Faculty of Health Sciences

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An assessment of the implementation of the provincial cervical screening programme in selected primary health care clinics in the Ilembe region, KwaZulu-Natal
(2002) Sibiya, Maureen Nokuthula; Grainger, Linda D.
Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme.
An assessment of the Somatology extended curriculum programme at the Durban University of Technology
(2019-09-05) Makgobole, Mokgadi Ursula; Bass, Gregory Hylton; Puckree, Lina
Since the beginning of democracy in South Africa post 1994, the debate in South African Higher Education has progressed from, initially, increasing disadvantaged student access to higher education to improving student success and improving throughout rates and high attrition amongst the previously disadvantaged students. In order to increase access of students from disadvantaged educational backgrounds and improve success in higher education, institutions have introduced additional programmes such as Extended Curriculum Programmes (ECP). The ECP is an alternative curriculum structure that creates the space needed to equip underprepared students with skills to assist them to succeed in higher education. The Somatology programme at the Durban University of Technology (DUT) introduced the ECP in 2005. However, there is limited published research on the impact of the ECP in the Somatology programme since its inception. Using a mixed convergent parallel design, and following a post-positivist paradigm, this dissertation aimed to assess the impact of the Somatology ECP on students’ throughput, success and dropout rates and to understand the general satisfaction of the students placed in the ECP with being placed in the ECP. In order to establish quantitative data, a retrospective analysis of the student records of all students that had been registered at the Somatology programme at the Durban University of Technology for the period 2005 to 2013 was sourced from DUT’s Institutional Management Information System (MIS). The throughput and dropout rates were analysed using descriptive statistics, ANOVA, and t-test. The data obtained is valid as access to the MIS system is restricted and only authorised DUT staff have access to MIS data. In contrast, the qualitative phase prospectively focus on students who graduated from the Somatology programme via the ECP. A simple random sampling technique was used to select a total of 15 participants who were interviewed using semi-structured interviews. The qualitative data generated was analysed using thematic content analysis. The quantitative analysis found that there was a marked improvement in the throughput rate of students who enrolled via the ECP programme. However, no significant difference was recorded in the throughput (P>0.05) and dropout rates (P>0.05) of the ECP when compared with the mainstream cohort (P>0.05) over the period under study. In addition, the overall success rate of the ECP cohort were comparable to that of the mainstream (P>0.05) showing that the interventions delivered on the ECP were successful for students entering the Somatology programme considered underprepared for higher education. In probing the factors that had influenced the improved throughput rate, a key finding from the qualitative analyses was that participating students attributed their ultimate success to the additional interventions given in the ECP. The ECP students felt they were at an advantage when it came to assessments compared to mainstream. In light of the study findings, this dissertation found that the Somatology ECP was a successful programme as there was an improvement in the academic success of the students in terms of their throughput and dropout rates of the cohort studied.
Causes and effect of student nurses absenteeism at the KwaZulu-Natal College of Nursing
(2015-05) Singh, Pratima; Sibiya, Maureen Nokuthula
INTRODUCTION A four-year diploma nursing programme undertaken by the KwaZulu-Natal College of Nursing provides training to students to become professional nurses. However, it has been noted that absenteeism of student nurses enrolled in this programme has increased. Absenteeism could result in demotion, extension of training or termination of students from the programme. This would result in fewer student nurses completing training and therefore a shortage of professional nurses. AIM OF THE STUDY The aim of the study was to determine the causes and effects of absenteeism amongst student nurses that are currently registered for a four-year diploma programme (R425) in the KwaZulu-Natal College of Nursing (KZNCN). METHODOLOGY A quantitative method was used, which comprised two phases, namely, data collection through the use of a self-administered questionnaire and a retrospective record review. Simple random sampling was used to select students from the peri-urban Midlands and rural uGu districts. Stratified random sampling of 301 student nurses at different levels of training from the three campuses was done. A total of 301 questionnaires were distributed to participants; all were returned, resulting in a 100% response rate. During a retrospective record review student records were examined to assess clinical and theoretical performance of students. Statistical analysis was done using the SPSS version 22.0. RESULTS The results of the study revealed that students experienced problems in the clinical/practical areas that resulted in them absenting themselves. There were 14 terminations of training due to absenteeism. Student nurses who did not absent themselves obtained entry to the examination, whilst students with excessive absenteeism did not obtain entry to the examination.
Cervical cancer screening among University students in South Africa : a theory based study
(PLOS, 2014-11) Hoque, Muhammad Ehsanu; Ghuman, Shanaz; Coopoosmay, Roger; Hal, Guido Van
Introduction: Cervical cancer is a serious public health problem in South Africa. Even though the screening is free in health facilities in South Africa, the Pap smear uptake is very low. The objective of the study is to investigate the knowledge and beliefs of female university students in South Africa. Methods: A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, and screening history. Results: A total of 440 students completed the questionnaire. The average age of the participants was 20.39 years (SD = 1.71 years). Regarding cervical cancer, 55.2% (n = 243) had ever heard about it. Results indicated that only 15% (22/147) of the students who had ever had sex and had heard about cervical cancer had taken a Pap test. Pearson correlation analysis showed that cervical cancer knowledge had a significantly negative relationship with barriers to cervical cancer screening. Susceptibility and seriousness score were significantly moderately correlated with benefit and motivation score as well as barrier score. Self-efficacy score also had a moderate correlation with benefit and motivation score. Students who had had a Pap test showed a significantly lower score in barriers to being screened compared to students who had not had a Pap test. Conclusion: This study showed that educated women in South Africa lack complete information on cervical cancer. Students who had had a Pap test had significantly lower barriers to cervical cancer screening than those students who had not had a Pap test.
