bluuebunny/crossref_metadata_2025 huggingface dataset:
Have Noncompete Agreements Evolved Into an Unnecessary Restriction on Job Movement?
Authors: Stanberry Kurt , Aven Forrest
Published: December 2017

Noncompete agreements have been widely used by employers in the United States for decades, mainly to guard against loss of business to competitors, as well as to protect valuable proprietary information. Historically this technique has been used by employers for higher level employees, such as management executives, researchers and higher level sales personnel. In this context, the use of noncompete clauses is considered legitimate and fair because it protects valuable business interests by restricting movement of key employees to competitors. However, the use of noncompetes has spread steadily downward, and now covers, in many instances, workers at the mid and lower levels of employment. This means that workers who have little or no access to important proprietary information are being unnecessarily prevented from job movement by restrictive contracts. This article examines the effect of this development on both workers and the economy and explores possible reforms to address overuse of noncompete agreements.
Social Networks and Charitable Giving: Trusting, Doing, Asking, and Alter Primacy
Authors: Herzog Patricia Snell , Yang Song
Published: December 2017

This study examines social networks and financial giving to charitable or religious causes. Conventional social capital measures of general social trust and size of social network are studied as predictors of charitable giving. To these traditional measures, we add an examination of particular network aspects of giving: ego giving in relation to network alters who give, solicitations to give by network ties, and ego soliciting alters to give. In addition, the study disaggregates alter effects by alter position. Findings indicate that, net of social trust, social network factors significantly predict likelihood of being a giver. In particular, findings are that egos are especially likely to be donors when their primary alter donates. Three configurations of ego–alter giving and solicitations are significant predictors of ego giving, indicating that ego–alter doing matters more than asking. Theoretical contributions for relational and prosocial studies are discussed, as are practical implications for fundraising professionals.
Enhancement in mechanical properties and conductivity of modified epoxy resin composites
Authors: Bi Changlong , Zhao Dongyu
Published: December 2017

Nanosilver and nanonickel were first loaded on the surfaces of multiwalled carbon nanotubes (MWCNTs) by liquid-phase reduction method and the multiwalled carbon nanotubes/nanosilver-nickel (MWCNTs/Ag-Ni) composites were formed. The MWCNTs/Ag-Ni were homogeneously dispersed in the epoxy resin (EP), which can form epoxy resin/multiwalled carbon nanotubes/nanosilver-nickel (EP/MWCNTs/Ag-Ni) composites. The results based on X-ray photoelectron spectroscopy show the chemical bonds in the MWCNTs/Ag-Ni. By the scanning electron microscope method, it can be concluded that the enhancement in mechanical properties is due to the strong interaction between MWCNTs and the EP matrix. It is proved that through the comparative tests, the addition of nanosliver-nickel rigid particles can enhance the interaction between MWCNTs and the EP matrix, which can improve the mechanical properties of modified EP. Compared with the pure EP, the tensile strength and impact strength of nanocomposites improve around 81% and 139% by adding 1.3 wt% MWCNTs/Ag-Ni. In addition, the experimental results based on dynamic mechanical analysis (DMA) show that the glass transition temperature of modified EP (1.3 wt% MWCNTs/Ag-Ni in EP matrix) is significantly increased by about 18.6°C. Compared with the pure EP, the conductivity of modified EP (1.3 wt% MWCNTs/Ag-Ni in EP matrix) is also increased by around 63%. Because of the excellent mechanical properties and conductivity of EP/MWCNTs/Ag-Ni nanocomposites, the development of high-performance polymer materials will be greatly achieved.
Optical properties of phenylene–thiophene-based polyazomethine thin films
Authors: Jarząbek B , Hajduk B , Domański M , Kaczmarczyk B , Nitschke P , Bednarski H
Published: December 2017

Thin films of new aromatic polyazomethines, containing thiophene rings in their polymer chain structures, were obtained by the chemical vapor deposition method, via a polycondensation process from thiophene-2,5-dicarbaldehyde and one of four different aromatic diamines, as initial monomers. Spectroscopic ellipsometry, attenuated total reflectance mode of Fourier transform infrared spectroscopy, atomic force microscopy, and wide-angle X-ray diffraction techniques have been used to characterize these films. However, the optical transmission and reflectivity measurements, within the wide spectral UV-Vis-NIR range (0.5–6.2 eV), were the basic method of presented investigations. On the basis of optical measurements, the absorption coefficient spectra of these thin films were obtained and the absorption edge parameters, that is, the energy gap ( EG) and Urbach energy ( EU), were calculated in a way typical for amorphous semiconductors. These parameters allowed one to evaluate the length of conjugation and the extension of localized, defect states inside the energy gap, respectively, and to discuss the electronic transitions, being dependent on the chemical structure and conformation of polymer chains. Optical properties of these new phenylene–thiophene-based polyazomethine films were compared with their entirely phenylene counterparts. In general, the energy gaps of investigated films were clearly smaller (about 0.2 eV) than those of their phenylene counterparts, confirming that the presence of thiophene rings in polyazomethine structures improves conjugation.
Shoreline displacement and human resource utilization in the southern Baltic Basin coastal zone during the early Holocene: New insights from a submerged Mesolithic landscape in south-eastern Sweden
Authors: Hansson Anton , Björck Svante , Heger Katja , Holmgren Sofia , Linderson Hans , Magnell Ola , Nilsson Björn , Rundgren Mats , Sjöström Arne , Hammarlund Dan
Published: December 2017

