Theses and dissertations (Health Sciences)

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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.
An appraisal of homoeopathic proving methodology as a bridge between the indigenous and rationalist-scientific understandings of medicinal plants : the case of Strychnos henningsii
(2011) Ross, Ashley Hilton Adrian; Conolly, Joan Lucy; Kayne, Steven Barry
Aim This study sought to appraise homoeopathic proving methodology as a bridge between the indigenous and rationalist-scientific understandings of medicinal plants through a detailed exploration of the relationships existing between data derived from respective paradigmatic explorations of a single African traditional medicinal plant, Strychnos henningsii [Red bitterberry]. Methods The data derived from the implementation of a triple-blind, placebo-controlled homoeopathic proving methodology, on 32 healthy human subjects (50 percent placebo), using the bark of Strychnos henningsii in the 30CH potency, were evaluated for internal consistency and coherence, and subsequently compared to data derived from a phytochemical analysis of the crude bark sample, and translated data derived from semi-structured mothertongue interviews of eight Zulu traditional healers. The proving data took the form of subjective journal data and the results of four objective blood measures of erythrocyte sedimentation rate (ESR), redand white blood cell indices, and liver functions. The subjective data were evaluated in terms of defined inclusion criteria and presented in standard materia medica and repertory formats, and tabulations of objective data were subjected to independent statistical analysis, using repeated-measures ANOVA and profile plots. The crude bark sample was analysed in terms of the presence of strychnine and other indole alkaloids, using highperformance liquid chromatography-mass spectrometry, and interview data related to the indigenous understanding and application of Strychnos henningsii within the traditional African medical paradigm, were audiovisually recorded, collaboratively translated, and independently verified. ABSTRACT iii Qualitative data processing and analysis was effected with the aid of NVivo® software, and a range of comparative analyses were effected with the aid of Radar® homoeopathic software, materia medica references and the Mappa Mundi elemental theory model. Results The proving yielded 581 subjective symptoms, covering a broad range of physical and mental disease manifestations, and nine statistically-significant treatment effects within the objective data set. These included elevation of ESR and changes in two red blood cell indices, four white blood cell indices and two liver function indices. The two proving data sets were demonstrated to show high levels of correlation, although these correlations were not demonstrable for all provers. The phytochemical analysis confirmed the presence of between two and five strychnine-related compounds (excluding strychnine itself), and the field interview data served to confirm all except two documented traditions of use, as well as identifying a number of novel indications and application of Strychnos henningsii bark. The comparative analyses demonstrated the integrity of homoeopathic proving methodology as a mode of scientific investigation, and significant and widespread overlaps of proving symptomatology with both the pharmacology and toxicology of strychnine, and the physical and metaphysical understanding and application within the traditional African medical paradigm. Conclusions Homoeopathic proving methodology was discussed in terms of the evident degree of overlap with the indigenous and rationalist-scientific paradigms, and the incomplete nature of the homoeopathic ‘totality’. A number of recommendations were made for future cross-paradigmatic research.
The assessment of the facilitation of the clinical training component of an undergraduate nursing programme at a University of Technology
(2015) Xaba, Nompumelelo Pearl; Mkhize, B.T.; Adam, Jamila Khatoon
Background All nursing students need to undergo clinical training for them to be competent practitioners when they qualify. According to the South African Nursing Council (SANC) training facilities are accredited only if the clinical training component is effective. Therefore, it is important that students are accompanied in order for them to grow professionally and have values as future health care professionals. In nursing education, a student throughout the nursing training course receives instruction both theoretically and clinically in the subjects prescribed in the curriculum by the SANC. Clinical instruction is effected through clinical teaching and learning, which is a requirement by the nursing regulatory body, the SANC. For an undergraduate programme a student has to spend a minimum of 1000 hours per year in clinical placement to meet programme outcomes. It is the responsibility of all nursing schools, colleges and universities to ensure that each student meets these requirements. For this to be effective it has to be facilitated by lecturers and clinical instructors, through teaching and learning strategies to enable students to perform the clinical skill with knowledge and eventual competence. Therefore, clinical instructors are there to ensure that the students are competent in all skills, such as cognitive, affective as well as psychomotor skills. This will be beneficial to the programme in reduction of rates of failure and dropout and again by producing competent practitioners. A positive relationship and collaboration between the clinical training institutions and clinical placement facilities is vital for student achievement, especially because the clinical instructors assist students in correlating theory and practice. This study sought to assess the clinical training component of an undergraduate programme at this UoT in KwaZulu Natal. Findings may inform an improved clinical instruction programme as no such study had been undertaken. Methods A qualitative and quantitative design was used to explore feelings, perceptions as well as experiences of staff and student nurses with regard to clinical training component. Stratified random sampling was used to select student nurses according to levels of training and questionnaires were used to collect data. All permanently employed staff who had been working over six months were selected since they were directly or indirectly involved in the clinical facilitation. A focus group interview was conducted for the clinical instructors and questionnaires were used for the lecturers to collect data. Themes and sub-themes emerged and on analysis they were compared to the findings from the quantitative survey. Results and discussion The results revealed that collaboration of clinical placement facilities and training institutions is important for student’s support since all parties are able to communicate freely and students benefit. Students stated that they did not get enough support since the clinical facilitators were short staffed and they were also allocated to facilities that were far from the campus. The respondents cited problems during clinical accompaniments as there were very high expectations by staff members in the placement areas regarding student support. Lecturers were also expected to involve themselves in clinical accompaniment to bridge theory-practice gap. The employment of mentors will assist in student support as the mentors will be at placement areas and the staff and students easily contact them. Conclusion From the interviews the researcher managed to come up with important aspects that should be included in an accompaniment tool when developed, which should be user friendly to both lecturers and clinical facilitators. It will thus assist students with critical skills including critical thinking when performing any patient related nursing skill. It was recommended that the UoT management support staff by attending to their concerns including finding more clinical placement facilities close to the campus.
