Singapore medical journal最新文献

Introduction: Opioids are potent analgesics associated with potentially serious adverse effects, including abuse. The use of patient-provider opioid agreements is a regulatory approach in opioid prescription aimed at achieving pain management goals while minimising adverse effects. While national guidelines in Singapore recommend their use, there are limited data regarding the frequency of use and the experiences associated with them. This study aimed to examine clinicians' awareness, perceptions and frequency of use of opioid agreements in Singapore.

Methods: A multicentre cross-sectional electronic survey was conducted among doctors from various clinical specialties in Singapore. The survey questionnaire, hosted on a Singapore Government-secured website, was emailed as a link to 1051 potential respondents and remained active for 3 months. All responses were received anonymously and securely collated.

Results: There were 139 questionnaire responses, among which 129 (92.8%) participants were opioid prescribers. Eighty-six (66.7%) participants were unaware of the existence of opioid agreements. Only 21 (16.3% of total, 48.8% of aware) participants were actual users of opioid agreements; 95.4% of participants who were aware of opioid agreements felt that they were useful.

Conclusion: Awareness and use of opioid agreements among clinicians in Singapore are low, varying by pain management experience, prescribing frequency and practice specialty. Clinicians familiar with opioid agreements generally accept their clinical usefulness. Education and research are needed to increase awareness and develop guidelines for standardised administration of opioid agreements.

Introduction: Data on lung function abnormalities in Singapore are limited. Preserved ratio impaired spirometry (PRISm) and undiagnosed obstructive airway disease (UAD) are frequently overlooked conditions associated with worsened respiratory symptoms, airflow obstruction, and higher morbidity and mortality. We aimed to investigate lung function abnormalities in Singapore, including the prevalence, severity and associated factors of PRISm and UAD.

Methods: Participants from the Singapore Population Health Studies were invited to complete a self-administered questionnaire before undergoing health screenings, including spirometry. PRISm is defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥ 0.70, with FEV1 < 80% predicted, subcategorised into restrictive (FVC < 80% predicted) and non-restrictive (FVC ≥ 80% predicted). Obstructive airway disease (OAD) is defined as FEV1/FVC < 0.7, subcategorised into UAD and known OAD (KAD) based on prior diagnosis of asthma or chronic obstructive pulmonary disease.

Results: Of 2044 participants, 1817 (88.9%) had valid spirometry results. PRISm was present in 294 (16.2%; 14.0% restrictive, 2.2% non-restrictive), and OAD in 100 (5.5%; 3.1% UAD, 2.4% KAD). PRISm was associated with higher body mass index (BMI), Indian ethnicity, hypertension and childhood asthma. Undiagnosed obstructive airway disease was linked to lower BMI, older age, male gender, Malay ethnicity, and current smoking, with milder airflow obstruction than KAD.

Conclusion: This study highlights the high prevalence and clinical importance of PRISm and UAD in Singapore. Addressing these undiagnosed conditions improves spirometry practices, raise awareness and facilitate early diagnosis. Further research in Southeast Asia is needed to gain deeper insights.

Introduction: Singapore has a dual fee-for-service primary care system. Patients can consult at either public polyclinics or private general practitioner (GP) clinics. The new national Healthier SG programme recommends patients to enrol with one primary care provider (PCP) for care continuity. Patients' decision-making in selecting their preferred PCP remains unclear. The study aimed to explore healthcare system and policy factors that influenced their choice of PCP.

Methods: A descriptive qualitative research study was conducted at a polyclinic from June 2022 to December 2022, utilising purposive sampling to recruit Asian adults who consulted polyclinics and GP clinics for their non-communicable diseases (NCDs). Semi-structured interviews were conducted individually. The interview audio recordings were audited, transcribed, coded and analysed using a framework analysis to identify systemic factors influencing their PCP selection.

