中文由第27页起

A H E A LT H I E R , H A P P I E R L I F E

MY GP ANSWERS Our General Practitioners offer advice on treating dyspepsia and vertigo

AT THE ELEVENTH HOUR The psychology of procrastination and how to overcome it

PREVENTING POLYPHARMACY Keeping the elderly safe with multiple medications

Meet our medical social worker who serves with passion, empathy and heart

LIGHTING UP PEOPLE’S LIVES

SEP−OCT 2016 Changi General H o spi t al Magazine

EDITOR’S NOTE

Supervising EditorLim Ee GuanContributorsAndrea OngJoyce Ong Y.T.Translators Yip Laimei Alan Li Photographer Andy HoDesign & Production Publicitas Content Email: yourcontent@publicitas.comMedia Specialist: Mey Leong Email: mey.leong@publicitas.com Materials: Doreen Lau Email: doreen.lau@publicitas.com

Go Green!This publication is printed on paper produced by an environmentally friendly mill with pulp obtained from sustainable forests.

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is also available online at www.cgh.com.sg/CARING

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MCI (P) 051/01/2016. Company registration number: 198904226R. All rights reserved. Copyright © 2016. No part of this publication can be reproduced in any form or by any means without the permission of the publisher. The views and opinions expressed or implied in are those of the authors or contributors and do not necessarily reflect those of the publisher.

USEFUL NUMBERS

Pharmacy enquiries 1800 787 8787

Feedback 1800 850 2823

Appointments and general enquiries 6850 3333

Feedback 1800 850 2823

The CGH20 logo denotes our commitment to our patients and communities (the hearts), and our unending desire toward integration and collaboration within and without the organisation (the overlapping hearts). These aspects are emphasised through our use of blue (providing quality healthcare), fuchsia (care for our staff), and yellow (our stand on professionalism, innovation and continual improvement).

A Note fr om the Editorial Team How time flies! We are already in the last quarter of 2016. It’s always

been a wonderful privilege every two months to be able to meet different colleagues, patients and caregivers in order to gather and

present their uplifting stories for Caring. Their experiences are really the heart and soul of our magazine and through their sharing, they’ve made us proud to be part of the same mission to deliver the best care, with passion and empathy. Oftentimes, we’ve found their stories far more compelling than that of any celebrity!

This issue, we’d like to introduce you to two such persons, whom we are proud to call colleagues. The first is Medical Social Worker Ms Seng Yuh Jen (cover story, page 8) for her relentless drive to help those in need in CGH’s Geriatric Wards, and what she feel is the importance of constantly challenging yourself to do your best.

The other one is none other than this year’s President’s Award for Nurses recipient, Ms Hanijah Abdul Hamid (page 22), who serves patients with a golden heart. Hanijah is truly an inspiration to all her fellow nurses and colleagues in CGH.

In other sections this issue, you’ll find interesting features on helping elderly patients to prevent polypharmacy (page 2), how to fight procrastination (page 4), types of implants to address hearing loss (page 14) and much more, including our recipe on wholemeal pumpkin muffins (page 24)!

CONTENTSISSUE 144

SEP – OCT 2016

02 EMPOWER YOURSELF: THE MEDICINE LIST

Keeping the elderly safe with multiple medications

04 AT THE ELEVENTH HOUR Understand the psychology

of procrastination

08 LENDING A HELPING HAND Meet Seng Yuh Jen, an

exemplar of a dedicated MSW

14 LISTEN UP Cochlear implant and aural

rehabilitation to address hearing loss

18 CGH & TEMASEK POLYTECHNIC SIGN MOU

A new partnership to support SMEs in clinical trials for complementary health products

20 YOUR GPs CAN TREAT THESE CONDITIONS!

A GPFirst series

22 SERVING WITH HEART Hanijah Abdul Hamid is one

of the recipients of this year’s President’s Award for Nurses

24 HEALTHY EATS Wholemeal pumpkin muffins

25 SUBSCRIBE TO CARING

27 吃出徤康全麦南瓜松饼

28 掌控自己的健康：个人药物清单

确保老年人能够安全服用药物

30 临时抱佛脚 拖延症的心理特点及如何克服它

34 伸出援手 一探医疗社工盛裕祯

如何尽心尽力为病人服务

38 您听得见吗？ 人工耳蜗植入与听力复健能助您

恢复听力

40 您的家庭医生能治疗这些病症！

全新“家庭医生首选”系列

Feedback 1800 850 2823Feedback 1800 850 2823

14 38

08 34

02 28

18

2 S E P – O C T 2 01 6 C A R I N G

Preventing polypharmacy – Keeping the elderly safe with multiple medicines

EMPOWER YOURSELF: THE MEDICINE

LIST

Text by Ow Yong Pu En and Genevieve Ho Kar Yoke

Afew weeks ago, we dispensed a bag of medicines to 72-year-old Mdm Lo* upon her discharge. Her family expressed

concerns about their mother taking too many medicines when they visited during her hospital stay. Mdm Lo sees multiple doctors, and to avoid serving the wrong medicines, family members would collect a new bag of medicines each time she visited the clinic or when she was discharged from hospital. We saw that they faced a high risk of serving duplicate medicines or wrong doses to Mdm Lo because of multiple amendments made to her medicine doses and schedule. It was no surprise that the family was also frustrated at being unable to understand Mdm Lo’s medicine regimen. They shared that the family frequently quarrelled about the hoarding of medicines at home. None of them felt empowered enough to manage her medication needs.

We interviewed Mdm Lo and her family when she was first admitted to the hospital, to get a good sense of what medicines she was taking, how she was taking them and if she experienced any issues after taking them.

This process, called medication reconciliation, involves matching current

THINKING OF CREATING YOUR OWN MEDICINE LIST? IT’S SIMPLE!

You can better manage your medicines by creating and maintaining your own PML, complete with the intended purpose of each medicine and their side effects, dosage schedule and any additional information on the medicines that may be useful. Show this to your doctor and pharmacist at every visit, so that they can review all your medicines holistically to help you avoid hoarding medicines and inappropriate polypharmacy.

FEATUREHEALTH NOTES

medical conditions and problems with the medicines that a patient is taking. In doing so, we hope to help patients get the most out of their medicines.

At discharge, we were able to use the list of her most recent medicines, known as the Patient Medicine List (PML), to educate Mdm Lo and her family about what each medicine was for and what side effects to watch for. We reminded them to update the list each time medicines or doses were changed to keep track of Mdm Lo’s medicines. The family’s relief was palpable.

Realising that they could manage Mdm Lo’s medicines well and that they did not need to keep purchasing new ones constantly was a huge burden lifted off their shoulders. Needless to say, this made our day.

What Mdm Lo and her family are facing is a common situation involving polypharmacy, which is defined as the use of five or more medications, generally in adults aged above 65 years. When someone develops multiple chronic conditions requiring the use of multiple medicines or polypharmacy, it may be difficult to take medicines as prescribed.

Polypharmacy can sometimes be inappropriate. For instance, Mdm Lo was

previously prescribed a tricyclic antidepressant to help her sleep. Common side effects of this medicine in elderly patients are constipation, urine retention, dry mouth and dry eyes. Mdm Lo developed constipation and dry eyes and sought medical advice. She was given a laxative and eye drops by a private doctor who did not have access to her PML during the consultation. Had Mdm Lo produced her PML, the doctor would have seen that her problems were a side effect of the consumption of the antidepressant. This would have reduced the need for Mdm Lo to consume additional medicines unnecessarily.

Inappropriate polypharmacy is associated with poor adherence to medicines and greater risks of medicine-related problems, including overdosing, drug interactions, superimposed side effects of multiple agents, medication duplication and many more. All of these can result in falls, confusion, fractures and poor quality of life. Pharmacists are trained to assist with inappropriate polypharmacy – just ask your friendly pharmacist!

Ow Yong Pu En is a ward pharmacist at Changi General Hospital and Genevieve Ho Kar Yoke is a ward pharmacist at Khoo Teck Puat Hospital. They conduct daily review of patients’ medicines to ensure that they are safe and appropriate.*N

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4 S E P – O C T 2 01 6 C A R I N G

AT THE ELEVENTH

The psychology of procrastination and how to overcome it

Text by Ms Janet Chang

HOUR

I t’s 8am. I tell myself that I will spend the next four hours working on this article about procrastination. Ten minutes later,

I pick up my mobile phone and scroll through random websites. I catch myself there and try to start writing again. Fifteen minutes passed and I realised I have been staring blankly at the screen. I turn to a colleague and say, ironically, “I’m procrastinating about writing this article on procrastination.”

Research tells me that I’m not alone in feeling this way. Studies conducted overseas have found that around 20 per cent of adults are chronic procrastinators. This number was found to be higher among students. In a study of Singaporean undergraduates conducted in 2010, 59 per cent of students reported spending three hours or more a day procrastinating, and 44 per cent reported that procrastination had a negative influence on them.

Before you start panicking and labelling yourself as a procrastinator, it is important to know that there is a difference between

general procrastination (which we all do at certain times), and more problematic procrastination, which happens habitually and results in negative consequences. As Dr Joseph Ferrari, a writer and researcher on procrastination, puts it: “Everyone procrastinates, but not everyone is a procrastinator.”

