me+SH (November 2009) by me+SH

November-December 09

A SingHealth staff publication

Innovation. Creativity. Patient Care.

A winning season for allied health professionals

Charting Milestones NCCS and NNI turn 10!

Stepping Up On Care

CGH transforms its healthcare delivery model

Special Features ching Bright Idea Hat s!

Allied Health Award Entries

Contents • Foreword by GHRD Anna Fok • On The Cover

01-02 me+YOU • • • • • • •

SingHealth Smiles for President’s Challenge 2009 SingHealth Care Packs SingHealth Board Advance 2009 Allied Health Innovative Practice Award NCCS and NNI 10th Anniversary Vibrant Campus – NNI Radiographer Vibrant Campus – SHP Dietitian

03-12

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Awards Galore:

13, 14-15, 16-17, 20

SingHealth Bowling Team

• • • • • • • • • • •

Inaugural Physiotherapist Of The Year Award Inaugural President’s Science Award SGH Pharmacists win Awards Continuing care with CGH and SACH SGH Nurse tops Worldskills PGAHI’s sports rehabilitation development SingHealth Residency Program PGAHI’s faculty development programmes Introducing Singapore Health Dr Fatimah Lateef on Medicine MOH Clinical Quality Improvement Awards

15-26

me+SPOTLIGHT • • • •

On The Couch With… KKH Speech & Language Therapists Festive Recipe by James Worth Hear It From The Experts Upcoming movies

SingHealth Editorial Team Tan-Huang Shuo Mei Amelia Champion Katheryn Maung Jeanie Cheah Arthur Wong Mediactive Editorial and Design Team Lyon Low Florence Long Sher Maine Wong Mediactive Pte Ltd 65 Ubi Crescent #06-07 Hola Centre Singapore 408559 T: 6846 4168 | F: 6846 4768 info@mediactive.com.sg www.mediactive.com.sg

me+SingHealth or me+SH represents who we are in SingHealth—as intertwining threads conveying synergy and complementing one another to form a beautiful fabric. me+SH links you to the action in all of SingHealth and around the healthcare industry. Do check out me+SH Online (http://mysinghealth/Singhealth/ MeSH) and me+SH Flash in your emailbox too!

28-33 me+LIVING

• The lighter side • me@SingHealth…SingHealth Bowling Team

34-35

me+SMILES • Medical milestones

me+HORIZON

Patients. At the Heart of All We Do.

All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographs or illustrations.

MICA(P) 059/03/2009

our pride T

he diversity in healthcare never ceases to amaze me, despite the length of time I have spent in human resource in this sector. First, the number of professions boggles the mind.

And for each profession, there is a fulfilling career. I have seen many of my colleagues devote their lives to healthcare and I think they are the richer for it. Not necessarily materially, but they lead fuller lives because they are doing something worthwhile. This quarter, we see our staff garnering an array of awards, be it in nursing, research or allied health. Our people are pioneers in their own fields, constantly pushing the frontiers of clinical care, education and research. In recent years, we encounter diversity in yet another way at SingHealth. I should say the world is at SingHealth, with people from all parts of the globe joining us. Our international community strengthens us in various ways. They bring with them a wealth of different experience and we learn from the refreshing perspectives they offer. Ms Anna Fok Group Director, Human Resource, SingHealth

As we enter the last months of the year, it is useful to stop and take stock of what we have done over the larger part of 2009. For me, I decided to accept a role change from Institutional HR to Cluster HR. A close medical colleague from SGH told me that I dived into the wrong role. But I think that the challenge is timely. SGH and the healthcare sector have been good training ground. I have become more resilient, resourceful and agile in my thinking and mindset. I believe I can do more to attract and retain the right people to care for our patients. Just as healthcare policies drive behaviour and costs, HR policies and systems help mould culture and values amongst healthcare staff. I believe I could contribute in some small ways to the bigger whole, and together we can build the Academic Medical Centre of the future. This festive season, we celebrate our people for the passion they bring to their jobs. Well done, everyone, and continue to hold the torch as we usher in the new year. Happy New Year!

me+YOU

Our people,

me+YOU

A Celebration Of Celebrations There is much cause for celebration as we look towards the new year. This issue’s me+SH sings praises of our talented individuals. Some of our staff share their plans for 2010. Dr Tay Li Chye Registrar, Endodontic Unit, Department of Restorative Dentistry, NDC

Rathi Ramasamy Research Officer, NCCS

“The best way to spend the new year is to be with loved ones – surrounded by family and close friends.”

“I will be spending a very ‘green’ Christmas in the rainforests of Taman Negara this year.”

S M Arish Project Manager, IHiS

“Although an IT personnel, I do serve our patients the same way as our healthcare professionals. I would like to wish them all a happy new year and that we’re with you in your journey to good health in the coming year.”

Arthur Wong Executive, SingHealth Group Communications

“I believe the new year is a time to promise yourself new things, and for you to spend the rest of the year trying to fulfill them.”

Kalin Siow Principal Optometrist, SNEC

“Remember to take care of your eyes in the coming year – use lubricant if you experience dryness, and eat healthy food that has loads of lutein and zeaxanthin to help prevent common eye diseases.” Kirsty Charlotte Burrows Spine Physiotherapist, SGH

“I shall be spending the new year on Skype with my family who is back in England, as well as meeting up with friends!”

Teo Lay Hua Head, Medical Social Work Service, SHP

“My plan for the new year is to take care of myself and to be more environmentally responsible.”

Siti Nur Hashifah Bte Hamim Nurse Manager, Paediatric Medicine, KKH

“I will definitely be spending the year-end with my two children and family, maybe go off to neighbouring Malaysia for some makan!”

Yang Lee Fung Staff Nurse, NHCS

“I would like to go for further studies and open some doors for career advancement.”

��

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Smile

� ��

For A Good Cause

his year’s President’s Challenge at SingHealth has a special campaign where you can donate a smile, in addition to participating in fundraising and other community outreach programmes. You might have caught the Smiles Ambassadors in action. They go around SingHealth institutions wearing huge sandwich boards and flashing their best smiles at you. Every smile donated goes towards our target of collating 10k Smiles as a special gift to President Nathan for his leadership in creating a giving and gracious Singapore.

me+SH finds out what keeps the Smiles Ambassadors smiling.

“A picture speaks a thousand words. True enough, this was so during the smiles campaign at SHP where we received patients from all walks of life, with different stories to tell; yet ever ready to smile for the camera. At the end of the day, it was not the money but the sincere smiles from patients that made this campaign worth smiling for!” ~ Gracielynne Flores, Quality Management Assistant, SingHealth Polyclinics

“It was gratifying to see many staff and the public coming forward to donate to the charity. Other than the usual donations, I’m glad I was able to do my bit for President’s Challenge by manning the ‘Smiles On the Go’ booth.”

“It was definitely a joyful experience! Meeting new and familiar faces, getting to know fellow volunteers, working together — all for one aim: to collect 10,000 smiles. There were colleagues who had worked together for ages, but had never taken a group photo before. We were happy when we saw their satisfied faces upon seeing their photo printouts.”

“I enjoyed the experience very much. It gave me an opportunity to meet other SingHealth staff, patients and their friends and encourage them to do their part for charity in a fun, ‘smiling’ way’.”

~ Jocelyn Chng, Programme Coordinator (General Surgery), SingHealth Academy Residency.

~ Mohd Khair, Supervisor, SNEC & ISS Facilities Services, Housekeeping Dept

~ Yvonne Then, Assistant Director, Corporate Development, NHCS

Smiles Ambassadors with sandwich boards

SHP volunteers at Tampines Polyclinic

View the photos and add to the Smiles at www.singhealth.com.sg/PC09

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Kathryn Ng & Suzanne Soon

Teamwork

Packs A Punch

SGH distribution team

hen we reflect upon the more significant events of 2009, H1N1 would be one of the items at the top of most of our lists. We are thankful that the H1N1 virus appears less virulent than initially feared, and that a vaccine is now available. Nonetheless, now that everyone is preparing for the year-end festivities, SingHealth institutions are not letting up on any of our efforts to protect our patients, visitors and staff. Vigilance is necessary, no matter how onerous. At the frontline, it is a mammoth task that requires resilience and plenty of heart. Kudos to our teams who consistently put patients at the heart of all we do. While the frontline staff labour to keep patients safe, the corporate team also labours, albeit in a different way – to keep staff morale high and provide support for the frontline that can so

HR & Finance Colleagues who chipped in

easily be overlooked. Hence, the idea of a care pack evolved. The SingHealth Care Pack, specially designed and customised for staff, would not have been possible without team effort and the support of external sponsors.

“In developing the Care Pack, our idea was to create something that would not only be useful during the critical period, but also welcoming and functional at other times. I was heartened to see how companies such as our sponsors — Cadbury and Johnson & Johnson — willingly came forward to help recognise the dedication, care and professionalism of all staff across the SingHealth group. This is a testament to the goodwill that the healthcare profession has with the community at large,” says Kathryn Ng, Director, Market Development.

The team that took on the challenge of putting together the SingHealth Care Packs comprised Kathryn Ng, Suzanne Soon, Teo Chai Hoon and Lee Hwee Hwee. Packers were engaged from the Society For The Physically Disabled. One of the major challenges was the logistic nightmare of delivering the care packs to over 19,000 staff within a short span of two weeks. The operations and human resource teams from each SingHealth institution also came on board to ensure smooth and timely distribution. “The care packs provided us with much appreciated encouragement. It feels good to work in such a supportive environment, especially in times of crisis,” says Senior Staff Nurse Ong Mui Kiang, Accident & Emergency, CGH.

