Patterns and factors associated with the prescription of psychotropic medications after diagnosis of cancer in Chinese patients: A population-based cohort study.

PURPOSE: Patients with cancer may be prescribed psychotropic medications to address their psychiatric symptoms and disorders. This study examined the patterns and factors associated with the prescription of psychotropics after cancer diagnosis using a population-based database in Hong Kong. METHODS: Patients who were diagnosed with malignant cancer and had no documented psychiatric diagnosis or psychotropic medications prior to cancer diagnosis, were included. Multivariable log-binomial models were used to explore the associations between predictive factors and psychotropic medications use. RESULTS: Among 9337 patients, 1868 patients (20.0%) were newly prescribed with psychotropic medications after cancer diagnoses, most commonly hypnotics (50.3%) and antidepressants (32.8%). About one-third (31.4%) were prescribed chronic psychotropics (≥90 days). Approximately 48.3% of patients who were prescribed psychotropic medications received their prescriptions within 1 year after diagnosed with cancer. Only 18.6% of those prescribed psychotropic medications had a registered psychiatric diagnosis. Patients with multiple comorbidities (adjusted risk ratio[aRR] = 2.74; CI = 2.46-3.05) and diagnosed with oral (aRR = 1.89; CI = 1.52-2.35) or respiratory cancers (aRR = 1.62; CI = 1.36-1.93) were more likely to be prescribed psychotropics. CONCLUSIONS: The use of psychotropic medication is common (20%) among patients with cancer. Our findings highlight the importance of identification and documentation of psychiatric needs among patients with cancer.

Can ChatGPT Provide Quality Information on Integrative Oncology? A Brief Report.

This short report evaluated the accuracy and quality of information provided by ChatGPT regarding the use of complementary and integrative medicine for cancer. Using the QUality Evaluation Scoring Tool, a panel of 12 reviewers assessed ChatGPT's responses to 8 questions. The study found that ChatGPT provided moderate-quality responses that were relatively unbiased and not misleading. However, the chatbot's inability to reference specific scientific studies was a significant limitation. Patients with cancer should not rely on ChatGPT for clinical advice until further systematic validation. Future studies should examine how patients perceive ChatGPT's information and its impact on communication with health care professionals.

Association of markers of inflammation on attention and neurobehavioral outcomes in survivors of childhood acute lymphoblastic leukemia.

Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at-risk of developing cognitive impairment and neurobehavioral symptoms. Inflammation induced by a compromised health status during cancer survivorship is proposed as a pathophysiological mechanism underlying cognitive impairment in cancer survivors. Objectives: To evaluate the associations of biomarkers of inflammation with attention and neurobehavioral outcomes in survivors of childhood ALL, and to identify clinical factors associated with biomarkers of inflammation in this cohort. Methods: We recruited patients who were diagnosed with ALL at ≤ 18 years old and were currently ≥5 years post-cancer diagnosis. The study outcomes were attention (Conners Continuous Performance Test) and self-reported behavioral symptoms (Adult Self-Report [ASR] checklist). Using a commercial screening kit, survivors' plasma (5ml) was assayed for 17 cytokines/chemokine cell-signaling molecules that are associated with neurodegenerative diseases. The final panel of the targeted markers included interleukin (IL)-8, IL-13, interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1ß, and tumor necrosis factor-α. Biomarker levels were rank-ordered into tertiles based on the sample distribution. Multivariable general linear modeling was used to test for associations between biomarkers and study outcomes in the overall cohort and stratified by gender. Results: This study included 102 survivors (55.9% males, mean[SD] age 26.2[5.9] years; 19.3[7.1] years post-diagnosis). Survivors within top tertiles of IFN-γ (Estimate =6.74, SE=2.26; P=0.0037) and IL-13 (Estimate =5.10, SE=2.27; P=0.027) demonstrated more inattentiveness. Adjusting for age, gender and treatment, more self-reported thought (Estimate=3.53, SE=1.78; P=0.050) and internalizing problems (Estimate =6.52, SE=2.91; P=0.027) correlated with higher IL-8. Higher levels of IL-13 (RR = 4.58, 95% CI: 1.01-11.10) and TNF-α (RR = 1.44, 95% CI: 1.03-4.07) were observed in survivors had developed chronic health conditions (n=26, 25.5%). The stratified analysis showed that association of IFN-γ with attention was stronger in male survivors than in female survivors. Conclusion: Inflammation due to cancer-related late effects may potentially be mechanistic mediators of neurobehavioral problems in pediatric ALL survivors. Markers of inflammation can potentially be applied to assess or monitor the effectiveness of interventions, particularly behavioral interventions, in improving cognitive outcomes in survivors. Future work includes understanding the underlying gender-specific pathophysiology behind functional outcomes in the population.

