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Biomedical subjects

C L Lam

Publications and source records attributed to C L Lam.

At least 19 recordsLinked to original sources
PubMed2003

Coriolus versicolor polysaccharide peptide slows progression of advanced non-small cell lung cancer.

BACKGROUND: Non-small cell lung cancer (NSCLC) is a leading cause of cancer deaths, and over 60% of patients present with advanced stages. Although polysaccharide peptides (PSP), isolated from the fungus Coriolus versicolor, have been reported to have anti-tumor effects, its clinical efficacy has not been properly evaluated. METHODS: Double-blind placebo-controlled randomized study to evaluate the effects of 28-day administration of PSP (Windsor Pharmaceutical, Hong Kong) on patients, who had completed conventional treatment for advanced NSCLC. RESULTS: Thirty-four patients, with no significant difference in their baseline demographic, clinical or tumor characteristics, or previous treatment regimes (P>0.05) were recruited into each of the PSP and control arms. After 28-day treatment, there was a significant improvement in blood leukocyte and neutrophil counts, serum IgG and IgM, and percent of body fat among the PSP, but not the control, patients (P<0.05). Although the evaluable PSP patients did not improve in NSCLC-related symptoms, there were significantly less PSP patients withdrawn due to disease progression, than their control counterparts (5.9 and 23.5%, respectively; P=0.04; OR 4.00). There was no reported adverse reaction attributable to the trial medications. CONCLUSION: PSP treatment appears to be associated with slower deterioration in patients with advanced NSCLC.

Adult↗
PubMed2001

Internal consistency, reproducibility, responsiveness, and construct validity of the Chinese (HK) version of the asthma quality of life questionnaire.

The purpose of this study was to test the acceptability, psychometric properties and construct validity of a Chinese translation of the Asthma Quality of Life Questionnaire (AQOL) and to determine whether it has any advantage over the Chinese (HK) version of the generic MOS SF-36 Health Survey that has been validated on Chinese in Hong Kong. Fifty-two patients with asthma were interviewed using the Chinese (HK) AQOL and the Chinese (HK) SF-36. Thirty-four of the 52 patients were interviewed a second time 6 months later using the same questionnaires. The Cronbach's alpha coefficients were above 0.7 for all four domains of the AQOL questionnaire. Significant correlations were found between the scores of each of the four domains of the Chinese (HK) AQOL and forced expiratory volume in 1 s (FEV1) (%predicted) during the initial visit and between changes in the mean scores of most of the domains of Chinese (HK) AQOL and changes in FEV1 between visits. The Chinese (HK) AQOL was found to be reproducible in those with stable asthma, and for those whose asthma severity changed between visits, there was significant change in one of the domains. It can detect differences in quality of life in asthma patients of varying severity. We conclude that the Chinese (HK) translation of the AQOL is reliable, valid, reproducible and discriminative and can be used to supplement generic instruments in evaluating the quality of life of patients with asthma.

Adolescent↗
PubMed2001

Pulmonary cryptococcosis: a case report and review of the Asian-Pacific experience.

Pulmonary cryptococcosis is a very rare form of pneumonia, which is seldom seen among immunocompetent patients. We report the case of a 36-year-old man who presented with indolent pneumonia that was subsequently diagnosed to be pulmonary cryptococcosis without other systemic involvement. Contrary to formal belief, there was evidence of residual lung fibrosis 12 months after initial presentation. The features of pulmonary cryptococcosis reported in the Asian Pacific region are also reviewed.

Adult↗
PubMed2001

Feasibility and acceptability of the COOP/WONCA charts for identification of functional limitations in rural patients of the People's Republic of China.

The aim of this study was to test whether the COOP/WONCA Charts could help doctors in three specialty outpatient clinics of Hebei Provincial Hospital, China to identify functional limitations in rural patients and promote more patient-centred care. In this descriptive, cross-sectional study, a sample of 113 rural patients from Hebei Province attending outpatient Neurology, Orthopaedic and Cancer clinics completed the COOP/WONCA Charts. The 80 rural patients who indicated significant functional difficulty and 11 doctors then responded to questionnaires to determine perceived usefulness and satisfaction with use of the COOP/WONCA Charts. Respondents remained blind to the other's responses. A focus group interview was conducted to expand overall views on perceived advantages and disadvantages of the charts. Of the 113 patients completing the COOP/WONCA Charts, 71% (n = 80) were considered to report significant difficulty on at least one chart. Fifty-six per cent of patients rated themselves as having significant functional problems in physical fitness and 65% for daily activities. In contrast, a response indicating 'no or little limitation or effect' was given regarding patients' feelings and/or participation in social activities by 75% of patients in all three clinics. There was no statistically significant difference in the proportion of patients with functional impairment between the three clinics when analysed using a Chi-square test. Over 90% of doctors and patients perceived the COOP/WONCA Charts as helpful with 'increased communication' as an outstanding benefit. This study has shown the COOP/WONCA Charts to be feasible and useful tools: to help identify functional limitations in Chinese outpatients; to trigger a more functionally focused patient-centred model of practice; and to encourage appropriate referrals to existing rehabilitation efforts in large Chinese hospitals.

Activities of Daily Living↗
PubMed2001

Adenocarcinoma of the lung in Chinese patients: a revisit and some perspectives from the literature.

AIM: To establish an updated clinical profile of adenocarcinoma of the lung. DESIGN: Retrospective review of clinical charts, chest radiography, and computed tomography of consecutive patients who attended Queen Mary Hospital in Hong Kong between June 1995 and December 1997. RESULTS: In the 115 patients studied, 13% were <40 years of age (33.3% ever smokers). Haemoptysis is more common among patients with early disease, while finger clubbing was detected more commonly among smokers and ex-smokers. Most (98.3%) patients had abnormal chest radiology including presence of mass lesion, pleural effusion, collapse/consolidation, and effusion. Patients with adenocarcinoma were significantly more likely to be younger, female, in advanced disease (stage IIIB and IV), non-smoker, and symptomatic on presentation (p<0.05) than those with squamous cell lung cancer (n=128). CONCLUSION: The clinical profile of Chinese adenocarcinoma patients should help clinicians in the diagnosis and management of these patients.

Adenocarcinoma↗
PubMed2000

Does a brief clerkship change Hong Kong medical students' ideas about general practice?

OBJECTIVES: This study examines the impact on students of a brief general practice clerkship, during a curriculum that is otherwise almost entirely hospital-based and in a practice environment that often does not encourage good primary care. DESIGN: 15 focus group discussions were held with a total of 110 students, as part of an action research project. Student responses were audiotaped, transcribed and then analysed for recurrent themes. SETTING: General Practice Unit, University of Hong Kong. SUBJECTS: Medical students RESULTS: There was evidence of pre-existing negative stereotypes of general practice, but in many cases these were dispelled by the relationships students developed during their attachment to general practitioners in the community. In an overcrowded curriculum, students ration their time and energy, focusing their learning pragmatically on subjects that have a high profile during examinations. CONCLUSIONS: Even in healthcare and medical school systems that are specialist-dominated, and in which the circumstances of practice do not always encourage high standards of care, the general practice clerkship can allow students to gain an understanding of the importance of primary care, and of the significance of the general practitioner's role in the healthcare system.

Attitude of Health Personnel↗
PubMed2000

The impact of chronic diseases on the health-related quality of life (HRQOL) of Chinese patients in primary care.

BACKGROUND: Ageing of the population results in an increasing number of people living with chronic diseases that can adversely affect their quality of life. Information on the impact of chronic diseases on quality of life can make health services more patient-centred. OBJECTIVES: The aim of this study was to determine the impact of eight chronic diseases on the health-related quality of life (HRQOL) of Chinese patients. METHODS: A cross-sectional case-control study was carried out on 760 adult Chinese patients of a family medicine clinic in Hong Kong. Each subject answered the COOP/WONCA charts and a standard questionnaire on demographic and morbidity data. The likelihood of sub-optimal COOP/WONCA scores of each disease group was compared with that of patients without any of the surveyed diseases. The independent effects of each disease on the COOP/WONCA scores were analysed by multivariate logistic regression, controlling for demographic variables and co-morbidity. RESULTS: Depression increased the risks for sub-optimal scores in all but one COOP/WONCA chart with odds ratios (OR) ranging from 2.1818 to 3.8645. Hypertension increased the risk of a sub-optimal physical fitness score (OR 1.7263). Increased risk of limitations in daily activities was associated with stroke (OR = 1.8771), osteoarthritis of the knee (OR = 1.5867), diseases of joints other than the knees (OR 2.0187) and asthma/COPD (OR 2.1679). Osteoarthritis of the knees also increased the risk of sub-optimal overall health (OR = 1.7927). CONCLUSIONS: Depression was the most disabling disease, and osteoarthritis of the knee had more impact on the HRQOL than many other chronic diseases. The lack of adverse effects of diabetes mellitus and heart disease on the HRQOL of Chinese patients deserves further studies.

