NEUSLINKI s sue 6 • Ju ly – December 2015MCI (P) 079/06/2015

PATIENT CAREHarmonising Care for

Patients in Neurosurgery/ p.6

EDUCATIONThe Residency

Experience/ p.10

RESEARCHSeeking Future Breakthroughs for

Neurological Diseases/ p.14

How developments inpatient care, education

and clinical & basicscience studies are shaping

our research canvas

AdvisorsA/Prof Ng Wai HoeA/Prof Sitoh Yih YianA/Prof Seow Wan TewA/Prof Francis HuiProf Tan Eng KingMs Sandra Koh

AcknowledgementsA/Prof Ang Beng Ti, NNIDr Ady Thien, NNIDr Carol Tang, NNIDr David Lim, NNIA/Prof Deidre Anne De Silva, NNIMs Emily Ang, NNIMs Fu Liqing, TTSH Dr Goh Jia Jun, NNIMs Goh Mei Lian, Winnie, NNIMs Hasfizah Bte Mohd Hanef, TTSH Mr Ivan Tan, TTSH Ms Joluene Yong, NNIMs Juraidah Bte Abdul Rahman, NNI Ms Kamsiah Bte Jaafar, SGHDr Lester Lee, NNIMs Linda Lim, NNIProf Lim Shih Hui, NNI Ms Mariam Piperdy, TTSH Dr Mitesh Kumar, NNIDr Nicole Keong, NNI Mr Noel Loke, SGHMs Nur Nazaria Bte Baharudin, NNIDr Queck Kian Kheng, NNIMs Rohana Bte Basri, NNIMs Serene Tan, TTSH Prof Tan Eng King, NNI Dr Vincent Ng, NNIHovid BerhadMedtronic International Ltd

editoriAl teAmChristina WeeCynthia Anne Victor

designRedstone Communications

copywritingHedgehog Communications

AddressNeus-link c/o Corporate CommunicationsNational Neuroscience Institute11 Jalan Tan Tock SengSingapore 308433Tel: (65) 6357 7152 Fax: (65) 6256 4755Email: NNI-CorporateCommunications@nni.com.sgWebsite: www.nni.com.sg

PATIENT CARE

4 Endovascular Stroke Treatment 101

5 Faces of Healthcare

6 Harmonising Care for Patients in Neurosurgery

p. 6

CONTENTSIssue 6 • July – December 2015

EDUCATION

9 A Visionary Educator

10 The Residency Experience

12 Education Research for Nursing

EVENTS

13 Events at a Glance

RESEARCH

14 Seeking Future Breakthroughs for Neurological Diseases

16 In the Lab: Palm Tocotrienols for Parkinson’s Disease

18 Reducing the Occurrence of Falls

20 Leading the Way in Brain Tumour Research

22 Looking Deeper for Answers

CALENDAR

23 Upcoming Events

p. 20

p. 10

Stroke is a Significant Cause of Death and Disability

• In2013,strokewasthe4thhighestcauseofdeath,accounting for 8.9 per cent of total deaths in Singapore.

• StrokeistheNumberOnecauseofadultdisability.

• Two-thirdsofstrokepatientshavelong-termresidualimpairmentsanddisability.

Stroke is Common

• 3to4outofevery100Singapore residents over the age of 50 has had a stroke.

• Thereare9,000newstrokecases every year in Singapore.

24/7 Stroke Care

• Strokeiscaredforaroundthe clock; a multidisciplinary medicalteamisalwaysonguard to provide immediate attention for acute stroke patients.

EndovascularTreatment(EVT)isaminimallyinvasiveprocedurethathasbeen

proventobeclinicallybeneficialfor stroke patients. The treatment isnowstronglyrecommendedbythe American Heart Association/American Stroke Association (AHA/ASA) for acute ischaemic stroke. Basedonnewclinicaltrialdata from eight randomised clinical trials andotherrelevantdatapublishedsince2013,EVTresultsinbetterfunction compared to existing stroke treatments.

A/ProfDeidreAnneDeSilva,SeniorConsultant,DepartmentofNeurology,NNI,andPresident,SingaporeNationalStrokeAssociation(SNSA),said,“Endovasculartreatmentrevolutionises stroke care. The treatmentbenefitshavebeenconfirmedinnumeroustrialsandwillresultinpatientshavingbetterfunctionafterstroke,limiting

physicaldisabilityandlong-termsocialburden.”

EVTisperformedusingacatheterdevice that initially stents (creates apassage)thebloodvessel,thenretrieves the clot that is clogging itup.Previously,theonlyacutetreatment of ischaemic stroke due toblockageofbrainbloodvesselswastheclot-bustingdrug(calledtissueplasminogenactivatorortPA),whichcanbeadministeredtosomeeligiblepatientsinthefirst4.5hoursfrom stroke onset.

SaidA/ProfFrancisHui,Chairman,MedicalBoard,NNI,“Thenewtrialshaveshownthatnewstentdevicesworkingliketrawlernetshaveproventobemoreeffectivethantheoldcorkscrew(wineopener)retrieversintheremovalofbloodclotsblockingtheflowinbrainarteries.ThiswasourexperiencetooinSingapore,andwehaveswitchedtothenewdevicesforthepastfewyears.”

Giventhenarrowtime-windowfortPAandEVTof4.5hoursand6to8hoursrespectively,timeisoftheessencewhenitcomestostroketreatment. Early recognition of stroke symptoms and rapid access to treatmentisthereforekeytobetterstrokeoutcomes.However,currentlyless than 25 per cent of stroke patients arrive promptly enough to hospitaltobeconsideredforacutestroke treatment.

A/ProfNgWaiHoe,MedicalDirector,NNI,said,“Theeffectivewindowfortreatmentisonlyafewhoursinanacutestrokeandanydelaycanleadtoirreversiblebraindamage.Wemuststresstheimportance of early recognition of stroke symptoms and transfer the patient to a comprehensive stroke facility for prompt and definitivetreatment.”

FACEIf someone has his or her Face drooping when smiling

ARMArm weakness or drifting when held up

SPEECHSpeech is slurred or does not make sense

TIMEIt is Time to call an ambulance at 995

How Do You Recognise a Stroke?Remember F.A.S.T:

Stroke in Singapore

This SolitaireTM Revascularization Device is

one of many stents that work like trawler nets to remove

clots from the brain arteries.

Picture Credit: Medtronic International Ltd.

“NNI has the capabilities for both tPA and EVT with its

team of trained interventional neuroradiologists, advanced

neuroimaging technology and innovative devices.”

4

My ex-manager once told

me that anyone can do

the job as long as they

put their heart into it.

This is true especially

now, when healthcare

professionals like me

have to gain multiple

skills and knowledge,

and learn to coordinate

and communicate with

patients and colleagues.

Ms Winnie Goh Mei Lian Senior Enrolled Nurse, Neuroscience Clinic

I keep a list of

Chinese neurological

terms on hand so

that I can translate

the terms for elderly

patients who only

understand Chinese.

