Wei, Fangyuan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 182-211). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Aim. The overall aims of this study were to develop a tailor-made educational intervention and to examine its effectiveness on short- and longer-term outcomes among Chinese patients with traumatic limb fractures who had undergone surgery. / Background. Fracture limb and undergoing surgery is the common problem after injury. It is the most common source of pain and anxiety and research continues to demonstrate a high prevalence of unrelieved pain in injured patients who have undergone surgery. Patient's belief in pain is the major barrier in pain management. Strategies directed to have appropriate educational interventions are urgently needed to improve patient outcomes for those suffering acute pain after surgery for traumatic limb fracture. / Conclusion. The C-BEI was effective in terms of reducing the pain barrier, providing post-operative pain relief, reducing anxiety, and improving sleep satisfaction in patients with fractured limbs during their first week of hospitalization after surgery. This study has generated evidence supporting the use of a C-BEI in acute pain management. / Method. The study was conducted in the orthopaedic wards of two regional hospitals in Hong Kong and comprised two phases. In phase one, qualitative interviews were conducted with twenty-six Chinese patients who had traumatic limb fractures and were undergoing surgery regarding their experiences of and beliefs about pain management. Ten orthopaedic nurses were also interviewed about their perceived pain management practices and the barriers that prevented better pain control among patients. The findings from these qualitative interviews were used to develop a cognitive behavioural approach educational intervention (C-BEI). C-BEI was used to enhance knowledge of pain, modify their beliefs about pain management and promote positive coping thoughts and behaviour. The C-BEI consisted of two sessions. The first was a 30-minute session comprised a combination of patient education and breathing relaxation exercise and conducted at T0 (1 day before surgery). A 30-minute reinforcement session was conducted at day 7 after surgery (T3). / Results. A total of 125 participants completed the study, with 62 in the experimental group and 63 in the control group. The participants were homogenous in terms of demographic data (P > 0.05) and baseline clinical characteristics (p > 0.05). The short-term outcomes (from T0 to T3) for the participants in the experimental group were a statistically significant with lower pain barrier (p = .003), lower level of pain (p = .003), lower level of anxiety (p < .001), and better sleep satisfaction (p = .001) than the control group. The experimental group had a significantly higher frequency of analgesic use at T2 (p < .001) and better self-efficacy in pain management at T3 (p = .011) than the control group. There were no statistically significant differences in the total length of stay in hospital, although the mean length of stay was shorter in the experimental group than in the control group (8.1 day VS 10.1 days). For longer-term effects, the C-BEI was effective at the post-operative stage in anxiety reduction ( p = .002) and sleep satisfaction improvement (p = .002). There were no statistically significant differences for the VAS pain level, GSE scores, physical health summary component (PCS) and mental health summary component (MCS) of the SF36 between two groups over three months, although the experimental group had better scores in the mental health dimension. Findings of the process evaluation showed that most participants perceived the C-BEI as effective in enhancing their knowledge on pain management and the use of analgesics, and helping them to cope with pain, the could sleep better and regain self-control. / The main study was conducted in phase II which consisted of outcomes and process evaluation. A quasi-experimental design of two groups' pre-test and post-test between subjects was employed for the outcomes evaluation. All participants in the experimental group received the C-BEI and usual care, whereas those in the control group received usual care only. The short-term outcomes were treated as primary outcomes and evaluated in terms of the participants' pain barrier score, pain level (Visual Analogue Pain Scale: VAS, anxiety level (State-Trait Anxiety Inventory:STAI), sleep satisfaction, self-efficacy in pain management (General Self Efficacy Scale: GSE), and frequency of analgesic use. All of which were measured at T0, T1 (day 2), T2 (day 4), and T3 (day 7) after surgery. The total length of stay in hospital of the two groups was also compared. Longer-term outcomes were further evaluated over three months at T4 (1 month) and T5 (3 months), and included the VAS pain level, STAI, sleep satisfaction, GSE and health-related quality of life (SF36).The intention-to-treat method was adopted. The process evaluation involved a qualitative study using telephone interviews. / Wong, Mi Ling, Eliza. / Adviser: Sally Chan. / Source: Dissertation Abstracts International, Volume: 71-01, Section: B, page: 0231. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 256-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

Bone defects and fracture non-unions remain a substantial challenge for clinicians due to a high occurrence of delayed union or non-union requiring surgical intervention. The current grafting procedures used to treat these injuries have many limitations and further long-term complications associated with them. This has resulted in research efforts to identify graft substitution therapies that are able to repair and replace tissue function. Many of these tissue engineered products include the use of growth factors to induce cell differentiation, migration, proliferation, and/or matrix production. However, current growth factor delivery methods are limited by poor retention of growth factors upon implantation resulting in low bioactivity. These limiting factors lead to the use of high doses and frequent injections, putting the patients at risk for adverse effects. The goal of this work was to develop and evaluate the efficacy of BMP-2 delivery systems to improve bone regeneration. We examined two approaches for delivery of BMP-2 in this work. First, we evaluated the use of a self-assembling lipid microtube system for the sustained delivery of BMP-2. We determined that sustained delivery of BMP-2 from the lipid microtube system was able to enhance osteogenic differentiation compared to empty microtubes, however did not demonstrate a significant advantage compared to a bolus BMP-2 dose in vitro. Second, we developed and assessed the functionality of an affinity-based system to sequester BMP-2 at the implant site and retain bioactivity by incorporating heparin within a collagen matrix. Incorporation of heparin in the collagen matrix improved BMP-2 retention and bioactivity, thus enhancing cell-mediated mineralized matrix deposition in vitro. Lastly, the affinity-based BMP-2 delivery system was evaluated in a challenging in vivo bone repair model. Delivery of pre-bound BMP-2 and heparin in a collagen matrix resulted in new bone formation with mechanical properties not significantly different to those of intact bone. Whereas delivery of BMP-2 in collagen or collagen/heparin matrices had similar volumes of regenerated mineralized tissue but resulted in mechanical properties significantly less than intact bone properties. The work presented in this thesis aimed to address parameters currently preventing optimal performance of protein therapies including stability, duration of exposure, and localization at the treatment site. We were able to demonstrate that sustained delivery of BMP-2 from lipid microtubes was able to induce osteogenic differentiation, although this sustained delivery approach was not significantly advantageous over a bolus dose. Additionally, we demonstrated that the affinity-based system was able to improve BMP-2 retention within the scaffold and in vitro activity. However, in vivo implantation of this system demonstrated that only delivery of pre-complexed BMP-2 and heparin resulted in regeneration of bone with mechanical properties not significantly different from intact bone. These results indicate that delivery of BMP-2 and heparin may be an advantageous strategy for clinically challenging bone defects.

Sun, Minghui. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 125-159). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.