Regional Acute Hospital Research Articles

An fMRI Study Showing the Effect of Acupuncture in Chronic Stage Stroke Patients With Aphasia

Acupuncture is used as a treatment in stroke patients with aphasia, yet the underlying neural mechanisms are unknown. This study aims to examine the relationship between changes in language function and brain activation using functional magnetic resonance imaging in chronic stroke patients with aphasia who underwent an 8-week acupuncture protocol. Seven chronic stroke patients were identified from a stroke database of a regional acute hospital in Hong Kong between January and July 2007. Patients were treated three times a week over a period of 8 weeks. Four acupoints were stimulated on the weak side of the patient's body. No other rehabilitation was given during the study period. Changes in language function were measured by aphasia quotient (AQ) of Cantonese Aphasia Battery (CAB). Functional magnetic resonance imaging blood oxygen level dependent signals were used to demonstrate the correlation between changes in AQ and brain activation after treatment. The patients were divided into well-recovered and poorly- recovered groups based on their CAB scores at entry. The well-recovered group showed significant improvement in CAB scores after receiving acupuncture treatment. A significant correlation between changes in AQ and blood oxygen level dependent activation in the lesioned Wernicke's speech area was found. These preliminary results suggest that acupuncture may be beneficial to language recovery in chronic stroke patients.

Acupuncture of Motor-Implicated Acupoints on Subacute Stroke Patients: An fMRI Evaluation Study

Abstract Background: Motor impairment is common after stroke. Along with classic integrated physical and occupational therapy, acupuncture is also suggested as an adjunctive therapy. Objective: To evaluate the effectiveness of acupuncture on upper limb motor recovery of patients with subacute stroke. Design, Setting, and Patients: Eighteen subacute stroke patients, transferred from a regional acute hospital to a convalescent hospital for rehabilitation in Hong Kong, from March 2005 to November 2007. Two clinical and behavioral evaluations for motor function were given to each participant along with 2 functional magnetic resonance imaging (fMRI) scans. Intervention: Patients were treated with acupuncture 3 times a week over 8 weeks. The intervention set of 3 acupoints is known to influence the motor system, while a second control set does not. Physical and occupational therapy were also used as treatment (parallel to the interventions with acupuncture). Main Outcome Measures: The primary outcome measure wa...

Reliability and validity of the telephone version of the Cantonese Mini-mental State Examination (T-CMMSE) when used with elderly patients with and without dementia in Hong Kong

The objectives of this study were to examine the reliability and validity of a 26-point telephone version of the Cantonese Mini-mental State Examination (T-CMMSE) for a sample of 65 elderly patients, comprising 31 patients without dementia and 34 patients with dementia, in an acute regional hospital in Hong Kong, and to identify an optimal cut-off score to discriminate between those patients with dementia and those without. Participants were rated by using the face-to-face Mini-mental State Examination (MMSE) before inpatient discharge and the T-CMMSE after inpatient discharge, and were rated separately by two raters in two telephone follow-up sessions using the T-CMMSE. The results of the study indicated that the scale had excellent inter-and intra-rater reliabilities. There was substantial agreement between the two versions of the examination (kappa > 0.6-0.8 < or =) for orientation, registration, and recall items. An optimal cut-off score of < or = 16 was suggested for the T-CMMSE to discriminate between those with and without dementia. The T-CMMSE can be used in telephone follow-ups as an alternative to the conventional face-to-face version.

Managing the interface between acute care and rehabilitation &amp;mdash; can utilisation review assist?

We piloted the InterQual Criteria tool in a large regional acute hospital in NSW to determine the utility of this tool in the Australian context. In particular to compare the current "gold standard" of physician assessment for the selection of patients for rehabilitation and the timing of transfer, with the guidance provided by the tool. Consecutive acute care patients with a diagnosis of stroke, hip fracture or amputation, and patients referred for rehabilitation assessment, were followed using the InterQual Criteria. Results on 242 acute episodes, representing 2698 days in acute care, were analysed. In accordance with overseas studies, we found that high levels of inappropriate days of stay in acute care were suggested by the tool. Using the InterQual Criteria almost all patients were deemed appropriate for transfer to rehabilitation much earlier than current practice. We conclude that the InterQual Criteria may have a useful role in patient selection for rehabilitation, in facilitating the transfer of patients from acute to subacute care, and in improving patient flow within acute care. The reasons for the variation between the results obtained from the tool and current clinical practice requires further investigation, and may indicate a lack of validity of the tool in the Australian setting, inefficiencies in processes of acute care, or the lack of suitable alternative care settings or level of support available in these settings.

The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control

The aim of this study is to determine the effectiveness of a diabetes nurse clinic intervention in controlling the poor glycaemia of older patients with type 2 diabetes. This is a quasi-experimental design with pre- and follow-up tests. The study was conducted in a regional acute hospital in Hong Kong. A total of 150 (75 controls, 75 cases) poor glycaemic control older patients with diabetes were recruited in the study. Biomedical and psychological data were collected at pre- and follow-up period and compared between groups. The study results show an effective intervention of diabetes nurse clinic in giving consultation and education to the type 2 diabetic patients. Subjects in the nurse follow-up group showed an improvement in the HbA1c, and systolic blood pressure and reduction on healthcare utilization. The study provided evidence to support the diabetes nurse clinic in treating the older patients with diabetes. This study has provided confidence to the diabetes nurse to treat the unstable older patients with diabetes. Diabetes mellitus is a serious health concern that most commonly affects older people. As indicated by the results of this study, this educational programme can act as an effective nursing intervention to the type 2 diabetic patients.

Prospective Randomized Controlled Trial Comparing Plasmakinetic Vaporesection and Conventional Transurethral Resection of the Prostate

OBJECTIVE: Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital. METHODS: A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained. RESULTS: The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up. CONCLUSION: PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting. [Asian J Surg 2005;28(1):24–8]

Parents’ experiences of participation in the care of hospitalised children: A qualitative study

Background The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents’ experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population. Objectives This study explored Chinese parents’ experiences of their participation in taking care of their hospitalised child. Design A qualitative exploratory design was adopted to capture parents’ experiences of participation. Settings The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong. Participants Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited. Methods Data were collection by tape-recorded semi-structured interview. Results Four major categories that illustrated parents’ experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents’ desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation. Conclusions Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents’ need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.

The nutritional knowledge of Australian nurses

Sound nutrition is an essential component of good health. A number of health professionals, including nurses, provide nutritional information to the community. However, little research exists which measures the nutrition knowledge of nurses in Australia. The aim of this study was to determine the nutrition knowledge of nurses in regional Victoria. A descriptive cross-sectional study design was used with 103 nurses (81% currently practicing in an acute regional hospital). The nurses answered 48 multiple choice general knowledge questions (using a valid and reliable questionnaire) and provided educational and demographic details. Each multiple choice question was scored as correct or incorrect and given the value of one point (maximum possible 48 points). The mean knowledge score for all nurses was 60.2% (SD = 8.4). Older nurses, those with more years of experience, and nurses with general training (rather than a degree) scored higher average knowledge scores. Respondents reported requests for nutrition information from patients and clients, and indicated that the most frequently used nutrition information sources were dietitians, other nurses, professional journals, books and literature from the National Heart Foundation. The nutrition knowledge score reported in this study is low to moderate by definition from previous studies using the same questionnaire. It is recommended that the Australian nursing profession determines its own nutrition knowledge standard and the nutrition knowledge needs of nurses working in particular areas of practice. Further work is required to determine the validity and reliability of an Australian knowledge instrument.

Prospective Randomized Controlled Trial Comparing Plasmakinetic Vaporesection and Conventional Transurethral Resection of the Prostate

Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital. A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained. The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up. PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.

Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation.

To determine the long-term outcome of noninvasive ventilation in chronic obstructive pulmonary disease patients who refused intubation for acute hypercapnic respiratory failure. Prospective, observational study. Noninvasive ventilation unit in an acute regional hospital in Hong Kong. The study recruited 37 chronic obstructive pulmonary disease patients who had the do-not-intubate code and developed acute hypercapnic respiratory failure. They were offered noninvasive ventilation, and their long-term outcomes were followed. Survival and event-free survival (an event is death or recurrent acute hypercapnic respiratory failure) were analyzed by survival analysis. Their disease profile and outcome were compared with another 43 chronic obstructive pulmonary disease patients without the do-not-intubate codes, who had acute hypercapnic respiratory failure and received noninvasive ventilation during the study period (usual care group). Patients in the do-not-intubate group were significantly older (p =.029), had worse dyspnea score (p <.001), worse Katz Activities of Daily Living score (p <.001), worse comorbidity score (p =.024), worse Acute Physiology and Chronic Health Evaluation II score (p =.032), lower hemoglobin (p =.001), and longer stay in the hospital during the past year (p =.001) than patients who received usual care. In the do-not-intubate group, the median survival was 179 days, and 1-yr actuarial survival was 29.7%; in the usual care group, the median survival was not reached during follow-up, and 1-yr actuarial survival was 65.1% (p <.0001). In the do-not-intubate group, the median event-free survival was 102 days, and 1-yr event-free survival was 16.2%; in the usual care group, median event-free survival was 292 days, and 1-yr event-free survival was 46.5% (p =.0004). A 1-yr survival of about 30% was recorded in chronic obstructive pulmonary disease patients with the do-not-intubate code who developed acute hypercapnic respiratory failure requiring noninvasive ventilation. The majority of survivors developed another life-threatening event in the following year. Information generated from this study is important to physicians and chronic obstructive pulmonary disease patients when they are considering using noninvasive ventilation as a last resort.

