OBJECTIVE. To examine the loss of earning capacity and permanent impairment of a cohort of male patients who had experienced finger amputation due to occupational injury.

DESIGN. Prospective cohort study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Twenty-eight male patients aged 26 to 55 years who presented with work-related finger amputations in their dominant right hand from 1990 through 1991.

MAIN OUTCOME MEASURES. Type and extent of amputation, and hand function before and after (mean, 11 months; range, 8-6 months) the patients’ return to work. Assessment results were compared with patients’ percentage loss of earning capacity as calculated using the scale described in the Employees’ Compensation Ordinance of Hong Kong.

RESULTS. Patients with injuries that corresponded to a loss of earning capacity of 12% or greater had a significant impairment in their hand function (P<0.05); the hand function of this group after their return to work significantly improved (P<0.05). There were no significant differences between the loss of earning capacity scores as calculated by the Hong Kong, American Medical Association, or Indian Medical Association scales.

CONCLUSION. Patients whose loss of earning capacity of 12% or greater are likely to have significant long-term impairments of hand function. Thus, a more intensive rehabilitation programme should be provided to this group.

Key words: Accidents, occupational; Amputation; Disability evaluation; Finger injuries; Hand injuries

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OBJECTIVE. To evaluate the liquid-based ThinPrep Papanicolaou test.

DESIGN. Prospective comparison of the ThinPrep test with the conventional Papanicolaou test.

SETTING. Cervical smear specimens sent to a private practice, Hong Kong.

PATIENTS. A total of 16 541 ThinPrep test specimens and 7258 conventional Papanicolaou smears from Hong Kong women who had been screened for cervical cancer between mid-July 1998 and mid-January 1999.

MAIN OUTCOME MEASURES. Specimen adequacy, endocervical cell content, epithelial cell abnormalities, and micro-organisms present in both types of cervical smears; histological diagnosis of cervical biopsy specimens of women who had the ThinPrep test.

RESULTS. Compared with the conventional Papanicolaou smear test, the ThinPrep test showed a reduction in the frequency of ‘unsatisfactory’ (0.56% versus 1.36%; P<0.01), ‘satisfactory but limited’ (1.67% versus 15.87%; P<0.01), and ‘atypical squamous cells of undetermined significance’ reports (1.72% versus 3.64%; P<0.01). The ThinPrep test was also more effective at detecting squamous intraepithelial lesions, showing a 58% increase for low-grade lesions (2.66% versus 1.68%; P<0.01) and 28% increase for high-grade lesions (1.71% versus 1.34%; P<0.01). The sensitivity and positive predictive value of the ThinPrep system were 97.5% and 94.2%, respectively. The liquid-based method yielded a higher percentage of samples that contained endocervical cells compared with conventional smear specimens (70.57% versus 51.23%; P<0.001).

CONCLUSIONS. The ThinPrep test has high a sensitivity and positive predictive value. The ThinPrep test gives higher-quality specimens and has a higher detection rate of squamous intraepithelial lesions than does the conventional Papanicolaou smear test. The drawbacks of the liquid-based system, however, pertain to cost and the additional procedures and training needed.

Key words: Cervical intraepithelial neoplasia; Cervix neoplasms; Cytological techniques; Laboratory techniques and procedures; Vaginal smears/methods

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OBJECTIVE. To audit the diagnostic accuracy and value of fine-needle aspiration cytology in the assessment of thyroid nodules over a 5-year period.

DESIGN. Retrospective study.

SETTING. Private practice, Hong Kong.

PATIENTS. The computerised records from cytological and histological examinations of all thyroid specimens submitted from 1993 through 1997 were studied; the 1236 aspirates came from 1033 women and 175 men (gender was not specified in 28 cases).

MAIN OUTCOME MEASURES. Cytological reports were classified diagnostically, and histological and cytological correlations were determined.

