Transitional, Supportive & Palliative Care

Under the epidemic, the social distance among people has been continuously widening. This study focused on youth training and the provision of "digital outreach services" for the elderly, so that the connection between each other can be re-established. The study follows a mixed method design in which both qualitative and quantitative methods will be applied for data collection. A multi-centre, randomised controlled trial (RCT) with repeated measures will be conducted. This study has two main objectives. First, based on the "person-centred concept", this study makes better use of today's digital technology rehabilitation equipment and provide outreach rehabilitation services to the elderly, thereby enhancing their quality of life and reducing the "digital divide" problem. Second, this study provides vocational skills training for young people who are studying or unemployed to enhance their market competitiveness and secure employment opportunities.

Introduction: Poverty has a detrimental influence on psychological well-being of children. Existing evidence shows that positive psychology interventions are possible to mitigate such impact. This study examined the feasibility of implementing a positive psychology intervention among Hong Kong Chinese children living in poverty.

Methods: A feasibility randomized controlled trial will be conducted. A convenience sample of 120 children aged 13–17 years will be recruited from a community center in Kwai Tsing district. Participants who are randomized into the experimental group will join a 1.5 hour workshop covering four positive psychology techniques: 1) gratitude visits/letters, 2) three good things, 3) you at your best, and 4) using signature strengths. A booster intervention will be provided at 1-week. Control group participants will not receive any intervention. Assessments will be conducted at baseline and at 1-week, 1-month, 3-month, and 6-month follow-ups.

Analysis: Descriptive statistics will be used to calculate the feasibility measures. Effect sizes on psychological outcomes (i.e. self-esteem, depressive symptoms and quality of life) will be estimated by mixed between-within subjects analysis of variance using partial eta squared. Subgroup analysis (poverty, non-poverty) will be performed to test for differential effects.

Ethics and dissemination: Ethical approval has been obtained from the Hong Kong Polytechnic University Institutional Review Broad. We will obtain parental consent as our subjects are below18 years old. Findings from this study will be disseminated via international publications and conferences.

(a) Objectives:

(1) Increase early testing for Novel coronavirus disease (COVID-19) and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase digital health literacy, vaccine literacy and promote preventative measures against COVID-19 in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public’s motivation to stay at home and avoid nonessential high-risk social activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5).

(b) Study design:
We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short and long terms.

(c) Expected outcome(s):
Theory-driven interventions will address each study’s focus (e.g. social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Decreased infection risks are expected due to improved preventative behaviours and increased vaccine uptake. Improvements are expected to be seen in the outcomes of general population, especially in vulnerable and high-risk groups. Long-term sustainability of the approach will be achieved through the CBPR model.

Advance care planning (ACP) is a well-recognized quality indicator for palliative care. ACP facilitates communication among the patient, their family/carers/surrogates, and healthcare providers to enable a shared understanding of a patient’s end-of-life care preferences before he/she lacks capacity to make decisions. Despite two decades of effort, ACP-related documentation and end-of-life discussion rates remain low for palliative care patients. Although ACP is about self-determination and autonomy, studies consistently show the importance of family involvement in adult patient’s medical decision-making. Yet, research on ACP interventions with components targeting family member remained limited.  

This is a two-arm parallel randomized controlled trial with follow-ups at 6 and 12 months, aiming to (1) examine the effectiveness of a structured, family-supported, patient-centred ACP programme for adult palliative care patients and their families, and (2) whether hospital setting (rehabilitation-oriented hospital versus acute hospital) will has a moderating effect on the effectiveness of the structured ACP programme.

This study will randomize 170 palliative care patients and their family members to the structured, family-supported, patient-centred ACP programme (ACP-Family) or ACP service under usual care (ACP-UC). Within one month, they will receive two 60-90 minute sessions of the family-supported, patient-centred ACP programme covering five elements in ACP discussions delivered by a trained ACP facilitator; or usual care provided by the respective hospital. All discussion sessions in the ACP group will be recorded for quality checking.

The primary outcome is family’s prediction accuracy of patient’s treatment preferences at 6 months. Secondary outcomes include proportions of new ACP documentations and family-reported perception of whether the patient’s end-of-life care preference was respected, patient’s decisional conflict, and quality of communication, and family’s decision-making confidence, anxiety, depression and quality of communication. Outcomes of the two groups will be compared using regressions and mixed-effects models.

This study will provide rigorous scientific evidence on the effectiveness of a structured and well-design family-supported, patient-centred ACP programme for adult palliative care patients and their family members in the hospital setting. By targeting both patients and family members, the structured ACP programme should have a greater impact on discussions regarding end-of-life care preferences, and hence more likely to achieve the ACP goal of improving rates of preference-concordant care. The study will also generate information whether hospital setting has an impact of the effects of ACP discussions on ACP-related outcomes in both patients and their family.  

Background:
Transitioning from the burn unit to the home/ community can be chaotic with limited professional support. Some adult burn survivors may face varied concerns leading to poor outcomes in the early post-discharge period with limited access to professional help. Based on these, a nurse-led transitional burns rehabilitation programme has been developed and the current trial aims to ascertain its effects as well as explore the implementation process at the Gansu Provincial Hospital, Lanzhou, PRC.

Objectives:
1. To evaluate the effects of a nurse-led transitional rehabilitation programme on quality of life psychological functioning, sleep patterns, itchiness, pain, and physical role functioning/ performance among adult burn survivors.
2. To examine the process involved and issues encountered during the implementation of the transitional rehabilitation programme.

Methods:
A single-centre, double-arm randomised controlled trial with a process evaluation phase will be utilised for this study. All adult burn survivors aged ≥18 years with burn size ≥10% total burn surface area at the site during the study period will be screened for eligibility at least 72hours to discharge. A sample size of 150 will be block randomised to treatment (receiving the nurse-led transitional care programme and routine post-discharge service) and control groups (receiving routine post-discharge service). The nurse-led transitional care programme comprises of predischarge and follow-up phases with the delivery of bundle of holistic interventions lasting for 8 weeks with telehealth support.  There are three timelines for data collection: baseline, immediate post-intervention, 4 weeks post-intervention.
Potential impact: The findings from this study can potentially inform the development and organisation of post-discharge care and affirm the need for ongoing comprehensive home-based care for burn survivors and their families.
Trial registration: ClinicalTrials.gov Trial Registry approved the prospective registration on 20th August 2020. Registration details can be viewed on https://clinicaltrials.gov/ct2/show/record/NCT04517721.

Aims
It aims to compare the effects of a professional -led support programme using a mobile application versus telephone advice on clients at risk of coronary heart disease.

