Publications by authors named "Michael Yong"

27 Publications

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The effect of prior radiation on the success of ventral skull base reconstruction: A systematic review and meta-analysis.

Head Neck 2021 May 11. Epub 2021 May 11.

Department of Otolaryngology - Head & Neck Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA.

The incidence of cerebrospinal fluid leak after ventral skull base reconstruction is a primary outcome of interest to skull base surgeons. Exposure to pre-operative radiation may put patients at an increased risk of skull base reconstructive failure. A systematic search identified studies which included patients receiving ventral skull base reconstruction in the setting of pre-operative radiation. A meta-analysis using a random effects model was conducted to estimate an odds ratio of cerebrospinal fluid (CSF) leak in patients exposed to pre-operative radiation. A meta-analysis of 13 studies demonstrated that the odds ratio of CSF leak was 1.73 (95% CI 0.98-3.05). The majority of studies (77%) used vascularized tissue grafts for reconstruction. We identified an increased incidence of CSF leak among patients undergoing ventral skull base reconstruction after prior radiation therapy, although not of statistical significance. Skull base surgeons should exercise caution when planning reconstruction in this population.
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http://dx.doi.org/10.1002/hed.26709DOI Listing
May 2021

SARS-CoV-2 in migrant worker dormitories: Geospatial epidemiology supporting outbreak management.

Int J Infect Dis 2021 Feb 16;103:389-394. Epub 2020 Nov 16.

National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Background: Migrant worker dormitories-residential complexes where 10-24 workers share living spaces-account for the majority of cases of SARS-CoV-2 infection in Singapore. To prevent overspill of transmission to the wider population, starting in early April 2020, residents were confined to their dormitories while measures were put in place to arrest the spread of infection. This descriptive study presents epidemiological data for a population of more than 60 000 migrant workers living in two barracks-style and four apartment-style dormitories located in western Singapore from April 3 to June 10, 2020.

Methods: Our report draws from data obtained over the first 50 days of outbreak management in order to describe SARS-CoV-2 transmission in high-density housing environments. Cumulative counts of SARS-CoV-2 cases and numbers of housing units affected were analyzed to report the harmonic means of harmonic means of doubling times and their 95% confidence intervals (CI).

Results: Multiple transmission peaks were identified involving at least 5467 cases of SARS-CoV-2 infection across six dormitories. Our geospatial heat maps gave an early indication of outbreak severity in affected buildings. We found that the number of cases of SARS-CoV-2 infection doubled every 1.56 days (95% CI 1.29-1.96) in barracks-style buildings. The corresponding doubling time for apartment-style buildings was 2.65 days (95% CI 2.01-3.87).

Conclusions: Geospatial epidemiology was useful in shaping outbreak management strategies in dormitories. Our results indicate that building design plays an integral role in transmission and should be considered in the prevention of future outbreaks.
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http://dx.doi.org/10.1016/j.ijid.2020.11.148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955919PMC
February 2021

How the World's Children Hear: A Narrative Review of School Hearing Screening Programs Globally.

OTO Open 2020 Apr-Jun;4(2):2473974X20923580. Epub 2020 May 19.

Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.

Objective: School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research.

Data Sources: A structured search of the PubMed, Embase, and Cochrane Library databases.

Review Methods: A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up.

Conclusions: School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern.

Implications For Practice: There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.
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http://dx.doi.org/10.1177/2473974X20923580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238315PMC
May 2020

Cost-effectiveness of School Hearing Screening Programs: A Scoping Review.

Otolaryngol Head Neck Surg 2020 06 31;162(6):826-838. Epub 2020 Mar 31.

Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.

Objective: School hearing screening is a public health intervention that can improve care for children who experience hearing loss that is not detected on or develops after newborn screening. However, implementation of school hearing screening is sporadic and supported by mixed evidence to its economic benefit. This scoping review provides a summary of all published cost-effectiveness studies regarding school hearing screening programs globally. At the time of this review, there were no previously published reviews of a similar nature.

Data Sources: A structured search was applied to 4 databases: PubMed (Medline), Embase, CINAHL, and Cochrane Library.

Review Methods: The database search was carried out by 2 independent researchers, and results were reported in accordance with the PRISMA-ScR checklist and the JBI methodology for scoping reviews. Studies that included a cost analysis of screening programs for school-aged children in the school environment were eligible for inclusion. Studies that involved evaluations of only neonatal or preschool programs were excluded.

