Expert Insight

In recent years, leadless pacemaker has been introduced into clinical practice to overcome the lead- and pocket-related complications associated with conventional pacemakers, including infections and lead failure.

In 2016, a young woman in her 20s complained of sudden abdominal pain in the morning which then deteriorated rapidly, and was subsequently admitted to the intensive care unit (ICU) of Prince of Wales Hospital (PWH). The patient was diagnosed with Crohn’s disease (CD). During her ICU stay, the patient underwent 2 major surgical procedures and received massive blood transfusion due to her severe intestinal bleeding. The patient had been staying in the ICU for 3 months and was discharged from PWH only about 3 years later. This case reminds us of the considerable suffering of the CD patients and the immense challenges of overall disease management. Considering its rising prevalence in Hong Kong, CD is set to increase the medical needs of patients and the disease burden of the society. In an interview with Omnihealth Practice, Dr. Lam, Long-Yan Kelvin talked about the latest advances in CD management and the ongoing difficulties in local clinical practice.

With the median age of women having their first child in Hong Kong (HK) rising from 28.1 years in 1991 to 32.3 years in 2020, the rates of comorbidities and obstetric complications are expected to increase. Thus, notably, there is an increasing need for maternal critical care, resulting in the first HK maternal special care (MSC) unit being piloted in the Prince of Wales Hospital in May 2018 which aims to reduce maternal morbidity and mortality. In an interview with Omnihealth Practice, Dr. Hui, Shuk-Yi Annie talked about her experience in founding the first MSC unit in HK and shared a clinical case of preeclampsia with postpartum hemorrhage which benefited from the MSC unit and resolved without developing complications

Spontaneous pneumothorax (SP) is defined as the existence of air in the pleural space without a precipitating external event. It can be further classified into either primary or secondary based on the presence or absence of pre-existing lung diseases. SP accounts for at least 1,000 hospital admissions per year in Hong Kong. Many patients with SP present to the emergency departments. Traditionally, considerations for intervention rest primarily on the size of pneumothorax and presence of dyspnea. There has been hardly any high-powered clinical studies on SP as the recruitment processes are remarkably difficult, given the emergency nature and acute presentation of many SP. Recently, the results of several practice-changing clinical trials on SP have been published, including new data on the ambulatory devices supporting its selective utilization in clinical practice. In an interview with Omnihealth Practice, Dr. Lui, Mei-Sze Macy presented some new data on the management of SP including the use of ambulatory devices and shared a case of secondary SP which resolved well without any complications after using one of such devices.

Despite the increased awareness of schizophrenia in Hong Kong, there remains considerable stigma attached with the illness that prevents patients from receiving the appropriate treatment. A paradigm shift of the healthcare system with telemedicine is the next step to optimizing the management of schizophrenia in the post coronavirus disease 2019 (COVID-19) era. The United States (US) has taken initiatives to adopt artificial intelligence (AI) technologies in terms of telemedicine, treatment delivery, and treatment monitoring. As the technologies become mature, the issues of ethics and privacy must also be addressed. In a recent interview with Omnihealth Practice, Dr. Keith Hariman shared his views on the application of such technologies in the management of schizophrenia in Hong Kong.

Multiple sclerosis (MS) is among the most common central nervous system (CNS) inflammatory demyelinating diseases with an estimated global prevalence of 1 in 3,000 people in 2020. Although MS is regarded as relatively uncommon in the Asia Pacific Region and even rarer in Hong Kong with a local prevalence of 0.77 per 100,000 people in 1999, a recent study revealed that the local MS prevalence was 6.9 per 100,000 people in 2020, which was higher than mainland China and Taiwan. In an interview with Omnihealth Practice, Dr. Alexander Lau explained the rising trend of MS in Hong Kong over the past decade. To better manage MS, Dr. Lau also discussed the opportunity of having an integrative platform that combines both Western and Chinese medicine as a comprehensive approach for long-term MS treatment.

Hepatitis C is an infectious liver disease caused by the blood-borne hepatitis C virus (HCV). About 70% of patients infected with HCV will develop chronic hepatitis which may lead to cirrhosis and hepatocellular carcinoma (HCC). In Hong Kong, patients are mostly infected through blood or blood products transfusion prior to the introduction of anti-HCV screening to the blood transfusion service in 1991. In a recent interview with Omnihealth Practice, Dr. Loo, Ching-Kong, Specialist in Gastroenterology and Hepatology, shared his insights on the local management strategies of hepatitis C.

In routine clinical practice, a treatment decision can only legally proceed after patients are adequately informed and have voluntarily granted their consent for said decision. However, in patients whose mental capacity are compromised, a decision made on their behalf from an unauthorized third party may have legal, practical, or ethical repercussions especially when rapid treatment decisions are required. In a recent interview with Omnihealth Practice, Dr. Jess Leung brought out the issues encountered by persons without decision-making capacity (i.e., also known as mentally incapacitated persons, MIPs) and their carers. As everyone has a risk of losing their mental capacity, Dr. Leung called for earlier preparation by introducing the enduring power of attorney (EPA), advance directives (AD) and will, collectively known as the ‘3 instruments of peace (平安三寶)', to protect our interests while we are still mentally sound.

Ovarian cancer remains the most deadly gynecologic malignancy, and its incidence has been steadily increasing over the past few decades. In Hong Kong, ovarian cancer is the 7th leading cause of female cancer deaths. The crude death rate was 5.5 per 100,000 female population. In 2017, a total of 218 women died from this cancer, accounting for 3.7% of all cancer deaths in females. In a recent interview, Dr. William Foo, Specialist in Clinical Oncology, shared his insights on the management of ovarian cancer in Hong Kong.