bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pilot Randomised Clinical Trial of 3-In-1 Femoral Nerve Block and Intravenous Morphine as Primary Analgesia for Patients Presenting to the Emergency Department with Fractured Hip
Authors: Graham CA , Baird K , McGuffie AC 
Published: December 2017

Background Fractured neck of femur (NOF) is a leading cause of morbidity and mortality in the elderly. Published clinical guidelines suggest early adequate analgesia as a key management aim. The femoral nerve ‘3-in-1 block’ has previously been shown to provide effective analgesia for these patients in the peri- and post-operative phase of care. The aim of this study was to examine the use of the ‘3-in-1’ femoral nerve block as primary analgesia for patients with a fractured NOF presenting to the emergency department. Methods This was a single centre pragmatic randomised controlled open-label trial comparing femoral nerve block (using a ‘3-in-1’ technique) with intravenous (IV) morphine. A convenience sample of patients presenting to the emergency department of a district general hospital with a clinically or radiologically suspected fractured NOF were recruited. They were randomised to receive either 0.1 mg/kg IV bolus of morphine or a ‘3-in-1’ femoral nerve block with 30 ml of 0.5% plain bupivacaine. Visual analogue pain scores were noted prior to treatment and at 30 minutes, 2 hours, 6 hours and 12 hours after treatment. Immediate complications such as vascular puncture or the requirement for naloxone were noted. Results Forty patients were recruited, 22 patients were randomised to IV morphine and 18 patients were randomised to ‘3-in-1’ femoral nerve block. Complete data were available for 33 patients. There was no significant difference in initial median pain score (p=0.45). Analysis using the Wilcoxon test showed a significant decrease in pain score for the morphine group (p=0.01) and the nerve block group (p<0.01) at 30 minutes compared with baseline. Analysis using the Mann-Whitney U test between median pain scores at each time point showed a significant lower pain score in the nerve block group at 30 minutes (p=0.046). There were no immediate complications in either group. Conclusion Our results suggest that a ‘3-in-1’ femoral nerve block is at least as effective as IV morphine when used as primary analgesia for patients with fractured NOF. Our results suggest that the femoral nerve block may provide better analgesia at 30 minutes. Further larger scale randomised trials are warranted.
Hong Kong Poison Information Centre: Annual Report 2006
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2006. Methods From 1st January 2006 to 31st December 2006, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis. Results A total of 2555 poisoned cases were analysed. There were 1051 male and 1466 female patients and nearly 60% of the cases were between 20 and 49 years old. Common causes of exposure were suicidal attempts and accidents. Paracetamol, sedative-hypnotic and household products were common sources of poison exposure. The majority of the patients were managed conservatively, with 18.8% and 10.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Nearly half of the cases were managed in the accident & emergency department without hospitalisation. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong. Subsequent annual reports would provide important information on the trend of poisoning pattern and may guide further strategies in poison control and prevention in Hong Kong.
The Use of Patient Education Video in Improving Patient Satisfaction in the Accident and Emergency Department
Authors: Chan LW , Choi SY , Chan HH , Wong TW , Lau CC 
Published: December 2017

Objective To study the impact of patient education video in improving patient satisfaction in the accident and emergency department (AED). Methods This was a descriptive questionnaire study. A 20-minute patient education video in Cantonese was produced. The video was shown in the waiting hall from 9 am to 5 pm during the weekdays of a week in January 2008. All category 4 (semi-urgent) and category 5 (non-urgent) patients were invited to fill in an evaluation questionnaire after watching the video. The demographics of the patients were collected. There were two parts in the questionnaire. Part 1 contained four questions to test patients' knowledge retention after watching the video. These included questions on pharmacy location, triage system, use of patient identification slip and scope of the AED service. Part 2 contained six evaluation items (based on the 5-point Likert scale) to assess patients' opinion on the education video, understanding of the AED workflow and level of satisfaction after watching. Statistical analysis was performed to compare the knowledge retention scores and the Likert responses between different age and education level subgroups. Results Altogether 177 questionnaires were returned; 72 were excluded due to incomplete answers or absent patient gum label; and 105 completed questionnaires were analysed. Of the latter, 83 (79%) respondents scored 75% or more in the questions on knowledge retention, 79 (75%) respondents agreed that they understood the workflow of the AED better, 63 (60%) respondents thought that the video covered most frequently asked questions, and 69 (66%) respondents agreed that their level of satisfaction had improved after watching the video. There was no statistically significant difference on comparing the knowledge retention scores between different age and education level subgroups. Respondents more than 60 years old stated a better understanding about the location of consultation rooms after watching the video. Conclusion A patient education video is useful in providing information about operation and improving patient satisfaction in the accident and emergency department.
Inpatient and Outpatient Management for Foreign Body Ingestion: A Retrospective Review in an Emergency Department of Hong Kong
Authors: Tse CT 
Published: December 2017

