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Smart hospitals and A&E departments in Hong Kong: Advantages, considerations and way forward 香港智慧医院及急症室的优势、考虑因素及未来路向
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-10-27 DOI: 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.)
智能医院的概念并不新鲜,但新冠肺炎疫情前所未有地加速了其发展。ED操作上的吞吐量和性能仪表板以实时方式运行,将有助于ED管理人员保持ED操作的平稳,甚至预测和预测服务激增。ED健康大数据也将对老年医学和门诊急诊医学的发展产生潜在影响,以准确识别高敏锐度患者并对低风险患者进行门诊护理。【摘自文章】《香港急诊医学杂志》版权归Sage Publications股份有限公司所有,未经版权持有人明确书面许可,其内容不得复制或通过电子邮件发送到多个网站或发布到listserv。但是,用户可以打印、下载或通过电子邮件发送文章供个人使用。这篇摘要可以节略。对复印件的准确性不作任何保证。用户应参考材料的原始发布版本以获取完整摘要。(版权适用于所有摘要。)
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引用次数: 2
Evaluation of the utilization of extracorporeal toxin removal in lithium poisoning patients in Hong Kong 香港锂中毒患者体外毒素清除的应用评价
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-10-20 DOI: 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。
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引用次数: 0
Pediatric poisoning pattern: A comparison of preadolescent and adolescent groups in Hong Kong over 3 years 儿童中毒模式:3年来香港青少年前及青少年组的比较
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-10-11 DOI: 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.
目的:比较青春期前和青少年的局部中毒情况。方法:回顾性横断面研究。透过香港中毒资讯中心(HKPIC)中毒资讯及临床管理系统(PICMS)收集的资料。纳入2016年1月至2018年12月10 ~ 17岁的患者,分为青春期前(10 ~ 12岁)组和青春期(13 ~ 17岁)组。对分类变量进行统计学分析,采用卡方独立性检验,p < 0.05。用Cramer’s v检验关联强度,采用95%置信区间的比率来确定关联的性质,以青春期前为对照组。结果:共分析703例。青春期前组107例,青春期组596例。故意暴露(比率比:2.91,2.13-3.98)、在校暴露(比率比:0.30,0.21-0.44)和药物使用(比率比:1.95,1.57-2.44)三个变量呈中等相关性。青少年和青春期前最常见的暴露物质分别是镇痛药(n = 213, 24.94%)和烟雾、气体和蒸汽(n = 19, 15.08%)。结论:青少年前期与青少年之间仍存在流行病学差异。强调了青少年与故意中毒和使用药物的关系。该研究作为儿科中毒模式的最新更新,并希望为未来的研究提供参考。
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引用次数: 1
Professional quality of life and resilience in emergency department healthcare professionals during COVID-19 in Hong Kong: A cross-sectional study 香港新冠肺炎期间急诊科医护人员的职业生活质量和复原力:一项横断面研究
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-10-06 DOI: 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.
背景:COVID-19大流行期间,急诊科医护人员的职业生活质量可能会受到影响。目的:本研究旨在研究2019冠状病毒病(COVID-19)疫情期间香港急诊科医护人员的职业生活质量和复原力及其关系。方法:本研究采用横断面设计。在香港急诊科工作的医护人员(医生和护士)以滚雪球抽样的方式招募。采用《职业生活质量量表》(第5版)和《康纳-戴维森弹性量表》(10项)来评估他们的积极(同情满意度)和消极(继发创伤压力和倦怠)方面的职业生活质量和自我报告的弹性。还分析了社会人口统计学和工作相关特征。结果:共有106名参与者提供了有效的回答。结果显示,在急诊科医疗保健专业人员中,同情满意度,继发性创伤压力和倦怠的总体水平中等。康诺-戴维森弹性量表10项平均得分为23.8分。反向线性回归分析显示,自我报告的弹性是同情满意度的唯一显著预测因子(回归系数B = 0.875;p < 0.001)、继发性创伤应激(B = - 0.294, p < 0.001)和倦怠(B = - 0.670;P < 0.001),分别解释了总方差的70.6%、18.5%和59.8%。结论:2019冠状病毒病疫情期间,香港急诊科医护人员的整体职业生活质量处于中等水平。那些自我报告弹性水平较高的人有更好的同情满意度和较低的继发性创伤压力和倦怠水平。研究结果支持了制定干预措施的重要性,这些干预措施可以增强这群急诊科医疗保健专业人员对抗COVID-19的韧性。
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引用次数: 11
An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study 一项为住院医师准备儿科急诊医学轮换的电子学习计划:一项定性研究
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-09-15 DOI: 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.
