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Transitional, Supportive & Palliative Care

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Transitional, Supportive & Palliative Care

Transitional
The group's research priorities are on three areas:
  1. Symptom management in cancer, palliative care and life-limiting illnesses
  2. Traditional Chinese medicine and complementary therapies
  3. Models of care delivery with a focus on transitional care and community-based chronic disease management.
Our programme of research focuses on empirical testing of interventions for symptom management in clients who have life-limiting illnesses such as end-stage organ failure or cancer and require palliative care. The effectiveness of these interventions is demonstrated by improved symptom control and quality of life, enhanced total well-being and reduced unnecessary use of healthcare services.
Our work in this area supplements the previous research programme and evaluates the efficacy and mechanisms of complementary and alternative therapies including traditional interventions such as acupuncture, acupressure and herbal therapy, as well as psychosocial measures such as hope therapy and patient engagement. The effectiveness of integrating these therapies into mainstream western medical treatment for enhancing the quality of care is established through empirical studies.
Researchers in this area aim to develop models of care delivery for clients with chronic diseases and/or complex needs, who require cost effective and holistic interventions. Such studies will help promote cost-effective care delivery and quality outcomes.

Members

 

Centre for Smart Health

The Centre for Smart Health aims to create healthcare innovations with technology, making positive impacts to practice and the quality of care. We conduct cross-disciplinary applied research that capitalizes on our expertise in technology, including virtual reality and artificial intelligence, and translates the results into practice to improve healthcare education, diagnosis and treatment.

Impact Stories

Transitional care in support of post-discharge patients returning home

Frequent hospital readmissions disrupt patients’ life and add burden to the already over-strained hospital system. The 30-day readmission rate ranges from 15% to 35%, with chronically ill patients at the higher end. We tested transitional care programmes for different patient groups, and proved that they are effective at controlling readmission rates, enhancing patients’ self-efficacy and quality of life, and reducing costs. The model has been translated into practice and generated tremendous impacts related to research, service, society and policy, in both local and international settings. Team members include Arkers Wong, Candy Wu, Katherine Chang, Shaoling Wang and PhD graduates.

The research work involved accumulative stages of constructing and testing models in transitional care. The key researcher (PI) is Professor Frances Kam Yuet WONG, working with a team of academic members and doctorate students.

 

I. Telephone follow-ups (2002 – 2005)
A randomized control trial (RCT) using telephone follow-ups was conducted among diabetic patients to support needs of patients discharged early. A greater decrease in HbA1c level, better adherence, and more savings in hospital expenses were found in the intervention group.
Pivotal findings:
Early discharge of diabetic patients can be effectively supported with nurse telephone follow-up and potentially cost savings for the hospital.

 

II. Home visits and/or telephone calls (2006 – 2009)
The use of telephone calls was generally effective but it has its limitations. The research team introduced home visits in this phase of intervention. Positive results including reduced hospital use and improved health-related lifestyle behavior were found.
Pivotal findings:
Nurse home visits were effective in supporting patients discharged home with cardiac diseases and general medical conditions with the model tested in Mainland China as well as Hong Kong.

 

III. Multidisciplinary and mixed skills approach (2010 – 2012)
Previous studies used the nurse as the sole interventionist. The current model adopts a mixed skills and health-social partnership approach, with the nurse case manager supported by volunteers, social workers and physicians. The evidence generated showed that the model was not only clinically effective but cost-effective.
Pivotal findings:
A health-social partnership model using the nurse as case manager is effective in bringing significant results in quality of life, self-efficacy measures and reduced hospital use. The model was cost-effective up to 90% using National Institute Health and Clinical Excellence (NICE) reference. Knowledge transfer took place where the postdischarge services were sustained in the Hong Kong study hospital and the hypertension nurse clinic continued to operate in the community centre in Mainland China.

 

IV. Patients with palliative care needs (2013 – 2017)
This phase of research asked if the model worked among patients with complex needs. A nurse-led multi-disciplinary transitional care incorporating a palliative care approach was tested among a group of end-stage heart failure (ESHF) patients in their last year of life. Significant results in reduced hospitalization, increased quality of life, better symptom management and more cost-effective were found in the intervention group compared to the control group.
Pivotal findings:
The ESHF patients in the intervention group reached minimal clinically important difference in their symptom control and the model was proven to have cost-effectiveness with 85% and 100% at 1- and 3-months respectively using the thresholds recommended by both the NICE and World Health Organization threshold.

 

V. Community-owned model (2017- )
The model tested so far is hospital-based. The relatively healthy individuals should be owned and supported in the community instead of the hospital. This phase of study endeavors to establish and test empirically a primarily community-owned model.
Pivotal findings:
Evidence showed that there is significant improvement in systolic blood pressure, self-efficacy and reduced use of medical services in the intervention group with an aging-in-place community program.

• Wong, F.K.Y. & Chung, L.C. (2006). Establishing a definition for a nurse-led clinic: structure, process and outcome.Journal of Advanced Nursing, 53(3):358-369.

 

• Wong, F.K.Y., Ho, M. M., Yeung, S.Y., Tam, S.K. & Chow, S.K. (2011). Effects of a health-social partnership transitional program on hospital readmission: A randomized controlled trial.Social Science & Medicine, 73(7):960-969. doi: 10.1016/j.socscimed.2011.06.036.

 

• Wong, F.KY., Chau, J., So, C., Tam, S.K. & McGhee, S. (2012). Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients.BMC Health Services Research, 12:479. doi: 10.1186/1472-6963-12-479.

 

• Wong, F.K.Y., Ng, A.Y., Lee, P.H., Lam, P.T., Ng, J.S., Ng, N.H. & Sham, M.M. (2016). Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.Heart, 102(14):1100-1108. doi: 10.1136/heartjnl-2015-308638.

 

• Wong, F.K.Y., Chow. S.K., Chan, M.F., & Tam, S.K. (2014). Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomized controlled trial.Age and Ageing, 43(1): 91-97. doi:10.1093/ageing/aft123.

 

• Wong, F. K. Y., So, C., Ng, A. Y. M., Lam, P. T., Ng, J. S. C., Ng, N. H. Y., . . . Sham, M. M. K. (2018). Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure.Palliative Medicine, 32(2), 476-484.

 

Key research grants in support of the work, all granted to Frances Kam Yuet WONG as PI:

 

• Exploring The Phenomenon Of Hospital Readmission: A System Approach. Amount: $711,108. Funded by a Research Grants Council (RGC) Competitive Earmarked Research Grant (CERG) 2002-2003 (B-Q632). Grant Period: 2003-2006.

