Theses and dissertations (Health Sciences)

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2D brachytherapy planning versus 3D brachytherapy planning for patients with cervical cancer
(2015-03-05) Govender, Natalie; Naidoo, Subhadranalene; Govender, Poovandren
Research Aims The purpose of this study is to compare 2D HDR Brachytherapy planning and 3D HDR Brachytherapy planning in terms of dose distribution in order to accurately determine bladder and rectal doses. Further research questions were explored to determine whether relationships existed between Computer Tomography volumes and bladder and rectum dose. Methodology The 30 female patients that volunteered for the study were conveniently selected. Their age and ethnic group did not contribute to their selection. All participants were prepared for cervical HDR Brachytherapy. The Brachytherapy templates were computer generated and treatments were given based on the templates. They then had a Computer Tomography (CT) scan (3D data set) of the pelvis. The computer generated templates for 2D Brachytherapy planning were applied to the CT data set i.e. 2DBP. The plans were optimised to take into consideration the dose to the bladder and the rectum i.e. 3DBP. The 2DBP and the 3DBP were then evaluated in order to determine which method of planning yielded more acceptable dose distributions to the bladder and rectum. Results Significant differences in dose distribution were noted on comparison of 2DBP and 3DBP. A significant relationship was noted in respect of bladder mean dose and rectum mean dose. 3DBP proved to be more efficient in yielding lower mean dose to the bladder and the rectum. Whilst a significant relationship was noted in respect of bladder maximum dose, an insignificant relationship was noted for rectum maximum dose. Therefore, the efficiency of 3DBP to yield lower bladder maximum dose was established but its efficiency to yield lower rectum maximum dose is questionable. This has implications for the management of patients’ with cervical cancer who require cervical Brachytherapy. Recommendations It is imperative that imaging modalities be used for the accurate planning of cervical Brachytherapy. This study recommends that CT be used for HDR Brachytherapy planning by proving its greater efficiency compared to template planning.
The acceptance of westernised health care into the ulwaluko (traditional circumcision) custom by amaXhosa in a rural Eastern Cape village
(2002) Ntsaba, Mohlomi Jafta; Grainger, Linda D.
The Ulwaluko (traditional circumcision) custom among the AmaXhosa is a traditional rite of passage. Traditionally all young men are required to undergo the custom. Its modern manifestation, however, has become problematic, because there is an increase in the morbidity and mortality which is associated with gangrenous and septic complications of the wound. Therefore an intervention was needed to reduce the problems. A westernised health care project was developed and implemented but some communities have not accepted it. Therefore there was a need to understand how it came to be accepted in one village in order to adapt it and promote its acceptance by other communities. The purpose of this study is to explain the acceptance of westernised health care into the traditional circumcision and give nurses a better understanding of how to give culturally sensitive care. A qualitative research design was used, specifically Ethnography, since this is the tradition for studying the meaning, patterns, and experiences of a defined cultural group (Polit and Hungier, 1997). ABSTRACT The researcher conducted separate in-depth semi-structured face-to-face interviews with the two key informants from the community and three focus groups. A total of 18 AmaXhosa men participated in the study. Data was transcribed from taped sessions. Thematic analysis was carried out and 12 major themes and eight sub-themes emerged.
Access and utilisation of antenatal care services in a rural community of eThekwini District in KwaZulu-Natal
(2016) Bhengu, Thandeka Jacqueline; Sibiya, Maureen Nokuthula; Ngxongo, Thembelihle Sylvia Patience
Introduction Although the South African Government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilization of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. Aim of the study The aim of the study was to determine whether pregnant women from KwaMkhizwana rural community had access to and were utilising antenatal care services. Methodology A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s three delays model. Purposive sampling of the pregnant women and all categories of nurses who were employed in the three health care facilities in the area was done. Data was collected in two phases through in-depth semi-structured interviews with both the pregnant women and the nurses respectively between February and March 2016. The sample size was guided by data saturation. All data were analysed using the Tesch’s method of data analysis. Study findings Six major themes and several sub-themes emerged from the interviews with both Phase 1 and Phase 2 participants. The major themes included: 1) access to health care and emergency services, 2) availability of human and material resources, 3) social and cultural beliefs, 4) past pregnancy experiences, 5) communication and transparency regarding health care service delivery and 6) quality of antenatal care services. Summary of the findings The pregnant women encountered several challenges which led to delays in seeking, reaching and receiving antenatal care. Most of the pregnant women participants related limited access to health care, with under-utilisation of antenatal services. They were unhappy about the antenatal care services they received in the three available health care facilities in the area, which made these facilities to be inaccessible and underutilised. The nurse participants recognised the challenges facing the pregnant women regarding the access and utilisation of antenatal care services, together with the challenges faced by the nurses while working in the three available health care facilities in the area. Recommendations The recommendations that were made included: to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services are delivered in line with the South African Department of Health policies and guidelines and strengthening community education. A further study on provision of antenatal care services in the area is also recommended.
