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Biomedical subjects

C C Lau

Publications and source records attributed to C C Lau.

At least 19 recordsLinked to original sources
PubMed2006

Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department.

AIM: To evaluate the effect of triage rapid initial assessment by doctor (TRIAD) on waiting time and processing time of an emergency department (ED) without extra staff. METHOD: A senior emergency doctor was put into triage instead of a consultation cubicle for seven shifts of 9 hours each. All the patients were assessed and necessary interventions started at the time of triage. Waiting time and processing time of various categories of patients were compared with a control group that was sampled during the week before the trial period. RESULTS: In total, there were 1310 cases in the trial period and 1355 controls. Over a quarter (27%) of the patients received triage doctor interventions. The average waiting time was reduced by 38% and the average processing time by 23%. Patients without triage intervention also had a 24% shorter waiting time because of overall improvement in efficiency. Trauma patients and patients needing radiography particularly benefited from the new system. The waiting time and processing time of category 4 and 5 patients improved significantly as a result of more efficient processing of more urgent cases. CONCLUSION: The waiting time and processing time of the ED were greatly reduced by TRIAD without extra manpower.

Emergency Service, Hospital↗
PubMed2004

A survey on the involvement of accident and emergency doctors in medicolegal work in Hong Kong.

This study reports the results from a questionnaire survey on the pattern of medico-legal work undertaken by doctors working in Accident & Emergency Departments (ED) and their self-evaluation of competency in forensic medicine. A total of 155 questionnaires were returned with a response rate of 46%. Only 30% (46) respondents were fellows of the Hong Kong College of Emergency Medicine but 46% (71) had more than 6 years of experience working in the ED. Most of the requests for medical report came from police and insurance companies. Fellows had more experience writing reports on homicide, sexual assault and child abuse than non-fellows did. Nearly all fellows and three quarters (74%) of non-fellows had given evidence in courts of law. Physical assault was the commonest and sexual assault the least common experience. Most respondents had experience of attending district court (83%), followed by coroner inquest (67%), magistracy (66%) and high court (45%). Respondents were asked to rate themselves on their competence in various subject areas. It can be seen that respondents were less comfortable in areas like homicide, child abuse and sexual assault. On the job coaching by a senior seems to be the major mode of training. Both fellows (61%) and non-fellows (36%) favored some form of courses with a hands-on workshop element in future.

Attitude of Health Personnel↗
PubMed2004

Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation.

OBJECTIVE: To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation. METHODS: A prospective observational study in two phases. In phase one, midazolam 2-4 mg was used as induction agent and in phase two, etomidate 0.2-0.3 mg/kg was used. The haemodynamic data were recorded before and after intubation for comparison. Changes in mean systolic blood pressure were analysed with SPSS software. RESULTS: A 10% decrease in mean systolic blood pressure was observed in the midazolam group (p = 0.001) while there was no significant change in the etomidate group. Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant. CONCLUSIONS: Midazolam, even in low dose, was more likely than etomidate to cause significant hypotension when used as an induction agent for rapid sequence intubation. Etomidate is a better alternative.

Age Factors↗
PubMed2002

The utility of spectral karyotyping in the cytogenetic analysis of newly diagnosed pediatric acute lymphoblastic leukemia.

We applied multicolor spectral karyotyping (SKY) to a panel of 29 newly diagnosed pediatric pre B-cell ALLs with normal and abnormal G-banded karyotypes to identify cryptic translocations and define complex chromosomal rearrangements. By this method, it was possible to define all add chromosomes in six cases, a cryptic t(12;21)(p13;q11) translocation in six cases, marker chromosomes in two cases and refine the misidentified aberrations by G-banding in two cases. In addition, we identified five novel non-recurrent translocations - t(2;9)(p11.2;p13), t(2;22) (p11.2;q11.2), t(6;8)(p12;p11), t(12;14)(p13;q32) and t(X;8)(p22.3;q?). Of these translocations, t(2;9), t(2;22) and t(12;14) were identified by G-banding analysis and confirmed by SKY. We characterized a t(12;14)( p13;q32) translocation by FISH, and identified a fusion of TEL with IGH for the first time in ALL. We identified a rearrangement of PAX5 locus in a case with t(2;9)(p11.2;p13) by FISH and defined the breakpoint telomeric to PAX5 in der(9)t(3;9)(?;p13). These studies demonstrate the utility of using SKY in combination with G-banding and FISH to augment the precision with which chromosomal aberrations may be identified in tumor cells.

