3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An assessment of the impact of injuries due to assaults, gunshots and motor vehicle accidents on the admissions and costs of the Orthopaedic department at Addington hospital in Durban(2004) Lutge, Elizabeth EleanorThis research report examined the epidemiology of trauma in the orthopaedic ward at Addington hospital, Durban, over the year 2000. It also quantified the financial cost of trauma to this ward over the same period of time, using the “bottom up” costing method. The cost of trauma was also calculated using the “top down” method, as well as using tariff charges (used to bill patients with medical aid attending public hospitals). The overall cost of trauma to this ward for 2000 was found to be R5 440 964.20. A constant relationship was found between the costs as calculated using the three methods above.Item A cross sectional study investigating the functional movement screen score and injury status of triathlets(2017) Trent, Rodger LawrenceIntroduction: The popularity of triathlon as a multi-event sport is growing, however injuries can hinder the performance and delay the training regimen of those who participate in the sport. A screening tool such as the functional movement screen (FMS) may assist with early detection of these injuries. Therefore the main purpose of this study was to determine the relationship of injury status with FMS score in a group of South African triathletes. Methods: Sixty triathletes with a mean age of 38.8 ± 8.5 years volunteered and consented to participate in the study. Both male (n=28) and female (n=32) participants completed a history of injury questionnaire and performed the FMS. The questionnaire consisted of establishing number, site and cause of injury for each participant. The FMS is several fundamental movement patterns, scored on an ordinal of 3 to identify functional limitations or asymmetries. Results: Forty-nine of the participants reported sustaining injuries in the past six months. Twenty-four of these participants sustained more than one injury, with 31.7% (19.5%-43.8%) being acute injuries, while 48.3% (35.3%-61.3%) were overuse (or chronic) injuries. The majority of injuries sustained took place while running (for males it was 68%, and 74% for females). The mean FMS composite score for all participants was 14.5 ± 2.7. No relationships were found between the FMS scores of triathletes and injury (chronic or acute), (Chi (2)= 0.38; p=0.54). There were no significant statistical relationships found between the FMS score and injured versus non-injured groups, (Chi (2)=0.23, p=0.64). Conclusion: Previous injury of triathletes revealed a high prevalence of injury and a low overall average FMS score. However, no relationships were found between the FMS and previous injury, therefore the FMS cannot be used in isolation for determining injury incidence.Item The lower limb muscle activity and lumbo-pelvic movement control in soccer players: a matched case control study(2017) Roos, RialiBackground Soccer is a sport that is gaining in popularity in the elite and non-elite populations worldwide. As a result, the number of injuries in soccer is increasing. Hamstring injuries in particular, with a reported incidence rate as high as 63%, are of significant concern. Most hamstring injuries tend to occur during the swing phase of sprinting when hamstring activity is at its highest. As the speed of sprinting increases, greater mobility in the lumbo-pelvic area is required to maximise sprinting efficiency. Any abnormal or dysfunctional lumbo-pelvic movement during this phase could induce pain and hamstring injury. Lumbo-pelvic movement control dysfunction may therefore indirectly link abnormal lumbar spine movement to lumbo-pelvic pain and hamstring injury. The first aim of this study was to compare the performance of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles in soccer players, with and without recent hamstring injuries, while performing isometric contractions, a functional squat and sprinting. The study’s second aim was to compare lumbo-pelvic movement control in soccer players with and without recent hamstring injuries. Method Thirty soccer players were selected to participate in this study. Fifteen were assigned to the injured group and 15 to an uninjured group. The injured group comprised players who had sustained a hamstring injury six months prior to the research and who had partially returned to training, and the uninjured group comprised players with no recent hamstring injuries and who were actively involved in full training. Players were matched in respect of age, height, weight and playing position. All players gave informed written consent, completed the physical activity, training and injury questionnaire, and the Oslo hamstring injury questionnaire. Physical tests, which included isometric contraction of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles, a functional squat and a thirty-metre sprint were done. Muscle activity during these tests was recorded via electromyography (EMG). To determine the lumbo-pelvic movement control of the players, the dorsal pelvic tilt, waiter’s bow, one leg stand and prone knee bend tests were used. Cohen's d (parametric) and Spearman’s correlation coefficient (nonparametric) were used to calculate the effect size, and the Chi-square test and Fisher’s exact to analyse the lumbopelvic movement control data. To establish a statistical significance, the p-value of the study was set at p<0.05. Results EMG muscle activity during isometric contractions was lower in the erector spinae muscles (p=0.04) and biceps femoris muscle (p=0.02) of the injured group. Both these findings were statistically significant. There was no statistically significant difference in muscle activity during the functional squat between the study and uninjured groups. The results of the EMG activity in the thirty-metre sprint were determined to be significant as they demonstrated that the hamstring muscle (p=0.01) activation in the injured group was decreased in comparison with the uninjured group. During the performance of the lumbo-pelvic test, no association was found between the two groups in the dorsal pelvic tilt and one leg stand. The performance of the waiter’s bow (p=0.01) and prone knee bend (p=0.004) revealed statistically significant differences between the study and uninjured groups. The majority of the players in the injured group performed both of these functional tests incorrectly (WB n=10; PKB n=14). Conclusion The study found that the hamstring muscle is at great risk of injury during eccentric contraction of the hamstring muscles. This can be associated with poor lumbo-pelvic movement control, as the load on the hamstring muscle is increased to provide intersegmental stability around the neutral zone, the area of high spinal flexibility.Item Patterns of interpersonal violence presenting to a level one trauma centre in Johannesburg(2012) Asbury, Sarah LouiseTrauma and intentional injury form a major burden of disease in South Africa. This study examines the patterns of injury resulting from interpersonal violence presenting at a Level One trauma centre serving an urban population. This was a cross-sectional analysis of patients attending the Johannesburg Hospital Trauma Unit, over a period of forty-one consecutive days. In keeping with the worldwide experience of trauma care, the study showed the burden of trauma rests heavily upon young males. A majority of the incidents involved a weapon, used for penetrating or blunt injury. In cases where the weapon was documented, it was more commonly a weapon carried by one of the individuals involved such as a firearm or knife, than an item obtained spontaneously during the conflict. Patients subjected to weapon-based violence were significantly more likely to require advanced or invasive radiology, admission and operation. Weapon type influenced the pattern of injury sustained and the need for specialist consultation. It did not significantly affect admission or operation rates. Although blunt assault without a weapon may cause multiple injuries, they tended to be superficial injuries either allowing for discharge from the emergency room immediately or following a period of observation. This study showed the presence of a weapon greatly increases the morbidity resulting from the event for the patient and increases the subsequent cost to the healthcare system.Item Needlestick injuries at Kimberley Hospital Complex(2012-07-10) Loots, Johanna Jacoba MariaNeedlestick Injuries (NSI) that occur at Kimberley Hospital Complex (KHC) are reported by various categories of staff ranging from general workers to managers. They are regarded as medico-legal events and are classified as specific adverse events (AE). An AE is defined as any unexpected, unintended, unwanted event or circumstance that could have or did lead to unintended or unexpected harm, loss or damage. Although there were regular meetings related to NSI, there has been no systematic analysis of applicable data related to employees at KHC. The aim of this study was therefore to describe the NSI at KHC over a 1 year period (1 Jan 2009 – 31 Dec 2009) in order to obtain baseline information which will contribute towards improved planning of targeted preventive strategies in this setting. Methodology: A descriptive cross-sectional study was undertaken. This involved a retrospective review of selected hospital records relating to NSI reported by employees during this study period. No primary data was collected. Results: A total of 32 employees reported NSI during the study period. The prevalence of NSI was 2% of overall staff compliment. The highest reported prevalence was amongst the doctors (13, 10.4%) and the lowest amongst the general assistants (5, 0.6%). The majority of NSIs occurred during the recapping activity (20, 62.5%), was reported by female employees (27, 84.4%), took place mainly during normal working hours (23, 72%), and were mostly located within the Internal Medicine Department (10, 31.3%). About a third of the employees who reported NSIs were between 26 to 35 years (31%). The total treatment costs including drugs and vaccines provided during the study period were R 13 509.12, and the total laboratory test costs were R20 978.24. Overall the costs for drugs, vaccines and laboratory tests that made up the post-exposure measures amounted to R34 487.36. Results from this study suggest that reporting of NSI and other adverse events involving employees should be handled separately from those of patients. It is also important to profile the diverse employees that maybe at risk for this specific exposure and ensure that they are provided with the necessary training in this regard. There is a need to strengthen the relationship between the Quality Assurance Unit and the Wellness Clinic in order to optimize utilization of data regarding reported NSIs. Strategies to prevent NSIs should consider training on a regular basis and supervisors should work more closely with safety representatives in preventing NSIs.Item Injuries on duty at Klerksdorp/Tshepong/Potchefstroom Hospital Complex(2012-07-10) Tlhapi, Gloria TlhorisoBackground: The hospital as an organisation employs many people who may be at risk for Injuries on Duty (IOD). Although IOD occur across the hospital and impact on staff morale and quality of care, no formal study has been conducted within the public hospitals in South Africa on the profile of employees who have sustained these injuries. This study was aimed at comprehensively describing the IOD and related factors at Klerksdorp/Tshepong/Potchefstroom (K/T/P) Hospital Complex in order to better understand and plan appropriate preventive strategies. Methodology: The study was based on a cross-sectional design involving retrospective record review obtained from the hospital information system. No primary data was collected. The study setting was K/T/P Hospital complex. All records of employees who sustained IOD during the study period were reviewed. Data was collected on relevant variables such as employee profile, type of IOD during the study period. Descriptive statistics was used to analyse the data. Results: The study found that the total number of IOD during this period was 152. The annual prevalence rate was 2.3% (Klerksdorp-Tshepong Hospital Complex) and 2.8% (Potchefstroom Hospital). . The category of employees who experienced injuries were administration (5.3%), support (18.8%), medical (34.9%), nursing (36.2%), professional (4.6%). The types of the injuries sustained were cut (8.6%), fall (19.7%), minor injuries (9.2%), needle prick (49.3%), patient related (1.3%), splash (11.8%). With regard to PEP costs, Klerksdorp Hospital incurred the highest costs of R31 231 34, followed by Potchefstroom Hospital with R23 714 83 and Tshepong Hospital with R19 305 57 during the study periodItem An audit of injuries resulting from interpersonal violence at the Leratong Provincial Hospital, in 2009(2012-01-17) Saimen, AmashneeInterpersonal violence is a global health issue, the impact of which filters through every facet of society. Studies have shown that more than 1.6 million people die annually across the world as a result of violence; injured survivors may suffer from a range of physical, sexual, reproductive and mental health problems.3 The aim of this study is to describe the trends and profile of violence-related injuries originating in a South African community, with regard to the hospital records of an urban emergency department and crisis centre. Materials and Methods: A retrospective, descriptive study was conducted by reviewing patient files at Leratong Provincial Hospital. Relevant clinical information such as victim’s age and gender; time, date and day of hospital attendance; nature of injury; presence/absence of alcohol; and nature of weapon (if any) was extracted. Each patient record was given a unique study number and patient confidentiality was maintained at all times. The extracted information was recorded on a data sheet and analysed statistically. Results: Leratong Hospital sees a large number of patients with injuries due to interpersonal violence throughout the year, with an increase in May, November and December. Higher numbers of patients present in the last week of the month, and as found in other studies Saturday and Sundays experience the most hospital attendances due to interpersonal violence. Victims were predominantly male (64%), except in the case of sexual assault where the victims were all (100%) female; females also suffered more blunt injuries than penetrating injuries. Blunt injuries were the most frequent type of injury in the overall sample, although over the weekend males sustained more penetrating injuries than blunt injuries. Young males were noted to be the main victims of interpersonal violence, and possibly also the main perpetrators. Conclusion: This study highlights the trends in interpersonal violence injuries seen at Leratong Provincial Hospital. Young adults, especially males, are noted to be significantly affected by interpersonal violence.