If patients look

confused about

their medication or

appointment dates,

I’ll write instructions

down for them in

Chinese too. Simple

gestures such as

these give them

added assurance.

Ms Jessiline TeoPatient Services Assistant, Neuroscience Clinic

I am intrigued by how

125 trillion synapses can

spontaneously organise to

give rise to consciousness.

Neuroscience is moving from

mere theory to allowing us

to literally see thoughts and

dreams in real time. Science

fiction needs to play catch-

up with neuroscience!

Dr Justin Ker Year 3 Neurosurgery ResidentExtracted from SingHealth Residency Medical Students Connect: Issue 31. Visit http://www.singhealthresidency.com.sg/Pages/msc_31_fs.aspx to find out more about Justin’s story.

I graduated as a Registered

Nurse and I worked mostly with

Neurosurgical patients. Over

time, I was inspired to embark on

a clinical research career as I felt

that evidence-based practice has

become increasingly important in

the search for a cure.

As a research administrator,

I hope to find important clues

to solve basic problems that

affect the quality of research

outcomes. Simply put, we need

to ‘know-it-all, know first and be

all-rounder’. Just like James D.

Watson said, ‘The most complex

thing we have yet discovered in

our universe’.

Ms Jocelyn Cheong Mei YokeClinical Trial Research Unit (CTRU) Senior Executive, Department of Research

of

faces

HEALTHC RE

To view more anecdotes from SingHealth, please visit http://facesofhealthcare.tumblr.com.

Anecdotes from our Patient Care Advocates

5

(From Left) Ms Joluene Yong, Senior Staff Nurse, Department of Neurosurgery, NNI, Dr Ady Thien, Senior Resident, Department of Neurosurgery, NNI, Ms Serene Tan, Advanced Practice Nurse, TTSH, and Ms Fu Liqing, Nurse Educator, TTSH.

(Seated From Left) Ms Emily Ang, Advanced Practice Nurse, NNI, Ms Serene Tan, Advanced Practice Nurse, TTSH, Dr Vincent Ng, Co-Director, Neurosurgical Intensive Care Unit Programme, NNI, Dr Goh Jia Jun, Senior Resident Physician, NNI, and Sister Mariam Piperdy, Senior Nurse Manager (Unit), TTSH.

Standing with the Ward Nurses from TTSH and Nurse Clinicians from NNI are Mr Ivan Tan, Nurse Manager, TTSH (Standing on extreme left) and Ms Hasfizah Bte Mohd Hanef, Nurse Manager, TTSH (Standing on second from right).

Harmonising Care for Patients in Neurosurgery

PATIENT CARE

A Unique CollaborationWhensomeoneisadmittedintoTanTockSengHospital(TTSH)orSingaporeGeneral Hospital (SGH) for a neurological condition,thepatientbenefitsfromtheexpertise of the doctors and surgeons from NNI,thewardnursesfromTTSHand SGH,aswellasthespecialistnursesfromNNI. Their collective expertise advance patientcaretofarreachingheightswhen put together.

Involving Nurses in Ward RoundsOnesignificantdevelopmentasaresultofthisclosecollaborationisthatnursesarenowinvolvedindailywardrounds.DrVincentNg,Co-Director,NeurosurgicalIntensiveCareUnitProgramme,andConsultant from the Department of NeurosurgeryatNNI,shared,“Inhistoricaltimes,doctorshavetheirowntraditionalwardrounds,comprisingofateam

ofconsultants,registrarsandmedicalofficers.Theywilldocumentdownalltheinstructionsforwhatneedstobedone,andthenurseswillpickuptheorders.However,communicationgapsoccurastheinteractionisdonethroughdocumentation.”

Byinvolvingthenursesonthewardrounds,doctorsnowbenefitfromreceivingupdatedanddetailedinformationfromthenurses,wholookafterthepatientsaroundtheclock.

6

“It doesn’t matter if you’re from NNI or TTSH, we’re here for the patients. We have equal respect for each other’s specialisation. Whether you’re an NNI Nurse Clinician or a TTSH Nursing Officer, we all have a role to play and we function as one.”

- Sister Mariam Piperdy Senior Nurse Manager (Unit), TTSH

SaidMsSereneTan,AdvancedPracticeNurse(APN),TTSH,“Inthepast,whennursesdidnotattendwardrounds,theywereattimesunsureoftheplan,andhadto call the doctor to get updates. With thisimplementation,nursesnowknowthecurrentstatusofthepatients,andtheproceduresthatwillbedoneforthepatient,andtheyareconfidentenoughtoupdatefamilymembers.”

Implementation of External Ventricular Drain (EVD) ProtocolsAnotherareawherepatientsarebenefittingfromthiscollaborationistheEVDprotocolimplementation(seesidebaronnextpage),whichhasbeeninplacesinceJanuary2015.

AninitiativeofDrNicoleKeong,Consultant from the Department of NeurosurgeryatNNI,sheandherteamofdoctorsandnursesfromtheTTSHandSGH campuses put together a system of protocolstostandardisethewayEVDsareinserted and maintained throughout.Dr Keong explained that the impetus for theprojectwasthatpatientsshouldhavefairaccesstothebesttreatmentfortheirparticularconditionwherevertheywere.Sheadded,“Therearegoodpracticesineverycampus,sowewantedtoincorporatethoseandsharethemacrossthenetwork.Wewantedtobeabletodeliverclinicalgold-standardoneverysite.”

SisterKamsiahBteJaafar,Senior Nurse Manager at the Department of NeurosurgeryinSGH,sharedthatteamworkwasparamountfortheEVDprotocolimplementationtobesuccessful.Shesaid,“Bybringingtogetherthedoctorsandnursesfrombothcampuses,wewereabletoshareourexperiencesofwhatworkedandwhatdidn’twork.Forexample,atSGH,wefoundthatsamplestaken fartherawayfromthebrainreducedthe riskofinfection,andthiswassomething wewantedtosharewiththeothercampus.”

MsFuLiqing,anurseeducatoratTTSH,added,“Attheendoftheday,theteamneeds to disseminate the information and everyonehastobeonthesamepage.Onthedoctors’side,thereisapersonliaisingbetweentheconsultants,registrarsandMOs.Onmypart,Ihavetoeducatemynursesonthenewprotocols,andasenior

sisterwillmaintainthecommunicationchannelbetweenthedoctorsandnurses.”

Shortening Nil-by-Mouth Time (NBMt)AthirdcollaborativeprojectstartedoutasaservicequalityprojectbetweenAPNSereneTan,APNEmilyAngandSeniorResidentPhysician,DrGohJiaJun,bothfromNNI.

Asearlyas2013,APNTanbegantocollectdatatorecordtheNBMt(seesidebaron next page) of patients undergoing TracheostomyTubeChange(TTC).SheobservedthateventhoughpatientswereonlyrequiredtofastfortwohoursbeforeaTTC,theywouldoftenendupfastingforperiods much longer than that.