Results: Four of the 5 studies that conducted a cost-effectiveness analysis reported that school hearing screening was cost-effective through the calculation of incremental cost-effectiveness ratios (ICERs) via either quality- or disability-adjusted life years. One study reported that a new school hearing screening program dominated the existing program; 2 studies reported ICERs ranging from 1079 to 4304 international dollars; and 1 study reported an ICER of £2445. One study reported that school-entry hearing screening was not cost-effective versus no screening.

Conclusion: The majority of studies concluded that school hearing screening was cost-effective. However, significant differences in methodology and region-specific estimates of model inputs limit the generalizability of these findings.
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http://dx.doi.org/10.1177/0194599820913507DOI Listing
June 2020

Access to adults' hearing aids: policies and technologies used in eight countries.

Bull World Health Organ 2019 Oct 20;97(10):699-710. Epub 2019 Aug 20.

Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E Monument St. Suite 2-700 Baltimore, Maryland, United States of America.

As the proportion of older adults in the world's total population continues to grow, the adverse health outcomes of age-related hearing loss are becoming increasingly recognized. While research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, use of hearing aids remains low worldwide, even in many middle- and high-income countries. Reasons for poor uptake of hearing aids are likely to involve a combination of factors, ranging from increasing costs of hearing aid technology to a widespread lack of insurance coverage. This article aims to identify the current state of access to hearing aids, focusing on eight middle- and high-income countries. We discuss how to facilitate greater access to hearing aids for patients by addressing changes in how devices are regulated, technological advancements in hearing devices, the need to adjust reimbursement schemes and the importance of adaptation among the community workforce for hearing-care.
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http://dx.doi.org/10.2471/BLT.18.228676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796668PMC
October 2019

Application of augmented reality to surgical practice: A pilot study using the ODG R7 Smartglasses.

Clin Otolaryngol 2020 01 19;45(1):130-134. Epub 2019 Nov 19.

Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, Vancouver, BC, Canada.

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http://dx.doi.org/10.1111/coa.13460DOI Listing
January 2020

Subjective and objective vestibular changes that occur following paediatric cochlear implantation: systematic review and meta-analysis.

J Otolaryngol Head Neck Surg 2019 May 22;48(1):22. Epub 2019 May 22.

BC Rotary Hearing and Balance Centre, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.

Objective: Cochlear implantation can result in post-operative vestibular dysfunction of unknown clinical significance. The objective of this study was to characterize the presence, magnitude, and clinical significance of vestibular dysfunction that occurs after pediatric cochlear implantation.

Data Sources: The databases Embase, Medline (OvidSP), and PubMed were used. Only articles published in English were included. Grey literature and unpublished sources were also reviewed.

Study Selection: Articles published from 1980 until the present which documented pre-operative and post-operative vestibular testing on children under the age of 18 were used.

Data Extraction: Parameters that were assessed included number of patients, pre- and post-operative vestibular-evoked myogenic potentials (VEMPs), head impulse testing (HIT), calorics, and posturography, timing of pre- and post-operative testing, symptomatology, and other demographic data such as etiology of the hearing loss.

Data Synthesis: Ten articles were included. Relative risk values evaluating the effect of cochlear implantation on vestibular function were calculated for VEMPs and caloric testing due to the availability of published data. I values were calculated and 95% confidence intervals were reported. Separate analyses were conducted for each individual study and a pooled analysis was conducted to yield an overall relative risk. Assessment on risk of bias in individual studies and overall was performed.

Conclusion: Pediatric cochlear implantation is associated with a statistically significant decrease in VEMP responses post-operatively (RR 1.8, p < 0.001, I 91.86, 95%CI 1.57-2.02). Similar results are not seen in caloric testing. Insufficient data is available for analysis of HIT and posturography. Further studies are necessary to determine the effect of cochlear implantation on objective vestibular measures post-operatively and whether any changes seen are clinically relevant in this population.
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http://dx.doi.org/10.1186/s40463-019-0341-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530180PMC
May 2019

The use of video glasses improved learning of tonsillectomy and adenoidectomy surgery: A randomized controlled trial.

Int J Pediatr Otorhinolaryngol 2019 Feb 27;117:12-16. Epub 2018 Oct 27.

Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada.

Objective: One of the most common challenges in surgical education for trainees is gaining practical experience through observing procedures in the operating room. Due to the nature of some procedures, a narrow surgical view severely limits the learning experience. Video glasses are new devices that offer the potential to project the primary surgeon's exact view to learners in real-time, allowing for an enhanced operative learning experience.

Study Design: Single center randomized prospective trial.

Setting: Tertiary care pediatric hospital.

