Experimental study of the temporal profile of breath alcohol concentration in a Chinese population after a light meal.

In forensic science, the Widmark equation is widely used to deduce the blood alcohol concentration (BAC) at different time points. But the linear model specified by Widmark might be deficient in predicting the breath alcohol concentration (BrAC) at different time points, and extrapolating the peak and the corresponding time. In order to establish the temporal profile of alcohol concentration which captures the effects of non-linear nature of alcohol absorption, elimination, and peak, in particular of Chinese population after a light meal, a drinking experiment was conducted in this study. To achieve this, a double-blind drinking experiment was conducted to measure the BrAC of 52 Chinese participants after a light meal in this study. Prior to the experiment, all participants were required to abstain from food for 4 hours, more importantly, from alcohol and sedatives for 24 hours. A standard light meal was provided about 30 minutes prior to the alcohol intake in the experiment. The BrAC was measured at a 10-minute interval during the absorption phase and 30-minute interval during the elimination phase respectively. The measurements were stopped when the BrAC fell to 0.010 mg/100 ml or below, or more than 8 hours after the alcohol intake. Then, the temporal profiles of BrAC, assuming linear and non-linear relationships, were established using Full Bayesian approach. The linear component indicated the alcohol impairment in normal social function, with which a light meal is usually accompanied with drinking. On the other hand, the non-linear (gamma distribution) part replicated the absorption phase, elimination phase, and the peak of alcohol concentration. The proposed model well performed than the conventional regression model. Additionally, the confounding factors including gender, body weight, and dosage were controlled for. Results should be useful for the development of cost-effective enforcement measures that could deter against drink driving.

Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong.

INTRODUCTION: The perceptions of medical futility and decisions about termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) are highly heterogeneous and dependent on the practice of the attending emergency physicians. The objective of this study was to report and investigate the knowledge, attitudes, and practices regarding medical futility and TOR during management of OHCA in Hong Kong. METHODS: A cross-sectional survey was conducted among emergency medicine physicians in Hong Kong. The questionnaire assessed participants' background, knowledge, attitudes, and behaviours concerning medical futility and TOR in management of OHCA. Composite scores were calculated to reflect knowledge, attitudes, and practices of OHCA treatment. Subgroup analysis and multiple regression analysis were used to explore the relationship between participants' background, knowledge, attitudes, and behaviours. RESULTS: The response rate to this survey was 57% (140/247). Independent predictors of less aggressive resuscitation in OHCA patients included status as a Fellow of the Hong Kong College of Emergency Medicine (ß= -0.314, P=0.028) and being an Advanced Cardiac Life Support instructor (ß= -0.217, P=0.032). There was no difference in aggressiveness of resuscitation in terms of years of clinical experience (ß=0.015, P=0.921), knowledge of TOR (ß=0.057, P=0.509), or attitudes about TOR (ß= -0.103, P=0.214). The correlation between knowledge and attitudes was low (Spearman's coefficient=0.02, P=0.795). CONCLUSION: Clinical practice and behaviour of TOR was not demonstrated to have associations with knowledge or attitude. Status as a Fellow of the Hong Kong College of Emergency Medicine or Advanced Cardiac Life Support instructor were the only two parameters identified that had significant relationships with earlier TOR in medically futile patients with OHCA.

Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache.

