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Background: Opportunistic screening for atrial fibrillation (AF) in patients older than 65 years is currently recommended., Objective: We aim to examine the effectiveness of a nongovernmental organization-led community-based AF screening program carried out by trained layperson volunteers., Methods: AF screening was performed using a smartphone electrocardiogram in 11,574 participants., Results: Among all participants, smartphone electrocardiograms were interpretable in 10,735 citizens (92.8%; 8564 female citizens [79.8%]; mean age 78.6 ± 8.1 years). Two hundred forty-four participants (2.3%; 95% confidence interval [CI] 2-2.6%; 172 female participants [70.5%]; mean age 79.5 ± 7.9 years) had AF and were advised over phone by a nurse to seek medical attention. Newly diagnosed AF was found in 74 participants (0.69%; 95% CI 0.54-0.84%) with a mean CHA 2 DS 2 -VASc score of 3.9 ± 1.5. Thirty-six of them (48%; 95% CI 36.6-59.4%) were asymptomatic. The number needed to screen for 1 newly diagnosed AF was 145. Telephone follow-up of participants with AF was conducted 9 months after screening. Of 72 participants with newly diagnosed AF and indicated for oral anticoagulation, 47 (65.3%; 95% CI 54.3-76.3%) sought medical attention, 17 (23.6%; 95% CI 13.8-33.4%) received oral anticoagulants, and 16 (22.2%; 95% CI 12.6-31.8%) had 100% compliance. The number needed to screen for 1 appropriately treated newly diagnosed AF was 671., Conclusion: This nongovernmental organization-led community-based AF screening program is effective in identifying citizens with newly diagnosed AF. However, the effectiveness of the program in subsequently leading them to receive appropriate oral anticoagulation therapy is weakened by the lack of a more structured downstream management pathway., (Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Sibutramine is an amphetamine-like drug used for its weight reducing effect. Sibutramine-induced acute coronary syndrome has rarely been reported. We report a case of myocardial infarction associated with the use of sibutramine., Case Report: A 37-year-old woman presented to an Emergency Department (ED) with intermittent retrosternal chest pain, nausea, and sweating for 3 days. She reported taking one sibutramine tablet each day for 3 days. Blood pressure was 128/89 mm Hg and pulse 66 beats/min. An electrocardiogram revealed ST elevation over the inferior leads and ST depression over leads AVR and V1, the other leads were normal. Serum troponin T was 0.65 microg/L, and sibutramine was identified in her urine. Echocardiography revealed mild hypokinesia over the inferior wall without evidence of acute aortic dissection. The ST segment changes resolved spontaneously within 24 h of cardiac care unit (CCU) admission, a coronary angiogram performed 1 week later was unremarkable, and echocardiography performed 4 weeks after the event showed normal resting regional wall motion., Discussion: Seventeen medications containing sibutramine as an active ingredient were registered in Hong Kong in 2007. Sibutramine was introduced in the United States in 1997 and in Australia, United Kingdom, and Italy in 2001. Hypertension, tachycardia, dry mouth, and headache are the most commonly reported adverse reactions. Cardiovascular toxicities include tachycardia, palpitation, hypertension, and tachyarrhythmia., Conclusions: We postulate that the myocardial infarction was the result of coronary vasospasm associated with the therapeutic use of sibutramine-containing slimming pills.

Background: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion-referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population., Objectives: To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter-rater and test-retest reliability., Design: The study was a cross-sectional study., Settings: The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study., Participants: A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years., Methods: The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls., Results: The scale had a sensitivity of 31% and a specificity of 83% when the cut-off point was determined at 45. The field test demonstrated excellent inter-rater reliability with an ICC value of 0.97 (95%CI 0.94-0.98). Repeatability was high with an ICC of 0.98 (95% CI 0.98-0.99). The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item-to-scale correlation., Conclusions: The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.

Severe acute respiratory syndrome (SARS) is a highly contagious disease that has led to large hospital and community outbreaks, necessitating stringent infection control in its management. Among 90 SARS patients in our institution in the 2003 outbreak, 2 underwent cardiac catheterization. We report the personal respiratory protection and environmental control measures implemented to minimize the risk of droplets spread during these procedures, including re-engineering of the ventilation system of the cardiac catheterization laboratory (CCL). The report highlights the importance of collaboration of CCL personnel with relevant hospital engineering and management teams to develop a contingency infection control plan to prepare for future outbreaks of SARS or other epidemics.