ISSUE 17 APR 2017 A quarterly publication of the National University Health System

PLUS

NATIONAL CENTRES

NUH

NUP NUS SCHOOLS

ALEXANDRA CAMPUS

CLINICAL CARE Helping patients with advanced gastric cancer JURONG 4 HEALTH CAMPUS EDUCATION Readying students for 21st century healthcare 6 RESEARCH Debunking myths about antibiotics Better 9 COMMUNITY INTEGRATION Celebrating health in the heartlands 11 Better HEALTHCARE Contents INSTITUTIONAL NEWS

01 INSTITUTIONAL NEWS First Visit as Second Permanent Secretary | IAP Calls on SSHSPH | An Exchange of Ideas | Still Going Strong | NUHS to Operate Alexandra in 2018 | National Medical Research Council Awards 2017 Recipients

02 FEATURE Better Integration Better Healthcare 04 CLINICAL CARE Gut’s the Answer | Taking on Allergies | Best-Selling Doctors | Expanding Capabilities | Strengthening Paediatric Dentistry

06 EDUCATION An Eye on the Future | Reaching New Heights | A Revamped MPH Curriculum | They’re All “Ears” | Stronger Together 08 RESEARCH First Visit as Second Nurturing the Next Generation of Researchers | Eczema in Infants Linked to Tooth Decay | Antibiotics-Related Myths Debunked | Never Too Young Permanent Secretary to have a Heart Attack | New Combination Therapy for High Risk Heart Mr Ng How Yue (first from right), the new Second Permanent Attack Patients Secretary, Ministry of Health, and Ms Ngiam Siew Ying (first from left), Deputy Secretary (Policy), Ministry of Health visited National 10 COMMUNITY University Health System (NUHS) on 1 February 2017. They were given Student Healthcare Volunteers visit Pekanbaru, Indonesia | Jamiyah Partners an overview of NUHS, followed by a tour of its research and clinical NUHS to Build Capabilities | Celebrating Health in the Heartlands | facilities at Kent Ridge Campus. Strengthening Community-Based Care | Cancer Care on the Go | Heart Support Group Goes Snap-Happy | Shaping the Future of Public Health | Perfect Knots | Improving Colon Health | Supporting Organ Donation | Matters of the Heart | Every Drop Counts

Publisher National University Health System Pte Ltd is published by the Communications 1E Kent Ridge Road, NUHS Tower Block Office of the National University 119228 Health System, 1E Kent Ridge Road, Email: [email protected] Tower Block, L13, Singapore 119228. Website: nuhs.edu.sg Copyright © is held by the publishers. Editorial Committee All rights reserved. Reproduction in Eva Ho whole or in part without permission David Lee Lo Sok Ying is prohibited. Melinda Lim Eugene Low Yvonne Lin IAP Calls on SSHSPH Kenice Tay Printed in Singapore by Aaron Loh Crystal MK The NUS Saw Swee Hock School of Public Health welcomed members of KHL Printing Co. Pte Ltd. Luke Siah Valerie Tan Dawn Sim the School’s International Advisory Panel (IAP) — Prof David Heymann, Sylvia Fong MCI (P) 119/03/2017 Angeline Tan Prof Baron Peter Piot, Prof Kenneth Warner and Dr Margaret Hamburg. Astrid Khoo As part of their three-day visit from 1 to 3 February 2017, the IAP team was briefed on the School’s achievements and progress over the last Editorial Consultant five years, as well as future challenges to be faced.

Mediacorp Pte Ltd

An Exchange of Ideas Dr Vivian Lee, Dean and Chief Executive Officer of the University of Utah Health Sciences (UUHS), led a senior delegation on a visit to the NUHS from 13 to 15 March 2017. NUHS Senior Management gave the delegates an overview of the Group, as well as its strategies to overcome Singapore’s healthcare challenges. The top-ranked US university teaching hospital, in turn, shared its experience in successfully implementing Value Driven Outcomes. This initiative enables clinical decision makers to lead improvements in care FOLLOW US ON FACEBOOK/NATIONALUNIVERSITYHEALTHSYSTEM delivery taking into consideration cost, quality and patient service. National Medical Research Council Awards 2017 Recipients The National Medical Research Council (NMRC) Awards recognise clinician scientists and researchers for their outstanding achievements and contributions, and aims to support them in

The Department of Community, developing breakthrough research that benefits Occupational & Family Medicine in 1987 the Singapore population. We are proud to present the winners from NUHS!

SINGAPORE TRANSLATIONAL RESEARCH INVESTIGATOR AWARD Professor Chng Wee Joo National University Cancer Institute, Singapore NUS Yong Loo Lin School of Medicine NUS Cancer Science Institute of Singapore

CLINICIAN SCIENTIST AWARD – SENIOR INVESTIGATOR Prof Goh Lee Gan (far right) leading the toast to Associate Professor Christopher Chen commemorate 30 years of Academic Family Medicine in Singapore at the 30th Anniversary Dinner on 25 February 2017 National University Hospital NUS Yong Loo Lin School of Medicine

