Letter to the Editor
Knowledge, attitudes and readiness of final-year medical students towards clinical goals-of-care discussion
Dear Editor,
In a rapidly ageing global population,1 there is increasing recognition of the importance of clinical goals-of-care (GOC) discussions aimed at understanding patients’ goals, wishes and care preferences in the event of serious illness or end-of-life situations,2 in order to affirm patient-centred decision-making, improve quality of life and facilitate...
Letter to the Editor
Enhancing care in nursing homes: Qualitative insights from the ENHANCE programme
Dear Editor,
Empower Nursing Homes And improve staNdards of CarE (ENHANCE) was a pilot programme introduced by Sengkang General Hospital to address the challenges faced by Singapore’s ageing population. With nearly 1 in 4 Singaporeans projected to be aged 65 years and above by 2030, the demand for effective long-term...
Commentary
Transforming medical education in the AI era: Balancing technological expertise with humanistic care in tomorrow’s doctors
Standing at the precipice of a new era in healthcare, the integration of artificial intelligence (AI) into clinical practice is progressing at an unprecedented pace. From AI algorithms detecting tumours with remarkable accuracy to predictive models forecasting patient outcomes, these technological marvels are not only changing how we practice...
Editorial
Journey towards a smoke-free nation
“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Letter to the Editor
Facing death alone: An exploration of terminally ill individuals living alone in palliative care
Dear Editor,
Home palliative care clinicians provide end-of-life care for patients from diverse social and economic backgrounds. They include patients who live alone—a single-person household.1 Auon et al. found that 7–12% of patients under palliative care lived alone for more than a year.3 Demographic trends increasingly highlight this group to...
Editorial
Beyond survival: Addressing gaps in psychosocial support for survivors of childhood cancer
I read with great interest the study conducted by Fong et al. published in this issue of Annals, which evaluated psychological symptoms and health-related quality of life (HRQOL) among a cohort of 143 young adult survivors of childhood cancer in Singapore.1 Almost 1 in 4 survivors demonstrated significant psychological...
Original Article
Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore
Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...
Letter to the Editor
Evolving landscape of sports injuries and recommendations on injury preventions: A retrospective analysis in Singapore
Dear Editor,
Sports have become increasingly integral to the daily lives of Singaporeans. According to the National Sport and Exercise Participation Survey, the percentage of Singaporeans exercising weekly rose from 54% in 2015 to 73% in 2023.1 While this surge in sports activities brings numerous health benefits, it also results...
Letter to the Editor
Assessing the accuracy and consistency of generative pretrained transformers in assigning Eastern Cooperative Oncology Group performance status
Dear Editor,
The Eastern Cooperative Oncology Group (ECOG) is a commonly used performance status (PS) scale in oncology. It influences cancer treatment decisions and clinical trial recruitment. However, there can be significant inter-rater variability in ECOG-PS scoring, due to subjectivity in human scoring and innate cognitive biases.1,2 We propose that...
Editorial
How close are we from achieving demographic diversity in clinical trials? Insights from Singapore
Clinical trials are essential for assessing the efficacy and safety of new therapies. Because different patient subgroups may respond variably to treatments, it is important to emphasise diversity among participants. This approach ensures that the trial population accurately reflects the patients who will use the medication in real-world settings...
Original Article
Association between alcohol flushing syndrome and cancer: A systematic review and meta-analysis
Alcohol flushing syndrome (AFS) is characterised by intense facial flushing, often accompanied by palpitations, headache and nausea shortly after the consumption of alcohol. This phenomenon occurs in up to 46% of East Asians and to a much lesser extent Caucasians, due to the accumulation of acetaldehyde, a metabolic byproduct...
Original Article
Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore
Preschool children, particularly those with developmental, behavioural or emotional (DBE) issues, are highly vulnerable to the negative effects of excessive screen viewing time (SVT) on their social and emotional development.1,2 Singapore, an island nation with a declining birth rate,3 places significant emphasis on human potential, particularly the social and...
Editorial
Evaluating the effectiveness of cervical cancer screening and prevention in Singapore
Cervical cancer is the fourth most common cancer in women globally, with approximately 660,000 new cases and 350,000 deaths reported in 2022.1 In Singapore, it ranks as the 11th most common cancer among women and the 5th most frequent cancer among young women aged 15–44 years, with 309 new...
Letter to the Editor
Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore
Dear Editor,
Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Letter to the Editor
VOWELS: A communication framework for disclosing medical errors in medical oncology and palliative care
Dear Editor,
Recognising the impact of medical errors on patients and the doctor-patient relationship has underscored the need for better communication.1,2 For the most part, these efforts are informed by Chafe et al.’s 6 steps that entail: (1) the identification of the error in a timely fashion; (2) determination of...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Original Article
Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance
Breast cancer-related lymphedema (BCRL) is a chronic progressive pathological condition of the lymphatic system that can lead to significant impact on the quality of life after breast cancer treatment.1 It is characterised by swelling and accumulation of protein-rich fluid in body tissues, leading to pain, tightness, skin changes such...
Editorial
Breast cancer-related lymphedema (BCRL): Should we be doing more or less for the axilla?
