The impact of the type and screen test on hospital transfusion practice

ABSTRACT

Hong Kong Med J 1999;5:275-9 | Number 3, September 1999
MEDICAL PRACTICE
The impact of the type and screen test on hospital transfusion practice
EYD Chow
Department of Pathology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
 
 
The requirements of pretransfusion testing have undergone repeated modification, and those of the type and screen policy are currently the most widely accepted to be standard. The type and screen test policy, together with the abbreviated crossmatch procedure, was implemented in the United Christian Hospital in January 1997. This paper discusses the impact of the type and screen test policy on clinicians and patients, on the blood bank and hospital, and on the future of the hospital transfusion services.
 
Key words: Blood banks; Blood grouping and crossmatching; Blood group incompatibility; Computers; Blood transfusion
 
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Guidelines for the administration of hormone replacement therapy. The Hong Kong College of Obstetricians and Gynaecologists

ABSTRACT

Hong Kong Med J 1999;5:195–5 | Number 2, June 1999
MEDICAL PRACTICE
Guidelines for the administration of hormone replacement therapy. The Hong Kong College of Obstetricians and Gynaecologists
CJ Haines, S Fan, GWK Tang, LCH Tang
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To establish guidelines on the administration of hormone replacement therapy in Hong Kong for a primary audience of Fellows and Members of the Hong Kong College of Obstetricians and Gynaecologists and a secondary audience of all interested medical and paramedical personnel in Hong Kong.
 
PARTICIPANTS. The Quality Assurance Committee established a consensus panel of four College Fellows who had expertise of treating menopausal women by giving hormone replacement therapy. All the panelists were qualified obstetricians and gynaecologists.
 
EVIDENCE. The panelists drew their conclusions from the available scientific literature on hormone replacement therapy from Hong Kong and overseas.
 
CONSENSUS PROCESS. The consensus reached within the panel was presented to the Quality Assurance Committee on 23 June 1998, and subsequently revised and presented three times. The final version was approved by the Quality Assurance Committee on 2 March 1999 and the Council of the Hong Kong College of Obstetrics and Gynaecology on 11 March 1999.
 
CONCLUSIONS. The administration of hormone replacement therapy is effective in reducing the severity and frequency of menopausal hot flushes and sweating. Therapy protects against osteoporosis and reduces the risk of cardiovascular disease. There is some evidence to suggest that treatment also protects against Alzheimer’s disease and carcinoma of the colon. The most serious problem attributed to using hormone replacement therapy is the possible increase in the risk of breast cancer development; the exact risk is unknown. Side effects include unwanted bleeding and breast tenderness and sensitivity. The risks and benefits of using hormone replacement therapy should be explained to postmenopausal women so that they can make an informed decision about using this treatment.
 
Key words: Estrogen replacement therapy; Hong Kong; Practice guidelines
 
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Treatment of palmar hyperhidrosis using tap water iontophoresis: local experience

ABSTRACT

Hong Kong Med J 1999;5:191-4 | Number 2, June 1999
MEDICAL PRACTICE
Treatment of palmar hyperhidrosis using tap water iontophoresis: local experience
LY Chan, WYM Tang, KK Lo, WK Mok, CYF Ly, AWC Ip
Social Hygiene Services, Department of Health, Tuen Mun Social Hygiene Clinic, 5/F Tuen Mun Polyclinic, 4 Tuen Lee Street, Tuen Mun, New Terrirories, Hong Kong
 
 
To evaluate the efficacy and safety of tap water iontophoresis in the treatment of severe idiopathic palmar hyperhidrosis, nine Chinese patients with severe palmar hyperhidrosis that had failed to respond to topical aluminium chloride were given 6 weeks' treatment with tap water iontophoresis at the Social Hygiene Service, Department of Health, Hong Kong. The reduction in sweat output was assessed objectively and subjectively. The mean objective reduction in sweat output was 49%, 51%, 26%, and 22% at week 3, 6, 10, and 12, respectively, since the start of treatment with tap water iontophoresis The mean subjective improvements were 43%, 59%, 30%, and 12% at week 3, 6,10, and 12, respectively. The side effects reported were all mild and transient. We conclude that tap water iontophoresis is a safe and useful treatment modality for palmar hyperhidrosis.
 
