Chan J.C.N.,Chinese University of Hong Kong |
Chan J.C.N.,Prince of Wales Hospital |
Sui Y.,Prince of Wales Hospital |
Oldenburg B.,Monash University |
And 9 more authors.
JAMA Internal Medicine | Year: 2014
IMPORTANCE In type 2 diabetes mellitus (T2DM), team management using protocols with regular feedback improves clinical outcomes, although suboptimal self-management and psychological distress remain significant challenges. OBJECTIVE To investigate if frequent contacts through a telephone-based peer support program (Peer Support, Empowerment, and Remote Communication Linked by Information Technology [PEARL]) would improve cardiometabolic risk and health outcomes by enhancing psychological well-being and self-care in patients receiving integrated care implemented through a web-based multicomponent quality improvement program (JADE [Joint Asia Diabetes Evaluation]). DESIGN, SETTING, AND PARTICIPANTS Between 2009 and 2010, 628 of 2766 Hong Kong Chinese patients with T2DM from 3 publicly funded hospital-based diabetes centers were randomized to the JADE + PEARL (n=312) or JADE (n=316) groups, with comprehensive assessment at 0 and 12 months. INTERVENTIONS Thirty-three motivated patients with well-controlled T2DM received 32 hours of training (four 8-hour workshops) to become peer supporters, with 10 patients assigned to each. Peer supporters called their peers at least 12 times, guided by a checklist. MAIN OUTCOMES AND MEASURES Changes in hemoglobin A1c (HbA1c) level (primary), proportions of patients with attained treatment targets (HbA 1c <7%; blood pressure <130/80 mmHg; low-density lipoprotein cholesterol <2.6 mmol/L [to convert to milligrams per deciliter, divide by 0.0256]) (secondary), and other health outcomes at month 12. RESULTS Both groups had similar baseline characteristics (mean [SD] age, 54.7 [9.3] years; 57%men; disease duration, 9.4 [7.7] years; HbA1c level, 8.2%[1.6%]; systolic blood pressure, 136 mmHg; low-density lipoprotein cholesterol level, 2.89 [0.82] mmol/L; 17.4% cardiovascular-renal complications; and 34.9%insulin treated). After a mean (SD) follow-up period of 414 (55) days, 5 patients had died, 144 had at least 1 hospitalization, and 586 had repeated comprehensive assessments. On intention-to-treat analysis, both groups had similar reductions in HbA1c (JADE + PEARL, 0.30% [95%CI, 0.12%-0.47%], vs JADE, 0.29% [95%CI, 0.12%-0.47%] [P=.97]) and improvements in treatment targets and psychological-behavioral measures. In the JADE + PEARL group, 90% of patients maintained contacts with their peer supporters, with a median of 20 calls per patient. Most of the discussion items were related to self-management. CONCLUSIONS AND RELEVANCE In patients with T2DM receiving integrated care, peer support did not improve cardiometabolic risks or psychological well-being. Copyright 2014 American Medical Association. All rights reserved.
Yau T.,University of Hong Kong |
Cheng P.N.,Bio Cancer Treatment International Ltd |
Chan P.,Ruttonjee Hospital |
Chan W.,University of Hong Kong |
And 5 more authors.
Investigational New Drugs | Year: 2013
Summary: Background Hepatocellular carcinoma (HCC) cells are auxotrophic for arginine, depletion of which leads to tumour regression. The current study evaluated safety, pharmacokinetics (PK)/ pharmacodynamics (PD) parameters, and potential anti-tumor activity of pegylated recombinant human arginase 1 (peg-rhArg1) in advanced HCC patients. Methods Eligibility criteria included advanced HCC with measurable lesions, Child-Pugh A or B, and adequate organ function. Initial single IV bolus was followed by weekly doses of peg-rhArgI escalated from 500 U/kg to 2500 U/kg in a 3 + 3 design. Results Fifteen patients were enrolled at weekly doses of 500 U/kg (n = 3), 1000 U/kg (n = 3), 1600 U/kg (n = 3) and 2500 U/kg (n = 6). The median age was 57 years (33-74); 87% were hepatitis B carriers and 47% had prior systemic treatment. The most commonly reported drug-related non-haematological adverse events (AEs) were diarrhea (13.3%), abdominal discomfort (6.7%) and nausea (6.7%). No drug-related haematological AEs were seen. Only 1 of the six patients that received 2500U/kg peg-rhArg1 experienced DLT (grade 4 bilirubin elevation) and thus the maximum tolerated dose was 2500 U/kg. PK and PD analysis indicated that peg-rhArg1 was efficacious in inducing arginine depletion in a dose-dependent manner. Adequate arginine depletion dose was achieved in the 1,600-2,500 U/kg range and therefore the optimal biological dose was at 1600 U/kg, which was chosen as the recommended dose. The best response was stable disease for >8 weeks in 26.7% of the enrolled patients. Conclusion Peg-rhArg1 has manageable safety profile and preliminary evidence of activity in advanced HCC patients. © 2012 The Author(s).
Ip T.P.,Tung Wah Eastern Hospital |
Ip T.P.,University of Hong Kong |
Leung J.,Ruttonjee Hospital |
Kung A.W.C.,University of Hong Kong
Osteoporosis International | Year: 2010
Hip fracture is associated with high morbidity, mortality, and economic burden worldwide. It is also a major risk factor for a subsequent fracture. A literature search on the management of osteoporosis in patients with hip fracture was performed on the Medline database. Only one clinical drug trial was conducted in patients with a recent hip fracture. Further studies that specifically address post-fracture management of hip fracture are needed. The efficacy of anti-osteoporosis medication in older individuals and those at high risk of fall is reviewed in this paper. Adequate nutrition is vital for bone health and to prevent falls, especially in malnourished patients. Protein, calcium, and vitamin D supplementation is associated with increased hip BMD and a reduction in falls. Fall prevention, exercise, and balance training incorporated in a comprehensive rehabilitation program are essential to improve functional disability and survival. Exclusion of secondary causes of osteoporosis and treatment of coexistent medical conditions are also vital. Such a multidisciplinary team approach to the management of hip fracture patients is associated with a better clinical outcome. Although hip fracture is the most serious of all fractures, osteoporosis management should be prioritized to prevent deterioration of health and occurrence of further fracture. © 2010 The Author(s).
Ng F.-H.,Ruttonjee Hospital |
Tunggal P.,Ruttonjee Hospital |
Chu W.-M.,Ruttonjee Hospital |
Lam K.-F.,University of Hong Kong |
And 7 more authors.
American Journal of Gastroenterology | Year: 2012
Objectives: Little is known about the efficacy of proton pump inhibitors compared with H 2 receptor antagonists in preventing adverse upper gastrointestinal complications in patients with acute coronary syndrome (ACS) or ST elevation myocardial infarction (STEMI) receiving aspirin, clopidogrel, and enoxaparin or thrombolytics. The objective of this study was to compare the efficacies of esomeprazole and famotidine in preventing gastrointestinal complications. Methods: A double-blind, randomized, controlled trial was performed in patients receiving a combination of aspirin, clopidogrel, and either enoxaparin or thrombolytics. Patients received either esomeprazole (20 mg nocte) or famotidine (40 mg nocte) orally for 4-52 weeks, depending on the duration of dual antiplatelet therapy. The primary end point was upper gastrointestinal bleeding (GIB), perforation, or obstruction from ulcer/erosion (http://www.clinicaltrials.gov NCT00683111). Results: In all, 311 patients were recruited, with 163 and 148 patients in the esomeprazole and famotidine groups, respectively. Mean (s.d.) follow-up was 19.2 (17.6) and 17.6 (18.0) weeks, respectively. One (0.6%) patient in the esomeprazole group and 9 (6.1%) in the famotidine group reached the primary end point (log-rank test, P=0.0052, hazard ratio0.095, 95% confidence interval: 0.005-0.504); all had upper GIB. Conclusions: In patients with ACS or STEMI, esomeprazole is superior to famotidine in preventing upper gastrointestinal complications related to aspirin, clopidogrel, and enoxaparin or thrombolytics. © 2012 by the American College of Gastroenterology.
Ng F.,Ruttonjee Hospital |
Wong S.,University of Hong Kong |
Lam K.,University of Hong Kong |
Chu W.,Ruttonjee Hospital |
And 7 more authors.
Gastroenterology | Year: 2010
Background & Aims: Little is known about the efficacy of H2-receptor antagonists in preventing recurrence of aspirin-related peptic ulcers. We compared the efficacy of high-dose famotidine with that of pantoprazole in preventing recurrent symptomatic ulcers/erosions. Methods: We performed a randomized, double-blind, controlled trial of 160 patients with aspirin-related peptic ulcers/erosions, with or without a history of bleeding. Patients were given either famotidine (40 mg, morning and evening) or pantoprazole (20 mg in the morning and placebo in the evening). All patients continued to receive aspirin (80 mg daily). The primary end point was recurrent dyspeptic or bleeding ulcers/erosions within 48 weeks. Results: A total of 130 patients (81.1%) completed the study; 13 of 65 patients in the famotidine group reached the primary end point (20.0%; 95% one-sided confidence interval [CI] for the risk difference, 0.1184-1.0) compared with 0 of 65 patients in the pantoprazole group (P < .0001, 95% one-sided CI for the risk difference, 0.1184-1.0). Gastrointestinal bleeding was significantly more common in the famotidine group than the pantoprazole group (7.7% [5/65] vs 0% [0/65]; 95% one-sided CI for the risk difference, 0.0226-1.0; P = .0289), as was recurrent dyspepsia caused by ulcers/erosions (12.3% [8/65] vs 0% [0/65]; 95% one-sided CI for the risk difference, 0.0560-1.0; P = .0031). No patients had ulcer perforation or obstruction. Conclusions: In patients with aspirin-related peptic ulcers/erosions, high-dose famotidine therapy is inferior to pantoprazole in preventing recurrent dyspeptic or bleeding ulcers/erosions. © 2010 AGA Institute.
Li A.Y.W.,Ruttonjee Hospital |
Ng F.-H.,Ruttonjee Hospital |
Chan F.K.L.,Chinese University of Hong Kong |
Tunggal P.,Ruttonjee Hospital |
And 2 more authors.
Heart | Year: 2013
Background: Amlodipine inhibits cytochrome P450 (CYP) enzyme and has the potential to reduce clopidogrel bioactivation in vivo. Reports in previous retrospective studies described greater platelet reactivity in patients on amlodipine. Objective To evaluate the treatment effect of clopidogrel in patients on amlodipine versus not on calcium-channel blockers (CCBs). Design and setting Randomised, controlled, openlabel trial conducted in a regional acute hospital. Patients and interventions 98 patients on clopidogrel for ischaemic heart disease were recruited consecutively and randomised to take either amlodipine or drugs with inert CYP effects as controls. The P2Y12 reaction unit (PRU) was measured using whole blood obtained at baseline and on day 28. Main outcome measures The primary analysis involved the PRU values on day 28. The secondary analyses were percentage of platelet inhibition and poor response to clopidogrel as defined by PRU>235. Results: Both groups experienced comparable day 28 PRUs (amlodipine 227±84 vs control 214±90; mean difference 12.7, 95% CI -22 to +47). Percentage of platelet inhibition (amlodipine 33% vs control 38%, mean difference -4.5%, 95% CI -14% to +5%) and those with poor response on day 28 (amlodipine 49% vs control 45%; p=0.76) did not differ significantly. Conclusions Concomitant amlodipine has no negative impact on clopidogrel-mediated platelet inhibition in patients with ischaemic heart disease.
Cheung K.W.,Ruttonjee Hospital |
Mak Y.W.,Hong Kong Polytechnic University
International Journal of Environmental Research and Public Health | Year: 2016
It is common for elderly people and those with such chronic disorders as respiratory diseases to suffer severe complications from influenza, a viral infection. The voluntary uptake of vaccination is vital to the effectiveness of influenza prevention efforts. The Health Belief Model (HBM) is the most commonly used framework in the field of vaccination behavior to explain the decision that people make to accept or refuse vaccination. In addition, psychological flexibility is considered helpful in causing people to be open to adopting new practices that are consistent with their values. This study examined the role of psychological flexibility and health beliefs in predicting the uptake of influenza vaccination among people in Hong Kong. Eligible participants were Hong Kong permanent residents aged 18 years or above with a history of chronic respiratory diseases (CRD). A convenience sample of 255 patients was recruited to participate in a cross-sectional survey in which HBM components and factors of psychological flexibility were assessed. The following variables were found to be significant predictors of vaccination: age, smoking status, comorbidity, previous hospitalization, perceived susceptibility, perceived severity, and psychological flexibility. Enhancing psychological flexibility might be a potential new direction for motivating people to accept influenza vaccination. © 2016 by the authors; licensee MDPI, Basel, Switzerland.
Yu T.K.K.,Ruttonjee Hospital
CME Journal Geriatric Medicine | Year: 2010
Advances in telecommunication technology can provide new ways of caring for older people. This article will review specific areas of geriatric services where telemedicine may be useful and specific geriatric diseases where telemedicine may be of benefit. © 2010 Rila Publications Ltd.
Yuen C.K.,Ruttonjee Hospital |
Mok K.L.,Ruttonjee Hospital |
Kan P.G.,Ruttonjee Hospital
American Journal of Emergency Medicine | Year: 2012
Purpose: This study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD. Methods: Aprospective analysis of 49 consecutive patientswith x-ray-confirmed PASDwas performed.All patients were followed at an average of 6.9 days (ranged from4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT. Results: The prevalence of FTRCT after PASD is 37%(95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55%(95%CI, 36%-72%), 53%(95%CI, 35%-71%), 89% (95%CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively. Conclusions: The prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests. © 2012 Elsevier Inc. All rights reserved.
Leung K.Y.,Ruttonjee Hospital
Hong Kong Journal of Emergency Medicine | Year: 2016
Introduction: Establishing intravenous access is a common procedure being performed in the emergency department. Ultrasound guidance is useful for difficult intravenous cannulation. We compared a commercially available Blue Phantom™ and a self-made pork meat model for suitability of simulation based training. Methods: We recruited emergency physicians from two public regional hospitals in our locality. We also recruited Myanmar emergency physicians from an ultrasound course. They were given a 30-minute handson practice on both phantoms. Questionnaires, which asked about the practical feeling and overall impression of both phantoms, were distributed afterwards. Results: Thirty-nine emergency physicians with varied experience in ultrasound guided intravenous catheterisation enrolled in the study. The median score were 4 (i.e. agree) in seven out of eight pairs of questions. The practical feeling and overall personal impression were very similar between Blue Phantom™ and pork meat model. Conclusions: The suitability of self-made pork meat model was similar to Blue Phantom™ for the training of ultrasound guided IV catheterisation. Pork meat model can used as an alternative training tool. © 2016, Medcom Limited. All rights reserved.