Access and utilization of adolescent youth friendly services in primary health care clinics in Ekurhuleni South District, Gauteng Province
(2022-05-13) Naicker, Reshna; Naidoo, Vasanthrie; Munsamy, Michelle; Mavundla, Amile
Background- The Adult Youth Friendly Health Service (AYFHS) programme has been fragmented in the healthcare system. Regardless of youth healthcare being a priority, the inequalities within the implementation and sustenance of this service, there has been unmet health needs of many youth and adolescents within the community of Ekurhuleni in the South district of Gauteng. This study has therefore found it necessary to explore the youth perspectives in accessing and utilising adolescent/youth friendly health services within the community. Aim of the study-The aim of the study was to explore the perspectives of adolescents regarding their access and utilization of AYFHS in Primary Health Care clinics in the Ekurhuleni South District, Gauteng Province. Methodology- The study utilised a qualitative, explorative, descriptive approach where data was gathered through individual interviews from a study population based in the Ekurhuleni South District in Gauteng province and selected through a purposive sampling technique. The analysis and interpretation of the data revealed emerging themes which discussed and formed the core of the research findings. Conclusion- Access and utilisation of AYFHS in the Ekurhuleni South District, noted that several barriers existed. From the perspective of the youth that have been interviewed, it was noted that a lack of knowledge regarding the AYFHS programme was prevalent. Youth healthcare is the centre of priority in the healthcare system and AYFHS should be the programme of focus as it encapsulates the burden of disease holistically amongst the youth population. Provision of accessible, available, equitable and appropriate youth healthcare services are required at healthcare facilities in the Ekurhuleni South District. Recommendations- Policy makers and those in authority should routinely assess and evaluate healthcare facilities to ensure that the essential package of the AYFHS programme is implemented at all healthcare facilities and quality healthcare services are provided to the youth population. This study recommends that all aspects of quality service delivery, such as adequate infrastructure, human and material resources and operating hours of the healthcare facility need to be improved to meet the needs of the community. Education and training of staff and the community regarding AYFHS is required as matter of urgency. Strategies to improve satisfaction of healthcare services should be targeted and retaining the youth population within the healthcare facility must be given priority.
Achievement of clinical learning objectives by midwifery nursing students : an appreciative inquiry
(2020-06-19) Ngcobo, Ntombifuthi Pearl; Sokhela, Dudu Gloria
INTRODUCTION ABSTRACT Clinical practice in nursing education is vital as it provides a platform for nursing students to correlate what they have been taught in the classroom during a theory session and apply it in the real-life situation. There are specific objectives which midwifery nursing students must achieve in order to meet the required competency levels as prescribed by the South African nursing education regulating body the South African Nursing Council (SANC) (South Africa 2005: 5). Some of the learning objectives that have to be achieved by midwifery students are: demonstrate competency in the assessment, planning and implementation and evaluation of nursing care for a woman with an uncomplicated and complicated pregnancy, labour puerperium and normal new born baby. The country has embarked on an endeavour to improve maternal and child health as expressed in the Sustainable Development Goals (SDGs) (United Nations 2015: 3). Goal number 3 of the 17 SDGs is to ensure healthy lives and promote well-being for all at all ages. This goal is relevant to this study as competent midwives are the foundation for maintaining mother and child well- being during pregnancy, labour, delivery and post-delivery, yielding healthy families, communities and the nation. AIM OF THE STUDY The purpose of the study was to describe how an Appreciative inquiry (AI) was used to determine strategies used towards achievement of the midwifery clinical learning objectives. METHODOLOGY An AI approach with a qualitative descriptive research design was used to determine the strategies used by the lecturer and midwifery clinical instructors and students in the University of Technology (UoT) selected for this study and students towards achievement of their clinical learning outcomes. Purposive sampling was used to select the lecturer, midwifery clinical instructors in the UoT, hospital midwifery clinical instructors and students. Six professional nurses from the clinical facilities, one lecturer from the UoT, seven clinical instructors from the UoT and eleven midwifery nursing students were purposively sampled and interviewed. RESULTS The results of the study revealed that there were several factors that assisted students to achieve their midwifery clinical learning objectives. These included supervision by clinical instructors who modelled good behaviour, had no favouritism and were always willing to teach students. Collegiality and co-operation between lecturers, clinical instructors in the UoT and facility clinical instructors assisted in bridging the gap between theory and practice resulting in students achieving their midwifery clinical learning objectives. Staff development was cited as a key factor in ensuring that students are taught relevant and up-to-date knowledge. CONCLUSION Collaboration of all stakeholders in coordinating and planning student training is essential for the production of well-rounded, competent and confident students. In this collaboration, it is imperative to acknowledge that everyone’s contribution is equally important for good outcomes of students.
Adverse effects of shift work at a biscuits manufacturer
(2017) Mhlongo, Philisiwe Kenlly; Reddy, Poovendhree; Gabela, Sibusiso Derrick
Shift work is a necessity for many organizations. Reasons for shift work are mainly to ensure continuous and optimized operations. Many studies on shift workers have concluded that it can lead to adverse physiological, social and psychological health effects. This study examines challenges associated with working shifts at a biscuits manufacturing factory. Results should be able to assist the employer in implementing effective interventions directed at limiting the negative effects of shift work on employees. This is a convergent parallel design multi method stud among 152 shift workers in a biscuits manufacturer located in Durban, KwaZulu Natal. An abbreviated and modified form of the validated SSI questionnaire was used (Barton et al. 1995). The questionnaire contained a battery of items designed to examine the relationship of health and personal adjustment to shift work. Owing to the exploratory nature of the study, a focus group methodology was also used and this allowed for in-depth qualitative research which catered for a more comprehensive understanding of the current shift work issues. A retrospective review of injury records of employees who sustained occupational injuries between 2012 and 2013 was also conducted. The sample comprised of 85 (56%) males and 63 (42%) females. Logistic regression was used to estimate the association between shift work and the likelihood of sleep disturbance, poor health outcomes and limited time for social and domestic activities, adjusting for age, sex, partner working, years working night shift, marital status, job class and years employed. Odds ratio (OR) for reported sleep disturbance was slightly higher among women (OR=1.65; 95% CI = 0.25; 10.84; p < 0.05) compared to males, but this was not statistically significant. Longer shift work experience (i.e.11-20 years) was significantly associated with better health status (OR=0.18; 95%CI = 0.06; 0.46; p < 0.05). Shift work experience (11 to 20 years) was also found to be significantly associated with limited time for both social (OR = 0.10; 95%CI = 0.03; 0.30) and domestic activities (OR= 0.25; 95% CI = 0.11; 0.57; p < 0.05) (Table 4). Age had no effect on social and domestic activities, but those 40 years and above were more likely to have limited time for social and domestic activities (OR = 3.06; 95%CI =0.60; 15.60 and OR= 2.5; 95%CI=0.47; 13.06). Those with more shift work experience seemed to have more time for social and domestic activities compared to those with less than 10 years experience. Findings from the FGD’s revealed that most participants (91%) did not get sufficient sleep time after night shift; this was mainly because of the chores they had to do after getting home form night shift and disturbances from the household and neighbours. The average time spent sleeping by majority of participants after night shift was 5 hours. Swollen feet, gastric, sleep disorders, indigestion and headaches were some common complaints experienced by shift workers in this study. About 27% of participants reported to have been injured at work before. These incidents were reported to be related to drowsiness and fatigue. The company’s incident records showed a total of 160 injuires between 2012 and 2013, of which 38 occurred during night shift. In 2012, the company recorded 65 injuries which included 51 first aid (FA) injuries, 6 minor injuries (MI) and 8 lost time (LT) injuries, as categorized by the company. 2013 had the highest number of incidents, with 95 total injuries, averaging to 7.9 injuries annually. There were 84 first aid incidents recorded for year 2013, 9 minor injuries and only 2 lost time injuries. Twenty three percent (15, n=65) incidents occurred during night shift in year 2012, of which 11% (7, n=65) were females. The number of night shift incidents slightly increased to 24% (23, n=95) in 2013 and females accounted for 9.40%. The records showed that majority of injuries happened between 17h00 and 21h00 at night. Results of this study provides evidence that shift work impacts negatively on the lives of the employees and can lead to adverse health outcomes such as poor dietary intake, headaches and swollen feet to mention but a few.
