15thesundaytimes July 28, 2013SINGHEALTH

The bigger capacity for research at

Academia not only allows the sharing of space and equipment, it will also further fuel the exchange of knowledge and ideas. This will advance our research collaborations with universities, government agencies and industry integrating activities from basic to translational and clinical research.— Professor Ivy Ng, group chief executive officer, SingHealth

Ahmad Osman

DEFINING tomorrow’s medicine is the vision for SingHealth and the new iconic Academia building at Singapore General Hospital (SGH) campus.

This will be achieved through excellent and innovative clinical care, new knowledge from re-

search and dedicated training to build a highly skilled and compas-sionate health-care workforce with each generation exceeding the earlier one, says SingHealth group chief executive officer, Professor Ivy Ng (left).

Costing $360 million, the 13-storey twin towers building

with total floor area of 75,000sq m is the new home for the SGH Department of Pathology and Sing-Health’s research, education and training facilities.

Located within the vicinity of clinical services at SGH campus and Duke-NUS Graduate Medical School, Academia is a key milestone in academic medicine with a vibrant environment for network-ing and professional collaborations to advance the diagnosis, treatment and innovative care for pa-tients.

The school is SingHealth’s key partner in aca-demic medicine.

Its dean, Professor Ranga Krishnan, says: “The partnership is envisioned as an integrated working enterprise that guides and promotes the future of medicine, tapping on and combining the collec-tive strengths of SingHealth’s clinical expertise and Duke-NUS biomedical sciences research and medi-cal education capabilities.”

Planning for Academia, which was opened on July 20, was originally prompted by the need to build capacity for the SGH Department of Pathol-ogy and integrate the latest technology into labora-tory processes to further enhance test and diagnos-tic accuracy and reliability.

This is in line with the Ministry of Health’s health-care infrastructure plan to meet the project-ed population growth.

Pushing forth the boundariesThe new building Academia offers a more conducive environment for greater synergies in pathology, medical research and education to raise the benchmarks for better healthcare

PHOTOS: CHONG JUN LIANG,SINGHEALTH

As planning progressed, it became apparent that the building, jointly funded by the ministry and SingHealth, presented an excellent opportunity to create an environment to harness greater syner-gies from the convergence of pathology, medical research and education to set new benchmarks to achieve better outcomes for patients.

It is the only building in the SingHealth cluster built specifically with its vision as a central theme, Prof Ng says, adding that expanded and improved pathology services will impact every area of patient care including better and earlier diagnostics and more specific information to guide treatment and enhanced prognostication.

Academia’s state-of-the-art education facilities include simulation programmes, wet and dry labo-ratories, operating theatres, centralised and special-ised research facilities.

It is the location of SingHealth’s Translational Im-munology and Inflammation Centre, Tissue Reposito-ry, the Advanced Molecular Pathology Laboratory and a collaboration with the A*Star (Agency for Science, Technology and Research) Genome Institute of Sin-gapore to study individualised or stratified medicine.

“We aim to improve the lives of our patients,” Prof Ng says. “Research must be done with the aim of better care for our patients. Education is pursued so that we can have better trained and more skilled health-care professionals.”

Location of research entities in Academia, Prof Ng notes, will enhance effective and cross-functional

collaborations critical for research.Proximity of research facilities to the clinical care

areas has been shown to significantly improve the output of clinically impactful projects, she says.

She adds: “The bigger capacity for research at Academia not only allows the sharing of space and equipment, it will also further fuel the exchange of knowledge and ideas.

“This will advance our research collaborations with universities, government agencies and indus-try integrating activities from basic to translational and clinical research.

“On the education front, health-care staff will have access to more team-based training in simu-lated environments to hone their clinical, surgical, nursing care and life support skills.

“Education labs at Academia will be test beds for the development of new curriculum and teaching methodology using the latest technology.”

Space in Academia’s Diagnostics Tower is 75 per cent more than the former premises of SGH Depart-ment of Pathology, which will increase its capacity for pathology services by over 50 per cent.

The department’s annual workload grew by an average of 6.4 per cent since 2008 and it handled close to 12 million investigations last year. An age-ing population and the emergence of new diseases will drive continuing clinical demand for SGH pa-thology laboratory tests.

It has the most comprehensive range of test menus and is the referral centre for many special-

ised tests and second opinion consultations for Sin-gapore and other parts of the region.

Academia’s Discovery Tower for SingHealth’s re-search, education and training facilities has 42 re-search groups from various specialties.

This will help to build the critical mass, synergies and complementarities to transform SGH campus into a vibrant and holistic medical hub.

Controlled and realistic team-based training is pro-vided through a simulated patient ward, operating theatre, intensive care unit, specialist outpatient clin-ics and an emergency area resembling a mini hospital.

Expanded facilities in Discovery Tower are ex-pected to provide 35,500 annual training places for SingHealth staff and other people from external organisations.

Academia is the first phase of SingHealth’s infra-structure development plan to meet the growing health-care needs of Singapore’s population.

The new National Heart Centre Singapore build-ing will be opened next year. By 2018, Sengkang General Hospital with an attached community hospital will commence operations. This will be followed by the opening of a community hospital at SGH campus in 2020.

Prof Ng says the aim of these new SingHealth facilities together with SGH, KK Women’s and Chil-dren’s Hospital, five national specialty centres and SingHealth polyclinics is to seamlessly integrate patient centric primary, acute, intermediate and long-term care.

SINGHEALTH SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE 17thesundaytimes July 28, 2013

Suki Lor

STAFF at the Singapore General Hospital’s (SGH) Pathology Department now have a much more spacious and conducive work en-vironment with the latest technology to do their job better to benefit the thousands of pa-tients they serve each year.

The department, which used to operate from different premises, can finally bring all its staff under one roof at the Diagnostics Tow-er, one of the twin blocks comprising the re-cently opened Academia at the SGH campus. This has been a definite boon for the depart-ment, says its head of department Associate Professor Tan Puay Hoon.

Occupying the top seven floors in the new tower, the department’s laboratory space is nearly double what it used to be, enabling the installation of the most up-to-date equipment to further improve test accuracy and turnaround time. With 471 staff, SGH’s pathology depart-ment is the largest in Singapore.

“Being at multiple sites required duplication of resources with logistical challenges. Relocat-ing the laboratories within pathology into a single consolidated facility allows workflow re-engineering, right-sizing of laboratory space re-quirements and sharing of resources while pro-moting staff interaction,” Dr Tan says.

“Being at Academia allows us to be more efficient with the incorporation of new auto-mated processes that were not possible with the previous limited space and infrastructure. We will be able to implement novel technol-ogy such as digital pathology, improved safety for biosafety level 3 laboratories and provide a more conducive environment for staff to con-tinue to give their best to our patients,” she adds. The department’s biosafety level 3 labs handle certain infectious agents including my-cobacteria and viruses.

“Now we have the ability to put in the best equipment to handle the volumes and to fur-ther improve turnaround time. All these are for the improvement of patient services,” Dr Tan says.

Test volumes have burgeoned over the years.

The department, which has a 110-year history, handled close to 12 million investigations last year, up 7 per cent from the previous year.

Backbone of medicineApart from serving the patients of SGH and the various institutions such as the National Can-cer Centre, the National Heart Centre, the Sin-gapore National Eye Centre and the National Dental Centre, the pathology department also receives consults from other institutions and clinics. It also provides laboratory services to SingHealth Polyclinics.

As pathologists work behind the scenes, the public and patients may be unaware of the critical role that they play in the treatment and management of diseases.

“Pathology is the foundation of medicine. It is the basis for the diagnosis of disease. Cli-nicians managing patients use laboratory in-vestigations carried out in the pathology de-partment to confirm diagnosis, predict disease behaviour and help in deciding therapy. For instance, all patients who are being treated for cancer require a pathologist to confirm the di-agnosis of the type of cancer before appropri-ate treatment can begin,” Dr Tan says.

Apart from tissue diagnosis for cancer, the department also conducts blood investiga-tions to detect conditions such as diabetes and heart disease, while its microbiologists work to detect infections by agents such as bacteria and viruses.

Academic pathologyAt Academia, the department is in a better po-sition to expand its role in academic pathol-ogy encompassing clinical practice, research and education.

“Our department offers the most compre-hensive range of tests to serve patient needs. It has also been and continues to be a major training facility for the next generation of pathologists and medical technologists. The move to Academia has improved the educa-tional environment for this purpose,” Dr Tan

says.She is keen to groom the next generation

of pathologists, but as they typically function behind the scenes, the low profile can make it a challenge to attract young doctors to the discipline.

While she has spent 24 years with the de-partment, starting as a trainee, she has lost none of her passion for pathology, which she describes as an invigorating discipline that is “very forward, very cutting edge”.

“We require quite a number of pathologists over the next few years to fulfil our require-ments not just for practice but also for educa-tion and research. Singapore is building more hospitals and every hospital will need a pa-thology department. We foresee that nation-ally pathology will be a critical area that we will need to plan for,” Dr Tan says.

AJ Leow

A VISITOR entering the eight floor of the new Di-agnostics Tower at Academia can easily mistake it for a high-tech manufacturing facility especially when confronted with an array of consoles linked by a circuitous, mini-conveyor belt similar to that in some sushi outlets — except that the multi-track line carries individually tagged test-tubes and is monitored by technicians in long white lab coats looking into computer screens.

Most of these samples of body fluids — mostly blood but also urine and spinal fluids — have been sent to the biochemistry lab via an “underground” pneumatic-powered network of tubes from other sectors of the hospital.

Covering an area of 1,200sq m, the main clinical biochemistry lab at the Department of Pathology which is augmented by smaller, specialised labs at different levels is a key diagnostic hub at the Singa-pore General Hospital (SGH).

Backed by 80 clinical research and technical per-sonnel and the largest of its kind in Singapore, the labs carry out tests of mainly blood and tissue sam-ples, not only within SGH but also those from Sing-Health polyclinics and some private clinics. The labs perform some 8.8 million tests last year.

These range from the automated routine analy-sis to determine, for example, patients’ blood sugar and cholesterol levels with results available within two to four hours to highly specialised examina-tions of cells, chromosomes, tumour tissues at mo-lecular levels or monitoring of therapeutic drugs to help doctors with their prognosis and treatment of diseases and ailments. The latter, for example, is used to determine what dosages of immuno-suppressant drugs are needed to prevent organ re-jection in transplant patients.

Dr Yeo Chin Pin, head of Clinical Biochemistry who oversees the running of the lab, compared the dual-tier set-up to a TV channel which caters to a general audience and cable channels with more specialised programming such as foreign language offerings.

She says: “The bulk of the routine tests — more than 2,000 a day — have been automated so that our staff can be redeployed to handle the growing clinical demand for more specific or elaborate labo-ratory investigations.”

She adds that the higher capacity of the new 24/7 automatic systems also translates into greater cost-efficiency and turnaround time.

“The downtime is reduced. For example, we have now three blood centrifuges — probably the most for such a centre in the region — with one more to be installed later. This allows us to contin-ue to function at optimal levels even if one of them is being serviced. It enables us to take on heavier workloads which are expected to increase at a rate of 5 to 7 per cent per year,” Dr Yeo says.

The new and more spacious lab settings also en-able the pathologists and trainees to work side by-side in a more conducive and educationally enrich-ing environment, she adds.

Better ergonomics and workfl owsFor Dr Rafay Azhar, senior consultant for Histopa-thology, which is the study of diseased tissues, the advantage of the new labs is better workflow and improved ergonomics as well as a more spacious environment for his staff of 20.

“We are now integrated at one site, which means that there is greater proximity for fellow consult-ants to get together for discussions. That helps to speed up the diagnostic process and deliver faster and better patient outcomes,” he says.

He adds that the new workstations for trimming tissues come with voice-activated systems — such as turning on taps as well as backend transcription to replace handwritten notes — which allow the clinical histopathologist to concentrate on the job of handling tissue specimens. The workstations have been doubled from three to six, cutting down the queue time to extricate tissue samples.

The histopathology lab currently handles sam-ples from 40,000 local patients annually or 60 per cent of the case loads in Singapore. These translate into about 300 slides from approximately 20 cases each day, most of them from cancer patients and including pap smears. The number of slides per case can range from one to 70.

The samples are sliced and placed onto slides for scanning, which in the past was examined under a microscope and pictures taken with a camera. But with the latest equipment, the scanning is now au-tomated and more uniform in terms of magnifica-tion and is faster as well as more accurate in look-ing out for cancerous cells.

The lab’s newest auto-loading scanner, for exam-ple, is able to complete a scan of dozens of slides in two minutes instead of the previous 20 minutes.

The use of such technology in digital histopa-thology, says Dr Azhar, means that not only can the results be obtained more quickly, but the easier transfer of images also allows physicians to get a second opinion in a shorter time.

“You can now have an online conversation with an overseas expert with both looking at the same multiple images onscreen; or have images sent via

a mobile phone from the operating theatre to one of our consultants,” he says.

And unlike slide specimens that are likely to de-teriorate with time, digital images are easier to store and are a great repository for students, says Dr Tan Yong Cheng, a registrar for the department.

“In the past, only one or two students had access to a specific slide at a time with a double-barrel mi-croscope. With the image archival technology we have now, anyone can have access at anytime. This certainly helps to speed up the learning process.”

SGH’s cancer detectivesLike their counterparts in histopathology, the bulk of the workload for the clinical scientists at SGH’s cytogenetics lab involves tracking signs of cancer, except that it is done through investigation of hu-man genes.

The cytogenetics sleuths usually look into bone marrow, blood or lymph node specimens for signs of abnormalities in the chromosomes.

As Dr Alvin Lim, deputy head of the Cytogenet-ics Laboratory explains, cytogenetics is the study of

It’s all for the patientsBigger space, up-to-date equipment and integrated operations will improve the performance of SGH’s Pathology Department

Key diagnostic hub in laboratory workThe new state-of-the-art pathology labs at Academia speed up and enhance the diagnostic processes and patient care at Singapore General Hospital

Narendra Aggarwal

A HOST of new labs with state-of-the-art facilities and equipment in Academia promises to take health-care delivery to greater heights in Singapore. They have been built to international standards to provide staff a safe working environment.

Among them is the molecular laboratory of the Singapore General Hospital (SGH). It is a key com-ponent of the health-care system as it does tests to detect a wide range of infections.

The lab helped in the investigations of the Sars outbreak in 2003 and the influenza H1N1 pandem-ic in 2009, among other such incidents, as it is in-volved in surveillance work for specific viral infec-tions for the Ministry of Health.

Dr Lynette Oon, senior consultant at the molecu-lar lab, says that as the new lab has been designed with many new safety features and is more spacious, it provides a much better environment for the staff to work in.

“For instance, the bio safety cabinets provide en-closed box-like space for staff to do open work on samples,” she says. The space for such safe work has been doubled and this will ensure that staff do not bump into each other.

The molecular lab, with 16 staff, has a wide menu of infectious disease diagnostic tests and together with histopathology, it incorporates oncologic applications for increasingly individualised cancer treatment.

It can also measure the level of the infection as it does molecular tests for monitoring of viral loads for treatment purposes, detection of mutations and genotyping of viruses.

Dr Oon says that the lab is equipped to handle samples covering a wide range of viruses including hepatitis, HIV, influenza and dengue, which has been a problem this year.

Often, when a specimen is sent to the lab to look for a particular virus or target, the result can be pro-vided within a day.

On the other hand, if a person has a chest inflection,

the lab has a kit that does 16 tests on the same sample.Dr Oon says that with more space available, new

technologies will be added to strengthen and speed up its work for better turnaround time for providing results.

Safety fi rstIn view of the importance of a safe working envi-ronment, there is a pathology laboratories safety committee, which is chaired by Dr James Sim, as-sociate consultant, Microbiology.

“The key challenge for pathology is the wide va-riety of hazards we encounter in our daily work due to the extensive range of services we offer — physi-cal, chemical, biological and ergonomics,’’ he says.

For instance, the number of chemicals handled by the pathology labs can be much more than other in-dustries, even though they are in smaller quantities.

Dr Sim and his safety committee members look into the risks of using these chemicals and ways to mitigate them.

“Having the new Academia building allowed us to rethink and redesign our labs with safety in mind. With the experience accumulated over the years, we have incorporated engineering safeguards into our news labs,’’ says Dr Sim.

Examples include better air handling in the labs, dedicated rooms and cabinets for storage of chemi-cals and enhanced ergonomic features.

The new central tuberculosis (TB) lab housed in Academia is almost twice the size of the previous

one. This enables better compliance with recom-mended bio-safety practices and regulatory require-ments through facility design and workflow.

The lab gets over 55,000 samples for various di-agnostic tests every year. About 150 clinical samples are processed every day in the high-containment lab for TB cultures.

The lab plays a critical role in the diagnosis of TB and other mycobacterial diseases in Singapore and the region.

Dr Sng Li-Hwei, senior consultant at the central TB lab says the work emphasis is on increasing staff proficiency and efficiency, improving staff safety, reducing turnaround times, improving the integra-tion between the clinician, labs and TB controllers, and providing high-quality, cost-effective services.

Working with bacteriaTests to detect a wide range of infections are done in a safe environment where the hazards are minimised

The bulk of the routine tests — more than 2,000 a

day — have been automated so that our staff can be redeployed to handle the growing clinical demand for more specific or elaborate laboratory investigations.— Dr Yeo Chin Pin, head of Clinical Biochemistry

Dr Yeo (right, with Ms Wong Sau Yeng) says that more than 2,000 routine tests have been automated so staff can be redeployed to more specific laboratory investigations.

We are now integrated at one site, which means

that there is greater proximity for fellow consultants to get together for discussions. That helps to speed up the diagnostic process and deliver faster and better patient outcomes.— Dr Rafay Azhar, senior consultant for Histopathology

the structure of chromosomes at the cellular level to determine whether the DNA arrangement or sequence has been disrupted or deviated, leaving markers or signs of cancerous activities in the body.

In some ways, he explains that the detection method is like face recognition software except that it deploys fluorescent dyes to probe the ge-nome and observe if there is a gain or loss in the DNA genes.

“What we do is to look out for the tumour sup-pressant genes or oncogenes — the good and bad guys — and see who is winning.”

Dr Lim adds: “Cytogenetics can be a prognostic tool which informs the doctor if he should treat a patient conservatively without the need for

chemotherapy which can have strong side effects, especially in the case of children; or if the illness is at an advanced stage and needs to be treated aggressively.”

At SGH, the bulk of work done at its cytogenet-ics laboratory or about 4,000 cases a year is focused on detection, diagnosis and treatment for leukae-mia and lymphoma.

With the new and more automated set-up, turnaround time is now faster. Bone marrow tests which used to take up to 21 days now take 10 and may be reduced further to eight or nine days.

“We are letting the machines take over the more laborious and mundane tasks so that the scientists are freed to carry out more in-depth investigations as well as collaborative and research work with oth-er institutes to find even better ways for detection and treatment,” says Dr Lim.

He adds that efficiency has since doubled by 30 to 100 per cent depending on complexity of the cases and his staff are now able to look into four to five cases a day compared to two to three previously.

Dr Azhar (right), pictured with Dr Tan, says that the use of technology in digital histopathology means results can be obtained faster and images are easily transferred to allow physicians to get a second opinion in a shorter time.

The bulk of the work done at the cytogenetics lab is focused on detection, diagnosis and treatment for leukaemia. From left: Ms Teng Li Min, Dr Lim (standing) and Dr Chen Chuanfei. PHOTOS: CHONG JUN LIANG

We are letting the machines take over the

more laborious and mundane tasks so that the scientists are freed to carry out more in-depth investigations as well as collaborative and research work with other institutes to find even better ways for detection and treatment.— Dr Alvin Lim, deputy head of the Cytogenetics Laboratory

Having the new Academia building allowed us to rethink and redesign our labs with

safety in mind. With the experience accumulated over the years, we have incorporated engineering safeguards into our news labs.— Dr James Sim, associate consultant, Microbiology

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE 19thesundaytimes July 28, 2013

Fighting diseases Medical ‘twin towers’

Helping patients to see better

From bench to bedsidePeering through the microscope

Research work in Academia will help to combat the superbugs and develop new antibiotics

Academia will nurture the next generation of doctors and offer researchers a stimulating environment to improve diagnosis and treatments

Cornea research gets a boost in the new Academia building, reports Narendra Aggarwal

Bridging medical research and patient care is the way forward for treatments and therapies

Professionals in the field of pathology are the unsung heroes who ensure that patients get the right treatment

Narendra Aggarwal

SINGAPORE General Hospital’s (SGH) well-equipped pathology department is actively focused on research to help sup-port diagnosis of diseases.

Key among these areas is antibiotic re-sistance and infectious diseases research. The new strains of antibiotic resistant bacteria, commonly known as the su-perbugs, is under the microscope of As-sociate Professor Koh Tse Hsien, senior consultant, Diagnostic Bacteriology, De-partment of Pathology in SGH.

Singapore became the second country in the world after Japan to isolate the su-perbug bacteria in 1996.

“These carbapenemase-producing bacteria are known as superbugs because they are resistant to almost all antibiot-ics,” says Prof Koh.

There has been mixed success in con-trolling the spread of the superbugs.

There is now a National Public Health Laboratory that provides reference ser-vices to detect superbugs and the Min-istry of Health has recently formalised a national antimicrobial resistance sur-veillance system.

“Whereas in the past we could usually link a superbug to a patient with foreign travel, we are now increasingly isolating superbugs from patients with no history of overseas travel. This tells us that super-bugs are spreading locally,’’ says Prof Koh.

He collaborates with the infectious disease pharmacists and physicians who are trying to optimise the treatment for patients infected with superbugs.

