Lim LWZ, Toh KY, Cook AR
… +2 more, Lee JWJ, Lim JFY
Singapore Med J
· 2025 Aug · PMID 40472289
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INTRODUCTION: Despite the exponential increase in microbiome research, knowledge and beliefs about the gut microbiome and faecal microbiota transplantation (FMT) remain unclear. The aim of this study was to identify the...INTRODUCTION: Despite the exponential increase in microbiome research, knowledge and beliefs about the gut microbiome and faecal microbiota transplantation (FMT) remain unclear. The aim of this study was to identify the extent of knowledge, awareness and perception among the general public regarding the gut microbiome and FMT. METHODS: An online questionnaire on knowledge and beliefs about the gut microbiome and FMT was administered to 1831 participants. Data analysis software was used to generate descriptive statistics and explore associations between knowledge and sociodemographic variables. RESULTS: Even though only 33% of participants had heard of the gut microbiome, more than 92% had consumed probiotic drinks or supplements. While 85% had not heard of the FMT procedure, 72% of respondents would consider having FMT to treat Clostridioides difficile infection (CDI). Willingness to receive FMT depended mainly on recommendation from healthcare providers (77%). Knowledge and awareness regarding the gut microbiome and FMT were relatively low, despite most participants having prior gut health-related behaviours. CONCLUSION: This study identified the public's perceptions of FMT and the potential barriers to its uptake. Insights from the study highlight the need for health education to enhance acceptance of FMT and the importance of using information supported by medical professionals to immunise the public against poorly validated science.
Singapore Med J
· 2025 May · PMID 40353329
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INTRODUCTION: An enhanced recovery after surgery protocol following total knee arthroplasty (TKA) offers multiple benefits. However, there are concerns about whether old age should be a criterion for exclusion from this...INTRODUCTION: An enhanced recovery after surgery protocol following total knee arthroplasty (TKA) offers multiple benefits. However, there are concerns about whether old age should be a criterion for exclusion from this protocol. This study aimed to determine the safety and outcomes of ambulatory TKA for patients aged ≥80 years. METHODS: A retrospective study was conducted using data from our hospital knee registry database (2021-2024). We compared the length of hospital stay, complication rate, readmission rate, three-month postoperative functional outcomes and overall experiences of patients (aged ≥80 years) who underwent ambulatory TKA with patients (aged ≥80 years) who underwent non-ambulatory TKA and younger patients who underwent ambulatory TKA. Functional outcomes were evaluated using Oxford Knee Score (OKS), Knee Society Clinical Score (KSS) and Knee Society Functional Score (KSFS). The minimal clinically important difference cutoffs for OKS, KSFS and KSS were 5.0, 6.4 and 5.9, respectively. RESULTS: There were clinically significant improvements in the three-month postoperative functional scores compared to preoperative scores in all patient groups. Patients aged ≥80 years who underwent ambulatory TKA had lower complication and readmission rates compared to the other patient groups. They also had better three-month postoperative functional scores than patients who underwent non-ambulatory TKA ( P = 0.004 for OKS, P = 0.003 for KSFS), and similar outcomes as younger patients ( P > 0.050 for OKS, KSFS). Length of hospital stay, satisfaction rates and rates of expectation met were comparable between patients aged ≥80 years and younger patients who underwent ambulatory TKA. CONCLUSION: In carefully selected patients aged ≥80 years, ambulatory TKA is safe and yields outcomes comparable to those of younger patients.
Chan HY, Karande GY, Tan CH
… +5 more, Ng YH, Png MA, Ricci V, Young A, Chan LP
Singapore Med J
· 2025 May · PMID 40346782
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INTRODUCTION: Uncomplicated acute low back pain is usually self-limiting and does not warrant imaging. However, despite current recommendations, many patients continue to receive spinal imaging, increasing healthcare cos...INTRODUCTION: Uncomplicated acute low back pain is usually self-limiting and does not warrant imaging. However, despite current recommendations, many patients continue to receive spinal imaging, increasing healthcare costs. The Ministry of Health, Singapore, convened a multidisciplinary workgroup to develop a consensus guideline on magnetic resonance imaging (MRI) of the lumbar spine (Agency for Care Effectiveness [ACE] guideline) for low back pain that was incorporated into electronic radiology order forms. We analysed the MRI orders following implementation of the guideline. METHODS: A list of 'appropriate' and 'inappropriate' indications was developed based on existing literature. These indications were inserted into the MRI of the lumbar spine request form within the electronic system. It was mandatory for clinicians to specify on a drop-down list of indications. For 'inappropriate' indications, clinicians are required to fill out a free-text 'pop up' elaborating on their clinical reasoning for the MRI request. RESULTS: Baseline pre-intervention data were collected over 3 months. A total of 492 MRI scans were performed with 64 (13.0%) inappropriate orders. Post-intervention, we retrospectively analysed two sets of data over 3 months each in 2021 and 2022. In 2021, there were 86 (9.1%) inappropriate orders out of 940 scans performed. In 2022, there were 38 (7.3%) inappropriate studies out of 521 scans performed. There was a statistically significant overall decrease in inappropriate scans from 13.0% pre-intervention to 7.3% post-intervention ( P = 0.01). Among all the 124 inappropriate studies post-intervention, only one patient eventually required surgery. CONCLUSION: Our study demonstrates the positive impact of implementing a local guideline through electronic medical records in reducing inappropriate MRI of the lumbar spine for low back pain. Further studies on the impact of other behavioural nudges are recommended.
