Electronic Theses and Dissertations (Masters)

Permanent URI for this collection

https://hdl.handle.net/10539/37984

Browse

Now showing 1 - 11 of 11

Use of probiotics in community pharmacy in South Africa: a survey of pharmacist attitudes, perceptions and knowledge
(University of the Witwatersrand, Johannesburg, 2024) Kim, Yedam; Orchard, Ané
There has been a substantial increase in the consumption of probiotics in the last decade in South Africa. Pharmacists, as experts in the field of medicine, play a crucial role in educating both patients and other healthcare professionals on the appropriate use of probiotics in the healthcare setting. While there are several studies related to the use of probiotics, such as the study conducted among community pharmacists to explore their knowledge, attitudes, and practices regarding complementary and alternative medicines in South Africa, there is a gap in the literature regarding the knowledge, attitudes, and perceptions of qualified practicing pharmacists in South Africa regarding probiotic use. The findings of this study provide information for evaluating the current state of awareness and understanding regarding probiotics within the pharmacist community, offering a foundation for potential interventions and educational initiatives. A cross-sectional, descriptive-analytical study was conducted in community pharmacies across South Africa. Of the 476 study respondents, 237 were included in the final analysis, as 239 surveys were incomplete. Among the respondents, 18.5% demonstrated a good level of knowledge about probiotics, while 11.3% demonstrated a poor level of knowledge (Mean ± SD =13.81 ± 2.8). This finding demonstrated a lower knowledge level compared with similar studies conducted in other regions, such as Asia and the United States of America. These findings highlight a potential gap in knowledge among the respondents regarding the use of probiotics. Half of the respondents (49.9%) displayed positive attitudes toward probiotics (Mean ± SD = 43.33 ± 8.9) and 47.6% of the respondents displayed positive perceptions of probiotics (Mean ± SD = 32.14 ± 3.7). A significant association of knowledge of probiotics with biological sexes (X2 = 39.2132, p < 0.05) was found. There was a statistically significant difference in the demographics of respondents and their attitudes towards probiotics, including geographical region (X2 = 300.629, P<0.05), biological sex (X2 = 95.164, p < 0.05), age (X2 = 248.008, p < 0.05), highest degree obtained (X2 =191.428, p < 0.05), and the university from which they graduated (X2 = 417.775, p < 0.05). Statistically significant difference in the demographics of respondents and the perceptions of probiotics was found, including geographical region (X2 = 170.161, p < 0.05), age (X2 =52.378, p < 0.05), and the university from which they graduated (X2 = 238.514, p < 0.05. In this study, a significant but weak correlation between knowledge and attitude was identified (r = 0.1537, p = 0.0179). Correlation between attitudes and perception was also significant but weak (r = 0.3214, p = 0.000) and there was no statistically significant correlation between knowledge-perceptions variables (r = 0.0092, p = 0.8879). The study has identified limited knowledge regarding the use of probiotics among respondents, despite their positive attitudes and perceptions towards the use of probiotics. The study also has emphasized the complexity of factors influencing individuals' knowledge, attitudes and perceptions regarding probiotics. This study recommends further educational initiatives to investigate relationship between knowledge, attitudes and perceptions of pharmacists on the use of probiotics in South Africa
Targeted nanosystems for tuberculosis pericarditis interventions
(University of the Witwatersrand, Johannesburg, 2024) Ayodele, Simisola Ayobami; Kumar, Pradeep; Choonara, Yahya Essop
Tuberculosis (TB) maintains its infamous status regarding its detrimental effect on global health, causing the highest mortality by a single infectious agent. It presents as the second most lethal infectious disease after HIV/AIDS. The presence of resistance and immune-compromising disease favors the disease in maintaining its footing in the health care burden despite various anti-TB drugs. The main factors contributing to resistance and difficulty in treating disease include prolonged treatment duration (at least 6 months) and severe toxicity, which further leads to patient non-compliance, and thus a ripple effect leading to therapeutic non-efficacy. The efficacy of new regimens demonstrates that targeting host factors concomitantly with the Mycobacterium tuberculosis (M.tb) strain is urgently required. Due to the huge expenses and time required of up to 20 years for new drug research and development, drug repurposing may be the most economical, circumspective, and conveniently faster journey to embark