Activities of Daily Living↗
PubMed1999

How does a change in the administration method affect the reliability of the COOP/WONCA Charts? World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.

BACKGROUND: An interviewer is often needed to administer the COOP/WONCA Charts to Chinese patients, and this may affect the reliability of results. OBJECTIVES: We aimed to find out the reliability of the COOP/WONCA Charts administered by an interviewer, and whether a change in the interviewer or administration method would affect the results. METHODS: We carried out a cross-sectional test-retest study on 487 Chinese adult patients attending a family medicine clinic in Hong Kong. The COOP/WONCA Charts were administered by the same interviewer, two different interviewers or self-completion and interviewer administration, on test and retest. The random, inter-observer and inter-method variances were compared with the inter-subject variance. The reliability coefficient of each COOP/WONCA Chart was calculated for each method of administration. RESULTS: Random errors could change the scores by 0.57-1.04, inter-observer variations could change the scores of four charts by 0.72-0.80, and a change in the method could change the physical fitness score by 1.79 and the daily activities score by 1.31, on a five-point scale. The reliability coefficients of the six COOP/WONCA Charts were 0.68-0.92 for one interviewer, 0.59-0.82 for two interviewers and 0.46-0.81 for two methods. CONCLUSION: The Chinese COOP/WONCA Charts were reliable in detecting real differences when administered by an interviewer. A change in the method of administration significantly decreased the reliability of the results. The use of more than one method of data collection in the same survey should be discouraged.

Adult↗
PubMed1998

Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey.

Few health-related quality of life (HRQOL) survey instruments are available to the Chinese, although many have been developed for Western populations. This article describes the testing of the acceptability, conceptual equivalence, scaling assumptions and construct validity of a Chinese (HK [Hong Kong]) version fo the MOS SF-36 Health Survey. A Chinese (HK) SF-36 survey form was developed by an iterative translation process. It was administered to 236 Chinese subjects who also rated the understanding, difficulty, relevance, and acceptability of each question. The scores were tested against the original scaling assumptions. The SF-36 profile of our subjects was compared to U.S. results for conceptual equivalence. Most subjects did not have any problem in understanding and answering the SF-36. Item means were generally clustered as hypothesized. All but a few items satisfied all scaling assumptions. The shape of the eight-scale SF-36 profile was similar to that of American patients, suggesting conceptual equivalence. We conclude that the Chinese (HK) version of the SF-36 Health Survey has achieved conceptual equivalence and satisfied the psychometric scaling assumptions well enough to warrant further use and testing, using the standard scoring algorithms.

China↗
PubMed1997

Guidelines for international collaborative research.

OBJECTIVE: As the global village becomes a reality, there is an increasing need to conduct international collaborative studies in family practice. A workshop at the WONCA meeting in Hong Kong used international attendees to produce a set of guidelines for international research. METHODS: At the workshop four completed international projects, each using a different strategy, were presented so that common themes might become apparent. The themes were then discussed and guidelines emerged from the process. RESULTS: Seven guidelines emerged for consideration before embarking on an international collaborative research project in family medicine. The guidelines deal with the characteristics of the research question and the importance of communication. The need for simple, brief methods of data collection, funding and pilot testing were identified. CONCLUSION: The question must be relevant to all participants to maintain interest and measurement tools must be validated to understand the impact of cultural differences in understanding.

Communication↗
PubMed1995

Can the Hospital Anxiety and Depression (HAD) Scale be used on Chinese elderly in general practice?