Alcohol use amongst students in a university of technology in Kwazulu-Natal, South Africa
(2023-05-31) Ntombela, Florence Buzani; Sokhela, Dudu Gloria; Mahlanze, Hazel Thokozani
BACKGROUND Alcohol use among students in universities is becoming a major problem worldwide and has the potential of adversely affecting students’ performance academically, including in South Africa. Peer group influence in higher education institutions is more significant than parental or religious upbringing because students are away from home, not under their parents’ direction anymore and are free to do as they please. Therefore, peer group pressure plays a large role in the socialization of university students and in introducing alcohol as an acceptable culture of tertiary educational institutions. Aim The aim of this study was to determine the extent of alcohol use and drinking patterns among university students in a university of technology in KwaZulu-Natal, South Africa, and the relationship of these elements to their academic performance. Methods This was a quantitative, non-experimental, cross sectional descriptive study. A structured questionnaire was used for data collection were collected from a purposive sample of 349 undergraduate students in a university of technology in KwaZulu-Natal, South Africa. SPSS 26.0 was used for the statistical analysis of data. Results A significant number (67.0%) of respondents were in the age group of 20-24 years. Only 34% of the total number of undergraduate students attested to drinking alcohol, with 29.9% (n=35) drinking 3 to 4 standard drinks on one occasion and 5.1% (n=6) drinking up to 9 or more drinks per sitting. About 25.8% of respondents reported drinking monthly and 1.7% indicated weekly. About 5% of the sampled respondents were problematic alcohol users of which 2% had medium level problems and 1% had high-level problems. Conclusion Problematic alcohol use among students in a university of technology was associated with challenges like bunking classes, poor academic achievement, and peer pressure. This study recommends employing joint strategies including faculty, lecturers, and community leaders to reduce problematic alcohol use among students. The existing efforts can be strengthened through awareness campaigns and information given to all levels of undergraduates, starting in orientation week for the first years, a period where students are first acquainted into a new values and society.
An analysis of emergency response times within the public sector emergency medical services in KwaZulu-Natal
(2017) Finlayson, Melissa Joy; Naidoo, Raveen; Brysiewicz, Petra; Naguran, Sageshin
Introduction: Response times are considered to be one of the oldest and most popular indicators which are used to measure the efficiency of Emergency Medical Services (EMS), particularly to cases in which the patient’s condition is deemed to be life threatening. Purpose: To analyse emergency response times within the public sector Emergency Medical Services in KwaZulu-Natal and to compare these to the national norms. Methods: Using a mixed method approach, the study was conducted in two phases. The first phase involved collecting quantitative data for all the cases logged in the Umgungundlovu Health District Communications Centre over a period of one week (seven days). Phase Two involved the collection of qualitative data from focus group discussions which were conducted with three groups which had been identified. These groups included the communications centre staff, operational staff and supervisory staff. The aim of these focus group discussions was to identify factors that influenced response times as well as to propose strategies which would improve these response times. Content analysis was utilised to interpret the qualitative data which had been collected. Results: Quantitative data was collected from a total of 1 503 cases of which 680 were categorised as priority 1 (P1), 270 as priority 2 (P2) and 553 as inter facility transfer (IFT). The majority of the cases (895) had occurred in urban areas. A total of 406 cases were exempted as no patient was transported. The number of these cases was greater on days when the total case load was higher as compared to days with a lower total case load. The mean response time to cases in rural areas was 129 minutes and 110 minutes to cases in urban areas. All the time intervals were found to be longer for cases in rural areas as compared to those for cases in urban areas but with the exception of the EMD response interval. P1 cases had the shortest mean response times for both urban area cases (33 minutes) and rural area cases (95 minutes) as compared to the other case categories. Nevertheless, the national norm of 15 minutes in urban areas and 40 minutes in rural areas was not achieved in the majority of the cases. The mean Emergency Medical Dispatch (EMD) response interval was 41 minutes for P1 cases, 56 minutes for P2 cases and 96 minutes for IFT cases. The qualitative data revealed factors that impacted on the response times and helped to explain and account for the quantitative data results. Challenges regarding the availability of resources, including vehicles, staff and equipment, as well as the way in which such resources are managed, were highlighted. The high demand for services compared to the available resources was raised by the focus group participants with this high demand resulting in extended EMD response intervals. This was exacerbated by the overwhelming demand for IFT cases which are serviced by the same resources as emergency cases and which have a much longer mission time, thus delaying response times continuously. Exempt cases were also found to impact negatively on response times as, although operational vehicles are committed to these cases, services are not required. Inconsistencies with regards to case prioritisation and dispatch triage also emerged. External factors, including poor road infrastructure, lack of road names and house numbers, weather conditions and long distances between EMS bases, the patient or incident location and health care facilities were also identified as factors that resulted in extended response times. Strategies to improve the situation were explored. These strategies included the effective management of resources in order to ensure optimal availability, the introduction of a formal, computer aided, dispatch system, the adoption of demand pattern analysis and dynamic location/relocation models, standardised processes and procedures to guide all areas of EMS operations and the education of both the public and staff. Conclusion: South African EMS response time national norms for both rural and urban areas are unachievable under the majority of circumstances and, thus, they may be said to be unrealistic. Until these national norms, against which the efficiency of EMS in South Africa is measured, are revised, the service will be deemed to be incompetent.
