Dr Esther Chan Wai-yin— Drug Solutions for Emergencies | 陳慧賢博士 — 急症藥物解決方案

(中文版見於下方)

As a pharmacist of the emergency department at Austin Hospital in Melbourne Australia prior to joining HKUMed, Dr Esther Chan Wai-yin, Associate Professor of the Department of Pharmacology and Pharmacy encountered situations that spurred her discoveries on sedating drug use for behavioural emergencies and anti-blood clotting (anticoagulation) drugs.

Seeing patients in an agitated state who were at risk of harming themselves and others motivated her work on sedation drugs. “The agitation may be due to mental health issues or related to drug and/or alcohol abuse. But there had not been much data about which drugs work quickly and safely or how they compared,” she said.

She therefore conducted randomised clinical trials in Australia and Hong Kong to determine the best drugs and delivery methods for achieving quick and safe sedation. She showed that olanzapine was safe and effective to be delivered both intravenously and intramuscularly. The Hong Kong trial was the first clinical trial in Asia to compare sedative and antipsychotic medicines for use in behavioural emergencies.

Dr Chan also showed in a separate study that haloperidol — the most commonly prescribed antipsychotic medication in Hong Kong was associated with an increased risk of death compared with several other anti-psychotics. The study advised that elderly patients and those at risk of heart disease or pneumonia need careful monitoring or, preferably, should be given a different antipsychotic drug.

Her work in these areas have led to practice changes and recommendations in clinical practice guidelines including the Australian Therapeutic Guidelines, and are expected to guide and improve the future management of acute agitation in emergency settings in Hong Kong and abroad.

Dr Chan’s work on anticoagulation medicines was motivated by the fact that emergency rooms see a lot of patients with bleeding due to these medications, which are often prescribed to reduce the risk of stroke. She embarked on population-based cohort studies on oral anticoagulants — and found that gastroprotective agents could reduce the risk of gastrointestinal bleeds, which is a common concern in people taking anticoagulation medications. This has led to recommendations in clinical practice guidelines and changes in clinical practice. She continues to work on the most frequently used newer anticoagulation medications (dabigatran, apixaban, rivaroxaban and edoxaban) to discover more about their effectiveness and safety profiles.

She also studied the data of men and women patients being treated for atrial fibrillation by the Hong Kong Hospital Authority and found that newer oral anticoagulants could be more effective and safer, especially for women patients. Although warfarin was the most commonly used drug, Dr Chan and her team found that women who were prescribed a newer treatment, non-vitamin K antagonist oral anticoagulant, had a further reduced risk of bleeding in the brain compared with warfarin. The same effect was not seen in men.

“Big data is now an important part of the work we do. While clinical trials have its merits, they are resource intensive and you may only work with a few hundred or perhaps thousands of patients. With the good quality data we have in Hong Kong, we can look at tens of thousands of patients and in a way mimic clinical trials. And we can do this more efficiently and look at multiple clinical outcomes concurrently,” she said.

Biography

Dr Esther Chan joined the Department of Pharmacology and Pharmacy, HKUMed in 2012 and became Associate Professor in 2017. She is research lead for the Centre for Safe Medication Practice and Research, HKU.

During residency training at Austin Hospital (Melbourne, Australia) Dr Chan focused on clinical practice and research in the Emergency Department. She’s also trained in Infectious Diseases at Oxford Radcliffe NHS Trust (UK),
and Trauma and Emergency Care at the University Medical
Center (Tucson, Arizona, USA).

Dr Chan’s main research focus is to determine medicine safety and effectiveness, and expand drug application. Her areas of interest include the pharmacotherapy management of communicable and non-communicable disease areas including behavioural emergencies and mental health; cardiovascular and respiratory health, gastroenterology, infectious diseases and oncology. Her research methodologies utilise innovative Big Data and interventional randomised clinical study designs. Awards such as the Research Grants Council of Hong Kong (RGC) Early Career Scheme (2013) and The National Natural Science Fund of China (NSFC) — Young Scientist Fund (2018) are recognition of her
achievements.

