Singapore medical journal
-
Singapore medical journal · Feb 2024
Functional outcome of direct anterior versus posterior approach in total hip arthroplasty: a propensity-matched Asian study.
The direct anterior approach (DAA) to total hip arthroplasty (THA) is a surgical approach that minimises soft tissue trauma, resulting in faster rehabilitation when compared to a posterior approach (PA). This study aimed to evaluate the difference between the two groups in an Asian cohort using propensity score matching. ⋯ In this study, patients who underwent DAA THA had better functional outcome at 2 years and almost 2 days shorter overall LOS than those who underwent PA THA. Therefore, the DAA to THA is a novel technique that has shown improved functional outcomes, with fewer complications compared to PA THA.
-
Singapore medical journal · Feb 2024
Distilling lessons from home hospital implementation: a narrative scoping review.
Multiple Cochrane Reviews have demonstrated 'hospital at home' (HaH) as a promising healthcare model to be explored, with benefits such as higher care quality, reduced readmissions, shorter lengths of stay, lower cost and greater patient satisfaction. While there have been many reviews focusing on the quantitative clinical outcomes of HaH, there is generally a lack of collation of qualitative insights from stakeholders and lessons learnt from past HaH implementation. ⋯ HaH presents a promising alternative care model, and many of the success factors identified, including the strong push for multidisciplinary single care teams, existing frameworks for data sharing and strong community network, are already present today. As such, Singapore appears to be well positioned to adopt a new care model like HaH.
-
Singapore medical journal · Feb 2024
Analysis of a preimplantation genetic test for aneuploidies in 893 screened blastocysts using KaryoLite BoBs: a single-centre experience.
Does euploidy of trophectoderm (TE) biopsies correlate with conventional blastocyst morphological, maternal age and implantation potential? ⋯ Blastocyst morphology, rate of development and maternal age were found to be significantly associated with euploidy rate. There is a trend that suggests PGT-A may help to improve the pregnancy rate, but it is not statistically different, and therefore, PGT-A remains an unproven hypothesis. Due to the limitation of a small size of the control group, further studies with more data are needed.
-
Singapore medical journal · Feb 2024
Obstructive sleep apnoea and nocturnal atrial fibrillation in patients with ischaemic heart disease.
Arrhythmias, especially atrial fibrillation (AF) and ventricular arrhythmias, are independent risk factors of mortality in patients with ischaemic heart disease (IHD). While there is a growing body of evidence that suggests an association between obstructive sleep apnoea (OSA) and cardiac arrhythmias, evidence on this relationship in patients with IHD has been scant and inconsistent. We hypothesised that in patients with IHD, severe OSA is associated with an increased risk of nocturnal arrhythmias. ⋯ In patients with IHD, there was a significant association between severe OSA and nocturnal AF/flutter. This underscores the need to evaluate for OSA in patients with IHD, as it may have important implications on clinical outcomes.
-
Singapore medical journal · Feb 2024
Increased left ventricular remodelling index in paradoxical low-flow severe aortic stenosis with preserved left ventricular ejection fraction compared to normal-flow severe aortic stenosis.
Patients with paradoxical low-flow (LF) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) appear distinct from normal-flow (NF) patients, showing worse prognosis, more concentric hypertrophy and smaller left ventricular (LV) cavities. The left ventricular remodelling index (LVRI) has been demonstrated to reliably discriminate between physiologically adapted athlete's heart and pathological LV remodelling. ⋯ Pathological LV remodelling (increased LVRI) was more common in patients with LF AS, and increased LVRI independently predicts worse clinical outcomes.