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...
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
Using artificial intelligence as an ethics advisor
Dear Editor,
Ethical dilemmas are common in the practice of medicine and can lead to an array of seemingly reasonable decisions unless policies or regulations mandate certain actions. Choosing the appropriate solution requires not only biomedical evidence, but also requires the balancing of possibly divergent preferences, values, contextual factors 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
Screening of nasopharyngeal cancer in high-risk familial cohort: A practical approach using a screening algorithm
Dear Editor,
In Singapore, nasopharyngeal cancer (NPC) is among the top 3 cancers afflicting middle-aged males (30–49 years old).1 Unfortunately, patients with early-stage NPC are often asymptomatic, and most patients (approx. 70%) are diagnosed with advanced disease with adversely reduced survival. First-degree relatives of NPC patients have about 4 to...
Review Article
Clinical performance of automated machine learning: A systematic review
In medicine, machine learning (ML) has been applied in a wide variety of contexts ranging from administration to clinical decision support, driven by greater availability of healthcare data and technological development.1-5 Automated ML (autoML) enables individuals without extensive computational expertise to access and utilise powerful forms of artificial intelligence...
Editorial
Bridging expertise with machine learning and automated machine learning in clinical medicine
In this issue of the Annals, Thirunavukarasu et al.'s systematic review on the clinical performance of automated machine learning (autoML) highlights its extensive applicability across 22 clinical specialties, showcasing its potential to redefine healthcare by making artificial intelligence (AI) technologies accessible to those without advanced computational skills.1 This enables...
Commentary
Artificial intelligence in medicine: Ethical, social and legal perspectives
“Our future is a race between the growing power of our technology and the wisdom with which we use it. Let's make sure that wisdom wins.” — Stephen Hawking
The tsunami of artificial intelligence (AI) has arrived in medicine, penetrating every clinical specialty. Deep learning algorithms enable highly sensitive and...
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...
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...
Editorial
Promise and pitfalls of ChatGPT for patient education on coronary angiogram
The past decade has seen extraordinary and rapid progress in the field of artificial intelligence (AI), which produces computer systems capable of performing tasks that typically require human intelligence. These advancements have yielded wide-ranging applications across various domains that are revolutionising industries and transforming the way humans live and...
Original Article
Clinical efficacy of primary human papillomavirus (HPV) screening with partial genotyping for HPV-16 and HPV-18 subtypes in women from 25 years old
The World Health Organization has launched a campaign to eliminate cervical cancer on the basis of effective vaccines against oncogenic human papillomavirus (HPV) subtypes, with mass screening and eradication of high-grade pre-malignant lesions, cervical intraepithelial neoplasia grade-2 (CIN2) and grade-3 (CIN3).1,2 HPV-based screening has been shown to be sensitive...
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...
Review Article
Through the eyes into the brain, using artificial intelligence
Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...
Editorial
The eye as a window to the brain
Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact hold more truth than previously thought. We are currently able to distinguish a variety of systemic diseases by funduscopic inspection. Following the dawn of high-resolution...
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%...
Editorial
Idiopathic inflammatory myopathies: Not nearly the end of the road
The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and skin manifestations, to a potentially life-threatening complex condition of multiple organ involvement. In the recent decade, the discovery and addition of novel autoantibody profiles including...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Original Article
Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis
Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally. It is estimated that nearly 25% of the world’s population and more than 60% of type 2 diabetes mellitus (T2DM) patients have NAFLD. A prior...
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...
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...
Original Article
Glaucoma Pattern Amongst the Elderly Chinese in Singapore
Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of the blind due to glaucoma reside in Asia, the majority being Chinese.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Adenocarcinoma of the Cervix
It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...
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.
This article is available only as a PDF. Please...
Original Article
Use of Ligase Chain Reaction and Polymerase Chain Reaction on Urine Specimens to Detect Chlamydia trachomatis Infections in a Sexually Transmitted Diseases Clinic in Singapore
Infections caused by Chlamydia trachomatis are amongst the most common bacterial sexually transmitted diseases (STDs) in the world, causing substantial morbidity in young sexually-active people. C. trachomatis causes a variety of clinical syndromes in males (including urethritis and epididymitis), females (including cervicitis and pelvic inflammatory disease), and new-borns (including...
Original Article
Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial
While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for abnormal mammograms are proven to be benign on histology. An accurate correlation between abnormal mammographic features detected on screening and their corresponding histology or predictive...
Others
Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases
Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is more compact and less trabeculated than the right ventricle.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Current Understanding of Pre-eclampsia
Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly to perinatal morbidity and mortality.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Osteoporosis Risk Factor Assessment and Bone Densitometry—Current Status and Future Trends
Osteoporosis affects predominantly elderly women; although younger women and men may also be affected. Demographically, the number and proportion of the elderly (aged 65 years and above) in many countries is increasing rapidly, and the problem of osteoporosis will increase concomitantly.
This article is available only as a PDF. Please...
Original Article
Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice
The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications.
This...
Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Financing Newborn Screening Systems: US Experience
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Legal Issues in Neonatal Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Establishing a Universal Newborn Hearing Screening Programme
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Impact of the National Hearing Screening Programme in China
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Considerations in Choosing Screening Conditions: One (US) Approach
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
An Intelligent Tutoring System for Trauma Management (Trauma-Teach): A Preliminary Report
In Singapore, trauma1-7 is the leading cause of hospitalisation and the fifth leading cause of morbidity and mortality.8,9 Common causes of trauma include road traffic accidents, industrial accidents, falls and recreational activities. In treating the trauma patient, it is essential that the processes of resuscitation and the identification of...
Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Original Article
Screening Tools for Bacteraemia in a Selected Population of Febrile Children
Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from bacteraemia and sepsis, which is accompanied by findings of serious systemic illness.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Prevalence of Adolescent Idiopathic Scoliosis among Female School Children in Singapore
Scoliosis screening in schools is still widely practised worldwide despite some countries abandoning the practise in recent years. Screening usually consists of visual inspection of the back, Forward Bending Test (FBT) and measurement of the angle of trunk rotation (ATR) using a scoliometer.
This article is available only as a...
Review Article
Human Immunodeficiency Virus (HIV) in Pregnancy: A Review of the Guidelines for Preventing Mother-to-Child Transmission in Malaysia
Pregnancy, whether actual or anticipated, has been a critical driver for the diagnosis, treatment and care of women with human immunodeficiency virus (HIV). Unlike other viral infections during pregnancy, maternal HIV infection is not associated with congenital abnormalities, adverse effects on the miscarriage rate or pregnancy outcome. Transmission of...
Original Article
Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study
Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals. However, there is currently no recommendation for supplementary ultrasound scan in breast cancer screening. Moreover, it is known that dense breasts, which are common in...
Original Article
National Health Survey on the Prevalence of Urinary Abnormalities in the Population: then and now (1975 to 2012)
In the planning of a tuberculosis prevalence survey in Singapore in 1975, it was decided to include a urine examination of the respondents using Labstix (Ames Company, Elkhart, Indiana, USA). Respondents found to have proteinuria, haematuria or both in the examination centres were then referred to the Department of...
Original Article
Hearing Loss in Newborns with Cleft Lip and/or Palate
Cleft lip and/or palate (CL/P) is one of the commonest congenital malformations. A recent update collating data from international organisations for the years 2002 to 2006 reported an overall international rate of 7.94 in 10,000 live births with the highest prevalence of 10.2 occurring in the Asian continent. In...
Review Article
Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review
The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...