An evaluation of the pilot scheme on community care service vouchers for the elderly in Hong Kong.

The Pilot Scheme on Community Care Service Vouchers for the Elderly (CCSVs) from 2013 onward aims at empowering users with autonomy in choosing services and service providers, enhancing financial sustainability of community care services (CCSs) and encouraging participation by service providers. This article analyses the effectiveness of the CCSVs in terms of utilization rate, attrition rate and reasons for withdrawal, and provides sound short-, medium- and long-term recommendations for CCSs. Secondary data from the annual survey conducted by the Social Welfare Department with all voucher holders in the first (2013-2017) and second phases (2016-2020) were used. The utilization rate of the CCSVs in the first phase was satisfactory, but the second phase was constrained by a low utilization rate, as 17%-35% of the CCSV holders did not use their vouchers to purchase CCSs. Moreover, the high attrition rate of CCSV holders in both phases warrants special attention.

Clinical applications of circulating tumor-derived DNA in the management of gastrointestinal cancers - current evidence and future directions.

Advances in Next Generation Sequencing (NGS) technologies have enabled the accurate detection and quantification of circulating tumor-derived (ct)DNA in most gastrointestinal (GI) cancers. The prognostic and predictive utility of ctDNA in patiets with different stages of colorectal (CRC), gastro-esophageal (GEC) and pancreaticobiliary cancers (PBC) are currently under active investigation. The most mature clinical data to date are derived from studies in the prognostic utility of personalized ctDNA-based NGS assays in the detection of minimal residual disease (MRD) and early recurrence after surgery in CRC and other GI cancers. These findings are being validated in several prospective studies which are designed to test if ctDNA could outperform conventional approaches in guiding adjuvant chemotherapy, and in post-operative surveillance in some GI cancers. Several adaptive studies using ctDNA as a screening platform are also being used to identify patients with actionable genomic alterations for clinical trials of targeted therapies. In the palliative setting, ctDNA monitoring during treatment has shown promise in the detection and tracking of clonal variants associated with acquired resistance to targeted therapies and immune-checkpoint inhibitors (ICI). Moreover, ctDNA may help to guide the therapeutic re-challenge of targeted therapies in patients who have prior exposure to such treatment. This review will examine the most updated research findings on ctDNA as a biomarker in CRC, GEC and PBCs. It aims to provide insights into how the unique strengths of this biomarker could be optimally leveraged in improving the management of these GI cancers.

Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs.

BACKGROUND: The World Health Organization has asserted the importance of enhancing participation of people with disabilities within the International Classification of Functioning, Disability and Health framework. Participation is regarded as a vital outcome in community-based rehabilitation. The actualization of the right to participate is limited by social stigma and discrimination. To date, there is no validated instrument for use in Chinese communities to measure participation restriction or self-perceived stigma. This study aimed to translate and validate the Participation Scale and the Explanatory Model Interview Catalogue (EMIC) Stigma Scale for use in Chinese communities with people with physical disabilities. METHODS: The Chinese versions of the Participation Scale and the EMIC stigma scale were administered to 264 adults with physical disabilities. The two scales were examined separately. The reliability analysis was studied in conjunction with the construct validity. Reliability analysis was conducted to assess the internal consistency and item-total correlation. Exploratory factor analysis was conducted to investigate the latent patterns of relationships among variables. A Rasch model analysis was conducted to test the dimensionality, internal validity, item hierarchy, and scoring category structure of the two scales. RESULTS: Both the Participation Scale and the EMIC stigma scale were confirmed to have good internal consistency and high item-total correlation. Exploratory factor analysis revealed the factor structure of the two scales, which demonstrated the fitting of a pattern of variables within the studied construct. The Participation Scale was found to be multidimensional, whereas the EMIC stigma scale was confirmed to be unidimensional. The item hierarchies of the Participation Scale and the EMIC stigma scale were discussed and were regarded as compatible with the cultural characteristics of Chinese communities. CONCLUSION: The Chinese versions of the Participation Scale and the EMIC stigma scale were thoroughly tested in this study to demonstrate their robustness and feasibility in measuring the participation restriction and perceived stigma of people with physical disabilities in Chinese communities. This is crucial as it provides valid measurements to enable comprehensive understanding and assessment of the participation and stigma among people with physical disabilities in Chinese communities.