Tomorrow’s

Healthcare

he SingHealth Board Retreat 2009 was held on 9 October 2009. Chairman Mr Peter Seah, board members and senior management staff from our institutions deliberated on the theme of “Delivering Tomorrow’s Healthcare Today” and brought fresh ideas on how we can pave the way for better healthcare for Singaporeans. The discussions were fruitful and sometimes even fiery, but we are assured of our leaders’ commitment in ensuring that they bring good outcomes and propel us forward as a leader in healthcare.

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Delivering

T O D AY

Key

Conversation with Minister Khaw Boon Wan

Discussion

Points

Clinical Integration

Critical Talent Retention

• Promote right-siting of care by developing a sound and effective pricing and financial model • Standardise protocol across spectrum of care from specialist care to primary care

• Enhance HR policies to develop and retain critical talents for present and future leadership roles in the cluster and institutions

Service Excellence

Education

• Provide hassle-free seamless experience for elderly outpatients diagnosed with chronic illnesses who have multiple appointments

• Create Residency and Faculty exchanges with top organisations to facilitate collaboration

• Incorporate WHO’s Age-Friendly initiatives and bring the 5Cs programme to the next level as “the SingHealth way” in defining Service Excellence

• Ensure sufficient manpower and resources to ease workload so that clinicians can dedicate time for quality teaching

In Conversation With

Health Minister

SingHealth board members and leaders had an open and candid conversation with Minister for Health Mr Khaw Boon Wan on the changing demands of healthcare in Singapore. The three key points from the Minister are: • Focus on the needs of an ageing population • Ensure strong care integration by developing partnerships with community hospitals, VWOs and community care providers including nursing homes, GPs and home caregivers • Strengthen clinical excellence and address gaps while benchmarking ourselves against international healthcare standards

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Allied Health:

s a Ide

g n i h x c o B t e a Of Th

H Out

The eight contenders for the third Allied Health Innovative Practice Awards have come up with highly creative initiatives in their fields of work. Sher Maine Wong speaks to two of the teams.

Speeding up good news The simple act of delivering mammogram and pap smear results via SMS instead of letters through the post saves KK Women’s and Children’s Hospital (KKH) an estimated $5,400 and 828 man-hours a year. Previously, as many as 40,000 patients out of the 49,000 women who take such tests to detect breast and cervical cancer at KKH every year had to wait seven to 10 days for their test results. Those who have traces of cancer cells would be personally informed Many anxious women, unsure of whether they had the dreaded disease, would call the Specialist Clinic assistants, who would then spend time tracing their results. With the SMS notification, the patients can now receive their results – “No evidence of cancer” – within four working days. Said Charles Chan Ban Kee, Senior Manager, Diagnostic and Interventional Imaging Department, KKH, who led a team of eight members to put the SMS initiative in place: “We improve patient

The bringers of good news at KKH led by Charles Chan (extreme right)

care by reducing their anxiety and stress levels. For the staff, it saves time as there is better utilisation of manpower. There is better teamwork, collaboration and productivity.” The system was implemented in June. It was found, from a survey of 43 patients, that 80 per cent of them thought the SMS service was “very good”. What is more remarkable is that the entire effort was done in-house. If outsourced, it could have cost about $7,500.

According to KKH’s heads of departments who endorsed the team’s report – Dr Nancy Tee, Pathology and Laboratory Medicine Department, and Professor David Stringer, Diagnostic and Interventional Imaging Department: “This is an innovative practice as existing technologies and SMS were harnessed, utilised and configured in such a way as to allow “automatic” generation of SMS reports without additional “hands-on” or manual processing by the staff.”

For all the technology in the world there is to help the hearing-impaired make sense of their surroundings, these individuals still face difficulties in communication and integration into mainstream society because people around them fail to understand what being deaf is really like. That is why it is so crucial to educate the schoolmates, colleagues or family members of a hearing-impaired person, and that is why a team of 10 led by SGH Auditory-Verbal Therapist Stephanie Lim, started a Hearing Education Arcade precisely for that purpose. Said Ms Lim, who is from the Centre for Hearing and Ear Implants at the SGH Otolaryngoloy Department: “Through Reverse Education Therapy, the normal hearing person experiences the world of the hearing-impaired through various interactive and educational tools, specifically designed to help them understand what being hearingimpaired means.” Started four years ago, the HEAR Arcade, located at the basement of SGH Block 3, uses technology such that visitors can actually hear what speech would sound like to a hearingimpaired person. So if an elderly patient had highfrequency hearing loss, for instance, his family members can actually hear that the sentence “She sells seashells on the seashore” would emerge as a series of indistinct vowels with all the “s” sounds missing. Or, the parents of a baby diagnosed with profound hearing loss, would be able to hear the static which is all the baby can make out of speech if he/ she is not prescribed the appropriate hearing device. The Arcade also has a giant model of the human ear which shows how sound is transmitted through the ear canal; various simulated environments that are more conducive to the hearing-impaired child in a classroom, for example, a room with a ceiling fan versus an airconditioned room; success stories of

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Experiencing deafness

The hearing team at SGH led by Stephanie Lim (extreme right)

famous hearing-impaired individuals, and interactive games and quizzes. Prevention of noise-induced hearing loss is also emphasised in this Arcade, with visitors experiencing what might be too loud for their ears. More importantly, visitors can learn how to communicate better with a hearing-impaired person. For instance, stay within the visual field or rephrase if you are not understood instead of just repeating what was said loudly. To date, more than 300 people, consisting of students from various

educational institutions such as medical students, polytechnic students or walk-ins, have visited the Arcade. A survey of 66 visitors found that seven in 10 rated the experience “excellent”. Said Associate Professor Christopher Goh, who heads SGH Otolaryngology Department: “This effort has helped SGH become a Centre of Excellence for the management of hearing-impaired patients and is well-known not only in Singapore but also in the region.”

SingHealth Allied Health Innovative Practice Awards The awards cast the spotlight on about 2,500 allied health staff who play a crucial role in the delivery of healthcare at SingHealth. Innovation is the pre-requisite for these awards, which were started in 2007. But more than just creativity for its own sake, the projects and initiatives which are up for the awards must strengthen the three pillars of SingHealth: service, education or research. “The applications that the committee reviewed this year were all really innovative and had improved patient care at each centre. Several projects show real promise for both cost savings as well as improving patient care and satisfaction. I have served on many review panels and can say that the quality of the applications and the thought and work that went into these were first class,” commented chief judge, Prof Roger Beuerman, Senior Director, Singapore Eye Research Institute. The other six projects include research on fighting “superbugs”, reducing waiting time at a hospital outpatient pharmacy, a portable sitting lumbar traction unit to help patients with back pain, a special mask to better secure cancer patients undergoing brain radiation, and more effective ways of addressing the nutritional issues of malnourished elderly adults. The winners had not been announced at the time of printing.

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A Decade

Of Difference… And More By Lee Yuen Mei and Jeanie Cheah

“Everyone, including researchers and scientists, has to understand that they are very important in the journey of providing better care for the patient.” Prof Soo Khee Chee, Director, National Cancer Centre Singapore (NCCS). This total focus on the patient has made NCCS what it is today – Singapore’s number one multi-disciplinary one-stop cancer centre. But the journey does not end here. As NCCS celebrates its 10th year in the business of caring for and helping cancer patients recover, it does not forget to give back to the community in other ways. In September this year, NCCS hosted a gala dinner that raised more than $7.4million for cancer research in Singapore and for needy cancer patients, particularly children who lose their parents early in life. NCCS attributes its success today partly to generous corporations and individuals who have made many contributions. The major component of its success is, of course, the staff. What makes them tick? Dr Toh Han Chong, Head and Senior Consultant, Department of Medical Oncology, points out two crucial factors: “The ecosystem must be warm, inclusive and dynamic, where harmony is allowed to prevail; and there is a clearly articulated vision and direction of what we aim to achieve and where we aim to go. “My colleagues are excited by the amount of clinical expertise, technology and ‘heart’-ware they can bring to the care of their patients. The presence of government funding and support for their work also helps to encourage staff.” For most, NCCS is more than just a workplace to hone their skills. The team is like a big family who shares the common goal of making the lives of cancer patients and their families better.

From its humble beginnings as a unit of Singapore General Hospital in 1993, to having its own building boasting two levels of research facilities and successful integration of doctors from different specialties, NCCS has certainly come a long way. With the conviction that research underpins high standards of clinical practice, NCCS actively fosters and supports cancer research. It has established three divisions of research – Cellular and Molecular Research, Medical Sciences, and Clinical Trials and Epidemiological Sciences. Through its research programmes, NCCS hopes to cultivate successive generations of biomedical innovators and technopreneurs who will

strengthen Singapore’s biomedical industry. Another area of focus is palliative care, also known as therapeutic care. Therapeutic care is a form of medical treatment that relieves the symptoms of cancer in patients, especially those in advanced stages. This is a dynamic field in the region, being particularly helpful for patients in developing countries without access to expensive drugs. With its multi-disciplinary and holistic approach to cancer treatment, and its sterling track record, Prof Soo has every reason to say, “I am confident that if we continue to invest in our staff, marry the best of our research, education and clinical services, we will forge ahead as the premier cancer centre in the region.”

milestones 1991

White Paper is introduced in Parliament to set up the National Cancer Centre Singapore (NCCS).

1993

Set up as a unit of Singapore General Hospital (SGH).

1996

Professor Soo Khee Chee, Director of NCCS, receives the SGH Outstanding Teacher’s Award for Surgical and Felated Specialties including anaesthesia.