Hencein2014,APNTan,togetherwithAPNAngandDrGoh,decidedtogofor a quality improvement training course so that they could formally tackle the issue.

DrGohsaid,“Thesepatientsareusuallyfastedwellbeforetheirprocedure.Wetriedtotweakthefastingtimedurationsothatpatientsdon’thavetobewithoutfeedsandhydrationforlongperiodsoftime.”

Inorderfortheprojecttobesuccessful,thenurses in Ward 10 (Neuroscience Wards) hadtobeengagedtocollectinformationontheNBMTforoverasix-monthperiod.

(From Left) Mr Noel Loke, Nurse Clinician, Neuroscience ICU, SGH, Sister Kamsiah, Senior Nurse Manager, Department of Neurosurgery, SGH, and Dr Nicole Keong, Consultant, Department of Neurosurgery, NNI.

Continued on Page 8 7

“Thisisaproblemworthsolving.Someof these patients cannot speak for themselves.Eventhoughthenumber ofpatientsrequiringTTCissmall, theyaredefinitelystillworththe effort,”saidEmily.

Ultimately,animportantpointisthatpatientsbenefit,andasEmilyshared,“Wenowfastthemat10aminsteadof6am,sotheyhaveonemorefeed.Wearealsoreviewingtheneedforachestx-ray,whichcanhelptoshortentheoverallfastingtime.”

Asaresultoftheirgoodwork,theteam received the Merit Prize (Service Quality Category) at the Singapore Healthcare Management Congress 2015.

Overcoming ChallengesMrNoelLoke,aNurseClinicianfromtheNeuroscienceICUatSGH,believesthat“two-waycommunication”iskey.ThisiswhyeveryFriday,doctorsandnursesfromSGH,TTSHandNNIcome together to discuss patient issues and share their experiences from the pastweek.

SisterKamsiahadded,“Keepingoneanotherupdatedalsohelpsus,forexample,whendoctorsmaybeinanother hospital or in the operating theatre.Nursescanthenassistwithpreliminaryeducationforthepatients.”

Itisperhapsnotsurprisingtofindoutthatbeneaththisseriousgroupofmedicalprofessionalsliesaclose-knitteam.NurseManager,MrIvanTanfromTTSH,explained,“Wewanttobuiltintegration,rapportandbridgeswitheachother.It’saloteasiertoworktogetherwhenyouknoweachother.”

ForSisterMariamPiperdy,SeniorNurseManager(Unit),TTSH, shebelievesthateverythingcomes togetherwhenpatientsarethecentralfocus,whichresonateswithSingHealth’stagline,“Patients.Attheheartof whatwedo”.

“Itdoesn’tmatterifyou’refromNNIorTTSH,we’rehereforthepatients.Wehaveequalrespectforeachother’sspecialisation.Whetheryou’reanNNINurseClinicianoraTTSHNursingOfficer,weallhavearoletoplayandwefunctionasone,”saidSisterMariam.

EchoingSisterMariam’ssentimentisDrNg,whoalreadyfeelsthatthecollaborationisalmostseamless.“Infact,Ithinkthechallengeishowtomaintain and continue this very close collaboration,andhowtoinculcatethesevaluesandworkingpracticestonewstaff;andtocarryontothenextgeneration,”heconcluded.

Continued from Page 7

• Nil-by-MouthtimeorNBMtisthe timebywhichnofoodorfluidsareto betakenorally.

• Tracheostomytubesareinsertedintopatient’sairwaytoassistthemwithbreathing.Thesetubescanonlylastforamonthandhavetobechangedregularly.

• Usually,apatientisrequiredtofastforatleasttwohoursbeforeaTracheostomyTubeChange(TTC).Thisisaprecautionagainst pulmonary aspiration (contents from the stomach rising and entering therespiratorysystem)whichcancausesufferingandevendeath.

• AfteraTTC,patientstraditionallyhavetoundergoachestX-rayandwaitforadoctortoreviewitbeforetheycanstartfeeding again (Phase II of the project is torevisittheneedforpostTTCCXR).

Useful Facts AboutNBMtandTracheostomyTubes

EVD or External Ventricular Drain is a basictoolinneurosurgeryandisusedwhenpatients’conditionscausethemtohaveabuild-upofexcessivecerebrospinalfluid(CSF)inthebrain,whichleadstoraisedpressure in the head. Conditions that cause thisincludeaneurysms,traumaoratumour.

What is EVD?

8

The epitome of an exemplary clinician educator,ProfessorLimShihHuiwaspresentedwiththeNationalOutstandingClinicianEducatorAwardbytheMinistryofHealth(MOH)attheNationalMedicalExcellenceAwards(NMEA)Ceremonyon21August2015.ProfLimisrenownedforhisexpertiseinclinicalneurology,epilepsyandelectroencephalography(EEG)aswellashiseducationalefforts,placingSingaporeontheAsiaPacificandinternationalmapofneurology,epilepsyandEEGeducation.

His latest accolade is the icing on the cake of a list of impressive achievements garnered bythededicatedandpassionateclinicianeducator,includingSingHealth’sinauguralDistinguishedEducatorAwardandtheOutstandingEducatorAwardandPioneerAwardfromDuke-NUSMedicalSchool(Duke-NUS)in2011.

OntopofhisroleasGroupDirectorofEducationatSingHealth,ProfLimisalsoCo-DirectorofAcademicMedicineattheEducationInstitute(AM.EI),SeniorAssociateDeanofDuke-NUSaswellas

Co-ChairattheJointCommitteeonSpecialistsTraining(JCST).

Itis,however,ProfLim’sbeliefin lifelong learning that led him on the path of an educator alongside his clinical role at NNI as a Senior Consultant in the DepartmentofNeurology.Andsince1993,Prof Lim has devoted time to teaching clinical neurology and internal medicine to generations of prominent neurologists and physicians today.

Prof Lim is also a committed mentor whoguideshisstudentsindeveloping theirclinicalacumen,whileinstilling the strong ethics and standards demanded of the profession. He continues his teaching throughSingHealth’sInternalMedicineResidency Programme and the Neurology Senior Residency Programme at the NNI-SGHcampus.

ProfLim’soutstandingimpacthasextendedwellbeyondSingapore.AsChairmanoftheCommissiononAsianOceanicAffairsof International League Against Epilepsy (IALE)from1997to2009,hetrainedlocalandoverseasneurologyandepilepsyfellows,making Singapore General Hospital (SGH) one of the training centres for Epilepsy FellowsintheAsian-Oceanicregion.Healso set the standards of EEG practice byestablishinganEEGCertificationExamination in Asia.

Asalifelonglearner,ProfLimcontinues topursuehisowneducation.Besides obtaininganMBAfromtheNationalUniversityofSingapore(NUS),heis oneofthefewWestern-traineddoctors tohavebeenregisteredwiththeTraditionalChinese Medicine Board after completing anacupuncturecourse.Withhislicense, he proceeded to set up an acupuncture unitatSGH,displayingavisionto provide more integrated and holistic healthcare for patients.

