Dinner for a Cause. A Gift of Hope. Studying Surgical Site Infection (SSI) Botulinum Toxin and Phenol Injection Therapy for Post-Stroke Spasticity

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1 Extending the Healing Ministry of Christ January February 2017 Dinner for a Cause Studying Surgical Site Infection (SSI) Botulinum Toxin and Phenol Injection Therapy for Post-Stroke Spasticity Sharing Experiences in Perioperative Nursing A Gift of Hope

2 Contents 1 CEO MESSAGE 2 MEDICAL NEWS Botulinum Toxin and Phenol Injection Therapy for Post-Stroke Spasticity 10 EVENT HIGHLIGHTS AH Sharing Experiences in Perioperative Nursing 4 PHYSICIAN S CORNER Profile of Our New Doctors at TW 11 CHARITY EVENTS AH A Gift of Hope 7 CME HIGHLIGHTS 8 HOSPITAL NEWS AH Admission Rights Updated AH Dr Arthur A. Moores ( ) 9 SR Studying Surgical Site Infection (SSI) AH Tennis for Charity 12 AH Dinner for a Cause

3 CEO MESSAGE Happy new year to everyone. I hope you celebrated the start of the Year of the Rooster in good spirits with family and friends. Now that we re a few weeks into the New Year, it s good to look ahead to what the rooster will bring us. We have exciting plans for Stubbs Road campus in 2017, starting with the installation of new radiotherapy devices this year. The new system will be located on the basement floor of the hospital building and targeting fourth quarter of 2017 to start services. We ve also created new packages and programs to enhance our specialist services. The MIS Short Stay Center will provide one-stop minimally invasive surgery (MIS) services that are convenient for patients and doctors. The center is designed for patients undergoing MIS and require short-stay accommodation following their procedure. We ve streamlined the processes and now doctors are able to arrange the operation and subsequent short stay at the time of consultation with patients. Our Comprehensive Stroke Program to help patients prevent stroke and to meet the specialized needs of stroke patients launches in February of this year. The program is managed by our multidisciplinary team of professionals including: specialists in neurology, neurosurgery and radiology; our 24-hour Urgent Care department; the Intensive Care Unit; the Special Care Unit; and the Rehabilitation Center. Tsuen Wan campus continues with its facelift and the main entrance of new tower is nearly complete. The renovation of the out-patient department in the Old Wing will start soon. We ve cooperated with Hospital Authority (HA) and joined the Public Private Partnership Programme. This year, Tsuen Wan campus will provide computed tomography services to cancer patients under the care of HA. I wish you all much success in the Year of the Rooster! Mr Alex Lan President and CEO Hong Kong Adventist Hospitals Stubbs Road and Tsuen Wan 1

4 AH MEDICAL NEWS Botulinum Toxin and Phenol Injection Therapy for Post-Stroke Spasticity Dr TAM Cheuk Kwan Specialist in Geriatric Medicine Spasticity is a common complication of stroke, and affects 27 to 38 per cent of patients 12 months after stroke. The condition also occurs with other disorders or trauma, such as traumatic brain injury, hypoxic brain damage, cerebral palsy, spinal cord injury, and other spinal cord lesions. Despite taking preventative measures, many patients still develop severe spasticity and contracture of the limbs, which can lead to deformed joints. This ultimately causes a variety of problems including poor hygiene, fungal infections, skin maceration, development of pressure ulcers, and permanent contractures. Forceful movement of the limbs by caregivers may cause pain, muscle tears, or even bone fractures in patients, while those with less severe spasticity and good muscle recovery may still suffer from clumsy limb movements and struggle with walking and carrying out normal daily activities. Oral drug treatment is not always effective and carries many side effects, while surgical intervention is usually considered only for selected cases due to the high surgical risk in older patients with multiple comorbidities. wrinkles, botulinum toxin can also be used to treat squints, blepharospasm, spasticity, cervical dystonia, detrusor overactivity, and migraines. The therapeutic effect varies and depends on the injection techniques used. Clinical assessment is important as it helps physicans decide which muscles to inject, and determines the optimal dose of toxin to be used to ensure that spasticity is reduced but the muscles are not paralyzed. The use of real-time ultrasound improves the accuracy of the injection and reduces the risk of the toxin spreading to adjacent muscles or entering the bloodstream. Traditional injection sites based on EMG needle insertion points are usually not at the site of the motor endplate. Studies have shown that the effectiveness of the toxin is reduced by 50 per cent if the injection is 12mm away from the motor endplate. With this, the development of motor endplate-targeted injections has improved the effectiveness of the toxin and also minimized weakness of unexpected muscles. Benefits of toxin injection therapy Injection therapy with botulinum toxin or aqueous phenol has been proven to be a safe and effective means of alleviating spasticity. Botulinum toxin blocks the release of acetylcholine at the neuromuscular junction, thus relaxing or reducing the contraction force of the involved muscles. In addition to its cosmetic use for the reduction of Spasticity of the upper limb 2

