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Pancreaticopleural fistula: a rare cause of empyema. 胰腺胸膜瘘:引起肺水肿的罕见病因。
Pub Date : 2024-07-15 DOI: 10.4103/singaporemedj.SMJ-2023-165
Wei Rong Benjamin Tay, Bhavesh Kishor Doshi, Felicia Su Wei Teo, Kai Ting Cheryl Chua, Pyng Lee
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引用次数: 0
Enhanced Comprehensive Care Programme: a retrospective study of patient empanelment by generalist-led multidisciplinary teams to reduce acute care utilisation. 强化综合护理计划:由全科医生领导的多学科团队为减少急症护理使用率而进行的病人授权回顾性研究。
Pub Date : 2024-07-11 DOI: 10.4103/singaporemedj.SMJ-2023-049
Norshima Nashi, Derek Kam Weng Chan, Ginny Jing Xian Goh, Swee Chin Loo, John Tshon Yit Soong

Introduction: Singapore faces an increasingly aged population with complex multimorbidity and psychosocial impairment. This change in demographic is challenging for existing healthcare systems. Breaks in care coordination and continuity result in poor health outcomes, increased acute care utilisation and higher healthcare costs. We proposed a patient empanelment approach adapted for the Singapore context based on the University of Chicago Comprehensive Care Physician model.

Methods: This retrospective quasi-experimental, matched-controlled observational study sought to assess the effectiveness of the Enhanced Comprehensive Care Programme (ECCP) in reducing acute care utilisation at National University Hospital, Singapore. The primary outcomes were the number of hospitalisations and emergency department (ED) visits 6 months pre- and post-enrolment in ECCP. We used propensity score matching to balance prior healthcare utilisation between the intervention and control groups.

Results: Fifty-seven participants were recruited in the programme between October 2019 and April 2020. There was a reduction in the mean number of hospitalisations after intervention compared to before intervention (0.58 ± 1.03 vs. 1.90 ± 1.07, P < 0.001). There was also a reduction in the mean number of ED visits (0.77 ± 1.05 vs. 1.96 ± 1.14, P < 0.001). In the propensity-matched cohort, the mean number of hospitalisations was reduced in the intervention group (from 1.92 ± 1.07 to 0.58 ± 1.03, P < 0.001) compared to the control group (from 1.85 ± 0.99 to 1.06 ± 1.17, P = 0.04).

Conclusion: This observational study shows the potential benefits of ECCP healthcare redesign to reduce acute care utilisation.

导言:新加坡面临着越来越多的老龄人口,他们患有复杂的多病和心理障碍。这种人口结构的变化对现有的医疗保健系统提出了挑战。护理协调性和连续性的中断会导致不良的健康结果、急性护理使用率增加以及医疗成本上升。我们根据芝加哥大学的综合护理医生模式,提出了一种适合新加坡国情的病人授权方法:这项回顾性准实验、配对对照观察研究旨在评估强化综合护理计划(ECCP)在降低新加坡国立大学医院急症护理使用率方面的效果。研究的主要结果是参加 ECCP 前后 6 个月的住院和急诊就诊人数。我们采用倾向得分匹配法来平衡干预组和对照组之前的医疗利用率:在 2019 年 10 月至 2020 年 4 月期间,该计划招募了 57 名参与者。与干预前相比,干预后的平均住院次数有所减少(0.58 ± 1.03 vs. 1.90 ± 1.07,P < 0.001)。急诊室就诊的平均次数也有所减少(0.77 ± 1.05 vs. 1.96 ± 1.14,P < 0.001)。在倾向匹配队列中,与对照组(从 1.85 ± 0.99 到 1.06 ± 1.17,P = 0.04)相比,干预组的平均住院次数减少了(从 1.92 ± 1.07 到 0.58 ± 1.03,P < 0.001):这项观察性研究表明,重新设计 ECCP 医疗服务可降低急症护理的使用率。
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引用次数: 0
An unusual presentation of acute limb ischaemia secondary to metastatic endometrial sarcoma: a case study. 转移性子宫内膜肉瘤继发急性肢体缺血的不寻常表现:病例研究。
Pub Date : 2024-07-11 DOI: 10.4103/singaporemedj.SMJ-2023-201
Tze Gek Ho, Shaun Wen Yang Chan, Dexter Yak Seng Chan, Chuo Ren Leong
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引用次数: 0
Patellar management in total knee arthroplasty: an educational aid. 全膝关节置换术中的髌骨处理:一种教学辅助工具。
Pub Date : 2024-07-11 DOI: 10.4103/singaporemedj.SMJ-2023-154
Angelo Vasileiou Vasiliadis, Vasileios Giovanoulis
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引用次数: 0
Severe re-expansion pulmonary oedema after medical thoracoscopy. 内科胸腔镜手术后的严重再膨胀性肺水肿。
Pub Date : 2024-07-11 DOI: 10.4103/singaporemedj.SMJ-2023-213
Jeffrey Ng, Kay Choong See
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引用次数: 0
Impact of a codesigned and coproduced patient-centred discharge form on communication and understanding. 以患者为中心的出院表的编码设计和共同制作对沟通和理解的影响。
Pub Date : 2024-07-05 DOI: 10.4103/singaporemedj.SMJ-2019-224
Aiden Cushnahan, Boon Shih Sie, Vikas Wadhwa

