Changi General Hospital – Eastern Health Alliance Scientific Meeting 2013 Academic Medicine: Thinking Across, Moving Ahead 22 – 23 November 2013 Programme Book WELCOME MESSAGE Welcome to the Changi General Hospital-Eastern Health Alliance Scientific Meeting 2013 (CGH - EH Alliance Scientific Meeting 2013). This event will bring together the various disciplines and professions in Changi General Hospital as well as the Eastern Health Alliance (EH Alliance). The theme of this Scientific Meeting is: "Academic Medicine - Thinking Across, Moving Ahead". The focus is thus on the impact of academic medicine and how it complements the clinical aspects of medicine to contribute to improved patients' outcomes and how it would influence the quality of doctors for generations to come. We are pleased to have keynote speakers from our academic partners - the Singapore University of Technology and Design (SUTD) and Chang Gung Memorial General Hospital (CGMGH) as we celebrate our journey towards excellence in academic medicine. In addition, we have invited a prestigious and prominent panel of speakers, both locally as well as internationally, to share with us their experience and expertise as we strive towards improving healthcare and patient outcomes through unique innovation, quality research, top-notch healthcare education and excellent clinical practice. The Oral and Poster Competition has received an overwhelming number of abstract submissions for the various tracks. The winning projects and accepted submissions are on display at the CGH Atrium. You may also read the abstracts in this e-booklet. We would like to thank our committee members, as well as everyone who have helped in one way or another for their time and effort in organizing this meeting. Have a fruitful meeting! Dr Yuen Heng Wai Organising Chairman CGH - EH Alliance Scientific Meeting 2013 1 TABLE OF CONTENTS Welcome Message Programme at a Glance Clinical Track Clinical Symposium - Presenters’ Abstract and Bioketch Geriatric Fractures and Osteoporosis - A Multidisciplinary Symposium - Presenters’ Abstract and Bioketch Gastrointestinal Endoscopy Course & Soft Tissue Handling Course - Presenters’ Abstract and Bioketch Sleep Symposium & Workshop - Presenters’ Abstract and Bioketch Integrated Airway Symposium - Presenters’ Abstract and Bioketch Education Track Education Symposium - Presenters’ Abstract and Bioketch Education Workshops Presenters’ Abstract and Biosketch Innovation Track Presenters’ Abstract and Biosketch Research Track Presenters’ Abstract and Biosketch Sports Medicine Track Presenters’ Abstract and Biosketch Abstract of Presenting Authors Best Oral Abstract (Clinical Medicine) Best Oral Abstract (Innovation) Best Oral Abstract (Research) Best Poster Abstract (Clinical Medicine) Best Poster Abstract (Education) Best Poster Abstract (Research) Acknowledgements 1 3-6 7 8-9 10 - 18 19 - 20 21 - 28 29 - 30 31 32 - 34 35 - 40 41 42 - 45 _46 47 - 48 49 - 54 55 55 - 57 58 - 60 61 - 71 72 - 74 75 - 83 84 - 85 86 - 91 _ 92 - 98 99 - 109 110 - 118 119 - 143 144 - 155 156 - 187 188 PROGRAMME AT A GLANCE 21 November 2013, THURSDAY BEST ORAL PAPER AWARD 0900 – 1230 Best Oral Paper Award - Innovation Venue: CGH Centre For Innovation @ Training Centre Level 1 1100 – 1230 Best Oral Paper Award - Clinical Medicine Venue: CGH Lecture Room @ Training Centre, Level 1 1400 – 1515 Best Oral Paper Award - Research Venue: CGH Seminar Room @ Level 2 BEST POSTER AWARD Whole Day Best Poster Award - Clinical Medicine Best Poster Award - Education Best Poster Award - Research Venue: Changi General Hospital Atrium, Level 1 CONCURRENT SYMPOSIUMS / WORKSHOPS 0900 – 1730 Research Symposium Venue: CGH Tutorial Room @ Training Centre Level 1 3 PROGRAMME AT A GLANCE 22 November 2013, FRIDAY 0815 – 0850 Registration & Morning Tea (All guests to be seated by 0850) 0900 – 1100 Official Opening of CGH- EH Alliance Scientific Meeting 2013 CGH Auditorium Training Centre, Level 1 Opening Ceremony Guest of Honor: Mr Gan Kim Yong Minister for Health Keynote address by Professor Thomas Magnanti President, Singapore University of Technology & Design "Educating Technology Leaders for Design-Driven Innovation" Keynote address by Professor Chen Chao-Long Superintendent, Kaohsiung Campus, Chang Gung Memorial Hospitals & University "Innovation, Education and Social Responsibility of a Surgeon: My Personal Perspectives" *By invitation only 4 PROGRAMME AT A GLANCE 22 November 2013, FRIDAY 1130 – 1300 Concurrent Symposiums / Workshops 1145 – 1445 Education CGH, Lecture Room Training Centre, Level 1 Innovation CGH, Centre for Innovation Training Centre, Level 1 Clinical Medicine CGH, Seminar Room Level 2 Orthopedics SACH Seminar Room SACH Level 2 1300 – 1400 Lunch 1400 – 1700 1400 – 1730 1400 – 1610 Concurrent Symposiums / Workshops 1400 – 1700 Education Workshop Changi Simulation Institute Training Centre, Level 1 Sports Medicine CGH Auditorium Training Centre, Level 1 Innovation CGH, Centre for Innovation Training Centre, Level 1 Gastroenterology Workshop CGH, Seminar Room Level 2 5 PROGRAMME AT A GLANCE 23 November 2013, SATURDAY 0900 – 1630 0900 – 1100 0900 – 1225 1400 – 1600 0800 – 1630 1400 – 1600 Concurrent Symposiums / Workshops 1000 – 1210 Simulation Teaching Workshop Changi Simulation Institute Training Centre, Level 1 Research Symposium CGH, Seminar Room Level 2 Gastrointestinal Endoscopy Course (Hands-on training course) CGH, Skills Lab Basement 2 Sleep Symposium CGH Auditorium Training Centre, Level 1 Sleep Workshop CGH, Seminar Room Level 2 Soft-tissue Handling Course CGH Lecture Room Training Centre, Level 1 Integrated Airway Lecture CGH, Centre for Innovation Training Centre, Level 1 6 Clinical Medicine Track 21 - 23 November 2013 7 CLINICAL MEDICINE TRACK Clinical Medicine Symposium 22 November 2013, FRIDAY Changi General Hospital Seminar Room, Level 2 Chairperson: Associate Professor Ang Tiing Leong Chief & Senior Consultant, Department of Gastroenterology Deputy Head of Research, Clinical Trials & Research Unit 1130 - 1150 Tackling Obesity- Perspective of a Gastroenterologist Dr Jeannie Ong Consultant, Department of Gastroenterology Changi General Hospital 1150 - 1210 Colorectal Cancer Surgery: Maximising Success and Minimising Morbidty Dr Kevin Sng Consultant, Department of Surgery Changi General Hospital 1210 - 1230 Fish Oil in Parenteral Nutrition Ms Han Hsien Hwei Senior Clinical Pharmacist, Pharmacy Changi General Hospital 1230 - 1250 Nutrition for the Trauma Patient from the Perspective of a Trauma Nurse Ms Serena Koh Ee Ling Trauma Nurse Coordinator, Nursing Changi General Hospital 1300 - 1400 LUNCH 1400 – 1405 Opening: Master Class in Image Enhanced Endoscopy A/Prof Ang Tiing Leong Chief & Senior Consultant, Department of Gastroenterology Deputy Head of Research, Clinical Trials & Research Unit Changi General Hospital 1405 – 1415 Overview of Image Enhanced Endoscopy Dr Andrew Kwek Consultant, Department of Gastroenterology Changi General Hospital 8 CLINICAL MEDICINE TRACK Clinical Medicine Symposium 22 November 2013, FRIDAY Changi General Hospital Seminar Room, Level 2 1415 – 1435 1435 – 1455 1455 – 1515 1515 – 1530 1530 – 1550 1550 – 1610 1610 Image Enhanced Endoscopy of Esophagus A/Prof Noriya Uedo Department of Gastrointestinal Oncology Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan Image Enhanced Endoscopy of Stomach A/Prof Noriya Uedo Department of Gastrointestinal Oncology Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan Exercise in Upper GI Image Enhanced Endoscopy A/Prof Noriya Uedo Department of Gastrointestinal Oncology Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan Tea Break Image Enhanced Endoscopy of Lower GI: Kudo, Sano and NICE A/Prof Rajvinder Singh Senior Consultant Gastroenterologist, The Lyell McEwin Hospital Clinical Associate Professor, Department of Medicine University of Adelaide, Australia Exercise in lower GI Image Enhanced Endoscopy A/Prof Rajvinder Singh Senior Consultant Gastroenterologist, The Lyell McEwin Hospital Clinical Associate Professor, Department of Medicine University of Adelaide, Australia Closing Remarks A/Prof Ang Tiing Leong Chief & Senior Consultant, Department of Gastroenterology Deputy Head of Research, Clinical Trials & Research Unit Changi General Hospital 9 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1130 hrs - 1150 hrs Tackling Obesity - Perspective of a Gastroenterologist Abstract unavailable at time of print. PRESENTER’S BIOSKETCH Dr Jeannie Ong Consultant Gastroenterologist Changi General Hospital, Singapore Dr Jeannie Ong is currently working as a consultant gastroenterologist in Changi General Hospital, Singapore. She has had extensive training in both gastroenterology as well as internal medicine, and has obtained dual accreditation as a specialist in both gastroenterology and general internal medicine in the UK. Her main areas of interest are nutrition and inflammatory bowel disease. Dr Jeannie Ong is currently an active member of the nutritional support team. 10 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1150 hrs - 1210 hrs Colorectal Cancer Surgery: Maximising Success and Minimising Morbidty Abstract not available at time of print PRESENTER’S BIOSKETCH Dr Kevin Sng Consultant General Surgery Changi General Hospital, Singapore Dr Kevin Sng is a Consultant surgeon from the Colorectal Service under the Department of Surgery in Changi General Hospital. He is a Clinical Senior Lecturer with the Yong Loo Lin School of Medicine, National University of Singapore and a Clinical Physician Faculty Member under the Singhealth Residency Program. He was conferred Membership to the Royal College of Surgeons, Edinburgh in 2005 and obtained his Fellowship in 2010. He completed his HMDP Fellowship in Robotic and Laparoscopic Colorectal Surgery in Dec 2012 under Professor Kim Seon Hahn from the Division of Colorectal Surgery in Korea University Anam Hospital in Seoul, Korea. 11 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1210 hrs - 1230 hrs Fish Oil in Parenteral Nutrition Lipid emulsions for use in parenteral nutrition have been evolving gradually over the years. This lecture explores the purported benefits of fish oil, a novel ingredient in lipid emulsions, and examines how it holds up to the light of clinical trials. PRESENTER’S BIOSKETCH Ms Han Hsien Hwei Senior Clinical Pharmacist Pharmacy Changi General Hospital, Singapore Ms Han Hsien Hwei is a senior clinical pharmacist at Changi General Hospital, and an integral part of the Parenteral Nutrition Team. After graduating from the National University of Singapore with an honours degree, she went on to achieve board certification in Nutrition Support from the Board of Pharmacy Specialties (USA) in 2005. She has also been board certified as a Pharmacotherapy Specialist since 2009. Ms Han was a recipient of the American College of Clinical Pharmacy Heart Failure Traineeship and the Singapore Ministry of Health Specialty Residency Scholarship in Nutrition Support, which led to her spending some time in America for her post-graduate training. In addition to clinical practice, she has been actively involved in clinical trials and education. She was also part of the faculty for the Total Nutrition Therapy Course, which is a post-graduate course for physicians in Southeast Asia. 12 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1230 hrs - 1250 hrs Nutrition for the Trauma Patient from the Perspective of a Trauma Nurse Ms Serena Koh Ee Ling Trauma Nurse Coordinator, Nursing, Changi General Hospital Abstract and Biosketch unavailable at time of print. 13 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1405 hrs - 1415 hrs Overview of Image Enhanced Endoscopy Image-enhanced endoscopy comprise of various methods of enhancing contrast during endoscopy using dye, optical or electronic methods. The dye-based method include the use of Lugol’s solution, methylene blue or indigo carmine. Equipment-based methods include narrow-band imaging, flexible spectral imaging color enhancement and i-scan. With these methods, gastrointestinal mucosal lesions are better detected and characterized during endoscopy. PRESENTER’S BIOSKETCH Dr Andrew Kwek Boon Eu Consultant Gastroenterology Changi General Hospital, Singapore Dr. Andrew Kwek Boon Eu graduated from the Faculty of Medicine, National University of Singapore in the year 2000 and obtained his Master of Medicine (Internal Medicine) and MRCP (UK) in 2004. In 2008, he completed his specialist training in Gastroenterology and subsequently spent an additional year in Mumbai, training under Dr Amit Maydeo in advanced therapeutic endoscopy, including ERCP and EUS. He is currently Consultant Gastroenterologist in Changi General Hospital, serving the eastern sector of Singapore, with special interests in pancreatic and biliary diseases, advanced ERCP/EUS techniques and image-enhanced endoscopy. He also serves in the Gastroenterological Society of Singapore’s Executive Committee and remains active in medical education. He is the Associate Program Director of the SingHealth Gastroenterology Senior Residency Program and a senior clinical lecturer of the Medicine Faculty, National University of Singapore. He remains active in clinical research and has publications in various medical journals including Gastrointestinal Endoscopy, Journal of Gastroenterology and Hepatology, and Endoscopy. 14 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1415 hrs - 1435 hrs Image Enhanced Endoscopy of Esophagus Effective screening target of esophageal squamous cell carcinoma (SCC) is not only restricted to the malignant lesions, but also areas which are premalignant. NBI can effectively detect early neoplastic lesions as a well-demarcated brownish area. A brownish area, that is suggestive of high-grade neoplasia or early carcinoma, consists of brownish irregular (i.e. dilatation, tortuosity, caliber change, and variation in the shape) vessels and brownish epithelium (areas between irregular vessels). Brownish color change of the epithelium may be caused by the thinning of the keratinous layer due to neoplastic cell proliferation. Morphology of irregular vessels of the esophageal SCC in magnifying NBI image varies according to tumor invasion. Mostly, when irregular vessels preserve their loop structure (which is represented as brown dots in the non-magnifying view), the cancer is confined to the mucosa. If the loop like structure of the IPCL’s are destroyed and they have a thin tree-branch-like shape, the tumor appears to be likely to invade the muscularis mucosae or even infiltrate into the superficial submucosa. Thick bluish to greenish vessels are observed when the tumor has massive submucosal invasion. Muto and colleagues conducted a multicenter randomized controlled trial and indicated that NBI finding (irregular microvessel pattern + demarcation line) showed higher diagnostic yield of superficial cancers of the head, neck and esophagus in high risk patients compared to WLE diagnosis (a reddish area with uneven surface + disappearance of the background vascular network). Biosketch of presenter to be continued on the next page 15 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1435 hrs - 1455 hrs Image Enhanced Endoscopy of Stomach Histological features of the mucosa, thus magnified endoscopic findings are different between corpus and antrum of the stomach and they are contrasted with using narrow band imaging (NBI). A normal gastric corpus has a characteristic honeycomb-like subepithelial capillary network pattern that surrounds round or oval shaped gastric pits (Foveola type). The starfish-like collecting venules are usually seen in the Helicobacter pylori (Hp) negative corpus mcuosa. The gastric antrum has microridges which are separated by narrow sulci and demonstrates a coil-shaped and elongated subepithelial capillary in the center (Groove type). Subepithelial capillaries appear to be brown in color and collecting venules look cyan under NBI. Chronic Hp infection can lead to progression of atrophic gastritis and IM while being a risk factor for dysplasia and gastric cancer. Gastric atrophy is characterized by 1) loss of pit pattern and subepithelial capillary network with irregular arrange ment of collecting venules or 2) change of foveolar type mucosa to groove type mucosa. NBI enables us to detect intestinal metaplasia as whitish patchy areas via the specific mucosal features. Bansal et al. found that the recognition of ridge or vi llous pattern by NBI demonstrated high specificity and sensitivity (80% and 100% respectively) for IM. This finding may represent t he phenomena of ‘pseudo-pylorization or intestinalization of the oxyntic mucosa which normally have round or oval shaped gastric pits. Light-blue crest (LBC), which is characterized by the presence of fine blue-white line on micro-crests of the mucosa and is an accurate predictor of underlying IM (sensitivity and specificity of 89% and 93% respectively). Early gastric cancer (EGC) is defined as gastric carcinoma in which tumor invasion is limited to the mucosa/submucosal layer (T1) regardless of lymph node metastases. Yao et al, indicates malignant mucosa on magnification endoscopy demonstrates an irregular microvascular pattern (IMVP) or irregular microstructural pattern (IMSP) with demarcation line, which can be used to characterize magnified NBI findings of EGC (the VS classification system). Nakayoshi et al classified irregular microvascular pattern of superficial gas tric cancer to the fine network pattern; corkscrew pattern; and unclassified pattern. Fine network pattern and corkscrew pattern PRESENTER’S BIOSKETCH Dr Noriya Uedo Vice-director Department of Gastrointestinal Oncology, Osaka Medical Centre for Cancer and Cardiovascular Diseases, Japan Dr. Uedo is a clinical investigator and gastroenterologist at the Osaka Medical Center for Cancer and Cardiovascular Diseases. He graduated from the School of Medicine, Kagoshima University in 1992. He has joined the Department of Gastroenterology and Hepatology of the Osaka University, after finishing his internship in the Kawanishi City Hospital. In 1994, Dr. Uedo started his training in Gastrointestinal Oncology and Endoscopy in the Osaka Medical Center for Cancer and Cardiovascular Diseases. His current research interests are 1) clinical application of new endoscopic imaging and therapeutic technique for early detection and treatment of gastrointestinal cancers and 2) how to teach and learn advanced endoscopy technique. He is a councilor of Japanese Gastroenterological Endoscopic Society, Japanese Society of Gastroenterology and Japanese Gastric Cancer Association, and an international member of American Society of Gastrointestinal Endoscopy. 16 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1530 hrs - 1550 hrs Image Enhanced Endoscopy of the lower GI: Kudo, Sano and NICE classification A. Kudo’s pit pattern Shin ei Kudo introduced the Kudo’s pit pattern (KPP) classification in his seminal paper in 1994(1). Some of the commonly use d dyes include Indigo carmine (0.2%) which is a surface contrast agent, Methylene blue (2mls in 40 -50mls of water), a dye which is absorbed actively into the mucosa or crystal violet (0.2%: 10mls in 40 mls of water) which is generally used in exceptional cases where KPP type V needs to be defined further. The KPP is best visualized using high definition scopes with digital magnification or optical magnification (80 -115X) (2). Briefly, the KPP can be divided into: 1. Type I: Pits appears round- normal colonic mucosa 2. Type II: Pits appears star like or onion skin like - hyperplastic polyps 3. Type III: Elongated pits - adenomas 4. Type IV: Cerebreform pits- adenomas 5. a) Type V I: Irregular (I) asymmetrical pits indicating malignancy confined to the mucosa (suitable for endoscopic resection) b) Type VN: Pit patterns disappears, non-structured (N) or ‘structure less’- advanced or signifying invasive cancer (surgery) In an interesting abstract presented at the Digestive Disease Week 2009, Subramaniam et al.(3) looked at >27,000 polyps in 30 studies comparing the accuracy of standard white light endoscopy, chromoendoscopy, white light endoscopy with magnification , chromoe ndoscopy with magnification and NBI with magnification in the prediction of colorectal polyp histology. The authors found that using c hromoendoscopy and NBI, both with optical magnification were the most effective method in predicting polyp histology resulting in an area un der the ROC of more than 0.90. B. Electronic chromoendoscopy Some of the electronic chromoendoscopy techniques widely available now include Narrow Band Imaging (NBI, Olympus), I scan (Pe ntax) or the Flexible spectral Imaging Color enhancement (FICE, Fujinon). All these imaging modalities can assist in defining the micr o vascular architecture in colorectal polyps. There have been numerous classifications utilised which at times can be confusing. With NBI, the modified Sano’s classification appears to be the most ’user friendly’ (4, 5). In a preliminary feasibility stud y, the sensitivity (Sn), specificity (Sp), positive (PPV) and negative predictive values (NPV) in differentiating neoplastic from non-neoplastic lesions with high confidence was 98%, 89%, 93% and 97%, respectively, while the Sn, Sp, PPV and NPV in predicting endoscopic resectability (typ e II, IIIa vs. type I, IIIb) was 100%, 90%, 93% and 100%, respectively (6). The interobserver agreement between assessors (k value) was also substantial at 0.89. The classification has been recently updated to include Sessile Serrated Adenomas/ Polyps (SSA/P) (7) as follows: Type I: Pale, round pits with central brown star like dots or bland appearance with minute capillaries which may meander acro ss polyp (Hyperplastic) - Type IIo: Pink mucous cap, Cloud like appearance, wavy pits which may have central brown oval/round dots (Sessile Serrated Ad enoma) - Type II: Brown, linear or oval capillary network present which surrounds white linear or oval pits (Tubular Adenoma with Low Grade Dysplasia) - Type IIIa: Brown, high density capillary network with tortuosity, branching and lack of uniformity. Pits appear villous/ cere breform (Tubular Adenoma with High Grade Dysplasia/ Villous Adenoma/Intramucosal cancer) - Type IIIb: Avascular capillary network (Invasive cancer Recently, a multicentre study was undertaken to further simply the NBI classification of colorectal polyps - aptly termed the ‘NICE’ classification (8). This classification although easy to use, appears to have ignored the SSA/P’s. All 3 classifications will be discussed and deliberated further in the lecture Biosketch of presenter to be continued on the next page 17 CLINICAL MEDICINE TRACK PRESENTER’S BIOSKETCH A/Prof Rajvinder Singh Clinical Associate Professor & Senior Consultant Gastroenterologist , Gastroenterology University of Adelaide & the Lyell McEwin Hospital, Australia A/ Prof. Rajvinder Singh MBBS MRCP MPhil FRACP AM FRCP is a Clinical Associate Professor at the University of Adelaide, South Australia and a Senior Consultant Gastroenterologist at the Lyell McEwin Hospital, South Australia, Australia. Upon completion of his GI training, he received the Lancet International Fellowship which enabled him to undertake a higher research degree on Narrow Band Imaging in Barrett’s Oesophagus at the University of Nottingham, UK. He has a keen interest in Endoscopic research focusing mainly on Advanced Endoscopic Imaging Techniques and Endoscopic Treatment of premalignant and malignant lesions in the gastrointestinal tract. He has published more than 100 papers/abstracts and is frequently invited locally and overseas to lecture on this topic. He has been successful in obtaining various national and international grants to further investigate the utility of novel endoscopic imaging techniques in the detection of dysplasia and early cancer. He is presently a Fellow of the Royal Australasian College of Physicians (Australia), a Fellow of the Royal College of Physicians (Glasgow, Scotland), and a member of the Royal College of Physicians (London, United Kingdom). He is the Contributing Associate Editor in Chief of the World Journal of Gastroenterology, an Editorial Board member of Endoscopy, an Editorial Board member of the World Journal of Gastrointestinal Endoscopy and regularly reviews manuscripts for Gastrointestinal Endoscopy and Endoscopy. He sits on the council of the Australian Gastroenterology Endoscopic Association and is presently one of the co-organizers of the upcoming annual GI scientific meeting, the Australian Gastroenterology Week. 18 CLINICAL MEDICINE TRACK Geriatric Fractures & Osteoporosis 22 November 2013, FRIDAY St Andrew’s Community Hospital Seminar Room, Level 2 Geriatric Fractures & Osteoporosis – A Multidisciplinary Symposium Course Directors: Dr Dave Lee Consultant, Department of Orthopaedic Surgery Changi General Hospital Dr Poon Kein Boon Consultant, Department of Orthopaedic Surgery Changi General Hospital 1145 – 1200 1200 – 1215 1215 – 1230 1230 – 1245 1245 – 1330 Hip Fractures Treatment Options Dr Poon Kein Boon Consultant, Department of Orthopaedic Surgery Changi General Hospital Overview of Ortho-Geriatric Service and Hip Fracture Pathway SSN Aw Yang Wan Sim Senior Staff Nurse, Department of Case Management Changi General Hospital Hip Fractures- the Geriatrician's perspective Dr Goh Kiat Sern Associate Consultant, Department of Geriatric Medicine Changi General Hospital Non-Hip Osteoporosis Fractures; Management Options Dr Dave Lee Consultant, Department of Orthopaedic Surgery Changi General Hospital Lunch Break 19 CLINICAL MEDICINE TRACK Geriatric Fractures & Osteoporosis 22 November 2013, FRIDAY St Andrew’s Community Hospital Seminar Room, Level 2 1330 – 1345 1345 – 1400 1400 – 1415 1415 – 1430 1430 – 1445 Osteoporosis- Update in 2013 Dr Foo Joo Pin Consultant, Department of Endocrinology Changi General Hospital Exercise for Osteoporosis Dr Cindy Lin Staff Attending Physician, Department of Sports Medicine Changi General Hospital Physiotherapy and Conditioning after a Hip Fracture Ms Tan Shumei Senior Physiotherapist Department of Rehabilitative Services Changi General Hospital Falls Prevention Ms Elisabeth Piper Occupational Therapist, Department of Rehabilitative Services Changi General Hospital Q&A 20 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1145 hrs - 1200 hrs Hip Fractures Treatment Options Hip fracture is a common and increasing cause of hospitalization, morbidity, and even mortality. In the younger population, hip fracture is usually caused by a high-energy injury such as road traffic accident or falling from height. In the elderly population, hip fracture is usually caused by a low-energy mechanism such as a fall. Mortality may ensue from associated medical comorbidities that are exacerbated by injury-related immobility or complications. The hip fracture treatment decisions made by the orthopaedic surgeon, either conservative or surgical may have a significant impact on the patient’s outcome. Osteoporosis-related hip fractures in the elderly mainly consist of intertrochanteric femoral fracture and femoral neck fracture. Stable intertrochanteric femoral fractures are best treated with a dynamic hip screw. For unstable fractures, a cephalomedullary nail such as proximal femoral nail antirotation (PFNA) appears to be a better choice than dynamic hip screw. Elderly patients with nondisplaced or valgus impacted femoral neck fractures can be treated with cannulated screws fixation. Displaced femoral neck fractures can be treated with hemiarthroplasty with either cemented or cementless stem. Total hip replacement can be considered for highly functional elderly patients or patients with preexisting arthritis. PRESENTER’S BIOSKETCH Dr Poon Kein Boon Consultant Orthopaedic Surgery Changi General Hospital, Singapore Dr Poon Kein Boon is an Orthopaedic Consultant who specialises in the management of simple and complex limb fractures, pelvic and acetabular fractures and fragility fractures in the elderly as well as adult knee and hip joint replacement surgeries. His specialist areas of interest are the treatment of fractures and joint replacements using minimally invasive techniques. In addition, Dr Poon is committed to the AO Trauma Education and is the leader of the Ortho-Geriatric Team in managing fragility hip fracture patients. 21 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1200 hrs - 1215hrs Overview of Ortho-Geriatric Service and Hip Fracture Pathway Abstract was unavailable at time of print. PRESENTER’S BIOSKETCH Ms Aw Yang Wan Sim Senior Staff Nurse Case Management Changi General Hospital, Singapore Nurse Aw Yang Wan Sim is a nurse coordinator from Case Management for Ortho-Geriatric service. Graduated from Flinders University of South Australia with a nursing degree, she later pursued an Advanced Diploma in Geriatric Nursing in year 2006. Prior to joining case management, she was with CGH Transitional Care. Her current interest is to prevent secondary fracture in elderly and look forward to upcoming projects related to the subject. 22 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1215 hrs - 1230 hrs Hip Fractures – The Geriatrician's Perspective Dr Goh Kiat Sern Associate Consultant, Department of Geriatric Medicine Changi General Hospital Abstract and Biosketch unavailable at time of print. 23 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1230 hrs - 1245 hrs Non-Hip Osteoporosis Fractures; Management Options Dr Dave Lee Consultant, Department of Orthopaedic Surgery Changi General Hospital Abstract and Biosketch unavailable at time of print. 24 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1330 hrs - 1345 hrs Osteoporosis- Update in 2013 Dr Foo Joo Pin Consultant, Department of Endocrinology Changi General Hospital Abstract and Biosketch unavailable at time of print. 25 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1345 hrs - 1400 hrs Exercise as a Therapeutic Agent for the 21st Century Physical activity is known to be an important component of the prevention and management of many common chronic health conditions from obesity to diabetes and heart disease. This lecture will cover interesting and insightful findings from what the recent medical research in the 21 st century has discovered about the critical role of exercise in health promotion across the lifespan. PRESENTER’S BIOSKETCH Dr Cindy Lin Staff Attending Physician, Sports Medicine & Rehabilitation Medicine, Changi General Hospital, Singapore Dr Cindy Lin is a Staff Attending Physician in Sports Medicine & Rehabilitation Medicine at Changi General Hospital. She received her medical degree (MD) from Harvard Medical School. She is American Board certified in Sports Medicine and Physical Medicine & Rehabilitation. She is active in clinical care, research, and teaching in sports medicine and rehabilitation medicine. She is Director of Community Outreach for Exercise is Medicine Singapore. 26 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1400 hrs — 1415 hrs Physiotherapy and Conditioning after a Hip Fracture Hip fracture commonly occurs in the elderly population. Following surgery, it is especially important for this population to regain back their walking ability and exercise tolerance. This is not only for their general wellbeing, but also to prevent further deconditioning and minimise burden of care. This session will share with you the role of physiotherapy in the rehabilitation for this group of patients following hip fracture surgery. PRESENTER’S BIOSKETCH Ms Tan Shumei Senior Physiotherapist Rehabilitative Services Changi General Hospital, Singapore After obtaining her degree in Physiotherapy, Shumei has been working in Changi General Hospital since and mainly in the area of inpatient orthopaedics physiotherapy. Leading the team of Orthopaedics Inpatient Physiotherapists at CGH, she and her team have recently completed quality improvement project relating to hip fracture patients and are currently conducting a research project pertaining to rehabilitation of this population. 27 CLINICAL MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1415 hrs - 1430 hrs Falls Prevention Ms Elisabeth Piper Occupational Therapist, Department of Rehabilitative Services Changi General Hospital Abstract and Biosketch unavailable at time of print. 28 CLINICAL MEDICINE TRACK Gastrointestinal Endoscopy Course 23 November 2013, SATURDAY Changi General Hospital Skills Lab, Basement 2 Gastrointestinal Endoscopy Course (Hands-on Training) Course director: A/Prof Ang Tiing Leong Chief & Senior Consultant, Department of Gastroenterology Deputy Head of Research, Clinical Trials & Research Unit Changi General Hospital 1000 – 1020 Registration and Refreshment 1020 – 1030 Welcome address and briefing 1030 – 1100 Endoscopic haemostasis: Injection, Clips (Goup 1) Endoscopic haemostasis: SB tube, EVL (Group 2) Endoscopic haemostasis: Heater probe, APC (Group 3) 1100 – 1130 Endoscopic haemostasis: Injection, Clips (Goup 3) Endoscopic haemostasis: SB tube, EVL (Group 1) Endoscopic haemostasis: Heater probe, APC (Group 2) 1130 – 1200 Endoscopic haemostasis: Injection, Clips (Goup 2) Endoscopic haemostasis: SB tube, EVL (Group 3) Endoscopic haemostasis: Heater probe, APC (Group 1) 1200 – 1210 Debrief 29 CLINICAL MEDICINE TRACK Soft-tissue Handling Course 23 November 2013, SATURDAY Changi General Hospital Lecture Room, Training Centre, Level 1 Soft-tissue Handling Course Course Director: Dr Ian Loh Chi Yuan Consultant, Department of Otolaryngology Changi General Hospital Lecturers: Dr Tan Kar Su, Associate Consultant, Department of Otolaryngology, Khoo Teck Puat Hospital Dr Sandeep Uppal, Service Head, Facial Plastic and Reconstruction Surgery Service, Department of Otolaryngology, Head and Neck Surgery, Khoo Teck Puat Hospital Dr Stephen Lo, Service Head, Facial Plastic and Reconstruction Surgery Service, Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital 0800 – 0830 Registration 0830 – 0845 Introduction and opening 0845 – 0900 Introduction to needles, sutures and instruments 0900 – 0915 Principles of wound closure, healing, tissue handling, reconstruction ladder 0915 – 0930 Knot tying and suture methodology 0930 – 0945 The aesthetic subunit approach to planning incisions and flaps on the face 0945 – 1000 Scar revision techniques 1000 – 1015 Z-plasties, skin grafts and local flaps 1015 – 1045 Tea break 1045 – 1230 Practical Session 1 1230 – 1330 Lunch 1330 – 1600 Practical Session 2 1600 – 1630 Feedback and Certificate Presentation 30 CLINICAL MEDICINE TRACK PRESENTER’S BIOSKETCH 23 November 2013, Saturday 0800 hrs—1630 hrs Soft-tissue Handling Course Changi General Hospital Lecture Room, Training Centre, Level 1 Dr Sandeep Uppal Consultant Otolaryngology, Head and Neck Surgery Khoo Teck Puat Hospital, Singapore Dr Sandeep Uppal has served a one-year Facial Plastic Surgery Fellowship conducted by the European Academy of Facial Plastic Surgery. As a part of the fellowship he trained in all aspects of facial cosmetic and reconstructive surgery in world renowned centres in the Netherlands, Germany, UK, and United States of America. He achieved the highest score of all the international candidates in the examination conducted by the American Board of Facial Plastic and Reconstructive Surgery as part of the certification process of the International Board of Facial Plastic Surgery. Dr. Uppal’s research and clinical interests have resulted in 27 publications in peer reviewed international journals and numerous international presentations. Notable amongst these have been first author publications in Nature Genetics and BMJ. He has been a faculty member in numerous international and national Facial Plastic Surgery courses.He has recently been awarded a PhD for his thesis ‘Genetic Studies on Inherited Diseases Presenting with Unusual ENT Problems’ by the University of Leeds, UK. During his PhD he identified the genetic and molecular basis of the syndrome Pachydermoperiostosis, a condition that presents with aesthetic facial deformities resulting from thickening of facial skin. Adj A/Prof Stephen Lo Consultant ENT Tan Tock Seng Hospital, Singapore Consultant ENT Surgeon and Chief of Facial Plastic Surgery Service, Department of ENT, Tan Tock Seng Hospital Singapore, and Adjunct Assistant Professor, National University of Singapore Medical School. Otorhinolaryngology-head & neck surgery training in London. Subspecialist interest is in Facial Plastic Surgery and Rhinology. European Academy of Facial Plastic Surgery (EAFPS) fellowship trained and board certified. Core faculty and clinical scientist mentor of the Singapore National Healthcare Group ENT residency training program. Founding director of the annual Singapore Facial Plastic Surgery Course. Dr Tan Kar Su Associate Consultant, Department of Otolaryngology, Khoo Teck Puat Hospital Biosketch Unavailable at time of print. 