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[3/1896]

Echocardiography for early detection of heart disease in high risk diabetic patients
Hartnick, Maria Diana,
2015
Introduction: Diabetes mellitus is a chronic disease with a significant impact on personal lifestyle and wellbeing. It is associated with a high prevalence of myocardial disease, the early detection of which is important for prevention of disease progression. Although echocardiography is recognised as a leading cardiovascular imaging modality, there has been limited work on its role in the early detection of diabetes-related myocardial dysfunction. The aim of this study was therefore to evaluate the role of echocardiography in the early detection of diabetes-related myocardial disease, in a population with a high prevalence of type 2 diabetes mellitus. Methodology: A single sonographer, blinded to individual biochemical markers conducted detailed echocardiographic examinations on 407 participants from a Cape Town community with a high prevalence of diabetes mellitus. Participants were subsequently stratified by biochemical status, as normoglyceamia or hyperglycaemia. The echocardiographic features of the two groups were compared using the Pearson chi-squared and Mann-Whitney U tests. Findings: Hyperglycaemia was associated with left atrium (LA) enlargement (p ˂ 0.0014), aortic enlargement (p ˂ 0.0067) and inter-ventricular septal (IVS) thickening (p ˂ 0.0001). Conclusion: The findings suggest that echocardiography can be a useful screening tool for myocardial dysfunction in Type 2 diabetes mellitus.
http://hdl.handle.net/11189/2457
en
Cape Peninsula University of Technology
Diabetes

[4/1896]

Ultrasound evaluation of the carotid artery in a population at high risk of type 2 diabetes mellitus
Isaacs, Ferial,
2015
BACKGROUND: Diabetic patients are at increased risk of cardiovascular events and stroke, and its prevention is therefore the desired goal. In the arsenal of available techniques, ultrasound plays a vital role in primary healthcare. It is reliable, cost-effective and a noninvasive diagnostic tool that may prove beneficial for screening individuals at risk of cardiovascular disease (CVD) and stroke in SA. OBJECTIVE: To determine the interrelationships between carotid ultrasound findings with glycaemia status and contributing risk factors of atherosclerosis in the selected population. METHODS: Initially blinded by the glycaemia status, blood results, contributing risks and patient demographics, both carotid arteries were evaluated with duplex ultrasound (DUS), during July 2010 – July 2011. Using graphs, figures, frequency tables, means and standard deviations for the selected study population, univariate, multivariate and stepwise regression analysis was done to determine the association between ultrasound findings and risk factors for atherosclerosis. The hypothesis tested in this study was to determine if there is an increased incidence of carotid artery intima-media thickening (CIMT), plaque formation and stenosis in patients diagnosed with T2DM and hyperglycaemia in a very specific sub-population of mixedancestory, residing in Bellville South Africa (BSA). RESULTS: Of 534 subjects, 375 were of mixed ancestry and ≥35yrs of age, which met the inclusion criteria for the carotid ultrasound substudy. The glycaemic status for each individual was established, and 44% (165/375) were diagnosed hyperglycaemic, of which 66.7% (110/165) were diabetic (T2DM) and 33.3% (55/165) were pre-diabetic (Pre-DM). Majority (56%:265/375) had a normal glycaemic status. The ultrasound measurement of the carotid wall thicknesses (Mean Rt. and Lt. CIMT) revealed a statistically significant rise from normal glycaemia status to DM status for both the males (p = 0.0115*; p = 0.0259*) and females (p < 0.0001**; p < 0.0001**) respectively. In terms of plaques and internal carotid artery (ICA) stenosis (124/375), when grouped into normal and hyperglycaemic sub-groups, indicated plaque presence and some form of narrowing. A <50% stenotic ratio noted in 61% (76/124) of the hyperglycaemic group, that was 1.6 times higher than those with normal glycaemia (48/124). Predisposing factors demonstrated significantly higher levels in the females than in the males. The univariate multiple regression analysis after adjusted R² of 0.3247 for all independent variables (predisposing /contributing risk factor markers) of age (yrs.), SBP (mmHg), hs-CRP (mg/L), S-Cotinine (ng/mL) and LDL (mmol/L) showed statistically significant positive associations with dependent variable of the mean carotid wall thickness (p < 0.0001**, p< 0.0001**, p = 0.0033*, p = 0.0409* and p = 0.0044)* respectively. Statistically significant positive differences and standard error (SE), for every unit of change (1yr.) of age (yrs.), as a contributing factor for herosclerosis, there was a change in the mean carotid wall thickness as predicted according to this model. The total contribution of independent risk factors to CIMT ultrasound measurements were calculated as 34.5% (Adjusted R² = 0.3247). In the multivariate stepwise regression analysis, the independent variables of age (p< 0.0001) ** and systolic blood pressure (p < 0.0001) ** showed the strongest positive association with carotid wall thickeness changes. The hs-CRP (mg/L) inflammatory markers (p = 0.0014)* and LDL (mmol/L) (p = 0.0208)* were the 2nd and 3rd highest positive associated contributory risk factors for carotid artery wall thickening. The hip circumference (p = 0.0008)* and waist circumference (p = 0.0 555) + risk factors related to obesity was significant and approached significance, respectively, with the predicted increase of carotid artery wall thickening. CONCLUSION: Subjects diagnosed with T2DM and hyperglycaemia had increased levels of CIMT, plaques and carotid artery stenosis, compared to those subjects without T2DM. Age and systolic blood pressure, inflammatory (raised hs-CRP) and LDL cholesterol changes, and central (truncal) waist circumference adiposity, were positively associated with increased carotid intima media thickness. Smoking (S-Cotinine) and gender also reflected a direct relationship with CIMT changes. The hip circumference adiposity and diastolic blood pressure measurements were not directly associated with an increase in CIMT, which are in keeping with hypertension and obesity formulas. These findings confirm the association of thickened CIMT, plaques and stenosis with ‘unhealthy’ T2DM subjects at higher risk of CVD and stroke. The total contribution of independent risk factors to CIMT measurements were calculated as 34.5% (Adjusted R² =0.3247). The gathered information, discussion of results, and concluding statements thereby supports the recommendation of carotid artery ultrasound evaluation, for screening and diagnosis in primary health care, for ‘flagging’ high risk individuals at risk of stroke, so that lifestyle changes and appropriate management is early adopted.
http://hdl.handle.net/11189/3163
en_ZA
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Doppler ultrasonography

