Offered by SingHealth Polyclinics, the Medication Review Service (MRS) is a one-on-one consultation for

patients to advise them on their medical conditions and medication. At these sessions, pharmacists help patients reconcile all the medication prescribed by the different medical centres they visit.

“Many of our elderly patients with multiple chronic diseases have poor medication compliance due to factors ranging from poor understanding or memory, or confusion given the multiple medications they have to take. In the long term, these patients may develop more medical problems if their chronic conditions are not well-controlled,” said Bandy Goh, Clinic Pharmacist Manager at SHP.

SHP doctors refer patients with five or more chronic medication who have difficulty managing their chronic medications regimen to the service. While the pharmacists have received favourable feedback from both doctors and patients, no previous study had been done to find out how effective MRS exactly is.

To determine whether MRS can be an effective tool in improving patient’s medication knowledge and medication adherence, the SHP Department of Pharmacy conducted a study at SHP-Bedok, SHP-Tampines, SHP-Pasir Ris and SHP-Outram from June to December 2012.

Patients filled in a questionnaire at their first and follow-up appointments. Of 195 patients, close to 94 per cent showed gaps in their medication knowledge while about 70 per cent had issues with medication adherence.

The study results showed that MRS was effective in improving patients’ medication knowledge. It also halved the number of patients who had issues with medication adherence to just 36.9 per cent after an average of one session. Of the five domains studied, dosage and frequency showed the biggest improvement with the percentage of patients who could verbalise the correct dose and frequency improving by about 30 per cent each. The number of patients who reported high adherence scores after their MRS sessions also rose from 29.7 to 63.1 per cent.

Bandy added, “While each MRS appointment lasts only about 20 minutes, we have noticed that our patients usually appreciate the time and attention from our pharmacists. Our study results are a great motivating factor for the pharmacists

to know that we are moving in the right direction.”

Started in 2009, the pharmacist-led MRS serves, on average, nearly 160 patients a week at the nine polyclinics. With the service now in full swing, SHP has exceeded twice its original MRS target.

Besides MRS, SHP improves patients’ compliance to their medication with initiatives such as the Medication Counselling Service,

Medication Identification Aid, Patient Medication information leaflets and the use of pictogram stickers on medication packaging.

To follow up on this study, the researchers would like to explore whether MRS can be an effective service in improving clinical outcomes of some of the common chronic diseases that are managed in the polyclinics.

Healthcare professionals are constantly on the go. This means they often cannot access the staff

directory on the intranet because there are no computers available nearby. With the recent introduction of the SingHealth mDirectory mobile application, SingHealth staff can now easily search for staff phone numbers anytime, anywhere, at the tap of a screen.

The mDirectory is one of many initiatives of the SingHealth Appointment Access Taskforce (AATF) to improve access to appointments in SingHealth institutions by creating a seamless experience for patients and a user-friendly application for staff. The Taskforce is co-chaired by Professor Agnes Tan, Division Chair of Ambulatory and Clinical Support Services, SGH and Ms Lee Chen Ee, Director of Office for Service Transformation (OST), SingHealth.

SingHealth call centre agents receive a large volume of internal calls, many of them coming from staff enquiring about telephone numbers of their colleagues. In 2013, close to 2,000 calls per week came through the call centre’s general enquiry line requesting for contact numbers of SingHealth staff members although such contact details are readily available on the intranet.

Under AATF, the Appointment Rules Workgroup created the mDirectory application in March 2014 as one way to reduce the number of internal calls to the call centres. The Workgroup, co-led by Ms Sandra Koh, Director of Operations at SGH and Mr Lucas Goh, Assistant Director of Clinic Operations at SHP, worked closely with an IT team to develop the application.

The fact that staff can now look up staff contact details of through their mobile phones has reduced the number of internal calls to the call centre asking for staff phone numbers by about 45 per cent. At SGH Call Centre, it frees up about 35 man-hours each week.

