Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial.

INTRODUCTION: Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive. METHODS: In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge. RESULTS: A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001). CONCLUSION: Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.

Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong.

OBJECTIVES: To estimate the point prevalence of primary hyperaldosteronism in a government out-patient setting and to compare associated patient characteristics with those having essential hypertension. DESIGN: Case series with external comparison. SETTING: A single public hospital (Caritas Medical Centre) and all five associated general out-patient clinics in Sham Shui Po district in Hong Kong. PATIENTS: All patients with confirmed primary hyperaldosteronism and randomly selected patients with essential hypertension from a medical specialist clinic and general out-patient clinics, retrieved from a computer database for the period January 2007 to December 2008. MAIN OUTCOME MEASURES: Estimated point prevalence of primary hyperaldosteronism among hypertensive patients treated in the public sector of Sham Shui Po district. Patient age when hypertension was diagnosed, number of antihypertensive drugs used for treatment, and the presence of target organ damage in the patients with primary hyperaldosteronism and those with essential hypertension were compared. RESULTS: Among the 46 012 patients receiving antihypertensive treatment, 49 were confirmed to have primary hyperaldosteronism. The estimated point prevalence of primary hyperaldosteronism among these hypertensive patients was 0.106% only, which was far smaller than figures from other countries. When compared with the 147 patients with essential hypertension by multivariate analysis, those with primary hyperaldosteronism were: (1) associated with longer durations of hypertension (odds ratio=1.14; 95% confidence interval, 1.06-1.24) despite being younger at the time of study, (2) likely to be taking three or more antihypertensive drugs (odds ratio=2.51; 95% confidence interval, 1.59-3.95), and (3) more likely to have left ventricular hypertrophy (odds ratio=5.01; 95% confidence interval, 1.83-13.69). All primary hyperaldosteronism patients studied presented with hypokalaemia. The need for antihypertensive drugs was markedly reduced after adrenalectomy for adrenal adenoma. CONCLUSIONS: Primary hyperaldosteronism, which is potentially a surgically curable cause of hypertension, appeared to be underdiagnosed in our locality. Screening by aldosterone-renin ratio of high-risk individuals may help improve patient outcomes.

Use of developmental language scales in Chinese children.

The Reynell Developmental Language Scale (RDLS) and Symbolic Play Test (SPT) have been useful language tests for assessing the language age of children. Both tests have been validated in English-speaking children. However, there have been no studies conducted for Chinese children, whether Mandarin (Northerners) or Cantonese (Southerners) is used as the main dialect. As the Chinese population is the largest ethnic group in the world, and Chinese emigration occurred to nearly all parts of the world, it is essential to test whether these language tools can be applied for this ethnic group. The objective of this research was to study whether RDLS and SPT are useful in assessing the language age of Chinese children. Both RDLS (Chinese version) and SPT are conducted for 116 Chinese (Cantonese-speaking) children, aged 13-59 months, in Hong Kong. There is a significant positive correlation of the language age using RDLS and SPT with the chronological age of Chinese children. Both RDLS and SPT can be adopted in determining the language/mental age of Chinese (Cantonese-speaking) children.

A patient with three kidneys: a correlative imaging case report.

A man with three fully developed and well functioning kidneys was studied using correlative imaging. Renal scintigraphy and the renogram not only played a role in identifying the existence of three kidneys but also determined the level of function of each kidney. The use of renal scintigraphy and renography is pivotal in the diagnosis of supernumerary kidneys. An abbreviated review of embryogenesis is also given.

The evolutional stage changes in sarcoidosis on gallium-67 scintigraphy.

UNLABELLED: Gallium-67 scintigraphy has been proven as the imaging modality of choice in monitoring the presence of active disease in sarcoidosis. The purpose of this study is to analyze the patterns of evolutional stage changes of sarcoidosis while on steroid therapy by Ga-67 scintigraphy. METHODS: Eighty-six consecutive patients with biopsy-proved sarcoidosis are evaluated by Ga-67 scintigraphy. Thirty-six of 86 patients have had a baseline and one to eight follow-up Ga-67 scintigraphs (total 136 studies). The initial follow-up scintigraphs are obtained on average about 4-12 months after the baseline study. RESULTS: Seventeen of 36 patients (47.2%) are in stage IV at the time of the baseline study. Following their first course of corticosteroid therapy, 13 patients remained in the same stage and activity distribution pattern while 13 patients have shown reversion to other stages, eight patients showed complete remission while two patients became active from inactive stage. CONCLUSION: Evolutional stage changes are seen in 23 patients (63.9%), including eight patients (22.2%) who showed complete scintigraphic remission. The evolutionary stage changes remain quite variable and unpredictable. This, however, should not detract from the usefulness of Ga-67 scintigraphy in the diagnosis and prognostic evaluation of sarcoidosis, particularly when extrapulmonary involvement (Stage IV disease) is present.

Radionuclide venography: imaging monitor in deep-vein thrombosis of the pelvis and lower extremities.

Seventy-four adults with documented deep-vein thrombosis of the pelvis and/or lower extremities had baseline and follow-up radionuclide venography (RNV), giving a total of 171 studies. Fifty-nine of the patients had unilateral venous thrombosis, of which 36 (61.0%) involved the left side and 23 (39.0%) the right. The higher incidence in the left side was attributed to the longer and more horizontal course of the left common iliac vein, as well as to compression by the right iliac artery and inguinal ligament. In 13 patients bilateral involvement was noted. "Normalisation" of the venous circulatory pattern was characterised by recanalisation and partial or significant disappearance of abnormal collaterals. This occurred in 43/74 patients. In 24 cases, no change was recorded during the interval, while seven patients deteriorated.

Collateral pathways in superior vena caval obstruction as seen on gamma images.

The collateral pathways, known from contrast studies to take over the drainage of blood from the various parts of the body when the superior vena cava or its major tributaries are occluded because of disease, can easily be demonstrated with equal clarity (except for the vertebral plexus pathway) by radionuclides. The failure to delineate the vertebral plexus pathway is felt to lie in the close anatomical relationship between the vertebral plexus and the vertebrae, which cause attenuation of the emerging photons. Because of the existing anastomotic channels and their anatomical direction, location and distribution of the individual collateral pathways are individually identifiable. The site/level, extent, degree, and probable duration of occlusion directly affect the degree and extent of the collaterals that subsequently develop. In 20 of 49 abnormal radionuclide superior venacavograms, incidental but abnormal imaging features not ascribable to caval obstruction or syndrome were noted. These included persistent left superior vena cava, aortic aneurysm, pericardial effusion, and disparity in pulmonary perfusion.

Scintigraphic features of superior vena cava obstruction due to substernal non-toxic goitre.

Four men with clinical features of superior vena caval syndrome due to large substernal non-toxic multinodular goitre have undergone radionuclide superior vena caval studies. In all cases the dynamic scintigraphs showed a characteristic thyroidal configuration attributed to the definition of stretched thyroidal veins and their tributaries. Radiocontrast studies of two patients demonstrated the characteristic thyroid configuration. A radionuclide superior venacavogram taken post-thyroid lobectomy in one case showed the features had reverted to normal.

[99mTc] pertechnetate radionuclide venography--large-volume injection without tourniquet.

Radionuclide venography was performed in patients who were suspected clinically to have thromboembolic disease of the lower extremities and/or pelvis. A moderately large volume of pertechnetate was administered in the dorsal vein of each foot without the benefit of applied tourniquets at the time of injection. Sixty-five (27.2%) of 242 studies were abnormal; the majority revealed defect(s) and collaterals, some collaterals only, and a few defects only. In 140 normal patients only the deep venous system was outlined in 74.5%, while the remainder defined one or both sides of the superficial venous system (great saphenous vein). The merits and apparent advantages derived from radionuclide venographic procedure are discussed. The method is simple, reproducible, and useful in assessing thromboembolic disease, particularly in the deep venous system of the lower extremities and pelvis.

