Loyce Chua Mee Har,
Dosimetrist, Department of Therapeutic Radiology,
National Cancer Centre

Loyce will be heading to the University of California, San Francisco in USA to be trained in Intensity Modulated Radiation Therapy (IMRT) treatment planning of breast cancers.

IMRT represents one of the latest and advanced technique in radiotherapy. It uses computer-generated images to plan and deliver  more tightly focused radiation beams to cancerous tumours than is possible with conventional radiotherapy. This is made possible by 3-dimensional planning, as opposed to the conventional form of radiation therapy which is done on 2-dimensional planes. IMRT therefore enables clinicians to more accurately deliver a precise radiation dose to the shape and depth of the tumour while significantly reducing the adverse effects of doses on healthy tissues.

NCC is leading in this form of treatment, having first implemented the use of IMRT in the treatment of Head & Neck cancers in 2001. It has since expanded the use of IMRT for the treatment of Prostate Cancer and aims to further the use of IMRT in breast cancer. More than 300 patients have received treatment through IMRT since it first started. Most of these patients suffer from nasalpharygeal cancer.

At present, IMRT is not used in the treatment of breast cancer in NCC or Singapore. Loyce will be the first Dosimetrist to be trained in the treatment planning for the use of IMRT in breast cancer. 

NCC sees 400 - 500 breast patients yearly and the number is on the rise. With today's effective breast screening efforts, we are seeing more cases as they are being detected early. As these patients tend to live longer, the concern is also to reduce the side effects of radiation treatment. This can be achieved with the use of IMRT for the treatment of breast cancers.

As a Dosimetrist, Loyce's role in the delivering of treatment involves working out the appropriate doses of radiation to be delivered, through a dedicated software programme linked to the IMRT machine and planning the delivery of the treatment.  Loyce works hand in hand with oncologists; who diagnose and prescribe the treatment, pharmacists who oversee the planning of the prescribed treatment; and radiation therapists who deliver the prescribe and plan treatment to the patient.

Carol Mary Remedios
Senior Physiotherapist, Rehabilitation Department
KK Women's and Children's Hospital

Carol's HMDP training will be in the area of Neurodevelopmental Treatment/Therapy (NDT). She will be spending eight weeks in Australia for the training and another eight weeks in USA for a clinical attachment either with the Rehabilitation Institute of Chicago or The Children's Hospital of Philadelphea.

NDT is a therapeutic approach to the assessment and management dysfunction in people with neurological impairments. These include children with cerebral palsy and children with developmental delay (not a result of a medical condition). The ultimate goal of treatment and management is to maximise the person's functional disability. NDT emphasises on therapeutic handling which focuses on making desired movements more possible, while preventing undesired movements. It essentially works by getting the patient to use muscles as how these should be used, especially muscles which patients may not be aware of.

More information on NDT can be found at the following url:
http://www.pathwaysawareness.org/inter_NDT.php

NDT is a fundamental skill, which physiotherapists wishing to advance their clinical skills should be equipped with. Popular in the States and Australia for example, it is a relatively new field in Singapore. Acquiring of this skill is only possible through post graduate education and accreditation and it is only available overseas. This would add on to Carol's initial exposure to NDT from her undergraduate training in UK.

Carol will be the first Physiotherapist to be trained in NDT at KKH, especially in applying NDT to children. KKH works with children with neurological disabilities on a daily basis and NDT would add on to the breadth  and scope of techniques which could be applied to the patients. Her new found knowledge and skills upon completion of her training will augment the recently established multidisciplinary Neurology Rehabilitation Service. This service focuses on the rehabilitation potential of neurologically challenged patients and provides therapy and support for the patients while they are hospitalized, and provides follow-up therapy for discharged patients.

Apart from picking up the abovementioned specialised skills, Carol is also hoping to learn from the best centres in the world in this field and see how these could be applied at KKH to further improve patient care and service.

Noor Asiah Bte Abu Aman
Nurse Clinician
Changi General Hospital

Noor Asiah will be heading for her HMDP training later this year at the Concorde Hospital in Sydney Australia. She will be going for a clinical attachment in the Management of Acute & Chronic Stroke Patients. Her expected duration of training is two months.

With an ageing population, the number of stroke patients are expected to rise in Singapore. In fact, anecdotely, there has already been an increase in the number of patients with stroke seen. Hence, the need to build expertise in this area is even more important as the care and management of a stroke patient is complex and has long term implications. Proper care and management of stroke patients can lead to quicker and better recovery, hence a better chance of these patients being more independent, leading to a lesser burden of care.

CGH has recently started an acute stroke unit which is still in its infancy stage. Therefore, Nurse Clinician Noor Asiah's HMDP training at Concorde Hospital is timely as she is hoping to bring back with her skills and knowledge that would contribute towards the further development of CGH's acute stroke unit. She is keen to find out more about the latest trends in the management and treatment of stroke - both acute and chronic.

Noor Asiah will also be looking to learn from the hospital's community programme for stroke patients, i.e. how these patients are cared for in the community, especially for chronic stroke patients. This is an integral part of the holistic care of a stroke patient, because eventually, they would have to be discharged and cared for by their family members or others within their community.

Concorde Hospital in Sydney was chosen because of its well-known and well-placed stroke management unit, in addition to their well-established community programme for stroke patients.

Nurse Clinician Noor Asiah is a geriatric trained nurse and her HMDP training will add to her specialty training.