on. Host-directed therapy (HDT) will dampen the burden of the disease by acting as an immunomodulator, allowing it to defend the body against antibiotic-resistant pathogens whilst minimizing the possibility of developing new resistance to susceptible drugs. Repurposed drugs in TB act as host-directed therapies, acclimatizing the host immune cell to the presence of TB, improving its antimicrobial activity and time taken to get rid of the disease, whilst minimizing inflammation and tissue damage. Anti-TB drugs incorporated in nanosystems may reduce side effects by delivering the drug selectively into infection reservoirs such as macrophages, which may assist in clearing the TB bacilli faster and reducing the duration of therapy. Tuberculosis pericarditis (TBP) is a type of extrapulmonary tuberculosis caused by the retrograde lymphatic spread of the bacilli from lymph nodes. TBP is known to have a high burden in southern Africa due to the high prevalence of HIV and its contribution to TBP. Traditional anti-TB drugs have poor permeation across the pericardium, making TBP a difficult disease to treat with high mortality. Rapid HPLC methods were initially established for the detection and quantification of isoniazid and pyrazinamide at a physiological pH (pH 7.4). These methods were subsequently used for the detection and quantification of both compounds in the ex vivo pericardium studies. Although both drugs diffused across the pericardium, only isoniazid has anti-tubercular effects at physiological pH. Both drugs permeated across the pericardium at pH 7.4, but only isoniazid has anti-tubercular effects at this pH. Bedaquiline is known to shorten the duration of therapy but has limitations e.g., poor solubility and adverse effects such as prolongation of QT interval, causing careful use and close monitoring of its adverse effects and possible drug interactions. In this study, bedaquiline was incorporated into an inherently targeted nanosystem made of mannan (host-directed therapy) for improved permeation of the drug across the pericardium. The bedaquiline-loaded mannan-chitosan oligosaccharide lactate nanoparticles were prepared by a one-step ionic gelation probe sonication method. A PermeGear 7-in-line flow-through system was used for the ex vivo diffusion studies across porcine and human pericardium. The nano gel was loaded into the donor compartment. Phosphate buffer saline (pH 7.4 with 0.2% sodium lauryl sulphate) was pumped through the receptor compartments at 1.5 ml.h-1 (37 °C). Samples were collected every 2 h for 24 h and analyzed via HPLC. Bedaquiline loaded nanoparticles with particle size and potential of 192.4 nm and 40.5 mV, respectively, were synthesised. The chitosan-mannan bedaquiline loaded nanoparticles had an encapsulation efficacy of 98.7% and drug loading of 0.6%. Diffusion data of bedaquiline in the nanosystem indicated a flux of 2.889 and 2.346 μg.cm - 2. min -1 for porcine and human pericardium, respectively, as compared to 0.991 μg.cm-2.min-1 and 1.1578 μg.cm-2.min-1 for isoniazid and pyrazinamide, respectively. The permeation of the nanosystem indicated a consistent and linear diffusion pattern across both porcine and human pericardium, additionally approving the porcine pericardium as a great comparable tissue to human tissue for pericardial studies. The nanosystem, therefore, presents an exceptional direction for the treatment of tuberculosis pericarditis with prospectively minimized systemic side effects and host-directed therapy
Antibacterial stewardship practices in South Africa during the COVID-19 era: A retrospective review
(University of the Witwatersrand, Johannesburg, 2024) Spinickum, Logan Jade; Leigh-de Rapper, Stephanie
Background: Several mechanisms may facilitate and steer the development of antibiotic resistance patterns. The most prominent driver associated with antibiotic resistance has been indicated as inappropriate use or consumption of antibiotics. The sudden emergence of Coronavirus Disease 2019 (COVID-2019) changed the conventional practices related to drug utilisation through the repurposing of antibiotics. Despite the implementation of antibiotic stewardship programs, the pressure that COVID-19 placed on healthcare systems resulted in poor prescribing and antibiotic review practices, potentially exacerbating antibiotic resistance. Moreover, the public health sector faces various challenges that make it difficult to consistently assess and quantify antibiotic usage; while providing quality review, feedback, and intervention, especially in low- and-middle-income countries like South Africa. As a result, there is a paucity of information concerning antibiotic utilisation in the public healthcare sector, even following the emergence of the COVID-19 pandemic. It is essential to determine the extent of antibiotic use to improve antibiotic utilisation, patient outcomes and stimulate viable policies and initiatives