Objectives To evaluate the outcome of patients who presented to our accident and emergency department (AED) for foreign body (FB) ingestion, and were managed in inpatient or outpatient settings according to the departmental protocol. Methods It was a retrospective observational study of patients admitted to the AED of Kwong Wah Hospital for FB ingestion from 1st March to 30th June 2007. Patients without FB found by direct laryngoscopy were admitted for inpatient oesophagogastroduodenoscopy (OGD) if they were under 12 years old, had significant symptoms with haematemesis, vomiting more than twice, swallowed FB other than fish bone or had FB seen on cervical X-ray, according to the departmental protocol. Patients without the above criteria were discharged for outpatient OGD. Demographic data, clinical information, OGD findings and outcomes, including complication rate and re-attendance rate, were studied and compared. Results There were 152 patients in this study; 71 of them were admitted for inpatient OGD and 81 were discharged for outpatient OGD. The mean age of the inpatient group was 46.34 years and that of the outpatient group 51.08. The mean day of impaction was 1.39 days for the inpatient group and 1.25 days for the outpatient group respectively. OGD was done for 59 outpatients and 17 of them were found to have FB. OGD was done for 35 inpatients and 23 of them were found to have FB. Fish bones were the commonest FB detected. One patient of the inpatient group developed complication and one patient re-attended within one month. Re-attendance was not found in the outpatient group. Conclusion Foreign body ingestions were commonly encountered in the AED. No statistically significant difference in complication rate and re-attendance rate between inpatients and outpatients was demonstrated in this study.
Should N‐Acetylcysteine be Administered Orally or Intravenously for the Treatment of Paracetamol Overdose?
Authors: Cattermole GN 
Published: December 2017

IntroductionParacetamol is the most commonly used drug in deliberate poisoning. N‐acetylcysteine is the standard antidote for significant acute paracetamol overdose, but the route of administration varies between countries. This review aimed to find and appraise those comparative studies which would help answer the following question: in patients who have taken an overdose of paracetamol requiring antidote, is there any difference between intravenous and oral N‐acetylcysteine in mortality, hepatotoxicity, adverse drug reactions or cost?MethodsA literature search was conducted using Medline and other databases. Relevant papers were identified and appraised.ResultsOne animal study and seven comparative clinical studies were identified and appraised. The quality of the evidence was generally poor, and there was no clear difference in outcomes between the two routes of administration.ConclusionsWithout evidence of advantage for one route over the other, routine practice should not be changed. However, after 30 years experience, both routes appear to be effective and safe, and in countries where intravenous administration is the standard, it would be reasonable to consider the oral route as an alternative when intravenous access is problematic. There is a need for prospective, randomised trials to determine the relative effectiveness, safety and cost of intravenous and oral formulations of N‐acetylcysteine.
Acute Urinary Retention: How Useful is an Ambulatory Care Protocol?
Authors: Li YK , Leung CS , Hui TL , Chiu LH 
Published: December 2017

IntroductionAcute urinary retention (AUR) is a common urological presentation to emergency departments (ED). An ambulatory care protocol had been developed allowing trial without catheterization (TWOC) instead of admission to hospital after catheterization in the ED. This study aimed to evaluate the efficacy of the ambulatory care protocol for patients with AUR. The secondary aim was to identify any independent predictor(s) for successful weaning of urinary catheter in a short duration.MethodsThis was a prospective cohort study. A total of 143 male patients presenting with an episode of AUR underwent urinary catheterization once. Those who were unable to pass urine afterwards were catheterized again and discharged home with a urinary catheter in‐situ (Day 0). On Day 3, ability of spontaneous urination was assessed. If failed, spontaneous urination was assessed again on Day 6.ResultsSuccessful TWOC was recorded in 50.3% of the 143 patients after first catheterization. The cumulative successful rates for first (Day 3) and second (Day 6) follow‐ups were 76.9% and 79.0%, respectively. Among the associated predictors, only the urine retention volume on first catheterization was found to be independently associated with successful TWOC, using binary logistic regression (p=0.001).ConclusionThe ambulatory care protocol was successful in weaning off urinary catheter for 50.3% of patients with AUR after first catheterization and a further 26.6% on Day 3, making a cumulative success rate of 76.9%. Those who failed TWOC on Day 3 would get little benefit on further trials. The first catheterization volume was independently associated with the chance of successful TWOC.
The Efficacy of Emergency Medicine Ward for the Management of Patients with Mental Disorders
Authors: Chan CM , Wong MY , Chan SL , Wan MY , Mo YF 
Published: December 2017

ObjectivePatients with mental disorders are one of the target groups selected for management in the Emergency Medicine Ward (EMW) with the enrolment of psychiatric advanced practice nurses. This study aimed to determine whether the EMW can be efficiently used for the management of patients with mental disorders in terms of length of stay (LOS), admission rate, and re‐attendance rate when compared with the medical ward.MethodsThis was a retrospective descriptive study. Patients with mental disorders were defined and recruited from the Princess Margaret Hospital during two selected study periods: pre‐opening (pre‐EMW) and post‐opening (post‐EMW) of the EMW. All emergency department records of patients with mental disorders within these two periods were reviewed and data of the selected samples were retrieved from different computer databases.ResultsThe total number of patients with mental disorders was 565 in the pre‐EMW period and 404 in the post‐EMW period; 214 (37.9%) cases were admitted into the medical ward in the pre‐EMW period while only 62 (15.3%) were admitted into the medical ward in the post‐EMW period. The mean LOS in the pre‐EMW period was 67.7 hours. For the post‐EMW period, the mean LOS was 32.3 hours. The reduction in mean LOS was 35.4 hours, and 82% of the study patients treated in the EMW were discharged within 48 hours. Notably, 23.3% of the cases re‐attended the emergency department after discharge from the medical ward, whereas only 8.8% of cases re‐attended after discharge from the EMW.ConclusionPatients with mental disorders or related problems can be efficaciously managed in the EMW, as evidenced by a decrease in the length of stay, admission rate, and re‐attendance rate.
Differences in Injury Pattern and Mortality between Hong Kong Elderly and Younger Patients
Authors: Cheng CH , Yim WT , Cheung NK , Yeung JHH , Man CY , Graham CA , Rainer TH 
Published: December 2017

BackgroundThe rapidly aging population in Hong Kong is causing an impact on our health care system. In Hong Kong, 16.5% of emergency department trauma patients are aged ≥65 years.ObjectiveWe aim to compare factors associated with trauma and differences in trauma mortality between elderly (≥65 years) and younger adult patients (15 to 64 years) in Hong Kong.MethodsA retrospective observational study was performed using trauma registry data from the Prince of Wales Hospital, a 1200–bed acute hospital which is a regional trauma centre.ResultsA total of 2172 patients (331 [15.2%] elderly and 1841 [84.8%] younger) were included. Male patients predominated in the younger adult group but not in the elderly group. Compared with younger patients, elderly patients had more low falls and pedestrian‐vehicle crashes and sustained injuries to the head, neck and extremities more frequently. The odds ratio (OR) for death following trauma was 5.5 in the elderly group (95% confidence interval [CI] 3.4–8.9, p>0.0001). Mortality rates increased progressively with age (p>0.0001) and were higher in the elderly at all levels of Injury Severity Score (ISS). Age ≥65 years independently predicted mortality (OR=5.7, 95% CI 3.5–9.3, p>0.0001). The elderly had a higher co‐morbidity rate (58.6% vs. 14.1%; p>0.01). There was a lower proportion of trauma call activations for the elderly group (38.6% vs. 53.3%; p>0.01).ConclusionElderly trauma patients differ from younger adult trauma patients in injury patterns, modes of presentation of significant injuries and mortality rates. In particular, the high mortality of elderly trauma requires renewed prevention efforts and aggressive trauma care to maximise the chance of survival.
Association between Drink Driving and Severity of Crash Injuries to Road Users
Authors: Tsui KL , Sze NN , So FL , Wong SC 
Published: December 2017

