A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master Science in Medicine in Emergency Medicine, Johannesburg, 2013 / Objectives: To describe the current analgesic practices for hand injuries used at a private hospital emergency department in Johannesburg, Gauteng and to explore any differences in analgesic practice between different doctor groups with different backgrounds, working in the ED. Design: Retrospective descriptive review. Setting: Private hospital emergency department in Johannesburg. Patients: A study sample of 423 patients who presented to the emergency department with hand injuries during 2010. Methods: The emergency department register was used to identify patients who presented with hand injuries. The clinical notes and where appropriate, nursing notes of the identified patients were reviewed. Main Results: Hand injuries were found to represent 9.3% of patients presenting to the emergency department. The most commonly used form of analgesia for hand injuries was found to be nerve blocks, which constituted 30% of the analgesic use. Digital blocks were the most frequently used block accounting for 69% of all nerve blocks done. Parenteral analgesia was the second most common form of analgesia implemented with the intramuscular route being most favoured. Specialised techniques such as nerve blocks are possibly underutilised by doctors with less surgical and emergency department experience. Conclusions: Analgesic practices between different doctor groups are varied. Standardising pain management for hand injuries should lead to improved utilisation of techniques such as nerve blocks. Guidelines should be available and include nerve block techniques. Training should be provided to doctors who are unfamiliar with the use of additional modalities such as nerve blocks.

No description available.

ABSTRACT This study explored the clinical reasoning expert therapists use in relation to splinting the affected hand following neurological injury. An exploratory, descriptive, qualitative methodology was used in three focus groups with occupational therapists, experienced in neurorehabilitation. Data was analysed based on priori themes, specifically 1. The Model of Practice Development (Higgs and Titchen 2001b) - most value was placed on Procedural knowledge or clinical experience; reflection on protocols, working with and learning from others and having clear outcomes. Undergraduate training and current literature is insufficient to provide guidelines for practice. 2. The Three Track Model of Clinical Reasoning (Fleming 1991) –splinting was used to improve range of motion, maintain muscle length and affect muscle tone. Effectiveness of the splints depended on the patient’s response and the therapists’ ability to adapt to preferences and goals. Interactive reasoning was essential in understanding the South African context. The study provided guidelines for a newly qualified therapist.

by Cecilia Li Tsang Wai Ping. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves [175-185]). / ABSTRACT / AKNOWLEDGEMENTS / Chapter CHAPTER ONE --- INTRODUCTION / Chapter 1.1 --- INTRODUCTION --- p.1 / Chapter 1.2 --- AIMS OF STUDY --- p.3 / Chapter CHAPTER TWO --- RHEUMATOID ARTHRITIS / Chapter 2.1 --- DEFINITION --- p.4 / Chapter 2.2 --- PREVALENCE --- p.4 / Chapter 2.3 --- AETIOLOGY --- p.4 / Chapter 2.4 --- PATHOLOGY --- p.5 / Chapter 2.5 --- CLINICAL FEATURES OF RHEUMATOID ARTHRITIS IN HAND --- p.5 / Chapter 2.6 --- CRITERIA FOR DIAGNOSIS OF RHEUMATOID ARTHRITIS --- p.7 / Chapter CHAPTER THREE --- HAND DEFORMITIES IN RHEUMATOID ARTHRITIS / Chapter 3.1 --- THE HAND --- p.9 / Chapter 3.2 --- THE RHEUMATOID HAND --- p.13 / Chapter 3.4 --- CAUSES OF FLEXION CONTRACTURE AT THE PROXIMAL INTERPHALANEAL JOINT --- p.16 / Chapter CHAPTER FOUR --- SPLINTING FOR THE RHEUMATOID HAND / Chapter 4.1 --- SPLINTING IN RHEUMATOID ARTHRITIS --- p.19 / Chapter 4.2 --- SPLINTING FLEXION CONTRACTURES AT THE PROXIMAL INTERPHALANGEAL (PIP) JOINTS --- p.24 / Chapter 4.3 --- THE MECHANICAL ANALYSIS OF SPLINT DESIGN --- p.32 / Chapter CHAPTER FIVE --- HAND ASSESSMENT IN RHEUMATOID ARTHRITIS / Chapter 5.1 --- INTRODUCTION --- p.41 / Chapter 5.2 --- A REVIEW OF THE STANDARDISED HAND FUNCTION ASSESSMENT --- p.42 / Chapter 5.3 --- MEASUREMENT OF GRIP STRENGTHS --- p.48 / Chapter 5.4 --- MEASUREMENT OF ACTIVE RANGE OF MOTION OF FINGER JOINTS --- p.52 / Chapter CHAPTER SIX --- DEVELOPMENT OF HAND EVALUATION SYSTEM in RHEUMATOID ARTHRITIS / Chapter 6.1 --- INTRODUCTION --- p.56 / Chapter 6.2 --- AIMS OF STUDY --- p.56 / Chapter 6.3 --- DEVELOPMENT OF THE HAND EVALUATION SYSTEM --- p.57 / Chapter 6.4 --- A COMPARATIVE STUDY OF HAND GRIP ASSESSMENT TOOLS: THE JAMAR DYNAMOMETER AND THE REC PROTOTYPE GRIP ANALYSER --- p.58 / Chapter 6.5 --- A COMPARATIVE STUDY ON THE JEBSEN HAND FUNCTION TEST IN HONG KONG --- p.67 / Chapter 6.6 --- ASSESSMENT OF FUNCTIONAL RANGE OF MOTION --- p.77 / Chapter 6.7 --- CONCLUSION --- p.83 / Chapter CHAPTER SEVEN --- THE MAIN STUDY / Chapter 7.1 --- INTRODUCTION --- p.85 / Chapter 7.2 --- RESEARCH DESIGN --- p.85 / Chapter 7.3 --- DEFINITION OF VARIABLES --- p.86 / Chapter 7.4 --- SUBJECT SELECTION --- p.89 / Chapter 7.5 --- EXPERIMENTAL PROCEDURES --- p.89 / Chapter 7.6 --- PILOT STUDY --- p.91 / Chapter 7.7 --- STATISTICAL ANALYSIS OF DATA --- p.94 / Chapter CHAPTER EIGHT --- RESULTS / Chapter 8.1 --- RESULTS --- p.95 / Chapter 8.1.1 --- Age distribution --- p.96 / Chapter 8.1.2 --- Occupation --- p.98 / Chapter 8.1.3 --- Functional class --- p.98 / Chapter 8.1.4 --- Group characteristics --- p.99 / Chapter 8.1.5 --- Comparison of the effect of corrective splints on hand functions of clients --- p.100 / Chapter 8.1.6 --- Comparison of the effect of two types of corrective splintage on hand functions of clients --- p.103 / Chapter 8.2 --- SUMMARY --- p.113 / Chapter 8.2.1 --- Summary of findings --- p.113 / Chapter 8.2.2 --- Compliance and complication of the splint intervention programme --- p.114 / Chapter CHAPTER NINE --- DISCUSSION / Chapter 9.1 --- INTRODUCTION --- p.116 / Chapter 9.2 --- COMMENTS ON THE HAND EVALUATION PROTOCOL … --- p.117 / Chapter 9.3 --- DISCUSSIONS OF THE RESULTS OF THE PILOT STUDY --- p.121 / Chapter 9.4 --- DISCUSSION OF THE RESULTS OF THE MAIN STUDY --- p.125 / Chapter 9.5 --- IMPLICATION OF STUDY INTO OCCUPATIONAL THERAPY PRACTICE --- p.130 / Chapter 9.6 --- LIMITATION OF THE STUDY --- p.131 / Chapter 9.7 --- SUMMARY --- p.132 / Chapter CHAPTER TEN --- CONCLUSION AND RECOMMENDATIONS / Chapter 10.1 --- CONCLUSION --- p.134 / Chapter 10.2 --- RECOMMENDATIONS --- p.138 / Chapter 10.3 --- SUGGESTIONS FOR FURTHER RESEARCH --- p.139 / APPENDICES / REFERENCES

