Changi General Hospital – Eastern Health Alliance Scientific Meeting 2013

Transcription

Changi General Hospital –
Eastern Health Alliance Scientific Meeting 2013
Academic Medicine: Thinking Across, Moving Ahead
22 – 23 November 2013
Programme Book
WELCOME MESSAGE
Welcome to the Changi General Hospital-Eastern Health Alliance Scientific Meeting 2013 (CGH - EH Alliance Scientific
Meeting 2013).
This event will bring together the various disciplines and professions in Changi General Hospital as well as the Eastern
Health Alliance (EH Alliance). The theme of this Scientific Meeting is: "Academic Medicine - Thinking Across, Moving
Ahead".
The focus is thus on the impact of academic medicine and how it complements the clinical aspects of medicine to contribute to improved patients' outcomes and how it would influence the quality of doctors for generations to come.
We are pleased to have keynote speakers from our academic partners - the Singapore University of Technology and
Design (SUTD) and Chang Gung Memorial General Hospital (CGMGH) as we celebrate our journey towards excellence
in academic medicine. In addition, we have invited a prestigious and prominent panel of speakers, both locally as well
as internationally, to share with us their experience and expertise as we strive towards improving healthcare and patient outcomes through unique innovation, quality research, top-notch healthcare education and excellent clinical
practice.
The Oral and Poster Competition has received an overwhelming number of abstract submissions for the various tracks.
The winning projects and accepted submissions are on display at the CGH Atrium. You may also read the abstracts in
this e-booklet.
We would like to thank our committee members, as well as everyone who have helped in one way or another for their
time and effort in organizing this meeting.
Have a fruitful meeting!
Dr Yuen Heng Wai
Organising Chairman
CGH - EH Alliance Scientific Meeting 2013
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TABLE OF CONTENTS
Welcome Message
Programme at a Glance
Clinical Track
Clinical Symposium
- Presenters’ Abstract and Bioketch
Geriatric Fractures and Osteoporosis - A Multidisciplinary Symposium
Gastrointestinal Endoscopy Course & Soft Tissue Handling Course
Sleep Symposium & Workshop
Integrated Airway Symposium
Education Track
Education Symposium
Education Workshops
Presenters’ Abstract and Biosketch
Innovation Track
Research Track
Sports Medicine Track
Abstract of Presenting Authors
Best Oral Abstract (Clinical Medicine)
Best Oral Abstract (Innovation)
Best Oral Abstract (Research)
Best Poster Abstract (Clinical Medicine)
Best Poster Abstract (Education)
Best Poster Abstract (Research)
Acknowledgements
1
3-6
7
8-9
10 - 18
19 - 20
21 - 28
29 - 30
31
32 - 34
35 - 40
41
42 - 45
_46
47 - 48
49 - 54
55
55 - 57
58 - 60
61 - 71
72 - 74
75 - 83
84 - 85
86 - 91
_
92 - 98
99 - 109
110 - 118
119 - 143
144 - 155
156 - 187
188
PROGRAMME
AT A GLANCE
21 November 2013, THURSDAY
BEST ORAL PAPER AWARD
0900 – 1230
Best Oral Paper Award - Innovation
Venue: CGH Centre For Innovation @ Training Centre Level 1
1100 – 1230
Best Oral Paper Award - Clinical Medicine
Venue: CGH Lecture Room @ Training Centre, Level 1
1400 – 1515
Best Oral Paper Award - Research
Venue: CGH Seminar Room @ Level 2
BEST POSTER AWARD
Whole Day
Best Poster Award - Clinical Medicine
Best Poster Award - Education
Best Poster Award - Research
Venue: Changi General Hospital Atrium, Level 1
CONCURRENT SYMPOSIUMS / WORKSHOPS
0900 – 1730
Research Symposium
Venue: CGH Tutorial Room @ Training Centre Level 1
3
PROGRAMME
AT A GLANCE
22 November 2013, FRIDAY
0815 – 0850
Registration & Morning Tea
(All guests to be seated by 0850)
0900 – 1100
Official Opening of CGH- EH Alliance Scientific
Meeting 2013
CGH Auditorium
Training Centre, Level 1
Opening Ceremony
Guest of Honor:
Mr Gan Kim Yong
Minister for Health
Keynote address by Professor Thomas Magnanti
President, Singapore University of Technology &
Design
"Educating Technology Leaders for Design-Driven
Innovation"
Keynote address by Professor Chen Chao-Long
Superintendent, Kaohsiung Campus, Chang Gung
Memorial Hospitals & University
"Innovation, Education and Social Responsibility of
a Surgeon: My Personal Perspectives"
*By invitation only
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PROGRAMME
AT A GLANCE
1130 – 1300
Concurrent Symposiums / Workshops
1145 – 1445
Education
CGH, Lecture Room
Innovation
CGH, Centre for Innovation
Clinical Medicine
CGH, Seminar Room
Level 2
Orthopedics
SACH Seminar Room
SACH Level 2
1300 – 1400
Lunch
1400 – 1700
1400 – 1730
1400 – 1610
1400 – 1700
Education Workshop
Changi Simulation Institute
Sports Medicine
CGH Auditorium
Innovation
Gastroenterology Workshop
CGH, Seminar Room
Level 2
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PROGRAMME
AT A GLANCE
23 November 2013, SATURDAY
0900 – 1630
0900 – 1100
0900 – 1225
1400 – 1600
0800 – 1630
1400 – 1600
1000 – 1210
Simulation Teaching Workshop
Changi Simulation Institute
Research Symposium
CGH, Seminar Room
Level 2
Gastrointestinal Endoscopy Course
(Hands-on training course)
CGH, Skills Lab
Basement 2
Sleep Symposium
CGH Auditorium
Sleep Workshop
CGH, Seminar Room
Level 2
Soft-tissue Handling Course
CGH Lecture Room
Integrated Airway Lecture
6
Clinical Medicine Track
21 - 23 November 2013
7
CLINICAL MEDICINE
TRACK
Clinical Medicine Symposium
Changi General Hospital Seminar Room, Level 2
Chairperson:
Associate Professor Ang Tiing Leong
Chief & Senior Consultant, Department of Gastroenterology
Deputy Head of Research, Clinical Trials & Research Unit
1130 - 1150
Tackling Obesity- Perspective of a Gastroenterologist
Dr Jeannie Ong
Consultant, Department of Gastroenterology
Changi General Hospital
1150 - 1210
Colorectal Cancer Surgery: Maximising Success and Minimising Morbidty
Dr Kevin Sng
Consultant, Department of Surgery
1210 - 1230
Fish Oil in Parenteral Nutrition
Ms Han Hsien Hwei
Senior Clinical Pharmacist, Pharmacy
1230 - 1250
Nutrition for the Trauma Patient from the Perspective of a Trauma Nurse
Ms Serena Koh Ee Ling
Trauma Nurse Coordinator, Nursing
1300 - 1400
LUNCH
1400 – 1405
Opening: Master Class in Image Enhanced Endoscopy
A/Prof Ang Tiing Leong
1405 – 1415
Overview of Image Enhanced Endoscopy
Dr Andrew Kwek
Consultant, Department of Gastroenterology
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CLINICAL MEDICINE
TRACK
Clinical Medicine Symposium
1415 – 1435
1435 – 1455
1455 – 1515
1515 – 1530
1530 – 1550
1550 – 1610
1610
Image Enhanced Endoscopy of Esophagus
A/Prof Noriya Uedo
Department of Gastrointestinal Oncology
Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
Image Enhanced Endoscopy of Stomach
A/Prof Noriya Uedo
Exercise in Upper GI Image Enhanced Endoscopy
A/Prof Noriya Uedo
Tea Break
Image Enhanced Endoscopy of Lower GI: Kudo, Sano and NICE
A/Prof Rajvinder Singh
Senior Consultant Gastroenterologist, The Lyell McEwin Hospital
Clinical Associate Professor, Department of Medicine
University of Adelaide, Australia
Exercise in lower GI Image Enhanced Endoscopy
Senior Consultant Gastroenterologist, The Lyell McEwin Hospital
Clinical Associate Professor, Department of Medicine
University of Adelaide, Australia
Closing Remarks
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CLINICAL MEDICINE
TRACK
ABSTRACT
22 November 2013, Friday
1130 hrs - 1150 hrs
Tackling Obesity - Perspective of a Gastroenterologist
Abstract unavailable at time of print.
PRESENTER’S BIOSKETCH
Dr Jeannie Ong
Consultant
Gastroenterologist
Changi General Hospital, Singapore
Dr Jeannie Ong is currently working as a consultant gastroenterologist in Changi General Hospital, Singapore. She
has had extensive training in both gastroenterology as well as internal medicine, and has obtained dual
accreditation as a specialist in both gastroenterology and general internal medicine in the UK. Her main areas of
interest are nutrition and inflammatory bowel disease. Dr Jeannie Ong is currently an active member of the
nutritional support team.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1150 hrs - 1210 hrs
Colorectal Cancer Surgery: Maximising Success and Minimising Morbidty
Abstract not available at time of print
Dr Kevin Sng
Consultant
General Surgery
Dr Kevin Sng is a Consultant surgeon from the Colorectal Service under the Department of Surgery in Changi General
Hospital. He is a Clinical Senior Lecturer with the Yong Loo Lin School of Medicine, National University of Singapore
and a Clinical Physician Faculty Member under the Singhealth Residency Program. He was conferred Membership to
the Royal College of Surgeons, Edinburgh in 2005 and obtained his Fellowship in 2010. He completed his HMDP
Fellowship in Robotic and Laparoscopic Colorectal Surgery in Dec 2012 under Professor Kim Seon Hahn from the
Division of Colorectal Surgery in Korea University Anam Hospital in Seoul, Korea.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1210 hrs - 1230 hrs
Fish Oil in Parenteral Nutrition
Lipid emulsions for use in parenteral nutrition have been evolving gradually over the years. This lecture explores the
purported benefits of fish oil, a novel ingredient in lipid emulsions, and examines how it holds up to the light of
clinical trials.
Ms Han Hsien Hwei
Senior Clinical Pharmacist
Pharmacy
Ms Han Hsien Hwei is a senior clinical pharmacist at Changi General Hospital, and an integral part of the Parenteral
Nutrition Team. After graduating from the National University of Singapore with an honours degree, she went on to
achieve board certification in Nutrition Support from the Board of Pharmacy Specialties (USA) in 2005. She has also
been board certified as a Pharmacotherapy Specialist since 2009.
Ms Han was a recipient of the American College of Clinical Pharmacy Heart Failure Traineeship and the Singapore
Ministry of Health Specialty Residency Scholarship in Nutrition Support, which led to her spending some time in
America for her post-graduate training. In addition to clinical practice, she has been actively involved in clinical trials
and education. She was also part of the faculty for the Total Nutrition Therapy Course, which is a post-graduate
course for physicians in Southeast Asia.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1230 hrs - 1250 hrs
Nutrition for the Trauma Patient from the Perspective of a Trauma
Nurse
Ms Serena Koh Ee Ling
Trauma Nurse Coordinator, Nursing, Changi General Hospital
Abstract and Biosketch unavailable at time of print.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1405 hrs - 1415 hrs
Overview of Image Enhanced Endoscopy
Image-enhanced endoscopy comprise of various methods of enhancing contrast during endoscopy using dye, optical
or electronic methods. The dye-based method include the use of Lugol’s solution, methylene blue or indigo
carmine. Equipment-based methods include narrow-band imaging, flexible spectral imaging color enhancement
and i-scan. With these methods, gastrointestinal mucosal lesions are better detected and characterized during
endoscopy.
Dr Andrew Kwek Boon Eu
Consultant
Gastroenterology
Dr. Andrew Kwek Boon Eu graduated from the Faculty of Medicine, National University of Singapore in the year
2000 and obtained his Master of Medicine (Internal Medicine) and MRCP (UK) in 2004. In 2008, he completed his
specialist training in Gastroenterology and subsequently spent an additional year in Mumbai, training under Dr Amit
Maydeo in advanced therapeutic endoscopy, including ERCP and EUS. He is currently Consultant Gastroenterologist
in Changi General Hospital, serving the eastern sector of Singapore, with special interests in pancreatic and biliary
diseases, advanced ERCP/EUS techniques and image-enhanced endoscopy.
He also serves in the Gastroenterological Society of Singapore’s Executive Committee and remains active in medical
education. He is the Associate Program Director of the SingHealth Gastroenterology Senior Residency Program and
a senior clinical lecturer of the Medicine Faculty, National University of Singapore. He remains active in clinical
research and has publications in various medical journals including Gastrointestinal Endoscopy, Journal of
Gastroenterology and Hepatology, and Endoscopy.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1415 hrs - 1435 hrs
Image Enhanced Endoscopy of Esophagus
Effective screening target of esophageal squamous cell carcinoma (SCC) is not only restricted to the malignant
lesions, but also areas which are premalignant. NBI can effectively detect early neoplastic lesions as a
well-demarcated brownish area. A brownish area, that is suggestive of high-grade neoplasia or early carcinoma,
consists of brownish irregular (i.e. dilatation, tortuosity, caliber change, and variation in the shape) vessels and
brownish epithelium (areas between irregular vessels). Brownish color change of the epithelium may be caused by
the thinning of the keratinous layer due to neoplastic cell proliferation. Morphology of irregular vessels of the
esophageal SCC in magnifying NBI image varies according to tumor invasion. Mostly, when irregular vessels preserve
their loop structure (which is represented as brown dots in the non-magnifying view), the cancer is confined to the
mucosa. If the loop like structure of the IPCL’s are destroyed and they have a thin tree-branch-like shape, the tumor
appears to be likely to invade the muscularis mucosae or even infiltrate into the superficial submucosa. Thick bluish
to greenish vessels are observed when the tumor has massive submucosal invasion. Muto and colleagues conducted
a multicenter randomized controlled trial and indicated that NBI finding (irregular microvessel pattern +
demarcation line) showed higher diagnostic yield of superficial cancers of the head, neck and esophagus in high risk
patients compared to WLE diagnosis (a reddish area with uneven surface + disappearance of the background
vascular network).
Biosketch of presenter to be continued on the next page
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CLINICAL MEDICINE
TRACK
ABSTRACT
1435 hrs - 1455 hrs
Image Enhanced Endoscopy of Stomach
Histological features of the mucosa, thus magnified endoscopic findings are different between corpus and antrum of the
stomach and they are contrasted with using narrow band imaging (NBI). A normal gastric corpus has a characteristic
honeycomb-like subepithelial capillary network pattern that surrounds round or oval shaped gastric pits (Foveola type). The
starfish-like collecting venules are usually seen in the Helicobacter pylori (Hp) negative corpus mcuosa. The gastric antrum has
microridges which are separated by narrow sulci and demonstrates a coil-shaped and elongated subepithelial capillary in the
center (Groove type). Subepithelial capillaries appear to be brown in color and collecting venules look cyan under NBI.
Chronic Hp infection can lead to progression of atrophic gastritis and IM while being a risk factor for dysplasia and gastric
cancer. Gastric atrophy is characterized by 1) loss of pit pattern and subepithelial capillary network with irregular arrange ment
of collecting venules or 2) change of foveolar type mucosa to groove type mucosa. NBI enables us to detect intestinal
metaplasia as whitish patchy areas via the specific mucosal features. Bansal et al. found that the recognition of ridge or vi llous
pattern by NBI demonstrated high specificity and sensitivity (80% and 100% respectively) for IM. This finding may represent t he
phenomena of ‘pseudo-pylorization or intestinalization of the oxyntic mucosa which normally have round or oval shaped gastric
pits. Light-blue crest (LBC), which is characterized by the presence of fine blue-white line on micro-crests of the mucosa and is
an accurate predictor of underlying IM (sensitivity and specificity of 89% and 93% respectively). Early gastric cancer (EGC) is
defined as gastric carcinoma in which tumor invasion is limited to the mucosa/submucosal layer (T1) regardless of lymph node
metastases. Yao et al, indicates malignant mucosa on magnification endoscopy demonstrates an irregular microvascular pattern
(IMVP) or irregular microstructural pattern (IMSP) with demarcation line, which can be used to characterize magnified NBI
findings of EGC (the VS classification system). Nakayoshi et al classified irregular microvascular pattern of superficial gas tric
cancer to the fine network pattern; corkscrew pattern; and unclassified pattern. Fine network pattern and corkscrew pattern
Dr Noriya Uedo
Vice-director
Department of Gastrointestinal Oncology,
Osaka Medical Centre for Cancer and Cardiovascular Diseases, Japan
Dr. Uedo is a clinical investigator and gastroenterologist at the Osaka Medical Center for Cancer and Cardiovascular Diseases.
He graduated from the School of Medicine, Kagoshima University in 1992. He has joined the Department of Gastroenterology
and Hepatology of the Osaka University, after finishing his internship in the Kawanishi City
Hospital. In 1994, Dr. Uedo started his training in Gastrointestinal Oncology and Endoscopy in the Osaka Medical Center for
Cancer and Cardiovascular Diseases. His current research interests are
1) clinical application of new endoscopic imaging and therapeutic technique for early detection and treatment of gastrointestinal cancers and
2) how to teach and learn advanced endoscopy technique.
He is a councilor of Japanese Gastroenterological Endoscopic Society, Japanese Society of
Gastroenterology and Japanese Gastric Cancer Association, and an international member of American Society of Gastrointestinal Endoscopy.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1530 hrs - 1550 hrs
Image Enhanced Endoscopy of the lower GI: Kudo, Sano and NICE classification
A. Kudo’s pit pattern
Shin ei Kudo introduced the Kudo’s pit pattern (KPP) classification in his seminal paper in 1994(1). Some of the commonly use d dyes include
Indigo carmine (0.2%) which is a surface contrast agent, Methylene blue (2mls in 40 -50mls of water), a dye which is absorbed actively into the
mucosa or crystal violet (0.2%: 10mls in 40 mls of water) which is generally used in exceptional cases where KPP type V needs to be defined
further. The KPP is best visualized using high definition scopes with digital magnification or optical magnification (80 -115X) (2).
Briefly, the KPP can be divided into:
1. Type I: Pits appears round- normal colonic mucosa
2. Type II: Pits appears star like or onion skin like - hyperplastic polyps
3. Type III: Elongated pits - adenomas
4. Type IV: Cerebreform pits- adenomas
5. a) Type V I: Irregular (I) asymmetrical pits indicating malignancy confined to the mucosa (suitable for endoscopic resection)
b) Type VN: Pit patterns disappears, non-structured (N) or ‘structure less’- advanced or signifying invasive cancer (surgery)
In an interesting abstract presented at the Digestive Disease Week 2009, Subramaniam et al.(3) looked at >27,000 polyps in 30 studies
comparing the accuracy of standard white light endoscopy, chromoendoscopy, white light endoscopy with magnification , chromoe ndoscopy
with magnification and NBI with magnification in the prediction of colorectal polyp histology. The authors found that using c hromoendoscopy
and NBI, both with optical magnification were the most effective method in predicting polyp histology resulting in an area un der the ROC of
more than 0.90.
B. Electronic chromoendoscopy
Some of the electronic chromoendoscopy techniques widely available now include Narrow Band Imaging (NBI, Olympus), I scan (Pe ntax) or
the Flexible spectral Imaging Color enhancement (FICE, Fujinon). All these imaging modalities can assist in defining the micr o vascular
architecture in colorectal polyps. There have been numerous classifications utilised which at times can be confusing.
With NBI, the modified Sano’s classification appears to be the most ’user friendly’ (4, 5). In a preliminary feasibility stud y, the sensitivity (Sn),
specificity (Sp), positive (PPV) and negative predictive values (NPV) in differentiating neoplastic from non-neoplastic lesions with high
confidence was 98%, 89%, 93% and 97%, respectively, while the Sn, Sp, PPV and NPV in predicting endoscopic resectability (typ e II, IIIa vs.
type I, IIIb) was 100%, 90%, 93% and 100%, respectively (6). The interobserver agreement between assessors (k value) was also substantial at
0.89.
The classification has been recently updated to include Sessile Serrated Adenomas/ Polyps (SSA/P) (7) as follows:
Type I: Pale, round pits with central brown star like dots or bland appearance with minute capillaries which may meander acro ss polyp
(Hyperplastic)
- Type IIo: Pink mucous cap, Cloud like appearance, wavy pits which may have central brown oval/round dots (Sessile Serrated Ad enoma)
- Type II: Brown, linear or oval capillary network present which surrounds white linear or oval pits (Tubular Adenoma with Low Grade
Dysplasia)
- Type IIIa: Brown, high density capillary network with tortuosity, branching and lack of uniformity. Pits appear villous/ cere breform (Tubular
Adenoma with High Grade Dysplasia/ Villous Adenoma/Intramucosal cancer)
- Type IIIb: Avascular capillary network (Invasive cancer
Recently, a multicentre study was undertaken to further simply the NBI classification of colorectal polyps - aptly termed the ‘NICE’
classification (8). This classification although easy to use, appears to have ignored the SSA/P’s.
All 3 classifications will be discussed and deliberated further in the lecture
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CLINICAL MEDICINE
TRACK
Clinical Associate Professor & Senior Consultant Gastroenterologist ,
Gastroenterology
University of Adelaide & the Lyell McEwin Hospital, Australia
A/ Prof. Rajvinder Singh MBBS MRCP MPhil FRACP AM FRCP is a Clinical Associate Professor at the University of
Adelaide, South Australia and a Senior Consultant Gastroenterologist at the Lyell McEwin Hospital, South Australia,
Australia. Upon completion of his GI training, he received the Lancet International Fellowship which enabled him to
undertake a higher research degree on Narrow Band Imaging in Barrett’s Oesophagus at the University of Nottingham, UK. He has a keen interest in Endoscopic research focusing mainly on Advanced Endoscopic Imaging Techniques and Endoscopic Treatment of premalignant and malignant lesions in the gastrointestinal tract. He has published more than 100 papers/abstracts and is frequently invited locally and overseas to lecture on this topic. He has
been successful in obtaining various national and international grants to further investigate the utility of novel endoscopic imaging techniques in the detection of dysplasia and early cancer.
He is presently a Fellow of the Royal Australasian College of Physicians (Australia), a Fellow of the Royal College of
Physicians (Glasgow, Scotland), and a member of the Royal College of Physicians (London, United Kingdom). He is
the Contributing Associate Editor in Chief of the World Journal of Gastroenterology, an Editorial Board member of
Endoscopy, an Editorial Board member of the World Journal of Gastrointestinal Endoscopy and regularly reviews
manuscripts for Gastrointestinal Endoscopy and Endoscopy. He sits on the council of the Australian Gastroenterology Endoscopic Association and is presently one of the co-organizers of the upcoming annual GI scientific meeting,
the Australian Gastroenterology Week.
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CLINICAL MEDICINE
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Geriatric Fractures & Osteoporosis
St Andrew’s Community Hospital Seminar Room, Level 2
Geriatric Fractures & Osteoporosis – A Multidisciplinary Symposium
Course Directors:
Dr Dave Lee
Consultant, Department of Orthopaedic Surgery
Dr Poon Kein Boon
1145 – 1200
1200 – 1215
1215 – 1230
1230 – 1245
1245 – 1330
Hip Fractures Treatment Options
Dr Poon Kein Boon
Overview of Ortho-Geriatric Service and Hip Fracture Pathway
SSN Aw Yang Wan Sim
Senior Staff Nurse, Department of Case Management
Hip Fractures- the Geriatrician's perspective
Dr Goh Kiat Sern
Associate Consultant, Department of Geriatric Medicine
Non-Hip Osteoporosis Fractures; Management Options
Dr Dave Lee
Lunch Break
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CLINICAL MEDICINE
TRACK
Geriatric Fractures & Osteoporosis
St Andrew’s Community Hospital Seminar Room, Level 2
1330 – 1345
1345 – 1400
1400 – 1415
1415 – 1430
1430 – 1445
Osteoporosis- Update in 2013
Dr Foo Joo Pin
Consultant, Department of Endocrinology
Exercise for Osteoporosis
Dr Cindy Lin
Staff Attending Physician, Department of Sports Medicine
Physiotherapy and Conditioning after a Hip Fracture
Ms Tan Shumei
Senior Physiotherapist Department of Rehabilitative Services
Falls Prevention
Ms Elisabeth Piper
Occupational Therapist, Department of Rehabilitative Services
Q&A
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CLINICAL MEDICINE
TRACK
ABSTRACT
1145 hrs - 1200 hrs
Hip Fractures Treatment Options
Hip fracture is a common and increasing cause of hospitalization, morbidity, and even mortality. In the younger population, hip fracture is usually caused by a high-energy injury such as road traffic accident or falling from height. In
the elderly population, hip fracture is usually caused by a low-energy mechanism such as a fall. Mortality may
ensue from associated medical comorbidities that are exacerbated by injury-related immobility or complications.
The hip fracture treatment decisions made by the orthopaedic surgeon, either conservative or surgical may have a
significant impact on the patient’s outcome.
Osteoporosis-related hip fractures in the elderly mainly consist of intertrochanteric femoral fracture and femoral
neck fracture. Stable intertrochanteric femoral fractures are best treated with a dynamic hip screw. For unstable
fractures, a cephalomedullary nail such as proximal femoral nail antirotation (PFNA) appears to be a better choice
than dynamic hip screw.
Elderly patients with nondisplaced or valgus impacted femoral neck fractures can be treated with cannulated screws
fixation. Displaced femoral neck fractures can be treated with hemiarthroplasty with either cemented or cementless
stem. Total hip replacement can be considered for highly functional elderly patients or patients with preexisting
arthritis.
Dr Poon Kein Boon
Consultant
Orthopaedic Surgery
Dr Poon Kein Boon is an Orthopaedic Consultant who specialises in the management of simple and complex limb
fractures, pelvic and acetabular fractures and fragility fractures in the elderly as well as adult knee and hip joint
replacement surgeries.
His specialist areas of interest are the treatment of fractures and joint replacements using minimally invasive
techniques.
In addition, Dr Poon is committed to the AO Trauma Education and is the leader of the Ortho-Geriatric Team in
managing fragility hip fracture patients.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1200 hrs - 1215hrs
Overview of Ortho-Geriatric Service and Hip Fracture Pathway
Abstract was unavailable at time of print.
Ms Aw Yang Wan Sim
Senior Staff Nurse
Case Management
Nurse Aw Yang Wan Sim is a nurse coordinator from Case Management for Ortho-Geriatric service. Graduated from
Flinders University of South Australia with a nursing degree, she later pursued an Advanced Diploma in Geriatric
Nursing in year 2006. Prior to joining case management, she was with CGH Transitional Care. Her current interest is
to prevent secondary fracture in elderly and look forward to upcoming projects related to the subject.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1215 hrs - 1230 hrs
Hip Fractures – The Geriatrician's Perspective
Dr Goh Kiat Sern
Associate Consultant, Department of Geriatric Medicine
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CLINICAL MEDICINE
TRACK
ABSTRACT
1230 hrs - 1245 hrs
Non-Hip Osteoporosis Fractures; Management Options
Dr Dave Lee
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CLINICAL MEDICINE
TRACK
ABSTRACT
1330 hrs - 1345 hrs
Osteoporosis- Update in 2013
Dr Foo Joo Pin
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CLINICAL MEDICINE
TRACK
ABSTRACT
1345 hrs - 1400 hrs
Exercise as a Therapeutic Agent for the 21st Century
Physical activity is known to be an important component of the prevention and management of many common
chronic health conditions from obesity to diabetes and heart disease. This lecture will cover interesting and
insightful findings from what the recent medical research in the 21 st century has discovered about the critical role of
exercise in health promotion across the lifespan.
Dr Cindy Lin
Staff Attending Physician,
Sports Medicine & Rehabilitation Medicine,
Dr Cindy Lin is a Staff Attending Physician in Sports Medicine & Rehabilitation Medicine at Changi General Hospital.
She received her medical degree (MD) from Harvard Medical School. She is American Board certified in Sports
Medicine and Physical Medicine & Rehabilitation. She is active in clinical care, research, and teaching in sports
medicine and rehabilitation medicine. She is Director of Community Outreach for Exercise is Medicine Singapore.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1400 hrs — 1415 hrs
Physiotherapy and Conditioning after a Hip Fracture
Hip fracture commonly occurs in the elderly population. Following surgery, it is especially important for this
population to regain back their walking ability and exercise tolerance. This is not only for their general wellbeing,
but also to prevent further deconditioning and minimise burden of care. This session will share with you the role of
physiotherapy in the rehabilitation for this group of patients following hip fracture surgery.
Ms Tan Shumei
Senior Physiotherapist
Rehabilitative Services
After obtaining her degree in Physiotherapy, Shumei has been working in Changi General Hospital since and mainly
in the area of inpatient orthopaedics physiotherapy. Leading the team of Orthopaedics Inpatient Physiotherapists at
CGH, she and her team have recently completed quality improvement project relating to hip fracture patients and
are currently conducting a research project pertaining to rehabilitation of this population.
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CLINICAL MEDICINE
TRACK
ABSTRACT
1415 hrs - 1430 hrs
Falls Prevention
Ms Elisabeth Piper
Occupational Therapist, Department of Rehabilitative Services
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CLINICAL MEDICINE
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Gastrointestinal Endoscopy Course
Changi General Hospital Skills Lab, Basement 2
Gastrointestinal Endoscopy Course (Hands-on Training)
Course director:
1000 – 1020
Registration and Refreshment
1020 – 1030
Welcome address and briefing
1030 – 1100
Endoscopic haemostasis: Injection, Clips (Goup 1)
Endoscopic haemostasis: SB tube, EVL (Group 2)
Endoscopic haemostasis: Heater probe, APC (Group 3)
1100 – 1130
1130 – 1200
1200 – 1210
Debrief
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CLINICAL MEDICINE
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Changi General Hospital Lecture Room, Training Centre, Level 1
Course Director:
Dr Ian Loh Chi Yuan
Consultant, Department of Otolaryngology
Lecturers:
Dr Tan Kar Su, Associate Consultant, Department of Otolaryngology, Khoo Teck Puat Hospital
Dr Sandeep Uppal, Service Head, Facial Plastic and Reconstruction Surgery Service, Department of
Otolaryngology, Head and Neck Surgery, Khoo Teck Puat Hospital
Dr Stephen Lo, Service Head, Facial Plastic and Reconstruction Surgery Service, Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital
0800 – 0830
Registration
0830 – 0845
Introduction and opening
0845 – 0900
Introduction to needles, sutures and instruments
0900 – 0915
Principles of wound closure, healing, tissue handling, reconstruction ladder
0915 – 0930
Knot tying and suture methodology
0930 – 0945
The aesthetic subunit approach to planning incisions and flaps on the face
0945 – 1000
Scar revision techniques
1000 – 1015
Z-plasties, skin grafts and local flaps
1015 – 1045
Tea break
1045 – 1230
Practical Session 1
1230 – 1330
Lunch
1330 – 1600
Practical Session 2
1600 – 1630
Feedback and Certificate Presentation
30
CLINICAL MEDICINE
TRACK
23 November 2013, Saturday
0800 hrs—1630 hrs
Changi General Hospital Lecture Room, Training Centre, Level 1
Dr Sandeep Uppal
Consultant
Otolaryngology, Head and Neck Surgery
Khoo Teck Puat Hospital, Singapore
Dr Sandeep Uppal has served a one-year Facial Plastic Surgery Fellowship conducted by the European Academy of
Facial Plastic Surgery. As a part of the fellowship he trained in all aspects of facial cosmetic and reconstructive surgery in world
renowned centres in the Netherlands, Germany, UK, and United States of America. He achieved the highest score of all the
international candidates in the examination conducted by the American Board of Facial Plastic and Reconstructive Surgery as part
of the certification process of the International Board of Facial Plastic Surgery. Dr. Uppal’s research and clinical interests have
resulted in 27 publications in peer reviewed international journals and numerous international presentations. Notable amongst
these have been first author publications in Nature Genetics and BMJ. He has been a faculty member in numerous international
and national Facial Plastic Surgery courses.He has recently been awarded a PhD for his thesis ‘Genetic Studies on Inherited
Diseases Presenting with Unusual ENT Problems’ by the University of Leeds, UK. During his PhD he identified the genetic and
molecular basis of the syndrome Pachydermoperiostosis, a condition that presents with aesthetic facial deformities resulting from
thickening of facial skin.