[5/1896]

Ultrasound evaluation of the extracranial cerebrospinal venous system and carotid arteries in patients with multiple sclerosis
Nelson, Merlisa Claudia,
2013
Multiple Sclerosis (MS) is characterised by demyelination within the central nervous system (CNS), which may result in neurological disabilities over time, causing considerable hardship to patients and their families, in addition to being costly to treat. Recent studies have linked MS to impaired cerebral blood flow, called chronic cerebrospinal venous insufficiency (CCSVI). Anecdotal evidence has suggested that surgical correction thereof results in improvement of symptoms experienced by MS patients. To my knowledge, no information is available in the literature on carotid artery disease in MS. The USA National MS Society has therefore called for more research to be done in this area. This cross-sectional observational sub-study will determine, by ultrasound (B-Mode, Colour and Pulsed-wave Doppler), the prevalence of chronic venous insufficiency (CCSVI) and carotid artery disease in the selected sample of MS patients within the region of the Western Cape, South Africa. Biochemical data; lifestyle factors such as physical activity and smoking; and nutritional status of MS patients were determined from the main study entitled: “The development of a comprehensive gene-based, pathology supported intervention program for improved quality of life in patients diagnosed with multiple sclerosis” (Division of Chemical Pathology, NHLS, Tygerberg Hospital, and University of Stellenbosch). Twenty-nine (29) patients were aged between 28-64years and they suffered from MS for 0.83-27years. A larger proximal and mid cross-sectional diameter (CSD) of the right IJV compared to the left (differences significant, P= 0.026 and P=0.023) was demonstrated. Increased intima media thickness (IMT) was present in 13.33% of the non-smoking MS group and 20% in the smoking MS group. IJV reflux was evident in 13.33% of the MS group. A significant reduction of cross-sectional diameters of the IJV’s was evident in smoking MS patients; suggesting that smoking is not only a risk factor for atherosclerotic disease but could also be related to narrowing of the major neck veins. This study also supports findings of other studies viz that there’s no significant correlation between extracranial venous abnormalities and MS. Early carotid artery disease was noted in smoking and non-smoking MS patients, however the findings were non-significant.
http://hdl.handle.net/11189/1507
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
NavTech

[6/1896]