Methods
A multi-centre, single-blinded, randomized controlled trial will be conducted. 168 Clients who are at risk of coronary heart disease (CHD), able to use a smart phone will be randomized into the App Support group (App group) or the Nursing Telephone advice (NTA) group or control group. The self-developed mobile app will support clients in managing their health problems and lifestyle. It is comprised of: (1) a CHD knowledge health platform, (2) a membership area for individual health measures and exercise records, (3) a Chest Pain – Things to Do List.
All participants will receive same nursing educational briefing related to CHD. The App Group will additional receive an app use whereas the NTA group will receive nursing telephone advice for 20 minutes monthly.
Health outcomes will be collected at baseline (T0), 1 months (T1), 3 months (T2), and 6 months (T3). The primary outcome is total amount of exercise. Secondary outcomes are: (i) Self-efficacy and self-management behaviour; (ii) emergency department visit and hospitalization frequency ; (iii) Physiological health profile; (iv) and cardiovascular functional endurance; (v) perceived stress level; (vi) health literacy; and (vii) quality of life.

Data analysis: A Generalized Estimating Equations model will be used to assess differential changes in all outcome variables.

Background: The use of mobile health (mHealth) has become common in recent years and is regarded as one of the most effective interventions for developing disease-specific management skills and establishing confidence in making preventive health behavior changes and accomplishing health-related goals among community-dwelling older adults. Most mHealth designs adopt a reactive care approach whereby health care professionals do not respond until they receive abnormal assessment results from the database or a message or signal from the client. The purpose of this study is to determine the effectiveness of a proactive mobile health application program with the support of a community health-social care team for older adults dwelling in the community on improving their self-care health management.

Methods: This is a three-armed, randomized controlled trial. The study will be conducted in 7 community centers with an estimated sample size of 282 participants. The participants will be randomly assigned to mHealth with interactivity, mHealth, and control groups when they are (1) aged 60 or above, (2) complaining chiefly of pain, hypertension, or diabetes mellitus, (3) living within the service areas, and (4) smartphone users. Subjects in the mHealth with interactivity group will receive 2 main elements, the mHealth application and nurse case management supported by a social service team. The mHealth group will receive the mHealth application only. The primary outcome measure will be self-efficacy, and secondary outcomes will include self-management outcomes (pain score, blood pressure, capillary blood glucose), client outcomes (quality of life, depression), and health service utilization outcomes (institutionalization and health service utilization [general practitioner, outpatient clinic, emergency room, hospital admission]). Data will be collected before intervention, after intervention, and 3 months after intervention.

Discussion: The incremental benefits of adding interactivity in the mHealth program have not been confirmed. This present study will add valuable information to the knowledge gap of whether mHealth with nurse interaction supported by a health-social partnership can improve self-care management among community-dwelling older adults.

Background: The future practice of our graduates is no longer stable and predictable. Graduates are required to be not only knowledgeable and skillful, but also adaptive to the changing demands of work . The increasing use of simulation-based education (SBE) is to prepare nursing students for their practice. However, the standardized approaches with pre-determined outcomes only allow students to learn what is planned and delivered. The individualist and cognitive perspectives adopted in simulation are also insufficient to understand the process of how learning takes place in the complex professional practice. This understanding has an important implication for fidelity/realness in simulation since such scenarios cannot capture the full range of behaviours and interactions, most significantly within the embodied and material world of the nurse, notably the interface with physical tools, monitoring equipment, protocols, which shape and engineer practice. Hence emphasizing only the human or the social and the intended learning over the material and the unintended learning in SBE will undoubtedly limit our understanding of how knowledge is developed through SBE.

Purpose: The purpose of this study is to explore an innovative approach to student learning on palliative care communication through SBE, based on the sociomaterial perspective. Globally, palliative care is becoming increasingly complex, with ever more sophisticated treatment options and education needs for advanced care planning. This reality, combined with the tension and high emotions of patients, families, and nurses, is a clarion call to the importance of preparing nursing students through SBE to develop better communication with this population and their families prior to their clinical practice.

Method: An ethnographic approach will be adopted to examine SBE for nursing students' palliative care communication based on sociomaterial perspectives. In addition to a document review, data will be collected from field observations before simulations, video-recordings during simulations, focus group interviews through debriefings, and interviews with students after their subsequent clinical practice. There will be a collaborative analysis of data from field notes and videotapes; a content analysis of the focus group debriefings and follow-ups of students in practice, and a document and artifact analysis to determine how nurse-patient palliative care communication can be enhanced using the sociomaterial approach.

Relevance to simulation/clinical practice: The sociomaterial approach in SBE will help to attune us to the multiple ways in which human and non-human elements relate, which might otherwise go unnoticed during the simulation learning of palliative care communication.

Exercise has been proposed as a potential alternative treatment for insomnia. However, lack of time and high cost are major barriers keeping people away from starting and maintaining exercise. To overcome these barriers, a brief exercise training programme – Zero-Time Exercise (ZTEx) is designed to incorporate exercise into habitual daily routines so that the exercise costs no extra time and money from individuals.

This is a randomized controlled trial embedded with a longitudinal mixed-method process evaluation which aims to (1) examine the effectiveness of ZTEx, a lifestyle-integrated physical activity programme, in inactive adults with insomnia disorder; (2) collect pilot evidence on the effect of WhatsApp Anti-inertia Reminders on exercise adherence. The process evaluation will identify the facilitators and barriers of subjects’ exercise adherence and explore the possible mechanisms of impact on the study outcomes.

This study consists of two phases. In the first phase (baseline to week 8), 136 subjects will be randomly allocated to the ZTEx intervention group or the sleep hygiene education (SHE) comparison group. They will receive two two-hour ZTEx training or SHE lessons and practice ZTEx or follow the sleep hygiene instruction for 24 weeks. After assessment at week 8, for the second phase of the study (weeks 9-24) which is a proof-of-concept pilot, subjects in the ZTEx group will be randomly divided into ZTEx with WhatsApp reminder (ZTEx+R) or ZTEx without WhatsApp reminder (ZTEx alone) subgroup to evaluate the effects of WhatsApp reminders on exercise adherence. Post-training and post-follow-up qualitative focus group interviews will be conducted for process evaluation.

The primary outcome measure is the severity of insomnia symptoms and daytime impairments by the Insomnia Severity Index (ISI) at week 8, 16, and 24. The secondary outcomes include subjective sleep diary and objective actigraphy; objective cognitive functioning, anxiety and depressive symptoms, fatigue level, and quality of life; objective physical activity level and exercise adherence will be assessed by waist-worn accelerometers. ZTEx and SHE groups will be compared using a mixed-effects model. Exercise adherence in the ZTEx+R and ZTEx alone subgroups will be compared.

This study will be the world’s first randomized controlled trial to provide rigorous scientific evidence on the effectiveness of lifestyle-integrated exercise for insomnia disorder. ZTEx is a brief intervention that can be easily disseminated in the community by briefly trained healthcare professionals to help people to relieve their insomnia and prevent the negative consequences of physical inactivity.

