Validation of a Modified Glasgow-Blatchford Score for Risk Stratification of Patients with Suspected Upper Gastrointestinal Bleeding in an Accident and Emergency Department in Hong Kong

Objectives

To validate the use of a modified Glasgow-Blatchford Score (mGBS) for risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) in an accident and emergency department in Hong Kong.

Methods

This was a retrospective cohort study of patients who attended the emergency department of the study centre from January 2014 to June 2014 who were subsequently admitted to surgical wards with suspected UGIB. High risk patients were considered to be those who required in-patient clinical interventions (blood transfusion, therapeutic endoscopy, angiographic embolisation, or surgery). The mGBS was calculated for each patient. The sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the score were calculated.

Results

A total of 372 patients were included in the study. With an mGBS of 0 (low risk) for detecting the primary outcome, the sensitivity was 99.2% (95% CI, 95.6100%), and the specificity was 25.91 (95% CI 20.6-31.8%). The negative likelihood ratio was 0.031 (95% CI 0.004-0.2). The AUC was 0.90 (95% CI 0.87 to 0.93).

Conclusion

The modified Glasgow-Blatchford Score is a clinically useful tool for emergency physician to identify UGIB patients at low-risk of requiring in-hospital clinical interventions. (Hong Kong j.emerg.med. 2016;23:3-11)

Sonographic Measurement of the Epiglottis in Normal Chinese Adults

Objectives

(1) To assess the normal range of thickness of the epiglottis by means of ultrasound measurement. (2) To evaluate inter-observer agreement in measuring the thickness of the epiglottis of normal individuals by ultrasound. (3) To assess the association between biological factors and the thickness of the epiglottis.

Methods

Fifty adult volunteers working at a local accident and emergency department were recruited. The thickness of the epiglottis was measured by means of ultrasound examination, which was performed twice by two emergency physicians at different time. The study subjects' age, sex, height and body weight were recorded.

Results

The mean thickness of the epiglottis was 0.236 cm and the standard deviation was 0.020. Male subjects had thicker epiglottis. Interobserver agreement of the two emergency physicians who performed the ultrasound scan was very good. Multiple regression models showed that sex and height were useful predictors of the thickness of the epiglottis.

Conclusions

Bedside ultrasound assessment of the epiglottis is an easy, rapid and reliable method to evaluate its thickness. Further studies are needed to evaluate the thickness of the epiglottis in patients with epiglottitis before it can be put into clinical use.

On nurses moving from public to private hospitals in Hong Kong

AIMS AND OBJECTIVES

To explore the reasons why nurses leave public hospitals for the private sector.

BACKGROUND

While the global shortage of nurses is aggravating, this problem in public hospitals in Hong Kong is worsened by the trend of nurses moving to private hospitals. Thus, it is important to understand from the perspective of nurses the reasons affecting their decision to stay or leave a hospital.

DESIGN

Qualitative approach using narrative analysis.

METHODS

Data were collected using individual semistructured interviews. Twelve participants who had moved to a private hospital from a public hospital were encouraged to explain why they had made the move. Crossley's analytic method was adopted to analyse the collected data.

RESULTS

The nurses' stories were categorised into five sections: 'life in public hospitals', 'decision-making', 'life in the private hospitals', 'future plans' and 'values and beliefs'.

CONCLUSIONS

The results are consistent with those of previous studies showing that job satisfaction and demographic factors play significant roles in the decision of nurses to switch to another hospital. This study revealed specific reasons why the nurses made the move, such as the fairness of the remuneration policy, significant people and stressors.

RELEVANCE TO CLINICAL PRACTICE

The results have relevance for hospital management with regard to strategies to consider when addressing the issues of staff retention and recruitment.

