Ng IM, Wong TJ, Yang Y
… +8 more, Venkatachalam I, Sim JXY, Wee LE, Liew TM, Boon E, Ng TY, Han HK, Tan DYL
Singapore Med J
· 2025 Dec · PMID 41396291
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INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, contact tracers were under immense pressure to deliver effective and timely contact tracing, raising concerns of higher susceptibility to burnout. Ou...INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, contact tracers were under immense pressure to deliver effective and timely contact tracing, raising concerns of higher susceptibility to burnout. Our study aimed to determine burnout prevalence among hospital-based contact tracers and associated risk factors, so that interventions to reduce burnout risk could be formulated. METHODS: One hundred and ninety-six active contact tracers across three hospitals within a healthcare cluster were invited to complete an anonymous online survey. To identify burntout, data such as demographics, work-related variables and contact tracing-related variables were collected using the Copenhagen Burnout Inventory. Associated factors were identified using multivariate statistics. Open-ended questions were included to understand the challenges and potential improvements through qualitative analysis. RESULTS: A total of 126 participants completed the survey, giving a completion rate of 64%, and almost half of these participants (42.9%) reported burnout. Protective factors included being on work-from-home arrangements (adjusted odds ratio [OR] 0.22, 95% confidence interval [CI] 0.08-0.56), perception of being well supported by their institution (adjusted OR 0.25, 95% CI 0.08-0.80) and being married (adjusted OR 0.28, 95% CI 0.12-0.64). Risk factors included having an administrative role pre-COVID-19 (adjusted OR 3.62, 95% CI 1.33-9.83). Work-related burnout was related to being activated for more than 1 day in the preceding week (unadjusted OR 3.25, 95% CI 1.33-7.94) and multiple activations in a day (unadjusted OR 3.54, 95% CI 1.44-4.41). Biggest challenges identified by participants were language barrier (62.7%), followed by workflow-related issues (42.1%). CONCLUSION: Our study demonstrated burnout and other challenges faced by a team of mostly hospital-based administrative staff redeployed on a part-time basis to ensure timely contact tracing. To mitigate burnout, we recommend choosing staff on work-from-home arrangements and ensuring adequate manpower and rostering arrangements.
Goh JYA, Phng F, Ng CL
… +4 more, Chen JP, Phan P, Tan JSP, Wu CX
Singapore Med J
· 2025 Aug · PMID 41384586
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INTRODUCTION: Operating theatres significantly contribute to hospital expenditures. Traditional surgery scheduling, which is often based on manual methods or historical averages, lacks precision. This inefficiency impact...INTRODUCTION: Operating theatres significantly contribute to hospital expenditures. Traditional surgery scheduling, which is often based on manual methods or historical averages, lacks precision. This inefficiency impacts cost, timely care delivery and patient experience, particularly in high-volume surgeries. To address this, we aimed to create data-driven predictive models for cataract surgery durations, a largely unexplored area in local literature. METHODS: We utilised supervised machine learning models, including linear regression, random forest and extreme gradient boosting (XGBoost). Performance metrics were accuracy (within ± 10 min of actual surgery time) and mean squared error (MSE). The dataset, post-outlier removal, comprised 4242 cataract cases (80% training sets and 20% test sets). RESULTS: Compared to the embedded scheduling algorithm in EPIC (an electronic health records system) and surgeons' predictions, machine learning models displayed superior performance, achieving 40% and 20% greater accuracy compared to EPIC and surgeons, respectively, with a significantly lower MSE. Machine learning models' error margin primarily ranged from 0 to 5 min. Notably, underestimation beyond the ± 10-min threshold occurred in about 9% of cases. CONCLUSION: In this study, machine learning models have been shown to be more effective in predicting cataract surgery durations compared to current methods, offering practical benefits for optimising operating theatre management. The use of machine learning significantly improves the accuracy of surgery duration estimates.
