Ong, Pin Pin Maeve Pek, Li Juan Joy Quah, Shu-Ling Chong, Jia Hao Lim, Krislyn M Boggs, Carlos A Jr Camargo, Venkataraman Anantharaman, Andrew Fu Wah Ho","doi":"10.4103/singaporemedj.SMJ-2023-271","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-271","url":null,"abstract":"<p><strong>Introduction: </strong>The last national emergency department (ED) inventory was performed in 2007, and major changes in population demographics, healthcare needs and infrastructure have since occurred. We sought to obtain an updated inventory of EDs in Singapore to identify and describe changes in their characteristics and capabilities across the years.</p><p><strong>Methods: </strong>In 2021, the National Emergency Department Inventories (NEDI) instrument was administered to the leadership of Singapore EDs. Emergency departments in Singapore are opened round the clock, have no restrictions on who can access care and are equipped to handle general medical emergencies. The questionnaire comprises 16 items across three categories: (a) general characteristics, (b) patient volume and (c) medical capabilities.</p><p><strong>Results: </strong>We achieved 100% response rate from all 17 EDs - nine EDs in public hospitals and eight in private hospitals. In 2021, the EDs saw a total of 1,140,388 visits, an increase of 27% from 2007, with the median number of visits almost doubling (from 39,450 to 77,989); 41% and 59% of the EDs reported over 20% of visits arriving by ambulance and over 20% of visits resulting in inpatient admission, respectively. A clear distinction between public and private EDs across these metrics remained. Medical capabilities grew: 59% had access to a dedicated computed tomography scanner (up from 46%) and 82% had negative pressure isolation facilities (up from 54%). Overall, 41% of EDs self-assessed to be operating above their capacity.</p><p><strong>Conclusion: </strong>Singapore EDs have progressed in capabilities and capacity. Despite this, the increasing volume, complexity and acuity of patients are imposing strains on the emergency care system, signalling potential for systems improvement.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373981","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
Prevalence and risk factors of symptomatic venous thromboembolism in distal femur fractures. 股骨远端骨折患者无症状静脉血栓栓塞症的发病率和风险因素。
Pub Date : 2024-10-04 DOI: 10.4103/singaporemedj.SMJ-2023-265
Wei Mao, Joel Xue Yi Lim, Jiong Hao Tan, Shi-Min Chang, Choon Chiet Hong

Introduction: There is a paucity of published research on symptomatic venous thromboembolism (sVTE) after distal femur fractures (DFFs). This study aimed to explore the prevalence and risk factors of sVTE in DFFs.

Methods: We identified a total of 131 patients who underwent DFF surgeries without routine pharmacological thromboprophylaxis between October 2007 and November 2016. Cases of sVTE included symptomatic pulmonary embolism (sPE) and symptomatic deep vein thrombosis (sDVT). Patients with sVTE were compared to those without, and differences in demographics and fracture-related characteristics were explored. Multivariate logistic regression was used to eliminate confounding factors.

Results: Of the 131 patients, 20 (15.3%) had sVTE, of whom 16 (12.2%) had sDVT and six (4.6%) had sPE (two patients had both sPE and sDVT). Notably, 17 (85.0%) sVTE patients were aged ≥60 years, while only 62 (55.9%) non-sVTE patients were aged ≥60 years (P = 0.014). Fourteen (82.4%) patients with sVTE had body mass index (BMI) ≥25 kg/m2, while 49 (53.3%) patients without sVTE had BMI ≥25 kg/m2 (P = 0.032). Multivariate logistic regression demonstrated that age ≥60 years (adjusted odds ratio [OR] 5.05; P = 0.040) and BMI ≥25 kg/m2 (adjusted OR 3.92; P = 0.045) were independently associated with a higher risk of sVTE after DFF.

Conclusion: The prevalence of sVTE in DFFs is high at 15.3%. Advanced age (≥60 years) and being overweight (BMI ≥25 kg/m2) were two independent risk factors for sVTE in DFFs. The use of routine pharmacological thromboprophylaxis should be considered as a preventative measure.

