Truly, in NUH, our Patients are our Focus, and our People are our Pride!” - NUH
CEO, Mr Chua Song Khim ... blood sugar level is too low. Thus, having a single ...
A quarterly publication of National University Hospital
02
health matters Clearing The Air On Epilepsy And Seizures
08
health bites Coping With Irritable Bowel Syndrome (IBS)
10
Oct-Dec 2004
Mita (P) No. 184/07/2004
spotlight on... Occupational Therapist
11
cut it out Basic First Aid For Epilepsy
Our Patients - Our Focus Our People - Our Pride “Gaining accreditation for Joint Commission International (JCI) and bagging the People Excellence award are significant milestones in our history and mark yet another step forward in our journey of excellence, both in the areas of quality patient care and outstanding people development. These achievements certainly demonstrate our strong commitment to quality, safety and continuous improvements in patient care outcomes, and recognise us as one of “The Best of the Best” People Developers! Truly, in NUH, our Patients are our Focus, and our People are our Pride!” - NUH CEO, Mr Chua Song Khim International Recognition For Quality And Safe Patient Care Our hard work, continuous efforts and determination to ensure and provide quality and safe patient care of international standards have paid off!! NUH has been granted accreditation (on 13 September 2004) from the Joint Commission International (JCI) and we are the first hospital in Singapore to achieve this distinction. A subsidiary of the most trusted name in accreditation - the Joint Commission on Accreditation of Healthcare Organisations, JCI is dedicated to improving the quality, safety and efficiency of healthcare services around the world. JCI standards focus on areas that most directly impact patient care including access to care, assessment of patients, infection control, patient and family rights, and education. At the same time, JCI standards also address facility management and safety, staff qualifications, quality improvement, hospital leadership and information management. Being accredited with JCI is a recognition of our ongoing commitment to provide a high standard of patient care. Patients can now receive greater assurance that they are receiving quality and safe care in our hospital that meets globally accepted standards.
Recognition for People Excellence Besides gaining accreditation for quality and safe care, we have also been recognised for our outstanding people development practices. NUH is proud to be awarded the prestigious People Excellence (PE) Award, the highest accolade given to organisations for people excellence. This award is conferred only on “The Best of the Best” People Developers, and has been awarded to only seven other organisations since its launch in 2001. With a strong belief that staff is our key asset to achieving our mission to provide cost-effective quality healthcare services, NUH’s innovative People Excellence framework is geared towards developing staff to reach their fullest potential, creating job satisfaction and a sense of purpose, and recognising and rewarding good performance. In addition to developing programmes that build clinical competency, customer intimacy and leadership, NUH also endeavours to create a fun workplace so that staff can enjoy what they do. This award reflects the excellent pool of people in NUH and reaffirms our commitment to develop our people to be and to do their best so that we can “add years of healthy life to the people of Singapore”.
health matters
Clearing The Air On Epilepsy And Seizures Despite the knowledge that epileptic seizures are common neurological events (and not supernatural ones), many misconceptions about epilepsy still persist. People with epilepsy continue to face some discrimination and prejudice every day at work, school and in social settings. In this issue of Lifeline, we feature basic information about epilepsy and seizure disorders to help create greater awareness and acceptance of this condition.
f
irst, let us introduce you to how the brain and nervous system work. Our nervous system is a ‘communications network’ that controls our thoughts, memory, feelings and body movements. Like telephone lines, our nerves allow the brain to communicate with all parts of the body via millions of tiny electrical charges between the neurons (nerve cells) and the brain. What Is Epilepsy?
Epilepsy is a neurological condition that produces brief disturbances in the normal electrical functions of the brain. The brain’s normal electrical pattern may be interrupted by periodic bursts of electrical energy that are more intense than usual. This results in a brief alteration in the person’s consciousness, sensations, body movements and actions. Epilepsy is not a mental disorder or illness and is not contagious. You cannot ‘catch’ it from someone else. What Causes Epilepsy?
Do you know that epilepsy is one of the oldest conditions of the human race with a rich and interesting history? From the beginning of time until present day, epilepsy has and is still affecting millions of people across the world. According to the World Health Organisation, it is likely that around 50 million people in the world have epilepsy at any one time!
Epilepsy can be caused by anything that affects the brain. These include infections (meningitis or encephalitis), brain tumours, head injuries, events or complications before or during birth, or inherited brain disorders (such as tuberous sclerosis). Epilepsy may or may not run in the family; occasionally, causes of epilepsy cannot be found. Who’s At Risk For Epilepsy?
Common Manifestation Of Seizures
Epilepsy is often thought of as a childhood condition but it can develop at any stage in life. Anyone regardless of age, race or gender can develop epilepsy. However, there are in general two periods of relatively high incidence of epilepsy: infancy and early childhood, and in the later years of adulthood.