Breast cancer mortality has declined steadily over the years with breast cancer screening, and improvement in diagnostic and therapeutic regimens. Despite cancer survivors living longer, breast cancer-related lymphedema (BCRL) is a significant complication after major breast surgery that can impact quality of life adversely. The incidence of BCRL reported...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Original Article
Anti-osteoporosis drugs reduce mortality in cancer patients: A national cohort study of elderly with vertebral fractures
Osteoporotic vertebral fractures (OVFs) are the most prevalent type of fragility fractures, affecting 25% of adults in their early 70s and 43% of those over the age of 80.1,2 Following an OVF, persistence of the vertebral deformity may lead to spinal kyphosis, which is associated with chronic lower back...
Editorial
Anti-osteoporosis drugs and reduction of mortality in cancer patients
Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs,...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Review Article
AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management
Amyloidosis refers to disorders characterised by the deposition of insoluble amyloid fibrils, which are pathogenic,1 resulting in organ dysfunction. Amyloidoses differ in the protein precursor undergoing aggregation and downstream target organs implicated. Consequently, clinical manifestations are varied, from localised amyloidosis in Alzheimer’s disease, to systemic amyloidosis such as immunoglobulin...
Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Editorial
Improving management of AL amyloidosis
In this issue of the Annals, Tan et al. on behalf of Singapore Myeloma Study Group presented the consensus guidelines on light chain (AL) amyloidosis.1 This is an encouraging effort as AL amyloidosis is a rare disease, with diagnostic and therapeutic challenges. A comprehensive review examining its pathophysiology, diagnostic...
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Original Article
Development and validation of a new self-assessment tool to measure professionalism among medical students
Professionalism is a concept that is difficult to define, but in relation to medical practice, it can be summarised as values, behaviours and conduct that foster the public’s trust in doctors. It comprises a complex interplay of abstract concepts that have led to many attempts at defining professionalism.1-4 With...
Editorial
Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...
Editorial
Nurturing professional behaviours and ethical practice: From students to professionals
Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting...
Letter to the Editor
Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong
Dear Editor,
In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing System. It provides the healthcare recipients, that is, those who have registered in the system, a series of functions to manage their health, such as...
Letter to the Editor
Managing and preventing severe hand injuries among sugarcane juicer operators
Dear Editor,
Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is...
Letter to the Editor
Breast conservation treatment and frozen section analysis of margins
Dear Editor,
Re. Surgical margins assessment reduces re-excision rates in breast-conserving surgery I read with interest the article by Woon et al. published in a recent issue of the Annals on the reduction of re-excision rates with the use of intraoperative frozen section (FS) analysis.1 This certainly has the potential...
Editorial
Impact of pre-existing depression on severe COVID-19 outcomes
The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...
Letter to the Editor
Script concordance test to assess diagnostic and management reasoning in acute medicine
Dear Editor,
Clinical reasoning, an essential skill for patient care, can be difficult to assess. We created and validated a script concordance test (SCT) to assess clinical reasoning in acute medicine. This tool was used to provide feedback and targeted remediation for Postgraduate-Year-1 (PGY1) doctors, guide teaching and learning, and...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Letter to the Editor
A perfect match: The story of robotics in gynaecology
Dear Editor,
The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using a robot in performing remote damage control surgeries on the battlefield that sparked the commercialisation of robotic surgical technology for use in operating rooms.1 The...
Letter to the Editor
Preferences for oral anticoagulant medications for managing atrial fibrillation
Dear Editor,
Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of serious bleeding events.3 Warfarin and direct oral anticoagulants (DOACs) are the available oral anticoagulants for this indication. We developed a discrete choice experiment (DCE) survey4...
Original Article
Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore
Workers who have sustained an injury at work often face difficulties returning to work, according to a study showing that over 40% of injured workers in Singapore experienced increased lethargy at work and that about 40% had difficulties in performing work at pre-injury standards.1 One in 4 workers also felt...
Editorial
Proactive steps to population health: Starting early, starting right
The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....
Letter to the Editor
Investigating the stressors and coping mechanisms of students in medical school: A qualitative study
Dear Editor,
Medical school can be a stressful experience for students, with burnout being increasingly common.1 Stressors in medical education include a heavy academic workload, pressure of good academic performance, and comparison with peers of high aptitude.2 Stress can be either beneficial or detrimental to development, depending on personal regulation...
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Commentary
Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside
Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example, deep learning, which is a subset of the state-of-the-art machine learning techniques, has shown robust performance in image recognition, speech recognition and natural language processing.2...
Original Article
Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes
Diabetes mellitus and hypertension are serious public health issues. Approximately 451 million individuals worldwide aged 18–99 years were living with diabetes in 2017, and this number is expected to increase to 693 million by 2045.1 More than 90% of all diabetes cases were type 2 diabetes mellitus (T2DM).2 For...
Editorial
Promoting physical activity for population health
The chronic disease burden has risen globally. In Singapore, between 2007 and 2021, the crude prevalence of hyperlipidaemia (8.2–13.9%), hypertension (12.7–15.7%) and diabetes (4.9–6.9%) has increased.1 Based on the Global Burden of Disease Study (2019), lack of physical activity and other modifiable risk factors contribute 35% of the disability-adjusted...
