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JAN
FEB
2015
a Bimonthly Publication of
Singapore General Hospital
and SingHealth ACADEMIC
HEALTHCARE CLUSTER
MCI (P) 173/05/2014
www.sgh.com.sg | www.singhealth.com.sg
Best Overall
Editorial
Manage
medical
appointments
on the go
Bronze
COntent Marketing
Awards 2013
05
AWARD OF
EXCELLENCE
A new local language test for aphasia
kicks off the NEW FRONTIERS page
APEX Awards 2014
P3
12
Health care contributions of pioneer generation featured in year-long PIONEERS series
随时随地
更改门诊预约
P27
16
No need to go far: Care is now available in
the neighbourhood
21
Photo: alvinn lim
With brain injuries, severity depends on
location rather than on extent
30
无 创通气诊所 协助有呼吸系统问题的
患者改善呼吸和睡眠情况
02
singapore health
JAN– FEB 2015
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JAN– FEB 2015
Check and
click on “Yes,
I understand
and agree” to
confirm you
have enough
medication
required till
your new
appointment
date
Health Buddy app
SingHealth’s smartphone app,
Health Buddy, allows patients
to manage their medical
appointments anywhere,
anytime, throughout the year.
(Pictured are some stages
involved in rescheduling
appointments.)
Click on
“Confirm” for
your new
appointment
date
Appointments made easy
Gone are the days of trying to get through a busy phone line to reschedule a consultation session. Now,
patients can do this with their smartphones or go online, and staff can book these for patients directly
with the clinics
By Jessica Leow
P
Photos: alvinn lim
atients can now use SingHealth’s
very own smartphone app, Health
Buddy, to manage their medical
appointments, after a revamp of the
entire appointment system.
With a few clicks of the button,
patients can access their own appointments and make changes without calling
the appointment line or Call Centres of
the various institutions. And they can
do this anywhere, anytime, throughout
the year.
The mobile connection
Users need to download the Health
Buddy app (compatible with both iPhone
and Android) onto their smartphones
and use their SingPass for access.
A few clicks will bring them to a personalised appointments page where they
can see all their sessions in SingHealth
institutions on the screen. This makes
cross-checking dates and times a breeze.
There will also be a list of available
slots, some exclusively available through
the app and online.
This way, users get a bigger selection
than if they phoned the Call Centres and
find it easier to arrange sessions that fit
their own schedules. Appointments can
also be rescheduled 13 months ahead
instead of 30 days.
As a safety check, there are reminders
to ensure patients have enough medication to last until their next session.
NEWS
03
Click on
“Search” for
alternative
dates and
click on your
preferred slot
Read and
agree to
the terms
to proceed
Select the My
Appointments
tab
singapore health
Users can now check or reschedule
their medical appointments on the go.
Bypas sing the Call Centres of
SingHealth institutions has also reduced
delays caused by busy phone lines.
SingHealth gets nearly two million
calls a year, mostly enquiries about
appointments, opening hours, medication and medical reports. Most call to
check, reschedule or cancel appointments – things which can easily be done
electronically.
Since the mobile connection was
launched in April 2014, more people
have used their phones to manage their
appointments, and the Call Centres have
noticed a drop in calls. “We understand
that patients get frustrated trying to get
through the phone lines and having to
repeatedly check slot availability. We
improved the system so that they can
manage their appointments electronically
instead of by calling. The new platforms
help them do just that,” said Mr James Toi,
Chief Operating Officer (Ambulatory), Singapore General Hospital (SGH).
“We understand that patients and
their caregivers are busy individuals and
would like handy tools to better manage
their appointments. The Health Buddy
app and online appointment system
options now offer them convenience and
empowerment, 24/7, 365 days a year,"
said Ms Joyce Quek, Manager, Marketing
Communications, who developed the
app interface.
The online connection
The existing online electronic
appointments (e-appointments) system
was also enhanced. Now, users only need
to go to one website, (www.singhealth.
com.sg/appointments) even if they want
to reschedule multiple sessions in different institutions. Previously, they had to
go to each institution’s website to do this.
If an unexpected business trip crops up,
rescheduling is only a click away, online or
via a smartphone.
Currently, e-appointments are for consultations with doctors only, but there
are plans to expand them in the future
to other sessions such as physiotherapy,
special tests and scans.
The SingHealth institutions that can
be accessed by e-appointments are: the
The polyclinic
connection
About 15 per cent of
calls to SingHealth’s Call
Centres are internal, with
the bulk coming from its
nine polyclinics. They are
mostly from polyclinic staff
calling to book referral
appointments in specialist
clinics for patients. Usually,
an average call would take
between 15 to 20 minutes,
sometimes longer, with
half the time spent just
trying to get through to the
Call Centres.
Typically, polyclinic
staff had to go back and
forth between Call Centres
and patients, trying to
match the slots offered
with the patients’ availability. If no suitable slots
could be found, they would
ask patients to try on their
own later – not something
patients were generally
keen to do.
In the revamped
system, polyclinic staff
can book appointments
directly with individual
institutions or clinics
without going through the
Call Centres, saving time
for staff and patients.
According to Ms Fiona
Sun, Executive, Clinic
Operations, SingHealth
Polyclinics - Outram, it has
always been difficult to get
through the phone lines.
“Sometimes, when we
finally get an appointment,
the patient may find it
unsuitable and request
a change. We will then
call the hotline again.
Meanwhile, there would
usually be a long queue
of patients waiting, so we
really couldn’t afford to
spend 15 to 20 minutes
on each referral. So, we
might ask the patient to
call the institution himself.
Sometimes the patient
refuses and insists we call
anyway. Now, it’s great
that we can make the
appointments ourselves.”
> Continued on page 4
( 华文版本请翻阅至27页 )
04
NEWS
singapore health
JAN– FEB 2015
> Continued from page 3
Appointments made easy
Specialist Outpatient Clinics (SOC)
at SGH; KK Women’s and Children’s
Hospital (KKH); National Heart
Centre Singapore (NHCS); National
Cancer Centre Singapore (NCCS);
National Dental Centre Singapore
(NDCS); Singapore National Eye
Centre (SNEC); the nine SingHealth
Polyclinics (SHP); and Changi General Hospital (CGH), which is under
Eastern Health Alliance.
Considerations and exceptions
While things have been made easier
for patients, they are still advised
to try as far as possible to stick to
their original appointment dates.
This is for medical and treatment
purposes.
Last minute changes also create
unnecessary administrative work
for staff who have to scramble to
slot in replacement patients, when
they already have their hands full
serving patients.
There are also exceptions to the
rule. Some appointments cannot be
changed or rescheduled. These are
cases when the patients’ conditions
and care plans need close monitoring, such as diabetes, pregnancy,
cancer and heart problems.
The revamped system – fast and friendly
SingHealth’s revamped appointments
system is the result of a year-long project
by a multi-pronged team from different
SingHealth institutions.
The result – a faster, friendlier, more
intuitive system that takes fewer steps
to navigate. The biggest change, which
had the most impact, was the removal
of the need for everyone to go through
the Call Centres.
Now, staff from the polyclinics,
hospital wards, the Depar tment
of Emergenc y Medicine, and the
Ambulatory Surgery Centre, to name a
few, can book specialist consultations
for patients from computer terminals
on their premises. They simply log into
the appointment system and pick out
slots. Patients get their bookings faster,
and phone lines are freed up for those
who really need them, such as the
elderly. There is also no more need for
emails, faxes and paper communication
between institutions.
A ssociate Professor Agnes Tan
and Ms Lee Chen Ee, Co-Chairs of the
Appointment Access Task Force, said
the multi-functional team was tasked
to create a staff-friendly system that
provided a seamles s experience
for patients.
Using IT as an enabler, the team
unified mobile applications and internet
sites, allowing patients to access all their
appointments in SingHealth institutions
with one click, through a single website.
“We simplified the appointment
booking system, and trained and
empowered more staff to book intra- and
inter-institution appointments directly
through the system, bypassing our Call
Centres. The result was that droppedcall rates fell from more than 50 per cent
to less than 10 per cent. Patients got
their appointments faster, and staff were
Ward staff can now book specialist
consultations for patients directly
from computer terminals on their
premises instead of going through
the Call Centres.
empowered and became closer, working
together to provide a more seamless
experience for patients,” said Prof Tan,
who is also Director, Medical Affairs,
and Chairman, Division of Ambulatory &
Clinical Support Services, SGH.
Ms Lee, who is also Director for Office
of Service Transformation, said the task
force is one of several commissioned
by SingHealth to transform the patient
experience.
“What we’ve tried to do in the Task
Force was to look at existing processes
with fresh eyes. Instead of saying this is
the way things are as a default, we tried
to ask ourselves why we can’t change the
way we do things, to serve our patients
better.”
Almost 200 SingHealth staff are now
trained to use the appointment system
and have also been coaching patients
to go electronic too. They even hope to
convert senior citizens who own mobile
phones to it, as they believe many want
to be independent and not depend
on their children to manage their
appointments for them.
Response to the revamp has been
good. A few months after the system
went into use, the number of calls for
polyclinic referral appointments to some
SingHealth institutions showed a drop.
jan– feb 2015
singapore health
new frontiers
05
No beavers or
pretzels, please.
We’re Singaporean
A team of speech therapists has developed a local language test
to address the cultural and language inadequacies of the current
standard for assessing aphasia in stroke patients
By DENYSE YEO
illustration: Sergey Siz`kov / 123rf
instance, the team uses pictures of
chopsticks, the Singapore flag and
mahjong tiles – things which Singaporeans, especially the elderly, are
more familiar with.
“We felt that it was time for us to
come up with something more local
to potentially improve diagnosis and
the way that patients respond to the
pictures and the tests,” she said.
The seeds of the project were
sown in 2003. The speech therapists
looked at adapting from the standard
Western-developed test, but found
that it was difficult and costly. They
also looked at an existing test from
Hong Kong when developing the
Chinese version but, again, found
it inappropriate as it required
responses in Cantonese.
It was then that they decided to
start from scratch. Six years later,
the team received a $20,000 grant
from the SGH Research Fund to
The left side of the brain
Photos: alvinn LIM
T
he beaver, a river animal
commonly found in Europe
and North America. The pretzel, a salty snack. And the Egyptian
sphinx, a mythical creature.
These objec t s may not be
familiar to Singaporeans, but are
used in a test to assess language
problems in stroke patients. Not
surprisingly, many Singaporeans
were not able to identify them.
Yet, their responses were crucial to an accurate assessment by
speech therapists of their communication and language difficulties.
Only then could a treatment plan be
drawn up for their condition, also
known as aphasia.
Said Dr Valerie Lim, Senior Principal Speech Therapist, Speech
Therapy Department, Singapore
General Hospital (SGH): “As it’s
a language test, even though we
speak English, there are cultural
variations in the way we communicate, in terms of how words sound,
the kind of materials that are relevant to our society, and so on.
“When shown a picture of a
beaver, if the patient identifies it
incorrectly, it may not mean that he
has an impairment. Rather, it may
mean that the animal is unfamiliar
because he has not seen it before.”
The assessment tools, developed in English-speaking countries
such as the US, Australia and the
UK, require patients to be familiar
with things that are found in those
countries. The patient also has to
be proficient in English.
To address the shortcomings
of these tests, Dr Lim and other
speech therapists at SGH have
developed local tests. They are
conducted in English and Mandarin to better reflect the common
use of the two languages, and the
Singapore cultural context. For
The local language test for
assessing aphasia was developed
by a team of SGH speech
therapists, including Dr Valerie Lim
(left) and Ms Deirdre Tay.
Language difficulties may occur if
a stroke damages the brain’s left
hemisphere, the part where most
people’s language centre resides.
Depending on the severity of
the condition, known as aphasia,
the patient may have problems
understanding language, talking
or expressing themselves in words,
reading or writing. He may suffer
from one, a combination or all of
the functions.
To determine the type and
severity of their condition, patients’
speech, voice and comprehension,
as well as their ability to read and
write, are evaluated.
Treatment will then depend
on their needs and goals, and the
severity of their condition. Some may
suffer from mild symptoms, such as
taking a long time to find the right
words to express themselves, while
others may experience more severe
symptoms, such as not being able to
vocalise their thoughts or being able
to respond only by nodding.
Recovery depends on many
factors, such as the severity of the
stroke and the patient’s age. It is
generally more difficult for older
patients to make a full recovery.
About 30 to 40 per cent of stroke
patients suffer from aphasia.
develop the test and, in 2010, they
began work, completing the project
in 2012.
Said Dr Lim’s colleague, Principal
Speech Therapist Deirdre Tay: “The
local test was born out of need. We
hope we have filled a gap.”
The test is now used by SGH
speech therapists to assess patients
for moderate to severe aphasia, but
a research study, funded by the
Ministry of Health, is necessary to
validate the usefulness of the
test. The data from the study will
also help the team look for patterns, such as the range of scores
to indicate the condition’s stages
of severity.
Four other health care institutions
are involved in the study: National
University Hospital, Khoo Teck Puat
Hospital, St Andrew’s Community
Hospital and Changi General Hospital (CGH). Some 30 aphasia patients,
mostly from SGH, have taken the test.
The team hopes to test at least 120
more patients.
The test could also be useful
for speech therapists in Malaysia,
because of the cultural and other
similarities between the country and
Singapore. As it is a test for language
and comprehension, it could be used
to spot other conditions that affect
language ability, such as dementia.
Taking part
Anyone who suffered a left-brain
s troke in the las t t wo year s
can par ticipate in the aphasia
test study. They should be medically stable, right-handed, have
at least primary school education,
and be able to understand and
speak English or Mandarin. The test
is free. Call 6576-2715 to participate
or for more information.
06
NEWS
singapore health
jan– feb 2015
Chemotherapy before breast
surgery better for some
Patients with locally advanced or some early stage breast cancers can benefit from a new treatment programme
dedicated nurse clinician coordinates
the patient’s care journey, ensuring that
her needs, investigations and treatment
are efficiently and smoothly carried out,
said Dr Benita Tan, Senior Consultant,
SingHealth Duke-NUS Breast Centre.
