Touching Lives & Pioneering Care - Making A Difference Through Research Since 2010

Touching Lives & Pioneering Care Making a Difference through Research since 2010

Alexandra Health System Alexandra Health System is a regional healthcare system established on 1 April 2008 to take care of the 700,000 residents living in the northern part of Singapore. Our goal is to make a difference to the population in the north by working together with our partners and empowering the community and residents to manage their health for life.

Khoo Teck Puat Hospital, opened in June 2010, is a 590-bed general and acute care hospital which combines medical expertise with high standards of care, set within a healing environment.

Yishun Community Hospital, opened in December 2015, is a 428-bed community hospital which caters to the sub-acute and rehabilitation needs of patients.

Woodlands Integrated Health Campus, is opening in stages from 2022 and will comprise a large acute care hospital, a community hospital, a nursing home and other associated facilities and services.

Admiralty Medical Centre, is opening in 2017 and will provide day surgery and specialist outpatient care. The Medical Centre is being built within Kampung Admiralty, an integrated, mixed use development.

O PE N I N

2019

Sembawang Primary Care Centre, is opening in 2019 and will be a test bed for new care models and care processes. It will be built in Sembawang Sports and Community Hub, alongside a sports complex and a hawker centre.

Contents 2 Group Chief Executive Officer’s Message

31 Department of Otorhinolaryngology

3 Alexandra Health Fund Limited Chairman’s Message

32 Department of Anaesthesia

4 CRU Director’s Foreword 5 Brief History of Research Milestones from

Alexandra Hospital to Khoo Teck Puat Hospital 88 About Clinical Research Unit 10 Clinical Research Committee 11 The Research Support Team 12 NMRC Centre Grant 14 Diabetes Research in KTPH 16 Clinical Research Unit 20 Diabetes Centre 22 Department of General Surgery 24 Department of General Medicine 25 Department of Cardiology 26 Department of Ophthalmology and

Visual Sciences 27 Department of Diagnostic Radiology 28 Department of Geriatric Medicine

33 Department of Psychological Medicine

34 Department of Acute and Emergency Care /

Department of Orthopaedic Surgery

35 Rehab Services 36 Pharmacy 38 Nursing 39 Transformation Office: AIP Programme 40 Transformation Office: GeriCare @ North 41 Transformation Office: Innovative Projects 42 Pharma-sponsored Clinical Trials 44 External Collaborations & Partnerships 46 Past Events 50 Recent Development –

Geriatric Education and Research Institute 51 Research Metrics and Indicators 54 How to Start A Research Study 56 Information on Internal Grants

29 Department of Urology 30 Department of Family and Community Medicine

AHS Research Commemorative Book

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Group Chief Executive Officer’s Message Average life expectancy in Singapore has increased by more than 20 years over the last half century.

Unfortunately, some of these extra years are not very good years for many who suffer from poor physical and mental health. We all need to take better care of our health in order to live well, age well and die well. We, as healthcare professionals have the responsibility to help promote health in the community before people fall sick. With greater understanding of behavioural science, we now have a wider repertoire of approaches to help people lead a healthier lifestyle.

The vision of AHS is to help our people live a long healthy life and support them with thoughtful, dignified care to the end. Our mission is to provide good quality, affordable, hassle-free healthcare with Science, Love and Wisdom.

The world is changing rapidly. Technological advances in infocomm technologies, analytics, artificial intelligence, genomics, robotics, etc. will allow us to transform healthcare. We will be able to do more and do better to improve care and improve lives. Genomics and imaging technologies coupled with artificial intelligence will allow more accurate and faster diagnosis of diseases. Broken limbs can be replaced and made even better with artificial limbs. Diseases can be fixed with more effective drugs, engineered tissues, body parts and organs. The possibilities are unlimited.

Mr Liak Teng Lit

Yet at the same time, scientific and technological advances have been marred by incompetence, biased reporting, dishonesty and fraud. Some estimates suggest that more than half the research papers published in refereed journals could not be replicated.

Unfortunately some of these invalid results are being used by vested interests to promote dubious treatments.

Clinical guidelines are useful for spreading good clinical practices and ensuring greater consistency in practices. These have no doubt improved the quality of care for many. Yet, when applied blindly without consideration to the needs, concerns and circumstances of individual patients, the guidelines can be a waste of resource and even harmful to the patients. It is now not uncommon for frail elderly patients to be prescribed more than 10 medications. Many of these are unnecessary and some are downright harmful.

The population is ageing rapidly and the demand for healthcare will increase. With less young people, our ability to finance and provide new ways to care for the elderly in the most humane and sustainable way will be a huge challenge, but also an opportunity for us to innovate and do better. Acute hospitals, community hospitals, and even nursing homes are often not the best places to care for the frail elderly. We need to find more effective and efficient ways to use our limited human and physical resources.

Therefore, we need to keep pace with scientific and technological advances in order to take full advantage of these to help our patients. We need to be inquisitive and be discerning. We need to separate the good from the bad science; to challenge our own assumptions and new recommendations.

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AHS Research Commemorative Book

To succeed we must learn, unlearn and re-learn.

This commemorative book is a good documentation of some of the steps we have taken to live out our vision and mission.

Alexandra Health Fund Limited Chairman’s Message

Celebrating the Past, Embracing the Future It is with great joy that I offer my best wishes to all of you on the 1st Research Commemorative Book of Khoo Teck Puat Hospital (KTPH). The Alexandra Health System (AHS) family, which KTPH is an integral part of, should be very proud of this momentous milestone we celebrate together.

Many of you know that KTPH was named after Tan Sri Khoo Teck Puat to recognise the significant and generous donation by the Estate of the late Tan Sri Khoo Teck Puat. This donation subsequently led to the establishment of an endowment fund now under the purview of Alexandra Health Fund Limited (AHFL). AHFL’s objective and mission is to enhance health and improve quality of life for our patients through research and innovation, community collaboration, education and financial assistance for those in need.

To date, AHFL has supported several major programmes directed at improving the quality of life of our patients through research, innovation and education. It has also supported innovative programmes on care and outreach for the benefit of the less fortunate within the vicinity of KTPH, and has provided welcome support to programmes aimed at helping needy patients with their medical bills.

I am confident that these continuous efforts and investment will lead us to our ambition of enhancing healthcare for the benefit of the Singapore community, and even globally in the years to come. On behalf of AHFL, I would like to congratulate AHS on this milestone.

Mr Tan Boon Khai

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CRU Director’s Foreword To have some idea where we will be heading to, will require some knowledge of where we came from.

May I take the opportunity to thank our AHS senior management and the Board of Trustees, Alexandra Health Fund for their unwavering support; colleagues for their contributions and wise counsel; and staff of our Clinical Research Unit for their exemplary dedication. Without which, the journey we have travelled, and will be traveling together, will be a less fruitful and enjoyable one.

A few historical tractions at the turn of the millennium set the stage for the growth of clinical research in our institution.

•

Firstly, the completion of the human genome project, which promised the possibility of “reading the book of life” (and health or disease) of each individual with unprecedented resolution.

A/Prof Lim Su Chi

• Secondly, Singapore’s economic blue-print mandated a knowledge based economy including an ambitious growth plan in biomedical research.

•

Thirdly, the plan to restructure Alexandra Hospital.

Our senior management has wisely given the space for enthusiastic clinicians to try out ideas such as practicing academic medicine supported by clinically relevant research.

A number of consensus-decisions taken, with long-term objectives in mind appeared to be the defining moment.

•

Firstly, the initiation of longitudinal cohorts dedicated to common diseases such as dementia, obesity and diabetes. Besides careful disease-profiling (i.e. phenotyping), collection and cryo-preservation of baseline bio-specimens and the linkages with electronic health records greatly empowered the cohorts, making them conducive for multidimensional research (including genomic medicine).

• Secondly, serious commitment to research training, believing that excellence in clinically-relevant research will complement excellence in clinical care.

•

Thirdly, to grow research talent in Alexandra Health System (AHS). Besides grooming clinicians, bringing-in PhD scientists trained in basic-science to become clinical-scientist to work alongside with the clinicians.

This has greatly enhanced the synergy between clinicians and scientists for “bedside to bench and back to bedside” (“B to B”) type of translational research.

• Finally, to carefully nurture collaboration with other research institutions, both locally and internationally.

If we persevere, along with clinical service and teaching, clinically relevant research will become an integral component of the tricycle model of healthcare excellence.

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Brief History of Research Milestones - from Alexandra Hospital to Khoo Teck Puat Hospital

2000

Restructuring of Alexandra Hospital

Then Health Minister, Mr Khaw Boon Wan, announced a new regional hospital in Yishun. This hospital was later named the Khoo Teck Puat Hospital.

Clinical Research Unit 2002 (CRU) was established in the former Alexandra Hospital in a refurbished mortuary. Start-up funding approved by our then Chairman, Medical Board (CMB), Prof C Rajasoorya.

Building Infrastructure, Growing Research

2004

CORPORATE

Alexandra Hospital was restructured on 1 October 2000 and became part of the National Healthcare Group.

2007

2003

CRU built the cell culture facility with the support and contribution of the seed funding from the then CEO, Mr Liak Teng Lit and CMB, A/Prof Pang Weng Sun.

2008

The fledgling cell culture facility, led by A/Prof Tavintharan Subramaniam, was housed in a make-shift container.

CRU Team during Alexandra Hospital time

In the same year, the Diabetes Centre also kick-started the recruitment of its longitudinal Diabetic Nephropathy (DN) cohort.

Cell Culture Lab Converted Container (Clean Room)

Research Officers

1st Research Forum in 2008 ‘The Next Lap’ held at Alexandra Hospital

Main Research Laboratory space (This was about 80% of the lab space)

Over the years, with staunch support and resources provided by our senior management, CRU grew gradually by recruiting additional research scientists, research nurses and administrative staff, which eventually evolved to its three subsections respectively.

Research Admin Team

Research Forum 2008 & 2009

In April 2008, the first Research Forum was successfully held with the support of the senior management.

(Find out more @ pp46-49 Past Events) Research Nurses

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CLINICAL RESEARCH

A Decade of Transformation

Alexandra Hospital gained independence as a regional health system (RHS). In corollary, our then CMB, A/Prof Pang Weng Sun and senior management helped to secure research funds from our Endowment Board to continue the growth of our research roadmap.

New Laboratory @ Basement 1, Tower C, KTPH

A New Era of Hassle-free Quality Healthcare

Fosters excellence in multidisciplinary research in the field of cell culture, darkroom for medical imaging and centralised biobanking.

To support the burgeoning research, the facilities expanded by about 10 times with thrice the manpower.

CRU Biobank An experimental surgery laboratory helmed by A/Prof Tan Kok Yang had also been developed for cadaveric dissection in experimental procedures.

2010

CRU relocated to KTPH

2011

2012

1st Research Forum, renamed as Alexandra Health Forum was held at KTPH Since moving to KTPH, the Research Forum has undergone several rebrands to reflect evolving challenges of healthcare in Singapore. (Find out more @ pp4649 Past Events)

SMART2D Phases 1 & 2: CRU was awarded with NMRC PPG in the amount of S$2-million and NMRC CSIRG of S1.5 million.

st Research Forum 11st Research in conjunction with Forum in Nursing Fest conjunction with Nursing Fest

AH Forum eventually evolved into the AH Forum & AH Nursing Fest in 2012. (Find out more @ pp46-49 Past Events)

1st Research Forum in conjunction with Nursing Fest held in 2012

2013 KTPH was awarded S$3 million Centre Grant (CG) from the NMRC to develop and strengthen research capabilities for Common and Complex Chronic Conditions (4Cs) in Singapore. (Find out more

@ pp12-13 NMRC Centre Grant)

Research Gallery Opening in August to showcase the diverse research activities and results achieved for public viewing at Basement 1, Tower A, KTPH (outside Day Surgery Centre)

Ribbon Cutting Ceremony for Research Gallery Opening

Ongoing Study: SMART2D

In collaboration with National Healthcare Group Polyclinic, National Registry of Diseases Office, Genome Institute of Singapore and National University of Singapore.

Riding on our institution’s niche in diabetes and metabolic research, the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity (SMART2D) study was conceived.

Phase 1: Launched in March 2011 CRU was awarded with the National Medical Research Council (NMRC)’s Program Project Grant (PPG) of S$2 million

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Phase 2: Began in 2014 CRU was funded with S$1.5-million by NMRC Clinician Scientists Individual-Research Grant (CS-IRG) (Find out more @ pp16 Clinical Research Unit) AHS Research Commemorative Book

Setting up of off-site bio-banking facilities in collaboration with Geriatric Education and Research Institute (GERI)

GERI Biobank located at Level 3, Tower E,GERI

Soft launch of GERI Biobank

2014 Genomic Medicine Acquisition of Next Generation Sequencing Capability (Ion Torrent™ Technology) This DNA sequencer is capable of reading the nucleotide sequence of multiple genes simultaneously, enabling scientists and clinicians to quickly screen potential genetic causes of disease – an important step towards the development of genomic or personalised medicine.

Linking Up with the World In 2013 and 2014, our then CMB, A/Prof Kenneth Mak supported two consecutive fellowships in genomic medicine to world leading institutions in United Kingdom (UK) and United States of America (USA).

Exome-scale Sequencing: One step closer to complete genomic analysis

2015

Acquisition of the Exomescale sequencer in May facilitates the analysis of entire exomes, allowing us to uncover potential disease markers and causes across the entire genome.

HSRE Mini Forum 1.0 Organised in May to share the latest knowledge in the HSRE field.

Topics presented included Health Economics, Population Health, Quality Improvement, and Disease Management and Prevention.

During the move

2016

2016

CLINICAL RESEARCH

CRU Biobank located at Basement 1, Tower C, KTPH

CORPORATE

With the seed planted by our former CMB, A/Prof Pang Weng Sun, we set up additional bio-banking facility within GERI. Therefore, CRU acquired additional six -80°C freezers with WiFi capability for the temperature monitoring system to store patient samples for research purposes. In May, CRU has moved part of the bio-bank samples to the GERI Biobank. (Find out more @ pp50 Recent Development - Geriatric Education and Research Institute)

NMRC Clinician Scientist Award (CSA) An award that provides salary and project funding support for selected outstanding clinician scientists with a consistent record of excellence in research, enabling them to carry out internationally competitive translational and clinical research.

With the support of the current CMB, A/Prof Pek Wee Yang and CEO, Mrs Chew Kwee Tiang, our clinician scientists submitted their applications in June.

HSRE Mini Forum 2.0

In June, the 2nd HSRE Mini Forum was held in conjunction with the signing of Memorandum of Understanding between Alexandra Health System (AHS) and National University of Singapore (NUS).

(Find out more @ pp46 Past Events)

CRU Today

CRU has steadfastly grown over the years with a significant increase in staff strength.

It now supports research across all the clinical departments within KTPH. In preparation for the next phase of research history, CRU aspires to acquire additional core capabilities in medical imaging, immunohistochemistry and bioinformatics as envisioned in 2002.

Together with AHS, CRU will continue to grow as an integral component of the healthcare hub with the Yishun Community Hospital, Woodlands Integrated Health Campus, Admiralty Medical Centre and Sembawang Primary Care Centre in the years to come.

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Translational “Omics” Research

In improving our understanding of diseases, researchers are looking into the smallest processes to uncover potential targets for drug treatment. Understanding these small processes also allows researchers to find early signs of disease, which may allow patients to seek early treatment. Otherwise known as molecular research, the molecules are more than million times finer than hair.

CRU supports three areas of molecular research: metabolomics; proteomics; and stratified genomics: • In metabolomics, various bio-chemicals that are implicated in disease are studied.

• Proteomics study how the proteins in cells lead to disease.

• Stratified genomics uncover how our genes can cause disease. It also identifies at-risk people, who can benefit from early medical intervention.

Metabolomics

CRU works with Duke-NUS to support metabolomics research.

Metabolomics uncover new drug targets and disease indicators, by studying biological molecules from patients’ tissue and urine samples.

Through CRU, our Research Nurses and Research Officers receive and prepare samples for analysis at DukeNUS, and support result analysis.

Proteomics

Biobank

Figure 3: Proteins are separated on a gel and illuminated using ultraviolet imaging. Trained researchers can identify suspect disease culprits, using such images.

Figure 4: Tissues are stored at optimum condition in liquid nitrogen at -196°C.

CRU’s laboratory houses a range of equipment to separate and identify culprit proteins behind diseases, from patient samples. This include various gel apparatus, ultraviolet imagers, used to separate and illuminate target proteins.

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Figure 1: A researcher prepares for metabolomics analysis by loadings samples into tubes.

AHS Research Commemorative Book

CRU boasts 2 biobank facilities: A central biobank conveniently located at our CRU laboratory for easy access to researchers; and a satellite site at GERI. The biobank is a vital part of research, enabling researchers to accumulate and study samples from large, long-term cohorts.

Our biobanks store samples from thousands of patients, for more than 14 years, storing samples such as DNA, tissue, blood and urine. These samples are securely preserved from degradation in our -20°C, -80°C freezers, with tissues frozen at -196°C in liquid nitrogen.

Figure 2: A researcher separates and extracts biological molecules (metabolites) from blood for study.

Research

Clinical Research Unit (CRU) is set up to provide infrastructure for the proper conduct of clinically relevant research, which is one of the three key pillars that will distinguish KTPH/AHS as a centre of healthcare excellence.

Teaching

Vision & Mission

Clinical Service

About Clinical Research Unit

Genomics

CRU supports the various stages of genomic research. Our range of equipment allows researchers to find, and zoom in on the specific genes that can cause disease.

Cell Culture Room

The Cell Culture Room allows researchers to culture cancer cells and other tissue cells for microbiology, cancer and genetic expression studies. These studies allow researchers to understand what happens in diseases at the cellular level. The cell culture room is fully equipped, with sterile biosafety, incubators, and microscope, to enable high quality research.

Our equipment includes nextgeneration sequencers, which reads the entire genome of several patients, in a single day! This rapid and thorough analysis allows our researchers to accurately identify the genetic-basis of certain diseases.

This will inform personalized prevention and treatment strategies.

CRU also owns RT-PCR technology to support our research in genomic medicine.

Figure 7: A researcher uses microscopes and imaging equipment to observe how cells change their appearance during different stages of disease, and how this might affect organ function.

Figure 8: Cell cultures are regularly maintained in sterile conditions at our cell culture room. These cells are used to study how turning on and off genes in cells can affect disease.

Figure 5: The RT-PCR analyses how implicated genes run out of control in diseases.

Bioinformatics

In the course of research, several thousands of gigabytes of data are produced and compared against international databases every week.

Done manually, a single analysis can take two days to complete. CRU’s bioinformatics support provides solutions to achieve this in half the time and manpower.

Training

CRU organises several trainings and workshops throughout the year.

These trainings cater to the different stages, from grant writing; to literature appraisal; topical overview of latest research; statistics; as well as research forums. Our speakers come from our experienced researchers, as well as external speakers from local research institutes; universities; and overseas.

Figure 6: Programming enables researchers to speed up analysis, and compare their findings with international databases.

Figure 9: A selection of trainings offered by CRU in 2016.

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Clinical Research Committee Clinical Research Committee (CRC) comprises of representatives from various clinical disciplines within KTPH. CRC sets the directions and guidelines for its staff to conduct clinical research activities at the institution.