Singapore Med J
· 2025 May · PMID 40319362
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INTRODUCTION: While neoadjuvant chemotherapy with interval debulking surgery (IDS) has comparable clinical outcomes to primary debulking surgery (PDS) for advanced epithelial ovarian cancer, their economic dimension rema...INTRODUCTION: While neoadjuvant chemotherapy with interval debulking surgery (IDS) has comparable clinical outcomes to primary debulking surgery (PDS) for advanced epithelial ovarian cancer, their economic dimension remains understudied. METHODS: This retrospective chart review examined Stage IIIC-IV epithelial ovarian cancer patients who underwent IDS or PDS between 2011 and 2014. We compared the demographics, disease-specific, intraoperative, thirty-day clinical outcome and billing, and ten-year survival data. RESULTS: Patients who underwent PDS (n = 36) and IDS (n = 43) had similar characteristics, including age, comorbidity, cancer stage, cell type, nationality, and 30-day median bill sizes (SGD 31,649.69 vs. SGD 35,326.02). The IDS group had lower postoperative sepsis (2.3% vs. 16.7%), gastrointestinal complications (0.0% vs. 11.1%) and suboptimal debulking (14.0% vs. 33.3%) rates, shorter median hospital stay (5 vs. 8 days) and higher rates of complete gross resection (CGR) (62.8% vs. 36.1%) (all P < 0.05). There were significant associations between thirty-day complications and mucinous adenocarcinomas (odds ratio [OR] 10.8), packed cell transfusion (OR 1.87 per unit), and suboptimal debulking (OR 6.33). Thirty-day readmission or death was significantly associated with Clavien-Dindo Grade I-II complications (OR 46.8) and suboptimal debulking (OR 8.24). While PDS and IDS groups had similar ten-year survival (37.0% vs. 16.2%), PDS conferred a significantly lower recurrence rate (66.7% vs. 83.7%, P = 0.003). CONCLUSION: The thirty-day cost and ten-year survival of IDS and PDS are comparable. Although IDS offers lower postoperative sepsis and gastrointestinal complications, shorter hospital stays and higher CGR rates, the ten-year recurrence is higher.
Tang MYP, Tsui SYB, Chao SYN
… +2 more, Chan KWE, Lee KH
Singapore Med J
· 2025 May · PMID 40319361
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INTRODUCTION: 22q11.2 deletion syndrome (22q11.2DS) is associated with palatal abnormalities. It remains controversial as to when and how children with palatal abnormalities should undergo specific diagnostic 22q11.2DS t...INTRODUCTION: 22q11.2 deletion syndrome (22q11.2DS) is associated with palatal abnormalities. It remains controversial as to when and how children with palatal abnormalities should undergo specific diagnostic 22q11.2DS testing. There is also a lack of local data on the prevalence and clinical features associated with 22q11.2DS in children with cleft anomalies. We aimed to review the data on children diagnosed with 22q11.2DS who attended the cleft clinic at the Hong Kong Children's hospital. METHODS: We retrospectively reviewed the medical records of children who attended the cleft clinic at the Hong Kong Children's Hospital from January 2020 to April 2024 and had been tested for or diagnosed with 22q11.2DS. The age at genetic diagnosis, clinical features and details of palatal operation were reviewed. RESULTS: Based on clinical suspicions, 31 children were tested for 22q11.2DS, and of these, eight (26%) children were confirmed to have the 22q11.2DS. The majority (75%) of those tested and diagnosed received their genetic diagnosis after their palatal operations. Additionally, ten other children with 22q11.2DS were identified from hospital records, having received their genetic diagnosis elsewhere. CONCLUSION: A notable number of children who attended the cleft clinic suffered from 22q11.2DS. Clinicians managing children with cleft anomalies should maintain a high index of suspicion and consider early specific 22q11.2DS genetic investigations in accordance with locally available resource and disease prevalence.
