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過渡期照護、支援及紓緩護理

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過渡期照護、支援及紓緩護理

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本研究組的三大研究範疇為:
  1. 癌症,紓緩護理及疾病末期的症狀管理
  2. 傳統中醫藥和補充療法
  3. 過渡期護理及社區為本的慢性疾病管理服務模式
以處於疾病末期患者為對象(如患有末期器官功能衰竭或癌症並需接受紓緩護理者),試驗有助管理症狀的干預方案並觀察其成效。具成效的干預可助控制症狀,提升生活質素和整體健康,並使患者減少接受不必要的醫療服務。
參考過往的研究計劃,並進一步補充及探討,評估補充和替代療法(如:針刺療法、穴位按壓、中草藥療法)及心理社會測量 (如希望治療、病人參與)的療效和治療機制。利用研究實驗來評估補充和替代療法與主流的西方醫療整合後,如何提升護理質素。
慢性病患者或/及需要複雜醫護照顧的人士,要求具成本效益和整全的干預措施。研究員針對這類服務對象設計照護服務模式。研究有助促進護理服務的成本效益和果效。

成員

 

智慧健康研究中心

智慧健康研究中心運用科技創新醫護服務,促進醫護實踐及提升護理質素。我們善用科技專長 (如虛擬實境和人工智慧),開展跨專業應用研究,並把研究成果應用於實踐,以促進醫護教育,診斷和治療。

研究的影響

支援出院返家患者的過渡期護理

頻繁再入院會擾亂患者,使原本已過度緊張的醫院系統增加負擔。出院後30天的再入院率為15%到35%,慢性病患者的再入院率偏高。團隊測試了用於不同患者群體的過渡期護理計劃,證明它可以有效控制再入院率,提高患者的自我效能和生活質素並降低成本。研究模型已轉化為實踐,並在本地和國際層面,無論在研究,服務,社會和政策方面都帶來巨大影響。

團隊成員:王鈞正博士,胡麗霞博士,張嘉碧博士,王少玲博士和博士畢業生。

在不同階段構建和測試過渡期護理模型。主要(首席)研究員是黃金月教授與一群學術成員和博士生一起從事研究。

 

I. 電話跟進(2002年至2005年)
隨機對照試驗,以電話跟進糖尿病患者,支援早出院者的需求。研究發現干預組參與者的糖化血色素值下降更多,依從性更好,更省住院費用。
重要發現:
護士電話跟進能有效支援早出院的糖尿病患者,並可能為醫院節省成本。

 

II. 家訪和/或致電(2006年-2009年)
電話溝通有效但也有局限性。研究小組在此干預階段引入家訪。正面結果包括:減少醫院求診和改善健康相關的生活方式。
重要發現:
模型在內地和香港測試,發現護士家訪可以有效支援因患心臟病和一般醫療狀況入院後出院人士。

 

III. 多學科和混合技能取向(2010年至2012年)
先前的研究以護士為唯一干預者。最近的模式採用技能和健康-社會夥伴關係的混合方式,由義工,社會工作者和醫生支援護士個案經理。證據說明這模型在臨床上有效,而且有成本效益。
重要發現:
健康-社會夥伴關係配合護士個案經理的模型可以顯著改善生活質素,自我效能感和減少醫院求診。根據 “英國國家健康與照顧卓越研究院”的參照,該模型的成本效益高達90%。香港參與研究的醫院能持續提供出院後服務便有知識轉移。高血壓護士診所繼續在內地的社區中心運作及服務。

 

IV. 患者對紓緩護理的需求(2013年至2017年)
此研究階段探討模型能否用於有複雜醫護需要的患者起作用。對象是终末期心力衰竭患者。在對象生命的最後一年測試由護士主導的多學科過渡期護理結合紓緩護理方案。與對照組相比,干預組在減少住院,提高生活質素,改善症狀管理和成本效益方面都取得顯著成效。
重要發現:
干預組的终末期心力衰竭患者在症狀控制上臨床重要的差異不大,使用 “英國國家健康與照顧卓越研究院”及世界衛生組織推薦的臨界值,發現模型在一個月和三個月時成本效益分別是85%和100%。

 

V . 社區擁有模式(2017至今)
到目前為止,測試的模型都是以醫院為本。相對較健康的個人應該在社區受支援,而非在醫院。本研究階段努力建立和實驗測試社區擁有的模型。 重要發現:
證據顯示干預組參與者(居家安老社區計劃) 的收縮壓,自我效能和減少使用醫療服務率均有顯著改善。

• 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.

