Singapore medical journal最新文献

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused significant mental distress in populations globally. At the frontline of the pandemic, emergency departments (EDs) are the prime setting to observe the effects of the pandemic on the mental health of the population. We aimed to describe the trend of mental health-related ED attendances at an acute hospital in Singapore before and during the various stages of the COVID-19 pandemic.

Methods: This is a retrospective, descriptive study of patients who presented to the ED between 1 January 2019 and 31 December 2020. Patients diagnosed with mental health-related systematised nomenclature of medicine who visited the ED during this period were identified and were placed into mental health diagnosis categories for analysis. A comparison was made between patients who presented before the pandemic (2019) and during the pandemic (2020).

Results: During the study periods, we identified 1,421 patients, of whom 27 were excluded due to non-mental health-related diagnoses, leaving 1,394 patients for analysis. There was a 36.7% increase in mental health-related ED presentations from 2019 to 2020. The proportion of higher-acuity mental health-related ED attendances and number of suicide attempts also increased.

Conclusion: Our study described an increase in the proportion of high-acuity mental health-related ED attendances during the COVID-19 pandemic. Emergency physicians must be cognisant of the effects of the pandemic on mental health. Further research should be conducted to better equip the healthcare system for handling all aspects of the pandemic.

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.