bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Comparison between two Methods of Basic Life Support Instruction: Video Self-Instruction versus Traditional Method
Authors: Assadi T , Mofidi M , Rezai M , Hafezimoghadam P , Maghsoudi M , Mosaddegh R , Aghdam H 
Published: December 2017

Introduction Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method. Methods Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline. Results The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001). Conclusions Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. (Hong Kong j.emerg.med. 2015;22:291-296)
Predictors of Recurrent Seizure before Admission in Children Presented with Seizure to Emergency Department
Authors: Cheung ACK 
Published: December 2017

ObjectiveTo identify predictors for short term recurrence in young children presented with seizure to the accident & emergency department (A&E) in Hong Kong.MethodsIt was a retrospective cohort analysis based on A&E data from one district hospital. The study period was from 1st January 2008 to 31st December 2012. All children aged below 6 years presented with seizure attended A&E who required admissions to paediatric ward were included. Baseline characteristic factors were recorded. Primary outcome was presence of recurrent seizure before admission to paediatric ward. Binominal logistic regression was applied to identify the predictive factors.ResultsTotal 650 cases were included for analysis. Recurrent seizure before admission occurred in 101 cases (15.5%). Final diagnoses consisted of febrile seizure (77.8%), afebrile seizure (6.6%), epilepsy (13.8%), status epilepticus (1.2%) and others (0.5%). Statistically significant predictive factors include pre-hospital seizure duration 5-15 minutes (odds ratio [OR]=2.960; p<0.001), pre-hospital seizure duration more than 15 minutes (OR=16.164; p<0.001), history of prematurity (OR=3.941; p=0.006), history of epilepsy (OR=2.531; p=0.010) and fever in A&E (≥38°C) (OR=2.072; p=0.030).ConclusionsIn children aged below 6 years presented with seizure to A&E, prior seizure duration of 5-15 minutes, prior seizure duration of more than 15 minutes, history of prematurity, history of epilepsy and fever in A&E are independent predictors for recurrent seizure before admission. (Hong Kong j.emerg.med. 2015;22:297-302)
The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis
Authors: Zhu BF , Chen HL , Shen JH , Xing JL , Chen JR 
Published: December 2017

Objective To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest. Design Systematic review. Methods Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time. Results A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p<0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p<0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p<0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes. Conclusions Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)
The Effect of the Emergency Physicians' Clinical Decision of Targeted Ultrasonography Application in Non-Traumatic Shock Patients
Authors: Dine SE , Soyuncu S , Dinc B , Oskay A , Bektas F 
Published: December 2017

Introduction Clinical evaluation of non-traumatic shock patients with high risk of mortality and morbidity is problematic for emergency physicians. In this study, changes in the investigations, diagnosis and treatment decision of the physicians using the Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) protocol were examined. Methods In this clinical prospective study, the patients were ultrasonographically examined within the scope of the ACES protocol at 6 quadrants including cardiac, pleural, peritoneal, inferior vena cava and aorta. Pre- and post-US investigations, diagnoses and treatments were compared. Results A total of 141 patients were included in this study. Of these, 92 (65.2%) of the patients were males and 49 (34.8%) were females. The average age of the patients was 62.9±16.8 years (18-97). After the ultrasonographic evaluation, request for new investigations was needed in 25 (17%), and modification of the treatment was needed in 57 (40.4%) of the patients. It was seen that with a targeted ultrasonography (US), the number of the considered pre-diagnoses decreased in 51 (36.2%) of the patients, and the physicians made a new pre-diagnosis in 6 (4.3%) of the patients. When the pre-diagnoses made by the physicians after the US and the final diagnoses clinically made at the end of the follow-up process were compared, there were no changes in the diagnoses in 124 (87.9%) patients. Conclusion Ultrasonographic examination is considered useful for rapid evaluation, early diagnosis and treatment planning in non-traumatic shock patients in emergency department. (Hong Kong j.emerg.med. 2015;22:364-370)
Twelve‐Year Experience with Necrotising Fasciitis in an Intensive Care Unit of a Local Regional Hospital
Authors: Yip HW , Wong OF , Lee HM , Lam SK 
Published: December 2017

