bluuebunny/crossref_metadata_2025_split huggingface dataset:
Out-of-Hospital Cardiac Arrest in a Teaching Hospital in Hong Kong: Descriptive Study Using the Utstein Style
Authors: Wai AKC , Cameron P , Cheung CK , Mak P , Rainer TH 
Published: December 2017

Objective To describe, using the Utstein template, the characteristics of patients presenting with out-of-hospital cardiac arrest to a university teaching hospital in the New Territories of Hong Kong, and to evaluate survival. Design Prospective study. Setting The emergency department of a teaching hospital in the New Territories, Hong Kong. Participants Patients older than 12 years with non-traumatic out-of-hospital cardiac arrest who were transported to the hospital between 1 July 2002 and 31 December 2002. Main outcome measures Demographic data, characteristics of cardiac arrest and response time intervals of the emergency medical service presented according to the Utstein style, and also survival to hospital discharge rate. Results A total of 124 patients were included (49.2% male; mean age 71.9 years). The majority of cardiac arrests occurred in patients' home. The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3% (19/124). The most common electrocardiographic rhythm at scene was asystole, whilst pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) was found in 18.0%. The overall survival was 0.8% (1/124), and survival to hospital discharge was significantly higher for patients with VF or pulseless VT than those patients with other rhythms of cardiac arrest (11.1% versus 0%). The median witnessed/recognised collapse to defibrillation time was 14 minutes. The median prehospital time interval from collapse/recognition to arrival at hospital was 33 minutes. Conclusion The prognosis of out-of-hospital cardiac arrest in Hong Kong was poor. Major improvements in every component of the chain of survival are necessary.
Psychological Morbidity among Emergency Department Doctors and Nurses after the SARS Outbreak
Authors: Tham KY , Tan YH , Loh OH , Tan WL , Ong MK , Tang HK 
Published: December 2017

Objective To determine the psychological morbidity among emergency department (ED) doctors and nurses six months after the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. Methods During the SARS outbreak from 13 March to 31 May 2003, the study ED was designated as Singapore's only screening centre for SARS and was closed to all other patients. A self-administered questionnaire survey was conducted in November 2003. Doctors and nurses of the study ED who had patient contact during the outbreak were included. Data collected were demographics and responses to (a) Impact of Event Scale (IES) and (b) General Health Questionnaire 28 (GHQ 28). Scores were assigned to the responses whereby an IES score ≥26/75 or a GHQ 28 score ≥5/28 was indicative of post-event and psychiatric morbidity respectively. Results Thirty-eight out of 41 (92.7%) doctors and 58 out of 83 (69.9%) nurses responded. Fewer doctors reported post-event and psychiatric morbidity compared to nurses, with 5 (13.2%) doctors and 12 (20.7%) nurses scoring ≥26 on IES, 6 (15.8%) doctors and 12 (20.7%) nurses scoring ≥5 on GHQ 28. The doctors reported a median of 9.5 (range 0–47) on IES and 0 (range 0–11) on GHQ 28. The nurses reported a median of 15 (range 0–61) on IES and 1 (range 0–25) on GHQ 28. Conclusions Six months after SARS, the rates of post-event and psychiatric morbidity were relatively low among the study ED doctors and nurses. The results might have underestimated actual morbidity as the study was conducted six months after the outbreak.
Validation of a Modified Early Warning Score (Mews) in Emergency Department Observation Ward Patients
Authors: Lam TS , Mak PSK , Siu WS , Lam MY , Cheung TF , Rainer TH 
Published: December 2017

Objective The Modified Early Warning Score (MEWS) is a simple physiological scoring system, which can easily be applied at the bedside. The ability of MEWS to identify patients at risk of deterioration in a busy ward was investigated. Method In a prospective cohort study, we applied MEWS to patients admitted to the 16-bed emergency department observation ward (EDOW) of a tertiary teaching hospital. Results Data on 427 consecutive EDOW admissions were collected from 7 June to 4 July 2004. Main outcome measures were death, intensive care unit (ICU) admission and inpatient hospital admission. Scores of > 4 were associated with increased risk of death (OR 54.4, 95% CI = 4.7–633.7), ICU admission (OR 12.7, 95% CI = 1.1–147.3) and hospital admission (OR 9.5, 95% CI = 3.3–27.9). Conclusion MEWS is suitable for bedside application in an EDOW setting and may help identify patients at risk of deterioration who require increased levels of care as hospital inpatients and in ICU. Where experienced staff is not available to closely monitor patients in an EDOW, the use of the MEWS system may aid close monitoring and identification of high-risk patients.
Pain Management in the Emergency Department
Authors: Lim GH , Wee FC , Seow E 
Published: December 2017

