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P106: Palliative care for people with advanced dementia
- Kuei-Yu Liang, Yu-Hsuan Lai, Chung-Chi Ho
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 251-252
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Objective:
Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among elderly. In Taiwan, there are at least 300,000 people live with dementia. However, only 1.64% of people with dementia received palliative care. In this paper, we describe a real-world experience of palliative care for people with advanced dementia.
Method:Case report.
Result:Mrs. H, A 90-year-old illiterate woman, was referred to Home Care team after several admissions for urinary tract infection. Her past medical history included cerebral infarction with left hemiparesis 4 years ago. Over one year prior our first visit, her family had begun to notice a problem with her recent memory. Thorough investigation for dementia was arranged. She scored 11/30 on the Mini-Mental State Examination. Mixed Alzheimer’s and vascular dementia was impressed.
The Home Care service consisted of a once-monthly visit by physician and nurse. In the first year of service, we delivered active directed treatment for dementia. We also discussed nonpharmacological approaches for dealing with physical and behavior symptoms in each visit.
Then Mrs. H was hospitalized again due to fever and abdominal pain. Abdominal aortic aneurysm was diagnosed along with urinary tract infection. She had hypoactive delirium for two months after discharge. Meanwhile, Home Care team arranged a family meeting to discuss prognosis and appropriateness of palliative care. In the following two years, we focused on deprescribing and interventions for pain, dyspnea, eating problem, infection, and agitation to promote Mrs. H’s comfort and quality of life. Psychological support was crucial to facilitate continuity in carer and care setting. Mrs.H did not have burdensome transition anymore and passed away peacefully at home as her preference.
Conclusion:The need for palliative care in dementia is anticipated to increase over the next decades in Taiwan. In the patient presented, Home Care team acknowledged and offered palliative care to help her to live as comfortably as possible until death and to help carers cope during the course. A multidisciplinary health care is highly recommended for complex needs in dementia.
Air dispersal of severe acute respiratory coronavirus virus 2 (SARS-CoV-2): Implications for hospital infection control during the fifth wave of coronavirus disease 2019 (COVID-19) due to the SARS-CoV-2 omicron variant in Hong Kong
- Shuk-Ching Wong, Veronica Wing-Man Chan, Lithia Lai-Ha Yuen, Christine Ho-Yan AuYeung, Jessica Oi-Yan Leung, Chi-Kuen Li, Monica Oi-Tung Kwok, Simon Yung-Chun So, Jonathan Hon-Kwan Chen, Anthony Raymond Tam, Ivan Fan-Ngai Hung, Kelvin Kai-Wang To, Janice Yee-Chi Lo, Kwok-Yung Yuen, Vincent Chi-Chung Cheng
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 24 October 2022, pp. 1321-1324
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- August 2023
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We obtained 24 air samples in 8 general wards temporarily converted into negative-pressure wards admitting coronavirus disease 2019 (COVID-19) patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant BA.2.2 in Hong Kong. SARS-CoV-2 RNA was detected in 19 (79.2%) of 24 samples despite enhanced indoor air dilution. It is difficult to prevent airborne transmission of SARS-CoV-2 in hospitals.
Air dispersal of respiratory viruses other than severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and the implication on hospital infection control
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- Shuk-Ching Wong, Veronica Wing-Man Chan, Christine Ho-Yan AuYeung, Jonathan Hon-Kwan Chen, Cyril Chik-Yan Yip, Simon Yung-Chun So, Xin Li, David Christopher Lung, Anita Man-Ching Tsang, Kelvin Kai-Wang To, Kwok-Yung Yuen, Vincent Chi-Chung Cheng
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 5 / May 2023
- Published online by Cambridge University Press:
- 11 July 2022, pp. 768-773
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- May 2023
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Background:
Air dispersal of respiratory viruses other than SARS-CoV-2 has not been systematically reported. The incidence and factors associated with air dispersal of respiratory viruses are largely unknown.
Methods:We performed air sampling by collecting 72,000 L of air over 6 hours for pediatric and adolescent patients infected with parainfluenza virus 3 (PIF3), respiratory syncytial virus (RSV), rhinovirus, and adenovirus. The patients were singly or 2-patient cohort isolated in airborne infection isolation rooms (AIIRs) from December 3, 2021, to January 26, 2022. The viral load in nasopharyngeal aspirates (NPA) and air samples were measured. Factors associated with air dispersal were investigated and analyzed.
Results:Of 20 singly isolated patients with median age of 30 months (range, 3 months–15 years), 7 (35%) had air dispersal of the viruses compatible with their NPA results. These included 4 (40%) of 10 PIF3-infected patients, 2 (66%) of 3 RSV-infected patients, and 1 (50%) of 2 adenovirus-infected patients. The mean viral load in their room air sample was 1.58×103 copies/mL. Compared with 13 patients (65%) without air dispersal, these 7 patients had a significantly higher mean viral load in their NPA specimens (6.15×107 copies/mL vs 1.61×105 copies/mL; P < .001). Another 14 patients were placed in cohorts as 7 pairs infected with the same virus (PIF3, 2 pairs; RSV, 3 pairs; rhinovirus, 1 pair; and adenovirus, 1 pair) in double-bed AIIRs, all of which had air dispersal. The mean room air viral load in 2-patient cohorts was significantly higher than in rooms of singly isolated patients (1.02×104 copies/mL vs 1.58×103 copies/mL; P = .020).
Conclusion:Air dispersal of common respiratory viruses may have infection prevention and public health implications.
Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial
- Christy Lai Ming Hui, Andreas Kar Hin Wong, Elise Chun Ning Ho, Bertha Sze Ting Lam, Priscilla Wing Man Hui, Tiffany Junchen Tao, Wing Chung Chang, Sherry Kit Wa Chan, Edwin Ho Ming Lee, Yi Nam Suen, May Mei Ling Lam, Cindy Pui Yu Chiu, Frendi Wing Sai Li, Kwok Fai Leung, Sarah M. McGhee, Chi Wing Law, Dicky Wai Sau Chung, Wai Song Yeung, Michael Gar Chung Yiu, Edwin Pui Fai Pang, Steve Tso, Simon Sai Yu Lui, Se Fong Hung, Wing King Lee, Ka Chee Yip, Ka Lik Kwan, Roger Man Kin Ng, Pak Chung Sham, William G. Honer, Eric Yu Hai Chen
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- Journal:
- Psychological Medicine / Volume 53 / Issue 6 / April 2023
- Published online by Cambridge University Press:
- 11 February 2022, pp. 2339-2351
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Background
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
Methods360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
ResultsCompared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
ConclusionsSpecialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Multipronged infection control strategy to achieve zero nosocomial coronavirus disease 2019 (COVID-19) cases among Hong Kong healthcare workers in the first 300 days of the pandemic
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- Vincent Chi-Chung Cheng, Shuk-Ching Wong, Danny Wah-Kun Tong, Vivien Wai-Man Chuang, Jonathan Hon-Kwan Chen, Larry Lap-Yip Lee, Kelvin Kai-Wang To, Ivan Fan-Ngai Hung, Pak-Leung Ho, Deacons Tai-Kong Yeung, Kin-Lai Chung, Kwok-Yung Yuen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 3 / March 2022
- Published online by Cambridge University Press:
- 19 March 2021, pp. 334-343
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- March 2022
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Background:
Nosocomial outbreaks leading to healthcare worker (HCW) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic.
Objective:We implemented a strategy to reduce nosocomial acquisition.
Methods:We summarized our experience in implementing a multipronged infection control strategy in the first 300 days (December 31, 2019, to October 25, 2020) of the COVID-19 pandemic under the governance of Hospital Authority in Hong Kong.
Results:Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first pandemic wave (142 cases), second wave (896 cases), and third wave (3,770 cases) in Hong Kong. With the exception of 1 patient who died before admission, all COVID-19 patients were admitted to the public healthcare system for a total of 78,834 COVID-19 patient days. The median length of stay was 13 days (range, 1–128). Of 81,955 HCWs, 38 HCWs (0.05%; 2 doctors and 11 nurses and 25 nonprofessional staff) acquired COVID-19. With the exception of 5 of 38 HCWs (13.2%) infected by HCW-to-HCW transmission in the nonclinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population; P = .008). The incidence of COVID-19 among professional staff was significantly lower than that of nonprofessional staff (0.30 vs 0.66 per 1,000 full-time equivalent; P = .022).
Conclusions:A hospital-based approach spared our healthcare service from being overloaded. With our multipronged infection control strategy, no nosocomial COVID-19 in was identified among HCWs in the first 300 days of the COVID-19 pandemic in Hong Kong.
Absence of nosocomial influenza and respiratory syncytial virus infection in the coronavirus disease 2019 (COVID-19) era: Implication of universal masking in hospitals
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- Shuk-Ching Wong, Germaine Kit-Ming Lam, Christine Ho-Yan AuYeung, Veronica Wing-Man Chan, Newton Lau-Dan Wong, Simon Yung-Chun So, Jonathan Hon-Kwan Chen, Ivan Fan-Ngai Hung, Jasper Fuk-Woo Chan, Kwok-Yung Yuen, Vincent Chi-Chung Cheng
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 2 / February 2021
- Published online by Cambridge University Press:
- 17 August 2020, pp. 218-221
- Print publication:
- February 2021
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Universal masking for healthcare workers and patients in hospitals was adopted to combat coronavirus disease 2019 (COVID-19), with compliance rates of 100% and 75.9%, respectively. Zero rates of nosocomial influenza A, influenza B, and respiratory syncytial virus infection were achieved from February to April 2020, which was significantly lower than the corresponding months in 2017–2019.
Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19)
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- Vincent Chi-Chung Cheng, Shuk-Ching Wong, Veronica Wing-Man Chan, Simon Yung-Chun So, Jonathan Hon-Kwan Chen, Cyril Chik-Yan Yip, Kwok-Hung Chan, Hin Chu, Tom Wai-Hin Chung, Siddharth Sridhar, Kelvin Kai-Wang To, Jasper Fuk-Woo Chan, Ivan Fan-Ngai Hung, Pak-Leung Ho, Kwok-Yung Yuen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 11 / November 2020
- Published online by Cambridge University Press:
- 08 June 2020, pp. 1258-1265
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- November 2020
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Background:
The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)–laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports.
Methods:Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients’ clinical samples and environmental samples was analyzed.
Results:All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients’ mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001).
Conclusion:SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.
The 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies
- Sherry Kit Wa Chan, Kaspar Kit Wai Lee, Veronica Hei Yan Chan, Herbert H. Pang, Corine Sau Man Wong, Christy Lai Ming Hui, Wing Chung Chang, Edwin Ho Ming Lee, Wai Chi Chan, Eric Fuk Chi Cheung, Helen Fung Kum Chiu, Tin Po Chiang, Ming Lam, Joseph Tak Fai Lau, Roger Man King Ng, Se Fong Hung, Linda Chiu Wa Lam, Eric Yu Hai Chen
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- Psychological Medicine / Volume 51 / Issue 14 / October 2021
- Published online by Cambridge University Press:
- 29 May 2020, pp. 2501-2508
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Background
The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms.
MethodThis is a population-based two-phase household survey of Chinese population in Hong Kong aged 16–75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up.
ResultsThe 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up.
ConclusionsResults highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
Reusable blood collection tube holders are implicated in nosocomial hepatitis C virus transmission
- Vincent C. C. Cheng, Shuk-Ching Wong, Sally C. Y. Wong, Siddharth Sridhar, Cyril C. Y. Yip, Jonathan H. K. Chen, James Fung, Kelvin H. Y. Chiu, Pak-Leung Ho, Sirong Chen, Ben W. C. Cheng, Chi-Lai Ho, Chung-Mau Lo, Kwok-Yung Yuen
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- Infection Control & Hospital Epidemiology / Volume 40 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 30 January 2019, pp. 252-253
- Print publication:
- February 2019
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Effectiveness of antimicrobial hospital curtains on reducing bacterial contamination—A multicenter study
- Shik Luk, Viola Chi Ying Chow, Kelvin Chung Ho Yu, Enoch Know Hsu, Ngai Chong Tsang, Vivien Wai Man Chuang, Christopher Koon Chi Lai, Mamie Hui, Rodney Allan Lee, Wai Man Lai, Tak Lun Que, Sau Chun Fung, Wing Kin To, Vincent Chi Chung Cheng, Andrew Tin Yau Wong
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 40 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 18 December 2018, pp. 164-170
- Print publication:
- February 2019
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Objective
To determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.
DesignA prospective, open-labeled, multicenter study with a follow-up duration of 6 months.
SettingThis study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.
MethodCulture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.
ResultsWith a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).
ConclusionsAntimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.
Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission
- Vincent C.C. Cheng, Shuk-Ching Wong, Sally C.Y. Wong, Siddharth Sridhar, Cyril C.Y. Yip, Jonathan H.K. Chen, James Fung, Kelvin H.Y. Chiu, Pak-Leung Ho, Sirong Chen, Ben W.C. Cheng, Chi-Lai Ho, Chung-Mau Lo, Kwok-Yung Yuen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 39 / Issue 10 / October 2018
- Published online by Cambridge University Press:
- 29 August 2018, pp. 1170-1177
- Print publication:
- October 2018
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Background
A liver transplant recipient developed hospital-acquired symptomatic hepatitis C virus (HCV) genotype 6a infection 14 months post transplant.
ObjectiveStandard outbreak investigation.