WHAT IS PROCRASTINATION? Procrastination refers to the intentional act of delaying a task or goal in favour of doing something less important or more pleasurable with no valid reason, despite the negative consequences of doing so. As much as we would like to deny it, it is a deliberate decision that we make, although it sometimes happens habitually and almost automatically.

Procrastinators actively look for distractions, especially ones that don’t require a lot of commitment. In the Singapore study cited above, the most common distractor

MENTAL WELLNESS

Studies conducted overseas have found that around 20 per cent of adults are chronic procrastinators

activities that students engaged in were napping, eating or drinking something, watching television, and surfing the Internet.

Procrastinators often lie to themselves, convincing themselves that they still have a lot of time left to finish the task, and that they will feel more motivated the next day or that they work better under time pressure. They tend to underestimate the time it will take to complete a task and believe they can only work when they are in the mood to do so.

THE COSTS OF PROCRASTINATION Although delaying work to engage in more pleasurable activities can lower stress levels in the short term, it can increase your levels of guilt, shame, and stress in the long term. The result is often self-criticism and compromised work quality.

Procrastination can also affect your health, weakening immune systems, even causing insomnia and gastrointestinal problems. In addition, procrastinators tend to put off seeking medical treatments and tests.

When delaying work results in others having to take on the burden of our responsibilities, it can also lead to a strain in relationships.

Ms Janet Chang is a Clinical Psychologist at the Health Wellness Programme, Eastern Health Alliance

6 S E P – O C T 2 01 6 C A R I N G

WHY DO PEOPLE PROCRASTINATE?Contrary to common belief, procrastination is not about being lazy or having poor time management. Instead, it can be seen as a form of avoidance and an important sign that something is missing that might be preventing you from getting the work done. What then are we avoiding and why do we avoid it?

Understanding why we procrastinate can give us valuable information about ourselves and help us get “unstuck”. Try this: the next time you find yourself delaying a task, use the list above to identify your reasons for doing so. Ask yourself, “Do I need to plan this out in more detail?” or “Is this task important to me?” In addition, the following tips could be helpful:

1Create to-do lists, deadlines, and priorities. Include deadlines in your to-do

list, and set personal deadlines for tasks that do not have deadlines. Rate the importance of each task when you decide which one to start on first. Strike them off the list as you complete them.

2 Break down tasks. When a task is complex or unpleasant, breaking it down into smaller,

intermediate steps can make it seem easier and more manageable. Set yourself mini-deadlines for these intermediate steps. For example, for a task such as “find a job”, breaking it into smaller steps might look like this:• Consider my interests, skills

set, what I want in my job• Research for potential

jobs online and/or in newspapers

• Prepare a resume • Ask a friend/mentor for advice

to improve my resume• Send my resume

to employers

3Set specific goals and tasks. Specify the what, when, and how, and set a time frame.

For example, rather than saying, “Today I will search for a job,” say “This morning, I will spend 30 minutes looking through the newspaper for potential jobs.”

4Just five minutes. Tell yourself that you will work

for just five minutes, and then another five minutes and

so on. Slowly increase this to longer periods of time. People often find that it gets easier once

they have started, even if it was just for a bit.

CONFUSIONYou lack the skills,

information or resources to manage the task. It might

be a huge task or a new one, and you have no clear plan on where

or how to start.

UNPLEASANT TASK

We dislike a task, perhaps because it is boring or

uninteresting and, hence, we prefer not to do it.

HOW TO STOP PROCRASTINATING

IRRELEVANT

TASKThe task has been delegated to you but you personally find

it irrelevant or unimportant to your life goals.

5 Reduce distractions. Select a conducive time and place. Adjust your environment to

reduce possible distractions, e.g. put your phone away, study at a place without wireless Internet.

6Set time limits for your breaks. It

is important to take breaks but ensure you set a time limit, e.g. after working on a task for one hour, take a 10-minute break, then come back to it for another hour.

7Delay procrastination. Delay the urge to

engage in a distracting activity by telling yourself “later” or “another five minutes”. Once that urge passes, you might be surprised that

you end up managing to delay it for 30 minutes instead.

8Encourage rather than criticise. Learn

to forgive and encourage yourself, rather than beat yourself up.

9 Acknowledge fear, uncertainty and negative emotions. These feelings

are unavoidable but you can still carry out your tasks despite having those feelings.

10Reward yourself even for completing small tasks. For example, if you

procrastinate by going on social media, tell yourself instead that you will do so only when you accomplish a task. This can increase your motivation to work and reduce your guilt.

LOW SELF-CONFIDENCE AND FEAR OF FAILURE

People tend to avoid tasks when they doubt their ability to accomplish it or to perform. This protects their self-esteem as they can attribute

the failure to not putting in their best effort.

FATIGUESometimes,

procrastination might be a sign that you

need a break.

MENTAL WELLNESS

HOW TO STOP PROCRASTINATING

NO CLEAR GOALS AND DEADLINES

When there are no clear goals and hence no direction or no time

pressure, we are more likely to say we will do it “tomorrow”,

or “next week”, or “next month”.

ANXIETY AND UNCERTAINTY

We are unsure of what to expect or fear the outcome would not be favourable,

so we put off the task to avoid it.

8 S E P – O C T 2 01 6 C A R I N G 8 S E P – O C T 2 01 6 C A R I N G

Changi General Hospital Senior Medical Social Worker Seng Yuh Jen

COVER STORY

In 2001,You Light Up My Life – a heartwarming Channel 8 drama about social workers who guided and helped people in need – inspired Seng Yuh Jen to enter her current profession

as a Medical Social Worker (MSW). Now one of CGH’s MSWs, she enjoys

lending a helping hand to patients in need. “When the doctors see there’s a need for social work intervention for a particular patient, they alert us. An MSW will go to the ward to assess the patient and work with him or her, the family and the multidisciplinary team to determine the services that are appropriate to meet their needs,” she explains. “For example, if they suffer from dementia, we work out how to provide support to the patients and their families in caregiving and adjusting to the day-to-day living at home.”

COVER STORY

Medical social workers play an important role in ensuring patients have access to the right

resources to gain a full recovery

Text by Joyce Ong Y.T.

L E N D I N G A H E L P I N G

FUN FACT In You Light Up My Life, the

main female character won the Outstanding Social Worker Award and was presented with a trophy

– the exact same trophy and award that Dr Goh

received in 2001!

HAND

1 0 S E P – O C T 2 01 6 C A R I N G

In the first few years however, Yuh Jen found that the actual work was quite different from what was portrayed on the TV show. “The initial learning curve was very steep because I had completed my studies in social work in Malaysia so I wasn’t very familiar with the social policies and system in Singapore,” she recalls, noting that it took her over a year to settle in.

The most difficult part was not having enough experience to deal with patients’ complex psychosocial issues, and it was a big help for Yuh Jen that her colleagues and superiors such as Dr Goh Soon Noi, Head of the Medical Social Services (MSS) Department, were always ready to offer guidance. For the first six months after joining MSS, Yuh Jen was assigned a senior MSW as her supervisor who mentored her and had case discussions on every patient that she was assigned to. The department’s education arm runs a fortnightly group sharing session for every new MSW and a weekly journal club involving all the MSWs, and these also facilitate continuous learning.

ALL IN A DAY’S WORK Six and a half years later, Yuh Jen is now a senior MSW who confidently manages a caseload of about 40 per month, and has younger colleagues consulting her for advice, particularly when relating to her specialty in geriatric social work. She is currently leading a team of four MSWs to cover the Geriatric Wards. That’s not to say that being an MSW is easier now because she’s more experienced. While Yuh Jen does her best to put aside work once she clocks off as “it’s important so you can fully recharge and continue with the battle the next day”, she admits that she continues to find some cases, such as those involving hoarding and abuse or neglect, particularly challenging for her personally.

Each day of work offers a different set of challenges for an MSW. Even as they close some cases, new patients are referred to them

Each day of work offers a different set of challenges for an MSW

for assessment and, occasionally, home visits need to be coordinated and conducted. Once a week, Yuh Jen also attends multidisciplinary meetings in the morning, which involve

doctors, nurses and allied health professionals, to assist in care

planning for patients she’s in charge of.

She remembers managing the case of an elderly man who lived alone and was sent to A&E after a fall. His blurred vision was worsening and he had

developed an intense fear of falling. He could

not continue living alone, but it was difficult to admit

him to a nursing home since he only needed minimal assistance.

“We tried many things to help him like getting a visually impaired society to teach him to use walking aids, but because of his personality and anxiety, he was not able to learn. It took many months until we finally managed to get approval for him to go to a nursing home,” she says.

PAVING THE FUTURE Keen to nurture Yuh Jen to take on more leadership roles, CGH awarded her a scholarship to study a Master of Gerontology at UniSIM, which she completed earlier this year. Juggling part-time coursework with her job was not easy, but she reveals that being in class actually helped her de-stress: “I felt more energised because I was able to meet and talk to people from different professional backgrounds – some of them were policymakers or directors of programmes or services – and know their different perspectives about their work and the clients they serve.”

DID YOU KNOW?

The Medical Social Services Department has dedicated teams of MSWs serving outpatients and A&E patients, as well as providing support to patients from

various disciplines in wards.

COVER STORY

Yuh Jen with four MSW colleagues who

are in charge of the Geriatric Wards

C A R I N G J U L– A U G 2 0 1 5 1 1

1 2 S E P – O C T 2 01 6 C A R I N G 1 2 S E P – O C T 2 01 6 C A R I N G 1 2 S E P – O C T 2 01 6 C A R I N G

COVER STORY

It was this aspect of the course – being able to exchange ideas with policymakers and decision-makers and develop a more multi-layered perspective – that Dr Goh hoped Yuh Jen would most benefit from.

Dr Goh herself sits on various committees and boards, and believes that MSWs can add great value to the development of Singapore’s social and healthcare community by offering on-the-ground perspective in the decision-making process on, for example, where and how some resources should be channelled.

To be able to do so, however, Dr Goh notes that it requires MSWs to not simply be able to do their jobs well, but also be able to engage in more practice-based research. This June, she played a key role in driving the 8th International Conference on Social Work, which was held in Singapore.

The conference had over 850 participants; 35 per cent came from 30 other countries, with Australia, USA, Hong Kong and Israel forming the larger contingents. A total of 150 or 40 per cent of all papers presented were from Singapore – three times the targeted number she set for social workers in the country in 2010. “It gave us a sense of pride when we received feedback that the standard of social work here is comparable to the global stage,” says Dr Goh, adding that the conference is a way to increase the capability of social workers in Singapore to reflect on, study, and look at patterns and trends to improve on

social work practices in the country. With more than 35 years of experience

in social work under her belt, Dr Goh is also keen to dispel the notion of MSWs as almoners, who mainly helped people deal with financial problems and basic needs in Singapore’s early years. They were renamed MSWs in the early 1960s as the medical and social landscapes in the country changed and a more multidisciplinary approach was needed.

“While our role still includes assessing clients’ financial situation, we don’t just disburse monies or do the gatekeeping role now. Apart from helping patients identify and access the different financial and social support schemes, our work also empowers and strengthens the family support network,” explains Dr Goh.

She stresses that an MSW helps patients and their families solve issues related to wellbeing, and not simply to discharge them from the hospital. “We used to advocate for more services in the community to support families in the care of their loved ones, and we see an expansion of these services in recent years. The challenge for MSWs is to engage families and providers, and help weave a shared integrated care involving the patients, families, community and the government, to help the elderly, in particular, to ‘age in the right place’.”

Our senior MSWs are leaders of their respective teams

Dr Goh Soon Noi (front row, 4th from left) posing with the International Health Social Work Steering Committee at the 8th International Conference on Social Work in Singapore

1 4 S E P – O C T 2 01 6 C A R I N G

A quick look at how cochlear implant and aural rehabilitation can address hearing loss

LISTEN

UPText by Cochlear Implant Team, CGH

Prolonged exposure to loud noise/industrial deafness

34%

Infection or injury

17%

WHAT IS HEARING LOSS? Hearing loss is the reduced ability of both ears to detect sounds and of the brain to interpret those sounds. It can be experienced as an acute onset or a gradual decline in one or both ears. Damage in isolated or combined anatomy of the ear (see next page) – outer ear, middle ear or inner ear – can result in hearing impairment. TYPES OF HEARING LOSS Hearing loss can be classified as: Conductive: Abnormality in the middle ear

preventing efficient transmission of sounds into the inner ear or cochlea.

Sensorineural: Malformation or irreversible

4%Hereditary

damage to the sensory cells in the cochlea and connecting nerves

Mixed: Conductive and sensorineural hearing loss

Neural: Missing, malformation or diseases of the hearing nerve

28%Ageing

Damage in isolated or combined anatomy of the ear can result in hearing impairment

FEATURE

THE RISK FACTORS FOR HEARING LOSS:

COCHLEAR IMPLANT & THE ANATOMY OF THE EAR

1 6 S E P – O C T 2 01 6 C A R I N G

COCHLEAR IMPLANT For people with severe to profound hearing loss, hearing aids are sometimes not sufficient to improve their quality of hearing. The ear surgeon or otolaryngologist may explore cochlear implant or bionic ear as an alternative.

HOW DOES IT WORK Cochlear implant has two components: the external sound processor (pictured above) and the internal implant (see illustration).

The internal implant consists of an electrode array, which is surgically inserted into the cochlea. Severe to profound hearing loss is predominantly caused by the irreversible damage of the sensory cells in the cochlea.

The external sound processor picks up sounds with its microphone and controls the electrical stimulation of the hearing nerve with its inbuilt computer. It is connected to the internal implant through the scalp via magnetic

attraction and the two devices communicate via wireless signals. The signals are converted to digital information and picked up by the coils on the electrode array, which bypasses the damaged sensory cells to directly stimulate the hearing nerve, thus restoring the hearing sensation. COCHLEAR IMPLANT SURGERY The surgery is performed under general anaesthesia by the otolaryngologist. A skin flap behind the ear is raised for the insertion of the electrode array into the inner ear; the body of the internal implant is placed into a pocket beneath the skin flap to minimise shifting.

The surgical site is typically done behind the hair line and it is well hidden when the hair grows out. The candidate will be able to feel the receiver as a bump behind the ear and it is not immediately obvious to the untrained eye.

EARDRUM (Tympanic

membrane)

AUDITORY BONES

RECEIVER/STIMULATOR

EUSTACHIAN TUBE

EAR CANAL

SEMICIRCULAR CANALS

COCHLEA

TRANSMITTER

SPEECH PROCESSOR & MICROPHONE

identifying and diagnosing a hearing loss, providing different types of therapies to clients who are facing difficulties in hearing, and looking for compensatory ways to aid the client’s hearing abilities.

For those who have undergone a cochlear implant, rehabilitation includes auditory training, speech therapy, telephone training, training on communication repair strategies and music appreciation training.

Aural rehabilitation is conducted by speech therapists in either one-on-one sessions for more individualised training or in group settings for interaction and generalisation of techniques. Family and friends have a strong role to play in supporting the patient’s progress through this journey of relearning. As communication partners, they can conduct listening tasks and provide feedback on speech errors beyond clinical settings.

FEATURE

ELECTRODE ARRAY

The implant is ready to be ‘switched on’ by the audiologist three to four weeks after the surgery. The audiologist would place the sound processor on the ear to ensure that there is communication between the implant and the sound processor. Tests would be carried out to ensure that the implant is working.

The audiologist will further fine-tune the electrical stimulation of the hearing nerves through “mapping”. It is a gradual process to optimise sounds that the patient hears, and it can take up to a few years to achieve the desired result.

There is no age restriction for this surgery. Complications post-surgery are rare and the recovery is expected within a week. AURAL REHABILITATION & THERAPY SESSIONS Aural rehabilitation is the process of

OUTER EAR

MIDDLE EAR

INNER EAR

1 8 S E P – O C T 2 01 6 C A R I N G

This new partnership will support SMEs in clinical trials for complementary health products

CGH & TEMASEK POLYTECHNIC sign a Memorandum of Understanding

Text by Editorial Team

Increasing demand in recent years for complementary health products (CHPs) has prompted more players in the industry

to look to modernising and establishing high standards for the formulation, testing and sale of their products. In particular, there is increasing pressure on companies to make credible claims backed by rigorous scientific evidence.

These companies can now turn to Temasek Polytechnic’s new Centre of Innovation for Complementary Health Products for consultancy services, research and development expertise, and training. The centre is a one-stop service and resource centre for research and development, product testing and validation, product formulation, and shared facilities.

Changi General Hospital (CGH) is now one of the centre’s key strategic partners. On 16 June, the hospital’s Clinical Trials & Research Unit (CTRU) signed a Memorandum of Understanding (MOU) with Temasek Polytechnic to establish

common areas of focus to test the safety and efficacy of product groups from the fields of traditional medicine, health supplements and functional foods.

The partnership came about after key industry players highlighted their need for support in conducting clinical trials for CHPs. Such support is important because around 95 per cent of CHP-related enterprises in Singapore are small and medium-sized enterprises that face challenges in marshalling resources and information to stay globally competitive. Having access to clinical trial infrastructure and support would allow companies to make claims substantiated by solid research about the effectiveness and benefits of specific active ingredients in their products. This would help them establish a track record of excellence in safety and efficacy, giving them a leg-up in an increasingly competitive global market.

The importance of evidence-based research and quality control for CHPs was also emphasised by Senior Minister of

FROM LEFT TO RIGHT: Mr Ted Tan, Deputy Chief Executive, SPRING Singapore; Ms Amy Khor, Senior Minister of State, Ministry of Health; Mr Boo Kheng Hua, Former Principal & CEO, Temasek Polytechnic; and Dr Lee Chee Wee, Director, School of Applied Science, Temasek Polytechnic

CGH & TEMASEK POLYTECHNIC sign a Memorandum of Understanding

FEATUREWHAT'S NEW

community. We are confident that our partnership with the new Centre of Innovation for Complementary Health Products will yield fruitful results in driving innovation and promoting high clinical standards in the exciting and growing field of CHPs,” said Prof Teo Eng Kiong, Chairman Medical Board, CGH.