Current CRC Members

(1 January 2016 - 31 December 2017) Clinical Director

Deputy Clinical Director

A/Prof Lim Su Chi Diabetes Centre (General Medicine)

A/Prof Tavintharan Subramaniam Diabetes Centre (General Medicine)

Dr Edwin Seet Anaesthesia

Dr Angela Koh General Medicine

Dr Ooi Say Tat General Medicine

A/Prof Philip Yap Geriatric Medicine

Dr Goh Hsin Kai Acute & Emergency Care

Dr Sandeep Uppal Otolaryngology (ENT)

Dr Shahla Siddiqui Anaesthesia

Dr Surendra Mantoo General Surgery

Dr Lang Tee Ung Laboratory Medicine

Dr Chang Kok Meng Dental Surgery

Dr Ashish Chawla Diagnostic Radiology

Dr Benjamin Lam Family and Community Medicine

Dr Justin Tang Cardiology

Dr Timothy Teo Orthopaedic Surgery

Dr Kumari Neelam Ophthalmology and Visual Sciences (OVS)

Dr Serena Low Clinical Research Unit

Ms Yap Suk Foon Nursing

Ms Lee Siok Ying Pharmacy

Group photo of 1st batch of CRC Members

List of Past CRC Members from 2010 to 2015

No Position 1 Member

Name Dr Fidelia Tay

Designation Senior Consultant Senior Consultant Consultant

2

Member

Dr Teh Hui Seong

3

Member

Dr Goh Kian Peng

4

Member

A/Prof Tan Kok Yang

5

Member

Ms Sujata Rajaram

6

Member

Ms Chan Kar Lock

7

Member

Ms Chan Sue Mei

8

Member

Dr Doreen Tan

9

Member

Dr Lim Beng Leong

10

Member

Mr Cai Cong Cong

11

Member

12

Member

13

Member

Principal Physiotherapist Dr Andy Wee Teck Huat Visiting Consultant Dr Joey Chan Associate Consultant Dr Ngiam Kee Yuan Registrar

14

Member

Ms Lock Poh Leng

15

Member

Ms Chen Yuchan

14

Member

Ms Sharon Lim

Head, Senior Consultant Senior Nurse Clinician Senior Occupational Therapist Principal Dietician Chief Pharmacist Consultant

Department Dental Surgery Diagnostic Radiology General Medicine General Surgery Nursing Rehab Services Nutrition & Dietetics Pharmacy Acute and Emergency Care Rehab Services

Orthopaedic Surgery Laboratory Medicine General Surgery Senior Dietician Nutrition & Dietetics Senior Rehab Services Occupational Physiotherapist Senior Principal Rehab Services Physiotherapist

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Ms Ng Lih Yen Rehab Services

Ms Candy Chan Nutrition & Dietetics

The Research Support Team Research Nurses

Supporting both inpatient and outpatient clinical research activities, our team of research nurses at Clinical Research Unit play a significant role in coordinating for clinical research trials which are crucial for medical science advancements.

Expertise

Research nurses are trained in both clinical care and research procedures. To keep abreast of the latest skills and medical knowledge, they are certified in: • Singapore Guidelines for Good Clinical Practice (SGGCP), • Collaborative Institutional Training Initiative (CITI), • Post-basic Advance Diploma in Clinical Trial Management (or equivalent qualifications) and • Proper Conduct of Research

“Research nurses are the fulcrum of clinical trials.”

- Poston and Buescher (2010)

Responsibilities

A successful research endeavour requires collaborative effort from every member of the team, and research nurses are critical in ensuring the success of research studies. While Principal Investigators retain the ultimate responsibility for the conduct of a study, research nurses coordinate the day-to-day management from initiation to completion of a research study by: • Preparing all study-related documentation • Monitoring studies progress • Ensuring protocol compliance • Submitting study proposals for regulatory and ethical approval • Ensuring full adherence to informed consent process while recruiting research volunteers • Ensure the well-being and safety of research volunteers throughout the research study • Capturing of high quality research data and • Ensuring data integrity for valid and accurate results of the research study

Research Administrators

The Research Admin Team provides active support for both investigator-initiated studies and pharmaceuticalsponsored clinical trials in KTPH throughout the life-cycle of research projects. The scope of support are summarised in the diagram below.

Alexandra Health Forum The successful completion of research studies involves the sharing of new ideas and findings. The team helps to coordinate and organize the biannual cluster-wide Forum for investigators to share their scientific discoveries.

Statistical Support Run by both our visiting consultant and in-house biostatisticians through consultation clinics and software provision.

Contract Review and Management Provides legal support and advice to facilitate inter-institution and commercial collaborations and partnerships.

Ethical Review The team ensures proper ethical governance for research on human volunteers.

Research Training Workshops and seminars are regularly organised to train and keep researchers wellinformed on cuttingedge research methods.

Past workshops include epidemiology, statistics and evidence based medicine.

Project and Grant Management • Intramural and extramural research grants • Pharmaceutical sponsored trials • Project finances • Research output KPI reporting • Research infrastructure support Regulatory and Compliance Matters Sets up structure and processes for matters on research legislations, research policies & SOPs and research best practices.

The team was awarded Full Accreditation by the Association for the Accreditation of Human Research Protection Programs (AAHRPP) since March 2007. The accreditation is testament to KTPH’s rigorous standards for ethics, quality, and protection of people in research.

Core Team Research Nurses From L-R: Ms Michelle Yeo, Ms Philzah Othman, Ms Babitha Jevith, Ms Jessie Fong, Ms Su Jialei, Ms Liew Yiting, Ms Lim Boon Khim, Ms Jamaliah Rahim, Ms Chen Lin

Our visiting consultant, A/Prof Ng Tze Pin (MBBS, MD, FRCPHM) is an Associate Professor of Epidemiology at National University of Singapore (NUS) and also the Research Director of Department of Psychological Medicine at National University Health System (NUHS).

He helps our investigators in many aspects of biostatistical analyses.

Research Admin Team From L-R (Back): Mr Joseph Liew (Executive), Dr Willie Koh (Senior Manager), Mr Lim Renyi (Admin Assistant) From L-R (Front): Ms Rachel Gan (Senior Executive), Ms Leong Pei Yen (Executive), Ms Qiu Shijia (Senior Executive)

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NMRC Centre Grant In April 2013, KTPH was awarded $3 million by the National Medical Research Council (NMRC) Centre Grant (CG) for four years to develop and strengthen research capabilities for clinically Common and Complex Chronic Conditions (4Cs) based on five main Research Themes (Figure 1).

The CG has also set up three main Research and Administrative Cores (Figure 2) to provide various research resources (Figure 3) to support the research community in KTPH.

Common and Complex Chronic Conditions Metabolic Medicine

Geriatric Medicine

Metabolic Health in the Community

Diabetic Foot Syndrome

Gastrointestinal Metabolic Surgery

Genomic Medicine for Metabolic Disease

Integrative Dementia Research

Degenerative Macular Disease

Dr Benjamin Lam

A/Prof Tavintharan Subramaniam

Dr Anton Cheng

A/Prof Lim Su Chi

A/Prof Philip Yap

Dr Kumari Neelam

Family and Community Medicine

Diabetes Centre (General Medicine)

General Surgery

Diabetes Centre (General Medicine)

Geriatric Medicine

Ophthalmology and Visual Sciences (OVS)

Clinical Research Pharmaceutical Clinical Trials

Investigators-initiated Trials

Trans-disciplinary Cardiology Research

Hypertensionology

A/Prof Sum Chee Fang

Dr Edwin Seet

Dr Doreen Tan

Dr Justin Tang

Diabetes Centre (General Medicine)

Anaesthesia

Pharmacy

Cardiology

Health Services & Outcome Research (HSOR)

Allied Health & Nurses and Research

Emergency Medicine

Pharmacists Interventions

Care integration in North-east Singapore

Pharmacist and Infection-Control Team

Gerontology Care

Dr Goh Hsin Kai

Ms Claudine Oh

Dr Wong Chek Hooi

Ms Lee Siok Ying

Ms Yap Suk Foon

Acute and Emergency Care

Pharmacy

Geriatric Medicine

Pharmacy

Nursing

Figure 1: Five Research Themes

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Research and Administrative Cores

Pitch-For-Fund Project Manager STAR Award

Seed Funding

Clinical Research & HSOR

Administrative Core

Research Core

Biomarker Discovery & Genomic Medicine

Bio-banking Facilities

Figure 2: Three Main CG Cores

CG’s 3 main cores provide various research resources and support, as below: Category

Manpower

Equipment Software

Examples • Biostatistician, Bioinformatician, Epidemiologist, Senior Research Officer, Research Nurses, Research Officer (bio-banking) • Illumina NextSeq 500 sequencer and server (biomarker discovery and genomic medicine) • Freezers (bio-banking) • Inbody S10 (clinical research) • Statistical software (SPSS and STATA) • Literature reference management software (EndNote)

Workshop/ community outreach programme

• Statistical, metabolomics, statistical genetics, grant writing workshops • HSRE (Health Services and Research) mini-forums • KTPH World Diabetes Day community outreach programme

Bio-banking facilities

• Sample processing and storage for research purposes

Seed funding/ research funding

• Pitch-for-Fund (pilot grant up to $10,000/ grant) • Science – Translational and Applied Research (STAR) Award (upsized pilot grant up to $50,000/ grant)

Others

• MASTER (Medical and Scientific Electronic Journals Subscription) • Overseas Conference Sponsorship for CG PIs Figure 3: Resources provided by CG

NMRC CG Team Members From L-R: Ms Michelle Lian (Bioinformatician), Dr Resham Lal Gurung (Senior Research Officer), Ms Clara Chan (Research Officer), Ms Lee Wen Yan (Admin Assistant), Dr Grace Yee (CG Project Manager), Ms Jessie Fong (Research Nurse), Dr Zhang Xiao (Epidemiologist), Dr Wang Jiexun (Biostatistician), Ms Philzah Binte Othman (Research Nurse), Ms Michelle Yeo (Research Nurse)

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Diabetes Research in KTPH

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission

Over the years, KTPH has developed a niche in diabetes research and is well poised to contribute to advances in knowledge to this major healthcare challenge. In April 2016, The Straits Times reported that the Ministry of Health has declared “war on diabetes”. The condition can lead to other health complications such as heart disease, stroke, kidney failure, blindness and amputation where four Singaporeans are losing a limb each day. The NUS Saw Swee Hock School of Public Health, has estimated the local economic burden of diabetes to exceed S$2.5 billion by 2050.

Our research in diabetes dates back to 2002 in Alexandra Hospital when the first study was initiated in CRU. The Diabetic Nephropathy (DN) cohort seeks to understand the molecular epidemiology of how diabetes leads to kidney damage continued on in KTPH. Over a period of 15 years, this cohort had led to other major projects, as well as created research opportunities for other areas such as genetics of Mendelian-inheritance form of diabetes.

In 2007, Dr Anton Cheng Kui Sing from General Surgery initiated research in Bariatric Surgery, with an interest to see how gastrointestinal metabolic surgery can benefit diabetics. This study has published important findings in Singapore Medical Journal and Journal of Diabetes and Metabolism, and led to at least 6 presentations in local and international conferences.

a readily treatable condition, was a major determinant of hardened blood vessel.

Furthermore, Dr Liu together with Dr Zhang Xiao have published several papers discussing how the risk of CVD and end stage renal disease (ESRD) differed substantially among the ethnic groups in Singapore. In particular, Malays and Indians with T2DM have higher central arterial stiffness than the Chinese and this might explain their higher risk for adverse outcomes.

In addition to the ethnic disparity, Dr Zhang also found that arterial stiffness is associated with inflammation markers such as increased high-sensitive C-reactive protein (hs-CRP) and decreased soluble Receptor for Advance Glycation End-product (sRAGE) in all SMART2D patients.

Therefore, reducing the inflammatory load through lifestyle modification or pharmacotherapy may reduce the cardiovascular burden.

Formerly a cancer researcher, Dr Angela Moh now champions obesity-related research. She has demonstrated that central obesity is an important determinant of kidney dysfunction in patients with earlyonset T2DM. Her research also highlights the importance of managing insulin resistance so as to reduce the risk of blood vessel damage and consequent cardiovascular events in Chinese men with T2DM.

In 2011, taking advantage of the access to a new catchment population following our migration to the new campus at Yishun, we set-up the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity (SMART2D) cohort. SMART2D consists of several research teams: A/Prof Lim Su Chi (working on endothelial function and genetics), A/Prof Tavintharan Subramaniam (on diabetic foot syndrome), Dr Yeoh Lee Ying (on nephropathy), A/Prof Sum Chee Fang (on clinical epidemiology) and Dr Kumari Neelam (on retinopathy).

Our team of scientists in CRU has also contributed to advances in diabetes research in KTPH. Dr Liu Jian Jun has shown that age, Body Mass Index (BMI) and renal function are the main determinants of central arterial stiffness, which is an established Cardiovascular Disease (CVD) risk factor. We also demonstrated that obesity,

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CRU Researchers Front row: Ms Sylvia, Dr Serena Low, Dr Sharon Pek, Dr Angela Moh, Dr Zhang Xiao Second row: Ms Michelle Lin, Ms Clara Chan, Dr Ang Su Fen, Mr Zhou Shiyi, Mr Melvin Wong Third row: Ms Lee Wen Yan, Dr Liu Jian Jun, Dr Resham Lal Gurung

Results of KTPH’s diabetes research in the local news media

Source: Lianhe Wanbao

Source: The Straits Times

Source: ShinMin Daily News

Source: Tamil Murasu Š Singapore Press Holdings Limited. Reproduced with permission

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Clinical Research Unit The Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) was launched in 2011 to study the impact of diabetes on blood vessel function and commonly encountered diabetes-related complications among Singaporeans. The aim is to investigate the risk factors, both genetic and non-genetic, that can lead to alteration in blood vessel function and adverse outcomes such as diabetic foot syndrome, diabetic kidney disease, retinopathy, cognitive dysfunction and mood disorders.

Vascular function

Diabetic foot syndrome

Funded by the highly competitive National Medical Research Council (NMRC) Programme Project Grant (PPG) and Clinician Scientist Individual Research Grant (CS-IRG), SMART2D has recruited over 2000 participants with Type 2 Diabetes Mellitus (T2DM). In 2014, SMART2D embarked on a second-phase, followup longitudinal study which aimed to recall all of its initial participants for re-evaluation and collect new data to study disease progression in relation to changes in risk factors.

SMART2D has established collaborations with highprofile institutions including the National University of Singapore (NUS), Genome Institute of Singapore (GIS), National Registry of Diseases Office (NRDO), the National Healthcare Group Polyclinics (NHGP) and the Wellcome Trust Centre for Human Genetics at Oxford, United Kingdom. Observations from SMART2D have been published in renowned scientific journals and presented in conferences worldwide. In December 2015, we won the prestigious “Best Oral Presentation (Overall Category)” award at the 18th ASEAN Federation of Endocrine Societies (AFES) Congress 2015.

From L-R: 1) The research nurse takes photos of the subject’s eye to study diabetic-related eye problems 2) Testing for sensations on the feet of diabetic patients helps to identify signs of nerve damage 3) Surveying the subject’s blood vessels for signs of damage

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Nephropathy

Retinopathy

Diabetes is a rapidly evolving global epidemic. Our study volunteers have contributed pivotal data to help us better understand diabetes and find new ways to help our needy patients meet the challenges of living life to the fullest with diabetes. Teaming-up with our collaborators, we will wield the knowledge of today as weapons against the diabetic epidemic in the future. (Find out more @https://www.ktph.com.sg/cru/section_page/321/97)

Measuring the body composition (e.g. Body fat percentage, muscle mass) helps researchers to better understand the subject’s general health condition.

SMART2D Team From L-R: Ms Qi Xiao Ge (Research Nurse), Ms Ng Lai Fong (Research Nurse), Mr Darren Yeo (Executive), Dr Keven Ang (IRG Project Manager), Ms Amy Ou (Research Nurse), Ms Michelle Yeo (Research Nurse)

Type 2 Diabetes Mellitus and Complications: From Genes to Environment

Led by Dr Resham Lal Gurung, Ms Sylvia, Dr Liu Jianjun, Ms Babitha Jeevith, Mr Melvin Wong, A/Prof Lim Su Chi The risk of Type 2 Diabetes Mellitus (T2DM) complications increases with the duration of diabetes, and it is suggested that both genetic and environmental factors determines the severity of T2DM complications. We recently initiated a trans-omics approach, leveraging on high-throughput data across different platforms (metabolomics & next-gen sequencing based) with the aim of developing new strategies to identify high-risk T2DM group for better disease management.

Diabetic Nephropathy (DN) is one dreaded consequence of T2DM. Unfortunately, the incident rate of DN is increasing in Singapore and varies across different ethnic groups. Relying on our DN cohort, we identified T2DM patients from Chinese, Malay and Indian population with rapid decline in renal function and those with minimal decline in renal function. Measurement of plasma metabolites and genetic sequencing in these patients were carried out in order to identify genetic and environmental biomarkers for renal function decline.

To date, we have identified circulating metabolites that confer an increased risk for kidney disease in T2DM and have evidence showing that the levels of four “risky metabolites” in our blood are genetically determined.

We are now in the process of validating these novel observations in a larger independent cohort. These important observations may lay the foundation for patient stratification and individualised therapy for better management of renal function decline in T2DM patients, and potentially prevent disease formation in pre-diabetic patients.

A

Type 2 diabetes patients

Genetic variants Genetic screening

Patient stratification Personalised treatment

Standard treatment

• No side effects • Medication adherence

• Side effects • Reduce adherence

• Reduced Side effects • Improve Medication adherence

Pharmacogenetics studies of anti-diabetic drugs to identify patients with genetic susceptibility to side effects, and to provide alternative to improve medication adherence for better management of diabetes.

B

Genetic Factor

Type 2 diabetes patients

+

Type 2 diabetes Complication

Environmental Factor

Duration of Diabetes/ exposure

Differences in protein levels Differences in metabolities levels

Rapid decline in Renal Function

End Stage Renal Disease

A Trans-omics approach to identify both genetic and environmental factors contributing the disease and also to understand the complexity of disease in certain group of T2DM patients.

Extended Gene-panel Exonic Mutations Screening for Monogenic Diabetes

Led by Dr Ang Su Fen, Ms Clara Tan Si Hua, Ms Jessie Fong Choi Wan, Ms Sylvia, A/Prof Sum Chee Fang, A/Prof Tavintharan Subramaniam, A/Prof Lim Su Chi. A subgroup of individuals presents with diabetes from a young age because they have mutations in their genes.

This is known as monogenic diabetes or maturity-onset of the young (MODY) and accounts for 5% of youngonset diabetes under the age of 45 years.

We aim to identify individuals with MODY through the use of next-generation sequencing (NGS) and Taqman assay to determine the presence of any genetic mutation in 17 candidate genes that may cause their diabetes. Family members are also recruited to further analyze this genetic cause. An accurate genetic diagnosis will help inform clinicians on the best choice of treatment, susceptibility to diabetic complications, as well as genetic counseling for the affected individuals and family members.

Key achievements to date: • A patient with a KCNJ11 mutation has been successfully converted from insulin injections to oral sulphonylureas, a class of medication that has been shown to be effective for patients with mutations in this specific gene (Ann Acad Med, Singapore. Vol. 43: S284).

• Another patient, who was on insulin injections over the past 20 years, was found to carry a GCK mutation

•

and was successfully switched to dietary control. GCK mutations are known to cause mild diabetes that can be controlled by lifestyle changes alone without the need for medications (Presented in 11th Asia Pacific Conference on Human Genetics 2015, Hanoi, Vietnam).

We found an additional 19 mutations that may be potentially damaging. Five of these were novel and 13 of the 84 (~15%) patients sequenced were found to possess such mutations (Diab Res Clin Pract. (2016) Vol. 119: 13-22).

Patient recruitment by research nurse. Sample (blood, urine) collection is performed after informed consent has been obtained.

Next generation sequencing (NGS) is performed using the Ion Torrent Personal Genome Machine (PGM) from Life Technologies.

