Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Remote ischemic conditioning wikipedia , lookup
Coronary artery disease wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Myocardial infarction wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Cardiothoracic surgery wikipedia , lookup
Electrocardiography wikipedia , lookup
Atrial fibrillation wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
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