MethodsPatient chart review, interviews of patients and staff, observational study of patient care practices, environmental surveillance, blood collection simulation experiments, and phylogenetic study of HCV strains using partial envelope gene sequences (E1–E2) of HCV genotype 6a strains from the suspected source patient, the environment, and the index patient were performed.
ResultsInvestigations and data review revealed no further cases of HCV genotype 6a infection in the transplant unit. However, a suspected source with a high HCV load was identified. HCV genotype 6a was found in a contaminated reusable blood-collection tube holder with barely visible blood and was identified as the only shared item posing risk of transmission to the index case patient. Also, 14 episodes of sequential blood collection from the source patient and the index case patient were noted on the computerized time log of the laboratory barcoding system during their 13 days of cohospitalization in the liver transplant ward. Disinfection of the tube holders was not performed after use between patients. Blood collection simulation experiments showed that HCV and technetium isotope contaminating the tip of the sleeve capping the sleeved-needle can reflux back from the vacuum-specimen tube side to the patient side.
ConclusionsA reusable blood-collection tube holder without disinfection between patients can cause a nosocomial HCV infection. Single-use disposable tube holders should be used according to the recommendations by Occupational Safety and Health Administration and World Health Organization.
Prevalence of anxiety disorders in community dwelling older adults in Hong Kong
- Ada Wai Tung Fung, Wai-Chi Chan, Corine Sau-Man Wong, Eric Yu-Hai Chen, Roger Man-Kin Ng, Edwin Ho-Ming Lee, Wing-Chung Chang, Se-Fong Hung, Eric Fuk-Chi Cheung, Pak-Chung Sham, Helen Fung-Kum Chiu, Ming Lam, Tin-Po Chiang, Jim van Os, Joseph Tak-Fai Lau, Glyn Lewis, Paul Bebbington, Linda Chiu Wa Lam, The Hong Kong Mental Morbidity Survey Team
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- Journal:
- International Psychogeriatrics / Volume 29 / Issue 2 / February 2017
- Published online by Cambridge University Press:
- 21 October 2016, pp. 259-267
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Background:
Anxiety disorders are prevalent yet under-recognized in late life. We examined the prevalence of anxiety disorders in a representative sample of community dwelling older adults in Hong Kong.
Method:Data on 1,158 non-demented respondents aged 60–75 years were extracted from the Hong Kong Mental Morbidity survey (HKMMS). Anxiety was assessed with the revised Clinical Interview Schedule (CIS-R).
Result:One hundred and thirty-seven respondents (11.9%, 95% CI = 10–13.7%) had common mental disorders with a CIS-R score of 12 or above. 8% (95% CI = 6.5–9.6%) had anxiety, 2.2% (95% CI = 1.3–3%) had an anxiety disorder comorbid with depressive disorder, and 1.7% (95% CI = 1–2.5%) had depression. Anxious individuals were more likely to be females (χ2 = 25.3, p < 0.001), had higher chronic physical burden (t = −9.3, p < 0.001), lower SF-12 physical functioning score (t = 9.2, p < 0.001), and poorer delayed recall (t = 2.3, p = 0.022). The risk of anxiety was higher for females (OR 2.8, 95% C.I. 1.7–4.6, p < 0.001) and those with physical illnesses (OR 1.4, 95% C.I. 1.3–1.6, p < 0.001). The risk of anxiety disorders increased in those with disorders of cardiovascular (OR 1.9, 95% C.I. 1.2–2.9, p = 0.003), musculoskeletal (OR 2.0, 95% C.I. 1.5–2.7, p < 0.001), and genitourinary system (OR 2.0, 95% C.I. 1.3–3.2, p = 0.002).
Conclusions:The prevalence of anxiety disorders in Hong Kong older population was 8%. Female gender and those with poor physical health were at a greater risk of developing anxiety disorders. Our findings also suggested potential risk for early sign of memory impairment in cognitively healthy individuals with anxiety disorders.
Prevalence, Prediction, and Clonality of Methicillin-Resistant Staphylococcus aureus Carriage at Admission to Medical Units in Hong Kong, China
- Shik Luk, Alex Yat Man Ho, Tak Keung Ng, Iris Hoi Ling Tsang, Eliza Hoi Ying Chan, Kin Wing Choi, Ngai Chong Tsang, Rodney Allan Lee, Vincent Chi Chung Cheng, Sau Chun Fung, Wai Man Lai, Tak Lun Que, Andrew Tin Yau Wong
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 1 / January 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 42-48
- Print publication:
- January 2014
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Objective.
To determine the prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization at the time of admission to acute medical units and to develop a cost-effective screening strategy.