“Hopefully one day this will lead to antibiotic treatment that can be tailored to the specific bacteria causing the in-fection. Because we have a collection of superbugs, developers of diagnostic kits and pharmaceutical companies are also interested to access our bacteria strains.”

Looking ahead, the public stands to benefit from the antibiotic resistance re-search as it helps identify and define a problem. Others then use this information to try and find solutions to solve the prob-lem. For instance, the drug companies will be encouraged to develop new antibiotics.

“The end result is either the risk of the common man getting infected with a superbug is diminished or if they do get infected, they can be properly treated,” says Prof Koh.

Speeding up researchAn exciting new development in SGH’s pathology department is the Translational Pathology Centre (TPC), set up in Novem-ber last year. It provides a common plat-form for doctors and researchers with the aim of speeding up delivery of research findings for patient care.

Suresh Nair

ACADEMIC medical science will take a quan-tum leap with Academia.

“Academia will help us nurture the next generation of doctors more effectively,” says Professor Soo Khee Chee, deputy group chief executive officer, Research and Education, SingHealth, and director of National Cancer Centre Singapore.

A first in Singapore medical history, Aca-demia will boost capacity for pathology, research and education to meet projected growth and clinical demand. Its design and infrastructure will change the way collabora-tive research and academic work aimed at im-proving health-care delivery, are performed.

“Currently, the challenge in medical edu-cation is the ratio of people, space and pa-tients to the number of students. The grow-ing number of medical students each year, from 150 to 500, could lead to a degradation of medical education,” he adds.

“To prevent this, we have to find creative ways of delivering education and teaching. Academia has the right infrastructure such as bedside learning, simulation and virtual learn-ing to equip medical students with the skills-set that prepares them for clinical practice.

“For research, Academia is a co-location of basic and translational scientists with clini-cians. This leads to the sharing of resources, equipment, space and most importantly, ideas necessary to advance research for better patient care.”

Patients benefi tThe real winners will be Singaporeans because Academia will offer a vibrant and stimulating environment where research, scholarly work

THE Singapore Eye Research Institute (Seri), which has a special focus on cornea re-search, is now headquartered in the new Ac-ademia building. Its move to the new hub of pioneering health research in Singapore will give it significant synergy and provide new dyna-mism to its researchers.

“The move to Aca-demia will allow Seri to consolidate its laborato-ries and dry labs mostly under one roof, which is right next to the main clinical centre, the Singa-pore National Eye Centre (SNEC).

“The arrangement will be of great ben-efit for communication and exchange of ideas and data,” says Profes-sor Aung Tin, head (Re-search, Education & De-velopment) and senior consultant, Glaucoma Service, SNEC, and deputy director, Seri.

“We hope that this will result in better translational research and in the long term, the development of new research that may benefit our patients,” he adds.

Cornea research that can benefit the common man is being done at Seri and SNEC by associate professor Jodhbir S. Me-hta and his team of researchers in the Tis-sue Engineering and Stem Cell Group. Prof Mehta is head (Research), Cornea Service,

WORLD-CLASS professors Salvatore Alba-ni and Wang Lin-Fa are passionate about their research at Academia.

Prof Albani is an internationally re-nowned rheumatologist and immunolo-gist. He says: “My strategic role will be to act as a builder of bridges between molecu-lar medicine and patient welfare, between ideas and their tangible applications to-ward improvement of human life.

“ T r a n s l a -t iona l medi -cine spans this whole gradi -ent. My func-tion will be to catalyse creativ-ity, growth and c o m m u n i c a -tion and blend coherently clin-ical and basic research. A fun-damental mis-sion will also help new and promising talents to become leaders in translational medicine.”

His research focuses on understanding how the immune system is dysregulated in diseases like arthritis, allergy, infection or cancer.

Prof Albani, who is director, SingHealth Translational Immunology and Inflam-mation Centre, says: “My main ongoing projects are the development of a novel therapy for human arthritis, and the iden-tification of immunologic and epigenetic patterns which determine resistance to therapy. The first project will hopefully lead to a therapy. The second may lead to a chip which can prevent unnecessary exposure to expensive and only partially effective drugs.”

His vision is to make Singapore a world leader in translational medicine, and the place where the evolution toward precision medicine, a patient-centered and knowl-edge inspired way of practising, will occur.

Gloria Chan

IF YOU are a fan of crime movies and TV shows, you may associate pathology with images of dead bodies and people in lab coats investigating the cause of death in cases where foul play is suspected.

But this area is only one aspect of pa-thology. Sometimes referred to as the “foundation of medicine”, pathology is a combination of basic science and clinical medicine through which critical decisions on patient management are made. It is in-tegral in the diagnosis of every cancer.

There are times when the doctors are unable to make a diagnosis based on clinical assessment and radiology inves-tigations. This is when they need to do a tissue biopsy for histology, which is the microscopic study of the structure of the biological tissues to arrive at a definitive diagnosis. Histopathology is the special-ity in medicine that studies human tis-sues in diseased states.

Dr Timothy Tay, 29, who is a third-year resident specialising in pathology finds this aspect of medicine “interest-ing and challenging.” He likes peering through the microscope and studying tissue samples to investigate the cause or severity of the disease, or monitor its pro-gress or the effects of treatment.

He says: “We may be working behind the scenes, but it is as gratifying because what we do has an impact on the pa-tients. If we make a wrong diagnosis, then the patient will not get the right treatment. This is why we demand highly of ourselves to get the diagnosis right.

Its role is to “set up a translational plat-form for clinicians and researchers to use a fully accredited lab set-up for tests which can be used to recruit and allocate patients into trials”, says Associate Professor Tony Lim, senior consultant, Histopathology.

New advances in technology and re-search discoveries made can be validated in a clinical laboratory, provide opportu-nities for collaboration and make an im-pact on patient care.

Prof Lim says: “We provide early phase trial support and offer a validation pro-gramme in the initial period for tests and treatments which may benefit patients.”

While TPC is a common platform for SingHealth, a national-level platform has been set up under the name Polaris (Personalised OMIC Lattice for Advanced Research and Improving Stratification).

“Polaris will leverage A*Star’s scientific capabilities to identify new biomarkers and technologies that can predict how patients would respond to medical treat-

and education contribute to the advancement of better diagnosis, treatments and cures for patients. Its strategic location, close to clini-cal services and Duke-NUS Graduate Medical School, will foster a strong collaborative cul-ture and further promote a spirit of enquiry to boost innovations in patient care.

Prof Soo, who is also vice-dean, Clinical & Faculty Affairs, Duke-NUS Graduate Medical School, says the new medical infrastructure, through the collective efforts of SingHealth and Duke-NUS, will be a shot-in-the-arm in research and medical education capabilities.

The programmes, he adds, bring together all specialists in a particular discipline from various institutions. This allows the cross-fertilisation of ideas and sharing of resources to progress clinical care, education and research and will help to groom a strong pipeline of outstanding medical professionals and clinician scientists.

More than 1,500 health-care professionals will use the “Twin Towers” of Academia — Di-agnostics Tower for SGH Department of Pa-

Infectious disease researchChina-born and US-trained Prof Wang is an international expert in infectious dis-ease research. He is director, Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School.

He played a leading role in identifying bats as the natural host of the Sars virus in 2003 when working with the World Health Organization. He aims to collaborate closely

with SingHealth and other clinicians in Sin-gapore to bring his re-search from bench to bedside.

He emphasises the importance of rapid identification of un-known viruses and to prepare for the next major outbreak.