According to Ms Selina James Nanayakara, an Executive at SGH Call Centre, “Since the mDirectory was launched, it had resulted in more time to handle external calls and hence reduced waiting time for patients and public. It has also freed up our agents’ time to manage other more important calls such as code blue activation, civil emergencies and patients asking for top-up of medication.”

Mobile app frees up call centre for patients

SINGHEALTH DUKE-NUS ACADEMIC MEDICAL CENTRE

THE voICE of ACADEMIC MEDICINE

MEDICINEToMoRRow’S

ISSUE 14, DECEMbER 2014MCI (P) 054/07/2014

Research: Medication review yields positive results

Number of lost calls cut as staff refer to mobile directory for contact detailsA SingHealth Polyclinic study

gives clear evidence that medication review service improves patient’s medication knowledge and adherence

Many of our elderly patients with multiple

chronic diseases have poor medication compliance. In the long term, these patients may develop more problems if their chronic medical conditions are not well-controlled.

- Bandy Goh, Clinic Pharmacist Manager, SHP

[the app] has reduced the number of

internal calls asking for staff phone numbers by about 45 per cent. At SGH Call Centre, it frees up about 35 man-hours each week.

Continued on page 3

Medication review addresses medical problems arising from non-compliance

Before review

58(29.7%)

After review

123(63.1%)

Total number of adherent patients

Before review

137(70.3%)

After review

72(29.7%)

Total number of non-adherent patients

Frequency Indication Storage AdminstrationDOSE

43.1 45.7

85.6

9.2

33.3

12.8 13.8

63.6

0.521.5

100

80

60

40

20

0

Stud

y pa

tient

s (%

)

Fig 1. Knowledge deficiencies before and after medication review

Before After

Plagiarism, along with data fabrication and data falsification, is considered a cardinal sin in academic publishing.

Put simply, plagiarism is defined as the theft of words or ideas and is used to deceive readers as to their origins. The issue of plagiarism inevitably features in any consideration of academic misconduct, if only because the advent of word processing technology and the proliferation of full-text databases on the internet have made verbatim text-copying more prevalent.

Although it is deemed professionally unethical to steal ideas and words from other authors and deceive readers as to their origins, copying text from one’s own published work (“self-plagiarism”) is sometimes considered less egregious and leeway is granted for such reuse of text. Some have argued that the term “self-plagiarism” is oxymoronic, and that the seeming absurdity of stealing from one’s self does not constitute intellectual theft.

Self-plagiarism is divided into four forms: (1) duplicate publication, where the same results are published in a different paper; (2) segmented publication (also known as “salami-slice” publication), where the results of a large (usually complex) study are sliced up and published as multiple smaller papers; (3) augmented publication, where new data is added to previously published data,

reanalysed, and the manuscript submitted as a new study with adjusted study aims, often under a different title; and (4) text recycling, where large portions of previously published text are reused in another manuscript. The first three forms portray data that are likely to mislead other researchers, while the last is attributable to intellectual laziness.

Many authors fail to realise the legal implications of self-plagiarism. Authors generally transfer copyright of a paper to the journal upon publication, making it necessary to seek reproduction rights from the publisher. That said, there might be little grounds for litigation by publishers against self-plagiarising authors because of factors such as the potential defendant not being a third-party plagiarist, the absence of financial compensation for the original work, the transfer of copyright being procedural for publication of the work, and fair use laws.

A self-plagiarised manuscript was submitted to the Proceedings of Singapore Healthcare for consideration. Fortunately, it was detected before publication. In the light of the preceding discussion and our experience with self-plagiarism, what is the journal’s policy when it occurs? Like other journals, we regard duplicate publication as a clear breach of academic ethics. Both segmented and augmented publication are undesirable,

but may be considered if it includes relevant new data and contributes to the existing body of knowledge. The issue of text recycling is less clear-cut. Although the practice is highly discouraged, we recognise that there may be instances where there is no better way of expressing an idea than the ones already published (e.g. for complex methods). In such cases, recycling verbiage at acceptable levels might be considered less unfavourably.

