Background: Asthma is a global health problem affecting people of all ages. Despite huge progress on the management of asthma in recent decades, suboptimal health outcomes associated with under-management is still commonly encountered. Self management was shown to be a both clinically and cost effective approach to improve asthma outcomes in some studies. The role of pharmacists in promoting self management of asthma was explored in individual studies but limited review was conducted to assess its effectiveness. Objective: To investigate the effectiveness of pharmacist interventions on the self management of asthma patients in the community setting and to examine if the benefits, if any, could be realized by implementing such interventions in Hong Kong. Methods: A systematic search was conducted on Medline, Embase, Pubmed and Cochrane Library without time limit to identify studies assessing the clinical, humanistic and economic outcomes of pharmacist-led self management interventions towards adolescent or adult patients with asthma compared to usual care. Risk of bias of studies was appraised using a tool adapted from the Effective Practice of Organization of Care version of the Cochrane Risk of Bias Tool. Results: The search yielded 504 studies of which eight studies were eligible for inclusion. The included studies involved 1674 patients, were published between 2001 and 2008 and were originated from seven countries. Discrepancies of findings were noted in the majority of outcome measures reviewed. Significant benefits of pharmacist interventions included improvement of inhalation technique and reduction of rescue medication use although no significant effect was observed with regard to forced expiratory volume in one second and days lost from work or school. Conclusions: The evidence of pharmacist interventions on the self management of asthma remains inconsistent, probably attributable to variable quality of studies and heterogeneous assessment methods and outcome measures. Future research should aim to produce randomized, controlled studies incorporating allocation concealment with a follow-up period of over one year. Nevertheless, pharmacist-led asthma self management initiatives could be implemented at the general outpatient clinic setting in Hong Kong to further improve the quality of primary care. / published_or_final_version / Public Health / Master / Master of Public Health

Insomnia is recognized as one of the most common sleep complaints accompanied by daytime consequences in the general population worldwide. In recent years, the use of self-help cognitive behavioral therapy (CBT) has become a popular treatment option for insomnia. Firstly, a systematic review was conducted as an update and extension of a previous review (van Straten & Cuijpers, 2009). Two researchers systematically searched 6 major electronic databases in June 2012. We independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Meta-analyses of self-help CBT vs. waiting-list (WL), routine care or no treatment, therapist-administered CBT, and placebo were performed. Twenty randomized controlled trials were included; 10 of which were recent publications. Results showed that self-help CBT improved sleep, sleep-related cognitions, and anxiety and depressive symptoms. Effect sizes for sleep diary-derived sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average attrition rate of self-help CBT at immediate posttreatment was 15.6%. Therapist-administered CBT was significantly more effective than self-help CBT. Subgroup analyses supported the inclusion of telephone consultation, but not “full” multi-component CBT and programs  6 weeks. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped-care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as an adequate compromise. Secondly, a randomized controlled trial was conducted to evaluate the efficacy of an Internet-based cognitive behavioral therapy for insomnia (CBT-I) in Chinese insomnia population with or without medical and psychiatric comorbidities. Three hundred and twelve eligible participants were randomized to self-help CBT with telephone support (SHS), self-help CBT without telephone support (SH), and WL groups in a ratio of 1:1:1. Participants in the SHS and SH groups received self-help treatment once per week for 6 consecutive weeks, whereas participants in the WL group began treatment after 12 weeks of assessment. In addition to the standard self-help treatment, the participants in the SHS group received weekly brief therapist-administered telephone support. The Internet-based CBT-I showed significant improvements in insomnia symptoms and sleep-related dysfunctional cognitions. Improvement was further enhanced by weekly brief telephone support. The results suggested that Internet-based CBT-I is effective and acceptable to treat insomnia. / published_or_final_version / Psychiatry / Master / Master of Philosophy

Background: Group-based life coaching intervention is new in mental health service to promote early functional recovery. This study explored the experience of a 10-week group-based life coaching intervention for patients with schizophrenia from the users’ perspective. Method: A qualitative methodology was used based on individual interviews. Four participates referred by the coach were successfully engaged. The materials were taped and transcribed. Result: Seven categories forming four main themes were identified: the usefulness of the coaching intervention; characteristic of goals, subjective feeling during and after the coaching intervention; and perceived changes afterward. Conclusion: Participants were satisfied with the experience through the coaching intervention. They adopted the tactics acquired to cope with the life events and clinical symptoms such as positive and negative psychotic symptoms. Successful attainment of desirable career was their common goals which were facilitated by the sense of achievement continuously encountered during the intervention. Positive changes in both personal and interpersonal level were recorded and thus increased the courage to pursue their ultimate careers. Peer support in group-based intervention enhanced the perseverance towards the pathway to goal attainment. Dependence on the coaches after intervention was observed which was contradictory to one of the aims of life coaching. This study examined the possibility of the implementation of this newly developed intervention in mental healthcare setting in addition to the currently available psychological interventions. Further research directions to improve the utility and explore the domain of recovery are suggested. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Background: For early psychosis patients, the first few years were critical period for determining long-term illness outcome. The first experience of admission had significant bearing on the perception of subsequent psychiatric treatment received. From this perspective, it was important to be aware of how patients suffered and how they coped in order to regain their sense of self of insight and treatment adherence and trust with nurses’ rapport and their therapeutic relationship. In this regard, a qualitative study was done with an aim to (i) explore the admission experiences and beliefs participants held upon admission and after discharged within two months. (ii) any influences on their perceptions of experience during and after admission which might impact on therapeutic relationship and treatment attitude Method: Eight ICD-10 first-episode psychosis (FEP) patients aged between 18 and 55 years who admitted to psychiatric inpatient unit for the management of their FEP were recruited. Two face-to-face in-depth interviews were conducted for each participant. First interview was conducted within 2 weeks of admission, while second interview was conducted during psychiatric outpatient follow-up appointment within two months after discharged from hospital. All interviews were audiotaped and transcribed. Thematic analysis was employed to derive common themes regarding patients’ experience and perception on psychiatric hospitalization for their FEP. Results: Thematic analysis revealed six main themes regarding patients’ subjective experience and perception on the illness and hospitalization. These were uncontrollable sense of self, supportive relationship with family members, unpleasant admission procedure, and feeling out of control during hospitalization, perceived benefits of admission, and perceived adverse impacts of admission. Conclusion: Our findings indicated that ideas about what constitute admission perception needed to take into account of patient’s views and experience in order to emphasize therapeutic optimism rather than pessimism, and to inform treatment contexts and the views of nursing staff. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

University of Macau / Institute of Chinese Medical Sciences

No description available.

Three approaches, differing in flexibility of self-adjustments of insulin to food intake & exercise, have been identified in intensive management of Type I diabetes mellitus. They involve the exchange system (Protocols A/B) & carbohydrate counting (Protocol C) dietary strategies. The goal of this cross-over study was to determine differences among the approaches in terms of metabolic control (primarily glycated hemoglobin-GHb) and psycho-social adaptation (quality of life (QofL), self-efficacy (SE), stress & perceived complexity) in 15 adults with insulin-dependent diabetes. / There were no significant differences in terms of metabolic control, self-efficacy and quality of life. Perceived complexity increased (p $<$ 0.0001) as subjects progressed from protocols A to C (least to most flexible). However, the subjects continued with Protocol B (n = 12) or Protocol C (n = 3) at the end of the study. Subjects who were very accurate in their self-monitoring of blood glucose (SMBG) reporting were also accurate in counting carbohydrate (p $<$ 0.001), more confident (SE) in their ability to adjust their insulin (p $<$ 0.05) and more satisfied (QofL) with their diabetes (p $<$ 0.01). / This study indicated that patients who are not ready to undertake carbohydrate counting need not be excluded from intensive management programs. Accuracy in SMBG reporting can be used to direct educational efforts.

Diss. (sammanfattning) Umeå : Sveriges lantbruksuniv. / Härtill 4 uppsatser.

M.Tech.

M.Tech.