ObjectiveTo determine the association between alcohol impairment in drivers and risk of severe injury in other road users in Hong Kong.MethodThe Road Casualty Injury Information System (RoCIS) was set up by linking a regional hospital injury registry to the police traffic injury database. Based on the year 2004 linked dataset, a specific model namely the External Casualty Model (ECM) was designed to measure the association between severe injury outcome of other (non‐driver) road user casualties (as stratified by ISS groups [ISS <9 or ISS ≥9]) and the level of alcohol impairment (as measured by breath alcohol concentration [BAC <22 µg/100 ml or BAC ≥22 µg/100 ml]) in drivers involving in the crash, controlling for the driver's demographics (age and sex) and behaviour (as measured by driving‐offence points [DOP]) and another attribute (day of week of crash). Binary logistic regression was used in the analysis.ResultsOut of 1818 matched RoCIS cases in the year 2004, 439 ECM records were available for analysis. Alcohol impaired drivers led to a significantly higher risk of severe injury to other road users (OR=4.2, 95%CI=1.21, 14.36, p=0.02). Crashes on weekdays seemingly led to a lower severe injury risk (OR=0.57, p=0.08) than crashes on weekends. DOP of drivers did not predict a higher severe injury risk to other road users.ConclusionsAlcohol impairment on driver increases the risk of severe injury to other road users by four times. Road safety education campaign should stress on this adverse impact of drink driving on innocent people.
Cost Benefits of the Drug and Poison Information Centre in Preventing Unnecessary Hospitalisation: The Singapore Experience
Authors: Ponampalam R , Loh CS 
Published: December 2017

BackgroundThe Drug and Poison Information Centre (DPIC) in Singapore was piloted as a new service in April 2004. This study evaluated the cost benefits of its interventions in the first two years of its operation.MethodA two‐year retrospective review of DPIC call records was performed and the following outcome measures were noted: (A) proportion of patients who were managed onsite and hence did not need to attend the emergency department (ED); and (B) proportion of patients who were managed in the ED without the need for admission. Cost savings were calculated based on admission costs for patients with poisoning, including other out‐of‐hospital costs. This amounted to savings of S$1390 and S$1170 for patients who fulfilled outcome measures A and B respectively. Savings for the hospital was S$1477 per case. The cost of operating the DPIC over the same period was S$507,922.ResultsThere were 831 calls on acute toxic exposures over the study period. Of these, 115 and 405 patients fulfilled outcome measure A and B respectively with consequent cost savings of S$159,850 (115 x S$1390 per patient), and S$473,850 (405 x S$1170 per patient). The hospitals saved S$768,040 (520 x S$1477) from prevented admissions. Excluding operating cost, this gave net savings of S$893,818 over the two years from DPIC interventions.ConclusionThe cost savings from DPIC services is evident from this study. This translates to more effective use of limited healthcare resources.
A Volunteer Study on the Blood Salicylate Level of Excessive Use of Topical Methylsalicylate
Authors: Yip WL , Ng HW , Chan YC , Tse ML , Lau FL 
Published: December 2017

ObjectiveThe purpose of this study was to evaluate the serum level of salicylate after topical application of methylsalicylate (analgesic balm), and to determine the safety of its use in our population.MethodsThis was a human volunteer study involving six volunteers. Each of them applied 10 grams of analgesic balm (containing 5 grams of methylsalicylate) on the limbs, and serial serum salicylate levels were measured just before the trial, and 1, 2, 4 and 8 hours after application. The time required to reach the maximum blood level after application was recorded.ResultsThe serum salicylate level ranged from non‐detectable level up to near therapeutic level in different subjects. The maximum salicylate level measured was 130 mg/L in one of the volunteers 8 hours after application. The calculated systemic bioavailability of dermal methylsalicylate in our study was 19‐45%, which was comparable to previous studies.ConclusionsDermal application of massive amount of analgesic balm may cause unpredictable absorption of methylsalicylate. Patients and physicians should be aware of its potential risk.
Reliability and Validity of the “Extended ‐ Hurt, Insult, Threaten, Scream” (E‐Hits) Screening Tool in Detecting Intimate Partner Violence in Hospital Emergency Departments in Hong Kong
Authors: Chan CC , Chan YC , Au A , Cheung GOC 
Published: December 2017

ObjectivesTo assess the reliability and validity of a brief screening instrument, “E‐HITS” (Extended ‐ Hurt, Insult, Threaten, Scream), for detecting female intimate partner violence (IPV) in Hong Kong emergency departments (EDs).MethodQuantitative data were collected from a victim group (n=110) and a control group (n=116). Statistical properties of the instruments were analysed to ascertain its internal consistency, test/re‐test reliability, concurrent validity and discriminant validity.ResultsCronbach's alpha was 0.90 for the E‐HITS. Two‐week test/re‐test reliability was 0.71 (p<0.001). Respondents' scores on the E‐HITS positively correlated with those on psychological aggression, physical assault, sexual coercion and injury scales, and negatively correlated with the negotiation scale of the revised Conflict Tactics Scale at a statistically significant level. Subsequent Receiver Operating Characteristic (ROC) curve analysis revealed that E‐HITS reached a sensitivity of 98.2% and a specificity of 94.8% at a cut‐off of 8.5. The overall accuracy of the E‐HITS indicated by the area under curve (AUC) in the ROC is 0.991.ConclusionThese results show that the E‐HITS has good internal consistency, test/re‐test reliability, as well as concurrent and discriminant validity. The E‐HITS is a valid and reliable tool for screening intimate partner violence in Hong Kong EDs.
A Prospective Clinical Trial Comparing Self‐Administered Nitrous Oxide and Haematoma Block for Analgesia in Reducing Fracture of the Distal Radius in an Emergency Department
Authors: Man KH , Fan KP , Chan TN , Yue YM , Sin FP , Lam KW 
Published: December 2017

ObjectiveTo compare the effectiveness and efficacy of self‐administered nitrous oxide and haematoma block in pain relief during close reduction of fractured distal radius in adult patients.MethodsThis was a prospective clinical trial. All adult patients aged 18 years or above with fracture of the distal radius within 24 hours requiring close reduction in the Accident and Emergency Department of Kwong Wah Hospital were included. Patients with known contraindications were excluded. A consecutive series of patients were randomised into the two groups in alternating fashion. Pain perception (VAS score), procedure time, patient acceptance and complications were measured and monitored.ResultsA total of 67 patients (53 females and 14 males) with age ranging from 26 to 94 years were enrolled during the period from April 2008 to December 2008; 33 patients received Entonox and 34 received haematoma block. The average VAS score before reduction was 6.97 cm for the Entonox group and 6.76 cm for the haematoma block group (p=0.61). The average VAS score during reduction was 7.19 cm for the Entonox group and 2.80 cm for the haematoma block group (p<0.0001). For the difference of average VAS scores during and before reduction, there was 0.22 cm increase in the Entonox group and 3.95 cm decrease in the haematoma block group (p<0.0001). The relative change of mean VAS score was 3% increase in the Entonox group and 58% decrease in the haematoma block group (p<0.0001). The average procedure time was 6.29 min for the Entonox group and 6.44 min for the haematoma block group (p=1). In the Entonox group, 64% patients agreed to use the same analgesia method under similar circumstances whereas in the haematoma block group, it was 91% (p=0.009). There were no complications or failed reductions in both groups.ConclusionHaematoma block is a safe and effective analgesia in the reduction of fractured distal radius with less pain perception, more patient acceptance and similar procedure time compared with Entonox.