Still Going Strong Professor Yong Eu Leong NUS Yong Loo Lin School of Medicine National University Hospital celebrated 30 years of Family Medicine. NUS Yong Loo Lin School of Medicine Undergraduate training in Family Medicine began in Singapore in 1971 as a one-week posting to a general practice (GP) clinic and 10 CLINICIAN SCIENTIST AWARD – lectures on “Introduction to General Practice”, organised voluntarily INVESTIGATOR by the College of General Practitioners, Singapore. Thirty years on, the discipline is now a well-established Associate Professor Chan Shiao-yng undergraduate programme, as well as a postgraduate curriculum National University Hospital and Masters of Medicine (Family Medicine) examination. NUS Yong Loo Lin School of Medicine The Division of Family Medicine, NUS Yong Loo Lin School of Medicine, commemorated 30 years of Academic Family Medicine Dr David Tan Shao Peng with an anniversary dinner on 25 February 2017. The event was National University Cancer Institute, Singapore attended by Guest of Honour, Mr Chan Heng Kee, Permanent NUS Yong Loo Lin School of Medicine Secretary, Ministry of Health. NUS Cancer Science Institute of Singapore

Dr Ng Kar Hui National University Hospital NUS Yong Loo Lin School of Medicine NUHS to Operate Dr Citra Nurfarah binte Zaini Mattar National University Hospital in 2018 NUS Yong Loo Lin School of Medicine Minister for Health Mr Gan Kim Yong announced at the Ministry of (from May 15 grant call) Health Committee of Supply Debate 2017 that NUHS will operate Alexandra Hospital after Sengkang Health moves to its permanent TRANSITION AWARD location in 2018. Alexandra Hospital will complement other NUHS services Dr Feng Lei at Kent Ridge and Jurong. It will provide a person-centric health NUS Yong Loo Lin School of Medicine delivery model, in which one team of doctors, nurses and allied health professionals works closely with a patient and his or her Dr Anand Devaprasath Jeyasekharan family, and community partners. National University Cancer Institute, Singapore With a potential for redevelopment, NUHS envisions the NUS Yong Loo Lin School of Medicine Alexandra site to be a new health-empowering green campus NUS Cancer Science Institute of Singapore that will provide holistic and integrated care, as well as preserve Alexandra Hospital’s healthcare heritage.

APRIL 2017 01 FEATURE NATIONAL CENTRES

NUH

ALEXANDRA CLINICAL CAMPUS CARE RESEARCH & NUP EDUCATION Better Integration Better Healthcare A new NUHS emerges from the reorganisation of Singapore’s public heatlhcare system to provide comprehensive, integrated, seamless health and healthcare.

ur public healthcare system Eastern region — Singapore has made significant strides Health Services (SingHealth) and Oover the last few years (EHA) in realising the Healthcare 2020 have merged. Masterplan’s goal of improving the Western region — National accessibility, quality and affordability University Health System (NUHS) of healthcare. However, Singapore’s and Jurong Health Services future healthcare needs are bound to (JurongHealth) have merged. grow in volume and complexity due to our ageing population and rising By combining strengths and chronic disease burden. To get ahead talents, cluster partners can offer a of these challenges, the Ministry of fuller range of facilities and services Health (MOH) announced a major across different care settings, deploy reorganisation of Singapore’s public their resources and capabilities healthcare sector on 18 January 2017. more efficiently, and expand the Under the new system, the six career options and professional existing Regional Health Systems development opportunities available are grouped into three integrated to employees. MOH is also working clusters, each with its own network with the three clusters to ensure of polyclinics: cross-cluster information flow and Central region — National coordinated services. Healthcare Group (NHG) and The reorganisation — to be COMMUNITY Alexandra Health System (AHS) completed by early 2018 — enables have merged. patients to continue with their

02 Oral Health, Singapore); one medical centre (Jurong Medical Centre); three academic health sciences institutions Building the based at the National University of Singapore (NUS Yong Loo Lin New NUHS NUS School of Medicine, NUS Faculty SCHOOLS of Dentistry, NUS Saw Swee Hock Together School of Public Health); and a new entity, National University Polyclinics (NUP). Polyclinics play a critical role as primary care providers in delivering community-based, patient-centred care. NUP — Singapore’s third current healthcare arrangements polyclinic group — will eventually and appointments. It also puts have seven polyclinics. Five are healthcare institutions in a better already running in Bukit Batok, position to contribute towards Clementi, Choa Chu Kang, MOH’s transformation of Singapore’s Queenstown and Jurong, all of which healthcare system beyond 2020: were previously part of the NHG