 

• Effectiveness of a Case Management Approach among Renal Patients Undergoing Peritoneal Dialysis: A Randomized Controlled Trial. Amount: HK$ 473,324.00. Funded by a Central Research Grant, University Grants Council, Hong Kong (B-Q974). Grant Period: 2006-2009.

 

• Effects of a health-social partnership transitional care model for post-discharged elderly. Amount: HK$4,241,000 [Project led by the Salvation Army; an amount of HK$1,008,000 was designated to Professor Frances Wong to undertake the project evaluation using a randomized control trial] (Duration 36 months, completed on December 2010). Funded by CADENZA: A Jockey Club Initiative for Seniors (ZH60). Grant Period: 2008-2010.

 

• Effects of an enhanced transitional care programme on hospital readmission: A randomized controlled trial. Amount: HK$1,143,146 Funded by Research Grants Council, General Research Fund 2009-2010 (PolyU5479/09H) Grant Period: 2009-2012.

 

• Effects of a transitional palliative care model on patients with end-stage heart failure. Amount: HK$596,020. Funded by the Research Grants Council, General Research Fund 2012-2013 (PolyU5492/12H). Grant Period: 2013 – 2016.

 

• Effects of an aging-in-place health-social partnership program among community-dwelling older people: a randomized controlled trial. Amount: HK$990.952 Funded by Research Grants Council, General Research Fund 2015-2016 (PolyU156042/15H) Grant Period: 2016 – 2019

 

• An enhanced post-discharge home-based care program (EHP) to improve the quality of life for stroke survivors in Harbin China: a randomized controlled trial. Amount: HK$250,000 Funded by The T. S. Lo Foundation (5-ZH2Q) Grant Period 2017 – 2020

 

• Economic evaluation on an enhanced post-discharge home-based care program (EHP) to improve the quality of life for stroke survivors in Harbin China Amount: HK$160,000 Funded by Hong Kong Nurses Training & Education Foundation Ltd. (5-ZH2S) Grant Period 2018 - 2021

The work on transitional care has demonstrated impacts detailed below.

 

1.Research-related impacts
The work contributed to generation and dissemination of new knowledge, with 62 English and 19 Chinese referred articles published amounting to respectively 750 and 980 sum of times cited in the subject area. Five PhD graduates were educated and 3 still are in training. The impacts are local and international. The research published in Heart received an editorial recommendation appealing clinicians to ‘investigate opportunities for upstreaming and normalizing palliative care’ based on our findings (Reference 1). A research report commissioned by the Law Commission of Ontario, Canada included the same study to make recommendations for improving end-of-life care setting transitions (Reference 2). A guideline in consultation developed by NICE compiling evidence on the service delivery and organization for emergency and acute medical care also included our studies (Reference 3).
The knowledge transfer is evidenced by the numerous consultancy projects, amounting to over HK$2.5 million in Mainland China, Macau, and Singapore. The study protocols and findings also attracted commercial interest to translate the research protocols into practice operation formats. Two Foundations have donated an amount of HK$410,000 in 2018 to ask the research team to implement and test the model in Harbin among stroke patients.

 

2.Service impacts
As a result of the research findings, the practice in the study hospitals has been changed. Many of the study clinical sites sustained the service models and turned them into routine practices. As denoted in the appreciation letter from the Cluster General Manager Nursing of the Kowloon Central Cluster, the program introduced in the hospital was proven to be cost-saving and was awarded distinction point in the Hospital Accreditation exercise because of this initiative. In Mainland China, we have received reports from the First Affiliated Hospital of Guangzhou Medical University (FAH-GMU) and the Guangzhou Community Centre at Yuexie District (GCC-YD) updating us on the sustained impacts with our randomized controlled trials. The FAH-GMU, at the completion of our RCT, established two specialty nurse positions to continue with the work in respiratory rehabilitation. Fourteen new research projects were generated to extend the transitional care model in different disease groups. The study nurses now become leaders and educators providing role models and training for nurses all over the country in respiratory rehabilitation and case management. Members of the team have received multiple awards for their work based on the foundation that our team have built for them. At GCC-YD, the hypertension control rate reaches 40.6% supported by nurse clinic and family physician contractual services. The standardized management protocol is adapted from the original research protocol and continued in their service, bringing benefits to residents in the community.

 

3.Societal impacts
This model of transitional care has proven to have enhanced quality of life of patients with better symptom control and reduced use of hospital services. In Canada, our study on nurse clinics resulting in increasing access to care for people is referenced to appeal for similar practice for the Ontarians in Canada (Reference 4). In Hong Kong, wide media coverage is reported with the PI advocating nurse clinics in the hospital and community settings to provide responsive care to people in need.

 

4.Policy impacts
The PI with her substantial research work in the area, is a pioneer in establishing the accreditation criteria for nurse clinic, a mode of service to support transitional care. Her research findings are adopted as accreditation criteria for the Nurse Clinics at the Hospital Authority since 2006 and she serves as an advisor of the Accreditation Panel of Nurse Clinics at the Hospital Authority. The PI at present is also an expert member of the Kowloon West Hospital Cluster advisory group advising on the strategic development of the cluster with a total of 4,707 hospital beds and 16 general out-patient clinics.
At the government level, the PI is one of the Members of the Primary Health Care Steering Committee under the Bureau of Food and Health to shape primary healthcare policies in Hong Kong. The participation adds strength as she is also the elected President of the Hong Kong Academy of Nursing representing 3000 Advanced Practicing Nurses practicing in different specialty areas of the public and private healthcare sectors in Hong Kong.

Sources / References to substantiate the claims made in Section 4:

 

1. Editorial, Kavalieratos D, Rollman BL, Arnold RM. Heart Published Online First. doi:10.1136/heartjnl-2016-309385. (Original paper –Wong, F.K.Y., Ng, A.Y., Lee, P.H., Lam, P.T., Ng, J.S., Ng, N.H. & Sham, M.M. (2016). Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.Heart. Published Online First. doi: 10.1136/heartjnl-2015-308638.)

 

2. Wilson, D.M. & Birch, S.B. (2016) Improving end-of-life care setting transitions: a mixed-methods research report. Ontario, Canada: Law Commission of Ontario.

