3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Systemic lupus erythematosus: the Johannesburg experience
    (1986) Morrison, Richard C. A.
    This study is a predominantly retrospective analysis of patients in Johannesburg who presented with Systemic Lupus Erythematosus at 12 years of age or older. Johannesburg is situated at high altitude and has a high level of ultraviolet light irradiation/ a known exacerbating factor of the disease. This study draws comparisons with reported disease characteristics of lupus patients elsewhere in the world. In addition/ it examines differences in the clinical manifestations of the disease amongst the principle South African racial groups.
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    Inter-rater variability between anaesthetists when classifying patients the american society of anesthesiologists physical status (ASA-PS) classification system
    (2018) Soni, Zaheera Jalaluddin
    Background Anaesthetists convey the physical state of patients by use of the American Society of Anaesthesiologists Physical Status classification system (ASA-PS). It is a simple, popular tool with many uses, but not without fault, where variation between anaesthetists when classifying patients exists. To date there is no South African study comparing inter-rater variability between anaesthetists particularly between junior and senior anaesthetists. Our study includes scenarios with patients with Human Immunodeficiency Virus (HIV). A „modifier‟ and it‟s level of acceptance is also proposed. Method A questionnaire comprising of two parts was distributed. The first part assessed demographics and attitude towards a proposed “modifier” and the second consisted of ten hypothetical case scenarios which were created to incorporate a wide variety of conditions including Human Immunodeficiency Virus (HIV). Results After receiving 134 of the 200 questionnaires distributed, 132 were analysed. There were 93 juniors and 39 seniors. A Cohen‟s kappa statistic over all the scenarios of 0.23 (fair agreement) was determined. In none of the scenarios was there complete agreement. In each case there was a majority viewpoint shared by both juniors and seniors except Scenario 2. Large ranges were found in scenarios which included pregnant, geriatric and emergency patients. Conclusion Results are in keeping with other studies. Inter-rater variability is prevalent despite guidelines being available. A simple modifier such as letter “G” denoting a gravid patient may be acceptable
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    Investigation of the role of human parvovirus B19 in chronic anaemia of hiv infected TB patients
    (1994-09-30) van Niekerk, Albetus. Bernhardus. Willer.
    This study was undertaken to determine the role of human parvovirus B19 (B19) in chronic anaemia of HIV infected TB patients. Patients were selected from an existing databank of 307 patients included in a MRC HIV/TB study. Twenty-nine patients, 15 coinfected with HIV/TB and 14 infected with TB only, were identified for further evaluation. These patients’ sera were subjected to serological and DNA detection studies using IgG and IgM ELISA methods and a nested polymerase chain reaction (PCR) assay.
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    Benzodiazepine use in elderly residents of a ritirement village in Sandton: Knowledge, attitudes and perceptions of the patients, the nursing staff and the prescribing doctors
    (2003-08-26) Lambson, Meryl, Anne
    Residents of a Retirement Village (Rosehaven), in both the frail and the non-frail sections, were the subjects for this study. They were interviewed to determine demographic characteristics and attitude towards sleep and sleep problems. Subjects living in the frail care facility were compared to those living independently. In addition, the chronic use of benzodiazepines, and the perceptions of both the subjects, and the medical and nursing personnel caring for them, was studied. The physical and mental status of subjects currently taking benzodiazepines was compared with those who were not. No significant differences in demographic features, was found between the frail and the non-frail subjects. However, when subjects taking benzodiazepines were compared with those who were not, several interesting differences were determined. Frail subjects were more likely to be taking benzodiazepines. Sleep difficulties, and perception of poor sleep quality was more likely in the benzodiazepine group. Subjects taking benzodiazepines were more likely to be anxious, and to have suffered falls and resulting injuries. The daily functioning of subjects was rated using three well-validated scales: Instrumental Activities of Daily Living, Mini Mental State Examination, and the Geriatric Depression scale. Those subjects taking benzodiazepines scored significantly worse on all of these scales, independent of frail status (i.e. within both frail and nonfrail groups, subjects taking benzodiazepines scored significantly worse). In spite of the above findings, subjects’ perception of benzodiazepines was positive, and they believed them to be helpful. Nursing staff also perceived benzodiazepines to be beneficial medications. Most of the general practitioners questioned had doubts as to the safety of benzodiazepine use in elderly patients, however they were also generally happy to continue to prescribe them.