Chiropractic and public health : a study on the perceptions and attitudes of chiropractors on health promotion and disease prevention in South Africa
(2014-04-08) Ford, Timothy William; Korporaal, Charmaine Maria
Background: Considering the quadruple burden of disease and chronic shortages of health care professionals in South Africa, the stance of the chiropractic profession on public health (PH) matters has not been established. Therefore, this study aimed to determine the attitudes and perceptions of chiropractors practicing in South Africa on PH, health promotion (HP) and disease prevention (DP). The objectives were to determine demographic profile, lifestyle practices and attitudes and perceptions of practicing chiropractors in South Africa regarding PH agencies, HP and DP. Methods: An IRB approved quantitative survey (electronic and postal) was used to collect data from a total sample of practicing chiropractors in South Africa (meeting inclusion criteria). Follow up email and telephone calls were made to encourage response from participants. After a 17 - week period, returned questionnaires were collected and data analysed. Results: A response rate of 45% was obtained. Of the participants, 51.7% were female, 60.3% practiced in upper – middle income communities and 66.4% perceived themselves as neuro - musculoskeletal specialists. Over 90% of practitioners regularly counselled patients on postural habits, injury prevention and ergonomic risk reduction. Where as 35.1% agreed to counselling patients on STI / HIV prevention, tobacco cessation and related risks (41.4%), alcohol abuse (53.4%) and cancer prevention (56.9%). Regarding evidence – based practice (EBP) and PH agencies, 39.1% could not identify the statistical significance of the p value and 46% were unable to provide examples to journals they used to inform best practice. Similarly, 59% of the participants could not identify PH agencies to refer to for information on smoking cessation / risks or PH agencies to refer patients on HIV (57%), notifiable diseases (59%) and terminal illnesses (45%). Conclusion: The results suggest that chiropractors from this study were proficient on topics of DP, but were reletively less proficient in regards to PH, HP and EBP. It was recommended that further research be done regarding EBP within the profession and that greater emphasis be placed on topics of HP and PH in chiropractic training programmes.
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.
A clinical audit of the implementation of the tuberculosis screening tool amongst clients who are on anti-retroviral therapy in the eThekwini local municipality clinics
(2014-10-08) Munsamy, Michelle; Botha, Izel
Background : Tuberculosis (TB) is a global public health concern and is identified as the leading cause of morbidity and mortality in the population infected with Human Immune Deficiency Virus (HIV). South Africa (SA), particularly the KwaZulu-Natal Province, is burdened with persistently high rates of both TB and HIV infections. In an attempt to improve TB and HIV co-infection outcomes the South African health care system has adopted the World Health Organisation (WHO) guidelines for intensified TB case findings in all HIV positive individuals for regular screening of TB symptoms in order to promptly diagnose and treat active TB disease or to exclude TB for initiation Isoniazid Prophylactic Therapy (IPT). IPT has proven effective in preventing TB disease in People Living with HIV or AIDS (PLWHA). This critical first step of TB symptom screening is regarded as the intervention that could significantly reduce the challenge currently faced with TB-HIV co-infection. The study was conducted in selected eThekwini Municipality Primary Health Care (PHC) facilities with the focus on an investigation to determine the extent of the implementation of the TB symptom screening tool in HIV infected individuals, in addition to identifying treatment initiation or further investigations based on the tool implementation. It has been found during the literature review, that there is a lack of research in SA to show that this critical first step in TB identification has been investigated, yet one in six South African’s is HIV positive and the incidence of TB-HIV co-infection is not declining. Methodology : A quantitative, descriptive approach was utilised to conduct a retrospective patient chart review. A multistage cluster sampling technique comprising three stages was implemented to identify the sample. There was a random selection of clinics, and the required number of client records was obtained through convenience sampling from the selected clinics. Results : The findings of this study revealed there is inadequate implementation of the current national and provincial TB protocols. The study provides varied levels of information about TB symptom screening in HIV infected individuals in the PHC clinics of eThekwini Municipality. It was observed that Health Care Worker’s (HCW) in some facilities carried out TB symptom screening to an extent. However, the inconsistent and partial application of this screening tool warrants improvement to facilitate the broad success of TB-HIV care strategies.
