Journal articles on the topic 'Medical care China Hong Kong Evaluation'

IntroductionThis trial proposes to compare the effectiveness and cost-effectiveness of electroacupuncture (EA) plus on-demand gastrocaine with waiting list for EA plus on-demand gastrocaine in providing symptom relief and quality-of-life improvement among patients with functional dyspepsia (FD).Methods and analysisThis is a single-centre, pragmatic, randomised parallel-group, superiority trial comparing the outcomes of (1) EA plus on-demand gastrocaine group and (2) waiting list to EA plus on-demand gastrocaine group. 132 (66/arm) endoscopically confirmed,Helicobacter pylori-negative patients with FD will be recruited. Enrolled patients will respectively be receiving (1) 20 sessions of EA over 10 weeks plus on-demand gastrocaine; or (2) on-demand gastrocaine and being nominated on to a waiting list for EA, which entitles them 20 sessions of EA over 10 weeks after 12 weeks of waiting. The primary outcome will be the between-group difference in proportion of patients achieving adequate relief of symptoms over 12 weeks. The secondary outcomes will include patient-reported change in global symptoms and individual symptoms, Nepean Dyspepsia Index, Nutrient Drink Test, 9-item Patient Health Questionnaire (PHQ9), and 7-item Generalised Anxiety Disorder Scale (GAD7). Adverse events will be assessed formally. Results on direct medical costs and on the EuroQol (EQ-5D) questionnaire will also be used to assess cost-effectiveness. Analysis will follow the intention-to-treat principle using appropriate univariate and multivariate methods. A mixed model analysis taking into account missing data of these outcomes will be performed. Cost-effectiveness analysis will be performed using established approach.Ethics and disseminationThe study is supported by the Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region of China. It has been approved by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee. Results will be published in peer-reviewed journals and be disseminated in international conference.Trial registration numberChiCTR-IPC-15007109; Pre-result.

<p>The construction of the Guangdong, Hong Kong, and Macao health community is not only an inherent requirement for the economic development and social progress of the Pearl River Delta region, but also an inevitable requirement for the realization of the healthy China strategy and the internationalization and modernization of medical and health care in the three cities. This article discusses answers to issues related to the Guangdong, Hong Kong, and Macao health community. It takes the construction of Zhaoqing medical service system in Guangdong Province as an entry point.</p>

This paper examines empirically the determinants of student evaluation of teaching (SET). An empirical model was specified and estimated using the SET data collected in Hong Kong over six academic years. A key finding is that three different origins of students had a differentiated impact on teaching evaluation. In particular, students from mainland China appreciated and rated teaching favorably, and hence the more mainland talents in the class, the higher the class-average SET scores. However, local Hong Kong students valued teaching and learning effectiveness unfavorably. Exchange students from abroad also dropped the class-average SET scores, as well as class-average exam scores. The results suggest that raw SET scores should be used with care if classes are unbalanced with a large group of atypical students who work less but blame instructors for everything.

Hong Kong society became the site of active self-mobilization when there was a virus outbreak in early 2020. Hong Kong residents quickly adopted voluntary protective measures such as minimizing social contacts and buying personal protective equipment. After the presence of a new Coronavirus was confirmed, medical and health care workers went on strike in early February, clamouring for the Hong Kong SAR government to close border crossings with China. They feared the medical and health care system would not be able to bear the rising numbers of infection. The government responded with a pronouncement that the strike was endangering lives, and that a complete closure of border checkpoints was unfeasible. Generally, Hong Kong residents exercised self-protection and self-restraint, voluntarily choosing to stay home except to go to work or buy daily necessities. As a result, Hong Kong did not adopt a citywide lockdown. More people began to leave their homes when infection rates slowed, but this led to further waves of infection. The Hong Kong experience raises a number of questions about society that are relevant to education and citizenship. What are individuals’ responsibilities during a pandemic? Does a state of pandemic make it acceptable to limit freedom of movement and freedom of expression, and if so, how can this principle be applied in relation to the right to strike for the purpose of compelling the government to take stronger public health measures? Specific to education, how can young people be taught to follow safety advice amid the temptation to go outdoors for exercise under restrictive measures? There is a need for engaging students in social compassion and dialogues to face a persistent pandemic.

In order to obtain up-to-date information on the pattern of severe acute poisoning and the characteristics and outcomes of these patients, 265 consecutive patients admitted to an intensive care unit in Hong Kong for acute poisoning from January 2000 to May 2008 were studied retrospectively. Benzodiazepine (25.3%), alcohol (23%), tricyclic antidepressant (17.4%), and carbon monoxide (15.1%) were the four commonest poisons encountered. Impaired consciousness was common and intubation was required in 67.9% of admissions, with a median duration of mechanical ventilation of less than 1 day. The overall mortality was 3.0%. Among the 257 survivors, the median lengths of stay in the intensive care unit and acute hospital (excluding days spent in psychiatric ward and convalescent hospital) were less than 1 day and 3 days, respectively. Factors associated with a longer length of stay included age of 65 or older, presence of comorbidity, Acute Physiology and Chronic Health Evaluation II score of 25 or greater, and development of shock, rhabdomyolysis, and aspiration pneumonia, while alcohol intoxication was associated with a shorter stay. This is the largest study of its kind in the Chinese population and provided information on the pattern of severe acute poisoning requiring intensive care admission and the outcomes of the patients concerned.

SummaryObjectives: To clarify health record background information in the Asia-Pacific region, for planning and evaluation of medical information systems.Methods: The survey was carried out in the summer of 2009. Of the 14 APAMI (Asia-Pacific Association for Medical Informatics) delegates 12 responded which were Australia, China, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, the Philippines, Singapore, Thailand, and Taiwan.Results: English is used for records and education in Australia, Hong Kong, India, New Zealand, the Philippines, Singapore and Taiwan. Most of the countries/regions are British Commonwealth. Nine out of 12 delegates responded that the second purpose of medical records was for the billing of medical services. Seven out of nine responders to this question answered that the second purpose of EHR (Electronic Health Records) was healthcare cost cutting. In Singapore, a versatile resident ID is used which can be applied to a variety of uses. Seven other regions have resident IDs which are used for a varying range of purposes. Regarding healthcare ID, resident ID is simply used as healthcare ID in Hong Kong, Singapore and Thailand. In most cases, disclosure of medical data with patient’s name identified is allowed only for the purpose of disease control within a legal framework and for disclosure to the patient and referred doctors. Secondary use of medical information with the patient’s identification anonymized is usually allowed in particular cases for specific purposes.Conclusion: This survey on the health record background information has yielded the above mentioned results. This information contributes to the planning and evaluation of medical information systems in the Asia-Pacific region.

The present study reports the results of 2 surveys of the first behavioural surveillance system (BSS) set up to monitor sexually-related risk behaviours practised by Hong Kong-China cross-border travellers. The 2 studies interviewed 1263 and 1448 male adult Hong Kong residents in 1997 and 1998 respectively. About one-third of the respondents had had sexual intercourse with a commercial sex worker (CSW) in the past 6 months; about 20% had had sexual intercourse with a CSW or a non-regular sex partner in a single trip; about 35-40% of the CSW clients had not used a condom during the intercourse and about 20% of the respondents reported that they had contracted STD. When the results of the 2 surveys were compared, no significant changes in the outcomes of the surveillance indicators were detected; instead, some unfavourable changes in terms of condom use were observed. The effectiveness of the relevant prevention programmes in Hong Kong is not evident.

The licensing and regulation of physicians is an important topic worldwide and is often tied to discussions in various countries of health care system reform. We conducted a review of current practices for regulating physicians as a key group of health care professionals in eight jurisdictions in Asia and other parts of the world in order to draw implications for the development of future regulatory policies in Hong Kong. Jurisdictions studied included Australia, Canada, China, Malaysia, New Zealand, Singapore, the United Kingdom and the United States. A literature search, supplemented by interviews, was conducted. In analyzing information gathered about global regulatory systems, we used a framework for comparing regulatory typology, developed by the RAND Europe research institute. Our review found that the jurisdictions studied exhibited both similarities and differences in terms of how physicians are regulated and by whom. As a result of our search, we were able to identify 10 key trends in international medical regulation of importance to Hong Kong as it considers reforms to its health care system overall:Changes in medical regulation are seen as a way of improving the quality of patient care.Reform of medical regulation often requires government legislation.The creation of common principles for policies, structures and the organization of regulation between professions is an emerging practice.The involvement of lay people on boards and in inquiries is increasingly common.Medical regulation is moving away from models of self-regulation and toward regulatory models that emphasize partnership between professions and the public, physicians and patients.Health care providers and institutional regulators play complementary roles in medical regulation.Regulation impacts the quality of care — not just the detection and remediation of poor performance.Investigatory and disciplinary functions are increasingly separated and organized independently of each other.Continuous Professional Development (CPD) is compulsory for physicians in many jurisdictions.Overseas medical graduates are admitted into practice in different ways from country to country. These trends are important for regulators in all countries to note as they assess the basic structure and effectiveness of their own medical regulatory systems.

Emergency Medicine (EM) as a specialty discipline in China is gradually progressing to a mature status. However, emergency medical care development in large cities and in rural areas may have wide disparity. Rural hospitals need the same kind of support and development as hospitals in major cities. Assistance has come from many EM providers and faculties from western systems. The needs of a rural hospital in Sichuan, and the efforts of help provided from Hong Kong, is described.

The demand for elderly care in China is growing, and the elderly care industry has great development prospects. Climatic conditions are important factors that affect the health of elderly individuals and the development of the elderly care industry. This study will have important guiding significance for the layout of China’s elderly care industry. This paper utilizes ArcGIS and the spatial fuzzy comprehensive evaluation method to analyze the climatic suitability for the development of the elderly care industry in China’s four municipalities, the Hong Kong, Macao, and Taiwan regions, and 333 prefecture-level administrative regions based on six factors: temperature, humidity, airflow, air pressure, sunshine, and precipitation. In addition, development suggestions are proposed. The results show the following. (1) The areas with highly suitable climatic conditions for the development of the elderly care industry in China are concentrated in the eastern and southern areas of Southwest China and the southern areas of Central and East China, mainly in the Yangtze and Pearl River Basins. Slightly suitable areas are distributed around highly suitable areas, concentrated in the central and southern regions of China. Low-suitability areas are clustered, including an area spanning northern North China and East China, southern Northeast China, and central Northwest China, and there is another cluster in Xinjiang. The non-suitable area resembles a strip extending from Northeast China along the Inner Mongolia Plateau to the Qinghai-Tibet Plateau. (2) In Central and Southwest China, there are 57 prefecture-level administrative units with highly suitable temperature conditions that can develop an elderly care industry for patients with cardiovascular and cerebrovascular diseases. Twenty-eight prefecture-level administrative regions with comprehensively suitable temperature and humidity conditions scattered throughout the country can develop an elderly care industry for elderly patients suffering from rheumatic and respiratory diseases.

Background At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.

