Submitted in fulfillment of the Degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2011. / Background: Idiopathic dilated cardiomyopathy (IDC) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility. Idiopathic dilated cardiomyopathy (IDC) is the second commonest cause of heart failure in Africa. Some patients with idiopathic dilated cardiomyopathy present with significant pulmonary hypertension (PHT) which maybe out of keeping with the usual degree of PHT seen in patients with this disorder. Methods and Material: This is a prospective and longitudinal follow-up study of 66 patients with IDC who were evaluated after satisfying the inclusion and exclusion criteria of this study. The clinical evaluation of each patient included a complete medical history, physical examination, 12 lead electrocardiogram, 2D-echocardiography, continuous wave (CW), pulsed wave (PW), and tissue Doppler imaging (TDI). Results: The mean age of all patients was 48.5 ± 12.8, with 39/66 (59.1%) patients being male. The prevalence of pulmonary arterial hypertension (PAH) was documented in 47 patients (71.2%, 95% CI: 59 - 83%). Mean left ventricular ejection fraction (LVEF) was 25.3 ± 8.8%, and mean left atrial volume index (LA volume) was 44.5±19.8 ml/m2. Mitral regurgitation (MR) occurred in 56/66 (84.8%) of patients with moderate or severe MR detected in 60.6% of all cases of IDC. The presence of a tricuspid regurgitant jet was found in 56/66 (84.9%), with (95% CI: 75 -93%). Right ventricular dilatation was found in 65/66 (98.5%), with (95% CI: 95 - 101%). ii Age, LA volume, LVEF and MR were included into a multivariate logistic regression model to predict PAH. Only MR presence was independently associated with PAH adjusted (OR 6.02, 95% CI: 1.15- 31.47) (p= 0.03). Conclusion: The study has shown that there is a significant prevalence of pulmonary arterial hypertension (PAH), right heart involvement and tricuspid regurgitant jet in IDC patients. The present study also showed that in patients with dilated cardiomyopathy, the degree of mitral regurgitation was a good predictor of PAH.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Several tasks examined implicit and explicit memory in matched samples of Alzheimer's (AD) and Parkinson's disease (PD) patients, and healthy elderly subjects. Lexical priming, pursuit-rotor tracking, and a fragmented pictures test, followed by explicit memory tests, were given. AD patients were impaired on all explicit tests and on lexical priming, but were intact on pursuit-rotor tracking and the procedural learning (PL) component of the fragmented pictures test. PD patients were significantly better than AD patients on all explicit memory tests, but were selectively impaired on the PL component of the fragmented pictures test. Finally, a mirror reading test was given to the PD patients and matched control subjects, with no significant differences in performance between the two groups demonstrated. Results are discussed in terms of hypothetical cognitive processes and brain circuits underlying different explicit and implicit memory domains.

Government policies have emphasised the importance of patient and client involvement in all aspects of health and social care delivery, with a corresponding impetus for their involvement in the education of practitioners. Professional education programmes adopt andragogical, student-centred approaches and incorporate both academic and practice based learning and assessments. Practice experience is recognised as a crucial aspect of student learning and has become a major focus of quality reviews in health and social care education. Whilst it might seem self-evident that students on practice placements will learn from their interactions with patients and clients, this is a relatively neglected area for formal modeling, evaluation and research. This study, therefore, explores pre-qualifying nursing, midwifery and social work students’ experiences of learning from patients and clients during practice placements. The research project is underpinned by a descriptive phenomenological approach and the extensive data are analysed using phenomenological reduction (Giorgi, 1989a; 1989b). Two key themes and six categories emerged from the data. The first theme is presented as the ‘Ways of Learning’ and this comprises the categories of: facilitation of learning; critical incidents/patient stories; and role modeling. The second theme is presented as the ‘Nature of Learning’ and comprises three categories: professional ideals; professional relationships; and understanding patients’ and clients’ perspectives. It is evident that contemporary theories, including andragogy, social learning, experiential, reflective and transformative learning theories, remain relevant to professional education. The new knowledge obtained in this research is that the most powerful learning opportunities result from unplanned, informal learning opportunities involving interactions with patients and clients. However, this is not fully explained by these contemporary learning theories. This thesis will, therefore, argue that complexity theory is relevant to the requirements of professional education programmes. It will present an overarching framework to explain the data from this study and will propose strategies to harness the complexity inherent in this important aspect of student learning.

Bakgrund: Sjuksköterskor berör patienter, ibland med en speciell intention till exempel för att trösta, andra gånger på grund av nödvändighet för att kunna utföra arbetsuppgifter. Dessa två typer av beröring benämns expressiv respektive instrumentell beröring. Beröring har visat sig kunna stärka relationen sjuksköterskor och patienter emellan, samt främja patienters välbefinnande. Syfte: Syftet med denna litteraturöversikt var att belysa vuxna patienters upplevelser av fysisk beröring inom somatisk vård. Metod: Metoden för studien var en litteraturöversikt. Resultat: Fyra huvudteman och två subteman återfanns i analysen; att bli sedd som människa med subtemat kommunikationens betydelse för upplevelsen av att bli berörd, hur beröring kan ingjuta förtroende och trygghet, betydelsen av att ha kontroll och att inte vilja ha en manlig sjuksköterska med subtemat inställning till kön avseende intim beröring. Diskussion: Det framkomna resultatet bidrar till kunskapen om hur patienter upplever fysisk beröring vid omvårdnad, och kan implementeras i sjuksköterskors vårdarbete med patienter för att göra vården mer patientcentrerad. Dock anser författarna att vidare forskning inom detta område behövs för att bidra till kunskap om patienters upplevelser av beröring och en ökad förståelse som kan generera i en mer patientcentrerad vård. / Background: Nurses use touch on a daily basis in their work. They use touch to comfort, and because of necessity in their job assignments. These two kinds of touch are called expressive and instrumental touch. Touch has been shown to strengthen the relationship between nurses and patients, also to support patients’ well-being. Aim: The aim of this literature review was to illustrate adult patients’ experiences of touch in somatic care. Method: The method for the study was a literature review. Results: Four main themes and two subthemes emerged in the analyze; to be seen as a human being with the subtheme the meaning of communication in the experience of being touched, how touch can convey trust and security, the meaning of being in control and to dislike a male nurse with the subtheme attitudes towards gender regarding intimate care. Discussion: The outcome highlights the importance of making nursing care more patient-centered. Yet the authors consider that further research in this domain is needed about patients’ experience of touch to enable better patient-centered care.

M.A. (Community Development) / The statistics on HIV/Aids in this study overwhelm the imagination. It has great social and economical consequences for individuals, families and communities. The generation of between 15-24 years are vulnerable to infection especially women. From the population of about 46 million in South Africa, 5.7 million were HIV positive by the end of 2007 with about 1000 deaths every day. Sub-Saharan Africa appeared to be the most hit by this tragedy as indicated by statistics in this study. When parents die of Aids, the burden of orphaned children is left with relatives and extended families to look after those children. The number of orphans is escalating due to increasing death rate of parents. A detailed discussion on the extended families which includes their origin, roles they play as well as challenges they face in caring for orphaned children is included as well. Challenges include having to deal with grief and changing behaviour of the orphaned children. The goal of this study was to conduct an analysis of extended families affected by HIV/Aids taking care of orphans, living in the Kyasands informal settlement in order to improve service delivery. The main objectives of the study included exploring the needs of these extended families caring for orphaned children in terms of social, emotional and material aspects as well as challenges they face and how they manage to survive. A qualitative method was used in conducting this study with the use of semi-structured interviews to collect information. The main central question asked was, how do you manage to live with an additional member within your family. The main findings in this study were reported which included the strength and composition of assets and the extended families’ resources to make a living and adjust to shocks of life. Family was seen as the most trusted asset in this study by the respondents. Just to mention a few, most of the families owned shacks, battery operated radios and televisions since they live in formal settlement without any permanent infrastructures.

Background: When an individual is cared for in a hospital, which is a new and unknown environment, this can create feelings of uncertainty and insecurity for some. Insecurity can lead to a feeling of pressure and makes the caring more difficult. This can therefore worsen the recovery for the patient. Aim: The aim of this study was to illuminate the patient's perceived experience of safety at hospital. Method: A literature based study was done based on ten qualitative articles among men- and women at hospital. Result: The study showed that the feeling of safety could be experienced when the patient felt confirmed, the patient feels involved in their own care and when nursing staff cares for the patient. To felt safe is also found in how patients perceive their environment through the hospital's physical and social environment. The result of the articles were presented in two main themes; the meaning of the caring relationship and presence of others. Conclusion: There was several factors that contribute to the feeling of safety for the patient in hospital care. Patients’ feelings of safety can be experienced by acts such as to be confirmed by the care giving staff, the patient's opportunity to be involved and when the patient feels cared about. / Examensarbetet har för avsikt att belysa patienters upplevda erfarenhet av trygghet vid sjukhusvård. Trygghet är ett filosofiskt begrepp med olika innebörder och upplevs olika från individ till individ. Trygghet kan delas in i både inre och yttre trygghet där den inre tryggheten skapas av positiva minnen från barndomen såsom minnen från en vacker sommardag. Inre trygghet kan också skapas i vuxen ålder av positiva erfarenheter såsom bli väl bemött och omhändertagen under sjukhusvården. Yttre trygghet kan ses såsom miljön patienten har runt sig. Detta examensarbete benämner det som den sociala och fysiska miljön. Den sociala miljön skapas av närvaro av närstående, andra patienter och vårdpersonal. Den fysiska miljön handlar om hur sjukhusmiljön är utformad och påverkar den sociala miljön. Resultatet från de tio vetenskapliga artiklarna inkluderade i examensarbetet visar att upplevelse av trygghet är associerad med upplevelsen av vårdrelationen och relationen till andra signifikanta personer. Det framkommer att upplevelse av trygghet påverkas av graden av delaktighet i vården, relationen till personalen och närstående samt den fysiska vårdmiljön.