简介:关于股骨远端骨折(DFF)后无症状静脉血栓栓塞症(sVTE)的公开研究很少。本研究旨在探讨股骨远端骨折后症状性静脉血栓栓塞症的发病率和风险因素:我们确定了 2007 年 10 月至 2016 年 11 月间接受 DFF 手术且未进行常规药物血栓预防治疗的 131 例患者。sVTE病例包括症状性肺栓塞(sPE)和症状性深静脉血栓形成(sDVT)。将患有 sVTE 的患者与未患有 sVTE 的患者进行了比较,并探讨了人口统计学和骨折相关特征的差异。采用多变量逻辑回归消除混杂因素:在 131 名患者中,20 人(15.3%)患有 sVTE,其中 16 人(12.2%)患有 sDVT,6 人(4.6%)患有 sPE(两名患者同时患有 sPE 和 sDVT)。值得注意的是,17 名 sVTE 患者(85.0%)的年龄≥60 岁,而只有 62 名非 sVTE 患者(55.9%)的年龄≥60 岁(P = 0.014)。14名(82.4%)sVTE 患者的体重指数(BMI)≥25 kg/m2,而 49 名(53.3%)非 sVTE 患者的体重指数≥25 kg/m2(P = 0.032)。多变量逻辑回归显示,年龄≥60 岁(调整后的比值比 [OR] 5.05;P = 0.040)和体重指数≥25 kg/m2(调整后的比值比 3.92;P = 0.045)与 DFF 后较高的 sVTE 风险独立相关:结论:DFF术后sVTE的发生率高达15.3%。高龄(≥60 岁)和超重(体重指数≥25 kg/m2)是 DFF 中发生 sVTE 的两个独立风险因素。应考虑将常规药物血栓预防作为一种预防措施。
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引用次数: 0
Associations between parental bonding and health-related quality of life in a clinical sample of youths aged 14-35 years in Singapore. 新加坡 14-35 岁青少年临床样本中父母亲情与健康相关生活质量之间的关系。
Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI: 10.4103/singaporemedj.SMJ-2023-223
Yoke Boon Tan, Eng Hong Tay, Shazana Shahwan, Yunjue Zhang, Rajeswari Sambasivam, Mythily Subramaniam

Introduction: Individuals with psychiatric disorders tend to report having poorer bonds with their parents during their early years. These individuals often experience lower quality of life as well. This study investigated the associations between aspects of parental bonding and health-related quality of life (HRQOL) in a clinical sample of youths. It was hypothesised that high parental care and low parental overprotectiveness would be associated with higher levels of HRQOL.

Methods: Data were obtained from a larger cross-sectional study. The sample consisted of 400 psychiatric outpatients: 191 patients aged 14-21 (mean ± standard deviation 18.1 ± 2.22) years and 209 patients aged 22-35 (28.0 ± 4.33) years. The Parental Bonding Instrument was used to measure parental care and overprotectiveness. Short Form-12 measured physical health (physical component summary [PCS]) and mental health (mental component summary [MCS]) components of HRQOL, and the 8-item Patient Health Questionnaire assessed depressive symptoms. These scales and a sociodemographic form were self-administered. Multivariable linear regression was used for analysis.

Results: About half of the sample reported affectionless control for mothers (46.6%) and fathers (45.9%). After controlling for sociodemographic variables, no significant relationship was found between aspects of parental bonding and PCS scores. Maternal care was associated with MCS scores (β = 0.32, P < 0.01) and PHQ-8 scores (β = -0.12, P < 0.05).

Conclusion: Our results suggest that youths who experienced quality care from their mothers exhibit better mental health functioning despite their clinical diagnoses, which suggests that early maternal care exerts an overall long-term protective effect. Early parental education that promotes positive parenting practices could improve the overall HRQOL of individuals in adulthood despite their clinical diagnoses.