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    The effectiveness of lycra compression garments on the upper limb in patients with stroke
    (2017) Naubereit, Carene
    Introduction: Lycra compression garments have been documented as beneficial in affecting spasticity in children with cerebral palsy but there is little research on the use of Lycra compression garments in adults with neurological conditions. Thus, the purpose of this study was to explore the effectiveness of Lycra compression garments on motor function and functional use of the upper limb, in patients with stroke. Methods: A randomised control design with a control or intervention group was used. Both groups received routine upper limb rehabilitation while the experimental group also received a custom Lycra compression garment worn for a minimum of six hours a day. Results: Change between an initial assessment and assessment at six weeks, was measured on the Fugl-Meyer Assessment of Motor Recovery (FMA) and The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). While both groups had significant improvement in upper limb movement, statistically significant differences for change in total motor function, wrist and hand movement and coordination were found when the experimental group and the control group were compared. Small differences in measurements of pain, passive range of motion, sensation and functional use of the upper limb were found between the two groups. Conclusion: Results indicate that Lycra compression garments may be beneficial in facilitating the return of movement in the upper limb in individuals with stroke.
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    A retrospective record review of patients secluded at a tertiary psychiatric hospital
    (2014-04-10) Chiba, Gaveeta
    This study aims to determine the number of patients secluded over a specified period, provide a profile of patients that are likely to be secluded, and to ascertain the reasons for seclusion. Seclusion in the psychiatric context can be defined as the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. There are differing views on seclusion and consequently this has presented clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. In light of this, alternatives to seclusion have been explored. No data exists in South Africa on rates of seclusion for psychiatric purposes, and consequently neither the need for seclusion nor alternatives to seclusion have been explored. The study is a retrospective review of patients secluded at Sterkfontein Hospital, a tertiary psychiatric hospital, over a six month period. Data was collected from clinical records at Sterkfontein Hospital. RESULTS: 112 patients were secluded over the 6 month period. Users were secluded for a total of 59415.5 hours and on 4814 separate occasions. 84.8% of the users secluded were male. The mean age of users secluded was 29years. Just over half the users (52%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The commonest diagnosis was Schizophrenia (31.4%) followed by Cognitive Impairment (20.6%) and Bipolar Mood Disorder (13.7%). The most commonly used medication was Sodium Valproate (17%), followed by Haloperidol (11%) and Risperidone (11%). CONCLUSION: Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion in terms of rates and patient profiles so that we may improve seclusion practices.
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    Perceptions and experiences of antiretroviral treatment (ART) of patients in Themba Lethu Clinic in Johannesburg : an exploratory study.
    (2012-08-29) Mongwenyana, Constance
    Background – The researcher conducted an explorative, qualitative study to identify the perceptions and experiences about ART of patients currently on treatment at Themba Lethu clinic (TLC) in Johannesburg in order to establish strategies to decrease the high level of non-adherence to antiretroviral therapy (ART). This study included 30 HIV positive patients on ART who came to Themba Lethu clinic for their regular clinic visit. The researcher used the purposive sampling procedure to target particular individuals and categories of individuals for investigation. Interviews and questionnaires were used as a method of collecting primary information. The researcher posed a series of questions to willing participants about their characteristics, opinions, attitudes, or previous experiences by and tabulates their answers. Results – The research finds that the participants ‘ages ranged from 26 – 62 years (M = 39.4). The participants stay in the suburbs around Johannesburg in Gauteng and 77% of them have been living there for more than 5 years. Only 40% of these patients were originally born in Gauteng while others come from different provinces in South Africa including some of the sub-Saharan countries (13%). The participants were less likely to have completed secondary education but were more likely to have completed Matric. 30% of participants are afraid of stigma, 40% are concerned about side-effects, 33.33% believes that ART cures AIDS, 70 % are non-adherent and 20% visited traditional healers while on ART. Conclusion – There must be on-going education, counseling and support to increase adherence and decrease the clinic loss to follow-ups. Intervention to improve care and treatment should utilize the role of traditional healers to reduce the disease progression and to improve adherence to ART. Traditional healers could also work more closely with modern health professionals to provide AIDS information and evaluation of HIV/AIDS symptoms.
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