Review Article
An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore
Prostate cancer is the fifth most common cancer in Asian men, and with its rising incidence, is emerging as a health priority in Asia.1 Across Asian countries, age-standardised incidence rates (ASIRs) of prostate cancer range from 0.9 to 56.1 per 100,000 population, with the second highest ASIR reported in...
Editorial
Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore
Compared with other solid tumours, patients with metastatic prostate cancer typically have better survival in the range of years.1 The long survival translates to a high prevalence, and thus, a large number of men living with prostate cancer. Singapore has one of the highest age-standardised incidence rates of prostate...
Letter to the Editor
The role of PIVKA-II in hepatocellular carcinoma surveillance in an Asian population
Dear Editor,
Alpha-fetoprotein (AFP) is the most established biomarker for surveillance of hepatocellular carcinoma (HCC) in at-risk individuals. However, its sensitivity and specificity are not very satisfactory.1 Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a newer biomarker for HCC but without a widely established cut-off.2,3 Recent...
Letter to the Editor
Reducing non-clinical working hours of junior doctors could benefit patient outcomes
Dear Editor,
An 80-hour duty limit for residents was first introduced by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, with the further addition of a 16-hour continuous duty period limit for first-year residents in 2011. Prior studies1 have demonstrated an association between longer working hours and...
Original Article
Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma
Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility in women of reproductive age are commonly associated with endometriosis. The disease is estimated to affect about 1 in every 10 women of reproductive age,...
Original Article
Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore
Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes education and awareness of the disease contribute significantly to minimising complications and reducing morbidity and mortality.2 In addition, there is also a strong impetus to...
Editorial
Diabetes: Know thy foe
During the COVID-19 pandemic in 2022, Singapore’s Minister for Health Ong Ye Kung mentioned, “After the COVID-19 pandemic has passed, we need to tackle a far more challenging pandemic—which is longer-term chronic illness, and diabetes is a major one.”1
Truly, in the past decade, there has been an invisible global...
Letter to the Editor
Surgical margins assessment reduces re-excision rates in breast-conserving surgery
Dear Editor,
Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However, BCS is associated with a higher risk for local recurrence, and published literature has reported re-excision rates as high as 20–70% due to positive resection...
Review Article
Combating a resurgence of poliomyelitis through public health surveillance and vaccination
Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific Region.1 Prior to certification, there were multiple outbreaks in 1958, 1960 and 1963 with 415, 196 and 74 paralytic polio cases, respectively.2-4 The nationwide immunisation...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Editorial
Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication
Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2 and 3 were eradicated in 2015 and 2019, respectively. The World Health Organization (WHO) South-East Asia Region was declared free of poliovirus in 2014, and...
Letter to the Editor
Multidisciplinary lung cancer clinic: An emerging model of care
Dear Editor,
Lung cancer management is progressively complex and multidisciplinary input is often needed. The recent publication of CheckMate 816 heralds a paradigm shift in the treatment of resectable non-small cell lung cancer (NSCLC),1 with many other perioperative trials soon to follow.2 Oligometastasis and oligoprogression in stage IV NSCLC...
Commentary
Meeting today’s healthcare needs: Medicine at the interface
The demographic of Singapore has undergone dramatic changes. Historically, younger patients with communicable diseases predominated; however, patients are now older with chronic multimorbidity and functional impairment. This demographic shift challenges existing health and social care systems in Singapore, which must pivot to meet the changing need. The consequences of...
Original Article
Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of acquired, systemic autoimmune conditions characterised by muscular and extramuscular manifestations. As a subset within the family of IIM, dermatomyositis is distinguished by cutaneous features and has twice the risk of associated malignancy than polymyositis.1-3
Various meta-analyses have shown that between 10%...
Images in Medicine
A recurring nasal mass
A 56-year-old Chinese man presented to the Ear, Nose and Throat clinic with months of unilateral right-sided nasal obstruction. He reported occasional mucopurulent discharge and denied any hyposmia, episodes of epistaxis, or loss of weight and appetite. Nasoendoscopy revealed a right-sided nasal mass between the septum and middle turbinate....
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
Letter to the Editor
Early rehabilitation to improve functional outcomes in childhood cancer in Singapore
Dear Editor,
We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary...
Original Article
Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore
The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...
Editorial
From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system
The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach aims at ensuring the sustainability of the healthcare system. Crucially, it also embodies core principles of the health systems orientation that have long been advocated...
Letter to the Editor
Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...
Review Article
Barriers to breast cancer screening in Singapore: A literature review
Breast cancer is a major public health concern and a leading cause of cancer death among women worldwide, including Singapore.1 According to the 2018 Singapore Cancer Registry report, breast cancer has been consistently ranked as a leading cancer (29.3% of all cancers in Singapore) among women in Singapore for...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
Letter to the Editor
Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore
Dear Editor,
Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Original Article
Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore
Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the syndrome are varied, and multiple parameters are needed for its diagnosis.2,3 This complicates the diagnosis of PCOS and may cause patient dissatisfaction arising from delayed...
