Biomedical subjects

J Woo

Publications and source records attributed to J Woo.

402 records · Page 23Linked to original sources

PubMedDate not supplied

Survival, disability, and residence 20 months after acute stroke in a Chinese population: implications for community care.

A total of 304 Chinese patients with acute stroke were assessed at 3 and 20 months to determine survival, disability, and place of residence, and so to provide an estimate of the impact on community care resources. Approximately 30% of patients had died by 3 months; thereafter the mortality rate decreased, with a further 13% dying by 20 months. Age, rather than stroke subtype, determined the likelihood of death. Fifty-seven per cent of 3-month survivors were independent at 20 months, with only 18% moderately to severely disabled (Barthel Index less than 15). Thirteen per cent of patients improved and 14% deteriorated between 3 and 20 months. Older subjects had a lower Barthel Index at 20 months, and were more likely to show deterioration. Seventeen per cent of patients were living in institutions by 20 months, predisposing factors being age and mental test score. Although a low Barthel Index was a factor in univariate analysis, it did not contribute to the discriminant function model for predicting institutionalization, and nor did previous stroke, coexisting cardiovascular diseases, or diabetes mellitus influence eventual placement. Approximately 30% of patients were readmitted during the follow-up period, particularly elderly patients and those with a Barthel Index less than 15. Although only 9% of the original cohort required institutional care by 20 months, approximately half of all the government nursing home places in Hong Kong are likely to be taken up by these patients because of the large number of strokes occurring each year.

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PubMedDate not supplied

A geriatric day hospital in Hong Kong: an analysis of activities and costs.

A survey of the activities of a geriatric day hospital in Hong Kong was carried out. It revealed that alternative modalities of hospital-based treatment were impractical and difficult to organize. Most patients and their carers were satisfied with the day hospital service, and the main area for improvement was in transportation. Costs of day hospital treatment were also calculated, and were found to be cheaper than an equivalent period of in-patient rehabilitation or out-patient therapy.

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PubMedDate not supplied

Hospital readmission among older medical patients in Hong Kong.

OBJECTIVE: To study the risk factors for hospital readmission among older medical patients in Hong Kong. DESIGN: Cohort study. SUBJECTS: 1,204 consecutive hospital medical patients aged 70 years and over in Hong Kong. PROCEDURES: Subjects were interviewed by a research nurse on discharge, and were followed up for six months. OUTCOME: Unplanned hospital readmissions were identified and classified as avoidable or unavoidable. The risk factors for early (within 28 days), recurrent (three or more) and avoidable readmissions were studied by multiple logistic regression. RESULTS: Four hundred and fifty-five patients (37.7%) had at least one readmission in six months; 18%, 6.4%, and 2.9% of subjects had early, recurrent and avoidable readmissions respectively. Recent hospital stay predicted all types of readmissions. Early readmission was predicted by length of stay, Barthel index (assessment of physical and mental function) and unresolved medical problems. Recurrence readmission was predicted by poor family support, residence in a home for the elderly and unresolved medical problems. CONCLUSIONS: Hospital readmission may be prevented by ensuring adequate length of stay, so that medical problems are resolved before discharge.

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PubMedDate not supplied

Development of the Chinese nutrition screen (CNS) for use in institutional settings.

OBJECTIVES: To develop and validate a nutritional screening tool (CNS) for elderly Chinese subjects in the institutional setting. DESIGN: Using the MNA as a guide, a questionnaire was developed appropriate for the Chinese health care system, diet, food customs and culture, using physician assessment for comparison. PARTICIPANTS: 200 men and 200 women aged 65 years or older, approximately equally distributed by age between two cities in China (Hong Kong and Shanghai), were recruited from hospitals and old age homes for the reliability study. 340 men and 527 women were recruited for the validity study. RESULTS: The CNS compared with physician assessments based on two groups, normal or at risk with less than normal nutritional status, had kappa coefficients of 0.5 overall and were as high as 0.8 in Shanghai. CNS was able to identify about 90% of all persons with normal nutritional status and had about a 60% chance of correctly identifying a person at risk with a less than normal nutritional status. CONCLUSION: The CNS can be used in a 2-group classification to identify those who have a normal nutritional status (CNS > or = 21). Those who do not fall into this group should have their nutritional status evaluated in greater detail (CNS score < or = 20). The applicability of screening tools may vary depending on the site and the population characteristics.

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PubMedDate not supplied

Therapeutic monitoring of cyclosporine.

Therapeutic monitoring of immunosuppressive therapy with cyclosporine is a critical requirement because of intra- and interpatient variability of drug absorption, narrow therapeutic window and drug induced nephrotoxicity. The most widely used procedure involves measuring trough concentrations of cyclosporine (CsA) parent drug in whole blood using a specific monoclonal immunoassay. Trough concentrations generally correlate with adverse clinical events, e.g., episodes of rejection and nephrotoxicity. However, they do not correlate consistently with chronic events to allow prediction of adverse outcome. There is now increasing interest in using CsA pharmacokinetic profiling as a means of monitoring. This approach appears to offer a more valid index of drug exposure and hence a better prediction of clinical outcome. Nevertheless, multiple blood sample requirement and the complexity of pharmacokinetic profiling impose practical concern. The overall merit of either approach awaits further studies comparing clinical efficacy, technical requirements, and economic issues.

Cyclosporine↗

PubMedDate not supplied

Serum analyte pattern characteristic of fulminant hepatic failure.

Fulminant hepatic failure (FHF) is a poorly understood condition in which total liver failure occurs and is thought to be caused by a variety of conditions including Reye's syndrome, hepatitis, drug overdoses, and vascular insufficiency. While this condition is an uncommon one, it carries with it a high fatality rate and must therefore be diagnosed as rapidly as possible. Six patients have been observed over a two-year period with biopsy and/or autopsy-confirmed FHF: one with acute hepatitis B-delta; three with histories of alcoholism, two of them with cirrhosis; one with acute tylenol overdose; and one with hepatic vascular insufficiency. All of these patients, except one, exhibited a rapid, fatal downhill course after onset of symptoms. In all of these patients, a consistent elevation was observed in serum levels of aspartate aminotransferase (AST) or serum glutamate oxaloacetate transaminase (SGOT) and alanine aminotransferase (ALT) or serum glutamate pyruvate transaminase (SGPT) such that the ratio of AST to ALT was significantly greater than 1 and in serum levels of ammonia. Other liver function tests were found to be abnormal but not in so consistent a pattern, although total protein and albumin were found to be significantly decreased in all of these patients. The stereotypical elevation of the transaminases with high AST-to-ALT ratios and the rise in ammonia appear to characterize this life-threatening illness most reliably.

Acetaminophen↗