Occlusion of inferior vena cava--features by radionuclide venography.

Six adults with inferior vena caval obstruction are presented. Three were the results of surgical intervention, two were secondary to large thrombi, and one was due to pressure from a large renal-cell carcinoma and adjacent nodes. All underwent a modified approach of radionuclide venography, using a moderately large volume of sodium pertechnetate. Features characteristic of inferior vena caval obstruction were demonstrated in five of the six patients, and these various features are described and discussed.

Unusual bone images in hyperparathyroidism.

Whole-body scans with 99Tcm-Sn polyphosphate were performed on four patients suffering from hyperparathyroidism. Two of the patients were investigated twice, at intervals of five and eight months. A variety of unusual but symmetrical images were obtained, not always confined to the skeleton. It is suggested that in conditions of renal failure the radiopharmaceutical may be avidly accumulated on first passage by calcifying areas in the soft tissues. Deteriorating blood supply to the bones reduces uptake of 99Tcm in the the skeleton.

Hand images: normal and abnormal.

Supplemental hand scintigrams with abnormal features were obtained from 29% of patients (134 of 463) who were referred for routine minified bone imaging with 99mTc-Sn-polyphosphate. A wide spectrum of normal activity distribution ranging from well-defined to "wash-out" images is described in 329 cases (71%). In the abnormal images of the joints and individual bones, the changes--although not always characteristic of some particular disease--may often suggest a diagnosis and/or its pathophysiologic status. The joints with heavy uptake correlate well with the presence of active clinical findings, e.g., in the arthritides. The bone feature associated with metabolic disease, especially when full-blown, may be fairly characteristic. A potential application is in the assessment of digital circulation, particularly in obliterative vascular diseases such as scleroderma, Buerger's disease, chronic neuropathies, and possibly other collagen or vascular diseases that involve the hands. Interesting images, probably of somewhat limited usefulness, are observed in some congenital anomalies, fractures, camptodactyly, contracture deformities, unilateral lymphedema after mastectomy, etc.

Bone scan in mastocytosis: case report.

A 45-year old man with well-documented systemic mastocytosis showed generalized symmetric increased activity on bone imaging. These scan findings are grossly indistinguishable from those of patients with renal osteodystrophy or secondary hyperparathyroidism. The images of the hands, however, failed to show the changes observed in secondary hyperparathyroidism. The mechanism for this intense activity is thought to be due to aberrant new-bone formation.

Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy.

Bone scans in 13 of 14 patients on chronic dialysis were found to be abnormal. Symmetrical increased activity was noted in the calvarium, mandible, sternum, shoulders, vertebrae, and the distal aspects of the femur and tibia, as well as the patella. The scan abnormality is felt to be most likely the result of secondary hyperparathyroidism because of clinical and laboratory data, and, in four, confirmatory tissue diagnoses. The scan findings support the data of some earlier investigations on bone isotopic accretion in hyperparathyroidism. However, co-existing osteomalacia giving rise to abnormal activity in some of the patients cannot be excluded. Dihydrotachysterol may have minimized the extent of osteomalacia in these patients. Osteoporosis was probably present in some patients, but it appears differently on scan. Osteosclerosis was not detected on radiographic examination. Scan manifestations, especially mandibular activity, were pronounced and appeared earlier than the radiographic changes. The degree and extent of abnormal activity correlated with the length of dialysis and the level of alkaline phosphatase.

"Cold" lesions on bone imaging.

Photon-deficient foci or "cold" lesions were demonstrated on 99mTc-polyphosphate bone imaging in eight individuals with various malignancies and one in sickle cell crisis. The bone radiographs of five of these persons failed to show corresponding bony changes at the time of the imaging. Most of the "cold" lesions observed on bone imaging were located in the denser and tubular bones. A postulate has been advanced regarding the factors that might influence the different gamma-imaging manifestations of radiographically demonstrable lytic lesions. The cases presented herein further emphasize the importance of recognizing the existence of "cold" areas in the images of bones and the need to place these in proper perspective when interpreting scans.