Although self-plagiarism is an unfortunate side effect of the “publish or perish” mentality, it is still ethically bankrupt. The editorial board holds the journal to the highest standards of research integrity, and it is our fundamental obligation to readers to report accurate research that meets these standards. We hope that all present and future authors check not only their manuscripts, but also their moral compass in this regard.

Singapore’s medical system is excellent in treating patients – we have the evidence-based drugs and devices

that are recommended in major American and European treatment guidelines – but the Asian doctor is not comfortable talking about end of life issues with patients.

In our Heart Failure Programme*, I see a huge care gap between giving a patient their prognosis and preparing them for their healthcare journey ahead. There is a pronounced need for advance care planning for heart failure patients because of significant morbidity and mortality rates, along with potential sudden cardiac issues and the rapid deterioration that follow.

This patient care gap is representative of our community today. We must overcome this and create bespoke treatment plans according to patients’ needs and wishes. The key is to empower the patients with knowledge so they can make an informed

decision, exercising their rights to decide on their healthcare journey based on their education, cultural and family backgrounds.

Advance care planning allows a patient to decide the course of action for his treatment should he collapse, be very sick, or reach a semi-comatose state – instead of allowing the responsibility to fall on immediate relatives or caregivers who are already emotionally challenged at that stage to make such a demanding decision.

I, together with the Medical Social Services department of NHCS, initiated advance care planning for heart failure patients in NHCS as a pilot study after my study trip to Lacrosse, Wisconsin, in 2012. It was the first of such programmes in SingHealth.

A best case scenario for Singapore would be what I had witnessed in Lacrosse, where literally everyone has done advance care planning. Whenever an ambulance

was dispatched, the paramedics would go straight to the fridge when they enter the house, where the patient would have stuck the advance care plan.

We need to educate healthcare professionals and patients, and shift the idea of advance care planning as a terminal-stage need to a norm for every healthy person. As healthcare professionals, we need to overcome such cultural barriers, and acknowledge that it is perfectly fine to opt for quality of life and a graceful exit into the night.

For more information, visit: http://mysinghealth/SGH/Clinical/OIC/Programmes-and-Initiatives/Advance-Care-Planning-ACP/

TOMORROw’S Medicine - ISSUE 14, DEcEmbEr 2014PAGe 2

ediTORS-in-cHiefTan-Huang Shuo MeiAudrey Lau

ediTORSJennifer WeeArthur WongStephanie JadeRachel Kelly

JOinT ediTORiAl TeAMGoh Sai Luan (SGH) sub-editorIchha Oberoi (KKH) sub-editorEdwin Yong (NCCS) sub-editorCaroline Chia (NDCS)Kristie Chiew (NHCS)Dr Thiyagarajan Jayabaskar (SNEC)Eric Lim Wei (SHP)Wee Lai Ming (Duke-NUS)

cliniciAn AdviSORy PAnelProf Robert KameiAssoc Prof Darren Koh Liang KhaiAssoc Prof Koo Wen HsinAssoc Prof Lo Yew LongAssoc Prof Nigel Tan Choon KiatProf Tan Kok HianProf Wong Tien Yin

deSiGnRedstone Communications

cOPywRiTinGHedgehog Communications

DEcEmbEr 2014

All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographers or illustrations. Tomorrow’s Medicine reserves the right to edit all materials submitted for publication. While contributors will be given the opportunity to comment on articles for factual accuracy, this policy is about ensuring a consistent and clear writing style throughout.

Members of SingHealth duke-nUS Academic Medical centre

Singapore General Hospital (SGH)KK Women’s and children’s Hospital (KKH)

Sengkang Health (SKH)National cancer centre Singapore (NccS)National Dental centre Singapore (NDcS)National Heart centre Singapore (NHcS)

National Neuroscience Institute (NNI)Singapore National Eye centre (SNEc)

SingHealth Polyclinics (SHP)bright Vision Hospital (bVH)

Partner in Academic MedicineDuke-NUS Graduate medical School Singapore

(Duke-NUS)

Tomorrow’s medicine welcomes comments from our readers. Write to us at

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news Over Multiple channels

When reusing your own writing becomes theftBy Dr Ng Heok Hee*Senior Executive, PublicationsSingHealth Academy

Advance Care Planning to honour patients’ choiceBy Adj Asst Prof David SimDirector, Heart Failure ProgrammeConsultant, CardiologyNHCS

The Asian doctor is not comfortable

talking about end of life issues with patients.