Key words: Hand; Hyperhidrosis/therapy; Iontophoresis/methods; Sweat/secretion
 
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Physicians' practice patterns of treating Helicobacter pylori--associated peptic ulceration in public hospitals in Hong Kong: questionnaire survey

ABSTRACT

Hong Kong Med J 1999;5:187-90 | Number 2, June 1999
MEDICAL PRACTICE
Physicians' practice patterns of treating Helicobacter pylori--associated peptic ulceration in public hospitals in Hong Kong: questionnaire survey
KKH Or, JJY Sung, YW Luk, ST Lai, SC Tiu
 
 
To survey the practice patterns of physicians in public hospitals in Hong Kong when treating Helicobacter pylori--associated peptic ulceration, the records of all patients from 22 medical units who had new peptic ulcers that had been diagnosed endoscopically during August 1996 were examined systematically. Patient data were entered on a one-page questionnaire. Five hundred and twelve patients with peptic ulceration were studied; 173 (34%) of whom had presented with gastro-intestinal bleeding. The H pylori status had been determined in 449 (88%) patients, 280 (62%) of whom had subsequently tested positive for H pylori. The biopsy urease test or histological examination had been performed for more than 95% of patients. Of 260 patients who had tested positive for H pylori, 244 (94%) had received eradication therapy to eliminate this organism; a total of 291 patients, however, were receiving eradication therapy. The most commonly used regimen was proton pump inhibitor triple therapy (151 [52%] of 291 patients). Confirmation of the eradication of H pylori had been planned for 152 (52%) of the 291 patients, whereas ulcer-healing drugs - mainly H2-receptor antagonists - had been prescribed for 87 (30%) patients after eradication. Curing H pylori infection is therefore widely accepted in the management of peptic ulcer disease among physicians working in Hong Kong public hospitals.
 
Key words: Health care surveys, Helicobacter pylori, Peptic ulcer/drug therapy; Physician's practice patterns
 
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Influenza surveillance in Hong Kong: results of a trial Physician Sentinel Programme

ABSTRACT

Hong Kong Med J 1999;5:87-94 | Number 1, March 1999
MEDICAL PRACTICE
Influenza surveillance in Hong Kong: results of a trial Physician Sentinel Programme
KA Fitzner, SM McGhee, AJ Hedley, KF Shortridge
Health Services Research Group, Department of Community Medicine, The University of Hong Kong, Patrick Manson Building South Wing, 7 Sassoon Road, Pokfulam, Hong Kong
 
 
The H5N1 influenza outbreak in Hong Kong at the end of 1997 emphasised the need for viral surveillance so that new influenza epidemics can be foreseen. Although South China is regarded as the regional epicentre of influenza epidemics, there has been little epidemiological documentation of the disease there. A sentinel physician network was established in Hong Kong in 1993 to estimate the incidence, severity, and seasonality of influenza-like illnesses and to provide data on the demand for health care that is related to this illness. Influenza-like illness occurred throughout the year of the survey, peaking from March through May and accounting for 15% of doctor visits. The incidence was approximately 117 in 1000 patients and was greatest among children aged 1 to 4 years. Ongoing physician surveillance with appropriate coverage of the general population supported by a laboratory virus isolation capability may help control future influenza outbreaks.
 
Key words: Disease outbreaks; Hong Kong; Incidence; Influenza/epidemiology; Influenza/prevention & control; Sentinel surveillance
 
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Clinical management guidelines for osteoporosis in Hong Kong

ABSTRACT

Hong Kong Med J 1998;4:423-31 | Number 4, December 1998
MEDICAL PRACTICE
Clinical management guidelines for osteoporosis in Hong Kong
The Working Group for Formulating Clinical Management Guidelines for Osteoporosis in Hong Kong
 
 
The following guidelines provide a basis for the management of osteoporosis for the practising physician in Hong Kong. The guidelines have been compiled by a working group that represents the specialties concerned with osteoporosis and summarise the current management of osteoporosis based on available published evidence and relevant local experience.
 
Key words: Hong Kong; Osteoporosis; Practice guidelines
 
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Chemotherapy of tuberculosis in Hong Kong: a consensus statement

ABSTRACT

Hong Kong Med J 1998;4:315-20 | Number 3, September 1998
MEDICAL PRACTICE
Chemotherapy of tuberculosis in Hong Kong: a consensus statement
The Tuberculosis Control Coordinating Committee
 
 
This consensus statement is prepared primarily as a concise reference for tuberculosis chemotherapy in Hong Kong. Treatment should be tailored to patients individually, expert advice should be sought when necessary, and 'directly observed treatment' should be used where possible. A 6-month regimen is recommended as the initial treatment of uncomplicated pulmonary tuberculosis and a 9-month regimen is recommended for retreatment. Patients with disease that is resistant to isoniazid or rifampicin may require modified regimens. Multidrug-resistant tuberculosis should be managed in specialised centres, using multiple drugs as guided by in vitro susceptibility tests. Recommended regimens to treat extrapulmonary tuberculosis are based on limited current evidence, although shorter regimens may be acceptable when better evidence emerges. A longer duration of treatment is required for diabetic, immuno-compromised, or silicotic patients. During pregnancy, streptomycin should be avoided; the safety profiles of second-line drugs have not yet been ascertained. Hepatotoxic drugs should be used with caution in patients with liver dysfunction, and extra caution and dosage reductions are required if streptomycin and ethambutol are used in patients with renal impairment.
 
