Pub Date : 2022-01-01DOI: 10.1177/10249079211063270
K. Hung, Emily Y. Y. Chan, C. Graham
{"title":"Disaster preparedness of emergency departments in Hong Kong","authors":"K. Hung, Emily Y. Y. Chan, C. Graham","doi":"10.1177/10249079211063270","DOIUrl":"https://doi.org/10.1177/10249079211063270","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"3 - 4"},"PeriodicalIF":0.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47883052","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 : 2021-11-08DOI: 10.1177/10249079211049939
Ka Wing Tam, C. Chan, Sha Liu
Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.
{"title":"Anticoagulant rodenticide ingestion: Who will develop coagulopathy?","authors":"Ka Wing Tam, C. Chan, Sha Liu","doi":"10.1177/10249079211049939","DOIUrl":"https://doi.org/10.1177/10249079211049939","url":null,"abstract":"Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"87 - 95"},"PeriodicalIF":0.6,"publicationDate":"2021-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41892965","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 : 2021-10-27DOI: 10.1177/10249079211046399
C. Lui, Clara Wing Yee Wu, K. Ho
The concept of smart hospital is not new, but its development has unprecedentedly been accelerated by the COVID-19 pandemic. Throughput and performance dashboard on ED operation running in real-time manner would facilitate ED managers to maintain smooth ED operation or even predict and anticipate the service surge. The ED health big data would also have potential impact on the development of geriatric and ambulatory emergency medicine to accurately identify high-acuity patients and stratify low-risk patients for ambulatory care. [Extracted from the article] Copyright of Hong Kong Journal of Emergency Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
{"title":"Smart hospitals and A&E departments in Hong Kong: Advantages, considerations and way forward","authors":"C. Lui, Clara Wing Yee Wu, K. Ho","doi":"10.1177/10249079211046399","DOIUrl":"https://doi.org/10.1177/10249079211046399","url":null,"abstract":"The concept of smart hospital is not new, but its development has unprecedentedly been accelerated by the COVID-19 pandemic. Throughput and performance dashboard on ED operation running in real-time manner would facilitate ED managers to maintain smooth ED operation or even predict and anticipate the service surge. The ED health big data would also have potential impact on the development of geriatric and ambulatory emergency medicine to accurately identify high-acuity patients and stratify low-risk patients for ambulatory care. [Extracted from the article] Copyright of Hong Kong Journal of Emergency Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"335 - 337"},"PeriodicalIF":0.6,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44849518","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 : 2021-10-20DOI: 10.1177/10249079211049945
Shuk Hang Chow, C. Chan
Background: Extracorporeal toxin removal is used for enhanced elimination in severe lithium poisoning. The Extracorporeal TReatments In Poisoning workgroup provides recommendations on the use of extracorporeal toxin removal in poisoning. Objectives: Our aim was to identify the pattern for using extracorporeal toxin removal in managing lithium poisoning in Hong Kong and compare the outcomes in extracorporeal toxin removal-treated patients and non-extracorporeal toxin removal-treated patients if indicated for treatment as defined by The Extracorporeal TReatments In Poisoning criteria. Methods: Lithium poisoning presented between year 2009 and 2019 in Hong Kong Poison Information Centre (HKPIC) database was categorized into extracorporeal toxin removal-treated group and non-extracorporeal toxin removal-treated group. Comparative analyses were performed. Results: Among 112 lithium-poisoned patients, 21% were treated with extracorporeal toxin removal. Larger proportion of patients had fulfilled at least one Extracorporeal TReatments In Poisoning criteria for extracorporeal toxin removal in the extracorporeal toxin removal-treated group (87% vs 18%, p < 0.005). The extracorporeal toxin removal-treat group patients were more commonly presented with impaired consciousness, seizure and dysrhythmia (p < 0.05). They also got higher admission (3.62 mmol/L vs 2.18 mmol/L, p < 0.05) and peak (4.15 mmol/L vs 2.28 mmol/L, p < 0.05) serum lithium concentrations, as well as a significantly higher serum creatinine concentration upon presentation (263.74 µmol/L vs 98.66 µmol/L, p < 0.05). Extracorporeal toxin removal-treat group patients more frequently had a severe poisoning outcome (91.3% vs 9%, p < 0.05) and developed complications (69.6% vs 13.5%, p < 0.05). Logistic regression identified seizure, peak serum lithium concentration, and serum creatinine concentration upon presentation as risk factors for severe poisoning outcome. In subgroup analysis on patients with at least one indication for extracorporeal toxin removal as defined by Extracorporeal TReatments In Poisoning criteria, the proportion of severe poisoning remained higher in the extracorporeal toxin removal-treated group (90% vs 43.7%, p < 0.05). Complication rate was not significantly different between the two groups. Conclusion: Clinically severe lithium poisoning patients were treated with extracorporeal toxin removal in Hong Kong. Extracorporeal TReatments In Poisoning criteria can serve as a reference in considering extracorporeal toxin removal treatment for lithium poisoning patients. Nevertheless, Extracorporeal TReatments In Poisoning criteria recommend more extracorporeal toxin removal treatment than it was actually done. Lithium poisoning patients with positive Extracorporeal TReatments In Poisoning criteria have been managed without extracorporeal toxin removal. No statistically significant adverse outcome was observed in these cases.
