Khoo J, Lim RLC, Ng LP
… +5 more, Phoon IKY, Gani L, Puar THK, How CH, Loh WJ
Singapore Med J
· 2025 Oct · PMID 41090312
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This review examines strategies for the prevention and management of obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia, conditions that are increasing in Singapore, as components of individualised health...This review examines strategies for the prevention and management of obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia, conditions that are increasing in Singapore, as components of individualised health plans in 'Healthier SG' and beyond. We describe cardiometabolic disease prevention and management initiatives in Changi General Hospital (CGH), including collaborations with SingHealth Polyclinics, Active SG, Exercise is Medicine Singapore and community partners in the Eastern Community Health Outreach programme, and highlight advances in curable hypertension (e.g., primary hyperaldosteronism) and novel cardiovascular risk markers such as lipoprotein(a). We also outline technology-based interventions, notably the CGH Health Management Unit, which demonstrate the utility and convenience of telemedicine, and digital therapeutics in the form of apps that have been shown to improve treatment adherence and clinical outcomes. Individual empowerment, in partnership with community and healthcare providers and supported by research and innovation of care delivery, is key to building a healthier and stronger nation.
Singapore Med J
· 2025 Oct · PMID 41065048
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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 p...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.
Singapore Med J
· 2025 Oct · PMID 41064955
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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...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.
Chong KLT, Tan JML, Tan HC
… +3 more, Venugopal K, Pek JH, Lau YLC
Singapore Med J
· 2025 Oct · PMID 41051889
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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 n...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.
INTRODUCTION: Sniffin' sticks (SS) and the University of Pennsylvania smell identification test (UPSIT) are widely used olfactory tests, but have not yet been validated in Singapore. The primary objective of our study wa...INTRODUCTION: Sniffin' sticks (SS) and the University of Pennsylvania smell identification test (UPSIT) are widely used olfactory tests, but have not yet been validated in Singapore. The primary objective of our study was to compare the performance of the unmodified SS and UPSIT in healthy adults in Singapore. The clinical implication was illustrated with a group of patients with olfactory impairment. METHODS: The SS and UPSIT were prospectively administered to healthy adults at a tertiary otolaryngology clinic from 15 May 2023 to 31 July 2023. Primary outcome measures were identification scores, 10 th percentile scores, diagnosed olfactory function, and number of unfamiliar test odours. A retrospective review of patients with olfactory impairment was then performed. We compare their diagnosed olfactory function before and after benchmarking against heathy participants' scores. RESULTS: Fifty healthy participants (mean age 34 ± 9.4 years) were recruited. With SS, the mean score was 12 ± 2.5 (out of 16) and the 10 th percentile score was 10. With UPSIT, the mean score was 29.6 ± 5.8 (out of 40) and the 10 th percentile score was 25.5. The SS and UPSIT categorised 22 (44.0%) and 46 (92.0%) healthy participants as having hyposmia/anosmia, respectively. Agreement between both tests was minimal (weighted Cohen's kappa -0.020, 95% CI -0.240 to 0.101, P = 0.626). Many test odours were unfamiliar (43.8% in SS vs. 47.5% in UPSIT). Seventy-one patients with olfactory impairment were then analysed. After adjustment, 13.9% (5/36) and 25.7% (9/35) of patients who underwent SS and UPSIT, respectively, had changes in diagnosed olfactory function. CONCLUSION: Our findings show that olfactory identification tests must be adapted and validated for the Singapore population to ensure meaningful interpretation of results.