It is crucial that policy makers, healthcare providers and relevant stakeholders understand how integrated care may be improved at our emergency departments (EDs) and what benefits that would bring. The potential that exists for right-siting care of special patient groups who could be managed in an ambulatory setting with the integration of a variety of hospital-based and community-based clinical support services is tremendous. This review describes the best practice and value of integrated care at the EDs. Local evidence is cited and compared with findings from overseas. The opportunities of care transition interventions among discharged patients are outlined, including that for paediatric patients, palliative care patients and patients with chronic diseases. This review also suggests ways to move forward to meet the aim of providing holistic care at EDs through integrated care programmes, innovation and research.
Humans ; Emergency Service, Hospital/organization & administration* ; Delivery of Health Care, Integrated ; Palliative Care ; Chronic Disease

In recognition of the morbidity and mortality associated with human immunodeficiency virus (HIV), the Joint United Nations Programme on HIV/acquired immunodeficiency syndrome (AIDS) (UNAIDS) aims to end the epidemic by setting and striving to achieve the ambitious 95-95-95 targets. However, Singapore is still not performing well in the first UNAIDS target. The National HIV Programme (NHIVP) developed this set of recommendations based on an adaptation of major international guidelines from the World Health Organization and the US Centers for Disease Control and Prevention. The goals of this recommendation are: (1) to increase the uptake of HIV testing; (2) to allow earlier detection and identification of individuals with unrecognised HIV infection; (3) to facilitate linkage to clinical services; and (4) reduce further transmission of HIV infection in Singapore.
Humans ; Singapore/epidemiology* ; HIV Infections/epidemiology* ; United States ; HIV Testing ; Mass Screening ; World Health Organization ; Practice Guidelines as Topic ; Centers for Disease Control and Prevention, U.S. ; National Health Programs

INTRODUCTION: An interdisciplinary panel, comprising professionals from medicine, AI and data science, law and ethics, and patient advocacy, convened to discuss key principles on regulation, implementation and evaluation of AI models in healthcare for Singapore. METHOD: The panel considered 14 statements split across 4 themes: "The Role and Scope of Regulatory Entities," "Regulatory Processes," "Pre-Approval Evaluation of AI Models" and "Medical AI in Practice". Moderated by a thematic representative, the panel deliberated on each statement and modified it until a majority agreement threshold is met. The roundtable meeting was convened in Singapore on 1 July 2024. While the statements reflect local perspectives, they may serve as a reference for other countries navigating similar challenges in AI governance in healthcare. RESULTS: Balanced testing approaches, differentiated regulatory standards for autonomous and assistive AI, and context-sensitive requirements are essential in regulating AI models in healthcare. A hybrid approach-integrating global standards with local needs to ensure AI comple-ments human decision-making and enhances clinical expertise-was recommended. Additionally, the need for patient involvement at multiple levels was underscored. There are active ongoing efforts towards development and refinement of AI governance guidelines and frameworks balancing between regulation and freedom. The statements defined therein provide guidance on how prevailing values and viewpoints can streamline AI implementation into healthcare. CONCLUSION This roundtable discussion is among the first in Singapore to develop a structured set of state-ments tailored for the regulation, implementation and evaluation of AI models in healthcare, drawing on interdisciplinary expertise from medicine, AI, data science, law, ethics and patient advocacy.
Singapore ; Humans ; Artificial Intelligence/standards* ; Delivery of Health Care/organization & administration*

INTRODUCTION: The high prevalence and mortality rates of breast cancer and lung cancer in Singapore necessitate robust screening programmes to enable early detection and intervention for improved patient outcomes, yet 2024 uptake and coverage remain suboptimal. This narrative review synthesises expert perspectives from a recent roundtable discussion and proposes strategies to advance breast cancer and lung cancer screening programmes. METHOD: A 2024 roundtable convened clinical practitioners, health policymakers, researchers and patient advocates discussed current challenges and opportunities for improving cancer screening in Singapore. Perspectives and insights were analysed to identify themes related to existing programme gaps, opportunities for innovation and implementation challenges. DISCUSSION: Singapore's national breast cancer screening programme has been in place for over 2 decades, yet screening uptake remains suboptimal. A national lung cancer screening programme, in contrast, is still in its early stages of implementation. Regardless, employment of risk stratification approaches that integrate genetic, demographic and lifestyle factors could enhance screening effectiveness by identifying high-risk indivi-duals, while also taking local epidemiological trends into consideration. Integration of digital health technologies, artificial intelligence and behavioural change models can enhance cancer screening uptake and accuracy to overcome barriers such as low awareness, cultural beliefs and socioeconomic factors that contribute to low participation rates. CONCLUSION Key recommendations include enhancing public awareness, refining screening guidelines, expanding access and applying innovative technologies. A coordinated effort among stakeholders is crucial to continually assess and enhance screening programmes to narrow the practice-policy gap and ultimately reduce breast cancer and lung cancer burden in Singapore.
Humans ; Singapore/epidemiology* ; Lung Neoplasms/epidemiology* ; Breast Neoplasms/epidemiology* ; Early Detection of Cancer/methods* ; Female ; Mass Screening/organization & administration*

