Chan JL, Chua SC, Lee EP
… +4 more, Kwok J, Ricci V, Kim PA, Expert Group for Knee Osteoarthritis ACG
Singapore Med J
· 2026 Jun · PMID 42054041
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This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the management of knee osteoarthritis (OA), providing rationale and justifications for its recommendations. Knee OA is a prev...This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the management of knee osteoarthritis (OA), providing rationale and justifications for its recommendations. Knee OA is a prevalent and debilitating condition in Singapore, with significant disease burden and impacts on healthcare utilisation costs. The ACG addresses management gaps that contribute to suboptimal clinical outcomes, including insufficient uptake of conservative management, limited knowledge of community exercise and physiotherapist resources, and inappropriate use of complementary and alternative treatments. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop seven evidence-based recommendations that cover comprehensive biopsychosocial assessments, mainstay management strategies, pharmacological treatment, referral to allied health professionals, complementary and alternative treatment, and specialist referrals. This EtR framework summarises the factors that have informed the direction and strength of the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability.
INTRODUCTION: Despite kidney transplantation being the gold-standard treatment for end-stage renal disease, organ donation rates remain low. This study examined public perceptions and barriers to kidney donation to guide...INTRODUCTION: Despite kidney transplantation being the gold-standard treatment for end-stage renal disease, organ donation rates remain low. This study examined public perceptions and barriers to kidney donation to guide future efforts in Singapore. METHODS: An online survey on kidney donation knowledge and attitudes was distributed via FormSG. Categorical data were presented as counts and percentages, and chi-square tests were used for categorical comparisons. RESULTS: Of the 633 respondents, 91% were Singaporeans, 55.8% were female, 20.7% had medical background, 81.6% had university education and 59.5% had a household income >SGD 8000. While 94.3% were familiar with the term 'kidney transplantation', only 70% knew about Human Organ Transplant Act (HOTA), with higher awareness among older adults (P < 0.01), those with a medical background (P < 0.01) and higher-income groups (P = 0.01). Only 25.1% correctly identified organs covered by HOTA and 82.8% incorrectly believed the next of kin could refuse donation after brain death. Overall, 66.7% of respondents were willing to donate, with greater willingness among postgraduates (P = 0.02) and Hindus (P < 0.01); the strongest motivator was the relationship to the recipient (80.5%), while key deterrents were health concerns (49.6%) and financial impact (25.9%). Most (75.2%) incorrectly thought donor surgery was open rather than laparoscopic. Willing donors perceived higher transplant success rates (73.2% vs. 65.7%, P < 0.01) but underestimated actual success (85%-99%, P < 0.01). CONCLUSION: Our study identified several knowledge gaps about kidney transplantation, including HOTA provisions, donor nephrectomy approach, recovery period and long-term donor health outcomes. Sociocultural and economic factors influence the willingness to donate, necessitating targeted interventions to improve awareness and address misconceptions.
INTRODUCTION: Neonatal hyperbilirubinaemia is a common condition encountered globally with potential complications such as bilirubin encephalopathy. Phototherapy remains the standard treatment due to its accessibility an...INTRODUCTION: Neonatal hyperbilirubinaemia is a common condition encountered globally with potential complications such as bilirubin encephalopathy. Phototherapy remains the standard treatment due to its accessibility and effectiveness. This study compares the efficacy of 360° phototherapy versus single-surface LED phototherapy with a white curtain in managing neonatal hyperbilirubinaemia requiring intensive phototherapy. METHODS: A randomised controlled trial was conducted at Hospital Pakar Universiti Sains Malaysia from December 2022 to March 2023 involving 40 neonates requiring intensive phototherapy within the first week of life. Participants were randomised into two groups: an intervention group that received 360° phototherapy ( n = 20) and a control group that received single-surface LED phototherapy with a white curtain ( n = 20). The primary outcome was the mean reduction in serum bilirubin at 4 h, 10 h and 24 h of phototherapy, which was analysed using repeated measures analysis of variance and the log-rank test. Secondary outcomes included phototherapy-related side effects and device ease of use among nurses from the neonatal intensive care unit. RESULTS: Both phototherapy methods significantly reduced serum bilirubin levels over 24 h ( P < 0.001). The 360° phototherapy group showed greater reduction at 4 h (27 ± 6.13 μmol/L, P < 0.001) than the control group (2.61 ± 6.3 μmol/L, P = 0.616). The log-rank test showed a significant difference in phototherapy duration ( P = 0.005). At 24 h, the proportion that required phototherapy was 0 for the 360° phototherapy group and 0.05 for the control group (χ 2 = 7.6, degrees of freedom = 1, P = 0.005, hazard ratio 2.29, 95% confidence interval 1.17-4.51). Safety profiles were comparable. Most nurses reported no difficulty using the 360° device. CONCLUSION: 360° phototherapy achieves therapeutic goals more rapidly with a comparable safety profile.