Adj A/Prof Stephen Lo
Consultant
ENT
Tan Tock Seng Hospital, Singapore
Consultant ENT Surgeon and Chief of Facial Plastic Surgery Service, Department of ENT, Tan Tock Seng Hospital
Singapore, and Adjunct Assistant Professor, National University of Singapore Medical School. Otorhinolaryngology-head & neck
surgery training in London. Subspecialist interest is in Facial Plastic Surgery and Rhinology. European Academy of Facial Plastic
Surgery (EAFPS) fellowship trained and board certified. Core faculty and clinical scientist mentor of the Singapore National
Healthcare Group ENT residency training program. Founding director of the annual Singapore Facial Plastic Surgery Course.
Dr Tan Kar Su
Associate Consultant, Department of Otolaryngology, Khoo Teck Puat Hospital
Biosketch Unavailable at time of print.
31
CLINICAL MEDICINE
TRACK
Sleep Symposium
Changi General Hospital Auditorium, Level 1
Sleep Symposium
Course Directors:
Dr Sridhar Venkateswaran
Consultant, Department of Respiratory Medicine
Dr Alvin Tan Kah Leong
Senior Staff Attending Physician, Department of Otolaryngology
0900 – 0940
Advances and updates on sleep surgery
Professor Lin Hsin-Ching
Associate Professor, Dept. of Otolaryngology, Sleep Center, Chang Gung University,
Chang Gung Memorial Hospital
Vice Chairman, Department of Otolaryngology, Kaohsiung Medical Center, Taiwan
Director of Division of Laryngology and Sleep Surgery, Executive Council, Taiwan
Society of Sleep Medicine
0940 – 1020
Consequences and long term effects of sleep deprivation
Professor Michael Chee
Senior Consultant, Neuroscience and Behavioral Disorders Program
Duke-NUS Graduate Medical School
32
CLINICAL MEDICINE
TRACK
Sleep Symposium
1020 – 1100
1100 – 1120
Tea Break
Oral appliances in sleep-disordered breathing
Dr Eric Lye
Senior Consultant, Assistant Director Integrated Sleep Service
Oral and Maxillofacial Surgery, Visiting Specialist, Department of ENT
1120 – 1200
PAP therapy for obstructive sleep apnoea
Dr Tripat Singh
Clinical Manager Sleep, Philips Healthcare ASEAN
Philips Electronics(s) Pte Ltd
1200 – 1225
Transoral Robotic Surgery of the Tongue Base in OSA
Dr Toh Song Tar
Singapore General Hospital
1020 – 1100
1100 – 1120
Tea Break
Oral appliances in sleep-disordered breathing
Dr Eric Lye
Senior Consultant, Assistant Director Integrated Sleep Service
Oral and Maxillofacial Surgery, Visiting Specialist, Department of ENT
1120 – 1200
PAP therapy for obstructive sleep apnoea
Dr Tripat Singh
Clinical Manager Sleep, Philips Healthcare ASEAN
Philips Electronics(s) Pte Ltd
1200 – 1225
Dr Toh Song Tar
33
CLINICAL MEDICINE
TRACK
Sleep Workshop
Sleep Workshop
Course Directors:
Dr Sridhar Venkateswaran
Dr Alvin Tan Kah Leong
Senior Staff Attending Physician, Department of Otolaryngology
1400 – 1600
PAP therapy and mask fitting
Dr Tripat Singh
Clinical Manager Sleep, Philips Healthcare ASEAN, Philips Electronics(s) Pte Ltd
34
CLINICAL MEDICINE
TRACK
ABSTRACT
0900 hrs – 0940 hrs
Advances and Updates on Sleep Surgery
Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Most sleep physicians are in agreement that a certain number of OSAHS patients cannot or will not
use CPAP. Although other conservative therapies such as oral appliance, sleep hygiene and sleep positioning may
help
some
of
OSAHS
patients,
there
are
many
who
fail
all
conservative treatments.
Surgery for OSAHS is not a substitute for CPAP but is a salvage procedure for those who failed CPAP and other conservative therapies and therefore have no other options. Because there is no single treatment that eliminates sleep
apnea, a multidiscipline approach is valuable and necessary for these patients.
As otolaryngologists, we have the responsibility to screen patients for both symptoms and signs of OSAHS. As experts of the upper airway, we are often viewing an airway clearly and helping our patients understand the
importance of assessment and treatment for OSAHS.
This presentation is to provide an overview of upper airway surgery in patients with OSAHS. Current evidence-based
outcomes
of
sleep
surgery
and
innovative
techniques
for
sleep-related
breathing
disorders will be introduced.
35
CLINICAL MEDICINE
TRACK
Prof Hsin-Ching Lin
MD, FACS, FICS
Department of Otolaryngology, Sleep Center
Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Hsin-Ching Lin MD, FACS, is an associate professor of the Department of Otolaryngology and Sleep Center, Chang
Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Dr. Lin is Vice Chairman of the
Department of Otolaryngology and Director of Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital.
He had his residency at the Kaohsiung Chang Gung Memorial Hospital and completed a fellowship in Chicago, IL under the guidance of professor Michael Friedman, one of the world’s leading and most prolific ENT surgeons, especially in sleep surgery.
He is an active member of many societies, such as American Academy of Otolaryngology - Head & Neck Surgery
(AAO-HNSF), American Academy of Sleep Medicine, Taiwan Otolaryngological Society, Taiwan Society of Sleep Medicine and Asian Sleep Research Society…etc. He is a fellow of the American College of Surgeons. He has received
many awards from the Taiwan Otolaryngological Society, Taiwan Society of Sleep Medicine, including the 2009
AAO-HNSF Honor Award and the 2012 International Guest Scholarship Award of the American College of Surgeons.
Dr. Lin has a special interest in the surgical and non-surgical treatment of sleep-related breathing disorders with
extensive experience in a variety of advanced sleep surgeries. He has been involved many aspects of clinical
researches and published many papers in in the prestigious peer-review journals in the fields of the
otorhinolaryngology and sleep medicine. Dr. Lin has also presented numerous papers at local, international society
meetings and has been an invited speaker at many international conferences on sleep medicine.
36
CLINICAL MEDICINE
TRACK
ABSTRACT
0940 hrs - 1020 hrs
Consequences and Long Term Effects of Sleep Deprivation
Professor Michael Chee
Senior Consultant, Neuroscience and Behavioral Disorders Program
37
CLINICAL MEDICINE
TRACK
ABSTRACT
1100 hrs – 1120 hrs
Oral Appliances in the Management of Sleep-Disordered Breathing
Obstructive Sleep Apnea is a serious chronic medical condition that has gained prominence in the last 2 decades. It
has serious medical, social and economical implications when left untreated or undertreated. There is a
multidisciplinary approach towards the management of patients with this condition. Oral appliance management
has contributed significantly towards the initial treatment strategies used. However, there are some limitations,
technical knowledge and management protocols that must be understood in order to practice this treatment regime
effectively. With the correct understanding and using the correct approach, selected patients can be successfully
treated by oral appliance therapy. This lecture will give a summary of the various aspects of this approach.
Dr Lye Kok Weng, Eric
Senior Consultant
Oral & Maxillofacial Surgery
Changi General Hospital, National Dental Centre of Singapore, Singapore
Dr Eric Lye is the Deputy Director of the Integrated Sleep Service at Changi General Hospital (CGH) and Head of the
Obstructive Sleep Apnea (OSA) Clinic at the National Dental Centre Singapore (NDCS). He is also a senior consultant
of the department of Oral & Maxillofacial Surgery at both CGH and NDCS and the Associate Director of the Oral &
Maxillofacial Surgery programme at the National University of Singapore.
Dr Lye received training in the management of the OSA condition in 2006 and subsequently involved in the care and
treatment of OSA patients through oral appliance and orthognathic surgical management. He has given several
lectures and published in journals and books on these topics.
38
CLINICAL MEDICINE
TRACK
ABSTRACT
1120 hrs – 1200 hrs
PAP Therapy for OSA
OSA is associated with an increased risk of hypertension, ischemic heart disease, heart failure, stroke, cardiac
arrhythmias and increased mortality from cardiovascular events. The Wisconsin Sleep Cohort Study demonstrated a
dose-response association between OSA at baseline and the incidence of new hypertension 4 years later. OSA is an
independent predictor of coronary artery disease (CAD). 11-38% of patients with established heart failure have
predominant OSA. The prevalence of OSA is increased in patients with stroke and OSA is significantly associated with
a risk of stroke and death. Nocturnal desaturation in OSA patients is associated with a higher incidence of Atrial
Fibrillation. Over 7 years, patients with OSA are five times more likely to have cardiovascular disease than those
without OSA. The risk of fatal and nonfatal cardiovascular events is significantly increased in patients with untreated
severe OSA compared to healthy subjects. Evidence suggests that treating OSA in patients with cardiovascular
disease reduces systolic and diastolic blood pressure and, subsequently, reduces the cardiovascular risk associated
with OSA. Non-adherence to CPAP therapy is a frequent problem faced by physicians managing OSA patients.
Several factors may affect adherence to CPAP. Systematic educational programs which include increased intensity of
patient education, increased frequency of health provider contact has been recommended as Standard option by
American Academy of Sleep Medicine to improve CPAP compliance. Sleep specialist consultation prior to PSG may
be helpful in improving CPAP compliance.
Dr Tripat Deep Singh
Clinical Manager
Sleep Healthcare ASEAN,
Philips Electronics Pte Ltd, Singapore
Dr. Tripat Deep Singh is currently Clinical Manager Sleep Healthcare ASEAN Philips Electronics Singapore. He
graduated with MBBS from Govt. Medical College Patiala, Punjab, India in 2003. He obtained his Post -graduate
degree in Physiology from Vallabhbhai Patel Chest Institute University of Delhi, Delhi, India in 2009. He also
specialize in Sleep Medicine as International Sleep Specialist (World Sleep Federation program) and Sleep
Technology as Registered Polysomnography Technologist (RPSGT) & Registered Sleep Technologist (RST). His
research interest is in role of oxidative stress in pathogenesis of OSA; Jet lag disorder and Central Sleep Apnea. He
was Assistant Professor at Pondicherry Institute of Medical Sciences and taught Medical Physiology to Medical and
Nursing students. He was incharge of Sleep lab at Pondicherry Institute of Medical Sciences before joining Philips in
the current role. He is member of various Sleep Medicine and Sleep Technologist societies. He is frequent speaker at
various courses and workshops in ASEAN region.
39
CLINICAL MEDICINE
TRACK
ABSTRACT
1200 hrs - 1220 hrs
Dr Toh Song Tar
40
CLINICAL MEDICINE
TRACK
Changi General Hospital Centre for Innovation, Training Centre Level 1
Course Directors:
Dr David Chin Chao-Wu
Dr Imran Mohamed Noor
1400 – 1430
Chronic cough - investigations and management
1430 – 1500
Postnasal drip - A symptom to be sniffed at?
Dr Gan Eng Cern
Associate Consultant, Department of Otolaryngology
1500 – 1530
Lung function tests made easy
1530 – 1600
Integrated ENT - Respiratory medicine approach to upper airway inflammatory
disorders
Dr David Chin
41
CLINICAL MEDICINE
TRACK
ABSTRACT
1400 hrs - 1440 hrs
Chronic Cough - Investigations and Management
Dr Imran Mohamed
42
CLINICAL MEDICINE
TRACK
ABSTRACT
1430 hrs – 1500 hrs
Postnasal drip – A symptom to be sniffed at?
Postnasal drip is one of the most common ENT complains seen in the physician’s office. It is a sensation of nasal
mucous dripping down the back of the nose and throat that can be experienced by patients with or without
excessive production of mucus from the nasal mucosa. The term “drip” is a misnomer and implies that mucous can
drip from the soft palate or nasopharynx into the larynx or hypopharynx. This does not happen because of the rheological properties of the mucous, cohesional forces and adhesiveness. Although rhinologic conditions such as rhinitis
and rhinosinusitis can give rise to postnasal drip syndrome, often patients with a sensation of postnasal drip have no
obvious pathology and are simply hyperaware of their normal nasal mucous. This symposium will focus on the common causes of postnasal drip and the approach in managing such patients.
Dr Gan Eng Cern
Associate Consultant
Otolaryngology
Dr Gan Eng Cern is an Associate Consultant in the Department of Otolaryngology, Changi General Hospital. He
obtained his medical degree from the University of New South Wales in Sydney, Australia in 2002. He completed his
residency in Otolaryngology, Head & Neck Surgery in 2012. He has a keen interest in Rhinology and completed his
fellowship in Rhinology and Skull Base Surgery at St Paul’s Sinus Centre, Vancouver, Canada in July 2013.
43
CLINICAL MEDICINE
TRACK
ABSTRACT
1500 hrs - 1530 hrs
Lung Function Tests Made Easy
Dr Imran Mohamed
44
CLINICAL MEDICINE
TRACK
ABSTRACT
1530 hrs – 1600 hrs
Integrated ENT - Respiratory Medicine Approach to Upper Airway
Inflammatory Disorders
Asthma, sinusitis (acute and chronic), allergic rhinitis (AR) & chronic cough are common problems in
primary healthcare. Patients often present with both upper and lower airway symptoms. Chronic cough may be due
to a number of different causes of the upper or lower respiratory tract. Furthermore, while the role of allergic
inflammation in asthma and AR is well-known, some forms of chronic sinusitis are predominantly inflammatory rather than infective and frequently associated with late-onset asthma. Proper evaluation of these patients
therefore requires assessment of the entire respiratory tract from the nose to the lungs. Patient outcomes are
optimized with integrated management of both the upper and lower airway. The symposium will focus on the
integrated approach to the commonest problems of the respiratory tract.
Dr David Chin
Consultant
Otolaryngology Head & Neck Surgery
David Chin is a rhinologist ENT surgeon at Changi General Hospital in Singapore. He completed his ENT specialist
training in Singapore in 2011 and subsequently undertook a one-year fellowship in rhinology and endoscopic skull
base surgery with the Sydney Clinical Rhinology Fellowship.
In addition to endoscopic sinus surgery for inflammatory and neoplastic disease, he has special interest in functional
nasal surgery, objective nasal airway assessment, allergy and airway inflammation.
Apart from further developing rhinology services in CGH, he is also currently involved, together with
colleagues from respiratory specialists, in the development of an integrated airway service combining ENT and respiratory services at his hospital which aims to be a one-stop service for patients with
combined upper and lower respiratory tract problems.
45
Education Symposium
22 - 23 November 2013
Chairperson:
Associate Professor Goh Siang Hiong
Deputy Chairman, Medical Board (Education and Ambulatory)
Senior Consultant, Department of Accident & Emergency, Changi General Hospital
46
EDUCATION
TRACK
Changi General Hospital Lecture Room, Level 1
1130 – 1200
So You Want To Be A Clinical Educator?
Dr Jansen Koh
Associate Consultant, Department of Respiratory Medicine
1200 – 1230
So You Want To Be A Nursing Educator?
Dr Janet Choo
Deputy Director, Nursing Administration
1230 – 1300
Self-Directed Medical Education – New Learning for a New Generation
A/Prof Mohan Tiru
Chief & Senior Consultant, Department of Accident & Emergency
1300 – 1400
LUNCH
47
EDUCATION
TRACK
Changi Simulation Institute Training Centre, Level 1
1400 – 1420
10 Tips for Effective Feedback
Associate Professor Goh Siang Hiong
Deputy Chairman, Medical Board (Education and Ambulatory)
Senior Consultant, Department of Accident & Emergency
1420 – 1500
1500 – 1515
1515 – 1630
Simple Rules for Observation in Assessment, The KSA Framework & Reference
Frameworks
Dr Joan Khoo
Break
Workshop on Doing Evaluation and Tools For Assessment
Facilitators:
Dr Joan Khoo
Dr Rahul Goswami
Consultant, Department of Emergency Medicine
1630-1700
Learning with Social Media
Dr Rahul Goswami
Consultant, Department of Emergency Medicine
48
EDUCATION
TRACK
ABSTRACT
1130 hrs - 1200 hrs
So You Want To Be a Clinical Educator?
Abstract unavailable at time of print
Dr Jansen Koh
Consultant
Respiratory & Critical Care Medicine
Dr Jansen Koh obtained his MBBS from the National University of Singapore in 2001. He is a consultant at the
department of Respiratory & Critical Care Medicine, Changi General Hospital. He recently completed a fellowship in
Clinical Simulation and Medical Education at the Learning Institute, SickKids Hospital, Toronto, Canada. He is
currently the Associate Program Director of the Internal Medicine Residency Program at Singhealth. He also serves
as Chair of the Education Technology Workgroup at Changi General Hospital, a group responsible for identifying,
selecting and utilizing technology to enhance medical education. His specific clinical interest in Respiratory and
Critical Care is point of care ultrasonography, having obtained his certification from the American College of Chest
Physicians. In addition, he has developed several educational initiatives in simulation medical education at Changi
General Hospital. He is passionate about medical education for students and doctors and was awarded the 2011
NUS-YLL Dean’s Award for Teaching Excellence as well as the 2011 Changi General Hospital Best Teacher Award. His
research interest lies in advancing our understanding and effective use of simulation for clinical teaching and
process improvement in critical care.
49
EDUCATION
TRACK
ABSTRACT
1200 hrs - 1230 hrs
So You Want To Be A Nursing Educator?
Nurse educators are the key resource in preparing a nursing workforce that will provide quality care to meet the
health care needs of our population. They may practise in academic and/or clinical settings, and they must be
competent clinicians. Regardless of the setting in which the nurse educator is employed, there is a core of
knowledge and skills that is essential if one is to be effective and achieve excellence in the role. One of the strongest
motivators to be a nurse educator is that teaching provides an opportunity to influence student success and shape
the next generation of nurses. As an educator, one can model professional values and skills, and ultimately influence
the quality of care provided by future nurses. The author addresses the educational qualifications needed for
teaching and pays special attention to the essential skills needed to become a nurse educator and flourish in a
teaching role.
Dr. Janet Choo
Deputy Director
Nursing Administration
Janet Choo has accumulated a wealth of nursing knowledge and experience. Her knowledge and skills extend from
clinical nursing to nursing education, including clinical pathway and case management programs, wound
management, nursing quality, nursing research and most recently nursing administration.
In recognition of her expertise, Janet was also invited to speak at several international and local forums relating to
clinical pathways, case management programs, evidence-based practices and management. In recognition of her
consistent clinical excellence and professional contributions, she was awarded the National Day Efficiency Medal in
2002, the President’s Nurse Award in 2004 and the National Day Commendation Medal in 2013.
Janet holds a Bachelor’s Degree in Nursing from La-Trobe University, Australia. She was awarded the Academic
Excellence Award for her Masters’ Degree in Health Science Management from the University of Sydney and holds a
PhD in Nursing from the University of Melbourne. She is also an Honorary Teaching Fellow with the University of
Manchester.
50
EDUCATION
TRACK
ABSTRACT
1230 hrs - 1300 hrs
Self-Directed Medical Education – New Learning for a New Generation
A/Prof Mohan Tiru
Chief & Senior Consultant, Department of Accident & Emergency
Abstract and Biosketch unavailable at time of print
51
EDUCATION
TRACK
ABSTRACT
1400 hrs - 1420 hrs
Top 10 Tips in Giving (Good & Bad) Feedback To Your Residents
Faculty and supervisors need to learn to provide effective feedback to a learner, whether in medical school and
during residency in a variety of patient care settings. Some would even say feedback has to continue even into adult
working life. Without effective feedback, mistakes and bad habit practices go uncorrected and good performance is
not recognised or reinforced. One needs to recognise common barriers to providing feedback and how to overcome
them. Success for effective feedback includes establishing an appropriate culture using suitably agreed upon goals;
respecting the learner's emotions; mature nonjudgmental reflection on observed actions; and offering the right
amount of feedback in a timely fashion; with suggestions for rectification and improvement going forwards.
Prof Goh Siang Hiong
Dy CMB (Medical Education, Ambulatory Services)
Designated Institutional Official, Senior Consultant Emergency Physician
Accident & Emergency Department
Prof Goh Siang Hiong is an Emergency Medicine Senior Consultant specialist and is currently the Deputy Chairman
Medical Board for Ambulatory Disciplines and also Medical Education at Changi General Hospital. He has a deep
interest in EM medical education at both the undergraduate and postgraduate levels. He has more than 18 years of
Emergency Medicine Practice, and also presently an instructor for BCLS, ACLS, ATLS (Provider course) ATLS
(Instructor course), HazMat Life Support and Fundamental Critical Care Course. He has been selected before as Best
Teacher (Ambulatory Division) and also been awarded the SingHealth GCEO Excellence award for Medical Education.
He has also written several papers pertaining to the field of Emergency Medicine, and co-authored many too, and
has best research presentation awards twice at Scientific Meetings and Best Faculty Speaker in 2007 for the
SEMS’ (Society for Emergency Medicine in Singapore) ASM. Prof Goh is currently overlooking the CGH
residency-training programs as its Associate Designated Institutional Official.
52
EDUCATION
TRACK
ABSTRACT
1420 hrs - 1500 hrs
4 Simple Rules for Observation in Assessment, The KSA Framework &
Reference Frameworks
The direct observation of trainees performing clinical history-taking, physical examination and counseling is
essential for evaluation of their competence. Behavioural observation training focuses on improving the detection,
perception and recall of actual performance. The four simple rules of observation are 1) correct positioning of the
observer; 2) minimizing external interruptions; 3) avoiding intrusions; and 4) being prepared for the session.
The KSA (Knowledge, Skills, Attitude) framework increases the effectiveness of performance evaluation.
Performance Dimension Training (PDT) is designed to familiarize faculty with the appropriate performance
dimensions used in their own evaluation systems. PDT aims to define the criteria and definitions of a superior
performance, and the minimal criteria for a satisfactory performance which will define lower levels of performance.
Frame of reference training (FORT), an extension of PDT, specifically targets accuracy in rating by defining criteria
and levels of performance from the perspective of optimal patient outcomes. We will also discuss the use of
assessment tools to guide observation and provide feedback to trainees, such as checklists and the mini-Clinical
Evaluation Exercise (mini-CEX).
Dr Joan Khoo,
Consultant,
Endocrinology,
Dr. Joan Khoo graduated from the National University of Singapore in 2000. After receiving postgraduate
qualifications in 2004 from the Royal College of Physicians (UK) and completing specialist training in diabetes and
endocrinology in 2007, she was awarded a fellowship to pursue research in the Royal Adelaide Hospital. She served
as Director of the CGH Diabetes Centre from 2011-2012 and is currently a Consultant in the Department of
Endocrinology and Clinical Senior Lecturer in the Yong Loo Lin School of Medicine (NUS). Her Metabolic Syndrome
clinic is part of the multi-disciplinary weight management service in CGH.
Her clinical and research interests are obesity, diabetes, and exercise endocrinology. She has presented in international conferences and published in peer-reviewed journals, receiving research awards in 2011 and 2012. She is
involved in the Eastern Community Health Outreach (ECHO) community-based chronic disease and obesity
prevention program, and is a member of the Exercise is Medicine Singapore Task Force.
53
EDUCATION
TRACK
ABSTRACT
1645 hrs - 1715 hrs
Learning With Social Media
Dr Rahul Goswami
Consultant
Emergency Department
Dr Rahul Goswami is an Consultant Emergency Physician at CGH ED. He is a Fellow of the Australasian College for
Emergency Medicine and Academy of Medicine (SG). He holds a Masters in Disaster Medicine and a PGCert in Aeromedical transport. He is core faculty for the Singapore ACGME program for trainees in Emergency Medicine and is a
senior clinical lecturer for the National University of Singapore (School of Medicine). He has worked in over a dozen
hospitals on three continents and lucky enough to spend over a year with the Royal Flying Doctor Service in Western
Australia. He also runs 2 educational portals in medical education.
54
EDUCATION
TRACK
Changi Simulation Institute Training Centre, Level 1
0900 – 0930
0930 – 1030
Registration
Role of Simulation in Healthcare Today
Dr Jansen Koh
Associate Consultant, Department of Respiratory Medicine
1030 – 1045
1045 – 1230
BREAK
Exploring Various Aspect of Using Simulation to Improve Healthcare
Small Group Workshops
1330 – 1630
Crew Resource Management
Dr Lim Tiek Whai
Chief & Senior Consultant
Department of Anaesthesia & Surgical Intensive Care
55
EDUCATION
TRACK
ABSTRACT
0930 hrs - 1030 hrs
Role of Simulation in Healthcare Today
Simulation in medicine is increasingly used worldwide. At its broadest definition, simulation refers to the
representation or reproduction of something real by imitation. The predominant use of simulation in healthcare is in
medical education, for the purposes of training and assessment. The literature pertaining to simulation in healthcare
is vast. A MEDLINE search of simulation and medicine returned over 7000 references. It is essential to make sense of
the current available evidence to carry out medical simulation education effectively. Current best practices in
simulation in medical education are discussed together with specific techniques that are useful in medical
education. In addition to training and assessment in medical education, simulation can be used for a variety of
purposes in healthcare. These include using simulation in performing a learning needs assessment, root cause
analysis and for quality and process improvement.
Dr Jansen Koh
Consultant
Respiratory & Critical Care Medicine
Dr Jansen Koh obtained his MBBS from the National University of Singapore in 2001. He is a consultant at the
department of Respiratory & Critical Care Medicine, Changi General Hospital. He recently completed a fellowship in
Clinical Simulation and Medical Education at the Learning Institute, SickKids Hospital, Toronto, Canada. He is
currently the Associate Program Director of the Internal Medicine Residency Program at Singhealth. He also serves
as Chair of the Education Technology Workgroup at Changi General Hospital, a group responsible for identifying,
selecting and utilizing technology to enhance medical education. His specific clinical interest in Respiratory and
Critical Care is point of care ultrasonography, having obtained his certification from the American College of Chest
Physicians. In addition, he has developed several educational initiatives in simulation medical education at Changi
General Hospital. He is passionate about medical education for students and doctors and was awarded the 2011
NUS-YLL Dean’s Award for Teaching Excellence as well as the 2011 Changi General Hospital Best Teacher Award. His
research interest lies in advancing our understanding and effective use of simulation for clinical teaching and
process improvement in critical care.
56
EDUCATION
TRACK
ABSTRACT
1330 hrs - 1630 hrs
Crew Resource Management
Dr Lim Tiek Whai
Department of Anaesthesia & Surgical Intensive Care
57
Innovation Symposium
21 - 22 November 2013
Chairperson:
Dr Eugene Shum
Chief Corporate Development Officer
Eastern Health Alliance
58
INNOVATION
TRACK
Changi General Hospital Centre for Innovation, Level 1
1130 – 1200
How I Made it Happen: Developing An Idea and Making It Real
Ms Barbara Moscowitz
Director, MGH Senior HEalthWISE
Program Coordinator, Geriatric Social Work
Massachusetts General Hospital Geriatric Medicine Unit
1200 – 1220
Let’s Get Frank! How Design Thinking created a brand new concept in banking
Ms Natalie Koh
Assistant Vice President
OCBC Experience Design
1220 – 1240
Intra-Body Tracking: Navigating Inside the Human Body
Dr Foong Shaohui
Assistant Professor, Engineering Product Development
Singapore University of Technology and Design
1240 – 1255
Question & Answer
1255 – 1400
LUNCH
59
INNOVATION
TRACK
Changi General Hospital Centre for Innovation, Level 1
1400 – 1415
Together! Move it Move it!!: Stroke Gym Programme
Ms Charity Chu
Manager, Day Rehabilitation Centre
St Andrew's Community Hospital
1415 – 1430
AsthmaCare Buddy: Personalized app to keep asthma under control
Dr Tan Ngiap Chuan
Director of Research
SingHealth Polyclinics
1430 – 1445
Delivering Telehealth - Our Journey Continues
Ms Adeline Phang
Manager
1445 – 1500
Question & Answer
1500 – 1515
Showcase on Healthcare Management Unit initiative
1515 – 1530
Tea Break
1530 – 1545
Designing an Easy-to-use Pill Crusher (Collaboration with Peacehaven)
Mr Johnny Lee
Lecturer
ITE
1545 – 1600
Health Wellness Programme (HWP): Community-based Mental Health Care for
Chronic Disease Patients
Ms Lim Hui Khim
Senior Mental Health Counsellor
1600 – 1615
A Silent Handicap: Protect Your Hearing
Ms Joyce Lim
Senior Tinnitus Counsellor
1615 – 1630
Question & Answer
60
INNOVATION
TRACK
ABSTRACT
1130 hrs - 1150 hrs
How I Made it Happen: Developing An Idea and Making It Real
Ms Barbara Moscowitz
Medical Social Worker, Departments of Social Services and Geriatric Medicine
Massachusetts General Hospital (CIMIT)
61
INNOVATION
TRACK
ABSTRACT
1150 hrs - 1210 hrs
“Let’s get
!”
How Design Thinking created a brand new concept in banking
How did OCBC Bank go from the longest established bank in Singapore, well known for being financially strong and
traditional, to being “possibly the coolest bank Gen-Y has ever seen”? Hear how our efforts to dine, party, shop basically stalk – the Gen-Y led us to developing a banking concept that they can identify with. A bank they would
want to be identified with.
Ms Natalie Koh
Experience Designer
Experience Design & Group Customer Experience Division
Oversea Chinese Banking Corporation (OCBC Bank), Singapore
Ms Natalie Koh is 10% of a team of “banking misfits” – architect, retail designer, user experience designers and
graphic designers – known as the Experience Design team in OCBC Bank. Armed with no banking experience, but a
lot of innocent, silly questions, the team tackles customer issues the Bank faces. This resulted in simplifying a
200,000-page website into 600-page; developing a mobile banking app that’s highly lauded locally; reducing error
rates in commonly used forms; redesigning communication in product collaterals, letters, statements and ATM
screens, and of course FRANK.
Prior to joining this team, Natalie spent 6 years as a Service Experience Design consultant in a local consultancy,
counting Changi Airport, Wildlife Reserves Singapore and Sephora as clients.
In her non-designing time, Natalie loves to spend time with nature and her family.
62
INNOVATION
TRACK
ABSTRACT
1210 hrs - 1230 hrs
Intra-Body Tracking: Navigating Inside the Human Body
Numerous medical and surgical operations, in particular, minimally invasive procedures, require knowledge of the
position and orientation of the target device or instrument inside the body. Currently, tethered embedded vision
cameras and diagnostic imaging techniques (CT, X-Rays, MRI) are widely employed to gain instantaneous spatial
feedback of the target inside the body. However, these methods can be cumbersome to deploy and potentially
harmful to the patient under prolonged use. Here a non-invasive localization system harnessing passive magnetic
tracking technology is presented as a viable alternative to contemporary established protocols.
Asst Prof Foong Shaohui
Consultant
Orthopaedic Surgery
Foong Shaohui is an Assistant Professor in the EPD pillar and joined SUTD in Jan 2011. Prior to that, he did his
undergraduate and graduate studies in the Woodruff School of Mechanical Engineering at the Georgia Institute of
Technology in Atlanta, Georgia, USA. He has a keen interest in mechatronics, which is the synergistic integration of
the multiple disciplines of mechanics, electronics, control theory and computer science, and not surprisingly his
research is focused around designing and developing novel mechatronic and intelligent systems for a wide spectrum
of applications: from agricultural, industrial, robotics and medical.
63
INNOVATION
TRACK
ABSTRACT
1400 hrs - 1415 hrs
Together! Move it! Move it! : Stroke Gym Programme
Stroke rehabilitation at a Day Rehabilitation Centre (DRC) focuses on maximizing patients’ functional level in basic
activities of daily living (ADL). Patients who have regained independence in basic ADL would either be discharged to
a Day Care Centre or home. However these patients might still experience some degree of impairment that would
impact their ability to conduct daily activities with ease.
SACH DRC piloted the Stroke Gym Programme (SGP) for stroke patients who have attained plateau stage at the DRC
sessional programme. This is a transitional care programme, done in a group setting. It aims to help stroke patients
fully optimise their functional recovery and physical abilities, enhance their muscles strength and balance, and thus
enable them to be fully independent in the community. This programme helps to improve patients’ quality of life
and safety in the community.
Ms Charity Chu
Principal Physiotherapist & Manager
Rehabilitation Center
St Andrew’s Community Hospital, Singapore
Ms Charity Chu is a Principal Physiotherapist and the Manager of the Day Rehabilitation Center at St Andrew’s
Community Hospital. Prior to her arrival in Singapore 4 years ago, Charity practiced as a physiotherapist in Hong
Kong. Since 1996 she has worked in various settings including community hospital, psychiatrist nursing home, acute
hospital, private clinic and Home therapy services.