Humans ; Pediatric Obesity/epidemiology* ; Child ; Consensus ; China/epidemiology* ; Ambulatory Care Facilities/organization & administration*

Signal detection is a critical task in drug safety regulation. However, it inevitably generates irrelevant or false signals, posing challenges for resource allocation by marketing authorization holders. To reasonably assess these signals, different countries have established various principles for prioritizing the evaluation of risk signals. This study systematically compares these principles and finds that the U.S. Food and Drug Administration(FDA) focuses on practical issues, such as identifying drug confusion or drug interactions. However, China's Good Pharmacovigilance Practices and the European Medicines Agency(EMA) emphasize a comprehensive evaluation framework. The Council for International Organizations of Medical Sciences(CIOMS) emphasizes the consistency of multiple data sources, highlighting the reliability of signal evaluation. China practices a multidisciplinary approach combining traditional Chinese and western medicine, and the risk signals related to traditional Chinese medicine(TCM) have unique characteristics, including complex components, cumulative toxicity, specific theoretical foundations, and drug interactions. The different priorities in risk signal evaluation principles across countries suggest that China should strengthen clinical trial research, emphasize corroboration with evidence of multiple sources, and pay particular attention to the risks of drug interactions in the TCM regulatory science. Establishing the risk signal prioritization principles that align with the characteristics of TCM enables more precise and efficient scientific regulation of TCM.
Humans ; Medicine, Chinese Traditional/standards* ; China ; Drugs, Chinese Herbal/adverse effects* ; United States ; United States Food and Drug Administration

With the development of education and technology, the construction of research public platforms has emerged as a critical initiative for many universities and top-tier public hospitals. The core and most fundamental function of a basic public platform is to aggregate large instruments and specific resources, providing open services for instrumental analysis and sample testing. Optimized management and high-quality, efficient services are essential for such platforms. This article elucidates the construction of a research public platform in West China Hospital, focusing on the adoption of hierarchical management and precise services. The core of the hierarchical management lies in building a multi-level service platform composed of routine support platforms, advanced technology platforms, and specially qualification platforms, while establishing a talent hierarchy that differentiates between core and routine positions. This structure is designed to accurately meet the diverse needs of users and enhance resource efficiency. By implementing user access control with differentiated permissions for internal and external users and a dynamic credit-based review system, the laboratory can ensure safe and efficient operations. The four service modes-instrument usage, in-lab experiments, sample testing, and collaborative projects-are precisely aligned with various research scenarios. Proactive engagement with grant-funded projects, customized services for research groups, and a multidimensional training system further strengthen the platform's support for major scientific research tasks. Through systematic management and service innovation, this model achieves efficient integration and sustainable development of platform resources, providing a valuable reference for the construction of public platforms in similar medical institutions.
China ; Research ; Laboratories/organization & administration*

Revision of anterior cruciate ligament (ACL) reconstruction is more challenging than primary ACL reconstruction and often yields less favorable outcomes. The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) has established a consensus regarding preoperative diagnosis, assessment, and selection criteria for ACL revision surgery. This consensus addresses 18 key issues that are most pertinent to clinical practice, providing guiding recommendations aimed at improving the prognosis of ACL revisions.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Arthroscopy/methods* ; Anterior Cruciate Ligament Injuries ; Societies, Medical ; Reoperation ; Consensus ; Anterior Cruciate Ligament/surgery* ; Europe ; Sports Medicine ; Knee Injuries/surgery* ; Knee Joint/surgery*

Primary malignant bone tumors are extremely rare. Osteosarcoma, chondrosarcoma, Ewing's sarcoma, and myeloma are the most common malignancy in bone. Osteosarcoma and Ewing's sarcoma are common in children and adolescents, and the tumors are high lethality due to the high rate of pulmonary metastasis. While chondrosarcoma, myeloma, and chordoma are more common in middle aged and elderly people. Japanese Orthopaedic Association (JOA) published the secondary clinical practice guideline on the management of primary malignant bone tumors. We put an emphasis on explanation some important issue of this guideline for help Chinese musculoskeletal tumor professionals in clinical practice.
Humans ; Bone Neoplasms/surgery* ; Chondrosarcoma/therapy* ; Japan ; Orthopedics ; Osteosarcoma/pathology* ; Practice Guidelines as Topic ; Sarcoma, Ewing/therapy* ; Societies, Medical

Hallux rigidus is the most common type of foot degenerative arthritis. With the aging of the population and the increasing demand for exercise, its incidence rate continues to rise. In October 2024, the American College of Foot and Ankle Surgeon (ACFAS) published 24 clinical consensus statements in the Journal of Foot & Ankle Surgery. The latest expert opinions are formed around hallux rigidus assessment, classification, conservative treatment, surgical indications, surgical method selection. Combined with the characteristics of Chinese patients and the current clinical situation, this article interprets and analyzes the key points of the consensus, and proposes individualized surgical plans for joint preservation, with the aim of providing evidence-based basis and decision-making reference for colleagues in domestic foot and ankle surgery.
Humans ; Hallux Rigidus/diagnosis* ; Consensus ; United States ; Foot/surgery* ; Ankle/surgery* ; Societies, Medical