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Biomedical subjects

C Y Ko

Publications and source records attributed to C Y Ko.

At least 19 recordsLinked to original sources
PubMed2006

Osteoporosis prevention education programme for women.

AIM: This paper reports an evaluation of a nurse-initiated education programme on four specific osteoporosis prevention behaviours which led to their adoption or to positive attitude changes. BACKGROUND: In the past, osteoporosis was a serious health concern that most commonly affected women in Northern Europe and the United States of America, but was less commonly seen in Asian women. However, in Hong Kong, osteoporosis is currently among the top five conditions causing disability and prolonged hospital stay for older people. From an economic perspective, the most cost-effective approach is to focus on primary prevention via education, and nurses often have the responsibility of providing such educational programmes. METHOD: A randomized controlled study was conducted from July 2004 to March 2005 with 76 women (38 cases and 38 controls) recruited in two private beauty clinics in Hong Kong. Pre-, post- and follow-up education data were compared regarding attitudes and adoption frequency before and after the education programme. RESULTS: The results showed statistically significant increases for each behaviour: consumption of soy foods (P < 0.001), milk (P < 0.001), more exercise (P = 0.01) and vitamin D/exposure to sunlight (P < 0.001) for the case group compared with the control group. Most participants either disagreed (n = 15, 39.0%) or strongly disagreed (n = 23, 61.0%) that there was not enough information provided in the education programme to motivate them to change. They rated the nurse's performance as either satisfactory or very satisfactory on presentation, ability to answer their questions and ability to describe each behaviour clearly. CONCLUSION: Although positive results with a nurse-initiated education programme were demonstrated, future research examining the effects of education and occupation on these four adoption behaviours should focus on more diverse populations with respect to age, income or ethnicity. The findings suggest the value of creative approaches in future health education for the prevention of osteoporosis, and the need for a critical appraisal of current strategies and a re-evaluation of services and funding.

Adolescent↗
PubMed2002

Biological monitoring of environment exposure to safrole and the Taiwanese betel quid chewing.

A rapid and sensitive biological monitoring (BM) method for assessing exposure to the environmental carcinogen safrole has been developed. The method is an isocratic high-performance liquid chromatographic (HPLC) analysis of urinary dihydroxychavicol (DHAB) and eugenol, the urinary metabolites of safrole. Good linearity, precision, and accuracy were demonstrated. A recovery of 98.8 +/- 5.4% (SD, n = 3) was found for DHAB and 84.1 +/- 3.4% (n = 3) for eugenol. The quantitation limits of the method were 8 ng for DHAB and 10 ng for eugenol. The validity of the method was demonstrated by a linear dose-response relationship observed in rats given oral doses of safrole at 30, 75, and 150 mg/kg body weight. The method was also used to monitor the environmental exposure to the Taiwanese betel quid (TBQ) chewing, because TBQ used in Taiwan not only contains areca (betel) nut, slaked lime, and catechu but also Piper betle inflorescence or its leaves. Both of the latter have a high content of safrole. The feasibility of the method to monitor TBQ chewing was demonstrated by an analysis of 153 spot human urine samples. The results showed that the p value of the nonparametric group comparison was < 0.001 for DHAB and 0.832 for eugenol. The TBQ chewers also exhibited a significantly higher rate of urinary DHAB (but not eugenol) than the nonchewers with an odd ratio of 3.47 (95% CI, 1.61-7.51). However, when only the eugenol-positive subjects were taken into analysis, the ratio rose to 24.38 (95% CI, 3.00-197.90).

Administration, Oral↗
PubMed2001

Long-term outcomes of the ileal pouch anal anastomosis: the association of bowel function and quality of life 5 years after surgery.

