recognition & awards congratulations -...

April 2015Issue 02

THE OFFICIAL RAMSAY SIME DARBY HEALTH CARE NEWSLETTER FOR DOCTORS

QUARTERLY NEWSLETTER

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SUBANG JAYA MEDICAL CENTRET : +(603) 5639 1212F : +(603) 5639 1675E : [email protected]

1, Jalan SS 12/1A, 47500 Subang JayaSelangor Darul Ehsan, Malaysia

ARA DAMANSARA MEDICAL CENTRET : +(603) 5639 1212F : +(603) 7846 0925E : [email protected]

Lot 2, Jalan Lapangan Terbang SubangSeksyen U2, 40150 Shah AlamSelangor Darul Ehsan, Malaysia

MEDIPLEXT : +(603) 5639 1212F : +(603) 5639 1910

Tenancy Management OfficeGround Floor, Flavours Food Hall, Mediplex1, Jalan SS 12/1A, 47500 Subang JayaSelangor Darul Ehsan, Malaysia

RAMSAY SIME DARBYHEALTHCARE COLLEGET : +(603) 5191 2121 / 1296 / 1346F : +(603) 5191 1357E : [email protected]

Centrepoint Business ParkAdministration Office, Block A1-1 and A1-2,Lot 728, No.5, Jalan Tanjung Keramat 26/35Seksyen 26, 40400 Shah AlamSelangor Darul Ehsan, Malaysia

INTERNATIONAL PATIENT SERVICEST : +(603) 5639 1666E : [email protected]

PARKCITY MEDICAL CENTRET : +(603) 5639 1212F : +(603) 6279 3399E : [email protected]

No. 2, Jalan Intisari PerdanaDesa ParkCity 52200Kuala Lumpur, Malaysia

NEW DOCTORS ON BOARD

Dato' Sri Dr Zulkharnain Ismail SSAP DIMPConsultant Orthopaedic Surgeon

Conferred the Darjah Kebesaran Sultan Ahmad Shah Pahang Yang Amat Di Mulia –Peringkat Pertama Sri Sultan Ahmad Shah Pahang (SSAP) which carries the title Dato’ Sri.

Dato' Dr Lee Eng Lam SSAConsultant Paediatrician

Conferred the Darjah Kebesaran Dato’ – Sultan Sharafuddin Idris Shah award, carrying the title Dato’. Awarded by His Royal Highness The Sultan of Selangor on 11 December 2014 at the Balairuang Seri,Istana Alam Shah, Klang in conjunction with His Royal Highness’ birthday.

RECOGNITION & AWARDS

Specialty Name Place of Practice

Anaesthesiology

Dermatology

Dr Ng Kim Swan ADMC

Dato' Dr Sharil Azlan Bin Ariffin

Dr Wong Kang Kwong

Dr Felix Yap Boon Bin

General Surgery

Hand and Microsurgery

Dr Pok Eng Hong

Dr Rashdeen Fazwi B Muhammad Nawawi

Orthopaedic Surgery Dr Thaveethu Moses

OphthalmologyDr Loo Voon Pei, Angela

Dr Ngo Chek Tung

Otorhinolaryngology Dr Loo Chun Pin

Radiology

Dr Chan Ruoh Syuan

Dr Nor Afida Hasnita Bt Shuib

Dr Siti Fathimah Bte Hj Abbas

ADMC

ADMC

SJMC

ADMC

PMC

SJMC

SJMC

SJMC

PMC

ADMC

PMC

SJMC

SJMC - Subang Jaya Medical Centre

ADMC - Ara Damansara Medical Centre

PMC - ParkCity Medical Centre

Congratulations to the following recipients on their awardship:

2015 Primary Care Cardiac SymposiumECG Made Easy1 March 2015 Ara Damansara Medical Centre

ADMC held another successful Primary Care CardiacSymposium for General Practitioners in March which saw close to 100 GPs and medical officers from private and publichospitals and clinics attending the event. The symposium provided an overview of ECGs and how to read them, as well as other heart conditions frequently seen and how to manage them. In addition, the symposium aimed to strengthen the partnership between hospital and the attending doctors. Speakers for the symposium were Dr. Abdullah Asad Siddiqui, Emergency & Occupational Safety Health Physician, and Cardiologists Dr. Liew Chee Koon and Dr. Ahmad NizarJamaluddin.

Heart of the MatterSeminar for Primary Care Physicians15 February 2015 ParkCity Medical Centre

The seminar was organised in conjunction with the launchof the Catheterization Laboratory (Cath Lab) and the official opening of ParkCity Medical Centre's Cardiology unit. Around 30 GPs attended the seminar which was purposely targeted for a smaller group so as to allowa more interactive environment between GPs andspecialists. All doctors were taken on a tour of the Cath Lab to allow them to experience and understand the new Siemens Artis Q machine.

The speakers were Dr. Chua Seng Keong who spoke about "ECG Crash Course & Updates on Cardiac Imaging (MRI Scan)" and Dr. Choong Yoon - Sin on "Updates on Cardiology Intervention".

EVENTS & HAPPENINGS

14

Remembering

Do you have any feedback or articles you would like

to share with us?

Simply send your articles or feedback to:

Branding and Communications Department

Level 5, Ara Damansara Medical Centre

Lot 2, Jalan Lapangan Terbang Subang

Seksyen U2, 40150 Shah Alam

Selangor Darul Ehsan

Email : [email protected]

or [email protected]

EDITORIAL SUPPORT

CREATIVE SUPPORT

DAMAYANTHIRASAPPAN

SENIOR MANAGERMedical Services

Administration

FAITH TANGPUI SEE

MANAGERInternational Marketing

MELINDER KAUR

ASSISTANT MANAGERMarketing,

Ara Damansara Medical Centre

SUMITHASURENDRANATHAN

ASSISTANT MANAGERBranding and

Communications

VELLE LEE PHIN PHIN

ASSISTANT MANAGERMarketing and

Communications, ParkCity Medical Centre

SALLY TAN EARN LING

EXECUTIVECreative Designer

NURBAIZURAAHMAD KAHAR

SENIOR EXECUTIVEBranding and

Communications

TAN JUI KOK

SENIOR MANAGERReferral and

Reference Business

JESSICA MOOILAI HENG

SENIOR MANAGERSales and Marketing,

Subang Jaya Medical Centre

DR. ARMIJN MAHPHAFANSURI MUSTAPA

ADMINISTRATORMediplex and

Corporate Marketing

01

DR SABRI MD REJAB1939 -2014

We proudly honor the wonderful life and loving memory of one of the founding members of Subang Jaya Medical Centre.

He was a committed leader, constant advocate, pioneer and champion of our hospital’s vision and mission.

We sincerely thank him for his wealth of wisdom,service and guidance.

We, the Editorial Team,would like to extend our sincere condolences

to the family of the late Dr Sabri Md Rejab.

Office Orthopedics8 February 2015 Holiday Inn Glenmarie

16 November 2014 Holiday Inn, Subang Jaya

General Medicine for Family Physician (Part II)

Following the success of Part I on General Medicine for Family Physician which took place in January 2014, this event was met with the same amount ofenthusiasm and encouraging response. Attended by 85 GPs hailing from the Subang Jaya and USJ areas, the speakers were:

Dr. Sanjay WoodhullConsultant Paediatrician“Paediatric Pyrexia - The Ten Commandments”

Dr. Vigneswaren PonnuduraiConsultant Obstetrician and Gynaecologist“The Enigma of The Woman with Lower Abdominal Pain”

Dr. Alex Tang Ah LakConsultant Radiologist"If Chemotherapy Fails, Is That the End of the World"

Dr. Bala Sundaram MariappanConsultant Urologist"Doctor, There is Blood in My Pee"

Dr Tharmaraj T. RenganathanConsultant General and Colorectal Surgeon"I'm Passing Blood in My Stool! Do I have Cancer?"

Ara Damansara Medical Centre collaborated with MMA Selangor for a workshop on the management of joints diseases which aimedto give GPs an insight on the management of injections, steroids and gels for various orthopaedic conditions routinely encounteredin general practice. The speakers touched on indications related to the diseases and gave demonstrations on the injectionprocedures for conditions like frozen shoulder, painful arc syndrome, shoulder impingement, tennis / golfers’ elbow, planter’s fasciitis and calcaneal spur among others. Speakers for this workshop, were Dr. Siva Kumar Ariaretnam, Dr. Shamsul Iskandar Hussein and Dr. Yeap Ewe Juan.

EVENTS & HAPPENINGS

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WHAT’S NEW

ParkCity Medical Centre Installs Siemens Artis Qto Enhance Cardiac Patient CareParkCity Medical Centre (PMC) has become the latest hospital in Malaysia to invest in the advanced interventional innovation from Siemens Healthcare. The recent installation of the Siemens Artis Q technology into their new Catheterization Laboratory now provides the infrastructure for PMC to grow in structural heart disease and endovascular surgery, facilitating the latest techniques, procedures and devices in these fields. The Artis Q angiography system for interventional imaging is a visionary breakthrough in X-ray generation and detection that takes performance, precision and sensitivity to the next level.

The new equipment will provide a higher level of accessibility and precision for doctors when treating and managing heart conditions, therefore, providing patients with assurance and confidence.

The Artis Q can help clinicians identify small vessels up to 70% better than conventional X-ray tube technology with the unique GIGALIX flat emitter instead of coiled filament traditionally found within X-ray tubes, allowing the lowest appropriate dose to be achieved plus provide fine focal spot sizes and grid pulse technology. This protects patients, doctors and medical staff, especially during longer interventions.

The Artis Q angiography system was selected due to its excellent image quality following comprehensive evaluation of other systems available on the market. With its ability to visualize tiny blood vessels and devices, it will allow clinicians to provide a highly accurate service for complex conditions.

The Artis Q boasts the following features:

1. Offers unparalleled performance with a new X-ray tube entirely developed around the unique flat emitter technology.2. Innovative applications to support precise guidance during interventional procedures.3. CLEARstent Live where stents are imaged in real-time during therapy, with motion stabilization created by simultaneous correction for the heartbeat. 4. Ultra low radiation dose for patient safety.5. Unique water cooled 16-bit detector, which provides 4 times the depth resolution, when compared to conventional 14-bit detectors.

