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Introduction: Since the beginning of Coronavirus disease 2019 (COVID-19) pandemic, schools in Hong Kong were suspended intermittently as part of the anti-epidemic measure. This study aims to investigate the impact of COVID-19 pandemic on the epidemiology of paediatric fracture and bone health of children. Method(s): We recruited patients aged 3-17 admitted to tertiary paediatric orthopaedic trauma centres for fractures from 1st February 2020 till 4th March 2021 during COVID-19 period as study group and compared with patients admitted from 1st February 2019 till 31st January 2020 before COVID-19 as control group. Result(s): Total number of admissions due to fracture was reduced by 49% (pre-COVID period: 345, COVID period: 177). Demographic data such as age, age group distribution, sex, location of fractures, energy of injury, prior history of fracture were comparable in the two groups. There was no statistically significant difference in the proportion of patients requiring operative treatment. Significant change was found in injury mechanisms, with injury related to body-powered vehicles (33.7%, n = 58) becoming the leading cause of injury during COVID period (p < 0.001). There was significant drop in proportion of patient with injury from level ground fall (p < 0.001) and sports (p < 0.001). The percentage of obese children increased significantly (p = 0.009) during the COVID period (32.7%, n = 48) than pre-COVID period (21.0%, n = 67). The proportion of patients with hypocalcaemia was found to be higher (p = 0.002) during COVID period. Conclusion(s): This study reflects paediatric bone health issues during COVID-19 pandemic. We postulate the reduction in fracture incidence, change in the distribution of injury mechanisms, and more obesity could be related to a more sedentary lifestyle during COVID period. Hypocalcaemia can be associated with reduced sunlight exposure, obesity, and lack of physical activities. If the problem is left neglected, it can lead to long-term bone health problems.Copyright © The Author(s) 2023.
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Introduction: Depression is a debilitating disorder affecting individuals' level of bio-psychosocial functioning across different age groups around the globe. The recent development of a new NIBS called Transcranial Pulse Stimulation (TPS), also known as low-intensity extracorporeal shock wave therapy (Li-ESWT), has been proven effective for only a 2-week treatment of 35 patients with Alzheimer's disease (AD). Patients' cognition and memory have shown significant improvement which lasted up to 3 months. However, there is a lack of scientific evidence on the efficacy of this TPS intervention on other psychiatric population such as Major Depressive Disorder (MDD), which is increasingly prevalent in Hong Kong and nationwide especially during the COVID-19 pandemic. Nonetheless, there is no trial evaluating the efficacy of TPS on other neuropsychiatric disorders. This gave us the impetus to evaluate the efficacy of TPS on young adults with Major Depressive Disorder (MDD) in Hong Kong. Method(s): In this single-blinded, randomized controlled trial, participants had a confirmed clinical diagnosis of MDD, recruited from the community, NGOs and private enterprise. The intervention was a 2-week TPS treatment comprised six 30-min TPS sessions, delivered by trained mental health professionals. A total of 30 participants were recruited and randomized into either the TPS group or the Waitlist Control (WC) group. Randomization was stratified by gender and age by an independent statistician on a 1:1 ratio. Our primary outcome was determined by whether participants' depressive symptom severity demonstrated significant reduction, compared with the WC group, using the Hamilton Depression Rating Scale-17 (HDRS17). This trial is registered with Clin.Trials.gov, number NCT05006365. Result(s): We recruited 30 participants from 1 August to 31 Oct 2021. They were between 18-54 years old and were predominantly female (73%), ethnically Chinese. There was a significant group x time interaction (F(1, 28) = 818.8, p <.001). Compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, Cohen's d = -0.93). Results showed a significant intervention effect and the effect was large. Conclusion(s): TPS is safe and effective to reduce depressive symptoms among young individuals with MDD in this trial. Therefore, TPS may be considered as a top treatment option for neuropsychiatric disorders in clinical psychiatry. Funding(s): This trial is funded by the Departmental General Research Fund, the Hong Kong Polytechnic University, Hong Kong SAR, China. Copyright © 2022
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Aim: Conventionally, patients are gathered to watch an introductory video at the clinic before endoscopic investigations take place. This may arouse practical issues under the COVID pandemic. Our centre, in collaboration with students from a local secondary school, has designed a set of animations which patients can easily access to with a QR code using their own mobile devices, so as to avoid patient gathering and increase their flexibility to read the information. This study aims to evaluate patients' perception of the QR code-based introductory animations of esophagogastroduodenoscopy (OGD) and colonoscopy (CLN). Method(s): A QR code linking to the animation was attached to the appointment sheet. Patients were asked to watch the animation with their own mobile devices before the endoscopy. A questionnaire with 5 questions was distributed after completion of their procedures. Result(s): A total of 144 patients undergoing OGD and CLN were recruited in May-June, 2022 at Tin Shui Wai Hospital. The response rate was 91.7%. Positive feedback was received. 12 patients (8.3%) did not gain access to the animation. A majority of patients agreed or totally agreed that the animation offered them more flexibility to understand the procedures before their OGD (75.4%) and CLN (79.1%). The QR code-based animation was deemed easy-to-use (80.3%), appealing (78.0%) and educational (81.0%). Conclusion(s): With increasing accessibility to mobile devices, patient education in preparation for medical procedures is no longer confined to the hospital setting. QR code-based animation is shown to be an effective and welcoming tool to prepare patients for endoscopies.
