NEWS - SingHealth

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NEWS - SingHealth
NOV
DEC
2013
a Bimonthly PuBlication of
SingaPore general hoSPital
and Singhealth academic
healthcare cluSter
mci (P) 069/06/2013
www.sgh.COm.sg | www.siNghEalth.COm.sg
sPECial
BeSt overall
editorial
4-PagE malaY
sUPPlEmENt
brONzE
CONtENt markEtiNg
awarDs 2013
Nov
Dis3
201
n
TerbiTaal besar
HospiT ura dan
singap lan
Kumpu alTH.
singHe
n
alaka
Menyjangka
bom
Klinikudaraanf
Peng n invasi
Buka (Niv)
3,
a, blok
sGH
it luar
si
LoKa pakar pesak
N
Klinik sgH
arKa 2011, klinikn
1,
Ditaw
aras
yaNG pada tahun it denga
pesak an yang
aPa
uhkan
para
ditub bantu pengudara ya meskan
aman udar a
ini mem
n
guna
terut
meng invasif, an lalua dan bagi
n
tekan (bpap), masalah
buka
esin
ai
an
in-m dwi-tahap puny
if
fas deng
mem
posit
berna an lebih ka yang
mere fasan akantidur deng kema
perna baik dan
kan risiko
lebih , mengurang
nding
selesa hospital. How, peru n dan
afasa sgH,
Thun
sukan ong
pern
al,
tan
dr
Kritik ai seogaan
n, Jaba
Kana atan penjai mempuny masaga
n
menj
perub ta: “Kam
anga
berka doktor yang, dan kakitmencari
fasan untuk n bpap,
dirang
kal
perna
telah kit
alah gan tekni mesin-mesi pesakit
0 orang penya
2010.t
sokon masalah
u para n atau
da 10,00
tal untuk
bant
tapa
daripake hospi pada tahunakiba
punca
mati itu.
pene
Lebih kkan
rti mem
i
kronik
sepe esua ikan
masu fasan orang telah tahun
ng
r Terap
meng
pada
ia mera-mesin
OnD
perna ar 440
paka n, unit
but
meny p mereka.”
a
Desm
sepitu meno
lew,
mesin ahap untuk
Sekit kit terse
Oleh
pelitu nanc y pernafasa bekerja
sot secar
p muka
penya
nya. laluan udara
66, hidup hnya
tif dwi-t
mero apai usia i
cik
yang fung si
urus
bin,
fasan
an
kita
ke pelitu t encikdi ruma
an
peng Tidur, sgH,
tiub
perna
tekan
paru a kita menc it fungs
mulu
Ho Weetawanan lalu.
dan
elask da para i
mesin melalui g dan meningkat
unsedik yakan
si paru- k sahaj
guan
ng
nciK
en
sa
meng
hidun
gang ik ini, menj kepa hidap
udara
“Fung an sebai kehilangan keban dari
oksig
apa tahun
erti seora
an
bagi
u tidak pasarayah lak menutupi but, sentiatekanan antara
persin bpap meng
beber
diklin
perlah s. Kita tahun.
itan
– katak usia 95
yang
n-me
kan
terse
sejak lama belia elah,
yang
ngka
k balas
berka mereka
mesi
ndah
baru
25 keata setiap kita mati pada boleh
h
mesin
beli-b a mela minit
kit
kit
tinda
paru
Ho.
mere
ng
suda t mem keran
kin
enya
apa
bantu
pesa
paru- , pada saatg atau barah masih
utan
dan
pusa
nafas
beber
akit-p
mem yang mungajar
kan ai samb
ti.
kita
usan. pakan seoraberpeny an, dan
jungi keda i kopi,a untuk
orang
paru
sesak
aktivi
g,
os
sudah
gan jantun
kan
sebag an dan hembu meru
oran
i paruyakan
i kos-k juga meng akai
nafas
atau dari flatny ebab
Ho yang orang anak , seran – fungs
keban teng ah abkan
mem
1998.
aham
r
sedut
lu, belia
untuk
mem lukan. “saya untuk endalikan
kelua boleh meny
tahun
sese
diseb
tahun selera
ik.
dahu aktif. encik i dua
n 40-an
a
akan
genet
cepat
punya
unga menonit cara meng
yang
diper
sahaj
han. g sihat sejak tiada
digun
un bagi
lingk
n
pesak serta
dan
orang
-paru
lelaki dan mem
“nam an ini lebihkerentanan
para p muka, beliau.
in
rakan
paru
dan keleti kuran a penat
denga
rapa
dalam
atau fungsi paru sama
rosot
dan
“saya beras mpa bebe mendapati” kahw berusia masanya al dengan .
,
pelitu
yang
” kata i darah
a
keme merokok
ini.
sering
t
lelaki habiskan
tahun di tahap 80 hingg
berbu melawatnyasering
an saya,
sesi ujian, fungs n di klinik
saya n. saya berju ka tidak
tabia usia 60
a
ia
dan
deng
mere
ujian dalika
berad
yang
berus
siniasa
ra yang
- mengTV, tidur
maka r, tetapi
yang
diken
luarb
- pada ka akan ka yang
disah
ra-ma lawatanital besar
ton
ya
paru
dokto pa yang
mere
tetap
dr
beliau onar i
ngi toksin
an mere
0
dan saudasatun h ke Hosp janji penkata
2004,
.
andu
apa-a
deng
10,00
.”
satu- adala
alat
tahun akit pulm , satu
k temu
beliau
meng da tren ini, perokok
ada
tnya
i
a
kata
copd
90 tahun rokok
darip menurut
ya
peny
) untu membawaa.
a pada
kepa
semu
dibua
atau
fungs
Hany hidap
asap
n
parun
ng
ksa
k,
an
ra (sgH
an lebih 2010, pada Jun
buka
terpa bersamany kin teruk
umba
pera)
i paru- k penmeng yang kroni
gapu
s
deng
ntara keme rosot r 30
alih u sema
kan
ital, n pada tahun
meny
(WHo
beliau
ila saya
s Time
rosolang mana fungsdua bentu tiub
seme
nya. a mudah
sekita
hosp
keme
terha
di
sukka ar strait atan duniamenjadi
belia ini. “apabTV yang . ong. mend eritapantas,
pat k, di mana kan
aan
gudar
dima
aan
alami yang berebab
bakal seluruh
ngan sesak
n Kesih
an akhb
kead rosak . Terda
akan paru yang meng
Kead rapa tahun
ok
dan
itis kronig meny
buha
di
copd
ranca
tahap
lapor
tif
mula
i
a
tian
bebe
pertu n bahw
telah ini – bronk radan berlendir;
parunton
kin akan ng perok alam
saya
t sensi
sepkema
paru.
sejak
adi
2012.
meng sama
nebuyakit ial menj
ng menorik, nafas sanga perubamalka utama
tus mung s. seora
sa
an yang an paruakan
unaan kan
mera - seda u mena penat dan seper ti
2030.
kok
rosot
sur yang ok.
- mera ketiga
bronk berpanjang
tan panta
adbir ut
mero beran
keme p akan
mero
terlal senang kitaran,
perok kan meng h sebab menjelang suk pengg
saya
satu
an
batuk
terma yang ment dised
hida bernafas. utaema,
p diri lagi henti rosot yang bukan disah k adala
perse
saya
dunia
tan
yang
k
ebab
peng
dap
fasan
emfis
h
yang kroni
keme
angga
ka
rawa
is alat kabus
peny
.
terha
mero
para sukar untu
meng
a masi gsian
paru ramai pero it
– sejen bentuk mesin perna
erti mere usan lelaki
satu
mula biasa
ok harus
kin
han cuaca pi saya ah keranus kefun berliser
perat
kit paru-a lebih an pesak
h salah
dalam – atau para perok
sema
“Teta bertu
dan
Ho telah n, dan
penya
paru
perat
nyak
adala
ubat
aparu udara.
at
biasa
kok a. encik 12 tahu a
hidap tinggi, keran
i parudr ong. n pern sang punyai 18
i. Keba ngan 70-anngkat
ke paru- laluan
orang
hingg
kata
fungs
a
lelak
usia
mesi
h
an
many
lebih
us
urang
mem
Ho,
itu meni hari.
yak dua u
n purat
pada
tekan nti merokok,
adala dalam lingku
dian
akan
encik bantu mengalat-alat
kok
(18 perat denga
kok
ia
ri. belia
kes
kok seban
ing
berhe
kemu
, batuk
a keros
seha menghidup
band seusia).”
mero
ini berus
nafas
a
dalam dapat mem ke sgH.
keran jelas pada
h
kotak
annya iki mutu beliau
yang
ding
sesak
itu
a utam
a
tiga nti setela
h
80-an
.
han. k adala
perun
punc
h lawat perba
hany termasuk
fasan
rkan
kok
fasan
berhe i keadaannya
keleti
dan
mem
How,
jumla
bena ong.
Ho
kroni akibatMero Thun
anya ng dan
kan
perna gaan
bantu it, mem
dr
etahu
encik
meng tahun
kata
dr ongn, Jabatan penja ata: gejal a panja pernafasan
ini mem
Kini, dilampirng pesak aktif,
jangk
ruh yang pada
at
akit
Kana perubatan berk
nya
pura
peny
a terko h seora kekal agak
a ketuj
ilai
biasa pada emp
dan kal, sgH,
bern
a utam di singa 440 nyaw ketuju
untuk
an
tian
kan
17/10/13
Encik
punc
yang 00.
ira
ke
Kriti
nti,
paru rosak
keada pesakit
kema
pera yak $20,0
kan apabila kira-k
i paru-telah
pakan
Fungs Bin kuat merseban
2010, juga meru kemasukan
Ho Weeh lama bergantung
ia
n
ban. lazim bagi
setela Beliau -mesi tan di
g
okok. a mesin keliha menpalin
aWard of
eXcellence
-paru u
paru
perl
hkan kini dia
a
usna
h mem sehingg
k tela sekali, hidup
merokoitu teruk k terus
kuat
untu
beg
Tabiat lelaki a mesin
en dan
oksig
mpu udara posi- i
seorang ng pad
antu
mi penu
an fungs
an laluan
berg
ngku
ekalk
tekan
e
5:13
PM
kepadrti yanga) untuk nya.
(sepe angny
fasan
belak an perna
etapk
FoTo:
Vee cHin
aPEX awarDs 2013
2013
M1-M4
UsE Of PlastiC bag
ENCOUragEs mOrE
tO wEar PrEssUrE
stOCkiNgs
Malay
v4 AB.indd
1
Nov-Dec
06
Doctors develop automated system to
manage blood pressure during delivery
P3
07
SGH team crafts rehab care map for
stroke patients
21
穿长袜的好点子
使病人顺从率大增
P27
Photo: ZaPhS Zhang
Demystifying age-old practices that
proffer alternative forms of treatment
28
食物接触到受细菌污染的表面会导致
胃肠炎
02
singapore health
noV – DeC 2013
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singhealth & sgh
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Angela Ng (SGH)
Lim Mui Khi (SGH)
Corinne Tan (SingHealth)
Chio Shu Yu (SingHealth)
Ann Peters (SingHealth)
Deborah Moh (SGH)
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nOV – DeC 2013
singaPORe HealtH
Small idea, big results
A minor improvement in the way anti-embolism stockings are worn has resulted
in a huge jump in the number of patients using them now
Nurses now take only
four minutes, instead
of 10, to put on antiembolism stockings
with a plastic bag.
The seven-member
multi-disciplinary
NHCS team who
came up with the
idea included Patient
Care Assistant Chia
Li Sen (seated),
Nurse Clinician
Chang Choong Kek
and Senior Nurse
Manager Lee Chin
Hian (right).
By Lediati tan
P
atients who have open heart surgery are given strict advice – wear
anti-embolism stockings after surgery for four to six weeks, to prevent serious, sometimes fatal, complications. But
previously, despite warnings, only 17 per
cent of patients complied after discharge.
all this has changed, thanks to a small
improvement made by a team at the
national Heart Centre singapore (nHCs),
on how the stockings are worn. now, 70
per cent of patients – a whopping 53 percentage point increase – are using them.
Retiree Madam ivy Jayamoni, 75, who
had a heart bypass and valve replacement surgery, is one of them.
in the hospital, she did not flinch
when nurses slipped the stockings up
from her feet to her upper thighs. and
this was despite a long wound running
down one leg where doctors had harvested leg veins to use as graft in her
bypass surgery.
Once home, she intends to continue
using them, and is confident her caregiver can handle it, she said.
The secret – it glides, not tugs
the improvement is simple yet effective,
and was the work of a seven-member
multi-disciplinary nHCs team.
it involves placing a transparent plastic bag – the type you get at supermarkets
when buying fruits – over the patient’s
foot before the stockings are worn. the
plastic bag prevents the toes from getting caught in the stocking’s opening and
provides better glide, especially around
the difficult spot – the heel. Once over the
heel, the stocking can be slowly slipped
over the rest of the leg, even over the
wounds (see sidebar).
the team had tried other solutions
such as using powder and creams to
get the stockings to glide better, but
these were found to be too messy and
unsuitable for heart bypass patients with
leg wounds.
It’s the cheapest and
most effectIve way to
prevent venous
thromboembolIsm
(blood clots In veIns
of the leg).
Dr Loh Yee Jim, Visiting ConsuLtant, Department of CarDiothoraCiC surgerY,
nationaL heart Centre singapore, on whY
patients shouLD wear the anti-emboLism
stoCkings to heLp preVent CompLiCations.
the fuss-free plastic bag solution
helps both patients and staff. it used to
take nurses 10 minutes to do the task.
now it takes four, freeing them up for
other duties.
For their contribution, the nHCs team
was placed ninth in the team excellence
Best team Competition 2013 in July.
the award recognises the contributions
NEWS
03
Step-by-step
procedure on
how plastic bags
are used to help
patients wear
the stockings
The nurse helps the patient
slip her foot into a transparent
plastic bag. The plastic bag
should ideally be big enough to
cover the ankle.
The nurse then rolls up the
stocking from top to bottom
before slipping it over the
patient’s foot. The plastic bag
prevents the toes from getting
caught in the stocking’s opening
(where the toes are) and
provides better glide over the
most difficult spot to navigate –
the heel.
The nurse then pulls and adjusts
the stocking further up the leg,
taking extra care to ensure that it
is wrinkle-free.
of teams and individuals to continuous
improvement and innovation.
Wear them to prevent complications
team member, Dr loh Yee Jim, Visiting
Consultant, Department of Cardiothoracic surgery, nHCs, said patients who
have had open heart surgery need to
wear the stockings all day, for four to six
weeks after surgery. Other patients who
must wear them are those who are less
active for a long period, such as those
with cancer or who have undergone
orthopaedic surgery.
> Continued on page 4
( 华文版本请翻阅至27页 )
The nurse further adjusts the
stocking until it extends all the
way up to the upper thigh.
When the stocking is in place, the
plastic bag is removed and the
process is repeated for the other
leg. The same plastic bag can be
re-used for the other leg.
04
NEWS
SINgapOre HeaLTH
NOV – DeC 2013
> Continued from page 3
Small idea, big results
Better education and involvement
While implementing the new method,
the team also beefed up on educating
patients and caregivers about why it is
important to continue wearing the stockings, and showing them how to do so.
Subsequently, they saw compliance rise.
Ms Lee Chin Hian, Senior Nurse Manager, Ward 56, NHCS, and the team’s facilitator, said some patients had stopped
Possible complications if
patients do not wear antiembolism stockings:
Leg oedema (swelling) – prolonged
periods of inactivity can lead to fluid retention which causes swelling in the affected
tissues. This brings discomfort to patients
trying to regain mobility after a long period
of inactivity.
pHOTOS: ZapHS ZHaNg
Over 1,000 patients undergo open
heart or thoracic surgery at NHCS each
year and are required to wear anti-embolism stockings. Dr Loh said if they stop
wearing them, there can be swelling of
the leg, oozing from leg wounds, and the
complication of blood clots travelling
from the leg to the lungs resulting in serious damage or death (see sidebar).
The stockings reduce the risk of blood
clots forming in the leg veins of patients
who are less active than normal. It does
this by exerting pressure on veins in
the legs, resulting in better blood flow
through the legs. The stockings also help
to reduce swelling in the leg.
Dr Loh said while complications can
be severe, they can be easily prevented.
“It’s the cheapest and most effective way
to prevent venous thromboembolism
(blood clots in veins of the leg).”
because it was tedious and time consuming, or found it too hot for this weather.
Some men found it too feminine and
others stopped once they felt better.
The team’s leader, Mr Chang Choong
Kek, Nurse Clinician, Ward 56, NHCS,
said the team also carefully monitored
patients after discharge, making regular
phone calls to ask if they were still wearing the stockings at home.
“If they stopped, we would urge them
to resume and explain why it was important to do so. This was also why compliance rose,” said Mr Chang.
Wearing antiembolism stockings
helps prevent oozing
from leg wounds
in patients who
have had leg veins
removed for use in
their heart bypass
surgeries.
Oozing from leg wounds – Heart bypass
surgery usually involves patients having leg
incisions to remove the great saphenous
vein, which runs down both legs from the
groin to the foot, for use as graft in the operation. The stockings help to reduce swelling
and oozing from leg wounds by improving
blood flow.
Pulmonary embolism – It is the sudden
blockage of a lung artery or one of its
branches by a substance, usually a blood
clot, which has travelled from elsewhere in
the body. It is a serious condition that can
result in permanent damage to the affected
lung as well as damage to other organs due
to the lack of oxygen. If the clot is large or if
there are many clots, it can also cause death.
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NOV – DeC 2013
sINGAPOre HeAlTH
NEWS
05
Walk to a bigger bank account
A new study wants to find out if financial incentives will encourage office workers to be more active
By AJ Leow
Activity levels tracked in real time
Participants in the study are randomly
divided into four research groups with different incentives and goals.
The Control group has no physical
activity goals, but participants will earn
$4 a week for six months. The other three
groups – Fitbit Only, Cash Incentive and
Charity Incentive – all get a Fitbit Zip, a
smart pedometer which counts steps, and
PHOTO: ZAPHs ZHANG
H
ere’s a good reason to get out
of your chair and move about a
bit. A new study by the Duke-NUs
Graduate Medical school and the Health
Promotion Board will use cash to reward
office workers who are more active.
The study, known as TrIPPA (Trial
of Incentives to Promote Physical Activity), is being funded by the Ministry of
Health. It brings together technology,
different economic incentives and
recommended activity goals to help
people improve their health, said Professor eric A. Finkelstein, Health services
and systems research Program, DukeNUs Graduate Medical school. He heads
the TrIPPA programme.
some companies in the United states
are prepared to shell out Us$500 (about
s$624) a year for each employee, outside
of regular medical benefits, to ensure
a healthier workforce, he said. Physical
activity may forestall the onset of diabetes and Alzheimer’s disease, whereas
inactivity can increase the risk of obesity
and a host of other chronic illnesses such
as hypertension and diabetes.
“We hope that the study will see its
value extended beyond research and be
deployed eventually in the workplace by
employers,” Prof Finkelstein said. The
12-month research programme is targeted at full-time office staff as studies
have shown them to be one of the least
active groups. A recent National Health
survey revealed that 40 per cent of singaporeans do not participate enough in
physical activities.
tracks and collates distance walked and
calories burnt.
Participants in the Fitbit Only group
earn $4 a week for six months and are not
given a physical activity goal, but their
activity is monitored.
Participants in the Cash Incentive and
Charity Incentive groups earn monetary
incentives for six months for meeting
physical activity goals. They are given $15
a week if they walk at least 50,000 steps
per week, or $30 a week for at least 70,000
steps each week, but incentives from the
Charity Incentive group will be donated to
the charity of the participant’s choice.
Data collected by the Fitbit is used
to calculate the incentives earned,
while an accelerometer measures
the participants’ physical activity for a
seven-day period at months zero, six and
12 of the study.
Prof Finkelstein said that most people
walk about 5,000 steps a day, half the
minimum 10,000 steps needed for better
health. They should be able to achieve the
Professor Eric A. Finkelstein
(standing) heads the
TRIPPA programme
which brings together
technology, different
economic incentives and
recommended activity
goals to help participants
improve their health.
minimum 10,000 steps with a 45-minute
walk or a 30-minute jog on top of their
normal daily activities.
Prof Finkelstein said early data suggested that volunteers who opted to
donate their incentives to a charity tended
to be the most active, and the idea of
including the charity portion had come
from the popularity of charity walkathons
in singapore.
Incentives will only be paid for the first
six months of the study, but participants
who are given the Fitbit will have to wear
their smart pedometer for all 12 months
of the study. The incentives are suspended
after six months to see if the patterns
of activity will continue (that is, to find
out if individual behaviour can indeed
be changed).
so far, about 200 people have been
recruited. The full study needs 200
people for each of the four groups. Participants have to be fully employed,
between 21 and 65 years old – mirroring
the profile of the workforce here – and
must not have a medical condition that
may be impaired by participation in physical activity.
Visit trippa.com.sg for information about TrIPPA
and how to participate.
GROUP
PHYSICAL ACTIVITY GOALS
INCENTIVES
Control
None
$4 weekly for 6 months
Fitbit Only
None
$4 weekly for 6 months
Cash Incentive
Less than 50,000 steps weekly
$0
50,000 – 69,999 steps weekly
$15
At least 70,000 steps weekly
$30
Charity Incentive
Same as Cash Incentive group,
but rewards will be donated to a
charity of the participant’s choice
More cash-incentive studies from Duke-NUS team
TrIPPA (Trial of Incentives to Promote Physical Activity) is one of
several studies involving economic
incentives that the Duke-NUs Graduate Medical school is undertaking.
