Eliza L.Y. Wong

Citation classics: Top 50 cited articles in ‘respiratory system’

Identifying citation classics in the field is one of the key methodologies used to conduct a systematic evaluation of research performance. The objective of this study was to determine the most frequently cited articles published in journals that are placed under the ‘respiratory system’ subject category (Institute for Scientific Information (ISI) Journal Citation Reports) and to compare them with the most frequently cited respiratory‐related articles published in any journal, regardless of subject category. The authors utilized the ISI Journal Citation Reports: Science Edition 2010 database in April 2012 to determine the most frequently cited articles by respiratory system subject category and by respiratory‐related keywords. The top 50 most‐cited articles were identified in each category and evaluated according to various characteristics. The majority of these papers originated from the United States. The median numbers of citations for the top 50 cited articles stratified by respiratory system subject category and respiratory‐related keywords were 841.5 and 2701, respectively. Half of the top 50 cited articles identified by respiratory‐related keywords were published in general medical or basic science journals, whereas only three out of these were published in journals under the respiratory system subject category in ISI Journal Citation Reports. In summary, respiratory‐related articles published in general medical or science journals attracted more citations than those published in the specific respiratory journals.

Citation Classics in Nursing Journals: The Top 50 Most Frequently Cited Articles From 1956 to 2011

Background:Assessing the impact of individual journal articles provides information for understanding trends in science and translation of findings on practice. Citation analysis is an important way to highlight the contributions of individual author/investigator and journals on nursing practice. Objective:The purpose of this study was to identify the most frequently cited articles published in nursing journals from 1956 to 2011. Methods:The Science Citation Index Expanded and Social Sciences Citation Index were searched for citations through 2011 to articles published in the 89 nursing journals listed on the Journal Citation Reports (2010 edition). The number of citations, topic, countries, and institutions of origin based on the first author affiliation, year of publication, study design, publishing journal, journal country, and journal impact factor were noted. The most frequently cited articles published in the 89 nursing journals from 1956 to 2011 were identified. Results:The top 50 most frequently cited articles were published in 10 nursing journals between 1970 and 2005. The top cited article received 784 citations. The most common topics were methodology for qualitative studies, validation procedures for tool development, and nursing care and practices in cancer and mental health. The most common study designs were reviews including meta-analysis and instrument validation. Most of the top 50 cited articles were published from 1986 to 1995. Discussion:The findings provide insights into priorities and trends in nursing research and translational science.

Isoflavones in Treating Watchful Waiting Benign Prostate Hyperplasia: A Double-Blinded, Randomized Controlled Trial

OBJECTIVES This study aims to determine the efficacy and safety of soy isoflavones in controlling the symptoms and signs of lower urinary tract symptoms due to benign prostate hyperplasia (BPH). DESIGN This was a prospective, randomized, double-blind, placebo-controlled pilot study. SETTING This trial was conducted at two hospitals in Hong Kong between May 2006 and September 2007. PARTICIPANTS One hundred and seventy-six (176) participants diagnosed with BPH were recruited from outpatient clinics. Participants with lower urinary tract symptoms were recruited through newspaper and radio interviews, posters placed at government outpatient clinics, and a public seminar offered by the investigators. INTERVENTIONS Participants were randomly assigned to either intervention (40 mg of isoflavones daily from Soylife 40) or placebo groups in a double-blind fashion. MAIN OUTCOME MEASURES The primary outcome parameter of peak urine flow rate and the second outcome parameters of postresidual urine volume, lower urinary tract symptoms, testosterone, prostate-specific antigen, quality of life, diet, and safety profile (liver and renal function) were collected. All parameters were assessed at baseline, 6 months, and 12 months in a 12-month study period except testosterone, prostate-specific antigen, and safety profile, which were assessed at baseline and at 12 months. RESULTS The peak urine flow rate (Qmax), postresidual urine volume, International Prostate Symptoms Scores (IPSS), and 36-Item Short Form Health Survey (SF-36) significantly improved from baseline to the 12th month within both groups. However, when compared between groups, Qmax (p=0.055) and incomplete emptying subscore in IPSS (p=0.05) were marginally/statistically different between the two groups from the 6th to the 12th months, in addition to the general health domain of SF-36 from the baseline to 12th month (p=0.02) and from the 6th month to the 12th month (p=0.055). Isoflavones were generally safe and well tolerated. CONCLUSIONS This randomized control pilot study showed only slight superiority of isoflavones over placebo over 12 months with otherwise surprising beneficial effects in both groups. Tolerability of isoflavones was excellent; thus it has laid foundations for further studies of isoflavones in BPH with focus on dosage and possible specificity of the effect.

