Singapore medical journal最新文献

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.

Introduction: Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterised by dyspnoea and platypnoea (oxygen desaturation that follows the assumption of an upright position from recumbency). Since the coronavirus disease 2019 (COVID-19) outbreak, increasing reports of COVID-19-related POS and its associated morbidity have been reported around the world. We aimed to study the characteristics of COVID-19-related POS and orthodeoxia (including associations leading to a more prolonged orthodeoxia), and the postdischarge functional outcomes of patients with COVID-19-related POS.

Methods: An observational cohort study was conducted in a tertiary hospital that managed post-COVID-19 patients. Twenty-four participants with severe-to-critical COVID-19 disease/pneumonia and POS, who received inpatient pulmonary rehabilitation, were enrolled. Descriptive analysis of the data was performed to describe POS/orthodeoxia characteristics and functional outcomes in these participants. Correlation analyses were carried out to identify significant factors associated with a prolonged orthodeoxia.

Results: The mean duration of POS and orthodeoxia was 12.9 ± 8.3 days and 28.5 ± 14.6 days, respectively. All participants demonstrated resolution of POS and orthodeoxia by hospital discharge. On multivariable analysis, intensive care unit admission and maximal level of respiratory support were significantly associated with a prolonged duration of orthodeoxia. One participant was lost to follow-up. The remaining 23 participants achieved independence in self-care. With the exception of one patient, who was recovering from a hip fracture, the rest achieved independence in ambulation and independent community access.

Conclusion: Resolution of orthodeoxia was observed in all our participants with COVID-19-related POS. Good functional outcome can be attained with timely and effective rehabilitation interventions.

Introduction: Inhaler therapy is paramount in asthma management, yet non-adherence poses a significant challenge. This study investigates inhaler adherence patterns among adult asthma patients, employing the Test of Adherence to Inhalers (TAIs) questionnaire.

Methods: This cross-sectional study recruited 99 eligible patients from a specialist outpatient clinic over six months. The TAI questionnaire was administered to the patients. Data on asthma control test scores, medication possession ratio, and healthcare utilisation were collected. Statistical analyses were performed to examine the associations between adherence, patient characteristics, and clinical outcomes.

Results: More than half of the patients (68.7%) exhibited intermediate ( n = 23) or poor ( n = 45) adherence, with younger age associated with poorer adherence. Different patterns of non-compliance were identified; 38.8% ( n = 19) of patients with poor adherence showed deliberate non-compliance, whereas only 7.3% ( n = 3) with good adherence showed unconscious non-compliance. Surprisingly, patients with intermediate and poor adherence often achieved good asthma control, revealing potential challenges in outcome-based adherence assessments. A relatively higher but statistically non-significant proportion of patients with poor adherence had at least one hospitalisation or emergency department attendance due to asthma (42.2% with poor adherence vs. 35.5% with good adherence) or at least one asthma exacerbation requiring oral corticosteroid (64.4% with poor adherence vs. 48.4% with good adherence) in the past 12 months.

Conclusion: This study provides insights into inhaler adherence among local adult asthma patients, identifying distinct adherence patterns and recognising potential complacency issues associated with traditional adherence assessments. Despite these limitations, our findings contribute to the optimisation of asthma care through a nuanced understanding of inhaler adherence.