Download here - National Heart Centre Singapore

The official publication of
National Heart Centre (NHC) of Singapore
MARCH 2005
MITA 208/07/2004
Reg No 199801148C
NHCNews
COVER STORY
1
PATIENT CARE NOTES
2
CORPORATE NEWS
5
NURSING NEWS
7
Visit our website at : www.nhc.com.sg
Cardiovascular Magnetic Resonance
The New Kid On The Block
By Dr Tan Ru San
Acting Director, Clinical Trials
Consultant, Department of Cardiology
Cardiovascular magnetic resonance (CMR) has emerged as an
important non-invasive cardiac imaging modality as it allows an
extensive and comprehensive evaluation of cardiac disease without
the risks associated with the more traditional, invasive procedures.
With CMR, various aspects of the heart such as its morphology,
function, perfusion, viability, angiography or flow measurement
can now be measured.
Are There Risks Involved?
CMR is a safe technique. Unlike invasive cardiac catheterisation,
computed tomography and radionuclide imaging, there is no
exposure to ionising radiation or nephrotoxic contrast media.
Patient-friendly scanner design and the availability of nonferromagnetic physiologic monitors and resuscitation equipment
enhance patient comfort and safety.
How Are CMR Images Produced?
Cardiac images are reconstructed using the electromagnetic signals
produced from the interaction of external magnetic fields and
magnetic spins of individual hydrogen atoms that are present in
body tissues.
Due to the potential for device malfunction and induction of ectopy
or heat injury, CMR should not be performed in patients with
implanted cardioverter-defibrillators, active permanent pacemakers
or ventricular assist devices. The presence of fixed body implants
(e.g. coronary artery stents, mechanical prosthetic heart valves, hip
or knee implants) are not contraindications. Patients with cerebral
aneurysm clips should not undergo CMR, unless the clip used has
been conclusively shown to be MR-compatible (this may be
impossible to prove in most cases).
The images have superior tissue characterisation and spatial
resolution, and can be acquired in any desired orientation in three
dimensions. Compared to imaging of other stationary body parts,
MR imaging of the moving heart demands the best and the fastest
MR scanner performance. With the latest technology, high quality
images acquired within short examination times are now routine.
Who Should Undergo CMR?
Established indications for CMR include:
1. Congenital heart disease;
2. Quantitation of left and right ventricular mass and function;
3. Myocardial viability assessment (delayed hyperenhancement);
4. Cardiac masses;
5. Pericardial disease;
6. Thoracic aortic disease;
7. Proximal coronary artery visualisation, e.g. anomalous coronary
arteries;
8. Alternative to echocardiography where acoustic window access
is limited.
Quantitative assessment of ventricular function using CMR is the
gold standard, especially for measuring right ventricular function,
which is problematic with other modalities.
LEFT TO RIGHT:
> Figure 1: (Pictures a-c
from left)
Typical CMR Images. Ao =
aorta, LA = left atrium, LV =
left ventricle, RA = right
atrium, RV = right ventricle.
> Figure 2: (Pictures d-e )
Recent anterior myocardial
infarct. Cine CMR (left) and
delayed hyperenhancement
image acquired after
g a d o l i n i u m - D T PA
administration (right). Bright
areas indicate anterior infarct
(arrow). Dark areas at the
infarct core (arrowheads)
suggest microvascular
obstruction.
Delayed hyperenhancement is a technique that uses gadoliniumDTPA, a contrast agent, to reveal non-viable infarct tissue. It is an
accurate method for determining myocardial viability in patients
with ischaemic cardiomyopathy, who may potentially benefit from
coronary revascularization.
Figure 1 a.
b.
c.
SGH and NHC’s ‘New Kid On The Block’
A new state-of-the-art MR scanner (Avanto 1.5T Siemens) was
recently installed and has been operational since September 2004
as a joint collaborative project between the Department of
Diagnostic Radiology, Singapore General Hospital and the National
Heart Centre to establish a clinical outpatient and inpatient
CMR service.
This joint collaboration not only brings about the combination of
two areas of expertise, but also, added value to patients since
experts from both Cardiology and Diagnostic Radiology would be
available to give a good sound interpretation of the images.
While the service is still new, the tangible benefits from using this
scanner are already apparent, as images from the new scanner are
significantly better as opposed to images from the older scanner.
In addition, both staff and patients can save on time since the time
used for imaging is significantly cut down.
Doctors who wish to refer patients for this CMR service are
invited to call the National Heart Centre’s GP dedicated hotline at
6436 7848 for more information.
Figure 2 d.
e.
NHCNEWS p02
PATIENT
CARE NOTES
Extraction Of Chronic
Transvenous Pacing And ICD Leads
By Dr Teo Wee Siong
Acting Director, Eletrophysiology and Pacing
Senior Consultant, Department of Cardiology
By Dr Ruth Kam
Visiting Consultant, Department of Cardiology
By Dr Hsu Li Fern
Consultant, Department of Cardiology
By Dr Tan Teing Ee
Consultant, Department of Cardiothoracic Surgery
The Growing Importance Of Lead Extraction
In recent years, lead extraction has become a necessity because
of the increasing number of pacemaker and Implantable
Cardioverter Defibrillator (ICD) devices implanted. The number of
pacemaker devices implanted has grown tremendously because
of the ageing population. Similarly with the expanding indication
for ICDs in patients at risk for sudden cardiac death, the number
of ICDs implanted is expected to increase rapidly.
In addition, patients with these implanted devices are also now
surviving longer and a small portion of these patients develop
complications that require these devices to be removed. The
indications for lead extraction as suggested by the North American
Society of Pacing and Electrophysiology (NASPE) are shown in
Table 1. Additional factors that need to be considered before
doing a lead extraction are shown in Table 2.
The Challenges Of Lead Extraction
The explantation of the pulse generator is generally easy but the
removal of the chronically implanted lead is much more
complicated. One reason is that there is often progressive growth
of fibrous tissues around the lead body and electrode tip and this
creates a major barrier to the removal of these leads. Simple
traction is not successful and may result in insulation break and
retention of a fragment of the lead that can potentially result in
life threatening arrhythmias, thromboembolism or other problems.
A definition proposed by NASPE is that the term extraction should
be applied to the removal of any transvenous lead that has been
implanted in excess of one year or a lead that requires tools
beyond standard stylets and simple traction to remove. Thus,
special locking stylets are needed to gain control of the whole
lead and localise traction to the lead tip where it is needed.
Dilator sheaths are then used to free the lead from adhesions in
the venous system. Metal sheaths are used only to enter the central
circulation when significant scar tissue or calcification prevents
insertion of the more flexible sheaths. The mechanical dilator
sheaths (Telfon or polypropylene) are then used to free the lead
inside the superior vena cava (SVC), right atrium (RA) and right
ventricle (RV).
When the mechanical dilator sheaths fail, powered sheaths using
radiofrequency are used to free the lead from the adhesions. The
critical sites are at the junction of the innominate vein with the
SVC. The acute bend in the venous anatomy is prone to tearing
as the sheath makes the bend. If the tear is above the pericardial
reflection, bleeding will enter the right pleural space with resultant
hemothorax. Another site is the junction of SVC with right atrium.
A tear in this area will result in pericardial tamponade.
Once the sheaths are advanced to approximately one cm from
the tip of the lead, the lead is pulled up against the sheath and
the lead is removed. ICD leads are similarly removed but are
technically more difficult because of their larger size and often
aggressive fibrosis around the shocking coils. The success of lead
extraction depends on the duration that the lead has been
implanted prior to removal and the presence of multiple leads.
National Heart Centre’s Experience With Lead Extraction
At the National Heart Centre, 22 patients have undergone lead
extraction. There were 10 males and 12 females. The mean age
of the patients was 60.7 + 12.9 years (range 40-84 years old).
The mean duration of the leads that had been implanted was
79.8 + 57.5 months. The mean procedure time which includes
the whole procedure of removing the leads and implanting the
new system was 105.8 + 51.7 mins. 86.4% of the leads were
successfully completely removed. In 9.1% of patients, the lead
was partially successfully removed and there was one patient
where the leads were not successfully removed.
Lead extraction however, is technically difficult and not without
complications. Women, older patients as well as patients with
multiple leads in place are at a higher risk than others. The
procedure is done in the operating room under general
anaesthesia together with a cardiothoracic surgeon so that all
emergency complications can be treated immediately.
In the National Heart Centre’s series of patients, vascular repair
at the venous entry site was required in one patient. One patient
had delayed bleeding and pericardial tamponade on the third
postoperative day that required surgical drainage and
subsequently made a complete recovery.
In conclusion, lead extraction though technically difficult, can be
safely and successfully performed in up to 95% of patients. It is
an important therapy which must be made available to our
patients who have pacemaker and ICD devices implanted should
the need arise.
Continued from previous page
> LEFT:
Explanted lead after 14 years
> RIGHT:
Explanted lead after 11 years
Photographs courtesy of Dr Ruth Kam
TABLE 1
NASPE INDICATIONS
CLASS 1 (conditions for which there is a general agreement
that leads should be removed):
A. Sepsis (including endocarditis) as a result of documented
infection of any intravascular part of the pacing system,
or as a result of a pacemaker pocket infection when the
intravascular portion of the lead system cannot be
aseptically separated from the pocket.
B. Life-threatening arrhythmias secondary to a retained lead
fragment.
C. A retained lead, lead fragment, or extraction hardware
that poses an immediate or imminent physical threat to
the patient.
D. Clinically significant thromboembolic events caused by
a retained lead or lead fragment.
E. Obliteration or occlusion of all usable veins, with the need
to implant a new transvenous pacing system.
F. A lead that interferes with the operation of another
implanted device (eg. pacemaker or defibrillator).
CLASS 2 (conditions for which leads are often removed, but
there is some divergence of opinion with respect to the
benefit versus risk of removal):
A. Localised pocket infection, erosion or chronic draining
sinus that does not involve the transvenous portion of
the lead system, when the lead can be cut through a clean
incision that is totally separate from the infected area.
B. An occult infection for which no source can be found, and
for which the pacing system is suspected.
C. Chronic pain at the pocket or lead insertion site that
causes significant discomfort for the patient, is not
manageable by medical or surgical technique without
lead removal, and for which there is no acceptable
alternative.
D. A lead that, because of its design or failure, may pose a
threat to the patient that is not immediate or imminent
if left in place.
E. A lead that interferes with the treatment of a malignancy.
F. A traumatic injury to the entry site of the lead for which
the lead may interfere with reconstruction of the site.
G. Leads preventing access to the venous circulation for
newly required implantable devices.
H. Non-functional leads in a young patient.
CLASS 3 (conditions for which there is general agreement
that removal of leads is unnecessary):
A. Any situation where the risk posed by removal of the lead
is significantly higher than the benefit of removing the
lead.
B. A single lead in a vessel that has become non-functional
in an older patient.
C. A normally functioning lead that has a reliable
performance history at the time of pulse generator
replacement.
TABLE 2
Additional clinical factors that should be taken into
consideration:
1. Age of the patient.
2. Gender of the patient.
3. Overall health (physical and mental) of the patient, ie.
comorbidities, cardiovascular status, previous family and
surgical history, ability to receive transfusion (religiousbased limitations), surgical candidacy, and presence of a
malignancy.
4. Present of a calcification involving the lead(s).
5. Presence of vegetations in the heart.
6. Number of leads in the intravascular space.
7. Duration of the implant.
8. Fragility, condition, and physical characteristics of the lead.
9. Prior experience of physician.
10. Desires of the patient.
NHCNEWS p03
PATIENT
CARE NOTES
NHCNEWS p04
PATIENT
CARE NOTES
Surgery for Atrial Fibrillation
By Dr Chua Yeow Leng
Head & Senior Consultant
Department of Cardiothoracic Surgery
Introduction
Atrial fibrillation is the most common sustained cardiac
arrhythmia. The overall prevalence of atrial fibrillation is 0.4%.
This increases with age, reaching 3-5% in those over 65 years and
9% in those over 80 years. Atrial fibrillation is more common in
patients with structural heart disease, in particular 30-50% of
patients undergoing mitral valve surgery are affected by atrial
fibrillation.
Atrial fibrillation is associated with significant morbidity and
mortality with a relative risk of 1.5 for men and 1.9 for women.
Because of loss of effective atrial contraction and consequent
stasis of blood in the atria (particularly the left atrial appendage),
patients with atrial fibrillation have an increased risk of
thromboembolic complications. The risk of stroke in patients
with atrial fibrillation is five times greater than in age-matched
controls and atrial fibrillation is responsible for as many as 15%
of all strokes.
Historical Background of Surgery for Atrial Fibrillation
Early attempts at surgical control of medically refractory atrial
fibrillation included atrioventricular node ablation and pacemaker
insertion, and Guiraudon’s corridor procedure. While these
techniques achieved a regular rhythm, they failed to restore atrial
contraction and consequently still left the patient susceptible to
thromboembolism.
After extensive laboratory investigation, James Cox performed
the first successful maze in September 1987. This initial procedure
was modified twice ultimately culminating in the Cox maze III
procedure. In the largest series of 346 patients undergoing the
maze procedure, Cox et al reported an operative mortality of 2%,
a cure rate of 99% and only 2% requiring postoperative
antiarrhythmic medication. Temporary postoperative atrial
fibrillation was common, occuring in 38% of patients, but did not
diminish the long-term results. Similar excellent results in
restoration of sinus rhythm, low risk of late stroke and very low
operative morbidity and mortality have been reported in several
major, high-volume centres.
Despite the good results however, the Cox-maze procedure did
not gain widespread application because it was perceived as
complex and time-consuming by most surgeons. Consequently,
few patients were referred for surgery of lone atrial fibrillation
and even in patients requiring cardiac surgery for other reasons,
surgeons were reluctant to add the maze procedure.
The next major advancement to atrial fibrillation surgery came
with the advent of technology that enabled application of various
forms of energy directly to the atrial myocardium. This enabled
creation of lesions to block propagation of re-entrant circuits
without the need for time-consuming and technically demanding
cutting and sewing. Amongst the energy sources in use today
are radiofrequency, microwave, laser, electrocautery and
cryotherapy. To date, radiofrequency and microwave are the
most extensively reported energy sources for alternative maze
procedures.
By Dr Lim See Lim
Consultant
Department of Cardiothoracic Surgery
National Heart Centre Experience
The experience in atrial fibrillation surgery at the National Heart
Centre has been entirely with radiofrequency energy applied
with the Medtronic Cardioblate devices. From July 2001 to
January 2005, 83 patients underwent the radiofrequency Coxmaze III procedure while undergoing concomitant cardiac surgery
at the National Heart Centre. All patients who have a history of
atrial fibrillation and are in atrial fibrillation at the time of surgery
for their primary cardiac problem are considered candidates for
the radiofrequency maze procedure.
In our first 46 patients, we used a monopolar probe while our
most recent 37 patients have undergone the radiofrequency
maze procedure with a combination of monopolar and bipolar
probes. Concomitant surgeries include 75 mitral valve procedures
(25 repairs and 50 replacements), 32 tricuspid valve procedures
(29 annuloplasties and 3 replacements), 6 aortic valve
replacements, 9 coronary artery bypass surgeries, 5 closures of
atrial septal defects or patent foramen ovale and 6 reduction
atrioplasties. The radiofrequency maze procedure was performed
to achieve the full bi-atrial lesion set of the classical Cox maze III
procedure as described by Sie.
Freedom from atrial fibrillation and flutter after radiofrequency
maze procedure was 96% immediately after surgery, 58% at one
week, 56% at one month, 72% at three months, 80% at six months,
74% at one year, 80% at 1.5 years and 79% at two years
postoperatively.
Success rates (i.e. freedom from atrial fibrillation) level off after
six months. There were two early postoperative deaths, both
unrelated to the radiofrequency maze procedure. None of the
patients suffered injury to neighbouring structures in our series.
There is a high incidence of recurrent atrial fibrillation in the first
six months. It has therefore been our practice to leave patients
on antiarrhythmic medication for six months and continue
anticoagulation for up to one year after surgery.
Our experience with the radiofrequency Cox-maze III procedure
has been positive with both the monopolar, and especially the
combined monopolar and bipolar systems. Our data suggests
that sinus rhythm is more stable in the first six months after
combined monopolar and bipolar radiofrequency maze
procedure as compared to monopolar alone, and there is a trend
towards higher success rates after the combined monopolar and
bipolar radiofrequency maze procedure. Regardless of technique,
the radiofrequency maze procedure adds less than 20 minutes
of additional cardiopulmonary bypass time and does not increase
the risk of the primary cardiac surgery. As such it has become
our standard surgical treatment for patients with atrial fibrillation
undergoing cardiac surgery.
Cardiovascular Rehabilitation &
Preventive Cardiology Week 2004
(FROM LEFT TO RIGHT):
To reinforce the need for cardiovascular risk factor modification, the National Heart Centre
(NHC)’s Cardiovascular & Preventive Cardiology (CVR & PC) Unit held its annual CVR & PC
Week in October 2004.
