A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Emergency Medicine, Johannesburg / Introduction Point-of-care ultrasound (PoCUS) is a widely utilized tool in Emergency Medicine (EM). The core PoCUS curriculum in South Africa (SA) does not currently include lung ultrasound or basic bedside echocardiography, although the burden of disease in a typical South African Emergency Department (ED) is skewed towards respiratory and cardiac pathologies. This study was undertaken to determine the profile of PoCUS examinations actually performed and potentially indicated in this ED, and whether current training in PoCUS is meeting the need in clinical practice. Methods This was a prospective observational audit of bedside PoCUS examinations actually performed, and potentially indicated, over a two-week period in the Helen Joseph Hospital ED in Johannesburg. Results The study included 372 patients. Ultrasound aided in the diagnosis and management of 107 (28,8%) of the patients. A total of 137 PoCUS investigations were performed. A total of 38,9% of the patients had positive ultrasound findings. The most frequently performed PoCUS applications were e-FAST (extended focused assessment by sonography in trauma) (32,8%), DVT assessment (13,9%) and procedural guidance (10,9%). A total of 758 PoCUS examinations were indicated in 307 (82,5%) of the patients. Overall, 18,1% of the potentially indicated PoCUS investigations were performed. The most frequently potentially indicated PoCUS applications were lung ultrasound (28,2%), basic cardiac (28%) and haemodynamic assessments (20,4%). Conclusions These findings reflect the high number of respiratory and cardiac cases seen in South African EDs. This highlights the consequent need for additional ultrasound skills to assist in the emergency management of such cases. Training of future South African EM specialist consultants should include both lung ultrasound and basic bedside echocardiography. It is time to update to the South African core PoCUS curriculum. / LM2019

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Thesis (M.S.)--Boston University / This was an exploratory study of factors related to unplanned termination of treatment. The cases of ten women who had been in casework at the Massachusetts Memorial Hospitals' Psychiatric Social Service Department and who had withdrawn from casework after five or more interviews were studied by examination of the records and by an interview with each subject. The following areas were investigated: the worker client relationship, the personal attributes of the client, the current environment, and the attitude of a significant person toward treatment. Analysis of the data indicated that the majority of discontinuers had not felt helped by their casework contact; that there had been some confusion for all subjects in one of the following areas: treatment goals, worker's role, or treatment plans; that important situational changes in the subject's environment around the time of discontinuance appeared to be directly related discontinuance,; that subjects tended to have more interests and activities at the time of discontinuance than they had at the beginning of treatment; and, that the attitude of a significant person toward treatment was positive more frequently around the time treatment began that it was around the time of discontinuance. It appeared that the factors examined may well influence a client's continuance in treatment.

Thesis (M.S.)—Boston University

Thesis (M.S.)--Boston University

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