Acute Disease↗
PubMed2002

Attitude towards rape among doctors working in the emergency department.

In this study, a 29-item questionnaire survey was conducted to explore the attitude and knowledge toward rape amongst doctors working in Hong Kong. The Likert scale was used for questions on attitude and knowledge. A composite score was computed for both attitude and knowledge. Comparisons of the attitude and knowledge scores were made between doctors of different genders and ranks. Existing practices in the handling of rape cases were also explored. The response rate was 58%; 175 questionnaires were completed by 147 (84%) male and 28 (16%) female doctors. There were 12 (6.3%) consultants, 44 (23%) senior medical officers and 119 (62%) medical officers. The average length of emergency department experience was 4.7 years. Most doctors held a favourable attitude towards rape victims, and there was no significant difference between senior and junior doctors (P=0.062) or between doctors of different genders (P=0.793). However, 36% of the doctors agreed that 'a women should be responsible for preventing her own rape', and more female doctors agreed that 'a woman can successfully resist rape if she tries hard enough' (P<0.042). Senior doctors had a higher knowledge score (P<0.0001). The correlation between knowledge and attitude scores was low (Spearman coefficient 0.258; P<0.05). In conclusion, doctors working in the emergency department generally held favourable attitudes towards rape victims. However, there is still room for improvements in attitude and knowledge. A one-stop service is suggested to avoid fragmentation and prevent 'revictimization'.

Attitude of Health Personnel↗
PubMed2000

Profile and outcomes of patients transported to an accident and emergency department by helicopter: prospective case series.

OBJECTIVES: To study the profile of airlifted patients and their outcomes after arrival at the hospital, and to evaluate the appropriateness of their prehospital care and the decision to use aeromedical evacuation. DESIGN: Prospective case series. SETTING: Accident and emergency department of a public hospital, Hong Kong. PATIENTS: All patients transported to the department by a helicopter of the Government Flying Service from June 1998 through November 1998. MAIN OUTCOME MEASURES: Demographic data, sources and locations of referral, clinical features, triage category, interventions used, and outcome. RESULTS: A total of 186 patients were transferred by helicopter during the 6-month study period. The 101 patients who had been transferred from a rural hospital or clinic were older (mean age, 50 years versus 35 years), comprised more females (55% versus 26%), had a higher overall mortality rate (19.8% versus 3.6%), and had a higher hospital admission rate (91.1% versus 37.6%) than the 85 patients who had been airlifted from the scene of an emergency. Neurological disorders were the most common presentation among interfacility transfers (21.8%). Among the 85 scene transfers, limb injuries (32.1%) and heat illnesses (24.4%) were the most common reasons for helicopter transport. Most interfacility transfers were appropriate, but 34.1% of patients who had been transferred from the scene of the emergency were later discharged and 21.1% refused consultation. CONCLUSIONS: Scene and interfacility transfers by helicopter have different patient profiles, and a substantial proportion of scene transfers may be inappropriate. Guidelines such as field triage and helicopter dispatch criteria need to be established.

Adult↗
PubMed1999

Differential expression of NF1 type I and type II isoforms in sporadic borderline and invasive epithelial ovarian tumors.

The NF1 gene, a putative tumor suppressor gene, contains a GAP related domain (GRD) which accelerates hydrolysis of ras-bound GTP to GDP, thereby converting the ras oncogene from its active to inactive form. Two forms of the NF1 GRD transcript (Type I and Type II) are differentially expressed in neuroectodermal tumor tissue relative to differentiated neural cells, and in gastric cancer cell lines relative to normal stomach mucosa. We measured relative expression of NF1 Type II and Type I isoforms in cultured normal and malignant human ovarian surface epithelial cells(HOSE) and in invasive and borderline ovarian tumor tissue. We demonstrated an 11-fold increase in Type II:Type I ratio in 7 HOSE cultures relative to eight ovarian cancer cell lines. Our findings indicate a significant decrease in Type II isoform expression and increase in Type I expression in ovarian cancer cells and tumor tissue relative to HOSE cells. We also demonstrate an increase in Type II:Type I ratio, and a decrease in cell proliferation rate in three ovarian cancer cell lines on treatment with retinoic acid. We propose that differential expression of the NF1 Type I and Type II isoforms is related to cellular differentiation in ovarian epithelial cancer and strategies based on alteration in NF1 isoform expression may have therapeutic potential in ovarian malignancies.

