3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The aetiology of acute traumatic occupational hand injuries seen at Chris Hani Baragwanath Academic Hospital(2017) Stewart, AndrewIntroduction: Acute traumatic occupational hand injuries are the second most common cause of all traumatic hand injuries in both developed and developing countries and the most commonly injured body part during occupational accidents. Traumatic hand injuries account for approximately one third of all traumatic injuries seen at state hospitals in South Africa. The aetiology of occupational hand injures in South Africa is unknown. Aim: The purpose of this research was to highlight the patient demographics and types of hand injuries sustained on duty and to identify the common causes and risk factors for these injuries. Materials and Methods: An observational cross sectional study was done at Chris Hani Baragwanath Academic Hospital (CHBAH) between January and July 2016. A total of 35 patients over the age of 18 years were interviewed using a specially designed questionnaire. Results: The results showed that the patients were predominantly male (88,5%) between the ages of 20 - 61 years old (average 35 years), 54% dropped out of school before grade 11. The average monthly income was low (R1000 - R9000 pm) and 85% were the primary breadwinner in the household. Only 51% of the patients had ‘formal’ employment, the rest were either selfemployed, contract workers or had intermittent ‘piece’ jobs. The majority of injuries occurred to machine operators, general manual labourers and construction workers. Of the patients, 80% had never received any occupation specific training and 71% of the patients were not using any gloves for protection at the time of injury. The three most common sources of injury were power tools, powered machines and building material. Lacerations, crush injuries and fractures were the most common type of injury seen, involving predominantly the index, !iv middle and ring finger. Twenty eight percent sustained minor injuries, 34% moderate, 20% severe and 17% major as defined by the Hand Injury Severity Score. Conclusion: Patients with traumatic work related hand injuries are poorly trained and often aren’t provided with protective gloves. They typically injure their index, middle and ring finger using either a power tool, powered machine or by handling building material. The injuries sustained are most commonly lacerations, fractures and crush injuries. As a result, occupational health and safety must be improved to reduce the socio-economic burden of these injuries. Novel ways of improving safety in the informal labour market are requiredItem An audit of analgesic use for hand injuries in a private emergency department in Johannesburg(2014-04-25) Maloney, Jan RustObjectives: To describe the current analgesic practices for hand injuries used at a private hospital emergency department in Johannesburg, Gauteng and to explore any differences in analgesic practice between different doctor groups with different backgrounds, working in the ED. Design: Retrospective descriptive review. Setting: Private hospital emergency department in Johannesburg. Patients: A study sample of 423 patients who presented to the emergency department with hand injuries during 2010. Methods: The emergency department register was used to identify patients who presented with hand injuries. The clinical notes and where appropriate, nursing notes of the identified patients were reviewed. Main Results: Hand injuries were found to represent 9.3% of patients presenting to the emergency department. The most commonly used form of analgesia for hand injuries was found to be nerve blocks, which constituted 30% of the analgesic use. Digital blocks were the most frequently used block accounting for 69% of all nerve blocks done. Parenteral analgesia was the second most common form of analgesia implemented with the intramuscular route being most favoured. Specialised techniques such as nerve blocks are possibly underutilised by doctors with less surgical and emergency department experience. Conclusions: Analgesic practices between different doctor groups are varied. Standardising pain management for hand injuries should lead to improved utilisation of techniques such as nerve blocks. Guidelines should be available and include nerve block techniques. Training should be provided to doctors who are unfamiliar with the use of additional modalities such as nerve blocks.Item Understanding the occupational therapists use of splinting the affected hand of adult patients with neurological injuries(2014-04-23) Chazen, Lee-AnneABSTRACT This study explored the clinical reasoning expert therapists use in relation to splinting the affected hand following neurological injury. An exploratory, descriptive, qualitative methodology was used in three focus groups with occupational therapists, experienced in neurorehabilitation. Data was analysed based on priori themes, specifically 1. The Model of Practice Development (Higgs and Titchen 2001b) - most value was placed on Procedural knowledge or clinical experience; reflection on protocols, working with and learning from others and having clear outcomes. Undergraduate training and current literature is insufficient to provide guidelines for practice. 2. The Three Track Model of Clinical Reasoning (Fleming 1991) –splinting was used to improve range of motion, maintain muscle length and affect muscle tone. Effectiveness of the splints depended on the patient’s response and the therapists’ ability to adapt to preferences and goals. Interactive reasoning was essential in understanding the South African context. The study provided guidelines for a newly qualified therapist.