Browsing by Author "Nikodem, Cheryl"

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    An assessment of the adherence to guidelines for the management of asthma exacerbations in selected primary healthcare facilities in the Western Cape
    (University of the Western Cape, 2006) Brickels, Vernon; Nikodem, Cheryl
    INTRODUCTION: Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of "acute attacks" or exacerbation may occur in susceptible individuals. The onset of these episodes maybe associated with external stimuli such as cold or pollen. Asthma could be a controllable disorder and most people with asthma should be able to lead a normal, productive life if their asthma is managed effectively. A review of literature recommend that adherence to uniform guidelines on asthma management can reduce the frequency of acute attacks. Guidelines for the management of asthma have been implemented in health care facilities in the Western Cape for more than a decade. OBJECTIVE: The objective of this study was to investigate the extent to which doctors adhere to the prescribed asthma guidelines. METHOD: Record review. PARTICIPANTS: Forty records were reviewed. SETTING: The study was conducted at four Primary Health Care (PHC) centres in the Western Cape. INTERVENTION: A review of patient records was done to examine adherence to the implementation of the recommended guidelines. RESULTS: The results are in line with the literature which shows that adherence to the asthma guidelines is sub optimal. CONCLUSION: It is recommended that authorities should regularly follow health care facilities to evaluate to what extend guidelines are adhered to and ongoing training should be given to make health workers aware of these guidelines.
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    An assessment of the knowledge and practice of registered midwives regarding policy guidelines for routine episiotomies at two academic, state tertiary hospitals in the Western Cape.
    (University of the Western Cape, 2004) de Maar, Major Colleen; Nikodem, Cheryl
    An episiotomy is the surgical incision of the perineum. As far is known, was this procedure was done as early as 17 41. Sir Fielding Quid, was the first person to describe this procedure in his "Treatise of Midwifery in Three parts", as an aid to assist with difficult deliveries. The implementation of this intervention is a worldwide phenomenon and has been recorded during the 19th century as one of the most common surgical procedures in the clinical practice. The World Health Organisation has taken a clear stand against routine episiotomies and recommend that episiotomy rates should be around 10% and no more than 20%. There are no clear guidelines in the literature available that give true and valid indications for the performance of an episiotomy. Aim The aim was to determine whether the two tertiary academic institutions in the Western Cape have policies and guidelines available regarding the performance of episiotomies by registered midwives and to determine the knowledge and practice of registered midwives regarding these policies and Methodology The researcher made use of a descriptive survey to explore the issue whether guidelines exist regarding episiotomies and whether midwives are aware about these guidelines. Structured questionnaires were used to gain information from the registered midwives. The researcher also made use of documents (birth register) and in-depth interviews (unit managers). Results The findings of the study concluded that midwives are aware of the latest evidence that episiotomies are not done routinely even though no evidence of existing policies could be allocated in any of the two wards. The finding further shown that the current guidelines are not based on evidence. Midwives do not directly rely on guidelines in the wards (non available), but an inference is made that the midwives obtain access via secondary sources such as obstetricians. Midwives feels competent to do episiotomies but would like to be updated on knowledge regarding procedures and agree that skills updates are important. They are not aware of how to gain access to evidence based literature such as systematic reviews. Conclusions There is an urgent need to inform the regulatory professional body to review their regulations as the current regulation as it stands promotes more harm than good. Similarly is there a need to inform the national, provincial and local government I institutions, that if they publish guidelines they need to ensure that these guidelines are based on the latest evidence where possible. It is further important that policies be available to all members of staff to update them self with current information. In-service updates on evidence.
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    A descriptive study to evaluate the effect of guidelines used by counsellors to improve adherence to antiretroviral therapy in the private sector
    (University of the Western Cape, 2006) Marais, Melanie; Nikodem, Cheryl
    INTRODUCTION: To achieve a virological outcome to antiretroviral therapy, a high adherence level is required. OBJECTIVE: To implement and evaluate guidelines that will be used by treatment support counsellors in an attempt to increase client adherence to antiretroviral treatment. METHODS: A quasi - experimental comparative study was used to assess whether a structured treatment support guidelines can improve client adherence to antiretroviral therapy. The treatment outcome of two groups was compared: one group received the adherence guidelines and the other group was a historical group where no adherence guidelines were applied. The main outcome measure was whether adherence guidelines improved adherence to ART. PARTICIPANTS: Forty clients were exposed to the adherence guidelines and 34 were not. SETTING: Clients that subscribe to Aids for Aids . Intervention: A structured guideline used by counsellors with regular contact. RESULTS: Specific guidelines used by counsellors to improve adherence to antiretroviral therapy has shown that significantly more clients in the intervention group had their CD4 blood tests done after six months and adhered to regularly claim their medications. In addition were there more clients in the intervention group who had viral loads of less than 400 copies I ml after six months. CONCLUSION: Specific counselling using effective guidelines improve adherence to antiretroviral treatment.