Clinical outcomes associated with intradialytic food ingestion in patients undergoing high volume online haemodiafiltration
(2021-05-27) Nundlal, Archal; Memela, Mduduzi E.; Jamila K., Adam
Introduction: The quality of haemodialysis (HD) treatment received by chronic renal failure patients is important for their overall well-being. Adequate HD improves patients quality of life, minimizes disease complications and hospitalizations. Dialysis inadequacy over a prolonged period exacerbates pre-existing conditions, increases morbidity and mortality, deteriorates patients health leading to a poor quality of life. Mitigating factors that may contribute to dialysis inadequacy is important for optimizing patient care and achieving good clinical outcomes. Dialysis centres often provide meals for patients while receiving their treatment. The aim of the study was to evaluate whether intradialytic food intake may affect dialysis adequacy in patients undergoing online haemodiafiltration (OL-HDF). In the present study Single- pool Kt/V and urea reduction ratio (URR) were the measurements of molecular clearance utilized to measure dialysis adequacy. Methodology: The study was conducted at Fresenius medical care dialysis clinics on adult patients undergoing OL-HDF treatment. Consent was obtained from the patients. Adequacy of dialysis was assessed using SpKt/V and URR. Patients underwent sampling of pre-dialysis and post-dialysis urea for the calculation of URR and SpKt/V was obtained from OCM® feature on the 5008s haemodialysis machine. The sampling was done on two consecutive mid-week treatments with and without food ingestion. The principal investigator also recorded MAP at 30 minute intervals for the assessment of post-prandial hypotension and pre- and post-Hgt for blood glucose stability during sessions with and without food ingestion. Results: Fifty-two adult chronic renal failure patients were enrolled into the study. Twenty-four were males and twenty 28 females. The two groups of participants included the AV-Fistula group which consisted of 38 participants (73.1%) and the Permanent catheter group 14 participants (26.9 %). The total sample was made of African, Indians and Whites. There were 21 Africans, 30 Indians and 1 White. The age distribution for AV-Fistula group was 55.29±8.45years (Mean±SD) and for Permanent catheter group was 56.86±10.35years. The mean URR with food ingestion 70.9±9.93 (p = 0.918) and without food ingestion 70.9±7.41 (p = 0.508). The mean spKt/V with food ingestion was 1.26±0.29 (p = 0.599) and without food ingestion 1.26±0.30 (p = 0.788). During sessions without food ingestion 13.5% of the patients were recorded to have hypotensive episodes and 86.5% did not experience hypotensive episodes. During sessions with food ingestion 38.5% patients were recorded to experience hypotensive episodes and 61.5% did not experience hypotensive episodes. There was a significant difference in the number of patients who did not have a hypotensive episode compared to those who did (p < 0.001). There wereno participants classified with hypoglycaemia as all of the minimum values were greater than 4.0mmol/L. The Mean±SD with food ingestion pre-dialysis was 9.12±4.93, post-dialysis 8.39±2.56. The Mean±SD without food ingestion predialysis was 9.39±4.38 and post-dialysis was 7.22±2.26. Discussion: The spKt/V and URR values for both the AV-Fistula and Permanent catheter groups were in optimal range as recommended by the KDOQI guidelines. There was no significant difference in the spKt/V and URR values achieved from the OL-HDF sessions with and without intradialytic food ingestion. Intradialytic food ingestion did not negatively impact dialysis adequacy, although it was noted that during sessions of food ingestion more patients did experience post-prandial hypotension as compared to without food ingestion and post-dialysis blood glucose levels were lower during sessions without food ingestion as compared to with food ingestion, there was no significant difference in these variables. Conclusion: Intradialytic food ingestion is recommended for patients undergoing OLHDF treatment. Patients that suffer severe malnutrition and low albumin levels should be considered to be treated with OL-HDF treatment and intradialytic feeding should introduced. This may contribute in an increase in quality of life in patients with CKD
Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
(National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
A comparison of mobilisation and exercise in the treatment of chronic non-specific neck pain
(2014-04-08) Meyer, Elsje Maria; Boodhoo, Vilash; Korporaal, Charmaine Maria
Background : Chronic non-specific neck pain is a common condition that negatively affects cervical muscle functioning and activities of daily living. Combined exercise and mobilisation are currently recommended as the most effective treatment for this condition. Mobilisation, such as mobilisation of the cervical spine, provides short-term pain relief and affects neural activity, while the craniocervical flexion exercise provides immediate pain relief and activates the deep cervical flexors. The short-term effect of mobilisation and the craniocervical flexion exercise have not been compared. Objectives : This study aimed to compare mobilisation and craniocervical flexion exercise in terms of subjective and objective outcome measures at a short-term follow-up consultation for the treatment of chronic non-specific neck pain. The null-hypothesis was that the mobilisation group would not respond differently to the craniocervical flexion exercise group. Method : A group of thirty females between the ages of 20 and 35 complaining of non-specific neck pain for more than three months were randomly allocated into either the mobilisation or craniocervical flexion exercise groups. During the first two consultations, a mobilisation was administered to the mobilisation group. Whereas the craniocervical flexion exercise and a posture correcting exercise were taught to the participants of the craniocervical flexion exercise group. The Numerical Pain Rating Scale, Neck Disability Index, Neck Bournemouth Questionnaire, cervical range of motion and algometer readings were taken at each of the three consultations. The Patient Global Impression of Change Scale was administered at the last consultation one week after the first consultation. Results : Both the mobilisation and craniocervical flexion exercise groups showed significant improvements in all of the subjective outcomes. The Neck Disability Index score of the craniocervical flexion exercise group was the only subjective outcome that did not decrease enough to be considered clinically significant. The PGIC score of the mobilisation group was slightly higher than that of the craniocervical flexion exercise group. There was no statistically significant improvement in the objective outcomes of either group. All ranges of motion decreased in both groups, while pain pressure threshold improved in both groups. There was no significant difference between the results of the subjective and objective outcomes of the mobilisation and craniocervical flexion exercise groups. Conclusions and recommendations : The two interventions were found to have a similar effect in the treatment of chronic non-specific neck pain in terms of subjective and objective outcome measures. Participants of both groups indicated on the subjective scales that their conditions improved, even though objective outcomes showed no significant change. In future studies, a larger sample size should be used and the sample should be stratified for ethnicity to increase validity of the results.
