Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

No / The establishment of a correct diagnosis links care to established guidelines and underpins all subsequent therapeutic activity. Problems can arise when definitions of disease overlap, as is the case with diabetic foot ulceration and pressure ulcers on the foot occurring in people with diabetes. In such cases, clinicians must ensure that patients receive a care bundle that recognises both the wound causation (pressure and shear) and the underlying pathology (diabetic neuropathy, potential foot architecture disruption and ischaemia). All patients with diabetes that have foot ulceration, irrespective of wound aetiology should, therefore, be seen by the multidisciplinary diabetic foot team. Care can then be optimised to include appropriate assessments, including assessment of peripheral perfusion, correct offloading, appropriate diabetic management, and general foot and skin care.

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Introduction: Pressure sores are the most common complication post spinal cord injury. Pressure sores of the sacral area commonly occur and often lead to patients being placed on bed rest. Bed rest periods delay rehabilitation, and may lead to other complications associated with immobility. Physiotherapy is crucial for these patients to decrease complications and increase function. This study set out to establish the treatment interventions physiotherapists provide to patients with sacral pressure sores and the factors that they take into consideration when deciding whether the patient should receive physiotherapy in bed (in the ward) or in the gym environment. Methods: This was a cross sectional survey administered to physiotherapists working in neurological rehabilitation units around South Africa that treat patients with spinal cord injuries. A self-administered questionnaire was used for data collection. The questionnaires were sent to all eligible physiotherapists via email. All the data was captured onto an excel spread sheet. Data collected were presented as frequencies and percentages with the aid of tables, pie charts and bar graphs as was appropriate. Results: Thirty-nine physiotherapists responded which showed a response rate of 76%.The majority of the respondents were female (98%). There were 11 rehabilitation facilities represented in the study with the majority of the respondents being from the private sector (69%) and 31% from the public sector. The most common practice for patients with sacral pressure sores is to be placed onto bed rest (98%). Nineteen physiotherapists stated that they did not have set protocols for the treatment of patients with sacral pressure sores. The most common physiotherapy interventions (70%) when the patient is on bed rest are upper limb strengthening, lower limb passive movements, positioning into prone and side lying as well as upper limb passive movements and passive stretching. The same were done when the patient was brought to the gym except that bed mobility training then also formed part of common intervention as well as the use of the tilt table for passive standing. The treatment environment was dependant mostly on doctors’ orders and the size, grade and duration of the pressure sores. The choice of treatment techniques was guided mostly by past clinical experience or the successful experience of colleagues. Conclusion: There is a need for the development of standardised protocols when treating spinal cord injured patients with sacral pressure sores to possibly ensure maximal healing and rehabilitation. Key words: Physiotherapy management of paraplegic patients, sacral pressure sores, bed rest

Purpose: To describe the microbiology results of corneal scrapings and morphology results of corneal ulcers over a one year period at the St John Eye Hospital with the following objectives: (i) to describe the positive culture results (ii) to describe the commonest causative organisms (iii) to describe resistance patterns to antibiotics (iv) to correlate the positive culture results with the clinical characteristics of the ulcer. Methods: A retrospective cross sectional review of patient medical records and microbiology reports of patients who presented with corneal ulcers at the St John Eye Hospital between October 2007 and October 2008. One hundred and fifty one (151) corneal scrapings submitted to the National Health Laboratory Services (NHLS) for microbiology, culture and sensitivity testing were analyzed. The following information was extracted from the microbiology reports and patient medical records: patient demographics, microbial isolations, antibiotic sensitivity and resistance, and corneal ulcer morphology (central versus peripheral). Results: Of the 151 patients who had corneal scrapings, 63(42%) were female and 88(58%) were male. The median age was 39.6(range 1-95; SD 19.3). An organism was identified in 78(52%) of the samples. Of the 93 pathogens isolated, 78(83.9%) were gram positive, 10(10.8%) were gram negative, and 5(5.4%) were fungi. Mixed isolates were found in 15 of the 151 corneal scrapings. The most common gram positive isolates were Staphylococcus aureus 23(29.5%), coagulase negative Staphylococcus 18(23.1%), and Streptococcus pneumoniae 16(20.5%). The two most commonly isolated gram negative organisms were Pseudomonas aeruginosa 3(30%) and Haemophilus influenza 3(30%). A total of 5 fungi were isolated from the 151 corneal scrapings with Fusarium 3(60%) being the most common fungus isolated. Antibiotic resistance patterns were as follows: Gram positive isolates (73) consistently showed 100% sensitivity to vancomycin. A small number of gram positive organisms showed in vitro resistance to the second generation fluoroquinolone ciprofloxacin. This was, however only a small number of gram positive isolates and therefore the P value (P<0.001) remained significant. Overall the gram positives isolates showed a 95.3% sensitivity to ciprofloxacin. Both second and fourth generation fluoroquinolones, ciprofloxacin and moxifloxacin respectively, showed equivalent (100%) in vitro activity against the gram negative isolates. All gram negative isolates showed 100% laboratory susceptibility to the aminoglycosides, gentamicin and amikacin. Inpatient medical records were available for 56 of the 151 corneal ulcer scrapings. Of the 56 inpatient records reviewed 42(75%) were central ulcers. Streptococcus pneumoniae 10(23.8%) was the most common organism isolated in central corneal ulcers, while staphylococcus aureus 4(28.6%) was the most common organism isolated in peripheral corneal ulcers. Conclusion: Compared with previous reports from the St John Eye Hospital, the spectrum of causative organisms has remained unchanged over the past 25 years. The organisms commonly responsible for microbial keratitis at the hospital are significantly susceptibility to the antibiotics currently being used as therapy.