Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management.

Patient blood management (PBM) is a patient-centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an effort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. The multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely affecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products.

Factors affecting the appreciation generated through applying human factors/ergonomics (HFE) principles to systems of work.

This retrospective study examined the levels of appreciation (applause) given by clients to Human Factors/Ergonomic (HFE) specialists after they have modified the systems of work. Thirteen non-academic projects were chosen because the HFE interventions involved changed the way workers work at their workplaces. Companies involved range from multi-national corporations and military organizations with thousands of employees to small trading companies with less than 10 employees. In 5 cases the HFE recommendations were fully adopted and well appreciated. In 4 they were largely ignored and not appreciated, with partial adoption and some appreciation in the other 4 cases. Three factors that predict appreciation were identified: (i) alignment between the benefits HFE can provide and the project's key performance indices; (ii) awareness of HFE among the client's senior management; and (iii) a team organization appropriate for applying HFE recommendations. Having an HFE specialist on the client's side can greatly increase levels of appreciation, but lack of such a specialist will not affect levels of appreciation. A clear contractual requirement for HFE intervention does not promote appreciation significantly, but its absence can greatly reduce levels of appreciation. These relationships are discussed using the Kano's model of quality. Means to generate greater appreciation of the benefits of HFE are discussed.

Linezolid versus vancomycin for prosthetic joint infections: a cost analysis.

BACKGROUND: Prosthetic joint infections (PJIs) caused by methicillin-resistant gram-positive bacteria are primarily treated by intravenous vancomycin. Linezolid, active against methicillin-resistant strains and available in oral and intravenous dosage forms, is a potential alternative to vancomycin for the treatment of PJIs. OBJECTIVE: To analyze the cost of linezolid therapy (outpatient setting) and vancomycin therapy (inpatient and outpatient settings) for PJIs caused by methicillin-resistant gram-positive bacteria. METHODS: A decision tree was designed to simulate the clinical outcome and healthcare resource utilization of linezolid, vancomycin by outpatient and home parenteral antimicrobial therapies (OHPAT) and vancomycin administered in inpatient setting (rehabilitation facility) for patients with PJIs caused by methicillin-resistant strains. Clinical inputs were estimated from literature and the cost analysis was conducted from the perspective of the public healthcare provider in Hong Kong. RESULTS: The base-case analysis showed that the vancomycin (OHPAT) group (USD14,470 per patient) was the least costly alternative, followed by the linezolid group (USD17,877 per patient) and the vancomycin (rehabilitation) group (USD19,980 per patient) (1USD = 7.8HKD). The clinical treatment success rates of vancomycin and linezolid were influential factors. Monte Carlo 10,000 simulations showed that the vancomycin (OHPAT) group was less costly than the arms of linezolid and vancomycin (rehabilitation) 64% and 100% of the time, respectively. The linezolid group was less costly than the vancomycin (rehabilitation) group in 65%of the times. CONCLUSION: Home-infusion of vancomycin therapy appears to be the least costly treatment approach for PJIs caused by methicillin-resistant gram-positive bacteria from the perspective of a Hong Kong public health organization.

A low cost, non-individualized surround sound system based upon head related transfer functions: an ergonomics study and prototype development.

This paper reports on the types and magnitudes of localization errors of simulated binaural direction cues generated using non-individualized, head-related transfer functions (HRTFs) with different levels of complexity. Four levels of complexity, as represented by the number of non-zero coefficients of the associated HRTF filters (128, 64, 32, 18 non-zero coefficients), were studied. Experiment 1 collected 1728 data runs that were exhaustive combinations of the four levels of complexity, nine simulated directions of sound (no direction (i.e., diotical-mono), 0 degrees , 45 degrees , 90 degrees , 135 degrees , 180 degrees , 225 degrees , 270 degrees , and 315 degrees azimuth angles at 0 degrees elevation), two repetitions, and 24 participants). Binaural cues generated from HRTFs of reduced complexity (from 128 to 18 non-zero coefficients) produced significantly higher localization errors for the directions of 45 degrees , 135 degrees , 225 degrees , and 315 degrees azimuth angles (p<0.01). From the directions of 0 degrees , 90 degrees , and 270 degrees azimuth angles, the cues produced by HRTFs with reduced complexity did not affect the localization error (p>0.2). Surprisingly, cues produced by HRTFs of 128 non-zero coefficients did not have the lowest number of errors. From 45 degrees , 135 degrees , 225 degrees , and 315 degrees , the lowest numbers of errors were obtained from cues produced by HRTFs of 64, 32, 32, and 64 non-zero coefficients, respectively. Based on these findings, a prototype virtual headphone-based surround-sound (VHSS) system was developed. A double-blind usability experiment with 32 participants indicated that the prototype VHSS system received significantly better surround-sound ratings than did a Dolby stereo system (p<0.02). This paper reports results from an original ergonomics study and the application of these results to the design of a consumer product.

Energy expenditure and physical activity of obese children: cross-sectional study.

OBJECTIVES: To investigate the total daily energy expenditure and physical activity pattern of a group of obese and non-obese Hong Kong children. DESIGN: Cross-sectional study. SETTINGS: University teaching hospital, Hong Kong. PARTICIPANTS: Eighteen obese children aged 6 to 17 years and 18 age- and sex-matched non-obese children in the local Hong Kong community. MAIN OUTCOME MEASURES: Total daily energy expenditure and physical activity pattern were estimated for 3 days using heart rate monitoring. Body composition was measured by dual-energy X-ray absorptiometry. RESULTS: In obese children, both total fat mass and fat-free mass were greater than in non-obese children. Total daily energy expenditure and its sleep and sedentary components were higher in absolute terms (by 42%, 43%, and 126%, respectively) for obese children. When normalised for body weight, the basal metabolic rate was no different between obese and non-obese children, while the total daily energy expenditure of the obese children was significantly lower (by 22%) than that of non-obese children. When normalised for fat-free mass, the basal metabolic rate and the sedentary component of total daily energy expenditure were significantly higher for obese children. Obese children spent 12% less time asleep, but 51% more time in sedentary activity and 30% less time physically active: a ratio of active-to-sedentary waking time of 0.6 for obese children and 1.9 for non-obese children. CONCLUSIONS: Although the basal metabolic rate may be influenced by body composition, the finding of a normal basal metabolic rate when normalised for body weight suggests that an intrinsic difference of metabolic rate is not a major contributory cause of obesity. The study pointed particularly to the potential benefit of increasing physical exercise time relative to sedentary activities to reduce the prevalence of childhood obesity. Obese and non-obese children had similar basal metabolic rates when adjusted by fat-free mass and fat mass. Obese children spent more time in sedentary activities.