Ann Acad Med Singap
-
Abstract
-
Ann Acad Med Singap · Dec 2018
Radiofrequency Microtenotomy with Concurrent Gastrocnemius Recession Improves Postoperative Vitality Scores in the Treatment of Recalcitrant Plantar Fasciitis.
Gastrocnemius recession and radiofrequency microtenotomy treat plantar fascia via different mechanisms. While studies have shown additive effects in performing plantar fasciotomy in conjunction with gastrocnemius recession, no such study exists examining the effects of performing radiofrequency microtenotomy with gastrocnemius recession. We hypothesised that performing both gastrocnemius recession and radiofrequency microtenotomy concurrently for recalcitrant plantar fasciitis is more effective than performing either procedure individually. ⋯ Combining radiofrequency microtenotomy and gastrocnemius recession in patients with recalcitrant plantar fasciitis and an underlying gastrocnemius contracture shows favourable medium- term outcomes compared to performing either procedure in isolation.
-
Psoriasis is a chronic inflammatory disease with a global prevalence of approximately 2% and significant psychiatric comorbidity. There is a great deal of existing literature assessing different aspects of psychology in psoriasis. We aimed to conduct an in-depth review of current evidence linking psoriasis to personality traits and psychiatric comorbidities, as well as factors that put these patients at risk of psychopathology. ⋯ The knowledge of personality characteristics, "at-risk" groups, and early recognition of psychological distress among patients with psoriasis can help clinicians provide better holistic care and encourage a change in patients' behaviour.
-
Ann Acad Med Singap · Dec 2018
Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap.
Clinical practice guidelines (CPGs) have become ubiquitous in every field of medicine today but there has been limited success in implementation and improvement in health outcomes. Guidelines are largely based on the results of traditional randomised controlled trials (RCTs) which adopt a highly selective process to maximise the intervention's chance of demonstrating efficacy thus having high internal validity but lacking external validity. Therefore, guidelines based on these RCTs often suffer from a gap between trial efficacy and real world effectiveness and is one of the common reasons contributing to poor guideline adherence by physicians. "Real World Evidence" (RWE) can complement RCTs in CPG development. ⋯ RWE can also advance the agenda of precision medicine in everyday practice by engaging frontline stakeholders in pragmatic biomarker studies. This will enable guideline developers to more precisely determine not only whether a clinical test or treatment is recommended, but for whom and when. Singapore is well positioned to ride the big data and RWE wave as we have the advantages of high digital interconnectivity, an integrated National Electronic Health Record (NEHR), and governmental support in the form of the Smart Nation initiative.
-
Ann Acad Med Singap · Dec 2018
Incipient Albuminuria in Persons with Newly Diagnosed Type 2 Diabetes Mellitus: A 5-Year Retrospective Cohort Study.
This study aimed to determine the 5-year incidence of albuminuria among Asian persons with newly diagnosed type 2 diabetes mellitus (DM), and to identify the risk factors at diagnosis for progression to albuminuria. ⋯ This study highlighted the importance of early screening and treatment of diabetes as well as prevention of hypertension, which could potentially delay the onset of microalbuminuria in persons with type 2 DM. Persons on ACEI or ARB treatment should continue to be monitored regularly for progression to albuminuria.