Structured assessment of mental capacity to make financial decisions in Chinese older persons with mild cognitive impairment and mild Alzheimer disease.

Previous studies suggested that patients with mild cognitive impairment (MCI) or dementia can have impaired and declining financial skills and abilities. The purpose of this study is to test a clinically applicable method, based on the contemporary legal standard, to examine directly the mental capacity to make financial decisions and its component decision-making abilities among patients with MCI and early dementia. A total of 90 patients with mild Alzheimer disease (AD), 92 participants with MCI, and 93 cognitively normal control participants were recruited for this study. Their mental capacity to make everyday financial decisions was assessed by clinician ratings and the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED). Based on the clinician ratings, only 53.5% were found to be mentally competent in the AD group, compared with 94.6% in the MCI group. However, participants with MCI had mild but significant impairment in understanding, appreciating, and reasoning abilities as measured by the ACED. The ACED provided a reliable and clinically applicable structured framework for assessment of mental capacity to make financial decisions.

Assessing mental capacity for everyday decision-making in the Chinese older population.

1. The abilities to make everyday decisions may be reliably measured in the local elderly population. 2. The Chinese version of the Assessment of Capacity for Everyday Decision-Making is a reliable tool to assess these abilities. 3. Significant proportion of participants with mild dementia was mentally incapable in making decisions on everyday tasks. Global cognitive functioning appeared to be an important prerequisite for intact mental capacity.

Twenty five years of beach monitoring in Hong Kong: A re-examination of the beach water quality classification scheme from a comparative and global perspective.

Hong Kong's beach water quality classification scheme, used effectively for >25 years in protecting public health, was first established in local epidemiology studies during the late 1980s where Escherichia coli (E. coli) was identified as the most suitable faecal indicator bacteria. To review and further substantiate the scheme's robustness, a performance check was carried out to classify water quality of 37 major local beaches in Hong Kong during four bathing seasons (March-October) from 2010 to 2013. Given the enterococci and E. coli data collected, beach classification by the local scheme was found to be in line with the prominent international benchmarks recommended by the World Health Organization and the European Union. Local bacteriological studies over the last 15 years further confirmed that E. coli is the more suitable faecal indicator bacteria than enterococci in the local context.

Two-port needlescopic cholecystectomy: prospective study of 100 cases.

OBJECTIVE: To test the feasibility of needlescopic cholecystectomy using a two-port technique with 3-mm miniaturised instruments. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: One hundred consecutive patients undergoing elective cholecystectomy from September 2001 to August 2002. INTERVENTION: Two-port needlescopic cholecystectomy all performed or supervised by a single laparoscopic surgeon. MAIN OUTCOME MEASURES: Conversion of the procedure, the operating time, postoperative analgesic requirement, pain score using the 10-cm visual analog scale, complications, and the postoperative stay. To determine the technical difficulty of this new technique, the data from the first 50 patients were compared with those of the latter 50. Outcome variables were also compared with a group of 58 patients operated on with the standard two-port laparoscopic cholecystectomy in a previous randomised trial. RESULTS: One conversion to open cholecystectomy was reported. Three patients required the enlargement of epigastric port to a size of 5 mm and six patients required an additional port to complete the operation. The median operating time was 62 minutes (range, 33-168 minutes). The median pain score was 3.5 (range, 0-9) and the median postoperative stay was 2 days (range, 1-14 days). Six patients had postoperative complications. When the first 50 patients were compared with the latter 50, there were no differences in the conversion rate, operating time, complication rate, and duration of hospital stay. However, the latter 50 patients had significantly lower pain scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet (median, 5 vs 9 hours; P<0.001). The median operating time of needlescopic cholecystectomy was notably longer (62 vs 46 minutes; P<0.001) compared with that of the two-port laparoscopic cholecystectomy. Patients undergoing needlescopic cholecystectomy had a better resumption of diet (median, 5 vs 7 hours; P<0.001) and less postoperative pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the two-port laparoscopic cholecystectomy group. Pain scores at individual port sites were also lower in needlescopic cholecystectomy group (umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median, 2.0 vs 3.6, P=0.036). CONCLUSION: Two-port needlescopic cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic cholecystectomy technique.

Introduction of the alien Xenostrobus securis (Bivalvia: Mytilidae) into Hong Kong, China: interactions with and impacts upon native species and the earlier introduced Mytilopsis sallei (Bivalvia: Dreissenidae).