Along parts of the Hanö Bay coast in south-eastern Sweden, remains of a submerged landscape can be found down to depths of almost 25 m b.s.l. The coastal landscape was formed during two periods of lowered water levels in the Baltic Basin: the Yoldia Sea and the Initial Littorina Sea stages. In order to reconstruct the local environment and shoreline displacement during the Yoldia Sea and Ancylus Lake stages, sediment sequences were obtained at 4.5, 17.5 and 18.7 m b.s.l. Detailed bathymetric mapping was based on multi-beam echo-sounding while surveillance and sampling of tree remains and archaeological findings were performed through diving. The Yoldia Sea low-stand reached its minimum level at 24–25 m b.s.l. just before 10,800 cal. BP. During the subsequent Ancylus transgression, a slow-flowing river passed through the area, accumulating thick deposits of fine-grained organic sediments in lagoonal basins. The river was surrounded by open woodland dominated by pine. Based on successive flooding of rooted tree stumps, the transgression rate was estimated at 4 cm·yr−1, until the Ancylus high-stand was reached at 5 m b.s.l. at 10,400–10,300 cal. BP. Findings of worked aurochs and beaver bones provide evidence of human presence in the landscape and show the importance of terrestrial resources for their subsistence. These integrated palaeoecological and archaeological investigations demonstrate the importance of submerged landscapes with well-preserved sediment, wood and bone material for our understanding of southern Baltic coastal landscapes and their inhabitants during the Early Mesolithic.
Rapid screening of commercial extra virgin olive oil products for authenticity: Performance of a handheld NIR device
Authors: Karunathilaka Sanjeewa R , Fardin-Kia Ali R , Srigley Cynthia , Chung Jin K , Mossoba Magdi M
Published: December 2017

The performance of a handheld near infrared spectroscopic device was evaluated for the rapid screening of extra virgin olive oil for authenticity. Without any sample preparation, the spectra of authentic reference extra virgin olive oils, refined olive oils, potential adulterants consisting of edible oils, extra virgin olive oil spiked with adulterants, and a total of 93 commercial olive oil products were each rapidly (10 s) measured in the transflection mode. The univariate conformity index and the multivariate supervised soft independent modeling of class analogy classification tools were used to differentiate among the various oils investigated. Out of 88 commercial products labeled extra virgin olive oil, 39 (44%) were classified as belonging to the class of authentic extra virgin olive oils. The results were compared to those recently reported for analyses carried out with a benchtop Fourier transform-near infrared spectrometer.
The state of water in soft contact lenses explored with near infrared spectroscopy and Aquaphotomics
Authors: Munćan Jelena
Published: December 2017

The structure of water in hydrogel materials of soft contact lenses was investigated by near infrared spectroscopy and Aquaphotomics. Near infrared spectroscopy offers rapid, reagent free, and nondestructive characterization of hydrogel materials, while Aquaphotomics provides detailed insight into the complex water structure inside the hydrogel consisting of many water molecular species. These findings push the limits of our knowledge beyond the current “three-state” model of water in hydrogels, while at the same time provide information about the state of the polymer itself thus justifying the “water molecular-mirror” concept of Aquaphotomics.
Linear transformations of multivariate calibration models in near infrared spectroscopy: A comparative study
Authors: Dubrovkin Joseph
Published: December 2017

It was shown that linear transformations are suitable for use in multivariate calibration in near infrared spectroscopy as data compression tools. Partial Least Squares calibration models were built using spectral data transformed by expansion in the series of classical orthogonal polynomials, Fourier and wavelet harmonics. These models allowed effective prediction of the cetane number of diesel fuels, Brix and pol parameters of syrup in sugar production and fat and total protein content in milk. Depending on the compression ratio, prediction errors were no larger than 30% of corresponding errors obtained by the use of the non-transformed models. Although selection of the most suitable transformation depends on the calibration data and on the cross-validation method, in many cases Fourier transform gave satisfactory results.
Acute Confusion in a Middle‐Aged Woman
Authors: Wong AYS , Wong TW , Lau CC
Published: December 2017