Prof Wang says: “We have much to learn from the bat, which has evolved to

avoid disease and live exceptionally long lives. Although bats are the second largest group of mammals, with over 1,000 species of bats documented so far, they are distinc-tive because they are the only mammals ca-pable of sustained flight; other mammals such as flying squirrels glide but do not fly.

“Cancer, ageing and infectious disease, these are the three major areas of concern for people. We have studied rats for 150 years to understand how to do better in these three areas.

“Now we have a system, the bat, which has done very well in evolution. We can learn from the bat. With modern tech-niques, we can design new drugs to slow down the ageing process, treat cancer and fight infections.”

Both professors agree that collaboration with every medical party is crucial to be better prepared, because capacity building during down time is the best way to tackle emerging infectious diseases. — Suresh Nair

thology; and Discovery Tower for SingHealth research and education.

Breakthroughs in cancerAmong the leading medical pioneers is Professor Teh Bin Tean, one of the world’s leading kidney cancer research scientists and a pioneer in molecular profiling of kidney cancer, who specialises in trans-lational cancer research, which trans-forms scientific discoveries arising from laboratory, clinical, or population studies into clinical applications to reduce can-cer incidence, morbidity, and mortality.

He says the facility’s new education labs will be test beds for the development of new health-care education curriculum, teaching methodology and education delivery tech-niques using the latest technology.

In just three years, Prof Teh’s team made many breakthroughs in cancer research, par-ticularly for cancers prevalent in the region. They have published papers in leading jour-nals and identified hundreds of novel genes that are mutated in cancers, as well as poten-tial drugs to treat them.

“Eventually, it doesn’t matter where the cancer is, because as long as we know the molecular signature, we know which drug to target it with,” says the Penang-born scien-tist, who is professor, National Cancer Centre Singapore and professor, Duke-NUS Graduate Medical School. He has written in over 280 high-impact medical journals and also sits on the editorial boards of many internationally renowned publications.

“It’s important to do such work here be-cause the cancers we’re looking at are more prevalent in Asians and if we don’t drive it, who else will?”

“On occasions, the doctor operating on a patient will send tissues for testing and he needs to have the result as soon as possible while the patient is still under anaesthesia to decide on the next step to take. For example, if the tissue is found to be cancerous, the doctor will continue to remove the diseased organ from which the tissues are taken.

“It can get quite intensive because

ment, as well as how their disease would progress,” says Prof Lim.

Polaris will work with leading Singa-pore clinicians to modify existing clinical care methods and refine stratified health-care delivery approaches.

It will bring cutting-edge science beyond a research setting and directly into patient care. This translates to better patient out-comes for treating individuals afflicted by cancer and chronic disease, based on their genetic and molecular biology profile.

Polaris will help to improve patients’ response to personalised medicine. This is because patients with diseases such as cancer, heart disease, and diabetes who present similar clinical features may dif-fer at the genetic or molecular level.

“These patients experience different disease progression, and respond differ-ently to the same treatment. By stratifying patients before treatment, specific thera-pies can be allocated to those patient sub-groups that are best predicted to respond

we’re under pressure to give our assess-ment of whether a tumour is benign or malignant in the shortest possible time-frame,” says Dr Tay.

Apart from the doctors, medical technologists like Ms Soo Huey Fen are among the allied health professionals working in the lab to make sure that the tests are carried out correctly, efficiently and quickly. The Clinical Biochemistry

well to the treatment, thus leading to bet-ter patient outcomes,’’ says Prof Lim.

Polaris fills a critical gap in transla-tional and clinical research in Singapore: It stratifies patients for effective and tar-geted treatment through the combina-tion of scientific and clinical informa-tion specific to each individual.

“Polaris is an integrated programme involving scientists and clinicians that seeks to identify and validate novel bio-markers for specific diseases, which will in turn support clinical decision-making on what treatment will benefit a patient most — in other words, match the right patient to the right drug,” says Prof Lim.

Breast cancer Interesting disease-focused research work on breast cancer, which is common in Singapore, is being done by Dr Jabed Iqbal, senior consultant, Histopathology, Department of Pathology, SGH.

He says that phyllodes tumour, which is a fibroepithelial tumour, is quite com-monly diagnosed in Singapore women, and more common in Asians than in the west. It has propensity of recurrence, treatment options being limited in the malignant variety.

“Our group has been working on this tumour and has recently developed a re-currence risk calculator after surgery. Sci-entists at National Cancer Centre Singa-

pore (NCCS) have cultured malignant phyllodes tumour cells into viable cell lines which will help us to test drugs spe-cifically targeted towards this tumour.

His team is studying triple negative breast cancer (TNBC), which occurs in about 10 to 20 per cent of diagnosed breast cancers and is more likely to affect younger people and/or those with a certain gene mutation. It lacks expression of certain bio-markers which are normally measured in breast cancer to plan proper management. Since the tumour cells lack the necessary re-ceptors, common treatments like hormone therapy and drugs that target estrogen and progesterone, and HER-2 are not effective.

Patients with TNBC have a significant-ly increased risk of relapse and shorter survival rate than patients affected with tumours of other subtypes. Although TNBC accounts for a relatively small proportion of breast cancer cases, it is re-sponsible for a disproportionate number of breast cancer deaths. Additionally, a lower proportion of TNBC are discovered by breast screening, possibly due partly to the age distribution of these patients.

Dr Iqbal says that using chemothera-py to treat TNBC is still an effective op-tion and that TNBC responds better to chemotherapy in the earlier stages than other forms of cancer. These tumours are usually treated with some combination of surgery, radiation and chemotherapy.

Laboratory in the Singapore General Hospital (SGH) which handles more than 3,000 samples a day. The laboratory is op-erational round-the-clock.

Ms Soo, 26, graduated with a degree in biomedical science from the National University of Singapore. She has been working in SGH Department of Pa-thology for about three years.

Patient safety is a top priority for her. “Although much of the analyti-cal process is now automated, there is stringent quality control to make sure that the test results are not only reported quickly, but more impor-tantly, also accurately,” says Ms Soo.

She explains: “The sooner we are able to get the results back to the doctor, the sooner the doctors are able to start treating the pa-tients.”

And it is not always as straightforward. Assessment of quality control reports and patient test results — normal and abnormal — are not auto-mated processes and requires the medical technologists to be well trained and vigilant.

“We may not be in direct contact with patients, but we empathise with them. You need to feel the compassion so that you’ll be more vigilant. The cor-rect results reported in a timely manner will ensure that the patients get the right treatment quickly,” says Ms Soo.

From left: Prof Lim, Dr Iqbal and Prof Koh. SGH’s pathology department is focused on research to help diagnosis and in particular, antibiotic resistance and infectious disease research. PHOTOS: CHONG JUN LIANG

Ms Soo and Dr Tay (right) are integral in ensuring that tests are carried out accurately and on time, and the right diagnoses are made. PHOTOS: CHONG JUN LIANG

PHOTOS: CHONG JUN LIANG

Prof WangProf Albani

SNEC and clinical scientist and head, Tissue Engineering and Stem Cell Group, SERI.

“The cornea is the No. 1 transplanted organ in the world. The ability to remove blindness and enable people to see is what

drives our research work as often we can see the effect quite fast,” he says.

With a $25 mil -lion grant from the Government in 2008, new equipment was purchased, additional manpower was hired and skilled research-ers were attracted from overseas to put together a great team.

