SPEAKERS

    Plenary 1: Public-Private Collaboration – Lesson from the Pandemic

    DatoMohdShukrieMohdSalleh

    Dato’ Mohd Shukrie Mohd Salleh

    President & Managing Director KPJ Healthcare Berhad

    Speaker Profile

    Appointed on 1 April 2022, Dato’ Mohd Shukrie is a Chartered Accountant with the Malaysian Institute of Accountants and holds a Degree in Business Studies from the University of North London. Dato’ Mohd Shukrie brings to the table a wide spectrum of in-depth experiences spanning leadership roles in key transportation and logistics companies as well as in the areas of consumer and corporate banking, corporate finance and advisory, mergers and acquisitions, financial services, risk management, human resources and procurement. He began his career with Public Bank Securities Sdn. Bhd. And subsequently served with United Overseas Bank Berhad.

    In 2005, he joined DRB-HICOM Berhad as its Senior Manager, Corporate Finance & Advisory and then went on to assume several leadership roles within the Group including that of Principal Controller, Chief Financial Officer (“CFO”), Chief Operating Officer (“COO”) and Chief Executive Officer (“CEO”). During his tenure with the DRB-HICOM Group, he served as the CFO for Puspakom Sdn Bhd from 2006, the CFO/Principal Controller of KL Airport Services Sdn Bhd from 2007, and subsequently as its CEO/COO between January 2009 and June 2011. He then assumed the position of Group COO of Pos Malaysia Berhad in July 2011 and was thereafter re-designated as its Covering Group Chief Executive Officer in February 2013.

    In December 2013, Dato’ Mohd Shukrie became the CEO of Konsortium Logistik Berhad and later assumed the position of Group CEO of Pos Malaysia Berhad in November 2015. From February 2018 to April 2019, he assumed dual positions of CEO of Redbox Logistics and COO of AirAsia Malaysia. Subsequently, he joined Malaysia Airports Berhad (“MAHB”) serving in the capacity of COO (May to December 2019), Acting Group CEO (January to February 2020), and Group CEO (March 2020 to October 2021), where he has been instrumental in steering the Group through the worst period of the pandemic and sustaining the MAHB’s operation and financial stability.

    His involvement in the healthcare sector further widened into other organisations including being an active member of Association of Private Hospitals Malaysia (“APHM”), assuming the role of Vice President of the association in June 2022.

    Abstract

    Public-Private Collaboration (PPC) has been practiced in numerous forms across multiple sectors in Malaysia. The recent Covid-19 pandemic showed how the private healthcare sector can be galvanized to assist the government in times of crisis. The Pandemic has tested our country’s healthcare system like never before and stretched the country’s public health and public hospitals to the very limit. As the pandemic unfolded, we watched with concern the rising numbers of cases, the daily number of deaths, the acute shortage of ICU beds and ventilators, and shortages of certain medications.

    From the beginning of the pandemic KPJ through informal and formal meetings offered assistance to the government, specifically the Ministry of Health. We started doing the Covid-19 confirmatory tests early on in the pandemic to relieve the pressure in the government laboratories. There were 1.16 million tests done from February 2020 to June 2022 by KPJ Lablink. The rapid turn-around time provided by our laboratories helped in diagnosis, contact tracing, and placement of patients in hospitals and dedicated centers.

    As the number of Covid-19 cases increased in public hospitals, elective surgeries and procedures were deferred. In the later part of 2021, the Ministry of Health started decanting non-Covid cases to our hospitals. These included surgical and medical cases as well as referrals for imaging studies such as CT scans and MRIs.

    Under the public-private partnership, our hybrid hospitals assisted the Ministry of Health (MOH) in alleviating the stress put on public-sector hospitals through our offer of more than 100 types of services and procedures to MOH-decanted non-COVID-19 patients. This freed up the MOH’s capacity to better manage COVID-19 cases. We also provided supplies and equipment such as ventilators, as well as facilitated the nationwide secondment of medical professionals to the government healthcare system during the pandemic.

    KPJ also answered the call to expedite the rate of vaccination in Malaysia through the Governments’ National Immunisation Programme (NIP). KPJ plays vital support to the nation’s fight against the pandemic through participation in the Governments’ National Immunisation Programme (NIP). Our involvement initially saw 10 of our 28 hospitals nationwide operating as Vaccination Administration Centres or Pusat Pemberian Vaksin (PPV) for frontliners from within the KPJ Group as well as other private healthcare operators.

    KPJ then went on to continue support for Phases 2 and 3 of the NIP by working alongside The Special Committee for Ensuring Access to COVID-19 Vaccine Supply (JKJAV). In March 2021, we started our collaboration with the Ministry of Health and ProtectHealth Corporation Sdn Bhd for the vaccination program throughout the country. We ultimately had 22 of our 28 hospitals nationwide serve as PPV to play a part in Phase 2 and 3 of the NIP.

    KPJ is also among the healthcare players which supported the Mega PPVs at the Kuala Convention Centre (KLCC) and Mid Valley, South Key in Johor Bahru. Clocking in at almost 15,000 vaccinations daily at the height of the NIP, KPJ was the single largest private healthcare provider supporting the national programme. On top of this, a total of 13 of KPJ’s Klinik Waqaf An-Nur (KWAN) clinics and four mobile clinics set up information and registration kiosks have assisted with the registration of vaccine recipients via the officially approved platforms.



    Plenary 2: Beyond the Hippocratic Oath: A Planetary Health Pledge for the Malaysian Medical Community

    ProfTanSriDrJemilahMahmood.png

    Prof. Tan Sri Dr. Jemilah Mahmood

    Executive Director, Sunway Centre for Planetary Health, Sunway University

    Speaker Profile

    Dr. Mahmood is a medical professional with more than two decades experience managing crises in health, disasters and conflict settings. She is currently Professor and Executive Director of the newly established Sunway Centre for Planetary Health at Sunway University in Malaysia. She is currently a member of the Malaysian Climate Action Council and Consultative Council for Foreign Policy and a Senior Fellow of the Adrienne Arsht-Rockefeller Foundation Resilience Centre. Dr. Mahmood is also the Pro-Chancellor of Heriot-Watt University Malaysia. She is a strong advocate of planetary health and sustainability and actively advises on Environment, Social and Governance in the board roles she holds.

    She was the Special Advisor to the Prime Minister of Malaysia on Public Health and member of the Government of Malaysia’s Economic Action Council from April 2020-September 2021. Previous appointments include the Under Secretary General for Partnerships at the International Federation of Red Cross and Red Crescent Societies (IFRC), Chief of the World Humanitarian Summit secretariat at the United Nations, and Chief of the Humanitarian Response Branch at UNFPA. She is the founder of MERCY Malaysia, a southern based international humanitarian organisation.

    Dr. Mahmood is currently on the board of the Employees Provident Fund of Malaysia, National University of Malaysia, CVS Foundation and ALAM Foundation in Malaysia and joined the board of Roche in Switzerland in March 2022. She is also the Chair of the Surin Pitsuwan Foundation based in Singapore.

    She is the recipient of numerous national and international awards including the most prestigious Malaysian Merdeka Award in 2015 and the ASEAN Prize in 2019, for her contribution to peace, community development and humanitarian work. She also received the inaugural Isa Award for Humanity in 2013.

    Dr Mahmood graduated as a Doctor of Medicine (MD), has a Masters in Obstetrics & Gynaecology from the same university and is a Fellow of the Royal College of Obstetricians and Gynaecologists United Kingdom. She also completed executive education at the International Management and Development Centre, IMD Lausanne.

    Abstract

    The global COVID-19 pandemic has tested our resilience in more ways than one, but has also unquestionably highlighted the relationships between health, environment and economy. What are the roles of current and future generations of health professionals? How can we extend the Hippocratic Oath to address the impending and tougher challenges affecting not only health of humanity, but health of the planet?



    Symposium 1: Impact of COVID-19 on the Community
    The Long Covid – An Evolving Problem

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    Dr Tengku Saifudin Tengku Ismail

    Consultant Physician & Respiratory Medicine, KPJ Tawakkal KL Specialist Hospital

    Speaker Profile

    Assoc Prof (C) Dr Tengku Saifudin Tengku Ismail is a Consultant Physician & Respiratory Medicine in KPJ Tawakkal Hospital since 2014. He was previously an Associate Professor and Head of Department in Medicine Discipline in Faculty of Medicine, UiTM. He is a Fellow of the Royal College of Physicians and Surgeons of Glasgow, Royal Collegeyazlihamzah Physicians of Edinburgh and the American College of Chest Physicians. He has a Diploma in European Adult Respiratory Medicine and obtained his MD in Glasgow University in 2006 working on Pigeon Fanciers Lung.

    He has participated and led research in COPD, Asthma and various respiratory diseases and had obtained research grants and published articles on airway diseases. He is internationally recognized as a certified trainer in Bronchoscopy by the World Association of Bronchology and Interventional Pulmonology (WABIP) and is certified as a lung function (Spirometry) trainer by European Respiratory Society (ERS).