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Combination of Molecular Genetic Testing and Clinical Diagnosis for Familial Hypercholesterolemia (FH) / Autosomal Dominant Hypercholesterolemia (ADH) Led by Dr Sharon Pek, Dr Sanjaya Dissanayake, Ms Jessie Fong, A/Prof Tavintharan Subramaniam Familial Hypercholesterolemia (FH) is a hereditary disease characterised by the presence of high levels of plasma cholesterol (LDL-C), but less than 10% of patients are aware of their condition. Accurate diagnosis of FH involves DNA genetic testing, and has a sensitivity and specificity close to 100%. Prevalence of FH in Singapore is unknown and no specialised local laboratories offers genetic testing for FH. Research Grants from AHPL have allowed us to establish a complete workflow of patient identification, recruitment and mutation testing in CRU. We have recruited a pilot cohort of 42 patients with median age of 27.9 (20.7 – 38.9) years old. Mutation detection rate of LDLR, APOB, PCSK9 and 23 other lipid-related genes was 73.8% in patients whose DNA were sequenced. This “personalizedmedicine� strategy has allowed us to initiate treatment early, change course of medication or offer different dietary advice.

Concurrently, we are setting up an institutional database for FH patients. This will allow clinicians to manage

patient care, identify relatives for screening and treatment.

It will also allow sound rationale for the use of novel therapeutics (such as PCSK9 inhibitors) and provide expert advice to regulatory agencies. These resources will allow us to build a local model of care for FH recognition and treatment.

From L-R: Mr Zhou Shiyi, Ms Jessie Fong, Ms Michelle Lin, A/P Tavintharan Subramaniam , Dr Sanjaya Dissanayake, Dr Sharon Pek. Machine on the right is the Next Generation Sequencer used for the project, located in Research Lab

In Search of Markers for Rapid Kidney Function Loss in Patients with Diabetes Led by Dr Liu Jian-Jun, Ms Sylvia and A/Prof Lim Su Chi Asians with diabetes are found to be more susceptible than Caucasians to Diabetic Kidney Disease (DKD), which can progress to end stage renal disease (ESRD) if untreated. ESRD patients require dialysis for survival, which poses immense burden to patients, families and society.

Our data shows that nearly half of all diabetic patients in Singapore have DKD of varying severity. If we can predict the risk for rapid renal function loss in diabetic patients at an early stage, we can help doctors and patients make better informed decisions and provide early intensive treatment.

Up till now, increased albumin level in urine is the only predictor marker for risk of ESRD, but its accuracy is only

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50% in diabetic patients. We set out to search for a better predictor marker and found that urine haptoglobin to be a potential promising alternative. Haptoglobin binds free hemoglobin and facilitates its removal from the bloodstream. We found that haptoglobin level was elevated 11-fold in urine preceding the development of rapid renal function loss.

The addition of urine haptoglobin measurement over and above albuminuria increased the predictive ability to 74% in diabetic patients with early or mild renal function impairement. Our next step will be to work on translating these findings to daily clinical practices.

Novel Insights into the Paradigm of Kidney Disease in Type 2 Diabetes – Lessons from a 13-Year Retrospective Large Cohort Study Led by Dr Low Kiat Mun Serena, A/Prof Lim Su Chi, A/Prof Sum Chee Fang Although much research has been done on Type 1 Diabetes Mellitus (T1DM), little is known of the natural history of kidney disease in T2DM and factors associated with its onset and progression. In our retrospective cohort study on patients with T2DM from 2002 to 2014, blood and urine samples were collected at baseline and during follow-ups.

•

Long-term glycemic variability is a relatively new risk marker for onset and progression, and may have the potential to be used for monitoring DM control in an effort to prevent renal complication.

We identified 533 patients with no pre-existing kidney disease for onset of Chronic Kidney Disease (CKD) analysis and 967 patients with pre-existing kidney disease for CKD progression analysis. About 45% of patients developed CKD and 61% had CKD progression. Among patients with onset of CKD, three-quarters had only albuminuria. Among patients with CKD progression, about two-thirds had only estimated glomerular filtration (eGFR) decline. Albuminuria and long-term glycemic variability were independently associated with both onset and progression. Male and older age groups were associated with onset whereas poorer glycemic control, lower eGFR, higher systolic blood pressure and higher LDL-cholesterol were associated with progression.

The main findings from this retrospective study were: • Albuminuria was the first manifestation of CKD in most patients with T2DM. • The onset and progression of CKD were predicted by multiple risk factors, some of which were modifiable.

• The shared and unshared risk factors for onset and progression may inform potential treatment strategies.

Dr Serena Low won the Best Poster Award for this study at The 18th ASEAN Federation of Endocrine Societies (AFES) Congress 2015.

Research on Obesity and Response to Bariatric or Metabolic Surgery Led by Dr Angela Moh Mei Chung, Mr Melvin Wong, A/Prof Lim Su Chi, Dr Anton Cheng

Beginning from 2007, the Clinical Research Unit, in collaboration with Dr Anton Cheng’s team from the Department of General Surgery, has been collecting biological samples obtained from cross-sectional and prospective cohorts of obese patients (mean BMI ~40 kg/m2) who underwent different types of bariatric procedures. Using these bio-banked samples, we have initiated research to identify the genetics underlying poor weight-loss response to bariatric surgery, and the protective genes against T2DM in metabolically healthy obese individuals. Additionally, we are characterising the metabolic signature shift in T2DM after bariatric or metabolic surgery, and have presented our findings at conferences. We demonstrated that early alterations of various plasma metabolites after surgery may contribute to the early anti-diabetic effect of surgery.

Distribution of bariatric procedures performed on research participants recruited at KTPH between 2007-2015 Sleeve gastrectomy

45%

Roux-en-Y gastric bypass

Others

3%

34%

18%

Gastric band

BMI distribution of bariatric research participants recruited at KTPH between 2007-2015

Percentage of research participants

Bariatric or metabolic surgery is the most effective longterm weight loss treatment for obesity and Type 2 Diabetes Mellitus (T2DM), but the effects on weight loss and diabetes remission can vary substantially among patients.

Some individuals fail to achieve the desired weight and, or glycaemic control, and eventually revert to their preoperative state. The precise cellular and molecular mechanism of action of this surgery remains unclear, but is believed to result in different physiological changes that reset the body’s set point to a new equilibrium at a lower body weight. Genetic and environmental factors have been implicated to play a key role in determining a patient’s response to surgery.

45 40 35 30 25 20 15 10 5 0

<30 kg/m2 30-39.9 kg/m2 40-49.9 kg/m2 50-59.9 kg/m2 >60 kg/m2

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Diabetes Centre Diabetes Centre in KTPH is set up specially to help people with diabetes in managing their conditions and helping them to avoid or cope with complications that can arise. Our team comprises of specialists from multiple disciplines who are committed to advancing healthcare for our patients through research.

Fasting during Ramadan in people with Type 2 Diabetes Mellitus (T2DM) Led by Dr Ester Yeoh

An award winning research of the Annals Academy of Medicine Gold Best Paper Award in 2016, and published in the Annals Academy of Medicine Singapore 2015, “Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore”, was conducted at the KTPH Diabetes Centre during the month of Ramadan in 2011.

In this study, supported by a grant from the Endocrine and Metabolic Society of Singapore (EMSS), 29 Muslim patients with Type 2 Diabetes Mellitus (T2DM) were provided with pre-Ramadan education and followed up for changes in their dietary intake, body composition and metabolic profile namely HbA1c, lipid profile and blood pressure, before, during and after the fasting month.

From the study results, we concluded that fasting during Ramadan can be practiced safely with prior patient

Dr Ester Yeoh receiving the KTPH Research Scholarship from A/Prof Kenneth Mak (former Chairman, Medical Board, KTPH) at the KTPH Research & Innovation Forum on 27 October 2015.

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education and appropriate medication adjustment in patients with T2DM. There were also modest benefits on metabolic profile with improvements in HbA1c and body composition where a reduction in body fat mass was observed.

Performing this study enabled us to identify the needs of patients who fast during Ramadan. Many of the patients who were recruited remain on follow-up and attend the Ramadan pre-education workshop conducted at the Diabetes Centre.

The research was presented as a poster presentation at The Endocrine Society’s Annual Meeting (ENDO 2013) in San Francisco, USA. Study findings were also shared locally on News Radio Channel 938 Live with DJ Daniel Martin in July 2015.

Dr Ester Yeoh’s poster on management of diabetes during Ramadan.

Foot Screening in Patients with Type 2 Diabetes Mellitus Led by A/Prof Tavintharan Subramaniam, Ms Chelsea Law, Dr Sharon Pek, Dr Julian Wong Chi Leung, Dr Leung Chuo Ren, Dr Desmond Ooi Guo Shen

In Singapore, the prevalence of Type 2 Diabetes Mellitus (T2DM) in adults has reached an alarming 11.3% in year 2010. Lower-extremity diseases (LEDs), including diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD), are leading causes of non-traumatic amputations in patients with T2DM.

Image of a patient with a gangrene toe

Work in-progress Foot complications in patients with T2DM

25.0 20.0 15.0 10.0 5.0 0.0

<40

40-49

Age Groups

50-59

PAD

60-69 DPN Amputation

>69

Figure on prevalence of foot complications in 2054 patients with T2DM

As part of our efforts to monitor these high-risk patients, we are collecting anthropometric and blood biochemistry data, prospectively, from patients with chronic kidney disease (high-risk patients). In addition, we have on-going research collaborations with KTPH vascular surgeons, looking at outcome predictors in patients with T2DM and PAD including those with chronic kidney disease and patients with vascular interventions. As presence of neuropathy is also suggested to be an important predictor of higher economic burden to patients, further work is being planned to study the health economics of this group of patients.

We have been involved in studies related to foot complications in both the Singapore general population and patients from Diabetes Centre, KTPH. PAD is present in 4.3% and peripheral neuropathy in 7.5% of the Singapore general population. In patients with T2DM, 13.4% have PAD and 10.8% have DPN, suggesting that patients with T2DM are high-risk groups for amputations.

Screening strategies for high-risk patients, at a reasonable cost and appropriate time, are therefore required to be put in place.

Our study suggests that, within two years, one in five patients with diabetes and no PAD may have significant progression of peripheral arterial disease. Apart from poor glucose control, patients with hyperlidemia, kidney impairment and retinopathy are at high risk of foot complications. Annual foot assessment and better control of hyperlipidaemia may thus be required for atrisk patients, for early detection and prevention of foot complications.

From L-R: Ms Chelsea Law, Dr Julian Wong, A/Prof Tavintharan Subramanian, Dr Leong Chuo Ren, Dr Sharon Pek

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Department of General Surgery The Department of General Surgery takes pride in delivering integrated and coordinated transdisciplinary surgical care to our patients.

Transdisciplinary Care of Surgical Patients Helps to Improve Patient Outcomes Led by Dr Surendra Mantoo, A/Prof Tan Kok Yang and team

Pre-operative exercises taught by physiotherapist to patient and family before discharge. These exercises are to be continued at home by patient after the scheduled surgery.

Post-operative visit: Ong Yu Jing (SSN) doing medication reconciliation, ensuring medication compliance and to reduce poly-pharmacy.

Post-operative rehabilitation held in outpatient clinic; with a common goal set to regain patientâ&#x20AC;&#x2122;s functional status.

Dr Clement Chia received the Outstanding Patient Care Improvement Award from Mr Liak Teng Lit (GCEO, AHS) during AH Quality Conference on 14 April 2016.

Published and presented in Colorectal Disease Journal, our study illustrates the effect of prehabilitation and rehabilitation on elective colorectal surgery to achieve an excellent functional outcome in frail elderly patients.

It documents the regime of prehabilitation and how it can be delivered in a novel start to finish (STF) transinstitutional transdisciplinary model of care.

prospective study. Comparing the surgical outcomes of those who were in the STF programme after its initiation in January 2012 to the non-STF group, we managed to achieve a significantly shorter hospital stay in frail patients having colorectal surgery through the trans-institutional transdisciplinary approach. All elective patients who received prehabilitation achieved full functional recovery.

Patients who underwent major colorectal resection and were managed under Geriatric Surgery Service (GSS) from January 2007 to December 2014 were included in this

There were no significant differences in a Clavienâ&#x20AC;&#x201C;Dindo complication score of Grade 3 or more and 30-day mortality between the two groups.

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Bariatric Surgery to Help Patients with Obesity and Diabetes Led by Dr Anton Cheng, Ms Bernice Tan and team

Ms Bernice Tan (Research Nurse) taking the height and weight for a research volunteer.

The beneficial effect of bariatric surgery in the improvement or resolution of Type 2 Diabetes Mellitus (T2DM) in the morbidly obese is well documented.

However, the evidence for those not so obese is not as robust. Dr Cheng is currently conducting a randomised control trial to study if the not so obese population in Asia with BMI 27-32 is useful in controlling T2DM. Reported in The New Paper on 22 May 2015, obese diabetics, or diabesity, is a rampant problem and the number of people with the condition is projected to increase exponentially in the coming years. The

proportion of obese adults aged 18 to 69 years was 10.8% in 2010, according to a National Health Survey conducted by the Ministry of Health. This was significantly higher than the obesity level of 6.9% in 2004.

A combination of obesity and diabetes can be a chronic problem, which leads to death and disabilities through long-term health implications such as stroke, blindness, kidney failure, coronary heart disease, cardiovascular disease. Among the above, cardiovascular disease is a common health complication that patients with obesity and diabetes face.

Source: The New Paper Š Singapore Press Holdings Limited. Reproduced with permission

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Department of General Medicine Physicians in the Department of General Medicine are dedicated to providing effective, timely and holistic care for our patients. We believe in empowering the patient through patient education to collaboratively manage his/her condition better. We value research to understand our patients better and critically assess novel therapies and clinical tools, so as to improve clinical outcomes of our patients.

Understanding Our Diabetic Patients to Improve Treatment Outcomes Led by Dr Angela Koh, A/Prof Sum Chee Fang and team Type 2 Diabetes Mellitus (T2DM) is a rising problem in youths worldwide, with worrisome trends of youths with T2DM developing diabetes-related complications sooner than those with Type 1 Diabetes Mellitus (T1DM).

We reviewed patients under the age of 30 years on follow-up at the KTPH Diabetes Centre and found that patients with T2DM develop diabetes-related complications sooner than T1DM patients. It is hence imperative to intervene early to prevent or retard diabetes progression and complications in these patients.

While diet is a cornerstone in managing DM, tools developed in the west to evaluate one’s carbohydrate knowledge may not work well in our population, since the typical Asian diet consists of varied carbohydrate choices different from those in a Western diet.

Supported by Alexandra Health Enabling Grant and presented at the 73rd Annual Scientific Sessions of the American Diabetes Association, we developed a carbohydrate and insulin dosing knowledge quiz in patients with DM on a predominantly Asian diet. Our analysis suggested that this new

quiz had good reliability and validity, and will be a useful screening tool in clinical practice.

Dr Angela Koh with her poster at Alexandra Health (AH) Forum in conjunction with AH Nursing Fest 2014

Keeping Our Hospital Safe for Our Patients

Led by Dr Willis George Christopher, Dr Ooi Say Tat, Sister Foo Meow Ling and team Infection control is vital to prevent patients from getting a hospital acquired infection, particularly from multi-drug resistant “superbugs”.

From three years of data collected at KTPH, we noted significantly

lower rates of hospital-acquired methicillin-resistant staphylococcus aureus (HA-MRSA) infections among patients who were screened to be carriers of MRSA and received daily CHG baths compared to those in whom MRSA was not detected and

hence did not receive the CHG baths.

This simple strategy of daily CHG bathing for MRSA-colonized patients throughout their hospital stay renders a significant preventive effect on HA-MRSA infections in this high risk group.

Dr Willis George Christopher, Dr Ooi Say Tat, Sister Foo Meow Ling and team after performing their hand hygiene relay on Global Hand Hygiene Day 2015

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Department of Cardiology The Department of Cardiology provides round the clock specialist service to keep patients’ hearts healthy. Together with the Cardiovascular Centre, our highly trained team of doctors and healthcare professionals offers a wide range of imaging, nuclear and interventional cardiology procedures for a hassle free experience for our patients.

A PET Myocardial Perfusion and Metabolism Study Led by Dr Ling Lee Fong

Assessment of Myocardial Perfusion Imaging with Cardiac CT

Led by Dr Ong Hean Yee

Since the submission of our first protocol for the Institutional Review Board’s approval in 2009, followed by a publication in 2010, CT myocardial perfusion has become a subject of great interest. Till today, however, there remains no standard protocol for the technique despite having numerous papers published and a multicentre trial conducted.

Awarded the KTPH Small Innovative Grant (SIG) I, our study set out to compare various CT myocardial perfusion imaging protocols, establish the relative strengths and limitations of different protocols and also to benchmark the results against those obtained through other stress modalities.

Dr Ling Lee Fong was awarded the prestigious Young Investigators Awards by the American College of Cardiology during the 61st Prize Presentation in conjunction with Annual Convocation in March, 2012.

After the recent STITCH trial suggested that there is a lack of prognostic benefit of revascularization of myocardium deemed viable by standard techniques, we wanted to seek the impact of completeness of revascularization as compared to medical therapy in relation to jeopardized myocardium in patients with left ventricular dysfunction caused by known or suspected coronary artery disease.

As published in the Journal of the American College of Cardiology, we had 661 patients undergo fluorodeoxyglucose positron emission tomography (PET/FDG) and measured the extent of perfusion defects and metabolism-perfusion mismatch.

Within 90 days, revascularization was observed in 222 patients (of

which 103 underwent incomplete revascularization) and 439 were treated medically.

During a mean follow-up of 2.8 ± 1.4 years, we recorded 218 deaths and concluded that patients with ischemic cardiomyopathy received the greatest progressive benefit of complete revascularization with increased amounts of jeopardized myocardium.

We found that at ≥25% of jeopardized myocardium, there was an improved survival rate in patients with complete revascularization, but the same increase was less beneficial with incomplete revascularization as compared to medical therapy alone. Our study was awarded the prestigious Young Investigators Awards by the American College of Cardiology in 2012.

Through our simple design, we aimed to determine if the extent and location of coronary ischemia and infarction detected by CT myocardial perfusion studies are consistent with that identified by different CT protocols and different stress imaging modalities.

Also, we wanted to find out if stressrest protocols or rest-stress dynamic, static and dual-energy CT perfusion protocols are practical and easily performed in daily practice. We had also set out to establish normal values using this modality and results which were published in 2014.

While there are significant benefits in establishing comparability of CT perfusion imaging with other imaging modalities in detection of ischemia and infarction, it is important to note that patients were exposed to both contrast media as well as comparable amounts of radiation during CT perfusion imaging when compared to traditional SPECT imaging.

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Department of Ophthalmology and Visual Sciences At the Department of Ophthalmology and Visual Sciences (OVS), we are committed to offering patient-centred and proficient eye care. We employ state-of-the-art technology as well as conduct research into cutting-edge treatment options to care for our patients.

Understanding the Growing Problem of Age-related Macular Degeneration (AMD) in Singapore Led by Dr Kumari Neelam, Dr Henrietta Ho, A/Prof Chee Chew Yip, Dr Wenyun Li, Dr Au Eong Kah Guan AMD is a leading cause of irreversible blindness in the elderly population. With a global demographic shift towards an aged population, blindness from AMD will present an increasingly significant healthcare problem. This is especially so in Asia, which currently accounts for 60% of the worldâ&#x20AC;&#x2122;s population and will eventually contribute the highest global prevalence of AMD by 2040. Risk factor identification and modification remain an important approach to reduce the risk of development of AMD.

There is increasing evidence that macular pigment (MP) levels in the retina can be augmented following increased dietary intake of lutein (L) and zeaxanthin (Z), suggesting the possibility of therapeutic intervention to reduce the risk of development of AMD. We examined the spatial profile of MP and its relationship with serum concentrations of L and Z in subjects from a Singapore Chinese population.

In this cross-sectional study published in the journal Investigative Ophthalmology & Visual Science, the sociodemographic, lifestyle information, body mass index (BMI), visual acuity, MP spatial profile using a macular densitometer, and serum L and Z were recorded in 95 healthy subjects. A central dip in MP spatial profile was observed with older age and higher BMI, the two known risk factors for AMD, suggesting that atypical MP spatial profile may be associated with an increased risk of AMD. Further studies with larger sample sizes are required to confirm these observations.

