Pub Date : 2023-05-19DOI: 10.1177/10249079231175434
Ho Yin Fong
To externally validate the use of the Oakland score in identification of low-risk lower gastrointestinal bleeding patients who can be safely managed without hospitalisation in an accident and emergency department in Hong Kong. This single-centre retrospective cohort study included adult patients who attended the accident and emergency department for lower gastrointestinal bleeding and were subsequently admitted to hospital from 1 January 2020 to 31 December 2020. Safe discharge was defined as absence of all of the following adverse outcomes after hospital presentation: blood transfusion; therapeutic colonoscopy, mesenteric embolisation, or laparotomy for bleeding; in-hospital death (all causes); and readmission with subsequent lower gastrointestinal bleeding within 28 days. The sensitivities, specificities and area under the receiver-operating characteristic curve of the Oakland score were calculated. Among 376 patients who were included in this study, 114 (30.3%) of them experienced one or more adverse outcomes. The area under the receiver-operating characteristic curve for safe discharge was 0.88 (95% confidence interval, 0.84–0.91). Using an Oakland score threshold of ⩽8 points as in the original derivation study can achieve 100% sensitivity (95% confidence interval, 96.8%–100%) and 7.3% specificity (95% confidence interval, 4.4%–11.1%) for safe discharge. When the Oakland score threshold was extended to ⩽11 points, a much greater proportion of low-risk patients could be identified, with 97.4% sensitivity (95% confidence interval, 92.5%–99.5%) and 32.8% specificity (95% confidence interval, 27.2%–38.9%) for safe discharge. The Oakland score performed well in identification of lower gastrointestinal bleeding patients who were at low risk of experiencing adverse outcomes and could thus be safely managed without hospitalisation. Extension of the Oakland score threshold to ⩽11 points can allow identification of a greater proportion of low-risk patients while sensitivity is reasonably maintained.
{"title":"External validation of the Oakland score to assess safe hospital discharge among adult patients with acute lower gastrointestinal bleeding in an accident and emergency department in Hong Kong","authors":"Ho Yin Fong","doi":"10.1177/10249079231175434","DOIUrl":"https://doi.org/10.1177/10249079231175434","url":null,"abstract":"To externally validate the use of the Oakland score in identification of low-risk lower gastrointestinal bleeding patients who can be safely managed without hospitalisation in an accident and emergency department in Hong Kong. This single-centre retrospective cohort study included adult patients who attended the accident and emergency department for lower gastrointestinal bleeding and were subsequently admitted to hospital from 1 January 2020 to 31 December 2020. Safe discharge was defined as absence of all of the following adverse outcomes after hospital presentation: blood transfusion; therapeutic colonoscopy, mesenteric embolisation, or laparotomy for bleeding; in-hospital death (all causes); and readmission with subsequent lower gastrointestinal bleeding within 28 days. The sensitivities, specificities and area under the receiver-operating characteristic curve of the Oakland score were calculated. Among 376 patients who were included in this study, 114 (30.3%) of them experienced one or more adverse outcomes. The area under the receiver-operating characteristic curve for safe discharge was 0.88 (95% confidence interval, 0.84–0.91). Using an Oakland score threshold of ⩽8 points as in the original derivation study can achieve 100% sensitivity (95% confidence interval, 96.8%–100%) and 7.3% specificity (95% confidence interval, 4.4%–11.1%) for safe discharge. When the Oakland score threshold was extended to ⩽11 points, a much greater proportion of low-risk patients could be identified, with 97.4% sensitivity (95% confidence interval, 92.5%–99.5%) and 32.8% specificity (95% confidence interval, 27.2%–38.9%) for safe discharge. The Oakland score performed well in identification of lower gastrointestinal bleeding patients who were at low risk of experiencing adverse outcomes and could thus be safely managed without hospitalisation. Extension of the Oakland score threshold to ⩽11 points can allow identification of a greater proportion of low-risk patients while sensitivity is reasonably maintained.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44281247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-16DOI: 10.1177/10249079231174868
K. Lee, Chi-wai Chau
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). In the past 3 years, the COVID-19 pandemic has influenced every corner of the world and every aspect of patient treatment and management. The care of trauma patients was undoubtedly affected as it was one of the most frequently encountered and important conditions. Globally, researchers have examined the impact of COVID-19 on trauma patient care, trauma networks, and how the system evolved after the pandemic. Even during the crisis, efforts have ceaselessly been put in to discover new evidence, techniques, and devices for better trauma patient management. Researchers and studies of the current issue have also highlighted and addressed a few crucial areas. Sephton et al.1 conducted a study focused on the mechanism and diagnoses of injuries in a major trauma network in the United Kingdom during the lockdown in early 2020. They found a dramatic reduction in all emergency orthopedic referrals and the total number of operations performed. A similar phenomenon was observed in a city in China by Yang and Lu2; there was a reduction in the volume of trauma patients throughout the trauma system. Wickramarachchi et al.3 reported a setting with a dual site for delivering COVID19-free trauma service and retaining the COVID-19 trauma service separately. The mode produced a significant gain in medical bed capacity, with 100% of the trauma patients under the care and emergency operations not having developed COVID-19. Hong Kong has also used a similar system in some clusters. COVID-19 and non–COVID-19-related cases, including trauma patients, were bundled to be managed in different hospitals. Experience gained during COVID-19 for managing trauma patients and networking during the pandemic is invaluable. In the past years, there has been increasing awareness of the important role of metabolic derangements in traumarelated morbidities and mortality. Coagulopathy, hypothermia, and acidosis have been quoted as the “lethal triad” in trauma. Trauma-induced coagulopathy (TIC) is one of the most critical factors contributing to poor outcomes. TIC is present in approximately 24%–34% of hospitalized patients with trauma.4,5 Maegele6 addressed that advances and modern coagulopathy management emphasize goal-oriented and individualized care, which are guided by point-of-care viscoelastic assays. Early identification followed by aggressive management is of utmost importance.6 Evidence and recommendations are established to guide the use of various treatment options for TIC, which include tranexamic acid, fresh-frozen plasma, cryoprecipi
知识共享非商业性CC BY-NC:本文在知识共享署名-非商业4.0许可(http://www.creativecommons.org/licenses/by-nc/4.0/)的条款下发布，该许可允许非商业用途，复制和分发作品，无需进一步许可，前提是原始作品的署名与SAGE和开放获取页面(https://us.sagepub.com/en-us/nam/open-access-at-sage)上指定的一致。在过去的3年里，新冠肺炎大流行影响了世界的每一个角落，影响了患者治疗和管理的每一个方面。创伤患者的护理无疑受到了影响，因为它是最常见和最重要的疾病之一。在全球范围内，研究人员研究了COVID-19对创伤患者护理、创伤网络的影响，以及该系统在大流行后的演变。即使在危机期间，人们也不断努力发现新的证据、技术和设备，以更好地管理创伤患者。研究人员对当前问题的研究也强调并解决了几个关键领域。Sephton等人1进行了一项研究，重点研究了2020年初封锁期间英国一个主要创伤网络中的损伤机制和诊断。他们发现，所有急诊骨科转诊和手术总数都大幅减少。杨和卢在中国的一个城市也观察到了类似的现象;在整个创伤系统中，创伤患者的数量有所减少。Wickramarachchi等人3报告了一种双站点设置，用于提供无COVID-19创伤服务和单独保留COVID-19创伤服务。该模式显著提高了医疗床位容量，在护理和紧急手术下的创伤患者100%没有发生COVID-19。香港在一些集群中也采用了类似的系统。COVID-19和非COVID-19相关病例，包括创伤患者，被捆绑在不同的医院进行管理。在COVID-19期间获得的管理创伤患者和在大流行期间建立网络的经验非常宝贵。在过去的几年里，人们越来越意识到代谢紊乱在创伤发病率和死亡率中的重要作用。凝血功能障碍、体温过低和酸中毒被认为是创伤中的“致命三要素”。创伤性凝血功能障碍(TIC)是导致预后不良的最关键因素之一。大约24%-34%的创伤住院患者存在TIC。Maegele6指出，进步和现代凝血病管理强调以目标为导向和个性化的护理，这是由即时粘弹性试验指导的。5 .早期发现并积极治疗是至关重要的建立了证据和建议来指导TIC的各种治疗方案的使用，包括氨甲环酸、新鲜冷冻血浆、冷冻沉淀和凝血因子浓缩物，如凝血酶原复合物浓缩物和人纤维蛋白原浓缩物粘弹性分析为基础的治疗算法，包括血栓造影和旋转血栓弹性测量，也越来越受欢迎。这可以更早地发现凝血异常患者，从而实现更快速和精确的凝血管理。如今，老龄化是一个全球性问题。老年创伤患者护理已成为一个重要的研究领域。老年人遭遇不良后果的风险最大，严重受伤后死亡的风险也更高。随着年龄的增长，解剖和生理上的变化削弱了它们对损伤应激的反应能力。老年患者服用的药物可能会掩盖严重受伤的迹象。此外，他们不断受到伤害，增加了他们发病和死亡的风险。Braude等人8评估了老年病专家评估对因严重受伤入院的老年人临床结果的影响。研究表明，老年医学专家的评估与严重受伤的老年人死亡风险的降低有关。它还与重症监护时间的缩短有关。如何整合多学科的护理方法需要进一步研究，为老年创伤患者提供更好的护理模式和结果。创伤患者的长期预后可能被忽视了。创伤患者护理的进步提高了受伤患者的存活率。为使他们恢复尽可能好的健康状况，值得作出进一步努力。已经对受伤后重返工作岗位进行了研究Hung et al.9发现低教育水平、体力要求高的工作与工作相关的创伤患者管理:演变与挑战[j] .香港急诊医学杂志[j] . 10249079231174868