Participants: Using block randomization, medical students and surgical residents observed either a tonsillectomy or adenoidectomy, either directly at table-side or by real-time video feed from the surgeon's video glasses projected to a screen in the operating room, in random order. Participants then completed a survey comparing aspects of their learning experience viewing the procedure through the video feed in comparison to direct observation.

Main Outcome Measures: Evaluating the hypothesis that video glasses provided an improved overall learning experience and a realistic simulation of the open surgical procedures tested.

Results: 23 trainees participated in the study. Survey results demonstrated that the overall learning experience with the use of video glasses was significantly improved when compared to direct visualization (average Visual Analog Scale (VAS) score 82/100 vs. 64/100, p = 0.021). Video glasses were shown to be superior when comparing the view of the surgical field (83/100 vs. 54/100 on VAS, p < 0.001) and the ability to identify anatomical structures (79/100 vs. 56/100 on VAS, p = 0.001). The ease of following surgical steps with video glasses was also shown to be better than by direct visualization (81/100 vs. 69/100 on VAS, p = 0.039). All participants stated that video glasses closely simulated the learning environment of the real-life open procedure.

Conclusion: This study showed that the use of video glasses was beneficial for surgical education and a realistic tool for learners at varying levels of training. Video glasses may significantly improve the learning experience for procedures with a narrow field of view.
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http://dx.doi.org/10.1016/j.ijporl.2018.10.039DOI Listing
February 2019

Unique Case of Hearing Recovery After Otic Capsule Destruction and Complete Sensorineural Hearing Loss Caused by Langerhans Cell Histiocytosis.

Otol Neurotol 2017 09;38(8):1129-1132

Division of Pediatric Otolaryngology-Head and Neck Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

: A 14-year-old woman presented with right-sided otologic and vestibular symptoms after presenting with hormonal disturbances earlier that year. Imaging showed a gross destruction of the temporal bone, mastoid air cells, and external acoustic meatus with invasion into the otic capsule. The patient experienced complete sensorineural hearing loss in the right ear. Biopsy diagnosed Langerhans cell histiocytosis (LCH) and the patient was treated with chemotherapy. After 1 year of treatment, the patient's hearing partially recovered and imaging showed reconstitution of the temporal bone including the otic capsule. Our case is the first report of complete sensorineural hearing loss with partial recovery after LCH treatment.
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http://dx.doi.org/10.1097/MAO.0000000000001511DOI Listing
September 2017

Diagnosis of Superior Semicircular Canal Dehiscence in the Presence of Concomitant Otosclerosis.

Otol Neurotol 2017 09;38(8):1071-1075

BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Canada.

Objective: To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario.

Study Design: Retrospective patient series.

Setting: Tertiary/quaternary referral center.

Patients: Individuals with confirmed diagnoses of concurrent otosclerosis and superior semicircular canal dehiscence syndrome.

Interventions: Detailed history and physical examinations were performed on these patients, as well as detailed audiovestibular testing and computed tomography imaging.

Main Outcome Measures: Establishing a clear diagnosis of concurrent otosclerosis and superior semicircular canal dehiscence syndrome using a thorough diagnostic approach.

Results: Three patients presented with conductive hearing loss and normal tympanic membranes. When history and physical examination yielded suspicious third window symptoms/signs, more detailed audiovestibular testing and computed tomography scan imaging were performed. All three patients were ultimately identified to have concurrent otosclerosis and superior canal dehiscence. Conservative management was the option of choice for two of these patients (trial of a hearing aid) and surgical intervention was performed to treat the otosclerosis in the remaining patient.
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http://dx.doi.org/10.1097/MAO.0000000000001490DOI Listing
September 2017

Assessment of Depression, Anxiety, and Quality of Life in Singaporean Patients With Glaucoma.

J Glaucoma 2016 07;25(7):605-12

*Yong Loo Lin School of Medicine, National University of Singapore, National University Health System †Department of Psychological Medicine, Jurong Health, Alexandra Hospital ‡Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.

Purpose: To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety.

Methods: In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively.

Results: A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical β-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282).

Conclusions: There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.
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http://dx.doi.org/10.1097/IJG.0000000000000393DOI Listing
July 2016

Endoscopic ear surgery in Canada: a cross-sectional study.

J Otolaryngol Head Neck Surg 2016 Jan 19;45. Epub 2016 Jan 19.

University of British Columbia, Division of Otolaryngology - Head and Neck Surgery, ENT Clinic, 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.

