Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training

Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation (ECMO) programme. However, it is challenging due to the intrinsic characteristic of ECMO—a complex, high-risk, low-volume clinical activity which require teamwork, inter-professional communication, critical decision and rapid response especially in emergency. Thus, simulation is a rapidly evolving teaching methodology in ECMO education to address those training needs that cannot be entirely addressed by traditional teaching modalities. The development of a simulation programme requires commitment on resources for equipment, environment setup and training of personnel. Knowledge on ECMO management, education science and debriefing technique forms the cornerstone of successful ECMO simulation facilitators and hence the simulation programme. Currently, researches have already shown that ECMO simulation can improve individual and team performance despite that its impact on patient outcome is still unknown. In the future, the role of simulation will increase importantly in multicentre research, certifying specialists and credentialing if standardization of training curriculum can be achieved

A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B

OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading >/= 7 or fibrosis score >/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and > x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.published_or_final_versio

Career and life development intervention for non-engaged youth: Evaluating the Hong Kong Benchmarks (Community) Pilot Program

In our study, aimed at examining the effectiveness and impact of the Hong Kong Benchmarks (Community) Pilot Program, a career and life development (CLD) intervention program targeting non-engaged youth (NEY) in Hong Kong, we employed a pretest–posttest quasi-experimental design to compare changes in career-related competencies between a pilot group (N = 289) and a comparison group (N = 160). We also conducted five focus group interviews with the leaders of nongovernmental organizations, social workers, NEY, parents, and employers to explore the program’s impacts on the CLD service provisions. Our quantitative results indicate that the piloting group showed greater improvement in two career-related competencies—youth career development competency and career and life development hope—than the comparison group. Meanwhile, our qualitative results suggest both the benefits and difficulties experienced by stakeholders in the program. The findings thus provide preliminary evidence of the Hong Kong Benchmarks (Community) Pilot Program’s positive impacts on NEY and other important stakeholders. The implications of expanding the existing program and theorizing the community-based benchmark approach are also discussed

新媒體時代 = The era of new media

第一節由邵敏儀主持，分別由鄧婉晴主講〈Media on the Road ─ Waze 在移動中的社群經驗〉，李浩華主講〈網絡迷社群的建構與身份政治：以「達哥」的迷社群為例〉，魏嘉慰主講〈媒體如何鼓動影像消費──從 9GAG 流動應用程式說起〉，並由何凱婷評論及與講者進行討論

Effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain: A systematic review

BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain.MethodsFourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only.ResultsTwenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM) are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also inconclusive due to the limited number of studies.ConclusionAlthough most studies reviewed concluded that conventional and electroacupuncture could be effective for management of shoulder pain after stroke, the very high potential for bias should be considered. Further work in this area is needed that employs standardized acupuncture treatment modalities, endpoint assessments, and blinding of treatments

Pharmacokinetics of LB80331 and LB80317 following Oral Administration of LB80380, a New Antiviral Agent for Chronic Hepatitis B (CHB), in Healthy Adult Subjects, CHB Patients, and Mice▿

LB80380, a dipivoxil ester prodrug of LB80331 (metabolite, LB80317), is a novel antiviral agent for chronic hepatitis B (CHB). The pharmacokinetics of LB80331/LB80317 were evaluated in two clinical studies and a study with mice. The clinical studies were dose-escalating pharmacokinetic studies with six healthy subjects per single-dose group and six CHB patients per repeated-dose group. The mouse study was designed to measure the amounts of the phosphorylated portions of LB80331 and LB80317 in the liver. In healthy subjects receiving a single dose of LB80380, the plasma level of LB80331 increased as the dose increased. Although a high-fat diet delayed the time to the maximum concentration in plasma (Tmax) of LB80331, the area under the concentration-time curve from time zero to infinity was similar between the subjects in the fasted group and those in the group who consumed a high-fat diet. In CHB patients, the mean Tmax of LB80331 was 1.0 to 2.0 h postdosing at steady state. The steady-state plasma concentration of LB80331 declined in a monoexponential manner, and the apparent elimination half-life was 2.5 to 3.3 h. The steady-state plasma concentration of LB80317 was maximum at 3 to 8 h postdoing and declined in a monoexponential manner; the apparent elimination half-life was 45 to 62 h at the 30- to 240-mg doses, while LB80317 was measurable in plasma only at higher doses of 120 and 240 mg after the administration of the first dose of LB80380. Forty percent of the amount of LB80331/LB80317 in the mouse liver was detected as the phosphorylated form. In conclusion, LB80380 is rapidly absorbed and converted to LB80331. LB80317 has a long half-life at steady-state, supporting the use of a once-daily dosing regimen. The ingestion of a high-fat diet delays the rate of absorption of LB80380 without affecting the extent of absorption