[ICD-10 adaptation of 15 Agency for Healthcare Research and Quality patient safety indicators]. / Adaptation au codage CIM-10 de 15 indicateurs de la sécurité des patients proposés par l'Agence étasunienne pour la recherche et la qualité des soins de santé (AHRQ).

BACKGROUND: In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. METHODS: Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. RESULTS: Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. CONCLUSIONS: This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.

Childhood bronchiolitis obliterans in Hong Kong-case series over a 20-year period.

BACKGROUND AND OBJECTIVE: Bronchiolitis obliterans (BO) is a rare but serious condition. The natural history and outcomes remain poorly understood. In this clinical review, we aimed to describe the clinical characteristics and outcomes of children diagnosed with BO in Hong Kong (HK). METHODS: This was a retrospective study of pediatric patients with BO under the care of six respiratory units in HK from January 1996 to December 2015. Information was retrieved from medical records. RESULTS: Fifty-six patients were included with a male predominance (67.9%). The median age at diagnosis was 1.98 years (interquartile range [IQR]: 0.84-4.99 years). Postinfectious BO (PIBO) was the commonest cause (64.3%) followed by posthematopoietic stem-cell transplant (21.4%). Adenovirus (63.2%) was the commonest causative pathogen among PIBO. The median follow-up duration was 9.7 years (IQR: 2.9-14.3 years). Twenty-five patients (44.6%) could achieve symptom-free recovery at the time of follow-up. Five (8.9%) and three (5.4%) were oxygen or ventilator dependent, respectively. There were two deaths, both had posttransplant BO. Patients who developed BO after transplant had significantly worse lung function than those with PIBO. There were no risk factors significantly associated with worse clinical outcomes (oxygen/ventilator dependence or death) by logistic regression. Among patients with PIBO, coinfection at presentation was significantly associated with persistent symptoms at follow-up (p = .028). CONCLUSIONS: The most common cause of childhood BO in HK is postinfectious and coinfection at presentation was associated with persistent symptoms at follow-up. Further studies are needed to better elucidate disease progression, treatment options and long term outcomes.

Polymorphisms of glutathione S-transferase genes and functional activity in smokers with or without COPD.

OBJECTIVE: To determine the role of polymorphisms of genes regulating glutathione S-transferase (GST) and its plasma GST activity in the pathogenesis of chronic obstructive pulmonary disease (COPD). DESIGN: Case-control study. METHODS: One hundred and sixty-three patients with stable COPD from several community or regional hospitals were matched for age and pack-years smoked with the same number of health controls from the general population. Each participant underwent an interview-based respiratory and smoking questionnaire, lung function testing and gave a blood sample. Genotyping was carried out using a polymerase chain reaction-based method for polymorphisms of glutathione S-transferase theta 1 (GSTT1), glutathione S-transferase mu 1 (GSTM1) and glutathione S-transferase P 1 (GSTP1) genes. Plasma GST activity was measured using the spectrofluorometric method. RESULTS: There were no significant differences in the distribution of various genotypes of polymorphisms of GSTT1, GSTM1 and GSTP1 between COPD patients and healthy controls. GST activity was significantly higher in patients compared with controls, irrespective of their different genotypes, and was not different between patients with different levels of airflow obstruction. CONCLUSION: Polymorphisms of GSTT1, GSTM1 and GSTP1 genes are unlikely to be involved in the pathogenesis of COPD in Chinese in Hong Kong and Southern China.

Risk factors and nursing strategies to manage choking in adults with mental illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The review objectives are:Specifically, this review seeks to answer the following questions.

The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.

Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior. A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural). Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters.

Age-dependent changes in the distribution and concentration of human lens cholesterol and phospholipids.

