21 research outputs found
Trends of prescribing adherence of antiplatelet agents in Hong Kong patients with acute coronary syndrome: a 10-year retrospective observational cohort study
No full textObjectivesThe objective of this study is to examine the temporal trend of antiplatelet prescribing pattern during index hospitalisation discharge in Hong Kong (HK) acute coronary syndrome (ACS) population.DesignThe study is a retrospective observational cohort study.SettingThe study retrieved data from electronic health record from Hospital Authority (HA), HK.ParticipantsThe study included patients aged 18 years old or above, who were admitted to seven institutions under HA with diagnosis of ACS during 2008–2017.Primary and secondary outcome measuresThe primary outcome was the frequency of antiplatelet therapy prescription at the point of index hospitalisation discharge each year during 2008–2017. Association between demographics, baseline comorbidities, procedures and antiplatelet prescription were examined as secondary outcome using multivariate logistic regression model, with commonly used antiplatelet groups selected for comparison.ResultsAmong the included 14 716 patients, 5888 (40.0%) discharged with aspirin alone, 6888 (46.8%) discharged with dual antiplatelet therapy (DAPT) with clopidogrel, and 973 (6.6%) discharged with DAPT with prasugrel/ticagrelor. Prescribing rate of aspirin alone decreased substantially from 56.8% in 2008 to 27.5% in 2017. Utilisation of DAPT with clopidogrel increased from 33.7% in 2008 to 52.7% in 2017. Use of DAPT with prasugrel/ticagrelor increased from 0.3% in 2010 to 15.3% in 2017. Compared with those prescribed with DAPT with clopidogrel, male patients (adjusted OR (aOR) 1.34, 95% CI 1.09 to 1.65), patients with non-ST-elevation myocardial infarction (aOR 2.50, 1.98 to 3.16) or ST-elevation myocardial infarction (aOR 3.26, 2.59 to 4.09), use of glycoprotein IIb/IIIa (aOR 3.03, 2.48 to 3.68) or undergoing percutaneous coronary intervention (aOR 3.85, 3.24 to 4.58) or coronary artery bypass graft (aOR 6.52, 4.63 to 9.18) during index hospitalisation, concurrent use of histamine-2 receptor antagonists (aOR 1.35, 1.10 to 1.65) or proton pump inhibitors (aOR 3.57, 2.93 to 4.36) during index hospitalisation discharge were more likely to be prescribed with DAPT with prasugrel/ticagrelor. Patients with older age (aOR 0.97, 0.96 to 0.97), diabetes (aOR 0.68, 0.52 to 0.88), chronic kidney disease (aOR 0.43, 0.22 to 0.85) or concurrent use of oral anticoagulant (aOR 0.16, 0.07 to 0.42) were more likely to received DAPT with clopidogrel.ConclusionsUse of DAPT with prasugrel/ticagrelor was suboptimal yet improving during 2008–2017 in HK patients with ACS. Considering DAPT, predictors for clopidogrel prescription, compared with prasugrel/ticagrelor, were consistent with identified risk factors of bleeding
Life’s simple 7 and cardiovascular disease risk knowledge in Hong Kong
No full textBackgroundThis study aimed at investigating the CV health and CV disease knowledge in terms of LS7 score among 3 age groups in Hong Kong.MethodsA cross-sectional multicenter observational study was conducted to observe the CV health and disease risk knowledge in Hong Kong. Elderly subjects were recruited from 15 elderly centers, whereas young adults and the middle-aged were recruited from 6 on-campus health check sessions. Subjects’ demographics, lifestyle behavior and risk knowledge were obtained through questionnaire while their body mass index, random capillary blood glucose, blood cholesterol and blood pressure were measured. LS7 score and risk knowledge score was calculated.ResultsThe LS7 of younger adult, middle-aged and elderly were 10.6 ± 1.3, 9.3 ± 1.9 and 9.7 ± 1.7 respectively. Only 0.6% participants have attained ideal CV health and 35.9% have 5 to 7 ideal CV health metrics. Elderly performed worst in risk knowledge with a score of 8.1 ± 3.3 while young adult and middle-aged were similar (9.6 ± 1.8 and 9.7 ± 1.5). 71% of the participants correctly identified ≥9 components. Logistic regression revealed that subjects aged ≤65 years (OR 2.341, 95% CI 1.779 to 3.080) and with tertiary education (OR 2.031, 95% CI 1.527 to 2.701) were more likely to obtain optimum LS7. No association was found between having optimum LS7 and full knowledge.ConclusionOnly few adults in this study population had ideal CV health as defined by AHA. Knowledge has no association but young age and tertiary education has positive association with CV health.</p
