Allied Health: . - Q

SPEEDING UP GOOD NEWS The simple act of delivering mammogram and pap smear results via SMS instead of letters through the post saves KK Women's and Children's Hospital (KKH) an estimated $5,400 and 828 man-hours a year.

Previously, as many as 40,000 patients out of the 49,000 women who take such tests to detect breast and cervical cancer at KKH every year had to wait seven to 10 days for their test results. Those who have traces of cancer cells would be personally informed

Many anxious women, unsure of whether they had the dreaded disease, would call the Specialist Clinic assistants, who would then spend time tracing their results.

With the SMS notification, the patients can now receive their results - "No evidence of cancer" - within four working days.

Said Charles Chan Ban Kee, Senior Manager, Diagnostic and Interventional Imaging Department, KKH, who led a team of eight members to put the SMS initiative in place: "We improve patient

The eight • contenders.-for the

thifd.Aiiied Health innovative Practice Awards have come

up with highly creative initiatives in their fields of work. Sher Maine Wong

speaks to two of the teams.

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

care by reducing their anxiety and stress levels. For the staff, it saves time as there is better utilisation of manpower. There is better teamwork, collaboration and productivity."

The system was implemented in June. It was found, from a survey of 43 patients, that 80 per cent of them thought the SMS service was "very good".

What is more remarkable is that the entire effort was done in-house. If outsourced, it could have cost about $7,500.

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

E X P E R I E N C I N G D E A F N E S S For all the technology in the world there is to help the hearing-impaired make sense of their surroundings, these individuals still face difficulties in communication and integration into mainstream society because people around them fail to understand what being deaf is really like.

That is why it is so crucial to educate the schoolmates, colleagues or family members of a hearing-impaired person, and that is why a team of 10 led by S G H Auditory-Verbal Therapist Stephanie Lim, started a Hearing Education Arcade precisely for that purpose.

Said Ms Lim, who is from the Centre for Hearing and Ear Implants at the S G H Otolaryngoloy Department: "Through Reverse Education Therapy, the normal hearing person experiences the world of the hearing-impaired through various interactive and educational tools, specifically designed to help them understand what being hearing-impaired means."

Started four years ago, the HEAR Arcade, located at the basement of SGH Block 3, uses technology such that visitors can actually hear what speech would sound like to a hearing-impaired person.

So if an elderly patient had high-frequency hearing loss, for instance, his family members can actually hear that the sentence "She sells seashells on the seashore" would emerge as a series of indistinct vowels with all the "s" sounds missing.

Or, the parents of a baby diagnosed with profound hearing loss, would be able to hear the static which is all the baby can make out of speech if he/ she is not prescribed the appropriate hearing device.

The Arcade also has a giant model of the human ear which shows how sound is transmitted through the ear canal; various simulated environments that are more conducive to the hearing-impaired child in a classroom, for example, a room with a ceiling fan versus an air-conditioned room; success stories of

The hearing team at S G H led by Stephanie Lim (extreme right)

famous hearing-impaired individuals, and interactive games and quizzes.

Prevention of noise-induced hearing loss is also emphasised in this Arcade, with visitors experiencing what might be too loud for their ears. More importantly, visitors can learn how to communicate better with a hearing-impaired person. For instance, stay within the visual field or rephrase if you are not understood instead of just repeating what was said loudly.

To date, more than 300 people, consisting of students from various

educational institutions such as medical students, polytechnic students or walk-ins, have visited the Arcade. A survey of 66 visitors found that seven in 10 rated the experience "excellent".

Said Associate Professor Christopher Goh, who heads S G H Otolaryngology Department: "This effort has helped S G H become a Centre of Excellence for the management of hearing-impaired patients and is well-known not only in Singapore but also in the region." •

SingHealth Allied Health Innovative Practice Awards The awards cast the spotlight on about 2,500 aiiied health staff who pfay a crucial role in the delivery of healthcare at SingHealth.

\ ALLIED HEALTH

INNOVATM PRACTICE

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Innovation is the pre-requisite for these awards, which were w*~ started in 2007. But more than just creativity for its own sake, the projects and initiatives which are up for the awards must strengthen the three piiiars of SingHealth: service, education or research.

