Pope John Paul II: a psychobiographical study

This psychobiography is focussed on the life of Pope John Paul II, whose historical personage epitomises the redemptive theme of triumph over tragedy and eternal hope. A phenomenological approach to the study allowed the researcher to observe the subject’s lived experience through the theoretical lens of Erik Erikson’s psychosocial development theory as well has having his faith development illuminated by Fowler’s faith development theory. Together, these theories highlighted significant aspects of Pope John Paul II’s personality development, for the greater purpose of uncovering the significance of his historical personage by reconciling his spiritual, political and academic attributes. This psychobiographical undertaking was grounded in qualitative research in the form of a single case. Two methodological strategies were used in this study. Firstly, Alexander’s model was used to organise, extract, prioritise and analyse data. The indicators of salience ensured that all significant parts of biographical data were carefully considered for analysis. Guba’s criteria for trustworthiness guided the methodology to ensure reliable data extraction and interpretation. Posing specific questions to the data enabled the researcher to extract units of analysis relevant to the aim of the study. Secondly, the use of conceptual frameworks and matrices enabled the longitudinal exploration, categorisation and description of the stages of psychosocial and faith development. The findings of this psychobiographical study of Pope John Paul II strongly support the importance of Erikson’s (1950) theory in understanding the processes of personality development in an individual life. In this psychobiographical study, the complex process of adaption and growth was highlighted by Erikson’s (1950) theory and placed periods of Pope John Paul II’s development in context. This study also demonstrated that gaining meaning in life through faith (Fowler, 1981) provides the individual with greater internal support when adjusting to life changes. Furthermore, greater intentionality on the part of therapists to thread faith and spirituality into their practice, is evidence of the eugraphic impact of this study

Written language expression in linguistically diverse classrooms in the Western Cape : a case study

Includes abstract.Includes bibliographical references (leaves 181-195).This study investigated the current performance, values, present and further opportunities and barriers to written language in ordinary, linguistically diverse intermediate phase classrooms in the Western Cape. A single, within-site case study was conducted in one grade 5 and one grade 6 classroom in an urban school

Laparoscopy and loop colostomy : a new approach to extra-peritoneal rectal injuries

Includes bibliographical references.Distal rectal washout and presacral drainage appear to have little or no influence on the morbidity and mortality in patients with low-energy trauma to the rectum. The ever-increasing popularity and obvious advantages of minimal access surgery have prompted surgeons to apply its use to a variety of surgical diseases, including trauma-related conditions. This study retrospectively reviews and examines the safety and efficacy of laparoscopy and the formation of a diverting sigmoid loop colostomy through an abdominal wall trephine, in a limited number of carefully selected patients with isolated extra-peritoneal rectal injuries. The patient is thus spared a major laparotomy wound. The value of distal rectal washout and presacral drainage in such injuries is also examined

'It’s not just the learner, it's the system!' Teachers’ perspectives on written language difficulties: Implications for speech-language therapy

The failure to achieve academic outcomes in linguistically diverse classrooms in poor areas of the Western Cape, South Africa, is well documented. A major contributing factor is the written language communication difficulties experienced in these classrooms. This paper describes the views of intermediate-phase teachers on why written language difficulties are experienced by learners and ways in which these difficulties might be overcome. A series of interviews were conducted with two class teachers in one urban school from which there had been a high number of referrals for speech-language therapy. The teachers were individually interviewed using an in-depth, semi-structured format. Teachers reported that 50 - 70% of learners in their classes were not meeting grade level academic outcomes. They were asked to explain the difficulties experienced with regard to written language, and the challenges and solutions linked to these. The findings suggest that there are barriers and opportunities at the school system, individual learner and home/social community levels. Major challenges identified at the school system level included limited training and lack of support for teachers, poor foundation skills in learners and difficulties with language. The current opportunities for the development of written language were insufficient and teachers identified further opportunities to promote the learners’ written language development. These included training and support for teachers, clear and consistent assessment guidelines, remedial assistance for learners and safe, nurturing home environments. There is a need to look beyond the learner as the site of the problem; a systemic approach is essential. In the light of these findings, suggestions are made for the role of the speech-language therapist

