Spontaneous fractures in nursing home residents

ABSTRACT
Hong Kong Med J 2007;13:427-9 | Number 6, December 2007
ORIGINAL ARTICLE
Spontaneous fractures in nursing home residents
TC Wong, WC Wu, HS Cheng, YC Cheng, SK Yam
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVES. To evaluate spontaneous long bone fractures occurring in nursing home residents and to identify what factors put them at risk for fractures.
 
DESIGN. Retrospective study.
 
SETTING. Department of Orthopaedics and Traumatology of a pubic hospital in Hong Kong.
 
PATIENTS. A total of 30 nursing home residents who developed spontaneous long bone fractures between 1994 and 2005 were reviewed.
 
MAIN OUTCOME MEASURES. Demographic data, mechanism of injury, pattern of fractures, associated risk factors, complications, outcomes, and post-treatment status.
 
RESULTS. The mean age of patients was 84 years. Co-morbidities were as follows: 22 patients were bedridden, 21 required long-term feeding by Ryle's tube, 19 had a history of cerebrovascular accident and 18 of whom had a long bone fracture on the side of the hemiplegia, 15 had dementia, and 25 had lower limb contractures. Closed supracondylar fractures of the femur occurred in 23 patients, 17 of whom presented with limb deformity. In 21 patients, fractures were treated successfully with hinged braces. In one patient, the fracture changed from closed to open. In five patients, the fractures were complicated by sacrum or heel sores, and in one by infected nonunion. In 28 patients, the fractures eventually healed without further complications. Three formerly bedridden patients were able to sit after their fractures had been treated.
 
CONCLUSIONS. Female nursing home residents who require long-term Ryle's tube feeding, have dementia, hemiplegia, lower limb contractures, osteoporosis, or are bedridden, are at high risk for spontaneous fractures.
 
Key words: Femoral fractures; Fractures, spontaneous; Nursing homes; Risk factors
 
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The prevalence of cardiovascular risk factors in male patients who have lower urinary tract symptoms

ABSTRACT
Hong Kong Med J 2007;13:421-6 | Number 6, December 2007
ORIGINAL ARTICLE
The prevalence of cardiovascular risk factors in male patients who have lower urinary tract symptoms
CF Ng, A Wong, ML Li, SY Chan, SK Mak, WS Wong
Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To assess the prevalence of cardiovascular risk factors in men presenting with lower urinary tract symptoms, and their possible correlation with the severity of such symptoms.
 
DESIGN. Retrospective cohort study.
 
SETTING. Specialty clinic, Hong Kong.
 
PATIENTS. A total of 617 men presenting with lower urinary tract symptoms between April 2005 and October 2006.
 
MAIN OUTCOME MEASURES. Presence of cardiovascular risk factors inferred from the prior and current medical and social history as well as physical examination and investigative findings, among patients with International Prostatic Symptom Scores of different severity.
 
RESULTS. Of 617 patients, 268 (43%) had known hypertension and 318 (52%) had a history of smoking. According to the World Health Organization criteria for Asian populations, 396 (64%) patients were considered to be overweight (body mass index > or =23 kg/m(2)). A total of 178 (29%) patients were either known to have or were diagnosed to have dysglycaemia during workup. For dyslipidaemia and hyperuricaemia, the corresponding figures were 331 (54%) and 191 (31%). In total, 264 (43%) patients were newly diagnosed as having dysglycaemia, dyslipidaemia, or hyperuricaemia. Logistic regression indicated that only hyperuricaemia and a smoking history were significant predictors of moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8), with respective adjusted odds ratios of 2.20 (95% confidence interval, 1.12-4.31; P=0.022) and 2.11 (1.24-3.57, P=0.006). Patients with moderate-to-severe International Prostatic Symptom Scores had a statistically higher chance of having at least one cardiovascular risk factor during assessment (P=0.001).
 
CONCLUSIONS. Cardiovascular risk factors were prevalent in male patients who had lower urinary tract symptoms; a large portion of these cardiovascular risk factors were not recognised until their urological consultations. Patients with moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8) had statistically higher chances of having more cardiovascular risk factors.
 
Key words: Cardiovascular diseases; Hyperuricemia; Smoking; Urinary tract infections
 
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Seasonal variations in non-traumatic major lower limb amputation in Hong Kong Chinese diabetic patients

ABSTRACT
Hong Kong Med J 2007;13:379-81 | Number 5, October 2007
ORIGINAL ARTICLE
Seasonal variations in non-traumatic major lower limb amputation in Hong Kong Chinese diabetic patients
HB Leung, YC Ho, WC Wong, Jeff Guerin
Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Kowloon, Hong Kong (currently at Department of Orthopaedic Surgery, Queen Mary Hospital, Hong Kong)
 
 
OBJECTIVES. To study the relationship between hospitalisation for diabetic foot complications, non-traumatic major lower limb amputations, and seasonal variation in humidity and temperature.
 
DESIGN. Retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. Diabetic patients hospitalised for lower limbs infection during the inclusive period 1995 to 2004.
 
MAIN OUTCOME MEASURES. Monthly incidence of admissions for diabetic foot sepsis and non-traumatic non-neoplastic major lower limb amputations correlated with the monthly average humidity and temperature.
 
RESULTS. During the study period, a total of 770 patients contributed to 1285 episodes of hospitalisation and ensued 208 corresponding major lower limb amputations. Poisson regression study showed that the monthly incidences of hospitalisation as well as amputations were related to the monthly average temperature (P<0.001 and =0.0012, respectively) but not the monthly average humidity (P=0.1560 and 0.6332, respectively).
 
CONCLUSION. The warm and humid weather of Hong Kong exerts a seasonal variation on the diabetic foot infection presentations. Warm temperature aggravates the severity of infection and precipitates amputation. More intensive patient education and clustering of medical services in late winter and spring might reduce the incidence of diabetic foot amputation, which is a preventable complication.
 
Key words: Amputation; Diabetes mellitus; Humidity; Seasons; Temperature
 
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Clinical experience with a chronic pain management programme in Hong Kong Chinese patients

ABSTRACT
Hong Kong Med J 2007;13:372-8 | Number 5, October 2007
ORIGINAL ARTICLE
Clinical experience with a chronic pain management programme in Hong Kong Chinese patients
Alice KY Man, MC Chu, PP Chen, M Ma, Tony Gin
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVE. To describe experience with a chronic pain management programme in Hong Kong Chinese patients.
 
DESIGN. Prospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PARTICIPANTS. Patients with chronic pain who participated in the first six Comprehensive Out-patient Pain Engagement programmes between 2002 and 2005.
 
INTERVENTION. Comprehensive Out-patient Pain Engagement is a 14-day structured, multidisciplinary out-patient programme conducted over 6 weeks. It includes pain education, cognitive re-conceptualisation, training in communication skills and coping strategies, graded physical exercises and functional activities training. It aims to improve patient function and quality of life, despite persistent pain.
 
MAIN OUTCOME MEASURES. Changes in scores from baseline values after joining the programme, with respect to several assessment tools. These included the following: visual analogue pain scale, Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, Canadian Occupational Performance Measure, Medical Outcome Survey-Short Form 36 Questionnaire, and duration of physical tolerances, medication utilisation, and work status records.
 
RESULTS. Forty-five patients were available for analysis. After the Comprehensive Out-patient Pain Engagement programme, improvements in Medical Outcome Survey-Short Form 36 Questionnaire (role physical and vitality), Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, and Canadian Occupational Performance Measure were demonstrated (P<0.05). The duration of standing and sitting tolerances increased (P<0.05). An improvement in employment rate was also evident (P=0.01).
 
CONCLUSION. The initial results of our management programme in Chinese patients with chronic pain are encouraging. This type of programme should be promoted more widely in this group of patients, as it appears to improve physical function, psychological well-being, and productivity.
 
Key words: Chronic disease; Cognitive therapy; Combined modality therapy; Pain management; Quality of life
 
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Perceived child behaviour problems, parenting stress, and marital satisfaction: comparison of new arrival and local parents of preschool children in Hong Kong

ABSTRACT
Hong Kong Med J 2007;13:364-71 | Number 5, October 2007
ORIGINAL ARTICLE
Perceived child behaviour problems, parenting stress, and marital satisfaction: comparison of new arrival and local parents of preschool children in Hong Kong
Shirley SL Leung, Cynthia Leung, Ruth Chan
Family Health Service, Department of Health, 18/F, Wu Chung House, 213 Queen's Road East, Wanchai, Hong Kong
 
 
OBJECTIVE. To compare parental perception of child behaviour problems, parenting stress, and marital satisfaction in new arrival and local parents.
 
DESIGN. Cross-sectional survey; semi-structured interview.
 
SETTING. Maternal and Child Health Centres, social service centres, preschools.
 
PARTICIPANTS. Parents of preschool children, including new arrival parents and local parents.
 
MAIN OUTCOME MEASURES. Child behaviour problems, parenting stress, and marital satisfaction.
 
RESULTS. After controlling for socio-economic factors, new arrival parents were more troubled by their children's behaviour problems and their parent-child interactions were more dysfunctional than those of local parents. There were no differences in parent-reported severity of child behaviour problems, parental distress, and marital satisfaction. New arrival parents reported difficulties in adapting to the new living environment and lack of social support.
 
CONCLUSIONS. New arrival parents were more troubled by their children's behaviour, and their parent-child interactions were more dysfunctional than those of local parents. These might in part be related to their settlement difficulties. Parenting programmes should address their specific settlement needs.
 
