The development of a back pain scale for Tswana speaking individuals

A THESIS submitted in fulfillment for the degree of DOCTOR OF PHILOSOPHY. June 2015Pain is a subjective sensation and is difficult to measure. Quantifying pain provides a measure of assessing effectiveness of treatment and behaviour of the patient’s pain. In Africa unlike in the developed world, a paucity of research into the measurement of pain exists. Historically, Anglo-American scales have been used to measure pain in Africa. Aim: The aim of this thesis was to develop a back pain scale for use in Tswana speaking South Africans. Methods: Four hundred and forty participants from different education, gender and age groups participated in five studies. Study One developed new scales: Colour Analogue Scale(CAS green- red), modified Wong-Baker Faces Pain Scale (WBFPS three faces) , Ascending Injection Scale, Injection Size Scale, Ascending Coin Scale, Coin Heap Scale and previously used scales Visual Analogue Scale (VAS), CAS (white-red), WBFPS (six faces). Study Two tested these scales in 100 asymptomatic participants. “No pain” “”worst pain” was marked on original and reversed scales. Since no significant difference existed between the original and reversed versions, reversed versions were not taken further. In Study Three 40 back pain sufferers developed a Tswana Verbal Descriptive Scale. This was then tested together with the scales from the previous studies, in Study Four, in 250 Tswana individuals with back pain. Pain perception was marked on all scales. Study Five tested the Ascending Injection Scale and the Ascending Coin Scale (best scales from Study Four) and a right angle Triangle Scale in 50 back pain sufferers. “No pain”, “worst pain” and “present pain” perception was marked on all scales. Results: The Ascending Injection Scale was found to be the best understood pain scale in Tswana speaking, back pain sufferers. Conclusion: The Ascending Injection Scale can be used to test back pain severity in Tswana speaking South Africans. I recommend that this scale be translated into the other black languages spoken in South Africa for testing and possible use

The Potential of Service-Learning: Media Advocacy as Community Organizing with La Casa Guadalupana

For 16 weeks in a course on community organizing, I applied theory in practice through service-learning to maximize the capacity of La Casa Guadalupana, a nonprofit organization located in Southwest Detroit, Michigan, United States. Throughout the course, we learned the principles and fundamentals of service-learning and its implications in community organizing to achieve public health. The class was divided into smaller groups. Each group was assigned a specific project such as developing social media platforms, media production, health care workshops, tutoring, advocacy, and fundraising. My project was focused on media production, creating an echo in the community to attract contributors, community members, and elected public officials. All groups were sharing a common interest and we all worked together toward a common goal, empowering La Casa Guadalupana and its mission in improve the conditions of life of the Hispanic community members in Southwest Detroit. Education is the key element that is embedded in the core of its mission to enhance socioeconomic opportunities for the Hispanic community members

The reliability and validity of the Tswana translations of three pain rating scales amongst patients with back pain

ABSTRACT Pain is a subjective sensation and is difficult to measure. It is important to quantify pain as benefits are obtained from its quantification. The validity and reliability of pain outcome measures have been extensively researched in Europe, America and Asia. In Africa on the other hand, very few studies have been done. This study was a cross-sectional study to validate and test the reliability of pain scales.The aim of this study was to establish the validity and reliability of the Tswana translations of three pain scales, namely, the Visual Analogue scale (two versions), the Verbal Rating Scale and the Wong-Baker Faces Pain Measure. The validity of the study was determined by the face validity,criterion validity and construct validity.The statistical analysis of the results showed several significant p values (p< 0.05).However, none of the correlations illustrated a strong relationship as there were no r values in excess of 0.5 indicating a moderate correlation or greater than 0.7 indicating a good correlation. The statistical significance only indicated that the observed values were not due to chance.From the statistical analysis of the results, it became apparent that the subjects tested did not have an understanding of any of the three scales .This was seen in all the age groups and education levels selected for the purpose of this study. It is our recommendation therefore, that suitable, new scales be developed for our local population. The scales which have been used up until now are not being understood and hence are not being interpreted or used correctly in the South African context amongst Tswana speaking individuals. Future research needs to be done in developing entirely different scales for the South African scenario. More relevant and better understood scales should be developed for our local population to include persons of different languages and different education levels. This will assist in a better understanding of the health care process and will by so doing, improve their health care and management