The association of demographics and occupational factors with latent tuberculosis infection in radiology staff at public sector hospitals in the eThekwini health district
(2015-03) Ackah, Shiroma; Swindon, Lynda; Naidoo, Subhadranalene
Introduction Tuberculosis remains a leading cause of death, second to the Human Immunodeficiency Virus. The risk of latent tuberculosis infection and active tuberculosis disease is a known occupational hazard. In South Africa, a high tuberculosis burden country, the potential of Mycobacterium tuberculosis transmission to health care workers is high. This includes diagnostic radiographers and other radiology staff working in radiology departments. Purpose of the Study This study aimed to investigate the association of demographic and occupational factors with latent tuberculosis infection in radiology staff in public sector hospitals of the eThekwini Health District. Methodology This cross-sectional study was conducted from 26 February 2013 to 07 June 2013. Quantitative methods were used to test for associations of demographic and occupational factors with latent tuberculosis infection in participants. A sample size of 181 participants for an estimated population of 340 radiology staff was recommended at the proposal stage. The study consisted of two phases; the questionnaire survey (phase one) and the administration of a two-step tuberculin skin test (phase two). Data was obtained with regard to demographics, occupational history, social behaviours, medical history; and family and home histories. Demographic and occupational associations with latent tuberculosis infection were made in relation to the size of the first tuberculin skin test induration. Frequency distributions were developed to describe data categories. Pearson’s and Spearman rho’ correlation coefficients were used to test for correlations between the independent variables. The chi-square test was used to determine associations between the categorical independent variables and the dependent variable. Bivariate analyses were performed using these tests. The multivariate analysis was performed using logistic and linear regression on the dependent variable. Results A total of 182 questionnaires were returned from approximately 280 radiology staff. At the outset, all doctors working in the radiology department had to be excluded due to numerous failed attempts to enlist their participation. Fifty-three (29.12 percent) participants were excluded from phase one of the study and a further thirteen participants were excluded from phase two. The total sample was 116 participants. Of the 116 participants, 86.2 percent tested positive for latent tuberculosis infection at the first step of the two-step testing method used. One (0.86 percent) participant went on to convert at the second step, testing positive at this level. Demographic associations with latent tuberculosis infection included age (older) as an associated factor. A significant demographic association with latent tuberculosis infection was the use of alcohol (p-value 0.033 on the multivariate analysis). Occupational associations with latent tuberculosis infection included longer durations of employment. The annual income (higher income earners) displayed significant associations with latent tuberculosis infection (p-value 0.048 on the multivariate analysis). It is necessary in this study to note that participants include support personnel (lower income earners) making up 37.8 percent of the study, diagnostic radiographers making up 48.3 percent; and radiography managers/assistant managers (highest income earners) making up 13.8 percent of the study. Conclusion and recommendations The risk of transmission of Mycobacterium Tuberculosis to health care workers is a known occupational hazard. This study has described the prevalence of latent tuberculosis infection in radiology staff, at district and regional hospitals within the eThekwini Health District. With 23.62 percent of all participants already having active TB disease and 86.2 percent of the tested group displaying positive results for latent tuberculosis infection, using the tuberculin skin tests, the need for tuberculosis screening is essential. The findings of this study will be used as a health improvement mechanism for stakeholders, having identified potential gaps in medical screening in healthcare in Kwa-Zulu Natal. This study makes recommendations for the early detection of active tuberculosis infection and the monitoring of health care workers that are latently infected, thus assisting in reducing the rate of conversion of latent tuberculosis infection to active tuberculosis disease in radiology staff. This reduces long-term exorbitant costs related to health care associated infections, such as tuberculosis. It also reduces rates of transmission and cross infection to both co-workers and already immunocompromised patients, helping to curb the overall epidemic in South Africa.
Behaviour management challenges : the relationship between preparedness and practice experiences of Child and Youth Care Workers in KwaZulu-Natal
(2021-05-27) Mkhize, Lindelwa Vernon; Sibiya, Nokuthula M.; Hlengwa, R. T.
Background The Child and Youth Care (CYC) profession entails caring for children and youth at risk. The provision of this care includes various challenges with behaviour management being one of the main challenges. Children at risk are known to experience challenges in managing their own behaviours, thus needing Child and Youth Care workers (CYCWs) to assist in this area. Various studies have proven that CYCWs struggle with behaviour management. This study therefore intended to explore whether CYCWs are adequately and effectively trained and prepared to successfully cope with behaviour management challenges. This study focused on CYCWs educational preparation to assist children in residential care centres with behaviour management challenges. Aim of the study The aim of the study was to explore the relationship between preparedness and practice of CYC workers in relation to managing the behaviours of children at risk. Methodology This study used a qualitative, exploratory, descriptive and contextual design. The population of this study was CYCWs in KwaZulu-Natal who are working in residential Child and Youth Care Centres (CYCCs). Two CYCCs were approached for data collection, with 11 participants from one CYCC and 10 from the other CYCC. Data was collected via individual interviews which were conducted telephonically due to the COVID 19 pandemic. The collected data was analysed by the researcher using Tesch’s eight steps of analysis. Findings The following four major themes emerged from the interviews: The most common challenging behaviours displayed by children in CYC residential centres; integration of theory and practice; children’s response to behaviour management and the use of alternatives in managing children’s challenging behaviours. Conclusion The growth of the CYC profession is dependent on the type of individuals professionalised for practice in the field. Hence, putting effort in developing the best type of training may contribute towards achieving the level of care and growth needed in children at risk.
Chiropractic students’ perception and practice of patient education on management of musculoskeletal conditions at a tertiary education teaching clinic
(2023-05-31) Nieuwenhuis, Hardus; Maharaj, Praveena; Korporaal, Charmaine Maria
Background Modern healthcare is characterised by patient-centred care, which requires that healthcare professionals have equal proficiency in communication and practical skills. As part of their duty as healthcare professionals, chiropractors must show patients how to help themselves through patient education, which requires communication skills. Patient education no longer solely involves or refers to knowledge transfer alone, but rather working with patients in their specific context to build knowledge together from a partnership perspective and to share power in this dynamic. From this perspective, patient education becomes a tool to empower patients and improve their self-efficacy and coping habits, without constantly relying on passive care. This study presents a detailed evaluation of patient education within a South African chiropractic student context at the Durban University of Technology. Aims and Objectives This study aimed to describe chiropractic students’ perceptions and practice of patient education of musculoskeletal conditions at a teaching clinic. The objectives were to evaluate the students’ perception of patient education and the strategies they use; their self-reported practice of patient education; barriers that students face when educating patients; factors that contribute to their patient education skills development, and to determine whether there is an association between demographics, their perception and practice. Methods The study was an anonymous web-based questionnaire with a cross-sectional design within a quantitative paradigm. The survey used in this study stems from a physiotherapist study. Permission was obtained from the author to replicate the study in a South African context at the Durban University of Technology Chiropractic Day Clinic (DUT CDC). The original survey was then put through a focus group and pilot study and subsequently adapted to include questions related explicitly to chiropractic and the student population at the Durban University of Technology. Weekly reminders were sent via email to class representatives to distribute among their respective classes. A total of 42 completed questionnaires were used for analysis in this study. Cronbach’s alpha was used to assess internal consistency of scales. The scale scores were computed by averaging the 18 items for Question 6 and Question 5 respectively where Ttests were used to compare these scores between the demographic variables for binary data, ANOVA for ordinal data and Pearson’s correlation analysis, where the demographic variable was quantitative and normally distributed. A Wilcoxon signed ranks test was used for the comparison of time spent on patient education at initial consults and time spent on patient education at follow-up consults Results Overall, the students viewed most of the patient education items to be important and should be discussed with patients. In practice, however, the frequency of their practice did not correspond to the perceived importance. Only a few items were practised to the same extent as the perceived importance thereof. The chiropractic students’ discussions with their patients tend to focus on the main complaint of patients. In most cases, students educate their patients through one-on-one discussions, physical demonstration and anatomy models. During initial visits, students usually spend between 6–15 minutes educating their patients; in follow-up visits, the time is reduced to 6–10 minutes. In most cases, students cited patient characteristics as a barrier to effective patient education. For the chiropractic students, developing their patient education skills was largely dependent on their interactions with supervising clinicians. There was no association between demographics, perceived importance, and practice behaviour in this study. Conclusion Although the patient education topics were generally deemed important by chiropractic students, the topics considered most important are directly related to the main complaints of their patients, with more complex topics not being perceived as necessary as those directly related to the complaint, such as diagnosis. Like their perceptions, the students most frequently addressed the topics they deemed important; thus, their perceptions and practice were congruent (for issues related to the main complaint of the patients). An important finding of this study was that, although DUT follows an evidence-based paradigm, many students perceived pathoanatomical explanations to be important and, thus, provided their patients with such explanations, even though the literature does not support it. In addition, the students reported several methods through which they educate their patients. However, the assessment of whether it was successful was mainly centred around physical activity rather than the patients’ understanding of the information discussed. The results indicate an opportunity to improve the patient education skills of students, as they appear to have difficulty adjusting to difficult situations, and thereby perceive factors to be barriers that are not actual barriers but rather challenges.
