Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> Body Mass Index (BMI) <s> OBJECTIVE ::: To determine which aspects of ED management are adversely affected by patient obesity, to determine the level of obesity above which management is made more difficult and to make recommendations on how these effects might be mitigated. ::: ::: ::: METHODS ::: This was a cross-sectional survey of patients and the staff caring for them in a single ED. Doctors, nurses and radiographers managing consecutive patients, during a range of enrolment periods, completed a self-administered questionnaire. Each was asked to record how the level of their patient's obesity increased the difficulty of specific management items, using a Likert scale. Staff also provided recommendations to mitigate the effects of obesity for each patient, if applicable. For each management item, body mass index (BMI) and management difficulty were correlated (Spearman's rank correlation). ::: ::: ::: RESULTS ::: Seven hundred and fifty patients and their ED carers were enrolled. Patient BMI was positively correlated with all aspects of ED clinical management examined (correlation coefficient range 0.28-0.57, P < 0.001). BMI most strongly correlated with difficulty in finding anatomical landmarks, venous pressure measurement, physical examination, patient positioning and procedures generally, especially cannulation and venipuncture (coefficient > 0.5, P < 0.001). Doctors reported more difficulties than nurses and radiographers. Generally, management difficulty did not increase until the BMI was in the obese or morbidly obese range. Most staff recommendations related to issues of patient mobility including equipment, staffing and bariatric devices. ::: ::: ::: CONCLUSION ::: Patient obesity significantly increases the difficulty of ED patient management. Staff recommendations to mitigate these effects were few but may inform changes in ED practice. <s> BIB001 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> Body Mass Index (BMI) <s> Overweight and obesity have reached epidemic proportions in many Asian countries. These countries also face a grave burden of obesity-related disorders such as diabetes, hypertension, and cardiovascular diseases, which develop at a younger age than in Western populations. These disorders are also manifested in childhood. The major causative factors are related to the lifestyle changes occurring due to rapid socioeconomic transition. Asian populations show several differences in genetic factors when compared with the white population, and they also have lower cut points for environmental risk factors. National programmes targeting public awareness, education and improved structural facilities to facilitate healthy lifestyle are the keys to alleviate the economic and health care burden of the obesity-related disorders. <s> BIB002
The BMI is an estimate of body fat based on height and weight for calculation that applies to both adult men and women. BMI is a useful measure for indicating the characteristic of being overweight and/or obesity. The formula is BMI = kg/m 2 where kg is a person's weight in kilograms and m 2 is their height in meters squared  . The BMI measurement is very significant. A 2010 study by Kam J and Taylor D BIB001 showed that patient management difficulty did not increase until the BMI was in the obese or morbidly obese range, especially in cannulation and venipuncture. More so, obesity levels have reached epidemic proportions in many Asian countries and many of them have rates which are not far from that in the USA BIB002 with the Centers for Disease Control and Prevention (CDC) report in 2015-2016, of the obesity prevalence in US of 39.8% in adults and 18.5% in youth  . The highest rate of obesity in Asia is in Thailand and the lowest is in India. While, China was noted with rapidly increasing cases of obesity that occurred in a remarkably short period of time BIB002 .