OBJECTIVE: To validate the Ottawa subarachnoid haemorrhage (SAH) rule in an Asian Chinese cohort and to explore the roles of blood pressure and vomiting in prediction of SAH in patients with nontraumatic acute headache. METHODS: A retrospective cohort study was conducted in two regional hospitals. All patients aged ≥16 years who presented with non-traumatic acute headache to the study centres from July 2013 to June 2016 were included. A logistic regression model was created for the variables of the Ottawa SAH rule and other potential predictors, including vomiting and systolic blood pressure (SBP) >160 mm Hg. Model discrimination was evaluated using the area under the receiver operating characteristic curve. Net reclassification improvement and integrated discrimination improvement indices were evaluated. The model's diagnostic characteristics, including sensitivities and specificities, were evaluated. RESULTS: A total of 500 eligible headache cases were included, in 50 of which SAH was confirmed (10%). In addition to the predictors of the Ottawa SAH rule, vomiting and SBP >160 mm Hg were found to be significant independent predictors of SAH. Net reclassification improvement and integrated discrimination improvement indices indicated that including vomiting and SBP >160 mm Hg would improve the model prediction. The Ottawa SAH rule had 94% sensitivity and 32.9% specificity. The modified Ottawa SAH rule that included both vomiting and SBP >160 mm Hg as criteria improved sensitivity to 100%, specificity to 13.1%, positive predictive value to 11.3%, and negative predictive value to 100%. CONCLUSIONS: The Ottawa SAH rule demonstrated high sensitivity. Addition of vomiting and SBP >160 mm Hg to the Ottawa SAH rule may increase its sensitivity.

A simulation study of the effects of alcohol on driving performance in a Chinese population.

UNLABELLED: Driving under the influence of alcohol (DUIA) is a significant factor contributing to road traffic crashes, injuries, and fatalities. Although the effects of alcohol on driving performance are widely acknowledged, studies of the effects of alcohol impairment on driving performance and particularly on the control system of Chinese adults are rare. This study attempts to evaluate the effects of alcohol on the driving performance of Chinese adults using a driving simulator. METHOD: A double-blind experimental study was conducted to evaluate the effects of alcohol impairment on the driving performance of 52 Chinese participants using a driving simulator. A series of simulated driving tests covering two driving modules, including emergency braking (EB) and following braking (FB), at 50km/h and 80km/h were performed. Linear mixed models were established to evaluate driving performance in terms of braking reaction time (BRT), the standard deviation of lateral position (SD-LANE), and the standard deviation of speed (SD-SPEED). RESULTS: Driving performance in terms of BRT and SD-LANE was highly correlated with the level of alcohol consumption, with a one-unit increase in breath alcohol concentration (BrAC) degrading BRT and SD-LANE by 0.3% and 0.2%, respectively. Frequent drinkers generally reacted faster in their BRT than less-frequent drinkers and non-drinkers by 10.2% and 30.6%, respectively. Moreover, alcohol impairment had varying effects on certain aspects of the human control system, and automatic action was less likely to be affected than voluntary action from a psychological viewpoint. CONCLUSION: The findings should be useful for planning and developing effective measures to combat drink driving in Chinese communities.

Investigation of availability and accessibility of community automated external defibrillators in a territory in Hong Kong.

OBJECTIVE: To evaluate the availability and accessibility of community automated external defibrillators in a territory in Hong Kong. DESIGN: Cross-sectional study. SETTING: Two public hospitals in New Territories West Cluster in Hong Kong. PARTICIPANTS: Information about the locations of community automated external defibrillators was obtained from automated external defibrillator suppliers and through community search. Data on locations of out-of-hospital cardiac arrests from August 2010 to September 2013 were obtained from the local cardiac arrest registry of the emergency departments of two hospitals. Sites of both automated external defibrillators and out-of-hospital cardiac arrests were geographically coded and mapped. The number of out-of-hospital cardiac arrests within 100 m of automated external defibrillators per year and the proportion of out-of-hospital cardiac arrests with accessible automated external defibrillators (100 m) were calculated. The number of community automated external defibrillators per 10,000 population and public access defibrillation rate were also calculated and compared with those in other countries. RESULTS: There were a total of 207 community automated external defibrillators in the territory. The number of automated external defibrillators per 10,000 population was 1.942. All facilities with automated external defibrillators in this territory had more than 0.2 out-of-hospital cardiac arrests per automated external defibrillator per year within 100 m. Among all out-of-hospital cardiac arrests, 25.2% could have an automated external defibrillator reachable within 100 m. The public access defibrillation rate was 0.168%. CONCLUSIONS: The number and accessibility of community automated external defibrillators in this territory are comparable to those in other developed countries. The placement site of community automated external defibrillators is cost-effective. However, the public access defibrillation rate is low.

