published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Pharmacology and Pharmacy / Doctoral / Doctor of Philosophy

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Oral mucositis is a common adverse side-effect caused by cancer treatments and can lead to mucosa toxicity. Patients with oral mucositis may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Thirty to eighty five percent of patients undergoing chemotherapy would develop oral mucositis. Preventing or reducing incidence of oral mucositis and its severity can help reduce patients’ sufferings. One of the methods to achieve this objective is the oral cryotherapy, which is a prophylactic intervention. However, there is no evidence-based guideline to instruct nurses on providing oral cryotherapy to cancer patients. The aims of this study are 1) to establish an evidence-based guideline on applying cryotherapy to reduce the incidence and severity of chemotherapy-induced oral mucositis, 2) to develop a standard nursing care and assess its transferability and feasibility, and 3) to develop a communication plan and evaluation plan for this guideline in an oncology ii- department for the targeted local hospitals in Hong Kong. A systematic search of four electronic journal databases identified seven articles corresponding to 6 randomized controlled trials (RCTs) on using oral cryotherapy for adult cancer patients. Five RCTs with high to weak quality reported supporting evidence for the beneficial effect of oral cryotherapy on chemotherapy-induced oral mucositis, whereas 1 RCT with moderate quality failed to identify supportive evidence for the use of oral cryotherapy. However, potential confounding factors were identified to be presented in that insignificant RCT. Hence, there was sufficient evidence to show that oral cryotherapy can significantly reduce chemotherapy-induced oral mucositis in adult cancer patients. An evidence based guideline for using cryotherapy on chemotherapy-induced oral mucositis in adult cancer patients was established. The transferability and feasibility of the proposed oral cryotherapy guideline were assessed. As identified, the clinical situation and patient characteristics in the local settings are similar to those who reported in the reviewed studies. Staff readiness, skills and resources are also readily available in the target clinical settings. Findings from the reviewed studies of oral cryotherapy can be transferred to the local target settings and are feasible to be implemented. It is also estimated that the innovated guidelines for cryotherapy can save HK$3,210,745 per year for the target setting. Stakeholders for the innovated guideline in the local setting were identified. And a communication plan was developed. A pilot study lasting for 10 weeks will be conducted to test the feasibility of the staff training session and the implementation of the oral cryotherapy guideline. Modification of innovated guidelines will be made after evaluating the data collected from the pilot study. Eventually, the final version of the evidence-based guideline will be established. A six months evaluation plan will be used to evaluate the implementation of the new guideline. The policy for adopting the oral cryotherapy will be determined with the outcome measures, including the incidence of chemotherapy-induced oral mucositis, mean of the oral mucositis score, staff satisfaction level, and the cost and benefit ratio of the innovated guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

According to the World Health Organisation, hip fracture among elderly people is a global public health problem, with 1.7 million cases worldwide in 1991, a figure due to the aging population and believed likely to increase. Post-operative delirium is a common complication following hip-fracture surgery, and occurs in 25% to 65% of cases (Gustafson 1988). It not only affects the rehabilitation progress of the elderly, but also prolongs hospitalisation, which in turn increases the financial burden on the government. There are different ways of managing post-operative delirium among the elderly, including pharmacological and multifactorial interventions and education programmes. However, there is no standard nursing management of post-operative delirium in Hong Kong, and this affects both patient care and nursing standards. According to the National Institute for Health and Clinical Excellence (2011), multifactorial intervention is cost-effective and an effective method of reducing postoperative delirium, where nurses play an important role as gatekeepers, and thus allow such intervention to be introduced into the clinical setting. With this in mind, translational nursing research was performed by a review of four studies, to introduce the concept of multifactorial intervention to nurses, to formulate the implementation for the intervention, and finally to obtain feedback from colleagues. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Visual hallucinations (VH) are an important non-motor complication of Parkinson’s disease (PD) which carries a negative prognosis, but their biological basis is unclear. Multi-modal magnetic resonance imaging (MRI) can be used to evaluate structural and functional brain mechanisms underpinning VH in PD. Methods To assess cerebral microstructure and resting functional activities in patients with idiopathic PD and VH, I compared PD patients with VH (PDVH) and PD patients without VH (PDnonVH), while healthy controls (HC) were also recruited for comparison. Diffusion tensor imaging was used to calculate mean diffusivity (MD) and fractional anisotropy (FA). Structural MRI was used to calculate voxel-based intensity of grey matter (GM) and white matter (WM) across the entire brain and compared among groups. Furthermore, functional magnetic resonance imaging of the brain, acquired during rest, was processed to calculate the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC) to inform a model of VH. In addition, hippocampal volume, shape, mean diffusivity and FC across the whole brain was further examined. Hippocampal dependent visual spatial memory performance was compared between groups, and predicted correlations with hippocampal microstructural indices and VH severity were tested. Results In the first study, PDVH had lower FA than both PDnonVH and HC in the right occipital lobe and left parietal lobe, but increased FA in the right infero-medial fronto-occipital fasciculus and posterior inferior longitudinal fasciculus. Moreover, PDVH patients showed less GM volume compared to PDnonVH in the right lingual gyrus of the occipital lobe. In the second study, PDVH patients compared to non-hallucinators showed lower ALFF in occipital lobes, with greater ALFF in temporo-parietal region, limbic lobe and right cerebellum. The PDVH group also showed alteration in functional connectivity between occipital region and corticostriatal regions. Finally in the third study, although there were no gross hippocampal volume and shape differences across groups, individuals with PDVH had higher diffusivity in hippocampus than PDnonVH and HC. Both PD groups had significantly poorer visuospatial memory compared to HC. Poorer visuospatial memory was correlated with higher hippocampal diffusivity in HC and more severe VH in the PDVH group.FC between hippocampus and primary visual cortex, dorsal/ventral visual pathways was also lower in PDVH than other groups, whereas FC between hippocampus and default mode network regions was greater in PDVH group compared to others. Conclusion Compared to PDnonVH groups, the PDVH group had multiple structural deficits in primary and associative visual cortices. In term of hemodynamic activity, the PDVH group had lower ALFF in occipital lobe, but greater ALFF in regions that comprise the dorsal visual pathway. Moreover, this lower ALFF in the primary visual cortex was accompanied by lower functional connectivity across components of the ventral/dorsal visual pathway in the PDVH group compared to the PDnonVH group. Moreover, evidence supporting a specific role for the hippocampus in PDVH was obtained. In the absence of gross macrostructural anomalies, hippocampal microstructure and functional connectivity was compromised in PDVH. I observed an association between visuospatial memory and hippocampal integrity and suggest that hippocampal pathology and consequent disruption in visuospatial memory plays a key contribution to VH in PD. Thus, in the PDVH group, "bottom-up" primary visual cortex and “top-down” visual association pathways and attentional networks appear to be disrupted. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

published_or_final_version / Orthopaedics and Traumatology / Master / Master of Philosophy

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published_or_final_version / abstract / toc / Surgery / Doctoral / Doctor of Philosophy