As the manager of the Day Rehabilitation Center in St Andrew’s Community in Singapore, she actively seeks
opportunities to develop new programmes to meet the needs of the elderly living in the community. Some of the
programmes initiated include community integrated activities, a dementia programme and gym rehabilitation for
post stroke patients etc.
Her passion is to facilitate active involvement of the aged in the community and that drives her to play an active role
in the development of community-related programmes.
64
INNOVATION
TRACK
ABSTRACT
1415 hrs - 1430 hrs
AsthmaCare Buddy: Personalized app to keep asthma under control
Asthma is the commonest chronic lung disease, which can cause breathlessness and even death during asthma
exacerbations. Good asthma self-management can reduce asthma attack, improve patient’s quality of life and
healthcare costs.
Tele-healthcare innovations are increasingly used to support patients in their self-management of chronic diseases,
including asthma. An IDA survey shows that Singaporeans are avid users of smartphones, and innovations involving
these devices will gain widespread acceptance due to easy accessibility and are often free.
SingHealth Polyclinics (SHP) has launched its first mobile application(app), “Asthmacare Buddy”, in April 2013. It
aims to provide a one-stop resource portal for asthma sufferers where they can access essential information on the
disease, triggers and treatment, and view instructional videos on the use of various puffers.
The app allows easily access of patient’s personal treatment (action) plan that is initiated by their doctors. It directs
the users to take appropriate self-care measures during the window period before it becomes an asthma attack. The
action plan is readily available in the mobile and is portable as compared to the existing action plan in hardcopies.
Users do not have to carry their hard-copied plan and monitoring charts whenever they are out, and do not have to
fear of misplacing or forgetting their home-monitoring records for their doctor consultation.
Having the monitoring data available in their phones, users can share the information with their healthcare
providers. This provides their doctors with additional information on how the patients are managing their condition,
and to recommend appropriate treatment.
Presenter’s Biosketch on the next page.
65
INNOVATION
TRACK
Dr Tan Ngiap Chuan
Director
Department of Research
SingHealth Polyclinics, Singapore
Dr Tan Ngiap Chuan graduated with MBBS from National University of Singapore (NUS) in 1989, completed the
MMed(FM) in 1996 and is a Fellow of the College of Family Physicians in Singapore (FCFPS) since 2003. Dr Tan was
the Director of SingHealth Polyclinics (SHP)-Pasir Ris till 2012, and is currently a senior consultant and the Director of
Research in SHP.
Dr Tan received the HMDP award from Ministry of Health to undertake an immersion programme in primary care
research at the University of London in Britain in 2002. He received a National Research Foundation Scholarship in
2008 and is a pioneer graduate of the Master programme in Clinical Investigation (MCI NUS) in 2010. He is a recipient of the Singapore Healthcare Humanity award (2006) and the SingHealth GCEO Excellence Award for Outstanding
Clinician in 2012.
Dr Tan conducts in-house qualitative research since 2006. He is a co-trainer in research workshops at the WONCA
Asia Pacific regional (APRC) conferences in Kyoto (2005), Jeju (2012) and a primary care research workshop in Fiji
(2013). His research presentations received awards at the WONCA World Congress in Singapore (2007) and WONCA
APRC in Cebu (2011).
Dr Tan was the sub-editor for the Singapore Medical Journal from 2008 to 2012 and is the current Honorary Editor
of the Singapore Family Physician since 2011. Together with two other family physicians, Dr Tan pioneered the innovative research training workshop, “Research Championship” in 2010, which has become the highlight of the Asia
Pacific Primary Care Research Conference (APPCRC).
INNOVATION
TRACK
ABSTRACT
1430 hrs - 1445 hrs
Health Wellness Programme (HWP) in Eastern Community Health
Centre, Singapore
The Health Wellness Programme is a new initiative targeted at people who suffer from chronic physical illnesses
with co-existing mental health problems treated by primary care physicians in the community. It is a new
community-based model of care with an allied health team working closely with primary care physicians in
delivering interventions for mild to moderate mental health conditions.
Research has shown that people who suffer from chronic physical illnesses often have co-existing mental health
problems. A community-based study of mental disorders in Singapore found that chronic physical illnesses were
significant correlated to mental disorders. It is reported that people with common chronic illnesses such as,
cardiovascular, diabetic, respiratory, have much higher rates of depression and anxiety than the general population
(Chong, S.A. et al; 2009).
With funding support from the government, we have set up the Health Wellness Programme, a 5-year funded
programme, involving collaboration with various stakeholders. Our key concern, is that the greatest challenge lies
not in the setting up of such a service, but the integration of care with other healthcare professionals and in
breaking the stigma of mental health conditions in the community.
Presenter’s Biosketch on the next page
67
INNOVATION
TRACK
Ms Lim Hui Khim
Senior Mental Health Counsellor
Health Wellness Programme / Community Health Centre
Eastern Health Alliance, Singapore
Ms Lim Hui Khim is the Senior Mental Health Counsellor with the Health Wellness Programme under the Eastern
Community Health Centre. She is formerly the Deputy Head of Counselling at the National Addictions Management
Service (NAMS) housed in the Institute of Mental Health. She has been working in the field of mental health and
addictions counselling for over 12 years, providing individual and group counselling to patients and their families
with mental health issues, substance and behavioural addictions. Hui Khim is also trained in managing cases of
family violence, providing mandatory counseling for both perpetrators and victims in families with substance abuse
and gambling problems.
Hui Khim is certified by the International Certification and Reciprocity Consortium (ICRC) as a substance abuse and
gambling counselling and clinical supervisor in addiction counselling. She holds a Masters degree in Couselling and
Psychotherapy with Edith Cowan University and a Bachelor degree in Science (Applied Psychology) with University of
Southern Queensland. Hui Khim is also an adjunct lecturer / tutor and individual supervisor for counseling unit
students under Singapore Institute of Management.
Being in this field for a decade, Hui Khim is keen to see more integration of services and more support for both
mental health and addiction issues in the community. And being a trained supervisor in this field, Hui Khim believes
in the importance of imparting knowledge and experience to the next generation.
INNOVATION
TRACK
ABSTRACT
1530 hrs - 1545 hrs
Designing an Easy-to-use Pill Crusher (Collaboration with Peacehaven)
The Pill Crusher machine is different from existing pill crushers – it employs rollers to crush pills. Pills are gripped
and crushed to powder by 2 specially designed rollers with knurling patterns.
The machine is designed to be simple and safe to use. Being battery operated, it is also portable. There is a built-in
charger jack to charge the rechargeable battery whenever required.
Mr Johnny Lee
Lecturer
Teaching Faculty
Institute of Technical Education, Singapore
Johnny Lee was an industrial product designer for 12 years prior to joining ITE as teaching staff. He holds a B. Sc. (Hon)
in Technology degree from SIM University and had been active with student project work.
69
INNOVATION
TRACK
ABSTRACT
1545 hrs - 1600 hrs
A Silent Handicap: Protect Your Hearing
Today, using a personal music player (PMP) is a life-style choice for many people. While we know that excessive
PMP use can damage our hearing, most people don’t know what is meant by “excessive” use.
Come and meet Belle and Maxx, our sound measurement mannequins that were built by the CGH departments of
BioMedical Engineering and Otolaryngology. They can measure the sound level of your PMP and let you know what
an appropriate listening level should be.
Hearing, one of our five senses, is often underappreciated – until we lose it. With Belle and Maxx’s help, you can
better protect your hearing and prevent the development of a silent handicap!
Ms Joyce Lim
Senior Tinnitus Counsellor
Otolaryngology
Ms Joyce Lim is currently working as a Senior Tinnitus Counsellor in Department of Otolaryngology in Changi
General Hospital. She has been involves in the professional audiology service for over 20 years. She has a Specialist
Diploma in Counselling Psychology. She had received her audiology and tinnitus trainings in both the United
Kingdom and United States of America. Her research on the ‘Impact of Tinnitus as measured by Tinnitus Handicap
Inventory among tinnitus sufferers in Singapore’ had been published in the Singapore Medical Journal, 2010.
70
INNOVATION
TRACK
ABSTRACT
1600 hrs - 1615 hrs
Delivering Telehealth - Our Journey Continues
Ms Adeline Phang
Manager
Singapore
Adeline has years of experience in system solution and implementation in both commercial and healthcare industry
spanning across organisations at Raffles Medical Group, KKH, IMH, CPF, Singapore Telecommunications, Market
Research organisation and including a stint with CGH in her earlier years. Her experience involved in transforming of
organisational wide IT systems, business process reengineering for strategic key projects. Prior to joining EHA,
Adeline was with IMH where she led overall clinical applications systems that leads to a more integrated and
seamless hospital system.
Adeline graduated with an honours degree in Computer Science and holds Master degree major in Technology
Management. Her research dissertation specialised in business transformation through value based knowledge
management. She has also developed a locality distribution of patient needs system for the Foundation NHS Trust
as her thesis project during her study in the UK.
71
Research Symposium
21 & 23 November 2013
Chairperson:
Dr Tan Thean Yen
Senior Consultant Microbiologist, Department of Laboratory Medicine
Head of Research, Clinical Trials & Research Unit
72
RESEARCH
TRACK
CGH Tutorial Room , Training Centre Level 1
0900 – 1000
Formulating A Good Research Question
Dr Serena Koh
Deputy Director , Hospital Services Division, Health Services Group
Ministry of Health
1000 – 1100
The Truth Is Out There: Literature Review/ Appraisal Tools
Dr Dawn Tan
Principal Physiotherapist, Department of Physiotherapy
1100 – 1130
TEA BREAK
1130 – 1300
Clinical Trials: Research Design and Methods
Dr Lawrence Lee Soon-U
Visiting Consultant, Clinical Trials & Research Unit , Changi General Hospital
Assistant Professor, Department of Medicine, National University of Singapore
Academic Consultant Physician, Department of Infectious Disease, Tan Tock Seng
Hospital
1300 – 1400
1400 – 1445
1445 – 1515
1515 – 1600
LUNCH
We're In The Money: Successful Grant Funding
Dr Angela Chow
Head & Consultant, Department of Clinical Epidemiology
Tan Tock Seng Hospital
Citation Made Easy, the EndNote way
Ms Norasyikin Hassan
Nurse Clinician, Nursing Administration
Dazed, Confused and Befuddled: Data analysis and statistics
Ms Sajlia Jalil
Senior Speech Therapist
73
RESEARCH
TRACK
CGH Tutorial Room , Training Centre Level 1
1600 – 1630
TEA BREAK
1630 – 1730
Fame And Fortune Awaits: How To Get Published
A/Prof Seet Chee Seong, Raymond
Consultant, Division of Neurology
National University Hospital Singapore
0900 - 1000
1000 - 1100
A Very Early Rehabilitation Trial (AVERT)for Stroke: Experiences from a Multidisciplinary Collaboration
Dr Dawn Tan
Principal Physiotherapist, Department of Physiotherapy
Health services research- translating research, improving care
Dr Chow Wai Leng
Assistant Director, Health Services Research
74
RESEARCH
TRACK
ABSTRACT
21 November 2013, Thursday
0900 hrs - 1000 hrs
Formulating a Good Research Question
Developing a good question which is researchable is one of the most challenging tasks a researcher
encounters when starting up a project. Unanswered problems encountered in clinical practice or when experiences
dictate alternative care and clinical management often provokes a clinician to initiate and develops a clinical
research question. This presentation describes PICO (population, intervention, control, and outcomes) criteria in
framing a research question. A research question should also be formulated keeping in mind the FINER (feasible,
interesting, novel, ethical, and relevant) criteria and that the research findings should fill gaps in existing knowledge.
Finally, we also assess the characteristics of a research question in the context of my experience initiating a research
project.
Adjunct A/Prof Serena Koh
Deputy Director
Standards and Quality Improvement Division/ Hospital Services Division,
Ministry of Health, Singapore
Adjunct A/Prof Serena Koh is the Deputy Director, Standards and Quality Improvement Division at the Ministry of
Health, Singapore (MOH). Her portfolio includes developing the National Quality Assurance (QA) framework, patient
safety strategies and National Standards of Healthcare across the continuum of care.
Concurrently she is Deputy Director (Hospital Services), overseeing the implementation of Human Organ Transplant
Act (HOTA), Medical Therapy, Education, Research Act (MTERA), Coroners' Act and Advanced Medical Directive
(AMD).
A/Prof Koh had received her PhD in Medicine, Dentistry and Health Sciences, from the School of Nursing, University
of Melbourne, Australia in year 2008. She holds concurrent appointment at the Alice Lee Centre for Nursing Studies,
NUS, teaching undergraduates & postgraduates on research, evidence-based practice, patient safety and quality as
well as supervision of the students for their research thesis.
She has worked in KKH as a midwife since 1995, and extended to research and teaching roles since 2001. Her research interests are in evidence based practice and patient safety. A/Prof Koh has vast experiences in supporting,
promoting and implementing evidence-based practice, and has coordinated various research activities, developed
and initiated numerous nursing quality improvement & risk management strategies to improve quality care, patient
safety and outcomes.
75
RESEARCH
TRACK
ABSTRACT
1000 hrs - 1100 hrs
The Truth Is Out There: Literature Review/ Appraisal Tools
There is a move towards evidence based practice where patient care is driven by scientific evidence, patient
preferences, clinical expertise and other resources. This lecture covers the formulation of clinical questions using the
PICO format, systematic literature searching and critical appraisal tools commonly used to assess the
methodological quality of clinical research.
Dr Dawn Tan
Principal Physiotherapist
Department of Physiotherapy ,
Singapore General Hospital , Singapore
Dawn completed her Masters in Neurological Physiotherapy and Doctor of Clinical Physiotherapy with the University of
Melbourne in 2006 and 2010 respectively.
She works with patients with neurological and vestibular disorders in the outpatient setting at the Singapore General
Hospital. Dawn’s areas of research interests include stroke, Parkinson’s disease and vestibular rehabilitation. She has
participated and presented in various local scientific conferences .
76
RESEARCH
TRACK
ABSTRACT
1000 hrs - 1100 hrs
Clinical Trial: Research Design and Methods
Clinical research, or research involving human subjects, is the only way to confirm results of in vitro and animal
studies.
There is a large variety of types of clinical research, ranging from case reports to observational studies to clinical
trials to meta-analyses.
This lecture will focus on the design of clinical trials and will cover the clinical trial phases from phase 1 to phase 4
designs.
Dr Lawrence Lee
Consultant
Department of Medicine
National University Health System, Singapore
Dr Lawrence Lee is Assistant Professor in the Department of Medicine at the National University of Singapore. He is
a full time faculty member in the Division of Infectious Diseases at National University Health System and Tan Tock
Seng Hospital. He is also a Visiting Consultant in the Clinical Trials Research Unit, Changi General Hospital.
Doctor Lee has been involved in clinical research for over 10 years. He has performed a large variety of phase 1 to 4
clinical trials, both in academia and in industry. He is an internationally recognized speaker, clinician, and researcher
and has published extensively in medical journals. Currently he is on the editorial board of “Singapore Medical
Journal”.
77
RESEARCH
TRACK
ABSTRACT
1400 hrs - 1445 hrs
We're in the Money: Successful Grant Funding
A successful grant application requires time and effort. Early planning and development of a good grant proposal is
fundamental. The essential steps in the grant application process include consideration of: qualification, design,
writing, submission, and review.
Dr Angela Chow
Head & Senior Consultant
Clinical Epidemiology
Institute of Infectious Disease & Epidemiology, Tan Tock Seng Hospital, Singapore
Dr Angela Chow is Head and Senior Consultant of the Department of Clinical Epidemiology at the Institute of
Infectious Disease & Epidemiology at Tan Tock Seng Hospital. She is also an Adjunct Associate Professor and Lead for
Public Health & Health Services Outcome Research at the Lee Kong Chian School of Medicine, and an Adjunct
Assistant Professor at the Saw Swee Hock School of Public Health. Dr Chow has been actively involved with the
epidemiological surveillance, prevention and control of hospital-associated infections and emerging infectious
diseases including SARS, chikungunya fever, avian and pandemic influenza, and the novel human coronavirus. She is
involved with various clinical and epidemiological research studies and has held several research grants including
the recently-awarded inaugural Ministry of Health’s Communicable Disease Public Health Research Grant.
78
RESEARCH
TRACK
ABSTRACT
1445 hrs - 1515 hrs
Citation Made Easy; The EndNote® Way
In-text citation for academic writing or manuscript is equally mandatory and tedious to avoid plagiarism. The writers
are expected to follow the preferred referencing style set by the faculty or editorial board which requires them to
switch from one referencing style to another. In the market, there are several citation software which facilitate
writers to organise in-text citations and reference list in an orderly fashion. This lecture provides an overview of
EndNote®, demonstrates importing and exporting citations from online journal database to EndNote® library and
using EndNote® Cite While You Write command while writing a paper in Microsoft Word.
Ms Norasyikin Hassan
Nurse Clinician
Nursing Department
Ms Norasyikin is a Nurse Clinician at Changi General Hospital, Nursing Department. She graduated with Master of
Nursing Science in 2011 with a research interest in qualitative methods. She is also an associate teaching member in
the Faculty of Health Sciences, School of Nursing at The University of Adelaide. In CGH, Norasyikin coordinates
nursing research activities and being the resource person for nursing research matters. She is also the program
coordinator for the in-house nursing research course where she teaches research methodologies in hermeneutic
phenomenology.
79
RESEARCH
TRACK
ABSTRACT
1515 hrs - 1600 hrs
Dazed, Confused, and Befuddled: Data Analysis and Statistics
Data analyses and statistical methods can be overwhelming for researchers. This sharing aims to present an
overview of the common quantitative statistical analyses used for research in the healthcare setting. Participants will
engage in hands on practice linking their research questions and variables to the corresponding statistical
analyses that are to be conducted.
Ms Sajlia Jalil
Senior Speech Therapist
Rehabilitative Services
Ms Sajlia Jalil is a Senior Speech Therapist at the Changi General Hospital. She works with adults with
communication and swallowing deficits following neurological injury. She is also a part-time lecturer at the National
University of Singapore, teaching students from the MSc (Speech and Language Pathology) course. Ms Sajlia is
currently a PhD candidate with the University of Sheffield, with a research focus on cognitive-communication
deficits in Malay-English bilinguals with Traumatic Brain Injury.
80
RESEARCH
TRACK
ABSTRACT
1630 hrs - 1730 hrs
Fame And Fortune Awaits: How To Get Published
A/Prof Seet Chee Seong, Raymond
Consultant, Division of Neurology
National University Hospital Singapore
81
RESEARCH
TRACK
ABSTRACT
0900 hrs - 1000 hrs
A Very Early Rehabilitation Trial (AVERT) for Stroke: Experiences from a
Multidisciplinary Collaboration
AVERT (A Very Early Rehabilitation Trial) is an international, multi-center, randomized controlled trial which aims to investigate
the clinical and cost benefits of very early rehabilitation in people with acute stroke. The trial was developed by the Natio nal
Stroke Research Institute (NSRI) in Melbourne, Australia. It aims to recruit a total of 2104 subjects internationally.
In August 2009, Singapore General Hospital (SGH) became the inaugural site for AVERT in ASIA and was also awarded the
SingHealth Foundation Research Grant in the same year. AVERT Singapore aims to recruit 120 patients. To date, we have
Dr Dawn Tan
Principal Physiotherapist
Department of Physiotherapy ,
Singapore General Hospital , Singapore
Dawn completed her Masters in Neurological Physiotherapy and Doctor of Clinical Physiotherapy with the University
of Melbourne in 2006 and 2010 respectively.
She works with patients with neurological and vestibular disorders in the outpatient setting at the Singapore General
Hospital. Dawn’s areas of research interests include stroke, Parkinson’s disease and vestibular rehabilitation. She
has participated and presented in various local scientific conferences.
82
RESEARCH
TRACK
ABSTRACT
1000 hrs - 100 hrs
Health services research- translating research, improving care
While health services research (HSR) has been established overseas, the awareness and use of HSR to improve
healthcare locally has only started to gain momentum in the recent years. The breakthrough discoveries of bench
research would usually come to mind when research is mentioned. However, it is in the translation of research into
actual clinical practice that would enable the provision and delivery of better care to patients. HSR enables the
translation of research into better patient care. By describing what HSR is and the types of health services research
studies, the speaker seeks to illustrate how health services research is a critical component of a health system that is
interested in providing quality patient care.
Dr Chow Wai Leng
Assistant Director
Health Services Research,
Eastern Health Alliance, Singapore
Dr Chow Wai Leng obtained her MBSS from NUS and subsequently obtained a post graduate diploma in Family
Medicine. She was practicing as a doctor in the various healthcare institutions in Singapore for seven years before
she embarked on a career in quality management and health services research. Previously, during her term as
Assistant Director of SingHealth’s Centre for Health Services Research, Wai Leng was also involved in the training
and planning of the clinical quality improvement programme at SingHealth. She has keen interest in conducting
research that would lend insights to healthcare providers to enable improvement of healthcare delivery. Wai Leng
now heads the Health Services Research department at the Eastern Health Alliance and continues to actively
promote the use of research to improve patients’ quality of and access to care.
83
Sports Medicine Symposium
22 November 2013
Chairperson:
Dr Kelvin Chew
Senior Consultant, Changi Sports Medicine Centre
84
SPORTS MEDICINE
TRACK
1300 – 1400
Lunch and Welcome
1400 – 1420
Introduction to Exercise is Medicine
Dr Benedict Tan Chi Loong
Changi Sports Medicine Centre, Changi General Hospital
1420 – 1450
National Physical Activity Guidelines
Dr Robert Sloan
Centre Head/Chief Exercise Physiologist, Physical Activity Centre of Excellence
Health Promotion Board
1450 – 1520
Exercise In Obesity: An Update
Dr Goh Kian Peng
Head, Medical Unit 2, Consultant
Khoo Teck Puat Hospital
1520 – 1540
TEABREAK
1540 – 1605
Dr Cindy Lin
Staff Attending Physician, Department of Sports Medicine
1605 – 1620
Exercise Demonstration
Ms Shamsynar Ani
Senior Sports Physiotherapist
1620 – 1645
Teaching Exercise To Health Care Providers And Fitness Professionals – The EIMS
Experiences
Dr Ng Chung Sien
Staff Attending Physician
Changi Sports Medicine Centre, Changi General Hospital
1645 – 1700
Questions & Answers
Panel of Speakers
85
SPORTS MEDICINE
TRACK
ABSTRACT
1400 hrs - 1420 hrs
Exercise is Medicine Global Initiative – An Overview
Exercise is Medicine (EIM) is a global initiative of the American College of Medicine. Since 2007, the EIM movement
has spread to 40 odd countries, including Singapore. The programme aims to get doctors and other healthcare
workers to be more confident in prescribing exercise and supervising exercise, especially for those with chronic
diseases like diabetes and cardiovascular disease. EIM Singapore was launched in 2011, with professional education,
research, and public awareness as its key thrusts. The EIM Southeast Asia Regional Centre is headquartered in
Singapore. This presentation identifies the barriers to exercise prescription in everyday practice, together with the
solutions and interventions that are being implemented.
Dr Ben Tan
Chairman
Exercise is Medicine
Dr Ben Tan, a Sports Physician, is the Chairman of Exercise is Medicine, Singapore (EIMS), as well as the Director of
Exercise is Medicine Southeast Asia (EIM SEA). Dr Tan completed his Sports Medicine training at the Australian
Institute of Sports in 1997, and is now Chief and Senior Consultant at the Department of Sports Medicine, Changi
General Hospital. The Department runs two comprehensive Sports Medicine centres: the Changi Sports Medicine
Centre and Singapore Sports Medicine Centre. Dr Tan is on the Advisory Panel of the Singapore Sports Institute and
the Singapore Armed Forces. As President of the Singapore Sailing Federation, Dr Tan is not only an Asian Games
gold medallist in sailing, he also actively participates in kite boarding, marathon running, SCUBA diving, and downhill
skiing.
86
SPORTS MEDICINE
TRACK
ABSTRACT
1420 hrs - 1450 hrs
National Physical Activity Guidelines
Abstract not available at time of print
Dr Sloan
Centre Head/Chief Exercise Physiologist
Physical Activity Centre of Excellence
Health Promotion Board, Singapore
Dr Sloan has twenty years’ experience in health promotion in both the private and public sectors with eight years in
Japan and four years in Singapore focusing on physical activity, obesity prevention, and information communication
technology in public health.
His research interests include physical activity and health related quality of life and the use of technology to
promote healthy behaviours. His current position is with the Singapore Health Promotion Board serving as Centre
Head/Chief Exercise Physiologist, Physical Activity Centre of Excellence (PACE).
Robert trained at the Ochsner Heart and Vascular Institute in New Orleans, LA and the Cooper Institute for Aerobics
Research in Dallas, TX and has worked for the US Navy Public Health Centre in the USA and Japan. Throughout his
studies he has obtained a PhD in Public Health, MA Exercise Science & Health Promotion and a BA in Psychology as
well as being a Licensed Clinical Exercise Physiologist (LSBME & ACSM), and a Certified Community Health Education
Specialist (NCHEC).
87
SPORTS MEDICINE
TRACK
ABSTRACT
1450 hrs - 1520 hrs
Exercise in type 2 diabetes: A new look at an old problem
The risk of developing type 2 diabetes (T2DM) is affected by our genetic make-up and environment. While there is
evidence supporting a strong genetic component, the currently identified loci confer only a modest effect size in the
variation of disease susceptibility. Hence, the focus has shifted to environmental factors and the gene-environment
interaction. The strongest evidence linking lifestyle factors to T2DM risk relates to energy expenditure and physical
activity. Given that a sedentary lifestyle increases the risk for T2DM, this implies that exercise may reduce the risk of
its development and additionally be used to treat it. The detrimental effect of low energy expenditure through
reduced physical activity may be explained by hypothesizing that we have evolved as an exercise-dependent
species. Epidemiological studies have also shown that epigenetic mechanisms may be involved. If so, this implies
that the prenatal and early childhood environment are important life stages at which the risk of T2DM development
may be modified. At the molecular level, exercise stimulates glucose uptake acutely via a mechanism different than
insulin-stimulated glucose uptake. Energy sensing molecules such as AMPK and SIRT1 are involved. The
understanding of the signaling pathways may help in the identification of exercise-mimetics which may represent a
new class of anti-diabetic agents.
Dr Goh Kian Peng
Consultant and Head
Division of Endocrinology, Medical Unit 2, Department of Medicine
Khoo Teck Puat Hospital, Alexandra Health, Singapore
Dr Goh Kian Peng has served in a number of key positions as Consultant at the Department of Medicine, specialising
in endocrinology and diabetes mellitus. He is also the NHG-AHPL Internal Medicine Residency Associate Programme
Director. Following his post-graduate training in both Endocrinology and Family Medicine, he was awarded the
Human Manpower Development Programme Fellowship in 2007, during which he was attached to the Aberdeen
Royal Infirmary and also obtained a MSc in Molecular Exercise Physiology at the University of Aberdeen in UK. While
holding teaching and administrative posts, he is also the Principal Investigator for several NMRC research grants. His
main research interests are the roles and molecular adaptation of exercise in the treatment and prevention of chronic
diseases.
88
SPORTS MEDICINE
TRACK
ABSTRACT
1540 hrs - 1605 hrs
Physical activity is known to be an important component of the prevention and management of many common
chronic health conditions from obesity to diabetes and heart disease. This lecture will cover interesting and
insightful
findings
from
what
the
recent
medical
research
in
the
21 st century
has
discovered about the critical role of exercise in health promotion across the lifespan.
Dr Cindy Lin
Sports Medicine & Rehabilitation Medicine
Dr. Cindy Lin is a Staff Attending Physician in Sports Medicine & Rehabilitation Medicine at Changi
General Hospital. She received her medical degree (MD) from Harvard Medical School. She is American Board
certified in Sports Medicine and Physical Medicine & Rehabilitation. She is active in clinical care, research, and
teaching in sports medicine and rehabilitation medicine. She is Director of Community Outreach for Exercise is Medicine Singapore.
89
SPORTS MEDICINE
TRACK
ABSTRACT
1605 hrs - 1620 hrs
Exercise Demonstration
Ms Shamsynar Ani
Senior Sports Physiotherapist
90
SPORTS MEDICINE
TRACK
ABSTRACT
1620 hrs - 1645 hrs
Teaching Exercise To Health Care Providers And Fitness Professionals –
The EIMS Experiences
Dr Ng Chung Sien
91
Best Oral Paper Award Clinical Medicine
21 November 2013
1030 - 1300
Centre for Innovation, Level 1
92
(CLINICAL MEDICINE)
21 November 2013, THURSDAY @ 1100hrs - 1215hrs
Changi General Hospital, Lecture Room @ Training Centre, Level 1
Chairperson:
(CGH)
Judges:
Dr Chow Wai Leng
Ms Rosy Tay
Dr Melissa Ngai
(EHA)
(NP)
(NUH)
ORAL-CM (1100)
RASAGILINE VERSUS SELEGILINE AS AN INITIAL THERAPY FOR PARKINSON’S DISEASE IN OLDER ADULTS
Ms Gan Peiying, Geriatric Medicine, Ward 45, Changi General Hospital
ORAL-CM (1115)
BETA-LACTAM/BETA-LACTAMASE INHIBITORS VS CARBAPENEMS FOR THE
TREATMENT OF URINARY TRACT INFECTIONS (UTIS) CAUSED BY EXTENDEDSPECTRUM BETA-LACTAMASE (ESBL)-PRODUCING BACTERIA: A RECTROSPECTIVE
COHORT STUDY
Mr Lim Xi Wei, Pharmacy, Changi General Hospital
ORAL-CM (1130)
ORTHOSTATIC HYPOTENSION – PREVALENCE AND ASSOCIATED RISK FACTORS
AMONGST THE AMBULATORY ELDERLY IN AN ASIAN POPULATION
Dr Gilbert Tan Choon Seng, Geylang Polyclinic, SingHealth Polyclinics
ORAL-CM (1145)
EVALUATION OF VASOPRESSIN UTILISATION IN THE TREATMENT OF SEPTIC
SHOCK
Mr Widjaya Michael, Pharmacy, Changi General Hospital
IMPROVING MOBILITY IN MICU AT CGH: A MULTIDISCIPLINARY APPROACH
ORAL-CM (1200)
Ms Loke Shi Jia, Rehabilitative Services, Changi General Hospital
93
(CLINICAL MEDICINE)
ABSTRACTS
1100 hrs - 1115 hrs
RASAGILINE VERSUS SELEGILINE AS AN INITIAL THERAPY FOR PARKINSON’S
DISEASE IN OLDER ADULTS
Gan P*, Patel, S., Li, J., Kim, J.Y. & Ngo, S.
Department of Geriatric Medicine, Ward 45, Changi General Hospital, Singapore
Aims
Parkinson’s disease (PD) is associated with high morbidity and mortality among older adults. Although levodopa has
been advocated as the gold standard in anti-parkinsonism therapy, the unfavourable side effect/adverse reaction
profile has led clinicians to consider rasagiline and selegiline in the initial treatment of PD. This review hence aims to
compare the efficacy of both drugs in the initial treatment of PD in terms of their neuro-modifying effects, tolerability
and cost effectiveness.
Methods
An exhaustive literature search covered five databases: PubMed, CINAHL Plus with Full Text, EMBASE and the Science
Databases. A total of nine studies, consisting of one systemic review, four randomised control trials and four cohort
studies were selected for review. All studies were then appraised independently by at least 2 reviewers.
Results
Both rasagiline and selegiline are of comparable efficacy in the initial management of PD, with neuro-modifying results
most evident in Caucasians who are about 60 years of age. Both agents appear to be well tolerated at their daily
recommended dosage although selegiline is associated with a higher incidence of gastro-intestinal disturbances
Conclusions
Rasagiline (at 1mg dosing) is recommended over selegiline. However, it is still reasonable to consider selegiline as an
alternative therapy with adequate monitoring and management of side effects. There is a paucity of information addressing the cost-effectiveness of either drug in the management of PD.
94
(CLINICAL MEDICINE)
ABSTRACTS
1115 hrs - 1130 HRS
BETA-LACTAM/BETA-LACTAMASE INHIBITORS VS CARBAPENEMS FOR THE
TREATMENT OF URINARY TRACT INFECTIONS (UTIS) CAUSED BY
EXTENDED-SPECTRUM BETA-LACTAMASE (ESBL)-PRODUCING BACTERIA: A
RECTROSPECTIVE COHORT STUDY
Lim Xi Wei*, J Seah, WX Tong
Department of Pharmacy, Changi General Hospital, Singapore
Aims
To compare the treatment outcomes of patients with UTIs caused by ESBL-producing Enterobacteriaceae who were
treated with either a carbapenem or a beta lactam/beta-lactamase inhibitors (BLBLIs).
