bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Different Treatment Options on the Prognosis of Wasp Stings
Authors: Xia JB , Xu SS , Yang L , Zhang XW , Zhong WQ , Peng AM 
Published: December 2017

Introduction Severe wasp sting injuries often threaten patient's life. We compared the effects of three different therapies on the prognosis of wasp stung patients. Methods We conducted a randomised single-blind controlled trial. Patients stung by wasp were randomly assigned to one of the three treatment groups: group A received symptomatic treatment; those complicated with acute renal failure and haemolysis also received haemoperfusion combined with haemodialysis; for patients with severe haemolytic anaemia, plasmapheresis were applied; for patients with haemodynamic instability, continuous renal replacement therapy was used. Group B received intravenous methylprednisolone injection, 80 mg/d for continuous 3 days in addition to the symptomatic therapy; for patients with haemolysis, methylprednisolone 0.5 g/d was injected intravenously for 3-5 days. For group C, in addition to all treatments administrated to group B patients, subcutaneous injection of 0.5 ml 0.1% epinephrine was given immediately after admission. Primary endpoint was mortality. Major complications (gastrointestinal haemorrhage, toxic encephalopathy, haemolysis, and acute left ventricular failure) and serum enzyme spectrum elevate (alanine aminotransferase [ALT], creatine kinase [CK] isoenzyme and serum creatinine) were secondary endpoints. Results Of 134 patients recruited, 45, 44 and 45 patients were assigned to group A, B or C respectively. Therapy in group C reduced mortality compared with group A and B (respectively 24.4%, 9.09%, 0.00% for group A, B, C respectively; p<0.001); there was no significant effects on major complications among three groups (p >0.1). The incidence of elevated ALT was significantly lower in group B and group C than in group A (p<0.001). The incidence of elevated CK isoenzyme was significantly lower in group C than in group A and group B (p<0.001). Conclusions For patients with concurrent organ impairment by wasp sting, early combination of epinephrine and methylprednisolone with supportive treatment with renal replacement therapy can effectively reduce the incidence of organ damage and mortality. (Hong Kong j.emerg.med. 2013;20:270-275)
Detection of Intraocular Foreign Body with Ultrasound
Authors: Göksu E , Nokay AE , Sayraç AV , Kartal M , Kiliç T 
Published: December 2017

ObjectiveTo evaluate the accuracy of emergency ultrasound in the diagnosis of varying location, size, and composition (metal, plastic, wooden) of intraocular foreign body in a sheep model.MethodsThis was an experimental study using freshly harvested adult articulated sheep eyes. A total of 8 fresh sheep heads were used. Two of the eyes were randomised to include more than one foreign body, the first one with three different sizes of metallic fragments of 0.46×0.81×0.46 mm, 0.46×0.93×0.46 mm, 0.46×0.82×0.46 mm and the second eye containing plastic fragments with a size of 0.97×0.67×0.67 mm and 1.00×0.67×0.67 mm. The wooden fragment was 0.52×0.76 mm and the metallic fragment was 0.45×0.46×0.46 mm. Half of the eyes were chosen as the control group and the sclera of the control group was also punctured. A total of 5 residents, from different postgraduate years, and 2 attending physicians participated in the study.ResultsRegardless of the nature and number of foreign bodies, correct identification of the intraocular foreign body was achieved in 44 of the 56 assessments. The overall sensitivity was 78% (95% confidence interval [CI], 65%‐87%), and the overall specificity was 30% (95% CI, 19%‐44%). Positive and negative predictive values were 53% and 58% respectively.ConclusionThe dynamic nature of the ultrasound examination may be helpful in localising and determining the size and composition of the foreign body, but if the intraocular foreign body is a concern and the ultrasound and physical examination are negative, another imaging modality, such as a computed tomography scan of the globe, should be obtained. (Hong Kong j.emerg.med. 2014;21:88‐91)
A Randomised, Cross over Study Using a Mannequin Model to Evaluate the Effects on CPR Quality of Real-Time Audio-Visual Feedback Provided by a Smartphone Application
Authors: Park CS , Kang IG , Heo SJ , Chae YS , Kim HJ , Park SS , Lee MJ , Jeong WJ 
Published: December 2017