M.Cur. / The problem of relapsed psychiatric patients is global, it is high in rural areas where services are not readily available. Lack of knowledge of psychiatric conditions and the management by family of patients play a part in psychiatric patients relapsing. Families reject their family members (patients) when they are in hospital, for what they did when their illness started. Some patients assaulted people, stripped naked in the street. The family then disassociate themselves from the patient because of that behaviour. Studies have indicated that the following reduce the rate of relapse of psychiatric patients: • psycho-education for families regarding the causes of mental illness and its management; and • active involvement of families of patients in the treatment plan of these patients. The researcher’s interest was triggered by the high rate of psychiatric patient relapses in the institution where she works. The researcher decided to investigate the experiences of patients who have relapsed. An investigation was done whereby an explorative, descriptive, contextual and qualitative design was used to find out what the experiences of patients are who have relapsed. Phenomenological interviews were done with seven participants who were purposively selected. Permission was first obtained from the gatekeepers and participants. Thereafter, a pilot study was done with one patient who met the selection criteria for the study. This was done to help the researcher to discover the strong and weak points of the research and to make corrections where necessary. Following Guba’s model (Krefting, 1991:214-222) strategies ensured trustworthiness. Data analysis was done following Tesch’s method of data analysis (Creswell, 1994:154-156). The results showed that patients’ basic needs are neglected in some areas. Emotional dimensions of participants were not catered for by health workers, which resulted in participants getting frustrated and angry. After the data analysis guidelines for psychiatric nurses were described to assist psychiatric patients to mobilise their resources. Recommendations were made regarding the application of the results of the study in psychiatric education, nursing practice and research and for family members. It was concluded that the questions of the study were answered and the objectives were achieved.

"The purpose of this study is to provide information in the area of tuberculosis admission practices and policies which may assist in the control of tuberculosis in the State of Florida"--Introduction. / Typescript. / "May 12, 1953." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Joseph Golden, Professor Directing Study. / Includes bibliographical references.