Warfarin control in Hong Kong clinical practice: a single-centre observational study
No full textIntroduction: Time in therapeutic range (TTR) assesses the safety and effectiveness of warfarin therapy using the international normalised ratio. This study investigated the TTR in Hong Kong patients using both European and Japanese therapeutic ranges and patients' economic and clinical outcomes. Predictors of poor warfarin control and patient knowledge concerning warfarin therapy were assessed. Methods:A 5-month observational study with retrospective and prospective components was conducted in the Prince of Wales Hospital. The study examined electronic patient records of patients who received warfarin for at least 1 year during the period from January 2010 to August 2015.Patient knowledge was assessed via phone interview using the Oral Anticoagulation Knowledge (OAK) test. Results:In total, 259 patients were included; 174 completed the OAK test. The calculated mean TTR was 40.2±17.1% (European therapeutic range), compared with 49.1±16.1% (Japanese therapeutic range) [P<0.001].Mean TTR was higher in patients with atrial fibrillation than in patients with prosthetic heart valve (P<0.001).The abilities of TTR to predict clinical and economic outcomes were comparable between European and Japanese therapeutic ranges. Patients with ideal TTR had fewer clinical Warfarin control in Hong Kong clinical practice: a single-centre observational stud
Descriptive analysis of real-world medication use pattern of statins and antiplatelet agents among patients with acute coronary syndrome in Hong Kong and the USA
No full textObjectives The objective was to explore the differences in medication use pattern of lipid-lowering drug (LLD) and antiplatelet agents among post-percutaneous coronary intervention patients with acute coronary syndrome aged <65 in Hong Kong (HK) and the USA. Design Retrospective study. Setting This study used deidentified claims data from Clinformatics Data Mart database (OptumInsight, Eden Prairie, Minnesota, USA) and electronic health records from HK Hospital Authority Clinical Data Analysis and Reporting System database. Participants We used 1 year prescription records of LLDs and antiplatelet agents among 1013 USA patients and 270 HK Chinese patients in 2011-2013. Primary and secondary outcome measures Continuity was investigated on the assumption that one defined daily dose represented 1 day treatment. Medication possession ratio method was used to evaluate the adherence. Multivariate-adjusted logistic regressions were constructed to compare the good continuity and adherence levels in the merged database with the cutoffs set at 80%, and Cox proportional hazard models were built using the time to discontinuation as the dependent variable, to assess the persistence level. Results HK Chinese patients were less adherent (67.41% vs 84.60%, adjusted odds ratio (AOR) for Americans over Chinese=2.23 (95% CI=1.60 to 3.12), p<0.001) to antiplatelet agents compared with American patients but better adherent to statins (90.00% vs 78.18%, AOR=0.37 (0.23 to 0.58), p<0.001). The discontinuation with statins was more common in American patients (13.33% vs 34.25%, adjusted hazard ratio (AHR)=2.95 (2.05 to 4.24), p<0.001). Low-to-moderate potency statins and clopidogrel were favoured by our HK local physicians, while American patients received higher doses of statins and prasugrel. Conclusions We seemed to find HK physicians tended to prescribe cheaper and lower doses of statins and antiplatelet agents when compared with the privately insured patients in the USA, though the adherence and persistence levels of HK patients with statins were relatively good.</p
Genetic factors related to aspirin resistance using the Multiplate® device in Hong Kong Chinese patients with stable coronary heart disease