The medical school is also running TrIO (Trial for Incentives on
Obesity) to find out if and how cash
rewards will encourage people to
lose weight. like TrIPPA, TrIO control-group participants are rewarded
with cash when they meet weightloss targets. started in October 2012
and expected to wrap up in March 2015,
TrIO is run in collaboration with the
singapore General Hospital’s lifestyle
Improvement and Fitness enhancement
(lIFe) Centre. Participants have to enrol
in the lIFe Centre’s four-month obesity
management programme. The Centre’s
clinicians, dietitians and physiotherapists
help them lead a healthy lifestyle, and in
the process, achieve long-term weight
loss and weight maintenance. (Visit hssr.
duke-nus.edu.sg for more information
about TrIO.)
According to Professor eric A .
Finkelstein, Health services and systems research Program, Duke-NUs
Graduate Medical school, the DukeNUs team is also embarking on another
study, TAKsI (TAKing steps for Incentives), which will be funded by an
NUs grant.
TAKsI is targeted at another group of
inactive people – cabbies.
The study hopes to recruit 300 taxi
drivers between 50 and 75 years old to
meet a target level of physical activity
over an eight-month period. If the
participant is able to walk about
7,000 steps a day for at least 20 days
each month, he will be rewarded
with a day’s rental rebate.
“Taxi rentals are especially close
to the heart, as far as taxi drivers are
concerned. Taxi drivers also tend
to be the least active, which is why
they are one of the best subjects to
study the effect of the use of financial incentives to promote physical
activity,” said Prof Finkelstein.
06
NEWS
singapore health
noV – DeC 2013
DIVA in the operating theatre
KKH doctors have developed the world’s first automated system to manage blood pressure during delivery,
ensuring safer caesarean births
By Jamie ee
t
he DiVa (Double intravenous Vasopressor automated) system was
developed by doctors at KK Women’s and Children’s hospital (KKh) to
manage the blood pressure of patients
during a Caesarean section under spinal
anaesthesia. it automatically administers required amounts of medication to
normalise blood pressure and heart rate
when they drop.
the system has not yet been implemented in patient care, but has been
tested successfully. a 2011 study, jointly
carried out by KKh and Duke-nUs graduate Medical school and involving 55
women, showed that it was more effective than conventional methods at maintaining blood pressure during caesarean
section that involves spinal anaesthesia.
professor alex sia, Chairman, Medical Board, KKh, and Dr sng Ban leong,
Dr Sng Ban Leong simulating the application of the DIVA System in an operating
theatre.
Consultant, Department of Women’s
anaesthesia, KKh, led the study.
the DiVa system provides an important safety enhancement for patients. “it
is a novel invention, enabling very close
monitoring and rapid response to better
manage patients’ blood pressure during
caesarean delivery. this new research
development reinforces patient safety
and boosts clinical outcomes,” said prof
sia, who is also a senior Consultant at the
Department of Women’s anaesthesia, KKh.
low blood pressure during a caesarean delivery can harm both mother
and baby. Up to 60 per cent of women
experience it during a caesarean section where spinal anaesthesia is
administered. this may cause them
to feel nauseous during delivery and
in more severe cases, reduce blood
flow to the placenta, causing harm to
the baby.
at KKh, where 30 to 35 babies are
delivered a day, about a third are caesarean births. Currently, an anaesthetist monitors a patient’s blood pressure,
and when it falls, manually administers vasopressors – medication that
raises blood pressure by constricting
blood vessels.
this method is both labour-intensive
and limited by the monitoring equipment, which gives readings at one-minute inter vals, potentially delaying
response time.
the DiVa system, on the other hand, is
much quicker. Blood pressure and heart
rate data are measured and recorded
every second, and sent to a computer
from two finger cuffs worn by the patient.
an advanced programme then calculates the dosage of vasopressor required
and automatically administers it to the
patient through a syringe pump.
Besides safer deliveries, the DiVa
system also has other benefits.
Dr sng said: “the automated system
allows anaesthetists to focus on other
important aspects of holistic patient
care, including establishing better communication and rapport with the patients
and their partners. this further enhances
a patient’s comfort and experience
during a caesarean delivery.”
KKH opens largest NICU
in Southeast Asia
K
K WoMen’s and Children’s hospital (KKh) has expanded its neonatal intensive Care Unit (niCU) to a
32-bed facility – the largest in southeast
asia. With advanced features and technology, and a multi-disciplinary team
of highly experienced doctors, nurses
and allied health professionals, the new
facility is set to further enhance care for
critically-ill newborn babies.
the niCU, which manages about 400
cases a year, is self-sufficient with facilities to minimise the need for and risks
associated with moving sick little babies
out of the protected environment of the
niCU. these include an operating theatre
to perform major surgeries and a dedicated neonatal-surgical unit that cares
for babies who are recovering from sur-
geries or have open wounds that require
special care.
the niCU also houses a dedicated
facility to provide extracorporeal membrane oxygenation (eCMo) therapy for
babies with reversible cardio-respiratory failure, and a facility for therapeutic
hypothermia for babies who suffer brain
injury as a result of oxygen deprivation.
NOV – DEC 2013
siNgapOrE hEalth
NEWS
07
Rehab care map for stroke patients
SGH stroke patients warded at Bright Vision Hospital now undergo a standard follow-through of evaluations
and tests as part of a new structured programme
By DesmonD ng
The Amadeo is a hand rehabilitation
device used to assist patients who
have lost mobility in their fingers.
phOtOs: alViNN liM
s
trOkE patients who are admitted
to singapore general hospital’s
(sgh) rehabilitation ward at Bright
Vision hospital (BVh) in hougang probably won’t know that they are on a new
structured programme of care. But the
programme, called the stroke rehabilitation pathway, will make sure that they
are assessed comprehensively and given
the most appropriate type of care.
“We make sure he goes through best
practices in an organised way, so that
everybody gets the same high standard
of rehab,” said Dr Ng Yee sien, senior
Consultant and head, Department of
rehabilitation Medicine, sgh.
“it’s a checklist of a comprehensive
set of assessments by a multi-disciplinary team,” said Dr Ng. Without the
pathway, patient evaluations can be
subject to “inter-individual” variations.
Under the programme, all patients
will be given the same care and attention and undergo the same assessments, said Dr ashfaq ahmed larik, Consultant, Department of rehabilitation
Medicine, sgh. “it’s a plan of treatment,
or a checklist, that details the steps:
what needs to be assessed, what staff
should look out for, and the like. it’s a
whole range of standardised treatment,”
said Dr larik.
a team from about 10 medical disciplines are involved in the programme
and treatment plan. they include not
only doctors and nurses, but also physiotherapists, podiatrists, occupational
therapists, music therapists, dietitians
and pharmacists, to ensure that every
aspect of the patient’s care is covered,
he said. For example, if a patient is found
to be depressed or withdrawn, he may
be referred to a music therapist. singing
or playing musical instruments can help
improve a patient’s mood and quicken
his recovery.
Dr larik led a team of 14 other healthcare professionals from the various dis-
ciplines for about half a year in working
on the 40-page course of action that
would eventually be used within sgh.
the programme was rolled out in august
at BVh.
“a standardised pathway will make
it easier to track a patient’s progress,”
Dr larik said, adding that the results
data can form the basis for research and
study. at the same time, the care map
can be used to help orientate new staff.
patients who are treated at sgh for
stroke and whose conditions have stabilised can be referred to BVh for rehabilitation. stroke patients make up about 50
per cent of the patients admitted to the
56-bed rehab ward.
The multi-disciplinary medical team uses
the gait trainer to help a patient stand and
exercise. It is one of the newest pieces of
equipment at Bright Vision Hospital.
The Arjo Sara Plus standing hoist can
help a patient move from a sitting to
an upright, standing position during
physiotherapy.
TraiNiNg ThE Body To movE agaiN
after suffering a stroke, one of the
biggest challenges facing a recovering patient is finding the strength
and adequate control to stand
upright, said Mr adon Chan, principal
physiotherapist, singapore general
hospital (sgh).
as there is growing evidence that
getting the limbs moving as early as
possible can help boost recovery,
“we can use the equipment to selectively start patients on exercise,” Mr
Chan said. For instance, a patient is
hoisted upright on the gait trainer,
one of the newest pieces of equipment at Bright Vision hospital, and
different parts of his body can be
made to move by the machine. “in
the past, the focus was on strengthening (the muscles), but now the key
word is function. instead of getting
the patient to kick in bed, it is better
to get him to stand and do exercises
using the gait trainer.
“Being upright is important as
it helps the patient to reintegrate
his functions,” Mr Chan said. Other
equipment are available: the amadeo
helps patients to start moving their
fingers after they have lost that
function, and the arjo sara plus is
another machine that helps raise a
patient from a sitting to a standing
position during physiotherapy.
previously housed at alexandra
hospital for about two years, the satellite ward was conceived of a need for
more beds at sgh. in 2012, after the
community hospital became a sister
institution within the singhealth group,
the ward was moved to BVh.
stroke occurs when there is an
obstruction in the blood flow, or when an
artery that feeds the brain ruptures. the
disruption to blood flow causes brain cells
to die, and a person who suffers a stroke
may suddenly lose the ability to speak or
become paralysed on one side of the body.
physiotherapy is an important part of
a stroke patient’s rehabilitation as prolonged bed rest can lead to the muscles
getting weaker. Enhancing the work of
physiotherapists is the addition of new
and more advanced equipment for recovering patients – even those who might
not yet be mobile, said Dr larik.
rehab facilities at BVh are less hampered by a lack of space than at sgh.
“the machines help to support stroke
patients, as well as those who have
suffered spinal cord injuries, to stand.
the machines start these patients off
by giving them a feel of what’s it like to
stand again, after being in bed for some
time,” said Dr larik.
08
NEWS
singapore health
noV – DeC 2013
Automation hastens
pharmacy dispensing
RFID taggINg tEllS
SyStEm What to Do
A new intelligent, automated prescription drug delivery system at SGH’s
outpatient pharmacies cuts waiting time and enhances safety
A patient’s prescription, with a barcode,
is dropped into an RFID-tagged basket,
triggering the packing process.
The automatic drug picker holds
cartridges of the most commonly
dispensed drugs in the hospital,
such as paracetamol, atenolol and
folic acid. When a drug is needed,
the mechanical arm retrieves it and
drops it into the basket.
photos: alVinn liM
According to Mr Lim Mun Moon,
Deputy Director, and Ms Lee Soo
Boon, Assistant Director, both
from the Department of Pharmacy,
Singapore General Hospital, the
new automated drug picking and
packing system at the outpatient
pharmacies has reduced the
number of errors made during
dispensation to almost zero.
Drugs slated for automatic picking are
packed in cartridges, which are slotted
into the automatic picking machine. A
mechanical arm picks the correct drug
when it is needed.
By DESMOND NG
a
neW autoMateD drug picking
and packing system at singapore
general hospital’s (sgh) outpatient pharmacies is enhancing safety
as pharmacists can now spend more
time checking prescriptions, answering
patients’ queries, and making sure that
patients know how to take their medication correctly.
the system, which makes use of
radio-frequency identification (rFiD)
technology, will also shorten the waiting
time for patients who need to get their
prescriptions filled.
“the traditional method of picking
and packing medicines is manual,
labour-intensive and relies on trained
manpower. the speed and accuracy of
the process depend on the experience
of the staff, which is prone to human
errors such as the wrong drug or wrong
strength,” said Mr lim Mun Moon, Deputy
Director, Department of pharmacy, sgh.
using automation and technology to
track the process makes drug dispensing
“99.9 per cent accurate”, he said.
Medicine can sometimes be picked,
packed or labelled wrongly, said Ms lee
soo Boon, assistant Director, Department of pharmacy, sgh. But the near
misses have since decreased by about 38
per cent to almost zero, she said.
“these are lapses that happen within
the process before the medicine goes out.
it usually happens during the packing
stage and it could be a case of the wrong
drug or wrong strength. now we have
automated the packing process, and the
packing system is more accurate, with
an leD guide to where the drugs are. this
cuts down the ‘wrong drug and wrong
strength’ issue.”
Medicines are packed either automatically or manually. the machine is
only able to pack drugs that are of a standard size or amount, and cannot cut blister strip packs of 10, for instance, if the
prescription calls for just six tablets. a
pharmacist or pharmacy technician will
need to pack such drugs manually, and
an leD-guided system helps them find
the correct drugs easily.
When a basket containing a prescription has been filled, whether automatically or manually, it travels on a conveyor
belt to where it is picked up by a pharmacist for dispensing at the front counter.
the time taken to prepare a prescription, previously as long as 15 minutes,
has now been cut by about five minutes.
More counters have also opened to
serve patients as some 11 pharmacists
have been freed from their previous tasks
in the back room, said Mr lim. the phar-
The basket travels along a conveyor belt.
macy serving the specialist outpatient
Clinics now runs 23 counters, compared
to 14 in the past.
“safety has improved in the back
room, and the front-counter pharmacists
are less stressed, knowing that the prescriptions have been accurately packed
in the back room,” Mr lim said.
Currently, about 70 per cent of
patients get their medicine within
30 minutes. With the new system,
sgh is looking to have 95 per cent of
patients served within 30 minutes, said
Ms lee.
the design and implementation
of this integrated system – which cost
$4 million – is a collaborative effort by
sgh, innotech resources, psB technologies, eurekaplus and integrated
health information systems (ihis). it is
partly funded by the health Ministry and
spring singapore.
Drugs slated for manual packing are
stored in bins on shelves with LED lights.
When the barcode on a drug label is
scanned, the LED on the correct drug bin
lights up, helping the pharmacist to find
the correct drug easily.
When all the baskets containing
medication for the same prescription
have been packed, they are assembled
automatically and moved to the next
available dispensing counter. A
pharmacist picks up the basket and
dispenses the drugs to the patient.
NOV – dEC 2013
SINGapOrE HEaLTH
NEWS
09
Female “never-smokers” at risk
More women who have never smoked are being diagnosed with advanced stages of lung cancer
By Jamie ee
M
adaM Christine Chen* started
coughing on and off for four
weeks, and was initially given
antibiotics by her doctor to treat what he
suspected was a lung infection. However,
despite taking the antibiotics, she continued to cough, and in fact started feeling slight breathlessness when walking
or exercising.
She had no reason to suspect she had
lung cancer. after all, the 45-year-old was
medically fit and had no family history of
cancer. She worked in a primary school,
never smoked, and neither did anyone
in her family, so she had no exposure to
second-hand smoke either.
Mdm Chen went back to her doctor
and underwent a chest X-ray which
showed multiple spots in both lungs.
Subsequently, a CT scan was done at
a hospital and it picked up not only
bilateral lung masses but also enlarged
lymph nodes and fluid in her lungs. a
bronchoscopy and lung biopsy confirmed
that she had Stage 4 lung cancer and
that the cancer had spread to both lungs,
the lining (pleura) of her lungs, and her
lymph nodes.
Women are more at risk
Mdm Chen is not the only patient who has
never smoked, yet has fallen prey to lung
cancer. These “never-smokers” – as they
are referred to in the medical field – are
being hit by the disease, and hit hard too.
a study by the National Cancer Centre
Singapore (NCCS) found that three in
10 lung cancer patients here are neversmokers and the incidence is rising, said
dr ang Mei Kim, Consultant, department
of Medical Oncology, NCCS.
More than half the never-smokers
seen at NCCS are usually diagnosed with
advanced stage (Stage 3 or 4) lung cancer.
“There are few tell-tale signs. It sneaks
up on them to deal a heavy blow. Usual
symptoms at the time of diagnosis are
cough, blood in the phlegm, chest pain,
breathlessness and weight loss,” said
dr ang. She said women seem more
vulnerable than men, as 70 per cent
of never-smokers with lung cancer here
are women.
The statistic is even more glaring when compared globally, where it
appears that asian female non-smokers
are more vulnerable to lung cancer than
their Western counterparts.
“Less than 4 per cent of Chinese
women in Singapore smoke, yet, Singapore has a higher lung cancer rate among
women (21.3 cases per 100,000 females)
compared to other countries like Germany and Italy, where one in five women
smoke,” said dr ang.
Examining risk factors
Exposure to second-hand smoke at home
or at the workplace – one of the main
causes of lung cancer in never-smokers –
increases the risk by 25 per cent.
another risk factor is environmental
pollutants, particularly radon. Studies in
Chinese populations show that burning
coal and biomass, particularly in poorly
ventilated areas for cooking and heating,
may also increase the risk.
“a large proportion of lung cancers
in never-smokers cannot definitely be
associated with any established environmental risk factor. It is also thought
that certain genes, or changes that occur
in the genes, may affect a person’s susceptibility to these carcinogens and to
developing lung cancer. This is an area of
current intense research,” said dr ang.
Not the same type of lung cancer
Studies done around the world and in
Singapore show, in general, that neversmokers who develop lung cancer, have
a higher survival rate than current smokers and former smokers. This is most
likely due to differences in the types of
lung cancer that develop, and the distinct
changes or mutations, which promote
the growth and spread of the cancer cells
in the body.
Certain types of gene changes, when
found to be present, can be targeted with
specific drugs (targeted therapy). When
these drugs are given to patients with
advanced stage lung cancer, they may
block the growth and spread of cancer
cells more effectively than chemotherapy. dr ang said: “Studies show that never
-smokers have different genetic changes
in their lung cancer cells compared to
smokers, which may make their lung
cancers more responsive to these targeted treatments, compared to smokers
with lung cancer, and leading to better
survival outcomes.”
According to Dr Ang Mei Kim, 70 per
cent of never-smokers with lung
cancer in Singapore are women.
genetic differences that exist between
never-smokers and smokers with lung
cancer.
dr ang explained that the two
main types of lung cancer are small cell
lung cancer and non-small cell lung
cancer (NSCLC).
The diagnosis is based on microscopic
examination of a lung biopsy. Small cell
lung cancer makes up 10 per cent of all
lung cancers, and grows more rapidly
and spreads earlier to other organs than
NSCLC. It is also found almost exclusively
in smokers. Survival outcomes are poor.
On the other hand, NSCLC grows
more slowly than small cell lung cancer
and tends to be confined to the lung for a
longer period of time, and the chance of
survival is generally higher than for small
cell lung cancer.
Cancers, in general, have many gene
Treated similarly
Smokers and never-smokers undergo
similar treatments, depending on the
type of lung cancer and what stage of
cancer they have.
In Stage 1 and 2 NSCLC, surgery to
remove the cancer is usually performed.
Chemotherapy may be used after the
operation to lower the risk of relapse
and improve survival rates. In Stage 3
NSCLC, a combination of chemotherapy
and radiotherapy is usually used, while
in Stage 4 when cancer cells have spread
to other parts of the body, chemotherapy
and targeted treatments may be used.
That said, prevention is still better
than cure, said dr ang. “While lung cancer
can strike anyone, there are things that
never-smokers can do to better protect themselves. First, if you have never
smoked, don’t start. Second, avoid regular, long-term exposure to smoke. Third,
while not actually proven to lower the
risk of cancer or prevent it, many studies
show that in general, a healthy diet and
lifestyle, as well as exercise, are associated with lower rates of cancer.”
*Patient description is based on a typical patient
profile
10
NEWS
siNGaPoRE hEalth
NoV – DEC 2013
Photo: VERNoN WoNG
Creativity pays off
for SingHealth staff
Teams with innovative ideas that improve patient care won
awards at the Singapore Healthcare Management 2013 congress
By Teo Kuan yee
t
o iMPRoVE patient services and care, staff at singapore health services
(singhealth) are continually innovating. one way they do it is through small
improvement projects.
at the singapore healthcare Management 2013 congress, organised by singhealth, 130 such projects from the various healthcare clusters were submitted in a
poster contest. this year’s big increase in participation compared to 2012’s figures
reflects the strong innovative spirit among healthcare institutions. the projects
were from the supply chain, service quality, human resource, risk management, and
finance and communications sections.
here are three of the winning entries:
a Friend in need
Health Buddy – Singapore’s most
comprehensive health info app
team:
Joyce Quek, Kathryn Ng (singhealth)
aim oF the project:
to produce a comprehensive health
info app for use on mobile devices, that
will promote patient empowerment
towards healthy living and proactive
involvement in health management.
how it was carried out:
a team comprising representatives
from across all singhealth institutions
was formed to identity the most relevant content, presentation format, and
app features to be developed.
the basic idea was to incorporate
the most popular sections from multiple websites of the singhealth group,
and present them on a single mobile
platform. online studies were conducted to analyse visitors’ behaviour
and surfing patterns on existing singhealth websites.
Follow the Footsteps
Re-designing patient flow from
the main entrance to prescription
handover counter at the Outpatient Pharmacy.
reducing Falls
Evidence-based management of
patients’ risk of falling in the inpatient setting
team:
ang shin Yuh, Karen Perera, Rachel
teo Kai Yunn (singapore General
hospital (sGh))
aim oF the project:
Managing patients’ risk of falling has
always been a high priority for nurses
at sGh. this project aims to derive a
better assessment of the risk level for
falls and tailor the level of fall prevention
intervention measures according to the
patients’ needs.
how it was carried out:
Prior to 2012, sGh nurses used the Morse
Fall Risk assessment tool to evaluate the
risk of falling for all patients upon admission, and upon changes in conditions.
Patients were then classified into two
groups, namely those at risk and not at
risk. a comprehensive review was conducted to identify the diagnostic accuracy of different risk assessment tools.
the team also undertook an analysis of risk profiles of patients who suffered from serious injuries due to a fall,
and stratified patients’ risk of falling
according to low, moderate and high.
this was accompanied by the implementation of specific fall prevention
interventions according to level of risk.
results:
the team revalidated the relevance
and effectiveness of the Morse Fall Risk
assessment tool as the yardstick for predicting fall risks. together with the use
of a scoring system to segment patients,
preventive strategies for each risk level
were then devised for the revised risk
stratification. With risk stratification
and corresponding prevention strategies, sGh has since achieved lower fall
rates than other academic Medical Centres and Magnet-accredited hospitals.
team:
alan Chui, Janice lim, Xu Rujia, Chin C.
K., Jasper W.K. tong (KK Women’s and
Children’s hospital (KKh))
aim oF the project:
to improve patients’ experience at the
outpatient Pharmacy by helping them
to locate the prescription drop-off
counter in a timely manner.
a strategy was developed for regular updating and refreshing of content
to attract users to use the app on a
weekly basis.
results:
the health Buddy app has made access
to health information and healthcare
services more convenient, by offering relevant, highly-searched content.
For instance, it includes listings of
family doctor clinics with information
on their opening hours – a unique feature not found on any other website or
mobile app.
it also offers health tips that are
updated weekly, and direct connectivity
to a Youtube health channel with how-to
videos – a handy tool for caregivers.
the app has also helped address
basic health-related queries from the
public, and is available 24/7.
how it was carried out:
in line with efforts to continually monitor and improve efficiency and patient
experience, the outpatient Pharmacy at
KKh observed that some patients found
it difficult to locate the prescription dropoff (triage) counter. these patients would
approach counter staff for directions,
impacting the latter’s customer service
and efficiency.
the pharmacy team tested four different directional displays to guide patients
to the triage counter. these included
footprint stickers and yellow line stickers
on the floor, a standing signage indicating the location of the triage counter, and
flashing lights above the triage counter.
sixteen trials were carried out over
two weeks on more than 2,700 patients.
Footprint stickers and yellow line stickers
were found to be more effective.
results:
the footprint stickers, used on their
own, proved to be the most cost-effective, sustainable and flexible option.
Using this tool, patients have
been able to locate the counter in
6.3 seconds, and the percentage of
patients seeking directions from staff
has been halved.
NOV – DEC 2013
SiNgAPORE hEAlTh
NEWS
11
The selfless giving continues
Dr Tan Chee Beng, who donated his body to medical research, was a dedicated educator who believed in
nurturing the next generation
By desmond ng
Silent Mentors
S
iNghEAlTh Polyclinics Chief Executive Officer, Dr Tan Chee Beng,
made invaluable contributions to
healthcare during his tenure. Even after
his passing, he continues to do so.
Dr Tan, 50, succumbed to prostate
cancer on Sept 3 and donated his body
to the National University of Singapore’s
Yong loo lin School of Medicine (YllSOM)
for medical research.
Dr Tan’s son, Mr Benjamin Tan, 18, a
first year medical student at YllSOM, had
discussed the subject of body donation
with his father about three weeks before
Dr Tan Chee Beng (with tie) enjoying a light moment at the SingHealth Polyclinics
Dr Tan’s death. he had told his father that
Quality Awards Day in February this year.
few in Singapore were willing to donate
their bodies to medical research. his
father was very supportive of the idea,
but wondered if his body could still be of and postgraduate students in the medShe said his loss is felt very deeply
use after death, given his critical illness.
ical, dental, nursing, pharmacy and life by all at Singhealth Polyclinics and the
Mr Tan said: “My dad would rather sciences fields.
Singhealth family. “We remember him for
medical practitioners make as many
Professor ivy Ng, group Chief Exec- having put up a good fight in his battle
‘mistakes’ as possible on his body, than utive Officer of Singhealth, said Dr Tan against cancer. We have lost an inspiring
have them commit a single error on a was a dedicated educator who strongly physician leader, and a wonderful colliving patient.”
believed in nurturing the next generation. league and friend.”
Whole body donation allows doctors “his passion in teaching was matched
Dr Tan was appointed CEO of Singand medical students to research and by his humility. he was always willing to health Polyclinics in 2002 and saw the
practise new life-saving medical and sur- lend a listening ear, often dispensing with organisation grow from strength to
gical procedures. Donated bodies are formalities in his interactions with staff strength under his tenure. he is survived
used in the education of undergraduates and patients.”
by his wife, a son and a daughter.
A million thanks
By Lediati tan
F
named Thanks a Million as a tribute to
organ and tissue donors, was launched
by Dr Amy Khor, Senior Minister of State
for health and Manpower, on August 27. it
will be on display on the ArtsExpressions
wall in Block 2 until January 1 next year.
Mademoiselle Maurice, who was in
town to put up the installation, said
that the idea was to create a giant rainbow in two different hues to show repetition – akin to a recipient being given
How to make a full body
donation
Those who want to pledge their
bodies can do so under the Medical
(Therapy, Education and Research)
Act (MTERA), by completing the
yellow “Organ Donation Pledge
Form” and sending it to the National
Organ Transplant Unit.
Who can donate?
Singaporeans and non-Singaporeans
can donate their bodies, but must
be at least 18 years old and not
mentally unsound. Bodies of people
with infectious diseases cannot be
used, but those with chronic illnesses
or cancer may still be used for
education and research.
For more details, visit www.liveon.sg
The origami
artwork created
by Mademoiselle
Maurice (far left)
was made up
of some 15,000
paper flowers.
Over a million of
the flowers were
painstakingly
folded by 20,000
students and staff
of healthcare
institutions.
To pay tribute to organ and tissue donors, a French artist created a wall
installation made up of about 15,000 hand-folded paper flowers at SGH
RENCh artist Mademoiselle Maurice
is known for bringing a pop of colour
to any location with her origami
street art installations. her kaleidoscopic
works have decorated the streets of cities
from Paris to Tokyo and hong Kong.
in August, she left her mark on a wall
at Singapore general hospital (Sgh)
to raise awareness of organ and tissue
donation and transplantation, as part of
Singhealth’s annual Transplant Awareness Week.
The eye-catching origami artwork created by the 29-year-old Paris-based artist
was made of about 15,000 paper flowers.
Over a million flowers were painstakingly
folded by over 20,000 primary, secondary
and tertiary students, and staff of healthcare institutions under Singhealth as well
as Changi general hospital, Khoo Teck
Puat hospital and Tan Tock Seng hospital. The completed installation, aptly
People who donate their bodies to
medical research are referred to as
“Silent Mentors” – a mark of respect
and gratitude for those whose bodies
are used to educate students and the
next generation of doctors.
a new lease of life after receiving an
organ transplant. She also drew inspiration from the graphical representation
of electrocardiography (ECg) rhythms,
which show the electrical activity of the
heart. The vibrant paper flowers represent the gift of life and the gift of hope
that a transplant brings to the recipient
and his family. Another interesting aspect
of the origami display, said Mademoiselle
Maurice, was that it was partly created
by students, who represent “the people
of tomorrow”. Thus, it has the added
significance of bringing a lot of hope for
the future.
The artist also shared her views on
organ donation. Since she was a child,
her parents have always encouraged
her to donate her organs to save lives if
she ever has the opportunity. Mademoiselle Maurice did not understand what it
meant until she was older and realised
that instead of dying without helping
anybody, it was better to give up one’s
organs after death to help other people.
Through her artwork, she wanted to
express her thanks to those who had
made “a different sort of donation” by
giving up their organs. She said: “i think
it’s really important, if (our organs) are
not useful to ourselves (when we die),
(they) can be useful to other people. i
think it’s a beautiful action and it is very
generous of the (deceased’s) family.”
12
upclose
singapore healTh
noV – DeC 2013
World diabetes day
coping With a
lifelong disease
7
By 2030, the number of Singapore residents above 40 with diabetes is projected to increase by another
200,000 from about 400,000 today. As there is no cure for it, keeping it under control is crucial
In diabetes, the pancreas produces too little or ineffective
insulin, a hormone which lets body cells use blood sugar
for energy. Diabetics have higher blood sugar levels than
normal (hyperglycaemia). There are two major types of
diabetes: Type 1, often diagnosed in childhood, and Type 2,
largely caused by an unhealthy lifestyle and diet.
DiABeteS iS the
th
10
leading cause of death in
singapore, accounting for
1.7 % of total deaths in 2011
TreaTiNg
diaBeTeS
there is no cure for
diabetes, which is a lifelong
disease. it can be
controlled through
various means such as a
healthy diet, regular exercise,
oral medication to balance
blood glucose, insulin
injections, and regular
monitoring and control of
blood sugar.
common
symptoms
Fungal infection, itching
of skin and genitals
Frequent urination
Constant hunger
Unexplained weight loss
Blurred vision
tips for a healthy diet
1 dON’T FOrgeT
yOUr graiNS Unlike
refined grain foods like
white rice and white
bread, whole grains
are an excellent source
of vitamins, minerals,
fibre and protective
plant chemicals called
phytochemicals.
2 piCk FOOd riCH
iN prOTeiNS select
protein-rich foods
which are lower in fat
and cholesterol such
600,000
projected number by
2030
Numbness of hands
and feet
TO preveNT Type 2 diaBeTeS:
1
2
3
Slow healing of wounds
folloW a proper diet
Besides insulin and medicine,
eating healthily helps to
control blood glucose levels
and weight.
maintain a healthy Weight
if overweight, losing a few kilos
can reduce the risk of diabetes.
get regular exercise
exercise helps to control
weight and also keeps the
heart healthy.
400,000
number of diabetics in
Singapore in 2013.
as lean meat, fish,
yogurt, legumes
and nuts.
3 eaT yOUr FrUiT
aNd veggieS Fruit
and vegetables are
naturally low in fat
and rich in vitamins,
minerals and fibre.
4 CUT THe Oil, FaT,
SalT aNd SUgar
Choose healthier foods
which are lower in salt,
added sugar and fat.
limit alcohol intake.
40
Most are aged
above
346,000,000
The World Health Organization estimates that more than
people worldwide have diabetes.
TexT By Denyse yeo
Sources: Ministry of Health, Singapore General Hospital, singhealth.com.sg, www.healthxchange.com.sg, hpb.gov.sg, polyclinic.singhealth.com.sg
NOV – DEC 2013
siNgapOrE hEalth
people
13
Charting new territory
Associate Professor Terrance Chua spearheaded a whole new service – nuclear cardiology – at the National Heart Centre Singapore
By Thava Rani
SometimeS you can
deliver better care by
reorganiSing your
SyStem than by having
the beSt doctorS, or
the lateSt and
greateSt technology.
AssociAte Professor terrAnce chuA,
DePuty GrouP Director (MeDicAl),
sinGheAlth, AnD DePuty MeDicAl
Director AnD senior consultAnt,
DePArtMent of cArDioloGy,
nAtionAl heArt centre sinGAPore.
Against conventional wisdom
prof Chua, 54, is someone who does
not hesitate to go against conventional
wisdom if it makes sense to him. Often,
when he starts talking about efficiency,
people do a double take.
he believes that a department or service does not always need to operate at
maximum capacity. “in fact, sometimes
it needs to be just a little bit inefficient
so that the patient gets the best care,”
he said.
he cites his nuclear cardiology service
as an example. the service accepts scan
requests from the accident & Emergency
phOtO: zaphs zhaNg
a
ssOCiatE professor terrance Chua
was the first local cardiologist to
sub-specialise in nuclear cardiology when he studied it in los angeles.
When he returned, he paved the way
for a whole new service at the National
heart Centre singapore (NhCs), offering
patients state-of-the-art scans of their
cardiovascular systems.
it started off as a one-camera outfit
but grew rapidly. today, the department
has three fully-used scanners, including
one of the latest and fastest in the field.
about 9,000 patients use the service
each year.
“i don’t think it was as much due to
my efforts as it was because the service
turned out to be quite useful. We also
had help not only from our hardworking
team but also from other departments
such as the Nuclear Medicine physicians
and the physicists.
“i think it is great when people work
across boundaries rather than just staying within the well-defined space of
their own specialties, which is the natural thing to do,” said prof Chua, Deputy
group Director (Medical), singhealth, and
Deputy Medical Director and senior Consultant, Department of Cardiology, NhCs.
Prof Terrance Chua was the first local cardiologist to sub-specialise in nuclear
cardiology when he studied it in Los Angeles.
(a&E) Department for patients who come
in with chest pains within 24 to 48 hours
of their a&E visit. “that means i have to
set aside slots for these patients, instead
of filling up all my available slots. so efficiency-wise, that’s not optimal. But that
means the patient who really needs it
more urgently gets scanned faster and
therefore diagnosed earlier,” he said.
as about a quarter of these a&E
patients have heart problems which need
immediate treatment, that slight inefficiency is something his department can
tolerate as long as the patients benefit.
A good system delivers good care
a firm believer that the system, and
not the individual, provides care, prof
Chua supports projects that improve
care through teamwork – working with
other departments.
he says that many people assume
that getting good care means getting
a good doctor, and that getting a good
doctor guarantees good care. “although
there is some truth in that, our aim
should be to deliver good care regardless of which doctor you see. sometimes
you can deliver better care by reorganising your system than by having the
best doctors, or the latest and greatest
technology. teamwork, measurement of
outcomes, and feedback are essential. ”
prof Chua says that many healthcare
systems now realise that optimal health
care is delivered when the focus is on
long-term outcomes rather than episodic
care, even though sometimes, hospitals
are incentivised to benefit from more
admissions. “the ministry understands
this very well and so does singhealth, but
it is not easy to do it.”
his philosophy of life influences his
work, and vice-versa. Outside of work,
prof Chua also finds that learning new
things keeps him going. Currently, he
is picking up tips on medical education from his oncologist wife. they have
also gamely taken on tai chi with their
18-year-old son.
an avid reader, he is now reading The
Creative Destruction of Medicine. Written
by a cardiologist, it describes how medicine may change in the future with the
advancement of various things, including computer technology. Naturally, the
book has been making its rounds among
his colleagues.
although retirement is far from
his mind, prof Chua is already looking
beyond his own tenure. One of his biggest tasks at present is to build up the
next generation of cardiologists who will
succeed him and his peers.
“that’s one of our biggest challenges
– finding the talent and building it up,” he
said, adding half in jest, “so that we can
all retire!”
14
people
singapore health
noV – DeC 2013
The gadget guy
Mr Hanniel Lim switched from clinical work to research, where
his love for robotics is put to good use developing rehabilitative
devices for patients in need
a
s a ChilD, he was frequently in
and out of hospital because of a
childhood medical condition.
the loving care Mr hanniel lim received
there made him want to become a
healthcare professional.
When he grew up and was offered
a scholarship to study physiotherapy
in australia, he seized the opportunity.
graduating with first-class honours
in 2009, Mr lim returned to singapore
and started work at the singapore
general hospital.
Helping patients through research
last year, he switched from hands-on
clinical work to administration and
research. Currently a senior executive from group allied health, Mr lim
believes he can continue helping patients
through research.
“research can generate new paradigms of thought. singhealth’s researchbased academic Medicine culture
encourages research findings to be used
in clinical practice. this can mean better,
more effective treatments and cost savings for patients,” he said.
one example of this is a project he is
presently leading – the mobile lumbar
traction device (MltD) – an innovation
that a team of singhealth physiotherapists and ngee ann polytechnic students
developed together to help patients with
lower back pain.
the device, which helps reduce lower
back pain, allows patients to receive
physiotherapy on the move. it can be
photos: Jasper yu
By Sol E Solomon
The first prototype
of the mobile lumbar
traction device – which
aids patients with lower
back pain – is worn like a
backpack so patients can
use it while going about
their everyday activities.
worn while walking, standing, or going
about other everyday activities. the first
prototype looks, and is worn, like a backpack. it is an alternative to the heavy traction machine used in hospitals, which
needs to be managed by professionals
and requires patients to be strapped in.
GadGets today have
become incredibly
sophisticated, and
the healthcare sector
can make Greater use
of technoloGy to
provide better care
for patients.
Mr Hanniel liM, senior executive, group
allied HealtH
the prototype is currently being refined
and pared down so that the next, improved
version will be smaller, lighter, more
wearable, and just as effective. “Because
patients can use the MltD anywhere with
minimal help, they do not have to see their
physiotherapists as often. this allows
them to manage their conditions better
and save on consultation costs,” he said.
Mr lim, who played “matchmaker” in
linking up the project with the polytechnic’s mechanical engineering students,
is gathering feedback from hospital volunteers who tried the prototype, so that
their views could be incorporated in
its development.
love for gadgets
Currently, Mr lim is also working on
another collaboration between singhealth and the polytechnic – a robotics project to develop an exoskeleton to
treat tennis elbow, a condition caused
by the overuse of arm, forearm and
hand muscles.
these two projects combine perfectly
with his own love of robotics and gadgets, and his desire to help patients. it is
no wonder that he has naturally veered
towards such research work.
he added: “gadgets today have
become incredibly sophisticated, and
the healthcare sector can make greater
use of technology to provide better care
for patients.”
NOV – DEC 2013
siNgapOrE hEalth
Money
15
Boosting elderly independence
The enhanced Seniors’ Mobility and Enabling Fund can help the aged lead more active and fulfilling lives
By Stella thng
t
wO strOkEs over the course of 13
years and a hip injury seven years
ago left 75-year-old Madam ho ah
Foong paralysed. she also has parkinson’s disease, hypertension and osteoporosis. For a long time, she has been
housebound in the three-room flat she
shares with her 82-year-old husband and
domestic helper-caregiver.
like Mdm ho, many old people cannot
lead active, independent lives because
of health problems. some find it hard to
move around in their own homes and, in
extreme cases, may not step out of their
homes for months, or even years.
with the expanded seniors’ Mobil-
ity and Enabling Fund (sMF) announced
on July 1, Mdm ho and other old people
can now get subsidies to buy a range of
equipment to help them become more
mobile and independent.
the $50 million sMF subsidises the
purchase of a wider range of devices
such as commodes, hospital beds, pressure relief cushions and mattresses, and
motorised wheelchairs needed for independent living. previously, the subsidies
covered only standard mobility devices
like walking sticks and basic wheelchairs.
a new category, the Consumables subsidy, covers items like milk feeds, diapers
and wound dressings for people who are
How the seniors’ mobility and enabling Fund (smF) can help
1 Assistive Devices subsiDy
it covers a wide range of non-standard
devices, including motorised wheelchairs,
hospital beds, pressure relief cushions
and mattresses, geriatric chairs, pushchairs, hearing aids, and special equipment like ventilators.
SubSidy cap
Up to 90 per cent of the device’s actual
cost will be subsidised. the maximum
subsidy will depend on the type of device
required. applicants must be assessed by
a qualified assessor to certify the need
and type of device required.
Who qualifieS?
singapore citizen, aged 60 and above
applicant who lives in a three-room
hDB or smaller flat automatically
qualifies for the maximum 90 per cent
subsidy for devices costing less
than $500
applicant who lives in a four-room
or larger hDB flat, or a senior citizen
applying for devices that cost more
than $500, must undergo income
means testing
has monthly per capita household
income of $1,800 or less
hoW to apply
apply at all Ministry of health (MOh)funded restructured hospitals, community hospitals, dementia day-care centres,
dialysis centres, home care service
providers, senior activity centres, and the
agency of integrated Care (aiC).
2 trAnsport subsiDy
it reduces the financial strain on older
people who require specialised transport.
previously, the subsidy was available only
to people getting active rehabilitation at
MOh-funded day rehabilitation centres,
but it is now open to those attending
dementia day-care centres or renal dialysis centres too.
SubSidy cap
the subsidy amount will depend on the
income means test result.
Who qualifieS?
singapore citizen, aged 55 and above,
and attending a MOh-funded day
rehabilitation centre, dialysis centre,
or dementia day-care centre
applicant needs a wheelchair to move
around safely, and specialised transport to travel from home to the care
centre
has monthly per capita household
income of $2,600 or less
hoW to apply
speak to the therapist or manager at the
centre that the applicant attends. if the
criteria are met, the centre staff will process the application.
3 consumAbles subsiDy (neW)
it helps defray expenses for frail seniors
who are eligible for nursing homes but
prefer to stay at home while getting
home-based medical and nursing services. it covers items like milk feeds,
diapers, and wound dressings.
SubSidy cap
the subsidy amount will depend on the
income means test result.
Who qualifieS?
singapore citizen, aged 60 and above
applicant is receiving care at home
and from home-based healthcare or
singapore programme for integrated
Care for the Elderly (spiCE) providers
has monthly per capita household
income of $1,800 or less
hoW to apply
speak to the nurse or manager of the
home-based healthcare service provider
or spiCE providers, including peacehaven
Bedok Multi-service Centre, tembusu
rehab and Day Care Centre and ling
kwang home for senior Citizens. people
who meet the criteria will get help with
their applications.
For more information, visit silverpages.sg/smf
cared for at home or nursing homes.
in Mdm ho’s case, her various ailments mean that she cannot sit upright
for long periods. her head also needs to
be supported. her family applied to the
sMF for help to buy a wheelchair, a pressure relief cushion and mattress, and a
reclining geriatric chair.
with her new reclining chair, she is
now able to watch television comfortably, while the pressure cushion and
mattress help prevent bedsores from
sitting or lying in bed for long periods.
she also gets to go out more as her carer
is able to manoeuvre the new wheelchair more easily. it is also lighter than
her old one.
as Mdm ho lives in a three-room hDB
flat, she automatically qualifies for the 90
per cent assistive Devices subsidy. the
new equipment that now gives her more
comfort and a better quality of life, cost
her family $130, instead of $1,300.
like Mdm ho, Mr Yasmuddin, 92, is
another recent beneficiar y of the
expanded sMF. Mr Yasmuddin uses a
wheelchair to go out because he has
trouble walking. at home, he can move
about by holding on to the furniture for
support. as he qualifies for the 90 per
cent assistive Devices subsidy – he lives
with his elderly wife in a two-room rental
flat – he was able to buy an aluminium
shower chair for $6, which has proven to
be a great help when his wife helps him
with his daily shower.
it has also become easier to apply for
the subsidies. previously, all applications
for the sMF had to be approved by the
agency for integrated Care (aiC). Now,
applications can be made at 114 community-based service providers island-wide,
including restructured and community
hospitals, dementia day-care centres
and senior activity centres. these aiCtrained service providers can process
and approve applications, reducing
applicants’ queuing and waiting time.
16
singapore health
noV – DeC 2013
HealtH XcHange
Our experts answer all your questions about health
Eye strain at 40
Am I depressed?
I am 40 and have myopia (about 300
degrees), astigmatism and long-sightedness. I get eye strain 10 minutes after
reading, watching tV, or when looking
at a computer or mobile phone screen.
When I look away, I cannot focus on faraway objects for at least 30 minutes.
