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  • 1
    Online Resource
    Online Resource
    The effectiveness of an emergency physician–led frailty unit for the living-alone elderly: A pilot retrospective cohort study
    SAGE Publications ; 2020
    In:  Hong Kong Journal of Emergency Medicine Vol. 27, No. 3 ( 2020-05), p. 162-167
    Details
    In: Hong Kong Journal of Emergency Medicine, SAGE Publications, Vol. 27, No. 3 ( 2020-05), p. 162-167
    Abstract: We are facing an ageing population in Hong Kong. In response to the surge in service demand resulted from Silver Tsunami, a six-bed frailty unit was established in the Emergency Medicine Ward of Queen Elizabeth Hospital in December 2015. Frailty unit offers a bundle of multi-disciplinary approach for geriatric patients with an aim for early supported discharge. Objective: To evaluate whether this novel frailty care pathway, compared to the conventional general care pathway, would improve the outcome of the local elderly who were living alone. Method: This is a retrospective cohort study. Patients who were admitted from 1 September 2015 to 31 October 2017 were included in this study. Data were retrieved from the electronic patient record (ePR) of Hospital Authority. The outcome measurements are lengths of stay in acute and convalescent hospitals, transferral rate to a convalescent hospital and 28-day re-attendance rate. Results: A total of 190 patients were recruited (150 frailty vs 40 general). Baseline characteristics, including age, gender distribution, vital signs, laboratory results, use of mobility aids, Morse fall risk scale, Norton ulcer scale and Barthel Index were similar in both groups; except a higher diastolic blood pressure in novel frailty-care pathway. The length of stay in the acute hospital is significantly shortened (2.38 vs 3.27 days, p = 0.00018). The transferral rate to a convalescent hospital was less in frailty group (21.3% vs 42.5%, p = 0.00655). There was no significant difference in terms of total (7.10 vs 10.99 days, p = 0.09638) and convalescent (22.09 vs 18.16 days, p = 0.48183) length of stay between frailty group and general group, respectively; while the 28-day re-attendance rate was similar (26.7% vs 15.0%, p = 0.12589). Conclusion: This is a pilot study to first report a novel frailty-care model for the local geriatric population. It has shown a reduction in length of stay in acute hospital and transferral rate to convalescent hospitals, while introducing a non-significant reduction in total hospital stay, maintaining 28-day re-attendance rate and at an expense of a probable increase in the convalescent stay.
    Type of Medium: Online Resource
    ISSN: 1024-9079 , 2309-5407
    URL: Article
    DOI: 10.1177/1024907919825674
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2917387-5
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  • 2
    Online Resource
    Online Resource
    Impact of aerosol enclosure barrier to videolaryngoscopic oro-tracheal intubation: A pilot manikin study
    SAGE Publications ; 2021
    In:  Hong Kong Journal of Emergency Medicine Vol. 28, No. 1 ( 2021-01), p. 3-7
    Details
    In: Hong Kong Journal of Emergency Medicine, SAGE Publications, Vol. 28, No. 1 ( 2021-01), p. 3-7
    Abstract: Personal protective equipment used for protection of healthcare workers in the combat against Severe Acute Respiratory Syndrome Coronavirus 2 pandemic is in limited supply worldwide at present – 2020. Use of barrier enclosure during endotracheal intubation can potentially act as a cost-effective adjunct to minimize risks of transmitting the infection to healthcare workers. However, there is concern that the enclosure itself will act as a barrier to the intubation procedure in the emergency settings. Objective: To evaluate the negative effect of barrier enclosure (an aerosol box) on the performance of video-assisted intubation in a manikin Methods: A total of 41 Emergency Department doctors from a local hospital were recruited to perform intubation in a manikin simulating normal and more difficult airways (Cormack-Lehane grades I and IIb) with and without the box. The primary outcome was time of successful intubation. The secondary outcomes were first-attempt success rate, number of successful attempts, need of adjuncts, dental injury and ease of intubation as perceived by the participants. Results: The aerosol box had no significant negative effect on the time of successful intubation (p = 0.630 (Grade I airway) and p = 0.436 (Grade IIb airway)), first-attempt success rate, number of successful attempts, need of adjuncts or dental injury. Participants subjectively reported extra yet minor challenges during intubation in the presence of the box. Conclusion: Within limits of the pilot study, the aerosol box had no statistical significant difference but an increasing trend of prolonged endotracheal intubation interval in the Grade IIb airway and negative impact on first-pass success, and could potentially be used to protect healthcare workers during the aerosol-generating intubation procedure.
    Type of Medium: Online Resource
    ISSN: 1024-9079 , 2309-5407
    URL: Article
    DOI: 10.1177/1024907920965309
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2917387-5
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  • 3
    Online Resource
    Online Resource
    Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site
    Elsevier BV ; 2015
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 24, No. 6 ( 2015-06), p. 1223-1228
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 24, No. 6 ( 2015-06), p. 1223-1228
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.022
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2052957-0
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  • 4
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    Online Resource
    Management of acute agitation in Hong Kong and comparisons with Australasia
    Wiley ; 2015
    In:  Emergency Medicine Australasia Vol. 27, No. 6 ( 2015-12), p. 542-548
    Details
    In: Emergency Medicine Australasia, Wiley, Vol. 27, No. 6 ( 2015-12), p. 542-548
    Abstract: Little is known about the use of sedation drugs for the management of acute agitation in Hong Kong's Accident and Emergency Departments (AEDs) and how it compares with Australasian practice. Objective The aim of this study was to determine drug preferences, clinicians' perceived confidence in management, barriers/gaps in training and perceived usefulness of existing clinical practice guidelines (CPGs) in Hong Kong. Method A validated questionnaire was used, with case vignettes typical of patients presenting to AEDs with acute agitation. The questionnaire was distributed by hand to all trainees and fellows of the Hong Kong College of Emergency Medicine (HKCEM). Two reminders were sent. Results Of 483 HKCEM members, 280 (58.0% [95% CI 53.5–62.3]) responded. For monotherapy, 46.8% (95% CI 41.0–52.6) of respondents chose haloperidol to manage the undifferentiated patient, followed by midazolam (33.9%, 95% CI 28.6–39.7) and diazepam (13.9%, 95% CI 10.4–18.5). Most respondents (83.6%, 95% CI 78.8–87.5) would not administer combination therapy. Respondents were confident in managing agitation overall. The lack of local/institutional CPGs (55.7%, 95% CI 49.9–61.4) was perceived as an important barrier. Institutional guidelines were considered the most useful CPGs (66.4%, 95% CI 60.7–71.7). Most respondents (72.9%, 95% CI 67.4–77.7) perceived a HKCEM endorsed CPG would be useful. Conclusion Haloperidol and benzodiazepines are frequently used as monotherapy for the management of acute agitation in Hong Kong's AEDs. Management in Hong Kong differs from Australasian practice in that combination therapy is less common and clinicians' choice of sedation drugs are less variable overall. Results suggest that future work on CPG development and training regarding the safe use of combination therapy would be well received.
    Type of Medium: Online Resource
    ISSN: 1742-6731 , 1742-6723
    URL: Issue
    URL: Article
    DOI: 10.1111/emm.v27.6
    DOI: 10.1111/1742-6723.12499
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 1502447-7
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  • 5
    Online Resource
    Online Resource
    Non-cell autonomous cues for enhanced functionality of human embryonic stem cell-derived cardiomyocytes via maturation of sarcolemmal and mitochondrial KATP channels
    Springer Science and Business Media LLC ; 2016
    In:  Scientific Reports Vol. 6, No. 1 ( 2016-09-28)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 6, No. 1 ( 2016-09-28)
    Abstract: Human embryonic stem cells (hESCs) is a potential unlimited ex vivo source of ventricular ( V ) cardiomyocytes (CMs), but hESC- V CMs and their engineered tissues display immature traits. In adult V CMs, sarcolemmal (sarc) and mitochondrial (mito) ATP-sensitive potassium (K ATP ) channels play crucial roles in excitability and cardioprotection. In this study, we aim to investigate the biological roles and use of sarcK ATP and mitoK ATP in hESC- V CM. We showed that SarcI K, ATP in single hESC- V CMs was dormant under baseline conditions, but became markedly activated by cyanide (CN) or the known opener P1075 with a current density that was ~8-fold smaller than adult; These effects were reversible upon washout or the addition of GLI or HMR1098. Interestingly, sarcI K, ATP displayed a ~3-fold increase after treatment with hypoxia (5% O 2 ). MitoI K, ATP was absent in hESC- V CMs. However, the thyroid hormone T3 up-regulated mitoI K, ATP, conferring diazoxide protective effect on T3-treated hESC- V CMs. When assessed using a multi-cellular engineered 3D ventricular cardiac micro-tissue (hvCMT) system, T3 substantially enhanced the developed tension by 3-folds. Diazoxide also attenuated the decrease in contractility induced by simulated ischemia (1% O 2 ). We conclude that hypoxia and T3 enhance the functionality of hESC- V CMs and their engineered tissues by selectively acting on sarc and mitoI K, ATP .
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/srep34154
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
    detail.hit.zdb_id: 2615211-3
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