Use of the partogram in a private hospital in South Africa

© 2018 Elsevier Ltd Objective: to explore and describe the use of the partogram in private hospitals in South Africa. Design: an explanatory mixed method design. In-depth interviews were conducted with the midwives and midwife specialists to explicate the significance of the initial quantitative questionnaires. Setting: a private maternity hospital in Gauteng Province, South Africa. Participants: 11 midwives and 3 advanced midwives working in the labour unit of the private maternity hospital. Findings: although all the midwives and midwife specialists knew the purpose of the partogram, where to find the recommendations on the use of the partogram and the signs of true labour, not all were sure when the partogram had to be completed and who is accountable for plotting the findings. Fetal heart rate monitoring during the active phase of labour remains a concern. Key conclusion: the findings revealed that the midwives understood the importance of the partogram but are not using it within the parameters for which it was intended. The obstetricians intervened during labour with no or little use of the partogram. Implications for practice: the study identified the knowledge strengths and deficits of midwives working in a private hospital on partogram use that would benefit from training interventions and professional development. Evidence suggests a culture where the partogram is not central to care as obstetricians are not using the partogram. The purpose of the partogram in the private sector needs to be reviewed

The Place of Enucleation and Enucleo-Resection in the Treatment of Pancreatic Metastasis of Renal Cell Carcinoma

Context Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiotherapy and immunotherapy than other cancers. Metastasis of renal cell carcinoma to the pancreas occurs, even after long term radical nephrectomy, surgical resection remains the only potentially curative intervention. We performed surgery for pancreatic metastatic renal cell carcinoma and analyzed the results. Methods We retrospectively analyzed 11 patients who had undergone pancreatic resection or metastasectomy at our hospital from January 1994 to January 2010. Patient’s demographics, clinical variables, types of pancreatic resections (standard or atypical resection), primary histopathology, surgical outcomes, survival and disease free interval were examined. We compared the standard pancreatic resection to atypical resection (enucleation or enucleo-resection). Results Eleven patients underwent 14 pancreatic resections or metastasectomy (3 pancreaticoduodenectomy, 4 distal pancreatectomy, 1 completion of pancreatectomy, 4 enucleations and two enucleo-resections) for pancreatic renal cell carcinoma metastasis. The median age was 73 years, the median time period between nephrectomy and finding of pancreatic metastasis was 11.4 years. One patient showed synchronous pancreatic metastatic lesions on radiology. One patient died from a splenic artery pseudoaneurysm rupture 35 days after the surgery. Major complications occurred in 4 patients with standard resection (one hemoperitoneum, three pancreatic fistulas), and in one patient with atypical resection (duodenal fistula); six patients with standard resection presented postoperative diabetes mellitus. Median survival age was 6.5 years (range 1-9 years). Two patients died of metastatic disease 5 to 6 years, while 7 patients are alive and well 1 to 9 years after surgery. Conclusions According to these results and regardless of the small number of cases, atypical resection of metastatic renal cell carcinoma has a high median survival rate even after pancreatic recurrence or distant metastasis. It seems reasonable to favor a good quality of life and less diabetes with a limited atypical resection.Image: Institut Mutualiste Montsouris. Paris, France