Comparison of different intubation techniques performed inside a moving ambulance: a manikin study.

OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS. En-route intubation in an ambulance by conventional Macintosh laryngoscopy is superior to inverse intubation unless the cephalad access is impossible. GlideScope laryngoscopy appears to be associated with lower rates of eventful intubation in difficult airways and has better laryngoscopic view versus inverse intubation.

Aspirin desensitisation for Chinese patients with coronary artery disease.

OBJECTIVE. To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal anti-inflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012. RESULTS. There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt. No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. CONCLUSION. Given the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

Synthesis of Co3O4 nanowire arrays supported on Ni foam for removal of volatile organic compounds.

Crystalline Co3O4 nanowire arrays freely supported on Ni foam are successfully synthesized using a template-free method. The effects of reaction time, concentration of reactants, and temperature on the morphology of the nanowires are studied. The results indicate that uniform Co3O4 nanowires could be synthesized at 90 degrees C, and a transformation of the samples' morphology from nanoparticles to nanowires to microrods is observed by controlling the concentration of the reactants. The well-ordered nanowires synthesized under the selected reaction conditions are composed of spinel Co3O4 with diameters of 500-580 nm and lengths of 6-8 microm. These nanowires show good catalytic activity for the ozone catalytic oxidation of toluene.

Reperfusion strategy for ST-segment elevation myocardial infarction: trend over a 10-year period.

OBJECTIVES. To review the 10-year trend of reperfusion strategies in patients with ST-segment elevation myocardial infarction, and the adoption rate of percutaneous coronary interventions as opposed to thrombolytic therapy. Also to explore why some patients did not receive reperfusion therapy, and document changes in reperfusion strategies after the introduction of primary percutaneous coronary intervention programmes. DESIGN. Case series. SETTING. A regional hospital, Hong Kong. PATIENTS. All patients with ST-segment elevation myocardial infarction from January 2000 to December 2009. RESULTS. There were 1835 patients with ST-segment elevation myocardial infarction in that period, of which 1179 (64.3%) received reperfusion therapy (thrombolytic therapy, 46.0%; primary percutaneous coronary intervention, 17.5%; emergency coronary artery bypass graft, 0.7%). After introduction of the primary percutaneous coronary intervention programme, significantly more ST-segment elevation myocardial infarction cases underwent that particular intervention (1.6% in 2000 increasing to 30.6% in 2009), while the proportion receiving thrombolytic therapy declined (57.4% in 2000 decreasing to 35.0% in 2009). Seven reasons for no reperfusion therapy were identified. The commonest ones were delayed presentation (45.1%), succumbed before reperfusion (16.0%), multiple medical co-morbidities (15.2%), and contra-indication to thrombolytic therapy (14.8%). The proportion without reperfusion therapy due to a contra-indication to thrombolytic therapy declined (22.7% in 2000 decreasing to 4.9% to 2009), whilst an increasing proportion received primary percutaneous coronary interventions. CONCLUSIONS. Primary percutaneous coronary intervention is increasingly used as the reperfusion therapy in ST-segment elevation myocardial infarction and is replacing thrombolytic therapy, though the latter still remains a mainstay of therapy. A significant proportion of ST-segment elevation myocardial infarction cases received no reperfusion due to various reasons.

Identifying Feasible Design Concepts for Products with Competing Performance Requirements by Metamodeling of Loss-Scaled Principal Components.

Engineering design often involves the determination of design variable settings to optimize competing performance requirements. In the early design stages we propose narrowing down the domain of design solutions using metamodels of principal components of the multiple performance levels that have been scaled by a multivariate quadratic loss function. The multivariate quadratic loss function is often used as the objective function in reaching optimal solutions because it utilizes the correlation structure of the design's performance metrics and penalizes off-target performance in a symmetrical manner. We also compare the computational performance of these loss-scaled principal components when used to solve for the design with minimal expected multivariate quadratic loss under three modeling approaches: response surface methodology, multivariate adaptive regression splines, and spatial point modeling. We demonstrate the technique on the design of the mechanical frame of an electric vehicle with six desired performance levels determined simultaneously by the dimensions of eight mechanical design elements. The method is the focus in this work.

Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment.

OBJECTIVE: To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from January 2002 to December 2007. RESULTS: In all, 209 patients with ST elevation myocardial infarction had primary percutaneous coronary interventions between January 2002 and December 2007; 140 of them were admitted within office hours, 125 of whom came directly from Accident and Emergency Department. The mean door-to-balloon time of these patients was 115 minutes, and in 41% the time was less than 90 minutes (as recommended by the American College of Cardiology/American Heart Association guidelines). Since introduction of the new programme, the mean door-to-balloon time has diminished significantly, from 146 to 116 minutes (P=0.047). Delay in diagnosis (28%) and Cardiac Catheterization Laboratory being occupied (20%) were the two most common reasons for prolonged door-to-balloon times. CONCLUSION: We achieved satisfactory performance in our primary percutaneous coronary intervention programme, providing timely reperfusion therapy for patients with ST elevation myocardial infarction. A well-organised and systematic clinical pathway is a prerequisite for a centre that provides a timely and effective primary percutaneous coronary intervention service for patients with ST elevation myocardial infarction. Better public education and greater awareness on the part of medical service providers are needed, so as to facilitate urgent revascularisation and improve outcomes in patients with ST elevation myocardial infarction.

Bicycle crash casualties in a highly motorized city.

The characteristics of bicycle crashes in cities where bicycles are a minor transport mode have received little attention in road safety research. However, the characteristics of these injury-inflicting bicycle crashes are expected to be very different from those happening in cities where cycling is generally considered as one of the major transport modes. Specifically, this study has the following three objectives: (1) to conduct the first scientific spatial analysis of bicycle crashes in Hong Kong; (2) to analyze the circumstances leading to bicycle crashes; and (3) to conduct an epidemiological study on injury patterns of cyclist casualties. Various spatial and statistical tools, including buffer analysis, chi-square tests, analysis-of-variance and binary logistic regression, are used to analyze the bicycle crashes in Hong Kong from 2005-2007. An important finding of this paper is that the bicycle safety problem has a clear spatial dimension. The crash circumstances in different parts of the city differed systematically. Furthermore, the findings suggest that initiatives to develop new cycle tracks and to encourage bicycles as a transport mode must be planned carefully with new infrastructure and policies to ensure the safety of cyclists.

Prevalence of drugged drivers among non-fatal driver casualties presenting to a trauma centre in Hong Kong.

OBJECTIVE: To investigate the prevalence and characteristics of abusive drug exposure among non-fatal motor vehicle driver casualties presenting to a designated trauma centre in Hong Kong. DESIGN: Cross-sectional study. SETTING: Designated trauma centre/regional accident and emergency department in Hong Kong. SUBJECTS: Non-fatal motor vehicle driver casualties who presented to the trauma centre from 1 January 2007 to 31 December 2007. MAIN OUTCOME MEASURES: Screening of abusive drug exposure using commercial bedside urine immunoassay kits. RESULTS: Drug screening was performed in 395 injured drivers, 10% of whom tested positive for the drugs of interest. Ketamine was the most commonly detected abusive substance (found in 45% of the subjects). A significantly higher proportion of young drivers (aged <25 years) screened positive (odds ratio=2.3; 95% confidence interval, 1.0-5.2; P=0.04), with the rate being 21%. The presence of these drugs in urine was related to the time of occurrence of the crash; those occurring between midnight and dawn revealed a trend towards a higher proportion of casualties testing drug-positive (odds ratio=2.2; 95% confidence interval, 0.9-5.3; P=0.07). There were no significant differences in the frequency of persons testing positive for the screened drugs with respect to gender, class of motor vehicle driven, or the day of the week on which the crash occurred. CONCLUSIONS: The prevalence of drugged driving among non-fatal casualties in our series of Hong Kong drivers was 10%. The frequency of such drivers testing positive for drugs was significantly higher in persons aged less than 25 years. These findings indicate a need to amend existing laws and implement on-site drug screening for suspected drugged drivers.