Introduction: Recent studies suggest that incidence of multiple myeloma (MM) is increasing in Asian countries. Prevalence is also expected to rise due to ageing populations and advances in treatment. Therapeutic options continue to expand as new, targeted agents enter the market. However, despite advances in therapy and supportive care, MM remains incurable. Most patients receive care outside the setting of clinical trials. Therefore, the generation of Real-World Evidence (RWE) on practice, including long-term monitoring and evaluation of current and future treatment strategies, is important in informing optimal therapies for MM and enable benchmarking to improve outcomes, quality of life (QoL), and cost-effectiveness of care for patients. Some country-specific data are available in Asia, but few at regional level. We established the Asia-Pacific (APAC) Myeloma and Related Diseases Registry (MRDR) in 2018, as a regional collaboration and sister registry to the Australian and New Zealand MRDR (ACTRN12618000659202). The aims are collection of a standardised APAC dataset for analysis and benchmarking. Key opinion leaders from the participating countries were invited to form the steering committee to provide local clinical context and oversight of the registry. Early in the process, ethics committees and legal counsel were consulted to assist with challenges presented by the diversity in data privacy and ethical regulations across the APAC region. Participating hospitals are responsible for obtaining local ethics approval, patient recruitment, and data collection. Participants provide written informed consent before data collection. Methods: The APAC MRDR prospectively collects observational data on patient characteristics, diagnosis, medical history, treatment (including supportive therapies), and outcomes (overall and progression-free survival, and QoL using the EQ-5D-5L) on newly diagnosed MM (NDMM), plasma cell leukaemia, plasmacytoma, and MGUS patients via a secure, country-specific web-based database. Whilst the core dataset is standardised across countries to ensure comparability, regional differences such as units of measurements and local privacy laws were accommodated in the design of each country's database. Participants are reviewed 4-monthly for a minimum of 2 years. Longer-term outcomes will be collected through linkage with local cancer and death registries. Six-monthly hospital reports, providing de-identified, risk-adjusted outcome data at hospital- and country-level, will be provided to contributing hospitals. Preliminary APAC MRDR data from October 2018 to June 2019 were analysed. Results: Eleven hospitals now have Institutional Review Board approval to participate and patient recruitment has commenced at 6 hospitals in Korea and Singapore. Sites in Taiwan, Hong Kong, China, and Malaysia are in progress. To date, 182 patients have been enrolled and data collection on these patients is in progress. At the time of analysis, 85% (96/113) were NDMM. Median age was 66 years (IQR: 59-73) and 54% were male. Median EQ5D VAS Health State score at diagnosis was 70 (IQR: 50-80; self-report: 100=best health imaginable, 0=the worst). Comorbidities were present in 47%. Proportion of patients with main paraprotein type IgG: 64%, IgA: 17%, light chain only Kappa: 13%, light chain only Lambda: 6%. Median number of days from diagnosis to chemotherapy was 9.5 (IQR: 3-15). The top two most frequently used first-line regimens for NDMM patients in Korea and Singapore were: Korea: 1. bortezomib/thalidomide/dexamethasone (VTd: 39%), 2. lenalidomide/dexamethasone (Rd: 27%), and Singapore: 1. VTd: 41%, 2. bortezomib/cyclophosphamide/dexamethasone (VCD): 25%. Overall response rate to first-line chemotherapy (≥PR) was 86% (44/51). Conclusion: The APAC MRDR database is expanding and, as data mature and feedback is provided to participating sites, will provide RWE that will contribute to our understanding on current myeloma treatment strategies and patient outcomes in the Asia-Pacific region. Future plans include expansion to additional sites and countries, and linkage with local cancer and death registries. The registry can also serve as a regional resource by providing infrastructure and identifying eligible participants for clinical trials and other research. Disclosures Aoki: Janssen Asia-Pacific: Research Funding. Moore:Takeda: Research Funding; Gilead: Research Funding. Wood:Bristol-Myers Squibb: Research Funding; Novartis: Research Funding; Alexion: Research Funding; Roche: Research Funding; Takeda: Research Funding; Gilead: Research Funding; Janssen-Cilag: Research Funding; Amgen: Research Funding; CSL Behring: Research Funding; Sanofi: Research Funding; Celgene: Research Funding; Abbvie: Research Funding. McQuilten:Gilead Sciences: Research Funding; CSL Biotherapies: Research Funding; Celgene: Research Funding; AbbVie: Research Funding; Takeda Pharmaceuticals: Research Funding; Janssen-Cilag: Research Funding. Spencer:Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Haemalogix: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen Oncology: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Specialised Therapeutics Australia: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Secura Bio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

IntroductionImproving discharge information dissemination may improve patients’ health literacy of self-care and health outcomes, avoid unnecessary healthcare utilisation, and reduce the healthcare cost. This study aims to use an implementation science theory guided approach to examine the beliefs and behaviours of healthcare professionals regarding postdischarge information summary (PDIS) implementation in a public inpatient setting.Methods and analysisA multistage study design involving qualitative inquiry and Delphi expert discussion will be used to systematically explore the perceived barriers in the four implemented hospitals and enable the full implementation of the PDIS in geriatric and medical care. The theoretical domains framework (TDF), behavioural change wheel and realistic evaluation framework will be used to guide the investigation of implementation. This study consists of three steps: (1) identifying barriers and enablers from an implementation perspective using a TDF-informed interview guide; (2) devising theory-based implementation strategy packages to facilitate the adoption and enhancement of PDIS by performing a strategy mapping exercise and (3) developing an effective implementation strategy package for scaling up PDIS in other target hospitals as well as other specialities using the Delphi expert discussion. The goal of this multistage study design is to identify the perspectives from healthcare professionals towards the PDIS implementation and explore their barriers and facilitators of the process in the pilot phase. The invited healthcare professionals would share their daily experience on providing PDIS to patient in various study hospitals with similar ward setting. The implementation of discharge intervention in a study setting through different steps to aid in the exploration and development of the modified implementation strategies for the adoption and enhancement of PDIS in the discharge process.Ethics and disseminationEthics approval for the study was obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committees. Results of the study would be released as a report submitted to the Health and Medical Research Fund of Food and Health Bureau of the Hong Kong Government. The result would also be published in international peer-reviewed medical journals and presented in conferences.Trial registration numberChiCTR2000034382.

<p>E-learning has become an increasingly important teaching and learning mode in educational institutions and corporate training. The evaluation of e-learning, however, is essential for the quality assurance of e-learning courses. This paper constructs a four-phase evaluation model for e-learning courses, which includes planning, development, process, and product evaluation, called the PDPP evaluation model. Planning evaluation includes market demand, feasibility, target student group, course objectives, and finance. Development evaluation includes instructional design, course material design, course Web site design, flexibility, student-student interaction, teacher/tutor support, technical support, and assessment. Process evaluation includes technical support, Web site utilization, learning interaction, learning evaluation, learning support, and flexibility. Product evaluation includes student satisfaction, teaching effectiveness, learning effectiveness, and sustainability. Using the PDPP model as a research framework, a purely e-learning course on Research Methods in Distance Education, developed by the School of Professional and Continuing Education at the University of Hong Kong (HKU SPACE) and jointly offered with the School of Distance Learning for Medical Education of Peking University (SDLME, PKU) was used as a case study. Sixty students from mainland China, Hong Kong, Macau, and Malaysia were recruited for this course. According to summative evaluation through a student e-learning experience survey, the majority of students were very satisfied/satisfied on all e-learning dimensions of this course. The majority of students thought that the learning effectiveness of this course was equivalent, even better, than face-to-face learning because of cross-border collaborative learning, student-centred learning, sufficient learning support, and learning flexibility. This study shows that a high quality of teaching and learning might be assured by using the systematic PDPP evaluation procedure. It is hoped that the PDPP evaluation model and its application can provide a benchmark for establishing a wider e-learning quality assurance mechanism in educational institutions.</p><input id="gwProxy" type="hidden" /><input id="jsProxy" onclick="if(typeof(jsCall)=='function'){jsCall();}else{setTimeout('jsCall()',500);}" type="hidden" /><input id="gwProxy" type="hidden" /><input id="jsProxy" onclick="if(typeof(jsCall)=='function'){jsCall();}else{setTimeout('jsCall()',500);}" type="hidden" />

IntroductionDiabetic kidney disease (DKD) is a prevalent and costly complication of diabetes with limited therapeutic options, being the leading cause of end-stage kidney disease in most developed regions. Recent big data studies showed that add-on Chinese medicine (CM) led to a reduced risk of end-stage kidney disease and mortality among patients with chronic kidney disease (CKD) and diabetes. Astragalus, commonly known as huang-qi, is the most prescribed CM or used dietary herb in China for diabetes and DKD. In vivo and in vitro studies showed that astragalus ameliorated podocyte apoptosis, foot process effacement, mesangial expansion, glomerulosclerosis and interstitial fibrosis. Nevertheless, the clinical effect of astragalus remains uncharacterised. This pragmatic clinical trial aims to evaluate the effectiveness of add-on astragalus in patients with type 2 diabetes, stage 2–3 CKD and macroalbuminuria, and to identify related response predictors.Methods and analysisThis is an add-on, assessor-blind, parallel, pragmatic randomised controlled clinical trial. 118 patients diagnosed with DKD will be recruited and randomised 1:1 to receive 48 weeks of add-on astragalus or standard medical care. Primary endpoints are the changes in estimated glomerular filtration rate and urine albumin-to-creatinine ratio between baseline and treatment endpoint. Secondary endpoints include adverse events, fasting blood glucose, glycated haemoglobin, lipids and other biomarkers. Adverse events are monitored through self-complete questionnaire and clinical visits. Outcomes will be analysed by regression models. Subgroup and sensitivity analyses will be conducted for different epidemiological subgroups and statistical analyses. Enrolment started in July 2018.Ethics and disseminationThis study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West/East/Kowloon Central clusters (UW 16-553/HKEC-2019-026/REC (KC/KE)-19-0049/ER-4). We will report the findings in medical journals and conferences. The dataset will be available on reasonable request.Trial registration numberNCT03535935

Playing curriculum development based on early childhood learning is a major issue in international early childhood education discussions. This study aims to look at the concepts and practices of play-based curriculum in early childhood education institutions. The study uses qualitative methods with the CIPP model program evaluation on play-based curriculum. Data collection techniqueswere carriedout using participatory observation, document studies and interviews. Participants are early childhood educators, early childhood and parents. The results found that the play-based curriculum has not yet become the main note in the preparation and development of concepts and learning practices in early childhood. Play-based curriculum quality standards have not provided a solid and clear concept foundation in placing play in the center of learning models. 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Promotion of COVID-19 vaccination requires understanding its determinants, an important one of which is outcome expectancy. However, reliable and valid measurement tools are absent. This study thus developed and validated an Outcome Expectancy Scale for COVID-19 Vaccination (OES-COVID-19). An inductive approach was used for scale development; content validity of the items was then assessed by an independent evaluation expert panel. Iteratively, 17 scale items were created and validated in a population-based telephone survey conducted among 500 adults of the general population in Hong Kong, China, from August to September 2021. Using half of the sample (n = 249), exploratory factor analyses identified four factors of the OES-COVID-19, including (a) positive contribution to society, (b) functional benefits, (c) protective effect, and (d) negative impacts. Confirmatory factor analysis of these factors conducted on the second subsample (n = 251) was satisfactory. The OES-COVID-19 showed good psychometric properties in terms of internal consistency, absence of floor/ceiling effects, and concurrent validity. The newly created and validated OES-COVID-19 is deemed suitable for application. It may advance future studies related to COVID-19 vaccination behavior and intention, and potentially allows for comparisons across studies. Further validation with modifications across countries, populations, and phase of the pandemic are warranted.

Abstract Background. An outbreak of severe acute respiratory syndrome (SARS) occurred in our 22-bed intensive care unit (ICU; Prince of Wales Hospital, Hong Kong, HKSAR, China) from 12 March to 31 May 2003, when only patients with SARS were admitted. This period was characterized by the upgrading of infection control precautions, which included the wearing of gloves and gowns all the time, an extensive use of steroids, and a change in antibiotic prescribing practices. The pattern of endemic pathogenic organisms, the rates of acquisition of methicillin-resistant Staphylococcus aureus (MRSA), and the rates of ventilator-associated pneumonia (VAP) were compared with those of the pre-SARS and post-SARS periods. Methods. Data on pathogenic isolates were obtained from the microbiology department (Prince of Wales Hospital). Data on MRSA acquisition and VAP rates were collected prospectively. MRSA screening was performed for all ICU patients. A case of MRSA carriage was defined as an instance in which MRSA was recovered from any site in a patient, and cases were classified as imported or ICU-acquired if the first MRSA isolate was recovered within 72 h of ICU admission or after 72 h in the ICU, respectively. Results. During the SARS period in the ICU, there was an increase in the rate of isolation of MRSA and Stenotrophomonas and Candida species but a disappearance of Pseudomonas and Klebsiella species. The MRSA acquisition rate was also increased: it was 3.53% (3.53 cases per 100 admissions) during the pre-SARS period, 25.30% during the SARS period, and 2.21% during the post-SARS period (P &lt; .001). The VAP rate was high, at 36.5 episodes per 1000 ventilator-days, and 47% of episodes were caused by MRSA. Conclusions. A SARS outbreak in the ICU led to changes in the pathogen pattern and the MRSA acquisition rate. The data suggest that MRSA cross-transmission may be increased if gloves and gowns are worn all the time.

Background. An appropriate regulatory system to ensure and promote the quality, safety, and efficacy of the products of traditional medicine (TM) and complementary medicine (CM) is critical to not only public health but also economic growth. The regulatory approach and evaluation standards for TM/CM products featured with a long history of use are yet to be developed. This study aims to investigate and compare the existing regulatory approaches for TM/CM products with a long history of use. Method. A mixed approach of documentary analysis involving official and legal documents from official websites, as well as a scoping review of scholarly work in scientific databases about regulatory systems of TM/CM products in China, Hong Kong, Taiwan, Japan, and Korea, was employed in this study and used for comparison. Results. For registration purposes, all five regulatory systems recognized the history of use as part of the totality of evidence when evaluating the safety and efficacy of TM/CM products with a long history of use. Generally, the list of classic formulas is predefined and bound to the formulas recommended in the prescribed list of ancient medical textbooks. Expedited pathways are usually in place and scientific data of nonclinical and clinical studies may be exempted. At the same time, additional restrictions with the scope of products constitute a comprehensive approach in the regulation. Quality assurance and postmarketing safety surveillance were found to be the major focus across the regulatory schemes investigated in this study. Conclusion. The regulatory systems investigated in this study allow less stringent registration requirements for TM/CM products featured with a long history of use, assuming safety and efficacy to be plausible based on historic use. Considering the safety and efficacy of these products, regulatory standards should emphasize the technical requirements for quality control and postmarket surveillance.