This is a report of a previously healthy 47‐year‐old lady who presented to the Accident & Emergency Department (AED) with acute confusion. She was subsequently diagnosed to be suffering from acute disseminated encephalomyelitis (ADEM). We report this rare case to alert emergency physicians to consider acute disseminated encephalomyelitis when presented with a patient with acute confusion. The diagnosis, investigation, management will be discussed.
Patient Behaviour on Non‐Accidental Poisoning ‐ A Prospective Study
Authors: Man CY , Cheung WL
Published: December 2017

Poisoning or drug overdose is a common presentation to the Accident and Emergency Departments (AED) in Hong Kong. This prospective study examined 74 patients with intentional poisoning attending an Accident and Emergency department over a 3 month‐period. A pre‐set questionnaire was designed seeking the following information: demographic characteristics, patient behaviour, the source of ingestants, patient's knowledge about the ingestants, home interventions, medical and psychiatric history, and final outcomes. The incidence of intentional poisoning was 0.16%. Most were female in 21–40 years age group, single, had a job and had secondary level education. They were usually healthy and had no psychiatric illness. Drugs (mostly hypnotic/sedatives) and household products made up most of the ingestants. The ‘Sleep‐On’, ‘Sleep‐Qik’, and ‘Honslin’ were the most common hypnotic/sedative. These ingestants were chosen largely because of their easy accessibility rather than the toxicity. The majority presented within 2 hours of ingestion although with an initial attempt to die, paradoxically they did not believe that they would die from the overdose. Most events occurred at patient's own home. Emotional, family and marital problems constituted the vast majority of the precipitating factors. About 40% of patients ingested more than one substance (alcohol being the most common co‐ingestant) or had an concurrent acting‐out behaviour. Although most patients knew the nature of the ingestant, very few (less than 15%) understood its side‐effects or their contraindications. There was no mortality or significant morbidity. Over 60% did not have any psychiatric disorder after psychiatric assessment. Knowledge of pattern of poisonings and patient behaviour in local setting is important in terms of prevention, public education and the provision of the optimal care to these patients.
Tension Pneumoperitoneum after Cardiopulmonary Resuscitation
Authors: Lau YS , Kam CW
Published: December 2017

A 61‐year‐old chronic schizophrenic patient developed sudden cardiac arrest and ventricular fibrillation. Tension pneumoperitoneum was noted after cardiopulmonary resuscitation. The patient had hypotension, lower limbs cyanosis and priapism. The tension was relieved by insertion of a large bore IV catheter through the abdominal wall. Immediately after decompression, the blood pressure improved with the lower limbs cyanosis and priapism resolved.
A Pilot Experience of the use of Intramuscular Ketamine for Paediatric Sedation in an Accident and Emergency Department
Authors: Kun Wm , Yuen Cmc , Tung Wk
Published: December 2017

A prospective uncontrolled clinical trial was conducted to study the effectiveness and safety of using intramuscular ketamine in Accident & Emergency department in Hong Kong. Initial dose of 4 mg/kg (followed by a supplemental dose of 2–4 mg/kg if required) intramuscular ketamine was given to 35 children (between the ages of one to fourteen) to facilitate the carrying out of painful but necessary procedures. Satisfactory or acceptable sedation was obtained in more than 97% of these children without adjuvant physical restraint or local anaesthesia. The mean onset time was 6.78 minutes and mean time to regain consciousness was 94.97 minutes. Mean length of hospital stay was 186.65 minutes. None of these children developed laryngospasm, respiratory depression or cardiovascular instability. Trivial oxygen desaturation was observed in one child secondary to hypersecretion of saliva but he responded to suction and oxygen with no adverse sequel. The incidence of hypersalivation was 8.6%. Other side effects such as emesis (23.5%), muscle spasm (11.85%) were self-limiting There was no case of upsetting reaction observed. Ketamine by intramuscular route provides a better option to facilitate painful procedures in children in Accident & Emergency department as compared with the application of physical restraint. Yet expertise and equipment for advanced airway management is necessary for the uncommon risk of airway complications.
The Medical Management of Civil Disasters in Hong Kong
Authors: Cocks Ra
Published: December 2017