Development and validation of the Chinese oral anticoagulants knowledge tool (C-OAKT): A pilot study.

Objective: To develop and validate an oral anticoagulant knowledge tool for Chinese-speaking patients treated with warfarin or direct oral anticoagulants (DOACs) in Hong Kong. Method: This pilot validation study consisted of the following three phases: (1) the development of a knowledge tool and content validity assessment; (2) a pilot study of 200 participants, consisting of 100 patients taking warfarin or DOACs, 50 pharmacists, and 50 members of the general public; and (3) known-group validity and reliability assessments. Results: A 19-item "Chinese Oral Anticoagulants Knowledge Tool (C-OAKT)" was developed with a scale content validity index of 0.95. The mean score for known-group validity was significantly higher in the pharmacist group than the patient groups, and the patient groups scored significantly higher than the general public (mean ± standard deviation [SD] = 90.00 ± 7.11 vs. 51.55 ± 17.49 vs. 19.0 ± 15.42, respectively; p < 0.001). The mean score was higher for patients who attended a pharmacist-managed anticoagulant therapy management clinic (PAC) than for non-PAC patients (mean ± SD = 56.80 ± 13.60 vs. 46.30 ± 9.43; p = 0.004). An analysis of internal consistency showed a Cronbach's alpha value of 0.86. Conclusion: The results of the pilot validation study suggested that the C-OAKT is a valid and reliable instrument for assessing patients' knowledge of oral anticoagulants in ambulatory care settings. Innovations: This is the first validated Chinese version of an anticoagulant knowledge assessment tool. This tool will be utilized in public hospitals in Hong Kong, and will facilitate future research exploring the relationship between anticoagulant knowledge and patient-related outcomes.

Changes in Mental Health among Psychiatric Patients during the COVID-19 Pandemic in Hong Kong-A Cross-Sectional Study.

BACKGROUND: The COVID-19 pandemic has had substantial impacts on citizens' daily living. Concerns over mental health issues are rising. Recent studies assessing the psychosocial impact of COVID-19 on the general public revealed alarming results. Meanwhile, the impact of the COVID-19 pandemic on mental health among patients with pre-existing psychiatric disorders remained unclear. METHODS: Patients diagnosed with anxiety disorders, depressive disorders, bipolar disorders, or schizophrenia were invited to complete a survey between July and October 2020. The survey collected information on subjects' demographics, accommodation status, changes in mental health status during the COVID-19 outbreak, and the factors that affect subjects' mental health during COVID-19. The primary outcome of this study was the change in mental health, defined by psychiatric symptom change and patient satisfaction on symptom control. The secondary outcomes were patients' emotional status-measured by the Depression, Anxiety and Stress Scale (DASS-21)-during the COVID-19 pandemic and factors that impacted patients' mental health during the COVID-19 pandemic. RESULTS: Out of the 294 patients recruited, 65.0% were living in hostel while 35.0% were living in the community. The proportion of patients with 'unsatisfied' or 'very unsatisfied' mental disease control increased from 10.2% to 17.1% after the COVID-19 outbreak (p < 0.001). Under the DASS-21 questionnaire, 24.2% subjects, 32.6% subjects, and 18.9% subjects were classified as severe or extremely severe in terms of the level of depression, anxiety, and stress they experienced, respectively. Patients living in the community, patients with mood disorders, and female patients reported significantly worse control over anxiety and mood symptoms. The three major factors that affected patients' mental health during COVID-19 were 'reduced social activities', 'worries over people around getting infected', and 'reduced exercise'. CONCLUSION: Psychiatric patients in general have poorer disease control after the COVID-19 outbreak. Patients in the community appeared to be more affected than patients residing in hostels. More efforts should be directed to screening patients with pre-existing mental health disorders to enable timely interventions.

Using Electronic Health Records for Personalized Dosing of Intravenous Vancomycin in Critically Ill Neonates: Model and Web-Based Interface Development Study.