155 Background: The Pt-Reported Outcomes Version of the Common Terminology Criteria for AE (PRO-CTCAE) was developed for pts to report on the frequency, severity, and interference of SymAE. A study was conducted to identify a hepatocellular carcinoma (HCC)-relevant subset of the PRO-CTCAE's 124 items to enhance evaluation of SymAE in HCC trials and long-term effects in survivorship. Methods: Qualitative and quantitative data were collected from medical oncologists specializing in HCC and pts diagnosed with HCC stratified by Child-Pugh class and treatment. Oncologists were asked about HCC diagnosis, treatment, and SymAE and provided ratings (ranging from 0 = unimportant to 10 = very important) of the following: 1) importance to pts of 34 prevalent SymAE from past HCC trials (all phases); 2) importance to pts of each PRO-CTCAE item; and 3) their own perceived importance of each PRO-CTCAE item with regard to tolerability. Pts were asked about their diagnosis, treatment, and experience of SymAE after which they completed the PRO-CTCAE and were debriefed on the importance of each item. Results: Four medical oncologists from Spain, Taiwan, Korea, and Hong Kong with ≥ 20 years of experience completed interviews. SymAE from prior trials rated highly important to pts (mean rating across oncologists ≥ 7) included hand-foot syndrome, diarrhea, fatigue, decreased appetite, rash, vomiting, and weight loss. PRO-CTCAE items rated highly important to pts included diarrhea, vomiting, shivering or shaking chills, hand-foot syndrome, rash, fatigue, difficulty swallowing, and loss of control of bowel movements. Items rated highly for tolerability included diarrhea, shivering or shaking chills, and hand-foot syndrome. Pt interviews (planned up to 24) are ongoing. Conclusions: Oncologists identified 10 clinically relevant items from sponsor SymAE data and the PRO-CTCAE for use in HCC trials. Findings from pt interviews will compare provider and pt perspectives about SymAE and strengthen the set of selected items. Combining clinician and pt ratings with clinical trial data may be a promising method for identifying cancer-specific PRO-CTCAE item sets for use throughout the cancer care continuum.

Background Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters. For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms.

Predictions for acute care in the upcoming months are difficult. There will be challenges: there always are and that to a degree is what makes working in acute care so fulfilling. However, even the most adaptive and innovative acute care systems will toil when these challenges become overwhelming. Back in 2015, the then SAM President Mark Holland described a “perfect storm” of events that could lead to a challenging winter period. It was as predicted; but this storm continues to evolve and has not yet reached its perfected chaotic peak. A picture of the COVID pandemic without the brilliant and innovative work of Acute Medicine teams is even darker. As a specialty we should and must remain proud of the impact we are having in delivering safe and sustainable care despite immense pressures. There is an escalating sense of desperation to reach a post-pandemic phase. Increasingly the sense of community unity and spirit at the beginning of the pandemic is being replaced by fear and disgruntlement. A toxic mix of emotions permeates and increasingly hostile divisions as to how manage the next stage of the pandemic grow. Opposing viewpoints are entrenched and neither wants to countenance a brief reflection on any deviation from their position. Meanwhile many people simply observe with bafflement and a sense of betrayal desperate for their lives to return to “normal”. Delivering acute medical care on this background is a challenge that none of us have faced. The skills and resilience of our teams will face its sternest test yet. As a specialty we will continue to do what we have always done since its inception: evolve, adapt, innovate and deliver. This issue of the journal reflects the fantastic work in Acute Medicine that continues to be delivered internationally despite the current challenges. Chris Subbe and the SAM Quality Improvement team have written a review considering frameworks for measuring quality in Acute Medicine.1 Quantifying the impact that Acute Medicine has on the patient journey with defined measurable metrics is key to embedding high quality acute care. The recognition and evaluation of abnormal physiology remains core to the practice of Acute Medicine. International Acute Medicine colleagues from Denmark and Hong Kong present some innovative work on the potential use of thermography in predicting prognosis in acute care.2 In a prospective study of 726 patients they demonstrated that the temperature gradient between nose and eye could help identify variations in skin perfusion and was predictive of all cause 30 day mortality.3 This requires further study but may become a further useful tool in the assessment of physiology of acute unwell medical patients. Dutch colleagues prospectively studied 1328 patients presenting acutely with infective illnesses. Their results reaffirmed the superiority of NEWS to SIRS and qSOFA in predicting mortality and outcomes in this cohort.4 The evolving nature and clinical characteristics of COVID19 are described by Cat Atkin and her colleagues from Birmingham.5 This important paper provides robust data on which to benchmark the severity of future variants of the virus and can support complex service provision planning adapted to the pandemic. Once again, SAM and the editorial board of Acute Medicine thank all colleagues for their amazing and diligent work during the pandemic, which we know will continue long after it. We hope that all friends and colleagues are able to have some well deserved rest and relaxation during a summer break.

“The family” has long been a focus of cross-party attention. While family is perceived as foundational to society’s success, how parents rear their children is perhaps the most conservative or persistent part of concern. While Chinese immigrant families and Chinese families in Asia – in Hong Kong, Macau, Taiwan, mainland China, and elsewhere – are struggling with a socialization process that has emphasized support for traditional values, they are also simultaneously being confronted by modern ideologies and technologies. Professionals have a growing interest in addressing the culturally diverse needs and the gender issues of Chinese families. The theme of this issue of The Open Family Studies Journal, then, is “Gender, family and parenting in the Chinese context”. The heart of this special issue lies in a concern for families, in particular for the challenges posed to families and parenting practices in a changing world. The family, like any social group, is a product of history, culture and context. Because of economic and technological changes, and the increasingly pluralistic nature of our society, both gender relations and family structures have undergone tremendous change, and many challenges await elucidation. The seven papers in this special issue thus feature new perspectives on family, gender and parenting issues. The issue opens with a paper on scale validation. Since intimacy is a construct that has received limited attention in the Chinese context, the first paper, “Intimacy as a distinct construct: validating the intimacy scale among older adults of residential care homes in Hong Kong”, aims to develop a valid measurement for the quality of the relationship between older adults and family caregivers in the Hong Kong Chinese context. The study results demonstrate the reliability and validity of the instrument across samples of older adults. Paper 2 and 3 that follow are qualitative studies adopting cultural perspectives to understand Chinese American immigrant adults and older female survivors of intimate partner violence in Taiwan. In paper 2, “Understanding family connections and help-seeking behavior in Chinese parental lives. These findings illustrate how existentialism provides a new frame of reference and new practice directions for conducting parent-education programs. The final paper titled “Internet supervision and parenting in the digital age: The case of Shanghai” echoes the technological advancement and its impact on parenting. In a changing world, and in a society permeated by the Internet and by nearly instantaneous communication, families constantly need to adapt to different and changing ways of parenting. The paper explores the issue of parenting confidence in supervision of children’s Internet use in Shanghai, China. Multiple-regression models are used to identify factors affecting parents’ confidence about their own parenting. The findings suggest that efforts to assist parents should help them review their attitudes towards the Internet. American immigrant adults who attempt suicide”, the authors investigate beliefs, values and norms in the Chinese family culture and examine Chinese cultural influences on attitudes and beliefs about mental health and mental health services in the immigrant context. Paper 3, “Older female survivors of intimate partner violence in the Taiwanese cultural context” examines the needs of older female IPV survivors in another Chinese cultural context. The findings of both studies reflect the importance of family and the influence of Chinese family culture; they make it clear that traditional family beliefs are still highly valued and hold a prominent position in Chinese culture. The authors of these two papers question the efficacy of service-delivery models based on Western cultures, and they call for ethnically sensitive intervention approaches that incorporate cultural premises into developing viable options for service recipients. Paper 4 is titled “The Macau family-in-transition: the perceived impact of casino employment on family relationships among dealer families”. This paper draws on findings from a qualitative study to explore the impacts of casino employment on family life and family relationships. The family, like other social group, is a product of culture and context, and the specific socio-economic context of Macau poses challenges to dealer families and casino workers in performing their parental role. The paper sheds much-needed light on our understanding of Macau dealer families. The final three papers in this special issue all address the issue of parenting. Paper 5, “Reflective inquiry on professionals’ view on parents and about parenting”, examines professionals’ views of parents, their attitudes and beliefs about parenting, and the values underpinning their practice. The study’s findings on the theme of parent blaming provide an impetus for professionals to reflect on the attitudes and assumptions they hold, and their impact on parents. The paper calls for reflection on parenting work to recognize the difficulties and challenges faced by contemporary families. Paper 6, “Reviving parents’ life momentum: A qualitative evaluation of a parent education program adopting an existential approach”, reports the results of a qualitative analysis of the participants’ perceptions of a parent-education program. The findings of this study demonstrate that a program of this nature can make parents aware of the existential dimensions of being a parent and help them understand the significance of creating meaning in their In fact, family, parenting and gender are vastly contested terms which encompass a range of topics. The seven varied papers recommended for publication in this special issue reflect the considerable attention that we have placed on family, parenting and gender, and also the vision of this special issue. These papers add to the growing body of research and literature, and they provide both food for thought and a platform for discussion. In the last, I offer both my sincere thanks to the authors who have contributed to this special issue, and my gratitude to those who have participated as blind peer reviewers. Their thoughtful comments and criticisms have certainly improved the quality of each and every paper in this special issue.

Background Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and have increased risk of mortality. Whilst an age-based vaccination approach prioritising older groups is being implemented worldwide, vaccine hesitancy is high amongst minority ethnic groups. Methods and findings We conducted a systematic review and convergent synthesis to systematically examine perceptions of vaccinations amongst older adults from minority ethnic backgrounds. We included studies that reported on perceptions, beliefs, and attitudes towards vaccinations in older adults aged ≥65 years from a minority ethnic background. We excluded studies of vaccinations in investigation or development, studies focused on specific medical conditions, studies where ethnic background or age group was unidentifiable, systematic reviews, editorials, and conference abstracts. We searched MEDLINE, Embase, Virtual Health Library, Web of Science, Cochrane Library, medRxiv, and PROSPERO databases from inception to 15 July 2021. Risk of bias for studies was assessed using the Mixed Methods Appraisal Tool. The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative research (GRADE–CERQual) framework. A total of 28 eligible studies conducted between 1997 and 2020 were included in the final analysis (17 quantitative surveys, 8 focus group or interview studies, 2 mixed methods studies, and 1 case–control study). The majority were US studies in English or Spanish, except for 6 studies set in Hong Kong, 2 studies in Japan, 1 study in Brazil, and 1 multi-centre study (including China, Indonesia, Turkey, South Korea, Greece, UK, Brazil, and Nigeria). In total, 28,262 individuals with an estimated mean age of 69.8 years were included, 63.2% of whom were female. We summarised the common concepts and themes across studies and populations using a convergent synthesis analysis. Thirteen themes categorised as barriers or facilitators were identified and grouped into structural factors—healthcare provider and system related, patient related, and policy and operational—and were analysed by minority ethnic group. The main limitation of the study was the predominance of studies from the US and East Asia. Conclusions In this systematic review, we found that factors influencing vaccination uptake involve healthcare provider and system, patient-related, and governance-level factors that are specific to the older ethnic minority community being served. The evidence included in this review is supported by high or moderate certainty and can be translated to practice and policy. A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact of widespread vaccination policies.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論末期病人的決策過程的三個模式，即個人主義、家長主義和家庭本位主義。個人主義過份偏重病人的抉擇，家長主義只強調從專業角度照顧病人的個人最佳利益，這兩個模式均會令家庭角色邊緣化。本丈認為家庭本位主義，更符合東方社會文化，從倫理角度來看亦較其他兩個模式可取。This paper critically examines the liberal, the medical paternalist, and the familial models of decision making for the terminally ill. It is argued that the liberal model is excessively patient centered while the medical paternalist model overemphasizes the role of the physician. The paper concludes that since both models marginalize the role of the family in the decision-making process, they are morally inadequate and not suitable for societies with strong family ethics, particularly those in Asia.The liberal model is predominant in the United States. According to this model, a competent patient can express in an advance directive her prior wish of how she is to be treated when she lapses into incompetency. In the absence of an advance directive or in cases where the directive is vague or ambiguous, the surrogate decision-making process will be invoked, which is normally a procedure in which the family makes the decision on the patient's behalf. In this process, the family serves to assist the incompetent patient to exercise her self-determination by figuring out and then following her counterfactual choice in accordance with the substituted judgment standard. If it is impossible to arrive at a decision by following this standard, the family, with the assistance of the physician, will follow the standard of best interests to promote the well-being of the patient. In sum, in the process of surrogate decision making, only the individual choice and interests of the patient are a matter of concern. Thus, the liberal model is entirely patient-centered. The role of the family is marginalized in the sense of being subordinated to the (previous or counterfactual) choice and interests of the patient. The family therefore becomes a "shadow" of the patient with no independent status and is deprived of its self-sufficiency.In the United Kingdom, medical paternalism is more influential. There is a preference for a code of practice to legislation for advance directives, and the prevalence of the best interest standard. Yet, unlike the liberal model, the best interests of the patient are not determined by the family in accordance with the standard of a reasonable person. Rather the doctor is expected to make decision for the patient in accordance with a responsible and competent body of relevant professional opinion in determining the patient's best interests. Though the family will often be consulted, the principal decision maker is the physician. So the role of the family is also marginal in this model.In Asian societies, e.g., Japan, Mainland China and Hong Kong, the family plays a fundamental role in the decision making for the terminally ill, so the model of familialism prevails. In these societies, it is common that the patient will not be informed directly of her terminal illness by the physician. The decision for the incompetent patient is regarded not as an individual but a family decision, and the dying process is viewed a sharing process, the last journey that the patient undergoes together with her significant others.In the familial model, the decision for a terminally ill patient is regarded not entirely as an individual matter because other members will be affected by the patient's choice. Should a son merely consider the wishes or the best interests of his father without considering the burden of care and the feelings of his mother while his father is going through the last stage of his life? Should the mother also consider the financial burden that her son might have to bear for his father if he were to be kept alive at all costs? Such issues would not have a place in the liberal and the medical paternalist models, for what matters is only the choice or the best interests of the patient. On the contrary, due considerations are given to these issues in the familial model, which makes it more plausible than the other two models.DOWNLOAD HISTORY | This article has been downloaded 15 times in Digital Commons before migrating into this platform.