Analyses of total lipid in individual lenses 1.8-63 years of age indicate that both the cholesterol and the phospholipid concentrations have reached a high level of 10 and 14 micrograms/mg lens dry weight, respectively, after the first ten years of growth. Thereafter, the rate of phospholipid accumulation was greatly reduced to a value of 0.05 microgram/mg per year while that of cholesterol reduced to 0.19. Analyses of the distribution of lipid in successive lens fiber layers indicate that both the cholesterol and phospholipid levels increase in the entire lens between the age of 1.8 and 9 years. Older lenses showed a continuous increase in the accumulation of cholesterol in the deep cortical fibers, while little or no increase in phospholipid concentration was observed. These results indicate that the accumulation of lipids is greater than that of lens dry mass (protein) during the first decade of lens growth. Since more than 90% of lenticular lipids are associated with fiber cell membranes, these data suggest a gradual change in the differentiation of the newly formed secondary fibers from the epithelium during this period. Analyses of the phospholipid composition of the successive fiber fractions indicate that the major phospholipids of phosphatidyl ethanolamine (PE), phosphatidylserine (PS) and sphingomyelin maintained a uniform distribution in the 1.8- and 5-year-old lenses. While no change was observed with the cortical fibers, older lenses showed a gradual loss of PE and PS in the nuclear fiber up to 63 years of age. By the late teen years, nuclear PS can no longer be detected, while high levels of PE are maintained in lens nucleus. The disappearance of nuclear PE begins in the teen years and is completed by the age of 40. The decrease in PE and PS resulted in a continuous increase in the cholesterol/phospholipid ratio, a measure of membrane rigidity in the nuclear fiber in lenses 20 years of age and older. This decrease is also responsible for the exceedingly high rigidity of the nuclear fibers of lenses 60 years of age and older. Possible lamellar cholesterol organization in the lens fiber membrane is discussed.

Kawasaki disease in Hong Kong, 1994 to 2000.

OBJECTIVE: To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong. DESIGN: Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000. SETTING: Hospitals with a paediatric unit in Hong Kong. PATIENTS: Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong. MAIN OUTCOME MEASURES: Incidence of Kawasaki disease and coronary artery aneurysm rates. RESULTS: A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223, 32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100,000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, P<0.001). CONCLUSION: The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100,000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.

Recent Patents of Complementary and Alternative Medicine for Allergic Rhinitis.

Allergic rhinitis (AR) is a common respiratory disease affecting both adults and children worldwide. Affected patients may experience nasal congestion/stuffiness, rhinorrhea (anterior and/or posterior), nasal/ nasopharyngeal itching and sneezing. Allergen avoidance is the principal step in the management. Nasal saline irrigation to remove allergen (s) in the nose is a useful adjunctive therapy in the management of moderate to severe AR. Symptomatic relief and improved quality of life may be achieved in the majority of patients with appropriate pharmacotherapy. Mild-to-moderate cases are usually managed with either an oral second generation antihistamine or an intranasal corticosteroid. More severe cases may require treatment with an intranasal corticosteroid in combination with various oral medications. Patients who require medications for more than 6 months per year or have intolerable side effects from pharmacotherapy can be considered for immunotherapy. A wide range of complementary and alternative medicines (CAM) have also been proposed. This overview evaluates the evidence of use of CAM for AR. Some methods including acupuncture and herbal medicine have supportive evidence, but the efficacy of other CAM is controversial. Conversely, possible side effects of different modalities are often inadequately documented. The herbal formulae include Butterbur, Nigella sativa, Shi-Bi-Lin, Polyherbal formula, Grapeseed extract, Rosmarinic acid, Spirulina, Biminne, and Bhu-zhong-yi-qi-tong. Further research is needed to assess the efficacy and safety before they are employed in treating AR. This review article also discusses recent CAM patents for use in AR, which are exclusively traditional Chinese medicine (TCM) concoctions primarily for oral consumption but two as topical spray. Only 8 pertinent patents, all TCM compositions for treating AR and registered in 2014, were obtained. Description about their efficacy is impressive but objective outcome evaluation tools are lacking.

