Development of extracorporeal membrane oxygenation in Hong Kong: current challenges and future development

Sin, Simon Yung Wa; Young, Karl

doi:10.12809/hkmj175065

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…The competing demands to create additional public open spaces and preserving old sites in redevelopment areas also require developers to design low-density products at the expense of profits [45,46]. In addition, parts of Hong Kong have an existing plot ratio equal to or even greater than the maximum permissible level under the Outline Zoning Plan and Building (Planning) Regulations [47], further limiting developers' ability to make a profit and reducing the economic potential of redevelopment projects. With respect to the government's financial support, according to the Urban Renewal Authority, HKD 20.8 billion land premium payment exemptions were provided by the government for 48 projects by May 2022 under the Urban Renewal Authority [48], indicating that the expansion of direct financial support for redevelopment incentives imposes a huge additional burden on the government's finances.…”

Section: The Challenges Of Insufficient Private Sector Participationmentioning

confidence: 99%

Challenges, Experience, and Prospects of Urban Renewal in High-Density Cities: A Review for Hong Kong

Wang

Fan

Yang

2022

Land

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Redevelopment in Hong Kong must be accelerated in response to urban decay and land shortages. However, due to a lack of incentives and effective policy tools under Hong Kong’s floor area ratio regulations, there has been limited public–private partnerships in the urban renewal process, reducing both the public welfare and the efficiency of land use. We review the evolution of Hong Kong’s density schemes for addressing urban redevelopment issues to identify the most important barriers to private sector involvement. We also summarise the international experience and identify viable policies, compare cases in Hong Kong with successful transfer of development rights (TDRs) examples, point out TDRs’ shortcomings, and propose targeted policy optimisation strategies. On a practical level, this study has implications for the creation of targeted density policies to address Hong Kong’s ageing infrastructure and facilitate the urban transformation of Hong Kong and similar high-density cities so that they can continue to support sustainable urban growth.

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Section: The Challenges Of Insufficient Private Sector Participationmentioning

confidence: 99%

Challenges, Experience, and Prospects of Urban Renewal in High-Density Cities: A Review for Hong Kong

Wang

Fan

Yang

2022

Land

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“…2 In Hong Kong, various assessments of ICU performance have been performed for other disease entities, 3 but there have been few reports of ECMO-specific data and patient outcomes. 4 In particular, Hong Kong has a higher ECMO centreto-population ratio compared with international guidelines. 5,6 A retrospective study examined the risk score-mortality association in patients receiving ECMO, but it only included data from a single tertiary ICU and was not fully representative of territory-wide practices.…”

Section: Introductionmentioning

confidence: 99%

Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong

Ng,

Chan,

et al. 2023

Hong Kong Med J

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Introduction:The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong. Methods:We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann-Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality. Results:The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV-predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively).

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“…Hong Kong has a population of 7.6 million, and with a total land area of 1,110 km 2 , is one of the most densely populated cities in the world (3). The number of ECMO centers has grown from 4 in 2010 during the H1N1 influenza outbreak to 7 at present (4), to parallel a 24.9% increase in ICU admissions from 2008 to 2018 (5). Some studies have suggested that patient outcomes were better in high case-volume hospitals, but the lack of patient-level data did not permit a comparison of performance by using observed and predicted outcomes (6).…”

Section: Introductionmentioning

confidence: 99%

Effect of hospital case volume on clinical outcomes of patients requiring extracorporeal membrane oxygenation: a territory-wide longitudinal observational study

Ng¹,

Ip²,

Fang³

et al. 2022

J Thorac Dis

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Background: The utilization of extracorporeal membrane oxygenation (ECMO) has increased rapidly around the world. Being an overall low-volume high-cost form of therapy, the effectiveness of having care delivered in segregated units across a geographical locality is debatable.Methods: All adult extracorporeal membrane oxygenation cases admitted to public hospitals in Hong Kong between 2010 and 2019 were included. "High-volume" centers were defined as those with >20 extracorporeal membrane oxygenation cases in the respective calendar year, while "low-volume" centers were those with ≤20. Clinical outcomes of patients who received extracorporeal membrane oxygenation care in high-volume centers were compared with those in low-volume centers.Results: A total of 911 patients received extracorporeal membrane oxygenation-297 (32.6%) veno-arterial extracorporeal membrane oxygenation, 450 (49.4%) veno-venous extracorporeal membrane oxygenation, and 164 (18.0%) extracorporeal membrane oxygenation-cardiopulmonary resuscitation. The overall hospital mortality was 456 (50.1%). The annual number of extracorporeal membrane oxygenation cases in high-and low-volume centers were 29 and 11, respectively. Management in a high-volume center was not significantly associated with hospital mortality (adjusted odds ratio (OR) 0.86, 95% confidence interval (CI): 0.61-1.21, P=0.38), or with intensive care unit mortality (adjusted OR 0.76, 95% CI: 0.54-1.06, P=0.10) compared with a low-volume center. Over the 10-year period, the overall observed mortality was similar to the Acute Physiology And Chronic Health Evaluation IV-predicted mortality, with no significant difference in the standardized mortality ratios between high-and low-volume centers (P=0.46). Conclusions:In a territory-wide observational study, we observed that case volumes in extracorporeal membrane oxygenation centers were not associated with hospital mortality. Maintaining standards of care in low-volume centers is important and improves preparedness for surges in demand.

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Development of extracorporeal membrane oxygenation in Hong Kong: current challenges and future development

Cited by 3 publications

References 13 publications

Challenges, Experience, and Prospects of Urban Renewal in High-Density Cities: A Review for Hong Kong

Challenges, Experience, and Prospects of Urban Renewal in High-Density Cities: A Review for Hong Kong

Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong

Effect of hospital case volume on clinical outcomes of patients requiring extracorporeal membrane oxygenation: a territory-wide longitudinal observational study

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