INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

The field of onco-microbiome is rapidly expanding. Multiple studies have shown the crucial role of gut microbiota in the regulation of nutrient metabolism, immunomodulation and protection against pathogens. Tools for manipulating the gut microbiota include dietary modification and faecal microbiota transfer. Accumulating evidence has also documented the application of specific intestinal microbiome in cancer immunotherapy, notably in enhancing the efficacy of immune checkpoint inhibitors. The aim of this review is to focus on the East Asian microbiome and to provide a current overview of microbiome science and its clinical application in cancer biology and immunotherapy.
Humans ; Gastrointestinal Microbiome ; Neoplasms/microbiology* ; Immunotherapy/methods* ; Asia, Eastern ; Medical Oncology ; Fecal Microbiota Transplantation ; Immune Checkpoint Inhibitors/therapeutic use* ; East Asian People

Global Health ; Humans ; Medical Oncology ; methods ; organization & administration ; trends ; Neoplasms ; therapy ; Philosophy, Medical

In recent years, the impressive number of cancer immunotherapy drugs approved has been unprecedented-building on over a century of understanding on how the immune system combats cancer, and how cancer evades it. Leading the charge are the immune checkpoint inhibitor monoclonal antibodies, and adoptive cell therapy with chimeric- antigen-receptor (CAR)-T cell therapy. These breakthrough therapies have led to improved survival in patients with many advanced cancers. Some of the clinical outcomes have been striking, and may even be potentially curative in some terminal cancer patients. While immune checkpoint inhibitors work by blocking regulatory immune checkpoint signals between cancer and the immune cells to awaken an effective anticancer immunity, CAR-T cell therapy targets specific molecules on cancer cells. Tumour antigens as cancer targets take many forms and may not necessarily be proteins related to known functional cellular mechanisms. The convergence of cutting edge omics, bioinformatics, protein synthesis, immunobiology and immunotherapy have led to novel, potentially highly effective cancer targeting against neoantigens, hence reviving the quest for anticancer vaccines. Early clinical trials of neoantigen vaccines have provided proof-of-principle efficacy, especially in melanoma patients. Combinations of immunotherapies through rational design are underway aiming to further improve clinical outcomes. Moving forward, cancer immunotherapy will gain even more momentum from the discovery of more cancer targets-both on the cancer itself and in the tumour microenvironment as well as the identification of biomarkers of treatment resistance and efficacy.

Caregivers ; Humans ; Interdisciplinary Communication ; Medical Oncology ; trends ; Neoplasms ; diagnosis ; psychology ; therapy ; Treatment Outcome

Cancer immunotherapy has finally joined the pillars of cancer treatment—surgery, radiation, chemotherapy, hor-monal therapy, and targeted therapy—in improving cancer patient lives. In the last 5 years, the development of immune checkpoint inhibitor and T cell therapy, particularly chimeric antigen receptor (CAR) T-cell therapy, has been remarkable for the speed, scale, and number of drug approvals. Still, these treatments may also bring unusual adverse effects and clinical outcomes including unprecedented long-term survival. Interrogating the tumor microenviron-ment and identifying better biomarkers hold the key to improving cancer immunotherapies. CAR T-cell therapy has dramatic effect on leukemias and lymphomas with significant cure rates, but has yet to show comparable effect on solid tumors. Cutting-edge technology will improve both processing and clinical effect of such therapies. Asia has the largest, most rapidly aging population and the largest number of cancer patients in the world. Research and develop-ment and clinical trial conduct of cancer immunotherapy in Asia remain nascent, but should be a crucial priority.

Abscess ; surgery ; Adult ; Aged ; Aged, 80 and over ; Cysts ; surgery ; Drainage ; methods ; Endometriosis ; surgery ; Fallopian Tube Diseases ; surgery ; Female ; Humans ; Middle Aged ; Ovarian Cysts ; surgery ; Pelvis ; surgery ; Retrospective Studies ; Surgery, Computer-Assisted ; Tertiary Care Centers ; Treatment Outcome ; Ultrasonography ; Ultrasonography, Interventional ; methods ; Vagina ; Young Adult

Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.
Academic Medical Centers ; economics ; organization & administration ; Cost-Benefit Analysis ; Financing, Government ; Health Care Costs ; Health Care Rationing ; Quality of Health Care ; Singapore

Global Health ; Humans ; Internationality ; Neoplasms ; epidemiology ; prevention & control

Hope is essential in the face of terminal cancer. Generally in Western societies, patients and their families prefer their doctor to engage them in transparent, realistic, authoritative, empathic and open communication about the diagnosis and prognosis of cancer but this topic is not well studied in the Asian context. With the exponential increase in information about cancer and the many permutations in cancer treatment, rational and otherwise, the doctor-patient relationship is even more critical in planning the best treatment strategy and also in rendering both particular and general hope in the patient's war against cancer. Overall, the majority of drugs tested against cancer have failed to reach the market, and those that have, only provide modest benefits, several major therapeutic breakthroughs notwithstanding. Commoditised medicalisation of the dying process ingrained into the contemporary consciousness can potentially create unrealistic or false hope, therapeutic nihilism and a drain on the resources of both the patient and society. These factors can also detract from the dignity of dying as an acceptable natural process. Hope cannot be confined only to focusing merely on the existential dimension of improving survival through technological intervention. Psychosocial and, where appropriate, spiritual interventions and support also play major roles in relieving suffering and providing hope to the patient. Hope cannot be a victim of misinformation from self-interested external parties, nor be an obsession with just buying promises of extending survival time without sufficient regard for quality of life and achieving a good death.
Attitude to Death ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Physician-Patient Relations ; ethics ; Prognosis ; Spirituality ; Terminal Care ; ethics ; methods ; psychology ; Truth Disclosure ; ethics