One of the projects that Prof Mehta’s team is working on focuses on research in selec-tive tissue transplant in the cornea. Another major project involves

research to grow selective tissues. This means that healthy tissue from a cornea could potentially be transplanted to two or more eyes.

A research project in an advanced phase which would benefit most eye patients in-volves the development of drugs which would do away with having to put eye drops daily after an eye operation. The drug would protect the eye on a daily basis and dissolve after 30 days.

Prof Teh’s team has made many breakthroughs in cancer research,

particularly for cancers prevalent in the region. PHOTO: CHONG JUN LIANG

The Academia has the right infrastructure such

as bedside learning, simulation and virtual learning to equip medical students with the skills-set that prepares them for clinical practice.— Professor Soo Khee Chee, deputy group chief executive officer, Research and Education, SingHealth, and director of National Cancer Centre Singapore

The end result is either the risk of the common man getting infected with a superbug is diminished or if

they do get infected, they can be properly treated.— Associate Professor Koh Tse Hsien, senior consultant, Diagnostic Bacteriology, Department of Pathology in SGH

My strategic role will be to act as a builder of bridges

between molecular medicine and patient welfare, between ideas and their tangible applications toward improvement of human life.— Professor Salvatore Albani, director, SingHealth Translational Immunology and Inflammation Centre

The cornea is the No. 1 transplanted

organ in the world. The ability to remove blindness and enable people to see is what drives our research work as often we can see the effect quite fast.— Associate Professor Jodhbir S. Mehta, head (Research), Cornea Service, SNEC, and clinical scientist and head, Tissue Engineering and Stem Cell Group, SERI

One of the projects Prof Mehta (extreme right) and his team are working on focuses on research in selective tissue transplant in the cornea. PHOTO: CHONG JUN LIANG

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE 21thesundaytimes July 28, 2013

What’s inside the Academia building at SGH campus

AJ Leow

MEDICAL trainees — who are referred to in the health-care profession as residents — often picked up their experiential skills in handling critical care situations on the job, more often than not on an ad-hoc basis. In the case of rare or unusual events, this would normally hap-pen only by chance.

“In some of the extraordinary cases, it may take years before you encounter a particular medical scenario or not at all,” says Associate Professor Phua Ghee Chee, senior consultant for Respiratory & Critical Care Medicine at the Singapore General Hospital (SGH) and pro-gram director, Internal Medicine Residency.

That is one of the reasons why SingHealth has set up a “mini hospital” at Academia with simulation-based facilities including authentic replicas of an intensive care unit (ICU) and an operating theatre to enhance the standards of medical training, for not only the next gen-eration of health-care professionals including nurses, but also experienced surgeons.

Prof Koo Wen Hsin, group education direc-tor at SingHealth, adds that the cutting-edge facilities incorporating live streaming and video recording for educational purposes pro-vide a more structured and non-threatening environment that also enhances team-based training.

“The simulation can range from the pro-cess of transferring a patient from a ward to an operating theatre or ICU — which in normal circumstance would not be possible in a hos-pital without causing disruption — to more complex set-ups such as emergency or crisis scenarios which might not be possible with real patients due to an unavailability of real-life cases coinciding with specific stages during a resident’s training span.

“The result is that there is greater uniform-ity in the quality of training. Entire session can be recorded and replayed so that trainees can learn from their mistakes and respond better in real-life situations,” he adds.

The state-of-the-art manikins used for the training purposes in place of real patients are so advanced these days that they can be pro-

grammed to imitate physical symptoms such as fluctuations in breathing patterns, dilation in the eyes, bleeding and even cry out in pain in Hokkien.

Associate Professor Soh Chai Rick, Senior Consultant, Department of Anaesthesiology, SGH adds that simulation allows trainers to generate consistent and realistic scenarios to assess a physician or team’s ability to function.

Playback and learnThe trainees get to review their performances via videos. “Seeing can be a power learning tool. They get to see and reflect on what they did well and not so well, which was not pos-sible previously with real-life ICU cases,” adds Prof Phua.

Dr Zhao Yi Jing, a resident in her second year of training, says: “The playback really helps to improve our thought processes and learn not to make any jarring mistakes when we have to face a similar situation with a real patient.”

Dr Sim Yirong, a resident in general surgery, adds after a session in the simulated operating theatre that in the past, the main channels of in-struction were through reading of texts and jour-nals and by apprenticeship, which is through the observation of senior surgeons and hands-on learning assisting them.

“With the simulation labs, we are now able to brush up our skills in a stress-free environ-ment. The various life-like scenarios also ena-ble us to practise and prepare for the day when we face a patient in a difficult or challenging scenario.”

Practice makes perfectDr Jeremy Ng, consultant at the Department of General Surgery, SGH, notes: “With the simula-tion centre, we can teach the resident to manage stable or unstable patients with a single injury or multiple injuries that may require surgery or other forms of intervention. In short, it allows us to vary the pattern of injuries and increase the learning value for the resident.

“In addition, the trauma team simulation programme also allows team dynamics to be

taught and learnt as clinical situations in trau-ma are often not handled by physicians work-ing alone, but by working as a team.”

His colleague and fellow trainer for the simulated operating theatre centre, Dr Kam Ming Hian, senior consultant at the Depart-ment of Colorectal Surgery, SGH, points out that the training allows residents to practise at their own pace and develop their skills with specialised instruments including those used in keyhole surgery. Residents are also exposed to a wide spectrum of clinical conditions until they become familiar with the procedures re-quired before treating real patients.

Such training programmes are however not confined to residents but also more experi-enced surgeons to master new techniques, es-pecially with the introduction of new technol-ogy including robotics and instruments such as those used in laparoscopic or keyhole sur-geries that involve the manipulation of minia-ture forceps, cutters and cameras.

“The dexterity and skill sets required can be vastly different from traditional open surgery,” says Dr Kam, who adds that the current take-up rate for laparoscopic surgeries is only about 20 to 30 per cent. With more training, he says SGH hopes to double the percentage of such minimally invasive procedures that allow for faster recovery time and shorter hospital stays and hence better patient care.

Mini hospital for doctors Training facilities equipped with wireless technology and crying manikins make training realistic for the new generation of medical professionals

21thesundaytimesJuly 28, 2013

Training staff in real-life scenariosSimulated technologies enable nurse educators to better impart valuable skills and heighten confidence levels of trainees

Suki Lor

FOR seven years now, Ms Low Siew Ching, nurse educator at Singapore General Hospital’s (SGH) SingHealth Alice Lee Insti-tute of Advanced Nursing (Alice Lee IAN), has been teaching at the same institution where she received training in the past.

With the opening of Academia located in the SGH cam-pus, the training will take on an added dimension. The simulated ward at Academia has enhanced facilities which will enable more effective and in-depth learning compared with a similar ward located at the Alice Lee IAN’s premises at Bestway Building, says Ms Low.

“Trainees will be better off in both skills and confidence levels and will thus be able to provide safe, efficient and competent care to patients,” she says.

Hospital staff such as patient care assistants, nursing students as well as new and existing nurses undergoing in-house staff development programmes will receive training at the simulated ward. The four-bed ward is a replica of an actual hospital ward along with manikins but at the Aca-demia, new facilities include built-in closed-circuit televi-sion which can capture staff in action while they undergo training, says Ms Low.

“After that, trainees will be debriefed on the tasks they have performed through a playback of the video recording for a better learning outcome,” Ms Low says.

