Journal articles on the topic 'Medical care, Cost of - China - Hong Kong'

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.

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.

Background The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.

SummaryAllocation of additional resources for establishing or expanding anticoagulation clinic (AC) services is a significant concern for healthcare decision-makers when the payer is also the provider of the healthcare system. The majority of anticoagulated patients in Hong Kong are managed by routine medical care (RMC) instead of ACs, possibly due to the lack of local cost-effectiveness analysis of the AC setting. The aim was to compare the clinical and economic outcomes of anticoagulated patients who were managed by AC or RMC from the perspective of a public health organization in Hong Kong. A Markov model was designed to simulate, over 10 years, the economic and clinical outcomes of patients receiving chronic warfarin therapy managed by AC or RMC. The transition probabilities were derived from literature. Resource utilization was retrieved from patients managed by AC and RMC in Hong Kong. Sensitivity analysis was conducted to examine the robustness of the model. The total number of events per 100 patient-years and the direct medical cost per patient-year in the AC and RMC groups were 9.5 and USD 840, and, 19.3 and USD 1,179, respectively. The results of the model were sensitive to the variation of the probability of major bleeding in the AC group. In conclusion, the coordinated care provided by an anticoagulation clinic appears to be more cost-effective than routine medical care in the management of warfarin therapy from the perspective of public health organization in Hong Kong.

This article points to the importance of religion for refugees and the migration process. After World War II and civil war in China, many refugees flocked to Hong Kong (HK) for safe haven in the British colony, and possible subsequent migration abroad. Christian congregations in HK, and missionaries who themselves were refugees from China, offered hospitality and support services across refugee groups. They advocated for the colonial government to help settle refugees by building low-cost urban housing, schools, medical clinics and new infrastructure. This new workforce was crucial to HK’s industrialization which took-off in the 1950s. With the decline of HK’s trade economy due to the Cold War embargo of China, many refugees became entrepreneurs-of-necessity by starting family businesses that absorbed migrant labour. Religiously-inspired assistance to refugees, from within one’s group and beyond, made a big difference in assimilating newcomers and helping them to rebuild their lives in adverse conditions. Beyond Christian responses, the article also explores the role of the Wong Tai Sin Taoist temple in Kowloon, itself uprooted from Guangzhou and replanted in HK. It reassured displaced people with cultural continuity to their ancestor halls and offered psycho-social assistance through spirit-writing divination, herbal medicine and Taoist worship adapted from rural Chinese villages to urban workers struggling to improve their lives and adapt to Hong Kong.

<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>

The study examined the importance of socio-demographic factors, health conditions, health beliefs and health seeking behaviors in predicting the use of Traditional Chinese Medicine (TCM) in Hong Kong. A sample of 4,339 respondents was randomly selected and interviewed. Among the 1,651 respondents who had consulted a doctor in the three months prior to the survey, 8.6% consulted a TCM doctor. Besides, 13.5% of the entire sample reported that they had been using TCM drugs frequently or occasionally. Socio-demographic factors, health conditions, health beliefs and health seeking behaviors were all found predictive of the use of TCM. In particular, those who were older, female, new immigrants, unemployed, retired, had chronic disease such as rheumatism, bronchitis, asthma, and those taking non-prescribed medication and not seeking treatment when falling ill were more likely to use TCM. Perceived difficulty in obtaining medical services and high medical cost also predicted TCM use. In sum, the findings suggest that TCM users are likely to be those who have been marginalized in obtaining medical care.

BackgroundUnintentional household injuries are a major public health problem that affects large numbers of people. Various population-based surveys from the literature showed > 40% of households reporting an injury that required medical attention. However, there is a general lack in comprehensive population surveys to highlight the risk of post-injury, help-seeking behavior and its associated financial cost. This study is part of the urban, home-based injury epidemiological study series (2007–2010) in Hong Kong.MethodsA population-based, cross-sectional, random telephone survey was conducted using the last birthday method in 2009. A study instrument was developed and validated based on the modified Chinese World Health Organization guidelines for injury and violence surveys.ResultsThe study population comprised of non-institutionalized, Cantonese-speaking Hong Kong residents (n = 6,570). Among the 39.4% self-reported injuries within the past 12 months, only 8.6% of injured people had sought medical care. Respondents tended to seek medical care from the private setting in the first episode of post-injury treatment. Among health seekers, 70% of the injured participants reported having to seek a second treatment and the care-seeking pattern shifted from private to public medical service delivery setting. Predictors of service preferences were identified and discussed.ConclusionsMedical care seeking patterns post-unintentional household injury was identified. Medical and emergency services providers may wish to consider health service implications.

