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Biomedical subjects

Michael Leung

Publications and source records attributed to Michael Leung.

6 recordsLinked to original sources
PubMed2006

Control and management of hospital indoor air quality.

BACKGROUND: The complex hospital environment requires special attention to ensure healthful indoor air quality (IAQ) to protect patients and healthcare workers against hospital-acquired (nosocomial) infections and occupational diseases. The aim here is to recommend effective guidelines for the control and management of hospital IAQ. MATERIAL/METHODS: The authors have done an extensive literature review and conducted comprehensive IAQ assessments in nine hospitals. It is noted that the IAQ measurements are not presented in this paper because of confidentiality. However, the IAQ analysis was studied carefully in the development of the recommendations given in this paper. RESULTS: The airborne chemical and microbiological contaminants of concern for hospitals have been identified and the major emission sources, monitoring methods, and exposure limits have been well documented and are reviewed here. Proper engineering system designs and operations are also reviewed, with recommendations for effective dilution and removal of the contaminants. The control and mitigation measures cover mechanical ventilation, filtration, differential pressure control, directional airflow control, local exhaust ventilation, and ultraviolet germicidal irradiation (UVGI) disinfection. Their applications in critical environments, such as operating theatres, isolation rooms, and other typical units, such as outpatient departments and laboratories, are also considered. CONCLUSIONS: Effective IAQ monitoring methods and mitigation measures suitable for the hospital environment have been identified. Accordingly, strategies for the implementation of a hospital indoor air quality management system are recommended. Healthcare workers, hospital engineers, and administrative staff can use the above as guidelines to manage and run their hospitals with healthful indoor air quality.

Air Microbiology↗
PubMed2006

Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study.

Evidence suggests that flavonoid-containing diets reduce cardiovascular risk, but the mechanisms responsible are unclear. In the present study, we sought to determine the effect of flavanol-rich cocoa on vascular function in individuals with CAD (coronary artery disease). Forty subjects (61+/-8 years; 30 male) with CAD were recruited to a 6-week randomized double-blind placebo-controlled study. Subjects consumed either a flavanol-rich chocolate bar and cocoa beverage daily (total flavanols, 444 mg/day) or matching isocaloric placebos daily (total flavanols, 19.6 mg/day) for 6 weeks. Brachial artery FMD (flow-mediated dilation) and SAC (systemic arterial compliance) were assessed at baseline, 90 min following the first beverage and after 3 and 6 weeks of daily consumption. Soluble cellular adhesion molecules and FBF (forearm blood flow) responses to ACh (acetylcholine chloride; 3-30 microg/min) and SNP (sodium nitroprusside; 0.3-3 microg/min) infusions, forearm ischaemia and isotonic forearm exercise were assessed at baseline and after 6 weeks. FMD, SAC and FBF responses did not differ between groups at baseline. No acute or chronic changes in FMD or SAC were seen in either group. No difference in soluble cellular adhesion molecules, FBF responses to ischaemia, exercise, SNP or ACh was seen in the group receiving flavanol-rich cocoa between baseline and 6 weeks. These data suggest that over a 6-week period, flavanol-rich cocoa does not modify vascular function in patients with established CAD.

Aged↗
PubMed2006

Gluteal compartment syndrome.

Gluteal compartment syndrome is uncommon and is often diagnosed late, resulting in muscle necrosis and sciatic nerve palsy. The mainstay of treatment is prompt diagnosis and early surgery. A high index of suspicion is essential, especially in the setting of major bleeding and excessive pain. Embolization and hyperbaric oxygen may be considered as adjuncts to surgery.

Bicycling↗
PubMed2005

The hospital costs of treating necrotizing fasciitis.

BACKGROUND: Management of necrotizing fasciitis places significant demands upon hospital and medical resources. A successful management usually requires extensive surgical intervention and an adjunct hyperbaric oxygen treatment. The cost impact on the health care system has not been well characterized. We have, therefore, analysed the cost of treating this disease at an Australian tertiary referral hospital with extensive case experience and well-developed financial costing systems and have compared this with the current casemix-based government funding arrangements applying in Victoria, Australia. METHODS: Data was extracted from the medical records of 92 sequential patients treated by the Alfred Hospital (Melbourne, Australia) during the four financial years 2000-04. Clinical costing data and government funding data was provided by the hospital's Finance Departments. RESULTS: The total Alfred Hospital in-patient costs for treating the patients was $5,935,545 with a mean cost per patient of $64,517 (range, $1025 to $514,889). The total casemix-based funding allocation derived from treating these patients was calculated at $3,208,664 with the per patient mean $34,887 (range, $1331 to $387,168). This analysis does not include allowance for non-Alfred Hospital costs such as those incurred by the ambulance service, referring hospitals, for rehabilitation or as a result of the burden of residual disability. CONCLUSIONS: This study has confirmed that a significant economic burden is involved in treating necrotizing fasciitis. There is a substantial difference between the hospital costs and government funding for treating these patients in the Australian setting.

Diagnosis-Related Groups↗
PubMed2003

Too much vacuum-assisted closure.

There has been an explosion in the use of the vacuum-assisted closure device since 1997. Selectively and judiciously used, it is a valuable tool. However, we are concerned by the expanding list of 'indications' for its use. Prolonged applications, frequently several weeks, at the expense of early surgical reconstruction, might compromise the outcome in selected cases. We report four cases that illustrate this problem and stress the importance of timely surgical reconstruction utilizing the range of reconstructive techniques available as well as vacuum-assisted closure dressing.

Adult↗