Methods
A retrospective cohort study included patients diagnosed with the first episode of UTI caused by an ESBL-producing
Enterobacteriaceae showing susceptibility to both carbapenems and BLBLIs. Outcomes studied were clinical response,
microbiological clearance, length of hospitalisation, in-hospital mortality and reinfection or recurrence rates.
Results
A total of 511 patients with positive urine cultures were identified. However, the majority were excluded as patients
were asymptomatic, had concomitant infections or because cultures were polymicrobial. Fifty four patients were included in the study; fifteen (27.8%) received carbapenems, while 39 (72.2%) received BLBLIs. Most were female, with a
median age of 76.5 years old. The majority had pyelonephritis, and grew ESBL-producing Escherichia coli. The baseline
characteristics did not differ significantly between the two groups. The median duration of antibiotics use was 7 days
for carbapenem patients vs. 9 days for the BLBLI group. All patients showed clinical response to treatment and survived. Most patients did not have follow-up urine cultures to document clearance. For those who did, microbiological
clearance within one week of definitive treatment [carbapenem: 4 (80.0%) vs. BLBLI: 8 (66.7%), p=1.000] and overall
microbiological cure without reinfection or recurrence [6 (100.0%) vs. 12 (100.0%), p=1.000] did not differ between
groups. There was also no significant difference in length of hospitalization [carbapenem: 13 days (inter-quartile range
8-18 days) vs. 9 (6-14), p=0.070].
Conclusions
This study suggests that treatment of UTIs caused by ESBL-producing organisms with BLBLIs, as compared to carbapenems, did not result in worsening of outcomes.
95
(CLINICAL MEDICINE)
ABSTRACTS
1130 hrs - 1145 hrs
ORTHOSTATIC HYPOTENSION – PREVALENCE AND ASSOCIATED RISK FACTORS
AMONGST THE AMBULATORY ELDERLY IN AN ASIAN POPULATION
CSG Tan2, 4, HL Tan1, RG Wong1, RA Cuttilan1, CS Joshi1, QO Zhu1, GKJ Sng3, NC Tan2,4
1
Yong Loo Lin School of Medicine, National University of Singapore
Singhealth Polyclinics
3
Saw Swee Hock School of Public Health, National University of Singapore
4
2
Aims
The prevalence of orthostatic hypotension (OH) as defined by an objective decline in blood pressure (BP) on changes in
position is not well-established amongst the elderly population in Singapore. This study aims to determine the
prevalence of OH in patients aged 65 years and above attending a primary care clinic (polyclinic) for chronic disease
management, and to examine factors associated with the presence of OH.
Methods
All patients aged ≥65 years attending Geylang Polyclinic for chronic disease management were identified and
approached over a 4-day duration. Trained investigators interviewed the patients using a questionnaire documenting
the presence of symptoms and postulated risk factors such as medical history and medications. This was followed by a
single supine and standing BP measurement. OH was defined as a decrease in systolic-BP by ≥20mmHg or that in
diastolic-BP by ≥10mmHg.
Results
Of 511 eligible patients over a 4-day survey, we screened 364 patients (71% response rate). The prevalence of OH was
11.0% (95%CI: 8.2-14.8). On univariate analysis, age ≥70 years (PRR: 2.70, 95%CI: 1.10-6.67), occupational inactivity
(PRR: 4.17, 95%CI: 1.02-16.67), fatigue during standing from a supine position during blood pressure measurement
(PRR: 2.58, 95%CI: 1.06-6.33) and reported dizziness in the past one year (PRR: 2.37, 95%CI: 1.33-4.22) were found to
be significantly associated with the presence of OH. Multivariate analysis revealed reported dizziness in the past one
year (PRR: 2.61, 95%CI: 1.30-5.26) as an independent association.
Conclusions
Our study showed that one in ten elderly patients managed at a primary healthcare clinic in Singapore is affected by
OH. The presence of OH is associated with a reported history of dizziness, and possibly demographic factors such as
advanced age and occupational inactivity. Further prospective studies to establish a profile of individuals at high risk of
OH should be carried out to better target screening and intervention measures.
96
(CLINICAL MEDICINE)
ABSTRACTS
1145 hrs - 1200 hrs
EVALUATION OF VASOPRESSIN UTILISATION IN THE TREATMENT OF SEPTIC
SHOCK
Widjaya M*, YJI Wee, YLG Chan
Aims
Septic shock remains a leading cause of death in intensive care units. While noradrenaline may be considered as the
vasopressor of choice for the treatment of septic shock, the role of non-catecholamine vasopressors such as
vasopressin has not been fully delineated.The objectives of this study were to evaluate: (1) prescribing patterns of vasopressin, and (2) the impact of vasopressin on patient outcomes amongst critically ill patients with septic shock.
Methods
We conducted a 24-month retrospective cohort study of adult intensive care patients who had received vasopressin
for the treatment of septic shock. Relevant patient-specific data (including demographics, vasopressin utilisation, use
of concomitant vasopressors, and outcome measures) were extracted from manual and electronic medical records.
Results
Sixty eligible patients (mean age 66.3+/-13.5 years) were identified and reviewed. Usage was predominantly
adjunctive, and added to noradrenaline or dopamine in 95% and 40% of cases, respectively. At initiation, the mean
vasopressor dose, represented as noradrenaline-equivalent dose (NED), was 45.0+/-45.4 mcg/min. Patients requiring
an initial NED <20 mcg/min had a lower mortality rate (50%) and achieved a higher rate of haemodynamic stability
(defined as mean arterial pressure >65 mm Hg for >8 hours without vasopressors) (63.3%) compared to patients
requiring initial NED >20 mcg/min (86.8% and 18.3%, respectively). Forty-four patients (73.3%) eventually died. Age,
total vasopressin dose administered, and severity of illness (represented by SOFA scores) were found to positively
correlate with mortality, while late initiation of vasopressin was associated with significantly shorter lengths of
hospitalization.
Conclusions
Vasopressin was predominantly used as second- or third-line agent for the treatment of septic shock. Patients with
lower NED at initiation of vasopressin had a lower mortality rate and more frequently achieved haemodynamic stability. Mortality amongst vasopressin recipients was most closely associated with patients’ age, total amount of vasopressin administered, and severity of illness.
97
(CLINICAL MEDICINE)
ABSTRACTS
1200 hrs - 1215 hrs
IMPROVING MOBILITY IN MICU AT CGH: A MULTIDISCIPLINARY APPROACH
Loke SJ1, Wong TML1, TanPC2, Liu YJ2,Xu HY2,Ho WW2, Myra A2, Qamaruddin IH2, Lacson CV2,Xiao Q2,
Wallace JM2, Ariete M2, Poulose V3, Salem AJB4, Agdigos BLG4, Flora JKG4
1
Department of Rehabilitative Services,Changi General Hospital, Singapore
Department of Nursing, MICU, Changi General Hospital, Singapore
3
Department of Respiratory Medicine, Changi General Hospital, Singapore
4
Department of Respiratory Therapy Unit , Changi General Hospital, Singapore
2
Aims
Early mobilization (EM) of ICU patients has been found to reduce ICU and hospital length of stays. Our MICU first started the practice of EM in mid 2012 using a multidisciplinary team comprised of physiotherapists (PTs), nurses,
respiratory therapists and physicians. The aim of this study is to look at our EM rates over a 16 week period including
adverse events
Methods
A retrospective review of medical patients who were admitted to MICU between June 18, 2013 and September 30,
2013. Patients suited for EM were identified by a tool developed by Needham et al (2010). The hierarchy level of
mobilization was decided by the PTs. For patients who were mechanically ventilated, the PTs were assisted by the
MICU nurses and respiratory therapists. The contraindications for EM were 1) non co-operative patient 2) high
inotrope dose 3) high ventilator requirements 4) patients receiving dialysis or having intra-ventricular drains (EVD) 5)
manpower shortage
Results
Of the total census of 595 patients during this period, 115 (19.3%) were mobilized. There were 2 adverse events (one
dislodgement of PICC line and one dislodgement of a peripheral IV line) which did not impact patient’s health
Conclusions
EM was found to be feasible and safe in our MICU. In the future, we hope to implement a structured EM protocol and
look at clinical outcomes of EM
98
Best Oral Paper Award Innovation
21 November 2013
0900 - 1300
99
(INNOVATION)
21 November 2013, THURSDAY 0900hrs - 1230hrs
Chairperson:
TBA
Judges:
Mr Wong Kok Cheong
Dr Diana Tan
Dr Lim Hwee Boon
Ms Teo Sok Yeong
ORAL-IN (0900)
(CGH)
(CGH)
(POLYCLINIC)
(SACH)
PILOT IMPLEMENTATION OF A FULL-TIME “INTERIM CAREGIVER” SERVICE TO FACILITATE INPATIENT DISCHARGE
Ms Janet Toh Lay Siang, Nursing, Changi General Hospital
ORAL-IN (0910)
ENHANCING PATIENTS’ EXPERIENCE: BONE FOAM APPLICATION IN MANAGING
LOWER LIMB SWELLING
Ms Joyce Chen Qiu Yan, Nurse Manager, Changi General Hospital
ORAL-IN (0920)
IMPLEMENTATION OF TRACHEOSTOMY KIT AND THE ACRONYM OF “ABCD SUCTIONING”
Ms Song Xiaoying, SICU, Changi General Hospital
ORAL-IN (0930)
USE OF MODIFIED BACKSLAB IN PROMOTING WOUND HEALING FOR PATIENT
WITH HEEL’S WOUND/ PRESSURE ULCER
Ms Wang Chunmei, Wound Team, Case Management, Changi General Hospital
ORAL-IN (0940)
OPTIMIZING PHYSICAL ACTIVITY LEVEL OF COMMUNITY DWELLING ADULTS POST
DISCHARGE FROM HOSPITAL
Ms Joan Chia, Rehabiliative Services, Changi General Hospital
100
(INNOVATION)
ORAL-IN (0950)
WORKING WITH THE FOREIGN SPEAKING CAREGIVER ; HOW A MULTIDISCIPLINARY APPROACH HELP IN MAKING SENSE OF THE TEACHBACK METHOD AND
POST DISCHARGE TELEPHONIC REVIEW - THE ACTION TEAM'S EXPERIENCE AND
PERSPECTIVE
Ms Chan Man Ee, Senior Care Coordinator, Changi General Hospital
ORAL-IN (1000)
ENHANCING PATIENT’S VITAL SIGN MONITORINGS WHILE UNDERGOING SURGERY UNDER LOCAL ANAESTHESIA
Ms Noridah Rahman, Operating Theatre, Changi General Hospital
ORAL-IN (1010)
PHARMACIST OUTREACH PROGRAMME (POP): TELE-PHARMACY INNOVATION
Ms Shirlyn Su, Medical Social Services/ Action Team, Changi General Hospital
101
BEST ORAL PAPAER AWARD
(INNOVATION)
Abstract
0900 hrs - 0910 hrs
PILOT IMPLEMENTATION OF A FULL-TIME “INTERIM CAREGIVER” SERVICE TO
FACILITATE INPATIENT DISCHARGE
Janet Toh
Department of Nursing, Changi General Hospital, Singapore
Aims
To facilitate patient discharge from an acute care hospital in Singapore.
Development and Implementation of Idea
The Thye Hwa Kuan interim caregivers provided home care daily at a subsidised rate for only two weeks. They worked
two shifts either from 0800 to 2000 hours while family members continued working or from 2200 to 0800 hours to relieve the family members from caring for the patients during the night.
At CGH two key factors resulting in delayed patient discharge were:
a.
Waiting for long-term caregiving arrangements
b.
Waiting for nursing home placements.
Against this backdrop, CGH, the Ministry of Health and Thye Hua Kwan implemented a pilot full-time interim home
help service for patients with lower activities of daily living needs and awaiting for long-term caregiving arrangements
on 1st March 2013.
Impact of Solution
Monthly more than 10 patients opted into the pilot scheme versus the initial projected six patients monthly. As the
scheme was so successful, it was extended to patients waiting for day-care placement. Since March 2013, 86 patients
were recruited into the scheme. 79 patients had completed the pilot service with 7 patients still on this service as of 30
August 2013. The pilot had facilitated early discharge of patients without which patients would continue to be
hospitalised incurring additional hospitalisation costs, possible nosocomial infections, falls, hospital-acquired pressure
ulcers and adding to the tight bed crunch. Patients and relatives had verbalised satisfaction with the interim home help
service.
Conclusions
From the positive results, MOH is exploring extending the subsidy beyond the current two weeks, other service
providers for the interim care givers and to other acute care hospitals.
102
(INNOVATION)
Abstract
0910 hrs - 0920 hrs
ENHANCING PATIENTS’ EXPERIENCE: BONE FOAM APPLICATION IN MANAGING
LOWER LIMB SWELLING
QYJ Chen, JG Demaisip, S Shikandar Mydin, MA Abdullah
Department of Ward 36, Changi General Hospital, Singapore
Aims
To reduce total time taken for setting up a lower limb elevator by 80% and to achieve 100% patient’s
compliance rate to lower limb elevation.
In the management of lower limb swelling, a lower limb elevator called Brauns Frame is commonly used to reduce
swelling and pressure on the limb surface area. It is a tedious process to set up by using safety pins to achieve the
tautness of the fabric when it is wrapped. Its bulky, heavy frame restricts user’s movement when on bed, thus
resulted in poor patients’ compliance which can increased patients’ risk in serious complications such as
compartmental syndrome. Pre-implementation survey was carried out in a 40-bedded orthopaedic ward and the
results showed 82% of the patients were non-compliant to use Brauns Frame. The average time to set up was 31
minutes
Adopting Delphi technique, ideas from experts were gathered. We chanced upon a product called Bone Foam, which
was commonly used in overseas. It is lightweight, fluid proof, latex free and ensures contour support from patient’s
thigh to the foot. Bone Foam was brought in and its usage was trialled out in one orthopaedic ward for a period of 6
weeks. 17 patients participated in the trial.
Impact of Solution
Results of the post-implementation survey indicated that there was 100% patient compliance rate to the usage of
Bone Foam. It was ready to be used in just 4 minutes with a 87% time reduction in setting up a lower limb elevator. All
nurses in the ward liked and preferred to use Bone Foam. The usage of consumables was significantly reduced by
saving $1579.20 in a year.
Conclusions
The end users benefited from applying Bone Foam in managing lower limb swelling by enhancing patients’ safety. Patients were more compliant due to its comfort and support which reduced the risk of serious complications. It is
recommended that Bone Foam application be used in other disciplines in Changi General Hospital to experience similar
benefits
103
(INNOVATION)
Abstract
0920 hrs - 0930 hrs
IMPLEMENTATION OF TRACHEOSTOMY KIT AND THE ACRONYM OF “ABCD
SUCTIONING”
XY Song, HP Deng, Shahira Q, KL Chea, SK Neo
Department of SICU, Changi General Hospital, Singapore
Aims
Good quality of tracheostomy care provided for patients is important to reduce unplanned admissions to intensive
care unit. In order to provide optimized care and efficient process, our team aim to streamline the workflow process
and enhance accessibility with standardize practice.
A survey was conducted in selected general wards to gather information regarding tracheostomy care. 86% of the
responders reported that they have no confidence in caring for tracheostomy patients, 94% of them agreed that a
refresher course would be beneficial and 65% of them reported that accessories were not well organized. Therefore,
our team enhanced the workflow and workspace organization by creating a Tracheostomy Kit (T-Kit). Our team also
aimed to increase accessibility to information by formulating the acronym (ABCD of SUCTIONING). This was piloted in
four wards over a week.
A post implementation survey was conducted and the T-Kit was further modified to be more user friendly. The size of
the T-Kit was reduced to meet to the space constraint of bedside locker and more compartments were added for
storage to improve infection control.
Impact of Solution
Post implementation surveys were distributed and 94% of participant responded. 78% of responders reported that
there were less hassle and time taken in gathering accessories. 82% of responders felt that T-kit provides a proper and
organized storage area. ABCD of suctioning chart served as easy access of information to 88% of the responders.86% of
responders felt more confident in providing quality tracheostomy care for patients.80% of responders will be
compliant to usage of T-kit for tracheostomy patients once implemented.
Conclusions
The team met its objectives as the nurses’ confidence level increased and the time taken in gathering tracheostomy
accessories decreased. With the support from the management, the T-kit was implemented hospital wide on 6
September 2013 with the acronym ‘ABCD of SUCTIONING’
104
(INNOVATION)
Abstract
0930 hrs - 0940 hrs
USE OF MODIFIED BACKSLAB IN PROMOTING WOUND HEALING FOR PATIENT
WITH HEEL’S WOUND/ PRESSURE ULCER
C Wang*, L Ong, BG Low, Q Li and C Loo
Aims
To achieve effective offloading and promote wound healing for patients with heel ulcers.
Due to its anatomy, the heel is the second common sites for pressure ulcer formation. Pressure relief is the most
important nursing aspect of heel ulcer prevention and treatment. Pillows are often used to offload the heel because it
is cheap and readily available. In 2010, the National Pressure Ulcer Advisory Panel (NPUAP) highlighted the issue of
using pillows. It can be effective only for a short period as pillows flatten when pressure is exerted and the leg can fall
off quite easily from the pillow thus eliminating any offloading benefits. Currently in Changi General Hospital (CGH), we
use the Prevalon® Pressure-Relieving Heel Protector purchased from United State for patients with heel ulcers.
Unfortunately, it is costly and difficult to wash when stained during the hospitalisation. Moreover, our warm climate
makes is uncomfortable for patients to use. During my training in Italy, I saw how the wound care experts applied an
offloading backslab on patients with heel ulcer using Dynacast Prelude. I decided to utilize the same principle in CGH.
Using materials that were available locally, I created a modified offloading backslab for 9 patients with heel ulcers.
Impact of Solution
The offloading backslab was easy to apply. It is less costly and easy to replace when soiled. In addition, 7 out of 9 cases
that were using my modified offloading backslab showed improvement in the wound condition. Unfortunately, 2
patients discontinued the usage of backslab after discharge.
Conclusions
The modified offloading backslab is a cheap effective alternative in pressure relieving and promoting heel ulcer
healing. Training and application of modified offloading backslab is recommended for nurses.
105
(INNOVATION)
Abstract
0940 hrs - 0950 hrs
OPTIMIZING PHYSICAL ACTIVITY LEVEL OF COMMUNITY DWELLING ADULTS
POST DISCHARGE FROM HOSPITAL
JL Chia*, J Jumala, XY Chua, C Misola, P Leow, E Chai, NAM Noor
Department of Rehabilitative Services, Changi General Hospital, Singapore
Aims
To identify older adults with functional decline post hospitalization for acute medical illness and, to implement
proactive strategies to optimize their functional recovery and physical activity level.
Older patients discharged from medical wards rarely receive formal advice on how to resume their active lifestyle post
hospitalisation. Consequently, they refrain from participating in physical activities and become more sedentary.
Physical activity (PA) levels of older patients were measured using Physical Activity Scale for Elderly (PASE)
questionnaire and the ACTICAL monitoring device at 2nd week, 1st, 3rd and 6th month after discharge. Actical is a
3-dimensional accelerometer measuring activity count, total number of steps and calories burnt daily. Measurements
taken at 2nd week were used as baseline.
Strategies implemented include providing structured advice and exercise kits to patients on home-based physical
activity programme and organising healthy lifestyle workshops to encourage their participation in community-based
PA programs.
Impact of Solution
78% and 67% of patients who received these interventions demonstrated an improvement in their PA levels in their
Actical count and PASE scores at the 1st and 3rd month compared to baseline respectively. Comparatively, only 35%
and 25% of patients without these interventions, had an increase in their Actical count and PASE scores respectively.
Conclusions
These preliminary findings suggest that community-based interventions can help to increase physical activity level of
patients post-hospitalization thus optimizing their functional recovery.
106
(INNOVATION)
Abstract
0950 hrs - 1000 hrs
WORKING WITH THE FOREIGN SPEAKING CAREGIVER ; HOW A
MULTIDISCIPLINARY APPROACH HELP IN MAKING SENSE OF THE TEACHBACK
METHOD AND POST DISCHARGE TELEPHONIC REVIEW - THE ACTION TEAM'S
EXPERIENCE AND PERSPECTIVE
ME Chan*, HH Chong, H Lin, E Phua, D Zhang, J Phang
Department of MSS/Action Team, Dietetics, Pharmacy, Nursing, GRM, Changi General Hospital
Aims
To find new ways to improve how the Action Team Care Coordinator can apply the Teach Back Method and the telephonic reviews in the presence of a foreign speaking caregiver/patient while supporting healthy bowel movements at
home for the at risk elderly,.
A multidisciplinary team with different expertise was chosen for a more holistic approach. Using tools as the fishbone
diagram and pareto, the team concluded the lack of knowledge should be addressed and set out to develop a pictorial
factsheet that would ease the information exchange in teach back method and telephonic review of care plan outcome.
The initial factsheet that was developed led to the urgent development of a Meal Planner, a second pictorial to
complement the first tool in facilitating and clarifying information exchange.
A tablet PC was issued to further enhance the exchange of information on the patient's individual careplan.
Impact of Solution
The solution make it possible to
1)
2)
3)
4)
5)
6)
Use Teach Back method in the presence of a foreign speaking caregiver
Ease the collecting of information of how patient's is doing during telephonic review
To individualize careplan even during telephonic review
Increase care coordinator's work satisfaction eg one of them requesting the factsheet to use for her work even
after she has left the workgroup.
Increase caregiver's participation through better empowerment eg more spontaneous information ex
change.
Better health outcome for the patients eg improved appetite, sleep. reduced nocturnia.
Conclusions
Teach Back Method is evidenced based in promoting better care outcome for patient and with creativity, can still be
successfully implemented in the presence of a foreign speaking caregiver, and without easy access to translation
services
107
(INNOVATION)
Abstract
1000 hrs - 1010 hrs
ENHANCING PATIENT’S VITAL SIGN MONITORINGS WHILE UNDERGOING
SURGERY UNDER LOCAL ANAESTHESIA
N Rahman, Neo TG, Fung KB, Wong S, PHILIPS
Department of Nursing, Biomedical Engineering, Changi General Hospital
Aims
In line with the hospital’s commitment to patient safety, the initiative was implemented to increase patient’s safety
while undergoing surgery under Local Anaesthesia (L.A.) and enhance nurses’ awareness in perianaesthesia nursing for
quality patient care.
Respiratory rate is one of the basic vital signs that indicate physiological status of patients. During a L.A. surgery,
anaesthesia nurses monitored patients’ respiratory rate manually while they are under the drapes. The drapes were an
obstruction to accurate monitoring of the respiratory rate. There were other alternatives where carbon dioxide
sampling line is attached directly to patient to monitor their capnograph or using capnoline, the latter a useful method
but expensive. The Biomedical Engineering Department (BME) was included in the project to look into the vital sign
monitorings and liased with PHILIPS vendor to discuss how to configure the anaesthesia machines so that respiratory
rate measurement can be activated.
Impact of Solution
All the 8 theatres in the major operating theatre and 4 theatres in Day Surgery have been configured by BME to create
settings labeled as “L.A” profile. This mode was for all patients who were going for surgery under local anaesthetics. All
the monitors in PACU of MOT and DSOT were configured so that respiratory rate can be captured by ECG rhythm.
Conclusions
Positive feedbacks were received from operating theatre nurses with the new implementations of respiratory rate
monitoring. Knowledge and quality of care by anaesthesia nurses were also increased as more time could be spent in
providing alternative therapy in pain management during L.A. surgery. Patient’s safety was enhanced by attaining uneventful surgery for operating theatre personnel.
108
(INNOVATION)
Abstract
1010 hrs - 1020 hrs
PHARMACIST OUTREACH PROGRAMME (POP): TELE-PHARMACY INNOVATION
SC Su
Department of Medical Social Services, Changi General Hospital
Aims
To provide a platform, enabling real time video conferencing and consultation between ACTION care coordinators at
the ground and CGH pharmacists invovled in POP.
With video conferencing technology, real time virtual pharmacists' home visits can take place. Implementation of Telepharmacy includes selecting hardware items, installing software applications, going through the work flow processes,
planning virtual visit time slots with pharmacists and coordinating the actual virtual visits.
POP is a collaborative project between Aged Care Transition Team & CGH Pharmacists on medication management at
home.
Care coordinators refer potential POP cases to pharmacists for polypharmacy after care coordinators' initial home visits. Subsequently, home visits with pharmacists will be arranged and conducted at a later date to address these issues.
For urgent issues needing immediate advices from pharmacist, telephonic consultations will be conducted. However
real time face-to-face consultations and pharmacists' home visits are not feasible.
Impact of Solution
Provide real time services.
Enable interactive and effective communication between pharmacists, patients, caregivers and care coordinators as
compared to telephonic calls.
Reduce time spent for physical home visits and travelling cost.
Increase support to caregivers by providing immediate consultation online.
Conclusions
Tele-pharmacy is testing out the feasibility and effectiveness of using video conferencing platform to replace some of
the traditional physical home visits. Successful working models can be replicated in other areas where advices can be
sought without getting the experts there physically and without much delay.
109
Best Oral Paper Award Research
21 November 2013
1400 - 1700
110
(RESEARCH)
Changi General Hospital, Seminar Room @ Level 2
Chairperson:
NC Yu Xia Jessica
(CGH)
Judges:
Dr Serena Koh
A/Prof Susan Rickard Liow
Dr Wang De Yun
(MOH)
(NUS)
(NUS)
ORAL-RE (1400)
COMPARISON OF THE ACCURACY OF THE 3RD GENERATION IPAD VS PACS IN DETECTING PNEUMOTHORAX ON CHEST RADIOGRAPHS.
Dr Justin Sim, Diagnostic Radiology, Changi General Hospital
ORAL-RE (1415)
JUNIOR DOCTOR ROSTER OPTIMIZATION: A STUDY OF IMPACT ON PATIENT EXPERIENCE AT CGH ACCIDENT & EMERGENCY
Mr Oh Hong Choon, Health Services Research, Eastern Health Alliance
ORAL-RE (1430)
THE USE OF TOTAL PARENTERAL NUTRITION FOR SHORT DURATIONS - A COST
ANALYSIS
Mr Alvin Wong, Dietetic & Food Services, Changi General Hospital
ORAL-RE (1445)
EFFICACY AND COST-EFFECTIVENESS OF AN ELECTROMECHANICAL GAIT TRAINER
FOR AMBULATION TRAINING AFTER STROKE IN A SINGAPOREAN COMMUNITY
HOSPITAL: A SINGLE BLIND
Ms Joyce Chua Boon Hui, Inpatient Therapy Services, St Andrew's Community Hospital
111
(RESEARCH)
Changi General Hospital, Seminar Room @ Level 2
ORAL-RE (1500)
THE EFFECTIVENESS OF A NEW NURSING DOCUMENTATION FRAMEWORK
(SOAPIE) IN IMPROVING THE QUALITY OF NURSING DOCUMENTATION IN AN
ACUTE CARE HOSPITAL
Ms Ker Wanlin, Changi General Hospital
ORAL-RE (1515)
FACTORS INFLUENCING PARTICIPATION IN POST-STROKE REHABILITATION AFTER
DISCHARGE FROM HOSPITAL: AN EXPLORATORY STUDY ON THE SINGAPOREAN'S
PERSPECTIVE
Ms Elain Koh Wei Ling, Rehabilitative Services, Changi General Hospital
112
(RESEARCH)
ABSTRACTS
1400 hrs - 1415 hrs
COMPARISON OF THE ACCURACY OF THE 3RD GENERATION IPAD VS PACS IN
DETECTING PNEUMOTHORAX ON CHEST RADIOGRAPHS.
JJW Sim*, RD Mahmood, ACC Poh, TCC Lim, SH Goh, PH Ang, BY Leong, A Ananthasubramaniam, GL Yang.
Department of Diagnostic Radiology, Changi General Hospital, Singapore
Aims
To determine the accuracy of the 3rd generation iPad in detecting pneumothoraces on chest radiographs compared to
PACS.
Methods
Anonymised full DICOM images of 140 chest x-rays (CXRs) [40 normal, 48 small PTX (<2cm lung edge to chest wall) and
52 large (>2cm)] were retrospectively chosen from the PACS database and uploaded to 3 iPads (3rd gen). Three
radiologists and 3 emergency medicine physicians of equivalent experience (2 residents, 1 attending physician each)
independently read the CXRs on the iPad running iRAS viewing application (ASTAR, Singapore) and a 5MP Barco
monitor running Amalga PACS (Microsoft, USA). The sets were randomized and the PACS and iPad reading sessions
were separated by 1 month to avoid memory bias. Each reviewer had to indicate the absence or presence and location
of the PTX. The percentage of correct diagnosis was calculated for each display and reader. The detection accuracy of
small and large PTX between both displays was also compared.
Results
The iPad diagnoses of the 140 CXRs were accurate in 97.4% compared to 97.6% for PACS. In the CXRs that had PTX, the
accuracy of the iPad was 95.0% compared to 97.4% for the PACS monitor (p=0.03). 8.8% of small and 1.6% of large PTX
were missed on the iPad, compared to 4.5% and 0.9% on PACS respectively.
Conclusions
The 3rd generation iPad is accurate in detecting pneumothoraces on chest radiographs but small pneumothoraces are
more difficult to detect on the iPad than large pneumothoraces when compared to PACS.
113
(RESEARCH)
ABSTRACTS
1415 hrs - 1430 hrs
JUNIOR DOCTOR ROSTER OPTIMIZATION: A STUDY OF IMPACT ON PATIENT
EXPERIENCE AT CGH ACCIDENT & EMERGENCY
HC Oh1, WL Chow1, P Looi2, L Tiah2, B PL Goh2, T Mohan2
1
Health Services Research, Eastern Health Alliance, Singapore
Accident & Emergency, Changi General Hospital, Singapore
2
Aims
This study aimed to evaluate the impact of a new junior doctor roster on the time to first consult (TTFC) of P2 and P3
patients at CGH Accident & Emergency (A&E).
Methods
A new junior doctor roster was derived based on a published study that matching manpower availability with demand
was effective in reducing waiting time of A&E patients. The derivation entailed three steps. The first determined the
ideal number of junior doctors at every hour of a day by apportioning the total available man-hours according to the
hourly patient volume of A&E. The second step involved application of an integer linear programming (ILP) model to
assign available junior doctors to existing and new shifts so that the hourly number of doctors matched to their
respective ideal numbers derived in the first step as closely as possible. The last step involved adaptation of ILP
solution to operational preferences of A&E. The new roster included a new shift and its impact was evaluated by
comparing the TTFC performance of the pre-implementation period of weeks 10 to 26 of 2013 and
post-implementation period of eleven weeks which started one week after implementation of new roster.
Results
Compared to pre-implementation, there was reduction (percentage reduction) in the weekly average median, 95th
percentile and standard deviation of TTFC of P2 patients in post-implementation by 9.0 minutes (25.3%), 27.5minutes
(22.9%) and 9.2minutes (23.2%). During the same period, P3 patients experienced a reduction of 38.1 minutes (37.2%),
50.2 minutes (17.9%) and 17.4 minutes (20.3%) in weekly average median, 95th percentile and standard deviation of
TTFC respectively.
Conclusions
Although average weekly load of P2 and P3 patients decreased by 4.9% and 16.1% respectively from the
pre-implementation to post-implementation period, our preliminary findings suggested that the new roster was
effective in reducing TTFC of P2 patients.
114
(RESEARCH)
ABSTRACTS
1430 hrs - 1445 hrs
THE USE OF TOTAL PARENTERAL NUTRITION FOR SHORT DURATIONS - A COST
A WONG, H H HAN, J Ong
Department of Dietetic & Food Services, Pharmacy, Gastroenterology , Changi General Hospital, Singapore
Aims
Total Parenteral Nutrition (TPN) is indicated if Enteral Nutrition is contraindicated, or in conditions precluding the use
of intestinal tract for more than 1 week. This retrospective cost analysis aims to show the costs and manpower hours
incurred for patients initiated and weaned off TPN within a short duration defined as less than 5 days.
Methods
Patients admitted to CGH and initiated on TPN between September 2011 and July 2013 were audited. Patients were
excluded if they were started with TPN for more than 5 days, or died during the period on TPN, or if TPN was stopped
for palliative care, complications due to TPN such as line infection and cholestasis. All patients were prescribed
customised TPN by the Nutrition Team or ready-to-use Parenteral Nutrition bags (RTU) by the ICU intensivists.