Avisionaryeducatorwithextraordinarycontributionsanddedicationtowardsmedical training and education in Singapore andthroughouttheregion,ProfLimisaninspiration for the generations of clinicians andfieldofmedicaleducationtocome.

Prof Lim Shih HuiGroup Director, Education, SingHealthSenior Consultant, Department of Neurology, NNIWinner of the National Outstanding Clinician Educator Award

A committed mentor, Prof Lim Shih Hui guides his students in developing their clinical acumen, while instilling strong ethics and professional standards.

9

A Platform for LearningDr David Lim is in the second year of hisresidencyprogramme,specialisinginDiagnosticRadiology.Currently,onhisrotationatNNItodoNeuroradiology, DrLimappreciatesthat“NNIoffers morestructure”,andthat“trainingis morein-depth”.

“At8.30everymorning,wewillmeetwithconsultants to go through the difficult cases fromthepreviousnight,whichissomething

unique to NNI. It is a good opportunity forresidentstoaskquestions,and residentsareencouragedtoask,”says theJuniorResident.

Outsidetheirareaofspecialisation,residentsalsogettobenefitfrom weeklymulti-disciplinaryrounds. EveryWednesdaymorning,neurologists,neurosurgeons and neuroradiologists cometogetherforcombinedrounds, whereresidentsareexpectedtoprepare and present their various cases.

DrQueckKianKheng,whoisin histhirdandfinalyearofhissenior residencyinneurology,tellsusmoreononeofthethingsheappreciatesabouthisresidencyprogramme.“Thetrainingprogramme is designed to expose us to differentsub-specialties,sothatwecanmakeinformeddecisionsonwhichareatosub-specialiseinfuture.”

Besides the training that Dr Queck receivesonaweeklybasis,fromEEGto neuromuscular and neurocognitive specialisations,third-yearseniorresidentsalso get to rotate among various clinics dedicatedtoultrasound,movementdisorders and epilepsy.

But,itgoesbeyondlearningonthejob.ForDrLesterLee,afifth-yearneurosurgeryresident,hisFridayafternoonsarespentonresidencyteaching,duringwhichconsultantswillgivelecturesona particular topic of neurosurgery. “Thereisalotofemphasisonteaching. Evenduringsurgery,consultantswillexcuseyou to go for unit meetings and residency teaching,”DrLeeshares.

The Residency ExperienceIfyouthoughtmedicalschoolwaslong,considerthattheroadtowardsbecomingaspecialistconsultantinthefieldofneurosciencetakesanothersixtosevenyears.Inthisissue,wespeaktothreedoctorsundergoingtheirresidencyprogrammetodemystifywhattheexperienceentails.

EDUCATION

10

Parting WordsFinally,weaskthethreedoctorsforsomeadviceforthoseconsideringonembarkingon a residency programme in neuroscience. Hereiswhattheyhavetosay.

DrLim:“TofullymaximiseyourexperienceatNNI,youhavetocomewithanattitudeofwantingtolearn.Theconsultantsareverywillingtoteachandyouwilldefinitelybenefitfromtheconstantinteractionsthatyougetwiththeotherneurosurgeonsandneurologists. These interactions also provide uswithauniqueinsightandinfluencesourdecisionmakingprocess.”

DrLee:“Neurosurgeryisextremelytough,notglamorous,andhaslonghours.Butifyouareonewhoenjoyschallenges,itcanbeaveryrewardingexperience.”Headds,“The

set-upatNNIisveryintimate,andIdonotknowofanyotherplaceinSingaporeorintheworldthathassuchanintegratedfacilityunder one roof. This makes it easy for us to getourjobdone,aswearesoclosetotheother neurologists and neuroradiologists. NNIislikeafamily.”

DrQueck:“Thereisthis common misconception in neurology that many diseases havenotreatment,hencethereislittlesatisfactiontobefound.I have found my experience to bequitedifferent,andthereisactuallyalotthatwecandotoimproveapatient’slife.”

The Residency Experience

MentorshipMentors play an important role in the learning process. For Dr Lim and DrLee,theyappreciatethegroup mentoring approach that they have encountered in NNI.

DrLee,whohasbeeninclinedtowardssurgery even during his medical student days,explains,“Everymentorisdifferentandyoutakeawayabitofeverything.Itisnicetoseeaseniorconsultantdoabasic,straightforwardoperationthatyoucandobyyourself.Youobservethedifferentwaystheyapproachcertainthingsandyouimproveyourownmethodsfromthere.”

DrLimadds,“Ourmentorshavebeenencouragingandmeticulous,andtaketheefforttocomeandteachus.”

AndforDrQueck,onemajorlessonthathetakesawayfromhismentoristheemphasisonstudyingacasebeforehand.Throughouthisseniorresidency,hehashadtodohishomeworktothinkofallthedifferentpossibleapproachesindealingwithacasebeforehemeetsupwithhissupervisor.“Learningisanon-goingprocessformedicine.Preparingacasebeforeyouseeapatient can help you to manage the patient muchbetter,”saysDrQueck.

What Lies Ahead? ForDrLim,hefeelsthatitistooearlytodecideontheareathathewillbesub-specialisingin.Fornow,heisenjoyingthejourneyoflearningmoreaboutthedifferentfieldsinradiology,andiscontentedwithfocusing on completing his training.

DrLeeislookingforwardtoembarkingon a research year in 2016 as part of his residencyprogramme.Thiswillgivehimmoreopportunitiestobemoreinvolvedin

researchontopicsclosetohisheart,suchasthe efficacy for surgery on elderly patients above90yearsold,aswellasbloodclottingamong Asians in surgery.

Withjustafewmonthstogoincompletinghisresidencyprogramme,DrQueckalreadyfeelsquiteinclinedtowardstheareaofstroke.Ifthingsgoasplanned,hecanexpectanother year of overseas training in his areaofsub-specialisationafterhe completes his training.

Dr Lester LeeSenior Resident Neurosurgery

Dr Queck Kian KhengSenior Resident Neurology

11

Education Research for

Nursing

EDUCATION

Intheever-changingworldofhealthcare,wheresystemsarecontinuallyevolving,it is important for nursing professionals

to keep themselves updated on the latest practices.WesatdownwithMsLindaLim,an Advanced Practice Nurse (APN) from theDepartmentofNeurology,NationalNeuroscienceInstitute(NNI),tofindoutthe importance of Education Research in Neuroscience Nursing.

What is the purpose of Education Research for nursing at NNI?Apn lim:Medicineisadynamicfield,withaheavyemphasisonevidence-basedpractice.Withnurses’rolescontinuallyexpanding,nursingisnolongercontainedtojustprovidingthebestbedsidecaretopatients.Toequipthemtogettheirjobdone,theyrequireadditionalspecialisedtraining programmes. We see Education Researchasawaytoachievealltheseand to keep nurses up to speed.

