AHA Magazine Nov-Dec 2021

aha

ISSUE 5: NOV–DEC 2021

A CARE CULTURE OF DIGNITY & PERSONHOOD

MCI (P) 047/07/2021

A method of care based on empathy and relationship is enabling Yishun Health staff to better meet the needs of elderly patients

WHEN KNOWLEDGE 22 IS POWER

5 THINGS ABOUT 28 ACUPRESSURE

POOLING THE BENEFITS OF SWIMMING

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ontents

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COVER STORY A Care Culture of Dignity & Personhood Yishun Health staff are being trained in a method of care that fosters greater connectedness between them and elderly patients

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WHAT’S UP Community events, outreach efforts, and more

26 EVERYDAY HEROES

Devotion & Faith, in Sickness & in Health

Ruby’s marriage vows have seen her through the many years of caring for her husband, Richard

11 LIVE WELL

Taking Urban Farming to Greater Heights

A group of retired but passionate volunteers has set its sights 28 5 THINGS ABOUT… on turning the KTPH rooftop

Acupressure gardens into a productive farm

Know the five points to stimulate in order 20 Q&A to boost your body’s

Health and wellness questions self-healing abilities asked and answered!

30 DAILY DOSE 22 SPOTLIGHT

When Exercise

When Knowledge is Power Goes too Far

A registry to track people

Read about rhabdomyolysis, with a specific genetically a serious form of muscle linked-type of high cholesterol damage that can happen aims to empower them to take if you exercise action earlier excessively Part 2 of 3

FRAILTY, DIGNIFIED CARE & LEAVING WELL 2 |

Investing time to connect with patients, understanding their needs, and recognising their personhood have proven useful in improving the physical and mental well-being of older patients with high needs. At Yishun Health, staff are being trained in an empathy- and relationship-based method of care that is enabling and goes beyond tasks and routines to enhance the dignity and maximise the ability of vulnerable older patients, and in particular, to know what matters to them.

PUBLISHER Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM

32 32 MAKAN TIME

Cranberry Cheesecake

The recipe for this sweet treat comes just in time for the year-end festive season 34 FIT & FAB

Pooling the Benefits of Swimming

Not only is this form of exercise suitable for all ages and fitness levels, it is perfect for our tropical climate

Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction.

A/Prof Tan Kok Yang Bastari Irwan Caroline Tan Fatimah Moideen Kutty Shirley Heng Teresa Foong

www.ktph.com.sg/ about-us/media/publications aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg

aha

ISSUE 5: NOV–DEC 2021

A CARE CULTURE OF DIGNITY & PERSONHOOD

Maskless photos in this issue were taken before COVID-19 or with safe management measures in place

M A N AG I N G D I R E C T O R

Christopher Tay

H E A D, E D I TO R I A L

Chua Kim Beng

C O N T R I B U T I N G E D I TO R

A method of care based on empathy and relationship is enabling Yishun Health staff to better meet the needs of elderly patients

Sheralyn Tay E D I TO R

Dang Hui Ling MCI (P) 047/07/2021

H E A D, C R E AT I V E WHEN KNOWLEDGE 22 IS POWER

5 THINGS ABOUT 28 ACUPRESSURE

POOLING THE BENEFITS 34 OF SWIMMING

W

hy aha?

The name aha holds much significance for us at Yishun Health.

In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’.

Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

Sean Lee

H E A D, C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Lee Lily Vivienne Looi

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 047/07/2021

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hat’s Up

Celebrating the spirit of continuous learning and innovation

Hai Moy is a true advocate for patients, listening empathetically to her patients and continually thinking of ways to improve their care; Dhina’s passion for patient care and service motivated him to embark on career upgrading and upskilling to become a Healthcare Assistant

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wo Yishun Health staff were recognised at this year’s Public Sector Transformation Awards 2021 (PST). The PST Awards is a wholeof-government pinnacle platform to commend public officers and agencies for excellence in their work.

Over 84 winners were awarded across 11 categories.

One of them was Toh Hai Moy, Senior Nurse Clinician, Advanced Practice Nurse, and Specialty Nurse, KTPH. The veteran nurse and prolific inventor has made numerous contributions to patient care with her many inventions that meet patient and caregiver needs.

Among her inventions — known as ‘Angie’ inventions and based on a

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nickname conferred by a patient — are pants to conceal urine bags, and headbands to secure feeding tubes.

Within the wards, Hai Moy made a suggestion to install a glass panel at the top of restroom doors to serve as a visual cue for others to know whether the stalls are occupied.

This helps improve the safety and privacy of patients who forget to lock restroom doors. For her empathy and creativity, she was awarded the Exemplary Innovator Award.

Another winner from Yishun Health was M Dhinakaran, Healthcare Assistant, Ancillary Care, KTPH, who won the Exemplary SkillsFuture @ Public Service Award. Dhina joined KTPH in 2014 as a Portering Assistant.

He worked for five years before taking up job redesign training to become a Basic Care Assistant and began assisting the nurses in ward-based caregiving duties. In April 2020, Dhina rose up to the challenge of looking after patients with COVID-19. During this time, he also took the initiative to learn new skills, and was sponsored by the hospital in September 2020 to undergo a three-month long, fulltime Higher Certificate in Healthcare Support (Nursing Care) course under the Singapore Workforce Skills Qualification framework at the Institute of Health Sciences. He graduated in December 2020 and has since embarked on his new journey as a Healthcare Assistant.

A new milestone for Share a Pot

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ishun Health’s long-standing Share a Pot programme marked an important milestone on 27 October 2021, when it signed a letter of collaboration with the Rotary Club of Singapore (RCS). RCS has pledged to finance Share a Pot @ Home as their flagship initiative under their ‘Building Capacity for the New Normal’ programme.

Share a Pot supports communities in taking the lead to combat frailty that comes with old age

through the sharing of hearty, protein-rich soups and group exercise. To adapt to COVID-19, Share a Pot has pivoted to virtual exercise sessions and soup deliveries. Prof Chua Hong Choon, CEO of Yishun Health, welcomed the partnership, saying, “This is a shining example of how institutions and the community can embrace a whole-of-society approach towards achieving community goals!”

Shining a (UV) light on infection control

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n August 2021, a Yishun Health innovation — the UV Disinfectant Box — was awarded the Certificate of Commendation at the Workplace Safety & Health (WSH) Awards 2021.

The UV Disinfectant Box, which disinfects medical supplies and personal items, was developed by a crossfunctional team from Facilities Management, Infection Control, facilities vendor ISS, and Republic Polytechnic.

The device is clinically proven to kill around 99% of bacteria; it also eliminates viruses. With this, items such as masks, blood pressure cuffs, and stethoscopes can be easily disinfected and reused. This reduces waste and supports infection control efforts, especially during these COVID-19 times.

The annual WSH Awards is presented by the WSH Council and supported by the Ministry of Manpower; it recognises organisations and individuals who have achieved excellence in workplace safety and health.

The UV Disinfectant Box, which took just three months to be developed, has been proven to kill germs and viruses, and is now used across Yishun Health wards and offices

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Recognising excellence in medical education Y

ishun Health was well awarded at this year’s NUS Medicine Appreciation for Clinical Educators (NUSMedACE), held on 9 November 2021. NUSMedACE acknowledges the contributions of healthcare clinicians to the NUS Yong Loo Lin School of Medicine and their passion for educating the future generations.

In total, four departments and 11 individuals from Yishun Health were recognised. Among these, our Acute and Emergency Care Centre (A&E) received the Clinical Training Excellence Award, achieving

high scores and positive feedback from students. Other awards presented to Yishun Health included the Clinical Training Merit Award, Dean’s Award for Teaching Excellence, and the Special Recognition Award.

These achievements are a validation of the efforts that have gone towards maintaining a high standard of medical education despite the move towards smaller groups, simulations, and online learning.

Delivering cancer care to our community in the North K

TPH opened a new Oncology Service at Tower C, Clinic C50, to bring cancer care to the community in the North. It will offer the full suite of basic oncology services, including Medical Oncology and Radiation Oncology clinics and outpatient chemotherapy treatment. Where necessary, patients may be referred to our partner institutions within National Healthcare Group.

The service will be helmed by visiting consultants from Tan Tock Seng Hospital and National University

Cancer Institute, and run by Yishun Health’s experienced oncology specialty nurses, pharmacists and Patient Service Associates.

The oncology team will work closely with other cancer specialists and allied health professionals to provide multidisciplinary care to patients. These onsite Oncology services will also facilitate better care coordination and convenience for patients in the North who have multiple appointments at KTPH for cancer and other existing conditions.

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Honouring the strength of breast cancer warriors

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n support of Breast Cancer Awareness Month 2021, the KTPH Breast Surgery team collaborated with Breast Cancer Foundation to hold an art exhibition, entitled ‘Celebrating Life, Together’. The opening was graced by Minister Indranee Rajah, who launched the exhibit by unveiling the centerpiece of the exhibition, called ‘Be Strong’.