(This article was originally published in Medical Faculty News)

藥理及藥劑學系副教授陳慧賢博士在澳洲墨爾本奧斯汀醫院急症部門任職藥劑師時，日常目睹及經歷各種緊急情境，促使她研究鎮靜藥物治理緊急行為、以及抗凝血藥物的使用。

陳博士經常看到送來急症室的病人激烈躁動，瀕臨自殘和傷害他人的邊緣，讓她萌生研究鎮靜藥物的想法。她說：「病人激烈躁動的原因，可能與精神健康問題有關，也可能是濫用藥物及/或酗酒所致，但目前文獻中沒有足夠數據讓我們知道哪些藥物比較安全而且起效較迅速。」

陳博士因此在澳洲和香港展開隨機臨床試驗，試圖找出起效快而又安全的最佳鎮靜藥物及給藥方法，最後她發現名為奥氮平 (olanzapine) 的藥物，無論是用作靜脈注射還是肌肉注射，都安全有效。陳博士在香港進行的研究，乃亞洲區首個對用於治療緊急行為情況的各種鎮靜藥物及抗精神病藥物，進行比較的臨床試驗。

陳博士在另外一項研究中發現，在香港以至全球很常用的抗精神病處方藥物氟哌啶醇(haloperidol)，和其他數種抗精神病藥物比較時，有較高死亡風險。該項研究建議，老年病人以及有心臟病或肺炎風險的病人，在使用該藥時需要特別監察，可能的話，更應轉用另外一種抗精神病藥物。

陳博士在這方面的研究，促使「澳洲治療指引」等相關 機構改變臨床實踐的守則及建議，並有望指導和改善香港及 海外的急症部門對激烈躁動病人的治理。

另一方面，陳博士對抗凝血藥物的研究，也是源於過往在急症室的工作。當時她目睹許多病人為了減低中風風險，卻又在服用抗凝血藥物之後，因出血問題到急症室求診，其中腸胃道出血正是很多服用抗凝血藥病人常常遇到的問題。於是她開始 一項針對口服抗凝血劑、以人口為基礎的隊列研究，發現同時 服用腸胃道保護劑可以降低腸胃道出血的風險。這項研究同樣帶來了臨床實踐方面的新建議和改變。陳博士現時正在研究四 種常用的新型口服抗凝血劑（達比加群dabigatran、阿哌沙班apixaban、利伐沙班rivaroxaban和艾多沙班edoxaban），希 望對這些藥物的有效性和安全性有進一步發現。

從醫院管理局的數據庫裡，陳博士對接受過心房顫動治療的男女病人進行研究，發現新型口服抗凝血劑更有效、更安全，尤其是對女性而言。雖然華法林 (warfarin) 曾經是最常用的抗凝血藥物，但是陳博士及她的團隊發現，與華法林比較，給女性處方新型藥物，即非維他命K拮抗劑類口服抗凝血劑，有助進一步減低腦部出血的風險，但在男性身上未見同樣效果。

陳博士說：「大數據現時在我們的研究工作中非常重要。雖然臨床試驗有其優點，但是需要的資源也比較多，而且只能對數百個或是數千個病人進行試驗。如果可以利用香港 已有的優質數據做研究，我們可以檢視成千上萬匿名病人的資料，在某程度上模仿臨床試驗。這樣我們進行的研究可以更有效率，也可以同時檢視多種臨床結果。」

簡歷

陳慧賢博士於2012年加入港大醫學院藥理及藥劑學系，2017年晉升為副教授；她同時是香港大學藥物安全及應用研究中心的研究主管。

陳博士在澳洲墨爾本奧斯汀醫院接受駐院藥劑師實習培訓時，在急症部門期間致力於臨床實踐和研究。除此之外，她曾經在隸屬英國國民保健信託基金的牛津拉德克利夫醫院，接受與傳染病相關的訓練；及在美國亞利桑那州圖森的大學醫學中心，接受創傷與急症護理培訓。

陳博士的主要研究重點是確定藥物的安全性和有效性，以及擴展藥物的應用。她致力於研究各種傳染性及非傳染性疾病的藥物治療，研究範圍包括行為緊急情況治理及精神健康、心血管及呼吸道健康、腸胃病、傳染病和癌
症。陳博士在其研究中，採用了創新的大數據和介入性隨機臨床研究設計等研究方法。她的研究成果獲得不同資助機構的認可，包括在2013年及2018年分別榮獲大學教育資助委員會傑出青年學者計劃和國家自然科學基金「青年科學家基金」的獎項。

(原文刊登於港大醫學院 Medical Faculty News ）