Student T-Test was performed to determine any differences.
Results
Of the 143 patients initiated with TPN, 25 patients (17.5%) received TPN for 5 days or less (Mean 3.88 +/- 0.93 days).
Ninety-six percent (96%) of this group of patients progressed to oral or enteral nutrition within 5 days of commencing
TPN. Total additional costs for the duration of TPN before subsidy is $1682.50 +/- 349.78 and after subsidy (adjusted
for B and C class patient status) is $795.07 +/- 426.44.
Total manpower costs (Medical team, Pharmacist, Dietitian, Nursing Staff and Phlebotomist) not included in patient
final bill is estimated at $382.54 +/- 92.24, which is equivalent to additional manpower hours of 8.86 +/- 2.11 hours.
The average daily TPN associated bill for a patient on short term TPN is significantly higher at $221.24 +/- 141.34
versus $116.33 +/- 61.06 (p<0.0001) for patients on TPN >5 days (mean of 17.42 +/- 15.67 days).
Conclusions
TPN is indicated only if patient require it for longer periods of > 1 week. It does not make economical or clinical
benefits to start and wean patients off TPN within a short duration of less than 5 days. This increases the healthcare
cost for both the hospital and the country as 90% of the patients on TPN are subsidised up to 80% of all medical costs.
115
(RESEARCH)
ABSTRACTS
1445 hrs - 1500 hrs
EFFICACY AND COST-EFFECTIVENESS OF AN ELECTROMECHANICAL GAIT TRAINER FOR AMBULATION TRAINING AFTER STROKE IN A SINGAPOREAN
COMMUNITY HOSPITAL: A SINGLE BLIND
JBH CHUA*, J CULPAN, T TEO, E MENON
Inpatient Therapy Services, St Andrew’s Community Hospital, Singapore
Aims
1.
To compare the effects of a) gait training using the gait trainer (GT) combined with conventional physiotherapy,
with b) conventional physiotherapy alone, in non-ambulant sub-acute stroke patients.
2.
To compare the cost effectiveness of using GT combined with conventional physiotherapy to conventional physiotherapy alone in sub-acute stroke rehabilitation.
Methods
This was a randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
64 non-ambulant individuals approximately one month post-stroke were randomised to receive either 20 minutes GT
training and 5 minutes of stance/gait training (GT group) or 25 minutes stance/gait training (control group). Both
groups also had 10 minutes standing and 10 minutes cycling. Training was given 6 times per week for 8 weeks,
The primary outcome was Functional Ambulation Category. Secondary outcomes were Barthel Index, gait speed and
endurance, and the Stroke Impact Scale (SIS). Measures were taken before and after training, and at 24 weeks after
treatment initiation. Cost effectiveness was measured as the ratio of cost of intervention to improvements in SIS
(physical) sub-scale.
Results
At 24 weeks the GT group walked further [6 minute walk test: median (IQR) improvement 83.9(46.3 – 206.6) metres
compared to 32.7(6.3 – 136.5) metres (p=0.029)]. No other significant differences were observed.
GT training led to lower overall costs than the control intervention, as it permitted greater involvement of therapy
assistants. As there were no between-group differences in the improvements measured on the SIS (physical) sub-scale,
GT was deemed more cost effective.
Conclusions
This interim analysis shows that conventional physiotherapy applied alone can be as effective as the use of GT
combined with conventional physiotherapy for subacute stroke survivors. However use of GT is a cost effective
intervention for increasing walking distance in non-ambulant stroke survivors and should be considered where patients
are unable to engage in gait training without mechanical support.
116
(RESEARCH)
ABSTRACTS
1500 hrs - 1515 hrs
THE EFFECTIVENESS OF A NEW NURSING DOCUMENTATION FRAMEWORK
(SOAPIE) IN IMPROVING THE QUALITY OF NURSING DOCUMENTATION IN AN
ACUTE CARE HOSPITAL
W Ker
Aims
To examine the quality of nursing documentation in an acute care hospital and determine if it has improved after the
adoption of a new documentation framework called SOAPIE (Subjective data, Objective data, Assessment, Planning,
Intervention and Evaluation).
Methods
A pilot pretest-posttest quasi-experimental study was conducted from November 2012 to January 2013 in an acute
care hospital in Singapore. A modified and validated 15-item Nursing and Midwifery Documentation Content Audit
Tool (NMCAT) was used pre- and post-implementation of the SOAPIE documentation framework to evaluate the quality of nursing documentation. The quality of nursing documentation was first assessed prior to the start of the education on SOAPIE documentation framework to registered nurses in the pilot wards. The new documentation framework
was taught over a week during nurses’ row calls, and subsequently used by registered nurses in the pilot wards. Quality of nursing documentation was then measured against the NMCAT after one month of using the new framework.
Results
One hundred and twenty patient case-sheets were examined in this study. Only an average of 51.8% of nursing documentation was up to standard as defined in the NMCAT. After the adoption of SOAPIE documentation framework, a
48.8% variation improvement was observed, particularly seen in documentation written to reflect the objective clinical
judgement of nurses better. Using Chi-square/Fisher’s exact tests, nurses with higher nursing qualifications were observed to have association with better nursing documentation quality, while nurses in the morning shifts were observed to be associated with slightly poorer nursing documentation quality when using the SOAPIE documentation
framework.
Conclusions
The quality of nursing documentation before the use of SOAPIE documentation framework was poor, but has improved
after the adoption of SOAPIE documentation framework. Results highlighted the areas where documentation quality
can be further improved in this study.
117
(RESEARCH)
ABSTRACTS
1515 hrs - 1530 hrs
FACTORS INFLUENCING PARTICIPATION IN POST-STROKE REHABILITATION AFTER
DISCHARGE FROM HOSPITAL: AN EXPLORATORY STUDY ON THE SINGAPOREAN'S
PERSPECTIVE
WLE Koh*, C Barr, S George
Aims
To explore the obstacles that deter patients from continuing stroke rehabilitation after their discharge from the
hospital.
Methods
A qualitative study using individual semi-structured telephone interviews with inductive thematic analysis of
the data collected.
Thirty-one stroke patients who had been discharged from the hospital after completion of their post-acute
in-patient stroke rehabilitation (mean age 66.46 and mean duration post-discharge 95.82 days).
Results
Five themes were identified including: the means to access rehabilitative services; lapse in discharge
coordination; family member’s views and actions, discrepancies in expectation; and the perception that
rehabilitation is simple. Participants indicated a need of timely and appropriate information delivered
according to their individualised needs.
Conclusions
Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not
having a common understanding of rehabilitation accounts for the lack of adherence to therapy
recommendations. The results suggest that clinicians need to be more aware of their role in providing
well-coordinated information about therapy. The study also highlighted the need to review the goal-setting
processes that guides the course of rehabilitation. Goals should be more patient-centred to reduce the
discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in the
discharge-planning so as to minimise the dissatisfaction in care arrangement and information delivery.
118
Best Poster Award Clinical Medicine
21 November 2013
1030 - 1300
119
BEST POSTER AWARD
(CLINICAL MEDICINE)
Changi General Hospital, Atrium @ Level 1
Judges:
CM P-001
CM P-002
CM P-003
Dr Chow Wai Leng
Ms Rosy Tay
Dr Melissa Ngai
(EHA)
(NP)
(NUH)
A CASE REPORT ON ECHOLALIA
Ms Yu Xia, Pain Service, Changi General Hospital
PARANEOPLASTIC SYNDROME AS THE FIRST PRESENTATION IN BREAST CANCER
Dr Yvonne Ng, General Surgery, Changi General Hospital
EFFECTS OF ANTIBIOTIC DE-ESCALATION ON CLINICAL OUTCOMES OF CRITICALLY
ILL PATIENTS DIAGNOSED WITH BACTERIAL PNEUMONIA
Mr Immanuel Tang Zhi Xiong, Pharmacy, Changi General Hospital
CM P-004
VASOPRESSIN-ASSOCIATED HYPONATRAEMIA IN PATIENTS TREATED FOR SEPTIC
SHOCK
Ms Germaine Chan, Pharmacy, Changi General Hospital
CM P-005
CM P-006
AN AUDIT STUDY: FEEDING TARGETS IN THE FIRST 72 HOURS IN A MEDICAL INTENSIVE CARE UNIT
Mr Ong Qing Liang, Yong Loo Lin School of Medicine, National University of Singapore
POLYPHARMACY AND FALL RISK IN THE ELDERLY: A SYSTEMATIC REVIEW
Ms Lynette Wong Li Yi, Pharmacy, Changi General Hospital
120
BEST POSTER AWARD
(CLINICAL MEDICINE)
CM P-007
LAPAROSCOPIC LAVAGE FOR HINCHEY III DIVERTICULITIS IN SINGAPORE: AN INITIAL EXPERIENCE AND THE CASE FOR ADOPTION IN ACUTE SURGICAL CARE PRACTICE
Dr Teo Nan Zun, General Surgery, Changi General Hospital
CM P-008
A THREE YEAR RETROSPECTIVE STUDY OF TOTALLY EXTRA-PERITONEAL VERSUS
TRANS-ABDOMINAL PRE-PERITONEAL INGUINAL HERNIA REPAIR IN A SINGLE
INSTITUTION
Dr Denise Fok, General Surgery, Changi General Hospital
CM P-009
DAPTOMYCIN VERSUS STANDARD THERAPY IN THE TREATMENT OF SERIOUS
MRSA INFECTIONS WITH VANCOMYCIN MIC = 2 MCG/ML: A RETROSPECTIVE
STUDY OF CLINICAL FACTORS AND OUTCOMES
Mr Lee Wee Boon, Pharmacy, Changi General Hospital
CM P-010
AUDIT OF ENDOSCOPIC HAEMOSTASIS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING : THE CGH SURGERY EXPERIENCE
Dr Annalisa Ng Ya-Lyn, General Surgery, SingHealth
CM P-011
EFFECTS OF EARLY SWITCHING FROM IV TO ORAL ANTIBIOTICS ON THE OUTCOMES OF PATIENTS WITH BACTEREMIA SECONDARY TO URINARY TRACT INFECTIONS
Ms Nashirah Kamal Mustapa, Pharmacy, Changi General Hospital
CM P-012
USE OF AN ELECTRONIC ORDERSET IMPROVES PRESCRIBING OF AN MRSA DECOLONISATION PROTOCOL
Ms Ng Ying Ting, Pharmacy, Changi General Hospital
CM P-013
CM P-014
WARFARIN THERAPY FOR ATHEROMATOUS ARTERIAL DISEASE: CASE REPORT)
Dr Pande Shrikant, Rehab medicine, Changi General Hospital
SPINAL MYOCLONUS A CASE REPORT
Dr Pande Shrikant, Rehab medicine, Changi General Hospital
121
BEST POSTER AWARD
(CLINICAL MEDICINE)
CM P-015
STUDY OF PRESCRIBING HABITS OF VITAMIN D SUPPLEMENTS FOR GERIATRIC
INPATIENTS
Dr Goh Kiat Sern, Geriatric Medicine, Changi General Hospital
CM P-016
CM P-017
BONEBRIDGE IMPLANTATION WITH IMAGE-GUIDANCE LOCALIZATION
Dr Amanda Tan, ENT, Changi General Hospital
DIETARY COMPLIANCE WITH A PARTIAL MEAL REPLACEMENT DIET VS CONVENTIONAL REDUCED-FAT DIET IN OBESE MEN
Ms Ling Ping Sing, Dietetic & Food Services, Changi General Hospital
CM P-018
POST PROCEDURE CARE IN THE GENERAL WARD AFTER TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION: AN INITIAL EXPERIENCE
Dr Jason See Jia Hao, Cardiology, Changi General Hospital
CM P-019
CM P-020
COLONOSCOPY IN PATIENTS ON WARFARIN THERAPY: OUR PRACTICE - IS THERE
BLEEDING?
Mr Wong Chen Pong, Yong Loo Lin School of Medicine, National University of Singapore
A RANDOMISED CONTROLLED TRIAL ON ULTRASOUND-ASSISTED SPINAL ANAESTHESIA
Dr Lim Yean Chin, Anaesthesia, Changi General Hospital
CM P-021
OPTIMIZING ORAL HYGIENE TO REDUCE VENTILATED ASSOCIATED PNEUMONIA
AT CHANGI GENERAL HOSPITAL SURGICAL INTENSIVE CARE UNIT
Ms Lee Tian, Surgical Intensive Care Unit, Changi General Hospital
122
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
A CASE REPORT ON ECHOLALIA
X Yu
Department of Nursing, Changi General Hospital, SIngapore
Aims
To explore the possible causes of echolalia encountered in an elderly patient
Methods
A case report
Results
Madam Sim, a seventy-eight-year-old Chinese lady, was admitted for left hip pain after a fall. Premorbidly, she was
able to walk with quad stick and converse normally in English. She had a history of hypertension, iron deficiency
anaemia, atrial fibrillation (on digoxin and aspirin) and previous cataract surgery in 2012. During admission, she was
diagnosed with bilateral degenerative hip arthritis and muscle contusion over left hip, left hip fracture was ruled out.
She was able to ambulate with walking frame few days after admission and was on the road of recovery to her
premorbid functional status. A geriatrician was consulted for fall management and the patient was also referred to
pain service for pain over left hip. She was started on ultracet (combination of paracetamol and tramadol) and baclofen for her left hip pain control. Unfortunately, Madam Sim had an episode of loss of consciousness one day after she
was started on the oral analgesics. She developed fluctuating consciousness and echolalia, which lasted for 2 days. Urgent MRI and MRA report was unremarkable. Urgent electromyography (EMG) showed diffuses encephalopathy with
no epileptiform activity seen. Thereafter, the symptoms were completely resolved.
Conclusions
There was no similar episode encountered during her remaining stay in the hospital and she was discharged well.
123
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
PARANEOPLASTIC SYNDROME AS THE FIRST PRESENTATION IN BREAST CANCER
Ng YRY*, Ho CYD, Tan SM
Department of General Surgery, Changi General Hospital, Singapore
Aims
Breast carcinoma most commonly presents with an abnormal mammogram or breast lump; hence patients with
paraneoplastic presentations may be misdiagnosed initially resulting in delayed diagnosis of an underlying occult
breast tumour.
Methods
We report two cases where cerebellar degeneration and dermatomyositis were the foremost presentations.
Results
A 58-year-old female with paraneoplastic cerebellar degeneration first presented with vertiginous giddiness, impaired
coordination, speech difficulties and ataxia for a 1-week duration. Breast examination was normal, and neurological
examination confirmed the presence of gaze-evoked rotatory nystagmus, dysarthria, dysmetria, dysdiadochokinesia
and gait ataxia. Initial stroke work-up performed was negative. Cerebrospinal fluid examination showed lymphocytic
pleocytosis, increased CSF IgG relative to serum, and oligoclonal banding. She was given 5 days of intravenous
immunoglobulin therapy to no avail. Computed tomography (CT) chest performed revealed a 1.5cm right breast nodule with irregular margins, and axillary and subpectoral nodes suspicious for nodal metastasis. Further breast
investigations showed multicentric disease and histological confirmation of invasive ductal carcinoma (IDC) was made.
Formal Stage IIA T1N1M0 staging was made after a right simple mastectomy and axillary clearance (SMAC). Next, a
69-year-old female presented with atypical chest pain, generalized urticarial plaques in a photosensitive distribution,
nail fold erythema, arthralgia and progressive proximal upper extremity muscle fatigue and weakness in a symmetrical
distribution over a 3-month period. Skin and muscle biopsy were consistent with the diagnosis of dermatomyositis.
Clinical breast examination was again normal but initial workup for underlying malignancy showed features suspicious
of a right breast cancer with enlarged right axillary and subpectoral nodes on the CT chest. Core biopsy confirmed IDC.
Formal Stage IIIC T2N3M0 was made after a SMAC.
Conclusions
While rare, it is important to maintain a high level of vigilance for an underlying malignancy in such paraneoplastic
manifestations in order to attain an earlier diagnosis and allow curative management of the cancer.
124
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
EFFECTS OF ANTIBIOTIC DE-ESCALATION ON CLINICAL OUTCOMES OF CRITICALLY
ILL PATIENTS DIAGNOSED WITH BACTERIAL PNEUMONIA
ZXI Tang*, WX Tong, YJI Wee
Aims
Critically ill patients diagnosed with bacterial pneumonia are often treated empirically with broad spectrum antibiotics.
While increasing the possibility of a successful outcome, it also creates pressure for the selection of resistant
microorganisms. De-escalation is a strategy that attempts to balance the competing aims of providing appropriate
initial therapy and limiting the emergence of resistant pathogens. The aim of this study is to evaluate if de-escalation is
associated with poorer outcomes
Methods
A retrospective cohort study was conducted on adult patients admitted to the intensive care unit (ICU) diagnosed with
bacterial pneumonia from the period of September 2011 till August 2012. De-escalation in this project was defined as
narrowing of antimicrobial coverage, intravenous to oral conversion or discontinuing of antibiotics if no infection is
established within 5 days of therapy. The primary clinical outcome of this study was 30 days all-cause mortality.
Secondary outcomes include ICU length of stay (LOS) and hospital LOS. .
Results
A total of 75 critically ill patients were identified but only 51 patients were included into the study. The median age was
73.0 years old. The baseline characteristics did not differ significantly between the two groups. Antibiotic therapy was
de-escalated in 17 (33.3%) patients during the initial 5 days of therapy. All-cause mortality [de-escalation: 1 (5.9%) vs.
did not de-escalate: 7 (20.6%)] did not differ significantly between the 2 treatment groups. The ICU LOS and
hospital LOS are statistically different between the 2 groups, with the de-escalated group having shorter stays for both
ICU [2 (2-3) vs. 4 (2-6) days] and hospitalization [7 (5-13) vs. 15 (9-32) days]
Conclusions
This study suggests that antibiotic de-escalation in critically ill patients diagnosed with bacterial pneumonia does not
result in increased mortality and is associated with shorter ICU and hospital LOS.
125
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
VASOPRESSIN-ASSOCIATED HYPONATRAEMIA IN PATIENTS TREATED FOR SEPTIC
SHOCK
Chan GYL, Wee IYJ, Widjaya M
Aims
The management of septic shock typically involves volume resuscitation and the administration of vasopressors (e.g.,
vasopressin, noradrenaline) to maintain a target mean arterial blood pressure for adequate organ perfusion. While
vasopressin is known to have an effect on sodium levels, the incidence of hyponatraemia is not well established. This
study aimed to evaluate the characteristics of hyponatraemia in critically ill patients receiving vasopressin for treatment of septic shock.
Methods
We conducted a retrospective cohort study involving all intensive care patients (aged >21 years) who received at least
one dose of vasopressin for the treatment of septic shock between January 2010-December 2011. Patients were
identified via computerised pharmacy records. Both manual and electronic medical and medication records were
reviewed, and relevant patient data recorded. Assessment of the characteristics of hyponatraemia was performed
independently as well as in relation to concurrent corticosteroid administration.
Results
A total of 60 eligible patients were reviewed. The incidence of hyponatreamia (plasma sodium 131-135 mEq/L) and
severe hyponatraemia (plasma sodium <130 mEq/L) were 18.3% and 13.3%, respectively. The presence of any form of
hyponatraemia occurred mainly in the first 3 hours following vasopressin initiation. Normal saline accounted for more
than half of the total fluids administered during the first 48 hours following vasopressin initiation. Mean plasma
sodium concentrations were higher following vasopressin discontinuation compared to prior to initiation
(141.0 mEq/L vs 139.2 mEq/L, p = 0.022). In patients who received vasopressin and corticosteroids, the incidence of
hyponatremia was 19%, compared to 17% in patients who did not receive corticosteroids (p = 0.84).
Conclusions
Vasopressin-associated hyponatraemia occurred less often that reported in the literature, probably because of the
extent of normal saline administered. Concurrent use of corticosteroids was not found to have a statistically
significant impact on the incidence of hyponatraemia in this patient population.
126
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
AN AUDIT STUDY: FEEDING TARGETS IN THE FIRST 72 HOURS IN A MEDICAL
INTENSIVE CARE UNIT
Q L Ong1*, A Tee2
Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Aims
Nutrition therapy is an integral part of holistic patient care. Evidence-based early enteral nutrition (EN) protocols
improve clinical outcomes and survival of critically ill patients. The aim of our study was to assess current feeding
practices in our MICU.
Methods
We conducted a review of patients who were admitted to the MICU at Changi General Hospital between 13 May 2013
and 26 May 2013.
Inclusion criteria:
1)
Adult patients
2)
Mechanically ventilated within 24 hours of admission
3)
Stayed in the MICU for at least 72 hours
Data was collected on the time for EN initiation and the amount of nutrition delivered over a 72-hour period. Other
information recorded were patient demographics, main diagnoses and APACHE II scores.
The target caloric intake was calculated using the Schofield Equation, with adjustments made for activity and stress
levels. The target protein intake was calculated based on a recommended intake of 1.2g/kg/day.
Results
19 patients met the inclusion criteria. 2 patients did not start EN within the first 72 hours of ICU admission due to hemodynamic instability and were excluded from subsequent data analysis.
All of the remaining 17 patients commenced EN within 48 hours of MICU admission. 15 patients (88.2%) commenced
EN within 24 hours of admission.
In the first 24 hours, 88% and 82% of patients acquired less than 25% of their target caloric and protein intake
respectively.
In the next 24 hours, 53% and 47% of patients acquired more than 50% of their target caloric and protein intake
respectively.
By 72 hours, 64.5% and 59% of patients acquired more than 50% of their target caloric and protein intake respectively.
Conclusions
Adequate and safe feeding of critically ill patients is an achievable and worthwhile pursuit. In our MICU, the enteral
feeding protocol was effective in increasing caloric and protein intake of patients within a 72-hour period.
127
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
POLYPHARMACY AND FALL RISK IN THE ELDERLY: A SYSTEMATIC REVIEW
LYL Wong, KYA Lam, V Teo
Aims
At present, 9.9% of Singapore’s population belongs to the geriatric age group (65 years old or above) which will
increase to 18.4% in the year 2030. Although polypharmacy can occur at any age, the incidence is highest in the elderly
as they present with multiple co-morbidities. The objectives of this literature review are:
i.
To assess the relationship between polypharmacy and falls in elderly.
ii.
To identify if certain drug classes are correlated with a higher fall risk using The American Geriatrics Society
(AGS) 2012 Beers Criteria.
iii.
To evaluate pharmacists’ role in reducing medication-related falls.
Methods
The search strategy covered electronic bibliographic databases e.g. PUBMED, ScienceDirect and The JAMA Network
from August 2012 to February 2013. Search terms used were: Polypharmacy, Multiple Medications, Falls, Fall-Risk
Increasing Drug (FRID), Beers Criteria, Potentially Inappropriate Medications, Elderly and Geriatrics. A total of 18
articles were retrieved from the online search of relevant journals.
Results
Although studies have shown that polypharmacy correlates with a heightened fall risk in elderly, the number of
medications used has a weak influence on fall risk. Rather, the presence of a FRID coupled with other patient-related
variables such as chronic diseases are the key reasons for the higher fall risks. Commonly identified FRIDs include
psychotropics, cardiovascular and centrally-acting medications.
Conclusions
The presence of a FRID is associated with a higher fall risk, rather than polypharmacy itself. Pharmacists should be
aware of the presence of a FRID when evaluating the appropriateness of drug use in elderly and recommend safer
alternatives when available.
128
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
LAPAROSCOPIC LAVAGE FOR HINCHEY III DIVERTICULITIS IN SINGAPORE: AN
INITIAL EXPERIENCE AND THE CASE FOR ADOPTION IN ACUTE SURGICAL CARE
PRACTICE
NZ Teo*, R Wijaya, SM Tan
Department of Surgery, Changi General Hospital, Singapore
Aims
Laparoscopic Lavage (LL) is a minimally invasive (MIS) surgical technique used to treat perforated diverticulitis. We
report the first case of Hinchey III diverticulitis successfully treated with LL in Singapore. This article aims to review
literature and with this case report present an appropriate algorithm and serve as guide to surgical units with
adequate MIS capabilities and are keen to consider using this technique in suitable patients with Hinchey III
diverticulitis.
Methods
A review of literature was performed and with the description of management of this patient, we highlight the
indication, considerations, outcomes and limitations of this technique for emergency surgical treatment of perforated
diverticulitis.
Results
We successfully managed a middle-aged lady who presented with Hinchey III diverticulitis with LL. She was discharged
with resolution of symptoms 6 days after LL and did not develop recurrence of diverticulitis after 2 years of follow-up
without any resectional surgery. In literature, LL has been attempted most often in patients with Hinchey III
diverticulitis with a lavage failure rate of 4.3% and mortality rate of 1.7%. Post-operative colonic evaluation should be
performed after LL and in view of the lack of mature data, resectional surgery should still be discussed with the
patient, understanding the potential risk of recurrent diverticulitis.
Conclusions
LL can be safely performed in patients with Hinchey III diverticulitis and should be considered in patients who are
suitable for laparoscopy at presentation at an institution with adequate resources and surgeons trained for MIS.
129
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
A THREE YEAR RETROSPECTIVE STUDY OF TOTALLY EXTRA-PERITONEAL VERSUS
TRANS-ABDOMINAL PRE-PERITONEAL INGUINAL HERNIA REPAIR IN A SINGLE
INSTITUTION
D Fok*, Ching S S, J Lee
Aims
The primary aim of this study was to compare the recurrence rate between the two different techniques of
laparoscopic hernia repair.
The secondary aims of this study were to compare patient characteristics and evaluate differences in operative time,
length of hospital stay and surgical complications between the two techniques.
Methods
Retrospective review of 200 operations performed from 1st July 2009 to 30th June 2012. 182 patients were reviewed
after exclusions. 106 patients underwent TEP and 76 patients underwent TAPP.
Statistical analysis was performed using the Student T-test and Chi-Square test on SPSS v. 19.
Results
The age, racial distribution, body mass index, length of symptoms and risk factors were similar in both groups. 9 cases
of recurrence after laparoscopic repair. No significant difference in recurrence rate for TAPP vs. TEP (3.9% vs. 5.7%,
p=0.599). One incidence of visceral injury in the TEP group. Higher incidence of haematoma formation for unilateral
repair in TAPP vs. TEP (11.6% vs. 1.7%, p=0.037). Duration of surgery significantly shorter for TEP repairs vs. TAPP
repairs for both unilateral (57 ± 18 mins vs. 96 ±30 mins, p<0.001) and bilateral cases (77 ± 32 mins vs. 107 ± 25 mins,
p<0.001).
Conclusions
Significantly higher rate of haematoma formation in unilateral TAPP compared to TEP repair. Significantly longer
operating time for TAPP repairs. No other significant difference in outcomes between the two techniques. Further
prospective studies are required to validate these results
130
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
DAPTOMYCIN VERSUS STANDARD THERAPY IN THE TREATMENT OF SERIOUS
MRSA INFECTIONS WITH VANCOMYCIN MIC = 2 MCG/ML: A RETROSPECTIVE
STUDY OF CLINICAL FACTORS AND OUTCOMES
Fong RKC1, Lee WB*3, Rao S1, Oh HML1, Tan TY2, Seah J3
1
Department of Microbiology, Changi General Hospital, Singapore
3
Department of General Medicine, Changi General Hospital, Singapore
2
Aims
To evaluate effectiveness of daptomycin switch against conventional vancomycin therapy in treatment of MRSA bacteremia with high vancomycin MIC of 2 mcg/mL
Methods
This retrospective case-control study evaluated the clinical outcomes of vancomycin, compared with switching therapy
to daptomycin, in the treatment of MRSA bacteremia with a high vancomycin MIC of 2 mcg/mL.
Results
Fifty four vancomycin-treated subjects were compared with 18 subjects who were switched to daptomycin when vancomycin MIC data was available. (Median time to starting daptomycin after the first positive MRSA blood culture was
9.5 days (range 7-12 days). Daptomycin was used for a median of 14.5 days.) At baseline, both groups were not statistically different in terms of predictors of clinical severity or mortality (Charlson comorbidity score [P=0.86], and APACHE
II score [P=0.79].) Thirty-day mortality was not significantly different between the 2 groups (daptomycin (5/18) 27.8%
vs. vancomycin (12/54) 22.2%, [P=0.75].) Other secondary outcomes were similar; (1) microbiologic clearance 7 days
after starting respective antibiotics [daptomycin (10/18) 55.6% vs. vancomycin (29/54) 53.7%, P=0.891] (2) clinical response within 7 days (daptomycin (11/18) 61.1% vs. vancomycin (37/54) 68.5%, P=0.564] (3) recurrence of MRSA bacteremia within 3 months [daptomycin (2/18) 11.1% vs. vancomycin (1/54) 1.9%, P=0.152]; and (4) total length of hospitalisation (mean of 43 days in both groups, P=0.972)
Conclusions
In this case-control study, clinical outcomes were similar between daptomycin and vancomycin for the treatment of
MRSA infections with bacteremia and higher vancomycin MICs. These findings differ from other studies that showed
better outcomes with daptomycin treatment, and suggest that further trials are required to determine the optimal
therapy for such infections.
131
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
AUDIT OF ENDOSCOPIC HAEMOSTASIS IN NON-VARICEAL UPPER
GASTROINTESTINAL BLEEDING : THE CGH SURGERY EXPERIENCE
Ng YL A* , Lee J, Wong SY A
Aims
To describe the patient characteristics, diagnoses and outcomes of those presenting with non-variceal upper gastrointestinal bleeding (UBGIT) who underwent endoscopic haemostasis.To evaluate failure rates of endoscopic haemostasis
and to identify risk factors for failure.
Methods
Retrospective cohort study of all surgical patients admitted for non-variceal UBGIT requiring endoscopic haemostasis
(adrenaline injection, heater probe, clipping) over a 2 year period (1st January 2011 - 31st December 2012).
Data was obtained from endoscopy logs and case files which included variables such as location of ulcer, proton pump
inhibitors (PPI), haemostatic modalities, Rockall score, Forrest classification, haemodynamic parameters. Data analysis
performed with SPSS v19.
Results
148 therapeutic OGDs were performed for 127 surgical patients.
70.9% of patients were male and majority were Chinese (72.4%) with a mean age of 66.2 years. Main risk factor
identified for
The most common pathology was peptic ulcer disease (92.9%) of which duodenal ulcers were more prevalent (50.8%).
The 2 most common locations for bleeding were at D1 (33.0%) and D1/D2 junction (17.4%).
A Rockall score of > 3 was associated with a higher risk of failure of haemostasis (p=0.025). There was no significant
difference
Half of patients achieved haemostasis with a single haemostatic modality and 45.7% with dual modalities. 91.3% received intravenous PPI infusion therapy and 7.9% received intravenous BD dosing. There was no significant difference
in rebleeding rates between these 2 PPI therapies (p=0.721).
Failure of initial endoscopic haemostasis occurred in 23.6% of patients requiring repeat OGDs, angioembolisation and/
or surgery. Risk factors predicting initial failure were identified as requiring a greater amount of adrenaline for haemostasis (mean 9.97ml vs 7.9ml, p=0.028), Rockall score > 3 (p=0.025) and units of blood transfused (mean 3.1 vs 1.9,
p=0.01). However, only units of blood transfused was shown to be statistically significant on multivariate analysis (OR
1.29, 95% CI 1.03-1.61,p=0.025).
Conclusions
Patients who failed initial endoscopic haemostasis were more likely to require a greater amount of adrenaline, blood
transfusion and have a Rockall score > 3. The presence of hypotension, location of ulcer, Forrest grade and type of PPI
therapy was not shown to be significant in predicting failure of haemostasis in this study, which may be attributed to
the small study size.
We aim to establish a UBGIT database, vaildate the Rockall score in our population and implement routine use of dual
modalities for endoscopic haemostasis in the future.
132
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
EFFECTS OF EARLY SWITCHING FROM IV TO ORAL ANTIBIOTICS ON THE
OUTCOMES OF PATIENTS WITH BACTEREMIA SECONDARY TO URINARY TRACT
INFECTIONS
Nashirah K M*, L W H, Tie T K, Tong W X
Aims
Urinary tract infection (UTI) with gram-negative bacilli is common and bacteremia (with the same causative pathogen
in blood cultures) complicating this infection is frequently seen. Duration of antimicrobial therapy for bacteremic
patients is 14 days. In these cases, clinicians often prefer the parenteral route of administration. Early intravenous (IV)
to oral switch has been shown to reduce risks of line infection, length of stay in hospitals as well as increase comfort
level and mobility of patients. This project aims to evaluate the clinical outcomes of early switching from IV to oral
antibiotics in patients with bacteremia secondary to UTI. The hypothesis is that early switching to oral antibiotic
therapy may have little or no clinical disadvantage for these patients.
