Acute care service utilisation and the possible impacts of a user-fee policy in Hong Kong

OBJECTIVES: To examine the utilisation pattern of accident and emergency services and to study the possible impact of a user-fee policy on non-emergency attendances in Hong Kong. DESIGN: Retrospective study. METHODS: Four different scenarios are postulated to examine the impact on the number of accident and emergency attendances of a user-fee policy from 2000 to 2029. Patient volume data of accident and emergency attendances for 2000 were made available by the Hospital Authority of Hong Kong. RESULTS: Non-emergency use of the accident and emergency services is the main cause of over-utilisation and contributes to more than 70.0% of its use. Only 22.0% of patients attending accident and emergency departments were admitted to a ward for further treatment. By 2029, the number of accident and emergency attendances would increase by more than 47.0% if the present utilisation pattern prevails. However, if patients at triage levels 3, 4, and 5 were discouraged from using the accident and emergency services, the number of attendances would decrease by 76.4%. CONCLUSION: The proposed user-fee policy would act as a deterrent by preventing unnecessary use of accident and emergency services. However, the use of out-patient services may be increased as a result and attendance should be carefully monitored. Community health education and civic education relating to abuse of accident and emergency services would be effective in reducing over-utilisation of these services.published_or_final_versio

Emphysematous pyelonephritis: an eight-year retrospective review across four hospitals in a single cluster

香港泌尿外科學會Moderated Poster (Free Paper) Session II - Upper Tract and Robotic Surgery: MP.2-1OBJECTIVE: Emphysematous pyelonephritis (EPN) is a rare but life-threatening infection. We aim to review our cluster’s experience of managing this urologic emergency. PATIENTS & METHODS: Case notes of patients with EPN in four acute hospitals in the KWC (PMH, CMC, KWH and YCH) were retrospectively reviewed. The patients’ demographic data, clinical presentation, investigation findings, treatment and outcome were studied. OBJECTIVE: Emphysematous pyelonephritis (EPN) is a rare but life-threatening infection. We aim to review our cluster’s experience of managing this urologic emergency. PATIENTS & METHODS: Case notes of patients with EPN in four acute hospitals in the KWC (PMH, CMC, KWH and YCH) were retrospectively reviewed. The patients’ demographic data, clinical presentation, investigation findings, treatment and outcome were studied.published_or_final_versionThe 17th Annual Scientific Meeting of the Hong Kong Urological Association, Hong Kong, 6 November 2011. In Program Book, 2011, p. 6

A comparison between a conventional optical method and image-analysis for measuring the unimpeded eruption rate of the rat mandibular incisor

The impeded/unimpeded eruption rates of the rat incisor have been much studied. The most commonly used optical microscopic method, which has inherent weaknesses, was compared here with an image-analysis method to measure the eruption rate of the mandibular incisor. The study also evaluated the incisal edge as a reference point for the measurement of the unimpeded eruption rate, and the frequency of shortening the mandibular incisor. The image-analysis method was found to be a simple and reliable technique that could replace the optical method. There was no significant difference between the data from the two methods; their κ coefficients were similar at the 0.99 level. It was concluded that shortening the incisor in the measurement of the unimpeded eruption rate should be done at least every 48 h, and that the incisal edge of the shortened incisor can be used as the reference point for that measurement. © 2002 Elsevier Science Ltd. All rights reserved.postprin

Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review.

INTRODUCTION: Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. The findings will be used to recommend policy on the most effective responses and interventions in Hong Kong to effectively minimise and contain the spread of the disease within childcare facilities. METHODS: We searched the following databases for primary studies written in Chinese or English: MEDLINE, EMBASE, Global Health, WHO Western Pacific Region Index Medicus database, China National Knowledge Infrastructure Databases, and Chinese Scientific Journals Database. Studies conducted during or retrospective to outbreaks of hand, foot, and mouth disease caused by Enterovirus 71 from 1980 to 2012 within childcare facilities and with a study population of 0 to 6 years old were included. RESULTS: Sixteen studies conducted on outbreaks in China showed that hand, foot, and mouth disease spread rapidly within the facility, with an outbreak length of 4 to 46 days, especially in those with delayed notification (after 24 hours) of clustered outbreak (with five or more cases discovered within the facility) to the local Center for Disease Control and Prevention and delayed implementation of a control response. The number of classes affected ranged from 1 to 13, and the attack rate for children ranged from 0.97% to 28.18%. CONCLUSIONS: Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. Effective communication facilitates timely notification (within 24 hours) of clustered outbreaks to a local Center for Disease Control and Prevention. Timely implementation of a control response is effective in minimising incidence and length of an outbreak in childcare facilities. The government should provide incentives for childcare facilities to train infection control specialists who can serve as the first contact, knowledge, and communication points, as well as facilitate exchange of information and provision of support across stakeholders during a communicable disease epidemic

Maintaining hard disk integrity with digital legal professional privilege (LPP) data

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Superfluid vs Ferromagnetic Behaviour in a Bose Gas of Spin-1/2 Atoms

We study the thermodynamic phases of a gas of spin-1/2 atoms in the Hartree-Fock approximation. Our main result is that, for repulsive or weakly-attractive inter-component interaction strength, the superfluid and ferromagnetic phase transitions occur at the same temperature. For strongly-attractive inter-component interaction strength, however, the ferromagnetic phase transition occurs at a higher temperature than the superfluid phase transition. We also find that the presence of a condensate acts as an effective magnetic field that polarizes the normal cloud. We finally comment on the validity of the Hartree-Fock approximation in describing different phenomena in this system.Comment: 10 pages, 2 figure

Harvesting convalescent plasma for hyperimmune intravenous globulin production: a multicentre randomised double-blind controlled trial for treatment of patients with serious S-OIV H1N1 infection

Poster Presentations: Emerging / Infectious Diseases: abstract no. P107-Ab0089Symposium Theme: Translating Health Research into Policy and Practice for Health of the Populationpublished_or_final_versio

Harvesting convalescent plasma for hyperimmune intravenous globulin production: a multicentre randomised double-blind controlled trial for treatment of patients with serious S-OIV H1N1 infection

Poster Presentations: Emerging / Infectious Diseases: abstract no. P107-Ab0089Symposium Theme: Translating Health Research into Policy and Practice for Health of the Populationpublished_or_final_versio