Key words: Anititubercular agents; Drug therapy, combination; Hong Kong; Tuberculosis/drug therapy
 
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Is in-patient management of diastolic blood pressure between 90 and 100 mm Hg during pregnancy necessary?

ABSTRACT

Hong Kong Med J 1998;4:211-7 | Number 2, June 1998
MEDICAL PRACTICE
Is in-patient management of diastolic blood pressure between 90 and 100 mm Hg during pregnancy necessary?
KY Leung, TK Sum, CY Tse, KM Law, MYM Chan
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
A randomised controlled trial was performed at the Queen Elizabeth Hospital to compare the effects and acceptance of routine in-patient versus out-patient management of diastolic blood pressure between 90 and 100 mm Hg in pregnant women. There were no significant differences in the establishment of the diagnosis of hypertension, development of severe hypertension or proteinuric hypertension, the number of women requiring obstetric interventions, or the neonatal outcome between the two groups. Antenatal hospital stay for the in-patient group, however, was more than twice as long as for the out-patient group (difference in mean stay, 3.7 days; 95% confidence interval, 1.3-6.2). The number of hospitalisations in the in-patient group was almost four times greater than that in the out-patient group (difference in mean number of hospitalisations, 1.7; 95% confidence interval, 1.2-2.2). The two groups did not differ in their levels of satisfaction of the overall management of blood pressure. Nevertheless, a greater proportion of women preferred to choose the same type of care among the out-patient group than among the in-patient group if they had hypertension in a future pregnancy (83.7% versus 51.2%; P<0.001). More women were dissatisfied about the number of admissions than on the frequency of out-patient care (40.5% versus 16.3%; P<0.001). We conclude that in-patient care, day care, or home monitoring should be individualised.
 
Key words: Comparative study; Day care; Hospitalization; Hypertension/therapy; Pregnancy complications
 
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Emergency defibrillation performed by coronary nursing staff: a pilot report

ABSTRACT

Hong Kong Med J 1998;4:47-51 | Number 1, March 1998
MEDICAL PRACTICE
Emergency defibrillation performed by coronary nursing staff: a pilot report
WK Chan, NNS Kung, MC Ma, WP Ng, S Chan, FL Lau
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
 
 
The time taken to initiate defibrillation is a key factor in determining survival after cardiac arrest; all first-responding medical or paramedical personnel are thus recommended to receive training in defibrillation skills. We have recently established a working programme that allows trained coronary care nurses to defibrillate in emergencies. Prospective data collected from 1 October 1996 to 31 January 1997 showed that a total of 11 witnessed episodes of ventricular fibrillation or pulseless ventricular tachycardia occurred in nine patients, and were defibrillated by nurses. All the defibrillations were started within 1 minute of cardiac arrest. In five patients, defibrillation was commenced before the arrival of the crash team of doctors; three of the five patients survived. There were no violations of the resuscitation protocol or complications relating to defibrillation. Through programmed training in advanced cardiac life-support, coronary care nurses are capable of providing safe and prompt defibrillation. The importance of training and re-certification is also stressed.
 
Key words: Coronary care units; Electric countershock; Nursing staff, hospital/education
 
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Preventing avoidable death: the case of cervical cancer in Hong Kong

ABSTRACT

Hong Kong Med J 1997;3:427-32 | Number 4, December 1997
MEDICAL PRACTICE
Preventing avoidable death: the case of cervical cancer in Hong Kong
P Adab, AJ Hedley
Department of Community Medicine, The University of Hong Kong, Patrick Manson Building South Wing, 7 Sassoon Road, Pokfulam, Hong Kong
 
 
Cervical cancer remains an important cause of avoidable morbidity and mortality in Hong Kong. This paper briefly reviews the epidemiology of cervical cancer and explores the evidence on the effectiveness of screening. The essential components of a successful cervical cancer screening programme, based on international experience, are discussed. The present situation in Hong Kong is then examined and the options outlined for the way ahead.
 
Key words: Cervical intraepithelial neoplasia; Cervix neoplasms; Hong Kong; Mass screening
 
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