Background: Endoscopic ear surgery is an emerging technique with recent literature highlighting advantages over the traditional microscopic approach. This study aims to characterize the current status of endoscopic ear surgery in Canada and better understand the beliefs and concerns of the otolaryngology - head & neck surgery community regarding this technique.

Methods: A cross-sectional survey study of Canadian otolaryngologists was performed. Members of the Canadian Society of Otolaryngology were contacted though an online survey carried out in 2015.

Results: The majority of participants in this study (70%) used an endoscope in their practice, with a large proportion utilizing the endoscope for cholesteatoma or tympanoplasty surgery. To date, 38 Canadian otolaryngologists (70% of respondents) have used an endoscope for at least 1 surgical case, but only 6 (11%) have performed more than 50 endoscopic cases. Of the otolaryngologists who use endoscopes regularly, the majority still use the microscope as their primary instrument and use the endoscope only as an adjunct during surgery. However, the general attitude surrounding endoscopes is positive; 81% believe that endoscopes have a role to play in the future of ear surgery and 53% indicated they were likely to use endoscopes in their future practice. Participants who were earlier in their practice or who had more exposure to endoscopic techniques in their career were more likely to have a positive stance towards endoscopic ear surgery (p < 0.05, p < 0.01, respectively). The main concern regarding endoscopic ear surgery was the technical challenge of one-handed surgery, while the primary perceived advantage was the reduced rates of residual or recurrent disease.

Conclusions: Endoscopic ear surgery is a new technique that is gaining momentum in Canada and there is enthusiasm for its incorporation into future practice. Further investment in training courses and guidance for those looking to start or advance the use of endoscopes in their practice will be vital in the years to come.
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http://dx.doi.org/10.1186/s40463-016-0117-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717547PMC
January 2016

Use of electroconvulsive therapy for Asian patients with schizophrenia (2001-2009): Trends and correlates.

Psychiatry Clin Neurosci 2015 Aug 27;69(8):489-96. Epub 2015 Mar 27.

School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan.

Aims: Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates.

Methods: Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure.

Results: The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2)  = 0.264, P < 0.001).

Conclusions: ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.
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http://dx.doi.org/10.1111/pcn.12283DOI Listing
August 2015

QTc prolongation in schizophrenia patients in Asia: clinical correlates and trends between 2004 and 2008/2009.

Hum Psychopharmacol 2015 Mar 22;30(2):94-9. Epub 2015 Jan 22.

Faculty of Health Sciences, University of Macau, Macao, Special Administrative Region, China; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.

Objective: Little is known about the pattern of QT interval (QTc) prolongation in Asian patients with schizophrenia. This study examined trends of QTc prolongation in schizophrenia inpatients in six Asian countries and territories between 2004 and 2008/2009 and its independent demographic and clinical correlates.

Method: Data on 3482 hospitalized schizophrenia patients (2004 = 1826 and 2008/2009 = 1656) in six Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and QTc interval were recorded using a standardized protocol and data collection procedure.

Results: The frequency of QTc prolongation (>456 ms) was 2.4% in the whole sample, decreasing from 3.1% in 2004 to 1.6% in 2008/2009 (p = 0.004) with wide intercountry variations. However, this decreased trend was driven by decreased QTc prolongation detected in China and Hong Kong (both p-values < 0.05). Multiple logistic regression analysis of the whole sample revealed that patients having more likely to have an illness lasting longer than 5 years and received antipsychotics classified as list-1 drugs according to the Arizona Centre for Education and Research on Therapeutics. Compared with 2004, patients in 2008/2009 were less likely to have QTc prolongation. Thioridazine caused QTc prolongation most frequently (odds ratio (OR) 4.4; 95% confidence interval (CI) 1.2-15.2), followed by sulpiride (OR 2.4; 95% CI 1.3-4.5), clozapine (OR 2.4; 95% CI 1.4-4.2), and chlorpromazine (OR 1.9; 95% CI 1.07-3.5).

Conclusions: Frequency of QTc prolongation was low in Asian patients with schizophrenia. QTc prolongation in schizophrenia decreased in China and Hong Kong between 2004 and 2008/2009 but increased in Taiwan over the same period, remaining low in the other countries.
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http://dx.doi.org/10.1002/hup.2458DOI Listing
March 2015

Management of pediatric penile keloid.

Can Urol Assoc J 2013 Sep-Oct;7(9-10):E618-20

Faculty of Medicine, University of British Columbia, Vancouver, BC;

Keloids are abnormal scar tissue growths that extend beyond the original area of injury, occasionally occurring post-surgery. Risk factors for keloids include skin trauma, infection, prolonged wound healing and individuals of certain ethnicities. Keloid formation on the penis, however, is a rare occurrence even among circumcised males, and can produce both aesthetic and functional complications. We document the tenth patient in the literature, to our knowledge, to present with a keloid of the penis.
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http://dx.doi.org/10.5489/cuaj.408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776043PMC
September 2013

Common use of high doses of antipsychotic medications in older Asian patients with schizophrenia (2001-2009).