Original Article
A Randomized Trial of the Use of Print Material and Personal Contact to Improve Mammography Uptake Among Screening Non-attenders in Singapore
Breast cancer is the most common cancer among females in Singapore. Although lower than incidence rates in North America and the United Kingdom the incidence of breast cancer here has doubled from 20 to 38.8 per 100,000 women per year over the past 2 decades, and the disease is...
Original Article
Serum Selenium in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease, with cancer...
Original Article
Serum Ferritin and Iron Status in the General Population of Singapore, 1993 to 1995
Iron, a dietary constituent, is an essential element. Body iron stores can be measured by haemoglobin, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin.
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Original Article
Epidemiological Surveillance of Melioidosis in Singapore
Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention until the Vietnam War when French and US military personnel were affected by it.
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Original Article
Population-based Mammographic Screening in Singapore: What are Participants’ Views?
Breast cancer is the most common cancer among women in Singapore and has been increasing in incidence since 1968. This rise is particularly marked among younger women, suggesting that the increase will take place at an even faster rate in future.
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Original Article
Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease.
This article is...
Review Article
Theory and Practice in Continuing Medical Education
A physician’s education in medical science represents a continuum of several interrelated phases. It starts with medical school, passes through brief housemanship year, and continues throughout the professional career.
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Others
Cardiovascular Disease: Genes and Public Health
The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is assumed that the identification of mutations that confer susceptibility will provide the basis for new means of detection, prevention and treatment.
This article is available only...
Original Article
Body Mass Index Profile in Hong Kong Chinese Adults
Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become an epidemic with increasing prevalence in most parts of the world.
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Others
Quality Assurance of Problem-based Learning (PBL): The Hong Kong Experience
The Faculty of Medicine of the University of Hong Kong (HKU) was established in 1887 and its curriculum has been run in a traditional manner for over a century. The Faculty has been a major training ground for doctors in the Community of Hong Kong.
This article is available only...
Others
Clinical Reasoning Learning Sessions
Many medical schools worldwide have made the shift toward problem-based learning (PBL) medical education. Some of them employ these new techniques in only part of their teaching, and usually in the pre-clinical phases, to make basic sciences easier and more attractive.
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Others
Is Problem-Based Learning a Quality Approach to Education in Health Sciences?
Since the pioneering adoption of problem-based learning (PBL) by McMaster University in medical education more than three decades ago, increasingly more medical schools around the globe have been undergoing curriculum restructuring by incorporating some forms of PBL philosophy into their new curriculum. Some schools have believed and trusted in...
Review Article
Evidence-based Health Promotion: Applying it in Practice
There has been a growing interest in health promotion among health professionals and policy makers in Singapore. This is partly in response to the rising trend of chronic diseases and the finding that many of these diseases are lifestyle related and amenable to change.
This article is available only as...
Others
Is Healthcare Competition Healthy?
There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: “money no enough”.
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Others
Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context
It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care delivered to patients.1 The public disclosure of healthcare performance information is a phenomenon that has come to the fore in the United States (US) and...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
This article is available only as a PDF. Please...
Review Article
Current Concepts of Tumour Metastasis
Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor prognosis in patients with cancer. Early metastasis concepts were based upon the premise of uninterrupted tumour growth, stepwise spread of tumour cells with the inevitable...
Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response.
We present our qualitative study, guided by...
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Others
The Role of Public Health and Occupational Physicians in the New Millennium
I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4 years old, and yet I cannot see beyond the next decade, with things moving so rapidly.
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Original Article
A Study on SARS Awareness and Health-seeking Behaviour – Findings from a Sampled Population Attending National Healthcare Group Polyclinics
There was a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) caused by the novel coronavirus between November 2002 and July 2003. Singapore was one of the hot spots, in addition to China, Taiwan, Hong Kong, Toronto and Vietnam.
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Others
Book Review
These are challenging times for medical schools as the frontiers of knowledge have expanded enormously and rapidly in recent years. In order to keep up with the expanding knowledge and to impart it effectively and efficiently to our students, we as medical teachers will have to adopt new changes...
Original Article
Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population
Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically diverse populations is important for the understanding of cancer patterns and also to provide clues for aetiologic studies.
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Editorial
Issues and Challenges for Myopia Research
Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia is one of the highest worldwide, affecting 28% of school children at the start of their primary education and 70% of those completing university education.
This...
Original Article
A Problem-Based Learning Pathway for Medical Students: Improving the Process Through Action Research
Problem-based learning (PBL) is a student-centred, self-directed, integrated and contextual mode of learning. It has been widely perceived by many to confer advantages in promoting critical thinking, retention of knowledge, independent learning and interpersonal skills.
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Editorial
Curriculum TIPS For All of Us
Medical education is a lifelong learning process. Just as we remind our students and ourselves that the practice of medicine is a lifelong process in which we continually seek to improve our knowledge so that we give our patients the most effective care, so too with medical education.
This article...
Others
Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum
Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with colorectal cancers, but also because it implies a poor prognosis. We discuss 3 patients with rectal adenocarcinoma who subsequently developed cutaneous metastases.
