Patients’, families’ and healthcare providers’ perspectives on end-of-life communication in Chinese hospital settings: A qualitative study protocol

Background Perspectives of key stakeholders should be fully considered to enhance culturally appropriate strategies in end-of-life communication and strengthen healthcare service delivery. So far, little research evidence is available on Chinese patients’, families’, and healthcare professionals’ experiences with and perspectives of end-of-life communication in hospital settings. Aim The current study aims to explore experiences, perceptions and suggestions of end-of-life communication among Chinese terminally ill patients, their families and healthcare providers. Methods The phenomenology qualitative approach will be adopted. Semi-structured in-depth interviews and focus group discussions will be used to collect relevant data. Eligible terminally ill patients, family caregivers and healthcare providers will be recruited in two hospitals in Mainland China via purposive sampling. Thematic analysis will be performed to analyse data. The Standards for Reporting Qualitative Research (SRQR) checklist will be followed for reporting. This study has been registered at ClinicalTrials.gov (NCT05734781). Discussion This qualitative study is, as far as we are aware, the first to specifically address patient/family-provider end-of-life communication in the Chinese social-cultural context. The results hold the potential to enrich current knowledge of end-of-life communication, navigate culturally appropriate communication strategies, and inform the development of related training programs for healthcare providers in hospital settings

A Comparative Study of Routine Laparoscopic Versus Open Appendectomy

Scientific PapersOBJECTIVE: We evaluated the outcomes of routine laparoscopy and laparoscopic appendectomy (LA) in patients with suspected appendicitis. This is a retrospective study of the outcomes of patients undergoing laparoscopic appendectomy compared with outcomes for patients undergoing open appendectomy (OA) during the time that LA came into use. METHOD: Results of patients managed with routine laparoscopy and LA for suspected acute appendicitis were reviewed and analyzed. The preoperative and intraoperative findings were recorded. The clinical outcomes were compared with those of patients undergoing OA in the preceding 10 months. RESULTS: During the LA study period, 97 patients (47 men) with the median age of 34 years (range, 18 to 79) presented with clinical features of acute appendicitis. With the exclusion of 5 patients with open operations and 10 patients with other pathologies, 82 patients underwent laparoscopic appendectomy (Group A) for appendicitis. Thirty-one (37.8%) patients had complicated appendicitis (perforated or gangrenous appendicitis). Conversions were required in 6 patients (7.3%). During the OA period, 125 patients (57 men) with the median age of 42 (range, 19 to 79) years were operated on. With the exclusion of 6 patients with other pathologies, 119 underwent OA for acute appendicitis (Group B). Fifty-one (42.9%) had either perforated or gangrenous appendicitis. The median durations of surgery in Group A and Group B were 80 minutes (range, 40 to 195) and 60 minutes (range, 25 to 260), respectively (P < 0.005). Postoperative complication rates were comparable between the 2 groups (13.4% in Group A versus 15.8% in Group B). The median hospital stay for patients in Group A and Group B were 3.0 days (range, 1 to 47) and 4.0 days (range, 1 to 47), respectively (P = 0.037). CONCLUSIONS: We conclude that routine laparoscopy and LA for suspected acute appendicitis is safe and is associated with a significantly shorter hospital stay. Other intra-abdominal pathologies can also be diagnosed more accurately with the laparoscopic approach.link_to_OA_fulltex

An investigation of the effectiveness of human resource management in the Hong Kong police