Background: Although homebound older adults are among the highest users in hospital services, the existing health and social services that provided to them in the community are limited and fragmented. This study tries to bring this group of older adults to the providers’ attention and design a health-social oriented self-care mobile Health (mHealth) program and subject it to empirical testing.

Methods: This is a randomized controlled trial. The study is supported by five community centers with an estimated sample size of 68 subjects. The subjects will be randomly assigned to video-based mHealth and control groups when they are (1) aged 60 or above, (2) going outdoor less than once per week in current six months, (3) living within the service areas, and (4) using smartphone. Subjects in the video-based mHealth group will receive two main elements, which include nurse case management that supported by a social service team and an individual-specific video messages covering self-care topics that delivered via smartphone. The control group will receive usual care only. Data will be collected at two time points—pre-intervention (T1) and post-intervention (T2). The primary outcome measure will be activity of daily living and secondary outcomes will include health outcomes (blood pressure, capillary blood glucose, instrumental activities of daily living, medication adherence), perceived well-being outcomes (quality of life, self-efficacy, depression), and health service utilization outcomes (outpatient clinic, emergency room, hospital admission).

Discussion: The current study will add to the knowledge gap in using mHealth supported by a health-social team in enhancing quality of life and self-care and meeting the needs of these particularly vulnerable older adults.

ObjectiveThis pilot RCT will preliminary examine the effects of an electromoxibustion device and knee health education on reliving knee osteoarthritis pain.

Method Design-This pilot RCT will embed a two-arm randomized control trial. The project will recruit 48 participants with knee OA. Eligible participants will be randomized into 2 groups – (1) Electromoxibustion, or (2) knee health education at 1:1 ratio. Major assessments will be performed at baseline and 4.
Participants- A total of 48 participants aged 60 years or more with knee pain will be recruited from the community through the Neighborhood Elderly Centres of Yan Chai Hospital.
Interventions- Participants in the intervention group will receive electromoxibustion using a knee-brace-like device which produces thermal stimulation with a moxa pad inside. The treatment will be delivered by a registered Chinese medicine practitioner 3 times per week for 4 weeks.
Control- Participants in the control group will attend 2 sessions (120 minutes each, 1-week apart) of health education related to knee osteoarthritis symptom management. The instructor will be a registered physiotherapist or nurse.

Outcome measures- (1) Pain severity numerical rating scale, NRS (Primary outcome); (2) Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for pain, physical function, and stiffness related to knee osteoarthritis; (3) Short Form-6D for quality of life; (4) Timed Up & Go Test (TUG); (5) Fast Gait Speed (FGS) for knee functioning.

Objectives: To evaluate the short- and medium-term effectiveness of self-administered acupressure taught by a short training course on reducing knee osteoarthritis (OA) pain in middle-aged and older adults.

Hypothesis: The self-administered acupressure group would have a greater pain relief compared to the knee health education (KHE) control in subjects with knee OA at week 4 (short-term) and 12 (medium-term).

Design and subjects: In this fully-powered randomized controlled trial, 314 participants with knee OA recruited from the community will be randomized to self-administered acupressure or KHE group in a 1: 1 ratio.

Study instrument: Numerical rating scale (NRS) will be used to assess pain intensity in the knee.

Interventions: Participants in the self-administered acupressure will attend two 2-hour training sessions (1 week apart) to learn self-administered acupressure and practice twice daily for 12 weeks. Participants in the control group will receive knee health education of the same schedule and duration.

Main outcome measures: The primary outcome measure is the NRS score at 12 weeks. Other outcomes include Western Ontario and McMaster University Osteoarthritis Index, Short Form Six Dimensions, Timed Up & Go Test, Fast Gait Speed, pain medication usage. Compliance of self-administered acupressure will also be evaluated.

Data Analysis: Differences in the scale scores and test parameters will be examined using a linear mixed-effects model.

Expected results: Subjects in the self-administered acupressure group will have greater improvement in NRS and other related parameters compared to those in the KHE group at week 4 and 12.

Objectives Children with life-limiting diseases (LLD) and their families face enormous challenges. While the disease is non-curative, the children and families have tremendous needs requiring physical-psycho-social-spiritual support. It is recommended that pediatric palliative care (PPC) should be initiated once diagnosis is made. There is a paucity of knowledge of the essential elements that should be included in the PPC model that suits local needs. Our study aims to explore the needs of pediatric patients with LLD from the perspectives of the children, parents and the healthcare providers, as the exploratory phase towards the building of a PPC model.

Methods A multiple-case study research design. Purposive sampling of 25 sets of cases, with each case comprises of 3 informants, i.e. the child, family and the healthcare provider, that result in 75 individual interviews in total. Inclusion criteria are LLD children aged from 8 to 19, their parents and key healthcare providers. Data will be collected through in-depth semi-structured interview with the interview guide constructed to solicit the perceived needs on physical-psychosocial-spiritual support, informational support and the views on palliative care approach. Inductive thematic analysis will be used to analyze the data. Within-case and cross-case comparison will be executed to denote patterns, similarities and differences.

Expected result: This study will help inform healthcare policy makers and providers to build a palliative care model for the LLD children and their families to receive help that is coordinated and proactive for patients’ quality of life and potentially reduce unnecessary use of hospital services.

As palliative care is holistic care in nature and includes a crucial component of support for family caregivers, routine assessment of their unmet needs using a short psychometrically validated and highly accepted tool would assist healthcare providers in the early identification of a subgroup of caregivers at risk of unmet needs for timely intervention. This study aims to test the reliability, validity, and acceptability of the traditional Chinese version of the The Carer Support Needs Assessment Tool for family caregivers of palliative care patients in Hong Kong.This will be a methodological study that will adopt a cross-sectional and correlation design with repeated measures. Subjects will include at least 10 health professionals and 123 primary family caregivers of patients receiving palliative care. The study outcomes will include content validity, construct validity, test-retest reliability, and acceptability.

