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The kind of diseases affecting Japanese people and the causes of death in Japan have changed a great deal in the last several decades due to various factors, most notably the advancement of medical technology and changes in life style. The number of people who die from life style diseases such as cancer, which are chronic and possibly need long-term hospitalization, increases every year. In the 1970s the hospice philosophy was introduced to Japan from the West. It encourages patients and their families to affirm life and to regard dying as a normal process, and offers a support system to help patients live as actively as possible and sustain a sense of selfhood, autonomy, and dignity until they die. In practice, however, the dying process is still not regarded as normal in contemporary Japan and many patients fail to die in the way proposed by the hospice philosophy. There is also disagreement between the patients and the medical professionals regarding their respective idea of good death. Hospices and PCUs, which were initially developed in order to provide humane care, have become places which provide a new form of institutionalized death, and consequently constrain the patients' dying patterns. In this thesis, I investigate the above issues from the perspectives of the anthropology and the ethnography of Japan. I demonstrate how the framework of van Gennep's rites of passage and Turner's concept of liminality can be used to analyze the current situation in Japanese hospice settings. I also perform an ethnographic analysis of Japanese attitudes towards health, illness, and death in order to illustrate the reasons why some Japanese patients fail to die a good death as proposed by the hospice philosophy.

Cancer is often considered more frightening than other equally lethal diseases. There is a mythology surrounding cancer, with many superstitious beliefs. Cancer is associated with prolonged suffering, with wasting away, and with a slow lingering death. Cancer includes multiple physical needs, intense psychological distress manifested by pain, anxiety and depression and restrictions in social and sexual functioning for both the cancer patient and the relative. Cancer can increasingly be characterised as a chronic disease with considerable, continuing and fluctuating specific needs and problems for patients as well as their families. There is an obvious need for research on the family’s experience, essential to gain a better understanding of their emotions and needs. Most research has been performed among family members of the frail elderly or cognitively impaired patients. Research focusing exclusively on the caregiving process involving cancer patients and their families is scarce. The purpose of this study was to explore and describe family members’ experiences, and their specific needs in relation to the relative with cancer. The research design was based on qualitative research because of its exploratory, descriptive and contextual nature. The collection of the data was done by means of individual interviews and field notes reflecting the observation done during the interviews. The analysis of the data was done according to Tesch’s approach of data reduction. Literature was used to compare and complement the results. Applying Guba’s model on trustworthiness ensured the trustworthiness of the research. The results of the fieldwork indicated the following themes and categories: • Emotional experiences of the family members of a cancer patient • Uncertainty about how to relate to and care for the cancer patient. • Variety of emotions stemming from their experience with a cancer patient. • Family members express their specific needs. • Need to understand the nature and implications of the patient’s cancer. • Need to understand the impact on the family dynamics. • Need to gain insight into their personal relationships with the cancer patient. Based on these findings, guidelines were presented for the development of a psycho-educational programme to assist family members of cancer patients. / Prof. C.P.H. Myburgh

Introduction Human immunodeficiency virus (HIV) infection is becoming a global epidemic. In HIV-infected individuals, anorectal diseases are common and the commonest indications for surgical intervention. However, it has not been clear whether the cause and management of anorectal conditions differ in patients who are HIV negative and those who are HIV positive. Aim To compare the presentation of perianal diseases in HIV +ve and HIV –ve patients and to determine the best therapy for perianal diseases in HIV +ve patients Methods The study period was from 1999 to 2002. Patients seen at Helen Joseph Hospital during the author’s gastroenterology fellowship period and those from his private practice were recruited. Those who agreed to HIV testing and who were treated by the author were included in the study. The patients were categorized according to HIV status, CDC classification and perianal pathology. Standardized questionnaires were used for every patient. Patients were reviewed every two weeks after the procedure until fit for discharge. Results The sample comprised 241 patients: 100 HIV+ve (63 males and 37 females) and 141 HIV-ve (61 males and 80 females). The mean age of the HIV+ve patients was 34,8y (range 17-62y), and the mean age of the HIV-ve patients was 41y (range 5-82y). Follow-up was from two weeks to two years. The pathology included 62 (25 +ve, 37 -ve) haemorrhoids, 67 (27 +ve, 40 –ve) fistulas, 59 (25 +ve, 34 -ve) abscesses, 46 (11 +ve, 35 -ve) fissures, 24 (22 +ve, 2 -ve) anal ulcers, four (3 +ve, 1 -ve) anal warts, two (both +ve) pilonidal sinuses, three (all -ve) anal cancers and two (1 +ve, 1 -ve) hidradenitis suppurativa. Nine patients with haemorrhoids (4+ve, 5-ve) were treated conservatively, 11 patients with haemorrhoids (6+ve, 5-ve) had rubber band ligation and 42 patients with haemorrhoids (15+ve, 27-ve) had haemorrhoidectomy. Thirteen patients (1+ve, 12-ve; p<0.001) had complex fistulas and 8 patients (7+ve, 1-ve; p=0.006) had multiple fistulas. Ten HIV -ve patients with complex fistulas and seven patients with trans-sphincteric fistulas (3+ve, 4-ve) needed more than six weeks to heal after treatment. Thirty patients with anal fissures had sentinel piles, but there were none in the patients with anal ulcers (p<0.0001). Thirteen HIV +ve patients with anal ulcers had an abnormally weak anal tone, but only one HIV +ve patient with anal fissure had a weak anal tone (p<0.001). In the patients with anal fissure, 37 (8+ve, 29-ve) had a high anal tone, but none of the patients with anal ulcers had increased anal tone (p<0.0001). Of the 59 patients with perianal suppuration, 23 (8+ve, 15-ve) had primary fistulotomy as well as drainage of the abscess. Conclusions Multiple fistulas were more commonly seen in advanced HIV patients, whereas complex fistulas were more commonly seen in HIV negative individuals. Healing after fistula surgery is determined more by the type of fistula than the HIV status or stage. Anal fistulas associated with perianal suppuration can be treated the same way in both HIV negative and positive patients, without increased complications. Careful physical examination is essential to differentiate between anal ulcers and fissures. Both conditions are common, and have similar symptoms in HIV positive patients. They can, however, be readily and safely distinguished on clinical examination, since fissures are associated with high anal tone, and a sentinel pile, while the AIDS ulcer lacks the sentinel pile, and the pressure is low. Anal malignancies, especially squamous cell carcinoma, have been uncommon in our experience. With the addition of anti-retroviral therapy and antibiotics, haemorrhoids may be safely treated according to standard principles (rubber band ligation and haemorrhoidectomy, as appropriate). Our practice has favoured a conservative approach in patients with advanced HIV disease. However, anti-retroviral therapy and antibiotics may improve the safety and outcome after surgical procedures.