Having access to clinical trial infrastructure and support would allow companies to make claims substantiated by solid research

State for Health Amy Khor at the launch of the Centre of Innovation. “With a better educated and more discerning public as well as increase in health consciousness, many are using CHP for health maintenance and disease prevention. As with any medical product or treatment, there can be risks with CHPs. It is therefore critical that the use of CHPs be supported by scientific research or evidence, particularly from the perspectives of safety and effectiveness,” she said, citing the steady growth in the CHP industry in Singapore and the Asia-Pacific region that is projected to continue over the next few years.

“CGH has one of Singapore’s leading clinical trials and research units, and we believe in promoting industry-driven clinical research that is of real benefit to the wider

FRONT ROW, LEFT TO RIGHT: Dr Tiah Ling, Senior Consultant, A&E Department, Changi General Hospital; Dr Lee Chee Wee, Director, School of Applied Science, Temasek Polytechnic; Mr Liew Siao Foo, Deputy President, Singapore Chinese Physician Association; and Mr George Goh, Director, Techkon Properties Pte Ltd BACK ROW (VISIBLE), LEFT TO RIGHT: Prof Teo Eng Kiong, Chairman Medical Board, Changi General Hospital; Mr Ted Tan, Deputy Chief Executive, SPRING Singapore; and Mr Boo Kheng Hua, Former Principal & CEO, Temasek Polytechnic

2 0 S E P – O C T 2 01 6 C A R I N G

In January 2014, Eastern Health Alliance (EHA) launched the GPFirst programme to encourage patients in eastern Singapore to

see their general practitioners (GPs) for mild to moderate medical conditions rather than head to the emergency department first. In this regular series, our EHA community GPs offer advice on common ailments Caring readers might face.

Visit www.gpfirst.sg or see your GP for more information on common conditions such as cuts, bruises, mild scalds, nausea, nosebleeds, headaches, sprains and fevers. Read on to learn more about abdominal pain and bloating and vertigo.

YOUR GPs CAN TREAT THESE CONDITIONS

ABDOMINAL PAIN AND BLOATINGQuestion: My 22-year-old daughter works and studies at the same time. She often has irregular meals, and rushes to her night classes after work without having dinner. She has been having intermittent upper abdominal pain and bloating, especially in between meals. Recently, I was awakened by sounds of her groaning in pain and tossing in bed. The pain kept her up until morning. Should I take her to the A&E?

Answer: Your daughter could be suffering from functional dyspepsia, or what is commonly and loosely called “gastritis”. It is best for her to be reviewed by a General Practitioner (GP) first, as functional dyspepsia is a diagnosis of exclusion, and other serious abdominal conditions

need to be ruled out. Patients with dyspepsia will have one or

more of the following symptoms: feeling full or bloated after eating, inability to finish a normal-sized meal or feeling full with only a small amount of food, and epigastric (upper central abdomen) pain or burning sensation.

Dyspepsia may be associated with risk factors, such as irregular meals, dietary indiscretion, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), stress and Helicobacter pylori (H.pylori) bacteria infection in the stomach. Reducing these risk factors would reduce the incidence of gastritis.

A GP can review your daughter’s symptoms and perform a targeted physical examination to assess if she has a serious condition that requires a visit to the A&E

for urgent evaluation. The GP can also advise on whether your daughter would

require further non-urgent evaluation, which can be performed at a

later date. Some symptoms may

suggest a more serious condition. These include

persistent vomiting (especially if there is blood in the vomit), evidence of gastrointestinal bleeding (black

stools), difficulty in swallowing, unintended weight loss over a short

period of time, and a family history of cancer.

Once the GP has assessed that there is no emergency at the moment, he or she may prescribe medications, such as antacids and anti-secretory therapy, to reduce gastric acidity. The GP may also check for H.pylori infection through a urea breath test or stool antigen test

Dr Derek LeongisapartneroftheHealthmarkGroupandaResidentFamilyPhysicianatHealthmarkFamilyClinic(Waterway).HereceivedhisMBBSandDiplomainFamilyMedicine(GDFM)fromtheNationalUniversityofSingapore.Headvocatesthathealthylivingisthebestformofpreventivemedicine.

VERTIGO Question: I am a 30-year-old stay-at-home mum. Two weeks ago, I fell ill with flu. I recovered over the next couple of days but started experiencing a slight earache. Two mornings ago, I woke up feeling very dizzy, as if the entire room was spinning. I had to lie down to rest before I could get out of bed. The symptoms gradually eased but returned this morning, making it difficult for me to make my way home from the market. I was so nauseated by the time I arrived home that I vomited. There is also a ringing sound in my ear that comes and goes. I am worried that my condition may be serious, and wonder if the situation will deteriorate if I delay treatment. Can my regular family GP treat my condition or would it be safer to head to the A&E?

Answer: The whirling and spinning that you describe is called vertigo in medical terms. Patients suffering from vertigo usually complain that they or their surroundings are spinning. This is usually followed by nausea and vomiting. Occasionally, the patient might complain of ringing in the ears, which is medically known as tinnitus.

Based on your complaints of vertigo, tinnitus and a preceding bout of flu, you are most likely suffering from a condition called labyrinthitis. This occurs when a flu infection causes swelling or inflammation in the inner ear, which has nerves that are vital in maintaining balance. Irritation of these nerves from inflammation will result in vertigo, tinnitus, nausea and vomiting.

Other common causes of vertigo include:i. Benign Paroxysmal Positional Vertigo

(BPPV) – This occurs when calcium particles (canalith), which occur naturally in the inner ear, accumulate in the ear canal.

ii. Meniere’s disease – This is an inner ear disorder caused by fluid accumulation and a resultant change in pressure in the inner ear. Patients usually complain of tinnitus and vertigo symptoms.

Other causes of vertigo include migraine headaches, side effects of medication (antibiotics) and neurological conditions such as stroke. Your GP can review your symptoms and perform the necessary physical examinations to rule out dangerous causes of vertigo such as stroke, which require urgent evaluation.

Labyrinthitis may be due to viral or bacterial causes, and viral labyrinthitis is the more common form of labyrinthitis. Once your GP assesses that your condition is likely due to viral labyrinthitis, he or she will prescribe medications in the form of tablets or injections to relieve your symptoms.

Patients with associated sudden hearing loss may be prescribed a short course of steroids after the GP has assessed their pattern of hearing loss. However, if your GP assesses that your case of labyrinthitis is due to bacterial causes, he or she may prescribe you topical antibiotics.

If your vertigo symptoms are accompanied by difficulties in speaking and swallowing, visual disturbances – such as double vision, droopy face, weakness and numbness of limbs – and neck pain or a recent neck injury, this might indicate a neurological condition and you should head to the A&E immediately or call an ambulance by dialing 995.

Vertigo can be associated with chronic conditions, such as diabetes and high cholesterol. As such, a healthy balanced diet and regular cardiovascular exercise is essential.

Health supplements, such as ginkgo biloba, fish oil and vinpocetine (an extract from the periwinkle plant), are recommended in literature but have not proved to be beneficial in clinical trials.

Dr Kok Ta Wei, Kevin

Dr Kevin Kok is a resident GP at OneCare Clinic Tampines. He obtained his MBBS from National university of Singapore and is a Member of the Royal College of Surgeons (Edinburgh). His special interest in musculoskeletal pain stems from his previous training in orthopaedic surgery. He has presented his research at various local, regional and international conferences.

– both of which can be done at the clinic – or refer your daughter to a specialist for an endoscopy to check for gastric erosions, ulcers or other problems.

Dr Derek Leong

FEATUREMY GP ANSWERS

Text by Shukry Rashid and Fawwaz Baktee / Photos by CGH and NTUC This Week

Meet Hanijah Abdul Hamid, CGH’s Assistant Director for Nursing and a recipient of this year’s President’s Award for Nurses

2 2 S E P – O C T 2 01 6 C A R I N G

The girl was in the midst of preparing for her ‘O’ levels when her mother fell ill. Her father took her mother to the

hospital, and the girl tagged along. It was there that the girl saw a nurse

attend to her mother. She observed from a distance and saw that the nurse treated her mother professionally, yet still managed to show sincere care and concern.

The girl’s father then turned to her and said: “Look at that nurse. She’s showing care for your mother in a way you’ve yet to display. It’s my wish that you take up a calling and turn it into your career.”

SERVING WITH HEART

FEATURECGH CELEBRATES

“Both are a calling and I am blessed to be able to perform my current roles,” she said.

“As nurses, we provide competent care for patients, while as educators, we play a pivotal role in strengthening our nursing workforce by sharing our clinical experience. As nurse educators, we have the best of both worlds,” she said.

Ms Hanijah played an instrumental role in implementing the Health Ministry’s Clinical Practice Guidelines in CGH. She also developed evidence-based in-house training programmes for CGH nurses.

For her passion and good work, Ms Hanijah was recently presented the President’s Award for Nurses.