Parallel Genetic-Based Hybrid Pattern Matching Algorithm for Isolated Word Recognition

Dynamic Time Warping (DTW) is a common technique widely used for nonlinear time normalization of different utterances in many speech recognition systems. Two major problems are usually encountered when the DTW is applied for recognizing speech utterances: (i) the normalization factors used in a warping path; and (ii) finding the K-best warping paths. Although DTW is modified to compute multiple warping paths by using the Tree-Trellis Search (TTS) algorithm, the use of actual normalization factor still remains a major problem for the DTW. In this paper, a Parallel Genetic Time Warping (PGTW) is proposed to solve the above said problems. A database extracted from the TIMIT speech database of 95 isolated words is set up for evaluating the performance of the PGTW. In the database, each of the first 15 words had 70 different utterances, and the remaining 80 words had only one utterance. For each of the 15 words, one utterance is arbitrarily selected as the test template for recognition. Distance measure for each test template to the utterances of the same word and to those of the 80 words is calculated with three different time warping algorithms: TTS, PGTW and Sequential Genetic Time Warping (SGTW). A Normal Distribution Model based on Rabiner23 is used to evaluate the performance of the three algorithms analytically. The analyzed results showed that the PGTW had performed better than the TTS. It also showed that the PGTW had very similar results as the SGTW, but about 30% CPU time is saved in the single processor system.

Acute toxicity of excess mercury on the photosynthetic performance of cyanobacterium, S. platensis--assessment by chlorophyll fluorescence analysis

Measurement of chlorophyll fluorescence has been shown to be a rapid, non-invasive, and reliable method to assess photosynthetic performance in a changing environment. In this study, acute toxicity of excess Hg on the photosynthetic performance of the cyanobacterium S. platensis, was investigated by use of chlorophyll fluorescence analysis after cells were exposed to excess Hg (up to 20 microM) for 2 h. The results determined from the fast fluorescence kinetics showed that Hg induced a significant increase in the proportion of the Q(B)-non-reducing PSII reaction centers. The fluorescence parameters measured under the steady state of photosynthesis demonstrated that the increase of Hg concentration led to a decrease in the maximal efficiency of PSII photochemistry, the efficiency of excitation energy capture by the open PSII reaction centers, and the quantum yield of PSII electron transport. Mercury also resulted in a decrease in the coefficients of photochemical and non-photochemical quenching. Mercury may have an acute toxicity on cyanobacteria by inhibiting the quantum yield of photosynthesis sensitively and rapidly. Such changes occurred before any other visible damages that may be evaluated by other conventional measurements. Our results also demonstrated that chlorophyll fluorescence analysis can be used as a useful physiological tool to assess early stages of change in photosynthetic performance of algae in response to heavy metal pollution.

Trace metals in mussels from mariculture zones, Hong Kong

In 1997, concentrations of cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb) and nickel (Ni) were analysed in green-lipped mussels (Perna viridis) from three mariculture zones located in the north-east (Kat O), south (Lo Tik Wan) and to the west (Ma Wan) of Hong Kong. Spatial differences in the concentration of metals were found, chromium and copper were higher at Ma Wan and Lo Tik Wan compared to Kat O in the north-east. In contrast, the highest levels of lead (mean = 4.37 microg/g dry wt) were recorded at Kat O. There were no differences in the level of nickel between the study sites. A comparison of the metal concentrations in mussels with the results of a previous study seven years before, in 1990, showed a twofold increase in the mean levels of cadmium for all three sites. However, levels of the other metals in 1997 were lower by 12-32% for chromium, 32-39% for copper and 24-25% for nickel. The greatest reductions were recorded for lead: Kat O (39%), Ma Wan (51%) and Lo Tik Wan (75%). This may be related to the introduction of lead-free petrol in 1991. Despite the apparent reduction in some heavy metal bioaccumulation between 1990 and 1997, from a public health risk perspective, the data suggest a continued need for monitoring of heavy metals in mussels from mariculture zones.

Chronological observations of primary somatosensory cortical maps in kittens following low thoracic (T12) spinal cord transection at 2 weeks of age

The present study investigated the reorganization of the somatosensory cortex in kittens following T12 spinal cord transection at 2 weeks of age. Multiunit electrophysiological methods were used to map the somatosensory cortex of kittens at 3, 6, and 9 weeks after the transection. The entire reorganized cortical region was driven by substitute cutaneous inputs, primarily from the trunk, at 3 weeks after spinal cord transection. Although the level of cortical responsiveness remained the same throughout the 9 weeks studied, internal trunk representation changed, and there was an increase in shoulder girdle representation and emergence of forelimb representation. Poor somatotopic and topographic order was observed in the reorganized cortex, regardless of time posttransection. Finally, trunk receptive fields displayed a wide variety of shapes, sizes, and orientations not seen in the normal cortex.