Many courses aim to promote reflective thinking or reflection upon practice, but there is a scarcity of readily usable instruments to determine whether students engage in reflective thinking and, if so, to what extent. This paper reports the development and testing of such an instrument. To ensure validity, the constructs measured were derived from the extensive literature on reflective thinking, particularly the writing of Mezirow. A combination of the literature review and initial testing led to the development of a four-scale instrument measuring four constructs; habitual action, understanding, reflection and critical reflection. The final version of the instrument was tested with a sample of 303 students from eight classes of a health science faculty. The reliability of the scales was established by acceptable Cronbach alpha values. Confirmatory factor analysis showed a good fit to the proposed four-factor structure. Comparison of mean scores between the eight classes showed predicted significant differences on each of the four scales between undergraduate and postgraduate students.

Quality of life (QOL) is an important component in assessing people’s health. Environmental quality can influence people’s QOL in the physical health, psychological, social relationships and environment domains. QOL in the four domains, overall QOL and general heath of residents living in the Kowloon Peninsula of Hong Kong were assessed. The association between satisfaction with the neighborhood environment and QOL, and health-related behaviors which mediated the effect were investigated. A sample of 317 residents completed a questionnaire which comprised the WHOQOL-BREF (Hong Kong version) to assess QOL, the International Physical Activity Questionnaire (IPAQ) to study physical activities, and questions on satisfaction with the neighborhood environment, health-related behaviors and socio-demographics. One-way ANOVA and linear regression were used to study the associations between environmental satisfaction and QOL in the four domains, overall QOL and general health, followed by assessing the relationships between environmental satisfaction and the potential health-related behavior mediators with regression tests. Mediation analysis was conducted using multiple linear regressions to study the effects of environmental satisfaction on QOL in the four domains, overall QOL and general health, as well as the potential mediating roles played by various health-related behaviors. A P-value of < 0.05 was considered as statistically significant. The residents had a relatively higher physical health mean score of 70.83 ± 12.69, and a lower environmental mean score of 61.98 ± 13.76. Moderate satisfaction with the neighborhood environment had a significant relationship with QOL in the psychological domain (β = 0.170, P = 0.006), however, this effect was partially mediated by the non-smoking behavior of the residents (β = 0.143, P = 0.022). Our residents had lower QOL in the physical health and psychological domains but similar QOL in the social relationships and environmental domains compared to other countries. Only QOL in the psychological domain could be predicted by the satisfaction with the neighborhood environment, and non-smoking status was a partial mediator of the effect of moderate environmental satisfaction on QOL in the psychological domain. Refrain from smoking seems to be able to lower the influence of neighborhood environment on people’s QOL in the psychological domain to a certain extent.

Where courses have as an aim the promotion of reflective practice, it will enhance the achievement of the goal if the level of reflective thinking is assessed. To do this in a satisfactory way requires a reliable protocol for assessing the level of reflection in written work. This article presents a protocol that can be used to guide the allocation of work to four categories, namely: habitual action/non‐reflection, understanding, reflection, and critical reflection. Intermediate categories can also be used. Detailed descriptors of each category to guide the process are provided. The protocol was tested by four assessors independently using it to grade a set of written work, and very good agreement was obtained.

Objective: To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. Methods: This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using χ² tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS). Results: The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6% vs control 61.0% χ²=6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9% vs 16.1%, p<0.05), dyspnoea (62.2% vs 29.0%, p<0.05) and total ESAS score (73.0% vs 41.4%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires. Conclusions: This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF. Trial registration number: HKCTR-1562; Results.