OBJECTIVES. Although Picolax (sodium picosulphate and magnesium citrate) has been widely documented for use in bowel preparation, there is limited literature on its efficacy in the treatment of constipation. Refractory constipation is a more difficult situation with limited treatment options available. The primary objective of this study was to investigate the efficacy of Picolax in the treatment of refractory constipation.

DESIGN. Prospective single-centre cohort study.

SETTING. The Gastroenterology and Hepatology Centre of a major private hospital in Hong Kong.

PATIENTS. Patients aged 18 years or more with chronic constipation refractory to tegaserod or polyethylene glycol and attending the centre in the period of July 2009 to June 2010.

RESULTS. A total of 20 patients completed this 6-week single-centre study, with a 2-week baseline assessment and 4-week treatment period. Complete data sets were available for analysis from 17 of these patients. The mean (standard deviation) age of the cohort was 50 (9) years, of which 94% were female. Treatment consisted of half-a-sachet of Picolax taken orally on alternate days, 3 times a week. Patients were required to fill in daily and weekly diary entries of their bowel habit. The mean (standard deviation) number of weekly complete spontaneous bowel movements increased from 0.5 (0.9) to 2.4 (2.6) times per week (P=0.02) after initiation of the treatment, which was a clinically and statistically significant difference; with a mean change of +1.9 (95% confidence interval, 0.3 to 3.4) per week. As a secondary endpoint, 11 patients recorded the use of rescue medication before and after the 4-week treatment. The ratio of patients who took rescue medication decreased significantly from 73% (n=8) to 0% (n=0) [P=0.008]. The mean reduction in the frequency of resorting to rescue medication was 2.6 times (95% confidence interval, -4.2 to -1.1) per week.

CONCLUSIONS. Picolax improved the number of complete spontaneous bowel movements and significantly reduced resorting to rescue medication. This formulation could therefore be considered as a treatment option in patients with chronic constipation who are refractory to conventional treatment regimens.

Key words: Constipation; Laxatives; Picolines; Polyethylene glycols; Treatment outcome

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OBJECTIVE. To measure patient satisfaction in relation to in-patient experience in public hospitals.

DESIGN. Cross-sectional study.

SETTING. Twenty-five selected Hospital Authority acute and convalescence hospitals in Hong Kong.

PARTICIPANTS. Eligible patients discharged between 15 June and 27 September 2010 from the selected Hospital Authority public hospitals.

MAIN OUTCOME MEASURES. A total of 54 items were used to measure patient experience on aspects of hospital care. They included the process of admission to hospital, staying in the hospital and ward (environment, food and facilities; hospital staff; patient care and treatment), the process of leaving hospital, and the overall impression of hospital care. Free-text comments from respondents were also recorded.

RESULTS. A total of 5030 patients were successfully interviewed, amounting to a response rate of 52%. The findings showed that 80% (confidence interval, 79-81%) of patients rated the care they received in hospital as good or better. However, there were a few areas where performance was relatively low, including waiting time for a ward bed for accident and emergency cases, food quality, infection control, information provided about their condition/treatment, seeking patient input about their opinions and quality of care, and patient engagement in the decisions about their treatment and care, as well as the discharge process.

CONCLUSIONS. This patient experience survey used a validated instrument (Hong Kong Inpatient Experience Questionnaire) to provide important insights to executives and health care professionals on their care to patients and to identify areas for improvement in public hospitals. Further surveys should be carried out to monitor changes in patient experience and satisfaction on a regular basis. Such surveys could facilitate improvements through analysis of results on patient satisfaction.

Key words: Patient acceptance of health care; Patient satisfaction; Primary health care; Quality of health care

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OBJECTIVE. Medical professionalism has been widely discussed in western scholarly literature. However, since Hong Kong has a mixed Chinese-western culture, it remains uncertain whether Hong Kong health care professionals, medical students, and patients see medical professionalism in exactly the same way as westerners. The objective of the present study was to explore perceptions of medical professionalism in Hong Kong.

DESIGN. Individual semi-structured interviews.

SETTING. Medical faculty preceptors, residents, interns, nurses, and students from the Li Ka Shing Faculty of Medicine of the University of Hong Kong. Subjects were recruited at an out-patient clinic of Queen Mary Hospital.

PARTICIPANTS. We interviewed 39 subjects, including six medical faculty preceptors, six hospital residents, four medical interns, eight nurses, eight out-patients, and seven medical students. The interviews were transcribed and coded. Grounded theory was employed for framing and analysing the interviews.

RESULTS. A total of 30 primary themes were identified and grouped under three secondary themes, ie 'Expectations of a professional doctor', 'Work values', and 'Patient care'. In general, the primary themes were consistent with recognised professional attributes in western bioethics, such as knowledge and skills, holistic care, and communication skills. A closer analysis suggested that traditional Chinese thought also played an important role in shaping the medical professionalism of Hong Kong. Challenges to be faced by Hong Kong doctors due to recent social changes were also identified.

CONCLUSIONS. Medical professionalism in Hong Kong is shaped by both western medical ethics and traditional Chinese thought. The values treasured by Hong Kong health care professionals as well as technological advance, and the city's proximity to Mainland China makes Hong Kong health care unique. It is important to maintain the present work attitudes and at the same time adapt to new social changes.

Key words: Clinical competence; Delivery of health care; Physician-patient relations; Professional practice

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OBJECTIVE. To review our experience in virtual blood banking for intra-operative transfusion in Hong Kong.

DESIGN. Retrospective study.

SETTING. Three major acute hospitals and a specialised centre for joint replacement surgery with installation of an Operating Theatre Blood Transaction System.

PATIENTS. Patients undergoing surgery under anaesthesia and requiring intra-operative transfusion for the period from the implementation of the system in individual institutes (Queen Elizabeth Hospital: June 1997; Princess Margaret Hospital: May 2001; Queen Mary Hospital: October 2009; and Hong Kong Buddhist Hospital: December 2010) till September 2011.

RESULTS. Under the system, 58 923 units of red cells were released intra-operatively for 18 264 patients (11% of the total number of blood units issued by the blood banks in these institutes during the study period). About 1% of them (613 units) entailed unmatched red cells given to 183 patients for emergency transfusions during surgery. The mean time required for the issue of the first unit of red cells was less than 1 minute. A total of 1231 units of red cells were returned unused after being released. Among them, 95 units were deemed unfit for re-issue because they had left the temperature-monitored blood storage refrigerators in the operating theatres for more than 30 minutes. There was no delay in transfusion or postponement of surgery due to problems or downtime of the Operating Theatre Blood Transaction System.

CONCLUSION. Our experience has shown that our virtual blood banking system was efficient and effective, and helped ensure that the right patient received the right amount of the right blood at the right time. The system can be implemented either locally in the same hospital with a central blood bank, or in a more remote and networked site without a nearby supporting blood bank.

Key words: Blood banks; Blood grouping and crossmatching; Blood transfusion; Intraoperative care; Medical informatics

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OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease.

DESIGN. Prognostic study on a historical cohort.

SETTING. A regional hospital in Hong Kong.

PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital.

MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities.

RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors.

CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

Key words: Duodenal ulcer; Emergencies; Gastrectomy; Mortality; Stomach ulcer

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