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Wong RMY, Ng RWK, Chau WW, Liu WH, Chow SKH, Tso CY, Tang N, Cheung WH. Montreal cognitive assessment (MoCA) is highly correlated with 1-year mortality in hip fracture patients. Osteoporos Int 2022; 33:2185-2192. [PMID: 35763077 DOI: 10.1007/s00198-022-06426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/04/2022] [Indexed: 10/17/2022]
Abstract
UNLABELLED Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates. INTRODUCTION Hip fractures rank amongst the top 10 causes of disability and current mortality of hip fractures is high. Objectives were to determine 1) prevalence of cognitive impairment, 2) whether Montreal Cognitive Assessment (MoCA) score was an independent risk factor associated with mortality, 3) MoCA cut-off that result in high risk of mortality. METHODS This was a cohort study between July 2019 to June 2020. Inclusion criteria were 1) hip fracture, 2) > = 65 years old, and 3) low-energy trauma. Patients undergo assessment for cognitive impairment with MoCA. Prevalence was assessed, MoCA cut-off point, and accuracy of statistical model was evaluated. Logistic regression modelling was used to assess association between mortality and MoCA. RESULTS There were 260 patients recruited. Two hundred twenty-five patients had MoCA score < 22 signifying cognitive impairment, and 202 patients had MoCA score of < 19. 46 hip fracture patients died at 1-year follow-up. 45 of these patients had MoCA score < 19, and 1 patient had a MoCA > 22. Results showed statistical significance and good model effect (at least 0.8) with MoCA cut-off points between < 15 and < 19 (p < 0.05). After controlling confounding factors, statistical significance still existed in MoCA cut-off point at < 15 (odds ratio (95% CI) = 11.71 (1.14, 120.71); p = 0.04). CONCLUSION Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality in hip fracture patients. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality at 1-year after a hip fracture. AUC with MoCA score < 15 was 0.948. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.
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Affiliation(s)
- R M Y Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - R W K Ng
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - W W Chau
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W H Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - S K H Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C Y Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - N Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - W-H Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wong RMY, Chow SKH, Tang N, Chung YL, Griffith J, Liu WH, Ng RWK, Tso CY, Cheung WH. Vibration therapy as an intervention for enhancing trochanteric hip fracture healing in elderly patients: a randomized double-blinded, placebo-controlled clinical trial. Trials 2021; 22:878. [PMID: 34863272 PMCID: PMC8643183 DOI: 10.1186/s13063-021-05844-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are more than 300,000 hip fractures yearly in the USA with mortality rates of 20% within 1 year. The treatment of osteoporotic fractures is a major challenge as bone quality is poor, and healing is expected to delay due to the impaired healing properties with respect to bone formation, angiogenesis, and mineralization. Enhancement of osteoporotic fracture healing and function is therefore critical as a major goal in modern fracture management. Previous pre-clinical studies have shown that low-magnitude high-frequency vibration (LMHFV) accelerates osteoporotic fracture healing. The objective of this study is to investigate the effect of LMHFV on accelerating trochanteric hip fracture healing and functional recovery. METHODS This is a randomized, double-blinded, placebo-controlled clinical trial to evaluate the effect of LMHFV in accelerating trochanteric hip fracture healing. All fractures undergo cephalomedullary nail fixation. The primary outcome of this study is time to fracture healing by X-ray. Computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) will also be performed. Blood circulation at the fracture site will be assessed by dynamic perfusion magnetic resonance (MR). Clinical results include functional recovery by muscle strength, timed up and go test (TUG), quality of life questionnaire (SF-36), balancing, falls, and mortality. DISCUSSION Previous animal studies have demonstrated LMHFV to improve both normal and osteoporotic fracture healing by accelerating callus formation and mineralization. The mechanical stimulation stimulates angiogenesis by significantly enhancing vascular volume and blood flow velocity. This is the first study to translate LMHFV to enhancing hip fracture healing clinically. Positive results would provide a huge impact in the recovery of hip fracture patients and save healthcare costs. TRIAL REGISTRATION Clinicaltrials.gov NCT04063891. Registered on August 21, 2019.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Kwoon Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ning Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - James Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Hong Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Raymond Wai Kit Ng
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Wing Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