INTRODUCTION: Previous studies have reported that mean health related quality of life (HRQL) levels generally attain normalcy following construction of an ileal pouch anal anastomosis (IPAA). It appears inconsistent, however, that these normal HRQL levels are achieved while bowel function (BF) scores generally remain statistically worse than "normal" (e.g., 4-8 stools/day, possible anal leakage, diaper usage). To investigate this inconsistency, the current study attempts to determine if any statistical associations are present between HRQL and BF, specifically in the long term. Multivariate regression analyses are performed using each of 8 individual HRQL domains against the full model of BF characteristics. METHODS: All patients more than 5 years status post an ileal pouch anal anastomosis (IPAA) procedure for familial adenomatous polyposis (FAP) at a single institution were studied. FAP was chosen because patients are routinely asymptomatic preoperatively. BF (e.g., stool frequency, anal leakage) and HRQL (using the 8 health domains of the SF-36) were assessed by patient interview. Student's t tests and full model multivariate regression analyses were used to analyze associations between BF and HRQL. RESULTS: The sample included 25 patients (14 male). Mean age was 39 years, mean follow-up time was 11 years. Although mean scores for the 8 individual HRQL domains were not statistically different from the general United States population, regression analyses of the different domains did demonstrate significant associations with varying levels of BF. While controlling for age and gender, the analyses show that the physical function domain is improved with the ability to pass flatus independent of stool, and physical role and mental health domains are improved with decreased stool frequency. The social function domain is improved with increased stool retention time, while the perception of general health is improved with less diaper usage and less sexual dysfunction. CONCLUSIONS: This study shows that a statistically significant association between HRQL levels and BF is present. Of the numerous BF characteristics tested, five appear to be of greater importance with regard to certain HRQL domains. This finding may have clinical implications concerning pouch construction and surgical technique. Methodologically, this study demonstrates that merely using mean levels to describe HRQL may not elucidate meaningful relationships between important clinical outcomes, such as function and HRQL.

Adenomatous Polyposis Coli↗
PubMed2001

Internationalization of general surgical journals: origin and content of articles published in North America and Great Britain from 1983 to 1998.

HYPOTHESIS: The origin and characteristics of articles published in the 6 highest rated (Institute for Scientific Information classification) English-language general surgical journals have changed significantly during the past 15 years. DESIGN: All articles published in 1983, 1988, 1993, and 1998 in 5 US surgical journals and 1 British surgical journal were reviewed and characterized. MAIN OUTCOME MEASURES: Absolute numbers and proportions of national and international articles published in each journal. RESULTS: Articles reviewed included 4868 in US journals and 1380 in the British journal. The total number of US journal articles decreased by 15.1%. The total number of British journal articles increased by 58.9%. The percentage of national articles decreased from 87.5% to 68.8% in US journals (P<.001) and constituted the minority of freely submitted articles in 1998 in 3 of 5 US journals. The percentage of national articles also decreased from 74.8% to 47.1% in the British journal (P<.001). Articles by European and Asian authors showed the most striking increases in all journals. The percentage of basic research articles declined in US journals from 23.3% to 17.9% (P =.001) owing to a 14.9% decline in national basic research articles. The percentage of clinical randomized studies increased from 2.2% to 4.1% (P<.008), but the increase was attributable to international articles. Government funding alone decreased from 13.6% to 11.2%, and government plus another source of funding decreased from 19.2% to 16.7% for national articles in US journals. CONCLUSIONS: Internationalization of the highly rated British and the 5 highest rated US general surgical journals has occurred. The decrease in the number of national articles in the US journals has been accompanied by significant decreases in government funding and basic research articles and a static output of clinical randomized studies from North America.

Authorship↗
PubMed2001

Methodology standards associated with quality reporting in clinical studies in pediatric surgery journals.

BACKGROUND/PURPOSE: Reports of clinical trials often lack adequate descriptions of design and analysis; recent attention has focused on improving this omission so readers can properly assess the strength of the findings and draw their own conclusions. Similar analysis of study design and methodologic standards associated with quality reporting has not been carried out for pediatric surgery journals. METHODS: All studies (n = 642) published in 1998 in Journal of Pediatric Surgery (JPS) and Pediatric Surgery International (PSI), were reviewed for demographic data and study design. The frequency of reporting of 11 basic elements of design and analysis was evaluated in randomized clinical trials (RCT), nonrandomized clinical trials (NRCT), and retrospective cohorts (RC) from JPS by consensus of 2 assessors. RESULTS: Of the 642 studies, 17% of articles (111 of 642) were classified as clinical studies. Sixty-three were comparative studies and consisted of RC (n = 48), NRCT (n = 12), and RCT (n = 3). Two-thirds of articles published were either case reports or case series (431 of 642), and 16% were basic science articles. Demographic analysis showed a wide range of topics addressed, 4 authors per article, and multiple country of origin of authors. More than 66% of all RCT in JPS reported on eligibility criteria, admission before allocation, random allocation, method of randomization, patients' blindness to treatment, treatment complications, statistical analyses, statistical methods, loss to follow-up, and statistical methods; 2 elements of design and analysis, however, were poorly reported: blind assessment of outcome (33%) and power (17%). CONCLUSIONS: There were few randomized, controlled trials in pediatric surgery journals, and further attention should be given to evaluate the causal factors. Nine elements of quality reporting were well reported; however, 2 others were poorly reported; this may improve if editors of pediatric surgical journals provide authors with guidelines on how to report clinical trial design and analysis.