Induction of NG108-15 cells differentiation by human bone marrow stromal cells.

The survival and differentiation of neuronal cells is dependent on factors such as neurotrophins, cytokines and components of extracellular matrix. Bone marrow stromal cells have been shown to support the growth and differentiation of neuroblastoma cells. In an attempt to study the effects of bone marrow stromal cells on neuronal differentiation, we have co-cultured neuroblastoma x glioma hybrid NG108-15 cells with human bone marrow stromal cells. After co-culturing, clones exhibiting morphological differentiated phenotype and high level of neurofilament expression were isolated. Interestingly, these clones maintain their ability to proliferate in contrast to differentiated NG108-15 cells induced by dibutyryladenosine 3',5'-cyclic monophosphate. These results suggested that bone marrow stromal cells can induce partial differentiation of NG108-15 cells.

Echocardiography as a tool for determining the incidence of congenital heart disease in newborn babies: a pilot study in Hong Kong.

We studied, with echocardiography as the main tool, the incidence of congenital heart disease in newborn babies in Hong Kong. The population examined was the 20,928 babies who were born alive in the Prince of Wales Hospital from January 1987 to December 1989. All had a thorough physical examination by a paediatrician after birth, and an estimated 95% of the babies who were discharged from hospital received another routine physical examination at one of the five local Maternal and Child Health Centres within two months of birth. All babies with either suspected congenital heart disease or multiple congenital abnormalities were referred to the paediatric cardiologists in the Prince of Wales Hospital for further cardiovascular assessment that included echocardiographic examination. In all, 492 babies had Doppler and cross-sectional echocardiographic studies. Various abnormalities of the cardiovascular system were diagnosed in 216 babies. Almost all the babies who died within two months of life underwent autopsy. This proved the presence of congenital cardiac malformations in 15 babies, of whom 10 had correct echocardiographic diagnoses during life. One had a patent arterial duct which was missed by the echocardiography. The other four babies did not have echocardiographic examination while alive, either because of early death or absence of clinical suspicion. In total, congenital cardiac malformations were confirmed in 221 babies by echocardiographic examination and autopsy. Excluding 82 premature babies with patency of the arterial duct, and 6 babies with transient tricuspid regurgitation, there were 133 cases of structural cardiac malformation in the studied population, giving an incidence of 6.35 per thousand live births.(ABSTRACT TRUNCATED AT 250 WORDS)

Boosting your product pipeline through innovative licensing. Pinpointing and managing successful alliances to remain competitive.

With the recent outbreak of large mergers and acquisitions and the looming pipeline crisis among large pharmaceutical companies, this meeting aimed to bring together senior officers from the business development and licensing sectors of top biotech and pharma companies, to discuss all aspects of licensing with a focus on remaining competitive. Along with in-depth analyses and theories delivered by representatives from investment banks, consultancy firms and academia, the conference presented delegates with interesting viewpoints and practical advice on partnering strategies, and issues surrounding licensing.

Relations between the mesiodistal crown diameters of the primary and permanent teeth of Hong Kong Chinese.

Relations between these diameters were studied on serial dental casts of 112 Hong Kong Chinese (61 males, 51 females) taken at mean ages of 5.68 and 12.31 yr. Size relations were studied in terms of correlation coefficient, difference, and ratio between corresponding pairs of individual teeth and corresponding groups of teeth in both dentitions. The coefficients of correlation were low to moderate (0.2-0.8), with those between groups of teeth consistently higher. As for size differences, incisors and canines were larger in the permanent dentition in both arches by 1.2-2.0 mm. Premolars were smaller than their primary predecessors except for the upper first premolar. When the absolute values of the differences were ranked, the second premolar-second primary molar differences were the greatest (2.0-2.8 mm) while those between the first premolar-first primary molar were the smallest (0.3-0.7 mm). When tooth groups were assessed, the permanent teeth were larger than their predecessors in the anterior segments but smaller in the posterior segments. The leeway space was larger in the mandibular arch (2.2 mm) than in the maxillary arch (0.3 mm). When diameters of five teeth on one side of the arch were combined, the permanent exceeded the primary by 3.5 mm in the upper arch but only 0.5 mm in the lower. The ratios between the permanent and primary tooth sizes showed the same trend as the differences.

