To study genetic sequence variants underlying unresolved Mendelian disorders and improve interpretation of already identified high penetrance variants, a collection of 13,000 individuals with a rare disease and their relatives has been whole genome sequenced with an average 30x coverage. Participants were recruited at 57 National Health Service (NHS) hospitals in the UK and 26 non-UK hospitals using approved eligibility criteria for 15 different rare disease domains. We describe the population structure including ethnicity and relatedness estimation, high level phenotypes collected using Human Phenotype Ontology (HPO) terms and quality control and summary metrics for samples and variants. The resource contains over 165 million unique variants (including 90, 3 and 6% SNVs, small insertions and deletions respectively) in the 10,258 genetically independent samples with 47% of variants previously unobserved in other large scale publically available genome datasets (e.g. gnomAD, HGMD, UK10K). We summarise the curation of gene lists and pertinent findings in 2,000 unique diagnostic-grade genes for the 15 domains. Over 1200 reports assigning pathogenic or likely pathogenic causal variants have been issued following review by Multi-Disciplinary Teams. The diagnostic yield varied across the different domains from 0.5 to 55%, while the proportion of novel (compared to HGMD) causal variants ranged between 25 to 73%; causal variants in 10 genes have been reported that involve cross-domain findings, where the same gene is linked to different clinical phenotypes. We show the power of a recently developed rapid Bayesian association test, BeviMed, to identify novel genes (n>30) and causal variants in the non-coding space of the genome and to provide independent validation of recent rare disease gene discoveries by others. The rare disease pilot of the 100,000 Genomes Project has shown the feasibility of using whole genome sequencing across a national health system to deliver a molecular diagnosis for patients with inherited rare diseases and how a national resource of genotype accompanied by HPO-coded phenotypes provides a powerful platform for the identification of so far 46 novel diagnostic-grade genes.

•       This talk sets out the English National Health Service (NHS) approach to improving outcomes through greater personalisation of care underpinned by developments in genomics. •       It reviews how the world-leading 100,000 Genomes Project provided a proof of concept for the mainstream use of Whole Genome Sequencing to inform routine care. •       It then sets out how the work of the 100,00 Genomes Project and the long history of genomic developments in the NHS have together formed the foundation for  the introduction of a national Genomic Medicine Service. This will provide comprehensive, consistent and equitable access to the full range of genomic testing for country’s entire 55 million population. •       This new system is integrated across clinical services and is adopting an end-to-end pathway approach to support improvement of outcomes through personalisation of care, particularly in key clinical priority areas. All patients are also given the opportunity to participate in research, benefiting their future care and helping others with their condition.

近年來，廣東省堅持以基層為重點，以改革為動力，將提升縣級以下醫療機構服務能力為突破口，不斷提升基層醫療衛生服務能力。2017-2019年各級財政投入500億元專項用於加強縣及縣以下基層醫療衛生機構建設，同時強化三醫聯動，積極推動縣級公立醫院改革、醫聯體建設和人事薪酬制度改革等，2018年廣東省57個縣縣域內住院率達到83.5%，基本實現“大病不出縣”，成為全國基層醫療衛生服務能力建設的先行者，為推進分級診療制度建設打下堅實基礎。

上海申康医院发展中心是2005年9月由市政府设立的市政府办医的责任主体和市级医院国有资产投资管理运营的责任主体，具体承担28家市级医院的办医职责和10家三级医院的合作共建任务，推进医院的建设发展和深化改革。 自成立以来，申康中心分阶段推进市级医院医学科研和科技创新工作。一是自成立以来，立足办医主体职能定位，推动市级医院学科人才队伍建设，开展了五大类606项临床科技创新项目，提升资源配置能力，为临床诊疗能力提升和医学科技创新活动打下扎实的基础。二是2016年启动了《促进市级医院临床技能和临床科技创新三年行动计划》，首轮立项资助239个项目，包括重大疾病临床技能提升、疑难疾病精准诊治攻关、专科疾病临床“五新”转化和常见疾病适宜技术研发与推广应用等四大类，旨在鼓励市级医院有效整合临床医学研究力量和资源优势，开展高质量临床研究，取得一批在国际上有重要影响的临床医学研究成果，培养一批国内外知名的临床医学专家，用若干年时间使上海市级医院的临床医学研究走在全国前列，进入国际先进水平。三是2018年以来，在前述工作基础上，积极探索临床管理体系优化，筹建申康临床研究院，并在临床研究成果转化等方面开拓探索，推动市级医院跨越发展，让人民群众共享医学科技进步成果。

Risk of anaemia increases in chronic kidney disease patients, and is in proportion to the stages of kidney disease. The lecture will focus on pathogenesis of anaemia, of which relative deficit of erythropoietin and hypoxia-sensing mechanism are involved. In addition, role of iron deficiency has been increasingly recognized. The abovementioned factors provide insights to managing anaemia in kidney disease patients. Besides case illustration to highlight the challenges of anaemia, practice-changing studies will be discussed. The lecture will also discuss the management of patients with stage 4 to 5 chronic kidney disease and who have opted for palliative care. In particular, we reported our local observational study in which 39 such patients receiving erythropoiesis stimulating agent (ESA) were matched with a control group of 39 patients without ESA. With one-year observation period, patients in the control group had higher transfusion rate (incidence rate ratio IRR 3.63; 95% CI 2.49 – 5.31, P < 0.00001) and higher hospital admission rate (IRR 2.34; 95% CI 1.80 – 3.03, P < 0.000001) than the ESA group even after adjustment for comorbidities.

Patient blood management (PBM), with the principles of optimizing erythropoiesis, minimizing blood loss and optimizing patient-specific tolerance to anaemia, plays an increasingly important role in the management of both obstetric and gynaecological (O&G) patients. Severe iron-deficiency anaemia among the O&G patients can be caused by (1) chronic periodic blood loss i.e. menorrhagia from various causes, as well as (2) acute massive blood loss from gynaecological or obstetric emergencies. How to reduce the need for repeated blood transfusions in the O&G patients and how to raise their haemoglobin (Hb) levels safely, cost-effectively and with sustained efficacy become two great challenges in O&G practice nowadays.  In this presentation, the data on blood transfusion requirement among the gynaecology patients in Hong Kong, both from surgical and non-surgical causes, will be presented. A brief literature review on the use of intravenous (IV) iron therapy, as an alternative to blood transfusion, for the management of severe iron-deficiency anaemia among the gynaecology, antenatal and postpartum patients will be given.  The results from a local retrospective cohort study at Kwong Wah Hospital on the use of IV iron infusion with a simplified dose-standardized protocol for the treatment of menorrhagic patients with severe iron-deficiency anaemia (Hb level between 6-8 g/dL) will be presented. In this study, 114 patients were recruited, after counselling on the alternatives of blood transfusion versus IV iron therapy. Each patient was treated with two doses of IV Venofer, 200mg each, given within 2 weeks, followed with oral iron supplement. A significant rise in Hb and Ferritin levels was observed 4 weeks after starting IV iron treatment. Over 99% of patients had their anemic symptoms resolved after treatment. Only one case of mild allergy was reported.  Last but not the least, some of the important recommendations in the recently-released Hospital Authority Guideline on “Management of Iron-deficiency and Iron-deficiency Anaemia in O&G Units” will be highlighted. The suggestions on future directions to be considered in PBM in O&G practice will also be presented.

Clinical blood transfusion, since its introduction in the early 19th century, remains an important treatment modality in modern medicine. However, blood transfusion is associated with significant risks of complications, which are still here to stay despite the rapid advances in medicine over the last 200 years. With global population ageing and the resulting supply demand imbalance, efforts have been made to reduce blood treatment. Furthermore, there is growing evidence that transfusion might be associated with unfavorable clinical outcomes. Therefore Patient Blood Management (PBM), which is an evidence-based, patient-centered, and multidisciplinary approach to optimizing the care of patients who might need transfusion, is emerging in western countries over the last 20 years. While PBM is gradually becoming the new standard of care and, in principle, it should belong to every clinician, anaesthetist, who possesses a solid foundation in clinical pathophysiology and a perfect armamentarium of technical skills, together with the unique role of taking care of the patients during the entire peri-operative journey, is well-placed to lead the practice of PBM, at least in operative settings. Enhanced Recovery After Surgery (ERAS) similarly finds Hong Kong its arena for proliferation in recent years, since its earlier footprints in the western countries. Indeed, PBM has been considered one of the ERAS elements. Indeed, PBM is so important in modern medicine that it is more appropriate to phase that ERAS and PBM are supplementing each other. For example, early detection and optimizing of pre-operative anaemia at pre-anaesthetic clinic, as an optimizing patients’ RBC mass strategy in PBM, is also a risk stratification and optimization element in ERAS. To conclude, shift away from standard transfusion practice to PBM is a paradigm shift. Anaesthetist, being periopeative physician, has an important role to play in the practice and development of it.

As part of our ERAS programme, Patient Blood Management (PBM) came into place in Tseung Kwan O Hospital (TKOH) since 2016. PBM is a multidisciplinary, evidence based approach to optimize use of donor blood and to improve clinical outcomes by avoiding unnecessary exposure to blood components. In TKOH experience, we first started PBM in surgical patients undergoing major colorectal surgery, and then Total Knee Replacement surgery, and later patients undergoing major gynaecological surgeries. Iron sucrose was first used in the beginning of our programme, which had later been replaced by Iron Isomaltoside since its introduction in April 2018, due to its higher single dose limit, thus allowed a shorter time interval to surgery. We identified, evaluated and managed anemia preoperatively. Should iron deficiency anemia be found, we would start either oral or intravenous iron therapy promptly. Intraoperatively, we carefully manipulated patient’s haemodynamics, optimized haemostasis and avoided coagulopathy. While postoperatively, we followed up patients as a team with surgeon, and monitored and managed any postop anemia. For the period from April 2017 to Mar 2019, a total of 66 surgical patients and 25 gynaecological patients had been given intravenous iron therapy preoperatively. The average rise in Hb level was 2.49 g/dL in the gynaecological group, and 1.55 g/dL in the surgical group. The overall transfusion rate was lowered to 4% in the gynaecological group after the implementation of PBM compared to 8% before, and was 6% in the surgical group compared to 11% before.  We believe PBM had been a great success in TKOH. It significantly reduced transfusion rate and its associated morbidity and costs. With the trend of increasing demand for blood transfusion outweighing the supply of donated blood product, we believe PBM is the future trend to come.

IntroductionTraditionally physiotherapy has been a weekday-rehabilitation for inpatients stroke, with limited service such as chest-physiotherapy at weekends and holidays. Extended weekend rehabilitation for stroke may improve patient care and outcomes by eliminating the interrupting pattern of stroke rehabilitation. Criterion for effective selection of appropriate candidates and feasibility of 365-day rehabilitation for weekend stroke rehabilitation in local context has not been formulated. ObjectivesThis study aimed to evaluate correlations of total number of treatment-session of Physiotherapy and functional outcomes by using admission Functional Ambulation Classification (MFAC) stratifying patients into different level of mobility for stroke in Kowloon Hospital. MethodologyPatients with stroke receiving weekday-rehabilitation admitted to Kowloon Hospital(KH) from October 2018 to December 2018 were recruited. Functional Ambulation Classification(MFAC) was used to stratify level of mobility on-admission. The score of Modified Barthel Index(MBI), Modified Rivermead Mobility Index(MRMI) and MFAC were rated by in-charge Physiotherapist on-admission and at-discharge. The change score of all outcomes were calculated. The total number of Physiotherapy-session during hospital stay in KH was assessed. Spearman’s rho correlation of SPSS 23.0 was used to analyze the correlations of change score of outcomes with total number of Physiotherapy session by using admission categories of MFAC. Results & OutcomeData from 46 patients with stroke aged 65.6±15.4 years were analyzed. 60.9% was male and 58.7% diagnosis of stroke from cerebral infarction and 41.3% from haemorrhage. All outcomes improved at discharged including gain score from MBI 23.3±13.2 (N=46), MRMI 9.7±5.9 (N=46) and MFAC demonstrated a median progression of 2 (N=46). The average total number of Physiotherapy-session was 23.1±11.0 (N=46). The total number of Physiotherapy-session were found to be significantly correlated with change score of MBI (ρ=0.86, p< 0.05), MRMI (ρ=0.97, p< 0.05) and with MFAC (ρ=0.764, p< 0.05), respectively in split group of category II admission MFAC. The significant strong associations uncovered between number of therapeutic-session and progression of functional outcomes in group of MFAC II suggested that prudent identified target clients for the upcoming 365-rehabilitation service for stroke would affect performance. The results warranted the feasibility of 365-day rehabilitation service for stroke and supported using MFAC as a user-friendly stratification tool.   

IntroductionOccupational therapist (OT) are often required to conduct home environmental assessment to ensure safety before discharge as part of their role in rehabilitation teams. To improve the timeliness of occupational therapy home visits for discharge planning, a technology-assisted care model on pre-discharge home assessment was developed in medical convalescence wards of Tuen Mun Hospital. The carers involved in the service needed to fill in a specific home assessment form, and OT received patients’ home photos and measurement forms by using a designated e-mail address and WhatsApp platform. OT assistants were assigned to organize the home photos after information received.Objectives(A)To reduce the number of referrals to Community OT team and time during home visit after the home photos and measurement screening. (B)Through online platform, early intervention of home modification could be conducted to facilitate health care team in pre-discharge planning. MethodologyThis care model was implemented in medical rehabilitation services in Tuen Mun Hospital. After conducting comprehensive initial assessment by OT, if home measurement and home photos were indicated for discharge planning, a standard assessment form would be given to patients’ carers. Carers could follow the instructions to measure home environment, take home photos and send back to OT afterwards. After receiving the information, OT discussed with patient and carers about home environment interactively during carer training sessions. Environmental intervention included prescription of assistive device, home modification and advice on home safety. OT could simulate actual home environment for patients to practice skills in managing threshold at toilet entrance and bathtub transfer. Furniture re-arrangement would be suggested to facilitate accessibility of wheelchair use. After screening the information collected, OT might consider to refer community OT team to conduct on-site home visit for major constructional home modification if needed. Results & OutcomeFrom January to December 2018, 450 medical rehabilitation patients adopted technology-assisted care model on pre-discharge home assessment. 110 cases were referred to pre-discharge on-site home visit. This care model could stratify our patients to fast-track home safety intervention, greatly reduce the travelling time by OTs, especially some remote village house, thus the waiting time of home assessment was shortened. The technology-assisted care model on pre-discharge home assessment by occupational therapists was successfully implemented. This could increase the workflow efficiency of OT in services delivery and facilitate pre-discharge planning.   

IntroductionWith more elderly attending Accident and Emergency Department(AED), attention to common frailty syndromes has the potential to improve their outcomes in AED. Occupational therapist(OT) may help to identify their needs and offer support to enhance safe discharge to home. A pilot OT Frail Elderly Program(FEP) at AED of QMH composes of (1)OT screening at risk elderly at AED and (2)OT follow up for elderly with risk of fall or functional decline is developed. Patients underwent screening with fall risk or functional decline risk criteria achieved were triaged to different OT follow up interventions.ObjectivesTo evaluate the potential of OT in AED to facilitate safe discharge of frail elderly from AED and to reduce their revisit to AED in six months.MethodologyBetween December 2017 to December 2018, a convenient sample of elderly visited AED of QMH with age above 75 years, lived at home with AED triage category 4 or 5 were screened by OT once a day. Patients with high fragility risk, having fall risk or functional decline risk, and discharged directly from AED were recruited. OT interventions which promoting active lifestyle and activity engagement; resolving risky behavior by multifactorial approach; promoting caregiver’s understanding of the concept of safe & active lifestyle, facilitate frail elderly to build up their reserve. Number of patients revisited AED in six months was retrieved from Clinical Management System. Association of OT follow up with repeated presentation to AED in six months was analyzed between groups of patients with and without OT follow up by independent t test.Results & OutcomeTotal 111 patients were screened with mean age 83.2 years, 57(51.4%) patients discharged from AED. 25(43.8%) patients received OT follow up and 32(56.2%) patients declined service. No significant difference in baseline performance between these two groups. Results showed that significantly less patients who received OT follow up(4, 16%) revisited AED in six months as compared with those without OT follow up(15, 46.8%) (p=0.014). This preliminary finding shows that OT follow up is associated with less revisit to AED in six months due to fall or deconditioning. This suggests that a short but individualized OT intervention might reduce vulnerable of fall and deconditioning in frail elderly.   

IntroductionNursing documentation is one of the responsibilities of nurses to record clinical documentation promoting continuity of care and safe care. Accurate nursing record is an important factor to facilitate clinical handover and communication of patient information. In previous practice, Handover Sheet was used to record patient information and progress for clinical handover. However, the design appeared incomprehensive. Retrieval of patient information was difficult due to multiple pages without eye-catching remarks. Additionally, physical storage of Handover Sheets was limited and shredding was required for disposal. In view of the corporate direction of building digital workplace and the limitations of the Handover Sheet, an initiative was formed to develop an electronic Nursing Note Template for nursing documentation facilitating electronic based handover. Considering the benefits of the electronic nursing note template, it ensures secure access via Clinical Management System (CMS), turns paper documents into digital files and goes paperless. It markedly helps for efficient search of patient information of standard format facilitating effective handover in a consistent delivery of patient information and enhancing patient information communication between shifts and between health care professionals. More importantly, it retrieves patient information in a timely manner as access is possible everywhere when CMS device is provided.ObjectivesTo change nurses’ behaviours by using a structured electronic nursing note template to conduct electronic handover.Methodology1. To design a structured electronic nursing note template for nursing documentation. 2. To conduct few meetings in order to explain and clarify any problems and to reach consensus. 3. To develop and introduce an instruction manual on use of electronic nursing note template. 4. To observe the change of the way of using electronic nursing note for handover.Results & OutcomeThe evaluation showed the process was successful. Most of the nurses accepted the change of handover practice. Compliance to using electronic handover was 100%. Effective handover in a consistent manner was achieved. This change is a close match with the current work activities promoting operational efficiency. Apart from this, patient information communication between shifts and between health care professionals was enhanced.  

IntroductionThe emergence and spread of multidrug-resistant organisms (MDROs) are causing a global crisis. Among S. aureus isolates identified in the hospitals of Hospital Authority, 43.1% were MRSA; 55% and 8.6% of Acinetobacter species were carbapenem-resistant and multi-drug resistant, respectively (unpublished data). In continuing the response to this serious public health issue, World Health Organization (WHO) stated the priority area is improving surveillance of antimicrobial resistance. To stop the chain of transmission, early identification and monitoring of patients with MDROs are essential. In the Kowloon West Cluster (KWC), for culture isolates which are multiple drug resistant, laboratory staff would manually add infection control team as the printing location of the reports. Infection control personnel would then review the laboratory reports and the patients’ movements to recognize the source of acquisition or association; and the unusual clustering of MDROs at ward units within a time period. As the burden of MDROs is ever increasing, and the complexity of tracking patients’ journeys, early identification of potential MDRO outbreak is extremely difficult, if not possible. Improved efficiency and automation is thus urgently needed to cope with the heavy burden. Reference: 1. World Health Organization. Global Action Plan on Antimicrobial Resistance. [Internet]. Switzerland: World Health Organization; 2015 p. 1–28. Available from: http://www.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1 Objectives1) To pilot a web-based infectious disease dashboard surveillance information system developed by HA Information Technology & Health Informatics (HA IT&HI) in the KWC hospitals 2) To evaluate the system performance – by accuracy of MDRO detection and classification of specimen reports, and early clustering detection MethodologyThis is a prospective comparative study on the system performance of a web-based infectious disease dashboard https://dccmdro.home/Login.aspx to capture patients with MDROs and their respective hospital movements over a 3 months period. The online system retrieves microbiology culture and screening results from The Laboratory Information System (LIS) and the corresponding patients’ movements from the Patient Admission Information System (PAIS) at every midnight. Patients with history of MDROs are identified, with respective to all the locations in the hospital for the same admission. History of admission to HA hospitals is also displayed for up to 12 weeks. The distribution and the density of MDROs cases within the hospital are also visually displayed in a 3 dimensional floor plan, under Geographical View. A list of MDROs patients (the bed number, transfer-in time, and the duration between transfer-in and isolation of MDROs) residing in a particular ward can be viewed. The statistical view shows the number of newly reported MDROs acquired in different wards, which is defined as detection of MDROs after 48 hours of transfer-in or within 48 hours of transfer-out, in a defined period. Potential clustering can be detected at an early stage; and it also captures the positive specimens collected in other HA hospital. Patient tracing for each type of MDROs within a defined time frame, which is used to be performed manually, can be automated. The image can be exported for communication with frontline managers. Results & OutcomeThe system generated data of newly acquired MDROs at ward units is highly concordant to the data manually defined by infection control personnals. Besides, the automated patient tracing in a graphical presentation allows ICT to alert frontline managers for ward acquired MDROs cases, on a routine basis; which is impossible if performed manually. Last but not least, the system identified additional MDROs cases as laboratory staff may miss adding ICT as the printing location.   

IntroductionThe orthopedic team launched the multidisciplinary Non-specific Back and Neck Pain Rehabilitation Program(BNPP) in 2017, aiming to enhance the clinical management and rehabilitation protocol to patients with back and neck pain. Patients were included if their pain was not attributed to specific pathology (e.g. infection, tumor, osteoporosis, lumbar spine fracture, structural deformity, inflammatory disorder or cauda equina syndrome). The clinical management enhanced rehabilitation and facilitated appropriate continuity of care to specialist after discharge. The BNPP team involved Orthopedic doctors, Pain nurse, Physiotherapist(PT), Occupational Therapist(OT) and Clinical Psychologist(CP) in QMH and MMRC.ObjectivesTo review the clinical outcomes of BNPP in 2018MethodologyPatients were transferred to MMRC after screening by orthopedic doctors or nursing consultant in QMH. The multidisciplinary intervention in MMRC condensed to a two-week program with psycho-educational classes, pain management with analgesic medication, active training, work preparation and timely review. The intensive training from PT, OT and CP were scheduled for at least 3 hours daily. Clinical outcomes included Numeric Pain Rating Scores(NPRS), Patient Specific Functional Scale(PSFS), Roland Morris Disability Questionnaire(RMDQ), Global Rating of Changing Scale(GCRS), Modified Barthel Index(MBI), Lawton’s Instrumental Activities of Daily Living(IADL), Oswestry Disability Index(ODI) would be rated before and after the program. Return to work rate and readmission rate were also reviewed in this report.Results & OutcomeA total of 222 patients were recruited (male 50.7% and female 49.3%, mean age 56,). The average length of stay(LOS) was 9 days. There were significant improvement in NPRS of 4.7(Z=-11.8, p< 0.001), PSFS of 4.8(Z=-12.375, p< 0.001) and RMDQ 8.3(Z=-12.3, p< 0.001). Significant functional improvement was gained in MBI and IADL scores of 5.7(t=6.6, p< 0.001) and 4.7(t=8.4, p< 0.001) respectively. The ODI also had significant improvement with 20.8% reduction in disability(t=12.8, p< 0.001). The average GRCS was 63%. 34% of patients were assessed and triaged to orthopedic specialty follow-up, whereas 54% referred to family medicine. The return to work rate was 73.6% and 30-day readmission rate was 3%. In conclusion, the Orthopedic doctors led BNPP had successfully applied to patients with back and neck pain with satisfactory clinical outcomes.  

IntroductionThe waiting time for new case booking of Orthopaedics and Traumatology was over 100 weeks in Kowloon West Cluster (KWC) Specialist Out-Patient Clinic (SOPC). In November 2017, KWC Family Medicine Specialist Clinic in Orthopaedics (FMSC Ortho) started service provision to patients with stable musculoskeletal problems in FM clinic.ObjectivesPhysiotherapy (PT) support to FMSC Ortho commenced in General Out-Patient Clinic (GOPC), with collaboration between FM Department, Physiotherapy Department of Yan Chai Hospital (YCH) and Princess Margaret Hospital (PMH). Our target patients were those with degenerative joints pain and repetitive stress injuries.MethodologyWe adopted triage and stratified model, which first screened referrals and offered physiotherapy consultation within 4 to 14 weeks. With the mode of individual assessment, exercise prescription, and exercise group, we aimed to provide patients with knowledge and self-management means on chronic pain. Patients who required secondary care would be referred to either YCH or PMH SOPC PT.Results & OutcomeSince May 2018, there were 90 patients, including 32 male and 58 female with aged from 14-84, had discharged from FMSC Ortho physiotherapy service. 34%, 33% and 23% of patients suffered from back and neck pain, lower limb and upper limb problems respectively. The average treatment sessions required were 3.2 (from 2 to 7 sessions). About 19% cases had 100% improvement in terms of numeric pain rating scale, whereas 55% of cases had more than 50% improvement upon discharge. There were 4 cases (2%) had to refer back to SOPC PT for secondary care. Over 97% and 98% of patients expressed that the program was helpful to both their pain as well as early physiotherapy access.  

The main goal of management for Geriatric fragility fractures is to achieve an optimal functional state with maximal independence in community. This cannot be achieved without a care pathway with Ortho-geriatric collaboration and community partnership. A clinical pathway management with medical-social collaboration for fragility fracture provides a cross-sector platform for healthcare and social professionals from different disciplines to organize their rehabilitation and support services in a coherent and consistent manner. Patient with fragility fractures discharged from Hospital will be referred to community partner with mutually-agreed assessment tools and training protocols, offering the best chance for successful outcomes in a cost-effective way. A seamless integration of medical, rehabilitation and social supports in a cross-sector clinical pathway. Lifestyle adjustment, social and community reintegration, and competence building of both patients and their caregivers optimize independence. In long run, it enhances the overall effectiveness of the local hospital and rehabilitation systems and facilitates aging in place.

Geriatric hip fracture contributes significant morbidity and mortality to older people. The number of fragility hip fracture is expected to increase exponentially over the next 30 years as a result of increased life expectancy and population growth. Older adults with fragility fractures tend to have frailty and multiple comorbidities. Treatment is not only focusing on the orthopaedic problem, but also the geriatric issues associated with the fracture. To improve treatment outcomes, multidisciplinary treatment approaches with involvement of different healthcare professionals in the care pathway has been implemented. In this talk, the role of geriatrician, in particular, the comprehensive geriatric assessment (CGA) of patients with fragility fractures will be highlighted. CGA is a multidimensional and interdisciplinary process that seeks to determine the medical problems, functional and mental capacity, nutritional status and social situation of older patients in order to develop a coordinated and integrated care plan for treatment and long-term follow-up. In patients with fragility hip fracture, CGA and management emphasizes on collateral history, assessment of co-morbidities, medication review, optimization of medical conditions, peri-operative care and discharge planning. Furthermore, the importance of continuity of care when discharged from hospital, namely community rehabilitation, fall prevention, bone health, secondary prevention of fractures and follow-up, will also be emphasized.

With ageing of the society, chronic diseases management has become a priority among various public health issues. Moreover, ageing is also associated with frailty, which can alter the treatment goal and method of chronic disease management. In this talk, I am going to give a brief introduction about age-associated frailty syndrome and then how it can and should re-orientate our treatment goals and strategy in chronic disease management. I shall use diabetes in old age as a prototype of age-associated frailty syndrome and present an update perspective about management of frailty in older patients with diabetes mellitus. In addition, the importance of nutrition, resistive exercise and muscle strength preservation will be discussed in the prevention and intervention of frailty.

Coordination of inpatient and outpatient care is an important challenge in improving population health, but evidence examining the effectiveness of existing care coordination programs is mixed. To address this need, the Comprehensive Care Physician (CCP) Program at The University of Chicago provides patients at increased risk of hospitalization the opportunity to receive inpatient and outpatient care from the same physician. We compared patient satisfaction, self-related health general and mental health status, and self–reported hospitalization rates of patients randomly assigned to the CCP program vs. standard care (SC) in which patients receive inpatient care from hospitalists and outpatient care from a primary care physician who does not care for them in the hospital.  Two-thousand Medicare patients with at least 1 hospitalization in the past year or in the emergency department at the time of recruitment were randomly assigned in equal proportions to CCP or SC between November 2012 and June 2016. Patients were surveyed every 3 months by telephone for a minimum of 1 year and maximum of 5 years to assess patient experience with their primary physician, general and mental health status, and hospitalization rate. Longitudinal outcomes were analyzed using mixed-effect regression models.  At baseline, mean age was 63 years, 62% were female, 88% were black, and 45% were eligible for both Medicare and Medicaid. There were no statistically significant differences in demographic or health measures between CCP and SC patients at baseline. Follow-up rates to 1 year were 95% for CCP and 85% for SC. Mean patient satisfaction ratings of their physicians were 0.27 points higher for CCP vs. SC patients (p0. 0001, 95% CI:[0.16, 0.37]), corresponding to the difference between the 80th percentile and 95th percentile in such scores nationally. Mean self-rated health status measured from 1 (poor) to 5 (excellent), was not significantly different for CCP vs. SC for general health (DCCP-SC=-0. 001, p=0. 9701, 95%CI: [-0.06, 0.06]), but were 0.11 higher for CCP compared to SC mental health (p=0. 0033 95% CI: [0.03, 018]). Using a zero-inflated Poisson mixed-model, the rate of hospitalization was 22% lower and statistically significant (p=0.030, event rate ratio 0.78, 95% CI: [0.62, 0.98]) for CCP compared to the SC at the first 3-month follow-up wave and remained at least 15% below SC and statistically significant up to the minimum 1 year follow-up. These findings suggest that the CCP model may improve patient experience and health status while substantially reducing utilization for patients at increased risk of hospitalization.

Despite all the great work that has taken place around the world to improve the safety of care, harm continues to happen at an alarming rate! In Canada, patient safety incidents are the third leading cause of death behind cancer and heart disease. And a recent national survey showed that very few Canadians are even aware that unintended harm can happen in the health care system. Yet we continue to do the same interventions hoping for different results! So what can we do to change this? During this presentation, you will learn about the winning conditions for creating a patient safety culture and your role in leading that change. The Canadian Patient Safety Institute has adopted a bold new strategy that will be shared as well as the tools that you’ll need in your toolbox to effect the necessary change. And although it should go without saying, patients as true partners will be profiled throughout the session!

Healthcare is very different from aviation; it is more complex, more diverse and much more reliant on human interaction than aviation or other safety-critical industries. This means that approaches to safety used in aviation cannot simply be transferred into healthcare. However, with suitable modification and testing, it might be possible to adapt some aviation safety practices to healthcare. The approach to investigation of serious accidents and incidents in aviation has led to a significant improvement in safety. The same is not true in healthcare. Most healthcare systems experience recurrent systemic failures but despite the extensive use of incident reporting and investigation, healthcare has not got safer.  The Healthcare Safety Investigation Branch was established by the English healthcare system in 2017 to investigate serious, systemic, patient safety issues using approaches developed from aviation and other safety critical industries. The Chief Investigator is a former pilot who led the UK’s Air Accident Investigation Branch and investigators are from a range of backgrounds including healthcare, air, military and marine accident investigation and academia.  Learning objectives; By the end of this session delegates will be able to; 1. Describe the different safety models used in other safety-critical industries. 2. Understand how some of these might be applied in different areas of healthcare. 3. Understand the benefits and challenges of adapting safety investigation techniques from aviation into healthcare.

The approach to prenatal diagnosis has been revolutionised by advances in prenatal molecular diagnostics. The most important breakthrough in prenatal screening using maternal plasma cell-free fetal DNA as a non-invasive prenatal testing (NIPT) for fetal chromosomal abnormalities was discovered by Professor Dennis Lo from Hong Kong. Polymerase chain reaction (PCR) as a rapid aneuploidy test, and chromosomal microarray (CMA) for molecular karyotyping are going to replace traditional karyotyping. Whole exome sequencing (WES) and whole genome sequencing (WGS) are coming. Ultrasound does maintain a pivotal role, being the strongest link between the various tests in the new algorithms. New algorithms in prenatal diagnosis are evolving and becoming increasingly complicated (Figure 1, from Leung WC. New algorithms in prenatal diagnosis. MIMS JPOG 2017;43(2):81-8). The goal is to maximize the prenatal information for pregnant women and their families to make choices for their next generations.

Traditional karyotyping had been the standard test for prenatal diagnosis in Hong Kong since 1981. Chromosomal microarray (CMA), either performed by array comparative genomic hybridization (aCGH) or single nucleotide polymorphism (SNP) array has become more widely used 30 years later. CMA offers increased diagnostic yield on detection of submicroscopic changes (microdeletions and microduplications) not detected by karyotyping and at a shorter reporting time. The new workflow of using CMA as primary test in HA prenatal diagnostic service include rapid aneuploidy detection by quantitative fluorescent polymerase chain reaction (QF-PCR) to exclude trisomies 13, 18, 21, monosomy X and triploidy (these aneuploidies would proceed to karyotyping only). Those with normal QF-PCR results would proceed to CMA. The new workflow would be offered to patients who undergo invasive prenatal diagnosis, stillbirth and second trimester miscarriage. The cost-effectiveness of the new algorithm can be demonstrated from both the healthcare system and societal perspectives. This shall enhance patient access to improved clinical laboratory service and patient care pathways in prenatal diagnosis.

Use of dried blood spots (DBS) to screen newborns for inborn errors of metabolism (IEM) began as a pilot study in Hong Kong (HK) in 2015. Results from the pilot study showed the collective incidence of the 24 screened conditions to be 1 in 1,682. The pilot study demonstrated feasible logistics and a higher than previous estimation of 1 in 4,500 incidence of IEM in HK. Thus, upon completion of the pilot study, the HK government decided to extend the program in phases to all babies born in government hospitals. Universal implementation of metabolic newborn screening has only been made possible by usage of tandem mass spectrometry technology to process the DBS cards collected from newborn babies. The same technology can also be utilized and applied beyond the newborn period with some limitations. The rapid turnover time for important metabolic analytes makes it an attractive tool to frontline clinicians managing sick newborns and children while awaiting conventional confirmatory investigations. We present three cases in whom timely diagnosis of an IEM condition was made using DBS cards. We would like to raise awareness of physicians to the extended scope of using dried blood spots to diagnose IEM diseases beyond the newborn period.

Use of dried blood spots (DBS) to screen newborns for inborn errors of metabolism (IEM) began as a pilot study in Hong Kong (HK) in 2015. Results from the pilot study showed the collective incidence of the 24 screened conditions to be 1 in 1,682. The pilot study demonstrated feasible logistics and a higher than previous estimation of 1 in 4,500 incidence of IEM in HK. Thus, upon completion of the pilot study, the HK government decided to extend the program in phases to all babies born in government hospitals. Universal implementation of metabolic newborn screening has only been made possible by usage of tandem mass spectrometry technology to process the DBS cards collected from newborn babies. The same technology can also be utilized and applied beyond the newborn period with some limitations. The rapid turnover time for important metabolic analytes makes it an attractive tool to frontline clinicians managing sick newborns and children while awaiting conventional confirmatory investigations. We present three cases in whom timely diagnosis of an IEM condition was made using DBS cards. We would like to raise awareness of physicians to the extended scope of using dried blood spots to diagnose IEM diseases beyond the newborn period.

Use of dried blood spots (DBS) to screen newborns for inborn errors of metabolism (IEM) began as a pilot study in Hong Kong (HK) in 2015. Results from the pilot study showed the collective incidence of the 24 screened conditions to be 1 in 1,682. The pilot study demonstrated feasible logistics and a higher than previous estimation of 1 in 4,500 incidence of IEM in HK. Thus, upon completion of the pilot study, the HK government decided to extend the program in phases to all babies born in government hospitals. Universal implementation of metabolic newborn screening has only been made possible by usage of tandem mass spectrometry technology to process the DBS cards collected from newborn babies. The same technology can also be utilized and applied beyond the newborn period with some limitations. The rapid turnover time for important metabolic analytes makes it an attractive tool to frontline clinicians managing sick newborns and children while awaiting conventional confirmatory investigations. We present three cases in whom timely diagnosis of an IEM condition was made using DBS cards. We would like to raise awareness of physicians to the extended scope of using dried blood spots to diagnose IEM diseases beyond the newborn period.

Inborn errors of metabolism (IEM) comprise a large group of both clinically and etiologically heterogeneous disorders involving in human metabolism. There are more than 1000 different IEM disorders ranging from organic acidemias, amino acid metabolism, urea cycle defects, fatty acid oxidation, mitochondrial disorders, carbohydrate metabolism disorders, peroxisomal disorders, purines and pyrimidines metabolism, transport and mineral disorders, mucopolysaccharidoses, mucolipidoses, cholesterol and neural lipid metabolism, lipid storage disorders, lysosomal disorders, and miscellaneous. IEM can present at any age from fetus to elderly. Clinical presentations of IEM are protean and often non-specific rendering clinical diagnostic difficulties. So far, there is no single ??universal?? screening test available for all IEM. In order to achieve an accurate and timely diagnosis, a right test should be carefully chosen on a case-to-case basis. IEM are individually rare but collectively common with an overall incidence of at least 1 in 1400. The local incidence of amino acidemias, urea cycle defects, fatty acid oxidation disorders and organic acidemias is about 1 in 4000. However, for detection of these four IEM groups, the diagnostic values of spot urinary tests (Ferric Chloride test, Dinitrophenylhydrazine test, Berry test, Nitroprusside-cyanide test and Nitrosonaphthol test) are limited. While performing plasma amino acids, plasma acylcarnitines and urinary organic acids analyses are very laborious and time consuming, the wide-spread uses are often restricted. In view of the above disadvantages and limitations, we introduce you a better service of dried blood spot broad spectrum metabolic test by tandem mass spectrometry, which has be

Many patients experience severe to excruciating acute pain during a wide range of medical procedures.  Excessive pain is an important medical problem that can have long term negative consequences for patients.  For example, children often find it scary to visit the dentist (cavities) or the doctor (needles and blood draws), and this early learning (aversive conditioning) can make the patients avoid healthcare.  For children severely burned in a fire, pain during physical therapy exercises, and pain during cleaning of severe burn wounds is often severe to excruciating, even when powerful pain medications such as ketamine are used.  Psychological factors such as fear, anxiety, expectations of pain can amplify/increase how much pain patients consciously experience.  Fortunately, a new psychological pain control technique, VR distraction, can greatly reduce pain.  There is growing evidence that immersive virtual reality can dramatically reduce how much pain patients experience during painful medical procedures.  Patient look into a pair of virtual reality goggles, and have the illusion of going into a 3D computer generated world called SnowWorld.  In SnowWorld, patients throw snowballs at snowmen, penguins, and other objects.  Virtual Reality gives patients the illusion of “being there” in SnowWorld instead of being in the hospital.  The patient’s attention is so distracted by “going into” virtual reality that their brains have less attention available to process incoming nociceptive signals from the pain receptors.  In clinical research studies, patients with severe burn injuries report large and significant reductions in pain during Virtual Reality, and report having significantly “more fun” during wound care during VR.  In addition to feeling less pain during VR, fMRI brain scan studies with healthy volunteers show large reductions in pain-related brain activity during virtual reality.  Developing new non-pharmacologic analgesics such as VR is an international priority for the future of medicine.