“This expedites patient care as it avoids
redundancies and improves waiting times
for treatment, and is a huge benefit for
our patients,” said Dr Tan.
Dr Ong Kong Wee, Head and Senior Consultant, SingHealth Duke-NUS Breast Centre
apy allows clinicians to directly observe
the effects of chemotherapy on a breast
cancer, further treatment can be tailored
according to the response, said Dr Lee
Guek Eng, Associate Consultant, Division
of Medical Oncology, National Cancer
Centre Singapore (NCCS).
“If the cancer completely resolves after
preoperative chemotherapy, this heralds
a good sign for the patient. This group of
patients tends to have a better outcome.
Conversely, for patients with cancers that
hardly shrink with chemotherapy, we can
then react early by including additional
chemotherapy options or expediting surgery,” said Dr Lee, who is part of the team
behind the programme.
Another is Dr Rebecca Dent, Senior
Consultant, Division of Medical Oncology, NCCS, who said that preoperative
treatment is widely practised in the US
and the UK. Up to 80 per cent of patients
will respond favourably to chemotherapy, with the response rate usually
higher for more aggressive breast cancers, underscoring the case for starting
chemotherapy early for these patients.
A few patients have been put on the
Preoperative Breast Cancer Programme
since it star ted in October 2014. A
The SingHealth Group is redesigning
the way health care is provided, and the
set-up of the Breast Centre brings specialists with different expertise together.
The Breast Centre functions as a multidisciplinary team where breast surgeons
work closely with medical and radiation
oncologists, plastic surgeons, radiologists, pathologists, pharmacists, rehabilitation therapists, nurses and medical
social workers from Singapore General
Hospital and NCCS.
“We are essentially putting the
patient in the middle and placing a
whole medical team that will adequately
address her needs around her,” said Dr
Ong Kong Wee, Head and Senior Consultant, SingHealth Duke-NUS Breast Centre.
Photo: Alvinn Lim
C
hemotherapy may form part of
the first line of treatment before
surgery for patients with locally
advanced or some early stage breast
cancers, under a new programme at the
SingHealth Duke-NUS Breast Centre.
Having a patient undergo chemotherapy as early as possible allows the whole
body to be treated and any circulating
cancer cells present to be targeted. Doing
this lowers the risk of the cancer spreading, allows doctors to observe how well
the tumour is responding to chemotherapy, and helps shrink the breast tumour,
facilitating breast cancer surgery.
If chemotherapy is able to shrink the
tumour significantly, a smaller area of the
breast may need to be removed. For some
patients, a mastectomy can be avoided,
allowing them to safely opt for breast-conserving or reconstructive surgery instead,
said Dr Veronique Tan, Consultant,
SingHealth Duke-NUS Breast Centre.
“Surgery remains necessary as residual live tumour cells are often present.
Essentially, patients who respond well to
preoperative chemotherapy have more
surgical options,” said Dr Tan, who specialises in oncoplastic breast surgery.
Because preoperative chemother-
Dr Veronique Tan (left) and Dr Benita
Tan are part of the multi-disciplinary
team at the SingHealth Duke-NUS
Breast Centre, where specialists
with different expertise across
the SingHealth group are brought
together to address patients’ needs.
To treat breast cancer,
one or a combination of
treatments may be used,
depending on the type
and severity of the
disease and other factors
Chemotherapy
• Anti-cancer drugs,
often given through
an injection, are used
to kill cancer cells
• The drugs circulate in
the blood
We are essentially
putting the patient in
the middle and placing
a whole medical team
that will adequately
address her needs
around her.
Preoperative chemotherapy allows clinicians to directly observe the effects
of chemotherapy on a breast cancer so that further treatment can be tailored
according to the response.
Destroying
cancer cells
Surgery
• Mastectomy, where
the entire breast is
removed
• Lumpectomy, where
just the tumour is
removed
Radiation
• High energy x-rays are
used to kill cancer cells
• It is a local treatment
to the chest wall that
sometimes includes
the lymph nodes
Targeted therapy
• Some breast cancer
cells have unique
proteins, and targeted
therapies, like the use
of the drug trastuzumab (commercially
known as Herceptin),
specifically attack
these cells
• Unlike chemotherapy
drugs, targeted therapies can destroy cancer
cells with minimal
effect on healthy cells
Hormonal therapy
• The female hormones,
oestrogen and progesterone, can promote
the growth of some
breast cancers
• Hormone therapy,
like the drug tamoxifen,
acts to block the action
of oestrogen
• Works best for patients
with such cancers
jan– feb 2015
singapore health
Getting a grip
A local study has found that handgrip tests in the
elderly not only point to their overall health, but also
their mortality
P
ay attention if you notice an elderly
relative’s hand getting weaker. A
local study has shown that a weak
handgrip in the old is a cause for concern.
The study – the first of its kind in Singapore – spanned four years and was
carried out by a team from Duke-NUS
Graduate Medical School, SingHealth
Polyclinics and Japan’s Nihon University.
They wanted to see if handgrip strength,
measured at a single point in time, was
associated with a risk of dying within that
four-year period.
They took handgrip strength measurements (a marker for muscle strength,
nutritional status and overall health) of
4,131 people aged 60 and above in 2009.
In the five-minute test, participants had
to grip and squeeze two bars on a dynamometer while standing. Other factors
like chronic diseases, depression and cog-
nition were taken into account when
compiling results. Four years later,
in 2013, they matched these measurements against data from Singapore’s Registry of Births and Deaths,
and found that 9.1 per cent of the
participants had died.
The data showed when an old
person’s handgrip was weaker
by 5kg compared to another old
person with a similar health status
and socio-demographics, the one
with the weaker handgrip had a 33 per
cent higher chance of dying within four
years, said Assistant Professor Rahul Malhotra, Program in Health Services & Systems Research, Duke-NUS, who led the
team. But he clarified that a weak handgrip in itself was not the cause of death.
The findings were similar to those in
Western studies, but one drawback here
Photo: Darren Chang
By Chua Hwee Leng
Gripping a dynamometer: Data showed
when an old person’s handgrip was
weaker by 5kg compared to another
old person with a similar health status
and socio-demographics, the one with
the weaker handgrip had a 33 per cent
higher chance of dying within four years.
NEWS
07
was that Western reference values for
handgrip strength were not applicable to
Singaporeans because of anatomical and
other differences. The team is now compiling Singapore-specific reference values
derived from a study of 3,000 healthy
elderly people, as this will help doctors to
better assess local patients.
Handgrip strength tests are not widely
used in Singapore, but some doctors use
it on elderly patients with cancer and in
the preoperative phase. Prof Malhotra
said it is too early for clinical use now, as
more clarity is needed, but he is confident
that it will be used in the near future.
Meanwhile, it is never too late to
improve health. Dr Tan Ngiap Chuan,
Senior Consultant and Director of
Research, SingHealth Polyclinics and a
member of the research team, said the
elderly can delay frailty and sarcopenia (the loss of muscle mass with age)
by maintaining a healthy lifestyle with
proper diet and exercise. It is a mistaken
notion that a weak handgrip – and hence
mortality – can be improved with forearm exercises. A weak handgrip must be
viewed and managed in the context of the
overall health assessment of a patient.
Dr Tan advises the elderly to increase
their daily physical activities to their best
capabilities, with supervision from caregivers and periodical reviews by their
family doctors.
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NEWS
08
singapore health
jan– feb 2015
care is closer to home
Health care in the
neighbourhood
Photo: florence tan Bee Lay
SingHealth’s new community health centre makes chronic
disease management more convenient for the elderly
By Sol E Solomon
S
enior citizens living in and
around Tiong Bahru now have
quicker access to essential services for chronic disease management
with the opening of the new Tiong
Bahru Community Health Centre (CHC).
The CHC – SingHealth’s first – helps
complement care by general practitioners (GPs) to elderly residents with
stabilised chronic diseases. Lower- and
middle-income patients on the Community Health Assist Scheme (CHAS)
will continue to enjoy subsidised health
care at the CHC, which is supported by
the Ministry of Health.
Tests done here include eye screening through diabetic retinal photography to detect early retinal changes that
can cause vision loss.
C
M
Y
CM
MY
CY
CMY
K
Also available are diabetic foot
screenings, dietetic services, nurse
counselling and health education.
Screening results are sent directly to
GPs within two weeks to enable prompt
follow-up.
Family physicians in the area used
to have to refer patients to hospitals for
such tests, but with the CHC’s opening,
this is no longer necessary, said Professor Fong Kok Yong, SingHealth’s Group
Director (Medical), and Singapore General Hospital’s Chairman of Medical
Board. Since starting operations in July,
the CHC has received referrals from
close to 40 GPs.
“It meets the ageing population’s
health care needs, which have become
more complex, especially with those
(From left) Professor Ivy Ng, Group CEO, SingHealth, Ms Indranee Rajah,
Senior Minister of State for both Law and Education and Member of
Parliament for Tanjong Pagar GRC, and Ms Jinna Chin Miew Mei, Senior
Enrolled Nurse, Tiong Bahru CHC, at the opening of the centre.
who suffer from chronic illnesses and
require longer term medical care,” said
Prof Fong. “By working closely with GPs,
we can institute early detection, timely
follow-up and active management of
chronic diseases to help patients delay
or even avoid complications.”
Ms Indranee Rajah, Senior Minister
of State for both Law and Education
and Member of Parliament for Tanjong
Pagar GRC, who officiated at the open-
ing of the centre, said: “For the elderly,
sometimes, going into a hospital is very
daunting as they may fear that they will
not come out or that they’ll have to stay
there for very long. Having something
in the neighbourhood that is very community friendly like this is really good
for the elderly, because of the sense
that it’s right where they are and they
can go home after treatment. That is
very important.”
jan– feb 2015
singapore health
NEWS
09
Directing patients to suitable care
A new class of health care professionals known as navigators have been trained to identify and connect those
patients in most need of post-hospital care with the wider health care team in the community
By Sol E Solomon
photo: Vernon Wong
W
hen she noticed an elderly
patient being admitted to
Singapore General Hospital’s
(SGH) A&E all too frequently – every few
weeks – for giddiness and sometimes,
a fall, alarm bells began ringing in SGH
Senior Staff Nurse Tan Lay Hong’s head.
Investigating, Ms Tan found that
72-year-old Mrs Aw*, who suffers from
diabetes and hypertension, lives with
her daughter. Left alone at home when
her daughter is at work, Mrs Aw often
forgot or mixed up the medications
she is on. Not taking medication properly to regulate her blood pressure and
blood glucose, Mrs Aw often felt giddy.
Ms Tan called Mrs Aw’s daughter
to discuss her situation. Ms Aw, who
works as a clerk, can’t afford to employ
a live-in help to look after her mother.
With a better understanding of Mrs Aw’s
situation, Ms Tan looked into day and
home care facilities, and referred her to
a medical social worker for help in managing the costs of added assistance.
Ms Tan explained to Ms Aw the
importance of having her mother take
her medication regularly, and gave her
dietary tips and other advice. Now,
when Ms Aw is home, she makes sure
her mother takes her medication regularly. As a result, Mrs Aw visits SGH
much less frequently.
“Such cases are very common,” said
Mdm Salimah Mohd Ayoob, Assistant
Director, Nursing, SGH.
To make sure that patients get the
best care possible, not just in hospital
but also after they are discharged, a
new class of health care professionals
known as patient navigators have been
trained at the SingHealth Group. They
identify patients most in need of afterhospital care.
Ms Tan was one of 33 senior nurses
trained in early 2014 as patient navigators. They underwent a four-month
programme that armed them with
the essential skills and knowledge to
assess, plan and coordinate care for
patients after discharge from hospital.
They connect patients with the wider
health care team, community hospitals,
external agencies and the community.
Navigators go through new cases,
checking the patients’ medical records
and social backgrounds to determine
who would need low, moderate or complex care upon discharge.
Complex care cases are those who
suffer from more than one chronic medical condition, consume more than five
medications, or have disability and
social issues, said Nurse Clinician Xu
Yi, another patient navigator. Complex
Senior Staff Nurse Tan Lay Hong (left) and Nurse Clinician Xu Yi (right), pictured with Assistant Nursing Director Salimah
Mohd Ayoob, are among the first senior nurses to be trained as patient navigators. Mdm Salimah is the programme’s
clinical facilitator.
cases are those most at risk of readmission, largely because of a lack of
support at home. “We screen and enrol
those cases with complex social backgrounds and who require complex
care,” said Miss Xu.
Navigators also monitor these
patients’ conditions at home through
regular follow-up calls, and refer them
to community and social agencies that
can best help them.
Early feedback from
patients and their
families suggests that
they appreciate the
navigators’ role as a
one-stop reference
point for their care
and social needs.
Dr Salimah Mohd Ayoob, Assistant
Director, Nursing, SGH
The pioneer patient navigators
comprise 24 nurses from SGH, five
from KK Women’s and Children’s Hospital, and four from the National Heart
Centre Singapore. They are all senior
nurses, and were chosen for seniority,
clinical competence, and communica-
tion and “managerial skills, because
they manage patients and decide
what’s best”, said Mdm Salimah, who
is also the clinical facilitator for the
patient navigators.
Patient navigators are relieved of
supervisory roles like managing ward
staff to give them more time to look
into each patient’s discharge needs in
depth. As nurses, they work closely with
their patients and get to understand
their problems first-hand. Their clinical
knowledge helps the navigators understand chronic disease care and management, said Ms Tan.
What they do for patients doesn’t
stop at medical-related needs. They
might liaise with medical equipment
vendors for a patient with breathing
difficulties who needs oxygen devices
at home. A patient who has suffered
a stroke might need support bars or
other devices installed in his bathroom,
or other changes to his home. His navigator might offer the names of contractors who can do such renovations. If
cost is an issue, the navigator looks out
for subsidies that the patient can apply
for to make these changes to his home.
