Patients' Acceptability and Satisfaction With Teleconsultation for Pelvic Floor Exercises for Stress Urinary Incontinence During COVID-19.

OBJECTIVES: This was the first urogynaecology specialty nurse teleconsultation offered by a public hospital during COVID-19 for learning pelvic floor exercises. This study assessed patients' perception, acceptance, and satisfaction using 2 validated questionnaires. METHODS: In total, 25 patients with stress urinary incontinence attended the teleconsultation via videoconferencing in April 2022, and completed the Telemedicine Perception Questionnaire (TMPQ) and Telemedicine Satisfaction Questionnaire (TSQ). The TMPQ was a 17-item, 5-point Likert scale questionnaire for assessing the acceptability of telemedicine. The TSQ was a 14-item, 5-point Likert scale questionnaire for assessing satisfaction with teleconsultation. The higher the score, the greater the acceptance and satisfaction. Information on demographics, symptom severity by Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, internet access, and transport arrangements were included. RESULTS: Participants had a mean age of 54.6 ± 7.37 years. Their mean Urogenital Distress Inventory-6 score was 40.60/100 (SD = 17.83) and Impact Questionnaire-7 was 27.90/100 (SD = 19.83). Pre-teleconsultation mean TMPQ score was 59.16 ± 5.78/85. Post-teleconsultation mean score was 64.92 ± 5.21/85, which was 3.64 higher (t = 3.642, df = 24, P = 0.001), indicating a significant increase in positive perception and acceptability. There were fewer concerns with the usage (P = 0.017) and reliability (P = 0.003) of technology, while there was increased agreement that teleconsultation is cost-saving for the health care system (P = 0.003) and offers easier access to health care providers (P = 0.006) after the teleconsultation. Mean TSQ score was 59.85 ± 9.46/70. CONCLUSION: Our pilot study demonstrated positive perception, high acceptability, and satisfaction from patients' first teleconsultation experience. Further multi-centre studies with the inclusion of a control group would help in understanding patients' needs and for service planning.

Telemedicine in urogynaecology during COVID-19 in Hong Kong: An assessment of Chinese patients' acceptability using a validated questionnaire.

AIMS: There is no urogynaecology teleconsultation services available in Hong Kong's public health system. This cross-sectional study aimed to assess Chinese womens' acceptance of teleconsultations during the COVID-19 pandemic using the validated Telemedicine Perception Questionnaire (TMPQ). MATERIALS AND METHODS: One hundred and fifty-one patients attending our urogynaecology clinic between February and March 2021 were recruited for an in-person interview. Patients who could not comprehend the questionnaire due to neurological or psychiatric conditions were excluded. TMPQ is a 17-item, five-point Likert scale questionnaire developed to assess the acceptability of telemedicine. Scores range from 17 to 85; a higher score reflects a more positive overall perception of telemedicine. Additional questions on demographics, medical history, Internet access and transport arrangements were included. RESULTS: Mean age was 67.5 ± 11.3 years. Mean TMPQ score was 53.93 ± 8.49. Younger age, higher education, employment, prior telecommunication platform usage, lower travelling costs and interest in telemedicine were associated with a higher TMPQ score (P < 0.05). Multiple linear regression analysis found age (ß = -0.132, 95% CI (confidence interval): -0.225 to -0.04), interest in telemedicine (ß = 10.169, 95% CI: 8.073-12.266) and post-operative status (ß = 4.743, 95% CI: 1.172-8.314) significantly predicted TMPQ score (adjusted R2  = 0.427). CONCLUSIONS: Our study found that the acceptability of telemedicine in Hong Kong was weak and identified patient groups that showed favourable attitudes. Future research directions would be to perform pilot studies to assess any change in perception after using telemedicine so that this service can be provided to patient groups who would benefit most, ensuring effective use of public resources.

Impact of suspending labour companionship during the COVID-19 pandemic on intrapartum care and delivery outcomes.

BACKGROUND: As part of infection control measures during the COVID-19 pandemic, labour companionship was suspended intermittently at public hospitals across Hong Kong. AIMS: The aim was to assess the impact of restricting labour companionship on intrapartum care and maternal and neonatal outcomes. MATERIALS AND METHODS: This is a retrospective cohort study comparing patients admitted for vaginal delivery with and without a labour companion. Deliveries during 1 February to 20 May and 17 July to 11 September 2020 ('alone group') were compared to deliveries during the same periods one year earlier when companionship was unrestricted ('accompanied group'). Outcomes were controlled for age, parity, body mass index, birth weight, education level and induction of labour. RESULTS: There were 651 and 491 deliveries in the accompanied and alone groups, respectively. Overall, physiological maternal and neonatal outcomes were not significantly different. Neonates in the alone group were more likely to have skin-to-skin contact delayed beyond 60 min after delivery (odds ratio 1.48, 95% confidence interval 1.45-1.51). None of these infants were exclusively breastfed at the time of discharge. CONCLUSIONS: The presence of a labour companion may encourage earlier initiation of skin-to-skin contact, which has been shown to improve bonding experience. However, families that have already been affected by previous restrictions can be provided some reassurance that physiological outcomes do not appear to be significantly different. In addition, interventions that encourage companion involvement, such as breathing exercises and massages, were not hindered, as midwives took on a greater role in supporting the parturient.

Community palliative care services on addressing physical and psychosocial needs in people with advanced illness: a prospective cohort study.

BACKGROUND: The integration of palliative care into primary health care has been advocated to improve its accessibility and the continuity of care. Recent studies on such an approach have mainly focused on health care cost and utilization. This study aims to evaluate the effects of a community interdisciplinary palliative care program on the symptom experience of patients with advanced disease. METHODS: A prospective cohort study was conducted. The Integrated Palliative Care Outcome Scale was used for monthly assessment to monitor their condition. Wilcoxon signed-rank test was used to examine changes in symptom experience across time. RESULTS: Forty-eight patients with a predominance of cancer diagnoses, enrolled in the program. They reported anxiety, hardly feeling at peace, and neither receiving information as wanted nor being able to share their feeling with family/friends as more overwhelming than physical symptoms. Improvements in emotional symptoms was statistically significant at 1-month follow up (p < 0.001). Improvements in communication/practical issues were also significant at the 1-month (p < 0.001) and 2-month (p = 0.005) follow-up. However, changes in symptom experiences in the subsequent months were not apparent. CONCLUSIONS: This study reveals the overwhelming emotional, communication and information needs among patients with advanced diseases and provides empirical evidence of the community palliative care program in short term. Further work is needed to strengthen the medical-social partnership to support care in place albeit health deterioration.

Use of music in reducing pain during outpatient hysteroscopy: Prospective randomized trial.

AIM: To evaluate the effect of music in reducing pain during outpatient hysteroscopy under no anesthesia. METHODS: We conducted a prospective randomized controlled trial From June 2019 to December 2019 in Pamela Youde Nethersole Eastern Hospital in Hong Kong. A total of 107 patients were randomized to music group (n = 54) or non-music group (n = 53). Music was played during outpatient hysteroscopy in the music group. Patients in the non-music group had the procedure done in the same setting without music. Primary outcome was the level of pain measured using the visual analog scale (VAS) score before and during the procedure. Secondary outcomes were vital parameters that reflect the level of pain including blood pressure and heart rate. RESULTS: Patients in the music group experienced significantly less pain during outpatient hysteroscopy (VAS score 4.54 ± 2.89 vs 5.88 ± 2.90; P = 0.02). The anticipated pain level was similar in both groups (VAS score 5.59 ± 2.27 vs 6.11 ± 2.43; P = 0.27). There was no statistically significant difference between the two groups in all the vital parameters. CONCLUSION: Listening to music during outpatient hysteroscopy under no anesthesia significantly reduces pain in a well-matched Chinese population. Music is easy to provide with low-cost equipment and manpower. We recommend the routine use of music during outpatient hysteroscopy to improve patient care.

A Cost-Effectiveness Analysis of Using the JBR.10-Based 15-Gene Expression Signature to Guide Adjuvant Chemotherapy in Early Stage Non-Small-Cell Lung Cancer.

BACKGROUND: Adjuvant chemotherapy (ACT) improved survival in the NCIC Clinical Trials Group JBR.10 trial of resected stage IB/II non-small-cell lung cancer. A prognostic 15-gene expression signature was developed, which may also predict for benefit from ACT. An exploratory economic analysis was conducted to assess the potential cost-effectiveness of using the 15-gene signature in guiding ACT decisions. METHODS: A decision analytic model was populated by study patients with quantitative reverse transcription polymerase chain reaction tumor profiling, current costs, and quality-adjusted survival. Analysis was performed over the 6-year follow-up from the perspective of the Canadian public health care system in 2015 Canadian dollars (discounted 5%/year). Incremental cost-effectiveness and cost-utility ratios were determined for ACT versus observation using clinical stage, gene signature, or a combined approach to select treatment. RESULTS: The mean survival gain of ACT versus observation was higher using the gene signature (1.86 years) compared with clinical stage (1.28 years). Although more costly, ACT guided by the gene signature remained cost-effective at $10,421/life-year gained (95% confidence interval [CI], $466-$19,568 Canadian), comparable to stage-directed selection ($7081/life-year gained; 95% CI, -$2370 to $14,721; P = .52). Incremental cost-utility ratios were $13,452/quality-adjusted life-year (95% CI, $373-$31,949) and $9194/quality-adjusted life-year (95% CI, -$4104 to $23,952), respectively (P = .53). Comparing the standard and test-and-treat approaches, use of the gene signature did not significantly alter survival compared with the standard strategy, but it reduced the ACT rate by 25%. CONCLUSION: If validated, the use of the 15-gene expression signature to select patients for ACT may increase the survival gain of treatment in patients with high-risk stage IB/II non-small-cell lung cancer, while avoiding toxicities in low-risk patients.