Thesis advisor: Dorothy A. Jones / Cardiac surgery is frequently performed as a surgical intervention within the United States; but there is little known about how the older adult (70 years of age or greater) experiences cardiac surgery and recovery over time. This qualitative research study utilized narrative methodology to interview 13 older adults to inform understanding of the older adult's cardiac surgical experience. The purpose of this study was to describe the story of the older adult both coming to surgery (preoperative period) and during the transitional time of the acute recovery period following cardiac surgery (up to 8 weeks after cardiac surgery). The primary research question asked was "What stories do older adults tell of their experience of cardiac surgery from the preoperative period through the first 2 months postoperatively?" Using narrative analysis of participant discourse, consisting of both structural (re-storying of narrative content) and thematic analysis of interview content, there emerged an overarching story of older adult experience of cardiac surgery which can be described thematically as: Moving toward healing: engaged in and appreciating life while conscious of time passing amidst the primacy and struggle of the symptom experience. Knowledge gained from this study can help to broaden the understanding of the experience and the trajectory of older adult recovery after cardiac surgery, and also serves to inform nursing education and practice models, nursing interventions, instrument development and innovative models of care designed to support the perioperative care of older adults. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A report on a study submitted to the Department of Speech Pathology, Faculty of Arts. University of The Witwatersrand, Johannesburg in Partial fulfilment of the requirements for the Degree of Masters of Arts in Speech Pathology, Johannesburg, 1998. / This study was designed to examine the incidence of dysphagia in a group of fifty diabetic patients. The interrelationship between dysphagia and other complications of diabetes was examined. These included neuropathy, orthostatic dysfunction, renal dysfunction and respiratory disorders. Issues such as type of diabetes, patient age and age of onset were addressed. The utility and sensitivity of an interview schedule devised by the researcher was critically evaluated. Data were obtained through the administration of a standardized open-ended interview schedule coupled with an examination of the patients' hospital files. Results were interpreted and tabulated by the researcher. Results revealed that a significant proportion of diabetic patients are experiencing swallowing difficulties within all three phases of the swallow process. It is postulated that the cause of the dysphagia may be due to severe autonomic neuropathy and consequent vagal denervation. The highest incidence of dysphagia appeared to be amongst Type I diabetics who developed diabetes before the age of forty. The interview schedule was thus able to detect those patients experiencing dysphagia. However it was found to be unsuccessful in determining the severity of the problem. Clinical implications for both the Speech Therapist and the Medical team are discussed. Suggestions for future research are put forward.

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0300009Y Masters Dissertation (Faculty of Health Sciences) / A phase I dose escalation study of Cisplatin chemotherapy in patients with carcinoma of the cervix receiving pelvic radiotherapy PATIENTS WITH CARCINOMA OF THE CERVIX RECEIVING PELVIC RADIOTHERAPY.

This study aims to determine the number of patients secluded over a specified period, provide a profile of patients that are likely to be secluded, and to ascertain the reasons for seclusion. Seclusion in the psychiatric context can be defined as the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. There are differing views on seclusion and consequently this has presented clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. In light of this, alternatives to seclusion have been explored. No data exists in South Africa on rates of seclusion for psychiatric purposes, and consequently neither the need for seclusion nor alternatives to seclusion have been explored. The study is a retrospective review of patients secluded at Sterkfontein Hospital, a tertiary psychiatric hospital, over a six month period. Data was collected from clinical records at Sterkfontein Hospital. RESULTS: 112 patients were secluded over the 6 month period. Users were secluded for a total of 59415.5 hours and on 4814 separate occasions. 84.8% of the users secluded were male. The mean age of users secluded was 29years. Just over half the users (52%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The commonest diagnosis was Schizophrenia (31.4%) followed by Cognitive Impairment (20.6%) and Bipolar Mood Disorder (13.7%). The most commonly used medication was Sodium Valproate (17%), followed by Haloperidol (11%) and Risperidone (11%). CONCLUSION: Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion in terms of rates and patient profiles so that we may improve seclusion practices.