Theses and dissertations (Health Sciences)
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Item A comparative study of the 14C-Urea Breath Test and histology for the detection of Helicobacter pylori in terms of cost effectiveness and patient acceptability(2001) Peer, Fawzia Ismail; Simjee, A. E.The purpose of this study was to evaluate the Carbon-14 Urea Breath Test e4C-UBT) and histology for the detection of Helicobacter pylori (H pylori) in terms of cost-effectiveness and patient perceptions. It was hypothesized that the 14C_UBTwas more cost-effective and more easily tolerated than a histological analysis of a biopsy specimen obtained on endoscopy for H pylori detectionItem The efficacy of genesen acutouch pointers in the treatment of osteoarthritis of the knee(2001) Robertson, Brendon Ian; White, Horace LindsayThe purpose of this study was to determine the efficacy of Genesen Acutouch pointers in the treatment of osteoarthritis of the knee. This was a prospective, randomized clinical trial consisting of sixty patients who volunteered from the general population of Durban. The patients, diagnosed as having osteoarthritis of the knee, were randomly divided into two different treatment groups. Each group consisted of thirty patients between the ages of eighteen and eighty five years. One group received active Genesen Acutouch Therapy, while the second group received placebo Genesen Acutouch Therapy. Data capturing took place for both groups on the first, fifth and ninth consultations. Subjective data was collected using the Numerical Pain Rating Scale-l Ol, the Visual Analogue Scale and the Patient Specific Functional Scale. Objective data was gathered from goniometer and algometer readings. For statistical analysis, only parametric tests were used in all hypothesis tests due to the large sample size. All readings were considered to be continuous variables. The twosample (unpaired) two-tailed t-test was used to compare two independent samples. The two-sample paired t-test was used to compare results from related samples. All tests were conducted at a = 0.05 level of significanceItem The relative effectiveness of a single dry needle insertion compared to multiple fanning dry needle insertions in the treatment of myofasciitis in the cervical and upper thoracic spine(2001) Rowley, Neil Charles; Mathews, RobertMyofascial Pain Syndrome (MPS) is a clinical syndrome of soft tissue pain arising from skeletal muscle. It is manifested by characteristic trigger points (TrPs) in palpable taut bands of muscle fibres with typical referred pain patterns, restricted range of motion and local twitch responses. Treatment of MPS appears to be aimed at disrupting the reverberating neural circuits responsible for the self-perpetuation of the pain-spasm pain cycle. This occurs through inactivating the active TrP through releasing the taut bands with various techniques including massage, ischaemie compression, spray and stretch, ultrasound, hydrocollator moist heat, trigger point injection, dry needling, and TENS. There are many treatments available yet little research substantiating efficiency of one specific therapy over another, with the result that choice of treatment often becomes based on personal preferences rather than clinical evidence. Among many authors, dry needling has been shown to be an effective form of treatment. The therapeutic effect of dry needling relies on the mechanical disruption or direct stimulation of the TrP and that the strongest analgesic effect is achieved when the most painful spot is precisely reached with a fme needle, normally an acupuncture needle. This immediate analgesia produced by needle puncture of a TrP has been termed theItem An evaluation of the effectiveness of the sonogram and the clinical determination of the arterio-venous fistula site in the diabetic population entering the chronic haemodialysis program(2013) Ramnarain, Rakhee; Haffejee, A. A.; Adam, Jamila KhatoonDiabetic nephropathy is a serious complication of diabetes that can lead to end stage renal failure (ESRF). It is now the most common cause of ESRF in patients accepted onto renal replacement therapy (RRT) programmes. Kidney disease is common in South Africa. 60-65% is due to inherited hypertension and 20-25% due to Type 2 diabetes (National Kidney Foundation of South Africa, 2002). The renal replacement therapies include haemodialysis, peritoneal dialysis and transplantation. Successful long-term haemodialysis in patients with end stage renal disease (ESRD) depends to a large extent upon a trouble- free vascular access. Achieving a successful vascular access remains a challenge especially in the diabetic population. Current Kidney Dialysis Outcome Quality Initiative (KDOQI) guidelines encourage placing Arterio-Venous Fistula (AVF) in more haemodialysis patients. While the upper limb is the preferred site for AVF creation, researchers are undecided on which is the ideal location (distal or proximal arm) in the diabetic population. Many new fistulae fail to mature sufficiently to be usable for haemodialysis. Pre-insertion work-up with regard to haemodialysis access is important in maintaining the most appropriate access in the growing diabetic population requiring haemodialysis. Pre-operative vascular mapping to identify suitable vessels has been reported to improve vascular access outcomes . In South Africa, duplex scanning is not routinely done, and a clinical judgement by the surgeon remains in most instances the deciding factor on the site of the AVF. Whilst conducting this research, it has been found that while