Int J Geriatr Psychiatry 2014 Apr 13;29(4):359-66. Epub 2013 Aug 13.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Beijing Anding Hospital, Capital Medical University, Beijing, China.

Objective: This study aimed to examine the use of high doses of antipsychotic medications (≥600 mg/day chlorpromazine equivalent) in older Asian patients with schizophrenia and its demographic and clinical correlates.

Method: Information on hospitalized patients with schizophrenia aged ≥50 years was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study (2001-2009). Data on 2203 patients in six Asian countries and territories, including China, Hong Kong, Japan, Korea, Singapore and Taiwan, were analyzed. Socio-demographic and clinical characteristics and antipsychotic prescriptions were recorded.

Results: The frequency for high-dose antipsychotic medications was 36.0% overall, with 38.4% in 2001, 33.3% in 2004 and 36.0% in 2009. Multiple logistic regression analysis of the whole sample showed that compared to patients receiving low-medium antipsychotic doses, those on high doses had a longer illness duration (odds ratio (OR): 2.0, 95% confidence interval (CI):1.2-3.3, p = 0.008), were more likely in the 50-59-year group (OR: 0.95, 95% CI: 0.94-0.97, p < 0.001), more often had current positive (OR: 1.5, 95% CI: 1.2-1.8, p < 0.001) or negative symptoms (OR: 1.3, 95% CI: 1.03-1.6, p = 0.03), and more commonly received antipsychotic polypharmacy (OR: 5.3, 95% CI: 4.1-6.7, p < 0.001). Extrapyramidal symptoms (p = 0.25) and tardive dyskinesia (p = 0.92) were not more frequent in the high-dose group.

Conclusions: High doses of antipsychotic medications were used in more than one third of older Asian patients with schizophrenia. The reasons for the frequent use of high antipsychotic doses in older Asian patients warrant further investigation.
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http://dx.doi.org/10.1002/gps.4011DOI Listing
April 2014

Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009).

Asia Pac Psychiatry 2013 Jun 29;5(2):E81-7. Epub 2012 Aug 29.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.

Introduction: Little is known about the prescription patterns of adjunctive antidepressants in Asian schizophrenia patients. This study aimed to examine trends in the use of antidepressants and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009.

Methods: A total of 6,761 hospitalized schizophrenia patients in nine Asian countries and territories were examined: 2,399 in 2001, 2,136 in 2004 and 2,226 in 2009. Patients' socio-demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.

Results: The proportion of antidepressant prescription was 6.8% in the whole sample; 5.3% in 2001, 6.5% in 2004 and 8.7% in 2009. There were wide inter-country variations at each survey ranging from 0.9% in Hong Kong to 15.3% in Singapore in 2001; from 1.9% in Korea to 15.4% in Singapore in 2004; and from 2.7% in Japan to 22.0% in Singapore in 2009. Multiple logistic regression analysis of the whole sample revealed that patients on antidepressants were younger, more likely to receive benzodiazepines and have significant extrapyramidal side-effects and less likely to have significant positive symptoms.

Discussion: Unlike findings in Western countries, adjunctive antidepressant prescription for schizophrenia was not common in Asia. The frequency of antidepressant prescription varied among countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining antidepressant use in Asia.
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http://dx.doi.org/10.1111/j.1758-5872.2012.00231.xDOI Listing
June 2013

Use of clozapine in older Asian patients with schizophrenia between 2001 and 2009.

PLoS One 2013 10;8(6):e66154. Epub 2013 Jun 10.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China ; Beijing Anding Hospital, Capital Medical University, Beijing, China.

Background: To date there has been no large-scale international study that examined the use of clozapine in older patients with schizophrenia. This study examined the use of clozapine and its demographic and clinical correlates in older patients with schizophrenia in East Asia during the period between 2001 and 2009.

Method: Information on 1,157 hospitalized patients with schizophrenia aged 50 or older in five East Asian countries and territories (China, Hong Kong, Korea, Singapore and Taiwan) was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) project. Socio-demographic and clinical characteristics and prescription of psychotropic medications were recorded.