<p>The second ESMO Asia 2016 Congress, led by an international committee to promote the sharing of expertise and interaction between regional and international experts in oncology, returned for a second appearance at the Suntec Convention and Exhibition Centre in Singapore recently. Organized by the European Society for Medical Oncology (ESMO), the Asian leg of the annual scientific and educational congress was held from December 16–19th, 2016 and attended by over 2,000 healthcare professionals and exhibitors, including representatives from AMOR who were also present to cover the event. <br /> <br />ESMO Asia 2016 brought together oncologists from the Asian region and beyond to discuss important discoveries in oncology and to update delegates on the latest standards of care, the organizer noted in its media release. More specifically, delegates attending the meeting took the opportunity to exchange thoughts and ideas on current clinical challenges and novel treatment strategies for a variety of tumor subtypes, as well as to highlight emerging cancer therapeutics that are rapidly gaining attention in clinical settings. In addition to highlighting the latest in cancer research, the congress also sought to underscore bioethical, economic, and social challenges posed by cancer by addressing crucial issues such as the rising costs of treatments, the need for psychological support for patients, the need for better palliative care, and the vital importance of improving access to innovative drugs. <br /> <br />In this edition of the ESMO Asia congress, the keynote lectures consisted of two topics: how the differences between tumors can impact the design of effective treatments, and the link between common Epstein-Barr virus and nasopharyngeal cancer. With these two keynote lectures setting the tone for the congress, delegates saw a wide range of key discussions pertaining to the clinical relevance of molecular advances and innovative treatment approaches. Moreover, sessions that focus on improving current clinical understanding of various tumor types and novel treatment strategies for different tumor subtypes were also prominently featured. <br /> <br />In his opening remarks, ESMO President Prof. Fortunato Ciardiello said, “We are glad to be returning to Singapore for the second ESMO Asia Congress. Consolidating activities in Asia underlines the importance ESMO places on collaboration with partners in this region. The program this year will have a strong emphasis on state-of-the-art education and on the current standard of care across all major tumor types.” He continued, “In addition to practical seminars and wide-ranging discussions about how oncologists and other stakeholders can best collaborate for greater treatment results for cancer patients, delegates can look forward to opportunities for interaction with both local experts and key opinion leaders from the international oncology community.” <br /> <br />The opening ceremony was graced by the Guest-of-Honor – Dr. Amy Khor, Singapore’s Senior Minister of State for Health. In her speech, Dr. Khor laid emphasis on how events such as the ESMO Asia Congress are essential in providing an open platform to facilitate research collaboration. “To address the challenges presented by the complexity of cancer, the development of regional and international research networks is increasingly important to catalyze scientific communication and collaboration,” she said. To this end, Dr. Khor lauded the partnership between ESMO and the Singapore Society of Oncology in setting up a new office for cancer research aimed at facilitating collaborations between researchers in Europe and Asia — ESMO’s first footprint in Asia. “By building capabilities and strengthening our partnerships, we can do much more to improve patient care and treatment, especially for the Asian population,” she said. <br /> <br />Dr. Ravindran Kanesvaran, President of the host organization – Singapore Society of Oncology, echoed the sentiment. “Oncology is a rapidly evolving field that requires a multi-disciplinary approach between various healthcare professionals from different backgrounds and experience extending across all areas of cancer care trying their best to bring an end to this growing scourge. This collaborative endeavor is key to improve access, raise the quality of treatment delivery, and standard of cancer care in Singapore and Asia in general,” he stated. The cancer research office, which is yet to be officially named and launched, will open in the first quarter of 2017 at the National Cancer Centre Singapore and will administer educational grants, workshops, and conferences between Europe and Asia, Dr. Ravindran added. <br /> <br />The ESMO Asia 2016 Congress was supported by 20 of the most important and influential oncology associations in the region, including the Singapore Society of Oncology and the oncology societies from Australia, Bangladesh, China, Hong Kong, India, Indonesia, Iran, Japan, Malaysia, Myanmar, New Zealand, Pakistan, the Philippines, South Korea, Taiwan, Thailand and Uzbekistan. <br /> <br />During the congress, AMOR spoke to Dr. Susanna Hilda Hutajulu, a representative of the Indonesian Society of Hematology and Medical Oncology (ISHMO). Dr. Hutajulu is a practising medical oncologist in Indonesia who is actively involved in clinical research work and she is a regular participant of ESMO meetings, having recently attended ESMO 2016 in Copenhagen, Denmark. Dr. Susanna had also attended the inaugural ESMO Asia congress in 2015 and is an avid supporter of the congress’s multi-faceted agenda. On the development of cancer research in South East Asia, she told AMOR, “I agree that there should be a dedicated platform to showcase and promote the research work of oncology specialists and organizations in South East Asia.” <br /> <br />Dr. Hutajulu added, “Researchers in Indonesia place great importance in Scopus indexing when it comes to choosing the right journals to publish their research work in.” Meanwhile, the Myanmar Oncology Society (MOS) was represented by Dr. Shu Mon, who is based at the Thurein Mon Clinic in Yangon, Myanmar. During the congress, she gave a presentation on breast cancer management that is specific to the Myanmar experience. According to Dr. Shu Mon, there are only 30 qualified medical oncologists serving the whole of Myanmar, a country with a population of about 51 million people. On establishing collaborations with an academic journal, she said, “MOS is willing to work with a journal such as AMOR to promote the oncology research in Myanmar provided that there are suitable opportunities that both sides could agree on.”</p><p> </p><p>During the congress, Assoc. Prof. Dr. Ho Gwo Fuang, the guest managing editor for AMOR’s upcoming special issue and a representative of the Malaysian Oncological Society (MOS) at ESMO Asia 2016, was featured as one of the panelists of the ESMO-COS-MOS-NZSO Joint Symposium on ‘New insights into gastrointestinal cancers’. Dr. Ho, who is a medical oncologist at Malaysia’s University Malaya Medical Centre, delivered a talk entitled ‘Adjuvant aspirin for colorectal cancer? A cross-Asia collaborative effort’, a multi-nation initiative involving Singapore, Malaysia, and other Asia Pacific countries. His presentation offered strong scientific and observational data to support the adjuvant use of aspirin in reducing the formation of polyps and metastases after colorectal cancer diagnosis. Towards the end of his presentation, Dr. Ho highlighted the ongoing curation of AMOR’s Special Issue and invited his peers to submit papers to the journal for consideration.</p>

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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During physical distancing, children do not meet their peers to play or talk together. Peer relationships have a crucial influence on all child development, especially for social skills or behaviour during early childhood. This study aims to determine changes in children's social behaviour during physical distancing during the Covid-19 pandemic. This research method is a descriptive quantitative study designed with the percentage value was used as a score for measuring the results of parental observations of children concerning the child's social behaviour instrument. Quota sampling (150 parents) was used to reach participants from various cities in Indonesia to see cultural differences. Data on children's social behaviour was obtained using the Preschool and Kindergarten Behaviour Scale (PKBS) tests. The data were then analysed using descriptive statistics. The results show that there are changes in children's social behaviour during physical distancing. Children who are less independent (58.9%) are the biggest decline in social behaviour reported by parents, while the one who changes the least is cleaning up the mess that has been made (38.7%). The implication of the results of this study is that parents should continue to pay attention to their children's social behaviour by providing opportunities for children to interact with peers in the house while still paying attention to health protocols. Keywords: Early Childhood, Social Behaviour, Physical Distancing References: Aksoy, P., & Baran, G. (2010). Review of studies aimed at bringing social skills for children in preschool period. Procedia - Social and Behavioural Sciences, 9, 663–669. https://doi.org/10.1016/j.sbspro.2010.12.214 Al-Tammemi, A. B. (2020). The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience. Frontiers in Public Health, 8(May), 1–6. https://doi.org/10.3389/fpubh.2020.00188 Arkorful, V., & Abaidoo, N. (2015). 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Abstract Background Reporting quality is a critical issue in health sciences. Adopting the reporting guidelines has been approved to be an effective way of enhancing the reporting quality and transparency of clinical research. In 2012, we found that only 7 (7/1221, 0.6%) journals adopted the Consolidated Standards of Reporting Trials (CONSORT) statement in China. The aim of the study was to know the implementation status of CONSORT and other reporting guidelines about clinical studies in China. Methods A cross-sectional bibliometric study was conducted. Eight medical databases were systematically searched, and 1039 medical journals published in mainland China, Hong Kong, Macau, and Taiwan were included. The basic characteristics, including subject, language, publication place, journal-indexed databases, and journal impact factors were extracted. The endorsement of reporting guidelines was assessed by a modified 5-level evaluation tool, namely i) positive active, ii) positive weak, iii) passive moderate, iv) passive weak and v) none. Results Among included journals, 24.1% endorsed CONSORT, and 0.8% endorsed CONSORT extensions. For STROBE (STrengthening the Reporting of Observational Studies in Epidemiology), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), STARD (An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies), CARE (CAse REport guidelines), the endorsement proportion were 17.2, 16.6, 16.4, and 14.8% respectively. The endorsement proportion for SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials), TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis), AGREE (Appraisal of Guidelines, Research, and Evaluation), and RIGHT (Reporting Items for Practice Guidelines in Healthcare) were below 0.7%. Conclusions Our results showed that the implementation of reporting guidelines was low. We suggest the following initiatives including i) enhancing the level of journal endorsement for reporting guidelines; ii) strengthening the collaboration among authors, reviewers, editors, and other stakeholders; iii) providing training courses for stakeholders; iv) establishing bases for reporting guidelines network in China; v) adopting the endorsement of reporting guidelines in the policies of the China Periodicals Association (CPA); vi) promoting Chinese medical journals into the international evaluation system and publish in English.

Dental graduates have a variety of career-path choices. After graduation, they may join private dental practice, government- or hospital-based dental care services, research groups, academia, business or industry. With globalization and frequent international exchange, dental graduates nowadays can explore careers outside their home country. However, dental education systems and job opportunities vary widely across different regions and countries. Diversity of accreditation in dental education, different licensure requirements, and lack of global competencies in dental care often limit the globalization, operation and survival of dental practice and education worldwide. The requirements for professional education and practice can be quite diverse, and these differences will be barriers to dental graduates seeking career development outside their home home country. Fresh dental graduates have minimal experience in job hunting. More specifically, they are unfamiliar with potential career paths. This paper was based on the 4th trilateral symposium 2022 organized by The University of Hong Kong, Tohoku University, and Fujian Medical University, which offered a lecture to discuss career paths for dental graduates in Hong Kong, Japan, and mainland China. The aim of this paper was to provide dentists, particularly fresh graduated dental students, with practical insight into different career paths in Hong Kong (Special Administrative Region of China, SAR), Japan and mainland China, and factors that may influence their career options. It assists dental students in exploring possibilities in dentistry and preparing for their career development after graduation from dental school.