Laparoscopic liver resection for hepatocellular carcinoma.

OBJECTIVE: To provide an updated review on the clinical experience in laparoscopic liver resection, specifically for hepatocellular carcinoma. METHODS: A comprehensive literature search in MEDLINE was conducted for all English papers up to May 2010 on laparoscopic liver resection for hepatocellular carcinoma. Patient characteristics, perioperative results, and oncologic outcomes were compared and analysed. RESULTS: We analysed 11 clinical studies involving 466 hepatocellular carcinoma patients treated with laparoscopic hepatectomy. Thirty-seven (9%) patients underwent major resection. Cirrhosis occurred in 62%. The mean operative time was 189.5 min, and the mean blood loss was 315.6 mL. Blood transfusion was required in 14.6% of patients. There were two operative deaths. Postoperative complications included bile leakage (1%), bleeding (2.9%), liver failure (5.1%), and ascites (6%). The 1-year, 3-year, and 5-year disease-free survival rates ranged from 60% to 90%, 50% to 64%, and 31% to 50%, respectively, and the corresponding overall survival rates ranged from 85% to 100%, 67% to 100%, and 50% to 97% respectively. CONCLUSION: Laparoscopic liver resection for hepatocellular carcinoma appears to be safe and to achieve acceptable oncologic outcomes even in cirrhotic livers, but whether it is comparable to conventional open surgery needs to be evaluated in a randomized, controlled trial setting.

Predictors and markers of clozapine response.

RATIONALE: With other atypical antipsychotics now available, having predictors of clozapine response would be of considerable value, offering clinicians guidance in their decision as to when, and if, a trial of clozapine is warranted. OBJECTIVES: The aim was to review existing evidence regarding identified predictors and markers of clozapine response. METHODS: Relevant studies were identified through PUBMED searches (1975-June 2004) and cross-referencing of reviews and included studies. The data were summarized under two main categories: clinical (general, neurological, cognitive/neuropsychological, clozapine levels) and biological (biochemical, endocrine, genetic, metabolic, morphological, dopamine D2 receptor occupancy). 'Reliable' predictors/markers were defined a priori as those with support of at least two independent reports that addressed overall response, with no contradictory findings to date. 'Potential' predictors/markers had the support of a single report that addressed overall response and at least one other evaluating treatment outcome but not directly addressing response status. RESULTS AND CONCLUSIONS: Higher baseline clinical symptoms and functioning in the previous years and low cerebrospinal homovanillic acid/5-hydroxyindoleacetic acid levels were identified as reliable. Three potential measures were identified: reduction of frontal cortex metabolic activity, reduction of caudate volume, and improvement in P50 sensory gating.

Schizophrenia hippocampus has elevated expression of chondrex glycoprotein gene.

To identify genes associated with schizophrenia, DNA microarray chips were used to compare schizophrenia and control hippocampus tissues, revealing four genes with elevated expression, chondrex (or YKL-40), histamine-releasing factor, HERC2, and heat-shock 70. However, using the quantitative real-time polymerase chain reaction method, only the expression of the chondrex gene, an extracellular matrix glycoprotein involved in cell growth and migration, was found to be significantly elevated, by 1.8-fold. Real-time PCR found that the expression of the histamine-releasing factor gene, known to be associated with cognitive deficits in Alzheimer's disease, was significantly reduced by 19%. The expression of the HERC2 and heat-shock 70 genes, as measured by real-time PCR, were not significantly altered in the schizophrenia hippocampus. The altered gene expression of chondrex suggests that disruption in neuronal migration may be involved in schizophrenia. The change in expression of the histamine-releasing factor gene suggests that this gene may be associated with the negative symptoms of impaired learning and memory in schizophrenia.