背景:体外毒素脱除法用于重度锂中毒的强化清除。中毒的体外治疗工作组提供关于使用体外毒素去除中毒的建议。目的:我们的目的是确定在香港使用体外毒素去除治疗锂中毒的模式，并比较体外毒素去除治疗的患者和非体外毒素去除治疗的患者的结果，如果根据中毒的体外治疗标准进行治疗。方法:将2009年至2019年香港毒物信息中心(HKPIC)数据库中出现的锂中毒病例分为体外除毒组和非体外除毒组。进行了比较分析。结果:112例锂中毒患者中，21%采用体外毒素脱毒治疗。在体外毒素去除治疗组中，达到至少一项体外毒素去除中毒标准的患者比例更大(87% vs 18%， p < 0.005)。体外毒素去除组患者出现意识障碍、癫痫发作和心律失常的发生率更高(p < 0.05)。患者入院时血清锂离子浓度较高(3.62 mmol/L vs 2.18 mmol/L, p < 0.05)，峰值时血清锂离子浓度较高(4.15 mmol/L vs 2.28 mmol/L, p < 0.05)，入院时血清肌酐浓度较高(263.74µmol/L vs 98.66µmol/L, p < 0.05)。体外毒素去除组患者出现严重中毒结局(91.3%比9%，p < 0.05)和并发症发生率(69.6%比13.5%，p < 0.05)较高。Logistic回归确定癫痫发作、峰值血清锂浓度和血清肌酐浓度是严重中毒结果的危险因素。在中毒标准中至少有一种体外毒素去除指征的患者的亚组分析中，体外毒素去除治疗组的严重中毒比例仍然更高(90% vs 43.7%， p < 0.05)。两组间并发症发生率无明显差异。结论:香港临床重症锂中毒患者采用体外毒素去除法治疗。中毒时的体外治疗标准可作为锂中毒患者考虑体外除毒治疗的参考依据。尽管如此，中毒的体外治疗标准推荐的体外毒素去除治疗比实际做的更多。在中毒标准中，体外治疗阳性的锂中毒患者不进行体外毒素清除。在这些病例中没有观察到统计学上显著的不良结果。
{"title":"Evaluation of the utilization of extracorporeal toxin removal in lithium poisoning patients in Hong Kong","authors":"Shuk Hang Chow, C. Chan","doi":"10.1177/10249079211049945","DOIUrl":"https://doi.org/10.1177/10249079211049945","url":null,"abstract":"Background: Extracorporeal toxin removal is used for enhanced elimination in severe lithium poisoning. The Extracorporeal TReatments In Poisoning workgroup provides recommendations on the use of extracorporeal toxin removal in poisoning. Objectives: Our aim was to identify the pattern for using extracorporeal toxin removal in managing lithium poisoning in Hong Kong and compare the outcomes in extracorporeal toxin removal-treated patients and non-extracorporeal toxin removal-treated patients if indicated for treatment as defined by The Extracorporeal TReatments In Poisoning criteria. Methods: Lithium poisoning presented between year 2009 and 2019 in Hong Kong Poison Information Centre (HKPIC) database was categorized into extracorporeal toxin removal-treated group and non-extracorporeal toxin removal-treated group. Comparative analyses were performed. Results: Among 112 lithium-poisoned patients, 21% were treated with extracorporeal toxin removal. Larger proportion of patients had fulfilled at least one Extracorporeal TReatments In Poisoning criteria for extracorporeal toxin removal in the extracorporeal toxin removal-treated group (87% vs 18%, p < 0.005). The extracorporeal toxin removal-treat group patients were more commonly presented with impaired consciousness, seizure and dysrhythmia (p < 0.05). They also got higher admission (3.62 mmol/L vs 2.18 mmol/L, p < 0.05) and peak (4.15 mmol/L vs 2.28 mmol/L, p < 0.05) serum lithium concentrations, as well as a significantly higher serum creatinine concentration upon presentation (263.74 µmol/L vs 98.66 µmol/L, p < 0.05). Extracorporeal toxin removal-treat group patients more frequently had a severe poisoning outcome (91.3% vs 9%, p < 0.05) and developed complications (69.6% vs 13.5%, p < 0.05). Logistic regression identified seizure, peak serum lithium