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Delivering Care That Is Effective

E1. What Is The Success Rate Of Our Patients Who Underwent In-Vitro Fertilization (IVF)?

Approximately 10% of couples have difficulty conceiving a child after one year of unprotected intercourse [1]. In Vitro Fertilization (IVF) is a method to help infertile couples to conceive a child outside the body. In this procedure, the eggs are usually fertilized with sperm in a laboratory culture dish, and the resulting embryos are then placed in woman’s uterus in hopes of establishing a successful pregnancy. The common factors that may affect the outcome include age, egg/sperm quality, duration of the infertility, the health of the uterus, and medical expertise. The success rate of IVF in SGH compared favorably to those reported by our counterparts in Europe [2] and the United States [3].

IVF Success Rate

Source: Department of Obstetrics & Gynaecology, SGH

References:
1. Van Voorhis, B.J., Clinical practice. In vitro fertilization. The New England journal of medicine, 2007. 356(4): p. 379-86.
2. Andersen, A.N., et al., Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Human reproduction, 2007. 22(6): p. 1513-25.
3. Wright, V.C., et al., Assisted reproductive technology surveillance--United States, 2003. Morbidity and mortality weekly report. Surveillance summaries, 2006. 55(4): p. 1-22.

E2. What is the Survival Rate of Our Patients Who Have Received Haematopoietic Stem Cell Transplant for Acute Myeloid Leukaemia When They Were in Complete Remission?

The Hematopoietic Stem Cell Transplant (HSCT) is a form of therapy that involves collecting stem cells from a donor or cord blood and infusing them intravenously into a recipient. The donor can be the patient (autologous), a relative (allogeneic), or a matched unrelated donor. HSCT is an integral part of treatment for patients with acute myeloid leukaemia (AML). The HSCT program in SGH was established in 1985. For AML patients in SGH who were in complete remission (CR) and had HSCT treatment, the survival rate was 100% at 100 days and 1 year post autologous HSCT. The survival rates of related allogeneic HSCT were also comparable to those reported in US. As for the unrelated allogeneic HSCT, the survival rates, however, were slightly lower compared to the data reported in US though this can be associated with the different size of donor pool. Overall, our program has attained comparable or even better clinical outcomes than those reported by counterparts in the United States.


Source: Department of Haematology with data validation (2012)

References:
1. United States Health Resources and Service Administration report: Accessed on Dec 2012 at
http://bloodcell.transplant.hrsa.gov/research/transplant_data/us_tx_data/survival_data/survival.aspx  

E3. Are Our Patients On Oral Anticoagulation Therapy Optimally Managed?

Oral anticoagulation therapy is used to ‘thin’ blood and to reduce the risk of blood vessel blockages in a wide variety of diseases. It is estimated that 5 million patients worldwide are on anticoagulation therapy. International Normalized Ratio (INR) is a measure of how quickly the blood clots when the oral anticoagulation is used. It is important to keep INR within the therapeutic range [1], otherwise, the patients may risk bleeding or clotting. The doctors in the Department of Haematology, SGH, have closely monitored their patients’ INR. The percentage of patients with therapeutic ranges of INR was comparable to the data reported by our counterparts from Italy, Spain, Canada, France and the United States [2, 3].

References:
1. Yang, D.T., R.S. Robetorye, and G.M. Rodgers, Home prothrombin time monitoring: a literature analysis. American journal of hematology, 2004. 77(2): p. 177-86.
2. Ansell, J., et al., Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of anticoagulation management (ISAM). Journal of thrombosis and thrombolysis, 2007. 23(2): p. 83-91.
3. Samsa, G.P., et al., Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Archives of internal medicine, 2000. 160(7): p. 967-73.

E4. How Straight Are Our Computer-Assisted Minimally Invasive Total Knee Replacement Surgeries?

 

Total Knee Replacement (TKR) is an effective surgical procedure for relieving knee pain and restoring physical function in patients who suffer from arthritis. Minimally invasive TKR uses smaller incision than the one used in traditional TKR surgery to reduce the damage to the surrounding tissue. Patients who have minimally invasive TKR usually have shorter post-operative hospital stays, smaller scars, and better recovery. Computer-aided minimally TKR is able to measure critical anatomic factors precisely and improves the chance of having ideal mechanical axis of the operated leg (within ± 3 degrees). In SGH, approximately 92% of the patients who underwent this surgery achieved the ideal alignment [1]. This rate compared well with those reported by our counterparts in the United States [2-4] and Germany [5, 6].

