No description available.

A dissertation submitted to the Faculty of Arts. University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Arts (Clinical Psycholoqy). Johannesburg, August 1996 / This study aims to explore the relationship between intrusion and avoidance symptoms as described in the diagnostic category in the DSM-IV (American Psychiatric Association, 1994) and frequency and level of exposure to traumatogenic events. The effects of lay counselling after the event were taken into account in the analysis, and the sample consisted of voluntary First National Bank employees, who were exposed to more than one bank robbery between December 1989 and 1992. The hypotheses of the study were that an increasing number of exposures to potentially traumatogenic events, and increasing levels of exposure to potentially traurnatoqenic events would be related to the development of avoidant and intrusion symptoms. Further, it was hypothesised that the interaction of these two variables would also be significantly related to the development of avoidant and intrusive symptoms and the nature of this interaction was explored. The scale used to measure the symptoms was the impact of Events Scale (Horowitz, 1979). Level of exposure was measured on a four point scale, which included extreme exposure with physical injury; direct threat and coafrontatlon: indirect contact with the perpetrators, and the fourth category was indirect exposure, or secondary victimisation. The results indicated that level of exposure had a significant relationship with the development of both intrusion and avoidance symptoms. Contrary to expectations, frequency of exposure was not found to be related to symptomology and it was speculated that this might have been because of the crudeness of the measure. In this regard it is of note that level of exposure as measured in this study included frequency of exposure. The results indicated further that post trauma counselling was not significantly related to symptomology. The implications of these findings were discussed in the light of the general literature in PTSD.

Thesis (D Phil (Counselling Psychology))--University of Pretoria, 2007. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Current studies in peace-building suggest that effective peace-building approaches comprise of intervention strategies that value the interconnectedness of trauma and peace-building processes. However current research reports suggest that there is limited evidence supporting this notion. In addition, there is little information as to how to effectively integrate the two themes to achieve lasting peace. The research study aims to articulate the role of an integrated approach to peace-building to inform current practice and it serves to encourage the donor community to support initiatives which recognise the link between trauma and peace building. The research took a close look at experiences of participants who attended trauma recovery workshops conducted by Sinani (an isiZulu word meaning “we are with you”), the KwaZulu-Natal Programme for Survivors of Violence, the name of the Non-Governmental Organisation (NGO) for which the researcher works. In particular, it explored how participants who had attended these workshops could serve as catalysts to peace by examining their experiences of violence in relation to trauma and peace-building. In addition it attempted to explore experiences of participants who did not attend Sinani trauma recovery workshops and the possible implication this would have for trauma and peace-building. Furthermore it analysed recent research papers and reports which addressed trauma and peace-building from a psycho-social perspective. The proposed hypothesis is that if trauma support work is ignored in post conflict peace-building processes, certain survivors of past violence are at risk of becoming perpetrators of future violence. Integrating trauma support work in peace-building interventions will yield lasting peace. The emerging findings suggest several factors contribute to violence and peace-building. Children’s exposure to violence, the extent of trauma and certain aspects of the criminal justice system have been described by participants as factors that contribute to violence. Equally participants suggested a competent leadership collective, functioning safety and security structures as valuable contributions to peace. Other valuable insights were shared by participants on the role of spirituality as well as indigenous cultural rituals valuable in the trauma and peace-building field. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

Thesis (D Phil (Psychotherapy))--University of Pretoria, 2004. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Emergency Medical Services (EMS) is provided in a variety of different ways in the United States. Methods of service delivery range from the purely private to the completely public and include mixtures that are not clearly one or the other. Based on a review of the literature, this variation is hypothesized to reflect, in part, variation in community characteristics. Using localities in the Commonwealth of Virginia, this hypothesis is tested by examining the characteristics of forty-seven communities in which emergency medical services are provided. Survey research was used to explore the association between public or private provision of EMS and five variable clusters: socioeconomic, medical resources, geographic, governmental, and unique local resources. Analysis of these variable clusters resulted in the conclusion that there is a statistically significant difference between the characteristics of communities with public service provision and the characteristics of communities with private provision. Thus, it seems highly likely that the public-private variation in EMS service delivery reflects to a certain extent differences in the communities themselves. Socioeconomically advantaged, urban communities with quick access to a large number of medical facilities are more likely to provide EMS through private means. On-the-other-hand, relatively socioeconomically disadvantaged, rural communities with fewer medical resources are more likely to publicly provide EMS service. The fact that this relationship between the characteristics or nature of the community and the method of service provision exists raises several issues. It indicates that rural communities are carrying the burden of public service provision while more urban areas have been able to recover some costs. It also raises the issue of service provision to the indigent in urban areas, since we are unsure as to whether or not a fee structure inhibits utilization by the poor. The relationship between access to the EMS system and the selection of a financing strategy of service provision deserves investigation. Perhaps most importantly, this effort points out how little we know about emergency medical services in the larger context of municipal services. / Master of Urban and Regional Planning

