INTRODUCTION:E-learning is increasingly central to postgraduate medical education (PGME), yet system-level barriers may hinder its integration. In Hong Kong, the Academy of Medicine (HKAM) has invested in a learning management system and faculty development, but uptake among Academy Colleges remains uneven. This study examined barriers and enablers across Colleges to inform system-level implementation. METHODS:We used a sequential exploratory mixed-methods design. Phase 1 involved semi-structured interviews with one e-learning lead from each of the 13 participating Colleges, which were analysed thematically. Phase 2 comprised a survey of 266 education committee members, of whom 88 responded (33.1%). Items were rated on a five-point Likert scale (1=strongly disagree to 5=strongly agree), with optional free-text comments. RESULTS:Five themes emerged, namely, (1) limited strategic urgency; (2) gaps in faculty capability and trainee readiness; (3) weak system enablers; (4) lack of recognition and resources; and (5) the need for system-level strategies. The survey corroborated these findings, with the lowest ratings for information technology (IT) support and incentives and the highest for a clear HKAM policy (mean, 4.20) and inter-College benchmarking (mean, 4.01). System enablers received the lowest overall score (mean, 2.89); recognition and resource allocation also scored poorly (mean, 2.87). Strategic buy-in was moderate (mean, 3.53), highlighting a contrast between strong demand for central direction and limited operational support. CONCLUSION:Sustainable PGME e-learning requires integrated action across motivation, capability, and opportunity. Leadership signalling and recognition are needed to strengthen motivation; tiered faculty development and trainee orientation to build capability; and coordinated IT support, workflow integration, and resource sharing to expand opportunity.
INTRODUCTION:This study aimed to establish a predictive model for overall survival (OS) in early-stage medullary breast carcinoma (MedBC). METHODS:Clinical data for 606 355 patients with breast cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, along with data for 244 patients with MedBC from electronic medical records of the National Cancer Center of China. Univariate and multivariable Cox regression analyses were conducted to identify prognostic variables. Survival outcomes and model performance were evaluated. RESULTS:In total, 650 and 188 patients were included in the SEER and real-world cohorts, respectively. In the real-world cohort, the median Ki-67 index was 70%. Overall survival was not significantly associated with Ki-67 index (P=0.09) or family history of breast cancer (P=0.1). A predictive model for OS was established in the training cohort, incorporating age, tumour (T) stage, nodal (N) stage, and chemotherapy. The overall C-index was 0.76. Area under the curve (AUC) values were 0.83, 0.76, 0.75, and 0.76 for 1-, 3-, 5-, and 10-year OS, respectively. In the internal validation cohort, the C-index was 0.86; AUC values were 0.78 and 0.83 for 3- and 5-year OS, respectively. In the external validation cohort, the C-index was 0.90; AUC values were 0.85, 0.85, and 0.84 for 3-, 5-, and 10-year OS, respectively. The low-risk group had significantly better OS than the high-risk group across training and validation cohorts (P<0.05). CONCLUSION:A clinical model incorporating age (≥65 years), T stage (T3/T4), N stage (N2/N3), and chemotherapy (no) was developed to predict inferior OS in early-stage MedBC.
INTRODUCTION:Long proximal femoral intramedullary nails present challenges in the treatment of subtrochanteric fractures. Short nails may represent a suitable alternative; however, conventional preoperative planning has limitations in evaluating their appropriateness. This study investigated whether computer-assisted virtual planning can enhance implant selection consistency, short nail utilisation, and surgical outcomes. METHODS:This retrospective cohort study analysed 103 patients (57 virtual planning, 46 conventional planning) treated with proximal femoral intramedullary nailing at a Level I trauma centre in China between 2009 and 2018. Conventional planning relied on imaging and surgeon experience. Virtual planning used three-dimensional computed tomography reconstruction to simulate fracture reduction and determine optimal implant dimensions. Primary outcomes were the planned and actual implant dimensions selected. Secondary outcomes included operative parameters, complications, implant-associated adverse events, and functional scores at 12 months. Robust multivariate analysis of covariance and logistic regression analyses were performed. RESULTS:Compared with conventional planning, virtual planning demonstrated higher consistency between planned and actual short/long nail selection (kappa coefficient=0.95 vs 0.54) and implant dimensions (intraclass correlation coefficient=0.889-0.971 vs 0.786-0.870), with a higher actual short nail utilisation rate (75.4% vs 52.2%). Virtual planning reduced operative duration (90.21 vs 141.67 minutes; P<0.001), closed reduction duration (23.02 vs 30.43 minutes; P<0.001), blood loss (203.51 vs 294.78 mL; P<0.001), and number of fluoroscopy exposures (19.95 vs 29.67; P<0.001), and was associated with faster learning curves. Complications and functional scores were statistically similar between groups but numerically favoured the virtual planning group. CONCLUSION:Virtual planning improved implant selection consistency, short nail utilisation, and surgical efficiency. It demonstrated numerically superior clinical outcomes.