This constitutes the first record of the Australian alien mytilid Xenostrobus securis in China. The introduction occurred prior to 2010 probably via shipping arriving at Yantian in Mirs Bay, China, close to Hong Kong. Point sources of infection could be Australia or Korea or Japan where it has similarly been introduced. Analysis of X. securis in Hong Kong shows that it tolerates a wide range of salinities from 5.4‰ to 28.7‰. Water temperatures in Hong Kong match those in its native range. In Hong Kong, X. securis co-occurs with the similarly introduced Mytilopsis sallei and a native bivalve community. The population structure of X. securis suggests a lifespan of >2 years with new generations produced by conspecifics. Such a life history strategy is also exhibited by M. sallei. Now established in China, northern Asia, the Mediterranean and, most recently, the Iberian Atlantic, the invasion of other locations by X. securis seems probable.

Clinical phenotype of haemoglobin Q-H disease.

Seven patients of Chinese origin who had haemoglobin (Hb) Q-H disease were studied. They were found to have a similar clinical phenotype to that of patients with deletional Hb H disease, who have a near identical genotypic configuration. The complete absence of Hb A in Hb Q-H disease and the similar clinical phenotype to deletional Hb H disease lends support to the observation that Hb Q-Thailand shares similar functional properties with Hb A.

Important role of cardiac spect imaging in patients undergoing percutaneous transluminal coronary angioplasty.

OBJECTIVE: To examine the utilization and contribution of cardiac perfusion scans to patients undergoing percutaneous transluminal coronary angioplasty. METHODS: From July 1996 to January 1998, 34 patients underwent percutaneous transluminal coronary angioplasty and cardiac SPECT imaging was studied. Twenty-five patients had pre-procedure SPECT scans. The agreement between angioplasty strategies and SPECT findings of ischemia and hypokinesia was examined. RESULTS: When radionuclide imaging was performed before revascularization procedures, 84% of the patients had intervention strategies guided by scan findings. Perfusion scan findings including extent and severity of ischemia, degree of hypokinesia directed the selection of target vessel for angioplasty in the patient subgroup with multi-vessel disease. Post-angioplasty radionuclide cardiac scans were performed only on symptomatic patients, demonstrating ischemia and hypokinesia in most of them, conceivably reflected the selection bias. CONCLUSION: We recommend routine pre- and post-angioplasty radionuclide imaging with multigated scans for wall motion assessment for all patients receiving coronary intervention.

Undiagnosed acute myocardial infarction in the accident and emergency department: reasons and implications.

Because acute myocardial infarction causes significant morbidity and mortality, a correct diagnosis in the accident and emergency department is important so that early treatment including thrombolytic therapy can be given. The aim of this study was to evaluate the reasons for missed diagnosis of acute myocardial infarction in the accident and emergency department, and the implications. All patients admitted to our coronary care unit in 1995 with the confirmed diagnosis of acute myocardial infarction were analysed retrospectively. The demographic data, clinical profiles, diagnosis made at the accident and emergency department and feasibility of thrombolytic therapy were assessed. Analysis of the electrocardiography by the accident and emergency department doctor and the coronary care unit doctor were also compared. Forty-three out of 159 patients (27.0%) with acute myocardial infarction were missed in the accident and emergency department. The diagnoses made were mostly angina or chest pain. Absence of chest pain (25.6%) [vs. 10.2% in correct diagnosis group, p < 0.05] and lack of ST elevation in electrocardiograph (62.8%) [vs. 18.1% in correct diagnosis group, p < 0.0001] were the main predisposing factors for missed diagnosis. Because of missed diagnosis, only 25.6% (vs. 67.2% in correct diagnosis group, p < 0.01) of patients were admitted to the coronary care unit. About one-third (34.9%) of missed diagnosis patients (vs. 6.0% in correct diagnosis, p < 0.01) did not receive thrombolytic therapy because of delayed diagnosis. In the missed diagnosis group, 34.8% of them might be avoidable, if electrocardiogram interpretation was more accurate. More education and training of the involved medical personnel might improve the overall situation.

Prognostic value of adenosine stress myocardial perfusion by cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease.