Introduction: Adverse clinical outcomes and patient dissatisfaction with care often have elements of poor communication. Factors such as illness and pharmacotherapy can affect cognition, and overestimation of patients' health literacy may contribute to suboptimal communication with patients regarding their hospitalisation and post-discharge instructions. Improved patient understanding and recall of their diagnoses and treatment is critical for adherence to treatment, follow-up and optimal clinical outcomes. The aim of the study was to assess whether a coproduced and codesigned patient-centred discharge form (PCDF) improves patients' understanding of their discharge diagnosis, in-hospital treatment and post-discharge plan.

Methods: A sample of 111 patients was enrolled through simple randomisation by admission to one of two identically operating general medicine wards. Over a 3-month period, 59 patients received the coproduced and codesigned form and 52 patients were controls. Assessment of patients' understanding of diagnosis, in-hospital management, post-discharge instructions and overall experience of care was undertaken by a blinded phone survey conducted approximately 6 days after discharge.

Results: Patients who received PCDF were significantly more likely to report adequate understanding of their hospital management (P < 0.001) and the post-discharge plan (P < 0.001). There was no statistically significant difference between the intervention and control groups in terms of understanding of diagnosis. Patients who received PCDF reported better understanding of care and recall of admission.

Conclusion: The use of PCDF is associated with improved patient understanding with respect to their hospital management and post-discharge instructions. It is also associated with high levels of satisfaction as assessed by measures of patient experience.

简介不良的临床结果和患者对护理的不满往往与沟通不畅有关。疾病和药物治疗等因素会影响患者的认知能力,而高估患者的健康素养可能会导致与患者就住院治疗和出院后指导进行的沟通效果不佳。改善患者对诊断和治疗的理解和回忆对于坚持治疗、随访和获得最佳临床效果至关重要。本研究旨在评估共同制作和编码的以患者为中心的出院表(PCDF)是否能提高患者对出院诊断、院内治疗和出院后计划的理解:方法:通过简单的随机抽样,从两间同样运行的普通内科病房中选择一间入院,共抽取了 111 名患者。在为期 3 个月的时间里,59 名患者接受了共同制作和编码的表格,52 名患者为对照组。在患者出院约6天后,通过盲法电话调查评估患者对诊断、院内管理、出院后指导和整体护理体验的理解:结果:接受 PCDF 治疗的患者更有可能充分理解其住院管理(P < 0.001)和出院后计划(P < 0.001)。在对诊断的理解方面,干预组和对照组之间没有明显的统计学差异。接受PCDF治疗的患者对护理有更好的理解,对入院情况也有更好的回忆:结论:使用 PCDF 与患者更好地理解医院管理和出院后指导有关。结论:PCDF 的使用提高了患者对医院管理和出院后指导的理解,同时也提高了患者的满意度。
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引用次数: 0
Off-label transcatheter aortic valve-in-valve implantation in severe bioprosthetic aortic valve dysfunction after bioprosthetic Bentall operation: a scoping review, case study and proposed approach. 生物人工主动脉瓣 Bentall 手术后严重生物人工主动脉瓣功能障碍的标签外经导管主动脉瓣瓣内植入术:范围综述、病例研究和建议方法。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 10.4103/singaporemedj.SMJ-2022-168
Nicholas Wen-Sheng Chew, Rodney Yu-Hang Soh, Gwyneth Kong, Yinghao Lim, Ivandito Kuntjoro
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引用次数: 0
Approach to palpitations in primary care. 初级保健中治疗心悸的方法。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 10.4103/singaporemedj.SMJ-2021-417
Chun En Chua, Suphadetch Leungsuwan, Li Yan Ng, Desmond Boon Seng Teo
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引用次数: 0
Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review. 可穿戴技术在隐源性中风或来源不明的栓塞性中风后心脏监测中的应用:系统性综述。
Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.4103/singaporemedj.SMJ-2022-143
Jamie Sy Ho, Elizabeth Sy Ho, Leonard Ll Yeo, William Kf Kong, Tony Yw Li, Benjamin Yq Tan, Mark Y Chan, Vijay K Sharma, Kian-Keong Poh, Ching-Hui Sia

