OBJECTIVE. To examine the attitudes of Hong Kong Chinese elders with chronic disease with regard to advance directives and life-sustaining treatment.

DESIGN. Cross-sectional questionnaire survey.

SETTING. Medical unit of a regional teaching hospital in Hong Kong.

PARTICIPANTS. In-patients aged 60 years or above with chronic disease.

MAIN OUTCOME MEASURES. Demographic profiles and attitudes towards advance directives and life-sustaining treatment.

RESULTS. A total of 219 elderly patients completed the questionnaire. Their mean age was 73 (standard deviation, 8) years; 133 (61%) were female. The majority had neither heard about advance directives (81%), nor discussed the issue with others (73%) before participating in this study. After they were informed of the concept of advance directives, about half (49%) said they would consider using it if it is legislated in Hong Kong. The respondents generally supported the withholding or withdrawing of life-sustaining treatment in medically futile situations. In all, 55% of them believed that the patient alone should make the decision on withholding or withdrawing life-sustaining treatment, if competent to do so. If the patient became not competent, 44% believed that the individual's family alone should make such a decision.

CONCLUSION. The fact that most of the respondents had never heard about advance directives or discussed the concept with others points to a lack of knowledge and to the necessity to step up public education about such issues.

Key words: Advance directives; Chronic disease; Decision making; Ethics, medical; Life support care

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OBJECTIVES. To determine the trends in incidence and mortality of cervical cancer patients diagnosed during 1997 to 2006, and to describe stage-specific survival using population-based cancer registry data.

DESIGN. Retrospective, population-based study.

SETTING. Hong Kong.

PATIENTS. All patients diagnosed with cervical cancer between 1997 and 2006. Patients eligible for survival analysis were followed up till 31 December 2007.

MAIN OUTCOME MEASURES. Age-standardised incidence and mortality rates and average annual percent changes in these parameters were calculated using the Poisson regression model. Survival was expressed as relative survival rate using a period approach. Hazard ratios of mortality including 95% confidence intervals for certain variables were estimated using the Cox proportional hazards model.

RESULTS. During the 10-year period of the study, overall annual incidence and mortality rates decreased by 4.2% and 6.0%, respectively. Significant rates of reduction were observed in all age-groups except those younger than 45 years. The reduction in incidence of squamous cell carcinoma (3.6% annually) was less than that of adenocarcinoma (5.2%) and other histological types (6.8%). In all, 3807 (86.4%) of the patients were included in survival analysis. The overall 5-year relative survival rate was 71.3% (95% confidence interval, 69.5-73.1%), while the values for stages I, II, III, and IV were 90.9%, 71.0%, 41.7%, and 7.8%, respectively. Age, stage, and histology were independent prognostic factors. Survival of stage IA patients was as good as that of the general population.

CONCLUSIONS. As in other industrialised countries, the incidence and mortality rate of cervical cancer were decreasing. Stage-specific population-based cancer survival was available for the first time, and was useful as an indicator of cancer control. Collaboration between public and private sectors to further improve the follow-up data could provide more comprehensive surveillance information.

Key words: Epidemiologic studies; Incidence; Prevalence; Survival analysis; Uterine cervical neoplasms

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OBJECTIVE. To study the local medical profession’s opinions on the training requirements for the specialty of family medicine. This was to serve as a reference for future planning of the health care system.

DESIGN. Cross-sectional study.

PARTICIPANTS AND SETTING. All registered doctors in Hong Kong.

MAIN OUTCOME MEASURES. Doctors’ ratings on the importance of vocational training, professional assessment, job nature, and experience to become suitably qualified as a family doctor, and their opinions on the length of necessary vocational training.

RESULTS. A total of 2310 doctors (23% of doctors in the local register) responded. Professional assessment was mostly agreed as a qualification, followed by vocational training, clinical experience, and job nature. Over 70% agreed on a training period of 4 years or less. Non-family doctors were more likely to opt for professional assessment as the qualification and also opt for a longer training period.

CONCLUSION. Vocational training was considered important as a qualification for the specialty of family medicine. The length of training was mostly agreed to be 4 years or less, not the 6 years currently required by the Hong Kong Academy of Medicine. The vocational training programme for family medicine might require re-examination.