2000

• NCCS starts operations. • Collaborative biomedical research studies are established between NCCS and Defence Medical Research Institute through a Memorandum of Understanding. • NCCS becomes part of SingHealth.

2003

Professor Soo Khee Chee is awarded the National Day – Public Administration Medal (Gold).

2004

• Introduction of Singapore’s first linear accelerator with Intensity Modulated Radiotherapy (IMRT) and Respiratory Gating capabilities to improve tumour coverage and decrease the side effects of treatment. • Pioneers a new technique, Photodynamic Diagnosis and Treatment (PDT), to diagnose and treat cancer.

2005

Amongst nine Asian national cancer centres to sign a landmark agreement to collectively embark on cancer prevention advocacy, research, training and collaboration with the World Health Organisation and the International Agency for Research on Cancer (IARC).

2007

• Launch of an Oncology Clinic in collaboration with Kwong Wai Shiu Hospital. • Establishes NCC Foundation.

2008

• Professor Soo Khee Chee receives the MOH National Outstanding Clinician Mentor Award from the Ministry of Health. • Official opening of the Lien Centre for Palliative Care.

2009

• Kicks off the JCI accreditation process. • Unveils the Wall of Hope. • 10th Anniversary Charity Gala Dinner with President S R Nathan as the Guest of honour.

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Key

me+GROUP 10

Setting Neuroscience Milestones:

NNI Turns By A/Prof Tchoyoson Lim, Senior Consultant Neuroradiologist

o mark its 10th anniversary, the National Neuroscience Institute (NNI) hosted a series of staff activities and a public forum on 18 July 2009: Your Brain and Nervous System – How can they affect you? Celebrations took place over six months, culminating in a staff celebration and the launch of the 10th Anniversary Commemorative Special – We Are Here For Our Patients – on 17 July 2009. At the celebration, Director Professor Lee Wei Ling reaffirmed the institution’s dedication in neuroscience: “We will continue to do our best to improve patient care, remembering never to rest on our laurels… We will always function as Team NNI with all members, who include doctors, researchers, nurses, medical technologists, radiographers and administrative staff, pulling together with one common purpose: to provide the best neuroscience care to all our patients.”

NNI – Our Beginning NNI was established in 1999 when the Departments of Neurology and Neurosurgery moved from Tan Tock Seng Hospital (TTSH) to form the foundation of clinical service. The Department of Neuroradiology was initiated, becoming the first subspecialised radiology department in Singapore. It was supported by dedicated bench research laboratories as well as administrative and education resources. In 2001, NNI integrated the TTSH Neurology and Neurosurgery services and Research resources with the Department of Clinical Neurosciences at Singapore General Hospital.

A/Prof Lo Yew Long and A/Prof Tan Eng King at the “Memories of NNI” corner

NNI Today Service NNI has established itself as a leader in neuroscience care in Asia, with strong improvements in clinical service particularly in the areas of Parkinson’s disease and stroke management. The institution has been accredited by the American-based National Parkinson Foundation as an International Centre of Excellence, while its Neuroradiology Department is the first and only imaging centre in Singapore to provide 24-hour MRI scanning for acute patients. NNI has also developed the world’s first digitally integrated neurosurgical centre to provide the full range of treatment options combined within one facility, using the latest in neuroimaging for better patient outcomes and results. Its neurosurgeons have been gradually developing various subspecialty services and programmes for the various diseases to improve clinical delivery. The coordinated subspecialties have matured over the years and now include trauma, oncology, skull base, neurovascular, functional, paediatric and spine neurosurgery programmes that are comparable to the top neurosurgical centres around the world. Neuroscience nursing has been an integral part of clinical services since NNI was formed ten years ago. Our nurses specialise in the care and support of individuals affected by the central nervous system disorders as these patients have unique physical, social and emotional needs.

Education The neurosciences are often viewed as intimidating and difficult to learn; with “neurophobia” being a common complaint amongst undergraduates, nurses and doctors. To bridge this gap in knowledge, the Office of Neurological Excellence (ONE) at NNI-TTSH was started in 2004. ONE actively collects learner feedback to critically review existing teaching methods and provide data for medical education research. It has enabled NNI to continually experiment with new instructional methods for future neurology teaching.

Research Staying true to its mission to improve treatment and discover cures for neurological diseases, NNI research focuses on achieving a better understanding of basic physiological and disease mechanisms, discovering and exploring new medical and surgical therapies, and improving health care provision and delivery. Ongoing research projects are being carried out in the areas of neurodegenerative diseases, acute brain injury, stroke, surgical navigation and neuro-oncology.

Meet The Brain’s

me+GROUP

Camera-man

Mr Wee Liang Kwee has worked as a radiographer for nearly 30 years. Now focusing on brain imaging, he tells me+SH what makes his work so exciting.

n elderly patient has a weakened blood vessel in his brain. As blood pools and forms a balloon, the strained walls of the vessel mean that the aneurysm could rupture and cause death. It used to be that a surgeon would have to open up the patient’s brain and repair the damage directly. Now, we have a less invasive treatment called endovascular therapy for such patients. In this procedure, a special catheter is inserted into the patient’s femoral artery at his thigh, threaded into his brain through blood vessels and a special coil is released to fill the aneurysm and eliminate blood flow into it. Throughout the entire process, Mr Wee Liang Kwee, Principal Radiographer, Neuroradiology Department, National Neuroscience Institute (NNI), is the “camera-man” who generates images from inside the patient’s body and brain for the doctor to navigate. “To see the whole aneurysm and then see it obliterated, is very satisfying,” states Mr Wee. “The patient’s hair is intact, his head is not opened up, all he gets is a small scar at the groin when he wakes up from the anaesthesia!” When Mr Wee first graduated from the School of Radiography at Singapore General Hospital in 1979, his job was still very much about taking X-rays. “I had wanted to be a radiographer because it seemed a technological marvel: to be able to see inside the human body,” he enthuses. In three decades, Mr Wee has seen and tried his hand at an evolving series of diagnostic imaging techniques: from

“What made the most impact on me was how imaging became more than just that. It became interventional. We could really see the patient being treated.”

plain X-rays to CT scans, angiography and magnetic resonance imaging (MRI). “What made the most impact on me was how imaging became more than just that. It became interventional. We could really see the patient being treated,” says Mr Wee. At the NNI where he has spent the last 10 years, he focuses on interventional neuroradiology. He also oversees a group of six young radiographers, training them and keeping them up to date on new techniques like 3D angiography – where images generated are threedimensional – as well as honing basic techniques like how to visualise various blood vessels in the head. “Even though it’s been so many years, I still love my work,” shares Mr Wee. “I don’t mind late nights and long hours. I think I have been very lucky to choose the right profession.”

Singapore’s First

Physiotherapist Of The Year Dr Wong Wai Pong from SGH was recently crowned Singapore’s Physiotherapist of the Year for his leadership in the profession, and as a pioneering educator and fervent researcher. By Sher Maine Wong

bserving a group of elderly women dancing jauntily in sync to a popular tune in the void deck of an HDB flat, Dr Wong Wai Pong concluded: “If you are weak, the dancing might predispose you to falls, and then we have to look at fall prevention. But it’s also a very fun activity where the women make friends, and that’s about the quality of life.” That happened some years ago when Dr Wong, Senior Principal Physiotherapist, SGH, and recent winner of the Singapore Physiotherapy Association’s inaugural Physiotherapist of the Year Award, was conducting a study on the physiological, functional and psychological effects of country line dancing on older women. Dr Wong has since done more research on the elderly and fall prevention. He has also helped start a fall prevention clinic at SGH and is collecting data looking into the risks of falling by the elderly. “Singapore has an ageing population and there is a need for us to put in place some preventive measures,” he said. His research work shows how relevant and pervasive a role physiotherapy plays in our daily lives, and that the discipline isn’t just about massage and exercise. “Physiotherapy is a non-invasive approach to healthcare,” said Dr Wong, “and the approach is always on maintaining health rather than disease management. If you have fallen, physio helps you to prevent the next fall.” Dr Wong is also passionate about cardiovascular and pulmonary physiotherapy, where physical therapy is used to treat problems like asthma, acute upper

respiratory infections and trauma. He has published several papers on the subject in peer-reviewed journals and textbooks. As an educator, he was the driving force behind the first National Physiotherapy Congress in 1995 and he continues to mentor younger colleagues. He speaks proudly of how the field of physiotherapy has developed to the point where it can now address lymphedema, which can occur in post-chemotherapy cancer patients, and vertigo which causes dizziness.

It is no surprise that Dr Wong is known to colleagues as the “walking physiotherapy historian”, and to young researchers as the “walking clinical dictionary”. Dr Celia Tan, Deputy Director for Allied Health Division, SGH; Director for SGH-PGAHI, and current President of the Singapore Physiotherapy Association proudly quips: “I can’t think of a more deserving physiotherapist for this award than Dr Wong. Even as his ex-manager and senior, I have long admired and respected his astute observations and comments on professional trends and visions. If you need to know what is happening in the physiotherapy profession internationally, you only have to ask him! Truly an inspiration, leader and mentor for all physiotherapists.”

me+SPOTLIGHT

Celebrating Our Award Winners

me+SPOTLIGHT

Celebrating Our Award Winners

Eye TrioWin

Singapore’s Highest Research Award Having saved the sight of thousands of people locally and globally, it is no wonder that a high-powered trio from the Singapore National Eye Centre have been bestowed the inaugural President’s Science Award. By Sher Maine Wong

hey were the first in the world to alert millions of contact lens wearers globally to a contact lens cleaning solution, which could cause eye infections; thus saving the sight of thousands worldwide. …the first to grow human conjunctival stem cells from a person’s good eye, to transplant into the other eye to restore vision. …and the first to develop and commercialise a new surgical device to perform sutureless, small-incision, keyhole corneal transplantation, which is now used in more than 10 countries around the world. For all these firsts and more, Professor Donald Tan, who chairs the Singapore Eye Research Institute (SERI), Professor Roger Beuerman, SERI’s senior scientific director, and Associate Professor Aung Tin, SERI’s deputy director, have been awarded the first President’s Science Award.