Avaliação da eficácia da ciclosporina no tratamento de cães atópicos

Atopic dermatitis (AD) is an inflammatory, pruritic and chronic allergic skin disease. It is recognized as the second most common allergic skin disease of dogs, after flea allergy. Pruritus is the predominant sign of canine AD, and it affects a variety of areas of the body, leading to intense suffering in both the animal and its owner. The long-term use of glucocorticoid therapy can be devastating because of its numerous side effects and secondary diseases. Cyclosporine (CsA) has been considered a good therapeutic option to treat canine AD. CsA inhibits the activation of cells that initiate the cutaneous immune response (Langerhans cells and lymphocytes) and that mediate allergic reactions (mast cells and eosinophils). It also decreases the release of histamine and other cytokines. The objective of this study was to analyze the efficacy of CsA (5 mg/kg, SID for 60 days) to reduce skin lesions and pruritus in 21 atopic dogs using CADESI-03 and two scales to quantify the levels of body itching. This immunomodulatory therapy was considered to be an effective treatment for atopic dogs because it reduced skin lesions by 70% after 60 days of therapy. During that period, there was a 52.6% reduction of body itching as assessed via a verbal numeric scale, and there was a significant reduction of body itching on a qualitative scale, as the maximal levels of pruritus (“three” and “four”) were hardly observed after immunomodulatory therapy. CsA was effective and safe in the treatment of canine atopic dermatitis.A atopia ou dermatite atópica é uma doença inflamatória pruriginosa, crônica e recorrente reconhecida como a segunda alergopatia mais comum, estando aquém apenas da dermatite alérgica à picada de pulgas. Esta doença é caracterizada pela presença exacerbada de prurido corpóreo, infringindo sofrimento ao paciente e desalentando seu proprietário. Por se tratar de uma doença de longo decurso, o tratamento com glicocorticoides pode causar diversos efeitos adversos, além de doenças mais graves. Como alternativa ao tratamento de cães atópicos, a ciclosporina (CsA) acaba tornando-se uma boa opção terapêutica. A CsA inibe as funções das células que iniciam a resposta imunológica (células de Langerhanse linfócitos) e das células que efetuam a resposta alérgica (mastócitos e eosinófilos) e, também, diminui a liberação de histamina e de várias citocinas. O objetivo do presente estudo incluiu a: análise da eficácia da CsA (5mg/kg, SID durante60 dias) na redução de lesões corpóreas e do prurido com auxílio do CADESI-03 e de duas escalas de prurido corpóreo. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina pois reduziu as lesões corpóreas em 70% após 60dias de terapia. Nesse mesmo período ocorreu redução da intensidade do prurido corpóreo em 52,6%, avaliado através da escala numérica verbal; e observou-se redução significativa na escala qualitativa de prurido corpóreo, uma vez que os níveis máximos de prurido (“três” e “quatro”) quase não foram observados após a terapia imunomodulatória. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina

Evaluation of tramadol, an "atypical" opioid analgesic in the control of immediate postoperative pain in dogs submitted to orthopedic surgical procedures

The degree of analgesia after the preemptive administration of tramadol or flunixin meglumine was evaluated in thirty dogs submitted to orthopedic surgical procedures. Dogs received tramadol (2mg/kg) or flunixin meglumine (1.1mg/kg). Cardiovascular and respiratory depression were not observed during anesthesia. Animals treated with tramadol showed a higher score of analgesia. The quality of recovery of animals treated with tramadol was much better as it was free from excitation and discomfort, and presented a higher degree of sedation. We could conclude that tramadol can be applied successfully in preemptive analgesia, since recovery from anesthesia is accompanied by adequate analgesia and is free from excitation and discomfort.Comparou-se a qualidade da analgesia pós-operatória após administração preemptiva de tramadol (2 mg/kg/grupo 1) e flunixin meglumine (1,1 mg/kg/grupo 2) em 30 cães submetidos a procedimentos cirúrgicos ortopédicos. Os animais tratados com tramadol apresentaram maior grau de analgesia comparado ao grupo do flunixim meglumine. A qualidade do retorno anestésico dos animais tratados com tramadol foi superior, livre de excitação e desconforto e com grau de sedação superior ao grupo do flunixin meglumine. Não foram observadas alterações cardiovasculares e respiratórias durante a anestesia. Podemos concluir que o tramadol pode ser utilizado como analgésico preemptivo em cães submetidos a procedimentos cirúrgicos ortopédicos, já que o retorno anestésico apresentou adequada analgesia, livre de desconforto e excitação

SPECTRAL ASYMPTOTICS FOR MAGNETIC SCHRÖDINGER OPERATOR WITH SLOWLY VARYING POTENTIAL

Consider the Schrödinger operator with constant magnetic field and smooth potential V : H(ϵ) = H + V(ϵx, ϵy), H = D＾2_x + (D_y + μx)², (x, y) ∈ Ω_d, with Dirichlet boundary conditions. Here Ω_d = Π^d_] − a_j, a_j[×ℝ^d_y. The spectral properties of two operators H and H(ϵ) are investigated. For ϵ small enough, we study the effect of the slowly varying potential V(ϵx, ϵy). In particular, we derive asymptotic trace formula and we give an asymptotic expansion in powers of ϵ of the spectral shift function corresponding to (H(ϵ), H)