Civil Disasters (major incidents) are events which place stress on the emergency services, both in the pre-hospital and hospital phases. There is often intense media interest, and staff must cope with additional pressures while trying to create order from chaos. The need for special arrangements to cope with the large number or severity of casualties defines disasters and distinguishes them from the normal peaks of Accident and Emergency workload. Good organisation of the medical response at the scene requires an efficient medical manager, the medical control officer (MCO), and also the presence of trained staff, who are commonly provided by the Hospital Authority and Auxiliary Medical Services. The need for training and the value of full-scale disaster drills as well as regular table-top exercises is emphasized.
The Evolution of Emergency Medicine
Authors: Chung Ch
Published: December 2017

Objective

Emergency Medicine as an independent medical specialty has a history of only about 30 years. However, emergency medical care has been practised ever since human civilization. As emergency physicians, it is necessary to know the evolution of Emergency Medicine throughout the centuries and its development in different parts of the World. Lessons learned in the past may guide our future development.

Methods

Medical literature on evolution, development and history of Emergency Medicine were searched from the Medline, HealthSTAR and EMBASE. Relevant full text articles were retrieved through hospital library network. Information was also obtained through Internet and books on history of medicine.

Results

Most of the articles were contained in the International Report Section of the Annals of Emergency Medicine. The historical development, the catalysts for change and the different models of modern emergency care were found to be interesting and enlightening.

Conclusion

Emergency Medicine is still at its formative stage. Different models exist in different parts of the World. The specialty is rapidly changing and moving in different directions, both locally and internationally.
The Common Drugs of Abuse in Hong Kong
Authors: Yuen Ecp
Published: December 2017

Drug abuse has been a problem with every society and across every generation. In this review, the recent trends of drug abuse and the clinical features of the new drug of abuse in Hong Kong, namely Ecstasy, Ketamine and Gamma Hydroxybutyrate (GHB) are discussed. The data are collected from the Hong Kong Government Central Registry of drug abuse. It showed a rise in the total number of drug abusers in 2000. More alarmingly, we saw a dramatic rise (42.1%) in the under 21 years old age group. The drugs of abuse are also changing. Ecstasy was the most abused drug (51.5%) for the under 21 years old and overall it has become the second most common drug of abuse. The use of ketamine is also on the increase. The treatment and rehabilitation options available in Hong Kong are also discussed.
Case Report: Meningococcal Meningitis
Authors: Lee Gpc , Mak Yk , Kam Cw
Published: December 2017

A case of meningococcal meningitis in an adult male in March 2000 in Hong Kong is reported. The main features were fever for one day with headache, vomiting, dizziness, diffuse maculo-papular rash, and one purpuric rash on the dorsum of right hand and stable vital signs. Incidentally, there were three other unreported cases of meningococcal infection in the city during that period. It is important for emergency physicians to recognise this life-threatening condition in the initial stable phase to promptly provide the emergency management and to administer the antibiotic treatment to reduce mortality.
Noninvasive Ventilatory Support in Emergency Department: Initial Experience in Hong Kong
Authors: Tang Hm , Lau Fl
Published: December 2017

Background and Method

There is favourable evidence supporting the use of noninvasive ventilatory support (NIV) in Emergency Department (ED) in treating patients with non-traumatic acute respiratory distress (ARD). To determine the feasibility and potential uses of NIV in the ED of Hong Kong, a prospective study was done in the ED of a regional acute hospital. A convenience sample of patients with non-traumatic ARD was recruited within the first 3 months after the introduction of this modality of therapy. Haemodynamically unstable or uncooperative patients and those requiring immediate endotracheal intubaton (ETI) were excluded. Patients were placed on BiPAP noninvasive ventilator with face mask for at least 30 minutes in ED. Blood pressure, respiratory rate and arterial blood gases analysis were recorded before and after the therapy. Adverse effects of NIV in ED, necessity of ETI and hospital mortality were also recorded.

Results

28 patients were studied. The mean age was 76 years old (range 56–98). Causes of ARD included acute exacerbation of chronic obstructive airway disease (COAD, n=14), acute pulmonary oedema (APO, n=10) and bronchopneumonia (n=4). Patients were put on either Continuous Positive Airway Pressure (n=7) or Bilevel Positive Airway Pressure (n=21) modes of NIV. The COAD and APO groups responded favourably. The bronchopneumonia group showed only borderline or no improvement and 2 patients in this group needed ETI in ED, in contrast to only 1 patient in APO group and nil in COAD group. Only minor discomforts were felt by patients but no major adverse effect was observed. Two patients (2/4=50%) in bronchopneumonia group died from the disease.