diabetic patients may have AVF created, the maturation time is of a much extended period, and a challenge to achieve the desired dose of dialysis. This is a prospective, quantitative and qualitative study of 21 diabetic patients. These included patients that were starting on the chronic haemodialysis program and limited to patients that were having first attempt of AVF creation and aims to establish if sonogram testing provides a more accurate measure of the ideal location for the AVF, or if a clinical evaluation alone by the surgeon is sufficient. Surgical techniques are different amongst surgeons and clinical evaluation is more a subjective decision. By limiting the surgeons performing the AVF, a standardized surgical procedure was established. If an ideal AVF access for the patient is created, haemodialysis efficiency is increased and ultimately patient outcome improved. The AVF was created according to the clinical evaluation as is the current process, and the surgeons were not aware of the duplex sonogram results. Failure and success of AVF were analysed according to primary patency and functional success. A primary patency success of the AVF does not guarantee functional success. If an AVF is not able to complete an entire haemodialysis session trouble free at the prescribed dialysis dose, the AVF is considered a failure irrespective of primary patency success. This was evident with 10% of patients who had primary patency but functional success was not achieved. With a 55% functional success in this study with AVF created on clinical evaluation, there was no significance difference (p=0.795) if AVFs were based on duplex sonogram findings. However, there was evidence of increased AVF success in 33% of the failed AVFs when the new AVFs were created at the duplex sonogram site. 95% of patients in this study had commenced haemodialysis with a Central Venous Catheter (CVC). AVF success could be increased if early referral of diabetic patients for permanent access to the surgeon occurred. Maturation rate of AVF differed from KDOQI guidelines with AVF first cannulation only after 17 weeks, and not after the recommended time of 6 weeks. Blood flow rates on dialysis also varied with international standards, with only maximum of 400mls/min reached after one year. With distal arm AVF, diameter of radial artery of less than 2mm and cephalic vein less than 3mm was associated with AVF failure. This research study represents the first of its kind in Kwazulu Natal looking at vascular access sites in diabetic patients with End Stage Renal Disease on haemodialysis.Item The effect of bra size correction on selected postural parameter(2015) Mthabela, Nosipho PearlIntroduction: Symptoms associated with large breasts result from bra strap chafing, poor body posture, headaches, neck, shoulder, thoracic and lower back pain. There is a paucity of literature quantifying objective data regarding the effect of breast size on posture. Therefore correct bra sizing may improve posture, however this is undetermined. This study aimed to investigate the effect of bra correction on selected postural parameters in order to determine its relevance in a clinical setting. Methodology: Sixty five females who met the inclusion criteria had the following parameters recorded: age, height, weight, body mass index, occupation, and underbust and overbust bra size. An anterior-posterior, right and left lateral digital photographs were taken before and after bra correction. These were then processed using the Posture Pro software. The data was analysed using the latest version of SPSS. The results were presented by means of standard deviations and ranges and differences between pre and post measures were performed with an ANOVA. Results: It was found that there was no correlation between changes in any of the four parameters from pre to post correction, which changed significantly with postural correction (4/43 post correction significant readings) and the demographic variables. Most participants changed to a larger cup sizes after correction which is in line with Greenbaum, (2003) who found that participants tend to buy a smaller bra size. In this study 3% of the study population changed to a bigger cup size and 97% wore bras that were too tight. Similar to the findings of Wood eta/., (2008) who found that 70% of the study population wore bras that are too small and 10% wore bras that were too big. Conclusion: In the study on effect of incorrect bra size on selected postural parameters it was found the there were four parameters that changed significantly with pItem Assessment of respiratory risks associated with exposure to particulate matter (PM2.5) in informal waste pickers in a landfill site in KwaZulu-Natal(2015) Dalasile, Monica Ntombohlanga; Gumede, Phiwayinkosi; Reddy, PoovendhreeIntroduction Informal waste picking has both economic and environmental benefits, however there are many health risks associated with this activity. This cross sectional descriptive study assessed the respiratory health risks and dust (PM2.5) exposure among informal waste pickers operating at the New England landfill site in the Msunduzi Municipality. Data was collected from 102 informal waste pickers using a validated questionnaire adapted from the British Medical Research Council and American Thoracic Society. Our study population comprised of 66.4°/o women with a mean age of 36.7 years. Women reported greater use of safety shoes and gloves compared to men. Very few participants used dust masks or respirators. Results showed a high prevalence of chronic cough (57o/o), wheeze (51°/o) shortness of breath (31.6°/o) and cough with phlegm (29.0°/o) among all participants. Among those who reported having ever smoked, there was a significantly higher prevalence of cough with phlegm (45.2°/o p=0.02) and wheeze (73.1°/o, p= 0.05). Similarly, there was a bivariate association between current smoking and wheeze (p=0.02) and between ever smoked and wheeze {p< 0.05). A random sample of 28 waste pickers was chosen from the 102 participants for personal sampling. The levels and distribution of time weighted average to PM2.5 were calculated during an 8 hour working period. Average personal sampling levels of PM2.5 were very high compared to environmental levels. Personal sampling results showed a maximum exposure of 431 J.,Jg/m 3 and a mean of 187.4 J.,Jg/m 3 compared to a maximum level of 27.9 J.,Jg/m 3 and a mean of 16.5 J.,Jg/m 3 for environmental sampling. Mean personal sampling results significantly exceeded recommended eight hour time weighted average for South African National Standard for Occupational Exposure Limit (Republic of South Africa OHS ACT 85 of 1993), World Health Organisation and United State Environmental Protection Agency guidelines for PM2.5, while the environmental mean was within guidelines. This study showed that waste pickers are exposed to high levels of PM2.5 while working at the landfill site. Limited or no use of personal protective equipment increases risk of dust exposure and adverse respiratory effects. The relatively high prevalence of cough, shortness of breath and wheeze symptoms among these informal waste pickers may be linked to exposure to dust at the landfill siteItem The perception, knowledge and utilisation of research and its role in the chiropractic profession as determined by chiropractors attending the World Federation of Chiropractic biennial conference 2013(2015) d'Hotman de Villiers, Jason; O'Connor, LauraBackground The Chiropractic profession is considered a form of complementary and alternative therapy which began as a vitalistic approach to health care. Over the years research has become a main focus of the profession in order to validate its claims for its treatment modalities, with the profession having made advances in producing high quality research (Newell and Cunliffe, 2003). In an era of evidenced based practice medical professionals are required to use research findings to guide their practice therefore their perceptions towards using research are important to ascertain. Although there is some literature on Chiropractors' perception of research most studies focus on specific regional populations. Very few if any studies have assessed perceptions of research from different Chiropractic populations at the same time. The aim of this study was to determine the perception, knowledge and utilisation of research and its role in the Chiropractic profession as determined by Chiropractic delegates attending an international Chiropractic conference. In order to provide information to the profession as to how Chiropractors from varying regions perceive research and to see if the shift seen in other health care professions towards evidence based practice is seen in the chiropractic profession. Method This quantitative, cross sectional, descriptive survey was administered to Chiropractic delegates attending the World Federation of Chiropractic biennial conference 2013 in Durban, South Africa. The questionnaire was compiled by using the available literature and validated by means of a focus group and pilot testing. The questionnaire was administered to the delegates as part of their delegate packs at the conference and was made available electronically via SurveyMonkey© after the conference. Participants were required to give written informed consent prior to partaking in the research. The research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 26/13). On completion the questionnaire and the signed letter of information and consent were deposited into separate sealed containers at the conference or stored on SurveyMonkey© . When the study closed, data was coded into an excel spread sheet and imported into IBM SPSS version 21 for statistical analysis. Descriptive and inferential statistics were used to analyse the data Results A response rate of 34.48% (n = 140) was obtained. More than half of the respondents were male (52.2%), from the African region (51.1%), in possession of a master's degree in Chiropractic (51.4%), and were involved in professional chiropractic practice (60.7%). The respondents had a favourable perception towards research (51.4%), with almost all respondents perceiving that research was essential to the progression of the Chiropractic profession (97.5%). A more favourable perception of research was found in those who were from Europe as opposed to Africa (p = 0.001) and had an evidence based practice (EBP) philosophical orientation as opposed to a mixer or straight approach (p < 0.001). Overall the respondents displayed an adequate knowledge of research terminology (59.2%), with those from Europe as opposed to Africa (p = 0.001) having improved research knowledge along with those who had an EBP philosophical orientation (p < 0.001) compared to the straights and mixer approaches. In terms of research utilisation the respondents showed a high utilisation of research to improve clinical practice (88.9%), for self-development (90.1%) and to change their approach to conditions, polices and practice in their area of the Chiropractic profession (83%). There was a trend that being from Europe, North America and