Key words: Child behavior disorders; Emigration and immigration; Marriage; Parenting; Stress, psychological
 
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Analogues of erectile dysfunction drugs: an under-recognised threat

ABSTRACT
Hong Kong Med J 2007;13:359-63 | Number 5, October 2007
ORIGINAL ARTICLE
Analogues of erectile dysfunction drugs: an under-recognised threat
WT Poon, YH Lam, CK Lai, Albert YW Chan, Tony WL Mak
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
OBJECTIVES. To investigate the problem of drug analogue adulteration in male erectile dysfunction health products.
 
DESIGN. Survey of over-the-counter male erectile dysfunction health products available in convenience stores and pharmacies in Hong Kong.
 
SETTING. Tertiary referral centre for clinical toxicology analysis in Hong Kong.
 
MAIN OUTCOME MEASURES. The pattern and extent of adulteration of male erectile dysfunction health products with sildenafil, tadalafil, and vardenafil as well as their structurally modified analogues.
 
RESULTS. Of 26 products studied, one (4%) was found to contain undeclared sildenafil, while 14 (54%) contained drug analogues of different kinds. The latter included acetildenafil, hydroxyacetildenafil, hydroxyhomosildenafil, and piperidenafil. The first three were analogues of sildenafil and the last was an analogue of vardenafil. One young patient presented with ataxia after taking an acetildenafil-containing product.
 
CONCLUSIONS. The positive rate of concealed drug analogues in male erectile dysfunction health products is alarmingly high. Such analogues are difficult to detect by ordinary laboratory methods, and might be used in an attempt to evade regulatory inspection. Without going through the stringent drug testing process, the adverse effects of these chemicals remain largely unknown and unpredictable. Effective surveillance system and control measures are needed urgently. The medical profession and the public should be alerted to this under-recognised threat.
 
Key words: Designer drugs; Impotence; Sildenafil; Vardenafil
 
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Is regular follow-up scan for giant liver haemangioma necessary?

ABSTRACT
Hong Kong Med J 2007;13:353-8 | Number 5, October 2007
ORIGINAL ARTICLE
Is regular follow-up scan for giant liver haemangioma necessary?
Wilson WC Ng, YS Cheung, KF Lee, John Wong, Simon CH Yu, Paul SF Lee, Paul BS Lai
Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To review the reliability of radiological diagnosis and need of regular scans for giant liver haemangioma, in terms of long-term outcome and management options.
 
DESIGN. Retrospective study.
 
SETTING. Division of Hepato-biliary and Pancreatic Surgery, Prince of Wales Hospital, Hong Kong.
 
PATIENTS. Patients with giant liver haemangioma noted on initial imaging from February 1996 to July 2006.
 
MAIN OUTCOME MEASURES. Patient demographics, clinical assessments, management, and outcomes.
 
RESULTS. There were 42 female and 22 male patients with a median age of 49 (range, 27-84) years with a suspected haemangioma. The median maximal diameter of the lesions was 5.5 cm (range, 4.0-20.3 cm). They were first detected by ultrasonography (n=45), contrast-enhanced computed tomographic scan (n=18), or magnetic resonance imaging (n=1). Besides regular follow-up scans, 22 patients were investigated further to confirm the diagnosis/ exclude malignancy. Finally, 63 patients had a haemangioma and one had a hepatocellular carcinoma. Regarding the patients with haemangiomas, two were operated on for relief of pain and the rest were managed conservatively. The median duration of follow-up was 34 months. Most (54%) of the patients were asymptomatic, but in 17% the haemangioma enlarged to exceed its original size by more than 20%. There were no haemangioma-associated complications.
 
CONCLUSIONS. Majority of patients having giant liver haemangioma are asymptomatic and do not suffer complications. If the diagnosis is uncertain, selective further investigations may be necessary. Lesions with a confirmed diagnosis tend to remain static in size; performing regular scans for asymptomatic giant liver haemangiomas may not be necessary.
 
Key words: Hemangioma; Liver neoplasms; Magnetic resonance imaging; Tomography, X-ray computed
 
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Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients

ABSTRACT
Hong Kong Med J 2007;13:348-52 | Number 5, October 2007
ORIGINAL ARTICLE
Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients
SH Wan, TC Wong, TH Yip, FK Ip
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVE. To report preliminary experience on the Camitz operation for elderly Chinese patients in a Hong Kong public hospital.
 
DESIGN. Retrospective study.
 
SETTING. Tertiary referral hospital with hand surgery service in Hong Kong.
 
PATIENTS. Between January 2000 and January 2004, patients with carpal tunnel syndrome having the Camitz operation were recruited. They were assessed using the measurements of pinch and grip power, sensation, the Kapandji score, and functional grading as well as complications encountered during the subsequent follow-up.
 