A comparison of symptoms derived from a C4 trituration and the materia medica of an existing, well-proven homoeopathic remedy
(2011) Goote, Chryso; Botha, Izel
C4 trituration provings are a somewhat controversial method of uncovering the therapeutic value of homoeopathic remedies. The key advantage of this method over traditional proving methods is that a substance can be proved in a matter of hours, rather than weeks or months. However there is a lack of research to show whether the results of the two methods are comparable. AIM The aim of this study is to establish whether symptoms elicited in a C4 trituration proving are comparable to symptoms produced in traditional provings of the same substance. If a similarity can be demonstrated – even on a single substance – it may encourage further studies to determine the extent to which C4 provings can be used in association with, or instead of, traditional provings as a means of developing homoeopathic remedies. METHOD Ten triturators were recruited from an existing group of experienced triturators to prove an unknown substance. Data were harvested from debriefing sessions and from notes kept by triturators during the sessions, and these were transcribed and converted to rubrics. An unprejudiced repertorisation was undertaken in an (unsuccessful) attempt to identify the substance before unblinding. After the substance was revealed to be Borax, the rubrics from the C4 proving were statistically compared to rubrics associated with Borax in Radar 9.0, the electronic version of the repertory Synthesis: Repertorium Homoeopathicum Syntheticum (2004), which reflects traditional provings of this substance. The statistical comparison of rubrics was performed in SPSS; a Pearson Chi-Square test was applied to establish statistical significance; and a Cramer's V test was used to determine the strength of that association. RESULT The comparison failed to find a significant correlation between the rubrics from the C4 proving of Borax and traditional provings of the same substance. At a chapter level, there were significant associations between symptoms relating to Hearing and Kidneys but, for reasons discussed at length in the report, these results must be treated with circumspection. CONCLUSION While C4 provings are faster than the traditional method, as refined by Sherr, in view of the above findings it cannot be recommended that C4 provings be considered as a means of developing homoeopathic remedies instead of traditional provings, because C4 provings would not produce a complete symptom picture. RECOMMENDATIONS Recommendations arising from the study include that the exercise should be repeated with a different substance and group of provers, preferably with confidential debriefing of participants (as opposed to group debriefing, which is the norm for C4 provings), to verify these findings.
Comparitive study on the combination of Nigella Sativa with micro-needling for post-acne scarring
(2020-06-10) Jacobs, Moeneeba; Oguntibeju, Oluwafemi; Nkwanyana, Sinegugu
Acne is one of the leading skin disorders resulting in a debilitating physical appearance and psychological distress. Studies have shown that acne, and acne scarring are more common amongst women (76%) than men (24%). The need for acne scarring treatments is ever-rising. Post-acne scarring is a common, permanent, distressing, disfiguring skin disorder, which results from poor healing of active acne vulgaris. Post-acne scarring usually persists for a long time, even after the acne lesions have disappeared, due to its disfigurement leading to visible scarring, and post inflammatory hyperpigmentation. Acne scarring is more than a cosmetic concern, but rather, a medical problem, as it causes psychological problems. The growing interest in the use of botanical ingredients in modern aesthetics has grown phenomenally. This trend had led the researcher to using micro-needling in combination with oil from medicinal plant (Nigella sativa), with the aim of providing further insight in the growing interest and use of botanical ingredients. The aim of the study was to determine whether Nigella sativa, along with microneedling, would provide better results when compared to micro-needling alone. The addition of the botanical oil was used in order to act as a synergist for micro-needling by improving post-acne scarring. Thi study employed quantitative research approach with qualitative elements, making use of purposive sampling. A total of 50 female participants with post-acne scarring were recruited into the study, however only 42 completed the study. Participants were consulted and a participant demographic information sheet, post acne scarring grading scale and photographic images were taken at baseline with the Visia Skin Complexion Analyser®. The participant’s pain intensity scale, information sheet and satisfaction survey provided descriptive data. Data saturation was achieved after analysis of the results. The results that emerged from the study indicated an improvement in both the control and experimental group. The results of this study provided valuable insight into the use of botanical oils, combined with micro-needling. It is important to note that there is lack of research in South Africa in this area, especially on males, as studies have indicated that men have exhibited the same effects as females in relation to scarring. Results from the study indicated improvement in both the control and experimental group, however a significant improvement in scarring along with post-inflammatory hyperpigmentation was observed within the experimental group. This is indicative of the fact that the addition of the Nigella sativa oil helped to elicit a significant improvement, when combined with micro-needling. What further emerged from the study was the importance and use of a quality of life questionnaire, particularly in post-acne scarring, as limited research and studies exist. It is important to monitor acne, especially within a clinical setting
Complementary therapy in atopic eczema: the latest systematic reviews
(Taylor and Francis, 2014) Thandar, Yasmeen; Botha, Julia; Mosam, Anisa
Complementary and alternative medicines (CAM) are widely used for atopic eczema (AE) with user estimates as high as 63%. Despite the availability of effective conventional therapies, the chronic nature of AE and concerns about long-term steroid use lead many patients to seek alternative treatment. Evidence of the efficacy of these alternative therapies is inconsistent and available published data have shortcomings, making it difficult for clinicians to assess their role, if any, in management. To assess the evidence, systematic reviews of controlled studies have been undertaken for Chinese herbal medicines, homeopathy, evening primrose oil, borage oil, probiotics and certain dietary supplements. This overview summarises the findings from the most recent systematic reviews. Taken together, none of the alternative therapies evaluated demonstrated obvious and indisputable evidence of efficacy. Further studies are warranted with some therapies (Chinese herbal medicines, certain probiotic strains and fish oil), whereas homeopathy failed to show any treatment effect. Further studies on homeopathy, or evening primrose oil and borage oil, are difficult to justify. It must also be remembered that CAM products are currently under-regulated and may not meet the stringent quality standards of conventional medicines.