This article is available...
Editorial
Environmental Planning and Urban Health
Environmental exposures to the adverse effects from climate change are expected to increase for many urban populations in the United States during the next 50 years, potentially due to increased summertime heat stress, increased ambient ozone concentrations, and other pathways such as increased vector- and water-borne disease. Vulnerable elderly...
Review Article
SARS Revisited: Managing “Outbreaks” With “Communications”
In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed greater import and found common usage in the lexicon of governance by public health systems in our part of the world.
This article is available only...
Review Article
SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty
The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced by fears of severe decreases in travel, tourism and trade as a result of aggressive protective measures undertaken by other countries. It now comes from...
Review Article
SARS in Singapore – Key Lessons from an Epidemic
The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and people of Singapore. The SARS outbreak in Singapore began on 1 March 2003 and the last case of the outbreak was isolated on 11 May...
Original Article
Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)
A review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1977 to 1996 showed a declining number of all STIs notified in Singapore from 22,427 in 1978 to 5570 in 1996, with the 20-to-29 years age group consistently accounting for the highest proportion of...
Original Article
Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study
In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports of medical conditions in participants of the Manitoba Longitudinal Study. Since then, many population-based longitudinal studies have confirmed that global self-rated health remains an independent...
Others
Public Healthcare – Welfare, Market Share or Laissez-faire? – A Sentosa Carlsberg Skytower View
Recently, two doctor-administrators commented to me separately, “Singapore probably has the best public healthcare system in the world.” While I understand the basis for their view, the accolade of world’s best healthcare system, according to the World Health Organization’s ranking, actually goes to France.
This article is available only as...
Others
Disaster Relief and Initial Response to the Earthquake and Tsunami in Meulaboh, Indonesia
A massive earthquake and tsunami hit the South Asian region on 26 December 2004, killing more than 200,000 people and displacing countless more.1 The epicentre of the earthquake was near the coast of Aceh in Sumatra, Indonesia. 2 The subsequent tsunami, one of the deadliest in history, affected more...
Original Article
Facilitation of Students’ Discussion in Problem-based Learning Tutorials to Create Mechanisms: The Use of Five Key Questions
An important aspect of problem-based learning (PBL), particularly in the early years of the undergraduate medical, physiotherapy, nursing and dental courses, is teaching basic science in a clinical format.1,2 This approach should enhance students’ skills to develop reasoning strategies, use information in relevant situations, generate hypotheses for problems identified...
Review Article
What do You Mean by “Satisfactory”?
There were 2 questions which initiated this research. One became the title of this paper; the other was a concern that the integration of competencies into existing assessment practices could jeopardise the high standards required of trainees before they graduate as independent practitioners.
This article is available only as a...
Letter to the Editor
Towards a Global Educational Matrix for Tomorrow’s Health Systems
Society supports medical schools expecting them to produce physicians who can improve both the health of the population as well as the health system itself. This goal has not been achieved yet; deaths from tuberculosis (1.7 million, 2006) are but one of many examples that points to that failure...
Commentary
Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond
The effectiveness with which the world tackles its most pressing public health problems depends crucially on the calibre of its public health workforce. Institutions of higher learning play a critical leadership role in this regard, both to build capacity at the national, regional and global levels, and to ensure...
Others
Parathyroid Carcinoma: A Case Series
Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis, such as bone disease, renal disease, or hypercalcaemic crisis, in contrast to the relatively asymptomatic presentation of benign parathyroid disease.2 Problems encountered include difficulty in...
Original Article
Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses
In Asia, the challenges facing medical education are similar across different countries. The learning process is still problematic with large classes, and most of the curriculum time being spent on traditional lectures.
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Others
The Future of Medical Education: The Second 100 Years
This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in Singapore’s first university, we are reminded that it was the Medical School which laid the foundation for tertiary education in Singapore. It is appropriate that...
Others
The NUS MBBS-PhD Programme: Nurturing Clinician-Scientists for Tomorrow
The MBBS-PhD programme is a significant milestone in medical education in Singapore. In July 2000, the Faculty of Medicine, National University of Singapore (NUS) launched this programme in collaboration with the Institute of Molecular and Cell Biology (IMCB), with support from the Economic Development Board (EDB), and the Agency...
Others
A Century of Medical Students’ Activities (Medical College Union/Medical Society)
On 3 July 1905, the Straits and Federated Malay States Government Medical School was started with the objective of training the local men and women to become Assistant Surgeons and General Practitioners. After a petition set out by the Chinese and non-European communities to the then Governor of the...
Others
The First Graduates in 1910
The Medical School in Singapore was founded on 3 July 1905; it was named the Straits and Federated Malay States Government Medical School. It was the forerunner of the Faculty of Medicine, National University of Singapore (NUS). This year (2005), the Faculty of Medicine (NUS) and the NUS celebrate...
Others
Milestones of the Medical School and Medical Progress of Singapore over the Past 100 years
1905: The Medical School started off in an old female lunatic asylum on the site of the general hospital at Sepoy Lines.1 Called the Straits and Federated Malay States Government Medical School, it was founded on 3 July 1905. The official launch was on Thursday, 28 September 1905. The...