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.

Objective.To determine the prevalence, risk factors, and molecular epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) colonization at the time of admission to acute medical units and to develop a cost-effective screening strategy.Methods.Nasal and groin screening cultures were performed for patients at admission to 15 acute medical units in all 7 catchment regions in Hong Kong. All MRSA isolates were subjected tospatyping.Results.The overall carriage rate of MRSA was 14.3% (95% confidence interval [CI], 13.5–15.1). MRSA history within the past 12 months (adjusted odds ratio [OR], 4.60 [95% CI, 3.28–6.44]), old age home residence (adjusted OR, 3.32 [95% CI, 2.78–3.98]), and bedbound state (adjusted OR, 2.19 [95% CI, 1.75–2.74]) were risk factors selected as MRSA screening criteria that provided reasonable sensitivity (67.4%) and specificity (81.8%), with an affordable burden (25.2%).spatyping showed that 89.5% (848/948) of the isolates were clustered into the 4spaclonal complexes (CCs):spaCC1081,spaCC032,spaCC002, andspaCC4677. Patients colonized with MRSAspatypes t1081 (OR, 1.77 [95% CI, 1.49–2.09]) and t4677 (OR, 3.09 [95% CI, 1.54–6.02]) were more likely to be old age home residents.Conclusions.MRSA carriage at admission to acute medical units was prevalent in Hong Kong. Our results suggest that targeted screening is a pragmatic approach to increase the detection of the MRSA reservoir. Molecular typing suggests that old age homes are epicenters in amplifying the MRSA burden in acute hospitals. Enhancement of infection control measures in old age homes is important for the control of MRSA in hospitals.

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.

This issue is a Special Issue in that it predominantly features a series of articles that have arisen from the CPCE Health Conference 2019. The special issue commences with an editorial where Professor Yuen emphasises the ongoing collaboration with this Journal, the ACHSM and the Hong College of health Services Executives and with the CPCE. His leadership and contribution are appreciated. The first article of the Special Issue is by Hasegawa, Matsumoto, and Hirata of Toho University Tokyo Japan who present an article entitled ‘Aging and Diversity of Medical Needs: Cost of Illness of Cerebrovascular Disease in Each Prefecture of Japan. This is followed by the contribution from Ng, Fong and Kwong of Hong Kong on the ‘Transition of hospital acute-centric to long term care in an ageing population in Hong Kong - is it an issue of service gap’. In the next article, Chu and Chong of Hong Kong address the ‘Oncology Pharmacist’s role and the impact on multidisciplinary patient-centred practice of oncology clinic in public hospitals in Hong Kong. Two interesting articles follow from Kwan, Yick and Wong of the Institute of Textiles and Clothing, Hong Kong Polytechnic University of Hong Kong who provide a research article on the ‘Impact of Co- creation Footwear Workshops on Older Women in Elderly Centres in Hong Kong’ and the following article from Yick, Yip and Ng, again from the Institute of Textiles and Clothing and from the Division of Science and Technology of the Hong Kong College of the same University. The latter article examines the importance of thermal comfort in foot wear design for the elderly and is entitled ‘Thermal equations for predicting foot skin temperature’. In conclusion, Kwong and Fong provide a review article on a contemporary issue of ‘promotion of appropriate use of electronic devices among Hong Kong adolescents. We thank Professor Yuen and his authors for this important contribution to our understanding of humane, wholistic and integrated care from diverse international health systems. In support of this effort of our colleagues above, we have added some more articles ready for publication. This includes an editorial on Health Reform that was prompted by my plenary session contribution at the CPCE Hong Kong Conference. We also continue the international emphasis of this issue with a contribution from Sharma of Maharishi Markandeshwar University, Northern India with a research article on the ‘Extrinsic Rewards, Occupational Commitment, Career Entrenchment and Career Satisfaction of Dentists’. Our next article is by Mak and colleagues in a research article entitled ‘What is the Professional Identity of Allied Health Managers?’ Isouard and Martin provide a further contribution about the Australian workforce in an article entitled ‘Managers of aged care residential services: 2006-2016.’ Way and colleagues conclude this issue with an analysis of management practice in one local health district in Australia entitled ‘The pursuit of purposeful partnerships-making a health matrix successful’.