Many authors fail to realise the

legal implications of self-plagiarism.

*NHCS’ Heart Failure Programme helps heart failure patients improve their quality of life and survival, and reduce their need to be re-admitted

This article was first published in Proceedings of Singapore Healthcare Vol 23 No. 3 2014.For references, go to http://bit.ly/11lH43J

*Heok Hee received his PhD in Biology from University of Michigan, Ann Arbor, and has extensive experience in research and scientific writing. He has published more than 180 papers in scientific journals, six chapters in five books, and 25 articles for popular magazines. He has also reviewed papers for more than 20 scientific journals.

Mobile app frees up call centre for patientsContinued from cover page

The inaugural SingHealth-Duke NUS Gala Dinner will be held on Saturday, 5 September 2015 at the Ritz-Carlton, Millenia Singapore. This biennial fundraising event aims to raise funds for research and education causes for Academic Clinical Programs. Prof Soo Khee Chee, Deputy GCEO, is the Advisor to the Organising Committee for the Gala Dinner. Chairperson for the Gala Dinner is Associate

Professor Lee Shu Yen, Senior Consultant at SNEC’s Department of Vitreo-Retinal Service. Her Co-Chairperson is Dr June Goh, Senior Consultant at SGH’s Department of Anaesthesiology. TM catches up with Prof Lee and Dr Goh to find out more.

PAGe 3TOMORROw’S Medicine - ISSUE 14, DEcEmbEr 2014

AcP-led Gala to raise funds for Academic Medicine

There were numerous challenges the team faced in developing and launching the mDirectory application. The biggest of which was ensuring secure data access while maintaining a user-friendly experience. With constant changes in the staff directory database – new employees joining the SingHealth family and some others leaving – the team also has to ensure that contact information in the mobile application is promptly updated.

Koh Lin Lin, Deputy Director at IHiS and member of the Appointment Rules Workgroup, said, “Keeping our patients in mind is the most important factor. Everyone in the team wants to transform our staff connectivity and reduce the call centre workload to create a seamless experience for the patient.”

The workgroup’s job does not end here. The mobile application is just a start of more things to come: The team aims to use this platform to improve the call experience for patients and a more user-friendly experience for staff.

Congratulations on being appointed the Chair and Co-Chair of our inaugural Gala Dinner! What do you think will make it a success? Shu Yen: I hope that this Gala Dinner will build awareness of the importance of philanthropy as an enabling resource to uncover new treatments and new solutions to medical challenges. Personally, it is a success if we can cultivate a deeper understanding of the potential and impact of research and education on our patients, the community and the future. Research breakthroughs do not materialise overnight; all the more reason to do as much as we can today. Philanthropy drives these efforts. June: Many gala dinners are organised throughout the year - by healthcare institutions, schools, voluntary organisations and the various charities. It usually takes a few years for a gala dinner to become a “signature event” that supporters and donors look forward to attending. Our goal is to create that unique branding for the SingHealth Duke-NUS Gala Dinner.

How do you hope the ACPs can benefit from this fundraising effort? June: There is a lot of potential in partnering like-minded individuals and corporations to achieve our

research and education goals. Fundraising is a new area for all of us. I hope this Gala Dinner enables all our ACPs to embark on their respective fundraising journeys to showcase the potential of their projects and the opportunities for partnership. Shu Yen: I agree with June! I also believe it will also be an enriching experience for all of us to understand how we can work towards matching our causes with the interests and intent of donors.