Tell us more about the team that is involved in Education Research at NNI?Apn lim: Ourteamiscurrentlymadeupofagroupofpassionatenurseswhohaveaninterest in developing nursing education at NNI in a more structured manner. They are notfull-timenursingeducators,butnurses

whoalsoholdheavyresponsibilitiesintheirownclinicalsettings.

The nurses that make up this team include Nurse Clinician (NC) Zhou Li Feng,whohandlesin-serviceeducation andtraining,andAPN(Intern)TanIlFan,whoisworkingonaprojecttocreatea structured orientation programme for newnursingstaff.

Asformyself,besidescoordination work,Ialsoensurethatthestudentson attachment optimise their learning experience.Iconductweeklydebriefsessionswithstudentsstudyingfor the Advanced Diploma at Nanyang Polytechnic(NYP),aswellastheMasters of Nursing at the National University of Singapore (NUS).

How does the team come up with new tools and methods for effective training programmes, and what are some of the challenges faced?Apn lim: We keep ourselves updatedbyattendingmedicaleducationalconferences,interactingwithothereducators,andhavingdialoguesessionswithstudentsattached to NNI.

Timeisourbiggestchallenge.Wejugglebetween90percentofclinicalworkand10percentofeducationalwork.Toenableustoworkclosely,wekeepeachotherupdated;notonlythroughface-to-facemeetings,butalsowithWhatsAppchats.

What is in store for 2016?Apn lim: For2016,weplantogetnurseswhohaveattendedconferences,bothlocallyandoverseas,tosharetheirexperienceswiththe rest of the nursing community. We are alsogoingtofocusmoreon“howtoteach”,ratherthan“whattoteach”,sincemostofusare already quite the content experts.

Ms Linda LimAdvanced Practice Nurse (APN) Department of Neurology, NNI

12

DementiaAwarenessDaytookplaceonOctober6,onceagainjoininghandswiththePeople’sAssociation(PA)toengagethecommunitywithcomplimentarymemoryscreeningandcognitiveevaluation.Publicforumsessionsalsoranconcurrently,withdementiaspecialistssharingvaluableadvice and tips on the importance of early and regular assessments.

DEMENTIA AWARENESS DAy

The 15th Advanced Neuroradiology Course tookplacethisyearfromOctober14-16,hostinglecturesanddiscussionsondiagnostic and interventional procedures. TheeventwaschairedbyDrSumeetKumar,Consultant,DepartmentofNeuroradiology,NNI,andtopicsincludedadvancedneuroimaging,stroketreatments,braintumours,smallvesseldiseasesandhead&neck imaging.

Basedonthetheme,“RevealingtheUntoldStories”,theNeuroscienceNursingSeminarwasheldthisyearonJuly29attheTTSHTheatrette.TheGuest-of-Honour,MsTanSohChin,ChiefNursingOfficer,MinistryofHealth(MOH),gracedthe seminar and spoke in her opening addressabouthowtheeventencouragesnurses to focus on career development and multidisciplinarycollaborationstoadvancein patient care standards.

The NNI Education Day took place onOctober7atRamadaSingapore,ZhongshanPark.GracedbyGuest-of-Honour,A/ProfChanChoongMeng,CampusEducationDirector,SGH,theannual event carried on as an interactive platformforstafftobringforwardnewideas to enhance the teaching and learning experience at NNI.

TheASEANNeuroscience2015congresswasheldonJuly30-31bytheClinicalNeuroscienceSocietyofSingaporetoaddresspertinentup-todateissuesinneurologyandneurosurgerypractices.ChairedbyDrDavidLow,Consultant,DepartmentofNeurosurgery,NNI,andDrBernardChan,SeniorConsultant,DivisionofNeurology,NationalUniversityHospital(NUH),the congress stressed on the importance of clinicians and researchers to come together from multidisciplinaryfieldsinneurosciencetotreatpatientsandimproveoutcomes.

15Th ADVANCED NEURORADIOLOgy COURSE

NNI EDUCATION DAy

NEuROSCIENCE NURSINg SEMINAR

NNI EDUCATION DAy

ASEAN NEUROSCIENCE 2015

EVENTS AT A gLANCE

The 5thNNIEMG-AFT-Neuromuscular Ultrasound Workshop took place this year from 26-29November,providingastimulatinglearningexperienceinthefieldofelectrodiagnosis,ultrasound and neuropathology in neuromuscular diseases. The biennialeventwaschairedbyDrKamalK.Verma, SeniorConsultant,DepartmentofNeurology,NNI.

Localandinternationalfacultymembersconductedinteractive tutorials and live demonstrations on electrodiagnostic assessments. Participants also hadtheopportunitytosampleduringthehands-onsessionswithpatientsandinteractwiththefacultytogain a deeper understanding of the practice.

5Th NNI EMg-AFT-NEUROMUSCULAR ULTRASOUND WORkShOP

13

neurology phase 1 & 2 phase 3 & 4 total number of patients

Ischaemic Stroke 2 18 34 3,904

Alzheimer’sDisease&OtherDementia - 3 4 69

MovementDisorders,ParkinsonDisease 2 7 9 69

Multiple Sclerosis - 1 2 5

neurosurgery phase 1 & 2 phase 3 & 4 total number of patients

Surgical Neurotechnology - 2 4 145

Head Injury 1 6 8 62

Brain Haemorrhage - 2 3 59

Neuro-Oncology - 2 2 20

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Seeking Future Breakthroughs for Neurological Diseases

In the mission to improve treatment and discovercuresforneurologicaldiseases,clinicaltrialshelptotranslatescientific

findingsinthelaboratoryintopoint-of-caretreatmentsforpatients.However,thelong-drawnprocess–frompre-trialplanningandstart-uptopatientobservationanddataresolution–maytakeupto10yearsorlonger.Ultimately,thesuccessofaclinicaltrialdeterminesifandwhenapotentialtreatmentmayfinallyseethelightandbringhopetopatientsaroundtheworld.

As a leading neuroscience research facility inSingapore,theNationalNeuroscienceInstitute (NNI) has participated in many Phase II to IV pharmaceutical drug trials.Thiscontinuestobuildonitsstrengthstowardsbecomingaproductivesite for neurological clinical trials and future medicine.

Wide ScopeNNI’sclinicianslookafterover70percent of the neurology and neurosurgery patients in Singapore. This includes over 7,000neurologyinpatientsand4,000neurosurgery inpatients annually. NNI has the largest pool of neuroscience clinicians with37neurologists,25neurosurgeons andeightneuroradiologists.Inaddition, ourresearchissupportedbyover50researchassistantsandfellowswhoareinvolvedinclinicalandbasic/translationalresearchatbothTanTockSengHospital(TTSH)andSingaporeGeneralHospital(SGH) campuses.

Research CollaborationsNNI clinicians have a long and illustrious history in clinical research and have active local,regionalandinternational

collaborations.ManyofNNI’sclinicalscientists hold adjunct or joint faculty appointmentsatlocaluniversities, includingDuke-NUSMedicalSchool(Duke-NUS)andtheNationalUniversity of Singapore (NUS).