Ms Xu, who works in the medical
oncology ward, frequently helps her
patients look for domestic helpers.
Many of her patients are in advanced
stages of cancer, are very ill, and need
lots of community resources and home
help, she said. She might also arrange
for an interim caregiver from a commu-
nity service provider to help the family
while they wait – sometimes as long
as up to three weeks – for a domestic
helper to be employed.
Sometimes, a family might only
need a home care nurse to provide
additional support to a patient’s main
caregivers, such as when one domestic helper isn’t enough to care for the
patient. Such arrangements allow
patients to return home more quickly.
Before, said Ms Xu, very sick cancer
patients often had to stay in hospital for
prolonged periods.
Two patient navigators are assigned
to the emergency department, and one
each to the medical, oncology and general surgery wards in SGH, where, in the
patient navigators’ first three months
of work, they took on over 900 cases.
Early feedback from patients and
their families suggests that they appreciate the navigators’ role as a one-stop
reference point for their care and social
needs, said Mdm Salimah. Patients are
also directed to and placed in appropriate health care institutions, such as
community hospitals for patients who
are fit for discharge but need a longer
time to regain their functional abilities.
*Mrs Aw is not a real person but is based on
a typical patient profile of her age group
who suffers from multiple chronic medical
conditions.
More on the re-organisation
of health care on page 16
10
NEWS
singapore health
jan– feb 2015
2014 年9– 10月刊
Goodbye eye drops
新闻
31
专家解答
无法集中精神或健忘
眼镜或隐形眼镜和使用阿托品滴眼剂
无 论病 情 是 否已受
失去正能量或动力、无精打采（或 （Atropine Eye Drop）。眼镜和隐形眼
到 良 好 的 控 制，所 有
最近的烟霾使我的哮喘病病情恶 哮 喘 病 患 者 都 应 该
容易激动和焦躁不安）
镜的治疗效果因人而异，一般 成功率
化，经常发作。我该怎么做？
意志消极、过度内疚、绝望感，以及 从零至30%不等。如果选用隐形眼镜
随 身携带一 个吸 入
在哮喘病发作时，患者的呼吸道会收 器，预防哮喘病随时
有自杀倾向。
来治疗，家长必须加倍小心护理，以确
Glaucoma
patients may, in the future,
for 上症
this状new
painless
injection
窄，导致呼吸困难。如果没有适当地
但 如果以
连 续出现
超 过两
保孩子的眼睛不会受到感染和威胁到
发作。 be able to ditch their eye drops
控制病情，让呼吸道受到环境的触发 新加坡保健服务
周，并引起重大的痛苦或影响个人的日 视力健康。
集团综合诊疗所
因素所刺激，
病情很容易就会发作。
那可能就是抑郁症了。
阿托品滴眼剂是一种能够减缓近视
By Desmond
Ng
versible blindness
worldwide. In Singa- there’s
Research
Group at SERI. Prof Wong devel- 常生活能力时，
still a problem with our patients’
家庭内科顾问
要减少哮喘病发作，就必须控制好病 oped
恶化的有效药剂，
控制效率可达50%
pore, about 3 per cent of people over the ability to comply with
the injection with the NTU team led 竹脚妇幼医院心理医学科主管及高级顾问
what’s given. Ide医生黄忠伟
age of 50 have it. SNEC sees up to 10,000 ally,
we want
something
that will take
情。因此，患者可能需要服用适量的控 by Professor Subbu Venkatraman, Chair 医生陳瑜
至80%。
不过，
不同浓度的滴眼剂可能
laucoma patients may, in the of NTU’s School of Materials Science and
glaucoma patients each year.
away
the responsibility from them. With
制性药物。
会造成瞳孔放大和近距离视力模糊。
future, be able to replace their Engineering. The team is ready to conduct
Prof Wong said eye drops for glaucoma sustained
drug delivery through nano哮喘病的吸入性药物可被分为两大
副作用较轻的较低浓度滴眼剂去年
daily eye drop regimen for an eye larger clinical trials, most likely in the US, have some drawbacks. Some patients medicine such as ours, we can ensure that
种类：
上市，给使用者更多样化的选择。如果
injection once every six months, to treat and the injection is expected to be com- complain of red, itchy eyes and a bitter the medicine is working round the clock.
我经常感到情绪低落，
对任何东
控制性药物：
治疗肺炎，
同时降
低
你希望知道自己的孩子是否适合接受
their condition.
mercially available in about two and a half taste in their throats, and only 5 to 10 per We get a more targeted release of the drug
西都不感兴趣。这是不是抑郁症
我其中一名孩子患有近视。
请问有
肺部对于触发因素，
如烟霾这种环
以上治疗，
The
injection to the eyeball
is delivered years’
cent of the drug in each drop actually
gets without
time.
the请咨询你的医生。
side effects of eye drops, and
的征兆？
月经来潮之前感到忧郁消
什么方法治疗吗？
如何预防近视度
境污染物的敏感度，
从而减轻敏感
under local anaesthetic by a doctor, and
into the eye. “There’s a lot of wastage,” we
Prof Subbu said it took four and a
will be able to manage the disease
新加坡全国眼科中心及竹脚妇幼医院幼儿
眼科与斜视治疗组高级顾问医生谢玮玲
沉是正常的吗？
另外，我也开始限制小 more
反应。
takes
only a minute. It contains millions of half
he said.
years to move from concept to trial. 继续加深？
effectively.”
tiny
capsules of glaucoma
medicine which
One of the biggest challenges is
is currently
being used 儿子使用电脑和电子产品的时间。
月经来潮的前两周，
有些妇女可能会
缓解性药物：
在哮喘病发作时，
舒 “Nanomedicine
release
their contents slowly over time.
patients’ failure to apply eye drops as preto
treat cancer. The challenge in apply- 我是否过度反应了？
感到情绪低落是因为黄体酮（一种会
缓并扩张已收缩的气管。
This
breakthrough
procedure
was
scribed. A study showed that after a year,
ing
it
was
to
take
an
existing
drug,
put
it
在阴霾笼罩时，病情一般受到控制 导致情绪消沉的荷尔蒙）一直在体内 遗传和环境因素会导致近视。如果你
jointly developed by the Singapore Eye into a nano carrier and control its release
less than 25 per cent of patients came
的哮喘病患者可能会觉得病情转坏， 不断地增加所引起，又或者因为月经 有近 视，你孩子患 上近 视的几率会更
Research Institute (SERI) and a team from over a long period. For glaucoma, the drug
back to SNEC for more eye drops; after
而必须避免进行某些活动，
例如游泳/
并需要服用控制性药物。至于已在服
Nanyang
Technological University (NTU). had
three此外，
years,我们目前的生活模式也过份
only 10 per cent were using
to act for at least three months.
We 高。
水上运动、
穿紧身或浅色衣服，
甚至性 偏重于室内工作和近距离聚精会神。
药的患者，
Six
patients则可能需要医生调整药物
were involved in the first believe
eye drops at all. A US study showed that 10
this has
not been done before.”
保健促进局推
行为，
而感到沮丧。
剂量。trials in February 2013.
human
per为了减轻以上因素，
cent of glaucoma-resultant
blindness
Prof
Wong said: “We consider this a
“We
conducted the trial to ensure major
was due to计
incorrect
use孩子多到户外活
of eye drops.
breakthrough,
not just technologi- 行了一个
划，支持
至于抑郁症，
它主要的症状是情绪
所有的哮喘病患者都应该有一份列
that
the procedure was safe, feasible识别
and cally
Patients’
main reasons for
this were
but also in the way
we can administer 动，
避免长时间留在室内。
你也应该限
低落和意志消沉，
或对任何东西失去
明指示的哮喘病控制行动计划：
workable,”
Associate Professor 预防
Tina medicine,
forgetfulness and stopping because they
apart from through eye drops, 制孩子玩电脑游戏和看电视的时间，
并
兴趣和无法透过任何事物感到欢愉。
早期症状，said
以便采取适当的措施，
Wong, Senior Consultant Ophthalmologist to our patients in the future.”
did not understand what the eye drops did.
Prof Tina Wong (right) developed a
让他多到户外玩耍。
发作程度恶化；发作时需要采取的步 其他症状还包括：
at the Singapore National Eye Centre’s
Prof Wong said: “This is why we have such
In glaucoma patients, fluid build-up in
new painless injection for glaucoma
失眠（尤其是在凌晨醒来）
如
果
近
视
持
续
加
深，我
们
可
以
通
骤；
以及如何辨别发作程度是否严重
(SNEC) Glaucoma Service and head of the the eye creates pressure which damages
bad glaucoma in Singapore. We doctors
patients with the NTU team led by Prof
食欲不振和消瘦（或爆食和发胖）
到需要紧急救护治疗。
Subbu Venkatraman (left).
Ocular
Therapeutics and Drug Delivery the
are prescribing medicine in例如配戴特制
good faith, but
optic nerve – the major cause of irre- 过其他方法来控制它，
烟霾使哮喘病加剧
G
我患上抑郁症了吗？
近视可以治疗吗？
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readers Available at strategic locations
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jan– feb 2015
singapore health
11
12
pioneers
singapore health
jan– feb 2015
Throwing caution to the wind
His sense of adventure took him through unusual terrain but Mr Ho Meng Jang eventually found his place in
occupational therapy
M
R Ho Meng Jang has worked in
the Singapore General Hospital’s (SGH) occupational therapy
department for 38 years, but he once
thought of repairing cars as a career.
In the 1950s, being a mechanic was an
appealing notion to the then 13-year-old.
He and a friend rode their bicycles to the
Boys’ Town in Bukit Panjang to enrol in a
mechanics course.
“At the time, many people in Singapore
were jobless. We thought it would be good
to skip school for a few months to learn a
skill,” said Mr Ho, the third in a family of
four children. In the three months that he
was there, however, all he learnt was how
to file down an iron bar.
Mr Ho returned to school, eventually
graduating with a high school certificate. On a hunt for a job in 1961, he saw a
newspaper advertisement for pupil occupational therapists. “Nobody knew about
occupational therapy in those days, but
it sounded interesting,” he said. Curious,
he applied for the job.
Af ter learning the ropes at the
then-Woodbridge Hospital, he moved in
1977 to SGH, where he was department
head from 1980 to 1988. The 76-year-old
is still reluctant to retire fully; he continues to work as a senior principal occupational therapist, helping patients who
are unable to perform daily living tasks
properly to regain function.
Looking back at how the profession
has changed, the grandfather of five said:
“The job used to involve a lot of craft work
like basketry and paper flower-making,
as it was believed that leaving patients
to weave baskets and the like would help
them restore movement to their limbs.”
It was in the 1970s that another SGH
medical luminary, orthopaedic surgeon
Professor N Balachandran, stopped
this practice. He urged the therapists
to work with patients directly and not
just use craft work to restore their hand
mobility. “Prof Balachandran said: ‘Why
don’t you all (occupational therapists)
do what you are trained to do? If I see
another basket, I’m going to throw it out
of the window,’” said Mr Ho.
The job used to
involve a lot of
craft work like
basketry and
paper flowermaking, as it was
believed that
leaving patients to
weave baskets and
the like would help
them restore
movement to
their limbs.
Mr Ho Meng Jang, senior principal
occupational therapist,
occupational therapy
department, SGH
With the restructuring in the health
care sector in the 1980s, SGH’s general surgery departments started
branching out into sub-specialities.
Occupational therapy services likewise
began to specialise. “We now have a
hand surgery department specialis-
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In the past, patients were taught to
weave to help restore movement to
their limbs.
Photo: Alvinn Lim
By Wong Sher Maine
ing in restoring function in the hands,”
Mr Ho said, adding that occupational
therapists work closely with surgeons
to help patients recover their hand
functions.
It was during Mr Ho’s watch that Singapore’s first pressure garments – and
in-house seamstresses to sew them
– were introduced. These garments are
used on burn patients to prevent the
growth of abnormal, restrictive scar
tissue. During the 1970s, it was difficult to obtain the garments from overseas, where they were sold. Said Mr Ho:
“We searched high and low, and finally
found a company in Jalan Sultan selling
the stretchable material that we could
use to make the pressure garments.”
The seamstresses and the pressure
garment unit are still part of the occupational therapy department today,
but more sophisticated and advanced
devices such as lasers are also available.
After half a century in the same
field, Mr Ho still enjoys coming to work.
“People say ‘This guy has no ambition’! But it’s a fun job. I like dealing
with people, talking to them to try and
understand and help them with their
problems. And when patients remember and are grateful for what we did for
them, it makes my day!”
Jan – feb 2015
Modernising
Singapore’s
health care
Dr Kwa has had a long association
with SGH, starting from the time he
began clinical training in 1951 to becoming the hospital’s first chairman in 1989.
He has also contributed to the army:
in 1967, he was asked by then Defence
Minister Dr Goh Keng Swee to persuade
doctors to volunteer their services to
the People’s Defence Force. He has also
served on many public and professional
committees and companies, including as
Chairman of both Jurong Bird Park and
the Singapore Zoological Gardens.
Amid the multitude of responsibilities that he has had to shoulder, Dr Kwa
always kept his doors open to his staff,
both doctors and nurses alike.
Professor Christopher Cheng, ProTem CEO, Sengkang Health, hailed Dr
Kwa as a “shining example of a great
leader”, in an SGH tribute to Dr Kwa
in 1996. He recalled how as a firstyear medical officer, he called the Ministry of Health one evening and was
surprised when Dr Kwa picked up the
phone as his secretary had left for the
day. “Instead of cutting me off, he was
most interested in what I was enquiring.
In the end, we had a half-hour conversation about possible training opportunities and future paths. In spite of his many
other more pressing concerns, he finds
time for each individual,” said Prof Cheng.