XLIF Technique Pioneering TeamAt Ara Damansara Medical Centre

Article taken from the Society of Lateral Access Surgery (SOLAS) website: http://www.lateralaccess.org/

Consultant spine surgeons Dr. Appasamy Velu and Dr. Siow Yew Siong are Malaysia’s surgical pioneers specialising in Minimal Invasive Spine Surgery or keyhole spine surgery. They helped countless patients achieve a better qualityof life, addressing their spinal problems through thumb length incisions using state-of-the art surgical techniques involving lasers, endoscopes, operating microscopes, nerve monitoring devices, computer-assisted navigation system and others.

Dr. Appasamy and Dr. Siow are also acknowledged as the first trained surgeons in eXtreme Lateral Interbody Fusion Surgery (XLIF) in Malaysia and widely recognized for their high standard of patient spinal healthcare in Asia. They constantly strive to break new grounds and incorporate newer, safer and better techniques. The Society of Lateral Access Surgery, an international body representing communities of surgeons, specialists, leaders and physicians in lateral access spine surgery, have recently granted Dr. Appasamy and Dr. Siow membership. This recognition marks them as Asia’s first spinal surgeons to be accepted and part of a global community focused on leading, shaping and advancing spinal healthcare.

02

Orthopaedics Seminar for Primary Care Physicians19 October 2014 ParkCity Medical Centre

Organised by ParkCity Medical Centre, the talk includeda hands-on workshop on the role of primary physicians in preventing knee pain, and the procedure on foot and ankle injections. The talk aimed at cultivating the culture ofcontinuous learning, and to build strong relationshipbetween GPs and Specialists. The speakers for the event wereOrthopaedic Surgeons Dr Lee Chee Kuan who talked about "Obesity and Knee Pain", Dr Yeap Ewe Juan with his topic“The ABC's of Foot & Ankle Surgery” and Dr Siva Kumar Ariaretnam who spoke on “Minimally Invasive Knee Surgery;Arthroscope & Beyond”.

Hepashere KOL Instructional Workshop8 October 2014 Subang Jaya Medical Centre

SJMC successfully organised an International Symposium titled the Hepashere KOL Instructional Workshop which received huge response and was attended by Oncologists and Interventional Radiologists from Hong Kong, Taiwan, China, Thailand, Singapore and Japan. A total of 15 speakers spoke on areas related to oncology and Interventional Radiology. The illustrious line up of speakers included:

Prof. Shinichi Hori (Japan)Dr. Shahrina Man Harun (Malaysia)A. Prof. Dr. Pua Uei (Singapore)A. Prof. Dr. Anushya Vijayananthan (Malaysia)A. Prof. Dr Ouzrieah Nawawi (Malaysia)A. Prof. Dr. Luk Wing Hang (Hong Kong)A. Prof. Shafie Abdullah (Malaysia)Dr. Murbita Sari (Malaysia)Dr. Anil Gopinathan (Singapore)Dr. Nur Adura Yaakup (Malaysia)Prof. Basri Johan Jeet Abdullah (Malaysia)Dr. Anuchit Ruamthanthong (Thailand)Dr. Faizal Ali (Malaysia)Dr. Alex Tang (Subang Jaya Medical Centre, Malaysia)Dr. Nur Yazmin Yaacob (Malaysia)

[INTERNATIONAL]

EVENTS & HAPPENINGS

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What you need to know about the XLIFeXtreme Lateral Interbody Fusions (XLIF) have rapidly become an accepted treatment option for a number of spinal conditions. XLIF is the only lateral approach procedure validated by 10 years of clinical experience. More than 150 published clinical studies support the procedure, documenting excellent clinical outcomes such as reduced blood loss, less O.R. time, and shorter hospital stay, as compared to traditional open spine surgery.

XLIF Patient Benefits

1. Reduced operative time – Traditional procedures can take many hours to perform, the while XLIF procedure can be successfully completed in as little as one hour, reducing the amount of anesthesia time.

2. Reduced blood loss and minimal scarring – The MaXcess® retractor dilates the tissue rather than cutting, resulting in much less trauma to the affected area.

3. Reduced postoperative pain – The XLIF procedure does not require entry through sensitive back muscles, bones, or ligaments, so patients are usually walking the same day.

4. Reduced hospital stay – XLIF requires only an overnight stay in the hospital, compared to several days of immobility and hospitalization typical of traditional open approaches.

5. Rapid return to normal activity – Patients are usually walking the same day after surgery and recovery is typically around 6 weeks, compared to 6 months or more.

Introduction and Rationale

Methods

The aims of healthcare are to provide services that are safe, effective, patient centred and of value. Healthcare performance measurement then evaluates the extent to which the health services rendered to patients met these aims. These measurements are intended to serve accountability purposes and to promote improvements in the delivery of care. HPMRS (more details at www.hpmrs.com.my ) is the local statistical system developed to meet the increasing demands for healthcare performance measurement services. SJMC’s cancer care services, and specifically breast cancer care, is the focus of this report.

We have previously reported on SJMC’s Breast cancer care performance for process measures. The present report focus on SJMC’s care performance as measured by patient survival outcome for up to 5 years. Cancer survival is a key index of the overall effectiveness of health services in the management of patients with cancer. Persistent difference in survival between a centre’s performance and a referencepopulation’s or benchmark results represents many avoidable deaths.

We conducted a single-center, observational cohort study to estimate the survival outcome of patients diagnosed in SJMC between 2008 and 2012. The Ministry of Health’s Medical and Research Ethics Committee approved the study protocol.

Study population

The study population consisted of Malaysian women with pathologically confirmed primary breast cancer diagnosed between 2008 and 2012, and treated with one least treatment modality at SJMC. Cases are identified through the hospital register as well as operative surgery, chemotherapy and radiotherapy records. Case ascertainment was independently verified to be complete (100%). Foreign patients, patients with non-epithelial malignancy or recurrent tumor are excluded from analysis.

Data collection and definitions

At enrollment, data were abstracted from patients’ medical and histo-pathology (HPE) reports by trained data collectors. Demographic data abstracted include age, sex race and nationality; tumor characteristics include histologic type, grade, location, extent, and size; lymph node and distant organ metastases. Staging of disease was based on the American Joint Committee on Cancer (AJCC) criteria. AJCC stage I or II disease were considered early breast cancer (EBC), stage III locally advanced BC (LABC) and stage IV metastatic BC (MBC). After enrollment, all patients were followed up for 12 months to collect data on their subsequent exposure to cancer-directed therapies, which were abstracted from medical, operative surgery, chemotherapy and radiotherapy records.

For the purpose of measuring breast cancer care performance, we mostly adopted the performance measures developed and usedby Quality Oncology Practice Initiative (QOPI) [1,2], American Society of Clinical Oncology/National Comprehensive Cancer Network(ASCONCCN) [3,4] and, National Accreditation Program for Breast Centers (NAPBC) [5], while taking into account local clinical practice guideline [6].

Study shows SJMC Cancer Centre as World ClassClinical Research Findings

WHAT’S NEW

03

The impact of physical activity on SCA is rather debatable with different studies showing different results. But we can agree that moderate physical activity may be beneficial by decreasing platelet adhesiveness and aggregability.

Age, hypertension, left ventricular hypertrophy, intraventricular conduction block, elevated serum cholesterol, glucose intolerance, decreased vital capacity, smoking, relative weight, and heart rate identify individuals at risk for sudden cardiac death. Smoking is an important risk factor. In the Framingham study, the annual incidence of sudden cardiac deaths increased from 13 per 1000 in nonsmokers to almost 2.5 times that for people who smoked more than 20 cigarettes per day. Quitting smoking promptly reduced this risk, which may be mediated by an increase in platelet adhesiveness, release of catecholamines, and other mechanisms. Elevated serum cholesterol appears to predispose patients to rupture of vulnerable plaques, whereas cigarette smoking predisposes patients to acute thrombosis.

Certain ECG abnormalities can help identify patients who are atan increased risk for sudden cardiac death. These include the presence of AV block or intraventricular conduction defects and QTprolongation, an increase in resting heart rate to more than 90 beats per minute (bpm), and increased QT dispersion in survivors of out-of-hospital cardiac arrest.

Out-of-Hospital Resuscitation

The majority of SCA victims show no symptoms and were never identified as being ‘at high risk’ before it happens. Due to this, many SCA cases happen away from any medical facility, which is why it is extremely important to improve the outcome of resuscitation attempts outside the hospital. Unfortunately, there is a very short time frame after cardiac arrest during which circulation has to be restored to prevent death or irreversible cerebral damage. Within this short timeframe, several crucial steps must be taken to ensure the survival of the victim. Among the most important steps a person shouldlearn is how to identify and locate the SCA victim. This is due to thealarming fact that 80% of cardiac arrests occur at home, and from that percentage 40% go un-witnessed. Therefore, we must have warning systems that are able to recognize cardiac arrests, to raise an alarm, and to transmit the exact location of the victim to providers of basic and advanced life support.

Much attention has recently been given to public access defibrillation, allowing non-physicians to use widely distributed automated external defibrillators (AED). In fact, it was suggested several years ago in various studies done, that AEDs be made ‘as common as fire extinguishers’ to cover all the places a cardiac arrest can occur.

By following the steps below and acting fast we can all make the difference between life and death:

1. Learn how to recognize a sudden cardiac arrest.

2. Immediately call for help regardless of the place you witnessed the arrest, even in a hospital. Ask for an AED which can save lives and is far superior to human compressions. Currently we can spot AEDs at various public places like shopping malls and airports in Malaysia.

3. Check for the victim’s pulse for no more than 10 seconds. If you are not able to find an obvious pulse, start the compressions.

4. Continue compressions for two minutes. After every 30 compressions, give two rescue breaths. Do this for five cycles for approximately two minutes and check for pulse. If you do not feel a pulse, repeat the compression and ventilation cycle. 5. Use the AED as soon as it arrives. Survival rates after ventricular fibrillation (VF), which is most often the presenting rhythm in SCA, decrease approximately 7% to 10% with every minute that defibrillation is delayed. A survival rate as high as 90% has been reported when defibrillation is achieved within the first minute of collapse. When defibrillation is delayed, survival rates decrease to approximately 50% at 5 minutes, approximately 30% at 7 minutes, approximately 10% at 9 to 11 minutes, and approximately 2% to 5% beyond 12 minutes.

It is imperative that General Practitioners undergo training in CPR and AED use because emergency personnel cannot always get to the victim’s side quickly enough. If you haven't taken a CPR-AED course it's a good idea to spend some time learning these fundamental lifesaving skills.

Join Hands, Save Lives !!!!!Ara Damansara Medical Centre conducts Basic Life courses for medical andnon-medical personnel. If you are interested in learning lifesaving skills orwould simply like to know more, please call:

Customer Careline+603 5639 1212

Norliana MahussinMarketing DepartmentAra Damansara Medical Centre

Direct Line: +603 7839 9908

FEATURE

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ResultsA total of 836 patients who were potentially eligible for inclusion in this study were identified to have breast cancer through the hospital register as well as operative surgery, chemotherapy and radiotherapy records. Ninety patients were excluded because of incomplete data (34 uncertain date of diagnosis, 15 no pathology reports confirming cancer diagnosis, 41 no treatment details). A further 71 patients were excluded because of non-eligibility (non-primary tumor 50, nonepithelial tumor 10, foreign patients 14). Thus the final sample size was 675 subjects.

Mortality ascertainment and imputation

Complete and accurate ascertainment of mortality outcome among study patients is necessary to minimize bias in estimating cancer survival outcome. We follow a rigorous procedure described below to ensure this.

1. Case ascertainment was initially independently verified to be complete (100%).This is to avoid exclusion of deceased patients especially those who die soon after diagnosis.

2. Mortality outcome was noted during data abstraction for the study (6 deaths identified)

3. All cases enrolled were matched based on their names and national identity card number against the mortality database provided by the National Registration Department to ascertain their mortality outcome twice in 2013 and 2014 (total 41 deaths identified).

4. Remaining cases were matched based on their names and hospital number against the hospital register (which record all visits to the hospital). Patients who had a visit after the end of the study period (31 Dec 2013) are considered alive (403 ascertained alive).

5. A sample of the remaining cases with Stage I or II or no staging information and 100% of cases with Stage III or IV were contacted by phone or home visit to enquire about the patients’ mortality outcomes. All patients with Stage I and no staging information were alive. One (3%) patient out of 32 with Stage II was dead, likewise for 5 (12%) out of 42 Stage III and 2 (40%) out of 6 Stage IV.

6. For the purpose of survival analysis, we therefore assume all cases with Stage I or no staging information who were not contacted (60 cases) to be alive. For the 43 case with Stage II, we randomly select one case and impute her outcome as death. We assume all remaining uncontacted patients with Stage III (6 cases) and IV (1 case) to be dead. Thus, any bias in the survival estimates arising of missing information on mortality outcome is conservative (that is, the survival estimates can only be worse than they actually are).

Independent data audit

A copy of the HPE report was retrieved for all patients enrolled to verify tumor diagnosis and characteristics. In addition, patients’ demographic and treatment data were also subjected to independent data verification against source documents on site. The accuracy of the collected data with respect to demographics, surgery, radiotherapy, chemotherapy, hormonal therapy and trastuzumab treatment were all >95%.

Statistical methods

Continuous variables are described by summary statistics such as mean, median, and standard deviation and categorical (nominal/ordinal) variables, by the frequencies of each category.

For cancer survival outcome performance, results are expressed as overall survival and relative survival. Relative survival is the ratio of the survival observed in the study patients and the survival that would be expected if they had experienced only the background mortality (all-cause death rates) of the general population of the same age, sex and ethnicity (but not the same residential location, as only national lifetable is available in Malaysia). It shows the extent to which cancer shortens life compares to the general population.

Age standardized five-year relative survival us used for comparison of survival outcome between this study population and other centers’ or registry populations. Age standardized rate refers to the rate that would be observed if the patient populations compared had the same age structure as an external standard population, in this case, the International Cancer Survival Standard [10]. Age standardization allowscomparison of results between jurisdictions or countries.

Multivariable Cox regression is used to estimate the effects of covariates on survival outcome.

WHAT’S NEW

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WHAT’S NEW

3.1 Baseline characteristics of Breast cancer patients, SJMC 2008-2012The mean age of the women was only 53 years; 36% was aged <50 years, 77% was Chinese and 78% resided in Klang Valley or Selangor. 85% paid for their care out-of-pocket (OOP) and only 14% had their care financed by insurance or their employer.

For patients first presenting to SJMC only, it took a median of 6 days to arrive at a diagnosis of breast cancer. 65% of patients were diagnosed with Early Breast Cancer (Stage 1 or 2, EBC), another 20% with Locally Advanced Cancer and 4% with late stage metastatic cancer. 25% had T1 tumor and 24% were node negative. 72% were ER+, 63% PR+, 34% HER2+ and 13% triple negative.

3.2 Treatment for Breast cancer, SJMC 2008-2012Of the 675 patients treated at SJMC between 2008 and 2012, 553 (82%) patients had surgery there but only 30% of these were breast conserving surgery. 346 (51%) patients had radiotherapy and 307 (66%) had chemotherapy. 346 (73%) of 471 ER+ or PR+ patients had hormonal therapy and 42 (22%) of 189 HER2+ patients received Trastuzumab treatment.

3.3 Breast Cancer Survival Outcome performanceOverall survival at 5 years was 98% for patients with Stage I disease, decreasing to 36% for Stage IV disease. More impressively, the relative survival at 5 years was 101% indicating these patients were practically cured of their cancers. For Stage II disease, the result was 95% which is no less remarkable. These results showed that SJMC has accomplished similar if not better results than established centers of excellence such as the Cleveland Clinic.

Results on Age standardized Relative Survival at 5 years are available from Surveillance, Epidemiology and End Results (SEER) database, an often used reference population in cancer epidemiologic research. For all cancer stages, SJMC results are clearly superior to the average results accomplished by all cancer centres in the US, from which SEERS registry population is drawn.

Comparing with the results reported by other countries’ registries, SJMC’s relative survival results are among the highest. Of course it is not meaningful to compare the result of a single institution (SJMC) directly with the average result reported by a cancer registry for apopulation. However, in so far that SJMC’s results are above the average reported by these registries, it is reasonable to infer that its results match those of the better performing institutions reporting data to those registries.

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Comparative performance betweenSDMC and Cleveland Clinic in terms of

Overall Survival outcome of patients with Breast cancer

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Relative survival of patients with Breast cancertreated at SJMC, 2008-2012

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Ultrasound screeningThe 18 to 23 week scan or anomaly scan has been an important diagnostic tool in the management of pregnancies and detection of congenital defects. It allows the detection of structural abnormalities and soft markers suggestive of chromosomal disorders. The screening is offered routinely to patients due to the fact that a large number of abnormalities are picked up from low risk pregnancies.

CounselingExpectant mothers need to be counselled prior toperforming any screening procedures so that theyunderstand the procedure, the estimation of risks, side effects and, of course, the cost of the screening procedure itself. It is important that counseling include a segment on further management of an affected baby, should the test come out positive for abnormalities.

It is important to note here that a positive screen may require an invasive diagnostic prenatal test. However, this is not mandatory as a positive screen does not mean that the baby is definitely abnormal nor does a negative screen guarantee that the baby is normal.

SUDDEN CARDIAC ARRESTCODE BLUE.....!!!!!High speed car with an unconscious victim aged 45 years, at the back seat...... halts with a screech in front of our ER.......help help!!!!

Victim is urgently taken out of the car....!!!

Hello, hello.....no response from the victim!!!

Call for help.......!!!

No pulse detected on the victim!!!

Compression starts on the trolley bed even before the victim is wheeled into the resus room. Code blue has been announced.

DR. ABDULLAH ASAD SIDDIQUIEmergency PhysicianHOD EmergencyAra Damansara Medical Centre

This is a typical presentation of Sudden Cardiac Arrest (SCA) which is often mistaken for a massive heart attack. However, the latter is a condition that is treatable and does not have to lead to sudden death. SCA describes the unexpected natural death from a cardiac cause within a short time period of less than 1 hour from the onset of symptoms in a person without any prior condition that would appear fatal. Such a rapid death is oftencredited to cardiac arrhythmia.

SCA accounts for 300,000 to 400,000 deaths annually in US. SCA is the most common and often the first manifestation of coronary heart disease and is responsible for more than 50% of deaths from cardiovascular disease in developed countries according to the journal Circulation.

New report from the American Heart Association (AHA) suggests the incidence of out-of-hospital cardiac arrest is 326,200. The average survival rate is 10.6% and 8.3% of survivors have good neurological function. Nearly one in three victims survives when the arrest is witnessed by a bystander.

Arrhythmia is a conduction problem in the heart affecting its rate or the rhythm. In arrhythmia the rate can be either too slow or too fast affecting the cardiac output which in turn affects the brain, heart and lung. Normally, the sinoatrial node (SA node) shoots impulses which activate atrial muscles, these impulses then travel to the atrioventricular node (AV node) located between the atria and the ventricles. AV node holds the impulses allowing ventricles to dilate completely before allowing them to travel down to ventricles to contract again.Any disturbance in this conduction pathway will lead to an arrhythmia which may end up as a fatal complication.

The risk of SCA increases as age increases, and is 3-4 times more common among men than women. However, it has been reported that 30% of deaths for the age group between 14 – 21 years of age were caused by SCA.

Screening Tests For Pregnancy

FEATURE

Screening Test

Combined first-trimester screening

Blood test for PAPP-Aand hCG, plus anultrasound exam

Down syndromeTrisomy 13Trisomy 18

82-87%

85%

69%

81%

94-96%

85-88%

Neural tube defects

Down syndromeTrisomy 18Neural tube defects




Blood test for AFP

Blood test for AFP,hCG, and estriol

Blood test for AFP,hCG, estriol, and inhibin-A

Blood test for PAPP-Aand an ultrasound examin the first trimester, followedby quad screen in the secondtrimester

Same as integrated screeningbut no ultrasound exam

Second-trimestersingle screen for neuraltube defects

Second-trimester triplescreen

Second-trimester quadscreen

Integrated screening

Integrated screening(blood test only)

Test Type Down SyndromeDetection Rate

What Does ItScreen for?

10

WHAT’S NEW

Discussion and ConclusionSJMC is among the first hospitals in Malaysia to embark on routine measurement of the performance of its cancer care services.

SJMC’s cancer care process performance results have been consistently about 90%, this is close to the benchmark of 95%. Notsurprisingly the consistently high performing cancer care system in SJMC has translated into excellent patient survival outcomes, the key index of the effectiveness of cancer care services in the management of patients with cancer. Patients treated at SJMC between 2008 and 2012 had a relative survival at 5-year of 101% for Stage I disease. This means all such patients were cured by the treatment they had received at SJMC. Even for Stage IV disease, SJMC’s result was a respectable 36%.