BACKGROUND: Cardiac magnetic resonance imaging (CMR) has been intensely researched in recent years, and its high diagnostic accuracy for myocardial ischemia has been demonstrated. However, its prognostic information is very limited. AIM: We sought to assess the value of adenosine stress myocardial perfusion by CMR in predicting cardiac events in patients with known or suspected coronary artery disease (CAD). DESIGN: Retrospective study. METHODS: From January 2003 to December 2008, we retrospectively reviewed consecutive patients with or without history of CAD referred for evaluation of suspected myocardial ischemia who had undergone adenosine stress CMR in our hospital. End points were cardiac death or non-fatal myocardial infarction (MI). RESULTS: After a mean follow-up of 3.2 ± 1.6 years in 203 patients, 15 (7.4%) cardiac events occurred. The 4-year event-free survival was 96.2% for patients with normal stress CMR perfusion and 71.5% for those with abnormal stress CMR perfusion. Univariate analysis showed that both adenosine-induced reversible perfusion defect and delayed gadolinium enhancement by CMR were significant predictors of cardiac events [Hazard ratio (HR) 9.31; 95% Confidence Interval (95% CI) 3.18-27.3; and HR 9.24; 95% CI 3.27-26.08; P < 0.001, respectively). By multivariate analysis, adenosine-induced reversible perfusion defect remained an independent predictor of cardiac events (HR 7.77; 95% CI 2.50-24.18; P < 0.001). In a stepwise multivariate model (Cox regression), an abnormal stress CMR perfusion result had significant incremental predictive value over clinical risk factors and resting regional wall motion abnormality (RWMA) (P < 0.001). CONCLUSION: In patients with known or suspected CAD, adenosine stress CMR could be used to identify patients at high risk for subsequent cardiac death or nonfatal MI. A normal CMR perfusion was associated with a very low long-term event rate and excellent long-term prognosis. In addition, stress CMR perfusion provided important incremental prognostic information over clinical risk factors and RWMA.

Standard formula for liver volume in Middle Eastern Arabic adults.

OBJECTIVES: To determine a formula for estimating the standard liver volume (SLV) in Middle Eastern Arabic adults and to compare it with the 12 standard liver volume (SLV) formulas reported for eastern and western populations. METHODS: Liver volume measured using computed tomography (CTLV) was determined in 351 Saudi Arabian adults older than 16 years without liver or body build abnormality. This measurement was correlated with body indices including age, sex, height, weight, body mass index, and body surface area to derive a new formula using multiple-step linear regression analysis. The CTLV was compared with the 12 SLV formulas using the t test, with error % as (SLV - CTLV)/CTLV × 100. RESULTS: Body weight was the only significant factor that correlated with CTLV, that is, 12.26 × body weight (kg) + 555.65 (R(2) = .37; P = .000). Only the Vauthey formula (1267.28 × body surface area (m(2)) - 794.41) yielded an estimation of SLV that did not differ significantly from CTLV (P = .26), and had the least mean % error of +1% (underestimation by 15.7 mL) and the closest agreement, that is, 62.4% demonstrated less than ±16% error). Other formulas also yielded acceptable agreement with mean % error less than 12%, although the differences from actual measurements were statistically significant. The Chengdu and Chouker formulas were the exceptions, with more than 16% underestimation or overestimation. CONCLUSIONS: Either the formulas derived in the present study and the Vauthey formula could be used to estimate SLV in Middle East Arabic adults. However, the moderate coefficient of determination (R(2) = .37) suggested wide interindividual variation. Caution must be exercised when using these formulas in preoperative planning.

Is the content of the Chinese Quality of Life Instrument (ChQOL) really valid in the context of traditional Chinese medicine in Hong Kong?

BACKGROUND: Content validity is crucial in quality of life instrument development but there is very little literature on this in Chinese culture. The Chinese Quality of Life Instrument (ChQOL) was developed in Mainland China to capture the health-related quality of life (HRQOL) concepts specific to traditional Chinese medicine (TCM). The aim of this study was to evaluate the content validity of ChQOL in a Chinese population whose spoken dialect and health-care system are different from those of Mainland China to find out whether the instrument is generalizable. METHODS: 8 TCM practitioners and 10 patients rated the clarity, relevance and appropriateness of each of the 50 items of the ChQOL (HK version), and completed qualitative cognitive debriefing interviews. RESULTS: The content of ChQOL was rated valid by TCM practitioners with CVIs on clarity, relevance and appropriateness ranging from 80 to 100%. 49 out of 50 items were well understood by patients, but 12 items had CVI on relevance and 5 items had CVI on appropriateness lower than 70% among patients. After reviewing the patients and TCM practitioners' opinions, revisions were made for three items (2, 8 and 29) to form the ChQOL (HK version)-2008. In general, the ChQOL was found to be too long which called for shorter version. CONCLUSIONS: The content of ChQOL was shown to be really valid in the context of Chinese Medicine for Cantonese speaking Chinese. There was some discrepancy between the judgments of TCM practitioners and patients indicating the importance of evaluation by both experts and lay persons.