5 MEDICAL NEWS AH action is also longer than that of botulinum toxin, and also depends on the time required for nerve regeneration. The development of real-time ultrasound guiding and electrical stimulation has made the injection technique much more accurate and safe. The disadvantage is that not all muscles can be treated as some of the supplying nerves may not be accessible. Ultrasound-guided musculo-cutaneous nerve injection with aqueous Phenol Costs and dosage limitations Botulinum toxin therapy is restricted by the drug s recommended maximum doses for each session. For patients with severe spasticity involving a large number of muscles, the maximum dose is far from enough. Therapy is also hampered by the high cost of repeat injections, which are required every few months. An alternate treatment method is blocking the peripheral nerves with aqueous phenol or alcohol, which denatures proteins and causes nerve degeneration, thus relaxing the supplying muscles. The drug cost is lower and one single injection is enough to weaken several muscles. The duration of Powerful peripheral nerve blocking with aqueous phenol Another problem with phenol injections is that the effect is often too powerful, causing muscle paralysis. The resulting effect is also difficult to titrate as it blocks both the afferent and efferent nerve fibers of the tendon reflex arc responsible for spasticity. It is therefore very effective for treating patients with non-functioning limbs aiming at improving daily nursing care while it is not so suitable for patients aiming at improving limb function. In conclusion, injection therapy with botulinum toxin is helpful for improving the limb function of stroke patients and their activities of daily living. This treatment may be combined with peripheral nerve blockage using aqueous phenol or alcohol for patients with severe nonfunctioning spastic limbs. Ultrasound-guided injection of botulinum toxin Ultrasound-guided musculocutaneous nerve injection with aqueous phenol 3

6 TW PHYSICIAN S CORNER Dr AU Siu Kie Specialist in Clinical Oncology SCOPE OF SERVICE Clinical management of solid cancers including chemotherapy, immunotherapy, palliative care, radiotherapy, and targeted therapy STRENGTHS High-precision radiotherapy Application of biomarker testing for precision oncology including cancer biomarker testing, chemotherapy, targeted therapies, and immunotherapy CREDENTIALS MBBS(HK) FRCR FHKCR FHKAM (Radiology) HOBBIES AND INTERESTS Swimming, jogging, hiking, tennis, and photography. Dr CHONG Shing Lok, Johnson Specialist in Emergency Medicine WHAT WOULD YOU LIKE TO SHARE WITH US? He has told you, O man, what is good; and what does the Lord require of you but to do justice, and to love kindness, and to walk humbly with your God? (Micah 6:8) SCOPE OF SERVICE Acute medical care Emergency transfer Resuscitation STRENGTHS Acute Medical Care Emergency ultrasound Endoscopic removal of foreign body Resuscitation CREDENTIALS MBChB (CUHK) BMedSc (CUHK) MRCSEd DPD (Cardiff) FHKCEM FHKAM (Emergency Medicine) HOBBIES AND INTERESTS Information technology, driving, and photography. 4