Methods
The medical records of patients with bacteremia secondary to UTI were identified from the Antimicrobial Stewardship
Programme (ASP) database and reviewed. Early switching in this study was defined as time to switch to oral antibiotics
within the first seven days of treatment. Mann-Whitney U test was used to evaluate the length of stay between the
two groups and chi-squared test to evaluate the odds ratio of clinical complications and 30-day readmission in these
groups.
Results
98 patients with bacteremia secondary to UTI were identified. Early switching in bacteremia secondary to UTI patients
was shown to have significantly shorter duration of stay (median: 6 days vs 12 days) in hospital (p<0.01). Odds ratio for
clinical complications in early switch group was 1.58 (95% CI 0.30 – 8.28), and for 30-day readmission was 0.75 (95% CI
0.12-4.72). They were both insignificant with p=0.714, and p=0.759 respectively
Conclusions
From this study, early switching from IV to oral antibiotics has some implications in terms of length of stay. It does not
however, confer benefits or disadvantages in terms of clinical complications. Evaluation on more variables such as
mortality and monetary costs may be needed in a larger population group.
133
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
USE OF AN ELECTRONIC ORDERSET IMPROVES PRESCRIBING OF AN MRSA
DECOLONISATION PROTOCOL
Ng YT, Seah J. Oh MLH, O Connor R
Aims
The main aim of this study was to audit the level of adherence to the MRSA decolonisation policy in the inpatient
setting and to determine whether the implementation of the MRSA decolonisation electronic orderset increased the
level of adherence to the MRSA decolonisation therapy policy.
Methods
Patients included were randomly chosen inpatients who received MRSA decolonisation therapy before and after the
implementation of the orderset. Adherence to the hospital decolonisation protocol and utilisation of the MRSA
decolonisation orderset were assessed.
Results
A total of 240 patients were included, comprising of 120 patients each for the pre- and post-orderset groups. The
groups did not differ by gender or age. The introduction of the orderset resulted in a significant improvement (40%) in
adherence to the hospital decolonisation protocol (45% post-orderset vs. 5% pre-orderset, p<0.005). Appropriate
prescribing (frequency & duration of therapy) of nasal mupirocin and antimicrobial wash improved by 31% and 32%,
respectively. Almost all who were prescribed as per protocol utilised the orderset. However, there were 55% of cases
who did not utilise the orderset and hence did not comply with the protocol.
Conclusions
The implementation of an electronic orderset improved the prescribing of MRSA decolonisation therapy as per
protocol. However, a large proportion did not utilise the orderset and prescribed inappropriate decolonisation therapy.
Thus, education of medical staff is required to improved awareness and utilisation of the orderset.
134
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
Pande SD, Koh E, Lolong L, Wee T C
Department of Rehabilitation Medicine, Changi General Hospital, Singapore
Report Abstract
A 54 year old gentleman was admitted with right MCA territory infarct (Stroke). He further developed haemorrhagic
conversion in the MCA infarct for which he needed decompressive craniectomy.
He had long-standing history of smoking as a major risk factor.
During rehabilitation stay, he developed right lower limb ischemia for which further investigation (contrast scan and
angiography) revealed severe atherosclerotic disease of aorta. Initial treatment with vascular intervention prevented
him from having major amputation.
He also had simultaneous pulmonary embolism. After careful consideration (as he was still recovering from his haemorrhagic conversion), he was fully anicoagulated initially with heparin followed by warfarin.
During follow up study (contrast CT scan) after 3 months, his severe atheromatous disease of aorta showed near
complete resolution.
The single case report on this patent raises the possibility that apart from antiplatelets and lipid lowering agents,
anticoagulation with warfarin may be responsible for complete resolution of atheromatous disease and future
research on this treatment modality can be considered as a part of regular treatment for atheromatous disease.
Literature searches including PubMed, Ovid, journal references and differential diagnoses included in the full case
report.
135
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
Pande SD, Koh E, Lolong L, Wee T C
Department of Rehabilitation Medicine, Changi General Hospital, Singapore
Report Abstract
.A 48 year old gentleman was admitted with history of fall from the chair at workplace. He was admitted to CGH with
severe low back pain.
His past medical history was laminectomy for Lumbar spine (L3-L5) 2 years ago.
During this admission he was investigated with repeat MRI scan, which did not reveal any new injury to the spinal cord.
He continued have pain for which he received epidural analgesia, as he failed to respond to combination of NSAIDS,
Tramadol, Morphine substitutes.
After his pain control was achieved, epidural catheter was taken off.
He subsequently developed spontaneous involuntary movements of left lower limb.
Investigations done to identify underlying cause of his movements included: electrolytes, thyroid functions test,
calcium, magnesium levels, CT brain scan, EMG/NCS were all normal.
The frequency of movements of the left lower limb was 10-15 times per day with variable duration of 10 to 30 minutes
without any prior warnings. His movements exacerbated his back pain and limited his rehabilitation.
After reviewing his history a working diagnosis of spinal myoclonus was made.
He was started on Clonazepam and Sodium valproate. The dosages were slowly tittered.
After 1 week of therapy the movements frequency started to improve. By 1 month his frequency of involuntary
movements reduced to 2-3 per day and duration on each occasion reduced to few seconds. He was followed for more
than 12 months and remained stable.
Minor trauma to spine is very common and some of the patients may need epidural analgesia.
Epidural analgesia is also commonly used in obstetric practise; we have to bear in mind that this unusual complication
of this procedure can occur.
This case highlights the importance of unusual complications of epidural analgesia as; patients may end up in
unnecessary investigation and morbidity.
Literature searches and differential diagnosis included in the full case report
136
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
STUDY OF PRESCRIBING HABITS OF VITAMIN D SUPPLEMENTS FOR GERIATRIC
INPATIENTS
KS Goh*, D Zhang, GK Png, HM Lin, W Ang, J Lim
Department of Geriatric Medicine, Changi General Hospital, Singapore
Aims
To study the prescribing habits of vitamin D supplements for geriatric inpatients.
Methods
A cross-sectional retrospective study involving 206 patients admitted consecutively to geriatric acute wards in Changi
General Hospital was carried out. Information on patient clinical status, demographics and prescription of vitamin Dcontaining supplements was collected from the patient medical records. Total serum 25-hydroxyvitamin D levels were
measured. Vitamin D deficiency is defined as 20ng/ml or less; and insufficiency > 20 ng/ml and < 30 ng/ml. Descriptive
analysis of the differences in patient characteristics among categories of categories of vitamin D-containing supplements prescribed was performed.
Results
Of the 206 patients, 57.3% were prescribed vitamin D-containing supplements. The distribution of prescription was as
follows: nil, 88 (42.7%); calcium-vitamin D one tab, 5 (2.4%); calcium-vitamin D two tabs, 46 (22.3%); lynae, 49 (23.8%);
and ergocalciferol, 18 (8.7%).
Higher proportions of patients with vitamin D deficiency were prescribed lynae (71.4%) and erocalciferol (94.4%) than
those with vitamin D insufficiency (26.5% lynae and 5.6% ergocalciferol) and normal vitamin D level (2.0% lynae and
0.0% ergocalciferol). Among patients who were not prescribed vitamin-D containing supplements (n=88), 56.8% had
poor vitamin D status (27.3% vitamin D deficient and 29.6% vitamin D insufficient).
Among patients with full ADL dependence (n=29), only 27.6% were prescribed vitamin D-containing supplements. The
proportion of patients who were prescribed these supplements was 60.8% among those who with at least one
pre-existing conditions known to decrease vitamin D level (n=97).
Conclusions
There is heterogenity in the prescribing habits of vitamin-D containing supplements for the geriatric inpatients. As these patients are at high risk of vitamin D deficiency and insufficiency, it is necessary for clinicians to exercise vigilance in
the management with timely intervention to prevent complications from poor vitamin D status. Local guidelines on
vitamin D supplementation taking into account different high risk subgroups of geriatric inpatients may be useful to
ensure consistency of treatment.
137
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
BONEBRIDGE IMPLANTATION WITH IMAGE-GUIDANCE LOCALIZATION
A E P Tan, H W Yuen
Department of Otolaryngology, Changi General Hospital, Singapore
Aims
The Bonebridge implant is a bone-conduction hearing implant with a relatively large floating mass transducer (FMT),
which is seated within a bony well. This well is drilled in the mastoid process of the recipient. The FMT is then
anchored onto the bony cortex with two screws on the side of the well.
The location of the well is important so as to avoid vital structures such as the posterior canal wall, the dura mater of
the middle cranial fossa, and the sigmoid sinus. At the same time, the area chosen to site the well must also be
sufficient to accommodate the size of the FMT. This becomes even more important in patients with contracted
mastoids. As such, image-guidance localization (IGL) of the exact site of the well is useful in surgical planning.
Methods
IGL of the site of the well for the Bonebridge FMT has been utilized in Changi General Hospital.
Results
Four patients underwent Bonebridge implant surgery with IGL. Using IGL, rapid and accurate localization of the ideal
site of the well for the FMT was possible in each case.
Conclusions
The author recommends IGL as a safe, rapid and reproducible technique in localization of the site for the well for the
Bonebridge implant FMT.
138
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
DIETARY COMPLIANCE WITH A PARTIAL MEAL REPLACEMENT DIET VS
CONVENTIONAL REDUCED-FAT DIET IN OBESE MEN
PS Ling*, J Khoo, M Cheong, J Tan, A Teo, HL Ng, J Tan, R Chen, TL Tay
Department of Dietetic & Food Services, Endocrinology, Changi General Hospital, Singapore
Aims
This study aims to compare the dietary compliance between a diet consisting of 2 meal replacements daily, with a conventional reduced-fat diet. The study also evaluates the improvement in dietary knowledge, attitudes and practices
(KAP) post dietary intervention.
Methods
Men aged 30-65 years, with body mass index (BMI) ≥ 27.5 kg/m2, were recruited from both inpatient and outpatient
clinics in Changi General Hospital, as well as the general public. The subjects were randomized into 2 groups, partial
meal replacement or conventional reduced-fat diet group. At 4-week intervals, weight, percentage of body fat, and
waist circumference were measured, and food intake and adherence to the diet and exercise plan reviewed. At baseline and after 12 weeks of intervention, a nutritional questionnaire was conducted to assess changes in dietary
knowledge, attitudes and practices.
For subjects in the partial meal replacement group, meal replacement supplements were given to the patients to replace 2 meals per day. A diet plan consisting of a variety of normal food was given to provide the third meal. This diet
was designed to providea deficit of ~500 kcal/day based on the subject’s Basal Metabolic Rate (BMR) using the HarrisBenedict Equation, for adjusted body weight. For subjects on the conventional diet, no meal replacements was given,
instead, each subject was given a balanced meal plan which also provides ~500 kcal/day less than his/her BMR.
Results
Both the partial meal replacement group and the conventional group had similar reduction in weight. The meal replacement group had greater decrease in waist circumference and fat mass. The meal replacement group had a greater compliance with the meal plan provided compared to the conventional group. In terms of the dietary knowledge,
both meal replacement and the conventional group had similar improvement in dietary knowledge, attitude and practices.
Conclusions
Meal replacement diets are as effective as a conventional reduced-fat diet for weight loss, but the meal replacement
group showed higher compliance rate during the 12 week study. This confirms that meal replacements can help with
weight loss but further study is required to review the long term compliance and benefits.
139
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
POST PROCEDURE CARE IN THE GENERAL WARD AFTER TRANSRADIAL
PERCUTANEOUS CORONARY INTERVENTION: AN INITIAL EXPERIENCE
J See*, YS Goh, SH Ong, BW Liew, L Tay, CH Tan, KL Tong
Department of Cardiology, Changi General Hospital, Singapore
Aims
Percutaneous coronary intervention (PCI) is a mainstay therapy for patients with coronary artery disease. With advancing technologies and skills, the periprocedural risk of PCI has been declining. In recent years, the transradial approach for PCI has been gaining popularity with improvements in access site complication rates and outcomes. Locally,
post PCI patients are traditionally monitored in the High Dependency Unit (HDU). Given the limited availability of such
beds, this study aims to evaluate the safety of General Ward (GW) monitoring for transradial PCI patients who had uncomplicated procedures.
Methods
This was a single center protocol. Patients above 21 years of age and of both genders who underwent uncomplicated
transradial PCI were included. Exclusion criteria were patients with 1) Femoral vascular access 2) Myocardial infarctions 3) More than 1 vessel intervention 4) Left main intervention 5) Intra-procedural complications 5) Intra-arterial
line monitoring 7) Other conditions deemed by interventionalist/cardiologist-in-charge to require HD/ICU care.
An initial 20 patients were analyzed. All patients were monitored in a specialized Cardiology GW with telemetry monitoring. Management of complications were as per standard care.
Results
Mean age of the patients was 56.2 years. Majority were male (19 patients).
There was acute procedural success in all patients. No patient suffered any of the pre-defined outcomes of inpatient
myocardial infarction, stroke, acute kidney injury, arrhythmias, vascular complications or death. 2 patients were readmitted within 30 days after discharge for unrelated events (one for elective surgery, one for atypical chest pain).
Conclusions
The management of low risk patients in the GW is safe with a low prevalence rate of complications. This can free up
HDU beds for patients with acute and more serious conditions. Further data collection with this protocol could include
patients with haemodynamically stable acute coronary syndromes and those who had more complex interventions
(e.g. multi-vessel or bifurcation PCI).
140
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
COLONOSCOPY IN PATIENTS ON WARFARIN THERAPY: OUR PRACTICE - IS THERE
BLEEDING?
CP Wong*, F Teo, R Wijaya, KK Sng, SM Tan
Aims
To determine the overall risks of haemorrhage versus thromboembolism in patients on warfarin therapy undergoing
colonoscopy.
Methods
A retrospective, single-centre cohort study was conducted for a one-year period of patients on warfarin therapy
undergoing colonoscopy in the year 2011. Patient demographics, indications for colonoscopy, endoscopic findings,
type of endoscopic procedures carried out, use of concurrent antiplatelet agents, patient’s personal risk factors for
bleeding, and incidence of bleeding were documented from our centre’s electronic case records. Bleeding episodes
were classified as early or delayed. Colonoscopic polypectomy was defined as a high-risk procedure, while low-risk
procedures included colonoscopy with or without biopsy.
Results
21 patients on long-term warfarin therapy who underwent colonoscopy were reviewed. Warfarin therapy was
temporarily stopped in the patients before the procedure and none received bridging heparin therapy. Seven
underwent polypectomy. Mean pre-colonoscopy INR was 1.40. One patient from the polypectomy group had early
bleeding (14.3%), none from the low-risk group. The overall incidence of haemorrhage is 4.76%. There were no
thromboembolic events in all patients up to 30 days post-colonoscopy.
Conclusions
Patients on warfarin therapy who undergo colonoscopy according to existing guidelines confers an acceptable
thromboembolic risk with temporary cessation of warfarin prior to the procedure, however, there is an increased risk
of bleeding when the patient undergoes a polypectomy
141
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
A RANDOMISED CONTROLLED TRIAL ON ULTRASOUND-ASSISTED SPINAL
ANAESTHESIA
YC Lim*, CY Choo, KTJ Tan
Department of Anaesthesia, Changi General Hospital, Singapore
Aims
Pre-procedural ultrasound scan has been used to facilitate spinal anaesthesia in patients with difficult anatomical
landmarks and shown to improve first-attempt success rates in some studies. We studied whether pre-procedural
ultrasound scanning improves first-attempt success rate and decreases time taken for the procedure in the general
adult population.
Methods
In this prospective randomised controlled trial, 170 patients, aged between 21 and 80 years and ASA 1 to 3, were
recruited. Patients were randomised into two groups: ultrasound guided identification of landmarks (Ultrasound
Group) and manual palpation of landmarks (Manual Palpation Group). The primary outcome was the first-attempt
success rate and secondary outcomes were the time taken to perform the procedure, the number of needle
redirections, patient satisfaction and complications.
Results
The first-attempt success rate was 64% in the Ultrasound Group and 52% in the Manual Palpation Group (p=0.16).
Time taken for the procedure was shorter in the Ultrasound Group compared to the Manual Palpation Group (2.9±3.6
min vs 3.9±3.7 min, p= 0.007). Patient satisfaction was higher in the Ultrasound Group. There were no significant
differences between groups for procedure complications.
Conclusions
There was no statistically significant difference between the groups in the first attempt success rate. Evidence
supporting routine pre-procedural scanning of all patients having spinal anaesthesia is inadequate. We suggest that pre
-procedural ultrasound scans are limited to selected patients for whom spinal anaesthesia appears technically
challenging using conventional methods.
142
BEST POSTER AWARD
(CLINICAL MEDICINE)
ABSTRACTS
OPTIMIZING ORAL HYGIENE TO REDUCE VENTILATED ASSOCIATED PNEUMONIA
AT CHANGI GENERAL HOSPITAL SURGICAL INTENSIVE CARE UNIT
T LEE1*, ZC Sng1, XY Song1, K Yeo1, Mohd Bashir F1, PC Tan1,QS Meng2, NLSH Lim3
1
Department of Infection Control, Changi General Hospital, Singapore
3
Department of Anaesthesia, Changi General Hospital, Singapore
2
Aims
The objective of this study is to explore the possibility of increased frequency of oral toilet using Chlorhexidine
Gluconate 0.2% mouthwash to reduce VAP.
Methods
During March – August 2013, apart from the VAP care bundle adopted by the hospital to reduce VAP at CGH ICUs, all
SICU nurses were briefed to perform 4 hourly oral care using Chlorhexidine Gluconate 0.2% mouthwash for all
intubated patients.. Collected data during the period included nurses’ compliance to VAP protocol,4 hourly oral toilet
as well as type of endotracheal tube used. Incidences of VAP would be flagged out by CGH Infection Control
Department during their routine surveillence and attending intensivist would be consulted.
Results
In this study, out of 120 intubated cases at SICU, the average days of intubation were 8.19 days ranging from 3-59
days. 43.6% and 38.21 % were intubated with standard endotracheal tube and subglottic secretion drainage
endotracheal tube respectively. The nurses’ compliance to perform 4 hourly oral care with Chlorhexidine Gluconate
0.2% mouthwash and CGH VAP bundle was 95.1%. There was no incidence of VAP during this period.
Conclusions
Our findings indicate that increasing the frequency of oral toilet to 4 hourly with Chlorhexidine Gluconate 0.2%
mouthwash could possibly reduce the incidence of Ventilator Associated Pneumonia at SICU. This study merits ongoing
research as reducing the incidence of VAP will reduce the costs of patient care.
143
Best Poster Award Education
21 November 2013
1030 - 1300
144
BEST POSTER AWARD
(EDUCATION)
Judges:
ED P-023
A/Prof Goh Siang Hui (CGH)
Prof Chay Oh Moh
(KKH)
USING A REPOSITIONING REGIME IN PREVENTION OF HOSPITAL ACQUIRED PRESSURE ULCER (HAPU)
Ms Leong Yoke Yin, Ward 37, Changi General Hospital
ED P-024
THE COCA-COLA EXPERIMENT AND PICTURE TALES: AN EXPERIENTIAL
LEARNING IN UNDERSTANDING RESEARCH METHODS
Ms Norasyikin Hassan, Nursing Administration, Changi General Hospital
ED P-025
DEVELOPING A PRACTICAL AND USER-FRIENDLY ORAL CARE TOOLKIT
FOR DEPENDENT ELDERLY
Ms Janet Toh Lay Siang, Nursing, Changi General Hospital
ED P-026
ED P-027
THE EFFECTS OF CONDUCTING MANAGEMENT OF ANGRY, AGGRESSIVE
AND VIOLENT PATIENTS ON CHANGI GENERAL HOSPITAL STAFF
Ms Siti Aminah Abdul Majid, Psychological Medicine/Ward 14, Changi General Hospital
REDESIGN THE ASTHMA TREATMENT AND FOLLOW UP PROCEDURES IN
ORDER TO INCREASE THE HEALTH OF ACTIVE ASTHMA PATIENTS IN
QUEENSTOWN
Ms Chia Chin Wenn, Queenstown Polyclinic, Queenstown Polyclinic
ED P-028
ED P-029
TOOLS USED IN ASSESSING MEDICATION COMPLIANCE IN THE ELDERLY
Ms Lee Hoi Lun, Pharmacy, Changi General Hospital
AN INNOVATIVE ELECTIVE ON COMMUNITY GERIATRICS FOR YEAR 4 MEDICAL STUDENTS
Dr David Yong, Geriatric Medicine, Changi General Hospital
145
BEST POSTER AWARD
(EDUCATION)
ED P-030
CRANBERRIES SUPPLEMENTATION: EVIDENCE FOR CARDIOVASCULAR
HEALTH
Ms Karen Poh Shuet Ling, Case management, Changi General Hospital
ED P-031
REDUCING PNEUMONIA RATES IN NURSING HOME RESIDENTS THROUGH
IMPLEMENTATION OF ORAL HEALTH AND SAFE SWALLOW EDUCATIONAL
PROGRAM
Ms Lee Yan Qing, Rehabilitative Services/Speech Therapy, Changi General Hospital
ED P-032
WEB-BASED SELF-MONITORING WEIGHT CONTROL INTERVENTION FOR
CGH STAFF
Ms Angena Teo, Dietetic and Food Services, Changi General Hospital
146
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
USING A REPOSITIONING REGIME IN PREVENTION OF HOSPITAL ACQUIRED
PRESSURE ULCER (HAPU)
YY Leong
Aims
Pressure ulcers are easier to prevent than to treat, and once they have formed, they can lead to pain and even death.
For this reason, it is crucial that health care providers prevent pressure ulcers before they begin to form.
Repositioning reduces the length of time that the tissue is under pressure and maintaining an adequate supply of
oxygen and nutrients to the area; preventing tissue death.
To reduce pressure ulcer rate and evaluate the effectiveness after using a repositioning regime.
Methods
A standardized repositioning regime in the wards including training nurses on 2 hourly repositioning technique,
assessments of patient’s skin integrity upon admission/ transfer-in, selecting a posture that is acceptable for the
individual, proper lifting technique, usage of transfer aids to minimize friction and shear on the skin and soft tissues.
Proper documentation was also reinforcing to the nurses as it facilitates monitoring of progress of skin integrity. Data
for pre and post HAPU indicators were compared to determine the effectiveness of the repositioning regime.
Results
A total of 25 wards participated in the repositioning regime. Data on HAPU was collected from 4 July 11 to 26 August
11. Pressure ulcer rate was compared to pre repositioning regime from January to December 2012. Results showed
that pressure ulcer rate had reduced by 70% following the implementation of repositioning regime.
Conclusions
The results of this study showed that using the repositioning regime at regular intervals reduced pressure ulcer rates in
the hospital.
147
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
THE COCA-COLA EXPERIMENT AND PICTURE TALES: AN EXPERIENTIAL LEARNING
IN UNDERSTANDING RESEARCH METHODS
Norasyikin H*, BL Soh, PC Tan, Sri Rahayu M, Yang Chek S, Jessica Y
Aims
The project aimed to evaluate illusionary representations to enhance learners’ understanding of quantitative and qualitative research methods.
Methods
The illusionary representations are teaching techniques to engage learning. The Coca-Cola Experiment and Picture Tales were designed for teaching quantitative and qualitative research methods respectively at the nursing research
course held in June and September 2012 in Changi General Hospital. 29 nurses attended the course altogether.
The Coca-Cola Experiment was an exercise for learners to participate in measuring the effect of their pulse rate after
ingesting a caffeinated-carbonated drink to simulate a randomised controlled trial. During the “interventions”, the
learners were expected to state the sampling method, inclusion/exclusion criteria and measurement tool.
Pictures Tales was to enhance understanding on qualitative research methods and analysis. Random pictures of people
in their daily life were displayed in the class. There were group discussions to share their impressions of the subjects on
the pictures followed by group presentations. The learners were expected to state common terms from the
presentations and identify a theme to interpret the pictures.
Independent course evaluation tool using Learning Management System was used to evaluate the course materials,
training process and overall expectation. Commentary feedback was also included.
Results
Majority of the learners agreed the course materials were at an understandable level (n=23). 79.3% agreed there were
sufficient activities for practice. 75.8% of the learners agreed the visual aids reinforced their learning. The overall
impression of the course was positive with 79.3% stating it met their expectation. The verbatim feedback from learners
were “interesting”, “active interaction”, “easier for us to understand” and “the group activities enabled me to practise
what I have learned”.
Conclusions
Learners’ engagement is imperative in their learning process. The illusionary representations in the nursing research
course were visible in augmenting the learners’ understanding in research methods and application.
148
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
DEVELOPING A PRACTICAL AND USER-FRIENDLY ORAL CARE TOOLKIT FOR
DEPENDENT ELDERLY
LS Toh, MN Kee, Imma Harliny , I Fronda, B Wong, WG Seow, YQ Lee
Department of Nursing, Rehabilitation, Changi General Hospital, Singapore
Aims
To improve compliance and ease of oral care provision amongst nurses and caregivers through creation of new oral
care toolkits
Methods
A 3-pronged approach was adopted to achieve the aim; firstly, creating individualised and practical oral care toolkits as
each patient’s oral care needs are different and will require different items for care. Secondly, training the hospital
staff regarding the use of toolkit and the best oral care practices. Lastly, the continuity of care was reinforced by
educating patients’ caregivers regarding the oral care methods and the use of toolkit during caregiver training.
Caregiver training booklets were given to serve as a guide after discharge.
Subsequently, feedback forms and 5-point likert scale questionnaires were given out to the nurses and caregivers to
evaluate effectiveness of training and their opinion about the new oral care toolkits.
Results
Overall 100% of nurses and caregivers are generally satisfied with the new oral care toolkits and found the new toolkit
easy to use. 85% of the nurses found the new toolkits practical and would highly recommend the toolkit to other
colleagues.
Conclusions
Oral hygiene care is often neglected due to the circumstances surrounding acute hospitalisation. Oral hygiene plays an
important role in determining one’s chances for contracting pneumonia. The implementation of this project has
assisted the nurses’ and caregivers’ ease of use and compliance to the oral care practices by providing them with
appropriate training and a more practical and effective oral care toolkit. Consequently, the oral hygiene status of
patients are improved over a long-term basis.
149
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
THE EFFECTS OF CONDUCTING MANAGEMENT OF ANGRY, AGGRESSIVE AND VIOLENT PATIENTS ON CHANGI GENERAL HOSPITAL STAFF
Majid S A *, Sukor E S, Rahim S, Ayengar S K, Salikin Y C
Aims
The primary aim is to evaluate the effectiveness of the training programme in managing angry, aggressive and violent
patients for Changi General Hospital staff. It also focuses on improving staff’s awareness and understanding on the
cycle of aggression and violence.
Methods
A set of multiple choice questions was designed to assess participant’s knowledge on aggression, techniques and
communication. The test was administered before and after the training to measure pretest-posttest effect. Three
sessions were held from March 2013 to September 2013. 55 participants attended the training and participated in the
pretest and posttest sessions.
Results
The participants consisted of senior staff nurses 29% (n=16), staff nurses 33% (n=18) and enrolled nurses 24% (n=13).
Others comprised of principal enrolled nurse (n=3), medical social worker (n=1), resident physician (n=1), health care
assistant (n=1) radiographer assistant (n=1) and telecarer (n=2).
As for questions on aggression, causes and elements of anger and the assault cycle, the participants responded with an
average mean score of 66.7% in the pretest and 83.3% in the posttest; an improvement of 17%.
For questions asked on techniques and de-escalation, there was an average mean score of 87% in the pretest and 97%
in the posttest; an improvement of 10%.
Lastly, for questions on communication, the participants responded with an average mean score of 40% in the pretest
and 80% in the posttest, with an improvement of 40%.
Conclusions
To conclude, the posttest has generally showed an increased percentage in the participants' knowledge and
techniques managing angry, aggressive and violent patients. Further recommendations on the training would be to
include restraint techniques and also self-care. Follow-up research will also be conducted in the future to measure the
confidence level of staff who have completed the training in handling such confrontational situations as compared to
staff who have not attended the training programme.
150
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
REDESIGN THE ASTHMA TREATMENT AND FOLLOW UP PROCEDURES IN ORDER
TO INCREASE THE HEALTH OF ACTIVE ASTHMA PATIENTS IN QUEENSTOWN
C W Chia*, Anandan G T, Angela L K Y
Singhealth Polyclinic, Queenstown, Singapore
Aims
Asthma is a common lung condition seen in SingHealth polyclinics. Good asthma control results in improvement in
the quality of life and correlates well with Asthma Control Test (ACT) score of ≥20. The Percentage of patients with ACT
scores ≥20 is used by SingHealth Polyclinics as a Quality Indicator measuring the level of Controlled Asthma in the
Polyclinic setting. The percentage of active asthma patients with ACT score of ≥20 average was 73% in 2011 (77.5% is
the Key Performance Indicator target for asthma). The team members redesigned the asthma treatment and followed
up procedures in order to increase the health of active asthma patients in Queenstown Polyclinic.
Methods
For the intervention, 5 Plan-Do-Study-Act cycles were used to test and refine the workflow before implementation. A
sample size of 20 asthma patients were selected at random, we used 2 PDSA cycles to test before and after the new
implementation of the workflow.
Results
There was an increase in the percentage of ACT scores ≥ 20 for the 3 months following commencement of the EPIC
project. Overall, there was improvement seen in asthma patients' condition and increase in patient and staff
satisfaction. Patients with ACT score < 20 were sent for counselling by nurses. Workflow for asthma was redesigned to
include a reminder note for doctors. 6 monthly teaching sessions for nurses and doctors on asthma management were
implemented. An asthma registry was set up to keep track of patients with ACT< 20. Such patients were followed up
up by nurses 4 weeks post treatment for ACT rescoring.
Conclusions
As of November 2012, we have achieved and maintained the target of 77.5%. We would like to share this information
with other polyclinics to improve their ACT score.
151
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
TOOLS USED IN ASSESSING MEDICATION COMPLIANCE IN THE ELDERLY
Lee H L*, Ang W S T
Aims
Medication compliance is a prominent problem in the elderly patients and may be a result of polypharmacy and
complex pharmacological regimens required to control chronic medical conditions. There are immense consequences
to medication noncompliance such as possible worsening of health and inaccurate reassessments of the medical
conditions, giving a false impression that the existing medicines are insufficient and additional medicines are required
to better control the disease. Therefore accurate determination of medication compliance in the elderly patients with
a suitable tool is important so that appropriate actions can be taken to resolve issues that hinder compliance. The
appropriateness of the tools is dependent on the unique characteristics of the elderly, such as lower literacy, shorter
attention span and multiple comorbidities. The aim of this project is to identify the medication compliance tools
available, and to evaluate the tool that is most suitable for elderly patients.
Methods
A literature search was performed using the terms “elderly”, “medication compliance tool” and “medication
adherence tool”, with no date limit. Prospective and retrospective studies as well as meta-analyse were included.
Results
A total of 16 articles describing the use of nine medication compliance tools were shortlisted. These tools vary in the
level of literacy required for accurate assessment, and validity in the different disease states. The Morisky 4-item
Medication Adherence Scale was found to be validated in numerous disease states common in the elderly and
evaluated to be the simplest of all tools to assess medication compliance.
Conclusions
Taking into account the multiple comorbidites and lower level of literacy of the elderly, the Morisky 4-item Medication
Adherence Scale may be a suitable tool to assess medication compliance. Moving forward, we aim to conduct a
medication adherence survey to assess medication compliance of the elderly patients in CGH, so that necessary actions
can be taken for improvement.
152
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
AN INNOVATIVE ELECTIVE ON COMMUNITY GERIATRICS FOR YEAR 4 MEDICAL
STUDENTS
Lee P *, YONG D, LIEN C, , LOW S L
Aims
To describe the structure and process of the CGH Community Geriatrics Elective for Year 4 Medical Students
Methods
Whether or not a medical student chooses to specialize in Geriatrics, geriatric patients and issues will be a central part of their future practice.
The program will introduce the students to a rich and diverse experience in elderly care in the community, supplement and expand
their final year hospital geriatrics rotation and add value totheir overall medical learning.
