OBJECTIVES. To examine the practice and ethical attitudes of intensive care doctors in Hong Kong and to compare findings with those from European studies.

DESIGN. Structured questionnaire survey, modified from a similar questionnaire used in Europe.

SETTING. Eleven publicly funded intensive care units in Hong Kong.

PARTICIPANTS. Ninety-five doctors practising in intensive care units.

RESULTS. Of the sixty-five respondents, sizeable proportions indicated that the admission of patients to the intensive care unit is often (25%) or sometimes (51%) limited by bed availability. About 69% to 86% of doctors admit patients with limited prognosis or poor quality of life, although all felt that these admissions should be more restricted. ‘Do-not-resuscitate’ orders are applied by almost all respondents, and 52% and 89% of respondents would discuss such orders with the patient or with the family, respectively. The withholding and withdrawal of therapy from patients with no chance of recovery to a meaningful life is common in Hong Kong (99% and 89%, respectively). A total of 83% respondents involved patients or families in the decision to limit therapy, compared with less than half in Europe overall. When the family wanted aggressive life-support despite doctors’ recommendations to limit therapy, 62% of the respondents would still withhold therapy while only 9% would withdraw therapy. More than 60% of doctors feel comfortable talking to patients’ relatives about limitation of therapy. Approximately 75% felt that euthanasia is unacceptable. Most respondents (94%) reported that medical programmes should include more extensive discussion on ethical issues.

CONCLUSION. The ethical attitudes of intensive care doctors in Hong Kong are similar to those of counterparts in Europe. However, Hong Kong doctors tend to involve families more often in the discussion of end-of-life issues.

Key words: Decision making; Ethics, medical; Euthanasia, passive; Intensive care units; Withholding treatment

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OBJECTIVE. To delineate the clinical behaviour of chronic benign neutropenia in Chinese children in Hong Kong.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. All infants and children with absolute neutrophil count of 1.5 x 10⁹ /L or lower for more than 3 months.

MAIN OUTCOME MEASURES. Development of significant infection, and achievement of remission.

RESULTS. Twenty-four children with chronic benign neutropenia were identified between 1992 and 2001. Their median age of diagnosis was 9 months. The mean (standard deviation) initial absolute neutrophil count was 0.28 x 10⁹ /L (0.24 x 10⁹ /L). Twenty-three patients presented with infection. Of the 19 patients tested, four (21%) were positive for anti-neutrophil antibodies. Bone marrow examination was performed in 17 patients: nine had normal results, but six showed evidence of peripheral consumption, one showed late maturation arrest at band stage, and one showed phagocytosis of myeloid cells by histiocytes. The overall hospitalised infection rate was 51.6 episodes per 1000 patient months. Ten percent of cases were considered ‘significant’ infections and required hospital admission with either surgical intervention or intravenous therapy (antibiotics or fluid replacement). In the first year of diagnosis, more than 80% of patients had their lowest absolute neutrophil count (mean, 0.16 x 10⁹ /L; standard deviation, 0.11 x 10⁹ /L). Granulocyte-colony stimulating factor was used to treat three patients and induced transient elevation of absolute neutrophil count in all three. The projected remission rate was 55.4% at 3 years. Even for those with persistent disease, there was significant recovery in absolute neutrophil count to a mean of 0.5 x 10⁹ /L (P<0.01).

CONCLUSIONS. Patients with chronic benign neutropenia experienced a relatively benign clinical course regardless of their remission status. Only a small proportion of patients developed significant infections. A multi-centre prospective study may help identify predictive factors of remission.

Key words: Autoimmune diseases; Chinese; Immunoglobulins; Neutropenia

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OBJECTIVE. To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese.

DESIGN. Cross-sectional study.

SETTING. District hospital, Hong Kong.

PATIENTS. Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows).

MAIN OUTCOME MEASURES. Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength.

RESULT. The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman’s rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01).

CONCLUSION. The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.

Key words: Outcome assessment; Questionnaires; Tennis elbow

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OBJECTIVE. To investigate the relationship between musculoskeletal pain and disability among a group of geriatric out-patients.

DESIGN. Consecutive case series.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Attendees at a geriatric specialist out-patient clinic from October 2002 to February 2003.

MAIN OUTCOME MEASURES. Pain duration, location, intensity, and frequency; use of analgesics; ability to identify the cause of pain; disability (Barthel index) and Lawton Instrumental Activities of Daily Living scale score; depressive symptoms (Geriatric Depression Scale score); and self-reported sleep quality.

RESULTS. Of the 749 respondents, 461 (61.5%) had experienced pain in the previous 2 weeks. Among these patients, 51.3% had received a pain-relieving drug. Compared with men, women reported a higher pain intensity (5.87 versus 5.26; P=0.001), had a lower Barthel index (96.0 versus 97.9; P=0.005), and had a lower score on the Lawton Instrumental Activities of Daily Living scale (42.19 versus 44.52; P=0.008). Multivariate logistic regression showed that the presence of pain was associated with female sex (odds ratio=2.25), poor self-rated health (0.69), and depression (1.54).

CONCLUSION. Pain is a common problem among the elderly population, but it is not associated with physical disability, and only half of the patients received analgesics. The study provides information for health care workers to develop strategies to better assess and manage pain problems among elderly people.

Key words: Aged; Disability evaluation; Musculoskeletal diseases; Pain; Sex factors

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OBJECTIVE. To examine the profile and referral pattern of patients attending an out-patient pain management service in Hong Kong.

DESIGN. Prospective cross-sectional survey.

SETTING. Regional public hospitals, Hong Kong.

PATIENTS. All patients attending out-patient pain management clinics in the New Territories East public hospitals between 1 September and 31 December 2002.

MAIN OUTCOME MEASURES. Demographic profiles, referring specialty, pain diagnosis, pain sites, duration and severity of pain, treatment modality, litigation, compensation, and social welfare status. Data were collected using a standardised questionnaire.

RESULTS. Two hundred and forty-eight patients were interviewed. Most patients (70%) were middle-aged, with 21% over 60 years. Seventy-nine percent of patients were referred to the clinics either from orthopaedic surgeons (64.1%), general and other surgeons (14.9%), or general practitioners (3.6%). The median (range) duration of pain was 2.3 (0.08-26.7) years. The most common pain diagnoses were musculoskeletal back pain (46.4%) and neuropathic pain (27.8%). A total of 11.3% of the patients had two pain diagnoses, while 40.7% complained of pain in more than one location. Pain in the limbs was the most frequent complaint followed by the head, neck, and back. Approximately 38% of patients had tried four or more treatment modalities. Oral medication was the most common method (86.7%) of pain-relief treatment. More than half of the patients had also tried physiotherapy and traditional Chinese medicine. Approximately 37% of the patients were unemployed, while 31% were receiving social security subsidy. Eighty-six patients had pain associated with a work-related injury, and of these patients, 80% were involved in compensation claims.

CONCLUSIONS. The profile of patients referred to the pain management clinics was complex. Patients were mainly referred from specialists. The economic implication in this group of patients is likely to be significant as many patients utilised multiple treatment modalities, were unemployed and on social welfare benefits, and were involved in compensation and litigation proceedings.

Key words: Health care surveys; Pain; Pain clinics

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