Singapore medical journal
-
Singapore medical journal · Jan 2025
Characteristics and outcomes of patients with repeat rapid response team activations in a tertiary centre in Singapore.
Rapid response teams (RRTs) are prevalent in healthcare institutions worldwide. Repeated activations are associated with increased morbidity and higher resource utilisation, and represent a heterogeneous population that may benefit from early identification. To date, there are no published data on repeat RRT activations in Singapore. We aimed to compare the characteristics and outcomes between patients who required single versus multiple RRT activations. ⋯ Our study found that repeat RRT activations were significantly associated with higher in-hospital mortality rates and increased hospital length of stay, independent of age, performance status and comorbidities. The results of our study highlight the need for early recognition and intervention in this patient group and discussion on goals of care when appropriate.
-
Singapore medical journal · Jan 2025
Necrotising fasciitis in the elderly: comparison between patients aged 60 years and older and those younger than 60 years.
Increasing age is associated with an increased incidence of necrotising fasciitis. In this study, we aimed to compare the clinical presentation, investigations, microbiology and clinical outcome in elderly (age ≥60 years) and nonelderly (age <60 years) patients with extremity necrotising fasciitis. ⋯ In patients aged ≥60 years, necrotising fasciitis of the extremities is associated with significantly increased risk of amputation and mortality. It is important for the treating surgeon to be aware of this association, so that early appropriate empirical antibiotics and radical surgical debridement can be initiated and the patient appropriately counselled.
-
Singapore medical journal · Jan 2025
Impact of number of passes and futile reperfusion in basilar artery occlusion acute ischaemic stroke.
Mechanical thrombectomy (MT) is the standard of care in anterior circulation large vessel occlusion. A vital modifiable factor is successful reperfusion. While multiple passes improve the rates of successful reperfusion, previous studies have reported progressively diminishing returns. This study aimed to investigate the relationship between number of passes and outcomes in basilar artery occlusion (BAO). ⋯ Acute BAO patients treated with up to three passes of a thrombectomy device derived improved functional outcomes from reperfusion compared to those with more than three passes. Further prospective cohort studies are necessary to validate these findings.
-
Singapore medical journal · Jan 2025
Randomised controlled trials of dual antiplatelet therapy versus aspirin in patients with stroke or transient ischaemic attack: an updated meta-analysis.
We explored the efficacy and safety of dual antiplatelet therapy (DAPT) for individuals diagnosed with stroke or transient ischaemic attack (TIA), incorporating the latest insights from randomised controlled trials (RCTs). The emerging evidence surrounding DAPT in stroke and TIA plays a pivotal role in guiding clinical decisions. ⋯ Dual antiplatelet therapy - a combination of aspirin with either ticagrelor or clopidogrel - initated within 72 hours of a high-risk TIA or mild moderate ischaemic stroke is superior to aspirin alone in reducing the risk of recurrent stroke. However, DAPT comes with a higher risk of major bleeding.