Communication patterns in the homoeopathic interview : a comparative study of 5th year interns and qualified practitioners
(2004) Nell, Nicholas; Hopkins, Crofton Russell
The purpose of this study was to compare the communication patterns in the homoeopathic first consultation between qualified practitioners and student practitioners. The overall patterns were also compared to standard medical literature on patient practitioner dialogue. Patients and methods The research groups consisted of two groups of ten participants: one group of qualified registered, and practicing homoeopaths and the other of student interns at the Homoeopathic Day Clinic at the Durban Institute of Technology. Each participant conducted two consultations which were taped for research purposes. These were conducted in the setting of either their private practices or in the Homoeopathic Day Clinic. These tapes were used to generate a data set that described the relative frequencies of certain utterances according to the Rater Interaction Analysis System (RIAS). This data set was analysed statistically to give a comparison between the two groups, as well as being used to describe the patterns of communication in a homoeopathic setting in the larger context of medical interactions. IV Results Significant statistical differences were noted in the communication patterns of practitioners as opposed to student homoeopaths.
A comparative analysis of animal chiropractic regulation within seven countries
(2017) Du Plessis, Christine; Matkovich, Grant; Mullinder, Louis
Introduction: Chiropractic treatment of animals is a young and dynamic field of interest among chiropractors, veterinarians and animal owners. As a young profession, regulation of animal chiropractic is limited to only a few countries, with regulatory models in various legal paradigms. Bosman (2012) determined through a qualitative investigation that in order for the profession to grow, it would require well defined guidelines, proper governance, appropriate legislation and set educational standards. Presently there is a paucity in the literature regarding animal chiropractic regulation. Through a comparative study of current international animal chiropractic regulatory models, possible international trends in animal chiropractic regulation can be identified. This could assist in identifying any possible short comings or positive developments and possible future areas of progress in the regulation of animal chiropractic. Aim: To determine the regulatory status of animal chiropractic in selected countries, at statutory and professional association level, in order to ascertain whether an international trend in animal chiropractic regulation exists. Method: The study was a comparative analysis. The sample consisted of ten jurisdictions spread over seven countries. These were Australia (Victoria and Queensland), Canada (Ontario and Alberta), Ireland, New Zealand, South Africa, the United Kingdom and the United States of America (Texas and California). The validated data collection sheet (Appendix B) was used to extract quantitative data through the various organisations’ web pages and communication with the relevant organisations. Results: The regulation of the practice of animal chiropractic was found to be in various stages of regulation, with it being unregulated or largely unregulated in three out of the ten jurisdictions included in this study. In seven out of the ten jurisdictions the regulation of the practice of animal chiropractic fell under government devolved authority to the veterinary statutory regulatory body, although regulation was not very extensive in most of these jurisdictions. Four of the jurisdictions with regulation of the practice of animal chiropractic through government devolved authority had national animal chiropractic professional associations and two of the jurisdictions in which the practice of animal chiropractic was unregulated had a national professional association. None of these professional associations held government sanctioned authority. Statutory regulation played a more significant role in regulation of the practice of animal chiropractic in terms of the existence of codes of ethics, complaints and disciplinary procedures and CPD requirements than the national animal chiropractic professional associations did. Significance was also found in the legal requirement of registration as veterinarian or chiropractor in jurisdictions where veterinary referral was a legal requirement for chiropractic practitioners of animal chiropractic and where post-graduate animal chiropractic qualifications were only recognised by the veterinary statutory regulatory bodies if it was a legal requirement for registered veterinarians and chiropractors. No professional statutory regulatory body regulated or required regulation by educational statutory regulatory bodies or international accreditation of animal chiropractic education. The significance of national animal chiropractic professional associations was limited to their codes of ethics as it correlated with their limitation of membership by the professional association to mostly registered veterinary and chiropractic practitioners holding a post-graduate animal chiropractic qualification. Several trends were identified that could either hinder or promote the development of appropriate regulation for the practice of animal chiropractic. Conclusion: From the comparison of the current animal chiropractic regulation it was found that cooperation between veterinary and chiropractic statutory regulatory bodies appears to be important for the development of suitable and effective regulation of the practice of animal chiropractic. The study suggests that there is a need for standardisation and regulation of animal chiropractic education and the definition of the animal chiropractic scope of practice. This study also suggests continuation of cooperation between chiropractors and veterinarians that has been sought since the inception of the animal chiropractic profession. Involvement of functioning national animal chiropractic professional associations with the development of appropriate regulation, defining of animal chiropractic scopes of practice and promotion of the unity, integrity and identity of the animal chiropractic profession is recommended to achieve growth for animal chiropractic as a profession.
A comparative analysis of six international chiropractic regulatory systems
(2014-05-28) Adams, Justin; Korporaal, Charmaine Maria
Background: The function and roles of legislation primarily provide a protective function for the public by preserving their fundamental rights. Legislation also maintains the legitimacy of the professions and aids in defining the scope of practice within the profession. Legislation may however affect the international migration of practitioners, in addition to geographical proximity, shared language, customs and educational curricula as well as historical links. There is no published literature that compares chiropractic legislation in regulated countries, thus no understanding of where possible similarities and differences exist and the impact they may have on the migration of chiropractors Objective: The main objective of the study is to aid in increasing the understanding of the values, structures and operations of various international chiropractic regulatory systems with the goal of identifying the similarities and differences (viz. compare) between these chiropractic regulatory systems. Method: Six countries with chiropractic Legislation were selected using purposive sampling based on the number of practicing chiropractors. The USA was divided into states with the top three selected according to practicing chiropractors, Canada was divided and the top province selected based on practicing chiropractors. Information and data was obtained via desk based research and additional information was gathered by the researcher from the registrar of the respective regulatory bodies. Results: A variety of factors were identified that may either aid in or hinder the mobility of chiropractors across jurisdictions. By analysing the legislative documents, it was found that regulatory bodies remain similar in content and structure however significant differences were also found. Conclusion: In conclusion, regulatory bodies and their governing documents and procedures remain similar in content and structure. However the study revealed differences factors that could possibly affect the mobility of chiropractors across jurisdictions. These areas identified included: Educational standards and processes, competency maintenance, registration requirements (local and foreign), disciplinary procedure and processes and constraints placed by supranational bodies.
