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APSR Short-Term Research/Training Scholarship

Post-training report

Su Siew Choo

Paediatric Institute
Hospital Kuala Lumpur

Research/training:Paediatric respiratory medicine
November 2013 – November 2014
Host institute:Department of Respiratory Medicine, Royal Children's Hospital and Queensland's Children Medical Research Institute, Brisbane, Australia
Host supervisors:Dr Anne Chang, Dr Ian Brent Masters and Dr Alan Isles

It was an honour to be awarded the APSR Short-Term Research/Training Scholarship, which helped to support my scholarship at the Department of Respiratory Medicine, Royal Children's Hospital and Queensland's Children Medical Research Institute, Brisbane, Australia from November 2013 to November 2014. During my year in Brisbane, I had the opportunity to participate in the daily clinical work as a paediatric respiratory fellow and had exposure to a variety of interesting and complex respiratory cases. I also had the opportunity to improve my flexible bronchoscopic skills and diagnosis under the excellent guidance of my host supervisors. Besides the outstanding clinical experience, I also had the privilege to conduct clinical research and obtain unsurmountable research experience and knowledge.

One of my research studies was on the comparison between flexible bronchoscopy and virtual bronchoscopy in the detection of large airway abnormalities. Flexible bronchoscopy remains the gold standard for the diagnosis of large airway abnormalities. However, it is an invasive procedure that requires gaseous anaesthesiae in the paediatric age group, therefore our study is crucial to determine if virtual bronchoscopy, which is a less invasive procedure reconstructed from multidetector CT (MDCT) scan, is comparable to flexible bronchoscopy in the detection of large airway abnormalities. This is particularly important in developing countries where bronchoscopic services are scarce and limited. The recruitment of patients for our study was carried out from January to September 2014. Patients already booked for both a flexible bronchoscopy and CT thorax with no known large airway problem were consented for the study. Two respiratory physicians later independently reviewed and scored the recorded flexible bronchoscopy procedures, blinded to the others' results on separate days. The virtual bronchoscopy, which was reconstructed from the MDCT scans, was independently reviewed by two pairs, consisting of a respiratory physician and a paediatric radiologist each, blinded to one another's results. We then compared the sensitivity and specificity of virtual bronchoscopy as a diagnostic tool for major airway abnormalities in children as compared to flexible bronchoscopy.

Dr Su Siew Choo (left) and Dr Anne Chang (right)
(Click photo to enlarge)

My other research study was to determine the normal reference value of bronchoalveolar lavage fluid differential cytology in healthy immunocompetent children. Bronchoalveolar lavage is an important investigative tool in the assessment of the lower respiratory tract in both adults and children. While the adults have long established a normal reference value for the differential cytology of bronchoalveolar lavage fluid, in children this important reference value is scarce as it is unethical to subject normal healthy children to invasive flexible bronchoscopy just to obtain a set of normal values. There are only a handful of published data on the normal values of the cellular components of bronchoalveolar lavage fluid in children, all with small sample sizes. It is therefore important to have a set of normal reference values in children to enable a more accurate interpretation of the cellular constituents of bronchoalveolar lavage fluid in children with lung disease. Thus, our study was undertaken to provide a reference value in children from a larger sample size.

Lastly, Brisbane is a beautiful city with wonderful people and I thoroughly enjoyed my experience in Australia. I would like to thank the APSR for supporting me during my scholarship in Brisbane by offering me this short term research/training scholarship, which has given me an invaluable experience and broadened my knowledge and skills in flexible bronchoscopy, respiratory medicine and research. I would also like to extend my sincerest gratitude to Dr Anne Chang, Dr Ian Brent Masters, Dr Alan Isles (my host supervisors), Dr Rus Anida Awang and Dr Norzila Mohamed Zainuddin (my home supervisors), all the respiratory physicians and fellows, anaesthetists, radiologists, research assistants, nurses, scientists and the warm and wonderful staff at the Department of Respiratory Medicine at Royal Children's Hospital, Brisbane for being so welcoming and helpful during my scholarship. This was truly an amazing experience Down Under!

Su Siew Choo
Paediatric Institute, Hospital Kuala Lumpur
December 2014