Introduction: Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the evidence for the use of wearable devices in post-cryptogenic stroke and post-ESUS monitoring.

Methods: We performed a systematic search of PubMed, EMBASE, Scopus and clinicaltrials.gov on 21 July 2022, identifying all studies that investigated the use of wearable devices in patients with cryptogenic stroke or ESUS. The outcomes of AF detection were analysed. Literature reports on electrocardiogram (ECG)-based (external wearable, handheld, patch, mobile cardiac telemetry [MCT], smartwatch) and photoplethysmography (PPG)-based (smartwatch, smartphone) devices were summarised.

Results: A total of 27 relevant studies were included (two randomised controlled trials, seven prospective trials, 10 cohort studies, six case series and two case reports). Only four studies compared wearable technology to Holter monitoring or implantable loop recorder, and these studies showed no significant differences on meta-analysis (odds ratio 2.35, 95% confidence interval [CI] 0.74-7.48, I 2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9-27.2, I 2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%-11.9%, I 2 = 56%) of patients. Other devices investigated included patch sensors, handheld ECG recorders and PPG-based smartphone apps, which demonstrated feasibility in the post-cryptogenic stroke and post-ESUS setting.

Conclusion: Wearable devices that are ECG or PPG based are effective for paroxysmal AF detection after cryptogenic stroke and ESUS, but further studies are needed to establish how they compare with Holter monitors and implantable loop recorder.

导言:隐源性卒中或来源不明的栓塞性卒中(ESUS)发生后,有必要进行长时间的心脏监测,以识别需要抗凝治疗的心房颤动(AF)。与传统管理方法相比,可穿戴设备可提高房颤检测率。我们旨在回顾可穿戴设备用于隐源性卒中后和 ESUS 后监测的证据:我们于 2022 年 7 月 21 日对 PubMed、EMBASE、Scopus 和 clinicaltrials.gov 进行了系统检索,确定了所有调查可穿戴设备在隐源性卒中或 ESUS 患者中使用情况的研究。对房颤检测结果进行了分析。总结了基于心电图(ECG)(外部可穿戴、手持、贴片、移动心电遥测[MCT]、智能手表)和基于光电血压计(PPG)(智能手表、智能手机)设备的文献报告:共纳入了 27 项相关研究(2 项随机对照试验、7 项前瞻性试验、10 项队列研究、6 项病例系列和 2 项病例报告)。只有四项研究将可穿戴技术与 Holter 监测或植入式循环记录器进行了比较,这些研究在荟萃分析中未显示出显著差异(几率比 2.35,95% 置信区间 [CI]0.74-7.48,I2 = 70%)。20.7%(95% CI 14.9-27.2,I2 = 76%)的患者通过外部可穿戴设备检测到房颤,9.6%(95% CI 7.4-11.9%,I2 = 56%)的患者通过 MCT 检测到新房颤。调查的其他设备包括贴片传感器、手持式心电图记录仪和基于 PPG 的智能手机应用程序,这些设备在隐源性卒中后和 ESUS 后环境中均显示出可行性:结论:基于心电图或 PPG 的可穿戴设备可有效检测隐源性卒中和 ESUS 后的阵发性房颤,但还需进一步研究,以确定这些设备与 Holter 监护仪和植入式循环记录仪的可比性。
{"title":"Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review.","authors":"Jamie Sy Ho, Elizabeth Sy Ho, Leonard Ll Yeo, William Kf Kong, Tony Yw Li, Benjamin Yq Tan, Mark Y Chan, Vijay K Sharma, Kian-Keong Poh, Ching-Hui Sia","doi":"10.4103/singaporemedj.SMJ-2022-143","DOIUrl":"10.4103/singaporemedj.SMJ-2022-143","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the evidence for the use of wearable devices in post-cryptogenic stroke and post-ESUS monitoring.</p><p><strong>Methods: </strong>We performed a systematic search of PubMed, EMBASE, Scopus and clinicaltrials.gov on 21 July 2022, identifying all studies that investigated the use of wearable devices in patients with cryptogenic stroke or ESUS. The outcomes of AF detection were analysed. Literature reports on electrocardiogram (ECG)-based (external wearable, handheld, patch, mobile cardiac telemetry [MCT], smartwatch) and photoplethysmography (PPG)-based (smartwatch, smartphone) devices were summarised.</p><p><strong>Results: </strong>A total of 27 relevant studies were included (two randomised controlled trials, seven prospective trials, 10 cohort studies, six case series and two case reports). Only four studies compared wearable technology to Holter monitoring or implantable loop recorder, and these studies showed no significant differences on meta-analysis (odds ratio 2.35, 95% confidence interval [CI] 0.74-7.48, I 2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9-27.2, I 2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%-11.9%, I 2 = 56%) of patients. Other devices investigated included patch sensors, handheld ECG recorders and PPG-based smartphone apps, which demonstrated feasibility in the post-cryptogenic stroke and post-ESUS setting.</p><p><strong>Conclusion: </strong>Wearable devices that are ECG or PPG based are effective for paroxysmal AF detection after cryptogenic stroke and ESUS, but further studies are needed to establish how they compare with Holter monitors and implantable loop recorder.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051436","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
Ischaemia with no obstructive coronary arteries: a review with focus on the Asian population. 无阻塞性冠状动脉缺血:以亚洲人为重点的综述。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 10.4103/singaporemedj.SMJ-2023-116
Rodney Yu-Hang Soh, Ting-Ting Low, Ching-Hui Sia, William Kok-Fai Kong, Tiong-Cheng Yeo, Poay-Huan Loh, Kian-Keong Poh

Abstract: Ischaemia with no obstructive coronary arteries (INOCA) has been a diagnostic and therapeutic challenge for decades. Several studies have demonstrated that INOCA is associated with an increased risk of death, adverse cardiovascular events, poor quality of life and high healthcare cost. Although there is increasing recognition of this entity in the Western population, in the Asian population, INOCA remains elusive and its prevalence uncertain. Despite its prognostic significance, diagnosis of INOCA is often delayed. In this review, we identified the multiple barriers to its diagnosis and management, and proposed strategies to overcome them.

摘要:几十年来,无阻塞性冠状动脉缺血(INOCA)一直是诊断和治疗方面的难题。多项研究表明,无阻塞性冠状动脉缺血与死亡风险增加、不良心血管事件、生活质量低下和高昂的医疗费用有关。虽然西方人对这种疾病的认识在不断提高,但在亚洲人中,INOCA 仍然难以捉摸,其发病率也不确定。尽管 INOCA 对预后具有重要意义,但其诊断往往被延迟。在这篇综述中,我们指出了INOCA诊断和管理的多重障碍,并提出了克服这些障碍的策略。
{"title":"Ischaemia with no obstructive coronary arteries: a review with focus on the Asian population.","authors":"Rodney Yu-Hang Soh, Ting-Ting Low, Ching-Hui Sia, William Kok-Fai Kong, Tiong-Cheng Yeo, Poay-Huan Loh, Kian-Keong Poh","doi":"10.4103/singaporemedj.SMJ-2023-116","DOIUrl":"10.4103/singaporemedj.SMJ-2023-116","url":null,"abstract":"<p><strong>Abstract: </strong>Ischaemia with no obstructive coronary arteries (INOCA) has been a diagnostic and therapeutic challenge for decades. Several studies have demonstrated that INOCA is associated with an increased risk of death, adverse cardiovascular events, poor quality of life and high healthcare cost. Although there is increasing recognition of this entity in the Western population, in the Asian population, INOCA remains elusive and its prevalence uncertain. Despite its prognostic significance, diagnosis of INOCA is often delayed. In this review, we identified the multiple barriers to its diagnosis and management, and proposed strategies to overcome them.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556335","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
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Singapore medical journal
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