Advance directive and preference of old age home residents for community model of end-of-life care in Hong Kong

Key Messages: 1. Among 1600 cognitively normal elderly persons living in old age homes in Hong Kong, 88% preferred palliative treatments that could keep them comfortable and free from pain, and 88% agreed to have advance directives. Factors that favour having advance directives among Chinese elders included the practice of asking for relatives’ advice in medical decisions, wishing to be informed of their terminal illness diagnoses, absence of a stroke history, and having no problems in self-care. 2. Approximately one third of old age home residents would accept dying in place. Older age, religion (Catholic or non-believer of traditional Chinese religion), having a better mood score (Geriatric Depression Scale), having no siblings, not receiving an old age allowance, and being a resident of subvented old age homes were independent predictors of preference for community end-of-life care and dying in place. 3. End-of-life care in the hospital was expensive. The total bed-day costs for the 2084 deaths in the two clusters for the index death episode, cumulative 3, 6, and 12 months of hospitalisation were HK$65 474 591, HK$82 543 510, HK$100 170 949, and HK$108 960 348, respectively. The annual cost-savings in hospitalisation bed-days would be HK$177 million when about 30% of elders accepted dying in their old age homes. 4. Elderly residents were willing to pay an additional fee for community end-of-life care services in old age homes. Both the services of the doctor and old age home staff were important attributes. Hence, elderly people were prepared to use more community end-of-life care if better staff and doctor services were provided.published_or_final_versio

Brassiere wearing and breast cancer risk: A systematic review and meta-analysis

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Translocation-coupled DNA cleavage by the Type ISP restriction-modification enzymes

Endonucleolytic double-strand DNA break production requires separate strand cleavage events. Although catalytic mechanisms for simple dimeric endonucleases are available, there are many complex nuclease machines which are poorly understood in comparison. Here we studied the single polypeptide Type ISP restriction-modification (RM) enzymes, which cleave random DNA between distant target sites when two enzymes collide following convergent ATP-driven translocation. We report the 2.7 Angstroms resolution X-ray crystal structure of a Type ISP enzyme-DNA complex, revealing that both the helicase-like ATPase and nuclease are unexpectedly located upstream of the direction of translocation, inconsistent with simple nuclease domain-dimerization. Using single-molecule and biochemical techniques, we demonstrate that each ATPase remodels its DNA-protein complex and translocates along DNA without looping it, leading to a collision complex where the nuclease domains are distal. Sequencing of single cleavage events suggests a previously undescribed endonuclease model, where multiple, stochastic strand nicking events combine to produce DNA scission

The Prevalence and Correlates of the Use of Restraint and Force in Older Hospital Patients: A Study of Nurses and Nursing Assistants in Hong Kong.

Aims. This study examined the prevalence and correlates of the use of restraint and force in care for older people in the hospital setting in Hong Kong. Background. The use of restraint and force is common in care for older people. Although some knowledge exists on the potential consequences and characteristics of patients where restraint is used, little is known about the profiles of the nursing staff administering restraint. Design. Descriptive cross-sectional study. Method. Data were collected in 2006. A total of 187 nursing staff provided information on their demographic characteristics, coworker emotional support, burnout symptoms, attitudes toward patients with dementia, as well as their perceptions of the use of restraint and force in care for older people and their experiences with it. Results. More than two-thirds (73·8%) of the participants reported using restraint or force in the past three months, with physical restraint endorsed by 69%, the use of force in examination or treatment endorsed by 48·1% and the use of force in activities of daily living endorsed by 46·5% of the participants. Pearson correlation analysis results show that use of physical restraint was negatively correlated with the age of participants (r = −0·44, p 0·05). Conclusion. The use of restraint and force is common among nurses in hospital medical wards in Hong Kong. To reduce restraint use in patient care, steps need to be taken to mitigate feelings of burnout and to foster sense of social support among nurses. Relevance to clinical practice. The hospital administration can take a leading role in restraint reduction by setting standards of care and by formulating institutional policy regarding the use of restraint or force.link_to_OA_fulltex

Impact of oral health status on oral health-related quality of life in Chinese hospitalised geriatric patients

Objectives: To examine the oral health status of Chinese hospitalised geriatric patients and identify its impacts on their oral health-related quality of life (OHRQoL). Design: Cross-sectional correlational study. Setting: Geriatric wards of a regional hospital in Hong Kong. Subjects: A consecutive sample of Chinese hospitalised geriatric patients (N = 155) aged ≥ 65 years who were communicable. Measurements: The Brief Oral Health Status Examination (BOHSE) was used to evaluate oral status. The General Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. Results: The oral health status of the Chinese hospitalised geriatric patients was fair, with the more prominent problems being decayed teeth, lack of occluded teeth, coated tongue, excessive tartar, dry and rough red oral tissue and diseased gum. The GOHAI score indicated their compromised OHRQoL. By using hierarchical regression analysis, fewer than eight pairs of occluding teeth (β = -0.33, P < 0.001), unhealthy gum (β = -0.26, P = 0.03) and perceived oral dryness (β = -0.18, P = 0.04) significantly accounted for 17% of variance in the OHRQoL of Chinese hospitalised geriatric patients. Conclusion: This study suggests that routine screening for dental and gum problems, providing adequate adaptation of denture prosthesis and reducing oral dryness of geriatric patients may be important care to optimise the OHRQoL of Chinese hospitalised geriatric patients. The study needs to be replicated in larger-scale multicentre settings and incorporate the use of more-comprehensive oral assessment indices. © 2008 Springer Science+Business Media B.V.link_to_subscribed_fulltex

Public knowledge and attitudes towards cardiopulmonary resuscitation in Hong Kong : telephone survey

Objectives: To investigate the public's knowledge and attitudes about cardiopulmonary resuscitation in Hong Kong. Design: Cross-sectional telephone survey. Setting: Hong Kong. Participants: Hong Kong residents aged 15 to 64 years. Main outcome measures: The knowledge and attitudes towards cardiopulmonary resuscitation. Results: Among the 1013 respondents, only 214 (21%) reported that they had received cardiopulmonary resuscitation training. The majority (72%) of these trained respondents had had their latest training more than 2 years earlier. The main reasons for not being involved in cardiopulmonary resuscitation training included lack of time or interest, and "not necessary". People with full-time jobs and higher levels of education were more likely to have such training. Respondents stating they had received cardiopulmonary resuscitation training were more willing to try it if needed at home (odds ratio=3.3; 95% confidence interval, 2.4-4.6; P<0.001) and on strangers in the street (4.3; 3.1-6.1; P<0.001) in case of emergencies. Overall cardiopulmonary resuscitation knowledge of the respondents was low (median=1, out of 8). Among all the respondents, only four ofthem (0.4%) answered all the questions correctly. Conclusions: Knowledge of cardiopulmonary resuscitation was still poor among the public in Hong Kong and the percentage of population trained to perform it was also relatively low. Efforts are needed to promote educational activities and explore other approaches to skill reinforcement and refreshment. Besides, we suggest enacting laws to protect bystanders who offer cardiopulmonary resuscitation, and incorporation of relevant training course into secondary school and college curricula.School of Nursin

Effects of sorbitol dehydrogenase deficiency on nerve conduction in experimental diabetic mice

In this report, we made use of sorbitol dehydrogenase (SDH)-deficient mutant mice (C57BL/LiA) to test whether there is a close correlation between the level of polyol accumulation and the degree of reduction in motor nerve conduction velocity (MNCV) associated with diabetes. The C57BL/LiA mouse has SDH deficiency due to a G-to-A mutation at the +1 position of intron 8, thus producing only aberrant SDH transcripts. These C57BL/LiA mice should have higher levels of polyol accumulation in the peripheral nerve because of the inability to further metabolize sorbitol to fructose. Here, we confirm by Western blot analysis and high-performance liquid chromatography that these mice lack SDH in the sciatic nerve and other various tissues, whereas normal mice possess SDH. These C57BL/LiA mice do not display any obvious phenotype that includes peripheral neuropathy in the normal laboratory environment and breed normally as described previously, although the tissues that normally contain SDH accumulate more sorbitol. This finding suggested that C57BL/LiA mouse strain is a valid model for studying the role in diabetic neuropathy of the polyol pathway, which consists of two enzymes-aldose reductase for converting glucose to sorbitol and SDH for converting sorbitol to fructose. Sorbitol levels in the sciatic nerve of diabetic C57BL/10N, nondiabetic, and diabetic C57BL/LiA mice were increased 4.3-, 16.6-, and 38.1-fold, respectively, above that of nondiabetic C57BL/10N. The fructose level in the sciatic nerve was increased 2.4-fold in diabetic C57BL/10N mice compared with that of nondiabetic and diabetic C57BL/LiA mice. Diabetic SDH-deficient mice showed an MNCV reduction similar in magnitude to that of diabetic C57BL/10N mice, despite greater nerve sorbitol accumulation and the lack of fructose in the former. The present data suggest that the levels of sorbitol and fructose in the sciatic nerve of mice do not correlate with the severity of MNCV deficit associated with diabetes.published_or_final_versio