Through the simulated ward, staff are taught both clini-cal skills and soft skills. The former include basic cardiac life support and cannulation, which refers to the insertion of a cannula or tube into a vein so as to start an intravenous drip to administer drugs for example, and venepuncture — the puncture of a vein through the skin so as to draw blood.

“Besides learning clinical skills that the trainees have to practise and perform on real patients, they also need soft skills, such as counselling patients and teaching them to take care of themselves upon discharge,” Ms Low says.

She notes that ward simulation training allows trainees to make errors and learn from them with no adverse impact on real patients.

Ms Low (left) says that simulation training allows

trainees to make errors and learn from them,

without risk to patients.PHOTOS: CHONG JUN LIANG

Studying movement and pain

Jamie Ee

ACADEMIA houses the most advanced and comprehensive biomechanics lab in Singapore — Human Movement Study Lab — which is dedicated to the learning and study of human movement.

Located on Level 1, the 70sq m facility is dedicated to the learning and study of human movement and also one of the two key labs for human movement analysis and tissue testing within Academia’s Bioengineering Hub.

Mr Hanniel Lim, senior executive, Group Allied Health, SingHealth, says the lab will ful-fil two purposes: to train doctors, nurses and allied health professionals on how to use ad-vanced movement assessment tools to conduct research, and to spur further studies in the bio-mechanics field.

Elsewhere, research into the finer points of human movement has enabled doctors to de-fine the mechanisms underlying movement

disorders and pain. This has improved patient care and treatment.

“We are able to sub-classify certain disorders with the finer details captured by simulation technologies,” says Mr Lim, who is spearhead-ing the setting up of the lab. “So rather than giving a standard generic treatment, we are able to zoom in to the specific condition and and give a targeted treatment.”

Among the key features of the the lab are motion simulation equipment that consists of a 10-camera motion analysis system, force plat-forms, and an EMG (electromyography) system with fine wire needle capabilities that can record electrical activities of deep, specific muscles.

The lab is also fitted with a cardiopulmo-nary exercise testing system, which can test how the heart, lungs and muscles react to stress and activity. There are also simulators used in nerve conduction studies to understand how nerves activate muscles and movement.

Mr Lim believes the opening of the lab will

enable more high-quality local research in bio-mechanics, as well as spur collaborations with local and overseas researchers. Some possible work that can be done in the lab includes the testing of rehabilitation prototypes that Sing-Health health-care professionals have jointly developed with local polytechnic students.

In the pipeline is also the creation of a broad-based curriculum in the field of bio-mechanics, targeted at teaching clinicians in SingHealth on how to conduct clinically rel-evant research that can improve treatment for patients with movement disorders and cardiopulmonary-related conditions. There is currently no such curriculum here available to clinicians.

Mr Lim says: “We are opening this up to everyone in SingHealth who has an interest in biomechanics and we hope we can bring peo-ple and resources from various institutions in Singapore together to engage and perform bio-engineering activities.”

“In such an environment, trainees would be more con-fident and ready to take on daily challenges like managing medical emergencies and providing good quality of care even when dealing with demanding customers. They can repeatedly practise and master the skills required to be com-petent practitioners,” Ms Low says.

Training patient service associatesLike Ms Low, Ms Cheah Le Le, nurse educator at Alice Lee IAN is “very excited” about the new and high-tech facilities available at Academia, including four simulated specialised outpatient clinics (SOCs).

Each simulated SOC is set up to resemble a typical SOC but with loose furniture to provide for the flexibility of training using manikins. It also has one-way viewing win-dows and state-of-the-art audio visual monitoring systems to facilitate observation and recording during training.

All sessions are captured on cameras in the room. A play-back of the video recording makes possible a more sophisti-cated debriefing of all scenarios.

Ms Cheah says the simulated SOCs will be used to train mainly patient service associates, who are typically the first point of contact for patients when they arrive in the out-patient area.

She notes that each simulated SOC has a front desk to provide training in skills such as handling enquiries from patients, cashiering and bill payments in a simulated envi-ronment where it is easier to assess the trainees and track their progress.

Trainees previously had to go to an actual hospital to practise these skills and learn on the job, Ms Cheah says.

Apart from developing their administrative skills at the front desk, trainees are also taught how to help doctors in the consultation rooms.

“When the doctor needs a chaperone, for example, or somebody to stand by when he does an examination on the patient, they can go in and hand certain examination tools to the doctor,” says Ms Cheah. They may also have to assist in preparing the tools required in a clinic.

Training in such a simulated environment will boost the confidence of patient service associates when they commu-nicate with patients and handle their requests.

“This translates to patient safety because when staff know what they are doing, they are less likely to make mis-takes. They are able to anticipate the needs of patients, who have fewer complaints,” Ms Cheah adds.

This translates to patient safety because when staff know what they are doing, they are less likely to make mistakes. They are able

to anticipate the needs of patients, who have fewer complaints.— Ms Cheah Le Le, nurse educator, Alice Lee IAN

Prof Phua (left) can assess and guide trainees in the simulated ICU by observing them through a one-way viewing window.

With the simulation labs, we are now able

to brush up our skills in a stress-free environment. The various life-like scenarios also enable us to practise and prepare for the day when we face a patient in a difficult or challenging scenario.— Dr Sim Yirong, a resident in general surgery

DISCOVERY TOWERThe nucleus of research to push the boundaries of medicine.

L13 SingHealth Research Facilities

L11, Singapore Eye Research Institute (SERI) LaboratoriesL12 ● leading centre for eye and vision research in Asia

L10 SingHealth Research Core Platforms ● SingHealth Tissue Repository — facilitates basic,

translational and clinical research at SingHealth and Duke-NUS Graduate Medical School.

● AMPL@SingHealth — a collaboration between SingHealth and A*Star’s Institute of Molecular and Cell Biology; provides histopathology consultation and biomarker validation in clinical samples

● Flow Cytometry — provides cell sorting and analysis services

● Advanced Bio-imaging — provides state-of-the-art optical and electron microscopy imaging technologies.

● Polaris — a collaboration between A*Star’s Genome Institute of Singapore and SingHealth, which aims to deliver better patient outcomes through research.

L9 SGH Research Laboratories

L8 SingHealth Research Facilities SingHealth Research Core Platforms:

● SingHealth Translational Immunology and Inflammation Centre: drives clinical immunology and inflammation research through a joint academic collaboration between SingHealth and Duke-NUS Graduate Medical School.

● Clinical Pharmacology: provides core clinical pharmacological services.

L7 SingHealth Office of Research

L6 ◆ SERI◆ Academic Medicine Research

Institute◆ Principal Investigator Offices

L5 SGH Division of Surgery

L4 ◆ SGH Division of Medicine, Division of Surgery, Division of Ambulatory Care

& Clinical Support Service

L3 ◆ SGH Division of Medicine ◆ Library

L2 ◆ SingHealth Group Education, Postgraduate Medical Institute, Alice Lee Institute of Advanced Nursing, Institute for Medical Simulation and Education, Postgraduate Allied Health Institute

◆ Tutorial Rooms ◆ Seminar Rooms ◆ Auditorium ◆ Mini Hospital ◆ Dry Skills Lab

L1 ◆ Bio-Medicals Skills Laboratories ◆ Auditorium ◆ Seminar Rooms

B1 ◆ SingHealth Experimental Medicine Centre

◆ Wet Skills Laboratory

Postgraduate Medical Institute, Alice Lee Institute of Advanced

Bio-Medicals Skills Laboratories

L13

L7

L10

L4

L11

L5

L8

L2

L1

B1

L12

L6

L9

L3

DIAGNOSTICS TOWERThe bridge between science and clinical medicine to achieve rapid diagnoses of diseases for better patient care.