Australisia resulted in high research utilisation than those from Africa and Asia. The effectiveness of Chiropractic care for various musculoskeletal conditions was seen as the primary research focus area for the profession (95.1%), with 75% of the respondents wanting the profession to move in the direction of science as opposed to a philosophical focus. The respondents perceived research to play an integral role within Chiropractic by promoting its acceptance among other health care professionals (87%) and by third party payers (70%). Conclusion The respondents in this study had a favourable perception, knowledge and utilisation of research and supported the role of research and science in the future of the Chiropractic profession. Future studies should be conducted on more diverse groups of Chiropractors to see if the findings of this study are replicated, as well as investigate the disparity observed between developed and developing countries.Item Experiences of first-year student nurses nursing HIV and AIDS patients in the Umgungundlovu District(2015) Reddy, Noelene Belinda; Razak, AyishaAbstract The HIV pandemic continues to intensify in most countries, especially in Sub Saharan Africa, with 1.8 million new people becoming infected with the disease in 2011. Sub- Saharan Africa is the world's worst HIV and AIDS affected region. The intensity of the AIDS pandemic in South Africa creates additional challenges for health workers. Apart from the fact that they could be infected, they have to deal with an increasing number of people who suffer from a fatal disease for which no cure has been found. Nurses are expected to give all the necessary care to these patients. The HIV and AIDS epidemic in South Africa poses challenges for an overburdened health care system. There is limited knowledge about health care perceptions and emotional experiences of providing HIV and AIDS related care and support. It is against this backdrop that the researcher has chosen to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. Aim of the study The purpose of the study was to explore the lived experiences of first-year student nurses, nursing HIV and AIDS patients. Methodology A descriptive phenomenological research design was used to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. The research setting was two colleges of nursing in the uMgungundlovu District that offer the four-year nursing diploma programme. The type of purposeful sampling that was used was criterion sampling, which entailed studying cases which met pre-set criteria. In-depth interviews with the first-year student nurses, who had experienced nursing HIV and AIDS patients, were conducted. The data was analysed manually and put into categories and sub-categories as they emerged. Results The findings revealed that the participants had positive and negative experiences when they provided nursing care to HIV positive patients. The positive experiences were that the participants did not fear meeting HIV positive patients and they were not traumatized. These participants nursed HIV positive patients like any other patient. The participants expressed their feelings as sad and bad. Participants who had negative experiences were shocked, scared and cried when they met HIV positive patients. Six participants reported that they did not know of any facilities available for debriefing and sharing of experiences. The remaining participants identified the group lecturer, group mates, the psychologist and registered nurse in the ward. There was a lesson in class that was dedicated to debriefing and the sharing of experiences. The majority of the participants (n=10) stated that HIV and AIDS was transmitted through contact with infected body fluids and blood. The participants identified similar methods of transmission, which were unprotected sexual intercourse, needle-stick injuries, use of contaminated needles and mother- to- child transmission of HIV and AIDS. The participants were able to correctly identify the modes of transmission, except for one participant who was not sure if HIV and AIDS was transmitted through breast-feeding, due to a lack of knowledge of the modes of transmission. Six participants identified voluntary counselling and testing (VCT) as a support service available for nurses exposed to HIV and AIDS. Three participants verbalised that they did not know of any services available to student nurses. Some participants were not sure if the services were available and accessible and had no idea if the services were available and accessible to the student nurses. There were various problems that were encountered by the participants with regards to accessing the services. These included a lack of privacy, fear of giving information to colleagues, early closure of the clinic and unavailability of the counsellor when needed. Recommendations were made concerning the need for adequate preparation of student nurses in their early training, with regard to VCT, PMTCT, home- based care and support groups. The stigma for HIV and AIDS needs to be adequately addressed. Support for student nurses needs to be provided when dealing with death of HIV and AIDS patients, as a large majority voiced not being able to cope. Conclusion Student nurses who shared their experiences nursing HIV and AIDS patients had positive and negative experiences when they provided nursing care to HIV positive patients. The participants needed the relevant support and counselling to be available when needed. Stigma still exists, even though HIV and AIDS has existed for at least thirty years.