OBJECTIVE. To determine whether in the local lay Hong Kong population, video self-instruction about cardiopulmonary resuscitation has comparable results to traditional classroom instructions.

DESIGN. Prospective randomised single-blind controlled trial.

SETTING. A first-aid training organisation in Hong Kong.

PARTICIPANTS. Cantonese applicants for cardiopulmonary resuscitation courses aged between 18 and 70 years were recruited into the study. They were randomised into two groups. Those selected for self-learning were given a kit (consisting of a mini-manikin, a video compact disc, and an instruction manual) and sent home. The other group underwent usual classroom training. Both groups were examined together; the examiners remained blinded to the background training of the subjects. Those who passed were asked to come back for re-examination after 1 year.

MAIN OUTCOME MEASURES. The examination passing rates initially and after 1 year.

RESULTS. During a 1-year period between 1 April 2007 to 31 March 2008, 256 subjects were recruited into this study, 124 for self-learning and 132 for classroom training. The age range was 18 to 62 (mean, 39; standard deviation, 10) years. There was no significant difference in passing rate between the two groups at the initial examination or at the re-examination after 1 year. Notably, 28 (23%) of the participants of the self-learning group taught cardiopulmonary resuscitation to relatives and friends.

CONCLUSION. Video self-learning resulted in cardiopulmonary resuscitation performance as good as traditional classroom training.

Key words: Education; Heart arrest; Learning; Public sector; Teaching

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OBJECTIVE. To study the efficacy and safety of endoscopic ultrasonography–guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong.

DESIGN. Retrospective review of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography–guided fine-needle aspiration from July 1998 to June 2007.

MAIN OUTCOME MEASURES. The diagnostic accuracy and safety of the procedure and its influence in patient management.

RESULTS. Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography–guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically.

CONCLUSIONS. Trans-oesophageal endoscopic ultrasonography–guided fineneedle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.

Key words: Biopsy, needle; Carcinoma, non–small-cell lung; Endosonography; Lung neoplasms; Mediastinum

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OBJECTIVES. To identify concepts including misconceptions among the community members regarding family doctors, and determine factors affecting decisions on which doctor to consult in different clinical scenarios.

DESIGN. Household telephone survey conducted between 4 and 13 September 2006.

SETTING. Hong Kong community.

PARTICIPANTS. Cantonese-speaking Hong Kong residents aged 18 years or more were targeted. Randomly selected participants were asked to complete a questionnaire, which was designed based on a literature search and subsequent focus group discussions.

RESULTS. Among the 1811 households with eligible subjects to survey, 1204 completed the questionnaire (response rate, 67%). More than 85% considered a family doctor to be the first doctor they wanted to see even if it was inconvenient. "Clearly knowing my physical conditions", "fast-acting and effective treatment", and "doctor with friendly and sincere attitude" were the three most important factors influencing the choice of a family doctor. When affected by flu-like symptoms, 65% would go to a private clinic, 20% to a general out-patient clinic, 6% to a designated clinic with staff approved by their respective medical insurance/ medical benefit scheme, and 5% to a private hospital outpatient clinic. Among the latter two groups, 65% consulted the same doctor every time when they felt sick. More than 50% of those willing to have regular follow-up by a family doctor for hypertension and diabetes paid more than HK$300 per month. Approximately 64% might consider having regular follow-up at a general out-patient clinic by a nurse specialist.

CONCLUSION. Hong Kong inhabitants already have their own ideas regarding how to care for their own health, and what kind of family doctors they prefer. This survey should help both doctors and health care policy makers to realign their current thinking, and thus provide a platform for the development of a primary care model unique to Hong Kong.

Key words: Clinical competence; Patient satisfaction; Physician-patient relations; Physicians, family; Quality indicators, health care

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OBJECTIVES. To (1) determine the demographics of Chinese children admitted with primary spontaneous pneumothorax, (2) suggest how they may be quantified radiologically, (3) compare the difference in outcomes after their primary management by thoracentesis and chest tube insertion, and (4) review the local experience with surgical intervention for such children.

DESIGN. Retrospective, descriptive study.

SETTING. Acute tertiary public hospital, Hong Kong.

PATIENTS. Consecutive patients younger than 18 years and admitted with primary spontaneous pneumothorax between 1 January 1999 and 30 September 2007.

MAIN OUTCOME MEASURES. Hospital stay and risk of recurrence after thoracentesis versus chest tube insertion.

RESULTS. Seventy-seven patients with 114 episodes of primary spontaneous pneumothorax were reviewed. They were significantly taller (P<0.001) and thinner (P<0.001) than the population mean percentile. Both the Light index and Collins formula were accurate in quantifying pneumothorax volume, but as the former was simpler and more user-friendly, this was more applicable in children. Thoracentesis resulted in shorter hospital stays (mean, 4.6; standard deviation, 1.9 days) than chest tube insertion (6.9; 3.0 days), but there was no significant difference in the recurrence rates within 6 months (P=1.0), 1 year (P=0.9), and 2 years (P=0.1). Insignificant pneumothorax was treated with observation alone in 16% of the patients. For patients with a clinically significant pneumothorax, thoracentesis and chest tube insertion were successful in 78% and 67%, respectively (P=0.34). The success rate of video-assisted thoracoscopic surgery was 89%, and postoperative recurrence occurred more commonly in patients without a lung bleb.

CONCLUSION. Chinese children with primary spontaneous pneumothorax exhibited similar demographic characteristics to Caucasian children. Light index is simple and accurate for quantifying pneumothorax volume in children. Conservative treatment including observation, thoracentesis, and chest tube insertion should suffice for most patients with first episode of primary spontaneous pneumothorax. Early surgery is warranted for any patient who fails conservative treatment, for which video-assisted thoracoscopic surgery is safe and effective.

Key words: Chest tubes; Child; Pneumothorax; Recurrence; Treatment outcome

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OBJECTIVE. To review the clinical features and management of patients with injuries related to the Chinese cobra (Naja atra).

DESIGN. Retrospective study.

SETTING. Two acute hospitals in Hong Kong.

MAIN OUTCOME MEASURES. The nature of injuries, envenoming features, complications, response to antivenom therapy, and outcome.

RESULTS. Eighteen patients were recruited during the 5-year study period. Fifteen of them were snake-bitten, the remaining three suffered ocular injuries. Of the 15 patients with cobra bites, 14 (93%) presented with local swelling. No patient developed severe neurotoxic symptoms. Two patients had laboratory features of haemolysis. Fourteen patients received antivenom therapy and five of them subsequently underwent surgical interventions for extensive local tissue damage and necrosis. There was no fatality.

CONCLUSION. Bites from Chinese cobra result in serious local complications with extensive tissue necrosis and minimal neurotoxic symptoms. There is an apparent trend of favourable outcomes following the early administration of antivenom to patients without early signs of irreversible tissue damage. Further research is needed to evaluate the effectiveness of early antivenom use in Chinese cobra bites in order to minimise extent of tissue damage.

Key words: Antivenins; Cobra venoms; Emergency treatment; Necrosis; Snake bites

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