    Abstract

    Long COVID or Post COVID-19 conditions occur in individuals’ weeks or months after acquiring SARS-CoV-2 infection which cannot be explained by an alternative diagnosis. Common symptoms include fatigue, cough, shortness of breath, chest pain, cognitive dysfunction but also many others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time. The long-term symptoms following COVID-19 have been observed across the spectrum of diseases severity. Majority of people with Long COVID are PCR negative, indicating microbiological recovery. Long COVID is the time lag between the microbiological recovery and clinical recovery. Majority of those with Long COVID show biochemical and radiological recovery.

    The most effective means by which to prevent Long COVID is to prevent COVID-19 infection. It is likely that any measure that decreases the incidence or severity of acute COVID-19 infection will in turn decrease the incidence and severity of Long COVID. Patients that are at risk of Long Covid include ICU patients requiring non-invasive ventilation or mechanical ventilation, patients with preexisting respiratory disease, higher BMI, older age and have dyspnoea at 4-8 weeks follow up. The time to symptom resolution appears to depend upon premorbid risk factors as well as the severity of the acute illness and spectrum of symptoms experienced by the patient.

    Fatigue is by far the most common symptom experienced by patients regardless of the need for hospitalization. Although the fatigue resolves in most patients, it can be profound and may last for three months or longer, particularly among ICU survivors. Rehabilitation with exercise-based regime may be helpful to hasten recovery. Breathlessness usually resolves slowly in most patients over two to three months but may persists up to 12 months. This may occur despite normal SpO2 levels. Assessment of progression or recovery may include home pulse oximetry, 6 MWTs, lung function test, CXR, echocardiography and CT Thorax. Lung function may show restrictive pattern and radiological investigations show ground glass shadowing/pulmonary fibrosis.

    Cough occurs in majority of patients and usually resolves by 3 months. It is important to exclude other causes of cough such as airflow obstruction eg asthma/COPD, infection eg pulmonary tuberculosis, rhinosinusitis and gastro-oesophageal reflux. Inhaled corticosteroids may help to hasten recovery. Concentration and memory problems can persist for six weeks or more. Common complains include headaches, problems with attention and concentration, cognitive blunting (brain fog) and mental health problems like anxiety, sleep disorder, depression and PTSD. Observational data suggest that persistent symptoms do not worsen, and may improve, following the administration of the SARS-CoV-2 vaccine. Treatment of Long COVID requires a multidisciplinary approach including treatment of underlying problems, physiotherapy and rehabilitation program, occupational therapy and psychological support.


    Symposium 1: Impact of COVID-19 on the Community
    Omicron Infection – The New “Flu”?

    DrMuhamadYazliYuhana

    Dr Muhamad Yazli Yuhana, Consultant Physician & Infectious Disease Specialist

    KPJ Ampang Puteri Specialist Hospital

    Speaker Profile

    Dr Muhamad Yazli Yuhana is the infectious diseases resident consultant at KPJ Ampang Puteri Specialist Hospital, having graduated from the Royal College of Surgeons Ireland in 2005, and completed his Internal Medicine specialist training in 2012. From 2013 to 2015, he underwent his Clinical Fellowship in Infectious Diseases stint at Sungai Buloh Hospital, Kuala Lumpur General Hospital, and the National Heart Institute, as well as at the Hospital for Tropical Medicine, Mahidol University in Thailand.

    By 2018, Dr Muhamad Yazli completed his doctorate study in clinical tropical medicine at the Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University Bangkok, Thailand. He holds several active positions currently in the Asian Pacific Rickettsial Network, Malaysian Society of HIV Medicine, and is also an infectious diseases visiting consultant at the UiTM Private Specialist Centre, Sungai Buloh, Malaysia. Throughout his career, he has received research grants, and is extensively published.

    Abstract

    We are in the 3rd year of the Covid 19 infection. Where in the first 2 years, it created turmoil among medical practitioners, scientists and societies in general. Covid 19 vaccines and treatment have changed the landscape of the Covid 19 diseases worldwide including in our community, but with the current omicron variant and its new lineages, the future of Covid 19 is still unpredictable.



    Symposium 1: Impact of COVID-19 on the Community
    Vaccination In Children – Science And Prejudice

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    Dato’ Dr Musa Mohd Nordin

    Consultant Paediatrician & Neonatologist, KPJ Damansara Specialist Hospital

    Speaker Profile

    A 1982 graduate of Cardiff University (UK), he is a consultant paediatrician and neonatologist at KPJ Damansara Specialist Hospital, Kuala Lumpur. He is a Clinical Professor of Paediatrics at the KPJ International University College.

    Since 1999, he has served on various international advisory boards related to Hexavalent, MMR, Varicella, Rotavirus, Pneumococcal, Meningococcal, Human Papilloma Virus, and most recently, Dengue and mRNA COVID-19 vaccines. He is a founding member of the Asian Strategic Alliance on the Prevention of Pneumococcal Disease (ASAP) and Immunise4Life.

    He is the chief-editor of FIMA Yearbook and sits on the advisory boards of MIMS Paediatrics and International Journal of Human & Health Sciences. His latest book “Immunisation Controversies – What you really need to know” has been translated into four languages.

    Abstract

    In 2020 there were 7,730 cases among children less than 11 years old. In 2021 there were about 379,245 and for the first 3 months of 2022 alone, there have been 119,719 cases. This is probably an underestimate because children are often asymptomatic, less tested, less detected and therefore least reported. The increased burden of the infectious Omicron and sub-variants has led to several serious complications in unvaccinated children.The increased numbers of children infected has led to outbreaks in households, day care centers, kindergartens and schools. There were about 367 educational clusters prior to the school holidays. One can expect increasing reports of these clusters with the reopening of schools on 21 March 2022. There has been a 2.5-fold increase in kids being hospitalized. There is a 2-fold increase in kids admitted to the ICU for serious COVID infections namely due to MIS-C (Multisystem Inflammatory Syndrome in Children). Increasing number of deaths has also been reported in children below 18 years old. In 2020 there were 6 deaths, which increased to about 110 deaths in 2021. There were 22 deaths in children aged under 12 years old from 1 Jan – 11 March 2022, and 8 deaths were recorded during the second week of March alone, which is the highest in almost 6 months.

    The uptake of 2 doses of the vaccines for adults above 18 years, adolescents 12-18 years and children 5-11 years are 97.7%, 93.7% and 33.7% respectively. 2 major factors have contributed to the low uptake in children. Parents are freaked out by the safety of the mRNA vaccines. Misinformation is rife in social media on the dangers of the mRNA vaccines. Parents are in a “wait and see” mode which is very dangerous because the very contagious Omicron and sub-variants BA.2, BA.4 and BA.5 will not wait. The US has the largest experience with mRNA vaccines in children 5-11 years old. They have prescribed about 8.7 million doses. The AEFI were mostly mild and brief and consisted mainly of pain at the injection site, fatigue and headaches. There were 11 reported cases of myocarditis and all of the affected children recovered fully after 2-7 days. There were no causal links to any deaths. The National Pharmaceutical Regulatory Agency (NPRA) has reported the use of 1.1 million doses of mRNA vaccines up until 11 March 2022. There were 182 reports of AEFI, a rate of 0.17 per 1,000 children which is very similar to the reports from Canada and Australia. 97% of the AEFI were non serious and did not affect the child’s daily activities. Health Care Providers, parents and guardians should be reassured by these facts and figures and do not become victims of the misinformation disseminated by the fearmongering anti-vaccine groups.


    Symposium 1: Impact of COVID-19 on the Community
    Psychological Impact of Covid 19 Infection

    MsLoheswaryArumugam

    Ms Loheswary Arumugam

    Monash University Malaysia

    Speaker Profile

    Mrs Loheswary Arumugam is a Registered Consultant Clinical Psychologist. She has completed her specialty training with nearly 2000 hours with University Malaya Medical Centre and Bentong Hospital in Malaysia and became a full registered member of Malaysian Society of Clinical Psychology in the year 2015.

    In addition to her standard training, she has completed Choice Theory Reality therapy from William Glasser Institute, USA, Psychodynamic Therapy and Mental Health First Aider, certified by MHFA, Australia, Cognitive Behavioral Therapy, Family and Marriage Therapy. Currently, she is pursuing her PhD research in the area of Forensic Psychology to be considered as a specialist in the field of mental health and forensic psychology.

    Mrs Loheswary has been conducting individual and group therapy; intellectual and psychological assessments for children, adolescents and adults. She also provides training and support for caregivers, parents and teachers to learn skill-based knowledge to support mental health development for children and adolescents at school and at home. She has also been speaking in many major conferences in Malaysia and overseas in the area of therapy technique and treatment in the area of mental health. She also provides therapy, consultation and training for Non- Government agencies and government agencies in Malaysia and Overseas. Additionally, Mrs Loheswary also actively lecture and supervise psychology students from major Universities in Malaysia. She is also appointed as Industrial Training advisor for two major university in Malaysia.

    Abstract





    Symposium 2: Ethical Challenges in a Pandemic
    Can A Healthcare Worker Refuse Vaccination?