 

3. National Institute for the Health Care Excellence (2018) Emergency and acute medical care in over 16s: service delivery and organization (In consultation) accessible at https://www.nice.org.uk/guidance/ng94/resources/emergency-and-acute-medical-care-in-over-16s-service-delivery-and-organisation-pdf-1837755160261

 

4. Registered Nurses Association of Ontario (2009). Briefing note: increasing Ontarians’ access to health care services by fully deploying registered nurses. Accessible at http://rnao.ca/sites/rnao-ca/files/storage/related/5172_Briefing_note_NP_clinics_RN_roles_2009.pdf

‘East meets West’: Promoting healthy living and managing symptoms in chronic illnesses through integrative medicine

Integrative Medicine (IM) fills therapeutic gaps in existing healthcare practices; treats the whole person; and increases healthcare choices. We have demonstrated the clinical benefits of IM practice (namely, exercise, acupoints interventions and auriculotherapy) on improving health conditions and self-management of chronic diseases. The findings have supported the use of IM to achieve symptomatic relief and prevention of major chronic diseases in a substantial segment of patients including elderly, insomnia and cancer patients. Our research has influenced government health care policy, clinical practice in Hospital Authority in Hong Kong and non-governmental organisations (NGOs) with improved services offered, and health professional training.

Key researchers:
Prof. Alex Molasiotis (Chair Professor of Nursing and Head)
Dr Lorna Suen (Associate Professor)
Dr Jerry Yeung (Associate Professor)

 

IM brings closer together western medicine and traditional approaches to care to provide complementary effect and improve the illness experience and quality of life of patients with chronic illnesses. As western medical approaches do not fully improve chronic symptoms and have limitations, more holistic and culturally-relevant approaches can enhance the patients’ ill-health trajectory. There are few high quality trials in the field and there is an urgent need to improve the evidence-base of the field both for clinical and public/safety reasons. Our research effort in trials on traditional exercises and acupoints interventions (i.e., acupuncture, acupressure, auriculotherapy) have provided much needed evidence for our promotion of East and West practice on elderly/frail elderly, insomnia and cancer patients.

 

A systematic review synthesized the evidence of the effects of acupuncture on pain in adults [Ref:1] in 2015 and found that acupuncture can significantly improve pain in the post-operative period. The first large multisite trial in managing a complex symptom, cancer-related fatigue, for which we have very limited therapeutic options, with acupuncture, has been conducted in 2010-2012 [Ref:2]. Sleep studies is a common focus of our team’s research since 2002 (Ref 3). One such study found that auriculotherapy and acupuncture improved quality of sleep [Ref:3]. Our team has demonstrated the use of magnetic pellets for auricular therapy (auriculotherapy) to manage sleep problems among the elderly in terms of shortening sleep latency, decreasing the number of mid-sleep awakenings and improving overall sleep efficiency. This therapy is a hygienic, cheap, painless and safe treatment approach compared with other traditional TCM treatment modalities, such as ear acupuncture. Moreover, auriculotherapy does not involve the use of needles. The standardised treatment protocol is demonstrated to be equally effective in either ‘excessive’ or ‘deficient’ syndrome of insomnia.

1. Liu XL, Tan JY, Molassiotis A, Suen LKP, Shi Y. Acupuncture-point stimulation for postoperative pain control: a systematic review and meta-analysis of randomized controlled trials.Evid Based Complement Alternat Med.2015;2015:657809 doi: 10.1155/2015/657809.

 

2. Molassiotis A, Russell W, Hughes J, Breckons M, Lloyd-Williams M, Richardson J, Hulme C, Brearley SG, Campbell M, Garrow A, Ryder WD. The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: a randomized controlled trial.J Pain Symptom Manag.2014;47(1):12-25

 

3. Suen LKP, Wong TKS & Leung AWN . Effectiveness of auricular therapy using magnetic pearls on sleep promotion in the elderly.Am J Chin Med.2002; 30(4): 429–449.

Impact on clinical practice
As a result of our clinical trials of acupuncture (ie. ref.2 and two others from the team) have been included in the clinical guidelines of the international (29 countries) Society for Integrative Oncology [S1] reaching more than 1,000 society members and a large number through the open-access publication. Ref 2 is further included in National Comprehensive Cancer Network (NCCN) antiemetic guidelines [S2], reaching its >50,000 members and a strong advocacy service-user group, as well as USA’s National Guideline Clearing House, Agency of Healthcare Research & Quality. Also, work from Molassiotis and Suen have been incorporated in patient information websites [S3] and professional websites such as that of the USA Oncology Nursing Society accessed by >10,000 members [S3]. The National Cancer Institute in USA has cited our work in its Physician Data Query series on ‘Acupuncture’, a comprehensive source of cancer information available to clinicians and patients worldwide through its open-access document [S4].

 

Reference 1 was used as part of the evidence submitted by the Academic Consortium for Integrative Medicine & Health in the USA to the USA’s Department of Health & Human Services, on the latter’s consultation for the management of pain in adults [S5]. Since then key recommendations were adopted in all hospitals in the US.

 

Impact on community and primary health care
Our team has been invited by a number of NGOs as a consultant (including the Hong Kong Society for the Aged [SAGE], Evangelical Lutheran Church Social Service-Hong Kong [ELCHK] and the Neighbourhood Advice-Action Council) to offer ‘train the trainers’ workshops on auriculotherapy and sleep management for NGO staff, based on our trials’ findings. A total of 602 staff from over 130 non-governmental organizations have received training via the workshops on auriculotherapy by our team. Nearly 1500 clients (either through individualized or group therapy) have received the therapy, and 70%-85% of them expressed that their sleep problems improved after the therapy. Three different audio-visual or printed materials related to the use of auriculotherapy for sleep disturbances have been produced and distributed to NGOs by SAGE over the years, and have been put in 29 public libraries in Hong Kong. These include 1000’s DVDs, 1200’s booklets, and 2000s books on promoting sleep for elders. One of the NGO staff who has received training via the ‘train the trainers’ workshop on auriculotherapy was interviewed by the press for her successful application of the therapy to manage the sleep problems of her clients.

 

Impact to Professional training and curriculum
The research team shaped and reformed the curriculum of professional training by introducing IM courses in bachelor and master studies for the first time. Over 250 students, in each academic year, receive the training in IM. In addition, advanced training programs for practicing professionals in the Hospital Authority are also provided, often as consultancy to Hospital Authority.

S1: Clinical Practice Guidelines on Integrative Therapies in Cancer, where our work is cited. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411539/

 

S2: National Comprehensive Cancer Network clinical guidelines where our work is cited, reaching >50,00 members https://www.nccn.org/professionals/physician_gls/default.aspx#antiemesis

 

S3: research findings from the team cited in international patient websites https://www.asbestos.com/blog/2015/05/27/acupressure-points-for-cancer/ and professional websites (such as from the Oncology Nursing Society) https://www.ons.org/node/1311?topic=761

 

S4: National Cancer Institute’s in USA citing our work in its Physician Data Query series on ‘Acupuncture’, a comprehensive source of cancer information available to clinicians and patients worldwide through its open-access document https://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq

 

S5. Evidence submitted by the Academic Consortium for Integrative Medicine & Health in the USA to the USA’s Department of Health & Human Services, on the latter’s consultation for the management of pain in adults where are work (ref 3) is cited https://s3.amazonaws.com/imconsortium/wp-content/uploads/2019/04/01194647/HHS-Comments-from-The-Consortium-April-1-2019.pdf

 

Improving cancer patient outcomes through practice improvements and symptom management

Our research has a) produced precise radiotherapy protocols to deliver effective dosage to patients while minimising side-effects of radiotherapy, which are often severe and debilitating, and b) highlighted key issues in cancer symptom management for improved patient support and enhanced quality of life. Our findings have been incorporated into international clinical guidelines (e.g. Multinational Association of Supportive Care in Cancer, 2016; American College of Chest Physicians, 2017) reaching thousands of specialist oncology professionals and influencing patient care. A service model has been developed and this changed practice in several hospitals in Hong Kong and one in China.

Key researchers:
Prof. Alex Molassiotis (Chair Professor of Nursing and Head)
Prof. Frances Wong (Professor)
Dr Shirley Ching (Associate Professor)
Dr E Angela Chan (Associate Professor)
Dr Eileen Cheng (Assistant Professor)
Dr Choi wan Chan (Assistant Professor)
Dr Joyce Chung (Assistant Professor)
Dr Eva Ho (Assistant Professor)
Dr Katherine Lam (Research Assistant Professor)
Dr Doris Y.P. Leung (Research Assistant Professor)


Cancer is a major cause of death worldwide, and is the leading cause of death in Hong Kong. There are about 32,000 new cases of cancer each year in Hong Kong, and it is estimated that in 2019 there are more than 150,000 people living with cancer. Our integrated research platform into cancer incorporates the study of different research needs related to improved, non-invasive diagnostic and monitoring methods, more effective radiotherapy, reduced side-effects of radiotherapy and chemotherapy, and the design of supportive strategies for cancer patients through novel methods to alleviate mental and physical distress, thereby improving quality of life (QoL) of cancer patients and lowering treatment costs associated with hospital readmission.
In relation to cancer diagnostics, early diagnosis is crucial, and effective monitoring is needed for appropriate clinical decision making. Results of our randomized controlled trial (led by Ching in 2015-17) showed that a structured, nurse-led symptom management programme effectively reduced side effects and enhanced QoL of patients undergoing chemotherapy [1]. Several studies (led by Molassiotis from 2005 onwards) focused on specific cancer symptoms and identified key risk factors that place patients at higher risk of chemotherapy-related nausea and vomiting calling for a more personalized approach in antiemetic management [2], and contributed to new data that were incorporated into international clinical guidelines for standards of care in most parts of the world (2015). Work with malignant melanoma patients, the first large study internationally on their supportive care needs done in 2011-2013 has identified key informational and psychological unmet needs [3]. Extensive work (by Molassiotis) has been done in cough in lung cancer, a very distressing and under-reported symptom, starting with a Cochrane systematic review in 2010 and updated more recently [4] and extending to other observational or trial work during the past decade. Unfortunately treatments can fail, and cancer recurs. Based on previous research in transitional care modelling (led by Wong) a cancer survivor model was introduced. This is based on a palliative model for end-stage heart failure patients, who share similar symptom complaints and psychosocial needs towards their end stage of life. The model was tested using a RCT (led by Wong, 2013-2015) and was shown to bring about significant improvements in clinical outcomes related to symptom distress, QoL in patients at the end stage of life and lowered cost due to reduced readmissions to hospital [5].

1.Lai, X. B., Ching, S. S. Y., Wong, F. K. Y.,Leung, C. W. Y., Lee, L. H., Wong, J. S. Y., & Lo, Y. F. (2019). A nurse-led care program for Chinese breast cancer patients in a chemotherapy day centre: a randomized controlled trial.Cancer Nursing, 42(1), 20-34. doi: 10.1097/NCC.0000000000000539.

 

2.Molassiotis,A., Aapro, M., Dicato, M., Gascon, P., Novoa, S.A., Isambert, N., Burke, T.A., Gu, A., & Roila, F. (2014). Evaluation of risk factors predicting chemotherapy-related nausea and vomiting: results from a European prospective observational study.Journal of Pain and Symptom Management, 47(5), 839-848. doi: 10.1016/j.jpainsymman.2013.06.012

 

3.Molassiotis,A., Brunton, L., Hodgetts, J., Green, A.C., Beesley, V.L., Mulatero, C., Newton-Bishop, J.A., & Lorigan, P. (2014). Prevalence and correlates of unmet supportive care needs in patients with resected invasive cutaneous melanoma.Annals of Oncology,25(10), 2052-8. doi: 10.1093/annonc/mdu366

 

4.Molassiotis,A., Bailey, C., Caress, A., &Tan,J.Y. (2015). Interventions for cough in cancer.Cochrane Database of Systematic Reviews. 2015(5), 1-54.doi: 10.1002/14651858.CD007881.pub3.

 

5.Wong, F.K.Y., Ng, A.Y.,Lee, P.H., Lam, P.T.,Ng, J.S., Ng, N.H. & Sham, M.M. (2016). Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.Heart, 102(14):1100-1108. doi: 10.1136/heartjnl-2015-308638

Our cancer-related research is shaping diagnostic services, guiding clinical practice in cancer treatment, improving early detection of recurrence, enhancing patient safety and well-being during treatment, and improving QoL of those living with cancer. Therefore, significance and reach are high. The main users and beneficiaries are health care regulators and providers and cancer patients.

 

The risk prediction model study for chemotherapy-induced nausea and vomiting (CINV) led to the development of a website and application for use by clinicians to calculate CINV risk in patients before chemotherapy begins (www.riskcinv.org) and is hosted by an industry partner (Helsinn Pharma; released in late 2018). Usability data of this new online tool show that on average 137 clinicians (new users) in 10 countries are using this each month (data from February-March 2019). Further to this online risk assessment tool, our team developed a number of symptom management tools including the antiemesis scale (MAT) which is now available on Apple store as an app (https://itunes.apple.com/us/app/mascc-antiemesis-tool-mat/id536500719?mt=8), and as an android app in Google Play by Merck & Co. These apps are available free-of-charge for use by clinicians to aid clinical decision-making and improve communication with patients. The MAT is also used as a primary outcome measure in a large number of international antiemetic trials and observational studies (as perwww.clinicaltrials.gov, including currently USA, France, Italy and international trials, being translated in 16 languages (https://www.mascc.org/mat). The research on anticipatory nausea in chemotherapy patients and the risk factor research (reported in section 2) have also been used in the Antiemetic Guidelines of the Multinational Association of Supportive Care in Cancer (MASCC) and the European Society of Medical Oncology (ESMO) in 2016 (societies with a combined membership of >5,000 clinicians) [S1]. Use/uptake of antiemetic guidelines according to several studies is around 30%, suggesting that at least one-third of chemotherapy patients in western countries have improved antiemetic control as a result of these guidelines.