Review Article
The Emerging Challenge of Age-related Eye Diseases in Singapore
Singapore has one of the fastest ageing populations in the world today. The current elderly population, defined as persons 65 years or older, comprises 7% of Singapore’s total population and is expected to multiply almost threefold to 19% by the year 2030.1 Although the current figure stands at 7%,...
Review Article
Self-directed Learning in Health Professions Education
More than 600,000 new citations were published in MEDLINE in 2005; this raised the total number of indexed citations to more than 14 million citations. In a study be Williamson et al, 2 out of 3 primary care physicians described the volume of literature as unmanageable, and 1 out...
Commentary
Risk Communications: In Search of a Pandemic
The first decade of the new millennium has seen a string of disasters worldwide – earthquakes, tsunamis, floods, typhoons and acts of terrorism – bringing in its wake, scenes of utter devastation and death. Predictably, these disasters have been accompanied by public outrage, directed more often than not at...
Review Article
Prevention and Control of Avian Influenza in Singapore
Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to the influenza A genus of the Orthomyxoviridae family.
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Review Article
Preparing for an Influenza Pandemic in Singapore
The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild.
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Review Article
Avian Influenza and Pandemic Influenza Preparedness in Hong Kong
In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred that year resulted in 6 deaths. The outbreak was completely terminated after the culling of over 1.5 million chickens.
This article is available only as a...
Review Article
Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia
Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases with an extremely high fatality proportion of 81% . Those patients were reported from 12 out of 33 provinces (Fig. 1).
This article is available only...
Review Article
A Global Perspective on Avian Influenza
The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat of a influenza pandemic.
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Review Article
Twentieth Century Influenza Pandemics in Singapore
Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population is clinically infected by seasonal influenza annually, and excess mortality over the past decade was about 14.8 per 100,000 person-years – comparable to temperate United...
Original Article
A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak
Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic in several parts of Asia. To date, there have been more than 200 human cases of AI virus infection, mainly as a result of poultry-to-human...
Commentary
Translating the Family Medicine Vision into Educational Programmes in Singapore
The core of the Family Medicine (FM) vision is patient-centred care, requiring specific education and vocational training. Modern day FM began its existence as a “counterculture” to the disease-and-body-part focus of the hospital specialties in the 1960s.
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Editorial
Singapore and the Tobacco Pandemic
The World Health Organization, in its 2008 Report on the Global Tobacco Epidemic, has framed the problem in almost apocalyptic terms, in stating that tobacco smoking is now the number one preventable cause of death globally. Smoking will kill up to 1 in 2 smokers and is a major...
Original Article
Seeing the Wood for the Trees: Approaches to Teaching and Assessing Clinical Pharmacology and Therapeutics in a Problem-based Learning Course
Over the last 3 decades, the rate of knowledge accumulation in drug development has been enhanced by advances in molecular modelling, the molecular genetics of drug action and the screening from natural sources for novel therapeutic agents. These advances mandate the need for a more adaptive and responsive educational...
Original Article
Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care
The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...
Original Article
Public Perceptions of Healthcare in Singapore
Healthcare is increasingly dominating the policy agenda in developed countries. In the United States, healthcare has been ranked only behind the war in Iraq as the issue the American public would “most like the president and Congress to act on next year”, while 19% of Canadians deemed healthcare the...
Others
Thoracic Complications of Radiofrequency Ablation of Recurrent Hepatoma
Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the past 5 years.
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Original Article
Public Misperceptions About Transmission of Hepatitis B Virus in Singapore
Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia, as 4% to 10% of the total population are affected, and approximately 75% of patients with CHB worldwide reside in Asia.1,2 During the course of...
Others
A History of the Chapter of Public Health and Occupational Physicians
The history of the Chapter of Public Health and Occupational Physicians began with the founding of the Academy of Medicine in 1957. It was the first professional corporate body of medical and dental specialists in Singapore.
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Others
Impact of Various Continuing Medical Education Activities on Clinical Practice – A Survey of Malaysian Doctors on its Perceived Importance
Continuing medical education (CME) plays an indispensable role in the clinical practice of any doctor. The practice of evidence-based medicine today,1 or any meaningful learning per se, requires at least appropriate access to relevant updated medical information. However, the acquisition of such relevant medical knowledge can prove difficult and...
Letter to the Editor
Mohs micrographic surgery in Singapore: A long-term follow-up review
Dear Editor,
Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in...
Original Article
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore
As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be observed.1,2 This approach allows risk stratification that can reduce the rate of benign lesion removal by diagnostic lobectomies3 and its associated postoperative morbidity.4 However, thyroid...
Original Article
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...
Editorial
The case for better hospitalisation selection in cancer patients
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care.
There is little literature detailing emergency department (ED)...
Original Article
Characteristics of Medical School Graduates who Underwent Problem-Based Learning
Problem-based learning (PBL) is one of the medical education strategies to promote continuous active and self-directed learning.1,2 Our medical school implemented PBL in 1990 and currently there are 800 PBL graduates who are practising physicians. Studies have shown that PBL can change learning attitudes among undergraduate students3- 5 but...
Commentary
The Challenges of “Continuing Medical Education” in a Pandemic Era
Although pandemics of influenza have occurred (albeit rarely, i.e. once every few decades) for more than 3 centuries, recent outbreaks of H1N1 and H5N1 influenza1 and the severe acute respiratory syndrome (SARS),2 have necessitated the institution of such measures as school closure and mandatory quarantine of cases1 in a...
Clinical Update
The Evolving Role of the Community Pharmacist in Chronic Disease Management – A Literature Review
Pharmacy has matured as a clinical profession and is presently well positioned to transform itself from a product and task oriented (dispensing) to a patient oriented profession (provision of care, advice and counselling). Every day, millions of people across the world visit community pharmacies for their healthcare needs for...
Original Article
Pathological Video-Gaming among Singaporean Youth
Video-gaming and internet use are a part of the lives of children and adolescents today. Among countries that are highly wired with high speed internet access, Singapore had the second highest broadband penetration rate in 2008 next to South Korea in the world, with 88% of households having broadband...
Original Article
Trends in Importation of Communicable Diseases into Singapore
Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining 25% constitute of immigrant workers on work permit, foreigners on employment pass, and student pass holders.
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Original Article
Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from 13.7 million people in 2005 to 64.6 million people in 2050.
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Original Article
Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study
With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management of disease. However, participation in health screening can vary greatly within populations and is influenced significantly by sociodemographic and attitudinal factors.
This article is available only...
Original Article
The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening
Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an immediate and relevant setting. By linking theory and practice, experiential education differs from the traditional education in that it actively engages students in experiences that...
Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults.
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Original Article
Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics
In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and primary care clinics. Most studies have found that patients are agreeable to seeing medical students and value the opportunity to interact with them.
This article is...
Original Article
Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study
Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events.
This article is available only as a...
Original Article
Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore
The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign in advance to inform his or her attending doctor that he or she does not want any extraordinary life-sustaining treatment to be used to prolong...
Original Article
Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures
Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of the United States of America,1 the Emergency Preparedness Teams of the Singapore General Hospital and its sister institutions on the Outram Campus were activated. Measures...
Review Article
Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?
In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...
Original Article
Trends in Long-term Cancer Survival in Singapore: 1968-2002
With increasing health awareness and the greater extent of healthcare provision over the years, the life expectancy of Singaporeans has increased from 75.3 in 1990 to 78.4 in 2001. This suggests that cancer patients are surviving longer than before, due to an increasing number of delayed cancer deaths. Hence,...
Others
Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore
Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50 years. Today, 2.5 billion people over 100 endemic countries remain susceptible to this disease with an estimated annual incidence of 50 million leading to 22,000...
Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus.
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Original Article
Demographic Determinants of Survival in Osteosarcoma
The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that results of treatment have stagnated.
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Original Article
The Hidden Impact of Childhood Cancer on the Family: A Multi-Institutional Study from Singapore
Chronic childhood illnesses have varying degrees of impact on the children and their families. Some chronic conditions that have little or no impact on the children and their families whereas those at the other end of the spectrum that has a high impact, for example, the diagnosis of cancer....
Original Article
Two Strategies to Intensify Evidence-based Medicine Education of Undergraduate Students: A Randomised Controlled Tria
Knowledge and skills of evidence-based medicine (EBM) can be taught by many methods, such as role modeling evidence-based care, using evidence for clinical medicine instruction, and teaching specific EBM skills. Standalone courses and workshops away from the clinical environment are usually the traditional educational designs for teachers to convey...
Original Article
Causes and Features of Erythroderma
Erythroderma is a dermatological reaction characterised by extensive erythema and scaling of the skin secondary to a variety of causes. An improved understanding of the characteristics and aetiologies of this condition will guide management. In this retrospective study, we aim to describe the characteristics and explore the associated causes...
Letter to the Editor
Routine intraoperative frozen section adds little value to the management of thyroid nodules with Bethesda III cytology
Dear Editor,
We would like to highlight the need to reduce intraoperative frozen section (FS) during diagnostic hemithyroidectomy performed on thyroid nodules with Bethesda III cytology. Thyroid nodules are increasingly diagnosed and subjected to fine needle aspiration cytology. Bethesda III is a cytological category that consists of atypia or follicular...
Letter to the Editor
Telemedicine for palliative care: Current and future challenges
Dear Editor,
We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19 in Pakistan: Lessons, legislation challenges and future perspective”.1 We would like to share our perspectives on using telemedicine to deliver palliative care during the COVID-19...
Letter to the Editor
Managing buccal space tumours
Dear Editor,
The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are rare and hence present a management challenge. In a recent systematic review of 217 patients, 4 main surgical approaches were identified (intraoral, extended parotidectomy/rhytidectomy, transcutaneous...
Editorial
Sleep, Public Health and Wellness: The Elephant in the Room
The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of city dwellers can implement
to reduce their risk of accidents, coronary artery disease, diabetes, cancer and all-cause mortality while improving their cognitive performance. Unlike costly supplements...