Abstract Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.

Purpose The purpose of this paper is to review the development of mental health service policy in Hong Kong. After the return of Hong Kong’s sovereignty to China, mental health services in Hong Kong transformed from an institution-based care model supplemented by community care to a staging model covering primary prevention, early identification, treatment and integration. However, the staging model is subject to cultural barriers, including collectivist values and medical dominance. Therefore, the development of a community-based inclusive development model that follows a rights-based strategy and addresses the regression of the staging model (due to cultural barriers) should be considered. Design/methodology/approach It is a comprehensive literature review which covered the journal articles, policy review papers and service reports. The foundation of this review was laid upon the development of traditional Chinese culture and values. As brought by the influence of the Western world, the mental health service policy was cling towards a medically oriented system. Following the worldwide change in the definition of disability, the ideology of the mental health service system has been developing into a community-based and person-centred model which emphasised on equal participation and human rights. This review serves to evaluate and discuss how a community-based inclusive development can be further developed in Hong Kong. Findings A formal support system for providing personal assistance to people with mental health issues through supported decision-making and certified peer specialists forms the principal foundation of a community-based inclusive development model. A review and reconsideration of laws governing guardianship, compulsory treatment and detention should be conducted to enable the local implementation of supported decision-making. Originality/value The paper addressed and integrated the theoretical, historical and practical issues in developing a community-based inclusive mental health service policy in Hong Kong.

Purpose The aging of a population poses significant challenges to healthcare, housing, social security and elderly care services. Active aging is promoted by the Hong Kong government but is compromised by a shortage of nurses, doctors and professional aides. This study aims to review the history of nursing education in Hong Kong, evaluate Hong Kong's nursing manpower policy with a macro–micro analysis based on sociological imagination and provide sound recommendations. Design/methodology/approach This article analyzes the nursing shortage in Hong Kong. A comprehensive literature review was conducted, concerning the Hong Kong healthcare workforce and covering relevant government reports, consultation papers and articles from academic journals from 1943 to the present. Findings The nursing shortage in Hong Kong can be understood from both absolute and relative terms. The total number of practicing nurses and fresh graduates registering through the four aforementioned pathways increased from 17,034 in 1996 to 61,295 in 2020 (growth rate of 74.4%), but it is predicted that there will be a shortage of 455, 1,383 and 1,669 nurses in 2020, 2025 and 2030, respectively. Moreover, Hong Kong had 8.2 nurses per 1,000 people in 2020. Although this rate exceeds those of China, South Korea and Singapore, it lags behind those of the USA and Australia as well as the international recommendation of nine nurses per 1,000 people. The nurse shortage has been further aggravated by an interaction between macro factors, including aging population, a lack of coherent and long-term nursing manpower policy (an analysis is based on a health policy triangle), numerous obstacles imposed on nurses from abroad and micro factors emanating from an interplay of push–pull factors among nurses. Practical implications The proportion of the Hong Kong population aged 65 years or older was 18% in 2019. The availability of healthcare workers is essential for attaining optimal health outcomes for older adults. The high turnover rate of nurses in public hospitals negatively affects the provision of timely high-quality medical services in the dual-track medical system. Therefore, workforce projections should be made every three years. Such policy should rely primarily on local nurses trained both by University Grant Committee-funded institutions and by self-financed tertiary institutions. Foreign nurses should be a supplementary resource. The budget allocated to the public healthcare sector should be increased to improve remuneration, provide abundant training opportunities and improve working environment to retain nurses in public hospitals. Originality/value Given that deep-seated problems surrounding the quantity and quality of nurses, the avenues for pursuing nursing degree education and the turnover rate of nurses in public hospitals remain unsolved, it is imperative to investigate how to alleviate the healthcare workforce shortage in Hong Kong.

Abstract Background Studies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore’s newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students’ and clinical supervisors’ perspectives. Methods Students completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors. Results Fifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except “paracetamol overdose”. Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills. Conclusions The SAP improved students’ preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.

Background: Patients with transient ischemic attacks(TIAs) are at risk of developing ischemic stroke and therefore early management is of paramount importance. An alternative to the conventional physician-led assessment is nurse-led TIA clinic which can provide rapid access to evaluation and diagnostic investigations of TIA. Objective: To evaluate the efficacy of nurse-led TIA clinic in cardiovascular risk factors control and prevention of ischemic stroke Methods: A prospective study was conducted in a nurse-led TIA clinic in the United Christian Hospital of Hong Kong between January and July 2013. The referral sources included emergency room, medical wards and outpatient clinics. TIA patients were first screened by stroke nurse upon receiving the referrals, and then protocol-driven investigations and treatment were initiated quickly before further assessment by stroke physician. The efficacy endpoints were measured by healthcare utilization, changes in biomedical parameters, lifestyle modification and patients’ satisfaction score at 3 months. Results: A total of 213 patients were referred to stroke nurse for screening.95 patients were recruited and managed first in the nurse-led TIA clinic. 85 patients were diagnosed to be TIA after review by stroke physician. At 3 months(n=33), there were 3 patients hospitalized for non-vascular events,1 patient for recurrent TIA and none for non-stroke vascular events. The 3-month mortality was 0%. For biomedical parameters,significant reduction in mean total cholesterol(p=0.001), mean low-density lipoprotein(p<0.001), mean systolic blood pressure(p=0.011) and mean diastolic blood pressure(p=0.002). 3(38%) out of 8 active smokers ceased smoking. There was no change in the mean BMI. The mean patients’ satisfaction score was 9.1 out of 10(range 8 to 10) Conclusion: Nurse-led TIA clinic is efficient in triaging TIA referrals and providing early access to initial evaluation and diagnostic workup. Combined with physician’s treatment, TIA patients can achieve significant improvement in cardiovascular risk factors control and low incidence rate of ischemic stroke at 3 months. Our TIA patients are satisfied with this modality of assessment pathway and this can serve as a model of care for future TIA services

Background: Metastatic colorectal cancer (mCRC) imposes a heavy tumor burden worldwide due to limited availability of therapeutic drugs. Aflibercept, a kind of recombinant protein of the anti-vascular endothelial growth factor (VEGF) family, has been approved in clinical application among mCRC patients since 2012. A comprehensive analysis of the efficacy, safety, and cost-effectiveness of aflibercept in mCRC treatment is necessary.Objective: To evaluate the efficacy, safety, and cost-effectiveness of aflibercept for the treatment of mCRC in order to provide a decision-making reference for the selection of targeted drugs for second-line treatment of mCRC in Hong Kong, Macao, and Taiwan regions of China and the selection of new drugs for medical institutions in these regions.Methods: A systematic retrieve on databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu, as well as relevant websites and databases of health technology assessment including the National Institute of Health and Clinical Optimization, Centre for Evaluation and Communication at the University of York, and the Canadian Agency for Medicines and Health Technology, was conducted. The literature was screened according to the inclusion and exclusion criteria, and data were extracted and analyzed by two authors, while the quality of the literature was assessed.Results: Finally, we included two HTA reports, 11 systematic reviews/meta-analyses, and two cost-effectiveness studies in the rapid health technology assessment. For mCRC patients receiving second-line treatment, aflibercept combined with FOLFIRI significantly increased progression-free survival (PFS) and overall survival (OS) and the objective response rate (ORR) also improved, compared with folinic acid + fluorouracil + irinotecan (FOLFIRI). In terms of safety, mCRC patients who received aflibercept combined with FOLFIRI therapy had a higher incidence of grade 3–4 adverse events than those who received FOLFIRI alone, including anti-VEGF–related adverse events (hypertension, hemorrhagic events, and proteinuria) and chemotherapy-related adverse events (diarrhea, weakness, stomatitis, hand-foot syndrome, neutropenia, and thrombocytopenia). In terms of cost-effectiveness, two economic studies conducted in the United Kingdom and Japan, respectively, found that compared with FOLFIRI, aflibercept combined with FOLFIRI had no cost-effectiveness advantage in mCRC patients receiving second-line treatment.Conclusion: Compared with FOLFIRI treatment, aflibercept combined with FOLFIRI for the second-line treatment of mCRC patients has better efficacy, worse safety, and is not cost-effective. More high-quality clinical studies are required for further exploration of aflibercept’s clinical value. Medical institutions in Hong Kong, Macao, and Taiwan regions of China should be cautious when using or introducing aflibercept plus FOLFIRI as a mCRC treatment.

Fallopia multiflora Thunb. is a precious remedy in traditional medicine of many countries. In terms of chemical composition, emodin (EM) and 2,3,5,4′-tetrahydroxystilben-2-O-β-D-glucoside (THSG) were identified as chemical markers of Fallopia multiflora Thunb. This study was conducted to develop a preparing process that helps to minimize the THSG content while increasing the ratio between EM and THSG. The HPLC-DAD method was used to quantify these substances in the raw materials and samples after each processing stage to investigate the effects of the different processing conditions. It is found that the process of preparing Fallopia multiflora Thunb. can reduce at least 53% of THSG. The ratio of EM to THSG increased by more than 2.6 times after the processing. The process has many advantages, such as simplicity, no need of soaking the herb in rice water, and short processing time. The standards with such criteria as description, identification, loss on drying, extract, and assay for the prepared product were also proposed. Keywords: Fallopia multiflora Thunb., processing mechanism, emodin, 2,3,5,4′-tetrahydroxystilben-2-O-β-D-glucoside. References [1] Ministry of Health, Vietnamese Pharmacopoeia V, Medical Publishing House, Hanoi, Part 2, 2018, pp. 1180-1181 (in Vietnamese). [2] B. T. Thuong, P. X. Sinh, N. T. Hai, N. T. T. Binh, N. X. Tung, Effect of Traditional Preparation Processing on the Total Phenol Content and Antioxidant Activity of Fallopia multiflora Thunb., VNU Journal of Science: Medical and Pharmaceutical Sciences, Vol. 36, No. 4, 2020, pp. 23-30 (in Vietnamese), https://doi.org/10.25073/2588-1132/vnumps.4264[3] Commission Chinese Pharmacopoeia, Pharmacopoeia of the People’s Republic of China, China Medical Science and Technology Press: Beijing, China, Part I, 2015, pp. 175-177.[4] Department of Health, Hong Kong Chinese Materia Medica Standards, Hong Kong Special Administrative Region, Hong Kong, Vol. 2, 2008, pp. 223-233. [5] L. Lin, B. Ni, H. Lin, M. Zhang, X. Li, Xi. Yin, C. Qu, J. Ni, Traditional Usages, Botany, Phytochemistry, Pharmacology and Toxicology of Polygonum multiflorum Thunb.: A Review, Journal of Ethnopharmacology, Vol. 159, 2015, pp. 158-183, https://doi.org/10.1016/j.jep.2014.11.009.[6] Y. Liu, Q. Wang, J. Yang, X. Guo, W. Liu, S. Ma, S. Li, Polygonum multiflorum Thunb.: A Review on Chemical Analysis, Processing Mechanism, Quality Evaluation, and Hepatotoxicity, Frontiers in Pharmacology, Vol. 9, 2018, pp. 1-9, http://doi.org/10.3389/fphar.2018.00364.[7] Use the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human, Validation of Analytical Procedures:Text and Methodology Q2 (R1), International Conference on Harmonization, Geneva, Switzerland, 2005, pp. 6-13.[8] N. T. H. Ly, T. T. Thao, P. V. Truong, P. T. Phuong, Quality Evaluation of Fallopia multiflora in Vietnam Based on HPLC-FLD and Chemometrics, Natural Products Chemistry & Research, Vol. 6, No. 6, 2018, pp. 1-7, http://doi.org/10.4172/2329-6836.1000346.[9] P. X. Sinh, Traditional Pharmacology, Medical Publishing House, Hanoi, 2014, pp. 352-353 (in Vietnamese).[10] D. Q. Luo, P. Jia, S. S. Zhao, Y. Zhao, H. J. Liu,F. Wei, S. C. Ma, Identification and Differentiation of Polygonum multiflorum Radix and Polygoni multiflori Radix Preaparata through the Quantitative Analysis of Multicomponents by the Single Marker Method, Journal of Analytical Methods in Chemistry, Vol. 2019, 2019, pp. 1-13, https://doi.org/10.1155/2019/7430717.

