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29 active trials for Death

Cohort Study on Patient Outcomes, Effectiveness and Cost-effectiveness of Intervention Programmes for DM/HT Patients

Objectives: To determine the outcome trajectories of patients with hypertension (HT) and/or diabetes mellitus (DM), and evaluate the long-term effectiveness and cost-effectiveness of the Risk Assessment and Management Programmes (RAMP) and other primary care services such as Patient Support Call Centre (PSCC) on reducing complications and mortality Design: Population-based cohort study Setting: Hospital Authority (HA) primary care clinics Participants: All patients aged ?18 years with DM or HT managed in HA primary care clinics between 2006 and 2021 Main outcome measures: (1) incidence of DM/HT-related complications (cardiovascular disease, end-stage renal disease, retinopathy, neuropathy and all-cause mortality); (2) service utilization (out-patient clinics, Accident and Emergency and overnight hospitalizations); (3) Incremental cost-effectiveness ratio per complications or all-cause death avoided, and per QALY gained by RAMP or PSCC. Methods: A naturalistic cohort study (maximum 10-year follow-up) and retrospective data extraction from the HA clinical management system (CMS) database will be conducted to identify and correlate outcome trajectories of HT and/or DM patients with personal, service delivery and process of care factors. Outcomes of propensity score matched cohorts who have and have not participated in the programmes will be compared. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be conducted to evaluate the effect of RAMP, PSCC and other primary care services on the risk of complications, mortality and service utilization. Empirical costs and effectiveness data will be used to calculate cost-effectiveness from the provider's perspective. Significance: Findings will inform how to optimize service delivery for HT/DM patients in Hong Kong

Start: August 2019
Preserving Compassionate End of Life Care in the Pandemic

Compassionate and humanistic care for patients dying in the hospital has been especially challenging during the pandemic. Family presence is restricted, maximal barrier precautions are advised, and personal protective equipment must be preserved. This research examines the impact of adaptations to compassionate approaches to end of life care in a single center. The 3 Wishes Project (3WP) was created to promote the connections between patients, family members, and clinicians that are foundational to empathic end-of-life care. It provides a scaffold for discussions about preferences and values at the end of life and leads to acts of compassion that arise from soliciting and implementing wishes that honour the dying patient. It is partnered with the Footprints Project, which is an initiative encouraging staff to learn more about each patient. In a previous multi-center evaluation, the authors reported how the 3 Wishes Project is valuable, transferable, affordable and sustainable. During the pandemic, end of life care, facilitated by the 3 Wishes Project and Footprints Project, will be adapted to accommodate reduced family visiting and requirements to preserve PPE. The objective of this study is to evaluate whether the adapted 3 Wishes Project continues to be feasible and valuable during the pandemic, and determine how it influences the experiences of clinicians caring for patients dying during the pandemic.

Start: March 2020
Risk Calculators Validation for Elective Major General Surgery

Nowadays, over 300 million surgical operations take place every year worldwide, which increase at a rate of 33.6% comparing data from 2005 to 2013. According to Surgical Outcomes Monitoring and Improvement Program (SOMIP) reports, which is an Hospital Authority-wide (HA-wide) audit on postoperative outcomes, a growth in major and ultra-major operations performed in our locality is also observed between 2008 and 2016, which leads to an increasing demand of high dependency and intensive care in the postoperative period. With the advancement in surgical technology, increasing surgical complexity and aging population have raised concerns towards perioperative costs and postoperative complications. Therefore, there is a need of an objective tool for risk stratification, which would be useful to guide clinical decision in terms of the magnitude of operation, level of intraoperative monitoring and postoperative placement plan. Various risk scoring systems have been developed nowadays and each has its own limitations. As nowadays, the calculated risk score is commonly used in shared decision making process with patient and among the perioperative team. Risk calculation solely based on preoperative parameters will be more practical for daily clinical use. Therefore, in this study, the investigators would like to validate the postoperative mortality prediction with the risk calculators that are established merely using preoperative variables. Hopefully this would guide the future risk stratification in patients undergoing elective major surgical operation.

Start: November 2019