Traditionally, training in real environment is considered important for independence and successful community integration but often is given near the final stage of rehabilitation programmes. This talk will show case a few VR-based systems developed in Hong Kong, which target at assessment and training of patients with cognitive decline due to different pathologies. In a safe and near real-life environment, cognitive training can start even at the early stage and have demonstrated proven efficacy and effectiveness. With high generalization power of VR, together with activation of similar neural structure provided by the virtual environment and interaction activities, it is conductive for patients to apply learning to real environment and may reduce convalesce time. For instances, a VR-based prospective memory assessment has been developed with high validity and reliability for clinical use. VRehab is a computer-assisted rehabilitation system for patients to receive stimulation training, such as using public transport, mobile phones and ATMs as well as grocery shopping. A virtual boutique is a computer application on cognitive training, using a retailing boutique shop as the training scenario. Patients will assume the role of a sales person to carry out real-life tasks for training their attention, memory, executive function and problem solving abilities. Research findings indicated that they can better apply the skills they acquire in this training to their daily lives e.g. sales and problem solving. Another VR-based convenient shop has been developed to train more demanding cognitive skills such as prospective memory, execution and problem solving, as well as vocational skills for better employability of persons who have been limited from productive work due to cognitive deficits.

At the beginning of the presentation, we will discuss the current virtual reality (VR) technology in cinical and biomedical applications. We will demonstrate an example of using VR in medical simulation for type and screen training, which determines both the ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies. It involves a simple draw and laboratory test of a blood sample. There are a series of steps involving type and screen procedures. However, some medical staff members may overlook certain steps or conduct some steps unsuccessfully as many of these staff are overloaded and work under high pressure. Therefore, we have developed an integrative solution to provide blood taking training for medical staff members in a Hospital by using the latest VR technology. In the VR training program, medical staff members can navigate and interact without distractions in a safe and calm environment, which is difficult to find in the real environment. The VR training program not only provides opportunites for additional medical staff members practice repeatedly, but also eliminates training time and costs compared with traditional training method. The project outcome is expected to provide an interesting and effective training to thousands of medical staff members who require training in type and screen in Hong Kong. After the demonstration, we will also introduce the latest development of mixed reality (MR) and the future development of extended reality (xR). We will explore how the development of artificial intelligence (AI) technology can be integrated with VR in order to extend its application in the biomedical and clinical areas.

Patient safety is the cornerstone of high quality health-care service nowadays. Up to half of the adverse events in hospitals are preventable and many of the patient’s disability or death can be avoided with safe clinical practice.  In order to optimize patient care, health-care professionals have to learn and develop both technical and non-technical skills. The tradition concept of “See One, Do One & Teach One” is no longer ideal in today’s health-care environment. Simulation training has been proven to shorten the learning curve and reduce human errors, and become a valuable tool in health-care training in recent years.  With advancement of technology, we are inspired to develop a virtual reality program on a simple yet important clinical procedure. It offers novices a realistic environment for learning and an unlimited number of practices. Future development of virtual reality in medical training is going to offer huge opportunities in the fast-paced and high-pressure medical field.

The demonstrated capacity of immune cells to kill tumor cells suggests that they could be used to treat cancer. Conceivably, immune cells could overcome the resistance of cancer cells to standard treatment modalities while sparing normal tissues. Results of recent clinical trials with autologous T cells redirected against leukemia or lymphoma cells through the expression of anti-CD19 chimeric antigen receptors (“CAR”) have fully validated the potential of immune cells as living drugs. Dramatic tumor responses were observed in patients who had become resistant to all other available treatment. The clinical efficacy of these early immune cell-based therapies has stimulated great interest in this area of translational research, encouraged efforts to further improve CAR-T cell function, and renewed the enthusiasm for exploring the potential of other immune cells..  Simplifying ex vivo cell processing, widening the range of targetable antigens, and generating safer and more effective cell products are important objectives for the future. To overcome the need of developing an individual CAR for each target and allow the targeting of multiple cancer antigens simultaneously, we developed a CD16-based receptor which endows T cells with antibody-dependent cell cytotoxic capacity. This receptor has shown promise in preclinical studies and is currently being tested in clinical trials. We have also generated ways to target T-cell malignancies with CAR-T cells. Finally, methods to expand and genetically engineer NK cells have been established and validated in a clinical-grade setting, leading to several ongoing clinical trials. These immune cell therapy approaches are being explored with the vision of building an array of immunotherapeutic options that can complement, and ultimately replace, standard therapy of cancer.

Natural killer (NK) cells are normal white blood cells capable of killing cancer cells without prior sensitization. Unlike allogeneic T cells, NK cells do not cause graft-vs-host disease. Furthermore, allogeneic NK cell infusions are attractive for cancer therapy because of non–cross-resistant mechanisms of action and minimal overlapping toxicities with standard cancer treatments. Although NK therapy is promising, many obstacles will need to be overcome, including insufficient cell numbers, effector dysfunction, exhaustion, and tumor cell evasion. In this lecture, we will review recent NK cell biology studies and the advancements in biotechnology. We will examine novel approaches of NK cell therapy that may improve therapeutic efficiency and reduce side effects, including immunogenetic-based donor selection, refined NK cell bioprocessing, and novel augmentation techniques, to improve NK cell function and to reduce tumor resistance. Although data from clinical trials are currently limited primarily to hematologic malignancies, broader applications to a wide spectrum of solid cancers are under way. The unique properties of human NK cells may open up a new arena of novel cell-based immunotherapy against cancers that are resistant to contemporary therapies.

Over the past decade, there are many new advances in the management of cancers that included targeted therapies by either small molecules inhibitors or immunotherapy. Immunotherapy can further be classified into different categories such as active immunotherapy, passive immunotherapy, adoptive immunotherapy and immune check point inhibitor treatment. The active immunotherapy includes cytokines therapy and tumor vaccine. For children cancers, interferon alpha as a maintenance therapy for chronic myeloid leukemia previously and consolidation treatment for childhood nasopharyngeal cancers are examples of such approach. Tumor vaccine against GD2 for neuroblastoma is currently under clinical trial. For passive immunotherapy, use of monoclonal antibody against specific tumor associated antigen is the main strategy. This includes anti-CD20 for B-lineage acute lymphoblastic leukemia or non-Hodgkin lymphoma, anti-CD33 for acute myeloid leukemia, anti-GD2 for neuroblastoma and anti-CD30 for Hodgkin lymphomas. The newest approach is using bio-engineered bispecific antibodies that link a tumor specific antigen to cytotoxic T cells. We witnessed both success and failure of these active and passive immunotherapy approaches. They have to be used in combination with chemotherapy under most situations. For adoptive immunotherapy, it involves the use of either autologous or allogeneic immune cells. The most common forms are hematopoietic stem cells transplant (HSCT), NK cells, and CAR-T cells. In principle, the combination of both cellular and non-cellular immunotherapy can further enhance the efficacy. Finally, immune check-point inhibitors (PD-1 or PDL-1 inhibitor, CTLA-4 inhibitor) are emerging concept and PD-1 inhibitor has been used in refractory Hodgkin lymphoma with good preliminary result. Whether immune check point inhibitor can be used together with other immunotherapy remains to be explored. When using these new therapies, a totally new set of therapy-related toxicity emerged and clinicians have to be aware of these complications and know how to manage them. In summary, the new paradigm of applying immunotherapy for cancers is coming but we have to understand their respective strengths and weaknesses so they can be applied effectively. In addition, the markedly high cost of most of these therapies may limit their availability to most patients in needed. Concerted effort from both Governments and manufacturers are essential in order to improve their application to general public.

Timely initiation of dialysis is vital to chronic kidney disease stage 5 (CKD5) patients. Literatures reviewed that unplanned urgent initiation of dialysis was associated with poorer outcomes and early pre-dialysis education enhanced greater likelihood of elective dialysis. Pre-dialysis education is referred by renal physician when patients are approaching CKD5 and carried out in renal nurse clinic in Hong Kong. However, the average non-attendance rate of the new appointment in five renal nurse clinics under Hospital Authority (HA) was undesirable with 15.28% (n=288) from May 2017 to July 2017. Therefore, evidence-based practice (EBP) was applied to decrease the non-attendance of new appointment in these clinics. Method: Applying the John Hopkins Nursing Evidence-based Practice (Practice question, Evidence, Translation) Model, a new phone reminder service was implemented from July 2018 to September 2018 in these five renal nurse clinics. The clerks of the involved clinics called patients attending the first pre-dialysis education one week before appointment. Maximum three calls within two days were delivered. If the patients could not be contacted, voice messages were left to their message boxes if available. Changing of appointment was allowed upon patient??s request. The content of the reminder was standardized by a script and the compliance of the clerk was audited by a renal nurse with a standard audit tool. Results: Collectively 267 patients were booked for first pre-dialysis education during the intervention period in five renal nurse clinics. 24 patients requested changing appointment. 15 patients defaulted, the average non-attendance decreased from baseline 15.28% to 5.29% which was statistically significant (p=0.001). Conclusion: The judicious use of current best evidence to reduce the non-attendance rate of first pre-dialysis education in out-patient setting may be effective to reduce the possible risk of unplanned urgent initiation of dialysis to safeguard our patients.

Background: Fasciotomy is essential for the prevention and management of compartment syndrome on limbs. The traditional method is to wet to dry dressing to the wide laid open wound to well prepare the wound bed for closure. Most fasciotomy wounds will require delayed primary closure and there may require number of surgeries. Patients and method: Applied Evidence Base Practice (EBP) by using Negative Pressure Wound Therapy (NPWT) to the patients who suffered compartment syndrome with fasciotomy among five Orthopaedic and Traumatology units in Hong Kong hospital Duration: May, 2018 to Jan, 2019 Results: The usage of NPWT is increasing by 7% to 40% (n=8). The mean of wound closure times (day) of NPWT group is 15.86 days more than non-NPWT group. In the large wound size group, the mean of wound closure times in NPWT group is 3.42 days lesser than non-NPWT group. Conclusion: Usage of NPWT is more common in managing fasciotomy wound not only target on fasten the wound closure time but also benefit on edema control, promote granulation, decrease bacteria load and cosmetic appearance, but also for early reconstruction and rehabilitation. NPWT is tends to apply on large fasciotomy wound with effective wound bed preparation for wound closure.

A chemical eye injury is when a chemical gets into the eye and harms it. Different types of chemicals can cause a chemical eye injury. Examples include chemicals found in cleansing products, bleach, hair dyes, and lawn fertilizers. Some chemicals cause only mild or short-term symptoms. Other chemicals can cause severe damage, including scarring of the cornea or vision loss. How mild or serious an injury is depends on the type of chemical, how long the chemical is in the eye and how far into the eye the chemical spreads. Without prompt intervention, irreversible visual loss and cutaneous disfigurement may prevail. However, there is variation in practice in giving nursing intervention to adult patient with chemical eye injury in emergency departments. There is no standard operating procedure in Hospital Authority. Therefore, there are variation in methods, solutions, skills, time and performers. Our group aimed to find out the best evidence to deal with chemical eye injury to the adult patients while attending the emergency department by conducting a literature search with the Johns Hopkins evidence base practice framework. Finally, there are recommendations on such issue with the translation timetable into practice by the trail run in 5 local emergency departments.

Background Our hospitals Digestive Medicine Centre has a diverse patient population including those who may not understand English and/or Chinese. Patients who come to our centre for colonoscopy arrangement require adequate and clear instructions of bowel preparation. As colorectal cancer is the second leading cause of death in Hong Kong and third leading cause of death in the world, it is our foremost priority to ensure that colonoscopy preparation is optimal to ensure complete and accurate examination of the whole colonic lining. Patients must follow a strict pre-endoscopy diet and bowel prep protocol. According to the literature, many patients reported experiencing unpleasant, difficult and disruptive care during the bowel preparation process for a colonoscopy. Up to 25% of patients are not given adequate bowel preparation instructions. A visual educational leaflet may increase patient understanding of the procedure and improve bowel preparation. Purpose and Problem Statement Currently, we provide written instructions for patients for patients who are undergoing colonoscopy. The PICO question is: Does the implementation of visual instructional cards improve patient compliance on bowel preparation for a colonoscopy? Design and Method By obtaining the bowel preparation results from the endoscopy report. It divided into four parts: Good, fair, poor and not mentioned. Using descriptive statistics to analyze pre and post data. Implementation Plan With the support from Hong Kong Sanatorium and Hospital medical group doctors, four visual instructional cards were implemented with simple Chinese and English wordings. The four visual instructional cards are: how to take Pico-Prep, how to take Klean-Prep, the ready of the stool color for colonoscopy and the importance of a clean colon. These instructional cards were used in three centres: Digestive Medicine Centre, Gastroenterology and Hepatology Centre and endoscopy centre as a trial. Results The results were collected from September 2018. A total of 91 cases were reviewed and surprisingly found that 86% cases have good bowel preparation while there is no report without mention how the bowel preparation is. To compare with the same period with 127 cases reviewed by not using the visual instructional cards for bowel preparation education, there are only 37% cases have good bowel preparation

IntroductionFall prevention remains one of the most challenging patient safety issues in hospital setting. Prevention of fall is complex and multifaceted. Safe environment is one of the crucial factors to reduce fall risk in hospital. Patient Care Assistant (PCA) supporting staffs assist nurses to take care patients. Their knowledge deficit, improper technique and less awareness would affect patient safety. Studies (1, 2) had proved that enhancement training could strengthen their knowledge and practical skill, increase awareness on patient safety, enhance supportive teamwork and improve quality outcomes. Thus, “SMART” Fall Prevention Enhancement Program was introduced to PCA in TWEH.Objectives- Strengthen PCA’s updated knowledge and practical skill on fall prevention. - Increase PCA’s alertness on safe environment to prevent fall. - Promote the ‘Patient Safety & Comfort (PSC) Round’ at workplace.MethodologyThe “SMART (Safety, Measures, Alertness, Round and Teamwork)” Program for PCA was designed and implemented in year 2018 as follows: 1. Strengthen “Safety” knowledge on patient fall with lecture, use of fall prevention video show and education leaflet. 2. Enhance fall preventive “Measures” with scenario-based hands-on skill practice exercises. 3. Increase “Alertness” on ward environmental safety and be more sensitive to patients’ need with appropriate care provided such as offer assistance with patient’s toileting, address patient’s special need and ensure patient reach personal item. 4. Educate how to conduct PSC “Round” regularly with practical tips on systematic check from patients’ area to ward environment, hospital bed and patient’s comfort care provision. 5. Engage staff with “Teamwork” through recognition of “SMART” Ambassadors「精靈醒目巡視員」.Results & OutcomeThe “SMART” Program was practical and easily applied by Patient Care Assistants at workplace. The program could increase their alertness as well as strengthen ‘Patient Safety & Comfort Round’ by PCA in clinical setting. Total 48 PCAs completed the training with active participation on skill-based practice exercises. A six-point Likert Scale from (1) very unsatisfactory to (6) very satisfactory for staff satisfaction rating was adopted with 5.4 over 6 achieved. All participants agreed that the program was practical, easy to apply to their daily operations, could enhance their fall prevention knowledge & skill. They learned how to address patient comfort needs proactively, and to conduct ‘PSC Round’ systematically at workplace. Staff compliance audit was conducted with 100% compliance rate achieved.  

IntroductionNew nurse graduates often experience distress related to theory-to-practice gaps when transitioning to the professional clinical nurses. Caring for increasingly complex patients with multiple comorbidities also is their challenge. A Graduates Reasoning Advanced Interactive Nursing Skills (GRAINS) Program has designed for 2018 new nurse graduates in PYNEH to assist their transition. Through interactive scenario-based workstations, they can equip themselves with basic and advanced clinical skills on common nursing practices and enhance clinical competence.Objectives(1) to equip new nurse graduates with common and advanced nursing procedures to facilitate their role transition ensuring safe practice and critical thinking; (2) to evaluate the effectiveness of GRAINS Program in improving knowledge, ability and confidence levels of new nurse graduates.MethodologyThe design of the GRAINS Program was based on the comments from the past new nurse graduates and the clinical preceptors. It integrated lectures, scenario drills and hand-on practices. From October 2018 to December 2018, four identical one-day classes had been organized with 7 topics including naso-gastric tube care, urethral catheterization, wound care, chest drain care, peritoneal dialysis care, tracheostomy care and central venous catheter care. The participants rated their own knowledge, ability and confidence levels before and after training by completing self-evaluation questionnaires. The scale was ranged from very low (1), low (2), moderate (3) to High (4). Mean scores were compared. Besides, the participants’ feedbacks were collected by evaluation questionnaires. Results & OutcomeThere were 108 new nurse graduates attended the GRAINS Program. The evaluation response rate was 99%. The overall mean score of self-rating in knowledge, ability and confidence levels increased from 2.48 to 3.26. The three highest topics with significant improvement were central venous catheter care, chest drain care and tracheostomy care and, mean scores increased from 2.07 to 3.09, from 2.26 to 3.19 and from 2.35 to 3.17 respectively. Also, 98% of participants were satisfied with the program as a whole. In conclusion, GRAINS Program could enhance knowledge, ability and confidence levels of the new nurse graduates to master 7 selected common nursing practices. Besides, through this program, safe nursing practice could be ensured.   

IntroductionThe Patient Support Call Centre (PSCC), established in 2009 under Hospital Authority, entails the application of information and communication technology to deliver high-volume telephone calls of professional advices by trained nursing staff to support target patients living in the community. Shortfall in the workforce was constantly faced by PSCC. In response to the tight manpower situation, PSCC needed to develop new methods to deliver services more efficiently.ObjectivesTo enhance efficiency of PSCC services by restructuring service delivery process and empowering staff. MethodologyThe operation workflow of the 2 main services in the PSCC, High Risk Elderly (HRE) Program and Chronic Disease Management on Diabetes Mellitus [CDM(DM)] Program was examined and analyzed to identify the steps and areas that could be transferred to non-clinical staff. The service delivery process of both HRE Program and CDM(DM) Program were re-designed and the telephone Call-logging System was modified in order to support the real-time communication in job transfer between nurses and non-clinical staff. Documentation was facilitated through the enhanced IT system. To facilitate the implementation, training was provided to all staff with on-going monitoring by supervisors. Non-clinical staffs were empowered to participate in patient care for both High Risk Elders and DM patients.Results & OutcomeWith in-depth analysis, work that could be transferred to non-clinical staff had been identified. These included, calling High Risk Elders for outpatient appointment arrangement after assessment by PSCC nurses and providing recruitment call to DM patients to introduce CDM(DM) service through structured scripts. Careful workflow restructuring, IT system enhancement and staff training (included communication technique, IT system usage and documentation skills) enabled safe service delivery by non-clinical staff for both HRE and DM patients. 4 non-clinical staff had been trained with over 13,000 calls were handled by non-clinical staff in 2018. The restructuring not only sparing nurses more time to perform patient care but also increasing job satisfaction of non-clinical staffs by undertaking new role with more direct patient contact in the PSCC. Conclusions: The answer to the nursing workforce shortage is not only more staff. Modification in work flow and work transfer could help alleviate the situation and improve clinical staff efficiency. The smooth work transfer in service delivery relied also on the strong support from IT system enhancement. Wider workforce by empowering the non-clinical staff is essential to the future service development in the PSCC.   

IntroductionVaccination is an important cost-effective measure for preparing against influenza. CDC advises all healthcare providers to receive flu vaccination annually. However, uptake rate of flu vaccination was low among nurses worldwide. In Hong Kong, it was even lower, less than 30% in HA hospitals in 2017/2018. It is crucial to investigate the factors that influence nurses’ attitude and perception towards flu vaccination.ObjectivesThis study aimed to identify factors associated with nurses’ intention to influenza vaccination and their risk perception towards influenza and vaccination. MethodologyA cross-sectional questionnaire survey was conducted in January to February 2018. 300 nurses, who worked in Tseung Kwan O hospital, were recruited by convenience sampling from 12 departments. Descriptive statistics, univariate analysis and binary logistic regression analysis were used.Results & OutcomeResponse rate was 91.6%. For the coming year, 66 (24.6%) respondents were willing to receive influenza vaccine, 133 (49.6%) refused to be vaccinated, and 69 (25.7%) were undecided. For respondents who refused vaccination, factors “the flu vaccine may not be safe” (40.6%) and “the vaccine may not good for health” (21.1%) were statistically significant associated with outcome with p-value ≤ .05. In adjusted logistic regression model, variables related to the intention of vaccination were “Previous experience of vaccination” (OR=62.69, 95% CI [15.69-250.53]), “Taking seasonal influenza vaccination could effectively protect me from being infected with influenza” (OR=48.34, 95%CI [9.97-234.5]) and “likelihood of being infected in the coming influenza season” (OR=3.34, 95%CI [1.03-10.82]). These results facilitated 2018/19 flu vaccination promulgation strategies. Education and promotion activities which focus on vaccination safety and effectiveness were implemented. Information sessions about flu vaccination for new joint staff were arranged. Emphasizing the likelihood of contracting influenza can increase awareness and vaccination uptake rate among nurses. Flu vaccination uptake rate among nurses increased from 34.8% in 2017/2018 to 52.5% in 2018/2019. Conclusion: Exploring the factors which influence nurses’ attitude and perceptions towards flu vaccination is important. These research findings facilitated the planning and implementation of flu vaccination promulgation strategies. Higher uptake rate of influenza vaccination among nurses was obtained when compared with previous year.  

IntroductionFall prevention is always a big challenge in our surgical units. Not only elderly, even the young adult fell due to their illness status or medication side-effect. The fall incident rate was rising as only in the 1st quarter(1Q) of 2018 was 0.59. (n=5), while the fall rate was 0.4 (n=3) in 1Q 2017. On-going series of fall prevention strategies has been introduced and implemented after reviewing and analysing the past fall incidents each year. According to the fall incidents, fall audit and spot check results last year, there were some rooms to improve over the existing preventive interventions.ObjectivesTo promote patient safety and minimize the fall rate in the surgical department and orthopaedic & traumatology (O&T) department. To improve the existing fall preventive practice.Methodology(1) Analyse the past fall incidents, audit and spot check result to plan the improvement work in the departments. (a) Design eye catching pictures on the existing patrol record. b) Revise the red flag system of surgical department to increase staff alertness. (c) Proactive utilise the assistive device e.g. Alarm Mat on fall prevention to the high risk cases. (d) Count the number of “NO fall day” with reward in every 100 days without fall incidents in ward / department to encourage staff’s day-to-day work on the fall prevention. (2) Provide program briefing and education / refreshing the use of alarm mat to staff (3) Evaluate the program by conducting the spot check on the compliance of fall scheduled round and nursing audit on fall prevention.Results & OutcomeAfter program implemented in 2 surgical wards and 1 orthopaedic ward for 4 months, the fall rate of the departments reduced from 0.44 to 0.19. The usage rate of alarm mat increased from 51% to 73% in the department. The maximum days without fall in an individual ward was 256 days and 71 days in departments. The staff compliance rate was 98% in the department. To sum up, the results showed the positive outcome as the fall rate was reduced. The longer the no fall periods, the lesser the number of fall incidents. We are looking forward to the number of “NO fall day” keep rising.  

IntroductionThe utilization of simulation training has been proved to be useful in increasing staff confidence and competence in managing high risk or challenging clinical situations. Simulation training for outreaching staff on both physical and mental emergency situation was designed in 2014 with lots of positive feedback. In 2018, we designed brand new inter-professional scenario-based simulation training for staffs working in both community and in-patient services in managing various clinical high stress circumstances.Objectives1. To inspire participants to evaluate their professional accountability on caring of patients, carers and staffs. 2. To strengthen the awareness of clinical / community psychiatric situation through real scenarios. 3. To provide a platform to explore the most appropriate management of similar situational scenarios through discussions and experience sharing.MethodologyEight scenarios were selected and modified from real situations of which the highest stress score was rated by our staff. 4 scenarios were chosen for maximum 12 mental health professionals including Doctors, Nurses, Medical Social Workers and Occupational Therapists in each half day class. Some frontline staff was invited to be the actors to let them experience the feeling of being cared and treated. Interactive debriefing was conducted with self-reflection and learning consolidation, feelings sharing, encountering limitations and experiences. Quantitative and qualitative evaluations were collected at the end of the training.Results & Outcome12 classes with 106 participants in total were trained. Very positive feedbacks as demonstrated by high rating from 100% participants who perceived the classes were useful and practical with realistic scenarios. Qualitative data reflects that the debriefing is impressive and meaningful, good sharing and inspiration in a comfortable and relax atmosphere, increasing confidence and competence in dealing with similar clinical situations and deeper understanding on the benefits of caring the relatives and staff concern. With the persistent encouraging feedbacks, it is highly suggestible that this kind of simulation training is worth to be rolled out more widely and in on-going basis.  

IntroductionRecent sentinel events demonstrated incompetent tracheotomy care at frontlines in HA hospitals. Tracheostomy is used to sustain life by keeping patient’s airway patent. The investigation panel recommended to enhance staff’s awareness on different types of tracheostomy and management; as well as to improve handover communication. Spot check of Tracheal cuff pressure measurement was done in 2017 for 27 cases with 96.3% compliance in Department of M&G but also revealed inconsistency and suboptimal standard that posed great potential risk to both patient and staff safety.ObjectivesTo achieve compliance to Guideline on Tracheostomy Care for Adult Patient (2016) Hong Kong: Hospital Authority. To standardize tracheostomy care and to enhance nursing standard in respiratory practice in the department.MethodologyBased on HAHO Guideline, enhancement program was implemented in Department of M&G. Daily Inspection round with onsite respiratory nurse coaching starting from 2Q2017. Alert labels for tracheal tube securing method and tracheostomy kit at bedside are mandatory in all wards. Two ward-based identical Train-the-trainer lectures on Tracheal cuff pressure measurement were launched achieving 100% nurses training. From 1Q2018, Alert Signage for Permanent Tracheostomy must be placed at bedhead. In 2Q2018, eCare Plan on Tracheostomy care was developed. In 3Q2018, Quick audit tool was developed based on the essences reviewed after the above improvement actions. Hospital joint department Tracheostomy Workshops had been held in 4Q2018.Results & OutcomeGreat decreased 71.67 % (2Q2017 to 3Q2018) of overall frequency trend of alert triggers in daily ward inspection round. In 2Q2018 to 3Q2018, no alert on securing the tracheal tube; decreased alert from 6 to 1 in checking tracheal cuff pressure; decreased alert from 5 to 2 in patency of tracheal tube. In Oct 2018, Quick audit on tracheostomy care was performed in one snap shot in all M&G wards for all existing 12 real cases, overall compliance rate was 93.33%. Tracheostomy quick audit served as a regular clinical practice review and immediate refreshment, especially for junior nurses with inadequate clinical experience in high risk critical care, and more importantly to align nursing practice mandatory in the department. The result provided evidence based implications on tracheostomy care for ongoing evaluation of team effectiveness and could be generalized to all general ward settings that every nurses could be equipped as the auditor.   

As we approach the end of the WHO Decade of Action for Road Safety there has been little evidence of a decline in road deaths globally. Both Hong Kong and Australia exemplify the gross disparities in injury outcomes between high-income countries and low- and middle-income countries - that relate directly to the level of care received immediately post-crash and later in a health-care facility. Trauma epidemiology and incidence varies between Hong Kong and Australia due to geographical and population differences and these will be highlighted.  However, the principles of Trauma Systems, trauma care and trauma outcomes are similar. Perhaps it is time to consider Trauma Management (HK & Australia V East Asia)?

Hong Kong trauma system started from 1994. Before that, there is no interdisciplinary collaboration. This year, Professor Donald Trunkey, an US trauma expert advised on the development of trauma services through a multi-disciplinary approach. 24-hour trauma service has embarked the next year sequentially in all 17 HA acute hospitals. In the 2000 trauma review, Hong Kong trauma was reorganised, transfer of the seriously injured patients to the most appropriate facility hospitals was advised. Five major trauma centres were set up, QEH, PWH, QMH, TMH and PMH, based on their infrastructure, to balance the societal needs and quality of service. HA Central Committee on Trauma Service was found in 2004, constituting of the Trauma Directors and Trauma Nurses from the five major centres and representatives from different trauma related specialties. It is co-chaired by the Chief Manager of Infection, Emergency and Contingency of HA Head Office. This body provides strategic advice on service management, shares knowledge with commissioned training, monitors the effectiveness by annual report and set performance guidelines like the massive transfusion protocol and pelvic fracture management protocol for all the trauma centres to follow. Governance of every trauma centre is similar- with a Trauma Director with a Trauma nurse. The responsibility of Trauma Directors includes providing advice on clinical cases, education, research, inter-department coordination and guideline creation. Trauma Nurses would actively participate in every trauma case, and perform data collection, analysis and report generation. Central Committee Training Subcommittee also defines the priority of different training courses for the frontier and help in organization of funding. In Hong Kong, we have regular courses like Advanced Trauma Life Support (ATLS) at QMH for resuscitation in the Accident and Emergency Department and Advanced Surgical Trauma Course (ASTC) at QEH for operation theatre skills. We have yearly trauma case review and trauma symposium by different centres in turn to share trauma knowledge.

This session will describe the approach taken by one Local Health District in NSW to create the conditions for system transformation. The focus of this transformation was to ensure the organisation, its hospitals and local multiprofessional teams were supported to deliver safe and reliable care that was truly person centred. The session will describe the three year journey the organisation embarked on and the learnings and challenges in taking an organisation wide systems approach to change and improvement. In addition, how an emphasis on leadership and organisational development secured fiscal control without compromising quality and safety. After this session you will: - Understand the link between building capacity building and improved outcomes for patients - Understand how local data can be harnessed to support frontline teams to lead improvement that touches patients. - Understand how to take a strategic approach to safety system transformation

Modern health systems remain built around acute care in hospitals. These miracle factories have delivered dramatic improvements in life expectancy, but they were ill adapted to cope with the consequences of their success – an ageing population with a complex mix of chronic health conditions and social challenges. What is the point in handing out inhalers for asthma only to send people back to damp or unsanitary housing that is exacerbating their conditions? Is it enough to give courses of antibiotics to elderly people with pneumonia, without addressing the social isolation or poor nutrition that makes particular people vulnerable to infection? This presentation will discuss the broader role that hospitals – the healthcare organisations with the greatest influence and resources – can play in addressing the ‘social determinants’ of ill health and creating healthier communities. It argues that the greatest hospital systems are taking a broad perspective on their role and purpose, playing an active role in prevention rather than just treatment, and using their resources in ways that help to address the underlying social and economic factors causing ill-health.

The Princess Alexandra Hospital is a 1133 bed tertiary referral hospital located in Brisbane, Australia.  The hospital provides care in all major adult specialties, except for obstetrics.  The hospital is recognised for its expertise in trauma management, cancer care, cardiac care and rehabilitation medicine.  It is one of Australia’s busiest surgical hospital and a major transplant centre. The Princess Alexandra Hospital is a leading academic and research centre through its associated university partners and the Translation Research Institute. The hospital made a significant investment in building capability to support its digital hospital program and became a fully digital hospital in early 2017.  It now utilises the complete functionality of the Integrated Electronic Medical Record (ieMR) and related digital hospital systems. This has facilitated a fundamental move to the organisation providing high reliability care to patients. Being a digital hospital has enabled the service to deliver more effective and efficient health care with improved safety and quality. It is achieving measurable benefits through the innovative use of information technology, and the optimisation of processes and practices in clinical, operational and administrative functions. In hospital was awarded Electronic Medical Record Adoption Model recognition by the international Healthcare Information and Management Systems Society. This milestone recognised the hospital as having established clear goals for improving safety, minimising errors, and prioritising the introduction of an ieMR. The hospital is part of Metro South Hospital and Health Service which provides health care to a population of approximately 1.1 million people. All the hospitals in the Metro South area have subsequently become digital hospitals. This means that when a patient presents to any hospital in the Metro South area, their electronic medical record will be available to the medical staff at that hospital. The presentation will discuss the drivers for the change, the challenges experienced in delivering on the hospitals digital roadmap, the benefits realised and the lessons learned along the way.

As a rapid emerging interdisciplinary field, the science of big data is playing a disruptive role in many sectors in recent years. The application of big data science is considered as strategically important to many established sectors of science and business world. The big-data has the unique advantage in capturing the trend and formulating the national strategies.  Medicine, as a vital important variable of social development, should serve as the backbone of big data science. But for a very long time, medical data have been isolated in various medical institutions. The development of real-world medical big data has stagnated due to the difficult access to data. Without the integration with real-world big medical data, it is hard to achieve precision medicine only based genomic data research. In the world arena, even in the developed countries, such as the United States, the real-world big medical data is difficult to achieve due to the segmentation of healthcare system. In China, the large population, universal coverage of national Medicare system and strong government/policy leverage provides a unique opportunity for China to lead the development of science of big data in medicine. In this report, the essential characteristics of big data in medicine will be elaborated with real-world shown cases, which will focus on the current situation and future development of science and application of big data in medicine in China.

The UK’s National Health Service (NHS) Long Term Plan puts digital solutions at the forefront of its new transformation plan – through data, analytics, AI, cloud computing and mobile. New models of care, new clinical pathways and new patient tools are helping the NHS plan, manage and deliver safer and more efficient services for an ageing population and for rising disease prevalence across diabetes, obesity and mental health. As a single payer system, the NHS looks to innovators and accelerators from the international health community and from the SME marketplace to help deliver digital solutions and to expand our insights into clinical and patient adoption. Current priorities lie in prevention, well-being, population health management and in the faster diagnosis and treatment of cancer , mental health and cardio-vascular disease burdens.

‘Physician wellbeing is the foundation of professionalism’ (West & Shanafelt ,2007) and is described as the ‘missing quality indicator’ (Wallace, Lemaire and Ghali, 2009). Clinician burnout – a triad of emotional exhaustion, ‘depersonalisation’ (cynicism) and a low sense of accomplishment - is a global phenomenon. For example, studies show that nearly a third of doctors in the UK and Hong Kong experience burnout at some stage in their careers and nearly half of physicians in the USA have at least one symptom of burnout. Burnout can lead to mental illness, low morale, adverse patient outcomes, and difficulties with recruitment and retention in the workforce. Professionalism involves a set of values and behaviours that lead to trusting relationships and public confidence. It is underpinned by the virtues such as honesty, courage, compassion and practical wisdom.  But for professionalism to flourish, it requires a supportive environment and adaptive coping strategies.  In this presentation I will consider the personal and organisational resilience factors that reduce the risks of burnout and enhance wellbeing and professionalism. I will explore successful initiatives and programmes that have led to improved outcomes in terms of clinician wellbeing and patient outcomes. These include appreciative inquiry, ‘brain training’ such as mindfulness meditation and compassionate mind training, Schwartz Rounds, wellness programmes, team building, and compassionate leadership. These examples can inform individuals and institutions for potential ways of organising their working practices to optimise clinician wellbeing and patient care.

Introduction: In Canada, the healthcare and social services sector accounts for the highest number of non-fatal injuries that result in lost-time claims. According to the Association of Workers Compensation Boards of Canada, in 2017, accepted lost-time injury statistics show that the health care/social services industry accounts for the highest number of lost-time injuries at 45,001, representing nearly 18% of all lost-time injuries. Workplace violence, in healthcare, is on the rise and contributes significantly to the number of injuries reported. Research suggests that healthcare professionals are at an increased risk of developing physical and psychological disorders, including post-traumatic stress disorder, when exposed to violence and traumatic events. This discussion shares the response of a nation to addressing the impact of Violence in Healthcare settings including improvement initiatives aimed to protect and promote health, safety, and wellness of all healthcare professionals. Emphasis on sharing developments in legislation, policy, and standards on building resilience in healthcare providers and creating safer work environments. Methods: A review of current literature specific to improving health and wellness of healthcare professionals and workplace violence in the healthcare sector including amendments to Occupational Health and Safety legislation (both nationally and provincially) in Canada 2010 to 2019. Learning objectives: 1. Identify improvement initiatives to protect and promote health, safety, and wellbeing of healthcare professionals and those impacted by workplace violence 2. Gain an awareness of a multi-faceted approach to violence prevention including legislation developments both provincially and nationally in Canada.

Seasonal influenza viruses include influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B viruses. In Hong Kong, there is a distinct seasonal pattern with two peaks. The winter influenza season usually occurs from January to March/April, and another summer influenza season occurs at variable time between June and August. From 2015-2019, the typical winter seasons lasted for 12-17 weeks while the summer seasons lasted for 5-8 weeks only. The Centre for Health Protection of the Department of Health monitors seasonal influenza activity in the community through a series of surveillance systems. We have used the moving epidemic method to assess the impact and severity of seasonal influenza since 2019 as a pilot. Influenza seasons were usually predominated by one type of virus but there was co-circulation of more than one type in some seasons, e.g. 2015/16 winter season with co-circulation of H1N1 and B viruses. In seasons predominated by H3N2 (e.g. 2014/15 winter season and 2017 summer season), elderly ≥65 years were mostly affected. On the other hand, children were relatively more affected in seasons predominated by H1N1 or B (e.g. 2015/16, 2017/18 and 2018/19 winter seasons).  Regarding reported outbreaks of influenza-like illness, about 50% occurred in elderly homes during H3N2-predominant seasons while 70-80% occurred in child care centre/kindergartens and primary schools during seasons with predominance of H1N1 or B viruses. For influenza-associated hospitalisation rate, it was usually highest among young children < 6 years, followed by elderly ≥65 years and then children aged 6-11 years. The rate among elderly was relatively higher in H3N2-predominant seasons. During major influenza seasons in 2015-2019, 409-647 severe influenza cases (intensive care unit admissions/deaths) among adult patients were recorded with the majority affecting elderly ≥65 years (about 85% for H3N2 cases, 75% for B cases and 50% for H1N1 cases). Persons aged 50-64 years constituted up to about 35% of severe adult cases of H1N1, as compared to < 20% for H3N2 and B cases. For paediatric cases of influenza-associated complications/deaths, 18-27 cases (1-3 deaths) were recorded in major seasons with the highest incidence in young children < 6 years. In summary, the disease burden of seasonal influenza is significant in terms of institutional outbreaks, hospitalisations and mortality, especially among elderly and young children. Promoting seasonal influenza vaccination is the most effective means for prevention of seasonal influenza.

