OBJECTIVE. To investigate the relationship between musculoskeletal pain and disability among a group of geriatric out-patients.

DESIGN. Consecutive case series.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Attendees at a geriatric specialist out-patient clinic from October 2002 to February 2003.

MAIN OUTCOME MEASURES. Pain duration, location, intensity, and frequency; use of analgesics; ability to identify the cause of pain; disability (Barthel index) and Lawton Instrumental Activities of Daily Living scale score; depressive symptoms (Geriatric Depression Scale score); and self-reported sleep quality.

RESULTS. Of the 749 respondents, 461 (61.5%) had experienced pain in the previous 2 weeks. Among these patients, 51.3% had received a pain-relieving drug. Compared with men, women reported a higher pain intensity (5.87 versus 5.26; P=0.001), had a lower Barthel index (96.0 versus 97.9; P=0.005), and had a lower score on the Lawton Instrumental Activities of Daily Living scale (42.19 versus 44.52; P=0.008). Multivariate logistic regression showed that the presence of pain was associated with female sex (odds ratio=2.25), poor self-rated health (0.69), and depression (1.54).

CONCLUSION. Pain is a common problem among the elderly population, but it is not associated with physical disability, and only half of the patients received analgesics. The study provides information for health care workers to develop strategies to better assess and manage pain problems among elderly people.

Key words: Aged; Disability evaluation; Musculoskeletal diseases; Pain; Sex factors

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OBJECTIVE. To examine the profile and referral pattern of patients attending an out-patient pain management service in Hong Kong.

DESIGN. Prospective cross-sectional survey.

SETTING. Regional public hospitals, Hong Kong.

PATIENTS. All patients attending out-patient pain management clinics in the New Territories East public hospitals between 1 September and 31 December 2002.

MAIN OUTCOME MEASURES. Demographic profiles, referring specialty, pain diagnosis, pain sites, duration and severity of pain, treatment modality, litigation, compensation, and social welfare status. Data were collected using a standardised questionnaire.

RESULTS. Two hundred and forty-eight patients were interviewed. Most patients (70%) were middle-aged, with 21% over 60 years. Seventy-nine percent of patients were referred to the clinics either from orthopaedic surgeons (64.1%), general and other surgeons (14.9%), or general practitioners (3.6%). The median (range) duration of pain was 2.3 (0.08-26.7) years. The most common pain diagnoses were musculoskeletal back pain (46.4%) and neuropathic pain (27.8%). A total of 11.3% of the patients had two pain diagnoses, while 40.7% complained of pain in more than one location. Pain in the limbs was the most frequent complaint followed by the head, neck, and back. Approximately 38% of patients had tried four or more treatment modalities. Oral medication was the most common method (86.7%) of pain-relief treatment. More than half of the patients had also tried physiotherapy and traditional Chinese medicine. Approximately 37% of the patients were unemployed, while 31% were receiving social security subsidy. Eighty-six patients had pain associated with a work-related injury, and of these patients, 80% were involved in compensation claims.

CONCLUSIONS. The profile of patients referred to the pain management clinics was complex. Patients were mainly referred from specialists. The economic implication in this group of patients is likely to be significant as many patients utilised multiple treatment modalities, were unemployed and on social welfare benefits, and were involved in compensation and litigation proceedings.

Key words: Health care surveys; Pain; Pain clinics

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OBJECTIVES. To investigate precipitating factors for systolic and diastolic heart failure.

DESIGN. Prospective study.

PATIENTS AND METHODS. The study population consisted of 192 patients with heart failure treated for 536 episodes of acute decompensation of heart failure from 1998 to 2002. The patients were classified as having systolic or diastolic heart failure, and grouped according to aetiology and precipitating factors.

RESULTS. Coronary heart disease was the most common cause of systolic heart failure, whereas rheumatic heart disease was the most frequent cause of diastolic heart failure. The most important precipitating factors in systolic heart failure were infections (38%), arrhythmias (35%), and vascular causes (24%), whereas the precipitating factors in diastolic heart failure were infections (50%), arrhythmias (46%), and uncontrolled hypertension (26%). Avoidable precipitating factors in systolic and diastolic heart failure were noted in 34% and 68% of cases, respectively.

