bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-Instruction versus Traditional Training on Cast Application Technique
Authors: Cheung Lcc , Law Kl , Tsoi Lch , Chung Ch 
Published: December 2017

Objective To test the null hypothesis that for nurses working in emergency department, there is no difference between self-instruction and traditional method of training cast application technique, with respect to cost-effectiveness. Method This was a prospective, single-blind, randomised, controlled trial carried out at the Accident & Emergency Department of North District Hospital from 11 November 1998 to 16 May 2000. Thirty-three full-time emergency department nurses (9 nursing officers, 20 registered nurses and 4 enrolled nurses) were randomly assigned into two groups. Sixteen were given the self-instruction training program (intervention group) and 17 were instructed by traditional training program (control group). The primary outcome measure was cost-effectiveness analysis. The predetermined relative cost ratio was compared with the relative success ratio of the two methods. The secondary outcome measures were individual skill performance, knowledge scores and attitude ranks. Results There was no statistically significant difference between self-instruction and traditional method of training. The relative cost ratio of self-instruction to traditional method was 0.80. The relative success ratio of self-instruction to traditional method was 0.82. All nurses showed improvement in their knowledge (mean knowledge score, 38 versus 89). Trainees in the traditional method had more confidence performing cast application. Subgroup analysis showed that trainee characteristics and attitude did not predict the outcome. Conclusion Self-instruction method and traditional method may be equally cost-effective for training cast application technique. Both methods resulted in significant improvement in knowledge of cast application. Nurses trained with the traditional method had more confidence than those trained with self-instruction method.
Substance Abuse Patient Characteristics: A Scene from an Emergency Department near the Hong Kong – Shenzhen Border
Authors: Yuen WC , Tang WF , Chung CH 
Published: December 2017

Objective Drug abuse is an escalating problem in Hong Kong, especially among teenagers and young adults. A study was conducted in order to obtain the characteristics of drug abusers presenting to the Accident & Emergency department of North District Hospital, which is located in the New Territories near the Hong Kong – Shenzhen border. Design Prospective study. Setting Accident and Emergency department of a public general hospital. Patients Drug abusers presenting to the Accident and Emergency department in a six-month period. Main outcome measures Epidemiological data including demographic data, types of drug taken, place of drug abuse and magnitude of cross-border drug abuse were collected and analyzed. Results The sex distribution was male 59 and female 13 (ratio=4.5:1). The mean age was 29.2 (range 14 to 67 years). Of interest, 29.2% abused drugs at home; 29.2% abused drugs in parties such as karaoke, rave and disco; 68% abused drugs in Hong Kong; 32% abused drugs in China and 6.9% claimed themselves first-time drug abusers. The commonest drug taken was ecstasy (40.3%) – the majority (55%) in China and the rest (45%) in Hong Kong. For organic solvent abusers, 57.1% were below 18 years of age. One patient died, resulting in a mortality rate of 1.4%. Conclusion Ecstasy was the commonest drug abused on both sides of the “border”. The majority of substance abusers were teenagers or young adult males. This study confirmed the significant magnitude of psychotropic substance abuse problem among the young population in the North District, indicating the urgent need for clinical and social intervention.
Beware of the Migrating Chest Pain and Widened Mediastinum: Case Series on Aortic Dissection
Authors: Chung CH , Lai KK 
Published: December 2017

Objective Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design Retrospective case review for a period of 3 years and 4 months. Setting District general hospital near the Hong Kong – Shenzhen ‘border’ with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population All cases coded as ‘aortic dissection’ in the computerized ‘Clinical Management System’ of the hospital. Main outcome measures Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition.
Training and Willingness to Perform Bystander Basic Life Support
Authors: Rainer TH 
Published: December 2017