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Aims To establish an innovative web-based COVID adapted Neonatal Resuscitation Workshop (CaNRW) which provides regular Simulation Based Education in neonatal resuscitation to meet service need and training demand and at the same time satisfy strict infection control measures imposed on classroom simulation based training in a regional hospital with delivery of 6000 per annum during COVID-19 outbreak in Hong Kong since 2021. Methods A CaNRW was developed with the Multi-Disciplinary Simulation and Skills Centre (MDSSC) in January 21. It consists of a 1-hour lecture delivered in YouTube;a 1- hour video on skills recommended by Neonatal Resuscitation Program of American Academy of Pediatrics and a real time birth related drill performed at MDSSC- Pict 1. All trainees participate it online except those involved in the drill. All providers can join the drill and debriefing online simultaneously. Upon competition, they were asked to complete an evaluation. Results Total 113 providers consisting of pediatric and emergency department residents, neonatal nurses and midwives joined three CaNRW in 2021. Providers didn't report difficulties in viewing the program through electronic devices. Program facilitators felt more comfortable in executing this CaNRW. Seventy-three evaluations were analyzed. The providers reported this CaNRW was useful with high level of satisfaction (Score:4.41/5). They strongly recommended it to colleagues (Score:8.53/10). Nurses and midwives were granted continuous nursing education credits (figure 1). Conclusion Our data data shows that this web-based innovative CaNRW is feasible and well accepted by trainees. It provides regular neonatal resuscitation training and satisfies strict infection control measures imposed on classroom simulation based training amidst of COVID outbreak in a regional hospital in Hong Kong since 2021. Both neonatal nurses and midwives gained training credits to fulfill their continuous professional education. Therefore, this mode of web-based CaNRW worth promoting and should be made available to more trainees and departments in hospitals where strict infection control measures for classroom teaching is in place amidst of COVID- 19 Outbreak.. (Figure Presented).
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Background: A good and effect iveneonatal resuscitation training (NRT) program is important for retaining skills and achieving good outcome. A stimulation based Neonatal Resuscitation Workshop (NRW) has been held quarterly for Paediatric, Obstetric and Emergency Department trainees since 2011. The NRW was suspended since July 20 due to COVID-19 pandemic. A web-based COVID-adapted NRW (CaNRW) was developed in January 21 to achieve the objectives of providing NRT and abiding infection control measures. Methods: A CaNRW was developed with the Multi- Disciplinary Simulation and Skills Centre (MDSSC), Queen Elizabeth Hospital in January 21. It consists of a 1- hour lecture delivered in YouTube;a 1- hour video on skills and a birth related drill performed at MDSSC. All trainees participate it online except those involved in the drill. Trainees can join the drill and debriefing online simultaneously. Upon competition, they were asked to complete an evaluation. Results: Total 113 trainees joined three CaNRW in 21. Trainees didn't report difficulties in viewing. Facilitators felt more comfortable in executing this CaNRW. Seventythree evaluations were analysed. Trainees reported this CaNRW was useful with high level of satisfaction (Score: 4.41/5). Trainees strongly recommended it to their colleagues (Score: 8.53/10). Nurses and midwives were granted Continuous Nursing Education and PEM credits respectively. Conclusions: This innovative web-based CaNRW provides a simple and structured model for NRT during COVID-19 pandemic. Trainees welcomed and enjoyed it. Thus, this CaNRW is worth promoting and should be made available to more trainees and departments. More studies should be performed to testify its clinical values.
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BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) infections are rampant in hospitals and residential care homes for the elderly (RCHEs). AIM: To analyse the prevalence of MRSA colonization among residents and staff, and degree of environmental contamination and air dispersal of MRSA in RCHEs. METHODS: Epidemiological and genetic analysis by whole-genome sequencing (WGS) in 12 RCHEs in Hong Kong. FINDINGS: During the COVID-19 pandemic (from September to October 2021), 48.7% (380/781) of RCHE residents were found to harbour MRSA at any body site, and 8.5% (8/213) of staff were nasal MRSA carriers. Among 239 environmental samples, MRSA was found in 39.0% (16/41) of randomly selected resident rooms and 31.3% (62/198) of common areas. The common areas accessible by residents had significantly higher MRSA contamination rates than those that were not accessible by residents (37.2%, 46/121 vs. 22.1%, 17/177, P=0.028). Of 124 air samples, nine (7.3%) were MRSA-positive from four RCHEs. Air dispersal of MRSA was significantly associated with operating indoor fans in RCHEs (100%, 4/4 vs. 0%, 0/8, P=0.002). WGS of MRSA isolates collected from residents, staff and environmental and air samples showed that ST 1047 (CC1) lineage 1 constituted 43.1% (66/153) of all MRSA isolates. A distinctive predominant genetic lineage of MRSA in each RCHE was observed, suggestive of intra-RCHE transmission rather than clonal acquisition from the catchment hospital. CONCLUSION: MRSA control in RCHEs is no less important than in hospitals. Air dispersal of MRSA may be an important mechanism of dissemination in RCHEs with operating indoor fans.