Created by Dr Marc Ong, Consultant, and Dr Joelle Leung, Senior Resident Physician, ‘Be Strong’ symbolises women battling breast cancer, and pays tribute to their strength and positivity. As part of the fundraising efforts, original and prints of the artwork are available for purchase; all proceeds go to the Breast Cancer Foundation.

Held at the Fullerton Hotel’s East Garden Gallery, the exhibition showcases art pieces made by breast cancer patients and healthcare professionals to raise funds for breast cancer patients. The goal of the showcase is to create greater awareness of breast cancer and spread the message about the importance of early detection and breast screening.

Made with 3,000 strips of thin papers quilled meticulously in a myriad of shapes and colours, ‘Be Strong’ took Dr Ong and Dr Leung more than five months to complete

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hat’s Up

World Diabetes Day

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n this year’s World Diabetes Day, which falls on 14 November, Yishun Health participated in an inaugural webinar that involved the whole National Health Group cluster. Together with Tan Tock Seng Hospital, Woodlands Health, and NHG Polyclinics, a series of public talks was presented to highlight the need for early access to diabetes care in order to prevent complications. Other partners from Group Corporate Communications, Group

Corporate Development, NHG College (Group Education), and Group Integrated Care, as well as the People’s Association and Woodlands Grassroots Organisation, also collaborated to bring this event together.

Over Zoom and Facebook Live, more than 400 participants took part in the two-hour webinar, which saw NHG doctors, nurses and allied health professionals share on a variety of diabetes-related topics.

Lee Ting Yuan, Senior Staff Nurse, AdMC, spoke on the use of technology to better manage diabetes

Senior Dietitian Ryan Ong, Nutrition & Dietetics, KTPH, demonstrated an oyakodon recipe

Packs of care for our nursing home partners D

uring the week of 14 October 2021, a team comprising Yishun Health’s GeriCare, Operations and Human Resources delivered care packages to encourage various nursing homes in their pandemic efforts. A total of 200 care packs, containing refreshing drinks and medicated ointment, were personally wrapped and distributed to 10 of these homes. This initiative strengthens Yishun Health’s long-running partnerships with nursing homes, and the years of providing resources and timely support.

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Care packs were given to Apex Harmony Lodge, Sunshine Welfare Action Mission Home, Singapore Christian Home, Villa Francis Home for the Aged, Woodlands Care Home, The Lentor Residence, and Sunlove Nursing Home

The clear importance of AMD awareness T

o help spread awareness of macular diseases, KTPH’s Ophthalmology & Visual Sciences (OVS) department virtually launched the 17th run of AMD Week on 9 October with ‘Your Vision, Our Focus — See Through the Midst of Pandemic’. During the event, clinicians from Yishun Health and Tan Tock Seng Hospital highlighted the importance of

eye health, screening, and the community care resources available. Although it has not been possible to hold mass health screenings, members of the public were nevertheless encouraged to self-monitor using the KTPH MATA app, which was developed to flag vision abnormalities.

A design competition was held to determine this year’s AMD Week logo. Dr Preethi Jeyabal, from National University Health System, submitted the winning design. The tagline, ‘Keep an eye on your eye’, is a reminder to check vision regularly and attend regular eye screenings. A video was produced by Dr Aaron Goh and his team from MOHH; their short film featured a patient who lost his vision in 2017

It’s okay to be blue O

n World Mental Health Day (WMHD), which falls on 10 October, the Yishun Health campus joined more than 20 other landmarks all over Singapore to commemorate the occasion by being illuminated in blue light.

From 10–31 October, blue light brightened numerous areas of the campus to raise awareness of mental health, and to reduce its stigma through education and advocacy. Themed ‘It’s OKAY — Take 5’, this year’s WMHD hopes to encourage everyone to learn the importance of caring for their mental health and well-being, and to step forward and ask for support.

Feeling blue? It’s okay! This year’s message aims to reduce the stigma of mental health issues and encourage people to reach out for support

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hat’s Up

On teamwork and timely updates in stroke management T

o mark World Stroke Day on 29 October, KTPH’s Consultant, Neurology, National Neuroscience Institute, Acute Stroke Unit (ASU) conducted a webinar on and attended by 120 participants.

15 October 2021 to highlight the seriousness of stroke and raise awareness of its prevention and treatment. The team informed participants on the latest stroke management methods and treatments, as well as helpful information and best practices.

ASU nurses and allied health professionals from Rehabilitation Services also shared their expertise and provided a multidisciplinary overview that emphasised the importance and necessity of teamwork in caring for stroke patients.

During the forum, the ASU team provided a multidisciplinary approach and emphasised the The event was graced by ASU importance and necessity of teamwork in caring for stroke patients Chairman, Dr Chua Hoe Chin, Senior

Knee-d help with that injury?

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ishun Health held its 4th Orthopaedic Nursing Forum on 15 October 2021, with a focus on knee injury and recovery. Titled ‘KNEE: Repair, Replace, Rehabilitation’, the forum welcomed some 200 participants, including nurses from Tan Tock Seng Hospital, National Neuroscience Institute, Woodlands Health, and Parkway Shenton.

Clinicians, physiotherapists and nurses shared their experiences and insights on a team approach in the raising of care standards. In her opening address, Ms Shirley Heng, Chief Nurse, encouraged participants to continue learning and collaborating to improve patient care.

Yishun Health surgeons, sports physicians, physiotherapists, and orthopaedic nurses shared their perspectives on appropriate care and treatment for knee injuries

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ive Well

TAKING URBAN FARMING

TO GREATER HEIGHTS KTPH and YCH are well known for their lush landscaping — not only on their grounds, but on rooftops, too. Beyond growing pretty plants, a team of gardening volunteers is setting its sights on turning the rooftop plots into an even more productive farm.

The gardening volunteers (in blue) together with Yishun Health CEO Prof Chua Hong Choon and COO Ms Yen Tan during a visit to the rooftop farm

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olunteers have long been the lifeblood of Yishun Health’s rooftop farms, which grow a wide variety of fruits and vegetables, including some jumbo-sized, award-winning pumpkins and gourds. Working on a roster, they spend several hours every week to plant, weed and tend to the vegetable beds and fruit trees.

According to Simon Chan and Rosalind Tan, members of Yishun

Health’s landscaping team, there have been ambitions to ramp up the output of the gardens for a while now. And since 2019, a plucky group of eight volunteers has been taking on that challenge, moving the small vegetable farming operation into the fast lane to better prepare for the future. Venturing into hydroponics, they began to research, experiment and build their own vertical urban farming system from scratch.

FROM HOBBY GARDENERS TO HYDROPONICS FARMERS Among them are ex-Singapore Airlines colleagues, M Radhakrishnan (Krish), 69; A Jaiakumar (Jaia), 70; and Gomez Steven John (Steven), 52.

While the three of them have had a lifelong passion for gardening and plants, it has been an uphill task to learn about this new form of farming.

From building the tiered system | 11

ive Well

Volunteer Krish explaining how the hydroponics system works

and finding the best configuration to installing the piping system and calibrating the amount of nutrients, water and sunlight, the team put in many hours of experimentation. “It has been difficult,” admits Krish. “But Steven and Jaia worked for many hours to perfect the system.”

At the start, the team would buy seedlings from external vendors, which would be ‘planted’ into their hydroponics system, where they would come to maturity. However, this was an expensive route. At about $0.90 per seedling, a crop of 144 plantings used to cost them almost $130. To cut costs, they learnt how to germinate seeds, then transplanted the seedlings into their hydroponics system. The challenge was in ensuring a conducive growing environment for the small and fragile young sprouts. “It was not easy because, on a rooftop garden, temperatures tend to fluctuate and be quite extreme,” explains Krish.

After about six months of trial and

error with different growing mediums and seeds, they succeeded in transplanting their seedlings into the system and harvested their first crop of chye sim and kai lan in January 2021. This milestone was no mean feat. By germinating their own crop from seeds, they enjoyed significant savings — one pack of seeds costs just $3, and is enough to grow multiple harvests. Their vegetables have also passed the test, literally.

“We sent samples of our first crop to the hospital lab for testing to ensure they are safe and meet nutritional standards,” Krish shares with pride.

Seeing through a harvest brings them a great sense of achievement.

For Christopher A Nathan (Chris), 71, who joined the project in October 2020, it is an impressive feat to witness, and he has enjoyed participating in two harvests so far.

An old school friend of Jaia and Krish, he has enjoyed learning about this new form of farming. “This is very different from the kind of gardening

I grew up with,” he describes, recalling his youth in Malaysia, where he picked up tips from his avid-gardener father.

“I am so fascinated with what has been done at KTPH — from soilbased gardens and aquaponics to the hydroponics system.”

Since then, despite disruptions caused by COVID-19 restrictions, the team has completed five harvesting cycles and collected a total of about 30kg of vegetables. In fact, they have used their time well, taking up courses in the interim and making plans for an even bigger comeback.

Tapping into their SkillsFuture credits, Krish, Jaia and Steven have taken courses on soil management, pest control, and urban farming hydroponics. “The courses have helped us level up,” assures Jaia.