Raising the awareness of AMD by educating the public about prevention, importance of early detection and regular screening is crucial to limit the impact of this potentially blinding disease on our population and healthcare resources. At community level, the department has been organizing an annual AMD Awareness campaign since 2005 in conjunction with the Health Promotion Board, restructured hospitals and optical shops. After five years of nationwide awareness campaigns, awareness of AMD and its risk factors were assessed among 559 participants who were randomly selected from the Global Yellow Pages Singapore residential listings 2009/2010 through a cross-sectional questionnaire-based telephone survey. The results demonstrated that self-reported awareness of AMD among Singapore residents had increased four-fold from 7.3% in 2006 to 28.1% in 2011.

The study was published in Ophthalmic Epidemiology

by Dr Srinivasan Sanjay, You Chuen Chin, Hui Ting Teo, Shu Xuan Ong, Serene Hui Fang Toh, Ming Hui Khong, Anna C. H. Yeo, Kah-Guan Au Eong.

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Figure 1 Fundus photo showing Advanced AMD

Figure 2 Fundus photo showing Early AMD

Department of Diagnostic Radiology Role of Radiology in Medical Interventions Led by Dr Ashish Chawla, Dr Sivasubramanian Srinivasan, Dr. Sumer Shikhare, Prof Wilfred CG Peh

Radiology is indispensable in medical interventions for achieving accurate diagnoses and establishing suitable forms of treatment for our patients. With reference to the 2015 editions of Emergency Radiology and Singapore Medical Journal, we have documented a set of procedures and useful notes to overcome typical challenges posed by unique properties of the human anatomy and medical conditions during imaging in emergency settings.

Acute Cholecystitis and Cholecystitis Imaging Imaging studies including ultrasonography, computed tomography and magnetic resonance imaging are increasingly utilised for evaluation of suspected cases of cholecystitis. For quick diagnosis, identification of complications and surgical planning, going over a checklist is recommended.

Published in Singapore Medical Journal. 2015; 56(8):438-444.

MDCT in Uncommon Gastric Conditions The stomach is susceptible to various diseases, but remains overlooked in CT examinations.

Until recently, the role of CT has been negligible in gastric pathologies such as staging of stomach cancer and was considered inapt for evaluating other conditions.

Awarded Certificate of Merit at the European Congress of Radiology 2014.(Vienna, Austria)

Schematic Interpretation of Lateral Neck Radiographs The complex anatomy of the neck makes it tricky to differentiate soft tissue structures on a lateral radiograph. By reading the radiograph alongside case images of possible pathologies, this schematic interpretation can assist the radiologists to make an accurate diagnosis within the shortest time possible.

Published in Emergency Radiology. 2016 Feb;23(1):79-87

Noncardiovascular Thoracic Imaging A small subset of patients with underlying noncardiovascular conditions display similar symptoms of chest pain, dyspnoea, cough, haemoptysis and haematemesis. Imaging findings in common noncardiovascular conditions of the chest frequently encountered during emergencies make good references for radiologists in similar situations.

Published in Singapore Medical Journal. 2015 Nov;56(11):604-10.

Triple Bolus Technique with Dual Energy CT The triple-bolus CT urography technique uses dual energy CT and is a dose-efficient protocol permitting comprehensive study of the urinary system in a single acquisition. It can be used potentially as a standard protocol for CT urography.

Won the Young Radiologistâ&#x20AC;&#x2122;s Investigator Award (Oral) at the 15th Congress of the Asean Association of Radiology 2011.

(Singapore)

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Department of Geriatric Medicine Geriatric Medicine caters to the health needs of the elderly in Singapore. The vision is to add healthy life to older people through comprehensive geriatric care, education and research.

From L-R: Dr Nieh Chih Ming, Dr Anupama R Chowdhury, Ms Low Suat Fern, A/Prof Philip Yap, Dr Lawrence Tan, Dr Ng Chong Jin

Advance Care Planning for Patients with Early Cognitive Impairment

Led by A/Prof Philip Yap and team

Advance care planning (ACP) is advocated as a means to uphold the autonomy of individuals and enable them to express their wishes for the future while they still possess mental capacity.

We explored the perspectives of patients with Early Cognitive Impairment (ECI) on ACP, and in particular, sought to better understand their reasons for resistance which appear to be influenced by personal values, coping behaviours and sociocultural norms.

Published in Journal of the American Medical Directors 2015, our study showed that better education and higher executive function predict willingness to engage in ACP, and these factors are instrumental in a personâ&#x20AC;&#x2122;s ability to acquire knowledge and process information. Initiating ACP discussions early, increasing efforts at education, and providing tailored information are important interventions that facilitate completion of ACP, allowing more opportunities to engage and understand patients

Gain in Alzheimer care Instrument (GAIN)

who have not given much consideration to making advance care plans.

The main barriers to advance care planning were that patients had not given much thought to it, adopted a passive attitude, and depended on their families for making future care decisions. It is imperative to explore each of these barriers in greater depth and derive ways to help seniors through them.

Early intervention is also important to capitalise on the narrow window of opportunity before further cognitive decline renders them unable to meaningfully participate in ACP. â&#x20AC;&#x201C; A/Prof Yap

Family care givers of dementia patients are subject to emotional, physical, and financial burden, often resulting in negative effects on their health. However, caregivers also report positive experiences from caregiving. While caregiver burden and stress have been extensively studied, little has been published on the positive effects of caregiving.

We developed the Gain in Alzheimer care Instrument (GAIN), a new scale that measures caregiving gains that is grounded in the actual positive experience of dementia carers and derived from in-depth qualitative data. Psychometrically reliable and valid, GAIN adds an important dimension to carer assessment in dementia. To date, we have received several overseas requests for the use of the scale since its publication in 2010 in the esteemed The American Journal of Geriatric Psychiatry.

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Department of Urology Catheter-free First Postoperative Day Discharge

Led by Dr Cheuk Fan Shum, Dr Amit Mukherjee, A/Prof Colin Teo and team

Our department has adopted a protocol for catheter-free first postoperative day discharge after the bipolar transurethral resection of the prostate.

As published in International Journal of Urology 2014, all patients adhered to the protocol regardless of indications and background comorbid conditions. Bladder irrigation was stopped in the evening after transurethral resection of the prostate and the catheter was removed at 0600 hours.

All patients were discharged on the first postoperative day and later reviewed at an interval of one and six months with the International Prostate Symptom Score and uroflowmetry. The oldest patient in the study was 91 years old, and the largest resected weight was 133 grams.

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The improvement in terms of International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual volume was found to be comparable with those reported in literature for bipolar transurethral resection of the prostate. Early and late complication rates also compared favourably. The shortened post-operative hospital admission meant more cost-savings to the patients and the healthcare system, without compromise in surgical effectiveness and safety.

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From left to right 1. Dr Marrero Leynard Manuel 2. Dr Lau Weida 3. Dr Shum Cheuk Fan 4. Dr Lim Tow Poh 5. Dr Amit Mukherjee 6. Adj Asst Prof Colin Teo 7. Dr Molly Eng May Ping 8. Dr Yeow Siying 9. Dr Felicia Hong 10. Dr Amelia Yeap

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Department of Family and Community Medicine Studying a Novel Measure of Obesity and How Different Measures of Obesity Are Associated with Cardiovascular Disease Risk Factors Led by Dr Benjamin Lam

Obesity is characterized by a relative excess of fat and is commonly measured by Body Mass Index (BMI).

However, the BMI uses total body weight and is unable to differentiate between lean mass and fat mass. Hence, a novel measure called the Body Adiposity Index (BAI) was proposed in 2011, which was derived through a population study on Mexican Americans and African Americans.

Our first study was to validate the use of BAI in our local Chinese population, and we found that the BAI tends to underestimate one’s % body fat with a wide margin of accuracy. Also, when compared to the established BMI, the BAI was not better at predicting body fatness and hence, was not found to be a better overall index of adiposity than the BMI. This study clinched the Best Poster Gold award in the Clinical Research Category at the Singapore Health and Biomedical Congress 2012, and was published in Obesity Journal in 2013.

We then proceeded to study the relationship between various commonly used measures of adiposity (BMI, Waist Circumference, Waist Hip Ratio, Waist Height Ratio) together with the BAI, and common cardiovascular disease (CVD) risk factors such as high blood pressure, abnormal cholesterol levels and type 2 diabetes mellitus in a local population of 1,891 research volunteers, comprising 59.1% Chinese, 22.2% Malays and 18.7% Indians aged 21 to 74 years. And once again, we found that the BAI was not a better overall index of adiposity than the BMI, hence showing that the BAI is not only not very accurate but also lacks clinical efficacy in its relationship with CVD risk factors.

Poster Presentation by Dr Benjamin Lam at Australian and New Zealand Obesity Society (ANZOS) and the Australian Lifestyle Medicine Association (ALMA) Annual Scientific Meeting 2014 in Sydney

In addition, our study also suggested that in the assessment of CVD risk factors, a combination of measures for general and central adiposity would be more appropriate in the identifying of CVD risk factors.

We therefore concluded that a combination of BMI and Waist Height Ratio could have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore. This finding translates to a simple public health message of getting the public to visit their doctors for a medical evaluation for CVD risk factors if their waist circumference is more than half their height, especially if their BMI is ≥23.0 kg/m2.

This message was shared on news radio channel LIVE938’s Body and Soul segment on 2 November 2015, and this study has been presented at the Australian and New Zealand Obesity Annual Scientific Meeting 2014 in Sydney and also published in Public Library of Science (PLOS) Journal in 2015.

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Department of Otorhinolaryngology Use of Narrow-Band Imaging in Detection of Nasopharyngeal Carcinoma

Led by Dr Thong Jiun Fong, Dr David Loke, Dr Karumathil Ranjini, Dr Paul Mok Han Hwei The Department of Otorhinolaryngology undertook a study to find out if narrowband imaging would be useful in differentiating normal adenoidal tissue from nasopharyngeal carcinoma. A total of 30 patients with nasopharyngeal mass were evaluated using both conventional white light and narrow band light; of the 30, 21 patients had normal adenoidal tissue and seven had nasopharyngeal carcinoma.

After biopsies and the Epstein-Barr viral serology was tested on all of them, the features on the surface of adenoidal tissue and nasopharyngeal carcinoma appear to have distinctly different characteristics. The results showed that narrow-band imaging in

all normal adenoidal tissue featured regularly-arranged follicular pattern, where each ‘follicle’ is composed of a pale centre and surrounded by a dark periphery. Whereas in the appearances of nasopharyngeal carcinoma, narrow-band imagining showed an absence of surface pattern and/or a “reverse” haphazard follicular patterns with dark brown centres and pale peripheries.

While further diagnostics are needed to evaluate accuracy, it was concluded that narrow-band imaging was able to differentiate normal tissue from malignancy. The results were published in 127th volume of The Journal of Laryngology & Otology in February 2013.

Figure 1 Endoscopic appearance of normal nasopharynx comparing conventional white light with narrow-band light.

Regularly-arranged follicular patterns with pale-centred follicles and dark peripheries are clearly-visualised with narrow band imaging.

Figure 4 Endoscopic appearance of nasopharyngeal carcinoma comparing conventional white light with narrow band light. With narrow band light, it is clear that there are haphazardly-arranged follicular patterns and an increase in brown areas on the surface of the suspicious lesion.

Figure 2 Endoscopic appearance of adenoids comparing conventional white light with narrow-band light.

Figure 5 Endoscopic appearance of nasopharyngeal carcinoma showing irregular follicular patterns with reversal of follicular patterns (dark brown centre and pale periphery).

Figure 3 Magnified images of adenoids as seen with narrow-band light

Figure 6 Endoscopic appearance of nasopharyngeal carcinoma showing absence of surface patterns.

Obstructive Sleep Apnea (OSA)

Multilevel Obstruction in Obstructive Sleep Apnea: Prevalence, Severity and Predictive Factors Led by Dr Phua Chu Qin, Dr Yeo Wei Xin, Dr Paul Mok Han Hwei

Obstructive Sleep Apnea (OSA) patients suffer from obstruction of their upper airway which can be single or multilevel. However, the convenient assumption out there is that mild OSA is associated with single level obstruction or with fewer levels of obstructions. This is not necessarily true and patients may receive suboptimal treatment as a result. It is therefore important to understand the correlation of the severity of OSA with the levels of obstruction in order to provide a guide to the selection and prioritisation of treatment strategies in the surgical modification of the upper airway.

While recent surgical management trend towards multilevel surgery and preliminary data shows promising results, there is still a lack of data regarding the prevalence of single versus multilevel obstruction in our OSA patients. Currently, little is known regarding the severity of apnea hypopnea index (AHI) in relation to single level or multilevel obstruction.

In this study, we aimed to find out the prevalence, severity and predictive factors of multilevel obstruction in OSA. Our findings show that multilevel upper airway obstruction is more prevalent in the OSA population and is associated with more severe OSA, and also discovered that some anatomic levels of obstruction contribute more significantly towards the severity of OSA. From this, it was concluded that there should be greater focus on the surgical management of patients, with more attention being paid towards localising the levels of obstruction and the tailoring of surgical intervention for them.

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Department of Anaesthesia The Department of Anaesthesia comprises a team of dedicated doctors whose primary role is to provide safe and pain-free anaesthesia for patients undergoing surgery. In recent years their roles have expanded beyond the operating theatres to include the intensive care unit and pain clinic.

Obstructive Sleep Apnea (OSA) Led by Dr Edwin Seet and team

Obstructive sleep apnea (OSA) is defined by repetitive partial or complete upper airway obstruction characterized by episodes of breathing cessation during sleep. It is the most prevalent of sleep disorders, seen in about one in four males and one in ten females. Patients with OSA are more susceptible to postoperative adverse respiratory events, sustained arrhythmias, hypertension and other cardiovascular events. We have carried out in-depth studies on OSA in KTPH, and categorised our observations according to the stages prior to, during and after surgery for a comprehensive understanding of how patients with OSA should be cared for.

Pre-operative

Perioperative

Postoperative

We screened patients undergoing elective surgery for OSA using the STOP-BANG questionnaire, and found a novel association between higher pre-operative STOP-BANG scores with postoperative admission to critical care, which suggests that it could help plan scheduled postoperative critical care admission.

This study demonstrated that the STOP-BANG score may be used to stratify need for postoperative critical care, in addition to ASA physical status and previously diagnosed OSA.

Perioperative precautions, such as anticipation of a possible difficult airway, use of short-acting anesthetic agents, avoidance of opioids, and extubation in a non-supine position, should be undertaken for known or suspected high-risk OSA patients.

From our studies, we conclude that risk stratification should be undertaken for known and suspected OSA patients, and care should be individualized. Practical algorithms based on current best evidence and expert opinion may be useful in perioperative management.

Occurrence of OSA is common in the general surgical population, but majority of these patients are unrecognized at the time of surgery and might put them at higher risk of postoperative vascular events. The POSA study was started to determine the risks of postoperative vascular events in patients with unrecognised and untreated OSA. Specifically, it will facilitate surgeons and patients in making decisions and will guide perioperative patient management.

This project which was funded by Alexandra Health Enabling Grant in FY11, and has won first prize in the Clinical Research Category of the Annual Meeting of Society of Anaesthesia and Sleep Medicine on 12 October 2012 in Washington DC and was awarded Best Poster in the Clinical category at the AH Forum 2014. The perioperative practical algorithms for OSA management was published as a Continuing Professional Development article in the Canadian Journal of Anesthesia.

Intensive Care Units (ICU)

Led by Dr Shahla Siddiqui and team

The ICU is an area of high acuity and high mortality, and bears roughly 20% of any hospital budget. Our team studied the mortality profiles across our ICUs from our hospital’s 5-year database and found a trend of the number of elderly patients admitted across all ICUs (above 80 years), mostly requiring aggressive life-sustaining care. Follow-on detailed studies could be carried out to ascertain if triage and end-oflife decisions could be modified to provide better care to our patients.

Critical care rounds in the ICUs can be complex for medical trainees, and we also studied new methods to identify strengths and weaknesses in trainees’ clinical decision-making skills. We believe that the “Think-Aloud” tools and methods would benefit weaker and silent trainees. While doctors generally receive substantial training to communicate with patients and their families, this often neglects communication with peers, colleagues, or other team members. “Think-Aloud” tools can help learning in a complex clinical environment and, ultimately, to improved patient care.

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A North View student presenting a card to Dr Shahla Siddiqui

Melatonin and Pain Led by Dr Edwin Seet, Dr Liaw Chen Mei and Dr Sylvia Tay Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. Our study on the effect of melatonin premedication on postoperative pain and preoperative anxiety was awarded a $50K grant by the National Medical Research Council in May 2011 and published in the Singapore Medical Journal 2015.

76 patients aged between 21 and 65 years old scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia at KTPH received either 6 mg of melatonin or a placebo 90 minutes before surgery.

Their visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained and analysed. Our results showed that although melatonin use did not consistently contribute to pain and anxiety amelioration in all patients, there was a positive effect in female patients, suggesting a sexual dimorphism in melatonin use outcomes.

The article entitled “Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial” published in the Singapore Medical Journal 2015 has been awarded the second prize for the SMJ Best Research Paper Award 2015. Dr Edwin Seet was receiving the award during SMA Annual Dinner on 11 May 2016.

Department of Psychological Medicine The Prevalence of Post-Traumatic Stress Disorder in ICU Staff and the Common Coping Strategies Used

Led by Dr Shahla Siddiqui, Dr Surej John, Dr Yu Zheng Ong, Ms Zen Chen, Ms Su Chang

Dr Shahla Siddiqui

Dr Surej John

The medical personnel of the intensive care unit (ICU) encounter patients who require multiple life-sustaining interventions on a daily basis. Working in a stressful environment such as the ICU may have detrimental effects on the physiological and psychological well-being of the staff. Large studies on this are absent in Singapore and certainly not on its prevalence in ICU staff. We hypothesised that ICU staff may be at increased risk for developing symptoms of PostTraumatic Stress Disorder (PTSD) and other psychological disorders.

A study of our hospital’s doctors and nurses working in ICU was conducted through voluntary and anonymous surveys to measure the PostTraumatic Symptom Scale-10 (PTSS10), Hospital Anxiety and Depression Scale (HADS) and COPE Inventory.

28% of staff had experienced nightmares in relation to their work.

11% of staff had significant anxiety symptoms and 12% showed depressive symptoms. More than 86% of them found working in ICU to be stressful.

Majority of staff (92%) adapted positively with a large number resorting to active coping, positive reframing of religion, and acceptance.

To deal with this concern, it is important to make people aware of this phenomenon and make it easy for staff to seek help. KTPH has a Staff Crisis Programme where peer supporters provide emotional support and are trained to listen without judging.

This study was published in the Annals Academy of Medicine in May 2016.

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Department of Acute and Emergency Care Scalp Laceration Repair by Nurses in an Urban Emergency Department A Prospective Observational Study Led by Dr Desmond Mao

Scalp laceration is a common injury seen in the Emergency Department (ED) that requires a significant amount of time and resources for repair. A previous study had shown that with adequate training, nonphysicians were able to perform repair of lacerations with similar efficiency, low infection rate, and cosmetic outcomes as physicians thereby reducing their workloads and improve workflow within EDs. To our knowledge, this had not been replicated in a local setting.

Hence, we embarked on a project to evaluate the clinical efficacy and benefits of a nurse-driven scalp laceration repair program with wound infection as a primary outcome. It also aimed to measure both patient and nurse satisfaction with the new scalp laceration repair workflow through targeted surveys.

The study ED repaired at least 20 scalp lacerations per month. In March 2013, a new programme was approved by the study

hospitalâ&#x20AC;&#x2122;s medical board to assign Emergency Nurses (EN) scalp lacerations to manage and repair.

Consequently, 10 senior ENs were trained and accredited to perform scalp laceration repair by the study hospital.

The study has shown that successful implementation of the workflow had resulted in a greater sense of nursesâ&#x20AC;&#x2122; empowerment and had demonstrated that locally trained EN were capable of effective scalp laceration repair. Through this project, a stronger working relationship between doctors and nurses were also fostered in the department.

Dr Mao, the principal investigator, was awarded the very first KTPH Clinician Leadership in Research (CLR) Programme in Health Service track and a poster was presented at the 2016 SEMS-International Resuscitation Science Symposium.

He also gained knowledge in the pedagogy of research training and

brought back this skill to teach his juniors and peers in the department.

Going forward, this project will serve as a pilot for a bigger project that is being considered which will include more nurses and more complicated wound management.

Ms Rebacca Cheng (left) and Dr Desmond Mao at the SEMS Annual Scientific Meeting / International Resuscitation Science Symposium (SEMS I-ReSS) 2016

Department of Orthopaedic Surgery The Influence of Histological Subtype in Predicting Survival of Lung Cancer Patients with Spinal Metastases Led by Dr Aravind Kumar and team Recent advancements in systemic therapies for lung cancer have significantly improved the survival of patients with certain histological subtypes.

Since existing prognostic scoring systems do not consider the histological sub-type, they have little to no prognostic value in lung cancer spinal metastases.

In this article which was published in The Spine Journal, the survival of lung cancer patients with spinal metastases was analysed according to different histological subtypes by evaluating patient demographic variables, lung cancer histology and various modalities of oncologic treatment.

Univariate and multivariate cox regression analyses were also performed. The overall median survival time was 4.8 months.

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Given the non-predictive nature of prognostic scoring systems in this patient group, profiling patients according to factors such as female gender, Chinese ethnicity, nonsmall cell lung cancer, epidermal growth factor receptor tyrosine kinase inhibitor therapy, platinum doublet chemotherapy and local radiotherapy for spinal metastases should help guide decisions for surgical management of spinal metastases as they are all independent favourable prognostic factors.

This study was also presented at the Spine Society of Australia 27th Annual Scientific Meeting in Melbourne.

Rehab Services Rehab Services has completed numerous research papers over the past few years, all of them centered on improving the quality of care for our patients, especially the elderly.

So far, much research in the areas of normative data, mobility, and quality of life has been done at KTPH to meet the mounting demands of Singapore’s aging population.

Recently, one team looked into the correlation between normative data for grip strength and the risk of falls, quality of life, and fitness. The study hoped to help identify risk earlier so necessary preventive measures can be constructed accordingly.

“How strong is our grip?”

Team with their research poster during the World Confederation for Physical Therapy Congress, 2015.

Team with their research poster: “Impact on the Older Patients’ Walking Independence When Barriers Towards Maximising Their Mobility in the Geriatric Wards are Addressed”.

Titled ‘Getting Ambulatory Patients to “Keep Walking” During Hospitalization’, the research aimed to encourage patients to walk as part of their activities of daily living, out of therapy sessions, to prevent deconditioning during hospitalisation. The study found that the lack of walking aids and the nurses’ lack of confidence in mobilising patients were amongst the key factors holding the patients back.

In another research, the Rehab Services also found that a positive mealtime experience aids in social engagement and improving the quality of life.

After these root causes were identified and addressed, there was an increase in walking amongst our patients during hospitalization. In turn, it helped to prevent deconditioning during their hospital stay and also increased the confidence level of patients and their family members in their ability to manage care after discharge.

Prior to the study, our Speech Therapist had identified factors that could influence the mealtime experiences of residents during a staff-training program at a Singapore Nursing Home facility. Positive outcomes of the programme affirm the effectiveness of having in-house trainers within the nursing home as they facilitate feeding training for newly employed staff, monitor and ensure that ground staff nadhere to the good mealtime experience guidelines.

The mobility status on the bottom left indicates that the patient requires minimal assistance with a walking frame for ambulation.

Ms Chong Boon Keng, our Speech Therapist, with her poster presentation on “Enhancing Mealtime Experience for Residents in Singapore Nursing Home”.

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Pharmacy The Pharmacy Department aims to provide safe, timely and cost-effective healthcare good enough for our mothers. Led by our Chief Pharmacist, Dr Doreen Tan, we too are active in research, having presented at many scientific conferences, and active collaborations with both local and overseas partners.

PROJECT CUT-A-PILLER: When Less is More!

PROJECT CUT-A-PILLER has helped Madam Zaiton Yahya combat polypharmacy, a prevalent healthcare issue in Singapore where patients aged 65 and above are taking more than five medications daily. The programme, designed to flag review of medicines no longer necessary or problematic regimes, has impacted over 500 patients since its inception.

The 64 year-old housewife who was diagnosed with Type 2 Diabetes Mellitus (T2DM) since 1985 found herself taking up to 13 different medications daily when she suffered an arm fracture in 2012 and developed atrial fibrillation

in the same year. It was a struggle for Madam Zaiton to remember the precise doses of each medication putting her at risk of developing a stroke. She was admitted to hospital five times between 2011 and 2014.

At KTPH, our chief pharmacist, associate consultant and cardiology specialist pharmacist, Dr Doreen Tan, worked with Madam Zaiton’s doctors to remove medicines which she no longer requires, bringing the total number down to seven. With lesser medications, Madam Zaiton has not been admitted to the hospital since.

I’m happier with having fewer medicines because it’s a lot easier for me to remember which ones to take. It also makes me feel like I’m getting better.

– Madam Zaiton

PROJECT CUT-A-PILLER was published in The New Paper on 6 November 2014.

Source: The New Paper © Singapore Press Holdings Limited. Reproduced with permission

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CLOPRA: CLOpidogrel-PRAsugrel Switch Study

WARFGEN: Genotype-Guided Warfarin Dosing

Heart attack patients who undergo coronary stent implantations are required to take two anti-platelet medications: The combination of Aspirin with Clopidogrel or Prasugrel, to minimise the risk of clotting within the stent.

In 2012, a joint Pharmacy and Cardiology team at KTPH embarked on a CLOpidogrel-PRAsugrel switch study to compare the efficacy and costeffectiveness of these anti-platelets. As Prasugrel is more potent and far costlier than Clopidogrel, the study used platelet-reactivity testing to switch only poor responders of Clopidogrel to Prasugrel. This switch study amassed approximately $210,000 of cost savings since patients who were responders could stay on Clopidogrel, which is 27 times cheaper than Prasugrel.

CLOPRA won KTPH the Best Oral Poster at the Singapore Pharmacy Congress 2013. A larger study of 185 patients by the team was awarded third place in the Young Investigator’s Competition category at the Singapore Cardiac Society’s Annual Scientific Meeting 2014, the first institution other than the two national heart centres to be shortlisted in the Young Investigator Award (YIA) category.

Alexandra Health (AH) Forum in conjunction with AH Nursing Fest 2014 From L-R: Mr Aznan Omar, Ms Wendy Lee Boon Yee, Dr Grace Chang Shu Wen, Dr Doreen Tan

Despite its long standing history, warfarin is challenging to dose wherein under- or overdosing may lead to disastrous sequelae. There is wide interindividual variability in maintenance doses and is further complicated by changes in patients’ disease states, co-morbidities, diets and concomitant use of other medications.

WARFGEN, the genotype-guided warfarin dosing service, has improved patients’ anti-coagulation related clinical outcomes and significantly reduced time taken to achieve stable dose. Through this clinical lab-pharmacy collaboration, the team successfully established the warfarin genotyping service which is affordable and may potentially save costs from less appointments.

Published in AHa!, May-Jun 2014 From L-R: Dr Leow Khang Leng, Ms Aw Wan Xin Jernice, Ms Aliwarga Fransiska, Dr Doreen Tan, Dr Ong Hean Yee

WARFGEN emerged Top Alexandra Health Forum 2014 poster competition (Allied Health) and won the Best Abstract Award for Free Paper Session VI at the 27th Singapore Cardiac Society Annual Scientific Meeting 2015 with an expanded dataset. It also emerged victorious among Korean, Malaysian, Chinese and Australian competitors at the Joint Meeting of Coronary Revascularisation 2015 held in Korea, Busan.

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Nursing Nursing Services aims to ensure that each patient receives professional nursing care that is patient-centred and goal directed, and to support health care education and research in nursing and other disciplines.

Working in a Dementia Unit is Associated With Enhanced Person Centredness of Care Led by Fazila BN, Koh HM, Tan JC Jessie, Tay HE Felicia, Choo LH Juliet, Dr Yap LK Philip Person centred care (PCC) is synonymous with high quality healthcare today, particularly in dementia care for seniors.

Between nurses who worked in Dementia Unit (DU) versus conventional wards, we found that degree qualifications alone do not result in better delivery of PCC. The results suggested that better delivery is gained through on-the-job

exposure in a unit that espouses PCC, which can impact the knowledge, attitude and execution of PCC by nurses.

Hence, rotating nurses to work in DU can improve PCC delivery. This study received the Silver award at the 2015 Singapore Health & Biomedical Conference (SHBC) for Best Poster (Nursing).

Staff, supporters and volunteers of CAMIE ward celebrating 1,000 days of being Restraint Free

Creative Music Therapy Improves Mood and Factors Affecting Sedation Practices Engagement for Older Patients with Delirium amongst Nurses Caring for Mechanically & Dementia in an Acute Tertiary Hospital Ventilated Patients Led by Koh HM, Cheong CY, Foong YL, D Chen, J Tan, Tan JC, Ng CJ, P Yap

Led by Yap SF, Toh HM, Emily GTL, Kathy LSM, Wang W, He HG

Older patients with dementia and or delirium (PtDD) may feel stressed in an acute care setting, becoming agitated and resistive to care. Creative Music Therapy (CMT) was evaluated as a therapy to positively impact mood and engagement of PtDD in acute care. CMT was conducted through spontaneous music making with the therapist on the keyboard, bells or drums and playing the patient’s choice of songs. Patients who received CMT gained positive impact after 3 days across 2 mood scales. Because music transcends culture and language, CMT should be incorporated into routine patient care, especially in multicultural Singapore. This study received the Gold award at the 2014 SHBC for Best Poster (Nursing).

Sedative therapy is widely utilised in Intensive Care Units (ICUs) to provide comfort for mechanically-ventilated patients. Overseas studies have shown that nurses’ behaviour can affect sedation practice which may affect the patient’s outcome. In collaboration with the Alice Lee Centre for Nursing Studies at Yong Loo Lin School of Medicine, we found that nurse’s attitude and intention to sedate were factors affecting sedation practice, which is suggestive of knowledge gaps.

The investigators will work together with stakeholders to review current practice, and recommend suitable training and assessment to improve the consistency of sedation practice. This study received the Silver award at the 2014 SHBC for Best Poster (Nursing).

Singapore Health & Biomedical Congress (SHBC) 2014 From L-R: Senior Nurse Clinician Toh Hai Moy, Nurse Clinician Yap Suk Foon [Best Poster Award Nursing - (Silver)], Nurse Clinician Koh Hui Mien [Best Poster Award (Gold)], A/Prof Lim Su Chi.

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Transformation Office: AIP Programme The Transformation Office initiates and drives sustainable care models, to enhance patients’ care experiences in addition to good outcomes, through innovation, strategic integration, resource management, and assetbased stakeholder engagement.

Ageing-in-Place (AIP) Programme: Transitional Care and Community Nurse Services of a Regional Health System Delivering Integrated Post-Discharge Care to Support Patients in the Community Led by Mr Simon Goh Chun Kiat, Ms Linda Teo Lin Tah, Ms Jonathon Khoo Kay Chin, Dr Ang Yan Hoon, Dr Wong Sweet Fun What are Transitional Care and Community Nurse Services?

Since 2010, A&E attendances at Khoo Teck Puat Hospital (KTPH) A&E have been overwhelmed with multiple occasions of bed crunch. The Ageing-In-Place (AIP) Programme, comprising of Transitional Care (TC) and Community Nurse (CN) services, was conceptualised in 2011 to manage patients in the community and to relieve bed crunch.

as it enabled patients to flow seamlessly between the two programmes where necessary. Community nurses were well supported in the execution of the care plans they developed for the patients through this model.

Transitional Care serves to address the medical needs of sub-acute patients and to transit them smoothly from the hospital back to their homes. It is an island-wide service that provides up to 90 days of personalised clinical treatment by doctors, nurses and allied health professionals.

Community Nurse home visit programme is a health-social care model providing support to medically stable patients living in northern Singapore who require psychosocial care.

The Community Nurse is the patients’ single point of contact for care access and navigation of assistance schemes.

AIP collaborated actively with community care providers to assist patients in the community. Caregiver’s Training and Advance Care Planning were also conducted to help the patients’ family cope with caregiving needs.

What is the TC-CN collaborative model? How does it work?

The TC-CN collaborative model was developed and implemented from January 2013 to September 2015 to ensure that the needs of TC and CN patients requiring both medical and psycho-social support due to their changing conditions are met.

As part of care continuum, the collaborative model aimed to reduce unwarranted healthcare utilisation and provided integrated post-discharge care. Within this model, TC patients living in northern Singapore who required psychosocial care would be discharged to the CN programme. Correspondingly, CN patients whose conditions had worsened would be referred to TC service for prompt medical treatments.

What were the programme’s outcomes?

From January 2013 to August 2014, 1166 patients were recruited into the CN programme, out of which 64 patients were assessed to be requiring TC service but only 59 of them accepted. At the end of the TC service, 22 patients were discharged back to CN programme for continuation of support. During the same period, 567 patients were recruited into TC service. A total of 196 patients were discharged from TC to CN during that period for care continuity, out of which 117 patients were previously not under the Community Nurses.

How has the project benefited the community?

The TC-CN collaborative model benefited complex patients who needed medical as well as psychosocial care

What were the challenges?

The differences in TC and CN funding and care models posed challenges to the synergy and integration of the collaborative care model. The CN programme only supported patients staying in northern Singapore, causing patients staying out of north to be referred to other community services for follow up. Moreover, CN patients whose conditions turned acute might reject TC service due to costs.

What are the future plans for this programme?

For better integration of care, the programme evolved further and with effect from October 2015, the Ageing-inPlace–Community Care Team (AIP-CCT – the merger of TC and CN teams) was launched to replace the TC-CN collaborative model. The teams from both programmes were reorganised and retrained so that they are aligned and equipped with the necessary skill sets to support patients with different needs. This arrangement helps to reduce resistance in patients in the transfer between medical care model and health-social care model, as they remain under the care of the same nurse, regardless of the care model they are receiving.

Ageing-In-Place Programme Team

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Transformation Office: GeriCare @ North Led by Ms Toh Hui Jin, Ms Joanne Chia Wee Koon, Ms Ethel Koh Rui Li, Mr Kenneth Lam Thuan Yang, Dr Magpantay Gerlie Contreras, Dr Carl Mampusti De Leon, Dr James Alvin Low Yiew Hock

The GeriCare @ North programme is funded by the Ministry of Health, Singapore, to develop partnerships between an acute hospital and nursing homes situated in the North to enhance care. We hope that by our efforts to increase specialist access to the nursing homes and to enhance nursing skills, the number of unnecessary admissions to the acute hospital can be reduced.

Telegeriatrics - A Pilot Project to Reduce Unnecessary Hospital Admissions of Nursing Home Residents in Singapore

Geriatric specialists have been scarce in Singapore and this has drawn attention to a rising need in providing quality care for the ageing society. Enabling greater access to geriatric care could decrease the number of transfers from nursing homes to acute hospitals, thus improving residents’ quality of life.

To explore this, Telegeriatrics, a pilot project was implemented by an acute hospital in Singapore using videoconferencing systems to improve access to geriatric specialist care in nursing homes. We aimed to assess the impact Telegeriatrics has on the transfer rates of nursing homes to hospitals.

Two nursing homes were recruited from December 2010 to March 2014 with a total of 379 telemedicine consultation episodes conducted during this period. The hospital admission rates were monitored over a two-year period and compared against the nursing home’s level of engagement with Telegeriatrics.

The 2 nursing homes had different levels of engagement with the programme for various reasons. It was found that the more-engaged nursing home reported a significant decrease of 29% in hospital admission rates and had a lower rate of unnecessary hospital admission while the less-engaged nursing home only reported a 6% decrease.

Telegeriatrics has indeed the potential to reduce unnecessary hospitalisation frequently experienced by nursing home residents. Furthermore, a decrease in hospital admission rates will enable hospital beds to be better utilised, reduce medical spending and relieve residents’ distress. This project was presented at the International Conference on Information and Communication Technologies for Ageing and e-Health, 2015 (ICT4AgeingWell 2015).

A nursing home resident of Singapore Christian Home consulting our geriatrician with the help of a Telegeriatricstrained nurse in one of the scheduled tele-consultations.

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User Perceptions of the Telemedicine Programme in Nursing Homes The Singapore Perspective Geriatric care is a holistic approach to caring for older persons with complex health problems, so as to meet their long term care needs and maintain their independence for as long as possible. Due to a scarcity of geriatricians, Telegeriatrics was piloted in December 2010 by an acute hospital in Singapore to improve access to geriatric specialists for nursing homes.

This preliminary study explores the perspectives of users from the nursing homes and the acute hospital on two aspects of Telegeriatrics – the telemedicine consultation and the nurse training programme. Seven focus group discussions and two semi-structured moderate interviews were conducted with a total of 24 participants. Thematic content analysis was applied to identify important themes and new themes that emerged during the coding process. The most commonly recognised benefits were increased access to specialist care, reduced need for hospitalisations, improved quality of care, and enhanced nursing skills and knowledge.

The barriers perceived by the users were the lack of personal touch, technical issues, and medico-legal issues. Despite this, the users expressed general acceptance of Telegeriatrics in providing geriatric care.

They were aware of its limitations and challenges but also recognised it as a promising way of providing consultation and strengthening nursing skills. This project was presented at the ICT4AgeingWell 2015.

Ms Toh Hui Jin (third from the left) with other presenters at the ICT4AgeingWell 2015 at Lisbon, Portugal

Transformation Office: Innovative Projects Led by Dr Chia Hock Thye Daniel

KTPH has developed several innovations in delivering healthcare for higher accessibility and lower cost for patients. These were achieved with the valuable support of the senior management and through close collaboration among fellow colleagues across medical, nursing, and IT Departments. In line with the strategies laid out by the Ministry of Health, these innovations are examples of endeavours to transform healthcare from hospital to community, and from healthcare to health with Value Creation.

Transforming from quality healthcare to value creation – Enhancement of manoeuvrability of Hill-Rom beds We have enhanced the manoeuvrability of Hill-Rom beds, each has a laden weigh of up of 360kg. It consists of a computerized feedback control system with controlled linear cruising and turning speeds, helping to reduce the manpower from two to one for the transportation of patients on beds. This innovation has won the top Vendor Innovation Prize from NHG; showcased in Channel News Asia; and published in the Straits Times in March 2015.

99 units of this innovation had been successfully designed, fabricated and used in the wards of KTPH, with additional units currently underway.

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission

Transforming healthcare from hospital to community –Telehealth eye examination and smart health monitoring in clinics and Wellness Centres in the community MOSES (Mobile Ophthalmic Slit-lamp Examination System) is a patent-pending system created in collaboration with the Department of Ophthalmology and Visual Sciences to eliminate the need for an assistant to support wheelchair bound patients for eye examination.

When used with smart mobile Apps, our ophthalmologists can conduct telehealth and smart health monitoring with patients / residents in the community. A similar mobile App “EyeGallery” was awarded the top prize for innovation in NHG Eye Institute Conference held in July 2014, and received the IT Excellence Award for Quality Care presented by Health Minister Gan Kim Yong at the National Health IT Summit on 7 January 2015.

Figure 2 MOSES used by ophthalmologist for eye examination of bed / wheelchair bound patient.

MOSES helps to mitigate falls risks of patients in eye examination, and with a mobile device & smart mobile Apps, MOSES can be used for telehealth and smart health monitoring of patients / residents with the ophthalmologistextenders in a Wellness Centres in the community; and the ophthalmologist in the hospital to increase the accessibility of eye care; early detection and medical intervention of eye diseases in the population and reduction of healthcare cost.