Methods.Nasal and groin screening cultures were performed for patients at admission to 15 acute medical units in all 7 catchment regions in Hong Kong. All MRSA isolates were subjected to spa typing.
Results.The overall carriage rate of MRSA was 14.3% (95% confidence interval [CI], 13.5–15.1). MRSA history within the past 12 months (adjusted odds ratio [OR], 4.60 [95% CI, 3.28–6.44]), old age home residence (adjusted OR, 3.32 [95% CI, 2.78–3.98]), and bedbound state (adjusted OR, 2.19 [95% CI, 1.75–2.74]) were risk factors selected as MRSA screening criteria that provided reasonable sensitivity (67.4%) and specificity (81.8%), with an affordable burden (25.2%). spa typing showed that 89.5% (848/948) of the isolates were clustered into the 4 spa clonal complexes (CCs): spa CC1081, spa CC032, spa CC002, and spa CC4677. Patients colonized with MRSA spa types t1081 (OR, 1.77 [95% CI, 1.49–2.09]) and t4677 (OR, 3.09 [95% CI, 1.54–6.02]) were more likely to be old age home residents.
Conclusions.MRSA carriage at admission to acute medical units was prevalent in Hong Kong. Our results suggest that targeted screening is a pragmatic approach to increase the detection of the MRSA reservoir. Molecular typing suggests that old age homes are epicenters in amplifying the MRSA burden in acute hospitals. Enhancement of infection control measures in old age homes is important for the control of MRSA in hospitals.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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18 - Polycystic ovary syndrome in Asian women
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- By Ernest Hung Yu Ng, Queen Mary Hospital, Hong Kong, Carina Chi Wai Chan, Queen Mary Hospital, Hong Kong, Pak Chung Ho, Queen Mary Hospital, Hong Kong
- Edited by Gabor T. Kovacs, Monash University, Victoria, Robert Norman, University of Adelaide
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- Polycystic Ovary Syndrome
- Published online:
- 29 September 2009
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- 22 February 2007, pp 316-330
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Summary
Introduction
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age as this syndrome may affect 5–10% of premenopausal women in Western countries (Franks 1995). Women with this syndrome may present with one, all, or any combination of menstrual irregularities, chronic anovulation, infertility, obesity, and hyperandrogenism. There is substantial heterogeneity of symptoms and signs among women with PCOS and different criteria have been used to confirm the diagnosis. Ultrasound assessment of ovarian morphology is considered to be essential and the gold standard for defining polycystic ovaries in Europe (Adams et al. 1986, Balen 1999). Characteristic ovarian morphology is not required in the American definition, which states that PCOS is the association of hyperandrogenism with chronic anovulation in women without specific underlying diseases of the adrenal or pituitary glands (Dunaif 1997).
Recently, a revised definition of PCOS was agreed and required the presence of two from the following three diagnostic criteria: (1) oligo- and/or anovulation; (2) clinical and/or biochemical features of hyperandrogenism; and (3) the presence of polycystic ovary (PCO) morphology (The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004). In recent years, transvaginal ultrasound has become the most commonly used diagnostic method for the identification of PCO. In order to make a diagnosis of PCO, >10 follicles of 2–10 mm in diameter and increased density of ovarian stroma (Adams et al. 1986) are required.
Active CPU Cooling System with Piezoelectric Actuated Droplet Generator
- Chun-Fu Lu, Chi-Ming Huang, Jinn-Cherng Yang, Hung -Liang Chiang, Chien-Chung Fu, Chiang-Ho Cheng, Chun-Jung Chen
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- MRS Online Proceedings Library Archive / Volume 888 / 2005
- Published online by Cambridge University Press:
- 01 February 2011, 0888-V03-05
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- 2005
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Ink jet technology is applied to the industry application of CPU cooling in this study. The PZT actuated micro-cooling device which generating the micro-scale liquid droplet is used in the CPU cooling of desktop and laptop PCs. It consists the advantages of long lifetime of operation, simple and easily manufactured of the structure with PZT actuator. Since the high latent heat transfer rate, 2260 J/g, of water droplet for the liquid-vapor phase change cooling system, it removes heat from the CPU surface effectively for over 100 W. In order to design an efficient cooling device, it is important to study the PZT material property varies after the laser cutting process and the dimensional effects of PZT actuator on the nozzle plate vibration mode. The frequency and amplitude of the voltage used to energize the PZT transducer are also important parameters that should be properly controlled in order to achieve the optimal liquid breakup conditions. It also reveals the low noise and power consumption in the CPU cooling system with some appropriate operational conditions.