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Wong RMY, Ko SY, Chau WW, Lee LCY, Chow SKH, Cheung WH, Law SW. The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap? Arch Osteoporos 2021; 16:168. [PMID: 34743234 DOI: 10.1007/s11657-021-01036-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture liaison services (FLS) have been implemented worldwide, but we present one of the first reported experiences in China. Only 1 out of 226 patients had a secondary fracture within 1 year. This serves as a platform to improving solutions and decreasing imminent fractures for future use nationwide in China. INTRODUCTION Fracture liaison services (FLS) have been implemented worldwide but we present one of the first reported experiences in China. Vertebral fragility fracture is one of the earliest fracture to occur. The objective of this study was to implement a dedicated fracture service to decrease imminent fractures for future use nationwide in China. METHODS Patients 50 years or older with a recent vertebral compression fracture were recruited. All patients were offered investigation with DXA scan and blood taking. Treatment was provided with calcium and vitamin D supplements and denosumab injections. The primary outcome was the imminent fracture rate or the re-fracture rate occurring within 2 years of the initial one. Secondary outcomes were bone mineral density (BMD), treatment initiation, adherence to drug, compliance to follow-up, falls, mortality, pain, quality of life, pain-related disability with Roland-Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). RESULTS Two hundred twenty-six patients (n = 226) were analyzed. 0.4% (n = 1) had an imminent fracture within 2 years. 11.1% (n = 25) had a fall within 2 years, in which 1 resulted in a major osteoporotic fracture. 7.1% died (n = 16) within the 2-year time period. 97.8% (n = 221) underwent BMD investigation with an initial DXA scan. One hundred percent (n = 226) had treatment initiation and were prescribed with Denosumab injections. 89.8% (n = 203) were compliant and showed complete adherence to drug therapy over the 2 years. Pain, quality of life, and disability were significantly improved. CONCLUSION This is the first reported fracture liaison service for vertebral fracture patients reported in China. Future FLS should incorporate muscle and sarcopenic assessments as a routine, and also research on novel interventions in this area would significantly improve patient outcomes.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Shaau Yiu Ko
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Wang Chau
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Linus Chee Yeen Lee
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Kwoon Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
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Lau WCY, Cheung CL, Man KKC, Chan EW, Sing CW, Lip GYH, Siu CW, Lam JKY, Lee ACH, Wong ICK. Association Between Treatment With Apixaban, Dabigatran, Rivaroxaban, or Warfarin and Risk for Osteoporotic Fractures Among Patients With Atrial Fibrillation: A Population-Based Cohort Study. Ann Intern Med 2020; 173:1-9. [PMID: 32423351 DOI: 10.7326/m19-3671] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unclear whether anticoagulant type is associated with the risk for osteoporotic fracture, a deleterious complication of anticoagulants among patients with atrial fibrillation (AF). OBJECTIVE To compare the risk for osteoporotic fracture between anticoagulants. DESIGN Population-based cohort study. SETTING Territory-wide electronic health record database of the Hong Kong Hospital Authority. PARTICIPANTS Patients newly diagnosed with AF between 2010 and 2017 who received a new prescription for warfarin or a direct oral anticoagulant (DOAC) (apixaban, dabigatran, or rivaroxaban). Follow-up ended on 31 December 2018. MEASUREMENTS Osteoporotic hip and vertebral fractures in anticoagulant users were compared using propensity score-weighted cumulative incidence differences (CIDs). RESULTS There were 23 515 patients identified (3241 apixaban users, 6867 dabigatran users, 3866 rivaroxaban users, and 9541 warfarin users). Overall mean age was 74.4 years (SD, 10.8), ranging from 73.1 years (warfarin) to 77.9 years (apixaban). Over a median follow-up of 423 days, 401 fractures were identified (crude event number [weighted rate per 100 patient-years]: apixaban, 53 [0.82]; dabigatran, 95 [0.76]; rivaroxaban, 57 [0.67]; and warfarin, 196 [1.11]). After 24-month follow-up, DOAC use was associated with a lower risk for fracture than warfarin use (apixaban CID, -0.88% [95% CI, -1.66% to -0.21%]; dabigatran CID, -0.81% [CI, -1.34% to -0.23%]; and rivaroxaban CID, -1.13% [CI, -1.67% to -0.53%]). No differences were seen in all head-to-head comparisons between DOACs at 24 months (apixaban vs. dabigatran CID, -0.06% [CI, -0.69% to 0.49%]; rivaroxaban vs. dabigatran CID, -0.32% [CI, -0.84% to 0.18%]; and rivaroxaban vs. apixaban CID, -0.25% [CI, -0.86% to 0.40%]). LIMITATION Residual confounding is possible. CONCLUSION Among patients with AF, DOAC use may result in a lower risk for osteoporotic fracture compared with warfarin use. Fracture risk does not seem to be altered by the choice of DOAC. These findings may help inform the benefit-risk assessment when choosing between anticoagulants. PRIMARY FUNDING SOURCE The University of Hong Kong and University College London Strategic Partnership Fund.