“The award belongs to each and every one in CGH who made receiving the award possible. On a personal note, my husband was my pillar of support. Without him, I would not have been able to continue my journey or receive the award,” she said.

For those who are interested to join nursing, Ms Hanijah quoted billionaire insurance executive Art Williams: “I am not telling you that it is going to be easy, I’m telling you it is going to be worth it.”

This article first appeared in NTUC This Week, 18 September 2016 issue. Reprinted with permission.

As nurses, we provide competent care for patients while as educators, we play a pivotal role in strengthening our nursing workforce by sharing our clinical experience

What her father said that day struck a chord in her and the girl decided that her calling was in nursing as well.

A NURSE & AN EDUCATOR That teenage girl was Hanijah Abdul Hamid. After 25 years in the profession, she is now an Assistant Director for Nursing at Changi General Hospital (CGH).

“Those wise words from my father prompted me to identify my own values, and think about how to give to my nation rather than receive. Thus was my entry into nursing,” said Ms Hanijah, 45.

After a few years as a nurse, she ventured into nursing education in 1998. But Ms Hanijah does not differentiate between her roles as a nurse and an educator.

FAR LEFT: Hanijah Abdul Hamid receiving the

award from Singapore President Tony Tan

TOP RIGHT: CGH nursing

team congratulating Ms Hanijah

24 S E P – O C T 2 01 6 C A R I N G

HEALTHY EATS

A great source of Vitamin A, pumpkin adds natural sweetness to these muffins

PREPARATION TIME1 hour

SERVES12 muffins

WHAT YOU’LL NEED Cake flour 80g (2 ¾ oz) Baking powder (½ tsp) Baking soda (¼ tsp) Wholemeal (whole wheat) flour 100g (3 ½ oz)

Pumpkin 1, about 180g (6 ½ oz, halved, with flesh scooped out)

Low-fat margarine 55g (2 oz, softened at room temperature)

Maltitol 50g (1 ¾ oz) Eggs (2, medium) Low-fat evaporated milk 50ml (1 fl oz) Pumpkin seeds 30g (1 oz, shelled)

METHOD Preheat oven to 180 °C (350°F). Line a 12-hole muffin tin with paper cases and set aside.

Sift cake flour, baking powder and baking soda into a mixing bowl. Add wholemeal flour, mix well and set aside.

Divide pumpkin flesh into 2 equal portions. Using a blender, process 1 portion of pump-kin until smooth. Using a grater, finely shred remaining portion of pumpkin into thin strips. Set both aside.

In a mixer, beat margarine and maltitol on medium speed until creamy. Crack eggs in and mix well, then fold in half of flour mixture until just incorporated. Add evaporated milk and stir to mix, then fold in remaining flour mixture. Add blended and grated pumpkin,

pumpkin seeds and mix well.

Spoon batter into prepared muffin tin, filling cups three-quarters full. Bake for about 20 minutes until tops are golden brown and an inserted toothpick comes out clean.

Remove from heat and set aside to cool. Serve warm. Muffins can be refrigerated up to 3 days.

NUTRITIONAL INFO (PER SERVING)Calories 124kcalCarbohydrate 12.5gFat 5.1gCholesterol 35.4mgFibre 1.8g

This recipe was first published in A Cookbook for Diabetics by a Dietitian and a Chef, which is now available at all major bookstores

WHOLEMEAL PUMPKIN MUFFINS

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Postal Code 邮区 Tel (Home) 电话(住家) Mobile No. 手机号码

Email 电邮 Date of Birth 出生日期 (DD/MM/YY)

Nationality 国籍 Occupation 职业

Are you currently a patient of CGH? 您目前是不是樟宜综合医院的病人？ Your particulars will be used strictly for mailing and/or notification of CGH’s upcoming events and public forums. They will be kept confidential. 您的资料只供邮寄之用及/或通知您樟宜综合医院所主办的活动和讲座。您的资料将获得保密。

I want to be mailed to me! 我希望通过邮寄方式收到《关怀》！

I want to update my particulars! (for existing subscribers) 我希望更新我的个人资料！(仅限现有订阅者)

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EDITOR, CARING MAGAZINE CHANGI GENERAL HOSPITAL PTE LTD

CORPORATE AFFAIRS 2 SIMEI STREET 3 # LEVEL 2CHANGI GENERAL HOSPITAL

SINGAPORE 529889

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准备时间1小时

供做12个松饼

所需材料 低筋面粉 80克（2 ¾ 盎司） 发粉 ½茶匙 苏打粉 ¼ 茶匙 全麦面粉 100克（3 ½盎司） 南瓜 1个，约180克（6 ½ 盎司）， 切半后把果肉挖出来

低脂黄油 55克（2盎司），室温 麦芽糖醇 50克（1¾ 盎司） 鸡蛋 2个 中号 低脂炼乳 50毫升（1 液体盎司） 南瓜籽 30克（1盎司），去壳

做法 把烤箱温度设在180摄氏度（350华氏度）。在一个12孔的松饼模子里放入松饼杯，备用。

把低筋面粉、发粉和苏打粉一起筛一下。加入全麦面粉，搅拌均匀，备用。

把南瓜肉分成2份。把一份的南瓜肉用搅拌器搅拌至顺滑。把另外那份南瓜肉用擦菜板擦成薄丝。两者完成后备用。

该食谱首次出版于 《A Cookbook for Diabetics by a Dietitian and a Chef》现已在各大书局销售。

吃出健康

南瓜含有丰富的维他命A，并且给松饼增添天然的甜味。

全麦南瓜松饼

用搅拌器以中等强度把黄油和麦芽糖搅拌 至奶油状。加入鸡蛋，搅拌均匀，加入一 半的已筛面粉拌入至被吸收即可。加入炼乳，搅拌均匀。最后加入剩下的面粉， 拌入面团里。

把搅拌好的面团盛入松饼模，每个纸杯的份量不要超过 ¾ 。放入烤箱烘烤约20分钟，直到表面成金黄色和插入的牙签拔出来时是干净的。

从烤箱取出，放至冷却。以稍微温温的热 度上桌最为极佳。松饼可在冰箱内保存最 长3天。

营养信息(每份)热量 124卡路里碳水化合物 12.5公克脂肪 5.1公克胆固醇 35.4毫克纤维 1.8公克

2 8 S E P – O C T 2 01 6 C A R I N G

预防多重用药－确保老年人 能够安全服用药物

个人的药物清单

原文：欧阳溥恩与何嘉钰

掌控自己的健康：几个星期前，我们在72岁的罗女士出院时给她准备了所需的药物。她的家人在她住院期间来探访时便对他们的母

亲服用数种药物而感到担忧。罗女士得看好几个不同的医生，因此为了避免她用错药，她的家人会在她每次复诊或出院时为她领一袋新的药物。由于罗女士服用药物的剂量和规律更变过无数次，我们察觉到她的家人有可能会重复给她服用同一种药物或给予错误的剂量。我们也不难想像为何罗女士的家人会因为无法掌握好罗女士的用药规律而感到烦恼。他们透露，家庭成员间经常因为家里堆满了药物而起争执。他们对于无法管理好罗女士的药物需求感到束手无策。

我们在罗女士刚住院时访问过她和她的家属，以便了解她正在服用什么药物、如何服用，以及服用后是否有任何副作用。我们也把她目前所患的病症和医疗问题与她正在服用的药物配对好，以便让她从药物中获得最好的效果。

在她出院时，我们为罗女士准备了她近期服

FEATURE

用的药物清单（也称为病人药物清单，Patient Medicine List），以便教导她和她的家人有关每一个药物的作用及副作用。我们提醒他们在每次罗女士更换药物或剂量时，要记得更新清单，以便能够有效地跟进罗女士所服用的药物。他们全家瞬间都松了一口气。如今，能够有效地管理好罗女士的药物，并且无需经常购买新的药物，让他们都觉得如释重负。不言而喻，我们也感到非常欣慰。

罗女士和她的家人所面对的是多重用药（polypharmacy）所带来的常见问题。多重用药指的是病人服用5种或以上药物的情况，这在65岁以上的年长者身上较为常见。当一个人患有多种慢性疾病因而需要服用多种药物或多重用药时，要正确服用所有的药物会变得相当困难。

多重用药有时候会导致不恰当的药物管理。举例说，罗女士之前得服用一种三环抗抑郁药（tricyclic antidepressants）来帮助她睡觉。这种药物在老年病人中的常见副作用包括便秘、

尿潴留、口干舌燥及眼睛干燥。罗女士有便秘和眼睛干燥的问题，因此去求医。由于她的家庭医生在会诊时无法查看她的药物清单，因此给她开了通便剂和滴眼剂。若罗女士能够在和医生会诊时呈上她的药物清单，那医生便能够看出她的问题其实是服食抑郁药所导致的副作用。这从而可以免去罗女士服食更多没必要的药物。

不适当的多重用药及无规律地使用药物可提高与服药相关问题的风险，其中包括剂量过多、药物之间产生相互作用、多种药剂所引发的重叠性副作用、服用重复药物等。以上所述甚至可以导致跌倒、意识混乱、骨折及影响生活素质。药剂师能够协助您更有效地管理您的药物，避免不适当多重用药的问题。所以现在就向您友善的药剂师咨询吧！

欧阳溥恩与何嘉钰分别在樟宜综合医院与邱德拨医院担任病房药剂师。她们每天会评估病人的病情，以确保所服用的药物是安全及适当的。

想要建立您自己的药物清单吗？方法非常简单！

您可以通过建立和管理自己的药物清单来帮助您取得用药平衡，清单里记录了每个药物的作用和副作用、剂量和服用时段，以及其他相关的信息。在您每次去看医生或买药时，把清单呈上给医生和药剂师，他们便能够全面地评估您的药物需求，而从中避免囤积药物与不适当多重用药的困扰。

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3 0 S E P – O C T 2 01 6 C A R I N G

拖延症的心理特点 及如何克服它

原文由曾慧儿提供

时间是早上8点。我跟自己说我会在接下来的4个小时里编写这篇有关拖延症的文章。10分钟后，我拿

起手机没有目的地开始浏览起一些网站来。我发现自己分神了，赶紧把注意力集中回来后又开始写稿。15分钟过去了，我发现自己就只是呆呆地看着电脑的显示屏。我转身自嘲说：“我正在拖延时间写这篇有关拖延症的文章。”

研究数据告诉我，其实不只是我会有这种行为。有一些国外的研究便发现，有20%的成人是惯性的拖延者，而且以学生居多。在2010年展开的一项针对新加坡大学生的调查显示，有59%的学生每天有3小时或以上的时间都是在拖延时间，而有44％的学生说拖延对其有负面的影响。

先别乱了阵脚地开始责备自己，您要知道普通的拖延行为（这是我们大家偶尔都会做的事）和较为严重的拖延行为是有差别的，后者是一种习惯性行为并且会导致不良的后果。就如约瑟夫.法拉利医生（英文名称为Joseph Ferrari）所言：“每个人都会有拖延的行为，但不是每个人都是拖延

临时

抱佛脚者。”他是一名撰写和研究有关拖延症的学者。

什么是拖延症？ 拖延症指的是有意识地延迟完成某件事或目标，在没有特别理由和不顾不良后果的情况下转而把时间用来做一些较为不重要或较好玩的事。虽然我们否认这个说法，但这确实是我们有意识所做出的决定，即使在某些情况下它其实是一种习惯性动作。

拖延者不停地寻找可以让其分神的事物。在以上所述的新加坡调查显示，学生们最常做的拖延活动是打盹、吃或喝东西、看电视和上网。

拖延者经常欺骗自己，说服自己其实他们有很多的时间可以完成任务，并且到了明天他们会更积极地去做这件事，又或者是他们觉得在有时间压力的情况下其工作表现会更好。他们经常低估做一件事所需要的时间，并且相信只有在他们“有心情”的情况下才可以工作。

精神保健

有一些国外的研究便发现，有约20％的成人是惯性的拖延者

拖延的代价 虽然拖延工作进度来进行一些更有趣的活动能够暂时帮助减压，但是以长期来看，它会提升您的内疚感、羞愧感和压力。这最后往往会导致自我批判及影响到工作质量。

拖延行为也会影响到您的健康、削弱免疫系统和导致失眠及肠胃问题。此外，拖延者经常会推迟寻求医疗帮助或接受治疗。

拖延工作进度会导致他人必须承担起我们没有完成的任务，而这则会使得我们的人际关系受到负面的影响。

曾慧儿医生是东部医疗联盟身心保健计划的临床心理医生

3 2 S E P – O C T 2 01 6 C A R I N G

为什么有些人就 是会拖延时间？与大多数人的观点相反的是，拖延行为不是因为我们懒惰或时间观念差。它其实是一种逃避行为的体现，并且象征着或许有一些障碍正牵制着我们无法把任务完成。那我们要逃避的到底是什么，而我们又可以如何克服它？以下是几种说法：

了解到为什么我们会有拖延行为将能够给予我们明白自己的宝贵信息，从而有助解除这个“魔咒”。试一试：下次当您发现自己正拖延完成一件事的时候，翻查以上所述的各种原由以确认哪几个是导因。问问自己：“我是不是需要一个更详尽的计划？”，又或者是“这件事情对我而言重要吗？”此外，以下的小贴士或许也能够帮到您：

1设立待办事项表、完成期限和做优先排序：在您的待办事项表里加入完成期限，并且在那些没有

完成期限的任务上加入自己设定的完成期限。把所有的任务做优先排序，

这样有助于决定您要先进行哪一项任务。每当您完成一项任务后便把它从列表中删除。

2按步骤完成任务：任务较为复杂或让人厌烦时，按步骤设立中期目标会让任务看似较简单和易

应付。举例说，像找工作这种任务，您可以把它分成以下几个步骤进行：• 考虑您的个人兴趣、技能及

您对工作的期望• 在网上和／或报章上寻找

您有可能会感兴趣的工作• 准备履历• 咨询朋友或良师的意见来优

化您的履历• 把履历发送给雇佣者

3设立明确的目标和任务：明确地说明您要完成的目标、什么时候开始、要怎样完成和什么时候完

成。举个例子，与其说：“今天我要找工作。”，倒不如说“今天早上我要花30分钟的时间翻查报纸看是否有合适的工作。”

4就5分钟：告诉自己您就只工作5分钟，然后不断地在每5分钟

过去后再加5分钟，慢慢地延长您工作的时间。许多人觉得只

要他们开了一个头，要继续工作下去就会变得比较容易，即使只是一会儿。

小贴士：如何让您不拖延时间

混乱

您缺乏技能、信息或资源来完成任务。它或许是一件相当重大的任务，又或者是一项新任务，而您没有一个明确的计划或方向来

着手进行。

这是

件苦差事 或许是因为无聊或不感兴趣，我们厌恶这件差事，所以

不愿去做。

这件事和我不相干

您被指名做这件事，可是您觉得它跟自己根本扯

不上关系，也无助您完成人生目标。

5减少会使您分神的事物：选择一个适合的时间和地点。尽可能地减少您工作环境里会使得您分神

的事物，如手机或在一个没有无线互联网的地方温习功课。

6休息时间要有限制：是没错，在工作时插入休息时间是

很重要，但您必须设定一个时间限制，例如在工作了1小时后，您就休息10分钟，然后再回来工作1小时。

7延迟拖延时间：拖延您想要从事另外一个活动的冲动，跟自己说“等一会儿

吧”或“再多5分钟”。只要那股冲动过去了，您会惊奇地发现您成功地把让您分心的事延迟了 30分钟。

8鼓励自己，而不是自我批判：学习如何原谅和鼓励自己，而不是打碎自己的自信心。

9敢于面对恐惧、焦虑和负面情绪：这些情绪是

您不可以避免的——您可以带着它们，但仍然继续

进行您的任务。

10奖励自己，即使是完成了很小的任务：例如，如果您由于想上社交媒体而拖延您应该

做的事，您可以跟自己说在完成任务后就可以上网了。这有助于加强您的推动力，同时减少愧疚感。

精神保健

自信心

不足和害 怕失败

当一个人质疑自己是否有能力完成某件事时，他便会倾向于避开它。这样做能保护他的自尊，因为他可以把无法完成任务的责任归

咎于自己没有尽全力，而不会由于自己的能力不足

而感到失望。

焦虑

和不安 我们会由于对任务的不确定性或害怕其结果达不到预期中的效果而将其推迟

来进行。

疲劳

有时候，拖延行为的出现可能表示您须要

休息。

没有明

确的目标 和完成期限

当您缺乏明确的目标和方向时，在没有时间压力的情况下，我们更有可能会说“明

天才做吧！”，又或者是拖延到下星期或

下个月。

3 4 S E P – O C T 2 01 6 C A R I N G 3 4 S E P – O C T 2 01 6 C A R I N G

樟宜综合医院高级医疗社工盛裕祯

COVER STORY

新传媒8频道在2001年播出了一部感人的电视连续剧《如何对你说》，讲述了一群社工如何引导和帮助那些有需要的人。正是这部电视剧，激发了盛裕祯小姐加入医疗社工这个行业

的决心。目前在樟宜综合医院担任医疗社工的她，很喜欢向有需要的病人伸出援手。

“当医生们评估某位病人需要社工的协助时，他们会通知我们。随后，医疗社工便会去病房探访病人，和他们及其家人还有多学科医疗小组进行沟通，确认病人需要哪些服务。”她解释道，“举例来说，如果病人患有失智症，我们会尽力给病人和其家人提供支持，帮助他们更好地照顾病人并适应日常生活。”

然而，在最初几年里，裕祯发现社工的实际工作和电视剧所呈现出的样子有很大区别。她回忆道：“刚开始时要学习的事情特别多，加上我是在马来西亚完成社工的学业，所以对于新加坡的社会体制和政策都不是特别了解。”她花了一年多的时间才真正适应。

对裕祯来说，面对有着复杂社会心理问题的病人时缺乏经验，就是她最大的挑战。幸运的是，裕祯的同事和上司给了她很多帮助。特别是医疗社会服务部的主管吴顺莲博士，总是能够给予她指导。在加入医疗社会服务队伍的头6个月里，裕祯有一名资深的医疗社工做为督导，她负责引导裕祯并和她一起讨论遇到的每一个病例。部门的培训小组每两个星期会为新加入的社工举办一次小组分享活动，每星期所有的医疗社工还会一起参与专业时事研讨会，这些都有助于促进每一位社工不断学习新的知识。

封面故事

原文 Joyce Ong Y.T.