{"title":"Trauma patient management: Evolution and challenges","authors":"K. Lee, Chi-wai Chau","doi":"10.1177/10249079231174868","DOIUrl":"https://doi.org/10.1177/10249079231174868","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). In the past 3 years, the COVID-19 pandemic has influenced every corner of the world and every aspect of patient treatment and management. The care of trauma patients was undoubtedly affected as it was one of the most frequently encountered and important conditions. Globally, researchers have examined the impact of COVID-19 on trauma patient care, trauma networks, and how the system evolved after the pandemic. Even during the crisis, efforts have ceaselessly been put in to discover new evidence, techniques, and devices for better trauma patient management. Researchers and studies of the current issue have also highlighted and addressed a few crucial areas. Sephton et al.1 conducted a study focused on the mechanism and diagnoses of injuries in a major trauma network in the United Kingdom during the lockdown in early 2020. They found a dramatic reduction in all emergency orthopedic referrals and the total number of operations performed. A similar phenomenon was observed in a city in China by Yang and Lu2; there was a reduction in the volume of trauma patients throughout the trauma system. Wickramarachchi et al.3 reported a setting with a dual site for delivering COVID19-free trauma service and retaining the COVID-19 trauma service separately. The mode produced a significant gain in medical bed capacity, with 100% of the trauma patients under the care and emergency operations not having developed COVID-19. Hong Kong has also used a similar system in some clusters. COVID-19 and non–COVID-19-related cases, including trauma patients, were bundled to be managed in different hospitals. Experience gained during COVID-19 for managing trauma patients and networking during the pandemic is invaluable. In the past years, there has been increasing awareness of the important role of metabolic derangements in traumarelated morbidities and mortality. Coagulopathy, hypothermia, and acidosis have been quoted as the “lethal triad” in trauma. Trauma-induced coagulopathy (TIC) is one of the most critical factors contributing to poor outcomes. TIC is present in approximately 24%–34% of hospitalized patients with trauma.4,5 Maegele6 addressed that advances and modern coagulopathy management emphasize goal-oriented and individualized care, which are guided by point-of-care viscoelastic assays. Early identification followed by aggressive management is of utmost importance.6 Evidence and recommendations are established to guide the use of various treatment options for TIC, which include tranexamic acid, fresh-frozen plasma, cryoprecipi","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48009671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1177/10249079211050148
Sze Nok Ng, Lok Kan Tang, Chi Kei Leung, Chung Yi Cheng, Mei Shan Cheung, Yuet Yee Lam, Leong Ching Yeung, Yung Ting Tse, Wing Han Tai, P. Chau
Introduction: The study aimed to assess the level of standard first aid knowledge among Hong Kong undergraduates and identify the associated factors, and to examine their attitudes, training preferences and obstacles in first aid training. Methods: This cross-sectional study employed a structured online questionnaire covering demographic data, first aid knowledge assessment and attitude evaluation. Participants were recruited by convenience sampling from August to October 2020. Inclusion criteria included full-time undergraduates studying for the first degree in Hong Kong and receiving primary and secondary education in Hong Kong. To contrast undergraduates studying medical and non-medical degrees, a set ratio of 1:1 was employed, and estimated proportions were weighted according to the ratio of medical and non-medical undergraduates in the population. Unweighted data were used in logistic regressions. Results: Among 385 respondents, the weighted proportion of good knowledge of standard first aid was 15.2% (95% confidence interval (CI): 11.6%–18.8%) and that of good attitudes towards standard first aid was 71.3% (95% CI: 66.8%–75.8%). Holding valid or expired standard first aid certificates (valid: odds ratio (OR) = 9.897, p < 0.001; expired: OR = 4.816, p < 0.001) and studying medical-related degrees (OR = 3.693, p < 0.001) were shown by multiple logistic regression to be associated with good knowledge of standard first aid. Only being a current or past member of first aid cadet teams was associated with a greater likelihood of having good attitudes towards first aid (OR = 2.336, p = 0.047). Respondents proposed standard first aid training should take form of credit-bearing or non-credit-bearing courses in university curriculum, and academic workload should be taken into account when designing training schemes. Conclusion: The proportion of undergraduates in Hong Kong with good first aid knowledge was unsatisfactory, but the counterpart with a good attitude was encouraging. Standard first aid training should be proactively provided to all the local undergraduates, regardless of their enrollment in medical- or non-medical-related degrees.