EMBRACING TECHNOLOGY TO SCALE UP Their hands-on experience coupled with on-the-ground work have seen

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them develop an effective system.

Apart from chye sim and kai lan, they have also grown nai bai and xiao bai cai; Bayam spinach is next in line. Each batch of vegetables now takes about a month to grow from seed to harvest.

“The next goal is to improve our setup and increase our yield,” Jaia says.

And this is where their newest and youngest member comes in. Twentyyear-old M Devnavin (Dev), a family friend of Krish, has brought young blood, new ideas and technical knowhow to the team’s endeavours. Since joining in November 2020, Dev has taken the initiative to explore ways to modernise and automate the hydroponics system. By integrating more technology into the project, he hopes to raise the output and quality of the crop, as well as reduce the amount of manpower needed to monitor the plants. “I am looking at things like taking the temperature of the water, checking water levels, and ensuring nutrients are at the right concentration levels,” he explains.

In fact, Dev even has plans to rope in university mates who are pursuing studies in engineering and programming so that they can explore ways to improve operations.

Installing sensors and integrating them with mobile apps will go a long way to help increase productivity, he points out. “The goal is to reduce the manpower needed for monitoring so that we can focus on other areas, such as harvesting and germination.”

It also lays the foundation for future automation, such as the automatic topping up of nutrients or water, especially when scaling up. There is so much potential, Dev states.

“Vertical farming provides higher yield per unit area, and hydroponic farming reduces the need for pesticides, making for more sustainable and healthy operations.”

Together, this multi-generational team effort has taken a community gardening project into something

more. Hours of labour under the hot sun have seeded the ground for turning a rooftop garden into a farm-to-table operation. “When we first started tinkering with the idea in 2019, we were all greenhorns,” recalls Simon. “But our volunteers have done very well in developing

a workable hydroponics system.”

Says Rosalind, “It is my hope that we can expand our operations on the rooftop so we can intensify the farm and increase output. The dream is to grow enough to supplement our kitchens and share the fruits of our labour with all our patients.”

Water, nutrient pH levels and temperature are regularly checked and adjusted to optimise growth

Harvesting stage: Seeds that were carefully sprouted and transplanted into the hydroponics system are now fully grown and being harvested by the volunteers!

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Cover Story

A CARE CULTURE OF DIGNITY & PERSONHOOD

A/Prof Philip Yap (in apron, gloves and purple scrubs) leading a team to assist a geriatric patient

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FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 2 OF 3

Aligning with our efforts to be an age-friendly hospital, Yishun Health staff are being trained in a methodology to foster greater connectedness between healthcare providers and patients. This relationship-based approach improves the patient experience, harnesses innate potential in patients, raises care outcomes, and instils more dignity and compassion into care delivery — particularly for vulnerable and dependent persons.

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t 80-over-years old, diagnosed with dementia, and having experienced repeated falls, Aunty Doreen was too afraid to even stand on her own. This fear was causing her to decline physically during her stay at KTPH, as she was mostly confined to her wheelchair and bed.

Both her family and the staff saw little hope of her walking again.

However, gentle persuasion, active listening, masterly techniques, and positive reinforcement soon helped her to overcome her fears. To the delight of her care team — and Aunty Doreen herself — she gained the confidence to take a walk.

For Jessie Tan, Senior Nurse Clinician, experiencing this first-hand was mindset-changing. As a nurse with 30 years of experience — 25 of them in geriatrics — it was greatly validating for her to see how a shift in communication and techniques could make such a big difference in handling patients who were previously considered ‘challenging’, having ‘limited rehabilitation potential’, and ‘beyond hope’. “As an Advanced Practice Nurse in Geriatric Medicine, I believe that the care of elderly persons — particularly persons with dementia — needed to be changed,” she shares. “I’m truly happy to find a solution to change the way we care for these patients!”

Aunty Doreen was not the only patient who responded well to a

shift in care and communication.

Using a special care methodology called Humanitude, one patient with advanced dementia — who would scream intermittently due to agitation and confusion — was soothed from distress into sleep and calmness.

According to Mdm Yiap Pok Ling, Deputy Director, Nursing, it was first introduced to a small number of clinicians, nurses and Yishun Health leaders. Witnessing the profound impact on patient care during a pilot training session in 2019, the Yishun Health leadership team mooted the idea, and began to progressively roll out training of this technique to staff. Since the 2019 pilot, two more runs have taken place, the last of which took place in November 2021. In all, some 200 staff have taken part; among them were 16 doctors, 154 nurses, and 34 physiotherapists, occupational therapists and speech therapists. The goal is to train 500 staff, with greater participation from doctors and allied health professionals.

IMPROVING OUTCOMES FOR COGNITIVELY FRAIL PATIENTS A/Prof Philip Yap, Senior Consultant, Geriatric Medicine, who was also a participant in the pilot run, sees this methodology as an important way to improve care for vulnerable and

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FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 2 OF 3

dependent older patients in an acute setting.

He points out that a significant proportion of older patients in hospitals are frail, both physically and cognitively. Every day, there are approximately 300 patients in KTPH who suffer from dementia and/or delirium, and they make up 40–50% of those aged 78 years or older.

“These patients fit poorly into the hospital environment, are prone to hospitalisation-associated disability, and leave the hospital with marked functional decline, and in poorer physical, cognitive, psychological and functional states than at admission,” he shares. While the acute-care setting is effective in treating a patient for a problem such as pneumonia or a urinary infection, patients may deteriorate in other ways during a prolonged stay in hospital. “They tend to cooperate poorly, and spiral downwards very quickly in terms of overall wellbeing,” A/Prof Yap points out.

Compared with other patients who are independent, mobile and able to carry out activities of daily living, this group of patients — due to their physical and/or cognitive deficits — may not even understand the reasons for them being in the hospital. They are also unable to communicate their needs well.

Say, for instance, a patient with dementia needs to use the toilet, but

cannot understand why he is not allowed to get out of bed on his own. Instead, he has to use a diaper, which he has not done so since he was a child. Or take someone who wishes to get up for a stretch or a walk, but has to be confined to the bed, where he becomes increasingly bored, frustrated and even agitated.

“Naturally, if patients do not understand the reasons for care, they will begin to regard the caregivers and environment as hostile, especially if their freedom is thwarted,” elaborates Dr Rachel Cheong, Consultant, Geriatric Medicine. “They will become upset, and it can result in very trying situations both for them and their care team.” This may lead to patients acting up and being perceived as ‘difficult’.

Eventually, physical restraints and other restrictions may have to be applied, thus exacerbating the problem. “Once you restrain people, it takes away trust, leads to depersonalisation, and engenders animosity. And this compromises our care delivery,” she adds.

And as more cognitively frail patients with high needs are being admitted into the wards, it becomes more crucial that healthcare providers look for ways to care better for this group of vulnerable patients.

“When you undergo the practical training sessions, it is very convincing. You really start to see the impact of the approaches.”

Mdm Yiap Pok Ling Deputy Director, Nursing, KTPH

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SHIFTING FROM PROCESS ORIENTATION TO PERSONAL CONNECTIONS This is where Humanitude training comes in. It seeks to shift the caredelivery paradigm from one that is task-oriented to building care that is relationship-based and enabling. It emphasises sensory communication, where caregivers make use of gaze, speech, touch and verticality (an upright position) when interacting with patients. The idea is that these four relational behaviours are natural to us, and is what we learn from birth in the way we socialise as we build human relationships.

Dr Tay Poh Peng, Associate Consultant, Geriatric Medicine, explains, “These elements are often missing in the lives of older people with frailty and dementia, as they are usually left to languish in beds or chairs with little human contact. But through employing these techniques, we can enhance care for patients whom many see as lost or beyond restorative care.

Humanitude gives hope!”

Importantly, this approach dovetails with Yishun Health’s Cognition 6th Vital Sign initiative, which is aimed at improving care for vulnerable seniors in the hospital.

Staff at a Humanitude training session (above), and putting into practice what they have learnt during a hands-on session in the ward (left)

It comprises care standards and a care protocol for frail older patients with cognitive impairment of dementia and/or delirium. At its core, it seeks to nurture a work culture that shifts priorities from being taskfocused to being more person-based.

“We adapted the Institute for Healthcare Improvement’s (IHI) four criteria to deploy an age-friendly health system suited to the needs of our population. This has informed the 6 Vitals of Care,” says A/Prof Yap. This has meant extending IHI’s 4 Ms — What Matters, Medication, Mentation, and Mobility — to include addressing Malnutrition (including dehydration), and Multi-morbidity (co-existing chronic conditions).

Based on these standards, the team developed a care assessment tool, encapsulated in the acronym ‘KNOW our VIPS NEEDS BEST’: KNOW: Know patients as persons, and learn about their biographies, likes and dislikes, values and love language.

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VIPS: Each patient is Valued and cared for as a unique Individual.

