Singapore medical journal最新文献

Abstract: Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.

Abstract: The advances of modern medicine have inadvertently led to a globally ageing population plagued primarily with non-communicable diseases. In addition to traditional medical approaches, nature-based therapy is becoming an increasingly attractive option, with its potential to holistically address physical and mental facets of health and well-being, and to complement 'preventive' and 'population health' strategies, both of which form the bedrock of sustainable healthcare. However, at present, there is vast heterogeneity in the implementation of nature-based therapy, limiting its widespread and sustainable use. The aim of this review is to practically examine and provide a focussed summary of the current evidence with a view to identifying existing gaps and limitations, and to propose directions for future research and implementation within the healthcare setting.

Abstract: The clinical burden of colorectal cancer (CRC) is high. Population-based screening and early detection are essential to improve the long-term clinical outcome. Nonetheless, a significant proportion of patients still present at an advanced stage, including with acute large bowel obstruction. Image-enhanced endoscopy and artificial intelligence can improve the detection and diagnosis of colonic adenomas and early cancer. Endoscopic resection is regarded as the preferred curative treatment option for colonic adenoma and T0 and T1 CRC limited to the superficial submucosa. Emergency colonic stenting as bridge to interval curative surgery is increasingly accepted as a first-line option when technically feasible. Minimally invasive resection techniques such as laparoscopic colectomy and robot-assisted colorectal surgery have also come of age. These techniques reduce post-treatment morbidity, shorten the recovery process and can be cost-effective while maintaining long-term oncological cure. These outcome measures are relevant to our patients; therefore, minimally invasive approaches to curative resection should be embraced.

Abstract: Hospitals worldwide recognise the importance of data and digital transformation in healthcare. We traced a smart hospital's data-driven journey to build an artificial intelligence and digital ecosystem (AIDE) to achieve healthcare excellence. We measured the impact of data and digital transformation on patient care and hospital operations, identifying key success factors, challenges, and opportunities. The use of data analytics and data science, robotic process automation, AI, cloud computing, Medical Internet of Things and robotics were stand-out areas for a hospital's data-driven journey. In the future, the adoption of a robust AI governance framework, enterprise risk management system, AI assurance and AI literacy are critical for success. Hospitals must adopt a digital-ready, digital-first strategy to build a thriving healthcare system and innovate care for tomorrow.

Introduction: Sniffin' sticks (SS) and the University of Pennsylvania smell identification test (UPSIT) are widely used olfactory tests, but have not yet been validated in Singapore. The primary objective of our study was to compare the performance of the unmodified SS and UPSIT in healthy adults in Singapore. The clinical implication was illustrated with a group of patients with olfactory impairment.

Methods: The SS and UPSIT were prospectively administered to healthy adults at a tertiary otolaryngology clinic from 15 May 2023 to 31 July 2023. Primary outcome measures were identification scores, 10 th percentile scores, diagnosed olfactory function, and number of unfamiliar test odours. A retrospective review of patients with olfactory impairment was then performed. We compare their diagnosed olfactory function before and after benchmarking against heathy participants' scores.

Results: Fifty healthy participants (mean age 34 ± 9.4 years) were recruited. With SS, the mean score was 12 ± 2.5 (out of 16) and the 10 th percentile score was 10. With UPSIT, the mean score was 29.6 ± 5.8 (out of 40) and the 10 th percentile score was 25.5. The SS and UPSIT categorised 22 (44.0%) and 46 (92.0%) healthy participants as having hyposmia/anosmia, respectively. Agreement between both tests was minimal (weighted Cohen's kappa -0.020, 95% CI -0.240 to 0.101, P = 0.626). Many test odours were unfamiliar (43.8% in SS vs. 47.5% in UPSIT). Seventy-one patients with olfactory impairment were then analysed. After adjustment, 13.9% (5/36) and 25.7% (9/35) of patients who underwent SS and UPSIT, respectively, had changes in diagnosed olfactory function.

Conclusion: Our findings show that olfactory identification tests must be adapted and validated for the Singapore population to ensure meaningful interpretation of results.