Development and validation of the interview version of the Hong Kong Chinese WHOQOL-BREF.

INTRODUCTION: The Hong Kong Chinese version of the WHOQOL-BREF was designed as a self-administered questionnaire and has limitations in clinical application on subjects who have limitations in reading or writing. An interview version is therefore needed to avoid sampling biases in clinical studies. Since there are significant differences in the written Chinese and spoken Cantonese, which is a dialect commonly spoken among people in Hong Kong, and adaptation process for converting the written Chinese into spoken Cantonese was necessary. The interview version was designed to allow administration in both face-to-face interview and telephone interview mode. METHODS: Three members of the research team translated the formal written Chinese in the self-administered version of the WHOQOL-BREF(HK) into colloquial Cantonese separately. Brief notes extracted from the facet definitions of the WHOQOL-100 were added in brackets after some questions to further explain the intention of the questions. Two series of focus groups were conducted and subsequently the field test version was produced. 329 subjects were recruited by convenient sampling method for the field test. RESULTS: The interview version and the self-administered version was found equivalent. The ICC values of the domain scores ranged from 0.73 in the environment domain to 0.83 in the psychological domain. The face-to-face interview and telephone interview mode of administration were also found equivalent. The ICC for the domain scores ranged from 0.76 in the social interaction domain to 0.84 in the psychological domain. The other psychometric properties of the interview version were found comparable to the self-administered version. CONCLUSION: The self-administered and the interview version of the WHOQOL-BREF are regarded as identical in group comparison. The authors advise that it is acceptable to use different versions on different subjects in the same study, provided that the same version is applied on the same subject throughout the study.

Impact of untreated psychosis on quality of life in patients with first-episode schizophrenia.

Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years, few studies have focused on the potential adverse effects of the illness on QOL during the period of untreated psychosis. Our study compares the QOL of patients with first-episode schizophrenia when they first presented to the psychiatric service with that of the normal population, and identifies possible relationships with various clinical parameters. One hundred and seventeen patients with schizophrenia (aged 14-28 years) who entered the Early Assessment Services for Young People with Psychosis (EASY) programme in Hong Kong from June 2001 to January 2004 were assessed with the MOS 36 item Short Form Health Survey (SF-36) and the World Health Organization Quality of Life Measure, abbreviated Hong Kong version (WHOQOL-BREF(HK)). We compared their SF-36 scores with controls from the normal population matched by age, sex, marital status and educational level. We assessed clinical parameters including positive, negative and depressive symptoms by the Positive and Negative Syndrome Scale (PANSS), the Scale for Assessment of Negative Symptoms (SANS), and the Montgomery and Asberg Depression Rating Scale (MADRS). When compared with matched controls from the normal population, significantly lower scores in all of the eight scales of the SF-36 were found in our patient group (p < 0.005). Various QOL domain scores had significant inverse correlations with the total MADRS score. However, there was no significant correlation with other clinical parameters. Young patients with first-episode schizophrenia have poorer QOL in the period of untreated psychosis than their counterparts in the community. Amongst various clinical parameters, the severity of depressive symptoms correlates most with QOL.

An instrument to assess mental patients' capacity to appraise and report subjective quality of life.

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated.

Laparoscopic cholecystectomy: two-port technique.

BACKGROUND AND STUDY AIMS: Conventional laparoscopic cholecystectomy requires four ports. The present study describes a new laparoscopic cholecystectomy technique using two ports only. PATIENTS AND METHODS: Sixty-two consecutive patients with symptomatic gallstones underwent laparoscopic cholecystectomy using this two-port technique. The operation requires a straightforward laparoscope and a percutaneous sling to retract the gallbladder laterally and cephalad. RESULTS: The two-port method was successful in 52 patients; eight required an additional port, and two required conversion to open surgery. Our results showed that the operating time and complication rate were comparable to those in other series using the conventional laparoscopic method. CONCLUSION: The two-port method is technically more demanding, and should only be used to remove simple, uncomplicated gallbladders. The surgeon should always be prepared to insert more trocars or convert to open procedures when necessary.

One-stage thoracoscopic oesophagectomy: ligature intrathoracic stapled anastomosis.

Thoracoscopic oesophagectomy is usually performed in stages and intrathoracic oesophagogastric anastomosis often requires mini-thoracotomy or extension of the thoracoscopic incisions. This paper describes a new technique whereby such an operation could be completed in one stage and the need to extend the thoracoscopic incisions is obviated.