7 PHYSICIAN S CORNER TW Dr LAI Wai Man, Sonia Specialist in Obstetrics and Gynecology SCOPE OF SERVICE Antenatal care and delivery Women s health check Gynecological surgery STRENGTHS Minimally invasive gynecological surgery including hysteroscopic, laparoscopic, and vaginal surgery CREDENTIALS MBBS (HK) MRCOG FHKCOG FHKAM (Obstetrics and Gynecology) DPD (Cardiff) HOBBIES AND INTERESTS Participating in social services that target health promotion for underprivileged women Dr LEUNG Hon Bong, Adrian Specialist in Orthopedics and Traumatology WHAT WOULD YOU LIKE TO SHARE WITH US? I believe that a competent orthopedic surgeon is not merely a technician that fixes a broken bone or torn ligaments, or replaces a worn-out joint with an artificial joint. He should establish individualized treatment protocols that aim to enhance his patients quality of life. SCOPE OF SERVICE Trauma services for adults and children Spine surgery and rehabilitation Pain management Nerve conduction test and electromyography Arthroscopy and replacement of shoulder and knee Hand surgery and microsurgery STRENGTHS Minimally invasive spine surgery Image-guided diagnostic and therapeutic nerve blocks and joint injections CREDENTIALS MBChB (CUHK) MRCSEd DCH (Ireland) M Med Sc (HK) FRCSEd (Orth) FHKAM (Orthopedic Surgery) FHKCOS FHKCOS (Rehabilitation) HOBBIES AND INTERESTS Soccer 5

8 TW PHYSICIAN S CORNER Dr LEUNG Siu Lan Specialist in General Surgery SCOPE OF SERVICE Breast surgery General surgery STRENGTHS Breast surgery CREDENTIALS MBChB (CUHK) FRCSEd (Gen) FCSHK FHKAM (Surgery) MScWHS (CUHK) Dr WONG Chung Kit Specialist in Obstetrics and Gynecology SCOPE OF SERVICE Vaginal delivery Gynecological surgery STRENGTHS General obstetrics and gynecology CREDENTIALS MBBS(HK) MRCOG FHKAM (Obstetrics and Gynecology) FHKCOG HOBBIES AND INTERESTS Diving, soccer, camping. HKAH - SR TWAH - TW AMC 6

9 CME HIGHTLIGHTS TW Latest Update in GERD Management SPEAKER: Dr Siu Ka Fai, Danny Specialist in Gastroenterology & Hepatology Using NIPT Wisely SPEAKER: Professor Chiu Wai Kwun, Rossa Dr Chan Chong Pun, Ben Specialist in Obstetrics and Gynecology 7

10 SR CME HIGHTLIGHTS HIGHTLIGHTS State-of-the-Art Management of Kidney Malignancy SPEAKER: Dr Edmond Wong Specialist in Urology An Update on Diabetic Nephropathy SPEAKER: Dr Lam Man Fai Specialist in Nephrology An Update on Common Eye Diseases SPEAKER: Dr Victor Tam Specialist in Ophthalmology AH HOSPITAL NEWS Admission Rights Updated (From November to December 2016) Hong Kong Adventist Hospital Stubbs Road Specialty Name Anesthesiology Dr Law Cheuk San Cardiology Dr Chan Chi Kin, William Cardiology Dr Tsang Chi Yan Clinical Oncology Dr Kam Koon Ming, Michael Dentistry Dr Lau Wing Yan, Irene Dermatology & Venereology Dr Lam Yuk Keung Gastroenterology & Hepatology Dr Wong Tai Chiu General Practice Dr Brantly Charles Francis General Surgery Dr Chan Kin Chun, Sacha General Surgery Dr Chan Tak Ming, John General Surgery Dr Cheung Chi Ying, Genevieve Obstetrics & Gynecology Dr Chan Lok Zara Lin Zau Obstetrics & Gynecology Dr Lau Pui Kei, Amy Ophthalmology Dr Luk Oi Jing, Fiona Orthopedics & Traumatology Dr Chan Yu Sing Orthopedics & Traumatology Dr Wong Sze Hung Otorhinolaryngology Dr Mak Chi Keung Pediatrics Dr Lau Shing Chi Radiology Dr Chu Leysia Radiology Dr Chu Yiu Ching, Tiffany Radiology Dr Luk Sau Har Radiology Dr Yang Kwok Wai, Michael Respiratory Medicine Dr Lo Ho Yin Hong Kong Adventist Hospital Tsuen Wan Specialty Cardiology Dermatology & Venereology Emergency Medicine Gastroenterology & Hepatology Gastroenterology & Hepatology General Surgery Neurology Obstetrics & Gynaecology Orthopedics & Traumatology Orthopedics & Traumatology Orthopedics & Traumatology Orthopedics & Traumatology Otorhinolaryngology Psychiatry Radiology Name Dr Tsang Chi Yan Dr Lam Yuk Keung Dr Chong Shing Lok Dr Li Wing Heng, Simon Dr Wong Tai Chiu Dr Cheung Chi Ying, Genevieve Dr Fung Bun Hey Dr Lau Pui Kei Dr Fong Chi Ming Dr Li Hok Yin Dr Tong Sheung Chi Dr Wong Sze Hung Dr Ho Dick Wai, Terrie Dr Chung Kwok Hang Dr Chan Tao 8

11 HOSPITAL NEWS AH Dr Arthur A. Moores ( ) A Visionary Missionary who United East and West Dr Arthur Moores, a former missionary in Hong Kong, passed away on September 17, 2016 in Paradise, California, at the age of 93. He and his wife of 64 years, Verna, and their two sons, spent 11 years in Hong Kong, where Moores initially worked at the Tsuen Wan campus, later moving to the newly built Stubbs Road campus in The family returned to the US in We are sincerely grateful to Dr Moore and his wife for their tireless efforts and commitment to the development of the Hong Kong Adventist Hospitals. We extend our heartfelt condolences to his family. SR Studying Surgical Site Infection (SSI) Joe CHEUNG, Nursing Officer of Infection Control Data shows that Hong Kong Adventist Hospital Stubbs Road and its efforts over the past three years to reduce surgical site infections through multimodal strategies are paying off. Nosocomial infections pose a major risk for serious health issues that can lead to death. Surgical site infections (SSIs) account for 20 percent of all nosocomial infections (Klevens et al., 2007). According to data from the Society for Healthcare Epidemiology of America (SHEA), approximately two to five percent of surgical operations result in an infection. To reduce SSI, the hospital s infection control team conducted an internal SSI study, which included improvement evaluations and surgeon feedback. The study included general major/minor operations, obstetrics and orthopedic surgeries, and results showed that the SSI rates were 0.38% out of 529 surveyed cases in 2013, and zero for both 2014 and 2015 out of 1,148 surveyed surgeries. As of December 1, 2016, the SSI rate remained at zero based on the 452 cases surveyed. To further evaluate the cases and establish best practices, the team compared the data to those from the National Healthcare Safety Network (NHSN) and the Australian Council on Healthcare Standards (ACHS). The data indicated that our SSI rates are relatively low. For instance, the SSI rate for appendectomies from NHSN is 0.95% out of 5,873 surveyed cases (Edwards et al., 2009), while our SSI rate has remained at zero based on 64 surveyed appendectomies. To improve patient safety and uphold our zero tolerance approach to SSI, multimodal strategies have been implemented, including proper use of antimicrobial prophylaxis, skin preparation, and maintenance of blood glucose levels and normothermia. References: Klevens RM, Edwards JR, Richards CL Jr, et al. (2007) Estimating health care associated infections and deaths in U.S. hospitals, Public Health Rep; 122(2): pp Edwards, J. R., Peterson, K. D., Mu, Y., Banerjee, S., Allen-Bridson, K., Morrell, G.,... Horan, T. C. (2009). National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December American Journal of Infection Control, 37(10), doi: /j.ajic

