bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatial and Seasonal Variations of Submesoscale Eddies in the Eastern Tropical Pacific Ocean
Authors: Wang Shengpeng , Jing Zhao , Liu Hailong , Wu Lixin 
Published: December 2017

AbstractThe spatial and seasonal variations of submesoscale eddy activities in the eastern tropical Pacific Ocean (2°–12°N, 95°–165°W) are investigated based on a 1/10° ocean general circulation model (OGCM). In the studied region, it is found that motions shorter than 500 km are subject to submesoscale dynamics with an O(1) Rossby number and Richardson number and a −2 spectral slope for kinetic energy, suggesting that submesoscale eddies there can be well resolved by the model. Enhanced submesoscale eddy kinetic energy (SMKE) is found in the surface mixed layer centered at 5°N. A complete SMKE budget analysis suggests that the submesoscale eddies in the surface mixed layer are generated mainly by the barotropic instability and secondarily by the baroclinic instability. The nonlinear interactions lead to a significant forward energy cascade in the submesoscale range and play an important role in balancing the energy budget. As a response to the change of energy input through barotropic instability, the SMKE exhibits a pronounced seasonal cycle with the largest and smallest values occurring in boreal autumn and spring. Furthermore, the strong seasonal cycle plays an important role in modulating the seasonality of mixed layer depth (MLD). In particular, the restratification induced by the strong submesoscale eddies between July and October makes important contribution to the shoaling of MLD in this season.
Paracetamoloverdose Presenting to an Accident & Emergency Department of a Regional Hospital in Hong Kong
Authors: Lam M , Fung HT , Kam CW 
Published: December 2017

We carried out a review of the patient resuscitation records and hospital notes of paracetamol overdose patients initially treated in the Accident and Emergency Department of Tuen Mun Hospital during the period starting from January 1998 to April 1999. Altogether there were 42 patients but 46 cases were recruited in the study because 4 patients had overdose twice. Ten (22%) were male, 36 (78%) were female and young female constituted the majority of the patients Forty‐three cases (93%) took an overdose of paracetamol as a means of committing suicide and 20 cases (43%) ingested 10 grams or more of paracetamol. The most common provoking causes were adjustment disorder (18 cases, 39.1%) and acute stress reaction (8 cases 17.4%). The majority of the cases presented early and within 8 hours after the overdose. Two cases had impaired liver function, 3 had prolonged prothrombin time and 5 had transient metabolic acidaemia in the absence of liver failure. All patients recovered uneventfully. Forty one cases (89%) were given N‐acetylcysteine (NAC) infusion, of these 6 had toxic paracetamol level, 24 had non‐toxic level because NAC was given before the availability of paracetamol level in many cases and it was undetermined for the other 11 cases. Hypersensitivity reaction to NAC infusion was common (8 cases, 21%) but there was no long term sequelae. Highly variable approach in the use of NAC was noted, we suggest to set a clinical check‐list for the management of paracetamol overdose especially concerning the time to check the serum level and the initiation of NAC.
Knowledge Base of Doctors and Nurses Participating in a Trauma Workshop
Authors: Wong TW , Lau CC , Yong BH , Tan IKS , Kong JHB 
Published: December 2017

ObjectiveTo identify the knowledge base of doctors and nurses attending a trauma workshop. Methods: All participants of a trauma workshop were distributed a pre‐test questionnaire with 30 type A questions. Questions on patient assessment and the management of airway, breathing and circulation were included. Scores were analysed with regard to the specialty and years since graduation. The difficulty and discrimination indices of individual question were analysed.Results95 participants (33 were doctors) took the test. The participants were from the departments of surgery (41%), orthopaedics (24%), anaesthesia (20%) and emergency medicine (9%). The mean years from graduation of the participants were 3.22 (SD 3.77) for doctors and 3.56 (SD 6.06) for nurses. The mean score was 54% (SD 17%) for the whole group. The mean score of doctors was 68%, which was significantly higher than the nurses' score of 46%. (P<0.001) The mean score of Emergency Department doctors (82%) was highest among the four groups but the differences were not statistically significant. Non‐surgical trainees (anaesthesia, emergency medicine) had statistically significant better scores than surgical trainees (surgery, orthopaedics, neurosurgery) in airway (p = 0.02) and breathing (p = 0.03) There were no statistically significant differences among the four doctor groups in the other sub‐scores. For the doctors, only 3 questions had a correct response rate of less than 40%. On the contrary, for the nurse group, 13 questions attracted a correct response rate of less than 40%.ConclusionsA pre‐test was useful in helping us understand more about the knowledge base of different groups of participants.
Paediatric Patients who Absconded from the Emergency Department - A 9-Month Prospective Study
Authors: Lim Yh , Anantharaman V 
Published: December 2017

Study objectives To determine the main causes and consequences of abscondment of paediatric patients from the Emergency Department (ED) before obtaining appropriate treatment. Methods Records of all paediatrics patients (age group 0–12 years) who absconded from the ED of a tertiary level acute care hospital were traced and telephone interviews were conducted. The duration of study was from 1st July 1995 to 31st March 1996. Results 177 out of 19,556 registered paediatrics patients absconded before obtaining adequate medical care. 139 (78.5%) patients had telephone interviews conducted. 81 (58.3%) patients absconded because of long waiting for medical attention. 26 (18.7%) patients left because their parents/guardians felt that the patient's condition had improved. 32 (23%) patients left the department for various other reasons. 94 (67.6%) patients subsequently sought medical attention elsewhere and 5 (3.6%) patients required in-patient treatment. Conclusion The paediatric abscondment rate was low. Most of these patients absconded from the ED because of relatively long waiting for medical attention. A large proportion of these patients could have been adequately treated in a primary care facility in the first instance.
Survey on Plantar Puncture Injury in the Emergency Department
Authors: Siu AYC , Wong TW , Lau CC 
Published: December 2017

ObjectiveThis survey aimed at identifying the characteristics of plantar puncture injury in our locality.MethodsThis was a prospective consecutive case study. All patients presenting with plantar puncture injury were recruited and the characteristics of the injury were documented.Results64 patients (M: 50; F:14) suffering from plantar puncture injury were recruited from 1st July 1998 to 30th November 1998. Forty nine (76.6%) cases involved metallic nails and 40 (62.5%) cases occurred in construction site. Forefoot and hindfoot were the parts where injuries were usually found. There were signs suggestive of infection in 10 patients (15.6%) on presentation. No bone infection was found. The patients were prescribed 3 days of prophylactic or a full course of therapeutic antibiotics. Fourteen patients (22%) turned up for follow up after one week and no infective complications were identified.ConclusionsSerious complications due to plantar puncture injury were uncommon in our group of subjects. Plantar puncture injuries were most prevalent at construction sites. Construction site workers should be better educated in the occupational protection and first aid of such injuries.
An Opinion Survey on Patient Acceptance of a Two-Day Medication Supply Policy in Emergency Departments
Authors: Tang Wf , Chung Ch , Wu Tsf , Lai Kk 
Published: December 2017

Objective To obtain an idea on patient acceptance of a two-day medication supply policy in emergency departments, an opinion survey was carried out at the Accident & Emergency (A&E) department of North District Hospital. Methods Questionnaire were distributed to 200 ambulatory patients attending the A&E department on 4 April 2000, asking for their opinions on the reasonable duration of medication supply and its possible impact on emergency department misuse. The questionnaires were collected and the data analysed. Results A total of 78 questionnaires (39%) were returned. Forty-nine respondents (62.8%) accepted that dispensing two days of medications from emergency departments reasonable. Ten out of the 27 patients who disagreed on two-day supply (37.0%) considered that a three-day supply would be optimal. More than half of the respondents (52.6%) agreed with the hypothesis that a two-day supply policy would discourage misuse of emergency department service. Conclusion The great majority of patients attending A&E departments supported the prescription of two to three days supply of medication. This policy has important resource implication. However, its possible impact on misuse of emergency department service is controversial. (Hong Kong j.emerg.med. 2002;9:3–9)
A Retrospective Review of Patients with Necrotizing Fasciitis Presenting to an Emergency Department in Hong Kong
Authors: Sin Fp , Yuen Mc , Lam Kw , Wu Cw , Tung Wk 
Published: December 2017

