Having a family doctor is associated with some better patient-reported outcomes of primary care consultations

<b>Background</b> Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference.<p></p> <b>Methods</b> We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns.<p></p> <b>Results</b> One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns.<p></p> <b>Conclusion</b> People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations

Effectiveness of Traditional Chinese Medicine in Primary Care

Includes bibliographical references

Health-related quality of life of Southern Chinese with chronic hepatitis B infection

<p>Abstract</p> <p>Background</p> <p>Few studies have evaluated the health-related quality of life (HRQOL) of Southern Chinese with chronic hepatitis B (CHB) infection.</p> <p>Aim</p> <p>To evaluate the HRQOL of Chinese patients at different stages of CHB infection and to find out factors associated with HRQOL.</p> <p>Methods</p> <p>520 Chinese adult CHB patients of whom 156 were uncomplicated, 102 had impaired liver function, 139 had cirrhosis and 123 had hepatocellular carcinoma (HCC) were interviewed with a structured questionnaire, the SF-36 Health Survey version 2 (SF-36v2), and the Chronic Liver Disease Questionnaire (CLDQ). The differences in SF-6D health preference values and SF-36v2 scores between each CHB group and Hong Kong population norms were assessed by t-test. ANOVA was used to compare the mean SF-6D health preference, SF-36v2 scores, and CLDQ scores among CHB groups. Multiple linear regressions were performed to identify determinants of HRQOL.</p> <p>Results</p> <p>CHB patients had significantly lower SF-36v2 scores than the population norm. The SF-6D values of CHB patients with uncomplicated disease, impaired liver function, HCC and cirrhosis were 0.755, 0.745, 0.720 and 0.701, respectively, all significantly lower than the population norm of 0.787. Advanced stage of CHB illness, anti-viral treatment, bilirubin level, psychological co-morbidity, younger age and female were associated with poorer HRQOL.</p> <p>Conclusion</p> <p>CHB infection had a negative impact on HRQOL. There was a progressive decrease in health preference values with CHB disease progression. The results can be used for the estimation of quality adjusted life years (QALYs) for CHB patients in cost effectiveness or cost utility studies.</p> <p>Trial Registration</p> <p><url>http://www.hkclinicaltrials.com</url>; HKCTR-151.</p

Development of inductively coupled plasma-mass spectrometry method for determination of trace metals in black pepper berries

he inductively coupled plasma mass spectrometry (ICP-MS/MS) method was developed and validated for analysis of trace metals in black pepper berries. Pepper berries were digested using microwave assisted acid digestion procedure and analyzed using ICP-MS/MS. The acid digestion mixture, operating conditions (temperature and power) and flow rate of cell gas (helium) were optimized. Pepper berries were well digested using 3 mL of nitric acid at 220°C with a power of 1000 W. The cell gas set at a flow rate of 5 mL/min gave the best detection capacity. The optimized method attained satisfactory recovery performance (98.1–114.83%) with a low matrix effect. The response showed good linearity with correlation coefficient (R2) above 0.999. Good selectivity and sensitivity were yielded with the limit of detection (LOD) established at < 0.01 mg/kg for all elements. The method was applied to determine five trace metals (As, Cd, Hg, Pb and Sb) present in 115 black pepper berries samples originated from six countries (Cambodia, India, Indonesia, Sri Lanka, Vietnam and Malaysia). In all of the samples tested, As and Pb were elements commonly detected and the method could determine concentrations as low as 0.01 mg/kg. This finding indicated that the ICP-MS/MS method is best efficient for routine and compliance monitoring of trace metals in black pepper berries

A gene expression-based model predicts outcome in children with intermediate-risk classical Hodgkin lymphoma

Classical Hodgkin lymphoma (cHL) is a common malignancy in children and adolescents. Although cHL is highly curable, treatment with chemotherapy and radiation often come at the cost of long-term toxicity and morbidity. Effective risk-stratification tools are needed to tailor therapy. Here, we used gene expression profiling (GEP) to investigate tumor microenvironment (TME) biology, to determine molecular correlates of treatment failure, and to develop an outcome model prognostic for pediatric cHL. A total of 246 formalin-fixed, paraffin-embedded tissue biopsies from patients enrolled in the Children’s Oncology Group trial AHOD0031 were used for GEP and compared with adult cHL data. Eosinophil, B-cell, and mast cell signatures were enriched in children, whereas macrophage and stromal signatures were more prominent in adults. Concordantly, a previously published model for overall survival prediction in adult cHL did not validate in pediatric cHL. Therefore, we developed a 9-cellular component model reflecting TME composition to predict event-free survival (EFS). In an independent validation cohort, we observed a significant difference in weighted 5-year EFS between high-risk and low-risk groups (75.2% vs 90.3%; log-rank P = .0138) independent of interim response, stage, fever, and albumin. We demonstrate unique disease biology in children and adolescents that can be harnessed for risk-stratification at diagnosis. This trial was registered at www.clinicaltrials.gov as #NCT00025259

Acute decompensated heart failure in a non cardiology tertiary referral centre, Sarawak General Hospital (SGH‑HF)

Abstract Background: Data on clinical characteristics of acute decompensated heart failure (ADHF) in Malaysia especially in East Malaysia is lacking. Methods: This is a prospective observational study in Sarawak General Hospital, Medical Department, from October 2017 to September 2018. Patients with primary admission diagnosis of ADHF were recruited and followed up for 90 days. Data on patient’s characteristics, precipitating factors, medications and short-term clinical outcomes were recorded. Results: Majority of the patients were classified in lower socioeconomic group and the mean age was 59 years old. Hypertension, diabetes mellitus and dyslipidaemia were the common underlying comorbidities. Heart failure with ischemic aetiology was the commonest ADHF admission precipitating factor. 48.6% of patients were having preserved ejection fraction HF and the median NT-ProBNP level was 4230 pg/mL. Prescription rate of the evidencebased heart failure medication was low. The in-patient mortality and the average length of hospital stay were 7.5% and 5 days respectively. 43% of patients required either ICU care or advanced cardiopulmonary support. The 30-day, 90-day mortality and readmission rate were 13.1%, 11.2%, 16.8% and 14% respectively. Conclusion: Comparing with the HF data from West and Asia Pacific, the short-term mortality and readmission rate were high among the ADHF patients in our study cohort. Maladaptation to evidence-based HF prescription and the higher prevalence of cardiovascular risk factors in younger patients were among the possible issues to be addressed to improve the HF outcome in regions with similar socioeconomic background. Keywords: Acute decompensated heart failure, Epidemiology, Sarawak, Southeast Asia, Malaysi

Clinical Outcome Predictor using Killip Scoring in Acute Decompensated Heart Failure (ADHF): A Non-Cardiac Centre Pilot Experience

Background: Physicians in tertiary centers face a constant challenge in selecting patient with ADHF to be admitted from district healthcare centre, especially with limited resources. Appropriate risk stratification of patients with ADHF would improve the efficiency of our healthcare delivery system. Objective: We aim to find potential relationship between Killip clinical scoring with clinical outcome of ADHF, including in-patient mortality and requirement of advanced cardiorespiratory support. Methods: 35 consecutive cases with a discharge diagnosis of ADHF and admission creatinine clearance of more than 30 were randomly reviewed. Cases were analyzed retrospectively for their Killip score, in-patient mortality, requirement of advance cardiorespiratory care or ICU admission. Results: There were 21 male patients (60%) and 14 female patients. Mean age was 61±19 years old. Mean duration of ward-stay was 6±4 days. Comorbidities were 14 (40%) with history of coronary artery diseases and 17 (49%) with diabetes mellitus. 15 patients (43%) were on at least a single type of guideline directed medication for heart failure. The cohort was almost evenly distributed between those with a Killip score of 2 and above 2. A Killip score of 3 and above was found to have good positive predictive value (87%) for advanced cardio-respiratory care and negative predictive value of 78%. No in-patient death was observed for the group with Killip 2 while 5 deaths were recorded in the group scoring more than 2. A Killip score of 3 had excellent (100%) negative predictive value for in-patient mortality but poor positive predictive value (33%). Significant relationship (p<0.001) was observed for Killip scoring on both outcomes. Conclusion: Killip scoring may be useful for on-call physician to decide the need on tertiary care among patient with ADHF and mortality outcome. However, more prospective studies and patients should be recruited to validate the study

The epidemiology and natural history of depressive disorders in Hong Kong's primary care

Background: Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the factors affecting prognosis of these patients requires closer examination. Methods/Design. The aim of this study is to examine the prevalence, incidence and natural history of depressive disorders in primary care and the factors influencing diagnosis, management and outcomes using a cross-sectional study followed by a longitudinal cohort study. Doctors working in primary care settings across Hong Kong have been invited to participate in this study. On one day each month over twelve months, patients in the doctor's waiting room are invited to complete a questionnaire containing items on socio-demography, co-morbidity, family history, previous doctor-diagnosed mental illness, recent mental and other health care utilization, symptoms of depression and health-related quality of life. Following the consultation, the doctors provide information regarding presenting problem, whether they think the patient has depression, and if so, whether the diagnosis is new or old, and the duration of the depressive illness if not a new diagnosis. If the doctor detects a depressive disorder, they are asked to provide information regarding patient management. Patients who consent are followed up by telephone at 2, 12, 26 and 52 weeks. Discussion. The study will provide information regarding cross-sectional prevalence, 12 month incidence, remission rate, outcomes and factors affecting outcomes of patients with depressive disorders in primary care. The epidemiology, outcomes, pathways of care, predictors for prognosis and service needs for primary care patients with depressive disorders will be described and recommendations made for policy and service planning. © 2011 Chin et al; licensee BioMed Central Ltd.published_or_final_versio

Allelic Diversity of the Plasmodium falciparum Erythrocyte Membrane Protein 1 Entails Variant-Specific Red Cell Surface Epitopes

The clonally variant Plasmodium falciparum PfEMP1 adhesin is a virulence factor and a prime target of humoral immunity. It is encoded by a repertoire of functionally differentiated var genes, which display architectural diversity and allelic polymorphism. Their serological relationship is key to understanding the evolutionary constraints on this gene family and rational vaccine design. Here, we investigated the Palo Alto/VarO and IT4/R29 and 3D7/PF13_003 parasites lines. VarO and R29 form rosettes with uninfected erythrocytes, a phenotype associated with severe malaria. They express an allelic Cys2/group A NTS-DBL1α1 PfEMP1 domain implicated in rosetting, whose 3D7 ortholog is encoded by PF13_0003. Using these three recombinant NTS-DBL1α1 domains, we elicited antibodies in mice that were used to develop monovariant cultures by panning selection. The 3D7/PF13_0003 parasites formed rosettes, revealing a correlation between sequence identity and virulence phenotype. The antibodies cross-reacted with the allelic domains in ELISA but only minimally with the Cys4/group B/C PFL1955w NTS-DBL1α. By contrast, they were variant-specific in surface seroreactivity of the monovariant-infected red cells by FACS analysis and in rosette-disruption assays. Thus, while ELISA can differentiate serogroups, surface reactivity assays define the more restrictive serotypes. Irrespective of cumulated exposure to infection, antibodies acquired by humans living in a malaria-endemic area also displayed a variant-specific surface reactivity. Although seroprevalence exceeded 90% for each rosetting line, the kinetics of acquistion of surface-reactive antibodies differed in the younger age groups. These data indicate that humans acquire an antibody repertoire to non-overlapping serotypes within a serogroup, consistent with an antibody-driven diversification pressure at the population level. In addition, the data provide important information for vaccine design, as production of a vaccine targeting rosetting PfEMP1 adhesins will require engineering to induce variant-transcending responses or combining multiple serotypes to elicit a broad spectrum of immunity