by Yim-kam Kwong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves 119-133). / ACKNOWLEDGEMENT --- p.vii / LIST OF TABLES --- p.viii / LIST OF FIGURES --- p.x / ABSTRACT --- p.1 / SECTION / Chapter 1. --- INTRODUCTION --- p.3 / Chapter 2. --- LITERATURE REVIEW --- p.6 / Chapter 3. --- MATERIALS AND METHODS --- p.39 / Chapter 4. --- RESULTS --- p.61 / Chapter 5. --- DISCUSSION --- p.103 / Chapter 6. --- CONCLUSION --- p.116 / REFERENCES --- p.119 / APPENDIX --- p.134 / Chapter SECTION 1 --- INTRODUCTION --- p.3 / Chapter SECTION 2 --- LITERATURE REVIEW --- p.6 / Chapter 2.1 --- IRON --- p.6 / Chapter 2.1.1 --- CHEMISTRY --- p.6 / Chapter 2.1.2 --- METABOLISM --- p.6 / Chapter 2.1.2.1 --- Homeostasis --- p.6 / Chapter 2.1.2.2 --- Absorption --- p.8 / Chapter 2.1.2.3 --- Transportation - Role of transferrin in iron transport --- p.9 / Chapter 2.1.2.4 --- Storage --- p.10 / Ferritin --- p.11 / Haemosiderin --- p.13 / Chapter 2.2 --- IRON OVERLOAD --- p.14 / Chapter 2.2.1 --- AETIOLOGY --- p.14 / Chapter 2.2.2 --- PREVALENCE --- p.15 / Chapter 2.2.3 --- MECHANISM --- p.16 / Chapter 2.2.4 --- PATHOLOGY OF IRON OVERLOAD --- p.17 / Chapter 2.2.4.1 --- Increased absorption of iron from the diet --- p.18 / Chapter 2.2.4.2 --- Parenteral administration of excess iron --- p.21 / Chapter 2.2.4.3 --- Increased iron absorption combined with transfusional overload --- p.22 / Chapter 2.2.4.4 --- Miscellaneous conditions --- p.23 / Chapter 2.2.5 --- CLINICAL PRESENTATION --- p.24 / Chapter 2.2.6 --- EFFECT OF IRON OVERLOAD --- p.25 / Chapter 2.2.6.1 --- Role of iron in lipid peroxidation --- p.25 / Chapter 2.2.6.2 --- Iron and neoplasia --- p.26 / Chapter 2.3 --- ASSESSMENT OF IRON OVERLOAD --- p.26 / Chapter 2.3.1 --- NON-SERUM PARAMETER --- p.26 / Chapter 2.3.1.1 --- Localization of stored iron --- p.27 / Chapter 2.3.1.2 --- Morphometric assessment of hepatic iron in liver biopsy --- p.30 / Chapter 2.3.1.3 --- Hepatic iron concentration --- p.31 / Chapter 2.3.1.4 --- Atomic absorption spectrophotometry --- p.32 / Chapter 2.3.1.5 --- Hepatic imaging studies --- p.33 / Chapter 2.3.2 --- SERUM PARAMETERS --- p.34 / Chapter 2.3.2.1 --- Serum ferritin measurement --- p.34 / Chapter 2.3.2.2 --- Serum iron --- p.36 / Chapter 2.3.2.4 --- Transferrin saturation --- p.37 / Chapter SECTION 3 --- MATERIALS AND METHOD --- p.39 / Chapter 3.1 --- SUBJECTS --- p.39 / Chapter 3.1.1 --- SOURCE OF TISSUE SAMPLES AND CASE SELECTION --- p.39 / Chapter 3.1.1.1 --- The controls --- p.39 / Chapter 3.1.1.2 --- The transfusion group --- p.39 / Chapter 3.1.1.3 --- The non-transfusion group --- p.40 / Chapter 3.1.1.4 --- The total group --- p.40 / Chapter 3.2 --- METHODS --- p.40 / Chapter 3.2.1. --- HISTOLOGICAL METHOD --- p.44 / Chapter 3.2.1.1 --- Haematoxylin and Eosin Stain --- p.47 / Chapter 3.2.1.2 --- Perls' Prussian Blue Method --- p.49 / Chapter 3.2.1.3 --- The Rowe's Method of Iron Deposition --- p.47 / Chapter 3.2.1.4 --- Method 1 --- p.48 / Chapter 3.2.1.5 --- Method2 Estimation and grouping of % area --- p.49 / Chapter 3.2.1.6 --- "Comparison of Rowe's method, and the two histological iron grading methods" --- p.54 / Chapter 3.2.2 --- CHEMICAL MEASUREMENT --- p.55 / Chapter 3.2.2.1 --- Sectioning of paraffin liver blocks for chemical measurement --- p.55 / Chapter 3.2.2.2 --- Paraffin removal --- p.56 / Chapter SECTION 4 --- RESULTS --- p.61 / Chapter 4.1 --- HISTOLOGICAL ASSESSMENT --- p.61 / Chapter 4.1.1 --- HISTOLOGICAL STUDY --- p.61 / Chapter 4.1.2 --- SEX DISTRIBUTION --- p.65 / Chapter 4.1.3 --- AGE DISTRIBUTION --- p.65 / Chapter 4.2 --- CHEMICAL MEASUREMENT --- p.81 / Chapter 4.2.1 --- EVALUATION OF ANALYTICAL PRECISION --- p.84 / Chapter 4.2.2 --- RESULT OF CHEMICAL MEASUREMENTS --- p.81 / Chapter 4.2.3 --- ASSOCIATED CONDITIONS IN PATIENTS WITH LIVER TISSUE IRON > 50 μMOL/G --- p.86 / Chapter 4.3 --- CORRELATION OF HISTOLOGICAL ASSESSMENT WITH CHEMICAL MEASUREMENT --- p.88 / Chapter 4.3.1 --- CORRELATION OF HISTOLOGICAL ASSESSMENT WITH CHEMICAL MEASUREMENT BY METHOD 1 --- p.88 / Chapter 4.3.2 --- CORRELATION OF ASSESSMENT WITH CHEMICAL MEASUREMENT BY METHOD 2 --- p.89 / Chapter 4.3.2.1 --- Percentage area --- p.95 / Chapter 4.3.2.2 --- Score --- p.96 / Chapter 4.4 --- PANCREATIC AND MYOCARDIAC HAEMOSIDEROSIS --- p.100 / Chapter 4.4.1 --- METHOD 2 --- p.100 / Chapter SECTION 5 --- DISCUSSIONS --- p.103 / Chapter SECTION 6 --- CONCLUSIONS --- p.116 / REFERENCES --- p.119 / APPENDIX --- p.134