Well-loved and highly respected, Dr Kwa Soon Bee
has been credited for bringing in changes to
transform the health care landscape
By Wong Sher Maine
H
e was inclined towards nature,
and had thought of pursuing a
career related to agriculture. But
his father, a banker, harboured hopes
that his children would become doctors.
Of his 10 children, only one did. Still,
what that child – his ninth – achieved
was way beyond the duty of any doctor.
Dr Kwa Soon Bee, Emeritus Consultant, Department of Haematology, Singapore General Hospital (SGH), studied
medicine at the University of Malaya,
and later went on a government scholarship to specialise in haematology in
the UK. He returned as the first Singapore doctor to be fully trained in clinical
and laboratory haematology, and was
appointed the Head of the Singapore
Blood Transfusion Service in 1963.
At the time, it was difficult getting
Singaporeans and Asians to donate
blood, although “it was very clear that
Singapore needed blood for medicine
to progress,” Dr Kwa said in an interview
for the Oral History Centre. To encourage
blood collection, Dr Kwa said he “did
all sorts of entrepreneurial campaigns”,
including publicity, education and incentives. For his efforts in developing the
Blood Bank, he was awarded the Public
Administration Gold Medal in 1969.
More importantly for Dr Kwa, the
years building up the Blood Bank
allowed him to hone his administrative skills – these would be crucial
when he was charged to transform the
public health care sector. In the early
1980s, then Health Minister Howe Yoon
Chong was looking to change the way
that healthcare was delivered as “he
already saw the problems of old age
coming up in the year 2030,” said Dr
Kwa. Brought into the Ministry, Dr Kwa
became instrumental in initiating and
shaping a savings scheme for health
care (this led to the Medisave, Medishield and Medifund schemes).
He was also behind the restructuring and corporatisation of public hospitals, and the rebuilding and consolidation of government health care facilities,
including hospitals and polyclinics.
Dr Kwa played a major role in the
development of medical specialisation
in Singapore. To honour Dr Kwa when
he was made an Honorary Member of
the Singapore Medical Association in
1997, former SingHealth Group CEO Professor Tan Ser Kiat said: “This is a fact
not known to many. (Dr Kwa) implemented the recommendations of the
Committee on Medical Specialisation
in the 1970s as well as pushed for the
development of sub-specialisation in
various hospitals, resulting in the establishment of specialty centres like heart,
eye, mental health, dental and cancer.”
C
M
Y
CM
MY
CY
CMY
K
Dr Kwa Soon Bee (pointing to a blood collection barometer) said he turned to “all sorts
of entrepreneurial campaigns” to encourage reluctant Singaporeans to donate blood
to the Blood Bank.
singapore health
pioneers
13
14
singapore health
jan– feb 2015
Health Xchange
Our experts answer all your questions about health
Diagnosed with hernia
Can playing online games on the
tablet and laptop for hours cause a
child eye strain over time? Will a child
with floaters outgrow them, and is
there any treatment for the condition? Also, does an eye massager help
children have healthy eyes?
Too much near work or computer games
have been shown to be associated with
myopia. It does not matter what activities are performed during periods of near
work (i.e. reading, typing or watching
videos), your child should give his eyes a
break after 30 to 40 minutes of continuous near activity.
Floaters can be due to posterior vitreous detachment, a retinal tear or detachment, and rarely inflammatory conditions of the vitreous or retina. In children,
the above conditions are uncommon.
However, I recommend that a child with
floaters gets a comprehensive eye examination to exclude the above. Treatment
is dependent on the cause of his floaters. No, the eye massager has not been
proven scientifically to help with reducing myopia progression, or to aid the
development of healthy eyes.
I was recently diagnosed with hernia
after I noticed a lump in the groin
which appears more prominent when I
am standing up. I don’t feel pain or any
discomfort. What causes it?
Hernia occurs when a weakness in the
abdominal wall allows organs such as
the intestines to poke through the wall,
causing a bulge to appear underneath
the skin. It is generally not serious but
can become a medical emergency if the
bowel gets obstructed or strangulated.
Also, if the blood supply to the intestines
or other organs is cut off, gangrene can
set in. Immediate surgery is then required
to repair the damaged intestine and fix
the hernia.
For small and painless hernias, doctors may adopt a wait-and-see approach.
Growing and painful hernias need surgery. Although hernias usually do not
cause discomfort in the early stages,
they tend to grow larger over time. So it is
best to have it checked early. If you experience acute groin and abdominal pain,
nausea, vomiting and blood in the stools,
you should get emergency medical help.
SGH’s Department of General Surgery sees over 1,000 cases of groin hernia
a year. Lifting heavy objects, straining
excessively during bowel movements,
or even persistent coughing can all put
excessive pressure on the abdomen
and cause a hernia to develop. Obesity
increases the risk of getting a hernia too.
Paediatric Ophthalmology and Adult Strabismus
Department, Singapore National Eye Centre
photoS: maridav, ximagination / 123rf
Eye care for children
Tightness at back of
ankle refuses to go away
I recently felt an aching sensation
at the back of my ankle. The pain
is not severe and feels more like a
tightness of the muscle. I have had
foot massage but the tightness persists. I run several times a week but
don’t feel the pain then.
Muscle tightness or aching over the
back of the ankle can be associated
with calf tightness, Achilles tendinopathy or pain from neural structures or the lumbar spine. From the
description of your condition, you are
more likely to be suffering calf tightness or Achilles tendinopathy. For
these conditions, foot massage won’t
help to ease the tightness or ache.
The muscles in the calf help
primarily to lift the heel and support
the ankle. Tightness or aching is
a common condition among run-
ners and may develop over time.
Stretching can help to reduce calf
muscle strain.
Changes in a training regime such
as a sudden increase in intensity or
frequency or an abrupt halt to a daily
running routine can strain the Achilles tendon, which stretches from the
bones of the heel to the calf muscles. Adequate rest is necessary to
allow the tendon to heal. If not, the
damage may build up, resulting in a
weakened tendon which is less capable of withstanding stress.
As you have been experiencing
the tightness for some time, you
should see a doctor to rule out other
conditions, and be referred to a specialist if necessary.
Ms Cheryl Poon, Physiotherapist,
Singapore General Hospital
Professor Wong Wai Keong, Senior Consultant and
Head, Department of General Surgery, Singapore
General Hospital
These articles are from www.healthxchange.com.sg,
Singapore’s first interactive health and lifestyle portal.
Please visit our website listed above
to find out the discussion topics for
Jan-Feb 2015.
MYTH: The Pioneer Gene r a t i o n Pa c ka g e i s a
scheme to help elderly
Singaporeans. So, all Singapore citizens will benefit from it in
their golden years.
The package only applies to a certain
group of Singaporeans – those born on
or before 31 Dec 1949 and those who
obtained their citizenship on or before
31 Dec 1986. Its purpose is to honour and
recognise this generation of people for
their contributions to the country during
its challenging early years.
MYTH: I’m not poor, so the
Pioneer Generation subsidies are not for me.
The Pioneer Generation
Package is meant to honour an entire
generation for its contributions to
nation building, so its benefits are not
restricted to the needy. Anyone who
was born on or before 31 Dec 1949 and/
or obtained citizenship on or before 31
Dec 1986 qualifies for the subsidies.
MYTH: I can use my Pioneer Generation card at
my neighbourhood general
practitioner’s (GP) clinic.
The Pioneer Generation card can be used
at a GP clinic only if it is a clinic under the
Community Health Assist Scheme (CHAS).
GPs who are not under the scheme will not
recognise the Pioneer Generation card.
CHAS is a scheme that enables Singaporeans in low-income households
to receive subsidised health care from
participating GP and dental clinics. This
network of CHAS clinics now serves
Pioneer Generation members as well.
There are more than 1,000 CHAS clinics
spread across Singapore. Clinics under
the scheme can be identified by the CHAS
stickers displayed on their premises, and
a list of all CHAS clinics can be found at
www.chas.sg.
MYTH: All Pioneers can
enjoy subsidies at the specialist outpatient clinics
(SOCs) of public hospitals.
The subsidies apply only to Pioneers
who are classified by the SOCs as subsidised patients, like those who have
been referred to the SOCs by a polyclinic
doctor or CHAS GP. Pioneers who are
classified by the SOCs as non-subsidised patients, such as walk-in
patients, will not be eligible
for Pioneer subsidies.
singapore health
Pioneer
Generation
myths
debunked
The $8 billion Pioneer Generation Package
for Singapore’s founding generation has
generated some confusion
By lynn seah
Money
15
MYTH: I already have a
Health Assist card that
enables me to receive
CHAS subsidies. If I bring
both my Pioneer Generation card and
Health Assist card to a clinic, I’ll get
two kinds of subsidies.
Even if you hold both cards, only one set
of subsidies – the ones under the Pioneer
Generation package – will apply.
The subsidies for Pioneers are higher
than those for Health Assist card holders, so the Pioneer Generation card will
supersede the Health Assist card regardless of whether it is the blue Health
Assist card (for those with a monthly per
capita household income of $1,100 and
below) or the orange one (for those with
a monthly per capita household income
of $1,101 to $1,800).
So, the Health Assist card is no longer
necessary for patients who have a Pioneer Generation card.
MY TH: The Pioneer
Generation Package
covers only outpatient
health care.
The package includes help for Pioneers’
hospitalisation expenses through annual
top-ups to their Medisave accounts, and
through subsidies for the premiums they
will pay for MediShield Life, the compulsory medical insurance scheme for all
Singaporeans, to be implemented at the
end of 2015.
Pioneers with moderate or severe
disabilities can receive cash assistance
to defray the cost of their care through
the Pioneer Generation Disability Assistance Scheme. Some disabled Pioneers,
such as those who are claimants under
the ElderShield disability insurance
scheme, are automatically eligible for
this scheme. Others can apply for the
scheme by getting a functional assessment report from a doctor to certify
their condition.
MYTH: Pioneer Generation card holders can get
subsidised health screenings at polyclinics and
CHAS clinics at any time.
Only Pioneers holding Health Promotion
Board screening invitation letters are eligible for free health screenings and subsidised doctors’ consultations in relation to
the screenings. These letters are issued
to Pioneers recommending them
for specific health screening tests
such as for hypertension, diabetes, lipid disorders, colorectal
cancer and cervical cancer.
For more details, please refer to
www.moh.gov.sg
PHOTO: tpG images/click photos
jan– feb 2015
singapore health
jan– FEB 2015
Organising care
around the person
Singapore is re-looking the way it
delivers health care as the population
ages and the number of people with chronic
diseases rises. The focus has been on hospitalbased speciality care. The aim now is to develop a
system that is structured around the person, providing
a continuation of care in the community and at home, in
addition to the acute hospitals. To do this, public hospitals
are taking the lead in bringing partners from both the
social and health care sectors into the network. Health
care providers – from primary to acute to intermediate
and long-term care – and social support agencies
are working together to provide patients and
caregivers with appropriate care – at the
right time, at the right place, and by
the right care provider.
Staying well
More emphasis will be placed
on health promotion and
disease prevention. Efforts
will be stepped up to educate
people on how to take care of
themselves and to stay active
and healthy.
Managing early-stage or
chronic diseases
More than just seeing a
doctor, managing a longterm medical condition
is about seeing a regular
general practitioner (GP)
who monitors and keeps
the condition under control.
It also requires support by
allied health professionals
for lifestyle management and
screening for complications. Working closely with these
care partners, people with
such diseases can improve
or manage their conditions,
to remain independent and
continue with their daily
activities.
Getting specialist care
when needed
People with complex
conditions will still be able
to get care from hospital
specialists when needed.
But once their condition is
stable, they can be cared
for by their regular GP or at
a health care institution for
longer-term management. For
the convenience of patients,
patient navigators and other
health care coordinators will
help match them with an
appropriate care facility
within their community.
Specialist care at acute hospitals
and national speciality centres
a cce s
st
p
os
ecia
GPs and polyclinics
Care for life-long
chronic conditions
Hospital A&E for lifethreatening conditions
Patient navigators
Coordinate and help
people get to the
appropriate care
Find out more on page 9
list car
e
e
f
o
r
a
r
c
l
i
f
y
e
r
a
l
o
m
ng ch
i
r
P
ron
ic c
on
dit
ion
s
e
a
n
m
d
o
i
h
n
t
t
a
h
e
e
r
com
a
C
mu
n
special
c
i
a
e
l
p
i
s
s
t
l
c
a
t
a
i
re for c
p
s
o
H
omp
lex
dis
eas
es
16
Family medicine clinics
GPs care for life-long
chronic conditions
Nursing homes
Long-term
residential care
Palliative care and hospices
End-of-life care
jan– feb 2015
t ra
ns
t
fer
o
l
s
es
ac
e
ut
ca
singapore health
special
17
re
Community hospitals
Rehabilitation and restorative support
Social services
Support for home
care or self care
Community health centres
Tests and therapies
ordered by GPs
ka
cce
ss
to
ac
e
ed c
are at home
ut
ca
re
q u i c k a cce s s
to
ac
ut
e
ca
Family and friends
to
su
nit
y
pp
ort
re
t
re
Day care and
senior activity centres
Education and
empowerment
Wellness programmes and
disease prevention
Organising
care around
the person
ur
n
Maternity, dental and
school-based services
Bringing
care
closer
to home
Continuation of care in the community
illustrations: 123rf
quic
18
your say
singapore health
In a dental
emergency
Where do I find a dentist if I have a
dental emergency outside of regular clinic hours?
the severNDCS Toity match
of your condition
s a y s with the right level
of care, we advise you to go to your
regular dentist for non-emergency
dental treatment during normal
opening hours. Non-critical procedures include extraction (whether
simple or difficult), scaling, filling,
root canal treatment, removal of
wisdom teeth, and anything related
to dentures, crown/bridge implants
and braces.
