OBJECTIVE. To examine the cellular characteristics and other possible factors affecting the correct prediction of ThinPrep cervical smears from patients with high-grade squamous intraepithelial lesions.

DESIGN. Retrospective study.

SETTING. Private anatomical pathology service, Hong Kong.

PATIENTS. Patients (n=98) with biopsy-confirmed high-grade squamous intraepithelial lesion of the uterine cervix encountered between 2004 and 2006.

MAIN OUTCOME MEASURES. Correct prediction of the cervical ThinPrep Papanicolaou tests.

RESULTS. There were no significant differences in age, hormonal status, degree of inflammation, and the presence or absence of endocervical/metaplastic cells between the true-positive and false-negative groups. There was a significant difference in the number of abnormal cells present and the screening time between the two groups. Approximately 79% (34/43) false-negative smears had 100 or less abnormal cells, while only 11% (5/45) true-positive smears had 100 or less abnormal cells (P<0.001). The true-positive smears were also more likely to contain koilocytic cells and abnormal cells with hyperchromatic nuclei.

CONCLUSIONS. The number of abnormal cells present, the presence or absence of koilocytic cells, and the presence or absence of abnormal cells with nuclear hyperchromasia appeared to be independent factors affecting the correct prediction of smears from patients with high-grade squamous intraepithelial lesions.

Key words: Cervix uteri; Papillomavirus infections; Uterine cervical neoplasms; Vaginal smears

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OBJECTIVE. To study attitudes, knowledge, and actions of local medical students with regard to organ donation and self-perceived confidence and competence in approaching potential organ donors.

DESIGN. Cross-sectional questionnaire survey.

SETTING. Faculty of Medicine, The University of Hong Kong, Hong Kong.

PARTICIPANTS. Medical students, years 1-5.

MAIN OUTCOME MEASURES. Knowledge on various aspects of organ donation was assessed, and students' self-evaluated competence and confidence about counselling for organ donation was evaluated. Factors influencing attitudes and actions were determined. RESULTS. The response rate was 94% (655/694). A majority (85%) had a 'positive' attitude, but only a small proportion (23%) had signed the organ donation card. Inconvenience and lack of knowledge about organ donor registration, and concerns about premature termination of medical treatment accounted for such discrepancies. Socio-cultural factors such as the traditional Chinese belief in preservation of an intact body after death, unease discussing death-related issues, and family objections to organ donation were significantly associated with a 'negative' attitude. Knowledge and action increased with medical education yet only a small proportion of medical students felt competent and confident in counselling patients on organ donation.

CONCLUSIONS. The medical curriculum should increase medical students' awareness of the organ shortage problem. The donor registration system should be made more convenient and public education is recommended to correct misconceptions.

Key words: Attitude of health personnel; Living donors; Organ transplantation; Students, medical

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OBJECTIVE. To examine the side-effect and vital sign profile of nifedipine used as a tocolytic.

DESIGN. Retrospective audit.

SETTING. Tertiary care university hospital, Hong Kong.

PATIENTS. Women presenting with preterm labour (before 34 weeks of gestation) between March 2001 and September 2004.

MAIN OUTCOME MEASURES. Maternal heart rate, blood pressure, and foetal heart rate were monitored regularly. A four-point Likert scale multiple-choice questionnaire was used to assess the perceived degree of flushing, headache, nausea, dizziness, and shortness of breath. All assessments were performed at predefined intervals from the onset of treatment. Repeated measures analysis of variance was performed to identify any time-dependent association with nifedipine treatment.

RESULTS. In all, 212 episodes of preterm labour were treated with nifedipine in 203 women. In 120 episodes, preterm labour was suppressed for more than 48 hours. Treatment was discontinued in three women because of profound hypotension (<90/60 mm Hg), and in one because of severe flushing. Only one patient developed maternal tachycardia (??40 beats per minute), and in two foetal tachycardia (??80 beats per minute) was encountered. Moderate headache was experienced in nine women, flushing in nine, dizziness in four, nausea in three, and shortness of breath in one. Repeated measures analysis of variance with time of measurement revealed a significant reduction in maternal blood pressure and increase in maternal heart rate that plateaued after 1 hour of therapy. The foetal heart rate returned to baseline values 3 hours after commencing therapy.

CONCLUSION. In general, use of nifedipine as the first-line tocolytic was safe. However, severe maternal hypotension can occur and close monitoring of vital signs is warranted.

Key words: Nifedipine; Obstetric labor, Premature; Tocolysis

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OBJECTIVE. To identify predictors of rehabilitation outcomes for the development of a case-mix system to rehabilitate patients suffering from hip fractures.

DESIGN. Prospective cohort study.

SETTING. Two hospitals in Hong Kong.

PATIENTS. A cohort of hip fracture patients in 2005 (n=303) with a mean age of 82 years was studied. Rehabilitation outcomes were defined as: mortality, length of stay, placement, ambulation status, activity of daily living at the time of discharge and at 6-month follow-up. A comparison between groups and multivariate analysis was conducted to validate the best predictors.

MAIN OUTCOME MEASURES. Potential predictors and rehabilitation outcomes.

RESULTS. Two predictors, the Abbreviated Mental Test score of lower than 6 (odds ratio=0.19, P<0.05) and the Functional Independence Measures score of lower than 75 (odds ratio=38.0, P<0.05), at the time of admission to the rehabilitation setting were found to be related to outcomes. Our findings provided further support for a case-mix system based on these two factors, as they could correctly assign patients into three groups with different baseline characteristics and outcomes. A review of the possible limitations of the existing service with respect to each case-mix group was also conducted.

CONCLUSION. A case-mix system utilising the cognition and activity of daily living function is recommended. Revisions of respective care plans are advocated with more realistic outcome expectations and specific actions for the respective case-mix groups. An evaluation study on the usefulness of this case-mix classification could then follow.

Key words: Aged; Geriatric assessment; Hip fractures; Predictive value of tests; Prognosis

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OBJECTIVES. To investigate the proportion of sufferers of benign paroxysmal positional vertigo among hospitalised patients in Hong Kong who complained of dizziness, and to determine the predictive values and likelihood ratios of classical presenting symptoms.

DESIGN. Cross-sectional study.

SETTING. Convalescence/rehabilitation hospital, Hong Kong.

PATIENTS. A cohort of 88 newly admitted patients, who complained of dizziness or complained of having had dizziness in the 2 weeks prior to admission from September 2005 to February 2006.

MAIN OUTCOME MEASURES. Presence of the pathognomonic nystagmus of benign paroxysmal positional vertigo.

RESULTS. Five patients had benign paroxysmal positional vertigo, all with the posterior type. The frequency of its occurrence among patients complaining of dizziness was 6% (95% confidence interval, 1-11%), which was more than double the figure of 3% in our local convalescence/rehabilitation hospitals, though this difference was not statistically significant. Regarding the five identified patients, in two it involved the left ear, in two others the right ear, and in one it was bilateral. All four classical presenting symptoms had low positive predictive values, high negative predictive values, and small likelihood ratios.

CONCLUSION. Benign paroxysmal positional vertigo in the setting of a convalescence/rehabilitation hospital in Hong Kong seems to be underdiagnosed. Small and insignificant likelihood ratios for the classical presenting symptoms preclude their use in making the diagnosis. However, absence of these symptoms in a clinical setting of low occurrence rate can be regarded as against the diagnosis.

Key words: Prevalence; Sensitivity and specificity; Vertigo

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