A study was carried out in a general practice in Hong Kong to find out if the Hospital Anxiety and Depression (HAD) Scale could be used to detect psychological problems in Chinese elderly. The HAD Scale was translated into Cantonese and administered by an interviewer to 298 Chinese aged 60 or above before their doctor consultations. The acceptance rate of the Scale was 96% and each interview took only 5-10 min to complete. All 298 elderly understood and completed the HAD Scale. Validation of the results of the HAD Scale by the Clinical Interview Schedule (CIS) was done on a random sample of 100 elderly. Relative operating characteristic (ROC) analysis showed that the optimal cut-off points of the HAD Scale was a depression score of 6 and an anxiety score of 3. The sensitivity was 80%, specificity was 90%, OMR (overall misclassification rate) was 12%, positive predictive value was 67% and negative predictive value was 95%. Thirty-six per cent of the elderly had scores above these cut-off points. More females than males had high anxiety scores. Nearly half of those with positive HAD scores were not known to have any psychological illness. The HAD Scale has great potential to be used as a screening instrument for psychological illnesses in Cantonese-speaking Chinese elderly all over the world.

Age Factors↗
PubMed1995

A pill for every ill?

Many doctors believe that Chinese expect a pill for every ill but this has never been validated by research data. The aim of our study was to find out what Chinese really expect from medications when they are ill. We interviewed a random sample of the 1068 Chinese in Hong Kong by telephone with a structured questionnaire. Only 40% thought illnesses always needed drug treatment but 76% always expected a prescription from a consultation. Nearly 100% of their last consultations resulted in a prescription. Eighty-five per cent of the prescriptions consisted of three drugs or more. Seven per cent of them thought too many drugs were given. Less than half of the people finished all the medications last prescribed. Those who thought too many drugs were given were less likely to have finished them. Younger age and more education were associated with less likelihood of thinking illnesses always needed drug treatment, consulting doctors for their last illnesses and expecting a prescription for every consultation. We conclude that Chinese do not expect a pill for every ill but doctors prescribe in nearly 100% of the consultations. Doctors may have over-estimated Chinese patients' expectation for medications. They may even have created a high expectation for a prescription in every consultation through their own prescribing habit. More open discussion on the need and expectation for drugs between patients and doctors may help to make prescribing for Chinese patients more rational.

Adolescent↗
PubMed1994

Self-medication among Hong Kong Chinese.

A randomized telephone survey on the practice of self-medication in the preceding 2 weeks was carried out from October 1989 to April 1990 among Chinese living in Hong Kong. 1068 people were interviewed. Self-medication was a common and universal practice by Hong Kong Chinese with a prevalence of 32.5% in 2 weeks. Those who reported illness were significantly more likely than those who did not use self-medication (65 vs 18.2%) and to have used more than one item of medications (39 vs 20%). Chinese tonics were the most frequently used self-medications although they were the least known. Chinese medicines were used as often as Western medicines in the self-treatment of illnesses. People used self-medication mainly because they felt that they knew what to do. About 80% of the Western and Chinese medicines were perceived to be effective but only 49% of the tonics were reported so. Side effects were reported from all types of medications with an overall prevalence of 6.4%. There was a lack of knowledge of the possible side effects in over 96% of the self-medications which is an area for patient education. The popularity but the relative lack of knowledge of Chinese tonics call for more scientific research and better regulation on their sales.

Adolescent↗
PubMed1994

Can the Dartmouth COOP/WONCA charts be used to assess the functional status of Chinese patients?

This is the first study on the use of the Dartmouth functional health assessment charts COOP/WONCA in the assessment of the functional status of Chinese patients. The Chinese are the world's largest ethnic group and make up more than one-fifth of the world's population. We have developed a Chinese translation of the Dartmouth COOP/WONCA charts that satisfies the two minimal and one intermediate criteria on translation of scales and instruments set by the European Research Group in Health Outcome (ERGHO). We tested the charts on 84 Chinese patients with previous strokes when they attended follow-up at the General Practice Unit of the University of Hong Kong from 1 August to 30 November 1992. We found that the Dartmouth COOP/WONCA charts in Chinese were easy to administer and were well accepted by our patients. All but one patient understood all the charts. There was good face validity in the results obtained by the charts. The consulting doctors found that the information detected by the charts was moderately useful in 64% of the patients and was very useful in 5% of the patients. Our translation can be applied to other Chinese in Hong Kong as well as other countries, because there is only one written Chinese language. It is hoped that our pilot study will stimulate further research to establish the reliability, validity and clinical application of the COOP/WONCA charts in Chinese.

Activities of Daily Living↗
PubMed1994

p53 gene mutation spectrum in hepatocellular carcinomas in Hong Kong Chinese.

To examine the significance of mutation of the p53 tumour suppressor gene in the development of human hepatocellular carcinoma in a high-prevalence area for hepatitis B viral infection but a low-exposure area for aflatoxin B1, the spectrum of p53 gene mutations was examined in 21 tumour samples from Hong Kong Chinese patients, all of whom were HBsAg positive. DNA sequencing covering exons 5 to 9 of the p53 gene and Hae III restriction enzyme digestion for preliminary assessment of mutation at codon 249 were performed. Immunohistochemical staining with anti-p53 monoclonal antibodies was done on both tumour and nontumour liver tissues. Six tumours (28.6%) showed a p53 mutation and all were point mutations. Of the six point mutations, two (9.5%) were at codon 249 and both were G to T transversions (AGG-->ATG and AGG-->AGT transversions). The remaining point mutations were transversions scattered at codon 172 (exon 5), 214 (exon 6), 273 (exon 8) and 330 (exon 9). Mutated p53 protein was detected in five of these six cases with demonstrable point mutations by DNA sequencing, in contrast to none detected in all of the 15 cases without demonstrable point mutations. The presence of p53 mutations, including those at codon 249, did not show a significant association with tumour size, sex, age, tumour invasiveness in terms of liver invasion, microsatellites and venous permeation, cirrhosis and encapsulation, but tumours with low cellular differentiation tended to have a higher incidence (71%) of point mutations than those with high cellular differentiation (8%). In conclusion, both the overall p53 mutation rate and that a codon 249 in HCC in Hong Kong Chinese are lower than those reported in tumours from China and sub-Saharan Africa. The low mutation rate at codon 249 is compatible with a low aflatoxin exposure. A special type of p53 mutation has not been found to be associated with hepatitis B viral infection. Mutations of p53 gene tends to occur in tumours with low cellular differentiation, suggesting a late occurrence in the event of tumour progression.

Carcinoma, Hepatocellular↗
PubMed1993

Trends in asthma therapy in Hong Kong, 1987-1992.

To audit the clinical practice in drug treatment of bronchial asthma in Hong Kong, two questionnaire surveys were conducted in 1987 and 1992. The questionnaire was adapted from the 1984 European Audit. The response rate was 40% (248 of 615 mailings) in 1987 and 32% (207 of 652 mailings) in 1992. A total of 86% and 87% of responders were general practitioners (GP), respectively, and the others were chest physicians (CP). For treatment of acute severe asthma in adults, parenteral aminophylline was the first drug used by GP in 1987, whereas inhaled beta-agonist was used in 1992. Parenteral steroid was more often used by both GP and CP in 1992. In children, inhaled beta-agonist was always the first choice and parenteral steroid ranked higher in 1992, overtaking parenteral aminophylline. For maintenance therapy of chronic asthma in adults, inhaled beta-agonist ranked first in both surveys. Inhaled steroid has become much more popular with GP, ranking second in 1992, overtaking oral bronchodilators. With CP, inhaled steroid was already ranking second in 1987, and it was used as the first drug, as frequently as inhaled beta-agonist, in 1992. In children, in 1987, inhaled beta-agonist was the first drug of choice, and prophylactic drugs ranked lower than oral bronchodilators with both GP and CP. In 1992, cromoglycate and inhaled steroids were much more often used, so much so that among CP, inhaled steroid ranked first, just ahead of inhaled beta-agonist.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

A study of the correlation between serum total cholesterol and low-density lipoproteins (LDL) in Chinese.

Serum total cholesterol and lipoprotein analysis was performed on the same blood samples of 139 asymptomatic Chinese subjects aged 40-60 years. There was a highly significant correlation between serum total cholesterol and low density lipoproteins (correlation coefficient = 0.8376, p less than 0.001) in Chinese, which means that total cholesterol can be used as the initial screening to identify individuals who may need lipoprotein analysis. The American National Cholesterol Education Programme (ANCEP) recommended threshold total cholesterol levels that indicate lipoprotein analysis for the high risk and low risk groups were found to have high sensitivities and negative predictive values but relatively low specificities and positive predictive values. Thirty to forty per cent of the lipoprotein analyses recommended by the ANCEP guidelines were not necessary. There was no significant age or sex influence on the degree of correlation between serum total cholesterol and LDL.

Adult↗