Results: Clozapine was prescribed for 20.6% of the pooled sample; 19.0% in 2001, 19.4% in 2004 and 22.9% in 2009. Multiple logistic regression analysis of the whole sample revealed that patients taking clozapine had a longer duration of illness, more negative symptoms and were less likely to receive first generation antipsychotic and anticholinergic drugs, but more likely to report weight gain compared to those not receiving clozapine. Compared to those in other sites, older patients in China were more likely to receive clozapine.

Conclusions: The prescription of clozapine for older Asian schizophrenia inpatients has remained at a stable level during the past decade. The appropriateness of use of clozapine in China needs to be further explored.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066154PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677908PMC
February 2014

Common use of antipsychotic polypharmacy in older Asian patients with schizophrenia (2001-2009).

J Clin Psychopharmacol 2012 Dec;32(6):809-13

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.

Objective: The aim of this study was to survey the use of antipsychotic polypharmacy (APP) in older Asian patients with schizophrenia and examine its demographic and clinical correlates.

Methods: Information on hospitalized patients with schizophrenia aged 55 or older was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study. Data on 1439 patients in 6 Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, and Taiwan were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.

Results: The frequency of APP prescription was 51.6% in the pooled sample with wide intercountry variations. Multiple logistic regression analysis of the whole sample showed that patients on APP had higher antipsychotic doses and also were more likely to receive first-generation antipsychotics.

Conclusions: Use of APP was common in older Asian patients with schizophrenia. Given the limited evidence supporting its efficacy, the potentially severe side effects and high costs, APP should be used with caution in this population. The reasons for and outcomes of the use of APP in this patient population merit further exploration.
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http://dx.doi.org/10.1097/JCP.0b013e3182726623DOI Listing
December 2012

Use of first- and second-generation antipsychotic medications in older patients with schizophrenia in Asia (2001-2009).

Aust N Z J Psychiatry 2012 Dec 11;46(12):1159-64. Epub 2012 Jul 11.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.

Objective: This study examined the prescribing patterns of several first- (FGAs) and second-generation antipsychotic (SGAs) medications administered to older Asian patients with schizophrenia during the period between 2001 and 2009.

Method: Information on hospitalized patients with schizophrenia aged 65 or older was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001-2009). There were no older patients in Thailand, therefore data on 467 patients in eight Asian countries and territories including China, Hong Kong SAR, India, Japan, Korea, Malaysia, Singapore, and Taiwan were analysed. Cross-sectional socio-demographic data, clinical characteristics and antipsychotic prescriptions were assessed using a standardized protocol and data collection procedure.

Results: Of the 467 patients, 192 patients (41.1%) received FGAs only, 166 (35.5%) received SGAs only and 109 (23.3%) received a combination of FGAs and SGAs. Of the FGAs, haloperidol was the most commonly used (31.3%; mean 9.4 ± 6.7 mg/day), followed by chlorpromazine (15.4%; mean 126.4 ± 156.4 mg/day) and sulpiride (6.6%; mean 375.0 ± 287.0 mg/day). Of the SGAs, risperidone was the most commonly used (31.5%; mean 4.5 ± 2.7 mg/day), followed by olanzapine (13.1%; mean 13.6 ± 6.5 mg/day), quetiapine (7.3%; mean 325.0 ± 237.3 mg/day) and aripiprazole (1.9%; mean 17.6 ± 7.7 mg/day).

Conclusions: FGAs and higher doses of certain SGAs (risperidone, olanzapine and quetiapine) were still commonly dispensed to older Asian patients with schizophrenia. Considering older patients' reduced tolerability of potentially severe side effects associated with FGAs and higher doses of certain SGAs, continuing education and training addressing the rational use of antipsychotics in this population is clearly needed.
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http://dx.doi.org/10.1177/0004867412453625DOI Listing
December 2012

Common use of anticholinergic medications in older patients with schizophrenia: findings of the Research on Asian Psychotropic Prescription Pattern (REAP) study, 2001-2009.

Int J Geriatr Psychiatry 2013 Mar 7;28(3):305-11. Epub 2012 May 7.

Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China.

Objective: This study surveyed the use of anticholinergic medications (ACMs) in older Asian patients with schizophrenia and examined its demographic and clinical correlates.

Method: A total of 1452 hospitalized patients with schizophrenia aged 55 years or older in nine Asian countries and territories were surveyed between 2001 and 2009. The cross-sectional data of patients' socio-demographic and clinical characteristics and the prescriptions of antipsychotic drugs and ACM were recorded using a standardized protocol and data collection procedure.

Results: The frequency of ACM prescription was 64.6% in the pooled sample, with 72.4%, 61.9%, and 59.5% in 2001, 2004, and 2009, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on ACM had a higher dose of antipsychotic medications, and were more likely to have extrapyramidal side effects and receive first-generation antipsychotic medications.

Conclusions: Anticholinergic medications were frequently used in older Asian patients with schizophrenia. Considering the potential side effects of ACM, the rationale for their widespread use in this patient population should be revisited.
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http://dx.doi.org/10.1002/gps.3827DOI Listing
March 2013

Antipsychotic treatment in older schizophrenia patients with extrapyramidal side effects in Asia (2001 - 2009).

Int J Clin Pharmacol Ther 2012 Jul;50(7):500-4

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong.

Objective: This study surveyed the prescribing patterns of antipsychotic medications in Asian older schizophrenia patients with extrapyramidal side effects (EPS) during the period between 2001 and 2009.

Method: Information on 848 hospitalized patients with schizophrenia aged 60 or older was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001 - 2009). Data from those patients with reported EPS from 8 Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India and Malaysia were analyzed. The cross-sectional data of sociodemographic and clinical characteristics and antipsychotic prescriptions were collected using a standardized protocol and data collection procedure.

Results: Of the 309/848 (36%) patients suffering from EPS, 210 patients (210/309; 68.0%) received at least one type of first generation antipsychotic (FGA), and 99 (99/309; 32.0%) received second generation antipsychotics (SGAs) only. Of SGAs prescribed in patients with EPS, risperidone was the most commonly used (100/309; 32.4%) followed by olanzapine (33/309; 10.7%) and quetiapine (25/309; 8.1%).

Conclusions: FGAs were frequently used in Asian older schizophrenia patients with EPS. Considering the potential adverse effects of FGAs on existing EPS, the reasons for the frequent use of FGAs need to be urgently identified.
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http://dx.doi.org/10.5414/CP201683DOI Listing
July 2012

Prescribing patterns of low doses of antipsychotic medications in older Asian patients with schizophrenia, 2001-2009.

Int Psychogeriatr 2012 Jun 3;24(6):1002-8. Epub 2012 Feb 3.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.

Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.

Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001-2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.

Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.

Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.
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http://dx.doi.org/10.1017/S1041610211002791DOI Listing
June 2012

Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009.

Aust N Z J Psychiatry 2011 Nov 3;45(11):968-75. Epub 2011 Sep 3.

Department of Psychiatry, Chinese University of Hong Kong, Tai Po Hospital, New Territories, Hong Kong.

Objective: Optimizing treatment and outcomes for people with schizophrenia requires understanding of how evidence-based treatments are utilized. Clozapine is the most effective antipsychotic drug for treatment-refractory schizophrenia, but few studies have investigated trends and patterns of its use over time internationally. This study examined the prescription patterns of clozapine and its demographic and clinical correlates in Asia from 2001 to 2009.

Method: Clozapine prescriptions were collected in a sample of 6761 hospitalized schizophrenia patients in nine Asian countries and regions using a standardized protocol and data collection procedure.

Results: Overall, the proportion of patients receiving clozapine prescriptions was stable across the three surveys from 2001 to 2009, ranging from 14.5% to 15.9%. However, the rates and patterns observed within different regions and countries at each survey differed considerably. Clozapine use decreased significantly over time in China, while it increased in Korea and Singapore. Multiple logistic regression analysis revealed that patients taking clozapine were significantly younger, had a higher dose of antipsychotic drugs in chlorpromazine equivalents, were more likely to be female, had fewer extrapyramidal symptoms, and had more negative symptoms, admissions and weight gain in the past month than those not receiving clozapine.

Conclusion: The variability in overall rates and changes in prescription rates over time in these samples suggest that factors other than psychopharmacological principles play an important role in determining the use of clozapine in schizophrenia in Asia.
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http://dx.doi.org/10.3109/00048674.2011.607426DOI Listing
November 2011

The low frequency of reported sexual dysfunction in Asian patients with schizophrenia (2001-2009): low occurrence or ignored side effect?

Hum Psychopharmacol 2011 Jun-Jul;26(4-5):352-7. Epub 2011 Jul 12.

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.

Objective: The purpose of the study was to evaluate the frequency of reported sexual dysfunction (SD) in schizophrenia and its associations with sociodemographic and clinical variables in selected Asian countries.

Methods: A total of 5877 schizophrenia patients in nine Asian countries and territories were examined between 2001 and 2009. The patients' sociodemographic and clinical characteristics, prescription of psychotropic drugs, and drug-induced side effects were recorded using a standardized protocol and data collection. SD was evaluated as "present" or "absent" according to the clinical judgment of experienced psychiatrists.