31 CLINICAL MEDICINE TRACK Sleep Symposium 23 November 2013, SATURDAY Changi General Hospital Auditorium, Level 1 Sleep Symposium Course Directors: Dr Sridhar Venkateswaran Consultant, Department of Respiratory Medicine Changi General Hospital Dr Alvin Tan Kah Leong Senior Staff Attending Physician, Department of Otolaryngology Changi General Hospital 0900 – 0940 Advances and updates on sleep surgery Professor Lin Hsin-Ching Associate Professor, Dept. of Otolaryngology, Sleep Center, Chang Gung University, Chang Gung Memorial Hospital Vice Chairman, Department of Otolaryngology, Kaohsiung Medical Center, Taiwan Director of Division of Laryngology and Sleep Surgery, Executive Council, Taiwan Society of Sleep Medicine 0940 – 1020 Consequences and long term effects of sleep deprivation Professor Michael Chee Senior Consultant, Neuroscience and Behavioral Disorders Program Duke-NUS Graduate Medical School 32 CLINICAL MEDICINE TRACK Sleep Symposium 23 November 2013, SATURDAY Changi General Hospital Auditorium, Level 1 1020 – 1100 1100 – 1120 Tea Break Oral appliances in sleep-disordered breathing Dr Eric Lye Senior Consultant, Assistant Director Integrated Sleep Service Oral and Maxillofacial Surgery, Visiting Specialist, Department of ENT Changi General Hospital 1120 – 1200 PAP therapy for obstructive sleep apnoea Dr Tripat Singh Clinical Manager Sleep, Philips Healthcare ASEAN Philips Electronics(s) Pte Ltd 1200 – 1225 Transoral Robotic Surgery of the Tongue Base in OSA Dr Toh Song Tar Consultant, Department of Otolaryngology Singapore General Hospital 1020 – 1100 1100 – 1120 Tea Break Oral appliances in sleep-disordered breathing Dr Eric Lye Senior Consultant, Assistant Director Integrated Sleep Service Oral and Maxillofacial Surgery, Visiting Specialist, Department of ENT Changi General Hospital 1120 – 1200 PAP therapy for obstructive sleep apnoea Dr Tripat Singh Clinical Manager Sleep, Philips Healthcare ASEAN Philips Electronics(s) Pte Ltd 1200 – 1225 Transoral Robotic Surgery of the Tongue Base in OSA Dr Toh Song Tar Consultant, Department of Otolaryngology Singapore General Hospital 33 CLINICAL MEDICINE TRACK Sleep Workshop 23 November 2013, SATURDAY Changi General Hospital Seminar Room, Level 2 Sleep Workshop Course Directors: Dr Sridhar Venkateswaran Consultant, Department of Respiratory Medicine Changi General Hospital Dr Alvin Tan Kah Leong Senior Staff Attending Physician, Department of Otolaryngology Changi General Hospital 1400 – 1600 PAP therapy and mask fitting Dr Tripat Singh Clinical Manager Sleep, Philips Healthcare ASEAN, Philips Electronics(s) Pte Ltd 34 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 0900 hrs – 0940 hrs Advances and Updates on Sleep Surgery Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Most sleep physicians are in agreement that a certain number of OSAHS patients cannot or will not use CPAP. Although other conservative therapies such as oral appliance, sleep hygiene and sleep positioning may help some of OSAHS patients, there are many who fail all conservative treatments. Surgery for OSAHS is not a substitute for CPAP but is a salvage procedure for those who failed CPAP and other conservative therapies and therefore have no other options. Because there is no single treatment that eliminates sleep apnea, a multidiscipline approach is valuable and necessary for these patients. As otolaryngologists, we have the responsibility to screen patients for both symptoms and signs of OSAHS. As experts of the upper airway, we are often viewing an airway clearly and helping our patients understand the importance of assessment and treatment for OSAHS. This presentation is to provide an overview of upper airway surgery in patients with OSAHS. Current evidence-based outcomes of sleep surgery and innovative techniques for sleep-related breathing disorders will be introduced. Biosketch of presenter to be continued on the next page 35 CLINICAL MEDICINE TRACK PRESENTER’S BIOSKETCH Prof Hsin-Ching Lin MD, FACS, FICS Department of Otolaryngology, Sleep Center Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Taiwan Hsin-Ching Lin MD, FACS, is an associate professor of the Department of Otolaryngology and Sleep Center, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Dr. Lin is Vice Chairman of the Department of Otolaryngology and Director of Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital. He had his residency at the Kaohsiung Chang Gung Memorial Hospital and completed a fellowship in Chicago, IL under the guidance of professor Michael Friedman, one of the world’s leading and most prolific ENT surgeons, especially in sleep surgery. He is an active member of many societies, such as American Academy of Otolaryngology - Head & Neck Surgery (AAO-HNSF), American Academy of Sleep Medicine, Taiwan Otolaryngological Society, Taiwan Society of Sleep Medicine and Asian Sleep Research Society…etc. He is a fellow of the American College of Surgeons. He has received many awards from the Taiwan Otolaryngological Society, Taiwan Society of Sleep Medicine, including the 2009 AAO-HNSF Honor Award and the 2012 International Guest Scholarship Award of the American College of Surgeons. Dr. Lin has a special interest in the surgical and non-surgical treatment of sleep-related breathing disorders with extensive experience in a variety of advanced sleep surgeries. He has been involved many aspects of clinical researches and published many papers in in the prestigious peer-review journals in the fields of the otorhinolaryngology and sleep medicine. Dr. Lin has also presented numerous papers at local, international society meetings and has been an invited speaker at many international conferences on sleep medicine. 36 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 0940 hrs - 1020 hrs Consequences and Long Term Effects of Sleep Deprivation Professor Michael Chee Senior Consultant, Neuroscience and Behavioral Disorders Program Duke-NUS Graduate Medical School Abstract and Biosketch unavailable at time of print. 37 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1100 hrs – 1120 hrs Oral Appliances in the Management of Sleep-Disordered Breathing Obstructive Sleep Apnea is a serious chronic medical condition that has gained prominence in the last 2 decades. It has serious medical, social and economical implications when left untreated or undertreated. There is a multidisciplinary approach towards the management of patients with this condition. Oral appliance management has contributed significantly towards the initial treatment strategies used. However, there are some limitations, technical knowledge and management protocols that must be understood in order to practice this treatment regime effectively. With the correct understanding and using the correct approach, selected patients can be successfully treated by oral appliance therapy. This lecture will give a summary of the various aspects of this approach. PRESENTER’S BIOSKETCH Dr Lye Kok Weng, Eric Senior Consultant Oral & Maxillofacial Surgery Changi General Hospital, National Dental Centre of Singapore, Singapore Dr Eric Lye is the Deputy Director of the Integrated Sleep Service at Changi General Hospital (CGH) and Head of the Obstructive Sleep Apnea (OSA) Clinic at the National Dental Centre Singapore (NDCS). He is also a senior consultant of the department of Oral & Maxillofacial Surgery at both CGH and NDCS and the Associate Director of the Oral & Maxillofacial Surgery programme at the National University of Singapore. Dr Lye received training in the management of the OSA condition in 2006 and subsequently involved in the care and treatment of OSA patients through oral appliance and orthognathic surgical management. He has given several lectures and published in journals and books on these topics. 38 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1120 hrs – 1200 hrs PAP Therapy for OSA OSA is associated with an increased risk of hypertension, ischemic heart disease, heart failure, stroke, cardiac arrhythmias and increased mortality from cardiovascular events. The Wisconsin Sleep Cohort Study demonstrated a dose-response association between OSA at baseline and the incidence of new hypertension 4 years later. OSA is an independent predictor of coronary artery disease (CAD). 11-38% of patients with established heart failure have predominant OSA. The prevalence of OSA is increased in patients with stroke and OSA is significantly associated with a risk of stroke and death. Nocturnal desaturation in OSA patients is associated with a higher incidence of Atrial Fibrillation. Over 7 years, patients with OSA are five times more likely to have cardiovascular disease than those without OSA. The risk of fatal and nonfatal cardiovascular events is significantly increased in patients with untreated severe OSA compared to healthy subjects. Evidence suggests that treating OSA in patients with cardiovascular disease reduces systolic and diastolic blood pressure and, subsequently, reduces the cardiovascular risk associated with OSA. Non-adherence to CPAP therapy is a frequent problem faced by physicians managing OSA patients. Several factors may affect adherence to CPAP. Systematic educational programs which include increased intensity of patient education, increased frequency of health provider contact has been recommended as Standard option by American Academy of Sleep Medicine to improve CPAP compliance. Sleep specialist consultation prior to PSG may be helpful in improving CPAP compliance. PRESENTER’S BIOSKETCH Dr Tripat Deep Singh Clinical Manager Sleep Healthcare ASEAN, Philips Electronics Pte Ltd, Singapore Dr. Tripat Deep Singh is currently Clinical Manager Sleep Healthcare ASEAN Philips Electronics Singapore. He graduated with MBBS from Govt. Medical College Patiala, Punjab, India in 2003. He obtained his Post -graduate degree in Physiology from Vallabhbhai Patel Chest Institute University of Delhi, Delhi, India in 2009. He also specialize in Sleep Medicine as International Sleep Specialist (World Sleep Federation program) and Sleep Technology as Registered Polysomnography Technologist (RPSGT) & Registered Sleep Technologist (RST). His research interest is in role of oxidative stress in pathogenesis of OSA; Jet lag disorder and Central Sleep Apnea. He was Assistant Professor at Pondicherry Institute of Medical Sciences and taught Medical Physiology to Medical and Nursing students. He was incharge of Sleep lab at Pondicherry Institute of Medical Sciences before joining Philips in the current role. He is member of various Sleep Medicine and Sleep Technologist societies. He is frequent speaker at various courses and workshops in ASEAN region. 39 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1200 hrs - 1220 hrs Transoral Robotic Surgery of the Tongue Base in OSA Dr Toh Song Tar Consultant, Department of Otolaryngology Singapore General Hospital Abstract and Biosketch unavailable at time of print. 40 CLINICAL MEDICINE TRACK Integrated Airway Symposium 23 November 2013, SATURDAY Changi General Hospital Centre for Innovation, Training Centre Level 1 Integrated Airway Symposium Course Directors: Dr David Chin Chao-Wu Consultant, Department of Otolaryngology Changi General Hospital Dr Imran Mohamed Noor Consultant, Department of Respiratory Medicine Changi General Hospital 1400 – 1430 Chronic cough - investigations and management Dr Imran Mohamed Noor Consultant, Department of Respiratory Medicine Changi General Hospital 1430 – 1500 Postnasal drip - A symptom to be sniffed at? Dr Gan Eng Cern Associate Consultant, Department of Otolaryngology Changi General Hospital 1500 – 1530 Lung function tests made easy Dr Imran Mohamed Noor Consultant, Department of Respiratory Medicine Changi General Hospital 1530 – 1600 Integrated ENT - Respiratory medicine approach to upper airway inflammatory disorders Dr David Chin Consultant, Department of Otolaryngology Changi General Hospital 41 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1400 hrs - 1440 hrs Chronic Cough - Investigations and Management Dr Imran Mohamed Consultant, Department of Otolaryngology Changi General Hospital Abstract and Biosketch unavailable at time of print. 42 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1430 hrs – 1500 hrs Postnasal drip – A symptom to be sniffed at? Postnasal drip is one of the most common ENT complains seen in the physician’s office. It is a sensation of nasal mucous dripping down the back of the nose and throat that can be experienced by patients with or without excessive production of mucus from the nasal mucosa. The term “drip” is a misnomer and implies that mucous can drip from the soft palate or nasopharynx into the larynx or hypopharynx. This does not happen because of the rheological properties of the mucous, cohesional forces and adhesiveness. Although rhinologic conditions such as rhinitis and rhinosinusitis can give rise to postnasal drip syndrome, often patients with a sensation of postnasal drip have no obvious pathology and are simply hyperaware of their normal nasal mucous. This symposium will focus on the common causes of postnasal drip and the approach in managing such patients. PRESENTER’S BIOSKETCH Dr Gan Eng Cern Associate Consultant Otolaryngology Changi General Hospital, Singapore Dr Gan Eng Cern is an Associate Consultant in the Department of Otolaryngology, Changi General Hospital. He obtained his medical degree from the University of New South Wales in Sydney, Australia in 2002. He completed his residency in Otolaryngology, Head & Neck Surgery in 2012. He has a keen interest in Rhinology and completed his fellowship in Rhinology and Skull Base Surgery at St Paul’s Sinus Centre, Vancouver, Canada in July 2013. 43 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1500 hrs - 1530 hrs Lung Function Tests Made Easy Dr Imran Mohamed Consultant, Department of Otolaryngology Changi General Hospital Abstract and Biosketch unavailable at time of print. 44 CLINICAL MEDICINE TRACK ABSTRACT 23 November 2013, Saturday 1530 hrs – 1600 hrs Integrated ENT - Respiratory Medicine Approach to Upper Airway Inflammatory Disorders Asthma, sinusitis (acute and chronic), allergic rhinitis (AR) & chronic cough are common problems in primary healthcare. Patients often present with both upper and lower airway symptoms. Chronic cough may be due to a number of different causes of the upper or lower respiratory tract. Furthermore, while the role of allergic inflammation in asthma and AR is well-known, some forms of chronic sinusitis are predominantly inflammatory rather than infective and frequently associated with late-onset asthma. Proper evaluation of these patients therefore requires assessment of the entire respiratory tract from the nose to the lungs. Patient outcomes are optimized with integrated management of both the upper and lower airway. The symposium will focus on the integrated approach to the commonest problems of the respiratory tract. PRESENTER’S BIOSKETCH Dr David Chin Consultant Otolaryngology Head & Neck Surgery Changi General Hospital, Singapore David Chin is a rhinologist ENT surgeon at Changi General Hospital in Singapore. He completed his ENT specialist training in Singapore in 2011 and subsequently undertook a one-year fellowship in rhinology and endoscopic skull base surgery with the Sydney Clinical Rhinology Fellowship. In addition to endoscopic sinus surgery for inflammatory and neoplastic disease, he has special interest in functional nasal surgery, objective nasal airway assessment, allergy and airway inflammation. Apart from further developing rhinology services in CGH, he is also currently involved, together with colleagues from respiratory specialists, in the development of an integrated airway service combining ENT and respiratory services at his hospital which aims to be a one-stop service for patients with combined upper and lower respiratory tract problems. 45 Education Symposium 22 - 23 November 2013 Chairperson: Associate Professor Goh Siang Hiong Deputy Chairman, Medical Board (Education and Ambulatory) Senior Consultant, Department of Accident & Emergency, Changi General Hospital 46 EDUCATION TRACK 22 November 2013, FRIDAY Changi General Hospital Lecture Room, Level 1 1130 – 1200 So You Want To Be A Clinical Educator? Dr Jansen Koh Associate Consultant, Department of Respiratory Medicine Changi General Hospital 1200 – 1230 So You Want To Be A Nursing Educator? Dr Janet Choo Deputy Director, Nursing Administration Changi General Hospital 1230 – 1300 Self-Directed Medical Education – New Learning for a New Generation A/Prof Mohan Tiru Chief & Senior Consultant, Department of Accident & Emergency Changi General Hospital 1300 – 1400 LUNCH 47 EDUCATION TRACK 22 November 2013, FRIDAY Changi Simulation Institute Training Centre, Level 1 1400 – 1420 10 Tips for Effective Feedback Associate Professor Goh Siang Hiong Deputy Chairman, Medical Board (Education and Ambulatory) Senior Consultant, Department of Accident & Emergency Changi General Hospital 1420 – 1500 1500 – 1515 1515 – 1630 Simple Rules for Observation in Assessment, The KSA Framework & Reference Frameworks Dr Joan Khoo Consultant, Department of Endocrinology Changi General Hospital Break Workshop on Doing Evaluation and Tools For Assessment Facilitators: Dr Joan Khoo Consultant, Department of Endocrinology Changi General Hospital Dr Rahul Goswami Consultant, Department of Emergency Medicine Changi General Hospital 1630-1700 Learning with Social Media Dr Rahul Goswami Consultant, Department of Emergency Medicine Changi General Hospital 48 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1130 hrs - 1200 hrs So You Want To Be a Clinical Educator? Abstract unavailable at time of print PRESENTER’S BIOSKETCH Dr Jansen Koh Consultant Respiratory & Critical Care Medicine Changi General Hospital, Singapore Dr Jansen Koh obtained his MBBS from the National University of Singapore in 2001. He is a consultant at the department of Respiratory & Critical Care Medicine, Changi General Hospital. He recently completed a fellowship in Clinical Simulation and Medical Education at the Learning Institute, SickKids Hospital, Toronto, Canada. He is currently the Associate Program Director of the Internal Medicine Residency Program at Singhealth. He also serves as Chair of the Education Technology Workgroup at Changi General Hospital, a group responsible for identifying, selecting and utilizing technology to enhance medical education. His specific clinical interest in Respiratory and Critical Care is point of care ultrasonography, having obtained his certification from the American College of Chest Physicians. In addition, he has developed several educational initiatives in simulation medical education at Changi General Hospital. He is passionate about medical education for students and doctors and was awarded the 2011 NUS-YLL Dean’s Award for Teaching Excellence as well as the 2011 Changi General Hospital Best Teacher Award. His research interest lies in advancing our understanding and effective use of simulation for clinical teaching and process improvement in critical care. 49 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1200 hrs - 1230 hrs So You Want To Be A Nursing Educator? Nurse educators are the key resource in preparing a nursing workforce that will provide quality care to meet the health care needs of our population. They may practise in academic and/or clinical settings, and they must be competent clinicians. Regardless of the setting in which the nurse educator is employed, there is a core of knowledge and skills that is essential if one is to be effective and achieve excellence in the role. One of the strongest motivators to be a nurse educator is that teaching provides an opportunity to influence student success and shape the next generation of nurses. As an educator, one can model professional values and skills, and ultimately influence the quality of care provided by future nurses. The author addresses the educational qualifications needed for teaching and pays special attention to the essential skills needed to become a nurse educator and flourish in a teaching role. PRESENTER’S BIOSKETCH Dr. Janet Choo Deputy Director Nursing Administration Changi General Hospital, Singapore Janet Choo has accumulated a wealth of nursing knowledge and experience. Her knowledge and skills extend from clinical nursing to nursing education, including clinical pathway and case management programs, wound management, nursing quality, nursing research and most recently nursing administration. In recognition of her expertise, Janet was also invited to speak at several international and local forums relating to clinical pathways, case management programs, evidence-based practices and management. In recognition of her consistent clinical excellence and professional contributions, she was awarded the National Day Efficiency Medal in 2002, the President’s Nurse Award in 2004 and the National Day Commendation Medal in 2013. Janet holds a Bachelor’s Degree in Nursing from La-Trobe University, Australia. She was awarded the Academic Excellence Award for her Masters’ Degree in Health Science Management from the University of Sydney and holds a PhD in Nursing from the University of Melbourne. She is also an Honorary Teaching Fellow with the University of Manchester. 50 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1230 hrs - 1300 hrs Self-Directed Medical Education – New Learning for a New Generation A/Prof Mohan Tiru Chief & Senior Consultant, Department of Accident & Emergency Changi General Hospital Abstract and Biosketch unavailable at time of print 51 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1400 hrs - 1420 hrs Top 10 Tips in Giving (Good & Bad) Feedback To Your Residents Faculty and supervisors need to learn to provide effective feedback to a learner, whether in medical school and during residency in a variety of patient care settings. Some would even say feedback has to continue even into adult working life. Without effective feedback, mistakes and bad habit practices go uncorrected and good performance is not recognised or reinforced. One needs to recognise common barriers to providing feedback and how to overcome them. Success for effective feedback includes establishing an appropriate culture using suitably agreed upon goals; respecting the learner's emotions; mature nonjudgmental reflection on observed actions; and offering the right amount of feedback in a timely fashion; with suggestions for rectification and improvement going forwards. PRESENTER’S BIOSKETCH Prof Goh Siang Hiong Dy CMB (Medical Education, Ambulatory Services) Designated Institutional Official, Senior Consultant Emergency Physician Accident & Emergency Department Changi General Hospital, Singapore Prof Goh Siang Hiong is an Emergency Medicine Senior Consultant specialist and is currently the Deputy Chairman Medical Board for Ambulatory Disciplines and also Medical Education at Changi General Hospital. He has a deep interest in EM medical education at both the undergraduate and postgraduate levels. He has more than 18 years of Emergency Medicine Practice, and also presently an instructor for BCLS, ACLS, ATLS (Provider course) ATLS (Instructor course), HazMat Life Support and Fundamental Critical Care Course. He has been selected before as Best Teacher (Ambulatory Division) and also been awarded the SingHealth GCEO Excellence award for Medical Education. He has also written several papers pertaining to the field of Emergency Medicine, and co-authored many too, and has best research presentation awards twice at Scientific Meetings and Best Faculty Speaker in 2007 for the SEMS’ (Society for Emergency Medicine in Singapore) ASM. Prof Goh is currently overlooking the CGH residency-training programs as its Associate Designated Institutional Official. 52 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1420 hrs - 1500 hrs 4 Simple Rules for Observation in Assessment, The KSA Framework & Reference Frameworks The direct observation of trainees performing clinical history-taking, physical examination and counseling is essential for evaluation of their competence. Behavioural observation training focuses on improving the detection, perception and recall of actual performance. The four simple rules of observation are 1) correct positioning of the observer; 2) minimizing external interruptions; 3) avoiding intrusions; and 4) being prepared for the session. The KSA (Knowledge, Skills, Attitude) framework increases the effectiveness of performance evaluation. Performance Dimension Training (PDT) is designed to familiarize faculty with the appropriate performance dimensions used in their own evaluation systems. PDT aims to define the criteria and definitions of a superior performance, and the minimal criteria for a satisfactory performance which will define lower levels of performance. Frame of reference training (FORT), an extension of PDT, specifically targets accuracy in rating by defining criteria and levels of performance from the perspective of optimal patient outcomes. We will also discuss the use of assessment tools to guide observation and provide feedback to trainees, such as checklists and the mini-Clinical Evaluation Exercise (mini-CEX). PRESENTER’S BIOSKETCH Dr Joan Khoo, Consultant, Endocrinology, Changi General Hospital, Singapore Dr. Joan Khoo graduated from the National University of Singapore in 2000. After receiving postgraduate qualifications in 2004 from the Royal College of Physicians (UK) and completing specialist training in diabetes and endocrinology in 2007, she was awarded a fellowship to pursue research in the Royal Adelaide Hospital. She served as Director of the CGH Diabetes Centre from 2011-2012 and is currently a Consultant in the Department of Endocrinology and Clinical Senior Lecturer in the Yong Loo Lin School of Medicine (NUS). Her Metabolic Syndrome clinic is part of the multi-disciplinary weight management service in CGH. Her clinical and research interests are obesity, diabetes, and exercise endocrinology. She has presented in international conferences and published in peer-reviewed journals, receiving research awards in 2011 and 2012. She is involved in the Eastern Community Health Outreach (ECHO) community-based chronic disease and obesity prevention program, and is a member of the Exercise is Medicine Singapore Task Force. 53 EDUCATION TRACK ABSTRACT 22 November 2013, Friday 1645 hrs - 1715 hrs Learning With Social Media Abstract unavailable at time of print PRESENTER’S BIOSKETCH Dr Rahul Goswami Consultant Emergency Department Changi General Hospital, Singapore Dr Rahul Goswami is an Consultant Emergency Physician at CGH ED. He is a Fellow of the Australasian College for Emergency Medicine and Academy of Medicine (SG). He holds a Masters in Disaster Medicine and a PGCert in Aeromedical transport. He is core faculty for the Singapore ACGME program for trainees in Emergency Medicine and is a senior clinical lecturer for the National University of Singapore (School of Medicine). He has worked in over a dozen hospitals on three continents and lucky enough to spend over a year with the Royal Flying Doctor Service in Western Australia. He also runs 2 educational portals in medical education. 54 EDUCATION TRACK 23 November 2013, SATURDAY Changi Simulation Institute Training Centre, Level 1 0900 – 0930 0930 – 1030 Registration Role of Simulation in Healthcare Today Dr Jansen Koh Associate Consultant, Department of Respiratory Medicine Changi General Hospital 1030 – 1045 1045 – 1230 BREAK Exploring Various Aspect of Using Simulation to Improve Healthcare Small Group Workshops 1330 – 1630 Crew Resource Management Dr Lim Tiek Whai Chief & Senior Consultant Department of Anaesthesia & Surgical Intensive Care Changi General Hospital 55 EDUCATION TRACK ABSTRACT 23 November 2013, Saturday 0930 hrs - 1030 hrs Role of Simulation in Healthcare Today Simulation in medicine is increasingly used worldwide. At its broadest definition, simulation refers to the representation or reproduction of something real by imitation. The predominant use of simulation in healthcare is in medical education, for the purposes of training and assessment. The literature pertaining to simulation in healthcare is vast. A MEDLINE search of simulation and medicine returned over 7000 references. It is essential to make sense of the current available evidence to carry out medical simulation education effectively. Current best practices in simulation in medical education are discussed together with specific techniques that are useful in medical education. In addition to training and assessment in medical education, simulation can be used for a variety of purposes in healthcare. These include using simulation in performing a learning needs assessment, root cause analysis and for quality and process improvement. PRESENTER’S BIOSKETCH Dr Jansen Koh Consultant Respiratory & Critical Care Medicine Changi General Hospital, Singapore Dr Jansen Koh obtained his MBBS from the National University of Singapore in 2001. He is a consultant at the department of Respiratory & Critical Care Medicine, Changi General Hospital. He recently completed a fellowship in Clinical Simulation and Medical Education at the Learning Institute, SickKids Hospital, Toronto, Canada. He is currently the Associate Program Director of the Internal Medicine Residency Program at Singhealth. He also serves as Chair of the Education Technology Workgroup at Changi General Hospital, a group responsible for identifying, selecting and utilizing technology to enhance medical education. His specific clinical interest in Respiratory and Critical Care is point of care ultrasonography, having obtained his certification from the American College of Chest Physicians. In addition, he has developed several educational initiatives in simulation medical education at Changi General Hospital. He is passionate about medical education for students and doctors and was awarded the 2011 NUS-YLL Dean’s Award for Teaching Excellence as well as the 2011 Changi General Hospital Best Teacher Award. His research interest lies in advancing our understanding and effective use of simulation for clinical teaching and process improvement in critical care. 56 EDUCATION TRACK ABSTRACT 23 November 2013, Saturday 1330 hrs - 1630 hrs Crew Resource Management Dr Lim Tiek Whai Chief & Senior Consultant Department of Anaesthesia & Surgical Intensive Care Changi General Hospital Abstract and Biosketch unavailable at time of print 57 Innovation Symposium 21 - 22 November 2013 Chairperson: Dr Eugene Shum Chief Corporate Development Officer Eastern Health Alliance 58 INNOVATION TRACK 22 November 2013, FRIDAY Changi General Hospital Centre for Innovation, Level 1 1130 – 1200 How I Made it Happen: Developing An Idea and Making It Real Ms Barbara Moscowitz Director, MGH Senior HEalthWISE Program Coordinator, Geriatric Social Work Massachusetts General Hospital Geriatric Medicine Unit 1200 – 1220 Let’s Get Frank! How Design Thinking created a brand new concept in banking Ms Natalie Koh Assistant Vice President OCBC Experience Design 1220 – 1240 Intra-Body Tracking: Navigating Inside the Human Body Dr Foong Shaohui Assistant Professor, Engineering Product Development Singapore University of Technology and Design 1240 – 1255 Question & Answer 1255 – 1400 LUNCH 59 INNOVATION TRACK 22 November 2013, FRIDAY Changi General Hospital Centre for Innovation, Level 1 1400 – 1415 Together! Move it Move it!!: Stroke Gym Programme Ms Charity Chu Manager, Day Rehabilitation Centre St Andrew's Community Hospital 1415 – 1430 AsthmaCare Buddy: Personalized app to keep asthma under control Dr Tan Ngiap Chuan Director of Research SingHealth Polyclinics 1430 – 1445 Delivering Telehealth - Our Journey Continues Ms Adeline Phang Manager Eastern Health Alliance 1445 – 1500 Question & Answer 1500 – 1515 Showcase on Healthcare Management Unit initiative 1515 – 1530 Tea Break 1530 – 1545 Designing an Easy-to-use Pill Crusher (Collaboration with Peacehaven) Mr Johnny Lee Lecturer ITE 1545 – 1600 Health Wellness Programme (HWP): Community-based Mental Health Care for Chronic Disease Patients Ms Lim Hui Khim Senior Mental Health Counsellor Eastern Health Alliance 1600 – 1615 A Silent Handicap: Protect Your Hearing Ms Joyce Lim Senior Tinnitus Counsellor Changi General Hospital 1615 – 1630 Question & Answer 60 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1130 hrs - 1150 hrs How I Made it Happen: Developing An Idea and Making It Real Ms Barbara Moscowitz Medical Social Worker, Departments of Social Services and Geriatric Medicine Massachusetts General Hospital (CIMIT) Abstract and Biosketch unavailable at time of print 61 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1150 hrs - 1210 hrs “Let’s get !” How Design Thinking created a brand new concept in banking How did OCBC Bank go from the longest established bank in Singapore, well known for being financially strong and traditional, to being “possibly the coolest bank Gen-Y has ever seen”? Hear how our efforts to dine, party, shop basically stalk – the Gen-Y led us to developing a banking concept that they can identify with. A bank they would want to be identified with. PRESENTER’S BIOSKETCH Ms Natalie Koh Experience Designer Experience Design & Group Customer Experience Division Oversea Chinese Banking Corporation (OCBC Bank), Singapore Ms Natalie Koh is 10% of a team of “banking misfits” – architect, retail designer, user experience designers and graphic designers – known as the Experience Design team in OCBC Bank. Armed with no banking experience, but a lot of innocent, silly questions, the team tackles customer issues the Bank faces. This resulted in simplifying a 200,000-page website into 600-page; developing a mobile banking app that’s highly lauded locally; reducing error rates in commonly used forms; redesigning communication in product collaterals, letters, statements and ATM screens, and of course FRANK. Prior to joining this team, Natalie spent 6 years as a Service Experience Design consultant in a local consultancy, counting Changi Airport, Wildlife Reserves Singapore and Sephora as clients. In her non-designing time, Natalie loves to spend time with nature and her family. 62 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1210 hrs - 1230 hrs Intra-Body Tracking: Navigating Inside the Human Body Numerous medical and surgical operations, in particular, minimally invasive procedures, require knowledge of the position and orientation of the target device or instrument inside the body. Currently, tethered embedded vision cameras and diagnostic imaging techniques (CT, X-Rays, MRI) are widely employed to gain instantaneous spatial feedback of the target inside the body. However, these methods can be cumbersome to deploy and potentially harmful to the patient under prolonged use. Here a non-invasive localization system harnessing passive magnetic tracking technology is presented as a viable alternative to contemporary established protocols. Asst Prof Foong Shaohui Consultant Orthopaedic Surgery Changi General Hospital, Singapore PRESENTER’S BIOSKETCH Foong Shaohui is an Assistant Professor in the EPD pillar and joined SUTD in Jan 2011. Prior to that, he did his undergraduate and graduate studies in the Woodruff School of Mechanical Engineering at the Georgia Institute of Technology in Atlanta, Georgia, USA. He has a keen interest in mechatronics, which is the synergistic integration of the multiple disciplines of mechanics, electronics, control theory and computer science, and not surprisingly his research is focused around designing and developing novel mechatronic and intelligent systems for a wide spectrum of applications: from agricultural, industrial, robotics and medical. 