    MsMunitaKaur

    Ms Munita Kaur

    Partner Messrs Munita & Satvinder

    Speaker Profile

    Munita Kaur is a partner at Messrs Munita & Satvinder, a boutique law firm located in suburbs of Bangsar specialising in civil litigation and conveyancing. Munita is a graduate of University of London and was admitted to the Malaysian Bar in 1998. Munita also holds an LLM from University Malaya and an MA in Healthcare Ethics and Law from the University of Manchester. Munita has vast academic experience, especially in Tort Law.Munita was part of a team of leading academics at Malaysia's Primer Private Law Colleges having taught at both Advance Tertiary College, (Kuala Lumpur and Penang) and Brickfields Asia College, Kuala Lumpur, specialising in the areas Tort Law, Medical Law, Contract Law, the Law of Succession and General Paper on the Certificate of Legal Practice.

    Munita has taught health care ethics on an ad hoc basis at the Law Faculty of University Malaya, and at the Biomedical Faculty of the International Medical University. Munita has also held positions as a visiting Law Lecturer at Intect Tertiary College, Singapore, Lingnan Kong and the Polytechnic University of Hong Kong. Munita currently teachers Healthcare Ethics and Law on a part-time basis at University Malaya's Medical Faculty (MOHRE) and is part of Malaysia's Bioethics Community and a member of Clinical Ethics Malaysia.

    Abstract

    The World Health Organisation (WHO) defines vaccine hesitancy as the delay in acceptance or refusal of vaccination despite availability. The COVID-19 vaccine first became available in the early months of 2021 with health care workers being prioritised worldwide to receive some of its first doses. Whilst many health care workers rolled up their sleeves and got in line, having witnessed first-hand the horrors of the pandemic, some health care workers were and remain vaccine hesitant. A French study found 23.1% of health care workers in France hesitant and 3.9% completely against vaccination.1 In Malaysia, the Ministry of Health reported in November 2021 that there were 2,400 unvaccinated government health care workers although not all were vaccine hesitant.

    Vaccine hesitancy among healthcare workers presents a great challenge given the role of health care workers and institutions in mounting an effective pandemic response. Given the crucial role of vaccines in a pandemic and the ‘proven efficacy and safety’2 of the COVID-19 vaccine, can health care workers then ethically refuse vaccination? Laura Palazzani, Professor of Philosophy of Law says, no. “Vaccines are an ethical obligation for health professionals: their professional duty to treat the sick obliges them to avoid transmitting the infection, to operate in safe conditions, and to provide reliable information on the significance of vaccines for the protection of public health” she argues. This however begs the question of whether indeed it is that simple. Health care workers are no different from the general population they live and serve in, and although far more judicious in their consumption of information, they have reasonable fears.

    At the root of this ethical dilemma, is the conflict between public health ethics and the right to individual liberty and autonomy. Health care workers owe a duty to ‘do no harm’ which includes protecting patients and others from known or anticipated harms of infections. Placing and promoting their wellbeing first, (beneficence) and avoiding them harm (non-maleficence) are core of tenets of the profession. Whilst this is true, health care workers also have the fundamental right to make voluntary informed decisions about their own health, including refusing unwanted medical interventions (autonomy). How do we then square the circle?

    The latter half of 2021 witnessed an unprecedented raise in COVID-19 infections caused mainly by the Delta and Omicron variants. This spike in infections led to vaccine mandates for health care workers in many countries, including Italy, France, New Zealand and the United Kingdom. Mandates pushed many, but not all, to vaccinate. In France, 3000 health workers were suspended for refusing to vaccinate. Are mandates then the answer? Ethically mandates are difficult albeit not impossible to justify. However, given that mandates often end up promoting one interest over the other, they should always be employed as the last resort. Squaring the circle here involves a far more nuanced and measured response. Whether a health care worker can ethically refuse vaccination is a complex ethical dilemma and question that cannot be solved nor answered in an affirmative way. Whether a health care worker can ethically refuse vaccination depends on many variables which are often unique to that health care worker. Blanket judgements as such should be reserved.


    Symposium 2: Ethical Challenges in a Pandemic
    Tips To Deal With Challenging Situations: A Clinician’s View (Decanting)

    DrHueTeckLee

    Dr Hue Teck Lee

    Medical Director, KPJ Klang Specialist Hospital

    Speaker Profile

    Dr Hue Teck Lee obtained his medical degree from University of Malaya in 1994. He completed his postgraduate Master of Surgery in the year 2000 from the same alma mater. After his early years in training at University Hospital Kuala Lumpur, he was recognized as a clinical specialist in mid 2001, where he continued his practice until his resignation from public service in 2003. Formerly with Arunamari Specialist Medical Centre as a Surgical Consultant for 8 years, Dr Hue joined KPJ Klang Specialist Hospital in 2011. During his tenure with KPJ Klang Specialist Hospital, Dr. Hue has been appointed to the Board of Management as well as Board of Directors of the hospital. In 2020 to date, he is currently the Medical Director of KPJ Klang Specialist Hospital. An active member of the Malaysian Society for Quality in Health, Dr Hue has been a board member from 2019 to 2022, as well as an (MSQH) surveyor since February 2022.

    Abstract

    Outsourcing and decanting of non COVID 19 patients began in July 2021 till December 2021. KPJ Klang with a bed capacity of 123 beds had participated actively in the program. The decanting programme started with obstetric patients from HTAR and later extended to medical and surgical patients from Hospital Tengku Ampuan Rahimah, Hospital Shah Alam, Hospital Sungai Buloh and Hospital Serdang.

    Maternity ward contributed 10 beds and the paediatric ward was identified as the decanting ward for non-obstetric cases with a capacity of 28 beds, making a total capacity of 38 beds.

    Google sheet forms was used to update the government hospital of the bed availability and updated by the unit manager of the respective ward.

    To facilitate and enhance the communication, specialist on call roster together with hand phone numbers were made available to the government hospital so that their specialist can contact and discuss the patient condition with the recipient consultant.

    Once the patient is accepted for transfer, the respective coordinator will facilitate the transfer. An electronic tab was stationed in Emergency Department KPJ Klang to monitor the patient movement. As soon as the patient was received in Emergency Department, MRSA and COVID 19 PCR swab tests are done and the patient will be escorted to the designated rooms.

    Live chat groups were also set up to address any pressing concern to further enhance patient experience during decanting.

    A total of 345 patients were decanted during this period. HTAR: 273, HSA: 40, Hospital Sungai Buloh 22 and Hospital Serdang 10.



    Symposium 2: Ethical Challenges in a Pandemic
    What Are The Legal Implications

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    Raja Eileen Soraya binti Raja Aman

    Partner Raja, Daryll & Loh

    Speaker Profile

    Raja Eileen Soraya Binti Raja Aman is a senior partner with the firm, Messrs. Raja, Darryl & Loh and practises in the areas of civil and commercial litigation. Her practice currently focuses on medico-legal & dento-legal matters as well as reputational management and media law. Eileen has been recognized by the Asia Pacific Legal 500 2014 - 2020 as a Leading Lawyer in Dispute Resolution, and was listed in its Hall of Fame in the 2021 & 2022 edition. She was also ranked as a Leading Lawyer in Dispute Resolution in Asialaw Profiles 2016 - 2019 and as a Distinguished Practitioner for 2020 - 2022. Benchmark Litigation listed her as a Dispute Resolution Star from 2018 to 2022. In June 2020, Eileen was listed in the inaugural edition of Benchmark Litigation Asia-Pacific Top 100 Women in Litigation and was listed again in the 2021 edition.

    Eileen is the immediate past President of the Medico-Legal Society of Malaysia and currently serves the legal profession as a Chairperson in the Malaysian Bar Council’s Advocacy Training courses. She graduated from the London School of Economics & Political Science and was called to the English Bar before being enrolled as an Advocate and Solicitor of the High Court of Malaya.

    Abstract

    The pandemic brought with it various challenges on the healthcare industry. The distribution and allocation of life-saving resources coupled with the unprecedented working demands raised many questions of ethics and equity. This session will aim to discuss how the courts are likely to approach these difficult conditions of practice and the choices that healthcare providers were constrained to make.


    Symposium 3: Improving Outcomes in Clinical Practice
    Stroke: Role of time and technology

    DrWanAsyrafbinWanZaidi

    Dr Wan Asyraf bin Wan Zaidi

    Consultant Neurologist, University Kebangsaan Malaysia

    Speaker Profile

    Dr Wan Asyraf Wan Zaidi is a stroke neurologist and physician in Pusat Perubatan UKM, the first public university hospital with stroke care unit and with stroke reperfusion service in Malaysia. He is also a clinical lecturer in internal medicine and neurology. He did his attachment at the Comprehensive Stroke Center, Royal Melbourne Hospital, Melbourne, Australia as part of his subspeciality training and is the first cohort of World Stroke Organisation Future Stroke Leader. As the current Vice Chairman of Malaysia Stroke Council, he mainly involved optimisation of stroke care from education, research and implementation of stroke care. He is currently the national lead investigator for a few multi center international trials, regional stroke trainer for asia pacific region and advisor / steering committee for a few industry player related to stroke.