Objectives To determine the waiting time for administration of analgesia to patients presenting to the emergency department (ED) with traumatic pain, and to determine how the severity of pain affects the patient's perception of pain and the treatment they receive. Methods Consecutive patients aged 18–65 years presenting to the ED during the 2-week study period with complaint of pain secondary to trauma were prospectively recruited. The numeric rating scale (NRS) was used to indicate the level of pain experienced by the patients. They were interviewed using a structured questionnaire and a chart review was also done after the patients had completed their ED visit. Results The mean time to analgesia was 77.6 min (95% CI = 63.2–92.0 min). Patients requesting analgesia at triage had a median pain score of 7 (range 0–10) while those who declined had a median pain score of 5 (range 0–10) (p = 0.002, Mann-Whitney U-test). The severity of the injuries sustained did not affect the patient's perception of their pain nor their preference for early analgesia. Indian patients had a significantly higher median pain score (p = 0.048). Conclusion Time to delivery of analgesia fell short of our patients' expectations. Assessing pain using the NRS is useful and should be incorporated as the ‘fifth’ vital sign. Process-improvement, healthcare workers and patient education regarding pain management are needed. Patients with a pain score of 7 or more should be offered analgesia at triage. Those with a pain score of 6 or less should still be given analgesia at triage if they request it.
Nephrotoxicity Associated with Acute Paracetamol Overdose: A Case Report and Review of the Literature
Authors: Loh CS , Ponampalam R 
Published: December 2017

A 29‐year‐old, 65 kg, Chinese man presented to hospital 10 hours after ingesting 30 g of paracetamol (462 mg/kg body weight). The blood paracetamol level was 145 µg/ml at 10 hours post‐ingestion. He had no known risk factors for hepatotoxicity and was treated with intravenous N‐acetylcysteine (NAC). Serum creatinine level rose to a maximum of 455 µmol/L on day 8; it gradually declined without the need for dialysis. Little is known of the risk factors for nephrotoxicity, which may occur with or without concurrent liver damage, suggesting possible primary toxic effects on the kidney. The use of NAC in this case may have prevented the progression to liver failure and reduced the severity of the nephrotoxic effects.
Treatment of Acute Diarrhoea in Adults with Dioctahedral Smectite (Smecta): A Prospective Randomised Study
Authors: Cheung KH , Yuen WL 
Published: December 2017

BackgroundAcute diarrhoea is a common presenting problem to the accident and emergency department. This study aimed to assess the efficacy of dioctahedral smectite (Smecta) in altering the duration and frequency of acute diarrhoea in the adult population in Hong Kong.Material and methodsThis was a prospective, randomised controlled study carried out in the Accident and Emergency Department of Caritas Medical Centre from July 2005 to October 2005. One hundred and ninety eligible adult patients with acute diarrhoea lasting not more than 14 days were randomly assigned either (1) oral rehydration solution (ORS) one sachet three times daily and Smecta one sachet three times daily for two days; or (2) ORS one sachet three times daily for two days. The duration of diarrhoea, daily frequency of diarrhoea, presence of vomiting and fever following treatment were obtained by telephone interviews and mailed questionnaires.ResultsFor patients treated with or without Smecta, there was no statistically significant difference in the mean duration and daily frequency of diarrhoea in the first three days.ConclusionThe use of Smecta did not change the duration or frequency of acute diarrhoea in the adults in this study.
A Profile of Male Domestic Violence Victims Presenting to an Emergency Department in Singapore
Authors: Seow E , Foo CL 
Published: December 2017

Introduction This is the first study in Singapore to obtain a profile of the male victims of domestic violence. Methods The study was conducted in the Emergency Department (ED), Tan Tock Seng Hospital (an urban teaching hospital in Singapore). A structured questionnaire was administered to patients who volunteered or who admitted on questioning by ED staff that an intimate partner had assaulted them. Information was gathered about the demographics, characteristics of the assaults and knowledge of social and legal services. Results Fourteen victims were identified. The youngest was 29 and the oldest 63 years of age. Assailants were spouses or ex-spouses. Weapons were used in half of the assaults but injuries were superficial. The majority of the victims revealed that they had been abused previously, although most knew about helplines, family court and personal protection orders. Conclusion We hope that this study will raise awareness amongst healthcare workers of the existence of this problem.
Nurses Treating Patients in the Emergency Department? a Patient Survey
Authors: Ong YS , Tsang YL , Ho YH , Ho FKL , Law WP , Graham CA , Rainer TH 
Published: December 2017

