Tan Tock Seng Hospital

Reminiscence has been shown to augment quality of life, cognition and mood in persons with dementia. While its benefits are well-documented, less is known about how family caregivers can independently facilitate such activities (i.e., dyadic reminiscence) at home. This is particularly relevant for nurses, who prepare caregivers for home-based dementia care. This study examined the experiences and perceptions of family caregivers delivering structured home-based reminiscence to persons with dementia in Singapore. An exploratory descriptive qualitative study was conducted with eight family caregivers of persons with dementia, discharged from a public tertiary hospital. Semi-structured individual interviews were conducted, and data were analyzed inductively using thematic content analysis. Caregivers reported ease in conducting dyadic reminiscence activities using the provided package. Three themes and six subthemes emerged. The themes were: 1) Unlocking the power of Caregiver-delivered Reminiscence: Exploring its Benefits; 2) Limited by Design: Challenges Encountered with Home Reminiscence and 3) Looking ahead: Practical Suggestions for Enhancing Caregiver-delivered Home Reminiscence. While dyadic reminiscence helped foster relational connection and engagement, personalization and cultural resonance of the materials are needed for it to be sustained. Caregiver-delivered dyadic reminiscence demonstrates feasibility and potential as a low-cost, non-pharmacological therapeutic supplement in home-based dementia care. Active facilitation empowers caregivers as co-creators of meaningful engagement. Nurses play a pivotal role in equipping caregivers with practical skills, tailoring activities to cultural, personal contexts and embedding reminiscence into care planning. Further research is warranted to assess its broader applicability across Asian caregiving contexts.

Genetic nephrology has emerged as a distinct subspecialty within nephrology with growing evidence supporting its clinical utility and cost-effectiveness across diagnostic, prognostic, and management pathways. Yet significant implementation gaps such as undefined clinic models and outcomes, limited use of implementation science frameworks, ad hoc strategy development, and a narrow focus on diagnostic yield and clinical utility hinder its routine adoption and integration. This research programme aims to systematically design, implement, and evaluate a multidisciplinary kidney genetics clinic model, using a theory-informed and stakeholder-engaged implementation science approach, to translate genomic advances into improved service, patient-reported, and implementation outcomes, and to inform sustainable and scalable kidney genomics care policy. Using a interconnected four-part, mixed-methods, multi-frameworks design underpinned by implementation science theory, the research programme will (1) review global kidney genetics clinic models, outcomes, determinants of successful implementation, and implementation strategies; (2) assess local stakeholder perceptions, priorities and contextual determinants using Consolidated Framework for Implementation Research (CFIR)-guided qualitative inquiry; (3) co-design and refine tailored implementation strategies via Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) mapping and hybrid participatory methods; and (4) evaluate the clinic’s service, patients, and implementation outcomes in a prospective effectiveness-implementation hybrid type 2 quasi-experimental interrupted time-series study design. Outcomes assessed include (1) service outcomes (diagnostic yield, clinical utility, and timeliness of care); (2) patient-reported outcomes (personal utility, patient-reported outcome measures); and (3) Proctor-defined implementation outcomes (acceptability, appropriateness, readiness, feasibility, and fidelity, and penetration). We will measure outcomes longitudinally across pre-implementation, implementation, and post-implementation phases, and analyse data using segmented regression analysis to assess changes in outcomes over time. The Implementation Research Logic Model (IRLM) will guide evaluation and adaptation throughout. This programme is designed to address critical implementation gaps between genomic evidence and clinical practice. Through four sequential studies, the programme will generate standardised kidney genetics clinic models and care pathways, evidence-informed implementation determinants, and context-tailored, co-designed implementation strategies. Taken together, this programme will establish a policy-relevant genetic nephrology care model with improved service, patient-reported, and implementation outcomes for the benefit of patients and families living with genetic kidney disease.

A low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet is a primary therapy for irritable bowel syndrome (IBS). One-on-one sessions with registered dietitians (RDs) require considerable resources and may not be readily available. This literature review assessed the impact of a low FODMAP diet group education in patients with IBS. Three relevant articles were identified. The RD-led low FODMAP diet group education was found to significantly improve gastrointestinal symptoms with good diet adherence. Patient preferences for education format varied, with approximately a quarter favoring group education and over 40% expressing no preference. Group education can be a practical and cost-effective alternative in IBS management.