This is world class performance befitting a centre of excellence for cancer care.

0

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Stage I SJMC Stage I SEERStage II SJMC Stage II SEERStage III SJMC Stage III SEERStage IV SJMC Stage IV SEER

Comparison of Age standardizedFive-Year Relative Survival

between patients treated at SJMC and SEERS

90 88 8882 82

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SJMCMalaysia

SEERUS

ICBPAustralia

ICBPUK

CONCORDJAPAN

International comparisons of Breast Cancercare performance in terms of Five year Relative Survival

NEW DIAGNOSTIC LAB IN PENANG

Ramsay Sime Darby Health Care opened its new histopathology lab in Penang recently. Strategically located in the heart of Georgetown, the RSD Diagnostics Lab Penang occupies approximately 1,000 square feet of space on the ‘R’ Floor of the Loh Guan Lye Specialist Centre.

The lab will adopt the same principle that has allowed Subang Jaya Medical Centre (SJMC) to be one of the top laboratory facilities in the country.

Fully assisted by SJMC’s experienced team, the RSD Diagnostics Lab Penang offers pathology services with state-of-the-art technology in a full service computerised laboratory. Our Specialists and General Practitioners (GPs) can expect the following services:

• Histopathology• Cytology • Cytogenetics for Gynaecology• Cytogenetics for Oncology• Frozen Section• Comprehensive IHC (Immuno Histochemistry) - 205 types

Emulating the strengths of SJMC, the Penang Lab is set to provide excellent service with the following added benefits:

• High quality pathology reporting service• Competitive pricing• Improved reports turnaround time• Onsite sample collection or other logistic services (reverse charge on courier for high volume site)• Enhanced physicians' satisfaction by allowing easy access to our pathologist• Cost saving by reducing hospital’s cross referring fee• Consulting services to hospitals by visiting RSDH pathologist

The RSD Diagnostics Lab Penang is committed to deliver accurate, reliable, timely and affordable histology and cytology diagnostics services with good clinical and business practices to all our referral hospitals, medical consultants and their patients.

For more information, please contact +603 5639 122906

Expectant mothers are always concerned about the well-being of their baby which is why it is important to practice caution, eat a healthy balanced diet, exercise, stop smoking, reduce caffeine and alcohol intake and consume supplements. However, even when a mother goes to great lengths to ensure that she is taking goodcare of herself, sometimes there are problems that arise which areunavoidable.

Routine screening tests may be offered as early as 10 to 12 weeks where a blood test will be done for the following conditions.

AnaemiaApart from iron deficiency, anaemia conditions such as thalassemia and sickle cell anaemia may need to be tested among certainethnicities.

Blood group and Rh typingMothers with an uncommon blood group and Rhesus negative blood type need further testing in the later stages of pregnancy to detect antibodies that could damage fetal red blood cells. Immunoglobulin may be administered to mothers with Rh negative blood from the 28th week of gestation.

Infection screenMothers are tested routinely for Rubella, Hepatitis and STDs. Hepatitis B antigen positive mothers will be counselled on the need for their babies to be given immunoglobulin to reduce the risk of infection after birth. If you’re not vaccinated for Rubella or do not have antibodies, it would be important to try to avoid contact especially in the first trimester as the virus can be harmful to the baby. STD screens will be recommended as the parents could receive treatment during pregnancy reducing the risk of vertical transmission.

Modified/Glucose tolerance testAll women have a tendency for impaired glucose tolerance in pregnancy as a result of the placental hormones and a MGTT/GTT is routinely offered between 24 to 28 weeks or earlier if a high risk mother is identified.

GBS screeningThe Gp.B streptococcal bacteria is often screened between 35 to 37 weeks of pregnancy and if detected, treatment can be given during labour to reduce fetal spread.

Screening for Downs and other chromosomal abnormalities

About 2 % of babies may be born with major abnormalities. Current screening programmes will help to detect fetuses that may have a birth defect.

Mothers are selectively offered screening for chromosomalabnormalities, the most common being Down’s Syndrome. Screening is done to assess the risk of a fetus having a birth defect followed by diagnostic tests if any abnormalities are detected. Alternatively, these diagnostic tests may be offered as a first choice to pregnant women with a strong history of the condition.

The 1st trimester screeningIn the 1st trimester the mother is usually offered screening for chromosomal abnormalities. Typically this is done between 11 to 14 weeks of pregnancy although it is preferable for it to be done in the 12th week. The screening involves a combination of biochemical markers, measurements of hCG and PAPP-A levels and ultrasound of the nuchal translucency (as shown in the image below). Otherparameters taken include the age, weight of mother, race, and date of pregnancy as well as any history of diabetes In vitro fertilization (IVF). The sensitivity of the test is further improved by detecting the presence of the nasal bone. Some may also include the assessment of the tricuspid regurgitation and ductus venosus.

Non-invasive prenatal test (NIPT)For this test, cell free DNA which is present in maternal blood during pregnancy is analysed for Down’s Syndrome. The combination of maternal and fetal cell is derived from the placenta and must reach a required level in order to be tested which is usually around 10 weeks gestation. With more than 98% sensitivity, NIPT is more accurate than the 1 and 2 trimester biochemical markers when it comes to estimating the risk of the baby with Down’s Syndrome.

2nd trimester screeningThe triple and quadruple tests are options available from 15 to 20 weeks of pregnancy to screen the baby for chromosomal disorders, particularly Down’s Syndrome and spina bifida. The biochemical markers include AFP, hCG, Estriol and Inhibin A. In the test, the decreased levels of AFP and Estriol is seen in Downs while an increased AFP is seen in neural tube defects, abdominal wall defects as well as multiple gestations. Accurate dating is important prior to the test to avoid discrepancy in results. The sensitivity of the triple and quad test has been improved with false positives at 3-5 %.

Invasive fetal testingInvasive tests like amniocentesis and chorionic villous sampling are diagnostic tests which are offered to mothers with an increased risk of fetal aneuploidy. These risks include having a previous child with aneuploidy, structural abnormalities detected during ultrasound that may be associated with aneuploidy or parents who are carriers or have aneuploidy themselves. However, in certain circumstances, the non-invasive tests available are sufficient and greatly help to reduce the need of invasive testing.

UPDATES ON SCREENING IN PREGNANCY

DR. JASPAL SINGHConsultant Obstetrician and GynaecologistParkCity Medical Centre

st nd

FEATURE

09

07

Epilepsy Surgery Experience MediplexA new innovative facility at SJMC A Successful Public Private Partnership

Eof consciousness, to short periods of automatic (subconscious) behaviour and in more severe forms, epileptic convulsions that result in stiffness, jerking of the limbs and body with loss of consciousness. Seizures can occur at unpredictable moments.

In about 70% of patients, antiepileptic medication can lead tosatisfactory control of seizures. Accurate identification of the type of seizure and selection of the most appropriate drug regimen are essential for medical control of seizures.

In about the 30% of patients whose seizures are not controlled with drugs – such patients are considered to have refractory seizures. There is a risk of progressive impairment of higher mental function, behavior and social skills, leading to a significant deterioration in the quality of life. Such adverse effects are most pronounced in very young children(less than 5 to 6 years). The cost to family members of such patients include deterioration of quality of life and financial burdens, over the life time of the patient. There is also a significant drain on resources of the health care system. Hence the urgent need for control of refractory seizures.

In a proportion of patients with refractory seizures, the seizures originate from a single region of the brain. Surgical treatment of such seizures becomes possible, if the region of seizure origin can be removedor disconnected from the rest of the brain, without a significantdisturbance of brain function (especially speech and limb function). Selection of such patients is the single most important factordetermining success of surgery. The selection process involves a detailed clinical assessment, electroencephalography (EEG) which maps the electrical origin of seizures and sophisticated magnetic resonance scanning (MRI) techniques to identify the abnormalityresponsible for seizure origin, as well as mapping important brain function. This needs to be performed by a team of adequatelytrained personnel that include a Neurologist specially trained inEpileptology, Radiologists trained in detection of epileptogenic lesions and Neuropsychologists. In properly selected patients with refractory seizures, surgery offers a 60-70% of total cessation of seizures, with a significant improvement of the quality of life of patients and their families.

Since 2012, the Joint Programme between the Epilepsy Surgery Service at Ara Damansara Medical Centre headed by Dr Ben Selladurai,Consultant Neurosurgeon, and Department of Paediatric Neurology, Hospital Kuala Lumpur, headed by Dr Ahmad Rithauddin, has resulted in combining complementary sets of skills necessary for optimal surgical treatment of refractory seizures. The expertise in presurgical diagnostic skills at Department of Paediatric Neurology, Hospital Kuala Lumpur enables proper selection of surgical candidates . The extensive experience of the Epilepsy Surgery Team at Ara Damansara Medical Centre, enables surgical treatment of a wide spectrum of diseases causing refractory epilepsy, with results comparable to those at centers of excellence in epilepsy surgery globally.

As majority of patients who require epilepsy surgery in Malaysia are under the care of Ministry of Health and come from a financially

disadvantaged background, Yayasan Sime Darby ( YSD ) has set up a fund amounting to RM 500,000.00, to finance the cost of epilepsy surgery at Ara Damansara Medical Centre, for needy patients. Under this joint programme, patients selected for epilepsy surgery byDepartment of Paediatric Neurology, Hospital Kuala Lumpur and who come from a financially disadvantaged background, can have epilepsy surgery performed at Ara Damansara Medical Centre with the total cost of care sponsored by Yayasan Sime Darby. So far, 24 patients have benefitted from Yayasan Sime Darby sponsorship. Patients who qualify for such financial assistance are carefully vetted foreligibility by Jabatan Kebajikan, Hospital Kuala Lumpur as well as a panel of experts appointed by Ara Damansara Medical Centre.

Apart from subsidising the cost of epilepsy surgery, this joint programme also focuses on capacity building amongst local doctors nationwide. One of the programmes sponsored by Yayasan Sime Darby was a two-day symposium held on 10th and 11th January 2015, at the Ara Damansara Medical Centre, which was officiated by the Health Ministry Deputy Director-General (Medical) YBhg Datuk Dr S. Jeyaindran.165 participants, both from the public and private healthcare sectors including junior doctors as well as specialist neurologists, had the opportunity to learn from an expert panel of speakers that included Dr Simon Harvey, Director, Comprehensive Epilepsy Programme, Royal Children’s Hospital Melbourne, as wellas local specialists. Dr Simon Harvey has played a pivotal role in developing epilepsy surgery in Malaysia, sharing his knowledge and expertise and has also trained many Paediatric Neurologists inMalaysia, including Dr Ahmad Rithauddin. The participants of this symposium gained valuable insights into identification of patients who would potentially benefit from epilepsy surgery and the other different surgical procedures available as well as the expected outcomes.

The joint programme between Department of Paediatric Neurology, Hospital Kuala Lumpur and the Epilepsy Surgery Service at Ara Damansara Medical Centre and sponsored by Yayasan Sime Darby, is a role model for combining complementary sets of expertise, skills and facilities between public and private health sectors, in order to benefit patients who need access to high quality health care but who cannot afford the costs of such care.

Yayasan Sime Darby supports community-based programmes and sustainable initiatives which promote the wellbeing and health of disadvantaged individuals as well as enhancing the welfare ofneglected children and senior citizens, vulnerable women, people with disabilities and other marginalised groups.

pilepsy is a chronic disorder of the brain, affecting no less than three out of every thousand people. Epilepsy manifests itself as (epileptic) seizures. Such seizures may vary from brief lapses

Mediplex is something new and exciting in the Malaysian healthcare scene as this is the country’s first purpose-builthealthcare and retail complex dedicated to the wellbeing of the general public in a holistic way.

The 7 storey Mediplex will have a mix of healthcare, retail and leisure services. The following outlets are alreadyoperational since the beginning of March 2015:

• Flavours foodcourt (The Cooking Den, The Savoury Kitchen, Medifoods Express, Rainbow Fusion, Sushi Q, Boost Juice Bars)• Medifoods Café• Medibrands• The Chicken Rice Shop• Starbucks Coffee• Annes Kitchen

Soon to open, the comprehensive one-stop Health Screening Centre (HSC) will house a lab, imaging and diagnostic facilities and even aconsultation suite for VIPs. The HSC offers a newly improved layout for ease of movement and a more efficient, well-thought out process flow.While waiting for the screening report, one can go for a dental checkup or meet our dietician for counselling, enjoy some light refreshment while relaxing at the waiting lounge or alternatively, visit one of the many retail and F&B outlets available at Mediplex.

The following packages are available at the HSC:

For more information on the Mediplex or the Health Screening Centre and its various services, visit the websitehttp://mediplex.ramsaysimedarby.asia or email enquiries to [email protected]

FEATUREWHAT’S NEW

Package DetailsPre Marital Basic

MaleFemale

Medical HistoryPhysical Examinationby MOPhysical Examinationby SpecialistMedical Report Diet CounsellingDental ScreeningBP/Snellen Vision TestBMI AnalysisGSP (Regular)Hep A Screening Hep B Screening Hep C Screening TSHRheumatoid Factor Rubella IgGThallassaemia Screen HIV Screening VDRLTPHAUrine FEMEPap Smear Hs C-reactive ProteinHbA1cH pyloriAFPCEACA 19.9PSA CA 15.3CA125

Lung Function Test

Resting ECG

Stress Test

Gastroscopy

Colonoscopy

Chest X rayUltrasound Abd & PelvisPelvic ultrasound BMD 2 Parts Mammogram Ultrasound Breasts MRIMRATCD- Transcranial DopplerEchocardiography Coronary Calcium Score

Female

Premium Cancer Endoscopy Heart Stroke Gynae

Male Female Male Female Gastro Colon-rectal Digestive Basic < 40 Premiun > 40

HSC PACKAGES

Clin

ical

Ass

essm

ent

Dia

gno

stic

Imag

ing

End

osc

op

y

08

WHAT’S NEW

Discussion and ConclusionSJMC is among the first hospitals in Malaysia to embark on routine measurement of the performance of its cancer care services.

SJMC’s cancer care process performance results have been consistently about 90%, this is close to the benchmark of 95%. Notsurprisingly the consistently high performing cancer care system in SJMC has translated into excellent patient survival outcomes, the key index of the effectiveness of cancer care services in the management of patients with cancer. Patients treated at SJMC between 2008 and 2012 had a relative survival at 5-year of 101% for Stage I disease. This means all such patients were cured by the treatment they had received at SJMC. Even for Stage IV disease, SJMC’s result was a respectable 36%.

This is world class performance befitting a centre of excellence for cancer care.

020

4060

8010

0

lavivruS evitale

R


Stage I SJMC Stage I SEERStage II SJMC Stage II SEERStage III SJMC Stage III SEERStage IV SJMC Stage IV SEER

Comparison of Age standardizedFive-Year Relative Survival

between patients treated at SJMC and SEERS

90 88 8882 82

020

4060

8010

0

lavivruS evitale

R dezidradnats egA

SJMCMalaysia

SEERUS

ICBPAustralia

ICBPUK

CONCORDJAPAN

International comparisons of Breast Cancercare performance in terms of Five year Relative Survival

NEW DIAGNOSTIC LAB IN PENANG

Ramsay Sime Darby Health Care opened its new histopathology lab in Penang recently. Strategically located in the heart of Georgetown, the RSD Diagnostics Lab Penang occupies approximately 1,000 square feet of space on the ‘R’ Floor of the Loh Guan Lye Specialist Centre.

The lab will adopt the same principle that has allowed Subang Jaya Medical Centre (SJMC) to be one of the top laboratory facilities in the country.

Fully assisted by SJMC’s experienced team, the RSD Diagnostics Lab Penang offers pathology services with state-of-the-art technology in a full service computerised laboratory. Our Specialists and General Practitioners (GPs) can expect the following services:

• Histopathology• Cytology • Cytogenetics for Gynaecology• Cytogenetics for Oncology• Frozen Section• Comprehensive IHC (Immuno Histochemistry) - 205 types

Emulating the strengths of SJMC, the Penang Lab is set to provide excellent service with the following added benefits:

• High quality pathology reporting service• Competitive pricing• Improved reports turnaround time• Onsite sample collection or other logistic services (reverse charge on courier for high volume site)• Enhanced physicians' satisfaction by allowing easy access to our pathologist• Cost saving by reducing hospital’s cross referring fee• Consulting services to hospitals by visiting RSDH pathologist

The RSD Diagnostics Lab Penang is committed to deliver accurate, reliable, timely and affordable histology and cytology diagnostics services with good clinical and business practices to all our referral hospitals, medical consultants and their patients.

For more information, please contact +603 5639 122906

Expectant mothers are always concerned about the well-being of their baby which is why it is important to practice caution, eat a healthy balanced diet, exercise, stop smoking, reduce caffeine and alcohol intake and consume supplements. However, even when a mother goes to great lengths to ensure that she is taking goodcare of herself, sometimes there are problems that arise which areunavoidable.

Routine screening tests may be offered as early as 10 to 12 weeks where a blood test will be done for the following conditions.

AnaemiaApart from iron deficiency, anaemia conditions such as thalassemia and sickle cell anaemia may need to be tested among certainethnicities.

Blood group and Rh typingMothers with an uncommon blood group and Rhesus negative blood type need further testing in the later stages of pregnancy to detect antibodies that could damage fetal red blood cells. Immunoglobulin may be administered to mothers with Rh negative blood from the 28th week of gestation.

Infection screenMothers are tested routinely for Rubella, Hepatitis and STDs. Hepatitis B antigen positive mothers will be counselled on the need for their babies to be given immunoglobulin to reduce the risk of infection after birth. If you’re not vaccinated for Rubella or do not have antibodies, it would be important to try to avoid contact especially in the first trimester as the virus can be harmful to the baby. STD screens will be recommended as the parents could receive treatment during pregnancy reducing the risk of vertical transmission.

Modified/Glucose tolerance testAll women have a tendency for impaired glucose tolerance in pregnancy as a result of the placental hormones and a MGTT/GTT is routinely offered between 24 to 28 weeks or earlier if a high risk mother is identified.

GBS screeningThe Gp.B streptococcal bacteria is often screened between 35 to 37 weeks of pregnancy and if detected, treatment can be given during labour to reduce fetal spread.

Screening for Downs and other chromosomal abnormalities

About 2 % of babies may be born with major abnormalities. Current screening programmes will help to detect fetuses that may have a birth defect.

Mothers are selectively offered screening for chromosomalabnormalities, the most common being Down’s Syndrome. Screening is done to assess the risk of a fetus having a birth defect followed by diagnostic tests if any abnormalities are detected. Alternatively, these diagnostic tests may be offered as a first choice to pregnant women with a strong history of the condition.

The 1st trimester screeningIn the 1st trimester the mother is usually offered screening for chromosomal abnormalities. Typically this is done between 11 to 14 weeks of pregnancy although it is preferable for it to be done in the 12th week. The screening involves a combination of biochemical markers, measurements of hCG and PAPP-A levels and ultrasound of the nuchal translucency (as shown in the image below). Otherparameters taken include the age, weight of mother, race, and date of pregnancy as well as any history of diabetes In vitro fertilization (IVF). The sensitivity of the test is further improved by detecting the presence of the nasal bone. Some may also include the assessment of the tricuspid regurgitation and ductus venosus.

Non-invasive prenatal test (NIPT)For this test, cell free DNA which is present in maternal blood during pregnancy is analysed for Down’s Syndrome. The combination of maternal and fetal cell is derived from the placenta and must reach a required level in order to be tested which is usually around 10 weeks gestation. With more than 98% sensitivity, NIPT is more accurate than the 1 and 2 trimester biochemical markers when it comes to estimating the risk of the baby with Down’s Syndrome.

2nd trimester screeningThe triple and quadruple tests are options available from 15 to 20 weeks of pregnancy to screen the baby for chromosomal disorders, particularly Down’s Syndrome and spina bifida. The biochemical markers include AFP, hCG, Estriol and Inhibin A. In the test, the decreased levels of AFP and Estriol is seen in Downs while an increased AFP is seen in neural tube defects, abdominal wall defects as well as multiple gestations. Accurate dating is important prior to the test to avoid discrepancy in results. The sensitivity of the triple and quad test has been improved with false positives at 3-5 %.