背景:为了满足ACGME-I(国际研究生医学教育认证委员会)的培训和值班时间要求,我们将为期三周的儿科急诊医学入门课程转换为电子学习课程。目的:该研究旨在确定住院医生认为有用的电子学习计划领域以及帮助他们为临床工作做好准备的组成部分。方法:定性研究在一家三级儿科急诊科进行。来自家庭医学、急诊医学和儿科医学的27名住院医生参加了焦点小组讨论,探讨他们如何看待电子学习计划帮助他们为工作做好准备。对访谈进行录音,并对笔录进行分析,并按类别和主题进行编码。结果:从数据分析中得出四个主题:居民对电子学习计划的访问,教学方法,电子学习设计元素和补充学习。居民重视自主控制他们的学习速度,并使用与他们喜欢的学习方式相匹配的在线功能。问题和测验的使用等设计特点有助于刺激学习,但必须注意模块中问题的顺序和问题的格式。书面指导方针为学习者提供了很好的参考,在线学习项目附带的面对面会议有助于巩固知识,并提供了与教师互动以澄清问题的机会。结论:在为住院医师培训创建电子学习课程时,关注访问、教学方法和设计的系统规划是必不可少的。电子学习计划可以通过结合团队学习和附带的书面内容来增强。
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引用次数: 1
Airway management as a core competence in emergency medicine 气道管理是急诊医学的核心竞争力
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-09-01 DOI: 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
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。气道管理是急诊科(ED)重症患者护理的一项关键技能。与外科手术室(OT)的传统气道管理不同,急诊科的设置面临着独特的挑战:缺少或无法获得关键患者信息(病史或以前的气道经验),患者群体多样化(新生儿到老年人,孕妇到肥胖),生理或解剖紊乱(败血症和创伤)以及资源受限(设备,人员或培训)。在本期的香港急诊医学杂志中,我们将展示有关这些问题的原创文章以及ED气道管理的最新进展。急诊科医生经常面临的一个挑战是病人上呼吸道有液体或异物(如血液和呕吐的食物)。Ko等人1报道了在模拟上消化道(GI)出血情况下使用上呼吸道吸引导管的新技术。新技术和吸痰导管提高了插管成功率,减少了吸入物的量。这项技术可能适用于有大量上消化道出血的患者,不幸的是,这是东亚急诊科和世界范围内常见的情况。在另一项模拟研究中,Hung和Wong2研究了如何在插管时改善患者的体位。这种定位在急诊科通常没有得到同样多的关注相比,在门诊设置。这部分是由于缺乏资源(设备、人员或时间),但也可能是由于在一些急诊医学培训方案中没有推广这种技术。在他们的报告中,Hung和Wong2展示了通过将人体模型放在一个新的倾斜位置来改善插管时间和更好的声门视图。这个位置的优点是除了抬高床头外,不需要额外的设备,而且操作简单。新的插管设备不断被引进。本期我们有两篇关于视频喉镜的原创文章。在Wong等人的后续研究中(上述模拟胃肠道大出血文章的研究小组成员),他们的小组在模拟大出血的情况下比较了三种视频喉镜。众所周知,当气道内有液体时,视频喉镜的性能很容易受到影响。在这项研究中,他们展示了一种新型的吸引导管和特殊的技术,视频喉镜在急诊气道大量吐血的治疗中是有帮助的。另外,在对近300例插管的回顾性分析中,Weng等人4发现,在处理困难的气道时,视频喉镜使新手和专家在气道管理方面处于公平的竞争地位。翁等人4发现新手和专家都有相似的成功率。当急诊医学专家使用视频喉镜时,与直接喉镜相比,使用视频喉镜的成功率较低,这是相当令人惊讶的。这可能是由于以前接受过直接喉镜检查培训的高级急诊医师对新设备不熟悉。这篇文章增加了目前的文献,鼓励广泛使用视频喉镜,以提高“一次通过”的成功率。气道管理通常被认为是麻醉的一个领域。麻醉师经常被要求管理气道,甚至在OT之外。在严重创伤的多学科管理中,麻醉医师经常负责管理急诊科的气道。在对创伤气道管理的回顾性分析中,Tang等人5发现,在控制了潜在的联合创始人后,在创伤复苏期间,麻醉医师和急诊医师在存活率或气道相关并发症方面没有差异。虽然进一步的前瞻性研究可能需要做,麻醉医生可能不需要常规地要求创伤气道管理,使他们能够专注于正常的OT工作。事实上,这种安排在美国的教育机构中已经很普遍了。随着急诊医学专业的迅速发展,急诊医师承担了越来越多的以前与其他专业相关的职责。 有急诊医师领导的创伤复苏小组,以ed为基础的体外膜氧合(ECMO)气道管理是急诊医学的核心竞争力[35849]hkj0010.1177 /10249079211035849香港急诊医学杂志编辑编辑2021
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引用次数: 0
Current situation and expectation of emergency medicine education for 8-year Doctor of Medicine degree program in China 中国8年制医学博士急诊医学教育现状与展望
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-08-29 DOI: 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.