If you are unable to wait until
the next day to see a dentist, you
can go to a private dental clinic that
opens on weekends, or the Accident
and Emergency Department (A&E)
dental service at Singapore General
Hospital (SGH). The A&E dental service is set up to offer limited dental
services to manage conditions that
need urgent care, such as severe
pain, uncontrolled bleeding, facial
swelling due to infection, and trauma-related injuries (e.g. loosened
or dislodged teeth, broken teeth or
jaws, severe cuts to the gums and
lips).
The current A&E attendance fee
is $108 per visit. This covers basic
investigations and services. Emergency dental procedures will involve
extra charges. At the clinic, a dentist
will assess your condition. Temporary pain relief may be offered, and
you will be referred to our Centre for
follow-up care the next working day.
Most dental conditions are not
life-threatening, so instead of rushing to the SGH A&E to treat a lessthan-severe toothache, you may
want to take over-the-counter painkillers to ease your discomfort while
you wait for the regular dental clinics
to open.
Not given referral
My father experienced pain in his
hip and asked the polyclinic doctor
to refer him to a specialist at the
hospital. However, the doctor
refused to issue a referral letter.
Please explain.
jan– feb 2015
Heartened to know of eye exercises
market place
I found the article “Give your eyes a workout” in the NovemberDecember issue of Singapore Health very informative. When my son
was young, he was diagnosed with a squint. But we were fearful of
surgery and so didn’t have his condition – known as an alternating
divergent squint, where one eye deviates outwards – corrected. I
am very grateful and heartened to have read about available new
technology and eye exercises to help squint sufferers. Hopefully, the
exercises will help them make the best use of their eyes until their
old age. I also hope that Singapore Health will include articles with
tips on how to avoid depression, anxiety, insomnia and dementia. It
is common to see people looking very lost and loitering around aimlessly in public places such as transport hubs, shopping areas and
parks. Articles with drawings and sketches are easier to understand.
Mr J Xu
This letter wins two bottles of Spirulina 100% Extra 10% Deep Ocean Water (750 tablets
each) worth $118, sponsored by IMI Lifestyle Products Pte Ltd.
Standing wonder
Junior doctors are
not students
When I was at SGH for an appointment with a senior specialist, I was
told that I would first be seen by
a junior doctor. Later, the senior
consultant arrived and asked me
and the young doctor a few questions. The consultation was thorough but it took a long time. I also
felt a little like a guinea pig. Moreover, I was billed a senior consultant rate.
SGH
As part of a teaching hospital, our senior doctors
s a y s have the responsibility
of teaching medical students and
doctors who are training to be specialists. Equally important is the role
of our patients, even as they are
receiving care, in educating the next
generation of doctors.
Our junior doctors are qualified medical professionals, not
students. Senior doctors guide
their juniors in assessing patients’
conditions. Taking a patient’s
medical history, conducting physical examinations and interpreting
simple investigations are important aspects of this.
Ask before taking
photos in wards
Why can’t I take photos of my
elderly uncle warded in SGH? The
photos would have been for our
own use. We also wanted to
include the nurses as a way of
remembering their kindness,
but they said we had to seek
permission from their supervisor.
There are no signs forbidding
anyone from taking pictures.
Improve your balance and posture with the kyBounder. This
soft, supple mat’s rebound effect
relaxes leg muscles, taking the
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when standing. Achieve all-round
fitness and stay healthier with the
kyBounder effortlessly.
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SGH
When visitors take
photos of their family
s ays members, other
patients in the ward may be captured in the images by chance.
While such photos may generally
be for patients’ personal photo
albums, we cannot assume that
this is always the case. We do not
know the intentions of every photographer, and we need to consider
the privacy and safety of both our
patients and our staff.
The hospital does not have a
policy on photography relating
to our staff. It is at their and their
supervisors’ discretion to decide if
they agree to be photographed by
patients or their families.
Facial magic
Enjoy spa treatment at home
with the stylish Panasonic
Nano-sized Ionic Steam. A simple
push of a button releases warm
steam, which opens up pores and
removes makeup, dirt and oil for
deeper cleansing, while doubling
miraculously as a makeup primer.
www.panasonic.com
consultations, our
SHP During
doctors conduct the nec-
s ay s essary examination to
assess whether a patient needs to
be referred to a specialist at a hospital. A referral can be made when further management or investigation is
required.
After a doctor has ascertained a
patient’s condition, he will provide
appropriate advice depending on
the patient’s condition. If no specialist referral is needed, the doctor will
prescribe medication, and may offer
necessary referrals to other departments such as x-ray and physiotherapy instead. The patient will also be
advised to return for further consultation when necessary if the treatment offered is not effective or the
condition is severe and persistent.
about your he alth
experience and win a prize
for best letter
Letters must include your full name, address and
phone number. Singapore Health reserves the right
to edit letters and not all letters will be published.
Write to [email protected] or The Editor,
Singapore Health, Singapore General Hospital,
Communications Department, Outram Road,
Singapore 169608, or talk to us on Facebook.
The winner will receive a bottle of Kyäni Sunset™ and Kyäni Sunrise™ each.
The products, worth $165, are sponsored by Kyäni Singapore Pte. Ltd.
Sole harmony
Don’t let your feet suffer for the
sake of fashion. The ShoeCo. now
carries a wider range of footwear
brands that marry both comfort
and style. Exude glamour while
keeping your soles contented at
all times.
www.theshoeco.com.sg
jan– feb 2015
singapore health
19
20
FYI
singapore health
jan– feb 2015
▲
Walnuts
event Calendar
could slow prostate cancer growth
DATE Jan 10, Saturday
TIME 11.15am-12.30pm (Registration starts
at 11am)
VENUE National Cancer Centre Singapore
Auditorium (Level 4)
FEE Free
REGISTRATION Phone registration only. Call
6225-5655 for inquiries. Strictly no admission for
children below 12 years old.
Diets rich in whole walnuts or walnut oil could slow the
growth of prostate cancer, new research from the University
of California-Davis has revealed. Walnuts are already known
to benefit health, but the scientists wanted to know if it is
the meat, oil or omega-3 fatty acids in them that are
beneficial. After feeding mice with whole walnuts,
walnut oil or a control fat diet for 18 weeks, the
scientists found that the walnuts and walnut
oil diets had lowered cholesterol and slowed
prostate cancer growth while the control
fat diet had not. The results suggest that
components other than omega-3s are
conferring these benefits.
Learn more about clinical research on cancer,
investigator-initiated trials and international
trials at this public forum organised by the
National Cancer Centre Singapore. Highlights
include how cancer research improves patient
care in the clinic, and how one can benefit from
taking part in clinical trials.
▲
Source: University of California-Davis
Improving Cancer Treatment:
Today’s Research, Tomorrow’s Cure
Breast and Cervical Cancer: What
You Should Know
DATE Jan 13, Tuesday
data. The scientists found
that in eight out of 14 cases,
there was a clear increase
in page views four weeks
before health officials
declared an outbreak. They
monitored data relating to
the flu in the US, Poland,
Japan and Thailand,
dengue fever in Brazil and
Thailand, and tuberculosis
in China and Thailand.
Source: Los Alamos National Laboratory
80 million
may protect knees
from osteoarthritis
1.Name the SingHealth
smartphone app used for
management of medical
appointments.
2. Which story in this issue
did you find the most
informative?
Closing date: Jan 27, 2015
Send in your answers and stand to win a bottle of
VitaHealth Resveratrol Lifecare, worth $78, sponsored by
VItaHealth Asia Pacific (S) Pte Ltd.
to register.
For women only, this talk will focus on why
early detection of cervical and breast cancers
is important. Learn what a pap smear is, who
needs it and how often one should go for it.
Running regularly at any age
may protect the knees from
osteoarthritis, not cause it, a US
study has found. Osteoarthritis
usually affects middle-aged
and older people, occurring
when joint cartilage is damaged
progressively. It can cause
changes in joint structure, such
as fluid accumulation and bony
overgrowth, and can hinder
movement. Previous research
suggested that regular running
raises the risk of the painful
disease, but after studying 2,683
participants, researchers found
otherwise. Those who ran on a
regular basis, regardless of age,
were less likely to experience
frequent knee pain compared to
those who ran only rarely. The
study also found that those with a
lower body mass index (BMI) were
more likely to run regularly. Lower
BMI typically helps to protect
against knee osteoarthritis.
Source: Newswise
Source: Microbiome
contest
REGISTRATION Call 6377-5225 for inquiries and
Anticoagulation Management
Workshop
DATE March 9-12, Monday-Thursday
VENUE Academia, 20 College Road, Singapore
169856
FEE $1,200
REGISTRATION Closes on Feb 28, Saturday.
Call Ms Carlyn Wee, SGH Postgraduate Allied
Health Institute, at 6576-2711 or e-mail
[email protected] for details.
For health care professionals who want to boost
their knowledge and expertise in managing
patients on anticoagulation therapy, the
workshop offers lectures, discussions and
case studies. It includes a half-day clinical
attachment by SGH doctors and pharmacists.
▲
That’s the number of bacteria that Dutch scientists say
can be transferred in one 10-second kiss. Researchers
from the Netherlands Organisation for Applied
Scientific Research studied the kissing behaviour of
21 couples and found that those who kissed at least
nine times a day were most likely to share salivary
bacteria. But before you shrink away in horror, relax.
Our mouths alone contain more than 700 different
bacteria, and more than 100 trillion microorganisms
live in our bodies. They help us digest food, synthesise
nutrients and prevent disease. The scientists, who
published their findings in Microbiome, hope to design
therapies for people with bacterial problems.
Room 43/44
FEE Free
▲
Wikipedia page views can
predict disease outbreaks,
say Los Alamos National
Laboratory scientists. They
said people are searching
online for disease-related
information before seeking
medical attention, so
disease-related Wikipedia
page views were tracked
and analysed before being
compared with official
Running
VENUE SingHealth Polyclinics - Bukit Merah,
PHOTOs: 123fr
Wikipedia page views
“predict” outbreaks
TIME 9am-11am
Mind Your Ps: Periods, Pain and
Pregnancy
DATE March 14, Saturday
TIME 2pm-4pm
VENUE Academia (Level 1, Seminar Room L1-S1),
20 College Road, Singapore 169856
FEE $5 per person
REGISTRATION Pre-registration is required.
Call 6576-7658 (9.30am-5.30pm) to register.
Include your name, age, gender, address and telephone number.
Winners will be notified via phone or e-mail. Incomplete or multiple
entries will not be considered.
E-mail [email protected] Post The Editor, Singapore Health,
Singapore General Hospital, Communications Department,
#13-01 Surbana One, Blk 168, Jalan Bukit Merah, Singapore 150168
Winners of Contest 31: Each will receive a tube of Bone Health cream
(10% Glucosamine Sulphate Plus Bio-Calcium and Chondroitin),
worth $49.50, sponsored by Urah Transdermal Pte Ltd. Prizes must be
claimed by Jan 27, 2015.
1. Andrew Cheang Shiqiang 2. Serene Lee Yin Foong
3. Simon Lee 4. Liew Swee Chin 5. Tan Say Hiak
This public forum will explore the issues that
affect women in their 20s to 40s. Find out from
the experts at SGH O&G Department about
pelvic pain and menstrual troubles, as well
as available treatments. Other topics include
fertility, and how to get the body and mind ready
for the arrival of the little one.
Visit www.singhealth.com.sg/events or the
websites of respective institutions for any
changes, more information, and other listings.
JAN– FEB 2015
singapore health
21
It's about location
With brain injuries, it is less about the injury and more about where it occurs in the brain
By Wong Sher Maine
T
photo: alvinn lim
According to Associate Professor
Ng Wai Hoe, in Singapore and
most countries, brain injury is a
major cause of death and disability,
particularly in the young.
A patient in critical condition may be
put into an induced coma so that his brain
can slowly recover. This was the treatment
given to retired racing car driver Michael
Schumacher, who sustained a major head
injury in a skiing accident.
At NNI, most of the serious head injuries seen are caused by road traffic accidents. However, Prof Ng said that in the
last decade, the probability of people
getting serious head injuries from motor
vehicles accidents had lessened. “Pas-
Motor
cortex
Sensory
cortex
Movement
Sensations
Frontal lobe
thinking, planning,
organising and problem
solving, controlling
emotions and behaviours,
personality
Parietal
lobe
Perception,
arithmetic,
spelling,
making sense
of the world
Occipital
lobe
Vision
illustration: ng chin hooi
he brain is a complex organ, and
head injuries can be mild, moderate
or severe. Sometimes, an injury that
looks serious may actually be mild, or
vice versa.
Associate Professor Ng Wai Hoe, Medical Director, National Neuroscience Institute (NNI) and Academic Chair, SingHealth
Duke-NUS Neuroscience ACP, likens the
brain to real estate. “It’s all about location. If you have a small blood clot in a
critical area, you can lose function and
may even become paralysed. But if you
have a large blood clot in an area which
is not considered prime, there may be no
functional deficit and you might make a
full recovery over time,” he said.
When a serious head injury occurs,
time is key. The sooner a patient gets into
surgery, the better his chances.
But surgeons cannot fix brain injuries the way they can fix broken bones.
Surgery aims to prevent further damage
from arising from the initial injury. After
surgery, one can only allow the brain to
recover gradually on its own time.
Brain swellings and blood clots can
take lives. Removal of clots and damage
may result in a patient losing key functions
such as speech or hearing, but with rehabilitation, he may regain some of these. Brain
swelling, which can cause further damage
if not checked, is eased by removing a section of the skull. The bone can be replaced
when the swelling subsides.
Temporal
lobe
Memory,
understanding,
language
sengers are now well-secured in vehicles
with seat belts, and are better protected
with airbags.” NNI also sees head injuries
resulting from falls at home and at industrial worksites.
Prof Ng said that in Singapore and
most countries, brain injury is a major
cause of death and disability, particularly in the young. But he expects head
injuries among the elderly to increase.
He recounted treating five patients aged
85 to 101 in a single day, all of whom
had fallen at home and hit their heads.