Conclusion

NIV delivered in ED is feasible and is likely to be beneficial to patients with ARD due to COAD or APO. Further randomised controlled trials should be conducted to explore its potential uses in ED. (Hong Kong j.emerg.med. 2001;8:140–145)
Permanent Cardiac Pacemaker: an Emergency Perspective
Authors: Lam Cw
Published: December 2017

The number of patients with permanent pacemaker are increasing and may present into the emergency department with a variety of complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical issues. This article review the complications of the implant procedure, the causes, diagnosis and management of pacemaker malfunction, the pacemaker syndrome, Twiddler's syndrome. Interaction of permanent pacemaker with other medical condition and its implication in Emergency Department environment are also discussed.
Why are Follow-Up Clinic Services Required in Emergency Departments in Hong Kong?
Authors: Kam CW , Yau HH , Ku MS , Lin S , Kan CH
Published: December 2017

To identify the roles of follow-up clinic (FUC) of emergency departments (ED), which is unique of the western medicine of Hong Kong, a study was conducted between 1998 to 1999 to collect data on the case-mix of the FUC patients, their satisfaction with the services, the waiting period of the specialist out-patient department (SOPD) and the functions of the FUC as viewed by the Emergency Physicians in the ED of Tuen Mun Hospital. One hundred and fifty-eight patients were surveyed. The majority was of musculoskeletal trauma. Most were satisfied with the services. The waiting period of the SOPD was in terms of month. The respondent doctors considered the functions of the FUC were to fill in the gaps bridging the specialist and primary health care as well as to provide training for the physicians for medium-term after-care.
Anaphylaxis: an Emergency Physician's Perspective
Authors: Lee Hfl
Published: December 2017

Anaphylactic reaction is a common problem encounter by the emergency physician. Although the drug treatment and management of anaphylaxis had been well published in the literature, the emergency management of anaphylaxis is still unsatisfactory. Severe anaphylactic reaction and death is not uncommonly reported. This article reviews the pathophysiology, aetiology, clinical manifestation, diagnostic approach, management algorithm and prevention of anaphylaxis with particular emphasis on the emergency physician's perspective. The clinical manifestation of anaphylaxis is significantly variable in terms of severity, onset and progression, which imposed a diagnostic challenge to emergency physician. An awareness that severe anaphylaxis can be rapidly fatal is essential for those working in the emergency room. Life threatening clinical features such as laryngeal oedema, bronchospasm and circulatory collapse must be recognize early and treated aggressively as favourable prognosis is well documented. The key to success in managing anaphylaxis emergency depends on the early recognition of anaphylaxis reaction, initial assessment, anticipation of deterioration and finally prompt and aggressive support of airway, oxygenation, ventilation and circulation. Adrenaline is the cornerstone of the treatment modality in anaphylaxis. This is currently underused, although, it is safe and almost always effective. At last prevention of subsequent episode of anaphylaxis should be considered a priority for emergency physician before discharging patient.
Efforts to Help Develop Emergency Medicine in Rural Sichuan: A Brief Report
Authors: Chan SSW
Published: December 2017

Emergency Medicine (EM) as a specialty discipline in China is gradually progressing to a mature status. However, emergency medical care development in large cities and in rural areas may have wide disparity. Rural hospitals need the same kind of support and development as hospitals in major cities. Assistance has come from many EM providers and faculties from western systems. The needs of a rural hospital in Sichuan, and the efforts of help provided from Hong Kong, is described.
A Retrospective Study of Patients Discharged within 24 Hours after Emergency Admission in a Public General Hospital
Authors: Cheng SST , Chung CH
Published: December 2017

Objectives

To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission.

Design

Retrospective study.

Setting

Emergency admission in a public general hospital in Hong Kong.

Patients

Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission.

Main outcome measures

Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients.

Results

During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastroduodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty.

Conclusions

The issue of ‘discharge within 24 hours’ should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization.
Review on Flecainide Poisoning
Authors: Cheung ITF , Man Cy
Published: December 2017

Flecainide acetate is a Vaughn-Williams class IC antiarrhythmic. It is used mainly for treatment of supraventricular arrhythmias due to reentry and is highly effective in suppressing frequent premature ventricular depolarization and nonsustained ventricular tachycardia (VT). Although less than 1% of drug overdoses are fatal, severe intoxication with Vaughn-Williams class IC antiarrhythmics is associated with average mortality of 22.5% and the rate of mortality after flecainide overdose is approximately 10%. Severe flecainide overdose is frequently fatal because of the rapid onset of hypotension and ventricular arrhythmias. Its cardiotoxicity is mainly due to its sodium and potassium channels blocking effects. Commonly recommended therapies like haemolysis or haemoperfusion is not helpful because of its large volume of distribution. As a result, the treatment goals are to decrease the amount of blockade; correct aggravating conditions for arrhythmias, such as electrolytes disturbances or hypoxia; avoid drugs with sodium channels blocking effects. Recently, there are some successful data on using peripheral cardiopulmonary bypass technique in the treatment of severe flecainide intoxication. This may be a promising treatment option in this type of drug overdose.
Application of APACHE II in the Assessment, Classification of Severity and Predictive Ability of Chinese Patients Presenting to an Emergency Department Resuscitation Room
Authors: Lee CK , Rainer TH
Published: December 2017

Objectives

To evaluate the use of APACHE II (Acute Physiology and Chronic Health Status Evaluation) in Chinese patients managed in the resuscitation room of an Accident & Emergency Department of one of the teaching hospitals in Hong Kong.