Students participate in a 2 week clinical and didactic program in geriatrics at these various sites .Teaching will be done by following
two community geriatric careconsultants at various site visits such as a geriatric subacute and
rehabilitation ward, community hospital, day rehabilitation centre, sheltered home, nursing home and home care . They will also
visit new innovative service models like postacute Transitional Care, ACTION, SPICE and Transitional
Convalescent Facility.They will get an introduction to aspects of subacute, rehabilitative , preventive and long term care. They will
also gain an understanding of the roles of these respective services in care of elderly.Students can opt to do a short project : audit
or an observational study.
Students will discuss with and be taught by the consultant or service provider,and encouraged to keep a journal to
report their experiences.
They complete a short exit test and then give their feedback.
Learning Objectives 1 : To expose the medical student to the evaluation of elderly patients in the community which includes chronic disabling diseases, role of the environment, ethics and end of life care.
Learning Objectives 2 : To enhance the student’s understanding of appropriate utilization of health care resources as part of ‘slow
stream medicine’ to improve health outcomes The short project will introduce students to concept of data analysis.
Results
For last three years , the course has been fully subscribed( 8). Two students opted for project. One was an audit on weight loss in
Nursing Home which was presented by the student at the AIC National ILTC Conference, the other was an observational study on
poor feeding in NH residents. All have rated the course as excellent( >8/10), learning being 'fun or enjoyable' , having achieved
their learning objectives and would highly recommend it to their peers and juniors. Half of them wanted the course to be more
intensive.
Conclusions
This elective that offers students an opportunity to see and learn about patients enrolled for various services provided at different
community sites is well received.
153
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
CRANBERRIES SUPPLEMENTATION: EVIDENCE FOR CARDIOVASCULAR HEALTH
SLK Poh*, LL Chen, P Lum, W Soo, M Tan, LT Chan
Department of Nursing, Changi General Hospital, SIngapore
Aims
Health Benefits attributed to Cranberry includes the prevention of urinary tract infection and stomach ulcer. Research
has shown that cranberries has by far the largest amount of both free and total phenols among fruits which could contribute to reducing the risk of cardiovascular disease by increasing the resistence of LDL to oxidation and inhibiting
platelet aggregation. This study aims to report a meta analysis of scientific evidence of cranberry and explore its cardiovascular prevention benefits for healthy adults to be used for health education.
Methods
A systemic literature review was carried out in 2013 using ovidmedline and CINAHL Full text databases and hand
searching of database with keywords Cranberry, cardiovascular, lipid, cardioprotection and heart. This results in 41 full
text articles in which only 6 are relevant to the research. Papers that were excluded were not investigating the benefits between cranberries and the heart. A search of Cochrane (June 2013) yielded no results. Three reviewers assessed
the data found according to JBI methodology. The reviewers were not blinded to authors or journal.
Results
Reduction of LDL by consumption of cranberries were well supported by all research. Two studies report platelet aggregation inhibitation observed in their studies.In summary, the information available in the literature is supportive of
the cardiovascular benefits of cranberries which provides preventive treatment modality. Cranberry is reported to contain salicyclic acid, the active form of acetylsalicyclic acid. which consistent studies have proven its benefits impact with
CVD risk.
Conclusions
Cranberries could be used as preventive supplement for cardiovascular protection besides the other known benefits
such as prevention of urinary tract infection and stomach ulcer.
154
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
REDUCING PNEUMONIA RATES IN NURSING HOME RESIDENTS THROUGH
IMPLEMENTATION OF ORAL HEALTH AND SAFE SWALLOW PROGRAM
Lee Y Q*, Wong B Yong D, Lacuesta C
Department of Nursing, Rehabilitative Services, Geriatrics Medicine, Changi General Hospital, Singapore
Aims
Pneumonia is one of the most common reasons for hospitalization in nursing home residents. Through the
implementation of Oral Health and Safe Swallow (OHSS) Programme, the project aims to improve dysphagia
management, provide quality oral care, and reduce pneumonia rates in Nursing Home (NH) residents.
Methods
The OHSS Programme is an enhanced nurses training programme which aims to reduce pneumonia rates by targeting
two preventable factors contributing to pneumonia: aspiration from dysphagia, and poor oral care. In this project, 51
nurses and nursing aids from Lions Home (Bedok) were trained on identifying and managing dysphagia, safe feeding
strategies, and proper oral care methods. Training was conducted via didactic teaching, hands-on practical and
periodical visits for follow-up consultation. Ten OHSS Champions were identified to advocate for and ensure
compliance with appropriate oral care and safe feeding methods. Outcome measures included: Pre and Post-Training
Questionnaires to evaluate staff knowledge, Oral health status of all NH residents, and rates of residents admitted for
pneumonia.
Results
This is a one-year ongoing project which will be concluded in March 2014. Preliminary findings showed that 80% of
nursing staff achieved improved scores on the Post-Training Questionnaire. Seventy-eight percent of staff achieved a
score of at least 15/20 (75%) at post-training, compared to 41% at pre-training. All nurses indicated that the
programme was useful, easy to learn, practical and they would recommend it to other nursing homes. Though data
collections for oral health status and pneumonia rates are still ongoing, the data suggests that there is a decrease in
pneumonia rates during the course of implementation.
Conclusions
OHSS is an effective training program with high acceptance rate by NH staff to improve knowledge and skills for
managing dysphagia, improve oral care and reducing pneumonia rates. The success of this programme suggests that
OHSS can be replicated in other Nursing Homes, especially those with high pneumonia rates.
155
BEST POSTER AWARD
(EDUCATION)
ABSTRACTS
WEB-BASED SELF-MONITORING WEIGHT CONTROL INTERVENTION FOR CGH
STAFF
A Teo*, M Cheong, SH Tan, PL Chia
Department of Dietetic & Food Services, Changi General Hospital, Singapore
Aims
To improve the nutrition and exercise habits of CGH staff using a web-based intervention approach thus promoting
weight loss in overweight or obese individuals to encourage self-management.
Methods
CGH staff was invited to form teams of 2 or more staff and participate in an interdepartmental weight loss
competition. Over the course of 3 months, participants were encouraged to record their dietary intake and physical
activity on myhealth.sg while recording their weekly weights on SharePoint. Each participant was also weighed monthly and received hand-outs on nutrition and exercise. In addition, the weight loss of teams and more practical tips were
posted on SharePoint and sent via email to participants each month.
A pre and post-KAP (Knowledge, Attitude and Practices) survey was given to assess the intervention’s effectiveness in
changing eating knowledge, attitudes, and habits. A feedback form was also provided at the end of the competition to
gather information to improve future interventions.
Results
The highest average weight loss for a team was 4.38kg over 3 months. The greatest total individual weight loss 7.45kg
and the highest individual percentage weight loss was 9.88% over 3 months. The post-KAP surveys demonstrated an
overall increase in knowledge; greater importance was given to healthy eating attitudes, and more wholesome eating
practices. Feedback from the participants showed an improvement in knowledge of what to do to lose weight.
Although most participants did not record what they ate or what exercise/physical activity they did into myhealth.sg,
they valued the information communicated to them electronically, the support they got from colleagues to lose
weight, the regular monitoring of their weight, and the motivation that came from being in the competition.
Conclusions
A web-based self-monitoring approach is shown to increase knowledge amongst overweight and obese CGH staff. The
intervention also supports past literature that weight loss competitions are effective in motivating participants to lose
weight and to persevere with eating healthily. This web-based approach facilitates nutrition education and promotes
self- management for improved outcomes.
156
Best Poster Award Research
21 November 2013
1030 - 1300
157
BEST POSTER AWARD
(RESEARCH)
Judges:
RE P-032
Dr Serena Koh
Dr James Sim
Dr Tan Wei Wei
(MOH)
(SGH)
(KKH)
COGNITIVE-COMMUNICATION SCREENER FOR ENGLISH & MANDARIN
DOMINANT ADULTS WITH TRAUMATIC BRAIN INJURY
Ms Geraldine Tan, Rehabilitative Services, Changi General Hospital
RE P-033
RE P-034
AURAL REHABILITATION FOR ADULTS WITH COCHLEAR IMPLANTS
Ms Angie Foo An Qi, Speech Therapy, Changi General Hospital
NURSES’ PERCEPTION IN CARING FOR STROKE PATIENTS IN AN ACUTE
CARE HOSPITAL: A QUALITATIVE STUDY
Ms Yap Fui Chin, Case Management, Changi General Hospital
RE P-035
RE P-036
HEALTH AS A VALUE IN OLDER VS YOUNGER PRIMARY CARE PATIENTS
Dr Joanne Quah Hui Min, Outram Polyclinic, Changi General Hospital
DEVELOPMENT OF MOLECULAR DIAGNOSTIC ASSAY FOR DETECTION OF
BURKHOLDERIA PSEUDOMALLEI
Dr Boran Jiang, Laboratory Medicine, Changi General Hospital
RE P-037
UTILISATIN PATTERN OF REPEAT VISITORS TO ACCIDENT AND EMERGENCY AND FACTORS ASSOCIATED WITH REPEAT VISITS
Dr Tin Aung Soe, Health Services Research, Eastern Health Alliance
RE P-038
REFEEDING HYPOPHOSPHATAEMIA IN PATIENTS ON PARENTERAL NUTRITION SUPPORT - AN AUDIT ON INCIDENCE AND ASSOCIATED RISK FACTORS
Dr Alvin Wong, Dietetic & Food Services, Dietetic & Food Services
158
BEST POSTER AWARD
(RESEARCH)
RE P-039
POST MASTECTOMY PAIN SYNDROME (PMPS) IN LOCAL BREAST CANCER
SURGERY PATIENTS
Ms Ong Yet Yin, Nursing/Pain Service, Changi General Hospital
RE P-040
RE P-041
NEEDS OF ASIAN BREAST CANCER PATIENTS
Dr Chow Wai Leng, Health Services Research, Eastern Health Alliance
FACTORS THAT CONTRIBUTE TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ACCEPTANCE IN OBSTRUTIVE SLEEP APNEA (OSA) PATIENTS IN SINGAPORE
Ms Liang Jieying, Clinical Service Support, Sleep Lab, Changi General Hospital
RE P-042
TO EVALUATE THE EFFECTIVENESS OF THE COMPLIANCE KIT ON THE READMISSION RATES IN HEART FAILURE PATIENTS
Ms Zhang Shu Hua, Dietetic and Food Services, Changi General Hospital
RE P-043
THE EXPERIENCE AND PERCEPTION OF CARING FOR PERSONS WITH DEMENTIA BY THE NURSES WORKING IN THE GERIATRIC UNITS IN AN ACUTE
HOSPITAL.
Ms Zhang Di, Nursing, Changi General Hospital
RE P-044
ANTIMICROBIAL SUSCEPTIBILITIES OF ANAEROBIC ORGANISMS CAUSING
BLOODSTREAM INFECTIONS
Ms Lily Ng Siew Yong, Laboratory Medicine, Changi General Hospital
RE P-045
THE SIGNIFICANCE OF TWO-DIMENSIONAL STRAIN IN DOBUTAMINE
STRESS – SINGLE CENTRE EXPERIENCE
Ms Tan Puay Joo, Clinical Measurement Unit, Changi General Hospital
159
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
COGNITIVE-COMMUNICATION SCREENER FOR ENGLISH & MANDARIN DOMINANT ADULTS WITH TRAUMATIC BRAIN INJURY
G TAN*, G WEE & S JALIL
Aims
Cognitive-communication deficits post Traumatic Brain Injury (TBI) has been shown to be long-lasting and have a negative impact on re-integration into society (Chua & Kong, 1999). Although early diagnosis and intervention is crucial, till
date, there are no locally-developed screener for English or Mandarin Dominant adults with TBI. The aim of this research is to develop a sensitive and reliable TBI screener for use in the acute setting with English or Mandarin Dominant adults.
Methods
Firstly, a cognitive-communication screener in the English and Mandarin language was developed. Up to 18 different
sub-tests were developed to measure attention, memory, organization, reasoning, problem-solving and sequencing.
Secondly, normative data was collected from 60 neurologically-intact participants (from each study group) aged between 21 – 80 years old. The participants were further stratified by their education qualifications – ranging from primary to tertiary levels. Scores on accuracy and response times were taken as measures of ability for each subtest.
The English and Mandarin screeners were found to have good internal reliability with Cronbach’s alpha of .776
and .878 respectively. Percentiles for scores and response time are reported for normative benchmarking.
Results
All trauma patients who meet the criteria for TBI (failed Westmead Post Traumatic Amnesia test - a test to check for
presence of memory and orientation impairment post TBI, presence of neurological injury, coma) are identified from
the trauma database. These patients are then screened for cognitive-communication deficits using the locally normed
English and Mandarin local screener developed above.
Conclusions
This locally normed and reliable cognitive-communication screener developed for English and Mandarin Dominant
adults with TBI enables the Speech Therapists to identify areas of deficit quickly and thereby facilitate early intervention.
160
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
AURAL REHABILITATION FOR ADULTS WITH COCHLEAR IMPLANTS
AAQ Foo*, JY Choong, SLH Lee, S Kamath, LGR Peters, HW Yuen
Department of Speech Therapy, Changi General Hospital, Singapore
Department of Otolaryngology, Changi General Hospital, Singapore
Aims
Adults with severe to profound hearing loss who receive cochlear implants often lack the professional rehabilitative
support required to develop the ability to effectively use the sounds provided by implants. We aim to develop an aural
rehabilitation programme, specialising in the needs of adults so that they can effectively interpret their implant's
sounds. Encouraging patients to attune implant inputs with everyday sound awareness and speech recognition should
ultimately improve a patient's communication ability and quality of life.
Methods
Aural (re)habilitation programmes for cochlear implant recipients are highly developed for the paediatric population
based on auditory verbal therapy principles. However, aural rehabilitation for adults is sporadic and less developed in
Singapore and even in different parts of the world.
Speech therapists, audiologists and an ENT surgeon in CGH with the help of an auditory verbal therapist, pieced together limited materials from online and international sources to develop an aural rehabilitation programme appopriate for adults in local languages and with Singaporean flavour.
Results
Using speech tests and a self report questionnaire we found the adult cochlear implant recipients who went through
aural rehabilitation showed significant improvements in their speech understanding ability and quality of life.
Conclusions
CGH can lead the way in developing aural rehabilitation for adults into a recognised specialty in Singapore and various
parts of the world.
161
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
NURSES’ PERCEPTION IN CARING FOR STROKE PATIENTS IN AN ACUTE CARE
HOSPITAL: A QUALITATIVE STUDY
FC Yap*, P Wang, YY Li, XY Jiang, W Soo and M Tan
Department of Case Management, Changi General Hospital, Singapore
Aims
The aim of this study is to explore the general medical ward nurses’ perception of stroke care in an acute care hospital.
Methods
In this qualitative exploratory study, focus group interviews were conducted to examine nurses’ experiences in caring
for stroke patients. Nine registered nurses were randomly selected from the general medical wards. A total of 3 interview sessions were conducted with 2 to 4 registered nurses in each session. The interviews were audio recorded with
verbatim transcription. Individual transcripts were analysed for trends, patterns, and recurring themes.
Results
Out of 9 registered nurses being interviewed, 5 of them were Senior Staff Nurses and 4 were Staff Nurse. Their working
experiences ranged from 3 to 11 years with an average of 6 years. Four major themes emerged: 1) transferring 2) feeding 3) communication and 4) lack of time. Participants verbalized they experienced difficulties in transferring stroke
patients especially those with dense hemiplegia. Longer feeding time was required for those with impaired swallowing.
The communication with aphasic stroke patients was also a challenge. All of them felt that the inadequate time spent
on patient rehabilitation activities. They often do the tasks for the patient instead of assisting them to regain their
functional independence.
Conclusions
Understanding the challenges that general ward nurses faced in caring of stroke patients can help to identify areas to
improve the nursing care of stroke patients in general ward.
162
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
HEALTH AS A VALUE IN OLDER VS YOUNGER PRIMARY CARE PATIENTS
Eunice En Ni Lai1, Sze Jet Aw1, Sylvaine Barbier2, Joanne Hui Min Quah*3
1
Duke-NUS Graduate Medical School, Singapore
3
Outram Polyclinic, SingHealth Polyclinics, Singapore
2
Aims
A person’s values often determine how he or she will lead his or her life. A person’s value of health would then determine his preventive health behaviour.
Our study aims to determine the difference in the value of health between the young and the old in local primary care
patients, as well as to elicit the factors that are associated with this difference. Our study also aims to establish what
people of different age groups value the most.
Methods
The research was a cross sectional study of patients in Outram and SengKang Polyclinics. We systematically sampled
and conducted interviewer-based questionnaires on 262 patients. The Value of Health Scale by Lau et. al. and the
modified Rokeach Value Survey were used, and this data was correlated with social demographics of participants using
SPSS.
Results
We found that the younger primary care patients scored lower in the Health value scale than the older patients. Higher
educational levels attained correlated with a higher value of health. We also found that the value of health does not
have a significant association with favourable health behaviours, which suggest that healthy behaviours are not driven
by health alone. Notably, the young valued ‘an exciting life’ more than the old while the old valued ‘freedom’ more
than younger people.
Conclusions
As the younger population valued health less, efforts in encouraging healthy behaviours through promoting ‘health’ as
a value will not be productive. Instead, by encouraging the health behaviours through their other ‘more important’
values, they are more likely to engage in these behaviours.
163
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(RESEARCH)
ABSTRACTS
DEVELOPMENT OF MOLECULAR DIAGNOSTIC ASSAY FOR DETECTION OF
BURKHOLDERIA PSEUDOMALLEI
Boran Jiang*, Hao Zou, Danny Ong, Lily SY Ng, Thean Yen Tan
Department of Laboratory Medicine, Changi General Hospital, Singapore
Aims
Burkholderia pseudomallei is gram-negative environmental bacterium that causes the infectious disease, melioidosis,
which is endemic to Southeast Asia and Northern Australia. Melioidosis is a potentially fatal disease that could have
widely clinical manifestations, including acute septicemia and pulmonary infection with a fatality rate of 16.2% in Singapore, of which 50.4% were caused by septicemic melioidosis. Rapid detection of B. pseudomallei is important for
clinical diagnosis. This study is to evaluate analytical and clinical performance of two real time PCR assays which target
two different genes of B. pseudomallei.
Methods
Analytical sensitivity and specificity were evaluated by screening 32 B. pseudomallei strains and 39 non-B. pseudomallei strains (with 9 Burkholderia cepacia, 27 other gram-negative bacterial strains, and 3 gram-positive bacterial strains).
Clinical evaluation was performed by screening each assay across 93 clinical specimens (42 endotracheal tube aspirates
(ETTA), 35 sputum, 8 bronchoalveolar lavage (BAL), 4 urine, 2 nasopharyngeal swab, 1 tissue sample and 1 joint fluid).
Nucleic acid was extracted from the above samples and followed by real time PCR assays. PCR efficiency and limit-ofdetection (LOD) of these two assays were determined by analyzing a serial dilution of a clinical sample containing a
known number of colony forming units (cfu). Cut-off Ct of these two assays were determined based on the LODs. PCR
data was then compared against bacterial culture results.
Results
Both assays have high PCR efficiency, 100% for assay 1 and 103% for assay 2. LODs were found to be 4cfu/ul for assay 1
and 0.5cfu/ul for assay 2. Assay 1 showed analytical sensitivity of 96.9%, analytical specificity of 100%, clinical sensitivity of 92.3%, clinical specificity of 100%. Assay 2 had analytical sensitivity of 100%, analytical specificity of 100%, clinical
sensitivity of 100%, clinical specificity of 98.7%.
One patient with culture-confirmed systemic meliodosis had a urine sample tested that was culture-negative, but positive by PCR assay 2 (Ct 28.6).
Conclusions
This comparison study gives a comprehensive evaluation of two real time PCR assays which are valuable tools for rapid
identification of infection with B. pseudomallei. Based on limited data from this and other studies, PCR performed on
urine samples may improve the diagnostic yield of patients with meliodosis.
164
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(RESEARCH)
ABSTRACTS
UTILISATIN PATTERN OF REPEAT VISITORS TO ACCIDENT AND EMERGENCY AND
FACTORS ASSOCIATED WITH REPEAT VISITS
AS Tin1*, WL Chow1, T Mohan2
1
Department of Health Services Research, Singapore
Department of Accident & Emergency, Eastern Health Alliance, Singapore
2
Aims
The Accident and Emergency department (A&E) is a scarce resource that is being utilized more frequently by some patients than others. This study aimed to examine the factors associated with repeated A&E visits in a regional hospital in
Singapore.
Methods
We conducted a retrospective analysis of all attendances from 1 Jan 2011 to 31 Dec 2011 extracted from administrative databases. Variables examined included demographic characteristics, number of A&E visits, principle diagnosis,
mode of arrival and acuity status. Patients were categorized according to the frequency of A&E visits: 1 visit; 2-5 visits;
and ≥ 6 visits and compared for any differences in demographics and other factors. Ordinal logistic regression analysis
was performed using frequency of visits as dependent variable and other factors as independent variables.
Results
A total of 110417 patients accounted for 165031 visits. Mean age was 42 years, 59% were male, 55% were Chinese,
and 56% were P3 cases. 75.5% of patients had only 1 visit, 22.6% made 2-5 visits and 1.9% made ≥6 visits. About 24.5%
of patients who made > 1 visit contributed to 49.5% of total visits. Elderly patients (≥ 65 years) as well as young patients (≤ 25 years) had the highest age-specific re-attendance rate. Among the frequent repeated attendees (≥ 6 visits),
majority were self-referred (84%), 43% were ≤ 25 years, 19% of visits were for upper respiratory tract infection. Ordinal
logistic regression revealed that being male, ≤ 25 years, ≥ 65 years, self-referred and attending for asthma and common cold remained significantly associated with repeated A&E visits.
Conclusions
Our preliminary analysis suggested that interventions to address the problem of repeat A&E attendances would have
to be targeted based on the profile of the patient. More research should be performed to examine the factors influencing repeat A&E attendance among the young and elderly.
165
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(RESEARCH)
ABSTRACTS
REFEEDING HYPOPHOSPHATAEMIA IN PATIENTS ON PARENTERAL NUTRITION
SUPPORT - AN AUDIT ON INCIDENCE AND ASSOCIATED RISK FACTORS
WONG, A*., HSIEN, H.H., ONG, J.
Department of Dietetic & Food Services, Changi General Hospital
Department of Pharmacy, Changi General Hospital
Department of Gastroenterology, Changi General Hospital
Aims
Refeeding Syndrome is a known risk in patients on Total Parenteral Nutrition (TPN) and it is associated with medical
complications with neurological and cardiopulmonary involvement. Refeeding Hypophosphataemia (RH) is one of the
clinical signs of Refeeding Syndrome. An audit was performed to determine the incidence, risk factors involved, 30-day
and 6-month mortality of inpatient population with RH intiated on TPN.
Methods
Patients admitted to CGH and initiated on TPN between September 2011 and July 2013 were audited. Patients with
end stage renal failure and/or acute kidney injury requiring haemodialysis were excluded. Anthropometric, biochemical and demographic parameters were analysed. RH is defined as a decrease in serum phosphate levels of >0.16 mmol/
L to less than 0.65 mmol/L upon commencement of TPN. All patients were prescribed customised TPN by the Nutrition
Team or ready-to-use TPN bags (RTU) by the ICU.
Associations between RH and risk factors were determined with Fishers-Exact Test.
Results
Of the 129 patients initiated with TPN, 24 patients (19%) had RH. There was no sigificant associations found between
RH and Mortality rates, Baseline serum levels of Magnesium, Phosphate and Potassium, Carbohydrate and Calories
administered in TPN and ICU admission (p>0.05).
Relative risk (RR) of RH in underweight patients (BMI<18.5) is 1.385 (95%CI: 0.6-3.195, p=0.43). RR of RH in patients
initiated with RTU is 1.385 (95%CI 0.443-4.324, p=0.57) and is also higher at 1.345 (95%CI: 0.689-2.624, p=0.36) in patients with nil nutritional intake for more than 7 days.
Conclusions
There is a relatively high incidence of RH in patients initiated on TPN. Patients with BMI <18.5, and/or initiated on RTU
TPN bags without initial assessment by TPN team, and/or had minimal intake for >7 days may be at higher risk of RH.
These common predictive factors did not prove to demonstrate a significant risk for the development of RH in this audit, possibly due to the close monitoring of TPN patients, the provision of additional amounts of phosphate by the
team in anticipation of the development of RH and appropriate product selection for inclusion into the formulary, i.e.
RTUs with low dextrose loads, which thereby increased patient safety in general.
166
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ABSTRACTS
POST MASTECTOMY PAIN SYNDROME (PMPS) IN LOCAL BREAST CANCER SURGERY PATIENTS
CS Yoong*, YY Ong, Marlinda A, X Yu, SM Tan
Department of Anaesthesia and General Surgery, Changi General Hospital, Singapore
Aims
Chronic post-surgical pain (CPSP) is a common, but often unrecognized healthcare problem. CPSP has multifactorial
aetiologies - from nerve injury and excessive inflammatory response - causing peripheral and central sensitisation.
Post-mastectomy pain syndrome (PMPS) is one example of CPSP syndrome encountered after breast cancer surgery
(BCS). Sufferers can have persistent pain that interfere with Quality of Life (QOL). Studies indicate PMPS is present in
between 20 and 65% of BCS patients.
This study aims to study the prevalence of PMPS, its characteristics, and effects on QOL among Singapore patients, as it
has not been well studied locally, or among other Asian populations.
Methods
This cross-sectional, observational study reviewed a sample of 109 BCS patients recruited from a single breast surgery
centre. Patients were interviewed by 3 trained interviewers using a modified pain questionnaire and SF12 Health Survey questionnaire.
Results
Overall, 37 patients reported PMPS symptoms (33.9%). PMPS patients were younger (55.3 vs 63.0 years), although the
time interval since surgery were similar. The percentage of PMPS was significantly higher in non-Chinese patients
(48.7% vs 25.7%). PMPS patients did not differ in rates of mastectomies, axillary clearance and stages of the cancer.
Although “Current” and “Best Pain Scores” in PMPS patients were mild to moderate, four patients had “Worst Pain
Scores” in the severe range. PMPS patients had significantly lower SF12 physical component scores indicating an increase impact on physical health QOL.
Conclusions
PMPS is not uncommon in our local BCS patients, with a higher percentage of non-Chinese and younger patients. PMPS
patients had significantly poorer physical health QOL scores. As such, there should be more effort to highlight PMPS
and its effects to local clinicians, to allow more accurate and prompt diagnosis and treatment.
167
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(RESEARCH)
ABSTRACTS
NEEDS OF ASIAN BREAST CANCER PATIENTS
WL Chow*1, SM Tan2, AS Tin1
1
Department of Health Services Research, Eastern Health Alliance, Singapore
Department of Surgery, Changi General Hospital, Singapore
2
Aims
Breast cancer is the top cancer among females worldwide and in Singapore from 2008-2012. However, little research
has been done to understand the needs of breast cancer patients locally in order to better support them at the point of
diagnosis.
We therefore seek to examine the needs of breast cancer patients at the point of diagnosis.
Methods
This was a self-administered survey of all breast cancer patients diagnosed at a regional hospital from September 2009
to March 2013. Patients were surveyed on their needs in the following domains at the point of diagnosis: on the diagnosis of breast cancer, treatment, personal and emotional support, femininity and body image, family and friends, demographics and treatment details using a specific 5-point Likert scale questionnaire. Percentages of patients who
ranked each item very important or important were reported for each item.
Results
181 patients (response rate 53.4%) were recruited. Mean age was 52.6 years, majority were Chinese (75%) and married (70.6%). About 43.8% had early breast cancer (stage 0 and 1). The 3 areas that most patients felt were important
or very important at diagnosis involved treatment. They were: to have prompt information about treatment options
and side-effects (96.1%); ability to cope with treatment side-effects (95.5%); and to have prompt treatment for sideeffects (94.4%). The 3 areas that least patients felt were important or very important involved femininity and body image: to have information about reconstruction (47.8%); to have husband’s/partner’s acceptance of changed body appearance (56.7%); and to have time to adapt to one’s changed body appearance (63.5%).
Conclusions
Our study suggests that treatment concerns were of greater importance among majority of local breast cancer patients
at diagnosis, whereas body image and maintaining femininity were of lower importance. These findings will help inform the counseling and support for our patients.
168
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
FACTORS THAT CONTRIBUTE TO CONTINUOUS POSITIVE AIRWAY PRESSURE
(CPAP) ACCEPTANCE IN OBSTRUTIVE SLEEP APNEA (OSA) PATIENTS IN SINGAPORE
Liang JY, Seow ML, Goh MM, Wong JN, Sgeetha N, Thant E, Poh HL, Celedonio MC.
Department of Clinical Support Services, Sleep Laboratory, Changi General Hospital, Singapore
Aims
Continuous Positive Airway Pressure (CPAP) is the gold standard of treatment for Obstructive Sleep Apnea (OSA), but
acceptance is a significant problem that has been incompletely assessed.
Our aim is to determine the various factors which affect the acceptance of CPAP in patients with OSA.
Methods
A total of 745 patients were diagnosed with OSA (apnoea-hypopnea index ≥5/hour) from year 2011 – 2013 and referred to the CPAP counselling clinic for a one month CPAP trial. Patients were divided into two groups. One group consists of patients who refused CPAP treatment after undergoing the one month trial. The second group were those who
went through the trial and purchased the CPAP machine. Independent t-test was performed to identify the group
differences on the various factors like demographics and sleep study variables.
Results
From the whole research population of 745 OSA patients, 436 (58.5%) patients took up the one month CPAP trial.
Mean ± SD Age 48.5 ± 11.9 years; BMI 28.2 ± 7.6kg/m²; and RDI 43.3 ± 27/hour of sleep. Out of these 436 patients, 128
(17%) purchased the CPAP machine.
XAnalysis was made using the independent t-test and five variables were found to be significantly different (p<0.05)
between the two groups. These variables include desaturation (p=0.03), oxygen saturation (p=0.07), arousal index
(p=0.48), sleep efficiency (p=0.21) and Total Sleep Time (TST) (p=0.18).
Conclusions
We conclude that an overnight polysomnography study variable is the major factor that contributes to the patient’s
acceptance and purchase of the CPAP machine.
169
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
TO EVALUATE THE EFFECTIVENESS OF THE COMPLIANCE KIT ON THE READMISSION RATES IN HEART FAILURE PATIENTS
SH Zhang, Y Cao, Y Yeo, KT G Leong, S Lee, S Lim, DM Yang, K Poh, D Lim, SJ Loke, XY Chua, CH Lee
Department of Dietetic and Food Services, Changi General Hospital, Singapore
Department of Nursing, Department of Cardiology, Changi General Hospital, Singapore
Department of Rehabilitaive Services, Changi General Hospital, Singapore
Department of Pharmacy , Changi General Hospital, Singapore
Aims
Heart failure (HF) is associated with high mortality, morbidity and frequent readmission rates. Behavioural factors such
as noncompliance with medications and fluid or diet have been identified as one of the most common precipitants for
HF readmission. Our study aimed to evaluate the effectiveness of an intervention (compliance kit) on the readmission
rates in HF patients.
Methods
We conducted a prospective trial on 100 HF patients from Jun 2012- May 2013. A compliance kit comprising of a pill
box, water bottle, weighing machine and weight log book were given to facilitate self-monitoring. Patient also received
the standard HF education from the multi-disciplinary team. Telephone interview were conducted 30days after discharge to assess their compliance with utilisation and perception of the usefulness of the kit. Primary clinical outcome
of 30days all-cause readmission and HF readmission rates were compared to a matched group data in the same period
the previous year. Independent T-test and chi-square test were used for data analysis using SPSS version 19.0.
Results
A total of 93 patients were evaluated (7 lost to follow up).There were no significant differences in the race and cardiac
function between the two groups. The interventional group was younger (62 ±10.8 years compared to 70.7 ±10.8
years) and had more male (75.3% compared to 60.2%). The intervention was associated with a significant 13.2% decrease in all-cause readmission (12.9% vs 26.1%, p = 0.01) and a 9.1% decrease in HF readmission (3.2% vs 12.3%,
p=0.01). Patients rated the usefulness of each of the items in the kit between 97-100% with usage reported at 95-97%.
Conclusions
Our study demonstrated that with an implementation of a simple compliance kit significantly reduced readmission
rates in the HF patients.
