Tse S.,University of Hong Kong |
Cheung E.,Castle Peak Hospital |
Kan A.,University of Hong Kong |
Ng R.,Kowloon Hospital |
Yau S.,New Life Psychiatric Rehabilitation Association
International Review of Psychiatry | Year: 2012
This article provides an overview of mental health services (MHS) and the application of the recovery concept in Hong Kong, focusing on user participation. It presents stakeholders' views of the recovery movement in a round-table discussion format, demonstrating agreement that user participation merits more public and official attention. Some of the present difficulties with the movement are also reviewed. Social identity theory (SIT) is then analysed as a potentially useful framework for theorizing how service users' identities change as they become service providers. The paper then provides an overview of the current financial and political position of MHS, and identifies signs that the recovery approach is becoming accepted. It also addresses the cultural meanings of the concept, and sets out examples of its implementation in the health and social welfare sectors. Lastly, it summarizes the challenges facing service providers and users and concludes that as the recovery movement is still in its infancy in Hong Kong, more coordinated efforts are needed to establish the organizational support and policy framework, so that sustainable and evidence-based service provision can be achieved. © 2012 Institute of Psychiatry.
Zhang Z.-J.,Chinese University of Hong Kong |
Chen H.-Y.,Chinese University of Hong Kong |
Yip K.-c.,Kowloon Hospital |
Ng R.,Kowloon Hospital |
Wong V.T.,Hospital Authority
Journal of Affective Disorders | Year: 2010
Background: Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined. The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD). Methods: Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs). Results: Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n = 1998) and 15 of PSD (n = 1680) identified for high-quality protocol (Jadad score ≥ 3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants. Conclusions: Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined. © 2009 Elsevier B.V. All rights reserved.
Chung K.-F.,University of Hong Kong |
Yeung W.-F.,Chinese University of Hong Kong |
Yu Y.-M.,University of Hong Kong |
Yung K.-P.,University of Hong Kong |
And 5 more authors.
Journal of Clinical Psychiatry | Year: 2015
Objective: To evaluate the efficacy and safety of acupuncture for residual insomnia and other residual symptoms associated with major depressive disorder (MDD). Method: 150 participants having significant insomnia for more than 3 months and a history of MDD (both based on DSM-IV-TR criteria) were recruited from 4 psychiatric outpatient clinics in Hong Kong from May 2011 to August 2013 to receive 9 sessions of treatment over 3 weeks. They were randomized to receive acupuncture, minimal acupuncture, or placebo acupuncture. Primary outcome was sleep diary-derived sleep efficiency. Secondary outcomes included other sleep diary parameters, actigraphy, anxiety and depressive symptoms, daytime functioning, and adverse events. Results: The mean difference in sleep diary-derived sleep efficiency at 1-week posttreatment was -1.40 (95% CI, -7.08 to 4.28) between the acupuncture and minimal acupuncture groups and was 3.10 (95% CI, -3.64 to 9.84) between the acupuncture and placebo acupuncture groups. AX2 test showed that acupuncture produced a significantly higher proportion of participants achieving sleep-onset latency ≤ 30 minutes than did minimal acupuncture at 1-week posttreatment (P = .04). However, there was no significant between-group difference in most of the other outcomes. Treatment blinding was successful, as a majority of participants did not know which treatment they had received. Conclusions: Acupuncture was well tolerated, but the efficacy was only mild and similar to that of minimal acupuncture and placebo acupuncture. A high proportion of patients remained clinically significantly affected by insomnia after treatment. The finding raises certain doubts about the value of acupuncture and underscores the difficulties in the treatment of residual insomnia in MDD. Trial Registration: ClinicalTrials.gov identifier: NCT01707706. © Copyright 2015 Physicians Postgraduate Press, Inc.
Mok C.C.,Tuen Mun Hospital |
Chan K.Y.,Kowloon Hospital |
Lee K.L.,Pamela Youde Eastern Hospital |
Tam L.S.,Chinese University of Hong Kong |
Lee K.W.,Hong Kong Sanatorium and Hospital
International Journal of Rheumatic Diseases | Year: 2014
Objectives: To study the factors associated with withdrawal of the and tumor necrosis factor alpha (anti-TNFα) biologics in the treatment of rheumatic diseases. Method: Data from the Hong Kong Biologics Registry were retrieved. The cumulative rates of withdrawal of different biological agents were studied by Kaplan-Meier plot and the incidence of serious adverse events (SAEs) was calculated. Factors associated with the withdrawal of the anti-TNFα agents were studied by Cox regression. Results: Between 2005 and 2013, 2059 courses of biologics were used in 1345 patients. After 3454 patient-years, 1171 (57%) courses were terminated because of clinical inefficacy (38.1%), SAEs (22.3%) and financial reasons (15.9%). The most frequent SAEs (per 100-patient-years) were allergy (2.90), serious infections (1.34), tuberculosis (0.93) and infusion/injection site reaction (0.75). Among the anti-TNFα agents, the cumulative probability of drug withdrawal for either inefficacy or SAEs in 5 years was highest with infliximab (IFX) (64.5%), followed by etanercept (ETN) (44.2%) and adalimumab (ADA) (36.9%). The incidence of serious infections and tuberculosis (per 100 patient-years) for IFX, ETN and ADA users was 1.99, 0.85 and 0.63; and 1.68, 0.43 and 0.85, respectively. Infusion/injection site reaction was highest with IFX (1.38/100 patient-years). Cox regression revealed increasing age, female sex, not having a diagnosis of spondyloarthritis (SpA) and IFX use were significantly associated with drug withdrawal for either inefficacy or SAEs. Rheumatoid arthritis (RA) had the highest hazard ratio for drug withdrawal but SpA was favorable for drug retention, after adjustment for age, sex, disease duration and the choice of anti-TNFα agents. Conclusions: In our registry, the retention rate of the anti-TNFα agents was lowest but the incidence of tuberculosis, serious infections and infusion reaction was highest with IFX. Older female patients with RA and the use of IFX were independently associated with drug withdrawal. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Chin R.P.-H.,Queen Elizabeth Hospital |
Chin R.P.-H.,Kowloon Hospital |
Ho C.-H.,Queen Elizabeth Hospital |
Ho C.-H.,Kowloon Hospital |
And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2013
Background: Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery. Questions/purposes: We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points. Methods: We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols. Results: As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk. Conclusions: The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery. Level of Evidence: Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence. © 2013 The Author(s).
Chang T.C.S.,Kowloon Hospital |
Liu J.S.Y.,Kowloon Hospital
East Asian Archives of Psychiatry | Year: 2014
Peer support workers or peer experts are a new workforce in the mental health services of Hong Kong. As two of the few peer support workers in mental health services, we share our experience in working in a regional hospital. We share the amazing benefit of this new workforce to service users and service providers as well as the obstacles in the further development of this service. We hope our experience can help to examine the implementation of peer support services in Hong Kong. As this service is still in its preliminary stage in Hong Kong, we are looking forward to establish a win-win situation for both our peers and the service providers for the enhancement of mental health services in Hong Kong. © 2014 Hong Kong College of Psychiatrists.
Ng B.H.P.,East-West Center |
Tsang H.W.H.,East-West Center |
Jones A.Y.M.,East-West Center |
So C.T.,Kowloon Hospital |
Mok T.Y.W.,Kowloon Hospital
Journal of Alternative and Complementary Medicine | Year: 2011
Context: The initial gain from a Pulmonary Rehabilitation Program (PRP) among patients with chronic obstructive pulmonary disease (COPD) begins to fade away 6 months after the completion of a rehabilitation program. One possible reason may be due to the poor compliance of the patients to the existing forms of home exercise program (e.g., walking, weight training activities, etc.). Objectives: This study tested the efficacy of health qigong (HQG), a traditional Chinese exercise, as an adjunct home exercise program in optimizing the gains obtained from PRP until 6 months after discharge. Design: This was a randomized controlled trial (RCT) on a mind-body exercise intervention. Participants: Eighty (80) patients with COPD receiving conventional PRP pulmonary rehabilitation program were randomized to the HQG intervention group (n=40) and control group (n=40). Outcome measures: Assessments were undertaken by blinded assessors at baseline, discharge from training, and follow-up (FU) at 3 and 6 months. Primary outcomes involved functional capacity scales and secondary outcomes involved quality-of-life scales. Results: Intention-to-treat analysis identified trends of improvement in all outcome measures in the HQG group, whereas lesser improvement and trends of deteriorations were identified in the control group. Ancillary analysis using a per-protocol method, however, identified significantly better improvements in functional capacity measures among the HQG at the 6-month FU. Conclusions: This RCT provided some evidence to support the positive effect of HQG as an adjunct home exercise for rehabilitation among people with COPD and to support further related research. © Copyright 2011, Mary Ann Liebert, Inc.