What is causing this problem and what
can I do about it? How often should I go
for eye checks?
these symptoms are frequently experienced around the age of 40 when presbyopia sets in. like many patients with
low myopia, many with presbyopia will
simply remove their glasses to read.
Myopia compensates for presbyopia.
You can probably benefit from a visit to
your optician who can fine-tune your
spectacle lens power to match your visual
needs for various working distances.
Many patients also have accompanying dry eyes. if you experience grittiness,
redness and pain, applying eye drops
during visually-demanding tasks can alleviate the symptoms.
as for the frequency of eye checks,
there is no strict guideline. patients
with diabetes should book an annual
retinal photo with their family doctors.
those with a family history of glaucoma
are advised to have annual check-ups.
annual visits to a spectacle shop can
also be useful to optimise vision. some
ophthalmologists advocate yearly eye
reviews after the age of 40.
Coping with
weight issues
and eating disorders
Over a six-month period, I lost about
7kg and my weight has stayed at a
constant 38-39kg since. I now have
a BMI of 15.5 and no longer stay
away from carbohydrates.
However, apart from fruits and
milk, I find all other foods adulterated by the salt and chemicals used
to preserve them.
I also find it hard to think of
myself as skinny when there are
thinner people around me.
Will my period resume if I have
stopped menstruating for at least
two years? Will taking supplements over a long period cause side
effects?
Most people have concerns over
food, weight and body shape issues,
Dr Wang Jenn chyuan, Senior consultant, general
cataract and comprehensive Ophthalmology Service,
Singapore national eye centre
photos: gettY iMages
Testing for ovarian cancer
What are the symptoms of ovarian
cancer? are there any tests that can
be carried out to see if one is suffering
from it?
ovarian cancer does not have specific
symptoms. the majority of patients
complain of swelling of the abdomen,
early satiety, pressure symptoms such
as urinary frequency, constipation, and
abdominal or pelvic discomfort/pain.
some women may even feel a lump in
the abdomen and experience irregular menses or vaginal bleeding. Women
but these concerns normally do not
affect them physically, emotionally or socially. You seem, however,
to have been physically affected by
your obsessions over food. at a BMi of
15.5, you are severely underweight,
and amenorrhoeic (experiencing an
abnormal absence of periods).
Menstruation will resume when
you are within a healthy weight
range. For some people, it takes time
– sometimes at least six months of
maintaining a healthy weight – before
they start having their periods again.
there are no side effects to taking
supplements.
Dr lee Huei Yen, Senior consultant, Department
of Psychiatry, Singapore general Hospital
should be aware of these symptoms and
seek medical help if they experience any
of these for more than two weeks, or if
the symptoms are recurrent.
the use of serum blood markers or an
ultrasound scan of the pelvis may help to
diagnose ovarian cancer.
Currently, there is no proven or
cost-effective method of screening
for ovarian cancer among the general
population.
Dr timothy lim, Head, Pre-Invasive Disease and
Screening Unit, Department of gynaecological Oncology, KK Women’s and children’s Hospital
I am always feeling down and nothing
seems to excite me any longer. Is this
depression? Is it also normal to feel
depressed before the onset of menstruation?
the key symptoms that must be present
are either a low mood and a depressed
feeling, or loss of interest and inability to
take pleasure in anything.
other symptoms of depression
include:
poor quality of sleep (especially
waking up in the early morning)
loss of appetite and weight (or
overeating and gaining weight)
loss of concentration, forgetfulness
loss of energy, lethargy (or feeling
agitated and restless)
negative thinking, excessive guilt,
feeling s of hopeles snes s, and
suicidal thoughts.
these symptoms must be present
persistently for a period of two weeks or
longer, and cause significant distress or
impact a person’s level of functionality.
Before your menses is due, you may
feel down because of the increasing level
of progesterone (the hormone responsible for the depressed mood) during the
preceding two weeks. some women may
also feel frustrated as they have to refrain
from activities such as swimming, wearing tight or light-coloured clothing, and
even sex. a review paper in 2012 found
that premenstrual dysphoric disorder,
a form of depression characterised by
premenstrual episodes that affect functioning, occurs in 1.3 to 2.8 per cent of
women in asia, compared to 3 to 8 per
cent in Western countries.
Dr Helen chen, Head and Senior consultant, Department of Psychological Medicine, KK Women’s and
children’s Hospital
These articles are from www.healthxchange.com.sg,
Singapore’s first interactive health and lifestyle portal.
Topics for discussion in
November 2013:
Gynaecological tumours and managing
diabetes and high blood pressure.
Discussion is closed in December.
NOV – DEC 2013
SiNGAPOrE HEALTH
OpiniOn
17
Financial help available not only
for those with low income
Medical social workers at SGH have seen more middle-income Singaporeans seeking
assistance as they have difficulties paying for healthcare. Many are in their 20s to 40s
By EsthEr Lim
Help not only for the low income
Over the years, there has been a growing
trend among lower- to middle-income
groups applying for Medifund assistance
for their treatment costs.
While Medifund generally assists the
lower quintiles of income earners in society, it is rendered to anyone in genuine
need, and who are unable to afford their
medical expenses. A significant number
of these applicants are from middle-income households who are unable to
cope with their health expenses due to
rising healthcare costs and the higher
costs of living in Singapore.
Medical advances and the higher
incidence of chronic diseases also
contribute to the increasing healthcare costs in Singapore. While medical advances have led to people living
longer, the number of people with one
or more chronic conditions is also fast
increasing. Chronic diseases, which are
long term and progress slowly, include
PHOTO: ALViNN LiM
M
r LiM (not his real name), in his
40s, was diagnosed with short
bowel syndrome and was told
that he needed to take a special diet
preparation, called the total parenteral
nutrition (TPN), for life to ensure all his
nutritional needs are met. The nutrition
costs about $40,000 every six months.
At such a hefty sum, he was left feeling
anxious about his ability to cope and the
implications for his family.
Short bowel syndrome is a condition where nutrients in the body are not
properly absorbed because a large part
of the small intestine is missing, or has
been removed surgically. People with
this condition are given the nutrient
solution intravenously, bypassing the
digestive system.
Mr Lim is a civil servant and married with two school-going children. The
family of four lives in a five-room HDB
apartment. A domestic worker helps his
wife – who suffers from a chronic medical condition – care for their children
and with the household chores.
As the sole breadwinner, Mr Lim struggled with his health expenses initially.
Unable to cope, he eventually applied for
Medifund assistance through Singapore
General Hospital’s (SGH) Medical Social
Services. He now co-pays $2,000 over
six months for his TPN, allowing him to
cope better.
Today, Mr Lim lives life normally, and
continues to support his family.
According to Ms Esther Lim, the Medical Social Services at the Singapore General
Hospital processes about 100,000 applications for Medifund assistance per year
and 99 per cent of the cases are generally granted some form of assistance.
heart disease, stroke, cancer, chronic
respiratory disease and diabetes. The
more chronic diseases one suffers from,
the higher the health expenses. And this
is ostensibly so.
Apart from the destitute, we see a
growing proportion of middle-income
patients in need of Medifund assistance
for their healthcare costs. We help them,
fully or partially, to cope with their
healthcare expenses. Without assistance, their health, employment and
family may be affected negatively.
Patients can apply for assistance
at restructured hospitals’ medical
social work departments. Medical social
workers (MSWs) will assess their financial
situation, such as their household
income and expenses, to understand
their circumstances.
Applying for Medifund assistance can
be awkward for some, as applicants may
feel embarrassed having to open up their
family’s finances to scrutiny. To respect
the dignity of our patients and to protect their privacy, our team of trained
MSWs use individual interview rooms
during the assessment process.
in assessing an application, we look
at what patients and their families can
afford. Beyond considering their absolute family income, we also look at their
psycho-social circumstances and how
the illness may have impacted the family
in other ways.
These applications are submitted to
the approving platforms, complete with
the MSW’s explanations and recommendations for a certain level of assistance.
if the patients and families are able
to afford a percentage of their health
expenses, we recommend co-payment
to encourage individual and family
responsibility. if they are not able to
afford their health expenses, within
reason, we will do what we can to help.
Healthcare financing system in Singapore
Singapore’s healthcare financing system
is covered by government subsidies
and the 3Ms: Medisave, MediShield
and Medifund. Medisave is a savings
scheme used to pay for one’s own or
one’s immediate family’s hospitalisation, day surgery and certain outpatient treatment expenses. it is sup-
ported by MediShield, a basic medical
insurance scheme that helps pay part
of the expenses from the insured’s
hospital and certain outpatient treatments for serious illnesses at approved
medical institutions.
For those who are unable to cope
with their medical expenses, even after
government subsidies, Medisave and
MediShield, Medifund works as a financial safety net.
Medifund is an endowment fund set
up in April 1993 by the Singapore Government as a safety net to aid needy Singapore citizens who are unable to afford
their medical expenses.
Applications for Medifund assistance are submitted to the hospital’s
Medifund Committee for consideration
and approval. The Medifund Committee, made up of independent volunteers
from all walks of life, assesses the needs
and circumstances of the applicants
before recommending whether to provide assistance.
in SGH, we process about 100,000
Medifund applications each year. Of
these, 99 per cent of the cases are generally granted some form of assistance.
We are currently working with the
government ministries, as well as internally within SGH, to simplify the process
of applying for help and to reduce touch
points. We are also working towards
making information on financial assistance clearer so that people know where,
when and how to get help.
in active collaboration, we work with
social service agencies organisations,
such as the social services offices, family
service centres, and within the healthcare sector to identify and help those
who need financial assistance with
their healthcare costs. This is done with
the overall aim of increasing healthcare accessibility and affordability for
our patients.
if you are facing financial difficulty
with your healthcare expenses, it is
important that you seek help to cope,
so that you and your family can have
better peace of mind about meeting
your healthcare needs.
Ms Esther Lim is Head of Medical Social Services
at the Singapore General Hospital (SGH) and has
been a medical social worker for 18 years. She is
also a certified Master and Consultant in Applied
Suicide intervention Skills Training (ASiST). As
the first ASiST trainer in SGH, she pioneered the
programme in 2003 for healthcare and social work
professionals. Last year, she received the Outstanding Social Worker Award from President Tony
Tan Keng Yam at the annual President’s Tea reception for Social Workers.
18
It’s smarter to monitor
your blood pressure
before you fall sick.
your say
Buying medication
without consulting
doctor
The doctor at the polyclinic gave me
some medicine for stomachache and
cramps but I didn’t take them as prescribed – at the right times and in the
right amounts. Also, I forgot to take a
few doses. As a result, when I finished
the medication, the pain remained. I
would like to get a repeat prescription
but am not keen on going through the
hassle of consulting the doctor again.
I don’t see why this is necessary as
it is the same ailment. Can I get the
medication at the pharmacy counter
if I bring along my empty medicine
packets?
SHP
We are unable to dispense
medication without a doctor’s prescription. You are
advised to consult our doctor first so
that he can re-assess your condition and
make adjustments to your treatment
plan and medication, where necessary
based on your current health condition.
This practice is in line with the Singa-
Blood Pressure Monitor
Hi h bl
High
blood
d pressure (BP) is
i called
ll d the
th ‘silent
‘ il t
killer’ because there are often no symptoms.
Even though you feel well, you could have
had it for years without knowing.
And untreated high B
BP can cause damage to
your ar
arteries, leaving you more
sus
susceptible to heart attacks
and heart failure.
For better heart health,
you should have good
eating habits,
exercise regularly and
practise BP home monitoring.
pract
Knowing
your BP status helps
Know
you seek your doctor’s help
when necessary.
Visit www.omron-healthcare.com.sg to
learn how the leader in
BP home monitoring devices,
Omron, makes it easier for you to do so.
Check out in store for
Omron Blood Pressure Monitor
promotions!
Available at leading retail pharmacies
including major hospitals.
tributes
SAYS
pore Medical Council Regulations and
Ethical Standards. However, medication
that is available over the counter at retail
pharmacies can be purchased without a
doctor’s consultation.
Operation was
delayed twice
After her knee replacement surgery, my
mother was reviewed at SGH and found
to be fit for a similar procedure on her
other knee. She was scheduled for the
second surgery on July 9, but it was subsequently postponed twice, first to July
18, then to July 25. Why was the surgery
repeatedly delayed?
A procedure can be delayed for
SGH various
reasons. These include
SAYS
a shortage of Intensive Care
Unit beds for major procedures requiring
post-surgery intensive care, the surgeon
unexpectedly falling ill, or the surgeon
having to attend overseas conferences.
Patients who require urgent surgery
because of a more serious condition may
be moved forward in the queue, ahead of
elective, non-urgent procedures.
We were frantic when my wife,
who suffers from diabetes, suddenly
complained of poor vision. We were
not sure how to go about getting an
immediate evaluation. Luckily for
us, Ms Jaynthi Karappiah, a nurse
clinician at SGH’s Diabetes Centre,
responded to our query and arranged
for my wife to have a retina examination. She also provided detailed guidance on diabetes and went the extra
mile by replacing a medical leave certificate that contained a mistake. My
wife and I are deeply appreciative of
her efforts and assistance.
- Mr SH Teo
The staff in Ward 56, National
Heart Centre Singapore, consistently
showed care and concern, through
their personal and attentive ways,
towards my father. Whether it was
sponging him or giving him medicine,
they did it with warm and personal
touches, kind words and smiles.
Their warmth and cheer fulness
made a great difference to my father
every day. I was impressed by their
great service and cheerful attitude
towards not just him but all patients
in the room. They are truly an “A”
team of nurses.
- Mr Lee
I would like to commend the staff at
SGH’s A&E department for their warm
and helpful service. I was too sick to
remember their names but I found
everyone I encountered pleasant.
It made my pain at that time a little
easier to bear, and I feel such good
service deserves mention. Thank you.
- Ms L Rahmat
I would like to extend my thanks
to radiographer Phang Yi Xuan at
SGH’s Advanced Imaging Centre,
Camden Medical Centre, for attending to me. She was reassuring and
very professional. Thank you for the
excellent service.
- Mr ET Yeo
about your health
experience and win a
prize for best letter
Letters must include your full name, address and phone
number. Singapore Health reserves the right to edit letters and
not all letters will be published. Write to [email protected] or
the editor, singapore Health, singapore General Hospital,
Communications Department, outram road, singapore
169608, or talk to us on Facebook.
the winner will receive a satchel of spirulina 100% extra 10%
Deep ocean Water spirulina blended (2000 tablets). the product,
worth $128, is sponsored by iMi Lifestyle Products Pte Ltd.
For more information, please contact Kingston Medical Supplies, 6745 3922
NOv – Dec 2013
Occasionally, the hospital may face
a bed crunch that requires non-urgent
cases to be put on hold. When we postpone a procedure, we do a careful evaluation of the patient’s condition to make
sure that the delay won’t compromise his
or her condition. Our patients’ health and
safety are always our priorities.
Could not self-register
I had an appointment at the polyclinic
and tried to register at the Service
Selection Kiosk. However, I was not able
to do so. The system indicated that I had
an outstanding bill and prompted me to
go to the registration counter. Why did
this happen?
SHP
The Service Selection Kiosk
lets patients obtain queue
numbers for various service
points. Patients with outstanding bills
are advised to go to our registration
counter. This allows them to raise any
concerns or issues that they may have
with their bills, and for our staff to offer
assistance, such as financial counselling
and support, where necessary.
SayS
I went to the reception counter at
a clinic in the National Neuroscience
Institute and was attended to by Ms
Grace Krishnan, Senior Patient Services assistant. I explained to her
that I needed an additional test on
top of my blood test. as the doctor
was not around, she apologised
and was very courteous. She also
assured me that there was no cause
for worry as she would speak to
the doctor as soon as possible. She
promised to contact me after that.
The very next day, she called me to
say that the doctor had approved
my request. In my view, this is good
service indeed!
- Mr Wong
I want to thank Dental Officer, Dr
Ruebini anandarajan, and Dental
Surgery assistant, Ms Stella Kang,
who were very helpful and friendly
when I visited Queenstown Polyclinic
for teeth polishing and scaling. Dr
anandarajan did a thorough job and
advised me on my current tooth condition. He also patiently taught me
how to take care of my teeth. This has
completely changed my impression
of the service at polyclinics.
- Mr K loh
I called SGH one morning to
arrange for an earlier appointment
for my mother. Her original date
SiNgaPOre healTh
was in July but as the doctor was on
medical leave, it was postponed to
January next year. In frustration, I
called Clinic M to request for an earlier appointment so that my mum’s
prescription could be reviewed.
Nurse yee answered my call and listened patiently to my plea. Then,
she checked with the registration
staff and 15 minutes later, informed
me that my mum’s appointment has
been rescheduled to September. I
was very impressed with her customer service. Thank you Ms yee for
your help.
- Ms e Tan
My family and I are very appreciative of the excellent care given by
Dr Chua Hong Liang, Senior Consultant, Department of Obstetrics and
Gynaecology, SGH. He is very patient
and reliable, and always takes good
care of his patients. My sister and I
chose to have our babies delivered
at SGH because of Dr Chua. He gives
patients peace of mind and is the
best doctor we have met in Singapore, as well as overseas.
- Ms WF chan
I accompanied my father to the
Same Day admissions Centre very
early one august morning. He was
very apprehensive about undergoing
surgery. at the time, there were few
your say
19
nurses on duty. Two nurses – Enrolled
Nurse Cassandra Giam and Principal
Enrolled Nurse yeo Lay Choon – gently
reassured my father that the surgery
would go well. He became calmer and
less worried after that. I would like
to express my heartfelt thanks to the
two ladies. It wasn’t easy to soothe
my father’s nerves but their excellent service and professionalism won
the day.
- Mr ch goh
Ms Tan Sok Hiang, Medical Social
Worker, National Heart Centre Singapore, is an excellent social worker
who showed her patients outstanding care and concern. She does not
hesitate going the extra mile for
them. She would personally visit
my home to understand my situation and has offered great help to my
family and me. She has helped me
tremendously, changing my life for
the better.
- Ms Tan
I would like to thank Madam
Juriah Lon, Senior Patient Service
assistant, SingHealth Polyclinics
(Outram), for going out of her way
to help locate my misplaced pouch
which contained impor tant and
valuable items. I truly appreciate
her effort.
- Mr Kl Wan
20
FYI
singapore health
noV – DeC 2013
event Calendar
spiders
Red meat may increase
Most scientists agree that two proteins, tau and beta-amyloid,
cause Alzheimer’s disease. Now, researchers at the Semal Institute
for Neuroscience and Human Behaviour, University of California,
Los Angeles, believe there is a third cause: accumulation of
iron in the brain from eating too much red meat. Iron can
speed up the damaging reactions caused by free radicals
thus increasing the risk of developing Alzheimer’s disease.
MRI scans showed an
association between the
build-up of iron in the
hippocampus, an area
of the brain involved in
memory formation, and
tissue damage in that area.
Facebook use can
reduce well-being
Source: BBC News
Contest
1. name one complication that
patients might get if they do
not wear their anti-embolism
stockings.
2. Which story in this issue did you
find the most informative?
Closing date: December 4, 2013
send in your answers and stand to win a bottle each of Ultra
Hemoshield and Ultra organic green Barley, worth $112.85.
a Japanese study of more than 43,000 children found
a connection between breastfeeding and a lower
probability of children becoming overweight or obese.
researchers first attributed it to other factors that
could affect the children’s weight, such as gender and
the amount of time spent watching television or using
the computer, as well as their mothers’ education levels,
employment status or whether she smokes. looking at
records of how the children were fed during infancy, the
researchers from the okayama
University graduate school
of Medicine, Dentistry, and
pharmaceutical sciences
concluded that children
who were breastfed at
six and seven months of
age are less likely to
be overweight than
those who are fed
formula milk.
Conference room 1, training Centre,
Women’s tower, level 1
REgIsTRATIoN Closes on november 15,
Friday. Call 6394-1268 (Monday-Friday,
9am-5.30pm). Visit www.kkh.com.sg for
more details.
PRICE $10 (KKJC member) or $15 (nonKKJC member)
a nutritionist will share essential information on baby nutrition and weaning.
there will also be cooking demonstrations
on baby food. suitable for parents whose
babies are aged six months and above.
Source: JAMA Pediatrics Journal
include your name, age, gender, address and telephone number.
Winners will be notified via phone or e-mail. incomplete or
multiple entries will not be considered.
e-mail [email protected] Post the editor, singapore health,
singapore general hospital, Communications Department,
#13-01 surbana one, Blk 168, Jalan Bukit Merah, singapore 150168
Winners of Contest 24: each will receive a bottle of spirulina
100% extra 10% Deep ocean Water (750 tablets) worth $69.
prizes must be claimed by December 4, 2013.
1. Chin Meow Cheng 2. Lee Siew Hiang 3. Lim Li Li
4. Ng Shwee Hoong 5. Jeany Teo
Raising Healthy and
Happy Kids: The Early Years
DATE november 30, saturday
TIME 3-5pm
VENUE activity room, Choa Chu Kang
public library
REgIsTRATIoN online registration required.
▲
Researchers from the University of Michigan have found
that checking Facebook reduced people’s sense of wellbeing and satisfaction with life, and that the more they
browsed, the worse they felt. Facebook has more than a
billion members, half of whom log in daily. The researchers
said, “On the surface, Facebook provides an invaluable
resource for fulfilling the basic human need for social
connection. Rather than enhancing well-being, these
findings suggest that Facebook may undermine it.”
child obesity
Baby Weaning Workshop
DATE november 23, saturday
TIME 10am-12pm
VENUE KK Women’s and Children’s hospital
▲
Source: Medical News Today
public Forum: (Mandarin) 9am-10.15am,
(english) 10.45am-12pm
VENUE Memory assessment: nni
neuroscience Clinics, level 1;
public Forum: nni exhibition hall,
Basement 1
REgIsTRATIoN Memory assessment: Call
6357-7163;
public Forum: Mandarin – Call 6357-7152;
english – Call 6357-7163
(Monday to Friday, 9am-5.30pm)
Dementia and cognitive disorders, which
are chronic in nature, have become major
health concerns in singapore. learn about
dementia at public forums by the nni,
and get tips on how to prevent it. the
memory screening is free for members
of the public who are 55 years old and
above, with no prior medical follow-up for
memory problems. they will be asked sets
of questions designed to test a range of
everyday mental skills.