 

以下主要的研究資助金是全部授予首席研究員黃金月教授:

 

• 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

過渡期護理研究工作的影響力如下:

 

1. 研究相關影響
研究工作促進新知識的產生和傳播。團隊發表了62篇英文和19篇中文的學術論文著作,分別在範疇獲引用750次和980次。五名博士生已畢業,三名仍在接受培訓。本地和國際上甚有影響力。在Heart期刊發表的研究論文獲編輯推薦,呼籲臨床人員根據我們的成果“探討使紓緩護理正常化的機會”(參考文獻1)。由加拿大安大略省法律委員會委託撰寫的一份研究報告亦納入了上述研究,並建議改善臨終的過渡期照護環境(參考文獻2)。 “英國國家健康與照顧卓越研究院”制訂指引時諮詢各方並收集有關醫療服務提供,以及緊急和危重醫療服務機構的實證資料。指引納入了我們的研究結果(參考文獻3)。
團隊參與各種顧問研究計劃,包括有內地,澳門和新加坡的,促進知識轉移。這些顧問計劃金額超過港幣250萬元。研究方案和結果也吸引了商業興趣,把方案轉化為可實踐操作的格式。兩個基金會在2018年捐贈了港幣41萬元,邀請研究團隊在哈爾濱市為中風患者實行和測試過渡期護理模型。

 

2. 影響服務
研究結果改變了參與研究醫院的做法。許多參與研究的臨床機構持續採用了服務模型並把它轉變為常規做法。九龍中醫院聯網護理總經理向我們發出感謝信表示研究計劃在醫院推行,證實能節省成本。醫院受審核認證時,計劃獲表揚。
在內地,團隊收到廣州醫科大學附屬第一醫院和廣州越秀區社區中心的報告,告訴我們持續推行團隊隨機對照試驗研究計劃的成效。廣州醫科大學附屬第一醫院在團隊的隨機對照試驗計劃完結時設立了兩個專科護士職位,在呼吸康復範疇繼續我們的工作。團隊開展了14個新的研究計劃,把過渡期醫護模式擴展到不同疾病群組。參與研究的護士現已成為領導者,教育工作者和榜樣,在我們的基礎上培訓全國護士呼吸疾病康復工作和病例管理,並獲得了多個獎項。在護士診所和家庭醫生合約服務的支持下,廣州越秀區社區中心的高血壓控制率達到40.6%。中心把我們的研究方案改編成標準化管理方案應用,繼續提供服務,惠及社區居民。

 

3. 影響社會
事實證明過渡期護理模式可改善患者的生活質素,把症狀控制得更好,並減少醫院服務使用。團隊研究顯示護士診所可增加護理服務提供渠道。加拿大參考我們的研究並呼籲在加拿大推行類似的做法以造福安大略人(參考文獻4)。在香港,首席研究員黃金月教授倡導在醫院和社區設立護士診所,及時回應有需要人士並提供護理,媒體對此廣泛報導。

 

4. 影響政策
首席研究員黃金月教授進行了大量研究工作,率先制訂審核認證標準,支持成立護士診所。護士診所是支持過渡期護理的一種服務模式。自2006年以來,黃金月教授的研究結果獲得醫院管理局採納為轄下護士診所的認證標準。黃教授亦是醫院管理局的護士診所認證小組的顧問,九龍西醫院聯網顧問小組的專家成員,就該聯網的策略發展提供意見,該醫院聯網共有4,707張病床和16間普通門診診所。
黃教授獲選為香港護理專科學院主席,代表3000名在香港公營和私營醫療界別不同專科的資深執業護士。在政府層面,黃教授是食物及衛生局轄下基層醫療健康發展督導委員會的成員,負責參與制定香港的基層醫療健康政策。