12 AH EVENT HIGHLIGHTS Sharing Experiences in Perioperative Nursing Going above and beyond their call of duty, Adventist staff helped organize two international events in Hong Kong last October, where over 900 healthcare professionals from 17 countries came to share experiences in perioperative nursing. The 7th Asian Perioperative Nursing Leadership Forum and the ensuing two-day 5th Asian Perioperative Nursing Association (ASIORNA) Conference were both held at the Kowloon Bay International Trade and Exhibition Centre. Participants from across the Asia-Pacific region discussed the latest developments in surgical technology and their implications on perioperative nursing training. Keynote speakers presented information on the advances and challenges in perioperative care, as well as legal and ethical issues of concern. Participants were also divided into five small groups to visit five local hospitals. Our nursing director and president of the Private Hospital Operating Theatre Organization (PHOTO), Ms Clare Leung, chaired the ASIORNA organization committee. The events would not have been possible without her leadership, as well as the concerted efforts by other department managers who served on the committee. Seven unit managers at our two hospitals served as moderators at the conference, while seven abstracts prepared by our staff were approved by the institutional review board. We greatly appreciate the contributions of all colleagues involved in the events and look forward to more exchanges with our international counterparts in the future. From top to bottom Group photo of PHOTO and ASIORNA organization committee Mr Andrew TAM, operating rooms manager of HKAH SR, speaks at the conference. Mr HON Chi Ping and Ms Jullian HUI showcase their paper, which was displayed at the conference. Professor Sophia CHAN (middle), JP, Under Secretary for Food and Health; Professor John LEONG Chi-yan (second from left), SBS, JP, Chairman of the Hospital Authority; Dr Anthony LEE (far left), Chairman of Hong Kong Private Hospitals Association; and Ms Clara LEUNG (far right), who also presided over the opening ceremony. 10

13 CHARITY EVENTS A Gift of Hope The first Men of Hope luncheon was hosted by Hong Kong Adventist Hospital Foundation in October 2016 at Aberdeen Marina Club. The Men of Hope Awards were established to recognize influential men in Hong Kong who champion the call for social justice to benefit the greater community, as well as those who make an impact through their ability to create, inspire, and spread hope both here at home and abroad. All proceeds raised from the event was directed to the Adventist Pediatric Heart Fund to provide corrective heart surgeries for underprivileged children suffering from congenital heart diseases. From top to bottom Mr Sean LEE DAVIES (left) Ms Anne LIM-CHAPLAIN, co-founder and publisher of #legend, presents an award to Mr Kevin LAU. Men of Hope awardees: (from left to right) Mr Alan LO, Mr Geoffrey CHEAH, Mr Simon HOLLIDAY, Mr Sean LEE DAVIES, Mr Kevin LAU, and Mr Roger CHAN. Dr Eddie CHEUNG, Assistant Medical Director of the Adventist Pediatric Heart Fund, shares a story about APHF beneficiaries. Tennis for Charity Hong Kong Adventist Hospital Foundation was one of the beneficiaries of the Prudential Hong Kong Tennis Open (PHKTO) 2016, which was held in October. Friends of Asia Hong Kong, the official charity partner of this prestigious event, generously provided a dollar-for-dollar match on the total amount raised from PHKTO s charitable events in 2016, including the Can Challenge and Bounce For Charity. Their donation was allocated to the Foundation s Cancer Fund. From top to bottom Hope Bears were sold out at the HKAHF booth at the Tournament Village of Prudential Hong Kong Tennis Open Ms Jo SOO-TANG receives a check from Mr Philip MOK, Chairman of the Hong Kong Tennis Association and Ms Josephine LEUNG, Director of Events and Marketing of Friends of Asia Hong Kong. 11