The Department of Health (DH) has implemented the Government Vaccination Programme (GVP), the Vaccination Subsidy Scheme (VSS) and the Residential Care Home Vaccination Programme (RVP) since 2009. Among these, GVP provides free Seasonal Influenza Vaccination (SIV) to eligible groups which are at higher risk. The Hospital Authority (HA) and DH administer SIVs at its medical facilities to eligible persons. Under VSS, the Government provides monetary subsidy per dose of SIV given by private doctors to eligible persons. To further enhance coverage, particularly among schoolchildren, the Government introduced several new / enhanced initiatives in the 2018-19 season : (1) subsidy for SIV under VSS was increased from $190 to $210 per dose for all eligible groups; (2) VSS was expanded to cover Hong Kong residents aged 50-64 years; (3) School Outreach Vaccination Pilot Programme was launched for primary schools; (4) DH has actively assisted primary schools not participating in the Pilot Programme and kindergartens/child care centres (KG/CCCs) to arrange SIV outreach, such as through the newly launched Enhanced VSS Outreach Vaccination (eVSS) scheme. As at 10 March 2019, total doses administered via various SIV programmes was about 1,175,000, a 46.9% increase compared with same period last year. SIV administered via GVP and VSS (including eVSS Outreach) has increased by 1.9% and 74.3% respectively. The number of doses received by children aged 6 months to under 12 years increased by 107.4% (coverage 45.6%). Doses received by children aged 6 months to under 6 years increased by 33.5% (coverage 34.2%); and by children 6 years to under 12 years increased by 211.2% (coverage 55.3%). The number of primary schools with SIV outreach has increased more than fivefold, while the number of KG/CCCs with SIV outreach has increased by 206.7%. As of 12 March 2019, the relative risk of KG/CCCs with SIV outreach influenza-like illness (ILI) outbreak compared with those without was 0.63 (95% CI 0.49-0.80; p=0.0002). For primary schools with SIV outreach, the relative risk of ILI outbreak was 0.48 (95% CI 0.35-0.65; p< 0.0001). These showed that significantly lower proportions of schools with outreach SIV encountered ILI outbreak. In view of high acceptance and effectiveness of SIV outreach programmes, the Government has decided to cover more primary schools / KG/CCCs starting from 2019-20.

Each year, influenza viruses circulate worldwide and are responsible for a considerable burden of medical visits, hospitalizations and deaths, especially at the extremes of age, among the very young and the very old. Older adults are more vulnerable to influenza illness and less likely to benefit from preventive measures such as influenza vaccination due to the increased prevalence of chronic medical conditions with age and the systemic degeneration of immune functioning, known as “immunosenescence”. Indeed, although influenza vaccines have been used since the 1940s and the World Health Organization (WHO) recommends vaccinating older adults, there is limited evidence on vaccine efficacy in this age group and numerous reports of lower immunogenicity and clinical vaccine effectiveness (VE) in older compared to younger and middle-aged adults. We consider two strategies that may overcome some of these challenges. I will discuss the potential for vaccinating older adults every 6 months, instead of every year. This would increase the likelihood that vaccine components would match circulating influenza viruses, and may be particularly valuable in subtropical or tropical areas where there are multiple epidemics each year or prolonged periods of influenza activity. In a randomized controlled trial, we found that twice annual vaccination did provide higher year-round antibody titers in the first year, when vaccine strains were unchanged. The trial is ongoing. Then I will discuss the potential for using enhanced influenza vaccines in older adults. Vaccines which include a higher antigen content, or are adjuvanted, generate stronger immune responses, and may provide prolonged protection, and broader protection against mismatched viruses. A randomized trial is now being conducted to examine in more detail the immune responses to enhanced vaccination in older adults in Hong Kong, including the use of these vaccines in alternating/combination strategies.

Seasonal Influenza Vaccination (SIV) is the most effective measure to build up one’s defense against influenza and to prevent its complications. The vaccine efficacy ranges from 60-80% depending on the closeness of the vaccination strains and the circulating strains. The Government of the HKSAR implemented the Government Vaccination Programme (GVP) by providing free or subsidized SIV and pneumococcal vaccination to eligible persons every year since 2009. Hospital Authority (HA) has also been supporting the GVP to provide the vaccination to the eligible groups, including Health Care Workers (HCWs).  SIV of HCWs constitutes a significant infection preventive measure. It protects both HCWs and patients by preventing onward transmission of influenza and to reduce the chance of outbreak occurrence in healthcare settings. However, the vaccination uptake rate of HCWs in HA remained low and unsatisfactory when compared to UK and the USA. In 2017/18, around 32% of HCWs in HA had received SIV; while 68.7% and 78.4% of HCWs in UK and the USA received it respectively.  Therefore, for the GVP 2018/19, HA determined to work proactively on new initiatives to encourage vaccination among HCWs. With the support from top management, multidisciplinary approaches were adopted. Infection control teams collaborated with various departments to launch a series of promotional activities. These promulgation strategies aimed to raise the awareness of the importance of SIV; rectify the myths; enhance the accessibility and to recognize the effort and creativity of colleagues responsible for the promotion. We saw a flamboyant display of all sorts of promulgation materials. As a result of these campaigns, the uptake rate of HCWs in HA increased significantly. In this session I will share with you the promulgation plans and the results.

Knee osteoarthritis (OA) is one of the most common degenerative diseases that cause disability in elderly people. An epidemiological study by Felson et al showed that about 30% of all adults have radiological signs of OA; 8.9% of the adult population has clinically significant OA of the knee or hip, of which knee OA was the most common type. The Chinese population has a similar prevalence rate. A nationwide population-based study in China showed an 8.1% total incidence rate of symptomatic knee OA and increasing prevalence of knee OA with age. It is estimated that the percentage of older adults in the Hong Kong population will increase from 16.6% in 2016 to 31.1% by 2036, and the prevalence of knee OA is expected to increase.  Although clinical guidelines for managing lower limb osteoarthritis (LLOA) in the primary care setting were proposed in Hong Kong in 2004, comparison with recently updated international guidelines shows some differences from management in Hong Kong. Therefore, it is of paramount importance to keep updating OA management guidelines so as to provide the best possible evidence-based management in the primary setting. This may help to delay progression into end-stage OA and thus decrease the need for arthroplasty and alleviate long waiting times (the average waiting time for arthroplasty in public hospitals in Hong Kong is 66 months). The aim of the presentation is to compare and contrast the LLOA management guidelines proposed in Hong Kong with international guidelines, including the Osteoarthritis Research Society International (OARSI), the American Academy of Orthopaedic Surgeons (AAOS), and the American College of Rheumatology (ACR). The author will present the recent update in the management of osteoarthritis. The importance of patient education, exercise and weight management in the osteoarthritis management will be emphasized. Various controversial areas, including the role of glucosamine and chondroitin supplements, intra-articular viscosupplementation injection, arthroscopy, and joint preservation and replacement surgeries, will also be discussed.  The present abstract based on an article prepared by the presenting author  HS Kan, PK Chan, KY Chiu et al. Non-surgical management of knee osteoarthritis. Hong Kong Medical Journal, 2019 Mar 28 | https://doi.org/10.12809/hkmj187600  

Conventional non-surgical management of knee osteoarthritis (OA) stresses on improving knee muscle strength and range of motion. However, the results may not be satisfactory. Recent studies show that neuromuscular training is the key to enhance knee control and functional limitations in patients with knee OA. Knee OA management programmes such as the Good life with osteoarthritis in Denmark (Gla:D) and Better management of patients with osteoarthritis (BOA) in Sweden are successful examples. The essential elements of neuromuscular training are: emphasis on quality of movement, knee joint control with normal biomechanics and muscle activation and postural control to perform functional activities.  Locally,  the Comprehensive Osteoarthritic ManagEment program (COME) of MacLehose Medical Rehabilitaion Centre commenced in January 2016, with 100 patients (30 males and 70 females with age 65.3±13.3 and 64.1±7.4 respectively) recruited and completed a three-month and one-year evaluation in February 2019. All patients had completed a six-week and 12-session intensive training programme, including neuromuscular control, muscle strengthening, flexibility and aerobic training.  There were statistically and clinically significant improvements (p<0.05) from (a) baseline  to (b) six weeks, (c) three months and (d) one year post training in the following (mean±SD): 1. One-minute chair test in repetitions – (a) 30.3±11.2, (b) 40.5±11.9, (c) 43.2±13.8 2. Stairs management in seconds – (a) 7.1±3.3, (b) 5.4±1.6, (c) 5.4±1.7 3. Pain in weight bearing movement – (a) 4.2±2.6, (b) 2.9±2.5, (c) 2.9±2.5, (d) 3.2±2.5 4. Patient specific functional score (PSFS) – (a) 3.1±2.1, (b) 6.6±1.8, (c) 6.9±1.7, (d) 6.9±1.7 The results are promising and there were no adverse events reported from the patients. It is recommended that neuromuscular exercise be the essential component in the non-surgical management of knee OA.

Osteoarthritis of the knee is a common degenerative disorder affecting the local population. The prevalence of knee osteoarthritis is 13% in female and 7% in male based on a local study. In end stage osteoarthritis, surgical intervention is warranted when conservative measures failed. High tibial osteotomy is a well-recognized surgical treatment for osteoarthritis of the knee. Osteoarthritis of the knee commonly affects the medial compartment, resulted in varus alignment of the lower extremity. In patients with isolated medial compartment osteoarthritis, osteotomy over the proximal tibia and realignment of the lower extremity to valgus alignment allows unloading of the diseased medial compartment. The mechanical axis shifted from medial to lateral, allowing the spared lateral compartment to bear the load, thus alleviate the knee pain. Traditionally, high tibial osteotomy is regarded as a buy time procedure to postpone knee replacement in younger patients with isolated medial compartment osteoarthritis. However, in properly selected patients, with meticulous surgical technique, recent studies revealed a favorable long term survivorship of this procedure. High tibial osteotomy may not be simply buying time, but a procedure able to achieve durable result.

  A knee joint is composed of three compartments – medial tibiofemoral, lateral tibiofemoral and patellofemoral joint. When end-stage degeneration affects either one of the compartments, the traditional surgical treatment is total knee replacement with a prosthesis which sacrifices the normal cruciate ligaments and also the other normal joint compartments. More than 95% of prosthesis was reported to survive longer than 10 years. However, about 20% of patients were not satisfied and complained about the abnormal feeling of the replaced knee.     Partial knee replacement is minimally invasive with smaller surgical incision, and more importantly, preserves normal bone, normal cruciate ligaments and normal knee function. The speed of recovery and rehabilitation is faster than the total knee counterpart. It’s, however, not suitable when degeneration affects all three compartments or the cruciate ligaments are ruptured. Isolated medial compartment osteoarthritis is the most common indication. Many international studies reported the good outcome of partial knee prosthesis in the medial compartment. In a particular model of prosthesis, Oxford Knee, because of the design of congruent articulation with mobile bearing, it was found to have good result even in over-weight and young patient with high activity level. This could survive up to 90% in 20 years. This disproves the old belief that partial knee replacement is used to buy time for definitive total knee replacement.   When disease only affect lateral or patellofemoral compartment of knee, partial replacement of either of these compartments is also possible, although with less frequent occurrence. It was found the longevity of lateral partial knee replacement is similar to medial counterpart from the international experience. As for the patellofemoral replacement, the implant survivorship is not as good, but it’s expected to improve with better patient selection and better development of prosthesis.

The first Joint Replacement Centre was set up in Hong Kong in December 2010 at Buddhist Hospital. Aim is to better manage growing demand, more efficient utilization of resources and ensure service quality and safety. It’s targeted to perform extra 500 arthroplasty surgery in Kowloon Central Cluster per year. During the first 5 years, we managed to reduce the surgery waiting time from 50 months to about 10 months. More Joint Replacement Centers are being set up in other clusters. However, as more people are aware of the benefits of joint replacement surgery, in term of pain control and functional improvement, and the population continues to aged, there is a three-fold increase in the waiting list in Hospital Authority from 7065 in 2011 to 21481 in 2018. Therefore, the challenge has become HA-wide.

Since its invention more than a half century ago, total joint replacement surgery has become one of the most successful surgeries in orthopaedics. With advancing techniques, patients at younger and older age are benefitted from this surgery. The advance in fast-track surgery is unstoppable with the popularity of local infiltrative analgesics, blood saving surgery and even out-patient surgery. Patient satisfaction has become one of the most important outcome measures, and new measuring tools such as the Forgotten Joint Score have emerged. Despite this, there are still 15-20% of patients dissatisfied with their surgery. One of the main goals of recent research and development in joint replacement surgery is to tackle the dissatisfaction, particularly in knee replacement. Dissatisfaction could be caused by surgical technique and implant design. The last decade search for a perfect mechanical alignment by the use of navigation in total knee replacement has met some twists and turns. Newer targets could be patient-specific “kinematic” alignment or a deliberate varus alignment and the use of robotics may help not just in navigation but also in execution. New researches on the kinematic of a normal and replaced knee have raised some interest on knee prostheses which are aimed to reproduce normal kinematics. Examples are medial pivot knee, ultra-congruent insert and bicruciate-retaining or bicruciate-stabilized knee. Since more young patients are receiving knee replacement, there are recent researches on cementless tibial monoblock which has been designed for better fixation and implant longevity. Dislocation in total hip replacement is always a concern. One area of research is in the direct anterior approach. Despite the concern of possible higher intraoperative complication rate, there is increasing popularity of such surgical approach, particularly in US. Another area of interest is the spinopelvic sagittal balance. The research on this makes some rethinking on the conventional “safe zone” in acetabular cup orientation. The use of robotics may also help putting the cup in an optimum position with fewer outliers. How all these new interests translate into clinical benefits remain to be seen in a longer term.

IntroductionPublic hospitals are facing increasing challenge in service demand; to relieve heavy workload of doctors and nurses and to enhance medication safety, Tseung Kwan O Hospital piloted Ward Pharmacist Service on a medical ward on 5th March 2018. Ward pharmacists would station on ward and manage drug-related issues throughout patient journey.ObjectivesTo reduce workload of frontline doctors and nurses, enhance pharmaceutical care and medication safety and improve overall service quality and efficiency of discharge process.MethodologyWard pharmacists would station on an acute medical ward Monday to Friday from 9:00am to 1:00pm. Upon patients’ admission, pharmacists would perform medication reconciliation and compile patients’ “Best Possible Medication History” by reviewing medical records and performing patient interview. Pharmacists would communicate with doctors and nurses if unintentional discrepancies were identified. During inpatient stay, pharmacists would review patient progress, verify IPMOE orders on ward and provide on-site clinical pharmacy support to doctors and nurses when needed. At discharge, pharmacists would assist doctors by preparing discharge prescriptions in advance in CMS for doctors’ endorsement so as to free up their time for other clinical activities. For prescriptions prepared directly by doctors, pharmacists would perform discharge medication reconciliation. Pharmacists would also provide bedside discharge counselling to patients.Results & OutcomeTill 31st December 2018, ward pharmacists served 201 half-days and reviewed 894 cases. Unintentional discrepancies and compliance problems were identified in 143 cases (16.0%) during admission medication reconciliation. Pharmacists prepared 173 discharge prescriptions (38.9%) out of 445 discharge cases handled during service hours. From the remaining 272 prescriptions prepared by doctors, pharmacists identified unintentional discrepancies and other drug-related problems in 96 cases (35.3%). Overall, pharmacists made 979 treatment recommendations and 928 (94.8%) of them were accepted by doctors. Among all the cases reviewed (n=894), pharmacists made recommendations for 366 (40.9%) of them. The service was well accepted by ward staff. Over 90% of them agreed that pharmacists can reduce unintentional discrepancies and save doctors’ and nurses’ time in discharge process. They also agreed that Ward Pharmacist Service should be extended to other wards. Ward pharmacists could enhance patient care by providing on-site clinical pharmacy support, reducing workload of doctors and nurses and improving medication safety by reducing unintentional discrepancies.  

IntroductionThe aging people and on time discharge minimized prolong hospitalization, in order to face with the increasing demand and complexity of wound care in Primary Health Care. Before 2009, there is lack of standardization on wound assessment, planning, training and referral system, resulting in unnecessary dressing frequency and heavy workload.ObjectivesTo provide safe and effective wound care in primary health care.MethodologyA structural referral system was launched in 2009, from frontline to wound specialist which frontline nurses are responsible for screening and assessment. Wound link nurse in each clinic would devise a wound management plan and monitor the progress on healing. Wound specialist would initiate advanced investigations and interventions when healing is delayed. Knowledge & skill transfer like wound information update via Department Intranet, Wound Assessment Quick Guide and new wound products sharing class can facilitate frontline staff to tackle the wound problems. Through patient empowerment program (Leg Club and Walk with Diabetes - Foot Care), and a series of poster and educational pamphlet on burn & scald care, varicose, fallacies of wound care and ingrown toe nail care, etc. can arouse the awareness on patient immediate care on wound. Also local Evidence Based Studies on wound pain control and wound shower could build up the confidence on both patients and nursing staff. Results & OutcomeThe statistical dressing attendance in General Out-patient Clinic was dramatically drop around 25.2%, from 85536 in 2008 to 63999 in 2018. However, the numbers of patient were increased around 17.6% from 15802 to 18582 respectively. The healing rate on leg ulcer, burn & scald and traumatic wound have 30-50% speed up. Statistically showed that even increasing service capacity and without any extra nursing manpower and clinic space, the performance on wound care can be effectively delivered. The well establish referral system is getting efficient in wound management. Wound Clinic can provide continuity & safety care by close monitoring and enhanced service quality of wound care in community by early detection and proactive therapeutic nursing intervention and empowerment.   

IntroductionWorking in geriatric extended care wards, occupational therapists usually come across patients with wide range of medical conditions. Bell et. al. (2016) summarized in their study that the prevalence of geriatric syndromes of hospitalized patients referred to skilled nursing facility was 90%, of which 55% got ≥3 co-existing syndromes. Labella et. Al. (2011) highlighted the importance of improving the care by screening elderly patients for the presence of common geriatric syndromes. In order to provide a better quality of care, utilization of a clinical pathway that facilitating early screening and intervention of geriatric syndrome, would enhance rehabilitation outcomes in a cost-effective way. This paper reported the development of an OT clinical practice guide that facilitating recovery and discharge of elderly patients in extended care wards. Objectives1. To understand and learn the different geriatric syndromes, by review of evidence, which could lead to serious complication and highly impact on patients’ recovery during hospitalization. 2. Develop a comprehensive OT clinical pathway for early identification and intervention of geriatric syndromes 3. Pilot study in 2 geri-medical wards in KH to see the severity of the geriatric symptoms of the cases 4. Enhance clinical use of the pathway by in-services training, and then followed by further comprehensive research MethodologyOct-Dec 2018 Literature Review Jan 2018 Finalize the clinical pathway Feb 2018 Pilot study in 5 extended care wards of KH April 2018 In-services trainingResults & OutcomeThe OT clinical practice pathway outlined the therapists’ clinical tasks, assessment, intervention and precaution that beginning from the admission phase, the rehabilitation phase to the final pre-discharge phase. The content was disease specific and also with emphasis on early screening and intervention of the common geriatric symptoms including, falls, pressure sores, delirium, depressive symptoms and functional decline. Liaison work to enhance multi-disciplinary input was also the focus of the clinical pathway. After the development of the clinical pathway and the pilot study, related in-services training will be conducted to all the OT colleagues in the department. The clinical pathway will be commenced to be utilized in geriatric patients of extended wards of different specialties including orthopaedic, spinal, RMD and medical geriatrics. The information collected will be as a reference for further comprehensive retrospective study.   

IntroductionLiterature revealed that additional weekend and holiday Physiotherapy(PT) training is effective to improve functional recovery and reduce hospital length of stay in some patient groups. Strategic Service Framework(SSF) for Rehabilitation Services by Hospital Authority(HA) also stated the direction in providing rehabilitation service 7 day per week in selected patient group. One acute and one rehabilitation hospital in New Territories East Cluster(NTEC) launched the 7 day per week PT service for Geriatric Hip Fracture patients since 1st October 2017.ObjectivesTo test the hypothesis that additional weekend and holiday PT training in in-patient phase might speed up the rehabilitation process for geriatric hip fracture patients.MethodologyWith a retrospective case-control study design, 355 geriatric hip fracture patients’ medical records were analyzed. Patients admitted Tai Po Hospital(TPH) in October 2017 to March 2018 were assigned as study group while patients admitted TPH in October 2016 to March 2017 were assigned as control group. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Category(MFAC), Elderly Mobility Scale(EMS), Modified Barthel Index(MBI) and length of hospital stay.Results & Outcome[Data shown in (study group vs control group) in mean±SD] For patients from acute hospital with 7 day per week PT training, better MFAC (3.17±1.05 vs 3.05±1.254,p=0.015) and MBI (47.35±19.63 vs 42.99±20.02,p=0.042), similar EMS (3.81±3.03 vs 3.96±3.65,p=0.518) were observed with similar post-operative acute hospital stay(7.69±3.87 vs 7.41±5.03 days,p=0.192). A higher percentage of day having PT training during rehab hospital stay was shown with the implementation of new service(89.1% vs 65.9%). Comparable mobility status at discharge was demonstrated by similar functional outcomes, in MFAC (4.35±1.27 vs 4.25±1.61, p=0.788), EMS (8.19±5.45 vs 8.44±6.06, p=0.998) and MBI (63.00±23.43 vs 61.17±26.08, p=0.743) with a significant shorter rehab hospital stay(19.99±5.51 vs 24.26±9.86 days, p=0.000) in patients with 7 days per week PT training. To conclude, additional weekend and holiday PT training is effective to improve functional recovery and reduce hospital length of stay for geriatric hip fracture patients.  

IntroductionCancer-rated fatigue is the most commonly reported treatment-related side effect from chemotherapy. Such symptom can be very distressing and frustrating that affect mentally, physically, emotionally and spiritually, leading to reduced physical activity, social engagement and quality of life in cancer patients. Physiotherapy plays a crucial role in the management of fatigue symptoms. Exercises in correct dosage of intensity and method enable cancer patients to increase their physical activity, reduce fatigue and improve the functional status. However, majority of the cancer patients did not notice the causal relationship between exercise and fatigue and prone to remain physically inactive and exercise less. ObjectivesTo evaluate the effectiveness of Physiotherapy Fatigue Management Program on (1) promoting knowledge of cancer-related fatigue, (2) enhancing exercise habit and physical activity, and (3) improving symptom of fatigue and quality of life in cancer patients receiving chemotherapy.MethodologyPatients who were diagnosed of cancer and underwent chemotherapy that joined the Physiotherapy Fatigue Management Program from 1 April to 30 September 2018 were analyzed. The Program included both educational and exercise components. All patients were educated on knowledge and self-management tips about cancer-related fatigue and supplemented by an educational booklet with photos illustration on home exercise program and exercise log book. The exercise component included a multidimensional program that comprised of relaxation exercise, active limb mobilization exercise, aerobic exercise, strengthening exercise and acu-point massage. Participants were advised to exercise daily and record down their compliance in the exercise log book. Outcome measures included (1) questionnaire on fatigue knowledge, (2) Brief Fatigue Index (BFI-T) to measure severity and impact of fatigue, (4) Functional Assessment of Cancer Therapy – Fatigue (FACT-F) to measure quality of life. Evaluations were done at baseline and immediately upon completion of chemotherapy. Telephone follow-ups were conducted at 1-week and 2-month post-chemotherapy to check for exercise compliance and positive reinforcement was provided if participants come across any barriers. Results & OutcomeTwenty patients, aged ranged from 45 to 76 years old, were analyzed. Majority of them suffered from cancer in colorectal (60%), lung (15%), cervix (10%), lymphoma (10%), and small bowel (5%). Improvements were shown for all the outcome measures. At baseline, only 5% of the participants knew what was cancer-related fatigue and the related non-pharmacological management approach. On completion of education training, all participants (100%) showed understanding on the causal relationship between exercise and fatigue. At 1-week follow-up, 75% of the participants reported exercise of at least 150 hours per week. At 2-month follow-up, both the BFI-T score and FACT-F scores were significantly improved and higher (p< 0.05) in this group of participants as compared with those exercise less than 150 hours per week. Physiotherapy Fatigue Management Program was effective on promoting knowledge, enhancing physical activity and exercise habit, and reducing cancer-related fatigue and improving quality of life in cancer patients receiving chemotherapy.   

IntroductionA patient registry is a database of patients, which includes personal information, clinical information and/or information on complications, collected in a systematic and comprehensive way. It is a valuable tool for providing a real-world view of clinical practice, patient outcomes, safety and effectiveness. However, there is yet to be a patient registry of Orthopaedic Spinal interventions in Hong Kong.Objectives(1) To establish a cross-hospital patient registry for spine surgeries, with cervical myelopathy as the pilot pathology; (2) To review surgical varieties; (3) To review clinical outcomes and surgical complications; (4) To initiate multi-hospitals participation. Local database provides clinical information to patients regarding the surgical options, likely outcome and chance of complications. By comparing with overseas data, we understand our performance and improve our clinical care if necessary.MethodologyA patient registry was developed among Queen Elizabeth Hospital, Queen Mary Hospital, Tuen Mun Hospital and United Christian Hospital. All patients with cervical myelopathy in the sub-axial levels (from C2/3 to C7/T1) treated surgically from 01 May 2017 were input into a computer system solely developed for the registry. Exclusion criteria include myelopathy contributed by pathology above C2/3; trauma history within 1 year; infection; tumour and concomitant cervical radiculopathy. Patient demographics, clinical information, surgical procedures, complications and outcomes were recorded.Results & OutcomeFrom May 2017 to Dec 2018, there were 181 patients included in the registry. One hundred and eighteen patients were male and 63 were female. The mean age at surgery was 63 (range, 30 - 88 years). Anterior procedures were performed on 36 patients; 143 patients received posterior procedures and 2 patients received combined approach procedures. The Hong Kong Spine Surgery Registry – Cervical Myelopathy is a pilot registry programme and was effective to collect clinical information, to understand variations in current treatment practices and to collect longitudinal follow-up data on clinical outcomes. This demonstrates that multi-centre clinical outcome database is achievable in Hong Kong and this registry can function as a model.  

IntroductionPhysiotherapy to patients with Total Knee Arthroplasty (TKA) has been extended to daily service in Queen Mary Hospital since 1st Oct 2017 .ObjectivesWe sought to evaluate the 365-day physiotherapy service to TKA patients by analyzing the Hospital Length of Stay (LOS). Timed-up & go test (TUGT), Active Range of Motion (AROM) and Lower Extremity Functional Scale (LEFS).MethodologyPatients with primary unilateral TKA performed between 1 October 2016 and 31 September 2018 who were directly discharged home from Queen Mary Hospital were reviewed. They were divided into 2 groups: before (Pre-365 group) and after the daily physiotherapy service started (365 group). LOS, TUGT, AROM and LEFS were compared.Results & OutcomeThere were 80 patients in Pre-365 group and 81 patients in 365 group. Baseline assessment of both groups was similar. The LOS of Pre-365 group was 7.7 ± 2.0 days and 365 group was 6.6 ± 1.7 days. The difference between the two groups was statistically significant (p=0.001). The TUGT upon discharge for 365 group (33.3 ± 15.7 seconds) was statistically lower than that of Pre-365 groups (43.5 ± 28.1 seconds) (p=0.01). The TUGT on 2 weeks after the operation for 365 group (22.2 ± 12.7 seconds) was also found to be statistically lower than that of the pre-365 group (29.1 ± 21.7 seconds)(p=0.024). Both LEFS and AROM were similar and no statistical significant differences were found in both groups. The enhancement in provision of physiotherapy service was associated with the improvement in the mobility of patient (TUGT upon discharge and 2 weeks after the operation) and shortening of hospital LOS. This echoed with previous studies which had found that increasing therapy dose was effective in reducing LOS and improving patient outcomes. In conclusion, the service enhancement was effective in managing patients with TKA.  

‘Aging in place’ is about providing the necessary resources for older adults to remain in their own homes and communities safely and independently.  It is generally agreed that Chinese people prefer to continue living in a familiar environment with the support of their families as they age.  Policy makers and professionals have therefore placed great emphasis on conceptualizing aging in place as an attainable and worthwhile goal.  Over the years, an ecological model of aging has been used to conceptualize the policy agenda.  Improving the physical-spatial-technical environment to enable aging in place have been widely studied and publicized.  New partnerships and collaborations required to fund and maintain the aging in place agenda, such as private foundations, research institutes, health services organizations and technology companies are also developing rapidly in recent years. Yet, various local studies have found that traditional Chinese culture has been sapped, posing challenges to familial care for the elderly people.  Coupled with the lack of adequate support for family caregivers, this has presented a great challenge on realizing the aging in place agenda.  On the other hand, while technological devices and systems hold considerable promise in assisting a growing older population to age in place, there are a number of challenges that must be addressed before such technologies are fully developed, evaluated and disseminated.  These include the limited evidence base, economic barriers and the need to address older people’s sensory, cognitive and ergonomic challenges in the design and operation of such devices.  More importantly, successful use of technology to realize the aging in place agenda has to be backed up by well planned community care co-ordination services, such as home nursing and rehabilitative support programmes.  However, such support services has not been adequately planned and delivered.  More concerted multi-disciplinary efforts in enabling our older people to live with dignity and safety in the place they choose are required.

Ageing in place is not only a policy target of the HKSAR Government, but also the desire of many elderly people. In the recently completed Elderly Services Programme Plan, the government pledged to provide more community support services to elderly people to enable them to live in the community instead of moving into institutions unnecessarily. At the same time, there were new attempts to maintain the health of elderly people and reduce the caring burden of their carers through medical-social collaboration. A recent example was the Dementia Community Support Scheme jointly launched by the Food and Health Bureau, Social Welfare Department and the welfare sector. This presentation will introduce how technology could be employed to facilitate ageing in place, and illustrate how medical and social sectors can make use of technologies to enhance the effectiveness of their interventions. Some local and overseas examples will be quoted to demonstrate how technology could facilitate health management, early detection and intervention, and self-management, etc. New initiatives of the HKCSS will also be highlighted.

In face of the rapid ageing population, the Hong Kong Government has formulated her policy in its well-stated statement “Ageing in Place as the Core, Institutional Care as the Backup”. Studies has confirmed that senior people in Hong Kong prefer to age at their homes and familiar communities. Even though the government has invested huge resources on the provision of health and welfare services for the implementation of her policy, she is silent on the housing aspect. Hong Kong Housing Society, as a housing laboratory, has piloted various housing schemes to help seniors fulfil their dreams to age at their preferred environment. In the past 20 years, various housing schemes for the lower income groups, middle income groups and higher income groups have been implemented. Studies of the University of Hong Kong have confirmed the positive results of these housing schemes, for example, in its AIP scheme, it effectively achieved reduction in intention for institutional care, falls, use of A&E services and percentage of older people with depressive symptoms, and increase in satisfaction with living environment, utilization of community care services, participation in social activities, and subjective social support and percentage of elders with unimpaired cognitive performance. To convert these effectiveness in monetary term, the AIP scheme and the SEN scheme have generated $4.83 and $5.07 respectively in return for every dollar invested from its SROI assessment.

Diseases affecting the brain is the commonest reason for preventing aging in place. Commonest brain diseases associated with institutionalization are Alzheimer’s and cerebrovascular diseases (stroke, small vessel disease), degenerative (idiopathic Parkinson’s disease) and vascular (small vessel disease) types of parkinsonism. Other important factors affecting aging in place include availability and capacity of caregivers (e.g. spouse, children, domestic helper).  In this lecture, a clinical road map of enhancing aging in place will be discussed. In brief, the clinical road map includes early detection and early intervention, as well as continuous investment in research for development of simple yet accurate diagnostics and disease modifying therapies. On another front, strategy and support network that can empower informal caregivers in caring for the diseased elderly at home is also important. Achieving longevity with health and dignity requires collaborative effort from the whole society.

Doctors need to be personally competent but most doctors today work in teams, certainly in hospital care, and what patients really need is not just competent doctors but well-functioning teams. This can be a challenge for doctors who, historically, have often been selected on attributes which reflect single mindedness, perfectionism and personal achievement, often in competition with others. Indeed, during undergraduate medical education, students are often encouraged to directly compete with their peers and after medical school, obtaining the best posts and passing postgraduate exams is perceived as more about personal endeavour than teamwork. Teamwork is more than technical ability – this is a necessary but not a sufficient condition. For example, an operating theatre team need to be as efficient and competent as the team who refuel a Ferrari in Formula 1 but in medicine it is also about broader capabilities such as empathy and compassion.  Why does this matter so much? Evidence shows that the public want caring and listening teams despite the pressures, demands, expectations and lack of time of a busy service. The Francis report into the excess number of deaths of elderly patients at Mid Staffordshire Hospital emphasised that because we all work in teams, we cannot practise in ‘silos’ – we cannot walk past a patient in distress with the attitude that this is not my patient or their basic needs are the responsibility of other team members. Teams need good leaders who lead by example – in most healthcare systems, doctors still provide the bulk of clinical leadership if not managerial leadership. Just as in sports, in healthcare “teams that work together must train together” so interprofessional learning is important, for example in simulations. Good teams train together to be competent but also to observe the four C’s of excellent care: candour, compassion, communication and the team respects confidentiality, sharing information on a ‘need to know basis’. This plenary will explore these concepts and there will be an opportunity for questions.  

The new 1800-bed Woodlands Health Campus (WHC) is the latest healthcare development in Singapore, comprises an integrated acute and community hospital, specialist outpatient clinics, and long-term care facilities. To meet the needs of one of the fastest aging populations in the world compounded by increasing complex health and care coordination issues as well as rising public expectations, WHC set out to break new ground by re-defining the role of the hospital, from being siloed care provider into a vital hub of health ecosystem that integrates hospital with the community.   The design journey started with ethnographic study to understand the local community, and unearth their motivation and aspirations. These insights are fundamental in formulating both the care delivery strategy and the design vision of the campus. Embracing salutogenic design, the campus is positioned as a community asset to inspire healthy lifestyle and influence positive behaviour change through its placemaking and active design strategy. Person-centred medical planning has been the key enabler for seamless transition of care from setting to setting, minimizing transfer and unnecessary movement while empowering patients to self-care. Collaboration with multiple national agencies in seamlessly integrating the campus with the adjacent parkland was a key enabler in actualizing person-centred master plan. Inspired by the tropic rainforest, the campus and parkland were designed as one holistic place for healing  with different levels of intimacy and experience for both the patients and the community.

Many factors contribute to the wellness and sustainability of our people and our environments, including culture, community, lifestyle and design. The contemporary hospital’s place in our communities reaches past the confines of single-use, isolated institutions with finite lifespans. Hospitals are rapidly evolving into place-based, mixed-use facilities embedded into their environmental and social ecosystems, possessing both the opportunity and the responsibility to become community hubs for sustainable living. As architects, addressing this sea change requires a three-pronged approach to sustainability, weighing the environmental impacts alongside the economic and social aspects.   Environmental sustainability is the most urgent and clearly-defined tenet – has the design reduced or eliminated its effect on the environment?  A sustainable hospital is one which stands the test of time through quality materials, technology and construction practices, whilst moving flexibly into the future through adaptable functional design which can be reconfigured, repurposed or recycled over time.  Hospitals also need to demonstrate fiscal responsibility in capital and whole-of life costs as well as material procurement practices. However, economic sustainability extends far beyond the project budget - it considers the hospital’s role in providing care to all segments of society, elevating quality of life for all which, in turn, directly impacts the health of the community. When people are healthy the economy is healthy.  Socially sustainable design represents our responsibility to design for the poorest and most vulnerable, the youngest and the oldest. Sustainability, through this lens, involves the creation of ‘places’ with a sense of physical and emotional security, accessibility, opportunity and well-being; providing what each member of our community requires to live a meaningful and fulfilling life. Drawing from B+H’s international healthcare work, this presentation will examine and present examples of sustainability from the environmental, social and economic dimensions. Passive design strategies, such as naturally ventilated wards, photovoltaic panels, green roofs, and passive shading/cooling, will demonstrate how buildings can give back more than they take from their environments while reducing lifecycle costs. Socially, we will present new typologies that reintegrate recovering patients back into their communities by reimagining the traditional six-bed ward into a homelike environment that empowers elderly patients to make a return to independent living. Through these precedents we will demonstrate how sustainable healthcare design and planning can influence the wellness of a society through the creation of durable and socially responsive hospitals that form the bedrock of our communities. 

Myopia, or near-sightedness, is an ocular condition where there is a mismatch between the optical power and length of the eye. The combined optical power of the eye is too strong for its corresponding axial length, causing incoming light to focus in front of the retina. The most common form worldwide is secondary to elongation of the axial length of the eye, termed axial myopia. Myopia is the most common ocular disorder. It affects 20-50% of the population over 12 years of age in the United Stated. The prevalence is even higher in Asian, such as Singapore and Hong Kong. Recent evidence is pointing towards an increasing prevalence of myopia. Currently, the underlying mechanism for myopia development and progression remains unclear, however it is understood that the resultant axial length is determined by a complex interplay between individual genetics and environment. Outdoor activity was protective against myopic progression, while near-work activity had a detrimental effect, even adjusted for parental myopia and ethnicity. In addition, the associated increased axial length increases the risk of eye diseases, including presenile cataract, retinal detachment, myopic retinopathy and glaucoma. Myopia has been implicated as the sixth leading cause of visual loss. The importance of myopia should not be underestimated.

Myopia is in epidemic proportion in China and many Asian cities. The prevalence of myopia is well beyond 80% in these cities. Since high myopia increases the risk of sight-threatening diseases such as glaucoma, retinal degeneration and detachments, it is important to decrease the prevalence of myopia and in particular the high myopia population. In fact, China has identified myopia as a national concern in 2018 and different ministries are joining hands in leading major initiatives to combat myopia in China. From animal studies, we now know that eye growth is modulated by optical inputs received during the early developmental phase. Apparently, optically defocused images formed behind the eye (called hyperopic defocus) would accelerate eye growth; whereas defocused image formed in front (called myopic defocus) would slow down eye growth. This feedback mechanism is universal in many different animal species. In addition, our studies have shown that the eye can integrate simultaneously presented optical defocus and that myopic defocus is a power stop signal to eye growth. Using the principle, we have attempted to incorporate and project myopic defocus in novel optical devices for controlling myopia progression in children. The Centre for Myopia Research of the PolyU has successfully produced special contact lenses as well as spectacle lenses that have incorporated myopic defocus for myopia control. They are Defocus Incorporated Soft Contact lenses (DISC) and Defocus Incorporated Multiple Segments (DIMS) spectacle lenses. Randomised control clinical trials have been conducted in schoolchildren using these lenses and they have shown to effectively slow down the myopia progression by 60%. These new optical devices could significantly decrease the high myopia population and will be useful in controlling myopia in children clinically. Acknowledgement: The research was supported by the Edwin Leong Endowed Professorship, and industrial grants from Hoya Lens Ltd (H-ZG3B; H-ZG5N); Dean Reserve Fund (1-ZVN2), RGC/GRF PolyU 151033/15M; PolyU 151051/17M.