No full textObjective: Associations between single nucleotide polymorphisms (SNPs) and aspirin resistance (AR) have been studied with variable results. The associations of genetic variants with AR may be helpful to explain why some individuals demonstrate aspirin insensitivity with this anti-platelet therapy. The purpose of this research was to investigate the effect of different genotypes in candidate genes on aspirin response in patients taking long-term aspirin therapy by measuring the serum thromboxane B2 (TXB2) and platelet function using the Multiplate® analyser. Methods: A total of 266 patients with stable coronary heart disease (CHD) taking low-dose aspirin for long periods of time and without any other anti-platelet drugs medications were enrolled into the study. They were required to take 80 mg of aspirin every morning for a week including the day before blood tests. Blood samples were collected 24 h after the last dose. The 80 mg dose of aspirin was taken orally and blood samples were collected again 1 h later. The serum TXB2 levels were measured in samples at 24 h post-dose and 1 h post-dose using the EIA kit and platelet activity was determined using the Multiplate® Impedance Platelet Aggregometry (ASPI) assay. Genotyping assays were performed by the TaqMan SNP genotyping technique. Results: Of the 266 patients, only 251 patients were enrolled in the present study. The PTGS1/COX1-1676 A > G (rs1330344) and the PTGS2/COX2-765 G > C (rs20417) SNPs showed significant associations with the ASPI measurements in samples taken at 24 h post-dose, but not with the values at 1 h post-dose or with the TXB2 levels (P < 0.05). Conclusions: Our results suggest that polymorphisms in the PTGS1/COX1 and the PTGS2/COX2 genes may be associated with reduced anti-aggregatory effects and increased the risk of AR, but future larger-scale cohort studies are necessary for further validation
2016 Consensus statement on prevention of atherosclerotic cardiovascular disease in the Hong Kong population
No full textCarbon Storage in an Artificial Soil
No full textAs we strive to find new technologies to dispose of our municipal solid waste, compost-like outputs (CLOs) are becoming more widely created. As a product of both aerobic and anaerobic digestion, they provide a potentially important carbon store and some have proven to enhance existing carbon stores when added to brownfield sites and agricultural land. However, the CO2 flux from this artificial soil is relatively high when compared to natural soils. The aerobic digestion process under which it is produced lasts only 9 days, producing a material which is still comparatively unstable and yet to mature. The CLO is laid in windrows where it is hoped that it will stabilise and mature; if the humification process at this stage can be optimised, would an even greater carbon store be achieved?
This thesis seeks to answer this question, through the research into humification in both natural and artificial systems; through the measurement of CO2 flux to assess the stability of CLO over time; using adapted methodologies to gauge the maturity of this artificial soil by analysing the amount of humic acids present; by adding proposed catalysts to the material in fully factorial lysimeter studies; and by examining the affects of different physical environmental conditions under which CLO product humifies.
The results of a series of experimental trials, undertaken over a three year period, are presented. Manganese-coated sand and char, both currently ‘waste’ products were both used as potential catalysts for the humification process of CLO. Temporal trends were seen in most samples using infra-red gas analysis, an alkali extraction technique, UV photospectrometry, fluorescence and a novel pseudo-thermogravimetric analysis. The waterlogging of the samples appeared to have an effect on the humification process and a great deal of concurrent data was seen upon the addition of Mn-coated sand and char to the CLO. Both appeared to have a stabilising effect on the CLO, reducing flux rate and increasing humification as compared to a control.
An overriding theme present throughout this thesis is the heterogeneous and contaminated nature of the non-source-segregated CLO tested. It is therefore recommended that similar studies be undertaken on a purer, more homogenous CLO in order to assess whether promising results seen could be elucidated in order to gauge the efficacy of biochar and Mn in encouraging the production of humic substances. A field trial would allow the unified soil system to be considered, rather than the CLO alone
Gravitational lensing by x-ray luminous galaxy clusters
No full textSince the discovery that the large-scale dynamics of galaxy clusters are dominated by dark matter, cosmologists have aspired to measure the spatial distribution of dark matter and identify its nature. Gravitational lensing, especially employing the Hubble Space Telescope (HST) has emerged as the tool-of-choice for mapping dark matter. Standing on the shoulders of the pioneering 1990's, this thesis is the first homogeneous lensing study of clusters with HST. We measure the mass and structure of an objectively-selected sample of X-ray luminous clusters at a single epoch (z ~ 0.2). We present observations often clusters (L(_x)≥8x10(^44)[0.1=2.4 keV] ergs(^-1)) and use the numerous gravitationally-lensed features in these data to constrain a detailed model of the central regions (r ~ 500 kpc) of each cluster. Our models provide an unprecedented view of cluster morphology, revealing that 60% of the sample contain significant substructure. Chandra X-ray observations confirm this is a signature of dynamical immaturity, and show that the mean temperature of the intra-cluster medium of the morphologically complex clusters is ~ 25% higher than then regular siblings. This offset results in a critical, and previously unexplored, systematic uncertainty in the use of clusters to normalise the mass power spectrum. We also use the detailed morphology of the clusters to constrain the nature of dark matter. We then exploit the clusters as gravitational telescopes, using ground-based near-infrared imaging to construct a sample of 60 gravitationally magnified Extremely Red Objects (EROs), a population that is believed to harbour important clues on the formation epoch and mechanism of massive galaxies. This unique sample overcomes the faintness of EROs (R ≥ 23, K ≥ 18) to uncover a wealth of morphological, photometric and spectroscopic evidence of diversity in both passively evolving and dusty active EROs. Coupled with our deep number counts (to K ~ 22), these observations provide important new constraints on competing theoretical models of galaxy formation
The impact of illness and the impact of school closure on social contact patterns.
No full textBACKGROUND: Mathematical models, based on data describing normal patterns of social mixing, are used to understand epidemics in order to predict patterns of disease spread and plan interventions and responses. However, individuals who are ill show behavioural changes that affect their social mixing patterns and predictive models should take into account these changes if they are to be effective. OBJECTIVES: To describe and quantify the changes in (1) social contact behaviour experienced by individuals when they are ill with pandemic H1N1 influenza (swine flu) and (2) mixing patterns of school children that take place as a result of swine flu-related school closures. METHODS: For the first part of the study, a self-completed questionnaire-based study was carried out in the autumn/winter of 2009-10. The study population was individuals who had been diagnosed with swine flu and who received a swine flu antiviral prescription from an antiviral distribution centre (ADC). It consisted of an initial survey to be filled in when participants were symptomatic with swine flu and a follow-up survey to be filled in when they had recovered. Each part of the questionnaire had two sections: patient details and a contact diary. The second part of the study was adapted to quantify the difference in mixing patterns of pupils between the school term and the half-term holiday as school closures did not occur during the study period. Eight schools participated and questionnaire packs were distributed to them, containing two surveys: one to be filled in during the school term and one during the spring half-term holiday. RESULTS: For the patient study, approximately 3800 surveys were distributed by 31 ADCs. Overall, 317 responses to the initial survey were received and 179 participants returned the follow-up survey. For all types of a contact, except contacts made at home, there were highly significant differences in contact behaviour (Wilcoxon signed-rank test, p < 0.001). Individuals made substantially fewer contacts when they were ill than when they were well. Analysis showed that returning to work was the most significant predictor of increased numbers of contacts. Also, the greater the change in the number of symptoms reported, the greater the change in the number of contacts. For the school study, approximately 1100 questionnaire packs were distributed and 134 responses were received, with 119 paired contact diaries. Pupils reported on average 18.51 contacts each day during term time and 9.24 during the half-term holiday - a reduction of over 50% and a highly significant change (Wilcoxon signed-rank test, p < 0.0001). CONCLUSIONS: The evidence from this study suggests that ill individuals make substantial changes to their social contact patterns. These changes are strongly linked to absence from work and the severity of the reported illness. Epidemiological modellers should therefore consider the implications of illness-related behavioural changes on model predictions. Future studies to measure the extent of behavioural change in a broader cross-section of infected cases could be valuable, along with more detailed studies of the social contact patterns of school children, focusing on differences between school terms and school holidays
Recombinant human growth hormone for the treatment of growth disorders in children: a systematic review and economic evaluation
No full textStudy found that treatment with recombinant human growth hormone gave significantly greater benefits in stature for children with growth hormone deficiency (GHD), Turner syndrome, Prader–Willi syndrome, chronic renal insufficency, short stature homeobox-containing gene deficiency, and those who were small for gestational age, than for untreated children. However, treatment was considered to be cost-effective at a willingness to pay threshold of £20,000–30,000 per quality-adjusted life-year gained only for children with GHD, although the analysis is subject to a range of important uncertaintie
