Hong Kong Medical Journal最新文献_第10页

Prediction of hospital mortality among critically ill patients in a single centre in Asia: comparison of artificial neural networks and logistic regression-based model. 亚洲单一中心重症患者住院死亡率预测：人工神经网络与基于逻辑回归模型的比较。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-03-28 DOI: 10.12809/hkmj2210235

S Lau, H P Shum, C C Y Chan, M Y Man, K B Tang, K K C Chan, A K H Leung, W W Yan

{"title":"Prediction of hospital mortality among critically ill patients in a single centre in Asia: comparison of artificial neural networks and logistic regression-based model.","authors":"S Lau, H P Shum, C C Y Chan, M Y Man, K B Tang, K K C Chan, A K H Leung, W W Yan","doi":"10.12809/hkmj2210235","DOIUrl":"10.12809/hkmj2210235","url":null,"abstract":"Introduction: This study compared the performance of the artificial neural network (ANN) model with the Acute Physiologic and Chronic Health Evaluation (APACHE) II and IV models for predicting hospital mortality among critically ill patients in Hong Kong.Methods: This retrospective analysis included all patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital from January 2010 to December 2019. The ANN model was constructed using parameters identical to the APACHE IV model. Discrimination performance was assessed using area under the receiver operating characteristic curve (AUROC); calibration performance was evaluated using the Brier score and Hosmer-Lemeshow statistic.Results: In total, 14 503 patients were included, with 10% in the validation set and 90% in the ANN model development set. The ANN model (AUROC=0.88, 95% confidence interval [CI]=0.86-0.90, Brier score=0.10; P in Hosmer-Lemeshow test=0.37) outperformed the APACHE II model (AUROC=0.85, 95% CI=0.80-0.85, Brier score=0.14; P<0.001 for both comparisons of AUROCs and Brier scores) but showed performance similar to the APACHE IV model (AUROC=0.87, 95% CI=0.85-0.89, Brier score=0.11; P=0.34 for comparison of AUROCs, and P=0.05 for comparison of Brier scores). The ANN model demonstrated better calibration than the APACHE II and APACHE IV models.Conclusion: Our ANN model outperformed the APACHE II model but was similar to the APACHE IV model in terms of predicting hospital mortality in Hong Kong. Artificial neural networks are valuable tools that can enhance real-time prognostic prediction.","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"130-138"},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The maximum dose of atorvastatin and simvastatin as well as rosuvastatin should be restricted in East Asians. 应限制东亚人服用阿托伐他汀和辛伐他汀以及罗伐他汀的最大剂量。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-04-12 DOI: 10.12809/hkmj2311348

B Tomlinson, E Chow

引用次数: 0

Healing and humanitarianism: an interview with Dr Wing-yan Kwong. 治疗与人道主义：采访邝咏欣博士。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 DOI: 10.12809/hkmj-hc202404

S So, A Lau

引用次数: 0

Call to action: Bridging gaps in lipid management in Hong Kong. 行动呼吁：缩小香港血脂管理方面的差距。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-04-10 DOI: 10.12809/hkmj245158

B P Y Yan, K K Lau, A O Y Luk, M C S Wong

引用次数: 0

Many systemic diseases may mimic a primary knee disorder. 许多全身性疾病都可能模仿原发性膝关节疾病。

IF 3.1 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 DOI: 10.12809/hkmj2411506

J S M Leung

引用次数: 0

Detection of significant liver fibrosis in Chinese psoriasis patients receiving methotrexate: a comparison between transient elastography and liver histology. 检测接受甲氨蝶呤治疗的中国银屑病患者的明显肝纤维化：瞬时弹性成像与肝组织学的比较。

IF 3.1 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 DOI: 10.12809/hkmj2210364

C S M Wong, L L Y Mak, V K H Lee, R C L Lo, M M H Chung, F Chu, C K Yeung, M F Yuen, H H L Chan