Oral bacterial flora of the Chinese cobra (Naja atra) and bamboo pit viper (Trimeresurus albolabris) in Hong Kong SAR, China.

OBJECTIVE: To determine the oral bacterial flora associated with two common local venomous snakes in Hong Kong, namely the Chinese cobra (Naja atra) and the bamboo pit viper (Trimeresurus albolabris). DESIGN: Cross-sectional study. SETTING: A non-government organisation and a regional hospital in Hong Kong. SUBJECTS: Thirty-two Chinese cobras and seven bamboo pit vipers. MAIN OUTCOME MEASURES: Species identification of bacteria in the oral cavity of both snakes and their antibiotic susceptibilities. RESULTS: The oral cavity of Chinese cobra harbour a wide range of pathogenic bacteria, including: Gram-negative bacterial species like Morganella morganii, Aeromonas hydrophila and Proteus, and Gram-positive bacteria like Enterococcus faecalis, coagulase-negative Staphylococcus as well as anaerobic species (clostridia). The oral cavity of the Chinese cobra is more likely than that of the bamboo pit viper to harbour pathogenic bacteria associated with snakebite infection (P<0.001). The median number of pathogenic bacteria per snake was significantly higher in the Chinese cobra (P<0.001). All pathogenic Gram-negative bacteria isolated were susceptible to levofloxacin. Amoxicillin/clavulanate provided good coverage against pathogenic Gram-positive bacteria (Enterococcus faecalis) and anaerobes. CONCLUSION: 'Prophylactic' antibiotic treatment for Chinese cobra bites may be beneficial, owing to the multiple pathogenic bacteria in its oral cavity and the higher risk of ensuing necrosis. The regimen of levofloxacin plus amoxicillin/clavulanate appears promising for this purpose, but further study is required to confirm its clinical utility in patients.

Pedestrian injuries in an ageing society: insights from hospital trauma registry.

BACKGROUND: Traffic safety of the elderly is a growing public health issue. METHODS: This study makes use of a linked hospital and police database. A total of 4,290 traffic casualty records were analyzed. The proportions of serious injury and mortality for different age groups are compared between pedestrian and nonpedestrian injuries. Logistic regression analysis is used to examine the relative significance of age, injury pattern, gender, crash time, and vehicle type on each dependent variable of hospital stay > or = 7 days, injury severity score (ISS) > 15, ISS > 30, and mortality. RESULTS: The shares of pedestrian casualties with serious injury increased with higher age groups. Among pedestrian casualties, aged > or = 65 years was the only statistically significant variable in accounting for ISS > 30 and mortality. Aged > or = 65 years, lower extremity injury and heavy vehicles were important in accounting for long hospital stay. For ISS > 15, aged > or = 65 years, head or face injury, and thorax or abdomen injury were significant risk factors. After adjusting for confounding factors, the risk of hospital stay > or = 7 days, ISS > 15, ISS > 30, and mortality for an elderly pedestrian injury was 4.24 times (95% CI, 2.46-7.29), 2.77 times (95% CI, 1.17-6.55), 5.16 times (95% CI, 1.38-19.34), and 3.61 times (95% CI, 1.16-11.25) higher than a younger adult (aged 15-64 years). In contrast, age was not a significant independent risk factor for serious injury and mortality among nonpedestrian injuries. CONCLUSIONS: Most developed economies are facing the problem of ageing. To develop an effective strategy to deal with elderly pedestrian trauma, a good quality linked database is a prerequisite.

Misclassification of injury severity among road casualties in police reports.