Objective To evaluate the effect of real time feedback provided by smartphone application on cardiopulmonary resuscitation (CPR) performance. Methods Participants were randomised in two groups based on whether chest compression with or without the assistance of the smartphone application. Both groups performed hands-only CPR on a mannequin for 4 minutes. Data on CPR performance of both groups was compared. To assess the reliability the feedback value, we compared the CPR data from Skillmeter and data from smartphone. A questionnaire survey to participants about the usefulness of the application was also evaluated. Results Twenty-one subjects were recruited for the study. We found no significant difference in mean chest compression rate (103.3±5.0/min vs. 107.1±1.7/min; p=0.133) and depth between the two groups (47.3 [39.3, 56.2] mm vs. 45.8 [40.3, 49.9] mm; p=0.085). The proportion of adequate compression depth over the total compression was significantly higher in the group using the smartphone (38.1% vs. 22.2%; p=0.034). The CPR data displayed on smartphone application in mannequin's chest was not different from Skillmeter software. The majority of the participants considered the application easy to use, but holding the smartphone during CPR hampered compression. Conclusions Real-time audio-visual feedback on CPR depth and rate using a smartphone application can help to maintain the adequate chest compression depth in prolonged CPR. A better method to hold the smartphone may maximise the feedback effect on CPR quality. (Hong Kong j.emerg.med. 2014;21:153-160)
NT-Pro Brain Natriuretic Peptide: Is it a New Indicator of Brain Oedema?
Authors: Cetin GN , Albayrak SB , Yolcu S , Senol N , Tomruk O 
Published: December 2017

Objective To assess the role of the N-terminal prohormone form of brain natriuretic peptide (NT-proBNP) in patients with acute brain oedema. Methods This is a case control study. Twenty-two patients with acute brain oedema evidenced by computed tomography (CT) were recruited and compared to a control group of 30 healthy adult volunteers. Levels of NT-proBNP were measured in all patients at hospital admission and on the 12th and 24th hours after admission; as well as in a control group of 30 healthy blood donors. Results Twenty-two patients with brain oedema and 30 controls were included. There were significant differences between the brain oedema group and the control group on the NT-proBNP levels at admission time, on 12th or 24th hours after admission. There was no significant difference in NT-proBNP levels at admission time with the severity of brain oedema evidenced by CT. When we considered the relationship between mannitol usage and NT-proBNP levels, we found a significant difference between brain oedema severity and NT-proBNP level according to brain oedema severity after anti-oedema treatment, for 12th and 24th hours NT-proBNP levels. Conclusions There is a possible association between brain oedema and elevated serum NT-proBNP levels. (Hong Kong j.emerg.med. 2014;21:167-171)
Clinical Experience of Therapeutic Hypothermia in Cases of Near-Hanging and Recovered from Cardiac Arrest Due to Hanging
Authors: Lee Yh , Ahn Hc , Sohn Yd , Ahn Jy , Park Sm , Hong Ck , Hwang Sy , Na Ju , Shin Dh , Jo Ij , Song Kj , Sim Ms 
Published: December 2017

Objective There is no specific treatment for comatose patients after near-hanging or in those who recover from cardiac arrest (CA) caused by hanging. Since 2009, we have used therapeutic hypothermia (TH) to treat all comatose survivors of near-hanging and in patients who recovered from CA caused by hanging. The purpose of this study was to describe the outcomes in comatose patients after near-hanging. Design Case series. Setting Emergency departments of two regional hospitals. Methods We collected patient data from the Samsung Medical Center hypothermia database between November 2009 and November 2011. We included all patients presented with near-hanging or CA caused by hanging; who remained comatose and received TH after resuscitation for analysis. Clinical characteristics and outcome of patients were presented. Results During the study period, 26 patients were admitted to the emergency department after near-hanging or CA caused by hanging; 21 patients were enrolled in this study. Twelve patients with CA and 9 comatose patients without CA were treated with TH. Only 1 patient with CA had a good neurological outcome. By contrast, all near-hanging patients without CA had a good neurological outcome. Conclusions TH can be an effective therapeutic modality in cases of near-hanging without CA. However, the effectiveness of TH is questionable in patients who survive from CA caused by hanging. (Hong Kong j.emerg.med. 2014;21:316-321)
The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy
Authors: Othman N , Chan Ck , Lau Fl 
Published: December 2017

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)
The Use of Clinician-Performed Ultrasonography to Determine the Treatment Method for Suspected Paediatric Appendicitis
Authors: Kim C , Kang B , Park Jb , Ha Yr 
Published: December 2017