 

Our work [S2] has been incorporated in the UK’s NICE guidance on ‘Melanoma: assessment and treatment’ (2015). In addition, our work on cough related to lung cancer has been embedded into the 2017 guidelines on lung cancer of the American College of Chest Physicians (ACCP), which has been highly cited [S3]. Cough is present in 85% and is a distressing symptom in 65% of the 2 million people diagnosed with lung cancer in the world each year. These CHEST guidelines have wide reach, not only to the 50,000 chest physicians receiving the Chest Journal and the CHEST guidelines open-access website where this is also listed, but also by endorsement (as stated in the journal website) by the following societies: American College of Allergy, Asthma and Immunology; American Thoracic Society; Asian Pacific Society of Respirology; Canadian Thoracic Society; Irish Thoracic Society.

 

Continuity of care in supporting cancer survivors returning home to lead a life with quality is important. Wong & team showed empirical evidence of a well-structured nurse-led transitional home-based palliative care model. The General Manager (Nursing) of one of the study hospitals (>2,000 beds, serving a population of 900,000 encompassing one-third of all cancer patients in Hong Kong) confirmed the value of the work in enhancing clinical and patient outcomes and cost control leading to the hospital cluster receiving ‘Excellent’ rating by the Australian Hospital Accreditation Team on the service. Wong & team’s work is now incorporated in the NICE guideline 94 on Community Palliative Care, highlighting the effects of home-based transitional care in reducing hospital readmissions and enhancing patient QoL (S4).

 

Our research has supported cancer survivors to improve their lives, particularly during debilitating cancer treatments. The Hospital Authority adopted Wong’s work for nurse clinic accreditation (S4) for following up discharged patients in the community. Based on the work in transitional care, the use of community-based nurse clinics aroused wide media coverage advocating the use of nurse clinics to support health maintenance and individual well-being. The discussion was raised to the level of Government support with the need for resources and policy planning. Educationally, the American Society of Clinical Oncology (ASCO) has created a series of online materials in 2015-2018 related to the work of the team, with Molassiotis leading on some of the online clips, with access to over 50,000 oncology health professionals [S5].

S1. MASCC/ESMO International clinical guidelines where our research is cited, reaching >5,000 clinician members and a large (but unknown) number through its free availability/access of the guidelines https://www.esmo.org/Guidelines/Supportive-and-Palliative-Care/MASCC-and-ESMO-Consensus-Guidelines-for-the-Prevention-of-Chemotherapy-and-Radiotherapy-Induced-Nausea-and-Vomiting

 

S2. NICE guidance. Melanoma: assessment and treatment (2015). Citations in p54 and p.56 from our research. Influencing relevant section of standards of care. https://www.nice.org.uk/guidance/ng14/evidence/full-guideline-pdf-250314589

 

S3. American College of Chest Physicians (ACCP), CHEST clinical guidelines on cough in lung cancer. Used as standard of care. https://journal.chestnet.org/article/S0012-3692(17)30022-3/fulltext

 

S4. NICE guideline 94 on Community Palliative Care - https://www.nice.org.uk/guidance/ng94/evidence/14.community-palliative-care-pdf-172397464601

 

S5. American Society of Clinical Oncology (ASCO) webcasts disseminating information on our studies and sharing key results of our work, with findings reaching >50,000 ASCO members http://www.ascopost.com/issues/august-10-2016/more-focus-needed-on-chemotherapy-induced-nausea-as-a-cluster-of-symptoms/

Ongoing Research Students

Mar Lar AUNG

PhD Student

Cara CHEN

PhD Student

Weilin CHEN

PhD Student

Dereje Chala DIRIBA

PhD Student

Summer GAN

PhD Student

Win Yadanar HLAING

PhD Student

Eh Naw HSER

PhD Student

Qi LIU

PhD Student

Jiayin RUAN

PhD Student

Robbie WANG

PhD Student

Jolene YUNG

PhD Student

Mei Chi Jacqueline HO

PhD Student (Part-time)

Wilson KWOK

PhD Student (Part-time)

Mee Ling Bonnie TAM

PhD Student (Part-time)

Externally Funded Projects

Health and social needs of persons living in subdivided units: A mixed-method study

 

Investigators Name:
PI: Dr Kwan Ching WONG
Co-I: Dr Kin CHEUNG, Prof. Kam Yuet WONG, Mr Jonathan BAYUO, Mr Kelvin LEE, Mr Wai Mui KWAN

Funding Scheme/ Source of Funding: NICHE Research Grant

Total Grant: HK$120,000

Commencement Date: 1-Feb-22

Living in a subdivided unit is wrought with varied issues ranging from health and well-being risks to safety concerns. Yet, these persons may have limited financial resources to utilise health and social services. The proposed study aims to examine their health and social needs and make recommendations regarding how existing services can respond to their unique needs. A key component of the study is the comprehensive assessment of the person living in subdivided unit to ascertain their health status. The proposed study therefore has a strong focus on fostering holistic health related to physical, mental, and social dimensions among persons living in subdivided units and promoting awareness of early disease detection and prevention in the community.

Adopting a health-social partnership program to promote health and self-care management among older adults in the community: an effectiveness-implementation hybrid design

 

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-I: Dr Ka WU, Dr Kwan Ching WONG, Prof. Martin Chi Sang WONG, Ms Karen Kit Sum CHOW

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$1,499,960

Commencement Date: 2-Jan-22

Objectives
This study sets out:  (1) To examine the effectiveness, and (2) To explore reach, adoption, implementation, and maintenance of the implementation of a community-based health-social partnership program (C-HSPP) in promoting health and self-care management of community-dwelling older adults.

Design
An effectiveness-implementation hybrid design, using pre-post comparison with non-equivalent control group.

Setting
Six community centers of an NGO in different districts in Hong Kong.

Participants
For program effectiveness: 1040 eligible subjects (520 each for intervention and control group).  Key informants for implementation evaluation: service in-charge, service providers, and clients.