to strengthen public healthcare drug surveillance amidst the challenges of increased infectious diseases, resistance, and health personnel shortages. Aim of study: The aims of the study were to determine, analyse and compare antibiotic consumption amongst intensive care unit (ICU) patients admitted in a Gauteng public hospital during the pre-COVID-19 era and commencement of the COVID-19 era. Methodology: A retrospective cross-sectional data analysis of 335 medical files of ICU patients hospitalised in a Gauteng Provincial Tertiary Hospital (GPTH) between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables. Results: The study found that the more frequently prescribed antibiotics were amoxicillin/clavulanate (pre-pandemic = 31.99%; COVID-19 = 38.43%), followed by ceftriaxone (pre-pandemic = 15.44%; COVID-19 = 14.55%), piperacillin/tazobactam (pre-pandemic = 11.40%; COVID- 19 = 8.58%) and azithromycin (pre-pandemic = 7.73%; COVID-19 = 19.78%). Common bacterial pathogens detected in both periods included Acinetobacter baumannii (pre-pandemic = 29.2%; COVID-19 = 20.9%), Enterobacter cloacae (pre-pandemic = 10.4%;COVID-19 = 14.0%), Escherichia coli (pre-pandemic = 22.9%; COVID-19 = 25.6%), and Klebsiella pneumoniae (pre-pandemic = 25.0%; COVID-19 = 18.6%). Resistance was predominantly observed in ciprofloxacin (pre-pandemic = 11.4%; COVID-19 = 12.9%), piperacillin/tazobactam (pre-pandemic = 12.7%; COVID-19 = 0.1%), cefotaxime (pre-pandemic = 13.2%; COVID-19 = 14.7%), and cefepime (pre-pandemic = 12.7%; COVID-19 = 11.2). Resistance to commonly prescribed antibiotics observed a decrease trend moving from the pre-pandemic period into the COVID-19 pandemic. Conclusion: The macrolide and penicillin (in combination with beta-lactamase inhibitor(s)), classes demonstrated an increase in prescribing and use across the pre-pandemic period transitioning into the COVID-19 pandemic. While overall resistance observed a decline moving into the COVID-19 pandemic. However, “Watch” category antibiotic resistance increased slightly. An increase in prescribing and use of macrolides coupled with an increase in “Watch” category antibiotic resistance, highlights the need for improved antibiotic stewardship programs in public healthcare and pathogen-directed prescribing, to combat inappropriate and unnecessary use of antibiotics.
Knowledge, attitudes, and perceptions of healthcare workers on adverse drug reaction reporting in a government hospital in Botswana
(University of the Witwatersrand, Johannesburg, 2024) Lipholo, Lineo; Padayachee, Neelaveni; Vagiri, Rajesh
INTRODUCTION Adverse Drug Reactions (ADRs) are an inherent part of using medication to treat diseases. They impact negatively on the health of an individual, potentially leading to hospitalization and increase in the cost of caring for hospitalized patients. Healthcare professionals (HCP) need to assume an active surveillance role of reporting suspected ADRs. Spontaneous reporting (SR) becomes the practice to adopt to ensure safe use of medicines. Education and training are thus necessary to equip HCPs with the necessary skills to identify and report ADRs. OBJECTIVES The objective of this study explored the knowledge, attitudes, and perceptions of healthcare professionals in a government hospital in Botswana when it comes to reporting ADRs. METHOD A questionnaire composed of both open and closed ended questions was used to collect data on the knowledge, attitudes, and perceptions of HCPs to establish their disposition towards reporting of ADRs. The research tool was checked for its face and content validity as well as internal consistency. The data collected was captured in Microsoft Excel version 16.43 and then imported to SPSS version 27.0 for data analysis. RESULTS Based on the findings of this study 26.3% of the participants indicated that they had attended training pertaining to ADR reporting, whilst 39.8% indicated that they had seen and reported an ADR before. There was no statistical significance in reporting of ADRs between profession and gender (p=0.075). When assessing for a statistical association between the participants’ profession and having used an ADR reporting form before, there was no statistically significant association (p=0.28). The association between the average number of ADRs reported and having attended seminar/training was statistically significant (p<0.05). HCPs felt that reporting ADR was of high importance with a Mean Score of 4.67 and Standard Deviation of 0.63 on Likert items measuring attitude towards reporting ADR. HCPs showed positive perception towards reporting ADRs with a Mean Score of 3.07 and Standard Deviation of 1.17 on Likert items measuring perceptions. 