The practice of medicine—and especially the patient-doctor relationship—has seen exceptional shifts in ethical standards of care over the past few years, which by and large originate in occidental countries and are then extrapolated worldwide. However, this phenomenon is blind to the fact that an ethical practice of medicine remains hugely dependent on prevailing cultural and societal expectations of the community in which it serves. One model aiming to conceptualise the dichotomous efforts for global standardisation of medical care against differing sociocultural expectations is the individualism-collectivism model, with the ‘West’ being seen as individualistic and the ‘East’ being seen as collectivistic. This has been used by many academics to explain differences in approach towards ethical practice on key concepts such as informed consent and patient autonomy. However, I argue that this characterisation is incomplete and lacks nuance into the complexities surrounding cross-cultural ethics in practice, and I propose an alternative model based on the ethics of clinical care in Hong Kong, China. Core ethical principles need not be culture-bound—indeed, their very existence mandates for them to be universal and non-derogable—but instead cultural alignment occurs in the particular implementation of these principles, insofar as they respect the general spirit of contemporary ethical standards.

Abstract Background An obstacle in influenza therapeutics development is the lack of clinical endpoints, especially in hospitalized patients. A single time-point binary outcome measure is limited by patients’ diverse clinical trajectories and low event rates. Methods A 6-point ordinal scale with ascending clinical status severity (scoring: discharged; subacute care; acute care without/with respiratory failure; intensive care unit [ICU]; death) was proposed to study outcomes of adults hospitalized with influenza. Individual patient data from 2 active surveillance cohorts’ datasets (2015/2016−2017/2018; Edmonton, Hong Kong) was used for evaluation. The impact of neuraminidase inhibitor (NAI) treatment on longitudinal ordinal outcome changes over 30 days was analyzed using mixed-effects ordinal logistic regression and group-based trajectory models. Results Patient (n = 1226) baseline characteristics included age (mean 68.0 years), virus-type (A 78.1%, B 21.9%), respiratory failure (57.2%), ICU admittance (14.4%), and NAI treatment within 5 days of illness (69.2%). Outcomes at 30 days included discharged (75.2%), subacute care (13.7%), acute care (4.5%), and death (6.6%). Two main clinical trajectories were identified, predictive by baseline scoring (mean ± SD, 4.3 ± 0.6 vs 3.5 ± 0.6, P &lt; .001). Improved outcomes with NAI treatment within 5 days were indicated by significantly lower clinical status scores over time (unadjusted odds ratio [OR], 0.53; 95% confidence interval [CI], .41−.69; P &lt; .001; adjusted OR, 0.62; 95% CI, .50−.77; P &lt; .001, for baseline score, age, and within-patient correlations). In subanalysis, influenza vaccination was also associated with lower scores (adjusted OR, 0.67; 95% CI, .50−.90; P = .007). Analyses of binary endpoints showed insignificant results. Conclusions The ordinal outcome scale is a potentially useful clinical endpoint for influenza therapeutic trials, which could account for the diverse clinical trajectories of hospitalized patients, warranting further development.

Background: Understanding the "patient experience" is a key step in moving towards patient-centered care. The purpose of this study is to design a patient experience evaluation model to evaluate the effective components in the patient experience in hospitals of Mashhad University of Medical Sciences. Methods: This was a comparative descriptive study conducted using databases and information resources and based on a comprehensive review, and the models used in other parts of the world were extracted based on the research protocol and entered into a comparative matrix. The reliability of the extracted framework was verified using the agreement coefficient of the parties. In order to validate the model, the questions were prepared in the form of a questionnaire and validated by the specialists of Mashhad University of Medical Sciences during two-round Delphi using SPSS 16 software. Results: In this study, 10 models were obtained for evaluating patient experience in different countries, each of which was composed of several dimensions and some of them had overlap. The models included American model (8 dimensions), Swedish model (10 dimensions), British first model (7 dimensions), British second model (8 dimensions), Scotland model (6 dimensions), Hong Kong model (9 dimensions), Norway first model (6 dimensions), Norway second model (5 dimensions), India model (10 dimensions), and the model of Ethiopia (5 dimensions). The final model with 10 dimensions and 29 sub- dimensions was approved and validated. Conclusion: The results showed that the suitable pattern for Iran had 10 dimensions and 29 sub-dimensions. Among the dimensions, respect for the patient's privacy and dignity had the highest score and the way patients are discharged from the hospital had the lowest score.

BackgroundThe study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population.MethodsA random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed.ResultsOf the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS.ConclusionsPromotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.

In order to accelerate the development of advanced manufacturing, promote in-depth integration of the Internet, big data, artificial intelligence and the real economy, and foster new growth areas and new drivers in such areas as high-end and medium consumption, innovation-driven development, green and low-carbon development, sharing economy, modern supply chain and human capital services. Computer Academy of Guangdong, Association of Computing Education in Chinese Universities, and Zhuhai Ton-Bridge Medical Technology together with AEIC Academic Exchange Information Center, hosted the 2021 Guangdong-Hong Kong-Macao Greater Bay Area Artificial Intelligence and Big Data Forum (AIBDF 2021) in Zhuhai, China during September 24 to 26, 2021. This conference focused on artificial intelligence, big data and medical and big health AI science, aimed to provide a platform for experts and scholars, engineers and researchers to share scientific research results and cutting-edge technologies, understand academic development trends, broaden research ideas, strengthen academic research and discussion, and promote cooperation in the industrialization of academic achievements. About 300 participants from academic, high-education institutes and other organizations took part in the conference. The conference model was divided into two sessions, including oral presentations and keynote speeches. In the first part, some scholars, whose submissions were selected as the excellent papers, were given 15 minutes to perform their oral presentations one by one. Then in the second part, keynote speakers were each allocated 30-45 minutes to hold their speeches. We were very honored to have Prof. Guoqiang Han, from South China University of Technology as our Conference Chairman. In the keynote presentation part, we invited 16 professors as our keynote speakers. The first keynote speaker, Prof. Junlong Chen, Distinguished Chair Professor, Doctoral Supervisor, Dean of School of Computer Science and Engineering, from South University of Technology. The others keynote speakers as follow: Prof. Guoliang Chen, Parallel algorithms, high performance computing experts; Prof. Anhui Liang, the director of the interdisciplinary research center of optical fiber communication and bio-optics, Shandong University of Science and Technology; Prof. Weijia Jia, from International College of Beijing Normal University-Hong Kong Baptist University; Prof. Zhengtian Fang, from La Trobe University in Australia; Prof. Yutong Lu, from Sun Yat-sen University; Prof. Young Liang, from Macau University of Science and Technology; Prof. Nong Xiao, from Sun Yat-sen University; Prof. Xiaofeng Zhu, from University of Electronic Science and Technology of China; Prof. Jianxin Wang, from Central South University; Prof. Xuan Wang, from Harbin Institute of Technology institute; Prof. Guoqiang Zhong, a member of ACM, IEEE, IAPR and China computer society; Prof. Bing Shi, a member of IEEE, ACM and CCF; Assoc. Prof. Chunjiang Duanmu, from Zhejiang Normal University; Prof. Yang Yue, from Nankai University; Prof. Na Li, from Xi’dian University. The proceedings present a selection of high-quality papers submitted to the conference by researchers from universities, research institutes, and industry. All papers were subjected to peer-review by conference committee members and international reviewers. The papers were selected based on their quality and their relevance to the conference. The proceedings present recent advances in the fields of Direction of Big data, Direction of Artificial Intelligence, Direction of Medical and health care and others related research. I would like to express special gratitude to members of the conference committee and organizers of the conference. I would also like to thank the reviewers for their valuable time and advice which helped in improving the quality of the papers selected for presentation at the conference and for publication in the proceedings. Finally, I want to thank the authors, the members of the organizing committee, the reviewers, the chairpersons, sponsors, and all other conference participants for their support of AIBDF 2021. The Committee of AIBDF 2021 List of Committee member are available in this pdf.

Abstract Background Children with neurodegenerative conditions (CNDC) often suffer from severe neurodisability and high symptom burden with multisystemic involvement. However, their symptom burden and health-related quality of life (HRQOL) is not systematically documented in the literature, and there is no existing tool for such purposes. We designed our own tool for scoring of symptom burden amongst CNDCs and adopted the PedsQL generic score 4.0 to quantify the impact of overall symptom burden on children’s overall HRQOL. Methods The Symptom Profile for children with neurodegnerative condition (SProND) questionnaire was developed, which consisted of 14 questions grouped according to 5 categories, namely epilepsy, neurobehavioural, movement and mobility related, breathing and swallowing, and other daily activities. CNDCs were recruited during visits to the Comprehensive Neurometabolic / Neurodegenerative Program of the Duchess of Kent Children’s Hospital and Hong Kong Children’s Hospital between November 2019 and March 2020. The SProND and PedsQL 4.0 Generic Core Scales were distributed to consenting parents of CNDCs. Results 36 CNDCs were recruited and matched with community controls. The response rate of subject and control were 99.5% and 98.7% respectively. The Cronbach alpha was 0.61 for the neurobehavioural domain and > = 0.7 for other domains. The greater number of symptoms each subject experiences, the worse his/ her PedsQL scores. Subjects displaying hypersalivation and swallowing difficulties had average physical health summary scores of less than 30% compared with subjects without these symptoms. On the other hand, average psychosocial health summary scores of subjects with involuntary movements, joint stiffness, hypersalivation, sleep problem and anorexia were approximately 70% compared to subjects without these symptoms. Discussion and conclusion This is one of the first studies to look at CNDCs as a group. We propose the SProND questionnaire for evaluation of symptom profile amongst CNDCs with satisfactory internal and external validity. It demonstrates how physical symptoms impact both physical and psychosocial HRQOL, and the cumulative effect of individual symptoms on the overall HRQOL. As such, CNDCs should be systematically screened for multi-systemic symptoms as a routine part of their clinical care, and care plans should be individually catered to individual patients’ symptom burden and specific needs.

Abstract Background Heart failure (HF) evolves as a global pandemic and strains the over-stretched hospital service. Ineffective self-care remains the key factor to explain the avoidable hospital admission. Patient empowerment is as a theory-based strategy to optimize the patients' self-care changes for disease management [1]. Its cost-effectiveness to enhance self-care and health service utilization has yet to be determined. Purpose This was a double-blind randomized controlled trial to compare the effects and cost-effectiveness of a 12-week empowerment self-care program with a didactic education program on self-care maintenance and management as well as health service utilization among the community-dwelling HF patients. Methods A total of 236 HF patients were recruited from the specialist clinics of the Department of Cardiology in two regional hospitals. They were randomized to receive either the 12-week empowerment self-care program (Figure 1) or the 12-week didactic education. Outcome evaluation using the Self-care Heart Failure Index (SCHFI) at baseline, post-intervention (T1) and three months thereafter (T2), with record on the number of emergency room (ER) attendance and hospital admission. Cost effectiveness analyses were performed on total cost (medical, intervention and societal costs) incurred in both interventions as well as incremental cost-effectiveness ratios (ICER) expressed as incremental cost per 1) a reflected clinically meaningful improvement in self-care (i.e. a half standard deviation increase in SCHFI), 2) an ER attendance reduced, 3) a day of hospital stay reduced. Results As compared with the education group, the empowerment group reported significantly greater improvement in self-care management at T1 [B=13.77 (95% CI=6.07, 21.46), p&lt;0.001] and T2 [B=10.98 (95% CI=3.21, 18.75), p=0.006]. For cost-effective analysis, The ICER (empowerment-education) was −USD220/0.5 SD increase in SCHFI, indicating the mean cost saved per patient for making a clinically significant improvement in self-care was USD 220. The cost-effectiveness acceptability curve showed patients were willing to pay at USD 207- 441 for a 80–90% chance of improved self-care, indicating that the empowerment approach was a cost saving strategy. Although the empowerment approach was associated with a lower risk of ER attendance [IRR=0.55, 95% CI=0.31–0.95)] and hospital admission [IRR=0.38 (95% CI=0.31–0.95)], it is not cost saving for reducing hospital service utilization. Conclusions The empowerment-based self-care program is a cost-saving strategy to produce a clinical significant change in HF-related self-care. Although it is associated with lower risk for hospital service utilization, its effect is not significant enough to be cost-saving. Future care model may explore the need to integrate dyadic science [2] and e-health [3] to strengthen the care continuity and effects of self-care intervention. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Figure 1

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ELT Journal (Oxford University Press) 59.4 (2005), 287–297.06–49North, Sarah (The Open U, UK), Disciplinary variation in the use of theme in undergraduate essays. Applied Linguistics (Oxford University Press) 26.3 (2005), 431–452.06–50Nunan, David (U Hong Kong, China), Styles and strategies in the language classroom. The Language Teacher (Japan Association for Language Teaching) 29.6 (2005), 9–11.06–51Paribakht, T. Sima (U Ottawa, Canada; paribakh@uottawa.ca), The influence of first language lexicalization on second language lexical inferencing: A study of Farsi-speaking learners of English as a foreign language. Language Learning (Blackwell) 55.4 (2005), 701–748.06–52Potts, Diana (U British Columbia, Canada; djpotts7@hotmail.com), Pedagogy, purpose, and the second language learner in on-line communities. The Canadian Modern Language Review (University of Toronto Press) 62.1 (2005), 137–160.06–53Pretorius, Elizabeth J. (U South Africa, Pretoria, South Africa; pretoej@unisa.ac.za), English as a second language learner differences in anaphoric resolution: Reading to learn in the academic context. Applied Psycholinguistics (Cambridge University Press) 26.4 (2005), 521–539.06–54Ramírez Verdugo, Dolores (Universidad Autónoma de Madrid, Spain; dolores.ramirez@uam.es), The nature and patterning of native and non-native intonation in the expression of certainty and uncertainty: Pragmatic effects. Journal of Pragmatics (Elsevier) 37.12 (2005), 2086–2115.06–55Riney, Timothy J., Naoyuki Takagi & Kumiko Inutsu (Interntional Christian U, Japan), Phonetic parameters and perceptual judgments of accent in English by American and Japanese listeners. TESOL Quarterly (Teachers of English to Speakers of Other Languages) 39.3 (2005), 441–466.06–56Rossiter, Marian J. (U Alberta, Canada), Developmental sequences of L2 communication strategies. 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In 2006, a seminal report from the World Health Organization1 provided an all-encompassing definition of health workers as “all people engaged in actions whose primary intent is to enhance health,” whether involved in direct service provision (e.g., physicians, nurses, midwives) or administrative/support functions (e.g., administrative professional or driver in a healthcare facility), and with or without compensation (e.g., volunteer health workers, family caregivers). Because of limitations on data availability and measurement, however, technical and academic discussions about health workers, or more formally, human resources for health (HRH), focus on those under the formal sector.2 By and large, HRH is considered a vital pillar of a functioning health system3 because the health sector is a labor-intensive industry4 that relies on a substantial number of highly skilled staff to provide services to target populations, and consequently, the attainment of national and global health targets (e.g., Sustainable Development Goals). One challenge confronting HRH management is the issue of geographical imbalance, which means that health workers are attracted to work and settle in urban more than rural areas for a variety of individual, organizational, institutional, economic, political, and cultural factors.5,6 In the Philippine context, the Department of Health (DOH) reported in 2018 that there still exists a maldistribution of HRH in the country, particularly in “hardship” posts where municipalities could not entice, nor retain, HRH.7 For example, a separate analysis of institution-based HRH data in 2017 showed that the National Capital Region had significantly more physicians, nurses, and medical technologists than the Autonomous Region of Muslim Mindanao.8 The paper by Tejero et al.9 in this issue of Acta Medica Philippina adds further evidence to the underlying reasons for the geographical imbalance of HRH in the country. Based on interviews with officials and health workers from 76 rural municipalities across the Philippines, the researchers found that, in general, while local government units attempted to implement strategies to help recruit and retain health workers in their areas, such a response has mainly been inadequate and has failed to bridge the HRH gap confronting their locality. At its core, the financial obligations tied to the recruitment and retention process appear to be a significant driver of this situation since most rural municipalities are dependent on their share of national revenues by way of the Internal Revenue Allotment (IRA), which in turn is based on population (50%), land area (25%), and equal sharing (25%).10 That is to say, rural municipalities can only commit so much financial resources in their annual budget to fund the salary of health workers, given the other equally important social and development programs that need to be implemented. Even the impact of the expected increase in IRA based on the Mandanas Doctrine promulgated by the Supreme Court in 2019 revising the computation of national revenues may be modest at best since some programs, projects, and activities previously supported by the national government will have to be assumed again by local government units.11 The devolution of health services following the promulgation of the Local Government Code of 199112 with its promise of creating a governance structure that is more responsive to the needs of communities has resulted in a paradox whereby local government units are constrained in their strategies and initiatives by, among other things, the financial resources that are available at their disposal. To this end, two important points need to be considered by local government units to address the issue of the geographical imbalance of HRH. First, augmentation of available human resources for health through national-level initiatives (e.g., DOH HRH Deployment Program 8, Medical Scholarship, and Return Service Program 13) as well as private sector support (e.g., project-specific HRH for the tuberculosis control program 14) should be maximized, but with a clear intent that, as we have argued in past publications, these be regarded as temporary measures to rectify the issue in the short- to intermediate-term.14–18 Second, and more importantly, there is a need to explore, mobilize, and maximize non-financial incentives (e.g., housing) and extrabudgetary sources (e.g., share from the feed paid by social health insurance), as more long-term tactics.1,17 Unless and until a viable fiscal environment is put in place, coupled with implementation of a comprehensive policy and framework across the phases of the working lifespan1 , the challenge of HRH maldistribution will continue to persist. Carl Abelardo T. Antonio, MD, MPH Department of Health Policy and Administration College of Public Health University of the Philippines Manila, Manila, Philippines Department of Applied Social Sciences The Hong Kong Polytechnic University, Kowloon Hong Kong SAR, China REFERENCES World Health Organization. The World Health Report 2006: Working together for health [Internet]. Geneva: World Health Organization; 2006 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/43432 Al-Sawai A, Al-Shishtawy MM. Health workforce planning: an overview and suggested approach in Oman. Sultan Qaboos Univ Med J. 2015 Feb; 15(1):e27-33. World Health Organization. The World Health Report 2000. Health systems: improving performance [Internet]. Geneva: World Health Organization; 2000 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/42281 Buchan J. What difference does (“good”) HRM make? Hum Resour Health. 2004 Jun 7; 2(1):6. doi: 10.1186/1478-4491-2-6. Zurn P, Dal Poz MR, Stilwell B, Adams O. Imbalance in the health workforce. Hum Resour Health. 2004 Sep 17; 2(1):13. doi: 10.1186/1478-4491-2-13. Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006 May 27; 4:12. doi: 10.1186/1478-4491-4-12. Department of Health. National objectives for health Philippines 2017-2022 [Internet]. Manila, Philippines: Department of Health; 2018 [cited 2022 May 4]. Available from https://doh.gov.ph/sites/default/files/health_magazine/NOH-2017-2022-030619-1%281%29_0.pdf Dayrit MM, Lagrada LP, Picazo OF, Pons MC & Villaverde MC. The Philippines health system review [Internet]. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/274579. Tejero LS, Leyva EA, Abad PB, Montorio D, Santos M. Production, recruitment, and retention of health workers in rural areas in the Philippines. Acta Med Philipp. 2022; 56(8):31-42. Congressional Policy and Budget Research Department. Facts in figures, FF2012-03 [Internet]. Quezon City: House of Representatives; 2012 [cited 2022 May 4]. Available from https://cpbrd.congress.gov.ph/images/PDF%20Attachments/Facts%20in%20Figures/03-FnF%20IRA.pdf Manasan RG. Fiscal sustainability, equity, and allocative efficiency in the light of the 2019 Supreme Court ruling on the LGUs’ share in national taxes, DP 2020-18 [Internet]. Quezon City: Philippine Institute for Development Studies; 2020 [cited 2022 May 4]. Available from https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps2018.pdf Congress of the Philippines. Republic Act No. 7160, Local Government Code of 1991 [Internet]. Metro Manila: Congress of the Philippines; 1991 Oct 10 [cited 2022 May 5]. Available from https://www.officialgazette.gov.ph/downloads/1991/10oct/19911010-RA-7160-CCA.pdf Congress of the Philippines. Republic Act No. 11509, Doktor Para sa Bayan Act [Internet]. Metro Manila: Congress of the Philippines; 2020 Dec 23 [cited 2022 May 4]. Available from https://www.officialgazette.gov.ph/downloads/2020/12dec/20201223-RA-11509-RRD.pdf Antonio CT, Guevarra JP, Medina PN, Roxas EA, Cavinta LL, Manalo JA, et al. Facilitators and barriers to the implementation of selected local tuberculosis control programs in the Province of Laguna, Philippines. Philipp J Sci. 2021 Dec; 150(6A):1501-1506. Lawas ND, Faraon EA, Mabunga SY, Antonio CT, Tobias EM, Javier RS. An evaluation of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health. Acta Med Philipp. 2016; 50(3):186–193. doi: 10.47895/amp.v50i3.826 Medina PN, Bardelosa DD, Lara AB, Avelino MD, Agbon AG, Cengca RM, et al. A historical perspective of mandatory service policy in the Philippines: a document analysis. Phil J Health Res Dev. 2018; 22(3):1–12. Antonio CT, Guevarra JP, Medina PN, Avelino MD, Agbon AG, Sepe DC, et al. Components of compulsory service program for health professionals in low-and middle-income countries: A scoping review. Perspect Public Health.2020;140(1):54–61. doi: 10.1177/1757913919839432. Guevarra JP, Medina PN, Avelino MD, Cengca MM, Ting ML, Agbon AG, et al. Perception of program administrators and students on the implementation of return service agreement in the Philippines. Acta Med Philipp. 2020;54(3):289–95. doi: 10.47895/amp.v54i3.1666.

Photo by Ishan @seefromthesky on Unsplash ABSTRACT A strike to highlight the plight facing contract doctors which has been proposed has received mixed reactions from those within the profession and the public. This unprecedented nationwide proposal has the potential to cause real-world effects, posing an ethical dilemma. Although strikes are common, especially in high-income countries, these industrial actions by doctors in Malaysia are almost unheard of. Reviewing available evidence from various perspectives is therefore imperative to update the profession and the complexity of invoking this important human right. INTRODUCTION Contract doctors in Malaysia held a strike on July 26, 2021. COVID-19 cases are increasing in Malaysia. In June, daily cases ranged between 4,000 to 8,000 despite various public health measures. The R naught, which indicates the infectiousness of COVID-19, remains unchanged. During the pandemic, health care workers (HCWs) have been widely celebrated, resulting in a renewed appreciation of the risks that they face.[1] The pandemic has exposed flawed governance in the public healthcare system, particularly surrounding the employment of contract doctors. Contract doctors in Malaysia are doctors who have completed their medical training, as well as two years of internship, and have subsequently been appointed as medical officers for another two years. Contract doctors are not permanently appointed, and the system did not allow extensions after the two years nor does it offer any opportunity to specialize.[2] Last week, Parliament did decide to offer a two-year extension but that did not hold off the impending strike.[3] In 2016, the Ministry of Health introduced a contract system to place medical graduates in internship positions at government healthcare facilities across the country rather than placing them in permanent posts in the Public Service Department. Social media chronicles the issues that doctors in Malaysia faced. However, tensions culminated when and contract doctors called for a strike which ended up taking place in late July 2021. BACKGROUND Over the past decade, HCW strikes have arisen mostly over wages, work hours, and administrative and financial factors.[4] In 2012, the British Medical Association organized a single “day of action” by boycotting non-urgent care as a response to government pension reforms.[5] In Ireland, doctors went on strike for a day in 2013 to protest the austerity measures implemented by the EU in response to the global economic crisis. It involved a dispute over long working hours (100 hours per week) which violated EU employment laws and more importantly put patients’ lives at risk.[6] The strike resulted in the cancellation of 15,000 hospital appointments, but emergencies services were continued. Other major strikes have been organized in the UK to negotiate better pay for HCWs in general and junior doctors’ contracts specifically.[7] During the COVID-19 pandemic, various strikes have also been organized in Hong Kong, the US, and Bolivia due to various pitfalls in managing the pandemic.[8] A recent strike in August 2020 by South Korean junior doctors and medical students was organized to protest a proposed medical reform plan which did not address wage stagnation and unfair labor practices.[9] These demands are somewhat similar to the proposed strike by contract doctors in Malaysia. As each national health system operates within a different setting, these strikes should be examined in detail to understand the degree of self-interest involved versus concerns for patient’s welfare. l. The Malaysia Strike An anonymous group planned the current strike in Malaysia. The group used social media, garnering the attention of various key stakeholders including doctors, patients, government, and medical councils.[10] The organizers of the strike referred to their planned actions as a hartal. (Although historically a hartal involved a total shutdown of workplaces, offices, shops, and other establishments as a form of civil disobedience, the Malaysian contract doctors pledged no disturbance to healthcare working hours or services and intend a walk-out that is symbolic and reflective of a strike.)[11] The call to action mainly involved showing support for the contract doctors with pictures and placards. The doctors also planned the walk-out.[12] Despite earlier employment, contract medical doctors face many inequalities as opposed to their permanent colleagues. These include differences in basic salary, provisions of leave, and government loans despite doing the same job. The system disadvantages contract doctors offering little to no job security and limited career progression. Furthermore, reports in 2020 showed that close to 4,000 doctors’ contracts were expected to expire by May 2022, leaving their futures uncertain.[13] Some will likely be offered an additional two years as the government faces pressure from the workers. Between December 2016 and May 2021, a total of 23,077 contract doctors were reportedly appointed as medical officers, with only 789 receiving permanent positions.[14] It has been suggested that they are appointed into permanent positions based on merit but the criteria for the appointments remain unclear. Those who fail to acquire a permanent position inevitably seek employment elsewhere. During the COVID-19 pandemic, there have been numerous calls for the government to absorb contract doctors into the public service as permanent staff with normal benefits. This is important considering a Malaysian study that revealed that during the pandemic over 50 percent of medical personnel feel burned out while on duty.[15] This effort might be side-lined as the government prioritizes curbing the pandemic. As these issues remain neglected, the call for a strike should be viewed as a cry for help to reignite the discussions about these issues. ll. Right to strike The right to strike is recognized as a fundamental human right by the UN and the EU.[16] Most European countries also protect the right to strike in their national constitutions.[17] In the US, the Taft-Hartley Act in 1947 prohibited healthcare workers of non-profit hospitals to form unions and engage in collective bargaining. But this exclusion was repealed in 1947 and replaced with the requirement of a 10-day advanced written notice prior to any strike action.[18] Similarly, Malaysia also recognizes the right to dispute over labor matters, either on an individual or collective basis. The Industrial Relations Act (IRA) of 1967[19] describes a strike as: “the cessation of work by a body of workers acting in combination, or a concerted refusal or a refusal under a common understanding of a number of workers to continue to work or to accept employment, and includes any act or omission by a body of workers acting in combination or under a common understanding, which is intended to or does result in any limitation, restriction, reduction or cessation of or dilatoriness in the performance or execution of the whole or any part of the duties connected with their employment” According to the same act, only members of a registered trade union may legally participate in a strike with prior registration from the Director-General of Trade Unions.[20] Under Section 43 of the IRA, any strike by essential services (including healthcare) requires prior notice of 42 days to their employer.[21] Upon receiving the notice, the employer is responsible for reporting the particulars to the Director-General of Industrial Relations to allow a “cooling-off” period and appropriate action. Employees are also protected from termination if permitted by the Director-General and strike is legalized. The Malaysian contract healthcare workers’ strike was announced and transparent. Unfortunately, even after legalization, there is fear that the government may charge those participating in the legalized strike.[22] The police have announced they will pursue participants in the strike.[23] Even the Ministry of Health has issued a warning stating that those participating in the strike may face disciplinary actions from the ministry. However, applying these laws while ignoring the underlying issues may not bode well for the COVID-19 healthcare crisis. lll. Effects of a Strike on Health Care There is often an assumption that doctors’ strikes would unavoidably cause significant harm to patients. However, a systematic review examining several strikes involving physicians reported that patient mortality remained the same or fell during the industrial action.[24] A study after the 2012 British Medical Association strike has even shown that there were fewer in-hospital deaths on the day, both among elective and emergency populations, although neither difference was significant.[25] Similarly, a recent study in Kenya showed declines in facility-based mortality during strike months.[26] Other studies have shown no obvious changes in overall mortality during strikes by HCWs.[27] There is only one report of increased mortality associated with a strike in South Africa[28] in which all the doctors in the Limpopo province stopped providing any treatment to their patients for 20 consecutive days. During this time, only one hospital continued providing services to a population of 5.5 million people. Even though their data is incomplete, authors from this study found that the number of emergency room visits decreased during the strike, but the risks of mortality in the hospital for these patients increased by 67 percent.[29] However, the study compared the strike period to a randomly selected 20-day period in May rather than comparing an average of data taken from similar dates over previous years. This could greatly influence variations between expected annual hospital mortality possibly due to extremes in weather that may exacerbate pre-existing conditions such as heart failure during warmer months or selecting months with a higher incidence of viral illness such as influenza. Importantly, all strikes ensured that emergency services were continued, at least to the degree that is generally offered on weekends. Furthermore, many doctors still provide usual services to patients despite a proclaimed strike. For example, during the 2012 BMA strike, less than one-tenth of doctors were estimated to be participating in the strike.[30] Emergency care may even improve during strikes, especially those involving junior doctors who are replaced by more senior doctors.[31] The cancellation of elective surgeries may also increase the number of doctors available to treat emergency patients. Furthermore, the cancellation of elective surgery is likely to be responsible for transient decreases in mortality. Doctors also may get more rest during strike periods. Although doctor strikes do not seem to increase patient mortality, they can disrupt delivery of healthcare.[32] Disruptions in delivery of service from prolonged strikes can result in decline of in-patient admissions and outpatient service utilization, as suggested during strikes in the UK in 2016.[33] When emergency services were affected during the last strike in April, regular service was also significantly affected. Additionally, people might need to seek alternative sources of care from the private sector and face increased costs of care. HCWs themselves may feel guilty and demotivated because of the strikes. The public health system may also lose trust as a result of service disruption caused by high recurrence of strikes. During the COVID-19 pandemic, as the healthcare system remains stretched, the potential adverse effects resulting from doctor strikes remain uncertain and potentially disruptive. In the UK, it is an offence to “willfully and maliciously…endanger human life or cause serious bodily injury.”[34] Likewise, the General Medical Council (GMC) also requires doctors to ensure that patients are not harmed or put at risk by industrial action. In the US, the American Medical Association code of ethics prohibits strikes by physicians as a bargaining tactic, while allowing some other forms of collective bargaining.[35] However, the American College of Physicians prohibits all forms of work stoppages, even when undertaken for necessary changes to the healthcare system. Similarly, the Delhi Medical Council in India issued a statement that “under no circumstances doctors should resort to strike as the same puts patient care in serious jeopardy.”[36] On the other hand, the positions taken by the Malaysian Medical Council (MMC) and Malaysian Medical Association (MMA) on doctors’ strikes are less clear when compared to their Western counterparts. The MMC, in their recently updated Code of Professional Conduct 2019, states that “the public reputation of the medical profession requires that every member should observe proper standards of personal behavior, not only in his professional activities but at all times.” Strikes may lead to imprisonment and disciplinary actions by MMC for those involved. Similarly, the MMA Code of Medical Ethics published in 2002 states that doctors must “make sure that your personal beliefs do not prejudice your patients' care.”[37] The MMA which is traditionally meant to represent the voices of doctors in Malaysia, may hold a more moderate position on strikes. Although HCW strikes are not explicitly mentioned in either professional body’s code of conduct and ethics, the consensus is that doctors should not do anything that will harm patients and they must maintain the proper standard of behaviors. These statements seem too general and do not represent the complexity of why and how a strike could take place. Therefore, it has been suggested that doctors and medical organizations should develop a new consensus on issues pertaining to medical professional’s social contract with society while considering the need to uphold the integrity of the profession. Experts in law, ethics, and medicine have long debated whether and when HCW strikes can be justified. If a strike is not expected to result in patient harm it is perhaps acceptable.[38] Although these debates have centered on the potential risks that strikes carry for patients, these actions also pose risks for HCWs as they may damage morale and reputation.[39] Most fundamentally, strikes raise questions about what healthcare workers owe society and what society owes them. For strikes to be morally permissible and ethical, it is suggested that they must fulfil these three criteria:[40] a. Strikes should be proportionate, e., they ‘should not inflict disproportionate harm on patients’, and hospitals should as a minimum ‘continue to provide at least such critical services as emergency care.’ b. Strikes should have a reasonable hope of success, at least not totally futile however tough the political rhetoric is. c. Strikes should be treated as a last resort: ‘all less disruptive alternatives to a strike action must have been tried and failed’, including where appropriate ‘advocacy, dissent and even disobedience’. The current strike does not fulfil the criteria mentioned. As Malaysia is still burdened with a high number of COVID-19 cases, a considerable absence of doctors from work will disrupt health services across the country. Second, since the strike organizer is not unionized, it would be difficult to negotiate better terms of contract and career paths. Third, there are ongoing talks with MMA representing the fraternity and the current government, but the time is running out for the government to establish a proper long-term solution for these contract doctors. One may argue that since the doctors’ contracts will end in a few months with no proper pathways for specialization, now is the time to strike. However, the HCW right to strike should be invoked only legally and appropriately after all other options have failed. CONCLUSION The strike in Malaysia has begun since the drafting of this paper. Doctors involved assure that there will not be any risk to patients, arguing that the strike is “symbolic”.[41] Although an organized strike remains a legal form of industrial action, a strike by HCWs in Malaysia poses various unprecedented challenges and ethical dilemmas, especially during the pandemic. The anonymous and uncoordinated strike without support from the appropriate labor unions may only spark futile discussions without affirmative actions. It should not have taken a pandemic or a strike to force the government to confront the issues at hand. It is imperative that active measures be taken to urgently address the underlying issues relating to contract physicians. As COVID-19 continues to affect thousands of people, a prompt reassessment is warranted regarding the treatment of HCWs, and the value placed on health care. [1] Ministry of Health (MOH) Malaysia, “Current situation of COVID-19 in Malaysia.” http://covid-19.moh.gov.my/terkini (accessed Jul. 01, 2021). [2] “Future of 4,000 young doctors who are contract medical officers uncertain,” New Straits Times - November 26, 2020. https://www.nst.com.my/news/nation/2020/11/644563/future-4000-young-doctors-who-are-contract-medical-officers-uncertain [3] “Malaysia doctors strike, parliament meets as COVID strain shows,” Al Jazeera, July 26, 2021. https://www.aljazeera.com/news/2021/7/26/malaysia-doctors-strike-parliament-meets-as-covid-strains-grow [4] R. Essex and S. M. Weldon, “Health Care Worker Strikes and the Covid Pandemic,” N. Engl. J. Med., vol. 384, no. 24, p. e93, Jun. 2021, doi: 10.1056/NEJMp2103327; G. Russo et al., “Health workers’ strikes in low-income countries: the available evidence,” Bull. World Health Organ., vol. 97, no. 7, pp. 460-467H, Jul. 2019, doi: 10.2471/BLT.18.225755. [5] M. Ruiz, A. Bottle, and P. Aylin, “A retrospective study of the impact of the doctors’ strike in England on 21 June 2012,” J. R. Soc. Med., vol. 106, no. 9, pp. 362–369, 2013, doi: 10.1177/0141076813490685. [6] E. Quinn, “Irish Doctors Strike to Protest Work Hours Amid Austerity,” The Wall Street Journal, 2013. https://www.wsj.com/articles/no-headline-available-1381217911?tesla=y (accessed Jun. 29, 2021). [7] “NHS workers back strike action in pay row by 2-to-1 margin,” The Guardian, 2014. https://www.theguardian.com/society/2014/sep/18/nhs-workers-strike-pay-unison-england (accessed Jun. 29, 2021); M. Limb, “Thousands of junior doctors march against new contract,” BMJ, p. h5572, Oct. 2015, doi: 10.1136/bmj.h5572. [8] J. Parry, “China coronavirus: Hong Kong health staff strike to demand border closure as city records first death,” BMJ, vol. 368, no. 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Mesona chiensis Benth. is a natural and safe pharmaceutical ingredient with many nutrients and special medical functions. The aim of this study was to investigate the prevention and treatment effect of ethanol extract from Mesona chiensis Benth. on the plasma lipid concentration of high fat diet-induced obesity mice. Male white mice (Mus musculus) 5 - 6 weeks of age were fed a high-fat diet including standard pellets (65% in weight) and boiled lard (35% in weight) for 6 weeks model obese mice. The study was divided into 2 periods: the prevention period for 4 weeks and the treatment period for 15 days. Prevention group (normal-weight mice) received ethanol extract of Mesona chinensis Benth. (400 mg/kg bw) and be fed a high-fat diet for 4 weeks. Treatment group (obese mice) received ethanol extract of Mesona chinensis Benth. (400 mg/kg bw) and be fed a high-fat diet for 15 days. The finding of the present investigation showed that mice fed a high-fat diet had significantly higher levels of TC, TG and TC/HDL-C compared to those in mice fed a normal diet. Body weight (bw) was significantly and positively correlated to TG (r = 0.53, P < 0.05) and TC (r = 0.33, P < 0.05) levels. After 4 weeks of receiving ethanol extract of Mesona chinensis Benth., the TG concentration and TC/HDL-C of the prevention group were significantly lower than those of the control group. After 15 days of treatment with obese mice, no statistically significant differences in blood lipid concentrations were observed compared with mice receiving fenofibrat and NaCl. In conclusion, ethanol extract of Mesona chinensis Benth. has the effect of preventing hyperlipidemia in mice fed a high-fat diet. Keywords Mesona chiensis Benth., hypolipidemic, high fat diet, obesity mice. References [1] A.D. Smith, S.P. Datta, G.H. 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