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This study estimated the prevalence of autism spectrum disorder in a 5-year inpatient cohort of children and adolescents diagnosed with first-episode psychosis in two Hong Kong teaching hospitals, and explored the clinical characteristics predicting first-episode psychosis–autism spectrum disorder comorbidity. The autism spectrum disorder diagnoses of 103 patients with first-episode psychosis were confirmed by Autism Diagnostic Interview–Revised. Based on the (1) Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic checklist and (2) Autism Diagnostic Interview–Revised, three major observations were reported: (1) the prevalence of autism spectrum disorder among children and adolescents with first-episode psychosis was 28.2% (95% confidence interval = (19.7%, 37.9%)); (2) after administering the Autism Diagnostic Interview–Revised, an additional 31.0% of first-episode psychosis patients met the clinical diagnostic cut-off for autism spectrum disorder; and (3) multivariate binary logistic regression analysis showed that first-episode psychosis patients with a comorbid autism spectrum disorder diagnosis were more likely to be a male than a female (adjusted odds ratio = 3.57, 95% confidence interval = (1.29, 9.86), p = 0.014). Adding to the current literature, this study examined first-episode psychosis–autism spectrum disorder comorbidity with a large Chinese, inpatient sample with first-episode psychosis. Consistent with studies conducted overseas, we show that autism spectrum disorder is a common comorbidity among Chinese first-episode psychosis patients. A comprehensive autism spectrum disorder assessment that incorporates both observation-based and parent-report diagnostic tools is warranted for children and adolescents, especially boys, with psychosis. Autistic features are commonly observed in children and adolescents with first-episode psychosis, but they are sometimes overlooked by clinicians and caregivers. By comprehensively examining the clinical profiles of 103 children and adolescents (below 18 years old) with first-episode psychosis and conducting the Autism Diagnostic Interview–Revised (the 'gold standard' autism diagnostic tool) with their primary caregivers, we showed that around 28% of patients with first-episode psychosis had a comorbid autism diagnosis, and boys were 3.57 times more likely to have first-episode psychosis–autism spectrum disorder comorbidity than girls. After administering the Autism Diagnostic Interview–Revised, we also observed that an additional 30% of patients with first-episode psychosis met the autism spectrum disorder diagnostic cut-off; their autism spectrum disorder symptoms were probably overshadowed by prodromal psychotic symptoms and left undetected before this study. The co-occurrence of autism and first-episode psychosis might be more common than we previously thought. Careful autism screening and assessment is highly recommended for clinicians working with patients with psychosis. [ABSTRACT FROM AUTHOR]

The use of single-item measures of self-rated mental health (SRMH) has been increasingly valued in epidemiologic research. However, little is known about the reliability and mental health correlates of SRMH in Chinese populations. This study examined the reliability and mental health correlates of SRMH in three Chinese samples. We analyzed data collected from two convenience samples of Chinese adults from Hong Kong and/or Taiwan (Sample 1: N = 205; Sample 2: N = 377), and a random sample of Taiwan psychiatric inpatients (Sample 3: N = 100). Our results showed that the single-item measure of SRMH had moderate to good test–retest reliability (intraclass correlation [ICC] = 0.75) in Sample 1 and acceptable reliability between the self-report and interviewer-administered versions (ICC = 0.58) in Sample 3. It had a high positive correlation with self-esteem and a moderately high negative correlation with depression. It also had a consistently negative correlation with borderline personality disorder symptoms and post-traumatic stress disorder symptoms. The SRMH score was also associated with psychiatric service usage. These findings contribute to the body of knowledge regarding the use of a single-item measure of SRMH to assess overall self-perceived mental health in Chinese communities. [ABSTRACT FROM AUTHOR]

Background. Older adults in residential care homes in Hong Kong usually have multiple co-morbidities and need end-of-life (EOL) care. Repeated hospitalisations before death are common. The Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score is correlated with mortality. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Methods. This retrospective cohort study included older adults aged ≥80 years residing in care homes from 1 July 2018 to 30 June 2019. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Results. Of 113 clinical referral patients and 735 patients with HARRPE score ≥0.4, 102 and 96, respectively, fulfilled EOL programme criteria. Their mean age was 92 years, with female predominance (71%). Enrolment rates were similar (57% and 51%, respectively). Survival probability was higher among enrolled patients than among nonenrolled patients (p<0.001). The two groups were comparable in terms of the 180-day mortality rate and 365-day mortality rate. In both groups, survival probabilities were higher in patients who enrolled in the EOL programme, compared with patients who did not enrol (p<0.001). The median survival was longer in the HARRPE group (191 vs 155 days). Conclusions. Older adults in residential care homes requiring EOL care according to HARRPE score ≥0.4 have similar enrolment and mortality rates, compared with clinical referral. The HARRPE score is a feasible tool to supplement clinical referral for timely EOL care. [ABSTRACT FROM AUTHOR]

CT and IR examinations introduce the highest medical radiation dose to our patients and the public. Therefore, CT DRLs were developed in many countries and regions to optimize the radiation dose. However, due to the complexity of IR procedures, having a very close standard protocol for developing DRL is challenging. Thus, setting up a national or regional DRL of IR takes a lot of work to achieve. Despite everything, establishing an IR DRL for the local institute is helpful as a reference for radiation safety purposes. This paper will share the experience of establishing the DRL of DSA services at the University of Hong Kong Shenzhen Hospital. The dose management system recorded all the applied radiation doses for each case. The dose records were analyzed monthly and discussed in the quality and safety meeting. In addition, the researchers compared the variation of the median and 75th percentile radiation doses of similar DSA examinations by protocol name and machine. After two years of observation, the overall radiation dose applied to the patients was steady and had reached the plateau. The exposure level of this plateau becomes the diagnostic reference level for a particular type of DSA examination on a specific machine. Although it was not a formal and sophisticated DRL development as ACR-AAPM recommended, ICRP 135 suggested a local domestic IR DRL could help optimize the radiation dose after considering the complexity of IR. This DRL did help the quality assurance process spot high-dose cases for investigation and improvement in the practice. [ABSTRACT FROM AUTHOR]

Background: Dysregulation of gut microbiota–host bile acid (BA) co-metabolism is a critical pathogenic factor of diarrhea-predominant irritable bowel syndrome (IBS-D). Traditional Chinese Medicine (TCM), instructed by pattern differentiation, is effective in treating IBS-D, in which liver depression and spleen deficiency (LDSD) is the most prevalent pattern. Still, it is unclear the linkage between the LDSD pattern and the BA metabolic phenotype. Purpose: This study aimed to uncover the biological basis of the LDSD pattern from the BA metabolic perspective. Methods: Patients with IBS-D completed questionnaires regarding the irritable bowel severity scoring system (IBS-SSS), stool frequency, Stool Bristol scale, and Self-Rating Scales of mental health. Fasting blood and morning feces were collected to analyze the gut metagenome and BA-related indices/metabolites. Results: IBS-D patients with LDSD had a higher incidence of BA overexcretion (41% vs. 23% non-LDSD) with significant elevations in fecal total BAs and serum BA precursor 7α-hydroxy-4-cholesten-3-one levels. Compared to controls or non-LDSD patients, LDSD patients had a featured fecal BA profile, with higher proportions of deoxycholic acid (DCA), 7-ketodeoxycholic acid, and lithocholic acid. It is consistent with the BA-metabolizing genomic changes in the LDSD gut microbiota characterized by overabundances of 7-dehydroxylating bacteria and BA-inducible genes (baiCD/E/H). The score of bowel symptoms (stool frequency and abdominal pain) showing greater severity in the LDSD pattern were positively correlated with bai-expressing bacterial abundances and fecal DCA levels separately. Conclusion: We clarified a differed BA metabolic phenotype in IBS patients with LDSD, which closely correlates with the severity of bowel symptoms. It demonstrates that gut microbiota and host co-metabolism of BAs would provide crucial insight into the biology of the LDSD pattern and its internal relationship with IBS progression. [ABSTRACT FROM AUTHOR]

The purpose of this study was to establish whether application of the four states of relatedness (connectedness, disconnectedness, enmeshment, and parallelism) and four processes or social competencies (belonging, reciprocity, mutuality, and synchrony) within the theory of human relatedness may have relevance and transferability to the practicum experiences of an international nursing student population. Secondary data transcriptions derived from focus groups involving 20 final-year pre-registration nursing undergraduates at an academic institution in Hong Kong which directly examined their placement reflections and views were analyzed against the states of relatedness and process or social competences identified within this theory. Data from the study provided evidence to support every state of relatedness and process or social competency within the theory of human relatedness. Evaluating pre-registration nursing student placement experiences against this theory suggests that improving a practicum may necessitate creating conditions for workplace learning which more effectively foster connectedness, belonging, reciprocity, mutuality, and synchrony, minimize the need for parallelism and help prevent disconnectedness and enmeshment. [ABSTRACT FROM AUTHOR]