A comparative analysis of the proving symptomatology of Malus domestica with existing remedies from the Rosacea family
(2021-05-27) Zuma, Minenhle Goodenough; Maharaj, Mandusha
Introduction Over the years there has been an increase in the number of homoeopathic drug provings. This has in turn, led to an increase in the number of available homoeopathic remedies and, consequently, an expansion of the materia medica. The increase in the number of available homoeopathic remedies is a massive milestone in the field of homoeopathy. However, some practitioners acknowledge that finding a homoeopathic similimum is rather daunting due to the excessive volume of data. A system of prescribing that would make the process of finding a similimum logical is necessary. Numerous homoeopaths have developed methods to analyse and classify remedies. The Doctrine of Signatures, miasmatic theory developed by Samuel Hahnemann, the homoeopathic repertories and group analysis are but some of the developments that have been implemented to assist homoeopathic practitioners and students grasp the excessive content that exists in the materia medicae and the field of homoeopathy as a whole. These methods have also made prescribing for both students and homoeopaths logical and much easier. Innovative homoeopathic authors like Sankaran (2005a), Scholten (1993) and Mangialavori (2010) have developed systems of studying remedies in groups or kingdoms, now famously known as group analysis. Group analysis offers a valuable tool for studying and prescribing homoeopathic remedies with accuracy. Aim This is a non-empirical correlational, theoretical study with the aim of studying and comparing the proving symptomatology of Malus domestica with the following selected plant remedies within the Rosaceae plant family: Crataegus oxyacantha, Hydrocyanicum acidum, Laurocerasus, Prunus spinosa and Rosa damascene. This study also aimed to expand the knowledge of the Rosaceae family and by so doing improve the application of the remedies in a clinical context. A MacRepertory® search was conducted to choose remedies belonging to the Rosaceae family with the greatest number of rubrics hence the above-mentioned remedies were selected as the sample for this study. A good representation of the remedy in the materia medica and the number of successful clinical cases available were other factors that were considered on selecting sample remedies. Objectives 1. Describe and organise symptomatology of selected remedies of the Rosaceae plant family and tabulate their respective symptomatology in order to derive homoeopathic themes. 2. Determine homoeopathic symptomatology, rubrics and themes of Malus domestica in order to enable family contextualisation. 3. Compare the themes and sensations that emerge with existing themes and sensations of Malus domestica and the selected Rosaceae plant family remedies. Methodology To fulfil the purposes of this study the proving symptomatology of Malus domestica was thoroughly studied and interrogated. A computer repertory search was conducted using MacRepertory® to extract all the rubrics of the study remedies. The sources that were used included the documented proving of Malus domestica 30CH, materia medicae and MacRepertory®, which is an electronic database consisting of repertories, materia medica, books and journal articles. The symptomatology, themes, sensations, and rubrics were visually analysed and compared with each other in the form of tables for easy reference and to identify existing commonalities and differences. The collected themes and sensations were subsequently analysed. The emerging sensations were then compared with those proposed by Sankaran. Results The Rosaceae remedies yielded numerous themes and sensations, especially those relating to the mental sphere, chest, respiratory, heart and circulation, extremities and the head. The following sensations were noted: tightness, spasms, oppression, suffocation, paralysis, constriction, disconnection and pressure (inwards and outwards). A few polarities were noted in the mental themes. The polarity that exists between some of the themes are: • Calmness and quietness vs Nervousness, anxiety, restlessness, and fear; • Increased memory and concentration levels vs Mental weakness, mental dullness, loss of memory and mental exhaustion. The comparative analysis of the proving symptomatology of Malus domestica and existing Rosaceae plant remedies namely, Crataegus oxyacantha, Hydrocyanicum acidum, Laurocerasus, Prunus spinosa and Rosa damascene exhibited numerous commonalities. Conclusion The study established clearly discernable commonalities between Malus domestica 30CH and existing Rosaceae plant remedies, with the majority of these commonalities relating to the mind, head, chest, respiratory, extremities, heart and circulation and the abdomen. This study demonstrated that group analysis can validate and expand provings, hence expanding knowledge and clinical application of these remedies.
A comparative study on the effectiveness of application techniques of tissue oil enriched with Rooibos (Aspalathus Linearis) extract on dehydrated skin of women aged between 18 and 45 years
(2020-06-10) Van der Schyff, Raihaana; Dorinda, Borg; Brooks, D.
Human skin is the largest organ in the body and constitutes the first line of defense as it offers protection to the underlying structures such as the muscles, bones, ligaments and internal organs. Daily, the skin comes into contact with the environment and plays an important role in protecting the body against excessive water loss and dangerous pathogens. Due to these factors, the skin can develop conditions such as dehydration, sensitivity, sagging or dryness. Thus, women are constantly seeking effective and speedy treatments to increase the hydration levels and improve the appearance of their skins. This study aimed to compare the effectiveness of two different application techniques, (hot oil mask and Swedish massage), using Rooibos-enriched tissue oil on dehydrated skin of women to assist in establishing which application method was the most effective. The findings of this comparative study will provide Somatologists with the knowledge of the quickest and most effective treatment techniques when using this tissue oil to treat dehydrated skin for women between the ages of 18 and 45 years. An experimental design, using a pre-test and post-test method to compare participant groups was administered. Purposive sampling was used as only females between the ages of 18-45 years of age who were clinically diagnosed by a dermatologist with evidence of existing dehydration and measured on the Fitzpatrick scale between 3–5, were included in the study. The sample size comprised of sixty-two (n=62) participants. Participants (students and staff) were recruited from the Cape University of Technology in the Cape Province, South Africa. The Bt-AnalyzeTM skin identification and the Multi-skin test Centre 750® were used to perform the skin evaluations. The findings suggest that both the Swedish massage (p=0.000 to 0.003 across the different age groups) and the hot oil mask applications (p=0.000 to 0.004 across the different age groups) reflected a significant improvement in the hydration levels of the skin after just three applications (30%). Observations of clinical photographs suggested that the Swedish massage applications were visibly more effective for the age group 18-23 years(p=0.000) and 36-41(p=0.002), compared to the hot oil mask applications which appeared visibly more effective for the age groups 30-35(p=0.001) and 42-45(p=0.000). However, the TEWL values were statistically significant for all age groups except for the age group 30-35 (p<0.363), 36-41 (p<0.952) and 42- 45 (p<0.544). Upon completion of the study, all participants showed an improvement in hydration levels within the physiological parameters of the skin. The skin appeared visibly less dry with fewer fine lines. Participants who had previously reported experiencing flaky or taut skin, were more comfortable and satisfied with the texture of their skin post treatment as it felt smoother. In general, the tissue oil with rooibos extract had a positive hydrating effect on the skin irrespective of the application method although age did have an influence. Most of the improvements occurred after the first application of the product. Factors such as age, product usage, water consumption and exercise do influence the skin hydration levels. Therefore, these factors should be considered as future recommendations when designing treatment programmes for improving skin hydration levels. Finally, massage oil application methods should be incorporated into treatments designed for the younger age groups (under 40 years) and the hot oil mask is recommended for mature skin (over 40 years) to achieve the best results.
A comparison between the efficacy of radionically prepared gibberellic acid and homoeopathically prepared gibberellic acid (GHP) on the germination rate and seedling development of barley seeds
(2016) Kleingeld, Gerhard; Naude, David F.
Aim The aim of this controlled, experimental study was to compare the biological activity of various homoeopathic potencies of gibberellic acid manufactured radionically (AMS transfer device) and conventionally (GHP) in terms of their respective influence on germination rate and seedling development of barley seeds; all the respective results being contrasted against those produced by the distilled water control. Methodology The research was completed by employing quantitative research techniques and followed true experimental design. Homoeopathically (Hahnemannian) prepared gibberellic acid followed the manufacturing guidelines of method 5a involving liquid preparations, as specified in the German Homoeopathic pharmacopoeia (GHP) (Benyunes 2005). A second radionic ‘equivalent’ version of each of the Hahnemannian potencies was manufactured using the ‘AMS wave transfer’ device. Four sources of data were collected namely, germination count and rate, seedling development (root length), seedling dry mass, and number of seeds with measurable roots. All the data was collected and documented on a data collection sheet using Microsoft Excel. All the data was statistically analysed and subjected to analysis of variance (ANOVA) using GenStat Version 14 (VSN International, UK) at the 5% level of significance. The statistical data was used to produce a comparison between the different remedies and distilled water. Results All of the remedy treatment groups (Radionic 200c, Hahnemannian 200cH, Radionic 4c and Hahnemannian 4cH) displayed suppressive effects (to certain extents respectively ) on seed growth and development in comparison to the control group (distilled water). The control group displayed greater seedling development in comparison to all remedy treatment groups which was most evident in the average root lengths and high vigour seed lot root lengths having longer roots than all remedy treatment groups. The control group also displayed a higher number of seeds with measurable roots compared to all the remedy treatment groups in both total number of seeds and in the seeds accounted for in the high vigour lots. This suggests that all Homoeopathic remedies irrespective of potency or manufacture method (Radionic or Hahnemmanian) had similar suppressive effects on root growth and seedling development and this suppressive effect was in turn not evident in the control group. Conclusion The experiment results suggest that radionically manufactured homoeopathic remedies (AMS wave transfer device) have similar biological effects (suppressive effects) to the equivalent Hahnemannian manufactured homoeopathic remedies, although further research in this field is necessary to confirm these findings the results from this study are supportive of the use of radionically prepared remedies in homoeopathic practice.
Continuing professional development : opinions, awareness and compliance challenges experienced by radiographers in KwaZulu-Natal, South Africa
(2016) Naidoo, Kathleen; Naidoo, Subhadranalene; Puckree, Threethambal
Introduction: Continuing Professional Development (CPD) has been introduced as a means to ensure that professionals continuously update their knowledge and skills. In addition, CPD has become a mandatory requirement by the Health Professionals Council of South Africa (HPCSA). However despite CPD being mandatory, health professionals nationally and internationally alike have experienced numerous challenges obtaining the required CPD points/hours. Some of these challenges included lack of awareness of the CPD requirements, lack of available activities, lack of employer support, lack of funding and a lack of time to participate. No studies have been conducted amongst radiographers working in the province of KwaZulu-Natal (KZN), to determine if they are affected by similar challenges hence the need for this study. Purpose The purpose of this study was to identify the opinions, level of awareness, participation, and challenges related to CPD compliance by radiographers in KwaZulu-Natal, and to ascertain their suggestions for improvement to CPD practices in order to make recommendations to the HPCSA. Method A quantitative, descriptive research approach using a questionnaire with both open-ended and closed-ended questions was utilized. Radiographers from all four disciplines in Radiography, working in the province of KwaZulu-Natal were included in this study. A five point Likert scale was used for most of the closed questions. The open ended questions allowed respondents to express their opinions freely. The quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. The inferential statistics included bivariate correlations and Chi-square testing. Open ended questions were analyzed by means of thematic analysis. Results Two hundred and ninety two questionnaires were administered and one hundred and forty six were returned which resulted in a 50% response rate. The mean age of respondents were 31.3 years. The majority of respondents were females (85.6%). Most of the respondents were diagnostic radiographers (80.8%) hence 59.6% were shift workers. Fifty percent of the respondents were employed in the public health sector. Respondent’s acknowledged the importance of CPD however majority indicated engagement due to the mandatory requirements by the council. The most common challenges identified were lack of funding and time. Suggestions for having formal polices in place and allocation for financial support were recommended. A number of respondents suggested having an online database for the systematic recording of CPD points in order to improve the audit process. In this study relationships between different variables were tested. It was noted that a progression in rank resulted in a greater level of agreement that CPD does improve professional competence. The infrequency of CPD engagement was directly affected by the difficulties associated with evidence and record keeping of CPD activities. The lack of funding was a greater challenge amongst the public health sector employees as opposed to the private sector. It was also noted that a lack of employer support affected how often respondents engaged in CPD activities hence support from employers was deemed crucial. Conclusion Radiographers working in KwaZulu - Natal were experiencing numerous CPD challenges. Suggestions were made to overcome these challenges as well as improving the auditing system by the HPCSA.
Correlation between cerebral tissue oxygen saturation and central venous oxygen saturation during off-pump coronary artery bypass graft surgery
(2009) Harilall, Yakeen; Adam, Jamila Khatoon; Reddi, A.
Currently, off-pump coronary artery bypass surgery (OPCAB) is a selectively employed technique for myocardial revascularization used in the majority of heart units worldwide. This strategy obviates the documented deleterious effects of cardiopulmonary bypass. However the occurrence of neurological sequelae associated with OPCAB ranges from minor cognitive dysfunction to major stroke. Haemodynamic instability throughout the positioning, stabilization and interruption of coronary blood flow are regarded as important factors that affect the performance of off-pump surgery. Fluctuations during the perioperative period, in particular manipulation of the heart could result in temporary brain hypoperfusion and neurological sequelae. To predict those patients that are predisposed to cerebral complications, investigators have used neurological monitoring, in particular Near-infra red spectroscopy (NIRS) during cardiac surgery. Aims and Objectives of the study This prospective, observational study was carried out to assess the correlation between cerebral oxygen saturation and central venous saturation during OPCAB surgery. Central venous saturation is an important variable used to assess global tissue perfusion and could therefore be advocated as a surrogate measure of cerebral oxygen saturation. In addition variables such as mean arterial (MAP) pressure, heart rate (HR), patient oxygen saturation (SpO2), partial pressure of carbon dioxide (PcvCO2), haematocrit (Hct) and lactate were also measured to determine if they were independent predictors of cerebral desaturation. This study is one of the first done in the South African population group. iv Methodology Twenty patients undergoing OPCAB surgery from the Cardiothoracic unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa were recruited in the trial. Cerebral somasensors were placed on the patients forehead to measure left and right cerebral saturations. These sensors were linked by cables to the cerebral monitor (NIRS), INVOS model 5100C. Eight time periods throughout the surgical procedure whereby patients would be haemodynamically unstable were identified. These time periods included, post induction and pre sternotomy, pre and post placement of swabs beneath the heart, pre and post placement of the stabilizer device (Octopus), pre and post snaring of the LAD (left anterior branch of the coronary arteries), pre anastomosis and during anastomosis of the coronary arteries, second sample during anastomosis and post anastomosis, pre and post removal of swabs from beneath the heart, pre and post transfer of the patient to the ICU bed. These time periods constituted the sampling period pre and post manoeuvres. Eight paired measurements, i.e., MAP, PaCO2, HR, Hct, lactate, SpO2, central venous saturation (ScvO2) and cerebral oxygen saturation (rSo2) per patient were taken during these time periods. Recording of cerebral saturations and blood samples from the central venous line were taken during these eight time periods in order to determine the correlation between central venous and cerebral oxygen saturations. Results Strong positive correlations between central venous saturation and cerebral saturation presented in majority of the sampling time periods throughout the study (post induction and pre sternotomy, post placement of swabs beneath the heart, post snaring of the LAD (left anterior branch of the coronary arteries, pre anastomosis and during anastomosis of the coronary arteries, second sample during v anastomosis, pre and post transfer of the patient to the ICU bed). The positive correlation indicates that central venous saturation can be used as a surrogate measure of cerebral oxygen saturation during OPCAB surgery. Conclusion The absence or poor correlation of MAP, HR, PcvCO2, heamatocrit, lactate, and patient saturation to cerebral saturation in this study suggests that insertion of a central venous line (CVP) during OPCAB should be a fundamental clinical requirement.
A critical analysis of the implementation of obstetric management guidelines on common causes of maternal death, as applicable to midwives
(2021-05-27) Sewnunan, Asha; Puckree, T.; Basson, Petro Magdalena
Background Despite interventions by the United Nations which formulated the Sustainable Development Goals (SDGs), to replace the unmet targets of the Millennium Development Goals, the maternal mortality ratio (MMR) remains high in low-andmiddle income countries including South Africa (SA). The goal 3 of the SDG aims to achieve less than 70 maternal deaths per 100 000 live births by 2030, globally. The slow but steady decline in the number of maternal deaths in SA with 339 deaths over the last 2014-2016 triennium falls short of the SDG targets (National Department of Health, 2017). The institutional MMR for potentially preventable maternal deaths in South Africa was 83.3 over the last triennium. The management of obstetric emergencies in SA is based on the interventions laid out in the Essential Steps in Managing Obstetric Emergencies (ESMOE) which was adapted from internationally recognised obstetric management guidelines that have proven to reduce MMR’s if effectively implemented. The availability of a good clinical guideline is only part of the solution but ensuring effective implementation in the clinical environment is of greater significance to reduce preventable maternal deaths. Aim The aim of this study was to analyse the impact of the implementation of the ESMOE guidelines by midwives on the management of the common causes of maternal deaths. This included identifying gaps, challenges and successes of its implementation by the midwife at the different levels of health care facilities with the ultimate aim of developing a practice framework to implement the interventions into midwifery training, to improve relevant knowledge and skills in providing quality emergency obstetric care. Methodology A multi method data collection approach using quantitative and qualitative designs was implemented in four phases. This study was conducted in two of the eleven districts of KwaZulu-Natal. All level of hospitals and CHCs (eleven) in eThekwini (District A) and Ugu (District B) were chosen based on purposive sampling including the districts health system’s referral pattern. Data was collected by the researcher using self-designed data capturing sheets. Quantitative data was collected on resources and ESMOE training at all eleven selected facilities, as well as a retrospective chart review on a total of 17 maternal deaths that occurred over a specified period to assess the implementation of ESMOE interventions. Face to face interviews were conducted by the researcher with 14 ESMOE trained midwives to determine the barriers and challenges they experience that impedes successful implementation of the ESMOE interventions. To test for significant trends in the quantitative data, inferential statistics was applied, including Pearson’s correlation, ttests, Mann Whitney U test, Kruskal Wallis Test and Chi-square tests. Descriptive statistics included means and standard deviation as applicable. Relevant frequencies were represented in tables and graphs. Chi-square test of independence were used on cross-tabulations to see the significant relationships in resources at the various health facilities. The Kruskal Wallis test was used to compare specific variables across the different types of health facilities. The qualitative data was analysed using thematic content analysis. Finally, a Delphi Technique using ESMOE experts was employed to validate a practice framework to implement relevant ESMOE modules into midwifery training to enhance competencies of midwives and implementation of the guidelines. Results The findings of this study indicated that many barriers and challenges exist that prevent successful implementation of ESMOE interventions which would further reduce maternal mortality rates in SA. Of the 11 facilities chosen 45.5% (n= 5) were community health centres, whilst 54.5% (n=6) were hospitals. In phase two the results revealed that the CHCs and DH did not meet the criteria of being fully BEmONC compliant, which resulted in increased referrals to regional and tertiary hospitals. This was evident by the significant difference in normal vaginal deliveries at combination hospitals as compared to CHC (p=.037). An average of 2505 deliveries were conducted at combination/regional hospitals over a four- month period with averages of 1247 at a DH and 957 at a RH as compared to only 224 deliveries at a CHC. A general shortage of essential equipment was found across facilities. The CHCs had significant shortages of CTG machines and intravenous regulators. Staff with ESMOE training were insufficient to staff all the maternity units across the facilities. District A, the bigger of the two districts with eight facilities had a significantly lower number of ESMOE trained advanced midwives (n=11) as compared to District B with three facilities (n=12). The number of maternal deaths that occurred over January 2016 to April 2016 at three combination hospital were 82% (n=14) as compared to 12% (n=2) at the regional hospitals and only 6% (n=1) that occurred at a District hospital and no deaths at a CHC. Deaths due directly to hypertension were 41% (n=7), HIV was 6% (n=1), whilst 53% (n=9) were from other causes not directly relevant to this study. A significant number of relevant maternal deaths 54.5% (n=6) were due to delays in seeking treatment and sub-standard care. Transport delays to the health facility contributed to 18.2% (n= 2) deaths, whilst non-compliance to treatment and poor record keeping were found in 27.3% (n=3) of the relevant maternal deaths. The interviews with the midwives in phase three yielded results that were suggestive of inadequate ESMOE training, lack of updates, lack of regular skills and drills exercises that contributed to lack of knowledge and skills in providing effective EmOC. Other challenges in effectively implementing emergency obstetric care included poor morale due to staff shortages, heavy burdens of workload, lack of motivation and support that contributes to sub-standard care. In the final phase the researcher took these findings and built on this by developing an algorithm that shows the need to improve midwifery clinical competencies. This algorithm was taken further to develop a practice framework that proposes to implement ESMOE interventions into the basic midwifery training to improve relevant knowledge and skills in managing obstetric emergencies effectively within a collaborative team approach. Conclusion This study has shown that gaps in the implementation of ESMOE guideline interventions in the selected facilities in KZN could have contributed to sustained high MMR in the province. The midwives expressed the need for regular training and updates to continuously improve and maintain their knowledge, skills and competencies in providing effective obstetric care. The data allowed the development of an algorithm for improved emergency obstetric patient care and a practice framework for training of midwives to ensure optimal implementation of the guidelines.