Care must adopt the Perspective of the patient, and Social psychology allows us to tailor care to the needs of the patient. l NEEDS: Operationalise personcentred care in more concrete terms. It includes making the hospital experience close to what is Normal in the daily routine of the patient; Enabling and Empowering patient with greater agency and Dignity despite being hospitalised; and attending to older patients at a Slower pace. l BEST: Sets out the key medical and nursing needs of patients that warrant close attention to prevent and manage confusion. l

even for palliative care, where the goal is to secure good quality of life with good quality of care,” he adds.

The main challenge, however, is putting it into practice.

Mdm Yiap notes that the traditional approach of nursing care in the acute setting has always been very processdriven. “We work based on routines and sequences,” she says. But when it comes to patients with delirium or dementia, flexibility and patience are needed. “We have to slow down to

TIME WORTH TAKING According to A/Prof Yap, Humanitude “gives us the tools” to effectively achieve the 6 Vitals of Care. “And it can be extended to all areas of care,

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FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 2 OF 3

dependent older patients in an acute setting.

He points out that a significant proportion of older patients in hospitals are frail, both physically and cognitively. Every day, there are approximately 300 patients in KTPH who suffer from dementia and/or delirium, and they make up 40–50% of those aged 78 years or older.

“These patients fit poorly into the hospital environment, are prone to hospitalisation-associated disability, and leave the hospital with marked functional decline, and in poorer physical, cognitive, psychological and functional states than at admission,” he shares. While the acute-care setting is effective in treating a patient for a problem such as pneumonia or a urinary infection, patients may deteriorate in other ways during a prolonged stay in hospital. “They tend to cooperate poorly, and spiral downwards very quickly in terms of overall wellbeing,” A/Prof Yap points out.

Compared with other patients who are independent, mobile and able to carry out activities of daily living, this group of patients — due to their physical and/or cognitive deficits — may not even understand the reasons for them being in the hospital. They are also unable to communicate their needs well.

Say, for instance, a patient with dementia needs to use the toilet, but

cannot understand why he is not allowed to get out of bed on his own. Instead, he has to use a diaper, which he has not done so since he was a child. Or take someone who wishes to get up for a stretch or a walk, but has to be confined to the bed, where he becomes increasingly bored, frustrated and even agitated.

“Naturally, if patients do not understand the reasons for care, they will begin to regard the caregivers and environment as hostile, especially if their freedom is thwarted,” elaborates Dr Rachel Cheong, Consultant, Geriatric Medicine. “They will become upset, and it can result in very trying situations both for them and their care team.” This may lead to patients acting up and being perceived as ‘difficult’.

Eventually, physical restraints and other restrictions may have to be applied, thus exacerbating the problem. “Once you restrain people, it takes away trust, leads to depersonalisation, and engenders animosity. And this compromises our care delivery,” she adds.

And as more cognitively frail patients with high needs are being admitted into the wards, it becomes more crucial that healthcare providers look for ways to care better for this group of vulnerable patients.

“When you undergo the practical training sessions, it is very convincing. You really start to see the impact of the approaches.”

Mdm Yiap Pok Ling Deputy Director, Nursing, KTPH

16 |

SHIFTING FROM PROCESS ORIENTATION TO PERSONAL CONNECTIONS This is where Humanitude training comes in. It seeks to shift the caredelivery paradigm from one that is task-oriented to building care that is relationship-based and enabling. It emphasises sensory communication, where caregivers make use of gaze, speech, touch and verticality (an upright position) when interacting with patients. The idea is that these four relational behaviours are natural to us, and is what we learn from birth in the way we socialise as we build human relationships.

Dr Tay Poh Peng, Associate Consultant, Geriatric Medicine, explains, “These elements are often missing in the lives of older people with frailty and dementia, as they are usually left to languish in beds or chairs with little human contact. But through employing these techniques, we can enhance care for patients whom many see as lost or beyond restorative care.

Humanitude gives hope!”

Importantly, this approach dovetails with Yishun Health’s Cognition 6th Vital Sign initiative, which is aimed at improving care for vulnerable seniors in the hospital.

Staff at a Humanitude training session (above), and putting into practice what they have learnt during a hands-on session in the ward (left)

It comprises care standards and a care protocol for frail older patients with cognitive impairment of dementia and/or delirium. At its core, it seeks to nurture a work culture that shifts priorities from being taskfocused to being more person-based.

“We adapted the Institute for Healthcare Improvement’s (IHI) four criteria to deploy an age-friendly health system suited to the needs of our population. This has informed the 6 Vitals of Care,” says A/Prof Yap. This has meant extending IHI’s 4 Ms — What Matters, Medication, Mentation, and Mobility — to include addressing Malnutrition (including dehydration), and Multi-morbidity (co-existing chronic conditions).

Based on these standards, the team developed a care assessment tool, encapsulated in the acronym ‘KNOW our VIPS NEEDS BEST’: KNOW: Know patients as persons, and learn about their biographies, likes and dislikes, values and love language.

l

VIPS: Each patient is Valued and cared for as a unique Individual.

Care must adopt the Perspective of the patient, and Social psychology allows us to tailor care to the needs of the patient. l NEEDS: Operationalise personcentred care in more concrete terms. It includes making the hospital experience close to what is Normal in the daily routine of the patient; Enabling and Empowering patient with greater agency and Dignity despite being hospitalised; and attending to older patients at a Slower pace. l BEST: Sets out the key medical and nursing needs of patients that warrant close attention to prevent and manage confusion. l

even for palliative care, where the goal is to secure good quality of life with good quality of care,” he adds.

The main challenge, however, is putting it into practice.

Mdm Yiap notes that the traditional approach of nursing care in the acute setting has always been very processdriven. “We work based on routines and sequences,” she says. But when it comes to patients with delirium or dementia, flexibility and patience are needed. “We have to slow down to

TIME WORTH TAKING According to A/Prof Yap, Humanitude “gives us the tools” to effectively achieve the 6 Vitals of Care. “And it can be extended to all areas of care,

| 17

Cover Story

FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 2 OF 3

THE HUMANITUDE MODEL OF CARE

Humanitude is a care methodology developed by Yves Gineste and Rosete Marescotti in 1979 to care for vulnerable dependent persons, including those with dementia. It uses a multi-modal communication approach to enhance the connection and care between caregivers and patients.

Among the key techniques is to take time to know patients, their routines, and what is known as ‘relational kin’ — something about a person that helps to establish rapport quickly. It also uses gentle persuasion, elaboration, appropriate touch, and other tools to improve receptivity to care.

KEY APPROACHES Pre-preliminaries Knock

Preliminaries

Await response & enter patient’s space peacefully

Face-to-face interaction

Greet by preferred name

Introduce yourself and why you are here

SENSORY CIRCLE Promoting positive connection through relational pillars

A/Prof Philip Yap Senior Consultant, Geriatric Medicine, KTPH Gaze • Horizontal • Axial • Sustained • Near

connect and communicate better with more elaboration, and adapt to place the needs of the patient over tasks.”

For example, she shares that when giving sponge baths, nurses are taught to start with the face because the sequence is typically to start with the cleanest part of the body before moving on to the rest of the body. “But the face is a very personal part of the body,” she points out.

“It can be seen as intrusive to start there.” Under the new methodology, caregivers are taught to begin with the hands, arms and legs instead as a

18 |

“With its focus on people and relationships, Humanitude sparks the desire to care beyond merely completing tasks, and rekindles the joy and meaning of working as a healthcare professional.”

Touch • Professional • Progressive • Permanent • Sweeping

Speech • Frequent • Melodic • Soft/Low • Positive

way to help patients get used to the idea of a sponge bath.

Another example is making the effort to explain the care process and giving patients time to absorb the action. During a training session in September 2021, participants encountered a patient who refused care. He became confused and combative. By taking a little time to understand the source of his reactions, they found that he needed more time to process what was happening. What worked was the auto-feedback technique, which

Verticality • At least 20 mins/day

involved announcing and describing each step and allowing him time to process it. By explaining every step, it gave him more reassurance and security about what was going to happen. This was complemented by positive reinforcement so that he felt good about the care he was receiving.

This reduced his anxiety, as he was more aware of what the next step in care would be and how it benefited him. In the end, he was mollified into friendliness with his nursing team, even offering them some of his breakfast.

But while it may take more time,

REINVIGORATING CARE Giang Thuy Anh, Occupational Therapist, Rehabilitation Services, and her research team, under the mentorship of A/Prof Philip Yap, are conducting a study to evaluate the effectiveness of Humanitude on patients and healthcare staff.

In her research, she has found that the approach not only improved patient outcomes in terms of improved function, engagement and decreased agitation, it also boosted the job satisfaction of staff. They reported decreased burnout, increased empathy, and improved attitude towards people with dementia.

especially at the outset, Mdm Yiap and A/Prof Yap both believe it is time worth taking. “With high patient loads and time pressures, it can be challenging to take the time to know the patient well, but it can lead to better outcomes, and patients don’t resist,” assures Mdm Yiap. “When you undergo the practical training sessions, it is very convincing. You really start to see the impact of the approaches.” A/Prof Yap emphasises the crucial need for a mindset change. He is hoping to grow greater awareness and intensify training so that a more conducive environment can be developed for this approach.