Background: Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. Methods: A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method. Results: Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. Conclusion: Key obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure. [ABSTRACT FROM AUTHOR]

Interdisciplinary Education Perception Scale (IEPS) is one of the popular measures of perceptions of collaboration. In its original inception, a four-factor model was proposed but subsequent study offered alternative measurement models: three-factor model, two-factor model, and further revision of the three-factor model. Despite the changes in the model structures, none of these has been examined in the Asian context which could have paved the way for local researchers to start representing Asian perspectives in the discussion of interprofessional practice and cooperation in medical education. This study therefore aimed to examine the measurement properties of the IEPS by testing the four a priori models using the data from 335 Chinese students from eight prelicensure health and social care programs from two universities in Hong Kong. Through item analysis, confirmatory factor analysis, and regression, the results suggest that the 12-item, three-factor model best represented the sample and was invariant across genders and year levels. Theoretical and practical implications to interdisciplinary education literature are discussed. [ABSTRACT FROM AUTHOR]

Objective: To test the reliability of the modified Huddart-Bodenham (MHB) numerical scoring system and its agreement with the GOSLON Yardstick categorization for assessing the dental arch relationships in unilateral cleft lip and palate (UCLP) cases. Design: A retrospective study. Setting: Faculty of Dentistry, The University of Hong Kong. Patients: Forty-one nonsyndromic UCLP consecutive patients attending the Joint Cleft Lip/Palate Clinic at Faculty of Dentistry in the University of Hong Kong were selected. Interventions: Study models at 8 to 10 years old (T1) and 10 to 12 years old (T2) were obtained from each patient. Main Outcome Measures: Models were rated with the MHB scoring system and GOSLON Yardstick index. The intra- and interexaminer reliabilities as well as correlation of both scoring systems were evaluated. Furthermore, to investigate the outcome measurements consistency, the MHB scoring system and GOSLON Yardstick were independently used to compare the dental arch relationships from T1 to T2, with the samples split into intervention and nonintervention groups. Results: The MHB scoring system presented good intra- and interexaminer agreement, which were comparable to those of the GOSLON Yardstick. The correlation between the MHB scoring system and GOSLON Yardstick scores was good. Both scoring systems showed similar results when assessing the change in the dental arch relationships from T1 to T2. Conclusions: The MHB scoring system can be used as an alternative method to the commonly used GOSLON Yardstick for assessing dental deformities in UCLP patients. Both scoring systems showed similar results in assessing the improvement in dental arch relationships. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the validity and reliability of a newly-translated Thyroid-specific Patient-Reported Outcome short-form (ThyPRO-39) instrument for ethnic-Chinese patients suffering from benign thyroid diseases.Methods: The translation and cross-cultural adaptation of the English ThyPRO-39 were performed using the double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Cross-sectional data of 308 patients with benign thyroid diseases were utilized for this psychometric evaluation of ThyPRO-39 instrument. Convergent validity between similar construct in the ThyPRO-39, SF-6D, and SF-12v2 was assessed using Spearman correlations. The internal construct validity was assessed by corrected item-total correlations. Sensitivity of the ThyPRO-39 domain scores was determined by performing known group comparisons by independent t test. The internal consistency reliability was assessed by Cronbach's alpha coefficient.Results: Significant floor effects were observed in 9 out of 13 domains of the ThyPRO-39. The hypothesized correlations between similar constructs in the ThyPRO-39 and the SF-12v2 and SF-6D were generally observed, supporting convergent validity. The internal construct validity was supported in most items, except eight items in six scales. Scale score of hyperthyroid symptoms of the ThyPRO-39 was significantly higher in the group with Graves' disease or hyperthyroid disease than the group without Graves' disease nor hyperthyroid disease. Scale scores of eye symptoms and impaired daily life were significantly higher in the incidental group than the non-incidental group. For six domains (hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, depressivity, and emotional susceptibility), Cronbach's alpha did not reach the recommended standard of 0.7.Conclusions: This was the first psychometric study to translate and adapt the ThyPRO-39 instrument for non-Caucasian patients, and report its validity and reliability for use in Chinese patients with benign thyroid diseases. Given the low item-total correlations in eight items and low internal consistency reliability in respective scales of the ThyPRO-39, we suggest that the improvement of those eight items should produce a more valid and reliable ThyPRO-39 instrument. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to assess the diagnostic accuracy of ED doctors with variable training levels in detecting acute appendicitis, without access to advanced imaging in admitted patients with acute abdominal pain in a university hospital of Hong Kong. Methods A retrospective analysis was performed on data collected from prospectively identified patients presenting to the ED with acute abdominal pain and admitted to either a surgical or emergency medical ward between December 2011 and October 2012. Their ED diagnoses with regard to acute appendicitis status were compared with their final diagnoses on discharge from hospital. The gold standard was a histopathological diagnosis of acute appendicitis. The diagnostic accuracy was compared against that generally achieved by computed tomography (CT) scanning in other studies (93-98%), the best diagnostic test currently available for acute appendicitis. A good diagnostic test should have an overall accuracy rate of at least 95%. Results A total of 1653 patients were included in the study. The sensitivity, specificity, positive predictive value and negative predictive value of ED physicians' diagnosis of acute appendicitis were 81% (73-87%), 84% (82-86%), 31% (28-34%) and 98% (97-99%), respectively, giving an overall diagnostic accuracy of 84% (82-85%). The overall accuracy for separate female and male cohorts were 79% (76-82%) and 89% (83-91%), respectively. Conclusions Diagnostic accuracy of emergency doctors with variable training levels and no access to advanced imaging in a Hong Kong hospital in detecting appendicitis in patients with acute abdominal pain is higher in male patients than in female patients, but lower than that achieved by CT scanning. [ABSTRACT FROM AUTHOR]

