Ceci est une étude de cohorte prospective, avec un suivi d’un an, s’intéressant à la trajectoire postopératoire des patients gériatriques admis pour une fracture de la hanche. Un total de 254 patients étaient inclus dans cette cohorte. Cinq groupes de patients avec des trajectoires similaires ont été formés; 1-retour à domicile (n=63), 2-retour à la résidence (n=22), 3-réadaptation avant retour au milieu de vie original (n=36), 4- changement de milieu de vie (n=28) et 5-décès (n=37). Les patients évoluant dans la trajectoire 1 (évolution favorable) étaient plus jeunes. Les patients évoluant dans la trajectoire 5 (évolution défavorable) étaient plus âgés, étaient malnutris selon l’outil Mini Nutritional Assessement (MNA) et présentaient des troubles neurocognitifs selon leurs pointages du Mini-Mental State Examination (MMSE). Un délai chirurgical allongé était associé avec une mortalité à un an plus élevée, mais ces patients présentaient plus de comorbidités selon l’index de comorbidité de Charlson (CCI). Le délai entre le congé du patient et son départ réel de l’hôpital était associé avec le besoin d’un transfert dans un centre de réadaptation. Il y a donc un besoin de milieux intermédiaires pouvant accueillir les patients gériatriques ayant subi une chirurgie pour fracture de la hanche, afin qu’ils puissent quitter l’hôpital. Les efforts pour améliorer les soins aux patients gériatriques avec fracture de la hanche devraient être déployés pour résoudre ces enjeux. / This is a prospective observational cohort study of patients admitted for a hip fracture between 2011 and 2017, with a one-year follow-up. A total of 254 patients were enrolled in this cohort. Most patients evolved in one of the following trajectories at one year; (1) 30% went back at home (2) 11% went back to their senior residence (3) 16% needed readaptation (4) 13% were discharged to a different location than prior to admission (5) 18% were deceased at one year. Patients evolving in trajectory 1 (favorable outcome) were younger. Patients evolving in trajectory 5 (poor outcome) were older, had lower Mini Nutritional Assessment (MNA) scores and had lower Mini-Mental State Examination scores (MMSE). Longer surgical delay was associated with higher mortality and comorbidities. The delay between discharge from the attending staff and real departure from the hospital was associated with the need for a readaptation. There is a need for intermediate residences such as readaptation centers to facilitate discharge from the hospital. Efforts to improve the postoperative care for elderly patients with a hip fracture should focus on those issues.

Les traumatismes demeurent la principale cause de mortalité et de morbidité chez les jeunes adultes. Les traumatismes au bassin peuvent être mortels, principalement à cause d'un possible choc hypovolémique. Les fractures du bassin nécessitent une prise en charge rapide. Malheureusement, l'identification des patients avec une fracture pelvienne au préhospitalier est difficile et il existe actuellement peu d'interventions préhospitalières disponibles. La ceinture de compression pelvienne, une solution temporaire pour réduire le saignement, est utilisée à l'urgence, mais aussi au préhospitalier dans certaines provinces canadiennes et à l'international. Il y a toutefois une absence de consensus dans la littérature quant aux réels bénéfices associés et à savoir si son utilisation en préhospitalier dans notre système serait bénéfique. L'objectif de mon projet de maitrise était d'évaluer l'identification et la prise en charge des fractures du bassin à l'urgence et lors de la phase préhospitalière. Deux sous-études distinctes ont été utilisées pour établir le portrait de la situation dans la région de la Capitale-Nationale. Premièrement, une étude rétrospective de septembre 2017 à septembre 2021 comportant 228 patients traités au centre de traumatologie tertiaire à Québec. Cette étude a permis d'identifier un sous-triage élevé au préhospitalier et un manque de formation quant à l'installation de la ceinture dans les centres hospitaliers référents. La deuxième étude réalisée de juillet à août 2022 comportait deux cohortes prospectives : une collecte de données sur le terrain et une simulation à la Coopérative des techniciens ambulanciers du Québec (CTAQ). Sur le terrain, 29 patients ont été identifiés et 11 duos de paramédics ont participé à une simulation. Cette étude a permis de démontrer un manque de standardisation concernant l'évaluation du bassin au préhospitalier et par le fait même, des difficultés à bien les suspecter. Ces travaux s'inscrivent dans une lignée d'études portant sur l'amélioration des soins préhospitaliers d'urgence en traumatologie au Québec. / Trauma remains the leading cause of mortality and morbidity in young adults. Pelvic trauma can be fatal, mainly due to the hypovolemic shock sometimes associated with it. Pelvic fractures require rapid management to improve patient outcome. Unfortunately, identifying patients with pelvic fractures in the prehospital setting is difficult, and there are few pre-hospital interventions available. The pelvic binder, a temporary solution to reduce bleeding, is used in the emergency department, but also in the prehospital setting in some Canadian provinces and internationally. However, there is a lack of consensus in the literature as to the real benefits associated with it, and whether its use in the prehospital setting in our system would be beneficial. The aim of this master's project was to evaluate the identification and management of pelvic fractures in the emergency department and in the prehospital phase. Two separate sub-studies were used to establish a portrait of the situation in the *Capitale-Nationale* region. First, a retrospective study from September 2017 to September 2021 involving 228 patients who arrived directly or were transferred to the tertiary trauma center in Quebec City. This study identified high prehospital undertriage and a lack of training relative to pelvic binder installation in emergency departments. Secondly, a prospective cohort study was carried out from July to August 2022, involving two cohorts: data collection in the field and simulation at the *Coopérative des techniciens ambulanciers du Québec* (CTAQ). In the field, 29 patients were identified, and 11 paramedic duos participated in a case simulation. This study identified a lack of standardization in prehospital pelvis assessment, and consequently difficulties in correctly identifying them. This work is part of a line of studies to improve prehospital emergency care for traumatized patients in our healthcare system.

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.

Modélisation des usages des dispositifs TICE dans l'éducation spécialisée des enfants et des adolescents ainsi que dans l'insertion des adultes victimes d'exclusion.<br />Notre approche clinique de l'informatique met l'ordinateur au service de la pédagogie et du transfert et donc, dans sa finalité, au service du sujet. Il s'agit de rompre avec les pratiques traditionnelles d'aide et d'éducation qui dérivent trop souvent sur des logiques de domination et d'assistance donc d'aliénation. Nous avons tenté de créer un environnement humain et technologique offrant à des personnes en difficulté un cadre favorisant l'autonomie et l'émancipation, ce qui nous paraissait la seule voie d'insertion véritablement stable.

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.

La dispersion de colorant dans des écoulements newtoniens ou rhéofluidifiants a été étudiée optiquement dans deux fractures modèles rugueuses et transparentes. L'évolution du front de déplacement est analysé en fonction du temps et de la vitesse moyenne $U$ . Pour des rugosités de parois monodisperses et distribuées aléatoirement, l'étalement du front est diffusif ($\Delta x \propto t^{0.5}$) et caractérisé par une dispersivité $l_d$. Aux faibles vitesses, $l_d \simeq$ cst: la dispersion est dominée par les fluctuations spatiales de la vitesse et est amplifiée pour les fluides rhéofluidifiants ; aux vitesses élevées, $l_d$ augmente avec $U$ à cause de la dispersion de Taylor mais plus faiblement pour les fluides rhéofluidifiants. Pour une fracture avec deux parois autoaffines complémentaires décalées perpendiculairement à $U$, des chenaux macroscopiques s'étendent sur toute la longueur de la fracture suivant $U$ : l'épaisseur globale du front augmente alors linéairement avec le temps et plus fortement dans le cas rhéofluidifiant (étalement advectif). La croissance de l'épaisseur locale du front est par contre diffusive et due à la dispersion de Taylor.

Thesis (M.S.)--Mississippi State University. Department of Clinical Sciences, College of Veterinary Medicine. / Title from title screen. Includes bibliographical references.

Darbo objektas: kineziterapijos poveikis. Darbo tikslas: Nustatyti šlaunies raumenų jėgos, apimties ir judesių amplitudės pokyčius, taikant kineziterapiją, patyrus šlaunikaulio lūžį su poslinkiu ir be jo. Darbo uždaviniai: 1. Nustatyti ir palyginti šlaunies raumenų jėgą, patyrus šlaunikaulio lūžį su poslinkiu ir be jo, po 24 dienų kineziterapijos. 2. Nustatyti ir palyginti klubo sąnario judesių amplitudę, patyrus šlaunikaulio lūžį su poslinkiu ir be jo, prieš kineziterapiją, po 12 ir 24 dienų kineziterapijos. 3. Nustatyti ir palyginti šlaunies raumenų apimtį ir skausmą, patyrus šlaunikaulio lūžį su poslinkiu ir be jo, prieš kineziterapiją, po 12 ir 24 dienų kineziterapijos. 4. Įvertinti judėjimo funkciją ir savarankiškumą, patyrus šlaunikaulio lūžį su poslinkiu ir be jo, prieš kineziterapiją, po 12 ir 24 dienų kineziterapijos. Išvados: 1. 24 dienų kineziterapija turėjo teigiamą poveikį šlaunies raumenų jėgai patyrus šlaunikaulio lūžį su poslinkiu ir be jo. 2. 24 dienų kineziterapija turėjo teigiamą poveikį šlaunies lenkimo amplitudei patyrus šlaunikaulio lūžį su poslinkiu ir be jo. Patyrus šlaunikaulio lūžį be poslinkio, po kineziterapijos šlaunies lenkimo amplitudė buvo didesnė. 3. 24 dienų kineziterapija neturėjo reikšmingo poveikio šlaunies apimčiai ir skausmui patyrus šlaunikaulio lūžį su poslinkiu ir be jo. 4. 24 dienų kineziterapija neturėjo reikšmingo poveikio funkciniui mobilumui ir savarankiškumui patyrus šlaunikaulio lūžį su poslinkiu ir be jo. / The Object: effects of physiotherapy. Aim of study: To determine thigh muscle strength and circumferences, hip amplitude of the movements changes in patients after femur fractures with and without displacement using physiotherapy. Goals of study: 1. To determine and compare thigh muscle strenght after femur fracture with and without displacement after 24 days of physiotherapy. 2. To determine and compare hip amplitude of the movements after femur fracture with and without displacement before physiotherapy, after 12 and 24 days of physiotherapy. 3. To determine and compare thigh circumferences and pain after femur fracture with and without displacement before physiotherapy, after 12 and 24 days of physiotherapy. 4. To assess movement mobility and independence after femur fracture with and without displacement before physiotherapy, after 12 and 24 days of physiotherapy. Conclusions: 1. 24 days of physiotherapy had a positive effect on thigh muscle strength suffered femur fracture with and without displacement. 2. 24 days of physiotherapy had a positive effect on thigh flexion amplitude suffered femur fracture with and without displacement. Suffered femur fracture without displacement, the thigh flexion amplitude was higher after physiotherapy. 3. 24 days of physiotherapy hadn’t significant effect on thigh circumferences and pain suffered femur fracture with and without displacement. 4. 24 days of physiotherapy hadn‘t significant effect on movement mobility and... [to full text]

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.