published_or_final_version / Public Health / Master / Master of Public Health

According to the World Health Organization, life-threatening infectious diseases, even in remote and vulnerable locations, can be minimised through immunisation. Vaccines interact with the immune system to produce an immune response similar to that produced by natural infection. However, about 10% of the population avoid vaccination and other needle procedures because of “needle fear”. Because of the prevalence of injection pain and more concern about the adequacy of pain management, and with the steadily increasing number of recommended childhood immunisation, we identified a need for evidence-based guidelines on pain management to be developed in our local setting through translational nursing practice. After a critical appraisal of randomised controlled trials and systematic reviews, it is highly recommended that “topical anaesthetics are effective in reducing vaccination pain” (Grade A recommendation, based on level I evidence by SIGN). In order to facilitate practice from evidence, the implementation potential, transferability, feasibility and cost-benefit ratio - has been examined, and an evidence-based guideline has been developed simultaneously for the new practice. With the identification of stakeholders and the development of a communication plan, potential users of the guideline and pilot testing are discussed. Innovation outcomes and their effectiveness are examined and explored. It is expected that, through this translational nursing practice, vaccination induced pain and distress among healthy children can be managed well, according to the best evidence and up-to-date recommendations. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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Thesis (MSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: There is a high prevalence of musculoskeletal problems, including neck and shoulder pain (NSP) among nurses worldwide. Tygerberg hospital (TBH) is the second largest hospital in South Africa with a large complement of nurses. The prevalence of NSP and risks associated therewith have not previously been determined at TBH. It is unknown how the nurses at TBH experience NSP in their workplace. Objective: This study questioned whether the 12 month prevalence of neck pain, shoulder pain and combined NSP is similar to worldwide reports, and questioned the degree of association of NSP with lower back pain and demographic risk factors in the nursing population at TBH. Thereafter the qualitative experiences of nurses with NSP at TBH were elucidated. Methodology: A self-designed Neck and Shoulder Pain Questionnaire for nurses (NSPn) was distributed among seven wards of TBH from March to May 2009. The NSPn was compiled using the pain definition from the Nordic Musculoskeletal Questionnaire and elements of the Dutch Musculoskeletal Questionnaire. The NSPn gathered information regarding the presence of neck and shoulder pain as well as demographic and workplace risk factors. Thereafter semi-structured interviews were conducted with eight nurses working at TBH. Results: The 12 month prevalence of neck pain, shoulder pain and combined NSP was 29%, 34% and 43% respectively among a sample of 143 nurses. A high correlation of neck pain with lower back pain and of neck pain with shoulder pain was observed. No significant associations were found between age, ward module, tenure of work, and the nurses' perception of their general health and fitness with the presence of NSP. The qualitative results describe the conflict between the nurses' beliefs and their symptoms. The nurses named work-related stress as the most prevalent cause or aggravator of NSP. The main underlying cause of their stress was a shortage of nursing staff. Discussion and Conclusions: The prevalence of neck pain (29%) and shoulder pain (34%) among the surveyed TBH nurses was lower than the worldwide prevalence summary statistic of 50% and 52% respectively. However, the NSP prevalence (43%) was within the range of three international studies, suggesting that NSP is a significant concern for TBH nurses. The nurses' desire to hide pain and continue working perpetuates the problem of NSP. The underlying causes of NSP are multifactorial, with physical factors interacting with psychosocial factors. Preventative drives need to consider staffing levels and nurses' methods of coping with stress along with improvements in manual handling practices. / AFRIKAANSE OPSOMMING: Agtergrond: Daar is 'n hoё voorkoms van muskulosketale probleme, insluitend nek en skouer pyn (NSP), by verpleegkundiges wêreldwyd. Tygerberg Hospitaal (TBH) is die tweede grootste hospitaal in Suid-Afrika met 'n groot aantal verpleegkundiges. Die voorkoms van NSP en risiko's verbonde daaraan, is nog nie voorheen by TBH vasgestel nie. Dit is nie bekend hoe die verpleegkundiges by TBH NSP in hulle werksomgewing ervaar nie. Objektief: Hierdie studie ondersoek of die 12 maand teenwoordigheid van nekpyn, skouerpyn en gekombineerde NSP ooreenstem met wêreldwye aanmelding, en ondersoek die assosiasie van NSP met lae rugpyn en demografiese risiko faktore in die verpleegkunde populasie by TBH. Daarna is die kwalitatiewe ondervindings van die verpleegkundiges met NSP by TBH toegelig. Metodologie: Die self-ontwerpde "Nek en Skouer pyn in verpleegsters‟(NSPn) vraelys, is onder sewe sale vanaf Maart tot Mei 2009 versprei. Die NSPn het die die Nordiese muskuloskeletale pyn definisie en elemente vanaf die "Hollandse Bewegingsapparaat Vraelys‟ ingesluit. The NSPn het inligting oor die voorkoms van nek en skouer pyn, sowel as demografiese en werkplek faktore ingesamel. Daarna is semi-gestruktureerde onderhoude gevoer met agt verpleegkundiges wat by TBH werksaam is. Resultate: Die 12 maand voorkoms van nekpyn, skouerpyn en gekombineerde NSP was 29%, 34% en 43% onderskeidelik in die steekproef van 143 verpleegkundiges. 'n Beduidende korrelasie van nekpyn met lae rugpyn en nekpyn met skouerpyn is waargeneem. Geen betekenisvolle ooreenkomste is gevind tussen ouderdom, saal module, termyn van werk en die verpleegkundiges se persepsie van hulle algemene gesondheid en fiksheid, met die teenwoordigheid van NSP nie. Die kwalitatiewe resultate beskryf die konflik tussen die verpleegkundiges se oortuigings en hulle simptome. Die verpleegkundiges noem stres as die mees algemene oorsaak of verergeraar van NSP. Die grootste onderliggende oorsaak van stres was die tekort aan verpleegpersoneel by TBH. Bespreking en Gevolgtrekkings: Die voorkoms van nekpyn (29%) en skouerpyn (34%) was laer as die wereldwye voorkoms opsommings statistiek van 50% en 52% onderskeidelik. Maar die voorkoms van NSP(43%) was binne die grense van drie internasionale studies wat dui daarop dat NSP 'n merkbare kommer vir TBH verpleegkundiges is. Die verpleegkundiges se behoefte om die pyn weg te steek en aan te hou werk, vererger die problem van NSP. Die onderliggende oorsake van NSP is veelvoudig, met fisiese faktore en psigologiese faktore wisselwerkend op mekaar. Voorkomende veldtogte moet verpleegkundiges se stres en personeeltekorte saam met verbetering in manuele hanteringstegnieke in ag neem.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Typescript (photocopy) / 553 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychiatry, 1982

Background: Lateral elbow pain (LEP) is one of the most common musculoskeletal pains of the upper limbs. There is no substantial evidence of efficacy, particularly in the long-term use, of current conservative treatment options, many of which also carry considerable side effects. Finding a safe and effective treatment for LEP is therefore of high significance. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions, including LEP. Multi-center acupuncture randomized controlled trials (RCTs) are still relatively novel. However, they have methodological advantages over single-center RCTs, which lead to an enhanced external validity and generalizability of their results. On the other hand, pattern diagnosis, which is the basis for individualized treatment in Traditional Chinese Medicine (TCM), has been used in the treatment of LEP clinically, but such practice has not been standardized and its basis not understood. Study of pattern diagnosis in LEP may provide a better understanding of the nature of LEP and lead to better treatment outcomes in future clinical trials.;Conclusion: Our findings suggest that acupuncture is effective and safe in the treatment of LEP. Further international multi-center RCTs are suggested to investigate the long-term (3-6 months post-treatment) efficacy as well as the effect of individualized, pattern-based acupuncture (and moxibustion) for LEP. The subtypes of LEP discovered by the combined use of TCM pattern diagnosis and thermal imaging may be important in the understanding of LEP and may also be used to improve individualized treatment approach for this and other musculoskeletal disorders.;Methods: (1) A systematic review of acupuncture for LEP that included Chinese language studies and that used revised STRICTA criteria to appraise acupuncture procedures would first be performed. Based on the findings of the first study we then would (2) conduct an international, collaborative multi-center RCT of acupuncture for LEP; (3) systematically review TCM patterns for LEP; (4) conduct a Delphi study to create a LEP pattern questionnaire; and (5) investigate if distinct temperature profiles were associated with LEP patterns, using the LEP pattern questionnaire developed prior.;Results: The main findings are as follows: (1) results from previous acupuncture RCTs for LEP were inconclusive due to low methodological quality; (2) compared to sham laser, acupuncture showed a medium effect size (d = 0.48) in improvement of functional impairment of the elbow; (3) four major LEP patterns, that had unique features with distinct bio- physiological correlations were identified; (4) an LEP pattern questionnaire to assist and standardize LEP pattern diagnosis was created; and (5) we found for the first time that different TCM patterns had distinct skin temperature profiles, and such profiles might reflect different pathophysiological processes amongst LEP sufferers.;We set out to (1) review the current evidence of efficacy for acupuncture treatment of LEP; (2) to obtain evidence of efficacy for acupuncture treatment of LEP; (3) to review the diagnostic methods of Chinese medicine in the treatment of LEP; (4) to improve the diagnostic methods of Chinese medicine for the treatment of LEP; and (5) to determine if different TCM patterns are each associated with distinct, objective physiological changes in LEP.