Determinants of participation in a fall assessment and prevention programme among elderly fallers in Hong Kong: prospective cohort study

AIMS The study was undertaken to estimate the uptake rate of a fall prevention programme among older fallers and explore related factors. BACKGROUND Fall injuries are a major cause nationally of the loss of independence in old age, but they are preventable. Acceptance of fall prevention programmes is therefore important to reduce the risk of falling. METHODS Patients aged ≥60 attending the Department of Accident & Emergency of a regional hospital in Hong Kong between 2006 and 2007 were recruited. The study included a baseline interview, focus group interview and a cross-sectional 1-year follow-up telephone survey to assess uptake and its related factors. RESULTS A total 68% of 1194 older people attended the fall programme. Factors associated with programme participation included the perception of fall as being preventable [OR=3.47, 95% CI (1.59-7.56)] or recoverable [OR=1.73, 95% CI (1.06-2.82)], a safe outside environment; absence of chronic illness, and ability to walk without aids. Old-age people, those living in old-age homes and of lower education level were less likely to join the programme. CONCLUSION Older people with the selected characteristics were less likely to attend the fall prevention programme, thus were less likely to benefit from them. Support from family/carers may be an important element in participation. In a nursing context, in primary care practice, all of these factors should be taken into account in any future development of a fall prevention programme in Hong Kong of this nature.

Validation of inpatient experience questionnaire

OBJECTIVE A validation survey was carried out in this study to assess the acceptability, validity and reliability of the Hong Kong Inpatient Experience Questionnaire (HKIEQ), which was newly developed to measure patient experiences of hospital care in Hong Kong (HK). DESIGN Cross-sectional validation survey. MAIN OUTCOME MEASURES Principal component exploratory factor analysis assessed the construct validity of the questionnaire. Cronbachs alpha coefficients and Spearmans rank correlation coefficient estimated the reliability of the instrument. Acceptability of the questionnaire regarding the percentage of missing value of individual items was also assessed. RESULTS A total of 511 patients discharged from public hospitals in HK were interviewed. Low percentage of missing value (0.2 to 21.3%) showed high acceptability. Nine dimensions of hospital care explaining 75.4% of the variance were derived from factor analysis and content validity. These items showed satisfactory internal reliability consistency (0.49 to 0.97). Test-retest reliability ranged from 0.36 to 0.96. CONCLUSIONS The HKIEQ performed well on several psychometric indicators and is a promising measure of patient experience with public hospital inpatient care in HK. The findings provided important insight on developing tools to measure patient experience in hospitals to improve the quality of care and to lay the foundation for further research on patient expectations and needs regarding hospitalization.

Use of chinese and western over-the-counter medications in Hong Kong.

Benefits of engaging community pharmacists in providing wider primary care are internationally acknowledged; in Hong Kong, however, strategies for harnessing their potential contributions are yet to be launched. Here, community pharmacist and Chinese medicine retailers are responsible for providing western and Chinese over-the-counter (OTC) medications. Patterns of OTC uses reflect the characteristics of populations who rely on community pharmacists and Chinese medicine retailers as their main point of contact with the healthcare system. Analyzing the data from a Hong Kong survey (n = 33,263) on self medication and medical consultation patterns, we propose, in this article, an extended role for community pharmacists and Chinese medicine retailers, which entails aspects as follows: (1) referring patients to other medical services where appropriate; (2) providing health education and preventative services; (3) safeguarding the use of Chinese herbal medicines.

How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong

The World Health Organization advocates the goal of universal coverage of health systems to ensure that everyone can avail the services they need and are protected from the associated financial risks. Governments are increasingly engaging and interacting with the private sector in initiatives collectively referred to as public-private partnerships (PPPs) to enhance the capacity of health systems to meet this objective. Understanding the values that motivate partners and demonstrating commitment for building relationships were found to be key lessons in building effective PPPs; however there, remain many research gaps. This study focusses on the practice of PPPs at the inter-organisational (meso) level and interpersonal (micro) level in Hong Kong Special Administrative Region (HKSAR). The influence of the structural components of different PPPs on stakeholder interpretation and actions, as well as the eventual outcomes of the PPPs, is examined, in terms of a realist evaluation, which applies a context-mechanism-outcome configuration as the research methodology. Seven key factors initiating commitment in a partnership, critical for sustainable PPPs, were identified as follows: (1) building of trust; (2) clearly defined objectives and roles; (3) time commitment; (4) transparency and candid information, particularly in relation to risk and benefit; (5) contract flexibility; (6) technical assistance or financial incentive behind procedural arrangements; and (7) the awareness and acceptability of structural changes related to responsibility and decisions (power and authority).

Patient Experience and Satisfaction with Inpatient Service: Development of Short Form Survey Instrument Measuring the Core Aspect of Inpatient Experience

Patient experience reflects quality of care from the patients’ perspective; therefore, patients’ experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients’ experience would reflect the key aspect of inpatient care from patients’ perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients’ experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient’s journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients’ experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.

Chinese medicine: its role and application in the institutionalised older people

AIMS The aim of the study was to explore the need for and application of Chinese medicine services and factors which impact on the accessibility of Chinese medicine among the institutionalised older people. BACKGROUND Although complementary and alternative medicine is widely used by older Chinese both in Hong Kong and elsewhere, little is known about its use by the institutionalised older people. This study breaks new ground by exploring how Chinese medicine, the most popular form of complementary and alternative medicine used by older people, is used and accessed by the institutionalised older people in Hong Kong. DESIGN Qualitative method. METHODS Semi-structured interviews were conducted in 2007 with 18 older individuals aged between 63-93 and living in three long-term care facilities in Hong Kong. RESULTS Three main categories emerged from the data: (1) the role of Chinese medicine in the care of the aged; (2) barriers to the use of Chinese medicine in residences; and (3) factors facilitating the accessibility of Chinese medicine services in residences. Most of the older individuals interviewed claimed that Chinese medicine played a crucial role in their self-health management. The availability of Chinese medicine depended crucially on the support of the health care system, individual institutions and nursing staff. CONCLUSIONS The value of Chinese medicine in the care of the institutionalised older people was highlighted. Chinese medicine as a complement to western medicine was perceived as an important component of self-health management. Attitudes towards the use of Chinese medicine in nursing homes therefore need to be reviewed and developed further in accordance with the health strategy policy. RELEVANCE TO CLINICAL PRACTICE This research focuses on the role of complementary and alternative medicine in health care for the institutionalised older people. It provides health practitioners, researchers and policy makers with an additional perspective in the provision of quality client-centred care for older people living in long-term care.

Primary care for diabetes mellitus: perspective from older patients

Background Care of diabetes mellitus in the elderly requires an additional perspective to take into account impaired cognitive function, physical function, low level of education, and difficulty making lifestyle changes. Existing services tend to be driven by the views of tertiary and secondary care staff, rather than those of primary care staff and elderly patients. This study aimed to explore the attitudes and preferences of elderly patients with diabetes mellitus towards primary care (clinical care and community program). Method Elderly patients with diabetes mellitus aged 60 years or above were recruited from governmental diabetes mellitus clinics and diabetes mellitus specific community centers. Three focus group discussions of 14 diabetic elderly patients were conducted and their perspectives on the new service model were assessed. Participants were interviewed according to an open-ended discussion guide which includes the following items: comments on existing clinic follow up and community program, motivation for joining the community program, and suggestions on further clinical services and community service program development. Results Incapability of the current health service to address their special needs was a common concern in three focus group discussions. The majority highlighted the benefits of the new service program, that is, self-care knowledge and skill, attitudes to living with diabetes mellitus, and supportive network. Key facilitators included experiential learning, a group discussion platform, and goal setting with patients. Conclusions This study is the first qualitative study to explore the views of elderly diabetic patients’ on their self-care needs. Elderly people with diabetes mellitus in this study identified bad experiences of clinical follow-up; benefit from the community program; and recommendations for the future development of primary care. Study findings revealed a number of discrepancies between elderly diabetic patients’ needs and existing health services in Hong Kong. The study findings provide health practitioners, researchers and educators with an additional perspective on the provision of quality of care for elderly diabetic patients in the community.