Source: BBC News
Breastfeeding
linked to reduced
NNI Dementia Awareness Day
Public Forum and Memory
Screening for Dementia
DATE november 23, saturday
TIME Memory assessment: 8.30am-5pm;
▲
risk of Alzheimer’s disease
▲
Spinning blood vessels like
a University College london team has
demonstrated a way of building body
parts that mimics the way spiders spin
their webs. to weave new tissue, the
researchers use a constant stream of
cells mixed with a polymer. THIS FIBRE
IS THEN DRAWN OUT BY A 10,000 vOLT
ELECTRIC NEEDLE. THE PROCESS
HAS BEEN USED TO CONSTRUCT
BLOOD vESSELS IN MICE. one of the
researchers, Dr suwan Jayasinghe,
said: “at the moment no technology
can make an organ, we are coming
up with the process to patch up a
defective organ, not replace an organ.”
Visit golibrary.nlb.gov.sg for more details.
parents will learn how to help shape the
mental well-being of their young children.
practical tips will also be shared on
building the strengths and expanding the
coping strategies of their kids.
Toddler Feeding Workshop
DATE December 7, saturday
TIME 10am-12pm
VENUE KK Women’s and Children’s hospital
patient education room 1, Women’s
tower, level 1
REgIsTRATIoN Closes on november 29,
Friday. Call 6394-1268 (Monday-Friday,
9am-5.30pm). Visit www.kkh.com.sg for
more details.
PRICE $10 (KKJC member) or $15 (nonKKJC member)
Find out how to get your toddler to enjoy
food at this informative and practical
session with speech and language
therapists, and dietitians. suitable for
parents with toddlers aged one to three.
Visit www.singhealth.com.sg/events or the
websites of respective institutions for any
changes, more information, and other listings.
NOV – DEC 2013
siNgapOrE hEalth
21
YOUR GUIDE TO BETTER LIVING
Demystifying
age-old practices
Folk remedies might hold the key to treating a wide range
of medical problems but longevity is not a guarantee that
they are without risks. By Sol E Solomon
s
OmE non-mainstream health practices have been around since time
immemorial, or at least hundreds of years. some of these alternative
practices are still performed today, like circumcision, while others like
delayed cord clamping are gaining favour as scientific evidence has been
found to support its use.
a story in the Bible says that when god
promised to make abraham the father of
all nations, he also ordered the Jewish
patriarch to circumcise his sons and all
male descendants. in the Koran, ibrahim
– the muslim equivalent of abraham – was
told to do the same. the practice of cutting off the foreskin dates back thousands
of years, and continues today as a religious duty among Jews and muslims alike.
in more recent times, circumcision –
removal of the foreskin, the excess skin
covering the penis – has become an
option for men who want better personal
hygiene or for medical reasons, including
prevention against cancer of the penis.
then there are others who turn to this
procedure in the belief that circumcision
leads to greater sexual pleasure.
a circumcised penis will not lead to
greater sexual pleasure, but circumcision
can lead to better hygiene and a lower risk
of disease, said Dr Valerie gan huei li, registrar, Department of Urology, singapore
general hospital.
“some men ask for circumcision
because they have the idea that the procedure will result in a lengthening of the
penis or an increase in sexual pleasure,”
said Dr gan.
“these are myths, and in fact, studies
suggest that sensation at the penile glans
may be diminished after circumcision.”
men with an overly tight foreskin are
prime candidates for circumcision. When
the foreskin is too tight – a condition
known as phimosis – it can be difficult or
even impossible to pull back the flap of
skin over the glans or the head of the penis
for cleaning. this can increase the risk
of urinary tract infections and recurrent
inflammation of the foreskin, because urination can be a problem and the foreskin
can balloon with trapped urine.
“When phimosis is coupled with a loss
of skin colour and thickening of the foreskin and glans, it can lead to a condition
known as balanitis xerotica obliterans,” Dr
gan said. the condition, which has been
associated with penile cancer, can be
treated with circumcision. the protective
effect against penile cancer, however, is
only seen in circumcision performed on infants.
“Keep in mind though that
penile cancer is very rare and circumcision to prevent cancer alone
is not warranted,” Dr gan said.
three large studies done in africa,
she said, have showed that circumcision
reduces the risk of hiV infection in heterosexual men, possibly because the inner
foreskin is susceptible to tears and ulcers,
and is rich in hiV-target cells with minimal
keratin protection.
Other studies showed that circumcision is good for the female partners of
circumcised men as well; this group of
women had a lower cervical cancer rate
because circumcision reduced the prevalence of cancer-causing strains of human
papillomavirus or hpV.
however, for other sexually transmitted diseases like syphilis, herpes, gonorrhea and chlamydia, the jury is still out
on whether circumcision has a protective
effect, Dr gan said.
Nasal irrigation
Some chronic sinusitis
sufferers have turned to
nasal irrigation, where
a warm salt solution
is poured through the
nostrils using devices like
the neti pot, a squeeze
bottle or a syringe. It helps
flush out excess mucus and
lubricates the nasal cavity.
Nasal irrigation has its roots in the ancient hindu practice
of ayurveda and was first reported in Western medical
literature in the 1900s. rinsing the nasal cavity by pouring
a warm salt solution into the nasal passage is believed to
help sinus sufferers.
the sinuses are the air-filled spaces that surround the
nasal cavity as well as above and between the eyes. some
people are more prone to nasal congestion because of
recurrent infections of the upper respiratory tract, allergies, deformities in the nose, or immune deficiencies.
Doctors typically prescribe steroids and antibiotics to
treat chronic sinus sufferers. in cases where drug therapy
isn’t effective, surgery can help unblock the sinuses. surgery is also done if there are complications such as structural abnormalities or fungal sinusitis.
some sinus sufferers have turned to nasal irrigation
for help with their blocked nose. it isn’t clear how nasal
flushing actually works, but some believe that the rinsing action helps break up the mucus, while others think
rinsing stimulates the hairs in the nasal passage to clear
phOtOs: gEtty imagEs
Circumcision
the mucus, said Dr Ng yuk hui, Consultant, Department of
Otolaryngology, singapore general hospital (sgh).
some studies have shown that nasal rinsing does
help ease sinusitis symptoms, and improvements in scan
results have also been documented. the improvement in
symptoms is modest in some cases, and “in most studies,
the patients feel better after using the rinse,” Dr Ng added.
proper care and cleaning of the irrigation bottles is
essential as there is a risk of infection from contaminated
bottles or solutions. Dr Ng noted that in the United states,
people reportedly have died from amoebic contamination
of the nasal rinse when contaminated tap water was used
for the nasal irrigation. “although the risk of such contamination is low in our local setting, it is still advisable to use
distilled or cooled boiled water,” he said.
the practice is generally safe although users might feel
some common side effects such as a burning sensation
in the nose, nasal discomfort, and tearing. Nasal flushing
is performed on post-surgery patients as often as three
times a day at sgh, said Dr Ng, but once or twice is sufficient for other people.
> Continued on page 22
22
singapore health
noV – DeC 2013
> Continued from page 21
Demystifying age-old practices
Cord clamping
some parents have turned to delayed
cord clamping, a practice where the
umbilical cord is clamped and cut two
to three minutes after delivery – instead
of immediately. the belief, which is supported by some evidence, is that there
are benefits for the child, such as a lower
risk of anaemia if clamping was delayed.
the practice also supposedly benefits
babies born prematurely as they face the
risk of intraventricular bleeding or bleeding in the brain, which in turn can lead
to brain damage. the practice is uncommon in singapore, although many obstetricians will perform it at the patient’s
request in uncomplicated cases, said Dr
tan eng loy, Consultant, Department of
obstetrics and gynaecology, sgh.
Cord clamping was originally introduced to reduce the risk of the mother
experiencing serious bleeding after
giving birth, a potentially fatal condition.
For convenience, the cord was usually
clamped within a minute of delivery.
But, said Dr tan, “immediate cord
clamping has not been universally
accepted as part of the active management
of the third stage of labour (when the placenta is expelled after the delivery of the
baby).” surveys in europe showed a large
variation in practice with only 15 per cent
Babies carried to full term but who are at risk of anaemia or whose mothers
are iron-deficient, can benefit from having the umbilical cord clamped and
cut two to three minutes after delivery, instead of immediately.
of healthcare units in austria and 17 per
cent in Denmark practising immediate cord
clamping, versus as many as 77 per cent of
units in the United Kingdom, he said.
Babies carried to full term but who
are at risk of anaemia or whose mothers are iron-deficient, can benefit from
delayed cord clamping, said Dr tan. at
birth, an extra volume of blood resides
in the placenta. Delayed clamping lowers
the risk of anaemia and increases the
number of red blood cells in newborns.
Before the cord is clamped, blood
continues to pulse from the placenta
back to the baby until the pulses naturally stop several minutes after birth. For
an infant delivered at full term, this is
equivalent to receiving an additional 80
to 100mls of blood, or an extra 20 to 30
mg/kg of iron, sufficient for the baby for
about three months.
For preterm infants, the practice is also
associated with a smaller risk of necrotising enterocolitis, a serious condition that
involves tissue death in the bowels, and
intraventricular haemorrhage, Dr tan said.
one downside of delayed clamping,
said Dr tan, is the stronger risk of the baby
developing jaundice. a common condition in newborns, jaundice occurs when
bilirubin builds up in the blood. Bilirubin,
produced by the normal breakdown of
red blood cells, normally passes through
the liver and is excreted as bile through
the intestines. phototherapy uses light to
eliminate the excess bilirubin.
so, it is imperative that a mother
undergoing an uncomplicated full-term
delivery understand the jaundice risk.
in preterm infant s too, Dr tan
would only recommend it in uncomplicated deliveries not requiring immediate resuscitation.
another drawback is that no clear
standards of practice for delayed cord
clamping has been defined, such as the
best time to clamp, said associate professor Yeo Cheo lian, senior Consultant,
Department of neonatal and Developmental Medicine, sgh.
she added that while some studies
report a reduction in immediate post-delivery intraventricular haemorrhage in
premature babies (less than 33 weeks),
there has been no significant difference
in overall outcome of these infants. the
effects of this practice on mothers also
have not yet been adequately studied,
she said.
still, if there are no other complications, delayed clamping should pose very
little risk to the mother, said Dr tan. But
it should not be done in cases such as
severe maternal bleeding, if the umbilical
cord is wound tightly around the baby’s
neck, or if the baby is asphyxiated and
requires immediate resuscitation.
NOV – DEC 2013
Joints
ExtrEmE pAin
Gout AttAck LocAtions
most common
common
less common
Medication to lower uric acid levels can keep
gout under control. By Sol E Solomon
By lowering the uric
acid in the Blood
to a certain level, the
chance of getting
a gout attack is
drastically reduced.
Dr Tan York kiaT, ConsulTanT, DeparTmenT
of rheumaTologY anD immunologY,
singapore general hospiTal , on
TreaTmenT for gouT.
“gout crystals deposited in the joints
cause painful attacks, which is an inflammatory response,” said Dr tan York Kiat,
Consultant, Department of rheumatology and immunology, singapore general
hospital (sgh).
Not everyone who has a high level of
uric acid in the body will suffer from gout,
but people with a persistently high level
of the acid in their blood have a higher
risk of getting the disorder, said Dr tan.
been experiencing an attack almost
monthly in the last two years. the
father of two has modified his eating
habits, and avoids nuts and meat.
Because gout has caused him to walk
with a painful limp, he no longer plays
tennis and soccer or jogs. But to keep
fit, he swims as often as possible. “My
advice to people with gout is to stay positive and exercise. Don’t forget your diet
and medication. Most importantly, see
your doctor regularly,” Mr Zalfi said.
patients can never be cured of gout.
it is a long-term disease that can be controlled by a combination of medication
to control the uric acid level, and anti-inflammation drugs to treat a flare-up.
“lowering the level of uric acid is key to
treating gout, and patients must understand this. in the long term, if you do not
use the uric acid-lowering medication,
the gout will recur,” said Dr tan.
“We know that putting a patient on
uric acid-lowering therapy early helps.
By lowering the uric acid in the blood to
a certain level, the chance of getting a
gout attack is drastically reduced.”
some medicines reduce the formation of the uric acid in the blood while
others increase uric acid excretion from
the urine system. “All aim to reduce the
uric acid,” he added.
phOtO: gEttY iMAgEs
gout often runs in the family,
although diet also plays an
important role. it was once
known as a “rich man’s disease”
as it tended to affect the upper
class who could afford rich foods.
Now, gout can affect any part of the
population, including younger people, as
they become richer, eat more meat, and
drink more. “A Western diet of red meat,
liquor, alcohol and seafood tends to be
associated with gout,” said Dr tan.
gout is also linked to obesity, hypertension and diabetes. some drugs like
diuretics can cause gout as a side-effect.
gout attacks come and go, and the
intervals between painful flare-ups can
be as long as months or even years. But
as the disease progresses, the flare-ups
become more frequent and the intervals
shorter, Dr tan said.
in addition, some chronic sufferers
develop tophi, clumps of uric acid crystals that form around joints, tendons, ligaments, and even in their earlobes.
Without treatment, years of gout
attacks can damage the affected joints,
leading to deformities, chronic pain, and
immobility. A persistently high level of
uric acid can cause kidney stones and
affect kidney function.
Mr Zalfi, whose first attack occurred
in 1997 and the second a year later, has
EstrogEn may hElp cut gout risk
Dr Tan York Kiat examining the joints
of gout patient Mr Zalfi Hasril.
Between the age of 30
and 50 years, most gout
sufferers are men.
age
phOtO: ZAphs ZhANg
W
23
the first sign of a gout attack is often
a sudden, warm and throbbing
pain in the affected joint. Within
hours, this can rapidly escalate into
excruciating pain, accompanied by
swelling and redness of the joint.
the skin around the joint will also
be tender and sensitive, with the
slightest touch causing extreme
pain. gout affects the big toe in
about 90 per cent of people with
the condition.
on fire
hEN Mr Zalfi hasril first experienced an attack of gout, the
pain in his ankle was so bad
that he could hardly walk. he didn’t see
a doctor but turned to a traditional Malay
masseur because he thought the pain
was due to a fall. the pain went away
after about a week.
When he felt the same sort of excruciating pain a year later, Mr Zalfi decided
to seek medical attention. After tests, he
was found to be suffering from gout, a
metabolic disorder that occurs when the
kidneys are unable to get rid of excess
uric acid. the acid ends up being deposited as crystals in the joint cartilage, tendons and surrounding tissues.
siNgApOrE hEAlth
Avoid organ meats and keep diet balanced
Following a low-purine diet can help you limit the body’s uric acid production,
according to singapore general hospital’s Department of Dietetics. purine is a type
of protein present in various types of food. When these proteins are broken down,
uric acid is the end-product. gout sufferers should follow a well-balanced diet
while restricting their purine intake.
30
40
gout sufferers get their first
attack when they are in
their 30s.
Avoid foods rich in purine, such
as liver, kidney, brain, heart and
other organ meats; small fish
such as anchovies, ikan bilis and
sardines; mackerel; scallops and
meat extracts
50
gout starts to affect more
post-menopausal women
because their production of
the hormone, estrogen, falls
dramatically. estrogen is
believed to help the kidneys
excrete uric acid.
Drink plenty of fluids daily
limit alcohol and fat intake
Achieve and maintain a healthy
body weight
Consume asparagus, mushrooms
and legumes in moderation
24
Bone health
for women
It is crucial to build strong bones from
birth, but also never too late to start
keeping your bones healthy. By Puk Yingjia
C
aring for our bones is a lifelong
affair, as bones are living tissues
that break down and rebuild
themselves throughout our lives.
Men have wider, denser bones than
women. Studies show that osteoporosis
– a condition where bones become fragile
and more likely to break – occurs more
frequently in women than men.
Young women should take steps
to prevent osteoporosis early. in postmenopausal women, the ovaries stop
producing oestrogen, which increases
bone loss and leads to a rapid loss of
bone density.
it is crucial to build strong bones from
birth. in childhood and adolescence, our
bodies make new bone faster than it is
broken down. growth continues, but
eventually, as we age, bone loss outstrips
bone replacement. Ever yone loses
bone mass as they age, but those who
develop maximum bone strength and
density when young are better protected
against osteoporosis.
Peak bone mass (achieved when
the skeleton reaches maturity) may be
determined by genes, but diet, exercise
and other lifestyle factors are significant factors too. Plenty of physical activity during the teen and pre-teen years
increases bone mass and reduces the
risk of osteoporosis in adulthood.
it is never too late to take steps to
slow down natural bone loss and prevent brittle, weak bones, but one should
start healthy habits early on, with regular
exercise and a diet containing adequate
calcium and vitamin D.
From childhood to
old age, there are
different things to
take note of.
From birth
to nine: Good diet is key
Babies and young children need calcium for strong bones and teeth. Healthy
babies do not need supplements, except
for vitamin D, which is vital for calcium
absorption, said Dr Han Wee Meng, Principal Dietitian, KK Women’s and Children’s Hospital (KKH). Vitamin D deficiency may lead to rickets, which can
cause soft and weak bones.
Vitamin D is found in breast milk
and infant formula, but not in sufficient
amounts. The United States Centers for
Disease Control and Prevention (CDC)
recommends that all breastfed babies
be supplemented with 400 iU (10 mcg) of
vitamin D daily. requirements increase
as a child grows. the daIly recommended dIetary allowance (rda)
for calcIum Is 400mg for Infants,
500mg for ages one to three, 600mg
for ages four to sIx, and 700mg for
ages seven to nIne.
Ms Jeanette Yee, Dietitian, KKH, said
calcium-rich foods include milk, calcium-fortified soya milk, cheese, dried figs,
bean curd, and yogurt. Margarine, fortified milk and oily fish, such as sardines
or mackerel, are rich in Vitamin D. Dr Han
also mentioned that another potential
source of vitamin D is its synthesis in the
skin from exposure to sunlight for 10 to
15 minutes a day.
Between 10
and 30: Building
up bone mass
Bone mass acquired while young determines skeletal health for life. Puberty Is
a crucIal tIme for the develoPIng
skeleton. the crItIcal bone-buIldIng years are from ages 10 to 18.
For girls, having regular periods is
important to bone health, as it indicates
sufficient production of oestrogen, which
improves calcium absorption in the kidneys and intestines.
by age 19, bone mass accumulatIon slows down, but women contInue to buIld bone faster than
they lose It, untIl age 25 to 30
when they achIeve Peak bone mass.
after that, bone building slows down
Over 50: Move carefully
and avoid falling
and bone loss picks up, but bone mass
can be maintained with good nutrition
and exercise.
Dr ang seng Bin, head and consultant
Family physician, KKh, said studies show
that bone mass accumulated between
the ages of 11 and 13 is equivalent to the
amount of bone loss during the 30 years
after menopause.
Women with a family history of osteoporosis should take extra care from
puberty to ensure a higher peak bone
mass and lessen the risk of osteoporosis
in later life.
eat sufficient calciuM-rich
foods such as dairy products
and calciuM-fortified foods like
cereals and soya Milk, and do
weight-bearing exercises regularly. these allow gravity to exert
on the body, which is vital for
reaching MaxiMuM bone strength.
Bones adapt to the impact of the
weight and pull of muscles by building
more bone cells, making them stronger
and denser. simple exercises include
climbing stairs, skipping and brisk walking. More adventurous ones include
hiking, dancing and step aerobics.
the heath promotion Board’s (hpB)
rDa for calcium increases to 1,000mg
between the ages of 10 to 18, and drops
slightly to 800mg for ages 19 to 30. the
recommended vitamin D intake is
100iU (2.5 mcg) per day for ages
seven and above.
pregnant and breastfeeding
mothers are advised to take
1,000mg of calcium and 400iU
(10 mcg) of vitamin D daily.
Ms ang Bixia, senior Dietitian,
KKh, said this is crucial for
bone health, as inadequate consumption
may result in the
fo e tus dr awing
calcium from the
mother’s bones,
increasing her risk
of osteoporosis in
later life.
Between
30 and 50: Ditch bad habits
at this age, bone tissue is lost faster than
it is replaced.
Menopause before the usual
age of 45 can cause bone loss,
leading to early osteoporosis.
other causes are sMoking, drinking More than two units of alcohol daily, a sedentary lifestyle,
and long-terM calciuM intake of
less than 500Mg per day. studies
show that smoking reduces blood supply
to the bones and impairs calcium absorption, while too much alcohol affects the
liver, which is important for activating
vitamin D.
to minimise bone loss, get enough
exercise, calcium (800mg), and vitamin
D (100iU or 2.5 mcg) every day. exercise
maintains muscle mass, which preserves
and strengthens the surrounding bone,
and helps prevent falls. highly recommended for bone health are weight-bearing exercises that promote balance such
as tai chi, yoga, and qigong.
after 50, the dramatic fall in oestrogen
speeds up bone loss.
osteoporosis has no symptoms
during its early stages, but women may
later experience back pain, height loss
over time and a stooped posture. it also
becomes easier to fracture wrists, hips,
the spine or other bones.
Women over 65, or who experienced
menopause before 45, should consider
a bone mineral density scan to detect
early bone loss. X-rays will measure the
amount of calcium and other bone minerals packed into a segment of the bone.
commonly tested are bones in the spine,
hip and forearm.
siNgapore health
25
photo: getty iMages
Nov– Dec 2013
to keep bone problems at bay,
seniors should avoid getting intoxicated
and treat vision problems such as cataracts, in order to avoid falls. a fall can
cause fractures and impair one’s quality of life, resulting in a possible loss of
independence and the need to change
living arrangements.
it is advisable to iMprove balance, install good lighting and
non-slip floors, and declutter
the hoMe.
those over 50 years old should take
hpB’s recommendation of 1,000mg of
calcium and 100iU (2.5 mcg) of vitamin
D daily, while eating a balanced diet and
enjoying the sun. this, combined with
adequate exercise, can limit bone loss
and increase bone and muscle strength.