Demographic characteristics of patients attending DUT Chiropractic Day Clinic : a comparison of trends between 1994 and 2011
(2014-05-20) McDonald, Murray L.; Matkovich, Grant
Background: The Durban University of Technology (DUT) chiropractic teaching clinic (CTC) represents a training facility for future chiropractors as well as providing a healthcare service to the local population. It is important to measure the demographic characteristics and presenting complaints of patients attending the DUT CTC as this information prepares the student interns for private practice. It also provides an insight into the popularity of chiropractic in the community. Objectives: This study sought to measure certain demographic variables and presenting conditions of patients attending DUT CTC and to assess whether these have changed over time. Method: A retrospective, cross-sectional descriptive study was performed by drawing patient files of new patients presenting to the DUT CTC for the months of February through April, during 2000, 2006 and 2011 (data from a 1994 study was included for analysis). The files had the following information regarding the patient collected: age, gender, ethnicity, occupation, medical aid, main presenting complaint, as well the duration of the most recent complaint. The data was analysed for trends using statistical software (SPSS v19). Results: Data from 1 311 patient files were analyzed. The number of patients attending the DUT CTC had reduced significantly since 2000. The mean age ranged from 37.0 – 39.7yrs across the samples with a trend of increasing age occurring between 1994 and 2006. Ages ranged from 2 weeks – 89yrs, with 20 – 29yrs being the most common group. Females formed 50.5 – 51.2% of the samples with no significant change over time. White (46.3 – 64.2%) and Indian patients (27.2 – 40.9%) formed the majority, with Black patients showing a trend of increasing representation (from 6.4% in 2000 to 15.8% in 2011). The most common occupations were student (19.7 – 26.8%) and clerical (17 – 23%), with a trend noted between 1994 and 2006 of a decreasing student proportion. This trend reversed from 2006 – 2011. Medical aid subscription among patients reduced significantly (p<0.05) from 56.2% in 1994 to 41.6% in 2011. The main presenting complaints were spinal (68.2 – 84.1%), with low back (30.7 – 40.7%) and neck/head (27.8 – 33.8%) being the most common. Most main complaints were of a chronic nature (45.8 – 61.7%), though a trend of reducing chronicity was noted between 1994 and 2006. A trend of increasing sub-acute complaints was seen between 1994 and 2011. Conclusions: The patients attending DUT CTC are similar to most international CTC’s in terms of patients’ age, gender, occupation, and main presenting complaint. Compared to existing data on South African private practice, the patients at DUT CTC are generally younger, less likely to be female, less likely to be White, more likely to be Indian or Black, less likely to have medical aid, more likely to present with low back pain as appose to neck/head pain, and more likely to present in the acute/sub-acute phase. Between 1994 and 2006, the trend shows that patients at DUT CTC were older, less likely to be White, less likely to be students, less likely to have medical aid, and less likely to present in the chronic phase.
Determinants of key drivers for potable water treatment cost in uMngeni Basin
(2015-03-04) Rangeti, Innocent; Dzwairo, Bloodless; Barratt, Graham James
The study entailed the determination of key water quality parameters significantly influencing treatment cost in uMngeni Basin. Chemical dosage was used as a substitute for treatment cost as the study indicated that cost, in its monetary value, is influenced by market forces, demand and supply, which are both not directly linked to water quality. Chemical dosage is however, determined by the quality of water and thus provides a clear illustration of the effect of pollution on treatment cost. Three specific objectives were set in an effort to determine key water quality parameters influencing treatment costs in uMngeni Basin. The fourth objective was to develop a model for predicting chemical dosages. The first approach was analysis of temporal and spatial variability of water quality in relation to chemical dosage during production of potable water. The trends were explained in relation to river health status. For this purpose, time-series, box-plot, and the Seasonal-Kendal test were employed. The results showed that the quality of water significantly deteriorated from upstream to downstream in relation to algae, turbidity and Escherichia coli (E. coli). High mean range of E. coli (126-1319 colony count/100mL) and turbidity (2.7-38.7 NTU) observed indicate that the quality of water along the basin is not fit for human consumption as these parameters exceeded the target range stipulated in South Africa’s guidelines for domestic use. For water intended for drinking purpose, turbidity should be below 5 NTU, while zero E. coli count is expect in 100 mL. Among the six sampling stations considered along the uMngeni Basin, three dam outflows (Midmar, Nagle and Inanda) showed an improved quality compared with their respective inflow stations. This was expected and could be attributed to the retention and dilution effects. These natural processes help by providing a self-purification process, which ultimately reduces the treatment cost. While considering the importance of disseminating water quality information to the general public and non-technical stakeholders, the second objective of the study was to develop two water quality indices. These were; (1) Treatability Water Quality Index and (2) River Health Water Quality Index. The Treatability Water Quality Index was developed based on the Canadian Council Minister of Environment Water Quality Index (CCME-WQI). The technique is used to determine fitness of water against a set of assigned water quality resource objectives (guidelines). The calculated Harmonised Water Quality Resource Objectives (HWQRO) were used to compare the qualities of the raw water being abstracted at Nagle and Inanda Dam for the purpose of treatment. The results showed that Nagle Dam, which supplies Durban Heights, is significantly affected by E. coli (42% non-compliance), turbidity (20% non-compliance) and nitrate (18% non-compliance) levels. Wiggins Water Treatment Plant which abstracts from Inanda Dam has a problem of high algae (mean 4499 cell/mL), conductivity (mean 26.21 mS/m) and alkalinity (mean 62.66 mg/L) levels. The River Health Water Quality Index (RHWQI) was developed using the Weighted Geometric Mean (WQM) method. Eight parameters, namely, E. coli, dissolved oxygen, nitrate, ammonia, turbidity, alkalinity, electrical conductivity and pH were selected for indexing. Rating curves were drawn based on the target ranges as stipulated in South Africa’s guidelines for freshwater ecosystems. Five classes were used to describe the overall river health status. The results showed that the water is still acceptable for survival of freshwater animals. A comparison of the RHWQI scores (out of 100) depicted that dam inflow station (MDI(61.6), NDI(74.6) and IDI(63.8)) showed a relatively deteriorated quality as compared with their outflows (MDO(77.8), NDO(74.4) and IDO(80)). The third objective was to employ statistical analysis to determine key water quality parameters influencing chemical dosage at Durban Heights and Wiggins Water Treatment Plants. For each of the two treatment plants, treated water quality data-sets were analysed together with their respective raw water data-set. The rationale was to determine parameters showing concentration change due to treatment. The t-test was used to determine the significance of concentration change on each of the 23 parameters considered. Thereafter, the correlations between water quality parameters and the three chemicals used during treatment (polymer, chlorine and lime) were analysed. The results showed that the concentrations of physical parameters namely, algae, turbidity and total organic carbon at both treatment showed a significant statistical (p<0.05) reduction in concentration (R/Ro<0.95). This results implies that such parameters were key drivers for chemical dosage. From the results of the first three objectives, it is recommended that implementing measures to control physical parameter pollution sources, specifically sewage discharges and rainfall run-off from agricultural lands along the uMngeni Basin should assist in reducing the chemical dosage and ultimately cost. The fourth objective was to develop chemical dosage models for prediction purposes. This was achieved by employing a polynomial non-linear regression function on the XLStat 2014 program. The resultant models showed prediction power (R2) ranging from 0.18 (18%) up to 0.75 (75%). However, the study recommends a comparative study of the developed models with other modelling techniques.