背景:适当的急救医学课程和正规的培训在本科医学教育中越来越重要。迫切需要评估中国全国8年制医学博士学位课程学生的本科急诊医学教育,以期提取的数据最终能够用于帮助制定中国标准化的急诊医学课程。目的:本研究旨在准确描述中国8年制医学博士项目的急诊医学教育,包括急诊医学课程、急诊科临床实践以及对急诊医学教育的期望。方法:采用网上问卷调查的方法,对全国14所医学院参加过急诊医学教育的8年制医学博士生进行问卷调查。参与调查是自愿和匿名的。结果:共收集到529份有效回复。有急诊医学职业抱负的学生和没有急诊医学职业志向的学生之间存在明显差异。与已有急诊医学课程的国家相比,课堂时间和临床实践时间的短缺是中国教育效果不理想的主要原因。此外,还需要一份详细的统一急诊医学课程,概述对医学生的确切要求。结论:我国所有具有8年制综合医学博士学位课程的医学院都应编制统一的教学大纲和课程。急诊医学教育应涵盖的具体疾病和技能仍有待讨论。
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引用次数: 0
Sarcopenia measured with paraspinous muscle using computed tomography for predicting prognosis in elderly pneumonia patients 用计算机断层扫描测量棘旁肌肌减少症预测老年肺炎患者预后
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-08-29 DOI: 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.
背景:在老年人中,肺炎的诊断结果通常是非典型的。计算机断层扫描被推荐用于老年肺炎患者的诊断。最近,在急诊科使用计算机断层扫描作为肺炎筛查工具的情况有所增加。骨骼肌减少症被定义为骨骼肌质量和力量随着年龄的增长而减少。在本研究中,与CURB-65相比,通过计算机断层扫描评估肌肉减少症与预后之间的关系。方法:本研究对2018年3月1日至2020年3月31日通过计算机断层扫描诊断为肺炎的患者进行研究。在轴向计算机断层图像上测量位于T12椎弓根水平的棘旁肌的大小和衰减。棘旁肌大小以棘旁肌指数表示。通过受试者工作特征曲线下的面积来评估棘旁肌大小和衰减以及CURB-65对预后表现的差异。结果:共纳入509例患者,其中132例(25.9%)入住ICU, 58例(11.4%)死亡。棘旁肌指数是预测住院死亡率和ICU住院率的重要因素。预测死亡率的棘旁肌指数受者工作特征值下面积为0.738,CURB-65为0.707。棘旁肌指数和CURB-65预测患者入ICU的受者操作特征下面积分别为0.766和0.704。结论:作为衡量老年肺炎患者肌肉减少症的方法,棘旁肌指数优于CURB-65。使用计算机断层扫描预测老年肺炎患者的预后将减轻经济负担。
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引用次数: 0
Hong Kong Poison Information Centre: Annual report 2019 香港毒物资讯中心:2019年年报
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-08-21 DOI: 10.1177/10249079211038841
T. Chow, C. Chan, Sze Hong Ng, M. Tse
Background: The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005. Objective: To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019. Methods: This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019. Results: A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report. Conclusion: This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.