Background: Longer survival times resulting from recent advancements in medical treatment have led to more patients in need of long-term palliative care. Hong Kong is no exception to this international trend, with the number of people aged 65 or above projected to increase by 30% in 2041. Thus, it is of paramount importance for nurses to become competent in holistically assessing and addressing the needs of people with palliative care needs. Since the goal of palliative care is not only to prevent or relieve physical suffering, but also to address the psychosocial aspects associated with the illness, caring communication is an essential component in the delivery of holistic care. Newly graduated nurses often lack the confidence to engage in caring communication with people in palliative care. Hence, it is more important than ever to prepare graduating nurses for an education in palliative care through values clarification, vicarious experiences, and simulated-based education (SBE).
Purpose: The primary purpose of this study is to explore the impacts of SBE on caring communication in helping nursing students’ development of the knowledge, skills, and attitude to work in palliative care. The secondary purpose is to discern whether or not communication education using simulation enhance nursing students’ perceived self-efficacy in caring communication in palliative care.
Method: This is a mixed-method concurrent triagulation design with four phases. Phase 1 consists of students’ reflective value clarification with a pre and post questionnaire survey. Phase 2 included observations of nurse experts in real clinical settings and debriefing with nurse experts. Phase 3 refers to students’ demonstration of their communication skills through simulations with standardized patients, and the last phase consists of focus groups for students’ reflections on the simulated performances and the overall process. While quantitative data will be analysed through descriptive statistics and paired sample T-tests, the qualitative data will be evaluated by a content analysis.
Conclusion: The findings of this study will facilitate the learning of valued-based caring communication and the use of the various assessments in this study. This, in turn, will further our understanding of the best way for the students to learn holistic caring communication based on the concepts of trust, knowing, and presence as laid out in caring theories.

Objectives: To evaluate the clinical effects of self-administered acupressure for treating insomnia disorder delivered by a training course. Hypothesis: Subjects in the self-administered acupressure group will have greater improvement in insomnia symptoms and daytime impairment than those in the sleep hygiene education (SHE) group at 4 weeks and 8 weeks. Design and subjects: A randomized controlled trial. 184 subjects with insomnia disorder recruited from the community will be randomized to self-administered acupressure or SHE groups in a 1: 1 ratio. Study instrument: Insomnia Severity Index (ISI) will be used to assess insomnia symptoms and daytime impairment. Interventions: Subjects in the self-administered acupressure group will attend two training lessons (2-hour each) to learn self-administered acupressure and practice it every night for 4 weeks; subjects in the SHE group will receive sleep hygiene education with the schedule and duration that are same to the self-administered acupressure group. Main outcome measures: The primary outcome measure is the ISI score. Other measures include sleep parameters by subjective sleep diary and objective actigraphy, Hospital Anxiety and Depression Scale, and SF-6D at 4 and 8 weeks. Acceptability and compliance of self-administered acupressure will be evaluated. Data Analysis: Differences in the questionnaire scores, subjective and objective sleep parameters will be examined using a mixed-effects model. Expected results: Subjects in the self-administered acupressure group will have greater improvement in ISI score and other sleep parameters compared to those in the SHE group at 4 and 8 weeks. Subjects will continue practicing self-administered acupressure at 8 weeks.

Objectives: To investigate the effects and mechanism of electroacupuncture (EA) treatment during surgery-induced postoperative cognitive dysfunction (POCD) in a mouse model. Hypothesis to be tested: EA can attenuate inflammation to reduce cognitive dysfunction after surgery. Design and subjects: Male C57BL/6N mice (12 weeks old) will be divided into three groups: control, laparotomy only, and laparotomy + EA. Study instruments: Novel object recognition (NOR) test, Y-maze test, Radial-arm maze, Puzzle box, immunohistochemical staining, quantitative-PCR, Western blot analysis, and cytokine Immunoassay. Intervention: EA at Baihui (DU20) and Zusanli (ST36) for 30 minutes each day for 3 or 14 days after surgery. Main outcome: Cognitive changes will be assessed with NOR, Y-maze, Radial-arm maze, and Puzzle box tests. Peripheral inflammation will be measured using the gene and protein expression of inflammatory cytokines in the serum and liver. Similarly, neuroinflammation will be measured using the gene and protein expression of inflammatory cytokines as well as the changes in glial cell morphology in the brain. Western blot analysis will be used to quantitate the changes in tau phosphorylation and the expression of synaptic proteins and stress kinases. Data-analysis: Data for the biochemical and behavioral tests will be analyzed by one-way and two-way ANOVA (with repeated measures), respectively, followed by Student-Newman-Keuls test as a post hoc test. Expected results: This proposed study will show the effects of EA on inflammation and cognitive decline in a murine surgical model. The expected beneficial effects will provide further evidence to support future clinical trials using EA for POCD.

Background: Stroke is regarded as a global health-care problem that is common, serious, and disabling, and China bears the biggest stroke burden in the world. A randomized controlled trial (RCT) was funded to test the effects of an enhanced post-discharge home-based care program (EHP) on improving the quality of life for stroke survivors in Harbin, China. ). This study will examine the cost benefits, immediately after the completion of the EHP and after a period of time when the program is completed. Aim: To assess the cost-effectiveness of the EHP implemented for stroke survivors using the usual post stroke care as a comparator. Methods/Design: This is a trial-based economic evaluation study involving combined methods of cost-utility analysis (CUA) and cost-effectiveness analysis (CEA). It collects data related to cost dimension and uses the clinical data collected of the said funded project to estimate the cost benefits. An estimated sample size of the RCT is 144 participants recruited from a large general hospital in Harbin, Heilongjiang, China. The EHP intervention has two key components: enhanced discharge planning and home follow-up, and includes five intervention protocols for comprehensive assessment, treatment and procedures, teaching, guidance and counselling, case management, and surveillance. EuroQoL 5-dimensions 5-level (EQ-5Q-5L) health-related quality oflife score is the primary outcome of the trial study and this outcome will be transformed into in utility value. Within the economic evaluation, the primary outcome is the incremental cost-effectiveness ratio (ICER). Costs will be measured in a social perspective involving four cost categories: program costs, medical costs, non-medical costs and cost of productivity loss. Data will be collected at 90-, 180- and 365-days after the baseline assessment upon the hospital discharge. Costs and health outcomes will be compared between the two groups in the economic evaluation with relevant statistical analysis by using intention-to-treat approach. Significance/Implications: The trial study will empirically test an innovated care delivery model to address the challenges facing China on post-stroke care. It is expected that the current study findings would provide further evidence to inform healthcare policy makers, and other stakeholders including patients and their caregivers, and funding organizations for the possible cost benefit of the program.

