An analysis of policy on residential nursing care for the elderly in Hong Kong

published_or_final_versionPublic AdministrationMasterMaster of Public Administratio

Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage

Effects of activity intervention on cognitive and mood outcomes for participants with MCI-multiple domains deficits (Intention-to-treat method).

<p>() Standard Deviation, CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese Mini-mental state examination; ADAS-Cog—Alzheimer's Disease Assessment Scale cognitive subscale; CVFT—category verbal fluency test;. Differences between intervention programs were evaluated with three-level model with time point at level one, subjects at level two and activity groups at level three.</p><p>Effects of activity intervention on cognitive and mood outcomes for participants with MCI-multiple domains deficits (Intention-to-treat method).</p

Baseline demographic and cognitive characteristics of intervention groups.

<p>()—Standard deviation, sdMCI—Mild Cognitive Impairment, single domain deficit, mdMCI- Mild Cognitive Impairment, multiple domain deficit; CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; DAD-IADL—Instrumental activities of daily living of the Chinese Disability Assessment for Dementia; CSDD—Cornell Scale for Depression in Dementia. Group comparisons—Multi-level linear model-Baseline differences between intervention groups were evaluated with two-level model with subjects at level one and activity groups at level two. Differences between intervention groups were not significant.</p><p>Baseline demographic and cognitive characteristics of intervention groups.</p

Demographic and baseline cognitive profiles of sdMCI and mdMCI participants.

<p>()—Standard deviation, sdMCI—Mild Cognitive Impairment, single domain deficit, mdMCI- Mild Cognitive Impairment, multiple domain deficit; CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; CSDD—Cornell Scale for Depression in Dementia. Comparisons (t-tests)</p><p>Demographic and baseline cognitive profiles of sdMCI and mdMCI participants.</p

Effects of activity intervention on cognitive and mood outcomes for all participants (Intention-to-treat method).

<p>() Standard Deviation, CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; ADAS-Cog—Alzheimer's Disease Assessment Scale cognitive subscale; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; CSDD—Cornel Scale for Depression in Dementia. Multi-level model-Differences between intervention groups were evaluated with three-level model with time point at level one, subjects at level two and activity groups at level three.</p><p>Effects of activity intervention on cognitive and mood outcomes for all participants (Intention-to-treat method).</p

The adjuvanted recombinant zoster vaccine is efficacious and safe in Asian adults ≥ 50 years of age: a sub-cohort analysis of the ZOE-50 and ZOE-70 randomized trials

In two large clinical trials (ZOE-50 [NCT01165177] and ZOE-70 [NCT01165229]), two doses of the adjuvanted recombinant zoster vaccine (RZV) demonstrated >90% efficacy (VE) against herpes zoster (HZ) in adults ≥50 years of age (YOA). This post-hoc analysis assessed the VE against HZ and postherpetic neuralgia (PHN), in participants from Asian study sites enrolled in ZOE-50/70. Reactogenicity and safety were also assessed. Participants ≥50 YOA were randomized 1:1 to receive 2 doses of either RZV or placebo, 2 months apart. VE was evaluated for a median follow-up of 4 years post-vaccination overall and by age in the ZOE-50 Asian population ≥50 YOA and in the pooled ZOE-50/70 Asian population ≥70 YOA. Of the 2,729 participants included in the ZOE-50 Asian population ≥50 YOA, 3 RZV and 66 placebo recipients reported a confirmed HZ episode. Overall VE was 95.6% (95% confidence interval [CI]: 86.4–99.1) against HZ and 100% (95% CI: 35.44–100) against PHN. In the pooled ZOE-50/70 Asian population ≥70 YOA, 4 RZV and 75 placebo recipients out of the 2,723 participants reported a confirmed HZ episode. Overall VE was 94.7% (95% CI: 85.9–98.6) against HZ and 89.8% (95% CI: 28.39–99.77) against PHN. Pain and myalgia were the most frequent solicited local and general adverse events, respectively, in both populations. No safety concern was identified during the study periods. RZV is highly efficacious against HZ and PHN and has an acceptable safety profile in Asian populations ≥50 YOA, similar to what was observed in the general ZOE-50/70 populations. Trademark statement: Shingrix is a trademark owned by or licensed to the GSK group of companies

Safety profile of the adjuvanted recombinant zoster vaccine : Pooled analysis of two large randomised phase 3 trials

The ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) phase 3 clinical trials showed that the adjuvanted recombinant zoster vaccine (RZV) was ≥90% efficacious in preventing herpes zoster in adults. Here we present a comprehensive overview of the safety data from these studies. Adults aged ≥50 (ZOE-50) and ≥70 (ZOE-70) years were randomly vaccinated with RZV or placebo. Safety analyses were performed on the pooled total vaccinated cohort, consisting of participants receiving at least one dose of RZV or placebo. Solicited and unsolicited adverse events (AEs) were collected for 7 and 30 days after each vaccination, respectively. Serious AEs (SAEs) were collected from the first vaccination until 12 months post-last dose. Fatal AEs, vaccination-related SAEs, and potential immune-mediated diseases (pIMDs) were collected during the entire study period. Safety was evaluated in 14,645 RZV and 14,660 placebo recipients. More RZV than placebo recipients reported unsolicited AEs (50.5% versus 32.0%); the difference was driven by transient injection site and solicited systemic reactions that were generally seen in the first week post-vaccination. The occurrence of overall SAEs (RZV: 10.1%; Placebo: 10.4%), fatal AEs (RZV: 4.3%; Placebo: 4.6%), and pIMDs (RZV: 1.2%; Placebo: 1.4%) was balanced between groups. The occurrence of possible exacerbations of pIMDs was rare and similar between groups. Overall, except for the expected local and systemic symptoms, the safety results were comparable between the RZV and Placebo groups irrespective of participant age, gender, or race. No safety concerns arose, supporting the favorable benefit-risk profile of RZV