Original Article
Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting
The rising occurrence of individuals suffering from multiple chronic diseases, namely multimorbidity, is of public health concern globally.1 The current prevalence of multimorbidity in Singapore ranges from 26 to 89% by various studies depending on the definition used and the population studied.2-5 With Singapore’s fast ageing population, where 1...
Editorial
Prevention and management of multimorbidity to ensure healthcare sustainability
Singapore has a healthcare system that is distinguished by its ability to achieve top health outcomes at very low healthcare expenditures.1 Yet one of the Ministry of Health’s (MOH) foremost policy concerns is the sustainability of the healthcare system in the face of a rapidly ageing society. With an...
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...
Commentary
Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?
Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.
—Louis D Brandeis
As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...
Original Article
A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012
Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over the world. Studies estimate that between 60% and 90% of people will suffer from low back disorders at some point in their life. Among the...
Editorial
Mentorship in Academic Medicine: A Catalyst of Talents
The field of medicine is complex. Its interwoven structure of clinical practice, medical education and biomedical research, coupled with intricacies of the health system, makes it challenging for one to navigate through without any help. In any academic medical centre (AMC) or hospital, there is an imperative for senior,...
Original Article
How do English-speaking Cancer Patients Conceptualise Personhood?
Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...
Editorial
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary...
Original Article
Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals
In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...
Editorial
MERS-CoV: Where Are We Now?
Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals. However, their full pathogenic potential was only realised when an outbreak of severe pneumonia with a high fatality rate occurred in southern China, and they...
Original Article
An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit
Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes in critical care. These physiological-based systems and models allow patients to be stratified according to their severity of illness and provide prediction of in-hospital mortality....
Original Article
“Are Medical Students’ Views of an Ideal Physician Eroding? A Study on Perceived Qualities of a “Role Model” Doctor Before and After Housemanship and between Two Cohorts Five Years Apart “
Role modeling has been reported as an increasingly prominent teaching need and strategy in the field of medical education. This aspect of training helps novice doctors to imbibe key values, attitudes, behaviours and ethics that define the medical profession. With the primary goal of medical education being to train...
Original Article
Anaerobic Bacteraemia Revisited: Species and Susceptibilities
Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...
Images in Medicine
Bone in the breast: Clinical, radiological and pathological correlation
An 84-year-old woman presented with a left breast mass that had been rapidly growing over a few months. On clinical examination, there was a large and firm left breast mass with no overlying skin change. The right breast was normal. The patient was treated in accordance with the Declaration...
Letter to the Editor
Treatment of Ewing sarcoma in children: Results from a single centre
Dear Editor,
Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12 are unique molecular signatures.1,2 Compared with the West where the annual incidence is 1–3 per million, incidence has been reported to be lower among Asians1...
Review Article
Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review
Colorectal cancer (CRC) is the one of most common cancers worldwide. Metastatic disease occurs in approximately half of all CRC patients, in either synchronous or metachronous presentations.1 These patients form a heterogenous group that vary in presentation, disease progression and treatment options.
Advancements in surgery and chemotherapy have revolutionised the...
Original Article
Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study
Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...
Editorial
Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions
Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...
Editorial
Laparoscopic liver resection: Global diffusion and learning curve
Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the risk of uncontrolled major haemorrhage and potential compromise of oncologic outcomes, were not supported by the data. On the contrary, LLR was found to be...
Letter to the Editor
Health professions education in pandemics and epidemics: A proposed framework for educators
The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and after pandemics and epidemics. We developed a crisis management framework which
draws from diverse theories to emphasise preparedness, leadership, stakeholder perceptions and organisational learning to provide...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Commentary
Merits of a harmonised system to classify drug-related problems in Singapore
A drug-related problem (DRP) is commonly defined as an event or circumstance involving drug treatment that actually or potentially interferes with the optimal outcome of a patient’s medical care. It broadly includes events related to errors, adverse effects or adherence issues. DRPs are associated with increased healthcare costs and...
Original Article
Factors influencing protective behaviours during haze episodes in Singapore: A population-based study
Southeast Asia suffers from recurrent episodic air pollution from biomass smoke known as haze, which is mainly caused by human activities such as the extensive use of fire to clear land for agriculture,1 or to settle disputes over land rights.2 It is a major public health problem affecting an...
Editorial
Seasonal haze: Knowledge gaps and risk perception behaviours
The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural fires, has vast effects on multiple countries in the region.
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Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Images in Medicine
An unusual submandibular tumour
A woman in her 60s presented with a non-tender, non-enlarging swelling in the left submandibular triangle of the neck for 3 months. She had no significant past medical or surgical history. Examination showed a 2cm firm round lump in the left submandibular triangle, not attached to the skin, mandible...
Letter to the Editor
Penile preserving surgery in penile cancer management
Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates in developing countries (2.8–6.8 per 100,000) compared to Western countries (as low as 0.3 per 100,000). However, in the UK, which is a developed country,...
Original Article
Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore
Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years and above will be close to 1.5 million by 2030, corresponding to 2.7 working adults per older adult in 2030.2 Between 2019 and 2050, Singapore...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...