Résumé : Les réanimateurs ont recours à des interventions à la fois médicales et chirurgicales en contexte de choc traumatique. Le rôle des vasopresseurs dans cette prise en charge est controversé. Alors que les lignes directrices américaines considèrent que les vasopresseurs sont contre-indiqués, certains experts européens en encouragent l’utilisation pour diminuer le recours aux liquides intraveineux. Avant d’élaborer un essai clinique, il importe de comprendre la pratique actuelle à laquelle se comparera une intervention expérimentale, ainsi que de connaître le niveau d’incertitude dans la littérature entourant la question de recherche. Le Chapitre 2 de ce travail présente une étude observationnelle effectuée dans un centre régional de traumatologie québécois. Cette étude documente les pratiques de réanimation adoptées par les équipes de traumatologie en 2013, particulièrement le recours aux liquides intraveineux et aux vasopresseurs. Les résultats démontrent que les vasopresseurs ont été utilisés chez plus de 40% des patients, particulièrement les victimes de traumatismes crâniens (RC 10.2, IC 95% 2.7-38.5). De plus, les vasopresseurs ont été administrés dans les phases précoces de la réanimation, soit avant l’administration d’un volume important de liquides. Le Chapitre 3 présente une revue systématique portant sur l’utilisation précoce de vasopresseurs en traumatologie. Les bases de données MEDLINE, EMBASE, CENTRAL et ClinicalTrials.gov ont été interrogées, ainsi que les abrégés présentés dans les conférences majeures en traumatologie depuis 2005. La sélection des études et l’extraction des données ont été effectuées en duplicata. Aucune donnée interprétable n’a pu être extraite des études observationnelles et le seul essai clinique identifié n’avait pas une puissance suffisante (RR de mortalité avec vasopresseurs 1.24, IC 95 % 0.64-2.43). Cette synthèse met en lumière l’incertitude scientifique sur le rôle des vasopresseurs en traumatologie. Les vasopresseurs ont des bénéfices potentiels importants, puisqu’ils permettent entre autres de supporter étroitement l’hémodynamie des patients. En revanche, ils présentent aussi un fort potentiel de dangerosité. Ils sont utilisés fréquemment, malgré l’absence de données sur leurs risques et bénéfices. Ces trouvailles établissent clairement la pertinence clinique et le bien-fondé éthique d’un essai clinique sur le rôle des vasopresseurs dans la prise en charge précoce des victimes de traumatismes. / Abstract : Trauma teams often make use of both medical and surgical interventions in the early management of traumatic shock. Vasopressors have an important clinical potential, namely because they allow fluid restriction and narrow hemodynamic support. However, they also have the potential for significant harm. The role of vasopressors in this early phase of care is controversial. Although North American guidelines consider that vasopressors are contraindicated in this clinical setting, some European experts encourage their use in the hopes of reducing intravenous fluid administration and its inherent risks. Before designing an adequate clinical trial on vasopressor use, a number of vital questions must be answered. First, current accepted practice must be described in order to determine how it will compare with an eventual experimental intervention. Second, relevant knowledge gaps in the scientific literature must be identified in order to establish equipoise and refine the research question. Chapter 2 of this document presents an observational study conducted in a regional trauma centre in the province of Québec. This retrospective study documents current practice patterns adopted by trauma teams over the course of 2013, with particular emphasis on vasopressor and intravenous fluid use. Over this timeframe, more than 40 % of patients received vasopressors, most often in the presence of traumatic brain injury (OR 10.2, 95% CI 2.7-38.5). Moreover, these vasopressors were often administered in the very early phases of trauma care, before any significant intravenous fluid loading. Chapter 3 consists of a systematic review on the early use of vasopressors in the management of traumatic shock. MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov were searched, as well as conference proceedings from major trauma meetings since 2005. Independent reviewers completed study selection and data extraction in duplicate. Observational studies yielded no interpretable data, and the only clinical trial addressing the research question had insufficient power to inform clinical practice (RR of death with vasopressor use 1.24, 95% CI 0.64-2.43). This knowledge synthesis highlights the uncertainty surrounding the role of vasopressors in trauma. Trauma teams routinely make use of vasopressors despite the absence of data on their risks and benefits. These findings clearly establish both the clinical impetus and ethical justification for a clinical trial focusing on the early use of vasopressors in the management of traumatic shock.

Thesis (MA (Theol.))-University of Pretoria, 2007. / Includes bibliographical references.