INTRODUCTION: High-energy open fractures are complex orthoplastic problems. Limb salvage surgical goals include achieving bony stabilisation and adequate soft tissue coverage, while minimising bone and soft tissue compli...INTRODUCTION: High-energy open fractures are complex orthoplastic problems. Limb salvage surgical goals include achieving bony stabilisation and adequate soft tissue coverage, while minimising bone and soft tissue complications. Soft tissue coverage often requires free flap coverage due to thin overlying native soft tissue. Successful free flaps depend on multiple factors, including diabetes mellitus (DM), a prevalent modifiable disease in Singapore that represents a unique host factor. The objective of the study was to elucidate the effect of DM on the outcomes of free flaps done for open lower limb fractures. The primary outcome was the presence of partial or complete flap failure. Secondary outcomes included length of stay, osteomyelitis (OM) status, vascular intervention and requirement of bone reconstruction. METHODS: A retrospective cohort study was performed in patients with open lower limb fractures requiring free flap coverage over a 3-year period from March 2018 to December 2021 in Khoo Teck Puat Hospital, Singapore. Relevant parameters were obtained from the hospital's electronic medical records for statistical analyses to investigate primary and secondary outcomes. RESULTS: We obtained statistically significant data showing that the rates of flap failure (P < 0.01) and postoperative free flap complications (P < 0.05) were higher in diabetic patients. Statistically significant correlations were observed between DM and rates of OM, vascular interventions and requirement of bone reconstruction (P < 0.05), while increased length of stay was not statistically significant (P > 0.05). CONCLUSION: Patients with DM have statistically significant increased rates of flap failure and surgical complications. Holistic multidisciplinary perioperative optimisation of DM can potentially improve surgical outcomes.
INTRODUCTION: We aimed to evaluate the feasibility of a 12-week community-based group exercise programme, Steady Feet, for older adults at risk of falls. METHODS: Community-dwelling adults aged ≥60 years, with a Falls Ri...INTRODUCTION: We aimed to evaluate the feasibility of a 12-week community-based group exercise programme, Steady Feet, for older adults at risk of falls. METHODS: Community-dwelling adults aged ≥60 years, with a Falls Risk for Older People-Community setting score ≥4 and a Short Physical Performance Battery (SPPB) score of 7-11, were enrolled into a non-randomised, two-arm feasibility study. The intervention group (IG) participated in twice-weekly, 1-h sessions led by trained fitness instructors. Both the IG and the control group (CG) received fall prevention standard care. Feasibility was assessed using Bowen's framework, covering six domains: acceptability, demand, implementation, practicality (including safety), adaptation and limited efficacy. Functional outcomes (SPPB, Timed Up and Go [TUG], Four Square Step Test [FSST], 6-minute walk test and balance confidence) were evaluated at baseline and 12 weeks. RESULTS: Of 71 eligible participants, 65 enrolled (28 in IG, 37 in CG; 4 withdrew pre-baseline), and 49 (25 in IG, 24 in CG) completed the study. Programme acceptability was high, with all surveyed participants reporting satisfaction with Steady Feet and the instructors. Demand was reflected by high uptake (92% consented); attendance averaged 79% with a 72% completion rate. Implementation fidelity was high, and no falls or injuries occurred. Significant within-group improvements were observed in SPPB (IG: +1.2, CG: +0.9) and TUG for the IG (-1.3 s, P = 0.013). Only FSST showed a significant between-group difference favouring IG (P = 0.009). CONCLUSION: The programme was feasible, safe and well-received when delivered by fitness instructors in community settings. Findings support further refinement and progression to a larger study.
INTRODUCTION: Mechanical thrombectomy is the gold standard in acute ischaemic stroke management; however, intravenous thrombolysis remains essential, particularly in settings without access to endovascular therapy. Given...INTRODUCTION: Mechanical thrombectomy is the gold standard in acute ischaemic stroke management; however, intravenous thrombolysis remains essential, particularly in settings without access to endovascular therapy. Given its ongoing relevance, we aimed to investigate the age-related clinical, radiological and procedural factors affecting outcomes after intravenous thrombolysis. METHODS: We retrospectively evaluated patients who had acute neurological deficits within the first 4.5 h after the onset of symptoms and were given intravenous tissue plasminogen activator therapy. Patients were divided into three groups according to their age: <55, 55-75 and >75 years. A modified Rankin Scale 0-2 was considered as a good functional outcome. RESULTS: A total of 432 patients were included in the study, of whom 196 (45.1%) were women. The prevalence of diabetes mellitus (DM) and hypertension increased with age, while smoking was more frequent in patients aged <55 years. Atrial fibrillation was significantly more common in patients aged >75 years. In the >75 years age group, admission National Institutes of Health Stroke Scale (NIHSS) scores were higher ( P = 0.042). The proportion of patients with poor clinical outcomes also increased progressively across the three age groups. CONCLUSIONS: This study underscores age as a key predictor of outcomes following intravenous thrombolysis in acute ischaemic stroke. Among patients aged >75 years, prolonged symptom-to-needle time, atrial fibrillation, higher baseline NIHSS and DM were significantly associated with poor clinical outcomes. Younger patients demonstrated more favourable recovery profiles, whereas advancing age was associated with higher mortality. Notably, DM consistently emerged as a risk factor for unfavourable outcomes across all age groups.
INTRODUCTION: Preoperative mobility is frequently measured in hip fracture patients to evaluate surgical outcomes and may impact their length of stay (LOS). The Parker Mobility Score (PMS) is a validated method of quanti...INTRODUCTION: Preoperative mobility is frequently measured in hip fracture patients to evaluate surgical outcomes and may impact their length of stay (LOS). The Parker Mobility Score (PMS) is a validated method of quantifying a patient's mobility. The aim of this study was to investigate the correlation between preoperative PMS and LOS in hip fracture patients. We hypothesised that there is a correlation between preoperative PMS and LOS in a cohort of patients with hip fractures. METHODS: A retrospective study was conducted on all patients admitted with hip fractures who underwent surgery in a single tertiary hospital between 2020 and 2021. Variables collected included LOS, type of fracture, type of surgery, age, gender and ethnicity. The PMS was used to assess preoperative mobility. Binary logistic regression analysis was performed to determine associations between PMS and LOS, adjusting for demographic and clinical variables. RESULTS: A total of 579 patients were included. The mean age of patients was 80 years, and 67.4% were females. The mean LOS was 14 days. Long stayers were defined as patients with an LOS >10 days. Lower preoperative PMS was found to be a strong predictor of long stayers and remained significant after adjusting for age, gender, ethnicity, type of surgery and type of fracture in multivariable analysis (odds ratio 1.15, 95% confidence interval 1.08-1.24, P < 0.001). CONCLUSION: Preoperative PMS is a strong predictor of LOS in hip fracture patients. Integrating PMS assessments into preoperative evaluations can aid in identifying patients at risk of prolonged hospitalisation, enabling improved discharge planning and resource allocation.
Singapore Med J
· 2026 Apr · PMID 41987519
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INTRODUCTION: Singapore will become a 'super-aged' society by 2026, with an expected rise in geriatric emergency department (ED) attendances. Conventional triage tools such as the Patient Acuity Category Scale (PACS) and...INTRODUCTION: Singapore will become a 'super-aged' society by 2026, with an expected rise in geriatric emergency department (ED) attendances. Conventional triage tools such as the Patient Acuity Category Scale (PACS) and Emergency Severity Index (ESI) may not fully capture the complex presentations of older adults. This study compared the triage outcomes between geriatric and non-geriatric patients. METHODS: A retrospective observational study was conducted in adult patients presenting to a tertiary ED between 1 February 2021 and May 2021. Patients were stratified into geriatric (age ≥65 years) and non-geriatric groups. Primary outcomes were ED length of stay (EDLOS) and hospital admission rates. Multivariable analyses were performed to adjust for confounders. RESULTS: Overall EDLOS was longer in geriatric than non-geriatric patients in both unadjusted (317.4 vs. 217.2 min, P < 0.05) and adjusted (300.2 vs. 224.1 min, P < 0.05) analyses. Admission rates were also higher in geriatric patients (75.1% vs. 33.2%, P < 0.001). Stratified analyses showed significantly longer EDLOS in older patients in PACS 2 (346.3 vs. 286.7 min, P < 0.001) and ESI 3 (353.4 vs. 281.2 min, P < 0.001). Admission rates were higher in PACS 1-3 and ESI 1-4, with the highest odds in ESI 1 (odds ratio [OR] 65.9) and PACS 1 (OR 28.3). CONCLUSION: Despite being assigned to higher acuity, older adults had longer EDLOS and higher admission rates than younger adults within the same triage category. This highlights a mismatch between triage allocation and care needs, requiring enhanced geriatric-specific risk-stratification approaches.
Xu H, Siddiqui FJ, Koh ZX
… +2 more, Ho AFW, Ong MEH
Singapore Med J
· 2026 Apr · PMID 41987518
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INTRODUCTION: Singapore is among the fastest-ageing nations in the world, and studies have shown a steady rise in emergency department (ED) utilisation among older adults. This study aimed to describe trends and characte...INTRODUCTION: Singapore is among the fastest-ageing nations in the world, and studies have shown a steady rise in emergency department (ED) utilisation among older adults. This study aimed to describe trends and characteristics of ED use in Singapore over a 12-year period and to assess differences in utilisation across age groups. METHODS: Data from 2008 to 2019 on ED visits, admissions, patient characteristics and principal ED diagnoses were extracted from the electronic health records of a tertiary hospital. The primary outcome was admissions through ED, and the secondary outcome was the proportion of high-acuity visits. The Wilcoxon rank-sum test was used to assess trends. Multivariable logistic regression was used to assess factors associated with ED admissions and proportions of high-acuity visits, as well as test the interaction between year and age group. RESULTS: Although the number of ED visits decreased from 108,838 in 2008 to 102,890 in 2019, the ED admission rate increased from 35.1% to 47.0%. Across all age groups, older adults aged ≥80 years showed a greater increase in ED admissions over time compared to adults aged 18-64 years. In the same period, the proportion of high-acuity ED visits increased across all age groups, although age-related differences diminished over time. Some fluctuations were observed in the most common ED diagnoses. CONCLUSION: Our study showed that ED admission rates, particularly among older adults, increased from 2008 to 2019. This highlights the growing care needs of older patients and underscore the importance of geriatric-friendly EDs and evidence-based programmes to ensure high-quality care.
Tan HM, Yang C, Tay XY
… +5 more, Yap AFHW, Low KX, Ong ZY, Ting CWJ, Ho SF
Singapore Med J
· 2026 Apr · PMID 41987517
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INTRODUCTION: This is a descriptive review of the implementation of the Geriatric Faller Protocol (GFP) in the Department of Emergency Medicine (DEM) Emergency Diagnostic Treatment Unit, Singapore General Hospital, along...INTRODUCTION: This is a descriptive review of the implementation of the Geriatric Faller Protocol (GFP) in the Department of Emergency Medicine (DEM) Emergency Diagnostic Treatment Unit, Singapore General Hospital, along with a post-implementation internal audit over a 6-month period from 1 July 2024 to 31 December 2024. METHODS: The clinical records of patients admitted to GFP during the 6-month period were retrospectively reviewed. Data of patients were collated under the categories: (a) sociodemographics and clinical profile, (b) medication profile, (c) injury profile, (d) non-pharmaceutical interventions, (e) pharmaceutical interventions and (f) intervention outcome measures. RESULTS: Of the 115 patients admitted to GFP, 14 were excluded and 101 were included in the analysis (median age 81 years; 70.3% female). Most (79.2%) patients had a Clinical Frailty Scale of between 4 and 7. Acute hospital admission was avoided in 67.3% of cases; five reattended DEM within 30 days, of which only two were fall related. Falls were the primary reason for presentation (94.1%), with over half resulting in head or facial injuries. Polypharmacy was prevalent in 75% of patients (median number of medications: 9; interquartile range: 5-12), and 57.4% self-managed their medications. CONCLUSION: Front-loading of assessments and interventions by a multidisciplinary team for patients under GFP suggested possible hospital admission avoidance and a reduction in short-term adverse outcomes.
Kampan S, Thong-On K, Pongvirat K
… +2 more, Veeraditthakij M, Sri-On J
Singapore Med J
· 2026 Apr · PMID 41987516
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Managing acute pain in older adults is a complex challenge in emergency care, influenced by age-related physiological changes, multimorbidity and altered pharmacokinetics. Inadequate treatment contributes to frailty, del...Managing acute pain in older adults is a complex challenge in emergency care, influenced by age-related physiological changes, multimorbidity and altered pharmacokinetics. Inadequate treatment contributes to frailty, delirium, functional decline and reduced quality of life, yet oligoanalgesia remains prevalent. Accurate assessment is essential, using tools such as the numeric rating scale, Pain Assessment in Advanced Dementia and Abbey Pain Scale, according to cognitive status. Treatment prioritises acetaminophen as first-line therapy, with cautious use of nonsteroidal anti-inflammatory drugs and opioids, following the 'start low, go slow' principle. Alternative options, including intranasal or nebulised ketamine and methoxyflurane, as well as regional anaesthesia techniques such as pericapsular nerve group and serratus anterior plane blocks, offer additional benefits. A multimodal, individualised approach is essential to achieve safe and effective pain control in this vulnerable population.
Wong GWW, Hock M, Tan YY
… +2 more, Ho AFW, Chan JS
Singapore Med J
· 2026 Apr · PMID 41987515
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INTRODUCTION: Ageing populations present challenges for emergency departments (EDs), including rising ED attendances among older adults. Geriatric-centred ED observation units (Geri-EDOUs) provide a means of conducting c...INTRODUCTION: Ageing populations present challenges for emergency departments (EDs), including rising ED attendances among older adults. Geriatric-centred ED observation units (Geri-EDOUs) provide a means of conducting comprehensive geriatric assessment (CGA) with a view to reduce or shorten acute hospitalisations. A systematic review and meta-analysis was conducted to summarise such interventions and evaluate their outcomes. METHODS: Seven databases were searched for relevant articles from their dates of inception to 16 December 2024. Articles describing the implementation of Geri-EDOUs with CGA for managing older patients aged 65 years and above were included. Study characteristics and clinical outcomes such as length of stay (LOS), hospital admission, discharge and readmission rates, ED reattendance rates and mortality were narratively synthesised. Meta-analysis was conducted where appropriate. RESULTS: Fourteen studies were included out of 5656 titles and abstracts screened. We identified three models of Geri-EDOUs, with varied patient profiles and diagnosis categories, unit staffing, patient selection and CGA components. We observed that Geri-EDOUs were associated with shorter LOS and lower hospital admission and readmission rates. Meta-analysis showed a pooled mean LOS of 2.82 days, a mortality rate of 9%, 50% of admissions saved and a 30-day ED readmission rate of 11%. No significant differences in mortality, readmission rates or admissions saved were found in double-arm studies. CONCLUSION: Geriatric-centred EDOUs utilise a variety of designs to provide early access to CGA for patients admitted to EDs and demonstrate the potential to improve patient outcomes. Future studies should also consider evaluating patient-reported outcomes and the cost-effectiveness of running Geri-EDOUs.
INTRODUCTION: The Robotic Surgical Assistant (ROSA ® ) system (Zimmer Biomet, Warsaw, IN, USA) used in robotic total knee arthroplasties (rTKAs) employs either an image-based or an imageless pathway for surgical planning...INTRODUCTION: The Robotic Surgical Assistant (ROSA ® ) system (Zimmer Biomet, Warsaw, IN, USA) used in robotic total knee arthroplasties (rTKAs) employs either an image-based or an imageless pathway for surgical planning. While the image-based pathway requires preoperative two-dimensional radiographs, the imageless pathway does not require specific preoperative preparation. We evaluated the radiographic outcomes of ROSA rTKAs with and without preoperative imaging to compare the accuracy of both pathways. METHODS: A retrospective review of registry data was conducted for patients who underwent ROSA rTKAs with and without preoperative imaging at a single tertiary centre between 1 January 2023 and 31 December 2023. Two reviewers independently measured coronal alignment of femoral and tibial implant components relative to the mechanical axis at 3 months postoperatively. These angles were compared to planned intraoperative femoral and tibial cuts to assess for variations. RESULTS: A total of 97 patients were included: 35 in the image-based pathway and 62 in the imageless pathway. The imageless group showed greater variation in tibial component alignment compared to the image-based group (-0.8° ± 0.1° vs. -0.3° ± 0.1°, P < 0.001). No significant difference was found in femoral component alignment between the two groups (-0.1° ± 0.8° vs. -0.2° ± 1.3°, P = 0.546). CONCLUSION: Preoperative imaging provides greater component alignment accuracy in ROSA rTKAs. Although the difference is small, its potential clinical impact warrants further investigation. Preoperative imaging should therefore be strongly considered to enhance alignment accuracy in ROSA rTKAs.