ObjectivesTo evaluate the perceived ability and willingness of people to perform basic life support (BLS), to relate this to those most at risk of sudden cardiac death, and to identify groups of National Health Service (NHS) staff who could benefit from training in BLS.DesignProspective, survey.SettingThe Accident and Emergency (A&E) department based at Glasgow Royal Infirmary.SubjectsAll patients, accompanying persons and NHS staff who were able, willing and waiting in the A&E department.MethodsSubjects were asked to complete a proforma with questions relating to their experience and training in BLS. Their recognition of the importance of defibrillation in the light of current European guidelines for BLS was tested.Results718 proformas were completed. Fifty‐seven percent non‐clinical NHS staff had received no training in BLS. More than 50% subjects had relatives with risk factors of Ischaemic Heart Disease yet had no training in BLS. Seventy percent ambulance men and 50% clinical NHS personnel would perform mouth to mouth ventilation before calling an ambulance where they were required to perform BLS, as a bystander. Seventy percent non‐clinical NHS personnel and non NHS subjects would call an ambulance first.ConclusionsNon‐clinical NHS personnel form a hospital based group that could be trained in BLS, some of whom could assume an instructor role. A proportion of clinical and emergency personnel would not prioritise an early call for a defibrillator over BLS in the out of hospital setting.
An Analysis of Unscheduled Return Visits to the Accident and Emergency Department of a General Public Hospital
Authors: Ng CP , Chung CH 
Published: December 2017

Objectives To identify the reasons for unscheduled return visits to a public emergency department and possible strategies to reduce unscheduled return visits. Design Cross-sectional survey. Setting A public emergency department in Hong Kong. Patients Unscheduled return visits within 48 hours in a three-month period from 14 January 2000 to 15 April 2000. Main outcome measures Patients' epidemiological characteristics, reasons, complaints and outcome of the unscheduled return visits. Results During the study period, 3.3% (1,060) of the attendance was unscheduled return visits within 48 hours as recorded in the computerized A&E Information System of the hospital. However, only 738 patients (70%) responded to the questionnaire. These 738 patients formed the study population for further analysis. Illness-related factors accounted for 87% of the total unscheduled return visits. Patient-related factors were responsible for about 10% of unscheduled return visits. Doctor-related factors accounted for about 3% of unscheduled return visits. There was only one system-related unscheduled return visit. For the outcome of return visits, about 76% (559) was discharged after the second consultation. About 5% (40) was referred to specialist clinics. Around 24% (179) of patients was admitted. Of those admitted, 78% (140) was illness-related, 13% (23) was patient-related and 9% (16) was doctor-related. Upper respiratory tract infection was the most frequent complaint (34%), followed by painful conditions (23%) and injuries (10%). For children at or below 10 years of age, upper respiratory tract infection (60%) and febrile illness (15%) were the most frequent complaints. Conclusions The study found that the reasons for return visits were multiple. These “unscheduled return visits” should not be automatically regarded as poor indicator of service. Better patient education, organized family practice system, upgrading of professional training and targeted audit are possible means to reduce unscheduled return visits.
A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong
Authors: Ng VCH , Lau FL 
Published: December 2017

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.
Lightning Injury: Changi Hospital Experience
Authors: Tan HH , Goh SH 
Published: December 2017

IntroductionLightning injury is a major concern in Singapore, which has one of the highest incidences of lightning activity in the world. This study examined the frequency and type of lightning injuries that presented to an Accident and Emergency (A&E) department situated in the east of Singapore to identify the groups at risk and the spectrum of injuries sustained.Materials and methodsThis is a case series study with a sample size of 24. Cases that were seen in the A&E department of Changi General Hospital from July 1997 to June 2002 with the International Classification of Disease diagnosis code of E907 for lightning injury were collected and analyzed.ResultsIn our study, 83% lightning injuries were work-related and 79% occurred in those below 40 years old. In the work-related category, a significant proportion occurred at the airport (45%) with most of the incidents occurring while working near or in contact with the aircraft (7 out of 9). The other major proportion occurred at construction sites (40%) with a significant number of cases occurring while in contact with cranes (6 out of 8). There was one telephone-related injury. In the non-work related incidents, two out of four occurred while playing golf. Most of the injuries (87.5%) were minor with no long-term morbidity. There was one death and one critical case requiring cardiopulmonary resuscitation. The latter survived and recovered quite remarkably. One patient had serious depression requiring prolonged treatment.ConclusionPrecaution should be taken during lightning-prone weather conditions in workplaces that involve large metal structures like cranes and aircrafts and in open space. This also applies to recreational sports like golf. Lightning injury, though rare, is not uncommon and emergency room doctors should be conversant with the treatment of this condition and its complications. Immediate basic and advanced cardiac life support administered to a lightning casualty who collapsed can be life saving.
Should Differential White Cell Counts be Reported as Percentages or Absolute Counts in Patients with Severe Acute Respiratory Syndrome?
Authors: Rainer TH , Cameron PA , Smit DV 
Published: December 2017

