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Background There were recurrent upsurges in demand for public hospital services in Hong Kong. An understanding of the contribution of some possible factors for the rise in health care burden would help to inform hospital management strategies. Aim To evaluate the utilization patterns of hospitalizations in medical wards among public acute hospitals in Hong Kong during surge periods. Design Retrospective study. Methods By extracting the information in press releases between 2014 and 2018, descriptive statistics about medical ward occupancy situation during six surge periods were generated. A time series model was constructed to estimate the occupancy rate at each hospital and assess its relationship with the intensity of seasonal influenza activity, extreme weather, day of week and long holidays. Results There was a significant increase in the number of admissions to medical wards in all six surge periods. A significant variation in occupancy rate between weekdays and geographic regions was observed. The occupancy rate in 10, out of 15, hospitals was significantly associated with the influenza activity, while there was limited effect of weather on the occupancy rate. A significant holiday effect was observed during Christmas and Chinese New Year, resulting in a lower bed occupancy rate. Conclusions A differential burden in public hospitals during surge periods was reported. Contingency bed and staff management shall be tailored to individual hospitals, given their differences in the determinants for inpatient bed occupancy. [ABSTRACT FROM AUTHOR]

Objective.--Our goals were to determine the frequency and upgrade rate for atypical ductal hyperplasia (ADH) diagnosed with stereotactic 9-gauge vacuum-assisted breast biopsy and to compare the frequencies and upgrade rates of ADH between 9- and 11-gauge vacuum-assisted breast biopsy. Materials and Methods. We retrospectively reviewed the pathology results of 991 consecutive 9- or 11-gauge stereotactic vacuum-assisted breast biopsy procedures from February 2001 through June 2006 and identified lesions diagnosed as ADH. The final diagnosis after surgical excision was determined from medical records. The frequencies and upgrade rates to carcinoma were calculated for all ADH lesions and compared between 9- and ll-gauge procedures. The number of core samples was recorded and compared. Results.--One hundred forty-one of 991 (14.2%) lesions yielded a diagnosis of ADH at 9- or 11-gauge stereotactic vacuum-assisted breast biopsy. Upgrade to ductal carcinoma in situ or invasive carcinoma occurred in 26 of 123 (21.1%) patients. The frequency of ADH was 83 of 600 (13.8%) lesions for 9-gauge and 58 of 391 (14.8%) lesions for 11-gauge vacuum-assisted breast biopsy. The 9-gauge upgrade rate was 16 of 74 (21.6%) lesions compared with 10 of 49 (20.4%) lesions for 11-gauge vacuum-assisted breast biopsy. There was no significant difference between the number of core samples obtained with each device (p = 0.40). Neither the frequency of ADH (p = 0.66) nor the upgrade rates (p = 0.87) were significantly different between 9- and 11- gauge vacuum-assisted breast biopsy. Conclusion.--Compared with an 11-gauge vacuum-assisted breast biopsy device, the use of a larger 9-gauge vacuum-assisted breast biopsy needle does not decrease the upgrade rate of ADH. Our frequency of ADH at vacuum-assisted breast biopsy is higher than any previously reported and may reflect regional differences in the incidence of breast cancer or practice patterns of the pathologist. [ABSTRACT FROM AUTHOR]

