1) Briefly describe what you are currently working on or have recently worked on. What are your objectives?
I completed a study using a specialised amino acid mixture to test the impact of wound healing in pressure ulcers. I wanted to find out if this specialised amino acid mixture containing HMB, L-Glutamine and L-Arginine would have any effect on the rate of wound healing.
2) What are the results of the project?
The specialised amino acid mixture increased the proportion of healthy wound tissues in patients with pressure ulcers by 48%, compared with 25% for patients on standard wound and nutritional care. This could be an important development, as the incidence of pressure ulcers among bedbound patients in hospital settings is high and can have debilitating effects and potentially lead to increased readmission rates to the hospital because of poor wound healing. Speeding up the wound healing process will help reduce the levels of discomfort and potential health complications for our patients, and could also help decrease the length of hospital stays for patients.
3) Why do you enjoy doing research and what is the area of research you are most keen on?
I’m predominantly a gastrointestinal dietician and am interested in the area of nutritional support research for digestive diseases and parenteral/enteral nutrition.
Research is an essential part of patient care, and no area of health is too insignificant to be researched or investigated. For example, my project is in the realm of nutritional therapy, which had been a previously overlooked area for research, but is important in playing a huge role in our patients’ recovery. With more research, we can better assist the medical teams to optimise patient care.
4) What are the areas you hope to grow?
I hope to increase the amount of research done in the realm of nutritional therapy. I’m also in the midst of other research projects which include research on digestive diseases.
It’s my hope to see our Dietetic department conduct more research work on all areas of dietetics, with the aim of publishing more scientific papers and establish CGH as a centre of excellence for nutritional research in Singapore.
1) Briefly describe what you are currently working on or have recently worked on. What are your objectives? Any results to share?
I have completed a study involving the use of a wireless “Bravo” capsule device to measure oesophageal acid exposure in patients with suspected GERD.
Oesophageal acid exposure is used to assess and diagnose patients with suspected gastroesophageal reflux disease (GERD). GERD is a disease in which acid from the stomach flows back into the oesophagus, causing irritation and sometimes damage to the lining of the oesophagus.
I used the ‘Bravo’ capsule in healthy, asymptomatic volunteers in our local population and this has allowed me to generate normal values for Asians, and this can serve as a benchmark in determining whether pH readings generated by this device would classify a patient as having GERD.
2) Why is this research important? Who does it benefit?
Research helps me to keep abreast of the latest medical developments, and provides room for personal improvement in my area of sub-specialisation. The research journey can be a challenging and arduous one: from conceiving a research project, putting it through to the Institutional Review Board (IRB) for approval, conducting the study, analysing the results, presenting it at overseas meetings and the whole submission process to a journal. But truth be told, over the years, I have learned to enjoy the process because it keeps me intellectually stimulated. To see an article of mine accepted and published in a journal is a priceless reward. Along the years, this cycle has been a constant source of enjoyment and encouragement for me, and has instilled in me the values of discipline and determination in whatever I embark upon, especially when the going gets tough. I view research as a natural extension of daily clinical work, with the eventual aim of improving clinical outcomes for patients.
3) Why do you enjoy doing research and what is the area of research you are most keen in?
I enjoy my work thoroughly, and engage in research to keep me focused and to serve as a challenge to improve my knowledge. The mental rigor and discipline that research entails has also been extremely useful in other aspects of my daily life.
Having laid the foundation for research in GI motility disorders during my HMDP (Health Manpower Development Plan) stint in Belgium, my research work mainly pertains to areas related to reflux disease and motility disorders in the GI tract. Collaboration with various disciplines including the Ear, Nose and Throat (ENT) and Respiratory Departments in the area of reflux diseases has further added to the breath of clinical cases that we deal with in our daily clinical work. My main aim is to expand the motility services of the Gastroenterology Department so that we can continue to keep abreast with latest developments and novel technologies, particularly in the Asia-Pacific region.
1) Tell us more about what you do as a Physiotherapist.
I am a Musculoskeletal Physiotherapist, which means I see patients with orthopaedic, sports, joint and muscular problems. A lot of my work revolves around analysing movement patterns, feeling and touching joints, prescribing exercises and educating patients about their problems so that they can manage their pain independently.
2) Why do you think research is important?
Research helps us make the best informed decisions for our patients based on hard facts. It keeps us on our toes and encourages us to keep asking why, while looking for ways to show the cause and effect of health problems. Though not everything can be substantiated by research evidence, it keeps us engaged and curious!
3) What are some of your latest research projects?
We completed a research on neck pain (January to September 2011) in Singapore and its response to physiotherapy treatment. Earlier, we completed a two-year research on spinal pain and how different interventions worked for these patients. It was interesting to uncover local trends, as there is currently not much local data collected on spinal pain.
In 2009, we also did a study on lower back pain on a random sample of CGH patients who presented with this problem from January to June. We screened and treated them with a regime of tailored, manual therapy techniques, specific exercises and education, based on research evidence. The study showed that majority of these patients were in occupations that involved sustained postures, either sitting or standing, with minimal walking, and their conditions improved following a tailored physiotherapy treatment.
4) What do you like about your work?
I enjoy my work as it is multi-faceted and it challenges me in many ways. I am also actively involved in education and teaching, which I feel very passionate about. Most importantly, I like it most when I see my patients get better faster!
5) Can you share with us the programme you have initiated - Creating a Culture of Clinical Learning for Physiotherapists?
I was very inspired by my mentors from my Masters programme in Australia. They made physiotherapy interesting and sensible and gave me a structure I could work with clinically to help my patients get better faster. Much of the approach is quite simple, and I saw that it could be easily taught to physiotherapists. The key was to encourage thinking and the curiosity to keep asking "why". I was keen to apply this approach on a larger scale so that all our physiotherapists could understand the rationale behind what they do, and how to problem-solve effectively with patients.
Physiotherapists gain much of our skills from our daily interactions with patients, and through using feedback to improve ourselves. Such improvements would not be possible without good communication among us physiotherapists! This programme ensures that the seniors are paired with the juniors so that they have the opportunity to interact, encourage and learn from each other.
In addition, we run through case studies together regularly with a focus on evidence-based practices. This helps the team translate what we have learnt from research work to our patients. This programme is one of the most rewarding projects we have embarked on so far - to see patients getting better care and clinicians enjoying their work and improving continually.
1) Why did you specialise in Endocrinology?
My interest in endocrinology sparked when I met inspiring and dedicated teachers as a medical student at the National University of Singapore. I decided to specialise in this field because of the excellent teaching and guidance received in SGH and CGH’s endocrinology departments.
Endocrinology is very interesting and challenging, as many conditions caused by hormone disorders can be complex and affect many organ systems.
2) As a doctor in this field, what concerns you the most and why?
Obesity is increasing in Singapore and worldwide and is the foundation of many deadly health conditions like diabetes, high blood pressure, high cholesterol and heart diseases. However, many do not realise that weight loss can help to improve or even cure these conditions. Most of the patients I see have one or two of the conditions listed above and most of the Type 2 diabetic patients among them are obese or overweight.
3) Briefly describe what you are currently working on or have recently worked on.
I have just completed a study of the effects of different types of weight-loss diets on sexual function, urinary symptoms, quality of life and cardiovascular risk factors in local obese men. In the study, 70% of the men were found to have erectile dysfunction! This is an important point to note as erectile dysfunction has shown to precede the development of heart disease, especially in diabetic and obese men. A significant proportion of men may not seek medical attention for these symptoms despite knowing that these conditions pose a risk to their health and quality of life. My study has shown that 5% to 10% body weight loss can lead to an improvement of erectile function by up to 20%! Recognition that weight loss can improve erectile and urinary difficulties is a powerful motivator for changes in lifestyle, especially in younger man.
Currently, I am researching on the effects of exercise in obese men and I hope to eventually extend these studies for a longer period, to other types of lifestyle interventions, and to women as well.
4) Why do you enjoy doing research and what is the area of research you are proudest of?
I see research as the best evidence to investigate which medications, devices or behaviour changes will improve health and quality of life. It is an essential component of patient care. I am happy when research participants derive benefits from the studies, and am always striving to develop and innovate in areas which will help the patients I see, especially overweight and diabetic people.
5) What are the areas you hope to grow?
I would like to expand our weight management program to include multidisciplinary collaboration with other specialities which manage patients with obesity-related illnesses, such as obstructive sleep apnoea and fatty liver disease.
Dr Joan Khoo’s research is published in the International Journal of Obesity (Journal of Sexual Medicine) in 2010.
1) Briefly describe what you are currently working on or have recently worked on.
I was involved in a study to investigate the effectiveness of the Telestroke programme in initiating treatment for patients with ischaemic stroke at CGH. The study revealed that the programme improved the level of co-ordinated care for patients through prompt consult, diagnosis and treatment.
Besides the Telestroke Programme, I was also a Co-Investigator with a Smoking Cessation Counsellor to explore the profile of smokers who quit smoking. The findings revealed that a dedicated Smoking Cessation Counsellor coupled with follow-ups were critical factors in successfully helping smokers quit.
The National Neuroscience Institute (NNI) and Changi General Hospital (CGH) started their collaboration in the Telestroke programme in February 2011, utilising telemedicine for prompt treatment of suitable ischaemic stroke patients. Since then, A&E doctors are able to get access to 24-hour neurology consultation from NNI neurologists, allowing them to confirm the eligibility of A&E patients for a time-sensitive treatment to suitable stroke patients. To read more about the Telestroke programme, please click here.
With the evolving healthcare landscape and advancements in technology, it is important for nurses to keep up with the changing needs of the population through research activities, and crucially, translating that into practices that will ultimately benefit patients.
3) Why do you enjoy doing research and what is the area of research you are proudest of?
Passion in research is the driving force that has kept me going the last 10 years. I derive great satisfaction when a research project is completed and presented at local and international forums. It gives me immense pride to represent CGH as an ambassador in nursing research. Winning numerous awards in the various scientific meetings held by CGH has also been very encouraging. I thank the team of nurses who has journeyed tirelessly with me through these years.
I hope to grow a culture of research in CGH where all grades of nurses develop enquiring minds and challenge clinical practices using evidence-based protocols or findings.
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Changi General Hospital (CGH)