"The applications that the committee reviewed this year were all really innovative and had improved patient care at each centre. Several projects show real promise for both cost savings as well as improving patient care and satisfaction.! have served on many review panels and can say that the quality of the appiications and the thought and work that went into these were first class," commented chief judge, Prof Roger Beuerman, Senior Director, Singapore Eye Research institute.

The other six projects include research on fighting "superbugs", reducing waiting time at a hospital outpatient pharmacy, a portable sitting lumbar traction unit to help patients with back pain, a special mask to better secure cancer patients undergoing brain radiation, and more effective ways of addressing the nutritional issues of malnourished elderly adults.

The winners had not been announced at the time of printing.

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I BRANT C A M PUS

Dietitian Peggy Tan makes sure diabetics eat right as a proper diet is crucial for these patients. By Sher Maine Wong

T he four melamine bowls on dietitian Peggy Tan's desk are not for decoration. Rather, she

uses them to help her understand the actual amount of rice that patients eat,

"They tell me they are eating small bowls of rice, but then they point to my big bowl," explains Ms Tan, who looks after the dietary needs of patients at nine SingHealth Polyclinics. Most of her patients suffer from diabetes, but she also advises those suffering from hypertension, high cholesterol and other chronic diseases.

Ms Tan noted that she's been seeing younger patients with diabetes over the years, with some in their late 30s. Diabetes usually develops in adults aged 40 years and above.

"The younger ones are mostly overweight, probably as a result of consuming too many calories, coupled with a sedentary lifestyle," adds Ms Tan.

On a positive note, however, these younger patients are better informed about their health condition and are more willing to change their lifestyle.

"In the past, I had patients who would tell me 'die also never mind, must eat first!' Now they are generally less resistant to advice and less argumentative. They are more ready to accept what I tell them to do."

During a session of about 45 minutes, Ms Tan reviews the patient's lifestyle, exercise patterns and diet.

"In the past, I had patients who would

tell me 'die also never mind, must eat first!' Now they are

generally less resistant to advice and less

argumentative. They are more ready to

accept what I tell them to do."

She then makes recommendations such as the number of bowls of rice or slices of bread the patient should eat a day, and how to read food labels. "Through these sessions, I empower the patients to take control of their own diet, and learn how to live with diabetes."

One common misconception her patients have about diabetes is that they should stay away from rice, fruits, and anything with sugar. "In fact, they can eat all these things as long as they stay within their daily dietary allowance," states Ms Tan.

Ms Tan doesn't just see patients - about eight a day. She also helps to educate nurses as they "counsel quite a fair number of patients" as well as give talks on diabetic diets for nurses twice a year, as part of the skills enhancement programme offered by the Department of Nursing. •

CELEBRATING OUR AWARD WINNERS — I

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Singapore's Firsi Physiotherapist-OfThe Year

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

Maine e Wong

Observing a group of elderly women dancing jauntily in sync to a popular tune in the void deck of an HDB

flat, Dr Wong Wai Pong concluded: "If you are weak, the dancing might predispose you to falls, and then we have to look at fall prevention. But it's also a very fun activity where the women make friends, and that's about the quality of life."

That happened some years ago when Dr Wong, Senior Principal Physiotherapist, S G H , and recent winner of the Singapore Physiotherapy Association's inaugural Physiotherapist of the Year Award, was conducting a study on the physiological, functional and psychological effects of country line dancing on older women.

Dr Wong has since done more research on the elderly and fall prevention. He has also helped start a fall prevention clinic at S G H and is collecting data looking into the risks of falling by the elderly. "Singapore has an ageing population and there is a need for us to put in place some preventive measures," he said.

His research work shows how relevant and pervasive a role physiotherapy plays in our daily lives, and that the discipline isn't just about massage and exercise.

"Physiotherapy is a non-invasive approach to healthcare," said Dr Wong, "and the approach is always on maintaining health rather than disease management. If you have fallen, physio helps you to prevent the next

fall."

Dr Wong is also passionate about cardiovascular and pulmonary physiotherapy, where physical therapy is used to treat problems like asthma, acute upper

respiratory infections and trauma. He has published several papers on the subject in peer-reviewed journals and textbooks.

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

It is no surprise that Dr Wong is known to colleagues as the "walking physiotherapy historian", and to young researchers as the "walking clinical dictionary".

