NEW DOCTORS ON BOARD Specialty Anaesthesiology

Name

Place of Practice

Dr Ng Kim Swan

ADMC

Dato' Dr Sharil Azlan Bin Ariffin

ADMC

Dr Wong Kang Kwong

ADMC

Dermatology

Dr Felix Yap Boon Bin

SJMC

General Surgery

Dr Pok Eng Hong

ADMC

Hand and Microsurgery

Dr Rashdeen Fazwi B Muhammad Nawawi

SJMC

Dr Ngo Chek Tung

SJMC

Orthopaedic Surgery

Dr Thaveethu Moses

SJMC

Otorhinolaryngology

Dr Loo Chun Pin

PMC

Dr Chan Ruoh Syuan

ADMC

Radiology

Dr Nor Afida Hasnita Bt Shuib

PMC

Dr Siti Fathimah Bte Hj Abbas

SJMC

ADMC - Ara Damansara Medical Centre PMC

- ParkCity Medical Centre

RECOGNITION & AWARDS

to the following recipients on their awardship:

Dato' Sri Dr Zulkharnain Ismail SSAP DIMP Consultant 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 SSA Consultant 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.

SUBANG JAYA MEDICAL CENTRE

MEDIPLEX

T : +(603) 5639 1212 F : +(603) 5639 1675 E : [email protected]

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

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

ARA DAMANSARA MEDICAL CENTRE T : +(603) 5639 1212 F : +(603) 7846 0925 E : [email protected] Lot 2, Jalan Lapangan Terbang Subang Seksyen U2, 40150 Shah Alam Selangor Darul Ehsan, Malaysia

PARKCITY MEDICAL CENTRE T : +(603) 5639 1212 F : +(603) 6279 3399 E : [email protected] No. 2, Jalan Intisari Perdana Desa ParkCity 52200 Kuala Lumpur, Malaysia

Issue 02

THE OFFICIAL RAMSAY SIME DARBY HEALTH CARE NEWSLETTER FOR DOCTORS

SJMC - Subang Jaya Medical Centre

Congratulations

April 2015

PMC

Dr Loo Voon Pei, Angela

Ophthalmology

QUARTERLY NEWSLETTER

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EDITORIAL SUPPORT

DAMAYANTHI RASAPPAN

DR. ARMIJN MAHPHA FANSURI MUSTAPA

SENIOR MANAGER Medical Services Administration

ADMINISTRATOR Mediplex and Corporate Marketing

FAITH TANG PUI SEE

JESSICA MOOI LAI HENG

MANAGER International Marketing

SENIOR MANAGER Sales and Marketing, Subang Jaya Medical Centre

MELINDER KAUR ASSISTANT MANAGER Marketing, Ara Damansara Medical Centre

SUMITHA SURENDRANATHAN ASSISTANT MANAGER Branding and Communications

Remembering

EVENTS & HAPPENINGS

Heart of the Matter

Seminar for Primary Care Physicians 15 February 2015

ParkCity Medical Centre

The seminar was organised in conjunction with the launch of 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 allow a more interactive environment between GPs and specialists. 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".

NURBAIZURA AHMAD KAHAR SENIOR EXECUTIVE Branding and Communications

TAN JUI KOK SENIOR MANAGER Referral and Reference Business

DR SABRI MD REJAB 1939 -2014 VELLE LEE PHIN PHIN ASSISTANT MANAGER Marketing and Communications, ParkCity Medical Centre

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

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

SALLY TAN EARN LING

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

EXECUTIVE Creative Designer

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

2015 Primary Care Cardiac Symposium ECG Made Easy 1 March 2015

Ara Damansara Medical Centre ADMC held another successful Primary Care Cardiac Symposium for General Practitioners in March which saw close to 100 GPs and medical officers from private and public hospitals 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 Nizar Jamaluddin.

We, the Editorial Team, would like to extend our sincere condolences to the family of the late Dr Sabri Md Rejab.

Selangor Darul Ehsan Email : [email protected] or [email protected]

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EVENTS & HAPPENINGS

WHAT’S NEW

General Medicine for Family Physician (Part II) 16 November 2014

Holiday Inn, Subang Jaya

ParkCity Medical Centre Installs Siemens Artis Q to Enhance Cardiac Patient Care

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 of enthusiasm and encouraging response. Attended by 85 GPs hailing from the Subang Jaya and USJ areas, the speakers were:

ParkCity 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.

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

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 boasts the following features:

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

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.

Dr. Alex Tang Ah Lak Consultant Radiologist "If Chemotherapy Fails, Is That the End of the World" Dr. Bala Sundaram Mariappan Consultant Urologist "Doctor, There is Blood in My Pee" Dr Tharmaraj T. Renganathan Consultant General and Colorectal Surgeon "I'm Passing Blood in My Stool! Do I have Cancer?"

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.

Office Orthopedics

XLIF Technique Pioneering Team

8 February 2015

At Ara Damansara Medical Centre

Holiday Inn Glenmarie

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 quality of 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.

Ara Damansara Medical Centre collaborated with MMA Selangor for a workshop on the management of joints diseases which aimed to give GPs an insight on the management of injections, steroids and gels for various orthopaedic conditions routinely encountered in general practice. The speakers touched on indications related to the diseases and gave demonstrations on the injection procedures 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.

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

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WHAT’S NEW

What you need to know about the XLIF eXtreme 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.

Study shows SJMC Cancer Centre as World Class Clinical Research Findings Introduction and Rationale 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 reference population’s or benchmark results represents many avoidable deaths.

Methods 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.

EVENTS & HAPPENINGS

Hepashere KOL Instructional Workshop 8 October 2014

Subang Jaya Medical Centre

[INTERNATIONAL]

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)

Orthopaedics Seminar for Primary Care Physicians 19 October 2014

ParkCity Medical Centre Organised by ParkCity Medical Centre, the talk included a 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 of continuous learning, and to build strong relationship between GPs and Specialists. The speakers for the event were Orthopaedic 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”.

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 used by 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].

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WHAT’S NEW

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.

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. Certain ECG abnormalities can help identify patients who are at an increased risk for sudden cardiac death. These include the presence of AV block or intraventricular conduction defects and QT prolongation, 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.

4.

Out-of-Hospital Resuscitation 5. 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 should learn is how to identify and locate the SCA victim. This is due to the alarming 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.

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. 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. 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 !!!!!

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.

non-medical personnel. If you are interested in learning lifesaving skills or would simply like to know more, please call:

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 allows comparison of results between jurisdictions or countries.

Customer Careline

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

Ara Damansara Medical Centre conducts Basic Life courses for medical and

+603 5639 1212 Norliana Mahussin Marketing Department Ara Damansara Medical Centre

Direct Line: +603 7839 9908

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Results A 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.

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WHAT’S NEW

FEATURE

3.1 Baseline characteristics of Breast cancer patients, SJMC 2008-2012 The mean age of the women was only 53 years; 36% was aged