BackgroundNecrotising fasciitis (NF) is a life threatening condition and is a medical and surgical emergency. The mainstay of management includes early recognition, prompt surgical intervention, appropriate antibiotics and intensive care for organ support. However, the mortality is still very high despite the advance in the intensive care.ObjectiveTo examine the 12‐year outcomes, causative organisms, time to diagnosis, surgery and institution of adequate antibiotic coverage of patients with NF admitted to the intensive care unit (ICU) in a local regional hospital; and to identify the independent predictors of ICU mortality.MethodWe performed a retrospective analysis of the clinical records of all patients with NF admitted to the ICU between 1st July 2002 and 30th June 2014. Logistic regression analysis was conducted to identify the independent predictors of ICU mortality.ResultsOne hundred and thirty seven patients were recruited. Causative organisms included: Group A Streptococcus (16.2%), other streptococcus (31.1%), Methicilin‐resistant Staphylococcus aureus (8.8%), Vibrio species (14%) and other Gram negatives (44%). The mean length of ICU stay was 9.9 days (range: 1‐74 days) and the ICU mortality rate was 42.3%. The APACHE II score (odds ratio [OR] 1.132; 95% confidence interval [CI] 1.060‐1.209), Diabetes Mellitus (OR 5.017; 95% CI 1.919‐13.119), Glasgow coma scale ≤8 (OR 4.525; 95% CI 1.319‐15.530), low white cell count (OR 0.931; 95% CI 0.876‐0.990) and urea level (OR 1.049; 95% CI 1.001‐1.100) were statistically significant independent predictors of ICU mortality.ConclusionsThe mortality of patients with NF in ICU remains very high. The causative microorganisms in our locality are similar to those observed elsewhere. NF patients treated in ICU with underlying diabetes mellitus or presenting with Glasgow Coma Scale less than 8 are significantly more likely to die.
Lactate as an Early Predictor for Early Massive Transfusion in Trauma Patients: A Retrospective Study
Authors: Kyoung KH , Kim YH , Jung YJ , Hong SK 
Published: December 2017

ObjectiveTransfusion is a key treatment for patients with hemorrhage. Early massive transfusion (EMT) is defined as transfusion of 10 or more units of red blood cells (RBC) within the first 6 hours. We attempted to determine whether metabolic markers can be used as predictors for EMT.MethodWe retrospectively reviewed outcomes in 71 patients who visited the emergency department within 12 hours after trauma and received at least 1 unit of RBC within 24 hours between January 2008 and June 2010.ResultsOf the 71 patients, 54 were male and 17 were female; their mean age was 50.3±17.7 years. Of these, 15 required EMT and 56 did not; these patients received 17.7±13.1 and 2.8±2.3 units of RBCs, respectively. There were significant differences between EMT and non‐EMT groups in injury severity score (ISS; p=0.001), systolic blood pressure (SBP; p=0.010), base deficit (p=0.003), and lactate concentration (p=0.001). Logistic regression analysis showed that SBP <90 mmHg (odds ratio [OR] 11.71, 95% CI 1.83‐74.77, p=0.009), ISS ≥25 (OR 23.39, 95% CI 1.87‐293.23, p=0.015), and lactate ≥3.5 mmol/L (OR 6.99, 95% CI 1.10‐44.33, p=0.039) were significant predictors of EMT. The area under the curve for ≥3.5 mmol/L lactate was 0.79 (p=0.001), with a sensitivity of 76.7% and a specificity of 67.8%. The 30‐day mortality rate was significantly higher in patients with lactate ≥3.5 mmol/L than in those with lactate <3.5 mmol/L (p=0.002).ConclusionLactate concentration is an important predictor of the need for EMT and should be considered in the initial phase of trauma resuscitation to prepare for massive transfusion.
Hong Kong Poison Information Centre: Annual Report 2015
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015. Methods In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed. Conclusions This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.
Bamboo snake (Trimeresurus Albolabris) Bite in Hong Kong and its Prognostic Factors for Local Complications with Surgical Intervention, Coagulopathy and Thrombocytopenia
Authors: Suen PY 
Published: December 2017

Introduction Bamboo snake bite accounts for the majority of venomous snake bites in Hong Kong. The objectives of this study were to evaluate the clinical features and outcomes of Bamboo snake bite in Hong Kong and to identify its prognostic factors for local complications requiring surgical intervention, coagulopathy and thrombocytopenia. Methods It was a retrospective cohort study conducted in a regional hospital of Hong Kong from 1st January 2001 to 31st December 2015. Results Sixty-three subjects were in the final analyses. The mean age was 60 years old. The incidences of swelling, local bruises, blistering, regional lymphadenopathy and local necrosis were 90.5%, 33.3%, 6.3%, 1.6% and 3.2% respectively. The incidences of local complications with surgical intervention, coagulopathy and thrombocytopenia were 6.3%, 13% and 13% respectively. Univariate analysis showed only local necrosis (p=0.003) was significantly associated with local complications with surgical intervention; and only cardiovascular disturbance due to snakebite envenomation (p=0.002) was significantly associated with coagulopathy; and no significantly associated factor was found for thrombocytopenia. There were no case with systemic bleeding and death after Bamboo snake bite. There was no case with allergic reaction after the use of antivenom. Conclusions Local necrosis is significantly associated with surgical intervention. Cardiovascular disturbance is significantly associated with coagulopathy. Allergic reaction after the use of antivenom is rare in Hong Kong.
Circumcision Is Unethical and Unlawful
Authors: Svoboda J. Steven , Adler Peter W. , Van Howe Robert S. 
Published: December 2017