Background: Stroke is regarded as a global health-care problem that is common, serious, and disabling, and China bears the biggest stroke burden in the world. There were almost 11.1 million stroke survivors, approximately 2.4 million new strokes and nearly 1.1 million deaths from stroke annually across 31 provinces of China in 2012-2013, (Wang et al., 2017) and about 70% of them are living with the negative consequences of stroke. Post-stroke home-based care, a broad concept of rehabilitation, is an important care strategy to enhance recovery and improve quality of life for stroke survivors. Aim: To examine the effects of an enhanced post-discharge home-based care program (EHP) on improving the quality of life and the related outcomes of stroke survivors. Methods/Design: This is an evaluator-blind, 12-week, two-parallel group, randomized trial to assess the EHP compared with usual care for post-discharged stroke survivors. An estimated sample size of 144 (72 participants per group) will be recruited from four neurology units of a large general hospital in Harbin, Heilongjiang, China. Consented participants will be randomly assigned to receive either usual care or an EHP intervention. The EHP has two key components: enhanced discharge planning and home follow-up (involving home visit, reinforced call, telephone follow-up and 24-hour hotline), and includes five intervention protocols for comprehensive assessment, treatment and procedures, teaching, guidance and counselling, case management, and surveillance. The EHP will be provided by trained nw-se case managers with the support of an interdisciplinary consultation team. Data will be collected pre and post intervention at 3 months to evaluate the program effects on quality of life (primary outcome), activity of daily living, depression, adherence, satisfaction, and healthcare utilization and cost. Focus group interviews will also be conducted to gain an in-depth understanding of the experience of patients, informal caregivers and healthcare providers who participate in the EHP. Significance/Implications: The current study will empirically test an innovated care delivery model to address the challenges facing China on post-stroke care. It is expected that the study findings would provide evidence to support the decision on the provision of accessible and affordable quality care to post-stroke population for multi-stockholder, including patients and families, healthcare providers, decision makers of healthcare organizations and government.

Background: Insomnia is a very common complaint worldwide. Acupuncture is an alternative treatment for improving sleep quality. However, its efficacy and mechanism of action as a treatment for insomnia requires further investigation. Acupuncture may attenuate oxidative stress which is thought to be an important pathophysiological factor in insomnia. Aims: To evaluate the safety and efficacy of a semi-individualized acupuncture treatment in improving sleep, and to examine its effects on oxidative stress parameters in subjects with primary insomnia disorder. Methods: This will be a randomized controlled trial involving 140 subjects with DSM-5 insomnia disorder after excluding those with other medical conditions, psychiatric disorders, and sleep disorders that may cause insomnia. The subjects will be randomly assigned to either acupuncture treatment or sham acupuncture (control group) in a 1:1 ratio. The acupuncture treatment group will receive acupuncture treatments using a semi-standardized protocol. In a similar way, the sham acupuncture control group will receive acupuncture using validated noninvasive sham acupuncture needles. Both subjective (the sleep questionnaire and sleep diary) and objective (actigraphy) outcome measures will be recorded at baseline and at 1- and 5-week post-treatment. Fasting blood samples will be taken on the morning of the assessments at these time points to measure the oxidative stress parameters, including the malondialdehyde (MDA) level, and the glutathione peroxidase (GPx), paraoxonase (PON), and arylesterase (ARE) activities. The primary outcome is sleep efficiency, measured using a 7-day sleep diary and the oxidative stress parameters at 1-week post-treatment. Data analysis: Changes in the sleep and oxidative stress outcome measures will be compared between groups by using a mixed-effects model at each time point. Correlations between sleep parameters and oxidative stress parameters will be examined using a Pearson correlation. Mediation analysis will be performed to explore the possible mediating effect of oxidative stress factors on sleep. Significance: The relationship between oxidative stress and insomnia severity has been underresearched. To the best of our knowledge, there has thus far been no study on the effect of acupuncture on oxidative stress in subjects with insomnia disorder. The present study will not only provide high-quality evidence of the efficacy of acupuncture as a treatment for insomnia, but also of the associated changes in oxidative stress parameters. It will guide future studies on the treatment mechanism and pathophysiology of insomnia.

The use of smartphone has been increasing rapidly in the recent years. The number of smartphone users worldwide was one billion in 2012 and in 2015 this figure was doubled, and Hong Kong in particular has the highest penetration rate around the world, with more than 50% of primary school students, and more than 90% of secondary school students possessed smartphones. While the use of smartphone can improve our quality of life, excessive usage is likely to cause adverse health outcomes. Several studies examined the health impacts of excessive smartphone usage, and they showed that excessive smartphone usage was associated with increased sedentary behaviors, mental health problems, and sleeping problems. However, a common major limitation of these studies is the use of self-report usage level, in which the reporting was subjected to recall bias and the validity and reliability were unknown. Also, smartphone usage, sleeping quality, and physical activity level can vary day-by-day. In fact, objectively-measured smartphone usage can be obtained by monitoring the activities of the smartphone, but no studies on the association between objectively-measured smartphone usage and health outcomes. Here, we propose to build a comprehensive, objectively-measured smartphone usage data of Hong Kong adolescents and young adults by trace-logging their smartphone activities, and to study the temporal association between smartphone usage in daytime and bedtime, sleeping quality that night, and physical activity level in the following day. Participants will install a smartphone usage tracking application developed by the investigators for 7 consecutive days, and the time spent on each type of application (web browsing, multimedia, games and comics, tools, camera, instant messaging, social network, and health) and frequency of usage will be recorded. Concurrently, participants will wear a wrist-worn accelerometer to assess their sleeping quality and physical activity. Results of this study can scientifically infer further interventions about writing smartphone applications that control specific usage pattern, for example limiting prolonged game-playing with a specific cutoff of length. In addition, to compare the subjective well-being of using smartphone versus other activities, we will collect in situ well-being status in everyday situations by prompting the participants randomly throughout the day to response to questions concerning the details of the activity and their feeling just before the prompt. As a secondary analysis, participants will be required to self-report their smartphone usage pattern and validated against objectively-measured data. The degree of validity of the self-report smartphone usage data can inform stakeholders about the validity of the results deduced from further large-scale epidemiological studies in which objective measurement of smartphone usage is not feasible.

Over several decades, ineffective communication has been shown to be a major cause of critical incidents in hospitals, resulting in patient harm and sometimes death. Encouraging clinicians to ‘speak up’ whenever they have patient safety concerns has been identified as one possible way to avoid such miscommunication and prevent adverse incidents. However, most existing studies of speaking up have focused on English-speaking or European contexts. In addition, very few studies have based their recommendations on a detailed analysis of actual interactions in hospital settings. As a result, we know little about the contexts in which speaking up should be happening, the strategies clinicians are already using to raise patient safety issues during clinical interactions or the strategies that might be recommended for use in the unique cultural, linguistic and healthcare context of Hong Kong. This study set out to fill these gaps by exploring actual clinical interactions in the high-risk clinical setting of the ICU at a public hospital in Hong Kong. It also provides a better understanding of the communication challenges clinicians face in their day-to-day work and to make recommendations based on the reality of daily communication in context. Analysis of the actual interactions through discourse analysis was conducted. General barriers to speaking up were identified, and a series of recommendations were made.