170
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
THE EXPERIENCE AND PERCEPTION OF CARING FOR PERSONS WITH DEMENTIA
BY THE NURSES WORKING IN THE GERIATRIC UNITS IN AN ACUTE HOSPITAL
D ZHANG1*, YY CHONG1, NORHAYAH MN1, AML CHUO2, C PANDIAYA1, PS YOON2, BL SOH1, NAZARIAH S S1
1
2
Aims
The nature of dementia imposes high level of care needs on caregivers – formal or informal from family unit to the
health care professionals. As such, there is an emerging need to strengthen the knowledge base and up-skill nurses’
practice skills to deliver good standards of dementia care. The aim of the study is to explore dementia care experience
and identify the key issues and concerns associated with the care of persons with dementia from the perspective of
nurses, who work in the geriatric units in an acute hospital.
Methods
It is an exploratory qualitative study with a purposive sampling. 3 sessions of 60-minute focus group interviews of 4
enrolled nurses, 4 registered nurses and 4 nursing leaders were conducted respectively. The interviews adopted a semi
-structured form, which was guided by 5 self-constructed questions, exploring staff experience and challenging aspects
of providing dementia care, their perceived needs of persons with dementia; and staff’s coping strategies and resource
required for dementia care. The interviews were voice recorded and transcribed verbatim. Thematic analysis was employed for data analysis.
Results
Nurses described both positive (challenging, interesting and enjoyable) and negative experience (stressful, frustrating,
difficult, taxing and dilemma) in caring for persons with dementia. While emotional, environmental and basic needs
were perceived as the most important needs of the persons with dementia, their aggressive and wandering behaviours
were reported as the most significant challenge faced in the direct care provision. Expectation from others, be it the
family members and other health care professionals had also imposed challenges in care. Emotional-focused and problem- focused strategies were adopted by nurses in coping with those challenges. Besides enhancing knowledge and
skill in dementia care, resource including nursing manpower, material and equipment, and relevant policy and workflow were desired by the nurses in order to improve the standard of inpatient dementia care.
Conclusions
Education on dementia specific knowledge and skills as well as provision of adequate relevant resources are vital in
improving nurses’ experience in providing dementia care and supporting them in coping with the care challenges.
171
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
ANTIMICROBIAL SUSCEPTIBILITIES OF ANAEROBIC ORGANISMS CAUSING
BLOODSTREAM INFECTIONS
Lily Siew Yong Ng, Kwang Lee Ling, Thean Yen Tan
Aims
This retrospective study was performed to evaluate the organisms causing anaerobic bacteraemia in Changi General
Hospital, and to provide updated antibiotic susceptibilities for the more clinically relevant anaerobes causing blood
stream infections.
Methods
Data were retrieved from the laboratory information system for the period 2009-2011. During this time, blood cultures
were inoculated in Bactec™ Plus vials (BD, USA) and continuously monitored in the Bactec™ 9000 blood culture system
(BD, USA). Anaerobic organisms were identified using commercial identification kits, predominantly Vitek ANC cards
(bioMérieux, France) supplemented with API 20 A (bioMérieux, France). A representative subset of isolates were retrieved and antimicrobial susceptibilities to penicillin, amoxicillin-clavulanate, clindamycin, imipenem, moxifloxacin,
piperacillin-tazobactam and metronidazole were determined using the Etest method. Categorical susceptibility was
assigned using breakpoints from the Clinical Laboratory Standards Institute.
Results
323 strict anaerobes were isolated from blood cultures over the 3-year period. The predominant isolates were Bacteroides spp. (n=131; 41%), Clostridum spp. (n=41; 13%), Propionibacterium spp. (n=37; 11%) and Fusobacteria spp.
(n=20; 6%). The most active in-vitro antibiotics were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and
metronidazole, with susceptibilities of 95.0%, 93.3%, 90.8% and 90.8% respectively. Resistance was high to penicillin,
clindamycin and moxifloxacin. However, there were apparent differences for antibiotic susceptibilities between species.
Conclusions
Bacteroides spp. and Clostridium spp. form the majority of anaerobes isolated from blood cultures. Resistance to penicillin, clindamycin and moxifloxacin is high and these antibiotics should not be used as empiric therapy for anaerobes.
Metronidazole and the beta-lactam/beta-lactam inhibitors remain effective against anaerobes, but the presence of
metronidazole resistant anaerobes is of concern and should be prospectively monitered.
172
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(RESEARCH)
ABSTRACTS
THE SIGNIFICANCE OF TWO-DIMENSIONAL STRAIN IN DOBUTAMINE STRESS –
SINGLE CENTRE EXPERIENCE
Puay Joo Tan*, Leong Pearlie, Chow Alanis, Siti Aishah, Chee Tek Siong
Department of Clinical Measurement Unit, Changi General Hospital, Singapore
Aims
To evaluate the significance of using 2D strain in dobutamine stress echocardiography.
Methods
Dobutamine stress echocardiography was performed in 102 patients with known or suspected coronary artery disease. All patients
had resting LV ejection fraction of 45% to 60%. Standard 2D images from 3 planes, parasternal LV short axis(PSAX), apical 4chamber(A4C) and apical 2-chamber(A2C) views, were analyzed- with a frame rate of >40 to<90 fps. Positive dobutamine stress
echocardiography(n:55) was determined based on visual estimation of abnormal wall motion in any of the 3 planes analysed from
rest to peak stress. Negative dobutamine stress echocardiography(n:47) was determined when no abnormal wall motion changes
was detected throughout. Global 2D strain in three orthogonal planes(radial strain, circumferential strain, and longitudinal strain)
were analyzed at rest and at peak stages offline using GE Echopac Version11 software. Radial and circumferential strain were obtained from parasternal view, longitudinal strain from A4C and A2C views. The data was analysed using STATA version10.1 software.
Results
Patients
Negative Stress Test
Positive Stress Test
Average mean difference (%)±SD Average mean difference (%)±SD P Value
Radial
7.41 ± 22.77
-7.23 ± 21.35
Circumferential
-1.41 ± 6.56
1.83 ± 9.57
Longitudinal A4C
-1.11 ± 3.06
1.24 ± 4.83
Longitudinal A2C
-0.34 ± 3.44
2.4 ± 4.30
0.002
0.064
0.011
0.002
Table 1(% average mean difference is calculated based on all individuals peak global strain minus the rest global strain)
Global 2D strain showed that both radial and longitudinal strain in A4C and A2C views were significantly reduced in patients with
positive dobutamine stress tests. However there was no significant difference in dobutamine positive and negative patients for the
circumferential strain.
Conclusions
Both radial and longitudinal strains provide clinically useful information for myocardial deformation in stress echocardiography.
They are reliable markers for ischaemia.
173
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(RESEARCH)
ABSTRACTS
THE NO-SHOW PROJECT
YLJ Leong*, SH Lim, Rahim MA, STJ Ong, LC Yick, H Tan, & Mahmood Z.
Department of Medical Social Services, Changi General Hospital, Singapore
Aims
The No-Show project is an exploratory study which aims to understand why patients do not turn up to their outpatient appointments at the Medical Social Services (MSS) department. It also has a component of intervention and outcome evaluation.
Primarily, it seeks to understand the profile of these patients, and factors contributing to their no-shows. This can help MSS provide a service delivery that can help patients overcome existing constraints and barriers, reducing the negative impacts of patients’
no-shows on other patients.
Methods
Sample is being drawn from the Outpatient Appointment System (OAS) for the period of January to June 2012, for patients who
have not turned up for two or more MSS appointments.
The list of patients was then followed up with phone interviews where a survey questionnaire was used to guide the interviewer.
Patients were also given another appointment to see MSW. Reminder calls and SMSes were done to remind patients of their upcoming MSS appointments. Results of these rescheduled appointments were also collected and analysed using Excel.
Results
Patients experience logistical barriers such as not being able to leave work to attend MSS appointments, difficulty gathering supporting documents and caregiving issues. Psychological barriers include patients forgetting about appointments, and having perceptions that it is not necessary to inform when they do not need to see MSW anymore. Health barriers include patients feeling
unwell to turn up for the appointments.
Patients also indicated that being able to have their preferred time for appointment, reminder calls and SMSes will help their
attendances.
Conclusions
The study helped us understand the difficulties patients faced that lead to their no-shows. Introduction of reminder calls and attention to the helping relationships between MSWs and patients helped to improve patients’ satisfaction and motivation to show up
for their appointments.
174
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(RESEARCH)
ABSTRACTS
SYSTEMATIC REVIEW ON THE EFFECTIVENESS OF BLACK COHOSH FOR AMELIORATING HOT FLASHES IN WOMEN WITH BREAST CANCER
MX Tan*
Department of Ward 15, Changi General Hospital, Singapore
Aims
Systematic review on the efficacy and comparative effectiveness of black cohosh for relieving hot flashes experienced by women
with breast cancer and to explore the associative relationship between black cohosh and breast cancer risk.
Methods
Electronic databases such as Excerpta Medica Database, PubMed, Turning
Research into Practice and other methods such as citation and reference tracing were used to locate relevant literature.
Methodological quality of three systematic reviews, three randomised controlled trials, three cohort studies, one case-control
study and two clinical guidelines were critically appraised using validated critical appraisal tools.
Results
Most studies agreed that black cohosh was less effective in reducing frequency and intensity of hot flashes as compared to placebo
and active controls. A systematic review with meta-analysis found results in favour of black cohosh when comparedto venlafaxine
and gabapentin in achieving more mean percentage hot flash reduction inwomen with breast cancer than those without. External
validity of the selected studieswere limited by methodological shortcomings.
Association between black cohosh and breast cancer risk, a cohort and a case-control study in Germany suggested an inverse association between theuse of black cohosh in women with history of breast cancer and breast cancer recurrence. In contrast, a wide
cohort study conductedin the United States of America found no association between the regular use of black cohosh and the risk
of developing primary invasive breast cancer.
Conclusions
Evidence for the efficacy of blackcohosh was inconclusive and there was no positive association between black cohosh andbreast
cancer risk. Although few studies did not suggest that black cohosh could increase therisk of breast cancer, some brands of black
cohosh that contain phytoestrogen may not be suitable for women with hormone sensitive breast cancer.
175
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(RESEARCH)
ABSTRACTS
NEW EMPLOYEE ORIENTATION PROGRAM: AN EVALUATIVE STUDY
CW KHOON*, C WONG, NA SUDIRMAN, L TAN
Aims
This study aims to gain a better understanding of the orientation program and to provide recommendations to improve the effectiveness of the program after evaluating the existing program. The research questions of this study are:
1) How is the current orientation program helpful in facilitating the transition of new employees into the department and into their assigned roles?
2) How can the current orientation program better facilitate the transition of new employees into the department and into their assigned roles?
3) How conducive is the work environment for new employees in facilitating
and role transition?
organizational
socialization
Methods
A qualitative method was used to gather feedback from employees about the existing orientation program in MSS. Indepth interviews were conducted with nine “new” Medical Social Worker (MSW) or Medical Social Work Associate
(MSWA). These “new” employees have been with the department for a year or less.
Results
All nine respondents undergo a similar two weeks orientation program. Respondents found the information provided
to be comprehensive and covered basic aspects of their job but reported it to be a period of information overload. Information received was disjointed and there is a lack of practical application of the information, hindering respondents’ ability to integrate the information. The orientation is perceived to be task centric. Having a direct supervisor
contributes to professional development and helps respondents to ease into their new role. However, there is little
emphasis to ensure person-organization fit during orientation.
Conclusions
Adopting a more values-centred and employee-centric approach may transform the orientation program into a more
meaningful experience, where new employees learn to build conviction about the social work profession and establish
a sense of identity within the department and the hospital.
Taking into consideration the results and recommendations of this study, MSS department is redeveloping the orientation programme for new MSWs and MSWAs.
176
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
FREQUENT ADMITTERS – WHO THEY ARE AND THEIR IMPACT ON INPATIENT UTILIZATION
D Lim*, WL Chow
Department of Health Services Research, Eastern Health Alliance, Singapore
Aims
With limited healthcare resources, frequent admission to the hospital is a key concern to policy makers. A frequent
admitter is defined as an inpatient who is admitted four or more times in a calendar year. We profiled the frequent
admitters and examined their inpatient utilization.
Methods
This was a retrospective analysis of an observational cohort of inpatients obtained from administrative databases of
which patients were admitted to a regional hospital between 1 January and 31 December 2011. They were followed up
for one year from their first admission. Univariate logistic regression was performed to determine the key factors of
frequent admission by comparing frequent admitters with non-frequent admitters. Variables examined included age
category, gender, race, treatment class and primary diagnosis based on the International Classification of Diseases
(ICD) codes. We also studied the difference in the total number of admissions, total length of stay and average length
of stay between frequent admitters and non-frequent admitters.
Results
A total of 28566 inpatients and 42884 admissions were included in the analysis. Frequent admitters constitute 5.2%
(1478) of all individuals but accounted for 17.9% of all admissions and 22.4% of all bed days. Frequent admitter status
was associated with being elderly, admitted to subsidized treatment class, being female and non-Chinese. The top 5
ICD groups by percentage of admissions by frequent admitters were Heart Failure, Diabetes, COPD and Allied Conditions, UTI and Endocrine-related diseases. Frequent admitters stayed in general, two days more on average than nonfrequent admitters for each inpatient stay.
Conclusions
Frequent admitters utilize more inpatient resources than non-frequent admitters. Our study suggests that interventions to address the problem of frequent admitters could be targeted at the elderly patient with chronic diseases.
More research could be done to examine the relationship between socio-economic status and education level and frequent admission.
177
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
VIOLENCE TOWARDS NURSES IN A LOCAL HOSPITAL IN SINGAPORE
ST Quah, CSY Yap, YH Wu
Aims
This study aims to determine the prevalence of verbal and physical abuse, the main perpetrators of abuse and effects
of abuse among nurses in medical-surgical ward settings in a local hospital.
Methods
A non-probability purposive and convenience sampling strategy - questionnaire was used as the instrument for this
study. The questionnaire was adopted and modified from ILO/ICN/WHO/PSI joint program on workplace violence in
the health sector. Pilot study was conducted using the modified questionnaire with 15 participants who are nurses registered with SNB to test its content validity and reliability. Feedback and evaluation was asked from the respondents
and revisions were made. No identification of respondents was required in this study.
Results
69.1% respondents were between 20 to 30 years of age and 55% had 1 to 5 years of working experience. Even though
there were respondents that experienced physical, bullying and sexual abuse, there were 57.7% respondents that experienced verbal abuse. Verbal abuse by patients sometimes occurred in the hospital setting for the respondents. Respondents responded to the abuse via completion of compensation claim (77), reporting to a senior staff (43) or told
the perpetrators to stop immediately (43). 40 respondents that experienced verbal abuse had been disturbed by repeated, disturbing memories, thought or images of abuser and 23 had been super alert after the incident. 27.5% respondents replied that no actions were taken to address the abuse. However, 26.2% respondents’ employers did offer
opportunity to respondents to speak about the incident.
Conclusions
In this study, we were able to see that workplace violence does exist. The most common violence was actually verbal
abuse from patients. Adding to that, it also causes adverse effects on the nurses that experienced violence but little
was done to help them cope with it. However, this study is not conclusive of the whole nursing population as it only
targeted at nurses working in the medical-surgical wards. Therefore, bigger sample size could have been used and
questions on staff coping methods towards violence could also be generated.
178
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
EFFECTS OF WATER BASED THERAPY VERSUS LAND BASED THERAPY FOLLOWING
TOTAL KNEE REPLACEMENT IN CHANGI GENERAL HOSPITAL
Pal P*, Lim YP, Wong SH
Department of Rehabilitation Services, Changi General Hospital, Singapore
Aims
This single blinded randomized control trial compared the outcome measures between land-based and water-based
rehabilitation programmes following total knee replacement (TKR) in Changi General Hospital.
Methods
Eighteen TKR patients were recruited for this RCT spanning six-week in duration. Both land-based (n=11) and the water
-based (n=7) groups included functional exercises that lasted for an hour each.
Outcome measures included; pain scores (rest and ambulation), joint swelling, thigh girth, range of motion, ten repetition maximum, the time taken to walk 10 meters (at self-paced and fast-pace speed) and one flight of stairs at weeks'
one and seven. The Mann Whitney U statistical test was conducted by SPSSTM software.
Results
At week seven, the results showed improvements in all outcome measures for both groups compared to week one.
However, no significant difference was observed between both groups for most outcomes measures (p > 0.05) except
for time taken to climb stairs at week seven; where patients in the water-based group took significantly longer time
than land-based group. However, limited sample size might explain this observation.
Conclusions
Patients in both groups showed similar positve outcomes which is in agreement with published studies. This study
therefore suggests that once patients are competent and complaint with either water-based and/ land-based exercises
they can then perform these exercises independently in their community without the need to travel and without the
guidance of a physiotherapist. This offers patients a chance to choose the type of rehabilitation program that interests
and motivates them to full functional recovery. The result suggests that a physiotherapy exercise that focuses on functional training will aid in providing favorable outcomes in TKR patients.
179
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
PHYSIOTHERAPY PROFESSION AS A HEALTH CARE PARTNER: PERCEPTIONS OF
THE PUBLIC
PU Reddy*, TSY Melissa
Department of Rehabilitation, Changi General Hospital, Singapore
Aims
To analyse the awareness, perceptions and attitudes of the general public towards physiotherapy (PT) as a profession.
Methods
A survey was conducted among the members of general public attending annual PT Day celebrations. The questionnaire was asked in English and consisted of 20 close-ended questions. Information collected include: participant demographics; personal, medical and falls history; exercise habits; knowledge of PT as a healthcare profession; referral
sources and reasons; satisfaction, expectations and concerns regarding PT services; and alternative treatments preferred.
Results
144 members of general public participated - females (76%), males (24%); 21-50 year-olds (50%), 51-64 year-olds
(39%), over 65 year-olds (11%). A majority (69%) of them exercised less than 3 times per week.
48% have never visited a PT and only 40% of total participants were aware of the full scope of our services. Among the
52% who have seen a PT, 94% were satisfied with the services provided and 20% felt PTs provided better care than
other health professions. However, 31% perceived PT services as more expensive than a General Practitioner's.
66% of the participants expected PTs to explain the treatment procedures given to them, and 40% wants the PT to provide an estimate of the number of sessions required.
Conclusions
A high percentage of the public are satisfied with our services. To increase this further, PTs should incorporate education about treatment procedures given and give an estimate of the number of sessions required to the patients they
see.
The importance of being more proactive in health education and increasing public awareness in PT services is highlighted by the fact that 60% of the public sampled who had not attended PT services before were not aware of the scope of
PT services. This is especially so as PTs are specialists in human activity and movement.
180
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
PHYSICAL AND PSYCHIATRIC COMORBIDITY OF ALCOHOL USE DISORDERS IN AN
ACUTE GENERAL HOSPITAL
YC Ng*, LH Peh, SN Tan, YC Salikin, WL Teo, Patrick
Department of Psychological Medicine, Changi General Hospital, Singapore
Aims
This is a descriptive study of patients in an acute general hospital with physical and psychiatric disorders co-occurring
with alcohol use disorders.
Methods
A total of 103 inpatients admitted for physical and psychiatric disorders were screened and assessed for alcohol use
disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2000) and Alcohol
Use Disorders Identification Test (2001) were utilised in the assessment.
Results
76% (78 out of 103) patients exhibited alcohol use disorders (alcohol abuse or dependence) with comorbid physical
disorders such as gastrointestinal, cardiovascular, neurological, musculoskeletal, haematological, respiratory and endocrine disorders. 24% (25 out of 103) patients presented with co-occurring psychiatric disorders namely depression,
anxiety or adjustment disorders.
Conclusions
The findings of this study suggest that alcohol use disorders are associated with physical and psychiatric disorders
among patients admitted to an acute general hospital. This calls for early identification and assessment of any alcohol
use problems by the medical professions and referral to addiction medicine for further assessment and interventions.
Future study may look at the role of general practitioners who are in a unique position because of their long-term contact with patients to assess for alcohol use disorder co-occurring with physical and psychiatric disorders.
181
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
CARPAL TUNNEL SYNDROME: A PROFILE OF PATIENTS IN CHANGI GENERAL HOSPITAL
W.J. Lim*, H. Chen, S.C.S. Seah
Aims
This quantitative study aimed to build a detailed demographical profile of patients presenting to the Changi General
Hospital (CGH) Occupational Therapy clinic for carpal tunnel syndrome (CTS).
Methods
Participants were patients diagnosed with CTS, who were referred to the Occupational Therapy clinic at CGH. Data was
collected via: (a) CTS research questionaire that collects patient's demographic data, symptom presentation, and
household/occupational activity levels; (b) Boston Carpal Tunnel Questionairre (BCTQ) to assess symptom severity and
functional impact on the hand; (c) Michigan Hand Outcomes Questionaire (MHQ) to assess impact of disease on function.
Results
Interim findings from thirteen participants indicated that majority of the patients presenting with CTS were female
(85%), with the average age being 54.3 years old. All the participants were right hand dominant.
Average length of employment in current occupation was reported to be 17.6 years. 46% of the participants were light
manual workers, followed by heavy manual workers (23%) and housewives (15%). Housework activity levels were reported to be at medium levels for most participants (67%), with the average number of hours spent on housework
weekly being 20 hours. Average MHQ and BCTQ scores indicated limitations in general hand function as a result of CTS
symptoms.
Conclusions
Participant recruitment and data collection for this current study is still ongoing in order to maximise the strength of
this study. Interim results suggest that the demographic trends of CTS having a higher prevalence among women and
older patients (more than 50 years of age) found in previous studies appears to apply in the Singaporean context as
well. Further descriptive and correlational data analyses needs to be done after data collection is complete to (a) establish the demographical profile of patients presenting with CTS in CGH; (b) explore any existing relationships between demographical/activity-related (e.g. occupation, housework) variables and the development of CTS.
182
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
HOW HOME CARE ASSIST (HCA) PROGRAMME HAS BRIDGED SERVICE GAPS FOR
NEEDY MIDDLE-AGED PATIENTS.
CC Goh
Aims
A descriptive study on how HCA has bridged the gaps of various financial assistance schemes for middle-age patients.
Methods
This is a retrospective cross-sectional study using secondary data from the Social Work Information System (SWIS).
Targeted group is HCA recipients who are aged between 40 to 59 years. Data used is from 1 January 2011 to 31 December 2012.
A review of similar financial schemes to HCA, namely Senior Mobility Fund (SMF), Public Assistance (PA) Enhanced
scheme, Special Assistance Fund for needy patients in local context was done.
Results
There are a total of 574 HCA recipients for the study period. Of which, 40% (N=232) of them are below age 60 years
and middle-aged recipients (aged 40 to 59 years) formed 84% (N=195) of it. A profile study of the 195 recipients is
done.
The most common assistance rendered for this age group is podiatry products (about 43% of the recipients). Other
than HCA, there were no financial schemes that assisted with podiatry products.
23% of the recipients are assisted with home care equipment such as wheelchair and commode. These recipients do
not qualify for Senior Mobility Fund (SMF) due to their age. Though they might have qualified for Special Assistance
Fund (under SG Enable) for mobility aids, the application processing time can range from 3 weeks to a few months.
HCA thus comes in timely to meet the needs of the patients while awaiting long term assistance.
A handful of the recipients are on continuous HCA for long term as they do not meet the criteria (such as age, diagnosis
or income) of other financial schemes.
Conclusions
With the mushrooming of more assistance schemes, collaborative work with the different financial schemes providers
have to be done to relook at criteria, streamline work processes and ensure efficient allocation of resources. This
would help to prevent needy patients from falling through the service gaps.
183
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
PREVALENCE AND RISK FACTORS FOR BOTHERSOME LOWER URINARY TRACT
SYMPTOMS (LUTS) IN WOMEN WITH DIABETES MELLITUS (DM) IN SINGAPORE
HOSPITAL-BASED DIABETIC CENTRE.
Neo*, LH Tay, K Song, Rosemarie LV, SK Lim, FC Ng and S Rahayu
Department of Urology and Diabetic Centre, Changi General Hospital, Singapore
Aims
A prospective study to assess prevalence and risk factors for bothersome lower urinary tract symptoms (LUTS) and
voiding dysfunction in women with diabetes mellitus (DM).
Methods
This is a prospective study. The study will recruit 100 female diabetic patients who are receiving regular follow up at
the diabetic centre at Changi General Hospital. Participants will need to complete the King’s Health Questionnaire and
a structured American Urological Association (AUA) Symptom Index Questionaire to assess the participants’ lower urinary tract symptoms. Their parameters will be evaluated: they are age, type of diabetice therapy (diet, insulin, or hypoglycaemic agents). Only females are included in this study, age ranging from 21 to 85 years old and from all ethnic
groups.
Results
30 patients participated in this study. Participants completed the King's health questionnaire and structured American
Urological Association Symptom Index Questionnaire. 20% of the participants had bothersome lower urinary tract
symptoms. 10% of the participants had voiding dysfunction. 23% patients have nocturia and are the most bothersome
and affect quality of life in women with diabetic mellitus.
Conclusions
Nocturia are the most bothersome in diabetic women. This study will help to guide the nurses and to better understand the voiding patterns in this group of patients.
184
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
A PILOT STUDY FOR THE IMPLEMENTATION OF NURSING SHIFT HANDOVER
GUIDELINE
X Sun*, YYC Ong, SLK Poh, LFM Lin, XP Toh, MKN Lim, W Soo, Noorlina, N Jana, T Wu
Aims
The study aimed to standardize shift handover and to improve communication among nurses for continuity of patient’s
care.
Methods
A total of 35 nurses were recruited in the 5-week pilot study which was implemented in a 44-bedded ward in Changi
General Hospital. The pilot study included a week of daily in-service and four weeks of thrice a week observation of
nursing handover using a standardised guideline. Feedback forms were distributed and collected on the fifth week.
Both observation episodes and feedback from nurses were analysed.
Results
Of the 57 observation episodes using a checklist, 78.9% of nurses performed handover at patients’ bedside, 57.9% of
nurses conducted physical checks on patients and 42.1% either greet or self-introduce themselves to patients.
Out of the 35 feedback form distributed, 82.9% responded. Of the 29 nurses surveyed, 62.1% were staff nurses and
37.9% were enrolled nurses. 58.6% had 1-5 years of working experience followed by 27.6% with 6-10 years, 10.4% with
less than 1 year and 3.4% with 11-15 years of experience.
Of the nurses who attended the in-service, 93.2% of nurses found that this method of handover was informative, 86%
felt that the guideline enhanced communication during shift handover and 75.9% of nurses are open to using the
guideline in future. However, 31% of nurses encountered difficulties while using this guideline and felt that it was time
consuming.
Conclusions
The pilot study revealed that nurses felt that shift handover guideline enhances communication thus facilitating shift
handover. To make the guideline more feasible for nursing shift handover in CGH, future research involving other disciplines for using the revised handover guideline were recommended.
185
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
REFERRAL PATTERN AND HEALTHCARE PROVIDERS’ PERCEPTION ON THE RIGHTSITING OF PSYCHIATRIC OUTPATIENTS IN A SPECIALIST SETTING
I Tirtajana*, Chow WL, Wee MK, Yang Chek S, Lim HK, Pan HM, Peh LH
Department of Psychological Medicine, Changi General Hospital, Singapore
Aims
The aim of this survey is to determine the source of referrals, the types of cases referred, and the specialists' perception on the right-siting of cases.
Methods
Anonymised questionnaires were distributed to psychological medicine specialists located in a particular clinic in
Changi General Hospital. Data collection took place between April to September 2013. Apart from diagnosis and clinical measures of severity and level of function (CGI and GAF), the questionnaire also asks if the specialist feels the case
can be managed in a non-specialist setting, and to state the reason in they think otherwise in cases with low severity
and high functioning.
Results
The survey gathered 110 completed forms during the study duration. Of these cases, 25 (22.7%) were referred by private general practitioners (GPs) and the remaining 85 cases (77.3%) by Polyclinic doctors. Only 38 cases (34.5%) were
identified as having had treatment initiated by the primary healthcare provider (PHP). Out of the total number of cases, 47 (42.7%) were rated by specialists as being suitable for management in non-specialist settings, while 49 cases
(44.5%) were rated as being unsuitable. The reasons cited by specialists for unsuitability for management at a primary
care setting included: substance dependence, complex cases, inadequate response to treatment, unavalability of psychological therapy in primary healthcare setting, unavailability of certain medications in primary healthcare setting,
and legal issues requiring specialist assessment.
Conclusions
Right-siting of patients with psychiatric condition may be further improved. Access to allied mental health services may
provide further support for right-siting of patients.
186
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
EVALUATING THE BENEFITS OF THE BONEBRIDGE -THE NEW BONE CONDUCTION IMPLANT
SH Kamath, SLH Lee, HW Yuen
Department of Otolarynogology, Changi General Hospital, Singapore
Aims
Bone Bridge (BB) is a new and innovative active bone conduction hearing implant to treat single sided deafness and
conductive hearing losses. BB was available commericially in Singapore in October 2012. CGH was the first hospital to
conduct the surgery in Singapore. The objective of this study is to determine the post-surgical benefits of BB.
Methods
Consecutive patients in the age range of 20 to 45yrs of age with SSD and conductive hearing loss who were fitted with
BB between October 2012 to September 2013 were considered. Five self report questionnaires [Glasgow benefit inventory (GBI), International Outcome Inventory (IOI-HA), Hearing Device Satisfaction scale (HDSS), Abbreviated Profile
of hearing aid benefit (APHAB), Speech spatial Qualities(SSQ)] and an English speech test (Arthur Boothyrod words list
in noise) were used for evaluation, 3 months post BB fitting.
Results
HDSS, IOI-HA showed that all the 4 patients (100%) are still using the BB with no to little problems with handling and
cleaning of the device and are satisfied with the sound quality with the average scores of 85% and 95% respectively.GBI shows that they are able to carry out most of their daily activities including rough contact sports normally and
more confident socializing around improving their quality of life. The APHAB showed that all the patients experienced
significant hearing benefits of 40% with maximum scores(65%) on the hearing in Background noise subscale.SSQ
showed that mean scores improved from 3.2 without BB to 8.6 with BB.Speech test scores showed improved speech in
noise scores from 25% without BB to 75% with BB.
Conclusions
The benefits of BB are evident in majority of the patients in improving the spatial hearing and speech understanding in
noise. Patients are very satisfied with sound quality as well. Low care and maintainance, low incidence of infection,
cosmetic appeal and easy handling are the added benefits making BB, a good option among the implanted hearing
solutions for treating single sided deafness and conductive hearing losses.
187
BEST POSTER AWARD
(RESEARCH)
ABSTRACTS
PRELIMINARY EVALUATION OF A NEW, MORE SENSITIVE BETA-HCG COMBO TEST
KIT ON SERUM
WR Lim*, AH Toh, R Ng, CA Neo, M Afzal, S Ng, SP Tan, TC Aw
Aims
A new sensitive qualitative beta-hCG combo test kit, QuickVue+ (Sensitivity: 10 mIU/mL), is now available. We sought
to verify the performance of this new platform against the current one, Alere (Sensitivity: 25 mIU/mL), for serum samples.
Methods
Serum, tested on the Abbott Architect i-2000 SR instrument with quantitative results ranging from 1.4 to 3628 mIU/mL
(>10 mIU/mL: 65 samples, >25 mIU/mL: 19 samples), were recruited for this study (n=118).
Each sample was run simultaneously on the Alere and QuickVue+.
Results
Alere Technical Performance
Out of the 19 samples that were >25 mIU/mL, Alere detected 100% as reactive (19/19), i.e. 100% true positive. However, of the 99 samples that were <25 mIU/mL, 22 samples were detected as reactive (i.e. false positive), yielding a diagnostic specificity of 78% (77/99). While the predictive value of a negative result was 100%, the predictive value of a
positive result was only 46% (19/41).
QuickVue+ Technical Performance
Out of the 65 samples that were >10 mIU/mL, QuickVue+ detected 100% as reactive (65/65), i.e. 100% true positive. Of
the 53 samples that were <10 mIU/mL, 0 samples were detected as reactive, yielding a diagnostic specificity of 100%
(53/53). Predictive values of both negative and positive results were 100%.
Conclusions
As QuickVue+ has a lower detection limit, it is able to pick up low levels of beta-hCG and obviate uncertainty in samples with borderline hCG levels when screened using Alere. Thus QuickVue+ would be the preferred kit for hCG screening.
188
ACKNOWLEDGEMENTS

Changi General Hospital – Eastern Health Alliance Scientific Meeting 2013

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