Aim: Milligan-Morgan haemorrhoidectomy is considered the best treatment for haemorrhoidal disease. The major drawback is severe post-operative pain. We postulate that using the LigaSure™ vessel sealing system to divide the haemorrhoidal pedicle may cause less postoperative pain. Methods: This was a double-blinded randomised controlled trial in a single institution. Consecutive patients undergoing elective day-case haemorrhoidectomy were recruited. Patients were randomised into the diathermy (D) group or the LigaSure™ (L) group. The haemorrhoidal pedicle was coagulated with monopolar diathermy in D group or the LigaSure vessel sealing system in L group. Patients were seen in post-operative weeks 1, 3, 6 and 12 for assessment. Primary outcome was post-operative pain by 10cm visual analog pain score. Secondary outcomes include operative time, complications and day discharge rate. Results: 68 patients were recruited in this study (n=33 in D group versus n=35 in L group) with comparable demographic data. There was no significant difference in VAS pain score (median postoperative one-week cumulative pain score: D group = 40.2 versus L group = 39, p=0.93). More complications were observed in D group (5 versus 2, p=0.25) but this was not statistically significant. Day discharge rate was similar in the two groups at about 88%. Conclusion: Ligasure-assisted haemorrhoidectomy is not superior to diathermy haemorrhoidectomy. Day case haemorrhoidectomy is feasible and safe with both techniques. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effectiveness of ondansetron in the relief of post-operative nausea and vomiting in patients following ambulatory two port needlescopic cholecystectomy. Methods: Consecutive adult patients undergoing ambulatory two port needlescopic cholecystectomy were randomised to receive either a single dose of 8mg intravenous ondansetron or nothing. The primary outcome measure was the degree of post-operative nausea and vomiting (score 1 to 4) at 4 hours after surgery. Results: Patients' characteristics in the ondansetron (O) group (n=40) and the control (C) groups (n=41) were comparable. There was no significant difference between O and C groups in the incidence of PONV (17.5%versus 22%, p=0.615) and median PONV score (1 versus 1, p=0.226) at 4 hours after surgery. The post-operative pain score, analgesia consumption and post-operative stay were also similar in the two groups. Almost all the patients in both groups (97.5% versus 95.1%) could be discharged on the same day of operation. Conclusion: The administration of 8mg ondansetron conferred no additional benefit in post-operative nausea and vomiting. [ABSTRACT FROM AUTHOR]

Background: Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease., Method and Results: This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation., Conclusion: This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM., (Copyright © 2017. Published by Elsevier B.V.)

Introduction: Colorectal endoscopic submucosal dissection is not a widely adopted procedure due to its technical difficulties. This study aimed to share the experience in setting up this novel procedure and to report the learning curve for such a procedure at a low-volume district hospital in Hong Kong., Methods: This case series comprised 71 colorectal endoscopic submucosal dissections that were performed by a single endoscopist without experience in gastric or colorectal endoscopic submucosal dissection. Lesion characteristics, procedure time per unit area of tumour, en-bloc resection rate, R0 resection rate, complications, and length of stay were recorded prospectively. Results were compared for two consecutive periods to study the learning curve., Results: Overall, 41 (57.7%) tumours were located in the right colon, 21 (29.6%) in the left colon, and nine (12.7%) in the rectum. The median tumour area was 4 cm(2) (range, 0.25-16 cm(2)). The median operating time was 105 (range, 47-342) minutes. The median procedure time per unit area of tumour was 24.9 min/cm(2). There was one instance of intra-operative bleeding that required conversion to laparoscopic colectomy. There was no postoperative haemorrhage. The overall perforation rate was 15.5%, in which one required conversion to laparoscopic colectomy. The overall morbidity rate was 16.9% and there was no mortality. The median hospital stay was 1 day (range, 0-11 days). The overall en-bloc resection rate and R0 resection rate was 81.2% and 58.0%, respectively. Comparison of the two study periods revealed that procedure time per unit area of tumour decreased significantly from 31.5 min/cm(2) to 21.5 min/cm(2) (P=0.032). The en-bloc resection rate improved from 78.8% to 83.3% (P=0.15). The R0 resection rate improved significantly from 39.4% to 75.0% (P<0.01)., Conclusion: Untutored colorectal endoscopic submucosal dissection is feasible with acceptable clinical outcomes at a low-volume district hospital in Hong Kong.

Background and Study Aim: Nurse-administered propofol sedation (NAPS) and patient-controlled sedation using patient-controlled analgesia (PCA) pumps are gaining increasing popularity for gastrointestinal endoscopy. We compared the safety and efficacy of NAPS using PCA pumps with diazemuls-pethidine sedation (DPS) for outpatient colonoscopy., Patients and Methods: In a prospective randomized controlled trial patients underwent outpatient colonoscopy with sedation by either NAPS or DPS. For NAPS, following intravenous loading of 0.8 mg/kg propofol, mixtures of 14.3 mg propofol and 35 microgram alfentanil were titrated by nurses using a PCA pump. For DPS, 0.1 mg/kg diazemuls and 0.5 mg/kg pethidine were given as intravenous bolus; further titration was administered as half doses at the endoscopist's discretion. Adequacy of sedation was measured by the Observer's Scale for Sedation and Alertness (OSSA) score (range 1-5)., Results: Between July 2005 and June 2006, 88 patients were randomly allocated to NAPS and 90 to DPS. The groups were comparable for baseline characteristics and procedure time. With NAPS, levels of sedation both during colonoscopic intubation and at reaching the cecum were significantly deeper than with DPS (OSSA 3 vs. 5, P < 0.0001). There were no significant differences in cardiopulmonary complication rates, pain scores, satisfaction scores, and patients' willingness to repeat colonoscopy with the same sedation. Drugs cost for NAPS was higher than for DPS (Hong Kong dollars [HKD] 98.34 vs. 5.01)., Conclusion: Despite higher costs, nurse-administered propofol-alfentanil sedation using a PCA pump can provide deeper conscious sedation, comparable satisfaction, and similar complication risks compared with conventional opioid-benzodiazepine sedation.