Subject(s)
COVID-19 , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Aged , COVID-19/epidemiology , Carrier State/epidemiology , Humans , Methicillin , Methicillin-Resistant Staphylococcus aureus/genetics , Pandemics , Staphylococcal Infections/epidemiologyABSTRACT
Background and Objective In recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay. Material and Methods We performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were col-lated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively. Results In all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = < 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = < 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay. Conclusion From our observations of a large cohort of patients over a study period of almost five years, day case GL-PVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.
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Aim: Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff. Method: From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases. Results: 87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening. Conclusions: Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.
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Aim: COVID-19 pandemic has caused significant social, economic and health impact worldwide, including Hong Kong. It causes unpredictable challenges to healthcare system. After implementing quarantine and social distancing measures, it is believed that patients have avoided seeking medical help due to avoidance of medical settings. The aim of the study is to investigate the influence of COVID-19 on the presentation and clinical outcome of acute appendicitis, one of the commonest surgical disease. Mathod: Retrospective cohort study was carried out in our cluster to compare acute appendicitis patients during 1 January 2020 to 31 July 2020 with the same period 1 year before. Parameters including time of presentation, complicated appendicitis rate, post-operative complication rate, and length of stay were compared and analysed. Results: A total of 459 patients (229 in pre-COVID group vs. 230 in COVID group) were included. There was no significant difference in basic demographics. There was a significant higher incidence of complicated appendicitis (67% vs. 52%, p = .028), post-operative complication rate (29% vs. 7%, p = .042) and a trend of longer length of stay (7.27 vs. 9.67 days, p = .163) in February COVID group compare with pre-COVID group. The time of presentation was significantly longer in March COVID group(3.75 vs. 1.56 days, p = .031), which may correlate with the spike of local confirmed cases. Conclusion: During COVID-19 pandemic, more acute appendicitis patients presented late to hospital, with an increase in complicated appendicitis rate and post-operative complication rate. We must raise public awareness to ensure prompt attendance to medical help in case of alarming symptoms.
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Today’s engineering laboratory education often lacks opportunities for students to practice critical thinking through real-world problems. This particular objective is even harder to achieve through online laboratory experiments. In this article, we summarize our innovation in using a real-world challenge, analyze big data, to empower student data analysis skills in remote teaching platform. This approach allows students to collect data, analyze, and evaluate possible solutions continuously through hands-on experimentation with accessible resources around them. Compared to the video-recorded lab, our method achieves a higher level of learning in Bloom’s taxonomy. To further improve our approach, we summarize our lesson learned from transferring six different engineering laboratory courses online, in response to the COVID-19. A thriving 21st-century learning environment has to embrace agility, create flexibility, adapt to technology, and support virtual team collaborations. © 2020
Subject(s)
COVID-19/epidemiology , Pandemics , Quality Improvement , Surgery Department, Hospital/statistics & numerical data , Surgery Department, Hospital/standards , Electronic Health Records , Facilities and Services Utilization , Humans , SARS-CoV-2 , United Kingdom/epidemiology , Vascular Surgical Procedures/standards , Vascular Surgical Procedures/statistics & numerical dataABSTRACT
Background: Coronavirus disease 2019 (COVID-19) impacted Hong Kong in early January 2020. Quarantine and social distancing measures have been implemented to prevent disease spread. Material and Method: Retrospective cohort study was carried out in our cluster to compare the acute appendicitis cases during pandemic period, January 1, 2020 to June 30, 2020, with the same period 1 year before. Parameters including time of presentation, complicated appendicitis rate, operative time, post-operative complication rate, and total length of stay were compared and analysed. Results: A total number of 348 patients (160 in the pre-COVID group versus 188 in the post-COVID group) were included. There is no significant difference in basic demographics. The time of presentation was significantly longer in March (3.75 days vs 1.56 days, P =.031) and June 2020 (3.02 days vs 1.88 days, P =.026) compared with the pre-COVID group, which correlate with the spike of local confirmed cases. There was a significantly higher incidence of complicated appendicitis (67% vs 52%, P =.028) and post-operative complication rate (29% vs 7%, P =.042) in February post-COVID group compare with the pre-COVID group. Conclusion: During the COVID-19 pandemic period, more patients with acute appendicitis presented late to the hospital, with an increase in complicated appendicitis rate and post-operative complication rate. © 2020 College of Surgeons of Hong Kong