3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The survival status of People with Spinal Cord Afflictions following discharge from a Gauteng Provincial Government Hospital(2017) Burger, Elizabeth MargarethaBackground: A spinal cord affliction is defined as an insult to the spinal cord, and encompasses both traumatic and non-traumatic disruption to the spinal cord. There is a dearth of information on the epidemiology of spinal cord afflictions in low- and middle-income countries (LMIC) or the survival status of these individuals following discharge from hospitals. This study was conducted to determine the survival status of patients with spinal cord afflictions following discharge from a South African public sector academic hospital. Study design: This was a cross-sectional study, consisting of a five-year retrospective record review for the period 1 January 2008 until 31 December 2012, and follow up of surviving patients at their homes. Objectives: The objectives of the study were to: describe the demographic profile of People with Spinal Cord Afflictions (PSCA) discharged from the Dr George Mukhari Hospital Academic (DGMAH) Spinal Unit; determine the medical background information of all PSCA discharged; describe the environmental conditions faced by PSCA after discharge; and determine the survival status of PSCA following discharge from hospital. Setting: A public sector academic hospital, the DGMAH, in the Gauteng Province of South Africa. Methods: Using a cross-sectional study design, a record review was conducted of all PSCA admitted and treated at the DGMAH spinal unit for the period 1 January 2008 until 31 December 2012. A structured, pre-tested questionnaire was used to obtain demographic, medical and environmental information of PSCA. The patients admitted during the study period and known to be alive were contacted. During a home visit, a semi-structured questionnaire was completed with PSCAs. Descriptive data analysis was done using Microsoft Excel and Statistica ® 13. Results: A total of 264 records were reviewed and 55/264 (20.8%) of patients passed away during hospital stay. The mean age of all patients discharged during the review period was 37, standard deviation (SD) 15.3. The majority of patients discharged were male (66.3 %). In terms of medical profile, 45 % (94) had a TSCA and 48.3% (101) a NTSCA, with 6.7% (14) v unknown. The leading cause of TSCA was road traffic accidents (RTAs) at 63.7%, while tuberculosis (TB) was the leading cause for NTSCA at 43.3%. An additional 19 patients are known to have died following discharge from hospital. There was very high non-response rate of 57.8 % (n: 152) and only 19 patients were visited in their homes Conclusion: Patients with TSCAs were on average 10 years younger than those with NTSCAs. The study found that RTAs and TB were the leading causes of TSCAs and NTSCAs respectively, suggesting the need for a broader public health approach with prevention at its core. The high non-response rate suggests the need for improved hospital information systems to monitor patient outcomes after discharge. Key words: Spinal cord affliction, non-traumatic, traumatic, demographic, medical, environmental.Item The relationships between pain and sleep in spinal cord injury patients(2016) Pillay, Diana SubramonySpinal cord injury (SCI) is a devastating injury affecting many South Africans. The purpose of the study was to investigate the relationship between SCI pain and sleep issues during acute inpatient rehabilitation. Seventeen participants were recruited. There were 2 interviews in the study; the 1st interview was done on the day participants were recruited. The 2nd interview was conducted a day before participants were discharged. The time elapsed between the first and second interview was 7.9±2.4. The patients were discharged from the Auckland Rehabilitation hospital (Hope ward). In the 2nd interview the questionnaires for pain, sleep and mood measures were repeated, and two additional questions were asked and the answers recorded for analysis of content. The key findings were; majority of the participants were Black, male (82%). The main cause of traumatic SCI was motor vehicle accident (59%). The common sites of injury were in the legs and neck/shoulder areas in both assessment (admission and discharge). The verbal descriptors that were commonly chosen in both assessments were, “sharp, shooting and tight.” Below level neuropathic pain, followed by musculoskeletal pain were the common types of pain reported. Pain interference was reported greatest in sleep and on average pain intensity was moderate (4-6 on 11-point Numerical Rating Scale). Strong correlations and positive relationships between Pain Catastrophizing Scale and subscales, and with the Pittsburgh Insomnia Rating total scale and subscales were reported in this study. Environmental factors were reported to affect sleep. A high incidence of Restless Leg Syndrome was reported in this study (24%). Depression was commonly reported by participants in both assessments. No significant association was found for the measures of sleep, Restless Leg Syndrome, depression and quality of life and the injury characteristics that were assessed. Significant associations were found at the 95% confidence levels for pain scores and injury characteristics (completeness of injury, level of injury and pain sites). Further studies in this area of pain and sleep management is warranted. It is important that clinicians and researchers in this area find appropriate management for secondary issues which have a severe impact on the daily activities of SCI people, decreasing their quality of life. Key words: SCI pain, sleep disturbances, mood