Invasive fetal testingInvasive tests like amniocentesis and chorionic villous sampling are diagnostic tests which are offered to mothers with an increased risk of fetal aneuploidy. These risks include having a previous child with aneuploidy, structural abnormalities detected during ultrasound that may be associated with aneuploidy or parents who are carriers or have aneuploidy themselves. However, in certain circumstances, the non-invasive tests available are sufficient and greatly help to reduce the need of invasive testing.

UPDATES ON SCREENING IN PREGNANCY

DR. JASPAL SINGHConsultant Obstetrician and GynaecologistParkCity Medical Centre

st nd

FEATURE

09

WHAT’S NEW

3.1 Baseline characteristics of Breast cancer patients, SJMC 2008-2012The mean age of the women was only 53 years; 36% was aged <50 years, 77% was Chinese and 78% resided in Klang Valley or Selangor. 85% paid for their care out-of-pocket (OOP) and only 14% had their care financed by insurance or their employer.

For patients first presenting to SJMC only, it took a median of 6 days to arrive at a diagnosis of breast cancer. 65% of patients were diagnosed with Early Breast Cancer (Stage 1 or 2, EBC), another 20% with Locally Advanced Cancer and 4% with late stage metastatic cancer. 25% had T1 tumor and 24% were node negative. 72% were ER+, 63% PR+, 34% HER2+ and 13% triple negative.

3.2 Treatment for Breast cancer, SJMC 2008-2012Of the 675 patients treated at SJMC between 2008 and 2012, 553 (82%) patients had surgery there but only 30% of these were breast conserving surgery. 346 (51%) patients had radiotherapy and 307 (66%) had chemotherapy. 346 (73%) of 471 ER+ or PR+ patients had hormonal therapy and 42 (22%) of 189 HER2+ patients received Trastuzumab treatment.

3.3 Breast Cancer Survival Outcome performanceOverall survival at 5 years was 98% for patients with Stage I disease, decreasing to 36% for Stage IV disease. More impressively, the relative survival at 5 years was 101% indicating these patients were practically cured of their cancers. For Stage II disease, the result was 95% which is no less remarkable. These results showed that SJMC has accomplished similar if not better results than established centers of excellence such as the Cleveland Clinic.

Results on Age standardized Relative Survival at 5 years are available from Surveillance, Epidemiology and End Results (SEER) database, an often used reference population in cancer epidemiologic research. For all cancer stages, SJMC results are clearly superior to the average results accomplished by all cancer centres in the US, from which SEERS registry population is drawn.

Comparing with the results reported by other countries’ registries, SJMC’s relative survival results are among the highest. Of course it is not meaningful to compare the result of a single institution (SJMC) directly with the average result reported by a cancer registry for apopulation. However, in so far that SJMC’s results are above the average reported by these registries, it is reasonable to infer that its results match those of the better performing institutions reporting data to those registries.

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Overall survival of patients with Breast cancertreated at SJMC, 2008-2012

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Relative survival of patients with Breast cancertreated at SJMC, 2008-2012

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Ultrasound screeningThe 18 to 23 week scan or anomaly scan has been an important diagnostic tool in the management of pregnancies and detection of congenital defects. It allows the detection of structural abnormalities and soft markers suggestive of chromosomal disorders. The screening is offered routinely to patients due to the fact that a large number of abnormalities are picked up from low risk pregnancies.

CounselingExpectant mothers need to be counselled prior toperforming any screening procedures so that theyunderstand the procedure, the estimation of risks, side effects and, of course, the cost of the screening procedure itself. It is important that counseling include a segment on further management of an affected baby, should the test come out positive for abnormalities.

It is important to note here that a positive screen may require an invasive diagnostic prenatal test. However, this is not mandatory as a positive screen does not mean that the baby is definitely abnormal nor does a negative screen guarantee that the baby is normal.

SUDDEN CARDIAC ARRESTCODE BLUE.....!!!!!High speed car with an unconscious victim aged 45 years, at the back seat...... halts with a screech in front of our ER.......help help!!!!

Victim is urgently taken out of the car....!!!

Hello, hello.....no response from the victim!!!

Call for help.......!!!

No pulse detected on the victim!!!

Compression starts on the trolley bed even before the victim is wheeled into the resus room. Code blue has been announced.

DR. ABDULLAH ASAD SIDDIQUIEmergency PhysicianHOD EmergencyAra Damansara Medical Centre

This is a typical presentation of Sudden Cardiac Arrest (SCA) which is often mistaken for a massive heart attack. However, the latter is a condition that is treatable and does not have to lead to sudden death. SCA describes the unexpected natural death from a cardiac cause within a short time period of less than 1 hour from the onset of symptoms in a person without any prior condition that would appear fatal. Such a rapid death is oftencredited to cardiac arrhythmia.

SCA accounts for 300,000 to 400,000 deaths annually in US. SCA is the most common and often the first manifestation of coronary heart disease and is responsible for more than 50% of deaths from cardiovascular disease in developed countries according to the journal Circulation.

New report from the American Heart Association (AHA) suggests the incidence of out-of-hospital cardiac arrest is 326,200. The average survival rate is 10.6% and 8.3% of survivors have good neurological function. Nearly one in three victims survives when the arrest is witnessed by a bystander.

Arrhythmia is a conduction problem in the heart affecting its rate or the rhythm. In arrhythmia the rate can be either too slow or too fast affecting the cardiac output which in turn affects the brain, heart and lung. Normally, the sinoatrial node (SA node) shoots impulses which activate atrial muscles, these impulses then travel to the atrioventricular node (AV node) located between the atria and the ventricles. AV node holds the impulses allowing ventricles to dilate completely before allowing them to travel down to ventricles to contract again.Any disturbance in this conduction pathway will lead to an arrhythmia which may end up as a fatal complication.

The risk of SCA increases as age increases, and is 3-4 times more common among men than women. However, it has been reported that 30% of deaths for the age group between 14 – 21 years of age were caused by SCA.

Screening Tests For Pregnancy

FEATURE

Screening Test

Combined first-trimester screening

Blood test for PAPP-Aand hCG, plus anultrasound exam

Down syndromeTrisomy 13Trisomy 18

82-87%

85%

69%

81%

94-96%

85-88%

Neural tube defects





Blood test for AFP

Blood test for AFP,hCG, and estriol

Blood test for AFP,hCG, estriol, and inhibin-A

Blood test for PAPP-Aand an ultrasound examin the first trimester, followedby quad screen in the secondtrimester

Same as integrated screeningbut no ultrasound exam

Second-trimestersingle screen for neuraltube defects

Second-trimester triplescreen

Second-trimester quadscreen

Integrated screening

Integrated screening(blood test only)

Test Type Down SyndromeDetection Rate

What Does ItScreen for?

10

The impact of physical activity on SCA is rather debatable with different studies showing different results. But we can agree that moderate physical activity may be beneficial by decreasing platelet adhesiveness and aggregability.

Age, hypertension, left ventricular hypertrophy, intraventricular conduction block, elevated serum cholesterol, glucose intolerance, decreased vital capacity, smoking, relative weight, and heart rate identify individuals at risk for sudden cardiac death. Smoking is an important risk factor. In the Framingham study, the annual incidence of sudden cardiac deaths increased from 13 per 1000 in nonsmokers to almost 2.5 times that for people who smoked more than 20 cigarettes per day. Quitting smoking promptly reduced this risk, which may be mediated by an increase in platelet adhesiveness, release of catecholamines, and other mechanisms. Elevated serum cholesterol appears to predispose patients to rupture of vulnerable plaques, whereas cigarette smoking predisposes patients to acute thrombosis.

Certain ECG abnormalities can help identify patients who are atan increased risk for sudden cardiac death. These include the presence of AV block or intraventricular conduction defects and QTprolongation, an increase in resting heart rate to more than 90 beats per minute (bpm), and increased QT dispersion in survivors of out-of-hospital cardiac arrest.

Out-of-Hospital Resuscitation

The majority of SCA victims show no symptoms and were never identified as being ‘at high risk’ before it happens. Due to this, many SCA cases happen away from any medical facility, which is why it is extremely important to improve the outcome of resuscitation attempts outside the hospital. Unfortunately, there is a very short time frame after cardiac arrest during which circulation has to be restored to prevent death or irreversible cerebral damage. Within this short timeframe, several crucial steps must be taken to ensure the survival of the victim. Among the most important steps a person shouldlearn is how to identify and locate the SCA victim. This is due to thealarming fact that 80% of cardiac arrests occur at home, and from that percentage 40% go un-witnessed. Therefore, we must have warning systems that are able to recognize cardiac arrests, to raise an alarm, and to transmit the exact location of the victim to providers of basic and advanced life support.

Much attention has recently been given to public access defibrillation, allowing non-physicians to use widely distributed automated external defibrillators (AED). In fact, it was suggested several years ago in various studies done, that AEDs be made ‘as common as fire extinguishers’ to cover all the places a cardiac arrest can occur.

By following the steps below and acting fast we can all make the difference between life and death:

1. Learn how to recognize a sudden cardiac arrest.

2. Immediately call for help regardless of the place you witnessed the arrest, even in a hospital. Ask for an AED which can save lives and is far superior to human compressions. Currently we can spot AEDs at various public places like shopping malls and airports in Malaysia.

3. Check for the victim’s pulse for no more than 10 seconds. If you are not able to find an obvious pulse, start the compressions.

4. Continue compressions for two minutes. After every 30 compressions, give two rescue breaths. Do this for five cycles for approximately two minutes and check for pulse. If you do not feel a pulse, repeat the compression and ventilation cycle. 5. Use the AED as soon as it arrives. Survival rates after ventricular fibrillation (VF), which is most often the presenting rhythm in SCA, decrease approximately 7% to 10% with every minute that defibrillation is delayed. A survival rate as high as 90% has been reported when defibrillation is achieved within the first minute of collapse. When defibrillation is delayed, survival rates decrease to approximately 50% at 5 minutes, approximately 30% at 7 minutes, approximately 10% at 9 to 11 minutes, and approximately 2% to 5% beyond 12 minutes.

It is imperative that General Practitioners undergo training in CPR and AED use because emergency personnel cannot always get to the victim’s side quickly enough. If you haven't taken a CPR-AED course it's a good idea to spend some time learning these fundamental lifesaving skills.

Join Hands, Save Lives !!!!!Ara Damansara Medical Centre conducts Basic Life courses for medical andnon-medical personnel. If you are interested in learning lifesaving skills orwould simply like to know more, please call:

Customer Careline+603 5639 1212

Norliana MahussinMarketing DepartmentAra Damansara Medical Centre

Direct Line: +603 7839 9908

FEATURE

11

ResultsA total of 836 patients who were potentially eligible for inclusion in this study were identified to have breast cancer through the hospital register as well as operative surgery, chemotherapy and radiotherapy records. Ninety patients were excluded because of incomplete data (34 uncertain date of diagnosis, 15 no pathology reports confirming cancer diagnosis, 41 no treatment details). A further 71 patients were excluded because of non-eligibility (non-primary tumor 50, nonepithelial tumor 10, foreign patients 14). Thus the final sample size was 675 subjects.

Mortality ascertainment and imputation

Complete and accurate ascertainment of mortality outcome among study patients is necessary to minimize bias in estimating cancer survival outcome. We follow a rigorous procedure described below to ensure this.

1. Case ascertainment was initially independently verified to be complete (100%).This is to avoid exclusion of deceased patients especially those who die soon after diagnosis.

2. Mortality outcome was noted during data abstraction for the study (6 deaths identified)

3. All cases enrolled were matched based on their names and national identity card number against the mortality database provided by the National Registration Department to ascertain their mortality outcome twice in 2013 and 2014 (total 41 deaths identified).

4. Remaining cases were matched based on their names and hospital number against the hospital register (which record all visits to the hospital). Patients who had a visit after the end of the study period (31 Dec 2013) are considered alive (403 ascertained alive).

5. A sample of the remaining cases with Stage I or II or no staging information and 100% of cases with Stage III or IV were contacted by phone or home visit to enquire about the patients’ mortality outcomes. All patients with Stage I and no staging information were alive. One (3%) patient out of 32 with Stage II was dead, likewise for 5 (12%) out of 42 Stage III and 2 (40%) out of 6 Stage IV.

6. For the purpose of survival analysis, we therefore assume all cases with Stage I or no staging information who were not contacted (60 cases) to be alive. For the 43 case with Stage II, we randomly select one case and impute her outcome as death. We assume all remaining uncontacted patients with Stage III (6 cases) and IV (1 case) to be dead. Thus, any bias in the survival estimates arising of missing information on mortality outcome is conservative (that is, the survival estimates can only be worse than they actually are).

Independent data audit

A copy of the HPE report was retrieved for all patients enrolled to verify tumor diagnosis and characteristics. In addition, patients’ demographic and treatment data were also subjected to independent data verification against source documents on site. The accuracy of the collected data with respect to demographics, surgery, radiotherapy, chemotherapy, hormonal therapy and trastuzumab treatment were all >95%.

Statistical methods

Continuous variables are described by summary statistics such as mean, median, and standard deviation and categorical (nominal/ordinal) variables, by the frequencies of each category.

For cancer survival outcome performance, results are expressed as overall survival and relative survival. Relative survival is the ratio of the survival observed in the study patients and the survival that would be expected if they had experienced only the background mortality (all-cause death rates) of the general population of the same age, sex and ethnicity (but not the same residential location, as only national lifetable is available in Malaysia). It shows the extent to which cancer shortens life compares to the general population.

Age standardized five-year relative survival us used for comparison of survival outcome between this study population and other centers’ or registry populations. Age standardized rate refers to the rate that would be observed if the patient populations compared had the same age structure as an external standard population, in this case, the International Cancer Survival Standard [10]. Age standardization allowscomparison of results between jurisdictions or countries.

Multivariable Cox regression is used to estimate the effects of covariates on survival outcome.

WHAT’S NEW

04

Orthopaedics Seminar for Primary Care Physicians19 October 2014 ParkCity Medical Centre

Organised by ParkCity Medical Centre, the talk includeda hands-on workshop on the role of primary physicians in preventing knee pain, and the procedure on foot and ankle injections. The talk aimed at cultivating the culture ofcontinuous learning, and to build strong relationshipbetween GPs and Specialists. The speakers for the event wereOrthopaedic Surgeons Dr Lee Chee Kuan who talked about "Obesity and Knee Pain", Dr Yeap Ewe Juan with his topic“The ABC's of Foot & Ankle Surgery” and Dr Siva Kumar Ariaretnam who spoke on “Minimally Invasive Knee Surgery;Arthroscope & Beyond”.

Hepashere KOL Instructional Workshop8 October 2014 Subang Jaya Medical Centre

SJMC successfully organised an International Symposium titled the Hepashere KOL Instructional Workshop which received huge response and was attended by Oncologists and Interventional Radiologists from Hong Kong, Taiwan, China, Thailand, Singapore and Japan. A total of 15 speakers spoke on areas related to oncology and Interventional Radiology. The illustrious line up of speakers included:

Prof. Shinichi Hori (Japan)Dr. Shahrina Man Harun (Malaysia)A. Prof. Dr. Pua Uei (Singapore)A. Prof. Dr. Anushya Vijayananthan (Malaysia)A. Prof. Dr Ouzrieah Nawawi (Malaysia)A. Prof. Dr. Luk Wing Hang (Hong Kong)A. Prof. Shafie Abdullah (Malaysia)Dr. Murbita Sari (Malaysia)Dr. Anil Gopinathan (Singapore)Dr. Nur Adura Yaakup (Malaysia)Prof. Basri Johan Jeet Abdullah (Malaysia)Dr. Anuchit Ruamthanthong (Thailand)Dr. Faizal Ali (Malaysia)Dr. Alex Tang (Subang Jaya Medical Centre, Malaysia)Dr. Nur Yazmin Yaacob (Malaysia)

[INTERNATIONAL]

EVENTS & HAPPENINGS

12

What you need to know about the XLIFeXtreme Lateral Interbody Fusions (XLIF) have rapidly become an accepted treatment option for a number of spinal conditions. XLIF is the only lateral approach procedure validated by 10 years of clinical experience. More than 150 published clinical studies support the procedure, documenting excellent clinical outcomes such as reduced blood loss, less O.R. time, and shorter hospital stay, as compared to traditional open spine surgery.

XLIF Patient Benefits

1. Reduced operative time – Traditional procedures can take many hours to perform, the while XLIF procedure can be successfully completed in as little as one hour, reducing the amount of anesthesia time.

2. Reduced blood loss and minimal scarring – The MaXcess® retractor dilates the tissue rather than cutting, resulting in much less trauma to the affected area.

3. Reduced postoperative pain – The XLIF procedure does not require entry through sensitive back muscles, bones, or ligaments, so patients are usually walking the same day.

4. Reduced hospital stay – XLIF requires only an overnight stay in the hospital, compared to several days of immobility and hospitalization typical of traditional open approaches.

5. Rapid return to normal activity – Patients are usually walking the same day after surgery and recovery is typically around 6 weeks, compared to 6 months or more.

Introduction and Rationale

Methods

The aims of healthcare are to provide services that are safe, effective, patient centred and of value. Healthcare performance measurement then evaluates the extent to which the health services rendered to patients met these aims. These measurements are intended to serve accountability purposes and to promote improvements in the delivery of care. HPMRS (more details at www.hpmrs.com.my ) is the local statistical system developed to meet the increasing demands for healthcare performance measurement services. SJMC’s cancer care services, and specifically breast cancer care, is the focus of this report.

We have previously reported on SJMC’s Breast cancer care performance for process measures. The present report focus on SJMC’s care performance as measured by patient survival outcome for up to 5 years. Cancer survival is a key index of the overall effectiveness of health services in the management of patients with cancer. Persistent difference in survival between a centre’s performance and a referencepopulation’s or benchmark results represents many avoidable deaths.

We conducted a single-center, observational cohort study to estimate the survival outcome of patients diagnosed in SJMC between 2008 and 2012. The Ministry of Health’s Medical and Research Ethics Committee approved the study protocol.

Study population

The study population consisted of Malaysian women with pathologically confirmed primary breast cancer diagnosed between 2008 and 2012, and treated with one least treatment modality at SJMC. Cases are identified through the hospital register as well as operative surgery, chemotherapy and radiotherapy records. Case ascertainment was independently verified to be complete (100%). Foreign patients, patients with non-epithelial malignancy or recurrent tumor are excluded from analysis.

Data collection and definitions

At enrollment, data were abstracted from patients’ medical and histo-pathology (HPE) reports by trained data collectors. Demographic data abstracted include age, sex race and nationality; tumor characteristics include histologic type, grade, location, extent, and size; lymph node and distant organ metastases. Staging of disease was based on the American Joint Committee on Cancer (AJCC) criteria. AJCC stage I or II disease were considered early breast cancer (EBC), stage III locally advanced BC (LABC) and stage IV metastatic BC (MBC). After enrollment, all patients were followed up for 12 months to collect data on their subsequent exposure to cancer-directed therapies, which were abstracted from medical, operative surgery, chemotherapy and radiotherapy records.

For the purpose of measuring breast cancer care performance, we mostly adopted the performance measures developed and usedby Quality Oncology Practice Initiative (QOPI) [1,2], American Society of Clinical Oncology/National Comprehensive Cancer Network(ASCONCCN) [3,4] and, National Accreditation Program for Breast Centers (NAPBC) [5], while taking into account local clinical practice guideline [6].

Study shows SJMC Cancer Centre as World ClassClinical Research Findings

WHAT’S NEW

03

Office Orthopedics8 February 2015 Holiday Inn Glenmarie

16 November 2014 Holiday Inn, Subang Jaya

General Medicine for Family Physician (Part II)

Following the success of Part I on General Medicine for Family Physician which took place in January 2014, this event was met with the same amount ofenthusiasm and encouraging response. Attended by 85 GPs hailing from the Subang Jaya and USJ areas, the speakers were:

Dr. Sanjay WoodhullConsultant Paediatrician“Paediatric Pyrexia - The Ten Commandments”

Dr. Vigneswaren PonnuduraiConsultant Obstetrician and Gynaecologist“The Enigma of The Woman with Lower Abdominal Pain”

Dr. Alex Tang Ah LakConsultant Radiologist"If Chemotherapy Fails, Is That the End of the World"

Dr. Bala Sundaram MariappanConsultant Urologist"Doctor, There is Blood in My Pee"

Dr Tharmaraj T. RenganathanConsultant General and Colorectal Surgeon"I'm Passing Blood in My Stool! Do I have Cancer?"

Ara Damansara Medical Centre collaborated with MMA Selangor for a workshop on the management of joints diseases which aimedto give GPs an insight on the management of injections, steroids and gels for various orthopaedic conditions routinely encounteredin general practice. The speakers touched on indications related to the diseases and gave demonstrations on the injectionprocedures for conditions like frozen shoulder, painful arc syndrome, shoulder impingement, tennis / golfers’ elbow, planter’s fasciitis and calcaneal spur among others. Speakers for this workshop, were Dr. Siva Kumar Ariaretnam, Dr. Shamsul Iskandar Hussein and Dr. Yeap Ewe Juan.

EVENTS & HAPPENINGS

13

WHAT’S NEW

ParkCity Medical Centre Installs Siemens Artis Qto Enhance Cardiac Patient CareParkCity Medical Centre (PMC) has become the latest hospital in Malaysia to invest in the advanced interventional innovation from Siemens Healthcare. The recent installation of the Siemens Artis Q technology into their new Catheterization Laboratory now provides the infrastructure for PMC to grow in structural heart disease and endovascular surgery, facilitating the latest techniques, procedures and devices in these fields. The Artis Q angiography system for interventional imaging is a visionary breakthrough in X-ray generation and detection that takes performance, precision and sensitivity to the next level.

The new equipment will provide a higher level of accessibility and precision for doctors when treating and managing heart conditions, therefore, providing patients with assurance and confidence.

The Artis Q can help clinicians identify small vessels up to 70% better than conventional X-ray tube technology with the unique GIGALIX flat emitter instead of coiled filament traditionally found within X-ray tubes, allowing the lowest appropriate dose to be achieved plus provide fine focal spot sizes and grid pulse technology. This protects patients, doctors and medical staff, especially during longer interventions.

The Artis Q angiography system was selected due to its excellent image quality following comprehensive evaluation of other systems available on the market. With its ability to visualize tiny blood vessels and devices, it will allow clinicians to provide a highly accurate service for complex conditions.

The Artis Q boasts the following features:

1. Offers unparalleled performance with a new X-ray tube entirely developed around the unique flat emitter technology.2. Innovative applications to support precise guidance during interventional procedures.3. CLEARstent Live where stents are imaged in real-time during therapy, with motion stabilization created by simultaneous correction for the heartbeat. 4. Ultra low radiation dose for patient safety.5. Unique water cooled 16-bit detector, which provides 4 times the depth resolution, when compared to conventional 14-bit detectors.

XLIF Technique Pioneering TeamAt Ara Damansara Medical Centre

Article taken from the Society of Lateral Access Surgery (SOLAS) website: http://www.lateralaccess.org/

Consultant spine surgeons Dr. Appasamy Velu and Dr. Siow Yew Siong are Malaysia’s surgical pioneers specialising in Minimal Invasive Spine Surgery or keyhole spine surgery. They helped countless patients achieve a better qualityof life, addressing their spinal problems through thumb length incisions using state-of-the art surgical techniques involving lasers, endoscopes, operating microscopes, nerve monitoring devices, computer-assisted navigation system and others.

Dr. Appasamy and Dr. Siow are also acknowledged as the first trained surgeons in eXtreme Lateral Interbody Fusion Surgery (XLIF) in Malaysia and widely recognized for their high standard of patient spinal healthcare in Asia. They constantly strive to break new grounds and incorporate newer, safer and better techniques. The Society of Lateral Access Surgery, an international body representing communities of surgeons, specialists, leaders and physicians in lateral access spine surgery, have recently granted Dr. Appasamy and Dr. Siow membership. This recognition marks them as Asia’s first spinal surgeons to be accepted and part of a global community focused on leading, shaping and advancing spinal healthcare.

02

2015 Primary Care Cardiac SymposiumECG Made Easy1 March 2015 Ara Damansara Medical Centre

ADMC held another successful Primary Care CardiacSymposium for General Practitioners in March which saw close to 100 GPs and medical officers from private and publichospitals and clinics attending the event. The symposium provided an overview of ECGs and how to read them, as well as other heart conditions frequently seen and how to manage them. In addition, the symposium aimed to strengthen the partnership between hospital and the attending doctors. Speakers for the symposium were Dr. Abdullah Asad Siddiqui, Emergency & Occupational Safety Health Physician, and Cardiologists Dr. Liew Chee Koon and Dr. Ahmad NizarJamaluddin.

Heart of the MatterSeminar for Primary Care Physicians15 February 2015 ParkCity Medical Centre

The seminar was organised in conjunction with the launchof the Catheterization Laboratory (Cath Lab) and the official opening of ParkCity Medical Centre's Cardiology unit. Around 30 GPs attended the seminar which was purposely targeted for a smaller group so as to allowa more interactive environment between GPs andspecialists. All doctors were taken on a tour of the Cath Lab to allow them to experience and understand the new Siemens Artis Q machine.

The speakers were Dr. Chua Seng Keong who spoke about "ECG Crash Course & Updates on Cardiac Imaging (MRI Scan)" and Dr. Choong Yoon - Sin on "Updates on Cardiology Intervention".

EVENTS & HAPPENINGS

14

Remembering

Do you have any feedback or articles you would like

to share with us?

Simply send your articles or feedback to:

Branding and Communications Department

Level 5, Ara Damansara Medical Centre

Lot 2, Jalan Lapangan Terbang Subang

Seksyen U2, 40150 Shah Alam

Selangor Darul Ehsan

Email : [email protected]

or [email protected]

EDITORIAL SUPPORT

CREATIVE SUPPORT

DAMAYANTHIRASAPPAN

SENIOR MANAGERMedical Services

Administration

FAITH TANGPUI SEE

MANAGERInternational Marketing

MELINDER KAUR

ASSISTANT MANAGERMarketing,

Ara Damansara Medical Centre

SUMITHASURENDRANATHAN

ASSISTANT MANAGERBranding and

Communications

VELLE LEE PHIN PHIN

ASSISTANT MANAGERMarketing and

Communications, ParkCity Medical Centre

SALLY TAN EARN LING

EXECUTIVECreative Designer

NURBAIZURAAHMAD KAHAR

SENIOR EXECUTIVEBranding and

Communications

TAN JUI KOK

SENIOR MANAGERReferral and

Reference Business

JESSICA MOOILAI HENG

SENIOR MANAGERSales and Marketing,

Subang Jaya Medical Centre

DR. ARMIJN MAHPHAFANSURI MUSTAPA

ADMINISTRATORMediplex and

Corporate Marketing

01

DR SABRI MD REJAB1939 -2014

We proudly honor the wonderful life and loving memory of one of the founding members of Subang Jaya Medical Centre.

He was a committed leader, constant advocate, pioneer and champion of our hospital’s vision and mission.

We sincerely thank him for his wealth of wisdom,service and guidance.

We, the Editorial Team,would like to extend our sincere condolences

to the family of the late Dr Sabri Md Rejab.

April 2015Issue 02

THE OFFICIAL RAMSAY SIME DARBY HEALTH CARE NEWSLETTER FOR DOCTORS

QUARTERLY NEWSLETTER

www.ramsaysimedarby.asia

Like us on facebook.com/ramsaysimedarby.asia

Follow us on twitter.com/RamsaySimeDarby

SUBANG JAYA MEDICAL CENTRET : +(603) 5639 1212F : +(603) 5639 1675E : [email protected]

1, Jalan SS 12/1A, 47500 Subang JayaSelangor Darul Ehsan, Malaysia

ARA DAMANSARA MEDICAL CENTRET : +(603) 5639 1212F : +(603) 7846 0925E : [email protected]

Lot 2, Jalan Lapangan Terbang SubangSeksyen U2, 40150 Shah AlamSelangor Darul Ehsan, Malaysia

MEDIPLEXT : +(603) 5639 1212F : +(603) 5639 1910

Tenancy Management OfficeGround Floor, Flavours Food Hall, Mediplex1, Jalan SS 12/1A, 47500 Subang JayaSelangor Darul Ehsan, Malaysia

RAMSAY SIME DARBYHEALTHCARE COLLEGET : +(603) 5191 2121 / 1296 / 1346F : +(603) 5191 1357E : [email protected]

Centrepoint Business ParkAdministration Office, Block A1-1 and A1-2,Lot 728, No.5, Jalan Tanjung Keramat 26/35Seksyen 26, 40400 Shah AlamSelangor Darul Ehsan, Malaysia

INTERNATIONAL PATIENT SERVICEST : +(603) 5639 1666E : [email protected]

PARKCITY MEDICAL CENTRET : +(603) 5639 1212F : +(603) 6279 3399E : [email protected]

No. 2, Jalan Intisari PerdanaDesa ParkCity 52200Kuala Lumpur, Malaysia

NEW DOCTORS ON BOARD

Dato' Sri Dr Zulkharnain Ismail SSAP DIMPConsultant Orthopaedic Surgeon

Conferred the Darjah Kebesaran Sultan Ahmad Shah Pahang Yang Amat Di Mulia –Peringkat Pertama Sri Sultan Ahmad Shah Pahang (SSAP) which carries the title Dato’ Sri.

Dato' Dr Lee Eng Lam SSAConsultant Paediatrician

Conferred the Darjah Kebesaran Dato’ – Sultan Sharafuddin Idris Shah award, carrying the title Dato’. Awarded by His Royal Highness The Sultan of Selangor on 11 December 2014 at the Balairuang Seri,Istana Alam Shah, Klang in conjunction with His Royal Highness’ birthday.

RECOGNITION & AWARDS

Specialty Name Place of Practice

Anaesthesiology

Dermatology

Dr Ng Kim Swan ADMC

Dato' Dr Sharil Azlan Bin Ariffin

Dr Wong Kang Kwong

Dr Felix Yap Boon Bin

General Surgery

Hand and Microsurgery

Dr Pok Eng Hong

Dr Rashdeen Fazwi B Muhammad Nawawi

Orthopaedic Surgery Dr Thaveethu Moses

OphthalmologyDr Loo Voon Pei, Angela

Dr Ngo Chek Tung

Otorhinolaryngology Dr Loo Chun Pin

Radiology

Dr Chan Ruoh Syuan

Dr Nor Afida Hasnita Bt Shuib

Dr Siti Fathimah Bte Hj Abbas

ADMC

ADMC

SJMC

ADMC

PMC

SJMC

SJMC

SJMC

PMC

ADMC

PMC

SJMC

SJMC - Subang Jaya Medical Centre

ADMC - Ara Damansara Medical Centre

PMC - ParkCity Medical Centre

Congratulations to the following recipients on their awardship:

recognition & awards congratulations -...

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