3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Anaesthetists' knowledge of South African law pertaining to informed consent(2018) Mamoojee, Anisah IsmailLack of knowledge of the law places a medical practitioner at risk of litigation. Research has shown that medical personnel’s knowledge of law and their consent taking practices are inadequate. This prospective, contextual, descriptive study aimed to determine the University of the Witwatersrand (WITS) anaesthetists’ knowledge of South African Law pertaining to informed consent. 167 willing anaesthetists answered 10 multiple choice questions (n=167) and the mean score achieved was 60.09% (SD 12.61%). The question testing The Mental Health Care Act No. 17 of 2002 achieved the highest mean score of 88.92% (SD=22.22%) while the questions testing The Children’s Act No. 38 of 2005 achieved the lowest mean score of 51.82% (SD=17.84%). Knowledge of The Choice of Termination of Pregnancy Act No. 92 of 1996 worsened with increasing years after graduation from medical school (p=0.0013) while knowledge of The Children’s Act No. 38 of 2005 correlated positively with professional designation (p=0.0004), increased years of anaesthetic experience (p=0.0180) and attendance at formal postgraduate teaching on informed consent (p=0.0080). Improved knowledge of The National Health Act No. 61 of 2003 correlated with higher professional designation (p=0.0120). Knowledge of The Mental Health Care Act No. 17 of 2002 (p=0.0276) and of The Sterilisation Act No. 44 of 1998 (p=0108) worsened with increasing years after graduation from medical school. Professional designation correlated with overall mean questionnaire score (p=0.0163), with those of higher professional designation performing better. This study revealed that formal postgraduate teaching on informed consent correlated with a higher mean questionnaire score and, by implication, improved knowledge. The mean score in the group of participants that had not attended formal postgraduate teaching on informed consent was lower than the group that had attended. Educational interventions to improve knowledge should be instituted to provide an optimal service to the patient and to reduce the burden of medicolegal claims.Item Building a culture of research in clinical medicine: an ethnography of professional aspiration, privilege and crisis at the intersection of hospital and University in South Africa(2019) Van Der Wiel, ReneeThis thesis is an ethnography of a group of medical doctors in South Africa who produce clinical research based on their patient practice. These clinician-researchers are scarce around the globe but praised as contributing indispensable clinical insights to research in an aim to improve healthcare. In South Africa government and professional bodies recently took action to expand and racially transform this elite of knowledge producers with the aim of remedying the country’s healthcare, perceived as being in crisis. My ethnography centres on the University of the Witwatersrand (Wits), specifically its School of Clinical Medicine, its associated teaching hospitals, and its attempts to grow a so-called culture of research among doctors. It is a reflection on the relationship between clinical practice and knowledge production at the intersection of resource-insecure public hospital and research-intensive university — both powerful state institutions with competing demands for doctors. Drawing on interviews and participant-observation I describe and analyse the aspiration, contestation, contingency, and actual work of research production among local clinicians. Overall this thesis indicates that the resource-insecure context in which clinicians produce knowledge creates the opportunity for and the value of their research. But this context simultaneously limits the scale, translation, and social good of their research, undermines the valour and expertise of clinician-researchers, and in cases bifurcates their knowledge production from their clinical experiences. This undercuts the pervasive imaginary of doctors’ clinical insights as fundamentally valuable to clinical research; and the potential of their research to improve healthcare for a population with a unique demographic and epidemiology by providing locally-embedded evidence for best practice, rather than relying on research from the global north. My evidence also indicates that publicly claimed professional aspiration to create a more inclusive democratic scientific community of doctors sits in tension with the often unacknowledged professional privilege many doctors have in the dispersed labour of research and does not fully reflect the unequal professional experiences and engagement that research doctors have in relation to gender, race, language, and locality. I argue that attempts to build a culture of research in clinical medicine sit uneasily within its larger institutional structures and historical context. My ethnography of “studying up” is relatively uncommon in South African anthropology. But I demonstrate that profession is a useful lens through which to study the relationship between power, knowledge, and human suffering, including the brutalisation of professionals, in post-apartheid institutional life. The thesis also highlights the personal and epistemological challenges of doing interpretivist research among a professionally-privileged, research-literate community that places great value on instrumental knowledge production.Item The molecular basis of the phenotype observed when normal cells recover from camptothecin and methyl pyruvate(2018) Monchusi, Bernice AndriecaCancer has become a major cause of death in modern society. New cancer cases are estimated to increase to 22.2 million by 2030. Many chemotherapeutic drugs, such as irinotecan, target the p53 pathway in rapidly dividing cells. However, chemotherapeutic drugs possess little discrimination between normal and cancer cells since they target DNA replication, a normal physiological process. Many studies indicate that cancer and normal cells prefer different glucose metabolic pathways. Cancer cells rely mainly on glycolysis while normal cells prefer the oxidative phosphorylation (OXPHOS). We hypothesise that manipulating the known metabolic programme of cancer cells to follow the OXPHOS pathway experienced by normal cells may alleviate side effects experienced by normal cells and accelerate cancer cell death. In order to enhance OXPHOS optimal pyruvate levels were used. To investigate the effect of this on normal and cancer cell division, cell viability and cytotoxicity was measured in real-time using xCELLigence technology. Flow cytometry was then used to determine the mode of cell death and cell cycle changes induced by the various treatments. In order to characterise the molecular bases of this, differential gene expression upon treatment with the various drugs was measured by RT-PCR and Western blot analysis. Furthermore, we conducted microarray analyses using the Human Cancer PathwayFinder array to determine pathways affected by the drug combination in A549 lung fibroblast cancer and a normal lung fibroblast (MRC-5). Differentially expressed genes with a fold change ≥ 2 were analysed by PANTHER, GeneMania and Reactome. Overall, this study shows that the reversal of the metabolic program in A549 and MDA-MB 231 cancer cells with chemotherapeutic agents accelerates the death of cancer cells while promoting the survival of normal MRC-5 cells. However, in the breast cancer cell line, MDA-MB 231 with mutant p53, it is observed that inhibition of proliferation is by another cell death mechanism. RT-PCR and western blot analyses indicate that introduction of exogenous methyl pyruvate enhanced the p53/p21 axis of the apoptotic pathway resulting in cancer cell death. While promoting survival in MRC-5 normal lung fibroblast cells by turning off the p53/p21 axis of the apoptotic pathway. Furthermore, the introduction of exogenous methyl pyruvate promotes MRC-5 cell proliferation by modulating the expression of RBBP6 isoform 1 and isoform 3. Microarray analysis indicates alterations in specific genes promote the survival and growth of MRC-5 normal cells and death of A549 lung cancer cells. This knowledge may provide an opportunity to protect patients who undergo chemotherapy from the harsh side-effects and increase the success rate of chemotherapeutic drugs.