前言:本研究旨在评估香港本科生的标准急救知识水平及相关因素，并探讨他们对急救培训的态度、培训偏好及障碍。方法:本研究采用结构化的在线调查问卷，包括人口统计资料、急救知识评估和态度评估。参与者于2020年8月至10月采用方便抽样方式招募。纳入标准包括在香港修读第一学位及在香港接受小学及中学教育的全日制本科生。为了对比医学和非医学学位的本科生，采用1:1的固定比例，并根据医学和非医学本科生在人口中的比例对估计比例进行加权。未加权数据用于逻辑回归。结果:385名受访者中，对标准急救有良好认识的权重比例为15.2%(95%置信区间(CI): 11.6% ~ 18.8%)，对标准急救有良好态度的权重比例为71.3% (95% CI: 66.8% ~ 75.8%)。持有有效或过期的标准急救证书(有效:优势比(or) = 9.897, p < 0.001;过期:OR = 4.816, p < 0.001)和学习医学相关学位(OR = 3.693, p < 0.001)与良好的标准急救知识相关。只有现在或过去是急救学员队的成员，才更有可能对急救有良好的态度(or = 2.336, p = 0.047)。受访者建议标准的急救培训应在大学课程中采用学分或非学分课程的形式，并且在设计培训方案时应考虑到学术工作量。结论:香港大学生掌握良好急救知识的比例不理想，但态度良好的比例令人鼓舞。应主动向所有本地本科生提供标准的急救培训，无论他们是否就读于医学相关学位。
{"title":"Knowledge and training preference of standard first aid among undergraduates in Hong Kong: A cross-sectional survey","authors":"Sze Nok Ng, Lok Kan Tang, Chi Kei Leung, Chung Yi Cheng, Mei Shan Cheung, Yuet Yee Lam, Leong Ching Yeung, Yung Ting Tse, Wing Han Tai, P. Chau","doi":"10.1177/10249079211050148","DOIUrl":"https://doi.org/10.1177/10249079211050148","url":null,"abstract":"Introduction: The study aimed to assess the level of standard first aid knowledge among Hong Kong undergraduates and identify the associated factors, and to examine their attitudes, training preferences and obstacles in first aid training. Methods: This cross-sectional study employed a structured online questionnaire covering demographic data, first aid knowledge assessment and attitude evaluation. Participants were recruited by convenience sampling from August to October 2020. Inclusion criteria included full-time undergraduates studying for the first degree in Hong Kong and receiving primary and secondary education in Hong Kong. To contrast undergraduates studying medical and non-medical degrees, a set ratio of 1:1 was employed, and estimated proportions were weighted according to the ratio of medical and non-medical undergraduates in the population. Unweighted data were used in logistic regressions. Results: Among 385 respondents, the weighted proportion of good knowledge of standard first aid was 15.2% (95% confidence interval (CI): 11.6%–18.8%) and that of good attitudes towards standard first aid was 71.3% (95% CI: 66.8%–75.8%). Holding valid or expired standard first aid certificates (valid: odds ratio (OR) = 9.897, p < 0.001; expired: OR = 4.816, p < 0.001) and studying medical-related degrees (OR = 3.693, p < 0.001) were shown by multiple logistic regression to be associated with good knowledge of standard first aid. Only being a current or past member of first aid cadet teams was associated with a greater likelihood of having good attitudes towards first aid (OR = 2.336, p = 0.047). Respondents proposed standard first aid training should take form of credit-bearing or non-credit-bearing courses in university curriculum, and academic workload should be taken into account when designing training schemes. Conclusion: The proportion of undergraduates in Hong Kong with good first aid knowledge was unsatisfactory, but the counterpart with a good attitude was encouraging. Standard first aid training should be proactively provided to all the local undergraduates, regardless of their enrollment in medical- or non-medical-related degrees.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44097393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-21DOI: 10.1177/10249079231166211
{"title":"Reciprocal Abstracts HKJEM May 2023","authors":"","doi":"10.1177/10249079231166211","DOIUrl":"https://doi.org/10.1177/10249079231166211","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44824901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-18DOI: 10.1177/10249079231166331
Shinya Takeuchi, T. Norii, Marisa Rivera, Y. Homma
Despite the increasing demand for procedural sedation and analgesia training, the number of available instructors remains limited. The aim of this study is to compare distance education with in-person learning for knowledge acquisition and participant satisfaction in procedural sedation and analgesia education. We conducted a randomized controlled trial comparing distance education with in-person learning in Japan on three occasions. Twenty participants per course were randomly divided into five groups with stratification by year of graduation. The groups were randomized to either a distance education group or an in-person group. We conducted pre- and post-testing of procedural sedation and analgesia knowledge and surveyed participants’ perceptions by using a scale ranging from 0 (not enough) to 100 (enough). Our primary outcomes were knowledge acquisition and the quality of discussion. We included 48 healthcare professionals in the analysis. Forty-one participants (83.6%) were men and the median years of experience was 5 (interquartile range: 3–9). Both groups had similar knowledge acquisition with the pre-test and post-test score difference and reported similar scores on the quality of discussion with the exception of the clarity of audio quality (93 vs 100, p = 0.017). In a randomized trial of distance versus in-person learning for the sedation course, we did not observe statistically significant differences in knowledge acquisition and participant satisfaction between the two groups except for audio quality for the case discussion. Further efforts to improve quality for distance learning in procedural sedation and analgesia education are needed.