A Ten Year Review of Civilian Iliac Vessel Injuries from a Single Trauma Centre

AbstractObjectiveTo report the surgical management and outcome of iliac vessel (IV) injuries in a civilian trauma centre with a high incidence of penetrating trauma.Design, patients and methodsA retrospective record review of patients with IV injuries treated between January 2000 and December 2009.ResultsSixty nine patients, 59 with gunshot wounds, sustained 108 iliac vessel injuries. Mean revised trauma and injury severity scores was 7.06 and 28.4, respectively. Twenty nine patients required damage control laparotomy. Common or external iliac arteries were repaired by primary repair (10), temporary shunt with delayed graft (6), interposition graft (5) or ligation if limb non-viable (3). Forty-seven patients had injuries to the common or external iliac vein, 42 were ligated. Mortality was 25% and 6 survivors required amputation.ConclusionsIn a stable patient a primary arterial repair is preferred but a temporary shunt can be a life and limb saving option in the unstable patient. Ligating the common or external iliac veins is associated with a low incidence of prolonged leg swelling

Non-operative management of abdominal stab wounds- an analysis of 186 patients

Background: The modern management of abdominal stab wounds remains controversial and subject to continued reappraisal. In the present study we reviewed patients with abdominal stab wounds to examine and validate a policy of selective non-operative management with serial physical abdominal examination in a busy urban trauma centre with a high incidence of penetrating trauma. Methods: Over a 12-month period (2005), the records of all patients with abdominal stab wounds were reviewed. Patients with abdominal stab wounds presenting with peritonitis, haemodynamic instability, organ evisceration and high spinal cord injury underwent emergency laparotomy. No local wound exploration, diagnostic peritoneal lavage or ultrasound was used. Haematuria in patients without an indication for emergency surgery was investigated with a contrasted computed tomography (CT) scan. Patients selected for non-operative management were admitted for serial clinical abdominal examination for 24 hours. Patients in whom abdominal findings were negative were given a test feed. If food was tolerated, they were discharged with an abdominal injury form. Results: One hundred and eighty-six patients with abdominal stab wounds were admitted. There were 171 (91.9%) males, with a mean age of 29.5 years. Seventy-four patients (39.8%) underwent emergency laparotomy. There were 5 negative laparotomies (6.8%). The remaining 112 patients (60.2%) were assigned for abdominal observation. One hundred (89.3%) of these patients were successfully managed non-operatively. The remaining 12 patients underwent delayed laparotomy, which was negative in 2 cases (16.7%). Non-operative management was successful in 53.8% of patients overall. The overall sensitivity and specificity of serial abdominal examination was 87.3% and 93.5%, respectively. Conclusion: Serial physical examination alone for asymptomatic or mildly symptomatic patients with abdominal stab wounds enables a significant reduction in unnecessary laparotomies

Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma, a prospective randomized control study

BACKGROUND Early video-assisted thoracoscopic surgery (VATS) is the recommended treatment of choice for retained hemothorax (RH). A prospective single-center randomized control study was conducted to compare outcomes between VATS and thoracostomy tube (TT) reinsertion for patients with RH after penetrating trauma in a resource constrained unit. Our hypothesis was that patients with a RH receiving VATS instead of TT reinsertion would have a shorter hospital stay and lesser complications. MATERIALS AND METHODS From January 2014 to November 2019, stable patients with thoracic penetrating trauma complicated with retained hemothoraces were randomized to either VATS or TT reinsertion. The outcomes were length of hospital stay (LOS) and complications. RESULTS Out of the 77 patients assessed for eligibility, 65 patients were randomized and 62 analyzed: 30 in the VATS arm and 32 in the TT reinsertion arm. Demographics and mechanisms of injury were comparable between the two arms. Length of hospital stay was: preprocedure: VATS 6.8 (+/-2.8) days and TT 6.6 (+/- 2.4) days (p = 0.932) and postprocedure: VATS 5.1 (+/-2.3) days, TT 7.1 (+/-6.3) days (p = 0.459), total LOS VATS 12 (+/- 3.9) days, and TT 14.4 (+/-7) days (p = 0.224). The TT arm had 15 complications compared to the VATS arm of four (p = 0.004). There were two additional procedures in the VATS arm and 10 in the TT arm (p = 0.014). CONCLUSION VATS proved to be the better treatment modality for RH with fewer complications and less need of additional procedures, while the LOS between the two groups was not statistically different

