KK Urogynaecology, Centre for Advanced Pelvic Floor Reconstruction and Bladder Dysfunction. KK UG Centre, Clinical Outcome of Pelvic Organ Prolapse, C

KK Urogynaecology (UG) Centre is the first urogynaecology centre in Asia to provide one-stop services for the investigation and treatment of female bladder disorders and pelvic floor dysfunction.

The KK UG Centre is equipped with sophisticated equipment to help accurately diagnose urogynaecological problems. Its aim is to provide the best and affordable medical care to patients.

The Centre saw 2,046 new patients and 6,789 follow-up patients in 2006. Currently, it has 3 full-time urogynaecologists, 2 visiting urogynaecologists and 2 urodynamic-trained nurses.

The Centre also conducts training for both local and overseas doctors and is intensively involved in clinical research.

• Clinical Outcome of Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a common condition & 10% of the female population has symptomatic POP.

The surgeries offered by the centre for the treatment of POP are:
• Vaginal Hysterectomy (VH)
• Manchester Operation
• Pelvic Floor Repair
• Sacrocolpopexy
• Sacrospinous Ligament Fixation (SSLF)
• Sacrohysteropexy
• Gynaemesh in Cystourethrocele repair
• Sacrospinous Hysteropexy
• Prolift Mesh system for severe POP

We perform an average of 400 vaginal hysterectomies, 500 pelvic floor repairs and 100 sacrospinous ligament fixations each year for the treatment of pelvic organ prolapse.

Vaginal hysterectomy has an excellent surgical outcome with low post-operative morbidity and can be performed concurrently with other prolapse or continence surgeries.

Depending on the type and severity of vaginal wall prolapse, the pelvic floor repair can be either for the correction of bladder prolapse (cystourethrocele) or rectal prolapse (rectocele). In the past few years, Gynemesh *PS has been used to reinforce the cystourethrocele repair in severe bladder prolapse. This has been superseded recently by the use of the Prolift Mesh system, where the patient can decide to remove or to conserve the womb.

We are the first centre in Asia to start using Gynemesh*PS & the Prolift mesh system in pelvic floor reconstructive surgeries for severe bladder, vault or uterine prolapse.

Pelvic Organ Prolapse One Year Cure Rate*
Pelvic Floor Repair (PFR)
- Cystourethrocele Repair
- Rectocele Repair

83%
96%
Sacrospinous Ligament Fixation (SSLF)
- Severe Uterine Prolapse
- Vault Prolapse

96%
94%
Gynemesh*PS in Cystourethrocele Repair

86%
Anterior Prolift for severe or recurrent Cystourethrocoele
Posterior Prolift for severe Retocoele or Vault Prolapse
Total Prolift for severe Pelvic Organ Prolapse or severe Cystourethrocele
with Vault Prolapse

95%
100%
88%

* The cure rate is defined as the percentage of patients who has undergone the operation successfully without any recurrence.

• Clinical Outcome of Stress Urinary Incontinence (SUI)
Stress Urinary Incontinence affects 12-15% of the women population. For women who are 50 years old and above, the risk of having SUI increases to 1 in 3 women.

The common surgeries for the treatment of SUI are:
• Burch Colposuspension
• Tension-free Vaginal Tape (TVT)
• Tension-free Vaginal Tape-Obturator (TVT-O)

The Burch Colposuspension was formerly the gold standard in the surgical treatment of female SUI. With the invention of TVT in 1996, TVT has revoluntionalised the surgical treatment of female SUI and is now the gold standard. KK UG Centre is proud to be the second centre in Asia to introduce the TVT procedure in late 1998. We have performed more than 1,800 TVT procedures to date.

With the constant advancement in surgical techniques and devices, the operative time and complication rates have been further reduced with the introduction of the TVT-O. In 2004, KK UG Centre was the first in Asia to perform the TVT-O procedure, and since then, it has performed more than 800 TVT-O procedures.