Authorship↗
PubMed2000

Improving the Surgeon's participation in research: is It a problem of training or priority?

BACKGROUND: Although numerous important contributions have originated from basic science research performed by surgeons, it seems that such dedicated work is becoming increasingly difficult to accomplish. What are the reasons for this change and what improvements can be made? This study aims to characterize the basic research training and careers of senior academic surgeons to assess and devise strategies for sustaining productive and quality surgical research. METHODS: A 25-item survey was sent to 850 senior-level members of academic societies, including the Association of Academic Surgeons, Society of University Surgeons, and American Surgical Association. It addressed each surgeon's clinical and research training and career, as well as opinions concerning surgical research. RESULTS: Three hundred seventy-seven (44%) surveys were received. Mean age was 64 years, and 73% were full professors. Seventy-two percent of respondents performed basic science research during training, and for 71% of this group, research was a significant reason for choosing a clinical specialty. Ninety-one percent performed research in the same specialty area during and after training. Of those who performed research during training, a full 99% continued to perform research on completion of training. However, 38% stopped performing basic research by age 39. Seventeen and twenty-three percent stopped basic research between 40 and 49 and between 50 and 59 years of age, respectively. The most common factors causing them to stop were increased clinical load (40%) and increased administrative duties (38%). For respondents who had stopped research prior to age 40, 73% cited increased clinical load as the primary reason. Eighty-five percent felt a dedicated research period should be included in surgery training. CONCLUSIONS: Most respondents had participated in basic research during training, and continued similar research after training. However, an overwhelming clinical practice at the junior faculty level seemed to hinder research. We conclude: (1) the majority consensus is that research training is integral to the development of academic surgeons; (2) such research training opportunities appear adequate; however, (3) faculty performing research, particularly at the junior level, need to be better protected from other academic duties, such as clinical practice and administration. The challenge to the leadership of academic surgery will be to enhance such research productivity in the context of increasing academic demands.

Adult↗
PubMed2000

Primary duodenal adenocarcinoma: a 40-year experience.

HYPOTHESIS: In patients with duodenal adenocarcinoma, certain pathologic features of the tumor will have prognostic significance. DESIGN: Retrospective case series. PATIENTS: Forty-nine patients diagnosed with duodenal adenocarcinoma between 1957 and 1998. RESULTS: The tumors of 31 (63%) of the 49 patients underwent resection, 18 (37%) had surgical palliation or underwent biopsy. Mean (+/- SEM) survival for all patients was 49 +/- 9 months. The patients whose tumors were resected had longer survival than those who underwent palliation (mean +/- SEM, 66 +/- 13 months vs 18 +/- 6 months, P =.02). Multivariate analysis revealed large tumor size (P =.01), transmural invasion (P =.004), and moderate to poor tumor grade (P =.03) were negatively correlated with survival. Lymph node status did not influence survival. CONCLUSIONS: Our 40-year experience with duodenal adenocarcinoma demonstrates that large tumor size, advanced histological grade, and transmural invasion are associated with decreased survival. These results underscore the importance of early diagnosis, and suggest the presence of nodal spread is not a contraindication to resection.

Adenocarcinoma↗
PubMed2000

Does better functional result equate with better quality of life? Implications for surgical treatment in familial adenomatous polyposis.

