Quality of Care for Older Patients with Non-Cancer Diagnoses under the End-of-Life Care Program

Background: End-of-life (EOL) care is an important part of geriatric medicine in view of rapidly ageing populations in the world. Aim: We aimed to evaluate the quality of care for older patients with non-cancer terminal illnesses, who died in 2010, under the EOL care program of an academic medical unit in Hong Kong. This unit consisted of an acute hospital, Prince of Wales Hospital (PWH) and a convalescence hospital (Shatin Hospital, SH). Methods: This was a retrospective hospital-based audit of clinical effectiveness of the EOL service. We reviewed the quality of patient care during the final seven days of life. The quality of care was evaluated based on the compliance rates of five selected goals and the adoption of futile life-sustaining procedures and treatments. Results: Case records of 129 patients in the EOL care program were analyzed. Two goals, including minimization of regular monitoring of vital signs and no blood taking, achieved over 70% compliance at SH and 0% at PWH. The compliance rates of discontinuation of non-essential medications were 46.4% in SH and 47.1% in PWH; and the compliance rates of switching essential medications to non-oral routes were 63.4% in SH and 70.6% in PWH (not statistically significant). The compliance rates of using as-required intravenous or subcutaneous medications were extremely low (<2%) at both hospitals. All futile life-sustaining procedures and treatments were initiated at the PWH. Conclusions: We demonstrated significant differences in the quality of EOL care between the acute hospital and convalescence hospital. Greater emphasis on specialist training and education with allocation of resources may improve the EOL care in both settings.published_or_final_versio

GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures

© 2019, The Author(s). Bone area is one measure of bone size that is easily derived from dual-energy X-ray absorptiometry (DXA) scans. In a GWA study of DXA bone area of the hip and lumbar spine (N ≥ 28,954), we find thirteen independent association signals at twelve loci that replicate in samples of European and East Asian descent (N = 13,608 – 21,277). Eight DXA area loci associate with osteoarthritis, including rs143384 in GDF5 and a missense variant in COL11A1 (rs3753841). The strongest DXA area association is with rs11614913[T] in the microRNA MIR196A2 gene that associates with lumbar spine area (P = 2.3 × 10−42, β = −0.090) and confers risk of hip fracture (P = 1.0 × 10−8, OR = 1.11). We demonstrate that the risk allele is less efficient in repressing miR-196a-5p target genes. We also show that the DXA area measure contributes to the risk of hip fracture independent of bone density

Certain dietary patterns are associated with glim criteria among Chinese community-dwelling older adults : a cross-sectional analysis

202202 bchyVersion of RecordOthersThis work was supported by grants from the Health and Medical Research Fund of the Food and Health Bureau of Hong Kong (No. HMRF#12133811) and the Hong Kong Jockey Club Charities Trust. The funders had no role in study design, collection, analysis and interpretation of data, writing of the report and in the decision to submit the article for publication.Publishe

Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self-Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales

Background: With the intention to aid planning for elderly focused public health and residential care needs in rapidly aging societies, a simple model using only age, gender and three Minimum Data Set (MDS) subscales (MDS-ADL Self-Performance Hierarchy, MDS-Cognitive Performance and the MDS-Changes in Health, End-stage disease and Symptoms and Signs scales) was used to estimate long-term survival of older people moving into nursing homes. Methods: A total of 1820 nursing home residents were assessed by the MDS 2.0 and their mortality status 5 years later was used to develop a survival prediction model. Result: In December 2006, 54.2 of subjects were dead. Older age at nursing home admission (HR 1.036 per 1-year increment, 95 CI 1.0281.045), men (HR 1.895, 95 CI 1.6512.175), higher impairment level according to the MDS-ADL (HR 1.135 per 1-unit increment, 95 CI 1.0991.173) and MDS-CPS (HR 1.077 per 1-unit increment, 95 CI 1.0331.123), and more frail on the MDS-CHESS (HR 1.150 per 1-unit increment, 95 CI 1.0421.268), were all independent predictors of shorter survival after nursing home admission in multivariate analysis. Survival function was derived from the fitted Cox regression model. Survival time of nursing home residents with different combinations of risk factors were estimated through the survival function. Conclusion: The MDS-ADL, MDS-CPS and MDS-CHESS scales, in addition to age and gender, provide prognostic information in terms of survival time after institutionalization. The model may be useful for health care and residential care planning in an ageing community.link_to_subscribed_fulltex

Highly Recurrent RET Mutations and Novel Mutations in Genes of the Receptor Tyrosine Kinase and Endothelin Receptor B Pathways in Chinese Patients with Sporadic Hirschsprung Disease

Background: Hirschsprung disease (HSCR) is a congenital disorder characterized by an absence of ganglion cells in the nerve plexuses of the lower digestive tract. HSCR has a complex pattern of inheritance and is sometimes associated with mutations in genes of the receptor tyrosine kinase (RET) and endothelin receptor B (EDNRB) signaling pathways, which are crucial for development of the enteric nervous system. Methods: Using PCR amplification and direct sequencing, we screened for mutations and polymorphisms in the coding regions and intron/exon boundaries of the RET, GDNF, EDNRB, and EDN3 genes of 84 HSCR patients and 96 ethnically matched controls. Results: We identified 10 novel and 2 previously described mutations in RET, and 4 and 2 novel mutations in EDNRB and in EDN3, respectively. Potential disease-causing mutations were detected in 24% of the patients. The overall mutation rate was 41% in females and 19% in males (P = 0.06). RET mutations occurred in 19% of the patients. R114H in RET was the most prevalent mutation, representing 7% of the patients or 37% of the patients with RET mutations. To date, such a high frequency of a single mutation has never been reported in unrelated HSCR patients. Mutations in EDNRB, EDN3, and GDNF were found in four, two, and none of the patients, respectively. Two patients with mutations in genes of the EDNRB pathway also harbored a mutation in RET. Three novel and three reported polymorphisms were found in EDNRB, EDN3, and GDNF. Conclusion: This study identifies additional HSCR disease-causing mutations, some peculiar to the Chinese population, and represents the first comprehensive genetic analysis of sporadic HSCR disease in Chinese. © 2004 American Association for Clinical Chemistry.link_to_subscribed_fulltex