Noninvasive Ventilatory Support in Emergency Department: Initial Experience in Hong Kong

Background and Method There is favourable evidence supporting the use of noninvasive ventilatory support (NIV) in Emergency Department (ED) in treating patients with non-traumatic acute respiratory distress (ARD). To determine the feasibility and potential uses of NIV in the ED of Hong Kong, a prospective study was done in the ED of a regional acute hospital. A convenience sample of patients with non-traumatic ARD was recruited within the first 3 months after the introduction of this modality of therapy. Haemodynamically unstable or uncooperative patients and those requiring immediate endotracheal intubaton (ETI) were excluded. Patients were placed on BiPAP noninvasive ventilator with face mask for at least 30 minutes in ED. Blood pressure, respiratory rate and arterial blood gases analysis were recorded before and after the therapy. Adverse effects of NIV in ED, necessity of ETI and hospital mortality were also recorded. Results 28 patients were studied. The mean age was 76 years old (range 56–98). Causes of ARD included acute exacerbation of chronic obstructive airway disease (COAD, n=14), acute pulmonary oedema (APO, n=10) and bronchopneumonia (n=4). Patients were put on either Continuous Positive Airway Pressure (n=7) or Bilevel Positive Airway Pressure (n=21) modes of NIV. The COAD and APO groups responded favourably. The bronchopneumonia group showed only borderline or no improvement and 2 patients in this group needed ETI in ED, in contrast to only 1 patient in APO group and nil in COAD group. Only minor discomforts were felt by patients but no major adverse effect was observed. Two patients (2/4=50%) in bronchopneumonia group died from the disease. Conclusion NIV delivered in ED is feasible and is likely to be beneficial to patients with ARD due to COAD or APO. Further randomised controlled trials should be conducted to explore its potential uses in ED. (Hong Kong j.emerg.med. 2001;8:140–145)

Epidemiology of respiratory syncytial virus infection among paediatric patients in Hong Kong: seasonality and disease impact.

In a 5-year retrospective survey of respiratory syncytial virus (RSV) infections among hospitalized children, 1340 cases were identified of which, 98.4% were children < 5 years old with a male:female ratio of 1.5: 1. Most cases occurred from April to September showing a significant positive correlation with temperature and relative humidity. Community-acquired infections accounted for 92.5% of the cases with a mean hospital stay of 5 days. The estimated annual incidence of RSV infection requiring hospitalization was 2.5/1000 children < 5 years old with a mortality of 0.15% among hospitalized cases. On average, 248 children were admitted each year to the 1400-bed acute regional hospital accounting for an expenditure of HK S1.94 ((approximately US +/-0.25) million for hospitalization costs which equates to an annual cost in excess of HK $6.67 (approximately US $0.86) million for the whole of Hong Kong. An RSV vaccine should be a priority.

A disaster drill in Hong Kong

This case report relates the course of a disaster drill held on 19 August 1994 in a regional acute hospital (Pamela Youde Nethersole Eastern Hospital) in Hong Kong. The Hospital Civil Disaster Contingency Plan (the Plan) was put to trial on that day. Volunteers were invited to become simulated casualties in the exercise. Briefing seminars had been conducted with clinicians of the Accident and Emergency department (A & E) and other departments of the hospital. The scenario was a man-made type disaster. A double-decker bus turned over and injured 19 people in that afternoon. All the victims were sent to A & E by ambulance. The Plan was activated and relevant units were mobilized according to the Plan. It took 45 minutes to complete the disaster exercise. Debriefing sessions reviewed difficulties encountered throughout the drill and possible remedies.