{"title":"Detection of significant liver fibrosis in Chinese psoriasis patients receiving methotrexate: a comparison between transient elastography and liver histology.","authors":"C S M Wong, L L Y Mak, V K H Lee, R C L Lo, M M H Chung, F Chu, C K Yeung, M F Yuen, H H L Chan","doi":"10.12809/hkmj2210364","DOIUrl":"10.12809/hkmj2210364","url":null,"abstract":"Introduction: Methotrexate (MTX) is effective for treating psoriasis and psoriatic arthritis, but its potential hepatoxicity remains a concern. Liver biopsy, the gold standard for detecting MTX-induced liver injury, is invasive and carries considerable risk. Transient elastography (TE) offers a non-invasive alternative for detecting advanced liver fibrosis. This study investigated the performance of TE in detecting MTX-induced liver fibrosis among Chinese psoriasis patients, compared with liver biopsy.Methods: This study included adult patients with clinical psoriasis. Liver stiffness measurement using TE was performed in patients receiving MTX. Exclusion criteria were known liver cirrhosis, positive viral hepatitis carrier status, or conditions influencing TE performance. Liver biopsy was performed when liver stiffness was ≥7.1 kilopascals (kPa) or when the total cumulative dose (TCD) of MTX was ≥3.5 g.Results: A total of 228 patients were screened; among 34 patients who met the inclusion criteria, nine (26.5%) had significant liver fibrosis (Roenigk grade ≥3a). The area under the receiver operating characteristic curve was 0.76 (95% confidence interval=0.59-0.93; P=0.021), indicating that TE had satisfactory performance in detecting liver fibrosis. A cut-off value of 7.1 kPa of liver stiffness yielded 100% sensitivity and 68% specificity. Liver fibrosis was not correlated with the TCD of MTX or the duration of MTX use; it was significantly correlated with obesity and diabetes status (body mass index ≥30 kg/m2, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%).Conclusion: Transient elastography is reliable and superior to the TCD for detecting liver fibrosis in Chinese psoriasis patients receiving MTX. Liver biopsy should be reserved for high-risk patients or patients with liver stiffness ≥11.7 kPa on TE.","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":"30 2","pages":"110-119"},"PeriodicalIF":3.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploration of clinical and ethical issues in an expanded newborn metabolic screening programme: a qualitative interview study of healthcare professionals in Hong Kong. 探讨扩大新生儿代谢筛查计划中的临床和伦理问题：对香港医护人员的定性访谈研究。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-04-09 DOI: 10.12809/hkmj2210234

O M Y Ngan, C J Tam, C K Li

{"title":"Exploration of clinical and ethical issues in an expanded newborn metabolic screening programme: a qualitative interview study of healthcare professionals in Hong Kong.","authors":"O M Y Ngan, C J Tam, C K Li","doi":"10.12809/hkmj2210234","DOIUrl":"https://doi.org/10.12809/hkmj2210234","url":null,"abstract":"Introduction: The Newborn Screening Programme for Inborn Errors of Metabolism (NBSIEM) enables early intervention and prevents premature mortality. Residual dried bloodspots (rDBS) from the heel prick test are a valuable resource for research. However, there is minimal data regarding how stakeholders in Hong Kong view the retention and secondary use of rDBS. This study aimed to explore views of the NBSIEM and the factors associated with retention and secondary use of rDBS among healthcare professionals in Hong Kong.Methods: Between August 2021 and January 2022, semi-structured interviews were conducted with 30 healthcare professionals in obstetrics, paediatrics, and chemical pathology. Key themes were identified through thematic analysis, including views towards the current NBSIEM and the retention and secondary use of rDBS.Results: After implementation of the NBSIEM, participants observed fewer patients with acute decompensation due to undiagnosed inborn errors of metabolism. The most frequently cited clinical utilities were early detection and improved health outcomes. Barriers to rDBS storage and its secondary use included uncertain value and benefits, trust concerns, and consent issues.Conclusion: This study highlighted healthcare professionals' concerns about the NBSIEM and uncertainties regarding the handling or utilisation of rDBS. Policymakers should consider these concerns when establishing new guidelines.","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":"30 2","pages":"120-129"},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Informed consent: clarifying the post-Montgomery duty of care to discuss "reasonable alternative treatment". 知情同意：澄清讨论 "合理替代治疗 "的后蒙哥马利护理责任。

IF 3.1 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-03-28 DOI: 10.12809/hkmj245159

G K K Leung

引用次数: 0

In memoriam: Professor Joseph Wan-yee Lau (1947-2024). 悼念刘云怡教授（1947-2024）。

IF 2.7 4区医学

Hong Kong Medical Journal Pub Date : 2024-04-01 DOI: 10.12809/hkmj245160

K M Chu

引用次数: 0

Burkholderia pseudomallei pericarditis as a mimicker of tuberculous pericarditis: a case report. 模仿结核性心包炎的假马勒氏伯克霍尔德菌心包炎：一份病例报告。