40% of the HCPs indicated that they would report ADRs requiring hospitalization.21.8% of HCPs felt that workload could not allow for reporting of ADRs and 5.3% said lack of feedback discouraged from authorities reporting of ADRs. CONCLUSION There is a lack of knowledge of ADR reporting among HCPs. The lack of ADR reporting results in unsafe practices with the use of medications. This is despite strategies suggested to curb the challenge of underreporting. Some of the discouraging reasons to report include lack of feedback and communication from the authorities, and workload. These factors affect the overall reporting behaviour among the HCPs even when there is a positive attitude and perception of the importance of reporting ADRs. Education in the form of training and seminars should be a continuous practice, to equip HCPs with the necessary knowledge and skills needed to strengthen the practice of Pharmacovigilance in ensuring medication safety
Design and evaluation of a non-opioid tripartite release tablet for chronic inflammatory pain
(University of the Witwatersrand, Johannesburg, 2024) Mazarura, Kundai Roselyn; Van Eyk, Armorel; Choonara, Yahya E.; Kumar, Pradeep
Formulation-based approaches towards curbing the prescription opioid crisis include the discovery and development of non-opioid analgesics such as the novel benzyloxy- cyclopentyladenosine (BnOCPA). A more expedited approach involves the development of combinatorial systems of already existing non-addicting analgesics to tap into unexplored synergistic potentials. Despite the recent advances in drug delivery systems, tablets still hold the position of being the most widely used oral dosage form, particularly in the management of chronic ailments; it is cost-effective, non-invasive, and does not require administration expertise. Challenges in the production of complex geometry combinatorial, multi-drug tablets remain to some extent enigmatic to pharmaceutical researchers, hence the steady paradigm shift from traditional compression to 3-dimensional printing. Although it is superior in multiple aspects, the technique is still in its nascent stages with limited information on regulatory guidelines. Therefore, the aim of this work was to design and develop a non-opioid tripartite controlled- release tablet for efficient chronic inflammatory pain management. Because adherence to adjunct gastroprotective agents (GPAs) in non-steroidal anti-inflammatory drugs (NSAIDs) users has been established to be suboptimal, esomeprazole magnesium trihydrate (ESM) was added to the drug delivery system (DDS). The rationale behind the design was based on inherent drug properties, target release sites, desired therapeutic effects, and allowance for drug release manipulation, therefore a tablet was assembled, constituting an immediate- release top layer formulation of 250 mg paracetamol (PAR) for an early onset of analgesia; a cup layer for the delayed and retarded release of 100 mg of diclofenac sodium (DS) and 250 mg of PAR in tandem, and lastly a core containing a press-coated 20 mg ESM pill. A reproducible and efficient Reverse-Phase High-Performance Liquid Chromatographic (RP-HPLC) method was developed and validated for the simultaneous detection of the APIs over the concentration ranges studied. Deleterious drug-excipient incompatibilities were ruled out through pre-formulation investigations by FTIR, DSC, and TGA analyses. Combining both wet and dry granulation methodologies; the chosen formulation and polymers (7.5% hydroxypropyl methylcellulose (HPMC) K15M, 25.3% eudagrit L (EL) 100-55, and 10.5% croscarmellose sodium (CCS)), while considering the quality target product profiles (QTPPs), critical process parameters (CPP), and critical material attributes (CMAs), resulted in the development of a pragmatic tablet delivering fifty percent of the PAR dosage in the initial 30 minutes, with a cumulative release of 95.0% ± 0.08% and 94.9% ±3.87% for DS and ESM, respectively. Through in-process quality control tests, the validity of the manufacturing process was confirmed, with all results falling within pharmacopeial specifications. The release mechanism of PAR and DS from the cup after the 2-hour mark distinctly followed the Hixson-Crowell model where the geometrical characteristic of the cup was maintained with surface erosion. Visuals from scanning electron microscopy (SEM) analysis obtained prior to and during dissolution, confirmed hydration gravimetric analysis results as well as bulk and surface erosion mechanisms. The obtained ex vivo analysis results showed retarded permeation rates of the tabletted APIs compared to the APIs in their pure state. Therefore, it is imperative to consider improving the existing models employed for ex-vivo permeability studies of tableted formulations, with a particular focus on exploring the impact of excipients/polymers on drug permeation
Novel Design and Analysis of an Oral Cannabidiol (Cbd) Therapeutic Delivery System for Pain Management
(University of the Witwatersrand, Johannesburg, 2023-11) Khan-Flear, Faryal; Adeyemi, Samson A.; Kondiah, Pierre P. D.; Choonara, Yahya E.
Cannabidiol (CBD) is a non-psychoactive cannabinoid used for its antinociceptive, analgesic and anti-inflammatory properties in chronic pain. The endocannabinoid system (ECS) influences CBD: receptor binding to generate or regulate antinociceptive responses, producing centrally acting analgesia predominantly through Cannabinoid receptor 1 (CB1) abundant in the brain and spinal cord. In contrast, Cannabinoid receptor 2 (CB2) modulates inflammatory responses in immune system cells and tissues. Most oral medications can have inefficient absorption ability and insufficient therapeutic bioavailability due to the solubility of active ingredients and dosage form dissolution. Although the high lipophilicity of CBD enables it to cross the blood-brain barrier (BBB), which prevents the entry of most systematically administered drugs, the oil-soluble CBD is poorly soluble in water, resulting in erratic, incomplete absorption and poor drug bioavailability, preventing therapeutic doses from reaching specific receptors and regions in the brain. Directly ingested CBD also undergoes hepatic and intestinal metabolism, further contributing to therapeutic insufficiencies. Lipid-Based Drug Delivery Systems (LBDDS) can circumvent the drug's hysicochemical properties and the body's protective biological barriers to enhance drug-receptor interaction and elicit a biological response. Lipid combinations in self-emulsifying lipid formulations (SELF) create liposome nanocarriers that entrap and release CBD, providing a non-invasive, transitory, regionally selective delivery method. Nanoliposomes restrict therapeutic delivery to targeted areas, minimizing systemic toxicity and improving drug bioavailability. Manipulating the physical, chemical, and mechanical aspects of nano-liposomes and the material properties of their constituents concerning human anatomy and physiology can help or hinder therapeutic efficiency, drug safety, and delivery. Most therapeutic nanoliposome designs fall within 50–100 nm, facilitating passive transport across the BBB enabling drug receptor binding at brain and spinal cord receptor sites. Modulator uptake and interactions with host cells, enhanced uptake by target cells, and limits accumulation in specific tissues. Nanoliposomes smaller than 100 nm also extend blood circulation by evading renal, hepatic, and immunogenic sequestration and clearance by the mononuclear phagocyte system (MPS), the reticuloendothelial system (RES), opsonization, modulator uptake and interactions with host cells, limited accumulation in specific tissues, low uptake by target cells. This experiment used established system predictors such as HLB and LogP values, Poulton's Lipid Classification System (LCS), Biopharmaceutics Classification System (BCS), Lipinski's Rule of 5 (Ro5), FBDD Rule of 3 (Ro3), Biopharmaceutics Drug Disposition Classification System (BDDCS) to evaluate the critical quality attributes of two optimized formulations able to deliver CBD to the brain and spinal cord. Both formulations consisted of a phospholipid (soy lecithin), unmodified vegetable oils (coconut, olive/castor oil), surfactants (Span 80 and Tween 20), and a cosolvent (ethyl acetate) in the same ratios with the same ingredients, except that the olive oil in one formulation replaced castor oil in the other. These formulations molecularly dispersed CBD in the polymeric matrix of an unstable amorphous solid dispersion (ASD), improving drug solubility and bioavailability compared to crystalline forms. Thermodynamically unstable ASD must be assessed for quality, stability, and resilience to design helpful dosage forms. Both optimized validation batches successfully encapsulated CBD in liposomes in the eutectic ASD mixtures, as reflected in Fourier transform infrared spectroscopy (FTIR) spectrograms and the Differential scanning calorimetry (DSC). The olive oil-containing formulation produced self-micro-emulsifying drug delivery system (SMEDDS). At the same time, the castor oil preparation formed a self-nano-emulsifying drug delivery system (SNEDDS), accounting for the differences in particle size, size distribution, zeta potential, rheology, morphology, drug release and cell culture analysis. The differences arose due to the oils' unique fatty acid composition and chemistry. Drug release test results of each formulation loaded in hydroxypropyl methylcellulose (HPMC) capsules showed good timing for capsule dissolution and a burst release preceding sustained release over 48 hours. Drug release test results established cell viability in culture studies. The positive cell proliferation indicated that the CBD concentrations released by both formulations were non-toxic to mouse embryonic fibroblasts (NIH/3T3) and human embryonic kidney epithelial cell (HEK 293) cultures. Although both formulations yielded favourable results, the analysis indicated that the castor oil formulation was more robust and, therefore, suitable as a nanocarrier for CBD.