Information for this article was provided by Dr Ang Seng Bin, Head and Consultant Family Physician, Dr Han
Wee Meng, Principal Dietitian, Ms Ang Bixia, Senior Dietitian, and Ms Jeanette Yee, Dietitian, all from KK Women’s and Children’s Hospital.
AD
26
singapore health
noV – DeC 2013
Ask the dentists
Is it possible to be allergic to
commercial toothpaste?
Dr Low Yi Han, Senior Registrar,
Periodontic Unit, Department
of Restorative Dentistry: Yes,
possibly to flavours/fragrances in
the toothpaste, such as cinnamal
(flavouring from cinnamon) spearmint, peppermint, carvone (oils
from caraway seeds) and anethole (flavouring from star anise,
fennel and anise).
stage of gum disease) can be treated to minimise the consequences of leaving the disease to progress (for example, irreversible
bone loss around the teeth), which can
lead to more expensive dental treatment.
people with poorly controlled medical conditions such as diabetes, who
also have poor dental health, should
see their dentist once ever y two to
four months. this is because patients
with poorly controlled diabetes are
more prone to developing periodontal
disease, which may make it more difficult for them to control their blood sugar
levels. this increases their risk of diabetic
complications, such as kidney failure
and retinopathy.
Do you have questions for your dentist
that you never quite get around to asking?
Here are some we put to the experts at the
National Dental Centre Singapore.
By Satish Cheney
How much toothpaste do
you need?
Dr Low: a pea-sized amount
is suf ficient. toothpaste
contains a lot of abrasive
chemicals that can cause
unnecessary wear and sensitivity, so using too much is
not good.
Is it hygienic to keep toothbrushes in the toilet?
Dr Low: it is fine to keep them
in the toilet, so long as they are
kept separated, clean and dry
to avoid cross-contamination
by bacteria.
Some say rinsing your mouth a few times a day is
important. Is that true?
Dr Low: rinsing your mouth gets the food remnants
out when brushing is inconvenient. if you are diligent
about flossing and brushing twice a day using the right
technique, you should not even need a mouthwash.
however, if you have mouth sores or gum diseases such
as gingivitis or periodontitis, a prescription mouthwash
can help reduce bleeding and inflammation.
Can rubbing salt on teeth help prevent decay?
Dr Low: it used to be a traditional home-style alternative to using mouthwash at a time when dentistry was
not advanced. But rubbing salt on teeth actually causes
abrasions on the tooth surfaces.
Which is better in the long run: Get a root canal
treatment or simply extract the tooth?
Dr Lui Jeen Nee, Senior Consultant, Endodontic Unit,
Department of Restorative Dentistry: root canal
treatment is a viable alternative to tooth extraction
and is the only way to save a tooth with irreversible
pulp inflammation or infection. after a root canal procedure, the tooth is restored either with a filling or a
photo: gettY iMages
Should we brush our teeth after
waking up in the morning or after
breakfast?
Dr Low: either is fine, but if you brush your
teeth after a meal, try to do it only 20 to 30
minutes later. this is because food reduces
the ph level in the mouth. When the ph
level drops, our oral environment becomes
acidic and our teeth are more vulnerable
to attack. saliva in the mouth will gradually
clear out the acid and lay down new calcium to
repair patches of teeth that were dissolved during this
20- to 30-minute time frame. thus, it is always advisable to allow the ph level to recover before you brush
your teeth.
crown. Choosing to retain your natural teeth, when
possible, is always the best decision. But when there
is inadequate tooth structure to support the restoration
of the tooth due to extensive damage or decay, an
extraction may be recommended instead.
Is it really necessary to see a dentist every six
months? Why this interval? Why not just once a
year, for example?
Dr Marianne Ong, Senior Consultant, Periodontic
Unit, Department of Restorative Dentistry: this
would depend on your medical and dental health.
For people with good dental health, including those
with well-controlled medical conditions such as heart
disease and diabetes, i recommend they see a dentist
every six months to a year. this is because brushing
and flossing alone cannot get rid of plaque in harder-to-reach areas, such as the back of the molars or
around tilted teeth.
healthy people with oral diseases such as caries
(cavities) or gum disease due to poor oral hygiene,
need to visit a dentist every three to six months. this
is to ensure that oral diseases are nipped in the bud.
When picked up early, caries and gingivitis (the early
Root canal tReatment
is a viable alteRnative
to tooth extRaction
and is the only way
to save a tooth with
iRReveRsible pulp
inflammation oR
infection.
Dr Lui Jeen nee, Senior ConSuLtant,
enDoDontiC unit, Department of
reStorative DentiStry, nationaL DentaL
Centre Singapore
people with multiple medical conditions and who
are taking multiple medicines (usually the elderly)
should make a trip to the dental clinic once every two to
four months as they are more prone to developing xerostomia (dry mouth). a reduction in saliva as a side effect
of medication can lead to increased risk of dental caries.
in summary, the prevention of disease and the early
treatment of identified disease are key to maintaining
optimal oral health. Your dentist will advise you on the
appropriate dental recall interval based on your current
oral and general health.
Why do some people grind or clench their teeth
when they are asleep? Is this harmful? How can it be
prevented?
Dr Sapphire Gan Tsering, Registrar, Prosthodontic
Unit, Department of Restorative Dentistry: there
is no proven cause of tooth grinding or clenching.
however, they are often associated with stress, habitual tendencies or disturbed sleep cycles. prolonged
and intensive grinding or clenching of teeth can
cause the teeth to break down – this can range from
minor enamel chipping to vertical tooth fractures. it
can also cause the masticatory (chewing) muscles
to become tender and the jaw joints to wear down
more quickly. suggested prevention strategies for
tooth grinding include counselling sessions, massage
therapy, and adopting regular sleeping patterns. to
minimise the destructive effects of tooth grinding,
wearing a night splint (dental appliance used at night)
is often recommended.
新加坡中央医院与新加坡保健服务集团的双月刊
2013 年11 – 12月刊
小点子,大成果
新闻
27
新步骤只需 4 分钟
图:ZAPHS ZHANG
稍微改善如何穿上抗栓塞长袜的方法,病人顺从率大增
范实践新方法,也加强病人与护理
者的教育,让他们了解穿着袜子的重
要性。
团队协调员兼高级护士长李振香
说,病人脱下袜子的原因各有不同。
有些人觉得穿袜子很麻烦很费时,有
的则责怪天气炎热而脱下袜子。也有
些男性病人认为穿长袜属女性行为而
拒绝穿袜。其他病人则觉得伤口好转
也就不再需要穿袜。
团长兼临床护理导师张中凱说,团
队也定期致电给出院的病人,询问他
们是否还继续穿着袜子,以及他们的
康复情况。张中凱说:“如果他们已
把袜子脱下,我们就会敦促他们重新
穿上袜子,再解释原因。这也是为什
么听从人数会增加的原因。”
先把一个透明塑料袋套在病人
的脚上。塑料袋的大小应该足
以覆盖脚板至脚踝范围。
将长袜往下卷起,套在病人脚
上。塑料袋能避免脚趾勾住袜
子的开端,也让袜子顺利地滑
过脚后跟。
心脏绕道手术在病人的大腿上留下了很长的伤痕。穿上抗栓塞长袜能够促
进血液流通,有助于减少肿胀和伤口渗出浓液。
原文 Lediati tan
过
去一直以来,为了避免心脏
病病人手术后引发严重甚至
致命的并发症,医生总是不
断的提醒他们,手术后的4至6周内,
必须全天穿着抗栓塞长袜。尽管如此,
当中也只有17%的病人会遵从指示。
现在却有约70%的病人自愿遵从指
示穿上长袜。这要多亏了新加坡国家
心脏中心的医护团队想出的好点子,
促使遵从度大大增幅。
刚动完心脏绕道和瓣膜置换手术,
75岁的爱薇女士(Ivy Jayamoni)就是
其中一名遵从点子建议的病人。
心脏绕道手术在爱薇女士大腿上留
下了一道很长的伤痕。为了避免并发
症,她必须穿上抗栓塞袜。即便知道
当袜子经过伤口可能会引起疼痛,可
是爱薇女士却没因此而抗拒穿袜,反
而表示出院后会继续使用那点子穿
袜,还深信她的护理者能好好的胜
任。
穿袜秘诀大公开
乳霜。但这些材料使用起来很麻烦,
又容易弄脏病人、衣物和周围,不适
合腿上有伤的病人。
不仅如此,这简易的方法也为护士
们省下了不少穿袜的时间;从10分钟
减到4分钟,让她们有更多时间来应
付其他工作。
把袜子慢慢往上拉,直到延伸
至大腿,然后调整位置,再确
保袜子平滑无皱。
穿袜子有助预防并发症
每年,新加坡国家心脏中心为超过
1,000名病人进行心脏或胸腔外科手
术。手术后医生都会要求他们经常穿
上袜子。
发明点子的团员之一,心胸外科客
座顾问医生卢怡任表示,接受过心脏
手术的病人需要在手术后的4至6个星
期内,全天穿上抗栓塞长袜。
抗栓塞长袜通过压缩腿部静脉,促
进腿部血液流通,避免不活跃病人的
腿部静脉出现血块。此外,袜子有助
于减轻腿部肿胀的情况。
卢医生说,如果病人脱下袜子,不
但会导致腿部肿涨,伤口可能更会渗
出浓液。万一出现并发症,血块从腿
部流到肺部,可造成严重伤害,足以
致命。
卢医生还说,要避免发生严重并发
症其实不难。“抗栓塞长袜能预防腿
部静脉血栓栓塞,穿上它是最有效最
便宜的方法。”
这个既简单又能改善病人穿袜子的方
法就是新加坡国家心脏中心多学科医
护团队的杰作。
首先,在病人脚上套上透明塑料
袋。这塑料袋有助于袜子顺利地滑过
皮肤,同时也能避免脚趾勾住袜子的
开端。一旦袜子顺利滑过脚后跟,就
能轻而易举的将袜子慢慢地往上拉到
大腿为止。就算经过伤口也不成问题。 教育实践双管齐下
医护团队曾尝试过其他让袜子更容 如今已有越来越多的病人肯持续地穿
易滑过皮肤的方法,例如使用粉末和 着袜子。这是由于团队不只是利用示
提出建议的新加坡国家心脏中
心 7 人团员包括:病人护理助理
谢利先(坐着)、高级护士长
李振香(图右)和临床护理导
师张中凱。
穿好长袜后,拉出塑料袋,继
续为另一只腿穿袜。
病人若不穿上抗栓塞长袜,可能导致以下并发症:
下肢水肿(肿胀)
长期缺乏活动会导致水肿使得受影
响组织肿胀,让长时间未曾活动的
病人在尝试重拾行动能力时感到不
适,降低他们自行行动的意欲。
肺栓塞
当肺动脉或其中一条分支血管突然
被从人体其他部位传送过来的某种
物质阻塞时(以血块为最常见),
肺栓塞就会发生。这是一个严重
疾病,可导致受影响的肺部永久
受损,也可导致其他器官因缺氧而
受损。万一血块体积很大或数量很
多,更有可能致死。
腿部伤口渗出浓液
心脏绕道手术一般需要取出病人
双腿上的大隐静脉(从腹股沟至脚
部),以作移植之用。长袜的压力
能够促进血液流通,有助于减少肿
胀和伤口渗出浓液。
28
健康
2013 年11 – 12月刊
如何应对胃肠炎
上吐下泻,还会脱水。不管大人小孩,胃肠炎都是件痛苦的事
原文 Sheralyn Tay
胃
肠感冒,即胃肠炎,是一种
肠道感染疾病。大家对这应
该不会感到陌生。它会让人
产生腹痛、腹泻、呕吐和发烧等症状
的炎症。胃肠炎不仅然会使大人深陷
痛苦,也可能会危害到婴幼儿。
在竹脚妇幼医院,因胃肠炎而前往
儿科急诊室就诊的儿童就占了总急诊
病例约10%。
“导致胃肠炎的罪魁祸首是细菌和
病毒。它可以借由人际之间传播或接
触任何被污染的物体而传播,” 竹脚
妇幼医院儿童急诊医药高级顾问医生
谭丽萍解释说。食用或饮用被污染的
食物或水也可导致胃肠炎。
除此之外,冷冻或清洗不当的食品
也可能引起胃肠炎。谭医生指出,良
好的饮食卫生习惯可降低污染食品引
发肠胃炎的可能性。
然而,幼儿对环境和卫生意识比
大人来得低,例如他们经常在玩耍
时把肮脏或被污染的玩具,不经意
地放入口中,所以更容易被细菌和
病毒感染。
谭丽萍医生说,尽管医生可能
会开些药物来缓解呕吐或剧烈
腹痛等症状,大多数儿童都不
需要药物或抗生素来治疗胃肠
炎。疾病会自愈的,补充流失
的液体和预防脱水才是至关重
要。“家长不需要刻意改变儿
童的饮食,但一定要多喂水和
流食,”谭医生补充道。
如果孩子腹泻但无呕吐
母乳喂养宝宝的,可以继续母
乳喂养并增加喂养次数。
配方奶粉喂养宝宝的,可以继
续给宝宝平时的配方奶粉。但
如果腹泻持续超过10天,可以
考虑换成豆制奶粉或无乳糖配
方奶粉。
使用不同的砧板
切肉和蔬菜。食
物接触到受细菌
污染的表面会导
致胃肠炎。
不要只喂宝宝喝水。
宝宝每解一次大便,流食量如
米汤、薏米水或补液溶液,都
要增添60-100毫升,以补充流
失掉的电解质和盐分。
如果宝宝无法喝下任何液体,
则要寻求紧急治疗。
病毒感染是肠胃炎最常见的病因。
在住院病例当中,导致肠道感染的轮
状病毒(rotavirus)的比例最大。
轮状病毒的威胁
图:getty images
治疗小贴士
根据竹脚妇幼医院小儿肠胃科高级
顾问医生潘光武教授所主导的研
究报告,在2005年9月至2008
年4月期间,5岁以下儿童因
轮状病毒感染引起胃肠炎而
住院有近40%。
“他们平均住院时间是
3到4天。大多数儿童是年
龄介于1到2岁之间,紧跟
着的是新生儿到12个月的婴
儿,”潘教授说。
如有下列情况,
请立即就医:
有脱水迹象
大便或呕吐物带血
呕吐物呈绿色,可
能显示有肠道阻塞
有持续性腹痛
孩子年龄小于6个月
孩子嗜睡或烦躁不安
他还指出,约有95%的儿童会在5
岁之前患上轮状病毒性胃肠炎。“在
亚太地区,轮状病毒是导致幼儿腹泻
和脱水最常见的病因。一项基于亚洲
的研究显示,疫苗接种是预防儿童感
染轮状病毒最有效的措施。”
脱水的危险
胃肠炎会引起几种严重症状。呕吐
便是早期表现之一,不注意的话可
导致婴幼儿严重脱水。婴幼儿通常
会在最初的8至24小时内呕吐,然
后可能会持续腹泻2到4天甚至14
天。“要是症状同时发生,程度
一样严重的话,脱水的风险就会增
加,”谭医生说。
“儿童的免疫系统原本就比大人
还弱,所以患上胃肠炎的几率会比大
人更高更严重,尤其是婴儿。不但如
此,他们的血容量低,没有足够的储
备保持水分,所以更容易脱水。
严重脱水会诱发休克及血液循环
减缓,而呕吐及腹泻会导致盐和电解
质紊乱而引发癫痫发作。在罕见的情
况下,还会引发急性肾功能衰竭。所
以为了预防脱水,父母应当以流食和
奶为主,喂食孩子少吃多餐。
孩子的身体也会出现症状,常见
的例如:舌头和/或嘴唇干燥。谭医
生说:“孩童可能会嗜睡、少解尿或
无尿长达6个小时或更久的时间。眼
睛和囟门(即婴儿头部的软位置)可
能出现凹陷,皮肤也会失去弹性。”
她建议家长要多注意观察这些体征,
如有发现,需寻求紧急救治。
年龄较大的儿童不必限制饮
食,但要多喝米汤、薏米水或
补液溶液,果汁则要稀释四倍
才能喝。
如果孩子不到3岁,呕吐
但无脱水
在首3-4小时,每15分钟喂一
次 , 每 次 15毫 升 的 液 体 ( 米
汤、薏米水、补液溶液、奶或
稀释果汁)。如果孩子停止呕
吐,那么加倍液体量并延长间
隔喂食时间(即1小时喂2次,
每次30毫升,隔2-3小时后,每
小时喂60毫升)。
以母乳喂养为主的,增加喂养
次数、减少母乳量。
如果持续呕吐则应寻求治疗。
如果呕吐停止八小时后
母乳喂养宝宝的,可以恢复正
常护理。
配方奶粉喂养宝宝的,可以
开始喂食但量要少(约30-60
毫升)。
年龄较大的儿童,可喂粥、面
包、饼干、汤或马铃薯泥之类
的软食。
呕吐停止24小时后,孩子一般
上都可以恢复进食固体食物。
2013 年11 – 12月刊
新闻
29
医生要我母亲回家……
纳,还需要经过慈怀管理机构的审查
和核准。慈怀护理会根据病人和他们
的家庭情况,每一两个星期上门探访
病人一次,有需要时则得天天上门提
供护理。如有需要,慈怀护理也会免
费借用器材如轮椅、特制床铺和氧气
机给病人使用。
文 邹文学
张女士问:我母亲今年80多岁,几年
前患的癌症复发,医生说她生命的火
苗即将熄灭。他建议让母亲回家度过
最后的日子,并推荐母亲接受慈怀护
理。医生解释,慈怀护理的医生和护
士,会定期及在有紧急需要时登门护
理,及时为母亲解除疼痛和不适。我
们全家听了都有点茫然,什么是慈怀
护理?母亲能得到怎样的帮助?费用
多少?
医生会把病情严重、救治无望的病人
推荐给慈怀护理的医学队伍,因为慈
怀医学志不在挽救垂危的病情,却能
从多方面协助晚期病人减少痛苦,并
有效减轻家人和其他护理者经受的心
理压力,“护送”病人有尊严和安详
地走完人生的最后一段旅程。
比如晚期病人常会气喘,家人看到
病人挣扎着呼吸好不辛苦,只好急急
忙忙把他们送回医院。
其实,急诊室的医生对这类病人帮
不上什么忙,最多也只能为他们稍为
缓解病情,然后又送他们出院。
慈怀护理能24小时提供这些家庭
紧急协助,教导病人和他们的护理者
在遇见紧急情况时怎样有效解除痛
苦,如果还是不行,医生就会立即到
家协助。我们会指导病人服药,也会
教导他们正确的坐姿和呼吸方法。通
常呼吸困难的病人如果面对风扇而
坐,病情就能缓解。如果病人情况没
好转,慈怀的值勤医生就会赶到病人
家里,为他们打针和打点滴。
慈怀提供给末期病人及家属的
协助,其实还包含精神上和亲情上的
支援。
日间护理中心
慈怀护理专家张保贤顾问医生的病人,有九成是癌症晚期病人。
华族的老年晚期病人,十有八九
不愿意在医院里咽气。我们目前已能
协助六成病人完成在家离世的心愿。
不过,有部分病人不愿死在家里,却
是为了替家人着想,他们有的担心家
人护理起来太劳累,有的则担心会给
家里留下不祥的阴影。
慈怀护理也会在病人逝世后,
继续给家属提供各种协助包括哀伤
治疗。
一概不收费
慈怀护理除了总部,还设有5个服务
中心,负责照顾分散居住在全岛各地
的800名晚期病人。
我们负责照顾的晚期病人,每天
都有十多二十人逝世,但是每天也有
相近数目的病人被接纳进慈怀的护理
中心。慈怀负责护理的病人,都是医
学上判断寿命只剩一年的晚期病人,
其中九成是癌症病人,余下一成则
是患有各种严重慢性疾病如心脏病的
患者。
慈怀护理为晚期病人提供的居家
护理,不论对方的经济情况,是全不
收费的。医院和私人诊所的医生都能
介绍病人到慈怀护理,不过是否被接
慈怀护理总部也为那些还能行动的晚
期病人设立日间护理中心,并备有专
车接送病人,不需家属操心,活动时
间是早上9时30分至下午4时30分。每
个月还会携带病人出外郊游和参观。
日间护理中心提供午餐和茶点,也
有许多社工和义工定时前来陪伴病人
讲话聊天,或者为他们表演节目和主
持游戏。不过,参加日间护理中心的
病人需要根据家庭收入的级别缴纳一
定费用。
资料提供:
张保贤顾问医生
慈怀护理专家
文章以征得《优周刊》的许可转载
意见箱
读者建议:为什么医院不能自动自发地提
供实验报告而非等病人要求才提供?
当我从实验报告中得知我并没有罹患癌症时,我竟一时宽
慰而忘了向医生要一份报告的副本。于是,我打电话向医
院的医疗记录管理部要求报告,而得到的答复却是要我亲
自提出申请,还得付行政费。
我不了解为什么医院不能自动地提供报告而不是等到病
人提出要求才做这项工作。这样不但不能为病人省下时间
与金钱,也不能为医院节省日后检索文档所花的时间与精
力。本来,给病人备份实验报告是情理中的事,倘若病人
日后去另一家医院或是诊所寻医,他也可以把报告带去,
省略不必要的麻烦。
或许医院可以考虑设置像国家皮肤中心的病人医疗门户
网站一样,让病人可以上网阅览他们自己的医疗记录。
新加坡中央医院答复:医院将会考虑您的建议,让病人可以上网
阅览他们的医疗记录。
图:getty images
不能在其他医疗机构的药房
买药
慈怀护理提供给末期病人及家属的协助,还包含精神上和亲情上的支援。
我的母亲是新加坡国家心脏中心
的病人。我拿着该中心开出的药
方到勿洛综合诊疗所替我母亲
买药,但药房职员拒绝卖药给
我。请问我为何不能向综合诊疗
所买药?