BackgroundHong Kong residents are familiar with prolonged waiting times in emergency departments (ED), particularly with semi‐urgent or non‐urgent conditions. In the United Kingdom and Australasia, extended nurse practitioners are well established. The aim of this study was to identify whether Hong Kong patients would prefer treatment by ED nurses or traditional care by doctors under various waiting time conditions.MethodsThis was a prospective questionnaire study of patients who had been triaged into category 4 (semi‐urgent) or 5 (non‐urgent) during office hours from 20 to 27 June 2005. Following verbal consent, three waiting time scenarios were considered by the patient using an interviewer‐administered structured questionnaire. Statistical analysis used the chi square test.ResultsOverall, 253 patients were approached and 249 patients [119 (47.8%) male; mean age 48 (SD 19.4) years] verbally agreed to participate (98.4%). Patients were classified into three age groups. When the waiting time for nurse treatment was four hours shorter than doctors, patients aged 15–30 and 31–64 years more often chose nurses (overall 59.3%) for treatment but those aged ≥65 years preferred doctors to nurses (58.1% in favour of doctors), despite the longer waiting time (p=0.013, chi square test). Men also preferred nursing treatment compared to women (p<0.001). When the waiting time for doctors was 4 hours shorter than nurses or the same, 99.2% and 95.5% chose doctors respectively.ConclusionWhen the waiting times are long, Hong Kong patients <65 years would prefer to see suitably trained nurses in preference to doctors. Consideration should be given to providing training for senior nurses to have an extended role in Hong Kong EDs.
Emergency Department Triage Nurse Initiated Pain Management
Authors: Goh HK , Choo SE , Lee I , Tham KY 
Published: December 2017

Objectives1) To determine the time difference to analgesia administration for patients with painful limb conditions using an emergency triage nurse initiated pain management protocol versus analgesia administration by emergency doctors after consultation. 2) To determine the frequency of adverse events following such a protocol implementation.MethodsFor emergency department patients with isolated limb injury or inflammation, a triage nurse initiated pain management policy was implemented in 2004. The protocol did not require the triage nurse to consult a physician. The triage nurse would record the chief complaint, past medical history, allergy, medication, vital signs, and pain severity using a combination of 0 to 10 numerical and face pain scales. Unless contraindicated, the triage nurse would offer intramuscular ketorolac to patients with pain score ≥5. Medical charts of patients fulfilling the inclusion criteria were reviewed from 1 to 30 September 2004.ResultsTwo hundred seventy‐three patients were reviewed, of whom 73.3% were men and the overall mean age was 40.1 years (standard deviation SD 19.5). Two hundred and nine patients (76.6%) had pain score recorded at triage, and the median was 6. One hundred and five patients (38.5%) received analgesia, of which 69 were given by triage nurses and 36 by physicians. The mean time interval for analgesia given by triage nurse was 2.5 minutes (SD 8.9) and that for physician was significantly longer (p<0.0001) at 68.2 minutes (SD 59.5). There was no adverse drug reaction observed in patients who received intramuscular ketorolac given by triage nurses.ConclusionThe time interval for pain relief of emergency department patients with painful limb conditions was reduced when the triage nurse initiated pain management.
Health Status following Major Trauma in the West of Scotland: Pilot Descriptive Study
Authors: Graham CA , Craig N , Gordon MWG 
Published: December 2017

BackgroundData on the long‐term outcome of major trauma survivors in the United Kingdom (UK) is lacking. This pilot study aimed to investigate the health status of survivors of major trauma without significant head injury in the West of Scotland, and to compare the Short‐Form 12 (SF12) questionnaire administered by telephone (TSF12) to the longer Short‐Form 36 (SF36) questionnaire.MethodsThis was a descriptive, comparative, pilot clinical study. Eligible patients had an injury severity score (ISS) >15, sustained their injuries >2 years ago, abbreviated injury score (AIS) <2 for head trauma and were treated in two Glasgow hospitals. The Short‐Form 36 (SF36) health status questionnaire was completed at home, and the Short‐Form 12 (SF12) questionnaire was administered by telephone (TSF12).ResultsFrom 141 eligible patients (85% male, median age 35 years, median ISS 19 and median Ps 0.981), 13 patients completed the study. Despite small numbers, mean SF36 scores were significantly lower in four dimensions compared to UK means. SF36 summary scores were non‐significantly below US and UK means. The TSF12 physical summary score was significantly below US and UK means. Correlations between the SF36 and TSF12, and SF12 intra‐class correlations were high. One‐way ANOVA showed significantly lower mental summary scores for patients with spinal injuries.ConclusionsThis small study suggests that non‐head injured survivors of major trauma have lower health status than the UK average. The TSF12 appears to be a practical alternative to the conventional SF36 and warrants larger scale evaluation.
Serotonin Syndrome with Tramadol and Dextromethorphan
Authors: Kung SW , Ng MH 
Published: December 2017