Objectives: To review the accuracy of fine-needle aspiration cytology in diagnosing non-toxic thyroid nodules and determine what factors are predictive of malignancy in patients with indeterminate cytology results., Design: Retrospective study., Setting: Regional hospital, Hong Kong., Patients: Patients with non-toxic thyroid nodules undergoing thyroidectomy from December 1999 to December 2003., Main Outcome Measures: Sensitivity, specificity, positive and negative predictive value of fine-needle aspiration cytology, predictive factors for malignancy in patients with indeterminate fine-needle aspiration cytology results., Results: The sensitivity, specificity, positive predictive value, and negative predictive value of fine-needle aspiration cytology were 54%, 100%, 100%, and 75% respectively. For the 92 patients with fine-needle aspiration cytology reported as 'indeterminate for malignancy', aspiration cytology subgroup (P=0.005) and age (P=0.001) were significant risk factors for diagnosing malignancy., Conclusions: Fine-needle aspiration cytology has high positive predictive value for thyroid cancer, enabling us to 'rule-in' malignant lesions with confidence. Among those with indeterminate fine-needle aspiration cytology, atypical cell lesions and age greater than 40 years conferred increased risk of malignancy.

Objective: To test the feasibility of needlescopic cholecystectomy using a two-port technique with 3-mm miniaturised instruments., Design: Prospective study., Setting: Regional hospital, Hong Kong., Patients: One hundred consecutive patients undergoing elective cholecystectomy from September 2001 to August 2002., Intervention: Two-port needlescopic cholecystectomy all performed or supervised by a single laparoscopic surgeon., Main Outcome Measures: Conversion of the procedure, the operating time, postoperative analgesic requirement, pain score using the 10-cm visual analog scale, complications, and the postoperative stay. To determine the technical difficulty of this new technique, the data from the first 50 patients were compared with those of the latter 50. Outcome variables were also compared with a group of 58 patients operated on with the standard two-port laparoscopic cholecystectomy in a previous randomised trial., Results: One conversion to open cholecystectomy was reported. Three patients required the enlargement of epigastric port to a size of 5 mm and six patients required an additional port to complete the operation. The median operating time was 62 minutes (range, 33-168 minutes). The median pain score was 3.5 (range, 0-9) and the median postoperative stay was 2 days (range, 1-14 days). Six patients had postoperative complications. When the first 50 patients were compared with the latter 50, there were no differences in the conversion rate, operating time, complication rate, and duration of hospital stay. However, the latter 50 patients had significantly lower pain scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet (median, 5 vs 9 hours; P<0.001). The median operating time of needlescopic cholecystectomy was notably longer (62 vs 46 minutes; P<0.001) compared with that of the two-port laparoscopic cholecystectomy. Patients undergoing needlescopic cholecystectomy had a better resumption of diet (median, 5 vs 7 hours; P<0.001) and less postoperative pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the two-port laparoscopic cholecystectomy group. Pain scores at individual port sites were also lower in needlescopic cholecystectomy group (umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median, 2.0 vs 3.6, P=0.036)., Conclusion: Two-port needlescopic cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic cholecystectomy technique.

Neurofibromatosis type I (NF-1) belongs to a family of diseases named phakomatoses, which are characterized by congenital malformations of ectodermal structures. Neurofibromatosis type I affects 1 in 3000 people, and has a diverse clinical presentation as well as an array of imaging findings. In this article the authors review the various neuroimaging findings present in NF-1, including abnormalities of the parenchyma, meninges, vessels, and associated neoplasms.