BACKGROUND: Intravenous (IV) vancomycin is used in the treatment of severe infection in neonates. However, its efficacy is compromised by elevated risks of acute kidney injury. The risk is even higher among neonates admitted to the neonatal intensive care unit (NICU), in whom the pharmacokinetics of vancomycin vary widely. Therapeutic drug monitoring is an integral part of vancomycin treatment to balance efficacy against toxicity. It involves individual dose adjustments based on the observed serum vancomycin concentration (VCs). However, the existing trough-based approach shows poor evidence for clinical benefits. The updated clinical practice guideline recommends population pharmacokinetic (popPK) model-based approaches, targeting area under curve, preferably through the Bayesian approach. Since Bayesian methods cannot be performed manually and require specialized computer programs, there is a need to provide clinicians with a user-friendly interface to facilitate accurate personalized dosing recommendations for vancomycin in critically ill neonates. OBJECTIVE: We used medical data from electronic health records (EHRs) to develop a popPK model and subsequently build a web-based interface to perform model-based individual dose optimization of IV vancomycin for NICU patients in local medical institutions. METHODS: Medical data of subjects prescribed IV vancomycin in the NICUs of Prince of Wales Hospital and Queen Elizabeth Hospital in Hong Kong were extracted from EHRs, namely the Clinical Information System, In-Patient Medication Order Entry, and electronic Patient Record. Patient demographics, such as body weight and postmenstrual age (PMA), serum creatinine (SCr), vancomycin administration records, and VCs were collected. The popPK model employed a 2-compartment infusion model. Various covariate models were tested against body weight, PMA, and SCr, and were evaluated for the best goodness of fit. A previously published web-based dosing interface was adapted to develop the interface in this study. RESULTS: The final data set included EHR data extracted from 207 subjects, with a total of 689 VCs measurements. The final model chosen explained 82% of the variability in vancomycin clearance. All parameter estimates were within the bootstrapping CIs. Predictive plots, residual plots, and visual predictive checks demonstrated good model predictability. Model approximations showed that the model-based Bayesian approach consistently promoted a probability of target attainment (PTA) above 75% for all subjects, while only half of the subjects could achieve a PTA over 50% with the trough-based approach. The dosing interface was developed with the capability to optimize individual doses with the model-based empirical or Bayesian approach. CONCLUSIONS: Using EHRs, a satisfactory popPK model was verified and adopted to develop a web-based individual dose optimization interface. The interface is expected to improve treatment outcomes of IV vancomycin for severe infections among critically ill neonates. This study provides the foundation for a cohort study to demonstrate the utility of the new approach compared with previous dosing methods.

Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia.

INTRODUCTION: Dyslipidemia is closely related to erectile dysfunction (ED). Evidence has shown that the lipid-lowering agent, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statins), can improve erectile function. However, information about the potential role of another class of lipid-lowering agent, niacin, is unknown. AIM: To assess the effect of niacin alone on erectile function in patients suffering from both ED and dyslipidemia. METHODS: A single center prospective randomized placebo-controlled parallel-group trial was conducted. One hundred sixty male patients with ED and dyslipidemia were randomized in a one-to-one ratio to receive up to 1,500 mg oral niacin daily or placebo for 12 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was the improvement in erectile function as assessed by question 3 and question 4 of the International Index of Erectile Function (IIEF Q3 and Q4). Secondary outcome measurements included the total IIEF score, IIEF-erectile function domain, and Sexual Health Inventory for Men (SHIM) score. RESULTS: From the overall analysis, the niacin group showed a significant increase in both IIEF-Q3 scores (0.53 ± 1.18, P < 0.001) and IIEF-Q4 scores (0.35 ± 1.17, P = 0.013) compared with baseline values. The placebo group also showed a significant increase in IIEF-Q3 scores (0.30 ± 1.16, P = 0.040) but not IIEF-Q4 scores (0.24 ± 1.13, P = 0.084). However, when patients were stratified according to the baseline severity of ED, the patients with moderate and severe ED who received niacin showed a significant improvement in IIEF-Q3 scores (0.56 ± 0.96 [P = 0.037] and 1.03 ± 1.20 [P < 0.001], respectively) and IIEF-Q4 scores (0.56 ± 1.03 [P = 0.048] and 0.84 ± 1.05 [P < 0.001], respectively] compared with baseline values, but not for the placebo group. The improvement in IIEF-EF domain score for severe and moderate ED patients in the niacin group were 5.28 ± 5.94 (P < 0.001) and 3.31 ± 4.54 (P = 0.014) and in the placebo group were 2.65 ± 5.63 (P < 0.041) and 2.74 ± 5.59 (P = 0.027), respectively. There was no significant improvement in erectile function for patients with mild and mild-to-moderate ED for both groups. For patients not receiving statins treatment, there was a significant improvement in IIEF-Q3 scores (0.47 ± 1.16 [P = 0.004]) for the niacin group, but not for the placebo group. CONCLUSIONS: Niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.