PURPOSE: The main impetus for a patient with familial adenomatous polyposis to choose colectomy with ileorectal anastomosis over ileal pouch-anal anastomosis is the better functional result. However, does better functional result necessarily translate into better overall quality of life? Previous studies of other diseases have demonstrated no such correlation. This study was performed to determine whether any relationship exists between functional result and quality of life in patients with familial adenomatous polyposis after ileorectal anastomosis and ileal pouch-anal anastomosis. METHODS: All patients with familial adenomatous polyposis who underwent colectomy with ileorectal anastomosis or proctocolectomy with ileal pouch-anal anastomosis from 1980 to 1998 were studied. Functional data were obtained by questionnaire. Health-related quality of life was assessed by two validated instruments, the SF-36 Physical and Mental Health Summary Scales and the SF-36 Health Survey, which measure physical and mental functioning and eight separate health-quality dimensions, including health perception, physical and social functioning, physical and emotional role limitations, mental health, bodily pain, and energy or fatigue. RESULTS: Data were obtained in 44 of 68 patients, 14 with ileorectal anastomosis and 30 with ileal pouch-anal anastomosis. No differences were demonstrated between the two groups for patient age, mean follow-up time, and mean patient age at operation. Functional results were worse for the ileal pouch-anal anastomosis group vs. the ileorectal anastomosis group in number of bowel movements per day (7.5 vs. 5.2; P < 0.05), leakage (43 vs. 0 percent; P < 0.01), pad usage (17 vs. 0 percent; P < 0.01), perianal skin problems (33 vs. 7 percent; P < 0.01), food avoidance (80 vs. 43 percent; P < 0.01), and inability to distinguish gas (37 vs. 7 percent; P < 0.01). Results of the health-related quality-of-life surveys, however, demonstrated no difference between the ileal pouch-anal anastomosis and ileorectal anastomosis groups. The Physical and Mental summary scales for the ileal pouch-anal anastomosis and ileorectal anastomosis groups were not significantly different (Physical Health Scale, 50.3 vs. 50.9; Mental Health Scale, 51.7 vs. 49.6), and none of the eight dimensions of the SF-36 health survey demonstrated statistical differences between the ileal pouch-anal anastomosis and ileorectal anastomosis groups. CONCLUSION: Better functional results were not equated with better quality of life in this pilot study. Although patients with the ileorectal anastomosis have better functional results than those with ileal pouch-anal anastomosis, the measured health-related quality of life as determined by a validated generic health-related quality-of-life instrument is the same for both groups. These results suggest that all patients with familial adenomatous polyposis might be optimally treated with an ileal pouch-anal anastomosis. More importantly, this study suggests that health-related quality of life should play a greater role in the evaluation of care and treatment in colon rectal surgery.

Adenomatous Polyposis Coli↗
PubMed1998

Ion chromatography method and validation for the determination of sulfate and sulfamate ions in topiramate drug substance and finished product.

A stability-indicating assay method has been developed for monitoring topiramate degradation in drug substance and finished product by quantifying sulfamate and sulfate ions. Topiramate in the solid state is stable under ambient conditions but can degrade under stress conditions (elevated temperatures and humidities). This method detects and quantitates sulfamate and sulfate ions (the inorganic part of the decomposition) and in conjunction with an assay method for topiramate and its known organic degradation product provides total molar accountability. The chromatographic system consists of a sodium hydroxide gradient (2-25 mM) and an anion-exchange HPLC column and an anion suppressor. The analysis is complete in 30 min. The method utilizes the same sample preparation as the topiramate assay method which increases sample efficiency and throughput. The method has been validated for analysis of degraded and nondegraded topiramate drug substance and finished product.

Anticonvulsants↗
PubMed1998

What is the best method of surgical training?: A report of America's leading senior surgeons.

