Patient-physician communication about end-of-life care for patients with severe COPD.

Since patients with chronic obstructive pulmonary disease (COPD) infrequently discuss treatment preferences about end-of-life care with physicians, the goal of the present study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians, and how patients rate the quality of this communication. A total of 115 patients with oxygen-dependent COPD, identified in pulmonary clinics in three hospitals and through an oxygen delivery company, were enrolled in this study. A 17-item quality of communication questionnaire (QOC) was administered to patients, along with other measures, including satisfaction with care. The patients reported that most physicians do not discuss how long the patients have to live, what dying might be like or patients' spirituality. Patients rated physicians highly at listening and answering questions. Areas patients rated relatively low included discussing prognosis, what dying might be like and spirituality/religion. Patients' assessments of physicians' overall communication and communication about treatment correlated well with the QOC. Patients' overall satisfaction with care also correlated significantly with the QOC. In conclusion, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with chronic obstructive pulmonary disease. Future studies should determine the responsiveness of these items to interventions, and the effect such interventions have on patient satisfaction and quality of care.     

Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow up

Objective This article presents the results of a three and a half year follow up of patients recruited to a randomised controlled clinical trial comparing circumferential mucosectomy (stapled haemorrhoidectomy) vs conventional haemorrhoidectomy. Methods Patients were assessed in an outpatient setting to examine a number of outcome measures. Results Our data suggest that at the three and a half year follow up, there are no significant differences in outcome between the two groups. Conclusions It will be important to review the long‐term results of larger trials.     

Socio-economic factors and tuberculosis: a district-based ecological analysis in Hong Kong.

BACKGROUND: Relatively little is known about the impact of socio-economic factors on tuberculosis in a metropolitan city with high disease incidence. METHOD: District-specific tuberculosis notification rates for 1995--1997 and 2000--2002 were indirectly sex- and age-adjusted and compared with the socio-economic characteristics in the 1996 by-census and 2001 census. RESULTS: The differences between the 18 districts persisted after 3-year averaging and indirect standardisation. Only the percentage of population born locally, the percentage of the population widowed or divorced and the percentage of households residing in rooms or bedsits were consistently associated with the standardised notification ratios (SNR) for both periods, the first being negatively so (all P < 0.05). In a combined analysis with a general linear model for both periods, birth in China, residence <7 years, speaking other Asian languages, being married and in a single household were also significantly associated with the SNR (all P < 0.05). Using a backward conditional approach, only local birth, being married, and residing in rooms or bedsits were independent predictors of SNR (all P < 0.05). There was no significant association between SNR and socio-economic indices on education, occupation, unemployment and income. CONCLUSION: Socio-economic factors other than simple poverty are affecting the district-specific tuberculosis rates in Hong Kong.     

A parametric analysis of fixation post shape in tibial knee prostheses

A primary concern of total knee replacement (TKR) is aseptic loosening of the tibial component, which may be caused by shielding of mechanical stresses in the bone and may require subsequent revision surgery. A three-dimensional (3D) finite element (FE) model has been developed to study bone and interface stresses for four different tibial prosthesis designs. The model described here incorporates orthotropic and heterogeneous bone properties with physiologically representative loading conditions. Results from this model indicate that stress distribution is affected by the incorporation of anisotropy and spatial variation of bone properties. All bone properties were mapped from published data to characterize their anisotropy and heterogeneity. Physiological loading was incorporated by mapping experimentally determined contact patterns. Convergence testing was performed to ensure model accuracy. In terms of interface forces, a tapered post decreased post shear while slightly increasing post compression compared to a cylindrical post; a post of elliptical cross-section increased post shear and decreased post compression. In terms of cancellous bone stress, tapered and elliptical posts both relieved compression compared to a cylindrical post, while a tapered post also produced increased peripheral stress. The inclusion of medial and lateral pegs in addition to a central fixation post caused localized stress shielding in the periphery of the pegs. In general, all implant models caused a reduction of cancellous bone stress plus high compression beneath the central fixation posts.     

Cognitive-behavioral group program for Chinese heterosexual HIV-infected men in Hong Kong

This study explored the effects of cognitive-behavioral program (CBP) using a wait-list control group in 16 Chinese heterosexual HIV-infected men. Participants in the treatment condition underwent a 7-week group based CBP, which addressed various HIV-related issues. Relevant cognitive and behavioral strategies were taught as well. The aim of treatment was to improve the quality of life and to reduce psychological distress in a sample of heterosexual symptomatic HIV-infected men. Prior to intervention, baseline measures showed that our sample had a lower quality of life in comparison with the local general population. They also experienced a significant level of psychological distress. Following intervention, men in the CBP group demonstrated significant improvement in the mental health dimension of quality of life and a significant reduction in depressed mood. These preliminary findings suggested that short-term cognitive-behavioral therapy can be effective in improving the quality of life and mood of Chinese heterosexual HIV-infected men.     

Techniques in Cardiology : PDA Closure in Children

Background

Transcatheter closure of patent ductus arteriosus (PDA) with various devices has been evaluated worldwide and in selected cases can be performed successfully, thus avoiding the morbidity associated with surgical closure.

Methods and results

A 2 year old female child presented with PDA and aortic angiography showed large PDA (tubular). This defect can be closed nonsurgically by coils and devices. The coil used are normally 0.038” having delivery system called Flipper, but this child had a large PDA and so was closed by thicker coil 0.052” using a coil-Bioptome-sheath system, which is the first reported case from the Armed Forces.

Conclusions

We report the initial experience at our center of closure of PDA with a new coil-Bioptome-sheath system.Key Words: Patent Ductus Arteriosus (PDA), Children, Coil-Bioptome-Sheath system     

Beneficial effects of regular Tai Chi exercise on musculoskeletal system

This study was performed to evaluate the potential benefits of regular Tai Chi Chun (TCC) exercise on bone mineral density (BMD) and neuromuscular function in postmenopausal women. In this cross-sectional study, 99 healthy postmenopausal women, with a mean age of 55.9 ± 3.1 years and within 10 years after the menopause, were recruited; including 48 subjects who had been regularly practicing TCC exercise for more than 3h/week and 51 age- and sex-matched sedentary controls (CON). BMD was measured in the lumbar spine and proximal femur of the non-dominant leg (femoral neck, greater trochanter, and Wards triangle), using dual-energy X-ray absorptiometry (DXA). Neuromuscular function was evaluated, including magnitude of trunk bend-and-reach, quadriceps muscle strength, and single-stance time on the nondominant leg. The TCC group showed overall higher BMD at all measurement sites, with a significant difference found at the spine (7.1%), greater trochanter (7.2%), and Wards triangle (7.1%) of the proximal femur (all; P < 0.05). Functional tests revealed an average 43.3% significantly greater quadriceps strength (P < 0.01), and 67.8% significantly longer single-stance time in the TCC group as compared with the CON group (P < 0.05), as well as a greater magnitude of trunk bend-and-reach in the TCC group (P = 0.08). Bivariate linear correlation analysis showed that quadriceps muscle strength was significantly correlated with the single-stance time (r = 0.41; P < 0.01). This study revealed that regular TCC exercise may have an association with higher BMD and better neuromuscular function in early postmenopausal women.