Dr Celia Tan, Deputy Director for Allied Health Division, S G H ; Director for SGH-PGAHI , and current President of the Singapore Physiotherapy Association proudly quips: "I can't think of a more deserving physiotherapist for this award than Dr Wong. Even as his ex-manager and senior, I have long admired and respected his astute observations and comments on professional trends and visions. If you need to know what is happening in the physiotherapy profession internationally, you only have to ask him! Truly an inspiration, leader and mentor for all physiotherapists." •

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CELEBRATING OUR AWARD WINNERS

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Singapore's Highest Research Award

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

They were the first in the world to alert millions of contact lens wearers globally to a contact lens

cleaning solution, which could cause eye infections; thus saving the sight of thousands worldwide.

.. .the first to grow human conjunctival stem cells from a person's good eye, to transplant into the other eye to restore vision.

.. .and the first to develop and commercialise a new surgical device to perform sutureless, small-incision, keyhole corneal transplantation, which is now used in more than 10 countries around the world.

For all these firsts and more, Professor Donald Tan, who chairs the Singapore Eye Research Institute (SERI), Professor Roger Beuerman, SERI's senior scientific director, and Associate Professor Aung Tin, SERI's deputy director, have been awarded the first President's Science Award.

The award is the highest research award in Singapore recognising outstanding research scientists and engineers for their excellent achievements in science and technology. It was previously known as the National Science and Technology Awards.

Said Prof Tan, the team leader: "My team accepts the award on behalf of all the clinicians and scientists working together with us. We stopped thousands from being blinded by corneal fungal infections and have developed new forms of corneal transplantation, which are helping more to see. These are the most rewarding aspects of our work."

Professors Tan, Beuerman and Aung Tin's work was also outstanding as a result of their wide-ranging output, which included laboratory breakthroughs (bench), clinical innovations that directly benefitted patients (bedside), and public health interventions which affected whole communities (population).

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BENCH The trio are the first in the world to grow human stem cells in a laboratory to produce conjunctival tissue.

The tissue is grown from a patient's stem cells in the unaffected eye. It is transplanted in the patient's other eye to restore vision.

"We don't use animal cells or serum to grow our stem cells because we want to eliminate the risk of disease transmission, such as Bovine Spongiform Encephalopathy (BSE), more popularly known as mad cow disease", said Prof Tan.

Other research highlights include identifying a gene that blinds babies born with a severe form of congenital corneal blindness, known as Congenital Hereditary Endothelial Dystrophy (CHED).

The team also discovered mutations of the same gene in adults with the most common form of premature ageing of their corneas, known as Fuchs' Endothelial Dystrophy.

This discovery provides research opportunities to develop gene therapy for

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

BEDSIDE The team introduced new surgical innovations in keyhole corneal transplantation surgery (known as Endothelial Keratoplasty) to replace the damaged layer of a cornea through a four-millimetre incision.

During the surgery, a surgical device invented and patented by Prof Tan, called the Tan EndoGlide, enables coiling of the donor's cornea through a keyhole incision for transplantation into the eye.

The loss of healthy cells is reduced because surgeons do not use the conventional manual technique.

According to Prof Tan: "Without the device, the surgeon must hold the layer, fold it into two parts, push it through the incision and unfold the layer when it is in the eye. You lose 30 to 40 per cent of the healthy cells. The easy-to-use device cuts the loss to 19 per cent."

The SERI team is also the pioneer of a complex two-stage operation using the tooth of a completely blind patient to make and transplant an artificial cornea,

The Singapore National Eye Centre (SNEC) is one of the few places around the globe performing the operation.

All SNEC "tooth-in-eye" patients regained their maximal potential vision. Prof Tan, who is also Medical Director at SNEC, stated that 60 per cent now have perfect vision.

"We are working on a project to make a completely artificial cornea using bioengineered artificial polymers so that the patient's own tooth may not be used, or for patients without healthy teeth."

POPULATION They were the first to prove that contaminated ReNu contact lens cleaning solution, the world's most popular contact lens cleaning solution at that time, created a rash of infections in several countries in 2006.

Worldwide withdrawal of ReNu saved the eyesight of thousands of users of the popular solution. •

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