背景:自2005年以来,香港中毒资讯中心为医护人员提供咨询服务,并收集香港中毒的流行病学数据。目的:报告和分析香港毒物信息中心2019年的中毒数据。方法:回顾性分析2019年香港毒物信息中心毒物信息及临床管理系统中记录的所有中毒病例。结果:共分析中毒病例4016例,其中男性1698例(42.3%),女性2312例(57.6%),性别不详6例(0.1%)。大多数病例(77.3%)年龄在13 - 69岁之间,10.5%为13 - 19岁的青少年。自残/自杀企图(42.1%)、无意暴露(18.1%)和滥用药物(11.1%)是中毒的常见原因。除乙醇外,最常见的五种毒物是苯二氮卓类药物、扑热息痛、家用产品、佐匹克隆和中草药。虽然大多数患者接受支持性治疗,但16.5%和16.8%的会诊病例分别接受去污和解毒剂治疗。大多数病例恢复平稳,但1.0%死亡,4.7%有主要结局。本报告共讨论了六个有趣的病例和两次暴发。结论:第十四份年度报告提供了有关香港中毒模式的最新流行病学资料,并强调了与以往报告相比的一些重要变化。
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引用次数: 8
A randomized non-inferiority pilot study on the use of methoxyflurane (Penthrox®) for pain control in the emergency department 甲氧基氟烷(Penthrox®)在急诊科用于疼痛控制的随机非劣效性试点研究
IF 0.6 4区 医学 Q3 Medicine Pub Date : 2021-08-21 DOI: 10.1177/10249079211040695
K. Wong, J. S. K. Lau, A. Siu, Pui Gay Kan
Background: Patients commonly visit the emergency department for pain after musculoskeletal injury, but the problem of oligoanalgesia is prevalent. Methoxyflurane (Penthrox®) is an inhalational analgesic for moderate to severe trauma-associated pain in stable and conscious patients. It is a fast-acting, effective analgesic that can be readily administered via a non-invasive route, making it an attractive agent for managing acute pain in the emergency departments. Objectives: The aim was to assess the analgesic efficacy of methoxyflurane in patients with acute traumatic pain by comparing it to ketorolac, a standard analgesic treatment for moderate pain in emergency departments in Hong Kong. Methods: This was a single-center, open-label, randomized controlled, parallel-group, non-inferiority pilot study that enrolled adult patients with moderate trauma-associated pain in an emergency department in Hong Kong. Patients were randomized 1:1 to the methoxyflurane group or the ketorolac group. The primary outcome was the change in pain intensity measured by visual analogue scale from baseline to 5, 15, 30, and 60 min after drug administration. Results: Twenty patients received methoxyflurane, and twenty patients received ketorolac. There were significant reductions in pain score over 60 min in both groups. The pain reduction at 5 min was significantly greater for the methoxyflurane group (−13.912 mm; 95% confidence interval = −20.008 to −7.817) than for the ketorolac group (−4.888 mm; 95% confidence interval = −10.983 to 1.208), with the treatment effect (−9.025 mm; 95% confidence interval = −17.656 to −0.393; p = 0.041) demonstrating superiority of methoxyflurane. The treatment effect at 15 and 30 min demonstrated non-inferiority of methoxyflurane versus ketorolac. Conclusion: Methoxyflurane provided non-inferior analgesia in the first 30 min with a faster onset of action when compared with ketorolac in moderate traumatic pain. It can be considered a non-invasive, rapid-acting, and effective first-line alternative to currently available analgesics for traumatic pain in emergency settings.
背景:患者通常因肌肉骨骼损伤后的疼痛而去急诊科就诊,但缺乏镇痛的问题很普遍。甲氧基氟烷(Penthrox®)是一种吸入性镇痛药,用于稳定和清醒患者的中度至重度创伤相关疼痛。它是一种快速有效的止痛药,可以通过非侵入性途径轻松使用,使其成为急诊科治疗急性疼痛的一种有吸引力的药物。目的:通过与香港急诊科用于中度疼痛的标准止痛药酮咯酸进行比较,评估甲氧基氟烷对急性创伤性疼痛患者的镇痛效果。方法:这是一项单中心、开放标签、随机对照、平行分组、非劣效性的试点研究,在香港急诊科招募了患有中度创伤相关疼痛的成年患者。患者被1:1随机分为甲氧基氟烷组或酮咯酸组。主要结果是通过视觉模拟量表测量的疼痛强度从基线到5、15、30和60的变化 给药后min。结果:20例接受甲氧基氟烷治疗,20例接受酮咯酸治疗。疼痛评分在60分以上显著降低 min。5岁时疼痛减轻 min显著高于甲氧基氟烷组(−13.912 mm;95%置信区间 = −20.008至−7.817)高于酮咯酸组(−4.888 mm;95%置信区间 = −10.983至1.208),具有治疗效果(−9.025 mm;95%置信区间 = −17.656至-0.393;p = 0.041),证明了甲氧基氟烷的优越性。15岁和30岁时的治疗效果 min表现出甲氧基氟烷与酮咯酸的非劣效性。结论:甲氧基氟烷对前30例患者具有非劣效镇痛作用 与酮咯酸相比,min在中度创伤疼痛中起效更快。它可以被认为是一种非侵入性、速效和有效的一线替代品,可以替代目前可用的用于紧急情况下创伤性疼痛的止痛药。
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引用次数: 0
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Hong Kong Journal of Emergency Medicine
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