Adenocarcinoma↗
PubMed1999

Home accidents in elderly patients presenting to an emergency department.

A prospective study was carried out in an Accident and Emergency department (A&E) to (1) examine the pattern of home accidents in elderly patients presenting to the A&E; (2) determine the nature and mechanisms of the accidents; and (3) investigate the associated factors in these accidents. All patients aged 65 or above with a history of injury at home within one week were included. Patients who needed immediate resuscitation and patients with mental illness or violent behaviour were excluded. A convenient sample was chosen during an 8-week period. A standardized questionnaire was used to collect data on (1) demographics; (2) nature of the accident and injury; and (3) health status. Health status assessment involved three components: physical status, drug history and past health. A total of 100 subjects were included giving an average occurrence of 3.3 cases per shift. The mean age of the group was 75 with female patients (66) outnumbering the males by about two to one. The toilet was the most common site (29%) of home accident, followed by the sitting room (18%), the kitchen (14%), the bedroom (11%) and the dining room (10%). In 79 cases the patient was alone at home during the accident. Falls were the most common (75%) type of accident. The remaining 25% of injuries were categorized as sharps injury (8%), foreign body ingestion (6%), crush injury (4%), burns/scald (3%), hit by/onto fallen objects (3%) and finally, electric shock (1%). Eighteen fractures were recorded. Thirty-two patients were admitted, 16 to the surgical ward and 16 to the orthopedic ward. In the functional assessment only 34 patients could perform the get-up-and-go test satisfactorily and only 61 patients had good hand grasp. Visual and hearing impairment were common. Over 45% of the patients had more than one disease and the majority of patients (80) were taking some medication. The roles of A&E staff in the prevention of home accidents in the elderly are discussed.

Accidents, Home↗
PubMed1999

How good are accident and emergency doctors in the evaluation of psychiatric patients?

The aim of this study was to find out the agreement between psychiatrists and emergency department (ED) doctors in the diagnosis and treatment of psychiatric emergencies. All patients presenting with a psychiatric complaint and who were subsequently referred to the psychiatrist were included. A standard form was used to collect demographic data, provisional diagnoses and initial treatment by ED doctors, diagnoses by psychiatrists, and compatibility of ED diagnoses and treatment as judged by consulting psychiatrists. The mean age of the 223 patients enrolled was 36.5 years and the distribution between males and females was roughly equal. The most frequent presentations were aggressive behaviour (27.9%), depressive mood (13.5%) and suicidal idea (12.1%). Schizophrenia (39%) was the most common diagnosis followed by depression (20%) and adjustment disorders (9.5%). The agreements between psychiatrists and ED doctors in diagnosis and treatment were 61.4% and 89.5% respectively. Schizophrenia and bipolar disorders were least likely to be mis-classified. It is concluded that ED doctors were deficient in the diagnosis of psychiatric conditions especially in the less common diagnostic categories.

Adult↗
PubMed1999

Candidates for thrombolytic treatment in acute ischaemic stroke--where are our patients in Hong Kong?

