How long do the Hong Kong Chinese expect their URTI to last? – Effects on antibiotic use

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What do family medicine trainees say about their training?

Objective: To survey the vocational trainees' evaluation of their training. Design: Questionnaire survey with quantitative and qualitative components. Setting: All trainees, past and present, registered with the Hong Kong College of Family Physicians up to April 2002. Main outcome measure: Quantitative analysis on trainees' agreement/disagreement on specific items of their training, and qualitative analysis of themes extracted from all the responses to open-ended questions. Results: 247 out of 355 present and past trainees responded. Overall, the trainees found the training useful and they learnt the knowledge and skill of family medicine. The Basic Hospital Trainees were more likely to have dissatisfaction than the other trainees; they perceived low esteem, were engaged more in service than in training, and were uncertain about what they were expected to learn. The Basic Community Trainees had diverse and balanced opinions on their training and were more concerned with the variable quality of supervision. The Higher Trainees would like to have a more structured and organised training program than the present one. The trainees suggested that the College of Family Physicians could do more to assure quality of training and to facilitate more communication among the trainers, trainees and the College. Conclusion: The trainees have given a lot of useful and constructive information about their training.published_or_final_versio

Vocational training in family medicine: A qualitative study of perspectives of trainers in community-based training

Objective: To investigate how trainers perceived the vocational training programme in family medicine in Hong Kong. Design: Structured discussion with trainers who had trainees in the community-based segment of the vocational training programme of the Hong Kong College of Family Physicians. Subjects: Forty seven eligible trainers were identified and invited to attend the discussion. Thirteen trainers participated in two structured discussions. Main outcome measures: The opinions expressed by the participants towards the vocational training programme. Results: The response rate was 27.7%. The trainers were clear about their roles but saw an overlap between their functions and those of the trainees' supervisors. They were unsure on what to teach and how to teach, and looked for guidance from the Hong Kong College of Family Physicians. They felt that there should be more varied training methods, more resources at training centres, better training arrangements and more coordination among training stakeholders. Some trainers experienced difficulties with their trainees. All trainers saw the benefit of an annual trainers workshop. Conclusion: It is recommended that the College provides better organisation for and training of trainers. A trainers co-ordinator, a trainers handbook and an annual trainers workshop are some suggestions.published_or_final_versio

家庭醫生與非家庭醫生對於香港家庭醫學專科培訓所持意見的異同

目的: 探討本地醫生對家庭醫學專科培訓的意見，以作將來規劃醫療體制的參考。 設計: 橫斷面研究。 參與者及安排: 香港所有註冊醫生。 主要結果測量: 醫生對以下幾方面的評價：職業培訓的重要性、專業評核、工作性質和成為家庭醫生所需經驗，以及他們對於職業培訓所需年期的意見。 結果: 共2310位醫生完成問卷，佔本地醫生23%。最多醫生同意專業評核應為資格認可的因素，其他依次為職業培訓、臨床經驗及工作性質。七成以上受訪醫生認為培訓期應為四年或以下。非家庭醫生大多選擇專業評核作為資格認可的因素，他們亦傾向較長的培訓期。 結論: 職業培訓被認為是獲得家庭醫學專科資格的重要因素。大多數醫生認為培訓期應為四年或以下，而非香港醫學專科學院現時所訂立的六年期。因此，現時家庭醫學的職業培訓計劃或有檢討的需要。Objective: To study the local medical profession's opinions on the training requirements for the specialty of family medicine. This was to serve as a reference for future planning of the health care system. Design: Cross-sectional study. Participants and Setting: All registered doctors in Hong Kong. Main outcome measures: Doctors' ratings on the importance of vocational training, professional assessment, job nature, and experience to become suitably qualified as a family doctor, and their opinions on the length of necessary vocational training. Results: A total of 2310 doctors (23% of doctors in the local register) responded. Professional assessment was mostly agreed as a qualification, followed by vocational training, clinical experience, and job nature. Over 70% agreed on a training period of 4 years or less. Non-family doctors were more likely to opt for professional assessment as the qualification and also opt for a longer training period. Conclusion: Vocational training was considered important as a qualification for the specialty of family medicine. The length of training was mostly agreed to be 4 years or less, not the 6 years currently required by the Hong Kong Academy of Medicine. The vocational training programme for family medicine might require reexamination.published_or_final_versio

Co-targeting of DNA, RNA, and protein molecules provides optimal outcomes for treating osteosarcoma and pulmonary metastasis in spontaneous and experimental metastasis mouse models.

Metastasis is a major cause of mortality for cancer patients and remains as the greatest challenge in cancer therapy. Driven by multiple factors, metastasis may not be controlled by the inhibition of single target. This study was aimed at assessing the hypothesis that drugs could be rationally combined to co-target critical DNA, RNA and protein molecules to achieve "saturation attack" against metastasis. Independent actions of the model drugs DNA-intercalating doxorubicin, RNA-interfering miR-34a and protein-inhibiting sorafenib on DNA replication, RNA translation and protein kinase signaling in highly metastatic, human osteosarcoma 143B cells were demonstrated by the increase of γH2A.X foci formation, reduction of c-MET expression and inhibition of Erk1/2 phosphorylation, respectively, and optimal effects were found for triple-drug combination. Consequently, triple-drug treatment showed a strong synergism in suppressing 143B cell proliferation and the greatest effects in reducing cell invasion. Compared to single- and dual-drug treatment, triple-drug therapy suppressed pulmonary metastases and orthotopic osteosarcoma progression to significantly greater degrees in orthotopic osteosarcoma xenograft/spontaneous metastases mouse models, while none showed significant toxicity. In addition, triple-drug therapy improved the overall survival to the greatest extent in experimental metastases mouse models. These findings demonstrate co-targeting of DNA, RNA and protein molecules as a novel therapeutic strategy for the treatment of metastasis

Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation

Background Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost- effectiveness of LAAO for stroke prophylaxis in NVAF. Methods A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One- way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. Results LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115,$2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24$50,000/QALY. Conclusions Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. Condensed abstract The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management

Hip and knee weakness and ankle dorsiflexion restriction in individuals following lateral patellar dislocation: A case-control study

OBJECTIVE: To explore the relationship between ankle dorsiflexion range of motion (ROM) and hip and knee muscle strength between patients with a history of patellar dislocation (PD) to healthy controls. DESIGN: Case-control study. SETTING: Orthopedical specialty outpatient clinic at a tertiary hospital. PARTICIPANTS: Eighty-eight individuals were recruited; 44 individuals aged 16 years or older, of both sexes, with a history of at least one episode of atraumatic unilateral or bilateral PD requiring emergency care (14 men; 30 women; mean age 20 years) and 44 healthy (control) individuals (11 men; 33 women; mean age 21 years) matched for age, weight, and height to PD cases. INTERVENTION: Assessment of hip and knee strength and ankle dorsiflexion ROM. OUTCOME MEASURES: Ankle dorsiflexion ROM was assessed through the lunge test with a goniometer. Hip and knee muscle strength was evaluated through isometric hand-held dynamometry. Differences between healthy and control individuals were assessed using Student t Tests and Mann-Whitney U Test. RESULTS: Patellar dislocation individuals presented with a reduced ankle dorsiflexion ROM [mean difference (MD): 9 degrees; effect size (ES): 1.39; P < 0.001] and generalized hip and knee weakness (MD range: 4.74 kgf to 31.4 kgf; ES range: 0.52-2.35; P < 0.05) compared with healthy subjects. CONCLUSION: Individuals with a history of PD have reduced ankle dorsiflexion ROM and hip and knee muscle strength compared with healthy controls

New ways to turn on NKT cells

Godfrey and Rossjohn discuss the varied ways to turn on NKT cells in the context of recent findings

Return to work, work productivity loss and activity impairment in Chinese breast cancer survivors 12-month post-surgery: a longitudinal study

IntroductionExisting evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants.MethodsThis observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress.ResultsA 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes.DiscussionUsing a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW