A pilot randomized placebo-controlled study on modified MaZiRenWan: a formulated Chinese medicine to relieve constipation for palliative cancer patients.

BACKGROUND: Constipation is a common problem among advanced cancer patients; however, many of them find limited effective from current therapies. Thus, we aimed to test the effect of a traditional Chinese herbal formula, modified MaZiRenWan (MZRW), by comparing with placebo among palliative cancer patients with constipation. METHODS: This is a randomized, double-blind, placebo-controlled trial. Participants aged over 18 were recruited and randomized to MZRW or placebo group in addition to current prescriptions (including ongoing laxatives treatment) for two weeks. Exclusion criteria included cognitive impairment, presence of a colostomy or gastrointestinal obstruction and estimated life expectancy of less than one month. Individualized modification of MZRW was allowed according to the traditional Chinese medicine (TCM) pattern of patient. The primary outcome was the global assessment of improvement, which reflected whether the constipation had improved, remained the same or worsened. RESULTS: Sixty patients, with mean age 75.2 years (range 47-95 years), were randomized to MZRW or placebo group. Among the MZRW group, 59.3% (16/27) had improvement in the global assessment score, as compared with 28.6% (8/28) of the placebo group (p-value = 0.022). Besides, the MZRW group had significant increase in stool frequency, and reduction in constipation severity and straining of defecation (p-value < 0.05). No serious adverse event was reported due to the research medication. CONCLUSION: This pilot trial suggests modified MZRW is well-tolerated and effective for relief of constipation in patients with advance cancer. It could be considered as a potential treatment option for constipation in palliative care. TRIAL REGISTRATION: The trial had been registered in ClinicalTrials.gov with identifier number NCT02795390 [ https://clinicaltrials.gov/ct2/show/NCT02795390 ] on June 10, 2016.

Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong.

BACKGROUND: Stroke in Chinese Medicine (CM) includes the concepts of ischemic and hemorrhagic strokes from Western Medicine and is a common disease in Hong Kong. This clinical practice guideline (CPG) aims to evaluate and demonstrate CM treatment options for stroke, provide guideline for local CM practice, and act as a reference for decision makers on drafting CM related health policies. METHODS: Based on the principle of multidisciplinary integration and evidence-based medicine, a steering committee oversaw the CPG development process in accordance with a published protocol. Clinical questions and evidences were identified, appraised, and synthesised through systematic literature reviews, text mining, and two rounds of Delphi surveys with a multidisciplinary panel of experts. RESULTS: In this CPG, we defined stroke from the perspectives of both CM and Western Medicine, reported corresponding CM treatment options, and carried out evaluation based on levels of evidence and grade of recommendation. Suggested CM interventions include herbal medicine treatment based on pattern differentiation, acupuncture treatment, and nursing care. CONCLUSION: The target population is Hong Kong stroke patients with prodrome or sequela stage. This CPG is intended to help standardizing CM clinical practice and enhancing efficiency of clinical service in Hong Kong.

Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis.

Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: -0.76, 95% confidence interval: -0.14 to -0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36-1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas.

Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis.

Use of Chinese herbal medicines (CHM) in symptom management for cancer palliative care is very common in Chinese populations but clinical evidence on their effectiveness is yet to be synthesized. To conduct a systematic review with meta-analysis to summarize results from CHM randomized controlled trials (RCTs) focusing on symptoms that are undertreated in conventional cancer palliative care.Five international and 3 Chinese databases were searched. RCTs evaluating CHM, either in combination with conventional treatments or used alone, in managing cancer-related symptoms were considered eligible. Effectiveness was quantified by using weighted mean difference (WMD) using random effect model meta-analysis. Fourteen RCTs were included. Compared with conventional intervention alone, meta-analysis showed that combined CHM and conventional treatment significantly reduced pain (3 studies, pooled WMD: -0.90, 95% CI: -1.69 to -0.11). Six trials comparing CHM with conventional medications demonstrated similar effect in reducing constipation. One RCT showed significant positive effect of CHM plus chemotherapy for managing fatigue, but not in the remaining 3 RCTs. The additional use of CHM to chemotherapy does not improve anorexia when compared to chemotherapy alone, but the result was concluded from 2 small trials only. Adverse events were infrequent and mild. CHM may be considered as an add-on to conventional care in the management of pain in cancer patients. CHM could also be considered as an alternative to conventional care for reducing constipation. Evidence on the use of CHM for treating anorexia and fatigue in cancer patients is uncertain, warranting further research.

Effectiveness of Chinese herbal medicine for cancer palliative care: overview of systematic reviews with meta-analyses.

Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial. We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer. Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory. Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.

Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews.

Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients' quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited.

Predictors of levels of functioning among Chinese people with severe mental illness: a 12-month prospective cohort study.

AIM AND OBJECTIVES: The aim of the study was to identify the predictors of functioning in Chinese people with serious mental illness. BACKGROUND: Mental healthcare services for people suffering from serious mental illness are delivered to not only minimise their psychiatric symptoms but also enhance their levels of functioning in the community. Yet, there is insufficient research directed towards the associated or predictive factors that may influence different aspects of functioning, particularly in terms of patients' psychosocial variables. DESIGN: A longitudinal, prospective cohort study design was adopted. METHODS: A clustered random sample of 395 of 611 outpatients with serious mental illness completed the same set of questionnaires at baseline and at 12 months. Changes in patients' functioning as measured by self-maintenance, social functioning and community living skills were recorded over 12 months. Potential relationships between their level of functioning and symptom severity, self-esteem, self-efficacy, perceived negative familial response, negative self-stigma towards mental illness, re-hospitalisation rate and socio-demographic characteristics were investigated. RESULTS: Most participants reported moderate to moderately high levels of overall functioning, self-efficacy, self-stigma and perceived negative familial response at baseline and there were significant observed correlations between these variables. Results of multiple regression models indicated that while symptom severity predicted functioning in patients with psychotic and affective disorders, a negatively perceived familial response only predicted negative changes in social functioning of the patients with psychotic disorders (ß = -0·25). In addition, improvements in self-efficacy (ß = 0·23) and reduction in self-stigma (ß = -0·15) positively predicted changes in the community living skills of patients with affective disorders. CONCLUSION: The findings indicate the significance of psychiatric patients' symptom management and factors such as self-efficacy and self-stigma to predict their functioning over a 12-month follow-up. RELEVANCE TO CLINICAL PRACTICE: Mental healthcare services should consider giving priority to self-stigma reduction and empowerment to manage illness especially in this population of patients and their families, thus effectively enhancing their self-care ability to cope with their illness and/or difficult life situations.

Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach.

OBJECTIVE: Previous validation studies of the Chalder Fatigue Scale (CFS) suffer methodological shortcomings. The present study aimed to re-evaluate its psychometric properties using exploratory structural equation modeling (ESEM). METHODS: A Chinese sample of 1259 community-dwelling residents completed the 11-item Chinese CFS and a variety of health measures (anxiety, depression, exhaustion, sleep disturbance, and quality of life). In addition to traditional confirmatory factor analysis, ESEM was performed to assess the fit of two- and three-factor models using robust maximum likelihood estimation and oblique geomin rotation. Convergent validity of the CFS was examined via associations with five covariates (gender, age, exercise, perceived health, and life event) and the health measures in the ESEM model. RESULTS: The ESEM models displayed a superior fit to confirmatory factor models. The three-factor ESEM model showed a satisfactory model fit to the data but not for the two-factor model. The three factors were physical fatigue (three items, α = .800), low energy (four items, α = .821), and mental fatigue (four items, α = .861). The factors exhibited convergent validity with the model covariates and health measures. CONCLUSION: The results demonstrate the satisfactory reliability and convergent validity for the three-factor structure of the CFS as a valid measure of fatigue symptoms in the general population. Future psychometric studies could adopt the ESEM approach as a practical alternative to traditional confirmatory factor analysis.

Traditional Chinese exercises for pulmonary rehabilitation: evidence from a systematic review.

BACKGROUND: Qigong (QG) and tai chi (TC), alternative forms of exercise based on traditional Chinese medicine, are reported to be beneficial to patients with chronic obstructive pulmonary disease (COPD). This systematic review analyzed the evidence and made recommendations for clinical applications and future research. METHODS: Key words "qigong," "tai chi," "COPD," and "randomized controlled trial" or corresponding terms in Chinese were searched using MEDLINE, EMBASE, and 3 Chinese databases. Randomized controlled trials (RCTs) on QG and/or TC for patients with COPD were included. The quality of each RCT was appraised using the Physiotherapy Evidence Database (PEDro) scale. Outcome variables that were reported by greater than one-third of the RCTs were pooled for analysis. RESULTS: A total of 37 RCTs were identified, with 12 matching the inclusion criteria. The average PEDro score was 5.25, indicating that limitations were noted in the methodology. Only forced expiratory volume in the first second of expiration/forced vital capacity ratio and the 6-Minute Walk Test (6MWT) distance were common outcome measures in greater than one-third of the RCTs. The weighted mean differences and the 95% CI estimation for mean gains in forced expiratory volume in the first second of expiration/forced vital capacity ratio and mean gains in 6MWT distance between QG/TC and conventional exercise groups were 0.62 (95% CI, 0.30-0.93) and 12.18 (95% CI, 10.32-14.05) m, respectively. The corresponding values between QG/TC and no exercise groups were 2.90 (95% CI, 2.37-3.43) and 37.77 (95% CI, 35.42-40.12) m, respectively. CONCLUSIONS: This systematic review supports the therapeutic value of QG/TC in patients with COPD and highlights areas for future research.

International differences in understanding recovery: systematic review.

AIMS: Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations. METHODS: Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English. RESULTS: A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes. CONCLUSIONS: Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.

Usefulness of the model of human occupation in the Hong Kong chinese context.

Questions have been raised about the applicability of Western theory in an Eastern context. Two case studies are used to illustrate how the Model of Human Occupation (MOHO) is useful in problem identification and intervention planning in Hong Kong. The cases illustrate that MOHO provides useful insights to how Chinese culture influences participation of persons with disabilities.

Job profiles of people with severe mental illness: implications for rehabilitation.

Employment history is known to be a consistent predictor of vocational functioning of people with mental illness. A review of the literature, however, shows that studies that describe the employment pattern of those with psychiatric disabilities are limited. This study aimed to explore the employment histories and job profiles of people with severe mental illness in the Special Administrative Region of the Chinese Mainland: Hong Kong. The participants consisted of 64 patients (46 men and 18 women) recruited from two mental hospitals. A specially designed and validated instrument (work history record sheet) was used to collect data including medical history, educational and training background and employment information of the participants for the past 5 years. Some results were consistent with previous findings. All participants had a work history and had roughly 2 years of employment in a job; most of the jobs were in low-wage and low-prestige positions. In addition, interpersonal competence was of paramount importance for getting and keeping jobs. Some findings are different from earlier studies. For instance, most of the jobs were full time. The ways that people secured their jobs were not the same as in Western studies. Possible cultural differences leading to different findings and implications for rehabilitation services are discussed.

Evaluation of a Goal Attainment Program using the Goal Attainment Scale for Psychiatric In-patients in vocational rehabilitation.

The purpose of this study is to evaluate the newly developed clinical protocol "Goal Attainment Program" to assist psychiatric in-patients in Hong Kong to formulate realistic life goals, with a view to shortening their length of stay and motivating them to join in work rehabilitation. The Goal Attainment Scale for Psychiatric In-patients was validated and used to evaluate the change in life goals after attending the four-session Goal Attainment Program. The validated 10-item version of the Goal Attainment Scale for Psychiatric In-patients (GASPI-10) was found to have good inter-rater reliability (rho_{I} ranged from 0.64 to 0.88,p < 0.01; N = 26) and internal consistency (alpha of rater 1 = 0.92, rater 2 = 0.87, N = 26). Twenty-five chronic psychiatric in-patients of Castle Peak Hospital in Hong Kong completed the Goal Attainment Program and were assessed using a pre and post-test quasi-experimental design. The T-score computation of GASPI-10 indicated that 92% of patients showed improvement in goal attainment. Some 92% of patients stated that they were willing to leave hospital, and 72% of participants planned to seek paid employment upon discharge after completion of the program. The overall results of this study verified the effectiveness of the Goal Attainment Program in instilling hope in chronic patients with schizophrenia and the use of the Goal Attainment Scale in documenting patients' progress.

Gas discharge ion source III. Modified Berkeley multifilament ion source.

Total ion current, ion energy, mass and current density distributions, and the impurity content of the ion beams produced by a modified Berkeley multifilament ion source (MFIS) were measured as a function of source configuration, gas pressure, and operating conditions: the ''best'' configuration produced beams of 200 mA or more at pressures between 0.40 and 2.0 Pa. In comparison with earlier studies of duoplasmatron and duopigatron sources, the MFIS beams contained less D(+), only ca. 33%, but the beams had much narrower energy distributions and flatter current density distributions. The beams contained 1%-2% impurities which consisted mainly of masses 18, 20, and 22.

Gas discharge ion source. I. Duoplasmatron.

The effects of the plasma expansion cup on the operation of a duoplasmatron ion source have been investigated by measuring the total ion current and the distributions of the ion energy, mass, and current density. A copper expansion cup did not affect the magnetic field near the anode of the ion source and consequently the ion current density distribution was sharply peaked near the center of the cup. Ion energy distributions were approximately symmetrical about anode potential. The dominant ionic species were D(+) (3) and D(+) at low and high arc currents, respectively. Changes in the electrical potential of the copper cup with respect to the anode produced negligible changes in the above data. A mild steel plasma expansion cup caused the magnetic field to diverge and intercept the cup walls, resulting in ion current density distributions that were flatter and more amenable to focusing than the ones with the copper cup. With the steel cup at anode potential, the ion mass distribution was similar to that from the copper cup; however, the ion energy distribution was asymmetrical about the anode potential with a peak about 10-20 V above anode potential. The total ion current from this mode of operation was about one-third the value from the copper cup. If the steel cup assumed floating potential, about 50 V below anode potential, the total current increased to the level observed from the copper cup and the ion energy distribution was similar to that observed with the copper cup but the current density distribution was much flatter than that of the copper cup. The ion mass distribution was 60%-70% atomic ions over the entire arc current range investigated. Based on these data, a modified plasma expansion cup was designed with tapered steel walls lined with a boron nitride insert. The overall performance of the duoplasmatron ion source with this cup was superior to any of the previous three modes of operation. The improved design uses a molybdenum anode insert which is far superior to copper in regard to erosion over extended operating times. A total beam current of 200 mA was produced at an arc current of 24 A.

Gas discharge ion source. II. Duopigatron.

Ion source performance characteristics consisting of total ion current, ion energy distribution, mass distribution, and ion current density distribution have been measured for several models of a duopigatron. Variations on the duopigatron design involved plasma expansion cup material and dimensions, secondary cathode material, and interelectrode spacings. Of the designs tested, the one with a copper and molybdenum secondary cathode, and a mild steel plasma expansion cup proved to give the best results. The ion current density distribution was peaked at the center of the plasma expansion cup and fell off to 80% of the peak value at the cup wall for a cup 15.2 mm deep. A total ion current of 180 mA consisting of 60%-70% atomic ions was produced with an arc current of 20 A and source pressure of 9.3 Pa. More shallow cups produced a larger beam current and a more sharply peaked ion current density distribution. Typical ion energy distributions were bellshaped curves with a peak 10-20 V below anode potential and with ion energies extending 30-40 V on either side of the peak.