Experiences of midwives regarding the use of pharmacological and non-pharmacological labour pain interventions in Lejweleputswa District in Free State
- Parkies, Limakatso Elizabeth
- Authors: Parkies, Limakatso Elizabeth
- Date: 2022-03
- Subjects: Pharmacology , Anesthesia in obstetrics
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23567 , vital:58166
- Description: Due to the disabling effects of severe labour pains, labour pain management remains an important topic in midwifery and needs to be reviewed more often. According to studies, various pain relief options, both pharmacological and non-pharmacological, are available to help women cope with pain, but midwives did not employ these techniques adequately because of various experiences. Studies further indicate that, though the limited number of these techniques were employed they were not effective on some women. Thus, the purpose of this research study was to explore and describe midwives’ experiences on pharmacological and non-pharmacological labour pain management in the Lejweleputswa District of the Free State Province. This study employed a qualitative, descriptive, explorative, and contextual design. A purposive sampling technique was used to select the participants. The target population was midwives who work in the maternity wards of the institutions under study with three to five years’ experience in midwifery. Individual, face-face, semi-structured interviews were conducted; these were recorded for the researcher’s reference purposes, so as not to overlook important information. In addition, the researcher made use of field notes, recording in them what was heard, observed, felt, experienced, and thought during the interview. Ethical principles and trustworthiness were maintained throughout this study. Data analysis was done using Tesch’s approach to open coding in qualitative research. Confidentiality and anonymity were ensured throughout the interviews. The nine themes and 19 sub-themes that emerged during data analysis were discussed comprehensively. The findings indicate that midwives use both pharmacological and non-pharmacological methods in managing labour pain. Some methods are effective in relieving pain for certain mothers, while other methods proved ineffective. Midwives administer Pethidine and Phenergan as per doctors’ prescription; non-pharmacological methods, such as back massage, deep breathing exercises, mobilisation, and warm baths or showers are also employed. Midwives provide pharmacological methods to all women in labour, and routinely employ non- pharmacological methods. Although the midwives are willing to manage patients’ pain, they face certain challenges, such as shortage of staff, increased workload, as well as inadequate resources. This leads to inadequate provision of non-pharmacological care. In conclusion, the midwives’ experiences were that both pharmacological and non-pharmacological techniques were used for all labouring women and they had relaxing and calming effects on some women, resulting to them giving birth with ease, although for some they were not effective. In addition, the pharmacological interventions caused drowsiness to some women and babies. The findings will provide evidence-based information to the Free State Department of Health in order to assist policymakers and stakeholders in initiating and developing appropriate policies, guidelines, and interventions that can improve labour pain management. The Free State Department of Health should consider using other opioids and non-opioids in managing labour pain to broaden the scope of pain relief methods available to the midwives. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-03
- Authors: Parkies, Limakatso Elizabeth
- Date: 2022-03
- Subjects: Pharmacology , Anesthesia in obstetrics
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23567 , vital:58166
- Description: Due to the disabling effects of severe labour pains, labour pain management remains an important topic in midwifery and needs to be reviewed more often. According to studies, various pain relief options, both pharmacological and non-pharmacological, are available to help women cope with pain, but midwives did not employ these techniques adequately because of various experiences. Studies further indicate that, though the limited number of these techniques were employed they were not effective on some women. Thus, the purpose of this research study was to explore and describe midwives’ experiences on pharmacological and non-pharmacological labour pain management in the Lejweleputswa District of the Free State Province. This study employed a qualitative, descriptive, explorative, and contextual design. A purposive sampling technique was used to select the participants. The target population was midwives