Serotonin syndrome is an iatrogenic drug‐induced synaptic serotonin concentration related toxidrome. A 29‐year‐old man developed agitation, tachycardia and myoclonus of limbs after an intramuscular injection of 100 mg tramadol. He had recently been given multiple medications, including dextromethorphan (DXM) by a private doctor for flu‐like symptoms. The patient was stabilised with diazepam, midazolam and supportive treatment. Both tramadol and DXM could cause the serotonin syndrome, but usually in combination with monoamine oxidase inhibitors or serotonin reuptake inhibitors. This was the first reported case in the English literature of serotonin syndrome with tramadol and DXM. Therefore, a detailed drug history and knowledge of potential serotonergic drugs are important.
Admission Gatekeeping and Safe Discharge for the Elderly: Referral by the Emergency Department to the Community Nursing Service for Home Visits
Authors: Chiu SLH , Lam FM , Cheung C 
Published: December 2017

ObjectiveTo assess the gatekeeping effect and discharge safety in elderly referrals to the community nursing service (CNS) in a major accident & emergency department (AED).MethodsDescriptive review analysis of the referrals in 2002–2004.ResultsAltogether 333 patients were accepted, comprising 5% of the total CNS referrals in the hospital: 323 were aged ≥65 (median age 81), 13.8% were living alone, 21.6% had unscheduled return to the AED within 14 days, and 11.7% in 15–28 days. The ≤14 days and 15–28 days admission to hospital was 15.0% and 6.0%, with 4.8% and 0.6% patients admitted with the same or related diagnosis as the first visit respectively, including missed fractures and stroke. One patient died 17 days after discharge. Eight of the 162 falls returned within 28 days with a second fall. Overall, 317 admissions were avoided with 1,978 bed‐days saved. Living alone was strongly associated with unscheduled return and admission ≤14 and ≤28 days, while age was not. The six categories of community nursing care were fall‐related, tube care, skin and soft tissue care, pain control, medical and diabetic care. Injections were given for cellulitis, pain, and diabetics. Forty‐nine patients had phone follow‐ups.ConclusionThe gatekeeping effect of AED referrals to CNS remained small. The commonest referrals were falls with head injury. It was safe to discharge the elderly for CNS care. A wide range of home nursing care was feasible. CNS referral could decrease elderly return visits with falls. Living alone was strongly associated with return visit and admission.
A Case of Nonfatal Non‐Collapsed Patient with Extreme Hyperkalaemia
Authors: Lim YH , Hendricks J 
Published: December 2017

This is a report of a non‐collapsed patient with nonfatal, extreme hyperkalaemia of 10.7 mmol/L. The patient's hyperkalaemia was initially treated in the Emergency Department and then transferred to the Department of Renal Medicine of another hospital for further stabilisation. There have only been a few reported cases of successful management of extreme hyperkalaemia in excess of 10.0 mmol/L.
Capillary Refill Time in Adults Has Poor Inter-Observer Agreement
Authors: Anderson B , Kelly AM , Kerr D , Jolley D 
Published: December 2017

ObjectivesCapillary refill time (CRT) has been taught as a rapid indicator of circulatory status but to be a useful clinical test, CRT needs to be reproducible when performed by another health care worker. No inter-rater agreement studies have been reported for adult patients. The aim of this study was to determine the inter-observer reliability of CRT in a sample of adult emergency department (ED) patients. Methods This prospective observational study included clinically stable ED patients with a variety of conditions from two community EDs. A doctor and a nurse each measured CRT by estimation to the nearest half-second using a standard method on each patient. They were blinded to each other's measurements. The primary outcome of interest was inter-rater agreement. Secondary outcome was agreement in classification as normal or abnormal according to accepted definitions. Data was analysed using bias plot analysis, correlation, absolute percent agreement and kappa analysis. Results Totally, 209 patients were enrolled; 51% were female and 86% were Caucasian. Median CRT was 2 seconds (95% CI 2–2.35 seconds). The mean difference between measurements by the different observers was 0 second, however the 95% limits of agreement were very wide (–1.7 to +1.9 seconds). Agreement was 70% for classification of ‘normal’ or ‘abnormal’ using the 2-second definition of normal, with a kappa of 0.38. Conclusion Interobserver agreement in measurement of CRT was poor in adult subjects with wide limits of agreement. This is a serious threat to the appropriateness of this test for use in clinical practice.
A Retrospective Study of Geriatric Patients Presenting with Fever to an Accident and Emergency Department in Hong Kong
Authors: Leung YY , Ma KK , Tsang WT , Lau CL , Ko S , Chan WL , Ng F 
Published: December 2017

Objectives To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay. Methods Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5°C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared. Results There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems. Conclusion Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay.