William Ho Cheung Li

The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer

AIMS To examine the effectiveness of therapeutic play, using virtual reality computer games, in minimising anxiety and reducing depressive symptoms in Hong Kong Chinese children hospitalised with cancer. BACKGROUND There has been an increase in the use of therapeutic play intervention to help children cope with the stress of hospitalisation. However, it is not clear whether therapeutic play is an appropriate psychological intervention for Chinese children hospitalised with cancer. DESIGN A non-equivalent control group pretest-post-test, between-subject design was employed. METHOD Hong Kong Chinese Children (8-16 years of age), admitted to a paediatric oncology ward for the treatment of cancer during a 14-month period, were invited to participate in the study. Of the 122 children, 70 formed the control group receiving routine nursing care and 52 in the experimental group receiving therapeutic play interventions. RESULTS The results showed that children in the experimental group reported statistically significant fewer depressive symptoms than children in the control group on day 7. The results, however, find no differences in childrens anxiety scores between the two groups on day 7. CONCLUSION The study provides empirical evidence to support the effectiveness of therapeutic play, using virtual reality computer games, in the psychological preparation of children hospitalised with cancer, thus charting a path towards promoting holistic and quality care. RELEVANCE TO CLINICAL PRACTICE The findings heighten the awareness in healthcare professionals that play is a very important part of childrens life and that they need play even when they are ill.

Effectiveness of a play-integrated primary one preparatory programme to enhance a smooth transition for children

This study tested the effectiveness of a play-integrated preparatory programme to enhance a smooth transition for children from kindergarten to primary one. A randomized controlled trial was employed and 142 families were recruited. Children in the experimental group experienced greater happiness, fewer worries and lesser difficulty in psychological adjustment than children in the control group, providing evidence that the play-integrated preparatory programme is effective in enhancing a smooth transition for children. Findings from this study promote the awareness in parents and teachers that play is an important part of children’s lives, which is essential for their normal growth and development.

Enhancing the efficacy of psychoeducational interventions for paediatric patients in a randomised controlled trial: methodological considerations

AIM This paper described a case study of a randomised controlled trial with the aim to illuminate how the intervention described takes into account the important methodological considerations for enhancing the efficacy of psychoeducational interventions for paediatric patients. BACKGROUND Many nursing intervention studies commit a Type II error despite the fact that the intervention is effective. Lack of attention given to the threats of validity of an intervention study may lead to inaccurate inference about the efficacy of the intervention study, thereby precluding any definitive conclusions being drawn. DESIGN A case study of a randomised controlled trial was described. METHOD Two hundred and three Hong Kong Chinese children, admitted for elective surgery, were invited to participate in the study. By using a simple complete randomisation method, 97 children were assigned to the experimental group and received therapeutic play intervention and 106 children were assigned to the control group and received routine information preparation. RESULTS Children received preoperative therapeutic play intervention experienced lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures. CONCLUSION This case study illustrates that the more a measure is sensitive to differentiate between the experimental and control groups, the greater the likelihood of documenting intervention efficacy. Besides, the timing of measuring a dependent variable that matches with peak response to an intervention is crucial in evaluating the efficacy of an intervention. Additionally, outcome measures that are sensitive enough to differentiate between the experimental and control groups are extremely important to ensure greater accuracy in evaluating the efficacy of psychoeducational interventions. RELEVANCE TO CLINICAL PRACTICE It is anticipated that designing an effective psychoeducational intervention research design can facilitate the development of holistic and quality care in preparing children for hospitalisation.

Stable optical trapping and sensitive characterization of nanostructures using standing-wave Raman tweezers

Optical manipulation and label-free characterization of nanoscale structures open up new possibilities for assembly and control of nanodevices and biomolecules. Optical tweezers integrated with Raman spectroscopy allows analyzing a single trapped particle, but is generally less effective for individual nanoparticles. The main challenge is the weak gradient force on nanoparticles that is insufficient to overcome the destabilizing effect of scattering force and Brownian motion. Here, we present standing-wave Raman tweezers for stable trapping and sensitive characterization of single isolated nanostructures with a low laser power by combining a standing-wave optical trap with confocal Raman spectroscopy. This scheme has stronger intensity gradients and balanced scattering forces, and thus can be used to analyze many nanoparticles that cannot be measured with single-beam Raman tweezers, including individual single-walled carbon nanotubes (SWCNT), graphene flakes, biological particles, SERS-active metal nanoparticles, and high-refractive semiconductor nanoparticles. This would enable sorting and characterization of specific SWCNTs and other nanoparticles based on their increased Raman fingerprints.

Towards international consensus on patient harm: perspectives on pressure injury policy

AIMS To analyse influential policies that inform practice related to pressure injury management in Australia, England, Hong Kong, New Zealand, Scotland and the United States of America. BACKGROUND Pressure injuries are associated with significant harm to patients, and carry economic consequences for the health sector. Internationally, preventing and managing pressure injuries is a key nursing activity and quality indicator. EVALUATION Comparative review and synthesis of pressure injury policies that inform practice. KEY ISSUES The predominant focus of policy is on patient risk assessment, compliance with documentation and pressure relief. Financial penalty for institutions is emerging as a strategy where pressure injuries occur. Comparisons of prevalence rates are hampered by the lack of consensus on data collection and reporting. To date there has been little evaluation of policy implementation and implemented policy strategies, associated guidelines remain founded upon expert opinion and low-level evidence. IMPLICATIONS FOR NURSING MANAGEMENT The pressure injury policy agenda has fostered a discourse of attention to incidents, compliance and penalty (sanctions). Prevention and intervention strategies are informed by technical and biomedical interpretations of patient risk and harm, with little attention given to the nature or design of nursing work. Considerable challenges remain if this policy agenda is successfully to eliminate pressure injury as a source of patient harm.

Play interventions to reduce anxiety and negative emotions in hospitalized children

BackgroundHospitalization is a stressful and threatening experience, which can be emotionally devastating to children. Hospital play interventions have been widely used to prepare children for invasive medical procedures and hospitalization. Nevertheless, there is an imperative need for rigorous empirical scrutiny of the effectiveness of hospital play interventions, in particular, using play activities to ease the psychological burden of hospitalized children. This study tested the effectiveness of play interventions to reduce anxiety and negative emotions in hospitalized children.MethodsA non-equivalent control group pre-test and post-test, between subjects design was conducted in the two largest acute-care public hospitals in Hong Kong. A total of 304 Chinese children (ages 3-12) admitted for treatments in these two hospitals were invited to participate in the study. Of the 304 paediatric patients, 154 received hospital play interventions and 150 received usual care.ResultsChildren who received the hospital play interventions exhibited fewer negative emotions and experienced lower levels of anxiety than those children who received usual care.ConclusionThis study addressed a gap in the literature by providing empirical evidence to support the effectiveness of play interventions in reducing anxiety and negative emotions in hospitalized children. Findings from this study emphasize the significance of incorporating hospital play interventions to provide holistic and quality care to ease the psychological burden of hospitalized children.Trial registrationClinicalTrials.gov NCT02665403. Registered 22 January 2016.

E-Cigarette Awareness, Perceptions and Use among Community-Recruited Smokers in Hong Kong

Background Electronic cigarettes (e-cigarettes) are being increasingly used. We examined the correlates associated with e-cigarette awareness, use and perceived effectiveness in smoking cessation among Chinese daily smokers in Hong Kong. Methods Daily smokers (N = 1,307) were recruited to a community-based randomised controlled trial (‘Quit to Win’) in 2014. Socio-demographic characteristics, conventional cigarette smoking status, nicotine addiction level, quit attempts, quit intention, e-cigarette awareness, use and perceived effectiveness on quitting were reported at baseline and 1-week follow-up. Multivariate logistic regression was used to identify factors associated with e-cigarette awareness, use and perceived effectiveness in quitting. Results Most smokers (82.6%, 95% CI 80.2%-84.9%) had heard about e-cigarettes, and 13.3% (11.3%-15.5%) ever used e-cigarettes. Most users (74.1%) and non-users (91.2%) did not perceive e-cigarettes as effective in quitting. Being younger and having a larger family income were associated with e-cigarette awareness. Being younger, a tertiary education and a stronger addiction to nicotine were associated with e-cigarette use, which was itself associated with lower levels of intention to quit and had no association with attempts to quit (P for trend 0.45). E-cigarette use, the last quit attempt being a month earlier, having made a quit attempt lasting 24 hours or longer and perceiving quitting as important were all associated with the perceived effectiveness of e-cigarettes in quitting (all P <0.05). Conclusions Among community-recruited smokers who intended to quit, awareness of e-cigarettes was high, but most did not perceive e-cigarettes as effective in quitting. Correlates concerning e-cigarette perceptions and use will help to inform prospective studies, public education and policy on controlling e-cigarettes.

The impact of cancer and its treatment on physical activity levels and quality of life among young Hong Kong Chinese cancer patients

PURPOSE Despite the evidence that regular physical activity can have beneficial effects on the physical and psychological well-being of cancer patients, a review of the literature reveals that a majority of young cancer patients fail to attain the same levels of physical activity that they had before contracting the disease. This study is to examine the impact of cancer and its treatment on the physical activity levels and quality of life of young Hong Kong Chinese cancer patients. METHOD A cross-sectional study was conducted, with 76 young cancer patients admitted for treatment to a pediatric oncology unit, and another similar age group of 148 healthy counterparts from the two integrated child and youth service centers were invited to join the study. RESULTS The study found that the current physical activity levels of young cancer patients were markedly reduced when compared with their pre-cancer situation. Moreover, they were significantly less active in performing physical exercise, and reported lower levels of self-efficacy and quality of life than their healthy counterparts. The results of the hierarchical multiple regression analysis showed that physical activity is an important indicator of quality of life among young cancer patients. CONCLUSION The results provide further evidence that cancer and its treatment have negative effects on physical and psychological well-being and quality of life among young cancer patients. There is an imperative need for healthcare professionals to promote the adoption of regular physical activity among such patients, even during the treatment itself.

The Effect of Poverty and Income Disparity on the Psychological Well-Being of Hong Kong Children

OBJECTIVE This study explored the impact of poverty and income disparity on the psychological well-being of Hong Kong Chinese children. DESIGN AND SAMPLE A cross-sectional study was conducted in 12 elementary schools from the three highest and three lowest median household income districts. A total of 1,725 pupils were recruited with 898 pupils came from low-income and 827 from high-income families. MEASURES Participants were asked to respond to the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children, the Rosenberg self-esteem scale, and the Pediatric Quality of Life Inventory. The data were collected from 2012 to 2013. RESULTS Children from low-income families reported statistically significant lower scores in self-esteem and quality of life, but higher scores in depressive symptoms than those from high-income families. Income disparity had their greatest impact on childrens self-esteem. CONCLUSION This study has addressed a gap in the literature by comparing the self-esteem, depressive symptoms, and quality of life among children living in low- and high-income families. The results add further evidence to the literature that poverty and income disparity may have a negative impact on the psychological well-being of children.

Effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of Hong Kong Chinese children hospitalized with cancer

PURPOSE. To examine the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. DESIGN AND METHODS. A nonequivalent control group design was employed. Children (8-16 years of age; n= 122) admitted to a pediatric oncology ward during a 14-month period were recruited. RESULTS. The results support the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. PRACTICE IMPLICATIONS. The results heighten the awareness in nurses of the importance of integrating play activities as an essential component of holistic and quality nursing care.