The correlation between the suspected clinical diagnoses and the radiographic diagnoses for patients with shoulder pain
(2016) Redman, Jade Lee; Shaik, Junaid
Background The association between the radiographic and clinical findings of shoulder pain is unclear and it is not fully understood how plain film radiographs of the shoulder influence the suspected clinical diagnosis and conservative management of shoulder pain at the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT). Previous research at the CDC reported that plain film radiographs did not significantly influence the suspected clinical diagnosis and conservation management of the lumbar spine and knee conditions. This study was conducted in order to determine if a similar trend was observed for plain film radiographs of the shoulder and the suspected clinical diagnosis and conservative management of shoulder pain. Objectives Objective 1: To determine the association between the suspected clinical diagnosis and radiographic diagnosis of shoulder pain. Objective 2: To describe the type of incidental radiographic findings in the selected plain film radiographs of the shoulder. Objective 3: To determine the proportion of change in the suspected clinical diagnosis and the conservative management of shoulder after obtaining the radiographic report. Method The archives of the CDC at the Durban University of Technology were searched for plain film radiographs of the shoulder and corresponding patients’ records from 4 April 1992 to 19 September 2011. These were collected, examined and evaluated, and the relevant data was extracted. Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. The suspected clinical diagnoses were categorized into groups (trauma, mechanical conditions, muscular or tendon dysfunction, capsular syndromes, neurological conditions, arthritides and other). These were then constructed using two-by-two tables for the absence or presence of radiographic diagnoses versus the suspected clinical diagnosis. The McNemars chi square test was used to determine any association between the radiographic and suspected clinical diagnosis. Results The mean age of the patients whose clinical and plain film radiographic records were examined was 43.5 years, with 53.7% male and 46.3% female patients. It was not possible to find an association between the suspected clinical and radiographic diagnoses as the categories were too different for statistical testing to be done. Thirty one (57.4%) plain film radiographs were requested at the first consultation. In 53.7% (29/54 radiographs) of cases, no specific suspected clinical diagnosis was given and “suspected pathology” was the reason given for referral. Of the 54 patients, 21 had a change in the suspected clinical diagnosis; however, in many of these cases (13/21) it was not a direct result of the radiographic findings. A wide range of treatments were used both before and after plain film radiographs, including soft tissue therapy, manipulation and electrotherapy. There was no significant change in the frequency of use of any of the modalities post-radiographs. Conclusion The reasons provided for ordering plain film radiographs were sometimes vague or even invalid. Although there was a change in 21 of the 54 suspected clinical diagnoses it was not conclusively as a result of the radiographic findings. The management of shoulder complaints did not change appreciatively following plain film radiographs. These findings suggest that the current use of plain film radiographs in the clinical and management context at the CDC needs to be reviewed.
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.
The development of a nano-sized eggshell and titanium dioxide desensitising paste to re-mineralise teeth
(2019) Onwubu, Stanley Chibuzor; Mdluli, Phumlane Selby; Singh, Shenuka
Dentin hypersensitivity [DH] is a common occurrence and notable painful condition among dental patients. Clinically, the pain associated with DH is caused by external stimuli such as thermal, tactile, osmotic or chemical changes from open dentinal tubules. Traditionally, the treatment of DH is the use of at-home desensitising toothpaste. While there is a variety of desensitising paste such as Sensodyne® and Colgate sensitive Pro-Relief TM to treat DH, the dentin tubule remineralising characteristics of these paste are, however, limited in an acidic environment which could result in DH relapse. The limiting abilities of these desensitising paste prompt this study to develop a desensitising agent using nano-sized eggshell-titanium dioxide (EB@TiO2) as an active ingredient in the management of DH. A quantitative research design and an experimental research strategy were adopted. The research design included three phases. In phase one of this study, different characterisation techniques such as Fourier Transform Infrared Spectroscopy (FTIR); X-ray Diffraction (XRD); Energy Dispersive X-ray Spectroscopy (EDX) and Scanning Electron Microscope (SEM); High Transmission Electron Microscopy (HRTEM); and Thermo-Gravimetric were used to confirm the modification of EB@TiO2. Phase two, on the other hand, assesses the suitability of the EB@TiO2 as an oral healthcare product by examining its cytotoxicity and antibacterial properties. By contrast, phase three investigated the quality of the EB@TiO2 as a new approach to the management of DH. Particularly, the acid resistant, abrasivity, and remineralisation characteristics of EB@TiO2 were studied using bovine and eggshell model, respectively. Different analytical technique such as pressure sensor, gas displacement test, Atomic Force Microscope, Raman Spectroscopy, SEM, and EDX were used to examine the product quality of EB@TiO2 in comparison with some commercially available paste. In addition, a mathematical model was used to predict the duration and rate of remineralisation of EB@TiO2. Both descriptive and inferential statistics were used to present the data (P=0.05). The validity of the study was achieved following SANS 1302 (2008) requirement for preparation, developing, and testing toothpaste. The reliability was determined via reproducibility and repeatability of tests. Paper I and II examines the effectiveness of commercially available toothpaste in the prevention of tooth decay, using eggshell powder as a substitute for the human tooth. Paper I established that eggshell model can be used as a substitute for the human tooth to study the acid resistant properties of toothpaste. The salient point of the paper is that all the tested toothpaste were effective against erosive attacks. However, the eggshell alone without the protective covering of toothpaste showed limited acidic resistance. Paper II established that acid resistance properties of EB@TiO2 were significantly better than eggshell alone. The paper confirmed that modifying eggshell with titanium dioxide improved its acidic resistance characteristics. Paper III and IV evaluate the acidic resistance of EB@TiO2 using a bovine model. Paper III and IV established that the protective effects of EB@TiO2 were superior to the tested commercially available toothpaste. The FESEM, AFM, and Raman test further confirmed that EB@TiO2 offer better protection on the tooth enamel. Paper V and VI assess the occluding capabilities of EB@TiO2 and eggshell alone in comparison with other desensitising toothpaste. Paper V confirmed that there was complete remineralisation of the dentin tubules in the samples treated with EB@TiO2. At higher magnification, the particles of EB@TiO2 were very much evident. The EDX spectrum reveals that the Ti peaks observe before and after post acidic treatment were comparable. Paper VI established that occlusion of EB@TiO2 was highly effective in an acidic environment, as occluded tubules remained intact post-acidic treatment. In addition, the cytotoxicity study identified that EB@TiO2 had little effect on the NIH 3T3 cell line even at the highest concentration of 100μg/ml. Manuscript I assess the occluding capabilities of EB@TiO2 in comparison with a known occluding desensitising agent (Pro-Argin and NovaMin). Manuscript I established that as the brushing days increase the remineralisation or dentin tubule occluded by each respective desensitising agent improved. It was found that the occluding capabilities of EB@TiO2 were more superior to both Pro-argin and NovaMin products in both saliva and without saliva. Manuscript II described the use of the logistic equation to predict the remineralisation of the EB@TiO2. Manuscript II established that the logistic equation effectively predicted the remineralisation trends of EB@TiO2 and Pro-argin toothpaste (Colgate Pro-relief). Manuscript III assesses the abrasivity of EB@TiO2 in comparison with calcium carbonate, and hydrated silica containing toothpaste. Bovine enamel specimen was used for the in vitro experiment. Manuscript III established that enamel loss from the brushed surface, regardless of the sample group, were statistically different when compared to the covered surface. The study found that the abrasivity of EB@TiO2 were comparable with the calcium carbonate toothpaste. It was also established that EB@TiO2 was less abrasive when compared against hydrated silica containing toothpaste. In conclusion, the experimental finding has exhaustively provided evidence on the suitability of EB@TiO2 as an active ingredient in toothpaste formulation. The study, therefore, provides new evidence and approach for the management of DH, particularly in low-income countries where the cost of oral healthcare may be too high.