ABSTRACTObjective:This systematic review aimed to examine end-of-life (EoL) care research undertaken in an Eastern cultural context—Hong Kong—with the hope of better informing EoL care professionals and policy makers and providing lessons for other countries or areas that share similar EoL care challenges.Method:Eight databases were searched from their respective inception through to August of 2014. All of the resulting studies conducted in Hong Kong and relevant to EoL care or palliative care were examined. The included studies were assessed with respect to study design, care settings, participants, research themes, and major findings.Results:Some 107 publications published between 1991 and 2014 were identified. These studies were undertaken at a range of places by different professionals. Of the total, 44 were led by physicians, 36 by nurses, 17 by social workers, and 10 by other professionals. Participants included both inpatients and outpatients with different illnesses, nursing home residents, older community-dwelling adults, deceased individuals, care staff, and informal caregivers. A total of 13 research themes were identified: (1) attitudes to or perceptions of death and dying; (2) utilization of healthcare services, (3) physical symptoms or medical problems; (4) death anxiety or mental health issues; (5) quality of life; (6) advance directives or advance care planning; (7) supportive care needs, (8) decision making; (9) spirituality; (10) cost-effectiveness or utility studies; (11) care professionals' education and training; (12) informal caregivers' perceptions and experience; and (13) scale development or validation.Significance of results:While there has been a wide and diverse range of research activities in Hong Kong, EoL care services at primary care settings should be strengthened. Some priority areas for further research are recommended.

IntroductionHypertension (HT) and diabetes mellitus (DM) and are major disease burdens in all healthcare systems. Given their high impact on morbidity, premature death and direct medical costs, we need to optimise effectiveness and cost-effectiveness of primary care for patients with HT/DM. This study aims to find out the association of trajectories in disease patterns and treatment of patients with HT/DM including multimorbidity and continuity of care with disease outcomes and service utilisation over 10 years in order to identify better approaches to delivering primary care services.Methods and analysisA 10-year retrospective cohort study on a population-based primary care cohort of Chinese patients with documented doctor-diagnosed HT and/or DM, managed in the Hong Kong Hospital Authority (HA) public primary care clinics from 1 January 2006 to 31 December 2019. Data will be extracted from the HA Clinical Management System to identify trajectory patterns of patients with HT/DM. Complications defined by ICPC-2/International Classification of Diseases-Ninth Revision, Clinical Modification diagnosis codes, all-cause mortality rates and public service utilisation rates are included as independent variables. Changes in clinical parameters will be investigated using a growth mixture modelling analysis with standard quadratic trajectories. Dependent variables including effects of multimorbidity, measured by (1) disease count and (2) Charlson’s Comorbidity Index, and continuity of care, measured by the Usual Provide Continuity Index, on patient outcomes and health service utilisation will be investigated. Multivariable Cox proportional hazards regression will be conducted to estimate the effect of multimorbidity and continuity of care after stratification of patients into groups according to respective definitions.Ethics and disseminationThis study was approved by the institutional review board of the University of Hong Kong—the HA Hong Kong West Cluster, reference no: UW 19–329. The study findings will be disseminated through peer-reviewed publications and international conferences.Trial registration numberNCT04302974.

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.

Objective.To examine potential clinical outcomes and cost of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance with and without decolonization in neonatal intensive care units (NICUs) from the perspective of healthcare providers in Hong Kong.Design.Decision analysis modeling.Setting.NICU.Patients.Hypothetical cohort of patients admitted to an NICU.Methods.We designed a decision tree to simulate potential outcomes of active MRSA surveillance with and without decolonization in patients admitted to an NICU. Outcome measures included total direct medical cost per patient, MRSA infection rate, and MRSA-associated mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.Results.In the base-case analysis, active surveillance plus decolonization showed a lower expected MRSA infection rate (0.911% vs 1.759%), MRSA-associated mortality rate (0.223% vs 0.431%), and total cost per patient (USD 47,294 vs USD 48,031) compared with active surveillance alone. Sensitivity analyses showed that active surveillance plus decolonization cost less and had lower event rates if the incidence risk ratio of acquiring MRSA infections in carriers after decolonization was less than 0.997. In 10,000 Monte Carlo simulations, active surveillance plus decolonization was significantly less costly than active surveillance alone 99.9% of the time, and both the MRSA infection rate and the MRSA-associated mortality rate were significantly lower 99.9% of the time.Conclusions.Active surveillance plus decolonization for patients admitted to NICUs appears to be cost saving and effective in reducing the MRSA infection rate and the MRSA-associated mortality rate if addition of decolonization to active surveillance reduces the risk of MRSA infection.Infect Control Hosp Epidemiol 2012;33(10):1024-1030

Abstract Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.