新加坡保健服务集团综合诊疗所
答复: 新保集团诊疗所的药房主要
是为其诊疗所就诊的病人提供药物。
药物也是依照他们的病史所需而储备
的。一般上,不会储备其他专科中心
所使用的特效药。
至于被转介到任何新保集团诊疗
所就诊的病人,我们的医生将会根据
他们的病情重新评估他们用药需要。
不然,我们都会建议拥有其他医疗机
构处方的病人回到该机构购买所需的
药物。
若有任何关于入院手续、账单及程序等疑
问,可电邮至[email protected],我们会
在这个栏目里解答您的问题。
30
新闻
2013 年11 – 12月刊
真假难分
的牙齿
不用配戴牙托也能拥有完美笑容,植牙渐受欢迎
原文 Sheralyn Tay
认识人工植牙
上图:植牙零件
你
少了颗牙吗?不用担心,
植牙能让你再亮出完美无
暇的牙齿。
近年来,国人对植牙的需求有增
无减,拥护群更是为之广泛包括青少
年、年轻的专业人士、中年人与老年
人,而前往新加坡国立牙科中心植牙
的人数也有稳健增长的现象。在2005
年和2010年之间,植体手术的次数就
增长了三倍。
“相信这是科技方面和技术水平
的提高,促使需求量大增,”新加坡
国立牙科中心牙齿修复科副顾问医生
司徒永量说。
他说:“这十年来,需求随着科技
进步的步伐而增加,我们预测植牙成
功率的能力也更加纯熟。譬如,上颌
骨植牙90%、下颌骨植牙95%。”
缺牙患者的福音
司徒医生解释,植牙的优势比起其他
替代补缺牙齿的方法还要更多。例
如,它不会像牙桥一样,必须把邻近
的牙齿磨细,也不会像牙托一样,嘴
里有明显的突出感、不舒服和累积食
物碎屑。
那些牙齿几乎全掉光的老年人,
也可选择在缺牙区颌骨内人工种植两
图:AleciA Neo
司徒永量医生
为病人进行植
牙手术。
植牙手术的步骤
在拔牙处专孔植入
人工牙根,留下螺
丝盖直至骨整合再
植入植体。
取下螺丝盖准备
下一步骤。
颗牙植体,固定覆盖义齿支架,再把
牙托从底部装在植体上。这样就不用
种植更多假牙。
“与普通植牙相比,这做法不只
简单、便宜,保养也容易,”司徒医
生说。
然而不是人人都适合做植牙,像
颌骨质密度低或伤口难愈合的患者可
能不适合。
A 螺钉:固定在颌骨内的
人工牙根。材料可以是
纯钛、钛合金、陶瓷或
氧化锆。
术前检查的重要性
一般植牙手术费用起跳价
是$3,500。
司徒医生说,为了避免可能出现的风
险,牙医会在手术之前利用X-光和
锥束扫描等仪器来诊断、评估患者颌
骨宽度和密度,确定患者是否有足够
的骨量支撑牙植体。
“如果没有特别的情况,整个植
牙过程只需约三至四个月,” 司徒医
生说。“复杂点的病例,例如骨量不
足而需要先做骨移植,则可能需要六
至八个月。”
骨移植是一种增加骨量的手术。
看似很耗时的过程,但却能帮助牙医
确认口腔结构、避免触及神经和骨
骼,还有挑选合适植体的尺寸。
种植牙植体后会有一段愈合期,
称为骨整合,是让牙槽骨愈合同时与
牙龈、植体结合。“我们通常会等至
少两个月才装上持久性的牙冠,”
司徒医生说。
“这是因为尚未稳定的种植体无
法承受牙冠带来的压力,太早安装的
把基台装到植
体上。
安装牙冠(假牙)。
B 基台:装在螺钉上连结
牙龈的支台。
C 牙冠:避免基台受损
的义齿。材料可以是合
金、陶瓷或氧化锆。
话会增加手术失败的风险。但如果是
临时牙冠或假牙就可以,因为它不会
在新种植体上施压。”
微型植牙安全吗?
目前,市面上有另一项新技术,称为
微型植牙,是利用多个小螺钉将牙冠
固定在颌骨上的方法。虽然这比常规
植牙更快捷便宜,但是人们应该以持
久性为前提,慎重考虑。
“在新加坡国立牙科中心,微型
植牙技术通常只在牙齿矫正治疗中充
当支架,”司徒医生说。“况且也没
足够的证据说明微型植牙可以成为永
久性的替代品。因为牙植体直径非常
细窄,长期使用的话既不耐又容易断
裂破损。”
司徒医生说,新加坡国立牙科
中心也处理过不少因微型植牙使用
不 当 而 导 致 的 问 题 。“ 我 们 发 现 ,
与较宽直径的植体相比,微型植
牙作为长久措施更能引出不少并
发症。”
所以,为了提高缺牙替代的成功
率,除了了解不同方案的优劣势之
外,详细地检查和决定合适的植牙类
型也有很大的帮助。
“种植牙也会遭受咀嚼和啃咬的
磨损,因而选择适当的类型非常重
要。” 司徒医生补充道。
为了不影响牙槽骨愈合,人们应该
在手术后多注重口腔清洁和定期检查
牙齿。若是吸烟者应该及早戒烟,糖
尿病患也要控制血糖水平。这样一来
就能让植牙保持在最佳状态。
2013 年11 – 12月刊
新闻
31
专家解答
应该矫正儿童的
牙齿吗?
我7岁女儿的两只下门牙已掉落,
恒齿也长成了。不过,长得不整
齐,看起来像个倒反的 “V”形。
我应该现在给她矫正牙齿吗?
每星期应该做多少次
有氧运动?
在恒齿长出来之前,就已藏在颌骨
里。这些“齿芽”的位置决定了新长
的恒齿的位置。也许起初看起来有点
歪,不过当它们持续生长时,下唇和
舌头可能会慢慢地把它们推至正位。
这就是常被称为“丑小鸭阶段”的过
渡期。
空间充足的话,恒齿可能会排列整
齐;相反地,要是空间不足,恒齿就
会歪斜地排列。所以在这个阶段,矫
正牙齿通常是不必要的。将来,如果
牙列拥挤的问题持续,或影响到咬东
西的能力,才可能需要接受矫形齿科
检查。
有氧运动经常被推广为有助于减轻体重的活动。请问
每星期可以做多少次?
有氧运动量应该依据你的年龄、健康和基本体魄进行。一般来
说,我们认同美国心脏协会的以下建议:
每星期进行至少5天30分钟的中等强度有氧运动,完成总共
150分钟的运动;或每星期进行至少3天25分钟的剧烈强度有
氧运动,完成总共75分钟的运动;又或交替进行两种不同强
度的运动(中等和剧烈强度的有氧运动)
如果要达到额外的保健效益,你也可以每星期进行至少2天
中等至偏高强度的增强肌肉活动
新加坡国家心脏中心心内科顾问医生杨孔健
如何解决打嗝问题?
我有打嗝问题。尽管我少吃多
餐,每天只吃五餐,我仍在打
嗝。有时候,我会被积聚的胃气
而从睡梦中醒来,然后打嗝好一
段时间,才能重新入睡。我的身
体到底怎么了?
我们进食时会吞下空气。当咽下太多
空气时,人体就会通过打嗝把气体排
出体外。
过度打嗝可能是因为消化不良(非
溃疡性消化不良)所致,也有可能是
因为消化系统出现了未被诊断出来的
问题。
新加坡国立牙科中心口腔修复儿童牙科医生
黎芸佩
消化不良是当你吃过量或过多油
腻食物,或吃了不适合自己肠胃的食
物而产生的。它通常会在短时间内自
然解决。如果问题在于消化系统,那
么病人应该接受检查找出原因,并在
有必要的情况下接受治疗。
简单的预防措施、对症下药的疗
法或改变生活方式,如慢慢进食、少
喝汽水和啤酒和不吸烟,都可减少打
嗝次数或减轻某些消化不良的症状。
如果你怀疑自己有潜在的健康问题,
或需要仔细检查,你可向你的家庭医
生要求转介到专科医生进行检查。
新加坡中央医院肠胃肝胆科高级顾问医生
王伟聪
C
M
Y
中风能预防吗?
CM
当某人中风后,死亡是否就会接
踵而来?什么造成中风?我们应
该如何预防中风?
MY
CY
CMY
每位病人中风的情况都不一样。中风
的类型和位置,以及病人的年龄及其
健康背景,都会影响中风的后果。一
般来说,病人在中风后都会有短期和
长期性的死亡风险。
中风的两大主要原因是通往脑部
的血管阻塞,以及因血管破裂而导致
脑出血。
要预防中风,就必须控制各种致
病因素,例如高血压、糖尿病和高胆
固醇,加上维持健康的生活方式,包
括健康饮食、经常运动和避免吸烟,
以及按照医生的指示服药和复诊。
K
国立脑神经医学院神经科顾问医生
Deidre De Silva
32
2013 年11 – 12月刊
Nov
Dis
2013
TerbiTan
HospiTal besar
singapura dan
Kumpulan
singHealTH.
Menyalakan
bom jangka
Klinik
Pengudaraan
Bukan invasif
sGH (Niv)
Tabiat kuat merokok telah memusnahkan paru-paru
seorang lelaki begitu teruk sekali, sehingga kini dia perlu
bergantung pada mesin untuk terus hidup
Oleh DesmOnD ng
e
FoTo: Vee cHin
nciK Ho Wee bin, 66, hidup seperti seorang tawanan di rumahnya
sejak beberapa tahun lalu.
sudah lama beliau tidak mengunjungi pusat membeli-belah, pasaraya
atau kedai kopi, kerana melangkah
keluar dari flatnya untuk beberapa minit
sahaja boleh menyebabkan sesak nafas
dan keletihan.
“saya kurang sihat sejak tahun 1998.
saya sering berasa penat dan tiada selera
makan. saya berjumpa beberapa orang
doktor, tetapi mereka tidak mendapati
apa-apa yang luarbiasa dengan saya,”
kata beliau.
Hanya pada tahun 2004, beliau disahkan menghidap penyakit pulmonari
terhalang yang kronik, atau copd, satu
keadaan di mana fungsi paru-parunya
telah rosak. Terdapat dua bentuk penyakit ini – bronkitis kronik, di mana tiub
bronkial menjadi radang menyebabkan
batuk berpanjangan yang berlendir; dan
emfisema, satu kemerosotan paru-paru.
par a p enghidap akan mer as a
semakin sukar untuk bernafas. merokok adalah salah satu penyebab utamanya. encik Ho telah mula merokok pada usia 12 tahun, dan biasa
merokok sebanyak dua hingga
tiga kotak sehari. beliau
berhenti setelah mengetahui keadaannya.
Kini, encik Ho
biasanya dilampirkan pa da e mpat
peranti, yang bernilai
sebanyak $20,000.
ia merangkumi penumpu oksigen dan
mesin-mesin tekanan laluan udara positif dwi-tahap untuk mengekalkan fungsi
pernafasannya.
mesin tekanan laluan udara itu menolak oksigen melalui tiub ke pelitup muka
yang menutupi hidung dan mulut encik
Ho. mesin tersebut, sentiasa meningkatkan dan merendahkan tekanan udara
sebagai sambutan tindak balas antara
sedutan dan hembusan.
dahulu, beliau merupakan seorang
lelaki yang aktif. encik Ho yang sudah berkahwin dan mempunyai dua orang anak
lelaki berusia dalam lingkungan 40-an,
menghabiskan masanya dengan menonton TV, tidur dan berbual dengan rakan
dan saudara-mara yang melawatnya.
satu-satunya lawatan yang sering
dibuatnya adalah ke Hospital besar singapura (sgH) untuk temu janji tetapnya. beliau terpaksa membawa alat pengudara mudah alih bersamanya.
Keadaan beliau semakin teruk
sejak beberapa tahun ini. “apabila saya
sedang menonton rancangan TV yang
terlalu menarik, nafas saya mula sesak.
saya senang penat dan sangat sensitif
terhadap persekitaran, seperti perubahan cuaca.
“Tetapi saya menganggap diri saya
sangat bertuah kerana masih lagi
mempunyai 18 peratus kefungsian
(18 peratus fungsi paru-paru berbanding dengan purata orang biasa
yang seusia).”
Merokok punca utama
dr ong Thun How, perunding
Kanan, Jabatan pernafasan
dan perubatan penjagaan
Kritikal, sgH, berkata:
Fungsi paru-paru Encik
Ho Wee Bin telah rosak
setelah lama kuat merokok. Beliau bergantung
kepada mesin-mesin
(seperti yang kelihatan di
belakangnya) untuk menetapkan pernafasannya.
Lebih daripada 10,000 orang telah dimasukkan ke hospital untuk penyakit
pernafasan kronik pada tahun 2010.
Sekitar 440 orang telah mati akibat
penyakit tersebut pada tahun itu.
“Fungsi paru-paru kita merosot secara
perlahan sebaik sahaja kita mencapai usia
25 keatas. Kita kehilangan sedikit fungsi
paru-paru setiap tahun. bagi kebanyakan
orang, pada saat kita mati – katakan dari
serangan jantung atau barah pada usia 95
tahun – fungsi paru-paru kita masih boleh
digunakan untuk kebanyakan aktiviti.
“namun bagi sesetengah orang,
kemerosotan ini lebih cepat disebabkan
tabiat merokok atau kerentanan genetik.
pada usia 60 tahun, fungsi paru-paru
mereka akan berada di tahap yang sama
dengan mereka yang berusia 80 hingga
90 tahun.”
asap rokok mengandungi toksin yang
menyumbang kepada tren ini, kata dr
ong. sementara bukan semua perokok
akan menderita kemerosotan fungsi
paru-paru yang pantas, sekitar 30 peratus mungkin akan mengalami kemerosotan pantas. seorang perokok yang berhenti merokok akan mengalami tahap
kemerosotan beransur yang sama seperti mereka yang bukan perokok.
peratusan lelaki yang disahkan menghidap penyakit paru-paru kronik adalah
lebih tinggi, kerana lebih ramai perokok adalah lelaki. Kebanyakan pesakit
ini berusia dalam lingkungan 70-an dan
80-an kerana kerosakan itu meningkat
dan hanya jelas pada kemudian hari.
gejalanya termasuk sesak nafas, batuk
jangka panjang dan keletihan.
penyakit pernafasan kronik adalah
punca utama ketujuh yang mengakibatkan kematian di singapura pada tahun
2010, apabila kira-kira 440 nyawa terkorban. ia juga merupakan keadaan ketujuh
paling lazim bagi kemasukan pesakit ke
LoKasi
Klinik pakar pesakit luar a, blok 3,
aras 1, sgH
aPa yaNG DitawarKaN
ditubuhkan pada tahun 2011, klinik
ini membantu para pesakit dengan
menggunakan pengudaraan yang
bukan invasif, terutamanya mesin-mesin tekanan laluan udara
positif dwi-tahap (bpap), dan bagi
mereka yang mempunyai masalah
pernafasan akan bernafas dengan
lebih baik dan tidur dengan lebih
selesa, mengurangkan risiko kemasukan hospital.
dr ong Thun How, perunding
Kanan, Jabatan pernafasan dan
perubatan penjagaan Kritikal, sgH,
berkata: “Kami mempunyai seorang doktor yang menjaga masalah pernafasan, dan kakitangan
sokongan teknikal untuk mencari
punca masalah mesin-mesin bpap,
seperti membantu para pesakit
menyesuaikan penetapan atau
pelitup mereka.”
cik nancy lew, pakar Terapi
dan pengurus pernafasan, unit
gangguan Tidur, sgH, yang bekerja
diklinik ini, menjelaskan fungsi
mesin-mesin bpap kepada para
pesakit baru yang menghidapi
penyakit-penyakit berkaitan pernafasan, dan membantu mereka
memahami kos-kos yang mungkin
diperlukan. “saya juga mengajar
para pesakit cara untuk memakai
pelitup muka, serta mengendalikan
sesi ujian,” kata beliau.
ujian fungsi darah dan paruparu dikendalikan di klinik ini.
hospital, dengan lebih daripada 10,000
dimasukkan pada tahun 2010, menurut
laporan akhbar straits Times pada Jun
2012. pertubuhan Kesihatan dunia (WHo)
meramalkan bahwa copd bakal menjadi
sebab ketiga utama kematian di seluruh
dunia menjelang 2030.
rawatan termasuk penggunaan nebuliser – sejenis alat yang mentadbirkan
ubat dalam bentuk kabus yang disedut
ke paru-paru – atau mesin pernafasan
tekanan laluan udara. para perokok harus
berhenti merokok, kata dr ong.
dalam kes encik Ho, mesin pernafasan itu dapat membantu mengurangkan jumlah lawatannya ke sgH. alat-alat
ini membantu memperbaiki mutu hidup
seorang pesakit, membenarkan beliau
untuk kekal agak aktif, kata dr ong.
M2
berita
singapore health
nov– Dis 2013
Putus haid (Menopaus) meningkatkan risiko
penyakit jantung bagi kaum wanita
Bersenam untuk
mengurangkan
berat badan.
Kehilangan
serendah 5 hingga
10 peratus berat
badan boleh
mengurangkan
tahap kolesterol.
Kemerosotan tahap estrogen selepas putus haid boleh meningkatkan kolesterol yang
tidak baik bagi kaum wanita yang sudah berumur
Oleh lediati tan
i
anya aDalah pengetahuan umum
bahwa tahap kolesterol yang tinggi,
adalah penyumbang utama penyakit jantung. ini merupakan berita buruk
bagi kaum wanita yang lebih tua, terutamanya mereka yang telah mengalami
putus haid.
tahap estrogen kaum wanita yang
telah putus haid akan merosot, dan ini
akan meningkatkan tahap kolesterol
yang “jahat”.
penyakit jantung jarang dialami oleh
kaum wanita yang lebih muda dan yang
masih belum mengalami putus haid
sebab estrogen merendahkan tahap
lipoprotein berketumpatan-rendah (lpl,
biasanya digelar kolesterol “jahat”),
sementara meningkatkan tahap lipoprotein berketumpatan-tinggi (hDl, atau
digelar kolesterol “baik”).
apabila tahap estrogen mereka merosot, kaum wanita pasca-menopaus ini
akhirnya akan menghadapi risiko pen-
yakit kardiovaskular seperti kaum lelaki lemak binatang seperti lemak khinzir,
yang seumur.
minyak sapi, mentega, krim dan keju,
ini adalah satu proses semulajadi produk-produk sayuran seperti minyak
dan tiada perubatan tertentu yang kelapa dan coklat, serta makanan
boleh mengelakkannya, kata Dr tan yang diproses seperti biskut, kek dan
hong Chang, perunding Madya, Jabatan piza beku.
endokrinologi, hospital Besar singapura.
senaman juga dapat membantu
Beliau berkata bahawa gaya hidup mengur angkan tahap kole s terol
yang tidak aktif dan tabiat diet yang “jahat”, meningkatkan tahap kolesterol
tidak sihat adalah penyebab utama bagi “baik” dan membantu mengurangkan
penambahan berat badan dan indeks berat badan.
jisim badan yang tinggi – faktor-faktor
Kaum wanita juga harus kerap
utama yang boleh menyebabkan pen- memeriksa tahap kolesterol mereka.
yakit jantung. "tindakan awal merupaa m e r ika m e nasihat kan or ang
kan perubahan gaya hidup. Contohnya, ramai yang berusia lebih daripada 20
mereka yang terlalu gemuk perlu mengu- tahun untuk memeriksa tahap kolesrangkan berat badan. Menurunkan berat terol mereka sekali dalam setiap lima
badan sebanyak 5 hingga 10 peratus tahun. Kaum wanita yang melebihi usia
boleh mengurangkan tahap kolesterol,” 50 tahun dan mempunyai tahap koleskata Dr tan.
terol yang tinggi atau faktor-faktor risiko
orang ramai harus mengelakkan yang lain dinasihatkan supaya berbindari memakan makanan yang penuh cang dengan doktor untuk mengetahui
dengan lemak tepu, yang merangkumi berapa kerap kali mereka perlu memer-
Buasir tidak perlu menjadi satu
keadaan yang memalukan
Pilihan rawatan
Gejala ringan boleh dilegakan dengan mengambil serat secara sederhana seperti buah-buahan,
sayur-sayuran dan bijiran. Terlalu banyak atau
terlalu sedikit boleh mengakibatkan najis yang
keras. Para doktor mungkin turut menyarankan
ubat-ubatan seperti krim dan salap.
Fahami bagaimana buasir timbul dan bagaimana ia boleh diuruskan
Bagi pendarahan berterusan atau buasir
yang menyakitkan, prosedur kecil mungkin
diperlukan:
rubber band ligation, dimana doktor meletakkan sehinga tiga getah gelang yang
kecil disekeliling pangkal buasir dalaman
untuk menyekat peredaran darah. Buasir
kemudian akan mengecut dan gugur
dalam seminggu.
sclerotherapy, dimana doktor menyuntik
sejenis larutan kimia ke dalam tisu buasir
untuk mengecutkannya.
Oleh lediati tan
malahan cirit-birit teruk.
Buasir boleh diklasifikasikan sebagai
dalaman atau luaran. Buasir yang sebenar merupakan dalaman dan hanya terjulur keluar apabila ia membengkak secara
berlebihan. Buasir luaran adalah darah
beku yang terbentuk di luar dubur disebabkan teranan semasa pembuangan
air besar. Keadaan ini biasa dilihat dikalangan mereka yang berumur 25 hingga
50 tahun, dan menjejas kedua-dua lelaki
dan wanita.
semasa merawat buasir, matlamat
utama adalah untuk memulihkan keadaan
menjadi normal di dalam saluran dubur,
(lihat bar sisi untuk pilihan rawatan), kata
Dr Wong.
ia juga penting untuk mengenalpasti
dan membetulkan sebarang tabiat buruk
yang menyumbang kepada gejala, seperti tabiat meneran dan menghabiskan
masa yang terlalu lama di tandas (dengan
membaca, contohnya). pengambilan
serat dan cecair yang mencukupi, dalam
jumlah yang sederhana setiap hari, dalam
pemakanan untuk mencegah najis yang
keras boleh membantu ramai pesakit
untuk mengelakkan pembedahan.