63 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1400 hrs - 1415 hrs Together! Move it! Move it! : Stroke Gym Programme Stroke rehabilitation at a Day Rehabilitation Centre (DRC) focuses on maximizing patients’ functional level in basic activities of daily living (ADL). Patients who have regained independence in basic ADL would either be discharged to a Day Care Centre or home. However these patients might still experience some degree of impairment that would impact their ability to conduct daily activities with ease. SACH DRC piloted the Stroke Gym Programme (SGP) for stroke patients who have attained plateau stage at the DRC sessional programme. This is a transitional care programme, done in a group setting. It aims to help stroke patients fully optimise their functional recovery and physical abilities, enhance their muscles strength and balance, and thus enable them to be fully independent in the community. This programme helps to improve patients’ quality of life and safety in the community. PRESENTER’S BIOSKETCH Ms Charity Chu Principal Physiotherapist & Manager Rehabilitation Center St Andrew’s Community Hospital, Singapore Ms Charity Chu is a Principal Physiotherapist and the Manager of the Day Rehabilitation Center at St Andrew’s Community Hospital. Prior to her arrival in Singapore 4 years ago, Charity practiced as a physiotherapist in Hong Kong. Since 1996 she has worked in various settings including community hospital, psychiatrist nursing home, acute hospital, private clinic and Home therapy services. As the manager of the Day Rehabilitation Center in St Andrew’s Community in Singapore, she actively seeks opportunities to develop new programmes to meet the needs of the elderly living in the community. Some of the programmes initiated include community integrated activities, a dementia programme and gym rehabilitation for post stroke patients etc. Her passion is to facilitate active involvement of the aged in the community and that drives her to play an active role in the development of community-related programmes. 64 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1415 hrs - 1430 hrs AsthmaCare Buddy: Personalized app to keep asthma under control Asthma is the commonest chronic lung disease, which can cause breathlessness and even death during asthma exacerbations. Good asthma self-management can reduce asthma attack, improve patient’s quality of life and healthcare costs. Tele-healthcare innovations are increasingly used to support patients in their self-management of chronic diseases, including asthma. An IDA survey shows that Singaporeans are avid users of smartphones, and innovations involving these devices will gain widespread acceptance due to easy accessibility and are often free. SingHealth Polyclinics (SHP) has launched its first mobile application(app), “Asthmacare Buddy”, in April 2013. It aims to provide a one-stop resource portal for asthma sufferers where they can access essential information on the disease, triggers and treatment, and view instructional videos on the use of various puffers. The app allows easily access of patient’s personal treatment (action) plan that is initiated by their doctors. It directs the users to take appropriate self-care measures during the window period before it becomes an asthma attack. The action plan is readily available in the mobile and is portable as compared to the existing action plan in hardcopies. Users do not have to carry their hard-copied plan and monitoring charts whenever they are out, and do not have to fear of misplacing or forgetting their home-monitoring records for their doctor consultation. Having the monitoring data available in their phones, users can share the information with their healthcare providers. This provides their doctors with additional information on how the patients are managing their condition, and to recommend appropriate treatment. Presenter’s Biosketch on the next page. 65 INNOVATION TRACK PRESENTER’S BIOSKETCH Dr Tan Ngiap Chuan Director Department of Research SingHealth Polyclinics, Singapore Dr Tan Ngiap Chuan graduated with MBBS from National University of Singapore (NUS) in 1989, completed the MMed(FM) in 1996 and is a Fellow of the College of Family Physicians in Singapore (FCFPS) since 2003. Dr Tan was the Director of SingHealth Polyclinics (SHP)-Pasir Ris till 2012, and is currently a senior consultant and the Director of Research in SHP. Dr Tan received the HMDP award from Ministry of Health to undertake an immersion programme in primary care research at the University of London in Britain in 2002. He received a National Research Foundation Scholarship in 2008 and is a pioneer graduate of the Master programme in Clinical Investigation (MCI NUS) in 2010. He is a recipient of the Singapore Healthcare Humanity award (2006) and the SingHealth GCEO Excellence Award for Outstanding Clinician in 2012. Dr Tan conducts in-house qualitative research since 2006. He is a co-trainer in research workshops at the WONCA Asia Pacific regional (APRC) conferences in Kyoto (2005), Jeju (2012) and a primary care research workshop in Fiji (2013). His research presentations received awards at the WONCA World Congress in Singapore (2007) and WONCA APRC in Cebu (2011). Dr Tan was the sub-editor for the Singapore Medical Journal from 2008 to 2012 and is the current Honorary Editor of the Singapore Family Physician since 2011. Together with two other family physicians, Dr Tan pioneered the innovative research training workshop, “Research Championship” in 2010, which has become the highlight of the Asia Pacific Primary Care Research Conference (APPCRC). INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1430 hrs - 1445 hrs Health Wellness Programme (HWP) in Eastern Community Health Centre, Singapore The Health Wellness Programme is a new initiative targeted at people who suffer from chronic physical illnesses with co-existing mental health problems treated by primary care physicians in the community. It is a new community-based model of care with an allied health team working closely with primary care physicians in delivering interventions for mild to moderate mental health conditions. Research has shown that people who suffer from chronic physical illnesses often have co-existing mental health problems. A community-based study of mental disorders in Singapore found that chronic physical illnesses were significant correlated to mental disorders. It is reported that people with common chronic illnesses such as, cardiovascular, diabetic, respiratory, have much higher rates of depression and anxiety than the general population (Chong, S.A. et al; 2009). With funding support from the government, we have set up the Health Wellness Programme, a 5-year funded programme, involving collaboration with various stakeholders. Our key concern, is that the greatest challenge lies not in the setting up of such a service, but the integration of care with other healthcare professionals and in breaking the stigma of mental health conditions in the community. Presenter’s Biosketch on the next page 67 INNOVATION TRACK PRESENTER’S BIOSKETCH Ms Lim Hui Khim Senior Mental Health Counsellor Health Wellness Programme / Community Health Centre Eastern Health Alliance, Singapore Ms Lim Hui Khim is the Senior Mental Health Counsellor with the Health Wellness Programme under the Eastern Community Health Centre. She is formerly the Deputy Head of Counselling at the National Addictions Management Service (NAMS) housed in the Institute of Mental Health. She has been working in the field of mental health and addictions counselling for over 12 years, providing individual and group counselling to patients and their families with mental health issues, substance and behavioural addictions. Hui Khim is also trained in managing cases of family violence, providing mandatory counseling for both perpetrators and victims in families with substance abuse and gambling problems. Hui Khim is certified by the International Certification and Reciprocity Consortium (ICRC) as a substance abuse and gambling counselling and clinical supervisor in addiction counselling. She holds a Masters degree in Couselling and Psychotherapy with Edith Cowan University and a Bachelor degree in Science (Applied Psychology) with University of Southern Queensland. Hui Khim is also an adjunct lecturer / tutor and individual supervisor for counseling unit students under Singapore Institute of Management. Being in this field for a decade, Hui Khim is keen to see more integration of services and more support for both mental health and addiction issues in the community. And being a trained supervisor in this field, Hui Khim believes in the importance of imparting knowledge and experience to the next generation. INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1530 hrs - 1545 hrs Designing an Easy-to-use Pill Crusher (Collaboration with Peacehaven) The Pill Crusher machine is different from existing pill crushers – it employs rollers to crush pills. Pills are gripped and crushed to powder by 2 specially designed rollers with knurling patterns. The machine is designed to be simple and safe to use. Being battery operated, it is also portable. There is a built-in charger jack to charge the rechargeable battery whenever required. PRESENTER’S BIOSKETCH Mr Johnny Lee Lecturer Teaching Faculty Institute of Technical Education, Singapore Johnny Lee was an industrial product designer for 12 years prior to joining ITE as teaching staff. He holds a B. Sc. (Hon) in Technology degree from SIM University and had been active with student project work. 69 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1545 hrs - 1600 hrs A Silent Handicap: Protect Your Hearing Today, using a personal music player (PMP) is a life-style choice for many people. While we know that excessive PMP use can damage our hearing, most people don’t know what is meant by “excessive” use. Come and meet Belle and Maxx, our sound measurement mannequins that were built by the CGH departments of BioMedical Engineering and Otolaryngology. They can measure the sound level of your PMP and let you know what an appropriate listening level should be. Hearing, one of our five senses, is often underappreciated – until we lose it. With Belle and Maxx’s help, you can better protect your hearing and prevent the development of a silent handicap! PRESENTER’S BIOSKETCH Ms Joyce Lim Senior Tinnitus Counsellor Otolaryngology Changi General Hospital, Singapore Ms Joyce Lim is currently working as a Senior Tinnitus Counsellor in Department of Otolaryngology in Changi General Hospital. She has been involves in the professional audiology service for over 20 years. She has a Specialist Diploma in Counselling Psychology. She had received her audiology and tinnitus trainings in both the United Kingdom and United States of America. Her research on the ‘Impact of Tinnitus as measured by Tinnitus Handicap Inventory among tinnitus sufferers in Singapore’ had been published in the Singapore Medical Journal, 2010. 70 INNOVATION TRACK ABSTRACT 22 November 2013, Friday 1600 hrs - 1615 hrs Delivering Telehealth - Our Journey Continues Abstract unavailable at time of print PRESENTER’S BIOSKETCH Ms Adeline Phang Manager Eastern Health Alliance Singapore Adeline has years of experience in system solution and implementation in both commercial and healthcare industry spanning across organisations at Raffles Medical Group, KKH, IMH, CPF, Singapore Telecommunications, Market Research organisation and including a stint with CGH in her earlier years. Her experience involved in transforming of organisational wide IT systems, business process reengineering for strategic key projects. Prior to joining EHA, Adeline was with IMH where she led overall clinical applications systems that leads to a more integrated and seamless hospital system. Adeline graduated with an honours degree in Computer Science and holds Master degree major in Technology Management. Her research dissertation specialised in business transformation through value based knowledge management. She has also developed a locality distribution of patient needs system for the Foundation NHS Trust as her thesis project during her study in the UK. 71 Research Symposium 21 & 23 November 2013 Chairperson: Dr Tan Thean Yen Senior Consultant Microbiologist, Department of Laboratory Medicine Head of Research, Clinical Trials & Research Unit Changi General Hospital 72 RESEARCH TRACK 21 November 2013, THURSDAY CGH Tutorial Room , Training Centre Level 1 0900 – 1000 Formulating A Good Research Question Dr Serena Koh Deputy Director , Hospital Services Division, Health Services Group Ministry of Health 1000 – 1100 The Truth Is Out There: Literature Review/ Appraisal Tools Dr Dawn Tan Principal Physiotherapist, Department of Physiotherapy Singapore General Hospital 1100 – 1130 TEA BREAK 1130 – 1300 Clinical Trials: Research Design and Methods Dr Lawrence Lee Soon-U Visiting Consultant, Clinical Trials & Research Unit , Changi General Hospital Assistant Professor, Department of Medicine, National University of Singapore Academic Consultant Physician, Department of Infectious Disease, Tan Tock Seng Hospital 1300 – 1400 1400 – 1445 1445 – 1515 1515 – 1600 LUNCH We're In The Money: Successful Grant Funding Dr Angela Chow Head & Consultant, Department of Clinical Epidemiology Tan Tock Seng Hospital Citation Made Easy, the EndNote way Ms Norasyikin Hassan Nurse Clinician, Nursing Administration Changi General Hospital Dazed, Confused and Befuddled: Data analysis and statistics Ms Sajlia Jalil Senior Speech Therapist Changi General Hospital 73 RESEARCH TRACK 21 November 2013, THURSDAY CGH Tutorial Room , Training Centre Level 1 1600 – 1630 TEA BREAK 1630 – 1730 Fame And Fortune Awaits: How To Get Published A/Prof Seet Chee Seong, Raymond Consultant, Division of Neurology National University Hospital Singapore 23 November 2013, SATURDAY Changi General Hospital Seminar Room, Level 2 0900 - 1000 1000 - 1100 A Very Early Rehabilitation Trial (AVERT)for Stroke: Experiences from a Multidisciplinary Collaboration Dr Dawn Tan Principal Physiotherapist, Department of Physiotherapy Singapore General Hospital Health services research- translating research, improving care Dr Chow Wai Leng Assistant Director, Health Services Research Eastern Health Alliance 74 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 0900 hrs - 1000 hrs Formulating a Good Research Question Developing a good question which is researchable is one of the most challenging tasks a researcher encounters when starting up a project. Unanswered problems encountered in clinical practice or when experiences dictate alternative care and clinical management often provokes a clinician to initiate and develops a clinical research question. This presentation describes PICO (population, intervention, control, and outcomes) criteria in framing a research question. A research question should also be formulated keeping in mind the FINER (feasible, interesting, novel, ethical, and relevant) criteria and that the research findings should fill gaps in existing knowledge. Finally, we also assess the characteristics of a research question in the context of my experience initiating a research project. PRESENTER’S BIOSKETCH Adjunct A/Prof Serena Koh Deputy Director Standards and Quality Improvement Division/ Hospital Services Division, Ministry of Health, Singapore Adjunct A/Prof Serena Koh is the Deputy Director, Standards and Quality Improvement Division at the Ministry of Health, Singapore (MOH). Her portfolio includes developing the National Quality Assurance (QA) framework, patient safety strategies and National Standards of Healthcare across the continuum of care. Concurrently she is Deputy Director (Hospital Services), overseeing the implementation of Human Organ Transplant Act (HOTA), Medical Therapy, Education, Research Act (MTERA), Coroners' Act and Advanced Medical Directive (AMD). A/Prof Koh had received her PhD in Medicine, Dentistry and Health Sciences, from the School of Nursing, University of Melbourne, Australia in year 2008. She holds concurrent appointment at the Alice Lee Centre for Nursing Studies, NUS, teaching undergraduates & postgraduates on research, evidence-based practice, patient safety and quality as well as supervision of the students for their research thesis. She has worked in KKH as a midwife since 1995, and extended to research and teaching roles since 2001. Her research interests are in evidence based practice and patient safety. A/Prof Koh has vast experiences in supporting, promoting and implementing evidence-based practice, and has coordinated various research activities, developed and initiated numerous nursing quality improvement & risk management strategies to improve quality care, patient safety and outcomes. 75 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1000 hrs - 1100 hrs The Truth Is Out There: Literature Review/ Appraisal Tools There is a move towards evidence based practice where patient care is driven by scientific evidence, patient preferences, clinical expertise and other resources. This lecture covers the formulation of clinical questions using the PICO format, systematic literature searching and critical appraisal tools commonly used to assess the methodological quality of clinical research. PRESENTER’S BIOSKETCH Dr Dawn Tan Principal Physiotherapist Department of Physiotherapy , Singapore General Hospital , Singapore Dawn completed her Masters in Neurological Physiotherapy and Doctor of Clinical Physiotherapy with the University of Melbourne in 2006 and 2010 respectively. She works with patients with neurological and vestibular disorders in the outpatient setting at the Singapore General Hospital. Dawn’s areas of research interests include stroke, Parkinson’s disease and vestibular rehabilitation. She has participated and presented in various local scientific conferences . 76 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1000 hrs - 1100 hrs Clinical Trial: Research Design and Methods Clinical research, or research involving human subjects, is the only way to confirm results of in vitro and animal studies. There is a large variety of types of clinical research, ranging from case reports to observational studies to clinical trials to meta-analyses. This lecture will focus on the design of clinical trials and will cover the clinical trial phases from phase 1 to phase 4 designs. PRESENTER’S BIOSKETCH Dr Lawrence Lee Consultant Department of Medicine National University Health System, Singapore Dr Lawrence Lee is Assistant Professor in the Department of Medicine at the National University of Singapore. He is a full time faculty member in the Division of Infectious Diseases at National University Health System and Tan Tock Seng Hospital. He is also a Visiting Consultant in the Clinical Trials Research Unit, Changi General Hospital. Doctor Lee has been involved in clinical research for over 10 years. He has performed a large variety of phase 1 to 4 clinical trials, both in academia and in industry. He is an internationally recognized speaker, clinician, and researcher and has published extensively in medical journals. Currently he is on the editorial board of “Singapore Medical Journal”. 77 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1400 hrs - 1445 hrs We're in the Money: Successful Grant Funding A successful grant application requires time and effort. Early planning and development of a good grant proposal is fundamental. The essential steps in the grant application process include consideration of: qualification, design, writing, submission, and review. PRESENTER’S BIOSKETCH Dr Angela Chow Head & Senior Consultant Clinical Epidemiology Institute of Infectious Disease & Epidemiology, Tan Tock Seng Hospital, Singapore Dr Angela Chow is Head and Senior Consultant of the Department of Clinical Epidemiology at the Institute of Infectious Disease & Epidemiology at Tan Tock Seng Hospital. She is also an Adjunct Associate Professor and Lead for Public Health & Health Services Outcome Research at the Lee Kong Chian School of Medicine, and an Adjunct Assistant Professor at the Saw Swee Hock School of Public Health. Dr Chow has been actively involved with the epidemiological surveillance, prevention and control of hospital-associated infections and emerging infectious diseases including SARS, chikungunya fever, avian and pandemic influenza, and the novel human coronavirus. She is involved with various clinical and epidemiological research studies and has held several research grants including the recently-awarded inaugural Ministry of Health’s Communicable Disease Public Health Research Grant. 78 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1445 hrs - 1515 hrs Citation Made Easy; The EndNote® Way In-text citation for academic writing or manuscript is equally mandatory and tedious to avoid plagiarism. The writers are expected to follow the preferred referencing style set by the faculty or editorial board which requires them to switch from one referencing style to another. In the market, there are several citation software which facilitate writers to organise in-text citations and reference list in an orderly fashion. This lecture provides an overview of EndNote®, demonstrates importing and exporting citations from online journal database to EndNote® library and using EndNote® Cite While You Write command while writing a paper in Microsoft Word. PRESENTER’S BIOSKETCH Ms Norasyikin Hassan Nurse Clinician Nursing Department Changi General Hospital, Singapore Ms Norasyikin is a Nurse Clinician at Changi General Hospital, Nursing Department. She graduated with Master of Nursing Science in 2011 with a research interest in qualitative methods. She is also an associate teaching member in the Faculty of Health Sciences, School of Nursing at The University of Adelaide. In CGH, Norasyikin coordinates nursing research activities and being the resource person for nursing research matters. She is also the program coordinator for the in-house nursing research course where she teaches research methodologies in hermeneutic phenomenology. 79 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1515 hrs - 1600 hrs Dazed, Confused, and Befuddled: Data Analysis and Statistics Data analyses and statistical methods can be overwhelming for researchers. This sharing aims to present an overview of the common quantitative statistical analyses used for research in the healthcare setting. Participants will engage in hands on practice linking their research questions and variables to the corresponding statistical analyses that are to be conducted. PRESENTER’S BIOSKETCH Ms Sajlia Jalil Senior Speech Therapist Rehabilitative Services Changi General Hospital, Singapore Ms Sajlia Jalil is a Senior Speech Therapist at the Changi General Hospital. She works with adults with communication and swallowing deficits following neurological injury. She is also a part-time lecturer at the National University of Singapore, teaching students from the MSc (Speech and Language Pathology) course. Ms Sajlia is currently a PhD candidate with the University of Sheffield, with a research focus on cognitive-communication deficits in Malay-English bilinguals with Traumatic Brain Injury. 80 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 1630 hrs - 1730 hrs Fame And Fortune Awaits: How To Get Published A/Prof Seet Chee Seong, Raymond Consultant, Division of Neurology National University Hospital Singapore Abstract and Biosketch unavailable at time of print 81 RESEARCH TRACK ABSTRACT 21 November 2013, Thursday 0900 hrs - 1000 hrs A Very Early Rehabilitation Trial (AVERT) for Stroke: Experiences from a Multidisciplinary Collaboration AVERT (A Very Early Rehabilitation Trial) is an international, multi-center, randomized controlled trial which aims to investigate the clinical and cost benefits of very early rehabilitation in people with acute stroke. The trial was developed by the Natio nal Stroke Research Institute (NSRI) in Melbourne, Australia. It aims to recruit a total of 2104 subjects internationally. In August 2009, Singapore General Hospital (SGH) became the inaugural site for AVERT in ASIA and was also awarded the SingHealth Foundation Research Grant in the same year. AVERT Singapore aims to recruit 120 patients. To date, we have PRESENTER’S BIOSKETCH Dr Dawn Tan Principal Physiotherapist Department of Physiotherapy , Singapore General Hospital , Singapore Dawn completed her Masters in Neurological Physiotherapy and Doctor of Clinical Physiotherapy with the University of Melbourne in 2006 and 2010 respectively. She works with patients with neurological and vestibular disorders in the outpatient setting at the Singapore General Hospital. Dawn’s areas of research interests include stroke, Parkinson’s disease and vestibular rehabilitation. She has participated and presented in various local scientific conferences. 82 RESEARCH TRACK ABSTRACT 23 November 2013, Saturday 1000 hrs - 100 hrs Health services research- translating research, improving care While health services research (HSR) has been established overseas, the awareness and use of HSR to improve healthcare locally has only started to gain momentum in the recent years. The breakthrough discoveries of bench research would usually come to mind when research is mentioned. However, it is in the translation of research into actual clinical practice that would enable the provision and delivery of better care to patients. HSR enables the translation of research into better patient care. By describing what HSR is and the types of health services research studies, the speaker seeks to illustrate how health services research is a critical component of a health system that is interested in providing quality patient care. PRESENTER’S BIOSKETCH Dr Chow Wai Leng Assistant Director Health Services Research, Eastern Health Alliance, Singapore Dr Chow Wai Leng obtained her MBSS from NUS and subsequently obtained a post graduate diploma in Family Medicine. She was practicing as a doctor in the various healthcare institutions in Singapore for seven years before she embarked on a career in quality management and health services research. Previously, during her term as Assistant Director of SingHealth’s Centre for Health Services Research, Wai Leng was also involved in the training and planning of the clinical quality improvement programme at SingHealth. She has keen interest in conducting research that would lend insights to healthcare providers to enable improvement of healthcare delivery. Wai Leng now heads the Health Services Research department at the Eastern Health Alliance and continues to actively promote the use of research to improve patients’ quality of and access to care. 83 Sports Medicine Symposium 22 November 2013 Chairperson: Dr Kelvin Chew Senior Consultant, Changi Sports Medicine Centre Changi General Hospital 84 SPORTS MEDICINE TRACK 22 November 2013, FRIDAY Changi General Hospital Auditorium, Level 1 1300 – 1400 Lunch and Welcome 1400 – 1420 Introduction to Exercise is Medicine Dr Benedict Tan Chi Loong Chief & Senior Consultant Changi Sports Medicine Centre, Changi General Hospital 1420 – 1450 National Physical Activity Guidelines Dr Robert Sloan Centre Head/Chief Exercise Physiologist, Physical Activity Centre of Excellence Health Promotion Board 1450 – 1520 Exercise In Obesity: An Update Dr Goh Kian Peng Head, Medical Unit 2, Consultant Khoo Teck Puat Hospital 1520 – 1540 TEABREAK 1540 – 1605 Exercise as a Therapeutic Agent for the 21st Century Dr Cindy Lin Staff Attending Physician, Department of Sports Medicine Changi General Hospital 1605 – 1620 Exercise Demonstration Ms Shamsynar Ani Senior Sports Physiotherapist Changi General Hospital 1620 – 1645 Teaching Exercise To Health Care Providers And Fitness Professionals – The EIMS Experiences Dr Ng Chung Sien Staff Attending Physician Changi Sports Medicine Centre, Changi General Hospital 1645 – 1700 Questions & Answers Panel of Speakers 85 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1400 hrs - 1420 hrs Exercise is Medicine Global Initiative – An Overview Exercise is Medicine (EIM) is a global initiative of the American College of Medicine. Since 2007, the EIM movement has spread to 40 odd countries, including Singapore. The programme aims to get doctors and other healthcare workers to be more confident in prescribing exercise and supervising exercise, especially for those with chronic diseases like diabetes and cardiovascular disease. EIM Singapore was launched in 2011, with professional education, research, and public awareness as its key thrusts. The EIM Southeast Asia Regional Centre is headquartered in Singapore. This presentation identifies the barriers to exercise prescription in everyday practice, together with the solutions and interventions that are being implemented. PRESENTER’S BIOSKETCH Dr Ben Tan Chairman Exercise is Medicine Changi General Hospital, Singapore Dr Ben Tan, a Sports Physician, is the Chairman of Exercise is Medicine, Singapore (EIMS), as well as the Director of Exercise is Medicine Southeast Asia (EIM SEA). Dr Tan completed his Sports Medicine training at the Australian Institute of Sports in 1997, and is now Chief and Senior Consultant at the Department of Sports Medicine, Changi General Hospital. The Department runs two comprehensive Sports Medicine centres: the Changi Sports Medicine Centre and Singapore Sports Medicine Centre. Dr Tan is on the Advisory Panel of the Singapore Sports Institute and the Singapore Armed Forces. As President of the Singapore Sailing Federation, Dr Tan is not only an Asian Games gold medallist in sailing, he also actively participates in kite boarding, marathon running, SCUBA diving, and downhill skiing. 86 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1420 hrs - 1450 hrs National Physical Activity Guidelines Abstract not available at time of print PRESENTER’S BIOSKETCH Dr Sloan Centre Head/Chief Exercise Physiologist Physical Activity Centre of Excellence Health Promotion Board, Singapore Dr Sloan has twenty years’ experience in health promotion in both the private and public sectors with eight years in Japan and four years in Singapore focusing on physical activity, obesity prevention, and information communication technology in public health. His research interests include physical activity and health related quality of life and the use of technology to promote healthy behaviours. His current position is with the Singapore Health Promotion Board serving as Centre Head/Chief Exercise Physiologist, Physical Activity Centre of Excellence (PACE). Robert trained at the Ochsner Heart and Vascular Institute in New Orleans, LA and the Cooper Institute for Aerobics Research in Dallas, TX and has worked for the US Navy Public Health Centre in the USA and Japan. Throughout his studies he has obtained a PhD in Public Health, MA Exercise Science & Health Promotion and a BA in Psychology as well as being a Licensed Clinical Exercise Physiologist (LSBME & ACSM), and a Certified Community Health Education Specialist (NCHEC). 87 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1450 hrs - 1520 hrs Exercise in type 2 diabetes: A new look at an old problem The risk of developing type 2 diabetes (T2DM) is affected by our genetic make-up and environment. While there is evidence supporting a strong genetic component, the currently identified loci confer only a modest effect size in the variation of disease susceptibility. Hence, the focus has shifted to environmental factors and the gene-environment interaction. The strongest evidence linking lifestyle factors to T2DM risk relates to energy expenditure and physical activity. Given that a sedentary lifestyle increases the risk for T2DM, this implies that exercise may reduce the risk of its development and additionally be used to treat it. The detrimental effect of low energy expenditure through reduced physical activity may be explained by hypothesizing that we have evolved as an exercise-dependent species. Epidemiological studies have also shown that epigenetic mechanisms may be involved. If so, this implies that the prenatal and early childhood environment are important life stages at which the risk of T2DM development may be modified. At the molecular level, exercise stimulates glucose uptake acutely via a mechanism different than insulin-stimulated glucose uptake. Energy sensing molecules such as AMPK and SIRT1 are involved. The understanding of the signaling pathways may help in the identification of exercise-mimetics which may represent a new class of anti-diabetic agents. PRESENTER’S BIOSKETCH Dr Goh Kian Peng Consultant and Head Division of Endocrinology, Medical Unit 2, Department of Medicine Khoo Teck Puat Hospital, Alexandra Health, Singapore Dr Goh Kian Peng has served in a number of key positions as Consultant at the Department of Medicine, specialising in endocrinology and diabetes mellitus. He is also the NHG-AHPL Internal Medicine Residency Associate Programme Director. Following his post-graduate training in both Endocrinology and Family Medicine, he was awarded the Human Manpower Development Programme Fellowship in 2007, during which he was attached to the Aberdeen Royal Infirmary and also obtained a MSc in Molecular Exercise Physiology at the University of Aberdeen in UK. While holding teaching and administrative posts, he is also the Principal Investigator for several NMRC research grants. His main research interests are the roles and molecular adaptation of exercise in the treatment and prevention of chronic diseases. 88 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1540 hrs - 1605 hrs Exercise as a Therapeutic Agent for the 21st Century Physical activity is known to be an important component of the prevention and management of many common chronic health conditions from obesity to diabetes and heart disease. This lecture will cover interesting and insightful findings from what the recent medical research in the 21 st century has discovered about the critical role of exercise in health promotion across the lifespan. PRESENTER’S BIOSKETCH Dr Cindy Lin Staff Attending Physician Sports Medicine & Rehabilitation Medicine Changi General Hospital, Singapore Dr. Cindy Lin is a Staff Attending Physician in Sports Medicine & Rehabilitation Medicine at Changi General Hospital. She received her medical degree (MD) from Harvard Medical School. She is American Board certified in Sports Medicine and Physical Medicine & Rehabilitation. She is active in clinical care, research, and teaching in sports medicine and rehabilitation medicine. She is Director of Community Outreach for Exercise is Medicine Singapore. 89 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1605 hrs - 1620 hrs Exercise Demonstration Ms Shamsynar Ani Senior Sports Physiotherapist Changi General Hospital Abstract and Biosketch unavailable at time of print 90 SPORTS MEDICINE TRACK ABSTRACT 22 November 2013, Friday 1620 hrs - 1645 hrs Teaching Exercise To Health Care Providers And Fitness Professionals – The EIMS Experiences Dr Ng Chung Sien Staff Attending Physician Changi General Hospital, Singapore Abstract and Biosketch unavailable at time of print 91 Best Oral Paper Award Clinical Medicine 21 November 2013 1030 - 1300 Centre for Innovation, Level 1 92 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) 21 November 2013, THURSDAY @ 1100hrs - 1215hrs Changi General Hospital, Lecture Room @ Training Centre, Level 1 Chairperson: A/Prof Ang Tiing Leong (CGH) Judges: Dr Chow Wai Leng Ms Rosy Tay Dr Melissa Ngai (EHA) (NP) (NUH) ORAL-CM (1100) RASAGILINE VERSUS SELEGILINE AS AN INITIAL THERAPY FOR PARKINSON’S DISEASE IN OLDER ADULTS Ms Gan Peiying, Geriatric Medicine, Ward 45, Changi General Hospital ORAL-CM (1115) BETA-LACTAM/BETA-LACTAMASE INHIBITORS VS CARBAPENEMS FOR THE TREATMENT OF URINARY TRACT INFECTIONS (UTIS) CAUSED BY EXTENDEDSPECTRUM BETA-LACTAMASE (ESBL)-PRODUCING BACTERIA: A RECTROSPECTIVE COHORT STUDY Mr Lim Xi Wei, Pharmacy, Changi General Hospital ORAL-CM (1130) ORTHOSTATIC HYPOTENSION – PREVALENCE AND ASSOCIATED RISK FACTORS AMONGST THE AMBULATORY ELDERLY IN AN ASIAN POPULATION Dr Gilbert Tan Choon Seng, Geylang Polyclinic, SingHealth Polyclinics ORAL-CM (1145) EVALUATION OF VASOPRESSIN UTILISATION IN THE TREATMENT OF SEPTIC SHOCK Mr Widjaya Michael, Pharmacy, Changi General Hospital IMPROVING MOBILITY IN MICU AT CGH: A MULTIDISCIPLINARY APPROACH ORAL-CM (1200) Ms Loke Shi Jia, Rehabilitative Services, Changi General Hospital 93 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) ABSTRACTS 21 November 2013, Thursday 1100 hrs - 1115 hrs RASAGILINE VERSUS SELEGILINE AS AN INITIAL THERAPY FOR PARKINSON’S DISEASE IN OLDER ADULTS Gan P*, Patel, S., Li, J., Kim, J.Y. & Ngo, S. Department of Geriatric Medicine, Ward 45, Changi General Hospital, Singapore Aims Parkinson’s disease (PD) is associated with high morbidity and mortality among older adults. Although levodopa has been advocated as the gold standard in anti-parkinsonism therapy, the unfavourable side effect/adverse reaction profile has led clinicians to consider rasagiline and selegiline in the initial treatment of PD. This review hence aims to compare the efficacy of both drugs in the initial treatment of PD in terms of their neuro-modifying effects, tolerability and cost effectiveness. Methods An exhaustive literature search covered five databases: PubMed, CINAHL Plus with Full Text, EMBASE and the Science Databases. A total of nine studies, consisting of one systemic review, four randomised control trials and four cohort studies were selected for review. All studies were then appraised independently by at least 2 reviewers. Results Both rasagiline and selegiline are of comparable efficacy in the initial management of PD, with neuro-modifying results most evident in Caucasians who are about 60 years of age. Both agents appear to be well tolerated at their daily recommended dosage although selegiline is associated with a higher incidence of gastro-intestinal disturbances Conclusions Rasagiline (at 1mg dosing) is recommended over selegiline. However, it is still reasonable to consider selegiline as an alternative therapy with adequate monitoring and management of side effects. There is a paucity of information addressing the cost-effectiveness of either drug in the management of PD. 94 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) ABSTRACTS 21 November 2013, Thursday 1115 hrs - 1130 HRS BETA-LACTAM/BETA-LACTAMASE INHIBITORS VS CARBAPENEMS FOR THE TREATMENT OF URINARY TRACT INFECTIONS (UTIS) CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE (ESBL)-PRODUCING BACTERIA: A RECTROSPECTIVE COHORT STUDY Lim Xi Wei*, J Seah, WX Tong Department of Pharmacy, Changi General Hospital, Singapore Aims To compare the treatment outcomes of patients with UTIs caused by ESBL-producing Enterobacteriaceae who were treated with either a carbapenem or a beta lactam/beta-lactamase inhibitors (BLBLIs). Methods A retrospective cohort study included patients diagnosed with the first episode of UTI caused by an ESBL-producing Enterobacteriaceae showing susceptibility to both carbapenems and BLBLIs. Outcomes studied were clinical response, microbiological clearance, length of hospitalisation, in-hospital mortality and reinfection or recurrence rates. Results A total of 511 patients with positive urine cultures were identified. However, the majority were excluded as patients were asymptomatic, had concomitant infections or because cultures were polymicrobial. Fifty four patients were included in the study; fifteen (27.8%) received carbapenems, while 39 (72.2%) received BLBLIs. Most were female, with a median age of 76.5 years old. The majority had pyelonephritis, and grew ESBL-producing Escherichia coli. The baseline characteristics did not differ significantly between the two groups. The median duration of antibiotics use was 7 days for carbapenem patients vs. 9 days for the BLBLI group. All patients showed clinical response to treatment and survived. Most patients did not have follow-up urine cultures to document clearance. For those who did, microbiological clearance within one week of definitive treatment [carbapenem: 4 (80.0%) vs. BLBLI: 8 (66.7%), p=1.000] and overall microbiological cure without reinfection or recurrence [6 (100.0%) vs. 12 (100.0%), p=1.000] did not differ between groups. There was also no significant difference in length of hospitalization [carbapenem: 13 days (inter-quartile range 8-18 days) vs. 9 (6-14), p=0.070]. Conclusions This study suggests that treatment of UTIs caused by ESBL-producing organisms with BLBLIs, as compared to carbapenems, did not result in worsening of outcomes. 95 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) ABSTRACTS 21 November 2013, Thursday 1130 hrs - 1145 hrs ORTHOSTATIC HYPOTENSION – PREVALENCE AND ASSOCIATED RISK FACTORS AMONGST THE AMBULATORY ELDERLY IN AN ASIAN POPULATION CSG Tan2, 4, HL Tan1, RG Wong1, RA Cuttilan1, CS Joshi1, QO Zhu1, GKJ Sng3, NC Tan2,4 1 Yong Loo Lin School of Medicine, National University of Singapore Singhealth Polyclinics 3 Saw Swee Hock School of Public Health, National University of Singapore 4 Duke-NUS Graduate Medical School 2 Aims The prevalence of orthostatic hypotension (OH) as defined by an objective decline in blood pressure (BP) on changes in position is not well-established amongst the elderly population in Singapore. This study aims to determine the prevalence of OH in patients aged 65 years and above attending a primary care clinic (polyclinic) for chronic disease management, and to examine factors associated with the presence of OH. Methods All patients aged ≥65 years attending Geylang Polyclinic for chronic disease management were identified and approached over a 4-day duration. Trained investigators interviewed the patients using a questionnaire documenting the presence of symptoms and postulated risk factors such as medical history and medications. This was followed by a single supine and standing BP measurement. OH was defined as a decrease in systolic-BP by ≥20mmHg or that in diastolic-BP by ≥10mmHg. Results Of 511 eligible patients over a 4-day survey, we screened 364 patients (71% response rate). The prevalence of OH was 11.0% (95%CI: 8.2-14.8). On univariate analysis, age ≥70 years (PRR: 2.70, 95%CI: 1.10-6.67), occupational inactivity (PRR: 4.17, 95%CI: 1.02-16.67), fatigue during standing from a supine position during blood pressure measurement (PRR: 2.58, 95%CI: 1.06-6.33) and reported dizziness in the past one year (PRR: 2.37, 95%CI: 1.33-4.22) were found to be significantly associated with the presence of OH. Multivariate analysis revealed reported dizziness in the past one year (PRR: 2.61, 95%CI: 1.30-5.26) as an independent association. Conclusions Our study showed that one in ten elderly patients managed at a primary healthcare clinic in Singapore is affected by OH. The presence of OH is associated with a reported history of dizziness, and possibly demographic factors such as advanced age and occupational inactivity. Further prospective studies to establish a profile of individuals at high risk of OH should be carried out to better target screening and intervention measures. 96 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) ABSTRACTS 21 November 2013, Thursday 1145 hrs - 1200 hrs EVALUATION OF VASOPRESSIN UTILISATION IN THE TREATMENT OF SEPTIC SHOCK Widjaya M*, YJI Wee, YLG Chan Department of Pharmacy, Changi General Hospital, Singapore Aims Septic shock remains a leading cause of death in intensive care units. While noradrenaline may be considered as the vasopressor of choice for the treatment of septic shock, the role of non-catecholamine vasopressors such as vasopressin has not been fully delineated.The objectives of this study were to evaluate: (1) prescribing patterns of vasopressin, and (2) the impact of vasopressin on patient outcomes amongst critically ill patients with septic shock. Methods We conducted a 24-month retrospective cohort study of adult intensive care patients who had received vasopressin for the treatment of septic shock. Relevant patient-specific data (including demographics, vasopressin utilisation, use of concomitant vasopressors, and outcome measures) were extracted from manual and electronic medical records. Results Sixty eligible patients (mean age 66.3+/-13.5 years) were identified and reviewed. Usage was predominantly adjunctive, and added to noradrenaline or dopamine in 95% and 40% of cases, respectively. At initiation, the mean vasopressor dose, represented as noradrenaline-equivalent dose (NED), was 45.0+/-45.4 mcg/min. Patients requiring an initial NED <20 mcg/min had a lower mortality rate (50%) and achieved a higher rate of haemodynamic stability (defined as mean arterial pressure >65 mm Hg for >8 hours without vasopressors) (63.3%) compared to patients requiring initial NED >20 mcg/min (86.8% and 18.3%, respectively). Forty-four patients (73.3%) eventually died. Age, total vasopressin dose administered, and severity of illness (represented by SOFA scores) were found to positively correlate with mortality, while late initiation of vasopressin was associated with significantly shorter lengths of hospitalization. Conclusions Vasopressin was predominantly used as second- or third-line agent for the treatment of septic shock. Patients with lower NED at initiation of vasopressin had a lower mortality rate and more frequently achieved haemodynamic stability. Mortality amongst vasopressin recipients was most closely associated with patients’ age, total amount of vasopressin administered, and severity of illness. 97 BEST ORAL PAPER AWARD (CLINICAL MEDICINE) ABSTRACTS 21 November 2013, Thursday 1200 hrs - 1215 hrs IMPROVING MOBILITY IN MICU AT CGH: A MULTIDISCIPLINARY APPROACH Loke SJ1, Wong TML1, TanPC2, Liu YJ2,Xu HY2,Ho WW2, Myra A2, Qamaruddin IH2, Lacson CV2,Xiao Q2, Wallace JM2, Ariete M2, Poulose V3, Salem AJB4, Agdigos BLG4, Flora JKG4 1 Department of Rehabilitative Services,Changi General Hospital, Singapore Department of Nursing, MICU, Changi General Hospital, Singapore 3 Department of Respiratory Medicine, Changi General Hospital, Singapore 4 Department of Respiratory Therapy Unit , Changi General Hospital, Singapore 2 Aims Early mobilization (EM) of ICU patients has been found to reduce ICU and hospital length of stays. Our MICU first started the practice of EM in mid 2012 using a multidisciplinary team comprised of physiotherapists (PTs), nurses, respiratory therapists and physicians. The aim of this study is to look at our EM rates over a 16 week period including adverse events Methods A retrospective review of medical patients who were admitted to MICU between June 18, 2013 and September 30, 2013. Patients suited for EM were identified by a tool developed by Needham et al (2010). The hierarchy level of mobilization was decided by the PTs. For patients who were mechanically ventilated, the PTs were assisted by the MICU nurses and respiratory therapists. The contraindications for EM were 1) non co-operative patient 2) high inotrope dose 3) high ventilator requirements 4) patients receiving dialysis or having intra-ventricular drains (EVD) 5) manpower shortage Results Of the total census of 595 patients during this period, 115 (19.3%) were mobilized. There were 2 adverse events (one dislodgement of PICC line and one dislodgement of a peripheral IV line) which did not impact patient’s health Conclusions EM was found to be feasible and safe in our MICU. In the future, we hope to implement a structured EM protocol and look at clinical outcomes of EM 98 Best Oral Paper Award Innovation 21 November 2013 0900 - 1300 Centre for Innovation, Level 1 99 BEST ORAL PAPER AWARD (INNOVATION) 21 November 2013, THURSDAY 0900hrs - 1230hrs Changi General Hospital, Lecture Room @ Training Centre, Level 1 Chairperson: TBA Judges: Mr Wong Kok Cheong Dr Diana Tan Dr Lim Hwee Boon Ms Teo Sok Yeong ORAL-IN (0900) (CGH) (CGH) (POLYCLINIC) (SACH) PILOT IMPLEMENTATION OF A FULL-TIME “INTERIM CAREGIVER” SERVICE TO FACILITATE INPATIENT DISCHARGE Ms Janet Toh Lay Siang, Nursing, Changi General Hospital ORAL-IN (0910) ENHANCING PATIENTS’ EXPERIENCE: BONE FOAM APPLICATION IN MANAGING LOWER LIMB SWELLING Ms Joyce Chen Qiu Yan, Nurse Manager, Changi General Hospital ORAL-IN (0920) IMPLEMENTATION OF TRACHEOSTOMY KIT AND THE ACRONYM OF “ABCD SUCTIONING” Ms Song Xiaoying, SICU, Changi General Hospital ORAL-IN (0930) USE OF MODIFIED BACKSLAB IN PROMOTING WOUND HEALING FOR PATIENT WITH HEEL’S WOUND/ PRESSURE ULCER Ms Wang Chunmei, Wound Team, Case Management, Changi General Hospital ORAL-IN (0940) OPTIMIZING PHYSICAL ACTIVITY LEVEL OF COMMUNITY DWELLING ADULTS POST DISCHARGE FROM HOSPITAL Ms Joan Chia, Rehabiliative Services, Changi General Hospital 100 BEST ORAL PAPER AWARD (INNOVATION) 21 November 2013, THURSDAY 0900hrs - 1230hrs Changi General Hospital, Lecture Room @ Training Centre, Level 1 ORAL-IN (0950) WORKING WITH THE FOREIGN SPEAKING CAREGIVER ; HOW A MULTIDISCIPLINARY APPROACH HELP IN MAKING SENSE OF THE TEACHBACK METHOD AND POST DISCHARGE TELEPHONIC REVIEW - THE ACTION TEAM'S EXPERIENCE AND PERSPECTIVE Ms Chan Man Ee, Senior Care Coordinator, Changi General Hospital ORAL-IN (1000) ENHANCING PATIENT’S VITAL SIGN MONITORINGS WHILE UNDERGOING SURGERY UNDER LOCAL ANAESTHESIA Ms Noridah Rahman, Operating Theatre, Changi General Hospital ORAL-IN (1010) PHARMACIST OUTREACH PROGRAMME (POP): TELE-PHARMACY INNOVATION Ms Shirlyn Su, Medical Social Services/ Action Team, Changi General Hospital 101 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0900 hrs - 0910 hrs PILOT IMPLEMENTATION OF A FULL-TIME “INTERIM CAREGIVER” SERVICE TO FACILITATE INPATIENT DISCHARGE Janet Toh Department of Nursing, Changi General Hospital, Singapore Aims To facilitate patient discharge from an acute care hospital in Singapore. Development and Implementation of Idea The Thye Hwa Kuan interim caregivers provided home care daily at a subsidised rate for only two weeks. They worked two shifts either from 0800 to 2000 hours while family members continued working or from 2200 to 0800 hours to relieve the family members from caring for the patients during the night. At CGH two key factors resulting in delayed patient discharge were: a. Waiting for long-term caregiving arrangements b. Waiting for nursing home placements. Against this backdrop, CGH, the Ministry of Health and Thye Hua Kwan implemented a pilot full-time interim home help service for patients with lower activities of daily living needs and awaiting for long-term caregiving arrangements on 1st March 2013. Impact of Solution Monthly more than 10 patients opted into the pilot scheme versus the initial projected six patients monthly. As the scheme was so successful, it was extended to patients waiting for day-care placement. Since March 2013, 86 patients were recruited into the scheme. 79 patients had completed the pilot service with 7 patients still on this service as of 30 August 2013. The pilot had facilitated early discharge of patients without which patients would continue to be hospitalised incurring additional hospitalisation costs, possible nosocomial infections, falls, hospital-acquired pressure ulcers and adding to the tight bed crunch. Patients and relatives had verbalised satisfaction with the interim home help service. Conclusions From the positive results, MOH is exploring extending the subsidy beyond the current two weeks, other service providers for the interim care givers and to other acute care hospitals. 102 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0910 hrs - 0920 hrs ENHANCING PATIENTS’ EXPERIENCE: BONE FOAM APPLICATION IN MANAGING LOWER LIMB SWELLING QYJ Chen, JG Demaisip, S Shikandar Mydin, MA Abdullah Department of Ward 36, Changi General Hospital, Singapore Aims To reduce total time taken for setting up a lower limb elevator by 80% and to achieve 100% patient’s compliance rate to lower limb elevation. Development and Implementation of Idea In the management of lower limb swelling, a lower limb elevator called Brauns Frame is commonly used to reduce swelling and pressure on the limb surface area. It is a tedious process to set up by using safety pins to achieve the tautness of the fabric when it is wrapped. Its bulky, heavy frame restricts user’s movement when on bed, thus resulted in poor patients’ compliance which can increased patients’ risk in serious complications such as compartmental syndrome. Pre-implementation survey was carried out in a 40-bedded orthopaedic ward and the results showed 82% of the patients were non-compliant to use Brauns Frame. The average time to set up was 31 minutes Adopting Delphi technique, ideas from experts were gathered. We chanced upon a product called Bone Foam, which was commonly used in overseas. It is lightweight, fluid proof, latex free and ensures contour support from patient’s thigh to the foot. Bone Foam was brought in and its usage was trialled out in one orthopaedic ward for a period of 6 weeks. 17 patients participated in the trial. Impact of Solution Results of the post-implementation survey indicated that there was 100% patient compliance rate to the usage of Bone Foam. It was ready to be used in just 4 minutes with a 87% time reduction in setting up a lower limb elevator. All nurses in the ward liked and preferred to use Bone Foam. The usage of consumables was significantly reduced by saving $1579.20 in a year. Conclusions The end users benefited from applying Bone Foam in managing lower limb swelling by enhancing patients’ safety. Patients were more compliant due to its comfort and support which reduced the risk of serious complications. It is recommended that Bone Foam application be used in other disciplines in Changi General Hospital to experience similar benefits 103 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0920 hrs - 0930 hrs IMPLEMENTATION OF TRACHEOSTOMY KIT AND THE ACRONYM OF “ABCD SUCTIONING” XY Song, HP Deng, Shahira Q, KL Chea, SK Neo Department of SICU, Changi General Hospital, Singapore Aims Good quality of tracheostomy care provided for patients is important to reduce unplanned admissions to intensive care unit. In order to provide optimized care and efficient process, our team aim to streamline the workflow process and enhance accessibility with standardize practice. Development and Implementation of Idea A survey was conducted in selected general wards to gather information regarding tracheostomy care. 86% of the responders reported that they have no confidence in caring for tracheostomy patients, 94% of them agreed that a refresher course would be beneficial and 65% of them reported that accessories were not well organized. Therefore, our team enhanced the workflow and workspace organization by creating a Tracheostomy Kit (T-Kit). Our team also aimed to increase accessibility to information by formulating the acronym (ABCD of SUCTIONING). This was piloted in four wards over a week. A post implementation survey was conducted and the T-Kit was further modified to be more user friendly. The size of the T-Kit was reduced to meet to the space constraint of bedside locker and more compartments were added for storage to improve infection control. Impact of Solution Post implementation surveys were distributed and 94% of participant responded. 78% of responders reported that there were less hassle and time taken in gathering accessories. 82% of responders felt that T-kit provides a proper and organized storage area. ABCD of suctioning chart served as easy access of information to 88% of the responders.86% of responders felt more confident in providing quality tracheostomy care for patients.80% of responders will be compliant to usage of T-kit for tracheostomy patients once implemented. Conclusions The team met its objectives as the nurses’ confidence level increased and the time taken in gathering tracheostomy accessories decreased. With the support from the management, the T-kit was implemented hospital wide on 6 September 2013 with the acronym ‘ABCD of SUCTIONING’ 104 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0930 hrs - 0940 hrs USE OF MODIFIED BACKSLAB IN PROMOTING WOUND HEALING FOR PATIENT WITH HEEL’S WOUND/ PRESSURE ULCER C Wang*, L Ong, BG Low, Q Li and C Loo Department of Nursing, Changi General Hospital, Singapore Aims To achieve effective offloading and promote wound healing for patients with heel ulcers. Development and Implementation of Idea Due to its anatomy, the heel is the second common sites for pressure ulcer formation. Pressure relief is the most important nursing aspect of heel ulcer prevention and treatment. Pillows are often used to offload the heel because it is cheap and readily available. In 2010, the National Pressure Ulcer Advisory Panel (NPUAP) highlighted the issue of using pillows. It can be effective only for a short period as pillows flatten when pressure is exerted and the leg can fall off quite easily from the pillow thus eliminating any offloading benefits. Currently in Changi General Hospital (CGH), we use the Prevalon® Pressure-Relieving Heel Protector purchased from United State for patients with heel ulcers. Unfortunately, it is costly and difficult to wash when stained during the hospitalisation. Moreover, our warm climate makes is uncomfortable for patients to use. During my training in Italy, I saw how the wound care experts applied an offloading backslab on patients with heel ulcer using Dynacast Prelude. I decided to utilize the same principle in CGH. Using materials that were available locally, I created a modified offloading backslab for 9 patients with heel ulcers. Impact of Solution The offloading backslab was easy to apply. It is less costly and easy to replace when soiled. In addition, 7 out of 9 cases that were using my modified offloading backslab showed improvement in the wound condition. Unfortunately, 2 patients discontinued the usage of backslab after discharge. Conclusions The modified offloading backslab is a cheap effective alternative in pressure relieving and promoting heel ulcer healing. Training and application of modified offloading backslab is recommended for nurses. 105 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0940 hrs - 0950 hrs OPTIMIZING PHYSICAL ACTIVITY LEVEL OF COMMUNITY DWELLING ADULTS POST DISCHARGE FROM HOSPITAL JL Chia*, J Jumala, XY Chua, C Misola, P Leow, E Chai, NAM Noor Department of Rehabilitative Services, Changi General Hospital, Singapore Aims To identify older adults with functional decline post hospitalization for acute medical illness and, to implement proactive strategies to optimize their functional recovery and physical activity level. Development and Implementation of Idea Older patients discharged from medical wards rarely receive formal advice on how to resume their active lifestyle post hospitalisation. Consequently, they refrain from participating in physical activities and become more sedentary. Physical activity (PA) levels of older patients were measured using Physical Activity Scale for Elderly (PASE) questionnaire and the ACTICAL monitoring device at 2nd week, 1st, 3rd and 6th month after discharge. Actical is a 3-dimensional accelerometer measuring activity count, total number of steps and calories burnt daily. Measurements taken at 2nd week were used as baseline. Strategies implemented include providing structured advice and exercise kits to patients on home-based physical activity programme and organising healthy lifestyle workshops to encourage their participation in community-based PA programs. Impact of Solution 78% and 67% of patients who received these interventions demonstrated an improvement in their PA levels in their Actical count and PASE scores at the 1st and 3rd month compared to baseline respectively. Comparatively, only 35% and 25% of patients without these interventions, had an increase in their Actical count and PASE scores respectively. Conclusions These preliminary findings suggest that community-based interventions can help to increase physical activity level of patients post-hospitalization thus optimizing their functional recovery. 106 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 0950 hrs - 1000 hrs WORKING WITH THE FOREIGN SPEAKING CAREGIVER ; HOW A MULTIDISCIPLINARY APPROACH HELP IN MAKING SENSE OF THE TEACHBACK METHOD AND POST DISCHARGE TELEPHONIC REVIEW - THE ACTION TEAM'S EXPERIENCE AND PERSPECTIVE ME Chan*, HH Chong, H Lin, E Phua, D Zhang, J Phang Department of MSS/Action Team, Dietetics, Pharmacy, Nursing, GRM, Changi General Hospital Aims To find new ways to improve how the Action Team Care Coordinator can apply the Teach Back Method and the telephonic reviews in the presence of a foreign speaking caregiver/patient while supporting healthy bowel movements at home for the at risk elderly,. Development and Implementation of Idea A multidisciplinary team with different expertise was chosen for a more holistic approach. Using tools as the fishbone diagram and pareto, the team concluded the lack of knowledge should be addressed and set out to develop a pictorial factsheet that would ease the information exchange in teach back method and telephonic review of care plan outcome. The initial factsheet that was developed led to the urgent development of a Meal Planner, a second pictorial to complement the first tool in facilitating and clarifying information exchange. A tablet PC was issued to further enhance the exchange of information on the patient's individual careplan. Impact of Solution The solution make it possible to 1) 2) 3) 4) 5) 6) Use Teach Back method in the presence of a foreign speaking caregiver Ease the collecting of information of how patient's is doing during telephonic review To individualize careplan even during telephonic review Increase care coordinator's work satisfaction eg one of them requesting the factsheet to use for her work even after she has left the workgroup. Increase caregiver's participation through better empowerment eg more spontaneous information ex change. Better health outcome for the patients eg improved appetite, sleep. reduced nocturnia. Conclusions Teach Back Method is evidenced based in promoting better care outcome for patient and with creativity, can still be successfully implemented in the presence of a foreign speaking caregiver, and without easy access to translation services 107 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 1000 hrs - 1010 hrs ENHANCING PATIENT’S VITAL SIGN MONITORINGS WHILE UNDERGOING SURGERY UNDER LOCAL ANAESTHESIA N Rahman, Neo TG, Fung KB, Wong S, PHILIPS Department of Nursing, Biomedical Engineering, Changi General Hospital Aims In line with the hospital’s commitment to patient safety, the initiative was implemented to increase patient’s safety while undergoing surgery under Local Anaesthesia (L.A.) and enhance nurses’ awareness in perianaesthesia nursing for quality patient care. Development and Implementation of Idea Respiratory rate is one of the basic vital signs that indicate physiological status of patients. During a L.A. surgery, anaesthesia nurses monitored patients’ respiratory rate manually while they are under the drapes. The drapes were an obstruction to accurate monitoring of the respiratory rate. There were other alternatives where carbon dioxide sampling line is attached directly to patient to monitor their capnograph or using capnoline, the latter a useful method but expensive. The Biomedical Engineering Department (BME) was included in the project to look into the vital sign monitorings and liased with PHILIPS vendor to discuss how to configure the anaesthesia machines so that respiratory rate measurement can be activated. Impact of Solution All the 8 theatres in the major operating theatre and 4 theatres in Day Surgery have been configured by BME to create settings labeled as “L.A” profile. This mode was for all patients who were going for surgery under local anaesthetics. All the monitors in PACU of MOT and DSOT were configured so that respiratory rate can be captured by ECG rhythm. Conclusions Positive feedbacks were received from operating theatre nurses with the new implementations of respiratory rate monitoring. Knowledge and quality of care by anaesthesia nurses were also increased as more time could be spent in providing alternative therapy in pain management during L.A. surgery. Patient’s safety was enhanced by attaining uneventful surgery for operating theatre personnel. 108 BEST ORAL PAPAER AWARD (INNOVATION) Abstract 21 November 2013, Thursday 1010 hrs - 1020 hrs PHARMACIST OUTREACH PROGRAMME (POP): TELE-PHARMACY INNOVATION SC Su Department of Medical Social Services, Changi General Hospital Aims To provide a platform, enabling real time video conferencing and consultation between ACTION care coordinators at the ground and CGH pharmacists invovled in POP. Development and Implementation of Idea With video conferencing technology, real time virtual pharmacists' home visits can take place. Implementation of Telepharmacy includes selecting hardware items, installing software applications, going through the work flow processes, planning virtual visit time slots with pharmacists and coordinating the actual virtual visits. POP is a collaborative project between Aged Care Transition Team & CGH Pharmacists on medication management at home. Care coordinators refer potential POP cases to pharmacists for polypharmacy after care coordinators' initial home visits. Subsequently, home visits with pharmacists will be arranged and conducted at a later date to address these issues. For urgent issues needing immediate advices from pharmacist, telephonic consultations will be conducted. However real time face-to-face consultations and pharmacists' home visits are not feasible. Impact of Solution Provide real time services. Enable interactive and effective communication between pharmacists, patients, caregivers and care coordinators as compared to telephonic calls. Reduce time spent for physical home visits and travelling cost. Increase support to caregivers by providing immediate consultation online. Conclusions Tele-pharmacy is testing out the feasibility and effectiveness of using video conferencing platform to replace some of the traditional physical home visits. Successful working models can be replicated in other areas where advices can be sought without getting the experts there physically and without much delay. 109 Best Oral Paper Award Research 21 November 2013 1400 - 1700 Centre for Innovation, Level 1 110 BEST ORAL PAPER AWARD (RESEARCH) 21 November 2013, THURSDAY 1400hrs - 1515hrs Changi General Hospital, Seminar Room @ Level 2 Chairperson: NC Yu Xia Jessica (CGH) Judges: Dr Serena Koh A/Prof Susan Rickard Liow Dr Wang De Yun (MOH) (NUS) (NUS) ORAL-RE (1400) COMPARISON OF THE ACCURACY OF THE 3RD GENERATION IPAD VS PACS IN DETECTING PNEUMOTHORAX ON CHEST RADIOGRAPHS. Dr Justin Sim, Diagnostic Radiology, Changi General Hospital ORAL-RE (1415) JUNIOR DOCTOR ROSTER OPTIMIZATION: A STUDY OF IMPACT ON PATIENT EXPERIENCE AT CGH ACCIDENT & EMERGENCY Mr Oh Hong Choon, Health Services Research, Eastern Health Alliance ORAL-RE (1430) THE USE OF TOTAL PARENTERAL NUTRITION FOR SHORT DURATIONS - A COST ANALYSIS Mr Alvin Wong, Dietetic & Food Services, Changi General Hospital ORAL-RE (1445) EFFICACY AND COST-EFFECTIVENESS OF AN ELECTROMECHANICAL GAIT TRAINER FOR AMBULATION TRAINING AFTER STROKE IN A SINGAPOREAN COMMUNITY HOSPITAL: A SINGLE BLIND Ms Joyce Chua Boon Hui, Inpatient Therapy Services, St Andrew's Community Hospital 111 BEST ORAL PAPER AWARD (RESEARCH) 21 November 2013, THURSDAY 1400hrs - 1515hrs Changi General Hospital, Seminar Room @ Level 2 ORAL-RE (1500) THE EFFECTIVENESS OF A NEW NURSING DOCUMENTATION FRAMEWORK (SOAPIE) IN IMPROVING THE QUALITY OF NURSING DOCUMENTATION IN AN ACUTE CARE HOSPITAL Ms Ker Wanlin, Changi General Hospital ORAL-RE (1515) FACTORS INFLUENCING PARTICIPATION IN POST-STROKE REHABILITATION AFTER DISCHARGE FROM HOSPITAL: AN EXPLORATORY STUDY ON THE SINGAPOREAN'S PERSPECTIVE Ms Elain Koh Wei Ling, Rehabilitative Services, Changi General Hospital 112 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1400 hrs - 1415 hrs COMPARISON OF THE ACCURACY OF THE 3RD GENERATION IPAD VS PACS IN DETECTING PNEUMOTHORAX ON CHEST RADIOGRAPHS. JJW Sim*, RD Mahmood, ACC Poh, TCC Lim, SH Goh, PH Ang, BY Leong, A Ananthasubramaniam, GL Yang. Department of Diagnostic Radiology, Changi General Hospital, Singapore Aims To determine the accuracy of the 3rd generation iPad in detecting pneumothoraces on chest radiographs compared to PACS. Methods Anonymised full DICOM images of 140 chest x-rays (CXRs) [40 normal, 48 small PTX (<2cm lung edge to chest wall) and 52 large (>2cm)] were retrospectively chosen from the PACS database and uploaded to 3 iPads (3rd gen). Three radiologists and 3 emergency medicine physicians of equivalent experience (2 residents, 1 attending physician each) independently read the CXRs on the iPad running iRAS viewing application (ASTAR, Singapore) and a 5MP Barco monitor running Amalga PACS (Microsoft, USA). The sets were randomized and the PACS and iPad reading sessions were separated by 1 month to avoid memory bias. Each reviewer had to indicate the absence or presence and location of the PTX. The percentage of correct diagnosis was calculated for each display and reader. The detection accuracy of small and large PTX between both displays was also compared. Results The iPad diagnoses of the 140 CXRs were accurate in 97.4% compared to 97.6% for PACS. In the CXRs that had PTX, the accuracy of the iPad was 95.0% compared to 97.4% for the PACS monitor (p=0.03). 8.8% of small and 1.6% of large PTX were missed on the iPad, compared to 4.5% and 0.9% on PACS respectively. Conclusions The 3rd generation iPad is accurate in detecting pneumothoraces on chest radiographs but small pneumothoraces are more difficult to detect on the iPad than large pneumothoraces when compared to PACS. 113 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1415 hrs - 1430 hrs JUNIOR DOCTOR ROSTER OPTIMIZATION: A STUDY OF IMPACT ON PATIENT EXPERIENCE AT CGH ACCIDENT & EMERGENCY HC Oh1, WL Chow1, P Looi2, L Tiah2, B PL Goh2, T Mohan2 1 Health Services Research, Eastern Health Alliance, Singapore Accident & Emergency, Changi General Hospital, Singapore 2 Aims This study aimed to evaluate the impact of a new junior doctor roster on the time to first consult (TTFC) of P2 and P3 patients at CGH Accident & Emergency (A&E). Methods A new junior doctor roster was derived based on a published study that matching manpower availability with demand was effective in reducing waiting time of A&E patients. The derivation entailed three steps. The first determined the ideal number of junior doctors at every hour of a day by apportioning the total available man-hours according to the hourly patient volume of A&E. The second step involved application of an integer linear programming (ILP) model to assign available junior doctors to existing and new shifts so that the hourly number of doctors matched to their respective ideal numbers derived in the first step as closely as possible. The last step involved adaptation of ILP solution to operational preferences of A&E. The new roster included a new shift and its impact was evaluated by comparing the TTFC performance of the pre-implementation period of weeks 10 to 26 of 2013 and post-implementation period of eleven weeks which started one week after implementation of new roster. Results Compared to pre-implementation, there was reduction (percentage reduction) in the weekly average median, 95th percentile and standard deviation of TTFC of P2 patients in post-implementation by 9.0 minutes (25.3%), 27.5minutes (22.9%) and 9.2minutes (23.2%). During the same period, P3 patients experienced a reduction of 38.1 minutes (37.2%), 50.2 minutes (17.9%) and 17.4 minutes (20.3%) in weekly average median, 95th percentile and standard deviation of TTFC respectively. Conclusions Although average weekly load of P2 and P3 patients decreased by 4.9% and 16.1% respectively from the pre-implementation to post-implementation period, our preliminary findings suggested that the new roster was effective in reducing TTFC of P2 patients. 114 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1430 hrs - 1445 hrs THE USE OF TOTAL PARENTERAL NUTRITION FOR SHORT DURATIONS - A COST A WONG, H H HAN, J Ong Department of Dietetic & Food Services, Pharmacy, Gastroenterology , Changi General Hospital, Singapore Aims Total Parenteral Nutrition (TPN) is indicated if Enteral Nutrition is contraindicated, or in conditions precluding the use of intestinal tract for more than 1 week. This retrospective cost analysis aims to show the costs and manpower hours incurred for patients initiated and weaned off TPN within a short duration defined as less than 5 days. Methods Patients admitted to CGH and initiated on TPN between September 2011 and July 2013 were audited. Patients were excluded if they were started with TPN for more than 5 days, or died during the period on TPN, or if TPN was stopped for palliative care, complications due to TPN such as line infection and cholestasis. All patients were prescribed customised TPN by the Nutrition Team or ready-to-use Parenteral Nutrition bags (RTU) by the ICU intensivists. Student T-Test was performed to determine any differences. Results Of the 143 patients initiated with TPN, 25 patients (17.5%) received TPN for 5 days or less (Mean 3.88 +/- 0.93 days). Ninety-six percent (96%) of this group of patients progressed to oral or enteral nutrition within 5 days of commencing TPN. Total additional costs for the duration of TPN before subsidy is $1682.50 +/- 349.78 and after subsidy (adjusted for B and C class patient status) is $795.07 +/- 426.44. Total manpower costs (Medical team, Pharmacist, Dietitian, Nursing Staff and Phlebotomist) not included in patient final bill is estimated at $382.54 +/- 92.24, which is equivalent to additional manpower hours of 8.86 +/- 2.11 hours. The average daily TPN associated bill for a patient on short term TPN is significantly higher at $221.24 +/- 141.34 versus $116.33 +/- 61.06 (p<0.0001) for patients on TPN >5 days (mean of 17.42 +/- 15.67 days). Conclusions TPN is indicated only if patient require it for longer periods of > 1 week. It does not make economical or clinical benefits to start and wean patients off TPN within a short duration of less than 5 days. This increases the healthcare cost for both the hospital and the country as 90% of the patients on TPN are subsidised up to 80% of all medical costs. 115 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1445 hrs - 1500 hrs EFFICACY AND COST-EFFECTIVENESS OF AN ELECTROMECHANICAL GAIT TRAINER FOR AMBULATION TRAINING AFTER STROKE IN A SINGAPOREAN COMMUNITY HOSPITAL: A SINGLE BLIND JBH CHUA*, J CULPAN, T TEO, E MENON Inpatient Therapy Services, St Andrew’s Community Hospital, Singapore Aims 1. To compare the effects of a) gait training using the gait trainer (GT) combined with conventional physiotherapy, with b) conventional physiotherapy alone, in non-ambulant sub-acute stroke patients. 2. To compare the cost effectiveness of using GT combined with conventional physiotherapy to conventional physiotherapy alone in sub-acute stroke rehabilitation. Methods This was a randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. 64 non-ambulant individuals approximately one month post-stroke were randomised to receive either 20 minutes GT training and 5 minutes of stance/gait training (GT group) or 25 minutes stance/gait training (control group). Both groups also had 10 minutes standing and 10 minutes cycling. Training was given 6 times per week for 8 weeks, The primary outcome was Functional Ambulation Category. Secondary outcomes were Barthel Index, gait speed and endurance, and the Stroke Impact Scale (SIS). Measures were taken before and after training, and at 24 weeks after treatment initiation. Cost effectiveness was measured as the ratio of cost of intervention to improvements in SIS (physical) sub-scale. Results At 24 weeks the GT group walked further [6 minute walk test: median (IQR) improvement 83.9(46.3 – 206.6) metres compared to 32.7(6.3 – 136.5) metres (p=0.029)]. No other significant differences were observed. GT training led to lower overall costs than the control intervention, as it permitted greater involvement of therapy assistants. As there were no between-group differences in the improvements measured on the SIS (physical) sub-scale, GT was deemed more cost effective. Conclusions This interim analysis shows that conventional physiotherapy applied alone can be as effective as the use of GT combined with conventional physiotherapy for subacute stroke survivors. However use of GT is a cost effective intervention for increasing walking distance in non-ambulant stroke survivors and should be considered where patients are unable to engage in gait training without mechanical support. 116 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1500 hrs - 1515 hrs THE EFFECTIVENESS OF A NEW NURSING DOCUMENTATION FRAMEWORK (SOAPIE) IN IMPROVING THE QUALITY OF NURSING DOCUMENTATION IN AN ACUTE CARE HOSPITAL W Ker Department of Nursing, Changi General Hospital, Singapore Aims To examine the quality of nursing documentation in an acute care hospital and determine if it has improved after the adoption of a new documentation framework called SOAPIE (Subjective data, Objective data, Assessment, Planning, Intervention and Evaluation). Methods A pilot pretest-posttest quasi-experimental study was conducted from November 2012 to January 2013 in an acute care hospital in Singapore. A modified and validated 15-item Nursing and Midwifery Documentation Content Audit Tool (NMCAT) was used pre- and post-implementation of the SOAPIE documentation framework to evaluate the quality of nursing documentation. The quality of nursing documentation was first assessed prior to the start of the education on SOAPIE documentation framework to registered nurses in the pilot wards. The new documentation framework was taught over a week during nurses’ row calls, and subsequently used by registered nurses in the pilot wards. Quality of nursing documentation was then measured against the NMCAT after one month of using the new framework. Results One hundred and twenty patient case-sheets were examined in this study. Only an average of 51.8% of nursing documentation was up to standard as defined in the NMCAT. After the adoption of SOAPIE documentation framework, a 48.8% variation improvement was observed, particularly seen in documentation written to reflect the objective clinical judgement of nurses better. Using Chi-square/Fisher’s exact tests, nurses with higher nursing qualifications were observed to have association with better nursing documentation quality, while nurses in the morning shifts were observed to be associated with slightly poorer nursing documentation quality when using the SOAPIE documentation framework. Conclusions The quality of nursing documentation before the use of SOAPIE documentation framework was poor, but has improved after the adoption of SOAPIE documentation framework. Results highlighted the areas where documentation quality can be further improved in this study. 117 BEST ORAL PAPER AWARD (RESEARCH) ABSTRACTS 21 November 2013, Thursday 1515 hrs - 1530 hrs FACTORS INFLUENCING PARTICIPATION IN POST-STROKE REHABILITATION AFTER DISCHARGE FROM HOSPITAL: AN EXPLORATORY STUDY ON THE SINGAPOREAN'S PERSPECTIVE WLE Koh*, C Barr, S George Department of Rehabilitative Services, Changi General Hospital, Singapore Aims To explore the obstacles that deter patients from continuing stroke rehabilitation after their discharge from the hospital. Methods A qualitative study using individual semi-structured telephone interviews with inductive thematic analysis of the data collected. Thirty-one stroke patients who had been discharged from the hospital after completion of their post-acute in-patient stroke rehabilitation (mean age 66.46 and mean duration post-discharge 95.82 days). Results Five themes were identified including: the means to access rehabilitative services; lapse in discharge coordination; family member’s views and actions, discrepancies in expectation; and the perception that rehabilitation is simple. Participants indicated a need of timely and appropriate information delivered according to their individualised needs. Conclusions Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not having a common understanding of rehabilitation accounts for the lack of adherence to therapy recommendations. The results suggest that clinicians need to be more aware of their role in providing well-coordinated information about therapy. The study also highlighted the need to review the goal-setting processes that guides the course of rehabilitation. Goals should be more patient-centred to reduce the discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in the discharge-planning so as to minimise the dissatisfaction in care arrangement and information delivery. 118 Best Poster Award Clinical Medicine 21 November 2013 1030 - 1300 Centre for Innovation, Level 1 119 BEST POSTER AWARD (CLINICAL MEDICINE) 21 November 2013, THURSDAY Changi General Hospital, Atrium @ Level 1 Judges: CM P-001 CM P-002 CM P-003 Dr Chow Wai Leng Ms Rosy Tay Dr Melissa Ngai (EHA) (NP) (NUH) A CASE REPORT ON ECHOLALIA Ms Yu Xia, Pain Service, Changi General Hospital PARANEOPLASTIC SYNDROME AS THE FIRST PRESENTATION IN BREAST CANCER Dr Yvonne Ng, General Surgery, Changi General Hospital EFFECTS OF ANTIBIOTIC DE-ESCALATION ON CLINICAL OUTCOMES OF CRITICALLY ILL PATIENTS DIAGNOSED WITH BACTERIAL PNEUMONIA Mr Immanuel Tang Zhi Xiong, Pharmacy, Changi General Hospital CM P-004 VASOPRESSIN-ASSOCIATED HYPONATRAEMIA IN PATIENTS TREATED FOR SEPTIC SHOCK Ms Germaine Chan, Pharmacy, Changi General Hospital CM P-005 CM P-006 AN AUDIT STUDY: FEEDING TARGETS IN THE FIRST 72 HOURS IN A MEDICAL INTENSIVE CARE UNIT Mr Ong Qing Liang, Yong Loo Lin School of Medicine, National University of Singapore POLYPHARMACY AND FALL RISK IN THE ELDERLY: A SYSTEMATIC REVIEW Ms Lynette Wong Li Yi, Pharmacy, Changi General Hospital 120 BEST POSTER AWARD (CLINICAL MEDICINE) 21 November 2013, THURSDAY Changi General Hospital, Atrium @ Level 1 CM P-007 LAPAROSCOPIC LAVAGE FOR HINCHEY III DIVERTICULITIS IN SINGAPORE: AN INITIAL EXPERIENCE AND THE CASE FOR ADOPTION IN ACUTE SURGICAL CARE PRACTICE Dr Teo Nan Zun, General Surgery, Changi General Hospital CM P-008 A THREE YEAR RETROSPECTIVE STUDY OF TOTALLY EXTRA-PERITONEAL VERSUS TRANS-ABDOMINAL PRE-PERITONEAL INGUINAL HERNIA REPAIR IN A SINGLE INSTITUTION Dr Denise Fok, General Surgery, Changi General Hospital CM P-009 DAPTOMYCIN VERSUS STANDARD THERAPY IN THE TREATMENT OF SERIOUS MRSA INFECTIONS WITH VANCOMYCIN MIC = 2 MCG/ML: A RETROSPECTIVE STUDY OF CLINICAL FACTORS AND OUTCOMES Mr Lee Wee Boon, Pharmacy, Changi General Hospital CM P-010 AUDIT OF ENDOSCOPIC HAEMOSTASIS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING : THE CGH SURGERY EXPERIENCE Dr Annalisa Ng Ya-Lyn, General Surgery, SingHealth CM P-011 EFFECTS OF EARLY SWITCHING FROM IV TO ORAL ANTIBIOTICS ON THE OUTCOMES OF PATIENTS WITH BACTEREMIA SECONDARY TO URINARY TRACT INFECTIONS Ms Nashirah Kamal Mustapa, Pharmacy, Changi General Hospital CM P-012 USE OF AN ELECTRONIC ORDERSET IMPROVES PRESCRIBING OF AN MRSA DECOLONISATION PROTOCOL Ms Ng Ying Ting, Pharmacy, Changi General Hospital CM P-013 CM P-014 WARFARIN THERAPY FOR ATHEROMATOUS ARTERIAL DISEASE: CASE REPORT) Dr Pande Shrikant, Rehab medicine, Changi General Hospital SPINAL MYOCLONUS A CASE REPORT Dr Pande Shrikant, Rehab medicine, Changi General Hospital 121 BEST POSTER AWARD (CLINICAL MEDICINE) 21 November 2013, THURSDAY Changi General Hospital, Atrium @ Level 1 CM P-015 STUDY OF PRESCRIBING HABITS OF VITAMIN D SUPPLEMENTS FOR GERIATRIC INPATIENTS Dr Goh Kiat Sern, Geriatric Medicine, Changi General Hospital CM P-016 CM P-017 BONEBRIDGE IMPLANTATION WITH IMAGE-GUIDANCE LOCALIZATION Dr Amanda Tan, ENT, Changi General Hospital DIETARY COMPLIANCE WITH A PARTIAL MEAL REPLACEMENT DIET VS CONVENTIONAL REDUCED-FAT DIET IN OBESE MEN Ms Ling Ping Sing, Dietetic & Food Services, Changi General Hospital CM P-018 POST PROCEDURE CARE IN THE GENERAL WARD AFTER TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION: AN INITIAL EXPERIENCE Dr Jason See Jia Hao, Cardiology, Changi General Hospital CM P-019 CM P-020 COLONOSCOPY IN PATIENTS ON WARFARIN THERAPY: OUR PRACTICE - IS THERE BLEEDING? Mr Wong Chen Pong, Yong Loo Lin School of Medicine, National University of Singapore A RANDOMISED CONTROLLED TRIAL ON ULTRASOUND-ASSISTED SPINAL ANAESTHESIA Dr Lim Yean Chin, Anaesthesia, Changi General Hospital CM P-021 OPTIMIZING ORAL HYGIENE TO REDUCE VENTILATED ASSOCIATED PNEUMONIA AT CHANGI GENERAL HOSPITAL SURGICAL INTENSIVE CARE UNIT Ms Lee Tian, Surgical Intensive Care Unit, Changi General Hospital 122 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS A CASE REPORT ON ECHOLALIA X Yu Department of Nursing, Changi General Hospital, SIngapore Aims To explore the possible causes of echolalia encountered in an elderly patient Methods A case report Results Madam Sim, a seventy-eight-year-old Chinese lady, was admitted for left hip pain after a fall. Premorbidly, she was able to walk with quad stick and converse normally in English. She had a history of hypertension, iron deficiency anaemia, atrial fibrillation (on digoxin and aspirin) and previous cataract surgery in 2012. During admission, she was diagnosed with bilateral degenerative hip arthritis and muscle contusion over left hip, left hip fracture was ruled out. She was able to ambulate with walking frame few days after admission and was on the road of recovery to her premorbid functional status. A geriatrician was consulted for fall management and the patient was also referred to pain service for pain over left hip. She was started on ultracet (combination of paracetamol and tramadol) and baclofen for her left hip pain control. Unfortunately, Madam Sim had an episode of loss of consciousness one day after she was started on the oral analgesics. She developed fluctuating consciousness and echolalia, which lasted for 2 days. Urgent MRI and MRA report was unremarkable. Urgent electromyography (EMG) showed diffuses encephalopathy with no epileptiform activity seen. Thereafter, the symptoms were completely resolved. Conclusions There was no similar episode encountered during her remaining stay in the hospital and she was discharged well. 123 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS PARANEOPLASTIC SYNDROME AS THE FIRST PRESENTATION IN BREAST CANCER Ng YRY*, Ho CYD, Tan SM Department of General Surgery, Changi General Hospital, Singapore Aims Breast carcinoma most commonly presents with an abnormal mammogram or breast lump; hence patients with paraneoplastic presentations may be misdiagnosed initially resulting in delayed diagnosis of an underlying occult breast tumour. Methods We report two cases where cerebellar degeneration and dermatomyositis were the foremost presentations. Results A 58-year-old female with paraneoplastic cerebellar degeneration first presented with vertiginous giddiness, impaired coordination, speech difficulties and ataxia for a 1-week duration. Breast examination was normal, and neurological examination confirmed the presence of gaze-evoked rotatory nystagmus, dysarthria, dysmetria, dysdiadochokinesia and gait ataxia. Initial stroke work-up performed was negative. Cerebrospinal fluid examination showed lymphocytic pleocytosis, increased CSF IgG relative to serum, and oligoclonal banding. She was given 5 days of intravenous immunoglobulin therapy to no avail. Computed tomography (CT) chest performed revealed a 1.5cm right breast nodule with irregular margins, and axillary and subpectoral nodes suspicious for nodal metastasis. Further breast investigations showed multicentric disease and histological confirmation of invasive ductal carcinoma (IDC) was made. Formal Stage IIA T1N1M0 staging was made after a right simple mastectomy and axillary clearance (SMAC). Next, a 69-year-old female presented with atypical chest pain, generalized urticarial plaques in a photosensitive distribution, nail fold erythema, arthralgia and progressive proximal upper extremity muscle fatigue and weakness in a symmetrical distribution over a 3-month period. Skin and muscle biopsy were consistent with the diagnosis of dermatomyositis. Clinical breast examination was again normal but initial workup for underlying malignancy showed features suspicious of a right breast cancer with enlarged right axillary and subpectoral nodes on the CT chest. Core biopsy confirmed IDC. Formal Stage IIIC T2N3M0 was made after a SMAC. Conclusions While rare, it is important to maintain a high level of vigilance for an underlying malignancy in such paraneoplastic manifestations in order to attain an earlier diagnosis and allow curative management of the cancer. 124 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS EFFECTS OF ANTIBIOTIC DE-ESCALATION ON CLINICAL OUTCOMES OF CRITICALLY ILL PATIENTS DIAGNOSED WITH BACTERIAL PNEUMONIA ZXI Tang*, WX Tong, YJI Wee Department of Pharmacy, Changi General Hospital, Singapore Aims Critically ill patients diagnosed with bacterial pneumonia are often treated empirically with broad spectrum antibiotics. While increasing the possibility of a successful outcome, it also creates pressure for the selection of resistant microorganisms. De-escalation is a strategy that attempts to balance the competing aims of providing appropriate initial therapy and limiting the emergence of resistant pathogens. The aim of this study is to evaluate if de-escalation is associated with poorer outcomes Methods A retrospective cohort study was conducted on adult patients admitted to the intensive care unit (ICU) diagnosed with bacterial pneumonia from the period of September 2011 till August 2012. De-escalation in this project was defined as narrowing of antimicrobial coverage, intravenous to oral conversion or discontinuing of antibiotics if no infection is established within 5 days of therapy. The primary clinical outcome of this study was 30 days all-cause mortality. Secondary outcomes include ICU length of stay (LOS) and hospital LOS. . Results A total of 75 critically ill patients were identified but only 51 patients were included into the study. The median age was 73.0 years old. The baseline characteristics did not differ significantly between the two groups. Antibiotic therapy was de-escalated in 17 (33.3%) patients during the initial 5 days of therapy. All-cause mortality [de-escalation: 1 (5.9%) vs. did not de-escalate: 7 (20.6%)] did not differ significantly between the 2 treatment groups. The ICU LOS and hospital LOS are statistically different between the 2 groups, with the de-escalated group having shorter stays for both ICU [2 (2-3) vs. 4 (2-6) days] and hospitalization [7 (5-13) vs. 15 (9-32) days] Conclusions This study suggests that antibiotic de-escalation in critically ill patients diagnosed with bacterial pneumonia does not result in increased mortality and is associated with shorter ICU and hospital LOS. 125 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS VASOPRESSIN-ASSOCIATED HYPONATRAEMIA IN PATIENTS TREATED FOR SEPTIC SHOCK Chan GYL, Wee IYJ, Widjaya M Department of Pharmacy, Changi General Hospital, Singapore Aims The management of septic shock typically involves volume resuscitation and the administration of vasopressors (e.g., vasopressin, noradrenaline) to maintain a target mean arterial blood pressure for adequate organ perfusion. While vasopressin is known to have an effect on sodium levels, the incidence of hyponatraemia is not well established. This study aimed to evaluate the characteristics of hyponatraemia in critically ill patients receiving vasopressin for treatment of septic shock. Methods We conducted a retrospective cohort study involving all intensive care patients (aged >21 years) who received at least one dose of vasopressin for the treatment of septic shock between January 2010-December 2011. Patients were identified via computerised pharmacy records. Both manual and electronic medical and medication records were reviewed, and relevant patient data recorded. Assessment of the characteristics of hyponatraemia was performed independently as well as in relation to concurrent corticosteroid administration. Results A total of 60 eligible patients were reviewed. The incidence of hyponatreamia (plasma sodium 131-135 mEq/L) and severe hyponatraemia (plasma sodium <130 mEq/L) were 18.3% and 13.3%, respectively. The presence of any form of hyponatraemia occurred mainly in the first 3 hours following vasopressin initiation. Normal saline accounted for more than half of the total fluids administered during the first 48 hours following vasopressin initiation. Mean plasma sodium concentrations were higher following vasopressin discontinuation compared to prior to initiation (141.0 mEq/L vs 139.2 mEq/L, p = 0.022). In patients who received vasopressin and corticosteroids, the incidence of hyponatremia was 19%, compared to 17% in patients who did not receive corticosteroids (p = 0.84). Conclusions Vasopressin-associated hyponatraemia occurred less often that reported in the literature, probably because of the extent of normal saline administered. Concurrent use of corticosteroids was not found to have a statistically significant impact on the incidence of hyponatraemia in this patient population. 126 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS AN AUDIT STUDY: FEEDING TARGETS IN THE FIRST 72 HOURS IN A MEDICAL INTENSIVE CARE UNIT Q L Ong1*, A Tee2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore Aims Nutrition therapy is an integral part of holistic patient care. Evidence-based early enteral nutrition (EN) protocols improve clinical outcomes and survival of critically ill patients. The aim of our study was to assess current feeding practices in our MICU. Methods We conducted a review of patients who were admitted to the MICU at Changi General Hospital between 13 May 2013 and 26 May 2013. Inclusion criteria: 1) Adult patients 2) Mechanically ventilated within 24 hours of admission 3) Stayed in the MICU for at least 72 hours Data was collected on the time for EN initiation and the amount of nutrition delivered over a 72-hour period. Other information recorded were patient demographics, main diagnoses and APACHE II scores. The target caloric intake was calculated using the Schofield Equation, with adjustments made for activity and stress levels. The target protein intake was calculated based on a recommended intake of 1.2g/kg/day. Results 19 patients met the inclusion criteria. 2 patients did not start EN within the first 72 hours of ICU admission due to hemodynamic instability and were excluded from subsequent data analysis. All of the remaining 17 patients commenced EN within 48 hours of MICU admission. 15 patients (88.2%) commenced EN within 24 hours of admission. In the first 24 hours, 88% and 82% of patients acquired less than 25% of their target caloric and protein intake respectively. In the next 24 hours, 53% and 47% of patients acquired more than 50% of their target caloric and protein intake respectively. By 72 hours, 64.5% and 59% of patients acquired more than 50% of their target caloric and protein intake respectively. Conclusions Adequate and safe feeding of critically ill patients is an achievable and worthwhile pursuit. In our MICU, the enteral feeding protocol was effective in increasing caloric and protein intake of patients within a 72-hour period. 127 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS POLYPHARMACY AND FALL RISK IN THE ELDERLY: A SYSTEMATIC REVIEW LYL Wong, KYA Lam, V Teo Department of Pharmacy, Changi General Hospital, Singapore Aims At present, 9.9% of Singapore’s population belongs to the geriatric age group (65 years old or above) which will increase to 18.4% in the year 2030. Although polypharmacy can occur at any age, the incidence is highest in the elderly as they present with multiple co-morbidities. The objectives of this literature review are: i. To assess the relationship between polypharmacy and falls in elderly. ii. To identify if certain drug classes are correlated with a higher fall risk using The American Geriatrics Society (AGS) 2012 Beers Criteria. iii. To evaluate pharmacists’ role in reducing medication-related falls. Methods The search strategy covered electronic bibliographic databases e.g. PUBMED, ScienceDirect and The JAMA Network from August 2012 to February 2013. Search terms used were: Polypharmacy, Multiple Medications, Falls, Fall-Risk Increasing Drug (FRID), Beers Criteria, Potentially Inappropriate Medications, Elderly and Geriatrics. A total of 18 articles were retrieved from the online search of relevant journals. Results Although studies have shown that polypharmacy correlates with a heightened fall risk in elderly, the number of medications used has a weak influence on fall risk. Rather, the presence of a FRID coupled with other patient-related variables such as chronic diseases are the key reasons for the higher fall risks. Commonly identified FRIDs include psychotropics, cardiovascular and centrally-acting medications. Conclusions The presence of a FRID is associated with a higher fall risk, rather than polypharmacy itself. Pharmacists should be aware of the presence of a FRID when evaluating the appropriateness of drug use in elderly and recommend safer alternatives when available. 128 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS LAPAROSCOPIC LAVAGE FOR HINCHEY III DIVERTICULITIS IN SINGAPORE: AN INITIAL EXPERIENCE AND THE CASE FOR ADOPTION IN ACUTE SURGICAL CARE PRACTICE NZ Teo*, R Wijaya, SM Tan Department of Surgery, Changi General Hospital, Singapore Aims Laparoscopic Lavage (LL) is a minimally invasive (MIS) surgical technique used to treat perforated diverticulitis. We report the first case of Hinchey III diverticulitis successfully treated with LL in Singapore. This article aims to review literature and with this case report present an appropriate algorithm and serve as guide to surgical units with adequate MIS capabilities and are keen to consider using this technique in suitable patients with Hinchey III diverticulitis. Methods A review of literature was performed and with the description of management of this patient, we highlight the indication, considerations, outcomes and limitations of this technique for emergency surgical treatment of perforated diverticulitis. Results We successfully managed a middle-aged lady who presented with Hinchey III diverticulitis with LL. She was discharged with resolution of symptoms 6 days after LL and did not develop recurrence of diverticulitis after 2 years of follow-up without any resectional surgery. In literature, LL has been attempted most often in patients with Hinchey III diverticulitis with a lavage failure rate of 4.3% and mortality rate of 1.7%. Post-operative colonic evaluation should be performed after LL and in view of the lack of mature data, resectional surgery should still be discussed with the patient, understanding the potential risk of recurrent diverticulitis. Conclusions LL can be safely performed in patients with Hinchey III diverticulitis and should be considered in patients who are suitable for laparoscopy at presentation at an institution with adequate resources and surgeons trained for MIS. 129 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS A THREE YEAR RETROSPECTIVE STUDY OF TOTALLY EXTRA-PERITONEAL VERSUS TRANS-ABDOMINAL PRE-PERITONEAL INGUINAL HERNIA REPAIR IN A SINGLE INSTITUTION D Fok*, Ching S S, J Lee Department of General Surgery, Changi General Hospital, Singapore Aims The primary aim of this study was to compare the recurrence rate between the two different techniques of laparoscopic hernia repair. The secondary aims of this study were to compare patient characteristics and evaluate differences in operative time, length of hospital stay and surgical complications between the two techniques. Methods Retrospective review of 200 operations performed from 1st July 2009 to 30th June 2012. 182 patients were reviewed after exclusions. 106 patients underwent TEP and 76 patients underwent TAPP. Statistical analysis was performed using the Student T-test and Chi-Square test on SPSS v. 19. Results The age, racial distribution, body mass index, length of symptoms and risk factors were similar in both groups. 9 cases of recurrence after laparoscopic repair. No significant difference in recurrence rate for TAPP vs. TEP (3.9% vs. 5.7%, p=0.599). One incidence of visceral injury in the TEP group. Higher incidence of haematoma formation for unilateral repair in TAPP vs. TEP (11.6% vs. 1.7%, p=0.037). Duration of surgery significantly shorter for TEP repairs vs. TAPP repairs for both unilateral (57 ± 18 mins vs. 96 ±30 mins, p<0.001) and bilateral cases (77 ± 32 mins vs. 107 ± 25 mins, p<0.001). Conclusions Significantly higher rate of haematoma formation in unilateral TAPP compared to TEP repair. Significantly longer operating time for TAPP repairs. No other significant difference in outcomes between the two techniques. Further prospective studies are required to validate these results 130 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS DAPTOMYCIN VERSUS STANDARD THERAPY IN THE TREATMENT OF SERIOUS MRSA INFECTIONS WITH VANCOMYCIN MIC = 2 MCG/ML: A RETROSPECTIVE STUDY OF CLINICAL FACTORS AND OUTCOMES Fong RKC1, Lee WB*3, Rao S1, Oh HML1, Tan TY2, Seah J3 1 Department of Microbiology, Changi General Hospital, Singapore Department of Pharmacy, Changi General Hospital, Singapore 3 Department of General Medicine, Changi General Hospital, Singapore 2 Aims To evaluate effectiveness of daptomycin switch against conventional vancomycin therapy in treatment of MRSA bacteremia with high vancomycin MIC of 2 mcg/mL Methods This retrospective case-control study evaluated the clinical outcomes of vancomycin, compared with switching therapy to daptomycin, in the treatment of MRSA bacteremia with a high vancomycin MIC of 2 mcg/mL. Results Fifty four vancomycin-treated subjects were compared with 18 subjects who were switched to daptomycin when vancomycin MIC data was available. (Median time to starting daptomycin after the first positive MRSA blood culture was 9.5 days (range 7-12 days). Daptomycin was used for a median of 14.5 days.) At baseline, both groups were not statistically different in terms of predictors of clinical severity or mortality (Charlson comorbidity score [P=0.86], and APACHE II score [P=0.79].) Thirty-day mortality was not significantly different between the 2 groups (daptomycin (5/18) 27.8% vs. vancomycin (12/54) 22.2%, [P=0.75].) Other secondary outcomes were similar; (1) microbiologic clearance 7 days after starting respective antibiotics [daptomycin (10/18) 55.6% vs. vancomycin (29/54) 53.7%, P=0.891] (2) clinical response within 7 days (daptomycin (11/18) 61.1% vs. vancomycin (37/54) 68.5%, P=0.564] (3) recurrence of MRSA bacteremia within 3 months [daptomycin (2/18) 11.1% vs. vancomycin (1/54) 1.9%, P=0.152]; and (4) total length of hospitalisation (mean of 43 days in both groups, P=0.972) Conclusions In this case-control study, clinical outcomes were similar between daptomycin and vancomycin for the treatment of MRSA infections with bacteremia and higher vancomycin MICs. These findings differ from other studies that showed better outcomes with daptomycin treatment, and suggest that further trials are required to determine the optimal therapy for such infections. 131 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS AUDIT OF ENDOSCOPIC HAEMOSTASIS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING : THE CGH SURGERY EXPERIENCE Ng YL A* , Lee J, Wong SY A Department of General Surgery, Changi General Hospital, Singapore Aims To describe the patient characteristics, diagnoses and outcomes of those presenting with non-variceal upper gastrointestinal bleeding (UBGIT) who underwent endoscopic haemostasis.To evaluate failure rates of endoscopic haemostasis and to identify risk factors for failure. Methods Retrospective cohort study of all surgical patients admitted for non-variceal UBGIT requiring endoscopic haemostasis (adrenaline injection, heater probe, clipping) over a 2 year period (1st January 2011 - 31st December 2012). Data was obtained from endoscopy logs and case files which included variables such as location of ulcer, proton pump inhibitors (PPI), haemostatic modalities, Rockall score, Forrest classification, haemodynamic parameters. Data analysis performed with SPSS v19. Results 148 therapeutic OGDs were performed for 127 surgical patients. 70.9% of patients were male and majority were Chinese (72.4%) with a mean age of 66.2 years. Main risk factor identified for The most common pathology was peptic ulcer disease (92.9%) of which duodenal ulcers were more prevalent (50.8%). The 2 most common locations for bleeding were at D1 (33.0%) and D1/D2 junction (17.4%). A Rockall score of > 3 was associated with a higher risk of failure of haemostasis (p=0.025). There was no significant difference Half of patients achieved haemostasis with a single haemostatic modality and 45.7% with dual modalities. 91.3% received intravenous PPI infusion therapy and 7.9% received intravenous BD dosing. There was no significant difference in rebleeding rates between these 2 PPI therapies (p=0.721). Failure of initial endoscopic haemostasis occurred in 23.6% of patients requiring repeat OGDs, angioembolisation and/ or surgery. Risk factors predicting initial failure were identified as requiring a greater amount of adrenaline for haemostasis (mean 9.97ml vs 7.9ml, p=0.028), Rockall score > 3 (p=0.025) and units of blood transfused (mean 3.1 vs 1.9, p=0.01). However, only units of blood transfused was shown to be statistically significant on multivariate analysis (OR 1.29, 95% CI 1.03-1.61,p=0.025). Conclusions Patients who failed initial endoscopic haemostasis were more likely to require a greater amount of adrenaline, blood transfusion and have a Rockall score > 3. The presence of hypotension, location of ulcer, Forrest grade and type of PPI therapy was not shown to be significant in predicting failure of haemostasis in this study, which may be attributed to the small study size. We aim to establish a UBGIT database, vaildate the Rockall score in our population and implement routine use of dual modalities for endoscopic haemostasis in the future. 132 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS EFFECTS OF EARLY SWITCHING FROM IV TO ORAL ANTIBIOTICS ON THE OUTCOMES OF PATIENTS WITH BACTEREMIA SECONDARY TO URINARY TRACT INFECTIONS Nashirah K M*, L W H, Tie T K, Tong W X Department of Pharmacy, Changi General Hospital, Singapore Aims Urinary tract infection (UTI) with gram-negative bacilli is common and bacteremia (with the same causative pathogen in blood cultures) complicating this infection is frequently seen. Duration of antimicrobial therapy for bacteremic patients is 14 days. In these cases, clinicians often prefer the parenteral route of administration. Early intravenous (IV) to oral switch has been shown to reduce risks of line infection, length of stay in hospitals as well as increase comfort level and mobility of patients. This project aims to evaluate the clinical outcomes of early switching from IV to oral antibiotics in patients with bacteremia secondary to UTI. The hypothesis is that early switching to oral antibiotic therapy may have little or no clinical disadvantage for these patients. Methods The medical records of patients with bacteremia secondary to UTI were identified from the Antimicrobial Stewardship Programme (ASP) database and reviewed. Early switching in this study was defined as time to switch to oral antibiotics within the first seven days of treatment. Mann-Whitney U test was used to evaluate the length of stay between the two groups and chi-squared test to evaluate the odds ratio of clinical complications and 30-day readmission in these groups. Results 98 patients with bacteremia secondary to UTI were identified. Early switching in bacteremia secondary to UTI patients was shown to have significantly shorter duration of stay (median: 6 days vs 12 days) in hospital (p<0.01). Odds ratio for clinical complications in early switch group was 1.58 (95% CI 0.30 – 8.28), and for 30-day readmission was 0.75 (95% CI 0.12-4.72). They were both insignificant with p=0.714, and p=0.759 respectively Conclusions From this study, early switching from IV to oral antibiotics has some implications in terms of length of stay. It does not however, confer benefits or disadvantages in terms of clinical complications. Evaluation on more variables such as mortality and monetary costs may be needed in a larger population group. 133 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS USE OF AN ELECTRONIC ORDERSET IMPROVES PRESCRIBING OF AN MRSA DECOLONISATION PROTOCOL Ng YT, Seah J. Oh MLH, O Connor R Department of Pharmacy, Changi General Hospital, Singapore Aims The main aim of this study was to audit the level of adherence to the MRSA decolonisation policy in the inpatient setting and to determine whether the implementation of the MRSA decolonisation electronic orderset increased the level of adherence to the MRSA decolonisation therapy policy. Methods Patients included were randomly chosen inpatients who received MRSA decolonisation therapy before and after the implementation of the orderset. Adherence to the hospital decolonisation protocol and utilisation of the MRSA decolonisation orderset were assessed. Results A total of 240 patients were included, comprising of 120 patients each for the pre- and post-orderset groups. The groups did not differ by gender or age. The introduction of the orderset resulted in a significant improvement (40%) in adherence to the hospital decolonisation protocol (45% post-orderset vs. 5% pre-orderset, p<0.005). Appropriate prescribing (frequency & duration of therapy) of nasal mupirocin and antimicrobial wash improved by 31% and 32%, respectively. Almost all who were prescribed as per protocol utilised the orderset. However, there were 55% of cases who did not utilise the orderset and hence did not comply with the protocol. Conclusions The implementation of an electronic orderset improved the prescribing of MRSA decolonisation therapy as per protocol. However, a large proportion did not utilise the orderset and prescribed inappropriate decolonisation therapy. Thus, education of medical staff is required to improved awareness and utilisation of the orderset. 134 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS SPINAL MYOCLONUS A CASE REPORT Pande SD, Koh E, Lolong L, Wee T C Department of Rehabilitation Medicine, Changi General Hospital, Singapore Report Abstract A 54 year old gentleman was admitted with right MCA territory infarct (Stroke). He further developed haemorrhagic conversion in the MCA infarct for which he needed decompressive craniectomy. He had long-standing history of smoking as a major risk factor. During rehabilitation stay, he developed right lower limb ischemia for which further investigation (contrast scan and angiography) revealed severe atherosclerotic disease of aorta. Initial treatment with vascular intervention prevented him from having major amputation. He also had simultaneous pulmonary embolism. After careful consideration (as he was still recovering from his haemorrhagic conversion), he was fully anicoagulated initially with heparin followed by warfarin. During follow up study (contrast CT scan) after 3 months, his severe atheromatous disease of aorta showed near complete resolution. The single case report on this patent raises the possibility that apart from antiplatelets and lipid lowering agents, anticoagulation with warfarin may be responsible for complete resolution of atheromatous disease and future research on this treatment modality can be considered as a part of regular treatment for atheromatous disease. Literature searches including PubMed, Ovid, journal references and differential diagnoses included in the full case report. 135 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS SPINAL MYOCLONUS A CASE REPORT Pande SD, Koh E, Lolong L, Wee T C Department of Rehabilitation Medicine, Changi General Hospital, Singapore Report Abstract .A 48 year old gentleman was admitted with history of fall from the chair at workplace. He was admitted to CGH with severe low back pain. His past medical history was laminectomy for Lumbar spine (L3-L5) 2 years ago. During this admission he was investigated with repeat MRI scan, which did not reveal any new injury to the spinal cord. He continued have pain for which he received epidural analgesia, as he failed to respond to combination of NSAIDS, Tramadol, Morphine substitutes. After his pain control was achieved, epidural catheter was taken off. He subsequently developed spontaneous involuntary movements of left lower limb. Investigations done to identify underlying cause of his movements included: electrolytes, thyroid functions test, calcium, magnesium levels, CT brain scan, EMG/NCS were all normal. The frequency of movements of the left lower limb was 10-15 times per day with variable duration of 10 to 30 minutes without any prior warnings. His movements exacerbated his back pain and limited his rehabilitation. After reviewing his history a working diagnosis of spinal myoclonus was made. He was started on Clonazepam and Sodium valproate. The dosages were slowly tittered. After 1 week of therapy the movements frequency started to improve. By 1 month his frequency of involuntary movements reduced to 2-3 per day and duration on each occasion reduced to few seconds. He was followed for more than 12 months and remained stable. Minor trauma to spine is very common and some of the patients may need epidural analgesia. Epidural analgesia is also commonly used in obstetric practise; we have to bear in mind that this unusual complication of this procedure can occur. This case highlights the importance of unusual complications of epidural analgesia as; patients may end up in unnecessary investigation and morbidity. Literature searches and differential diagnosis included in the full case report 136 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS STUDY OF PRESCRIBING HABITS OF VITAMIN D SUPPLEMENTS FOR GERIATRIC INPATIENTS KS Goh*, D Zhang, GK Png, HM Lin, W Ang, J Lim Department of Geriatric Medicine, Changi General Hospital, Singapore Aims To study the prescribing habits of vitamin D supplements for geriatric inpatients. Methods A cross-sectional retrospective study involving 206 patients admitted consecutively to geriatric acute wards in Changi General Hospital was carried out. Information on patient clinical status, demographics and prescription of vitamin Dcontaining supplements was collected from the patient medical records. Total serum 25-hydroxyvitamin D levels were measured. Vitamin D deficiency is defined as 20ng/ml or less; and insufficiency > 20 ng/ml and < 30 ng/ml. Descriptive analysis of the differences in patient characteristics among categories of categories of vitamin D-containing supplements prescribed was performed. Results Of the 206 patients, 57.3% were prescribed vitamin D-containing supplements. The distribution of prescription was as follows: nil, 88 (42.7%); calcium-vitamin D one tab, 5 (2.4%); calcium-vitamin D two tabs, 46 (22.3%); lynae, 49 (23.8%); and ergocalciferol, 18 (8.7%). Higher proportions of patients with vitamin D deficiency were prescribed lynae (71.4%) and erocalciferol (94.4%) than those with vitamin D insufficiency (26.5% lynae and 5.6% ergocalciferol) and normal vitamin D level (2.0% lynae and 0.0% ergocalciferol). Among patients who were not prescribed vitamin-D containing supplements (n=88), 56.8% had poor vitamin D status (27.3% vitamin D deficient and 29.6% vitamin D insufficient). Among patients with full ADL dependence (n=29), only 27.6% were prescribed vitamin D-containing supplements. The proportion of patients who were prescribed these supplements was 60.8% among those who with at least one pre-existing conditions known to decrease vitamin D level (n=97). Conclusions There is heterogenity in the prescribing habits of vitamin-D containing supplements for the geriatric inpatients. As these patients are at high risk of vitamin D deficiency and insufficiency, it is necessary for clinicians to exercise vigilance in the management with timely intervention to prevent complications from poor vitamin D status. Local guidelines on vitamin D supplementation taking into account different high risk subgroups of geriatric inpatients may be useful to ensure consistency of treatment. 137 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS BONEBRIDGE IMPLANTATION WITH IMAGE-GUIDANCE LOCALIZATION A E P Tan, H W Yuen Department of Otolaryngology, Changi General Hospital, Singapore Aims The Bonebridge implant is a bone-conduction hearing implant with a relatively large floating mass transducer (FMT), which is seated within a bony well. This well is drilled in the mastoid process of the recipient. The FMT is then anchored onto the bony cortex with two screws on the side of the well. The location of the well is important so as to avoid vital structures such as the posterior canal wall, the dura mater of the middle cranial fossa, and the sigmoid sinus. At the same time, the area chosen to site the well must also be sufficient to accommodate the size of the FMT. This becomes even more important in patients with contracted mastoids. As such, image-guidance localization (IGL) of the exact site of the well is useful in surgical planning. Methods IGL of the site of the well for the Bonebridge FMT has been utilized in Changi General Hospital. Results Four patients underwent Bonebridge implant surgery with IGL. Using IGL, rapid and accurate localization of the ideal site of the well for the FMT was possible in each case. Conclusions The author recommends IGL as a safe, rapid and reproducible technique in localization of the site for the well for the Bonebridge implant FMT. 138 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS DIETARY COMPLIANCE WITH A PARTIAL MEAL REPLACEMENT DIET VS CONVENTIONAL REDUCED-FAT DIET IN OBESE MEN PS Ling*, J Khoo, M Cheong, J Tan, A Teo, HL Ng, J Tan, R Chen, TL Tay Department of Dietetic & Food Services, Endocrinology, Changi General Hospital, Singapore Aims This study aims to compare the dietary compliance between a diet consisting of 2 meal replacements daily, with a conventional reduced-fat diet. The study also evaluates the improvement in dietary knowledge, attitudes and practices (KAP) post dietary intervention. Methods Men aged 30-65 years, with body mass index (BMI) ≥ 27.5 kg/m2, were recruited from both inpatient and outpatient clinics in Changi General Hospital, as well as the general public. The subjects were randomized into 2 groups, partial meal replacement or conventional reduced-fat diet group. At 4-week intervals, weight, percentage of body fat, and waist circumference were measured, and food intake and adherence to the diet and exercise plan reviewed. At baseline and after 12 weeks of intervention, a nutritional questionnaire was conducted to assess changes in dietary knowledge, attitudes and practices. For subjects in the partial meal replacement group, meal replacement supplements were given to the patients to replace 2 meals per day. A diet plan consisting of a variety of normal food was given to provide the third meal. This diet was designed to providea deficit of ~500 kcal/day based on the subject’s Basal Metabolic Rate (BMR) using the HarrisBenedict Equation, for adjusted body weight. For subjects on the conventional diet, no meal replacements was given, instead, each subject was given a balanced meal plan which also provides ~500 kcal/day less than his/her BMR. Results Both the partial meal replacement group and the conventional group had similar reduction in weight. The meal replacement group had greater decrease in waist circumference and fat mass. The meal replacement group had a greater compliance with the meal plan provided compared to the conventional group. In terms of the dietary knowledge, both meal replacement and the conventional group had similar improvement in dietary knowledge, attitude and practices. Conclusions Meal replacement diets are as effective as a conventional reduced-fat diet for weight loss, but the meal replacement group showed higher compliance rate during the 12 week study. This confirms that meal replacements can help with weight loss but further study is required to review the long term compliance and benefits. 139 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS POST PROCEDURE CARE IN THE GENERAL WARD AFTER TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION: AN INITIAL EXPERIENCE J See*, YS Goh, SH Ong, BW Liew, L Tay, CH Tan, KL Tong Department of Cardiology, Changi General Hospital, Singapore Aims Percutaneous coronary intervention (PCI) is a mainstay therapy for patients with coronary artery disease. With advancing technologies and skills, the periprocedural risk of PCI has been declining. In recent years, the transradial approach for PCI has been gaining popularity with improvements in access site complication rates and outcomes. Locally, post PCI patients are traditionally monitored in the High Dependency Unit (HDU). Given the limited availability of such beds, this study aims to evaluate the safety of General Ward (GW) monitoring for transradial PCI patients who had uncomplicated procedures. Methods This was a single center protocol. Patients above 21 years of age and of both genders who underwent uncomplicated transradial PCI were included. Exclusion criteria were patients with 1) Femoral vascular access 2) Myocardial infarctions 3) More than 1 vessel intervention 4) Left main intervention 5) Intra-procedural complications 5) Intra-arterial line monitoring 7) Other conditions deemed by interventionalist/cardiologist-in-charge to require HD/ICU care. An initial 20 patients were analyzed. All patients were monitored in a specialized Cardiology GW with telemetry monitoring. Management of complications were as per standard care. Results Mean age of the patients was 56.2 years. Majority were male (19 patients). There was acute procedural success in all patients. No patient suffered any of the pre-defined outcomes of inpatient myocardial infarction, stroke, acute kidney injury, arrhythmias, vascular complications or death. 2 patients were readmitted within 30 days after discharge for unrelated events (one for elective surgery, one for atypical chest pain). Conclusions The management of low risk patients in the GW is safe with a low prevalence rate of complications. This can free up HDU beds for patients with acute and more serious conditions. Further data collection with this protocol could include patients with haemodynamically stable acute coronary syndromes and those who had more complex interventions (e.g. multi-vessel or bifurcation PCI). 140 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS COLONOSCOPY IN PATIENTS ON WARFARIN THERAPY: OUR PRACTICE - IS THERE BLEEDING? CP Wong*, F Teo, R Wijaya, KK Sng, SM Tan Yong Loo Lin School of Medicine, National University of Singapore, Singapore Aims To determine the overall risks of haemorrhage versus thromboembolism in patients on warfarin therapy undergoing colonoscopy. Methods A retrospective, single-centre cohort study was conducted for a one-year period of patients on warfarin therapy undergoing colonoscopy in the year 2011. Patient demographics, indications for colonoscopy, endoscopic findings, type of endoscopic procedures carried out, use of concurrent antiplatelet agents, patient’s personal risk factors for bleeding, and incidence of bleeding were documented from our centre’s electronic case records. Bleeding episodes were classified as early or delayed. Colonoscopic polypectomy was defined as a high-risk procedure, while low-risk procedures included colonoscopy with or without biopsy. Results 21 patients on long-term warfarin therapy who underwent colonoscopy were reviewed. Warfarin therapy was temporarily stopped in the patients before the procedure and none received bridging heparin therapy. Seven underwent polypectomy. Mean pre-colonoscopy INR was 1.40. One patient from the polypectomy group had early bleeding (14.3%), none from the low-risk group. The overall incidence of haemorrhage is 4.76%. There were no thromboembolic events in all patients up to 30 days post-colonoscopy. Conclusions Patients on warfarin therapy who undergo colonoscopy according to existing guidelines confers an acceptable thromboembolic risk with temporary cessation of warfarin prior to the procedure, however, there is an increased risk of bleeding when the patient undergoes a polypectomy 141 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS A RANDOMISED CONTROLLED TRIAL ON ULTRASOUND-ASSISTED SPINAL ANAESTHESIA YC Lim*, CY Choo, KTJ Tan Department of Anaesthesia, Changi General Hospital, Singapore Aims Pre-procedural ultrasound scan has been used to facilitate spinal anaesthesia in patients with difficult anatomical landmarks and shown to improve first-attempt success rates in some studies. We studied whether pre-procedural ultrasound scanning improves first-attempt success rate and decreases time taken for the procedure in the general adult population. Methods In this prospective randomised controlled trial, 170 patients, aged between 21 and 80 years and ASA 1 to 3, were recruited. Patients were randomised into two groups: ultrasound guided identification of landmarks (Ultrasound Group) and manual palpation of landmarks (Manual Palpation Group). The primary outcome was the first-attempt success rate and secondary outcomes were the time taken to perform the procedure, the number of needle redirections, patient satisfaction and complications. Results The first-attempt success rate was 64% in the Ultrasound Group and 52% in the Manual Palpation Group (p=0.16). Time taken for the procedure was shorter in the Ultrasound Group compared to the Manual Palpation Group (2.9±3.6 min vs 3.9±3.7 min, p= 0.007). Patient satisfaction was higher in the Ultrasound Group. There were no significant differences between groups for procedure complications. Conclusions There was no statistically significant difference between the groups in the first attempt success rate. Evidence supporting routine pre-procedural scanning of all patients having spinal anaesthesia is inadequate. We suggest that pre -procedural ultrasound scans are limited to selected patients for whom spinal anaesthesia appears technically challenging using conventional methods. 142 BEST POSTER AWARD (CLINICAL MEDICINE) ABSTRACTS OPTIMIZING ORAL HYGIENE TO REDUCE VENTILATED ASSOCIATED PNEUMONIA AT CHANGI GENERAL HOSPITAL SURGICAL INTENSIVE CARE UNIT T LEE1*, ZC Sng1, XY Song1, K Yeo1, Mohd Bashir F1, PC Tan1,QS Meng2, NLSH Lim3 1 Department of Nursing, Changi General Hospital, Singapore Department of Infection Control, Changi General Hospital, Singapore 3 Department of Anaesthesia, Changi General Hospital, Singapore 2 Aims The objective of this study is to explore the possibility of increased frequency of oral toilet using Chlorhexidine Gluconate 0.2% mouthwash to reduce VAP. Methods During March – August 2013, apart from the VAP care bundle adopted by the hospital to reduce VAP at CGH ICUs, all SICU nurses were briefed to perform 4 hourly oral care using Chlorhexidine Gluconate 0.2% mouthwash for all intubated patients.. Collected data during the period included nurses’ compliance to VAP protocol,4 hourly oral toilet as well as type of endotracheal tube used. Incidences of VAP would be flagged out by CGH Infection Control Department during their routine surveillence and attending intensivist would be consulted. Results In this study, out of 120 intubated cases at SICU, the average days of intubation were 8.19 days ranging from 3-59 days. 43.6% and 38.21 % were intubated with standard endotracheal tube and subglottic secretion drainage endotracheal tube respectively. The nurses’ compliance to perform 4 hourly oral care with Chlorhexidine Gluconate 0.2% mouthwash and CGH VAP bundle was 95.1%. There was no incidence of VAP during this period. Conclusions Our findings indicate that increasing the frequency of oral toilet to 4 hourly with Chlorhexidine Gluconate 0.2% mouthwash could possibly reduce the incidence of Ventilator Associated Pneumonia at SICU. This study merits ongoing research as reducing the incidence of VAP will reduce the costs of patient care. 143 Best Poster Award Education 21 November 2013 1030 - 1300 Centre for Innovation, Level 1 144 BEST POSTER AWARD (EDUCATION) 21 November 2013, THURSDAY 1000hrs - 1115hrs Changi General Hospital, Atrium @ Level 1 Judges: ED P-023 A/Prof Goh Siang Hui (CGH) Prof Chay Oh Moh (KKH) USING A REPOSITIONING REGIME IN PREVENTION OF HOSPITAL ACQUIRED PRESSURE ULCER (HAPU) Ms Leong Yoke Yin, Ward 37, Changi General Hospital ED P-024 THE COCA-COLA EXPERIMENT AND PICTURE TALES: AN EXPERIENTIAL LEARNING IN UNDERSTANDING RESEARCH METHODS Ms Norasyikin Hassan, Nursing Administration, Changi General Hospital ED P-025 DEVELOPING A PRACTICAL AND USER-FRIENDLY ORAL CARE TOOLKIT FOR DEPENDENT ELDERLY Ms Janet Toh Lay Siang, Nursing, Changi General Hospital ED P-026 ED P-027 THE EFFECTS OF CONDUCTING MANAGEMENT OF ANGRY, AGGRESSIVE AND VIOLENT PATIENTS ON CHANGI GENERAL HOSPITAL STAFF Ms Siti Aminah Abdul Majid, Psychological Medicine/Ward 14, Changi General Hospital REDESIGN THE ASTHMA TREATMENT AND FOLLOW UP PROCEDURES IN ORDER TO INCREASE THE HEALTH OF ACTIVE ASTHMA PATIENTS IN QUEENSTOWN Ms Chia Chin Wenn, Queenstown Polyclinic, Queenstown Polyclinic ED P-028 ED P-029 TOOLS USED IN ASSESSING MEDICATION COMPLIANCE IN THE ELDERLY Ms Lee Hoi Lun, Pharmacy, Changi General Hospital AN INNOVATIVE ELECTIVE ON COMMUNITY GERIATRICS FOR YEAR 4 MEDICAL STUDENTS Dr David Yong, Geriatric Medicine, Changi General Hospital 145 BEST POSTER AWARD (EDUCATION) 21 November 2013, THURSDAY 1000hrs - 1115hrs Changi General Hospital, Atrium @ Level 1 ED P-030 CRANBERRIES SUPPLEMENTATION: EVIDENCE FOR CARDIOVASCULAR HEALTH Ms Karen Poh Shuet Ling, Case management, Changi General Hospital ED P-031 REDUCING PNEUMONIA RATES IN NURSING HOME RESIDENTS THROUGH IMPLEMENTATION OF ORAL HEALTH AND SAFE SWALLOW EDUCATIONAL PROGRAM Ms Lee Yan Qing, Rehabilitative Services/Speech Therapy, Changi General Hospital ED P-032 WEB-BASED SELF-MONITORING WEIGHT CONTROL INTERVENTION FOR CGH STAFF Ms Angena Teo, Dietetic and Food Services, Changi General Hospital 146 BEST POSTER AWARD (EDUCATION) ABSTRACTS USING A REPOSITIONING REGIME IN PREVENTION OF HOSPITAL ACQUIRED PRESSURE ULCER (HAPU) YY Leong Department of Nursing, Changi General Hospital, Singapore Aims Pressure ulcers are easier to prevent than to treat, and once they have formed, they can lead to pain and even death. For this reason, it is crucial that health care providers prevent pressure ulcers before they begin to form. Repositioning reduces the length of time that the tissue is under pressure and maintaining an adequate supply of oxygen and nutrients to the area; preventing tissue death. To reduce pressure ulcer rate and evaluate the effectiveness after using a repositioning regime. Methods A standardized repositioning regime in the wards including training nurses on 2 hourly repositioning technique, assessments of patient’s skin integrity upon admission/ transfer-in, selecting a posture that is acceptable for the individual, proper lifting technique, usage of transfer aids to minimize friction and shear on the skin and soft tissues. Proper documentation was also reinforcing to the nurses as it facilitates monitoring of progress of skin integrity. Data for pre and post HAPU indicators were compared to determine the effectiveness of the repositioning regime. Results A total of 25 wards participated in the repositioning regime. Data on HAPU was collected from 4 July 11 to 26 August 11. Pressure ulcer rate was compared to pre repositioning regime from January to December 2012. Results showed that pressure ulcer rate had reduced by 70% following the implementation of repositioning regime. Conclusions The results of this study showed that using the repositioning regime at regular intervals reduced pressure ulcer rates in the hospital. 147 BEST POSTER AWARD (EDUCATION) ABSTRACTS THE COCA-COLA EXPERIMENT AND PICTURE TALES: AN EXPERIENTIAL LEARNING IN UNDERSTANDING RESEARCH METHODS Norasyikin H*, BL Soh, PC Tan, Sri Rahayu M, Yang Chek S, Jessica Y Department of Nursing, Changi General Hospital, Singapore Aims The project aimed to evaluate illusionary representations to enhance learners’ understanding of quantitative and qualitative research methods. Methods The illusionary representations are teaching techniques to engage learning. The Coca-Cola Experiment and Picture Tales were designed for teaching quantitative and qualitative research methods respectively at the nursing research course held in June and September 2012 in Changi General Hospital. 29 nurses attended the course altogether. The Coca-Cola Experiment was an exercise for learners to participate in measuring the effect of their pulse rate after ingesting a caffeinated-carbonated drink to simulate a randomised controlled trial. During the “interventions”, the learners were expected to state the sampling method, inclusion/exclusion criteria and measurement tool. Pictures Tales was to enhance understanding on qualitative research methods and analysis. Random pictures of people in their daily life were displayed in the class. There were group discussions to share their impressions of the subjects on the pictures followed by group presentations. The learners were expected to state common terms from the presentations and identify a theme to interpret the pictures. Independent course evaluation tool using Learning Management System was used to evaluate the course materials, training process and overall expectation. Commentary feedback was also included. Results Majority of the learners agreed the course materials were at an understandable level (n=23). 79.3% agreed there were sufficient activities for practice. 75.8% of the learners agreed the visual aids reinforced their learning. The overall impression of the course was positive with 79.3% stating it met their expectation. The verbatim feedback from learners were “interesting”, “active interaction”, “easier for us to understand” and “the group activities enabled me to practise what I have learned”. Conclusions Learners’ engagement is imperative in their learning process. The illusionary representations in the nursing research course were visible in augmenting the learners’ understanding in research methods and application. 148 BEST POSTER AWARD (EDUCATION) ABSTRACTS DEVELOPING A PRACTICAL AND USER-FRIENDLY ORAL CARE TOOLKIT FOR DEPENDENT ELDERLY LS Toh, MN Kee, Imma Harliny , I Fronda, B Wong, WG Seow, YQ Lee Department of Nursing, Rehabilitation, Changi General Hospital, Singapore Aims To improve compliance and ease of oral care provision amongst nurses and caregivers through creation of new oral care toolkits Methods A 3-pronged approach was adopted to achieve the aim; firstly, creating individualised and practical oral care toolkits as each patient’s oral care needs are different and will require different items for care. Secondly, training the hospital staff regarding the use of toolkit and the best oral care practices. Lastly, the continuity of care was reinforced by educating patients’ caregivers regarding the oral care methods and the use of toolkit during caregiver training. Caregiver training booklets were given to serve as a guide after discharge. Subsequently, feedback forms and 5-point likert scale questionnaires were given out to the nurses and caregivers to evaluate effectiveness of training and their opinion about the new oral care toolkits. Results Overall 100% of nurses and caregivers are generally satisfied with the new oral care toolkits and found the new toolkit easy to use. 85% of the nurses found the new toolkits practical and would highly recommend the toolkit to other colleagues. Conclusions Oral hygiene care is often neglected due to the circumstances surrounding acute hospitalisation. Oral hygiene plays an important role in determining one’s chances for contracting pneumonia. The implementation of this project has assisted the nurses’ and caregivers’ ease of use and compliance to the oral care practices by providing them with appropriate training and a more practical and effective oral care toolkit. Consequently, the oral hygiene status of patients are improved over a long-term basis. 149 BEST POSTER AWARD (EDUCATION) ABSTRACTS THE EFFECTS OF CONDUCTING MANAGEMENT OF ANGRY, AGGRESSIVE AND VIOLENT PATIENTS ON CHANGI GENERAL HOSPITAL STAFF Majid S A *, Sukor E S, Rahim S, Ayengar S K, Salikin Y C Department of Nursing, Changi General Hospital, Singapore Aims The primary aim is to evaluate the effectiveness of the training programme in managing angry, aggressive and violent patients for Changi General Hospital staff. It also focuses on improving staff’s awareness and understanding on the cycle of aggression and violence. Methods A set of multiple choice questions was designed to assess participant’s knowledge on aggression, techniques and communication. The test was administered before and after the training to measure pretest-posttest effect. Three sessions were held from March 2013 to September 2013. 55 participants attended the training and participated in the pretest and posttest sessions. Results The participants consisted of senior staff nurses 29% (n=16), staff nurses 33% (n=18) and enrolled nurses 24% (n=13). Others comprised of principal enrolled nurse (n=3), medical social worker (n=1), resident physician (n=1), health care assistant (n=1) radiographer assistant (n=1) and telecarer (n=2). As for questions on aggression, causes and elements of anger and the assault cycle, the participants responded with an average mean score of 66.7% in the pretest and 83.3% in the posttest; an improvement of 17%. For questions asked on techniques and de-escalation, there was an average mean score of 87% in the pretest and 97% in the posttest; an improvement of 10%. Lastly, for questions on communication, the participants responded with an average mean score of 40% in the pretest and 80% in the posttest, with an improvement of 40%. Conclusions To conclude, the posttest has generally showed an increased percentage in the participants' knowledge and techniques managing angry, aggressive and violent patients. Further recommendations on the training would be to include restraint techniques and also self-care. Follow-up research will also be conducted in the future to measure the confidence level of staff who have completed the training in handling such confrontational situations as compared to staff who have not attended the training programme. 150 BEST POSTER AWARD (EDUCATION) ABSTRACTS REDESIGN THE ASTHMA TREATMENT AND FOLLOW UP PROCEDURES IN ORDER TO INCREASE THE HEALTH OF ACTIVE ASTHMA PATIENTS IN QUEENSTOWN C W Chia*, Anandan G T, Angela L K Y Singhealth Polyclinic, Queenstown, Singapore Aims Asthma is a common lung condition seen in SingHealth polyclinics. Good asthma control results in improvement in the quality of life and correlates well with Asthma Control Test (ACT) score of ≥20. The Percentage of patients with ACT scores ≥20 is used by SingHealth Polyclinics as a Quality Indicator measuring the level of Controlled Asthma in the Polyclinic setting. The percentage of active asthma patients with ACT score of ≥20 average was 73% in 2011 (77.5% is the Key Performance Indicator target for asthma). The team members redesigned the asthma treatment and followed up procedures in order to increase the health of active asthma patients in Queenstown Polyclinic. Methods For the intervention, 5 Plan-Do-Study-Act cycles were used to test and refine the workflow before implementation. A sample size of 20 asthma patients were selected at random, we used 2 PDSA cycles to test before and after the new implementation of the workflow. Results There was an increase in the percentage of ACT scores ≥ 20 for the 3 months following commencement of the EPIC project. Overall, there was improvement seen in asthma patients' condition and increase in patient and staff satisfaction. Patients with ACT score < 20 were sent for counselling by nurses. Workflow for asthma was redesigned to include a reminder note for doctors. 6 monthly teaching sessions for nurses and doctors on asthma management were implemented. An asthma registry was set up to keep track of patients with ACT< 20. Such patients were followed up up by nurses 4 weeks post treatment for ACT rescoring. Conclusions As of November 2012, we have achieved and maintained the target of 77.5%. We would like to share this information with other polyclinics to improve their ACT score. 151 BEST POSTER AWARD (EDUCATION) ABSTRACTS TOOLS USED IN ASSESSING MEDICATION COMPLIANCE IN THE ELDERLY Lee H L*, Ang W S T Department of Pharmacy, Changi General Hospital, Singapore Aims Medication compliance is a prominent problem in the elderly patients and may be a result of polypharmacy and complex pharmacological regimens required to control chronic medical conditions. There are immense consequences to medication noncompliance such as possible worsening of health and inaccurate reassessments of the medical conditions, giving a false impression that the existing medicines are insufficient and additional medicines are required to better control the disease. Therefore accurate determination of medication compliance in the elderly patients with a suitable tool is important so that appropriate actions can be taken to resolve issues that hinder compliance. The appropriateness of the tools is dependent on the unique characteristics of the elderly, such as lower literacy, shorter attention span and multiple comorbidities. The aim of this project is to identify the medication compliance tools available, and to evaluate the tool that is most suitable for elderly patients. Methods A literature search was performed using the terms “elderly”, “medication compliance tool” and “medication adherence tool”, with no date limit. Prospective and retrospective studies as well as meta-analyse were included. Results A total of 16 articles describing the use of nine medication compliance tools were shortlisted. These tools vary in the level of literacy required for accurate assessment, and validity in the different disease states. The Morisky 4-item Medication Adherence Scale was found to be validated in numerous disease states common in the elderly and evaluated to be the simplest of all tools to assess medication compliance. Conclusions Taking into account the multiple comorbidites and lower level of literacy of the elderly, the Morisky 4-item Medication Adherence Scale may be a suitable tool to assess medication compliance. Moving forward, we aim to conduct a medication adherence survey to assess medication compliance of the elderly patients in CGH, so that necessary actions can be taken for improvement. 152 BEST POSTER AWARD (EDUCATION) ABSTRACTS AN INNOVATIVE ELECTIVE ON COMMUNITY GERIATRICS FOR YEAR 4 MEDICAL STUDENTS Lee P *, YONG D, LIEN C, , LOW S L Department of Geriatric Medicine, Changi General Hospital, Singapore Aims To describe the structure and process of the CGH Community Geriatrics Elective for Year 4 Medical Students Methods Whether or not a medical student chooses to specialize in Geriatrics, geriatric patients and issues will be a central part of their future practice. The program will introduce the students to a rich and diverse experience in elderly care in the community, supplement and expand their final year hospital geriatrics rotation and add value totheir overall medical learning. Students participate in a 2 week clinical and didactic program in geriatrics at these various sites .Teaching will be done by following two community geriatric careconsultants at various site visits such as a geriatric subacute and rehabilitation ward, community hospital, day rehabilitation centre, sheltered home, nursing home and home care . They will also visit new innovative service models like postacute Transitional Care, ACTION, SPICE and Transitional Convalescent Facility.They will get an introduction to aspects of subacute, rehabilitative , preventive and long term care. They will also gain an understanding of the roles of these respective services in care of elderly.Students can opt to do a short project : audit or an observational study. Students will discuss with and be taught by the consultant or service provider,and encouraged to keep a journal to report their experiences. They complete a short exit test and then give their feedback. Learning Objectives 1 : To expose the medical student to the evaluation of elderly patients in the community which includes chronic disabling diseases, role of the environment, ethics and end of life care. Learning Objectives 2 : To enhance the student’s understanding of appropriate utilization of health care resources as part of ‘slow stream medicine’ to improve health outcomes The short project will introduce students to concept of data analysis. Results For last three years , the course has been fully subscribed( 8). Two students opted for project. One was an audit on weight loss in Nursing Home which was presented by the student at the AIC National ILTC Conference, the other was an observational study on poor feeding in NH residents. All have rated the course as excellent( >8/10), learning being 'fun or enjoyable' , having achieved their learning objectives and would highly recommend it to their peers and juniors. Half of them wanted the course to be more intensive. Conclusions This elective that offers students an opportunity to see and learn about patients enrolled for various services provided at different community sites is well received. 