This is a story of the failing Texas foster care system, told by the people who work in it and more importantly, the children affected by it. Foster parents Jim and Kay Mayo and their foster children Brian and Heaven shared their troubled pasts and hopes for the future so more people could understand the problems facing them. There is no easy answer but hopefully some planned changes in policy will shape a better system. To delve deeper into the Mayo’s family dynamic and hear Brian tell his story in person, I invite you to see my video about Brian, Misael and Heaven here: “Far From Home” http://vimeo.com/41420290. The password is: foster care. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Public Health / Master / Master of Public Health

Background: With the aging of the global population, the prevalence and incidence of Alzheimer’s disease or related dementia are increasing. Most mild or moderate dementia clients are taken care of at home by informal caregivers, which leave a heavy burden to the caregivers. Researchers have found out that with good intervention services and programmes for the caregivers, their burden, emotional distress and even the care recipients’ symptoms and institutionalization rates would be improved. Objectives: This project is to review these researches to evaluate whether the interventions are effective and/ or cost-effective and how the decision-makers could use the results for evidence-based policy. Methods: A literature search was performed on randomized controlled trials in education, information/ support intervention programmes published from October 2005 to July 2012. Electronic databases (EBSCO, PubMed and CNKI) were searched until July 2012. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized controlled trials was used as the guideline to evaluate the quality of identified papers. Results: 16 papers (15 studies) were included in this review and classified into three groups, as home-based, individual-based and group-based interventions. This review found that the intervention programmes had various outcomes and showed some evidence of effectiveness. Most of the papers had good quality. The home-based programmes showed cost-effectiveness in the identified studies. Conclusion: There was some evidence that the home- and group-based interventions were effective and the home-based interventions could be cost-effective. Further studies are recommended and a meta-analysis on the studies and more researches on economic analysis are needed. A community-based long-term dementia management should be built up for better outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

Operating theatre is a cold environment and hypothermia (core body temperature lower than 36C) is prevalent among patients undergoing operations. Possible causes of this adverse condition include anesthetic effect, body part exposure, blood loss, and the low room temperature in the theatre. Hypothermia can impair wound healing, decrease drug metabolism, increase oxygen consumption, which in turn causing respiratory distress, bradycardia as well as atrial fibrillation. In extreme cases, it can be lethal. Numerous research studies have explored ways of interventions and new technologies to maintain normal body temperature of patients during operations. However, perhaps without proper translation to clinical practice, the rate of postoperative hypothermia still remains high in many hospital setting. The objectives of this thesis are to systematically review the current literature on the effectiveness of preoperative warming on reducing postoperative hypothermia of patients undergoing general anesthesia. Data from the relevant literature is extracted for setting up a table of evidence. Also, quality assessment is performed. An evidence-based practice guideline for preoperative warming is developed and its feasibility and transferability to the target patients is examined. The purpose of the guideline is to provide better care for patients undergoing general anesthesia. In this thesis, preoperative forced air warming is proposed. The target setting is the operating theatre department and day surgery centre in a local public acute hospital. The target population is patients who undergo general anesthesia. Data is extracted from six articles. The implementation potential of the proposed guideline is high, because of the high transferability, feasibility and cost-effective ratio. An evidence-based practice guideline is developed based on the evidence. Well-designed implementation and evaluation plan are developed for the implementation of the proposed guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

As a baby is born, the umbilical cord is cut and clamped, then it dries up and detaches. During the course of cord detachment and before the wound completely heals up, umbilical cord care is essential for preventing any local infection, which may lead to septicemia or infection of other organs. However, the yellowish and blood-stained discharge from the base of the cord and the appearance of the cord stump often causes anxiety among parents and make them hesitant to provide cord care. Hence, healthcare professionals are responsible for explaining the importance of proper cord care and provide consistent information on the course of cord detachment. This will decrease parental anxiety or the cord-related issues and improve compliance. Currently, different solutions are being used at different healthcare facilities. This leads to confusion among healthcare professionals and parents. Moreover, as evidenced in many studies, different solutions can affect the umbilical cord detachment time and prolongation of umbilical cord separation time, which can cause immense anxiety among the parents. Hence, a solution that is effective in reducing the umbilical cord separation time can help to alleviate parental anxiety. Dry care, such as using cold boiled water to clean the cord, is suggested to be suitable for umbilical cord care as it shortens the umbilical cord separation time compares to alcohol, which is still being used in many healthcare facilities. Therefore, this proposed innovation attempts to promote dry care as the standard umbilical cord care practice, to shorten the umbilical cord separation time, which in turn, decreases parental anxiety and the workload related to cord care for the healthcare professionals. The implementation of dry care was explored and it was found that this innovation is cost-effective and has a high transferability and feasibility in the current setting of Hong Kong Maternal and Child Health Clinics. An evidence-based practice guideline was developed and would be launched initially on a trial basis at one of the Maternal and Child Health Clinics after a well-developed communication and implementation plan is established. It is expected to take about 12 months from gaining approval, implementation of the innovation, data collection and to the last stage, program evaluation. / published_or_final_version / Nursing Studies / Master / Master of Nursing

End stage renal failure refers to an irreversible kidney dysfunction in which the kidneys fail to remove toxins from the blood stream. Haemodialysis is an effective treatment modality to sustain the lives of patients with end stage renal failure by removing waste products like urea, creatinine, and excess fluid. It involves a challenging regimen including dietary restrictions to ensure long-term survival. Failure to adhere with the regimen can result in fatal consequences. Renal patient discomfort related to non-adherence is commonly seen in clinical settings; however, there is currently no evidence-based fluid or dietary education program available to haemodialysis patients. This dissertation aims to identify and evaluate current evidence for the effectiveness of dietary and fluid control programs in the treatment of haemodialysis patients, to assess the transferability and feasibility of implementing a nurse-led education program regarding dietary and fluid control in haemodialysis patients, and to develop an evidence-based, nurse-led fluid and dietary control program for haemodialysis patients. Four electronic bibliographical databases including PubMed, Cochrane library, PsycInfo and CINAHL and two searching engines including Google scholar and ProQuest were used to identify studies that examined the effectiveness of educational programs or interventions on fluid or dietary control for patients on haemodialysis. Forty-five unique studies were identified as potentially relevant. Eleven of those studies met the selection criteria and were evaluated in this dissertation. Appraisal instrument was used to evaluate the quality of the selected studies. Six studies and three studies showed statistically significant in reduction of serum phosphate level and interdialytic weight gain respectively after educational intervention. Critical evaluation of the available studies led to an evidence-based, nurse-led, fluid and dietary control program for haemodialysis patients that followed the guideline development process of the Scottish Intercollegiate Guideline Network. Comparison on the similarity of patient characteristics, staff competence, and organizational settings of the evaluated studies were similar to those of the target unit. Therefore, the proposed program may be transferable and feasible. Furthermore, a cost-benefit analysis showed that the benefit of the fluid and dietary control program to patients outweighs the cost needed to implement the program. This dissertation outlines a proposed twenty-week program including marketing of the program, training of staff in the targeted renal unit, pilot testing, and application of the proposed program. Evaluation of the program will focus on three categories: patient outcome, health care provider outcome, and organization outcome. Clinical effectiveness of the program is defined by an overall reduction in patients’ mean interdialytic weight gain and mean serum phosphate level, improvement in knowledge test scores by patients, satisfactory nurses’ attendance rate in the renal training sessions, high nurse satisfaction with the educational program, and reduction of admission rate related to non-adherence. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background China never stops taking effort to reform its health care system. Health care financing, which is one of the essential control knobs to health care system, has significant influences on the sustainability of the health system, the quality of services it delivers, the health status of the population as well as the success of the whole health care reform process. Objectives This article aims to summarize the evolution of China’s health care financing system, its current situation and challenges, discuss what lessons China can learn from the successful experiences or unsuccessful pitfalls of others countries on its health care financing reform. Methods Articles were searched through PubMed and CNKI. Further relevant articles were identified by searching the citations listed in retrieved articles manually. 96 articles were reviewed. Statistics about China’s health care system were mainly from government white paper, SHA technical paper, Chinese government websites and WHO website. The information about the performance of health care systems in other countries was mainly from OECD database and WHO website. Results In China, insufficient government expenditure and high out-of-pocket payments; social health insurance providing limited risk protection, with low-level risk pooling; escalation of costs; inefficient financing resources allocation in providers; disparities among regions and provinces all lead to the inequity and inefficiency of the health care financing system and create heavy financial burden on patients. Based on experiences from other countries, the total health expenditure in China could take an even larger proportion of GDP in the future; it is reasonable to increase general government expenditure to further reduce the household out-of-pocket payment and provide financial protection and ensure equity; expanding services coverage and proportion of the costs covered, gradually merging the risk-pool units and different schemes can make social health insurance a more powerful tool to make sure people’s access to basic health care; a new payment mechanism and stricter supervision on supply side can effectively contain the escalation of the costs; government should inject more funding to front-line institutions and the function of primary care in China can be stimulated by a good primary health care delivery system, in which the role of primary care provider is clearly defined as the gatekeeper of the health care system, with a proper referral mechanism; more responsibility should be taken by central government to allocate financing resources based on the fiscal capability of local governments; Chinese government should foresee the demand of aging population and take actions before it is too late. Conclusion It is consensus that China’s health care reform is heading at the right direction. However, there are a lot of problems in China health care financing system remaining to be solved. Health care financing system varies greatly in each country and there is no perfect health care financing system in the world. Thus no single country can be one hundred percent copied by China. But general principles and one or some most successful and advanced portions of other countries’ health care financing systems can still be used as references by China after further assessment. Unsuccessful oversea experiences are also precious lessons for preventing Chinese government from making same mistakes. A good health care financing system should be designed on the basis of a systematic review of all domestic financing policy and previous international experiences. / published_or_final_version / Public Health / Master / Master of Public Health

Shrinking health care resources, especially the lack of health care staffs is an important public health challenge in the 21st century. One of the good practical solutions is to use volunteers as free supplementary human resources in healthcare settings. This literature review purposes to identify benefits of healthcare volunteerism, which covers three levels related to the benefits of healthcare volunteerism in terms of economic value analyses, patients’ satisfaction and safety, as well as benefits to volunteers and healthcare staff. Furthermore, this review aims to draw out the key health care policy issues and implications that healthcare organizers should take into consideration when setting up and implementing an effective, efficient and economical volunteering initiative. PubMed and Medline were searched using Medical Subject Heading (MeSH) and inclusion and exclusion criteria were applied, finally, sixteen studies were retrieved. Limitations of this literature review were also mentioned. / published_or_final_version / Public Health / Master / Master of Public Health