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.