In the literature, there is the increasing trend to link human resource planning with strategic planning giving greater importance to, and greater involvement of, human resource management in organization strategy. Also the Hong Kong Police is a manpower oriented discipline force and the human resource management functions play a critical role in the effective management of these human resources. Therefore, the critical nature of the human resource management of the Hong Kong Police justifies a management report orientation where the focus is on the production of positive and practical recommendations. The objectives of the report are to evaluate the effectiveness of the existing human resource management system of the Hong Kong Police and also if and where appropriate to make recommendations designed to enhance the present system. In order to achieve the objectives, four aspects were evaluated. The first aspect is the human resource management goals of the Hong Kong Police. It was evaluated against the criteria of the extent to which it is consistent with the ii Vision, Statement of the Common Purposes and Values of the Police. The second aspect is its policies and practices of the each of the functions, which include 1. human resource planning (HRP), 2. recruitment and selection, 3. training and career development, 4. compensation and benefits management, 5. performance evaluation, 6. employee and labor relations, 7. counseling and 8. termination of the existing human resource management. It was evaluated through the comparison between the policies and practices of the each of the functions mentioned above and the corresponding theoretical functional goals. The third aspect is outcomes of human resource management, including complaints from the public, and opinions to it from the general public. It was evaluated against the overall goals of human resource management of the Hong Kong Police. The last but not the least, others, which are the things other than the above, factors viewed as relevant including what it has done during 1996 to 1999. Peters and Waterman Model was used as a framework for evaluating how well the Police was doing during this period. After considering all the aspects, we concluded that the Hong Kong Police did well in the planning process of the human resource management, as theoretically, the effectiveness of the human resource management was achieved. However, further improvement is needed in certain areas concerning the actual performance during the implementation, which may imply there are some problems that may affect the effectiveness of the human resource management of the Hong Kong Police. Based on the evaluation, we suggest that Competency Assessment Methods can be used as a framework for the Hong Kong Police to develop a set of competency for evaluating the performance of the employees. Also, a number of ways were suggested to improve the existing promotion mechanism. The supervisor’s recommendation involved in it can be improved by giving guidelines to the supervisors and having a group of supervisors to evaluate the performance of the employee. Also the recommendations should base on credible information. Moreover, feedback channels should be given to the employees to raise their opinions towards the decision in the promotion mechanism. In order to improve the competency of the supervisors, training should be given to strengthen their accountability for handling their work. Also a flexible and cafeteria benefits package was recommended to increase the flexibility of the existing benefits package iv for motivating the employees by giving autonomy to choose the benefits they need

The development of universal retirement policy in Hong Kong : a study of political and administrative dynamics

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Synthesis of multisubstituted pyrroles by nickel-catalyzed arylative cyclizations of N-tosyl alkynamides

The synthesis of multisubstituted pyrroles by the nickel-catalyzed reaction of N-tosylalkynamides with arylboronic acids is reported. These reactions are triggered by alkyne arylnickelation, followed by cyclization of the resulting alkenylnickel species onto the amide. The reversible E/Z isomerization of the alkenylnickel species is critical for cyclization. This method was applied to the synthesis of pyrroles that are precursors to BODIPY derivatives and a biologically active compound

Pegylated derivatives of recombinant human arginase (rhArg1) for sustained in vivo activity in cancer therapy: preparation, characterization and analysis of their pharmacodynamics in vivo and in vitro and action upon hepatocellular carcinoma cell (HCC)

<p>Abstract</p> <p>Background</p> <p>Protein used in medicine, e.g. interferon, are immunogenic and quickly broken down by the body. Pegylation is a recognized way of preserving their integrity and reducing immune reactions, and works well with enzymes used to degrade amino acids, a recent focus of attention in controlling cancer growth. Of the two arginine-degrading enzymes being explored clinically, arginine deiminase is a decidedly foreign mycoplasm-derived enzyme, whereas human arginase 1 is a native liver enzyme. Both have been pegylated, the former with adjuncts of 20 kD, the latter with 5 kD PEG. Pegylation is done by several different methods, not all of which are satisfactory or desirable.</p> <p>Methods</p> <p>The preparation of novel polyethylene glycol (PEG) derivatives for modifying proteins is described, but directed specifically at pegylation of recombinant human arginase 1 (rhArg1). rhArg1 expressed in <it>Escherichia coli </it>was purified and coupled in various ways with 5 different PEG molecules to compare their protective properties and the residual enzyme activity, using hepatocellular cell lines both in vitro and in vivo.</p> <p>Results</p> <p>Methoxypolyethylene glycol-succinimidyl propionate (mPEG-SPA 5,000) coupled with very high affinity under mild conditions. The resulting pegylated enzyme (rhArg1-peg_{5,000 mw}) had up to 6 PEG chains of 5K length which not only protected it from degradation and any residual immunogenicity, but most importantly let it retain >90% of its native catalytic activity. It remained efficacious in depleting arginine in rats after a single ip injection of 1,500 U of the conjugate as the native enzyme, plasma arginine falling to >0.05 μM from ~170 μM within 20 min and lasting 6 days. The conjugate had almost the same efficacy as unpegylated rhArg1 on 2 cultured human liver cancer (HCC) cell lines. It was considerably more effective than 4 other pegylated conjugates prepared.</p> <p>Conclusion</p> <p>Valuable data on the optimization of the pegylation procedure and choice of ligand that best stabilizes the enzyme arginase 1 are presented, a protocol that should equally fit many other enzymes and proteins. It is a long lasting arginine-depleting enzyme in vivo which will greatly improve its use in anti-cancer therapy.</p

The Moderating Effect of Different Types of Internet Use on the Relationship between Transitional Aging Changes and Self-esteem of Older Adults

This study investigates the moderating effect of different types of Internet use regarding the relationship between three transitional aging changes and self-esteem of older adults. The current paper is still in progress; this is a research-in-progress paper. An aging population increases government expenditures and family responsibilities, thus drawing more attention from the academic community. Recent research posits that self-esteem tends to decline in individuals from the ages around 50-65 due to role loss, social loss, and dissatisfaction resulting from unaccomplished life goals. To address this issue, previous studies considered that the general use of the Internet may help to enhance self-esteem among older adults. To fill this research gap, the present study proposes that the cultural use of the Internet could moderate role loss of older adults, while social use of the Internet could mitigate social loss. Furthermore, economic use could moderate the dissatisfaction of unfulfilled life goals. Regarding various theoretical contributions, this is the first study to apply different types of Internet use, so as to investigate its moderating effect concerning the relationship between transitional aging changes and self-esteem. Findings of the present study can also help shed light on interventions for the caregiver in both community centers and the domestic environment to moderate the decline of self-esteem among older adults. The data will be collected through surveys distributed to District Elderly Community Centers (DECCs) in Hong Kong. Multiple regression analysis will then be utilized to test the moderating effect of each type of Internet use

Computer-aided screening of aspiration risks in dysphagia with wearable technology: a Systematic Review and meta-analysis on test accuracy

Aspiration caused by dysphagia is a prevalent problem that causes serious health consequences and even death. Traditional diagnostic instruments could induce pain, discomfort, nausea, and radiation exposure. The emergence of wearable technology with computer-aided screening might facilitate continuous or frequent assessments to prompt early and effective management. The objectives of this review are to summarize these systems to identify aspiration risks in dysphagic individuals and inquire about their accuracy. Two authors independently searched electronic databases, including CINAHL, Embase, IEEE Xplore® Digital Library, PubMed, Scopus, and Web of Science (PROSPERO reference number: CRD42023408960). The risk of bias and applicability were assessed using QUADAS-2. Nine (n = 9) articles applied accelerometers and/or acoustic devices to identify aspiration risks in patients with neurodegenerative problems (e.g., dementia, Alzheimer’s disease), neurogenic problems (e.g., stroke, brain injury), in addition to some children with congenital abnormalities, using videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) as the reference standard. All studies employed a traditional machine learning approach with a feature extraction process. Support vector machine (SVM) was the most famous machine learning model used. A meta-analysis was conducted to evaluate the classification accuracy and identify risky swallows. Nevertheless, we decided not to conclude the meta-analysis findings (pooled diagnostic odds ratio: 21.5, 95% CI, 2.7–173.6) because studies had unique methodological characteristics and major differences in the set of parameters/thresholds, in addition to the substantial heterogeneity and variations, with sensitivity levels ranging from 21.7% to 90.0% between studies. Small sample sizes could be a critical problem in existing studies (median = 34.5, range 18–449), especially for machine learning models. Only two out of the nine studies had an optimized model with sensitivity over 90%. There is a need to enlarge the sample size for better generalizability and optimize signal processing, segmentation, feature extraction, classifiers, and their combinations to improve the assessment performance.Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/), identifier (CRD42023408960)