Objective To investigate whether the clinician-performed ultrasonography based on the specific criteria for paediatric appendicitis could decrease the negative appendectomy rate without treatment failure. Methods The study was a retrospective review of paediatric patients with suspected appendicitis who presented at the emergency department of a teaching hospital over a period of 18 months. The clinicians performed the ultrasound and decided whether the patients with suspected appendicitis should be referred to surgery or managed conservatively. The determinative ultrasound criteria were the presence of periappendiceal fat infiltration and/or an obstructing appendicolith. Results The 166 paediatric patients with suspected appendicitis underwent ultrasonography performed by clinicians on weekdays; forty (24.1%) cases with an obstructing appendicolith and/or periappendiceal fat infiltration were treated surgically, and none had a pathologically negative appendectomy, which was significantly lower than the number in the computed tomography scan group (10.4%, 11/106) on weeknights or weekends. The remaining 126 (75.8%) patients without obstructing appendicolith or periappendiceal fat infiltration were treated conservatively, regardless of their appendiceal diameter, and no patients experienced a treatment failure. Conclusions The clinician-performed ultrasonography bases on the strict use of above specific ultrasound criteria to determine treatment strategies for suspected paediatric appendicitis can reduce the negative appendectomies without treatment failure. (Hong Kong j.emerg.med. 2015;22:31-40)
Coverage of Journals from Mainland China in the Field of Emergency Medicine by Major International Biomedicine Databases
Authors: Shao Jf , Shen Hy 
Published: December 2017

Objective We aimed to explore the visibility of emergency medicine (EM) journals in mainland China based on the coverage by major indexing and abstracting information agencies and services. Methodology We first searched each journal by entering its title in Google's search engine, and then entered its home page to collect associated information, like publication cycle, journal language, publisher, editorial board, authors, and journal website. Second, to collect the inclusion information, totally ten databases were selected on the basis that they were considered as representative sources within the biomedicine. We adopted two forms for searching every journal: searching for every Chinese EM journal title (both English title and Chinese ‘ping yin’ title), and searching for the word ‘China’ from the fields provided for publisher of sources or for country of publication of sources indexed. Results Currently, in Mainland China, there were 13 EM journals, 12 in Chinese and one in English. Among them, both Science Citation Index Expanded (SCIE) and BIOSIS Previews (BP) did not include any EM journals; both MEDLINE and Abstract Journals (AJ) included only one, respectively; Scopus, EMBASE, Index Copernicus (IC), and Japan Science and Technology Agency (JST) indexed two journals, respectively; Western Pacific Region Index Medicus (WPRIM) included four journals, and Chemical Abstracts (CA) included six journals. Conclusion Only a few Chinese EM journals are indexed or abstracted in the international databases. More work should be done to achieve higher visibility of EM journals. (Hong Kong j.emerg.med. 2015;22:41-45)
Effect of Safety Belts on Chest Compression Quality in a Moving Ambulance
Authors: Cho Ys , Kim Gw , Kim Gy , Lee Jh 
Published: December 2017

Objective This study aimed to examine the effect of specially designed safety belts on standard cardiopulmonary resuscitation (CPR) quality in a manikin and to determine whether straddle (STR) CPR is equivalent to standard CPR in a moving ambulance. Methods Thirty-five emergency medical technicians were recruited and divided into two groups. The first group subjects were randomly assigned to perform standard CPR with or without safety belts. The second group subjects wore safety belts and were randomly assigned to perform STR or standard CPR. Chest compression quality was evaluated by measuring the average rate, depth of compressions, the hands off time and incorrect hand position. Results The compression rate was significantly higher in the safety belt group (114.0/min vs. 106.5/min, p=0.001), but the compression depth was not significantly different. The hands-off time was also shorter in the safety belt group (24.5 seconds vs. 40 seconds, p=0.003). When STR CPR was performed, the compression depth was significantly deeper (42 mm vs. 36 mm, p=0.004), and the hands off time was shorter (6 seconds vs. 10 seconds, p=0.039) than with standard CPR. A follow-up questionnaire revealed that 65.7% of the respondents had stopped CPR in the past due to safety reasons, and 48.6% had been injured during CPR. Conclusions Wearing belts in a moving ambulance situation can increase the quality of CPR. If an appropriate belt can be designed, the STR method may be used effectively. (Hong Kong j.emerg.med. 2015;22:145-153)
Terazosin versus Alfuzosin in Treatment of Acute Urinary Retention in Patients with Benign Prostatic Hypertroph
Authors: Tang HN , Lui CT , Tsui KL , Fung HT 
Published: December 2017