“Seeing so many elderly patients wasn’t
the case five to 10 years ago."
He said the elderly are prone to brain
injuries because they are often frail, have
more problems with coordination and
hence are more likely to fall. “As you age,
The brain is a complex organ with
different parts that have different
functions. A small blood clot in a critical
area can cause one to lose function,
while a large blood clot in an area that
is not considered prime may cause no
functional deficit, and one may make a
full recovery over time.
your brain shrinks and atrophies, and recover.” This means that in a two-yearthat makes it more susceptible to injury.”
old whose speech is affected by a head
The very young are also prone to head injury, another part of the brain can take
injuries, as their heads are larger in pro- over because his speech centres have
portion to the rest of their bodies. “Like not fully developed. And an infant’s fona poppy on a stalk, the head of a young tanelle – the soft spot on top of the head
child is relatively heavier, and his brain – allows for brain swelling.
stem and upper cervical spine can be
Where head injury is concerned, the
easily traumatised,” Prof Ng said.
mantra is really “protect and prevent”.
This is why Shaken Baby Syndrome
– in which an infant gets a devastating Protection is key
brain injury from being shaken violently Prof Ng advised those who engage in
– is so serious. “Many either die or are sports during which head injuries may
condemned to a vegetative state.”
occur, such as cycling or in-line skating,
The one ray of hope is that a child to wear helmets. “It’s not foolproof. I
with a serious head injury can recover have seen motorcyclists with smashed
faster than an adult. “This is known med- helmets and injured brains. But helmets
ically as neuroplasticity. The brain is still can reduce the impact and absorb a sig‘plastic’ and has a remarkable ability to nificant amount of shock.”
He also advised those in vehicles to
wear safety belts, and if possible to shield
their heads with their arms or bodies
when an impact is imminent. He said
Don’t dismiss a blow or bump to the head
that this is crucial, and it is why someone
may die from a fall at home while another
After a head injury is sustained, seek medical attention if:
walks away from a bike crash.
The person is drowsy, irritable, confused or behaves differently
“If you mitigate impact by, say, break There is nausea or vomiting
ing a fall with your arm, the injury may
There is weakness or numbness in any part of the body
not be severe. But if your head is unpro These symptoms may not appear initially, but if they occur within
tected, and this happens frequently with
12 to 24 hours after impact (the danger period for brain trauma),
the elderly and people under the influsee a doctor without further delay
ence of alcohol or drugs, a direct impact
can be fatal,” Prof Ng said.
22
singapore health
JAN– feb 2015
jan– feb 2015
singapore health
23
Help is within REACH
Helping young people with mental health problems in the community. By Suki Lor
Y
Ms Evangeline Ng, Psychologist, DPM, KKH
Patients find that the new coping skills
help them better manage stressful situations and daily activities. Their moods
stabilise, their relationships improve, and
they fare better in school.
A multi-disciplinary team to help
The REACH East team, led by KKH's DPM,
is part of an islandwide Response Early
Intervention and Assessment in Community Mental Health (REACH) programme
launched in 2007. Other REACH teams
serve the North, South and West educational zones of Singapore.
The REACH East team serves about
13,000 students from about 100 educational institutions – from primary school
Looking out for:
Changes in the child’s behaviour,
such as social withdrawal, an
increase or decrease in appetite,
and mood swings
Behaviour that impedes day-today functioning, such as poor
concentration, poor hygiene or
impaired social interactions
Development that is poorer than
age-appropriate developmental
norms, such as significant delays
in language, cognitive abilities
and academic performance
Seeking help at:
Schools, general practitioners
and polyclinics, community
services, family service centres,
counselling helplines, and
psychiatrists or psychologists
The REACH East team found that mood disorders are the most common mental
health concerns among teens, with anxiety and depression being two moodrelated difficulties.
to junior college – and comprises medical most common mental health concerns
doctors, psychologists, medical social among teens, with anxiety and depresworkers, occupational therapists, nurses sion being two mood-related difficulties.”
and administrators from KKH.
Attention deficit hyperactivity disorder
Dr Delphine Koh, Senior Psycholo- (ADHD) is the most common difficulty
gist, DPM, KKH, who leads the REACH among younger children seen by the
East team, said: “We work closely with team. “While ADHD cannot be prevented,
schools, voluntary welfare organisations the child’s behavioural difficulties and
(VWOs) and family doctors to form a com- emotional frustrations can be alleviated
munity network that coordinates early through early assessment and intervendetection and intervention for children tion,” she said.
and adolescents with mental health conBoth Ms Ng and Ms Lim feel that close
cerns. Our aim is to address the mental partnership between the REACH East
health needs of the children within the team, schools and community partners
community, which minimises disruption is key to providing robust mental health
to their routines and environments.”
services to children in the community.
When students are identified as possi- “This model of care and intervention
bly having a mental health condition, they enables and trains members of a child’s
are referred to REACH by their school or a care team – parents, school counsellors,
VWO. Some may be referred to a hospital teachers, GPs and social workers in the
for more specialised assessment or care, community – to become competent in
but the majority are successfully cared supporting children with mental health
for in the community by the REACH team, problems at primary and secondary
or general practitioners (GPs) who are levels,” said Ms Ng.
partners of the REACH programme. The
“Such education helps to address the
REACH East team has 10 GP partners in stigma associated with mental health
the East zone trained in different areas of problems and promotes acceptance and
mental health.
tolerance of individuals with mental illnesses in our communities,” said Ms Lim.
Main problems teens face
For its innovative delivery of mental
Ms Estelle Lim, Senior Medical Social health care to children and adolescents
Worker, DPM, KKH, and a member of in the community, the REACH East team
the REACH East team, said: “Our team received the 7th Allied Health Innovative
has found that mood disorders are the Practice award from SingHealth in 2014.
Supporting their children by:
Accepting that having a mental
disorder is not the end of the
world and the child cannot
control it any more than people
can control their medical
conditions
Being emotionally present,
patient and understanding;
spending time together as a
family and setting aside time for
each child
photo: corbis
During therapy
sessions, the therapist
can work to help him
develop healthy coping
strategies, restructure
his thoughts and
better manage his
emotions.
Parents can
help by...
photo: corbis
oung people may struggle with periods of low mood and poor self-esteem. Some may even harbour
thoughts of suicide. Their relationships
may be strained. They may find it hard to
focus in and out of school, and engage in
self-hurting behaviour to cope with stress.
Teachers who notice such behaviour
can alert the school counsellor, who can
speak to the student’s parents about
inviting the community-based mental
health service, REACH East, to assess
their child.
After the initial assessment, if found
necessary, an integrated plan is put in
place to provide the child with support
and intervention. It may include supervision to ensure his safety and therapy to
help him better manage stressful events,
although not all children may need an
integrated plan, supervision or therapy.
Ms Evangeline Ng, Psychologist,
Department of Psychological Medicine
(DPM), KK Women’s and Children’s Hospital’s (KKH), said: “During therapy sessions, the therapist can work to help
him develop healthy coping strategies,
restructure his thoughts and better
manage his emotions.”
These are only some methods used,
and not the only ones focused on in therapy. “The children’s parents can also
attend sessions where requested, and
implement parenting strategies suggested by the REACH East team,” she said.
Teaching the child problemsolving and emotional
management skills
Showing the child how to actively
seek help through modelling
behaviour, rather than solving
their problems or sheltering
them from unpleasant feelings.
Tips were provided by Ms Evangeline
Ng, Department of Psychological Medicine and Ms Estelle Lim, Senior Medical
Social Worker, Department of Psychological Medicine, from KK Women’s and
Children’s Hospital.
C
singapore health
JAN– feb 2015
Lunching in
onvenience and cost are two reasons that office workers tend to eat
at hawker centres. According to the
2010 National Nutrition Survey, six in 10
Singaporeans eat out at least once a day.
Just six years before, the number was four
in 10.
Eating hawker fare like char kway
teow, fried carrot cake, bak kut teh, nasi
lemak, satay or laksa regularly can lead to
so-called lifestyle diseases such as heart
disease, high blood pressure and diabetes.
Efforts like the Health Promotion Board’s
Healthier Hawker Programme may ensure
that diners are offered healthier options
such as brown rice, healthier oils and less
sodium (salt), but it is still best to eat out
less often.
Eating home-cooked meals is better
as one has greater control over what goes
into a dish – less salt, less oil, less sugar
and fresh and better-quality ingredients.
Not everyone wants to pack lunch to work
every day or has the time to do so, but for
a start, try doing so once or twice a week.
Not only are they less costly, but
home-prepared meals are also generally
more nutritious and hygienic. Of course,
some planning and grocery shopping
ahead of time is necessary, but a little prep
time is well worth the effort. Moreover, it
isn’t always necessary to cook a separate
meal – just cook a bit extra at dinner and
take the leftovers to work the next day.
Lunchbox ideas
If dinner is the biggest meal of the day, one
option is to prepare a simple lunch to take
to work. For a meal that is both nutritious
and quick to prepare, try pumpkin and
carrot soup, cooked the night before or
early in the morning and kept hot in a thermos flask, plus a sprinkle of unsalted nuts
or seeds. Include a wholemeal sandwich
or a small bowl of salad and fresh fruit.
Another option is a combo of salad
vegetables, lean proteins such as baked
fish, chickpeas, boiled egg and grilled tofu,
whole grains like bulgur, quinoa or wholemeal pasta, plus a sprinkle of unsalted
nuts, seeds, and dried fruits with a vinaigrette dressing. The salad can be prepared
the night before. For dessert, have an
apple or orange. Fruit is not only refreshing but adds fibre to the diet.
If it is too much to cook a separate meal
to take to work, cook an extra portion of
dinner. Fried rice or noodles, using unpolished rice or brown rice beehoon, lean
proteins like prawns, egg or lean chicken,
and peas, carrots, corn or broccoli, can be
healthier than hawker centre versions.
Leftovers like lean roast chicken, meat
patties or kebabs make great sandwich
fillings. Add salad vegetables like romaine
lettuce and avocado, easily available at
supermarkets and wet markets. A homemade dressing can also be healthier.
Eating out at lunch can be hard not only on
the pocket but also on your health. It might be
better to spend a little time and effort to pack
a lunch box from home. By Lauren Ho
When eating out...
Limit or avoid fast food and
deep-fried food. Fried food
tends to be high in fat and
calories, and the oil for
frying is likely to contain
trans fats.
Dry noodles contain more
oil than soup noodles.
Drink the soup sparingly as
it tends to be high in salt.
Also, avoid minced meat
and deep-fried condiments.
Choose fresh sliced lean
meat, poultry or fish and
remove any visible fats,
including poultry skin.
Order smaller portions of
rice or noodles and opt
for unpolished rice if it is
available.
Refrain from adding gravy
to mixed rice dishes. Choose
lean meat or steamed
fish, and two servings of
vegetables.
End meals on a sweet note
with a serving of fresh fruit.
Satisfying mid-afternoon hunger pangs
A handful of unsalted
mixed raw or dry roasted
nuts or trail mix (nuts with
dried fruit)
A serving of unsweetened
or reduced sugar soya
bean curd (tau huay)
A serving of plain low-fat
yogurt topped with fresh
berries and a sprinkle of trail
mix, unsalted nuts or seeds,
or a small bowl of grapes
and cherry tomatoes
Instant oats mixed
with some low fat milk
powder and hot water
Carry a bottle of plain
water to drink with meals.
Otherwise, opt for a drink
with less sugar or a glass
of unsweetened fresh fruit
and/or vegetable juice.
photos: Natalia Klenova, Svetlana Foote, Tatjana Baibakova, Olga Kriger, yelenayemchuk/ 123rf / Corbis
24
For a citrusy sauce, mix together extra
virgin olive oil, lemon or lime juice, black
pepper, whole grain mustard, and the
seeds and pulp of a passion fruit. Stored
in a glass jar, the mixture keeps for up to a
week in the fridge.
People who are watching their weight
or have medical conditions such as diabetes, hypertension and high blood cholesterol should choose their meals wisely
to cut down their intake of saturated fat,
trans fat, sodium and sugar, and increase
their intake of dietary fibre. So if packing a simple lunch is not possible or difficult, bringing a salad, fruit or serving of
unpolished rice to increase intake of whole
grains can help supplement a poor diet
and/or increase the nutritional value of
lunches eaten out.
Ms Lauren Ho is a dietitian with over 20 years of
clinical experience.
JAN– feb 2015
singapore health
25
26
singapore health
jan– feb 2015
Talk to your dentist
Patients with chronic conditions may be unaware that their dentists need to know what
medicines they are on before they treat them. By Suki Lor
P
According to Dr Lennie Foo Lean
Heong, more than half the patients
treated at NDCS have chronic
medical conditions.
Prevention is
better than cure
photo: XiXinXing/Corbis
• Visit your dentist at least
twice a year.
•Brush your teeth with a soft
bristle toothbrush in the
morning and especially at
night. Your dentist can show
you the correct technique.
Common side effects of medicines for hypertension and heart conditions are swollen
and bleeding gums, and dry mouth. Dentists often need to discuss any modification
of medication with a patient’s doctors before dental treatment can commence.
prescribe a tranexamic acid mouth rinse
Dr Foo said that it is needful for
to control bleeding.
patients to be aware of the medicines they
Dr Foo said patients should ask are taking, and to inform their dentists of
their dentists why their gums bleed. “Is this and their conditions. She noted that
it related to poor gum condition or the more than half the patients treated at
medicine they are taking? You might need NDCS have chronic medical conditions.
to start gum treatment or improve oral “Being a tertiary institution, we see many
hygiene. Your dentist will be able to find medically-compromised patients. Twoway communication between patient and
the cause and solve the problem.”
Some drugs for high blood pressure dentist is needed in order to achieve a
can cause gum overgrowth, making it good treatment outcome.”
At NDCS, patients’ medical informadifficult to clean the teeth and resulting
in decay and progressive gum disease. tion such as lab test results and drug
Inflamed gums bleed easily and this may allergies are retrievable from the National
result in ulceration and soreness. The Electronic Health Record system, which
dentists might ask doctors to change the is highly secured and accessible across
medication. In extreme cases, gum sur- all SingHealth institutions for integrated
gery may be needed. “We strongly advise patient care.
Dr Foo said patient safety is a top
patients with this condition to get treatpriority. “We have to make sure that the
ment,” said Dr Foo.
Other hypertensive drugs reduce the patient is safe during and after treatment.
production of saliva, which lubricates If we know that a patient is on a particular
the mouth and neutralises acidity after medication, we can better manage the
eating. Low salivary levels cause dry side effects and plan for treatment.”
She added that patients with chronic
mouth and put a patient at risk of tooth
decay. A large cavity in a tooth might diseases who ignore oral hygiene will
progress and infect its root canal, and increase the inflammatory burden on
subsequently complicate treatment. The their bodies. “There’s some evidence that
patient may end up needing a root canal poor oral health is associated with diabetreatment and crown, rather than just a tes, cardiovascular disease, pre-term low
birth weight in babies and osteoporosis.
simple filling.
“In such a case I recommend a fluoride However, these associations are not yet
rinse to prevent tooth decay. They can fully understood.”
The rule of thumb is for people to
take more sips of water, use saliva substitutes if needed, or xylitol chewing gum. go for regular dental check-ups to preXylitol promotes the growth of healthy, vent losing their teeth, instead of
non-acidic bacteria, and the chewing resorting to implants or dentures in
the future.
motion stimulates saliva production.”
•Use a toothbrush with a
smaller head or a single- or
end-tufted brush to clean
teeth at the back of the
mouth properly.
•Floss daily. Use an interdental brush if you have big
gaps between your teeth
because of gum disease or
receding gums.
• Wait at least half an hour
after meals to brush your
teeth to avoid enamel erosion from acid in the food.
A stroke or elderly patient
who has dexterity issues can
use an electric toothbrush
rather than a normal one.
illustrations: 123rf
photo: max chan
atients on drugs for chronic diseases may suffer side effects that
affect their oral health, and in turn,
their dental treatment.
Some common side effects of medicines for hypertension and heart conditions are swollen and bleeding gums, and
dry mouth.
It is quite common for dentists to
need to discuss any modification of medication with a patient’s doctors before
dental treatment can begin, according
to Dr Lennie Foo Lean Heong, Registrar,
Periodontic Unit, Department of Restorative Dentistry, National Dental Centre
Singapore (NDCS).
One of the dangers is prolonged
bleeding. Anticoagulants and antiplatelet
drugs (blood thinners) are usually prescribed for certain heart conditions to
impede blood clotting. However, these
medications can sometimes cause gums
to bleed during brushing or when there
is trauma.
For instance, in extractions, there
is the danger of post-extraction bleeding. In scaling, bleeding can occur when
the dentist removes tartar from above
and below the gum line. In root planing, bleeding can happen when the dentist uses special instruments (while the
patient is on local anaesthetic) to remove
tough calculus and bacterial deposits
from beneath the gum line along the root
surfaces.
As these patients might bleed longer
than others, dentists need to modify
treatments before it is safe to proceed.
For example, a patient who is taking warfarin might be required to check his latest
International Normalized Ratio to assess
his bleeding tendency. He might need to
stop the medication prior to dental treatment only on physician’s instruction. Prolonged bleeding needs to be monitored
by the dentist who may, in extreme cases,
2015年1– 2月刊
新加坡中央医院与新加坡保健服务集团的双月刊
确认您持
有足够的药
物直到新的
预约日期再
点击 Yes, I
understand
and agree
[是的，我明
白并同意]
选择My Appointments
[我的预约]标签
[健康伙伴]
新保集团智能手机
应用程序让病患者
可以随时随地更改
门诊预约日期和时间
点击 Confirm
[确认]以锁定
新的预约时间
让您轻松预约
通过电子系统，病患者可以利用智能手机或上网更改预约时间，
而工作人员无须致电也能直接预约
中心、新加坡全国眼科中心和新保集 用户都转向网站或使用[健康伙伴]进行
团旗下9所综合诊疗所，以及樟宜综合 所有预约事项。
医院。
目前，电子预约虽然只限与专科门
在只要持有SingPass密码，
以往若患者有多过一个专科门诊 诊的预约，但集团计划在不久的将来
便可以轻轻松松更改预约
的预约，他们必须逐个向医疗机构打 能把这项 服务扩展 至其他医疗服务，
时间和日期了。新加坡保建 电话更换、协调或取消预约时间。现 如物理治疗、特别测试以及扫描等。
服务集团（简称新保集团）已提升现 在，新的电子预约可让用户一览自己与
有的电子预约(e-Appointment)。现在 所有新保集团属下的各医疗机构的预
责任与例外
除了可以上网（www.singhealth.com. 约记录，自己进行更改并直接被受理， 即使电子预约能为患者制造这么多的
sg/appointments），使用者也可以通 从此不必再那么的大费周章了。
便利，不过新保集团仍然希望患者能
过 智能手 机的应用程 序[健 康 伙伴]
“现在都市人的生活 越来越忙碌， 够尽量保持原有的预约时间，特别是
(Health Buddy)，浏览他们个人的预约
患者和他们看护人可能也是如此。所 有关治疗的安排，例如若病况有编入一
详情。
以我们看准了人们对智能手机的依赖， 些特别护理计划而需要密切观察的患
提升后的电子预约不但方便，为使 将电子预约从网上延伸到[健康伙伴]， 者，不能随便更改预约时间。这些案例
用者省下很多时间与麻烦，还有其他 让他们能够迅速解决预约事宜，”负 包括在新加坡中央医院妊娠糖尿病诊
好处。譬如，它比电话服务中心还开放 责设计应用程序界面的营销传播经理
疗所、竹脚妇幼医院的产科、新加坡国
了更多预约档期，而用户者也可以自行 郭玥妘小姐解释说。
立癌症中心的肿瘤内科以及新加坡国
将预约延期长达13个月的时间，比以
预约系统自去年4月改革以后，许多 家心脏中心的心血管与胸腔胸心外科。
往只能挪后30天来得方便。
新加坡中央医院门诊营运总监朱
发财先生说，
“我们深知若电话连连
不通，反复查询和调整预约，对患者
授权于综合诊疗所
来说是一件多么令人烦躁的事。所以
新保集团电话服务中心所接到的 长。其中一半的时间便是等候中心
改善预约系统，设定新的平台，让患者
来电之中，有15%是属于内线，而 接听电话。
无需通话也能够妥当地安排预约。”
据 欧南园综合 诊疗所营运行
这大多数是来自集团旗下的9所
政 人员孙 瑞荫小姐说，
“电话服
综合诊疗所。
改善联系方式
综合诊疗所的职员打电话到电 务中心的电话一直很难被接通。
电子预约服务连结的医疗机构和诊所
话服务中心，主要是为转诊患者 有 时当我 们 终 于 得 到了预 约 时
协调并安排专科门诊预约。每通 间，患者觉得配合不来，要求我
包括新加坡中央医院专科门诊 、竹脚
通话时间平均是15至20分钟或更 们更改，我们就得拨电给中心另
妇幼医院、新加坡国家心脏中心、新
加坡国立癌症中心、新加坡国立牙科
原文 Jessica Leow
27
新系统更快，更简易
点击Search [搜寻]
以寻找其他日期和
时间，然后点击您
的选择
阅读条款后
点击 I Agree
[同意]再继续
新闻
新保集团预约系统的翻新项目
前后进行一年的时间，由集团
旗下不同机构的代表组成多管
齐下的小组负责。小组利用信
息科技将移动应用程序和网站
结合，让患者能够通过单一网
站简易地处理预约事宜。
这个项目最 大 的改 变 莫 过
于削减电话服务中心的通话量，
提升各方面的服务效率。
诸如综合诊疗所、医院病房、
急诊部以及门诊手术中心的职
员可以通过电脑直接为患者与
专科医生预约。他们只需登录
预约系统，选择 预约时间，入
档即可。他们甚至可以为紧急
状况强制性安排预约。
这样一来，患者不但能够更
快捷地得到预约时间，空出来
的通话线也能让给真正有需要
的患者，如年长者等。此外，机
构之间也无需再互通电邮、传
真和信件通讯，节省资源。
预约系统特别小组副主 席
陈明辉副教授说：
“我们将预
约系统简化，并培训更多员工，
让他们直接通过系统进行机构
内与机构之间的预约工作，把
原有的通话中断率从超过50%
减到低于10%。因为赋予新的
权限，同事之间也可以建立更
密切的合作关系，共同为患者
提供顺畅无阻的体验。”
提 升后的系统 至今获 得良
好的反应。在系统启用后的几
个月内，新保集团的一些机构
所接获的预约电话已大大的减
少了。
Photo: alvinn lim
现
新加坡中央医院病房区内的
职员可以通过电脑直接为患
者与专科医生预约。
外协调，可是我们还有其他患者
在等着，所以实在不能每次花上
15到20分钟的时间来进行预约。
我 们 有 时 也会 要 求 患 者自己 打
电话到有关机构更改预约时间，
但是他们大多数都不肯。现在，
有这个新系统真是帮了我们一个
大忙。”
28
新闻
2015年1– 2月刊
肾衰竭
慢性的无声疾病
慢性肾病是一种能让肾脏无声无息、渐渐失去功能的疾病。若不及时治疗，可演变成肾衰竭或末期
肾病。导致慢性肾病的两大罪魁祸首是高血压和糖尿病。在本地，大约60%的新增末期肾病病例
都是因糖尿病所引起的。
在新加坡，每天有4人失去
肾功能，相等于大约一年
导致慢性肾病的两大
罪魁祸首是高血压和
糖尿病。在本地，
1,400
大约
宗肾衰竭病例。
7年
在新加坡等候移植
肾脏的平均时间是
的新增末期肾病病例都
是因糖尿病所引起的。
降低患病风险
多吃水果、蔬菜、谷类
和瘦肉，减少食用盐分和脂肪
多喝白开水，减少饮用汽水
和酒类
保持健康：每周至少
运动五次，不要吸烟