Design

Prospective study on Chinese patients.

Setting

Resuscitation Room in an Accident & Emergency Department of a university hospital in Hong Kong.

Patients and measurements

Consecutive patients managed in the resuscitation room between 14th August, 2000 and 20th August 2000 (excluding patients younger than 18 years old and patients who were not admitted to hospital after initial assessment and treatment). For each patient, demographic data, diagnosis, the chronic health points, and the worst physiological parameters in the A&E resuscitation room were recorded. The total APACHE II scores and the probability of death were calculated. The accuracy of APACHE II for predicting group mortality was assessed by receiver operating characteristic curve analysis and linear regression analysis.

Results

Of the 88 patients included in the study, 13 (15%) died and 75 (85%) survived. Significant factors associated with mortality included age, mean arterial pressure, heart rate, respiratory rate, arterial pH, serum sodium, Glasgow coma score, and chronic health points. For the three scoring subdivisions of APACHE II – total APS score, age points and chronic health points – higher mean values were found in those patients who died compared with patients who survived. Using logistic regression analysis, the APACHE II score determined in the emergency resuscitation room is a strong predictor of mortality (r2=0.712). At a cut off score of >28 the sensitivity is 100.0% (95% CI 100.0–100.0), specificity is 68.0% (95% CI 56.2–78.3), positive likelihood ratio is 3.13, positive predictive value is 35.1 and negative likelihood ratio is 100.0. Analysis of the ROC curve reveals an area under the curve of 0.910 (95% CI 0.829–0.960). In patients not admitted to ICU, there was a positive correlation between APACHE score and length of hospital stay in patient who survived (r=0.320, P=0.0075) and a negative correlation between APACHE score and length of hospital stay in patients who died (r=-0.760, P=0.0225).

Conclusions

The APACHE II scoring system may be usefully applied in emergency departments for predicting mortality, for classifying and assessing severity of disease, for evaluating performance and for planning departmental resource allocation.
An Overview of Chemical Warfare Agents
Authors: Chan JTS , Yeung RSD , Tang SYH
Published: December 2017

Chemical warfare agent is defined as a chemical which is intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects. Chemical agents are relatively simple to make and easy to transport. Moreover, their effects are immediate and dramatic. Therefore chemical weapons are commonly used by terrorists to kill or injure in order to achieve certain political purposes. Although chemical incident is uncommon, however, once it occurs, the consequence will be great. Therefore, fundamental knowledge about the basic concepts, toxicity, personal protection, decontamination and treatment with respect to chemical incident are very important.
Management of Status Epilepticus
Authors: Hui ACF , Man CY , Wong HC
Published: December 2017

Status epilepticus is due to a range of insults to the central nervous system and results in significant mortality rates, especially in the elderly. We review the current management of this disorder in light of the latest developments from recent trials and guidelines. Important principles in management includes early recognition of status epilepticus, identification of the underlying cause and prompt treatment to terminate seizures and reduce complications. The differentiation diagnosis, role of electroencephalographic monitoring and different treatment regimes are examined.
Emergency Department Violence: a Local Scene
Authors: Chung CH
Published: December 2017

Objectives

To study the nature, frequency and magnitude of violence in a local emergency department.

Design

Prospective epidemiological study in a three‐month period, during which involved staff filled in a survey form immediately after violence incidents.

Setting

Accident & Emergency Department of a public general hospital in the northeastern New Territories.

Population

Assailants and victims of violence in the emergency department.

Main outcome measures

Nature of violence, frequency, cause, morbidity, epidemiological characteristics of assailants and victims.

Results

There were 25 incidents with 26 assailants in the three‐month period. The great majority was verbal abuse only (64%). No weapon was involved. Long waiting time (36%), deranged mental condition (28%) and dissatisfaction with service (20%) were the leading causes of violence. Assailants showed a predominance of male (69%) and age between 21–50 years. They were either patients (69%) or accompanying persons (31%). Nurses (59%) and to a lesser extent doctors (23%), were the main victims.