Background Severe acute respiratory syndrome (SARS) is associated with a lymphopenia, thrombocytopenia and neutrophilia and suspected cases may be admitted to hospital on the basis of such abnormalities. Laboratories may report changes as percentages or absolute counts. Objective To investigate whether absolute or percentage differential counts were more predictive of patients with SARS pneumonia. Design Prospective observational study. Setting SARS clinic of an emergency department in Hong Kong. Subjects and methods Whole blood and differential counts were performed on 506 patients presenting to a SARS screening clinic. Ninety-six patients subsequently developed SARS pneumonia. Results Sixty-nine patients had abnormal lymphocyte absolute counts on first attendance at clinic of which 37 (54%) developed SARS pneumonia. This compared with 142 subjects with abnormal percentage lymphocyte values of which 50 (35%) developed SARS pneumonia. The area under the ROC curve for absolute lymphocyte counts is 0.851 (95%CI 0.816 to 0.881) and for percentage lymphocytes is 0.736 (95%CI 0.694 to 0.775). The area under the ROC curve for absolute monocyte counts is 0.535 (95%CI 0.489 to 0.580) and for percentage monocytes is 0.635 (95%CI 0.591 to 0.678). The area under the ROC curve for absolute neutrophil counts is 0.591 (95%CI 0.546 to 0.636) and for percentage neutrophils is 0.703 (95%CI 0.660 to 0.744). Conclusion Reporting absolute rather than percentage values for differential leucocyte counts are more accurate predictors of SARS pneumonia.
Patients who Self-Discharge from the Emergency Department: a Three-Month Telephone Survey
Authors: Lim YH , Anantharaman V 
Published: December 2017

Study objectives To determine the main causes and outcomes of patients who self-discharged from the Emergency Department (ED). Methods Records of all patients who self-discharged from the ED of a tertiary level hospital were traced and telephone interviews were conducted. The duration of the study was from 15 July 2002 to 14 October 2002. Results There were 28,898 new attendances during the period of study and of these, 450 (1.6%) patients signed the self-discharge form. Of the 357 patients recruited into the study, the majority signed the self-discharge form because of refusal of admission to inpatient units (52.1%) or the ED observation ward (43.4%) for further treatment. One hundred and thirteen (31.7%) patients acknowledged that they were unwell during the interview and 85 (23.8%) patients sought some form of medical attention after leaving the ED. Conclusion Most of the patients who self-discharged from the ED were for personal reasons and very few were due to financial reasons.
Horse-Related Injuries: a Local Scene
Authors: Ng CP , Chung CH 
Published: December 2017

Objectives To study the characteristics and nature of injuries relating to horse riding in the local setting and to compare the findings with those reported in the medical literature. Methods A prospective survey of patients with horse-related injuries attending the accident and emergency department of a public district hospital in Hong Kong within the year 2002. The data were analysed and compared with previous studies. Results Fifty-five patients were collected in the study. The mean age was 32.7 years. Forty-four (80.0%) of them were riders and 11 (20.0%) were non-riders. Thirteen (23.6%) were grooms. Fifteen patients (27.3%) were admitted and seven (46.7%) of those admitted required operations. There was no fatality. Thirty-nine patients (70.9%) suffered from single injury while the rest (29.1%) had multiple injuries. Most injuries (60.0%) were minor but fractures or dislocations occurred in 16 patients (29.1%). Isolated head and facial injuries occurred in 14.5% of patients. Most were simple concussion. Thirteen patients (23.6%) suffered from isolated upper limb injuries, with more than half sustaining fractures or dislocations. Falling from horse (60.0%) was the most frequent mechanism of injury. Among the non-riding patients, 72.7% were kicked or trodden by horse. There was no association between rider's status, previous riding or injury experiences, or the presence of supervision at the time of riding with the rate of admission. Conclusion Horse riding and working with horses can be an occupation or recreation with potential dangers. In our study, characteristics of patients, mechanisms and types of injuries were similar to other western studies. However, professional riders and those with more riding experiences were not exempted from severe injuries requiring admission. Moreover, previous injury experiences and the presence of supervision did not help reduce the admission rate either. Perhaps, as suggested by other studies, the quality of horsemanship and supervision appeared to be more important to reduce accidents. Further proper large scale controlled epidemiological studies will definitely help to improve the understanding of horse-related injuries.
Is There a Relationship between Asthma Severity and Abnormalities on Chest X-Ray?: A Pilot Study
Authors: Eddy E , Kelly AM 
Published: December 2017