This study aims to evaluate the discordance between police reports of injury severity among road casualties and the length of hospital stay and the Injury Severity Scale (ISS) by linking information from the crash records of the Hong Kong Police with the trauma records of a regional hospital. Sensitivity and specificity analyses suggest that police injury grading diverges noticeably from the definition of a 12-h hospital stay. Police reports overestimate injury severity remarkably. The results of logistic regression indicate that age, the ISS, and the position of the victim significantly determine the likelihood of police injury misclassification. Furthermore, an optimal demarcation point of the length of hospital stay for serious injury is estimated.

1700 Victims of intimate partner violence: characteristics and clinical outcomes.

OBJECTIVE: To investigate the demographics and clinical outcomes of intimate partner violence victims presenting to an emergency department. DESIGN: Retrospective, observational study. SETTING: Emergency department of a regional hospital in Hong Kong. PATIENTS: Adults presented with intimate partner violence during years 1999 to 2004. RESULTS: We assessed 1695 victims of intimate partner violence with a mean age of 39 (range, 18-84) years, of whom 87% were female. Most of the patients were in the age-group of 31 to 40 years and the overall male-to-female ratio was 1:7. In Tin Shui Wai and Yuen Long districts, such cases appeared to be on the increase. Nearly two thirds (65%) of all the victims presented to the emergency department outside the office hours of medical social workers. Approximately 10% had been abused once before, and 40% more than twice. The head (39%), face (30%), upper limbs (37%), and lower limbs (17%) were commonly the injured parts. The majority (73%) had mild injuries; severe injuries being relatively less common. The latter included lacerations or cuts (6.6%), nasal bone fractures (0.3%), limb fractures (0.8%), and ruptured tympanic membranes (0.9%). In-patient management was undertaken for 8% of the victims, due to physical injury in 68% of these individuals and psychological trauma in the remaining 32%. The hospital admission rate dropped from 12% in 2001 to 4% in 2004. CONCLUSIONS: Variations in demographic data had a significant impact on future service planning and management of intimate partner violence. Accident and Emergency Department and Emergency Medicine Ward services together with extended social worker support could provide timely, multidisciplinary care to meet the various needs of victims and subsequently reduce hospital admissions.

Evaluation of a point-of-care transcutaneous bilirubinometer in Chinese neonates at an accident and emergency department.

OBJECTIVE: To evaluate the use of a point-of-care transcutaneous bilirubinometer, JM-103 Minolta, for estimation of the serum bilirubin level in the management of neonatal jaundice in term or near-term Chinese neonates. DESIGN: Prospective correlation study. SETTING: Accident and Emergency Department of a regional hospital in Hong Kong. PATIENTS: All term or near-term Chinese neonates aged 3 to 7 days, who attended the Accident and Emergency Department because of jaundice between September and November 2007. MAIN OUTCOME MEASURES: Paired transcutaneous bilirubin measurements by the JM-103 Minolta and the total serum bilirubin measurement by a direct spectrophotometric method in the laboratory. RESULTS: The mean age of the 113 neonates at the time of data collection was 5 days (range, 3-7 days). Transcutaneous bilirubin showed a good correlation with total serum bilirubin; the highest correlation coefficient was 0.83 (P < 0.001). Transcutaneous bilirubin cutoff values of 230 micromoles per litre and 298 micromoles per litre could have 100% sensitivity and specificity respectively, to predict a total serum bilirubin level of higher than 250 micromoles per litre (the accepted threshold for treatment). The mean difference between transcutaneous and total serum bilirubin was 14 micromoles per litre (standard deviation, 28 micromoles per litre; P < 0.001); the JM-103 tended to overestimate total serum bilirubin. The 95% limits of agreement were between -40 and 69 micromoles per litre. CONCLUSION: The new point-of-care transcutaneous bilirubinometer, JM-103 Minolta, demonstrated good correlation with the serum bilirubin measurement in Chinese neonates aged 3 to 7 days. Thus, it is a useful screening device to facilitate quick decisions on disposal of jaundiced neonates presenting to accident and emergency departments or in out-patient clinic settings.