OBJECTIVE: Tissue plasminogen activator (t-PA) has been approved by the Food and Drug Administration in the treatment of patients with acute ischaemic stroke presenting within three hours from onset of symptoms. This study aims to identify the potential number of stroke patients suitable for t-PA in Hong Kong. METHODS: All patients with a clinical diagnosis of acute stroke were recruited. Data collected included demographics, vital signs, medical history, contraindications to thrombolysis, severity of stroke (Canadian neurological scale), time course from onset of symptoms to computed tomography, computed tomography results, and final diagnoses by physicians. RESULTS: During the five month study period, 201 patients were recruited and nine were subsequently excluded from further analysis because computed tomography was not performed. Their mean age was 70.9 (range from 41-91) years. Eighty (41.7%) and 100 (52.1%) patients presented to our emergency department within two hours and three hours respectively from symptom onset. The mean severity score (Canadian neurological scale) was 7.83 (out of a maximum of 11.5). A total of 132 (68.8%) patients had acute ischaemic stroke confirmed by computed tomography. Mean delay in computed tomography was 4.91 hours. Fourteen (7.3%) and 52 (27.1%) of all patients had computed tomography of the brain done within one and two hours respectively. Only 20 patients (10.45%) could meet the three hour criteria as stated in the National Institute of Neurologic Disorders and Stroke rt-PA stroke study and seven (3.6%) of them were confirmed to have acute ischaemic stroke. Two patients were further excluded because of high systolic blood pressure and current warfarin medication. CONCLUSION: At present very few patients could benefit from thrombolytic treatment. Delays in the chain of recovery in stroke management should be identified and corrected.

Acute Disease↗
PubMed1999

Evaluation of the value of an observation ward in an emergency department.

A prospective study was undertaken to describe the pattern of utilization of an observation ward in an emergency department (ED). During a 1-month study period, the following data were collected for all patients admitted to the observation ward: (1) patient demographics, (2) purpose of observation, (3) interventions at the observation ward, (4) disposal destinations, (5) disposal diagnosis, (6) outcome categories, and (7) duration of stay. A total of 12188 patients attended our ED and 1042 (8.51%) patients were admitted into the observation ward. An average of 34 patients was admitted into the observation ward each day. The age of the patients ranged from neonates to 94 years (mean age of 45.7 years, +/-25.7 SD). Sex distribution was almost equal. The diagnostic evaluation group was the largest (58%) followed by short-term therapy (38%) and psychosocial problems (3.5%). Of the 554 patients with a disposal diagnosis, 350 (59%) had their diagnosis clarified after the observation period. The percentage of patients admitted to the hospital was 23%. There were 42 chest pain and 46 trauma patients. The impact of an observation ward on the service in ED was discussed.

Adolescent↗
PubMed1998

DOC-2, a candidate tumor suppressor gene in human epithelial ovarian cancer.

Using RNA fingerprinting (RAP) strategy and Northern blot analysis, we identified a differentially expressed sequence DOC-2 which is detectable in all normal human ovarian surface epithelial (HOSE) cell cultures but not in ovarian cancer cell lines and tissues. Subsequent cloning of DOC-2 from a cDNA library generated from the HOSE cells was carried out using the 3' and 5' RACE approach. A 3268 base pair full length cDNA of DOC-2 was isolated and sequenced. The predicted protein has a length of 770 amino acids. Homology search of all NCBI sequences indicated that the amino acid sequence of DOC-2 shares 93% homology with the mouse p96/mDab2 phosphoprotein and has a phosphotyrosine interacting domain (PID) and multiple SH3 binding motifs. Chromosomal localization by FISH showed that the DOC-2 gene is located on 5p13. Western blot analysis showed that the 105 kDa DOC-2 protein was down-regulated in all the carcinoma cell lines. In-situ immunohistochemistry performed on normal ovaries, and benign, borderline and invasive ovarian tumor tissues showed down regulation of DOC-2 protein particularly in serous ovarian tumor tissues. When DOC-2 was transfected into the ovarian carcinoma cell line SKOV3, the stable transfectants showed significantly reduced growth rate and ability to form tumors in nude mice. These data suggest that down-regulation of DOC-2 may play an important role in ovarian carcinogenesis.

Adaptor Proteins, Signal Transducing↗
PubMed1998

A one centimorgan deletion unit on chromosome Xq12 is commonly lost in borderline and invasive epithelial ovarian tumors.

We have used polymerase chain reaction (PCR) amplification of tandem repeats to study the pattern of allelic loss on chromosome X11.2-q12 in borderline and invasive epithelial ovarian tumors. Using eight microsatellite markers spanning Xq11.2-q12, 41 borderline and 65 invasive ovarian tumors, together with their corresponding normal tissues, were analysed. The highest percentage of loss of heterozygosity (LOH) was observed at the DXS1194 locus in borderline tumors (four of 16 informative cases, 25%) and at the androgen receptor (AR) locus in invasive epithelial ovarian tumors (18 of 47 informative cases, 38%). X chromosome activation studies performed in cases with LOH at the AR locus showed that the allelic loss at the AR locus is not confined to the inactive allele. A one centimorgan region including the AR locus and flanked by the primers DXS1161 and PGK1P1 was identified as the smallest common loss region in both borderline and invasive epithelial ovarian tumors.