An analysis of injury profiles and management strategies utilised by chiropractic students at the 2015 Durban 'Rugby Rush Tournament'
(2015-07-28) McAlery, Caryn; Haswell, Garrick
Background Rugby union is one of South Africa’s most popular sports; it requires high levels of skill and fitness and is played at a high intensity and speed which allows for a greater risk of injury. The high risk of injury is said to be due to the nature of the physicality of rugby. It is because of this high risk of injury that several adaptations of rugby have since developed which rely more on speed and agility than physicality. These adaptations include tens or ten-a-side rugby, sevens or seven-a-side rugby and finally touch rugby, which is played with six players a-side. Each adaptation has its own set of rules and is played differently to the traditional rugby union or fifteen-a-side rugby. Hence, in these adaptations the physicality is said to decrease with a resultant increase in demand for speed and agility. The reduction of physicality and increase in the need for speed and agility would imply that the nature of injuries sustained will be different to those sustained in traditional rugby union. Objectives To develop a profile of injuries that describe the type, anatomical location and mechanism of injuries sustained in tens, sevens and touch rugby; to compare the injuries sustained between the three groups; and, to analyse management strategies utilised by chiropractic students at the 2014 Durban ‘Rugby Rush Tournament’. Additionally this study aimed to provide recommendations to the injury reporting form utilised. Method This study was a retrospective, quantitative, descriptive study based on the Chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of injury and treatment profiles. Participants who made use of the chiropractic treatment facility were required to complete the informed consent section of the injury reporting form. The chiropractic intern was required to complete the remainder of the form pertaining to the participant, complaint and treatment information. This study was limited to event participants to allow for subgroup analysis. The forms were then captured and analysed. Results The data collected consisted of a total of 345 individual patient forms which indicated 626 visits for a total of 733 complaints. The average participant age was 24 ± 5.58. The study found muscle strains (41.5%), SI Syndrome (17.6%) and Joint sprains (15.0%) to be the most frequent diagnoses. A history or previous injury or trauma was reported in 18.7% and 7.40% respectively. Acute injuries accounted for 64.3% and 35.7% were recorded as chronic in nature. The most frequent mechanism of injury was that of overuse (81.9%) and trauma accounted for 17.2% of injuries. The lumbar region (26.1%), thigh (20.7%) and shin/calf (15.6%) were the most commonly reported regions of complaint. Manipulation (58.8%), massage (32.0%) and stretch PNF (27.9%) were the most frequently used treatment protocols. Strapping was utilised in 21.1% of injuries of which 5.20% was applied to the muscle and 13.6% was applied to the joint. No comparison was made using the sevens subgroup as there were insufficient records, thus only tens and touch players were compared. A borderline non-significant difference (p = 0.057) was noted between the type of player and the history of previous trauma. Tens players were more likely to have a history of trauma compared to touch players. A significant difference (p = 0.001) was found between the type of athlete and mechanism of injury. Overuse was more common in touch players whereas trauma was more common in tens players. Due to statistical inconsistencies no significance tests were applicable to compare the type of player and region of complaint. Recommendations were proposed in order to avoid this in future research. Conclusion This study provides a base of knowledge regarding the injuries that were presented to the chiropractic treatment facility at the 2014 Durban ‘Rugby Rush Tournament’ and the management strategies utilised by the chiropractic interns at the event. This research provides insight into injury profiling of tens, sevens and touch rugby players. There were several recommendations proposed for future researchers in order to expand on this field of knowledge.