导言患有精神障碍的人往往表示,他们早年与父母的关系较差。这些人的生活质量通常也较低。本研究调查了临床青少年样本中父母亲情与健康相关生活质量(HRQOL)之间的关系。研究假设,父母的高度关爱和低度过度保护将与较高的 HRQOL 水平相关:数据来自一项大型横断面研究。样本由 400 名精神病门诊患者组成:191名患者的年龄为14-21岁(平均±标准差为18.1±2.22)岁,209名患者的年龄为22-35岁(28.0±4.33)岁。父母关系测量工具用于测量父母的关爱和过度保护。简表-12测量了HRQOL的身体健康(身体部分摘要[PCS])和心理健康(心理部分摘要[MCS])部分,8项患者健康问卷评估了抑郁症状。这些量表和一份社会人口调查表均为自填。分析采用多变量线性回归法:约有一半的样本报告称母亲(46.6%)和父亲(45.9%)缺乏亲情控制。在控制了社会人口学变量后,没有发现父母亲子关系的各个方面与 PCS 分数之间有明显的关系。母亲关怀与 MCS 分数(β = 0.32,P < 0.01)和 PHQ-8 分数(β = -0.12,P < 0.05)相关:我们的研究结果表明,经历过母亲优质照顾的青少年尽管有临床诊断,但他们的心理健康功能却更好,这表明母亲的早期照顾具有长期的整体保护作用。促进积极养育方式的早期父母教育可以改善成年后个人的整体 HRQOL,尽管他们有临床诊断。
{"title":"Associations between parental bonding and health-related quality of life in a clinical sample of youths aged 14-35 years in Singapore.","authors":"Yoke Boon Tan, Eng Hong Tay, Shazana Shahwan, Yunjue Zhang, Rajeswari Sambasivam, Mythily Subramaniam","doi":"10.4103/singaporemedj.SMJ-2023-223","DOIUrl":"10.4103/singaporemedj.SMJ-2023-223","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with psychiatric disorders tend to report having poorer bonds with their parents during their early years. These individuals often experience lower quality of life as well. This study investigated the associations between aspects of parental bonding and health-related quality of life (HRQOL) in a clinical sample of youths. It was hypothesised that high parental care and low parental overprotectiveness would be associated with higher levels of HRQOL.</p><p><strong>Methods: </strong>Data were obtained from a larger cross-sectional study. The sample consisted of 400 psychiatric outpatients: 191 patients aged 14-21 (mean ± standard deviation 18.1 ± 2.22) years and 209 patients aged 22-35 (28.0 ± 4.33) years. The Parental Bonding Instrument was used to measure parental care and overprotectiveness. Short Form-12 measured physical health (physical component summary [PCS]) and mental health (mental component summary [MCS]) components of HRQOL, and the 8-item Patient Health Questionnaire assessed depressive symptoms. These scales and a sociodemographic form were self-administered. Multivariable linear regression was used for analysis.</p><p><strong>Results: </strong>About half of the sample reported affectionless control for mothers (46.6%) and fathers (45.9%). After controlling for sociodemographic variables, no significant relationship was found between aspects of parental bonding and PCS scores. Maternal care was associated with MCS scores (β = 0.32, P < 0.01) and PHQ-8 scores (β = -0.12, P < 0.05).</p><p><strong>Conclusion: </strong>Our results suggest that youths who experienced quality care from their mothers exhibit better mental health functioning despite their clinical diagnoses, which suggests that early maternal care exerts an overall long-term protective effect. Early parental education that promotes positive parenting practices could improve the overall HRQOL of individuals in adulthood despite their clinical diagnoses.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"579-585"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Detection of soft tissue emphysema in emergency head and neck imaging. 在急诊头颈部成像中检测软组织气肿。
Pub Date : 2024-10-01 Epub Date: 2024-10-04 DOI: 10.4103/singaporemedj.SMJ-2021-453
Michael Che Hao Seng, Elena Tangtra, Chi Long Ho
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引用次数: 0
No health without mental health: united we stand. 没有心理健康就没有健康:我们团结一致。
Pub Date : 2024-10-01 Epub Date: 2024-10-04 DOI: 10.4103/singaporemedj.SMJ-2024-182
Kang Sim, Tiing Leong Ang
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引用次数: 0
期刊
Singapore medical journal
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