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.

Penetration of peritoneal dialysis (PD) varies tremendously across the world. It ranges from about 80% in Hong Kong and Mexico to just a few percentage points in the United States, Japan, and Germany. While PD is growing in China, India, and some Eastern European and South American countries, it is declining in many European and North American countries. In terms of outcomes, the survival of PD patients is generally comparable to that of hemodialysis (HD) patients and better than that of HD patients during the first few years on dialysis. According to the U.S. Renal Data System, survival of patients on PD has been improving faster than that of patients on HD. In terms of cost, PD is usually cheaper than HD. Hence, declining PD utilization is unjustified. Work is required to identify and overcome negative factors such as physician bias, unfair medical reimbursement systems, and poor patient education.

BackgroundThe relative effects of combinations of CKD, heart disease, and stroke on risk of mortality, direct medical costs, and life expectancy are unknown.MethodsIn a retrospective cohort study of 506,849 Chinese adults in Hong Kong with hypertension, we used Cox regressions to examine associations between all-cause mortality and combinations of moderate CKD (eGFR of 30–59 ml/min per 1.73 m2), severe CKD (eGFR of 15–29 ml/min per 1.73 m2), heart disease (coronary heart disease or heart failure), and stroke, and modeling to estimate annual public direct medical costs and life expectancy.ResultsOver a median follow-up of 5.8 years (2.73 million person-years), 55,666 deaths occurred. Having an increasing number of comorbidities was associated with incremental increases in mortality risk and medical costs and reductions in life expectancy. Compared with patients who had neither CKD nor cardiovascular disease, patients with one, two, or three conditions (heart disease, stroke, and moderate CKD) had relative risk of mortality increased by about 70%, 160%, and 290%, respectively; direct medical costs increased by about 70%, 160%, and 280%, respectively; and life expectancy at age 60 years decreased by about 5, 10, and 15 years, respectively. Burdens were higher with severe CKD.ConclusionsThis study demonstrated extremely high mortality risk and medical cost increases for severe CKD, exceeding the combined effects from heart disease and stroke. Mortality risks and costs for moderate CKD, heart disease, and stroke were similar individually and roughly multiplicative for any combination. These findings suggest that to reduce mortality and health care costs in patients with hypertension, CKD prevention and intervention merits priority equal to that of cardiovascular disease.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論香港醫療制度的融資安排與改革，並探討進行改革所帶來的社會公義問題。本文認為一個符合社會公義的公共醫療制度要保證市民得到一個得體而又最基本（decent minimum）的服務，這個服務水平要由一個公開和有廣泛公眾參加的醫療配給制度。本文建議香港確立一個這樣的配給制度監按公共醫療服務的增長，並且透過改革收費制度或輕微地增加稅收，便可以在符合社會公義的大前提下解決融資安排問題。本文反對採用強制性儲蓄計劃、保險計劃或保健組織（HMO） 制度對香港的醫療制度進行改革，因為這些供款計劃會帶來不少道德危險問題，有違社會公義。This paper discusses the financial arrangement of the healthcare system and the issues of justice arising from healthcare reform in Hong Kong. The current Hong Kong public healthcare system is quite efficient. The population of Hong Kong has higher life expectancy and lower infant and maternity mortality rates than that of many developed countries, such as the United States. However, the public expenditure in healthcare in Hong Kong only amounts to 2.18% of GDP. This is much lower than most of the developed countries although the per capita income of Hong Kong has surpassed that many industrialized nations, including Canada and Australia. But more than 90% of the hospital services is provided by public hospitals. Moreover, the all-inclusive per diem hospital charge is HK$68 (roughly US$8.5), which only covers 2% of the average cost of a patient