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