who work in the maternity wards of the institutions under study with three to five years’ experience in midwifery. Individual, face-face, semi-structured interviews were conducted; these were recorded for the researcher’s reference purposes, so as not to overlook important information. In addition, the researcher made use of field notes, recording in them what was heard, observed, felt, experienced, and thought during the interview. Ethical principles and trustworthiness were maintained throughout this study. Data analysis was done using Tesch’s approach to open coding in qualitative research. Confidentiality and anonymity were ensured throughout the interviews. The nine themes and 19 sub-themes that emerged during data analysis were discussed comprehensively. The findings indicate that midwives use both pharmacological and non-pharmacological methods in managing labour pain. Some methods are effective in relieving pain for certain mothers, while other methods proved ineffective. Midwives administer Pethidine and Phenergan as per doctors’ prescription; non-pharmacological methods, such as back massage, deep breathing exercises, mobilisation, and warm baths or showers are also employed. Midwives provide pharmacological methods to all women in labour, and routinely employ non- pharmacological methods. Although the midwives are willing to manage patients’ pain, they face certain challenges, such as shortage of staff, increased workload, as well as inadequate resources. This leads to inadequate provision of non-pharmacological care. In conclusion, the midwives’ experiences were that both pharmacological and non-pharmacological techniques were used for all labouring women and they had relaxing and calming effects on some women, resulting to them giving birth with ease, although for some they were not effective. In addition, the pharmacological interventions caused drowsiness to some women and babies. The findings will provide evidence-based information to the Free State Department of Health in order to assist policymakers and stakeholders in initiating and developing appropriate policies, guidelines, and interventions that can improve labour pain management. The Free State Department of Health should consider using other opioids and non-opioids in managing labour pain to broaden the scope of pain relief methods available to the midwives. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-03
Impact analysis of a down-referral chronic medication distribution system for stable chronic patients to primary health care facilities in an Eastern Cape District
- Authors: Ndwandwe, Miriam
- Date: 2014
- Subjects: Health services accessibility -- South Africa -- Eastern Cape , Pharmacology
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:10084 , http://hdl.handle.net/10948/d1020644
- Description: The purpose of the study was to assess the level of patient satisfaction with service provided in the Buffalo City sub-district following the implementation of the down-referral chronic medication distribution system between the tertiary(ELHC) and primary (clinics) levels of health care. The intervention was aimed at improving accessibility and availability of medication to the chronic patients. Research Design: A non-experimental descriptive quantitative research methodology was used. The sampling method for the study was the non-probability purposive sampling. Data was collected using a self-administered questionnaire that was given to respondents as they arrived at the facilities, and who, after completing the questionnaire, gave it back to the researcher. Findings: The results of the study revealed that the patients were generally satisfied about the down-referral chronic medication distribution system. However the patients were not satisfied about the services that they receive from the primary health care facilities when they go to collect their down-referred medication. Lack of communication to the patients regarding their medication by the hospital staff (pharmacists in particular) was a concern for patients. Conclusion: The down-referral chronic medication distribution system can benefit both the patients and the hospitals. Patient will receive their medication closer to their homes and save on the cost of transport. The hospital will have less patient congestion in the outpatient dispensaries and queues and waiting times will be reduced. Some strategies must be sought to improve the services at the primary health care facilities. The hospital should explore various communication methods to put into place, that will save pharmacists time and satisfy the needs of the patients. This would require the health services management from both the hospitals and the primary health care facilities to work together to ensure continued support for the patients.
