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.