Background Necrotizing fasciitis is a soft tissue gangrenous infection that require early diagnosis, radical debridement and broad-spectrum antibiotics. Aim To review the clinical spectrum and outcome of necrotizing fasciitis in Kwong Wah Hospital during a period of 18 months. Method Cases of necrotizing fasciitis were identified from discharge statistics for the period January 1999 to June 2000. Accident and Emergency Department (AED) notes and clinical records after admission were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome. Results Fifteen cases of necrotizing fasciitis were found but two of them had wrong diagnosis made. Of the thirteen cases, ten were male and three were female. The average age was 61.7 years old. Most of them presented with different combinations of swelling, pain, erythema and fever. They attended the emergency department with an interval of 3.5 days from the onset of symptoms. Risk factors were identified in 64% of patients, with diabetes mellitis (DM) and hypertension (HT) being the most common. Monomicrobial and polymicrobial infections were equally common in our study. Streptococcus pyogene was the most common pathogen. Only two NF (18%) were diagnosed in AED. Six patients were admitted to either surgical or orthopaedic wards and all of them underwent operations within 24 hours although two of them died. Other five patients were managed in medical ward and four of these patients underwent delayed operations but survived whilst one of them died despite of early surgical intervention. Overall mortality was 23%. Conclusions This condition affects a wide age group and have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in its management.
The Effectiveness of Catheter Aspiration in the Treatment of Spontaneous Pneumothorax
Authors: Tang Syh , Lau Hl , Chan Jts 
Published: December 2017

Catheter aspiration is a simple and minimal invasive method to treat spontaneous pneumothorax. It was recommended by British Thoracic Society in 1993 as the treatment for spontaneous pneumothorax. This study was designed to evaluate the effectiveness of catheter aspiration in the treatment of spontaneous pneumothorax. The protocol involved catheter placement by using Seldinger technique and serial chest X-rays were used to document the degree of lung re-expansion. We report a case series study in which eight patients were recruited into the study. All patients' pneumothorax re-expanded well after the initial attempt of aspiration. However, during the observation period, 5 patients had recurrence of pneumothorax requiring further aspiration. Despite that, these 5 patients finally required chest drain insertion. The remaining 3 patients were discharged after aspiration and were followed up on the following day. Two patients had recurrent pneumothorax and required further intervention. One patient had uneventful recovery. Conclusion catheter aspiration was effective in relieving spontaneous pneumothorax but with a high recurrence rate.
The use of Injectable Nonsteroidal Anti-Inflammatory Drugs in Local Accident & Emergency Practice
Authors: Chung CH 
Published: December 2017

Objective To review the utilization of injectable NSAID in local A&E practice. Materials and Methods NSAID utilization data, in relation to type and specialty, were retrieved through the hospital and central pharmacy computer systems of the Hospital Authority. Results A&E departments were the main users of injectable NSAID. Their expenditure exceeded other forms of NSAID and narcotic analgesics. Conclusion It seems that the use of injectable NSAID in local A&E practice may be excessive. The oral route should be the first consideration, as fast acting oral preparations are now available. As there are risks of severe local complications, stringent justifications should be confirmed before intramuscular administration.
Audit on Treatment and Recovery of Ankle Sprain
Authors: Lee WY 
Published: December 2017

Study ObjectivesThe object of this study is to audit the care of ankle sprain of different severity and the functional limitations at two weeks and six weeks post injury of patients presenting to the Emergency Department of my hospital.MethodsOver a three month period, all patients presenting with acute ankle sprain were recruited at triage (index visit). Exclusion criteria were ankle injuries more than twenty-four hours old or had already received radiological evidence of fractures. A self-administered questionnaire was used to determine the severity and treatment. At second and at sixth week post index visit, three telephone interview attempts were made respectively to ask for the functional limitations and recovery using a standard questionnaire.ResultsOne hundred and thirty-nine candidates were recruited. Of these, 35.3% had mild, 19.6% had moderate and 15.2% had severe ankle sprain. Those with moderately severe ankle sprain have the least medical leave days. Only 48% were given more than 3 days of medical leave compared to 71% (mild group) and 76% (severe group). The treatment is otherwise similar across the three groups. Eighty-one patients (58%) and 70 patients (50%) were captured in the 2nd and 6th week telephone interviews respectively. Those patients with moderate severity fared worse with higher overall percentages in functional limitations and secondary consultations. This was more obvious in the 6th week telephone interview.ConclusionPatients with moderate severity ankle sprain fared worse compared with patients with severe or mild ankle sprain over a six-week recovery period. This may be due to insufficient rest days given to this group of patients at initial presentation.
Strengthening Links in the “Chain of Survival”: A Singapore Perspective
Authors: Charles Ra , Lateef F , Anantharaman V 
Published: December 2017