The award is the highest research award in Singapore recognising outstanding research scientists and engineers for their excellent achievements in science and technology. It was previously known as the National Science and Technology Awards. Said Prof Tan, the team leader: “My team accepts the award on behalf of all the clinicians and scientists working together with us. We stopped thousands from being blinded by corneal fungal infections and have developed new forms of corneal transplantation, which are helping more to see. These are the most rewarding aspects of our work.” Professors Tan, Beuerman and Aung Tin’s work was also outstanding as a result of their wide-ranging output, which included laboratory breakthroughs (bench), clinical innovations that directly benefitted patients (bedside), and public health interventions which affected whole communities (population).

Bedside

Bench The trio are the first in the world to grow human stem cells in a laboratory to produce conjunctival tissue. The tissue is grown from a patient’s stem cells in the unaffected eye. It is transplanted in the patient’s other eye to restore vision. “We don’t use animal cells or serum to grow our stem cells because we want to eliminate the risk of disease transmission, such as Bovine Spongiform Encephalopathy (BSE), more popularly known as mad cow disease”, said Prof Tan. Other research highlights include identifying a gene that blinds babies born with a severe form of congenital corneal blindness, known as Congenital Hereditary Endothelial Dystrophy (CHED). The team also discovered mutations of the same gene in adults with the most common form of premature ageing of their corneas, known as Fuchs’ Endothelial Dystrophy. This discovery provides research opportunities to develop gene therapy for

The team introduced new surgical innovations in keyhole corneal transplantation surgery (known as Endothelial Keratoplasty) to replace the damaged layer of a cornea through a fourmillimetre incision. During the surgery, a surgical device invented and patented by Prof Tan, called the Tan EndoGlide, enables coiling of the donor’s cornea through a keyhole incision for transplantation into the eye. The loss of healthy cells is reduced because surgeons do not use the conventional manual technique. According to Prof Tan: “Without the device, the surgeon must hold the layer, fold it into two parts, push it through the incision and unfold the layer when it is in the eye. You lose 30 to 40 per cent of the healthy cells. The easy-to-use device cuts the loss to 19 per cent.” The SERI team is also the pioneer of a complex two-stage operation using the tooth of a completely blind patient to make and transplant an artificial cornea. The Singapore National Eye Centre (SNEC) is one of the few places around the globe performing the operation. All SNEC “tooth-in-eye” patients regained their maximal potential vision. Prof Tan, who is also Medical Director at SNEC, stated that 60 per cent now have perfect vision. “We are working on a project to make a completely artificial cornea using bioengineered artificial polymers so that the patient’s own tooth may not be used, or for patients without healthy teeth.”

Population They were the first to prove that contaminated ReNu contact lens cleaning solution, the world’s most popular contact lens cleaning solution at that time, created a rash of infections in several countries in 2006. Worldwide withdrawal of ReNu saved the eyesight of thousands of users of the popular solution.

me+SPOTLIGHT

premature degeneration of corneas among older folk in Singapore’s rapidly ageing population.

me+SPOTLIGHT

Celebrating Our Award Winners

A Prescribed

Formula

For Success

Pharmacists do more than just counting and pouring pills, they make significant contributions to the medical field too. Two of our pharmacists win awards for the stellar work they have done in changing the face of medicine in Singapore.

Who: Dr Andrea Kwa, Senior Principal Clinical Pharmacist, SGH Dr Andrea Kwa won the Professor Lucy Wan Outstanding Pharmacist Award 2009, which is the highest award given by the Pharmaceutical Society of Singapore to local pharmacists. She is internationally recognised for her research work, especially on the topic of antibiotic resistance in gram-negative bacilli.

Who:

Ms Lee Soo Boon, BCNSP, Senior Principal Clinical Pharmacist, SGH Ms Lee Soo Boon won the Shire Hospital Pharmacist Award 2009, which is given by the Pharmaceutical Society of Singapore to those who excel in hospital pharmacy practice. She is an expert in process re-engineering and quality frameworks like JCI accreditation, ISO and OHSAS. She is also a pioneer in the areas of clinical nutrition and clean room operations.

me+SPOTLIGHT

me+SH: Why did you become a pharmacist? Andrea: I wanted to do pharmaceutical research. Since I was young I like to daydream and find new ways of doing things.

Soo Boon: I wanted to grow my interest in chemistry in the healthcare setting. I remembered having great fun during the practical lessons in my university days, where we would “manufacture” different formulations and role play in patient counselling.

me+SH: How did your career evolve? Andrea: From the start I knew I did not want to just dispense medicine. I proactively requested for training opportunities to go overseas, where I learnt more about pharmaceutical and translational research. Upon my return, my learning curve continued to grow. One milestone was receiving the SGH ASM Young Investigator Award in 2006. Another was the GCEO Excellence Award for research this year. It is indeed strong endorsement by my peers and from SingHealth.

Soo Boon: I started out wearing a “space suit” preparing sterile medicines in a clean room. We set up the Home Parenteral Nutrition (HPN) programme, where patients can continue with nutrition support in the comfort of home. Our first patient was from Sarawak, and it was an adrenaline rushing experience, as we needed to get the nutrition bags to Sarawak within a stipulated timeframe in order to prevent deterioration of the contents! During my early days, I developed several clean room standards for Singapore, was involved in organising yearly Aseptic Dispensing workshops, and trained many like-minded pharmacists and technicians in Singapore and around the region. As I got more involved with back-end processes, my focus shifted to spearheading departmental initiatives and process re-engineering. Patients became the centre of focus and processes were redesigned to ensure a smoother and faster flow. I was also the main person developing quality frameworks and ensuring compliance to the relevant standards for the department. One initiative we introduced was the drug sample coupon system. This system has since enhanced the accountability, storage as well as medication review process associated with drug samples, and was adopted by other hospitals in Singapore.

me+SH: What has been most professionally satisfying for you all these years? Andrea: Saving lives! For instance, there are patients who catch bugs in the hospital, which are resistant to all types of antibiotics. I thought about trying a combination of antibiotics instead of just one antibiotic at a time. We came up with a concoction which was actually used during an outbreak, in the exact dosage we recommended. It saved patients, who might otherwise have died. They were moved out of the ICU after two weeks. In addition, one of the best outcomes over the years is earning the respect of the doctors, nurses and other healthcare professionals. It’s not easy to earn their trust at a level where they regard you as an integral part of their team and a comrade: to work and plan together or independently in both the clinical and research arena, for the common good of our patients. It’s also not easy for any individual to accept another individual from other backgrounds at work, for we tend to be more comfortable with co-workers of the same background and the same way of doing things. I do not give up for I strongly believe a team’s strength lies in their differences, not in their similarities and diversity is a blessing! Only in a strong team are we able to achieve groundbreaking results.

Soo Boon: I would have to say, the time I set up the first commercial pharmacy clean room in Asia Pacific, for Baxter Healthcare. This setup was based in Tan Tock Seng Hospital and was intended to be a showcase and model for the region. Until then, no commercial company had such a facility in the region. The main challenge was getting the required HSA certification and licences in place. While what I am doing now may not be directly working with the patients, I believe that a welldesigned process can still make a great impact; as pharmacy supports processes that cut across the entire hospital. It’s a very challenging job.

me+SPOTLIGHT

Stepping up on

the Care

Continuum From prevention to palliation, that is the vision CGH holds as it sets out to transform its model of healthcare delivery. By Jeanie Cheah

eds are a precious commodity in public hospitals. It is a constant challenge to ensure that beds are available for the next patient who needs one. This is especially true in acute hospitals where most cases require immediate treatment. But more important than simply resolving the issue of hospital bed space is the continuation of care when a patient leaves an acute hospital. In a population that has patients with multiple chronic diseases, managing continuity of care in primary care and community following hospital discharge is very important. This requires an integrated and seamless healthcare delivery system. As early as 2003, Changi General Hospital (CGH) had conceptualised the provision of integrated patient care. Various departments at CGH took the initiative to build a continuum of care for patients under their wings. One such example is the Ortho-geriatric Service, part of the Orthopaedic Department. Wilson Lee Wee Sing, Senior Staff Nurse specialises in the management and care of geriatric patients, 70 years and above, who are treated for hip fracture. He says, â&#x20AC;&#x153;The patients we see need a fair amount of time for rehabilitation. Staying on in an acute hospital for an intensive rehabilitation

What convinces patients to move to a community hospital? • Being assured that they get the right care for their stage of recovery. • Knowing that they will get the intensive rehabilitation programmes they need. • Receiving care from the same physician (or knowing that the next physician has full access to his medical history). • The proximity of SACH to CGH (doing away with the need for an ambulance) • The lower cost, if applicable. On the day of transfer, the patient would be accompanied by at least one member of family and a nurse. The nurse who wheels the patient over would manage the handover, which comes complete with a discharge summary and a rehabilitation therapy report. On two designated days in a week, the orthopaedic surgeon would personally visit the patient at SACH. Problems are surfaced and discussed before appropriate recommendations are made.

The larger vision for integrated care CGH is the first major hospital in Singapore to be paired with a community hospital. The collaboration

between CGH and SACH provides continuity in the care of patients, but it is not all. Shared CGH CEO, Mr T K Udairam, “Primary care providers such as the polyclinics and General Practitioners are an important part of this continuum of care. They are the ones patients consult on a regular basis. Integration would overcome the episodic nature of the present healthcare system.”

What it means for CGH and its staff In transforming a model of healthcare delivery, there is an investment in resources and manpower. A new “Eastern Regional Integrated Health Services Team” has been set up to develop the system and programmes to integrate care. The new team is looking into primary care integration, disease management, intermediate and long term care integration and prevention programmes. They will focus on five chronic diseases – diabetes, coronary diseases, COPD, hip fractures in the elderly and stroke – using tools such as integrated care pathways and a disease management team. The new IT system will track the medical needs of the patient in addition to capturing essential laboratory data and the medical history of the patient. It allows the attending doctor to study the trends in the patient’s condition and intervene if necessary, explained Prof Fock Kwong Ming, Chairman of the Eastern Health Cluster Clinical Integration Steering Committee. While challenges are anticipated in the journey towards integration, the vision is clear and the momentum has been set. As Mr Udairam puts it succinctly, “The point of integration is, really, to deliver healthcare that prevents a patient from having to come back to us again.”

me+SPOTLIGHT

programme to aid their recovery is not ideal.” Wilson plans the discharge of each hip-fracture patient at the Orthogeriatric Service to the last detail. He usually makes recommendations for patients to be transferred to St Andrew’s Community Hospital (SACH) as soon as they are fit after surgery. It is a process that needs him to play the role of educator and counselor. First he has to speak to the patients and their immediate family to tell them what the transfer entails and seek their agreement. He also has to explain why it is necessary and beneficial for the patient to make the move.

Celebrating Our Award Winners

me+SPOTLIGHT

SGH Nurse Tops Worldskills

Caroline (left) and Adeline flying the Singapore flag high

n an ever changing world, some things do remain constant. Carolyn Choo knew from a very young age that she wanted to be a nurse. In spite of initial objections from her parents, she heeded her calling. Today, Carolyn has much to be proud of and the unanimous support of both parents. She and Adeline Mah, a classmate at Nanyang Polytechnic, have topped the Worldskills International Competition 2009 in Calgary, Canada. They have done Singapore proud in surpassing participants from Italy, Finland, France, Nederlands, Norway, Mexico, Sweden and United Arab Emirates. The competition was a gruelling series of tests spread over four days. Participants were tested on how they would handle various scenarios involving different types of patients. Carolyn joined SGH as an Enrolled Nurse in 2008. Her competency and positive attitude impressed her supervisors who encouraged her to pursue further studies. She is currently on training leave to complete a diploma in nursing sponsored by SGH.

PGAHI Paves Way For

Team Approach To Sports Rehabilitation

he inaugural SGH Sports Rehabilitation Symposium took place on 22 October 2009 at the SGH Postgraduate Allied Health Institute (PGAHI). Developed in partnership with the SGH Physiotherapy Department and the SGH Department of Orthopaedic Surgery, this symposium is the first multidisciplinary gathering of sports experts under the umbrella of SGH-PGAHI. It is also part of a series of multi-disciplinary symposiums organised to focus on team approach for better patient care. Doctors, therapists and sports instructors — with a number of them hailing from as far as China and Indonesia — packed the event. They were welcomed by

Contributed By Goh Zewei

“The Symposium is timely as many Singaporeans have taken up sporting activities in recent years. It was well organised and valuable to the participants, who have come out from the event better prepared to care for our athletes.” ~ Prof Tay Boon Keng, Chairman, Medical Board, SingHealth International

guest of honour, Prof Tay Boon Keng, Chairman, Medical Board, SingHealth International; and addressed by some of Singapore’s foremost experts in sports rehabilitation, including keynote speaker Dr Benedict Tan, Head, Changi Sports Medicine Centre. In addition to discussions on wide ranging topics from Sports Psychology to Nutrition, the Symposium held demonstrations of sports rehabilitation therapies. The attendance and positive feedback bode well for the next SGH Sports Rehabilitation Symposium, to be held on 8 July 2010. Those interested can email their bookings to pgahi@sgh.com.sg by 24 June 2010.

me+SPOTLIGHT 21

SingHealth Residency:

Giving Medical Education An Overhaul

ome May 2010, training for junior doctors will move from the current British-based Specialist Training System to an American-style residency approach. As part of the Ministry of Healthâ&#x20AC;&#x2122;s initiative to advance local medical education, SingHealth residency information and dialogue sessions were held over two days on SGH Campus. Attended by close to 400 (in 2 sessions) Yong Loo Lin School of

Medicine students, current House and Medical Officers, and staff, the briefing sessions were aimed at providing a clearer understanding of the new programme as well as to answer any queries attendees might have.

For more information about the SingHealth Residency Program, check out the website http://www.singhealthacademy.com. sg/residencyprogram/

me+SPOTLIGHT

Building Teaching Capacity in Allied Health

Joint programme between SingHealth Academy, SGH-PGAHI and NUS strengthens pedagogic skills of allied health faculty. By Michelle Lam and Lydia Ng

llied health educators at SingHealth are now trained to teach, impart skills and mentor effectively through a first-of-its kind faculty development programme called Fundamentals of the Theory & Practice of Education. This is an exciting time for allied health professionals who will be able to build a strong faculty pool from among their own, reducing heavy reliance on foreign trainers and sporadic courses for formal healthcare training. The programme teaches them to customise, design and run their own courses, creating greater training accessibility as in-house teaching can now take place conveniently within departments on a regular basis. Comprising six sessions over a period of three months, the programme is a collaboration among SingHealth Academy, SGHPostgraduate Allied Health Institute (PGAHI) and the National University of Singapore (NUS), from which faculty is drawn to conduct the programme. The first run was attended by over 30 senior allied health members from Singapore General Hospital, who hold teaching roles in their departments.

pedagogy, curriculum design and assessment were delivered through lectures and workshops. It was an insightful time and a great networking opportunity for participants, as they went through case study exercises and group discussions with fellow educators. “The course expanded my awareness of the ways to enhance students’ learning experience and achieve specific learning outcomes through different teaching methods and tools.” said Dr Donald Yeo, Principal Neuropsychologist from the Neurodiagnostic Unit in SGH, who participated in the programme. Within six months after completing the programme, participants are required to create new courses for their area of work or revamp existing courses to enhance learning experiences –an immediate, tangible contribution to the profession. “This faculty development programme creates a paradigm shift in allied health education. We are no longer just passing down information to our mentees, but rather, we are able to better facilitate effective learning.” said Dr Tan.

“As clinical knowledge and skills increase, it is time to empower our senior staff to teach the juniors effectively. We want to equip them with the right teaching skills to facilitate teaching and learning processes, and eventually provide better care for our patients.”

Faculty Development Programmes A step further has been taken to enhance SingHealth’s strong culture of healthcare education. In addition to healthcare education and training programmes, SingHealth Academy has placed increased emphasis on developing faculty members within the cluster – clinical educators competent in teaching, mentoring and bringing out the best in our practitioners.

said Dr Celia Tan, Director of SGH-PGAHI. Comprehensive lessons covering topics such as

Aims of faculty development: •

Raise healthcare educators skilled in pedagogy to engage and teach effectively.

•

Equip faculty with powerful learning tools and innovative teaching methods (e.g. media and technology)

•

Provide certification and growth development opportunities to faculty members.

•

Build a strong pipeline of educators to advance learning and teaching at SingHealth.

To enquire about faculty development opportunities for your department, drop an email to academy@ singhealth.com.sg

me+SPOTLIGHT 24

Singapore Health

– truly a part of SingHealth

hink patient engagement. Think health literacy. Think Singapore Health. This first ever bilingual health newspaper in Singapore, jointly published by SingHealth and Singapore General Hospital, was launched on 3 November. Dr Amy Khor, Mayor, Southwest District, Senior Parliamentary Secretary, Ministry of the Environment and Water Resources, and Chairperson, REACH Panel, Ministry of Community Development, Youth and Sports, was guest of honour at the launch event. Singapore Health is the result of many months of intensive work led by the teams at SGH Communications and SingHealth Group Communications. With the support of colleagues from communications teams across the group, it builds on OutramNow, covering a wide range of topics. The collaboration makes this truly a SingHealth publication. Drawing on expert views and the specialist knowledge of medical professionals within SGH and the SingHealth Group, the newspaper provides practical information on health and wellness, the latest medical breakthroughs, and tips on navigating hospital processes. “This is an effort that will empower patients to make smart health decisions and optimise benefits that the public healthcare system offers,” said Professor Ivy Ng, Deputy CEO, SingHealth. Copies of Singapore Health are available at any of our three hospitals, national specialty centres and select SingHealth polyclinics. To widen the reach of Singapore Health, more distribution points have been added at high traffic areas within the central business district.

“

As the nation’s largest healthcare group with more than 4 million patient visits a year, we are committed to raising the health literacy level of Singaporeans.

”

- Professor Tan Ser Kiat, Group CEO, SingHealth

...It is an excellent publication to succeed OutramNow. I am very pleased that the newspaper exceeds my expectations and I think it will be a strong vehicle that the SingHealth cluster should make use of, for continuing outreach and health education for Singaporeans.” - Ms Priscylla Shaw, Board of Trustees, SHF

“...the inaugural issue of Singapore Health is an improvement from OutramNow. Glad to see interesting articles...” - Dr Lee Suan Yew, Board of Trustees, SHF

me+SPOTLIGHT

he global economic and financial crisis may have left the Singapore healthcare industry relatively unscathed, but healthcare management and personnel should use this period to review and reflect on our practice of Medicine. SARS and the recent H1N1 outbreak have made it clear that in any crisis, we have to stay updated as developments are fast and furious in Medicine. The following represent some areas we need to focus on.

“Walking our Talk” We need more positive role models for junior doctors and students. This becomes more crucial with patients who are increasingly discerning and have changing expectations. Communications at all levels must be strengthened as this is the crux of the good practice of our profession.

Collaborative culture and breaking down silos While we operate as multiple departments and in ‘silos’, patients and the public view us as one institution. There is a need to break down barriers and streamline patient flow across the institution. Artificial barriers based on tradition and unacceptable norms must be changed. Department name-calling and ‘negative’ and inappropriate blogging represent unprofessional behaviour. We must continue to strive for a collaborative institutional culture and sense of ownership.

A review of our practice of Medicine By Dr Fatimah Lateef, MBBS, FRCS(Edin)(A&E), FAMS(Em Med)

and powerful suppliers – can result in cost advantages which are potentially not negotiated by a single institution. We need to review our individual practices more consciously and assess utilisation rates, yet never compromising on quality patient care.

Talent Recognition and retention No matter how hard the work is, people will stay if they are happy and are given due recognition. Motivation is only potential energy until it is harnessed. Many staff have hidden talents which are not identified due to a lack of time and feedback channels. It is up to us to observe, identify and nurture.

Maintaining cost effectiveness in healthcare

Investment in Information Technology

A purchasing office - to negotiate on a level playing field with large

Currently, the use of IT is still uneven. As we move towards

‘one medical record per patient’, the interconnectedness between departments, laboratories and imaging centres becomes crucial. Many institutions already have some form of IT implemented but each will have to be fine-tuned and integrated accordingly, based on feedback from users. We must all latch onto the latest technology but ensure cost effectiveness. Technology helps in the continuity of care. This electronic exchange of healthcare data must be treated with utmost respect and be endowed the greatest confidence in keeping with our ethical and moral principles of practice.

Conclusion Institutions must continue to strengthen and integrate the healthcare ecosystem, where all key players and personnel will be in alignment and on the same platform.

Dr Fatimah Lateef is senior consultant at the Department of Emergency Medicine and director of Undergraduate Training and Education at Singapore General Hospital.

me+SPOTLIGHT 26

Championing

Improvements

SingHealth institutions walked away with the most number of awards at the MOH Clinical Quality Improvement Conference.

ingHealth and its institutions have Award Institution Lead Author always been strong advocates of quality First Prize SHP-Pasir Ms Jasmine Ris Heng improvement. This was affirmed at the recent MOH Clinical Quality Improvement KKH Dr Joseph First Conference, where SingHealth institutions Manuel Gomez Runnerswept five of the ten awards given out for Up quality improvement projects. NCCS Dr Neo Soek Merit Hui, Patricia Entries were judged based on patient safety, innovation, and eventual outcomes. CGH Dr Goh Soon Merit Participants had to present their projects on Noi posters. From an initial 111 entries, 39 finalists were selected to present at the conference held at the Suntec Convention Centre in September. The team from SingHealth Polyclinic-Pasir SHPDr Ng Lai Merit Tampines Peng Ris garnered the top prize with KKH hot on its heels! Dr Tan Ngiap Chuan, Director of SHP-Pasir Ris as well as project sponsor for the winning project, attributes the win to the overwhelming support the team has received:

Project Title

Improving blood pressure control in patients with cardiovascular diseases in SHP-Pasir Ris. Reducing healthcare-associated bloodstream infection in very low birth weight infants. Improvements in end-of-life care with a protocol based pathway for cancer patients dying in a Singapore hospital. Care transitions intervention by Care Coordinators for elderly patients with complex care conditions, who are at risk of hospital readmission and re-attendance in the Emergency Department. To increase the number of patients educated on Written Asthma Action Plan (WAAP).

“A proactive motivated team is key to the success of the project. Engaging the whole clinic staff to support the implementation of the interventions, from HOD to health attendants, is another prime factor.” Four out of five winning entries from SingHealth were birthed from successful Clinical Practice Improvement Programme (CPIP) projects that the participants have been involved in. Dr Tan is a firm supporter of CPIP and its benefits to our healthcare system: “CPIP is a training programme that provides useful tools to analyse the complex delivery of healthcare services. Clinicians can then introduce interventions based on work processes and workflow assessments to check on their effectiveness. The tools can be deployed in many areas of service delivery and can improve the quality of care in any healthcare institution.” To read the abstracts of winning entries, and for more information on CPIP, visit http://mysinghealth/Singhealth/CorporateOffice/QM/Programmes/CPIP/AboutCPIP/ Clinical+Practice+Improvement+Programme

Staging An Intervention How did SHP-Pasir Ris improve blood pressure control in their patients? me+SH finds out. • • • • •

Stamping patients’ appointment cards to educate and remind them of their blood pressure targets Holding talks and discussions for patients on health target education Using structured exercise assessments and prescriptions for patients by physicians and nurses to encourage physicians to discuss exercise as part of the mutually agreed goals Producing patient-centered education materials like posters and flyers to motivate patients in self-care Passing handouts to patients on home blood pressure monitoring

The effect of red yeast rice on lipids, inflammatory markers and plasma glucose in subjects with mild hypercholesterolemia and mildly elevated plasma glucose Martin Prøven Bogsrud1, Gisle Langslet1, Leiv Ose1, Inger Ottestad1, Ellen Charlotte Strøm1, Tor Arne Hagve2, Kjetil Retterstøl1 Lipid Clinic and 2Department of Medical Biochemistry, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway

Background

• Several large clinical trials have demonstrated that lowering cholesterol levels with statins reduces the incidence of cardiovascular events and mortality. • Red yeast rice has been used in China for centuries as a food preservative, food colorant, and to make rice wine. E.g. the famous red Peking duck is coloured by red yeast rice. Red yeast rice contains small amounts of monakolin K. This is the same substance discovered by Endo in 1979 and later commercialised as the drug lovastatin (Mevacor, MSD). • Several Chinese studies1 and one American study2 indicate that red yeast rice has a significant cholesterol lowering effect. • A recent Chinese study3 indicates that red yeast rice can significantly decrease the incidence of nonfatal myocardial infarction and deaths from coronary heart disease compared to placebo. • Some reports have suggested an effect of red yeast rice on fasting plasma glucose by unknown mechanisms.

Objectives

Results

• To evaluate in a European (Caucasian) population the effect of red yeast rice compared to placebo on lipids, inflammatory markers and plasma glucose markers in subjects with mild hypercholesterolemia and mildly elevated plasma glucose.

• 40 persons (23 men and 17 women, mean age mean age 60 years) completed the study and were included in the data analysis. • Data were assumed normal distributed. One-sample and paired-sample T tests were used for data analysis. • Patients receiving red yeast rice experienced a significant cholesterol lowering effect for both total-cholesterol, LDL-cholesterol and APOB compared to placebo after 6 and 16 weeks on treatment (Table 1. Figure 2-4). • Secondary endpoints, safety blood parameters, blood pressure measurements, weight and waist circumference measurements, and food questionnaire score did not differ between the two groups (Table 2).

Methods

• A randomized double-blind placebo controlled study (figure 1) Figure 1 Study design (n=42) Study end (week 16)

6 weeks

4 weeks

16 weeks

Wash-out Diet runin

Red yeast rice (n=22) or placebo (n=20)

Lab evaluation at Inclusion, Randomization/baseline, at 6- and 16 weeks of treatment

Table 1. Lipid concentrations in treatment and control group. Table shows mean concentration ± standard deviation.

• Eligible subjects were men and women between 18 and 75 years with: o fasting 3.0 mmol/L < LDL-cholesterol < 6.0 mmol/L o fasting TG < 4.5 mmol/L o 5.5 < HbA1c% < 7.5 and/or fasting plasma glucose > 5.5 mmol/L • The subjects (n = 42) were randomized and received either red yeast rice (Hypocol®, Wearnes Biotech & Medicals Pte Ltd, Singapore : 4 capsules / day = 2400 mg red yeast rice / day) (n=22) or placebo (n=20) for 16 weeks. • Prior to inclusion patients already taking cholesterol lowering drugs underwent a 6 weeks wash out period. • At inclusion all patients were instructed to follow a diet according to NCEP ATP III during a 4 week diet run in phase prior to randomization. • Fasting serum lipids (TOT-C, LDL-C, HDL-C, TG, APOB and APOA1), safety parameters (CK, ASAT, ALAT, GT, creatinine, urea) and fasting plasma glucose were measured at inclusion (week -4), baseline/randomization (week 0), and after 6 and 16 weeks on treatment. • Fibrinogen, high sensitivity CRP, TSH, insulin, and C-peptide were measured at inclusion, baseline/randomization and after 16 weeks on treatment. • Blood pressure, weight, and waist circumference measurements were collected at first and last visit. • Food questionnaire (Smart Diet®) was collected at first and last visit to allow measurement of any systematic dietary change. Figure 2

No significant difference (P<0.05) were seen between the groups Figure 4

6,17

5,86

6,04 6,01

5,71

5,71 4,76

4,72

Apolipoprotein B

LDL-cholesterol

red yeast rice placebo

mmol/L

Table 2. Safety data and secondary endpoints in treatment and control group. Table shows mean concentration ± standard deviation.

Figure 3 Total-cholesterol

8 7 6 5 4 3 2 1 0

1 Significant decrease from baseline to this visit in treatment group compared to control group (P<0.003) 2 Significantly different from control group at same visit (P<0.001). 3 Significantly different from baseline (P<0.045)

4,04

4,15

4,06

3,72

3,93

4,29

2,88

2,82

6 weeks (week 6)

16 weeks (week 16)

red yeast rice placebo

1 0

Inclusion (week -4)

Baseline (week 0)

6 weeks (week 6)

16 weeks (week 16)

Inclusion (week -4)

Baseline (week 0)

Mean reduction in total-cholesterol for patients receiving red yeast rice were 17.3% and 16.6% after 6 and 16 weeks of treatment, respectively. This was significant (P<0.001) different from placebo. Error bars show 95% confidence interval.

Mean reduction in LDL-cholesterol for patients receiving red yeast rice were 22.6% and 24.2% after 6 and 16 weeks of treatment, respectively. This was significant (P<0.001) different from placebo. Error bars show 95% confidence interval

Safety data

• No serious adverse events were reported. • 9 minor adverse events (AE) were reported during the study, 2 of which lead to drop out. In the red yeast group 1 person dropped out of the study due to general discomfort, and 1 person reported increasing flatulence, 6 other AE’s were very unlikely to be caused by study drug. 1 AE occurred in the placebo group.

1,4 1,2 1,0 0,8 0,6 0,4 0,2 0,0

1,05

1,11

1,00

0,99

Inclusion (week -4)

Baseline (week 0)

1,05

1,11

0,79

0,76

6 weeks (week 6)

16 weeks (week 16)

red yeast rice placebo

Time

mmol/L

Randomization/baseline (week 0)

Inclusion (week -4)

• Primary endpoints: The effect of red yeast rice on fasting blood values of total-cholesterol (TOT-C), LDLcholesterol (LDL-C), HDL-cholesterol (HDL-C), triglyceride (TG), apolipoprotein A1 (APOA1), and apolipoprotein B (APOB). • Secondary endpoints: The effect of red yeast rice on fasting plasma glucose, glycosylated haemoglobin (HbA1c), and high sensitivity CRP

Mean reduction in apolipoprotein B for patients receiving red yeast rice were 20.2% and 23.2% after 6 and 16 weeks of treatment, respectively. This was significant (P<0.003) different from placebo. Error bars show 95% confidence interval

Conclusion •This study is the first to show a cholesterol lowering effect of red yeast rice in a European (Caucasian) population. •The cholesterol lowering effect of the tested red yeast rice product is comparable to e.g. 20 mg Lovastatin or 40 mg of fluvastatin4 References

1 Kou W., Z. Lu, Guo J. [Effect of xuezhikang on the treatment of primary hyperlipidemia]. (Chinese). Zhonghua Nei Ke.Za Zhi. 1997;36:529-31 2 Heber D., et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary upplement. Am J Clin Nutr 1999;69:231-36. 3 Lu Z L. [China coronary secondary prevention study (CCSPS)]. (Chinese). Zhonghua Xin.Xue.Guan.Bing.Za Zhi. 2005;33:109-15. 4 Edwards J., Moore R. Statins in hypercholesterolemia: A dose-specific meta -analysis of lipid changes in randomized, double blind trials. BMC Family Practice 2003;4:

Lipid Clinic Oslo, Norway

The famous red Peking duck is coloured by red yeast rice Photo: Marina Oliphant

* Asiapharm Biotech Pte Ltd (formerly known as Wearnes Biotech)

Presented at XIV International Symposium on Atherosclerosis • Rome, Italy • June 18 – 22, 2006 This study was supported by an unrestricted grant from Pharmalogica AS, Oslo, Norway,the distributor of Hypocol ® in Norway.

me+LIVING 28

On The Couch With...

Hamimah Ahmat

Melanie Chastan

Hamimah Ahmat and Melanie Chastan give children who may have developmental or physiological constraints the gift of speech.

t was a five-year-old girl with Down’s Syndrome who changed the course of Ms Hamimah Ahmat’s working life over 15 years ago. “She was very smart and so happy-go-lucky,” said Ms Hamimah, on her pupil at the special school. “She just could not talk.” One day the child started screaming. “I felt such pain in my heart to hear her, but she just could not tell me what was wrong.” Though she eventually managed to calm the child down, she never figured out what was wrong.

“I decided there and then that I wanted to pull down the barriers to communication and help these children,” said Ms Hamimah. That was when she took up a scholarship from the National Council of Social Service to study speech therapy in Australia. Today the senior speech and language therapist at KK Women’s and Children’s Hospital (KKH) Department of Child Development, works with preschoolers aged up to seven years old who have speech, language and communication difficulties.

“The vice principal in my JC gave a talk about career opportunities and spoke about how there would be a big need for allied health professionals. At the same time, I also knew a speech therapist and had an idea of what they did. So when the opportunity came along to get a scholarship to study overseas, it made sense to me to grab it.” Today she works with babies as young as six months old with cleft palates, as well as adults with speech difficulties due to cleft issues which were not properly fixed. Ms Chastan is also part of Operation Smile mission trips as a team speech pathologist. Operation Smile is a children’s charity treating facial deformities such as cleft lips and cleft palates around the world. It is frustrating to her, however, when some parents actually decline surgery. Said Ms Chastan: “Sometimes parents decline palate surgery even though their child has good potential to speak much more clearly after surgery. I find cases like these so sad because you know that the child’s future won’t be very easy.”

Our Speech Therapists speak up 3 ways to use your professional knowledge in your personal life

3 things you look forward to at the end of your work day

Ms Chastan

•

I unconsciously screen the language of my friends’ children. I’m more aware of people in the community who look like they might have had cleft surgery. My husband says I’m too particular about how he says some words.

•

A nice dinner with friends. Watching Family Guy (an American animated TV sitcom) Light reading.

Ms Hamimah

•

I monitor my five-month-old son’s developmental milestones. I facilitate the development of his feeding, pre-verbal and play skills. I act as a source of information for relatives and friends and I provide free child-screening services for them!

• •

Picking up my son from the nanny’s and play time! Dinner with my husband. Catching my favourite 10pm TV shows or catching up with friends on Facebook.

me+LIVING

Ms Hamimah estimates that children with Autism Spectrum Disorders and learning disabilities form about 70 per cent of her case load. Sometimes she works with them to strengthen the muscles around the mouth area so they can better articulate or teaches them how to communicate with natural gestures and/ or pictures. Her colleague at KKH, Melanie Chastan, also helps children to find their voices. The difference is, Ms Chastan, a senior speech therapist at KKH Department of Plastic, Reconstructive and Aesthetic Surgery, sees children who cannot talk clearly because they have cleft or craniofacial differences. “Part of my job is to assess the impact of structural differences on their speech and to make recommendations for surgery. To do this, I get to practise the medical side of speech therapy.” She uses a scope to “see” the inside of a child’s throat or motion X-rays, to take a video. Unlike Hamimah, it was a talk at her junior college which steered Ms Chastan to the profession.

me+LIVING 30

A Pie pple

Three Recipes In One …plus three Ingredients: 1 lb short crust pastry

6 large (or 8 to 9 medium) Granny Smith apples ¼ to ½ cup sugar, depending on personal taste and tartness of apples used 3 tablespoons unbleached all-purpose flour 1 large egg, beaten Spice (you can use either one) • 1 teaspoon rose water (available at specialty or natural food stores) • 8 to13 whole cloves • ½ to 1 tablespoon cinnamon

Contributed by James Worth, Manager, Media Production, SingHealth

The best apple pies you can make on your own.

Method: 1.

Peel, core, and cut each apple into 8 equal wedges. 2. In a large bowl, toss the apples with the sugar and flour (plus cinnamon if you want a cinnamon spiced pie) until well-coated. 3. Roll out half the pastry for pie base and line a deep pie dish (do not trim excess yet). 4. Pile the apples into the pie crust, mounding them higher in the center. 5. Sprinkle rose water OR cloves evenly over the apples. 6. Roll out the remaining half of the pastry mixture. 7. With a pastry brush, brush the edges of the pie base with the beaten egg, then place the top crust over the pie, and crimp with fingers or the back of a tablespoon handle to seal the two crust together. 8. With a knife, trim excess pastry from the pie by running it around the edge of the pie dish. 9. Brush the top crust lightly with a mixture of the remaining beaten egg and a little water, then sprinkle lightly with additional sugar. 10. Cut 4 to 6 slits in the top of the top crust to allow steam to escape during baking. 11. Place pie on a baking sheet and bake on the lowest shelf of the oven for 1 hour.

To serve: For a pie with cloves (my favorite and the most traditional of English apple pies), serve hot with thick whipping cream (unwhipped) or hot custard.

For a pie with rose water, serve warm or at room temperature with vanilla ice cream or a wedge of sharp cheddar cheese.

For a pie with cinnamon (more of an American apple pie), serve warm or at room temperature with vanilla ice cream.

And the plus three: If you like fruit pie mixtures, add ½lb blackberries, ½lb blueberries or ¼lb raisins to the apple, flour and sugar mix. You can add cinnamon to the apple raisin mix but leave the blueberries and blackberries without any spice; their flavour with the apples is enough.

me+LIVING 32

This festive season, me+SH brings you some tips to keep healthy and keep your spirits up. Language

Weight Management

LAILA PATEL and JASMINE LEE Speech-Language Therapists, KKH

ERIC HO CHUN KEONG Senior Physiotherapist/Clinical Coordinator; Obesity and Metabolic Unit, SGH

As the festive season approaches, let’s use this opportunity to introduce new songs to our little ones! As you learn together, remember to take turns and help your children along as they learn the lyrics. Repeat the songs to give your children the opportunity to practise the new words they’ve learnt! Most importantly, enjoy the songs together — keep it fun and keep it going!

Body KIRSTY CHARLOTTE BURROWS Spine Physiotherapist, SGH

Everyone knows the Christmas season is a time of overindulging — so make sure you keep up with the exercise over this festive period! Merry Christmas and Happy New Year!

Studies have shown that dietary changes have favourable effects on disease prevention and weight management; people who are most successful in losing weight and maintaining the weight loss eat a light but healthy breakfast, have a reduced-calorie diet that is low in fat instead of following fad diets, and have a high fibre intake. For physical activities, adults should aim to take at least 10,000 steps daily and at least 30 minutes of moderate intensity aerobic exercises for most days of the week to maintain healthy weight. Above all, adopt a positive attitude and consult your specialist physician, dietitian or trained counsellor. — abstract from HealthXchange (www.healthxchange.com.sg) with permission from author.

Hearing STEPHANIE LIM Principal Auditory Verbal Therapist, SGH

Avoid listening to excessively loud noise as prolonged exposure causes damage to the hearing cells of the ear. Use ear plugs if you work in a noisy environment, listen to your music at a comfortable volume and take intermittent breaks to minimise damage to your ears.

Heart TEO LAY HUA Head, Medical Social Work Service, SHP

It’s always possible to get something out of a situation, no matter how unpleasant, difficult or even painful it might seem. Be positive. “Every cloud has a silver lining.”

Movie-watching is perhaps one of Singaporeans’ biggest past-times. me+SH takes a look at a few upcoming gems to hit our silver screens.

December 2009 Nutcracker: The Untold Story

A girl’s imagination brings her wooden nutcracker doll to life. Herein starts her adventure through a stunning dimension where toys come alive. Inspired by Tchaikovsky’s timeless ballet – The Nutcracker.

Alvin & The Chipmunk s 2: The Squeakquel In the sequel, the Chipmunks face tough competition from the equally talented Chipettes, while having to grapple with the troubles of going to a school full of human children.

Everybody’s Fine

Old Dogs

Tooth Fairy

Two friends and business partners find their lives turned upside down when strange circumstances lead to them being placed in the care of a pair of sevenyear-old twins.

February 2010 Did You Hear About The Morgans?

A highly successful couple’s troubled marriage turns for the worse as they are targeted by a hitman for being witnesses to a murder. They are then placed under witness protection in a deserted mountain area, where their marriage is given a second life.

January 2010

Sherlock Holmes

In a dynamic new portrayal of Sir Arthur Conan Doyle’s most famous characters, Detective Holmes will battle, as never before, to bring down a new nemesis and unravel a deadly plot that could destroy the country.

Alice in Wonderland

Ten years after her visit to Wonderland, the White Rabbit returns for Alice, claiming she is the only one who can save Wonderland from the Red Queen’s reign of terror.

me+LIVING

Cinema-tique A widower sets off on an impromptu road trip to reunite with each of his own children in a journey of discovery.

A hockey player who likes to knock out opposing players’ teeth, is sentenced to one-week hard labour as a reallife Tooth Fairy.

Exclusive deal

for SingHealth staff!

me+SMILES 34

Perfect Platter - James Worth (left), and winner Dr Kwa Chong Teck (right) Trophies up for grabs

C Kwa Race Duke

Beer Chugging Challenge

he grounds were frothing with excitement as staff and students guzzled down to the tunes of a live band at Oktoberfest 2009! Jointly organised by SingHealth Academy, Duke-NUS, SingHealth Epicurean Arts Team, and SingHealth Sports Club, this year’s Oktoberfest saw more than 300 people merrymaking on the grounds of the new Duke-NUS building. Highlights of the event (other than the endless flow of fun and spirits) were the exciting activities lined up by the organising committee – the inaugural C. Kwa Race, SingHealth Perfect Platter Competition, and the ever-popular Prof Tan Ser Kiat’s Beer Chugging Challenge! Delightful delicacies, fun activities, and a crowd who knows how to live it up – this is Oktoberfest at its best!

Started in 1810 to celebrate the 12 October marriage of Bavarian Crown Prince Ludwig to the SaxonHildburghausen Princess Therese, the Oktoberfest tradition is now held annually in Munich, Germany. This 16-day party attracts over six million people every year who consume 1.5 million gallons of beer, 200,000 pairs of pork sausage, and 480,000 spitroasted chickens. Talk about feasting! The main event of the original Oktoberfest is a horse race.

me@SingHealth

A good game of bowling can sometimes be ruined by that seemingly impossible shot. Francis gives us the lowdown.

n bowling, there are two types of difficult shots, namely “Fit-in Shots” and “Splits”. Making the most difficult shots can get frustrating, but with practice, one can become adept at making them from time to time. It’s shots like these that keep the game challenging and interesting.

Fit-in Shots

Pinning It Down

These happen when two pins adjacent to each other are left standing. Fit-in shots are so called because the ball must be placed accurately between the pins to succeed. They present the most worthy challenge to a bowler’s accuracy.

9 pin tap 2009 mixed qualifying

The SingHealth Bowling Team clinched gold in the Public Service Bowling Tournament. Arthur Wong speaks to bowling convenor Francis Koh (FK) about the experience. me+SH: Who are the SingHealth Bowling Team? FK: We are a team of 30 men and women (15 each) from various

Splits

These occur when there is a gap left between two pins. While no split is easy, there are two kinds of spilts that are considered the most difficult in bowling: the 3-6-7-10 and the 7-10. A 3-6-7-10 split consists of three pins lined up on the right, and a single me+SH: What challenges do you face as a team? pin in the back left corner. The best way FK: We meet once a month for social bowling sessions, which is to attempt this is to hit between the 3 and a great opportunity for everyone to train and socialise. Otherwise 6 pins, hoping that one of them will travel we tend to train individually because it is difficult to organise group across the lane and pick up the 7 pin while either training sessions since many of us have shift duties. the 6 pin or the ball knocks down the 10 pin. Picking up a 7-10 split Despite that we are quite a team! We give each other moral is considered a rare support by high-fiving when we strike or spare. We have strong team treat. This is when the spirit by being there for each other during the tournaments. two back corner pins are left 9 pin tap 2009 mixed finals 9 pin tap 2009 women’s finals standing and it is extremely difficult to hit both pins down. Some bowlers’ favourite technique, when faced with a 7-10 split, is to hit one of the pins really hard in an attempt to bounce it across the lane and take down the other pin.

SingHealth institutions who have gathered over the last few years to play a good game of bowling. We started out with annual inter-institution bowling tournaments to scout for talented individuals. Through training and bonding sessions, we have managed to win the Public Service Tournament, and are looking to come out tops in the ongoing Public Service League.

me+SMILES

The Hard Hitters

me+HORIZON

Medical Milestones

In History

1993

Look back to see how the culture of medical learning started and evolved through the years. Here are some of the more memorable milestones.

Medical Education On SGH Campus In recent years...

Podiatry was introduced The practice existed even in the time of France’s Napaleon Bonaparte, who had a personal podiatrist. As did US President Abraham Lincoln.

1992

First intake of School of Health Sciences at Nanyang Polytechnic for physiotherapy, occupational therapy and radiography

1949

From not too long ago...

President SR Nathan was a Medical Social Worker early in his career.

1905

From a little further back in time…

The first Diploma in Pharmacy was offered in 1950.

Medical Social Work was introduced

Pharmacy was introduced

Q THIS ISSUE’S QUIZ:

Q1. How many different allied health professions are featured in this issue of me+SH? a) 3 b) 6 c) 9

Q2. Which two SingHealth institutions celebrated their 10th anniversary this year? Q3. Which SingHealth staff won the Worldskills International Competition 2009?

Please email your answers (together with your name, designation, institution, department and contact number) to me.sh@singhealth.com.sg by 20 December 2009. Three lucky winners will each receive a 45min Tension Relief Body Massage worth $88 from Symphonie.

Here are the answers to the last ISSUE’S quiz: Picture 1 Picture 2 Picture 3 Picture 4 Picture 5 Picture 6 Picture 7 Picture 8

h. g. b. f. c. d. e. a.

Kitchen area at LIFE Centre Vicker’s House SGH Learning Centre at Level 18, Connection One SGH Hyperbaric & Diving Medicine Centre The Private Children’s Clinic at KKH Brain Suite at Block 3, Level 2 SingHealth Experimental Medicine Ctr Facilities at Sembawang Staff Gym toilet at Bowyer Block

And here are the lucky winners! 1. Sam Sim, Research Assistant, Duke-NUS 2. Eunice Nah, Senior Staff Nurse, SHP-Bukit Merah Each of them will receive a Golden Village Movie Pass worth $28! me+SH will be contacting the winners shortly with prize collection details.

Symphonie Promotion for SingHealth Staff Call 62222018 to make an appointment for a personalised facial at $19 (worth $120). The first 30 callers will enjoy a FREE hydroeye treat worth $68. SingHealth staff need only bring their passcards for verification. Address: 235 New Bridge Road, Level 2.

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We want to hear from you! Are you a wizard of words? Do you have a keen eye for capturing images? Would you like to use me+SH as an outlet to express your thoughts and expressions? If so, we welcome your contributions! Send your comments, feedback, story ideas, photos and even videos to me.sh@singhealth.com.sg Be sure to check out me+SH online (http://mysinghealth/singhealth/mesh), as well as me+SH on Facebook!

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