    Abstract

    Stroke treatment has been rapidly evolving since 1995 till today. Every single minute an occlusion persist in the blood vessel to the brain, estimated around 2 millions of neurons loss and translated to a morbid condition. The breakthrough of clot-busting agents and endovascular thrombectomy for hyperacute stroke with the advancement of imaging technology and modern stentretriever allows timely recanalization of blood vessels and giving hope to stroke patients to recover to their baseline or with outcome. Hyperacute stroke treatment require a fast well-coordinated system which can be assist telemedicine. The telemedicine service for stroke is known as “Telestroke”. It can be further enhance by artificial intelligence software(e-solution) as adjunctive tools to provide rapid accurate assessment, leading to early treatment and result in better clinical outcome. Speaker will elaborate on the advancement of stroke care in Universiti Kebangsaan Malaysia Medical Center, State Hospitals in Malaysia and the potential future of stroke care in public and private service.



    Symposium 3: Improving Outcomes in Clinical Practice
    Advances in management of Benign Prostatic Hyperplasia

    DrAzadHassanAbdulRazack

    Prof Dr Azad Hassan Abdul Razack

    Consultant Urologist, KPJ Tawakkal KL Specialist Hospital

    Speaker Profile

    Graduating from UM in 1986, he moved quickly through the surgical ranks, passing the FRCS (Edinburgh) examinations in 1991 and earning a scholarship from Petronas in 1993 to pursue higher surgical training in Urology which took him to London, UK, and Mansoura, Egypt. He returned to the university in 1996, and thus began his long career in the education and training of surgeons, while expanding clinical services in Urology and spearheading basic science and clinical research.

    In his tenures as Head of Surgery, Prof Azad’s goal was to bridge the gap between scientists and clinicians, particularly surgeons. In those days, few surgeons had personal experience of basic science research and many could not see its practical applications in the tactile world of surgery. Prof Azad had the vision to bring on non-surgeons as staff in the Department of Surgery, such as medical laboratory technicians, research assistants and scientists, and was possibly the first in the country to do so. He collaborated with academic staff from pre-clinical and paraclinical departments to further build research capacity. As Deputy Dean of Development of the Faculty of Medicine, Prof Azad was responsible for infrastructure and human resource planning and development.

    Abstract

    LUTS secondary BPH is an important medical condition that effects the quality of life as men age.

    The management of these symptoms and the condition has evolved over the years with better understanding of the pathophysiology of the disease.

    Medical management of BPH was introduced in 90’s and since then has been the main first line treatment. Alpha blockers and 5 alpha reductase inhibitors (5ARI) has been the main stay of treatment. Currently there is an increased use of combination of alpha blockers and 5ARI and is the primary treatment in most patients. The worldwide usage of the combination treatment continues to increase with the ageing population.

    TURP continues to be the main surgical intervention in BPH patients and remains the gold standard despite the availability of multiple minimally invasive surgical treatment. However, the trend is generally declining in the number of patients undergoing TURP and slow increase in minimally invasive options.

    The current options of surgical interventions apart from TURP are various forms of laser treatment and other methods of cavitation procedures like TUMT, TUNA and the latest method of Rezum.

    TURP and TUIP are more widely used on older patients above 65 and the other minimally invasive methods in younger patients from 50-65. Very few open prostatectomies are performed currently especially with the progress in various enucleation methods.


    Symposium 3: Improving Outcomes in Clinical Practice
    Transoral Endoscopic Thyroidectomy Vestibular Approach

    DrNorAzhamHakimDarail

    Dr Nor Azham Hakim Darail

    Breast & Endocrine Surgeon, Hospital Kuala Lumpur

    Speaker Profile

    Dr. Hakim graduated with an MBChB from Dundee University Medical School, Scotland in 1997. He completed his general surgical training with a Master in Surgery (General Surgery) degree from University Kebangsaan Malaysia in 2005. He then pursued further training in Breast & Endocrine Surgery with the Ministry of Health followed by a 1-year Fellowship in Endocrine Surgery in Yonsei University, Seoul, South Korea. Dr. Hakim trained in endoscopic and robotic thyroidectomy with Professor Woung Youn Chung who popularized robotic surgery for thyroid diseases. On his return, he continued to serve as a consultant Breast & Endocrine Surgeon in Hospital Kuala Lumpur where he started the endoscopic and robotic thyroid surgery services.

    Abstract

    In an effort to combine clinical efficacy with better cosmetic outcome, minimally invasive thyroid surgery has been pursued by surgeons for decades. This resulted in various different approaches, of which none could claim universal acceptance by thyroid surgeons far and wide; or is there?

    Angkoon Anuwong, in 2016, surprised the world surgical fraternity in publishing his first 60 cases of Transoral Endoscopic Thyroidectomy via the Vestibular Approach, in short TOETVA.

    In this series, he achieved a low rate of complications, particularly in terms of nerve injury, bleeding and infection; with a much superior cosmetic result. TOETVA is now performed in renowned thyroid centres in the world, either via conventional endoscopic approach or robotic approach. Numerous publications on TOETVA have further strengthens evidence of its efficacy, safety and now reproducibility in treating benign and malignant thyroid diseases. In Malaysia, TOETVA has made a slow start in 2018, and to date there are probably only a handful of surgeons providing this service to our public.

    TOETVA has probably become the most accepted endoscopic thyroid surgery approaches of the moment. For an endoscopic thyroidectomy approach to be well accepted, it needs to fulfil at least the following key criteria of strategic incision sites to hide scars, easy creation and maintenance of surgical operating field, enable clear anatomical visualization for ease of dissection, comparable safety and oncological clearance profile to open thyroidectomy and reproducible.

    In this talk, by comparing TOETVA with other popular endoscopic thyroidectomy techniques, showing a short video clip of the procedure itself, and illustrations of some cosmetic outcomes, I hope you can be convinced how TOETVA managed to fulfil these requirements and deservedly achieved its significant fame in such a short time.


    Plenary 3: Digitalization in Healthcare

    AzranOsmanRani

    Azran Osman Rani

    CEO and Co-founder Naluri

    Speaker Profile

    Azran is the CEO and co-founder of Naluri, a digital behavioral health startup that addresses mental health and chronic diseases together, in a preventive, holistic and outcomes-based approach. Since 2018, Naluri now serves 250,000 employees and insurance policyholders from 80 corporate clients and partners across five markets in Southeast Asia.

    He was previously CEO of AirAsia X where he grew it from a business plan to a $1billion IPO with 2,500 employees in six years, and CEO of iflix Malaysia which scaled to 20 million users in 20 markets in 3 years. He also held prior leadership roles at Astro, Bursa Malaysia and McKinsey & Company. He chronicles his leadership challenges, failures and overcoming adversity in his book, ’30 Days and 30 Years’. He holds a Master’s degree in Management Science & Engineering, and a Bachelors degree in Electrical Engineering, both from Stanford University. He is an Ironman triathlete.

    Abstract

    Digital therapeutics is a subset of digital health that deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders. Treatments typically rely on behavioural and lifestyle changes spurred by a collection of digital impetuses, and may or may not include consultation, guidance or coaching from healthcare professionals.

    Naluri has been pioneering the development of digital therapeutics in Malaysia and has since rolled out its services to regional markets including Singapore, Indonesia and Thailand. Naluri mainly works with healthcare payers - employers and insurance providers - to help them screen, risk-stratify, and provide digital health intervention programmes for their employees or policyholders who have, or are at risk of having, cardio-metabolic conditions such as diabetes and pre-diabetes, hypertension and heart diseases, and mental health conditions such as depression, anxiety and stress.

    The Naluri digital therapeutics model differentiates itself from tele-health services in four main ways: (1) moving care from reactive and transactional, to preventive and continuous care; (2) delivering care from individual specialists to a coordinated, multidisciplinary care in a holistic way, especially by integrating mental healthcare with chronic disease management; (3) moving care from fee-for-service to an outcomesbased care model; and (4) increase the productivity of professional care by up to tenfold, for example by increasing the reach of mental healthcare professionals from serving 50 clients a month, to 500 a month, supported by artificial-intelligence decision-support tools.

    Over 70,000 employees of Naluri's corporate clients have enrolled in their digital health services, and for those that opt into and completed a structured health coaching programme, the following were outcomes achieved: HbA1c reduction from 8.13 to 7.53 (p < 0.001); Systolic Blood pressure reduction from 149.8 to 142.2 (p < 0.001); Total Cholesterol reduction from 6.92 to 6.36 (p < 0.001); and BMI (weight) reduction from 33.1 to 31.5 (p < 0.05).



    Plenary 4: Building Positive Culture : Let's not just talk about it

    ProfDatoDrAziziHjOmar

    Prof Dato’ Dr Azizi Hj Omar

    Consultant Paediatrician & Paediatric Respiratory Physician, KPJ Damansara Specialist Hospital

    Speaker Profile

    Professor Dato’ Dr Azizi is a Consultant Paediatrician and Paediatric Respiratory Physician at KPJ Damansara Specialist Hospital where he was the Medical Director for 19 years from 1997 until May 2016. He is also a Professor and member of the Senate of KPJ University College, and heads the KPJ Research and Quality Innovation Committee as well as editor ot the KPJ Medical Journal. He was appointed to the Board of KPJ Healthcare Berhad on 1 February 2016 as an independent Non-Executive Director. He is also a member of KPJ’s Medical Advisory Committee.

    He was formerly a Professor of Paediatrics (Respiratory Paediatrics and Clinical Epidemiology) at the Universiti Kebangsaan Malaysia where he also served as Head of the Department of Paediatrics and a Deputy Dean (Research and Development) until his optional retirement in 1997 to join Damansara Specialist Hospital. He had also served as Adjunct Professor of Paediatrics at the Faculties of Medicine of UiTM and UTAR.

    Prof Dato’ Dr Azizi obtained his MBBS at University of Tasmania in 1977 and obtained his MRCP (UK) in 1982 and MMedSc (Clinical Epidemiology) from Newcastle University, NSW in 1990. He became Fellow of the Royal College of Physicians (FRCP) of Edinburgh (1994) and Glasgow (1995), Fellow of Academy of Medicine Malaysia (FAMM) in 1997, and Fellow of College of Chest Physicians (USA) (FCCP) in 1998. He received a Harvard Medical School Certificate for Healthcare Leadership (1 year programme, 2017 – 1018). He was conferred Darjah Kebesaran Indera Mahkota Pahang (DIMP) in 2004.

    Awards/Recognition/Past Experience
    • Established Respiratory Paediatrics as a Paediatric subspecialty in Malaysia
    • Pioneered research in paediatric asthma and respiratory illness in Malaysian children
    • Published substantially in international and local journals


    • Abstract

      Too often “culture change” has been mentioned as an important transformation ingredient in our strategy to regain dominance in the increasingly competitive healthcare playing field. However, little has been said on what needs to be done to drive this culture change. To be the “preferred healthcare provider” we need to develop a culture of service excellence. Service excellence is achieved through a conscious effort to proactively learn, improve and implement innovative strategies. If culture can be summarised as “how we do things around here” we need to enunciate what we want to do to achieve culture change and service excellence. We have to act and not just talk. Based on our knowledge of international experiences I would like to strongly put forward five key actions:- 1. Let us know our culture - really know, and not just think we know 2. Let us practise systems thinking and implement just culture to improve safety 3. Let us use improvement science to drive quality and safety innovations 4. Let us embrace fully patient and family centred care approach to provide a “seven star service” 5. Let us create “Joy in Work” to extract the best from our workforce A necessary prerequisite for achieving the above is an enlightened leadership. As we are all “leaders” we are the drivers of the above initiatives. To succeed we must adopt “transformative” and “humble” leadership styles. We have to learn about those initiatives and up-skill ourselves. Culture is driven by leaders. Bad culture arises from bad leadership. Any failure to achieve positive culture is a negative reflection on the leadership - that is US. Let us act together.


    Symposium 4: Improving Outcomes in Clinical Practice
    Multiple Stenosis In Coronary Arteries
    PCI vs CABG

    DrZulHilmiYaakob.png

    Dr Zul Hilmi Yaakob

    Consultant Cardiologist, KPJ Tawakkal KL Specialist Hospital

    Speaker Profile

    Dr Zul Hilmi is a Consultant Cardiologist at KPJ Tawakkal Specialist KL since September 2011. He did his medical degree (MBBS) at University of Tasmania, Australia. After coming back, he joined University Malaya as trainee lecturer and trained as physician and Cardiologist at University Malaya Medical Center.

    His interest is in interventional cardiology. He performs complex coronary procedures like left main intervention, Chronic total occlusions and calcified lesion.

    As career recognitions, he was awarded fellowship of National Heart Association Malaysia (FNHAM) in 2012, Asean Congress of Cardiology (FAsCC) in 2017, Asian Pacific Society of Interventional Cardiology (FAPSIC) in 2013, Society for Cardiac Angiography and Interventions (FSCAI) in 2015 and European Society Cardiology (FESC) in 2012.

    Abstract

    Coronary artery disease is number one cause of death in Malaysia and worldwide. Apart from lifestyle modifications and medications, revascularization forms the integral part in the management of coronary artery disease. Issues of coronary angioplasty or percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery as revascularization option remains unresolved especially in multivessel coronary disease.

    In the early years of percutaneous coronary intervention (PCI), studies showed CABG was a superior option. However, the gap has been narrowed with the vast and rapid advance in PCI in term of techniques and also equipments i.e balloons and stents. More recent trials showed outcome of PCI is not inferior to that of CABG in selected multivessel cases.

    Decision making and current recommendation by Heart Team approach is vital in order to offer best treatment option to patients. Patients need to be well informed the pros and cons of each PCI and CABG option and in the end decides what is best for them.


    Symposium 4: Improving Outcomes in Clinical Practice

    DatoDrMohdHamzahKamarulzaman

    Dato Dr Mohd Hamzah Kamarulzaman

    Consultant Cardiothoracic Surgeon, KPJ Damansara Specialist Hospital

    Speaker Profile

    Dato Dr Mohd Hamzah Kamarulzaman is a consultant cardiothoracic surgeon, who graduated from the National University of Malaysia in 1986. He obtained his Fellowship of the Royal College of Surgeons of Edinburgh in 1991. Dato’ Dr Mohd Hamzah is currently also the Medical Director and Person-incharge of Thomson Hospital Kota Damansara. Not one to rest on his laurels, Dato Dr Mohd Hamzah is the chairman of the Medical Education Committee (Cardiothoracic Surgery) of the Malaysian Medical Council; and programme training director for the nation as well as international surgical advisor to the Royal College of Surgeons Edinburgh. On top of his bustling practice, he is also a visiting consultant to the Ministry of Health hospitals’ cardiothoracic surgical departments (in Serdang, Kuantan, Kuching, Kota Bharu, Kota Kinabalu and Johor Bahru) and at KPJ hospitals (KPJ Damansara Specialist Hospital, KPJ Selangor Specialist Hospital, KPJ Klang Specialist Hospital and KPJ Ampang Puteri Specialist Hospital).

    Abstract

    The treatment of multivessel coronary artery disease (CAD) has been the subject of many investigations during the last 30 years. Improvements in the surgical techniques including the usage of multiple arterial grafts and the evolution of several generations’ stents from bare metal stent (BMS) to few generations of drug eluting stents (DES) showed that this is a dynamic field. The continuing interest proves that there is still no absolute solution for revascularization. Some of the main factors which have influenced the outcomes and skewed the opinion towards either PCI or CABG include the presence of Diabetes Mellitus, the site of the lesions on the coronary arteries, the evolution of the stents and the development of major adverse cardiovascular and cerebrovascular events (MACCE) and even the influence of medication in the course of treatment.

    To have a better understanding of the discussions some landmark clinical trials such as Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery trial (SYNTAX), Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM), the Vetereans Administration Coronary Artery Revascularization in Diabetes (VA CARD) shall be discussed. In the NordicBaltic-British Left Main Revascularization Study trial (NOBLE), the per protocol definition of events included periprocedural MI. In this trial, a significant advantage of CABG in the incidence of MI was shown (7% vs 2%, P ¼ .004). In the more recent randomized Evaluation of the Xience Everolimus Eluting Stent vs Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) study, the separate analysis of 30-day MI incidence shows a clear superiority of PCI (3.9% vs 6.2%, P ¼ .02), regarding LMD revascularization, with the difference driven by the incidence of periprocedural MI (3.6% vs 5.9%, P ¼ .02).7 Interestingly, no difference in 30-day or 3-year stroke incidence between the 2 procedures was demonstrated in this contemporary trial. Thus, more studies with these prespecified end points are needed.

    Another significant technical aspect in PCI procedures is the use of intracoronary modalities either for the evaluation of disease severity (fractional flow reserve [FFR]) or for the guidance of the PCI (Intravascular ultrasound [IVUS], and optical coherence tomography [OCT]). In most patients in randomized studies, multivessel CAD was defined according to the stenosis severity based on coronary angiography, thus missing the potential advantages of ischemiadriven revascularization. Lastly, another interesting point is the perioperative drug therapy in both CABG and PCI. Firstly, Verdoia and co-workers in their meta-analysis that dual antiplatelet therapy (DAPT), even in patients with CABG, could have prevented a significant number of MACCE. Secondly, the percentage of highdose statin loading is rarely mentioned in randomized studies. Interestingly, previous studies have shown the potential protective effect of high-dose statin loading before both PCI and CABG in the reduction of incidence of perioperative MI and stroke. However, in every day clinical practice, the respective recommendation is not widely practiced. The above suggests further missing elements in the comparison between CABG and PCI.

    In conclusion, 3-vessel CAD and unprotected LMD still represent an important debate for the choice of the most suitable procedure, PCI or CABG. It remains to be seen whether either modality convincingly show significant superiority over the other. More likely a Heart Team approach is likely the best approach toward recommending the best modality of treatment to a patient based on contemporary evidences.


    Symposium 5 : Advances in Robotic Surgeries
    Robotics In Urology- Unlocking New Possibilities Through Robotic Surgery

    DrLoHwaLoon.png

    Dr Lo Hwa Loon

    Hospital Kuala Lumpur

    Speaker Profile

    Dr. Lo was trained in Malaysia and overseas. He underwent subspecialty fellowship training in Neuro Reconstructive Urology and Female Urology in the United Kingdom at the Queen Elizabeth University Hospital, Glasgow and had a fellowship attachment in functional urology at the University Hospital California Davis in California, United States.

    He is also a highly trained and Europe-certified robotics surgeon, specializing in various complicated robotic surgeries for prostate and kidney cancers. He obtained his fellowship training in Robotic uro-oncology at the Peter Mc Callum Cancer Centre in Melbourne and at Guy’s Hospital & St Thomas Hospital, London. He also trained at Pitie Salpetriere Hospital, Paris in robotic functional urology. Dr. Lo is a recipient of the prestigious Tun Suffiah Foundation scholarship which supported his robotics training at Guy’s Hospital in London. To date, he has performed the largest series of robotic kidney cancer surgeries in Malaysia. He was made the chair of robotic surgical training in Malaysia at the end of 2020 and is now actively involved in conducting robotic surgical trainings for not just urologists but also for general surgeons and gynaecologists in Malaysia.

    Abstract

    The advent of robotic surgery has revolutionised the field of surgery. After it acquired FDA approval in 2000, it has gone on to gain traction in the world of medicine, and is expected to become the ‘new normal’ in the coming years as it offers absolute precision in surgery, venturing into and visualising the inner body sections where conventional surgery found impossible. Robotic surgery allows 3D vision and 10 times magnification, giving spectacular visibility and the ability to attain a multitude of movements and enhanced dexterity via robotic arms, allowing the surgeon to operate meticulously on difficult body parts and achieving much better functional and oncological outcomes. With its ergonomically considered designs, surgeons are also able to perform surgeries for long hours comfortably with the help of stable robotic instruments. These features allow the method to transcend the limitations of the conventional open and laparoscopic surgeries.

    For patients, they experience less pain and discomfort with robotic surgery, enabling them to ambulate earlier and achieve speedier recovery as the method is truly minimally invasive. It’s also more cosmetically acceptable due to smaller scars and a low risk of wound infection. Besides, complications such as bleeding and injuring the neighbouring organs are less likely due to its precision. As s result, its long-term sequelae/impediments are markedly reduced. Robotic surgical devices provide a platform for urologists to perform procedures on various urological tumours such as bladder, kidney and prostate cancers. It also allows the surgeon to perform nononcological surgeries such as pelvic organ prolapse repair, vesico-vaginal fistulas, benign prostate enlargement and various congenital abnormalities such as pelvi-ureteric junction obstruction and vesico-ureteric reflux diseases.

    The advancement of telecommunications technology has also boosted the versatility and usefulness of robotics in medicine. For example, digital connectivity now allows the supervision of complicated surgeries by experts from anywhere around the world without them being physically present in the operating theatre. Using 5G technology, robotic instruments can also be connected to other digital devices, which help accelerate data transmission and reduce control delays, leading to optimized telemanipulation with improved accuracy. Robotic machines have also evolved over a few generations, the latest being single port devices that retain all the essence of delicate robotic features, needing only single miniscule incisions on the body and enabling patients to feel less pain and see faster recuperation.

    Robotic surgery also opens up possibilities for other surgical disciplines such as gynaecology, cardiothoracic, gastrointestinal, ENT, orthopaedics and general surgery. In general, this cutting-edge technology allows surgeries which were perceived as technically challenging before as achievable now with improved and promising outcomes.

    Furthermore, it has the potential to expand surgical treatment modalities beyond the limits of the human ability.

    Cost has been the main disadvantage of robotic surgery - not just the cost of purchasing the instruments but also the cost of maintenance. Surgeons also needs to take on the role of engineers to manipulate the robotic arms and troubleshooting if the device malfunctioned, thus the making the training curve steep and lengthy. It is the vision that robotic surgery can be made more common and affordable for the benefit of patients as it is truly the way forward, especially in procedures that are complicated and delicate.


    Symposium 5 : Advances in Robotic Surgeries
    Robotics in ENT - Role Of Robotic Surgery In Oropharyngeal And Laryngeal Diseases: Our Malaysian Experience

    DrAhmadKusyairiKhalid.png

    Dr Ahmad Kusyairi Khalid

    Consultant Surgeon ORL-HNS, UITM Private Specialist Center and Avisena Specialist Hospital

    Speaker Profile

    Dr. Ahmad Kusyairi bin Khalid graduated from National University of Ireland, Cork. He underwent basic surgical training in Ireland and subsequently returned to Malaysia where he pursued specialist training in Otorhinolaryngology - Head and Neck Surgery (ORL-HNS) in Universiti Kebangsaan Malaysia. He is currently working as a Consultant Surgeon ORL-HNS at UITM Private Specialist Center and Avisena Specialist Hospital. Dr Ahmad Kusyairi is a certified Robotic ENT Surgeon as he completed the Da Vinci System Training as a Console Surgeon (Robotic Surgery for ORL-HNS) from the Intuitive Surgical and Yonsei University Hospital, Seoul, Korea.

    He has performed various transoral robotic base of tongue, larynx and oropharynx procedures for both benign and malignant cases utilizing the Da Vinci System. He also completed his clinical fellow attachment in Sleep Surgery at Singapore General Hospital as well as in Head and Neck Oncology Surgery at Universiti Kebangsaan Malaysia. Since then, he has set up Sleep Surgery and Head and Neck Oncology Surgery services at his place of practice. Dr Ahmad Kusyairi is also keen on sharing his expertise – to date, he has clinical fellows from Malaysia and other Asian countries doing attachments with him, and he has also been invited as a speaker and demonstrator of robotic surgery at various conferences across national, ASEAN and international level.

    Abstract

    Transoral robotic surgery (TORS) is the newcomer in the field of minimally invasive head and neck surgery. It was first described by O‘Malley et al. in 2005, where they performed supraglottic partial laryngectomy on cadavers and canine models using the da Vinci robotic system. TORS capitalised on the presence of the oral cavity as an access point for natural orifice transluminal endoscopic surgery, thus providing access to the pharynx, parapharyngeal space and larynx without the morbidity of cervical incisions and associated disruption of the pharyngeal musculature. Within a decade, TORS evolved from proof-of-concept to standard-of-care in high-volume robotic centres after it obtained FDA approval both for benign and malignant diseases in 2009. In Malaysia, TORS is relatively new, however it is already available and may be accessible for our patients in selected centers. Henceforth, we would like to share our experience in robotic surgery in ENT and Head and Neck surgeries pertaining to Oropharyngeal and Laryngeal Diseases and we hope to raise more awareness on the availability of this expertise in Malaysia.



    Symposium 5 : Advances in Robotic Surgeries
    Robotics In Orthopedics- “Robotic Assisted Joint Replacement : THE GAME CHANGER IN MODERN ARTHROPLASTY!”

    DrJeffreyJayaRaj

    Dr Jeffrey Jaya Raj

    Consultant Orthopedic Surgeon, Hospital Kuala Lumpur

    Speaker Profile

    Dr Jeffrey Jaya Raj is a Consultant Arthroplasty and Joint Reconstruction Orthopaedic Surgeon currently practicing in Hospital Kuala Lumpur. He graduated from Melaka-Manipal Medical College in 2004 and subsequently completed his Masters in Orthopaedic Surgery in 2014.He then served in Hospital Queen Elizabeth Sabah and Hospital Tengku Ampuan Afzan Kuantan and has vast experience in orthopaedic trauma and adult joint hip and knee reconstruction. He went on to complete his subspecialty under the purview of Ministry of Health Malaysia. He has a keen interest in Robotic Adult Hip and Knee (Partial and Total Knee) replacements and was trained in the prestigious Prince Charles Hospital and St Vincent’s Private Hospital Brisbane, Australia under renowned Professor Ross Crawford. He has vast experience in performing a large number of cases using the Mako Robotic Assisted Hip, Partial Knee and Total Knee replacement surgery and was involved in more than 300 cases in Brisbane, Australia. He also is experienced in Revision Hip and Knee arthroplasty. He has numerous publications and has presented various papers pertaining to orthopaedic trauma and arthroplasty.

    He also has been involved in various arthroplasty related courses and was invited as guest speaker for Basic Arthroplasty Course IIUM as well as an Exeter Level II trainer involved in training young junior orthopaedic surgeons exploring the world of Arthroplasty. He was awarded Best New Principal Investigator Award 2017 for Embarking on new Industry initiated Study as Principal Investigator on DVT prophylaxis drug for prevention of DVT post TKR patients.

    He was appointed Honorary lecturer for Widad Medical College Kuantan teaching medical students and was also involved in the training of houseman and medical officers in the Orthopaedic Department. He is a life member of the Malaysian Society of Hip and Knee Surgeons (MSHKS) and member of the Malaysian Orthopaedic Association (MOA) Malaysia.

    Abstract

    Robotic Knee and Hip replacement have revolutionized modern arthroplasty in ways we cannot imagine. The incidence of Osteoarthritis worldwide has increased dramatically and it is postulated that in the US the need for Total Hip arthroplasty is projected to increase 71 percent to 635000 procedures and Total Knee replacements by 85 percent to 1.26 million procedures by 2030. In Malaysia, the incidence of osteoarthritis is around 30 percent. Robotic assisted arthroplasty in Malaysia has been available only very recently and the available robotic systems are namely Mako (Stryker), ROSA (Zimmer) and Navio (Smith and Nephew) The workflow and setup of MAKO Rio Robotic assisted systems are highlighted for the unicompartmental knee replacement, Total Knee Replacement and Total Hip Replacement.

    The Mako Robotic assisted arthroplasty is the only exclusive system which works based on CT scan images done preoperatively and has accustop haptic boundary technology for better accuracy and soft tissue preservation leading to early faster recovery. It gives real time feedback when balancing the joint especially during dynamic joint balancing. An overview of the workflow processes from pre op implant planning, sizing, array placement, checkpoints, landmark registration and verification as well as bony saw cuts using robotic arm is shown to give a clearer picture as to how robotic assisted surgery is carried out.

    The supporting research with regards to robotic assisted surgery are highlighted. Robotic assisted knee replacement reduces post op pain significantly and lowers the need for pain medication usage. It also improves patient outcome measures, reduces complications namely the need for MUA (manipulation under anaesthesia) and reduces readmission rates to the hospital. In terms of health economics, robotic assisted surgery reduces operative costs in the long run and reduces healthcare resource utilization.

    Various research work done in the past few years further strengthen the advantage of robotic assisted surgery for example the publication by Jean-Pierre St Mart in Bone joint Journal 2020 March reiterates that the Mako assisted Restoris UKA had a significantly lower overall revision rate compared to all other types of non-robotically assisted procedures(HR 0.58(95% CI)p< 0.001) at 3 years .The revision rate for aseptic loosening was also lower for the Mako robotic assisted UKA compared to all other non-robotic assisted UKA.

    Total knee arthroplasty is a successful procedure with good long-term results. Studies indicate that 15% – 25% of patients are dissatisfied with their total knee arthroplasty. In addition, return to sports activities is significantly lower than total hip arthroplasty with 34% – 42% of patients reporting decreased sports participation after their total knee arthroplasties. Roboticassisted surgery can assist in many of the variables that influence outcomes of total knee arthroplasty including: implant positioning, soft tissue balance, lower limb alignment and proper sizing. Pagnano has noted that optimal alignment may require some deviation from mechanically neutral alignment and individualization may be preferred. This is also likely to be a requirement of more customised or bicruciate retaining implant designs. The precision of robotic surgery may be necessary to obtain this individualised component alignment.

    Conclusion: Robotic surgery is the gamechanger in modern arthroplasty and paves the way for good functional outcome for patients requiring total knee or hip replacement and as arthroplasty surgeons we should be open about embracing technology especially as the evidence and research favouring robotic surgery is overwhelming.


    Symposium 5 : Advances in Robotic Surgeries
    Robotics In Reconstructive Surgeries

    MsNaseemGhazali

    Ms Naseem Ghazali

    Consultant Oral and Maxillofacial/Head & Neck Oncology & Reconstructive Surgeon, Shrewsbury and Telford Hospitals, NHS Trust

    Speaker Profile

    Naseem Ghazali is dual-qualified Head & Neck Oncology Surgeon, having trained in Dentistry at University of Malaya, and Medicine at Guy's, King's and St Thomas School of Medicine at King's College London. Following her MRCS of Surgery in General, she completed Higher Surgical Specialist Training in Maxillofacial Surgery at the London and Kent, Surrey & Sussex Deaneries, culminating with the FRCS (Oral & Maxillofacial Surgery) in 2010. Naseem Ghazali undertook a Doctorate in Medicine at the University of Liverpool during her Clinical Research Fellowship at Aintree University Hospital, and completed a Head and Neck Surgical Fellowship at University of Maryland, Baltimore, USA.

    Naseem Ghazali is currently working at the Shrewsbury and Telford NHS Trust as a Consultant in Oral, Maxillofacial-Plastics, Head & Neck Oncology and Robotics Surgery. Her clinical practice currently covers specialised work in Head and Neck Surgical Oncology, Maxillofacial Reconstruction including microvascular surgery, Head & Neck Robotic Surgery, Skin Cancer and Facial Aesthetics, Salivary Gland pathology, and Sleep Apnoea surgery; and undertakes general work in Oral and Maxillofacial Surgery. She has pioneered Head & Neck Robotic Surgery in Lancashire, having successfully set up the only such service in the North-West region of England in 2016. Her Head & Neck Robotic team has won Team of the Year award in 2021 for 'an outstanding service that provided a clear and significant difference to the patients in the region'.

    Naseem Ghazali is widely published, having more than 50 peer-reviewed scientific papers, and chapters in Surgical textbooks. She has won awards for her papers and research activities. In her education role, she is the Educational Lead for Dental Core Trainees in her hospital, and contributes as a clinical supervisor for Specialist Maxillofacial trainees. She is a Visiting Professor at the Faculty of Dentistry, University of Malaya, and at the Biomedical Engineering division at the School of Engineering at Bradford University. She contributes her time regularly in supporting various international surgical outreach programmes, as well as her local and national Head and Neck patients support groups in the UK.

    Abstract


    Robotics in Reconstructive Surgery

    Robotic-assisted reconstruction is increasingly used as Head and Neck robotic surgeons become more adept at using the technology in managing resection of tumours of the upper aerodigestive tract through the minimally invasive transoral robotic surgery (TORS)  approach. The presentation will briefly discuss the indications, technical issues, and outcomes of TORS-assisted reconstruction in the upper aerodigestive tract.




    Symposium 6: Business Transformation
    Value-Based Healthcare In The Context Of The Malaysian Healthcare System

    DrMohdLutfiFadilLokman.png

    Dr Mohd Lutfi Fadil Lokman

    Executive Director Hospitals Beyond Boundaries

    Speaker Profile

    Dr. Lutfi is a Clinical Data Scientist at Avantgarde Health, a Boston-based healthcare company founded at Harvard University with a mission to transform health systems towards one that is aligned to value. From 2013 to 2017, he served as a medical doctor at Sungai Buloh Hospital and later as a health economics researcher at the Malaysian Institute of Health Systems Research. He was also an intern at the World Health Organization Headquarters in Geneva. In 2012, he founded Hospitals Beyond Boundaries (HBB), a non-profit organization that builds clinics and hospitals for poor communities around South East Asia, where he served as the Chief Executive Officer until 2017. During time as Founder and CEO of HBB, he received several international recognitions including Forbes 30 under 30 and United Nations Young Leader For Sustainable Development Goals.Dr. Lutfi received his MD from the National University of Malaysia (UKM) in 2012 and completed his doctorate at Harvard University in 2020 where his thesis is focused on the implementation of value-based health care through innovations in health information technology. Dr. Lutfi regularly give guest lectures at his alma-mater, Harvard University where he teaches Value-based Health Care and at Yale University where he teaches Social Entrepreneurship in healthcare. He currently lives in Boston with his wife and 3 children.

    Abstract

    Value-based health care (VBHC) is a relatively new health care delivery and payment approach that ties physicians’ incentives to patient outcomes. Several countries proved that VBHC improves overall patient outcomes without raising costs. Today Malaysians live longer with better health than the past with almost universal access to health care. However, health care costs are steadily outpacing the national resources allocated for health care - indicating that this system in unsustainable. Nearly one-third of our health care expenditures are spent on unnecessary services and duplication of services largely due to discontinuity of care. Furthermore, across providers, there is wide variation in practice, costs, and outcomes for the treatment of the same disease for patients with very similar risk profiles even in the same region.

    VBHC’s ties providers’ compensation to patient outcomes by focusing on incentivizing physicians based on value, defined as the health outcome achieved per dollar of cost expended. To put it in simple terms, the better the outcomes achieved at a lower cost, the higher the value. A health care system where providers compete by offering the best value to patients is known as a value-based health care system. When a health system is aligned with value, the problem of rising health care costs can potentially be curbed through several mechanisms: the first is through the elimination of inefficiencies and ineffective services or treatments; the second is by the encouragement of competition across providers based on quality and price when results are publicly available. Third, when patients have better information on outcomes when choosing a provider for their specific conditions, market forces can potentially drive costs down until the optimal cost to achieve good results becomes apparent. Although no national health system has yet fully embraced VBHC, several providers within health systems that have adopted VBHC showed promising results by reducing cost, increasing efficiency and improving patient care.

    For the Malaysian health system to transform towards a system that is aligned with value, several transformations must occur: at the individual patient care level, at the provider level (both private and public clinics/hospitals), and at the public policy level. At the patient care level, health outcomes and the cost required to deliver those outcomes across the full cycle of care (from screening to rehabilitation) must be measured continuously. One recommended method used to measure this cost is TimeDriven Activity-based Costing, or TDABC. At the provider level, four transformations must occur within the Malaysian health system: (1) increasing the use Electronic Medical Records; (2) establishing national benchmarking and research tools; (3) reorganizing patient care from departmental to Integrated Practice Units (IPUs); and (4) transitioning our payment mechanisms in both public and private facilities towards bundled payments. At the policy level, legal and regulatory environment should that support and accelerate all the above. One of the most important roles for policymakers is to require mandatory reporting of results as well as establishing an infrastructure that allows for the dissemination of cost and health outcomes information. This would enable the identification of providers that provide the best value for each condition or disease, which in turn would provide would establish a national benchmark. Patients would then be able to choose providers that are proven to provide the best value in treating their condition or disease.

    Although a lot of transformation involving several stakeholders need to happen, there is a huge opportunity for the Malaysian health system to leapfrog from the current state towards one that is aligned with value. A stepby-step approach, starting with improving our health information system, is feasible. Some of the transformations are already happening within the country. In the future, when all providers measure and report results, when the information on results is made publicly available, and when patients make informed decision when choosing providers, there is no doubt that the Malaysian health system will be able to unleash its full potential to drive down costs while maintaining excellent outcomes.


    Symposium 6: Business Transformation
    KPJ Ambulatory Care Center - Specialist Care In The Community

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    Prof Emeritus Dato’ Dr Lokman Saim

    Vice Chancellor and Dean of the Graduate School of Medicine, KPJ University College

    Speaker Profile

    Prof. Emeritus Dato’ Dr Lokman Saim is Dean Graduate School of Medicine and Vice Chancellor of KPJ Healthcare University College, Malaysia. He is an ENT surgeon, with sub- specialization in Otology and Neurotology. His clinical practice is at KPJ Tawakkal Specialist Hospital, Kuala Lumpur. He was formerly Professor of Otorhinolaryngology and Dean Faculty of Medicine and Director of Universiti Kebangsaan Malaysia Medical Center. Prof. Lokman Saim is amongst the pioneer in cochlear implant surgery in ASEAN and Asia Pacific region. He is appointed as consultant surgeon to establish ear and hearing centers and to perform cochlear implant surgeries in Brunei Darussalam, Jakarta Indonesia, Lahore and Karachi Pakistan and Ho Chi Minh City and Hanoi, Vietnam.

    To date, he has performed and assisted in more than 1000 cochlear implant surgeries. He received his Medical Degree from Universiti Kebangsaan Malaysia in 1984 and his Master of Surgery (ORL) from Universiti Kebangsaan Malaysia in 1991. He obtained his Fellowship of the Royal Colleges of Surgeons Edinburgh in 1989. He did Fellowship in Otology and Neuro-otology at Harvard Medical School, Boston USA in 1993-1994. He was appointed Clinical Professor at the School of Advanced Medicine, Macquarie University Sydney 2010- 2013. He was conferred Emeritus Professor by Universiti Kebangsaan Malaysia in 2018.

    Abstract

    Private medical services in Malaysia are generally provided at two levels, namely private general practitioners (GP) and private specialist clinics and specialist hospitals. While private general practitioners are present in almost every part of the country including the small towns and rural areas, private specialist hospitals are mainly in the bigger towns and cities. Majority of GP clinics in Malaysia are run as a single-practice clinic with minimal facilities and limited breadth of clinical services. There is definitely a big gap between services in the GP clinics and the private specialist hospitals.

    The primary objective of establishing the KPJ Ambulatory Care Center (ACC) is to bridge this gap. KPJ ACC serves the need of patients for primary level specialist care which will be provided by Family Medicine Specialists (FMS). FMS are trained to provide primary specialist care across all ages and diseases including NCDs, maternity, child health, geriatrics and mental health. ACC also have outpatient specialty and subspecialty clinics and facilities for day-care surgeries. It is to be established closer to the community in cities, towns and even in the rural areas. For more complex conditions, ACC will refer them to the vast network of KPJ Specialist hospitals. ACC provides comprehensive primary specialist care for patients and their families and therefore be the center that ensure continuity of care from GP to specialist hospitals.



    Symposium 6: Business Transformation
    Big Data Analytics In Private Hospitals – Challenges And Opportunities

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    Prof Datuk Dr A. Rahman A. Jamal

    Professor of Paediatric Haemato-Oncology and Molecular Biology and Senior Principal Research Fellow at UKM Medical Molecular Biology Institute

    Speaker Profile

    Professor Datuk Dr. A Rahman A Jamal is a professor of paediatric haematology, oncology and molecular biology at Universiti Kebangsaan Malaysia. He is the senior principal research fellow of the UKM Medical Molecular Biology Institute (UMBI) and an honorary professor at the University of Dundee, Scotland, UK. He is the project leader for The Malaysian Cohort and the Cohort Biobank which is the largest in South-East Asia, with data and biospecimens from 120000 participants.

    He was the project director for the UKM Specialist Children’s Hospital (2010-2019) and the Pro Vice-Chancellor for the UKM Kuala Lumpur campus (2017-2021). He was a member of the Majlis Hospital Canselor Tuanku Muhriz (equivalent to a hospital board) from 2014-2021) and a board member for the UKM Specialist Centre (2017-2021). His research interests include cancers, other noncommunicable diseases, molecular epidemiology of Covid-19 and cohort studies. He has 220 indexed publications and an Hindex of 29. He has supervised 23 PhD and 50 MSc students. He was chief scientist for the National Angkasawan Programme (2006- 2007). He leads the genome research team in UMBI and the team has performed whole genome sequencing on cancers and other diseases. He has completed the Cancer Genome Atlas Malaysia project for colorectal cancer. His latest project is the Cov-Gen study to investigate host factors that determines the severity, outcome and long-term complications of Covid-19 infection. He is involved in two MRC UK-Malaysia research projects on diabetes and obesity. He is the chairman of National Stem Cell Committee for Ethics in Research and Therapy, Ministry of Health (MOH) and member of the National Clinical Trials Committee MOH.

    He is a fellow of the Academy Sciences of Malaysia and heads a task force for the Precision Medicine Initiative. He is currently a board member for the Clinical Research Malaysia Sdn Bhd, Melaka Biotechnology Corporation and NanoMalaysia Berhad. He is a member of the Wellcome Trust UK Funding Committee for Longitudinal Population Studies, International Health Cohort Consortium (IHCC), and the International Commission for Human Germline Genome Editing (National Academy of Sciences USA and Royal Society UK). He has given more than 180 invited lectures including plenary and keynote lectures. During this Covid-19 pandemic, he is the chairman of the task force for the MOHE-MOSTI collaboration for Covid19 testing labs in the universities and the leader of the Covid-19 Genome Surveillance project under MOSTI-MOH-MOHE.

    Abstract

    Big Data (BD) is transforming healthcare in a big way across the globe. BD analytics in healthcare and Digital Health are two of the hottest initiatives around the world. Most hospitals have BD but much of these data have not been harnessed or exploited to provide the business intelligence that could improve processes, save costs, reduce wastage, enhanced patient care and perhaps most importantly better treatment outcomes. Hospital data is best recorded, stored and managed in the digital format. Central to this is the electronic medical record (EMR) or the electronic health record (HER). Most BD in hospitals are in the unstructured form (case notes, treatment orders, prescriptions, forms, surveys, etc.). BD is also a key driver for precision medicine, which is aimed at giving the right treatment to the right patient at the right time, hence giving the best chance of cure and avoiding adverse effects. There are key challenges in BD: 1. Putting in place a total hospital information system (THIS) in place that works efficiently, and where all the modules are well integrated. This is to ensure data is captured digitally from all possible sources i.e. patient records, laboratory, imaging data, procedures, prescriptions, hospital charges, discharge summary, referrals, complications etc. 2. Integrating and storing the data in the data lake or warehouse. The two clear choices are one that is premise-based (the need to have the physical servers and big data centers) and cloud-based storage. 3. The Big Data analytics itself, which warrants the need for data scientists, biostatisticians and experts in bioinformatics.

    Opportunities are plenty. Public-private partnership is key as data from the private hospitals could enrich the data from the public hospitals. BD analytics should also give the hospital management real time summary data on a dashboard that include current BOR, revenue, medication error rate, waiting time, patient satisfaction, human resource utilization, etc. All these data could be leveraged to improve further all the business processes and those related to patient care. There are also opportunities to collaborate to develop modules of THIS that could be tested and validated in both the private, public and university hospitals. Perhaps the most exciting part of BD analytics is using it to come up with prediction models to improve patient care and in precision medicine. For example, BD analytics can group diabetic patients into more effective treatment cluster groups and providing each one of them the personal risk score of developing future complications. BD analytics can provide cancer patients a more comprehensive diagnosis, a better prognostication matrix and identify patients suitable for targeted therapies. Transforming big data into better business processes and better treatment decisions will certainly bring the nation to the next level of healthcare, which is better, faster and more cost-efficient.