Biomedical subjects
Publications and source records attributed to T Kwok.
A 76 year old woman developed a psoas abscess from vascular seeding of an infected subclavian venous catheter. The presentation was insidious and diagnosis delayed. Despite adequate surgical drainage, the case proved to be fatal. Venous catheters should be regarded as a potential source of septicaemia and occult abscess formation.
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OBJECTIVE: To compare the accuracy of the predictive equations derived from older Chinese people without vertebral deformity with those derived from unselected older people, in estimating height from armspan. METHODOLOGY: Height and armspan were measured in 789 older Chinese and 885 young Chinese in Hong Kong. All the older subjects had spinal X-ray (T4 to L4). Vertebral deformity was determined by a trained technician using a translucent digital analyser. Definite deformity was defined by a greater than 3 standard deviation increase in one of the three vertebral height ratios (anterior/posterior, middle/posterior and posterior/posterior). Eighty of the older subjects without vertebral deformity were randomly selected from the studied population for internal validation of predictive equations. The remaining subjects were used to derive sex-specific predictive equations for height by linear regression against armspan. The accuracy of these equations was analysed by the Bland and Altman method. RESULTS: Vertebral deformity was present in 30.7% and 15.6% of older female and male subjects, respectively. Older women without vertebral deformity had significantly greater armspan: height ratio when compared with the young (1.04 versus 1.02), but the corresponding ratios were the same in older and young men (both 1.04). The predictive equation derived from older females without vertebral deformity had lower standard error of estimation and gave estimates closer to measured height than those derived from unselected older women. But this was not the case in older men. CONCLUSION: In deriving predictive equation to estimate height by armspan in older Chinese women, selecting out older women without vertebral deformity increased accuracy of the equation. This was, however, not the case in older men.
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.
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.