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Affiliation(s)
- Wallis C Y Lau
- UCL School of Pharmacy, London, United Kingdom, and Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, China (W.C.L., K.K.M.)
| | - Ching-Lung Cheung
- Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, China (C.C., E.W.C., C.W.S.)
| | - Kenneth K C Man
- UCL School of Pharmacy, London, United Kingdom, and Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, China (W.C.L., K.K.M.)
| | - Esther W Chan
- Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, China (C.C., E.W.C., C.W.S.)
| | - Chor Wing Sing
- Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, China (C.C., E.W.C., C.W.S.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, and Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.L.)
| | - Chung-Wah Siu
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China (C.S.)
| | - Joanne K Y Lam
- Osteoporosis Centre, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China (J.K.L., A.C.L.)
| | - Alan C H Lee
- Osteoporosis Centre, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China (J.K.L., A.C.L.)
| | - Ian C K Wong
- UCL School of Pharmacy, London, United Kingdom, Centre for Safe Medication and Practice Research, The University of Hong Kong, Hong Kong, and The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China (I.C.W.)
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Wong RMY, Ho WT, Wai LS, Li W, Chau WW, Chow KHS, Cheung WH. Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies. Arch Osteoporos 2019; 14:104. [PMID: 31659457 DOI: 10.1007/s11657-019-0648-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/27/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Imminent fracture risk, or fractures within 2 years of an initial fracture, is a pressing issue worldwide. Hong Kong is a city with one of the longest life expectancies. The concern of fragility fractures and the imminent risk of a subsequent fracture is becoming a top priority. The objective of this study was to present the epidemiology of incident fragility fractures of all public acute hospitals and the imminent risk of a subsequent fracture in Hong Kong. METHODOLOGY This was a retrospective population-based analysis. Patient records from all acute hospitals in Hong Kong from 1 January 2004 to 31 December 2018 were retrieved for patients ≥ 50 years of age with hip, distal radius, or proximal humerus fractures. Secondary fractures and falls were identified in the subsequent 5 years. Post hoc analysis in recent 2013-2018 period was performed. Overall survival (re-fracture incidence) on age subgroups using Kaplan survival analysis and variables was compared using the log-rank test. Cox proportional hazard regressions, obtaining the hazard ratios (HR) and their respective 95% confidence intervals (CI), were used. RESULTS There is an overall increasing trend of fragility fractures (hip, distal radius, proximal humerus) from 5596 in 2004 to 8465 in 2018. The average cumulative imminent risk of fractures from recent 5 years is 3.87% at 1 year and 6.50% at 2 years. 49.5% of the patients with a secondary fracture occurred within 2 years since the initial major fragility fracture. Post hoc analysis in recent 2013-2018 period (N = 7039) showed male patients were 1.21 times more likely to have further fractures with time (HR = 1.21 (1.02, 1.45), p = 0.03) compared with female patients. Patients over age 95 were 2.01 times higher than patients of age under 75 to have further fracture over time. CONCLUSIONS Following an initial fracture, prompt treatment strategies should be adopted to avoid imminent risk of fractures. This window of opportunity in the first 2 years is a golden period to treat osteoporosis and prevent falls. Our post hoc analysis has shown that male patients and patients older than 95 are at even higher risk. Clinicians and allied healthcare professionals should be alert on these patients.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China
| | - Wing Tung Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China
| | - Law Sheung Wai
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China
| | - Wilson Li
- Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China
| | - Wai Wang Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China
| | - Kwoon-Ho Simon Chow
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China.
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Neurocognitive function, performance status, and quality of life in pediatric intracranial germ cell tumor survivors. J Neurooncol 2018; 141:393-401. [DOI: 10.1007/s11060-018-03045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
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Wong ATY, Chen H, Liu SH, Hsu EK, Luk KS, Lai CKC, Chan RFY, Tsang OTY, Choi KW, Kwan YW, Tong AYH, Cheng VCC, Tsang DNC. From SARS to Avian Influenza Preparedness in Hong Kong. Clin Infect Dis 2018; 64:S98-S104. [PMID: 28475794 DOI: 10.1093/cid/cix123] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The first human H5N1 case was diagnosed in Hong Kong in 1997. Since then, experience in effective preparedness strategies that target novel influenza viruses has expanded. Here, we report on avian influenza preparedness in public hospitals in Hong Kong to illustrate policies and practices associated with control of emerging infectious diseases. The Hong Kong government's risk-based preparedness plan for influenza pandemics includes 3 response levels for command, control, and coordination frameworks for territory-wide responses. The tiered levels of alert, serious, and emergency response enable early detection based on epidemiological exposure followed by initiation of a care bundle. Information technology, laboratory preparedness, clinical and public health management, and infection control preparedness provide a comprehensive and generalizable preparedness plan for emerging infectious diseases.
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Affiliation(s)
- Andrew T Y Wong
- Infectious Disease Control Training Centre, Hospital Authority Head Office
| | - Hong Chen
- Infectious Disease Control Training Centre, Hospital Authority Head Office
| | - Shao-Haei Liu
- Infection, Emergency & Contingency, Quality and Safety Division, Hospital Authority Head Office
| | - Enoch K Hsu
- Infectious Disease Control Training Centre, Hospital Authority Head Office
| | | | | | | | - Owen T Y Tsang
- Hospital Authority Infectious Disease Centre, Princess Margaret Hospital
| | - K W Choi
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital
| | - Anna Y H Tong
- Information Technology and Health Informatics Division, Hospital Authority Head Office
| | | | - Dominic N C Tsang
- Chief Infection Control Officer Office, Hospital Authority Head Office, Hong Kong Special Administrative Region, China
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Zainal INA, Karim NAA, Soh YC, Suleiman AK, Khan TM, Hameed MA, Ming LC, Lean QY. Key Elements of Pharmacoinformatics for the Degrees of Bachelor and Master of Pharmacy. Ther Innov Regul Sci 2017; 51:419-425. [DOI: 10.1177/2168479017701977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stewart R, Davis K. 'Big data' in mental health research: current status and emerging possibilities. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1055-72. [PMID: 27465245 PMCID: PMC4977335 DOI: 10.1007/s00127-016-1266-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/08/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE 'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS A narrative review. RESULTS Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.
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Affiliation(s)
- Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK.
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK
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Tam WWS, Wong TW, Ng L, Wong SYS, Kung KKL, Wong AHS. Association between air pollution and general outpatient clinic consultations for upper respiratory tract infections in Hong Kong. PLoS One 2014; 9:e86913. [PMID: 24466288 PMCID: PMC3900683 DOI: 10.1371/journal.pone.0086913] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/15/2013] [Indexed: 01/24/2023] Open
Abstract
Background and Objectives Many studies have shown the adverse effects of air pollution on respiratory health, but few have examined the effects of air pollution on service utilisation in the primary care setting. The aim of this study was to examine the association between air pollution and the daily number of consultations due to upper respiratory tract infections (URTIs) in general outpatient clinics (GOPCs) in Hong Kong. Methods Daily data on the numbers of consultations due to URTIs in GOPCs, the concentrations of major air pollutants, and the mean values of metrological variables were retrospectively collected over a 3-year period (2008–2010, inclusive). Generalised additive models were constructed to examine the association between air pollution and the daily number of consultations, and to derive the relative risks and 95% confidence intervals (95% CI) of GOPC consultations for a unit increase in the concentrations of air pollutants. Results The mean daily consultations due to URTIs in GOPCs ranged from 68.4 to 253.0 over the study period. The summary relative risks (and 95% CI) of daily consultations in all GOPCs for the air pollutants PM10, NO2, O3, and SO2 were 1.005 (1.002, 1.009), 1.010 (1.006, 1.013), 1.009 (1.006, 1.012), and 1.004 (1.000, 1.008) respectively, per 10 µg/m3 increase in the concentration of each pollutant. Conclusion Significant associations were found between the daily number of consultations due to URTIs in GOPCs and the concentrations of air pollutants, implying that air pollution incurs a substantial morbidity and increases the burden of primary health care services.
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Affiliation(s)
- Wilson W. S. Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Tze Wai Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- * E-mail:
| | - Lorna Ng
- General Outpatient Clinics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Kenny K. L. Kung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Andromeda H. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Cheung CS, Tong EL, Cheung NT, Chan WM, Wang HH, Kwan MW, Fan CK, Liu KQ, Wong MC. Factors associated with adoption of the electronic health record system among primary care physicians. JMIR Med Inform 2013; 1:e1. [PMID: 25599989 PMCID: PMC4288082 DOI: 10.2196/medinform.2766] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/13/2022] Open
Abstract
Background A territory-wide Internet-based electronic patient record allows better patient care in different sectors. The engagement of private physicians is one of the major facilitators for implementation, but there is limited information about the current adoption level of electronic medical record (eMR) among private primary care physicians. Objective This survey measured the adoption level, enabling factors, and hindering factors of eMR, among private physicians in Hong Kong. It also evaluated the key functions and the popularity of electronic systems and vendors used by these private practitioners. Methods A central registry consisting of 4324 private practitioners was set up. Invitations for self-administered surveys and the completed questionnaires were sent and returned via fax, email, postal mail, and on-site clinic visits. Current users and non-users of eMR system were compared according to their demographic and practice characteristics. Student’s t tests and chi-square tests were used for continuous and categorical variables, respectively. Results A total of 524 completed surveys (response rate 524/4405 11.90%) were collected. The proportion of using eMR in private clinics was 79.6% (417/524). When compared with non-users, the eMR users were younger (users: 48.4 years SD 10.6 years vs non-users: 61.7 years SD 10.2 years, P<.001); more were female physicians (users: 80/417, 19.2% vs non-users: 14/107, 13.1%, P=.013); possessed less clinical experience (with more than20 years of practice: users: 261/417, 62.6% vs non-user: 93/107, 86.9%, P<.001); fewer worked under a Health Maintenance Organization (users: 347/417, 83.2% vs non-users: 97/107, 90.7%, P<.001) and more worked with practice partners (users: 126/417, 30.2% vs non-users: 4/107, 3.7%, P<.001). Efficiency (379/417, 90.9%) and reduction of medical errors (229/417, 54.9%) were the major enabling factors, while patient-unfriendliness (58/107, 54.2%) and limited consultation time (54/107, 50.5%) were the most commonly reported hindering factors. The key functions of computer software among eMR users consisted of electronic patient registration system (376/417, 90.2%), drug dispensing system (328/417, 78.7%) and electronic drug labels (296/417, 71.0%). SoftLink Clinic Solution was the most popular vendor (160/417, 38.4%). Conclusions These findings identified several physician groups who should be targeted for more assistance on eMR installation and its adoption. Future studies should address the barriers of using Internet-based eMR to enhance its adoption.
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Affiliation(s)
- Clement Sk Cheung
- Hospital Authority Information Technology Services, Health Informatics Section, Hong Kong, China (Hong Kong)
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Park S, Parwani AV, Aller RD, Banach L, Becich MJ, Borkenfeld S, Carter AB, Friedman BA, Rojo MG, Georgiou A, Kayser G, Kayser K, Legg M, Naugler C, Sawai T, Weiner H, Winsten D, Pantanowitz L. The history of pathology informatics: A global perspective. J Pathol Inform 2013; 4:7. [PMID: 23869286 PMCID: PMC3714902 DOI: 10.4103/2153-3539.112689] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.
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Affiliation(s)
- Seung Park
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Ting S, Ip W, Tsang AH, Ho GT. An integrated electronic medical record system (iEMRS) with decision support capability in medical prescription. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/13287261211255347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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ZHU TRACYY, TAM LAISHAN, LEUNG YINGYING, KWOK LAIWA, WONG KONGCHIU, YU TRACY, KUN EMILYW, LI EDMUNDK. Socioeconomic Burden of Psoriatic Arthritis in Hong Kong: Direct and Indirect Costs and the Influence of Disease Pattern. J Rheumatol 2010; 37:1214-20. [DOI: 10.3899/jrheum.090988] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective.To estimate the direct costs and indirect costs of patients with psoriatic arthritis (PsA) in Hong Kong.Methods.A retrospective cost-of-illness study was performed on 125 patients with PsA. Participants completed questionnaires on demographics, employment status, and out of pocket expenses. Health resources consumption was recorded by chart review and patient self-report questionnaire. Patients were grouped according to disease pattern, i.e., peripheral and axial disease. Multiple regression was used to determine the predictors of the costs.Results.The average annual direct costs were $4,141 (2006 US dollars) per patient. Costs of inpatient care accounted for 27% of direct costs, followed by costs of visits to healthcare providers (25%). The estimated average indirect costs were $3,127 per patient-year. Forty-eight (42%) patients had no indirect costs. Sixty percent of patients with peripheral disease were still employed, compared to 39% of patients with axial disease. Patients with axial disease had almost twice the indirect costs compared to those with peripheral disease (p = 0.005). Increased pain and poor function were independently associated with increased direct costs. Worse physical health status, determined by indirect costs borne by the patient, and poor function and old age predicted high costs.Conclusion.PsA imposes substantial economic burden. Pain and function are significantly associated with costs. Improvements in treatments to reduce pain and restore function are likely to reduce the costs incurred by these patients.
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Factors Affecting Knowledge, Attitudes, and Skills Levels for Nursing Staff Toward the Clinical Management System in Hong Kong. Comput Inform Nurs 2009; 27:57-65. [DOI: 10.1097/ncn.0b013e31818dd3b0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abd Ghani MK, Bali RK, Naguib RNG, Marshall IM. Electronic health records approaches and challenges: a comparison between Malaysia and four East Asian countries. ACTA ACUST UNITED AC 2008; 4:78-104. [PMID: 18583297 DOI: 10.1504/ijeh.2008.018922] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An integrated Lifetime Health Record (LHR) is fundamental for achieving seamless and continuous access to patient medical information and for the continuum of care. However, the aim has not yet been fully realised. The efforts are actively progressing around the globe. Every stage of the development of the LHR initiatives had presented peculiar challenges. The best lessons in life are those of someone else's experiences. This paper presents an overview of the development approaches undertaken by four East Asian countries in implementing a national Electronic Health Record (EHR) in the public health system. The major challenges elicited from the review including integration efforts, process reengineering, funding, people, and law and regulation will be presented, compared, discussed and used as lessons learned for the further development of the Malaysian integrated LHR.
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Affiliation(s)
- Mohd Khanapi Abd Ghani
- Biomedical Computing and Engineering Technologies Applied, Research Group (BIOCORE), Faculty of Computing and Engineering, Coventry University, Coventry, CV1 5FB, UK.
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Chan MF. Investigating nurses' knowledge, attitudes, and skills patterns towards clinical management system: results of a cluster analysis. ACTA ACUST UNITED AC 2007; 31:161-74. [PMID: 16954054 DOI: 10.1080/14639230600643608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To determine whether definable subtypes exist within a cohort of Hong Kong nurses as related to the clinical management system use in their clinical practices based on their knowledge, attitudes, skills, and background factors. Data were collected using a structured questionnaire. The sample of 242 registered nurses was recruited from three hospitals in Hong Kong. The study employs personal and demographic variables, knowledge, attitudes, and skills scale. A cluster analysis yielded two clusters. Each cluster represents a different profile of Hong Kong nurses on the clinical management system use in their clinical practices. The first group (Cluster 1) was labeled 'lower attitudes, less skilful and average knowledge' group, and represented 55.4% of the total respondents. The second group (Cluster 2) was labeled as 'positive attitudes, good knowledge but less skilful'. They comprised almost 44.6% of this nursing sample. Cluster 2 had more older nurses, the majority were educated to the baccalaureate or above level, with more than 10 years working experience, and they held a more senior ranking then Cluster 1. A clear profile of Hong Kong nurses may benefit healthcare professionals in making appropriate education or assistance to prompt the use of the clinical management system by nurses an officially recognized profession. The findings were useful in determining nurse-users' specific needs and their preferences for modification of the clinical management system. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' knowledge, attitudes, and skills toward such system.
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Affiliation(s)
- M F Chan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Chan MF. A Cluster Analysis to Investigating Nurses' Knowledge, Attitudes, and Skills Regarding the Clinical Management System. Comput Inform Nurs 2007; 25:45-54. [PMID: 17215676 DOI: 10.1097/00024665-200701000-00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.
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Affiliation(s)
- M F Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
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Cheung NT, Lam A, Chan W, Kong JHB. Integrating images into the electronic patient record of the hospital authority of Hong Kong. Comput Med Imaging Graph 2005; 29:137-42. [PMID: 15755533 DOI: 10.1016/j.compmedimag.2004.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2004] [Revised: 03/31/2004] [Accepted: 09/30/2004] [Indexed: 11/25/2022]
Abstract
Over a period of 10 years the Hospital Authority has developed an integrated clinical information system (The Clinical Management System-CMS), including a territory-wide longitudinal electronic patient record (ePR). The CMS and ePR are used by over 4000 doctors and 20,000 other clinicians to document and review care. The ePR currently has nearly 3TB of data covering 44 million episodes for 6.4 million patients. To date the CMS has largely dealt with textual data. However, PACS technology is increasingly being adopted in the HA. This paper describes our strategy for taking the hospital image archives and making them available throughout the Authority as part of the longitudinal patient record, leveraging the ePR to distribute radiological and other images in a manner which is integrated, affordable and sustainable.
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