Objective: To determine the optimum treatment protocol of auriculotherapy (AT) on the improvement of sleep conditions and quality of life on the elders with sleep disturbances. Hypotheses: (1) The use of combined MAT and LA have a synergistic effect and is more effective than MAT or LA alone on the improvement of sleep conditions and quality of life in the elderly with sleep disturbances. (2) The use of magneto-auriculotherapy (MAT) or laser auriculotherapy (LAT) alone or in combination are more effective than the control treatment on the improvement of sleep conditions and quality of life in the elderly with sleep disturbances. Design and subjects: A 2x2 factorial randomised double-blinded design is used. Subjects aged 60 and exhibit poor sleep conditions are recruited. Interventions: Group 1: Subjects will receive MAT followed by a deactivated laser treatment on seven specific auricular points. Group 2: Subjects will receive LAT and placebo MAT. Group 3: Subjects will receive a combined approach (both MAT and LAT). Group 4: Subjects will serve as placebo controls. The treatment will be delivered 3 times/week, with a 6-week treatment period. Main outcome measures: Sleep conditions and quality of life will be evaluated at baseline; end of 6-week treatment; and at one-, three-, and six-month follow-up periods. Data analysis: Descriptive statistics, ANOVA, paired t-test, and mixed effect modeling will be conducted as appropriate. Prevention, treatment and control of infectious diseases x Effectiveness of auriculotherapy on older people with insomnia x Public health, human health, health services and Chinese medicine. New Submission: 1. SUBMISSION 3. PROJECT TITLE (Word limit: 25 words) (Word limit: 250 words, in BMJ format). Expected results: This study would advance our knowledge the optimum treatment protocol of AT in the improvement of the sleep conditions of the elderly population.

The aim of this study was to explore how the provision of community care in a cancer support center can help cancer patients and survivors cope with the demands of cancer and its treatment. A focused ethnographic approach was adopted. Data were collected through participant observations and focus group interviews with various stakeholders. The data from the focus group interviews were transcribed verbatim and analyzed using constant comparative analysis. Four main themes emerged: 1. Enabling patients to achieve mental well-being on their coping journey, 2. Empowering them to work with their odds, 3. Enhancing meaningful nurturing interactions through the design of spaces and colors, and 4. Evolving through seeing more value in themselves. These 4Es occurred through intimate human interaction in the center, which resulted in psychological renewal and the rebuilding of a sense of self among the users. This study provides insights on the provision of community support services for cancer patients, specifically on how to help cancer patients to regain control over their lives, not only through providing services for psychosocial renewal by engaging in intimate human interactions, but also by contributing to an understanding of the effect of the physical environment and space on healing.

Objectives: To identify the pattern and demographic, socio-economic, and parental caregiver correlates of smart device usage, and to identify the prospective association of excessive smart device usage and addiction with lifestyles behaviors, physical fitness, and eye problems among Hong Kong adolescents. Hypothesis to be tested: Hong Kong adolescents with a better socio-economic status and higher smart device control of parental caregiver will have higher risk of excessive smart device usage. Excessive usage of smart devices will lead to unhealthy lifestyles, poor physical fitness, and eye problems. Design and subject: A prospective study with 1-year follow-up period on students studying P.3-P.5 and S.1-S.3 in Hong Kong. Around 15 to 20 schools will be recruited, with an estimated sample size of 2,880 students. In addition, the questionnaire will be administered after 6 months of baseline. Study instruments: Height, weight and body composition, refractive error, range of motion, hand grip strength, pinch strength, and 7-day activity monitoring with accelerometer will be measured. Main outcome measures: Smart device usage and lifestyle behaviors (physical activity, dietary habits, sleeping problem) will be assessed by self-administrated questionnaire. Physical fitness and eye problems will be measured at health examination, and will be conducted at baseline and 1-year follow-up at schools. Data analysis: Multi-level regression will be used to examine the association between demographic and socio-economic status on the pattern of smart device usage, and the association between baseline smart device usage and health outcomes. Expect results: Excessive usage of smart devices and addiction will lead to health problems.

Aim: To explore the current speak-up culture among healthcare professionals in the ICU at Queen Elizabeth Hospital (QEH). Objectives: To explore the attitudes and views on the speak-up culture among critical care doctors and nurses in relation to patient safety lb. To explore whether the staff have the same or different perceptions of their communication openness towards their speak-up behaviours in the following comparison groups: doctor vs nursei junior vs seniori male vs female. 2. To identify the possible factors that encourage or prohibit speaking up at the ICU. 3. To analyse the communication strategies and language adopted in promoting speak-up culture.

The aging population is of concern to policy makers and society because aging is associated with increased prevalence of chronic illnesses and decreased independence, which potentially place a burden on the health and social system. Older people themselves prefer to aging in place (AIP) at their own homes rather than receiving institutional care. AIP is a concept that advocates the older people to live with optimal health and a level of independence that enables them to manage daily life in the community. Supporting AIP requires a health-social partnership, since many of the health issues require social interventions (e.g. meals-on-wheels) and likewise some social issues are health-related (e.g. diminished health reduces social activities). Existing disease management programs are delivered by hospital nurses and doctors, with proven outcomes. However, the ownership of health for community-dwelling people should lie with the community itself and not the hospitals. The community-based systematic approach advocates a delivery design that can mobilize resources and involve the stakeholders in strengthening supported self-care. This study aims to test the effect of an AIP Health-social Partnership (HSP) program using randomized controlled trial. A sample size of 491 subjects in each arm is required for an effect size of 0.2, a power of 80% and significance level of 5%. The study will take place in public housing estates in a Hong Kong district with support of the community leaders and geriatric team of the district hospital. The intervention involves a 3-month AIP program coordinated by a nurse case manager with nursing and community background. S/he will initiate a home-based comprehensive assessment based on the Omaha framework that addresses issues in environmental, psychosocial, physiological and health-related behaviors domains and develops a plan of care with contracted goals with the client. The follow-up will happen weekly in the first month and then biweekly in the second and third month with home visits/telephone calls. The design is guided by national guidelines and evidence that aims at enhancing self-care and self-efficacy. The intervention events are protocol-driven to ensure standardization and consistency. The control group will receive routine care and social calls. The outcome measures include perceived wellbeing, (self-efficacy, QOL, satisfaction), evaluated health outcomes (BP, BMI, ADL, nutritional status, medication adherence) as well as institutionalization and health service utilization. This study is original in building a HSP-AIP program with active participation of the health-social sectors and clients themselves, and subject the program to empirical testing.