An analysis of inter-healthcare facility transfer of neonates within the eThekwini Health District of KwaZulu-Natal
(2013-01-18) Ashokcoomar, Pradeep; Adam, Jamila Khatoon
Introduction The safe transfer of neonates from one healthcare facility to another is an integral component in the process of neonatal care. Neonates, a term applying specifically to infants during the first 28 days of life, are transferred from medical healthcare facilities which do not have specialist care or intensive care management to more specialised facilities in order to improve their clinical outcome and chance of survival. The transfer system is thus an important aspect of the overall care provided to neonates. The transfer process, however, poses a threat of aggravating the clinical condition of the neonate. Inter-healthcare facility transfer of a neonate requires careful planning, skilled personnel and specialised equipment to maintain the continuum of care, as this directly impacts on the morbidity and mortality of the neonate. Purpose of the study The purpose of the study was to undertake a descriptive analysis of the current neonatal inter-healthcare facility transfer system in the eThekwini Health District of KwaZulu-Natal (KZN). This service is provided by the public sector ambulance service known as the Emergency Medical Rescue Service (EMRS). The study, based on 120 consecutive transfers, assessed the clinical demographics of the neonates, the time taken to complete the transfers, including time sub-intervals, the equipment that was necessary for the transfers and the qualifications and procedures performed by the transfer team. The study also identified any adverse events that were encountered during the transfers. Methodology The study was conducted from 19 December 2011 to 30 January 2012. It used quantitative methodology and a non-experimental prospective design to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two types of questionnaires. A descriptive survey method incorporated logistic and deductive reasoning to evaluate the objectives of this study. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using chi- square. Results During the study period there were a total of 120 neonatal inter-healthcare facility transfers. All referrals were undertaken by road ambulances. Eighty-three (62.2%), transfers were undertaken by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Thirty one (28.5%) transfers were on Fridays, followed by 24 (20.8%) on Mondays and 20 (16.6%) on weekends. Ninety seven (80.8%) were during the hours of dayshift (07h00-19h00) and 23 (19.2%) were during nightshift (19h00-07h00). Of the 120 neonatal transfers, 29 (24.2%) were specialised transfers, of which 22 (75.9%) were ventilated. With reference to the gestational ages of the neonates being transferred 90 (76.7%), were pre-term, 26 (21.7%) were term and 2 (1.7%) were post-term. There were 11 (9.2%) newborns (from birth to 4 hours), 56 (46.7%) early neonates (from 4 hours to 7 days) and 53 (44.2%) late neonates (from 7 days to 28 days). Of the 120 neonatal transfers, 90 (75.0%) were pre-term having associated co-morbidities and 49 (40.8%) had respiratory problems. The mean time ± standard deviation (SD), taken by EMRS eThekwini to complete an inter-healthcare facility transfer was 3h 49min ± 1h 57min. The minimum time to complete a transfer was 55min and the maximum time was 10h 34min. The mean time ± SD from requests to dispatch was 1h 20min ± 1h 36min. The delays in dispatch were associated with no ambulances being available 70 (58.3%), no ALS personnel available 48 (40.0%), no equipment available 23 (19.2%) and no ILS personnel available 7 (5.8%) to undertake the transfers. Junior or inexperienced personnel in the communication centre also contributed to the time delays by dispatching ALS personnel for non-specialised transfers and requesting neonatal equipment when it had not been requested by the referring personnel for the transfer. The mean time ± SD from the referring hospital to the time mobile to the receiving hospital was 43min ± 26min. Six (5.0%) neonates were clinically unstable at the referring facility for transfer. For 15 (12.5%) transfers, neonates had been inappropriately packaged for transport by the hospital staff, which added to the delays, p. value = 0.018. The necessary equipment was unavailable for 37 (30.8%) of the transfers. The lack of equipment was due to problems such as poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The pre- departure checklist had not been completed in 50 (41.67%) of the transfers. The study identified 10 (8.3%) adverse events related to the physiological state of the neonate and included 1 (0.8%) mortality. Nine (7.5%) neonates suffered serious life threating complications during transportation, 8 (6.7%) of which were due to desaturation, 6 (5.0%) due to respiratory deterioration, 3 (2.5%) due to cardiac deterioration and 1 (0.8%) due to temperature related problems. Eighteen (15.0%) of 120 transfers experienced equipment related adverse events of which 9 (7.5%) were associated with ventilators, 9 (7.5%) with incubators, 3 (2.5%) with the ambulance, 2 (1.7%) with the oxygen supply and 1 (0.8%) with arterial cannulation. Five (33.3%) of the 15 equipment related adverse events contributed directly to life threatening physiologically related adverse events, p. value = 0.007. Conclusion and recommendation The Emergency Medical Rescue Service (EMRS) is involved in the transportation of a significant number of neonates between various healthcare facilities in the eThekwini Health District, some requiring intensive care and some not. This descriptive, prospective study has identified numerous shortfalls in the service provided by the EMRS in the eThekwini District. Inter-healthcare facility transfer of neonates can be safely performed by the transport services if the operations are well co-ordinated and there are dedicated, specialised and trained transport teams armed with appropriate equipment and medication, together with the guidance of policies and quality assurance. Transport teams must be trained to provide this specialised care in various environments, including ground and air ambulances and understand the multiphase neonatal transfer processes. There must be good communication and co-ordination by all role players, which is underpinned by good team work to improve the standards of neonatal care and monitoring. Only then can clinical excellence be achieved when transporting neonates between healthcare facilities.
An analysis of patients transported by a private helicopter emergency service within South Africa
(2015) Muhlbauer, Dagmar; Naidoo, Raveen; Hardcastle, Timothy Craig
Introduction: A Helicopter Emergency Medical Service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. There is an absence of literature describing the types of patients treated and the clinical outcome of these patients flown by Helicopter Emergency Medical Services within South Africa. The paucity of literature on this topic poses a challenge for current aeromedical services as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS within South Africa. Purpose of the study: The purpose of this study was to undertake a descriptive analysis of the patients flown by the Netcare 911 HEMS over a 12 month period in both Gauteng and KwaZulu-Natal and to assess the patients’ outcomes. The objectives of the study were to analyse the clinical demographics of patients transported by the Netcare 911 HEMS operation, determine the time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital and undertake a correlational analysis of crew qualifications, clinical procedures performed and their outcomes at 24 hours and 72 hours. A further objective was to make recommendations regarding the refinement of current aeromedical policies as well as the education and training requirements. Methodology: The research study was conducted utilizing a retrospective quantitative, descriptive design to undertake an analysis of patients transported by a private helicopter emergency medical service within South Africa. The records of all patients transported by the Netcare 911 HEMS operations between 01 January 2011 and 31 December 2011 were included. Results: In the 12 month study period there were a total of 547 cases. However, the final study population was made up of 537 cases as 10 cases had to be excluded due to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KwaZulu-Natal HEMS and 455 (84.7%) were managed by the Gauteng HEMS. Findings revealed that the majority of patients flown in both Gauteng and KwaZulu-Natal were adult males: males (n=398; 74.1%) and adults (n=437; 81.4%). Motor vehicle accidents were the most common incident type for both operations (n=193; 36%). At the 24-hour follow up, 339 (63.1%) patients were alive and stable and at the 72-hour follow up, 404 (75.3%) were alive and stable. Conclusion and recommendations The findings of this study provide valuable information that may have an impact on the current staffing and authorization criteria of South African HEMS operations.