Investigating the attitudes of physiotherapists about telerehabilitation and their opinions on its feasibility in South Africa
(University of the Witwatersrand, Johannesburg, 2022) Thomas, Tylla
Background: Telerehabilitation has not been a permitted nor been a focus in healthcare in South Africa. There is little awareness, knowledge, and skill amongst physiotherapists on how to conduct effective telerehabilitation. However, this is not the case globally, where telerehabilitation has been proven effective in the treatment of patients with various conditions. Advances in telerehabilitation worldwide are occurring daily but there is scarce literature on telerehabilitation in South Africa. Due to Covid-19, the HPCSA has granted permission to conduct telehealth, however, numerous barriers first need to be overcome for telerehabilitation to become a common therapeutic practice. The attitudes of physiotherapists on telerehabilitation and its feasibility have not been investigated and hence the current use, or willingness to use, is unknown amongst the South African population. Aim: To investigate the attitudes of physiotherapists and their opinions on the feasibility of telerehabilitation in daily practice in South Africa. Methods: This quantitative, cross-sectional study included 356 physiotherapists belonging to the SASP, recruited through convenience sampling. An electronic self-reported questionnaire was developed from existing literature and other exiting questionnaires e.g. the Physiotherapy Mobile Acceptance Questionnaire (PTMAQ) (Blumenthal, Wilkinson, and Chignell, 2018). The questionnaire was emailed to all physiotherapists belonging to the SASP and they could voluntarily answer it. Descriptive data analysis was conducted to describe the demographic profile of physiotherapists and to determine their attitudes on telerehabilitation as well as the feasibility thereof in South Africa. One-Way ANOVA (analyses of variance) was used to establish a relationship between participants’ demographics and their attitudes and feasibility 2 regarding the use of technology for rehabilitation in South Africa. The study obtained ethical clearance from the Human Research Ethics Committee (Medical), clearance number M200946. Results: Most participants were between the ages of 25-35 (170, 47.8%), working more than 20 years (101, 28.4%), mostly in orthopaedic manipulative therapy (137, 38%) and in outpatient practice (199, 55.9%). Most participants had positive attitudes regarding the perceived ease of use and perceived usefulness (Valdez et al., 2009). Only 18.3% of participants used telerehabilitation in their clinical settings and less than half of the participants state that they would be willing to use telerehabilitation in their clinical setting. Only 37.3% of participants thought that the South African population would be receptive to telerehabilitation. Most participants thought that there is not enough knowledge (308, 86.5%) and awareness (262, 73.6%) about telerehabilitation but do have the capacity and resources to conduct telerehabilitation sessions in their clinical settings (227, 63.8%). Participants in OMT and outpatient practice had a more favourable attitude toward telerehabilitation. No significant effects of age were found. Conclusion: Physiotherapists show positive attitudes on the use of telerehabilitation but are not willing to do it in their clinical settings due to numerous barriers that affect the feasibility thereof. This study is one of the first to investigate the attitudes of physiotherapists on the use of telerehabilitation, however, further studies need to be conducted to examine the effectiveness of telerehabilitation amongst physiotherapists in South Africa. It is the hope that the awareness, knowledge, and skill to conduct telerehabilitation increases among physiotherapists in South Africa so that use of telerehabilitation can become common practice.
Identification of third year midwifery skills that could benefit from simulated practice prior to clinical midwifery placements
(2021) Singaram, Kerry-Ann
Neophyte midwifery students often feel anxious and inadequate during their clinical placements, as they are expected to perform midwifery skills as early as their first day in the clinical environment. Midwifery educators are seeking out creative ways to create practice opportunities for their students with regards to skills practice, and simulation as a teaching strategy offers a learning environment for safe practice of skills. The use of simulation in midwifery is a fairly new concept, and its future growth is dependent upon research to provide a sound base from which it may grow and develop to meet the needs of the students. The purpose of the study was to identify key midwifery skills that could be taught and practiced using simulation prior to student midwives’ clinical placements that would better equip student midwives to manage their midwifery clinical placements. Findings from the study could serve as a foundational basis for future midwifery simulated programs. The research design and method was qualitative in nature and data was collected from focus group discussions with fourth-year student nurses and their respective midwifery lecturers. Clinical facilitators who are based in the clinical environment and responsible for the training of third year midwifery students were invited to participate in the study, however, were unable to attend. The researcher felt that, this created a limitation to the study as they might have added additional information or a different perspective about novice midwifery skills training. Findings identified specific midwifery skills that could benefit from simulated practice as well as how best skills could be practiced within facilitation of simulation in third year midwifery practice. Summary of findings included the identification of the following midwifery skills that participants identified as being important with regards to simulated practice: completion of documentation; vaginal examinations; management of second stage of labour and offering of psychological support. IV, Participants together with the researcher gives suggestions on how best simulation can be facilitated for developing confidence in neophyte student midwives before their first clinical placement. Based on the findings of this research, recommendations were made to guide midwifery lecturers when planning simulation activities.
Experiences of professional nurses in providing support to student nurses in the clinical practice environment of a private hospital in Gauteng
(2021) Jones, Jennifer
Quality in nursing education is a global focus due to the many challenges facing healthcare the world over. Clinical learning is an important component in nursing training and nursing experiences during clinical placement are crucial to prepare the student to become safe, competent Professional Nurses. However recent studies have shown that the students’ clinical training is not always effective in preparing them for their future role. Support in the clinical environment by the Professional Nurse is crucial to assist the student to develop confidence and competence to transition into the Professional Nurse role. The objective of this study was to describe the experiences of Professional Nurses in providing support to student nurses in the clinical practice environment of a private hospital. An exploratory qualitative study using in depth interviews of fifteen Professional Nurses was done. The data collected was then analysed using thematic analysis. The identified themes and categories were discussed to offer meaning and insight. The study provided an understanding of how support of the student nurse is currently experienced and perceived by the Professional Nurse in the clinical practice environment with a view to identifying ways of improving support to the student nurse in the future. It was found that the clinical environment is unpredictable and whilst the Professional Nurses acknowledged they needed to support the student, it was often challenging to do this effectively leaving them feeling frustrated and disappointed. The study took place during the COVID -19 pandemic which caused major disruptions to the everyday functioning and operations of hospitals globally, and the study site was no exception. Recommendations to improve support to the student nurse were made in the areas of Clinical Practice, Nursing Education and Research.
The impact of lower limb amputation on quality of life: a study done in the Johannesburg Metropolitan area, South Africa
(University of the Witwatersrand, Johannesburg, 2010-01-29T07:15:06Z) Godlwana, Lonwabo L.
Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semi-structured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status. Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.
Record review of patients with brain abscess and empyema.
(University of the Witwatersrand, Johannesburg, 2010-01-22T10:28:25Z) Schwenke, Katherine Linda
Studies of patients presenting with brain abscess (BA) and Empyema are not routinely focused on occupational therapy (OT). There is a paucity of literature on deficits other than hemiplegia. Aims of this study were to determine the relationship between BA, Empyema, motor and other deficits and whether an OT intervention protocol is needed. Record review was used to establish clinical presentation trends. Hemiplegia was the most common motor deficit and the majority scored below the norm on the Beery- Buktenika Developmental Test of Visual Motor Integration (VMI). Patients with Brain Abscess generally had more significant deficits than those with Empyema for both motor and process deficits. Part B followed up a small sample (n=8) which indicated clinical improvement on the VMI test with the score on the supplemental test of motor coordination remaining a concern. Occupational Therapy is recommended to address these issues based on the Occupational Therapy Practice Framework-II.

Browse

Recent Submissions