Standard modifiable risk factors (SMuRFs) are associated with increased risk of acute myocardial infarction (AMI). Patients with AMI in the absence of standard modifiable risk factors (SMuRF-less) have demonstrated excess mortality. The study aims to forecast trends in prevalence and case fatality of SMuRF-less AMI in Singapore and United Kingdom. Data from the Singapore Myocardial Infarction Registry and the UK Myocardial Ischemia National Audit Project were used to construct Poisson regression models to predict the prevalence and case fatality rate of SMuRF-less AMI from 2025 to 2040. From 2025 to 2040, SMuRF-less AMI cases are expected to contribute to larger proportions of total AMI cases in Singapore (5.8% [95% CI: 5.2%-6.4%] to 8.5% [95% CI: 6.2%-10.8%]) and United Kingdom (13.8% [95% CI: 13.0%-14.6%] to 16.9% [95% CI: 15.1%-18.7%]). The proportion of SMuRF-less AMI mortality of the total AMI mortality is set to decrease in the United Kingdom (11.3% [95% CI: 10.5%-12.1%] to 9.5% [95% CI: 7.7%-11.4%]), but increase in Singapore (6.3% [95% CI: 5.7%-6.9%] to 13.3% [95% CI: 10.9%-15.6%]). Men continue to bear the majority of SMuRF-less AMI prevalence, with the most rapid rise in young adults in Singapore (8.1%; 95% CI: 7.5%-8.7%) and middle-aged adults in the United Kingdom (2.3%; 95% CI: 1.5%-3.1%). The increase in SMuRF-less AMI prevalence is set to be more rapid in the overweight/obesity population (3.9%; 95% CI: 3.3%-4.5%). By 2040, SMuRF-less AMI will expand to a larger proportion of the AMI census in Western and Eastern populations. SMuRF-less AMI vulnerability will shift toward a younger, male-dominant demographic, with overweight/obesity as a dominant risk factor.

Abstract Vibrios are important aquatic human pathogens, causing gastroenteritis, wound infections, and cholera. Vibriosis (non-cholera infection) has been increasing in temperate climates due to correlation between Vibrio abundance and water temperature. However, how warming oceans differentially influence various Vibrio species, and whether incidence is higher in tropical regions, remains understudied. We assembled the first comprehensive dataset of culture-confirmed vibriosis cases outside a temperate climate from equatorial Singapore. Comparison to cases from the detailed United States (US) CDC COVIS system revealed that vibriosis incidence is over two times higher in Singapore than the United States. Causative species also differ markedly, with Vibrio fluvialis and non-toxigenic Vibrio cholerae dominating in Singapore (>40%) but are much less prominent in the United States (<15%). Singapore cases have remained stable in the last decade, while US incidence is rising rapidly, especially for V. fluvialis and V. cholerae (13% and 17% per year). Differences in causative species in Singapore and the United States suggest ecological factors may shape infection dynamics, with some species benefitting more from warming oceans, raising their equatorial prominence. Incidence is stable in Singapore, likely due to slower warming of waters near the equator. In contrast, vibriosis in the United States will likely continue to increase steadily, with changing species composition, likely becoming tropicalized.

To compare the performance and safety of six LLM-based scribing tools in generating ophthalmological clinical notes from simulated physician-patient encounters. This cross-sectional comparative study involved seven ophthalmic encounters, transcribed by six scribing tools (Heidi AI, Whisper GPT-4o, Whisper Gemini 1.5 Pro, i-scribe, Lyrebird, Twofold). Scribing tools were prompted to generate notes using Subjective, Objective, Assessment, and Plan (SOAP) format. Consultant-level ophthalmologists evaluated note quality using the Physician Documentation Quality Instrument (PDQI-9), which evaluates eight dimensions: "accurate", "thorough", "useful", "organized", "comprehensive", "succinct", "synthesized", "internally consistent" on a 5-point scale (with a maximum sum of 40). Text-generation metrics (ROUGE-L, BERTScore, BARTScore, AlignScore) were also used. Safety analysis was conducted to identify documentation errors categorised as omissions, incorrect information, and extraneous content. Heidi AI achieved the highest overall documentation quality (PDQI-9: 38.524, 95%CI: 37.815-39.233), followed by Whisper GPT-4o (38.048, 95%CI: 36.747-39.349). It scored highest in accuracy, usefulness, organisation, comprehensiveness, and succinctness, and led in ROUGE-L (0.326, 95%CI: 0.276-0.374), BERTScore (0.727, 95%CI: 0.707-0.747), and AlignScore (0.704, 95%CI: 0.650-0.758). All tools, however, exhibited errors. The most common were omissions of clinically relevant details, including disease severity, coexisting ocular conditions, systemic comorbidities, and management specifics. Some tools also generated incorrect or extraneous content, such as hallucinated patient requests or incorrect patient names. Among the evaluated LLM based scribing tools, Heidi AI demonstrated the highest performance and shows promise for supporting ophthalmology documentation. However, persistent errors, particularly omissions of critical details, were observed across all tools and could compromise patient care. Human oversight and rigorous verification processes remain essential before clinical integration.