concentration, and serum creatinine concentration upon presentation as risk factors for severe poisoning outcome. In subgroup analysis on patients with at least one indication for extracorporeal toxin removal as defined by Extracorporeal TReatments In Poisoning criteria, the proportion of severe poisoning remained higher in the extracorporeal toxin removal-treated group (90% vs 43.7%, p < 0.05). Complication rate was not significantly different between the two groups. Conclusion: Clinically severe lithium poisoning patients were treated with extracorporeal toxin removal in Hong Kong. Extracorporeal TReatments In Poisoning criteria can serve as a reference in considering extracorporeal toxin removal treatment for lithium poisoning patients. Nevertheless, Extracorporeal TReatments In Poisoning criteria recommend more extracorporeal toxin removal treatment than it was actually done. Lithium poisoning patients with positive Extracorporeal TReatments In Poisoning criteria have been managed without extracorporeal toxin removal. No statistically significant adverse outcome was observed in these cases.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"96 - 102"},"PeriodicalIF":0.6,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43700005","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 : 2021-10-11DOI: 10.1177/10249079211051193
Safiyyah Nok Sze Lui, C. Chan
Objective: To compare local poisoning patterns of preadolescents and adolescents. Methods: Retrospective cross-sectional study. Data collected through the Hong Kong Poison Information Centre (HKPIC) Poisoning Information and Clinical Management System (PICMS). Patients aged 10 to 17 years old from January 2016 to December 2018 were included and divided into preadolescent (10–12 years old) and adolescent (13–17 years old) groups. Statistical analysis for categorical variables was performed using chi-square test of independence, p < 0.05. Strength of association examined with Cramer’s V. Rate ratios with 95% confidence interval were used to determine nature of association, using preadolescents as comparison group. Results: A total of 703 cases were analyzed. There were 107 cases in the preadolescent group and 596 cases in the adolescent group. Three variables showed moderate association: intentional exposure (rate ratio: 2.91, 2.13–3.98), exposure in school (rate ratio: 0.30, 0.21–0.44), and the use of pharmaceuticals (rate ratio: 1.95, 1.57–2.44). The most common substance of exposure were analgesics (n = 213, 24.94%) and fumes, gases, and vapors (n = 19, 15.08%) in adolescents and preadolescents, respectively. Conclusion: Epidemiological difference still exists between preadolescents and adolescents. The association of adolescents with intentional poisoning, and the use of pharmaceuticals was highlighted. The study acts as a recent update of pediatric poisoning patterns and hopes to act as a reference for future studies.
