Biomedical subjects

Florence Yap

Publications and source records attributed to Florence Yap.

3 recordsLinked to original sources

PubMed2006

Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU.

OBJECTIVE: To describe the extent and temporal pattern of transmission of severe acute respiratory syndrome (SARS) to intensive care unit staff. DESIGN: Retrospective observational cohort study. SETTING: University hospital intensive care unit, caring solely for patients with SARS or suspected to have SARS. PARTICIPANTS: Thirty-five doctors and 152 nurses and healthcare assistants who worked in the ICU during the SARS epidemic. INTERVENTIONS: Infection control measures designed to prevent transmission of disease to staff were implemented. MEASUREMENTS AND RESULTS: Sixty-seven patients with SARS were admitted to the intensive care unit. Four nurses and one healthcare assistant contracted SARS, with three of these developing symptoms within 10 days of admission of the first patient with SARS. Doctors were exposed to patients with SARS for a median (IQR) of 284 (97-376) h, while nurses and healthcare assistants were exposed for a median (IQR) of 119 (57-166) h. The ICU did not meet international standards for physical space or ventilation. CONCLUSIONS: In an ICU in which infection control procedures are rigorously applied, the risk to staff of contracting SARS from patients is low, despite long staff exposure times and a sub-standard physical environment.

Cohort Studies↗

PubMed2004

Short-term outcome of critically ill patients with severe acute respiratory syndrome.

OBJECTIVE: To document the outcome and determine prognostic factors for patients with severe acute respiratory syndrome who require admission to an intensive care unit. DESIGN: Observational cohort study involving retrospective analysis of demographic, clinical, laboratory and radiological data. SETTING: Adult intensive care unit in a tertiary referral university hospital involved in a major outbreak of severe acute respiratory syndrome (SARS). PATIENTS: The first 54 patients admitted with SARS to an intensive care unit (ICU). All were treated with corticosteroids, ribavirin, broad spectrum antimicrobials and supportive therapy. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: All patients were admitted for respiratory failure. The median APACHE II score was 11 (interquartile range 8-13). At 28 days 34 patients (63%; 95% CI 49.6-74.6) were alive and not mechanically ventilated. Six patients were alive but ventilated (11.3%; 95% confidence interval 5.3-22.6) and 14 had died (25.9%; CI 16.1-38.9). Seven of 27 ventilated patients developed evidence of barotrauma (25.9%; 95% CI 13.2-44.7). Median maximal multiple-organ dysfunction score was 5 (interquartile range 3.3-9). Median maximal respiratory dysfunction score was 3 (interquartile range 3-4). Increased age, severity of illness, lymphocyte count, decreased steroid dose, positive fluid balance, chronic disease or immunosuppression and nosocomial sepsis were associated with poor outcome on univariate analysis. Poor outcome was defined as death or need for mechanical ventilation at 28 days after ICU admission. CONCLUSIONS: Mortality amongst critically ill patients with SARS is high. It causes predominantly severe respiratory failure, with little other organ failure, and a high incidence of barotrauma amongst those requiring mechanical ventilation.

Adult↗

PubMedDate not supplied

Severe acute respiratory syndrome: thin-section computed tomography features, temporal changes, and clinicoradiologic correlation during the convalescent period.

OBJECTIVE: To evaluate thin-section computed tomography findings of patients with severe acute respiratory syndrome (SARS) in the convalescent period and to correlate the results with clinical parameters and lung function tests. METHODS: Ninety-nine severe acute respiratory syndrome patients with persistent changes on follow-up chest radiography were included. One hundred seventy computed tomography examinations at baseline (n=70), 3 months (n=56), and 6 months (n=44) were retrospectively evaluated to determine the extent of ground-glass opacification, reticulation, and total parenchymal involvement. Patients' demographic information, clinical information during treatment, and results of lung function tests at 3 and 6 months were correlated with computed tomography findings. RESULTS: A significant serial improvement in the extent of overall ground-glass opacification, overall reticulation, and total parenchymal involvement was observed (P <0.01). Advanced age, previous intensive care unit admission, mechanical ventilation, alternative treatment, higher peak lactate dehydrogenase, and peak radiographic involvement during treatment showed a positive correlation with overall reticulation and total parenchymal involvement at 6 months. There was a significant negative correlation between overall reticulation and total parenchymal involvement with diffusion capacity adjusted for hemoglobin at 3 and 6 months (P <0.01). CONCLUSION: Lung changes on thin-section computed tomography of severe acute respiratory syndrome patients improved with time during the convalescent period and showed a significant correlation with advanced age, parameters indicating severe illness, and diffusion capacity adjusted for hemoglobin on follow-up.

Adult↗