from Hospital to Community, and SingHealth polyclinic groups. Concerns raised by staff at the Town Hall sessions from Quality to Value, and from Another two polyclinics will be set were addressed by CE NUHS Prof John EL Wong Healthcare to Health. up in Pioneer (by July 2017) and Bukit (third from the right) and other senior leaders of NUHS. “This reorganisation of the Panjang (by 2020). public healthcare clusters will enable Assuming the role of NUP’s To explain the rationale of the us to meet our future healthcare Chief Executive Officer (CEO) is reorganisation and address NUHS challenges,” said Mr Gan Kim Yong, Dr Lew Yii Jen, who was Senior staff concerns, CE NUHS Professor Minister for Health, in January. Director of Clinical Services at John EL Wong and other senior leaders “I am confident that we will be NHG Polyclinics. Mr Foo Hee Jug, of NUHS held Town Hall sessions on able to better optimise resources formerly CEO of JurongHealth, is 20 and 26 January 2017. Among the JURONG and capabilities, and provide now Deputy Chief Executive (Deputy questions raised were those relating to HEALTH more comprehensive and patient- CE) of NUHS and he continues to be pay structure, harmonisation of policies CAMPUS centred care to meet Singaporeans’ the CEO of Ng Teng Fong General and practices within the NUHS cluster, evolving needs.” Hospital. He serves alongside the and how to integrate the new entities three existing Deputy CEs, Mr Chua into the new NUHS. THE NEW NUHS Song Khim, Adjunct Associate Prof Wong explained that as a start, The Western region will now be Professor Joe Sim and Associate priority is being given to ensuring that under the care of NUHS. With the Professor Yeoh Khay Guan. Professor patient care continues. Functional merger of NUHS and JurongHealth, John EL Wong continues in his Integration Committees made up of the new NUHS comprises three role as Chief Executive (CE) of the representatives from both NUHS and (National University newly-incarnated NUHS, which will JurongHealth are being formed to map Hospital, Ng Teng Fong General continue with its tripartite mission of out the work that needs to be done. Hospital and Jurong Community advancing patient care, biomedical Staff will have opportunities to give Hospital); three national specialty research and health science their input on the reorganisation as well centres (National University Cancer education. The integration will also as receive regular progress updates. Institute, Singapore, National enable the new NUHS to provide Above all, Prof Wong called on University Heart Centre, Singapore comprehensive, integrated and everyone to play their part by focusing and National University Centre for seamless health and healthcare. on providing good care and “value- driven outcomes” that ultimately benefit patients. “We go back to the [fundamental] principles — trust, transparency, fairness,” he added. DRIVING PRIMARY CARE “These are tools with which we can TRANSFORMATION make good and rational decisions within NUHS to enable us to achieve the aims of the reorganisation.” A management team led by Dr Lew Yii Jen Looking ahead, we will is already in place to oversee NUP’s work even closer with the overall operations. While ensuring various healthcare partners minimal disruptions to polyclinic in the new NUHS for better operations during the transition integration of care across primary period, the team will drive a team- care to tertiary care. The key opportunities based model of patient care that aligns lie in being able to develop and strengthen the efforts of Family Physicians, care primary care to enable our population in managers, allied health professionals, the West to receive quality, integrated and hospital staff and personnel within seamless care in the community and closer NUHS institutions, as well as external to their homes.” community partners. Dr Lew Yii Jen CEO, National University Polyclinics

APRIL 2017 03 CLINICAL CARE

Gut’s the Answer Chemotherapy through the abdomen may help patients with advanced gastric cancer.

he preliminary findings of patients can go home on the same researchers from the National day. The procedure, as Professor TUniversity Cancer Institute, Jimmy So, Head of Surgical Singapore (NCIS) have shown that Oncology at NCIS describes it, is a using intraperitoneal chemotherapy in “simple, outpatient treatment”. addition to conventional chemotherapy Patients with advanced gastric may help patients with advanced cancer usually survive three to gastric cancer to survive longer and 10 months with conventional Intraperitoneal enjoy a better quality of life. treatment. But of the 22 patients Chemotherapy When intraperitoneal chemotherapy in the Phase II clinical trial at NCIS, is used, about one litre of chemotherapy with intraperitoneal chemotherapy, liquid containing Paclitaxel is inserted 16 of them survived longer than a into the abdomen. The drug then year, with half living for more than kills any cancer cells it comes into 18 months. The team’s findings contact with. However, as the drug were presented at Digestive is a large molecule, very little Disease Week held in May 2016, of it will be absorbed into in San Diego, California and the bloodstream, which published in the Journal of makes it fairly safe to use. Gastrointestinal Surgery After an hour of treatment, in March, 2017. Best-Selling Doctors A textbook on emergency medicine techniques by two associate professors from NUS Yong Loo Lin t is common wisdom that children with allergies should School of Medicine has Taking on Iavoid allergens, be these become an international cow’s milk, egg or nuts like bestseller. Guide to the cashew and pistachio. But the Essentials in Emergency Food Oral Immunotherapy (FOI) Medicine was written Allergies programme at the National by Associate Professor University Hospital (NUH) may Shirley Ooi and NUH’s Food Oral relieve parents of the burden of Associate Professor Peter Immunotherapy programme constantly checking labels and Manning, and contains foods for possible allergens. practical instructions on brings hope to children with Started in August 2015, the tackling common life- food allergies. treatment programme introduces threatening conditions. patients to a miniscule amount Assoc Prof Ooi and of a certain food allergen. The Assoc Prof Manning are amount is gradually increased also senior doctors over several months, until at the National the child increases his or her University Hospital’s tolerance to the allergen. Through (NUH) Emergency FOI, the threshold of an allergic Medicine Department. reaction is increased significantly — a child who would have an allergic reaction after taking 1/200th of a single peanut can raise that threshold to as many as 20 peanuts. The programme is led by Dr Soh Jian Yi, a Consultant at NUH’s Paediatric Allergy, Immunology and Rheumatology division. It was initially rolled out to treat allergies to cow’s milk, but will be expanded to include eggs 13-year-old Tng Shih Kai can now take about 10 to 12 peanuts after and tree nuts. completing the 10-month food oral immunotherapy programme at NUH. With him are Dr Soh Jian Yi (right) and his father, Mr Tng Yan Hui.

04 MP for Chua Chu Kang GRC (Keat Hong), Mr Zaqy Mohamad (third from left) and grassroots leaders Mr Johnny Yeo, PBM (first from left), and Mr Chua Kok Wei, PBM (second from left), visited KHFMC on 24 March 2017. COMPREHENSIVE CARE AT KHFMC

High level of care continuity Management of chronic diseases Affordability through subsidised rates and Medisave-based schemes

Keat Hong Family Medicine Clinic’s partnership with NUHS Expanding gives patients access to more services, among them eye and Capabilities mental . eat Hong residents now enjoy partnership with NUHS makes it part medical records and communicate with convenient access to quality and of a larger multidisciplinary team of NUH specialists, ensuring a high level of Kintegrated care at the newly- healthcare professionals in western care continuity. opened Keat Hong Family Medicine Singapore. This gives Keat Hong Beyond primary care, KHFMC’s Clinic (KHFMC). The facility, nestled residents convenient access to NUHS’ collaboration with its partners enables within Keat Hong Community Club, resources and expertise, including it to provide more specialised services. is the newest Family Medicine Clinic an NUH-run pharmacy. Medication With the support of optometrists and (FMC) set up in partnership with NUHS. is dispensed here at prices similar to specialists from NUH, KHFMC can treat Frontier FMC in Clementi was the first. polyclinics, and is offered at lower cost and manage patients with eye conditions In addition to common ailments to seniors and children. like glaucoma. There is also a Mood & like fever, cough and flu, KHFMC’s The partnership also allows KHFMC Anxiety Clinic run by a team of mental family doctors and nurses also manage and NUH to work together through a health professionals and supported by chronic conditions like and common IT platform. KHFMC’s doctors community partners like the Agency for high blood pressure. The facility’s can easily access NUH patients’ Integrated Care, Fei Yue and Club Heal. Strengthening Paediatric Dentistry The NUS Faculty of Dentistry welcomes its newest member, internationally recognised researcher Professor Monty Duggal. Over the years, he NUS Faculty of Dentistry’s including dental traumatology. He has Prof Duggal newly-developed Graduate published more than 130 research has been awarded TPaediatric Dentistry programme papers in international journals and is more than will be strengthened with the the author of Restorative Techniques S$ appointment of Professor Monty in Paediatric Dentistry, which has been Duggal as its advisor. The three- published in seven languages and sold 11 year course develops graduates’ more than 16,000 copies worldwide. MILLION in research understanding of all aspects of Prof Duggal joins NUS from the grants. paediatric dentistry. Leeds Dental Institute, where as As an internationally recognised Professor and Chair of Child Dental researcher, Prof Duggal will also Health, he oversaw an internationally- expand the Faculty’s research acclaimed postgraduate paediatric capabilities. His primary research dentistry programme. He also led interests are cariology and translation the Institute’s Trauma and research in clinical paediatric dentistry, Transplantation service.

APRIL 2017 05 EDUCATION

An Eye on 1,200 PARTICIPANTS from 33 countries attended APMEC 2017, the Future making it the biggest Readying students for 21st-century healthcare was a central medical education conference in the theme of the Asia Pacific Medical Education Conference, Asia-Pacific region the region’s largest.

ow can medical educators Keynote speakers included thought keep up with rapidly changing leaders like Professor Matthew Gwee Htechnology and demographic from CenMED and Professor Ronald disruptions? These were some of M Harden, Professor of Medical the issues tackled at the 14th Asia Education (Emeritus) at the University Pacific Medical Education of Dundee. In line with this year’s Conference (APMEC), which was theme of healthcare in a global context, hosted by the Centre for Medical the sessions reviewed current trends, Education (CenMED), Yong Loo Lin issues and priorities and strategies in School of Medicine. Themed medical education. “From Globalisation of Education Speakers also stressed the to Globalisation of Healthcare”, importance of nurturing a new the five-day conference took place generation of healthcare practitioners from 11 to 15 January 2017 at the who are competent and well-equipped National University of Singapore to deliver 21st-century healthcare. EXAMPLES OF (NUS). It was co-organised by “We hope (that this) global view DEMOGRAPHIC Singapore’s Ministry of Health and of medical education will not only DISRUPTION INCLUDE: the Accreditation Council of Graduate serve to educate our community of Medical Education (International) of educational scholars and teachers, but Longer life expectancies the United States. that it will also serve as inspiration to Expanding ageing populations As in previous years, participants them to stay current for the benefit of The rise of ‘lifestyle’ diseases like obesity attended a series of plenary talks, our students and, ultimately, for our and type 2 diabetes workshops and panel discussions. respective nations,” said Prof Gwee.

06 Like-minded healthcare professionals across various restructured hospitals at the inaugural NTFGH Nursing Symposium. A Revamped MPH Curriculum The revised NUS Saw Swee Hock School of Public Health Masters in Public Health (MPH) programme will be launched in the upcoming academic year (AY2017/2018). Taking into consideration feedback from employers, alumni, students and faculty, the revised MPH programme should better serve the training needs of public health professionals in Singapore and the region. All students will now complete the programme within 12 months (full-time) or 24 months (part- Reaching time). Core modules will be complemented by electives structured within three focus areas in Health Policy and Healthcare Delivery, Epidemiology, Health Promotion and Global Health and an 8MC practicum New Heights project. The revised specialisation in Occupational Nurses kept abreast of developments in Health will also be offered and caters to both healthcare practices at Ng Teng Fong General medically and non-medically qualified applicants. Hospital’s first-ever Nursing Symposium.

g Teng Fong General Hospital plenary sessions that gave participants (NTFGH)’s inaugural Nursing an insight into the latest trends and NSymposium attracted more developments in healthcare practices. than 300 delegates from various In addition, nurses also attended healthcare partners, including hospitals, specialised workshops where they intermediate and long-term care learnt about harnessing technology institutions and nursing homes. to improve patient care and work

Themed “Building Capability for Quality processes. Prof Dale Fisher (seated, third from right) represented and Safety”, the symposium was held The symposium also included NUH & NUS at the GOARN Meeting of Training between 9 and 10 March 2017. sharing sessions that facilitated Partners, held in London from 13 to 14 February 2017 Over two days, NTFGH staff as discussions on the challenges and well as external speakers led several issues facing the sector. Stronger Together NUS took part in an international dialogue on response strategies to global disease outbreaks.

he NUS was among 20 global healthcare and medical institutions that participated in the recent TGlobal Outbreak Alert and Response Network (GOARN) Meeting of Training Partners, held in London from 13 to 14 February 2017. Other notable attendees included the World Health Organization (WHO), US and They’re Africa CDC, Robert Koch Institute of Germany, universities from most continents and the London School of Hygiene and Tropical Medicine. All “Ears” At the two-day meeting, participants explored how global response to disease outbreaks could At the inaugural World Hearing Day be enhanced through training and capacity development. Research Symposium, participants got a The plan is for a three-tiered competency based training programme that all deployees in outbreaks should better understanding of the latest research undertake. “Investment in training is giving our staff the in otorhinolaryngology. best chance to save lives in the field,” said Professor Dale Fisher, Vice Chair and Training Lead, GOARN Steering TFGH marked World Hearing Day by co-organising the World Hearing Committee and Chair, Infection Control, at the National Day Research Symposium with Ear Science Institute Australia. The full- University Hospital. Nday conference on 3 March 2017 attracted a good mix of ENT surgeons, GOARN is a key international outbreak response audiologists, students and Allied Health Professionals. Through the day’s coordination mechanism, involving WHO, healthcare four sharing sessions, participants better understood the implications of new networks, United Nations agencies and non governmental research into ear and hearing health. Among the topics discussed were tissue organisations. It devises strategies for the global regeneration in the ear, and trends in hearing aid usage in Singapore over the response to outbreaks of deadly diseases like Ebola and last decade. yellow fever.

APRIL 2017 07 RESEARCH

Nurturing the NUHS SUMMIT Next Generation RESEARCH PROGRAMMES of Researchers 1 Cancer The Summit Research Programmes train, test and stretch 2 Metabolic Disease the capabilities of young, budding clinician-scientists. 3 Tuberculosis

arly-career scientists are being nurtured to become the next generation of biomedical 4 researchers under the Summit Research Programmes (SRP) of the National University Synthetic Biology EHealth System (NUHS). The aim of the initiative, launched on 21 October 2016, is to 5 achieve significant improvements in disease understanding as well as clinical practice and 6 GUSTO* Birth innovations that will improve health outcomes, and lead to societal and economic benefits for Cohort Study Singapore. SRP draws on the participation of clinician-scientists and medical experts across

the NUHS. Six research programmes are part of the SRP (see box). * Growing Up in Singapore Towards Healthy Outcomes Eczema in Infants Linked to Tooth Decay ew findings, released in Technology and Research (A*STAR). January this year, indicate that In a paper published in The Journal Nbabies with eczema are three of Allergy and Clinical Immunology ECZEMA times more likely to develop tooth (JACI), the research team outlined how is one of the decay at two and three years of age. they found the link between eczema most common The relationship between eczema, or and tooth decay, and the need for skin conditions atopic dermatitis (AD) and tooth decay timely intervention to ensure early worldwide and is largely unknown, and this is the first detection and prevention of tooth affects about time a link between the two diseases decay in toddlers. The study was has been discovered. The research part of the Growing Up in Singapore was led by the National University of Towards healthy Outcomes (GUSTO)

Singapore (NUS) Faculty of Dentistry, programme, a nationwide birth cohort 1 IN 5 which is part of the NUHS, and study involving collaborators from school-going children Singapore Institute for Clinical Sciences the NUS, NUHS, KK Women’s and in Singapore. (SICS) of the Agency for Science, Children’s Hospital and SICS.

08 Antibiotics- Never Related Too Young Myths to have a Debunked Heart Attack Misconceptions about antibiotics are n a study of 15,000 heart attack cases in Singapore, common, with a substantial minority cardiac investigators from National University Heart abusing these drugs, a study reveals. ICentre, Singapore (NUHCS) , National Heart Centre Singapore, , Changi General study has uncovered misconceptions and inappropriate practices Hospital and Hospital have found related to knowledge and use of antibiotics in Singapore among that heart attack occurring before 40 years of age in Apatients attending primary care clinics. The results of the NUHS- Singapore is uncommon. Of the 15,000 patients studied, led study — driven by medical students from the NUS Yong Loo Lin 601 cases (approximately four per cent of heart attack School of Medicine with the guidance of Public Health, Family Medicine patients were less than 40 years of age. and Infectious Disease specialists — were published in November 2016. That being said, the same study shows that young The researchers hope that the findings can be used to educate the people who suffer a heart attack have a significantly public about when antibiotics are necessary, and to stem the spread of higher chance of dying compared with other young antibiotic-resistant bacteria. people of the same age. This increased risk of dying emerges as early as seven to eight years after the heart KEY FINDINGS: attack occurs, and worsens progressively from eight years onwards. This means that young persons with a heart % 12% 78 attack have a significantly shorter life span than young 14% people in general. 33% 50% 7% 65% A third of patients 50 per cent of Other wrong from the study those expecting antibiotic practices RISK FACTORS expect antibiotics antibiotics in the uncovered to be prescribed study would ask Misconceptions include “keeping Prominent risk factors for by their GPs for their doctors to by the majority of antibiotic stocks young heart attack patients are: common ailments prescribe the respondents who at home” (12%), like coughs, sore medication or would did not know that “taking leftover throats, runny see another doctor “antibiotics are antibiotics” (14%), nose and blocked if antibiotics was ineffective against and circulating nose (ie Upper not prescribed. viruses” (78%) and prescribed antibiotics Respiratory Tract who thought that among other family Infection, URTI- “antibiotics cure members (7%). related symptoms). URTI faster” (65%).

Family history of 1 coronary heart disease New Combination and Therapy for High Risk Heart Attack Patients esults of a Dyslipidemia statin therapy. This once-daily 2 Smoking International Study (DYSIS), combination tablet effectively Rled locally by Associate lowers cholesterol through its Professor Poh Kian Keong, dual mechanism of action: it Senior Consultant, Department of treats the two main sources It is therefore important for young persons with a family Cardiology, NUHCS, showed that of cholesterol in the blood by history of coronary heart disease to go for early health more than 70 per cent of patients inhibiting the absorption of screening for high cholesterol levels, high blood pressure from thirty countries worldwide with cholesterol in the digestive tract and diabetes, and to get these treated early. This study also post-acute coronary syndrome (ACS) — through ezetimibe — and the serves to caution the young about the harmful effects of and stable coronary heart disease production of cholesterol in the smoking and further reinforces that there is no ‘safe’ level of (CHD) were unable to achieve low- liver through atorvastatin. The smoking. It is an illusion to think that smoking will not cause density lipoprotein (LDL) cholesterol DYSIS study results were revealed major harm to young people. targets despite diet, exercise, and in February 2017.

APRIL 2017 09 COMMUNITY

Student Healthcare Volunteers visit Pekanbaru, Indonesia ifteen undergraduates from the National out for symptoms that warrant medical attention. University of Singapore (NUS) Yong Loo Lin They also conducted health screenings and held FSchool of Medicine (NUS Medicine) made a trip demonstrations to teach the villagers about to Riau Province in Sumatra in late 2016 to provide personal hygiene, such as the correct way to basic healthcare to the residents of its capital wash hands and brush teeth. The group also Pekanbaru. They were part of the 25-strong team helped the villagers to clean their homes and in a student-led trip, in a community service project undertook some maintenance work. They also called Project Sukacita, from 4 to 11 December 2016. taught English and held art and craft lessons for The other volunteers were Indonesian students younger villagers. from the Singapore Management University and “Taking part in this project allowed me to Nanyang Technological University who went along appreciate how much I have learnt since entering as translators. medical school, and how everything I have learnt The villagers do not often get to see a doctor, has such important applications,” said Jaron Koh, so the NUS Medicine students taught them to look a Year 2 NUS Medicine student.

amiyah Nursing Home (JNH) to conduct their own Chronic has expanded its eldercare Disease Management Programme Jamiyah Partners Jservices, thanks to a workshops in the community Memorandum of Understanding to empower patients and NUHS to Build (MOU) that JNH has signed with caregivers with self-management four partners to deliver integrated techniques. community care. NUHS and Jamiyah will Capabilities The partners are the National jointly develop an appointment University Health System (NUHS), consolidation programme to National Healthcare Group help JNH patients consolidate Diagnostics (NHG Diagnostics), their multiple visits to the NUHS Muslim Healthcare Professionals Specialist Outpatient Clinic Association (MHPA) and the West (SOC) and explore ways for such Coast Constituency (WCC). patients to be seen by one single Under the MOU, JNH works doctor where possible. with NUHS on NUHS’ Infectious The MOU signing ceremony Diseases Community Programme, was held at JNH on 25 February to develop, adapt and implement 2017 and graced by Minister relevant and appropriate infection for Trade and Industry Mr S prevention and treatment Iswaran. It also coincided with (Seated from right): Dr Tan Xin Quan and Dr Sue-Anne Toh from NUHS Regional Health System Planning Office signing the MOU protocols in the home. the official opening of the in the presence of Minister for Trade and Industry Mr S Iswaran Through this collaboration, JNH Senior Care Centre and (standing on the right). NUHS helps to train JNH staff Dementia Ward.

10 Strengthening Community-Based Care

community cares for its residents — and to strengthen such care, the NUHS A set up a series of meetings between management staff and Grassroots to discuss and define collaborative steps to achieve better health for their residents. NUHS Chief Executive Professor John EL Wong, Deputy MP Vivian Balakrishnan (fifth from left), MP Liang Eng Hwa and Mayor Dr Teo Ho Pin visited the NUHS Primary Care Network booth. Chief Executives Mr Chua Song Khim and Adjunct Associate Professor Joe Sim; and JurongHealth Group Chief Operating Officer Ms Joanne Yap Celebrating Health met Bukit Batok Advisor Mr Murali Pillai on 8 January 2017, and Clementi Advisor Dr Tan Wu Meng on 24 January 2017. Discussions in the Heartlands centred on the healthcare and social support esidents of Bukit Panjang enjoyed a fun day at Health Fiesta @ currently available within the constituencies, Bukit Panjang on 5 March 2017. The event was held at Bukit Panjang and explored potential collaborative efforts to RCommunity Club and kicked off with a morning mass brisk-walk improve residents’ health. exercise. There were also health talks and health-themed exhibitions. The Chinese New Year celebration, organised The NUHS set up a Primary Care Network (PCN) booth at the event. The by the Jelapang Residents’ Committee and PCN comprises General Practitioners, nurses and primary care coordinators held on 12 January 2017, was another opportunity who provide medical, social and financial support to patients with chronic for such engagement. During the event, NUHS medical conditions. At the booth, visitors could learn more about the Deputy Chief Executives Adjunct Assoc Prof Sim available healthcare services and how such a network could benefit them. and Mr Chua interacted with General Practitioners They could also have their blood pressure, height and weight measured, and (GPs) from the PCN @ Bukit Panjang. PCNs were their Body Mass Index (BMI) and risk of chronic diseases assessed for free. set up to bring together GPs, nurses and primary A free colorectal cancer screening kit was also made available for those care coordinators to form a support network for aged 50 and above. residents with chronic medical conditions. The event was jointly organised by Bukit Panjang, Senja-Cashew and Zhenghua Community Centre, and supported by Al-Iman Mosque. Cancer Care Heart Support Group on the Go Goes Snap-Happy ith the recent launch of the NCIS On The Go aving a hobby helps in keeping oneself active and healthy. programme, cancer patients are now able to receive Towards this end, Ng Teng Fong General Hospital’s Art&Health Wtreatment at satellite clinics located near their homes. Hprogramme organised a nature photography workshop on 4 March Convenient locations aside, they are able now to sidestep the 2017 for the budding shutterbugs among their patients. 15 members of waiting time at hospitals. the NTFGH’s Heart Support Group – a platform for patients to connect, These satellite clinics are situated island-wide and include encourage, lend support and motivate each other – attended a workshop community centres, recreational centres and medical centres conducted by Mr Fong Chee Wai, President of the Nature Photographic where oncology nurses from the National University Cancer Society, Singapore, at the Singapore Botanic Gardens. Institute, Singapore (NCIS)’s Home Care team are stationed. At the workshop, participants learnt about various camera functions and These nurses provide basic treatment care and services, such picked up tips on how to compose a photo. The gloomy weather did nothing as changing dressings, giving injections, taking blood, and even to dampen their enthusiasm, and they went around the Gardens to practise administering chemotherapy treatment (for selected patients). applying their new knowledge. The workshop concluded with a group A schedule is updated quarterly on the NCIS website and review, during which participants shared their snaps and gave each other patients can phone in or email for an appointment, at least a constructive feedback. day in advance. The NCIS On The Go programme was launched on 1 February 2017. There are plans to offer other treatments such as subcutaneous chemotherapy treatments.

APRIL 2017 11 COMMUNITY Shaping the Future of Public Health Celebrate public health achievements made in Singapore and help the next generation of public health professionals by supporting SSHSPH’s fundraising dinner.

very eligible individual with a passion for disease prevention deserves an equal opportunity to pursue a desired education at the National University of Singapore E(NUS)’s Saw Swee Hock School of Public Health (SSHSPH). With that in mind, to raise money for its Help-A-Student Fund that goes towards building bursaries and scholarships, as well as subsidise higher-learning programmes, the School will hold its fundraising dinner on 19 May 2017 at the Della and Seng Gee Guild Hall, National University of Singapore Society, Kent Ridge Guild House. Themed “Celebrating Public Health”, the event will honour the public health fraternity’s camaraderie, dedication and partnership that enabled significant milestones achieved over the past decades. Over 250 public health leaders and colleagues are expected to attend the event.

To find out how you can support, please contact Ms Czarina Buenaventura at [email protected] or 6601 3450.

Improving Colon Health Perfect Knots Guard against colorectal cancer with A community project brings Jurong regular screening and a healthy lifestyle. residents together to create fabric olorectal cancer is a artworks for Ng Teng Fong cancer of the large WHY SCREEN? General Hospital (NTFGH). intestine (colon and C Screening can detect rectum). Most colorectal cancers early cancer or polyps eyond decorative value, art can be a therapeutic and begin as small non-cancerous expressive tool to promote healing and comfort for growths (polyps) which may later Polyps can be removed Bpatients and their families. With this intention in mind, become cancerous. Early cancer if treated, NTFGH’s Arts&Health programme actively collaborates with To remind visitors and can be cured local artists and the community to co-create visual art for patients about Singapore’s permanent display in NTFGH and Jurong Community Hospital leading cancer and what they (JCH). “Ties that Bind” is a series of 15 fabric collages by local can do to improve colon health, visual artist Ms Tay Bee Aye — together with residents of Jurong these educational displays were East View RC and Taman Jurong. placed by National University To create the artworks, fabric pieces of different colours and Hospital to enhance knowledge, textures were collected and then knotted to form gardenscapes, raise awareness and encourage blue skies and 3D insects. early detection. Ms Tay hoped that the art-making process would also build bonds among strangers and encourage unity in the community. A free Faecal Immunochemical Test (FIT) kit is available to COLONOSCOPY Ties That Bind is on display from now till end-June 2017 at Art Singaporeans and Permanent is the best way to detect and remove polyps Wall opposite Discharge Pharmacy, Level 2, Tower B, Ng Teng Residents aged 50 and above (growth on the inner Fong General Hospital. The artworks will be installed permanently at Colorectal Centre, Level 16, surface of the colon). in NTFGH Ward B8 at the end of the 6-month exhibition. NUH Medical Centre.

12 Supporting Organ Donation Matters of NUS students were treated to informative sharing sessions the Heart by recovered organ transplant patients at Game of Go Red for Women is a global Survivors. The fundraising event of the National University annual campaign to raise Centre for Organ Transplantation (NUCOT) was held at awareness of women and University Town on 16 February 2017. heart disease. As part of International Women’s Day and Mothers’ Day, the Women’s Heart Health Clinic of the National University Heart Centre, Singapore has events lined up for May.

Organised in partnership with National University Another highlight was a forum for tertiary students of Singapore (NUS) Medical Society and TeamNUS, to share their views on organ donation. The session the event featured a treadmill challenge. Every aimed to debunk myths of organ transplantation THE HEART OF A WOMAN 1km ran was matched with a $10 donation. After and inspire undergraduates to do their part for six hours, 150 treadmill runners raised more than the cause. PRECEPTORSHIP COURSE $6,000 to assist needy transplant patients. 6 May 2017, 8.30am to 1.30pm Seminar Rooms T09-03/04, Level 9, NUHS Tower Block This seminar for medical students and healthcare professionals aims to educate and foster action about prevention, identification and treatment of women’s cardiovascular diseases, as well as offer new understandings on how the disease affect men and women differently. To register, call 6772-3282 or Through games, participants learnt different facts NUCOT’s very own band, The New Chords, formed and information on organ donation, including the by organ transplant patients, healthcare profession- email [email protected] Human Organ Transplant Act (HOTA). als of NUCOT, and NUS Medical Society students, entertained the audience with their performance. HEALTHY MUMMY, HEALTHY FAMILY SYMPOSIUM 6 May 2017, 10.30am to 12.30pm Every Drop Counts Taurus Ballroom, Level 1, Staff of NTFGH and Jurong Community Hospital (JCH) Marina Mandarin Singapore set an example by joining members of the public Find out about women and heart disease and to donate blood on 24 February 2017. Many were learn some nutrition tips for the family from first-time donors. , Ms Valerie Teong. Singapore’s top bento artist will be there to conduct a Hearty Bento Workshop for selected participants. I’m saving lives in the ICU every day, but this is different!” Tickets at www.sistic.com.sg/events/chealth0517 I hope to pay it forward. In future, Jomilyn Cabali Senior Staff Nurse, if I happen to need blood, I hope ICU, NTFGH someone will do the same for me.” TAKE IT TO HEART Irene Chan Friends of JurongHealth Lower the risk of cardiovascular I’m still saving lives at the age Volunteer diseases with the following tips: of 64. This makes me feel great! I’m proud of myself for Take part in moderate physical activity doing this.” such as brisk walking for at least 30 min Anita Kwan each day, five times a week. Porter, NTFGH & JCH As a doctor, I know the importance of blood and that’s why I want to do Control your cholesterol and sugar intake this regularly.” by choosing foods such as whole- and Dr Vivekandan multi-grains products, fruits, vegetables, I’m a nurse and I see blood often Panchalingam nuts, and fatty fishes including salmon, but donating blood still makes me Medical Officer, mackerel and albacore tuna. nervous. This is my first time NTFGH donating and I’ll Drink in moderation. Women should limit do this again.” their alcohol intake to no more than two Elizabeth Hau standard drinks a day. Enrolled Nurse, JCH Avoid smoking. CALLING FOR VOLUNTEERS FOR HEPATITIS B STUDY

he liver is a vital human organ. virus (HBV) is available, but people TIt converts the food we eat into who are already infected can at best energy; it filters blood to get rid of control their condition by taking toxins; and it helps in digesting and antiviral drugs. removing waste products from the The National University Health body. Hepatitis — the inflammation System (NUHS) is leading research or swelling of the liver — would studies about Hepatitis B — and we disrupt these functions and affect an are looking for suitable volunteers. individual’s ability to survive. If you are 21 to 71 years old and HBV- No cure exists as yet for hepatitis B. positive for longer than six months, A preventive vaccine for hepatitis B call us now to be a part of it.

ABOUT THE STUDY Aim: To discover the key triggers leading to long term immune control of Hepatitis B as well as to improve the rates of patient follow up Research Partners: Agency for Science, Technology and Research (A*STAR); National University of Singapore; Duke–NUS Medical School; Singapore General Hospital; Tan Tock Seng Hospital; and Duration: 5 years Benefits: Free lab tests and consultations + possible compensation for travel expenses

For more info, call 6772 5715 / 9889 4164 or visit www.facebook.com/nuhshepatitistrials.

THIS STUDY IS IMPORTANT BECAUSE: QUICK FACTS ON HBV Many people infected with HBV feel well and do not show symptoms such as jaundice (yellowing of the skin and eyes), dark-coloured urine and joint pain. They may A virus found in the unknowingly pass the virus to others. blood and other bodily fluids of a person About 160,000 Singaporeans, or 3.6% of the population, suffer from HBV infection, most of whom are unaware they are carriers. Transmitted through Liver cancer is the third most common cancer in Singapore. direct contact with bodily fluids, sexual Worldwide, some 240 million people have chronic hepatitis B and contact or unsanitary 1.4 million people die each year from HBV-related liver diseases. sharing of needles