An analysis of selected Bach flower remedies and their relationship to existing Homoeopathic Materia Medica
(2021-05-27) Andrew, Crystal Jade; Maharaj, Mandusha
With the increase of daily stressors in our lives, an individual may find it debilitating and can subsequently reduce the quality of life. According to a study done on the life time prevalence of common mental disorders in South Africa, it was found that anxiety disorders have the highest prevalence in life time disorders. Thus, appropriate treatment or management of anxiety disorders and fear-related disorders may be necessary. The Bach flower remedies have been used to treat mental or emotional states. These remedies were discovered by Dr Edward Bach. Dr Bach analysed the flower remedies and categorised them distinctively into groups based on similar characteristics of which flower remedies displayed. The Bach flower remedies Aspen, Cherry plum, Mimulus, Red chestnut and Rock rose have been placed into the fear group as a result of being collectively fearful, although the cause of the fear and anxiety are diverse. AIM The aim of the study was to explore the relationship of selected Bach flower remedies, the fear group, to the existing Homoeopathic Materia Medica noting the themes that emerged. METHOD This study paradigm involved an intensive literature-based review study with detailed analysis of data in the public domain. There were no participants needed for the study. The repertorisation method has been used extensively in Homoeopathy to detect the remedies of repertorial similarity. In other words, the common remedies that arise in symptom patterns. The development of the repertory came from the idea of having multiple remedies which was difficult to memorize. This study employed this method to detect the emerged Homoeopathic remedies per selected Bach flower remedy. The mental/emotional symptoms of the Bach flower remedies were converted to rubrics with the use of Schroyens (2012) repertory. The study integrated thematic analysis using the data achieved after repertorisation. RESULTS The remedies of repertorial similarity were determined by the repertorisation of the characteristic symptoms of the selected Bach Flower remedies. Three best suited remedies were selected per Bach flower remedy of which the researcher thoroughly analysed to distinguish common themes that arise. Upon further comparison between the selected Bach flower remedy mental and emotional symptomology and the emerged Homoeopathic remedies, the researcher noted the results showed significant similarities of the mental/emotional symptoms between the Bach flower remedies and the Homoeopathic remedies. CONCLUSION After much analysis, the researcher found that for each Bach flower remedy there was a distinctive Homoeopathic remedy which showed similarities of the Bach flower remedies pertaining to the mental/emotional symptomology. The Homoeopathic remedies following simply displayed the main themes of anxiety and fear, but not in detail when analysed with the corresponding Bach flower remedy. The researcher thus noted that since there are similarities between the Bach flower remedies and the emerged Homoeopathic remedies, the Bach flowers will be of aid as a conjunctive therapy which will enhance the treatment of the Homoeopathic remedies for anxietybased disorders.
An analysis of the combined effects of swimming and overhead throwing on the shoulder complexes of male first division waterpolo players
(2021-05-10) Gibb, Conor Beckett; Matkovich, Grant
Background Abstract Waterpolo is often compared to other sports, mainly swimming and overhead throwing sports. Swimming favours a posture of glenohumeral internal rotation and horizontal adduction. Overhead throwing sports can characteristically cause posterior shoulder immobility with a loss in glenohumeral internal rotation and horizontal adduction. Based on the fact that waterpolo players combine both swimming and overhead throwing whilst playing and training, it is the purpose of this study to investigate the sport-specific characteristics of the shoulder complexes of waterpolo players in an effort to determine how these unique characteristics may relate to the development of overuse injuries. Aim The aim of this study is to compare the dominant and non-dominant shoulder complexes of male water polo players in terms of posture, range of motion and sport- specific overuse injuries in order to develop an understanding of the combined effects of swimming and overhead throwing on the shoulders of water polo players. Methods The study used an observational based research design and consisted of 33 male waterpolo players currently competing in the Kwa-Zulu Natal mens 1st division waterpolo league. Participants underwent a shoulder digital posture examination as well as a shoulder-complex physical examination consisting of range of motion and orthopaedic testing which was then compared between the dominant and non- dominant shoulders. Participants were assessed for the presence of rotator cuff injury, glenoid labrum and LHBT injury, and anterior glenohumeral instability using the following physical tests: Empty can test, painful arc test, external rotation resistance, Hawkins-Kennedy test, Neer test, Yergassons test, Biceps Load test II, and the apprehension-relocation-surprise test. Glenohumeral range of motion was assessed using manual goniometry to measure passive internal and external rotation and horizontal adduction. Statistical analysis was performed using IBM SPSS version 27 statistical analysis software. Paired tests were used to compare outcomes from the dominant and non-dominant shoulders of the participants. To compare the posture measurements, as well as injuries present between the dominant and non-dominant shoulders, McNemar’s chi square tests were used. To compare the Range of motion measurements between the dominant and non-dominant shoulders, paired t-tests were used. A p value < 0.05 was considered statistically significant. Results Forward head posture with rounded shoulders was extremely common, with 73% of the participants in this study displaying a bilateral forward shoulder position ranging from moderate to severe, and 45% of participants displaying a bilateral forward head posture ranging from mild to severe. Glenohumeral internal and external rotation ROM measurements showed no difference between sides. There was a borderline significant difference (p=0.05) in the horizontal adduction measurements, with the non- dominant side showing greater values. The only injury test that yielded significant results was the empty can test for supraspinatus injury that had a higher prevalence for being positive on the dominant side. Conclusion The results of this study suggest that water polo players are prone to the development of a bilaterally equal forward head posture with rounded shoulders and are susceptible to similar mechanisms of bilateral overuse injury as swimmers. In addition, the dominant shoulders of these athletes are susceptible to damage caused by the repetitive, traumatic forces experienced by the posterior cuff musculature and posterior glenohumeral joint capsuloligamentous structures during the follow-through and deceleration phases of overhead throwing, resulting in an increased risk of supraspinatus-specific rotator cuff injury and a loss of glenohumeral horizontal adduction that potentially increases the risk of glenoid labrum and LHBT injury.
An analysis of the Somatology programme offered at South African Universities of Technology to determine whether it meets the needs of industry
(2015-03-11) Rammanhor, Kiveshni; Bhagwan, Raisuyah
The beginning of the 20th century presented the Somatology profession with unprecedented challenges of acquiring a scientific base and achieving professionalisation. It is in this milieu that a few research studies were previously undertaken with regard to Somatology education however, none particularly focused in relation to areas that are preparing graduates for industry. The current study was a national study that explored the existing National Diploma offering through the lens of students, educators and members of the Durban University of Technology’s Advisory Board. In particular, it focused on developing broad guidelines to guide academics on what further content was required to be integrated into the current Somatology education. A triangulated approach using both quantitative and qualitative methods was used to guide the operationalisation of the research process. Five Universities of Technology participated in the study, viz. Cape Peninsula University of Technology, Central University of Technology, Durban University of Technology, Tshwane University of Technology and the University of Johannesburg. Third year and B.Tech students were surveyed with regard to the current Somatology Programme and what further aspects needed to be integrated into it to better prepare graduates for industry. In addition, in-depth interviews were also held with ten academics, two from each University of Technology, to examine what they thought needed to be included in education to strengthen the current programme. The same was done through a focus group discussion with members of the Durban University of Technology Advisory Board. A programme analysis of current content being taught at the five Universities was also undertaken. The results reflected that although most of the samples were satisfied with the current educational programme, they still believed that gaps existed and that graduates were still not adequately prepared for industry. It was found that both students and educators saw the need for more therapies to be included in the training. Both educators and the Advisory Board sample also saw the need for a stronger emphasis to be placed on practical skill development. The Advisory Board sample also strongly articulated for training to occur in an industry context as opposed to the University based experiential setting. Using data from these multiple samples, a set of guidelines was developed and presented. These guidelines were based on what further therapies needed to be integrated into education. The Duke Integrative Medicines Wheel of Health was adopted as the theoretical framework of the study. It was also utilised to identify specific areas that needed to be interwoven into education to further strengthen graduates’ preparedness for industry.
An appraisal of Hahnemann’s vital force as a complete vitalist concept
(2020-06-10) Raubenheimer, Francois J.; Ross, A.
Hahnemann’s ‘vital force’ was an early 19th century understanding, elaborated to some extent by 20th century authors such as Kent (‘simple substance’) and Close (‘vital principle’). Homoeopathy considered disease to be the result of a weakened vital force and therefore disease to be “a dynamic expression of the disturbance of the harmony and rhythm of the vital energy" (Roberts 1997: 23). According to Makewell (2008) the concept of vital force remains ‘19th century’, therefore comparisons to analogous vitalist concepts within other medical and philosophical traditions, such as ‘aether’, ‘prana’, and ‘q’i’ was a prudent decision made by the researcher. Moreover, the researcher feels recent explorations such as Reich’s concept of ‘orgone’ will be beneficial to the currency of homoeopathic philosophy. This study sought to critically appraise Hahnemann’s notion of vital force through the comparative exploration of conceptual overlaps and deficiencies between the Hahnemannian concept and the parallel vitalist concepts in a range of medicinal and philosophical traditions in terms of the understandings of the nature, function and role of vital energy in the maintenance of health. This research was conducted by means of a qualitative methodology as a comparative exploration using NVivo® 10 to identify and extract themes derived from the stated objectives from key source texts within each of the vitalist philosophical and medical traditions Homoeopathy, Traditional Chinese medicine, Ayurveda, Orgonomy, animal magnetism and hermetic alchemy. Such derived data was compared to similarly derived data extracted from homoeopathic writings regarding the ‘vital force’ [viz. Hahnemann, Kent and Close].An analysis was conducted on the vitalist concepts within each tradition and the conceptual overlaps and deficiencies which exist between each conceptual view and the notion of vital force as described by Hahnemann. Themes of each vitalist principle were analysed from the literature in terms of their nature, function, and role in the maintenance of health and compared to the homoeopathic concept of the vital force. Data analysis began with familiarisation and immersion with the data and note-making tables and diagrams were used to focus and organise information. Common themes were identified, and data was coded in NVivo 10® according to these themes. The data was then revised until there was suitable representation of all the information. The data was then interpreted, relationships identified, differences outlined in concepts and the presented in an informative and descriptive manner. Some vitalist concepts had more in common with Hahnemann’s vital force than others, while others were poorly defined and remained steeped in mystery as there were no detailed writings and documentations as was the case with animalmagnetism. Prana and qi seemed to have the strongest overlaps with vital force, but additional attributes set them apart from the concept of the homoeopathic vital force. The concepts of ‘orgon’ and ‘aether’ also showed a strong similarity to vital force, particularly aether. The researcher concluded that the data reflected in this comparative analysis established that all the vitalist concepts in the various vitalist medical disciplines did in fact describe the same phenomenon. One difference is that some some disciplines described energy in more detail as seen with prana and qi where the flow of energy was deemed to collect in energy reservoirs in the body namely the chakras and nadis in Ayurveda and the dan tiens and meridians in Traditional Chinese Medicine. Vital force on the other hand, was not described as having energy reservoirs but as having a more generalised and unspecific distribution. Furthermore, Hahneman seems to have been influenced by hermetic teachings regarding aether in his development of his vitalist philosophy.
An appraisal of homoeopathic quinquagenimillesimal potencies of plumbum metallicum and stannum metallicum by means of nuclear magnetic resonance spectroscopy.
(1999) Power, Sean Michael; Ross, Ashley Hilton Adrian
The purpose of this study was to investigate the Nuclear Magnetic Resonance spectra of samples of LM6; LM14 and LM22 homoeopathic quinquagenimillesimal (LM) potencies of tin (Stannum metallicum), lead (Plumbum metallicum) and two lactose based controls: one control which is prepared by the means of potentisation and one control prepared without the means of potentisation. It was hypothesised that in terms of the effect of different substances (Stannum metallicum and Plumbum metallicum, and the lactose controls) and of different dilutions (LM6, LM14, LM22) of these substances that significant differences exist between the chemical shift and relative integration values of the CH3, CH2, OH and H20 signals of these homoeopathic substances.
The approaches of frequent and infrequent application of chiropractic treatment : a study of their relative efficacy in the management of mechanical low back pain
(1995) Mathews, Robert; Penter, C. S.
Variations in prescribed treatment frequencies have resulted from an absence of tested theory. In response to this, the objecti ve of this study was to compare the efficacy of once and three times weekly treatment frequencies in the management of mechanical low back pain. It was hypothesised that both treatment protocols would be effecti ve, but the three times weekly protocol was expected to be more effective. This randomised clinical trial consisted of experimental and descriptive survey design. Thirty voluntary subjects diagnosed as having facet syndrome, sacroiliac syndrome or a combination of these two were divided into two groups of fifteen and randomly allocated to each study group. Chiropractic treatment was administered, according to the allocated frequency, for a maximum of three weeks. The outcome measures included the response of patients to the NRS-lOl pain intensity scale, the Oswestry Back Disability Index, positive orthopaedic test scores and lumbar spine ranges of motion. Data was collected from these measurement criteria before the onset of treatment, at the end of the last treatment session, and at a follow up consultation one month after the last treatment.
Assessing infection control knowledge and compliance in theatre at a private hospital in KwaZulu-Natal, South Africa
(2022-09-29) Naidoo, Elizabeth Laura; Adam, Jamila Khatoon
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. A qualitative, research design was used to explore the knowledge and compliance of infection control practices of Cardiovascular Perfusionists by conducting online semi structured interviews. The interviews were conducted online due to the current pandemic of COVID-19, where much consideration was given to social distancing and modes of virus transmission. Duration of the interviews lasted no more than 20 minutes. Prior to conducting the main study, a pilot study was pursued in order to ensure that the interview questions were relevant and that the participants had clear engagement with the questions and no modification nor questions were added to the interview guide. The researcher found that the actual description of the professions differed in the procedures carried out, however, the theatre environment is the same, and only a few questions pertaining to the difference in practice of the participants had to be slightly rephrased in order to be more applicable to the main study. The study was conducted by means of a purposive sample of Cardiovascular Perfusionists. The interviews conducted were limited to only those that practice in the private sector. Participants were chosen based on their ability to provide the necessary information. The interviews were transcribed and then coded by a statistician. The rationale for selecting this strategy was that the researcher was seeking knowledge about the factors that influence the knowledge and compliance of Cardiovascular Perfusionists in the private sector regarding infection prevention and control techniques. Subsequently, these participants would be therefore able to contribute valuable information. The major themes which emerged where namely., infection control and prevention, knowledge of healthcare associated infections, awareness of healthcare acquired infections, cardiovascular perfusionists procedures and precautions followed in cardiovascular surgery. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies.
An assessment of ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal
(2008) Naguran, Sageshin
The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.
The assessment of cardiopulmonary health risks associated with PM₁₀ and PM₂.₅ exposure on the community of Kriel Town and Thubelihle Township in the province of Mpumalanga
(2020-06-10) Shezi, Lucky; Pillay, Julian David; Gabela, Sibusiso Derrick
Background: In the wake of rapid industrialisation and urbanisation amongst developed and developing countries, there has been increasing awareness that air pollution, especially particulate matter (PM) and its components, is linked with a variety of adverse health effects. There is strong evidence suggesting that air pollutants originating from industrial/commercial facilities may cause adverse effects on human health. Objectives: To analyse the levels of PM10 and PM2.5 emissions for Kriel and Thubelihle during the year 2017, using the Kriel village air monitoring station and the Elandsfontein monitoring station; To determine the incidence of cardiopulmonary conditions amongst the town of Kriel residents (within a 10-kilometre radius of the Eskom-owned Kriel coal power station) and Thubelihle Township residents (residing outside a 14- kilometre radius of the Kriel coal- power station); and to establish the association, if any, between PM10 and PM2.5 emissions at each site. Methods: The study was a quantitative, cross-sectional and descriptive study conducted to provide information regarding particulate matter air pollution and the incidence of cardiopulmonary conditions in the town of Kriel and the Thubelihle Township in Mpumalanga province. The health records were obtained of all the people who were diagnosed or treated for cardiopulmonary conditions during the months of January 2017 to June 2017 at Kriel Community Health Centre (CHC) and the Thubelihle Township CHC. Data on the exposure to ambient PM levels was also obtained from January 2017 to June 2017. Results: This study established that there was a statistically significant difference between PM10 and PM2.5 emissions at the town of Kriel and Thubelihle Township. The mean PM10 emissions in the town of Kriel was 46.25±25.23 µg/m3 and 28.70±15.05 µg/m3 in Thubelihle Township (p < 0.005; Mann-Whitney U). The mean PM2.5 emissions in the town of Kriel was 24.31±13.21 µg/m3 and that of Thubelihle Township was 20.23±10.35 µg/m3 (p < 0.005; Mann-Whitney U). The study also established that the incidence of cardiopulmonary conditions amongst the town of Kriel residents and Thubelihle Township residents was significantly different (c2 = 146.60, df = 4; p˂0.05). This study revealed that there was a significant relationship between PM10 and PM2.5 concentration at the town of Kriel and Thubelihle Township. The town of Kriel PM10 and PM2.5 emissions were (p˂0.05; r=0.63 Spearman’s rho). Thubelihle Township PM10 and PM2.5 emissions were (p˂0.05; r=0.61 Spearman’s rho). Conclusion: This study has demonstrated the association between PM levels and the incidence of cardiopulmonary conditions such as asthma, bronchitis, pneumonia and bronchiectasis amongst the community members of Kriel and Thubelihle who reside in the vicinity of the coal- power plant. The Emalahleni Municipality in Mpumalanga, the Department of Environmental Affairs and Eskom are urged to review environmental policies towards lowering PM pollution to acceptable levels.