Stress Urinary Incontinence
One Year Outcome*
Cure
Improved
Failure
Burch Colposuspension 90% 10% 0% TVT 94% 4.8% 1.2% TVT-O 95.2%
3.6% 1.2%

* The definition of Cure, Improved & Failure are as follows:
Cure: Symptoms successfully treated and tests were negative
Improvement: Symptoms improved significantly
Failure: Persistent of symptoms

In August 2006, the KK UG Centre has started performing TVT-SECUR procedure which can further reduce the risk & morbidity of surgery. The Centre is once again the first in Asia to start this procedure. The long-term results of TVT-SECUR are still under evaluation.

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Trends of Eclampsia in KKH, significantly to maternal, pre-eclampsia poses substantial risks for the obstetric patient and her baby

As the largest maternity facility in Singapore, and one of the largest in South-East Asia, KKH provides care for over 14,000 women and their babies every year. This amounts to about one-third of the total number of babies born in Singapore.
Perinatal Mortality Rates.

The hospital is recognized for its Integrated Labour Ward Risk Management Programme, a comprehensive risk management programme that features speedy staff mobilization, constant reviews and audits, training as well as a computerized early-warning system. The programme identifies and manages potential risks in the delivery suite, thus helping to improve the safety of women in labour and their newborns.

So successful is the programme in ensuring patient safety that KKH’s perinatal mortality rate for 2005 is 4.92 per 1,000 births – one of the lowest in the world.

Eclampsia Rates

Pre-eclampsia and eclampsia are diseases in pregnancy, which contribute significantly to maternal and foetal mortality and morbidity. Severe pre-eclampsia poses substantial risks for the obstetric patient and her baby. Utero-placental perfusion is severely compromised, which puts the fetus at high risk for problems such as preterm birth and perinatal mortality. It may also lead to severe maternal hypertension and multi-systemic organ dysfunction and damage, including eclampsia and abruption placentae.

The incidence of eclampsia in KKH has dropped significantly from 101.3 per 100,000 births in 1995 to 6.9 per 100,000 deliveries in 2004. This rate is likely to be the lowest for a tertiary maternity hospital. The implementation of improvement strategies for the reduction of eclampsia, and an introduction of regular medical education for doctors involved in antenatal care of pre-eclampsia, have led to this low rate.

Trends of Eclampsia in KKH

Period 1955 1957 1968 1981 1990-1993 1994-1999 1999-2003

Incidence per 100,000 deliveries 337.5 288.4 140 33.1 45.3 67.2 16.2

Risk of Eclampsia 1:296 1:348 1:715 1:3025 1:2270 1:1489 1:6160

Maternal Mortality – (%) 7.8 - - - 3.7 1.6 0

Perinatal Mortality – (%) 26 - - - - 9.7 - 0


Cesarean Section in KKH


KKH's Cesarean section rate in 2005 was 27%, lower than most hospitals in Singapore.

In 1995, the Royal College of Obstetrics and Gynaecology published an organisational standard for maternity service in which they proposed a maximum 30-min interval time between the decision and time of delivery for urgent Caesarean sections.

In 1997, KKH established a protocol named for extremely urgent Caesarean section (“crash” CS). Once the decision for “crash” CS was made, a public announcement system was used to activate the obstetrician, the anaesthetist, the neonatologist as well as the operating theatre staff that a “crash” CS was required.

Following this protocol, an internal audit was conducted by the hospital from Feb 2003 – Feb 2004 and it revealed that the hospital was able to achieve 100% of deliveries within 30mins with the protocol, reliably achieving the standards laid down by the Royal College of Obstetrics and Gynaecology.

1998 (1 year audit) 2003 (6 months audit)

Total no. of deliveries 16,267 7,512

Total no. of caesarean sections 3,367 1,728

Crash Caesarean 113 45

Mean Delivery Time (mins) 14.9 7.5

Patients delivered < 30 mins 112/113 45/45



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KK Gynaecological Cancer Centre, HPV Vaccine Trial - FUTURE II Study, papilloma virus, cervical cancer, Cancer of the Cervix, Cancer of the Uterus

The mission of the KK Gynaecological Cancer Centre (GCC) is to provide an excellent, efficient and compassionate service to our patients through better care made possible with the highest ethical standards and professionalism.
KK Gynaecological Cancer Centre is the only centre in Singapore and Asia to participate in the HPV Vaccine Trial - FUTURE II Study. This is a worldwide trial on a vaccine to protect women against the human papilloma virus (HPV), which causes cervical cancer.

We are the only treatment center in Singapore to offer this HPV vaccine to the women of Singapore.

Cancer of the Cervix

In its earliest stages, cervical cancers are highly curable. Early detection is therefore the key to improving survival.

Here at KKH, our 5 year survival rate for Cervix cancer is:-

Stage 1a 98%
Stage 1b 84%
Stage 2a 71%
Stage 2b 50%


Cancer of the Uterus
Cancer of the uterus is the third commonest cancer of the female genital tract in Singapore. It usually affects the endometrium (lining of the uterus). If treated early, the cure rate is very good.

Here at KKH, our 5 year survival rate for Uterus cancer is:-

Stage 1 92%
Stage 2 90%

Ovarian Cancer

Epithelia cell cancers of the ovary are more common than germ cell cancers. Names of different types of epithelia ovarian cancers include mucinous or serous cystadenocarcinoma, clear cell carcinoma and endometrioid carcinoma of the ovary.

For very early stage disease and non-aggressive types, further treatment may not be required. For the more advance and aggressive types of cancers, often chemotherapy is the treatment of choice.

Here at KKH, our 5 year survival rate for Ovarian cancer is:-

Stage 1 90%
Stage 2 55%




KKIVF Centre, infertility, diagnostic, frozen embryo transfer of 22

IVF Success Rate

KKIVF Centre is a leading infertility center in South-East Asia, offering a comprehensive range of diagnostic and treatment procedures for infertility related services.



The center has:-

* Performed more than 800 cycles in 2005
* Achieved a consistently good clinical pregnancy rate between 34% to 40% over the past four years
* Achieved clinical pregnancy rate per frozen embryo transfer of 22%

In 2001, KKIVF achieved the 1st Laser Assisted Hatching pregnancy in Singapore, which resulted in a live birth in May 2002.

Improvements in clinical techniques, embryo culture techniques and embryo selection have also led to a rise in success rates & a reduction in the risks of multiple pregnancies. Over the last 3 years, our elective double embryo transfer cycle (hence, avoided the risk of triple pregnancies) achieved an average of 42% success per embryo transfer.
Asia’s first IVF (In-Vitro fertilization) baby was born in KKH on 19 May 1983.

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Hospitals in the Asia-Pacific, Paediatric Surgery, Vermont Oxford Network , Transplant and Leukemia survival rates, High Risk Asthma Outcomes, Women’s

As a leading hospital for women and children, we constantly strive to achieve a higher standard in clinical care through the use of Clinical Indicators across all medical departments. Clinical Indicators also allow patients the ability to make choice decisions for their treatment.

International Reputation
1. We are the first hospital in Asia Pacific to receive the prestigious Asian Hospital Management Award (AHMA) for measures taken to improve the safety of women in labour and their newborns.
2. KKH has gained accreditation from the US-based Joint Commission International (JCI) in 2005, which affirmed the quality of our patient care and safety.

Local Reputation

1. Spring Singapore (previously the Productivity and Standards Board) awarded KKH the coveted People Developer award in 2000. This award recognizes the hospital’s investment in a comprehensive system for developing our people and to bring out the best in them.
2. In 2005 KKH achieved the Singapore Quality Class Award. It is conferred by SPRING Singapore to selected organization which have demonstrated commitment to business excellence, measured in the following dimensions – Leadership, Planning, Information, People, Process.

Medical Reputation
1. KKH is the accredited center with the Royal College of Obstetrics & Gynaecology (UK) in obstetric ultrasound.
2. KKH's Department of Diagnostic Imaging is accredited as a training centre for paediatric radiology by the Royal Australian and New Zealand College of Radiologists (RANZCR).
3. KKH’s Gynaecological Cancer Centre is accredited as a recognised training centre for fellows pursuing the Certificate/Diploma in Gynaecological Oncology of the Royal Australian-New Zealand College of Obstetrics & Gynaecology (RANZCOG).

Some of our hospital’s progresses in clinical excellence are:

Women’s Services

* Gynaecological Cancer Centre
- 5 year survival rate for Cervix Cancer
- 5 year survival rate for Uterus Cancer
- 5 year survival rate for Ovarian Cancer

* KK IVF Centre
- IVF Success Rates

* Obstetrics
- Perinatal Mortality Rates
- Eclampsia Rates
- C-Section Rates

* KK Urogynaecology Centre
* KK Minimally Invasive Surgery Unit


Children’s Services

* High Risk Asthma Outcomes
* Transplant and Leukemia survival rates
* Vermont Oxford Network
* Paediatric Surgery
- Laparoscopic Surgery for Appendicitis Outcomes - Updated
- Post-Tonsillectomy and post-adenoidectomy Hemorrhage in Children

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ADHD, Viennese School of Medicine, World Federation of ADHD, symposia, video, events, workshops and guided poster tour, Young Scientist Sessionsand, p

We are very pleased to invite you to one of the cities of the world's most interesting, Vienna (Austria), for the International Congress on ADHD which will be held 21-24 May 2009.

The beauty of this city rich in history and culture, the famous "Viennese School of Medicine" extraordinary and many hot spots will make the congress in the heart of the spectacular event.
Following this Congress
1. Würzburg Congress in a successful big step forward and collect outstanding scientists on ADHD from the five continents with more than 1.600 Attendees from 68 countries will be the most important we highlight the World Federation of ADHD.

A very good collection of scientific sessions have been developed based on suggestions from members of the international Scientific Program Committee: interactive educational seminars, plenary lectures with rewarded experts, hot topics symposia, video, events, workshops and guided poster tours.
Young scientists, especially for those who are present in the search for Young Scientist Sessionsand so that the benefits from Congress. The 2nd International Congress on ADHD will improve our understanding of ADHD as a multidimensional development of psychopathology, as the disruption of short-term living with a complex etiology.

Topics of the congress covers all aspects of the neurobiological, psychological, and social correlates of ADHD, Transcultural and influence of gender and age dependent comorbidity. Presentations will be given to psychotherapeutic and psychopharmacological topics, discuss the results of the treatment efficiency, effectiveness and quality of life aspects. The congress will focus on five main topics bridging the gap between:


1. Our scientific and clinical knowledge on ADHD from early childhood on, through persistence and continuity in youth to adult, the lifespan development perspective will return one of the pillars of the most extraordinary scientific program of the congress, a fast developing science and clinical knowledge in adult ADHD topics that will be extraordinary.


2nd Our knowledge about the most obvious symptoms of psychopathological behavior, the various features related to the structure of the brain, brain metabolism and brain function, psychological and biological related endophenotypes of the human body in general and their interaction with genetic and environmental correlates considered from the perspective of development.


3. The majority of the research purpose, method and discipline: Child and Adolescent Psychiatry, Adult Psychiatry in cooperation with the clinical and basic research disciplines such as epidemiology, statistics, brain imaging, neurochemistry, physiology, psychology, psychotherapy, neuropsycho-pharmacology and the development of genetics.


4th Transcultural understanding of a variety of ADHD, its comorbidities and gender specifics.


5th Psychotherapy and psychopharmacology.

Come and enjoy the city of Vienna and the Congress to combine hard work with the social and cultural interest, meeting colleagues and strengthen cooperation and friendship. But most of all, do not miss the unique opportunity to share knowledge which is the power of the World Federation of ADHD and profession.are our knowledge that is power of the World Federation of ADHD and our profession.

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Discover a fast, proven system that you can use a successful and peaceful TAKE ON OF CANCER diagnosis in only a few hours each day ... Learning to suc

My name is Jennifer Mamby-Alexander, and I've got to ask questions of people who can change your life now ...

Are you depressed by cancer diagnosis, if you do not have a family history of cancer and mind you do everything right, in the case of a healthy lifestyle?

Now, I am sure you are overwhelmed, confused and not know where to turn. Your most frequently asked questions is probably "What is wrong and what should I do now? No doubt, you will experience a number of mixed emotions.

My aim is to encourage and inspire you to challenge in all this.

There are many challenges to face, and adjustments to all the uncertainty that leads to cancer diagnosis can be difficult and will require time, BUT I assure you that there are practical ways to educate and EASY YOUR SELF that will help you to overcome, starting RIGHT NOW.

Remember that the battle to overcome the difficulty is done mostly in your mind, and that every day when you pass the exam, you will be closer to one the following day. You should not give up or settle for less.

I have an incredible opportunity I'm about to share with you ...



Believe me, I feel your concern and your pain and I know exactly what you are experiencing. I am the best person to help you.

I am a doctor who diagnosed and triumphed over breast cancer for 20 years. I do not have a history of cancer in my family and I live a so-called healthy lifestyle. When I was diagnosed, I remember I too depressed, surprised and pained, and I also "What do I do now?" Surprising, because my doctor does not easily hurt. However, I become a unique experience to become a doctor and patient, now I created a new authority to guide you through the challenges of cancer. Not only that ...

* I have councelled and guidance through the challenges of cancer patients with cancer, some of them are now living healthy for more than 15 years.
* I have absolute proof that the methods work, as I am a survivor of survivors coped well and advanced breast cancer.
* I am a mother of three wonderful boys, and continue dancing, playing sports and living an active life despite the challenges.

I am proud of my achievement, and I worry you to achieve the same results, with the only change of focus with some new thoughts and ideas for several hours each day. Believe me, even if you do not diagnosed "early", there are ways to cope and survive.

Here is proof.

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Errol Dr Daley is a doctor and gynecologist,

READ WHAT OTHERS HAVE SAID

* "Dr Mamby-Alexander to help me when I needed him, and now I am happy that he finally available to other people with similar challenges"

Donna is 15 years old cancer survivor Payudara

* "Although from the experiment and Suffering from the disease, Dr Alexander Mamby-Stocks with the development of our character to him, he lives and strengthen Inspiration from the ambitions, by triumphing over cancer. He has a formula on how to win over all our difficulties."

"Dr Mamby-Alexander died and the personal struggle he afraid to produce an inspirational, detailed terms and Help for coping with cancer."

Dr. Garth Rattray is a Medical Practitioner

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Benign breast, cancer diagnosis, chemotherapy, mastectomy, breast cancer, lymph nodes, coping methods, Believe me, I've been EXACT, LET CANC

When I considered to be young and healthy, I am surprised by a lump in the breast. All tests are negative and with negative family history, I have considered benign breast disease.
Constant after three years of follow-up diagnostic tests and missed, and I finally correct diagnosis with breast cancer when a lump is much bigger in size, and not known to all, also have to spread to my sternum. I was treated with chemotherapy and a mastectomy for Stage I breast cancer re-scan my lymph nodes and no evidence indicates that spread. Because of the missed and delayed diagnosis during the 3 years I was forced to apply the method of coping with cancer who are working very well for me over the years, and being16 after years in remission, the cancer cells hiding in the sternum was eventually found. My sternum was removed and treated with radiation therapy. Now, I'm 20 years since the initial diagnosis and I continue to live a healthy, happy and productive life, only apply to the relatively simple coping methods every day.
I am so excited about what they have done and hope I can help you do the same.
Believe me, I've been in the EXACT same place you are now in the ... I remember the stress, fear, questions unanswered, the hopelessness and even a sense of loneliness that you feel right now. But it's not like that for me and I want to help you to be more in charge of your life and to overcome this disease as me. Let us together to change this to be more positive. You deserve the best for themselves and nothing less. It is time to make changes in your life, for the better, right NOW. LET CANCER BE A LIFE EXPERIENCE FOR YOU This is why I collect this guide "A Practical Guide to coping with cancer." I have to learn these secrets through costly "trial and error," and this is the secret to learning about you today.

My life is tested proven strategies and advice given in the book. YOU do not need to make a mistake made and I think your way through the treatment - I've done that to your principal, and as a result, you will learn how to prove simple but can be used to easily prepare for cancer diagnosis, and calmly face the challenges to its .

With the encouragement and tips provided, you will easily overcome your fear of cancer through education and practical ways to address them.
This is the book you want is owned BEFORE your experience with cancer.
My strategy has been proven by me and some of my patients, and the best things about them is ... * You do not need to search for answers * You need not be too depressed about the future.

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