{"title":"Pediatric poisoning pattern: A comparison of preadolescent and adolescent groups in Hong Kong over 3 years","authors":"Safiyyah Nok Sze Lui, C. Chan","doi":"10.1177/10249079211051193","DOIUrl":"https://doi.org/10.1177/10249079211051193","url":null,"abstract":"Objective: To compare local poisoning patterns of preadolescents and adolescents. Methods: Retrospective cross-sectional study. Data collected through the Hong Kong Poison Information Centre (HKPIC) Poisoning Information and Clinical Management System (PICMS). Patients aged 10 to 17 years old from January 2016 to December 2018 were included and divided into preadolescent (10–12 years old) and adolescent (13–17 years old) groups. Statistical analysis for categorical variables was performed using chi-square test of independence, p < 0.05. Strength of association examined with Cramer’s V. Rate ratios with 95% confidence interval were used to determine nature of association, using preadolescents as comparison group. Results: A total of 703 cases were analyzed. There were 107 cases in the preadolescent group and 596 cases in the adolescent group. Three variables showed moderate association: intentional exposure (rate ratio: 2.91, 2.13–3.98), exposure in school (rate ratio: 0.30, 0.21–0.44), and the use of pharmaceuticals (rate ratio: 1.95, 1.57–2.44). The most common substance of exposure were analgesics (n = 213, 24.94%) and fumes, gases, and vapors (n = 19, 15.08%) in adolescents and preadolescents, respectively. Conclusion: Epidemiological difference still exists between preadolescents and adolescents. The association of adolescents with intentional poisoning, and the use of pharmaceuticals was highlighted. The study acts as a recent update of pediatric poisoning patterns and hopes to act as a reference for future studies.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"103 - 110"},"PeriodicalIF":0.6,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46717913","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 : 2021-10-06DOI: 10.1177/10249079211049128
C. Wong, Bun Young, Berachah Sze Chung Lui, A. Leung, Jerome Lok Tsun So
Background: The professional quality of life of healthcare professionals in emergency departments may be compromised during the COVID-19 pandemic. Objectives: This study aims to examine professional quality of life and resilience as well as their relationships among emergency department healthcare professionals in Hong Kong during the COVID-19 outbreak. Methods: This study employed a cross-sectional design. Healthcare professionals (doctors and nurses) working in emergency departments in Hong Kong were recruited via snowball sampling. The Professional Quality of Life Scale, version 5, and the 10-item Connor-Davidson Resilience Scale were used to assess their positive (compassion satisfaction) and negative (secondary traumatic stress and burnout) aspects of professional quality of life and self-reported resilience. Socio-demographics and work-related characteristics were also analysed. Results: A total of 106 participants provided valid responses. The results showed an overall moderate level of compassion satisfaction, secondary traumatic stress and burnout among emergency department healthcare professionals. The mean score of the 10-item Connor-Davidson Resilience Scale was 23.8. Backward linear regression analyses revealed self-reported resilience was the only significant predictor of compassion satisfaction (regression coefficient B = 0.875; p < 0.001), secondary traumatic stress (B = −0.294, p < 0.001) and burnout (B = −0.670; p < 0.001), explaining 70.6%, 18.5% and 59.8% of total variance, respectively. Conclusion: Emergency department healthcare professionals in Hong Kong experienced an overall moderate level of professional quality of life during the COVID-19 outbreak. Those with a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout. The results support the importance of developing interventions that foster resilience among this group of emergency department healthcare professionals to combat COVID-19.
{"title":"Professional quality of life and resilience in emergency department healthcare professionals during COVID-19 in Hong Kong: A cross-sectional study","authors":"C. Wong, Bun Young, Berachah Sze Chung Lui, A. Leung, Jerome Lok Tsun So","doi":"10.1177/10249079211049128","DOIUrl":"https://doi.org/10.1177/10249079211049128","url":null,"abstract":"Background: The professional quality of life of healthcare professionals in emergency departments may be compromised during the COVID-19 pandemic. Objectives: This study aims to examine professional quality of life and resilience as well as their relationships among emergency department healthcare professionals in Hong Kong during the COVID-19 outbreak. Methods: This study employed a cross-sectional design. Healthcare professionals (doctors and nurses) working in emergency departments in Hong Kong were recruited via snowball sampling. The Professional Quality of Life Scale, version 5, and the 10-item Connor-Davidson Resilience Scale were used to assess their positive (compassion satisfaction) and negative (secondary traumatic stress and burnout) aspects of professional quality of life and self-reported resilience. Socio-demographics and work-related characteristics were also analysed. Results: A total of 106 participants provided valid responses. The results showed an overall moderate level of compassion satisfaction, secondary traumatic stress and burnout among emergency department healthcare professionals. The mean score of the 10-item Connor-Davidson Resilience Scale was 23.8. Backward linear regression analyses revealed self-reported resilience was the only significant predictor of compassion satisfaction (regression coefficient B = 0.875; p < 0.001), secondary traumatic stress (B = −0.294, p < 0.001) and burnout (B = −0.670; p < 0.001), explaining 70.6%, 18.5% and 59.8% of total variance, respectively. Conclusion: Emergency department healthcare professionals in Hong Kong experienced an overall moderate level of professional quality of life during the COVID-19 outbreak. Those with a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout. The results support the importance of developing interventions that foster resilience among this group of emergency department healthcare professionals to combat COVID-19.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"168 - 176"},"PeriodicalIF":0.6,"publicationDate":"2021-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42601703","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 : 2021-09-15DOI: 10.1177/10249079211044911
A. Tyebally, C. Dong
Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.
{"title":"An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study","authors":"A. Tyebally, C. Dong","doi":"10.1177/10249079211044911","DOIUrl":"https://doi.org/10.1177/10249079211044911","url":null,"abstract":"Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"358 - 364"},"PeriodicalIF":0.6,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45631097","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 : 2021-09-01DOI: 10.1177/10249079211035849
M. L. Yang, J. Walline
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). Airway management is a key skill for caring for critically ill patients in the emergency department (ED). Unlike traditional airway management in surgical operating theatre (OT), there are unique challenges to the ED setting: missing or unavailable key patient information (medical history or previous airway experiences), a diverse patient population (neonate to geriatric and pregnant to obese), physiological or anatomical derangements (sepsis and trauma) and constrained resources (equipment, staffing or training). In this issue of the Hong Kong Journal of Emergency Medicine, we showcase original articles dealing with these issues and recent developments in ED airway management. One challenge often faced by ED physicians is a patient with fluid or foreign material in the upper airway (e.g. blood and vomited food). Ko et al.1 reported a novel technique using an upper airway suction catheter in simulated upper gastrointestinal (GI) bleeding situations. The new technique and suction catheter were shown to improved intubation success rates and reduce the amount of aspirated material. This technique is potentially applicable to patients who are having massive upper GI bleeding, an unfortunately common situation faced in East Asian EDs and worldwide. In another simulation study, Hung and Wong2 examined how to improve patient positioning during intubation. Such positioning in the ED typically does not receive the same amount of attention compared to the OT setting. This is partly due to the lack of resources (equipment, personnel or time), but may also be due to lack of promulgation of such techniques in some emergency medicine training programmes. In their report, Hung and Wong2 demonstrated improved intubation times and better glottic views by putting the mannequin in a novel ramped position. The advantage of this position is that no additional equipment is needed other than elevation of the head of bed and is simple to achieve. New intubation equipment are constantly being introduced. In this issue, we have two original articles involving video laryngoscopes. In a follow-up study by Wong et al.3 (part of the group responsible for the simulated massive GI haemorrhage article above), their group compared three video laryngoscopes in the setting of simulated massive haematemesis. It is well known that video laryngoscope performance can be easily compromised when there is fluid in the airway. In this study, they showed that with a novel suction catheter and special technique, video laryngoscopes are helpful in the m
{"title":"Airway management as a core competence in emergency medicine","authors":"M. L. Yang, J. Walline","doi":"10.1177/10249079211035849","DOIUrl":"https://doi.org/10.1177/10249079211035849","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). Airway management is a key skill for caring for critically ill patients in the emergency department (ED). Unlike traditional airway management in surgical operating theatre (OT), there are unique challenges to the ED setting: missing or unavailable key patient information (medical history or previous airway experiences), a diverse patient population (neonate to geriatric and pregnant to obese), physiological or anatomical derangements (sepsis and trauma) and constrained resources (equipment, staffing or training). In this issue of the Hong Kong Journal of Emergency Medicine, we showcase original articles dealing with these issues and recent developments in ED airway management. One challenge often faced by ED physicians is a patient with fluid or foreign material in the upper airway (e.g. blood and vomited food). Ko et al.1 reported a novel technique using an upper airway suction catheter in simulated upper gastrointestinal (GI) bleeding situations. The new technique and suction catheter were shown to improved intubation success rates and reduce the amount of aspirated material. This technique is potentially applicable to patients who are having massive upper GI bleeding, an unfortunately common situation faced in East Asian EDs and worldwide. In another simulation study, Hung and Wong2 examined how to improve patient positioning during intubation. Such positioning in the ED typically does not receive the same amount of attention compared to the OT setting. This is partly due to the lack of resources (equipment, personnel or time), but