INTRODUCTION:Massive primary postpartum haemorrhage (PPH; blood loss ≥1500 mL within 24 hours after delivery) is a major cause of maternal morbidity and mortality in Hong Kong. We compared the incidence, management strategies, and maternal outcomes of massive primary PPH across two time periods at a single obstetric unit in Hong Kong. METHODS:This retrospective cohort study included patients with massive primary PPH at Kwong Wah Hospital between 2006 and 2011 (retrospectively identified) and between 2017 and 2022 (identified using the prospectively completed Hospital Authority electronic audit form). Maternal characteristics, causes of PPH, treatment modalities, and outcomes were analysed. Regression analyses examined associations between second-line therapies and blood loss or hysterectomy. RESULTS:The incidence of massive primary PPH in our hospital increased from 0.27% to 0.44% (P<0.001). Use of second-line therapies also increased in the recent cohort (P<0.001). Furthermore, the recent cohort had a significantly lower median estimated blood loss than the earlier cohort (1700 mL [interquartile range (IQR), 1500-2000] vs 2000 mL [IQR, 1600-3000]), lower packed red blood cell transfusion requirements (2 [IQR, 1-4] vs 4 [IQR, 2-11] units), and a lower hysterectomy rate (2.2% vs 14.3%) [all P<0.001]. Regression analyses showed that second-line therapy was associated with greater blood loss overall; however, the excess blood loss associated with its use was substantially attenuated in the recent cohort. CONCLUSION:Despite the rising incidence of massive primary PPH in our hospital, maternal outcomes improved over time. These findings suggest that second-line and adjunctive medical therapies are used earlier and more frequently in contemporary practice.
INTRODUCTION:This study investigated the timing and risk factors of restenosis (≥50% stenosis) in patients undergoing carotid artery stenting (CAS). METHODS:This retrospective case series included patients who underwent CAS between January 2007 and December 2022 at a tertiary referral vascular centre in Hong Kong. Patient demographics, co-morbidities, operative details, and clinical and radiological surveillance findings were reviewed. Univariate and multivariable Cox regression analyses were performed. RESULTS:In total, 120 CAS procedures (13 bilateral) were performed in 102 patients. Overall, 80% of patients were male (mean age: 66.9 years), and 45 (37.5%) were symptomatic preoperatively. The mean follow-up duration was 6.7 ± 4.2 years. Post-procedure, ipsilateral stroke occurred in 10 (8.3%) cases; the stroke-related mortality rate was 2.5%. In all, 51 (46.4%) of 110 evaluable cases developed restenosis, of which 29 (26.3%) occurred within 1 year postoperatively. The mean time to ≥50% restenosis development was 94.9 months. Univariate Cox regression analysis showed that a history of nasopharyngeal carcinoma (hazard ratio [HR]=2.12; P=0.01) and previous neck radiotherapy (HR=2.96; P<0.001) were significantly associated with higher restenosis risk. A greater number of stents, longer stent length, and post-dilation balloon diameter >5.5 mm (all P<0.001) were linked to higher restenosis risk. In multivariable Cox regression analysis, a history of radiotherapy (HR=3.72; P=0.01) and larger post-dilation balloon diameter (HR=2.10; P=0.01) remained associated with higher restenosis risk. CONCLUSION:The 12-month restenosis rate was 26.3%, although restenosis rarely caused new neurological events. A history of radiotherapy and larger post-dilation balloon diameter were associated with higher restenosis risk.
INTRODUCTION:We conducted a study to linguistically translate and psychometrically validate a translated and culturally adapted Chinese version of the European 3-item benign prostatic hyperplasia (BPH) screening tool (TOOL), then assess its diagnostic accuracy for identifying BPH with a prostate volume above 40 mL. METHODS:The study was conducted in two phases. The first phase involved a rigorous translation process performed by skilled multilingual translators using forward and backward translation techniques. The second phase focused on psychometric validation and was conducted in urology units across our hospital network. RESULTS:Sixty-six male patients of Chinese ethnicity, aged 18 to 90 years, who presented with lower urinary tract symptoms for at least 4 weeks were recruited. The study evaluated the TOOL's reliability, internal consistency, and validity, including convergent, concurrent, and criterion validity. Statistical analyses demonstrated strong internal consistency (Cronbach's alpha=0.890) and substantial test-retest reliability (intra-class correlation coefficient=0.715). The screening tool demonstrated moderate to strong correlations with both the International Prostate Symptom Score and prostate volume, supporting its validity. Furthermore, responsiveness analysis showed significant reductions in TOOL scores after surgery. The combination of the screening tool (cut-off: ≥3) and prostate-specific antigen level (cut-off: >2.35 μg/L) exhibited high sensitivity and specificity for detecting prostate volume above 40 mL (sensitivity: 92%, specificity: 73%; area under the receiver operating characteristic curve=0.842). CONCLUSION:These findings support the reliability and validity of the TOOL as a culturally adapted instrument for evaluating lower urinary tract symptoms in Chinese-speaking populations. Its use may improve the management of BPH.