There are basically two main groups of seizure manifestationgeneralised or partial. Generalised seizures involve all parts of the brain and there is usually loss of consciousness. There are many types of generalised seizures:
What Are Seizures?
Seizures are a symptom of epilepsy. Seizures are sudden and unusual, or erratic electrical changes in the nerve cells in the brain that we cannot control. Seizures can happen for many different reasons, for example, a person may have a seizure if the blood sugar level is too low. Thus, having a single seizure doesn’t necessarily mean that a person has epilepsy. If however, there are recurring seizures which begin in the brain, it is likely that the person has epilepsy.
02
Lifeline Oct - Dec 2004
a) Generalised tonic-clonic seizures usually last for two to five minutes. This type of seizure makes the patient fall, become stiff (the tonic part) and start to jerk (the clonic part). This is what most people think epilepsy is. The entire brain is affected. During this time, the child may not be able to hear you and may not respond to you. When the child regains his consciousness, he may feel confused and sleepy.
healthmatters b) Absence seizures begin and end abruptly. The seizure can be so brief (usually lasting for only a few seconds), that it can go undetected. However, this may happen many times a day, interrupting attention and concentration. A child, for example, may stop suddenly in mid-sentence, stare for a moment or two, and then continue without realising that a break has taken place. Sometimes, these seizures also produce blinking or chewing movements. He may move an arm, pull at clothing, get up and walk around, all the time looking as if he is in a daze. The child may or may not hear you and will not respond until the seizure has run its course. Frequent absence seizures may result in learning difficulties if not recognised and treated. This type of seizure is often mistaken as daydreaming or inattentive behaviour. c) Atonic seizure results in a sudden loss of muscle tone. This is a sudden drop of the head, or sudden fall to the ground. These seizures can be difficult to manage, resulting in falls and causing a range of injuries, particularly to the head and the face. d) Myoclonic seizures are brief, lightning-like muscle jerks. It may cause a person to spill what they are holding or fall off a chair. Sometimes they involve the whole body all at once; sometimes it’s just the face or arms. The seizure may occur singly or they may occur as a cluster of myoclonic jerks. Children/adolescents who have this type of seizures are often mistaken for being clumsy. e) Infantile spasms are quick, sudden jerks in an infant. This condition usually affects infants between three to nine months of age. A baby with this condition may look startled or as if in pain. He may draw his knees suddenly up to his stomach, and bring both arms up at the same time. If he is sitting, his head and arms may fall forward suddenly. Partial seizures involve part of the brain. Some partial seizures may progress on to a generalised seizure. There are two main types of partial seizures: a) Simple partial seizure produces changes in sensation, movement or feeling without losing consciousness. The child may feel strange sensations on one side of the body. The seizures may cause a child to become confused, see spots, or hear ringing sounds. This type of seizure can be mistaken for an emotional disturbance or a mental problem.
b) Complex partial seizure makes the child act as if only half-awake. In a seizure, one arm may become rigid and start moving uncontrollably but other muscles will not get affected. It may produce dramatic changes in behaviour including laughing or apparent fear. The child cannot control his/her actions and is unable to remember what happened when the seizure stops. There is usually a set of actions that each person follows every time a seizure happens. Seizure Triggers
Lack of sleep is a common trigger of seizures. Not taking medication for epilepsy regularly can also be one of the reasons why children with epilepsy have recurrent seizures. When a child with epilepsy is sick or has a fever, this may trigger further seizures. Flashing or flickering lights can also trigger seizures in some children with certain types of epilepsy. Treatment Options
Most children with epilepsy are treated with anti-epileptic medication(s). However, if the child’s seizure is resistant to the anti-epileptic medication or when there is unacceptable medication toxicity, other treatments may be considered. One of the treatments to be considered is the ketogenic diet. It is an old form of dietary therapy tried since the 1920s for seizure control. A special high-fat, low-protein and low-carbohydrate diet prescribed by a doctor, it is designed to induce and maintain ketosis and thus reduce or prevent seizures. Doctors usually recommend the ketogenic diet for children whose seizures do not respond to seizure medication. A special powdered milk formula can be used to maintain ketosis in children with epilepsy, and thereby reduce or prevent seizures. The ketogenic diet or milk formula is tried for up to three months, and if effective, can be continued for the next two to three years with a gradual weaning process undertaken in the third year of therapy. Epilepsy can also be treated by surgery. It is recommended for seizures that start in a fairly small area of the brain which can be removed by surgery without damaging eloquent areas of the brain (which control important functions such as limb movements, speech, vision and memory).
(continues on page 4)
Lifeline Oct - Dec 2004
03