以下資料可佐證第4節提出的研究影響力:

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

“東西薈萃”:結合中西醫藥促進健康生活並控制慢性病症狀

中西醫結合治療整個人,提供醫療選擇,並填補現有醫護實踐的空隙。團隊證明IM練習(即:運動,穴位干預和耳穴療法)的臨床益處,包括:改善健康狀況,幫助自我管理慢性病。研究結果支持大部分患者,包括:老年人,失眠和癌症患者以IM緩解症狀和預防主要慢性疾病。團隊的研究結果影響政府的醫療健康政策,香港醫院管理局和非政府組織的臨床實踐,促使這些機構改進服務以及醫護專業培訓。

主要研究員:
莫禮士教授(護理學講座教授及學院主任)
孫桂萍博士(副教授)
楊頴輝博士(副教授)

 

中西醫結合是把西醫和傳統護理方法的長處結合,提供補充效果,以改善慢性病患者的病情和生活質素。西方醫學有局限亦不能完全改善慢性症狀,整全和文化相關的方法可以改善患者健康狀況。現時高質素的試驗不少,由於臨床和公共/安全原因,迫切需要更多研究提供成效證據。團隊研究傳統運動和穴位干預(即:針灸,穴位按壓和耳穴療法)進行試驗找出證據,證明中西結合護理實踐的成效,可促進老年人/體弱長者,失眠和癌症病人健康。

 

在2015年,我們的系統回顧研究綜述了針灸對成人疼痛的成效並提出證據[參考:1]。此外,指出針灸可以顯著改善術後疼痛。在2010-2012年,我們進行首個大型多站點試驗,測試治療複雜症狀與癌症相關疲勞的成效。當時針灸療法的治療選擇仍非常有限[參考:2]。自2002年以來,睡眠研究一直是團隊研究的重點項目(參考3)。一項研究發現,耳穴療法和針灸可以改善睡眠質素 [參考:3]。團隊證明用磁丸進行耳穴治療(耳穴療法)可以縮短睡眠潛伏期,減少睡眠中期醒來次數及提高整體睡眠效率,解決老年人的睡眠問題。相比其他傳統中醫治療方法(例如耳針),耳穴療法衛生,廉價,無痛且安全,耳穴療法亦不涉及使用針頭。事實證明我們標準化的治療方案對處理“實証“或“虛証“的不寐症皆同樣有效。

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.

影響臨床實踐
國際結合腫瘤治療學會[S1] (29個國家)把團隊的針灸臨床試驗(即參考2和團隊的另外兩個試驗)納入其臨床指引。指引分發給學會1000多名會員,學會的論文著作向外開放亦吸引大量讀者。 “國家綜合癌症網絡”亦把參考2納入其止吐指引中[S2]。該網絡成員超過5萬名,有強大的服務使用者倡導群組。我們的研究資訊加入到指引之中,亦即資訊傳播到 “美國國家指引交換所”, “醫療研究與質素辦事處”。

 

此外,莫禮士教授和孫桂萍博士的研究工作已整合到患者資訊網站[S3]和專業網站,例如:有超過一萬名會員[S3]的美國腫瘤護理學會網站。美國國家癌症研究所在其醫生資料查詢系列有關“針灸”引用了我們的研究,通過開放文檔[S4],為全球臨床人員和患者提供全面的癌症資訊。美國衛生與公共服務部諮詢管理成人疼痛[S5]的意見。 “美國結合醫學和保健學術聯會”向美國衛生與公共服務部提交了參考1作為其中一部分的成效證據。自此以後,美國所有醫院都採納了當中的關鍵建議。

 

