Ann Acad Med Singap
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Ann Acad Med Singap · Feb 2021
ReviewMetformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review.
Practice guidelines advise caution on the use of metformin in patients with type 2 diabetes mellitus with chronic kidney disease (CKD). This review aims to examine the evidence for the benefits and risks of metformin use in patients with T2DM and CKD. ⋯ Existing recommendations to restrict metformin use in diabetes patients with CKD need to be reviewed in light of emerging evidence supporting its overall benefits in these patients.
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Ann Acad Med Singap · Feb 2021
Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore.
Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers. ⋯ Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.
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Ann Acad Med Singap · Feb 2021
Causes, functional outcomes and healthcare utilisation of people with cerebral palsy in Singapore.
A voluntary cerebral palsy (CP) registry was established in 2017 to describe the clinical characteristics and functional outcomes of CP in Singapore. ⋯ Optimisation of pre- and perinatal care to prevent and manage prematurity could reduce the burden of CP and their overall healthcare utilisation.
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Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets and genetic mutations) underlying various phenotypes (age of onset, ethnicity, disease severity, etc.). The corresponding heterogeneity in underlying patho-mechanisms of the disease has resulted in an impetus towards an endotype-driven management of AD. We propose a practical approach that is based on classifying AD patients into intrinsic and extrinsic phenotypes and their corresponding underlying endotypes. This approach aims to provide a practical method that integrates recent understanding of AD pathogenesis for a targeted endotype-driven management of AD.