day, and so the system is almost universally accessible as well. In fact, since 1974, the government has adopted the policy that no one should be denied adequate medical treatment through lack of means.However, the current system has been under stress mainly for three reasons: (1) aging population, (2) increasing medical expenditure arising from the advancement of medical technology, and (3) rising expectation from the community triggered by the rapid economic development over the past one to two decades. Various proposals have been put forward to reform the healthcare system in Hong Kong so as to make it more financially sustainable in the long term. These proposals include: increase in personal and corporate income tax;increase in the per diem charge of public health care services;mandatory savings scheme;coordinated voluntary or mandatory insurance scheme;health maintenance organization scheme.This paper concedes that healthcare reform is not only a technical issue in financial management, but will have long term impact on the distribution of healthcare benefits and burdens in Hong Kong society. So the problem of justice must be addressed before launching any healthcare reform plan.This paper discusses the major approaches to the justice problem in healthcare financing. The libertarian approach is rejected because the free market mechanism advocated by the approach, such as voluntary insurance schemes, will put the worse off in a vulnerable position. The paper on the one hand agrees with the egalitarian approach that the claims of healthcare needs have their moral force, but on the other hand maintains that the egalitarian approach may overburden the public healthcare system. Based on the ideas of public choice theory and socialized care, it is argued that a just healthcare system needs only to guarantee a decent minimum level of healthcare services for all that is regarded as affordable by the general public.The paper maintains that what constitutes such a level of services should be determined by a rationing system. Various utilitarian approaches to rationing are critically examined. It is found that although these approaches provide useful indices for decision-making in healthcare rationing, none of them could provide a mechanical procedure that could substitute for a fair deliberative process. The paper argues that the decent minimal level of healthcare services guaranteed for all should be determined by an open and a democratic process, and recommends that such a rationing system be set up in Hong Kong.Since various performance indices have shown that the healthcare system in Hong Kong is quite efficient, the claim that the existing system is "on the verge of reaching a crisis situation" is likely to be an exaggeration. Those who uphold this claim tend to support the more radical proposal of introducing various contributory schemes, including proposals (3) - (5), to reform the financial arrangement of the existing healthcare system. The paper rejects this approach, because social justice could be undermined by the moral hazard problems created by these contributory schemes and the government would consequently not be able to uphold the policy already adopted in 1974, which guarantees that no one will be denied adequate medical treatment because of inability to pay.It is believed that the stress of the public healthcare system in Hong Kong can be alleviated to a large extent by setting up an open and a democratic rationing system to monitor the increase of medical costs, a modest increase in service charges, a further improvement in the efficiency of the existing system, and perhaps a small increase in tax rates too. For the sake of justice, as the paper maintains, the government must be very cautious in adopting any more radical reform initiative.DOWNLOAD HISTORY | This article has been downloaded 159 times in Digital Commons before migrating into this platform.

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

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.

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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<p>The fast growing field of immunotherapy was one of the topics extensively discussed during the recently concluded ESMO Asia Congress 2016, held from December 16– 19th December at the Suntec Convention and Exhibition Centre in Singapore. <br /> <br />Unlike drug-based chemotherapy, immunotherapy exploits the body’s own immune system to fight cancer and is increasingly touted as the future of cancer treatment. The concept of using the immune system as a disease-fighting tool was introduced by Dr. William Bradley Coley, the ‘Father of Cancer Immunotherapy’, in the 19th century based on his work that sought to stimulate a patient’s own immune system against bacterial infection. However, a persistent question remains since the advent of immunotherapy over a century ago – can the immune system accurately recognize malignant tumor and eliminate it effectively? The answer to this question remains hotly debated owing to the differing opinions and attitudes on the application of immunotherapy. <br /><br />Dr. Coley noticed that in a number of cases, patients with cancer went into spontaneous remission after developing erysipelas. In 1891, Dr. Coley injected streptococcal organisms (which cause erysipelas) into a patient with inoperable cancer and observed remarkable tumor regression. Although he had treated almost 900 patients with bacterial preparations that eventually became known as “Coley’s toxins”, his treatment method was not widely accepted by the medical community possibly owing to the low cure rates and the severe fever caused by the bacteria. Some physicians also feared that the immune system might not have adapted well enough to recognize and eliminate malignant cells exclusively. As a consequence, most oncologists relied on another treatment that was rapidly gaining acceptance at that time, i.e. radiation. <br /><br />It was only after about a century later that the medical community observed a revived interest in immunotherapy. In 1976, a trial was conducted to test the effectiveness of the tuberculosis vaccine Bacille Calmette-Guérin (BCG) in treating superficial bladder cancer. The BCG treatment, in which BCG bacilli are inserted directly into a patient’s bladder via a catheter, proved to be an effective form of immunotherapy and the groundbreaking technique is still used today. <br /> <br />In general, studies on immunotherapy have presented researchers with two important conclusions: First and foremost, researchers were finally able to prove that the immune system is indeed capable of recognizing cancer cells as a ‘foreign entity’ although they originate from the body’s own tissues. Secondly, by boosting the immune response, researchers are able to enhance other cancer-killing agents at the same time, thus increasing the chances of a successful treatment via immunotherapy. Based on these conclusions, researchers all over the world now face the challenge of figuring out which therapy works best for a specific type of cancer and why some cancer patients respond better than others to the prescribed treatments.</p><p> </p><p>At the ESMO Asia 2016 congress, lead author Dr. Makoto Tahara presented his paper ‘Asian head and neck cancer patients live longer with immunotherapy than mixed race group’, in which his team of researchers reported the sub-analysis results on the safety and efficacy of pembrolizumab in 26 patients (of Asian Pacific origin) who received a fixed dose of the humanized antibody for 24 months until the detection of disease progression or adverse events. They observed that both the median overall survival and the disease control rate were better in Asians than the overall population, i.e. 11.5 versus 8.4 months and 50.5% versus 37.9%, respectively.</p><p> </p><p>According to Dr. Tahara, “The fixed dose of pembrolizumab was well-tolerated in Asian Pacific patients with recurrent/metastatic head and neck cancer. Although the Asian population was small, our findings suggest that they have better median overall survival with pembrolizumab than a mixed population. The clinical benefit of the fixed dose of pembrolizumab in the first and second line treatment of recurrent/metastatic head and neck cancer is being evaluated head-to-head with standard of care chemotherapy in phase 3 trials around the world, including Asia Pacific.” </p><p><br />Meanwhile, another research paper on immunotherapy presented at the ESMO Asia 2016 was by Dr. Herbert Loong, Clinical Assistant Professor at the Department of Clinical Oncology of the Chinese University of Hong Kong, who discussed about the cost-effectiveness of immunotherapy with pembrolizumab for advanced melanoma patients in Hong Kong. Dr. Loong said, “We have determined that whilst pembrolizumab is expensive, the increase in quality adjusted life years (QALYs) compared with standard cytotoxic chemotherapy, and even so with ipilimumab, qualifies it as a cost-effective approach.” <br /><br />Commenting on the results of the research by Dr. Loong and his colleagues, Dr. Mark Tang – a senior consultant dermatologist said, “Given the high costs of these new treatment options, cost effectiveness studies such as this one are timely and useful as further evidence for the use of pembrolizumab in the treatment of advanced melanoma. This is particularly important in an Asian context where, although rare, acral melanoma has unfortunately been known to present late advanced disease.” <br /> <br />Taking all these exciting discoveries into account, a good number of studies have repeatedly shown that progress in cancer immunotherapy has accelerated and resulted in the development of several effective and promising therapies for multiple forms of cancer. At this critical juncture, oncological organizations such as ESMO provide an important knowledge transfer platform for the sharing of expertise and interaction between regional and international experts in the area of onco-immunology. Moving forward, immunotherapy and targeted medicine are expected to remain in the spotlight and will be an indispensable arsenal in the long fight against cancer.</p>

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>

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. Other findings the institution has not been able to use the DAP (Developmentally Appropriate Practice) approach fully, and has not been able to carry out the philosophy and ways for developing a curriculum based on play. However, quite a lot of research found good practices implemented in learning centers in early childhood education institutions, such as develop children's independence programs through habituation to toilet training and fantasy play. Keywords: Play Based Curriculum, Center Learning Model, Curriculum Quality Standards, Early Childhood Education Reference Alford, B. L., Rollins, K. B., Padrón, Y. N., & Waxman, H. C. (2016). Using Systematic Classroom Observation to Explore Student Engagement as a Function of Teachers’ Developmentally Appropriate Instructional Practices (DAIP) in Ethnically Diverse Pre- kindergarten Through Second-Grade Classrooms. 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(2010). Children’s classroom engagement and school readiness gains in prekindergarten. Child Development, 81(5), 1534–1549. https://doi.org/10.1111/j.1467-8624.2010.01490.x Cortázar, A. (2015). Long-term effects of public early childhood education on academic achievement in Chile. Early Childhood Research Quarterly, 32, 13–22. https://doi.org/10.1016/j.ecresq.2015.01.003 Danniels, E., & Pyle, A. (2018). Defining Play-based Learning. In Encyclopedia on Early Childhood Development (Play-Based, pp. 1–5). OISE University of Toronto. Ejuu, G., Apolot, J. M., & Serpell, R. (2019). Early childhood education quality indicators: Exploring the landscape of an African community perspective. Global Studies of Childhood. https://doi.org/10.1177/2043610619832898 Faas, S., Wu, S.-C., & Geiger, S. (2017). The Importance of Play in Early Childhood Education: A Critical Perspective on Current Policies and Practices in Germany and Hong Kong. Global Education Review, 4(2), 75–91. Fisher, K. 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The impact of high stakes testing: The Australian story. Assessment in Education: Principles, Policy and Practice, 19(1), 65–79. https://doi.org/10.1080/0969594X.2011.592972 Martlew, J., Stephen, C., & Ellis, J. (2011). Play in the primary school classroom? The experience of teachers supporting children’s learning through a new pedagogy. Early Years, 31(1), 71– 83. https://doi.org/10.1080/09575146.2010.529425 Mcginn, A. (2017). Play-based early childhood classrooms and the effect on pre-kindergarten social and academic achievement (University of Northern Iowa). Retrieved from https://scholarworks.uni.edu/grp Miller, E., & Almon, J. (2009). Crisis in the Kindergarten. Why children need to to Play in School. In Alliance for childhood. Retrieved from www.allianceforchildhood.org. Özerem, A., & Kavaz, R. (2013). Montessori Approach in Pre-School Education and Its Effects. Tojned The Online Journal of New Horizons in Education, 3(3), 12–25. Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Peng, Q. (2017). Study on Three Positions Framing Kindergarten Play-Based Curriculum in China: Through Analyses of the Attitudes of Teachers to Early Linguistic Education. Studies in English Language Teaching, 5(3), 543. https://doi.org/10.22158/selt.v5n3p543 Pyle, A., & Bigelow, A. (2015). Play in Kindergarten: An Interview and Observational Study in Three Canadian Classrooms. Early Childhood Education Journal, 43(5), 385–393. https://doi.org/10.1007/s10643-014-0666-1 Pyle, A., & Danniels, E. (2017). A Continuum of Play-Based Learning: The Role of the Teacher in Play-Based Pedagogy and the Fear of Hijacking Play. Early Education and Development, 28(3), 274–289. https://doi.org/10.1080/10409289.2016.1220771 Reid, A. (2009). Is this a revolution?: A critical analysis of the Rudd government’s national education agenda. 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Chinese Researchers Demonstrate that Icotinib Creates Better Progression-Free Survival with Fewer Side Effects than Whole Brain Radiation in Non-Small Cell Lung Cancer Patients with Brain Metastases. Depressed Patients Are Less Responsive to Chemotherapy. Sanofi and JHL Biotech Announced Strategic Biologics Alliance in China. Chinese Scientists Developed Cancer Breath Test. BGI Opens Seattle Office for North America Expansion. Mederi’s Stretta Therapy for GERD Approved in China. HONG KONG NEWS – Experts Call for Urgent Multi-Stakeholders Collaboration in the Development of an Integrated Cancer Strategy to Safeguard the Sustainability of Hong Kong's Health Care System. HONG KONG NEWS – Uni-Bio Science in Multiple Drug Co-Development Deal with Beijing Sun-Novo. HONG KONG NEWS – Immunotherapy with Pembrolizumab Deemed Cost-Effective for Advanced Melanoma Patients in Hong Kong.

AUSTRALIA — Australia Launches New Online Service to Explain Laboratory Tests. AUSTRALIA — Australia Government Pledges US$86 Million to Indonesia to Fight HIV/AIDS. CHINA — New Test Improves Detection of Liver Cancer. CHINA — CAS Scientists Discover New Mechanism for Neural Stem Cell Maintenance. CHINA — Price of Herbs to Increase in China. HONG KONG — Scientists from Chinese University of Hong Kong Discover New Treatment for Chronic Hepatitis C with Less Side Effects. INDIA — AKCDA to Set Up Drug Information Center at Trichur in Kerala. INDIA — India Invests in Nanotech Park in Bangalore. INDIA — Serum Institute of India Launches Low-cost HIB Vaccine in India. INDIA — Indian Government Launches Campaign to Curb Mother-to-Child HIV Transmissions. INDONESIA — WHO Urges Indonesia to Share Live H5N1 Virus Samples. NEW ZEALAND — New Zealand Minister Rejects GM Corn. SINGAPORE — Singaporean Scientists Make Medical Breakthrough Findings in Crab Blood. SINGAPORE — IBN and Caltech to Tie Up in Nanomedicine. SOUTH KOREA — South Korean Scientist Created World's First "Virgin Birth" by Accident. TAIWAN — Leukemia Drug Used as a Treatment for Alzheimer's Disease. VIETNAM — Vietnam Finds Bird Flu Poultry Near China Border.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions.Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country.Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0–5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA).Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

Abstract Background HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. Methods We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. Results We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. Conclusions HPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.

AUSTRALIA – New Test Will Help Identify Viral Cattle Disease. AUSTRALIA – Vision CRC Technology to Control Myopia. AUSTRALIA – Living Skin for Burns Victims. AUSTRALIA – IVF Clinic Develops Improved Screening. AUSTRALIA – Glaucoma Affecting 150,000 Australians. AUSTRALIA – Bionic Eye Design to be Unveiled. AUSTRALIA – Australian Scientists in TB Drug Breakthrough. CHINA – China Suffering Diabetes Epidemic: Report. CHINA – Chinese Researchers Discover First Therapeutic Hepatitis B Vaccine in the World. CHINA – In Annual Rite, Chinese Science Showered With Riches. HONG KONG – Swine Flu's Got New Genes On. INDIA – Apollo Hospitals to Conduct Research in Ayurveda. INDIA – Project to Check Heart Disease in Corporates Launched. INDIA – Indian Scientist Develops Low-cost Cancer Detector. INDIA – Conjoined Twins Separated After a 14-hour surgery at Delhi hospital. JAPAN – Genetically Modified Mosquitos may Help Fight Malaria. SINGAPORE – NUHS to Partner Harvard. SINGAPORE – S'pore Team Develops Mobile ECG Machine. SINGAPORE – Novel Method to Produce Precise Medical Images for Detection of Diseases. SINGAPORE – Singapore Got S$1.2 bn Investment in BMS in 2009. SINGAPORE – Singapore and Sweden Institutes Ink Research Collaboration on Environmental Technologies. SINGAPORE – Simple Test for Lung Patients. TAIWAN – Taiwan, Japan Entities Team up on Research. VIETNAM – HCM City Public Hospitals Run Out of Recognized Vaccines. OTHER REGIONS — NORTH AMERICA – Researchers Seek Funding to Study How Climate Change Influenced Human Evolution. OTHER REGIONS — EUROPE – A Blood Test to Detect Breast Cancer.

Australia — New Federal Research Money for Plant Genomics. Australia — New Clinical Trial Facility Under Construction in Western Australia. Australia — New Blood Test to Check for Parkinson's Disease. Australia — Australian Prime Minister Discusses Possibility of Stricter Immigration Rules for HIV-Positive People. Australia — Murdoch Study Shows Positive Results for Rockeby. Australia — Biotech Companies Benefit from Australian Government's Marketing Grants. China — Chinese Project to Help Prepare for Flu Pandemics. China — China Experts Identify Cancer-Preventing Gene Type. China — China Plans On-the-Spot Checks of Drug Manufacturers. China — HIV/AIDS Victims in Henan Get Free TCM Treatment. China — WHO Calls for Human Bird Flu Samples from China. China — Sino-Swiss Center for Cassava Technology Opens in Shanghai. Hong Kong — HK and Australian Experts to Launch Trials on New Therapy for NPC. India — NGOs in India Protest Abbott's Decision to Withhold Essential Medicines from Thailand. India — Global AIDS Research Body CAVD Keen on India. India — Torrent Pharma Launched the World's First Polypill. India — India and Germany to Set up Joint Group on Agriculture. India — India Among Six WHO Developing Nations to Receive Grant for Influenza Vaccine Technology. India — NHS of Britain to Make Huge Investments in Indian Healthcare Sector. India — ICMR's HIV Vaccine Showing Positive Response in Clinical Trials. India — Dr Reddy's Laboratories Cuts Costs of Cancer Therapy. India — Indian Herbal Remedy Cancer Hope. Indonesia — Indonesia to get Influenza Vaccine Technology from WHO. Indonesia — US Sets Up Jakarta Office to Boost Bird-Flu Fight. Singapore — TNT Appoints New Managing Director. Singapore — Cancer Research Gets Boost with US$20 Million Donation. Taiwan — Research Brings Hope for Alzheimer's Cure. Taiwan — Researchers Demonstrate Cost-Effective Platform for Producing Blood Clotting Proteins. Others — Bristol-Myers Squibb and Pfizer Announce Worldwide Collaboration to Develop and Commercialize Anticoagulant and Metabolic Compounds. Others — WHO's 9-Point Plan will Protect Patients from Medical Errors.

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