Sexual violence cases in a hospital setting in Hong Kong: victims' demographic, event characteristics, and management.

INTRODUCTION: Rainlily, the first one-stop crisis centre in Hong Kong, was set up in 2000 to protect female victims of sexual violence. This study aimed to analyse the characteristics of sexual assault cases and victims who presented to two hospitals in Hong Kong. The data are invaluable for health care professionals and policymakers to improve service provision to these victims. METHODS: This retrospective analysis of hospital records was conducted in two acute hospitals under the Hospital Authority in Hong Kong. Sexual assault victims who attended the two hospitals between May 2010 and April 2013 were included. Characteristics of the cases and the victims, the use of alcohol and drugs, involvement of violence, and the outcome of the victims were studied. RESULTS: During the study period, 154 sexual assault victims attended either one of the two hospitals. Their age ranged from 13 to 64 years. The time from assault to presentation ranged from 1 hour to more than 5 months. Approximately 50% of the assailants were strangers. Approximately 50% of victims presented with symptoms; the most common were pelvic and genitourinary symptoms. Those with symptoms (except pregnancy) presented earlier than those without. The use of alcohol and drugs was involved in 36.4% and 11.7% of cases, respectively. Approximately 10% of the screened victims were positive for Chlamydia trachomatis. There were 11 pregnancies with gestational age ranged from 6 weeks to 5 months at presentation. Less than half of the victims completed follow-up care. CONCLUSIONS: Involvement of alcohol and drugs is not uncommon in sexual assault cases. Efforts should be made to promote public education, enhance coordination between medical and social services, and improve the accessibility and availability of clinical care. Earlier management and better compliance with follow-up can minimise the health consequences and impact on victims.

Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Hong Kong.

Community-associated methicillin resistant Staphylococcus aureus is an emerging cause of skin and soft tissue infections in Hong Kong, especially among certain ethnic minorities.

Stages of condom use and decisional balance among college students.

AIMS: To explore sexual behaviours and condom use and differences in specific items of perceived benefits and barriers to condoms using the Transtheoretical Model (TTM) stages among college students in southern Taiwan. BACKGROUND: The TTM suggests that individuals in the action or maintenance stage exhibit higher levels of perceived benefits and lower levels of perceived barriers related to condom use than people in the precontemplation, contemplation or preparation stage. METHODS: This was a descriptive, cross-sectional design with cluster sampling among college students from two universities in southern Taiwan. Participants completed self-administered questionnaires, including demographic data, Sexual History and Condom Use Scale and Condom Use Decisional Balance Scale. RESULTS: Of the 279 participants, 57% were sexually active, of these only 11.9% used condoms consistently. Respondents in the TTM stage of action/maintenance perceived greater benefits in relation to feeling more responsible (P = 0.031) and protecting their partners as well as themselves (P = 0.028), and perceived more barriers in believing that using condom needs to rely on partner's cooperation (P = 0.046) than participants in precontemplation. Participants in precontemplation and contemplation perceived more barriers related to worry about making their partner angry if condoms were used than those in action/maintenance (P = 0.008). CONCLUSION: Low levels of condom use among Taiwanese college students remain a significant public health concern. HIV prevention programmes for college students in Taiwan may be enhanced if they incorporate readiness to change and perceived benefits and barriers. Future research should include a larger sample with diverse groups.

The clinical outcome of 137 rape victims in Hong Kong.

From 1 August 2001 to 31 July 2004, 137 patients were referred from the Association Concerning Sexual Violence Against Women to the Accident and Emergency Department at the Kwong Wah Hospital for alleged rape. Approximately half of the patients presented within 3 days of the alleged assault. Fifty-one patients were prescribed emergency contraception: one patient remained pregnant despite treatment and was referred with a further six patients to the Gynaecology Department for termination of pregnancy. Thirty-two patients received hepatitis B immunoglobulin injection. One patient had a positive result for rapid plasma reagin 3 months following the assault and was referred to the Social Hygiene Clinic. All tests for antibody to human immunodeficiency virus were negative. Antimicrobial therapy was prescribed for women who had an endocervical and/or high vaginal swab positive for Chlamydia trachomatis (n=9), Trichomonas vaginalis (n=1), and gonococcus (n=1).

On the look out for a rarity--interstitial/cornual pregnancy.

