Implementation of evidence on management of pleural diseases: insights from a territory-wide survey of clinicians in Hong Kong.

BACKGROUND: Major advances in management of common pleural diseases have taken place in the past decade. However, pleural diseases are often managed by physicians of diverse training background and research on implementation of new knowledge is scanty. We aim to evaluate the practice pattern in pleural medicine among physicians in Hong Kong, for identification of possible gaps for clinical service improvement. METHODS: The Hong Kong Thoracic Society undertook a cross-sectional questionnaire survey in 2019, targeting clinicians of various subspecialties in internal medicine and levels of experience (basic and higher trainees, specialists) from twelve regional hospitals of diverse service scopes throughout Hong Kong. Respondents were selected by non-probability quota sampling. The questionnaire tool consisted of 46 questions covering diagnostic and therapeutic aspects of common pleural diseases. The responses were anonymous, and analysed independently using SPSS statistics software. RESULTS: The survey collected 129 responses, 47(36%) were from clinicians specialized in respiratory medicine. Majority of the respondents (98%) managed pleural diseases, including performing pleural procedures in their practice. Fifty-five percent of all the respondents had not received any formal training in transthoracic ultrasonography. A significant proportion of clinicians were unaware of pleuroscopy for investigation of exudative pleural effusion, indwelling pleural catheter for recurrent malignant pleural effusion, and combined intra-pleural Alteplase plus DNase for treatment of pleural infection (30%, 15% and 70% of non-respiratory clinicians respectively). Significant heterogeneity was found in the management of pleural infection, malignant pleural effusion and pneumothorax among respiratory versus non-respiratory clinicians. Contributing factors to the observed heterogeneity included lack of awareness or training, limited accessibility of drugs, devices, or dedicated service support. CONCLUSION: Significant heterogeneity in management of pleural diseases was observed among medical clinicians in Hong Kong. Continuous medical education and training provision for both specialists and non-specialists has to be strengthened to enhance the implementation of advances, improve quality and equity of healthcare provision in pleural medicine.

Supramolecular self-assembly of 1D and 3D heterometallic coordination polymers with triruthenium building blocks.

Ru(3)(TSA)(6) (1; H(2)TSA=2-thiosalicylic acid), which bears six peripheral carboxylate groups and was isolated in the form [NEt(4)](1.5)[Ru(3)(HTSA)(2)(TSA)(4)](OAc)(0.5)·3.5H(2)O, serves as a building block for assembly of heterometallic coordination polymers. Treatment of 1 with [Fe(acac)(3)] (acac=acetylacetonate) in EG/H(2)O (EG=ethylene glycol) afforded 1D Ru(3)-Fe coordination polymer 2 by means of the connection of the building block 1 through iron centers. Treatment of 1 with MnCl(2) in EG resulted in the formation of 1D Ru(3)-Mn(3) coordination polymer 3, which features self-assembled polynuclear linking units Mn(3)(OCH(2)CH(2)O)(3), each of which contains a planar Mn(3)O(3) ring. By treating 1 with Gd(NO(3))(3) and NaHCO(3) in EG, a 3D Ru(3)-Gd(6) coordination polymer 4 was obtained; this 3D coordination polymer features unprecedented Gd(6)(µ(3)-CO(3))(4) units. The magnetic properties of 1-4, along with DFT calculations on the electronic structure of 1, are also described.

Molecular wheels of ruthenium and osmium with bridging chalcogenolate ligands: edge-shared-octahedron structures and metal-ion binding.

Inventing new wheels: reaction of [M(3)(CO)(12) ] (M=Ru, Os) with 4-RC(6)H(4)SH afforded [{M(S-4-RC(6)H(4))(2)(CO)(2)}(8)] (R=H; I) or [{M(S-4-RC(6)H(4))(2)(CO)(2)}(6)] (R=Me, iPr; II; see scheme), all of which have been structurally characterized. The octamers I are unique metal molecular wheels featuring skew-edge-shared octahedra with a central planar M(8) octagon. [{Ru(S-4-iPrC(6)H(4))(2)(CO)(2)}(6)] selectively binds a Cu(+) or Ag(+) ion to form [M'{Ru(S(4-iPr-C(6)H(4)))(2)(CO)(2)}(6)](+) (III).

Survival of mechanically ventilated ward patients and association with organisational factors: a multicentre prospective study.