Negative pressure wound therapy management of the "open abdomen" following trauma: a prospective study and systematic review

INTRODUCTION: The use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma. METHODS: A prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality. RESULTS: A total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT. CONCLUSION: This new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient

The management of complex pancreatic injuries

Major injuries of the pancreas are uncommon, but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. Late mortality is a consequence of infection or multiple organ failure. Neglect of major pancreatic duct injury may lead to life-threatening complications including pseudocysts, fistulas, pancreatitis, sepsis and secondary haemorrhage. Careful operative assessment to determine the extent of gland damage and the likelihood of duct injury is usually sufficient to allow planning of further management. This strategy provides a simple approach to the management of pancreatic injuries regardless of the cause. Four situations are defined by the extent and site of injury: (i) minor lacerations, stabs or gunshot wounds of the superior or inferior border of the body or tail of the pancreas (i.e. remote from the main pancreatic duct), without visible duct involvement, are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the body or tail with visible duct involvement or transection of more than half the width of the pancreas are treated by distal pancreatectomy; (iii) stab wounds, gunshot wounds and contusions of the head of the pancreas without devitalisation of pancreatic tissue are managed by external drainage, provided that any associated duodenal injury is amenable to simple repair; and (iv) non-reconstructable injuries with disruption of the ampullary-biliary-pancreatic union or major devitalising injuries of the pancreatic head and duodenum in stable patients are best treated by pancreatoduodenectomy. Internal drainage or complex defunctioning procedures are not useful in the emergency management of pancreatic injuries, and can be avoided without increasing morbidity. Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery, and optimal results are most likely to be obtained by an experienced multidisciplinary team

Nosocomial infections: A further assault on patients in a high-volume urban trauma centre in South Africa

Background. Hospital-acquired infections (HAIs) are a major cause of morbidity and mortality. Surgical site infection (SSI) rates are reported to range from 2.5% to 41%. HAI increases the risk of death by 2 - 11%, and three-quarters of these deaths are directly attributable to SSIs.Objectives. To determine the incidence of HAI and to identify risk factors amenable to modification with a resultant reduction in infection rates.Methods. An analysis of HAIs was performed between January and April 2018 in the trauma centre surgical wards at Groote Schuur Hospital, Cape Town, South Africa.Results. There were 769 admissions during the study period. Twenty-two patients (0.03%) developed an HAI. The majority were men, and the mean age was 32 years (range 18 - 57). The mean length of hospital stay (LoS) was 9 days, higher than the mean LoS for the hospital of 6 days. Fourteen patients underwent emergency surgery, 3 patients underwent abbreviated damage control surgery, and 9 patients were admitted to the critical care unit. Most patients with nosocomial sepsis were treated with appropriate culture-based antibiotics (82%). Four patients were treated with amoxicillin/clavulanic acid presumptively prior to culture and sensitivity results, after which antibiotic therapy was tailored. All but 1 patient received antibiotics.Conclusions. A combination of measures is required to prevent trauma-related infections. By determining the incidence of nosocomial infections in our trauma patients, uniform policies to reduce infection rates further could be determined. Our low incidence of infection may be explained by established preventive care bundles already in place.