Led by NHC’s Director of CVR & PC Unit Dr B A Johan and the CVR & PC team, the week
long programme included a Mandarin public forum held at Choa Chu Kang Community
Club, a walkathon for past and present Cardiovascular Rehabilitation patients and their
families at East Coast Park, and a GP Symposium held at the Four Seasons Hotel.
The Mandarin public forum, which was held on 4 October 2004, touched on the
management of risk factors such as diabetes and dietary modifications for weight control.
Attended by over 100 participants, the Mandarin public forum involved doctors from
both NHC as well as a dietician from Singapore General Hospital.
Guest of Honour Senior Minister of State for Information, Communication and the Arts
& Health Dr Balaji Sadasivan led the walkathon, which was held on 10 October 2004 at
East Coast Park. About 270 past and present Cardiac Rehabilitation patients and their
families participated in the event by walking a distance of either 3km, 5km or 7km.
Finally, a GP Symposium which was sponsored by Pfizer was held at the Four Seasons
Hotel on 2 October 2004. The symposium, which touched on current trends in cardiovascular
risk factor modification, was well attended by over 130 participants.
NHC GP Heart Care
Symposium on Lipids
> PUBLIC FORUM:
NHC Registrars Dr Peter Ting
and Dr Stanley Chia, SGH
Dietician Mr Lim Meng Thiam
and NHC Senior Consultant
Cardiologist Dr Lim Soo Teik
speaking at the Mandarin
public forum.
> GP FORUM:
Director of Cardiovascular
Rehabilitation and
Preventive Cardiology and
Senior Consultant Dr B A
Johan, Senior Consultant Dr
Gunasegaran, Consultant
Cardiothoracic Surgeon Dr
Lim Chong Hee and Acting
Director of Clinical Trials and
Consultant Dr Tan Ru San
speaking during the Q & A
session of the GP Symposium.
> MORNING WALK:
Guest of Honour Dr Balaji
Sadasivan, Senior Minister of
State for Information,
Communication and the Arts
& Health taking a morning
walk with NHC Medical
Director A/Prof Koh Tian Hai
and Health Promotion Board
CEO Dr Lam Sian Lian.
(FROM LEFT TO RIGHT):
> PANEL DISCUSSION:
NHC Consultant Dr
Gunasegaran having a
discussion with fellow panel
members SGH Consultant
Endocrinologist Dr Tai E
Shyong, NHC Senior
Consultant Dr Ding Zee Pin,
NHC Senior Consultant Dr
Lim Soo Teik and NHC
Consultant Dr Aaron Wong.
To keep General Practitioners (GPs) abreast of the latest developments in the management of patients with cardiovascular disease, the
National Heart Centre (NHC) held another GP Heart Care Symposium on lipids on 27 November 2004 at Conrad International Centennial
Singapore.
Sponsored by Astra Zeneca, the symposium was attended by over 100 GPs and touched on issues such as lipid profiles and the various
types of lipid agents used for these various profiles. The speakers included doctors from NHC such as Dr Ding Zee Pin, Dr Lim Soo Teik
and Dr Aaron Wong, as well as Dr Tai E Shyong from the Department of Endocrinology of Singapore General Hospital.
NHCNEWS p05
CORPORATE
NEWS
NHCNEWS p06
CORPORATE
NEWS
Diploma in Cardiac Technology
Students Graduate with Flying Colours
(FROM LEFT TO RIGHT):
A total of 37 students from both the specialist diploma and full-time diploma in cardiac technology courses graduated recently at
Singapore Polytechnic. The graduates comprised 23 specialist diploma students (out of which, 15 were sponsored by the National
Heart Centre) and 14 from the full-time diploma course (two students were sponsored by NHC as well).
> GRADUATION:
A group photo of the NHCsponsored graduates from
both the specialist diploma
and full time diploma in
cardiac technology courses.
The diploma courses, which were the first of its kind in Asia, aimed to upgrade
the professional standards and competency of both working cardiac
technologists and students by teaching basic theoretical concepts in the
practice of cardiac technology and their applications in clinical settings.
> SPECIALIST DIPLOMA
A unique aspect of the diploma courses was the absence of examinations,
since students were assessed through continual assessments through the
teaching period. In addition, students not only learnt the theoretical aspects
of cardiac technology, they were also given opportunities to practise the skills
learnt during the work practice sessions.