影響社區和基層醫護健康
團隊成員受許多非政府組織邀請擔任顧問(包括:香港耆康老人福利會,基督教香港信義會社會服務部和鄰舍輔導會),為職員提供導師培訓,並根據研究試驗結果,指導學員學習耳穴療法和睡眠管理。有130多個非政府組織,共602名工作人員參加了耳穴療法培訓。約1500名患者,參與了個人或小組治療,其中70%-85%的患者表示治療有助改善睡眠問題。香港耆康老人福利會多年來製作了三種與耳穴療法治療睡眠障礙有關的視聽資料或刊物,並分發給各非政府組織及全港29間公共圖書館,其中包括:1000張光碟,1200份小冊子和2000冊有關促進老年人睡眠的書籍。一位參與了耳穴療法導師培訓班的非政府組織工作人員接受媒體訪問時表示她成功用療法協助服務對象解決睡眠問題。

 

影響專業培訓和課程
團隊首次在學士學位和碩士學位課程中引入IM課程,影響及和改革專業培訓課程。每個學年有超過250名學生接受IM培訓。此外,我們為醫院管理局提供顧問意見,開辦醫護專業人員高級培訓計劃。

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

 

改進實踐和症狀管理以改善癌症患者的健康

我們的研究:a)制定了精確的放射治療方案,建議有效劑量,降低放射治療的副作用。副作用通常嚴重並使人衰弱;b)指出癌症症狀管理的關鍵問題,改善患者支援並提高生活質素。研究結果已納入國際的臨床指引(例如:多國癌症支持照護協會,2016年;美國胸腔科醫生學院,2017年),供過千名腫瘤科專家參考,並影響患者的護理。此外,提出了一種改變現有做法的服務模式,模式在香港幾間醫院和內地一間醫院實行。

主要研究員:
莫禮士教授(護理學講座教授及學院主任)
黃金月教授(教授)
程小燕博士(副教授)
陳胡安琪博士(副教授)
程慧琳博士(助理教授)
陳彩雲博士(助理教授)
鍾愛群博士(助理教授)
何家欣博士(助理教授)
林家慧博士(助理教授(研究))
梁燕萍博士(助理教授(研究))

 

癌症是全球主要的死因,也是香港主要死亡原因。香港每年約有3萬2千名癌症新病例。據估計到2019年會有超過15萬癌症患者。我們的癌症綜合研究平台涵蓋各種研究需要,包括:改進無創的診斷和監測方法,更有效的放射療法,減少放射療法和化學療法的副作用,用新方法為癌症患者制定支持策略以減輕精神和生理困擾,從而改善癌症患者的生活質素並降低再入院引起的治療費用。
癌症早期診斷至為重要,有效的監測有助作出適當的臨床決策。程小燕博士於2015-17年領導研究計劃隨機對照試驗結果顯示具結構性,由護士主導的症狀管理計劃可有效降低化療患者的副作用並提高生活質素 [1]。由莫禮士教授領導,自2005年開始的幾項研究專注於特定的癌症症狀,識別了使患者有更高化療相關噁心和嘔吐風險的主要因素,並呼籲在止吐管理上採用更加個性化的方法[2]。這些新的研究資料已納入世界大多數地區的國際臨床標準護理指引中(2015年)。
2011年至2013年,我們以惡性黑色素瘤患者為對象,首次開展國際大型研究以探討患者的支持照護需求。研究識別了主要未滿足的資訊和心理需求[3]。莫禮士教授大量研究肺癌相關咳嗽,這種症狀令人十分痛苦但報告不足的。研究始於2010年的Cochrane系統回顧論文,最近更新了回顧論文內容[4],過去十年,莫教授一直從事其他觀察或試驗。不幸是癌症會復發,治療亦可失敗。因此,莫教授根據先前由黃金月教授領導的過渡期護理模型研究,引入癌症倖存者模型。這模型是根據終末期心力衰竭患者的紓緩護理模型來設計。兩個模型相似之處是患者都是在生命末期,有類似的症狀和社會心理需求。以隨機對照方法測試該模型(由黃金月教授領導,2013-2015年)。結果顯示模型可顯著改善生命末期患者的臨床照護成效,例如:降低症狀困擾,改善生活質素,降低再入院率,並使成本下降 [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