趣闻在电视连续剧《如何对你说》里，女主角获得了杰出社工奖，并且被赠予一座奖杯——这个奖项和奖杯正是吴博士在

那年所获得的。

伸出援手医疗社工在病人的康复道路上扮

演着至关重要的角色，他们确保了 病人能够得到适当的帮助。

3 6 S E P – O C T 2 01 6 C A R I N G

每一天都有新的挑战 6年半后的今天，裕祯已成为了一名高级医疗社工，独当一面处理每个月近40起个案，并带领由4名医疗社工组成的团队专门负责老年病房。同时，她还为较年轻的同事提供指导，特别是在她专长的老年社会工作领域。虽然已经积累了丰富的经验，但这并不意味着工作就变得轻松了。裕祯在下班后会尽可能不去想工作上的事。她说：“给自己充满电是很重要的，这样你才能够继续第二天的战斗。” 她坦言，那些涉及被虐待或疏于照顾的个案对她来说仍然是比较棘手的。

一名医疗社工每天所面对的挑战都是不一样的。在结束一些个案的同时，仍然会不断有新的病人被转介过来，有时候她们还要安排家访。每个星期，裕祯会参加一次多学科会议，与会者包括医生、护士和其他专业领域的同事，如物理治疗师、职业治疗师、语言治疗师 、营养师等，一起探讨如何更好地照顾病人。

她至今仍然记得曾处理过的一位老先生个案。他是一位独居老人，在一次意外跌倒后被送入医院急诊室。他的视力衰退，看东西越来越模糊，并且非常害怕再次跌倒。这种情况使他无法再继续自己一个人生活，但除此之外，其实他在日常生活中所需的协助很低，因此很难申请入住老人院。 她回忆道：“我们尝试了很多不同的方法来帮他，比如请盲人协会教他怎样使用助行器，但由于他的个性原因和焦虑的情绪，使这条路仍然行不通。我们花了几个月的时间才最终为他申请到入住老人院的许可。”

为将来铺路 为了培养裕祯承担更多领导性的职务，樟宜综合医院颁发了一笔奖学金，让她在新加坡新跃大学修读老年学硕士学位。她在今年初完成了学业。要半工半读不是一件容易的事，但她表示，上课对她而言其实是一种减压方式。她说：“我觉得自己更有活力，因为我可以和不同专业背景的人交流——他们有些是政策决策者、有些是某项目或服务的总监——从而了解到他们对工作的不同观点和服务对象的情况。”

这正是吴博士希望裕祯能够从课程和面对

“一名医疗社工每天所面对的挑战都是不一样的。”

不同服务对象的情况——和决策者交换意见，从而建立多层面的视角。吴博士自己也是多个委员会和理事会的成员，她相信医疗社工能够在决策过程中加入实务工作的视角，例如资源应当如何分配，从而对新加坡社会和医疗保健

社区的发展做出贡献。而要做到这点，吴博士认为医疗社工仅仅把自己的工作做好

是不够的，他们还必须参与更多以实践为基础的研究

工作。今年6月，在新加坡

举办的第8届社工国际研讨会的筹办工作里，吴博士便扮演了重要的角色。该研讨会吸引了超过850名参与者，35

％的人来自30个不同的国家，其中澳洲、美国、

香港和以色列的阵容最为强大。新加坡一共发布了150份

研究报告，占研究报告总数的40%，这是她在2010年给新加坡社工所定下

的目标的3倍。“当我得到的反馈是本地社工的质量能和国际水平相较时，我们都感到无比的骄傲。”吴博士说道。她也指出研讨会能够增强新加坡社工在反思、探讨和认识行业趋势方面的能力，这有助于优化本地的社工工作。

拥有超过35年社工经验的吴博士也在致力于改变人们对早期医疗社工的刻板印象，即医疗社工都是施赈人员，主要只是帮助人们解决经济困难和满足基本需要。事实上，1960年代初期以后，医疗社工就被重新定义了，因为国家的医疗和社会体系逐渐改变，转而需要一个更多学科的医疗模式。

“虽然仍需要评估病人的经济状况，但我们已不仅仅只是做拨款者或是把关人的角色。除了帮助病人了解和申请各经济和社会援助之外，我们的工作还包括增进和加强病人的家庭支持网络。”吴博士强调，医疗社工的另一个角色是帮助病人和其亲属解决和身心状态有关的问题。“我们之前曾提倡在社区里建立更多的服务项目，来支持那些需要照顾亲人的家庭。近几年，这些服务也确实在扩大。对医疗社工来说，最大的挑战是要整合家庭和服务提供者的力量，一同编织一个包括病人、家庭、社区和政府的共享性综合护理网络，从而帮助年长者在适合的地方安享晚年。

你知 道吗？

在医疗社会服务部门里，各个医疗保健学科都有不同的医疗社工团队负责提供支持。例如，医疗社会服务部里的骨外科团队和外伤团队负责为医院骨科、外科提供支持；医疗团队负责为呼吸内科、心脏和肾内科以及全科提

供支持；门诊团队和急症团队负责为门诊部门提

供服务。

从左上顺时起：裕祯与四名来自老年病房的医疗社工同事；我们的高级医疗社工都是其小组组长；吴顺莲医生（前排左边第四位）与国际医疗社工指导委员会在新加坡举行的第八届国际社会工作研讨会上的合影

封面故事

C A R I N G J U L– A U G 2 0 1 5 3 7

3 8 M AY – J U N 2 0 1 6 C A R I N G

人工耳蜗与耳解剖结构

3 8 M AY – J U N 2 0 1 6 C A R I N G

一探人工耳蜗与听力复健如何助您恢复听力

何谓听力损失？听力损失就是耳朵失去听力功能，加上脑部理解

声音能力减低。这种状况可分为突发性或慢性地

发生在一只或是双耳。

耳朵构造分为三个部分，包括外耳，中耳，

以及内耳。这些构造若受到独立性或是综合性损

坏，将会导致听障。

您听得见吗?

听力 损失种类听力损失种类分为：

传导性听力损失：中耳受损并导致声音无法

有效地被传入内耳或是耳蜗。

感应神经性听力损失：耳蜗内的感应细胞及

连接神经遭到故障或损坏。

混合性：传导性及感应神经双双遭到损坏。

神经性：听觉神经遭受疾病感染，有缺陷，

甚至不存在。

当助听器已不受用或效果不佳时。。。。人工耳蜗对重度至深度听力损失者 来说助听器有可能已

经不能达到改善听力素质的功能。耳鼻喉专科医

生也许会提议植入人工耳蜗。

它如何运作呢人工耳蜗入植由两个部分组成：

外部声音处理器

内部人工耳蜗入植体 – 包含一个被植入耳

蜗的电极排列。

重度至深度听力损失大多数是被永久性

耳蜗感应神经损坏所造成。这种损坏是无法

逆转的。

外部声音处理器使用麦克风收取声音，然

后利用内置计算器来控制所传达到听觉神经

传送器

言语处理器及传声器

原文 樟宜医院人工耳蜗治疗团队

遭受感染或受伤

17%

长期遭受噪音影响，导致工业型听障

34%

4%遗传性

导致听力损失的风险因素有哪些呢？

28%年龄性失聪

调整言语处理器 听力学家会在电击听觉神经的程序上作出调

整， 使听力更加清楚。这是一个逐渐改善声

音的过程，有可能要用上好几年的时间才会达

到入植者所期望的成果。

听力复建 听力复建是指证实及诊断听力损失，并提供各

样理疗方法，也包括教导弱听者如何使用各种

不同的策略来应付及补助听觉能力。

耳蜗植入后的复建项目有：

听力训练

言语治疗

电话沟通训练

改善沟通能力策略训练

音乐欣赏训练

治疗课程 听力复建是由言语治疗师来主导的，可以以

一对一的方式来进行个人化的训练，或是以

群体的方式来训练互动技巧以及实践所学习的

技巧。 在这重新学习的过程/阶段中， 家人及

亲友扮演非常重要的角色，那就是对耳蜗入植

者 表示全力的支持。作为主要的沟通对象，

亲友也可以在诊所以外的地方与耳蜗入植者进

行听力训练，从中指点耳蜗入植者有关言语沟

通的技巧和策略，帮助他们改进沟通技巧。

鼓膜

耳小骨电极排列

接收器/ 刺激器

耳咽管

耳道

半规管

耳蜗

外耳 中耳 内耳

特写

的信息。外部处理器使用磁铁透过头皮将内

外部分连接，好让它们能够以无线信号来传

达信息。

此信息将被转换成数字信息，后被电极

排列线圈接收。电极排列取代损坏的感应细

胞，直接刺激听觉神经，因而恢复听觉。

人工耳蜗植入手术 此手术是由耳鼻喉专科医生来进行的。入植

者在全身麻醉的情况下，耳朵后面的皮肤将

被掀开来，这是为了将电极排列植入内耳；

内部入植器会被安置在皮肤下层的口袋里，

以免入植器移位。

人工耳蜗入植并没有年龄限制。手术后

的并发症很少见，并且预期在一个星期内复

原。手术部位通常选择在发际线后方，头发

长出来以后，就会遮盖伤口。

入植者将能够摸得到耳朵后方凸起的部

位，那便是接收器。但一般人看来，并不明

显。

启动耳蜗入植器手术后3至4个星期，入植器就可以由听力学

家来启动了。听力学家 将把言语处理器置放

在耳朵上，以确保入植器与处理器之间的衔

接。此外，听力学家也会进行测试来确定入

植器的功能健全。

4 0 S E P – O C T 2 01 6 C A R I N G

梁国轩医生是康脉诊所组群的合伙人，并且是康脉家庭诊所（榜鹅水道）的常驻家庭医师。他拥有新加坡国立大学的内外全科医学学位和本地的家庭医学专业文凭。他提倡健康的生活方式为预防疾病的最佳“药物”。