Development and validation of a patient satisfaction monitoring tool for the Durban University of Technology Chiropractic Clinic
(2018) Singh, Ashmindher; Varatharajullu, Desiree; Cruickshank, Gillian
Background Patient perceptions of the value of services and care they obtain at healthcare practices offer healthcare providers and staff important information to effect improvements. Studies have shown a high rate of patient satisfaction of patients receiving chiropractic care. South Africa is distinguished as the only country in Africa to offer training in chiropractic. Currently, only two tertiary establishments in South Africa, the Durban University of Technology and the University of Johannesburg offer a master’s in Chiropractic degree. There is, however, no feedback system currently implemented at the Durban University of Technology Chiropractic day clinic for patients to indicate levels of satisfaction. Patient satisfaction surveys are considered as a means of gathering patients valued opinions on primary health care services that they have received. This study evaluated the patients’ feedback in creating a patient satisfaction survey for use at the DUT CDC on a continual basis. Aim The aim of this study was to develop a valid and reliable patient satisfaction questionnaire, which could easily be used on a routine basis in order to monitor patient satisfaction levels at the DUT CDC in terms of quality of care, accessibility and interpersonal factors. Method This study consisted of three phases. Phase one was a preliminary review of the literature on questionnaire design and conceptual frameworks. Phase two consisted of instrument development, expert group and pilot testing. The development of the instrument and its contents was informed by the review of the literature and questionnaire exemplars from phase one. In this phase, a second questionnaire was developed and trialled with the expert group, as it was used to rate the significance of the questions on the patient satisfaction questionnaire (PSQ); subsequently the PSQ was piloted. Phase three was the handing out of the PSQ and the rating patient satisfaction questionnaire (RPSQ) to patients attending at the DUT CDC. Results The PSQ and RPSQ questionnaires were completed by 400 patients. The patients gave their suggestions as to which statements should be included in the final PSQ. The statements with a majority agreement were included in the final PSQ. The final PSQ was shown to be reliable with Cronbach's Alpha score of 0.93. Conclusion The final PSQ could help to continually monitor patient satisfaction at the DUT CDC. The clinic committee could utilise the feedback to implement or build on quality improvement initiatives, which would assist in demonstrating a commitment to patient-centred care and improve the overall healthcare experience at the DUT CDC.
Development of a disinfection protocol for the public sector Emergency Medical Services in the eThekwini District of KwaZulu-Natal
(2013) Williams-Claassen, Natalee Jean; Sibiya, Maureen Nokuthula; Naguran, Sageshin
Background In the Emergency Medical Services (EMS), paramedics play a vital role in the treatment of critically ill or injured patients, as they are often the first link or point of contact for the patient in the healthcare setting. They may therefore also play a vital role in the prevention and control of the transmission of communicable diseases, provided that proper infection control measures are in place. The objectives of the study There is presently no national policy on communicable diseases and infection control that is specifically designed for use in the South African prehospital environment. Given the paucity of research in the area, qualitative multiple case studies were conducted to develop an ambulance specific disinfection protocol and to evaluate its effectiveness in the public sector EMS in the eThekwini District of KwaZulu-Natal. Methodology The study comprised of three phases. In the first phase focus group discussions were conducted to identify the factors needed to develop a disinfection protocol. The study population consisted of both operational and management staff from the EMS under study. The first four focus groups consisted of eight to ten EMS operational staff each and the fifth focus group consisted of five EMS management staff. Thereafter, the information gathered was used in conjunction with internationally accepted guidelines to develop an ambulance specific disinfection protocol (Phase Two). The third phase entailed the implementation of the protocol at seven ambulance bases in the eThekwini health district and the evaluation of the protocol with the use of an open-ended questionnaire at two weeks and four weeks after implementation. A single ambulance crew and their immediate supervisor from each base were utilized in this phase. Conclusion and recommendations An ambulance specific disinfection protocol was developed and implemented in the EMS under study. During the development, implementation and evaluation of the protocol, many themes with regard to infection control in EMS were identified. These themes were used to better understand the present situation in EMS in relation to infection control and in the formulation of recommendations to assist in the improvement of the present situation. The researcher recommended that all EMS staff require training and education with regard to infection control and prevention. The development and implementation of a protocol and policy document for infection control specifically for EMS is required. There is a need for the deployment of more ambulances and the employment of more operational EMS staff together with the appointment of Infection Control Supervisors at all ambulance bases. Without adequate infrastructure needed to meet infection control and prevention requirements, there may be a serious risk to both staff and the patients they serve.
The development of a framework to retain migrating South African undergraduate Advanced Life Support paramedics
(2010) Govender, Pregalathan; Grainger, Linda D.; Naidoo, Raveen
South Africa currently has 1631 registered Advanced Life Support (ALS) paramedics to tend to the pre-hospital advanced life support needs of just under 50 million people. Compared to the globally accepted ratio of 1:10 000, the number of ALS paramedics in South Africa is grossly inadequate. The current shortage of South African ALS paramedics may be ascribed to migration. However, although literature on health worker migration in general abounds, there is a marked lack of national or international statistics and information on migration of ALS paramedics and their migration. Current measures to manage migration appear to be ineffective. The success of future strategies is dependent on an understanding of the migration of South African ALS paramedics - an understanding that presently does not exist. Purpose The purpose of this study was to describe the migration of South African undergraduate Advanced Life Support paramedics who qualified between 2001 and 2006, and to then develop a framework of retention strategies. In particular, it determined the extent and nature of their migration, identified the factors that have contributed to their decision to work outside South Africa and identified strategies to retain or encourage the return of ALS paramedics to practice exclusively in South Africa. Methods The study consisted of a two-phase mixed method descriptive survey. Paramedics with ALS undergraduate diplomas who qualified in South Africa between 2001 and 2006 made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N=97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n=10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were Page vi integrated to obtain an in-depth understanding of South African ALS paramedic migration. Results Significant differences existed in the distribution of age (p=0.035), and years of experience post-graduation (p=0.007) and the ALS paramedic deemed most likely to migrate were individuals between the ages of 21 – 30. 15 (55%) of the participants working outside the country were engaged in short term contracts while all 24 (100%) of participants working inside South Africa were permanently employed. 18 (75%) of respondents working inside South Africa intended migrating, 12 (67%) of which intended to do so within 0 to 2 years. Nine major factors or reasons for migration were identified by participants. Working conditions, physical security and economic considerations were ranked as the top three major factors most likely to contribute to the decision or intended decision to migrate. This study also found five primary decisions that likely emerge during the life of a South African ALS Paramedic. The outcome of each decision is a result of facilitators weighted against barriers. Facilitators are factors that supported each of the primary decisions while barriers weakened or rejected them. Findings indicated that many barriers existed which rejected or weakened the decision of ALS paramedics to work inside South Africa, return to South Africa or remain in South Africa. On the converse, a vast number of facilitators existed which spurred continued migration. Conclusions As the decision to migrate may be conceptualised as early on as when individuals decide to become ALS paramedics, the constructs of return and retention strategies have to extend as far as revising recruitment policies. Preference or places into training programmes should be given to individuals who are less inclined to migrate, these include: military personnel; those already employed in the EMS, older mature candidates; candidates with families that have already settled in SA; and recognition of prior learning (RPL) candidates who are predominately obligated by contract to remain in South African EMSs.