Medication Management Service for Old Age Homes in Hong Kong Using Information Technology, Automation Technology, and the Internet of Things: Pre-Post Interventional Study.

BACKGROUND: Innovation in technology and automation has been increasingly used to improve conventional medication management processes. In Hong Kong, the current practices of medication management in old age homes (OAHs) are time consuming, labor intensive, and error prone. To address this problem, we initiated an integrated medication management service combining information technology, automation technology, and the Internet of Things in a cluster network of OAHs. OBJECTIVE: This pilot study aimed to evaluate the impact of the medication management program on (1) medication management efficiency, (2) medication safety, and (3) drug wastage in OAHs. We compared the time efficiency and the reductions in medication errors and medication wastage in OAHs before and at least 2 weeks after the implementation of the program. METHODS: From November 2019 to February 2020, we recruited 2 OAHs (serving 178 residents) in Hong Kong into the prospective, pre-post interventional study. The interventional program consisted of electronic medication profiles, automated packaging, and electronic records of medication administration. Using 3-way analysis of variance, we compared the number of doses prepared and checked in 10-minute blocks before and after implementation. We received anonymous reports of medication errors from OAH staff and analyzed the results with the Fisher exact test. We also calculated the quantity and cost of wasted medications from drug disposal reports. RESULTS: The number of doses prepared and checked in 10-minute blocks significantly increased postimplementation (pre: 41.3, SD 31.8; post: 70.6, SD 22.8; P<.001). There was also a significant reduction in medication errors (pre: 10/9504 doses, 0.1%; post: 0/5731 doses; P=.02). The total costs of wasted medications during January 2020 in OAH 1 (77 residents) and OAH 2 (101 residents) were HK $2566.03 (US $328.98) and HK $5249.48 (US $673.01), respectively. CONCLUSIONS: Our pilot study suggested that an innovative medication management program with information technology, automation technology, and Internet of Things components improved the time efficiency of medication preparation and medication safety for OAHs. It is a promising solution to address the current limitations in medication management in OAHs in Hong Kong.

Vancomycin Prescribing Practices and Therapeutic Drug Monitoring for Critically Ill Neonatal and Pediatric Patients: A Survey of Physicians and Pharmacists in Hong Kong.

Background: Deviations from the optimal vancomycin dosing may occur in the neonatal and pediatric population due to inconsistencies in the recommended dosing algorithms. This study aims to collect the expert opinions of clinicians who practice in the neonatal or pediatric intensive care units (NICU/PICUs) of 12 major medical centers in Hong Kong. Methods: This was a multicenter, cross-sectional study. Eligible physicians and pharmacists completed a structured questionnaire to identify the challenges they encountered when selecting the initial intermittent vancomycin dosing. They also answered questions concerning therapeutic monitoring services (TDM) for vancomycin, including the targeted trough levels for empirical vancomycin regimens administered for complicated and uncomplicated infections. Results: A total of 23 physicians and 43 pharmacists completed the survey. The top clinical parameters reported as most important for determining the initial vancomycin dosing were renal function (90.9%), post-menstrual/postnatal age (81.8%), body weight (66.7%), and suspected/documented pathogen (53.0%). Respondents reported challenges such as difficulties in determining the optimal initial dose for a targeted level (53.0%), inconsistencies between dosing references (43.9%) and a lack of clear hospital guidelines (27.3%). Half of the pharmacists (48.8%) reported that they had helped to interpret the TDM results and recommend vancomycin dose adjustments in >75% of cases. For methicillin-resistant Staphylococcus aureus infection, physicians, and pharmacists reported target trough levels of ~10-15 and 15-20 mg/L, respectively. For suspected moderate/uncomplicated Gram-positive infections physicians tended to prefer a lower trough range of 5-10 mg/L, while pharmacists preferred a range of 10-15 mg/L. Conclusions: Our results demonstrate that clinicians used varying vancomycin dosing guidelines in their practices. The multidisciplinary TDM service in Hong Kong can be improved further by establishing a standardized dosing guideline and implementing a well-structured, evidence-based service protocol. Future work includes conducting drug utilization studies to evaluate real-world antimicrobial usage patterns and the impact on tangible clinical outcomes, and developing pharmacokinetic-guided dose calculator for antimicrobials in critically ill neonates and pediatric patients.

Effects of phenotypic and genotypic factors on the lipid responses to niacin in Chinese patients with dyslipidemia.

The acyl-CoA:diacylglycerol acyltransferase (DGAT) enzymes DGAT1 and DGAT2 catalyze the final step in triglycerides biosynthesis. This study examined the relationships of baseline phenotypes and the common polymorphisms in DGAT1 and DGAT2 with the lipid responses to niacin.Lipid responses in Chinese patients with dyslipidemia treated with the extended release (ER) niacin/laropiprant combination 1000/20 mg for 4 weeks and then 2000/40 mg for 8 weeks (n = 121, the primary study) or with ER niacin 1500 mg for at least 4 weeks (n = 68, the replication study) were analyzed according to genotypes of DGAT1 rs7003945 T>C and DGAT2 rs3060 T>C polymorphisms.Treatment with ER niacin improved all lipid parameters in both studies. Absolute and percentage changes in lipids were related to their baseline levels, particularly for low-density lipoprotein cholesterol (LDL-C). The DGAT2 rs3060 T>C polymorphism was associated with lower baseline LDL-C, apoB, high-density lipoprotein cholesterol (HDL-C), and apoAI in patients on statin therapy in the primary study. Subjects with the DGAT2 rs3060 T>C variant had less reduction in LDL-C in the primary study and smaller changes in triglyceride and HDL-C in the replication study but these associations became non-significant after adjusting for baseline lipid values. The DGAT1 rs7003945 T>C polymorphism was not related to lipid baseline values or changes in either study. Concomitant statin therapy and lower body weight were also associated with greater reduction in LDL-C.Baseline lipid levels were the main determinants of lipid responses especially for LDL-C. The DGAT2 rs3060 polymorphism might influence the lipid responses depending on baseline phenotype, but this association did not persist after adjustment for the baseline lipid levels.

Noncontinuous use of antidepressant in adults with major depressive disorders - a retrospective cohort study.

BACKGROUND: Noncontinuous antidepressant use is frequently observed in clinical practice despite the standard recommendation of at least 6-9 months of continuous treatment. The problem may be more serious in Chinese populations where stigmatization is common. This retrospective cohort study investigated the rate of noncontinuous antidepressant use and subsequent rate of relapse and recurrence in psychiatric Chinese outpatients by examining the prescription records, electronic medical records, and written medical records. Factors associated with noncontinuous antidepressant use were also identified. METHODS: We reviewed the medical records of 189 patients newly dispensed with an antidepressant in the psychiatric outpatient clinic during year 2006 and 2007. Primary outcome was the rate of noncontinuous antidepressant use within 6 months of therapy. Secondary outcomes included the factors associated with noncontinuous antidepressant use and the rate of subsequent depression relapse and recurrence within 1 year of starting treatment. RESULTS: Among the 189 subjects included in this study, 46% were noncontinuous users of the newly prescribed antidepressant therapy. The noncontinuous users were found to have an eightfold increase (OR: 8.42, 95% CI: 3.30-21.47) in the risks of relapse/recurrence depressive episodes within 1 year after treatment initiation. Younger age (P = 0.008), female, (P = 0.029), residency in public housing estate (P = 0.029), experiencing side effects (P = 0.024), infrequent follow-ups (P = 0.006), and earlier onset of diagnosis (P = 0.034) were factors significantly associated with noncontinuous antidepressant use. CONCLUSIONS: Noncontinuous antidepressant use is common in the local Chinese depressive patients and associated with a high rate of relapse and recurrence. Collaborative multidisciplinary approaches that target patient education and enhancement of follow-up adherence are needed.