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This was followed by an interactive discussion of investigation and management plan. Appropriate radiological imaging such as an MRI brain scan was shown to the group using the “share‐screen” function. Other clinical information such as laboratory results can likewise be displayed. The session was completed after thorough discussion on the appropriate treatment plan with respect to the patient’s scenario.

Aim Spasticity gives rise to impairment in motor functions and activities of daily living. Botulinum toxin (BTX) can be injected to temporarily paralyze the affected muscles, which provides a window of opportunity for rehabilitation. We present our 2.5-year experience with BTX injection and a patient-specific rehabilitation program provided by a multidisciplinary team, which consists of neurosurgeons, nurses, physiotherapists, occupational therapists and prosthetic orthotists. Patients and Methods This is a retrospective study of prospectively collected data in a local hospital including 22 patients suffering from spasticity. Outcome measures include goal attainment, caregiver burden and biomechanical assessment by Modified Ashworth Scale and Modified Tardieu Scale (MTS). Results OnabotulinumtoxinA injection together with rehabilitation facilitates the attainment of patient-centred physical goals in daily activities. It reduces caregiver burden. Spasticity is reduced particularly for finger and wrist flexors as well as hip adductors. Responses of ankle plantarflexors are less satisfactory which may be due to inadequate dosages. Initial improvement in the R2 component of the MTS for ankle plantarflexors and hip adductors may be attributable to the application of ankle–foot orthosis and abduction pillow. Conclusions Multidisciplinary management for spasticity is feasible within our healthcare setting and our promising findings indicate its wider adoption in this locality.

RADA16-I is a synthetic type I self-assembling peptide nanofiber scaffold (SAPNS) which may serve as a novel biocompatible hemostatic agent. Its application in neurosurgical hemostasis, however, has not been explored. Although RADA16-I is nontoxic and nonimmunogenic, its intrinsic acidity may potentially provoke inflammation in the surgically injured brain. We conducted an animal study to compare RADA16-I with fibrin sealant, a commonly used agent, with the hypothesis that the former would be a comparable alternative. Using a standardized surgical brain injury model, 30 Sprague-Dawley rats were randomized into three treatment groups: RADA16-I, fibrin sealant or gelatin sponge (control). Animals were sacrificed on day 3 and 42. Astrocytic and microglial infiltrations within the cerebral parenchyma adjacent to the operative site were significantly lower in the RADA16-I and fibrin sealant groups than control. RADA16-I did not cause more cellular inflammatory response despite its acidity when compared with fibrin sealant. Immunohistochemical studies showed infiltration by astrocytes and microglia into the fibrin sealant and RADA16-I grafts, suggesting their potential uses as tissue scaffolds. RADA16-I is a promising candidate for further translational and clinical studies that focus on its applications as a safe and effective hemostat, proregenerative nanofiber scaffold as well as drug and cell carrier.

Summary Background Hand hygiene is an important component of patient-safety education. The World Health Organization recommends the use of hand hygiene measures at five clinical moments. While previous studies have treated hand hygiene as a single entity, we investigated whether and how the compliance of students may vary across the five clinical moments. We also studied their reasons for non-compliance with a view to inform teaching. Method A voluntary self-administered questionnaire survey was conducted on a convenient sample of 339 medical and nursing students. The five clinical moments studied were: before touching a patient (moment 1); before a clean/aseptic procedure (moment 2); after body fluid exposure risk (moment 3); after touching a patient (moment 4); and after touching the patient's surroundings (moment 5). Results The overall reported compliance rate was 83.0 per cent. The compliance rates were significantly lower at moments 1 and 5. Nursing students reported better overall compliance (p = 0.01), and at moments 2 (p = 0.0001) and 3 (p = 0.0001), than medical students. Medical students fared better at moment 4 (p = 0.009). The most common reason reported for non-compliance was ‘forgetfulness’. Discussion We identified differences in compliance rates across the five clinical moments of hand hygiene. Education programmes should not treat the hand hygiene process as a single entity, but should adopt a moment-specific approach to promote recall, with particular emphases on moments 1 and 5. Nursing and medical students may require different education strategies. Future studies on hand hygiene may also adopt a moment-specific approach.

Aim There is a lack of recent data regarding the incidence of central nervous system (CNS) tumours in Hong Kong patients of Chinese origin. The aim of this study was to provide a current registry of brain and CNS tumour incidence in Hong Kong, which would contribute to the current knowledge of brain tumour epidemiology. Patients and Methods Prospective data were collected from neurosurgical centres in Hong Kong between July 2008 and June 2009. Demographic and diagnostic data were collected for each patient diagnosed with a brain tumour, and collated at a central coordination centre. Diagnosis was confirmed either histologically or radiologically. Results There were 1031 newly-diagnosed cases of spinal/intracranial tumours, 759 of which were primary tumours. The estimated annual incidence of spinal/intracranial tumours was 14.7 per 100 000. The annual incidence of primary CNS tumours was 10.8 per 100 000, and 3.5 per 100 000 for meningiomas. A total of 70 high-grade gliomas (incidence rate of 1/100 000) and 171 pituitary tumours were diagnosed, both of which were more prevalent in the 45–64-year age group. Meningiomas and pituitary tumours were more common in females. In paediatric patients, there were 36 cases of newly-diagnosed brain tumours, glioma being the most common. Conclusion The annual incidence rate of malignant gliomas was one per 100 000 in the Hong Kong population of Chinese origin. From comparisons with other studies, this suggests geographical and racial differences in the incidence of brain tumours, and warrants further collaboration and research regarding brain tumour epidemiology.

Neurocutaneous melanosis is a rare condition characterized by cutaneous melanocytic naevi and the presence of melanocytes in the leptomeninges. It is commonly associated with malignant melanoma formation in the central nervous system (CNS) with poor prognosis. Herein, we report a 13-year-old boy with neurocutaneous melanosis who presented with seizure with diffuse CNS malignant melanoma, as demonstrated by magnetic resonance imaging (MRI). 18F-fluorodeoxyglucose positron emission tomography (PET) was carried out, but was unable to detect the CNS involvement. So far, this is the first report involving the use of PET in neurocutaneous melanosis and we suggest that MRI is more sensitive than PET with 18F-fluorodeoxyglucose in such conditions.

The presence of a regionalized trauma system has been shown to improve outcome in trauma. Trauma care has undergone significant changes in Hong Kong in recent years. In 2003, five public hospitals were designated as trauma centres. Since then, there has been a progressive improvement in trauma patient outcome in Hong Kong. Trauma centre designation by itself, however, does not constitute a trauma system. The latter is an integration of prehospital care, interhospital transfer, trauma centres, rehabilitation, prevention, education and research. Under the primary trauma diversion policy, trauma patients in Hong Kong are no longer sent to the nearest hospitals, but transferred directly to trauma centres where definitive care can be implemented earlier. The present article describes some of these changes and addresses issues pertinent to the future development of trauma service in Hong Kong.

With advances in the understanding of the pathophysiology of traumatic brain injury, many novel cerebroprotective measures have been developed. Many of them have undergone preclinical trials and have shown promising results, but the results have not translated into clinical benefits. Evidence of these cerebroprotective measures including NMDA-receptor antagonist, steroids, free radial scavengers, nimodipine, ziconotide, bradykinin receptor antagonist and dexanabinol has been reviewed. Problems encountered in clinical studies of traumatic brain injury are mainly related to the heterogenicity of traumatic brain injury and the design of clinical studies. Given all these difficulties, clear benefit of these measures cannot be shown and an optimum treatment strategy has yet been developed.

Pre-operative hand-washing is essential for the reduction of surgical site infection (SSI) rate. This article aims to review the current literature regarding the issues on: (i) the duration of washing; (ii) the use of the brush; and (iii) the reagents used. Based on current evidence, preoperative hand-washing for 10 min is not recommended and 2–5 min is adequate. There is no evidence supporting the use of the brush, and washing without the brush may confer further advantages of reducing skin irritation and delayed colonization. The newly developed aqueous alcoholic solutions (AAS) are equally effective as conventional reagents such as chlorhexidine gluconate and povidone-iodine in preventing SSI. Aqueous alcoholic solutions have the advantage of better user compliance and causing fewer occupational hazards. The author concluded that a 1 min non-antiseptic hand-wash, followed by thorough rubbing with AAS until dry and without brushing is a safe and effective alternative to the conventional scrubbing technique.

Objective: To review the outcome of surgical treatment for chronic subdural haematoma (CSDH) at a local neurosurgical centre, with emphasis on major treatment-related complications. Method: A total of 108 patients received operations for chronic subdural haematoma at the University of Hong Kong Medical Centre between January 1995 and December 1999. Medical records and imaging studies were studied retrospectively. Patients’ clinical features and treatment modalities were analysed and major postoperative complications, including mortality, haematoma recurrence, infection and epileptic seizure, were studied. Results: All 108 patients underwent burr hole craniostomy for the drainage of CSDH; one patient also underwent formal craniotomy. Recurrence occurred in six (5.5%) patients, seizure in two (1.8%) and intracranial infection in one (0.9%). There were four deaths, giving rise to a mortality of 3.7%. All four patients who died were elderly and had presented in an unconscious state and died subsequently of chest infection after surgery. Conclusion: Although surgical drainage of CSDH is often considered to be a straightforward, effective and safe procedure, it is not entirely without risks. The surgical outcome of the present series is in accordance with the current standard of neurosurgical care.