腹部胀痛问题：我的女儿今年22岁，目前半工半

读。她经常由于忙于工作或课业而饮食不

定。她通常5点半下班，然后紧接着7点钟

去上夜校，完全来不及吃晚餐。最近不时

听她说上腹疼痛，并且有腹胀的感觉，尤

其是在用餐前后的时间。昨晚，我被女儿

的呻吟声和辗转反侧给吵醒。她的疼痛

一直持续到早晨，我在想是否应该带她到

急诊部门求医。

解答：您的女儿很有可能是患有功能性消化

不良，又或者是人们常说的肠胃炎。她最好还

是先向家庭医生求诊。这是由于功能性消化

不良是通过排除法进行诊断的，意味着医生

必需首先排除其它严重腹部疾病的可能性。

您的家庭医生能治疗这些病症！东

部医疗联盟于2014年1月份推出了“家庭医生首选”计划，为的是要鼓励居住在新

加坡东部的病人在碰到轻微或中度的医疗状况时首先向家庭医生求助。在这个专栏里，东部医疗联盟的社区家庭医生将帮助《关怀》的读者解答一些常见的疾病问题。

浏览www.gpfirst.sg或咨询您的家庭医生更多有关常见的医疗状况，如割伤、撞伤、轻微烧伤、呕吐、流鼻血、伤风、蚊虫咬、头痛、扭伤及发烧。以下是读者 发来有关腹部胀痛和眩晕的提问。

患有消化不良的病人会有以下一种或多

种症状：用餐后感觉腹胀、无法吃完一个正

常分量的餐食又或是只吃了很少分量的食

物便有饱满的感觉，以及上腹部疼痛或有灼

热感。

消化不良与许多风险因素有关，如饮食不

定、过量饮食、摄取酒精、使用以非类固

醇抗炎药为本的止痛剂、压力及胃部受

幽门螺旋杆菌感染。减低这些风险因

素将有助减少肠胃炎的发生几率。

家庭医生会首先查看您的症状，

并且做针对性的身体检查以确认

是否必需马上到急诊部门求

医。如果您需要的是进一步

的非紧急性检查，家庭

医生也能够给您提供

意见。

有些较严重的症状就

包括持续性呕吐（尤其是如

果呕吐物里带有血丝）、肠胃

出血的现象（粪便泛黑色）、

吞咽困难、在短时间内不经

意的体重减轻，以及有患癌的

家族病史。

一旦家庭医生确认病情在现

阶段无需紧急救治，他会给病人开

一些缓解症状的药物，如解酸剂和

抑制分泌治疗，以便缓解胃的酸性。

他也或许会在后期为病人做尿素呼

吸试验或分辨抗原测试以确认胃部

是否有幽门螺旋杆菌，这些测试都

能够在家庭医生的诊所内进行。他

也会把病人转诊到专科部门做内

郭大伟医生目前是益心诊疗所（淡滨尼）的家庭医生。他拥有新加坡国立大学的内外全科医学学位和爱丁堡皇家外科医师学会的会员证。由于他曾在整形外科工作，促使他对肌肉与骨骼疼痛有关的疾病非常感兴趣。他也曾在多个本地、区域和国际的研讨会上发表他在这方面的研究。

FEATURE

眩晕问题：我是一名30岁的全职母亲。在2

个星期前，我感冒了。几天后感冒好多

了，但我的耳朵开始有轻微的疼痛。2天

前我早上醒来时觉得头晕目眩，感觉好

像整个房间在旋转，我得躺在床上休息

好长一段时间才可以起床。症状后来有

所改善，直到今天早上又开始感受到严

重的晕眩，最后好不容易才从巴刹走回

家。到家的时候我已经感觉很恶心,而且

还吐了。我的耳朵里也不时会嗡嗡作响。

我担心自己的情况严重，而且会不会因

为我拖延治疗而恶化呢？我的家庭医生

可以医疗我的病症吗？还是我应该直接

去急诊部门检查更为安全？

解答：您所说的头晕目眩的医学名称是眩晕。

患有眩晕的病人通常会感觉四周环境在旋转，

又或者是他们自己在旋转。这种旋转的感觉通

常会引起作呕和呕吐。

病人有时候也会出现耳朵嗡嗡作响的症

状，这在医学上称作为耳鸣。

根据您所形容的眩晕、耳鸣及不久前患感

冒来推测，您很有可能是患上了“迷路炎”（英

文名称为Labyrinthitis）。内耳里有一组神经

是使得我们取得平衡感的关键部分。当这些

神经由于发炎而受到刺激时便会导致眩晕、耳

鸣、作呕和呕吐的症状。

其它导致眩晕的常见因素还包括：

1. 良性阵发姿势性眩晕（英文名称为 Benign

Paroxysmal Positional Vertigo）：是由

于内耳里的钙颗粒（耳石）囤积所导致。这

些钙颗粒是发送信息到大脑让身体取得平

衡感的重要组成部分。

2. 梅尼埃病（英文名称为 Meniere’s Dis-

ease）：是一种内耳疾病，由于液体累积而

导致内耳的压力产生了变化。病人通常会

有耳鸣和眩晕的症状。

其它的因素还有偏头痛、药物所产生的副

作用（抗生素）及脑部疾病如中风。

您的家庭医生会查看您的症状并且为您

做相关的身体检查，以排除那些可能导致眩

晕的较严重因素如中风。

迷路炎有可能是由病毒或细菌所导致，并

且以病毒所引发的迷路炎较为普遍。一旦您的

家庭医生确诊您的情况属于病毒所引发的迷

路炎，他便会给您配一些有助缓解症状的药

物，这可能是口服的药片又或者是打针。至于

那些有突发性失聪症状的病人，家庭医生会对

失聪的情况做评估，然后让病人在短期间内服

用一些泼尼松龙（Prednisolone，是一种类固

醇药物）。

如果家庭医生的诊断是细菌所引发的迷路

炎，他则会给病人配一些局部性的抗生素。

如果您的眩晕症状连带了说话困难、吞咽

困难、视觉受影响（如看见双重影像）、脸部下

垂、四肢无力和发麻、颈部疼痛或最近颈部受

过伤，那您应当即刻前往紧急部门求医或呼叫

救护车，因为这可能是脑部出现了问题。

眩晕也和慢性疾病如糖尿病和高血压有

关联。因此，保持一个健康均衡的饮食和定

期做有氧运动是非常重要的。

保健补充品如白果叶（Gingko Biloba）

、鱼油（Fish Oils）和长春西汀（Vinpoce-

tine）也被推荐为有益健康的保健品，但其功

效还未获得临床证实。

由郭大伟医生提供解答

窥镜检查以确认是否是胃糜烂、胃溃疡或是其

它的问题。

由梁国轩医生提供解答

家庭医生解答

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RegistrationWelcomeGallbladder: Friend or Foe?Liver supplements - Are you wasting your money?Cirrhosis - Separating fact from fictionLiver Cancer - How can we treat it?Pancreas Cancer and treatment - the cutting edgeQ&AEnd

Dr. Chan Chun Yip, SGHDr. Terence Huey, TTSHMs. Shirley Pang, CGHDr. Lee Guan Huei, NUHDr. Lee Ser Yee, SGHDr. Adrian Chiow, CGH

登记致词胆囊：朋友还是敌人?肝脏保健品- 物有所值吗？ 肝硬化- 解开谜思肝癌 – 我们如何治疗？胰脏癌之疗法 – 最先进治疗方案问答时间结束

Dr. Tan Siong San, CGHDr. Lee Lip Seng, CGHMs. Yee Mei Ling, SGHDr. Yew Kuo Chao, TTSHDr. Tan Siong San, CGHDr. Alfred Kow, NUH

To register, email to Liverpancreasforum2016@gmail.com OR contact us @ 6484 3526 (Monday to Friday, 9am-6pm)

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肝脏和胰腺健康讲座2016 Liver and Pancreas Health

肝脏和胰腺健康讲座2016 Liver and Pancreas Health

节目

了解它，爱护它，保护它

5 November 201610am -12pm (English) 2pm - 4pm (Chinese)

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