Echocardiography nomograms in Black South African neonates
(2020-06-10) Hadebe, Nondumiso Memory; Prakaschandra, Rosaley; Ntsinjana, Hopewell; Cilliers, Antoinette
The subspecialty of Paediatric cardiology has adapted and refined techniques adopted from adult cardiology to manage children, (Mahle, Blaine and Silverman 2009:33). Although a quantitative evaluation of cardiac chambers, valve annulus and great vessel dimensions in paediatric echocardiography is important, nomograms for these structures are limited. Several studies have already provided normal values in the paediatric population that represent most populations of the world but there is lack of data that has been published in sub-Saharan Africans, (Lemmer et al. 2014:1 and Roge et al. 1978:285). AIMS AND OBJECTIVES Aim: To establish reliable echocardiography nomograms for cardiac chambers, valve annuli, great vessels and thymus dimensions in the Black South African neonatal population. Objectives: To determine normal values of cardiac chambers, valve annuli, great vessel and thymus dimensions. To determine inter-observer variability. To determine the effect of confounding factors such as gender and type of delivery on the measurements obtained. METHODS This is a descriptive, cross-sectional study evaluating cardiac chambers, valve annuli, thymus and great vessel dimensions in 386 African neonates with normal hearts using echocardiography. The study data consists of two arms, a retrospective arm utilizing echocardiographic data acquired during a previous study entitled “To assess the accuracy of pulse oximetry screening as a tool to detect critical congenital heart disease in asymptomatic newborns” and a prospective arm. INCLUSION CRITERIA: Healthy newborns at an age of 12 hours or more before discharge. Patients without any heart disease, with a “normal heart” by echocardiography excluding hemodynamically non-significant patent ductus arteriosus and patent foramen ovale. Black South African patients. Full term babies delivered by caesarian section and normal vertex. EXCLUSION CRITERIA: Patients less than 12 hours from birth. Patients with known structural heart lesion. Patients who are non- black South Africans. Pre-term neonates. DATA COLLECTION AND ANALYSIS: Collected data was entered on excel spreadsheet and analyzed using excel, XLSTAT 2019 and STATISTICA version 13.5.0 statistical packages for analysis by the principal researcher (Nondumiso M. Hadebe). A p-value of less than 0.05 and significance level of 95% was considered statistically significant. A professional biostatistician at University of the Witwatersrand was consulted for assistance in data analysis. Homoscedasticity and heteroscedasticity were tested using Shapiro-Wilk, Kolmogorov-Smirnov, Breusch-Pagan and White tests. The inter-observer variability was tested with intraclass correlation coefficient using Pearson’s correlation coefficient to detect bias. Weight was used to express measurements to body size and to predict mean values of each echocardiographic measurement that were expressed as Z-scores. RESULTS A total of 386 patients from both arms were enrolled with almost equal gender distribution with a slightly higher percentage of females, 191 (49%) were males and 195 (51%) were females. The study involved neonates born through normal vaginal delivery (NVD) and through caesarian section (C/S) which showed equal distribution. The assumption of normality was tested which showed most measurements being homoscedastic. Heteroscedasticity was tested which showed most measurements to be homoscedastic. Effects of confounding factors were tested which showed that body weight has a significant effect on all cardiovascular dimension measurements. Mode of Delivery (MOD) had a significant effect on the size of atrioventricular valve, pulmonary artery and pulmonary artery branch measurements. Gender and BSA had no significant effect on most measurements but with some significant effect on a few measurements. There was no significant effects seen for body length (BL) and gestational age (GA). The echocardiography measurements of 168 patients were used to test for inter-observer variability which showed a strong correlation on most measurements. Birth weight was used to express cardiac measurements to body size. All echocardiographic measurements were grouped into 3 categories of weight and are presented as mean and +/-3 SD. Z-scores and its boundaries for all measurements is presented graphically. This study showed slightly higher dimensions to previous studies from other centres. CONCLUSION This study presents nomograms that are reliable because they were acquired from healthy neonates using current recommendations by the American Society of Echocardiography, (Lopez et al. 2010: 465-495). Weight showed significant potential as a confounding factor and as an independent variable for data normalization. This study showed slightly higher dimensions to previous studies emphasizing that it is important to develop and use regional nomograms because of the effects of environmental, economic and social factors of the region. This study covered the gap of knowledge on cardiac chamber, valve annuli, and arterial and thymus dimensions in the neonatal age group. Further studies are required to reinforce these findings that will also involve the right cardiac dimensions. More studies are needed based on African paediatric populations including the all paediatric age groups (0-18 years).
The effect of a lumbar support pillow on low back pain in long distance truck drivers in the eThekweni District
(2019) Van Wyk, Brittany; van der Meulen, Anthony G.
BACKGROUND A lack of adequate lumbar support when driving has been said to be an important causative factor of low back pain (LBP) in long-distance truck drivers. Health practitioners prescribe a lumbar support pillow even though the findings of several studies are uncertain. EnVision Tomorrow After Pain (ENTAP) claims that its lumbar support pillows result in an improved posture, a decrease in pain and an increase in comfort (ENTAP 2016). The ‘ENTAP Lumbar Support’ has not yet been tested on participants and, therefore, these claims cannot be currently validated. Therefore, this study intended to determine the effectiveness of the ‘ENTAP Lumbar Support Pillow’ in decreasing LBP in long-distance truck drivers. OBJECTIVE To determine the effect of the ‘ENTAP Lumbar Support Pillow’ on LBP in long-distance truck drivers in terms of pain parameters (intensity and duration of pain), activities of daily living and disability when compared with a polyester lumbar support pillow and no lumbar support pillow. METHODS Sixty-three long-distance truck drivers experiencing LBP were recruited from a trucking company by random allocation. The study was a quantitative paradigm, double blinded, true experimental study design. Participants had to fill out a general questionnaire to determine whether they met the inclusion criteria. A baseline, three-week and six-week questionnaire, consisting of the Numerical Pain Rating Scale (NPRS), the Oswestry LBP Scale and the Patients‟ Global Impression of Change (PGIC) Scale. Statistical Package for the Social Sciences (SPSS) version 25.0 was used to analyse the data. The mean body mass and height were compared between the three treatment groups using one-way Analysis of Variance (ANOVA) tests. Repeated measures ANOVA testing was used to assess the treatment effect of the intervention group compared to the other groups (Esterhuizen 2018). Post hoc comparison of the intervention effect between time points and between treatment groups was done using a Bonferroni correction for multiple testing (Esterhuizen 2018). RESULTS The NPRS within the subjects‟ contrast showed a progressive variation from baseline testing to the three week (p=0.04) and the six week (p=0.001). The profile plot revealed that the mean pain score decreased much faster in Group B ‘ENTAP Lumbar Support Pillows’ compared with both the other groups. The Oswestry LBP Disability Questionnaire score revealed that the score tests within the subjects‟ contrasts showed that the interaction of time x group was significant only at six weeks (p<0.001) compared with baseline. The profile plot showed that the mean Oswestry LBP Disability Questionnaire score decreased (improved) much faster in Group B ‘ENTAP Lumbar Support Pillow’ compared with both the other groups. There was a highly significant treatment effect overall (time x group p<0.001) for the PGIC Scale, indicating that the change in score over time was different in the two groups (p<0.001). The profile plot showed that the mean PGIC score increased (improved) in the Group B ‘ENTAP Lumbar Support Pillow’ while it decreased (worsened) in the polyester group. There was a highly significant treatment effect overall (time x group p<0.001) for the degree of change score, meaning that the change in score over time was different in the two groups. The profile plot showed that the mean degree of change score decreased (improved) in Group B ‘ENTAP Lumbar Support Pillow’ while it increased (worsened) in the Group C (polyester-filled lumbar support). All participants in both lumbar support groups answered “yes” to the question on whether they found the support comfortable at both three weeks and six-week time points. CONCLUSION The ‘ENTAP Lumbar Support Pillow’ was effective in decreasing LBP in long-distance truck drivers. It was considered to decrease LBP, improve activities of daily living and decrease disability, and it was also considered as comfortable. Therefore, the Alternate Hypothesis (Ha) which states that there will be a statistically significant (p<0.05) improvement in LBP in the participants who use the ‘ENTAP Lumbar Support Pillow’ compared to no lumbar support pillow and the polyester-filled lumbar support pillow is accepted and the Null Hypothesis is rejected.
The effect of cervical spine manipulation compared to muscle energy technique on neck muscle activity and range of motion in asymptomatic participants
(2020-06-10) King, Sasha Lee; Docrat, Aadil; Abdul-Rasheed, Ashura
Background: Clinical evidence supports the use of spinal manipulative therapy (SMT) and muscle energy technique (MET) for the treatment of cervical spine dysfunctions. However, the physiologic mechanism behind their effectiveness is not well understood. Joint dysfunctions are associated with hypertonicity of segmentally related muscles and can occur in both symptomatic and asymptomatic individuals. Neck pain (NP) has been associated with cervical muscle dysfunction, due to the presence of altered muscle activity and impaired kinematics, demonstrated in NP patients. This includes the upper trapezius and posterior cervical muscles, whose dysfunction can be a source of NP. Spinal manipulative therapy and MET are mechanical interventions, that when applied to joint dysfunctions, produce neurophysiological changes, specifically the modulation of muscle activity and improved range of motion (ROM). However, the demonstration and comparison of the neurophysiological effects of SMT and MET in the neck, and its related musculature, are unknown. Aim: The aim is to determine the effect of cervical spine manipulation compared to MET on neck muscle activity and range of motion in asymptomatic participants. Method: This is a quasi-experimental study utilising a pre-test, post-test design, which employed 50 asymptomatic participants aged between 18 – 35 years of both genders and all races. The participants were randomly allocated into one of two treatment groups. Group 1 received cervical spine manipulation (CSM) and Group 2 received MET. Before and after the respective interventions, resting upper trapezius and posterior cervical electromyographic muscle activity and the cervical spine range of motion (CROM) (lateral flexion and extension) were measured. The IBM SPSS version 24 was used to analyse the data. The intra-group changes were compared pre- and post-intervention using paired Wilcoxon signed ranks tests. Median changes between pre- and post- were compared between the two treatment groups using Mann-Whitney U tests. A p value < 0.05 was considered as statistically significant. Results: None of the demographic or background variables differed significantly between the two groups. Both treatments had an effect, although not all significant, involving mostly reductions in resting electromyographic muscle activity and improvements in CROM. This was significant for the right posterior cervical muscles in the SMT group (p = 0.012) and for ROM in both groups (p < 0.001). No evidence of a difference in treatment effect was found. Conclusion: The results of this study suggest that SMT and MET mostly decrease resting neck muscle activity and improve CROM. Muscle energy technique may possibly be equally as effective as CSM. Concurrent changes in both outcomes suggest that more than one physiologic mechanism may likely explain these effects.
The effect of Phosphoricum acidum 200CH on the adverse physiological effects induced by exercise in cyclists
(2011) Pantalone, Giovanni; Botha, Izel
The treatment with homoeopathic remedies, namely Phosphoricum acidum 200CH has proved to be effective in many clinical situations; however confirmation of its use within the sporting industry is limited. This study aimed to test Phosphoricum acidum 200CH efficacy in treating highly trained cyclists. This study was a superiority trial, in which the homoeopathic intervention was hypothesized to be superior to the placebo control group, in a statistically significant way (p < 0.05). Aim This study aimed to test the use of Phosphoricum acidum 200CH in treating the adverse physiological and psychological symptoms induced by exercise on cyclists. The aim for treating these adverse symptoms, induced by exercise, is to enhance performance and recovery of cyclists. Performance and recovery were tracked by assessing blood lactate concentration, oxygen consumption rate, heart rate, peak power output and emotional status. Methodology The study was a randomized controlled clinical trial, parallel group design. Participants were selected using convenience sampling of male road and mountain bike cyclists in the Western Cape. This study followed an explanatory Randomized Controlled Trial test, where the efficacy of the homoeopathic remedy (Phosphoricum acidum 200CH) was under investigation. The participants were selected with great care and testing was completed under highly controlled conditions. Thirty competitive male cyclists volunteered for this study. All participants were required to complete two cycling power to exhaustion interval tests, consisting of a ten minute warm-up at 100 Watts, followed by a five minute constant load at 150 Watts. The purpose of the constant load was to test cycling economy (CE). Thereafter the workload was increased to 200 W for 30 seconds and then the workload was increased by 20 Watts every 30 seconds. The test continued until the participant could no longer maintain the set repetitions per minute for that workload. The peak power output attained iv was recorded. The first test served as a baseline, after which a single dose of Phosphoricum acidum 200CH or identical placebo was administered, a 30 minute recovery period allowed for the remedy to take effect. The test interval was then repeated, the second test results were then compared to the first baseline test to determine the effect of treatment. The study took many different aspects of the remedies action on the cyclists into account, including mental and physiological effects. Breath-by-breath gases were continuously recorded. Expired gases, volumes and air flow were sampled through a flow meter and gas sampling line and heart rate was measured through telemetry (Polar®, Polar Electro, Oy, Finland) and analyzed by a cardio-pulmonary metabolic system (Quark CPET ® Cosmed, Rome, Italy, 2009). Data recorded was filtered for values outside the normal ranges and averaged for every five seconds. Oxygen consumption (vO2 mL.min-1) and heart rate (bpm) at different stages of each test interval were recorded. More specifically oxygen consumption and heart rates were averaged over the 5 minute section following the warm-up to determine cycling economy, directly after exhaustion for one minute and two minutes following exhaustion for another one minute period. Maximum attained heart rate was recorded for each interval test. Maximum oxygen consumption (vO2Max Absolute) was calculated as the mean of the highest three values attained, this mean was then divided by the participants body mass to determine maximum aerobic capacity (vO2Max Relative). Blood lactate levels were tested before, 15 minutes into and directly after each interval, to assess resting lactate status, cycling economy and to determine maximum lactate accumulation. Psychological testing included mood analysis, using a Stellenbosch mood scale (STEMS) questionnaire and further symptoms were analyzed using a Numerical rating scale (NRS) with symptomatic questions. Results From the results, it was clearly apparent that the control group proved to be of a higher calibre when comparing performance variables of the two groups namely:  Higher peak power output  Higher vO2Max  Lower economy lactate v  Lower resting lactate Despite the treatment group being the weaker of the two groups, they showed improvement in performance after administration of the remedy. This improvement was manifest through physiological alteration in the second test. More exclusively is the acceptance of the hypothesis concerning heart rate and oxygen consumption, whereby results showed that the administration of Phosphoricum acidum 200CH decreased heart rate and submaximal oxygen consumption rates during performance and recovery. There was no observable psychological effect during this study. The results suggest that Phosphoricum acidum 200CH primary demonstrated physiological effects on the cyclists. The researcher believes that this is due to insufficient time given for psychological alterations. Conclusion The Phosphoricum acidum 200CH has proven to be effective in enhancing cycling economy, reducing maximum heart rate and enhancing recovery to a large degree for the first minute following exhaustion. These positive effects are of great importance as the treatment group was the weaker of the two groups. Resulting in the possibility of even larger results being observable in repeated studies where both groups have similar performance abilities.