Sengkang General Hospital (abbreviation: SKH) is one of Singapore's public hospitals. The 1000-bed hospital opened its doors on 18 August 2018 and serves mainly the population of northeast Singapore, in particular Sengkang, Punggol, Hougang and Pasir Ris.The hospital is managed by Sengkang Health.Offering general hospital services with community-based care, the hospitals are part of Singapore's master plan in providing quality and accessible healthcare to all Singaporeans. The Sengkang General Hospital also partners with primary care physicians, polyclinics and intermediate and long-term care providers to offer more community-based care for the residents of northeast Singapore.
Existing self-administered, pre-participation screening questionnaires for physical exercise have not demonstrated high take-up rates in many populations. There is evidence that part of the reason for this may be the language of these questionnaires and difficulty in understanding these questions by lay persons, especially those with existing medical conditions that may be of concern if engaging in physical exercise. The medical referral rates for existing questionnaires appears excessive. There has also not been a demonstrable decrease in sports emergencies following current use of these questionnaires. Based on the lessons learnt from previous surveys and the evidence behind existing questionnaires, an eight-question International Physical Exercise Screening Questionnaire (IPESQ) is proposed. This paper discusses the roles played by pre-participation screening questionnaires in preventing or minimizing the occurrence of sports emergencies, desired characteristics of pre-participation exercise screening questionnaires and describes the justification for each of the IPESQ questions and how the Questionnaire may be implemented. It proposes a tool that is based on studies that have actively sought public feedback, and used the level of evidence currently available in the scientific literature as proof of relevance and usefulness. The proposed IPESQ will need to be actively implemented and its impact determined with monitoring of sports-related emergency rates. It is relevant to an international audience, since sports emergencies such as cardiovascular collapse, injuries and heat illnesses are universal phenomena. The IPESQ can be regarded as a promising but not yet proven instrument to minimize the occurrence of sports emergencies.
Diabetes mellitus presents a growing public health challenge across geographies including Asia, particularly in countries where blood glucose monitoring (BGM)—referring to capillary finger-prick self-monitoring of blood glucose (SMBG) using a meter and test strips—is underutilized. Having evolved and improved over recent decades, glucose monitoring (GM)—including SMBG and continuous glucose monitoring (CGM)—has become an essential tool for effective diabetes management, yet remains underutilized because of systemic, economic, and educational barriers. This work synthesizes expert insights and published evidence to develop best practice recommendations for BGM. A targeted literature review (TLR) was conducted across five thematic domains: monitoring practices, clinical decision-making, patient engagement and adherence, technology and innovation, and policy and reimbursement. Insights were complemented by a structured expert forum involving clinicians from seven Asian countries, underscoring larger implications in geographies where SMBG remains underutilized within the diabetes care continuum. The forum highlighted disparities in device access, affordability, and insurance coverage, and emphasized the need for structured diabetes self-management education (DSME) and digital integration. Findings support the use of structured SMBG for non-insulin-treated type 2 diabetes and CGM for insulin-treated individuals and those at risk of hypoglycemia. Evidence from the literature review also highlighted the importance of proper SMBG technique, with common errors such as inadequate handwashing, repeated lancet use, and excessive finger squeezing contributing to inaccurate readings and finger-site injuries. Hybrid models combining CGM and SMBG for calibration or confirmation are pragmatic solutions balancing clinical utility and affordability. Digital platforms, AI-driven analytics, and mobile apps enhance patient engagement and glycemic control but face challenges of scalability and regulation. Policy reforms, including inclusion of BGM in national health benefit packages, expanded insurance coverage, and public–private partnerships, are critical to improving access. The recommendations advocate for personalized, context-specific monitoring strategies that balance clinical efficacy with affordability and infrastructure realities. This consensus-based framework aims to guide healthcare professionals in optimizing BGM practices and improving long-term outcomes for people living with diabetes. FITTER BiG is a new extension of the long-standing FITTER initiative, which has provided insulin injection technique recommendations for more than two decades. FITTER BiG complements this work by focusing specifically on best practice recommendations for blood glucose monitoring. FITTER BiG will provide BGM-specific recommendations designed to complement the injection technique guidance outlined in the FITTER Forward consensus statement (Klonoff et al. Mayo Clin Proc 100:682–699, 2025 [1]). Diabetes is increasing rapidly across Asia, and many people do not monitor their glucose levels often enough, even though regular glucose checking helps prevent serious health problems. Glucose monitoring can be done in two main ways: through a finger-prick test using a glucose meter, or through a wearable sensor that measures glucose levels throughout the day. These tools help people understand how food, medicines, physical activity, illness, and daily routines affect their glucose levels. In this project, we reviewed published research and gathered insights from diabetes specialists from seven countries across Asia to better understand how glucose monitoring is used, what challenges people face, and what practical guidance would help improve care. Specialists highlighted important barriers, including cost, limited insurance coverage, lack of education about proper technique, and difficulties accessing digital tools that help interpret glucose patterns. The experts agreed that finger-prick monitoring is useful for people who do not use insulin, while continuous monitoring with sensors is most helpful for people who use insulin or are at high risk of low glucose episodes. Using both methods together either at the same time or at different times can balance usefulness and affordability. Our recommendations provide simple, practical guidance on when to use each method, how often to check, and how to interpret glucose readings. We also describe policy actions, such as expanding insurance benefits and strengthening public–private partnerships, to help more people access these monitoring tools and achieve better long-term health outcomes.
