No description available.

Employment outcomes in persons with traumatic brain injury (TBI) are far from ideal and have serious implications for quality of life and financial well-being post-injury. Numerous potential correlates of return to work, including locus of control and awareness of deficit, have been examined in past studies with mixed findings. The current study investigated these issues in a relatively ignored segment of the TBI population—those who receive services through state-funded vocational rehabilitation programs. Thirty State of Alaska Division of Vocational Rehabilitation (DVR) clients with TBI completed comprehensive interviews, the Patient Competency Rating Scale (PCRS), the Internal Control Index (ICI), and several neuropsychological test measures. Overall time spent working decreased from 75% pre-injury to 39% post-injury. Participants with poor vocational outcomes underestimated their level of impairment on the PCRS relative to informant ratings, and generally fared worse post-injury than participants with more accurate awareness of their limitations. Locus of control and cognitive function measures did not predict vocational outcome. Given the need for DVR clients to be aware of their deficits in order to set realistic goals, vocational counselors should address awareness of deficit early in the rehabilitation process to optimize employment outcomes and allocation of resources. / Graduate

A brief review of the literature on traumatic anuria (acute tubular necrosis, lower nephron nephrosis) has been presented, including a complete bibliography. Special attention was paid to the pathology and pathogenesis of the syndrome and it was concluded that Oliver's recent work (271) probably comes closest to presenting the true picture. He describes tubular necrotic lesions for which the chemical toxins (mercuric chloride, carbon tetrachloride) were responsible, and tubulorhectic lesions which were characteristic of the shock kidney. These lesions could appear at any level in the renal tubule and were characterized by destruction of the basement membrane. Pigment casts were apparent if intravascular pigment release was associated with the illness. The work of Phillips, Van Slyke and associates (291, 292, 355, 356), of Oliver (271) and of Block et al (41) lead one to conclude that renal ischemia is the chief pathogenetic mechanism, though it is obvious that specific extrinsic renal toxins play a major role in specific cases. The role of hemoglobin appears to be chiefly in the production of obstructive casts later in the course of the disease; these pigments are precipitated in the lower nephron where urine is concentrated; and acidified, and dehydration and oliguria contribute to their formation. Three hundred rats were studied in eighteen experiments concerning crush syndrome. It was concluded that the most important single factor tending to aggravate the renal effects of crushing injury is the antecedent state of dehydration. Myoglobin is not an essential factor in the development of renal damage but tends to aggravate the existing uremia. Acute renal failure was seen to be a late effect of shock; animals developed acute tubular necrosis only if initial shock was severe, but not severe enough to produce death from circulatory failure. Development of this delicate balance of factors was aided by reduction of renal reserve by unilateral nephrectomy. A seldom described but distinct and consistent phenomenon was observed in the development of marked, immediate and persistent diuresis in response to the trauma of limb ligation. This polyuria was of a dilute urine and was taken as an indication of initial increased glomerular filtration followed by decreased reabsorption of water because of tubular damage. It was not an indication of a recovery phase as is recorded in the clinical syndrome. Testosterone propionate, desoxycorticosterone acetate, cortisone acetate and Compound F did not appear to be promising as therapeutic agents, although in one experiment Compound F showed some promise. Neither did combined therapy with testosterone and cortisone reduce the mortality rate or decrease uremia. Although there was no doubt that the syndrome of acute renal failure due to acute tubular necrosis could be produced in large numbers of these relatively inexpensive laboratory animals by dehydration and limb ligation, production could not altogether be standardized and the syndrome ran such a short course that serial observations were difficult to obtain and separation of shock deaths was occasionally impossible. It is felt that future work might well make use of some other laboratory animal, perhaps the dog or cat, and that an initial stress of controlled hypotension or renal artery occlusion could be used. It is also our opinion that further investigation into the value of Compound F as a therapeutic agent in this syndrome is justified. / Medicine, Faculty of / Graduate

The effects of septal lesions in rats on the hyperglycaemic response to stress, adrenal weight and water intake were investigated. Tested four times post-operatively at approximately weekly intervals, septal rats did not manifest significantly different resting blood glucose levels than control animals nor did they demonstrate an abnormal degree of hyperglycaemia following periods of unavoidable foot shock. No adrenal hypertrophy was evident in septal subjects compared to controls. Daily water intake was significantly higher among septals. The results concerning blood sugar levels and adrenal weights are taken as evidence that septal rage may not represent true hyperemotionality since certain appropriate physiological concomitants are absent. A second experiment investigated resistance to capture and handling and aspects of open field behaviour in septal and control rats following injections of chlorpromazine hydrochloride or saline. Septalectomized rats resisted handling and capture to a greater extent than controls, traversed fewer squares and demonstrated less rears in an open field, and had a greater tendency to leave a home cage and enter an open field. Chlorpromazine affected neither control nor septal subjects except to suppress the tendency of septal rats to leave a home cage and enter an open field. The behaviour of septal rats is discussed in terms of apparent emotionality. / Arts, Faculty of / Psychology, Department of / Graduate

M.P.H., Faculty of Health Science, University of the Witwatersrand, 2011 / Needlestick 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.

Interpersonal 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.

No description available.

Yes / The purpose of this workshop was to promote interdisciplinary learning and collaborations between UK and India in the area of bacteria and wounds, particularly when bacteria are increasingly antibiotic resistant. To this end we invited colleagues from India with clinical experience ofmanaging bacterially infected wounds in patients, particularly when antibiotic resistant (Dr Prashant Garg) and colleagues from India with expertise in developing new drug delivery systems (Prof Nikhil Singh and Dr Vamsi Venuganti) and together with UK delegates, spanning those with international experience in investigating bacterial infections (Prof Simon Foster), investigating how biofilms communicate (Prof Paul Williams), international expertise in discovering materials for antimicrobial resistance and for instruction of macrophages (Prof Morgan Alexander), expertise in developing responsive films for detecting infection in wounds using a visible signal (Prof Toby Jenkins) and other scientists working on the axis of detecting and treating infection in wounds. / MRC/DBT

No / Lower-limb ischaemia is a frequently unrecognised consequence of arterial disease. It not only compromises wound healing, but is a harbinger of more generalised cardiovascular disease. Detection and appropriate management will not only improve wound healing, but also reduce patient morbidity and mortality by allowing proactive risk modification. Ischaemia is an important factor in skin vulnerability and a major cause of delayed wound healing. Recognition of ischaemia is, therefore, important if wound prevention strategies are to be effective and wound healing optimised. The detection of ischaemia can, however, be difficult and requires a careful evaluation of patient symptoms and clinical signs [Box 1]. It is also important to carry out a detailed physical examination, often supported by investigations, such as Doppler examination of peripheral pulses, ankle blood pressure measurements and the calculation of the ankle brachial pressure index (ABPI).

No / As the prevalence and incidence of wounds are predicted to increase due to an ageing population with increasing comorbidities, reducing the burden of wounds by optimising healing is seen as a key factor in lowering wound care costs. Inappropriate or delayed treatment adversely affects the time to wound healing, impacting quality of life, and increasing the burden on patients, their families and carers, society and the health economy. Identifying non-healing wounds is vital to cost reduction. Failure to recognise wounds not progressing towards healing increases the subsequent risk of non-healing and places the patient at unnecessary increased risk of wound complications.