Any words of advice or encouragement for the ACPs in this fundraising effort? Shu Yen: Know your causes for support very well! Your passion will come through when you explain to potential donors why it is the right investment to make. Patients, in particular, may be very interested to know about your area(s) of research and do their part to help. It is not the amount donated that matters. Every gesture (sponsorships) and donation counts!

June: Keep an open and positive mind! You will be surprised at the vast network of contacts that we have, both as individuals and collectively. Be open to sharing your contacts or be a connector for projects and potential donors! SingHealth Foundation will also be matching the amount raised through table sales (subject to a cap), so the more tables sold, the better!

dr June Goh co-chairperson

Associate Professor lee Shu yen chairperson

SingHealth Duke NUS Gala Dinner 2015 Steering CommitteeACP Clinician Representatives (supported by ACP administrators and Development officers)

Cardiovascular Assoc Prof Ching Chi Keong

Medicine Dr Steven Mesenas

Neuroscience Dr David Low

Obstetrics & Gynaecology

Assoc Prof Tan Hak Koon

Oncology Dr Tan Hiang Khoon

Ophthalmology & Visual Sciences

Dr Ho Ching Lin

Oral Health Assoc Prof Teoh Khim Hean

Paediatrics Assoc Prof Chan Yoke Hwee

Pathology Assoc Prof Lai Siang Hui

Radiological Sciences

Assoc Prof Winston Lim

Surgery Dr Andrew Chin Yuan Hui

Anaesthsiology* Assoc Prof Chan Yew Weng

Family Medicine*

Dr Ruth Lim Mien Choo

* ACPs targeted for implementation

it may be a little too soon for him to talk about leaving a legacy, but Dr Edmund Wong has a clear vision on what he wants to leave behind. “I want to leave with the knowledge that I have cared for and saved the vision of many people and have done my best to help people with eye problems see better,” he says.

“After having looked after my patients well, I would also like to have developed a group of interested, passionate younger doctors to follow in the footsteps left behind by my seniors and those before them.”

This, to him, is most important to impart to the next generation — a caring mind dedicated to caring for as many patients as possible.

Dr Edmund WongDeputy Medical Director (Clinical Services)Senior Consultant, Vitreo-Retinal Service, SNEC

OUR PeOPle, THeiR STORieSFollow them on facesofhealthcare.tumblr.com

How to download the SingHealth mDirectory app

1. What You Need• 3G/4GmobilenetworkorWI-FIconnection• MobileOSversion:IOS6.0andlater;Android4.0andlater

2. Download the Application• Keythisintoyourmobilephonebrowser:http://www.

singhealth.com.sg/mobile/staffdirectory/• LoginusingyourinstitutionADID• Select“install on your xxx device”todownloadthe

application

3. SingHealth mDirectory• LoginusingyourinstitutionADID• ThosewhoneedtechnicalassistancecanemailSingHealthITHelpdeskor

calltheirrespectiveinstitutionhelpdesknumbers.

it was hard to picture Prof Lim’s entry into biology as a mature student in 1988, while he shared Parkinson’s disease

(PD) breakthroughs today as the Assistant Director of Research and Head & Principal Research Scientist of the Neurodegeneration Research Laboratory at NNI.

Prof Lim’s journey as a scientist devoted to a chosen subject matter is representative of many researchers’ years of hard work and grit that sustain medical breakthroughs alongside cutting-edge technology. Today, Prof Lim is one of the leaders in the local neurodegeneration research frontier, actively working towards identifying PD markers that can provide early diagnosis for preventive interventions and enhance therapy development.

Prof Lim and his team are part of a PD clinical science consortium headed by Professor Tan Eng King, Senior Consultant Neurologist and Director of Research of NNI, that was awarded the NMRC Translational and Clinical Research Flagship Programme Grant of $25 million for their work on the degenerative neurological disease. Prof Lim considers PD an “equal opportunity” disease

with about 0.3 per cent of Singapore’s population above 50 suffering from it regardless of culture and race. The number is expected to increase more than 2.5 times by 2030. NNI is in the race to develop better therapies as Singapore’s ageing population climbs.

