Medical volunteers in commercial flight medical diversions.

BACKGROUND: In-flight medical emergencies are difficult to manage and medical volunteers can be valuable when these events occur. The study objective was to examine the role of medical volunteers in medical emergencies which resulted in medical flight diversions. METHODS: This was a retrospective cohort study of medical diversions in a large Hong Kong commercial airline from December 2003 to November 2008. This study is derived from a database of in-flight medical events which has been previously reported. The presence of medical volunteers, the need for diversion, and the outcome for all in-flight medical events were recorded. The records of the medical diversion incidents were reviewed in detail and symptom-based categorization applied. RESULTS: Medical volunteers were available in 1439 (35.4%) of the 4068 medical events and in 39 (84.8%) of the 46 cases which required medical diversions. Suspected stroke cases, as categorized under the nonspecific category, was the most common, followed by chest pains and deaths. CONCLUSIONS: Medical volunteers presented more often for more serious events, and may be due to the airline medical incident policy and medical legal concerns for volunteers. This study identified measures which may reduce medical diversions, including cabin crew training for stroke screening, and promote the use of the Medical Information Form (MEDIF) and indemnity forms. Recommendations for medical diversion may require more specialized training than is currently given in undergraduate medical courses, and may benefit from better communication with ground-based medical advice services.

Prevalence of infections in residential care homes for the elderly in Hong Kong.

OBJECTIVES: To study the prevalence of commonly occurring infections among residents of residential care homes for the elderly and their associated risk factors. DESIGN: Point prevalence survey. SETTING: Residential care homes for the elderly in Hong Kong. PARTICIPANTS: Residential care homes for the elderly were treated as a cluster and about 30% of the residents from each home were selected by systematic sampling with bed numbers ending with the digits of 2, 5, and 8. Selected residents were invited to participate. RESULTS: Data from 1603 residents aged 60 years or older from 43 residential care homes for the elderly were analysed. Most (85%) of the residents had underlying medical problems and 55% had more than one problem. The overall prevalence of infection among these residents was 5.7% (95% confidence interval, 4.2-7.1%). The three most common infections were: common cold or pharyngitis (1.9%; 95% confidence interval, 0.9-3.0%), skin and soft-tissue infections (1.4%; 0.5-2.4%), and symptomatic urinary tract infections (0.6%; 0.2-0.9%). Being 'bed-ridden' was a significant risk factor for skin and soft-tissue infections (odds ratio=3.1; 95% confidence interval, 1.4-6.9). Presence of a urinary catheter was a significant risk factor for symptomatic urinary tract infections (odds ratio=62.8; 95% confidence interval, 18.2-217.0). Chronic obstructive pulmonary disease was a significant risk factor for lower respiratory tract infection (odds ratio=16.5; 95% confidence interval, 3.4-81.2). CONCLUSIONS: This is the first territory-wide prevalence survey of infections among residents in residential care homes for the elderly in Hong Kong. The data retrieved enable us to target our infection control programme in residential care homes for the elderly to those with a high prevalence. So as to monitor seasonal and secular trends, targeted regular surveillance is needed for better profiling of the actual situation.

Chromatic contrast thresholds as a prognostic test for visual improvement after macular hole surgery: color vision and macular hole surgery outcome.

PURPOSE: To evaluate the relationship between preoperative chromatic contrast thresholds, postoperative visual acuities (VA), and visual improvement after macular hole surgery. METHODS: A consecutive series of patients with Stage II to IV macular holes was studied before macular hole surgery. Preoperative chromatic contrast thresholds, VA, and reading acuity were analyzed in relation to the postoperative visual function. The chromatic contrast thresholds were measured using a computerized cathode ray tube-based system along red-green and tritan confusion axes. RESULTS: Preoperative and postoperative chromatic contrast thresholds were elevated significantly in affected eyes (P < 0.001). Preoperative VA showed a strong correlation with postoperative VA (r = 0.66, P < 0.001) but a weak correlation with visual improvement (r = -0.33, P = 0.03). Red-green contrast threshold correlated strongly with both the distance visual improvement (r = -0.77, P < 0.001) and reading visual improvement (r = -0.61, P < 0.001). Tritan contrast threshold, however, showed a slightly weaker correlation (distance: r = -0.63, P < 0.001; reading: r = -0.47, P < 0.005). CONCLUSIONS: These results suggest that chromatic contrast thresholds, especially the red-green contrast threshold, represent a better prognostic guide for visual improvement after macular hole surgery than VA measurement.