接受身体健康检查
定期
资
料
简
报
5,521
67%
3,299
2013
2003
1,642
855
新增肾衰竭病例，
从2003年的855宗
至2013年的1,642宗
上升了92%
92%
正在接受肾透析治疗的
病人人数，从2003年的
3,299名病人至2013年
的5,521人上升了67%
illustrations: 123rf
新加坡肾病
研究中心的
最新初步报告
（2 014 年）
新 加 坡 是 全 球 第 五 大肾 衰 竭 发 病 率 最高 的 国 家 。
近年来本地的糖尿病发病率有显著性的增加，根据
医 生估 计，肾 衰 竭 病 例 的 数 目 也 将 相 对 的 上 升。
在 过 去1 0 年，
原文 Denyse Yeo
资料来源：新加坡肾病研究中心（Singapore Renal Registry），全国肾脏基金会和保健促进局
2015年1– 2月刊
焦点
29
呵，他老了，忘了
抑郁症和失智症都是因为血管疾病所引起的，并没有固定的发生次序
当
他还补充说，任 何疾 病都可使大
脑产生化学变化，而这个变化能产生
抑郁 症。“一切都是你脑子在作祟！
这俗语说的一点也没错。 ”
抑郁症的成因有很多。除了脑血管
受损之外，其他还包括压力、营养和
潜在的遗传因素。症状包括无端感到
悲哀、消极，对事物甚至食物失去兴
趣，闭门、疏远、回避社会现实，睡眠
紊乱，过分地自我责备，对未来产生
无助感、无望感、无价值感，以及萌生
自杀念头。
失 智 症的 症 状 是 失去 短 期 记忆，
长期记忆则丝毫不受影响。
“近期记
忆 就像 洋葱的外层一样，总是会比
核心既久远记忆先剥落。”
已退休的林先生忘了怎么使
用电视遥控器或忘了午餐吃
了些 什么时，他的家 人 就 会
说:“呵，他老了，忘了。”
随着时间的流逝，林先生的记忆开
始更加模 糊起来了。他忘了自己儿孙
的名字，忘了回家的路，甚至连镜中的
自己也不认得，唯独自己的童年往事依
然历历在目。就这样，林先生的老年
痴呆症逐渐恶化，抑郁症也随之频频
发作。
像林先生类似的个案，已是全球各
地迫切性的问题。研究人员虽早已着
手探讨抑郁症和失智症之间的关系。
可是，两者之间真的有关联吗？如果有， 病因和预防方式
那一个先，那一个后？
伦格教授说，老龄会提高罹患失智症
的风险，尤其是60岁以上的人士，症
全是你脑子在作祟
状也像其他疾病一样。它出现的越早，
杜克-国大医学研修院的院长伦格克 就表示病情越严重，越快的恶化成严
里斯南教授（Ranga Krishnan）教授解 重失忆症。
释说，抑郁症和失智症基本上是相同
另外，无症状中风患者患上失智症
的病症，所以没有先后顺序之分。
的风险也相当高。尽管全球各地都把
回顾过去二十年大约200项相关的 中风归咎于基因遗传，然而在亚洲，一
研究里，不难发现，尽管通常是患者 群40至50多岁罹患失智症的中风患者
先有抑郁症，后才有失智症，但其实两 却与遗传因素没有丝毫关系，反倒是
者都是血管性疾病所致的精神病症。 与高血 压、高胆固醇、糖尿病，吸烟
“只是某些人会先出现失智症的症状， 以及高盐分的日常饮食有关联。
有些人则先出现抑郁症的症状。”
伦格教授说，目前失智症固然无法
伦格教授解释说，人们往往难以察 根治，但可以依靠药物减缓病情。因
觉，反复性或无症状中风其实是会损 此，当年长者出现早期症状时，必须
害脑前神经，并且导致血管性抑郁症。 及时就医，患有抑郁症的青少年也应
当这损害达到一定的程度时，就会造 该努力克服病症，保持身心健康，积
成血管性失智症。
“受损程度轻，患者 极 生 活，以预 防中年 时患 上中风 和
会得抑郁症，受损程 度重的话，则会 失智症。
得失智症。”
至于那些没有失智症基因的人士，
PHOTO: GETTY IMAGES
原文 SATISH CHENEY
可通过运动和配合健康饮食习惯（与
心脏健康的饮食建议相同），和保持
正面的生活态度，来减低无症状中风
的风险。
“因为若头脑受到影响，身
体也会出现问题，两者是相呼应的，”
他说。
人们往往难以察觉，反复
性或无症状中风其实是
会损害脑前神经，并且导
致血管性抑郁症。当这损
害达到一定的程度时，就
会造成血管性失智症。
当年老的亲人感到
抑郁或变得健忘时
不 要假 定老了就一定会
变成这样。人变老后，的
确会比较抽离现实和慢下
来，但如果您立即把一切
归咎 于“老人病”，那么
您 就 无法注 意到或看出
实际的问题。
不要立即把全部事情归
咎于其他医学问题，例如
糖尿病或心脏衰弱，因为
这会阻碍您寻求真正治疗
失智症的方法。
PHOTO: ZAPHS ZHANG
根据伦格克里斯南教授所说，患有抑郁症的青少年必须努力康复，健康地
生活，保持积极的人生观，以预防在中年时患上中风和失智症。
伦格教授也强调意志力储备的重
要性。即便患病以后，这些正能量也
能帮助我们击退疾病。
“我们体内存
在着某种可以应付心理和生理问题的
储备。若储备太低，失智症会更容易
地显现出来，尤其是年长的病人。所
以为了提高意志力储备能量，我们应
该多用用脑和保持积极的心态。虽然
这些并不能改变疾病，但可减低无症
状中风的风险。”
不过，他说目前没有这一方面的研
究。
“我们只能假设。”
PHOTO: 123RF
杜克-国大医学研修院院长
伦格克里斯南教授
不要跳过 接受医生评估
的步骤。虽然失智症不能
根治，但药物可以让年长
者延长完全失智并维 持
好心情和精神状态，活得
更精彩。
30
健康
2015年1– 2月刊
重新感受
呼吸畅快
特殊仪器帮助脊柱异常弯曲的患者重新正常呼吸
正常的脊柱会呈现
正常的生理弧度。
从临床的
角度，脊柱
弯曲通常是指偏
离正常水平的
弧度。
多数人的脊柱
会随着年龄轻微弯曲。
不过，有一小部分
的人的弯曲程度会
比较严重。
原文 Desmond Ng
庞
女士从小就非常好动，常与
姐 姐到家附近的草坡上玩
耍。年轻时也曾经单枪匹马
到过英国徒步旅行。没想到如今每走
一步犹如提着千斤重般一样艰难。
庞女士患的是脊柱后侧凸，脊椎弯
曲的程度非常严重。
“我20来岁的时候，肩膀一边比另一
边高，背部也有稍微突起的现象但不
太明显，也不觉得有任何的不适，直到
2005年在地铁站内摔的那一跤后，背
部就开始疼痛而且日渐加剧，”庞女士
说道。
“现在就算是步行到邻近的车站都
感到非常吃力，脊椎和髋部也倍感压
力，所以我不能站太久。”
起初，庞女士只是向中医师调理、
缓解疼痛，后来症状恶化方才到新加
坡中央医院求医。
新加坡中央医院呼吸与重症科高
级 顾问医生兼睡眠失调组组长王丹
浩表示，多数人的脊柱会随着年龄增
长而出现轻微的弧度。
“不过，也有一
小部分的人的弯曲程 度会过分严重，
以致胸腔受到挤压，没有剩余的空间
供肺部呼吸。”
脊柱若弯曲到出现呼吸衰竭的状
况，那么即便接受手术也无补于事。
王医生进一步 表示：
“在这种情
况下，我 们只能 提 供 支 援帮助患者
呼吸。”
通常，医生会让患者使用特殊的
仪器来帮助呼吸，尤其是在睡觉的时
候。因为肺部受到挤压，无法正常运
作，身体就会开始依赖横膈膜的下降
运动，然后将空气吸入肺中。不过当
患者睡觉时，横膈膜处于松弛状态，
无法好好的运动，体内的氧气水平就
会下降，二氧化碳水平升高。
王医生说：
“我们会 让 患者 使用
双水平气道正压（bi-level positive
airway pressure，简称BPAP）呼吸机，
帮助他们提高体内的氧气水平，改善
通气情况。我们有数据显示，和单单
使用制氧机或不接受类似治疗的患者
相比，双水平气道正压呼吸机能提高
患者的存活率超过10年。”
庞女士每晚睡觉时都会使用这台
呼吸机。她说：
“虽然戴着面罩睡觉
会有一点不舒服，不过还是可以接受。
有一次我的哮喘病发作，使用呼吸机
后，我的呼吸就变得比较顺畅了。”
photo: vee chin
王丹浩医生（右）和
呼吸治疗师示范如
何使用双水平气道
正压呼吸机并解释
它的功能。
庞女士每隔三个月
都会带着那轻巧的呼
吸机 到新加 坡中央医
院 新 设 立 的无 创通气
诊所复诊，该诊所是专
为使用双水平气道正压
呼吸机的患者提供服务。
她说：
“诊所的呼吸治疗
师会从我的呼吸机下载使
用数据，测定我的体重和
血压以确保我的氧气水平
保持在标 准值内。最 后才
让王医生检查我的数据并
在必要时作出调整。”
呼吸机能够记录并储
存呼吸情况。这些资料包
括所吸入的空气量、面罩
是否有外漏、患者是否有
正确地使用呼吸机、有没
有使 用呼 吸机，以 及
使用时间的长短。
一台双水平气道
正压呼吸机的价格
为3千多元 。王医 生
表示，呼吸机的功能
不单是把空气推入患者
当脊柱弯曲程度
越来越严重时，胸腔
空间的减少会造成
肺部受到挤压，导致
患者呼吸困难。
体内，还会帮助肺部保持
膨胀以促进氧气的吸收。
患 者 呼 气 时，呼 吸机 会
避免气道中的气压下降
至零。
王医生说：
“多亏这
类呼吸机，不只能提高
体内的氧气水平，同时
也还能减低二氧化碳水
平，让 患者在日常生活中
维持一定的活跃程度，享受那程
度范围的生活素质。”
新加坡中央医院无创通气诊所
(Non-invasive Ventilation clinic)
设立于2011年的诊所为使用无创呼
吸机的患者，尤其是双水平气道 正
压呼吸机的患者提供专项服务，并
帮助这些有呼吸系统问题的患者改
善呼吸和睡眠的情况，从而降 低他
们住院调节的必要。
新加坡中央医院呼吸与重症科高
级顾问医生王丹浩表示：
“诊所医疗
人员包括一名负责诊治呼吸道的问
题的专科医生，和帮忙处理呼吸机
问题的技术人员，例如帮助患者 调
整呼吸机的设置或面罩。”
呼吸治疗师也负责向新患者解释
并说明呼吸机的各种功能和让他们
了解相关费用。
诊所的10 0名患 者当中，有约 三
分之一的患者被诊断患有脊柱后侧
凸。医疗小组会监测使用呼吸机的
患者，下载呼吸机所 记录的数 据并
指导患者如何充分地使用呼吸机。
诊所也会为患者进行血检和肺功能
检查。
2015年1– 2月刊
点燃一根烟，
引爆生命计时炸弹
被转送急诊部
我的胸口突然出现难以忍受的疼
痛，于是我要求贵机构的任何一名
医生紧急为我检查。我愿意等侯下
一个空余的会诊时间，但贵机构的
职员建议我到最邻近的急诊部。为
什么我不可以直接在新加坡国家心
脏中心接受心脏紧急治疗？
在
何先生家里有四台总价值两万
元的仪器，其中两台是制氧机和
双水平气道正压呼吸机。
双水平气道正压呼吸机通过一
条导管把氧气输送到面罩，然后
根据何先生的吸气和呼气来调节
气压的升降，帮助他保持呼吸顺
畅。出门时，他也必须随身携带
便携式呼吸器。
年轻时，他的生活是多么的活
跃，每天忙着家族在林厝港的鹌
鹑养殖生意。自从被诊断患上慢
性阻塞性肺病之后，何先生不是
在睡午觉就是在电视机前度过每
一天。幸好偶尔也有亲戚或朋友
来找他聊天，为他目前的生活增
添些许乐趣。
新加坡国家心脏中心答复： 我们建
议严重胸痛长达超过20分钟的人士前往
最邻近医院的急诊部，以接受紧急协助。
除了心脏病发作外，造成胸痛的原因还包
括其他各种可能十分严重的疾病，因此到
急诊部接受全面的评
估，是比 较安 全的
做法。
新 加 坡 国 家
心脏中心的专 科门
诊部是为现有病人
进行非紧急性会
诊 和 长期 复诊而设
的。该处并没有处 理
紧急医 疗状况的全 套
设 施 。在 经 历严重 症
状时，而不及时就医，
对 病 人 来说 是 很 危
险的，可能会致命。
在2010年，有超过10,000的病人因慢性呼吸疾病
而需住院。在同一年里便有多达440人因而死亡。
他感叹道：
“现在啊，每看到 素之一。虽然并非所有的吸烟者
精彩、好笑的电视节目时，都会 都会出现肺功能加速退化的情
气喘不已。我很容易就感到疲倦， 况，不过当中有约30%的吸烟者
对周遭环境也非常敏感，例如气 的肺功能会退化得比其他吸烟
候转变等。”
者快，而成功戒烟者肺功能退化
何先生进一步说：
“日子虽然 速度会放缓至与非吸烟者肺功
难挨了些，不过也算是非常幸运 能退化的速度相近。
的了，因为我还能保有如正常同
肺部受损是日积月累的，而症
龄人80%的肺功能。”
状要过了很久才会出现，通常被
诊断患病时已经七、八十岁了。
抽烟为主要病因
慢性呼吸疾病的症状包括气
新加坡中央医院呼吸与重症科 喘、久咳不愈和感觉疲倦。此疾
高级顾问医生王丹浩表示：
“人体 病是本地第七致命原因，1万起
的肺功能在我们25岁过后便会开 病例就有约440人因该病而死亡。
始慢慢退化。”
世界卫生组织预测到了2030
“大部分的人每年都会丧失一 年，慢性阻塞性肺病将成为全世
小部分的肺功能。不过，对大多 界导致人们第三大主要死因。
数人来说，即使到我们逝世的那
王医生表示，目前治疗慢性
一天，比方说在95岁时心脏病发 呼吸疾病的方法包括使用喷雾器
或因罹患癌症而死亡，我们的肺 （一种通过喷雾的方式让患者把
功能还是足以应付大部分的日常 药物吸入肺部的器具）或气道正
活动。”
压呼吸机。她进一步表示，吸烟
“但是，对于一些人来说，由于 者也应该戒烟。以何先生的情况
吸烟的恶习或遗传因素，他们的 来说，呼吸机有助于放缓肺功能
肺功能退化的速度会快很多，60 损坏的速度，对他说不失为一件
岁的肺功能就会犹如80岁至90岁 值得开心的事。王医生表示，这
的肺功能相似。”
些仪器帮助改善患者的日常生活
王医生说，香烟所含的毒素是 质 量，让 患者 维 持 一定程 度的
构成人们患上慢性呼吸疾病的因 活跃生活。
医院访客超额
最近，我在新加坡中央医院留院。
在我隔壁床位的病人每次都同时
接见8至10名访客，让我不胜其烦。
为什么他可以一次过接见那么多名
访客，但其他病人却最多只可同时
有4名访客在场？此外，那名病人
的访客可以随时探病。为什么他们
可以在指定探访时间外进入病房？
新加坡中央医院答复：为了保护我们
的病人，我们有一套严格的访客政策。过
多访客同时出现在病房里，可能会影响需
要休息和安静的病人，尤其是那些刚动完
手术和从麻醉中苏醒的病人。
我们的护士长会在探访时间结束时促
请访客离开病房，但某些访客可能有个别
的理由，例如工作或其他个人原因，而只
能在较晚的时间探病。如果可以的话，我
们会尽量弹性处理，让他们与病人共度一
些时间。此外，病危的病人的访客人数也
不受限制。
我们的职员在平衡病人和他们的亲戚
的需要上，经常面对种种挑战，而且不时
会因此受到辱骂。我们希望每个人都可以
体谅彼此，协助我们使病房的环境保持
愉快舒适。
photos: 123rf
香烟所含的毒素是构
成人们患上慢性呼吸
疾病的因素之一。此
疾病是本地第7致命
原因。
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意见箱
肺部遭受严重损坏，烟民毕生得依靠机器来过日子
过去四年里，对66岁的
何辉彬先生（译名）来
说，家就像牢笼一样。
他 忘了上一次 逛 商场、超 市
或在咖啡店消磨时间到底是 何
年何月的事情了。因为现在只要
一踏出家门，即使是短短的几分
钟，也会让他感到喘不过气，疲
惫不堪。
何先生说：
“早在16年前我就
感觉到自己有些不太 对劲了，总
是容易疲倦又没有胃口吃东西。
我 看 过 好几 名医 生，但 是 他 们
都诊不出我哪里出了问题。”直
到2004年被证实患有慢性阻塞
性 肺 病（chronic obstruc tive
pulmonary disease，简称COPD）。
呼吸困难是慢性阻塞性肺病
的主要症状，而抽烟是引发疾病
的主因之一。何先生从12岁便开
始抽烟，一天可抽上两、三包烟，
直到发现自己的病况后，才把烟
给戒了。
健康
若有任何关于入院手续、账单及程序等疑问，
可电邮至[email protected]，我们会在这个栏
目里解答您的问题。
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2015年1– 2月刊
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