“While lack of time is often cited as a reason for not being able to commit to relationship-centred care, in actuality, this approach is able to lower the incidence of challenging behaviours, build better rapport, and increase cooperation, which ultimately

The training also reinforced participants’ passion for the work. “Humanitude has been very empowering and spiritually uplifting.

It’s the kind of care I would want for myself,” states Ummu Kharr Unais, Senior Staff Nurse, Ward D48. For Tha Zin Aung, Nurse Educator, Nursing Administration, it is the recognition of dignity and personhood in care. She says, “The four pillars of Humanitude are essential; all human beings — especially the vulnerable and sick — deserve to receive them.”

The team has witnessed very encouraging patient transformations since using Humanitude care approaches. A disengaged patient who had to be bed-bound with restraints started sitting up and

saves time on reactive interventions,” he advises. He emphasises that research has repeatedly shown that Humanitude actually saves time compared to conventional care because patients do not fight or resist attempts to provide care.

Just as importantly, this approach to care also improves staff satisfaction and reduces turnover. “With its focus on people and relationships, it sparks the desire to care beyond merely completing tasks, and rekindles the joy and meaning of working as a healthcare professional,” adds A/Prof Yap. He hopes that, with the roll-out to more staff, KTPH can help set new standards of effective and agefriendly hospital care for older people in Singapore. “By recognising patients’ individual needs and innate potential, independence is enabled and dignity maintained, care is improved and the patient’s experience is elevated.”

eventually walked with assistance; she also started expressing concern for another patient, even holding that patient’s hand to provide comfort. Another patient in a similar state was going to be placed in a nursing home, but turned around and came off his nasogastric tube, ambulating with support, and was eventually discharged!

| 19

Cover Story

FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 2 OF 3

THE HUMANITUDE MODEL OF CARE

Humanitude is a care methodology developed by Yves Gineste and Rosete Marescotti in 1979 to care for vulnerable dependent persons, including those with dementia. It uses a multi-modal communication approach to enhance the connection and care between caregivers and patients.

Among the key techniques is to take time to know patients, their routines, and what is known as ‘relational kin’ — something about a person that helps to establish rapport quickly. It also uses gentle persuasion, elaboration, appropriate touch, and other tools to improve receptivity to care.

KEY APPROACHES Pre-preliminaries Knock

Preliminaries

Await response & enter patient’s space peacefully

Face-to-face interaction

Greet by preferred name

Introduce yourself and why you are here

SENSORY CIRCLE Promoting positive connection through relational pillars

A/Prof Philip Yap Senior Consultant, Geriatric Medicine, KTPH Gaze • Horizontal • Axial • Sustained • Near

connect and communicate better with more elaboration, and adapt to place the needs of the patient over tasks.”

For example, she shares that when giving sponge baths, nurses are taught to start with the face because the sequence is typically to start with the cleanest part of the body before moving on to the rest of the body. “But the face is a very personal part of the body,” she points out.

“It can be seen as intrusive to start there.” Under the new methodology, caregivers are taught to begin with the hands, arms and legs instead as a

18 |

“With its focus on people and relationships, Humanitude sparks the desire to care beyond merely completing tasks, and rekindles the joy and meaning of working as a healthcare professional.”

Touch • Professional • Progressive • Permanent • Sweeping

Speech • Frequent • Melodic • Soft/Low • Positive

way to help patients get used to the idea of a sponge bath.

Another example is making the effort to explain the care process and giving patients time to absorb the action. During a training session in September 2021, participants encountered a patient who refused care. He became confused and combative. By taking a little time to understand the source of his reactions, they found that he needed more time to process what was happening. What worked was the auto-feedback technique, which

Verticality • At least 20 mins/day

involved announcing and describing each step and allowing him time to process it. By explaining every step, it gave him more reassurance and security about what was going to happen. This was complemented by positive reinforcement so that he felt good about the care he was receiving.

This reduced his anxiety, as he was more aware of what the next step in care would be and how it benefited him. In the end, he was mollified into friendliness with his nursing team, even offering them some of his breakfast.

But while it may take more time,

REINVIGORATING CARE Giang Thuy Anh, Occupational Therapist, Rehabilitation Services, and her research team, under the mentorship of A/Prof Philip Yap, are conducting a study to evaluate the effectiveness of Humanitude on patients and healthcare staff.

In her research, she has found that the approach not only improved patient outcomes in terms of improved function, engagement and decreased agitation, it also boosted the job satisfaction of staff. They reported decreased burnout, increased empathy, and improved attitude towards people with dementia.

especially at the outset, Mdm Yiap and A/Prof Yap both believe it is time worth taking. “With high patient loads and time pressures, it can be challenging to take the time to know the patient well, but it can lead to better outcomes, and patients don’t resist,” assures Mdm Yiap. “When you undergo the practical training sessions, it is very convincing. You really start to see the impact of the approaches.” A/Prof Yap emphasises the crucial need for a mindset change. He is hoping to grow greater awareness and intensify training so that a more conducive environment can be developed for this approach.

“While lack of time is often cited as a reason for not being able to commit to relationship-centred care, in actuality, this approach is able to lower the incidence of challenging behaviours, build better rapport, and increase cooperation, which ultimately

The training also reinforced participants’ passion for the work. “Humanitude has been very empowering and spiritually uplifting.

It’s the kind of care I would want for myself,” states Ummu Kharr Unais, Senior Staff Nurse, Ward D48. For Tha Zin Aung, Nurse Educator, Nursing Administration, it is the recognition of dignity and personhood in care. She says, “The four pillars of Humanitude are essential; all human beings — especially the vulnerable and sick — deserve to receive them.”

The team has witnessed very encouraging patient transformations since using Humanitude care approaches. A disengaged patient who had to be bed-bound with restraints started sitting up and

saves time on reactive interventions,” he advises. He emphasises that research has repeatedly shown that Humanitude actually saves time compared to conventional care because patients do not fight or resist attempts to provide care.

Just as importantly, this approach to care also improves staff satisfaction and reduces turnover. “With its focus on people and relationships, it sparks the desire to care beyond merely completing tasks, and rekindles the joy and meaning of working as a healthcare professional,” adds A/Prof Yap. He hopes that, with the roll-out to more staff, KTPH can help set new standards of effective and agefriendly hospital care for older people in Singapore. “By recognising patients’ individual needs and innate potential, independence is enabled and dignity maintained, care is improved and the patient’s experience is elevated.”

eventually walked with assistance; she also started expressing concern for another patient, even holding that patient’s hand to provide comfort. Another patient in a similar state was going to be placed in a nursing home, but turned around and came off his nasogastric tube, ambulating with support, and was eventually discharged!

| 19

&A

staying

CONNECTED

Yishun Health experts answer your frequently asked questions about health, well-being, and medical conditions.

In consultation with Dr Goh Kah Hong, Head & Senior Consultant, Psychological Medicine, KTPH

There have been many disruptions to our regular schedules due to the COVID-19 pandemic, from practising working from home and homebased learning to limiting outdoor and social activities. As a parent of two children under 10 years of age, I’m finding that we’re spending too much time on our screens 20 |

and not as much quality time with each other.

What can we do as a family to rediscover our bonds and build new but healthy routines?

The stresses and changes brought on by the last two years have undeniably been taxing on family life.

Working from home under lockdown measures has blurred the distinction between work and play times. It is admirable that you recognise the

need to reinforce your family bonds and nurture your relationship with your children.

One important way to build new routines is to set some boundaries for work, school, family and personal times. It is a good practice to set a goal of spending time with your family, such as having dinner together.

To keep to this goal, you can try the SMART technique, where goals are Specific, Measurable, Achievable, Relevant, and Time-bound.

SPECIFIC Make a detailed plan with key elements clearly defined

û I will spend more time with my family.

MEASURABLE Set clear targets

û I will have dinner with my family

ü I will spend time bonding with my spouse and children over dinner.

As for your own mental well-being, it is important to find time and space for yourself. You can do this by:

whenever possible.

ü I will have dinner with my family at least once a week.

ACHIEVABLE Ensure your goal is realistic and attainable

û I will ensure that my family has dinner together every single day.

ü I will work in flexibility and structure that suit everyone’s schedule for family dinner.

RELEVANT Set tasks relevant to your desired goal

û I will have a balanced diet.

TIME-BOUND Set a timeframe to put the plan into action

û I will put my plan into action

ü I will invite suggestions for what to cook or order in so everyone gets to enjoy something they like or something new. Perhaps we could also prepare the food together.

sometime soon.

Keeping yourself physically active Exercise improves your mental and physical health, and helps you connect with the most important person of all: yourself! Get yourself an exercise buddy and you can build up healthy interactions even as you build healthy muscles.

ü I will start my plan next week.

COVID-19 has meant that — for now and perhaps quite a while yet — we may not be able to have social activities and interactions among large groups of people. What are some ways I can continue to keep connected with friends and family who may or may not be physically with me here in Singapore? How else can I maintain my own mental health and well-being?