14 CHARITY EVENTS Dinner for a Cause HKAHF Charity Gala Dinner Raises Funds for Cardiac Programs and Health Promotion Over HK$2 million was raised for the Hong Kong Adventist Hospital Foundation (HKAHF) at the charity gala dinner held in November 2016, boosting support for our pro bono healthcare services. The main purpose of this charity dinner was to raise funds to support underprivileged adult and pediatric patients suffering from cardiac diseases. Donations have been allocated to the Foundation s Adventist Pediatric Heart Fund to provide Row 1 Mr Alex LAN thanks the guests. Dr Maurice LEUNG Chairman of Adventist Pediatric Heart Fund, shares a few patient stories. Row 2 Ms Juliana LAM (far left), Professor Alice CHIU (second from left), Mr Alex LAN (second from right), and Ms Jo SOO-TANG (far right) receive a cheque donated by Professor Patrick WONG (center), presented by Sheen Hok Charitable Foundation. (From front to back, left to right) Professor Marcopolo TAM; Mr Patrick MAK; Mr Sam HUI Wai Kwong; Professor Patrick WONG, BBS, JP; Mr CHAU How Chen, GBS, OBE, JP; Ms Juliana LAM; Professor Alice CHIU, BBS, JP; Dr KO Wing Man, BBS, JP; Mr Alex LAN; Ms Jo SOO-TANG; Ms Helen LI; Dr CHENG Shing Fung; Mr SHIH Wing Ching; Dr LEE Yuk Lun, JP; Ms LEE WONG Wai Kuen; Mr LEE Yuk Fat, FPVCB; Mr Aaron LIU; Ms Rachel YEUNG; Dr. CHAN Lung Wai; Dr Kenneth HO; Pastor Daniel JIAO; Dr Peter Ni Boon LO; Ms Corona CHEUK, MH; Mr Paul S. H. LAW, MH; Mr Simon Wai Kit LEUNG; Mr Samuel HUANG; Dr Anthony LI; Dr Monty LEE; Mr Simon SIM; Mr Paul YAM. 12

15 CHARITY EVENTS cardiac surgeries to underprivileged children suffering from congenital heart disease, as well as the Charitable Cardiac Program for interventional procedures for financially disadvantaged patients referred by public hospitals. In addition, part of the funds raised at the gala dinner will also be allocated to educational programs, which will be launched jointly with district groups to help raise awareness of disease prevention within the community. A total of 480 guests and donors attended the dinner, including Secretary for Food and Health, Dr Ko Wingman. Guests enjoyed performances by acclaimed singer, Mr Calvin Choy, and renowned tenor, Mr Samuel Huang, and enthusiastically supported the charitable sale of environmentally friendly blankets. We would like to take this opportunity to extend our heartfelt thanks to all the guests and donors for their support of HKAHF and its work in the community! From top to bottom Ms Katherine MA (third from right), Chairman of Tung Wah Group of Hospitals. (From left to right) Mr LEUNG Wai Kwong, Jason, CEO of Yan Chai Hospital; Dr CHENG Shing-fung, Baldwin, Chairman of Yan Chai Hospital; and Mr LEE Yat Sun, Deputy Chief Executive of Yan Chai Hospital. (From left to right) Ms Juliana LAM, Professor Alice CHIU, Mr Alex LAN, Dr KO Wing-man, Ms Jo SOO-TANG, and Dr Alan LEE. Dr KO Wing-man (center), the guest of honor at the event, supports the charity sales managed by student volunteers from the HKAH nursing schools. Mr HUI Wai-kwong, Sam, Chief Staff Officer of the Auxiliary Medical Service (far left) and Mr SHIH Wing Ching, founder of Centaline Property Agency Limited (second from right), take a photo with members of the Board of Governors of HKAHF. 13

16 CHARITY EVENTS There are seven auction items. The 7.14-carat ruby, donated by Ms Juliana LAM, is the hottest item of the night with the highest price of HK$500,000. From left to right Mr Hing CHAO bids for one of the auction items. Ms JIN Ling hosts the auction at the event. Mr Real DING (fourth from right) successfully bids for a painting titled, I am good at keeping the spirit of righteousness, by famous painter, Mr Kinsan CHUNG (third from right). Mr Samuel Huang, a world-class tenor, performs O sole mio. Three doctors also perform at the gala dinner in a charitable effort to raise more funds for the Foundation. Top Mr Calvin CHOY (right) sings and also, together with Ms Juliana LAM, encourages guests to donate. All attending guests received a fleece blanket as souvenir. Mr Samuel HUANG delivers a stirring musical performance. Mr Ricky FAN (left) and Ms Heidi CHU are the masters of ceremony that evening. Bottom (From left to right) Dr Peter LO, Dr CHAN Lung Wai, and Dr Monty LEE perform at the dinner to raise funds. Hong Kong Adventist Hospital Stubbs Road 40 Stubbs Road, Hong Kong (852) hkahinfo@hkah.org.hk Hong Kong Adventist Hospital Tsuen Wan 199 Tsuen King Circuit, Tsuen Wan, NT, Hong Kong (852) info@twah.org.hk