OBJECTIVES: To characterize the career choices and developments made by leading senior surgeons in this country and to examine hypothetically whether application of a short tracking program would have hindered their career decisions. DESIGN: A survey pertaining to each surgeon's career, decisions, and opinions concerning surgical training. SETTING AND PARTICIPANTS: Senior surgeons of regional and national surgical societies. MAIN OUTCOME MEASURE: Survey responses. RESULTS: A total of 352 surveys (41.4%) were received. Respondents answered that the most common reasons for choosing a specialty were role models or mentors (56%), research (51%), and available patient population (23%). The 2 most common stages in a career at which the respondents became interested in a specialty, or an area of expertise, were at the junior residency level (when the specialty was chosen) and at the assistant professor level (when a more specific topic within the specialty was chosen). The most common stage at which the group believed they acquired their expertise was also at the assistant professor level. Seventy-one percent of respondents believed broad training was superior to a short tracking system, although none had participated in shortened surgical training. CONCLUSIONS: Most leading senior surgeons in this country still believe that broad surgical training is superior and should be maintained. Because career specialties in this surveyed group were generally chosen in early residency, a hypothetical application of the short tracking system would have still allowed for these important decisions to be made. Also, it seems likely that specialty and career development would not have been hindered because "expertization" mostly occurred after training was completed. Regardless of training method, a role model or mentor seems most important in career choices and developments.

Adult↗
PubMed1998

Lung volume reduction surgery: a cost and outcomes comparison of sternotomy versus thoracoscopy.

It remains unknown whether it is better to perform lung volume reduction surgery (LVRS) through video-assisted thoracoscopy (VATS) or sternotomy. This study compares both approaches in terms of surgical and patient outcomes as well as the associated costs. All patients undergoing LVRS from 1995 to 1997 at one institution by a single surgeon (PFW) were investigated. Preoperative, postoperative, and cost data were obtained from medical and financial records. A total of 42 patients with severe emphysema underwent LVRS (19 via sternotomy and 23 via thoracoscopy). Both groups were comparable preoperatively. Comparison of intraoperative times revealed VATS takes longer to perform (sternotomy, 118 +/- 29 minutes; thoracoscopy, 168 +/- 20 minutes). Postoperatively, the sternotomy patients had more days on the ventilator, more days in the intensive care unit, more days with an air leak, and longer hospital stays. In both groups, the majority of patients reported improvement in oxygen dependence as well as quality of life. Neither surgical approach conferred any long-term medical advantage; however, the average total hospital costs and charges were reduced in the VATS group (average cost: VATS, $27,178; sternotomy, $37,299). This study concludes that 1) LVRS seems to be beneficial for selected patients with end-stage emphysema; 2) postoperative morbidity and length of hospital stay are decreased in the VATS group; 3) long-term improvement in postoperative pulmonary function is not influenced by surgical approach; and 4) the overall charges and costs of the VATS approach is less than that of sternotomy.

Aged↗
PubMed1997

Biofeedback is effective therapy for fecal incontinence and constipation.

OBJECTIVE: To define the role of biofeedback in fecal incontinence and constipation. DESIGN: A case series of patients with fecal incontinence or constipation with pelvic floor dysfunction. SETTING: Tertiary care center with an anorectal physiology laboratory. PATIENTS: Patients with 1 of the following: (1) chronic or acute fecal incontinence, (2) fecal incontinence and neurologic injury, or (3) constipation with pelvic floor dysfunction. INTERVENTION: Electromyogram-guided biofeedback retraining of the pelvic floor. MAIN OUTCOME MEASURES: Resolution of electromyographic abnormalities and subjective resolution of fecal incontinence or constipation. RESULTS: Of the patients with fecal incontinence, 92% experienced significant improvement with biofeedback without significant improvement in electromyographic values. Of the patients with constipation and pelvic floor dysfunction 80% experienced improvement with biofeedback without significant change in electromyographic values. CONCLUSION: Biofeedback is effective in selected patients with fecal incontinence and constipation with pelvic floor dysfunction.

Acute Disease↗
PubMed1997

Preemptive analgesia in patients undergoing appendectomy.

OBJECTIVE: To evaluate the use of preemptive analgesia in patients who were undergoing an operation for acute appendicitis. DESIGN: Double-blind, randomized control trial. SETTING: Public hospital. PATIENTS: Patients who presented with presumed appendicitis. INTERVENTION: Patients received 1 of the following treatments: group 1, preemptive analgesia with a combination of lidocaine hydrochloride and bupivacaine hydrochloride; group 2, preemptive analgesia with saline solution; or group 3, nothing. MAIN OUTCOME MEASURES: The Wong-Baker FACES Pain Rating Scale, analgesic requirements, number of analgesic doses required, and length of hospital stay. RESULTS: No differences were noted in postoperative pain, the total number of analgesic doses per day, the quantity of narcotic medication administered, and the length of hospital stay. CONCLUSIONS: Compared with healthy control subjects, preemptive analgesia did not reduce postoperative pain, reduce analgesic requirements, or shorten the length of hospital stay in patients who underwent an appendectomy. Premptive analgesia may be applicable only for patients without preoperative pain.