may also be due to lack of promulgation of such techniques in some emergency medicine training programmes. In their report, Hung and Wong2 demonstrated improved intubation times and better glottic views by putting the mannequin in a novel ramped position. The advantage of this position is that no additional equipment is needed other than elevation of the head of bed and is simple to achieve. New intubation equipment are constantly being introduced. In this issue, we have two original articles involving video laryngoscopes. In a follow-up study by Wong et al.3 (part of the group responsible for the simulated massive GI haemorrhage article above), their group compared three video laryngoscopes in the setting of simulated massive haematemesis. It is well known that video laryngoscope performance can be easily compromised when there is fluid in the airway. In this study, they showed that with a novel suction catheter and special technique, video laryngoscopes are helpful in the m","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"267 - 268"},"PeriodicalIF":0.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44638601","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 : 2021-08-29DOI: 10.1177/10249079211040971
Zengzheng Ge, Shi Feng, Xiangning Liu, Shi-Gong Guo, Yanxia Gao, X. Lu, Shi-yuan Yu, Lina Zhao, Di Shi, Ji-hai Liu, Huadong Zhu, Yi Li
Background: Appropriate lessons and formalized training concerning emergency medicine is becoming increasingly important in undergraduate medical education. There is an urgent need to evaluate undergraduate emergency medicine education of students enrolled on the 8-year Doctor of Medicine degree programs nationwide in China with the aim that the data extracted could ultimately be used to help develop a standardized emergency medicine curriculum in China. Objectives: The aim of the study is to accurately describe emergency medicine education of 8-year Doctor of Medicine program in China, including emergency medicine classes, clinical practice in emergency medicine department, and expectations toward emergency medicine education. Methods: An online questionnaire was distributed to all the medical students of 8-year Doctor of Medicine program who have attended emergency medicine education in 14 medical schools in China. Participation in the survey was voluntary and anonymized. Results: In total, 529 valid responses were collected. There was a clear difference between students with a career aspiration in emergency medicine and those without. Comparing to countries that have an established emergency medicine curriculum, shortage of classroom hours and clinical practice time is a major cause of unsatisfactory educational outcomes in China. A detailed uniform emergency medicine curriculum that outlines exact requirements for medical students is required as well. Conclusion: A consolidated syllabus and curriculum should be compiled by all the medical schools with the 8-year integrated Doctor of Medicine degree program in China. The specific diseases and skills that should be covered in emergency medical education remain up to debate.
{"title":"Current situation and expectation of emergency medicine education for 8-year Doctor of Medicine degree program in China","authors":"Zengzheng Ge, Shi Feng, Xiangning Liu, Shi-Gong Guo, Yanxia Gao, X. Lu, Shi-yuan Yu, Lina Zhao, Di Shi, Ji-hai Liu, Huadong Zhu, Yi Li","doi":"10.1177/10249079211040971","DOIUrl":"https://doi.org/10.1177/10249079211040971","url":null,"abstract":"Background: Appropriate lessons and formalized training concerning emergency medicine is becoming increasingly important in undergraduate medical education. There is an urgent need to evaluate undergraduate emergency medicine education of students enrolled on the 8-year Doctor of Medicine degree programs nationwide in China with the aim that the data extracted could ultimately be used to help develop a standardized emergency medicine curriculum in China. Objectives: The aim of the study is to accurately describe emergency medicine education of 8-year Doctor of Medicine program in China, including emergency medicine classes, clinical practice in emergency medicine department, and expectations toward emergency medicine education. Methods: An online questionnaire was distributed to all the medical students of 8-year Doctor of Medicine program who have attended emergency medicine education in 14 medical schools in China. Participation in the survey was voluntary and anonymized. Results: In total, 529 valid responses were collected. There was a clear difference between students with a career aspiration in emergency medicine and those without. Comparing to countries that have an established emergency medicine curriculum, shortage of classroom hours and clinical practice time is a major cause of unsatisfactory educational outcomes in China. A detailed uniform emergency medicine curriculum that outlines exact requirements for medical students is required as well. Conclusion: A consolidated syllabus and curriculum should be compiled by all the medical schools with the 8-year integrated Doctor of Medicine degree program in China. The specific diseases and skills that should be covered in emergency medical education remain up to debate.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"338 - 348"},"PeriodicalIF":0.6,"publicationDate":"2021-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44960702","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 : 2021-08-29DOI: 10.1177/10249079211041872