A dedicated mentor in the laboratory, Prof Lim also teaches at Duke-NUS. He seeks to educate student researchers that many things are interrelated, and scientists should balance topical focus with acknowledging the relationship between their causes and others’. “Multidisciplinary approaches allow us to interrogate the system in ways we cannot do on our own. We have to recognise our strengths and also our limitations,” Prof Lim said.

A collaboration between Prof Lim’s laboratory and NUS Chemistry Professor Yao Shao Qin’s team led to the development of a fluorescence probe that tracks PD progression in patients’ blood, enabling potential early detection and preventive monitoring of PD.

Prof Lim highlighted this partnership as an example of balancing research and networking, as one never knows how collaborations can form, “My post-doctoral fellow plays basketball with a chemist post-doctoral fellow at NUS, and the PD probe collaboration was a slam-dunk through their friendly discussions after ball games. People should go out and have fun as serendipitous discoveries can arise from events that you

will not immediately tie into research.”

There are still many challenges to PD research, but Prof Lim feels the key is that ongoing research offers hope to patients with the disease. He shared, “Hope can be a very powerful medicine. When you are looking at disease-related research, the end

point is to try and improve human lives. As an activist once shared: The funding that we receive as researchers is for the betterment of human health and not for the betterment of individual careers. I think that’s in essence what research, particularly disease-related research, should be.”

SingHealth Office of Research Grant Call Reminder

Grant Closing Date Grant Amount

MOH Industry Alignment Fund (IAF) Cat 2 2 Jan 2015 <S$3M for up to 3 years

Duke /Duke-NUS Research Collaborations Open throughout the year • USD$50K to USD$150K to Duke PI

• S$50K to S$150K to Duke-NUS PI

NMRC Clinical Trial Grant - Co-Development Scheme (Co-D) Open throughout the year <S$5M for a period of 3 years

MOH Industry Alignment Fund (IAF Cat 1) Open throughout the year <S$500K; <S$1M; <S$1.5M

(3 subcategories) for a period of 3 years

Khoo Mentored Research Award (KMRA) Open throughout the year <S$300K for a period of 2 years

Khoo Pilot Award Open throughout the year <S$30K for a period of 1 year

For more information on funding sources and support for research in SingHealth, visit http://research.singhealth.com.sg or email office.research@singhealth.com.sg

AM•EI EventsOpen to all SingHealth and Duke-NUS staff. For details and registration, contact the Academic Medicine Education Institute (AM•EI) at amei-info@duke-nus.edu.sg. For membership enquiries, email amei-members@duke-nus.edu.sg.

PROGRAMMES AT SGH CAMPUS

8 Jan 5.00pm-6.00pm

Education Grand Round: Feedback and Learning – The use of learning/shift card

14 Jan2.00pm-5.00pm

The “flipped” classroom: Using team-based learning to enhance the learning within your course

27 Jan2.00pm-5.00pm Designing effective objectives and quality multiple choice questions

11 Feb9.00am-1.00pm Becoming a leader in Academic Medicine: Honing and developing your skills

PAGe 4

People and passion behind Parkinson’s disease research

TOMORROw’S Medicine - ISSUE 14, DEcEmbEr 2014

Assoc Prof lim Kah leong is searching for genetic markers that can provide early diagnosis and treatment for Parkinson’s disease

Associate Professor Lim Kah Leong says breakthroughs are powered by interdisciplinary partnerships, unrelenting curiosity and sometimes, serendipity

Hope can be a very powerful medicine.

When you are looking at disease-related research, the end point is to try and improve human lives.

- Assoc Prof Lim Kah Leong, Assistant Director of Research, Head & Principal Research Scientist, Neurodegeneration Research Laboratory, NNI

(l-R): Thamizhanban Manoharan, chai Bing Han, dr Zhang cheng wu dr Joan Sim, Assoc Prof lim Kah leong, dr Grace lim,

eugenia Hong, doreen chua