Acute Disease↗
PubMed1997

Durability of prefabricated versus normal random flaps against a bacterial challenge.

UNLABELLED: Numerous reports of flap prefabrication have demonstrated good survival. The durability of these flaps compared with that of other flap types or normal tissue, however, remains unknown. The purpose of this study was to determine how prefabricated flaps respond to a bacterial challenge compared with identically sized normal random-pattern flaps. Rat abdominal cutaneous-panniculus carnosus flaps were prefabricated with a standard-sized groin fasciovascular tissue carrier and then inoculated with Staphylococcus aureus. The prefabricated flaps were divided into two groups. Group one (standard prefabricated flap, n = 24) received no growth factor. Group two (n = 24) received an angiogenic growth factor between the carrier and flap tissue. A random-pattern flap served as a nonprefabricated control (n = 12). Grading of the prefabricated flaps with growth factor versus the standard prefabricated flaps versus controls showed dehiscence (41 versus 37 versus 4 percent), ulceration (21 versus 29 versus 18 percent), erythema/cellulitis (40 versus 44 versus 8 percent), and necrosis (9 versus 29 versus 0 percent). The control flaps had significantly less dehiscence, erythema/ cellulitis, and necrosis than the standard prefabricated flaps. Similarly, the prefabricated flaps with angiogenic growth factor had significantly less necrosis than the standard prefabricated flaps. CONCLUSIONS: (1) prefabricated flaps were demonstrated to be less durable than random-pattern flaps against a bacterial challenge, (2) angiogenic growth factor may help to improve the durability of prefabricated flaps against bacterial infection, and (3) the biologic behavior of prefabricated flaps is not the same as that of normal tissue and deserves further investigation.

Animals↗
PubMed1997

The spontaneous return of sensibility in breasts reconstructed with autologous tissues.

Some spontaneous return of sensibility following autologous tissue breast reconstruction is often suspected but not well documented. In the present study, objective touch-pressure, pain, temperature, and vibratory sensibilities were recorded in 33 autologous breast reconstructions at an average of 25.2 months postoperatively. Correlation of the sensory return with patients' satisfaction toward reconstruction was done by a detailed questionnaire. All except one patient regained a variety of sensibilities touch pressure in 97 percent of patients (averaging 81.05 gm/mm2 versus control of 7.98 gm/mm2), pain in 88 percent of patients, heat in 64 percent of patients (45 percent of quadrants), cold in 82 percent of patients (67 percent of quadrants), and high- and low-frequency vibration in 100 percent of patients (high in 90 percent of quadrants, low in 96 percent). Subjectively, 94 percent considered their chest comfortable to touch following reconstruction compared with 34 percent following mastectomy. On a scale from 1 to 10, patients rated their reconstructions an average of 9.3. Our findings confirm the spontaneous return of sensibility following a variety of autologous tissue breast reconstructions. The value of the sensory return is suggested by the high degree of satisfaction in nearly all patients. Further attempts to correlate the degree of sensory return with the degree of satisfaction were inconclusive because of the uniformly high satisfaction reported by the patients. The mechanism of reinnervation appears to come both from the skin margins and from the deep surface of the flap. Future developments in breast reconstruction should take into consideration the eventual quality of sensory return.

Adult↗
PubMed1997

Surgical treatment of pathologic fracture of the femur.

A retrospective study of the surgical treatment of 32 metastatic lesions of the femur in 30 patients at the Kaohsiung Medical College Hospital was performed from 1987 to 1994. There were 16 women and 14 men with an average age of 61 years. A surgical technique combining internal fixation or prosthesis and methylmethacrylate cement was used in all cases. Adequate pain relief was achieved in thirty-one cases (97 %). Of the entire group, 20 cases (62%) remained ambulatory, 10 cases (31%) were confined to a wheelchair, only two cases had implant failure and one suffered from infection.

Adult↗