M.Tech. (Chiropractic) / Introduction: Myofascial pain syndrome is often seen in clinical practice as a cause for pain. It is characterized as a dull ache to a burning pain that can cause referral of pain to other areas of the body (Travell and Simons, 1999). One method used to treat this, is by dry-needling therapy (DNT). DNT has proved to be effective in the treatment of myofascial pain, but it has shown to cause post needling soreness. This soreness discourages many patients from receiving further dry-needling or treatment (Kamanli et al. 2005). Ways to help alleviate post-soreness are heat, stretching, ultrasound and application of pressure (Fleckenstein et al. 2010). All these modalities are done after the needle has been removed. This then adds an extra modality to the treatment as well as increased treatment time; therefore these modalities are often skipped by practitioners (Hong, 1994). Another factor to look at is that many of these modalities have not been researched objectively for effectiveness on relieving the post-needling soreness (Kamanli et al. 2005). Using a moxi cigar, placed on top of the acupuncture needle whilst inserted into the active trigger point is a way in which heat as a modality to treat post-needling soreness can be combined into the needling time. Aim of study: The aim was to investigate if heat conduction using a moxi cigar is an effective modality in alleviating post-needling soreness when treating myofascial pain syndrome with DNT. Methodology: The trial comprised of 90 participants divided randomly into three equal groups. Group 1 received DNT of active trigger point 1 of the trapezius muscle only. Group 2 received DNT of active trigger point 1 of the trapezius muscle, with the addition of the burning moxi cigar to conduct heat through the acupuncture needle to the trigger point. Group 3 received DNT of active trigger point 1 of the trapezius muscle, followed by 5 minutes of ultrasound therapy over the acupoint. Each participant was treated once with readings being recorded pre-treatment, post-treatment and then final readings were taken 24 hours post-treatment. Subjective data was in the form of a numerical pain scale questionnaire and a pain diary. Objective data was CROM and algometer readings. Data analysis: data collected by the researcher was analyzed with the help of a statistician at STATKON at the University of Johannesburg. After consultation, it was concluded that results would be analyzed using Shapiro-Wilk test for normality and Levene’s test for equal variances. For all objective data collected, parametric testing would be used on objective data. The parametric tests used were: One way Anova and Post Hoc test. For subjective data, non-parametric testing was used on subjective data namely: Kruskal Wallis, Wilcoxon-signed rank and Mann-Whitney U test. Conclusion: Based on the results, clinically, the study showed that dry needling with the addition of ultrasound or moxibustion, as a treatment for post-needling soreness did appear to have better results. The use of these two added modalities did ease post-needling soreness which for many patients is the reason they don’t wish to receive further dry-needling treatment. When using moxibustion the post-needling soreness is eased. This added treatment can be used during the dry needling and does not require additional treatment time for the practitioner or for the patient. To conclude, the efficacy of using a moxibustion to alleviate post-needling soreness has been seen clinically. This treatment can be used with minimal addition treatment time and could be used in clinical practice.

D.Litt. et Phil. (Psychology) / Chronic pain affects 11%of the adult population and acute pain affects a further 5% at any given time, (France, & Krishnan, 1988). An estimated 65 000 people in the United States of America suffer from permanent disabilities caused from back injuries alone. 1% of the population is considered to be totally disabled from chronic pain annually, (Mayer, Gatchell, Mayer, Kishino, & Mooney, 1987). "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" (LA.S.P. Subcommittee on Taxonomy, Pain Terms; A list of definitions and notes on usage. In Pain, Q(1979), 24,2 - 252). Persistent pain is one of the most frequently presented complaints seen in a medical setting, yet is one of the most difficult symptoms to treat because of the etiologies and individualised responses to pain - Successful intervention generally leads to resolution of the pain complaint, however in some cases, the pain continues. It is ironic that in an age of advanced medical technology, success often hinges on the relief of a symptom which cannot really be measured, seen, percussed or palpated. In order for this to be possible, a comprehensive understanding of pain as seen from all perspectives and theories available must be investigated and presented. The concept of pain and its puzzling phenomenology has been recognised since antiquity.

Recent studies have shown the efficacy and practicality of the integration of complementary and alternative therapies and biomedical treatments for various diseases and illnesses, including high blood pressure, diabetes, epilepsy, and cancer. Saper et al. (2013) demonstrated that once-weekly yoga classes were equally as effective for relieving chronic low back pain in low-income, minority populations than twice-weekly yoga classes. Pain medication data collected from this 12-week study was used to examine the effect of yoga on analgesic use. Pain medications were categorized into four major groups: (1) acetaminophen, (2) opiates, (3) non-steroidal anti-inflammatory drugs (NSAIDS), and (4) other. The average number of NSAID pills taken daily decreased from baseline to 12 weeks. In addition, there was no statistically significant difference in the average number of any type of analgesic taken between once- and twice-weekly yoga groups from baseline to 12 weeks. Our findings suggest that yoga is most useful for individuals with mild to moderate chronic low back pain; however, further studies with more powerful sample sizes must be conducted in order to make more precise conclusions.