To present a pattern-based, multimodality imaging approach for differentiating true high-flow vascular lesions from their clinical, imaging, and hemodynamic mimics in the head and neck. This curated pictorial review draws on cases from two tertiary institutions in Singapore, encompassing true high-flow vascular lesions – including arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), and carotid-cavernous fistulas (CCFs) – as well as mimics, including carotid arterial wall pathologies (e.g. pseudoaneurysms, carotid blowout, dissections) and hypervascular tumors (e.g. paragangliomas). Imaging findings across ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) were analyzed, with emphasis on structural and hemodynamic features. True high-flow vascular lesions are defined by direct arteriovenous shunting, with key imaging features including early venous opacification, arterialized venous drainage, and the presence of a nidus (in AVMs). In contrast, mimics may demonstrate overlapping clinical presentations or apparent high-flow characteristics but lack true arteriovenous communication. Advanced imaging techniques – including 3D CT angiographic reconstructions and time-resolved contrast-enhanced MR angiography (e.g. TWIST) – improve delineation of vascular architecture and enable dynamic assessment of flow patterns. Digital subtraction angiography remains essential for definitive characterization and treatment planning. Differentiation of true high-flow vascular lesions from their mimics relies on recognition of key hemodynamic and structural imaging features, particularly the presence of arteriovenous shunting. A pattern-based multimodality imaging approach facilitates accurate diagnosis, guides appropriate management, and reduces misclassification of clinically significant mimics.
To investigate whether the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in methadone-treated patients with opioid use disorder (OUD) and type 2 diabetes (T2D) is associated with improved cardiometabolic and mental health outcomes. This retrospective population-based cohort study of adults (≥ 18 years) on methadone with both OUD and T2D (hemoglobin A1c ≥ 6.5
Surgical simulation has evolved significantly, transitioning from basic models to advanced virtual reality (VR) platforms, addressing the limitations of cadaveric training such as cost, availability, and ethical concerns. VR offers a risk-free, immersive environment for trainees to practice complex procedures, providing real-time feedback and objective performance metrics. Despite its potential, VR applications in Otolaryngology (ENT), particularly temporal bone surgery, remain underexplored due to anatomical complexity and specialty size. The primary hypothesis of this pilot trial was that VR simulation would achieve comparable technical performance to cadaveric dissection, while enhancing self-perceived competency. As a pilot study, no pre-specified non-inferiority margin was established; statistical non-significance was interpreted as potential equivalence requiring validation in a powered trial. This study presents the development and pilot evaluation of a VR-based temporal bone dissection simulator, comparing its efficacy against traditional cadaveric training. A single-centre crossover trial involving 14 ENT residents was conducted, with participants randomized into two arms: one starting with VR simulation (VRS) and the other with cadaveric dissection (CD). The VR platform, developed in collaboration with I3 Simulations, incorporated haptic feedback, real-time performance tracking, and scaffolded learning modules. Outcomes were assessed using pre- and post-simulation questionnaires, System Usability Scale (SUS), Technology Acceptance Model (TAM), and Zirkle grading for procedural accuracy. Results demonstrated a 26.7