Intervention
There are two phases: pre-implementation and implementation.  At the pre-implementation phase, the researchers engage the service providers in the design of the 3-month C-HSPP to ensure that the intervention is acceptable and feasible.  At the implementation phase, a nurse will conduct the C-HSPP to the clients in collaboration with the social workers and enactment of the referral network if indicated.

Main outcome measures
Outcomes selected take reference of RE-AIM framework, which include Treatment Effectiveness (self-efficacy, self-reported and objective well-being measures) and Implementation outcomes (Reach, Adoption, Implementation, Maintenance).

Data analysis
Generalized estimating equation will be used for analysing quantitative data.  Continuous, binary and counted data will be treated respectively using linear, logistic and Poisson link functions.  Framework Method will be employed to treat qualitative data in deriving categories and themes.

Expected results
The results will shed light on the implementation of health-social partnership program in real life context and produce evidence to inform policy-makers to strengthen health-social collaboration.

Outcomes of a Risk Assessment and Management Program using telecare consultation among patients with diabetes mellitus in general out-patient clinic: A hybrid effectiveness-implementation study

 

Investigators Name:
PI: Dr Kwan Ching WONG
Co-I: Prof. KAM Yuet WONG, Dr Jinxiao LIAN, Dr Danny Wah Kun TANG, Dr Cheuk Wai LO, Dr Jun LIANG, Dr Hong LEE, Dr Tsun Kit CHU, Dr Man Li CHAN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$1,496,704

Commencement Date: 2-Jan-22

OBJECTIVES: 1) Examine the clinical effectiveness, and 2) Explore Reach, Adoption, Implementation, and Maintenance in implementing a Risk Assessment and Management Program (RAMP) using telecare consultation in general out-patient clinics (GOPC) among patients with diabetes mellitus.

DESIGN: Hybrid effectiveness-implementation design.

SETTING: Seven New Territories West Cluster GOPCs.

PARTICIPANTS: For the clinical effectiveness aim: 700 eligible subjects (350 each for the telecare consultation and conventional consultation groups). Key informants for the implementation aim: clinic managers, service providers, and patients.

INTERVENTIONS: The Generic Implementation Framework guides the overall implementation strategies. In the development and preparation phases, the research and GOPC service teams have meetings to discuss ways of implementing and continuing the use of the RAMP in routine care. In the operation phase, subjects in the telecare group will receive alternate face-to-face and telecare consultations, while the subjects in conventional group will receive onsite consultation.

MAIN OUTCOME MEASURES: The 95% 1-sided confidence interval of the differences between the effects of both groups will be calculated using the independent samples t-test. Thematic analysis will be adopted to treat qualitative data in deriving the categories and themes.

Feasibility study of a musical training program in improving the neurocognitive functioning of children surviving brain tumours

Investigators Name:
PI: Dr Oi Kwan CHUNG
Co-I: Dr Yin Ping LEUNG, Ms Monique Sin Yu PONG, Dr William Ho Cheung LI, Ms Sau Ying CHIU, Mr Theodore Ching Kong CHEUNG, Prof. Chi Fung Godfrey CHAN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$100,000

Commencement Date: 3-Dec-21

The effects of a tele-health program to facilitate the usage of internet of things among community-dwelling older adults: a randomized controlled trial

Investigators Name:
Rep.Co-PI: Dr Kwan Ching WONG
Co-I: Mr Siu Man WONG, Ms Hiu Hung Vicky YUEN, Ms Shun Ngo YU, Ms Po Bonnie WONG, Ms Ka Wing LAM, Ms Nok Sum KONG

Funding Scheme/ Source of Funding: The Social Innovation and Entrepreneurship Development Fund

Total Grant: HK$300,000

Commencement Date: 8-Nov-21

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.

The use of a positive psychology intervention (PPI) to promote the psychological well-being of children living in poverty: a feasibility randomised controlled trial

Investigators Name:
PI: Dr Ka Yan HO
Co-I: Dr Yim Wah MAK, Dr Jingxia LIN, Dr Ka Wai Katherine LAM, Dr William Ho Cheung LI, Dr Daniel Thomas BRESSINGTON

Funding Scheme/ Source of Funding: Health and Medical Research Fund

Total Grant: HK$100,000

Commencement Date: 8-Nov-21

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 community-based participatory research approach to reduce the COVID-19 risk in Hong Kong: developing and testing social and behavioural interventions

Investigators Name:
PI: Prof. Alexandros MOLASIOTIS

Funding Scheme/ Source of Funding: Commissioned Research on the Novel Coronavirus Disease (COVID-19) under the Health and Medical Research Fund

Total Grant: HK$27,605,783

Commencement Date: 1-Nov-21

(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.

Effects of a structured, family-supported, and patient-centred advance care planning on end-of-life decision making among palliative patients and their family members: A randomized controlled trial

Investigators Name:
PI: Dr Yin Ping LEUNG
Co-I: Dr Siu Yin CHING, Dr Raymond, S.K. LO, Prof. Helen Yue-lai CHAN

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK$911,220

Commencement Date: 1-Jun-21

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.  

Effects of a Nurse-led transitional burns rehabilitation programme (4Cs-TBuRP) for adult burn survivors: A randomised controlled trial

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-I: Mr Jonathan BAYUO

Funding Scheme/ Source of Funding: Sigma Small Grants

Total Grant: HK$34,677

Commencement Date: 1-Jun-21

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.

Effectiveness of the professional-led support programme using a mobile application versus phone advice on patients at risk of coronary heart disease – A randomized controlled trial (Phase 2)

Investigators Name:
Rep.Co-PI: Dr Yin Ping LEUNG
Co-PI: Dr Mi Ling Eliza WONG
Co-I: Prof. Yee Man Angela LEUNG, Dr Ching LAM, Dr Lap Yip Larry LEE, Dr Shuk Yee KO

Funding Scheme/ Source of Funding: Nam Kee Noodle Foundation Ltd

Total Grant: HK$270,000

Commencement Date: 3-May-21

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.

Effects of mHealth on promoting self-care health management among older adults in the community: A 3-arm randomized controlled trial

Investigators Name:
PI: Dr Kwan Ching WONG
Co-I: Mr Siu Man WONG, Ms Kit Sum Karen CHOW, Prof. Kam Yuet WONG

Funding Scheme/ Source of Funding: NICHE Research Grant

Total Grant: HK$137,844

Commencement Date: 4-Jan-21

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.