Lim DY, Tan M, He YK
… +7 more, Yew WS, Chua T, Jappar IA, Lee ASY, Cai XJ, Yeo YSI, Loh HP
Singapore Med J
· 2025 Aug · PMID 41384582
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INTRODUCTION: The routine use of preoperative electrocardiograms (ECGs) in patients scheduled for cataract surgery is a deeply entrenched practice in Singapore, despite a lack of evidence supporting its role. Unnecessary...INTRODUCTION: The routine use of preoperative electrocardiograms (ECGs) in patients scheduled for cataract surgery is a deeply entrenched practice in Singapore, despite a lack of evidence supporting its role. Unnecessary ECGs and downstream referrals result in increased healthcare costs, strain on healthcare resources and poorer patient experience from multiple hospital visits, investigations and operation delays. International guidelines recommend against routine use of preoperative ECGs. We launched a quality improvement project to reduce the routine use of preoperative ECGs in low-risk patients undergoing cataract surgery, with the aim of aligning our practice with international guidelines and assessing the impact of this on the incidence of surgical cancellations, perioperative morbidity, and mortality. METHODS: One thousand patients scheduled for elective cataract surgery were assigned to either a control group, where routine ECG is performed (current practice) or an intervention group where the need for ECG was determined through standardised screening of relevant symptoms and vitals as per international guidelines. Adverse medical events and surgery postponement were recorded. RESULTS: There was no statistically significant difference in overall cancellation rates between the control and intervention groups (4% vs. 3.2%, P = 0.79). There were no significant differences in the rate of intraoperative events or unplanned admissions between the control and intervention arms. CONCLUSION: The results of this project indicate no benefit from the current practice of routine preoperative ECG for cataract surgery in asymptomatic individuals. The study also provides local data to support international guidelines which recommend against this routine practice.
Rawal P, Tham KM, Lim GH
… +3 more, George JM, Singh PA, Leong XYA
Singapore Med J
· 2025 Nov · PMID 41201116
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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 ach...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.
Lim K, Li AY, Lorenzo JSL
… +6 more, Yong S, Ling NCA, Wee HL, Tai ES, Seow WJ, Lim HF
Singapore Med J
· 2025 Oct · PMID 41131849
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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 wit...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.
Chow W, Venkataraman N, Oh HC
… +8 more, Ramanathan S, Sridharan S, Arish SM, Wong KC, Hay KKX, Hoo JF, Tan WHL, Liew CJY
Singapore Med J
· 2025 Oct · PMID 41090318
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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...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.
Singapore Med J
· 2025 Oct · PMID 41090317
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Correctional facilities are a major hub of hepatitis C virus (HCV), with rates far higher than those observed in the general population. Once considered an intractable crisis, the current situation offers a unique opport...Correctional facilities are a major hub of hepatitis C virus (HCV), with rates far higher than those observed in the general population. Once considered an intractable crisis, the current situation offers a unique opportunity. The advent of direct-acting antivirals has changed the HCV treatment landscape, making its elimination possible. This review summarises the scientific evidence and progress towards HCV elimination in correctional health systems. It outlines the evolution of 'test-and-treat' models, assesses micro-elimination success worldwide, especially in Singapore, and highlights collaborative efforts between Changi General Hospital and Singapore Prison Services. Their implementation of HCV treatment guidelines serves as a key case study in this context. This review also analyses the various barriers - structural, financial, clinical and logistical - that hinder progress. It consolidates strong evidence that prison-based HCV treatment is cost-effective, promotes health equity, supports the World Health Organization 2030 goals and reduces the societal burden of HCV.
Singapore Med J
· 2025 Oct · PMID 41090316
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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...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.
Singapore Med J
· 2025 Oct · PMID 41090315
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Aviation medicine safeguards flight safety by addressing three critical areas: managing physiological challenges of the aviation environment, preventing in-flight medical incapacitation and ensuring psychological fitness...Aviation medicine safeguards flight safety by addressing three critical areas: managing physiological challenges of the aviation environment, preventing in-flight medical incapacitation and ensuring psychological fitness for flight. The field adopts occupational medicine's hierarchy of risk control to mitigate physiological risks in the operating environment, while employing systematic medical screening with tailored standards based on operational requirements to reduce the likelihood of in-flight incapacitation. A comprehensive approach incorporating mental health education, support systems and regular monitoring helps prevent psychological incapacitation. Recent data from the Singapore Changi Aeromedical Centre reveal that ophthalmological, otolaryngological and respiratory conditions are the primary causes of medical disqualification during air force pilot screening, reflecting the unique physiological demands of military aviation. This review emphasises the ongoing challenge of balancing rigorous medical standards with maintaining an adequate pilot recruitment pool, while highlighting the need for evidence-based approaches to aeromedical assessment and certification.
Koh EY, Chan WF, Lim HCS
… +12 more, Tan BKT, Ong CT, Singh PA, Tan MBH, Sim MJH, Ong LW, Tan H, Tan SY, Huong WCH, Seah J, Ang TL, Yeo JA
Singapore Med J
· 2025 Oct · PMID 41090314
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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...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.
Singapore Med J
· 2025 Oct · PMID 41090313
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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 pres...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.