癌症相關研究的意義和影響力很高。主要使用者和受益者是醫療服務監管人,服務提供者及癌症患者。研究影響診斷服務,指導癌症治療的臨床實踐,改善檢測以早期發現復發,提升患者在治療過程的安全和幸福感,以及生活質素。一項針對化學療法引起的噁心和嘔吐風險預測模型促成建立網站 (www.riskcinv.org) 讓臨床人員在化學療法之前計算患者的噁心和嘔吐風險。網站由行業合夥人Helsinn Pharma開辦,於2018年底向外開放。網站使用數據顯示,每月平均有來自10個國家137位臨床人員(新用戶)使用網站(數據:2019年2月至3月)。網上風險評估工具以外,團隊還開發了許多症狀管理工具,包括:止吐量表。工具已開發成應用程式,可以在Apple Store下載使用 (https://itunes.apple.com/us/app/mascc-antiemesis-tool-mat/id536500719?mt=8) Android用戶可以在Google Play by Merck & Co. 下載應用程式。應用程式免費供臨床人員使用,以助臨床決策並改善與患者的溝通。國際的止吐試驗和觀察研究皆使用止吐量表作為主要的成效評估(根據 www.clinicaltrials.gov 資訊),近期包括有:美國,法國,意大利和各種國際試驗,並已翻譯成16種語言 (https://www.mascc.org/mat) 。化療患者噁心預期的研究和風險因素研究(在第2節中已提及)也於2016年納入於多國癌症支持照護協會的指引和歐洲醫學腫瘤學會的止吐指引中。(兩會成員合計超過5,000名的臨床人員)[S1]。數個研究指出止吐藥指引的使用率約為30%,這表示指引有助加強止吐成效,使西方國家至少三分之一接受化療的患者受惠。

 

團隊的研究成果[S2]已納入 “英國國家健康與照顧卓越研究院”關於黑色素瘤:評估和治療的指引(2015年)。此外,肺癌相關的咳嗽研究已納入 “美國胸科醫生學院2017年肺癌指引”中,該指引經常獲引用 [S3]。全球每年診斷患肺癌的二百萬人中,有85%患者有咳嗽,當中 65%患者認為咳嗽症狀令人感痛苦。CHEST指引使用者廣泛,包括5萬名收到《胸科期刊》的胸腔科醫生,該指引亦列於網站向外開放。以下協會認可指引並把指引列於其網站:美國過敏,哮喘和免疫學學院;美國胸腔科學會;亞太呼吸病學學會;加拿大胸腔科學會;愛爾蘭胸腔科學會。

 

持續的護理服務有助癌症倖存者返家過高質素的生活。 黃金月教授和團隊的研究展示了結構良好及由護士主導的過渡期居家紓緩護理模型的經驗證據。其中一間參與研究醫院(床位超過2,000張,為90萬人提供服務,包括香港三分之一的癌症患者)的護理總經理表示研究項目有助提高臨床和患者成效及控製成本,使澳洲醫院審核認證團隊給予醫院聯網服務優秀評級。

 

黃金月教授及團隊的研究結果已納入英國國家健康與照顧卓越研究院指引第94項社區紓緩護理,強調家居過渡期護理可減少再入院率和提高患者生活質素(S4)。

 

癌症治療過程往往使患者衰弱。我們的研究支持癌症倖存者改善生活。醫院管理局採納了黃金月教授的護士診所認證準則(S4),這有助護士在社區跟進出院患者。建基於過渡期護理研究結果成立社區護士診所,提倡護士支持患者維持健康和安康,這引起媒體廣泛報導,相關討論涉及政府的支持,資源和政策籌劃。在教育上,美國臨床腫瘤學會在2015-2018年制作了一系列與團隊研究工作相關的網上資料。其中莫禮士教授的網上影片獲得五萬多名腫瘤科醫護保健專業人士觀看。[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/

在學研究生

Mar Lar AUNG

博士生

陳姝成

博士生

陳煒琳

博士生

Dereje Chala DIRIBA

博士生

甘婷

博士生

Win Yadanar HLAING

博士生

Eh Naw HSER

博士生

劉琪

博士生

阮佳音

博士生

汪冕

博士生

容英瓊

博士生

何美芝

博士生 (Part-time)

郭陽煜

博士生 (Part-time)

譚美玲

博士生 (Part-time)

校外資助計畫

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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