No description available.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / toc / Surgery / Doctoral / Doctor of Philosophy

The goal of this thesis was to evaluate the cost-effectiveness of implantable Doppler technology (IDT) used to monitor free tissue transfer (FTT) procedures in the treatment of cancer of the upper aerodigestive tract (UADT). First, a systematic review of the literature on the effectiveness of traditional and IDT monitoring techniques was performed. Second, a utility survey using a time trade-off technique was created and administered. The results from this survey were used to establish utility values for health states common in patients undergoing FTT procedures. Third, a cost study using the microcosting data available through the Ottawa Hospital was performed. Finally, a decision analytic model was created and an economic evaluation from the payer perspective was completed. A probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI) were performed. The thesis found that the currently available evidence supports IDT as a cost-effective intervention. Further research should be directed towards determining the effectiveness of both traditional and IDT monitoring.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / The purpose of this investigation was to evaluate the efficacy of the adjustment of the first rib as an adjunct to the manipulative treatment of mechanical neck pain, according to subjective and objective clinical findings. The results of this study would indicate to Chiropractors which specific types of adjustments, used for the treatment of mechanical neck pain, would potentially increase the cervical range of motion and / or decrease pain experienced by the patient and thus lead to a more effective treatment protocol. The outcome of the study will help clinicians select the more appropriate treatment for patients based on the subjective and objective outcomes. / M

Dissertation submitted to the Faculty of Health in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to test the Effectiveness of Proprioceptive Neuromuscular Facilitative Stretching combined with administration of Diclofenac compared to Proprioceptive Neuromuscular Facilitative Stretching and placebo medication for the treatment of Cervical Facet Syndrome in a clinical experimental setting. Neck pain is a common disorder, which can often be attributed to mechanical dysfunction of the cervical spine. The patient with facet syndrome may complain of sudden onset of unilateral neck pain, often with referred pain. Muscle spasm is usually present causing restricted movement. Pain increases with movement and is relieved by rest. The pain is aggravated by hyperextension and relieved by flexion and often follows a sclerotomal rather than a dermatomal pattern. Forty subjects with mechanical neck pain were screened for facet syndrome and randomly divided into two groups of twenty. Each patient received Proprioceptive Neuromuscular Facilitative (PNF) stretching of the Posterior Cervical and Trapezius musculature. In conjunction with this, half the patients received Cataflam D while the other half received placebo medication. The patients were treated five times over a period of two weeks. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Numerical Pain Rating Scale 101, Short Form McGill Pain Questionnaire and the CMCC) and algometer and goniometer measurements respectively. The data was collected at the initial, middle and final treatments for each patient. / M

Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2001. / For neck pain, the first-line treatment of allopathic physicians is usually the prescription on non-steroidal ant-inflammatory drugs (NSAIDs), whereas the firstline treatment of chiropractic physicians is usually cervical manipulation. The literature shows that both chiropractic manipulation alone and NSAIDs alone are effective for the treatment of cervical facet syndrome, with chiropractic manipulation being much safer than the use of NSAIDs. Furthermore, patients that receive chiropractic care have been shown to generally be much more satisfied than those that receive conventional medical care. The aim of this study was to determine the short-term effectiveness of cervical spine manipulation as compared to Piroxicam administration in the treatment of chronic cervical facet syndrome. The study design that was chosen was that of a comparative clinical trial. Forty consecutive patients diagnosed with chronic facet syndrome of the cervical spine were randomly assigned to either the manipulation group or the NSAID group (twenty patients in each group). Each patient in group A received manipulative therapy of the cervical spine on three consecutive days. Each patient in group B received 40 mg of Adco Piroxicam on the first two days of treatment, and 20 mg daily for the remainder of the seven day treatment period. The patients were assessed by means of objective and subjective data obtained before each consultation on days 1, 3 and 7. The objective data was gathered from algometric pressure-pain threshold readings over the involved facet joint. The subjective information was obtained from the Short-Form McGill Pain Questionnaire, the Numerical Pain Rating Scale - 101 and the CMCC Neck Disability Index, as well as the patients perceived improvement which was recorded as a percentage on days 3 and 7. / M

Background In the treatment of head and neck cancers (HNCs), radiotherapy (RT) has the advantage of organ preservation compared to surgery. However, treatment toxicities associated with RT can affect important functions for everyday life, both in the acute and late stage. RT to macroscopic tumour in HNC is commonly combined with elective RT to cervical lymph nodes at risk of microscopic involvement. The resulting risk reduction of the elective treatment based on dose-volume parameters is sparsely evaluated. So is the relationship between the elective treatment and treatment toxicity. The present thesis addresses these aspects. A strategy aimed at improving the outcome of RT is accelerated fractionation (AF). AF strives to shorten total treatment time to minimise proliferation of the tumour tissue during the RT period. We have investigated the impact of AF on both disease control and toxicity. Methods In the ARTSCAN study, 750 patients with localised HNC were randomised between AF (68 Gy in 4.5 weeks) and conventional fractionation (CF) (68 Gy in 7 weeks). The elective treatment volume was prescribed 46 Gy with CF in both treatment arms. The thesis is based on four individual papers, investigating the issues above in the whole study population or in sub-populations. Results No difference in disease control or late toxicity between CF and AF was observed at five years. However, there was an increased acute toxicity with AF. Weight loss was associated with treatment volume, independent of tumour stage. The elective treatment volume was found to be an independent risk factor for late aspiration, as well as mean dose to the pharyngeal constrictor muscles, neck dissection, and age at randomisation. There was a significant risk reduction for node relapses in volumes treated to an elective dose. Only a relapse in volumes treated to &gt;60 Gy affected the survival. Conclusion The present thesis questions the benefit of AF in definitive RT as well as extensive elective treatment of the cervical nodes.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / Whiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders. / M