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.
Management of Foreign Bodies in Throat: An Emergency Department's Perspective
Authors: Chiu Hs , Chung Ch 
Published: December 2017

Objectives To review the share of emergency physicians and surgeons in the removal of foreign bodies in throat, and to revisit the concept of home observation and elective endoscopic examination for this group of patients. Design Retrospective study for a five month period. Setting Public general hospital with emergency and surgical departments. Population All patients attending the emergency department from 1st January 1999 to 31st May 1999 with a diagnosis or chief complaint of foreign body in throat or foreign body ingestion. Main outcome measures Success rate of foreign body retrieval, method of removal, specialty and patient outcome. Results 79.8% of the foreign bodies were fish bones. Eighty-nine percent foreign bodies was removed by direct laryngoscopy in the emergency department, 6.7% by emergency physicians in the endoscopy unit as outpatients and 4.3% by surgeons after admission. Conclusion In the absence of frank clinical or radiological sign, a short period of home observation before proceeding to elective oesophagogastro-duodenoscopy (OGD) assessment may be helpful as well as cost-effective. This policy screens out some unnecessary instrumentation, without increasing the rate of complications. As emergency physicians remove the majority of foreign bodies, their expanded involvement on an ambulatory basis is both reasonable and feasible.
Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines
Authors: Tsui Sh , Sham Ask , Chan-Yeung M , Tong Hk 
Published: December 2017

Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.
Injury Related Deaths in Singapore
Authors: Leong MKF , Mujumdar S , Raman L , Lim YH , Chao TC , Anantharaman V 
Published: December 2017

BackgroundInjury is the commonest cause of morbidity and mortality amongst the younger age groups. Management of injuries has been identified as one of the major health issues facing our community. The study objective was to define the epidemiology of injury related deaths in Singapore.MethodsA nationwide review of all deaths arising as a result of injury in 1995 was conducted.ResultsThere were 913 cases with an injury mortality rate of 27 per 100,000 population. Ninety‐seven percent (97%) were due to blunt injury. Falls from heights from deliberate self‐harm was the commonest mechanism, followed by motor vehicle collisions (MVC). Fifty‐two percent (52%) of MVC deaths were motorcyclists or pillion riders. Sixty‐six percent (66%) of all deaths occurred in the prehospital phase. Central nervous system injury was the main cause of hospital deaths.ConclusionResults from this study will help our community focus on the appropriate preventive strategies to reduce mortality and the cost of injuries to our society.
A Study on Police bean Bag Injuries in a Pork Model
Authors: Chan JTS , Yeung RSD 
Published: December 2017

IntroductionCurrently law enforcement agencies in 10 countries have been granted approval for the use of police bean bag. The need for “less lethal” weapon to control violent suspects is under hot discussion. The manufacturer acknowledges that this weapon will only cause bruises, skin abrasions and minor injuries so as to incapacitate the violent suspect. The objective of this study was to see the degree of trauma produced by shooting police bean bag at different firing ranges.Materials and methodsFresh pork was chosen for this test. The pork was subjected to police bean bag challenge at two different firing ranges. A standard shotgun (Model Remington 870P) was used. In order to test the degree of trauma to different parts of the body, regions with small amount of soft tissue (pig rib) and large amount of soft tissue (pig thigh) were selected. Each region would receive challenge of police bean bag at three and five meters range shot. The above test was repeated with heavy clothing covering the pork.ResultsIt was shown that all shots of police bean bag could produce injuries, ranging from minor indentation to laceration of soft tissues. The degree of trauma was greatly diminished if the target had been protected by heavy clothing. Moreover, the trauma produced on rib region was more severe than that of the thigh region. The larger volume of soft tissue, the better absorption of kinetic energy was expected and resulted in lesser degree of injuries.ConclusionAlthough police bean bag can still produce injuries, there is great potential for bean bag technology as this is an alternative to deadly force. Both suspects and law enforcement agencies can benefit from this less lethal technology as police bean bag clearly causes fewer fatal injuries and death than traditional bullets.