ObjectiveTo compare the efficacy and adverse reactions of terazosin and alfuzosin in treatment of acute urinary retention in patients with benign prostatic hypertrophy.DesignCase control study.SettingEmergency department of a regional hospital in Hong Kong.MethodsOur study included all adult male with age at least 18 years old presented with acute urinary retention, having residual urine volume greater than or equal to 300 ml after urinary catheterisation and with a presumed diagnosis of benign prostatic hypertrophy. Patients treated with terazosin from December 2013 to February 2014 were retrospectively included while patients treated with alfuzosin from April to September 2014 were prospectively included. We compared the two groups on: trial without catheter (TWOC) rate, potential adverse effects including drug‐associated postural hypotension, haemodynamic changes and prolongation of corrected QT interval in electrocardiogram. Cost effectiveness analysis was performed.ResultsA total of 116 patients were included with 59 and 57 patients in the terazosin and alfuzosin group respectively. Logistic regression showed that residual urine volume (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996‐0.999, p=0.008) and presence of precipitating factors (OR=2.264, 95% CI=1.045‐5.793, p=0.045) were independent predictors of successful TWOC. There was no significant difference in the TWOC rate for patients treated with alfuzosin and terazosin. There was significantly more symptomatic postural hypotension in the terazosin group compared with the alfuzosin group. The number need to treat with alfuzosin for terazosin to avoid one adverse drug effect was 12.3 patients (95% CI=4.7‐21.6) and 9.9 patients (95% CI=5.3‐84.6) to reduce one postural hypotension and symptomatic postural hypotension respectively.ConclusionsAlfuzosin is comparable to terazosin in TWOC rate. However, alfuzosin is associated with a lower rate of symptomatic postural hypotension and less haemodynamic impact than terazosin. (Hong Kong j.emerg.med. 2015;22:210‐218)
Assessment of Geographic Variations regarding the Transportation of Stroke Patients in Korea
Authors: Sohn YD , Ahn JY , Park SM , Lee YH , Ahn HC 
Published: December 2017

IntroductionStroke recently became the second cause of death in Korea. Nevertheless, many studies have reported that the delay of emergency medical service (EMS) transportation in specific areas is a major obstacle to reduce the mortality and morbidity of stroke. The objective of this study was to assess geographic variation regarding this factor at the national level in Korea throughout a funnel plot.SettingEmergency departments.MethodsData were obtained from the “2010 Emergency Medicine Annual Report” published by the National Emergency Medical Centre of Korea. This report describes the general characteristics of eligible Emergency Departments (EDs) across Korea. Therefore, we were able to calculate retrospectively the percentage of stroke patients who reached an ED within 3 hours after the development of symptoms against the volume of total visiting patients according to area. Subsequently, we generated a correlation matrix between ratio of stroke patients who visited EDs within the therapeutic period and ratio of usage of EMS ambulances.ResultsWe found that four areas out of 16 administrative divisions in Korea were located beyond the lower control limit and one area was between the lower warning and lower control limits, according to a funnel plot showing the percentage of patients within the therapeutic period of stroke against the total volume of patients according to area. The ratio of stroke patients who visited EDs within the therapeutic period was significantly correlated with the ratio of use of EMS ambulances to a moderately positive degree (r=0.51; p<0.05).ConclusionsEncouraging the public in Korea to use an EMS ambulance in case of stroke may shorten the pre‐hospital delay.
Practical Experiences and Lessons of Medical Response to Major Disasters in China
Authors: Shen WF , Jiang LB , Zhang M , Ma YF , Jiang GY , He XJ 
Published: December 2017

Introduction The construction of a medical emergency response system for disasters, which plays an important role in medical emergency response to multiple catastrophic events, has been sped up in China since the 2008 Wenchuan earthquake. However, the implementation process has also exposed some problems, particularly the disaster relief system. Methods In this review, we summarised and analysed emergency medical rescue efforts after major disasters in China in recent years, including 2008 Wenchuan earthquake, 2010 Yushu earthquake, ‘7.23’ Yongwen major railway line accident and 2013 Lushan earthquake. Results Critically wounded persons after Wenchuan and Lushan earthquake were managed according to the “four centralised strategies of care”, namely casualties, experts, resources and patients, which were designed to make the best use of limited resources. The collection of disaster response resources was not the sooner the better. The vulnerability and anti-disaster capacity of quake-hit zone and the degree of matching between critical elements of a response system and its supporting systems should be considered. The training of rescue teams in rural and high-altitude areas should be strengthened. Non-government organisations, the government and the public should join together to deal with the disaster. Conclusions In this paper, we evaluate the disaster relief systems in China through a retrospective analysis of medical practice of catastrophic events in recent years. This review suggests that there are a lot of experiences and lessons on how to prepare and respond to disasters in China, especially those in plateau mountain region and those considering emergency responses to catastrophic events. (Hong Kong j.emerg.med. 2015;22:270-280)