3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
Search Results
Item A radiation dose review for paediatric fluoroscopy in an Academic South African referral hospital(2017) Venter, MauritzINTRODUCTION Children are more sensitive to radiation and it is therefore important to reduce their exposure. There are currently no published data on South African paediatric fluoroscopic upper GIT, contrasted enemas and vesico-urethrogram dosage reference levels. AIM To determine the dose area product (DAP) values in common paediatric fluoroscopic examinations: Upper GIT studies, contrasted enemas and vesico-urethrograms. The primary endpoint was comparing our median and upper third quartile DAP values to international standards. METHOD We adhere to the Radiological Society of South Africa (RSSA)/South African Society of Paediatric Imaging’s (SASPI) guidelines to minimise radiation exposure. The upper third quartile and mean DAP values were collected between March 2013 and March 2016 for each study, categorised into four age groups (0–1, 2–5, 6–10 and 11–15 years) and stratified by our three major examinations. The data were compared to literature from the National UK Radiological Protection Board. RESULTS DAP values for upper GIT studies were significantly lower in the three younger age groups. There was no significant difference in the oldest age group. DAP values for vesico-urethrograms were significantly lower in the youngest age group. There was no significant difference in the three older age groups. For our contrasted enemas, there were no suitable data for comparison. CONCLUSION By following the RSSA / SASPI guidelines, our overall DAP values compared better than the UK National Patient Dose Database in the younger age groups and no worse in the older age groups.Item An audit of pneumatic reduction in paediatric ileo-colic intussusception cases at Chris Hani Baragwanath and Charlotte Maxeke Johannesburg academic hospitals(2017) Pillay, ParushaINTRODUCTION: Intussusceptions may cause significant morbidity and mortality if not treated timeously. One method of conservative management is pneumatic reduction, the outcome of which is dependent on a number of factors. AIM: To determine the proportion of children with intussusception who have evidence of bowel obstruction on initial abdominal radiograph, and the failure rate of pneumatic reduction in patients with and without bowel obstruction. The study also looked into whether there were any associations between the radiological presence or absence of bowel obstruction and pneumatic reduction outcome, the finding of necrotic bowel at surgery, and CRP and WCC levels. METHOD: A retrospective study was performed using an existent paediatric surgery intussusception database. Three different readers read the baseline abdominal radiographs and subjectively determined whether bowel obstruction was present or not. Treatment choices, outcomes of the pneumatic reduction, and if available, clinical presentation and lab results were captured from the patient’s discharge summary and NHLS portal. RESULTS: A sample size of 45 patients was studied. The median age of presentation was 7 months, with 83% of the patients having had symptoms for 3 days or less. 80% of patients had bowel obstruction on initial X-ray, and of these patients, only 17% had successful pneumatic reduction. No significant association was found between bowel obstruction and the presence/absence of necrotic bowel. 64% had their symptoms documented, and only 26 % and 42 % had CRP and WCC documented respectively, which did not meet sample size requirements. CONCLUSIONS: Even though a strong association was shown between evidence of bowel obstruction and pneumatic reduction outcome, the sample study was too small to make between-group comparisons. Due to this limitation, it is recommended that further investigation be done, possibly by including patients from other South African tertiary hospitals in order to obtain statistically significant results.Item Parents'/caregivers' and rehabilitation professionals' perspectives of occupational performance of children with cerebral palsy: a comparative study(2017) Chigonda, BeniginerThe study sought to compare the caregivers’ evaluation of the occupational performance and assistance needed by children with cerebral palsy (CP) to that of treating therapists to ascertain agreement about the children’s strengths/weaknesses so goals for intervention can be set. The Paediatric Evaluation of Disability Inventory (PEDI) parent/caregiver and therapist scores of 50 children with CP in Harare aged four to six and half years were analysed. The association between PEDI scores and the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels as well as the internal consistency of the PEDI for this sample were also determined. Correlations for the caregivers’ and therapists’ scores on the PEDI were strong to excellent. A marked decrease in functional skills on the PEDI was noted in relation to the GMFCS and MACS levels with a negative moderate correlation between the PEDI scores and the GMFCS levels for self care, a negative strong correlation for mobility but a negative weak correlation for social function. The similarity of scores indicates positive correlation that allows for collaborative goal setting and Family Centred Therapy with these children. Internal consistency was excellent for all functional skills domains and caregiver assistance.