Menurut Dr Mark Wong,
apabila merawat buasir,
matlamat utama adalah
untuk memulihkan
keadaan menjadi normal
di dalam saluran dubur.
Foto: Jasper yU
s
ering disalah anggap sebagai
penyakit, buasir sebenarnya
adalah sebahagian normal struktur
tubuh kita.
Buasir adalah “kusyen vaskular” di
dalam saluran dubur kita yang membantu dalam pembuangan air besar,
kata Dr Mark Wong, perunding, Jabatan
pembedahan Kolorektal, hospital Besar
singapura (sgh).
Buasir hanya menjadi masalah –
digelar penyakit buasir bergejala – apabila
ia membengkak secara melampau mengakibatkan gejala lain seperti pendarahan, kesakitan, atau jika ia terjulur keluar
dari dubur, kata Dr Wong, yang juga merupakan pengarah, Makmal Fisiologi dan
anorektal Ultrabunyi sgh.
penyakit buasir sering dikaitkan
dengan tekanan dalaman perut yang
meningkat berterusan, yang boleh mengakibatkan pembengkakan saluran darah.
tekanan itu boleh disebabkan oleh teranan melampau semasa pembuangan air
besar (lebih teruk jika sembelit), kehamilan (janin memberikan tekanan lebih
besar kepada urat pinggul ibu, yang boleh
menyebabkan pembengkakan buasir)
iksa tahap kolesterol.
sesetangah
wanita mungkin tidak
dapat mengurangkan tahap kolesterol
mereka ke tahap sihat
walaupun mereka
telah mengubah gaya
hidup mereka. Mengambil ubat seperti statin
boleh ditetapkan. Dr
tan berkata: “Ubat bagi
tahap kolesterol tinggi
selalunya diambil untuk
jangka masa panjang, biasanya kerana
sebab-sebab lain, seperti penuaan dan
putus haid, yang tidak boleh berbalik
semula atau diubah.
“Dosnya boleh dikurangkan jika
tahap kolesterol menurun dengan
ketara, tetapi untuk pesakit menghentikan perubatan dengan sepenuhnya
jarang berlaku.”
Dalam kes-kes yang lebih teruk atau mungkin
yang tidak bertindak balas terhadap langkah-langkah kurang invasif ini, pembedahan,
seringnya dilakukan sebagai prosedur siang,
akan dijalankan:
Conventional haemorrhoidectomy, dimana
tisu buasir yang berlebihan akan dibuang
melalui pembedahan.
haemorrhoidal stapling, dimana alat khas
digunakan untuk menstapel dan membuang
tisu buasir yang berlebihan.
transanal haemorrhoidal dearterialisation,
dimana alat ultrabunyi khas digunakan
untuk mengenalpasti dengan tepat lokasi
saluran darah buasir. saluran-saluran itu
kemudian akan dijahit untuk menyekat
bekalan darah dan mengurangkan pembengkakan dan pendarahan.
Nov– DIS 2013
SINgapore health
kesihatan
M3
Membesar dengan penyakit asma
FotoS: Morveh Koh
Oleh kerana orang dewasa tidak akan pulih sepenuhnya daripada penyakit asma yang dihidapi pada zaman kanak-kanak,
mereka perlu lebih berwaspada untuk mencegah serangan
Dengan bantuan Puan Zainah Mahmood, seorang jururawat menunjukkan rawatan
penyelamatan yang akan dilakukan apabila kakitangan poliklinik mengesan pesakit
yang menunjukkan tanda-tanda sesak nafas.
Oleh AJ leOw
p
uaN ZaINah Mahmood telah menghidapi penyakit asma sejak kecil
lagi , tetapi tidak mengalami serangan asma sepanjang zaman dewasanya.
pada tahun 1992, penyakit asmanya mula
berubah setelah beliau menjalani radioterapi untuk barah payudaranya pada usia
40 tahun.
“paru-paru saya terjejas kerana saya
telah menjalani radioterapi di bahagian
dada. Sebelum itu, saya tidak mengalami
serangan asma selama hampir 20 tahun,”
kata pesara berumur 60 tahun itu.
Kini, jika ada perubahan pada alam
persekitaran, ia boleh mencetus serangan
asmanya. Dalam satu lawatannya ke timur
tengah baru-baru ini, beliau telah diserang
asma semasa ribut pasir melanda secara
tiba-tiba. “Ia bermula dengan batuk lalu
tekak berasa sakit dan perit. Kemudian
saya mula berdehit,” kata beliau.
pengalaman beliau mengetengahkan
fakta yang kurang diketahui: penghidap
asma harus sentiasa berjaga-jaga walaupun mereka mungkin kelihatan seperti
telah pulih daripada penyakitnya apabila
mereka meningkat dewasa.
“Sebaik sahaja anda menghidapi penyakit asma, anda cenderung untuk mempunyainya sepanjang hidup anda,” kata Dr
tan Ngiap Chuan, pengarah penyelidikan,
poliklinik Singhealth.
“gen anda tidak boleh berubah. apabila
kanak-kanak berpenyakit asma meningkat
usia, saluran pernafasan mereka menjadi
lebih besar dan mereka juga akan kurang
menghadapi gejala-gejala asma. tetapi,
jika mereka terdedah kepada pencetus,
penyakit asma mereka boleh kembali lagi.”
penyakit asma boleh menjejas saluran
pernafasan yang menghantar oksigen ke
seluruh tubuh. Keradangan akan menyebabkan saluran udara di dalam paru-paru
menjadi sempit dan berlendir, lalu menyebabkan saluran udara menjadi lebih tersumbat. akibatnya, pesakit itu akan menghadapi sesak nafas. penyempitan yang
berlaku di saluran pernafasan juga akan
mengakibatkan dehitan.
Kanak-kanak akan lebih terdedah,
disebabkan saluran pernafasan mereka
yang lebih kecil. hanya penyempitan yang
sedikit pada saluran pernafasan kanakkanak akan menyebabkan tidak keselesaan. Manakala, orang dewasa akan mengalami penyempitan yang agak banyak
sebelum mereka mengalami serangan
yang teruk.
Kanak-kanak yang menghidapi penyakit asma harus diperiksa oleh seorang
doktor dari masa ke semasa, setiap
tiga hingga enam bulan, walaupun
mereka tidak menjalani sebarang
rawatan secara tetap.
Satu cara untuk mengesahkan penyakit asma adalah melalui ujian fungsi
paru-paru, dimana pesakit menghembus
ke dalam mesin spirometer, yang membenarkan kakitangan perubatan untuk mengukur aliran udara dari dalam paru-paru.
gejala-gejala lain termasuk hidung yang
sensitif atau ekzema, satu keadaan kulit
yang kering. Kajian menunjukkan bahawa
sebahagian besar kanak-kanak dengan
ekzema turut menghidapi penyakit asma.
Sesetengah pesakit turut mengalami mata
yang berair dan gatal. penyakit ini mungkin
ada unsur keturunan. Misalnya, ibu puan
Zainah turut menghidapi penyakit asma.
“Jika seseorang mengalami serangan
asma, dia akan berasa sesak nafas dan
kurang sihat. Itulah, sebabnya mengapa
kami ingin memulakan rawatan secepat
mungkin untuk melegakan gejala-gejala
yang sedang dialami pesakit,” kata Dr
tan. “Sekurang-kurangnya, 70 peratus
daripada pesakit kami dirawat dalam
masa 15 minit.”
Sebaik sahaja tanda-tanda serangan asma kelihatan reda, doktor akan
memeriksa semula keadaan pesakit dan
mengajar mereka mengenai penjagaan
diri termasuk memberikan pelan ranBagaimana poliklinik
cangan tindakan asma (lihat di bawah).
mengendalikan asma
Di bawah perancangan puan Zainah
Jururawat-jururawat yang berpangka- bersama doktornya, dia perlu menyelan berdekatan pintu masuk poliklinik suaikan dos ubat penyedutnya dalam
Singhealth akan memerhatikan pesakit satu tempoh yang singkat untuk menceyang menunjukkan tanda-tanda kes- gah serangan asma. Dia juga dinasihatesakan nafas. Mereka akan memer- kan supaya membawa alat penyedut
iksa riwayat kesihatan pesakit dan jika pelega bersamanya. lazimnya, beliau
pesakit mempunyai sejarah penyakit hanya mengambil ubat penyedut penceasma, pesakit itu akan dibawa segera gah setiap hari, apabila sihat. apake bilik rawatan, dimana jururawat bila berasa kurang sihat, beliau tahu
yang dilatih khas akan memulakan bagaimana untuk meningkatkan dos
rawatan penyelamatan.
atau mengambil ubat steroid berdasarIni merupakan hasil program baru kan pelan.
dimana para jururawat telah dilatih
Jika gejala-gejala asmanya tidak reda
untuk mendengar bunyi pernafasan di dalam beberapa hari, beliau diarahkan
bahagian dada pesakit dan memulakan supaya berjumpa doktor dengan segera.
rawatan dengan segera jika serangan “rancangan tindakan asma memberi
asma telah dikesan secara klinikal. Ini saya kuasa untuk menjaga diri saya
membenarkan mereka yang mengalami dengan lebih baik,” kata puan Zainah.
serangan asma yang kritikal untuk diberikan bantuan dengan cepat kerana penyakit ini boleh berkemungkinan menganDr Tan Ngiap Chuan
cam nyawa.
turut perasan satu
trend asma yang
Sebelum program tersebut
semakin meningkat
dimulakan, para pesakit terpaksa berdi Singapura dan
atur untuk berjumpa doktor sebelum
beliau kini sedang
rawatan diberikan.
mengkaji sebabsebabnya.
Zon hijau
● tidak batuk
● tiada sesak dada
● tidak berdehit
● tiada sesak nafas
● tidak terbangun
pada waktu
malam
pesakit baik dan boleh
menjalankan aktiviti biasa
hariannya. Bagaimanapun,
sesetengah mungkin
masih perlu untuk
teruskan penggunaan
ubat pengawal.
asma semakin
meningkat
pelan
tindakan
asma
Ia menggunakan analogi
lampu isyarat untuk menggambarkan betapa seriusnya
gejala dan ubat yang mesti
diambil pesakit di setiap tahap
serangan asma, bermula
dengan tahap
hijau.
Zon kuning
● selsema
● Batuk berkahak
● nafas berdehit
● sesak nafas
● sesak dada
● terbangun pada
waktu malam
pesakit harus mula menyesuaikan ubat
sedutan menurut dos yang ditetapkan. Jika
dia tidak berasa sedikit pulih setelah beberapa
hari, dia harus berjumpa doktor.
Zon merah
● ubat-ubatan tidak
membantu ● Pernafasan
kuat dan cepat ● tidak boleh
mengira dari satu hingga 10
dalam satu nafas ● asma
menjadi semakin teruk
dengan cepat ● tulang
rusuk boleh dilihat
apabila bernafas
pesakit telah sampai ke tahap kecemasan. Dia
mesti berjumpa doktor dengan segera. Jika perlu,
hubungi ambulans di talian 995.
Sembilan poliklinik di bawah
Kumpulan Singhealth merawat 2, 300 hing ga 2, 500
pesakit setiap bulan dan ia juga
mengumpul data asma secara
bulanan. trend asma didapati
sedang meningkat di Singapura
sejak beberapa tahun yang lalu
dan “kami masih cuba untuk
memahami mengapa ianya terjadi”, kata Dr tan.
Mujurlah, hanya 9.3 peratus pesakit asma yang mengunjungi poliklinik memerlukan terapi penyelamatan,
di mana pesakit diberikan ubat
penyedut melalui alat istimewa
yang dipang gil “spacer ”,
iaitu membantu mereka
menyedut ubat terus ke dalam
paru-paru mereka.
M4
berita
singapore health
nov– Dis 2013
Kesan awal
Tanda-tanda awal kemerosotan makula berkaitan umur, yang boleh
menyebabkan kebutaan, termasuk penglihatan yang terherot atau
tompokan di tengah-tengah penglihatan seseorang itu
Oleh Thava Rani
tanda-tandanya semakin ketara dan,
akhirnya, akan terjadi kehilangan penglihatan utama.
“semua benda-benda di sekeliling boleh kelihatan jelas, tetapi apabila
pesakit cuba untuk menumpukan perhatian kepada muka seseorang, contohnya,
mereka akan melihat tompok gelap di
mana kawasan muka orang itu. pesakit
dengan aMD jarang sekali menjadi buta
sepenuhnya,” kata Dr lim.
lazimnya ia menjejas mereka yang
berumur 50 tahun, aMD merupakan hasil
penuaan progresif sel-sel di retina, yang
merupakan lampiran nipis tisu “fotografik”
yang melapisi bahagian belakang dalam
dinding mata.
terdapat aMD kering dan basah. Jenis
yang kering adalah lebih lazim. Kerosakan
kepada retina berlaku secara berans-
Pilihan Rawatan
Jika rawatan bermula sebelum parut mula
terjadi, ia boleh memperbaiki penglihatan
dengan ketara. “piawaian keunggulan
kini ialah untuk menyuntuk ubat ke dalam
mata, yang akan menyebabkan saluran
darah untuk mengecut.” Di sneC para
pesakit diberikan satu suntikan setiap
bulan untuk tiga bulan.
selepas itu, pesakit akan dipantau
setiap bulan. “Jika terdapat sebarang
pendarahan, kami akan memulakan
semula suntikan,” kata Dr lim.
Doktor juga cuba mengesan varian
tertentu aMD basah yang dikenali sebagai
polypoidal choroidal vasculopathy, yang
lebih lazim bagi orang asia. pesakit-pesakit seperti itu memerlukan rawatan
laser di samping suntikan.
pada masa lalu, rawatan yang berjaya
bermakna mencegah kehilangan teruk
kepada penglihatan. hari ini, ia lebih
kepada berapakah peningkatan visual
yang dapat tercapai.
“Mungkin seorang pesakit telah
datang dengan hanya boleh membaca
abjad-abjad besar pada carta sahaja,
tetapi kami boleh mengembalikan penglihatan memandu mereka jika mereka
datang cukup awal. Kebanyakan pesakit
mendapatkan semula penglihatan berfungsi baik,” kata Dr lim.
Fotos: getty iMages
r
a M a i w a r g a emas yang silap
menyifatkan semua perubahan
kecil dalam penglihatan itu akibat
penuaan, tetapi mereka mungkin tidak
sedar bahawa mereka mungkin menghidapi satu penyakit kemerosotan makula
berkaitan umur (aMD). apabila penglihatan mereka menjadi terlalu terherot, ia
mungkin sudah terlambat.
Jika mereka telah berjumpa doktor
lebih awal, beberapa jenis aMD boleh
dirawat dengan berkesan. Dalam peringkat awalnya, bintik-bintik kuning yang
kecil dikenali sebagai “drusen” – diperhatikan hanya setelah ujian mata – boleh
timbul di bawah retina. “Keadaan ini
biasanya tidak akan menjadi sesuatu
yang lebih teruk. Kebanyakan pesakit
tidak memerlukan rawatan pada saat ini,”
kata Dr laurence lim, perunding Madya,
perkhidmatan vitreo-retinal, pusat Mata
nasional singapura (sneC).
tetapi apabila keadaan bertambah
teruk, penglihatan menjadi semakin terherot. garisan yang lurus boleh kelihatan
beralun, atau beberapa perkataan kelihatan menghilang, terutama sekali jika ia
berada di kawasan pertengahan penglihatan (tumpuan utama).
gejala-gejala ini biasanya hanya
menjejas satu mata pada mulanya, dan
mungkin kerana itu ia tidak begitu ketara,
kecuali orang itu menutup mata yang
terjejas. apabila keadaan semakin teruk,
ur-ansur dan penglihatan pesakit bagi
penglihatan utama semakin berkurangan
dengan setiap tahun yang berlalu.
tiada rawatan yang boleh didapati
untuk aMD kering, tetapi pesakit boleh
belajar untuk menyesuaikan diri kepada
keadaan mereka. Dengan bantuan perkhidmatan penglihatan rendah di sneC,
mereka menggunakan berbagai alatalat untuk mengatasi keadaan mereka.
Mereka juga mempelajari untuk tidak
melihat secara langsung kepada objek
yang ingin ditumpukan.
Dalam jenis yang basah, kehilangan
penglihatan terjadi dengan lebih cepat,
kadang kala dalam hanya beberapa hari.
saluran darah yang tidak normal berkembang di bawah retina, kemudian bocor
atau berdarah ke dalam retina menyebabkan tiba-tiba menjadikan penglihatan
utama menjadi lebih buruk.
"ia boleh dirawat. tetapi jika dibiarkan
terlalu lama tanpa rawatan, yang boleh
terjadi dalam diri pesakit-pesakit yang
lebih tua, akan terjadi parut di retina.
pada ketika itu, ia sudah tidak boleh
diubah,” kata Dr lim.
apabila kemerosotan makula menjadi
semakin teruk,
satu tompok gelap
mungkin muncul di
pertengahan penglihatan seseorang.
Penglihatan mungkin menjadi terherot. Garisan lurus
mungkin kelihatan beralun.
Beberapa perkataan, terutamanya di pertengahan
penglihatan, mungkin
akan hilang.
beritahu kami
Tiada perasa dalam
makanan
Semasa tinggal di hospital baru-baru ini,
saya telah berulang kali meminta kicap
atau garam untuk dihidangkan bersama
makanan saya, tetapi dulang hidangan
selalu datang tanpa perasa yang diminta.
Mengapa ini berlaku?
SGH
semua makanan yang
kami sediakan telah diranJawaPaN cang khas oleh pakar dietetik kami untuk memenuhi keperluan
perubatan dan pemakanan anda. hidangan biasanya menggunakan garam dan
minyak yang berkurangan untuk diet
yang lebih sihat.
sebagai tambahan, atas sebab-sebab
perubatan, sesetengah pesakit mungkin
telah ditetapkan oleh doktor atau pakar
dietetik mereka agar mengikut diet yang
rendah lemak, kolesterol, garam, protein
atau gula.
pakar dietetik hospital dan chef
bekerja bersama untuk memastikan
bahawa makanan dihidangkan kepada
pesakit adalah sihat dan menyelerakan.
pilihan masakan Cina, india/Muslim dan
Barat, serta makanan vegetarian, boleh
didapati untuk memenuhi selera para
pesakit kami yang berbeza.
Diet khas juga boleh didapati untuk
para pesakit yang memerlukan diet terkawal khusus atau sedang menjalani
terapi diet khas.
sekiranya anda memerlukan perundingan dengan salah seorang daripada pakar dietetik kami, sila hubungi
mana-mana jururawat wad anda untuk
mendapat bantuan.
Untuk maklumat lanjut, sila layari
www.sgh.com.sg/patient-ser vices/
admission/hospitalcuisine/pages/
hospital-cuisine.aspx.
Subsidi pergigian disediakan untuk warga emas
Saya mendapati bahawa terdapat kadar
berlainan bagi para pesakit swasta dan
mereka yang menerima subsidi. Bapa
saya, 58 tahun, ingin giginya diperiksa.
Bagaimanakah beliau boleh mendapatkan status subsidi? Institusi perubatan
manakah yang perlu dikunjunginya?
NDC
JawaPaN
pemeriksaan dan rawatan
umum pada kadar subsidi
boleh diatur di klinik pergi-
gian poliklinik atau klinik pergigian pengamal umum (gp) yang turut serta dalam
skim Bantuan Kesihatan Masyarakat
Kementerian Kesihatan (Chas).
terdapat lebih daripada 200 klinik
pergigian gp yang turut serta dalam
Chas, dan banyak bertempat di kawasan
estet hDB. Untuk maklumat lanjut, sila
layari chas.sg/indexpatients.aspx. Jika
doktor gigi umum yang merawat bapa
anda mengesahkan masalah gigi yang
memerlukan rawatan pakar, beliau akan
merujuk bapa anda kepada pakar yang
sesuai untuk rawatan lanjut.
Di pusat pergigian nasional singapura, pesakit yang berumur 40 tahun
keatas yang telah dirujuk dari klinik-klinik
Chas untuk menerima rawatan pakar
akan diberikan status subsidi.
Pelepasan secara automatik selepas dua tahun
Saya merupakan seorang pesakit tetap
di Pusat Jantung Nasional Singapura
(NHCS). Setelah beransur pulih, saya
memutuskan untuk tidak lagi datang
ke sana untuk pemeriksaan susulan.
Bagaimanapun, disebabkan saya berasa
tidak sihat lagi, saya cuba untuk mem-
buat temu janji untuk berjumpa doktor
saya di NHCS, tetapi telah diberitahu
bahawa saya telah dilepaskan secara
automatik oleh sistem mereka setelah
dua tahun tanpa sebarang temu janji.
Kini, saya perlu untuk mendapatkan
rujukan untuk berjumpa doktor saya
sekali lagi. Mengapa ini berlaku?
NHCS
sebagai sebuah pusat
penyakit kardiovaskuJawaPaN lar, nhCs merawat lebih
daripada 100,000 pesakit luar setahun.
Kami juga menguruskan pesakit-pesakit yang mempunyai keadaan jantung
yang lebih kompleks dan akut. apabila pesakit tidak kembali untuk temu
janji selama dua tahun. Mereka akan
dilepaskan secara automatik. ini membolehkan para pakar kardiologi kami
untuk memberikan tumpuan bagi merawat pesakit-pesakit yang memerlukan penjagaan pakar. para pesakit yang
berasa tidak sihat, sementara menunggu
untuk berjumpa pakar jantung, dinasihatkan supaya mendapatkan nasihat
perubatan daripada doktor pengamal
umum atau pergi ke Jabatan Kemalangan dan Kecemasan, bergantung kepada
keterukan keadaan mereka.