153 BEST POSTER AWARD (EDUCATION) ABSTRACTS CRANBERRIES SUPPLEMENTATION: EVIDENCE FOR CARDIOVASCULAR HEALTH SLK Poh*, LL Chen, P Lum, W Soo, M Tan, LT Chan Department of Nursing, Changi General Hospital, SIngapore Aims Health Benefits attributed to Cranberry includes the prevention of urinary tract infection and stomach ulcer. Research has shown that cranberries has by far the largest amount of both free and total phenols among fruits which could contribute to reducing the risk of cardiovascular disease by increasing the resistence of LDL to oxidation and inhibiting platelet aggregation. This study aims to report a meta analysis of scientific evidence of cranberry and explore its cardiovascular prevention benefits for healthy adults to be used for health education. Methods A systemic literature review was carried out in 2013 using ovidmedline and CINAHL Full text databases and hand searching of database with keywords Cranberry, cardiovascular, lipid, cardioprotection and heart. This results in 41 full text articles in which only 6 are relevant to the research. Papers that were excluded were not investigating the benefits between cranberries and the heart. A search of Cochrane (June 2013) yielded no results. Three reviewers assessed the data found according to JBI methodology. The reviewers were not blinded to authors or journal. Results Reduction of LDL by consumption of cranberries were well supported by all research. Two studies report platelet aggregation inhibitation observed in their studies.In summary, the information available in the literature is supportive of the cardiovascular benefits of cranberries which provides preventive treatment modality. Cranberry is reported to contain salicyclic acid, the active form of acetylsalicyclic acid. which consistent studies have proven its benefits impact with CVD risk. Conclusions Cranberries could be used as preventive supplement for cardiovascular protection besides the other known benefits such as prevention of urinary tract infection and stomach ulcer. 154 BEST POSTER AWARD (EDUCATION) ABSTRACTS REDUCING PNEUMONIA RATES IN NURSING HOME RESIDENTS THROUGH IMPLEMENTATION OF ORAL HEALTH AND SAFE SWALLOW PROGRAM Lee Y Q*, Wong B Yong D, Lacuesta C Department of Nursing, Rehabilitative Services, Geriatrics Medicine, Changi General Hospital, Singapore Aims Pneumonia is one of the most common reasons for hospitalization in nursing home residents. Through the implementation of Oral Health and Safe Swallow (OHSS) Programme, the project aims to improve dysphagia management, provide quality oral care, and reduce pneumonia rates in Nursing Home (NH) residents. Methods The OHSS Programme is an enhanced nurses training programme which aims to reduce pneumonia rates by targeting two preventable factors contributing to pneumonia: aspiration from dysphagia, and poor oral care. In this project, 51 nurses and nursing aids from Lions Home (Bedok) were trained on identifying and managing dysphagia, safe feeding strategies, and proper oral care methods. Training was conducted via didactic teaching, hands-on practical and periodical visits for follow-up consultation. Ten OHSS Champions were identified to advocate for and ensure compliance with appropriate oral care and safe feeding methods. Outcome measures included: Pre and Post-Training Questionnaires to evaluate staff knowledge, Oral health status of all NH residents, and rates of residents admitted for pneumonia. Results This is a one-year ongoing project which will be concluded in March 2014. Preliminary findings showed that 80% of nursing staff achieved improved scores on the Post-Training Questionnaire. Seventy-eight percent of staff achieved a score of at least 15/20 (75%) at post-training, compared to 41% at pre-training. All nurses indicated that the programme was useful, easy to learn, practical and they would recommend it to other nursing homes. Though data collections for oral health status and pneumonia rates are still ongoing, the data suggests that there is a decrease in pneumonia rates during the course of implementation. Conclusions OHSS is an effective training program with high acceptance rate by NH staff to improve knowledge and skills for managing dysphagia, improve oral care and reducing pneumonia rates. The success of this programme suggests that OHSS can be replicated in other Nursing Homes, especially those with high pneumonia rates. 155 BEST POSTER AWARD (EDUCATION) ABSTRACTS WEB-BASED SELF-MONITORING WEIGHT CONTROL INTERVENTION FOR CGH STAFF A Teo*, M Cheong, SH Tan, PL Chia Department of Dietetic & Food Services, Changi General Hospital, Singapore Aims To improve the nutrition and exercise habits of CGH staff using a web-based intervention approach thus promoting weight loss in overweight or obese individuals to encourage self-management. Methods CGH staff was invited to form teams of 2 or more staff and participate in an interdepartmental weight loss competition. Over the course of 3 months, participants were encouraged to record their dietary intake and physical activity on myhealth.sg while recording their weekly weights on SharePoint. Each participant was also weighed monthly and received hand-outs on nutrition and exercise. In addition, the weight loss of teams and more practical tips were posted on SharePoint and sent via email to participants each month. A pre and post-KAP (Knowledge, Attitude and Practices) survey was given to assess the intervention’s effectiveness in changing eating knowledge, attitudes, and habits. A feedback form was also provided at the end of the competition to gather information to improve future interventions. Results The highest average weight loss for a team was 4.38kg over 3 months. The greatest total individual weight loss 7.45kg and the highest individual percentage weight loss was 9.88% over 3 months. The post-KAP surveys demonstrated an overall increase in knowledge; greater importance was given to healthy eating attitudes, and more wholesome eating practices. Feedback from the participants showed an improvement in knowledge of what to do to lose weight. Although most participants did not record what they ate or what exercise/physical activity they did into myhealth.sg, they valued the information communicated to them electronically, the support they got from colleagues to lose weight, the regular monitoring of their weight, and the motivation that came from being in the competition. Conclusions A web-based self-monitoring approach is shown to increase knowledge amongst overweight and obese CGH staff. The intervention also supports past literature that weight loss competitions are effective in motivating participants to lose weight and to persevere with eating healthily. This web-based approach facilitates nutrition education and promotes self- management for improved outcomes. 156 Best Poster Award Research 21 November 2013 1030 - 1300 Centre for Innovation, Level 1 157 BEST POSTER AWARD (RESEARCH) 21 November 2013, THURSDAY 1030hrs - 1200hrs Changi General Hospital, Atrium @ Level 1 Judges: RE P-032 Dr Serena Koh Dr James Sim Dr Tan Wei Wei (MOH) (SGH) (KKH) COGNITIVE-COMMUNICATION SCREENER FOR ENGLISH & MANDARIN DOMINANT ADULTS WITH TRAUMATIC BRAIN INJURY Ms Geraldine Tan, Rehabilitative Services, Changi General Hospital RE P-033 RE P-034 AURAL REHABILITATION FOR ADULTS WITH COCHLEAR IMPLANTS Ms Angie Foo An Qi, Speech Therapy, Changi General Hospital NURSES’ PERCEPTION IN CARING FOR STROKE PATIENTS IN AN ACUTE CARE HOSPITAL: A QUALITATIVE STUDY Ms Yap Fui Chin, Case Management, Changi General Hospital RE P-035 RE P-036 HEALTH AS A VALUE IN OLDER VS YOUNGER PRIMARY CARE PATIENTS Dr Joanne Quah Hui Min, Outram Polyclinic, Changi General Hospital DEVELOPMENT OF MOLECULAR DIAGNOSTIC ASSAY FOR DETECTION OF BURKHOLDERIA PSEUDOMALLEI Dr Boran Jiang, Laboratory Medicine, Changi General Hospital RE P-037 UTILISATIN PATTERN OF REPEAT VISITORS TO ACCIDENT AND EMERGENCY AND FACTORS ASSOCIATED WITH REPEAT VISITS Dr Tin Aung Soe, Health Services Research, Eastern Health Alliance RE P-038 REFEEDING HYPOPHOSPHATAEMIA IN PATIENTS ON PARENTERAL NUTRITION SUPPORT - AN AUDIT ON INCIDENCE AND ASSOCIATED RISK FACTORS Dr Alvin Wong, Dietetic & Food Services, Dietetic & Food Services 158 BEST POSTER AWARD (RESEARCH) 21 November 2013, THURSDAY 1030hrs - 1200hrs Changi General Hospital, Atrium @ Level 1 RE P-039 POST MASTECTOMY PAIN SYNDROME (PMPS) IN LOCAL BREAST CANCER SURGERY PATIENTS Ms Ong Yet Yin, Nursing/Pain Service, Changi General Hospital RE P-040 RE P-041 NEEDS OF ASIAN BREAST CANCER PATIENTS Dr Chow Wai Leng, Health Services Research, Eastern Health Alliance FACTORS THAT CONTRIBUTE TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ACCEPTANCE IN OBSTRUTIVE SLEEP APNEA (OSA) PATIENTS IN SINGAPORE Ms Liang Jieying, Clinical Service Support, Sleep Lab, Changi General Hospital RE P-042 TO EVALUATE THE EFFECTIVENESS OF THE COMPLIANCE KIT ON THE READMISSION RATES IN HEART FAILURE PATIENTS Ms Zhang Shu Hua, Dietetic and Food Services, Changi General Hospital RE P-043 THE EXPERIENCE AND PERCEPTION OF CARING FOR PERSONS WITH DEMENTIA BY THE NURSES WORKING IN THE GERIATRIC UNITS IN AN ACUTE HOSPITAL. Ms Zhang Di, Nursing, Changi General Hospital RE P-044 ANTIMICROBIAL SUSCEPTIBILITIES OF ANAEROBIC ORGANISMS CAUSING BLOODSTREAM INFECTIONS Ms Lily Ng Siew Yong, Laboratory Medicine, Changi General Hospital RE P-045 THE SIGNIFICANCE OF TWO-DIMENSIONAL STRAIN IN DOBUTAMINE STRESS – SINGLE CENTRE EXPERIENCE Ms Tan Puay Joo, Clinical Measurement Unit, Changi General Hospital 159 BEST POSTER AWARD (RESEARCH) ABSTRACTS COGNITIVE-COMMUNICATION SCREENER FOR ENGLISH & MANDARIN DOMINANT ADULTS WITH TRAUMATIC BRAIN INJURY G TAN*, G WEE & S JALIL Department of Rehabilitative Services, Changi General Hospital, Singapore Aims Cognitive-communication deficits post Traumatic Brain Injury (TBI) has been shown to be long-lasting and have a negative impact on re-integration into society (Chua & Kong, 1999). Although early diagnosis and intervention is crucial, till date, there are no locally-developed screener for English or Mandarin Dominant adults with TBI. The aim of this research is to develop a sensitive and reliable TBI screener for use in the acute setting with English or Mandarin Dominant adults. Methods Firstly, a cognitive-communication screener in the English and Mandarin language was developed. Up to 18 different sub-tests were developed to measure attention, memory, organization, reasoning, problem-solving and sequencing. Secondly, normative data was collected from 60 neurologically-intact participants (from each study group) aged between 21 – 80 years old. The participants were further stratified by their education qualifications – ranging from primary to tertiary levels. Scores on accuracy and response times were taken as measures of ability for each subtest. The English and Mandarin screeners were found to have good internal reliability with Cronbach’s alpha of .776 and .878 respectively. Percentiles for scores and response time are reported for normative benchmarking. Results All trauma patients who meet the criteria for TBI (failed Westmead Post Traumatic Amnesia test - a test to check for presence of memory and orientation impairment post TBI, presence of neurological injury, coma) are identified from the trauma database. These patients are then screened for cognitive-communication deficits using the locally normed English and Mandarin local screener developed above. Conclusions This locally normed and reliable cognitive-communication screener developed for English and Mandarin Dominant adults with TBI enables the Speech Therapists to identify areas of deficit quickly and thereby facilitate early intervention. 160 BEST POSTER AWARD (RESEARCH) ABSTRACTS AURAL REHABILITATION FOR ADULTS WITH COCHLEAR IMPLANTS AAQ Foo*, JY Choong, SLH Lee, S Kamath, LGR Peters, HW Yuen Department of Speech Therapy, Changi General Hospital, Singapore Department of Otolaryngology, Changi General Hospital, Singapore Aims Adults with severe to profound hearing loss who receive cochlear implants often lack the professional rehabilitative support required to develop the ability to effectively use the sounds provided by implants. We aim to develop an aural rehabilitation programme, specialising in the needs of adults so that they can effectively interpret their implant's sounds. Encouraging patients to attune implant inputs with everyday sound awareness and speech recognition should ultimately improve a patient's communication ability and quality of life. Methods Aural (re)habilitation programmes for cochlear implant recipients are highly developed for the paediatric population based on auditory verbal therapy principles. However, aural rehabilitation for adults is sporadic and less developed in Singapore and even in different parts of the world. Speech therapists, audiologists and an ENT surgeon in CGH with the help of an auditory verbal therapist, pieced together limited materials from online and international sources to develop an aural rehabilitation programme appopriate for adults in local languages and with Singaporean flavour. Results Using speech tests and a self report questionnaire we found the adult cochlear implant recipients who went through aural rehabilitation showed significant improvements in their speech understanding ability and quality of life. Conclusions CGH can lead the way in developing aural rehabilitation for adults into a recognised specialty in Singapore and various parts of the world. 161 BEST POSTER AWARD (RESEARCH) ABSTRACTS NURSES’ PERCEPTION IN CARING FOR STROKE PATIENTS IN AN ACUTE CARE HOSPITAL: A QUALITATIVE STUDY FC Yap*, P Wang, YY Li, XY Jiang, W Soo and M Tan Department of Case Management, Changi General Hospital, Singapore Aims The aim of this study is to explore the general medical ward nurses’ perception of stroke care in an acute care hospital. Methods In this qualitative exploratory study, focus group interviews were conducted to examine nurses’ experiences in caring for stroke patients. Nine registered nurses were randomly selected from the general medical wards. A total of 3 interview sessions were conducted with 2 to 4 registered nurses in each session. The interviews were audio recorded with verbatim transcription. Individual transcripts were analysed for trends, patterns, and recurring themes. Results Out of 9 registered nurses being interviewed, 5 of them were Senior Staff Nurses and 4 were Staff Nurse. Their working experiences ranged from 3 to 11 years with an average of 6 years. Four major themes emerged: 1) transferring 2) feeding 3) communication and 4) lack of time. Participants verbalized they experienced difficulties in transferring stroke patients especially those with dense hemiplegia. Longer feeding time was required for those with impaired swallowing. The communication with aphasic stroke patients was also a challenge. All of them felt that the inadequate time spent on patient rehabilitation activities. They often do the tasks for the patient instead of assisting them to regain their functional independence. Conclusions Understanding the challenges that general ward nurses faced in caring of stroke patients can help to identify areas to improve the nursing care of stroke patients in general ward. 162 BEST POSTER AWARD (RESEARCH) ABSTRACTS HEALTH AS A VALUE IN OLDER VS YOUNGER PRIMARY CARE PATIENTS Eunice En Ni Lai1, Sze Jet Aw1, Sylvaine Barbier2, Joanne Hui Min Quah*3 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore Duke-NUS Graduate Medical School, Singapore 3 Outram Polyclinic, SingHealth Polyclinics, Singapore 2 Aims A person’s values often determine how he or she will lead his or her life. A person’s value of health would then determine his preventive health behaviour. Our study aims to determine the difference in the value of health between the young and the old in local primary care patients, as well as to elicit the factors that are associated with this difference. Our study also aims to establish what people of different age groups value the most. Methods The research was a cross sectional study of patients in Outram and SengKang Polyclinics. We systematically sampled and conducted interviewer-based questionnaires on 262 patients. The Value of Health Scale by Lau et. al. and the modified Rokeach Value Survey were used, and this data was correlated with social demographics of participants using SPSS. Results We found that the younger primary care patients scored lower in the Health value scale than the older patients. Higher educational levels attained correlated with a higher value of health. We also found that the value of health does not have a significant association with favourable health behaviours, which suggest that healthy behaviours are not driven by health alone. Notably, the young valued ‘an exciting life’ more than the old while the old valued ‘freedom’ more than younger people. Conclusions As the younger population valued health less, efforts in encouraging healthy behaviours through promoting ‘health’ as a value will not be productive. Instead, by encouraging the health behaviours through their other ‘more important’ values, they are more likely to engage in these behaviours. 163 BEST POSTER AWARD (RESEARCH) ABSTRACTS DEVELOPMENT OF MOLECULAR DIAGNOSTIC ASSAY FOR DETECTION OF BURKHOLDERIA PSEUDOMALLEI Boran Jiang*, Hao Zou, Danny Ong, Lily SY Ng, Thean Yen Tan Department of Laboratory Medicine, Changi General Hospital, Singapore Aims Burkholderia pseudomallei is gram-negative environmental bacterium that causes the infectious disease, melioidosis, which is endemic to Southeast Asia and Northern Australia. Melioidosis is a potentially fatal disease that could have widely clinical manifestations, including acute septicemia and pulmonary infection with a fatality rate of 16.2% in Singapore, of which 50.4% were caused by septicemic melioidosis. Rapid detection of B. pseudomallei is important for clinical diagnosis. This study is to evaluate analytical and clinical performance of two real time PCR assays which target two different genes of B. pseudomallei. Methods Analytical sensitivity and specificity were evaluated by screening 32 B. pseudomallei strains and 39 non-B. pseudomallei strains (with 9 Burkholderia cepacia, 27 other gram-negative bacterial strains, and 3 gram-positive bacterial strains). Clinical evaluation was performed by screening each assay across 93 clinical specimens (42 endotracheal tube aspirates (ETTA), 35 sputum, 8 bronchoalveolar lavage (BAL), 4 urine, 2 nasopharyngeal swab, 1 tissue sample and 1 joint fluid). Nucleic acid was extracted from the above samples and followed by real time PCR assays. PCR efficiency and limit-ofdetection (LOD) of these two assays were determined by analyzing a serial dilution of a clinical sample containing a known number of colony forming units (cfu). Cut-off Ct of these two assays were determined based on the LODs. PCR data was then compared against bacterial culture results. Results Both assays have high PCR efficiency, 100% for assay 1 and 103% for assay 2. LODs were found to be 4cfu/ul for assay 1 and 0.5cfu/ul for assay 2. Assay 1 showed analytical sensitivity of 96.9%, analytical specificity of 100%, clinical sensitivity of 92.3%, clinical specificity of 100%. Assay 2 had analytical sensitivity of 100%, analytical specificity of 100%, clinical sensitivity of 100%, clinical specificity of 98.7%. One patient with culture-confirmed systemic meliodosis had a urine sample tested that was culture-negative, but positive by PCR assay 2 (Ct 28.6). Conclusions This comparison study gives a comprehensive evaluation of two real time PCR assays which are valuable tools for rapid identification of infection with B. pseudomallei. Based on limited data from this and other studies, PCR performed on urine samples may improve the diagnostic yield of patients with meliodosis. 164 BEST POSTER AWARD (RESEARCH) ABSTRACTS UTILISATIN PATTERN OF REPEAT VISITORS TO ACCIDENT AND EMERGENCY AND FACTORS ASSOCIATED WITH REPEAT VISITS AS Tin1*, WL Chow1, T Mohan2 1 Department of Health Services Research, Singapore Department of Accident & Emergency, Eastern Health Alliance, Singapore 2 Aims The Accident and Emergency department (A&E) is a scarce resource that is being utilized more frequently by some patients than others. This study aimed to examine the factors associated with repeated A&E visits in a regional hospital in Singapore. Methods We conducted a retrospective analysis of all attendances from 1 Jan 2011 to 31 Dec 2011 extracted from administrative databases. Variables examined included demographic characteristics, number of A&E visits, principle diagnosis, mode of arrival and acuity status. Patients were categorized according to the frequency of A&E visits: 1 visit; 2-5 visits; and ≥ 6 visits and compared for any differences in demographics and other factors. Ordinal logistic regression analysis was performed using frequency of visits as dependent variable and other factors as independent variables. Results A total of 110417 patients accounted for 165031 visits. Mean age was 42 years, 59% were male, 55% were Chinese, and 56% were P3 cases. 75.5% of patients had only 1 visit, 22.6% made 2-5 visits and 1.9% made ≥6 visits. About 24.5% of patients who made > 1 visit contributed to 49.5% of total visits. Elderly patients (≥ 65 years) as well as young patients (≤ 25 years) had the highest age-specific re-attendance rate. Among the frequent repeated attendees (≥ 6 visits), majority were self-referred (84%), 43% were ≤ 25 years, 19% of visits were for upper respiratory tract infection. Ordinal logistic regression revealed that being male, ≤ 25 years, ≥ 65 years, self-referred and attending for asthma and common cold remained significantly associated with repeated A&E visits. Conclusions Our preliminary analysis suggested that interventions to address the problem of repeat A&E attendances would have to be targeted based on the profile of the patient. More research should be performed to examine the factors influencing repeat A&E attendance among the young and elderly. 165 BEST POSTER AWARD (RESEARCH) ABSTRACTS REFEEDING HYPOPHOSPHATAEMIA IN PATIENTS ON PARENTERAL NUTRITION SUPPORT - AN AUDIT ON INCIDENCE AND ASSOCIATED RISK FACTORS WONG, A*., HSIEN, H.H., ONG, J. Department of Dietetic & Food Services, Changi General Hospital Department of Pharmacy, Changi General Hospital Department of Gastroenterology, Changi General Hospital Aims Refeeding Syndrome is a known risk in patients on Total Parenteral Nutrition (TPN) and it is associated with medical complications with neurological and cardiopulmonary involvement. Refeeding Hypophosphataemia (RH) is one of the clinical signs of Refeeding Syndrome. An audit was performed to determine the incidence, risk factors involved, 30-day and 6-month mortality of inpatient population with RH intiated on TPN. Methods Patients admitted to CGH and initiated on TPN between September 2011 and July 2013 were audited. Patients with end stage renal failure and/or acute kidney injury requiring haemodialysis were excluded. Anthropometric, biochemical and demographic parameters were analysed. RH is defined as a decrease in serum phosphate levels of >0.16 mmol/ L to less than 0.65 mmol/L upon commencement of TPN. All patients were prescribed customised TPN by the Nutrition Team or ready-to-use TPN bags (RTU) by the ICU. Associations between RH and risk factors were determined with Fishers-Exact Test. Results Of the 129 patients initiated with TPN, 24 patients (19%) had RH. There was no sigificant associations found between RH and Mortality rates, Baseline serum levels of Magnesium, Phosphate and Potassium, Carbohydrate and Calories administered in TPN and ICU admission (p>0.05). Relative risk (RR) of RH in underweight patients (BMI<18.5) is 1.385 (95%CI: 0.6-3.195, p=0.43). RR of RH in patients initiated with RTU is 1.385 (95%CI 0.443-4.324, p=0.57) and is also higher at 1.345 (95%CI: 0.689-2.624, p=0.36) in patients with nil nutritional intake for more than 7 days. Conclusions There is a relatively high incidence of RH in patients initiated on TPN. Patients with BMI <18.5, and/or initiated on RTU TPN bags without initial assessment by TPN team, and/or had minimal intake for >7 days may be at higher risk of RH. These common predictive factors did not prove to demonstrate a significant risk for the development of RH in this audit, possibly due to the close monitoring of TPN patients, the provision of additional amounts of phosphate by the team in anticipation of the development of RH and appropriate product selection for inclusion into the formulary, i.e. RTUs with low dextrose loads, which thereby increased patient safety in general. 166 BEST POSTER AWARD (RESEARCH) ABSTRACTS POST MASTECTOMY PAIN SYNDROME (PMPS) IN LOCAL BREAST CANCER SURGERY PATIENTS CS Yoong*, YY Ong, Marlinda A, X Yu, SM Tan Department of Anaesthesia and General Surgery, Changi General Hospital, Singapore Aims Chronic post-surgical pain (CPSP) is a common, but often unrecognized healthcare problem. CPSP has multifactorial aetiologies - from nerve injury and excessive inflammatory response - causing peripheral and central sensitisation. Post-mastectomy pain syndrome (PMPS) is one example of CPSP syndrome encountered after breast cancer surgery (BCS). Sufferers can have persistent pain that interfere with Quality of Life (QOL). Studies indicate PMPS is present in between 20 and 65% of BCS patients. This study aims to study the prevalence of PMPS, its characteristics, and effects on QOL among Singapore patients, as it has not been well studied locally, or among other Asian populations. Methods This cross-sectional, observational study reviewed a sample of 109 BCS patients recruited from a single breast surgery centre. Patients were interviewed by 3 trained interviewers using a modified pain questionnaire and SF12 Health Survey questionnaire. Results Overall, 37 patients reported PMPS symptoms (33.9%). PMPS patients were younger (55.3 vs 63.0 years), although the time interval since surgery were similar. The percentage of PMPS was significantly higher in non-Chinese patients (48.7% vs 25.7%). PMPS patients did not differ in rates of mastectomies, axillary clearance and stages of the cancer. Although “Current” and “Best Pain Scores” in PMPS patients were mild to moderate, four patients had “Worst Pain Scores” in the severe range. PMPS patients had significantly lower SF12 physical component scores indicating an increase impact on physical health QOL. Conclusions PMPS is not uncommon in our local BCS patients, with a higher percentage of non-Chinese and younger patients. PMPS patients had significantly poorer physical health QOL scores. As such, there should be more effort to highlight PMPS and its effects to local clinicians, to allow more accurate and prompt diagnosis and treatment. 167 BEST POSTER AWARD (RESEARCH) ABSTRACTS NEEDS OF ASIAN BREAST CANCER PATIENTS WL Chow*1, SM Tan2, AS Tin1 1 Department of Health Services Research, Eastern Health Alliance, Singapore Department of Surgery, Changi General Hospital, Singapore 2 Aims Breast cancer is the top cancer among females worldwide and in Singapore from 2008-2012. However, little research has been done to understand the needs of breast cancer patients locally in order to better support them at the point of diagnosis. We therefore seek to examine the needs of breast cancer patients at the point of diagnosis. Methods This was a self-administered survey of all breast cancer patients diagnosed at a regional hospital from September 2009 to March 2013. Patients were surveyed on their needs in the following domains at the point of diagnosis: on the diagnosis of breast cancer, treatment, personal and emotional support, femininity and body image, family and friends, demographics and treatment details using a specific 5-point Likert scale questionnaire. Percentages of patients who ranked each item very important or important were reported for each item. Results 181 patients (response rate 53.4%) were recruited. Mean age was 52.6 years, majority were Chinese (75%) and married (70.6%). About 43.8% had early breast cancer (stage 0 and 1). The 3 areas that most patients felt were important or very important at diagnosis involved treatment. They were: to have prompt information about treatment options and side-effects (96.1%); ability to cope with treatment side-effects (95.5%); and to have prompt treatment for sideeffects (94.4%). The 3 areas that least patients felt were important or very important involved femininity and body image: to have information about reconstruction (47.8%); to have husband’s/partner’s acceptance of changed body appearance (56.7%); and to have time to adapt to one’s changed body appearance (63.5%). Conclusions Our study suggests that treatment concerns were of greater importance among majority of local breast cancer patients at diagnosis, whereas body image and maintaining femininity were of lower importance. These findings will help inform the counseling and support for our patients. 168 BEST POSTER AWARD (RESEARCH) ABSTRACTS FACTORS THAT CONTRIBUTE TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ACCEPTANCE IN OBSTRUTIVE SLEEP APNEA (OSA) PATIENTS IN SINGAPORE Liang JY, Seow ML, Goh MM, Wong JN, Sgeetha N, Thant E, Poh HL, Celedonio MC. Department of Clinical Support Services, Sleep Laboratory, Changi General Hospital, Singapore Aims Continuous Positive Airway Pressure (CPAP) is the gold standard of treatment for Obstructive Sleep Apnea (OSA), but acceptance is a significant problem that has been incompletely assessed. Our aim is to determine the various factors which affect the acceptance of CPAP in patients with OSA. Methods A total of 745 patients were diagnosed with OSA (apnoea-hypopnea index ≥5/hour) from year 2011 – 2013 and referred to the CPAP counselling clinic for a one month CPAP trial. Patients were divided into two groups. One group consists of patients who refused CPAP treatment after undergoing the one month trial. The second group were those who went through the trial and purchased the CPAP machine. Independent t-test was performed to identify the group differences on the various factors like demographics and sleep study variables. Results From the whole research population of 745 OSA patients, 436 (58.5%) patients took up the one month CPAP trial. Mean ± SD Age 48.5 ± 11.9 years; BMI 28.2 ± 7.6kg/m²; and RDI 43.3 ± 27/hour of sleep. Out of these 436 patients, 128 (17%) purchased the CPAP machine. XAnalysis was made using the independent t-test and five variables were found to be significantly different (p<0.05) between the two groups. These variables include desaturation (p=0.03), oxygen saturation (p=0.07), arousal index (p=0.48), sleep efficiency (p=0.21) and Total Sleep Time (TST) (p=0.18). Conclusions We conclude that an overnight polysomnography study variable is the major factor that contributes to the patient’s acceptance and purchase of the CPAP machine. 169 BEST POSTER AWARD (RESEARCH) ABSTRACTS TO EVALUATE THE EFFECTIVENESS OF THE COMPLIANCE KIT ON THE READMISSION RATES IN HEART FAILURE PATIENTS SH Zhang, Y Cao, Y Yeo, KT G Leong, S Lee, S Lim, DM Yang, K Poh, D Lim, SJ Loke, XY Chua, CH Lee Department of Dietetic and Food Services, Changi General Hospital, Singapore Department of Nursing, Department of Cardiology, Changi General Hospital, Singapore Department of Rehabilitaive Services, Changi General Hospital, Singapore Department of Pharmacy , Changi General Hospital, Singapore Aims Heart failure (HF) is associated with high mortality, morbidity and frequent readmission rates. Behavioural factors such as noncompliance with medications and fluid or diet have been identified as one of the most common precipitants for HF readmission. Our study aimed to evaluate the effectiveness of an intervention (compliance kit) on the readmission rates in HF patients. Methods We conducted a prospective trial on 100 HF patients from Jun 2012- May 2013. A compliance kit comprising of a pill box, water bottle, weighing machine and weight log book were given to facilitate self-monitoring. Patient also received the standard HF education from the multi-disciplinary team. Telephone interview were conducted 30days after discharge to assess their compliance with utilisation and perception of the usefulness of the kit. Primary clinical outcome of 30days all-cause readmission and HF readmission rates were compared to a matched group data in the same period the previous year. Independent T-test and chi-square test were used for data analysis using SPSS version 19.0. Results A total of 93 patients were evaluated (7 lost to follow up).There were no significant differences in the race and cardiac function between the two groups. The interventional group was younger (62 ±10.8 years compared to 70.7 ±10.8 years) and had more male (75.3% compared to 60.2%). The intervention was associated with a significant 13.2% decrease in all-cause readmission (12.9% vs 26.1%, p = 0.01) and a 9.1% decrease in HF readmission (3.2% vs 12.3%, p=0.01). Patients rated the usefulness of each of the items in the kit between 97-100% with usage reported at 95-97%. Conclusions Our study demonstrated that with an implementation of a simple compliance kit significantly reduced readmission rates in the HF patients. 170 BEST POSTER AWARD (RESEARCH) ABSTRACTS THE EXPERIENCE AND PERCEPTION OF CARING FOR PERSONS WITH DEMENTIA BY THE NURSES WORKING IN THE GERIATRIC UNITS IN AN ACUTE HOSPITAL D ZHANG1*, YY CHONG1, NORHAYAH MN1, AML CHUO2, C PANDIAYA1, PS YOON2, BL SOH1, NAZARIAH S S1 1 Department of Nursing, Changi General Hospital, Singapore Department of Geriatric Medicine, Changi General Hospital, Singapore 2 Aims The nature of dementia imposes high level of care needs on caregivers – formal or informal from family unit to the health care professionals. As such, there is an emerging need to strengthen the knowledge base and up-skill nurses’ practice skills to deliver good standards of dementia care. The aim of the study is to explore dementia care experience and identify the key issues and concerns associated with the care of persons with dementia from the perspective of nurses, who work in the geriatric units in an acute hospital. Methods It is an exploratory qualitative study with a purposive sampling. 3 sessions of 60-minute focus group interviews of 4 enrolled nurses, 4 registered nurses and 4 nursing leaders were conducted respectively. The interviews adopted a semi -structured form, which was guided by 5 self-constructed questions, exploring staff experience and challenging aspects of providing dementia care, their perceived needs of persons with dementia; and staff’s coping strategies and resource required for dementia care. The interviews were voice recorded and transcribed verbatim. Thematic analysis was employed for data analysis. Results Nurses described both positive (challenging, interesting and enjoyable) and negative experience (stressful, frustrating, difficult, taxing and dilemma) in caring for persons with dementia. While emotional, environmental and basic needs were perceived as the most important needs of the persons with dementia, their aggressive and wandering behaviours were reported as the most significant challenge faced in the direct care provision. Expectation from others, be it the family members and other health care professionals had also imposed challenges in care. Emotional-focused and problem- focused strategies were adopted by nurses in coping with those challenges. Besides enhancing knowledge and skill in dementia care, resource including nursing manpower, material and equipment, and relevant policy and workflow were desired by the nurses in order to improve the standard of inpatient dementia care. Conclusions Education on dementia specific knowledge and skills as well as provision of adequate relevant resources are vital in improving nurses’ experience in providing dementia care and supporting them in coping with the care challenges. 