Tan MB, Chua YR, Fan Q
… +2 more, Fortier MV, Chang PP
Singapore Med J
· 2025 Apr · PMID 40258236
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INTRODUCTION: In this study, we aimed to compare the performance of a convolutional neural network (CNN)-based deep learning model that was trained on a dataset of normal and abnormal paediatric elbow radiographs with th...INTRODUCTION: In this study, we aimed to compare the performance of a convolutional neural network (CNN)-based deep learning model that was trained on a dataset of normal and abnormal paediatric elbow radiographs with that of paediatric emergency department (ED) physicians on a binomial classification task. METHODS: A total of 1,314 paediatric elbow lateral radiographs (patient mean age 8.2 years) were retrospectively retrieved and classified based on annotation as normal or abnormal (with pathology). They were then randomly partitioned to a development set (993 images); first and second tuning (validation) sets (109 and 100 images, respectively); and a test set (112 images). An artificial intelligence (AI) model was trained on the development set using the EfficientNet B1 network architecture. Its performance on the test set was compared to that of five physicians (inter-rater agreement: fair). Performance of the AI model and the physician group was tested using McNemar test. RESULTS: The accuracy of the AI model on the test set was 80.4% (95% confidence interval [CI] 71.8%-87.3%), and the area under the receiver operating characteristic curve (AUROC) was 0.872 (95% CI 0.831-0.947). The performance of the AI model vs. the physician group on the test set was: sensitivity 79.0% (95% CI: 68.4%-89.5%) vs. 64.9% (95% CI: 52.5%-77.3%; P = 0.088); and specificity 81.8% (95% CI: 71.6%-92.0%) vs. 87.3% (95% CI: 78.5%-96.1%; P = 0.439). CONCLUSION: The AI model showed good AUROC values and higher sensitivity, with the P-value at nominal significance when compared to the clinician group.
Lim WX, Tan MLL, Teo TLS
… +2 more, Gan WH, Wong SHJ
Singapore Med J
· 2025 Apr · PMID 40258235
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The Singapore Green Plan 2030 was released by the Singapore government to set targets for sustainability by 2030. The adoption of novel technologies, processes and substances creates new jobs, and such developments bring...The Singapore Green Plan 2030 was released by the Singapore government to set targets for sustainability by 2030. The adoption of novel technologies, processes and substances creates new jobs, and such developments bring about new challenges and risks for both employers and workers. Beyond emerging hazards, traditional hazards still remain, but they may take on new forms through new work processes. This review aims to provide an overview of the potential occupational health issues we may encounter or anticipate in these key sectors: solar energy, waste management and recycling, green buildings, electric vehicles and battery recycling, and sustainable fuels. While existing Occupational Safety and Health regulations in Singapore serve as a foundation, there may be gaps in addressing the specific hazards and risks associated with green jobs. In this review, we propose and outline possible approaches to the protection of worker safety and health.
INTRODUCTION: Maternal anaemia is the most common condition in pregnancy. It has profound consequences for both the mother and child, despite being easily treatable with iron supplementation. Our study aimed to investiga...INTRODUCTION: Maternal anaemia is the most common condition in pregnancy. It has profound consequences for both the mother and child, despite being easily treatable with iron supplementation. Our study aimed to investigate its prevalence, risk factors, and the current compliance to screening and treatment. METHODS: Women who delivered a baby between 1 October 2019 and 31 December 2019 at KK Women's and Children's Hospital, Singapore, were included. Haemoglobin levels at booking, 24-28 weeks and delivery were analysed. The frequency of treatment with iron supplementation or blood transfusion was also evaluated. Patient demographics were analysed using descriptive statistical methods, while Pearson's chi-square test was used for analyses of proportions. RESULTS: The prevalence of maternal anaemia at the time of delivery was 17.2%. Significant risk factors included receiving subsidised healthcare (associated with lower socioeconomic status), teenage pregnancy, multiparity, Indian ethnicity, thalassaemia and antepartum haemorrhage (P < 0.05). Compliance to screening was 62.8% at 24-28 weeks. Only 38.4% of women with anaemia at booking and 74.9% with anaemia at 24-28 weeks were prescribed oral iron. A total of 11.2% of women with maternal anaemia received intravenous iron. The mean haemoglobin level of women who received blood transfusion was 8.3 g/dL, which may not have been appropriate. CONCLUSION: Institutions should create guidelines to standardise the screening and treatment of maternal anaemia and conduct regular audits to monitor their implementation. We recommend a multi-pronged strategy targeting prevention, routine screening, and appropriate treatment of maternal anaemia.