RESULTS. Of the 1236 aspirates, 113 (9.1%) were unsatisfactory; 1013 (82.0%), including cysts, were benign; and 110 (9.0%) were neoplastic or malignant. Histological follow-up was available for 149 cases; 13 were unsatisfactory for cytological diagnosis. Statistical analysis of the remaining 136 cases yielded the following results: sensitivity of fine-needle aspiration cytology, 56%; specificity, 90%; positive predictive value, 74%; negative predictive value, 80%; accuracy, 79%. These results were within the range of previously published values. The sensitivity was improved by combining clinical information: if nodules larger than 3-cm diameter were excised (despite a non-neoplastic aspiration cytology report), the sensitivity increased to 71% and the accuracy to 84%.

CONCLUSION. Fine-needle aspiration cytology is an effective screening test to help evaluate whether surgery is required in the management of thyroid nodules. False-positive and false-negative rates can be minimised by taking clinical and imaging data into consideration.

Key words: Biopsy, needle; Cytodiagnosis; Predictive value of tests; Sensitivity and specificity; Thyroid neoplasms

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OBJECTIVE. To review the data of paediatric cancer that had been collected by the Hong Kong Cancer Registry from 1982 through 1991.

DESIGN. Cross-sectional retrospective study.

SETTING. Hong Kong.

PATIENTS. Children aged 15 years or younger.

MAIN OUTCOME MEASURES. The types of cancer were classified into 12 diagnostic groups according to morphology (following the International Classification of Diseases for Oncology M-code). The incidences of the different types of cancer were obtained with reference to the Hong Kong population aged 15 years or younger. Data collected between 1989 and 1991 were checked by paediatric oncologists from the Hong Kong Paediatric Haematology and Oncology Study Group.

RESULTS. A total of 1756 cases of paediatric cancer were registered during the 10-year period. The incidence of cancer was 144.3 new cases per million children. Leukaemia was the most common form of childhood cancer (40.0%), followed by brain tumour (16.3%), and lymphoma (10.8%). The relative frequencies of neuroblastoma (2.4%) and Wilms’ tumour (3.5%) were lower than those reported from western countries.

CONCLUSION. The incidences and types of paediatric cancer in Hong Kong are similar to those in western countries. Collaboration with paediatric oncology groups should provide more accurate information on the incidence and survival rates of children with cancer in Hong Kong.

Key words: Age factors; Child; Neoplasms/epidemiology; Neoplasms/mortality; Survival rate

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OBJECTIVE. To assess a nurse-implemented geriatric screening system.

DESIGN. Descriptive study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. All (5080) elderly patients admitted between 1 January 1996 and 31 December 1996.

MAIN OUTCOME MEASURES. Patient characteristics such as disease, prior admission, living quarters, and regular medications; interventions taken; and morbidity and mortality.

RESULTS. The most common interventions were referral to a convalescent hospital, patient education, and carer contact. The overall death rate was 8.5% and the diseases with the highest mortality rates were renal failure, liver cirrhosis, and cancer. Approximately one quarter of patients had been admitted to hospital in the previous month. The death rate was higher among women than men (10.8% versus 6.7%, P<0.001; odds ratio=1.68; 95% confidence interval, 1.38-2.05), as was the percentage of those with a history of admission in the previous month (32.8% versus 20.0%, P<0.001; odds ratio=1.95; 95% confidence interval, 1.71-2.21). Patients with multiple pathologies and polypharmacy had a greater frequency of previous 1-month admission compared with those who did not have these features (37.5% versus 20.0%, P<0.001; odds ratio=2.37; 95% confidence interval 2.0-2.7). Patients living in old-age homes had a higher death rate and more previous 1-month admissions than home dwellers, and patients living in private old-age homes had a higher death rate but lower number of previous 1-month admissions than those living in subsidised old-age homes.

CONCLUSIONS. This study has collected important data from one form of integrated geriatric practice, which can be used for future service provision.

Key words: Aged; Geriatric assessment; Health services for the aged; Hospitalization; Patient care team

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