National Neuroscience Research Institute Singapore (NNRIS)TheNNRISwasestablishedin2014asajointventurebetweenNNIandDuke-NUSwiththeaimstointegrateresearchprogrammes and resources for common use,aswellasdevelopanewresearchfacilityforneuro-behaviouralexperiments.Bringingtogetherthestrengths,talentandresourcesfrombothinstitutesmakesitfertilegroundforscientificdiscoveriesandmedicalbreakthroughs.

Past Clinical Trial ExperienceNNIconductedatotalof66trialsoverthepast10yearswithatotalof4,333patients.

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Seeking Future Breakthroughs for Neurological Diseases

Areas of ResearchNNI’smainareasofresearchcoverthebreadthanddepthofneurologicalconditionsrelevanttotheneedsofSingaporeanditsregion.

i s c HA e m ic st rok eIschaemic stroke is the most common neurological conditionamongin-patients.Annually,NNIcliniciansseeover5,000strokepatients.The team has vast experience in stroke clinical trials and is a top recruitment site for many trials.

BrAin HAemorrHAgeA type of stroke relatively more common among Asians,NNItreatsabout1,000patientswhosufferfrombrainhaemorrhagesannually.

A l z H e i m e r’ s di se Ase & ot H e r de m e n t iANNIhasacombineddatabaseofover2,000patientswithdementia.Overthelastthreeyears,NNIhasbeentheleadingcentreforDementiaClinicalTrialrecruitmentinSingapore.

H e A d i n j u ry / st rok e /t r Aum At ic Br A i n i n j u ryIn2014,NNIsawover800patientswithheadinjuries.Approximatelyfivepercentofthepatientssufferedfromsevereheadinjuriesandrequired hospital care.

pA r k i n s on di se Ase A n d mov e m e n t di s or de r sNNI’sParkinsonDiseaseandMovement DisordersCentrehasbeendesignatedasaNational Parkinson Foundation (NPF) Centre ofExcellence.ThisrecognitionisawardedtohealthcareinstitutionsthatexcelinParkinson-relatedcomprehensivecare,researchandcommunity outreach programmes.

n e u rot e c H nol o g y ( su rg ic A l nAv ig At ion )Theuseofmedicaltechnologyandneuro-navigational imaging to support clinical diagnosis and treatment in neurosurgery is arapidlydevelopingfieldandakeyfocusofresearch in NNI.

m u lt i pl e s c l e ro si sNNI actively manages around 150 cases of multiple sclerosis (60 per cent) and neuromyelitis optica (40 per cent) at the neuroimmunology clinic,thelargestpoolinSingapore.

n e u ro - onc ol o g yEveryyear,NNIseesabout200patientswithbraintumours.TheNeuro-OncologyresearchprogrammeatNNIfocusesondevelopingpatient-tailored therapy for malignant gliomas.

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In the Lab: Palm Tocotrienols for

Parkinson’s Disease The all-natural compound found in palm oil

is under the microscope after a new MoU between Hovid Berhad and the National

Neuroscience Institute (NNI) sets in to explore its potential neuroprotective effects.

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HovidBerhadandNNIsignedaMemorandumofUnderstanding(MoU)on8May2015toembarkonresearchtostudytheneuroprotectiveeffectsofpalmtocotrienolsinParkinsonDisease(PD).HovidBerhadisanestablishedpharmaceuticalmanufacturerandalsotheleadingpioneerinpalmtocotrienols’innovation.

ProfessorTanEngKing,DirectorofResearch,NNI,said,“AsSingapore’snationalspecialtycentreforthemanagementandtreatmentofneurologicaldiseases,wearekeentopartnerwithHovidBerhadtoinvestigatethepotentialofpalmtocotrienolasapreventativetherapyforthesediseasesthataffectagrowingnumberofpatients.Wehopethatembarkingonthistranslationalclinicalresearchprogrammetotackleageing-relatedbraindisorderswillhelpfacilitategreatercooperationamongmedicalresearchersandindustriesintheregion.”

Clinicalinvestigationshaveshownthatpalmtocotrienolshavetherapeuticandpreventiveeffectsforneurologicaldiseasesintheareasofstrokeanddementia.Thesestudiesshowthat200mgofpalmtocotrienols,whentakentwicedaily,isabletoprotecthumannervesfromneurologicaldamage.

Currently,therearelimitedtreatmentoptionsforPDpatients,suchasoralmedicationandDeepBrainStimulation(DBS)surgery.However,manytreatmentsmainlyimprovethesymptomsofthedisease.Furthermore,medicationshavesideeffectsandthechallengeforPDresearchisto develop a drug that can prevent PD from developing or delay the onset of the disease.

Looking Deeper into TocotrienolsTheresearchcollaborationhopestodemonstratethattocotrienolscanreverseor reduce damage in neuronal cells derived from PD patients and also in animal models. The research aims to investigate the role of tocotrienols in PD using various in vitro and in vivo models.

UtilisinghumanneuronalcellslinesandanimalmodelsofPD,theresearchteam willdeterminetheoptimalsafetyrangeoftocotrienols,andconducttherapeutictests inwild-typeandmutantmodels.

Thenumberofage-relatedneurologicaldiseasesisexpectedtorisewithSingapore’sageingpopulation.ThispartnershipbetweenNNIandHovidBerhadisamajorsteppingstonethatwillpavethewayforfurthercollaborationsonthetreatmentandpreventionofotherage-relatedneurologicaldiseases such as dementia and stroke.

(Left) From NNI: Assoc Prof Ng Wai Hoe, Medical Director, and Prof Tan Eng King, Director, Research, with Mr David Ho, Managing Director, Hovid, and Professor Yuen Kah Hay, University Sains Malaysia.

“We hope that embarking on this translational clinical research programme to tackle ageing-related brain disorders will help facilitate greater cooperation among medical researchers and industries in the region.”- Professor Tan Eng King Director of Research, NNI

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Reducing the Occurrence of Falls

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Increasing Number of Falls at NSOCTheideatoembarkonaresearchprojecttoreducetheoccurrenceoffallsattheNeuroscienceClinic(NSOC)inNNIfirstcametoSisterRohanaBteBasri,NurseManager,NSOC,backin2014.Shesharedherobservations,“Sometimes,whilestandingatthecounter,wewouldseepatientsfallsuddenly.”

ShethenapproachedtheHeadofNSOC,DrKamalK Verma,todiscussthepossibilityofaresearchprojecton fallprevention.Itwasknownthatmanyofthesepatients hadpre-existingmedicalconditions,suchasepilepsy,ParkinsonDisease(PD),strokeorneuro-musculardisorders,whichputthematanincreasedriskoffalls.Butmoreresearchhadtobedone.

Embarking on the Research ProjectToassistherinleadingtheresearchandhelpingfellow nursesattheNSOC,SisterRohanaformedateamwith threenurseswhowerekeenontheproject;namelyNazaria,WinnieandJuraidah.AscreeningformwasthencreatedwithNazaria’shelp,togetherwithsomeconsultationbyDrKamalandanEPIC(SingHealth’sEnhancingPerformanceImprovingCare) facilitator.

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Thegroupthenembarkedonasix-monthprojectfrom JunetoDecember2014,whichconsistedofseveralstages. MsNurNazariaBaharudin,aSeniorStaffNursefrom NSOC,explained,“Thefirststageinvolvesscreeningofpatientsovertheageof65,withmedicalconditionssuchasmovement disorders. Using the fall risk assessment form that wecreated,weclassifiedpatientswithascoreofatleast2tobefall-riskpatients.”

Nazariaadded,“Whilstwaitingfortheirdoctor’sconsultation,weconductedapre-educationknowledgetestonthemtogatherdataontheirlevelofawarenesstofactorswhichincreasedfall-risk.Fallpreventioneducationwasthenconductedaftertheirdoctor’sappointment.Thefinalstepwasapost-educationknowledgetest,whichweconductedonthepatientsbetweenonetothreemonthslater.”

Basedontheresultsoftheresearchproject,theteamwasabletoidentifythedemographicsofpatientsmostatrisk,aswellasthevariousriskfactorsforfalls.“Butperhaps,themostencouragingresultwasfromthepost-educationtestwhichshowedthat98percentofpatientscompliedwithfallpreventionmeasures.Infact,betweenJunetoDecember2014,thegapbetweenfallsincreasedsignificantlyfrom32to175days,”SisterRohanashared.

Challenges FacedMsJuraidahBteAbdulRahman,aSeniorEnrolledNursealsofromNSOC,toldusthattheyfacedsometeethingproblemsatthebeginningoftheproject.Shesaid,“Forexample,wewerelimitedbythetime-framebetweenthedoctor’sconsultations.Thereweretimeswhenthedoctorwasreadytoseethepatients,butwehadn’tconductedthepre-educationknowledgetest.Intheend,wehadtodotothetestaftertheconsultation,whichwasnottheidealcase.”

SisterRohanaadded,“However,overtime,wegained the acceptance from our colleagues. We have also simplifiedandsmoothenedtheprocess.Today,itis justasimpleonlineNNIFallRiskAssessmentform.”

Buttherewerealsoissuesthatcamefromthepatients.“Forexample,problemswithlanguageduringtheassessment.Luckily,wehadhelpfromthevariousnurseswithdifferentlanguageabilitieswhowereabletotranslatebetweenthevariouslanguagesanddialects,”saidSisterRohana.

Anotherchallengefacedatthebeginningwasthatpatientswereunhappythattheyhadtodothefallriskassessment,asitmadeitseemlikethereweremanyfallsoccurring,andmakingthecliniclookbad.

“Someexplanationwasneeded,buteventuallytheyaccepteditandevencamebackforadditionalbrochuresindifferentlanguages,”sharedSisterRohana.

Patient Education Beyondreducingtheoccurrenceoffallsattheclinic, patienteducationalsocontributedtopositivechanges outsidetheclinicandathome.Juraidahexplained,“Oncewegotovertheinitialbarriers,wereceivedalotofpositivefeedbackwithregardstothepatienteducation.Notonlydo weeducatethepatients,wealsosharethebrochureswith theirfamiliesandhelpers.”

SisterRohanaagreed,“Somereallyappreciatethepatienteducation,andhavegoneontoengagecontractorsto installgrabbarsathome,getbettershoesoruseatongkat(walkingstick).”

MsWinnieGoh,SeniorEnrolledNursefromNSOC,alsoobservedthatmanyofthefactorsforfallsareinfactenvironmental.“Wehavetotellthemtoremoveclutterathome,placethingslower,andnottostandonstools,wiresmustbecoiled,etc,”shesaid.

“Patients’childrenalsooftenaskustotelltheirparentsnottodothesethings.Whentheytellthem,theydonotlisten.Buttheytendtolistenwhenwesayit,”Nazariaquipped.

Future PlansAsaresultoftheirproject,theteamwonthesecondplaceattheSingaporeHealthcareManagementCongress2015.“Wedidn’texpecttowin,butitfeelsgoodthatthejudgesfeelthatourprojectcanmakeapositivedifferenceinthelivesofourpatients,”saidNazaria.

Withthepositivefeedbackgathered,SisterRohanafeelsthatthenextlogicalstepwouldbetocollaboratewithphysiotherapist services to control fall risk due to gait/ mobilityproblems.

“Wearealsolookingintoworkingwithoccupationaltherapiststoconducthousevisitstoseewhatcanbedoneintheirenvironmenttopreventfutureorrecurrentfalls,”shesaid.

(From Left) Nurses Juraidah Bte Abdul Rahman, Winnie Goh and Nur Nazaria Baharudin worked with Sister Rohana, Nurse Manager, to initiate the research project on reducing falls in the Neuroscience Clinic.

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Leading the Way in Brain Tumour ResearchParadigm Shift in Analysing Brain TumoursAnewdiscoverybyscientistsfromtheNeuro-OncologyProgrammeattheNationalNeuroscience Institute (NNI) may radically changethewaydoctorslookatbraintumours.

Theteam,ledbyA/ProfAngBengTi,HeadandSeniorConsultant,DepartmentofNeurosurgery,NNI(SGHcampus),andDrCarolTang,SeniorResearchScientist,hasidentifiedagene,knownasST3Gal1,whichtriggerstumourcellstoaggressivelyspreadthroughoutthebrain.Usingamolecularsignature,whichconsistsofasetofgenes,proteins,geneticvariantsandothervariablesasabiomarker,theywereabletomeasuretheincreaseinST3Gal1activityinpatients,andprovideinsightintounderstandingthetumourbehaviour.

Thismethodofdiagnosisissignificantlydifferentfromtraditionalmeansoflookingatage,tumourgradeand patientfunctionalstatus;itisalsomorereliable.

SaidA/ProfAngandDrTang,“Thisfindingissignificantbecauseit introduces a novel paradigm in treatment decision and patient care;thatis,weshouldnotberelyingontumourcharacteristicsseenunderthemicroscopetoguidetherapy.Weneedtoestablishmolecular grouping approaches to more accurately target the group ofpatientssusceptibletoaspecificchemotherapy.”

Whiletumoursmaylookalikeunderthemicroscope,theirbehaviourvariesinpatients.Understandingthesedifferencescanexplainwhysomepatientsresponddifferentlytodrugtreatments.A/ProfAngfurtherexplainedthatbyfocusingonthemolecularpatternofthepatient’stumourtoguidetheselectionofspecificchemotherapy,patientscouldbesparedfromthesideeffectsandfinancialcostsofcertainchemotherapytreatments,iftheirmolecular information indicated poor response to it. This method of focusing on the molecular pattern of the tumour is an example

New discovery may alter the treatment of brain tumours.

Involved in Neuro-Oncology research at NNI are: (From Left) A/Prof Ang Beng Ti, Head and Senior Consultant, Department of Neurosurgery, NNI (SGH campus), and Dr Carol Tang, Senior Research Scientist, Neuro-Oncology Research Laboratory, NNI.

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Leading the Way in Brain Tumour Research

ofPrecisionMedicine,whichwasacknowledgedbyUnitedStatesPresident,BarackObama,duringhisStateoftheUnionaddressin2015.Itpotentiallyopensupaneweraofmedicineinwhichresearchers,providersandpatientsworktogethertodevelopindividualised care.

Oneofthereasonsforabraincancerpatient’spoorsurvivalrateisthe changing molecular pattern of these tumours. When the cancer cellsspread,patientswillbecomehighlyresistanttofirst-linedrugsandunfortunatelysuccumbtotheirdiseaseafterayearorso.Includingmolecularinformationintobraintumourclassificationmightthenchangethewaytumoursarebeingtreated–bytargetingindividualtumoursbasedontheirsusceptibilitytospecificdrugs,whichcouldimprovepatients’qualityoflife.

The Methodology Behind the ResearchBesidesA/ProfAngandDrTang,theresearchteamalsoincludedA/ProfNguanSoonTanfromNanyangTechnologicalUniversityandDrJoannaHolbrookfromtheSingaporeInstituteforClinicalSciences,A*STAR.

Thestudy,whichhasbeenpublishedintheprestigiousJournaloftheNationalCancerInstitute,wasbasedon“livecelllines”derivedfromsurgicallyremovedtumours,andmolecularandclinicalinformationrelating to the patient and tumour investigation. This contrasts withthenormalmethodofusingprocessedorfixedtissuesamplesobtainedatsurgery.

Usingtumourcelllines,theteamrecreatedthetumourinamousemodel.Specificquestionsrelatingtotumourbiologyand itsresponsetospecificdrugscouldthenbetestedonthe tumour-ladenlabmouse.

Applications Beyond Brain TumoursTheeffectsofthisgroundbreakingdiscoverygobeyondbraintumourtreatmentapplications.Asresearcherslearnmoreabout thechangesincancercellsandhowtheyareprovoked,thedevelopmentofdrugsalsomovestowardscuresthatspecificallytargetthesetriggers.Currently,targetedtherapiesarebeingused foradvancedlung,liverandgastriccancers.

Dr Chong Yuk Kien (Extreme Left), Postdoctoral Fellow, and Mr Edwin Sandanaraj (Extreme Right), Senior Research Fellow, from the Neuro-Oncology Research Lab, are the principal authors of the study that was led by A/Prof Ang and Dr Tang.

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RESEARCh

Dr Mitesh Kumar clues us in on the role of radiology in dealing with Central Nervous System (CNS) infections.

Making a DifferenceForDrMiteshKumar,aClinicalAssociateattheDepartmentofNeuroradiologyinNNI,his decision to specialise in neuroradiology wasbynomeansanaccident.

During his residency days at the Rajah Muthiah Medical College and Hospital (under the Annamalai University in TamilNadu,India),DrMiteshdevelopeda fascination for the use of machines to diagnosediseases.Atthesametime,healsonoticedthatbackinhishometownofPurnia,manysufferedfromCentralNervousSystem(CNS)disorders,yetgoodneuroradiologistswerefewandfarinbetween.Puttingtwoandtwotogether,DrMiteshdecidedthatspecialisinginthefieldofneuroradiologywaswherehewasgoingtobeabletomakethebiggestdifference.

About CNS InfectionsDr Mitesh explains that the majority of CNS infections are due to the presence of micro-organismssuchasbacteria,virusesandparasitesandcanaffectthebodyinthefollowingways:“Themicro-organismscausingCNSinfectionscaneitheraffectthemeningesleadingtomeningitis,thegreymatterofbrainparenchymaresultinginencephalitis,thewhitematterofnervesorvessels,oracombinationofanyofthese,”he said.

Andwhileinfectionstendtobemore

prevalent and serious in undeveloped and developingcountries,duetofactorssuchasbadhygiene,poornutrition,andalackofpropermedicalcare,theseinfectionscouldstillposeseriousproblemsforus.

“Inspiteoftheadvancesinthemedicalandsurgicalmanagementoftheseinfections,theycanstillbepotentiallylifethreateningattimes.Hence,thisstressedontheimportance of neuroradiology in the early detection of complications of these infections,”DrMiteshelaborated.

Detecting CNS DisordersDrMiteshtellusthatwhilethemainmethods used to diagnose CNS infections areblood,serumandcerebrospinal fluidanalysis,thedistinctadvantage ofneuroimagingliesinitsabilitytopromptly detect these infections and their complications.

“Duetotheadvancednature ofthetechnology,wearenowabletopinpointtheexactunderlyingmicro-organismandthus reduce the incidence of biopsies,”heshared.

Today,thetwomostcommontypes of neuroimaging used in the diagnosis and management ofCNSinfectionsareCTscansand MRIs.

AndwithCTscansbeinginexpensiveandwidelyavailable,theynowplayasignificantrole in the formulation of management plans,enablingdoctorstomonitorresponses to treatment.

Safer and More EffectiveFinally,respondingtoconcernsofthenegativesideeffectsofneuroimaging,DrMitesh gives us an update on the advances inthetechnologyandsoftware.

“ThelatestgenerationofCTscanners,oneofwhichhasbeenrecentlyinstalledinourdepartmenthasbeenoptimisedtoreducetheradiationdosetothepatientwithoutcompromisingitsquality.Similarly,thesideeffectsoftheintravenouscontrastmediausedinCTandMRIstudieshavealsobeenreduced due to advances in their chemical composition,”saidDrMitesh.

Dr Mitesh KumarClinical Associate Department of Neuroradiology, NNI

For enquiries, contact the Conference SecretariatNational Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433

Tel: (65) 6357 7162 / 7163 Fax: (65) 6256 4755 Email: nni_secretariat@nni.com.sg

16th SINGAPORE

SAVE THE DATE!7th - 8th October 2016

Pre-conference Workshops

on 6 Oct 2016

VENUE:

The Academia

Singapore General HospitalDetails on programme, abstracts

and registration will be announced soon.

Organised by Secretariat

STROKE CONFERENCEThe Science & Art of Stroke care

22

For enquiries, contact the Conference SecretariatNational Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433

Tel: (65) 6357 7162 / 7163 Fax: (65) 6256 4755 Email: nni_secretariat@nni.com.sg

16th SINGAPORE

SAVE THE DATE!7th - 8th October 2016

Pre-conference Workshops

on 6 Oct 2016

VENUE:

The Academia

Singapore General HospitalDetails on programme, abstracts

and registration will be announced soon.

Organised by Secretariat

STROKE CONFERENCEThe Science & Art of Stroke care

23

ContaCt UsNational Neuroscience InstituteCorporate Communications Department11 Jalan Tan Tock Seng, Singapore 308433Tel: (65) 6357 7152; Fax: (65) 6256 4755Email: NNI-CorporateCommunications@nni.com.sgWebsite: www.nni.com.sg

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