INTERVENTION. The Camitz operation.
 
RESULTS. A total of 21 patients (8 male and 13 female; mean age, 70 years) were recruited. The mean duration of follow-up was 15 months. There was significant improvement in pinch power, grip power, and hand functions, as well as a positive correlation between the functional score and the Kapandji score. No major complication was recorded. One patient with pre-existing osteoarthritis of the ring finger developed contracture of the proximal interphalangeal joint.
 
CONCLUSION. The Camitz operation is a simple, effective, and safe means of improving hand function in elderly Chinese patients with long-standing carpal tunnel syndrome and thenar muscle atrophy. Newly acquired strength in antepulsion of thumb resulted in improved pinch, grip, and hand function in this patient group.
 
Key words: Aged; Carpal tunnel syndrome; Hand/surgery; Thumb
 
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Evaluation of a Hong Kong Chinese version of a self-administered questionnaire for assessing symptom severity and functional status of carpal tunnel syndrome: cross-cultural adaptation and reliability

ABSTRACT
Hong Kong Med J 2007;13:342-7 | Number 5, October 2007
ORIGINAL ARTICLE
Evaluation of a Hong Kong Chinese version of a self-administered questionnaire for assessing symptom severity and functional status of carpal tunnel syndrome: cross-cultural adaptation and reliability
Margaret WM Fok, HB Leung, WM Lee
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam Road, Hong Kong
 
 
OBJECTIVES. To evaluate the application of a translated version of an established self-administered questionnaire for carpal tunnel syndrome on Chinese patients in Hong Kong.
 
DESIGN. Evaluation of an instrument tool.
 
SETTING. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong; Holistic Medical Centre, Aberdeen, Hong Kong.
 
PARTICIPANTS. Patients with carpal tunnel syndrome, translators.
 
MAIN OUTCOME MEASURES. The adaptation was based on forward-backward translation from English to Chinese (Hong Kong) and vice versa. Meetings with translators, investigators, and patients were organised to generate an acceptable version of the questionnaire. A pilot study was carried out on 20 patients and subsequently minor adjustments were added. Fifty patients were recruited to validate the reliability and internal consistency of the questionnaire.
 
RESULTS. The ordinality of response agreed with the original instrument. Test-retest reproducibility showed no significant difference between tests. The Pearson correlation coefficient ranged from 0.83 to 0.93. Internal consistency was good, at 0.85.
 
CONCLUSION. Through the validation of the Hong Kong Chinese version of the questionnaire, we are able to produce an assessment tool for the local patients. Furthermore, we are able to create a platform for: (i) a cross-national and cross-cultural epidemiological comparison as well as a means of (ii) evaluating different types of treatments.
 
Key words: Carpal tunnel syndrome; Questionnaires; Reproducibility of results
 
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Attitudes towards day-case surgery in Hong Kong Chinese patients

ABSTRACT
Hong Kong Med J 2007;13:298-303 | Number 4, August 2007
ORIGINAL ARTICLE
Attitudes towards day-case surgery in Hong Kong Chinese patients
YC Lee, PP Chen, Jacqueline Yap, Patricia Yeo, Christopher Chu
Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong
 
 
OBJECTIVE. To evaluate attitudes of Chinese patients towards day-case surgery.
 
DESIGN. Prospective cross-sectional questionnaire survey. SETTING. District public hospital, Hong Kong.
 
PATIENTS. Two hundred patients attending a preanaesthetic assessment clinic between 1 January and 30 June 2004 were invited to participate.
 
MAIN OUTCOME MEASURES. Demographic profiles, understanding and attitudes towards day-case surgery, preference for day-case surgery before and after the experience, postoperative adverse effects, and patient satisfaction.
 
RESULTS. The mean age of the patients was 28 (standard deviation, 19) years. In all 200 respondents completing the survey, 180 preferred day-case surgery. Important reasons for this view were: shorter duration of hospitalisation, dislike of hospital environments, belief that hospitals are highly infectious, need to look after their families, desire to return to work early, and doctors??advice. Small home environments and belief that day-case surgery was unsafe were not important. Respondents who did not prefer day-case surgery stressed the importance of better care available for hospital in-patients, concerns about surgical complications, postoperative nausea and vomiting, and doctors??advice. Only 11% patients complained of postoperative adverse effects. Demographic characteristics and previous day-case surgery experience did not have any effect on patient preferences. However, experiencing a postoperative adverse effect significantly affected the preference (P=0.005) and satisfaction (P=0.001) of respondents for day-case surgery.
 
CONCLUSION. Local Chinese patients attending our institution have a high preference for day-case surgery. Postoperative adverse effects might influence the respondents??satisfaction and preference after their surgical experience.
 
Key words: Ambulatory surgical procedures; Patient satisfaction
 
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