Ann Acad Med Singap
-
Ann Acad Med Singap · Dec 2023
ReviewPolycystic ovary syndrome v.2023: Simplified diagnostic criteria for an East Asian phenotype.
Two decades after the Rotterdam 2003 consensus workshop, there have been considerable advances in elucidating the pathophysiology and epidemiology of polycystic ovary syndrome (PCOS). This has prompted the re-examination of the features that characterise this common condition. Current definitions have led to great heterogeneity in the prevalence of PCOS and have contributed to inconsistent treatment protocols and assessment of therapeutic outcomes. Diagnosis is further complicated by the lack of universal agreement on threshold cut-offs for ovarian dysfunction and ethnic differences in hirsutism; both of which are key features in the definitions that are commonly used currently. These challenges often result in dissatisfaction with medical care among PCOS patients and their physicians. ⋯ As such, we propose a simplified criteria wherein the presence of at least 2 of the 3 features below would be sufficient to define PCOS: (1) chronic oligo-ovulation or anovulation as indicated by oligomenorrhea (cycle lengths >35 days) or amenorrhea; (2) PCOM: raised AMH ≥37.0 pmol/L instead of transvaginal ultrasound assessment of ovaries; and (3) Androgen excess, or raised serum androgens above the laboratory reference for women. Further studies are required to examine whether the proposed criteria would reduce diagnostic confusion and improve care and outcomes, especially among patients of East Asian ethnicities.
-
Ann Acad Med Singap · Dec 2023
Review Meta AnalysisA systematic review and meta-analysis on the effect of goal-directed fluid therapy on postoperative outcomes in renal transplantation surgeries.
This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature. ⋯ While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.
-
Ann Acad Med Singap · Dec 2023
An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study.
Determining the exact weight of children is a challenging task during emergency situations. Current guidelines recommend the use of length-based weight-estimating tapes. However, healthcare providers must either always carry the tapes or take time to locate them. Moreover, they may not know how to use them. To address these issues, we developed an augmented reality smartphone application for length-based weight estimation called the Paediatric Augmented Reality Scale (PARS). We evaluated its performance and compared it to that of the Broselow tape (BT) and Paediatric Advanced Weight Prediction in the Emergency Room extra-long and extra-large (PAWPER-XL) tape methods. ⋯ PARS exhibited a modestly better performance than BT and PAWPER-XL in estimating body weight. PARS-estimated body weights correlated fairly accurately with the actual body weights. PARS holds potential utility in paediatric emergencies.
-
Ann Acad Med Singap · Dec 2023
Understanding the use of evidence-based medical therapy in patients with peripheral artery disease: A qualitative study using the Tailored Implementation for Chronic Diseases Framework.
The global burden of peripheral artery disease (PAD) has been increasing. Guidelines for PAD recommend evidence-based medical therapy (EBMT) to reduce the risks of cardiovascular events and death but the implementation of this is highly variable. This study aimed to understand the current practices regarding EBMT prescription in PAD patients and the key barriers and facilitators for implementing PAD guidelines. ⋯ Findings from this study may inform strategies for improving healthcare professionals' adherence to guidelines and patients' medication adherence.