GRADUATES:
N H C Ca rd i a c Tra i n i n g
Executive Ms Lata P Jaybalen
(right) with the group of
NHC-sponsored Specialist
Diploma graduates.
When asked about her thoughts of the Specialist Diploma course, graduate
and NHC award winner Ms Fock Jianyi said: “Although being a cardiac
technologist is a very specialised profession, I am glad I still went for the
Specialist Diploma in Cardiac Technology Course. The diploma has certainly
helped me get a recognised certificate in this very specialised field and I am
confident that this diploma will be recognised even by other healthcare
institutions in Asia.”
All 37 graduates have since secured jobs either at the National Heart Centre
or cardiac / medical laboratories in Singapore upon their graduation.
Accreditation of NHC by the
Australasian Board of Cardiovascular Perfusion
The National Heart Centre is pleased to announce its accreditation by the Australasian Board of Cardiovascular Perfusion (ABCP).
following a successful assessment and inspection tour. The National Heart Centre can now enroll its staff in the Australasian Diploma
of Perfusion Course.
The ABCP, which was established in 1989, comprises two Surgeons, from the Royal Australasian College of Surgeons (RACS), and two
Anaesthetists, from the Australian and New Zealand College of Anaesthetists (ANZCA) and three Perfusionists, from the Australasian
Society of Cardio-Vascular Perfusionists (ASCVP). The ABCP maintain the standards in the field of cardiovascular perfusion through
qualifying examinations and procedures for re-certification.
Certification in cardiovascular perfusion by the ABCP is evidence that a perfusionist's training and academic qualifications for the
operation of extracorporeal equipment are recognised by an established international standard.
As such, the National Heart Centre is proud to be accredited and owes its success to its team of perfusionists, led by John Ng.
Calendar of Events
Date
Event
Venue
Enquiries
09 Apr 05
GP Symposium – Approach to Chest Pain
To be advised
Ms Rosalind Lee
Tel: 6236 7415
14 –15 May 05
ECG Course
To be advised
Ms Jessica Koh
Tel: 6236 7418
NHC Nurses Receive EXSA Awards
A total of seven staff from the various nursing departments of the National Heart Centre (NHC) were awarded the Excellent Service Award
(EXSA) in 2004. NHC took home six Gold Awards and one Superstar Award under the Healthcare cluster.
The EXSA Award, which is organised by the Standards, Productivity and Innovation Board (SPRING Singapore), recognises individuals
who have delivered outstanding services. The EXSA Award was awarded to the following NHC staff in November 2004:
SUPERSTAR AWARD
1. Mdm Lim Swee Hia
Director, Nursing, NHC & SGH
Nursing Director, Outram Campus
GOLD AWARDS
1. SSN Anne Tok Kim Lian
2. SSN Pauline Lim Paw Ling
3. NM Lee Chin Hian
4. SEN Lim Chuan Kah
5. SNM Lim Suh Fen
6. NM Teo Lee Wah
CTS ICU
CTS ICU
Ward 56
Ward 44
Cardiac Clinics
Cardiovascular Rehabilitation &
Preventive Cardiology
FROM LEFT TO RIGHT:
> EXSA WINNERS:
SSN Anne Tok, Head of
Cardiothoracic Surgery Dr
Chua Yeow Leng, NM Lee
Chin Hian, SNM Lim Suh Fen,
SSN Pauline Lim, Director of
Nursing Mdm Lim Swee Hia
and SEN Lim Chuan Kah. Not
present in picture is NM Teo
Lee Wah.
NHC would like to congratulate all winners on their accomplishments.
NHC Director of Nursing
Receives EXSA Superstar Award
Mdm Lim Swee Hia, the Director of Nursing at the National Heart Centre, received the coveted EXSA Superstar Award at the EXSA Award
Ceremony in November 2004. She was one of the nine recipients and the only healthcare representative in Singapore to receive this top
honour for her outstanding contributions to excellent service.
A firm believer in training, Mdm Lim has worked to improve the
standards of nursing care through the development of various training
programmes. This in turn has remarkably increased the nursing morale
as well as the quality of service provided by nurses.
Mdm Lim played a pivotal role in training mature workers to provide
quality care for the healthcare sector in Singapore when in 2001, she
pioneered the Healthcare Skills Training Employability and Enhancement
Redevelopment (STEER) programme for Singapore. Collaborating closely
with the Ministry of Manpower, National Trade Union Congress (NTUC)
and various Skills Development Departments, these programmes
enabled retrenched and unemployed workers to gain employment
in the healthcare sector.
