Background: Obesity is associated with an impaired ability to switch from fatty acid to glucose o... more Background: Obesity is associated with an impaired ability to switch from fatty acid to glucose oxidation during the fasted to fed transition, particularly in skeletal muscle. However, whether such metabolic inflexibility is reflected at the gene transcription level in circulatory mononuclear cells (MNC) is not known. Methods: The whole-body respiratory quotient (RQ) and transcriptional regulation of genes involved in carbohydrate and lipid metabolism in MNC were measured during fasting and in response (up to 6 h) to high-carbohydrate and high-fat meals in nine lean insulin-sensitive and nine obese insulin-resistant men. Results: Compared to lean subjects, obese subjects had an impaired ability to increase RQ and switch from fatty acid to glucose oxidation following the high-carbohydrate meal (interaction term P < 0.05). This was accompanied by an impaired induction of genes involved in oxidative metabolism of glucose in MNC, such as phosphofructokinase (PFK), pyruvate dehydrogenase kinase 4 (PDK4), peroxisome proliferator-activated receptor alpha (PPARα) and uncoupling protein 3 (UCP3) and increased expression of genes involved in fatty acid metabolism, such as fatty acid translocase (FAT/CD36) and fatty acid synthase (FASN) (P < 0.05). On the contrary, there were no differences in the gene expression profiles between lean and obese subjects following the high-fat meal. Conclusions: Postprandial expression profiles of genes involved in glucose and fatty acid metabolism in the MNC reflect the differing metabolic flexibility phenotypes of our cohort of lean and obese individuals. These differences in metabolic flexibility between the lean and obese are elicited by an acute meal challenge that is rich in carbohydrate but not fat.
Online first papers have undergone full scientific review and copyediting, but have not been type... more Online first papers have undergone full scientific review and copyediting, but have not been typeset or proofread. To cite this article, use the DOIs number provided. Mandatory typesetting and proofreading will commence with regular print and online publication of the online first papers of the SMJ.
Development and validation of a consensus methodology for the classification of the ANCA-associat... more Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies.
Long duty hours have been associated with significant medical errors, adverse events, and physici... more Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
Background: Obesity-related insulin resistance is linked to inflammation. Immunometabolic functio... more Background: Obesity-related insulin resistance is linked to inflammation. Immunometabolic function differs between lean and obese subjects, but whether macronutrient composition of ingested meals affects these responses is not well known. We examined the effects of a single meal rich in fat, protein, or carbohydrate on immunometabolic responses. Methods: Nine lean insulin sensitive (LIS) men and 9 obese insulin resistant (OIR) men ingested high-carbohydrate (HC), high-fat (HF) or high-protein (HP) mixed meals in random order. We assessed plasma glucose, insulin, and cytokine responses and cytokine gene expression in circulating mononuclear cells (MNC) at fasting and postprandial states (up to 6-h). Results: Expression of NF-κB and TNFα genes were greater; whereas that of TGFβ and IL-6 genes were lower, in the OIR compared to the LIS individuals. The differences were significantly greater after the HC meal, but not after the HP or HF meal. Similar results were obtained for plasma concentrations of TNFα and IL-6. Conclusions: Our findings indicate that a single HC meal has a distinct adverse effect on immunometabolic responses in the OIR individuals. The cumulative effect of such adverse responses to meals rich in carbohydrate may predispose the OIR individuals to a higher risk of cardiovascular disease.
OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely relate... more OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely related, and anti-diabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of anti-diabetic agents for the treatment of NAFLD in patients with T2DM. METHODS Medline and Embase were searched for randomised controlled trials relating to the use of antidiabetic agents including sodium-glucose transport protein 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin on its on NAFLD in patients with diabetes. The p score was used as a surrogate marker of effectiveness. RESULTS A total of 14 articles were included in the analysis. PPARγ agonists was ranked as the best treatment in steatosis reduction. PPARγ agonists resulted in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists (MD: -6.02%, CI: -10.37% to -1.67%) and SGLT2i (MD: -2.60%, CI: -4.87% to -0.33%) compared to standard of care for reduction of steatosis. Compared to PPARγ agonists, SGLT2i resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). BMI reduction was highest in SGLT2i and GLP1-RA. Additionally, SGLT2i was ranked as the best treatment in increasing HDL and reducing LDL. CONCLUSION GLP-1RA and SGLT2i were found to be suitable alternatives for the treatment of NAFLD in diabetics with reduction in BMI, fibrosis, and steatosis. SGLT2i were also found to have the added benefit of lipid modulation.
Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options i... more Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). However, previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. Thus, this updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of bypass against restrictive procedures and standard first-line treatment for patients with T2DM. Methods Embase, Medline and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM. A Bayesian network meta-analysis was conducted to compare between bypass, restrictive bariatric procedures, medical therapy and lifestyle intervention. Primary outcomes were T2DM remission and improvements in glycated haemoglobin (HbA1c). Secondary outcomes included changes in body mass index (BMI), lipoprotein levels and blood pressure. Results T...
was delayed due to poor functional status and concurrent discovery of an EBV-positive nasopharyng... more was delayed due to poor functional status and concurrent discovery of an EBV-positive nasopharyngeal carcinoma. Prior to surgery patient was treated with phosphorus and calcitriol supplements. Post-operatively serum phosphorus and FGF-23 levels were normalized. Patient also improved clinically. Patients treatment course was complicated by secondary hyperparathyroidism; however, this improved following surgery. Conclusion: Diagnosis of TIO can be delayed due to its nonspecific symptoms. Thus, in patients with chronic bone pain, muscle weakness, and atraumatic fractures, TIO should be kept on the differential and these patients should undergo thorough biochemical and imaging evaluation. Tumor localization could be challenging. Patients should be managed with supplements of active vitamin D and phosphorus with goal to normalize phosphorus level to prevent further bone demineralization prior to surgery. However, surgical intervention remains the mainstay of management as this is curative of TIO.
Conclusions This meta-analysis and systematic review demonstrate the high prevalence of CAD in pr... more Conclusions This meta-analysis and systematic review demonstrate the high prevalence of CAD in pre-LT patients, the associated risk factors and outcomes. More studies are required to determine the optimal screening methodology for CAD in pre-LT patients.
ii ACKNOWLEDGEMENTS iv APPROVAL SHEET v PERMISSION SHEET vi DECLARATION vii TABLE OF CONTENTS vii... more ii ACKNOWLEDGEMENTS iv APPROVAL SHEET v PERMISSION SHEET vi DECLARATION vii TABLE OF CONTENTS viii LIST OF TABLES xii LIST OF FIGURES xiv LIST OF ABBREVIATIONS/NOTATION/GLOSSARY OF TERMS xvii
A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia ... more A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia and ketonemia. Inferior ST-elevation was present on 12-lead ECG with raised troponin I, but coronary arteries were normal on emergency cardiac catheterization. Despite no previous history of diabetes mellitus and normal HbA1c levels 7 months prior, diabetic ketoacidosis (DKA) was diagnosed, complicated by subsequent shock. The underlying cause was acute pancreatic disease, supported by elevated pancreatic enzyme levels and a history of chronic heavy alcohol use. There are no previous reports, to our knowledge, of patients with acute pancreatitis presenting to the ED with secondary DKA mimicking STEMI.
OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely relate... more OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely related, and anti-diabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of anti-diabetic agents for the treatment of NAFLD in patients with T2DM. METHODS Medline and Embase were searched for randomised controlled trials relating to the use of antidiabetic agents including sodium-glucose transport protein 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin on its on NAFLD in patients with diabetes. The p score was used as a surrogate marker of effectiveness. RESULTS A total of 14 articles were included in the analysis. PPARγ agonists was ranked as the best treatment in steatosis reduction. PPARγ agonists resulted in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists (MD: -6.02%, CI: -10.37% to -1.67%) and SGLT2i (MD: -2.60%, CI: -4.87% to -0.33%) compared to standard of care for reduction of steatosis. Compared to PPARγ agonists, SGLT2i resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). BMI reduction was highest in SGLT2i and GLP1-RA. Additionally, SGLT2i was ranked as the best treatment in increasing HDL and reducing LDL. CONCLUSION GLP-1RA and SGLT2i were found to be suitable alternatives for the treatment of NAFLD in diabetics with reduction in BMI, fibrosis, and steatosis. SGLT2i were also found to have the added benefit of lipid modulation.
Long duty hours have been associated with significant medical errors, adverse events, and physici... more Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
Background Off-label testosterone prescribing for androgen deficiency (AD)-like sexual and energy... more Background Off-label testosterone prescribing for androgen deficiency (AD)-like sexual and energy symptoms of older men without pathologic hypogonadism has increased dramatically without convincing evidence of efficacy. Methods In a randomized, double-blind, placebo-controlled study with three phases we entered 45 men aged at least 40 years without pathologic hypogonadism but with AD-like energy and/or sexual symptoms to either daily testosterone or placebo gel treatment for 6 weeks in a cross-over study design with a third, mandatory extension phase in which participants chose which previous treatment they preferred to repeat while remaining masked to their original treatment. Primary endpoints were energy and sexual symptoms as assessed by a visual analog scale (Lead Symptom Score (LSS)). Results Increasing serum testosterone to the healthy young male range produced no significant benefit more than placebo for energy or sexual LSS. Covariate effects of age, BMI and pre-treatment b...
Background: Obesity is associated with an impaired ability to switch from fatty acid to glucose o... more Background: Obesity is associated with an impaired ability to switch from fatty acid to glucose oxidation during the fasted to fed transition, particularly in skeletal muscle. However, whether such metabolic inflexibility is reflected at the gene transcription level in circulatory mononuclear cells (MNC) is not known. Methods: The whole-body respiratory quotient (RQ) and transcriptional regulation of genes involved in carbohydrate and lipid metabolism in MNC were measured during fasting and in response (up to 6 h) to high-carbohydrate and high-fat meals in nine lean insulin-sensitive and nine obese insulin-resistant men. Results: Compared to lean subjects, obese subjects had an impaired ability to increase RQ and switch from fatty acid to glucose oxidation following the high-carbohydrate meal (interaction term P < 0.05). This was accompanied by an impaired induction of genes involved in oxidative metabolism of glucose in MNC, such as phosphofructokinase (PFK), pyruvate dehydrogenase kinase 4 (PDK4), peroxisome proliferator-activated receptor alpha (PPARα) and uncoupling protein 3 (UCP3) and increased expression of genes involved in fatty acid metabolism, such as fatty acid translocase (FAT/CD36) and fatty acid synthase (FASN) (P < 0.05). On the contrary, there were no differences in the gene expression profiles between lean and obese subjects following the high-fat meal. Conclusions: Postprandial expression profiles of genes involved in glucose and fatty acid metabolism in the MNC reflect the differing metabolic flexibility phenotypes of our cohort of lean and obese individuals. These differences in metabolic flexibility between the lean and obese are elicited by an acute meal challenge that is rich in carbohydrate but not fat.
Online first papers have undergone full scientific review and copyediting, but have not been type... more Online first papers have undergone full scientific review and copyediting, but have not been typeset or proofread. To cite this article, use the DOIs number provided. Mandatory typesetting and proofreading will commence with regular print and online publication of the online first papers of the SMJ.
Development and validation of a consensus methodology for the classification of the ANCA-associat... more Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies.
Long duty hours have been associated with significant medical errors, adverse events, and physici... more Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
Background: Obesity-related insulin resistance is linked to inflammation. Immunometabolic functio... more Background: Obesity-related insulin resistance is linked to inflammation. Immunometabolic function differs between lean and obese subjects, but whether macronutrient composition of ingested meals affects these responses is not well known. We examined the effects of a single meal rich in fat, protein, or carbohydrate on immunometabolic responses. Methods: Nine lean insulin sensitive (LIS) men and 9 obese insulin resistant (OIR) men ingested high-carbohydrate (HC), high-fat (HF) or high-protein (HP) mixed meals in random order. We assessed plasma glucose, insulin, and cytokine responses and cytokine gene expression in circulating mononuclear cells (MNC) at fasting and postprandial states (up to 6-h). Results: Expression of NF-κB and TNFα genes were greater; whereas that of TGFβ and IL-6 genes were lower, in the OIR compared to the LIS individuals. The differences were significantly greater after the HC meal, but not after the HP or HF meal. Similar results were obtained for plasma concentrations of TNFα and IL-6. Conclusions: Our findings indicate that a single HC meal has a distinct adverse effect on immunometabolic responses in the OIR individuals. The cumulative effect of such adverse responses to meals rich in carbohydrate may predispose the OIR individuals to a higher risk of cardiovascular disease.
OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely relate... more OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely related, and anti-diabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of anti-diabetic agents for the treatment of NAFLD in patients with T2DM. METHODS Medline and Embase were searched for randomised controlled trials relating to the use of antidiabetic agents including sodium-glucose transport protein 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin on its on NAFLD in patients with diabetes. The p score was used as a surrogate marker of effectiveness. RESULTS A total of 14 articles were included in the analysis. PPARγ agonists was ranked as the best treatment in steatosis reduction. PPARγ agonists resulted in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists (MD: -6.02%, CI: -10.37% to -1.67%) and SGLT2i (MD: -2.60%, CI: -4.87% to -0.33%) compared to standard of care for reduction of steatosis. Compared to PPARγ agonists, SGLT2i resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). BMI reduction was highest in SGLT2i and GLP1-RA. Additionally, SGLT2i was ranked as the best treatment in increasing HDL and reducing LDL. CONCLUSION GLP-1RA and SGLT2i were found to be suitable alternatives for the treatment of NAFLD in diabetics with reduction in BMI, fibrosis, and steatosis. SGLT2i were also found to have the added benefit of lipid modulation.
Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options i... more Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). However, previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. Thus, this updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of bypass against restrictive procedures and standard first-line treatment for patients with T2DM. Methods Embase, Medline and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM. A Bayesian network meta-analysis was conducted to compare between bypass, restrictive bariatric procedures, medical therapy and lifestyle intervention. Primary outcomes were T2DM remission and improvements in glycated haemoglobin (HbA1c). Secondary outcomes included changes in body mass index (BMI), lipoprotein levels and blood pressure. Results T...
was delayed due to poor functional status and concurrent discovery of an EBV-positive nasopharyng... more was delayed due to poor functional status and concurrent discovery of an EBV-positive nasopharyngeal carcinoma. Prior to surgery patient was treated with phosphorus and calcitriol supplements. Post-operatively serum phosphorus and FGF-23 levels were normalized. Patient also improved clinically. Patients treatment course was complicated by secondary hyperparathyroidism; however, this improved following surgery. Conclusion: Diagnosis of TIO can be delayed due to its nonspecific symptoms. Thus, in patients with chronic bone pain, muscle weakness, and atraumatic fractures, TIO should be kept on the differential and these patients should undergo thorough biochemical and imaging evaluation. Tumor localization could be challenging. Patients should be managed with supplements of active vitamin D and phosphorus with goal to normalize phosphorus level to prevent further bone demineralization prior to surgery. However, surgical intervention remains the mainstay of management as this is curative of TIO.
Conclusions This meta-analysis and systematic review demonstrate the high prevalence of CAD in pr... more Conclusions This meta-analysis and systematic review demonstrate the high prevalence of CAD in pre-LT patients, the associated risk factors and outcomes. More studies are required to determine the optimal screening methodology for CAD in pre-LT patients.
ii ACKNOWLEDGEMENTS iv APPROVAL SHEET v PERMISSION SHEET vi DECLARATION vii TABLE OF CONTENTS vii... more ii ACKNOWLEDGEMENTS iv APPROVAL SHEET v PERMISSION SHEET vi DECLARATION vii TABLE OF CONTENTS viii LIST OF TABLES xii LIST OF FIGURES xiv LIST OF ABBREVIATIONS/NOTATION/GLOSSARY OF TERMS xvii
A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia ... more A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia and ketonemia. Inferior ST-elevation was present on 12-lead ECG with raised troponin I, but coronary arteries were normal on emergency cardiac catheterization. Despite no previous history of diabetes mellitus and normal HbA1c levels 7 months prior, diabetic ketoacidosis (DKA) was diagnosed, complicated by subsequent shock. The underlying cause was acute pancreatic disease, supported by elevated pancreatic enzyme levels and a history of chronic heavy alcohol use. There are no previous reports, to our knowledge, of patients with acute pancreatitis presenting to the ED with secondary DKA mimicking STEMI.
OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely relate... more OBJECTIVE Type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) are closely related, and anti-diabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of anti-diabetic agents for the treatment of NAFLD in patients with T2DM. METHODS Medline and Embase were searched for randomised controlled trials relating to the use of antidiabetic agents including sodium-glucose transport protein 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin on its on NAFLD in patients with diabetes. The p score was used as a surrogate marker of effectiveness. RESULTS A total of 14 articles were included in the analysis. PPARγ agonists was ranked as the best treatment in steatosis reduction. PPARγ agonists resulted in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists (MD: -6.02%, CI: -10.37% to -1.67%) and SGLT2i (MD: -2.60%, CI: -4.87% to -0.33%) compared to standard of care for reduction of steatosis. Compared to PPARγ agonists, SGLT2i resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). BMI reduction was highest in SGLT2i and GLP1-RA. Additionally, SGLT2i was ranked as the best treatment in increasing HDL and reducing LDL. CONCLUSION GLP-1RA and SGLT2i were found to be suitable alternatives for the treatment of NAFLD in diabetics with reduction in BMI, fibrosis, and steatosis. SGLT2i were also found to have the added benefit of lipid modulation.
Long duty hours have been associated with significant medical errors, adverse events, and physici... more Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
Background Off-label testosterone prescribing for androgen deficiency (AD)-like sexual and energy... more Background Off-label testosterone prescribing for androgen deficiency (AD)-like sexual and energy symptoms of older men without pathologic hypogonadism has increased dramatically without convincing evidence of efficacy. Methods In a randomized, double-blind, placebo-controlled study with three phases we entered 45 men aged at least 40 years without pathologic hypogonadism but with AD-like energy and/or sexual symptoms to either daily testosterone or placebo gel treatment for 6 weeks in a cross-over study design with a third, mandatory extension phase in which participants chose which previous treatment they preferred to repeat while remaining masked to their original treatment. Primary endpoints were energy and sexual symptoms as assessed by a visual analog scale (Lead Symptom Score (LSS)). Results Increasing serum testosterone to the healthy young male range produced no significant benefit more than placebo for energy or sexual LSS. Covariate effects of age, BMI and pre-treatment b...
Uploads
Papers by Shao Feng Mok