For patient-centeredness, the skilled and sensitive use of communication with patients is essential to the practice of nurses and is known to be the core aspect of caring. Patients living with cancer often experience anxiety and depressionl. Nurses have the best opportunity to acknowledge and attend to the in.formation and emotional needs of these patients. However, communication with cancer patient is often not ideal. At best, nurses tend not to respond to and/or miss the information and emotional needs of these patients expressed as cues and concerns. At worst, mounting evidence of ineffective communication at all levels of t!he healthcare system has shown poor patient outcomes, including significant physical and psychological harm2, and patient and clinician dissatisfaction. While time is usually cited as a barrier to nurses communicating with patients, recent findings challenge this belief. This raises the possibility that it is the quality of the nurses' cue responses to patients' needs and concerns, rather than the quantity of time spent in communicating, that is important. Related questions that consider patients' satisfaction with nurses' cue-responding behaviors also merit attention as an understudied area in communication research. There is a paucity of research on the process of communication, as cue-responding, between nurses and cancer patients within their routine care and the corresponding patient satisfaction and insufficient care/care problem that may have resulted from the under-recognized cues and concerns of patients. The aim of this study is to address this critical gap, thereby giving nurses some guidance in reexamining their nurse-patient communication through cue-responding behaviors, and to explore with them ways of adjusting their practice. It is hoped that the result will be able to improve oncology nurses' receptivity to patient cues and concerns during brief encounters3 in routine care. A focused ethnographic approach and conversational analysis will be adopted in this study, using observations, a patient's concern checklist with semi-structured interviews, audio-recordings of nurse­patient interactions, nonverbal observations, nurses' reflective focus groups, and document reviews. We will analyze, describe the actual conversations, and identify the context (oncology ward environment and the particular situation/encounters) and ways in which communicative practices can be enhanced between nurses and cancer patients within the Chinese culture. Culture is known to have an influence on effective communication in healthcare, and this study is the first of its kind in Hong Kong.

Given the importance of healthcare communication for patient safety, nurses' handover reporting is an activity at every commencement of a shift that carries the significance of accountability and the expected accuracy of information transfer. In the studies of patient safety and healthcare communication, limited studies have explored the nurses' handover communication. In this investigation, a research team consists of linguists, applied linguists and clinicians spent two days observing and recording nursing handovers in two medical and surgical wards during the first phase of the study. The 80 patient handovers were then transcribed, translated into English and analysed by the English-speaking and Cantonese-speaking team of linguists and clinicians. The team also interviewed nurses about handover practice and collected samples of both formal and informal handover documentation. Analysis of all the material collected revealed that nurses perform their handovers professionally and efficiently. However, the team identified four main areas in the realms of information and interaction dimensions of the handover where changes to handover practice are likely to enhance patient safety and continuity of care. If implemented, the recommended changes would also equip nursing staff with the skills to adapt their handover practice to include patients, should the hospital eventually move to bedside handover practice, increasingly the preferred mode for handover internationally. These recommended changes were introduced to practice through training sessions for nurses based on interactive activities and the use of an authentic video-recorded of four medical and four surgical handovers in the hospital. The effectiveness of the training were evaluated within a week and one month and the results are positive.

Objectives: To examine the efficacy of electroacupuncture for tapering benzodiazepines in long-term users. Hypothesis to be tested: Subjects receiving electroacupuncture will have a higher benzodiazepine cessation rate than those receiving non-invasive placebo acupuncture at 2-week post-treatment (week 6) and 12-week post-treatment (week 16). Design and subjects: Randomized, subject- and assessor-blind controlled trial. One-hundred and forty-four eligible subjects will be randomized in a ratio of 1:1 to (1) Electroacupuncture combined with gradual tapering; or (2) Placebo acupuncture combined with gradual tapering. Study Instruments: Subjects will be told to record their daily benzodiazepine use in a standardized record form. Other instruments include Benzodiazepine Withdrawal Symptom Questionnaire (BWSQ), Insomnia Severity Index (ISI), and Hospital Anxiety and Depression Scale (HADS). Adverse events will be monitored by a standardized adverse events report form. Interventions: Subjects will be randomly allocated to either electroacupuncture combined with gradual tapering, or non-invasive placebo acupuncture combined with gradual tapering over 4 weeks. Main outcome measures: The primary outcome measure is benzodiazepine cessation rate, defined as the proportion of subjects who discontinued benzodiazepines for 14 consecutive days. Secondary outcome measures include percentage reduction in benzodiazepine usage, withdrawal symptoms by BWSQ, insomnia severity by ISI, and anxiety and depression symptoms by HADS. Data Analysis: Comparisons of benzodiazepine cessation rate between the groups will be performed using Chi-square tests at 2-week post-treatment (week 6) and 12-week post-treatment (week 16). Difference in questionnaire scores will be examined using two-sample t test. Expected Results: Electroacupuncture is more efficacious than placebo acupuncture for benzodiazepine tapering.

Background: Clinical placements are an integral component of nursing education. However, research has shown that nursing students can experience stress during their clinical placements. Aim: This study aimed to explore the mechanism contributing to burnout and resilience in the context of clinical placements. Design: This was a descriptive qualitative study.
Setting: The study was conducted in a university. Participants: Twenty-four final year baccalaureate nursing students, who were identified in the quantitative phase of the study as having scores indicating the following: a) low resilience and high burnout; b) high resilience and low burnout. Method: Ten focus group interviews were conducted using a semi-structured interview guide. The interviews were digitally recorded and transcribed verbatim in Chinese for a thematic analysis. Results: Two main themes were identified from the interviews: a) stressors arising from students’ expectations of the clinical placement (i.e., the practice demands of busy wards, striving for learning opportunities, and discovering the social rules), and b) coping as a process of fitting into the ward culture. While the students all reported similar stressors, the coping mechanisms that they used to deal with these stressors differed between the two groups. Those students with high resilience and low burnout scores had a self-directed goal and used self-regulation strategies. Students with high burnout and low resilience adopted external orientation and self-blame strategies. Conclusions: The resilience and burnout scores of the student nurses provide insight into the way that nursing students deal with stressors. To build and maintain resilience in the students, the following are recommended: interventions to enable the students to actively fit into the clinical environment; encourage engagement in reflection to facilitate self-awareness; and encourage flexible use of personal and external resources.

Objectives: Effect of a pressure ulcer (PU) prevention programme in for-profit private nurstng homes in Hong Kong. Hypothesis to be tested: The experimental group will have lower PU prevalence, incidence and risk than the control group at the 6th week and the end of protocol implementation. The experimental group will have higher PU knowledge and skills of the care staff than the control group after the staff training course. Design and subjects: Cluster randomised controlled trial in eight private nursing homes with 130 to 150 beds. Two nursing homes from each of the four conveniently selected districts will be randomly assigned to the experimental or control group. Study instruments: PU prevalence, incidence and risk of residents, and PU knowledge and skills of care staff will be assessed with locally validated forms.
Interventions: The PU prevention programme includes a staff training course tailor-made to non-professional care staff and a prevention protocol guiding them to assess the PU risk and provide preventive interventions accordingly. The protocol will be implemented for 12 weeks. The control group will receive usual pressure ulcer prevention care. Main outcome measures: PU prevalence, incidence and risk of residents. Data analysis: Chi-square test will be performed to compare PU prevalence and incidence between the two groups. Mixed between-within subjects ANOVA will be performed to compare PU risk between the two groups and over time. Expected results: The PU prevention programme will significantly reduce PU prevalence, incidence and risk at the 6th week and the end of protocol implementation.

Background: The adequate fit of an N95 respirator is important for healthcare workers to reduce the transmission of airborne infectious diseases in the clinical setting. This study aimed to evaluate whether adequately sealed N95 respirators may provide consistent protection for the wearer while performing nursing procedures. Materials and methods: Participants were a group of nursing students (n=120). The ‘best fit’ respirator for these participants was identified from the three common models, 1860, 1860S, and 1870+ (3M, US) using the quantitative fit test (QNFT) method. Participants performed nursing procedures for 10-minute periods, while wearing a backpack containing the portable aerosol spectrometers throughout the assessment to detect air particles inside the respirator. Results: The average fit factor of the ‘best fit’ respirator worn by the participants dropped significantly following nursing procedures (184.85 vs. 134.71) as detected by QNFT. In addition, significant differences in particle concentration of different sizes (>0.3, >0.4, >1.0, and > 4.0 μm) inside the respirator were detected by the portable aerosol spectrometers before, during, and after nursing procedures. Conclusion: Body movements during nursing procedures may increase the risk of face seal leakage. Further research, including the development of prototype devices for better respirator fit are necessary to improve respiratory protection of users.

Objective: to test the effectiveness and the cost impact of an 8-week course of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients receiving neurotoxic chemotherapy.

Hypothesis: Acupuncture is more effective than non-penetrating sham acupuncture or standard care alone in patients experiencing CIPN-related pain.

Design & subjects: Randomised placebo-controlled trial with three groups. 108 lung, breast or gynaecological cancer patients with CIPN-related symptoms. Intervention: Subjects will be randomized to receive a) acupuncture twice weekly for 8 weeks needling 8 specific points, b) placebo non-penetrating acupuncture in non-acupuncture points and c) only standard care. Study instruments: Primary outcome will be pain intensity over the past week.

Secondary measures: CTC grading and WHO scale for neuropathy, and the FACT-COG-Ntx quality of life scale, assessed at baseline, end of treatment (8 weeks), week 14 and week 20 from the beginning of treatment, sensory examination and health economics assessment.

Data Analysis: Intention to treat analysis will be used. Analyses will include analysis of variance to assess between-groups differences, regression analysis and 95% CIs.

Expected Results: New information about the delivery and outcomes of acupuncture in the management of a debilitating symptom/side effect of cancer therapies in order to inform decision-making, policy-making, providers and consumers, contributing to the evidence base for the treatment of chemotherapy-induced peripheral neuropathy. We will provide information that can lead to improvements in the care of cancer patients, have a positive impact on quality of life and may increase the number of patients successfully completing neurotoxic treatments.

Objectives: Physical activity (PA) and sleep are important to health, thus it is important for researchers to have valid tools to measure them. Accelerometers have been proven valid for measuring PA and sleep, but only one device does this simultaneously: the wActiSleep-BT, however, the sleep monitoring function has not been validated. This study aims to evaluate the predictive power of wActiSleep-BT sleep parameters against a validated accelerometer (Actiwatch
2). Hypothesis to be tested: The wActiSleep-BT can assess sleep parameters including total sleep time, wake after sleep onset (awake time after sleep), and sleep efficiency.
Design and subject: A random sample of 50 adults aged 18-64 will be invited to wear both accelerometers on their non-dominant wrist for 7 consecutive days. Study instruments: Sleep parameters will be measured using wActiSleep-BT and Actiwatch 2. The presence of sleeping disorder will be measured by the Chinese version of the Pittsburgh’s Sleeping Quality Index.
Main outcome measures: Total sleeping time, wake after sleep onset, and sleep efficacy. Data analysis: Epochs from both accelerometers will be classified as either sleep or awake using established algorithms (Cole-Kripke, Sadeh, Sazonov), and these data will be transformed to total sleeping time, wake after sleep onset, and sleep efficacy. The agreement of the two accelerometers will be compared using correlations and accuracy by t-test / Wilcoxon signed-rank test. The predictive power of the wActiSleep-BT to monitor sleep/wake status will be evaluated by sensitivity, specificity, accuracy, and ROC analyses. Expect results: The wActiSleep-BT can accurately assess sleep parameters.

Objectives: To identify the adoption of a health promoting lifestyle and the influencing factors among Chinese breast and colorectal cancer survivors during the first 5 years after completion of treatment.
Design: Combining cross-sectional quantitative survey and focus group interviews.Subjects and setting: 197 adult Chinese breast! coloreclal cancer survivors who have completed treatment within the past five years will be recruited from hospitalsl community organizations in Hong Kong. Twenty four breast and colorectal cancer survivors will be invited to join focus group interviews through purposive sampling.
Study instruments: Demographic and medical data sheets, modified Health Promoting Lifestyle Questionnaire, Perceived Self-efficacy and Multidimensional Health Locus of Control Scale (MHLOCS) will be adopted in quantitative survey. Interview guide will be used in focus group interview. Interventions: No intervention will be delivered.
Main outcome measures: Questionnaires will be used to collect data on breast and colorectal cancer survivors' perceived locus of control, perceived self-efficacy, and adoption of health promoting lifestyle behaviors. The subjects' adoption of health promoting lifestyles, the influencing factors, and their comments on the serv·lces required will be explored in focus group interview.
Data analysis: Pearson's r correlation will be used to test the existence of relationships between the perceived self-efficacy, perceived locus of control, and health promoting lifestyle. The relationships among all the independent variables and the dependent variable (I.e. health promoting lifestyle) will be evaluated by path analysis. Qualitative content analysis will be used to analyze interview data.
Expected results: Health promoting lifestyle of breast and colorectal cancer survivors may be affected by personal, medical and cultural factors.

Palliative care for end-stage organ failure patients has been included as one of the key programs to be implemented in 2011-2012 by the Hospital Authority, Hong Kong. Among all the disease groups, end-stage heart failure (HF) patients have the highest mortality rate. Patients at the end stage of HF have health concerns shared by other end-stage patients, including cancer patients. Many guidelines, local and world-wide, have advocated a palliative approach to caring for HF patients who are at the end stage. Studies have shown that end-stage HF patients tend to make frequent emergency room visits and are repeatedly admitted to hospital. Also, these patients suffer from a number of health problems that adversely affect their QOL. There are few experimental studies informing practitioners which models work best for palliative patients in Hong Kong. Randomized controlled trials have been conducted outside Hong Kong which suggest that a multidisciplinary approach to palliative care is possible in order to reduce readmissions, but evidence is not present for other outcomes such as symptom control and carer burden. In an attempt to fill the knowledge gap and inform practice with evidence, this study will be launched to compare the effects of customary hospital-based palliative HF care and an interventional Home-based Palliative HF Program.