Mdm Lim has also developed numerous programmes and workshops to train nurses in improving their patient service skills and standards
to meet the needs of all patients. Noting the importance of how caregivers should also be equipped with cardiopulmonary resuscitation
(CPR) and life-saving skills, she started a Support Heart-Saver programme to train family members and recovered patients in the necessary
life-saving procedures and skill sets.
Mdm Lim's commitment to quality service was also exemplified when a group of foreign nurses faced accommodation difficulties when
they first arrived in Singapore. Mdm Lim and her team of staff put in late nights for more than a week to settle the issue and even went
out of their way to purchase the necessary bedding and furniture to equip the foreign nurses’ apartments.
The National Heart Centre would like to congratulate Mdm Lim on her achievement.
> NCH’S SUPERSTAR:
EXSA Superstar winner Mdm
Lim Swee Hia, Minister, Prime
Minister's Office & Second
M i n i s t e r fo r N a t i o n a l
Development Mr Lim Swee
Say and NHC Medical
Director A/Prof Koh Tian Hai.
NHCNEWS p07
NURSING
NEWS
NHCNEWS p08
NURSING
NEWS
NHC Nurse Awarded
Best Oral Nursing Research Paper at
SingHealth Annual Scientific Meeting
> NHC'S WINNER: SNC
Phoon Poh Choo giving her
winning oral presentation at
the SingHealth Scientific
Meeting.
National Heart Centre’s Senior Nurse Clinician Phoon Poh Choo was one of the two nurses presented
with the Best Oral Presentation Award in the Nursing Category at the 1st SingHealth Annual Scientific
Meeting, which was held on 15 – 17 October 2004. The other award went to a nurse from Changi General
Hospital.
SNC Phoon’s paper was entitled ‘Routine Screening of MRSA for Elective CABG Surgery is Not Necessary:
A Retrospective Study” .
Patients are routinely screened for MRSA (Methicillin-Resistant Staphylococcus Aureus) colonisation prior
to elective CABG surgery at the National Heart Centre. However, these patients would have had their
surgery regardless of their MRSA status.
As such, a retrospective research study was done to assess the MRSA carrier state to determine the correlation of MRSA colonization and
surgical site infections.
The results showed that there was no association between MRSA colonization and surgical site infections. In response to this, NHC’s
Department of Cardiothoracic Surgery has stopped screening for MRSA colonisation in patients admitted for elective CABG surgery.
As each MRSA screening costs $35, this implemented change in practice not only reduced the work process for healthcare workers, but
also, has an average cost saving of more than $16, 000 per year.
NHC Nurse Volunteers for
SingHealth Tsunami Disaster Relief Team
The tsunami tragedy that occurred on 26 December 2004 gripped everyone as
heart-rending news of disaster, chaos and loss was reported in the nearby
countries of Indonesia, Thailand, Malaysia, Sri Lanka and India.
> JOB WELL DONE:
NHC Director of Nursing Mdm
Lim Swee Hia welcoming back
SSN Foo Lee Lian.
To aid the victims of the tsunami disaster, healthcare professionals from the
various SingHealth institutions have stepped forward to form relief teams to
render onsite medical assistance.
One such volunteer is NHC’s very own Senior Staff Nurse Foo Lee Lian from Ward
44’s Cardiac Care Unit. Already an avid volunteer at the moral home for the aged,
SSN Foo was part of SingHealth’s two-member enhancement team sent together
with the SAF contingent to Banda Aceh on 15 January 2005.
> BON VOYAGE:
SingHealth DCEO Mrs Karen
Koh and NHC Director of
Nursing Mdm Lim Swee Hia
were amongst the group of
SingHealth representatives
present to send off SSN Foo
Lee Lian (fourth from right).
In spite of the daunting task, SSN Foo and her team accomplished their mission
and SSN Foo returned home safely together with her comrades on 22 January
2005.
The National Heart Centre is proud of SSN Foo’s accomplishments and would
like to congratulate for a job well done.
Acknowledgements
Advisor:
A/Prof Koh Tian Hai
Editor:
James Toi
Editorial Team:
Mrs Chan Siok Tian
Dr Terrance Chua
Dr Chua Yeow Leng
Dr B A Johan
Mdm Lim Swee Hia
Mr John Ng
Ms Sharon Ng
Ms Yvonne Then