{"title":"Comparison of distance education and in-person education in procedural sedation and analgesia: A randomized controlled trial","authors":"Shinya Takeuchi, T. Norii, Marisa Rivera, Y. Homma","doi":"10.1177/10249079231166331","DOIUrl":"https://doi.org/10.1177/10249079231166331","url":null,"abstract":"Despite the increasing demand for procedural sedation and analgesia training, the number of available instructors remains limited. The aim of this study is to compare distance education with in-person learning for knowledge acquisition and participant satisfaction in procedural sedation and analgesia education. We conducted a randomized controlled trial comparing distance education with in-person learning in Japan on three occasions. Twenty participants per course were randomly divided into five groups with stratification by year of graduation. The groups were randomized to either a distance education group or an in-person group. We conducted pre- and post-testing of procedural sedation and analgesia knowledge and surveyed participants’ perceptions by using a scale ranging from 0 (not enough) to 100 (enough). Our primary outcomes were knowledge acquisition and the quality of discussion. We included 48 healthcare professionals in the analysis. Forty-one participants (83.6%) were men and the median years of experience was 5 (interquartile range: 3–9). Both groups had similar knowledge acquisition with the pre-test and post-test score difference and reported similar scores on the quality of discussion with the exception of the clarity of audio quality (93 vs 100, p = 0.017). In a randomized trial of distance versus in-person learning for the sedation course, we did not observe statistically significant differences in knowledge acquisition and participant satisfaction between the two groups except for audio quality for the case discussion. Further efforts to improve quality for distance learning in procedural sedation and analgesia education are needed.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43806549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.1177/10249079231165947
R.K.M. Cheung, R. Cocks
{"title":"Resuscitation: Bread and butter in emergency medicine","authors":"R.K.M. Cheung, R. Cocks","doi":"10.1177/10249079231165947","DOIUrl":"https://doi.org/10.1177/10249079231165947","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1177/10249079231191866
L. Westafer, Erica Jessen, Michael Zampi, E. Boccio, S. D. Casey, P. Lindenauer, D. Vinson
STUDY OBJECTIVE Although recommended by professional society guidelines, outpatient management of low-risk pulmonary embolism (PE) from emergency departments (EDs) in the US remains uncommon. The objective of this study was to identify barriers and facilitators to the outpatient management of PE from the ED using implementation science methodology. METHODS We conducted semistructured interviews with a purposeful sample of emergency physicians using maximum variation sampling, aiming to recruit physicians with diverse practice patterns regarding the management of low-risk PE. We developed an interview guide using the implementation science frameworks-the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Interviews were recorded, transcribed, and analyzed in an iterative process. RESULTS We interviewed 26 emergency physicians from 11 hospital systems, and the participants were diverse with regard to years in practice, practice setting, and engagement with outpatient management of PE. Although outer setting determinants, such as medicolegal climate, follow-up, and insurance status were universal, our participants revealed that the importance of these determinants were moderated by individual-level and inner setting determinants. Prominent themes included belief in consequences, belief in capabilities, and institutional support and culture. Inertia of clinical practice and complexity of the process were important subthemes. CONCLUSION In this qualitative study, clinicians reported common barriers and facilitators that initially focused on outer setting and external barriers but centered on clinician beliefs, fear, and local culture. Efforts to increase outpatient treatment of select patients with acute PE should be informed by these barriers and facilitators, which are aligned with the deimplementation theory.
