OBJECTIVE. To evaluate the ability of patients to recall information provided during a preoperative visit.

DESIGN. Qualitative study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Sixty patients scheduled for elective surgery under general anaesthesia or central neuro-axial block.

MAIN OUTCOME MEASURES. Satisfactory recall of preoperative information, defined as the ability to remember at least 75% of adverse effects described.

RESULTS. Fifty-nine (98.3%) patients were satisfied with the preoperative information. Forty-two (70%) patients rated anaesthetic complications as important. At the interview on the day of the operation, 57 (95%) patients had satisfactory recall of the information provided. Eighty-five percent of patients remembered that the information was provided by an anaesthesiologist. After the operation, of those who experienced adverse effects, 48 (96%) patients remembered being told to anticipate the adverse anaesthetic event. Univariate analysis found that age, sex, education level, occupation, and the modality of anaesthesia did not affect patient recall of preoperative information on the day of surgery or 1 day postsurgery.

CONCLUSION. There was satisfactory recall of preoperative information by the majority of patients in the study. Most patients expressed satisfaction with the information provided.

Key words: Anesthesia; Memory/drug effects; Recall

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OBJECTIVES. To evaluate performance characteristics of the newly available handheld combined glucose and ketone meter for beta-hydroxybutyrate measurement.

DESIGN. Laboratory method evaluation.

MAIN OUTCOME MEASURES. Accuracy of beta-hydroxybutyrate measurement and effect of acetoacetate interference at clinically important beta-hydroxybutyrate levels.

RESULTS. Deming regression analysis of beta-hydroxybutyrate measurements assessed by the ketone sensor and a laboratory enzymatic method revealed a coefficient of determination of 0.989 (P<0.001). Passing-Bablok regression analysis showed a linear relationship between the two methods, ie Y= –0.32+1.13X. The 95% confidence interval of the slope and y-intercept were: slope=1.13 (95% confidence interval, 1.04 to 1.22); intercept= –0.32 (95% confidence interval, -0.59 to -0.06). The Bland-Altman plot showed a small proportional bias between the two methods. The mean bias ±2 standard deviations was between -0.53 and 0.67 mmol/L. Beta-hydroxybutyrate measurements made by the sensor were linear up to 6 mmol/L. Replicate analysis of two samples spiked with 3.6 mmol/L and 0.8 mmol/L of beta-hydroxybutyrate resulted in coefficients of variation of 3.3% and 13%, respectively. The presence of acetoacetate caused a negative interference in beta-hydroxybutyrate measurement. Beta-hydroxybutyrate recovery was 97.0% and 90.7% when the ketone body ratios were 6:1 and 3:1, respectively.

CONCLUSION. The analytical performance of the sensor, when operated according to manufacturer’s instructions, could meet the needs of point-of-care beta-hydroxybutyrate measurement. Additional clinical studies are needed to assess the benefits of introducing such an assay in a clinical setting.

Key words: 3-Hydroxybutyric acid; Ketones; Point-of-care systems

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OBJECTIVE. To identify risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage.

DESIGN. Retrospective study.

SETTING. Regional obstetric unit, Hong Kong.

SUBJECTS AND METHODS. Women delivered at Princess Margaret Hospital between 1 January 1990 and 31 December 1997. Possible risk factors for preterm delivery among women with placenta praevia and antepartum haemorrhage including onset, pattern, and severity of vaginal bleeding; presence of uterine contractions on admission; and type of placenta were assessed.

RESULTS. Three risk factors for preterm delivery were identified from univariate analysis. These included second trimester vaginal bleeding (odds ratio=4.19; 95% confidence interval, 1.29-13.66), the presence of uterine contractions on admission (odds ratio=4.00; 95% confidence interval, 1.57-10.19), and a haemoglobin decrease of more than 20 g/L (odds ratio=3.00; 95% confidence interval, 1.00-9.04). Using the logistic regression model, second trimester vaginal bleeding and the presence of uterine contractions were found to be independent risk factors for delivery before 36 weeks.

CONCLUSION. Preterm delivery is increased in women with placenta praevia and antepartum haemorrhage who have second trimester vaginal bleeding or the presence of uterine contractions. This high-risk group may benefit from close in-patient monitoring and more aggressive management.

Key words: Labor, premature; Placenta praevia; Uterine hemorrhage

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OBJECTIVE. To identify characteristics of patients who abscond from general hospital wards, and to determine patient outcomes.

DESIGN. Retrospective study.

SETTING. In-patient wards of a public general hospital, Hong Kong.

SUBJECTS AND METHODS. Incident reports of 116 absconding episodes over a 20-month period from 1 November 1998 to 30 June 2000 were reviewed. Clinical characteristics, time and reason for absconding, destination of patient, outcomes, and adverse events were recorded.

RESULTS. The majority of patients who absconded were middle-aged males admitted through the Accident and Emergency Department to the specialty of Medicine. Most incidences occurred within 24 hours of admission while in the emergency admission wards. Twelve percent of incidents were due to repeat episodes of absconding. The most common clinical diagnoses given to this patient group were drug overdose, intoxication, and soft tissue injury. Known drug addicts (29.3%) formed a substantial proportion of the patient group. Forty-seven patients returned to the ward within a few hours, while a further nine (7.8%) re-attended the Accident and Emergency Department of the hospital within 4 days. Several adverse outcomes were recorded: one patient died following a fall from height and two patients committed criminal offences.

CONCLUSION. Patient absconding incidents are an important issue in hospital risk management. They can delay the delivery of appropriate medical treatment and may also lead to other adverse patient outcomes, in addition to potential medicolegal consequences.

Key words: Hospitals, general; Inpatients; Patient dropouts; Risk management

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OBJECTIVE. To study the epidemiology of Chinese multiple sclerosis in Hong Kong.

DESIGN. Cross-sectional questionnaire survey.

SETTING. All neurologists and some paediatric neurologists who looked after multiple sclerosis patients in Hong Kong from January through June 1999.

PARTICIPANTS. All confirmed multiple sclerosis patients.

MAIN OUTCOME MEASURES. Demographic data, investigation results, Kurtzke’s Expanded Disability Status Scale during the last follow-up visit, number of relapses between 1997 and 1998, and treatments used/currently in use.

RESULTS. Fifty-three Chinese multiple sclerosis patients were identified. The prevalence was therefore estimated to be 0.77 per 100 000 head of population. This low prevalence was also noted in other multiple sclerosis studies from South-East Asia (range, 0.8-4 per 100 000 head of population). The female to male ratio among the Chinese multiple sclerosis sufferers was 9.6:1, a figure somewhat higher than that reported in the other studies from South-East Asia (range, 3.2-6.6:1). The Chinese multiple sclerosis patients in this study also had a high spinal cord involvement (66%) and a low presence of cerebrospinal fluid oligoclonal banding (40%). These findings were different from those in Caucasian multiple sclerosis patients.

CONCLUSION. Chinese multiple sclerosis in Hong Kong has a low prevalence, a high female to male ratio, and a low cerebrospinal fluid oligoclonal banding presence.

Key words: Epidemiology; Hong Kong; Multiple sclerosis

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