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision.
Experiences of Integrated Care for Dementia from Family and Carer Perspectives: A Framework Analysis of Massive Open Online Course Discussion Board Posts
Authors: Robertshaw David , Cross Ainslea 
Published: December 2017

Background Integrated Care for dementia is an increasingly popular approach to supporting people with dementia, bringing services together to form a single cohesive provision for service users. This approach is still in its infancy but has the potential to improve the management of dementia, social care and to enhance the patient experience. Aims To understand views and experiences of integrated health and social care for dementia from the perspective of carers, families, healthcare professionals and researchers. Methods Crowdsourcing views and experiences from ‘Bridging the Dementia Divide’, a massive open online course at the University of Derby, provide a rich source of qualitative data from carers, families and healthcare professionals. We analysed 847 massive open online course discussion board posts using a Framework Analysis approach. Results Participants described how Integrated Care for dementia should be person-centred and holistic, involving a multidisciplinary team of health and social care practitioners, as well as the patient, the family and the wider community. The establishment of Integrated Care for dementia was viewed positively.
Dementia looming!
Authors: Oliemeulen Lisette 
Published: December 2017

Background I, the 45-year-old scientist, the PhD, the sublime researcher, now subject to dementia? I felt confused, very ashamed and told no one, until they found out. I suffer from brain atrophy, associated with multiple sclerosis I am suffering from for years. My cognitive impairment is the result of my shrinking brain! Objectives With my personal view ‘Dementia Looming!’, I hope to contribute to and support healthcare professionals and scientists in understanding the meaning of dementia. Although not scientific, my paper gives a unique behind-the-scenes view into what it means to experience dementia symptoms.
The lived experiences of dementia in married couple relationships
Authors: Clark Suzannah , Prescott Tim , Murphy Gemma 
Published: December 2017

Background and purpose There are a growing number of couples who become affected by dementia as one partner develops the condition while the other becomes a carer. However, our knowledge about the experiences of couples affected by dementia is limited. Very little knowledge about the impact of dementia on couples has been gained in previous research. The aim of this study was to explore the dyadic perspective of dementia within a couple relationship. Methodology: Six couples were interviewed about their experience of living with dementia. Interview transcripts were subjected to interpretive phenomenological analysis to identify themes across participants’ accounts. Results and conclusion: The analysis revealed three themes: (i) maintaining a bond, (ii) change and adjustment, and (iii) the challenge of coping. The results highlight the importance of studying the dyadic perspective and including people with dementia in research. Couples experienced an enduring commitment to one another as they adjusted to life with dementia.
Using public engagement and consultation to inform the development of ageing- and dementia-friendly pharmacies – Innovative practice
Authors: Gilmartin-Thomas Julia F-M , Orlu Mine , Alsaeed Dalal , Donovan Ben 
Published: December 2017

This study explored public perceptions about the importance of, and how to create, ageing- and dementia-friendly pharmacists and pharmacies. In September 2016, four focus groups (45 minutes each) were conducted with 16 participants who represented organisations, groups or forums working with and/or for older people and people with dementia in Greater London. Discussions were recorded via handwritten notes and thematically analysed. Participants confirmed the importance of pharmacists and pharmacies being ageing- and dementia-friendly and described variability in whether this is currently the case. Suggested strategies for improvement included targeting communication, pharmacist leadership and shop layout.
Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline
Authors: Carter Jeanne , Lacchetti Christina , Andersen Barbara L. , Barton Debra L. , Bolte Sage , Damast Shari , Diefenbach Michael A. , DuHamel Katherine , Florendo Judith , Ganz Patricia A. , Goldfarb Shari , Hallmeyer Sigrun , Kushner David M. , Rowland Julia H. 
Published: December 2017

PurposeThe adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment.MethodsASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations.ResultsThe ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience.RecommendationsIt is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .