M.Tech. (Homeopathy) / Students of Chiropractic, attending the University of Johannesburg (UJ), start the practical component of their training from their third year of study (Bunge & Tyranes, 2007). Each student must be proficient in 250 adjustments (200 of which must be spinal) by the end of their fifth year of study (Fletcher et al., 2005). As these manual manipulations are complex psychomotor skills, they require a good deal of practice to master (Bunge & Tyranes, 2007). Due to the practical nature of the course, Chiropractic students are required to practice their techniques of adjustment on each other. This places the students under a great deal of physical and mental strain as adjustments and techniques designed to reduce pain and restore normal musculoskeletal and neurological function in the presence of pathology are being consistently and repetitively applied to healthy individuals (Ebrall, 2003). This in turn results in the individuals experiencing various adverse effects such as headaches, muscular pain and joint pain (Bergman & Peterson, 2011; Botha, 2011; Venter, 2011). Conventional treatment for musculoskeletal pain (such as the use of non-steroidal anti-inflammatories and analgesic drugs) can be costly and are known to have potential adverse effects (Neal, 2002). No research has been done to date on the effect of Homoeopathic Similimum treatment on musculoskeletal pain, as a result of practicing adjustments in Chiropractic students. The aim of this study was to determine the efficacy of the Homoeopathic Similimum on musculoskeletal pain produced in Chiropractic students (attending the University of Johannesburg) as a result of practicing adjustments, by means of a Numeric Pain Scale Rating as well as via a 5-Point (Likert-type) Treatment Satisfaction Scale. This was a 2 week, randomised double-blind placebo-controlled, matched-pair study using 30 participants (third to fifth year UJ Chiropractic students, males and females, aged 20-35). Participants who met the inclusion criteria were matched according to the body-region affected (i.e. head, upper limb, back, lower limb or whole body) (Appendix C); they were then randomly divided into either the placebo or treatment group. Thereafter, an initial case-taking and focused physical examination (including vital signs) was conducted and the initial Numeric Pain Scores (baseline measurements) obtained (Appendix C) (Cox, 2010). The participant’s case was analysed, repertorised (using the Mercurius Computer Repertory-The Complete Repertory 2012) and the Similimum remedy was selected. The Homoeopathic Dispenser dispensed the medications and participants received either their Similimum remedy (in a 30cH potency to be administered in a dosage of 5 pillules once a day and as needed by the individual participant) or the placebo (composed of unmedicated pillules with identical dosage instructions). A follow-up consultation (on day 7) was conducted to assess progress, obtain the participant’s intermediate numeric pain score and to assess the prescription (Appendix E). After careful evaluation of the case, the researcher considered (depending on the participant’s response to the initial treatment) whether to change the prescription, alter the repetition of the dose, continue the same course of treatment or to stop the prescription altogether. On day 14 a final consultation was conducted (including a final physical examination) to assess overall progress, obtain final Numeric Pain (Appendix E) and Treatment Satisfaction Scores (Appendix F) (Cox, 2010; Pellegrin et al., 2001) and terminate prescriptions. Data collected from the Numeric Pain Scale Ratings and Treatment Satisfaction Score Sheets was analysed by STATKON. Frequencies, descriptives and cross-tabulations were done. The Shapiro-Wilk test assessed normality. A Mann-Whitney test was used to compare the two groups. Comparisons over time for each group were assessed using a Friedman test and a Wilcoxon Signed Ranks test was done to ascertain where the differences occurred (Smith, 2011). The Friedman test results showed significant differences in both groups (i.e. the pain scores decreased in comparable increments for both groups over the two-week study period) and the Wilcoxon Signed Ranks test showed that both groups’ pain scores started to decrease at the 2nd consultation (i.e. at the end of week one). The results of the Mann-Whitney test showed that there were no statistically significant differences between the treatment and placebo groups, either in terms of reduction of pain or participant satisfaction with treatment. Therefore it can be concluded that the Homoeopathic Similimum was not more effective than placebo in the treatment of musculoskeletal pain experienced by UJ Chiropractic students as a result of practicing adjustments. However, further research utilising a larger study sample and a longer period of study should be conducted before any definitive conclusions can be drawn.

Thesis (MMed (Occupational Medicine))--Stellenbosch University, 2013. / Introduction Exposure incidents involving blood and body fluids represent a major hazard for medical undergraduates. Every medical teaching university experiences the problem of undergraduate medical students sustaining such incidents. Although Post Exposure Prophylaxis (PEP) is readily available and accessible to medical undergraduates following an incident, continuity and quality of care extends beyond the provision of PEP. This includes follow up consultations after receiving PEP according to protocol. Study Design This study was performed at the Tygerberg Campus of Stellenbosch University in Cape Town, South Africa to assess compliance with follow up consultations following an exposure incident. The study base consisted of all the medical undergraduates who reported an exposure incident at the Campus Health clinic. Cases were defined as medical undergraduate students of Stellenbosch University who had reported an exposure incident between January 2007 and December 2011. They were identified using the clinic database and records. Influential factors associated with the exposure incident, including compliance regarding follow up consultations were obtained from standardised reporting forms and medical records. The data was analysed in 2 sections, a cross sectional component (descriptive and analytical) and a retrospective cohort component. Two student cohorts were retrospectively followed from the beginning of their 3rd year to the end of their medical curriculum (6th year). Results There were 280 exposure incidents reported in the study period, of which 174 were low risk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP). For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow up consultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6 month follow up visit. There was an increase in the number of exposure incidents from 2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery (n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood was the most common reported activity associated with exposures. Of notable importance was recapping, disposing of needles and insertion of blood into sample tubes. These activities accounted for 63 of the 280 exposure incidents. The 4th year students were the least at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual average cumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%) and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years (clinical exposure time). Recommendations There is an urgent need for the number of exposure incidents to be reduced, e.g. needle recapping and disposal, and insertion of blood in sample tubes cause numerous preventable incidents. Various other strategies can be implemented in order to reduce the number of incidents across all undergraduate years of study. It is envisaged that by reducing the number of exposure incidents, there will be a subsequent decrease in the number of individuals requiring PEP. The importance of ensuring compliance with regard to follow up consultations needs to be emphasized. Factors that lead to noncompliance need to be investigated in a separate study.