ABBREVIATIONS MPJ – Metacarpophalangeal joints PIPJ – Proximal interphalangeal joints DIPJ – Distal interphalangeal joints OIJ – Own interphalangeal joints (PIPJ + DIPJ) DPTB – Deep partial thickness burns ST– Sparing tactics AST – Active surgical tactics KMUH–Kaunas Medical University Hospital MRSA - Meticylin resistant Staphylococcus aureus MSSA - Meticylin sensitive Staphylococcus aureus ADP – Autodermoplastics TBSA – Total burn surface area BAH– Burnt area of hand IHF – Impairment of hand’ function AASH – The Association of American Surgeons of Hand 1. INTRODUCTION Hand actively participate in daily activities of a human, therefore hand are the mostly vulnerable part of human’s body. According to the data of various authors, the injuries of hand and fingers make even 30-75% of all industrial traumas (Antonopulos et al. 1992, Burm et al. 1999), and burns of hand make about 6% of all traumas of hand (Mam et al. 1998). According to the data of the Lithuanian Information Center of Health, the number of injuries of shoulder bend and hand in these latter years is increasing constantly (Picture 1). Moreover, every year more than 6000 people sustain burns and about 2000 of them are treated at hospitals. About 500 people, who sustained burns, are treated every year at the specialized hospitals. Burns of one or both hand are diagnosed to about half of hospitalized patients, and deep partial thickness burns of hand are diagnosed to 15-20% of them. a b... [to full text]

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Objective: The purposes of this thesis included: i) To explore the annual incidence and time-loss duration of traumatic, work-related injuries of four nature-of-injury (fractures, nerve lacerations, tendon lacerations/disruptions and amputations) and two part-of-body categories (hand and wrist); and ii) To identify the incidence and time-loss duration, and examine explanatory variables that were associated with time-loss duration for subjects with hand fractures. Methodology: Data on incidence, time-loss duration and explanatory variables were reviewed on claims accepted between January – December 2006 at WorkSafe-New Brunswick. Descriptive statistics and non-parametric tests were used to explore incidence and time-loss duration. Using a biopsychosocial framework, explanatory variables associated with time-loss duration were analyzed using Cox Proportional Hazards regression. Results: The incidence for hand and wrist trauma involving fractures, tendon lacerations/disruptions and amputations was low (3%). Incidence was significantly higher for fractures and for injuries to the hand, while time-loss duration was significantly higher for the wrist (p< .05). The incidence rate of hand fractures was low (1.5%) and average time-loss duration was high (92 days). Increased time-loss duration was associated with greater medical aid costs (used as a proxy for injury severity) older age and increased receipt of therapy (Physiotherapy/Occupational Therapy). Conclusions: The annual incidence of specific injuries involving the hand and wrist is challenging to compare to the literature since incidence is presented in many ways. Time-loss duration following hand and wrist injuries is highly variable. Time-loss duration for hand fractures exceeded reports in the literature and predicted values reported in disability duration guidelines. Consideration of the impairment, personal and environmental factors is warranted to provide a framework to the return-to-work process for all stakeholders involved in the care of the hand- and wrist-injured worker.

Diss. (sammanfattning) Örebro : Univ., 2003. / Härtill 4 uppsatser.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference while remaining rooted in an occupational therapy perspective. Hand function is important for participation in daily occupations. The current focus in assessment and treatment of clients in occupational therapy remains on body structure and function which is also true in South Africa. The gap in the literature about the effects of OBHT indicates that there is a need for a study in a South African context. This research was conducted to examine the influences of an OBHT among clients with hand injuries within occupational therapy practice in a South African context.