Orthokeratology involves the use of a specially designed contact lens to correct myopia. This treatment is popular among children since it could provide good vision without glasses during daytime. However, there could be chance of infection if the lens is handled improperly. Cases of severe infection leading to irreversible damage to vision has been reported. Parents considering using this lens should be aware of the risks.

Myopia is a global health threat. By year 2025, it is predicted approximately 50% and 10% of world’s population being myopic and highly myopic respectively. Notably, high myopia is associated with sight-threatening complications, including pre-senile cataract, glaucoma, retinal detachment, and choroidal neovascularization etc. Effective methods for myopia control is important. In this lecture, the author will present his works on Low-concentration Atropine for Myopia Progression (LAMP) Study. Purpose: Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy and optimal concentration remained uncertain. Our study aimed to evaluate the efficacy and safety of low-concentration atropine eye drops at 0.05%, 0.025%, and 0.01% compared with placebo over a one-year period. Design: Randomized, placebo-controlled, double-masked trial. Participants: 438 children aged 4-12 years with myopia of at least -1.0 diopter (D) and astigmatism of -2.5D or less. Intervention: Subjects were randomly assigned in a 1:1:1:1 ratio to receive 0.05%, 0.025% and 0.01% atropine, or placebo eye drop, respectively, once nightly to both eyes for one year. Cycloplegic refraction, axial length, accommodation amplitude, pupil diameter, and best-corrected visual acuity were documented measured at baseline, 2 weeks, 4 months, 8 months, and 12 months. Visual function questionnaire CHI-VFQ-25 was administered at the one-year visit. Main outcome measures: Changes in spherical equivalent (SE) and axial length (AL) were measured, and their differences among groups were compared using generalized estimating equation. Results: After one year, the mean SE change was -0.27±0.61D, -0.46±0.45D, -0.59±0.61D, and -0.81±0.53D, in the atropine 0.05%, 0.025%, 0.01%, and placebo groups, respectively (P < 0.001), with respective mean increase in AL at 0.20±0.25mm, 0.29±0.20mm, 0.36±0.29mm and 0.41±0.22mm (P < 0.001). The accommodation amplitude was reduced by 1.98±2.82D, 1.61±2.61D, 0.26±3.04 D, and 0.32±2.91D, respectively (P < 0.001). The There was an increase in the pupil sizes under photopic and mesopic conditions were increased respectively by in the treatment groups (1.03±1.02mm and 0.58±0.63mm in 0.05% atropine, 0.76±0.90mm and 0.43±0.61mm in 0.025% atropine, and 0.49±0.80mm and 0.23±0.46mm in 0.01% atropine), and 0.13±1.07mm and 0.02±0.55mm compared with minimal change in the placebo group (P < 0.001). Distant or near visual acuity; and vision-related quality of life was not affected in each group. Vision-related quality of life was similar between groups. Conclusions: The 0.05%, 0.025% and 0.01% atropine eye drops could reduce myopia progression along a concentration-related dependent response. All concentrations were well tolerated without adverse effect on vision-related quality of life. Of the three concentrations used, 0.05% atropine was more most effective in controlling myopia SE progression and AL elongation over a period of one year.

In the past decade, 3D printing technologies were widely applied to the medical services by the medical service providers. The technologies provide more details and accurate information to the surgical team in order to prepare the pre-operative planning before surgery. In addition, 3D printing technologies allow the team to design and make the patient specific instrument (PSI) and the anatomical models by using the patient’s imaging files --- DICOM files which are acquired through CT or MRI. The well prepared surgical plan, the PSI and anatomical models can lead to more accurate surgical result and reduce patient’s health risk during surgery, such as reduce the invasive imaging exposure, reduce the analgesic time and blood lost, etc. It is expected that the time needs for rehabilitation can be shorten and patient’s physical function after surgery could be improved earlier. P&O colleagues paid an important role to assist the surgeon to design the pre-operative planning and patient specific instruments by applying our knowledge in 3D printing as well as in biomedical engineering. For the last few years, some surgeries acquired an amazing results by using the 3D printing techniques. On the other hand, Prosthetist and Orthotist also apply the 3D printing technologies in P&O service. The services include to design and 3D print the tailor-made functional partial hand prosthesis and different kinds of orthoses. In this opportunity, I would like to share our experiences in 3D printing to different specialists and other healthcare professions.

Technology is a common element in our everyday lives. The goal of occupational therapy is to enhance or enable meaningful participation in the occupations (activities) important to the clients served. Occupational Therapist prescribes assistive technology device to increase, maintain, or improve the functional capabilities of individuals with disabilities. Ultra-bag Connecting Device (UC Device) was first invented and developed in 2006 through the conjoint effort of the Occupational Therapy Department and the Renal Team of United Christian Hospital (UCH). The device helps renal patients with impairment in eye hand function to perform Self-continuous ambulatory peritoneal dialysis (CAPD) in a safe and independent way. With the guidance of UC device, patients with hand tremor and visual impairment can perform continuous ambulatory peritoneal dialysis (CAPD) with lower risk of contamination. It also promotes the better quality of life, increase the independency of patient and hence reduce caregiver stress and burden. Until now, there were over 200 patients in Hong Kong benefit from UC Device and the device was widely recognized among health care professionals. UC Device was awarded Excellent Award in Asia Hospital Management Awards 2013 and the device was widely reported by press on 4/2013. Since 2017, UCH Occupational Therapy Department has applied 3D printing technology in renal device fabrication. The digital model of the UC device is created with computer aided design (CAD) software. Different parts of subsets were then 3D printed with dual extruder and 100-micron layer resolution using Polylactic acid (PLA) filaments. With the assistance of 3D technologies, the renal devices can be fabricated more accurate and precise, also less expensive and less manpower required. In the future, more new renal devices can be invented to apply in different dialysis systems and benefit more patients. With the rapid development of 3D printing technology, it can promote more new creative assistive device invention to serve our patient needs.

The steady increase in the incidence of geriatric hip fracture places an increasing burden on health care service in Hong Kong. Post fracture limitations are prominent and restrain many of the elderly from returning to community, rehabilitation is therefore important for reducing their long-term disability. By integrating the results from pilot application of video guided training and tele-physiotherapy program in different phases of rehabilitation, a Mobile Application (app) is developed aiming to improve hip fracture patients’ and their carers’ experience throughout the healthcare journey and empower them to manage their own health. A steering group comprised of physiotherapists, informatics and university research expert is formed to co-design the app, compose education content and formulate the promulgation and evaluation strategies. Meetings are also held with all involved clinicians to refine the app before implementation. This app provides features for hip fracture rehabilitation including "Understanding Hip Fracture", "Hip Fracture Care", "Training" and "Companion". Patients and their carers can obtain hip fracture care related information through the app anywhere, anytime, instead of coming to the clinics in person or reading the information on pamphlets. Physiotherapists can use the app to set training program for discharged patients with “Push Reminder” function and training record can be saved in “Progress Summary”, which facilitates them and carers to get a grip on the patients’ rehabilitation progress. Besides monitoring the download rate, a cohort study will be conducted to evaluate the effectiveness of the app from different perspectives, including the users’ acceptance and satisfaction, patients’ program compliance and functional recovery. The process and findings learnt from this project may also provide additional information for the development of the corporate “Rehab” app, which is going to be launched in late 2019.

Radioactive iodine therapy (RAI) using a high dose of I-131 (3 or 5.5 GBq) is an effective regime to eradicate or ablate any remnant cancerous thyroid tissues after surgery or thyroid cancer which has metastasized. Hong Kong radiation regulations mandate that a patient with radioactivity of higher than 0.4 GBq of I-131 has to be hospitalized. In practice, these radioactive patients are isolated individually in radiation-shielded isolation rooms in a cancer ward until their remaining radioactivity falls below 0.4 GBq. Normally, for a dose of say, 3 GBq, it may take a couple of days for the body to excrete the excess iodine to below the quarantine level. A physicist is usually called to the ward and perform an external dose rate measurement to try to ensure the residual radioactivity to be below discharge level using a handheld radiation monitor, measuring at 1 meter from the patient. This procedure may need to be repeated if the current measured radiation level exceeded the patient discharge threshold. In this project, the cumbersome manual approach was replaced with an in-house developed automated method by mounting a wireless radiation monitor on a wall and ask the patient to stand on a footmark on the floor at 1 meter and radiation data acquired automatically with a WiFi-connected mobile phone (with an in-house app installed). A print-to-discharge button will only be enabled when the measured radioactivity is below 20 micro-sieverts per hour, which approximately equates to 0.4 GBq of I-131 in an average patient. Radiation exposure to the physicist is minimized since he/she no longer needs to enter the isolation room when the measurement can be obtained outside through Wi-Fi. This system started to go clinical in Queen Mary Hospital??s clinical oncology ward in September 2015. The advantages of this new system of radioactive patient discharge can be enhanced if ward nurses use it to discharge patients in non-office hours including weekends and bank holidays when physicists are not available on site.

Rapid multiplex real-time polymerase chain reaction (PCR) is an all-in-one real-time pathogen detection method that integrates sample preparation, amplification, detection and analysis. It can simultaneously detect multiple targeted pathogens in a run. The system requires shorter laboratory processing time in comparing to the routine real-time PCR method and it has significantly shorter turn-a-round time than the traditional culturing method. In Queen Mary Hospital, two rapid multiplex PCR systems (Cepheid GeneXpert and BioFire FilmArray) have been installed in 2017 for rapid detection of pathogens causing emerging infectious diseases (e.g. Mycobacterium tuberculosis, respiratory viruses including MERS Coronavirus) and multi-drug resistant bacteria (e.g. MRSA, CPE, VRE) causing nosocomial infections in hospitals. During the recent influenza surge periods, the systems were also extensively used for rapid seasonal flu detection. By comparing the rapid multiplex PCR system with the routine real-time PCR method, the laboratory processing time in the laboratory can be significantly shortened from 5 hours to 1 hour for seasonal influenza virus and MERS coronavirus detection. Recent studies have shown that the introduction of rapid PCR can significantly reduce 21.5 hours of hospital stay in median among patients with positive rapid viral PCR testing results and significantly reduce the airborne infection isolation (AII) duration from 68.0 to 20.8 hours in comparing to the use of conventional smear microscopy for mycobacteria infection. This method can have positive effect to the control of medical inpatient bed occupancy rate. It can also improve the hospital infection control by reducing the risk of pathogen transmission. The rapid multiplex PCR is quick and simple to handle. Although the use of rapid multiplex PCR system will increase the laboratory running cost, the shortened turn-a-round time can significantly improve patient care. In conclusion, the introduction of rapid multiplex real-time PCR for diagnosis of emerging infectious diseases is highly recommended in public hospitals in Hong Kong.

IntroductionFalls are serious cause of morbidity and costs, especially in Cancer Palliative Care. Most patients with these incurable diseases were aged, terminally-ill and highly stressful. Patients with bone metastasis or brain metastasis were extremely high risk. Cancer patients could suffer from more immense consequences of physical injuries, fractures, post-fall syndrome and functional decline. It was also followed by prolonged hospital stays, follow-up investigations and treatments; consequently, it increased the costs and risks significantly in health care system. To take comprehensive preventive measures, 5S-Strategy was launched. ObjectivesTo reduce fall rate To minimize prolong hospital stay due to fall To enhance staff engagement To foster safety culture MethodologySystems Universal screening was performed for all patients upon admissions. The individual needs of screened patients would be addressed, such as assisted toileting round, morning warm water round, providing non-skid slippers, alarm pad and yellow vest, keeping bed at low level, and providing anti-slippery spray. All these rounds aimed at improving the observation level and preventing high risk activities for example toileting and filling warm water. Strategy Post-fall incident investigation of each fall is a necessary component and must indicate how a client was assessed and the specific strategies implemented for that patient to prevent further falls. The results for every new operation would be documented and announced. Shared Values High-risk patients and their relatives would be engaged through face-to-face discussions or phone call. Education would be given and consensus would be gained to achieve mutual understanding. When patients, relatives and clinicians had the same shared values and goals, patients would comply with instructions from the ward. Staff Multidisciplinary approaches, including physicians, nurses, physiotherapists, occupational therapists, were involved in the fall program. Repeated assessments would be conducted as conditions of cancer patients would deteriorate suddenly. Multidisciplinary approaches with repeated assessments can provide a quick response to change of conditions and timely prevention can be taken in advance. Skills Supporting staff was trained as the eyes of clinicians. Two workshops were provided by nurses annually. In each shift, supporting staff would be informed of the patients with high risks. As supporting staff had a high intensity of interaction with patients, they were able to enhance the observation level and provide assistance. Results & OutcomeThe fall rate decreased from 10.04 cases per 1000 episodes in 2012/13 to 4.89 cases per 1000 episodes in 2017/18. Causes of falls are multiple and hard to prevent all of them. The preventive measures should be from different angles and implemented by different people.   

IntroductionCertain types of syrup medications, especially antibiotics, are freshly reconstituted in pharmacy upon receipt of prescriptions from physicians. Under previous practice, the use-before dates are manually calculated and filled on drug labels by dispensers after reconstitution. Auxiliary labels of “Refrigerate” are also stuck accordingly if appropriate. Information is thus checked by another dispenser and then pharmacist before issuing. Although there are information charts assisting colleagues in checking shelf life and storage condition of individual medications, the following challenges exist: 1. There is a range of medications that require fresh reconstitution. Effort is needed for colleague to check and calculate each time for the use-before dates and storage conditions. 2. Manual error may occur during calculation process. 3. Poor handwriting and/or diffusion of ink may lead to difficulty in reading information from the labels. ObjectivesThis project aims to: 1. Improve medication safety through replacing manual written labels by automatic printing 2. Ensure patients will not be using an expired product due to incorrect use-before date 3. Optimize dispensing process and improve efficiency 4. Improve tidiness and neatness of dispensing labels for better readability by patients/carers or nursing staff when administering the drugMethodologyTo improve the current practice and quality of dispensing, a computerized program is designed to calculate and print use-before date and auxiliary label automatically from label printer after scanning barcodes which is originally printed on dispensing labels.Results & OutcomeThis project targets to achieve the following outcomes: 1. Elimination of wrong calculation or writing of use-before date and wrong labelling of “refrigerate” after medication reconstitution 2. Elimination of poor readability of manual writing of use-before date, so as to safeguard correct medication administration and patient safety 3.Reduction of pharmacy staff workload and optimization of dispensing process. Zero near miss of incorrect use-before date and refrigerate instruction was recorded since implementation in AHNH main pharmacy and TPH main pharmacy. Improvement of dispensing efficiency is evaluated by interviewing dispensing staff (pharmacists and dispensers) after implementation. All staff interviewed agreed new measure can reduce workload for manual calculation, reduce frontline stress and increase dispensing accuracy and efficiency. ​ Questionnaires were distributed to patient/carers and nursing staff. 100% of respondents are satisfied with the new measure. Most respondents agreed that new measure can improve tidiness of instruction, reduce mistakes and misunderstanding of information, and hence improve medication safety.   

IntroductionThere has been an increase in frequency of changes in patient conditions during training in physiotherapy department due to frailty, multiple comorbidities and more acute status of patients that may endanger patients’ safety. Patients’ safety is always first priority in delivering treatment to patients.ObjectivesTo derive a systematic, practical and sustainable system to minimize the occurrence of change of patient condition in physiotherapy departmentMethodologyRoot cause analysis was conducted for the “change of patient condition” data (10 cases happened for 15148 patient attendances) in first 10 months in 2017. It included patient’s medical record review and staff interview. Major information reviewed including screening of patients’ medical history, any checking and monitoring of vital signs for those patients. Major causes were postural hypotension (60 %) and poor blood pressure (BP) control (10%). Practice of monitoring of vital signs was inconsistent amongst different therapists. In addition, focus group was formed with physiotherapist team in-charge in different specialties, to gather opinions on safety measures. A three steps “SAFE” model: Screening, Checking and Monitoring” was implemented in January 2018. Step 1 “Screening” was a procedure that using standardized screening checklist, which included contra-indications and precautions for screening of medical conditions and unstable vital signs. All physiotherapists needed to conduct this procedure. Step 2 “Checking” was checking patients’ vital signs (using reference range from screening checklist) before training in physiotherapy department. Staff needed to sign a checking record, with regular audit by senior staff. Step 3 “Monitoring” was monitoring of vital signs during training if the patients’ vital signs was within borderline range (regarded as precautions in screening checklist). Results & OutcomeAfter implementing the procedures of “Screening” and “Checking”, percentage of patients cancelled due to unstable vital signs was 2.2% (482 out of 21909 patients booking) in 2018. Unstable vital signs included fever (58.5%), unstable BP (27.8%) and unstable pulse rate (3.7%). Together with the measures of “Monitoring”, the occurrence rate of change of patient condition in physiotherapy department showed a marked decreasing trend (decrease 64.1%) from 0.92 incidents per month in 2017 (out of 18178 yearly attendances) to 0.33 incidents per month in 2018 (out of 21424 yearly attendances). Staff evaluation questionnaire showed that all staff agreed that the 3 steps “SAFE model” could increase staff awareness on patients’ safety and decrease occurrence of change of patient condition in physiotherapy department. Continuous data collection and evaluation, and regular safety measures review are necessary to enhance patients’ safety in future.   

IntroductionEffective communication is a driver of performance for clinical team and helps the timely and relevant information is provided to Nursing Management Team. SharePoint is typically associated with web content management and document management systems, it is actually a much broader platform of web technologies, capable of being configured into a wide range of solution areas. By using SharePoint to create an electronic platform – “Nurse Coordinator e-Handover System”, this platform provides DOM/WMs/NOs/APNs to easy access for monitoring daily Medicines & Geriatrics ward operation, quality and safety via workstations and home computers, also this platform helps the Nursing Management team get information and give response effectively. ObjectivesThe objectives of the project are: (a) To enhance efficiency in clinical management (b) To enhance communication between DOMs/WMs/NOs/APNs even working area or home (c) Provide update, timely and relevant information to Nursing Management team (d) Data can be retrieved for evaluation and statistics MethodologyThe I2E2 (i.e. Inspiration, Infrastructure, Education and Evidence) strategies are adopted for facilitating the implementation of the project: (a) Review the existing workflow of Nursing Coordinator handover method (b) Develop an electronic platform (c) Conduct training and competency assessment (d) Prepare for the rollout of the project to meet operational need (e) Collect staff feedback (f) Assess the readiness for implementation and provide timely feedback (g) Monitor the utilization Results & OutcomeWith the collaboration from DOMs/WMs/NOs/APNs, the project was successfully rollout on 4Q2018, at least 200 records are documented. The concept of M&G Nurse Coordinator e-Handover System was supported by Nursing Management Team. This platform facilitated communication and improve work efficiency. Positive feedback and suggestions from Nursing Management Team on enhancing the system are followed up for further improvement. In conclusions, an innovative and good quality information could provide staff Timely, Relevant and Efficiency clinical area.   

IntroductionDorsogluteal (DG) region, the upper outer quadrant, of buttock is a common site for intramuscular injection by nurses. In December 2016, the Medical Council of Hong Kong recommended changing to the ventrogluteal (VG) site. Therefore, an evidence-based project group was established under our Nursing Services Division to follow up this issue.ObjectivesThe group aimed at (i) examining the evidence for the VG site; (ii) formulating the evidence-based strategies for promoting the practice change among our nurses; and (iii) implementing the action plan of change and evaluating its effectiveness.MethodologyThe Johns Hopkins Nursing Evidence-based Practice Model was adopted. Apart from reviewing the evidence for VG site, the project also covered the: (a) optimal locating method of VG site; (b) occupational and health issues concerned; and (c) optimal method for facilitating the change. Hospital-wide nurses training was conducted, especially for senior nurses who had never learned the VG injection skill before. As informed by the evidence, simulated practice was incorporated, a new poster was designed for work places, and a video clip was produced for on-going education. Participants were required to pass the skill assessment in simulation setting. Their knowledge gain, attitude change and performance would be evaluated. Incidence of patient injury and staff needle stick injury would also be captured.Results & OutcomeThirty identical training sessions were conducted from December 2017 to October 2018 for nearly 860 nurses. No incidence of patient injury and staff needle stick injury was reported so far. After training, the nurses’ mean knowledge score increased from 2.98 to 5.58/6 (p< 0.001, paired t-test). Proportion of nurses willing to use VG rose from 19.3% to 95.6% (p< 0.001, McNemar's test). Among the 691 nurses who used to choose DG site, 654 of them (94.6%) were willing to change to VG. The strongest motivator was the knowledge of the benefits of VG over DG. Conversely, difficulty of the VG skill perceived was the most common barrier for change. Analysis by the logistic model also revealed that more experienced the nurses, less likely they would choose VG. But they tended to be more willing to change after training in our cohort. These results are promising. Clinical audit will be conducted later to verify the actual clinical behaviour.  

IntroductionPatient fall incidents remain the first priority in the risk registry of Occupational Therapy Department in Kowloon Hospital in the pass years. In order to improve the patient safety and quality of services, interventions to prevent patient fall incidents while receiving treatment are required. Currently different specialty team have their own way to orientate new staff and train up their professional and supporting staff to help them to be more competence in serving their unit. However, the training is not comprehensive and lack of focuses on fall prevention as well as suitable for all level of our colleague.ObjectivesA comprehensive Fall Prevention Training package was developed for all level of staff which covered the content of general fall information and patient’s condition, proper use of wheelchair, wheelchair transfer, plinth activities, standing frame activities and use of hoist. The training was implemented and Questionnaire survey was performed to evaluate change in the Level of knowledge and confidence before and after the training as well as the evaluation of the usefulness and satisfactory of the training.MethodologyTraining package was developed in power point presentation, sound recording and video clip for present the Fall prevention strategy, knowledge and skill for staff training. The training package was presented to staff in various ranking including Occupational Therapist, Personal care assistant (PCA) and Operation Assistant (OPA). A self-report questionnaire was designed in four point ordinal scale from strongly agree to strongly disagree to investigate degree of knowledge gain and level of confidence of the colleagues was filled by the colleagues before and after the training session. The usefulness and satisfactory of the training content were also evaluated. The characteristics of the response was analyzed, compared and reported.Results & OutcomeTwo training sessions was implemented. The distribution of response was classified by staff groups (OT, PCA and OPA) and rating of knowledge gain and confidence gain before and after the training was compare to evaluate for any significant change. For the training of fall prevention part 1: 31OT, 22PCA and 11OPA attended, the result found that rating of significant knowledge gain increased from 91% to100% in OT group, increase from 32% to 96% in PCA group and increased from 25% to 80% in OPA group. Rating of significant confidence gain increased from 89% to 99% in OT group, increased from 45% to 96% in PCA group and increased from 19% to 87% in OPA group. Overall usefulness of daily practice of the training was for OT, PCA and OPA were 94%, 91% and 91% respectively and satisfactory rate of the training for OT, PCA and OPA were 94%, 100% and 100% respectively. For the training of part 2 (hoist using): 24OT, 10PCA and 7OPA attended, the result found that rating of significant knowledge gain increased from 39% to 86% in OT group, increase from 20% to 86% in PCA group and increased from 0% to 100% in OPA group. Rating of significant confidence gain increased from 93% to 96% in OT group, increased from 56% to 94% in PCA group and increased from 0% to 100% in OPA group. Overall usefulness of daily practice of the training was for OT, PCA and OPA were 96%, 90% and 100% respectively and satisfactory rate of the training for OT, PCA and OPA were 96%, 90% and 100% respectively. Average severity of patient fall incident captured from the data of AIRS after training on June 2018 was only 1.7 while the data of last five years were 2(2013-14), 2(2014-15), 2.3(2015-16, 1.7(2016-17) and 2.3(2017-18).  

IntroductionLeg ulcers affects ~1% of population (Sarkar PK, 2000). Frontline Nursing staffs often encounter patients' with leg ulcers. However, frontline nurses may not recognize those potential illness like the underlying vascular diseases which lead to those leg ulcers. Different types of leg ulcers (arterial, venous or mixed types) wounds may not be accurately identified & classified & therefore they may be improperly treated. By implementing the Leg Ulcer Management & Empowerment Program, nursing staff would be taught to gain more knowledge on leg ulcers. They would be more competent to identify and classify leg ulcers. They are encouraged to refer the leg ulcers to wound nurses and other healthcare professionals like podiatrist for assistance. They are also encouraged to inform Doctor for prompt, advance and expertise assessment and management. Thurs, the leg ulcers wounds healing prognosis, staff communication and management could be promoted and enhanced. Objectives- To enhance Nursing staffs' awareness & knowledge on caring patients' with leg ulcer - To promote the nursing care on leg ulcers - To promote the multidisciplinary approach on patients' with leg ulcer - To enhance frontline Nursing staffs' communication with the wound nurses MethodologyTarget participants: - Nursing Staff from Dept. of Surgery 1. Review (Feb-April 2018) 2. Process and Planning (Aug - Sept 2018) 3. Implementation (Oct - Nov 2018) - organize workshops for the designated frontline staff on leg ulcer management 4. Evaluation (Dec 2018 - Jan 2019) - evaluating effectiveness of the workshop by implementing post-test and survey (same as pre-test) - review whether the objectives of the workshop are accomplished and achieved - generate overall report of the workshop and discuss with designated WMs - determine the future direction of the program.Results & Outcome12 individual workshops were organized with total 50 Nursing staffs participated. After the workshops, a survey was conducted to compare the pre-test and post-test results. It was showed that there is significant improvement from the staffs in dealing patients' with leg ulcers, especially in: 1. The knowledge on ABI (improved by 30%) 2. The service and role of Occupational Therapist and Podiatrist (improved by 40%) 3. The confidence in caring patients with leg ulcers (improved by 28%) 4. The understanding of management with leg ulcers (improved by 15%) 5. The communication and cooperation between Nursing staffs and Wound Nurse (improved by 12%)  

The Gram-negative bacterial pathogen Klebsiella pneumoniae has consistently evolved over the past two decades, generating genetic variants that exhibit mixed phenotypes of hyper-resistance and hypervirulence including carbapenem-resistant K. pneumoniae (CRKP), hypervirulent K. pneumoniae (HvKP) and carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP). These bacterial strains were found to persist as ‘normal flora’ in patients and remain viable for a prolonged period in clinical settings, resulting in further dissemination and infections among hospital patients. Treatment with the last resort antibiotics such as ceftazidime/avibactin and colistin readily leads to the development of resistance, resulting in extremely limited choices of agents for treatment of infections caused by these superbugs. Comprehensive surveillance data in China showed that K. pneumoniae has become the most common clinically isolated bacterial pathogens since 2014. It is also listed as the most common bacterial pathogen that causes blood stream infections and the bacterial species that causes the highest mortality rate. It is commonly accepted that K. pneumoniae poses a major threat to hospital patients, with the situation being out of control in certain countries in Asia. A thorough understanding of the evolution trend, transmission dynamics and pathogenic mechanisms of this notorious pathogen is essential for development of effective intervention strategies to promptly prevent it from being further disseminated to a scale of global public health calamity. In this talk, I will share with you the updates research conducted in our lab on the understanding of evolution and current trend of K. pneumoniae in clinical setting.

ICU beds are expensive and critical resources in modern healthcare. Its under provision would jeopardise the quality of healthcare, while its over provision overburden the limited resources. However, there is no hard and fast rule on what is the optimal number of ICU beds for a given population. Hong Kong has around 3.5 ICU beds per 100,000 population, which is on the low side when compared with other developed countries. As such, the occupancy rate of ICU beds is always high in Hong Kong. A native view of the occupancy rate is to see whether an ICU is "busy" or not. However, it is an oversimplified view and may not be accurate. Is there any other insight we could gain from the ICU utilisation data? In the presentation, the current ICU bed utilisation data of Hong Kong will be reviewed. Then, a few examples on how other uses of the utilisation data will be discussed: determining the number of required isolation room in an ICU expansion project; demonstrating the impact of new service commissioning on the availability of ICU service to other users. Lastly, a method of resampling of the ICU utilisation data would be introduced. With this method, one could estimate the strain of ICU beds with minimal assumptions. When resampling is applied to data from local ICUs, the results showed that triage pressure existed to a varying degree.

The relationship between intensive care medicine and healthcare quality and safety will be explored in this session. From the exploration, the speaker will identify opportunities and threats to share with the audience.

Genomic analysis of gastrointestinal cancers, the most common cancer types worldwide, has revealed marked histological and molecular heterogeneity linked to different pathways of cancer development with therapeutic implications. For example, colorectal cancers that progress through serrated polyps are enriched for WNT upstream alterations, raising therapeutic opportunity through development of Wnt secretion inhibitors. Gastric cancers with chromosomal instability carry frequent diverse oncogenic driver amplifications that could be targeted by specific targeted agents. Because of these molecular diversity and potential differential mechanisms for aggressive behaviour and therapy resistance, good in vitro models that encompass unique subtypes are necessary for precision medicine development. We hence developed a primary gastric and colorectal cancer organoid culture biobank that includes normal, dysplastic, cancer and lymph node metastases from cancer patients that encompass most known molecular subtypes. The organoid cultures capture regional heterogeneity and subclonal architecture, remain closely similar to in vivo tumors by morphology, transcriptome and genomic profiles, that remained stable in long-term culture. Large-scale drug screening is possible that show differential sensitivity to drugs that can be linked back to patient drug response. Overall, coupling genomics and organoid-based drug screening, linking back to patient pathology and therapeutic response will empower the development of precision cancer therapy.

•       This talk will review the key elements necessary to ensure professional and public confidence in the effective operation of genomic medicine as a mainstream component of health systems, in the context of the developments made by England’s 100,000 Genomes Project and the National Genomic Medicine Service. •       It will consider the laboratory, service and informatics infrastructure that were established by the National Health Service and Genomics England to deliver clinical care and support discovery and research. It will also reflect on the measures taken to provide assurance around cyber security and ethics

One day when I was seeing patients in the clinic, I overheard two junior doctors talking next to my room.    Doctor A: Oh! We have less than 10 minutes to see each patient in the clinic, how can it be possible if they are not thyroid problems? Doctor B: Yes, thyroid is simple; you either give carbimazole for high and thyroxine for low, that’s it. Just hope that all patients are thyroid patients.   What happens if high is not really high and low is not simply low? In this presentation, I try to discuss with you some daunting challenge of thyroid diseases including the laboratory interference, discordant thyroid function and how common presentation could bamboozle us, and ultimately what make thyroid so tantalizing. I hope you can realize something you don’t know you don’t know about the kaleidoscopic spectrum of thyroid diseases My aim is simple: Thyroid is NOT simple.  

Osteoporosis is characterized by low bone mass and deterioration of bone quality, leading to increased risk of fragility fractures and the resulting mortality and morbidities. It is often called a ??silent disease?? because there are no symptoms or pain until a fracture occurs. The silence of the disease unfortunately masks its huge health impact. Hip fractures, in particular, are associated with up to 20% of long-term nursing care and another 20%

The UK’s National Health Service (NHS) sets out a bold vision to shift the paradigm of care settings from paper to paper-free over the next few years. At the centre of the paper-free programme lies the roll-out of EMR across the nation and the creation of local care records that follow a patient through primary, secondary and tertiary settings. The approach taken to roll-out has been the creation of a Smart Hospitals- a 'Global Digital Exemplar' cohort of leading hospitals who will reach HIMSS 7 in the next couple of years and who will share their knowledge and experience with the next cohort of fast-followers. The lessons learned have highlighted the importance of efficient and agile hospital design, integrated care masterplans, extensive user engagement and the benefits of building competence and capability ahead of complex implementation.

The term FinTech, a portmanteau of "financial technology", is used to describe new digital technology which has the potential to improve the delivery of financial services. FinTech helps companies, business owners, and consumers to better manage their financial operations, processes, and daily lives through the use of specialised software and algorithms in computers and, increasingly, in smartphones.  Today, FinTech is involved in nearly all technological innovation and automation in the financial sector, and is responsible for major advances in retail banking, wealth management, lending and borrowing, fundraising, money transfers/payments, investment management, and more. In this presentation, Mr. Vincent Hui will give an overview of Hong Kong’s FinTech ecosystem as well as the implications of emerging technologies for the city’s banking and healthcare industries. Mr. Hui will also share some updates on the Bank of East Asia’s latest developments in innovation and digitalisation.  

Innovating for better care via a common mobile patient app platform to is one of the key strategies in the Hospital Authority (HA) in enhancing patient experience and health outcome. To empower patients in improving their own health, a common patient app platform (HA Go) is built in 2019 so that patients can easily and safely access HA services with unified user experience. It interfaces with the hospital Clinical Management System and connects patients with healthcare professionals whilst they are at home. HA Go will undergo a trial period and make available to selected patients from July 2019 aiming to identify acceptance of HA Go users, impact to operation and the system/app performance. The app will then be put on public app stores in Q4, 2019 and invite HA patients for its Phase 1 implementation. Services which are essential for patients to manage their own health and health service affairs, such as appointment booking and enquiry, medication, rehabilitation, and payment settlement, will be included in the initial phase. It is anticipated that more mini-apps will be developed to assist patients to stay active in the community while healthcare professionals to devote their resources to take care of patients who are in need. HA Go marks an important step for HA to modernize her healthcare service via technology innovation.

‘Disruption’ is a term that has been used in business sectors to describe a process in which an underrated product or service starts to become popular enough to replace, or displace, a conventional product or service. Disruptions in medicine often refer to events or processes that cause us to change the way we practice. They include changes in the population demographic, disease epidemiology, climate, needs of the community, technologies and the medical workforce. These will need to be taken into account when developing a training curriculum for medical specialists. The world over is facing an ageing population, some of whom may remain single or childless with heavy reliance on public social and health support. A more patient-oriented approach in the management of the aged is needed in the future. Besides, as we become more prosperous, non-communicable diseases are becoming the major health burden on the society. Training of future specialists therefore needs to cater for these changes. In addition, with rapid advances in medical technologies, not only do future clinicians need to become life-long leaners but they also need to have a better understanding of medical ethics and law. Changes in the climate are often overlooked by those who develop the medical curriculum. Both natural and man-made disasters may have significant impact on the health of the society. Not only may such ‘disasters’ cause physical injuries but also psychosocial stresses and increased risk of communicable diseases. Future clinicians need to be prepared and be able to respond to such events! Finally, the wellbeing of the medical workforce is increasingly becoming a major concern in the healthcare system. Early- or mid-career is often the time of greatest stress and burnout, and poses an increased risk of anxiety and depression. Much needs to be done to enable early detection of and support for colleagues with psychological stresses!

IAMRA (International Association of Medical Regulatory Authorities) is an international organisation with 116 members in 48 countries, including Hong Kong. IAMRA has as one of its strategic goals, to ‘provide support for members to achieve high standards for the education of doctors through appropriate accreditation processes’. There is considerable diversity in the types of bodies offering postgraduate (specialist) training programs and there is potential for the quality of these programs to vary greatly. Specialist training is frequently profession-led through Colleges or Boards, although provision in the university and private for-profit sectors is not unusual.  Internationally, it is increasingly common for specialist training programs to be accredited by the government, a Medical Regulatory Authority, or an independent body established for the purpose.  Within IAMRA’s membership, each of these accreditation models is in effective practice, but there are many countries where specialist training is not subject to independent accreditation. In 2018, IAMRA members endorsed the following concluding statement: ‘IAMRA supports and encourages the development and implementation of robust, independent postgraduate medical education accreditation systems that ensure the provision of high quality training, identify inadequate programs, assist providers to improve the quality of their programs and ultimately, protect patients.’ This paper will explore: - the many benefits of independent specialist training accreditation;  - the characteristics of an effective accreditation body; - a framework for developing accreditation standards.

In the 21st century clinicians are confronted with increasingly complex ethical challenges in their medical practice.  These include everyday relational issues such as truth-telling, consent, medical confidentiality, assessing capacity, conflicts with colleagues, patients and their relatives over treatment decisions, as well as difficult problems at the beginning and end of life and coping with medical errors. Added to these are newer ethical challenges arising from technological and scientific advances, such as wearable technologies, the use of artificial intelligence in healthcare, robotics, genomics, gene editing, non-invasive prenatal testing and novel infertility treatments. Will AI render doctors obsolete or change their roles and responsibilities? Voluntary euthanasia and physician assisted suicide (now described as ‘assisted dying’) is legally permissible in a rising number of countries and states, creating pressures on professional roles and values. Will there remain scope for conscientious objection? Demographics are changing and people in developed nations are living longer with an extended period of frailty and dependency, creating strains on the medical and social care systems. Rising costs of healthcare can lead to difficult choices in allocating resources. In this changing landscape clinicians need to develop and sustain their professional virtues such that they can continue to best serve their patients. In my presentation, with illustrative examples, I shall explore a selection of these ethical issues and the well-developed methods for engaging with them and for deliberating in order to achieve optimal outcomes. I shall refer to my experience and learning as a clinician-ethicist, as well as my membership of the Nuffield Council in Bioethics and Imperial College NHS Trust clinical ethics committee.

Healthcare professionals abide by codes of conduct built around respect of life and human dignity, respect for autonomy of the patient, minimizing harm and doing good, justice, respect for colleagues and other professional etiquette.  Some of these elements are as ancient as Hippocrates (c. 370 BC), some did not gain wide acceptance until the 1970’s.  With rapid of advances in biomedical sciences and technologies, complex ethical issues arose.  In an increasingly secular and divided world, upholding professional ethics is ever more important, but its limitations must also be acknowledged.  Selected current topics in bioethics (physician assisted suicide, precision medicine, genome editing) are discussed in this presentation to illustrate the importance of a broader view on professional medical ethics. 