Alleles↗
PubMed1998

Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department.

OBJECTIVE: To assess the value of ultrasound in an emergency department in the diagnosis of early pregnancy complications, the efficacy of a study protocol in identifying ectopic pregnancies, and the agreement on ultrasound findings among emergency department staff and gynaecologists. METHODS: All women presenting with early pregnancy complications had a transabdominal ultrasound scan performed by the attending doctor and checked by a senior doctor. The ultrasound findings were classified as normal intrauterine pregnancy (IUP), probable abnormal pregnancy, definite ectopic pregnancy, no definite IUP, and other. Women with clinical and ultrasound findings compatible with threatened abortion were referred to a gynaecologist, or were admitted if findings suggested abnormal or ectopic pregnancy, or if a definite IUP could not be confirmed on ultrasound scan. For patients who were admitted or referred, a transvaginal ultrasound scan was performed by the attending gynaecologist. The findings of the gynaecologist were used as the gold standard. RESULTS: 151 cases were enrolled during a four month study period. Ultrasound findings in the emergency department included definite IUP in 95 (63%), probable abnormal IUP in 20 (13%), no definite IUP in 23 (21%), and other findings in four (3%). For evaluating the presence or absence of IUP, sensitivity of the initial scan was 82% (95% confidence interval 76% to 88%) and specificity 92% (88% to 96%). Agreement between junior and senior emergency department doctors on their ultrasound findings was 81% (75% to 87%) and between emergency department senior staff and gynecologists 85% (79% to 91%). The diagnoses made in the emergency department were thought to be compatible with the final assessments by gynaecologist in 72% (65% to 79%). Using either no definite IUP or other findings as a positive screening test for ectopic pregnancy, the sensitivity, specificity, positive predictive value, and negative predictive value were 80% (74% to 86%), 78% (71% to 85%), 12% (7% to 17%), and 99% (97% to 100%), respectively. CONCLUSIONS: Transabdominal ultrasound performed in the emergency department is useful in screening for early pregnancy complications. Ectopic pregnancy should be suspected when no IUP is found on preliminary scanning.

Adult↗
PubMed1997

Enhancement of 131I-mediated cytotoxicity by caffeine.

In cell culture, caffeine has been shown to enhance the lethality of DNA-damaging agents including ultraviolet rays, X-irradiation, and alkylating agents. We have previously reported a Phase I clinical trial demonstrating the feasibility of intraperitoneal radioimmunotherapy in patients with refractory ovarian cancer using 131I-labeled monoclonal antibody OC125. We are now exploring the possibility of using caffeine to enhance the toxicity of 131I-irradiation in target cells. As an in vitro model we tested this hypothesis using Chinese hamster ovary (CHO) cells exposed to 131I-labeled human serum albumin at various doses (4 to 70 microCi/ml) for 24 hr followed by 24 hr of incubation with caffeine. Cytotoxicity was measured by clonogenic survival and a nuclear fragmentation assay. The results show that caffeine, at a concentration of 7.7 mM, significantly enhances the cytotoxicity of 131I-irradiation.

Animals↗
PubMed1997

A disaster drill in Hong Kong.

This case report relates the course of a disaster drill held on 19 August 1994 in a regional acute hospital (Pamela Youde Nethersole Eastern Hospital) in Hong Kong. The Hospital Civil Disaster Contingency Plan (the Plan) was put to trial on that day. Volunteers were invited to become simulated casualties in the exercise. Briefing seminars had been conducted with clinicians of the Accident and Emergency department (A & E) and other departments of the hospital. The scenario was a man-made type disaster. A double-decker bus turned over and injured 19 people in that afternoon. All the victims were sent to A & E by ambulance. The Plan was activated and relevant units were mobilized according to the Plan. It took 45 minutes to complete the disaster exercise. Debriefing sessions reviewed difficulties encountered throughout the drill and possible remedies.

Disaster Planning↗