Key words: Clinical competence; Family practice; Health services; Primary health care; Quality of health care

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OBJECTIVE. To evaluate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy and standard laparoscopic partial nephrectomy in a teaching hospital.

DESIGN. Retrospective study.

SETTING. Division of Urology, Department of Surgery, Queen Mary and Tung Wah hospitals, Hong Kong.

PATIENTS. The first 10 consecutive patients who had robot-assisted laparoscopic partial nephrectomy for renal tumours between January 2008 and September 2009 with prospective data collection were evaluated. Their outcomes were compared with the last 10 consecutive patients in our database, who had standard laparoscopic partial nephrectomy between November 2004 and October 2007.

MAIN OUTCOME MEASURES. Demographics, tumour characteristics, perioperative outcomes, renal function, and pathological outcomes.

RESULTS. There were no differences between the groups with regard to age (63 vs 56 years; P=0.313) and tumour size (2.7 vs 2.8 cm; P=0.895). No significant difference was found between the two groups with respect to the operating room time (376 vs 361 min; P=0.722), estimated blood loss (329 vs 328 mL; P=0.994), and length of hospital stay (7 vs 14 days; P=0.213). A statistically significant shorter mean warm ischaemic time for the robotassisted group was noted (31 vs 40 minutes; P=0.032). Respective renal functional outcomes as shown by the difference between day 0 and day 60 serum creatinine levels were comparable (+10 vs +7 mmol/L; P=0.605). In both groups, there were no intra-operative complications or instances of surgical margin tumour involvement. Three patients endured postoperative complications in the standard laparoscopic group (a perinephric haematoma, urine leakage, and lymph leakage) compared with one in the robot-assisted group (a perinephric haematoma). These complications all resolved with conservative treatment.

CONCLUSIONS. Robot-assisted laparoscopic partial nephrectomy is a technically feasible alternative to standard laparoscopic partial nephrectomy, and provides comparable results. Robot-assisted laparoscopic partial nephrectomy appears to offer the advantage of decreased warm ischaemic time. Longer follow-up is required to assess renal function and oncological outcomes. Further experience and randomised trials are necessary to compare robot-assisted with standard laparoscopic partial nephrectomy.

Key words: Kidney neoplasms; Laparoscopy; Nephrectomy; Robotics; Suture techniques

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OBJECTIVE. To review the epidemiology of total knee arthroplasty for primary osteoarthritis and the change of patient characteristics over the last decade.

DESIGN. Retrospective review.

SETTING. A tertiary referral centre for joint replacement surgery in a teaching hospital in Hong Kong.

PATIENTS. All patients who underwent primary total knee arthroplasty for primary knee osteoarthritis from January 2000 to December 2009.

RESULTS. In all, 1157 total knee arthroplasties (589 left and 568 right) were performed on 588 females and 162 males. The annual number of total knee arthroplasties increased from 91 in 2000 to 181 in 2009. The annual number of patients increased from 58 (46 female, 12 male) in 2000 to 159 (117 female, 42 male) in 2009. When compared yearly results, there were no significant changes in the preoperative Knee Society Knee Score, Knee Society Functional Assessment, and passive range of motion of these patients. However, there was a significant decreasing trend with regard to lower limb mechanical axis mal-alignment, from 15.1º deviation from the neutral axis in 2000, to 14.8º deviation in 2004, and then 12.9º deviation in 2009 (mostly varus deformity). There was no difference between left knees and right knees, and between females and males. The mean age of the patients did not show significant change over the past decade, but the number and proportion of patients over 80 years old showed an increase from 4.8% (2000 to 2004) to 13.8% (2005 to 2009). On the other hand, the number and proportion of patients under the age of 60 years did not change.

CONCLUSIONS. There was an increasing trend towards total knee arthroplasties, both in terms of number of operations and patients. The number of younger patients having total knee arthroplasty did not increase over the last 10 years, whereas the number of those older than 80 years increased significantly over that period.

Key words: Arthroplasty, replacement, knee; Hong Kong; Knee joint; Osteoarthritis, knee; Registries

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