CONCLUSIONS. Better patient education and better follow-up of patients by physicians according to the most recent guidelines may decrease the frequency of heart failure events and consequent morbidity and mortality.

Key words: Heart failure, congestive; Precipitating factors; Ventricular dysfunction, left; Ventricular dysfunction, right

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OBJECTIVE. To assess the safety, feasibility, and acceptability of patient-controlled sedation for elective day-case colonoscopy, and the factors predicting patients' unwillingness to use patient-controlled sedation for colonoscopy.

DESIGN. Prospective, non-randomised study.

SETTING. University-affiliated endoscopy centre, Hong Kong.

PARTICIPANTS. Five hundred patients who underwent elective day-case colonoscopy were prospectively recruited from January 2001 to June 2002.

INTERVENTION. Sedation for colonoscopy was a mixture of propofol and alfentanil, which was delivered by means of a patient-controlled syringe pump. Each bolus delivered 4.8 mg propofol and 12 μg alfentanil. No loading dose was used and the lockout time was set at zero.

MAIN OUTCOME MEASURES. Cardiopulmonary complications, dose of patient-controlled sedation used, recovery time, satisfaction score, delayed side-effects, and the willingness to use the same sedation protocol for future colonoscopy. A multiple stepwise logistic regression model was used to assess which factors might predict unwillingness to use patient-controlled sedation for colonoscopy.

RESULTS. The mean (standard deviation) age of patients was 53.0 (13.9) years. The mean dose of propofol consumed was 0.93 (0.69) mg/kg. Forty-three (8.6%) patients developed hypotension during the procedure. The mean satisfaction score was 7.2 (2.6). Sixteen (3.2%) patients developed delayed side-effects. The median (interquartile range) recovery time was 0 (0-5) minutes. Approximately 78% of patients were willing to use patient-controlled sedation for future colonoscopy if needed. Younger age (<50 years), female sex, a higher mean dose of sedatives used, a lower satisfaction score, and the presence of delayed side-effects were independent factors that were associated with patients" unwillingness to use patient-controlled sedation for colonoscopy.

CONCLUSION. The use of patient-controlled sedation for elective colonoscopy is safe, feasible, and acceptable to most patients.

Key words: Alfentanil; Colonoscopy; Conscious sedation; Propofo

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OBJECTIVES. To study the spectrum of diseases that can be detected by magnetic resonance imaging in patients suspected to have vestibular schwannoma (acoustic neuroma) presenting with sensorineural or mixed hearing loss, and to assess the extent of the problem of hearing loss in a screened population.

DESIGN. Retrospective study.

SETTING. Diagnostic radiology and imaging department of a regional hospital, Hong Kong.

PATIENTS. A total of 1821 consecutive patients from September 1999 to February 2001 with sensorineural or mixed hearing loss were referred by otolaryngologists for magnetic resonance imaging of the internal auditory canal.

MAIN OUTCOME MEASURES. Vestibular schwannoma; other cerebellopontine angle masses and other diseases that could account for the patients’ hearing loss.

RESULTS. In all, 132 (7%) patients had positive findings that could explain their hearing loss. Fifty-four (41%) of the 132 patients had vestibular schwannoma; 39 (30%) had inflammation of the middle ear and mastoids; 17 (13%) had ischaemic foci in the brainstem; 10 (8%) had other cerebellopontine angle masses or tumours; four (3%) had inner ear dysplasia; seven (5%) had vascular loop compression; and one (1%) had chronic cryptococcal meningitis. The overall incidence of vestibular schwannoma detected in this screened population was about 3%.

CONCLUSIONS. This study indicates that magnetic resonance imaging is an effective tool to screen for vestibular schwannoma in patients with sensorineural or mixed hearing loss. It can also be used to assess a considerable number of different pathological conditions in patients with audiovestibular disorders.

Key words: Hearing loss; Magnetic resonance imaging; Neuroma, acoustic

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