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    A home-based physical activity programme in combination with massage therapy to improve motor and cognitive development in HIV positive children on antiretroviral therapy: A randomised controlled trial
    (University of the Western Cape, 2014) Khondowe, Oswell; Frantz, José; Nikodem, Cheryl; Harper, Kim
    The aim of this study was to prospectively, evaluate the effectiveness of an individually designed home-based physical activity programme in combination with massage therapy, on motor and cognitive development in children infected with HIV. This study used a randomized controlled trial design. One hundred and twenty-eight infants and toddlers (children) were recruited between March 2010 and September 2010 and randomly allocated to receive either an individually designed home-based physical activity programme in combination with massage therapy or standard treatment and massage on a 1:1 ratio. Motor and cognitive development was measured using the Bayley Scales of Infant Development third edition (Bayley-III)
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    A systematic review evaluating the effects of bilateral tubal ligation on menorrhagia and dysmenorrhoea (post-tubal ligation syndrome)
    (University of the Western Cape, 2006) Muntanga, V. L.; Nikodem, Cheryl; Daniels, Felicity M.
    INTRODUCTION: The complaints about the tubal sterilization surgery leading to post-tubal ligation syndrome first surfaced in the 1950s. With the introduction in the 1970s of laparoscopy, which was a less invasive surgery, more women choose tubal ligation as a family planning method, and reports of complaints of tubal-ligation syndrome increased. Changes in menstrual flow, dysmenorrhoea, menorrhagia and change in cycle length after tubal sterilization have been reported in several studies since 1970. The term "post tubal ligation syndrome" has been used to refer to these changes. Often studies have failed to account for the cause in the menstrual changes other than tubal ligation.Objective: The primary objective of this research project was to evaluate the long-term risks associated with female tubal ligation by executing a systematic review. SEARCH STRATEGY: An electronic search of available search engines was used to draw literature relevant to bilateral tubal ligation. SELECTION CRITERIA TYPES OF STUDIES: All randomized controlled, quasi-randomized or clinical controlled trials that mention an experimental and comparison group (own controls were allowed), reporting on long-term risks associated with changes in the menstrual cycle after female sterilization were included in the review. TYPES OF PARTICIPANTS: Women in their reproductive years who had a tubal ligation compared to women who did not have a tubal ligation. TYPES OF INTERVENTION: Tubal sterilization (by macro- or micro-surgery, laparotomy, minilaparotomy or laparoscopy). TYPES OF OUTCOME MEASURES: Outcome measures relevant to post-tubal sterilization long-term risks concentrating on: Dysmenorrhoea, menorrhagia and duration of menstruation period. DATA ANALYSIS: The reviewer extracted the data unto a data collection sheet. Thereafter it was captured onto a computer. Review Manager software program was used for analyses. RESULTS: The results showed that women who have a tubal ligation have an increased risk to experience dysmenorrhoea and menorrhagia after the procedure. They may also be at risk to experience an increase in the duration of their menstruation period.
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    A systematic review evaluating the effects of bilateral tubal ligation on menorrhagia and dysmenorrhoea (post-tubal ligation syndrome).
    (University of the Western Cape, 2004) Muntanga, Veronica Longwe; Nikodem, Cheryl
    A systematic review evaluating the effects of bilateral tubal ligation on menorrhagia and dysmenorrhoea (post-tubal ligation syndrome). The complaints about the tubal sterilization surgery leading to post-tubal ligation syndrome first surfaced in the 1950s. With the introduction in the 1970s of laparoscopy, which was less invasive than previous surgery, more women than never before chose tubal ligation, and reports of post-operative symptoms increased. Alteration in menstrual flow, dysmenorrhoea, menorrhagia and change I n cycle length after tubal sterilization have been reported in several studies since 1970. The term "post sterilization syndrome" has been used to refer to these changes. Often studies have failed to account for factors other than tubal sterilization that can affect menstrual cycles. The primary objective of this research project is to evaluate the long-term risks associated with female tubal ligation by executing a systematic review.