S. Bae, K. Kim, S. J. Yun, S. Lee
Background: In the elderly, diagnostic findings of pneumonia are often atypical. Computed tomography was recommended for the diagnosis of pneumonia in elderly patients. Recently, the usage of computed tomography as a screening tool for pneumonia in emergency departments has increased. Sarcopenia is defined as the loss of skeletal muscle mass and strength with aging. In this study, the association between sarcopenia and prognosis measured through computed tomography was evaluated compared to CURB-65. Methods: This study was conducted on patients diagnosed with pneumonia through computed tomography from 1 March 2018 to 31 March 2020. The paraspinous muscle size and attenuation were measured at a level located at the T12 pedicle level on axial computed tomography images. Paraspinous muscle size was presented as paraspinous muscle index. Differences in the prognostic performance among the paraspinous muscle size and attenuation, and CURB-65 were evaluated by the area under the receiver operating characteristic curve. Results: A total of 509 patients were included and 132 patients (25.9%) were admitted to the ICU, and 58 patients (11.4%) died in hospital. Paraspinous muscle index was the significant factor for predicting in-hospital mortality and ICU admission. The area under the receiver operating characteristic value of paraspinous muscle index for prediction of mortality was 0.738 and CURB-65 was 0.707. The area under the receiver operating characteristic of paraspinous muscle index and CURB-65 for predicting ICU admission were 0.766 and 0.704, respectively. Conclusion: As a method of measuring sarcopenia, paraspinous muscle index was superior to CURB-65 in elderly pneumonia patients. The use of computed tomography in predicting prognosis for elderly pneumonia patients will ease the economic burden.
{"title":"Sarcopenia measured with paraspinous muscle using computed tomography for predicting prognosis in elderly pneumonia patients","authors":"S. Bae, K. Kim, S. J. Yun, S. Lee","doi":"10.1177/10249079211041872","DOIUrl":"https://doi.org/10.1177/10249079211041872","url":null,"abstract":"Background: In the elderly, diagnostic findings of pneumonia are often atypical. Computed tomography was recommended for the diagnosis of pneumonia in elderly patients. Recently, the usage of computed tomography as a screening tool for pneumonia in emergency departments has increased. Sarcopenia is defined as the loss of skeletal muscle mass and strength with aging. In this study, the association between sarcopenia and prognosis measured through computed tomography was evaluated compared to CURB-65. Methods: This study was conducted on patients diagnosed with pneumonia through computed tomography from 1 March 2018 to 31 March 2020. The paraspinous muscle size and attenuation were measured at a level located at the T12 pedicle level on axial computed tomography images. Paraspinous muscle size was presented as paraspinous muscle index. Differences in the prognostic performance among the paraspinous muscle size and attenuation, and CURB-65 were evaluated by the area under the receiver operating characteristic curve. Results: A total of 509 patients were included and 132 patients (25.9%) were admitted to the ICU, and 58 patients (11.4%) died in hospital. Paraspinous muscle index was the significant factor for predicting in-hospital mortality and ICU admission. The area under the receiver operating characteristic value of paraspinous muscle index for prediction of mortality was 0.738 and CURB-65 was 0.707. The area under the receiver operating characteristic of paraspinous muscle index and CURB-65 for predicting ICU admission were 0.766 and 0.704, respectively. Conclusion: As a method of measuring sarcopenia, paraspinous muscle index was superior to CURB-65 in elderly pneumonia patients. The use of computed tomography in predicting prognosis for elderly pneumonia patients will ease the economic burden.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"305 - 313"},"PeriodicalIF":0.6,"publicationDate":"2021-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716062","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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