Conclusion

The incidence of emergency department violence (0.08%) was low and the majority was verbal abuse only. Nurses bore the brunt of the violence. Long waiting time, confused patients and dissatisfied patients were high risk factors.
A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study
Authors: Chiu HS , Chan KF , Chung CH , Ma K , Au KW
Published: December 2017

Objective

To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy.

Design

Retrospective study in a two‐month period.

Setting

Accident & Emergency Department of a public general hospital, which had four in‐patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics.

Subjects

All cases admitted through the emergency department in the study period.

Main outcome measures

Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis.

Results

Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken.

Conclusion

History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.
An Outcome Study on the Management of Alleged Fish Bone Ingestion Using Fibre-Optic Endoscope by Emergency Physician
Authors: Ma KK , Yuen WL
Published: December 2017

Background

Patient with alleged fish bone ingestion with negative oropharyngeal examination requires an upper gastrointestinal (GI) endoscopy for definitive care.

Aim

To study the competency and cost-effectiveness in patients with alleged fish bone ingestion using fibre-optic endoscope by emergency physician.

Method

A retrospective study in patients with endoscopy for alleged fish bone ingestion for a period of six months from January to June 2001. A telephone survey was conducted specifically asking for post-endoscopy or fish bone ingestion related complications.

Results

Ninety-six patients were recruited in the study. There were 42 males and 54 females with a ratio of 1:1.3. The detection rate was 32%. Eighty-seven percent of the fish bones was retrieved, and 13% was dislodged. Over 90% of fish bones were found in oropharynx and laryngopharynx. In the telephone survey, 81 patients (84.4%) could be contacted by phone and they experienced uneventful outcome after endoscopy. Of those who could not be contacted, there was no documented attendance or admission in any other hospital (under Hospital Authority) according to the computer records in Clinical Management System. Ninety-six hospital bed-days, which were equal to $350,400, could be saved under our approach in alleged fish bone ingestion without admitting patients into surgical unit for treatment.

Conclusion

Emergency physician was competent enough in performing upper GI endoscopy, and this method of managing alleged fish bone ingestion was shown to be safe and cost saving.
Clinical Audit in Emergency Medicine
Authors: Chung CH
Published: December 2017

Clinical audit is the review of clinical performance against agreed standards, and the refining of clinical practice as a result – a cyclical process of quality improvement in clinical care. The different steps of the clinical audit cycle are discussed. Publications on clinical audit in connection with Emergency Medicine are scarce in the medical literature. Clinical audit should be made compulsory for all healthcare professionals providing clinical care, and emergency physicians are no exceptions.
How Evidence-Based is our Practice in a Hong Kong Emergency Department?
Authors: Pang PKM , Lim B , Lee KP , Lok CL , Chung CS , Ngan HK
Published: December 2017

Objective

To evaluate how evidence-based our daily practice was.

Design

Retrospective study.

Setting

Emergency department of a public district hospital.

Patients and Methods

Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis.

Results

Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints.

Conclusion

Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.
A Case Series of Using Aspiration Catheter for the Management of Spontaneous Pneumothorax
Authors: Siu AYC , Chung CH
Published: December 2017

Introduction

Catheter aspiration is a relatively new treatment for spontaneous pneumothorax in emergency departments in Hong Kong. It causes less pain and shortens hospitalisation. However, there is limited local experience especially in regard to the target group that can be benefited. We reported on the initial experience of catheter aspiration in the management of spontaneous pneumothorax in our emergency department.

Method

Patients (age >=16 years) presenting with spontaneous pneumothorax were recruited. Patients with history of asthma or chronic obstructive airway disease were excluded. History of smoking, previous pneumothorax and pleurodesis were recorded. The aspiration catheter was inserted by the Seldinger technique. The extent of pneumothorax was assessed from the chest X-ray and initial aspirated volume. Successful patients were observed in the department and discharged if chest X-rays were reassuring after 12 hours. Factors associated with the outcome of patients were analysed.

Result

Seventeen patients were recruited from October 1999 to September 2000. Their age ranged from 16 to 40 years (mean 22.6). The overwhelming majority (16) was male. Twelve cases (70.6%) occurred on the left side. Five patients had previous pneumothorax and one had previous pleurodesis. Fifteen succeeded in immediate re-expansion, but seven re-collapsed during observation. The overall success rate was 47.1%. Initial aspiration volume >2,000 ml was associated with early failure (p=0.01).