Exploring the feasibility of simulation-based education on undergraduate students’ palliative care communication: Innovating a practice-based theory approach

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Dr Ka Pik Katherine CHANG, Dr Pui Man CHUNG, Dr Siouta ELENI, Dr Yuen Man SIU, Ms Ping Kit Kitty WONG, Prof. Marie Ann RAFFERTY, Prof. Slade DIANA 

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK$631,984

Commencement Date: 1-Jan-21

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.



Zero-time Exercise - Integrating Exercise into Daily Life Activity at No Extra Time and Cost to Improve Sleep in Physically Inactive Adults with Insomnia Disorder: a Randomized Controlled Trial with Mixed-method Process Evaluation

Investigators Name:
PI: Dr Wai Fai YEUNG
Co-I: Dr Ka Fai CHUNG, Prof. Tai Hing LAM, Dr Yuen Kwan LAI, Dr Lai-ming HO, Prof. Yan-Yee HO, Dr Yuen Shan HO, Dr Kwai Ping Lorna SUEN

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK$827,372

Commencement Date: 1-Jan-20

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.

Effects of a Video-based mHealth Program for the Homebound Older Adults: A Pilot Randomized Controlled Trial

Investigators Name:
PI: Dr Kwan Ching WONG
Co-I: Ms Kit Sum Karen CHOW, Prof. Kam Yuet WONG, Mr Siu Man WONG

Funding Scheme/ Source of Funding: NICHE Research Grant

Total Grant: HK$119,865

Commencement Date: 1-Jan-20

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.



Electromoxibustion and Knee Health Education for Knee Osteoarthritis in Older Adults

Investigators Name:
PI: Dr Wing Fai YEUNG
Co-I: Dr Cheuk Chi Teris CHEUNG, Dr Yuen Shan HO, Dr Doris Y LEUNG, Dr Chun Lung SO, Dr Kwai Ping Lorna SUEN

Funding Scheme/ Source of Funding: Yan Chai Hospital (Collaborative)

Total Grant: HK $77,080

Commencement Date: 15-Sep-19

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.

Self-Administered Acupressure for Knee Osteoarthritis in Middle- and Older-aged Adults: A Randomized Controlled Trial

Investigators Name:
PI: Dr Wing Fai YEUNG
Co-I: Dr Shuk-ting Denise CHEUNG, Mr Tsz-chung CHONG, Dr Lai-ming HO, Dr Yuen Shan HO, Prof Li-xing LAO, Dr Kwai Ping Lorna SUEN, Dr King-ho Carlos WONG

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $1,194,640

Commencement Date: 1-Sep-19

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.

Understanding Needs of Paediatric Patients with Life-Limiting Diseases: Towards a Model of Paediatric Palliative Care

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-I: Dr Cheong-wai Stephen CHAN, Dr Chi-hang Assunta HO, Ms Mei Chi Jacqueline HO, Dr Po-yee Lilian LEE, Ms Wai-yee Susanna LEE, Dr Chak-ho Rever LI, Prof Chi-kong LI, Dr Kwing-wan TSUI

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$565,725

Commencement Date: 15-Jun-19

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.

Validation and Acceptability of the Carer Support Needs Assessment Tool: A Holistic Needs Screening Scale for Routine use in Hong Kong Palliative Care Settings

Investigators Name:
PI: Dr Huilin CHENG
Co-I: Dr Ching LAM, Dr Yin Ping LEUNG, Dr Andrew Luk LEUNG, Ms Ko Po SHAN

Funding Scheme/ Source of Funding: Nethersole Institute of Continuing Holistic Health Education (NICHE)

Total Grant: HK$101,464

Commencement Date: 1-Jul-19

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.

Could Graduating Nurses of the Undergraduate Programme Embrace Caring Communication in Palliative Care? A Mixed-methods Study

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Dr Ka Pik Katherine CHANG, Dr Pui Man CHUNG, Ms Ko Po SHAN, Ms Ping Kit Kitty WONG

Funding Scheme/ Source of Funding: Nethersole Institute of Continuing Holistic Health Education (NICHE)

Total Grant: HK$120,000

Commencement Date: 1-May-19

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.

Self-administered Acupressure for Insomnia Disorder: A Randomized Controlled Trial

Investigators Name:
PI: Dr Wing Fai YEUNG
Co-I: Dr Ka-Fai CHUNG, Dr Fiona Yan-Yee HO, Dr Lai-Ming HO, Dr Kwai Ping Lorna SUEN, Prof Li-Xing LAO, Prof Zhang-Jin ZHANG 

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $836,360

Commencement Date: 1-Aug-18

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.

Investigating the Effects of Electroacupuncture on Postoperative Cognitive Dysfunction: A Preclinical Study

Investigators Name:
PI: Dr Yuen Shan HO
Co-I: Dr Raymond Chuen-Chung CHANG, Dr Gordon Tin Chun WONG, Dr Wing Fai YEUNG, Prof Hong Qi 

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $1,198,000

Commencement Date: 2-May-18

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.

Economic Evaluation on an Enhanced Post-discharge Home-based Care Program (EHP) to Improve the Quality of Life for Stroke Survivors in Harbin China

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-PI: Dr Shao Ling WANG
Co-I:  Li Jie WU

Funding Scheme/ Source of Funding: Hong Kong Nurses Training & Education Foundation Limited

Total Grant: HK $160,000

Commencement Date: 1-Mar-18

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.

An Enhanced Post-discharge Home-based Care Program (EHP) to Improve the Quality of Life for Stroke Survivors in Harbin China: a Randomized Controlled Trial

Investigators Name:
Rep Co-PI: Prof. Kam Yuet WONG
Co-PI: Dr Shao Ling WANG
Co-I: Li Jie WU

Funding Scheme/ Source of Funding: T.S. Lo Foundation

Total Grant: HK $250,000

Commencement Date: 3-Jan-18

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.

Determining the Role of Acupuncture in the Modulation of Peripheral Oxidative Stress in Patients with Insomnia: A Randomized Placebo-Controlled Trial

 

Investigators Name:
PI: Dr Wing Fai YEUNG

Funding Scheme/ Source of Funding: RGC Early Career Scheme

Total Grant: HK $735,971

Commencement Date: 1-Jan-18

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.

Temporal Association Between Objectively-Measured Smartphone Usage, Sleeping Quality, and Physical Activity in Hong Kong Adolescents and Young Adults

 

Investigators Name:
PI: Dr Hong LEE

Funding Scheme/ Source of Funding: RGC Early Career Scheme

Total Grant: HK $513,340

Commencement Date: 1-Jan-17

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.

A Language Analysis of Speak-up Strategies in an Intensive Care Unit Using Existing Data of Audio-recorded Clinician-to-clinician Interactions

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Dr Kang Yiu LAI, Dr Wing Yiu George NG, Dr Hang Kwong Eric SO

Funding Scheme/ Source of Funding: Hong Kong Hospital Authority

Total Grant: HK $184,000

Commencement Date: 14-Nov-16

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.

Effectiveness Of Auriculotherapy On Older People With Insomnia

Investigators Name:
PI: Dr Kwai Ping Lorna SUEN
Co-I: Dr Chao Hsing YEH, Prof. Alexandros MOLASIOTIS

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $1,016,414

Commencement Date: 3-May-16

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.

Uncovering the Meanings of Psychosocial Care Experience of Cancer Patients and/or their Informal Care-givers at Maggie's Cancer Caring Centre

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Dr Siu Yin CHING, Mrs Helen LUI, Ms Jacobi SHING

Funding Scheme/ Source of Funding: Maggie’s Cancer Caring Centre

Total Grant: HK $388,088

Commencement Date: 3-May-16

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.

Smart Device Usage, Lifestyles Behaviors, Physical Fitness, and Eye Problems: A Prospective Study in Hong Kong Adolescents

Investigators Name:
PI: Dr Hong LEE
Co-I: Dr Chi Wai DO, Dr Regina Lai Tong LEE, Dr Chun Lung SO, Dr Pui Yuk Grace SZETO

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $1,166,500

Commencement Date: 1-Apr-16

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.

Speaking Up for Patient Safety in ICU - A Pilot Study

 

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Ms Ka Wai Christina CHAN, Dr Lap Yin HO, Dr Man Kit Marvin LAM, Dr Wing Yiu NG, Dr Hang Kwong Eric SO, Prof. Diana SLADE, Prof. Martin Christian Mat MATTHIESSEN

Funding Scheme/ Source of Funding: Hong Kong Hospital Authority

Total Grant: HK $95,400

Commencement Date: 1-Feb-16

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.

Effects of an Aging-in-Place Health-Social Partnership Program Among Community-Dwelling Older People: A Randomized Controlled Trial

 

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-I: Dr Choi Wan CHAN, Dr Ka Pik Katherine CHANG, Dr Ka Yee Susan CHOW, Dr Hong LEE, Dr Lai Har WU, Mr Yick Hay CHOW, Mr Hon Fat WONG, Ms Adela Shuet Fun LAI

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $1,309,142

Commencement Date: 1-Jan-16

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.

A Contextualized Understanding of Nurse-Patient Communication and its Impact on Nurses' Learning and Patient Satisfaction

 

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Prof. Martin Christian Mat MATTHIESSEN, Prof. Diana SLADE, Dr Siu Yin CHING, Dr Wah Kun TONG, Dr Fiona Yan Yan WONG, Miss Yuk Yin LAM

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $646,008

Commencement Date: 1-Jan-16

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.

Improving Continuity of Care for Patient Safety through Effective Nursing Handover Communication

Investigators Name:
PI: Dr Engle Angela CHAN
Co-I: Prof. Diana SLADE, Dr Man Kit Marvin LAM, Ms Manbo MAN

Funding Scheme/ Source of Funding: Hong Kong Sanatorium & Hospital Nurses Alumni Association

Total Grant: HK $20,000

Commencement Date: 1-Dec-15

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.

Electroacupuncture for Tapering Off Long-Term Benzodiazepine Use: A Randomized Controlled Trial

Investigators Name:
PI: Dr Wing Fai YEUNG
Co-I: Dr Wai Chi CHAN, Dr Ka Fai CHUNG, Dr Lai Ming HO, Dr Lixing LAO, Dr Shi Ping ZHANG, Dr Zhang Jin ZHANG

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $756,607

Commencement Date: 1-Jul-15

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.

Building Resilience in the Nursing Student Workforce: Qualitative Study among Nursing Students in Hong Kong

Investigators Name:
PI: Dr Siu Yin CHING
Co-I: Dr Kin CHEUNG

Funding Scheme/ Source of Funding: Sigma Theta Tau International

Total Grant: HK $38,773

Commencement Date: 1-Jun-15

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.

The effectiveness of a pressure ulcer prevention programme for older people in for-profit private nursing homes: A cluster randomised controlled trail

Investigators Name:
PI: Dr Hong LEE
Co-I: Dr Wai Yung KWONG, Dr Kwan Mo YEUNG, Ms Siu Ming Susan LAW, Mr Yiu Cho KWAN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $875,000

Commencement Date: 15-May-15

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.

Assessment of In-use Reliability of N95 Respirators for Respiratory Protection of Health Care Workers

 

Investigators Name:
PI: Dr Kwai Ping Lorna SUEN
Co-I: Dr Maureen Valerie BOOST, Dr Margaret May O'DONOGHUE, Dr Lin YANG, Mr Hin Kee Keith FUNG, Ms Suk Ki HO

Funding Scheme/ Source of Funding: Hong Kong Infection Control Nurses' Association

Total Grant: HK $93,500

Commencement Date: 1-Apr-15

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.

A Randomised Controlled Trial to Assess the Effectiveness and Cost Effectiveness of Acupuncture in the Management of Chemotherapy-induced Peripheral Neuropathy

 

Investigators Name:
PI: Prof. Alexandros MOLASIOTIS
Co-I: Prof. Tony MOK, Prof. Winnie YEO, Dr Howan LEUNG, Dr Kwai Ping Lorna SUEN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $969,700

Commencement Date: 16-Mar-15

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.

Can the wActiSleep-BT Accelerometer Accurately Measure Total Sleep Time, Awake Time After Sleep, and Sleep Efficiency?

 

Investigators Name:
PI: Dr Hong LEE
Co-I: Dr Kwai Ping Lorna SUEN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $80,000

Commencement Date: 1-Mar-15

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.

Adoption of Health Promoting Lifestyle among Chinese Breast and Colorectal Cancer Survivors during the First 5 Years after Completion of Treatment

Investigators Name:
PI: Dr Siu Yin CHING
Co-I: Prof. Esther MOK

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $80,000

Commencement Date: 20-Jan-14

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.

Effects of a Transitional Palliative Care Model on Patients with End-stage Heart Failure

Investigators Name:
PI: Prof. Kam Yuet WONG
Co-I: Dr Moon Fai CHAN, Dr Ka Yee Susan CHOW, Dr Po Tin LAM, Dr Sheung Ching Jeffrey NG, Dr Mau Kwong Michael SHUM, Miss Po Shan KO, Miss Man Wai LEUNG, Ms Faith LIU, Prof. Sarah MCGHEE

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $597,812

Commencement Date: 1-Jan-13

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.

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