Low magnitude high frequency vibration accelerated cartilage degeneration but improved epiphyseal bone formation in anterior cruciate ligament transect induced osteoarthritis rat model.

OBJECTIVES: To evaluate the effects of low-magnitude high-frequency vibration (LMHFV) on degenerated articular cartilage and subchondral bone in anterior cruciate ligament transection (ACLT) induced osteoarthritis (OA) rat model. METHODS: 6 months old female Sprague-Dawley rats received ACLT on right knee and randomly divided into treatment and control groups. OA developed 12 weeks after surgery. LMHFV (35 Hz, 0.3 g) treatment was given 20 min/day and 5 days/week. After 6, 12 and 18 weeks, six rats of each group were sacrificed at each time point and the right knees were harvested. OA grading score, distal femur cartilage volume (CV), subchondral bone morphology, elastic modulus of cartilage and functional changes between groups were analyzed. RESULTS: Increased cartilage degradation (higher OA grading score) and worse functional results (lower duty cycle, regular index and higher limb idleness index) were observed after LMHFV treatment (P = 0.011, 0.020, 0.012 and 0.005, respectively). CV increased after LMHFV treatment (P = 0.019). Subchondral bone density increased with OA progress (P < 0.01). Increased BV/TV, Tb.N and decreased Tb.Sp were observed in distal femur epiphysis in LMHFV treatment group (P = 0.006, 0.018 and 0.011, respectively). CONCLUSION: LMHFV accelerated cartilage degeneration and caused further functional deterioration of OA affected limb in ACLT-induced OA rat model. In contrast, LMHFV promoted bone formation in OA affected distal femur epiphysis, but did not reverse OA progression.

A territory-wide electronic health record--from concept to practicality: the Hong Kong experience.

In Hong Kong, a pilot project is being undertaken to implement a web-based electronic patient record system to allow integrated, real time patient based information to be shared in clinics, private and public hospitals. Such sharing aims to ensure that complete and accurate healthcare information is available to citizens' multiple points of care through a stable IT system. A challenge is to share this electronic information whilst ensuring privacy and security. Hong Kong has achieved its initial goals and pioneered in building a territory-wide electronic health record (EHR). This paper will outline the tasks involved, approach, method used and initial review of the pilot project. Barriers to implementation are discussed and critical success factors are identified.

Building a womb-to-tomb health record in Hong Kong--an application of information architecture.

The Hospital Authority developed the Information Architecture (IA) model in 2002 to support a fast, robust, flexible and accurate electronic patient record (ePR) to meet the high-tempo health care environment in Hong Kong. With several successful applications in sharing data that were created for the same patients in various systems, the IA model was further developed to extend the longitudinal ePR to include one's fetal data as entered in the mother's record. This paper describes how various IA elements: Section, View, Form, Group, Entity, Content, Document supports the building of a true womb-to-tomb ePR for the HA patients. The future focus of Information Architecture in the HA will include building a Information Architecture Management System and linking the ePR with other patient records in the community.

Early clinical predictors of severe acute respiratory syndrome in the emergency department.

OBJECTIVES: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). METHODS: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. RESULTS: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature degrees >38 degrees C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature >or=38 degrees C (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. CONCLUSIONS: Two components of the World Health Organization case definition - fever and contact exposure - are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

Accuracy of clinical diagnosis versus the World Health Organization case definition in the Amoy Garden SARS cohort.

OBJECTIVES: To compare the diagnostic accuracy of emergency department (ED) physicians with the World Health Organization (WHO) case definition in a large community-based SARS (severe acute respiratory syndrome) cohort. METHODS: This was a cohort study of all patients from Hong Kong's Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical findings and WHO case definition criteria were recorded, along with ED diagnoses. Final diagnoses were established independently based on relevant diagnostic tests performed after the ED visit. Emergency physician diagnostic accuracy was compared with that of the WHO SARS case definition. Sensitivity, specificity, predictive values and likelihood ratios were calculated using standard formulae. RESULTS: During the study period, 818 patients presented with SARS-like symptoms, including 205 confirmed SARS, 35 undetermined SARS and 578 non-SARS. Sensitivity, specificity and accuracy were 91%, 96% and 94% for ED clinical diagnosis, versus 42%, 86% and 75% for the WHO case definition. Positive likelihood ratios (LR+) were 21.1 for physician judgement and 3.1 for the WHO criteria. Negative likelihood ratios (LR-) were 0.10 for physician judgement and 0.67 for the WHO criteria, indicating that clinician judgement was a much more powerful predictor than the WHO criteria. CONCLUSIONS: Physician clinical judgement was more accurate than the WHO case definition. Reliance on the WHO case definition as a SARS screening tool may lead to an unacceptable rate of misdiagnosis. The SARS case definition must be revised if it is to be used as a screening tool in emergency departments and primary care settings.

A quantifiable approach in the comparison of isokinetic assessment data--new correlation equations for the Johnson antishear device and standard shin pad in the isokinetic assessment of the knee.

The rehabilitation of the knee with a deficient anterior cruciate ligament (ACL) always presents a great challenge. Isokinetic assessment allows muscle performance to be quantified. The antishear device, introduced by Johnson, has the distinct advantage of minimizing the anterior translation force during isokinetic exercise. In a previous report, there was a significant difference between the Johnson double pad antishear device and the standard single pad device in knee extension. The main purpose of this study was to define a correlation equation such that data generated in the use of the two different devices can be compared for assessment. Ten subjects were tested with the Cybex isokinetic dynamometer with a randomly selected sequence of test speeds. Correlation coefficient (r), regression analysis and paired t tests (P) were performed to estimate the correlation and difference between the two devices. It is concluded that a significant difference in the data generated between the two devices indicated that a single device should be selected to carry out a series of comparisons on a particular subject. However, if the two devices are used in a series of testings, a set of correlation equations has been defined to facilitate such comparison. The findings in this study will widen the application of comparison of isokinetic data in the quantitative approach of rehabilitation of the knee with a deficient anterior cruciate ligament.

The hidden agenda and diagnosis in general practice.

Diagnosis in general practice involves more than the diagnosis of a physical illness. An important objective of a general practice consultation is to understand the hidden feelings and fears of the patients. Seven case reports are presented to demonstrate the need to go beyond the physical diagnosis and to identify the hidden agenda in order to make a comprehensive biopsychosocial diagnosis of the patient's problems. A good bedside manner is more than good manners. It is an essential ingredient of the diagnostic process in general practice.