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

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Subject: search.filters.subject.Substance abuse--Treatment

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    Attitudes towards individuals with substance use disorders: the impact of knowledge and the moderating effects of exposure
    (2018) Dennis, Simone
    The current study aimed to explore whether or not levels of substance use disorder-related knowledge is associated with attitudes towards people with Substance Use Disorders (SUDs) through a convenience sample of young adult psychology students registered at the University of the Witwatersrand (Wits). This research particularly sought to explore the potential moderating effects of exposure to people with SUDs in this relationship. METHOD: The convenience sample employed in this study comprised 253 participants, all of whom completed an online survey which included a brief demographic questionnaire, a questionnaire measuring SUD-related knowledge, a questionnaire measuring SUD-related exposure, and a questionnaire measuring SUD-related attitudes. RESULTS: The results of the study indicated that, on average, the current sample evidenced positive SUD-related attitudes across more domains than not. Additionally, SUD-related knowledge amongst participants in this study appeared to be somewhat limited. The results suggest that exposure to SUDs amongst the participants is varied and that significant links exist between SUD-related attitudes and exposure. Furthermore, the results call to question the extent to which SUD-related knowledge alone impacts on attitudes towards SUDs. CONCLUSIONS: The primary implication of these findings relates to the SUD-specific training of health professionals. This research suggests the inadequacy of such knowledge-focused training and motivates for the incorporation of exposure to real individuals living with SUDs in such training programmes.
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    a clinical ausit of selected predictors of mortality of patients admitted to Charlotte Maxeke Johannesburg academic hospital intensive care unit with human immunodeficiency virus and tuberculosis co-infection
    (2019) Singh, Avani
    Background: The high level of co-morbid TB/HIV cases with severe organ failure on presentation in South Africa, results in an increased number of ICU admissions often with a poor prognosis at presentation. In this study, the aim was to identify patients admitted with HIV/TB co-infection and calculate the APACHE II scores and SOFA scores for each patient. Predicted percentage mortality was compared with actual mortality. Predictors of mortality were further identified, as well as the benefit of initiating ARV treatment in patients who are ARV naive upon admission to ICU. Methods: A retrospective audit of consecutive cases over a 24 month period was completed. Patient demographics; CD 4 count; ARV treatment status; ICU and 30 day mortality; the APACHE II Score; SOFA scores and correlating predicted percentage mortality were documented. The survival of patients was assessed using Kaplan Meier survival curves, and a univariate analysis was performed to identify risk factors for mortality. Calculated predicted mortality was compared with actual mortality to validate each scoring system and infer which was the better tool. Results: Of 75 patients admitted with pulmonary (43 cases) or extra-pulmonary (32 cases) TB, 23 died in the ICU (mortality 30,7%), and a further 10 died in the first 30 days of hospitalisation (30 day mortality 44%). A survival analysis established ARV treatment and CD 4 counts greater than 50 cells/mm3 were associated with a higher survival rate at any point of the analysis. In the entire study period, only 2 patients were initiated on ARV therapy during their ICU stay, 1 survived to discharge and 1 died in ICU. The APACHE II Predicted Mortality was within the 95% Confidence Intervals for all groups while the SOFA score was outside the upper bound limit of the 95% confidence intervals of actual mortality for those patients taking ARV treatment (52%, 95% CI 43,1% - 59,5% vs actual mortality 30%, 95% CI 17,7% - 46,1%), those with a CD 4 count of more than 50 (53,5% 95% CI 45,4% - 60,6% vs actual mortality 34%, 95% CI 22,1% - 48,4%) and female patients (51,2%, 95% CI 41,6% - 58,1% vs actual mortality 35,1%, 95% CI 21,4% - 50,4%). Conclusion: The study found that both the APACHE II and SOFA scoring systems were both statistically significant in prognosticating mortality in the study population. The APACHE II scoring system however showed a slightly improved prognostication in specific cohorts who had improved survival. It was also confirmed that patients with a CD 4 count of more than 50 cells/mm3, and those on ARV therapy had a statistically significant improved mortality. Further studies reviewing survival benefit of ARV initiation in ICU are warranted. ACKNOWLEDGEMENTS Supervisor: Prof GA Richards Co-Supervisor: Dr SHH Mohamadali Statistician: Mr MH Zondi Assistant - Data Collection: Ms S Madanlall
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