Ng R.M.K.,Kowloon Hospital |
Pearson V.,University of Hong Kong |
Chen E.E.Y.,University of Hong Kong |
Law C.W.,Queen Mary Hospital
International Journal of Social Psychiatry | Year: 2011
Background: The attitudes of medical professionals towards recovery from schizophrenia are key in defining the therapeutic encounter and may change as they move through their medical career. Method: A qualitative methodology was used based on three focus groups of medical students and trainee psychiatrists in Hong Kong. Both held pessimistic attitudes towards recovery in schizophrenia. Four major categories and one central theme emerged, with little difference between students and doctors. The four categories were: (1) recovery is defined by the cessation of medication and the resumption of normal psychosocial functioning; (2) formal recovery requires medical confirmation plus the patient's admission of illness; (3) recovery should be discussed, but largely in terms of the contribution of drug compliance; and (4) participants recognized that stigma was an impediment to recovery while holding attitudes that were as unaccepting towards people with schizophrenia as lay people's. Conclusions: Traditional medical education over-emphasizes symptomatic recovery and ignores the need for a more flexible construction of the concept. Professional knowledge must incorporate both quantitative and qualitative data and inculcate humanitarian concern through active contact with users, and acceptance of the legitimacy of their expert experience. Medical education should seek effective ways to change entrenched negative attitudes in students about schizophrenia and the possibility of recovery. Further large-scale research should be carried out to establish attitudes of medical professionals towards recovery from schizophrenia and how this changes during typical career trajectories. This information could then be used to devise effective means within medical education to combat stigma and change attitudes. © The Author(s), 2010.
Fong K.N.K.,Hong Kong Polytechnic University |
Jim E.S.W.,Hong Kong Polytechnic University |
Dong V.A.Q.,Hong Kong Polytechnic University |
Cheung H.K.Y.,Kowloon Hospital
Clinical Rehabilitation | Year: 2013
Objective: To investigate the effects of sensory cueing with repetitive practice on hemiplegic arm functions in children with unilateral cerebral palsy. Design: A single-group pre/post comparison. Setting: A special school for children with physical disabilities. Subjects: Eight children with unilateral cerebral palsy aged 6-18 years. Interventions: Participants were required to wear for three weeks a sensory cueing, non-activated wristwatch device and complete 5 hours of conventional therapy per week (treatment A). This was followed by three weeks of continuing conventional therapy and wearing the now activated wristwatch, which prompted the children to do predetermined exercises on the hemiplegic arm for 6 hours daily, 5 days per week, for three weeks (treatment B), and three weeks follow-up. Main measures: Assessments of arm efficiency, functional hand use and arm impairments were carried out at baseline (day before treatment A), posttest 1 (day after treatment A), posttest 2 (day after treatment B) and follow-up (three weeks after treatment B). Results: Arm efficiency as revealed by the Jebsen-Taylor Hand Function Test and the Bruininks-Oseretsky Test of Motor Proficiency - but not actual arm use and grip strength - showed significant improvement after treatment B to follow-up (from 286.0 ± 73.9 to 191.9 ± 73.5, P = 0.002, and from 15.5 ± 5.0 to 18.1 ± 7.7, P = 0.021). Conclusion: This pilot study provides proof-of-concept data showing that a wearable device might be used to remind children with cerebral palsy to perform a set of predetermined arm exercises in order to promote hemiplegic arm function. © The Author(s) 2012.
Chan B.K.S.,Kowloon Hospital |
Ng S.S.M.,Hong Kong Polytechnic University |
Ng G.Y.F.,Hong Kong Polytechnic University
Neurorehabilitation and Neural Repair | Year: 2015
Background. Impaired trunk motor control is common after stroke. Combining transcutaneous electrical nerve stimulation (TENS) with task-related trunk training (TRTT) has been shown to enhance the recovery of lower limb motor function. Objective. This study investigated whether combining TENS with TRTT would enhance trunk control after stroke. Methods. Thirty-seven subjects with stroke were recruited into a randomized controlled clinical trial. Subjects were randomly assigned to any one of the three 6-week home-based training groups: (1) TENS + TRTT, (2) placebo TENS + TRTT, or (3) control without active training. The outcome measures included isometric peak trunk flexion torque and extension torque; forward seated and lateral seated reaching distance to the affected and unaffected side; and Trunk Impairment Scale (TIS) scores. All outcome measures were assessed at baseline, after 3 and 6 weeks of training, and 4 weeks after training ended at follow-up. Results. Both the TENS + TRTT and the placebo-TENS + TRTT groups had significantly greater improvements in isometric peak trunk flexion torque and extension torque, lateral seated reaching distance to affected and unaffected side, and TIS score than the control group after 3 weeks of training. The TENS + TRTT group had significantly greater and earlier improvement in its mean TIS score than the other 2 groups. Conclusions. Home-based TRTT is effective for improving trunk muscle strength, sitting functional reach and trunk motor control after stroke in subjects without somatosensory deficits. The addition of TENS to the trunk augments the effectiveness of the exercise in terms of TIS scores within the first 3 weeks of training. © The Author(s) 2014.