Hong Kong, Hong Kong
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Background: Hong Kong has an ageing population. Some elderly patients with multiple medical conditions are prescribed with multiple medications. In a local study conducted in 2010 at a medical specialist clinic, 65% ofelderly patients were taking ≥5 medications and 10.8% were taking ≥10 medications. Polypharmacy increases the risks of adverse drug reactions. Potentially inappropriate prescriptions (PIPs) refers to the prescription of any medications to a patient where the risks of occurrence of adverse drug reactions, drug-drug interactions, drugdisease interactions outweigh the clinical benefits of that medication and when safer or more effective alternatives are available. Possible prescribing omissions (PPOs) refers to medications with clear evidence of clinical benefits which are not prescribed to patients without valid supporting reasons. Identification of PIPs and PPOs helps to improve clinical outcomes and quality of life of elderly patients. Objectives: To review the condition of PPOs and PIPs in elderly patients in Hong Kong. Method: This was a cross-sectional study conducted in a convalescent hospital in Hong Kong involving elderly patients (≥65 years of age). Demographics and medication profile were collected by reviewing information in clinical notes of index admission and past medical records. PPOs and PIPs were evaluated using the Screening Tool to Alert to Right Treatment (START) and the Screening Tool of Older People’s Prescriptions (STOPP) (version 1), respectively. Results: 57 patients were evaluated. 39 (68%) patients had at least 1 PPO, and 28 (49%) patients had at least 1 PIP. Warfarin, statins, angiotensin-converting enzyme inhibitors, calcium and vitamin D supplements were the most common PPOs. Laxatives (as the commonest duplicate class prescriptions) and neuroleptic drugs (in patients prone to falls) were the 2 most common PIPs. 61.4% patients had polypharmacy, and 14% of patients were suspected to have adverse drug reactions. Conclusion: Medication-related problems are common in the elderly patients. PIPs and PPOs should be carefully evaluated in every elderly patient. START and STOPP are useful tools to review the appropriateness of prescriptions in elderly patients in Hong Kong. © 2016, Hong Kong Academy of Medicine Press. All rights reserved.


Ng D.S.,Tung Wah Eastern Hospital | Ng D.S.,Hong Kong Sanatorium and Hospital | Kwok A.K.,Hong Kong Sanatorium and Hospital | Chan C.W.,Tung Wah Eastern Hospital
Clinical and Experimental Ophthalmology | Year: 2012

Myopic choroidal neovascularization (CNV) is a vision-threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle-aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized-controlled study in treatment of subfoveal myopic CNV. However, its long-term benefit is controversial. Recently, intravitreal injections of anti-vascular endothelial growth factors have shown promising results. In the absence of randomized-controlled trial comparing the efficacy of anti-vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.


Yam J.C.S.,Hong Kong Sanatorium and Hospital | Yam J.C.S.,Tung Wah Eastern Hospital | Chan C.W.N.,Tung Wah Eastern Hospital | Cheng A.C.K.,Hong Kong Sanatorium and Hospital
Journal of Refractive Surgery | Year: 2012

PURPOSE: To report the demarcation line depth after corneal collagen cross-linking (CXL) for keratoconus and postoperative LASIK ectasia with Visante (Carl Zeiss Meditec) optical coherence tomography (OCT) and investigate correlations between this depth and preoperative parameters and postoperative visual and keratometry outcomes. METHODS: Retrospective interventional case series of 40 eyes with keratoconus or postoperative LASIK ectasia treated with riboflavin ultraviolet-A CXL. Ophthalmic evaluation included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), corneal topography (Pentacam, Oculus Optikgeräte GmbH), and postoperative anterior segment OCT. Correlation analyses were performed. Statistical significance was indicated by P<.05. RESULTS: At 6 months postoperative, mean demarcation line depth was 281.4á53.3 μm. Thinner minimal corneal thickness (r=0.413, P=.008), older age (r=-0.490, P=.001), higher grading of ectasia (for both keratoconus and postoperative LASIK ectasia) (r=-0.332, P=.044), female sex (r=0.343, P=.030), postoperative LASIK ectasia (r=-0.420, P=.007), and longer duration of disease (r=-0.377, P=.023) were correlated with shallower demarcation line depth. Forward stepwise multiple linear regression analysis showed that among all preoperative factors, minimal corneal thickness (standardized β=0.473, P=.003) and age (standardized β=-0.317, P=.036) were significantly associated with demarcation line depth. The CXL demarcation line depth and change in CDVA (r=-0.16, P=.325) and change of the steepest keratometry at 6 months (r=0.084, P=.637) were not correlated. CONCLUSIONS: The Visante OCT can be used for assessing CXL demarcation line depth. The demarcation line depth may decrease with the severity of ectasia and age.


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).


Chan C.-W.,Chinese University of Hong Kong | Siu S.-C.,Tung Wah Eastern Hospital | Wong C.K.W.,Tung Wah Eastern Hospital | Lee V.W.Y.,Chinese University of Hong Kong
Journal of Cardiovascular Pharmacology and Therapeutics | Year: 2012

Objective: To investigate the effect of a pharmacist care program on cardiovascular risks in type 2 diabetic patients. Methods: A 9-month, prospective, randomized, controlled study was conducted in a public hospital in Hong Kong. Patients in the intervention group had regular drug-counseling sessions with pharmacists in addition to routine medical care, whereas patients in the control group received only routine medical care. The primary outcome was the change in coronary heart disease (CHD) risk. Results: A total of 105 patients completed the study. Patients in the intervention group had a statistically significant reduction in CHD risk compared to those in the control group (-1.64% ± 3.56%; n = 51 vs -0.01% ± 3.08%; n = 54, P =.013). For stroke, a reduction in risk was noted in the intervention group, while an increased risk was noted in the control group (-1.06% ± 1.82% vs 0.31% ± 2.51%, P =.002). In addition, hemoglobin A1c levels were significantly reduced in the intervention group compared with the control group (-1.57% ± 1.50% vs -0.40% ± 1.19%, P <.001); a similar profile was seen with low-density lipoprotein cholesterol (-0.36 ± 0.76 vs -0.03 ± 0.74, P =.026). Furthermore, there were nonsignificant improvements in high-density lipoprotein cholesterol, triglyceride, and blood pressure in the intervention group. The increased level of understanding regarding medications in the intervention group was statistically significant (P <.001), yielding a better enhancement in compliance compared with patients in the control group (22.5% ± 13.4% vs 2.0% ± 5.0%, P <.001). Conclusion: The pharmacist care program implemented in this study demonstrated a significant cardiovascular risk reduction in type 2 diabetic patients; therefore such a program would be a valuable addition to a multidisciplinary care of diabetic patients. © SAGE Publications 2012.


Yau D.T.Y.,Hong Kong Polytechnic University | Yau D.T.Y.,Tung Wah Eastern Hospital | Chung R.C.K.,Hong Kong Polytechnic University | Pang M.Y.C.,Hong Kong Polytechnic University
Calcified Tissue International | Year: 2013

Our purpose was to identify risk factors for falls among older adults who had recently undergone hip fracture surgery. The subjects in this study were 69 older adults (aged 65 years or more) who had sustained a hip fracture and were admitted to an orthopedic rehabilitation ward after surgery. Potential fall risk factors were assessed using the physiological profile assessment, timed-up-and-go test, berg balance test, and activities-specific balance confidence scale at discharge from the hospital. Each individual was followed for a period of 6 months to obtain information on the incidence of falls. Receiver operating characteristic curves were constructed to determine the optimal cutoff score for each potential risk factor identified. Multivariate logistic regression was then used to identify the significant predictors of falls and their odds ratios (ORs). During the 6-month follow-up period, 10 of the 69 patients experienced one or more falls. The results showed that fallers were older than nonfallers (p = 0.009). Fallers also had poorer performance in the high-contrast visual acuity test (p = 0.015) and lower knee flexor (p = 0.021) and knee extensor (p = 0.005) muscle strength values. Multivariate logistic regression analysis showed that high-contrast visual acuity (cutoff score Z = -2.280, OR = 6.14, 95 % CI 1.13-33.29, p = 0.035) and knee extensor muscle strength (cutoff score Z = -1.835, OR = 4.81, 95 % CI 1.04-22.33, p = 0.045) were predictors of falls. Poor visual acuity and knee muscle weakness are modifiable predictors of falls and should be the key target areas in fall-prevention programs for older adults with hip fractures. © 2012 Springer Science+Business Media New York.


Koo S.C.Y.,Tung Wah Eastern Hospital | Chan C.W.N.,Tung Wah Eastern Hospital
International Ophthalmology | Year: 2011

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula. © 2010 The Author(s).


Yam J.C.,Tung Wah Eastern Hospital
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus | Year: 2012

To compare postoperative drift after bilateral lateral rectus recession for infantile exotropia (XT) and for intermittent XT and to compare initial postoperative alignment with long-term motor outcome. Medical records of all patients with infantile exotropia or intermittent exotropia who had undergone bilateral lateral rectus muscle recession surgery with a follow-up longer than 3 years were reviewed. The pre- and postoperative angles of deviation at distance and at near and postoperative drift at distance were compared. Surgical outcome was categorized as "success" (esotropia <6(Δ) or exotropia <11(Δ)), "recurrence" (>10(Δ) exotropia), or "overcorrection" (>5(Δ) of esotropia). The overall mean postoperative exotropic drift at 3 years was 10.4(Δ) in the infantile XT group and 7.2(Δ) in the intermittent XT group (P = 0.05). Both groups had a low success rate at 3 years: 41% in the infantile XT group and 51% in the intermittent XT group (P = 0.270). For patients with an initial esotropia of 0(Δ) to 10(Δ), the success rate at 3 years was 86% in the infantile XT group (12 of 14) and 65% in the intermittent XT group (28 of 43). Postoperative exotropic drift is clinically similar in patients with intermittent versus infantile exotropia. Esotropia of 0(Δ) to 10(Δ) during the early postoperative period may be associated with the best long-term ocular alignment. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.


Ng D.S.,Tung Wah Eastern Hospital
Korean journal of ophthalmology : KJO | Year: 2013

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.


Ng D.S.-C.,Tung Wah Eastern Hospital | Ching R.H.-Y.,Tung Wah Eastern Hospital | Chan C.W.-N.,Tung Wah Eastern Hospital
International Ophthalmology | Year: 2015

This study aims to determine the incidence of angle recession and glaucoma after traumatic microhyphema. Records of all patients treated for traumatic hyphema or microhyphema admitted to a district hospital throughout a 10-year period were retrospectively reviewed. Patients with open-globe injury were excluded. The following clinical features were recorded during patients’ initial presentation and follow-up visits: Snellen visual acuity, examination with slit-lamp biomicroscopy, intraocular pressure (IOP), dilated fundoscopic examination, gonioscopic examination and treatment. For patients with IOP > 21 mmHg and requiring glaucoma medications, visual field tests were performed. A total of 97 patients met the study criteria, of which 62 had microhyphema and 35 had gross hyphema. Among the traumatic microhyphema patients, 47 (75.8 %) had angle recession and 4 (6.5 %) had glaucoma with mean follow-up of 49 months (range 6–98 months). A statistically significant association was found between angle recession greater than 180° and the occurrence of glaucoma (p < 0.01). No statistically significant differences were found between groups of patients with microhyphema or gross hyphema regarding the incidence of angle recession and glaucoma. The complications of angle recession and glaucoma in patients after traumatic microhyphema appear similar to those found in patients after gross hyphema. © 2014, Springer Science+Business Media Dordrecht.

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