背景 屈指肌腱腱鞘炎，叉稱扳機指、彈響指，屬於中醫「傷筋」、「筋辨」範疇 。本病好發於拇指 、中指、無名指，患者女性多於男性，中老年發病較多 。本病是由於各種原因造成屈指肌腱在腱鞘內長時間、反復過度的機械性摩擦，出現纖維結締組織增生、粘連、增厚，或過度勞累、受涼，導致血瘀停滯，經脈受阻不能濡清養經筋而發為本病 。 目的 本文將從文獻研究及臨床病例報告兩方面，了解本病的診療情況。於文獻研究方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法，更著重從療效、復發、不良事件發生三方面探討各種類療法，從中了解屈指肌腱腱鞘炎的各種診療方法並找出更準確、更快捷、更方便的診治方法。於臨床病例報告方面，分享自己和跟診病例的經驗和體會，從而學習、了解本病 。 方法 本文將從文獻統計及臨床病例報告兩方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法。 （一）文獻研究 於數據庫中搜索文獻，並篩選及分類，把所需文獻分為實驗研究文獻和臨床研究文獻。於臨床研究文獻中根據一定的納入／排除標準選用相關文獻，然後分為診斷／ 檢查與治療兩部分作統計，得出療效、復發、不良事件發生的相關統計結果，最後根據統計探討相關診斷／檢查與治療方法 。 （二）臨床病例報告 於臨床時遇到此類患者的病例報告。跟據記錄臨床表現及治療結果作出報告和總結。 結果 （一）文獻研究 數據庫中沒有本病的實驗研究文獻，亦僅有少量文獻的內容包括專項檢查及影像學檢查。 在統計療法方面時，針刀類和手術治療的治愈率普遍較高，而針刀類、手術治療的復發率最低，沒有不良事件發生率的比較 。 （二）臨床病例報告 收錄了四個臨床病例，本病早期、中期、後期均有最少一個病例。整體而言，針灸加推拿治療對屈指肌腱腱鞘炎有一定的療效。尤其針對其疼痛，效果較明顯，但是對於減輕彈響、交鎖現象則效果不大。雖然從文獻中知道針刀治療療效不錯，但對操作者的要求較高，如對病位解剖有深入認識、了解操作原理、如何避免不 良事件發生。 結論 因為針刀類和手術治療的治愈率最高和復發率最低，故於多種療法中為最佳的療法。從臨床研究文獻之中，發現有很多有待發掘的方向，如客觀化研究、不同等級療效研究等。於臨床病例中，針灸、推拿對屈指肌腱腱鞘炎的疼痛、活動受限有一定的療效，但對彈響、交鎖則療效不大 。

University of Macau / Faculty of Health Sciences

University of Macau / Faculty of Health Sciences

Thesis(MSc(Med)(Pharmacy))--University of Limpopo, 2012. / CHAPTER 1 INTRODUCTION 1.1 INTRODUCTION This chapter presents the background and rationale for the study followed by the problem statement. The aim and objectives of the study as well as the significance of the study will also be explained. 1.2 BACKGROUND AND RATIONALE FOR THE STUDY In the past decade, patient satisfaction has become an important performance and outcome measure of health care (Moret, Nguyen, Pillet, Faissard, Lombrail & Gasquet, 2007). Although high levels of patient satisfaction are important for a successful strategy against Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), research into patient satisfaction with health care services in general, and with antiretroviral treatment (ART) services in particular, has been limited in South Africa (Myburgh, Solanki, Smith & Lalloo, 2005). In a weakened healthcare system, it is even more crucial to ensure a high quality of care and patient satisfaction to maximise the benefits of scarce resources. In addition, patient views on the quality of public sector antiretroviral (ARV) care are relatively unexplored (Igumbor, 2003; Myburgh et aI., 2005). The assessment of satisfaction among hospitalised patients is increasingly recognised as a major component of quality management in patient care. Continuous quality improvement, comparison of hospital performances and demands for accountability are some of the reasons that lead hospitals to measure patient satisfaction (Ross, Steward & Sinacore, 1995). As has been observed in many industrialised countries, the provision of ART via public health systems, can transform AIDS from a fast, insidious killer into a more manageable, though still incurable, chronic illness (Abdool Karim, 2005). However, in resource-limited settings, there are many challenges in successfully scaling-up ART and reorienting service delivery towards chronic disease care. Shortages in human resources for healthcare are often cited as the most important obstacle to a specific for all ART sites in the province should be developed and monitored. A long term strategy to address the critical shortage of healthcare professionals should be developed by provincial policy makers which will in the long run reduce long waiting times experienced by our clients.

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published_or_final_version / Public Health / Master / Master of Public Health

Constipation is a multifactorial digestive disorder highly prevailing among the hospitalized elderly Orthopaedic patients. Unlike Western countries, laxative therapy is used to be the first line remedy for constipation in many hospitals of Hong Kong although fiber-rich diet has been proven by numerous studies as the best alternative with low cost and less complications. This dissertation is a translational nursing research which aims at formulating a programme of using fiber-rich food products for relieving constipation in elderly Orthopaedic patients, based on the best available research evidences. It was started with an integrated and systematic review of papers studying the dietary interventions for relieving constipation and reducing laxative consumption in elderly with ADL dependency. Seven relevant studies were identified and critically appraised using the methodology checklist for RCTs designed by Scottish Intercollegiate Guidelines Network (SIGN). After summarizing and synthesizing the data, three dietary interventions with 1+ level of evidence were concluded as the most effective strategies for eradicating the clinical issue. Following assessment of the implementation potential of the proposed innovation in designated clinical setting in terms of transferability, feasibility and cost-benefit ratio, an evidence-based dietary fiber enrichment programme was developed with recommendations for patient recruitment, intervention and evaluation. Furthermore, to assure a smooth change of practice and to determine the effectiveness of the programme, comprehensive plans of communication with different stakeholders, pilot study and evaluation were also subsequently established. With this evidence-based programme, the prevalence of functional constipation and laxative consumption are hoped to be reduced in elderly Orthopaedic patients. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Breast cancer is the number one cancer in female in Hong Kong. Breast cancer-related lymphoedema causes both physical and psychological sufferings in breast cancer survivors and significantly degrades their quality of life. Medical costs for these women are substantially higher than women without lymphoedema. Effective and standardized intervention for these patients will be beneficial to both patients and healthcare institutes. The dissertation aims to evaluate the current evidence on the effectiveness of manual lymphatic drainage in managing breast cancer-related lymphoedema, to develop an evidence-based guideline for nurse-led manual lymphatic drainage in managing breast cancer-related lymphoedema as well as to assess its implementation potential and to design implementation strategies and an evaluation plan for its adoption in a local public hospital in Hong Kong. A systematic search of the literature revealed seven studies on manual lymphatic drainage for breast cancer related lymphoedema that met the selection criteria of the dissertation. Methodological quality of the selected studies was evaluated according to the method developed by the Scottish Intercollegiate Guidelines Network and data were extracted and synthesized. Five of the trials were of moderate to good methodological quality and they demonstrated that manual lymphatic drainage was safe and had additional benefits over exercise and compression alone especially in patients with early lymphoedema. A protocol on manual lymphatic drainage for breast cancer related lymphoedema was subsequently developed. The implementation potential of the protocol in the local setting was established by examining its feasibility, evaluation potential and cost-benefit. Adoption of the program was found to be able to produce a potential annual saving of HK$ 444,200 for the hospital on top of benefits to patients and staff. A three-phase implementation plan was designed in which an implementation team would initiate and guide the proposed change through a careful communication plan and a pilot study would be conducted to confirm feasibility of the protocol. An evaluation plan including patient, healthcare provider and system outcomes would then help ensure the effectiveness and sustainability of the manual lymphatic drainage protocol and guide its future refinement. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Epilepsy is usually controlled, but not cured, with medication. However, over 30% of people with epilepsy do not have seizure control even with the best available medications. A new antiepileptic drug as adjunctive therapy for patients with partial onset seizures has been discovered. Perampanel (E2007) is an orally active, noncompetitive, and highly selective AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid)-type glutamate receptor antagonist. AMPA receptor antagonist is a potential pharmacologic treatment for partial onset seizures by blocking excessive neuronal materials activation.[1] Perampanel was well tolerated and displayed favorable pharmacologic properties, including oral bioavailability and a long half-life in Phase I studies[2]. Perampanel has not been shown to interact with other ionotropic glutamate receptors and is without the behavioral phencyclidine-like adverse events that may be observed with some NMDA-receptors antagonists[3]. Objective: The aim of the meta-analysis is to demonstrate the magnitude of safety and efficacy of perampanel in treating the refractory partial onset seizures when compared to placebo. Methods: A systematic review of Randomized controlled trials (RCTs) of perampanel was conducted. An electronic literature was identified by searching Medline, Embase and the Cochrane database. The primary efficacy end points were the 50% responder rate and treatment emergent adverse effects (TEAS). The secondary efficacy end points were the percent change in seizure frequency per 28 days relative to pre-perampanel baseline and incidence of withdrawal. In order to compare perampanel and placebo, we used Revmen to calculate Odds Ratio (OR), Confidence intervals, Risk Ratio (RR) and Risk Differences (RD). Results: A total of five RCTs were included in the studies. During Phase II studies (labeled as studies 206[4] and 208[4]) 201 patients were involved. During Phase III studies (labeled as 304[1], 305[3] and 306[5]) 1331 patients were included. For 50% responder rate, the pooled odds ratio of 4mg, 8mg and 12mg perampanel compared with placebo was 1.76 [95%CI:1.15, 2.69], 2.26[95%CI:1.66, 3.08] and 2.11[95%CI:1.35, 3.32] respectively. The pooled odds ratio of perampanel for adverse events: headache 1.03 [95%CI : 0.79, 1.34] ; dizziness 3.48 [95%CI: 1.94, 6.24] ; somnolence 2.09 [95%CI: 1.39, 3.15] and fatigue 1.83 [95%CI: 1.23, 2.71] respectively. Conclusion: The pooled odds ratio suggested perampanel might be more effective than placebo comparing the 50% responder rate. However, the risks of the TEAs were higher in the perampanel group when comparing with the placebo group. The use of 12 mg perampanel was shown be highly related with dizziness and somnolence. / published_or_final_version / Pharmacology and Pharmacy / Master / Master of Medical Sciences

Acne is a disorder of the pilosebaceous unit often complicated by scarring. Five studies were performed to test the hypothesis that acne is common among Chinese and that the use of laser and light source is safe and effective for the treatment of acne and acne scars in Asians. The self-reported prevalence of acne in Hong Kong was assessed using a questionnaire among a randomised sample of 522 persons aged 15-25 years. The prevalence was 91.3% with a point prevalence of 52.2%, and acne scars and pigmentation were reported by 52.6%. The existing topical and oral anti-acne medications are limited by their efficacy, adverse effects and patient compliance. Light can target the pilosebaceous unit and reduce the growth of Propionibacterium acnes, for which lasers or light sources have been explored as therapeutic options. The aim of this study was to determine whether lower fluence and shorter cooling of the 1450-nm diode laser would improve acne while minimising post-laser hyperpigmentation in Asians. A total of 26 Chinese subjects received four treatments of three passes with this laser at a fluence of 8 J/cm2 with dynamic cooling of 25 ms. A 40% reduction (p<0.03) in mean lesion count was observed 6 months after treatment with a significant improvement in sebum production and a hyperpigmentation rate of 3.8%. A split-face, controlled study was performed to evaluate the effectiveness of intense pulsed light (IPL) alone or in combination with short-contact 16% methyl aminolevulinate photodynamic therapy (PDT) in 30 Chinese subjects with acne. Among the PDT-treated group, 25% withdrew due to treatment discomfort. No significant differences in the reduction of inflammatory lesions were observed between the intervention groups and the control group. A delayed effect with reductions in non-inflammatory lesions was observed in the PDT-treated (38%; p=0.05) and IPL-treated (43%; p=0.01) groups 12 weeks after treatment. Liposome was used to deliver 5-aminolevulinic acid (5-ALA) into the pilosebaceous unit to lower the concentration of 5-ALA by 40-fold during PDT. The study aimed to investigate the tolerability and efficacy of PDT with IPL using 0.5% liposomal 5-ALA for inflammatory acne. A mean reduction of 65% in the inflammatory lesion count was observed after 6 months (p=0.043) in 12 Chinese subjects. No dropout or significant side effects were observed. The treatment of acne scars has often been complicated by Asian skin phototypes regarding the risk of post-inflammatory hyperpigmentation. Fractionated radiofrequency induces deep dermal heating with less epidermal disruption. The aim of this study was to examine the efficacy and safety of combined bipolar radiofrequency and fractional diode 915 nm laser followed by fractional radiofrequency in 24 Chinese subjects with acne scars. The mean grade improved by 29% (p<0.001), and 52% subjects were rated as having at least a moderate global improvement at 3 months. Subjective improvement was moderate to significant in 36.8%. Hyperpigmentation occurred after 6.5% of the treatments. In conclusion, the studies indicated that laser and light source can be used effectively and safely for the treatment of acne and acne scars commonly found in Asians. / published_or_final_version / Medicine / Master / Doctor of Medicine