Establishing the content validity in Hong Kong of the prioritised criteria of consultation competence in the Leicester Assessment Package (LAP)

Objective: To test the content validity in Hong Kong of the prioritised criteria of consultation competence in the Leicester Assessment Package (LAP). Design: A detailed questionnaire was sent to doctors with experience of family medicine in Hong Kong to seek their views on the seven prioritised consultation categories and 39 component competences in the LAP on a six-point scale (strongly approve to strongly disapprove). Respondents also had the opportunity to reject or suggest alternative categories, components and/or weightings. Background demographic and professional data were collected. Subjects: 489 full members of the HKCFP with current Hong Kong postal address. Main outcome measure: The respondents' collated levels of approval of the LAP consultation categories, component competences and weightings and any consensus for changes. Results: There was a response rate of 57%. Of the respondents 92%, and 82% to 97% either strongly approved or approved of the overall LAP set of consultation categories and the individual categories respectively. Thirty-seven of the 39 suggested component competences were supported by more than 80% of respondents. There was little support for excluding, including or shifting any categories or component competences. Ninety-three percent of respondents were in favour of the need to identify priorities between any categories of consultation competence and 88% of respondents expressed approval of the suggested weightings. Conclusion: The high levels of approval from respondents suggest that the content validity of the categories and components of consultation competence in the LAP has been established in Hong Kong and that the LAP weightings of consultation categories have also been validated. Indeed, the results closely correlate with the findings of the original study in the United Kingdom. The LAP criteria of consultation competence may be used with confidence as measures against which consultation performance can be judged in formative or regulatory assessment (and improvement) of consultation competence in family medicine in Hong Kong.published_or_final_versio

Effects of SARS on consultations in primary care in Hong Kong

Objective: To study the infection control measures and concerns in primary care practices, and the effects of SARS on primary care consultation using the Leicester Assessment Package (LAP) criteria during the SARS episode in Hong Kong. Design: A postal survey using a questionnaire. The questionnaire consisted of three parts on the demographic data, infection control precautions taken and concerns of the respondents, and the effect of SARS on consultations. Subjects: Full members and fellows of the HKCFP. Main outcome measures: Infection control precautions including performance of initial screening/triage, by whom and how these were carried out, actions for the triaged patients, use of personal protection equipments (PPE), organisation and format of infection control training of staff and decontamination practice; perceptions of adequacy of protection and areas of concern; and proportion and degree to which consultation skills were affected using the LAP criteria. Results: The response rate was 60%. 71.4% respondents triaged their patients. 85.9% took temperatures of their patients. All respondents wore a mask during consultations. 69.8% organised training for their staff and clinic. Most respondents regularly decontaminated their clinic. 56% felt adequately protected by their infection control precautions and use of PPE but 44% did not. The major concerns were the variable clinical presentations of SARS, the practicability of wearing full protection, and the lack of early and reliable diagnostic tests. The type of practice was found to be a factor affecting the choice of infection control precautions. Consultation skills were found to be affected in ≤ 25% of consultations. History taking, physical examination, management and problem solving were found to be more difficult but relationship with patients and anticipatory care became easier. Conclusion: Choice of infection control precautions was related to the type of practice. The major concerns of primary care physicians were the variable clinical presentations of SARS and the lack of early and reliable diagnostic tests. Consultation skills were affected in ≤ 25% of consultations but patients were found to be more receptive to anticipatory care.published_or_final_versio

Associated Fungal Infections, Related to the Global Covid-19 Pandemic (Literature Review)

The 2019 coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has swept the globe. Based on a retrospective analysis of SARS and influenza data from China and around the world, we suggest that fungal co-infections associated with global COVID-19 may be missed or misdiagnosed. Although there are few publications, patients with COVID-19, especially severely ill or immunocompromised patients, are more likely to develop invasive mycoses. Aspergillus and Candida infections in patients with COVID-19 will require early detection by comprehensive diagnostic intervention (histopathology, direct microscopy, culture, (Arabian: 2004, Tilavberdiev: 2016) -β-D-glucan, galactomannan, and PCR assays) to ensure effective treatment. We consider it appropriate to assess risk factors, types of invasive mycoses, strengths and weaknesses of diagnostic methods, clinical conditions, and the need for standard or individual treatment

Regulatory assessment of the consultation competence of Family Physicians in Hong Kong

Objective: To evaluate the Consultation Skills Assessment (CSA) component of the Exit Assessment of the Higher Vocational Training Programme of the Hong Kong College of Family Physicians with particular reference to content validity and reliability. Design: An observational study in which candidates were directly observed and independently assessed by three assessors in the candidates' own practice setting during which they were expected to consult with six unselected and consecutive patients within two hours of consulting time. Subjects: Eighty-one candidates, 476 patients and 26 assessors (one external). Main outcome measures: Content validity and reliability (contributions to variance and generalisability) of the overall process. Results: Between 1997 and 2003, 81 clinical assessments were carried out. Internal assessors conducted a range of 1-19 assessments and the external assessor was present at 59 assessments (78.7%). The pass rate per CSA diet varied from 25-100%.published_or_final_versio

Intraspecfic variation in cold-temperature metabolic phenotypes of Arabidopsis lyrata ssp petraea

Atmospheric temperature is a key factor in determining the distribution of a plant species. Alongside this, plant populations growing at the margin of their range may exhibit traits that indicate genetic differentiation and adaptation to their local abiotic environment. We investigated whether geographically separated marginal populations of Arabidopsis lyrata ssp. petraea have distinct metabolic phenotypes associated with exposure to cold temperatures. Seeds of A. petraea were obtained from populations along a latitudinal gradient, namely Wales, Sweden and Iceland and grown in a controlled cabinet environment. Mannose, glucose, fructose, sucrose and raffinose concentrations were different between cold treatments and populations, especially in the Welsh population, but polyhydric alcohol concentrations were not. The free amino acid compositions were population specific, with fold differences in most amino acids, especially in the Icelandic populations, with gross changes in amino acids, particularly those associated with glutamine metabolism. Metabolic fingerprints and profiles were obtained. Principal component analysis (PCA) of metabolite fingerprints revealed metabolic characteristic phenotypes for each population and temperature. It is suggested that amino acids and carbohydrates were responsible for discriminating populations within the PCA. Metabolite fingerprinting and profiling has proved to be sufficiently sensitive to identify metabolic differences between plant populations at different atmospheric temperatures. These findings show that there is significant natural variation in cold metabolism among populations of A. l. petraea which may signify plant adaptation to local climates

Paclitaxel targets FOXM1 to regulate KIF20A in mitotic catastrophe and breast cancer paclitaxel resistance

FOXM1 has been implicated in taxane resistance, but the molecular mechanism involved remains elusive. In here, we show that FOXM1 depletion can sensitize breast cancer cells and mouse embryonic fibroblasts into entering paclitaxel-induced senescence, with the loss of clonogenic ability, and the induction of senescence-associated beta-galactosidase activity and flat cell morphology. We also demonstrate that FOXM1 regulates the expression of the microtubulin-associated kinesin KIF20A at the transcriptional level directly through a Forkhead response element (FHRE) in its promoter. Similar to FOXM1, KIF20A expression is downregulated by paclitaxel in the sensitive MCF-7 breast cancer cells and deregulated in the paclitaxel-resistant MCF-7TaxR cells. KIF20A depletion also renders MCF-7 and MCF-7TaxR cells more sensitive to paclitaxel-induced cellular senescence. Crucially, resembling paclitaxel treatment, silencing of FOXM1 and KIF20A similarly promotes abnormal mitotic spindle morphology and chromosome alignment, which have been shown to induce mitotic catastrophe-dependent senescence. The physiological relevance of the regulation of KIF20A by FOXM1 is further highlighted by the strong and significant correlations between FOXM1 and KIF20A expression in breast cancer patient samples. Statistical analysis reveals that both FOXM1 and KIF20A protein and mRNA expression significantly associates with poor survival, consistent with a role of FOXM1 and KIF20A in paclitaxel action and resistance. Collectively, our findings suggest that paclitaxel targets the FOXM1-KIF20A axis to drive abnormal mitotic spindle formation and mitotic catastrophe and that deregulated FOXM1 and KIF20A expression may confer paclitaxel resistance. These findings provide insights into the underlying mechanisms of paclitaxel resistance and have implications for the development of predictive biomarkers and novel chemotherapeutic strategies for paclitaxel resistance.Oncogene advance online publication, 11 May 2015; doi:10.1038/onc.2015.152.published_or_final_versio

Etoricoxib-induced life-threatening hyperkalemia and acute kidney dysfunction against the background of telmisartan and a low sodium diet

Drug-induced hyperkalemia is not uncommon and may be life-threatening when presenting acutely in the emergency department. We present a case of severe hyperkalemia precipitated acutely by etoricoxib in a patient who was on telmisartan and a low sodium (potassium chloride-rich) diet. A 75-year-old male with a past medical history of well-controlled diabetes and hypertension was prescribed etoricoxib (90 mg daily) for 3 days for musculoskeletal backache. He had been taking his routine medications including telmisartan and a potassium-rich salt substitute for many years, without any recent change in dosage or quantity. There was evidence of microalbuminurea; however, the renal functions and electrolytes prior to starting etoricoxib were normal. He presented to the emergency department with signs and symptoms of life-threatening hyperkalemia (serum potassium 7.7 mEq/dl), accelerated hypertension, congestive heart failure, pulmonary edema and acute renal failure. Acute medical management and withholding all drugs that could cause hyperkalemia improved his serum potassium levels over 24 h and renal parameters within 5 days. All the other drugs except etoricoxib were restarted under observation over 8 weeks with no recurrence of the acute episode. Non-steroidal analgesics and other COX-2 inhibitors (rofecoxib and celecoxib) have been known to precipitate renal failure and hyperkalemia specially in patients at risk for the same; although not unexpected, this may be the first reported case of life-threatening hyperkalemia precipitated by etoricoxib in a previously stable patient having increased risk of renal failure and hyperkalemia

Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

© 2014, van der Linden et al.; licensee Springer. Background: Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. Methods: A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ2 tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. Results: Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were ‘accessibility and convenience’ and perceived ‘medical necessity’. Conclusions: A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem

The association between internet addiction and psychiatric co-morbidity: A meta-analysis

Background: This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature.Methods: Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR).Results: Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001).Conclusions: IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety. © 2014 Ho et al.; licensee BioMed Central Ltd