{"title":"Reciprocal Abstracts September 2023","authors":"L. Westafer, Erica Jessen, Michael Zampi, E. Boccio, S. D. Casey, P. Lindenauer, D. Vinson","doi":"10.1177/10249079231191866","DOIUrl":"https://doi.org/10.1177/10249079231191866","url":null,"abstract":"STUDY OBJECTIVE\u0000Although recommended by professional society guidelines, outpatient management of low-risk pulmonary embolism (PE) from emergency departments (EDs) in the US remains uncommon. The objective of this study was to identify barriers and facilitators to the outpatient management of PE from the ED using implementation science methodology.\u0000\u0000\u0000METHODS\u0000We conducted semistructured interviews with a purposeful sample of emergency physicians using maximum variation sampling, aiming to recruit physicians with diverse practice patterns regarding the management of low-risk PE. We developed an interview guide using the implementation science frameworks-the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Interviews were recorded, transcribed, and analyzed in an iterative process.\u0000\u0000\u0000RESULTS\u0000We interviewed 26 emergency physicians from 11 hospital systems, and the participants were diverse with regard to years in practice, practice setting, and engagement with outpatient management of PE. Although outer setting determinants, such as medicolegal climate, follow-up, and insurance status were universal, our participants revealed that the importance of these determinants were moderated by individual-level and inner setting determinants. Prominent themes included belief in consequences, belief in capabilities, and institutional support and culture. Inertia of clinical practice and complexity of the process were important subthemes.\u0000\u0000\u0000CONCLUSION\u0000In this qualitative study, clinicians reported common barriers and facilitators that initially focused on outer setting and external barriers but centered on clinician beliefs, fear, and local culture. Efforts to increase outpatient treatment of select patients with acute PE should be informed by these barriers and facilitators, which are aligned with the deimplementation theory.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49503562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1177/10249079221127611
T. Chow, C. Chan, Sze Hong Ng, M. Tse
Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005. Objective: To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic. Methods: A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020. Results: A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0–12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13–19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed. Conclusion: This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports.
{"title":"Hong Kong poison information centre: Annual report 2020","authors":"T. Chow, C. Chan, Sze Hong Ng, M. Tse","doi":"10.1177/10249079221127611","DOIUrl":"https://doi.org/10.1177/10249079221127611","url":null,"abstract":"Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005. Objective: To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic. Methods: A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020. Results: A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0–12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13–19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed. Conclusion: This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42343059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-18DOI: 10.1177/10249079231152382
{"title":"Reciprocal Abstracts March 2023","authors":"","doi":"10.1177/10249079231152382","DOIUrl":"https://doi.org/10.1177/10249079231152382","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45546960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-12DOI: 10.1177/10249079231153719
R. Lo, L. Lyngholm, M. Brabrand, L. Leung, K. K. Hung, S. Laugesen, S. Posth, T. Cooksley, C. Graham, C. Nickel
Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.
{"title":"A tale of two continents: The performance of six early warning scores in two emergency departments","authors":"R. Lo, L. Lyngholm, M. Brabrand, L. Leung, K. K. Hung, S. Laugesen, S. Posth, T. Cooksley, C. Graham, C. Nickel","doi":"10.1177/10249079231153719","DOIUrl":"https://doi.org/10.1177/10249079231153719","url":null,"abstract":"Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45543391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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