Cancer survivorship has emerged as a critical healthcare priority as global survival rates continue to improve. With the increase in cancer incidence and declining mortality in Singapore, healthcare systems face increasing demands to provide comprehensive care across the cancer continuum, from diagnosis and active treatment to end of life, while also addressing the long-term survivorship challenges, including psychosocial distress, fear of recurrence, and the absence of personalised survivorship plans. Current survivorship care remains oncologist-centric with limited stratification between hospital-based oncology services and community health providers. This underscores the urgent need for a national cancer survivorship framework and guidelines to meet the growing demands of cancer survivors while ensuring quality healthcare delivery. This review examines the current state and ongoing work of cancer survivorship care in Singapore, identifies existing challenges, and explores future directions towards developi
The competency-based medical education framework has driven the adoption of entrustable professional activities (EPAs) for workplace-based assessment, yet real-world implementation experience from Southeast Asian settings remains scarce. In this commentary, the authors describe the transition to an EPA-based assessment model in an internal medicine residency programme in Singapore, drawing on perspectives from the programme director, core faculty members, programme coordinator, and graduates who participated in a roundtable discussion. Six key lessons emerged. First, explicit and repeated dialogue about trust is needed to secure buy-in from learners and assessors. Second, EPA tasks and standards must be clearly linked to core professional competencies while balancing assessment burden through simplified, distributed workplace-based assessments. Third, informal feedback from supervisors, though often undocumented, carries valuable performance information that should be systematically captured. Fourth, overall
Complement-mediated thrombotic microangiopathy (C-TMA), previously referred to as atypical haemolytic uraemic syndrome, is a rare cause of thrombotic microangiopathy (TMA). Secondary TMAs are heterogeneous conditions associated with established triggers (e.g. drugs, infection, pregnancy), some of which may be driven by complement activation. Differentiating between C-TMA and secondary TMA can be difficult, as there may be considerable overlap between the conditions. The authors describe 3 cases of TMA potentially involving complement activation as examples of a multidisciplinary approach to diagnosis and management in Singapore. Complement component 5 (C5) inhibition is central to the treatment of C-TMA, but lack of access to therapy remains a major challenge in the region, as illustrated by Case 1 (probable C-TMA). Case 2 (gemcitabine-associated TMA) and Case 3 (lupus nephritis-associated TMA) explore the emerging role of C5 inhibitors in secondary TMAs. Short-duration C5 inhibitor treatment is feasible for some patients without pathogenic gene variants but should be undertaken only with appropriate monitoring.
Introduction: Oral squamous cell carcinoma (OSCC) is a common malignancy that is frequently diagnosed at advanced stages, partly because of limitations in conventional diagnostic approaches. This systematic review aimed to evaluate the diagnostic performance of artificial intelligence (AI) models in detecting OSCC from clinical images. Methods: PubMed, ScienceDirect, the Cochrane Library, and Embase were searched from January 2000 to September 2024. Studies assessing the diagnostic accuracy of AI models for OSCC using clinical images were included. Studies that did not involve clinical images, were not specific to OSCC, or were not published in English were excluded. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, study selection was performed independently by 4 reviewers, with disagreements resolved through consensus. Subsequently, diagnostic accuracy data were extracted, risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies using AI, and thematic analysis was performed by 2 reviewers. Where appropriate, a random-effects meta-analysis was conducted. Results: Nine studies comprising 47,987 oral clinical images were included, with 6 studies in the meta-analysis. AI models demonstrated a pooled sensitivity of 0.94 (95% confidence interval [CI] 0.87–0.97), specificity of 0.95 (95% CI 0.86–0.98), and an area under the curve of 0.975 (95% bootstrap CI 0.911–0.986). AI systems generally achieved higher diagnostic accuracy than general practitioners and performance comparable to specialists under controlled study conditions. Conclusion: AI models show strong diagnostic performance for OSCC detection from clinical images. However, current evidence is largely derived from retrospective and heterogeneous datasets without external validation. Prospective and blinded studies are required to determine their role as decision-support tools in real-world settings.
Introduction: Sexual health is integral to women’s overall well-being, yet sexual dysfunction among women of reproductive age remains under-recognised and undertreated. These guidelines provide evidence-based recommendations for the screening, assessment, education, and optimisation of sexual health in this population. Methods: A multidisciplinary workgroup developed these guidelines using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)-ADOLOPMENT framework, supplemented by the appraisal of existing international guidelines using the Appraisal of Guidelines for Research & Evaluation II instrument. Two systematic reviews evaluated evidence on sexual health screening and interventions in women aged 21–45 years. The recommendations were adopted, adapted, or developed de novo based on certainty of evidence, balance of benefits and harms, patient values, resource considerations, and local applicability, and are classified as either evidence-informed or consensus-based with source attributions documented in a master recommendation table. Consensus was achieved through iterative discussion and formal voting across 2 rounds, with all recommendations reaching 100% agreement among the 20-member workgroup. Results: These guidelines cover 4 core domains: (1) Screening—promoting proactive sexual health discussions and the use of validated assessment tools; (2) Assessment—differentiating transient concerns from persistent dysfunction while considering medical, psychosocial, and relational contributors; (3) Education—enhancing sexual health literacy, promoting safe practices, and normalising variation; and (4) Optimisation—managing underlying medical conditions, promoting pelvic health, and facilitating timely specialist access. Special considerations for preconception, antenatal, postnatal, and other high-risk groups are included. Conclusion: These guidelines provide a structured, evidence-based framework to support sexual health among women of reproductive age. Implementation may enhance early identification and promote holistic, patient-centred management of sexual dysfunction, supporting positive sexual and overall health outcomes.