Interstitial (cornual) pregnancy is a rare form of ectopic pregnancy that can be difficult to diagnose both clinically and ultrasonographically. However, early detection is essential to avoid fatal outcome. We report a case of interstitial/cornual ectopic pregnancy. The patient presented with uterine rupture over the cornual region resulting in catastrophic bleeding. The risk factors, clinical features and ultrasonographic signs are reviewed.

A survey on the involvement of accident and emergency doctors in medicolegal work in Hong Kong.

This study reports the results from a questionnaire survey on the pattern of medico-legal work undertaken by doctors working in Accident & Emergency Departments (ED) and their self-evaluation of competency in forensic medicine. A total of 155 questionnaires were returned with a response rate of 46%. Only 30% (46) respondents were fellows of the Hong Kong College of Emergency Medicine but 46% (71) had more than 6 years of experience working in the ED. Most of the requests for medical report came from police and insurance companies. Fellows had more experience writing reports on homicide, sexual assault and child abuse than non-fellows did. Nearly all fellows and three quarters (74%) of non-fellows had given evidence in courts of law. Physical assault was the commonest and sexual assault the least common experience. Most respondents had experience of attending district court (83%), followed by coroner inquest (67%), magistracy (66%) and high court (45%). Respondents were asked to rate themselves on their competence in various subject areas. It can be seen that respondents were less comfortable in areas like homicide, child abuse and sexual assault. On the job coaching by a senior seems to be the major mode of training. Both fellows (61%) and non-fellows (36%) favored some form of courses with a hands-on workshop element in future.

The use of the Spaso technique in a patient with bilateral dislocations of shoulder.

Although anterior shoulder dislocation is a common traumatic condition managed in the accident and emergency department, bilateral anterior shoulder dislocations are rare. We report a patient with bilateral anterior shoulder dislocations after electric shock and stress the need for a high index of suspicion required for the diagnosis of this condition. For this patient, we have adopted a new reduction method to reduce the dislocated shoulders. A brief review on the new method-the Spaso technique-is presented in the discussion.

An uncommon cause of foot ulcer: tuberculosis osteomyelitis.

Tuberculous osteomyelitis is an uncommon infection that usually involves the vertebrae. An otherwise healthy young man with a chronic discharging sinus on his right foot caused by tuberculous osteomyelitis is described. The risk factors, clinical features, radiological findings, and investigations of tuberculous osteomyelitis are briefly reviewed. Tuberculous osteomyelitis usually runs an insidious course; emergency physicians should be aware of the possibility of tuberculous osteomyelitis especially when patients present with chronic unexplained musculoskeletal symptoms.

Validation of the Ottawa ankle rules in a Hong Kong ED.

The Ottawa ankle rules (OAR) have been validated in many Western countries. However, a recent study performed in an accident and emergency department in Singapore failed to validate the OAR. Therefore, the implementation of the use of OAR in accident and emergency departments in Hong Kong may be treated with skepticism. This prospective study was performed to validate the ordering of radiographs using OAR in Chinese patients with foot and ankle injuries in Hong Kong. Emergency physicians trained in the use of the OAR assessed 773 eligible patients and one hundred thirty-one fractures were identified. The sensitivity and specificity of the OAR for ankle injuries was 98% and 40.8%. For midfoot injuries, the sensitivity and specificity of the OAR was 100% and 43.8%. We concluded that the OAR are applicable in our population with potential advantages for reducing the number of unnecessary investigations and shortening the patients' length of stay in accident and emergency departments.

An easy method to reduce anterior shoulder dislocation: the Spaso technique.

OBJECTIVE: To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. DESIGN: Retrospective case series. SETTING: Urban accident and emergency department. PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: The Spaso technique was applied by the emergency medicine residents to reduce anterior shoulder dislocation. RESULTS: The emergency medicine residents applied the Spaso technique to reduce 16 cases of anterior dislocated shoulder during the study period. The Spaso technique was successful in 14 of 16 cases. The overall success rate was 87.5% (95% CI 60.4, 97.8%). No complications were noted. CONCLUSION: A new method has been introduced for reduction of anterior shoulder dislocation by reporting the experience of junior residents. The Spaso technique is simple, effective and able to be performed by single operator. Although the sample size was small, the result of the study could provide background information for planning a properly designed randomised controlled trial to evaluate the Spaso technique.