Results: Twenty-one patients, aged 38 to 82 years, were recruited. One factor influencing patients' choice of PCP is consultation fees offset by government subsidies or company insurance. Practice accessibility, including distance from home and opening hours, also mattered. The range of service, such as available facilities, shared electronic medical records, telehealth and medication delivery were highlighted. An efficient appointment system with greater availability and convenient booking was preferred, and patients sought less crowded clinics with shorter waiting times.

Conclusion: Consultation expenditure, practice accessibility, comprehensive services, efficient appointment system and turnover time in the clinic influenced the selection of PCP. Understanding these factors allows PCPs to tailor their clinic set-up and services to meet patients' preferences and provide care continuity to those with NCDs.

Introduction: We aimed to describe the clinical course of bacterial exogenous endophthalmitis (EE) in a Singapore tertiery hospital and identify the risk factors associated with poor visual outcomes.

Methods: This was a retrospective chart review of patients diagnosed with EE between 1 January 2014 and 31 December 2021. Microbiological data, aetiologies, treatment and visual acuities (VAs) were assessed. Poor visual outcome was defined as final VA poorer than 6/60.

Results: Overall, 18 eyes of 18 patients were identified (postoperative endophthalmitis [POE]: n = 11, 61.1%; postinjection endophthalmitis [PIE]: n = 3, 17.7%; posttraumatic endophthalmitis: n = 2, 11.1% and keratitis-induced endophthalmitis: n = 2, 11.1%). Among the 11 POE patients, cataract surgery was the most common cause (n = 8, 72.7%). The median VA was hand movement (HM) (range from 6/30 to no light perception [NLP]) at presentation and HM (range from 6/6 to NLP) at final review. Patients with presenting VA of 6/60 or better were significantly less likely to have poor visual outcomes (0% vs. 78.6%, P = 0.01, Fisher's exact test). Coagulase-negative Staphylococcus (CoNS) was the most common organism (n = 6), followed by Enterococcus spp. (n = 3), Bacillus spp. and Pseudomonas spp. (n = 2 each). Compared to Gram-positive endophthalmitis, a greater proportion of patients with Gram-negative endophthalmitis had poor visual outcomes (100% vs. 33.5%, P = 0.06).

Conclusion: Between 2014 and 2021, POE was the most common cause of bacterial EE, followed by PIE. The most common organism isolated was CoNS. Patients with better presenting VA may have better visual prognosis after treatment.

Introduction: Boarders refer to patients who have been admitted to the hospital but remain in the emergency department (ED) while waiting for an available inpatient bed. We aimed to examine the correlations between the number of boarders and outcome measures, including effectiveness of patient care, patient safety, efficiency of patient care, patient experience and staff well-being in the ED.

Methods: A retrospective study was carried out. Correlations between the number of boarders and outcome measures were assessed using Pearson's correlation (r) or Spearman's rho (ρ).

Results: The average number of boarders correlated strongly with these outcomes: wait times for triage (r = 0.883, P < 0.001); consult among P2 (urgent) (r = 0.829, P < 0.001) and P3 (ambulatory) patients (r = 0.825, P < 0.001); urinary test (r = 0.562, P < 0.001) and computed tomography (r = 0.733, P < 0.001); time taken for administration of analgesia (r = 0.960, P < 0.001), antibiotics (r = 0.828, P < 0.001) and intravenous fluids (r = 0.872, P < 0.001); and the length of stay for admitted patients (r = 0.995, P < 0.001) and discharged patients (r = 0.797, P < 0.001). Additionally, medical errors (ρ = 0.646, P < 0.001), compliments (ρ = 0.520, P = 0.006), patients who were triaged but did not go through consult (ρ = 0.848, P < 0.001), as well as medical leave taken by doctors (r = 0.626, P = 0.001) and nurses (r = 0.815, P < 0.001) strongly correlated with the average number of boarders in the ED.

Conclusion: Boarders lead to insufficient space and inefficient work processes, which compromise the delivery of emergency care in a timely and safe manner for patients in EDs.