Source: Published research report from the Department of Orthopaedic Surgery, SGH

References
1. Dutton, A.Q., et al., Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2008. 90(1): p. 2-9.
2. Bolognesi, M. and A. Hofmann, Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res, 2005. 440: p. 162-9.
3. Anderson, K.C., K.C. Buehler, and D.C. Markel, Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty, 2005. 20(7 Suppl 3): p. 132-8.
4. Kim, S.J., et al., Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty, 2005. 20(7 Suppl 3): p. 123-31.
5. Bathis, H., et al., Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br, 2004. 86(5): p. 682-7.
6. Haaker, R.G., et al., Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res, 2005(433): p. 152-9.

E5. What Is The Chance Of Our Patients Getting A Definitive Diagnosis After A Procedure Such As The Small Bowel Endoscopy?

Small bowel endoscopy is a first-line tool for detecting abnormalities of the small bowel. It can visualize patients’ small intestines clearly and take tissue samples for definitive diagnosis. In SGH, the doctors were able to make a definitive diagnosis in 73% of the patients who underwent the procedure. This rate appeared comparable or even better than the data reported by other centers worldwide. In addition, the rate of complications among our patients was lower and the time taken to perform this procedure was shorter.

* Major complications include bleeding and perforation

Reference
1. Ang, D., W. Luman, and C.J. Ooi, Early experience with double balloon enteroscopy: a leap forward for the gastroenterologist. Singapore Med J, 2007. 48(1): p. 50-60.
2. Mehdizadeh, S., et al., What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc, 2006. 64(5): p. 740-50.
3. Yamamoto, H., et al., Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol, 2004. 2(11): p. 1010-6.
4. Ell, C., et al., Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Endoscopy, 2005. 37(7): p. 613-6.

E6 Do patients’ severity of psycho-social impairment and health improve after 6-months treatment at the Eating Disorders Unit?

A total of 45 patients with newly diagnosed eating disorders (ED) participated in the study held by the Eating Disorder Unit in SGH from 01 Aug 2010 to 31 Mar 2011. All of the patients’ health status was assessed using 2 questionnaires, both at the baseline and after 6 months of treatment. The first questionnaire, the Clinical Impairment Assessment (CIA), is a validated 16-item self-report questionnaire that measures the severity of the psychosocial impairment due to eating disorders [1]. The second is the European Quality of Life-5 Dimensions Visual Analogue Scale (EQ-5D VAS)[2], where the patients indicate the level of their perceived health status on that day. The patients had an average improvement of 12.2 points in their CIA score and an increase of 12.4 points in EQ-5D VAS score after the treatment. All the above indicated that the ED patients have had a significant improvement in the quality of life after the clinical treatment.

*Source: Department of Psychiatry with data validation.

References:
1. Bohn, K., et al., The measurement of impairment due to eating disorder psychopathology. Behav Res Ther, 2008. 46(10): p. 1105-10.
2. EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health PolicyHealth Policy, 1990. 16(3): p. 199-208.

E7. What Is The Patient’s Satisfaction Level After Undergoing Minimally Invasive Surgery For Gynaecomastia?


Gynaecomastia, an abnormal enlargement of male breast tissue, is a common problem of the male breast. Since 2007, SGH has been using power assisted liposuction (PAL) together with microdebrider increasingly for the treatment of gynaecomastia which achieves excellent aesthetic results with minimally invasive techniques[1]. Interview to the patients with standard questionnaire, based on a 10-point scale[2], were conducted to compare patient satisfaction level and impact of the surgery against the established technique (Direct Excision). The patients’ self-assessment opinion revealed a good level of overall satisfaction after PAL with microdebrider (mean score 7.9). Likewise, average self-confidence level showed significant improvement from 3.9 (before surgery) to 8.1 (after surgery)[3].


* Source: Department of Plastic, Reconstructive & Aesthetic Surgery

References:
1. Goh, T., B.K. Tan, and C. Song, Use of the microdebrider for treatment of fibrous gynaecomastia. J Plast Reconstr Aesthet Surg, 2010. 63(3): p. 506-10.
2. Hodgson, E.L., B.H. Fruhstorfer, and C.M. Malata, Ultrasonic liposuction in the treatment of gynecomastia. Plast Reconstr Surg, 2005. 116(2): p. 646-53; discussion 654-5.
3. Grace Tan, T.G., Bien Keem Tan, Review of Treatment of Gynaecomastia, in SingHealth Duke NUS Scientific Congress 3-4 August 2012.

Last Modified Date :09 May 2014