Objectives To determine the rate of chest X-ray (CXR) ordering for patients with acute asthma in the emergency department (ED) and the rate of relevant abnormalities on CXR for each asthma severity classification. Methods Retrospective explicit chart review involving adult ED patients with asthma presenting between 1 July and 31 December 2001. Data collected included severity classification according to the National Asthma Guidelines (NAG) [Australia], demographic information, temperature, white cell count, CXR ordering and findings on CXR. The main outcomes were the rate of CXR ordering and the rate of relevant abnormality on CXR by severity category. Results Altogether, 158 presentations by 140 patients were analysed. The overall rate of CXR ordering was 68% [mild 54%, moderate 66%, severe 84%]. The overall rate of abnormalities was 8% [mild 0%, moderate 9%, severe 14%]. Ninety-one percent of patients admitted to hospital had CXR of which 13% [8/60] revealed significant abnormalities. Conclusion The rate of CXR ordering in acute asthma was high with a low yield of relevant positive findings in the mild and moderate severity groups. This was at odds with NAG recommendation. Our results suggest that routine CXR may be warranted in patients with severe asthma but should be guided by clinical examination in other severity classes.
An Opinion Survey on Emergency Medical Assistant Motor Cycle Service in the Hong Kong Fire Services Department
Authors: Chim PL , Lau SSF 
Published: December 2017

Emergency Medical Assistant Motor Cycle (EMAMC) plays a crucial role in prehospital care in the Ambulance Service. In Hong Kong, the implementation of Ambulance Aid Motorcycle started in 1982. It provides a more rapid response to various types of patients in order to increase survival rates such as by the provision of early defibrillation. The demand of EMAMC is significant and therefore the fleet size has been expanded to 37 motorcycles in 2004. In order to review the development and operational aspects, interviews were conducted with different riders to collect their views. This article discusses issues in different categories such as training, vehicle, equipment and mobilisation. This survey revealed some common concerns of the riders.
Validation of a 3-Item Screening Tool for Geriatric Depression in the Observation Unit of an Emergency Department
Authors: Lee VMS , Wong TW , Lau CC 
Published: December 2017

Introduction The purpose of this study was to validate a new 3-item Emergency Department Depression Screening Instrument (ED-DSI) in screening for depression in elderly patients presenting to the emergency department (ED). Methods All Cantonese-speaking ED patients 65 years or older staying in the observation ward were included. Patients with a known diagnosis of dementia or depression and those with severe hearing problems were excluded. The doctor-in-charge would administer the 3-item ED-DSI which was adapted from the Geriatric Depression Scale (GDS). The research nurse who was blind to the answers of the initial screening then administered the 15-item GDS to the same patient. The 15-item GDS, which had been validated previously in the local population, was used as the reference standard. Results One hundred patients of whom 70 were female, were recruited. The mean age of the group was 75 years with a range from 65 to > 96 years. Using a cut-off score of 2, the new 3-item ED-DSI was shown to be as effective as the 15-item GDS (using a cut-off score of 8) in identifying depressed subjects. The sensitivity and specificity of the instrument were 90% and 74%, respectively. Conclusions The new 3-item ED-DSI for depression correlated well with the 15-item Geriatric Depression Scale. It can be used for screening of depression in elderly patients in a busy emergency department.
Efficacy and Safety of Snake Antivenom Therapy: Experience of a Regional Hospital
Authors: Fung HT , Lam KK , Kam CW 
Published: December 2017

IntroductionSnakebite is a commonly encountered envenomation emergency in the rural areas of Hong Kong. The majority of cases do not warrant antivenom therapy. We looked into those receiving antivenom to enhance the understanding of the results of antivenom therapy.MethodsThis was a retrospective review of the snakebite cases treated with antivenom in Tuen Mun Hospital from 1st January 2000 to 31st August 2005, focusing on both the therapeutic and side effects of the antivenom.ResultsTwelve patients were identified. All had local symptoms of swelling or numbness. Two of them subsequently developed skin necrosis requiring operative treatment. Thrombocytopenia was less amenable to correction than prolonged INR. No early or late allergic reactions were observed.ConclusionBecause of the small number of cases, the apparent safety of the antivenoms in the current review warrants larger trials in future.