171 BEST POSTER AWARD (RESEARCH) ABSTRACTS ANTIMICROBIAL SUSCEPTIBILITIES OF ANAEROBIC ORGANISMS CAUSING BLOODSTREAM INFECTIONS Lily Siew Yong Ng, Kwang Lee Ling, Thean Yen Tan Department of Laboratory Medicine, Changi General Hospital, Singapore Aims This retrospective study was performed to evaluate the organisms causing anaerobic bacteraemia in Changi General Hospital, and to provide updated antibiotic susceptibilities for the more clinically relevant anaerobes causing blood stream infections. Methods Data were retrieved from the laboratory information system for the period 2009-2011. During this time, blood cultures were inoculated in Bactec™ Plus vials (BD, USA) and continuously monitored in the Bactec™ 9000 blood culture system (BD, USA). Anaerobic organisms were identified using commercial identification kits, predominantly Vitek ANC cards (bioMérieux, France) supplemented with API 20 A (bioMérieux, France). A representative subset of isolates were retrieved and antimicrobial susceptibilities to penicillin, amoxicillin-clavulanate, clindamycin, imipenem, moxifloxacin, piperacillin-tazobactam and metronidazole were determined using the Etest method. Categorical susceptibility was assigned using breakpoints from the Clinical Laboratory Standards Institute. Results 323 strict anaerobes were isolated from blood cultures over the 3-year period. The predominant isolates were Bacteroides spp. (n=131; 41%), Clostridum spp. (n=41; 13%), Propionibacterium spp. (n=37; 11%) and Fusobacteria spp. (n=20; 6%). The most active in-vitro antibiotics were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with susceptibilities of 95.0%, 93.3%, 90.8% and 90.8% respectively. Resistance was high to penicillin, clindamycin and moxifloxacin. However, there were apparent differences for antibiotic susceptibilities between species. Conclusions Bacteroides spp. and Clostridium spp. form the majority of anaerobes isolated from blood cultures. Resistance to penicillin, clindamycin and moxifloxacin is high and these antibiotics should not be used as empiric therapy for anaerobes. Metronidazole and the beta-lactam/beta-lactam inhibitors remain effective against anaerobes, but the presence of metronidazole resistant anaerobes is of concern and should be prospectively monitered. 172 BEST POSTER AWARD (RESEARCH) ABSTRACTS THE SIGNIFICANCE OF TWO-DIMENSIONAL STRAIN IN DOBUTAMINE STRESS – SINGLE CENTRE EXPERIENCE Puay Joo Tan*, Leong Pearlie, Chow Alanis, Siti Aishah, Chee Tek Siong Department of Clinical Measurement Unit, Changi General Hospital, Singapore Aims To evaluate the significance of using 2D strain in dobutamine stress echocardiography. Methods Dobutamine stress echocardiography was performed in 102 patients with known or suspected coronary artery disease. All patients had resting LV ejection fraction of 45% to 60%. Standard 2D images from 3 planes, parasternal LV short axis(PSAX), apical 4chamber(A4C) and apical 2-chamber(A2C) views, were analyzed- with a frame rate of >40 to<90 fps. Positive dobutamine stress echocardiography(n:55) was determined based on visual estimation of abnormal wall motion in any of the 3 planes analysed from rest to peak stress. Negative dobutamine stress echocardiography(n:47) was determined when no abnormal wall motion changes was detected throughout. Global 2D strain in three orthogonal planes(radial strain, circumferential strain, and longitudinal strain) were analyzed at rest and at peak stages offline using GE Echopac Version11 software. Radial and circumferential strain were obtained from parasternal view, longitudinal strain from A4C and A2C views. The data was analysed using STATA version10.1 software. Results Patients Negative Stress Test Positive Stress Test Average mean difference (%)±SD Average mean difference (%)±SD P Value Radial 7.41 ± 22.77 -7.23 ± 21.35 Circumferential -1.41 ± 6.56 1.83 ± 9.57 Longitudinal A4C -1.11 ± 3.06 1.24 ± 4.83 Longitudinal A2C -0.34 ± 3.44 2.4 ± 4.30 0.002 0.064 0.011 0.002 Table 1(% average mean difference is calculated based on all individuals peak global strain minus the rest global strain) Global 2D strain showed that both radial and longitudinal strain in A4C and A2C views were significantly reduced in patients with positive dobutamine stress tests. However there was no significant difference in dobutamine positive and negative patients for the circumferential strain. Conclusions Both radial and longitudinal strains provide clinically useful information for myocardial deformation in stress echocardiography. They are reliable markers for ischaemia. 173 BEST POSTER AWARD (RESEARCH) ABSTRACTS THE NO-SHOW PROJECT YLJ Leong*, SH Lim, Rahim MA, STJ Ong, LC Yick, H Tan, & Mahmood Z. Department of Medical Social Services, Changi General Hospital, Singapore Aims The No-Show project is an exploratory study which aims to understand why patients do not turn up to their outpatient appointments at the Medical Social Services (MSS) department. It also has a component of intervention and outcome evaluation. Primarily, it seeks to understand the profile of these patients, and factors contributing to their no-shows. This can help MSS provide a service delivery that can help patients overcome existing constraints and barriers, reducing the negative impacts of patients’ no-shows on other patients. Methods Sample is being drawn from the Outpatient Appointment System (OAS) for the period of January to June 2012, for patients who have not turned up for two or more MSS appointments. The list of patients was then followed up with phone interviews where a survey questionnaire was used to guide the interviewer. Patients were also given another appointment to see MSW. Reminder calls and SMSes were done to remind patients of their upcoming MSS appointments. Results of these rescheduled appointments were also collected and analysed using Excel. Results Patients experience logistical barriers such as not being able to leave work to attend MSS appointments, difficulty gathering supporting documents and caregiving issues. Psychological barriers include patients forgetting about appointments, and having perceptions that it is not necessary to inform when they do not need to see MSW anymore. Health barriers include patients feeling unwell to turn up for the appointments. Patients also indicated that being able to have their preferred time for appointment, reminder calls and SMSes will help their attendances. Conclusions The study helped us understand the difficulties patients faced that lead to their no-shows. Introduction of reminder calls and attention to the helping relationships between MSWs and patients helped to improve patients’ satisfaction and motivation to show up for their appointments. 174 BEST POSTER AWARD (RESEARCH) ABSTRACTS SYSTEMATIC REVIEW ON THE EFFECTIVENESS OF BLACK COHOSH FOR AMELIORATING HOT FLASHES IN WOMEN WITH BREAST CANCER MX Tan* Department of Ward 15, Changi General Hospital, Singapore Aims Systematic review on the efficacy and comparative effectiveness of black cohosh for relieving hot flashes experienced by women with breast cancer and to explore the associative relationship between black cohosh and breast cancer risk. Methods Electronic databases such as Excerpta Medica Database, PubMed, Turning Research into Practice and other methods such as citation and reference tracing were used to locate relevant literature. Methodological quality of three systematic reviews, three randomised controlled trials, three cohort studies, one case-control study and two clinical guidelines were critically appraised using validated critical appraisal tools. Results Most studies agreed that black cohosh was less effective in reducing frequency and intensity of hot flashes as compared to placebo and active controls. A systematic review with meta-analysis found results in favour of black cohosh when comparedto venlafaxine and gabapentin in achieving more mean percentage hot flash reduction inwomen with breast cancer than those without. External validity of the selected studieswere limited by methodological shortcomings. Association between black cohosh and breast cancer risk, a cohort and a case-control study in Germany suggested an inverse association between theuse of black cohosh in women with history of breast cancer and breast cancer recurrence. In contrast, a wide cohort study conductedin the United States of America found no association between the regular use of black cohosh and the risk of developing primary invasive breast cancer. Conclusions Evidence for the efficacy of blackcohosh was inconclusive and there was no positive association between black cohosh andbreast cancer risk. Although few studies did not suggest that black cohosh could increase therisk of breast cancer, some brands of black cohosh that contain phytoestrogen may not be suitable for women with hormone sensitive breast cancer. 175 BEST POSTER AWARD (RESEARCH) ABSTRACTS NEW EMPLOYEE ORIENTATION PROGRAM: AN EVALUATIVE STUDY CW KHOON*, C WONG, NA SUDIRMAN, L TAN Department of Medical Social Services, Changi General Hospital, Singapore Aims This study aims to gain a better understanding of the orientation program and to provide recommendations to improve the effectiveness of the program after evaluating the existing program. The research questions of this study are: 1) How is the current orientation program helpful in facilitating the transition of new employees into the department and into their assigned roles? 2) How can the current orientation program better facilitate the transition of new employees into the department and into their assigned roles? 3) How conducive is the work environment for new employees in facilitating and role transition? organizational socialization Methods A qualitative method was used to gather feedback from employees about the existing orientation program in MSS. Indepth interviews were conducted with nine “new” Medical Social Worker (MSW) or Medical Social Work Associate (MSWA). These “new” employees have been with the department for a year or less. Results All nine respondents undergo a similar two weeks orientation program. Respondents found the information provided to be comprehensive and covered basic aspects of their job but reported it to be a period of information overload. Information received was disjointed and there is a lack of practical application of the information, hindering respondents’ ability to integrate the information. The orientation is perceived to be task centric. Having a direct supervisor contributes to professional development and helps respondents to ease into their new role. However, there is little emphasis to ensure person-organization fit during orientation. Conclusions Adopting a more values-centred and employee-centric approach may transform the orientation program into a more meaningful experience, where new employees learn to build conviction about the social work profession and establish a sense of identity within the department and the hospital. Taking into consideration the results and recommendations of this study, MSS department is redeveloping the orientation programme for new MSWs and MSWAs. 176 BEST POSTER AWARD (RESEARCH) ABSTRACTS FREQUENT ADMITTERS – WHO THEY ARE AND THEIR IMPACT ON INPATIENT UTILIZATION D Lim*, WL Chow Department of Health Services Research, Eastern Health Alliance, Singapore Aims With limited healthcare resources, frequent admission to the hospital is a key concern to policy makers. A frequent admitter is defined as an inpatient who is admitted four or more times in a calendar year. We profiled the frequent admitters and examined their inpatient utilization. Methods This was a retrospective analysis of an observational cohort of inpatients obtained from administrative databases of which patients were admitted to a regional hospital between 1 January and 31 December 2011. They were followed up for one year from their first admission. Univariate logistic regression was performed to determine the key factors of frequent admission by comparing frequent admitters with non-frequent admitters. Variables examined included age category, gender, race, treatment class and primary diagnosis based on the International Classification of Diseases (ICD) codes. We also studied the difference in the total number of admissions, total length of stay and average length of stay between frequent admitters and non-frequent admitters. Results A total of 28566 inpatients and 42884 admissions were included in the analysis. Frequent admitters constitute 5.2% (1478) of all individuals but accounted for 17.9% of all admissions and 22.4% of all bed days. Frequent admitter status was associated with being elderly, admitted to subsidized treatment class, being female and non-Chinese. The top 5 ICD groups by percentage of admissions by frequent admitters were Heart Failure, Diabetes, COPD and Allied Conditions, UTI and Endocrine-related diseases. Frequent admitters stayed in general, two days more on average than nonfrequent admitters for each inpatient stay. Conclusions Frequent admitters utilize more inpatient resources than non-frequent admitters. Our study suggests that interventions to address the problem of frequent admitters could be targeted at the elderly patient with chronic diseases. More research could be done to examine the relationship between socio-economic status and education level and frequent admission. 177 BEST POSTER AWARD (RESEARCH) ABSTRACTS VIOLENCE TOWARDS NURSES IN A LOCAL HOSPITAL IN SINGAPORE ST Quah, CSY Yap, YH Wu Department of Nursing, Changi General Hospital, Singapore Aims This study aims to determine the prevalence of verbal and physical abuse, the main perpetrators of abuse and effects of abuse among nurses in medical-surgical ward settings in a local hospital. Methods A non-probability purposive and convenience sampling strategy - questionnaire was used as the instrument for this study. The questionnaire was adopted and modified from ILO/ICN/WHO/PSI joint program on workplace violence in the health sector. Pilot study was conducted using the modified questionnaire with 15 participants who are nurses registered with SNB to test its content validity and reliability. Feedback and evaluation was asked from the respondents and revisions were made. No identification of respondents was required in this study. Results 69.1% respondents were between 20 to 30 years of age and 55% had 1 to 5 years of working experience. Even though there were respondents that experienced physical, bullying and sexual abuse, there were 57.7% respondents that experienced verbal abuse. Verbal abuse by patients sometimes occurred in the hospital setting for the respondents. Respondents responded to the abuse via completion of compensation claim (77), reporting to a senior staff (43) or told the perpetrators to stop immediately (43). 40 respondents that experienced verbal abuse had been disturbed by repeated, disturbing memories, thought or images of abuser and 23 had been super alert after the incident. 27.5% respondents replied that no actions were taken to address the abuse. However, 26.2% respondents’ employers did offer opportunity to respondents to speak about the incident. Conclusions In this study, we were able to see that workplace violence does exist. The most common violence was actually verbal abuse from patients. Adding to that, it also causes adverse effects on the nurses that experienced violence but little was done to help them cope with it. However, this study is not conclusive of the whole nursing population as it only targeted at nurses working in the medical-surgical wards. Therefore, bigger sample size could have been used and questions on staff coping methods towards violence could also be generated. 178 BEST POSTER AWARD (RESEARCH) ABSTRACTS EFFECTS OF WATER BASED THERAPY VERSUS LAND BASED THERAPY FOLLOWING TOTAL KNEE REPLACEMENT IN CHANGI GENERAL HOSPITAL Pal P*, Lim YP, Wong SH Department of Rehabilitation Services, Changi General Hospital, Singapore Aims This single blinded randomized control trial compared the outcome measures between land-based and water-based rehabilitation programmes following total knee replacement (TKR) in Changi General Hospital. Methods Eighteen TKR patients were recruited for this RCT spanning six-week in duration. Both land-based (n=11) and the water -based (n=7) groups included functional exercises that lasted for an hour each. Outcome measures included; pain scores (rest and ambulation), joint swelling, thigh girth, range of motion, ten repetition maximum, the time taken to walk 10 meters (at self-paced and fast-pace speed) and one flight of stairs at weeks' one and seven. The Mann Whitney U statistical test was conducted by SPSSTM software. Results At week seven, the results showed improvements in all outcome measures for both groups compared to week one. However, no significant difference was observed between both groups for most outcomes measures (p > 0.05) except for time taken to climb stairs at week seven; where patients in the water-based group took significantly longer time than land-based group. However, limited sample size might explain this observation. Conclusions Patients in both groups showed similar positve outcomes which is in agreement with published studies. This study therefore suggests that once patients are competent and complaint with either water-based and/ land-based exercises they can then perform these exercises independently in their community without the need to travel and without the guidance of a physiotherapist. This offers patients a chance to choose the type of rehabilitation program that interests and motivates them to full functional recovery. The result suggests that a physiotherapy exercise that focuses on functional training will aid in providing favorable outcomes in TKR patients. 179 BEST POSTER AWARD (RESEARCH) ABSTRACTS PHYSIOTHERAPY PROFESSION AS A HEALTH CARE PARTNER: PERCEPTIONS OF THE PUBLIC PU Reddy*, TSY Melissa Department of Rehabilitation, Changi General Hospital, Singapore Aims To analyse the awareness, perceptions and attitudes of the general public towards physiotherapy (PT) as a profession. Methods A survey was conducted among the members of general public attending annual PT Day celebrations. The questionnaire was asked in English and consisted of 20 close-ended questions. Information collected include: participant demographics; personal, medical and falls history; exercise habits; knowledge of PT as a healthcare profession; referral sources and reasons; satisfaction, expectations and concerns regarding PT services; and alternative treatments preferred. Results 144 members of general public participated - females (76%), males (24%); 21-50 year-olds (50%), 51-64 year-olds (39%), over 65 year-olds (11%). A majority (69%) of them exercised less than 3 times per week. 48% have never visited a PT and only 40% of total participants were aware of the full scope of our services. Among the 52% who have seen a PT, 94% were satisfied with the services provided and 20% felt PTs provided better care than other health professions. However, 31% perceived PT services as more expensive than a General Practitioner's. 66% of the participants expected PTs to explain the treatment procedures given to them, and 40% wants the PT to provide an estimate of the number of sessions required. Conclusions A high percentage of the public are satisfied with our services. To increase this further, PTs should incorporate education about treatment procedures given and give an estimate of the number of sessions required to the patients they see. The importance of being more proactive in health education and increasing public awareness in PT services is highlighted by the fact that 60% of the public sampled who had not attended PT services before were not aware of the scope of PT services. This is especially so as PTs are specialists in human activity and movement. 180 BEST POSTER AWARD (RESEARCH) ABSTRACTS PHYSICAL AND PSYCHIATRIC COMORBIDITY OF ALCOHOL USE DISORDERS IN AN ACUTE GENERAL HOSPITAL YC Ng*, LH Peh, SN Tan, YC Salikin, WL Teo, Patrick Department of Psychological Medicine, Changi General Hospital, Singapore Aims This is a descriptive study of patients in an acute general hospital with physical and psychiatric disorders co-occurring with alcohol use disorders. Methods A total of 103 inpatients admitted for physical and psychiatric disorders were screened and assessed for alcohol use disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2000) and Alcohol Use Disorders Identification Test (2001) were utilised in the assessment. Results 76% (78 out of 103) patients exhibited alcohol use disorders (alcohol abuse or dependence) with comorbid physical disorders such as gastrointestinal, cardiovascular, neurological, musculoskeletal, haematological, respiratory and endocrine disorders. 24% (25 out of 103) patients presented with co-occurring psychiatric disorders namely depression, anxiety or adjustment disorders. Conclusions The findings of this study suggest that alcohol use disorders are associated with physical and psychiatric disorders among patients admitted to an acute general hospital. This calls for early identification and assessment of any alcohol use problems by the medical professions and referral to addiction medicine for further assessment and interventions. Future study may look at the role of general practitioners who are in a unique position because of their long-term contact with patients to assess for alcohol use disorder co-occurring with physical and psychiatric disorders. 181 BEST POSTER AWARD (RESEARCH) ABSTRACTS CARPAL TUNNEL SYNDROME: A PROFILE OF PATIENTS IN CHANGI GENERAL HOSPITAL W.J. Lim*, H. Chen, S.C.S. Seah Department of Rehabilitative Services, Changi General Hospital, Singapore Aims This quantitative study aimed to build a detailed demographical profile of patients presenting to the Changi General Hospital (CGH) Occupational Therapy clinic for carpal tunnel syndrome (CTS). Methods Participants were patients diagnosed with CTS, who were referred to the Occupational Therapy clinic at CGH. Data was collected via: (a) CTS research questionaire that collects patient's demographic data, symptom presentation, and household/occupational activity levels; (b) Boston Carpal Tunnel Questionairre (BCTQ) to assess symptom severity and functional impact on the hand; (c) Michigan Hand Outcomes Questionaire (MHQ) to assess impact of disease on function. Results Interim findings from thirteen participants indicated that majority of the patients presenting with CTS were female (85%), with the average age being 54.3 years old. All the participants were right hand dominant. Average length of employment in current occupation was reported to be 17.6 years. 46% of the participants were light manual workers, followed by heavy manual workers (23%) and housewives (15%). Housework activity levels were reported to be at medium levels for most participants (67%), with the average number of hours spent on housework weekly being 20 hours. Average MHQ and BCTQ scores indicated limitations in general hand function as a result of CTS symptoms. Conclusions Participant recruitment and data collection for this current study is still ongoing in order to maximise the strength of this study. Interim results suggest that the demographic trends of CTS having a higher prevalence among women and older patients (more than 50 years of age) found in previous studies appears to apply in the Singaporean context as well. Further descriptive and correlational data analyses needs to be done after data collection is complete to (a) establish the demographical profile of patients presenting with CTS in CGH; (b) explore any existing relationships between demographical/activity-related (e.g. occupation, housework) variables and the development of CTS. 182 BEST POSTER AWARD (RESEARCH) ABSTRACTS HOW HOME CARE ASSIST (HCA) PROGRAMME HAS BRIDGED SERVICE GAPS FOR NEEDY MIDDLE-AGED PATIENTS. CC Goh Department of Medical Social Services, Changi General Hospital, Singapore Aims A descriptive study on how HCA has bridged the gaps of various financial assistance schemes for middle-age patients. Methods This is a retrospective cross-sectional study using secondary data from the Social Work Information System (SWIS). Targeted group is HCA recipients who are aged between 40 to 59 years. Data used is from 1 January 2011 to 31 December 2012. A review of similar financial schemes to HCA, namely Senior Mobility Fund (SMF), Public Assistance (PA) Enhanced scheme, Special Assistance Fund for needy patients in local context was done. Results There are a total of 574 HCA recipients for the study period. Of which, 40% (N=232) of them are below age 60 years and middle-aged recipients (aged 40 to 59 years) formed 84% (N=195) of it. A profile study of the 195 recipients is done. The most common assistance rendered for this age group is podiatry products (about 43% of the recipients). Other than HCA, there were no financial schemes that assisted with podiatry products. 23% of the recipients are assisted with home care equipment such as wheelchair and commode. These recipients do not qualify for Senior Mobility Fund (SMF) due to their age. Though they might have qualified for Special Assistance Fund (under SG Enable) for mobility aids, the application processing time can range from 3 weeks to a few months. HCA thus comes in timely to meet the needs of the patients while awaiting long term assistance. A handful of the recipients are on continuous HCA for long term as they do not meet the criteria (such as age, diagnosis or income) of other financial schemes. Conclusions With the mushrooming of more assistance schemes, collaborative work with the different financial schemes providers have to be done to relook at criteria, streamline work processes and ensure efficient allocation of resources. This would help to prevent needy patients from falling through the service gaps. 183 BEST POSTER AWARD (RESEARCH) ABSTRACTS PREVALENCE AND RISK FACTORS FOR BOTHERSOME LOWER URINARY TRACT SYMPTOMS (LUTS) IN WOMEN WITH DIABETES MELLITUS (DM) IN SINGAPORE HOSPITAL-BASED DIABETIC CENTRE. Neo*, LH Tay, K Song, Rosemarie LV, SK Lim, FC Ng and S Rahayu Department of Nursing, Changi General Hospital, Singapore Department of Urology and Diabetic Centre, Changi General Hospital, Singapore Aims A prospective study to assess prevalence and risk factors for bothersome lower urinary tract symptoms (LUTS) and voiding dysfunction in women with diabetes mellitus (DM). Methods This is a prospective study. The study will recruit 100 female diabetic patients who are receiving regular follow up at the diabetic centre at Changi General Hospital. Participants will need to complete the King’s Health Questionnaire and a structured American Urological Association (AUA) Symptom Index Questionaire to assess the participants’ lower urinary tract symptoms. Their parameters will be evaluated: they are age, type of diabetice therapy (diet, insulin, or hypoglycaemic agents). Only females are included in this study, age ranging from 21 to 85 years old and from all ethnic groups. Results 30 patients participated in this study. Participants completed the King's health questionnaire and structured American Urological Association Symptom Index Questionnaire. 20% of the participants had bothersome lower urinary tract symptoms. 10% of the participants had voiding dysfunction. 23% patients have nocturia and are the most bothersome and affect quality of life in women with diabetic mellitus. Conclusions Nocturia are the most bothersome in diabetic women. This study will help to guide the nurses and to better understand the voiding patterns in this group of patients. 184 BEST POSTER AWARD (RESEARCH) ABSTRACTS A PILOT STUDY FOR THE IMPLEMENTATION OF NURSING SHIFT HANDOVER GUIDELINE X Sun*, YYC Ong, SLK Poh, LFM Lin, XP Toh, MKN Lim, W Soo, Noorlina, N Jana, T Wu Department of Nursing, Changi General Hospital, Singapore Aims The study aimed to standardize shift handover and to improve communication among nurses for continuity of patient’s care. Methods A total of 35 nurses were recruited in the 5-week pilot study which was implemented in a 44-bedded ward in Changi General Hospital. The pilot study included a week of daily in-service and four weeks of thrice a week observation of nursing handover using a standardised guideline. Feedback forms were distributed and collected on the fifth week. Both observation episodes and feedback from nurses were analysed. Results Of the 57 observation episodes using a checklist, 78.9% of nurses performed handover at patients’ bedside, 57.9% of nurses conducted physical checks on patients and 42.1% either greet or self-introduce themselves to patients. Out of the 35 feedback form distributed, 82.9% responded. Of the 29 nurses surveyed, 62.1% were staff nurses and 37.9% were enrolled nurses. 58.6% had 1-5 years of working experience followed by 27.6% with 6-10 years, 10.4% with less than 1 year and 3.4% with 11-15 years of experience. Of the nurses who attended the in-service, 93.2% of nurses found that this method of handover was informative, 86% felt that the guideline enhanced communication during shift handover and 75.9% of nurses are open to using the guideline in future. However, 31% of nurses encountered difficulties while using this guideline and felt that it was time consuming. Conclusions The pilot study revealed that nurses felt that shift handover guideline enhances communication thus facilitating shift handover. To make the guideline more feasible for nursing shift handover in CGH, future research involving other disciplines for using the revised handover guideline were recommended. 185 BEST POSTER AWARD (RESEARCH) ABSTRACTS REFERRAL PATTERN AND HEALTHCARE PROVIDERS’ PERCEPTION ON THE RIGHTSITING OF PSYCHIATRIC OUTPATIENTS IN A SPECIALIST SETTING I Tirtajana*, Chow WL, Wee MK, Yang Chek S, Lim HK, Pan HM, Peh LH Department of Psychological Medicine, Changi General Hospital, Singapore Aims The aim of this survey is to determine the source of referrals, the types of cases referred, and the specialists' perception on the right-siting of cases. Methods Anonymised questionnaires were distributed to psychological medicine specialists located in a particular clinic in Changi General Hospital. Data collection took place between April to September 2013. Apart from diagnosis and clinical measures of severity and level of function (CGI and GAF), the questionnaire also asks if the specialist feels the case can be managed in a non-specialist setting, and to state the reason in they think otherwise in cases with low severity and high functioning. Results The survey gathered 110 completed forms during the study duration. Of these cases, 25 (22.7%) were referred by private general practitioners (GPs) and the remaining 85 cases (77.3%) by Polyclinic doctors. Only 38 cases (34.5%) were identified as having had treatment initiated by the primary healthcare provider (PHP). Out of the total number of cases, 47 (42.7%) were rated by specialists as being suitable for management in non-specialist settings, while 49 cases (44.5%) were rated as being unsuitable. The reasons cited by specialists for unsuitability for management at a primary care setting included: substance dependence, complex cases, inadequate response to treatment, unavalability of psychological therapy in primary healthcare setting, unavailability of certain medications in primary healthcare setting, and legal issues requiring specialist assessment. Conclusions Right-siting of patients with psychiatric condition may be further improved. Access to allied mental health services may provide further support for right-siting of patients. 186 BEST POSTER AWARD (RESEARCH) ABSTRACTS EVALUATING THE BENEFITS OF THE BONEBRIDGE -THE NEW BONE CONDUCTION IMPLANT SH Kamath, SLH Lee, HW Yuen Department of Otolarynogology, Changi General Hospital, Singapore Aims Bone Bridge (BB) is a new and innovative active bone conduction hearing implant to treat single sided deafness and conductive hearing losses. BB was available commericially in Singapore in October 2012. CGH was the first hospital to conduct the surgery in Singapore. The objective of this study is to determine the post-surgical benefits of BB. Methods Consecutive patients in the age range of 20 to 45yrs of age with SSD and conductive hearing loss who were fitted with BB between October 2012 to September 2013 were considered. Five self report questionnaires [Glasgow benefit inventory (GBI), International Outcome Inventory (IOI-HA), Hearing Device Satisfaction scale (HDSS), Abbreviated Profile of hearing aid benefit (APHAB), Speech spatial Qualities(SSQ)] and an English speech test (Arthur Boothyrod words list in noise) were used for evaluation, 3 months post BB fitting. Results HDSS, IOI-HA showed that all the 4 patients (100%) are still using the BB with no to little problems with handling and cleaning of the device and are satisfied with the sound quality with the average scores of 85% and 95% respectively.GBI shows that they are able to carry out most of their daily activities including rough contact sports normally and more confident socializing around improving their quality of life. The APHAB showed that all the patients experienced significant hearing benefits of 40% with maximum scores(65%) on the hearing in Background noise subscale.SSQ showed that mean scores improved from 3.2 without BB to 8.6 with BB.Speech test scores showed improved speech in noise scores from 25% without BB to 75% with BB. Conclusions The benefits of BB are evident in majority of the patients in improving the spatial hearing and speech understanding in noise. Patients are very satisfied with sound quality as well. Low care and maintainance, low incidence of infection, cosmetic appeal and easy handling are the added benefits making BB, a good option among the implanted hearing solutions for treating single sided deafness and conductive hearing losses. 187 BEST POSTER AWARD (RESEARCH) ABSTRACTS PRELIMINARY EVALUATION OF A NEW, MORE SENSITIVE BETA-HCG COMBO TEST KIT ON SERUM WR Lim*, AH Toh, R Ng, CA Neo, M Afzal, S Ng, SP Tan, TC Aw Department of Laboratory Medicine, Changi General Hospital, Singapore Aims A new sensitive qualitative beta-hCG combo test kit, QuickVue+ (Sensitivity: 10 mIU/mL), is now available. We sought to verify the performance of this new platform against the current one, Alere (Sensitivity: 25 mIU/mL), for serum samples. Methods Serum, tested on the Abbott Architect i-2000 SR instrument with quantitative results ranging from 1.4 to 3628 mIU/mL (>10 mIU/mL: 65 samples, >25 mIU/mL: 19 samples), were recruited for this study (n=118). Each sample was run simultaneously on the Alere and QuickVue+. Results Alere Technical Performance Out of the 19 samples that were >25 mIU/mL, Alere detected 100% as reactive (19/19), i.e. 100% true positive. However, of the 99 samples that were <25 mIU/mL, 22 samples were detected as reactive (i.e. false positive), yielding a diagnostic specificity of 78% (77/99). While the predictive value of a negative result was 100%, the predictive value of a positive result was only 46% (19/41). QuickVue+ Technical Performance Out of the 65 samples that were >10 mIU/mL, QuickVue+ detected 100% as reactive (65/65), i.e. 100% true positive. Of the 53 samples that were <10 mIU/mL, 0 samples were detected as reactive, yielding a diagnostic specificity of 100% (53/53). Predictive values of both negative and positive results were 100%. Conclusions As QuickVue+ has a lower detection limit, it is able to pick up low levels of beta-hCG and obviate uncertainty in samples with borderline hCG levels when screened using Alere. Thus QuickVue+ would be the preferred kit for hCG screening. 188 ACKNOWLEDGEMENTS
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