Introduction: Affective abnormalities resulting from traumatic brain injuries can pose major threats to the long-term outcomes of neurorehabilitation, especially when they have gone unattended in the process of rehabilitation. This study reports a case of a 46-year-old woman who survived a severe traumatic brain injury to the right occipital cortex (BA18/19) at the age of 10. While her cognitive recovery was remarkable, she has been living with a significant affective disturbance: difficulty with feeling others' feelings. Method: Neuropsychological tests and self-reported questionnaires capturing the patient's neuropsychological profile, social cognitive abilities, emotional responses, affective awareness and visual imager were administered to the patient. Results: While cognitive functioning beside attention has recovered well, findings clearly indicate that she is indeed suffering from a high level of alexithymia. Conclusion: It is speculated that the alexithymia observed may relate to the damage to the visual cortex, which is an important neural substrate for visual imagery and/or damage to the bottom-up stimulus-driven attention system in the right hemisphere. This case exemplified a possible organic basis of social affective disturbance, which may be overlooked in the process of neurorehabilitation. [ABSTRACT FROM AUTHOR]

Background: Hospital accreditation is expected to improve health care quality and patient satisfaction. However, little and conflicting evidence is currently available to support its effect on patient outcomes, particularly patient experience. Hong Kong recently launched a pilot programme to test an infrastructure for accreditation of both private and public hospitals with the Australian Council on Healthcare Standards. This study aims to evaluate the longitudinal impact of hospital accreditation on patient experience in a publicly-funded university teaching hospital in Hong Kong.Methods: Three cross-sectional surveys were conducted at three time points: 9 months pre- accreditation as baseline (T1), three (T2) and fifteen months (T3) post-accreditation. Acute care inpatients aged 18 to 80 were recruited on the second day of hospital admission to complete the Picker Patient Experience Questionnaire-15 (PPE-15). Baseline data was first compared to the 2005 Hong Kong average for public hospitals using t-tests. Data was then analyzed using ANOVA and multiple linear regression to evaluate differences across the three cross-sections and examine the effect of accreditation over time while controlling for covariates.Results: 3083 patients (T1 = 896, T2 = 1093, T3 = 1094) completed the survey for a response rate of 83.5, 86.1, and 83.8%, respectively. The hospital baseline domain and summary patient experience scores differed from the Hong Kong public hospital average obtained from the 2005 Thematic Household Survey. All domain and summary patient experience scores declined (improved) over the study period (T1 to T3). The multiple regression results confirmed the time point score comparisons with declining (improving) parameter estimates for T2 and T3 for all domain and summary scores except the 'continuity and transition' domain, for which the declining coefficient was only significant at T3.Conclusions: While hospital accreditation has not been shown to improve patient outcomes, this study suggests the accreditation exercise may enhance patient experience. Moreover, it suggests the quality improvement initiatives associated with accreditation may address areas of concern emphasized by Hong Kong patients, such as involvement in care and emotional support from providers. [ABSTRACT FROM AUTHOR]