Echocardiography for early detection of heart disease in high risk diabetic patients
Hartnick, Maria Diana,
2015
Introduction: Diabetes mellitus is a chronic disease with a significant impact on personal lifestyle and wellbeing. It is associated with a high prevalence of myocardial disease, the early detection of which is important for prevention of disease progression. Although echocardiography is recognised as a leading cardiovascular imaging modality, there has been limited work on its role in the early detection of diabetes-related myocardial dysfunction. The aim of this study was therefore to evaluate the role of echocardiography in the early detection of diabetes-related myocardial disease, in a population with a high prevalence of type 2 diabetes mellitus. Methodology: A single sonographer, blinded to individual biochemical markers conducted detailed echocardiographic examinations on 407 participants from a Cape Town community with a high prevalence of diabetes mellitus. Participants were subsequently stratified by biochemical status, as normoglyceamia or hyperglycaemia. The echocardiographic features of the two groups were compared using the Pearson chi-squared and Mann-Whitney U tests. Findings: Hyperglycaemia was associated with left atrium (LA) enlargement (p ˂ 0.0014), aortic enlargement (p ˂ 0.0067) and inter-ventricular septal (IVS) thickening (p ˂ 0.0001). Conclusion: The findings suggest that echocardiography can be a useful screening tool for myocardial dysfunction in Type 2 diabetes mellitus.
http://hdl.handle.net/11189/2457
en
Cape Peninsula University of Technology
Diabetes

[7/1896]

Pain assessment : the role of the radiation therapist
Kyei, Kofi Adesi,
2010
The focus of this study is the role of the Radiation Therapist (RTT) in the assessment of pain in cancer patients. The study was carried out at a Radiotherapy Department of a large Teaching Hospital in Ghana and addressed the following research questions; 1) What is the role of the RTT in the assessment of pain in cancer patients, 2) Why should the RTTs’ role be extended to include pain assessment, 3) What are the challenges for the RTT when taking on the role of pain assessment in radiation oncology and 4) How can pain assessment become a routine role for the RTT in a busy radiation oncology department? 5) How would this extended role of the RTT assist management of patient? This study was conducted because many cancer patients suffer pain and to many, it can be more debilitating than the primary disease itself. The RTTs who are involved in the daily management of cancer patients during their radiation treatment can find it stressful to witness their patients going through such pain particularly when they do not have a role in the management of pain. In Ghana, there are few radiation oncologists (ROs) and therefore an extended scope for RTTs, that includes pain assessment and a meaningful contribution to the management of their patients’ pain, would be advantageous to all. A mixed method research approach was adopted for gathering quantitative and qualitative data. This included data collection of; interview, observation and review of existing document. A pain questionnaire SF-MPQ-2 by Melzack (2009) was adapted as a tool for assessing pain in the study participants. RTTs administered the questionnaire and experienced the role of pain assessment being included in their daily routine. Ninety patients were asked to complete the questionnaire after carefully and willingly consenting to participate in the study. The findings of this study built knowledge on pain in cancer patients through research in a radiotherapy department in Ghana. This included gaining a deeper understanding of how patients describe their pain and how location, site and other factors increase or decrease their pain. Data analysis further revealed and confirmed that RTTs have a role in the assessment of pain which will contribute to the management of that pain and that pain assessment can be included in the RTTs role in a busy radiation oncology unit. The extended role recommended due to the findings of this study are that RTTs can: administer a limited pain questionnaire, use this for clinical assessment of patients with pain, refer patients who need urgent medical attention to the doctors, monitor the patients daily especially those on ‘watchful waiting’ and those receiving chemotherapy alongside radiotherapy, provide meaningful suggestions to the multidisciplinary team on the management of the pain, give reassurance and support to patients regarding their pain, offer careful monitoring to patients undergoing radiotherapy, promote planning as a routine practise in the department, educate and counsel patients and their relatives or care givers about pain, and provide appropriate positioning during simulation and treatment for patients suffering with pain. It is evident that extending the RTTs’ role is a need in the radiotherapy department in Ghana and by so doing, the quality of care to patients will be improved. Role extension will lead to reduction of the workload of the few oncologists as well as reduce patients’ waiting time. This will further improve patient satisfaction and staff job satisfaction. The research suggests and recommends ways of achieving this extended role such as the regularization of pain assessment into the existing roles of the RTT through the appropriate professional body and use of the new pain assessment tool that was developed through the study.
http://hdl.handle.net/11189/238
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Radiation -- Measurement

[8/1896]

Three-dimensional thinking in radiography
Venter, Dalene,
2008
Introduction Research to date has not been able to agree whether spatial abilities can be developed by practice. According to some researchers spatial ability is an inherited cognitive ability, compared to spatial skills that are task specific and can be acquired through formal training. It is commonly assumed that radiographers require general cognitive spatial abilities to interpret complex radiographic images. This research was conducted to investigate second year radiography students’ three-dimensional thinking skills pertaining to film-viewing assessments. Materials and methods The experimental research strategy was mainly applied together with correlation research. Two trials were run (in 2005 and 2006). The sample group consisted of fifteen second year diagnostic radiography students in 2005 and twenty-three second year diagnostic radiography students, of the same institution, in 2006. Each year group was randomly divided into a control group and an intervention group. Two instruments were used, that is a film-viewing assessment and a three-dimensional test, Academic Aptitude Test (University) (AAT) nr. nine: Spatial Perception (3-D). The whole class completed this basic spatial aptitude test, as well as a base-line film viewing assessment, which focused on the evaluation of technique/anatomy of second year specialised radiographic projections. The marks that the students achieved in the fore-mentioned tests were compared, to determine if there was any correlation between their performances in the different tests. A curricular intervention, which was intended to improve applied three-dimensional skills, was subsequently applied. The students executed certain modified radiographic projections on parts of a human skeleton. For each radiographic projection, the students had to draw the relation of the X-ray beam to the specific anatomical structures, as well as the relation of these structures to the film. The related images of these projections were also drawn. With each of the following sessions, films including images of the previous session were discussed with each student. After the intervention, the whole class wrote a second film-viewing assessment. The marks achieved in this assessment were compared to the marks of the initial film-viewing assessment to determine the influence of the intervention on the performance of the intervention group. Following this assessment, for ethical reasons, the same intervention took place with the control group. A third film-viewing assessment was then written by all the diagnostic second year students to evaluate the overall impact of the intervention on the applied three-dimensional skills of the class. The marks of both the 2005 and 2006 classes (intervention classes) were compared to the marks achieved by former classes from 2000 to 2004 (control classes), in film-viewing assessments to evaluate the role of the curricular intervention over the years. The students again completed the three-dimensional test, Spatial Perception (3-D) to evaluate the impact of the intervention on students’ general three-dimensional cognitive abilities. These marks were also compared to the marks of the third filmviewing assessment, to determine if there was any correlation between the students’ performances in the different tests. Results The intervention groups did not perform significantly better in film-viewing assessments after the intervention, compared to the control groups, but reasonable differences, favouring the intervention group, were achieved. Statistical significance was achieved in film-viewing assessments with both year groups after the whole class had the intervention. The intervention year groups also performed significantly better than the previous year groups (without the intervention) in film-viewing assessments. The performance in general three-dimensional cognitive abilities of the group of 2006 improved significantly after the intervention, but on the contrary, the performance of the group of 2005 declined. There was a small intervention effect on the performance of the group of 2006. Only a weak to moderate correlation between the marks of the students achieved in the three-dimensional tests and the marks achieved in the film-viewing assessments, was found. Conclusion The contrasting evidence between the data of the two groups (2005 and 2006) in the three-dimensional tests and the small intervention effect on the performance of the group of 2006, makes the intervention not applicable for the increase of general spatial abilities. The results of this research show that the applied three-dimensional skills of radiography students in interpreting specialised and modified projections can be improved by intensive practice, independent of their inherited spatial abilities.
http://hdl.handle.net/11189/1416
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Theses, dissertations, etc.

[9/1896]

Professional communication practices of radiotherapists in the workplace and classroom in higher education in the Western Cape, South Africa.
Wyrley-Birch, Bridget Diana,
2008
The focus of this study is the professional communication practices of radiotherapists as clinical practitioners and as teachers of student/novice radiotherapists. The study was undertaken at a higher education institution and a radiation oncology department in South Africa and addressed the research question; what are the communication practices of radiotherapists in their professional practice and as higher education teachers. This work on professional communication was based on practice and discourse theory as relating to a local context of professional practice and education. Professional communication, seen in this sense, is a social practice which needs to be understood as operating within educational, work and social discursive practices of radiation therapy. A case study approach was chosen as the most appropriate research strategy for capturing the authentic communication practices of radiotherapists in clinical and educational practice. The professional communication practices of ten student and five qualified radiotherapists were investigated through typical teaching and learning interactions in a work integrated learning curriculum. The learning interactions were observed and video-taped in the classroom, tutorial, and demonstration room. Communication interactions were observed and audio taped in the clinical workplace. The research participants, using the video footage as part of their reflections, were interviewed about their communication practices. All interviews were audio taped and transcribed. Analysis of the data was by means of thematic analysis where the data was coded and categorised by means of pattern matching.
http://hdl.handle.net/11189/4828
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
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