OBJECTIVES: Determine 90-day mortality of mechanically ventilated ward patients outside the intensive care unit (ICU) and its association with organisational factors. DESIGN: Multicentre prospective observational study of mechanically ventilated ward patients. Modified Poisson regression was used to assess association between nurse to patient ratio (NPR) and 90-day mortality, adjusted for designated medical team, Society of Critical Care Medicine (SCCM) triage priority and centre effect. NPR was divided into low (1:9.6 to 1:10), medium (1:6 to 1:8) and high (1:2.6). Sensitivity analysis was conducted for pneumonia with or without acute respiratory distress syndrome (ARDS) to assess magnitude of association. SETTING: 7 acute public hospitals in Hong Kong. PARTICIPANTS: All 485 mechanically ventilated patients in wards from participating hospitals between 18 January 2016 and 17 April 2016 were recruited. Three hundred patients were included after excluding patients with limitation of therapy within 24 hours of intubation. MAIN OUTCOMES: 90-day mortality, Mortality Prediction Model III Standardised mortality ratio (MPMIII0 SMR). RESULTS: 201 patients died within 90 days after intubation (67.0%, 95% CI 61.5% to 72.1%), with MPMIII0 SMR 1.88, 95% CI 1.63 to 2.17. Compared with high NPR, medium and low NPRs were associated with higher risk of 90-day mortality (adjusted relative risk (RRadj) 1.84, 95% CI 1.70 to 1.99 and 1.64, 95% CI 1.47 to 1.83, respectively). For 114 patients with pneumonia with or without ARDS, low to medium NPR, too sick to benefit from ICU (SCCM priority 4b), no ICU consultation and designated medical team were associated with risk of 90-day mortality (RRadj 1.49, 95% CI 1.40 to 1.58; RRadj 1.60, 95% CI 1.49 to 1.72; RRadj 1.34, 95% CI 1.27 to 1.40; RRadj 0.85, 95% CI 0.78 to 0.93, respectively). CONCLUSION: The 90-day mortality rates of mechanically ventilated ward patients were high. NPR was an independent predictor of survival for mechanically ventilated ward patients.

Formation of µ-dinitrogen (salen)osmium complexes via ligand-induced N···N coupling of (salen)osmium(VI) nitrides.

Treatment of [N(n)Bu(4)][Os(VI)(N)Cl(4)] with a stoichiometric amount of H(2)L (L = N,N'-bis(salicylidene)-o-cyclohexylenediamine dianion) in the presence of PF(6)(-) or ClO(4)(-) in MeOH affords [Os(VI)(N)(L)(OH(2))](PF(6)) 1a and [Os(VI)(N)(L)(CH(3)OH)](ClO(4)) 1b, respectively. The structure of 1b has been determined by X-ray crystallography and the Os≡N bond distance is 1.627(3) Å. In the presence of a N-donor heterocyclic ligand in CH(3)CN, 1a reacts at room temperature to afford the mixed-valence µ-N(2) (salen)osmium species [(X)(L)Os(III)-N≡N-Os(II)(L)(X)](PF(6)), 2-14 (X = py 2; 4-Mepy 3; 4-(t)Bupy 4; pz 5; 3-Mepz 6; 3,5-Me(2)pz 7; Im 8; 1-MeIm 9; 2-MeIm 10; 4-MeIm 11; 1,2-Me(2)Im 12; 2-Meozl 13; 4-MeTz 14). These complexes are formed by ligand-induced N···N coupling of two [Os(VI)≡N](+) to give initially [Os(III)-N(2)-Os(III)](2+), which is then reduced to give the more stable mixed-valence species [Os(III)-N(2)-Os(II)](+). Cyclic voltammograms (CVs) of 2-14 show two reversible couples, attributed to Os(III,III)/Os(III,II) and Os(III,II)/Os(II,II). The large comproportionation constants (K(com)) of (5.36-82.3) × 10(13) indicate charge delocalization in these complexes. The structures of 3 and 14 have been determined by X-ray crystallography, the salen ligands are in uncommon cis-ß configuration. Oxidations of 4 and 14 by [Cp(2)Fe](PF(6)) afford the symmetrical species [(X)(L)Os(III)-N≡N-Os(III)(L)(X)](PF(6))(2) (X = 4-(t)Bupy 15; 4-MeTz 16). These are the first stable µ-N(2) diosmium(III,III) complexes that have been characterized by X-ray crystallography.

Dual anti-angiogenic and cytotoxic properties of ruthenium(III) complexes containing pyrazolato and/or pyrazole ligands.

An oxo-bridged diruthenium(III) complex containing pyrazolato and pyrazole ligands is stable against ascorbic-acid reduction, induces apoptosis (60%, 48 h) against HeLa cells at 10 microM level and exhibits promising anti-angiogenic activity at its sub-cytotoxic concentrations. Other mononuclear ruthenium(III) complexes containing pyrazole ligands [Ru(pz)(4)X(2)](+) exhibit dual anti-angiogenic and cytotoxic properties.