L13 Central Tuberculosis ● provides tertiary reference-level laboratory diagnosis

of tuberculosis and other mycobacterial diseases; TB control; and evaluation of new diagnostic methods.

L12 Virology ● Protects the public against pandemics and provides

a comprehensive range of virological tests

Molecular ● offers tests for the detection of a wide range of

viruses and other microorganisms; works with Histopathology to incorporate oncologic applications for increasingly individualised cancer treatment

L11 Diagnostic Bacteriology ● identifies and tests bacteria that cause infections

provides diagnosis of parasitic and fungal infections; supports outbreak investigations within the hospital and community and carries out research; provides diagnosis of unusual or emerging pathogens and studying multi-drug resistant bacteria and their spread.

Immunology and Serology ● provides diagnoses for a variety of infectious

diseases through the detection of antibodies and antigens to bacteria, parasites and fungi

L10 Histopathology ● studies diseases at the macroscopic, microscopic

and molecular levels; evaluate tissue sections under the light microscope to provide a pathologic diagnosis. Through a histopathologic diagnosis, appropriate clinical care for cancer and other diseases can be given.

Cytology ● evaluates cells in relation to disease, primarily in the

detection of cancers, but also of specific infections or pre-cancerous conditions; accredited laboratory in the national cervical screening programme.

L9 Haematology ● largest provider of haematology services in

Singapore; delivers clinical and laboratory services for the diagnosis and treatment of all blood and blood-related disorders

Cytogenetics ● offers state-of the-art chromosomal investigations

for cancers, constitutional abnormalities and pre- and postnatal diagnoses; and conducts a wide range of molecular tests.

L8 Clinical Biochemistry ● integrates state-of-the-art automated analytical

processes with cutting-edge technology to offer a large repertoire of tests that complements the wide spectrum of clinical services in SGH

L7 SGH Department of Pathology

What’s inside the Academia building at SGH campus

— Dr Sim Yirong, a resident in general surgery— Dr Sim Yirong, a resident in general surgery

◆ SGH Division of MedicineL13

PHOTO: SINGHEALTH

The biomechanics lab takes research in this field a step forward

PROJECT EDITOR Lai Yi Ming WRITER Ahmad Osman CONTRIBUTORS AJ Leow, Gloria Chan, Jamie Ee, Narendra Aggarwal, Suki Lor, Suresh Nair ART AND DESIGN Kimmie Tan, Vikki Ann Chan, Lynnette Chia PHOTOGRAPHER Chong Jun Liang EDITOR Lee Kim Chew DEPUTY EDITOR Leong Phei Phei CHIEF SUB-EDITOR Uma Venkatraman ART DIRECTOR Chris Tan ADMIN MANAGER Zain Afridi ADVERTISING SALES Lam Wy-ning (9368-5685), Lina Tan (9620-1355), Tan Keng Boo (9620-1363)

For reproduction of articles or reprints of photographs, call SPH's Information Resource Centre: 6319-5508 or 6319-5726. E-mail feedback to spu@sph.com.sg

Jamie Ee

GENERATIONS of doctors have sharpened their surgical skills by observing the masters and per-forming procedures on patients under the watchful eye of more experienced doctors.

But these days, surgeons are increasingly using simulation technologies to hone their craft safely and in a more structured way, instead of learn-ing on real patients.

There are several reasons for this shift: the increase in the number of medical students and trainees, smaller patient volumes, shorter training hours available and increasing patient expecta-tions, which have resulted in fewer learning opportunities for training surgeons, says Professor London Lucien Ooi, chairman, Division of Surgery, Singapore General Hos-pital (SGH) and academic chair, Surgery ACP (Academic Clinical Program), SingHealth.

“With the changing landscape in health care, there is a need to provide more training opportu-nities in a more controlled envi-ronment before the student or trainee is allowed to perform a procedure on a patient,” he says.

Computerised simulation training overcomes some of these limitations. Students and trainees are able to perfect their skills at their own pace, as well as have a clear measure of their competency. Since there is no direct contact with patients, simulation training also reduces medical errors and enhances patient safety.

Simulation technologies allow medical students to gain hands-on experience at their own pace

Sharpening surgical skills

To provide greater realism, Academia is equipped with a fully functional, state-of-the-art operating theatre system that allows surgeons to gain hands-on experience working in a real operating room — but without real patients.

The system, called the Storz OR1 Neo, is located in the Skills Laboratory on level B1, and is the latest operating theatre system from Karl Storz, a global medical device company.

Instead of using mock-ups, trainee doctors and surgeons will use this real equipment to practise various surgical operations, particularly minimally invasive surgery, on “models”.

These human-like manikins can simulate a real patient’s physiological changes, such as fluctuations in blood pressure, pulse rate and breathing rate, during an operation.

Creating a real operating room environment is important, says Prof London Lucien Ooi, chairman, Division of Surgery, SGH and academic chair, Surgery ACP, SingHealth, as it allows trainees to learn how to handle various types of surgical emergencies without any risk to real patients.

It also helps different groups of health-care professionals, including surgeons, anaesthetists and nurses, to become familiar and develop confidence in the operating room, he adds.

The Storz OR1 Neo represents the latest in operating theatre system design, where integration is key. It provides centralised control of all surgical equipment and systems, and can gather and display real-time data from various sources, such as anaesthetic monitoring data, operating system images and X-ray information to everyone in the surgical team.

The equipment costs $3.8 million, which also includes 10 minimally invasive surgery operating towers that can be used individually and simultaneously for training surgeons. Each tower is linked to the central Storz OR1 Neo system to allow trainers to view the procedures at each training table from the master table and vice versa.

At SingHealth, surgeons have been training us-ing simulation technologies for a few years now, but these were done in various locations. In Academia, these technologies — and new ones — will be cen-tralised and housed in the SGH Surgical Skills Centre.

The equipment ranges from basic task trainers like knot-tying boards and suturing pads to high-

fidelity computerised simula-tors that allow users to gain hands-on experience for a range of minimally invasive, endoscopic and endovascular procedures — all of which re-quire surgeons to have a high level of psychomotor skills and hand-eye coordination.

As the users control the surgical tools on the simula-tors, they are able to feel re-sistance from the tissues they are working on, which makes the experience very realistic. The computerised simulators are also able to track perfor-mance of the user, which is useful in deciding if a trainee can move on to contact with real patients.

Some of the simulators also allow for specific patient data to be keyed in so that surgeons can practise and perfect the proce-dure before replicating it on the real patient.

To maximise learning, the 24-hour centre can be accessed at anytime with a card. It is also fitted with an AV system that allows live transmission of a task being performed to other seminar rooms and classrooms for sharing, teaching and discussion.

Training surgeons with human-like manikins that simulate a real patient’s physiological changes

thesundaytimes July 28, 2013 22SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

PHOTO: CHONG JUN

LIANG

With the changing landscape in health

care, there is a need to provide more training opportunities in a more controlled environment before the student or trainee is allowed to perform a procedure on a patient.– Professor London Lucien Ooi, chairman, Division of Surgery, SGH

July 28 2013 thesundaytimes 23