Microbial hydroxylation and glucuronidation of the angiotensin II (AII) receptor antagonist MK 954.

The microbial metabolism of MK 954 (Fig. 1), a novel nonpeptide angiotensin II receptor antagonist, was investigated using 40 microorganisms in an initial screen for cultures that will produce metabolites similar to those produced in the mammalian liver. The microbial transformation occurred under aerobic conditions in shake flasks incubated at 27 degrees C. Three metabolites of MK 954 were isolated and identified as the 1'-hydroxy M2, 3'-hydroxy M1, and glucuronic acid conjugated M3 derivatives. The structures of the metabolites were established by UV, 1H-NMR spectroscopy and FAB-MS spectrometry and are identical to metabolites produced by incubation of MK 954 with mammalian liver slices.

Age dependent lipid and protein changes in individual bovine lenses.

Successive fiber fractions isolated from individual bovine lenses were fractionated to examine changes in lens proteins and membrane lipids as a function of age. In calf lens of about 1.2 gm wet weight, cholesterol (C) is maintained at a level of 3.3 microgram/mg dry weight in the outer cortical 30% of the lens. In the inner cortex, a C content of 2.4 micrograms/mg was found that decreased somewhat to 2.1 micrograms/mg in the inner nuclear 20% of the lens. The almost linear decrease in phospholipid (P) content from 11.6 in the cortex to 1.7 micrograms/mg in the nucleus resulted in a cortex to nucleus increase in C/P ratio from 0.5 to about 2.0 (mol/mol). Compared to calf lenses, a low C level of 2.4 micrograms/mg was observed in the outer cortex of cow lenses (approximately 3.0 gm wet weight). No significant difference in C level was found between the calf and cow lenses either in the inner cortical or nuclear regions. The P level was reduced to 6 and 1.2 micrograms/mg in the outer cortex and nucleus of the cow lens, respectively. The low nuclear P content is responsible for the observed high C/P value of 3.6. The lower lipid content found in the cortex of older lens suggests an age dependent decrease in the amount of available membrane lipid to envelope the newly formed fibers. A cortex to nucleus increase in the amount of urea-soluble (US) protein fraction from about 6 to 14% of total fiber mass was observed with the calf lens. In the cow lenses, the nuclear US fraction accounts for almost 30% of the fiber.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbial enhancement of Cu2+ removal capacity of Eichhornia crassipes (Mart.).

Bacteria resistant to Cu2+, Ni2+ or Zn2+ were isolated from the rhizosphere of water hyacinth (Eichhornia crassipes (Mart.)) and their metal ion removal capacities (RCs) were determined. The Ni2+ and Zn2+ RCs of the respective metal ion-resistant bacteria were less than 4.1 mg g(-1), while one of the Cu2+-resistant bacteria (Strain CU-1) showed a significant high Cu2+ RC of 10.6 mg g(-1). The effect of inoculating water hyacinth with Strain CU-1 on its Cu2+ RC was further studied. Water hyacinths were treated with an antibiotic, oxytetracycline (OTC), to remove most rhizospheric bacteria of plant roots. Inoculation of Strain CU-1 increased the Cu2+ RC of the plant root by 1.91 (OTC-treated) and 1.56 (OTC-untreated) folds respectively when compared with the control. Results also showed that Strain CU-1 colonized onto the plant root and led to the increase of Cu2+ RC of the roots of water hyacinth.

A computer-aided study of speaking spaces.

A computer-aided system was devised to investigate the speaking space. Thirty native Cantonese speakers with Class I occlusion were selected and test sentences were designed for speech analysis by a Sona-Graph. The investigation indicated that the sibilant sounds produced the closest speaking space and that the mean and the variability of the closest speaking space in Cantonese speakers were smaller than that in English speakers. The beliefs that the closest speaking space was smaller than that of the freeway space and that the speaking space of m sound was similar to the freeway space were not supported by this study.

Rimmed, vacuolar distal myopathy in two Taiwanese siblings.

Distal myopathy with rimmed vacuoles (DMRV) is a rare disease that has not previously been reported in Taiwan. This paper reports two siblings with DMRV. Each showed a different pattern of disease progression, one being slowly and the other rapidly progressive. Both patients' initial symptoms appeared in early adulthood, manifesting as muscular wasting and weakness of the legs, especially in the distal muscles. Severe generalized involvement of skeletal muscles, with sparing of the facial, extraocular, bulbar, intercostal and diaphragm muscles was recognized in the advanced stage. The striking finding in their muscle biopsy specimens was the presence of "rimmed" vacuoles. Magnetic resonance imaging showed more severe involvement of the anterior compartment muscles of the lower legs. DMRV is thought to be inherited as an autosomal recessive trait and is distinguishable from other types of distal myopathy on the basis of clinical and pathologic findings. The literature on the subject is reviewed with emphasis on the differences between distal myopathic syndromes.

Patterns of referral to the paediatric specialist clinic of a regional hospital: descriptive study.

OBJECTIVE: To study the patterns of referral to a paediatric specialist out-patient clinic. DESIGN: Descriptive study. SETTING: Regional hospital, Hong Kong. PATIENTS: The 1985 referral letters of patients who were referred to the paediatric specialist clinic during 1998 were studied. MAIN OUTCOME MEASURES: Common referral diagnoses according to sources of referral. RESULTS: The common sources of referral were maternal and child health centres (34.7%), accident and emergency departments (26.9%), the Student Health Service (12.9%), private practitioners (10.5%), and general out-patient clinics (9.8%). The common referral diagnoses from maternal and child health centres (n=689) were growth problems (37. 7%), heart murmurs (16.8%), and neonatal jaundice (10.9%). Asthma or suspected asthma constituted the majority of referrals from accident and emergency departments (227/533; 42.6%). Deviations in growth (41. 4%), problems regarding puberty (13.7%), apparent heart problems (13. 3%), and nocturnal enuresis (11.7%) were the common referral diagnoses from the Student Health Service (n=256). CONCLUSIONS: Studying referral patterns from various sources is helpful in organising medical services and identifying training needs.

Evaluation of the accuracy of leukocyte esterase testing to detect pyuria in young febrile children: prospective study.

OBJECTIVE: To study the accuracy and clinical application of the dipstick leukocyte esterase test in the detection of pyuria in young febrile children suspected to have urinary tract infection. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Urine samples were taken from 215 children younger than 2 years who were suspected to have urinary tract infection (fever without an obvious focus of infection). MAIN OUTCOME MEASURES: The accuracy of the dipstick leukocyte esterase test in detecting significant pyuria defined as a leukocyte count >or=10 mm(3) (>or=0.01 x 10(9) /L). RESULTS: Two hundred and fifty-four urine samples collected by bag, midstream clean-catch, suprapubic bladder aspiration, or urethral catheterization were examined. Using urine microscopy results as a reference, the sensitivity and specificity of the leukocyte esterase test in detecting significant pyuria were found to be 72.0% and 85.8%, respectively; the positive and negative predictive values were 55.4% and 92.6%, respectively; and the positive and negative likelihood ratios were 5.1 and 0.3, respectively. CONCLUSIONS: The dipstick leukocyte esterase test cannot accurately detect pyuria in young febrile children. It is also not appropriate as a screening test to exclude pyuria, reduce the need for the microscopic examination of urine, or indicate when a hospital admission for probable urinary tract infection is needed.