There are many ways to keep connected with others; by investing time to build relationships, you are also contributing to your own wellbeing, and better physical, social, intellectual, spiritual and emotional health. In fact, studies show that close relationships are a better predictor of long and happy lives compared to other factors, such

as social class, intelligence, or even genetics. Here are some ways to stay connected with others:

Watch a movie or play a game together Engaging in activities with loved ones can help us feel a stronger sense of connection with them. You can even use technology to stream movies in real-time or play games together with your loved ones, even if they are far away.

Sign up for an online course or join an online community together Learning something new while also getting to meet like-minded people is a great way to expand your social connections, upgrade yourself, and find a community.

Helping others in need One of the best ways to pick yourself up is to uplift the spirit of other people.

Find ways to invest your time, energy and skills in support of other folks, and you will build a sense of control and purpose. It is simple to reach out: send a text message to someone you love, cook for a friend, make something for your community, or volunteer.

Reaching out for help If you are feeling alone, sad or stressed, connect with someone you can speak to. There is no shame in asking for help. If needed, you can also engage with a trained professional for support. | 21

potlight

WHEN KNOWLEDGE IS POWER

A registry to track the prevalence of a high-cholesterol condition aims to put knowledge, power and action into the hands of people who carry this genetic trait — and spur early detection, treatment and the prevention of serious complications.

F

or many, high cholesterol is a lifestyle disease brought on by diet and habits that begins to affect people in their later adult years. But for some, it is a genetic disorder that starts at birth.

Take Mr Chew, 55, who was only in his 30s when he discovered he had high cholesterol. He had been visiting a General Practitioner for a mild cough when his GP recommended a blood test. The observant doctor had noticed a white ring around Mr Chew’s eyeball — a condition known as corneal arcus, which occurs when fat is deposited in the eye because of high cholesterol levels.

After a blood test confirmed the diagnosis, Mr Chew started taking medications to bring his cholesterol levels down, not thinking it was too serious. However, despite years of treatment, his condition never really responded well to medication.

In 2016, he was recommended to go for a special type of genetic screening at KTPH to check whether his problem was due

22 |

to a condition known as Familial Hypercholesterolemia (FH). FH is a genetic disorder where a defective gene impairs the body’s ability to remove low-density lipoprotein (LDL or ‘bad’) cholesterol from the blood. Without treatment, this may result in an aggressive and premature cardiovascular disease that starts from a very young age.

“I always knew that high cholesterol ran in my family,” says Mr Chew, “But I never knew it was due to a genetic problem.”

Finally understanding the cause of his problem has helped him better understand the illness; more importantly, he has learnt to manage it better to prevent complications.

UNCOVERING A ‘HIDDEN’ DISEASE Mr Chew is one of 540 patients who have been enrolled in Familial Hypercholesterolemia: Case identification, Assessment and Reduction in adverse Events (FHCARE), KTPH’s FH registry.

Headed by A/Prof Subramaniam

“Once a person has been identified to be positive for FH (the index case), we go on to screen their next closest relatives — parents, brothers and sisters, children — because there is a 50% chance that they will be positive, too.”

DR SHARON PEK, PRINCIPAL RESEARCH OFFICER, CLINICAL RESEARCH UNIT (CRU), KTPH

Yishun Health’s FHCARE team — (from left) Dr Sanjaya Dissanayake, A/Prof Subramaniam Tavintharan and Dr Sharon Pek (right) — received the Outstanding Research Impact Award from Prof Lim Tock Han, Deputy GCEO (Education & Research), NHG, at the 2019 Singapore Health & Biomedical Congress

Tavintharan, Clinical Director and Senior Consultant, Diabetes Centre, the FHCARE Registry was started in 2015 and currently receives referrals from clinicians across 11 sites, including National Healthcare Group, SingHealth, and National University Health System.

Dr Sanjaya Dissanayake, Senior Consultant, General Medicine (Endocrinology), KTPH, explains that FH is one of the most common inherited diseases, and affects one in every 200 to 300 people. “In Singapore, it’s estimated that some 20,000 people have the condition, but not many people know they have it.”

This is because the condition often presents with few overt symptoms apart from high cholesterol levels, which can only be picked up by a blood test. Some people, like Mr Chew, may develop a corneal arcus over time. “The concern is that those with FH have high cholesterol from birth and live with the condition for a long time; they do not get picked up for years, even decades,” Dr Sanjaya points out.

This accumulated period of high cholesterol since birth results in more significant damage to the body over time. People with untreated FH have

a 20-fold increased risk for coronary artery disease compared to the general population. In families with FH, it is not uncommon for people to have heart attacks as young as in their 20s or 30s.

Therein lies the goal of the FHCARE Registry. “Our aim is to identify FH as early as possible so we can start treatment early,” advises Dr Sanjaya. Dr Sharon Pek, Principal Research Officer, Clinical Research Unit (CRU), KTPH, adds that the second goal is to do cascade screening. “Cascade screening is like contact tracing,” she elaborates. “Once a person

| 23

potlight

FHCARE Coordinators and research laboratory officers with team head A/Prof Subramaniam Tavintharan (in blue shirt)

has been identified to be positive for FH (the index case), we go on to screen their next closest relatives — parents, brothers and sisters, children — because there is a 50% chance that they will be positive, too.” The more people are identified with FH, the better care can be rolled out earlier, Dr Pek emphasises.

For most people with FH, the genetic mutations that cause the condition are often resistant to regular cholesterol-lowering regimes. Patients must be given higher doses of statins along with other drugs that limit the absorption of cholesterol in food. The good news is that this more-intensive mode of treatment is effective.

ENGAGING PATIENTS AND THEIR FAMILIES Today, thanks to cascade screening, the KTPH FHCARE Registry has tested about 800 participants. This empowers each one of them to take action and seek early treatment.

For FHCARE Coordinators Wan Wen Yi, Atiqa Binte Zulkifli and Fariha

24 |

Siraj, educating patients about the importance of screening is a crucial part of the work. “For every new patient who gets referred to the registry, we take the time to engage them, and explain the condition and its consequences,” says Fariha. It takes about an hour each time to help them understand the nature of FH. Although it is not necessary for the research or for data collection, this engagement effort is aimed at encouraging index patients to invite family members to get tested as well. Mr Chew’s two daughters, aged 20 and 26 respectively, have been screened and were found to have FH, too. While this was a disappointing outcome for Mr Chew, he is glad his children can now seek help early. “This condition is cumulative, so the earlier we manage it, the more beneficial it will be,” he shares. He has also convinced his siblings to get tested.

The test is a form of genetic screening using a special technology called a next-generation sequencing machine. “We perform

DNA extraction per patient, batch them, and sequence 32 samples in parallel per run,” explains Siti Nur Afiqah Binte Kamaruddin, Research Assistant, CRU, KTPH. While patients are informed of their FH status, the registry also receives anonymised data for study. The genetic sampling helps to not only confirm FH status, but a better understanding of each FH variant.

“It pinpoints which of the many causative mutations are responsible for causing FH,” Siti says.

For clinicians, this is essential data that can be used to develop more precise treatment, because every variant has a different response to different treatments.

Building this knowledge within KTPH’s FHCARE Registry will lead the way in driving a better understanding of FH. The data will help inform larger community studies, Dr Sanjaya insists. “This is important, as it will help guide more effective treatments and allow us to lay the foundations for precision medicine and individualised treatments.”

FH SYMPTOMS

Adults and children with FH have very high levels of ‘bad’ cholesterol in their blood, which builds up in the walls of the arteries. The excess cholesterol can sometimes be deposited in other parts of the body, such as the: • Skin around the hands, elbows and knees

• Tendons, such as those in the hands or foot (e.g. Achilles tendon)

• Eyes, which presents as a white or grey ring around the iris

WHAT HAPPENS DURING FH SCREENING?

1

You will undergo a counselling session about the condition

2

A blood sample will be taken for genetic testing and analysis

3

If you are FH-positive, you will be given a referral letter so you can seek specialist help at a clinic of your preference and convenience

4

FH-positive patients are highly encouraged to recommend screening to their immediate family members

If you have high cholesterol and would like to get tested for FH, contact the FHCARE team by: E-mail: cholesterol.info@ktph.com.sg Phone: 9674 5167, 9825 9793, 9863 7690 You can also check out the following website for more information: https://www.myheart.org.sg/my-heart/preventions-risks/fh/

| 25

veryday Heroes

Devotion & faith,

in sickness & in health

After more than a decade of sickness, the trials of caregiving have done little to dent the marital devotion of Ruby for her husband, Richard. If anything, it has strengthened the bond between them.

“W

e’re doing okay, right?”

With a tender look in her eyes, Ruby, 71, pats the arm of her husband, Richard, 74. Though he can’t hear well anymore, he responds to the affectionate gesture with a small tilt of his head.

These subtle shared moments speak volumes about their 48 years of marriage, and their supportive interdependence on each other.

This bond has kept them going, especially throughout Richard’s two battles with cancer, hearing loss, and swallowing problems.

The latter difficulty was their most recent challenge, Ruby shares. About two-and-a-half years ago, Richard became quite ill when he became unable to eat. “He had a fainting spell and fell in the bathroom, so we had to call an ambulance, and he was sent to KTPH,” Ruby recounts.

At KTPH, Richard was diagnosed with dysphagia, a swallowing problem that makes it difficult to eat. There was a high risk of choking and food entering the lungs — a dangerous 26 |

cause of pneumonia. Because he could not swallow safely, Richard had to have a feeding tube (percutaneous endoscopic gastrostomy tube or PEG) inserted for safer eating.

When Richard was discharged, Ruby and her long-time helper were able to manage quite well on their own, except for a few times when the tube got stuck, which required a visit to the A&E. “Initially, we were not so sure of what we were doing, and were afraid of doing things wrong.

But now, we’ve gotten the hang of it,” Ruby says.

Ruby is thankful to have support from Yishun Health’s Ageing-in-Place Community Care Team (AIP-CCT), which has been a reassuring form

of ‘back up’ for times when she needed a little extra guidance and advice. This includes PEG tube care, physiotherapy for exercise, and phlegm management, as well as dietitian consultations to ensure Richard’s liquid diet was optimised.

“I am glad that we have a group of community nurses. Around 15 years ago, when Richard was first sick, I was so lost, I did not know what to do. Now I have more help and it is much easier.”

Ruby says that the team communicates well with Richard, and helps them to manage better so that they do not need to go to the A&E as often. It is at this point that she looks to her husband and touches his arm

“I wish caregivers to know that they are not alone, and that there is help available.

There are people around us who are willing to help. I hope those in the same boat as we are know they have the strength to pull through.”

— a simple gesture she often does to convey ‘we’ve got this’.

THE WILL TO GO ON The ability to ‘do okay’ has been due in part to Ruby’s devoted caregiving, but also Richard’s tenacity. Ruby shares that Richard was first diagnosed with throat cancer about 15 years ago; a few years after that, a second cancer was discovered below his eye. Both times, he has pulled through. “His willpower is very strong,” Ruby shares.

With pride, she tells of how he quit smoking in just one day, and how steadfast he has been to resist the temptation of eating. “He loves food, but he will just smell the dishes and refuses to even taste it.” Her heart aches for her husband’s situation.

“My poor old man,” she laments. “He cannot eat, he cannot hear. It is so hard for him, but he keeps going.”

Richard shares that it is his family — especially his two grandchildren — that keeps him fighting. He simply wants to see them grow up, finish their studies, and be independent adults. Though COVID-19 restrictions have made it difficult for them to see each other, they keep in touch via texts and video calls.

So, while they hope for the day to come when the entire family can meet and be with each other again, Ruby and Richard spend their days accompanying each other and keeping occupied with their own hobbies. For Ruby, it means watching Korean dramas, while Richard reads avidly. “Our other pastime is going for medical appointments,” Ruby says with amused exasperation.

BITTERSWEET MEMORIES Ruby looks back on the times when they used to take long road trips up to Malaysia as a young couple when their son was little. She delights in sharing how, as a young man, Richard was a vainpot, with a hairdo just like his favourite singer, Elvis Presley, and dressed in fancy shirts and bellbottoms. “He had ‘curry puff’ hair and used to play the guitar!” Ruby says, laughing.

Music was not just Richard’s pastime, but his work — it was while he and Ruby both worked in the entertainment industry that they met.

Richard used to book music acts and fondly remembers interacting with bands and seeing them perform live. He has even met legendary musicians such as the great jazz

trumpeter, Louis Armstrong, and Cuban musician, Perez Prado.

Looking back on their married life, Ruby gets emotional thinking about what keeps her going. “When we got married, we promised to be there for each other in sickness and in health, and for richer or poorer,” she says, overcome with tears. She admits that there have been many times when she felt overwhelmed. “When the waves come in, I just bow my head and I ride it; I know that one day it will pass.” Looking to the future is just as difficult for her, because she fears what it holds. “Whatever I do, I will treat it as my last so I have no regrets.” Her goal is to simply love and care for her husband, and cherish all the days they have together.

As painful as it is to think and talk about her worries, Ruby knows it does her good to let her emotions out. She finds strength in her Catholic faith, her love for her husband, and help from those around her. Be it spiritual, emotional or practical support, she encourages caregivers to seek what they need to push on.

Being a caregiver can be challenging, but there is no need to be alone, Ruby advises. “I wish caregivers to know that they are not alone, and that there is help available.

There are people around us who are willing to help. I hope those in the same boat as we are know they have the strength to pull through.” | 27

Things About...

5

Things About...

acupressure

In need of a little pain relief?

Try this five-minute, five-point acupressure routine. Based on principles of Traditional Chinese Medicine (TCM), it refers to the stimulation of key points of qi (healing energy), known as ‘acupoints’, to boost the body’s self-healing and restorative processes.

In consultation with Amanda Chua, Acupuncturist, and Melissa Ong, Senior Acupuncturist, Sports & Exercise Medicine Centre, KTPH

28 |

1

安眠 AN MIAN

• This acupoint is located around 1.5 inches (the width of two fingers) behind your earlobe • Locate a depression along your hairline An Mian means ‘peaceful sleep’. Stimulating this acupoint can calm the mind and reduce stress and anxiety. An animal study suggests that acupuncture on An Mian increases non-rapid eye movement (NREM) sleep duration, the stage of sleep where the body repairs tissues and muscles.

2 合谷 HE GU

• This acupoint is located on the dorsum of your hand • Locate it approximately at the depression next to the middle of the second metacarpal bone He Gu is one of the most commonly used acupoints, and has been extensively studied in clinical research. According to TCM theory, qi and blood aggregate at this acupoint. Stimulating it can bring numerous health benefits, including easing neck pains and headaches, and increasing the production of ‘happy’ hormones.

Do note that this point should not be stimulated during pregnancy.

3 足三里 ZU SAN LI

• Bend your knee 90 degrees • Locate the two small depressions on your kneecap • Place four fingers below the outer depression of your knee cap • This acupoint is located right below your little finger Zu San Li is commonly referred to as the Point of Longevity, and is indicated in strengthening the digestive system. A strong digestive system helps increase the body’s healing energy, thereby improving immunity.

Japanese researchers confirmed that simulating Zu San Li and other points could help regulate the immune system, while other studies showed it boosted lymphocyte (a type of white blood cell) proliferation in elderly individuals.

4 三阴交 SAN YIN JIAO

• Place four fingers above the tip of your inner ankle bone • This acupoint is located just above the middle of your index finger Studies indicate that stimulating San Yin Jiao among other points may increase night time melatonin (the ‘sleep’ hormone) secretion, boost general health in women and relieve menstrual cramps.

However, this point should not be stimulated during pregnancy.

5 太冲 TAI CHONG

• Slide your finger downwards along the space between your first and second toe to the tip of the metatarsal joint • This acupoint is located in the depression just before your finger touches the metatarsal joint According to TCM principles, this acupoint can boost the flow of qi through the body, easing pain and re-balancing the body’s yin and yang. Several randomised controlled trials have shown that stimulating Tai Chong and other points can help in managing depression and anxiety.

SOME PRECAUTIONS TO NOTE • Do not perform acupressure directly on burns, infections, ulcerous conditions, recently formed scars, open wounds, and broken skin (e.g. eczema), or on areas with broken bones and joint implants.

• Do not do acupressure on an empty stomach.

• Patients with serious medical conditions should consult their doctor before using acupressure or other alternative therapies.

• The information provided is not a substitute for an acupuncturist or any form of medical care.

Individual symptoms differ due to different body constitutions and diagnosis. Do consult a licensed acupuncturist for accurate diagnosis and treatment.

A FIVE-POINTER WELLNESS BREAK Indulge in a little wellness pick-me-up with this five-minute routine.

• Get comfortable.

• Begin with An Mian and work your way down the body. From An Mian to He Gu and Zu San Li, followed by San Yin Jiao and, finally, Tai Chong.

• Apply firm pressure in circular motions while breathing steadily.

If you are pressing on the correct point, you should feel some soreness.

• Spend 30 seconds for each point on both sides of the body.

You should find this routine very relaxing! Try this routine once in the morning after breakfast, and once more at night before you sleep.

Acupuncture services are available at Khoo Teck Puat Hospital and Admiralty Medical Centre.

Please call 6555 8000 for enquiries. | 29

aily Dose

WHEN EXERCISE

GOES TOO FAR High-intensity exercise is getting more popular as people seek more exciting and effective ways to work out. However, excessive exertion carries a small risk of serious muscle damage, known as rhabdomyolysis.

In consultation with Dr Benjamin Soh, Registrar, Sports & Exercise Medicine Centre, KTPH

I

t is common to experience muscle soreness after rigorous exercise, especially if you are new to a fitness regime or have just increased the intensity of your workout. However, if your muscle aches are more severe than normal and accompanied by nausea, rapid heartbeat, and/or brown-coloured urine, it could be a sign of something more serious.

The condition is called rhabdomyolysis, a potentially life-threatening condition where damaged muscle breaks down and ‘leaks’ into the blood and urine.

Rhabdomyolysis can be caused by: • Traumatic injury: when a limb is trapped/crushed in an accident • Substance abuse: the use of illegal drugs and excessive alcohol • Strenuous exertion: which causes muscle cells to be depleted, causing them to die

30 |

HOW COMMON IS EXERCISERELATED RHABDOMYOLYSIS? Generally, most hospitals see only a few cases of rhabdomyolysis related to exertion a year; it is far more common to be caused by trauma. A study in military recruits undergoing basic training showed 22.2 cases per 100,000 per year, an incidence of only about 0.02%.

Even though the condition is relatively rare, it has come under the spotlight recently due to the rise in popularity of high-intensity workouts, including spinning. However, the overall risk remains low and should not discourage individuals from exercising.

WHO IS AT RISK OF EXERCISE-RELATED RHABDOMYOLYSIS? In most cases, those who are less fit are more at risk, but it can still happen to anyone who exerts themselves too much — even elite athletes, although it is generally less common. Other risk factors include: • Exercising in extremely hot and humid conditions • Dehydration • Wearing clothes or taking medications that reduce sweating • Pre-existing medical conditions, such as poorly controlled diabetes or thyroid issues • Exercising when unwell (e.g. with a viral infection)

HOW IS EXERCISE-RELATED RHABDOMYOLYSIS TREATED? Treatment depends on the severity of the condition, but typically consists of supportive care with lots of intravenous fluids to help flush the toxic by-products of the broken-down muscle tissues out of the body.

In more severe cases, short-term damage to the kidney may occur, which will entail the need for additional medications and a short period of dialysis.

Most people who have exertionrelated rhabdomyolysis have milder cases, and can be discharged from hospital in about a week, once blood tests have normalised.

However, due to the

muscle damage and death, it may take several weeks to months to train them back to their previous state.

WHAT ARE SOME STEPS TO PREVENT EXERCISE-RELATED RHABDOMYOLYSIS? Most importantly, start slow and progress gradually if it is your first time doing a new activity, or if it has been a long time since you have exercised.

Being good at one type of exercise does not necessarily mean you will automatically be good at all types, so take several sessions to familiarise yourself and build tolerance to the specific exercises you are doing.

It is also important to prevent dehydration, as this is a big risk factor for rhabdomyolysis.

• Keep yourself hydrated during exercise with small sips • Avoid exercising under extremely hot and humid conditions, such as outdoors at midday • Wear light and nonrestrictive clothing • Avoid exercising if you are unwell • Do not exercise if you are taking cough and cold medicines, as these can reduce sweating • Do not exercise under the influence of alcohol If you have any pre-existing medical conditions that you are unsure about, please consult your doctor for further advice.

RHABDOMYOLYSIS:

SYMPTOMS TO LOOK OUT FOR

• • • • • • • •

Severe muscle aches Weakness or swelling in affected muscles Brown-coloured urine Fever Rapid heartbeat even at rest Nausea and vomiting Reduced urination Confusion However, not everyone with rhabdomyolysis will exhibit all these symptoms. If you are experiencing any of these, do not panic. Visit a doctor to get a confirmed diagnosis through blood and urine tests.

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30-31 Daily Dose.indd 31

14/12/21 3:19 PM

akan Time

32 | 32

cut & keep

Cranberry Cheesecake

Light yet creamy, this pretty, cranberry-studded cheesecake is a great addition to your festive table.

Recipe provided by Chef Ng Cheng Lean, Food Services, KTPH, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS SERVES 8 • • • • •

130g reduced fat cream cheese 65ml low-fat milk 50g margarine 4 egg yolks and 6 egg whites 40g plain flour

• 30g corn flour • 110g caster sugar • 170g IQF (Individually Quick Frozen) cranberries, mashed

METHOD 1. Pre-heat oven to 160oC 2. In a saucepan, over very low heat, combine the cream cheese, margarine and low-fat milk; let them melt until smooth, then set aside to cool

NUTRITIONAL INFORMATION (PER SERVING) Energy

198kcal

Carbohydrates

23g

Protein

6g

Fat

6g

• Saturated

4g

• Polyunsaturated

1.4g

• Monounsaturated

3.2g

Cholesterol

83mg

Dietary Fibre

1.2g

Sodium

115mg

Potassium

>71mg

Phosphate

>64mg

3. Once the mixture has cooled, add in the egg yolks, plain flour and corn flour; stir well 4. In a big mixing bowl, whip the egg whites with sugar until it forms stiff peaks 5. Fold in the melted cream cheese mixture, then add the cranberries gradually, mixing well 6. Grease a round cake pan and wrap the outside of the pan with aluminium foil tightly to prevent any leakage while baking 7. Pour the cheesecake mixture into the cake pan 8. Place the cake pan in a hot water bath; the water should reach halfway up the side of the cake pan 9. Bake for 25mins at 160oC, then reduce it to 140oC and continue to bake for another 55mins 10. Remove cake from oven; set aside to cool completely before serving | 33

it & Fab

Pooling the Benefits of Swimming

Swimming is not only a great way to cool off in our tropical weather, but is also a highly beneficial exercise suitable for all ages and fitness levels.

In consultation with Dr Shauna Sim, Registrar, Sports & Exercise Medicine Centre, KTPH

S

wimming is one of Singapore’s most popular recreational sports, and no wonder — it is accessible, fun, perfect for our weather, and an essential life skill. Swimming also confers many benefits, some of which are unique to the sport because of the particular properties of water.

For one, swimming is a full-body workout that can increase cardiovascular fitness if done regularly. Being hydrostatic, water exerts a mild pressure on the body.

This increases blood flow returning to the heart during exercise, and leads to lower heart rates and blood pressure for the same amount of energy exerted on land. This means it is ideal for people with cardiovascular vascular risk factors, such has high blood pressure.

Water also provides resistance due to its viscosity, 34 |

so any aerobic exercise in water adds an element of resistance training, which increases muscle strength and helps maintain muscle mass — especially important as we grow older. Incorporating equipment such as flippers or paddles into the exercise, or simply increasing your swimming speed, can intensify this benefit.

For those with joint issues, swimming is a suitable low-impact activity. The buoyancy of water supports body weight, reduces impact on the joints, and promotes flexibility. The deeper you go, the more you are supported. Interestingly, if you are waist-deep in water, your body weight is reduced up to 50%; in shoulder-deep water, it is reduced by up to 90%! The cushioning effect of water means less risk of sustaining injuries to your muscles, tendons and joints.

TIPS FOR SWIMMING SAFELY

SWIMMING IN A PANDEMIC

As good as swimming is, it has its dangers.

You must always take precautions and be water-safe, especially if exercising alone in the water — no matter how experienced a swimmer you are!

If you are not confident in swimming, ensure that you are accompanied at all times, and stick to a pool height where you can stand comfortably. It is also safer for you to swim in a pool than in open water, where the tides and currents can become too challenging for you to cope. Where possible, use facilities with a lifeguard present.

One question on the minds of many is whether swimming increases the risk of COVID-19 infection.

But if you love swimming, you should continue to do it as a way to maintain physical and mental health.

The COVID-19 virus is not water-borne, so swimming pool water itself is unlikely to be a vector of transmission.

Any contact with others in the pool is also minimal when you are in motion. This means you do not need to wear a surgical or reusable face mask in the water as it loses its protective function when wet; masks also make it difficult to breathe. However, to prevent air-borne transmission, wear a clean dry mask when you are out of the pool. You may also consider taking your shower at home rather than using shared facilities, and limit mask-off interactions.

STAY DRY IN THESE CONDITIONS And while swimming is a suitable form of activity across all age groups, you should avoid it if you suffer from certain conditions, such as: • Seizure

• Syncope (loss of consciousness with no clear cause)

• Heart conditions (which can predispose you to fainting spells)

• Open wounds

• Uninvestigated • Breathlessness chest pain

This is because losing consciousness in water can have much more severe consequences compared to on land. It is difficult to identify people who are having trouble or difficulty in water and to administer immediate treatment in the water.

DOES THE CHLORINE IN POOLS KILL GERMS? The chlorine in pool water kills germs, including viruses, if it is added in the proper amounts.

However, there is no scientifically based evidence that chlorine definitively kills COVID-19 or reduces the risk of transmission.

Having said this, there is no evidence that coronavirus spreads through the water in pools. Hence, swimming can be done safely even with COVID-19, but we have to be responsible and conscientious about reducing the risk of transmission by minimising the time we spend with our mask off.

RINSE BEFORE & AFTER As a general matter of hygiene and pool etiquette, do rinse off before and after using the pool. Rinsing prior helps to remove sweat, dirt, germs and other matter, which can react with the chlorine and reduce its efficiency. Rinsing off afterwards helps to remove the chlorine from the skin and prevent it from getting dry.

| 35

Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the North. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting.

Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)*

115 Chong Pang

260 Nee Soon East

765 Nee Soon Central

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

*In light of COVID-19 safe management measures, please check the KTPH website for the centre schedule and call in advance to see if there are vacancies for group activities.

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 795-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore.

It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital