INTRODUCTION: This study aimed to assess the retention of dispatcher-assisted cardiopulmonary resuscitation (CPR) skills and knowledge among newly trained laypersons in Singapore who were trained using the Dispatcher-Ass...INTRODUCTION: This study aimed to assess the retention of dispatcher-assisted cardiopulmonary resuscitation (CPR) skills and knowledge among newly trained laypersons in Singapore who were trained using the Dispatcher-Assisted first REsponder (DARE) programme. METHOD: This was a prospective before-after, single group simulation study using simulation-based assessments (SBA). Fifty participants were recruited and assessed over three rounds of simulated cardiac arrest. Participants were assessed before training for a baseline measure, immediately after DARE training and 4 months after DARE training. Participants' performance in executing the proper CPR sequence was evaluated using a ten-item scorecard. Secondary outcomes, as measured using a feedback device, included CPR compression quality (measured by depth, rate and chest recoil), time to administration of the first chest compression and time taken to administer the first AED shock. RESULTS: Twenty-seven participants completed the study. The average (SD) pre-training SBA baseline score was 18.96 (3.87). The post-training SBA score was 25.22 (2.64), and the 4-month retention SBA (Ret-SBA) score was 23.63 (3.52). There was an average decline of 1.59 (P < 0.001) decline in the retention SBA score. CONCLUSION: Laypeople dispatcher-assisted CPR performance in this study declined 4 months after training. However, skill performance remained above pre-training levels. These findings suggest the need for retraining to sustain trainees' proficiency in dispatcher-assisted CPR skills; however, the optimal frequency of retraining requires additional investigation.
Singapore Med J
· 2025 Aug · PMID 40875190
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INTRODUCTION: Physical activity has been shown to offer numerous benefits in improving mortality and morbidity outcomes. However, the specifics of advising and/or prescribing exercise in patient management may not be tau...INTRODUCTION: Physical activity has been shown to offer numerous benefits in improving mortality and morbidity outcomes. However, the specifics of advising and/or prescribing exercise in patient management may not be taught comprehensively in undergraduate and postgraduate medical curriculum. This study aimed to evaluate primary care physicians' habits in advising and/or prescribing exercise to their patients. METHODS: Primary care physicians practising in all public primary care clinics in Singapore were invited via email and posters to participate in an anonymous online questionnaire. The questionnaire explored physicians' habits in advising and/or prescribing exercise to their patients. RESULTS: Results showed that 95.9% of primary care physicians gave patients advice on exercise. However, only 24.7% prescribed exercise (specific written instructions) to their patients. Time constraint is the top barrier cited by primary care physicians for not giving exercise advice and/or prescription. The top three conditions for which exercise advice and/or prescription was given by physicians were diabetes mellitus, dyslipidaemia and hypertension. Physicians who cited insufficient expertise/knowledge as a barrier were more likely to have never attended an exercise prescription course. CONCLUSION: Most primary care physicians in Singapore advised exercise as part of the management plan for their patients. However, a much lower proportion gave specific exercise prescription. The most commonly cited barrier to advising or prescribing exercise is time constraint, while lack of expertise or knowledge may stem from not having received relevant training. Future efforts could focus on providing primary care physicians with targeted training to overcome the barrier of insufficient expertise or knowledge in exercise advice and prescription.
Koh JH, Lim CYJ, Tan LTP
… +5 more, Bhogal P, Sia CH, Andersson T, Tan BYQ, Yeo LLL
Singapore Med J
· 2025 Aug · PMID 40873246
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Patients with symptomatic atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions face a high risk of recurrent ischaemic stroke despite best medical therapy. Previous trials of extracran...Patients with symptomatic atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions face a high risk of recurrent ischaemic stroke despite best medical therapy. Previous trials of extracranial-intracranial (EC-IC) bypass surgery showed no benefit for stroke prevention in this population, but they may have been underpowered. This study evaluates the efficacy of EC-IC bypass surgery in reducing the risk of the composite outcome of stroke or death within 30 days or ipsilateral ischaemic stroke beyond 30 days through 2 years. Following a PROSPERO-registered protocol (CRD42023457824), we conducted a systematic review of PubMed, Embase and Cochrane Library for randomised trials, comparing the use of EC-IC bypass surgery plus medical therapy versus medical therapy alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischaemic stroke beyond 30 days through 2 years after randomisation. One-stage and two-stage meta-analyses using reconstructed individual patient data in hazard ratios (HRs) were performed. Four trials (2102 participants) were included. No statistically significant differences were observed between the two groups in the one-stage (HR 1.019, 95% confidence interval [CI] 0.860-1.209, P = 0.06) and two-stage (HR 0.954, 95% CI 0.841-1.241, P = 0.21) meta-analyses. Rates of ipsilateral ischaemic stroke, any stroke or death, and any stroke were also similar between groups at 2 years. In symptomatic ICA or MCA occlusion, adding bypass surgery to medical therapy does not significantly lower the risk of the composite outcome of stroke or death compared to medical therapy alone.
Singapore Med J
· 2026 Mar · PMID 40873230
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INTRODUCTION: Ischaemic stroke is a major health burden. The aim of this observational study was to compare the incidence of ischaemic stroke between Muslims and non-Muslims living in southern Thailand. METHODS: Patients...INTRODUCTION: Ischaemic stroke is a major health burden. The aim of this observational study was to compare the incidence of ischaemic stroke between Muslims and non-Muslims living in southern Thailand. METHODS: Patients with nonrecurrent computed tomography-proven ischaemic stroke admitted to Yala Regional Hospital during the Hijri years (AH) 1435-1439 were recruited for the study. Demographic, religious and risk factor data (hypertension, diabetes mellitus), smoking and atrial fibrillation) were collected. The study was divided into three periods using AH months as follows: baseline (months 1-4), pre-Ramadan (months 5-8) and Ramadan (months 9-12). Poisson regression was performed to explore the association between the time periods and rates of ischaemic stroke. RESULTS: Smoking was more common in Muslims than non-Muslims, with a higher incidence of 10.7 per 100,000 vs. 4.9 per 100,000 ( P = 0.016). In relation to the three time periods, the incidence of ischaemic stroke was higher among Muslims than non-Muslims during Ramadan (13.5 vs. 5.4, P = 0.032), but not during the other time periods. For Muslims, the incidence rate ratio was higher during Ramadan (1.07; P = 0.049) than at baseline and pre-Ramadan (1.00 and 0.97, respectively; P = 0.576), whereas the ratios remained unchanged in the non-Muslim group. CONCLUSION: There was a higher incidence of ischaemic stroke exclusively among Muslims during the Ramadan.
Lim SJM, Chen K, Tan YY
… +5 more, Tay SW, Lim TCT, Salazar E, Chan WP, Tan MTK
Singapore Med J
· 2025 Aug · PMID 40833756
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INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a significant cause of disease morbidity. One-third of patients with ASUC are steroid refractory. Rescue therapy may not successfully induce remission, necessitatin...INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a significant cause of disease morbidity. One-third of patients with ASUC are steroid refractory. Rescue therapy may not successfully induce remission, necessitating colectomy. We aimed to identify predictors of rescue therapy and colectomy in ASUC assessed within 24 h of admission for early risk stratification. METHODS: We conducted a retrospective cohort study of 58 admissions for ASUC among 47 patients from August 2002 to January 2022. Serum biomarkers assessed were measured on admission. Primary outcomes were the need for rescue therapy during the same admission and colectomy within 1 year of admission. RESULTS: Rescue therapy (all with infliximab) was given in 20 (34.5%) of the admissions. Colectomy was done within 1 year for nine (15.5%) of the admissions. An elevated C-reactive protein (CRP) of >30 mg/L (relative risk [RR] 1.63), a CRP-albumin ratio of >0.85 (RR 1.63), and a composite factor of both CRP > 30 mg/L and age ≥60 years (RR 2.37) were significantly associated with the need for rescue therapy. Hypoalbuminaemia ≤ 25 g/L (RR 4.35) and the use of biologics at presentation (RR 1.54) were significantly associated with colectomy within 1 year of admission, while a CRP of ≥ 80 mg/L was a significant protective factor (RR 0.70). CONCLUSION: Patients with ASUC who have elevated CRP or CRP-albumin ratio on admission should be considered at risk for steroid-refractory disease. Those with hypoalbuminaemia on admission and using biologics at presentation are more likely to require colectomy in the first year after admission for ASUC.
Tan AXH, Soh AYS, Kuang JZ
… +3 more, Siah KTH, Ong AML, Ang D
Singapore Med J
· 2025 Aug · PMID 40833755
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Neurogastroenterology and motility disorders of the upper gastrointestinal (GI) tract represent a complex and heterogeneous group of conditions that involve the interaction between the GI tract and the central nervous sy...Neurogastroenterology and motility disorders of the upper gastrointestinal (GI) tract represent a complex and heterogeneous group of conditions that involve the interaction between the GI tract and the central nervous system. They constitute a significant number of outpatient gastroenterology visits, resulting in a high healthcare burden. These disorders often occur in the absence of identifiable structural causes on routine endoscopy and radiological imaging. A more targeted approach in the assessment of functional GI disorders is increasingly being integrated into routine clinical practice, given the recent advancements in technology and physiologic testing. When used in the appropriate clinical context, these tests not only elucidate the physiological basis for the patient's symptoms, but also prevent inappropriate treatment and repeated investigations. This review aims to summarise the advances in clinically available diagnostic tools for the evaluation of upper GI functional disorders.
Singapore Med J
· 2025 Aug · PMID 40833754
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Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedu...Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedures, and other therapeutic procedures. Today, EUS-guided drainage of symptomatic walled-off pancreatic fluid collections is the norm, with endoscopic necrosectomy as an adjunct. For high-risk surgical patients unsuitable for cholecystectomy, EUS-guided gallbladder drainage of acute cholecystitis is an option. Additionally, EUS-guided drainage of obstructed biliary and pancreatic ductal system can be performed as salvage procedures after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Bariatric procedures such as Roux-en-Y gastric bypass alter the gastric anatomy, hindering access to the major papilla. This can be overcome by creating a conduit through the excluded stomach using EUS-directed transgastric ERCP. Gastric outlet obstruction and afferent loop syndrome can be treated using EUS-guided gastrojejunostomy. These therapeutic interventions are a major advancement in the field of interventional EUS, achieving significant clinical impact.
Singapore Med J
· 2025 Aug · PMID 40802555
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INTRODUCTION: Febrile infants often undergo septic workups, with urinary tract infection (UTI) being the most common serious bacterial infection. However, lumbar puncture practices vary, and the rate of concurrent mening...INTRODUCTION: Febrile infants often undergo septic workups, with urinary tract infection (UTI) being the most common serious bacterial infection. However, lumbar puncture practices vary, and the rate of concurrent meningitis remains uncertain. This systematic review and meta-analysis aimed to determine the rate of concomitant bacterial meningitis in febrile infants with UTI. METHODS: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and conference proceedings from inception to August 2023 were searched. Included studies involved febrile infants ≤90 days old with UTI and no clear infection source, where ≥10 infants underwent lumbar puncture. Studies with localising symptoms of another diagnosis or premature infants were excluded. Studies were independently reviewed and data were extracted. Meta-analysis was performed using random-effects models with heterogeneity tests. Study quality was assessed via the Newcastle-Ottawa Scale. RESULTS: Thirty-nine observational studies met the eligibility criteria. The prevalence of concomitant definite bacterial meningitis in febrile infants with UTI was 0.3% (95% confidence interval [CI] 0.1%-0.4%). Between-studies comparison suggested this rate may be higher in neonates (≤28 days) than older infants (29-90 days old) (pooled estimate 0.7%, 95% CI 0.3%-1.1% vs. 0.2%, 0.0%-0.3%), while within-studies comparison showed no risk difference between the two groups. No association between bacterial meningitis and bacteraemia in infants with febrile UTI was observed. CONCLUSION: In clinically well febrile infants without symptoms or signs suggesting meningitis, a screening urine sample should be recommended instead of a routine full septic workup.
Singapore Med J
· 2025 Aug · PMID 40759432
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Sarcopenia is the loss of muscle strength, mass and function. It is often exacerbated by chronic comorbidities such as cardiovascular diseases (CVDs). There is a bidirectional relationship between sarcopenia and CVD. Sar...Sarcopenia is the loss of muscle strength, mass and function. It is often exacerbated by chronic comorbidities such as cardiovascular diseases (CVDs). There is a bidirectional relationship between sarcopenia and CVD. Sarcopenia can lead to increased adiposity, insulin resistance and chronic inflammation, predisposing adults to developing cardiovascular events. Chronic inflammation and decreased physical activity observed in cardiac patients can lead to accelerated muscle loss and the development of sarcopenia. Sarcopenia is linked to faster CVD progression, higher mortality and reduced quality of life. The co-occurrence of obesity with sarcopenia is termed sarcopenic obesity (SO). This condition is associated with worse outcomes than either condition individually. Early detection is crucial, as interventions can slow or reverse sarcopenia and improve cardiovascular outcomes. This review summarises evidence on the interplay between CVD and sarcopenia, discusses diagnostic approaches and management strategies, and identifies knowledge gaps for future research.
Singapore Med J
· 2025 Aug · PMID 40758999
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INTRODUCTION: Mental health research on elite athletes in Asian populations trails behind that of the West, especially in multiethnic societies such as Singapore. This study explored the prevalence and risk factors assoc...INTRODUCTION: Mental health research on elite athletes in Asian populations trails behind that of the West, especially in multiethnic societies such as Singapore. This study explored the prevalence and risk factors associated with mental health symptoms among national athletes in Singapore across various sports. METHODS: Singapore national athletes answered an internet-based questionnaire comprising validated screening tools for symptoms of four mental health conditions - athlete-specific psychological strain, depression, anxiety and disordered eating. RESULTS: A total of 356 athletes participated in the study. Of these, 70% of respondents reported 'high' to 'very high' levels of athlete-specific psychological strain, 41% reported clinically significant ('mild' to 'severe') depressive symptoms, 18% reported 'moderate' to 'severe' anxiety symptoms, and 16% were suspected for disordered eating. Females were more likely to have clinically significant depressive (adjusted odds ratio [aOR] 3.44, P < 0.001) and anxiety (aOR 2.59, P = 0.006) symptoms compared to males. Athletes of Indian ethnicity were more likely to have depressive (aOR 4.18, P = 0.018), anxiety (aOR 4.24, P = 0.032) and psychological strain (aOR 11.83, P = 0.021) symptoms than their Chinese counterparts. Athletes who recently underwent a change in school (aOR 8.89, P = 0.002) or major examinations (aOR 3.23, P = 0.014) were more likely to have depressive symptoms than those who did not. Respondents with a current injury were more likely to experience greater athlete-specific psychological strain (odds ratio 1.79, P = 0.031) compared to those who were not injured. CONCLUSION: High-performance athletes from various sports in multiethnic Singapore carried a significant burden of poor mental health, comparable to both the local general population and Western sporting populations. Prioritisation of resources to target high-risk groups may serve to bridge the sizeable treatment gap.
Wan JYJ, Tan YY, Koh LYR
… +2 more, Chew Z, Teo HLT
Singapore Med J
· 2025 Aug · PMID 40758997
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INTRODUCTION: Lumbar endoscopic discectomy (LED) is an increasingly common minimally invasive procedure used in treating lumbar disc herniation and decompressing spinal nerves. Various techniques have been described, eac...INTRODUCTION: Lumbar endoscopic discectomy (LED) is an increasingly common minimally invasive procedure used in treating lumbar disc herniation and decompressing spinal nerves. Various techniques have been described, each offering improved intraoperative visualisation and safety profile yet maintaining smaller incisions, resulting in better surgical outcomes and shorter hospital stay, as compared to minimally invasive microdiscectomy (MISD). This study aimed to investigate the cost-effectiveness of LED (uniportal and biportal approaches) against conventional MISD. METHODS: This is a single-centre, multi-surgeon, retrospective case cohort study of 24 and 18 patients who underwent elective single-level uniportal LED and biportal LED, respectively. In addition, an age-matched group of 42 patients who underwent single-level MISD was included. Patient demographics (age, gender, body mass index, Charlson Comorbidity Index and Functional Independence Measure), 6-month postoperative complications and inpatient hospitalisation costs were compared. RESULTS: Both uniportal and biportal endoscopic discectomy groups had significantly higher operation durations but maintained comparable hospital length of stay, and intra- and postoperative complication rates. The uniportal group had significantly higher overall inpatient hospitalisation bill compared to the biportal and MISD groups due to the rental fee for specialised endoscopic equipment. CONCLUSION: The biportal endoscopic approach - due to its equipment versality - has lower equipment costs than uniportal endoscopic discectomy. For the biportal approach to potentially become a cost-effective and safe alternative to conventional MISD, a learning curve remains for surgeons and institutions to overcome in order to achieve shorter hospital stays and operative durations.