Figure 1 KTPH was invited by the Ministry of Trade and Industry and the National Health Innovation Centre (NHIC) to showcase the enhanced Hill-Rom bed in TechInnovation 2015.

From Healthcare to Health – SAVAS Productivity of visual acuity test in the Eye Clinic and in the Wellness Centres in the community could be increased through the implementation of the Self-administered Automated Visual Acuity System (SAVAS). The project was awarded with a Rapid Prototyping Innovation Grant that led to a prototype successfully designed, built and demonstrated at the Alexandra Health Forum 2014 organised by KTPH. A patent was filed with the Intellectual Property Office of Singapore in 2014 (Application no.: 10201405894Q).

Figure 3 Self-administered Automated Visual Acuity System (SAVAS) being demonstrated to the Chief Nurse of Health Promotion Board during the Alexandra Health Forum 2014 held in KTPH.

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Pharma-sponsored Clinical Trials PARADIGM-HF

Led by Dr Ong Hean Yee (Cardiology)

PARADIGM-HF was an industry-sponsored clinical trial conducted in KTPH between 2009 and 2013. The trial tested a new heart failure medication that is now made available in Singapore after the clinical trial. With 29.9%* of deaths caused by Cardiovascular Diseases in 2014, the new medication is set to benefit many heart disease patients in the near future.

earlier than intended because preliminary data showed overwhelming benefits the new medication could provide.

Now available in the market, this is the first novel class of medication that is able to improve on mortality in heart failure since 1999.

KTPH’s participation in this trial was featured in numerous local newspapers such as The Straits Times, Berita Harian, The New Paper and My Paper in March and April 2016. *Data given by the Ministry of Health

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission

Spearheaded by Dr Ong Hean Yee in KTPH, the results of the trial which was published in 2014’s New England Journal of Medicine, demonstrated that patients who were given the new LCZ696 medication had a 20% and 21% reduced risk of death and hospitalization for heart failure respectively. The trial stopped 10 months

EMPA-REG OUTCOME

Led by A/Prof Sum Chee Fang (Diabetes Centre)

In 2012, KTPH participated in EMPA-REG OUTCOME – an industry-sponsored trial conducted in 42 countries globally and involved a total of 7,028 diabetes patients between 2010 and 2013. Empagliflozin, the drug that was tested, was later described by The Straits Times to be ‘a game-changer in the treatment of diabetes’.

Results from the trial showed that type 2 diabetes patients had a lower rate of cardiovascular outcome when empagliflozin was prescribed in addition to the standard diabetes medication. 38%, 32% and 35% reduction in cardiovascular death, death from any cause, and hospitalization from heart failure, were observed in patients who received empagliflozin (compared to patients who received placebo), respectively.

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission

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PARADIGM-HF Study Team From L-R: Ms Liew Yiting (Research Nurse) and Dr Ong Hean Yee (Head & Senior Consultant, Cardiology)

With strong evidence that empagliflozin can help with reducing cardiovascular risk, the new drug, with data published in the New England Journal of Medicine, was submitted to Health Sciences Authority (HSA) for registration, and has been approved for use in Singapore since December 2014.

EMPA-REG OUTCOME Study Team From L-R: Ms Liew Yiting (Research Nurse) and A/Prof Sum Chee Fang [Senior Consultant, Diabetes Centre (General Medicine)]

ROCKET-AF (Atrial Fibrillation) & VTE Study

Led by Dr Ong Hean Yee (Cardiology)

Rivaroxaban has been used in Singapore to prevent blood clots from forming in the veins of adults undergoing total hip or knee replacement surgery. In December 2013, the drug was given the approval to be used as an oral blood thinner by the Health Services Authority (HSA).

surgery in 2011-2012, found that the incidence of VTE was 2.1%. The study also found that patients over 75 years old are at higher risk of VTE. The findings have allowed KTPH to manage the risk of VTE, and to prevent the development of this fatal condition on our post-operative patients.

The ROCKET-AF clinical trial was conducted to investigate how effective Rivaroxaban is in reducing the risk of ischemic stroke in patients with atrial fibrillation as compared to conventional anticoagulation medication (warfarin).

The outcome of the VTE study was reported in Shin Min Daily News, The New Paper and Lianhe Wanbao in April 2014, as well as in The Straits Times in June 2014.

The trial recruited and followed-up a total of 14,264 patients with atrial fibrillation globally between 2006 and 2010, of which 44 patients were from Singapore. The data, published in the New England Journal of Medicine in 2011, concluded that Rivaroxaban worked as well as warfarin in preventing stroke or systemic embolism.

In conjunction with ROCKET-AF, Dr Ong also led a team to investigate the incidences of venous thromboembolism (VTE), i.e. blood clots that form in veins, and the prescription of thromboprophylaxis amongst Asians.

The cross-sectional study collected data from 1,103 KTPH patients who had undergone major orthopaedic or abdominal

ROCKET-AF & VTE Study Team From L-R: Dr Ong Hean Yee (Head & Senior Consultant, Cardiology), Dr Doreen Tan (Chief Pharmacist), Ms Koh Yueting (Senior Pharmacist), Ms Liew Yiting (Research Nurse), Ms Lim Boon Khim (Research Nurse)

Source: The Straits Times Š Singapore Press Holdings Limited. Reproduced with permission

DUAL-I

Led by A/Prof Sum Chee Fang (Diabetes Centre) To investigate the dual action of basal insulin (degludec) and GLP-1 analogue (liraglutide), an industry-sponsored trial called DUAL-I was conducted in 19 countries to compare the once-daily injection IDegLira (a combination of degludec and liraglutide) on type 2 diabetes patients, with degludec and liraglutide given alone.

DUAL-I Study Team From L-R: Ms Lim Boon Khim (Research Nurse) and A/Prof Sum Chee Fang [Senior Consultant, Diabetes Centre (General Medicine)]

KTPH was one of the hospitals that participated in the trial, and was led by A/Prof Sum Chee Fang. The outcomes published in The Lancet Diabetes Endocrinology Journal indicated that IDegLira combines the clinical advantages of basal insulin and GLP-1 receptor agonist treatment, resulting in improved glycaemic control compared to its components given alone.

Patients with diabetes often receive insulin treatment, but this regime is limited by the side effects it induces such as hypoglycaemia and weight gain.

Glucagon-like peptide-1 (GLP-1) analogues are known to be able to reduce risk of hypoglycaemia while stimulating insulin secretion in the body; they also possess the physiological property of inducing weight loss.

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External Collaborations & Partnerships Over the past few years, numerous collaborations and partnerships have been forged with external institutions to extend research beyond AHS. Collaborators

Institution • • •

Biopolis and National University of Singapore (NUS) Saw Swee Hock School of Public Health (SSHSPH), NUS Department of Biochemistry, NUS

Details • • • • •

•

•

A/Prof Lim Su Chi is working on the metabolic syndrome and microangiopathies in Asians.

•

Singapore General Hospital (SGH), Singapore Eye Research Institute (SERI), NUS NUS, NUH, SGH

•

•

SERI

•

•

KK Women’s and Children’s Hospital (KKH)

•

Dr Lim Ling Choo is studying the Detection of RET/PTC expression and its role as a molecular and prognostic marker in local patients with papillary thyroid carcinoma.

Began the Glaucoma Initial Treatment Study (GITS) to compare the effectiveness of Selective Laser Trabeculoplasty with Topical Medication.

Development of novel ultrathin miniature force sensor to deliver optimal cricoid pressure for airway protection in patients at high risk of gastric aspiration.

•

Tan Tock Seng Hospital (TTSH)

•

•

NUS, TTSH, NHG Polyclinics

•

•

Saw Swee Hock School of Public Health (SSHSPH)

•

•

SSHSPH, TTSH, SGH, Genome Institute of Singapore, B.R.A.H.M.S Biotechnology centre

•

Duke-NUS Graduate Medical School

•

Studied the effects of four-month therapy of levothyroxine on non-alcoholic fatty liver disease and diabetes control in diabetic male patients

•

School of Chemical and Life Science

•

To identify novel urinary biomarkers in nonalbuminuric diabetic nephropathy subjects.

•

Singapore Institute of Clinical Science (SICS)

•

•

Singapore Consortium of Cohort Studies (SCCS)

•

•

Genome Institute Singapore (GIS)

•

To develop translational medicine approach to identify genomic and epigenomic causes of Type 2 Diabetes Mellitus (T2DM).

To examine the genetic and environmental factors that are important in the development of diabetic complications in diabetic patients.

Ongoing collaboration regarding environmental surveillance of Methicillin-resistant Staphylococcus aureus and genomic exploration of the nasal microbiome in S. aureus carrier and non-carriers.

Pharmacogenomics studies of drugs used in the prevention of Thrombotic Events.

Understanding gastro-intestinal intolerance to metformin among Asians with T2DM using next generation sequencing.

•

•

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Studies the molecular epidemiology of nephropathy secondary to type 2 diabetes.

A/Prof Tavintharan Subramaniam is working on the mechanisms of simvastatin-induced hepotoxicity to study hepatic gene expression profiles.

He is also working on untargeted metabolomics to understand how certain metabolite signatures can distinguish patients of different glucose tolerance.

Ongoing collaboration to study the genome wide transcriptomic study on HepG2 cells.

Understanding miRNA profiling of subjects with and without metabolic disorders.

•

Bioinformatics Institute (BII)

•

•

National Parks (NParks)

•

Studied the genetics implications in diabetes nephropathy.

Researched how to better manage diabetes in patients under the care of specialist centres.

Followed up on individuals with diabetes recruited from our Diabetes Centre.

Studied the association between pathway-related candidate genes with “intermediate phenotype” and diabetic nephropathy using customized microarray of 1,536 SNPS.

Develop and evaluate the Park Prescription Interventions to promote physical activity and mental well-being amongst patients and people living in the community.

Signing of Memorandum of Understanding (MOUs) July 2010

1. Working with the Genome Institute of Singapore to Reduce Hospital Infections

Minimising the risk of hospitalacquired infections is important to ensure patient safety. It also directly impacts the length of time a patient has to remain in the hospital.

On 29 July 2010, Alexandra Health and the Genome Institute of Singapore (GIS) signed an MOU to conduct genomic research on understanding the impact of genes on infection control and longevity.

Under this MOU, three Methicillinresistant Staphylococcus aureus (MRSA)–related studies were planned

to further understand how MRSA spreads and to identify ways of improving clinical processes and treatment methods. In line with KTPH’s mission to promote personal responsibility for healthy and active ageing, this research will explore the complex relationship between longevity and genes especially among Asians.

From L-R: Dr Eugene Shum (AHS), Dr Liu Jian Jun (GIS), Prof Edison Liu (GIS), Dr Wong Sweet Fun (Chief Transformation Officer, AHS), Dr Martin Hibberd (GIS), A/Prof Pang Weng Sun (Chairman, Medical Board, YCH), unidentified, Dr Willis George Christopher (Senior Consultant, General Medicine, KTPH), Mr Liak Teng Lit (GCEO, AHS)

August 2013

2. Signature Programme in Health Services and System Research at Duke-NUS Graduate Medical School Singapore

Alexandra Health and Duke-NUS Graduate Medical School Singapore signed an MOU on 27 August 2013 to establish a collaborative programme and working relationship for health services research and research capacity development.

The collaboration aims to evaluate and further enhance the effectiveness of Alexandra Health’s Ageing-inPlace (AIP) programme, which identifies and offers assistance to patients with a history of hospital readmissions. Duke-NUS Graduate Medical School Singapore will

be providing expertise to give an overall impact evaluation of the AIP programme. This will give Alexandra Health a better understanding of the dynamics of a more widespread system-wide level of integration and to fill knowledge gaps in implementation of a community-level programme in Singapore.

From L-R: A/Prof Angelique Chan (Health Services & System Research Program, Duke-NUS Graduate Medical School Singapore), Prof David B. Matchar (Program Director, Health Services and Systems Research Program, Duke-NUS Graduate Medical School Singapore), Prof K. Ranga Rama Krishnan, M.D. (Dean, Duke-NUS Graduate Medical School Singapore), A/Prof Pang Weng Sun (Chairman, Medical Board, YCH), Dr Wong Chek Hooi (Senior Consultant, Geriatric Medicine,KTPH), Mr Liak Teng Lit (GCEO, AHS)

August 2015

3. International Clopidogrel Pharmacogenomics Consortium-Asia (ICPC-Asia) Asia

Alexandra Health signed an MOU with ICPC-Asia on 17 August 2015.

The Principal Investigator is Dr Doreen Tan from the Department of Pharmacy.

This collaboration aims to discover new genetic variants that are

June 2016

important for predicting response to clopidogrel using candidate gene, genome wide association studies (GWAS) and other methods. In particular, there is an interest among a number of pharmacogenomics research centres in working together to perform a new GWAS

and, or candidate gene study on a large cohort looking for variations associated with clopidogrel response.

This creates an opportunity to perform genotyping on DNA samples and then to combine the resulting genotype and associated phenotype data and to link them effectively to each other.

4. Health Services Research and Evaluation with National University of Singapore Alexandra Health signed an MOU with the National University of Singapore to collaborate on Health Services Research and Evaluation.

These Projects include mathematical modelling in disease prediction and prevention using big data to better inform clinical decisions, behavioral economics to better understand

the psychological, social, cognitive, and emotional factors on the economic decisions of individuals and operational research to improve hospital flow. The Guest-of-Honour was Prof Ho Teck Hua, Deputy President of Research & Technology, National University of Singapore.

From L-R: Dr Wong Sweet Fun (Chief Transformation Officer, AHS), Ms Magdalene Chai (Group Chief Human Resource Officer, AHS), Mrs Chew Kwee Tiang (CEO, KTPH), Mr Liak Teng Lit (GCEO, AHS), Prof Ho Teck Hua (Deputy President of Research & Technology NUS), Prof Melvyn Sim (Professor, Department of Decision Sciences, NUS Business School NUS), Dr Wong Chek Hooi (Deputy Executive Director, Geriatric Education and Research Institute)

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Past Events Alexandra Health (AH) Forum & AH Nursing Fest

Alexandra Health (AH) Forum & AH Nursing Fest is a biennial event which provides the platform for health professionals to share their professional experience and exchange ideas, including research observations.

Additionally, the Nursing Fest aims to share, motivate, cultivate and challenge the nursing profession to be key driver in uplifting and transforming patient care standards.

In August 2016, AH Forum & AH Nursing Fest will be in its third iteration. Previously, the research forum and Nursing festival were organized as separate events.

renamed to AH Forum and was the first research forum to be held at KTPH. This forum was themed “New Frontiers: Translating research into clinical practice” and was organised in collaboration with the Genome Institute of Singapore (GIS), and Nanyang Technological University (NTU). It featured lectures on the applications of genomic research and engineering innovations, oral presentations

by KTPH researchers on their research findings and even a manuscript writing workshop for clinician and researcherscientists alike.

The roots of our AH Forum came from the first two Research Forums held at Alexandra Hospital in 2008 and 2009. These were respectively themed “The Next Lap” and “Translational Research: Bridging Science and Patient Care”.

AH Nursing Fest was inaugurated in 2008 with the advice of Dr Francis Lee and Ms Low Beng Hoi in Alexandra Hospital. The theme was “Pursuing Excellence” and was chaired by Mdm Chua Gek Choo. After our migration to KTPH, we held our 2nd Nursing Fest in November 2010 with the theme of “Breaking Boundaries”. AH Forum eventually evolved into the AH Forum & AH Nursing Fest in 2012 when A/Prof Lim Su Chi approached Nursing Admin to combine Research Forum with Nursing Fest.

Since moving to KTPH, the Research Forum has undergone several rebrands to reflect the evolving challenges of healthcare in Singapore. In 2011, it was

2008 in Alexandra Hospital – The Next Lap

2009 in Alexandra Hospital - Translational Research: Bridging Science and Patient Care

2011 in Khoo Teck Puat Hospital - New Frontiers : Translating Research Into Clinical Practice

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Meeting a rapid rising demand on manpower and resources in healthcare, the different components of healthcare have to be integrated in order to facilitate the delivery of top-quality seamless clinical care to our patients. The theme for the first AH Forum in conjunction with Nursing Fest in 2012 was “Integrative Care Towards Better Patient Outcome” to reflect the joint organisation between clinicians and nurses. In line with the theme, the scientific programmes were novel and different compared to the previous forums. There was interaction across disciplines and discussions on how to integrate care for complex patients who require multifaceted care.

The Forum also featured plenary lectures by key opinionleaders like Prof Sally Chan and Prof C Rajasoorja.

Also, there were transdisciplinary symposia on fast-cruiseslow medicine, innovative collaborations, personalised medicine through genetics, research abstract competitions and hands-on workshops.

2012 in Khoo Teck Puat Hospital – Integrative Care Towards Better Patient Outcome

Dr Amy Khor, Senior Minister of State, Ministry of Health was the Guest of Honour of the forum.

The second iteration of the AH Forum & AH Nursing Fest in 2014 was themed “Healthcare Beyond Limits: Transcending People, Place and Time” to reflect KTPH’s research endeavours which were gaining more recognition locally and internationally. The three-day forum, which saw a participation of over 400 local and overseas participants, aimed to explore new healthcare models needed to face current and future healthcare challenges. It also managed to attract 170 abstract submissions under three main categories: Clinical Research, Basic Science Research and Quality Improvement.

With rapidly evolving healthcare advancements, the theme for AH Forum in conjunction with AH Nursing Fest for 2016 was “Healthcare For The Future: Shifting Paradigms for Population, Patients and Professionals”. It aims to provide participants with an enriching journey of insights based on evidence-based practices. Through lectures, symposia and workshops, helmed by distinguished local and foreign faculties, new models that will address current and future healthcare challenges are to be explored.

2014 in Khoo Teck Puat Hospital – Healthcare Beyond Limits: Transcending People, Place and Time

Mr Gan Kim Yong, Minister of Health was the Guest of Honour of the forum

2016 in both Khoo Teck Puat Hospital & Yishun Community Hospital Healthcare for the Future: Shifting Paradigms for Population, Patients and Professionals

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Past Events World Diabetes Day 2014 and 2015

Established in 1991 by the International Diabetes Federation and the World Health Organisation, World Diabetes Day (WDD) is a global awareness campaign to raise awareness about diabetes. Taking place on the 14th of November annually, Clinical Research Unit (CRU) uses this opportunity to both share knowledge on current research topics and activities, as well as thank research participants for their participation.

WDD 2014

WDD 2015

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In 2015, over 200 people participated in our education and outreach tour, which featured presentations from our scientists. Also on display were some of the diagnostic equipment used in research to raise awareness about the tools and capabilities of our Unit. For those who wished to find out more about research, our research nurses were on hand to dispel myths and help them understand what their participation means to the wider community. Each year, we hope that WDD participants walk away with a better understanding of diabetes and research activities at KTPH.

Health Services Research and Evaluation (HSRE) Mini Forum 1.0, 27 May 2015 The 1st HSRE Mini Forum was held in KTPH Auditorium on 27 May 2015. The Forum shared the latest knowledge in the HSRE field, as well as recent HSRE projects in KTPH. Topics included: • Health Economics • Population Health • Quality Improvement • Disease management and prevention

The Forum was conducted by a mix of in-house and external speakers. The external speakers were Prof David Matchar from Duke-NUS Graduate Medical School and A/Prof Josip Car, Chair of Lee Kong Chian School of Medicine. The internal speakers were colleagues from Dept of Geriatric Medicine, Anaesthesia, Pharmacy and Population Health.

A/Prof Pang Weng Sun (Chairman, Medical Board, YCH) presented a token of appreciation to A/Prof Josip Car (Chair, Lee Kong Chien School of Medicine)

Opening Introduction by Dr Wong Chek Hooi (Senior Consultant, Geriatric Medicine, KTPH)

A/Prof Pang Weng Sun (Chairman, Medical Board, YCH) presented a token of appreciation to Prof David Matchar (Duke-NUS Graduate Medical School)

Health Services Research and Evaluation (HSRE) Mini Forum 2.0, 10 June 2016

The 2nd HSRE Mini Forum was held in KTPH Auditorium on 10 June 2016.