Results: The frequency of reported SD in the whole sample in women and men was 3.0%, 0.8%, and 4.6%, respectively, with variations across study sites. In the multivariate analyses, male sex, more second-generation antipsychotics, benzodiazepines, and antidepressants were independently associated with higher likelihood of reported SD, whereas negative symptoms had an inverse association with reported SD.

Conclusions: The results of this study indicate that SD was seldom recorded as a side effect by Asian psychiatrists while treating patients with schizophrenia. It is unclear whether the low prevalence of reported SD compared with Western data is real or whether the results are being insufficiently recognized.
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http://dx.doi.org/10.1002/hup.1213DOI Listing
March 2013

AMPK agonist downregulates innate and adaptive immune responses in TNBS-induced murine acute and relapsing colitis.

Biochem Pharmacol 2010 Dec 24;80(11):1708-17. Epub 2010 Aug 24.

Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.

AMP-activated protein kinase (AMPK), a cellular energy sensor, has been reported to participate in modulating inflammatory responses, but its role in intestinal inflammation remains unclear. IBD has been characterized by excessive innate and adaptive immune responses. Here, the roles of 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), an agonist of AMPK, in regulating immune responses of experimental colitis were investigated. In vitro effects of AICAR on LPS-induced macrophage activation and Th1 and Th17 differentiation, as well as in vivo effects of AICAR in mice with 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis, were explored. In acute colitis, daily AICAR treatment commenced 2 days after TNBS delivery (day 1), while in relapsing colitis, AICAR treatment commenced after three weekly TNBS administrations. Colon inflammation, production of proinflammatory cytokines and NF-κB activation in colon tissues, and Th1 and Th17 cell populations in lamina propria mononuclear cells (LPMCs) and mesenteric lymph node cells (MLNs) were assayed. Results show that AICAR significantly inhibited in vitro LPS-induced macrophage activation and Th1 and Th17 cell differentiation. Administration of AICAR was therapeutically effective in ameliorating acute and relapsing experimental colitis, as shown by reduced body weight loss and significant attenuation in colon histological inflammation. Moreover, this treatment inhibited NF-κB activation in macrophages, and reduced levels of TNF, Th1- and Th17-type cytokines, and Th1 and Th17 cell populations in LPMCs and MLNs. AICAR-initiated AMPK activation may act as a central downregulator in ongoing innate and adaptive immune responses of murine colitis, providing a novel therapeutic approach in the treatment of IBD.
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http://dx.doi.org/10.1016/j.bcp.2010.08.009DOI Listing
December 2010

Novel anti-inflammatory action of 5-aminoimidazole-4-carboxamide ribonucleoside with protective effect in dextran sulfate sodium-induced acute and chronic colitis.

J Pharmacol Exp Ther 2010 Jun 17;333(3):717-25. Epub 2010 Mar 17.

Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada.

AMP-activated protein kinase (AMPK) is an important cellular energy sensor that is responsible for maintaining systemic and cellular energy balance. Its role in intestinal inflammation remains unclear. Recent studies indicate that AMPK activation initiated by 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR) participates in modulating inflammatory responses. Inflammatory bowel disease (IBD) has been characterized by sustained intestinal mucosa inflammation, caused mainly by excessive macrophage activation and T helper type 1 (Th1) and Th17 immune responses. Thus, we sought to determine the effect of AICAR on inflammatory responses of murine models of IBD. Mice with acute or chronic colitis induced by dextran sulfate sodium (DSS) were treated with or without AICAR. Body weight and colon inflammation were evaluated, and production of proinflammatory cytokines in colon tissues was determined. Nuclear factor kappaB (NF-kappaB) activation in colon tissues was assayed, and Th1 and Th17 cell responses were also evaluated. By inducing AMPK activation, AICAR had a therapeutic effect in ameliorating acute and chronic DSS-induced murine colitis as shown by reduced body weight, loss and significant attenuation in clinical symptoms, and histological inflammation. Moreover, AICAR treatment inhibited NF-kappaB activation in macrophages, reduced levels of Th1- and Th17-type cytokines in colon tissues, and down-regulated Th1 and Th17 cell responses during the progress of acute and chronic experimental colitis. AICAR acts as a central inhibitor in immune responses of experimental colitis. Our data show that AICAR-initiated AMPK activation may represent a promising alternative to our current approaches to suppress intestinal inflammation in IBD.
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http://dx.doi.org/10.1124/jpet.109.164954DOI Listing
June 2010