School of Therapeutic Sciences (ETDs)

Permanent URI for this communityhttps://hdl.handle.net/10539/37954

Browse

Now showing 1 - 20 of 36

A Framework for Integrating Simulation into the Bachelor of Nursing Science Programme in Eswatini
(University of the Witwatersrand, Johannesburg, 2024) Shongwe, Sithembile Siphiwe; Armstrong, Susan J.
Background: Simulation-based education is a required pedagogical method for preparing undergraduate students to become nurses. Its ultimate goal is to develop practice-ready professionals rather than introduce the latest technology into training. In Eswatini, simulation is used; however, no framework guides nursing education institutions on how to integrate simulation into their educational programmes to enhance clinical teaching and learning effectively. Purpose: The aim of this study was to develop a framework for integrating simulation into the Bachelor of Nursing Science programme in Eswatini. Research methods: A mixed methods approach utilising multilevel designs guided the inquiry process. Inferences drawn from the various strands of the mixed methods data were integrated to address the study problem. Phase one was a scoping review conducted to explore best practices of simulation-based education in the educational preparation of undergraduate nursing students locally (sub-Saharan Africa) and internationally. A Joanna Briggs Institute methodological approach guided the research process. Sixty articles were included in this scoping review. Phase two was a survey study conducted to assess the state of simulation use in the educational preparation of Bachelor of Nursing Science Students in Eswatini through auditing four (4) simulation laboratories (Study A) and a survey with (n=46) nurse educators, a census (total) sampling technique was used to select the study participants. Phase three used an iterative process together with simulation experts (n=2) to develop the framework and to identify activities to consider when integrating simulation in Eswatini. These were sourced from tabulated lessons learned or inferences drawn based on the findings of phases 1 and 2. The NLN Jeffries simulation theory guided the development of the framework. In phase four, Eswatini nurse educator experts (n=16) evaluated the framework’s utility in a Delphi study completed in two rounds. Findings: In phase one, best practices principal to simulation-based education emerged. The study findings were inductively developed, resulting in four core codes, namely: (i) lecturer preparation, (ii) student elements, (iii) designing simulations and (iv) innovations in simulation. Ninety-five per cent (95%) of the literature was from international settings compared to 5% from the African context. Phase two: Eswatini nursing education institutions were somewhat ready for simulation; this status was attributed to the lack of trained educators in simulation principles, a lack of financial and resource planning and limited infrastructure and equipment for supporting simulation-based education. Phase three: a framework with the following five domains was developed to guide the process of integrating simulation into the Nursing Education programme in Eswatini: Training or preparation of educators; Integration of simulation into the nursing/midwifery programme; Simulation equipment; Simulation infrastructure; and Student/simulation participants. Phase four: Eswatini nurse educators found the framework relevant and suggested feasible strategies for the Eswatini nursing education context. The strategies included sensitising management to increase simulation-based education support and sourcing funding for procuring equipment and infrastructure development. Conclusion: The framework for integrating simulation into the Bachelor of Nursing Science Programme was designed to allow a step-by-step implementation approach due to existing contextual challenges. The challenges include a lack of trained educators/lecturers on simulation-based education principles, an absence of simulation champions, insufficient equipment, infrastructure inadequacies, fiscal constraints and dwindling management support. The framework can potentially guide the successful integration of effective simulation into Eswatini nursing education institutions. Recommendations: There is a need for the current nurse educators to be trained in the simulation teaching and learning strategy to ensure the effective use of simulation-based education. Nursing education institutions must develop financial plans for funding the required simulation resources (educators’ training, equipment and infrastructure) to ensure the sustainability of simulation-based education
A psychosocial support programme for caregivers of children with developmental disabilities in Ghana
(University of the Witwatersrand, Johannesburg, 2024) Abeasi, Doreen asantewa; Nkosi, Nokuthula Gloria
Background: Informal caregivers, mainly family members of children diagnosed with developmental disabilities [DD], are often left with the responsibility of caregiving. Usually, they receive little or no training, have no time to prepare for the caregiving role, or do not have adequate resources to carry out their responsibilities as caregivers. The complex nature of care and its continuous nature make caregiving stressful, leading to adverse health effects on caregiver’s and child with DD. Aim: The current study’s main goal was to develop a psychosocial support programme for caregivers of children with DD in the Ghanaian context to improve their wellbeing. Methodology: A multi-method research design was employed in this study. This study was organized into three phases. In phase one, a qualitative study and scoping review were done. The phenomenological design was used to explore experiences and needs of caregivers, which influenced the components of the psychosocial support programme. A scoping review was conducted to inform the psychosocial support programme’s design and structure. Phase two consisted of developing the components of the psychosocial support programme by triangulating the results of phase one, guided by the Medical Research Council [MRC] framework for development of complex interventions. Phase three involved the pilot testing and evaluation of the support programme. Results: Phase one a of the study revealed that caregivers mainly saw caregiving as stressful and time-consuming. Five themes were generated, namely: perception of caregiving, stressors, caregiver needs, negative health outcomes and coping resources. Different caregiver support programmes were reviewed from included studies in the scoping review, which were varied in the scope of interest. All the studies were conducted in lower- and middle-income countries. A psychosocial support programme referred to as Caregiver Well-being Improvement [CaWELLIS] programme was developed, confirmed by a group of experts, and implemented for caregivers of children with developmental disabilities in Ghana. There was improvement in caregiver outcomes, namely; stress, burden, anxiety, depression, support, blood pressure, and cortisol levels. Conclusion: The study provided evidence that the CaWELLIS programme had a positive influence on stress, the primary outcome of the study, as well as on secondary outcomes like vanxiety, depression, burden, and blood pressure levels. The CaWELLIS programme is a comprehensive, context-specific programme that has the potential to respond to the needs of caregivers of children with DD. The use of a one group pre-test post-test design to evaluate the effectiveness of the CaWELLIS programme has some limitations, therefore the gold standard of randomised control trial is suggested for future research.
A retrospective review on the utilisation of meropenem in a tertiary hospital setting
(University of the Witwatersrand, Johannesburg, 2024) Mohun, Shameeda
Introduction: The discovery of antibiotics is widely regarded as a groundbreaking accomplishment in the medical industry, as it has facilitated the elimination of countless diseases. Nonetheless, the overuse and reckless consumption of these medicines have led to a global upsurge in antibiotic resistance, particularly in broad-spectrum antibiotics such as meropenem, which are often prescribed for severe infections. Aim: The aim was, therefore, to assess the utilisation trends of meropenem in treating patients at a tertiary hospital located in the North-West Province of South Africa. Methodology: This study involved a retrospective review of hospital records at a 396-bed tertiary hospital in the public sector of South Africa, for patients who were prescribed meropenem between January and December 2021. A total of 218 patient files were included in the analysis after removing the duplicates and incomplete files. Variables investigated were patient demographics, prescribing criteria, diagnosis, treatment indication, microorganisms, and sensitivity cultures, as well as the appropriateness of prescribing. Descriptive statistics were employed to analyse the data. Results: Meropenem was primarily used empirically in adult patients (65.1%), while clinicians treating paediatric patients generally reserved its use for definitive cases (55.1%). Recording of the source of infection was poor with 72.1% of adults and 96.6% of paediatrics lacking such documentation. Although all prescriptions analysed were deemed valid, only a small percentage of treatments were considered appropriate (3.1% in adults). The study also revealed that clinicians frequently ordered microbiological cultures and blood sensitivity tests prior to administering antibiotics, at rates of 50.4% in adults and 71.9% in paediatrics. Notably, the most cultured bacteria were Klebsiella pneumoniae (25.2%) in paediatric patients and Acinetobacter species (25.0%) in adults. Conclusion: The study's results reveal a clear contrast between suggested protocols and clinical practices in the real world, stressing the pressing need for effective antimicrobial strategies to counter the growing threat of meropenem resistance. Several areas of concern were identified, including non-adherence to guidelines, insufficient step-down therapy, and incomplete documentation. Despite being a broad-spectrum antibiotic intended for definitive diagnoses, meropenem is often prescribed empirically, further highlighting the need for continuous medical education, practical therapeutic committees, and frequent drug utilisation evaluations to tackle this issue
A Survey of the Delivery of Clinical Services in Independent Community Pharmacies in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Ismail, Tahir; Khan, Razeeya
Introduction The community pharmacists' role has evolved from traditional medicine dispensing to patient- centred service provision. Community pharmacy clinical service provision is an integral component of public health intervention and contributes to universal health coverage. The extent of clinical services offered in community pharmacies in South Africa has yet to be studied. Assessing the extent of clinical service provision in community pharmacies provides insight into the willingness of South African pharmacists to deliver these services. Aim This study aimed to identify the clinical services offered in independent community pharmacies in South Africa and the extent to which these services are available. In addition, the willingness to provide clinical services and the barriers to service provision were also assessed. Methodology A quantitative, cross-sectional exploratory research design was used. Responsible pharmacists of the Independent Community Pharmacy Association member pharmacies were invited to participate in an anonymous electronic REDCap© survey from September 2022 to March 2023. Data was exported to Microsoft Excel® and analysed using descriptive statistics. Results Of the 156 responses received, most were located in urban areas (70%) and based in Gauteng (34.8%). The most frequently delivered clinical services were diabetes screening (88.9%), blood pressure measurement (80.8%) and Influenza vaccination (78.9%). Clinical services were primarily delivered by a pharmacist (39.5%), with most pharmacists (94.7%) willing to implement additional clinical services. However, lack of time and remunerations for services (57.1%) were identified as barriers to implementation. Most pharmacists also expressed an interest in additional training to improve clinical skills. Conclusion This study revealed the extent of clinical service delivery in independent community pharmacies in South Africa. Although community pharmacists are willing to provide clinical services, significant barriers limit these interventions. This study also informs service providers of training programmes that need to be developed to meet the specific needs of independent community pharmacists. Further research must address how the barriers identified may be mitigated to facilitate clinical service implementation in community pharmacies
A thermo-responsive scleral device for the management of ocular tumours
(University of the Witwatersrand, Johannesburg, 2024) Abdalla, Yosra Mahjoub Ahmed
Several ocular diseases that lead to blindness could benefit from effective treatment delivery to the site of action. Efficacy, however, remains restricted due to the multiple static and dynamic barriers present in the eye, despite substantial study into administration procedures and delivery vehicle. Ocular tumours are a broad group of diseases that range from benign to malignant and that occur in different anatomical regions within the eye. Ocular surface tumours are tumours of the conjunctiva of the eye and are therefore readily accessible for drug delivery. The management of ocular tumours is faced with the challenge of developing a suitable treatment strategy that meets individual patient needs, considering their anatomical location. Foremost is the need to develop strategies with high benefit to risk ratios. This is closely followed by the need to develop therapies that improve patient compliance while limiting the need for frequent hospital visits. Thirdly, the high cost of immune-therapeutic agents currently used for the management such as interferon demands sustained release strategies that deliver the same efficacy from much lower doses. Interferon alpha has been used to treat patients with ocular tumours for decades; however, its short half-life and poor tolerability necessitate frequent administration. This novel study employed a pH responsive/protective nanoparticle embedded into a thermo-responsive hydrogel for site-specific IFN-α2b delivery in the treatment of ocular tumours. Loading the IFN-α2b in a hydrogel isolates the drug from the releasing medium; the inclusion of core-shell nanoparticles increases the loading capacity of the drug and provided pH-responsiveness to the acidic tumour microenvironment, protecting the entrapped drug. As a result, the concentration gradient is reduced and the release pathway extended, furthermore, shielding the IFN-α2b against rapid clearance, and degradation at lower pH of the tumour microenvironment. Nano-embedded thermo-responsive hydrogel were prepared and their physiochemical properties, thermo-responsive behaviour, pH-responsiveness, in vitro and in vivo release and toxicity were evaluated. Fourier transform infrared (FTIR), 1H–nuclear magnetic resonance (1H-NMR), and X-ray powder diffraction (XRPD) analysis confirmed the synthesis of the copolymer. The rheological analysis revealed a sol-gel transition temperature in the range of 26-45°C which was concentration–dependent. A concentration of 20% w/v was selected based on suitability for in vivo application. The surface morphology of the hydrogel was evaluated using scanning electron microscopy (SEM) and porositometric analyser, the SEM images revealed the presence of a mesh-like structure on the surface of the hydrogel. The presence of the pores was further confirm by porositometric analysis. The presence of pores is critical for the diffusion of liquid within the hydrogel, which allows the NP to diffuse out of the hydrogel and release the loaded drug. The formed nanoparticles had particle sizes ranging from 137.1 to 230.6 nm (PDI 0.27–0.137) and zeta potentials ranging from -23.9 to -3.36 mV, demonstrating a pH-responsive controlled release in an acidic medium simulating the tumour environment, with an entrapment efficiency of 89%. The in vitro release studies demonstrated a two-phase release pattern of IFN-α2b and stability of the released IFN-α2b from IFN-α2b nano-embedded PECE hydrogel (IFNPH) for the duration of the study; thus, the IFNPH exhibits pH-protective and temperature-responsive properties. In vitro biocompatibility findings on the human retinal pigment epithelial cell line highlighted that the IFNPH is safe within the tested range of 5000 to 0.625 μg/mL and does not pose any adverse cytotoxic effects. The in vivo studies were performed by administering a single subconjunctival injection of the IFNPH to New Zealand albino rabbits. The pharmacokinetic data revealed that the Cmax of 129.7 pg/mL was reached after 24 hrs (Tmax) in the vitreous humour. The IFNPH delivered biological active IFN-α2b in a sustained manner, compared to eye drops and subconjunctival injection of IFN-α2b solution, thus limiting dosing frequency and enhancing patient compliance. This investigation highlights that the IFNPH is a potential suitable candidate for ocular delivery of IFN-α2b
An evaluation of the effects of metal complexes on lung cancer cell lines
(University of the Witwatersrand, Johannesburg, 2024) Mangena, Zanele; Harmse, Leonie
Lung cancer remains a predominant global health concern, accounting for approximately 18% of cancer-related deaths. In South Africa, it imposes a significant burden due to high rates of late-stage diagnoses, resulting in compromised survival outcomes. Despite available targeted therapies, treatment efficacy is hindered by drug resistance and severe side effects, highlighting the need for alternative agents. This study aimed to investigate a series of complexes in an in vitro setting to assess their potential as alternative agents for lung cancer therapy. This study evaluated 20 compounds, encompassing novel epidermal growth factor receptor kinase inhibitors, AD and OM copper complexes, and copper imidazo[1,2-a]pyridines in vitro. Their cytotoxicity against A549 lung cancer cells was determined by the MTT assay, and the most potent compounds were chosen for further investigation. The mode of cell death for these compounds was assessed through cell morphology, Annexin-V, caspase-3/7, mitochondrial membrane potential, and caspase-8 assays. The capacity of the active compounds to induce reactive oxygen species was measured through the CellROX™ Deep Red assay kit. Immunohistochemistry techniques were employed to analyze the expression and distribution of p21 and p53. Furthermore, changes in the expression levels of apoptosis-related proteins post-treatment with the most effective compound were assessed using the Proteome Profiler Human Apoptosis Array kit. Four copper-imidazo[1,2-a]pyridines, namely JD35, JD46, JD47, and JD88, were the most active, with IC50 values in A549 cells between 1.67 μM and 3.37 μM. These compounds induced apoptotic cell death, characterized by chromatin condensation, fragmented nuclei, Annexin-V binding, and activation of caspase-3/7. They also caused a decline in mitochondrial membrane potential, indicating activation of the intrinsic apoptotic pathway, while also inducing late caspase-8 activation. Furthermore, these compounds enhanced reactive oxygen species and upregulated nuclear p21 and p53 expression, suggesting DNA damage leading to apoptosis initiation. Analysis of apoptotic proteome array data showed that JD88 treatment significantly upregulated the wild-type tumour suppressor protein, p53 in A549 cells while significantly downregulating anti-apoptotic proteins such as Bcl-2, Bcl-xL, XIAP, cIAP-2, survivin, and heat shock proteins (HSP27, HSP60, and HSP70). These findings suggest a reduced threshold for apoptosis and a potential promotion of apoptosis, possibly through p53 activation. Copper-imidazo[1,2-a]pyridines have demonstrated effectiveness in inducing apoptotic cell death in A549 cells, impacting both intrinsic and extrinsic apoptotic pathways and influencing critical proteins for cellular survival and apoptosis. This study contributes to a better comprehension of apoptotic mechanisms in A549 cells, stimulating inquiries into the activation of extrinsic apoptotic pathways especially by copper complexes. These findings support further pre-clinical evaluations of copper-imidazo[1,2-a]pyridines, including efficacy assessments in lung cancer animal models, toxicity studies, and determination of pharmacokinetic properties
Antibacterial stewardship practices in South Africa during the COVID-19 era: A retrospective review
(University of the Witwatersrand, Johannesburg, 2024) Spinickum, Logan Jade; Leigh-de Rapper, Stephanie
Background: Several mechanisms may facilitate and steer the development of antibiotic resistance patterns. The most prominent driver associated with antibiotic resistance has been indicated as inappropriate use or consumption of antibiotics. The sudden emergence of Coronavirus Disease 2019 (COVID-2019) changed the conventional practices related to drug utilisation through the repurposing of antibiotics. Despite the implementation of antibiotic stewardship programs, the pressure that COVID-19 placed on healthcare systems resulted in poor prescribing and antibiotic review practices, potentially exacerbating antibiotic resistance. Moreover, the public health sector faces various challenges that make it difficult to consistently assess and quantify antibiotic usage; while providing quality review, feedback, and intervention, especially in low- and-middle-income countries like South Africa. As a result, there is a paucity of information concerning antibiotic utilisation in the public healthcare sector, even following the emergence of the COVID-19 pandemic. It is essential to determine the extent of antibiotic use to improve antibiotic utilisation, patient outcomes and stimulate viable policies and initiatives to strengthen public healthcare drug surveillance amidst the challenges of increased infectious diseases, resistance, and health personnel shortages. Aim of study: The aims of the study were to determine, analyse and compare antibiotic consumption amongst intensive care unit (ICU) patients admitted in a Gauteng public hospital during the pre-COVID-19 era and commencement of the COVID-19 era. Methodology: A retrospective cross-sectional data analysis of 335 medical files of ICU patients hospitalised in a Gauteng Provincial Tertiary Hospital (GPTH) between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables. Results: The study found that the more frequently prescribed antibiotics were amoxicillin/clavulanate (pre-pandemic = 31.99%; COVID-19 = 38.43%), followed by ceftriaxone (pre-pandemic = 15.44%; COVID-19 = 14.55%), piperacillin/tazobactam (pre-pandemic = 11.40%; COVID- 19 = 8.58%) and azithromycin (pre-pandemic = 7.73%; COVID-19 = 19.78%). Common bacterial pathogens detected in both periods included Acinetobacter baumannii (pre-pandemic = 29.2%; COVID-19 = 20.9%), Enterobacter cloacae (pre-pandemic = 10.4%;COVID-19 = 14.0%), Escherichia coli (pre-pandemic = 22.9%; COVID-19 = 25.6%), and Klebsiella pneumoniae (pre-pandemic = 25.0%; COVID-19 = 18.6%). Resistance was predominantly observed in ciprofloxacin (pre-pandemic = 11.4%; COVID-19 = 12.9%), piperacillin/tazobactam (pre-pandemic = 12.7%; COVID-19 = 0.1%), cefotaxime (pre-pandemic = 13.2%; COVID-19 = 14.7%), and cefepime (pre-pandemic = 12.7%; COVID-19 = 11.2). Resistance to commonly prescribed antibiotics observed a decrease trend moving from the pre-pandemic period into the COVID-19 pandemic. Conclusion: The macrolide and penicillin (in combination with beta-lactamase inhibitor(s)), classes demonstrated an increase in prescribing and use across the pre-pandemic period transitioning into the COVID-19 pandemic. While overall resistance observed a decline moving into the COVID-19 pandemic. However, “Watch” category antibiotic resistance increased slightly. An increase in prescribing and use of macrolides coupled with an increase in “Watch” category antibiotic resistance, highlights the need for improved antibiotic stewardship programs in public healthcare and pathogen-directed prescribing, to combat inappropriate and unnecessary use of antibiotics.
Brain concentrations and the neurochemical effects of passively administered fluoxetine in Flinders sensitive line rat offspring
(University of the Witwatersrand, Johannesburg, 2023) Steyn, Stephanus Frederik
Background: Globally, 36 % of women who have recently given birth, experience symptoms of depression and anxiety. Effective antidepressant treatments are limited, with fluoxetine being a popular treatment option. Fluoxetine is expressed in the breast milk, yet it is unclear to what extent fluoxetine, or its active metabolite, norfluoxetine, reaches the brain of the developing child and what the effects of such exposure on the related neurobiological processes would be. Due to ethical considerations and practical restrictions, clinical investigations into the neurodevelopmental effects of passively administered antidepressants (via the breast milk) are problematic. Therefore, pre-clinical investigations into this topic are not only important but clinically relevant. Aims & objectives: We aimed to quantify the concentration of passively administered, i.e., via the breast milk during nursing, fluoxetine, and its active metabolite, norfluoxetine in the whole brains of exposed Flinders sensitive line (FSL) rats (an established rodent model of depression). We further aimed to establish if said exposure would associate with changes in whole-brain serotonergic function and redox status. Methods: Adult FSL dams received fluoxetine (10 mg/kg/day), or placebo for fourteen days, beginning on postpartum day 04. Offspring (n = 16 per exposure group; 1:1 male: female) were passively exposed to fluoxetine until postnatal day 18 and euthanized on postnatal day 22. Whole brain fluoxetine, norfluoxetine, serotonin, 5-hydroxyindoleacetic acid (5-HIAA), and reduced and oxidized glutathione (GSH and GSSG) concentrations were measured via liquid chromatography/mass spectrometry (LC-MS). Results: Fluoxetine, was undetectable in the brain of FSL offspring, while norfluoxetine concentrations, averaged 41.28 ± 6.47 ng/g. Neither serotonin, nor its metabolite (5-HIAA), was affected by passively administered fluoxetine in the juvenile brain. In terms of redox status, pups exposed to fluoxetine presented with a compromised antioxidant defence, as evinced by a lower GSH/GSSG ratio. Discussion and conclusion: Although fluoxetine and norfluoxetine concentrations have been measured in breast milk and infant plasma, to the best of our knowledge, it has not been quantified in the juvenile brain until now. Our results are in line with clinical findings, suggesting the infant norfluoxetine/fluoxetine ratio to be elevated, probably because of the prolonged half-life of norfluoxetine. Although only norfluoxetine was detected, this did not influence the central serotonin concentrations of offspring. However, it associated with increased oxidative stress, of which the pathophysiological significance remains to be established. Taken together, our findings confirm that passively administered fluoxetine does reach the infant brain in the form of norfluoxetine and may manipulate processes of oxidative stress regulation. Further studies into the long-term bio-behavioural effects are however needed to effectively inform breast feeding mothers on the safety of antidepressant-use during the postpartum period
Breathing pattern dysfunction amongst patients with median sternotomy post hospital discharge: a cross- sectional study within a South African context
(University of the Witwatersrand, Johannesburg, 2024) Hurst, Samantha; Roos, Ronel
Introduction: Patients following cardiac surgery via median sternotomy surgical approach experience a deficit in chest wall expansion and respiratory muscle strength during hospital stay. To date, no study has assessed whether there is a long-term breathing pattern dysfunction (BPD) present in patients following cardiac surgery via median sternotomy surgical approach. Aim: To establish whether patients within the period of three months to one year post cardiac surgery via median sternotomy surgical approach still experience a BPD and, if so, to determine the risk factors to development of such a dysfunction. Methods: A cross-sectional observational study was conducted in a private hospital in Pretoria, South Africa from December 2022 - November 2023. Male and female patients between the age of 18-65 years who underwent an elective cardiac procedure via median sternotomy surgical approach were invited to participate. Participants were assessed once within the period of three months to one year post hospital discharge via questionnaires emailed to them and a telephonic video consultation. Outcome measures used included work- and health-related demographic questionnaires, the Physical Activity Vital Sign (PAVS), the Self-Evaluation of Breathing Questionnaire (SEBQ), The Nijmegen Questionnaire (NQ), the Breath Hold Time (BHT) Test, and the measures of upper and lower chest expansion (CE). Data were evaluated using descriptive and inferential statistics. Statistical significance was set at p<0,05. Results: The study population consisted of 52 participants, of which, most identified as male gender (59,60%, n=31) and underwent coronary artery bypass graft surgery (CABG) (51,90% ,n=27). The median age of participants was 57,00 (IQR 14,00) years and most participants presented with an elevated body mass index (28,90 kg/m², IQR 6,60). Return to work rate was established to have been 61,50% (n=32) with a median return to work time (RTWT) of six (IQR 4,00) weeks. Of the participants who returned to work, the majority (17,30%,n=9) worked in administrative occupations involving prolonged sitting (42,50%, n=17). The majority of participants scored positive in three of the outcome measures (51,90%, n=27) for BPD. A weak negative correlation existed between age and NQ and between age and SEBQ (r=-0.32, p=0,02). There was a weak negative correlation between length of hospital stay and lower CE (r= -0,30, p=0,03). There were weak positive correlations between PAVS aerobic scores and upper CE (r=0,33, p=0,02) ,lower CE (r=0,39,p<0,01) and BHT (r=0,29,p=0,04). There was a weak negative correlation between PAVS aerobic scores and SEBQ scores (r=-0,30,p=0,03). In terms of predictive values, being identified as male gender reduced the odds of developing a BPD in the psychophysiological dimension by 82%. Participants who underwent the surgery classified as “other” were 21 times more likely to score positive in the psychophysiological dimension of BPD than participants who underwent CABG, valve or mixed CABG and valve surgery. Participants who acquired cardiac complications were 11,67 times more likely to score positive in the psychophysiological dimension of BPD than participants who did not acquire complications or acquired other non-cardiac related complications. The absence of post-operative complications reduced the risk of developing a BPD in the psychophysiological dimension by 77%. Additionally, for every minute a patient partook in weekly aerobic exercise, the odds of developing a BPD in the psychophysiological dimension decreased by 1%. In terms of the biochemical dimension of BPD, participants who returned to work were 4,42 times more likely to score positive for BPD in this dimension. Conclusion: There is a high prevalence of long-term BPD amongst patients who underwent cardiac surgery via median sternotomy surgical approach. Factors found to increase the risk of developing BPD in a multidimensional context include the female gender, the type of surgery (particularly thymectomies and atrial septal defect repairs), cardiac post-operative complications and whether a participant has returned to work. Factors found to reduce the risk of developing BPD include the duration of weekly aerobic exercise and the absence of post-operative complications
Contextually responsive support and development strategies for generalist occupational therapists delivering hand-injury care in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Stormbroek, Kirsty van
Hand injuries are common in South Africa and safe and effective hand therapy is critical to appropriate care. By necessity, this care is delivered by non-specialist occupational therapists working in challenging settings, despite hand therapy commonly being considered a specialist area of practice. Safe and competent management of hand injuries by therapists is crucial for achieving a return to full participation in daily life. It is therefore necessary to describe what the support and development needs of these non-specialist occupational therapists are, and how these needs can be met effectively and sustainably. This project aimed to describe how the support and development needs of generalist occupational therapists delivering hand-injury care within the South African public health sector can be met in a contextually responsive manner. A multi-method approach was chosen, with a separate study design employed for each of the three studies. The policy context is an essential aspect of contextually responsive intervention; therefore the first study aimed to develop policy-based principles for hand rehabilitation services delivered by occupational therapists in South Africa. A descriptive qualitative approach was employed, and framework analysis, as a content analysis method, was undertaken. Local and international policies (n=29) were included in the analysis, and eighteen principles were generated that articulate the goal of rehabilitation (principle 1), prescribe the nature of rehabilitation (principles 2-6), and outline the enablers of rehabilitation (principles 8-18). These generic principles are applied to the practice of hand-injury care in South Africa. Contextually responsive intervention responds to the needs and experiences of service providers. Study two (which consisted of Study 2A and Study 2B) used a qualitative instrumental case-study design to describe generalist occupational therapists’ experience of delivering hand –injury care in order to identify their support and development needs and to describe how these can be met in a contextually responsive manner. Study 2A undertook this aim with a group of novice occupational therapists (n=9) completing a compulsory year of state service directly after graduation and made use of an online community of practice for data collection. Study 2B used site visits and in-depth interviews to collect data from fully registered occupational therapists (n=6) working in diverse public health settings in South Africa. Reflexive thematic analysis was used to generate rich themes, which informed recommendations for the support and development of therapists extrapolated from both studies. Study 3 sought to combine the evidence produced by Studies 1 and 2 with the diverse perspectives of service users, other service providers, local and international scholars, educators and professional bodies. The aim of the study was to identify capacity strengthening strategies for generalist occupational therapists responsible for delivering hand-injury care in the South African Public Sector. A hybrid consensus development conference was used to facilitate the presentation of relevant evidence. A stakeholder panel (n=14) followed a nominal group guided by a skilled facilitator. The panel generated and ranked ideas, which were developed into ten prioritized areas for action. Extensive ideas within each of these ten areas were recorded. These areas formed the foundation of the guidelines developed by the project. A pragmatist approach to evidence synthesis was used in the final stage of the project to systematically generate guidelines for the support and development of generalist occupational therapists delivering hand-injury care in South Africa. Eleven guidelines were developed, with the first guideline addressing the need to align hand-injury care services with professional values (1), including the mandate to improve participation and inclusion. Five guidelines address generalist occupational therapists’ direct need for support and supervision (2), resources (3), core competencies for hand-injury (4), the creation of a learning stratosphere to support this (5), as well as the imperative to nurture resilience (6). The final five guidelines address factors that are indirectly essential to therapists capacity to deliver hand-injury care: the need to strategize and operationalize (7), strengthen health systems (8), build stronger communities (9), strengthen human resourcing (10), and strengthen the medical and surgical management of hand injuries and conditions (11). Finally, key implications for practice, learning and development, leadership and management, policy, and research are proposed
Design and evaluation of a non-opioid tripartite release tablet for chronic inflammatory pain
(University of the Witwatersrand, Johannesburg, 2024) Mazarura, Kundai Roselyn; Van Eyk, Armorel; Choonara, Yahya E.; Kumar, Pradeep
Formulation-based approaches towards curbing the prescription opioid crisis include the discovery and development of non-opioid analgesics such as the novel benzyloxy- cyclopentyladenosine (BnOCPA). A more expedited approach involves the development of combinatorial systems of already existing non-addicting analgesics to tap into unexplored synergistic potentials. Despite the recent advances in drug delivery systems, tablets still hold the position of being the most widely used oral dosage form, particularly in the management of chronic ailments; it is cost-effective, non-invasive, and does not require administration expertise. Challenges in the production of complex geometry combinatorial, multi-drug tablets remain to some extent enigmatic to pharmaceutical researchers, hence the steady paradigm shift from traditional compression to 3-dimensional printing. Although it is superior in multiple aspects, the technique is still in its nascent stages with limited information on regulatory guidelines. Therefore, the aim of this work was to design and develop a non-opioid tripartite controlled- release tablet for efficient chronic inflammatory pain management. Because adherence to adjunct gastroprotective agents (GPAs) in non-steroidal anti-inflammatory drugs (NSAIDs) users has been established to be suboptimal, esomeprazole magnesium trihydrate (ESM) was added to the drug delivery system (DDS). The rationale behind the design was based on inherent drug properties, target release sites, desired therapeutic effects, and allowance for drug release manipulation, therefore a tablet was assembled, constituting an immediate- release top layer formulation of 250 mg paracetamol (PAR) for an early onset of analgesia; a cup layer for the delayed and retarded release of 100 mg of diclofenac sodium (DS) and 250 mg of PAR in tandem, and lastly a core containing a press-coated 20 mg ESM pill. A reproducible and efficient Reverse-Phase High-Performance Liquid Chromatographic (RP-HPLC) method was developed and validated for the simultaneous detection of the APIs over the concentration ranges studied. Deleterious drug-excipient incompatibilities were ruled out through pre-formulation investigations by FTIR, DSC, and TGA analyses. Combining both wet and dry granulation methodologies; the chosen formulation and polymers (7.5% hydroxypropyl methylcellulose (HPMC) K15M, 25.3% eudagrit L (EL) 100-55, and 10.5% croscarmellose sodium (CCS)), while considering the quality target product profiles (QTPPs), critical process parameters (CPP), and critical material attributes (CMAs), resulted in the development of a pragmatic tablet delivering fifty percent of the PAR dosage in the initial 30 minutes, with a cumulative release of 95.0% ± 0.08% and 94.9% ±3.87% for DS and ESM, respectively. Through in-process quality control tests, the validity of the manufacturing process was confirmed, with all results falling within pharmacopeial specifications. The release mechanism of PAR and DS from the cup after the 2-hour mark distinctly followed the Hixson-Crowell model where the geometrical characteristic of the cup was maintained with surface erosion. Visuals from scanning electron microscopy (SEM) analysis obtained prior to and during dissolution, confirmed hydration gravimetric analysis results as well as bulk and surface erosion mechanisms. The obtained ex vivo analysis results showed retarded permeation rates of the tabletted APIs compared to the APIs in their pure state. Therefore, it is imperative to consider improving the existing models employed for ex-vivo permeability studies of tableted formulations, with a particular focus on exploring the impact of excipients/polymers on drug permeation
Developing strategies for alleviating caregiver burden among informal caregivers of persons with severe mental disorders in Bushbuckridge, Mpumalanga province
(University of the Witwatersrand, Johannesburg, 2025) Silaule, Olindah Mkhonto; Adams, Fasloen; Nkosi, Nokuthula
Background: Globally, implementation of deinstitutionalisation led to a shift from institutional to community care of persons with severe mental disorders. This move calls for informal caregivers including families, relatives, friends, or neighbours to become key role players in the care and management of persons with severe mental disorders. The role of informal caregiving results in stress that consequently leads to caregiver burden. In South Africa, limited evidence exists on the extent of the burden experienced by the informal caregivers of persons with severe mental disorders and strategies for supporting these informal caregivers in their role are lacking. This study aimed to explore the burden of care to inform the development of strategies for alleviating burden among informal caregivers of persons with severe mental disorders in Bushbuckridge, Mpumalanga province. Methods: This study used a three-phased mixed methods approach with a multiphase design to facilitate a comprehensive investigation of caregiver burden among informal caregivers and to develop the multilevel strategies for alleviating the burden. Sequential and concurrent methods were combined to collect quantitative and qualitative data across five studies that were conducted to address the study objectives. Results: The established extent of burden revealed that most informal caregivers (44.7%) reported moderate-to-severe levels of objective burden, and 35.9% reported moderate-to-moderate levels of subjective burdens. Objective burden levels were significantly associated with age, gender and residence (p = 0.025, p = 0.034, and p = 0.038, respectively), while subjective burden was significantly associated with daily caregiving (p = 0.012). The exploration of lived experiences revealed that most informal caregivers experienced burden with subsequent impact on their emotional, mental, and physical health. The subsequent burdens were attributed to dealing with the chronic nature of severe mental disorders, role and financial strain, and stigmatisation from family and community. To deal with their caregiving demands informal caregivers expressed reliance on their internal resources, including resilience and resourcefulness. Expressed support needs included access to mental health services, and empowerment and social support from family, government, and religious and community organisations. The findings identified the need for conducting health screenings among the informal caregivers, as well as the need for strategies to support informal caregivers to complement their internal coping resources. The findings of the scoping review revealed that most studies were conducted in Asian countries. Psychoeducation and support group interventions were identified as predominant strategies for alleviating caregiver burden. The service provider’s perspectives revealed that the current state of formal and informal community mental health services is inadequate to meet the needs of the informal caregivers. Conclusion: The study’s findings informed the development of strategies for alleviating caregiver burden among informal caregivers in a low-resourced setting. The complexity of caregiver burden requires multilevel strategies, namely caregiver-driven, health worker-driven, community-based, intersectoral, policy, and legislature strategies across the individual, interpersonal, organisational, community, and policy levels. Caregiver empowerment, family and peer support, development of caregiver-orientated institution and community-based services, task sharing, and task shifting were identified as overriding strategies relevant for alleviating informal caregiver burden in a low- resourced setting
The effect of a scissor skills program on bilateral fine motor skills in preschool children in South Africa including skill improvement, equivalence, transferability of skills and skill retention
(University of the Witwatersrand, Johannesburg, 2010-01-27T12:43:24Z) Ratcliffe, Ingrid
The purpose of this study was to assess the improvement of scissor skills after a graded scissor skills program in preschool children in South Africa (SA). A bilateral fine motor skills assessment tool was developed for use in this research. This task-based assessment included every day activities required at school as well as personal management items. This research phase included the development of the test items and test instructions, scoring as well as validity and reliability testing of the assessment. A suitable scissor skills program was then developed for Grade 0 children in South Africa. The program was validated by a pilot study and also by a focus group of occupational therapists. Some changes were made to the picture selection, the grading of the program, as well as to teacher instructions on how to present the program before it was finalised and ready for use in the implementation phase of the research study. The implementation phase of the study included the individual assessment of 149 learners (mean age of 5 years 6 months), from three different schools in South Africa. The main aim was to establish the effectiveness of the scissor skills program by measuring skill improvement, transferability of skills and skill retention. A further aim was to compare the difference of skill levels of learners from various socio-economic backgrounds in South Africa. The results showed statistically significant improvement in scissor skills in all groups from the three different schools, as well as an ability to retain the learnt skills. Participants from lower socio-economic backgrounds demonstrated the least skill initially but made the greatest gains during the program, at times decreasing the gap between themselves and other participants. It was concluded that children benefited from a graded scissor skills program, which allowed them to improve and retain their scissor skills but improvement did not transfer to other fine motor tasks.
Essential oil compounds in combination with conventional antibiotics for dermatology
(University of the Witwatersrand, Johannesburg, 2024) Simbu, Shivar Bram; Van Vuuren, Sandy
Skin and soft tissue infections represent a heterogeneous array of clinical entities with varying severity, causative pathogens, and rates of progression. The slow development and overuse of antimicrobial agents have perpetuated the spread and severity of antimicrobial resistance. Natural products such as essential oils and their compounds are often investigated for their pharmacological properties, with particular interest in their antimicrobial properties. This study aimed to investigate the effects of combining six essential oil compounds (α-pinene, γ-terpinene, ±linalool, eugenol, carvacrol, and cinnamaldehyde) with eight conventional antimicrobials (amoxicillin, ciprofloxacin, erythromycin, gentamicin, meropenem, tetracycline, miconazole, and nystatin) against six commonly encountered skin pathogens (Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis ATCC 12228, Pseudomonas aeruginosa ATCC 27853, Acinetobacter baumannii ATCC 19606, Cutibacterium acnes ATCC 11827, and Candida albicans ATCC 10231) to elucidate the interactive profiles, toxicity, and anti-inflammatory properties. The antimicrobial analysis involved determining the minimum inhibitory concentrations (MIC) of the conventional antimicrobials and essential oil compounds, singularly and in combination, using the broth microdilution assay. The sum of the fractional inhibitory concentrations (ΣFICs) was calculated to investigate the interactive profile of the combinations. Synergistic interactions were further analysed at varying ratios and depicted on isobolograms. Eight synergistic interactions were identified, with seven against Gram-positive bacteria (ΣFIC 0.07– 0.42) and one against P. aeruginosa (ΣFIC 0.32). In addition, it was demonstrated that when in combination, the selected combinations resulted in reduced toxicity (Brine-shrimp lethality assay). The combination of amoxicillin and eugenol demonstrated the lowest toxicity (LC50 = 1081 μg/mL) and the highest selectivity index (14.41) when in a (70:30) ratio with the antibiotic in the higher ratio. Based on the synergistic results from the antimicrobial analysis, a selection of essential oil compounds with conventional antimicrobials were assessed for cytotoxicity and anti- inflammatory properties. The cytotoxicity properties were determined using the MTT assay on HaCAT keratinocytes. The anti-inflammatory properties were determined using lipopolysaccharide (LPS) activated RAW 264.7 macrophages, and the reduction in nitrate (NO) production was measured. Cinnamaldehyde demonstrated the highest cytotoxicity (IC50 = 28.63 μg/mL, p < 0.05) and the greatest reduction (77.44%) in nitrite production, which was also concentration dependent. The combination of ciprofloxacin and cinnamaldehyde demonstrated the lowest cytotoxicity (88.42% ± 3.72 cell viability; combination index of 0.12) and the highest reduction in nitrite production (77.42%; ΣFa = 0.44). Further investigations on the interactive properties of ibuprofen were undertaken. The antimicrobial, cytotoxicity, and anti-inflammatory properties of ibuprofen were analysed singularly and in combination with all essential oil compounds and conventional antimicrobials against reference and clinical skin pathogens. For the MIC results, four synergistic interactions were identified between ibuprofen and conventional antimicrobials (ΣFIC 0.33 - 0.50). For the cytotoxicity (MTT assay), none of the combinations demonstrated a cytotoxic effect (cell viability of 93.6-100%) and significant reduction on nitric oxide production. Additionally, higher order combinations involving the synergistic combinations were investigated with the inclusion of the essential oil compounds. Three synergistic interactions were identified (One against C. acnes and two against A. baumannii). The triple combinations were slightly cytotoxic (cell viability of 77.59 - 90.44%; combination index of 0.95 -1.10) on the HaCAT cell line and did not reduce nitric oxide production. Based on the overall results from this study, combinations of essential oil compounds and some conventional antimicrobials demonstrate promising therapeutic approaches to attenuate antimicrobial resistance. These results demonstrated that combinations that comprise cinnamaldehyde have noteworthy antimicrobial and anti-inflammatory properties which may warrant further investigation. Combining ibuprofen with conventional antimicrobials and essential oil compounds may also offer potential advantages in managing resistant infections through direct and indirect antimicrobial mechanisms.
Exercise dosages for the management of generalized anxiety disorder: A scoping review
(University of the Witwatersrand, Johannesburg, 2024) Leander, Natalie; Olivier, Benita
Objective: This review was conducted to map the extent of evidence relating to the dosage of exercise for anxiolytic effect, in youth and adolescents with Generalized Anxiety Disorder (GAD). Introduction: Exercise is known for its benefit to people living with depression and anxiety in adult populations. Less is known about the differences in exercise prescriptions used for the management of anxiety subtypes in younger populations. The rationale for this topic in adolescents and youths, living with GAD was to ascertain the extent to which this cohort has been studied regarding the use of exercise in the treatment of anxiety and which dosages were used. Inclusion criteria: All studies with participants aged 10-24 years of age with a GAD diagnosis, were considered, where exercise was used as part of the management of their anxiety. No restrictions were placed on study types. A scoping review was performed using the JBI methodology. Databases searched included Pubmed, PEDro, Cochrane database of systematic reviews and Cinahl Ultimate along with grey literature databases. No time restrictions were applied, and all types of research articles were considered. The charted data was tabulated using a modified JBI data extraction instrument. The initial result of 728 results was reduced to four studies that met with inclusion criteria. The final four studies had populations in the upper range of between 18 to 24 only. No applicable data was found in the 10 to 17-year age range. The exercise types used in these four studies were treadmill running, Pilates, lower limb strengthening and dynamic cycling. Two studies incorporated a single bout of vigorous treadmill running for 30 minutes. One study did a single bout of beginner Pilates for 30 minutes and the last study used lower limb strengthening and dynamic cycling biweekly for six weeks. The literature on exercise dosage for the management of GAD in adolescents and youth is severely limited. Data on exercise for specific subtypes of anxiety in adolescents and youth seems to be limited in general as well. This is an important area for research as anxiety starts in early childhood and GAD in particular has a peak age of onset of 15 years. It seems feasible to try and approach anxiety in youth and adolescents with non-invasive therapies such as exercise but there is a definite gap in the literature regarding its use in managing GAD
Experiences of professional nurses in providing support to student nurses in the clinical practice environment of a private hospital in Gauteng
(2021) Jones, Jennifer
Quality in nursing education is a global focus due to the many challenges facing healthcare the world over. Clinical learning is an important component in nursing training and nursing experiences during clinical placement are crucial to prepare the student to become safe, competent Professional Nurses. However recent studies have shown that the students’ clinical training is not always effective in preparing them for their future role. Support in the clinical environment by the Professional Nurse is crucial to assist the student to develop confidence and competence to transition into the Professional Nurse role. The objective of this study was to describe the experiences of Professional Nurses in providing support to student nurses in the clinical practice environment of a private hospital. An exploratory qualitative study using in depth interviews of fifteen Professional Nurses was done. The data collected was then analysed using thematic analysis. The identified themes and categories were discussed to offer meaning and insight. The study provided an understanding of how support of the student nurse is currently experienced and perceived by the Professional Nurse in the clinical practice environment with a view to identifying ways of improving support to the student nurse in the future. It was found that the clinical environment is unpredictable and whilst the Professional Nurses acknowledged they needed to support the student, it was often challenging to do this effectively leaving them feeling frustrated and disappointed. The study took place during the COVID -19 pandemic which caused major disruptions to the everyday functioning and operations of hospitals globally, and the study site was no exception. Recommendations to improve support to the student nurse were made in the areas of Clinical Practice, Nursing Education and Research.
Guidelines for the implementation of blended learning in a nursing college campus in Gauteng: a mixed methods study
(University of the Witwatersrand, Johannesburg, 2024) Maré, Magdalena Elizabeth; Armstrong, Sue
The purpose of the study is to develop guidelines on how a nurse educator can best be prepared to implement blended learning in a Nursing Education Institution in Gauteng. The readiness of nursing students and nurse educators in a nursing education institution in Gauteng was determined to serve as a point of reference for the development of guidelines to support nurse educators to implement blended learning in the institution. Blended learning is the thoughtful integration of different instructional methods that contain face to face on online components. It enhances the educational experience for nursing students, preparing them to meet the challenges of modern health care and promoting lifelong learning. The methodology used was a mixed method study, combining a quantitative survey using the Blended Learning Readiness Engagement Questionnaire (BLREQ®) to determine readiness for blended learning amongst nursing students and nurse educators, and two focus groups with nursing education managers and nurse educators respectively. The focus groups were done to determine how best nurse educators can be supported to offer blended learning in the Nursing education institution. The Community of Inquiry framework was used to analyse the data from the focus groups and the data from Section C of the BLREQ®. According to the survey, both nursing students and nurse educators perceived themselves as ready for the implementation of blended learning, although there are gaps in their technical abilities and ability to navigate online environments. The qualitative data revealed that both nursing students and nurse educators need support and guidance for the implementation of blended learning. Nursing education managers expressed that nursing educators are still using traditional methods of teaching and that they need to be supported to use innovative teaching methods such as blended learning through regular skills development sessions. Nurse educators and students also indicated that they are not confident in participating in online platforms and discussions and that they need orientation and support navigating online platforms and the current learner management system. Although both nursing students and nurse educators see themselves as having the basic digital skills, they indicated a need for training in spreadsheet, presentation, and online communication software as well as collaborative cloud computing. The availability of technology infrastructure and lack of resources for the successful implementation of blended learning in the Nursing Education Institution were identified by nursing education managers, educators, and students. Guidelines were developed to assist the nursing education managers, nurse educators and students to address the gaps identified and to orientate new students and nurse educators to navigate the blended learning environment to assist them to adapt to new technologies and ways of learning and teaching
Identification of third year midwifery skills that could benefit from simulated practice prior to clinical midwifery placements
(2021) Singaram, Kerry-Ann
Neophyte midwifery students often feel anxious and inadequate during their clinical placements, as they are expected to perform midwifery skills as early as their first day in the clinical environment. Midwifery educators are seeking out creative ways to create practice opportunities for their students with regards to skills practice, and simulation as a teaching strategy offers a learning environment for safe practice of skills. The use of simulation in midwifery is a fairly new concept, and its future growth is dependent upon research to provide a sound base from which it may grow and develop to meet the needs of the students. The purpose of the study was to identify key midwifery skills that could be taught and practiced using simulation prior to student midwives’ clinical placements that would better equip student midwives to manage their midwifery clinical placements. Findings from the study could serve as a foundational basis for future midwifery simulated programs. The research design and method was qualitative in nature and data was collected from focus group discussions with fourth-year student nurses and their respective midwifery lecturers. Clinical facilitators who are based in the clinical environment and responsible for the training of third year midwifery students were invited to participate in the study, however, were unable to attend. The researcher felt that, this created a limitation to the study as they might have added additional information or a different perspective about novice midwifery skills training. Findings identified specific midwifery skills that could benefit from simulated practice as well as how best skills could be practiced within facilitation of simulation in third year midwifery practice. Summary of findings included the identification of the following midwifery skills that participants identified as being important with regards to simulated practice: completion of documentation; vaginal examinations; management of second stage of labour and offering of psychological support. IV, Participants together with the researcher gives suggestions on how best simulation can be facilitated for developing confidence in neophyte student midwives before their first clinical placement. Based on the findings of this research, recommendations were made to guide midwifery lecturers when planning simulation activities.
Impact of a rural context in Kwazulu Natal on primary caregiver's management of pain innon-communicating children with severe neurological impairment
(University of the Witwatersrand, Johannesburg, 2024) Pretorius, Jeanette; Franzsen, Denise
Untreated pain is known to have negative consequences on the development and wellbeing of “non-verbal” children with severe neurological impairment (SNI). Healthcare workers and caregivers must ensure that pain is managed in this population, even though pain may be difficult to assess. Occupational therapists need to understand how context affects the management of pain experienced by a child with SNI, as well as its impact on the care of the child. This study determined how a rural KwaZulu Natal context impacted how primary caregivers recognized and manage pain and the care of their child with SNI. Methods: A multiple descriptive, embedded case study design using a demographic and pain questionnaire, with cross sectional design. There were nine respondents’ qualitative and quantitative information content analysis and descriptive statistics were used to report. Results: Financial, environmental, emotional and physical strain factors associated with the rural context were identified may be adding to the burden of care and affecting the occupational performance of the child with SNI and their caregiver. Specific difficulties included limits in access to clean running water, the practice of bed sharing and poor infrastructure affecting access to healthcare facilities. Primary care givers also mentioned their other responsibilities in the house and the physical strain of caring for a child with SNI affected them and their child. Despite this, all primary care givers were able to recognise and act when their child was in pain and relied on crying duration and intensity as a reliable sign of pain in their child. All primary care givers were confident in their ability and method of recognising and addressing pain in their child with SNI. More experienced primary caregivers used fewer signs to recognise when their child with SNI was in pain. Conclusions: A rural African context is associated with barriers and opportunities for the care, the recognition- and management of pain in children with SNI. More research related to supporting participation and occupational performance by addressing the effects of pain in children with SNI on the child and the primary caregiver living in rural contexts is required
The impact of lower limb amputation on quality of life: a study done in the Johannesburg Metropolitan area, South Africa
(University of the Witwatersrand, Johannesburg, 2010-01-29T07:15:06Z) Godlwana, Lonwabo L.
Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semi-structured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status. Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.