Deputy President of Research & Technology, National University of Singapore (NUS).

The Forum shared the topics on disease prediction and prevention using real-data mathematical modeling to better inform clinical decisions, and in behavioral economics of our patients and community that can impact hospital operations. The Guest-of-Honour was Prof Ho Teck Hua,

The speakers were Prof Melvyn Sim (Professor, Department of Decision Sciences, NUS Business School NUS) and Dr Wong Chek Hooi (Deputy Executive Director, Geriatric Education and Research Institute). Following the panel discussion by representatives from both Parties, there was a signing ceremony of Memorandum of Understanding.

Presentation by Dr Wong Chek Hooi (Deputy Executive Director, Geriatric Education and Research Institute)

Presentation by Prof Melvyn Sim (Professor, Department of Decision Sciences, NUS Business School NUS)

Panel Discussion From L-R: Dr Wong Chek Hooi (GERI), Mr Liak Teng Lit (GCEO, AHS), Prof Ho Teck Hua (NUS), Prof Melvyn Sim (NUS Business School)

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Recent Development – Geriatric Education and Research Institute Geriatric Education and Research Institute (GERI) is set up by the Ministry of Health as a national institute to develop, coordinate and implement initiatives to strengthen geriatric education and research in Singapore. GERI is led by Executive Director, A/Prof Pang Weng Sun.

Front (From L-R) Ms Elna Ng (Deputy Director, Ops), A/Prof Wee Shiou Liang (Deputy Director, Research & Education Resources), A/Prof Pang Weng Sun (Executive Director), Dr Wong Chek Hooi (Deputy Executive Director), Dr James Low (Geriatric Education Lead), Dr Wong Sweet Fun (Seniors Care Delivery Lead) Back (From L-R) Ms Jamaica Tan (Research Officer), Dr Lilian Chye (Research Fellow), Ms Qiu Shijia (Senior Executive), Ms Stephanie Fong (Senior Executive), Mr Jesper Lim (Intern, SMU), Mr Robin Choo (Biostatistician), Dr Willie Koh (Senior Manager), Ms Tan Hwee Koon (Research Officer), Ms Lynette Ha (Research Officer), Ms Kong Lai Ho (Senior Manager), Ms Isabelle Lim (Research Executive)

With an ageing population, there is an important need to conduct geriatric research on areas such as age-related physiological and clinical changes. It is also necessary to translate findings of basic sciences and clinical research to inform clinical care, treatment modalities, disease prevention, risk factors management, and health promotion.

Another key role of GERI would be to facilitate development of curriculum to train and educate all healthcare professionals in areas of medical, nursing and allied health among others, to understand the special needs and clinical management of elderly patients and incorporate it as part of their core-competencies.

Facilities: The facilities of GERI include space for six labs and one Smart Home lab to study the needs of the geriatric population. The size of these labs ranges from 80m2 to 175m2. The first lab in GERI will be kitted out for the Gait Lab, which will study the relationship between mobility and cognitive decline through gait and falls measures, and test interventions to improve gait and prevent falls.

GERI has a Biobank to provide long-term storage of patients’ samples for research purposes. The Biobank is furnished with twelve -80°C freezers with WiFi capability for temperature monitoring system, one -20°C freezer, one 4°C fridge, and two liquid nitrogen tanks for sample storage. The Biobank has a chemical room for flammable chemical storage and pneumatic tube system for transportation of samples from other sites. It also comes equipped with two biosafety cabinets for sample processing and two lab benches.

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Research Metrics and Indicators List of Clinical Trials from 2006 - 2016 S/N 1

Study Short Title CRESCENDO

Sponsor SANOFISYNTHELABO

PI / Dept

Long Title

Year started

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

COMPREHENSIVE RIMONABANT EVALUATION STUDY OF CARDIOVASCULAR ENDPOINTS AND OUTCOMES (CRESCENDO)

2006

Randomized, multinational, multicenter, double-blind, placebo-controlled, two-arm parallel group trial of rimonabant 20 mg OD for reducing the risk of major cardiovascular events in abdominally obese patients with clustering risk factors

2

ALTITUDE (CSPP100E2337)

Novartis (Singapore)

Dr Yeoh Lee Ying General Medicine

A Randomised, Double-blind, Placebo-controlled, Parallel-group Study to Determione whether, in Patients with Type 2 Diabetes at High Risk for Cardiovascular and Renal Events, Aliskiren, on Top of Conventional Treatment Reduces, Cardiovascular and Renal Morbidity and Mortality (ALTITUDE)

2007

3

Averroes LTOLE (ASA_CV185048)

Bristol-Myers Squibb & Pfizer

Dr Ong Hean Yee Cardiology

Apixaban Verus Acetysalicyclic Acid (ASA) to prevent stroke in Atrial Fibrillation Patients who have failed or are unsuitable for vitamin K Antagonist Treatment: A Randomised Double Blind Trial

2008

4

APPRAISE-2

Bristol-Myers Squibb Company & Pfizer

Dr Ong Hean Yee Cardiology

Apixaban for Prevention of Acute Ischemic Events - 2

2009

A Phase 3, Randomized, Double-Blind, Evaluation of the Safety and Efficacy of Apixaban In Subjects with a Recent Acute Coronary Syndrome

5

View 2

Bayer (South East Asia)

Dr Ajeet Madhav Wagle Ophthalmology & Visual Sciences

A randomised, double masked, active controlled, phase 3 study of the efficacy, safety and tolerability of repeat doses of intravitreal VEGF Trape-Eye in subjects with nevovascular age-related macular degeneration (AMD)

2009

6

PARAMOUNT

Novartis (Singapore)

Dr Ong Hean Yee Cardiology

A 36-week, Randomized, Double-blind, Multi-center, Parallel Group, Active Controlled Study to Evaluate the Efficacy, Safety and Tolerability of LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction

2009

7

PARADIGM (SHF) CLCZ696B2314

Novartis (Singapore)

Dr Ong Hean Yee Cardiology

A multi-center, randomized, double-blind, parallel group, active-controlled study to evalute the efficacy, safety and of LCZ696 therapy compared to enalapril on morbidity and mortality in patients with chronic heart failure and reduced ejection function

2010

8

ADAS-Cog, DAD and NTB

Wyeth Pharmaceuticals

A/Prof Philip Yap Geriatric Medicine

A 78-Week Noninterventional Longitude Study to Validate the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog), Disability Assessment for Dementis (DAD), and Neuropsychological Test Battery (NTB) in Asian Subjects With Mild to Moderate Alzheimer’s Disease

2010

9

RADIANCE

Novartis (Singapore)

Dr Ajeet Wagle Ophthalmology & Visual Sciences

A 12 month, phase III, randomized, double-masked, multicenter, active-controlled study to evaluate the efficacy and safety of two different dosing regimens of 0.5 mg ranibizumab vs. verteporfin PDT in patients with visual impairment due to choroidal neovascularization secondary to pathologic myopia

2010

10

Novo Nordisk-DUAL Action

Novo Nordisk Pharma

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

Dual Action of Liraglutide and insulin degludec in type 2 diabetes. A 26 week randomised, parallel three-arm, open-label, multi-centre, multinational treat-to-target trial comparing fixed ration combination of insulin, degludec and laraglutide versus insulin degludec or liraglutide alone, in subjects iwth type 2 diabetes treated with 1-2 oral antidiabetic drugs (OADs).

2011

11

White Coat Hypertension Study

Institut de Recherches Internationales Servier

Dr Ong Hean Yee Cardiology

Perindopril arginine/Amlodipine versus Valsartan/Amlodipine antihypertensive strategies: Efficacy and safety in mild to moderate hypertensive patients.

2011

A randomised, double-blind 6-month study followed by 8-month open label long-term follow-up with Perindopril arginine/Amlodipine.

12

EMPA-REG OUTCOME

Boehringer Ingelheim Pharmaceuticals, Inc.

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

A Phase III, multicentre, international, randomised, parallel group, double blind cardiovascular safety study of BI 10773 (10 mg and 25 mg administered orally once daily) compared to usual care in type 2 diabetes mellitus patients with increased cardiovascular risk

2012

13

AMG145 (FOURIER)

Amgen

A/Prof Tavintharan Subramaniam Diabetes Centre (General Medicine)

A Double-Blind, Randomized, Placebo-controlled, Multicenter Study Accessing the Impact of Additional LDL-Cholesterol Reduction on Major Cardiovascular Events When AMG 145 is Used in Combination With Statin Therapy in Patients with Clinically Evident Cardiovascular Disease

2012

14

Novartis-Galvus Add-on Insulin (LAF)

Novartis (Singapore)

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

A 24-week, multi-center, double-blind, randomized, placebo-controlled, parallel-group study to assess the efficacy and safety of vildagliptin 50mg bid as an add-on therapy to insulin, with or without metformin, in patients with type 2 diabetes mellitus

2012

15

Major Depressive Disorder

Institut de Recherches Internationales Servier

Dr Cheok Cheng Soon Christopher Psychological Medicine

Study CL3-20098-060

2012

16

X-vert

Bayer (South East Asia)

Dr Ong Hean Yee Cardiology

A prospective, randomized, open-label, parallel-group, active-controlled, multicenter study exploring the efficacy and safety of once-daily oral rivaroxaban (BAY 59-7939)compared with that of dose-adjusted oral vitamin K antagonists (VKA) for the prevention of cardiovascular events in subjects with nonvalvular atrial fibrillation scheduled for cardioversion. Explore the efficacy and safety of once-daily oral rivaroxaban for the rpevention of cardiovascular events in subjects with nonvalvular atrial fibrillation scheduled for cardioversion.

2012

17

ODYSSEY EFC 11570

Sanofi-Aventis

Dr Ong Hean Yee Cardiology

A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Effect of SAR236553/REGN727 on the Occurrence of Cardiovascular Events in Patients Who Have Recently Experienced an Acute Coronary Syndrome

2013

18

CAPTAIN

Ever Neuro Pharma

Dr Eugene Yang General Surgery

A randomized, double-blind, placebo-controlled trial to investigate safety and efficacy of Cerebrolysin in patients with traumatic brain injury

2013

19

PCV Everest II CRFB002A2412

Novartis

Dr Lekha Gopal Ophthalmology & Visual Sciences

A 24-month, phase IV, randomized, double masked, multicenter study of ranibizumab monotherapy or ranibizumab in combination with verteporfin photodynamic therapy on visual outcome in patients with symptomatic macular polypoidal choroidal vasculopathy

2013

20

SOCRATES REDUCED

Bayer (South East Asia)

Dr Ong Hean Yee Cardiology

A randomized parallel-group, placebo-controlled, double-blind, multi-center dose finding phase II trial exploring the pharmacodynamic effects, safety and tolerability, and pharmacokinetics of four dose regimens of the oral sGC stimulator BAY 1021189 over 12 weeks in patients with worsening heart failure and reduced ejection fraction (HFrEF) - SOluble guanylate Cyclase stimulatoR in heArT failurE patientS with REDUCED EF (SOCRATES-REDUCED)

2013

21

SOCRATES PRESERVED

Bayer (South East Asia)

Dr Ong Hean Yee Cardiology

A randomized parallel-group, placebo-controlled, double-blind, multi-center dose finding phase II trial exploring the pharmacodynamic effects, safety and tolerability, and pharmacokinetics of four dose regimens of the oral sGC stimulator BAY 1021189 over 12 weeks in patients with worsening heart failure and preserved ejection fraction (HFpEF) - SOluble Guanylate Cyclase stimulatoR in heArT failurE patientS with PRESERVED EF (SOCRATES-PRESERVED)

2013

22

SONAR M11-352

AbbVie

Dr Yeoh Lee Ying General Medicine

A randomized, multicountry, multicenter, double-blind, parallel, placebo-controlled study of the effects of Atrasentan on renal outcomes in subjects with type 2 diabetes and nephopathy - SONAR: Study of Diabetic Nephropathy with Atrasentan

2014

23

Pharmacodynamics

Institut de Recherches Internationales Servier

Dr Ong Hean Yee Cardiology

Evaluation of the pharmacodynamics, pharmacokinetics and safety of repeated escalating oral doses of S 38844 versus placebo in patients with chronic heart failure and left ventricular systolic dysfunction

2014

24

Unravel CRFB002AMAX-IL-01

Novartis (Singapore)

Dr Lekha Gopal Ophthalmology & Visual Sciences

UNcovering the difference between Ranibizumab and Aflibercept, focusing on systemic anti-VEGF effects in patients with neovascuLar AMD (UNRAVEL): A 3 months, patient-and rater blinded, randomized, prospective study comparing systemic anti-VEGF effects between ranibizumab and aflibercept in treatment naïve neovascular Age-related Macular Degeneration (nAMD) patients

2014

25

AFFILIATE

Pfizer

Dr Ong Hean Yee Cardiology

A Multinational, Multicenter Study To Assess The Effects Of Oral Sildenafil On Mortality In Adults With Pulmonary Arterial Hypertension (PAH)

2014

Effects of agomelatine versus escitalopram on emotional experiences in outpatients suffering from Major Depression Disorder.

An exploratory, randomnized, double-blind, international, multicentre study with parallel groups: agomelatine (25 to 50 mg/day) versus escitalopram (10 to 20 mg/day) over a 6-month period.

AHS Research Commemorative Book

51

S/N

Study Short Title

Sponsor

PI / Dept

Long Title

Year started

26

Nondialysis CKD Anemia

Fibrogen

Dr Terina Seow General Medicine

A Phase 3, Randomized, Double-Blind, Placebo Controlled Study of the Efficacy and Safety of FG-4592 for the Treatment of Anemia in Chronic Kidney Disease Patients not on Dialysis

2015

27

Allergan AGN 192024-091 Bimatoprost SR

Allergan

Dr Jason Cheng Ophthalmology & Visual Sciences

The Efficacy and Safety of Bimatoprost SR in Patients with Open-angle Glaucoma or Ocular Hypertension

2015

28

PARAGON-HF

Novartis (Singapore)

Dr Ong Hean Yee Cardiology

A multicenter, randomized, double-blind, parallel group, active-controlled study to evaluate the efficacy and safety of LCZ696 compared to valsartan, on morbidity and mortality in heart failure patients (NYHA Class II-IV) with preserved ejection fraction

2015

29

C.Diff H-030-014

Sanofi Pasteur

Dr Pushpalatha General Medicine

Efficacy, Immunogenicity, and Safety Study of Clostridium difficile Toxoid Vaccine in Subjects at Risk for C. difficile Infection (Randomized, observer-blind, placebo-controlled, multi-center, multi-national, Phase III trial in 15,000 subjects) Toxoid Vaccine in Subjects at Risk for C. difficile Infection”

2016

30

FIGARO-DKD (17530)

Bayer (South East Asia)

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

A randomized, double-blind, placebo-controlled, parellel-group, multicenter, event-driven Phase III study to investigate the efficacy and safety of finerenone on the reduction of cardiovascular morbidity and mortality in subjects with type 2 diabetes mellitus and the clinical diagnosis of diabetic kidney disease in addition to standard of care

2016

31

FIDELIO-DKD (16244)

Bayer (South East Asia)

A/Prof Sum Chee Fang Diabetes Centre (General Medicine)

A randomized, double-blind, placebo-controlled, parellel-group, multicenter, event-driven Phase III study to investigate the efficacy and safety of finerenone, in addition to standard of care, on the progression of kidney disease in subjects with type 2 diabetes mellitus and the clinical diagnosis of diabetic kidney disease

2016

32

Allergan CEDAR 150998-005

Allergan

Dr Lekha Gopal Ophthalmology & Visual Sciences

Allergan Abicipar Pegol 150998-005 (CEDAR) Study: The Safety and Efficacy of Abicipar Pegol (AGN150998) in Patients with Neovascular Age-related Macular Degeneration

2016

List of Patents filed from 2014 to 2016 S/N

Inventors

Title

Filing Date

1

A/Prof Yip Chee Chew, Dr Hu You Wei Jeremy and Dr Chia Hock Thye Daniel

Self-administered Automated Visual Acuity System (SAVAS)

Sep-14

2

Dr Seet Chuen Ping Edwin, Dr Tan Leng Zoo, Dr Chia Hock Thye Daniel and Dr Liaw Chen Mei

Tele-medicine Oximetry System

Apr-15

3

Dr George Christopher Willis, Dr Wong Sweet Fun, Dr Chia Hock Thye Daniel and Dr Ooi Say Tat

Hand Hygiene Compliance Nudging System

Nov-15

4

Dr Hee Hwan Ing(KKH), Dr Yvonne Wong (KTPH), Dr Sun Tao (IME), Dr Xue Ning (IME), Dr Alex Gu Yuandong (IME) and Dr Yu Hong Bin (IME)

A sensing device, system and a method of manufacture thereof (Previously entitled A system to aid delivery of optimal cricoid pressure for airway protection in patients at high risk of gastric aspiration in provisional application

May-16

5

A/Prof Yip Chee Chew, Dr Anoop Thomas, Dr Chia Hock Thye Daniel and Mr Kendrick Nigel Co Tan

Mobile Ophthalmic Slit-lamp Examination System (MOSES)

May-16

List of Awards from 2011 to 2015 S/N

Name of Awardee / Dept

Type of Award

Project Title

Date of Award

Awarding Agency

1

Sumer Shikhare; Teh Hui Seong; Paul See Diagnostic Radiology

First prize - Young Radiologist’s Investigator Award - Oral presentation

Triple Bolus Technique with Dual Energy MDCT: A New Perspective in CT Urography

May-11

15th Congress of the Asean Association of Radiology

2

Edwin Seet Anaesthesia

Best Free Paper

Oropharyngeal leak pressure with the laryngeal mask airway SupremeTM at different intracuff pressures: a randomized controlled trial

Aug-11

Singapore Society of Anaesthesiologist

3

Low Suat Fern Pharmacy

Oral Presentation 2nd Runner Up

The Economic Impact of Nursing Home Medication Reviews

by Pharmacists

Aug-11

Singapore Pharmacy Congress

4

Doreen Tan Su-Yin Pharmacy

Oral Presentation First Place

Allelic Determinants of Response to Clopidogrel in Singaporean Chinese, Indians and Malays: The Asian study of CLOpidogrel Pharmacogenomics II (ASCLOP II)

Sep-12

Singapore Pharmacy Congress 2012

5

Edwin Seet Anaesthesia

Best Clinical Research 1st prize

Design and Rational for the Postoperative Vascular Events in Unrecognized Obstructive Sleep Apnea Trial

Oct-12

Society of Anaesthesia and Sleep Medicine Conference 2012

6

Ali SZ, Srinivasan S, Peh WCG Diagnostic Radiology

3rd prize for Best Educational Exhibit

MR imaging in necrotising fasciitis of the extremities.

Feb-13

2nd Joint Meeting of the Asian Musculoskeletal Society and the Arabian Gulf Society of Skeletal Radiology

7

Chow MB, Srinivasan S Diagnostic Radiology

3rd prize for Best Poster

Remembering Benjamin Felson through his signs - tribute to a legend.

Jun-13

3rd World Congress of Thoracic Imaging

8

Doreen Tan Su-Yin Pharmacy

First Oral Presentation

CLOpidogrel-PRAsugrel switch study in Asian subjects Acute Coronary Syndrome requiring PCI (CLOPRA): A Preliminary Analysis

Aug-13

Singapore Pharmacy Congress

9

Heng Jian Wei Pharmacy

ESPEN Travel Fellowship

Factors Involved in Predicting Duration of Parental Nutrition

Sep-13

The European Society for Clinical Nutrition and Metabolism

10

Srinivasan S, Teh HS, Chawla A, Bosco JI Diagnostic Radiology

“Cum Laude” Citation for Excellence of Educational Exhibit

Applications of dual-energy CT in vascular imaging.

Dec-13

99th Scientific Assembly and Annual Meeting of the Radiological Society of North America

11

Siddiqui, S, Anaesthesia

PRIME lecture

Teaching the intricacies of managing critically ill patients to undergraduates in an interprofessional manner

Feb-14

National University of Singapore

12

Melvin Wong Clinical Research Unit

Best Poster Presentation

Urinary Proteomics of Progressive Diabetic Nephropathy

Mar-14

National Kidney Foundation

13

Chokkappan K, Chinchure D, Chawla A, Subramanian M, Krishnan V, Srinivasan S Diagnostic Radiology

Merit

“Pushing the envelope!” - Role of MDCT in uncommon gastric conditions.

Mar-14

European Congress of Radiology 2014

14

Jeffrey Tan Orthopaedic Surgery

Best Poster Award

Short to medium term results of ligamentous Lisfranc injuries with diastasis of first/second metatarsals that were treated conservatively

May-14

AO Trauma Asia Pacific

May-14

15

Anusha Kannan Anaesthesia

Membership Medal by The College of Anaesthetists of Ireland

MCAI

16

Anusha Kannan Anaesthesia

Best faculty award- Primary FRCA/MCAI examination preparation course

Primary FRCA/MCAI examination preparation course

Jul-14

Changi General Hospital

17

Ong Guan Hong Ophthalmology & Visual Sciences

First prize, 2014 International Congress of Ophthalmology (Quality & Safety Category)

The Eye Gallery App system - a novel software platform to improving the clinical diagnostic capability in Eye Care

Aug-14

2014 International Congress of Ophthalmology (Quality & Safety Category)

18

Ong Guan-Hong Ophthalmology & Visual Sciences

MOH Health IT Excellence Award 2014 have won in the following category:Category C: IT Excellence in Providing Quality of Care

The Eye Gallery App system - a novel software platform to improving the clinical diagnostic capability in Eye Care

Dec-14

MOH Health IT Excellence Award 2014 Working Committee

19

Clement Chia General Surgery

Young Investigator Award

Randomised Controlled Trial Comparing a Novel Perineal Device with Glyceryl Trinitrate Ointment in the treatment of Chronic Anal Fissures - An Interim Analysis

Jan-15

8th Colorectal Disease Symposium in Tokyo

20

Keith Foo, WS Fan, SF Oh Pharmacy

First Runner-up Oral Presentation (competitive)

A Three Pronged Approach in Improving Patient Wait Time: Optimization of Queue Series Management, Manpower Extrapolation and Predictive Order Request.

Mar-15

Healthcare Quality Society of Singapore (HQSS)

52 AHS Research Commemorative Book

College of Anaesthetists of Ireland

S/N

Name of Awardee / Dept

Type of Award

Project Title

Date of Award

Awarding Agency

21

Desmond Mao Acute and Emergency Care

KTPH Clinician Leadership in Research award

Scalp Laceration Repair by nurses in an Urban Emergency Department

14-Mar

Khoo Teck Puat Hospital

22

Grace Chang Shu Wen, Wee XT, Tan SME, Aw JWX, Ong HY, Omar A, Ho HK, Tan DSY Pharmacy

BEST ABSTRACT AWARD for Free paper session VI Oral Presentation

Genotype-Guided Warfarin Dosing In Local Patients Initiating Oral Anticoagulation (WARFGEN)

Apr-15

Singapore Cardiac Society

23

Mina Han Peishan, Chan Kar Lock OT

May Day Model Partnership Awards 2015

Enhancement for Active Seniors HDB

May-15

Singapore Labour Foundation, NTUC, WDA

24

Jason Cheng Ophthalmology and Visual Sciences

Research Award

Can the Hypertensive Phase be predicted using a preimplantation test?

Jun-15

Canadian Ophthalmologists society

25

Chang Shu-wen Grace, Oh Su Fen Claudine Pharmacy

Oral Presentation [Competitive] CA001 1st runner-up Pharmacy Education Category

The making of an anticoagulation clinic (ACC) pharmacist – Update of our existing model of pharmacist competency & privileging in Khoo Teck Puat Hospital (KTPH)

Sep-15

25th Singapore Pharmacy Congress 2015 Pharmaceutical Society of Singapore NUS Pharmacy

26

Genevieve Ho, Liew FGF, Tan DSY Pharmacy

Oral Presentation [Competitive] CA003 1st Runner-up Health Outcomes Category

Defining the roles of the pharmacist in a general and acute care hospital’s Accident and Emergency (A&E) Department

Sep-15

25th Singapore Pharmacy Congress 2015 Pharmaceutical Society of Singapore NUS Pharmacy

27

Keith Foo, Fan Weishan, Claudine Oh Pharmacy

Poster Presentation [Competitive] CA023 BEST POSTER (FIRST)

A Statistical Approach in Improving Patient Wait Time in An Outpatient Pharmacy: Optimization of Queue Series Management and Predictive Partial Order Request

Sep-15

25th Singapore Pharmacy Congress 2015 Pharmaceutical Society of Singapore NUS Pharmacy

28

Ma Yuet Ting, Nuengruetai J Pharmacy

Oral Presentation [Competitive] CA062 1st Runner-up Pharmacy Practice Category

A Drug Use Evaluation on Erythropoietin-Beta Usage in PreDialysis Chronic Kidney Disease (CKD) Patients

Sep-15

25th Singapore Pharmacy Congress 2015 Pharmaceutical Society of Singapore NUS Pharmacy

29

Geraldine Cheong Anaesthesia

Best Abstract Presentation (Oral)

Use of Proseal LMA is associated with less intraoperative problems – A prospective observational study

Nov-15

Singapore Society of Anaesthesiologists

30

Anusha Kannan Anaesthesia

2nd Prize Poster Presentation

Changing Practices in Airway Management - A Prospective Observational Study of Endotracheal Intubation

Nov-15

World Airway Management Meeting

31

Chang GSW, Wee XT, Tan SME, Aw JWX, Ong HY, Omar A, Ho HK, Tan DSY Pharmacy

Oral Presentation First Prize

Genotype-Guided Warfarin Dosing (WARFGEN) in Local Patients Initiating OAC

Dec-15

2015 Joint Meeting of Coronary Revascularization Foundation of Circulation Research, Dong-A University Hospital Regional Clinical Trial Center

32

Yip Chee Chew Ophthalmology & Visual Sciences

Research Skills in Medical Education (RSME) Certificate (APMEC 2015)

Medical Education Scholarship project “The impact of micro-CEX on the academic performance of medical undergraduates in Ophthalmology”.

Dec-15

Association for Medical Education Europe (AMEE)

33

Lim Su Chi Clinical Research Unit

First prize in Oral presentation

Prospective cohort study suggests that central arterial stiffness is an independent predictor of albuminuria progression among Asians with type 2 diabetes.

Dec-15

ASEAN Federation of Endocrine Societies (AFES) 2015

34

Serena Low,Lim SC, Yeoh LY, Liu JJ, Sharon F, Su C, Zhang X, Tavintharan S, Sum CF Clinical Research Unit

Winner in Oral presentation

Novel Insights into the Paradigm of Kidney Disease in Type 2 Diabetes – Lessons from a 13- Year Retrospective Large Cohort Study

Dec-15

ASEAN Federation of Endocrine Societies (AFES) 2016

List of Singapore Health & Biomedical Congress (SHBC) Awards from 2011 to 2015 S/N

Name of Awardee / Dept

Type of Award

Project Title

Date of Award

1

Melvin Wong Clinical Research Unit

Basic Science / Translational Research

Western Blot Validation of Urinary Zinc Alpha-2 Glycoprotein in NormoAlbuminuric Diabetic Nephropathy

Nov-11

2

Edwin seet, Lye Soh Teng, Liaw Chen Mei, Koh Kwong Fah Anaesthesia

Singapore Clinician Investigator Award (Gold)

A Comparison Between Novice and Trained Personnel When Using the Macintosh

Sep-12

3

Mawarni Binte Arof, Amizah Binte Asrap, Ou Yao, Cheok Poh Lin, Norefa Binte Riffin, Ng Xiaowei, Naomi John Lum, Yeoh Lee Ying, Tavinthran Subramaniam, Sum Chee Fang, Lim Su Chi Clinical Research Unit & General Medicine

SHBC Best Poster Award - Nursing (Silver)

Validation of the Accuracy of Bio-Impedence Body Composition Analyzer (InBody S20) in Estimating Waist Circumference among Subjects with Type 2 Diabetes

Sep-12

4

Lin Lifang Bernice, Pek Li Ting Sharon, Woon Kaing, Liew Yiting, Dong Xiuchun, Sum Chee Fang, Lim Su Chi, Subramaniam Tavintharan Clinical Research Unit & Diabetes Centre (General Medicine)

SHBC Best Poster Award - Basic Science/Translational Research (Silver)

Hepatoprotective Role of Coenzyme Q10 and Detection of Early Biomarkers in Statin-Related Liver Injury

Sep-12

5

Lam Chih Chiang Benjamin, Michael Wong, Lim Su Chi Family and Community Medicine & General Medicine

SHBC Best Poster Award - Clinical Research (Gold)

A Method-Comparison Study to Validate a Novel Parameter of Obesity, the Body Adiposity Index (BAI), in Chinese Subjects

Sep-12

6

Ngiam Juzheng, Tan Kok Yang, Phyllis Tan General Surgery & Nursing

SHBC Best Poster Award - Clinical Research (Bronze)

Functional Outcomes in the Elderly Who Have Undergone Major Colorectal Surgery

Sep-12

7

Lim Su Chi Clinical Research Unit

Best Poster Award - Basic Science/ Translational Research

Validation of a Novel Mutation (H126D) in Hepatocyte Nuclear Factor-1A (HNF-1A) Gene Associated with Maturity Onset Diabetes of the Young Type 3 (MODY3) Using The Next Generation Sequencer (NGS)

Sep-13

8

Melvin Wong Clinical Research Unit

Best Poster Award - Basic Science/ Translational Research (Bronze)

Association between visceral adiposity, inflammation (C-reactive protein), microvascular endothelial dysfunction and nephropathy in multi-ethnic Asians with type 2 diabetes (SMART2D cohort)

Sep-14

9

Cheong Chin Yee Geriatric Medicine

Best Poster Award - Health Professions Education (Bronze)

Simulated Patients In The Teaching Of Mental State Examination: Factors Influencing Learning Among Junior Medical Students

Sep-14

10

Nieh Chih Ming Geriatric Medicine

Best Poster Award - Health Services Research (Gold)

A Tertiary Hospital Special Care Unit For Dementia Is Cost Effective And Improves Outcomes

Sep-14

11

Koh Hui Mien Ward C41

Best Poster Award Nursing (Gold)

Creative Music Therapy Improves Mood And Engagement In An Acute Tertiary Hospital For Older Patients With Delirium & Dementia

Sep-14

12

Yap Suk Foon Ward B36

Best Poster Award Nursing (Silver)

Factors Affecting Sedation Practices Amongst Nurses Caring For Mechanically Ventilated Patients

Sep-14

13

Lim Su Chi Clinical Research Unit

Best Poster Award (Bronze), Basic Science / Translational Research

Exon sequencing of the APOE gene to identify variants responsible for the monogenic basis of chronic kidney disease

Oct-15

14

Fazila Bte Nijal Ward B55

SHBC Best Poster Award - Nursing (Silver)

Working in a Dementia Unit is associated with enhanced person centredness of care

Oct-15

15

Ng Chong Jin Geriatric Medicine

Best Poster - Clinical Research (Silver)

Executive Function And Education Mediate Willingness In Advance Care Planning Engagement In People with Early Cognitive Impairment

Oct-15

16

Nieh Chih Ming Geriatric Medicine

Best Poster - Health Services Research (Silver)

A New Music Therapy Engagement Scale (MTED) for People With Dementia In A Music Therapy (MT) Programme

Oct-15

17

Sandhya DEVI Nayang Technological University [Mentor: A/Prof Subramaniam Tavintharan, Senior Consultant, Diabetes Centre]

Best Poster – Singapore Young Investigator Award (Students) (Gold)

Effects of Fenofibrate On Pigment Epithelium-Derived Factor (PEDF) in Clinical Human Subjects and ARPE-19 Eye Cells

Oct-15

Laryngoscope, the Pentax AWS, the C-MAC and the Bonfils Intubation Fiberscope: A Manikin Study

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53

How to Start A Research Study Following the passing of the Human Biomedical Research (HBR) Act by the Singapore Parliament in August 2015, human biomedical research is now regulated by the Singapore government to protect the safety and welfare of human research subjects and participants.

Requirement for Ethics Review

d) e) f)

g)

Under this HBR Act, all research involving human participants needs to be reviewed and approved by an Institution Review Board (IRB) prior to the commencement of the research study. The IRB will assess the (i) ethics of the study, and (ii) qualifications of the researchers, to determine if the safety and welfare of human participants are met. Alexandra Health System has appointed the Domain Specific Review Board (DSRB) as our IRB to review all research studies involving human participants.

How do I submit my research study for DSRB review?

Submissions to DSRB needs to be done online via NHG’s Research Online Administration & Management (ROAM) portal under Submissions > Ethics Submissions > Submit New Study .

Does my study require DSRB review?

New users are required to create a new NHG ROAM account using valid institutional emails to initiate a submission.

Activities that involve systematic investigation and contribute to generalisable knowledge are considered research and will require review by DSRB. This includes the following: a) Clinical trials b) Epidemiological research (including surveys) c) Retrospective medical records review research

(including case series of 3 or more subjects)

Study Role

Genetic research Database studies Quality assessment and improvement projects (that contribute to generalisable knowledge) Tissue repositories

Minimum training requirements to become a researcher

The minimum training requirements differ according to the study roles. Please refer to the table below.

CITI

CITI FCOI

SGGCP ✔

Pls and Site Pls conducting clinical trials

✖

✔

(Regardless of whether CITI was completed)

Pls and Site Pls conducting research studies other than clinical trials

✔

✔

✖

Co-investigators

✔

✔

✖

Other study team members

✖

✔

✖

The Collaborative Institutional Training Initiative (CITI) Program is the minimum requirement for researchers to understand and apply ethical principles to their research studies. Investigators conducting Population Health Research (DSRB Domain F) are required to complete 5 elective modules out of the 11 Social, Behavioural and Educational (SBE) related modules.

Principal Investigators (PI) who wish to conduct clinical trials are required to complete the Singapore Guideline for Good Clinical Practice (SGGCP) training course and certification.

More information can training requirements can be found on our website: KTPH>CRU>Research Application Process.

Declaration of Financial Conflict of Interest (FCOI)

All investigators and study team members involved in the design, conduct or reporting of research in institutions will need to submit a Financial Conflict of Interest (FCOI) Declaration to DSRB annually and within 30 days if there are any changes to the financial interest status to the DSRB FCOI secretariat.

More information on making this declaration can be found on NHG’s DSRB website.

54 AHS Research Commemorative Book

Selection of Biomedical or Population Health Domains on DSRB

DSRB is comprised of five Biomedical Domains (A-E) based on broad but related disease groupings, and a Population Health Domain (F). The PI should select the most appropriate DSRB domain to review their study according to the chart below.

DOMAIN SPECIFIC REVIEW BOARDS Domain A

Domain D

• Ophthalmology • Psychiatry • Neurology/Neurosurgery • Genetics • Geriatric Medicine • Palliative Medicine

• Obs/Gynaecology • Anaesthesia • Surgery# • ENT • Dentistry • Sports and Rehab Medicine • Allied Health

Domain B • Oncology • Hematology • Pathology • Paediatrics • Respiratory Medicine

Domain C • Cardiovascular Science • Pharmacology • Emergency Medicine • Endocrinology • Diagnostic Imaging • Family Medicine*

*

Non organ/disease specific Family Medicine studies only.

Domain E • Infectious Disease • Gastroenterology • Renal Medicine • Rheumatology/Immunology • Dermatology

Domain F — Population Health • Health Services and Outcomes Research • Education Research • Research on Prevention and Health Promotion Programs • Social and Behavioural Research • Epidemiological Research • Community-based Participatory Research # includes General Surgery, Orthopaedic Surgery, Plastic Surgery and Urology.

Selection of Exempt or Non-Exempt Application Forms Submissions to DSRB can be categorised into either Exempt or Non-Exempt.

Studies that fall into one of the exempt review categories below may be submitted using Application Form 2 Exempt Category.

1. Normal Educational Practices and Settings 2. Anonymous Educational Tests, Surveys, Interviews, or Observations 3. Identifiable Subjects in Special Circumstances 4. Collection of Existing Data 5. Public Benefit or Service Programs 6. Taste and Food Evaluation and Acceptance Studies All other studies should be submitted using Application Form 1 - Non-Exempt Category. DSRB will then determine if the study will be reviewed under the Expedited or Full Board category.

Insurance Coverage Investigator-initiated studies conducted in AHS are covered under the National Clinical Trial (CT) Group Insurance Policy. Studies involving particularly risky procedures will require separate declarations. Please consult Clinical Research Unit (CRU) on this.

For Sponsored Pharma Studies, Sponsors should primarily be responsible for ensuring that subjects receive payment and compensation in the event of injury or illness as a result of their participation in a clinical trial, or offer a no-fault compensation to research subjects.

Declaration of insurance coverage in the DSRB submission should reflect either of the above.

For enquiries on the conduct of your research study, please contact CRU at 6602 3305.

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55

Information on Internal Grants

Building Human Capital

Supporting Translation Enabling Researchers Supporting Pilot Studies

The pursuit of medical discoveries begins with the exploration of suitable research projects. Such exploration is carried out through pilot studies. Also, talents are required to drive research projects from discovery to healthcare. To support discovery and human capital development, various grants are provided in KTPH for our clinicians and scientists.

For aspiring researchers, KTPH Research Scholarship aims to groom and nurture up-and-coming talents who wish to enhance their knowledge and skills in research.

Formerly known as the Clinician Leadership in Research programme, the scholarship is open to Doctors, Nurses and Allied Health Professionals. The programme consists of mentorship, customised training and funding for research and academia.

To support our clinicians and scientists, KTPH offers the RISE (Researcher-Investigator-Scientist-Enabler Grant) scheme. The scheme complements current institutional and departmental efforts in supporting Clinician-Scientists by funding a portion of their salary in commensuration with their time spent in research.

56 AHS Research Commemorative Book

The Alexandra Health Enabling Grant (AHEG) and Science-Translational & Applied Research (STAR) grant both support research pipeline in their early development stages. AHEG is designed to support pilot studies to accumulate preliminary data for more competitive grants, while STAR (formerly known as the Small Innovative Grant) is a short-term grant designed to support clinical and translational research that answer targeted research questions.

STAR offers two levels of support, depending on the projectâ&#x20AC;&#x2122;s development stage.

For smaller exploratory studies, STAR I provides up to $100,000 for two years. Successful projects completed under STAR I are offered follow-up support under STAR II which encourages the translation of research into patient care. The grant offers researcher $600,000 for three years.

So far, both grants have collectively generated at least 194 publications and presented 205 abstracts in conferences and presentations since 2014. These grants also serve as springboards for projects to secure larger national grants such as the $1.5 million Individual Research Grant (IRG) from National Medical Research Council (NMRC).

Acknowledgements The production of a publication such as this requires a considerable effort, and would not have been possible without the support and generous contributions of many people. Special thanks and acknowledgements go to all writers and contributors, and to our Corporate Communications colleagues who have shared their valuable inputs in this book.

Research Commemorative Book Editorial Team Editorial Advisor : A/Prof Lim Su Chi Chief Editor : Dr Willie Koh Deputy Editor : Ms Leong Pei Yen Assistant Editor : Mr Joseph Liew

This publication is produced by Clinical Research Unit, Khoo Teck Puat Hospital. Š 2015 Khoo Teck Puat Hospital. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the written permission of the copyright owner.

ALEXANDRA HEALTH SYSTEM 90 Yishun Central Singapore 768828 www.alexandrahealth.com.sg • Khoo Teck Puat Hospital • Yishun Community Hospital • Woodlands Integrated Health Campus • Admiralty Medical Centre • Sembawang Primary Care Centre