Novel psychotrophic substances (NPS), also known as emerging drugs of abuse, are constantly evolving structural analogues of traditional drugs of abuse that have become a threat to public health worldwide and within our locality. This study reviewed the NPS detected in cases referred to the Hospital Authority Toxicology Reference Laboratory – the only tertiary clinical toxicology laboratory in Hong Kong. The associated clinical features and toxicological were also documented.  A total of 111 cases involving 104 patients and 22 types of NPS were identified. The identified NPS included 2-phenyl-2-(ethylamino)-cyclohexanone (2-oxo-PCE, a ketamine analogue), para-methoxymethamphetamine, 4-fluoroamphetamine, phenazepam, 3-trifluoromethylphenylpiperazine, 5-methoxy-diisopropyltryptamine, 2-diphenylmethylpyrrolidine, methoxyphenidine, the N-methoxybenzyl drugs, cathinones, synthetic cannabinoids and opioids.  Among the acute poisoning cases attributable to NPS use, the severity was fatal (n = 3), severe (n = 17), moderate (n = 67) and minor (n = 17). And 11 patients required intensive care unit admission. All three fatal cases were associated with paramethoxymethamphetamine use. It is concluded that a rising trend of new psychoactive substance use is observed locally, which is associated with considerable morbidity and mortality. Continued vigilance from frontline clinicians and medical professionals is imperative in the combat against NPS use.

E-cigarette was created in 2003, and gained popularity over the past decade. It has been perceived to be good in term of a harm reduction product for chronic smoker, environmental friendly, or even “fashionable”. Although user of e-cigarette may expose to less known toxic substances such as nitrosamines from conventional cigarette, e-cigarette is definitely harmful. The existing evidence shows that e-cigarette aerosol contain multiple toxicants.  Thousands of e-cigarette refill liquid or e-liquid are available in the market. E-liquid commonly contains nicotine of varying concentration, glycerin, propylene glycol and flavour chemicals. The exact ingredients of e-liquid may not be reliably listed. It was found about one-fifth of e-liquid samples had significant discrepancy (>20%) in the labelled nicotine content. Besides, e-liquid may contain high concentration of different flavor chemicals of potential toxicity. One example is the flavor chemical “diacetly”, which is a culprit for “popcorn lung disease”.  From a clinical perspective, e-cigarette poisonings have increased significantly in recent years. Poison centres data suggest majority of the e-cigarette exposure involve children. Although severe toxicity is uncommon, fatality from accidental exposure did occur. The major toxicological concern is acute nicotine poisoning. Besides, e-cigarette “explosion’ resulted in significant burn and blast injury were noted in case reports.

IntroductionAccording to the Seven Brunnstrom Stages of Motor Recovery (Brunnstrom 1970), stroke patients go through stage of flaccidity to some spastic tone, marked spasticity and synergistic movements in the first 4 stages. At stage 5, spasticity fading with synergies gradually reduced and develop coordinated and complex movement and back to normal. However, it is the most challenging task for therapists to help stroke patients who have developed mark spasticity to revert to regain normal movement from adapted synergistic movements. Sunnerhagen et. al., 2016, reviewed some predictors of post stroke spasticity. Based on Neuro-IFRAH approach, Occupational Therapy in Kowloon Hospital has been working in previous years to prevent and reduce spasticity for patients with stroke. The application is from sub-acute to out-patient phases. It involve in/out patient phase patient and care taker education on handling and positioning for shoulder protection and spasticity risk factors, stratified treatment in early trunk control, facilitative upper limb training, application of flexor tone inhibitory splints and home programs.Objectives(1) To prevent and reduce severe spasticity development in stroke survivors. (2) To enhance better upper limb and self-care function for patients with stroke. MethodologyA retrospective review of stroke outcome data from CDARS is compared for in and out patients in the period of 2016 to 2018. For cases who had received intensive OT training together with botox injection or TMS treatment by Rehab Specialist, a pre-test and post –test design was used to compare the efficacy of intervention in spasticity, upper limb function and self-care function. Results & OutcomeThe retrospective review of inpatient data showed significate different of Functional Independence Measurement (FIM) gain for stroke patients (p< 0.001) in 2014/15 (n=803) average gain is 8 while 2016 to 2018 (n=2869) FIM gain is 11.1. From 2016 to 2018 CDARS data, Functional Test of Hempilegic Upper Extremity (FTHUE) gained average 0.5 (in-patients), and average 2 (out-patients). The intensive OT anti-spasticity program was also collaborated with two intervention of TMS and Botox injection by our Rehab Specialist in Kowloon Hospital also reflected positive outcomes in terms of FTHU, FIM active, passive range of movement and spasticity.   

IntroductionLean and Six Sigma is widely used in healthcare system to improve quality of care. Proper Anti-Embolism Stocking (TED) application is crucial to avoid patients suffering from deep vein thrombosis as a result of immobility. The author adopted Lean and Six Sigma framework to enhance effective application of TED in Neurosurgical Unit, PWH.Objectives(1) To Identify the root causes of inappropriate application of TED (2) To make a sustainable improvement of TED application in Neurosurgical Unit. MethodologyThe Lean and Six Sigma framework included: (1) Define phase, a multidisciplinary team included neurosurgical nurses and physiotherapists was formed in Neurosurgical Unit, PWH. A project charter was created to set the goal and scope of the program. Literature review about updated TED usage and monitoring was done. (2) Measure phase, for assessing staff performance, physiotherapists were invited to conduct pre-audit in collaboration with a Six Sigma Leader (Author). Moreover, nurses' and supporting staff knowledge was assessed with questionnaire. (3) Analyze phase, members performed data and graphical analysis to identify the root causes which were inadequate training and staff knowledge. (4) Improve phase, training sessions on proper TED application were held by nurses and physiotherapists. The video of training session was shared on electronic mobile platform for easy retrieval. In addition, the post-audit of TED application and staff knowledge assessment were conducted. (5) Control phase, a control plan included new staff orientation, regular internal audits were established. To make the improvement more sustainable, signage was designed and posted up to increase staff and relatives' awareness. A video was produced for educating relatives on the usage and care of TED, which would be broadcasted during visiting hours. Results & Outcome200 samples were collected in pre-& post-audits respectively. “Toe stick out of inspection hole” and “wrinkles” were the two most common problems. The number of improper TED wearing dropped from 148 to 69 after staff sharing sessions (95%CI, p-value< 0.001, Chi-square test). The Overall Effectiveness improved from 0.26 to 0.65 (95%CI, p-Value< 0.001, paired t-test). The SIGMA level increased from 2.4 σ to 3 σ. Staff knowledge also increased significantly, with mean score increased from 5.9 to 8.8 (95% CI, p-value< 0.001, paired t-test).   

IntroductionSarcopenia is a common but always underestimated condition in elderly population. According to Asia Working Group of Sarcopenia (AWGS), Gait speed < 0.8m/s and/or Handgrip Strength with Male < 26 Kg and Female < 18 Kg and Skeletal Muscle Index (SMI) with Male < 7kg/m2 and Female < 5.7kg/m2 are classified as sarcopenia. Sarcopenia in elderly is a known predictor for future morbidity and mortality. Early detection and intervention with Resisted Exercise Training are needed to augment the muscle-related functions of the sarcopenia elderly. Objectives1. Analyze the prevalence of ambulatory community-dwelling elderly (unaided or one handed aids) sarcopenia in Geriatric Day Hospital (GDH) 2. Evaluate the effect of an 8-week Resisted Exercise Training on muscle mass and the muscle-related functions.MethodologyElderly who were able to walk independently in GDH from July 2018 to September 2018 were selected. Elderly with pacemaker and metal implant were excluded. Handgrip Strength and bio-impedance body muscles composition assessment including SMI were assessed. The muscle-related functions including Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) were assessed. They were divided into two groups. One group (conventional) attended the conventional PT training in GDH and the other group (RE) received an 8-week Resisted Exercise Training at GDH and home regime with log book. All participants received the pre assessment and post 8 weeks assessment.Results & OutcomeResults: Among 39 elderly assessed, 54% (N=21) was classified as sarcopenia according to AWGS definition. 12 and 9 sarcopenia elderly were assigned to RE and conventional group respectively. After 8-week training, both groups (3 cases drop out in RE group) showed significant improvement in BBS (RE: p=0.0001; conventional: p=0.001; paired t-test). RE group showed significant improvement in BBS (p=0.034; independent t-test) compared to conventional group. Only RE group showed significant improvement in TUGT (p=0.007; paired t-test). There was no significant difference in SMI in both groups. Conclusion: The prevalence of sarcopenia in GDH is quite high but they are often overlooked. Resisted Exercise Training has shown to be more effective to improve the muscle-related functions. Public Implications: Early screening and intervention with Resisted Exercise Training help to augment the muscle-related functions of sarcopenia elderly.   

IntroductionCatheter-associated urinary tract infection (CAUTI) is a major cause of hospital-acquired infection. For the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) database from July 2015 to June 2016, symptomatic urinary tract infection rate in different surgical teams under HAHO, the mean score was 2.5%. However, the score in our colorectal surgical team was 5%. Cases were all systematically reviewed. Total 240 cases with colorectal resection performed during the year and 12 cases were post-operatively diagnosed of CAUTI. It was found that majority of the patients were suffered from rectal cancer and intra-abdominal pelvic surgeries were performed. The indwelling catheter should be kept at least 3 to 5 days after operation in order to close monitor the urine output and prevent from dehydration.Objectives1.To reduce the rate of catheter-associated urinary tract infection of patients undergo colorectal resection 2.To improve the quality of urinary catheter care in the Department of Surgery MethodologyIn order to compare the difference outcomes for difference interventions, project team planned to conduct the program into two phases within 6 months. In Phase I, five comprehensive strategies would be implemented from October to December, 2017. And in Phase II, five strategies with one more intervention would be implemented from January to March, 2018. Phase I 1.Reinforce strict aseptic technique of catheterization 2.Stop the practice of changing urometer, provide training to healthcare supporting staff and audit the practice 3.Design and use a paper card reminder for daily review catheter maintenance 4.Involve patients and carers for indwelling catheter care during post-operative period 5.Using devices to keep catheter in place after insertion Phase II Using antimicrobial 100% silicone urinary catheter in bundle with five preventive CAUTI interventions Results & Outcome Total of 110 patients were recruited in the program. The duration of catheterization at the period of 1/4/2017 – 30/9/17 and 1/10/17 – 31/3/18 was compared. Patients with catheterization more than 4 days (Post-operative Day 3) on 1/4/17 – 30/9/17 were 61.5% but only 34.5% on 1/10/17 – 31/3/17. It has been decreased 27%. Besides, there were total 4 patients with CAUTI during phase I of study. The percentage of CAUTI was 3.5% which was decreased 1.5% compared with the data of SOMIP in 2016. And it was shown that zero case of CAUTI in phase II after using antimicrobal urinary catheter.  

IntroductionThe volume of patients with osteoporosis has been increasing in recent years due to multiple reasons. The frequency of follow-up for old cases in Osteoporosis Clinic has lengthened from 24+/-3 weeks in 2013 to 34+/-2 weeks in 2016. Such a lengthening is also contributed by the advanced age of osteoporosis patients as travelling may sometimes be difficult. In order to maintain our service quality, a nurse-led program, the Osteoporosis Phone Direct Enquiry Service (OPD-ES) has been implemented since Nov 2017.Objectives1.To enhance service quality and continuity of care to patient with osteoporosis with lengthening follow-up duration; 2.To evaluate the effectiveness of OPD-ES MethodologyOPD-ES functions as an active communication channel between patients, their carers and health care professionals. A direct hotline operated in office hours allows patients and carers to actively seek advices from healthcare workers concerning their disease management in between their routine follow-up sessions. After addressing the enquiries immediately over the phone, nurse clinics are arranged for patients requiring individual education or counselling. All enquiries concerning patients’ medical condition are discussed in case conferences with in-charge physicians. Ad-hoc medical consultation appointment is arranged if considered necessary by the physician. The effectiveness of the service was assessed by the number of cases who used the service, and number of ad-hoc follow-up sessions arranged. Reasons of phone enquiries were also analysed.Results & Outcome463 (94% female) patients attended Osteoporosis Clinic from Nov 2017 to Nov 2018. All were put on anti-osteoporotic agents (Denosumab: 234, 50.5%; Bisphosphonates: 211, 45.6%; Teriparatide: 16, 3.5%; and Strontium: 2, 0.4%). 237 (51.2%) patients and/ or carers used OPD-ES. Reasons of enquiries included use of anti-osteoporotic agents (143, 30.9%), issues related to dental complaints or procedures (65, 14.0%) and changes in medical condition (29, 6.3%). 54 (22.8%) patients were arranged for education and counselling in nurse clinic, and 25 (10.5%) patients required ad-hoc medical consultation (medication intolerance: 9; new fracture: 7; deranged renal function: 5; stroke: 2; dental issue related to bisphosphonate osteonecrosis of jaw: 2). OPD-ES functions effectively to enhance good service quality and maintain good continuity of care to patients with osteoporosis who have long follow up duration. The program also empowers patients and carers to participate actively in their disease management through the service.   

IntroductionRefractory breathlessness is a disabling and distressing symptom that is common in incurable cancer and end-stage chronic cardio-respiratory illnesses. Non-pharmacological interventions have positive impacts on the individual’s perception of breathlessness and the self-efficacy of symptom management. A palliative one-point access multidisciplinary(MDT) Breathlessness Support Service(BSS) was started in PYNEH.Objectives(1)To enhance the self-efficacy on breathlessness management; (2)to alleviate psychological distress; (3)to improve the quality of life(QoL).MethodologyThis pilot MDT BSS consists of a short-term four half-day weekly sessions catering 4-6 patients. Participants are delivered the skills of breathing & physical exercises, energy conservation and relaxation to cope with ADL tasks, targeted psychological support, and home caring advice by the physiotherapists, occupational therapists, clinical psychologists and palliative care nurses. Pre- and post-intervention assessment were carried out to evaluate the outcome.Results & OutcomeThere were 37 participants (M:F: 27:10; 19 ONC patients, 18 MED patients) from March to December 2018. Lung cancer(43%) and COPD(32%) were the main diagnoses. The mean age was 74.2 years old(range 46-94 years). 19 patients completed the pre- and post-intervention assessments. Physiotherapy: The Six-Minutes Walk Test significantly improved from 253.0m to 312.4m(p=0.001). Occupational Therapy: Modified ADL Scale capturing the domains of personal care, domestic, physical and leisure activities recorded mixed responses. Significant better confidence was noted for the mastery of toileting(1.00±1.803, p=0.036). All ADL items in terms of “SOB”, “Exertion” and “Confidence” level could be sustained without deterioration. Clinical Psychology: Chinese Breathlessness Beliefs Questionnaire(CBBQ) reported a significant decrease on the mean scores of Somatic Focus subscale(Mdiff=4.68, SD=5.96, t(18)= 3.42, p < 0.01) and Activity Avoidance(AA) subscale(Mdiff=5.05, SD=6.20, t(18)=3.56, p < 0.01), meaning the reduction of anxiety-provoking thoughts and negative beliefs about physical activities. The self-ratings of SOB-related fear level and SOB-related anxiety level were also reduced, though statistically non-significant. The Palliative care outcome scale(POS) showed a trend towards QoL improvement (Pre-: M=8.21, SD 5.55; post- M=5.47, SD 4.81; t(18) =1.88, p=0.08). All patients rated the BSS as “excellent” in the service satisfaction survey. Conclusions: This BSS model improves the participants’ physical function, self-mastery skills on managing breathlessness to cope with ADL tasks. It can reduce the breathlessness induced emotional distress, and potentially improve the QoL.   

IntroductionPatients commonly experience difficulties in personal care tasks due to the disease or deconditioning upon discharge. But the caregivers' needs are often given low priority in the management of patient upon discharge. Carer education plays an important role in preparing patients and carers physiologically and psychologically for early discharge. In the conventional intervention, an occupational therapist will conduct individual carer training skills to patient’s carer. To improve our workflow efficiency, we designed a carers empowerment program.Objectives(1) To equip carers with knowledge and skills for discharge planning (2) To enhance the independence of the patients; (3) To encourage sharing and discussion within the group; (4) To deliver service in a more effective wayMethodologyOccupational therapists will conduct ADL assessment to patients transferred to medical unit of TMH. Patients were stratified by their level of assistance required. Minimal to moderate assistance level patients were referred to the carer empowerment program if needed. The group was conducted by one OT and one PCA. It contained educational and practical session, assistive device and home modification were introduced. Home screening was also initiated for indicated cases. In practical session, carers were invited to participate in role-play. Carers could learn from each other interactively through feedback and discussion. Each session lasted for 30-45 minutes.Results & Outcome9 sessions of carer empowerment group were held from September 2017 to November 2018. 40 carers attended the groups. A satisfaction survey was conducted and majority of participants appreciated the group (Extremely & Strongly Agree: 89%). Most of them believed the group improved their knowledge and skills (Extremely & Strongly Agree: 78%) and boosted their confidence (Extremely & Strongly Agree: 78%). Most importantly, they agreed that the group facilitated future care planning (Extremely & Strongly Agree: 85%). Feedback from case therapists expressed the group could streamline the workflow and could facilitate discharge planning. Each carer empowerment group could serve 4-5 carers at the same time. When compared with conventional individual carer training around 30 minutes for each patient, the group training can enhance occupational therapist workflow efficiency. Conclusion To conclude, feedbacks from participants provided evidence in supporting the carer empowerment program. The objectives of the group were achieved through this mode of service delivery. The carer empowerment program can shorten the discharge planning time.  

In patients with acute leukemia, peripheral blood and bone marrow samples are periodically examined to monitor response to therapy and recovery of normal hematopoiesis. This is traditionally done by assessing cell morphology, a practice that lacks sensitivity and is prone to errors. Assays that can detect minimal residual disease (MRD), referring to leukemic cells undetectable by standard methods, have a higher sensitivity than morphology and are generally much more precise.  The most reliable methods to study MRD in acute leukemia are flow cytometric detection of aberrant immunophenotypes and polymerase chain reaction amplification of rearranged immunoglobulin and T-cell receptor genes. The latter approach has been refined by deep-sequencing analysis. These methods can detect 1 leukemic cell among 10,000 or greater normal bone marrow or peripheral blood cells and are applicable to most patients with acute lymphoblastic leukemia (ALL). In patients with acute myeloid leukemia (AML), flow cytometry is the only method that allows MRD monitoring in the majority of patients. This approach has been considerably improved by the recent discovery of new markers that can be used to distinguish AML cells from normal myeloid cells, and by the availability of increasingly sophisticated analytical software.  It is indisputable that MRD monitoring in patients with newly diagnosed ALL and AML provides critical information to guide treatment decisions. MRD methods can refine assessment of early treatment response, and provide powerful prognostic parameters for risk-classification algorithms. More recent applications include the use of MRD using an eligibility or response criterion for new agents. In the context of chimeric antigen receptor (CAR)-T cell therapy, MRD by flow cytometry allows a precise assessment of the immunophenotype of residual leukemic cells, defining the proportion of cells expressing the targeted antigen before and after CAR-T cell infusion.

Bone marrow and blood transplantation is currently the most commonly used modality of cell therapy for paediatric cancer. However, transplantation may not be possible because of lack of donor and may not always be successful because of various adverse events. In recent years, other cell based therapies such as chimeric antigen receptor modified T cells and NK cells are increasingly used. These cells do not cause graft-vs-host disease, have non–cross-resistant mechanisms of action, and have non-overlapping toxicities with standard cancer treatments. These therapeutic cells may be used alone, or in combination with other immunotherapy approaches such as antibody treatment or cytokine therapy. In this lecture, we will review the contribution of paediatric cellular and immunotherapy programme to the treatment of childhood illnesses. Potential barriers will be addressed, including toxicity of therapy, complexity in cell manufacturing, cost, and lack of long-term efficacy. Novel immune-oncology approaches will be discussed. Promising data from recent clinical trials will be reviewed.

When asked, most people will answer the question "why did you go into healthcare?" with "because I wanted to make a difference". Yet once in the work force, this often becomes increasingly difficult due to overburdened systems, lack of sufficient staff, poor morale....the list can go on. The research tells us that joy at work and workplace safety is inextricable linked to patient safety yet we have historically viewed these domains as separate entities. During this presentation we will go on a journey together to examine the current state of workplaces and what can be done to bring back the joy we felt as we started our careers We will take a side trip to discuss how we can best support out colleagues when healers become wounded. And finally, we will learn how we will know when we get there.

Across the world, countries are attempting to join together patchworks of fragmented primary, community, hospital and social services into more coherent health and care systems. In the English NHS, groups of local healthcare providers are attempting to reduce duplication between services, to make better use of staff and resources, and to improve coordination between related services. The opportunities for improvement are enormous. If we ensure access to high quality primary care services, we solve in a stroke the problem of inappropriate attendance and hospitals’ accident and emergency departments. If we ensure that patients with renal failure attend their community dialysis appointments, we avoid the huge costs of emergency dialysis treatment. However, it is also true that progress in unlocking these efficiencies has been slow, in part because of the need to coordinate between many different organisations with competing interests and priorities. This presentation highlights some common features of highly effective integrated systems which have allowed them to integrate care across services. These include the leadership, vision and culture of these local systems as well as their financial and contractual ‘wiring’ and their infrastructure to support learning and improvement. 

Before we can engage colleagues, in the speaker’s opinion, we should admit that there is real crisis in physician morale. Over half of physicians are burned out. This affects everyone. The lecture has been dedicated for anyone who has to lead people on a daily basis, and in particular in a busy workplace like Hospital Authority.  There is sharing of tools - well-known and not so well-known - that will remind us to bring people to work for purpose. Don’t expect straight answers. Expect food for thought. To allow the growth of a team with the gut and heart to fight long and hard, we wish to foster a mindset to admit burnout is the leader’s business (and our fault). Leadership commitment is vital.

Evidence points to many benefits of “early palliative care” to improve patients’ quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancy (HM). Unfortunately, patients with HM are also known to have heavy symptom burden, significant psychological distress, and aggressive care at the end of life, including a greater likelihood of dying in the acute hospital and receiving chemotherapy at the end of life.  To bridge the service gap, an early integrated palliative care (EIPC) collaboration has been established between Haematology Unit of Queen Mary Hospital and Palliative Medical Unit (PMU) of Grantham Hospital since early 2018.  HM patients who failed two or more lines of disease treatment with palliative care needs were identified during hematology clinic visit or joint round.  These patients will be referred to our PC services including outpatient clinic, home care, in-patient and day care services after screening.  We have a joint hematology palliative clinic in QMH with palliative medicine, haematology , nursing and clinical psychology input.  In the first session, HM patients will be firstly seen by hematologist for disease treatment and then transit to our PC team for symptom management and psychosocial care. Ongoing advance care planning (ACP) will be discussed if patients are ready. Their family caregivers will be provided with counselling and emotional support.  There are also regular hematology joint rounds followed by multidisciplinary case conference (CC) in GH PMU. Our team will provide complicated symptom management including pain while the hematologist will be responsible for disease treatment eg target therapy. We have ethical discussions including chemotherapy, blood transfusion frequency, use of antibiotics as well as antifungal. The CC will focus on the patient acceptance, care plan and discussion on bereavement issues. Clinical psychologist will provide opinion on the management of difficult patients or families. After one-year review of EIPC, the number of referrals to PC was markedly increased. And some of the major symptoms including appetite, depressed mood, itchiness was improved after follow-up visits in hematology PC clinic. Our pilot result also showed that early PC group (≥3 month) had significantly reduction in number of acute admissions for the last 90 days before death when compared with the late PC group.

Promoting collaboration between palliative care (PC) and other specialties through a shared care model according to patients’ needs is one of the strategic directions stated in the Hospital Authority Strategic Service Framework for Palliative Care in 2017. A new Inter-hospital Palliative Care Consultative Service has been established in Kowloon West Cluster since October 2018 under the Framework, aiming to improve PC coverage in acute hospitals, enhance early discharge to community, triage patients with complex needs to Palliative Care Unit (PCU) and to enhance quality of dying for patients who die in place. Preliminary data analysis included 69 patients served from 2 Oct to 7 Nov 2018. The mean waiting time from referral to PC service was 1 working day, compared to 14 days before the start of the service. The consultative team provided symptom assessment (98.6%), symptom management such as suggestions on medications (56.9%) and opioids (22.2%), psycho-spiritual assessment and support (77.8%), caregivers support including carer stress assessment (98.6%) and management (70.8%). Advance care planning discussion such as discussion on diagnosis and prognosis (98.6%), DNACPR (81.9%) and life sustaining treatment (56.9%) was offered. Among the patients served, 43% was discharged, 35% died in parent ward and 22% was transferred to PCU. Ongoing analysis of the data and evaluation of the consultative service continues to ensure continuous improvement of the service and quality of patient care.

The World Health Organization defines palliative care as a way of caring for people with life-threatening illnesses which focuses on quality of life, through the prevention and relief of suffering by prevention and management of pain and other problems, physical, psychological and spiritual. In 2014, the World Health Assembly Resolution on Palliative Care urged member countries to include palliative care as an integral component of treatment within the continuum of care.  With emerging new treatment strategies against cancers, there is a growing proportion of patients with advanced cancer, strongly associated with younger age group, using prolonged anti-cancer drug therapy, mostly with palliative intent, and even until near end of life. Although researchers have identified the advantages of early integration of palliative care in oncological treatment, however, many patients are referred to palliative care service only after discontinuation of systemic anti-cancer treatment. The reasons behind low access rate to palliative care could be inadequate resource availability, ignorance or lack of awareness of resources, referrer or patient and family reluctance and restricted service eligibility. In Mar 2018, we initiated a programme of early psychosocial support for advanced cancer patients undergoing systemic anticancer treatment as a form of integrated palliative care service in oncology treatment. Screening tools are used to measure the stress level of every new patient attending chemotherapy clinic. High scored patients are referred to social workers of oncology team for individual counselling. Trained nurses focus on physical as well as psychosocial complaints of patients followed up in chemotherapy nurse clinics. Streamlined pathway is used to ensure an efficient referral of service from frontline clinical staffs of the department. 

75% of S & P companies will be replaced by new firms by 2027. Innovation for big enterprise is no longer an option, it is a must. The world is changing very fast, and innovation is becoming more difficult, especially for those corporates which are still reacting slow to digital distribution. Fortunately, the open innovation mode is rising in the global range, and some international giants have led and promoted the development of the open innovation and ecological system. This presentation will analyze what are the key pain points of the big enterprises, and show what innovation models are suitable for big enterprises and what roles should big enterprise, start-ups and accelerators play in the whole innovation ecosystem. The speaker will also talk about his experiences of accelerating innovation for big enterprises in China.

Financial technology promises to bring improvements to many areas in banking and finance, including payment, deposit, and wealth management. How will traditional financial institutions and technology companies respond to these opportunities? What challenges will they face? How should they work with regulators and how should they gain the trust of the public?

CYDA (Craft Your Daily Adventure) is a mobile application that aims to re-energize the daily lives of retired elders, as statistics reveals this population group comprises with a significant proportion of solitary elderly suffering from mental depression. While our backend is complemented by sophisticated technologies, the idea itself is simple and understandable. Elders first use voice-to-text recognition to record daily activities, the content is then digitalized into a virtual diary book. Elderly are therefore encouraged to expand their social network by growing their virtual community and sharing their one-and-only journeys. Besides, the project also serves the goals to synergise data-driven policies and offer more instant support from professionals to support the needs of the seniors.

One of the many education outcomes among medical graduates is to prepare their readiness to serve the public or to embark on specialist training. Clinical training would be essential to achieve these objectives. Apart from the two university-affiliated teaching hospitals (Prince of Wales Hospital and Queen Mary Hospital), clinical training of medical students in Hong Kong relies heavily on exposure in various HA hospitals. However, with the increasing number of medical students, teaching and learning in the congested ward setting have become more difficult. Many medical educators maintain the view that real patients with real pathologies are essential for clinical training, but the availability of training opportunities or accessibility to real patients presents a real challenge. The ever-changing service demand and development of specialties have imposed significant pressure on the already-packed curriculum. Technological and information technology advancement has revolutionised the care model but if our future healthcare professionals are not ready, our patients will suffer. The use of innovative education pedagogies such as simulation training is expected to lessen the need for real patients. Ethical practice should be enhanced through training in professionalism and bioethics. Also through dedicated training in crew resource management, human factors or non-technical skills, we can prepare our future healthcare professionals to work in healthcare teams where quality and safety in clinical practice can be ensured. Medical schools cannot do all these alone. We need to partner with all the major stakeholders including healthcare providers such as the Hospital Authority and our local regulator. Active participation in the education processes won’t benefit only our future healthcare professionals, it could be a powerful change agent to the current staff and the service units and will bring mutual benefit. Through synergizing our effort, we can produce safe and competent doctors to serve our patients in the community.  

There are challenges of teaching junior doctors on patient safety. For junior doctors, particularly interns, those at the start of their professional career, found it difficult to identify with patient safety as a discipline, so they did not prioritize it. In part this was because those with little clinical experience found it hard to relate to patient safety when presented as an abstract academic concept. The lack of explicit focus on patient safety was an obstacle, as was competition for interns’ attention from other aspects of their busy clinical duties.   Junior doctors responded positively to several ways of learning patient safety. These include:  (1) learning from patients, particularly through patients’ stories. Story-telling is an effective form of communication.  (2) Learning from medical errors and adverse events, and applying tools such as root cause analysis to identify lessons that could be learnt from them. Real-life incidents capture the attention of interns and junior doctors instantly. Complicated incidents and lessons learnt can be illustrated with a combination of images, audio and movement in an animated story. Animated stories present heavy content in a refreshing and interesting way, make learning engaging and interactive for contemporary doctors.  (3) Integrating safety teaching into clinical placements, with an explicit focus on patient safety, offer to interns’ actual or simulation training module.   

Recent pedagogical focus has shifted from teacher-orientated knowledge transfer to outcome-based learning. In an undergraduate orthopaedic teaching module, Student Learning Outcomes (SLO) are explicitly specified right at the start of the module. To help students cope with the SLO through harnessing advancement in information technology (IT), a web-based SLO Mapping Platform (the SMP) supporting multimedia teaching materials was constructed in phases.  SMP-I represented the first phase through incorporation of three key components within one single hub: (i) the learning outcomes mapped with (ii) a comprehensive archive of electronic homemade learning materials and (iii) self-assessment exercises. Following the success with the initial SMP-I, an upgrade version was developed, the SMP-II, engineered with an advanced attribute-based Performance Analysis Reporting (PAR) System that was coupled with a MCQ bank and its attribute-dependent examination paper generator. In addition, a discussion platform was installed for student’s upload of questions on academic topics, constructive messages regarding teaching arrangement or appreciative remarks that can be most incentivizing for teachers to continue teaching out of their busy work schedule. To understand whether the SMP was serving our students well, surveys were conducted to collect feedback questionnaires and other outcome measures. Among 232 students recruited to fill in acceptance and usefulness questionnaires with a “1-6” Likert Scale, the average scores for various items ranged from 4.67 to 5.08 indicating very satisfactory outcomes. As for the PAR System, 168 Year-5 medical students underwent a mid-module Formative Assessment (FA) of 30 A-type MCQs covering ten orthopaedics sub-topics. PAR was released shortly after the FA for students’ reference on study adjustment. Feedback questionnaires were used to evaluate users’ acceptance. The performance at the final examination was compared between two consecutive years without and with PAR respectively. Feedback questionnaires' average scores for various items ranged from 4.01 to 4.36 in students (n=147) and from 4.50 to 5.25 in teachers (n=14) indicating good results. Mean scores on A-MCQ items at the final examination increased from 27.04±3.03 in 2014 (n=167, without PAR) to 28.33±3.26 in 2015 (n=168, with PAR) (p< 0.05). The evaluation so far indicated a very satisfactory outcome with the SMP, both for its initial form and the subsequent SMP-II. Students found the SMP a useful learning tool with clear layout. Given its acceptance and usefulness for an undergraduate program, and improvement in students’ academic performance associated with its use, the SMP is an effective web-based teaching and learning tool not only for orthopaedic modules, but also for other professional training programs requiring low cost for long-term administration of this IT platform.  This project was supported by UGC Teaching Development Grant (2009-12 & 2012-15 Triennium)  

In our daily practice, we aim to improve patients' outcome by providing all sorts of treatment modalities. However, are we really creating suvivors and not victims? Studies have shown that patients discharged from ICU may suffer from post ICU syndrome, in which patients will be manifested as impairment in physical, cognitive and mental health. Apart from ABCDEF bundle (A-assess, prevent and manage pain; B-both spontaneous awakening and breathing trials; C-choice of medication management; D-delirium; E-early mobility and exercise; F-family engagement and empowerment), appropriate nutrition therapy can improve patients' outcome. There are a lot of convertrosies in the field of critical care nutrition, but the basic concept is to start early when the patient has adequately resuscitated, not to give too little or too much. We should bear in mind that every patient is different and one size does not fit all. Therefore, when we are considering nutrition therapy to our patients, we should provide assessment for individual patient.  We will encounter different obstacles during the journey of nutrition therapy. It is important for us to identify those obstacles and try to overcome them with the aim to reduce interruptions during nutrition therapy. It is also a time to review the role of gastric residual volume; which is a tradition to guide enteral feeding tolerance, and the establishment of nutrition therapy team (NTT) should be considered. Our local position statement for critical care nutrition is currently under construction, with the support from Hong Kong Society of Critical Care Medicine (HKSCCM) and Hong Kong Society of Parenteral and Enteral Nutrition (HKSPEN). Hopefully this position statement can serve as a guide of nutrition therapy for critically ill patients in our locality.

In resource limited regions, many critically ill patients receive invasive mechanical ventilation in a non-ICU/designated high-care environment. In Hong Kong there are different models-of-care provided for this group of patients in general wards: unstructured care in general wards, or a designated ward with either a designated ventilation team, or a supporting team from ICU. We conducted a prospective observational cohort study to evaluate outcomes, and whether different models-of-care are associated with mortality. Data from 7 hospitals, from January to April 2016, was recorded. Hospital mortality, and time from study recruitment to death, or 90 days, was recorded. Standardized mortality ratio (SMR) using the Mortality Probability Model (MPM III) was calculated. Cox regression was used to estimate the hazard ratio (HR, with 95% CI) for comparing mortality between models-of-care, taking hospitals clustered within models-of-care into account. We excluded 185 patients either undergoing limitation-of- life-support within 24 hours, or being cared in one hospital adopting a different model-of-care (only 15 eligible patients), the analysis was based on 285 patients, with 3 different models-of-care: Model A: Designated ward/no designated ventilation team/supporting team from ICU (1 hospital) Model B: Designated ward/designated ventilation team/no supporting team from ICU (2 hospitals) Model C: No designated ward/no designated team/no supporting team from ICU (3 hospitals) Of 285 patients, 173 died (61%, 95% CI: 55%-66%) in hospital, and 187 (66%, 95% CI: 60%-71%) had died within 90 days after intubation. Overall SMR was 1.82 (95% CI:1.56-2.11). In the cox regression model, stratified by mechanical ventilation duration (< 48h vs ≥48h), and adjusted for MPM III score and causes for respiratory failure, there was a significant difference between models-of-care (P< 0.001). Discrimination was acceptable (c-statistic=0.71). A designated ward, and a ventilation team or supporting team from ICU may improve survival.

As the survival rate in critically ill patients improves, the morbidities and the long-term complications of the intensive care unit (ICU) survivors are increasingly recognized. Among these chronic morbidities, Intensive Care Unit-acquired weakness (ICUAW) is one of the commonest. It is defined by the American Thoracic Society as a syndrome of generalized limb weakness that develops while a patient is critically ill without alternative explanation other than the critical illness itself. The incidence of ICUAW was reported to be 25.3% to 100%. ICUAW is associated with prolonged mechanical ventilation and ICU length of stay (LOS), as well as high ICU, hospital, and 1-year mortality rates, and persistent functional disability even up to 5 years. Despite there are growing evidence that early mobilization may improve the outcomes of critically ill patients, the practice among varies ICU are very variable. This is related to certain organization factor and practical barrier. Even so, it is worthwhile for us to identify and overcome the barriers to early mobilization.

The increase in prevalence of obesity among children is a worldwide problem. Obesity in childhood is associated with long term morbidity and mortality. A sustainable and effective program for treatment of childhood obesity is important. Prevention is always better than cure, promotion of healthy lifestyle should also be a common goal by different stakeholders in the community. From September to November 2018, I underwent a three month clinical fellowship at the Endocrine and Diabetes Unit, BC Children’s Hospital in Vancouver, Canada. During these three months, I had the opportunity to participate in the care of paediatric patients suffering from endocrine diseases and know the model of obesity care in the British Columbia. “Shapedown” , BC province’s free obesity program, is a family centred, multi-disciplinary program which accommodats the complexity of behaviors and/or cognitive skills as well as the need for enhanced support for behavior change. The team workers include family physician, dietician, mental health specialist and exercise specialist. The target is to promote active living and healthy eating through a no-diet, holistic approach. Both participants and their parents are assessed before joining the program that they are prepared to make changes and attend on a regular basis. The program is in partnership with YMCAs and recreation centres, for encouraging physical activities and family participation.  In British Columbia, Canada, SCOPE ( Sustainabe Childhood Obesity Prevention through Community Engagement) is a community program focusing on the spread of message of “Live 5-2-1-0”  to prevent the occurrence of obesity . The “ Live 5-2-1-0” messages include daily targets of : i) Enjoy 5 or more portions of vegetables and fruits; ii) No more than 2 hours of screen time; iii) Play actively for at least 1 hour and iv) Zero sugar-sweetened drinks.   

With service commencement of Hong Kong Children’s Hospital in 2018, five paediatric oncology centres will be merged into one tertiary centre. In order to cope with the service needs, I had attached to Great Ormond Street Hospital for Children in London, aiming to find out good clinical pharmacy practices and service models that can be incorporated into paediatric oncology patients in HK.  The presentation illustrates through a patient journey from diagnosis to discharge, to see how pharmacists provide patient-centered pharmaceutical care in different dimensions, and to appreciate how pharmacists evolved from traditional gatekeeper to proactive therapeutic advisor in paediatric oncology area. Inspired by oversea pharmacists’ works, our future service model will be discussed.   

The World Health Organization (WHO) defines palliative care for children is the active total care of the child’s body, mind and spirit and also involves giving support to the family. With the social and medical advances, more infants or children can live longer with medical complex condition. Many of them are receiving extensive medical and nursing care to sustain their lives. With the innovation of health care, the Paediatric Palliative Care was highlighted and aims to improve quality of life of children and support the families. Although Adult Palliative Care was well developed in Hong Kong, Paediatric Palliative Care services were underdevelopment. It may be due to the relatively low demand.  The three weeks observational visit of Paediatric Palliative Care in SickKids enables us to broaden our vision in palliative care. SickKids provides facilities which promote the child and family-centred care to patient and family. The hospital was decorated with child-friendly environment with colourful wall painting. Family space such as Marnie’s lounge, Samsung Space and Women’s Auxiliary Play Park for patient and family members to play and rest in a safe environment and experience normalcy while at hospital. Family Centre provides a lot of information about the disease management and prevention. The Paediatric Advanced Care Team in SickKids provided child and family-centred care. They planned and delivered care collaboratively by an interdisciplinary team. The purpose was to provide optimal comfort and quality palliative care. They discussed the goals of care which reflected the values and preferences of life-limiting child and their family members to maximize the quality of life of the child. Acute Pain Service in SickKids provided services on prevention and management of pain. Through the guidelines of pain assessment, they used appropriate pain management to minimize the pain.  

Objective and Purpose of the Overseas Training Sickkids Toronto is a research-intensive and worldwide famous institute which dedicates to improve children’s health in Canada. It offers comprehensive services across a wide range of pediatric clinical specialties. Through partnership with the University of Toronto, it provides teaching & training to healthcare workers locally & globally. We are honor to participate in the one-month training in Sickkids Toronto. The main theme was to visit hematology & oncology unit & to look for good practices that could be translatable to Hong Kong local setting.  Key Activities The overseas training was held from 26th February to 23rd March 2018. We had ward visit to observe ward settings, nurses’ daily practices & operation. We had plenty of chances to interact with healthcare workers there & exchange experience. It was impressive that Sickkids Toronto has a concrete schedule of training for all new comers & plenty of update courses for experienced nurses, which we attended some of them. We also visited the late effect clinic, sat in meeting with palliative team, visited Emily’s House (children hospice) & met with pediatric interlink community cancer nurses. We even had chance to visit places & to meet people other than hematology & oncology unit which work closely together; for example the Acute Pain Service Team, the Image Guided Therapy (IGT) unit to observe insertion & removal of central venous catheter in operation theatre, tour to families friendly spaces & Good-To-Go Program. The one-month trip was fruitful, inspiring & enlightening.  Outcomes & Experience Sharing This year, the scientific programme of the HA Convention 2019 focuses on the HA’s core values, namely “People-centred Care”, “Professional Service”, “Committed Staff” and “Teamwork”. Speaker will try to conclude & share her experience in Sickkids Toronto under these four HA core values. Some of them are totally innovative to local setting & some may inspire how we could improve our current practices.   

The Orthoptic service in HK is teamed with the general Ophthalmology service to serve patients of all ages. With the opening of Hong Kong Children Hospital, it is necessary to re-engineer the Orthoptic service to meet the specific needs of children, the requirements of paediaric ophthalmologists and paediatricians. In order to gain insight and learn from other successful models, a visit to Guys and St.Thomas NHS Trusts in UK was arranged. 

IntroductionRehabilitation therapy is of paramount importance to help individuals recovering from illnesses and rebuild their lives in returning to the community. Increased rehabilitation intensity (including weekend therapy) has improved outcomes in different patient populations. A multidisciplinary rehabilitation program involving Physiotherapists, Occupational therapists, Nurses, Medical social worker and community NGO was launched on weekends and public holidays for stroke patients in Shatin hospital (SH) since 1 October 2017.ObjectivesTo evaluate the benefit of the new multidisciplinary 365-days stroke rehabilitation service modelMethodologyStroke patients admitted to SH from 1 October 2017 to 30 September 2018 receiving daily rehabilitation services were recruited (365 group). Their clinical and service outcomes including Modified Functional Ambulation Classification (MFAC), Modified Rivermead Mobility Index (MRMI), Bergs Balance Scale (BBS), Modified Barthel Index (MBI) and Functional Test for the Hemiplegic Upper Extremity (FTHUE) for functional independence; Montreal Cognitive Assessment Hong Kong Version (HK-MoCA); Response Time of initial assessment and treatment (RT); Length of Stay (LOS) and Patients & Caregivers Satisfaction Survey were collected and compared with the data of patients with the same diagnostic group captured in 1 October 2016 to 30 September 2017 (non-365 group).Results & OutcomeTotal of 185 patients were recruited in the 365 group. 87% was infarct type of stroke and 13 % was hemorrhagic. 95 of patients were male and 90 were female with mean age of 74.37 +/- 11.23 years old. Their functional and cognitive outcomes were all significantly improved (p< 0.05) in the 365 group compared with those of non-365 group (mean difference of MFAC change: from 0.65 to 1.09; mean difference of MRMI change: 4.46 to 7.99; mean difference in BBS change: 7.07 to 11.49; mean difference in MBI change: 7.89 to 12.11; mean difference in FTHUE change: 0.61 to 0.84; mean difference in HK-MoCA change: 0.84 to 1.34) with comparable LOS (20.732 +/- 8.77 days to 20.730 +/- 8.49 days). The RT was 53% faster than the non-365 group. For the Patients and Caregivers Satisfaction Survey, higher satisfactory scores were obtained in terms of treatment frequency, treatment intensity, response time, patients’ confident upon discharge, caregiver participation and overall service provision in 365 group compared with the non-365 group of patients. In conclusion, the newly-launched 365-days multidisciplinary service model in stroke rehabilitation achieved better functional and cognitive recoveries, higher patients and caregiver satisfaction to service with comparable hospital stay. Data collection should be continued and regularly review for continuous service improvement.  

IntroductionCompared to conservative management alone, patients with moderate-to-severe knee osteoarthritis treated with total knee arthroplasty showed a better pain relief and functional outcome. However, post-operative pain relief remains an important challenge. Considering steroid as an adjunct to the multimodal analgesic regime, it can reduce post-operative inflammation and surgical stress response. However, the effect of systemic steroids on post-operative pain control for total knee arthroplasty in Chinese population has yet been studied. Majority of the randomized-controlled trials focused on post-operative control of pain, nausea and vomiting, the data for improvement in range of movement in total knee arthroplasty was scarce. No studies investigated on patient’s satisfaction towards post-operative pain control with intravenous steroids in total knee arthroplasty. ObjectivesThe aim of this study was to investigate the effect of pre-operative high dose methylprednisolone on pain relief and recovery after total knee arthroplasty in Chinese population.MethodologyThis is a prospective, randomized, double-blinded, placebo controlled single-centre trial. 60 patients undergoing elective primary unilateral total knee arthroplasty during June 2017 to March 2018 were randomized into intervention and control group. The pre-operative, intra-operative and post-operative anesthetic and analgesic regimes were standardized. The intervention group received an additional of 125mg methylprednisolone intravenously on induction of anesthesia. Subjects were assessed at 24, 30, 48 hours after surgery and upon discharge by physiotherapists. In each assessment, rest pain and pain on movement from operated knee were assessed with 100mm visual analogue scale. Range of movement from operated knee was also charted. Patient's satisfaction were documented. C-reactive protein level before and after operation was calculated. Adverse reactions were documented. Subjects were followed up at 6 weeks and 4 months. Results & OutcomeRest pain and pain on movement, including straight knee raise, maximal knee flexion and walking with frame for 5 metres, were significantly reduced in the methylprednisolone group at 24 and 30 hours after surgery then the placebo group (ANOVA p=0.030, p=0.003, p=0.032, p=0.010 respectively). The methylprednisolone group demonstrated a greater range of movement from the operated knee at 24-hour and 30-hour post-operative assessment (ANOVA p=0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p< 0.001). Patient's satisfaction was higher in methylprednisolone group(p< 0.001). Incidences of hypokalaemia, hyperglycaemia and sleep disturbance were not statistically significant. No wound complications were noted at 6-week and 4-month follow-up. Pre-operative intravenous methylpredinsone can improve post-operative pain and range of movement after total knee arthroplasty. It can act as an effective adjunct in the multi-modal analgesic regime.  

IntroductionChildren with Chronic Kidney Disease (CKD) were reported to have reduced exercise capacity, including muscle strength and aerobic fitness. This may reduce their functional ability. Physical training may help improve their exercise capacity.ObjectivesTo study the efficacy of the physical training program in improving the exercise capacity of local children with CKD.MethodologyA four-week exercise training program with two sessions each week was conveyed to local children with CKD. The training program consisted of education on proper exercising, cardiopulmonary training, muscle strengthening, and establishment of exercise habit. Inclusion criteria of subjects were (1) age 11 to 18, (2) medically stable for exercise, (3) volitional participation. Outcome measures were (1) muscle strength: right and left handgrip (HGR, HGL), shoulder abductors (ShA), elbow flexors (ElbF), hip flexors (HipF), knee extensors (KnE), knee flexors (KnF); and (2) aerobic fitness: distance walked in 6-minute-walk-test (6MWD) and Fitkids Treadmill Test Endurance Time (FTTET). All outcomes were measured at baseline (within four weeks pre-program) and after intervention (one week post-program). Non-parametric Wilcoxon Signed Ranks Test was used to assess pre- and post-program differences because of the small subject number (< 30). Results & OutcomeFifteen subjects, with age 13 to 18 (15.36±1.8), were recruited. Eleven of them (72.2%) completed the training program and evaluations. Muscle strength (HGR, HGL, ShA, KnF), and aerobic fitness (6MWD, FTTET) were significantly improved post-program. (1) Muscle strength: HGR improved from 30.5±20.3lbs to 49.07±17.6lbs (p=0.004), HGL from 24.82±20.53lbs to 46.52±16.46lbs (p=0.004), ShA from19.86±5.24lbs to 24.5±6.3lbs (p=0.013), KnF from 24.88±8.05lbs to 30.14±6.73lbs (p=0.016); (2) Aerobic fitness: 6MWD improved from 442.45±69.14m to 518.72±61.78m (p=0.003), FTTET from 7.55±2.86min to 9.84±1.8min (p=0.004). Conclusion: The exercise capacity of local children with CKD can be improved by a four-week program of physical training, especially in the aspect of aerobic fitness. The long-term effect of the program should be further investigated.  

IntroductionThe 2016 statistics from Department of Health indicated that 86.8% of mothers breastfed their babies at discharge, but the breastfeeding rate dropped to 55.5% at 4 months after delivery. Of the many reasons that mothers stopped breastfeeding, painful blocked ducts leading to reduction of milk production is a known cause of premature cessation of breastfeeding. Although there several studies have assessed the effectiveness of using therapeutic ultrasound to clear ductal blockage, there is only limited information on the pain reduction for these mothers.ObjectivesA Lactation Consultant Clinic was set up in Dec 2017 in collaboration with Physiotherapist to provide ultrasound therapy for mothers with the problem of blocked ducts.MethodologyLactating mothers with blocked ducts would be referred to the Physiotherapist for ultrasound therapy. The study period was from December 2017 to November 2018. The pain score pre- and post- ultrasound therapy was assessed by Numeric Pain Rating Scale (NRPS); and milking and hand expression was performed by Lactation Consultant immediately after the treatment. Phone follow-up was done to evaluate the effectiveness and the feeding pattern after 4 months.Results & Outcome91 mothers who attended the Lactation Consultant Clinic had USG therapy performed for blocked ducts within the study period. 18.7% (17/91) and 38.5% (35/91) of them expressed breast refusal or were separated with their babies after delivery. The percentage of pain reduction during the first USG therapy were 54.0 ± 28.3 and 55.0 ± 28.8 from the right breast and left breast respectively. The percentage of pain reduction during the second USG therapy were 45.8 ± 29.0 and 49.7 ± 26.0 from the right breast and left breast respectively. 80 mothers were successfully contacted at 4 months after the treatment. 16.3% (13/80) of mothers had exclusively breastfed their babies, 35.0% (28/80) of mothers gave breast milk by direct latch on or expressed breast milk. 25.0% (20/80) of mother gave expressed breast milk and formula, while 23.8% (19/80) of mothers had stopped breastfeeding. In order to assist mothers to solve the problem of blocked ducts, massaging and expression by hands is a vital, but very painful procedure. Nevertheless, ultrasound therapy could help in reduction of pain and increased the milk flow. This would be a therapeutic option for the Lactation Consultant to manage blocked mammary ducts and preventing the occurrence of mastitis.   

IntroductionChronic knee pain affects 31% of elderly in Hong Kong (HK). The waiting list for total knee replacement (TKR) was doubled dramatically from 2014 to 2018. Guidelines recommend exercise and self-management education as core management for knee osteoarthritis (OAK). The National Health Service of the United Kingdom adopted an evidence-based ESCAPE-knee pain programme, mandatory before TKR. Cultural adaptation of this programme was undertaken for HK Chinese –Integrated Exercise and Self-management Programme (IPES-knee) – and found to be feasible in clinical application and acceptable to patients. Potential improvement in exercise adherence and health care utilisation was found at one-year follow-up compared with usual physiotherapy. The next step was adoption and implementation of IPES-knee in local clinical setting while maintaining fidelity for effectiveness.Objectives1) To adopt IPES-knee for implementation of local OAK management 2) To observe retention rate and clinical benefits of IPES-knee in a physiotherapy out-patient clinic (PT clinic); 3) To compare outcomes of the shortened IPES with the original ESCAPE-knee pain HK. MethodologyThe original 10-sessions programme was modified and shortened to match with local demand and current manpower situation. A physiotherapist led discussion on self-management and exercise in all six-weekly sessions, 75-minutes each. Topics included exercise benefits, goal-setting, flare-management and others. One-day staff training was conducted to update evidence on OAK, management strategies, ESCAPE-knee pain and motivational skills. IPES-knee was provided to OAK patients referred to the PT clinic. Patient demographics and attendance were recorded. Outcome measures included Knee injury and Osteoarthritis Outcome Score (KOOS), Patient-specific Functional Score (PSFS), Self-efficacy for Exercise (SEE-C), walk-speed and chair-stand tests, numeric pain (NPR) and global improvement (GIR). Descriptive statistics was analysed for completers and defaulters of the programme. Results & OutcomeIn 2018, 464 OAK patients received IPES-knee. A total of 323 (69.6%) patients completed the final visit (mean 5.91 sessions), with 68.1% female, mean age 66.0(SD 8.5), body-weight index 26.6, and pain for 4 years. Those defaulted (2.4 sessions) were excluded from the analysis and did not differ from completers in their baseline characteristics except 2 years younger. All outcome measures showed significant improvement (p=.000): KOOS-pain 8.13(15.12)/100, physical function 7.15(15.39)/100, quality-of-life (QoL) 7.67(18.88)/100 points; PSFS 1.67(1.66)/10; SEE-C 1.52(2.24)/10; walk-speed 0.19(0.63) m/s, chair-stand 2 times and GIR 5.52/10 points. The Cohen'sd for pain, PS and QoL were 0.48, 0.41 and 0.40 respectively. Compared with the original study, the shortened IPES-knee showed 50% as good in pain and QoL, 70% in reported functions and 100% in physical testing. IPES-knee is recommended as territory-wide implementation for OAK management under constraints.   

IntroductionAccording to the Centers for Disease Control and Prevention, falls are the most common cause of fatal and non-fatal injuries among older adults over the age of 65. Falls can lead to a myriad of traumatic physical & emotional consequences and discourage older adults from engaging in meaningful activities. As fall is multi-factorial, new approach to address individualized need is important for better outcome. The Lifestyle integrated Functional Exercise Program (LiFE), has been proven to prevent falls and decrease the fear of falling in older adults worldwide. LiFE uses an occupation-based approach by incorporating balance and strengthening activities into individual’s lifestyle routine. Training is therefore accessible and elderly are better motivated. Compliance to training regime is improved. To meet worldwide fall prevention standard, Occupational Therapists (OT) have introduced and developed this worldwide fall prevention program for community dwelling elderly in Hong Kong (HK).ObjectivesTo reduce fall rate and medical utilization for community dwelling elderly with fall risks through the LiFE program; and to develop a common practice guidelines in fall prevention for community dwelling elderly based on the LiFE program to enhance evidence-based practice for OT in Hong Kong. Methodologythe development of local LiFE program consists of three parts: 1)Local program content development  Collaborated with the Hong Kong Occupational Therapy Association and the University of Sydney for development and clinical application of the HK LiFE program in 2015  Established a task group on the HK LiFE program under the Elderly Specialty Group & Family Medicine Specialty Group, OTCOC, HA in 2015  Translated LiFE Participant’s and Trainer’s manuals (Chinese version) with internal peer reviewed. Manuals were published and trial used in HK in 2017 and 2018 respectively 2)Staff training and engagement  Conducted commissioned training and workshops on HK LiFE program for HK OT in 2017 and 2018 respectively 3)Clinical application  Implemented the HK LiFE program in HA OT Departments and conducted cross clusters pilot study in 2017Results & OutcomeHK LiFE program was developed in 2017. A total 155 HK Occupational therapists in 7 clusters (13 acute and 7 rehabilitation/ convalescent hospitals) were trained of the program. HK LiFE Participant’s and Trainer’s manuals (Chinese version) were standardized and adopted in the OT departments in the 7 clusters. A total of 8 patients were recruited from 7 clusters and 8 OT units (include GDH, NAHC-Fall Prevention Clinic, SOPD, COT, ICDS) for the cross clusters pilot study from July to Oct 2017. Their mean age were 79.5 (SD 6.1) and mean program session were 7.7 (SD 2.0). Paired samples t-test revealed that there was significantly reduced in fall rate (1.2 to 0, p=0.00), hospital admission (0.5 to 0, p=0.03) and AED admission (0.87 to 0, p=0.00). Significantly increased balance outcome (Tandem walk time, p=0.00) & fall efficacy (ABC, p=0.01) and increased travelled distance (life space index, p=0.00). Patient feedback of the program was promising. Conclusion: Result of the pilot trial of the HK LiFE program to local community dwelling elderly was found effective. The HK LiFE program is a new approach to fall prevention in OT which addresses individualized needs through embedding fall prevention training with routine functional daily activities. Further review after more extensive application of the program and a cross-cluster research on its effectiveness are highly recommended.  

IntroductionNumber of studies suggested that Non-invasive Brain Stimulation techniques including repetitive Transcranial Magnetic Stimulation(rTMS) and Transcranial Direct Current Stimulation(tDCS) could enhance upper limb functional recovery in chronic stroke patients. However, results obtained in chronic stroke patients are not necessarily similar to those in acute stroke. Thus, a study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients.ObjectivesTo examine and compare the effects of rTMS and tDCS on enhancing upper limb functional recovery in acute stroke patients.MethodologyPatients diagnosed with Stroke less than 14 days and with wrist and fingers control of Oxford Manual Muscle Power Testing System Grade 2 or above were recruited from the Rehabilitation Stroke Unit of TMH. Patients with contraindications to rTMS/tDCS were excluded. Patients were assigned to rTMS, tDCS or control group. For the rTMS group, inhibitory stimulation was conducted to Abductor Pollicis Brevis area of the unaffected hemisphere. Patient received 1200 pulses of 1Hz rTMS at 90% of resting motor threshold. Five consecutive sessions of rTMS together with intensive physiotherapy upper limb training were given. For the tDCS group, anodal stimulation by tDCS was conducted to hand area of primary motor cortex of the affected hemisphere. Patient received 1mA tDCS for 20 minutes. Five consecutive sessions of tDCS together with intensive physiotherapy upper limb training were given. For the control group, five sessions of intensive physiotherapy upper limb training were given. The upper-extremity section of the Fugl-Meyer Scale (UE-FM) was used as outcome measure. Kruskal-Wallis H Test and Mann-Whitney U Test were used for statistical analysis. Results & OutcomeThirty-six patients (18 female and 18 male) were assigned to the rTMS (n=12), tDCS (n=12) and control (n=12) group. The mean age was 60.9 ± 11.7 years old and the mean time between stroke onset and the first UE-FM assessment was 9.56 ± 3.18 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups. (X2(2)=5.07, p=0.08) (X2(2)=1.05, p=0.59) (X2(2)=0.49, p=0.78) No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.3 ± 6.03) and tDCS group (16.6 ± 5.04) were statistically significantly larger than that in control group (9.67 ± 3.89). (U=-3.65, p=0.000) (U=-3.04, p=0.001), however there was no significant difference between rTMS and tDCS group (U=-1.45, p=0.16). Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neuro-rehabilitation.   

Resuscitative thoracotomy is an uncommon event that can yield good survival rates (27% blunt trauma and 42% penetrating trauma) when clear clinical triggers and appropriate training have been introduced. This presentation will review the decision processes required, the outcomes expected, and the training required – using The Alfred and the Pamela Youde Nethersole Eastern Hospitals program as an example.  

Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) is indicated to be used in exsanguinating pelvic fractures not responsive to fluid resuscitation. In primary survey, there has been no less invasive and effective means to stop internal non-compressible bleeding in exsanguinating pelvic fractures. Before the introduction of REBOA, the patients can only be managed by the following ways with their respective limitations: - Fluid resuscitation and blood transfusion: these are not targeted on hemorrhage control but circulation replenishment which is recently proven to be harmful - Application of pelvic binder: this is with limited efficacy - Cross-clamping of descending aorta through thoracotomy wound for bleeding control: this is seldom practiced locally Those non-responders or partial responders to fluid resuscitation cannot be saved or suffered from a stormy postoperative course in ICU with significant mortality because of massive blood loss and blood products transfusion. REBOA can have temporary control of bleeding for initial assessment and resuscitation and buy time for effective surgical planning and definitive treatment. The procedure of REBOA is to be performed on the resuscitative table in AED resuscitation room for initial bleeding control, followed by definitive treatment including 3-in-1 procedures in the operation theatre. Current evidence from the literature supports the use of REBOA. Training courses for designated operators have been organized before patient use, in order to ensure safety and minimize potential complications of the procedure.  

In Hong Kong, blunt trauma prevails. Carotid artery is vulnerable to be injured in different common mechanisms like hyperextension in neck whiplash, stretching of the carotid by mandibular or LeFort’s fractures occurred in fall or motorcycle accidents. Blunt carotid artery injuries account for 3 to 10% of all carotid injuries and 1% of blunt trauma cases. It is not common but not rare. It has high neurovascular sequela if left untreated and unnoticed. The natural progression and presentation is bizarre, from asymptomatic initially, vague neurological and vascular soft signs, to stroke within 30 days. Carotid blunt trauma does respond to medical and surgical treatment if it is diagnosed early. In the late 90’s, different trauma centres have been looking into and tried to predict the occurrence of blunt carotid trauma from various signs, symptoms and risk factors of concomitant injuries. If the patients fit the screening criteria, they should have an imaging within 12 hours. Screening modalities are CTA (60%), MRA (22.8%), conventional arteriography (15%) or duplex USG (1.7%). Denver group further grades the disease with the injury morphology, stroke rate, mortality rate, progress and suitable treatment modalities. The goals are to minimise disease progress, decrease ischemic event and improve neurological deficits. In the endovascular era, the inaccessible part of the carotid can be accessed and treated by stenting together with medications like Aspirin or anticoagulant. In KCC, a conjoint screening programme was embarked in 2018 based on the signs, symptoms and the associated neighbouring fractures to look into this under-diagnosed but disabling disease.  

Point of Care Testing (POCT) is becoming increasing popular in different specialties of medicine. It has gained its popularity and recognition gradually over recent years. It allows for real-time and rapid assessment of patient status. It is especially important for those situations in which the patient status is changing rapidly, for example, dire medical emergencies, dire surgical emergencies, haemorrhage situations (including trauma, post-partum haemorrhage, major surgical reconstruction cases), transplants, etc. It allows for rapid titration of our management to the rapidly changing patient’s needs. This facilitates the success of management of modern medicine and surgery. In major trauma cases, severe bleeding is commonly encountered. How to control the bleed and to minimize the bleed is the key to successful management. Apart from good surgical skills to control the bleeding source, optimising the patient’s haemostatic environment is also very important. In major trauma cases, very often, torrential bleeding is frequently encountered. In these cases, various processes involved in haemostasis (clot formation, clot stabilisation, fibrinolysis) are all changing from minute to minute. How to monitor these changing parameters on real-time basis can be the key to success. This supports the Anaesthesiologist to tackle the lethal triad (coagulopathy, acidosis and hypothermia). Point of Care Test (POCT) is increasingly used in different major Trauma Centres in different parts of the world (Europe, Australia, Asia and US). Sonoclot, TEG, ROTEM are different viscoelastic technologies providing POCT test on haemostatic profile. Studies have shown that this allows for reduction in consumption of blood products in major bleeding cases.

The Healthcare Safety Investigation Branch was established by the English healthcare system in 2017 to investigate serious, systemic, patient safety issues using approaches developed from aviation and other safety critical industries. The Chief Investigator is a former pilot who led the UK’s Air Accident Investigation Branch and investigators are from a range of backgrounds including healthcare, air, military and marine accident investigation and academia. Our investigations do not seek to apportion blame or liability but are based on human factors and just culture principles. The UK government is developing legislation to offer legal protection for witness statements given during the course of investigations, which is standard practice in aviation. Although many healthcare systems use Root Cause Analysis (RCA) to investigate patient safety events, most other safety-critical industries use a range of other methods based on human factors principles. We have carried out patient safety investigations using a variety of such models and have found that these models might be better suited to the complexities of healthcare than RCA. Learning objectives; By the end of this session delegates will be able to; 1. Understand the basic principles behind alternative investigation models and how we have used them in healthcare. 2. Understand the benefits and challenges of adapting approaches from aviation and other industries to healthcare. 3. Learn about some of our experiences in undertaking patient safety investigations using different methods.  

This session will describe how to use improvement science to drive improved outcomes in patient safety. The session will demonstrate how the model of improvement can empower frontline clinical teams and their patients to drive improvement. The approach will describe how the Lens of Profound Knowledge by Demming can be a leadership tool to build capability in your organisation for safety and improvement.  Taking a strategic approach to building capability in your organisation in the expert areas of improvement science, measurement and change is pivotal. After this session you will: - Understand the link between building capacity building and creating the conditions for change to thrive. - Understand how local data can be used as a tool for discussion not judgement and empower clinical teams - Understand how to take a strategic approach to capability plans for improvement and safety  

Performance Management is an important issue in organization performance. The current performance appraisal tool in Hospital Authority is Staff Development Review (SDR), which was implemented since 1994. The objectives of current SDR are focused on development based on the achieved result; strengthen management planning and control process; identify; constructive communication and future appointment decision. There was no formal review of effectiveness and process of the appraisal along these 25 years. A pilot study was conducted in a local hospital in 2018. The objective is to review the effectiveness, process and implementation of the current appraisal; and comparing the results with the international studies and make recommendations. Assessment the possibility of implementation of latest Worldwide performance management revolution in Hong Kong Public Hospital was also conducted.

Most doctors provide a high standard of care to their patients. In addition to expertise in their specialty, they must also demonstrate important generic professional capabilities which are essential to providing safe and effective patient care. These broader human qualities – such as being able to communicate effectively, to work as part of or lead a team, to teach or educate and to apply a range of other professional skills or judgements in complex or difficult circumstances – are in combination the foundation of professional practice. In the UK, the General Medical Council working jointly with the Academy of Medical Royal Colleges has been helping medical royal colleges and faculties embed generic professional capabilities into all postgraduate medical curricula from 2017 onwards. United Kingdom General Medical Council data over many years show that most doctors who get into trouble do not do so because of a lack of medical knowledge or technical competence. Most commonly it is because of a failure of professional skills – poor team working or communication, unprofessional behaviour or lack of insight into personal difficulties. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date but also establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law. Good doctors work in partnership with patients and respect their rights to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability. I will explore these concepts and there will be an opportunity for questions.  

Medical professionalism is the belief system that formulates and upholds the values and standards of medical practice. It underpins our social contract with society that allows us to self-regulate and maintain autonomy. Changing expectations from patients and doctors as well as the introduction of disruptive technologies such as genomics and genetics, robotic surgery and big data analytics prompt us to re-think how medical professionalism should be articulated and inculcated in the contemporary era.  The recent establishment of the Professionalism and Ethics Committee by the Hong Kong Academy of Medicine (HKAM) is a response to the challenges. This Committee is tasked to: (1) promote medical professionalism and ethical practice among Academy Fellows through education, training and advocacy; (2) review and advise on the provision of specialty-specific training in medical ethics and professionalism by Academy Colleges; (3) respond to requests by the Academy Council, the Education Committee and others as appropriate, and collaborates with relevant external organizations when necessary, on ethical issues related to the practice of specialty medicine and dentistry, public policy and other Academy matters; (4) identify, examine and bring forward issues of ethical importance deserving the attention of the Academy Council, its constituent Colleges or committees; This paper examines the opportunities for and challenges against these endeavors.  

Risk, in regulatory terms, is usually considered in terms of risk to patients, but students and practitioners may, themselves be at risk  of harm or self-harm in environments where they are unsupported or subject to unreasonable demands. Students and doctors are at risk of poor performance because of: - lack of knowledge and skill (training and CPD) - inability to apply knowledge and skill (personal and external factors) - impairment (mental or physical illness, substance abuse, age related conditions) - lack of professionalism (personality and circumstantial factors) When a student or doctor demonstrates features of both impairment and poor performance, it is essential to deal with their health as the priority. They are unlikely to be responsive to remedial interventions if they are unwell or cognitively impaired. It is a consistent findings across jurisdictions that poor performance is particularly associated with older age, male gender, previous complaints/poor prescribing, isolated practice, international graduates, high volume practice. Recognising these risk factors enables limited resources to be targeted where they are most effective. Clearly, it is desirable to identify potential performance issues early, when intervention (remediation or risk-modification) is easier and before harm, either to patients or the student/practitioner occurs. This often requires a partnership between the workplace and the regulator; the latter offering a range of graded interventions that reserve disciplinary action for a minority of cases. This paper will explore: - the identification of medical students and doctors at risk - work-place interventions - ‘right-touch’ regulatory interventions

Acute ischemic stroke caused by large vessel occlusion (LVO) carries high morbidity and mortality, but is readily treatable if diagnosed early. Expeditious diagnosis and triage of LVO patients to hospitals equipped to perform emergency revascularization treatment maximizes the patient’s chance of good clinical outcome. Current clinical LVO screening tools either lack precision or require specialized personnel to perform comprehensive clinical assessment. The objective of the present study is to develop a novel, rapid and automated computer algorithm capable of detecting and predicting signs and likelihood of LVO. A preliminary model developed with machine learning techniques utilized clinical and imaging data of 300 patients provided by the Hospital Authority. Building on the pilot results, we further fine-tuned the computer algorithm with more patient data and imaging parameters derived from contrast CT-angiograms and CT brain scans interpreted by a team of Neuroradiologists to determine the ‘ground truth’ (i.e., the presence of absence of LVO in individual patients). Deep learning is performed with the information generated to establish a computer algorithm to predict the likelihood of LVO, as well as to assess the feasibility of computer interpretation of CT and CT-angiogram for signs of LVO. Here we present the developmental process and findings of this multi-disciplinary collaborative project, and discuss the potential to apply this innovation in clinical practice.

Background There has been a lot of hype around the application of artificial intelligence (AI) in medical imaging. The number of publications on this subject has exploded lately. However, the vast majority of published studies were about development, validation and postulation of benefit of AI systems. Examples of actual usage of such systems are still scanty. We here share our early experience of actual usage of an AI system to triage non-urgent chest x rays. Aim The chest x-ray is the most commonly performed radiology investigation. Its sheer volume precludes reporting of all of them by radiologist in HA. And for exams reported, report turnaround time has much room for improvement. We aim to apply AI to triage non-urgent CXRs so that those exams requiring early attention could be reported earlier.  Methodology We used convolutional neural network based algorithms and leveraged a public dataset of CXRs to kickstart creation of a prediction model for CXRs. This model was applied to classify non-urgent CXR exams requested by general out-patient clinics into high or low risk such that priority reporting by radiologists can be done for high risk exams. We have performed retrospective virtual simulation of this AI-enabled priority reporting workflow followed by prospective pilot of such workflow in Hong Kong West Cluster. Results Both retrospective and prospective results showed that AI-enabled priority reporting workflow resulted in dramatic reduction in average report turnaround time for CXR exams that required early attention. This was achieved without additional radiologist manpower. Conclusion Employing AI to prioritize non-urgent CXRs translated into shorter report turnaround time for exams that required early attention.   Authors: VSH Chan1, BXH Fang1, ITH Chen2, ESL Yau2, VKL Lau2, EYW Yeung2, PTM Lui2, JCH Wan2, AYH Tong2, MCY Cheng2, JCM Poon2, WWT Chan2, NT Cheung2, YC Wong3, DML Tse1, WWM Lam1, TPW Lam1 1 Department of Radiology, Queen Mary Hospital, Hong Kong 2 Information Technology and Health Informatics Division, Hospital Authority Head Office 3 Department of Radiology and Nuclear Medicine, Tuen Mun Hospital

Phalangeal fractures of the hand are common and potentially debilitating. The majority of these fractures may be treated conservatively. Surgery may speed recovery and avoid complications such as malunion and arthrosis in selected cases. A variety of procedures offer either relative or absolute stability. A review of the management of phalangeal fractures will be presented. Treatment options, rehabilitation and common complications are discussed. Early mobilization of the fractured hand is emphasized since soft tissue recovery can be more problematic than that of bone.  

Introduction With the advancement in surgical techniques and arthroscopic instrumentations, minimally invasive hand surgery has become the most popular treatment options for most common hand diseases. It has proven to have faster patient recovery and lower morbidity. These can be divided into arthroscopic surgery, endoscopic surgery and percutaneous soft tissue surgery. Arthroscopic surgery - Proximal interphalangeal joint (PIPJ) and Metacarpophalangeal joint (MCPJ) arthroscopy: indications include synovectomy for inflammatory arthritis, removal of loose bodies and osteophytes. - Thumb carpometacarpal joint (CMCJ) arthroscopy: indications include synovectomy for inflammatory arthritis, assisted reduction in fracture fixation, hemi-trapeziectomy and fusion for osteoarthritis. - Wrist arthroscopy: it has become the gold standard for detecting intra-articular pathology, including the cartilage status, ligament injury, and the triangular fibrocartilage complex (TFCC). It also has an important role in the treatment of intra-articular distal radius fracture and other carpal bones fracture. Endoscopic carpal tunnel release Endoscopic carpal tunnel release has become the current trend in treating carpal tunnel syndrome. Its advantages include: reduced postoperative pain, faster recovery and earlier return to work and fewer wound-related complications such as scar tenderness. Percutaneous soft tissue surgery 1) Percutaneous trigger finger release - Percutaneous technique by using a needle can accomplish the same surgical result as traditional open surgery with faster recovery and better surgical outcome. 2) Percutaneous fasciotomy for Dupuytren’s contracture - Percutanous fasciotomy for Dupuytren’s contracture can be performed by using a needle under local anaesthesia. It has a lower incidence of nerve injury and reflex sympathetic dystrophy. It also has a faster recovery and less wound complications. Advantages of Minimally invasive surgery Advantages include: 1) less post-op wound pain, 2) faster rehabilitation and recovery, 3) less surrounding soft tissue adhesion, 4) better preservation of surrounding vascularity and 5) better cosmesis.  

Scaphoid, being the ‘keystone’ of the carpus linking up proximal and distal carpal rows, is the most commonly fractured carpal bone, with the peak incidence in young active individuals. Its peculiar anatomy, blood supply and orientation create challenges in the diagnosis and treatment of its fracture. Malunited or non-united fractures alter wrist kinematics, resulted in continued wrist pain, stiffness, and early arthrosis. Most clinical tests showed very high sensitivity but lack specificity individually in diagnosis of scaphoid fracture. Radiographs can sometimes be difficult to interpret due to the orientation and shape of the bone. Early use of advanced imaging like CT or MRI in suspicious cases has been shown to be cost effective when analysing societal cost. For acute non-displaced fracture, cast immobilisation remained effective, with union rate approaching or exceeding that attained with operative intervention. Evidence support equal outcome when using a short arm or long arm cast with or without the thumb spica component. Operative treatment is indicated for unstable, displaced or proximal pole fracture. Clinical and biomechanical data support both volar and dorsal approaches as safe and effective. Location of the fracture therefore dictates the surgical approach. Implants providing rigid fixation have evolved from the original solid screw and jig as described by Herbert and Fisher, to various designs of cannulated headless compression screws, or even plates. Anatomic rigid fixation has been shown to lead to faster time to union, reduced risk of non-union, improved functional outcome and earlier return to work. Minimal invasive techniques, including percutaneous and arthroscopy-assisted techniques, have been developed to better preserve the local vascularity and ligamentous integrity around the scaphoid. Arthroscopy-assisted technique allows better assessment of reduction, fracture stability, vascularity of fracture fragments, associated ligament injury and cartilage status, which can guide subsequent treatment. Bone grafting of reducible non-union can also be performed with such technique. Various local and free vascularised bone grafting techniques were developed since the 1980s, particularly to address non-unions associated with proximal pole avascular necrosis or failed previous attempted surgical treatment. The use of computer-assisted navigation and robotic assistance for more accurate placement of screw has also been investigated in recent years. However, evidence for recommending these techniques is not strong.

Most of the wrist pain following injuries are actually related to injuries to ligament rather than fractures. So most of them may not be revealed on conventional plain x ray. Careful history taking about mechanism of injury and physical examination is he clue to diagnosis and interpretation of MRI need to correlated with physical signs. Without proper diagnosis and treatment the ligament injury may become chronic and develop symptoms caused by carpal instability. The two most common instabilities: scapholunate and distal radioulnar joint instability will be discussed in the lecture.  

Replantation is a surgical process to re-attach a separated body part by microsurgical techniques, aiming to re-establish circulation for survival of the detached part. Since the first replantation was being done in 1963 by Chinese Pioneer Dr Chen Zhong-Wei, there has been a lot of development. 1. Indication: With advancement in technology in surgical instrumentation and magnification, indications for replantation surgery may extend to very distal fingertip amputation, crushed injury or avulsion injury. 2. Refinement in surgical techniques: with better understanding of the anatomy, replantation is more easily to be done as those anatomical structures can be more easily identified. Use of volar veins improved the chance of success. One may also use artery to vein anastomosis in very distal replantation. Other adjunct procedures, such as venous flap or cross finger flaps may also improve survival rate. 3. Ectopic banking: It is a technique used for temporary nourishes the amputated part in a nonanatomical position when immediate replantation is not possible. It is hope later reconstruction is feasible after optimizing the wound condition. 4. Replantation Centers: There are well-established replantation centers in some countries. These established replantation centers would be more equipped with the necessary support for replantation surgery, from transport, post-operative monitoring and rehabilitation. These will also improve outcome of replantation surgery. Hong Kong may consider the development in this direction.  

Hand injuries, especially hand fractures, are known to have a very high incidence rate amongst the other body parts. Being a specialized unit for manipulation, support, sensation perception and communication, hand injuries have a significant impact on patients’ physical as well as psychosocial functions.  Along with the advancement of physiology understanding and evolution of operative techniques, different treatment approaches and stronger reduction are developed to restore the hand anatomy.  Yet complications such as pain, stiffness are not uncommon.   The role of occupational therapists in hand rehabilitation is to maximize the patients’ hand function and capacities to facilitate resumption of their life roles.  Various treatment modalities are employed to restore motion, strength and functions.  The application of these techniques will be discussed in the presentation with case illustrations.  

In order to tackle with the growing pressure on the healthcare system in Hong Kong, it is important for all nurse leaders to develop leadership competencies and build up high performing teams regardless of their level of responsibilities and working background. From 9th to 20th October 2017, a group of six nurses attended the clinical observational training in leadership organized by The Johns Hopkins Hospital in Baltimore, United State. This was the first time to involve a group of nurses from different positions and working background participating in an overseas leadership training program. The Johns Hopkins Hospital is the first Magnet Hospital recognized by American Nurses Credentialing Center for its excellence in nursing care. During this 2-week training, we were arranged to visit different clinical areas including Department of Medicine, Perioperative Services and Preoperative Evaluation Center, Comprehensive Transplant Unit, Adult Emergency Department and Pediatric Emergency Department. Besides, we also attended 3-day Nursing Leadership Academy and one-day Patient Safety Summit. Although the healthcare system in United State is different from Hong Kong, we are now facing similar challenges such as increasing demand for healthcare service and insufficient nursing manpower. Through this overseas visit, we had the opportunity to meet many experienced nursing leaders in The Johns Hopkins Hospital and learned how to engage staff, create high performing teams, promote evidence-based practice, and manage transition and conflicts effectively. As a team, we not only shared the visit journey in various clinical areas in The Johns Hopkins Hospital with each other, but also had fruitful discussion about the challenges we are facing in our own clinical settings from different perspectives. And as a novice at leadership, I cherished what I have learnt from the visit and all groupmates.  

The Corporate Oversea Leadership Program provides a good opportunity to build up the competence of clinical leader and also broaden our perspectives in oversea health care service delivery. The UC San Diego hospital we visited, was bestowed the Magnet recognized health care organization for quality patient care, nursing excellence and innovation in nursing practice. The Magnet Hospital is based on strengths in five key areas as structural empowerment, transformational leadership, exemplary professional practice, new knowledge innovations and improvements and empirical outcomes. The transformational leadership plays a proactive role in the healthcare management that inspiring followers to change perceptions and motivations to work towards the common goals of the organization and creating a sense of commitment. The regular executive patient safety rounds and Nurse Collaborative Round among nurses and the leaders in the UC San Diego hospital can facilitate the mutual learning and sharing of the best practice to enhance safety of patient and quality of care. The periodic clinical nurse workshops act as a good platform to encourage staff to gain recognition through conducting research to develop new models and evidence based nursing care. The just culture is facilitated in the UC San Diego hospital for open communication focused on the improvement of care instead of blaming or criticism. The clinical service development and enhancement in individual hospital as well as the cluster based service in Hospital Authority in HK will also be led by competent leader. The roles of the clinical leader in the healthcare unit are to promote the teamwork among staff and motivate staff to function at a high level of performance. The new generation of clinical leaders needed to be equipped and nurtured with significant training and support to enhance the continuum and standard of care. The synergy in nursing chain can be best demonstrated in our groups of participants for this leadership program in different ranks from RN, APN, DOM and GMN. This nursing chain reaction is powerful as it provides a great platform to learn and share the management skills from different positions and specialty nursing.  

Background Aortic stenosis (AS) is the most prevalent native valve disease in the elderly with a prevalence of 4.6% in adults 75 years of age. Patients with symptomatic severe AS have high risks of sudden death and their 2-year survival rate is only 30-40%. Surgical AVR is the standard of care but Transcatheter Aortic Valve Implantation (TAVI) is an innovative and alternative treatment option for the elderlies. A multi-disciplinary heart team approach has been recommended as Class I indication for managing patients with severe AS according to AHA and ESC guidelines. The “Heart Team” is used to describe the entire multidisciplinary team involved in the care of these high-risk, elderly patients in pre-procedural planning, intra-operative procedural details and post-procedural care It includes cardiologists, cardiac surgeons, radiologists, cardiac anesthesiologists and cardiac nurses. Being a member of the Heart Team, nurses play a crucial role in the whole patient’s journey. The nurse’s competencies and expertise can provide administrative and clinical leadership within the Heart Team. Cardiac nurses help to screen and evaluate potential candidates, ensure they receive necessary assessment by echocardiogram, CT scan and angiogram to decide on suitability. Besides, the patients and family have to be well-informed for such high risk procedure pre-operatively. Intra-operatively, nurses have to prepare the valve going to be implanted and as an assistant as well after receiving appropriate training. After the procedure, cardiac nurses have to monitor the patient’s recovery and prepare the patient and family for discharge. After discharge, nurses have to keep track on patients’ follow up schedule and ensure ongoing monitoring of the health condition for each patient. Other than clinical duties, cardiac nurses have to organize heart team meetings and keep everyone abreast of the cases. Last but not least, keeping a good data registry with regular audit is very important as well. Conclusions In the early era of TAVI, most attention has been drawn to how successful the procedure was done by the physicians. In fact, multi-disciplinary team approach is the key to success. Cardiac nurse as the core member of the Heart Team, not only help to organize and facilitate communication among different disciplines but also integrate best practices for best patient outcomes. Hopefully, this group of high-risk patients can regain their lives with reasonable quality and good outcomes.  

Electrophysiological recording (IONM) during neurosurgical, orthopedic, and vascular surgery are gradually becoming part of standard medical practice, mainly because it provides information regarding the functional integrity of the nervous system. The merits of IONM have been extensively reported in the literatures worldwide, in terms of its high sensitivity, specificity and prognostic value in surgical outcome. Currently, multimodal methodology include monitoring of electroencephalogram (EEG)/ electrocorticography (ECoG), evoked potentials (EPs), electromyography (EMG), nerve conduction velocity (NCV), and spinal reflex are employed together in many types of major neurosurgical procedures. It serves to avert damage (e.g. ischaemia and mechanical injury) of neural tissues that are at risk during surgical maneuvers, and to identify specific neural structures and landmark (e.g. central sulcus mapping, motor & speech cortex mapping, cranial & spinal nerves functional mapping and integrity check etc). Continuous measurement of electrophysiological signal changes allows one to objectively assess, detect and quantify the variations of the functional integrity of neural structures over time. The real-time information also enables the assessment of efficacy of surgeon’s corrective effort upon the alert of potential damage and effectiveness of surgical intervention. In Hong Kong, IONM programme has been developing in each neurosurgical centre since 1996. Staffing of the monitoring team usually include Neurosurgery Nurse Consultant (NC) or Advanced practice nurse (APN) with related training at local or overseas, and under supervision of reading surgeon during the course of monitoring. Most of the local practice guidelines are adopted from overseas professional Neurodiagnostic Society (e.g. the American Electroencephalographic Society, American Clinical Neurophysiology Society), in terms of monitoring technique, equipment, personnel competency, and documentation etc. In our review, the overall outcome of those critical neurosurgical procedures with IONM is comparable with the results from literatures. The coming direction of our service will be the emphasis on advanced training, technology & skill update, research, and professional development of monitoring staff, as well as, extended applications covering wider variety of surgery.  

Population ageing is a worldwide phenomenon. Emergency department is indispensable in the chain of care for geriatric population, hence the need of quality geriatric acute care in the field of emergency medicine. There are two main models of acute geriatric care worldwide: 1. UK model is characterized by Geriatrician-led clinic at A&E Department; 2. Canadian and Singapore model is a joint-effort of emergency physicians and nurses with geriatricians. In this presentation I am going to share the model of geriatric ambulatory care in Singapore, where I had a 3-week attachment in 2018 to different emergency departments with special geriatric protocols. The practice and setting of emergency medicine in Singapore are very similar to the HK system, except that human resources and health care funding are remarkably different. The latter depicts the challenges faced by HK emergency departments in implementing geriatric-specific protocols.  

The Endovascular technique was rapidly developed in last two decades with the needs in community.The endovascular procedure becamethe main trend when treating peripheral vascular diseases. The endovascular procedures were minimal invasive, patient’s length of stay was short, yet stents implanted raised concerns about the patency of vessels after procedures. Therefore, surveillance for the patency of treated vessels becamea significant role at the vascular surgery.  The duplex ultrasound was one of the best tools for the surveillance role. The full picture of the vessel was presented,which marked with a great sensitivity and specificity and extraordinary low cost compared with other existing methods.  A team of vascular nurses was sent to Gold Coast, Australia to study vascular ultrasound last year. The course concluded the global leading vascular ultrasound technique with explored Australian vascular nursing growth. We are planning to expend our local service on Post-procedure surveillance to meet the up-to-date needs and the global standards.  

With the increased complexity in patient care management due to comorbidities, the use of information technology in community care has drawn increasing attention. There is emerging evidence that information technology can help to improve the access to specialists’ care, identity patients’ health problems earlier, initiate and evaluate treatment plans timely; and hence enable more appropriate and efficient healthcare service delivery. Experience from the Community Outreach Services Team (COST) of the North District Hospital on how to incorporate the use of technologies to manage the ever-increasing service demands in home care settings will be shared. These include barriers and solution that COST nurses encountered during the application of the information technology in community care settings. Moreover, the collaboration with other specialties regarding the use of information technology on patient management through teleconsultation and telecommunication; and the use of mobile device to enhance quality care and data security in community care will also be evaluated and discussed.  

The concept of active aging has been promulgated for promoting well-being in older people. Rehabilitation plays an important role in helping elderly patients resume daily functioning and make adjustment to the environment. Functional task training is the core Occupational Therapy (OT) intervention to facilitate skill learning and enhance participation. The challenge is to devise appropriate training to the patients with individual needs in physical capacity, cognitive capacity and psycho-social aspect.  Rehabilitation of elderly patients has been enriched by various evidence-based modalities. Incorporated with the advancement of technology, specific training based on these evidence-based modalities can be delivered to the elderly patients with different needs. Assessment systems are now detecting even small changes in patient’s functional performance for giving the immediate and the required facilitation for task completion. Cognitive training has been programmed according to theory-based learning strategies for patients with dementia. Desirable stimulation can also be provided in group therapy through interactive technology for multiple users. Skill practice done in the environment relevant to the patient has been one of the OT training focuses. Training systems with virtual-reality technology serve this purpose well and offer more options for improving safety awareness in elderly patients.  The emergence of technology-led innovation in rehabilitation of elderly patients broadens the breadth and depth of training opportunities and optimizes their participation in activity training throughout the hospitalization phase to community phase. The key issue leading to successful application relies on the accurate analysis of the applicability of the equipment in meeting patients’ needs. The input from Occupational Therapists enables the right selection and proper usage of the technology.   

IntroductionThe Community Speech Therapy (CST) Service was started in 2001 in HKWC. The service provides outreach swallowing management by HA Speech Therapist (ST) to patients living in residential care home for the elderly (RCHEs) in cluster. Currently, 0.9 FTE ST is allocated in HKWC and provides services to 57 RCHEs. The allocated manpower is inadequate for the huge population in RCHEs and limits the quantity and quality of service delivery. In 2012, 3 RCHEs under The Hong Kong Society for the Aged (SAGE) in HKWC started to provide out-sourced private ST service by their funding. In 2013, 1 FTE ST was recruited by the institution. The scope of institution ST service overlapped with that of HA outreach ST. The swallowing aspects of the elderly were unavoidably managed by STs from two parties. It was foreseeable that frontline staffs of RCHEs would be confused when there were discrepancies on swallowing management. Meetings between HA ST, Community Care Service Team (CCST) and the management of SAGE were held in 2013. The following common goals were agreed: - Better utilization of public and private resources (Public Private Partnership) - Better communication of STs from both parties - Ensure the continuity of swallowing management from HA to institution There were consensuses on several areas: - The elderly would be managed by both HA ST and Institution ST together. - Information flow of patients swallowing aspect between both parties was guaranteed. - Logistic of overall workflow and referrals criteria were agreed. ObjectivesThis pilot study aims to evaluate the treatment effectiveness of the new co-operated ST service delivery model to RCHEs in HKWC, where the swallowing management was provided jointly by HA outreach ST and RCHEs institution ST under the PPP framework.Methodology- Study design: Retrospective cohort study. - Participants: Patients aged 65 years or above, referred to HA CST service and living in the 3 RCHEs under SAGE. - Sampling period: July 01, 2010 – June 31, 2011 with HA CST service only, and July 01, 2016 – June 31, 2017 with PPP ST service. - Data source: Retrospectively collected from discharge summary on HA electronic patient record (ePR). - Descriptive data: Number of new attendance, number of follow-up attendance, average waiting time, and number of visit. - Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 and 12 months of the first HA CST appointment in RCHEs. - Statistical analysis: Effect measures by relative risk, absolute risk reduction, number needed to treat, 95% confidence interval whenever appropriate. Results & OutcomeDescriptive data: Number of new attendance: 75 in period with HA CST service only, 104 in PPP ST service period Number of follow-up attendance: 88 in period with HA CST service only, 73 in PPP ST service period Average waiting time: 43.5 days in period with HA CST service only, 23.9 days in PPP ST service period Number of visit by CST: 21 visits in period with HA CST service only, 29 visits in PPP ST service period Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 months: - Relative risk = 0.618, 95% CI [0.391, 0.977] - Absolute risk reduction = 14.3% - Number needed to treat = 7.01 Acute hospital admission rate with medical diagnosis of pneumonia within 12 months: - Relative risk = 0.714, 95% CI [0.536, 0.951] - Absolute risk reduction = 18.6% - Number needed to treat = 5.36 Interpretation: - Statistically significant reduced risk of hospitalization due to pneumonia post 3-month and 12-month after first assessment for PPP ST service - Treating every 7.01 and 5.36 patients under PPP ST service would respectively prevent one adverse outcome of hospitalization due to pneumonia within 3 months and 12 months of first assessment   

IntroductionAccording to the SOMIP report, not all the hospitals under the Hospital Authority can perform immediate breast reconstruction operation. Having the option of immediate breast reconstruction for breast cancer patient is it consider as a privilege? However, when offered this option, patient may not take up the procedure. Therefore, exploring the patient attitudes and own preferences of life style can be a consideration affecting her own treatment decision.ObjectivesRetrospectively look into pretreatment life style and attitude of patient who had considered immediate breast reconstruction from 2016 to 2018.Methodology99 patients who had attended the “combined breast and plastic clinic” for assessment from 2016 to 2018 and records were reviewed. Their mean age was 48.5. 28.28% patients were ductal carcinoma in-situ and 66.67% were invasive carcinoma on diagnosis. Most of their education levels were secondary or above and most of them were middle social class. < 20% patients claimed they had friends who had breast reconstruction done or had used prosthesis after mastectomy. Most of our patients thought it was important to let all the breast cancer patients knew about breast reconstruction. However, 24% patients claimed even knowing about breast reconstruction information did not relieve the traumatic psychological morbidities of having breast cancer. Nearly 20% of patients afraid having breast reconstruction might block or blur the breast cancer monitoring and increase chance of recurrence in the future.Results & OutcomeThe records of breast cancer patients who had the choice of immediate breast reconstruction from 2016 to 2018 were reviewed. Every patient before attending the “combined breast and plastic clinic” for assessment was invited to fill a questionnaire about patient’s attitude and own preference on her daily activities. The focus of this retrospective review is to identify the concern that may influence the decision of immediate breast reconstruction. The results suggested there are psychological burden related to cosmetic outcomes, post-operative complications and surveillance. In our centre, only around 12% newly diagnosed breast cancer patients would have interested in discussion on immediate breast reconstruction and eventually, 2/3 of patients chose immediate breast reconstruction. Shared decision making and good information transfer were our strategies to facilitate patients with more confidence in clinical decisions.   

IntroductionFalls are a major cause of morbidity and mortality in the older population. Among the community-dwelling elders of age 65 and above in Hong Kong (HK), the fall rates range from 20%-30% and are higher after age 75 (Chu, Chi & Chiu, 2007; HKSAR, 2012). Among those who fall, about 75% would sustain an injury and admit to hospital or residential care home (HKSAR 2016). Falls are not a normal part of ageing. They do not “just happen” but are resulted from the interactions of biological, behavioural and environmental risk factors. Among these factors, home hazards play a significant role, associating with a 38% increased risk of falls (Letts, Moreland & Richardson, 2010). In preventing and reducing elderly falls and the fall-related morbidity and mortality, modifiable risk factors are intervened through behavioural and home-based environmental modifications with booster follow-up home visits to maintain the effectiveness (Chu, et al., 2017). Touching the northern boundary of HK, North District of the New Territories is a rural area with a population of 320,000 which North District Hospital (NDH) serves. Among the residents, 11.1% are elders and 20% are scattering in 117 villages where the traditional cultural habits of the region are the most maintained (HKSAR, 2015). As such and to be effective, the fall prevention interventions have to accommodate the remoteness of the elders’ residence as well as their unique cultural and daily living habits.ObjectivesTo provide care-in-place for elders at risk of domestic falls, a medical-social collaboration project was put into pilot for two years to support safe living at home for the elder patients discharged from NDH. Home safety devices are installed and potential risks are eliminated to prevent falls and reduce injury severity such that hospital admissions due to falls at home were prevented. Follow-up on the implementation of the fall prevention measures prescribed by occupational therapist was supported through volunteers.MethodologyLed by occupational therapists, care-in-place was realized by integrating medical and rehabilitation services with home care upon empowering a non-government organization (NGO) in the community such that the therapist-prescribed fall prevention measures were reinforced in implementation by and in the elder patients’ homes through the neighbourhood young-old volunteers of the local community. With this intersectoral collaboration, leverage was offered through pooling the expertise and resources of the hospital with NGO to generate better service in an accessible manner.Results & Outcome190 hospital-discharged elders aged 60–97 were served for six months or more in fifteen project months, with 57 (30.00%%) aged 60-75 and 133 (70.00%) aged above 75. 1,826 home safety devices of 32 types were delivered. 524 home visits were made by occupational therapist. 282 friendly visits were paid by volunteers, averaging to 1.5 visits per patient. Of the patients served, 3 died from medical illnesses. 26 (13.90%) reported falls at home, indicating a relatively lower incident rate than their well community-dwelling peers. Among these elders with falls, 22 (84.62%) were admitted to hospital. Being older (>70) and at the time just after discharge from hospital might pose them at a higher fall risk than their peers. Referencing to the global and local fall incidence of community-dwelling well elderly, the project outcomes were encouraging. Upon the support for safe living, the elders can enjoy life in their own natural home environment. Being familiar with the local culture and daily living habits, the project experience showed aptness of the young-old volunteers in communicating with, understanding and encouraging the elders in the service process. Involving them did significantly enhance the service effectiveness and acceptability intended of the project. For the local community, a network system of neighbourhood volunteer support has also emerged.  

IntroductionResearch evidence consistently supports the benefits of exercise in people living with diabetes. In addition, regular exercise is crucial for enhancing overall sense of well-being, which eventually can help to improve many other health conditions. However, patients may find it difficult to initiate exercise activity and persevere the habit. Therefore, a train-the trainer exercise program was promulgated in our Hospital to facilitate patients to establish exercise behavior and perform safe and appropriate exercise practice.ObjectivesThe program aimed to equip Diabetes Exercise Dance Ambassadors through a train-the trainer program. On the other hand, the trained ambassadors conducted Diabetes Exercise Dance classes under staff supervision. As a result, both ambassadors and patients could enjoy the benefit and fun of exercising together.MethodologyA structured exercise training program was managed by multi-disciplinary professionals. Before the exercise class, participants would be educated on practical issues related to diabetes and exercise, such as preventive measures, calorie counting and proper foot wear. In addition to knowledge delivery, the exercise ambassadors were also empowered to be the leader of running the exercise dance. A Diabetes Chair Dance DVD incorporated meaningful lyrics and delightful melody was employed to guide the training on dancing steps and movements. Pre and 6-week post exercise behavior and knowledge were evaluated.Results & OutcomeA total of 9 Diabetes Dance Ambassadors (Female = 7, mean age 60 year) and 61 diabetes patients (Female = 42, mean age 66 year) were trained. Post evaluation showed that exercise knowledge was significantly improved by 50%. It was encouraging to notice that 62% of the attendees could maintain at least 150 minutes of moderate intensity exercise per week. After the program, the participants mentioned they found it easier and were more keen to perform regular exercise. In conclusion, through this innovative approach, a structured Diabetes Exercise Program was successfully launched to encourage patients with diabetes to have regular exercise behavior. Long term benefit on metabolic control should be monitored and continuing evaluation to assess the sustaining effect is also essential. We would like to give special acknowledgement to Hospital Authority Charitable Foundation for funding support of this program.   

IntroductionEmpowering patient on knowledge of self-care after discharge is crucial for patient safety and health. HAHO Patient Experience and Satisfaction Survey on Inpatient Service (PESS) 2015 showed area of improvement on provision of “Information on Leaving Hospital” in PYNEH.Objectives1. To empower patient knowledge and enhance patient satisfaction on discharge information. 2.To empower and facilitate nurses in providing concrete and written discharge information to patient. MethodologyWorking Group on Pre-discharge Patient Empowerment Program (PPEP) designed a discharge information toolkit with department specific information leaflets. These toolkits were given by nurses when patient upon discharge; they included instructions and side effects of common medications, the danger signals and recovery information; and the ward contacts. A “Discharge Medication Gentle Reminder” Label was stuck on Patient’s Copy to alert and educate patient for any changes of medication regime. All of them were packed in a specially designed zip bag to patient. After implementation of the program, a “Patient Telephone Survey” was conducted to discharged patients by trained hospital volunteers to solicit feedback and explore any improvement area from patients. Meanwhile, a “Nurse Satisfaction Survey” was conducted to get opinion from nurses. Results & OutcomeFrom Apr to Aug 2018, 72.4% (239/330) of target patients completed the “Patient Telephone Survey”. Compared with the PESS in 2015, there was an overall improvement on provision of “Information on Leaving Hospital”. The average scores of four items ranged from 6.3 to 9.2 (0 - No; 5 - Yes, to some extent; 10 – Yes, completely or definitely). From Feb to May 2018, 79% (68/86) of nurses completed the “Nurses Satisfaction Survey”. Nurses agreed with the PPEP would raise patient’s satisfaction and facilitate them in conducting patient education upon discharge; they expressed the workload was acceptable and they supported the PPEP for continuous promotion. With the assistance of discharge information kit, nurses only spent average 4.6 minutes more on patient education upon discharge after implementation of this program. Conclusion: The PPEP was effective in strengthening the discharge information support to patient and facilitating nurses to provide concrete and written information to patient on discharge. The mutual communication and appreciations were achieved.   

IntroductionMild Cognitive Impairment (MCI) might not cause significant dysfunction in daily life initially, but might result in cognitive decline without appropriate intervention. There is a service gap in managing patients with MCI in the public primary care settings. The Department of Family Medicine and Primary Healthcare (FM&PHC) in Hong Kong West Cluster (HKWC) identified a service gap after the early detection of MCI and collaborated with the Department of Occupational Therapy (OT) to develop a time-limited OT Elderly Cognitive Care Program (OTECCP) in the general out-patient clinics (GOPCs) since January 2014.ObjectivesOTECCP used an experiential learning approach to help patients and carers to understand the importance of brain health, participation in cognitive stimulating activities and active lifestyle as a potential strategy to delaying cognitive decline in MCI.MethodologyPatients aged 60 or above in GOPCs with Abbreviated Mental Test (AMT) score ≥8 were referred to OTECCP. They were further assessed using The Montreal Cognitive Assessment Hong Kong version (HK-MoCA) and Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV). Patients with HK-MoCA score≤2 percentile were triaged to receive Specialty OT service for dementia at David Trend Rehabilitation Centre (DTRC). Patients triaged to have MCI were recruited to join the OTECCP, which included 1-4 sessions of cognitive group training and subsequence periodical active lifestyle groups within 1 year.Results & OutcomeOf 788 patients screened from January 2014 to December 2018 (mean age 74.3 years, 60.3% women), the mean scores of AMT, HK-MoCA and ADLQ-CV were 9.1, 20.6 and 13.7 respectively. 10.5%(83) were triaged to receive Specialty OT training at DTRC. 705 patients were recruited to the OTECCP and 222 completed the one-year-follow-up re-assessment. There were significant differences between the mean scores of HK-MoCA(p< .001) and ADLQ-CV(p< .005). HK-MoCA was increased 0.96(95% CI [-1.35, -0.57]) whereas ADLQ-CV was decreased 1.82(95% CI [0.57, 3.08]). The results indicated that cognitive functions have improved and the patients have less subjective memory complaints. Upon completion of the OTECCP starting from Oct 2018, needy patients were referred to Patient Resource Centre of Queen Mary Hospital for bridging to suitable NGO partners for long term support in the community.  

IntroductionRecent studies revealed that seven in ten HK undergraduates showed symptoms of depression and anxiety. The Centre for Suicide Research and Prevention of Hong Kong University analyzed 34 students’ suicidal cases and found that only 20% were receiving mental healthcare before their deaths. This harmful stigmatization associated with MI may reduce students’ motivation for seeking support from mental health service. Stigma defined as a process involving labeling, separation, stereotype awareness and discrimination in a social context . A series of anti-stigma of MI campaign was launched in Yung Fung Shee (YFS) Psychiatric Day Hospital (PDH) since 2017 with collaboration with HK University of Science and Technology (HKUST) Counseling and Wellness Centre, HK Polytechnic University (HKPU) and Tung Wah College (TWC). It included educational programs and collaboration projects of people with MI and University students through different direct contact. Objectives1. Facilitate positive social contact experience between students and people with SMI to enhance acceptance of MI and facilitate help seeking 2. Provide opportunities for people with MI to demonstrate their strength to public in order to reduce self-stigma and encourage social recovery MethodologyTwo nature of programs are carried out: 1. Education: Educational talk was held to explain the facts and myth about MI, useful community resources and the undergraduates could experience the life of a person with MI through a creative board game; 2. Contact: Joint programs were launched to promote contact between people with MI and the undergraduates: a) Lived experience sharing by clients in the three institutes. Clients shared their ways to cope with MI and students had open discussion with them; b) Clients held different tasks group for the students to demonstrate their strength and abilities; c) Students were invited to visit PDH to experience the real life of clients. d) Anti-stigma booth and busking performance were collaborated by people with MI and students in campus during World Mental Health Day.Results & Outcome13 service users and over 80 students from the three institutes joined the scheme. Internalized Stigma of Mental Illness (Cantonese) Scale was used to evaluate the effectiveness of the scheme. Paired Sample T-test showed significant improvement among service users in Question 1 (p=0.007), 4(p=0.021), 5(p=0.013), 10(p=0.007) and total average score (p=0.018). Focused interview was held among the students for qualitative analysis, reflecting improvement in awareness of MI, equality of service users and students, acceptance of MI and more willingness to seek help. To conclude, the medical-social collaboration approach for anti-stigma campaign is an innovative project which not only helped the service users re-integrating into the society, but also reduced discrimination and facilitated help-seeking of students toward mental health support services.   

Support Operations are one of the critical functions in hospital operations. At the new 1800-bed Woodlands Health Campus (WHC) in Singapore, support operations were identified as a key area for innovation.  A coherent strategy was developed in tandem with clinical services planning to provide efficient, scalable and sustainable support to 24/7 hospital operations while achieving an space-lite & resource-lite operating model. The Support Operations strategy included: - Integration of spaces, e.g. logistics hub - Harmonization of processes, e.g. shared network resources - Operations model innovations through appropriate technology adoptions - Digital supply chain 3D Simulation tools were applied in the logistics operations planning, to inform the planning on vertical and horizontal transportation systems and logistics systems, and optimize the delivery sequence and schedules. A last-mile delivery model leveraging on robotics technology was developed, with trials conducted in real-life operation settings. Smart inventory management and sensor-based trigger for on-demand and Just-in-time service were other examples of the innovations.  

Princess Alexandra Hospital is one of Australia’s leading tertiary referral teaching hospitals and has a bed platform of 1133 beds. The hospital provides care in most major adult specialties including acute medical, surgical, mental health, cancer, rehabilitation and allied health services. The hospital is home to many state-wide services including the Queensland Spinal Cord Injuries Service and the Queensland Liver and Renal Transplant Services. The hospital is part of Metro South Hospital and Health Service which provides health care to a population of approximately 1.1 million people through its network of 5 hospitals. All the hospitals have become digital hospitals with the successful roll-out of a fully Integrated Electronic Medical Record (ieMR) across the organisation. The health service is experiencing the same challenges that health services are experiencing worldwide. This includes the need to maintain activity levels while balancing the need to provide access to emergency, elective and outpatient care for patients. With the implementation of the ieMR there was an opportunity to maximise the use of digital information to actively manage patient flow across the pre-hospital, hospital and community environment. A command centre or Patient Access and Coordination Hub (PACH) was established to actively manage patient flow and access. The PACH is staffed by senior ambulance paramedics and nursing staff who have real time visibility of patient flows across the health service and the authority manage patient flows to hospitals and within the hospital network. The digital displays used in the centre were developed by in house business analysts and applications development specialists in collaboration with the frontline staff in the emergency departments and hospital based patient flow units. These digital displays provide real time information that facilitates active and appropriate decision making that optimises both patient care and patient flow. The benefits of the centre include improved quality of care through faster access to accurate and timely medical information and improved quality of care through improved patient flows. The presentation will discuss the drivers for the change, the challenges experienced in delivering digital displays, the benefits realised and the longer term development with respect to decision support.  

Simulation-based education (SBE) provides a safe and effective learning environment for learners. Historically, simulation has been widely used in military and aviation training, and was only introduced into medical education in the 1960s. In the last 20 years, concerns about patient safety have given the impetus to develop SBE in healthcare professionals training. This method of learning allows specific clinical task and situation to be created in a simulated environment with mannequins, part-task trainers, and standardised patients, or with computer-generated simulations and even virtual reality to provide a realistic experience for the learners. Simulation provides a learning experience without the risks associated with the real event that may cause harm to learners themselves, their patients or others. The experience may be repeated until competence is achieved, while different level of difficulty may be introduced to challenge the learners. The experiential simulated event coupled with a structured approached to debrief the experience have been shown to be an effective learning method. Simulation is now commonly used in the training of clinical skills, problem solving, decision making, and team communication and interaction. Despite its popularity, significant challenges remained in the appropriate use of simulation in medical education and healthcare professional training where consistent standards of training must be assured and maintained, and that best practices in the application of simulation are supported by evidence of effectiveness. The lecture will explore the historical perspectives, current practices and challenges in the development of simulation training for healthcare professionals.  

Based on ancient techniques, mindfulness is a powerful psychological intervention/coping skill that has been shown to improve mood and reduce stress. Mindfulness involves bringing one’s attention into the present moment; bringing full awareness into present experiences on purpose and nonjudgmentally.  Dialectical Behavioral Therapy® (DBT®) uses mindfulness to help patients learn valuable skills to overcome psychologically unhealthy thought processes and behaviors. Patients start by directing their attention towards simple perceptual stimuli (e.g., sights and sounds), without self-criticism. They later learn how to experience emotions, thoughts, and sensations while still being able to focus their attention on an activity. Unfortunately, many patients have attention deficits that make mindfulness challenging.  Our team developed a new treatment that teaches patients mindfulness skills while they are in virtual reality.  Immersive virtual reality involves wearing/looking into VR goggles as a window into a 3D simulation designed to make the patient feel “present” in the virtual world, as if the computer-generated world is a place they are visiting.  One of the first patients to try this new technique was a 39-year-old male patient hospitalized with a traumatic spinal cord injury C4-5 resulting in quadriplegia and respiratory failure requiring trachiotomy (breathing through a hole in his throat) after falling out of 4 story building.  He had severe depression, and anxiety symptoms.   Methods: The patient looked into VR goggles, and had the illusion of slowly “floating down” a river in virtual reality while listening to DBT® Mindfulness Skills training instructions. The patient filled out brief psychological ratings before and after each VR session, after four sessions.   Results: As predicted, the patient reported reductions in negative emotions after each VR DBT® Mindfulness session. Conclusion:  Results were encouraging.  Additional research and development will be needed to determine whether VR DBT® Mindfulness Skills training leads to any long term improvements in outcome.

Initiated in February 2017, “Dementia Community Support Scheme” (DCSS) is a two-year pilot scheme launched by the Food and Health Bureau (FHB), in collaboration with the Hospital Authority (HA) and the Social Welfare Department (SWD). The pilot scheme was funded by the Community Care Fund and implemented from February 2017 to January 2019, with an ultimate goal of utilising collaboration of social and medical support at primary care level and specialist care to form an integrated support network for the patients in the long run. Four HA clusters and 20 District Elderly Community Centres1 (DECCs) participated in the Pilot Scheme to provide support services to elderly persons with mild or moderate dementia and their carers in the community through a “medical-social collaboration” model so as to enhance their functional level and quality of life, and relieve carers’ burden.  Under DCSS, elderly persons with mild or moderate dementia and their carers are arranged to attend structured intervention programmes based on an individual Integrated Care Plan (ICP) at the DECCs, with an aim to delay their functional and cognitive decline. DCSS also aims at enhancing the capacity and expertise of the staff of NGOs at the community level in the provision of dementia support services to elderly persons, so that in the long run, reliance on HA specialist services may be alleviated when those suffering from early dementia and their carers can acquire relevant support services in the community. Over a two year period, the pilot scheme served over 2000 elderly persons with dementia and their carers. The feedback from the participating patients and their carers was overall positive; the evaluation study conducted by Sau Po Centre on Ageing of the University of Hong Kong also suggests generally effective implementation. From February 2019 onwards, Dementia Community Support Scheme is regularised and extended to all 41 DECCs and seven HA clusters in the territory. The 20 DECCs and four HA clusters which participated in the pilot scheme would continue to provide support services and the other 21 DECCs and three HA clusters join DCSS from May 2019 onwards.  

Community geriatric assessment services was established in 1994 by HA to better serve elderly from residential care  homes of the elderly (RCHE), who are high volume users of HA services. CGAS vision of seamless care was to provide timely geriatric management together with social sector partners to enhance care quality in the community. Service scope started with outreach geriatric specialist clinics and nurse-led care improvement initiatives, rehabilitation and assessment for central infirmary waiting list. Following SARS in 2003, expert recommendations endorsed by government led to the CGAS VMO scheme aimed to reduce infectious outbreaks in RCHEs and to curb surges in hospitalization.  Present CGAS services have evolved with enriched partnerships to include end of life care for RCHE residents, pharmacist-led medication reconciliation and integrated nursing model with community nursing services.  The future of CGAS contemplates our service model to meet rising demand arising from increasing RCHE places with increased care complexity expected to parallel ageing demographics in Hong Kong. New enhanced CGAS service models, especially in mega-homes will reduce demand for hospital beds. On-site end of life care and rehabilitation should be standards in care with structured medical social partnerships and quality monitoring. In addition, the wise use of IT, big data and telemedicine add to exciting prospects. To navigate future challenges, CGAS teams can learn from 25 years of lessons in teamwork, compassionate care and innovation.  

Our experience developing the Comprehensive Care Physician (CCP) program within the Section of Hospital Medicine at the University of Chicago has illustrated the value of relational continuity in the care of patients with complex medical needs. For patients with increased risk of hospitalization and who are willing to find a new primary care physician, the program suggests significant value in having a single provider care for patients in both the inpatient and outpatient setting. Additional opportunities to leverage patient-provider and provider-provider relationships remain for patients at lower risk of hospitalization and those with established primary care relationships.  Traditional United States hospitalist models are based upon schedules where providers work intermittent, intense shifts, typically working 7 days in the hospital followed by 7 days of respite time. These schedules lead to frequent hospitalist-hospitalist handoffs within a patient’s hospitalization. In addition, the large number of hospitalists at many institutions and their intermittent schedules makes it difficult to establish relationships between inpatient and outpatient providers. To better leverage the value of patient-provider continuity within prolonged hospitalizations and provider-provider relationships for hospitalists and outpatient clinicians who frequently admit patients to the hospital, we propose a new model for hospitalist care. Under the Rounder Model, the work of hospitalists typically performed over intense 7-day periods will be re-allocated across more weekdays, thereby enabling hospitalists to sustainably work more days per year. This reorganization of hospitalist work will enable greater patient-provider continuity within hospitalizations by enabling individual hospitalists to direct the care of a patient throughout his or her entire hospitalization. The Rounder Model will also enable pairing of individual hospitalists or small groups of hospitalists to outpatient providers to promote provider-provider relationships across the inpatient and outpatient domain as well as patient-hospitalist relationships for patients from paired groups who are frequently hospitalized themselves. We hypothesize that this reorganization of care will result in reduced length of stay and increased quality of care for hospitalized patients by leveraging relationships to promote smoother transitions of care. In addition, we hypothesize that this model will serve as a more sustainable long-term career option for the hospitalist workforce.

Established in 1965, New Life Psychiatric Rehabilitation Association is a leading non-governmental organization specializing in mental health serving around 15,000 people in recovery (PIR) of mental illness and their families, as well as 43,000 general public in mental health education annually by 70 service units/ projects and over 20 social enterprises. Our Association pioneered the first Integrated Community Centre for Mental Wellness (ICCMW), The Wellness Centre (TWC) at Tin Shui Wai in 2009. From October 2010 onwards, service points extended to Sham Shui Po, Yau Tsim Mong, Sha Tin, Kwai Chung, Tuen Mun and Islands Districts. In 2015, our Association moved forward from recovery-oriented service to promote well-being for all. We integrate 330 (physical, psychosocial and transcendental well-being) into daily life. Three-tier service model ranging from primary (community well-being and public education); secondary (early identification and intervention); to tertiary intervention (person-centered services) is adopted in The Wellness Centres (TWCs). Selected highlights at each level would be shared. At the primary level, TWCs promote well-being to the public on understanding of mental health; advocating for anti-stigma and collaborating with district partners to build an inclusive society by organizing exhibitions, talks and activities in the community. “330@ New So Uk Estate”, a three-year project funded by the Community Investment and Inclusion Fund (CIIF), was launched in 2016 to enhance the community well-being, facilitate the accumulation of social capital and provide neighborhood support to residents of the re-developed So Uk Estate. At the secondary level, TWCs worked closely with the Hospital Authority, Social Welfare Department and community partners to provide proactive, comprehensive and intensive casework support services to people suspected of having mental health problems. Last but not least, at the tertiary level, our professional staff team, consisting of clinical psychologists, social workers, occupational therapists and psychiatric nurses, provides casework counselling and outreaching home visits, helping PIR and their family members to cope with their mental health and life challenges, actualizing self-directive in their journey of recovery and leading to a fulfilling life in the community.

Hong Kong has one of the highest penetration of mobile phones and tablets in the world, providing a great platform for HA not only to provide better service to our patients, but also to engage and connect our entire workforce anytime, anywhere. The HR App, a tailored made mobile App for HA staff, provides an one-stop mobile platform with a wide variety of functions for all staff to manage their own important information such as leave application and approval, payslip and tax return, training records and staff benefits. The mSHR module allows staff clinic booking and access to one’s own clinical data. In addition, HA Chat provides a secure environment for instant communication amongst HA colleagues. HA has embraced HR App, with the registration rate exceeding 76%. This fantastic response has inspired the development team to continue to develop new modules to transform the way the HA reaches, engages and connects our staff. It is the solid foundation to further enhance our workplace digitally. In the family of HA, Human Resources professionals were impressed as a desk-bound administrative workers until the birth of unexpected mobile solution – the HR App. It is the first mobile solution which is designed successfully with more than 70,000 staff registered. Supporting staff members with limited access to email communication in particular consider the HR App an effective and relevant to them by drawing them closer to the organization.  The HR App also helps transform the working mode of HR professionals from policy administrators to technology explorer in facilitating organization culture building. This is a critical step for HR to reposition as staff advocate for a caring organization by bridging values among our staff. Hospital Authority HR will continue its modernization and digital journey. Staff members have high expectation on HR to go beyond the current scope of HR App to include other core operation functions, such as procurement approval, dissemination of important messages at critical time points e.g. duty and transport arrangement during inclement weather or other crisis, teleconferencing etc. Finally, a word of caution - mobile solution is only an mean to our ultimate goal i.e. Bridging between YOU and ME. HAHR would hold on to this principle for any future further enhancement on HR App.   

Introduction:  In healthcare, a paradigm shift in thinking is required as many healthcare workers often excuse or condone acts of violence from patients. Although few people come into a healthcare environment with intent to harm, violence is real in healthcare settings due to the nature of illness faced by certain patient populations. Prevention begins by creating a culture that supports this philosophy will inevitably reduce and eliminate harm experienced by violent acts. Designing safety systems to ensure there is an understanding of why these events occur is key to preventing future occurrences. Encouraging reporting is critical to understanding and addressing all factors that contribute to violent incidents and is an essential step in the development of effective preventative measures.  Objective: (1) Reduce and eliminate harm experienced from violent acts in the workplace. (2) Encourage and improve reporting and situational awareness of workplace violence events. (3) Build systems that support early detection and correction. Methods: University Health Network (UHN), Canada’s largest academic hospital system, recognized that most acts of violence are preventable within the workplace. Embarking on a strategic transformation, UHN identified safety as a core value, signifying their commitment to zero preventable harm. Safety is embedded in every aspect of the delivery of care. Transforming a culture began with an exploration beyond what happens during incidents of violence to learning why these incidents occur which lead to addressing system failures that contribute to causation; the key to preventing harm.  Results: UHN’s approach, unique in the healthcare industry, encourages reporting and response to near-miss events, which is critical in the development of effective preventative measures. This proactive organizational methodology to workplace violence builds systems to support early detection and correction. Building a "safety culture" where staff and patients embrace safety as a core value starts with leaders. Having a safety culture proved to be successful in reducing the harm experienced from violence. Shifting the focus on creating resilience by incorporating harm reduction and prevention strategies into daily practice enables sustainability.  

CLP Power has served Hong Kong for more than 115 years with a wholehearted commitment to making lives brighter, today and tomorrow. The company aims to use energy resources to bring a positive impact to people’s lives. This mission depends upon a team of talented, happy, and dedicated employees working together for the common good. CLP Power has a comprehensive and holistic human resources strategy. Managing Director Mr T K Chiang will explain in this presentation how the company builds and maintains a sustainable and innovative workforce by investing in employee wellbeing and people development together with a competitive remuneration package. CLP Power cares for its employees and have set many family-friendly policies with an emphasis on staff retention including maternity leave, marriage leave, and the introduction of adoption leave. Recognising that a healthy lifestyle is beneficial to workplace performance, CLP Power encourages its employees to achieve a healthy work-life balance and to regularly take part in social, recreational and sports activities. It also promotes volunteer and youth development programmes to support the communities in which we live and work. To stay competitive in a rapidly changing business environment, the company deploys the latest technology and methodology in its training and development to raise the proficiency and professionalism of its employees. It draws on cutting-edge innovation to expand the knowledge and expertise of the workforce, which gives its employees the opportunity to realise their full potential. CLP Power also embraces diversity in our workforce and have taken steps to attract more female to join our industry. The company’s commitment to employee development and wellbeing have been recognised by a host of awards including being named Most Attractive Employer in Hong Kong in the 2018 Randstad Awards, and Manpower Developer 1st (2010-2020) in the Employees Retraining Board Manpower Developer Award Scheme. CLP Power has also been named Distinguished Family-Friendly Employer in the Family-Friendly Awards Scheme organised by the Family Council.

Globally, Plasmodium vivax and P. falciparum malaria are the most important causes of malaria. Falciparum malaria is generally the most severe form of disease which causes the majority of malaria deaths. Nevertheless, vivax and knowlesi malaria can also result in severe disease and even mortality. In most case series from Europe and North America, malaria frequently comes up as the commonest cause of fever in the returned travellers. Although malaria is not the commonest cause of fever in the returned travellers in Hong Kong, it is a diagnosis that must not be missed because fatalities due to falciparum malaria do occur regularly, and some of these cases in the past had been related to delays in diagnosis or initiating treatment. Malaria must be considered in any sick returned traveller who had stayed in an endemic area. The shortest incubation period for falciparum malaria is 7 to 8 days. There are no pathognomonic symptoms and signs of malaria. Malaria is often mis-diagnosed as other diseases such as respiratory tract infection, gastroenteritis, or bacterial sepsis. The classical periodic fever is present in only a minority of patients at the time of presentation. One should be aware of common pitfalls in the diagnosis and treatment of malaria. Patients with severe malaria should be treated and monitored in intensive care settings. For severe malaria, intravenous artemisinin is the drug of choice because of its rapid clearance of parasitaemia. Radical cure with primaquine should be offered to patients with vivax and ovale malaria after checking the glucose-6-phosphate dehydrogenase status.  

Influenza infection can lead to a variety of neurologic complications including influenza‐associated encephalitis/encephalopathy, acute necrotizing encephalitis, febrile convulsion, acute encephalopathy with biphasic seizures and late reduced diffusion, acute disseminated encephalomyelitisas, Guillain–Barré syndrome, Reye's syndrome, and encephalitis lethargica.  The neurological complication of 1918 Spanish Influenza A pandemic is dominated by encephalitis lethargica. Juvenile form of encephalitis lethargica is characterized by a change in personality and rapid transformation of the victim from normal behavior to delinquency, often leading to institutionalization. The non-structural NS1 protein and PB1-F2 protein through inhibiting the interferon response and induction of apoptosis via opening of the mitochondrial transmembrane transition pore contribute to the virulence of the virus.  With the emergency of human H2H2 and H3N2 influenza A virus the neurological complication is initially dominated by the development of Reye’s syndrome due to the use of aspirin. Influenza-associated neurological complication is uncommon in Caucasians children after the withdrawal of aspirin in the management of influenza A virus infection. After the withdrawal of influenza vaccination program in children in Japan, Japan has experienced an upsurge of influenza-associated encephalopathy that may rapidly progress to necrotizing encephalitis during acute influenza infection due to the prevalence of mitochondrial beta-oxidation disorder among the Japanese population. Cytokine dysregulation, microglial activation and apoptosis are pivotal in the pathogenesis of influenza-associated encephalopathy.  The 2009 H1N1 influenza virus contain a non-structural gene segment that can produce potent cytokine dysregulation. Most of the severe cases and death of 2009 H1N1 influenza A infection in children in the western world presented with respiratory complications with influenza-associated neurologic complications observed in only around 4% of patients. In contrast, the leading causes of death among children with 2009PV in Japan were encephalopathy and unexpected cardiopulmonary arrest. Deaths associated with respiratory failure were infrequent and occurred primarily among children with preexisting conditions.  

Work rehabilitation (WR), target at helping patients return to work, was one of the core service of Occupational Therapy (OT) since its beginning in 1950s. In 2002, a major revamp of the service model to reorganize the WR service for standardization and improvement was conducted by the Work Rehabilitation Specialty Group (SG) under the OTCOC in HA. Idea of designated centers in each cluster was adopted which helped to align service standard and nurture expertise. As a result, 10 designated Work Rehabilitation Centers (DWRC) is formed. In 2004, the 10 Work Rrehabilitation centers started to collect data on patients’ profile, throughput and outcome; and formed a minimal data set. Regular analysis of the data provided valuable information for service planning and evaluation. This presentation is the review of the application of the data set from 2004 till 2018. Over these years, a number of quality improvements were made. 1. Learning that the majority of the caseload condition is Low Back Pain (LBP) of Musculoskeletal Conditions, a LBP Work Rehabilitation Protocol was developed in 2005 - 2007 to share among the DWRC. 2. Analyzing the factors for delaying the outcome of return to work is related to psychosocial issues, a reference to enhance work readiness and return to work process were developed in 2013. The practice was aligned among the OTs of the DWRC. 3. After learning the data characteristics of the majority condition groups, focus of data collection changes towards those new emerging clinical conditions which in need of work rehabilitation protocol development in 2016. These include Cardiac, Oncology, CVA, Neurological and Other Medical conditions. 4. With increasing cases of injured commercial drivers refer for work rehabilitation, a Driver Rehabilitation Protocol for this occupational group is developing in 2018 Lately, with the OT Work Rehabilitation Assessment report (in CMS) could be interfaced by the Clinical Data Analysis and Reporting System (CDARS) in December 2016, the collection method change from paper marking format to extraction of minimal data in CMS by CDARS. The validation of the conversion was conducted by a 3-month project. Satisfactory outcome was shown with the mean of accuracy is 90% . In conclusion, the minimal data set helped to build a more effective Service Delivery Model among the DWRC. Quality of practice of OT in work rehabilitation service in HA is standardized. This further facilitates the development of relevant condition-specific protocols with evidence and local trial.  

Attaining upper limb functional recovery in stroke patients is always an ambitious goal for health care professionals. Recent evidences suggested that Non-invasive Brain Stimulation (NIBS) techniques could enhance upper limb functional recovery in stroke patients.  A pilot upper limb rehabilitation program utilizing one of the NIBS techniques – Transcranial Direct Current Stimulation (tDCS) for stroke patients was developed. The program evaluation showed that combined tDCS and physiotherapy treatment have positive effect on enhancing upper limb functional recovery in stroke patients. In the light of the positive results of this program, another NIBS technique – Transcranial Magnetic Stimulation (TMS) was introduced in physiotherapy department. This presentation will give an overview on TMS, and share the local experience of developing physiotherapy TMS service. Service review suggested that repetitive TMS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. And these positive findings warrant further investigation of the application of this non-invasive brain stimulation technique to neuro-rehabilitation.  

Incidence of incorrect annotation of radiological images is common in radiology  department and can lead to grave consequence of patient. At radiology department, image annotation about the laterality (e.g. Left, Right) or view position (e.g. AP, PA) is required for every image. As the annotation process is a pure human performed procedure, human error is inevitable. The common type of  incorrect image annotation includes wrong laterality of extremity images and falsely flipped Chest  images. Falsely flipped Chest images can cause the patient misdiagnosed as dextrocardia. If physician based on the falsely flipped Chest image to perform the drainage procedure for pleural effusion, a wrong side chest drain incidence can occur. Wrong laterality of extremity images is the other commonly occurred incidence at radiology department. For example a left hand X-ray image may be labeled with right, such error can potentially mislead radiologist and result in wrong side report. In order to minimize the incorrect annotation incidence at radiology department of Pok Oi Hospital, a radiological quality control application SureSide is developed to minimize the wrong annotation of radiological images. SureSide is a self developed DICOM application with computer vision capability to analyze the dicom tag and the annotation of radiological image, it is a server-client application with server situated at PACS network to receive auto-routed DICOM objects from PACS server and client  installed at the workstations of radiological exam room to display the warning windows if incorrect annotation is detected at the image. By extracting the pixel data of the DICOM object, the image is evaluated by the open source computer vision library OpenCV to detect image of digital marker or physical maker. Simple computer vision technique “template matching” is used to detect image of digital marker, while feature descriptor named “KAZE” is used to detect the image of physical marker. If discrepancy is found for image’s dicom tag of “View Position” and the image of annotation, a warning window will pop up at SureSide’s client to alert Radiographer, so Radiographer can rectify the problem image as soon as possible. Apart from the falsely flipped Chest images, SureSide is also capable to detect the wrong laterality labelled images. By counter checking the laterality of requested exam and the marker(Left/Right) applied at the image, SureSide can spot out the wrong laterality marker.  

Facing with an ever-increasing turnover rate and increase fragility of in-patient in Shatin Hospital, finding an effective method to improve the accuracy in treatment prescription and improving the patient safety is always our utmost concern.  Recent advancement of technology empowers us to have an innovative idea in address this issue. In 2014, we work together with an IT company in designing and creating the PMS. In this new project, we designed the layout and display of the hardware and laid down the simple logistic in operation while the company offers us the technical support in software and hardware development. PMS is a computerized system for Occupational therapist to manage daily treatment activities scheduling and provides vital signs monitoring for patients. When using PMS, patient’s journey in Occupational Therapy starts from check-in to the system, implementation of training activities, vital signs real-time monitoring, precautions alert and check out. This system can also provide summary reports for therapist to review patient’s progress and update treatment accordingly. PMS launched out in Jul 2015 after about a year’s development and preparation work.  The succeed of PMS in improving patient safety, treatment accuracy and operation efficiency encouraged us to continue develop and explore its application potential. Currently we are developing the phase 5 PMS in Shatin Hospital. With continuous evolution and enhancement, PMS is now consisting 6 operation modules: 1) Monitoring and Scheduling System (MS), 2) Monitoring and Scheduling System GDH (MS GDH), 3) Aids Loan System (AL), 4) Wheelchair Management System (WSM), 5) Mobile Outcome Measurement (MOM) and 6) Psychiatric Mobile Outcome Measurement (PMOM).  The coverage is not limited to rehabilitation in-patient, but also extended to Geriatric Day Hospital and psychiatric in-patient as well.  From now on, every detail about our patients, including their diagnosis, precautions, monitoring data, prescribed training and performance outcomes were stored in the Hospital no. as a barcode on their wristbands. Objectives 1. Provide the right treatment to right patient within the right amount of time 2. Minimize human error in vital data capturing 3. Improving efficiency and accuracy of treatment scheduling and monitoring 4. Facilitate electronic documentation and clinical outcome evaluation  5. Improve the efficiency and monitoring of clinical operation systems  Major components of PMS 1. Tablet PC for prescription of training, precautions and monitoring  2. Handheld barcode scanner for recap of prescribed instructions and data recording 3. Bluetooth gadgets for vital monitoring  4. VGA TV for display of scheduling and monitoring information 5. Back-end server for centralized data analysis and management   

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care resulting in substantial improvements in clinical outcomes and cost effectiveness. It is a multimodal and multidisciplinary approach for surgical patients. A local ERAS team was established in United Christian Hospital since 2017 and Physiotherapy (PT), as one of the core members had her key roles re-defined from pre and post-operative physiotherapy to (1) pre-operative risk stratification; (2) pre-habilitation; and (3) post-operative early mobilization for facilitation of recovery. In pre-operative phase, PT delivers the service directly in surgery clinic where stratification of cardiac risk and empowerment for pre-operative physiotherapy are performed. Screening of cardiac risk through Functional Capacity Evaluation using Step Test enriches Anesthetist’s comprehensive pre-operative assessment. Cases with the Revised Cardiac Risk Index score > / = 2 are indicated for the test and patients achieved lower than 4 METS would be alerted for further investigation and optimization before the surgery. Multi-disciplinary collaboration in the joint clinic not only facilitates one-stop patient service, but also enhances inter-disciplinary communication in which patients with suboptimal physical capacity are identified and recruited for pre-habilitation. This is either a home-based or out-patient conditioning program, making use of individualized and specific exercise regime to augment functional incapacitation and speed up recovery after operation. Post-operative “Early Mobilization” defined as mobilizing out of bed at least once in the first 24 hours (D1) after operation is one of the key predictors of successful hospital discharge. With better pain management and nausea control, upright mobilization could be advanced to operative day. Mobility Cue Card facilitates inter-disciplinary communication and collaboration in ward where patients are continuously receiving rehabilitation until regaining independency in ambulation. From 2017 to 2018, a total of 351 patients (224 male, 127 female, mean age 70.6) having colorectal surgeries are under the ERAS program. Data analysis reveals that (1) 51% of patients required Functional Capacity Evaluation Test; (2) more than 80% of patients achieved upright mobilization on D1 and (3) more than 98% of patients achieved independent ambulation and directly discharged home after surgery. ERAS is an evidence-based care improvement process requiring collaborative team work and PT is a core member throughout the patient journey from risk stratification to rehabilitation pre- and post-surgery.

The incidence of breast cancer has been increasing in Hong Kong. Multidisciplinary approach of breast cancer management is currently the gold standard in treatment of breast cancer.  Breast surgery is more than removal of cancer; it combines the oncological principles with the aim of minimizing disfigurement and maintenance of quality of life. The Helsinki university hospital and the Memorial Sloath Kettering Cancer Center were one of the high volume institutions in Northern Europe and USA respectively. This 4-month overseas training program provided hands-on experience and exposure to surgical techniques such as breast reconstruction, oncoplastic surgery and fat grafting.  Surgery was not the only mainstay treatments in breast cancer. The author not only gained insights in surgical techniques, but other areas of breast cancer management, such as clinical oncology, radiology, pathology and allied health adjuncts, which were equally essential elements in multidisciplinary management of breast cancer.   

Advances in novel therapies have revolutionised cancer care in recent years. They introduce new options and hopes, but also risks and challenges. Patient needs and treatment decisions have become more complex than ever, calling into play the full power of a multidisciplinary team.At the Royal Marsden Hospital, a leading specialist cancer hospital based in London, pharmacists have a crucial role in the care continuum, from participating in individual clinical decisions to developing institutional guidelines, and from providing direct patient education to coordinating off-site chemotherapy. As part of a multidisciplinary team, pharmacist independent prescribers may also prescribe medications, including chemotherapy, within their clinical competence.Back in Hong Kong, clinical pharmacy at Queen Elizabeth Hospital has grown rapidly in the last decade, most notably in cancer care. Services include clinical verification of prescriptions, inpatient medication review, patient counselling clinics, as well as protocol development. These responsibilities encompass a broad range of expertise and skills – a challenge for pharmacists to evolve from theory to practice, and an opportunity to establish a robust approach in training and credentialing. The model at the Royal Marsden Hospital has shown insights into a continuous service development process, not only the knowledge and skills, but also the standards of practice and a professional competency framework.  

Ageing population and advancement of healthcare technology affect patient care. Telemedicine and telenursing has emerged as new modalities for 21st century to improve healthcare effectiveness and efficacy. Telenursing is regarded as a new modality of nursing care over distance.1 It continues to grow as a valuable method for providing nursing care to patients, especially in their homes.2 Clinical applications of telenursing has been widely adopted in western countries under different settings. Nurses use their nursing knowledge and skills to assess, plan, initiate, educate and evaluate nursing interventions for their distant patients through electronic means. Telecare nurses collect and interpret information on the phone from callers (patient or caregivers), seeking advice. The feasibility of telenursing using mobile phones in supporting psychoeducational needs of colorectal cancer caregivers in Hong Kong was first investigated in 2013.3 The effectiveness and efficacy were further evaluated by a randomized controlled trial in 2014. Telephone intervention was found to improve psychological wellbeing and quality of life in the intervention group. 4 Apart from these, benefits of telenursing on colorectal cancer patients receiving the Enhanced Recovery After Surgery (ERAS) Program was investigated by a prospective four-week intervention study in four hospitals (QMH, UCH, CMC and QEH). A structured nurse telephone follow-up was given to ERAS patients after their discharge. Fifty patients with mean age of 67.94 (S.D. 11.1, 29-89) years were recruited. Telephone follow-up was found to be feasible with 147 out of 150 telephone calls (98.67%) successfully made. The mean duration of each telephone conversation was 10.03 (S.D.3.944; 3-20) minutes. Telephone call was well accepted by patients with 47 patients (94%) retained in the study. Patients reported different home care problems and nursing advice could be provided immediately. The mean scores for stress, anxiety and depression measured at baseline decreased over time after telephone intervention. Hence, telenursing was found to be both feasible and acceptable.  Telenursing is not going to replace bedside or patient-centered nursing. However, it will be expected to benefit the model of future health care delivery in terms of timely health care advice.  

The increase in the number of older adults in Hong Kong characterizes an increase in the number of people living with chronic and progressive diseases. There are evidence that palliative care can improve the quality of life to those patients. The challenge to provide high quality of palliative care service throughout patient’s disease journey is undoubtedly a burning issue. Through the corporate scholarship program, we have the opportunity to visit Royal Free Hospital in United Kingdom about the palliative care service. The palliative care team (PCT) has specialist skills in pain relief and symptom management and provides emotional support and advice on terminal illness. It works closely with the occupational therapy and physiotherapy departments, as well as chaplaincy teams and community palliative care services, including local hospices and community providers. The PCT works closely with all health care professionals involved in a patient's end of life care. The seamless collaboration between GPs and palliative care team continues to provide support for patients in community. The consultative team in Royal Free hospital provided service to cancer and non-cancer patients in palliative care needs.  Other than to give advice on symptom management to parent team, the role of nurses in PCT are very crucial that facilitates the family meeting for decision making, goal of care and understanding the expectation from patients and their families. They also showed competency on screening referral with categorisation of priority. Thus, the role and competency of PC nurse has room to enhance for better palliative care service in Hong Kong.  

The objectives of this training program were to consolidate skills in evidence-based interventions and strategies to promote adjustment and reduce overall risk of psychopathology of patients in palliative care setting. It also aimed to help us delineating and enhancing the role of clinical psychologists in the multi-disciplinary collaborative practice through learning about different service delivery models in the training program. The training took place at the University of Melbourne and on the clinical oncology department in St. Vincent’s Hospital in Melbourne, Australia. The training was divided into two parts – a four day training workshop and a 2-weeks clinical attachment. Similar to the practice in Hong Kong, the palliative care team provides inpatient, outpatient, consultancy and day care service. The team also liaises closely with services in the community, e.g. the Melbourne City Mission team who offers home visit and home based support. After office hours telephone support service was often operated by senior palliative care nurses so as to support patients and carers living in the community. At St. Vincent Hospital, there is a specialized team named the Psychosocial Cancer Care team to offer inpatient and outpatient psycho-oncology service to cancer and palliative care patients. The team is led by psychiatrists and includes clinical psychologists, music therapist and art therapist. Through this training, we learned about the use of Biopsychosocial-spiritual (BPSS) Model in understanding patients’ psychosocial and spiritual needs and guiding psychological treatment. We also observed how the use of psychotropic drug for psychiatric problems or illness related symptoms could ease patients’ distress efficiently. Lastly, participation in staff support group had equipped us to offer spiritual support to our team in the future. This overseas training offers a valuable opportunity for us to update our professional knowledge and clinical skills in assessment and management of psychiatric and psychological distress in palliative care setting. The combination of training workshop and clinical attachment is perfectly arranged for our learning, to apply what we have learnt in clinical practice.  

IntroductionStereotatic body radiotherapy on liver relies on real time position management (RPM) to monitor breathing motion. Regular and consistent breathing pattern is the key factor to achieve an accurate treatment delivery. The implementation of visual coaching system in SBRT liver patients during imaging and radiotherapy can link up the recognition for patient to reproduce a regular and consistence breathing motion. Meanwhile, it minimizes the dosimetric impact caused by irregular respiratory motion and maximizes the treatment efficiency in respiratory-gated liver tumour.ObjectivesTo evaluate the in-house cost-efficient visual coaching system in respiratory-gated radiotherapy liver cancer patient.MethodologySix patients with SBRT liver were recruited in this study. 60 sets of respiratory breathing patterns under visual coaching display were compared with ten previously treated liver cancer patients without visual coaching display. The time engaged in training, CT, verification, and treatment were compared and evaluated. Patient was initially arranged to attend a training session. He/she was asked to lie on the same treatment set up and breath normally as usual. Real-time positioning management system was used to record the breathing period and breathing amplitude. After that, in-house wireless visual display was mounted on couch for patient to visualize his/her own breathing pattern under coaching. The breathing parameters were recorded again, and analysis was made for selecting the gating or free-breathing technique. During CT and radiotherapy session, those parameters were recorded again to evaluate the reproducibility of breathing pattern. All the patients were positioned by X-ray and treatment were performed within our planned breathing pattern.Results & OutcomeThe time used to acquire CT imaging of each patient was significantly reduced by 30% and consistency for CT planning was enhanced as well. With the consultation session and visual coaching display, the treatment failure rate due to the anatomical changes was significantly decreased from 25% to 10%. The usage of kilo-Voltage on-board imaging for patient positioning was reduced from an average of 5 to 3.1 times per treatment session. A more consistent and reproducible breathing pattern could be obtained with less imaging dose induced to patient.  

IntroductionThe awareness of Recovery Orientated Care (ROC) keeps increasing. Different from the traditional psychiatric nursing care which emphasizes on symptom management and relapse avoidance, ROC suggests supporting the sufferers to better identify their strengths and to set goals under the restrictions imposed by their illness, in order to enhance their life satisfaction. Numbers of evidence have proven its advantages, such as facilitating the sufferers’ sense of hope, autonomy, empowerment and decision making. A successful service transformation contained the elements of changing staff's attitude and enhancing staff's knowledge. Pioneers and scholars suggested that a favorable organization culture had positive influence on staff's attitude in transformation. Meanwhile, providing sufficient training helped enhancing staff's knowledge, which could facilitate its promotion in department. Therefore, the transformation has gone through the journey of organization culture exploration, knowledge equipment and clinical application. Objectives(1)To transform the traditional psychiatric care to ROC in Department of Psychiatric in PYNEH; (2)To enhance staff’s confidence in promoting ROC in Department of Psychiatry in PYNEH; (3)To change staff’s attitude towards the ROC implementation in Department of Psychiatry in PYNEH. MethodologyInitially, organization culture was explored by conducting a pre-recovery self-assessment survey developed by Yale University. The acceptance and concern of implementation of ROC among different stakeholders were explored. A 3-tier training program was formulated based on the result, preparing the ROC implementation in moving forward to the next stage, “knowledge equipment”. At the 1st tier stage, representatives from each unit were nominated as a Recovery Promoter to participate into an intensive training. They helped their unit’s members to equip ROC related knowledge. At the 2nd tier, a series of ROC related training elements were provided to all the front-line nurses in the department. At the 3rd tier training, selected patients were recruited to join the intensive training programs. They were then employed as a peer support worker with on-the-job coaching provided. After the knowledge was well equipped, it came to the clinical practice stage. Recovery log book in two versions were distributed to facilitate the patient care practice. Moreover, different tools were established including Camberwell assessment, Need-Strength-Risk assessment and relapse management plan for guiding the implementation of ROC. Regular peer newsletters with different topics were published to share the experience of patient recovery journey. Results & OutcomeA post-test survey was completed by staff. Result showed that approximate 80% of staff rated they were confident of promoting ROC. Moreover, from the post-recovery self-assessment survey, staff had significant improvement in the following practices, including: (1)Staff encourage program participants to have hope and high expectations for their recovery; (2)Staff listen to and respect the decisions that program participants make about their treatment and care; (3)Staff regularly ask program participants about their interests and the things they would like to do in the community. The results indicated that staff is positive to ROC and is trying to adopt it into their health care practices.   

IntroductionPreterm babies born at less than 32 weeks of gestation are with highest mortality and morbidity. The anxiety from preterm labour induced impacts on pregnant women in biological, psychological and social aspects. This causes burden to the pregnant woman and the whole family. There are various interventions suggested to alleviate anxiety, such as providing information on infants’ prognosis and coping strategies. Maternal satisfaction is strongly correlated with staff professionalism, empathy, information and explanations provided to these women. Therefore, an educational programme was designed and the effectiveness was explored. (Ethic approval was obtained from KWC REC on 19 September 2017)ObjectivesThe objectives were to alleviate anxiety of women, enhance the counselling roles of midwives, and encourage a multidisciplinary approach in promoting psychosocial well-being of these women.MethodologyFor pregnant women who were less than 32 weeks, admitted for threatened preterm delivery were recruited after written consents were obtained. Two instruments were used, one was the state-trait anxiety inventory (STAI), which was given when the eligible woman met the inclusion criteria on admission. Another self-reported survey was also given to participant upon discharge to explore their feelings and their level of anxiety at different stages. Analyses was performed by SPSS (version 16.0) statistical software. Paired t-test was used to compare the means of data from two pre and post test score of State-Trait Anxiety Inventory on the same participant after receiving the programme.Results & Outcome19 women recruited and 16 women had completed the surveys during the study period. 31.2% (5/16) was nulliparous and 68.8% (11/16) was multiparous. 31.2% (5/16) were more than 28 weeks of gestation and 68.8% (11/16) were less than 28 weeks of gestations. The mean scores of mother’s pretest measurement on STAI-form Y1 and STAI-form Y2 were 52.94 (SD=7.23) and 48.38 (SD=9.58) respectively, whereas for the posttest measurement were 46.00 (SD=8.38) and 44.06 (SD=8.97) respectively. To examine the effectiveness of educational programme, pair sample t-test was used to measure mother’s pretest and posttest performance. The mean score of STAI form-Y1 decreased by 6.94 (SD=5.62), t=4.94, p< 0.05 when compared the pretest and posttest. The mean score of STAI form-Y2 decreased by 4.31 (SD=5.36), t=3.21, p< 0.05 from pretest to posttest. The anxiety scores were significantly decreased after the counseling. For the survey, the emotions experienced by mothers were nervous (93%), anxious (75%), disappointed (75%). 15 mothers were able to expressed breast milk to baby in postnatal ward.  

IntroductionThere is no fixed position for the used suction tubing in surgical ward. It is usually suspended around the suction bottle, suction meter, oxygen meter, or even put on the patient bedside drawer. It is not appropriate for both 5S (organization, cleanliness) and infection control standard.ObjectivesTo fix the used suction tubing in order to achieve the 5S principle and infection control standard.Methodology1. Stick a hook next to the suction bottle. 2. After the suction tubing is used and it is flushed with water, it is then fixed on the hook. 3. Ensure that tubing will not be suspended around other equipments. 4. Make sure that the opening of the tubing is upwards. Therefore, no water inside the tubing will spill out. 5. Educate nurses about the use of hook. Communicate and encourage other staff (such as doctors and physiotherapist) to put the suction tubing on the hook. 6. Carry out audit to measure the compliance. Results & OutcomeSatisfaction: Staffs are satisfied with the use of hook to fix the suction tubing. They agree that it makes patient’s bedside tidier. Also, this can prevent fluid to spill out from the suction tubing. Compliance: The compliance rate is 100%. Staffs are willing to use the new method to handle the used suction tubing.  

IntroductionElongation of population life expectancy leads to increase in the number of people with chronic health issues, including cognitive impairment. In our local Hong Kong population, there were around 103,433 people suffering from dementia in 2009, and it was expected to raise 222% to 332,688 in 2039. Facing the escalating number of people affected by cognitive impairment, exploring affordable and easy-to-use cognitive intervention program is thereby one of the essential approaches in dementia care. Previous studies revealed that learning therapy, using reading aloud and solving arithmetic calculation, can improve cognitive functions including executive functions, verbal episodic memory, processing speed and attention. Studies of learning therapy have only been commenced in Japan, America and Taiwan. Nevertheless, it is not well known whether learning therapy can improve other diverse cognitive and IADL functions, despite cultural difference in Hong Kong.ObjectivesThe objective of this study is to perform a pilot study to examine the effectiveness of Learning Therapy in HK elderly with cognitive impairment. The effects of Learning Therapy on subjects’ cognitive competence and IADL functions were investigated.MethodologyWe used a single-blinded, quasi-experimental intervention with two groups, learning therapy treatment group and waitlist control group. 22 Hong Kong elderlies were invited to the study, in which 11 of them were assigned to treatment group and 11 of them in control group. In treatment group, participants performed learning therapy for 2 months. Waitlist control group did not participate in the intervention. Diverse cognitive components and instrumental activities of daily living (IADL) functions were measured before and after 2 months intervention period.Results & OutcomeThe present study is the first study investigating learning therapy in local elderly population. The findings of our study suggest a positive treatment effect of learning therapy in cognitive and IADL performance in HK elderly with cognitive impairment. Compared to waitlist control group, results revealed that learning therapy improved attention, language, abstraction and delayed recall as measured by HK-MoCA, attention, initiation/preservation and memory as measured by CDRS, and IADL performance as measured by HKLIADL (All Ps < 0.05). Part of the result was not explored in previous study outside HK, for instance the improvements in language, abstraction and IADL competence. This quasi-experimental study can show the benefits of learning therapy in Hong Kong elderly with cognitive impairment in the perspectives of cognitive and IADL performance. Despite more definitive conclusions might be reached in the future when more large-scaled studies commence, the result would be useful in facilitating future service revamp and clinicians could have more modalities in meeting the needs of elderly with cognitive impairment.   

IntroductionScreening for latent tuberculosis infection (LTBI) before initiation of biologic is recommended internationally especially in tuberculosis (TB) endemic area like Hong Kong. However, there is no gold-standard and local guideline recommends use of either tuberculin-skin-test (TST) or interferon-gamma-release-assay (IGRA) before starting biologic for rheumatic diseases. Both tests have reduced sensitivity in immunosuppressed patients and a previous local study has demonstrated that the two tests have fair level of agreement only. We conducted this retrospective cohort study to determine whether dual LTBI screening could reduce incidence of TB.ObjectivesThis study aims to determine whether dual testing with both TST and IGRA before initiation of biologic agents for rheumatic patients can reduce incidence of TB.MethodologyThis is a retrospective cohort study. Consecutive patients who have received biologic for rheumatic diseases in a regional hospital in Hong Kong from July 2007 to February 2018 were reviewed. All patient underwent LTBI screening, either with single testing by TST/ IGRA or dual testing by both. They were categorized into single or dual test group. Background demographics, concurrent medications and choices of biologic were documented. All patients were followed-up regularly since initiation of biologic agents for at least 6 months. Isoniazid chemoprophylaxis was prescribed if the patient was tested positive for LTBI. The primary outcome was the difference in incidence of TB between two groups. Secondary outcomes included incidence of IGRA and TST test positivity, concordance rates of TST and IGRA, risk factors for the development of TB and adverse events associated with isoniazid chemoprophylaxis.Results & Outcome198 patients were included in this study. 119 patients underwent single LTBI testing with either TST or IGRA and 79 patients underwent dual testing. In the single test group, 115 patients had TST only and 4 patients had IGRA only. There is no significant differences in demographic between the two groups. The major indication of biologic agents was rheumatoid arthritis (58% in single test group versus 54% in dual test group). 91.3% in the single test and 84.8% in the dual test group had received at least one anti-tumour-necrosis-factor therapy. TB occurred in 9 out of 119 patients in single test group versus 1 out of 79 patients in dual test group (7.56% versus 1.26%, p=0.048). 35 patients in the single test group and 36 patients in the dual test group were tested positive for LTBI and given isoniazid chemoprophylaxis (28.5% versus 41.1%, p=0.014). The level of agreement between IGRA and TST is 73.4% (kappa value 0.446). However, in patient on prednisolone at screening, kappa value is reduced to 0.384 and further reduced to 0.107 in patients on at least 10mg daily prednisolone. Among all biologic agents, infliximab use was significantly associated with the incidence of TB (p=0.001). Reversible hepatotoxicity occurs in 6 out of 71 courses of isoniazid given, which was not significantly different between the two groups. Conclusion: Dual testing strategy with both TST and IGRA appears to be an effective way to reduce the incidence of tuberculosis in patients on biologic agents for rheumatic diseases. It should be considered especially for patients who are on prednisolone when undergoing LTBI screening.   

IntroductionNeuromuscular disease (NMD) is a broad spectrum of progressive diseases affecting the functioning of the muscles. When the respiratory muscles are involved in the long run, the vital capacity of the lung is reduced whereas the alternation of mechanical properties of the lung leads to the cough ineffectiveness. Particularly, patients with peak cough flow (PCF) less than 270 L/min are prone to develop respiratory tract infection due to ineffective cough. While PCF offers an overall evaluation of cough efficacy, suspected respiratory muscle weakness is not quantitatively assessed. Therefore, other respiratory muscles performance parameters are required to provide additional information regarding the coughing efficiency of the patient such that early intervention can be provided to avoid sputum retention.ObjectivesTo quantitatively evaluate the coughing effort of NMD patients by exploring the relationship between PCF and maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and sniff nasal inspiratory pressure (SNIP).MethodologyThis was a cross-sectional study in collaboration with the Department of Medicine, Queen Elizabeth Hospital (QEH). Since September 2017, NMD patients who attended the NMD clinic of QEH underwent detailed comprehensive cough assessment including measurements on PCF, MIP, MEP and SNIP conducted by experienced physiotherapists. Spearman’s rank correlation coefficient was used to quantify the relationship between different respiratory parameters. The correlation coefficient (r) above 0.5 was considered having moderate to good relationship. Receiver Operating Characteristic (ROC) curves were used to estimate the cut-off scores of MIP, MEP and SNIP.Results & OutcomeFrom September 2017 to November 2018, 16 patients of NMD clinic were referred for cough assessment. 62.5% were male patients. The mean age was 59.4±12.7 years old. A significant positive correlation of PCF to MIP (r=0.606, p=0.013), MEP (r=0.531, p=0.034) and SNIP (r=0.555, p=0.026) was demonstrated. In identifying an effective cough (PCF ≥ 270L/min), the cut-off scores of MIP, MEP and SNIP were 22.0 cmH₂O, 49.5 cmH₂O and 27.5 cmH₂O respectively. The result of this pilot study showed that there is significant correlation between PCF and other respiratory muscles performance parameters. Following the identification of ineffective cough, individualized intervention could be provided to the NMD patients including manual assisted cough, air stacking, mechanical insufflation-exsufflation and nasopharyngeal suctioning. With the comprehensive cough assessment, NMD patients with ineffective cough could be early intervened before the development of pulmonary complication and hence to relieve the burden to both patients and healthcare providers.