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    A systematic review of post-breast cancer lymphoedema and its treatment with natural medicine
    (2009) Zygmont, Jesica Graciela Massaro; Nikodem, Cheryl; Armer, Jane
    In this minithesis a systematic review of all of the available contemporary literature on post-breast cancer lymphoedema was undertaken. The purpose of this systematic review was to search for, collate, synthesize and thereby provide the reader with a comprehensive, evidence-based account of all the available research published between 1988 and 2008 on the treatment of post-breast cancer lymphoedema with natural medicine.Because the large number of articles published every year across a plethora of biomedical journals makes it incredibly difficult for practitioners to keep up-to-date within their specialized areas, systematic reviews are particularly useful as they summarize high quality, contemporary scientific knowledge on a topic in one place (Antman, Lau, Kupelnik, Mosteller & Chalmers, 1992). One such topic on which many health practitioners have a paucity of information regarding management and risk reduction is lymphoedema (Radina, Armer, Culbertson & Dusold,2004) The primary objective of this research project was to assess the effects of natural medicine on post-breast cancer lymphoedema in regard to 1) life style improvement including any signs and symptoms related to the condition such as heaviness, tightness, pain, ache, itch, mobility of the affected arm, skin texture as well as psychological symptoms like distress;2) arm volume changes of the affected limb; 3) adverse effects; and 4) modification or cessation of treatment.Several online databases were searched for articles that contain the term lymphoedema, lymphedema, limb swelling or "linfedema" (Spanish and Portuguese); thereby including all possible spellings in English, Spanish and Portuguese. Relevant information was extracted and recorded in tabular format. The quality of each study was analysed using a checklist,which was drawn up by the primary researcher and study supervisor based on the CONSORT guidelines (Altman, 1996).To ensure quality, only randomized controlled trials, quasi-randomized controlled trials or clinical trials that met the inclusion or exclusion criteria, reporting benefits or adverse effects of natural medicines for the treatment of post-breast cancer lymphoedema were included. In addition,studies had to focus on natural medicine versus placebo or routine treatment or no treatment as types of intervention; and participants had to include women of all ages that had been diagnosed with post-breast cancer lymphoedema.The relevant data from included studies was entered into Review Manager 5 (Revman 5) software for meta-analysis. The primary studies included in this systematic review generally suffered from small sample sizes, varied somewhat in their operationalisation of outcomes and the format for presenting results, making meta-analysis very difficult. However, results suggest that sodium selenite taken orally and CYCLO 3 FORT also taken orally are effective in the reduction of limb volume. The results also suggested that aromatherapy using an intervention cream containing wheat germ oil and essential oils of fennel, sage, geranium, black pepper and juniper; and vitamin E plus pentoxifylline taken orally are not effective.Seeing as these results are drawn from single studies with heterogeneous outcome variables, they should be seen as tentative until they are confirmed by replication. Gaps in the literature regarding natural medicine as a treatment for post-breast cancer lymphoedema were identified, and recommendations for further research are proposed.
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    A systematic review on effects of physical activity Interventions on early motor development in children with Down syndrome
    (University of the Western Cape, 2007) Khondowe, Oswell; Simons, Johan; Nikodem, Cheryl
    PURPOSE: The main aim of this review was to evaluate the effect of physical activity on motor development in children with Down Syndrome by means of a systematic review. METHODS: An extensive literature search of published studies in English from 1980 to May 2006 was performed. Of the fifty-eight studies identified only four met the inclusion criteria. This review included studies that investigated the effects of physical activity on motor development in children with Down Syndrome and evaluated the outcomes in terms of the level of activity. RESULTS: One study showed a significant decrease in length of time to independent walking in the intervention group (C l -101(-180.48 - -21.52]. Two studies (N=84) reported a significant improvement in the total developmental quotient following intensive physical activity (wmd and Cl 95% -13.07 [-17. 66, -8.48]. Three studies showed an increased in locomotor developmental skills following physical activity intervention. CONCLUSION: The results of this review support the use of programmes that are designed to improve motor development in children with Down Syndrome. We recommend that physical activity programmes need to be intensive and parents should be incorporated to strengthen the outcomes.