Conclusion

Our initial experience did not support catheter aspiration to completely replace chest drain in the initial management of spontaneous pneumothorax. The procedure is likely to fail if the initial aspirated volume is greater than 2,000 ml. Further study is needed to identify the subgroup that may be benefited.
Thrombolysis as a Therapeutic Modality in Cardiac Arrest
Authors: Tay SY
Published: December 2017

Introduction

In recent years, thrombolysis has emerged as a potentially promising treatment for cardiac arrest. Patients with cardiac arrests from myocardial infarction or pulmonary embolism, as well as out-of-hospital cardiac arrests, were reported to have improvement in both survival and neurologic outcome after being treated with thrombolysis. This paper aims to review the available literature on the use of thrombolysis in cardiac arrest.

Method

Study of papers from PubMed literature search for all articles with terms related to thrombolysis and cardiac arrest in title or abstract.

Results

Thrombolytics are thought to act by lysing both macroscopic clots and microthrombi, particularly in the cerebral microcirculation, thus alleviating or reversing post-arrest cerebral no-reflow. Their use in cardiac arrest has been restrained by concerns over their safety after cardiopulmonary resuscitation, in particular bleeding-related complications, although these concerns seem to have been misplaced.

Conclusions

Thrombolysis for cardiac arrest is likely to be most efficacious in a pre-hospital environment, and future research should be directed to this setting.
Emergency Medical team: an Entrapped Patient
Authors: Shek KC , Mak YK , Kam CW , Yau HH
Published: December 2017

Motor vehicle collision is one leading cause of morbidity and mortality. Victims may be trapped in the deformed vehicles. Emergency medical team may be summoned to help in the extrication process. The principles of resuscitation in the pre-hospital phase are the same as in the in-hospital phase, but clinicians would face greater impediments to success in the former situation. We present a case of motor vehicle collision in which an emergency medical team was called to assist in the extrication of an entrapped patient. The principles of pre-hospital trauma care are discussed.
Closed Reduction Techniques for Acute Anterior Shoulder Dislocation: from Egyptians to Australians
Authors: Chung CH
Published: December 2017

Acute anterior shoulder dislocation is a common presentation to emergency departments. A standard technique for reduction does not exist. Most dislocations can be reduced by one or more simple manoeuvres involving traction-countertraction, leverage and/or pulsion. The better-known methods are discussed, highlighting the manoeuvres, virtues and drawbacks.
Sweat and Blood – Runner's Haematuria: Discharge or Further Evaluate?
Authors: Sia JYS , Wong YT
Published: December 2017

An elite runner presented with macroscopic haematuria after six hours of non‐stop running during his training for Trailwalker. The haematuria resolved after two days of conservative treatment. The history, pathophysiology and complication of runner‐related haematuria are discussed. A simplified management plan is suggested in order to avoid unnecessary anxiety to the patients, inappropriate referral and wasting of medical resources.
A Retrospective Study of Seclusion in an Emergency Department
Authors: Chan CC , Chung CH
Published: December 2017

Objectives

To study the practice of seclusion in an emergency department (ED) and to explore high‐risk elements during seclusion.

Methods

The study consisted of two parts: an in‐depth analysis on all incidents associated with seclusion in a six‐year period (1998–2004) and a two‐year (2002–2004) retrospective analysis of secluded patient records to understand the rationale and patient outcome.

Results

Part 1: A total of 9 incident records were collected. Four patients were related to setting fire. Five patients had violence or threat of violence. The median length of stay (LOS) in seclusion at the time of incident was 129 minutes. Although 66.7% of the patients had additional restraint prior to the seclusion, incidents still occurred. Two staff sustained injuries and hospital facilities were damaged in some of the incidents. Six patients were later admitted to psychiatric hospital. Part 2: 141 patient data were collected in the study (M: 89 and F: 52). The average monthly number of patients secluded was about 6. The mean age was 45 years (SD 19) and the mean LOS was 616 minutes (SD 478). There were three incidences (2.1%) during the two‐year period. A total of 82 patients (58.2%) were associated with violence or threat of violence and 38 (46.3%) of the group had psychiatric illness; and 50 patients (35.5%) were associated with alcohol or drug intoxication. Ultimately, 56 patients (39.7%) were admitted to psychiatric hospital and 64 patients (45.4%) were treated and discharged from the ED.

Conclusion

Seclusion is a high‐risk practice. In our department, the most frequent indication was violence (58.2%), with nearly half of them having history of psychiatric illness. Psychiatric illness had the highest risk for incidents, especially those with violence or threat of violence. The LOS in seclusion was relatively long in the ED and might be one of the risk factors for incidents. Inadequate removal of potentially dangerous belongings from patients before seclusion may end up with catastrophic outcomes. Curiously, ED nurses are not allowed to search patients before seclusion. They are exposed to legal liability in exercising restraint and in searching for potentially dangerous items from patients. It is suggested that clear protocols and quality assurance programs should be instituted to ensure safe seclusion.