- Full Text:
- Date Issued: 2014
- Authors: Ndwandwe, Miriam
- Date: 2014
- Subjects: Health services accessibility -- South Africa -- Eastern Cape , Pharmacology
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:10084 , http://hdl.handle.net/10948/d1020644
- Description: The purpose of the study was to assess the level of patient satisfaction with service provided in the Buffalo City sub-district following the implementation of the down-referral chronic medication distribution system between the tertiary(ELHC) and primary (clinics) levels of health care. The intervention was aimed at improving accessibility and availability of medication to the chronic patients. Research Design: A non-experimental descriptive quantitative research methodology was used. The sampling method for the study was the non-probability purposive sampling. Data was collected using a self-administered questionnaire that was given to respondents as they arrived at the facilities, and who, after completing the questionnaire, gave it back to the researcher. Findings: The results of the study revealed that the patients were generally satisfied about the down-referral chronic medication distribution system. However the patients were not satisfied about the services that they receive from the primary health care facilities when they go to collect their down-referred medication. Lack of communication to the patients regarding their medication by the hospital staff (pharmacists in particular) was a concern for patients. Conclusion: The down-referral chronic medication distribution system can benefit both the patients and the hospitals. Patient will receive their medication closer to their homes and save on the cost of transport. The hospital will have less patient congestion in the outpatient dispensaries and queues and waiting times will be reduced. Some strategies must be sought to improve the services at the primary health care facilities. The hospital should explore various communication methods to put into place, that will save pharmacists time and satisfy the needs of the patients. This would require the health services management from both the hospitals and the primary health care facilities to work together to ensure continued support for the patients.
- Full Text:
- Date Issued: 2014
An investigation into the neuroprotective and neurotoxic properties of levodopa, dopamine and selegiline
- Authors: Scheepers, Mark Wesley
- Date: 2008
- Subjects: Parkinson's disease , Nervous system -- Degeneration -- Treatment , Neurotoxic agents , Neuroanatomy , Oxidative stress , Pharmacology , Dopamine , Selegiline , Dopaminergic neurons
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3789 , http://hdl.handle.net/10962/d1003267 , Parkinson's disease , Nervous system -- Degeneration -- Treatment , Neurotoxic agents , Neuroanatomy , Oxidative stress , Pharmacology , Dopamine , Selegiline , Dopaminergic neurons
- Description: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a profound loss of dopaminergic neurons from the substantia nigra (SN). Among the many pathogenic mechanisms thought to be responsible for the demise of these cells, dopamine (DA)-dependent oxidative stress and oxidative damage has taken center stage due to extensive experimental evidence showing that DA-derived reactive oxygen species (ROS) and oxidized DA metabolites are toxic to SN neurons. Despite its being the most efficacious drug for symptom reversal in PD, there is concern that levodopa (LD) may contribute to the neuronal degeneration and progression of PD by enhancing DA concentrations and turnover in surviving dopaminergic neurons. The present study investigates the potential neurotoxic and neuroprotective effects of DA in vitro. These effects are compared to the toxicity and neuroprotective effects observed in the rat striatum after the administration of LD and selegiline (SEL), both of which increase striatal DA levels. The effects of exogenous LD and/or SEL administration on both the oxidative stress caused by increased striatal iron (II) levels and its consequences have also been investigated. 6-Hydroxydopamine (6-OHDA) is a potent neurotoxin used to mimic dopaminergic degeneration in animal models of PD. The formation of 6-OHDA in vivo could destroy central dopaminergic nerve terminals and enhance the progression of PD. Inorganic studies using high performance liquid chromatography with electrochemical detection (HPLC-ECD) show that hydroxyl radicals can react with DA to form 6-OHDA in vitro. SEL results in a significant decrease in the formation of 6-OHDA in vitro, probably as a result of its antioxidant properties. However, the exogenous administration of LD, with or without SEL, either does not lead to the formation of striatal 6-OHDA in vivo or produces concentrations below the detection limit of the assay. This is despite the fact that striatal DA levels in these rats are significantly elevated (two-fold) compared to the control group. The auto-oxidation and monoamine oxidase (MAO)-mediated metabolism of DA causes an increase in the production of superoxide anions in whole rat brain homogenate in vitro. In addition to this, DA is able to enhance the production of hydroxyl radicals by Fenton chemistry (Fe(III)-EDTA/H2O2) in a cell free environment. Treatment with systemic LD elevates the production of striatal superoxide anions, but does not lead to a detectable increase in striatal hydroxyl radical production in vivo. The co-adminstration of SEL with LD is able to prevent the LD induced rise in striatal superoxide levels. It has been found that the presence of DA or 6-OHDA is able to reduce lipid peroxidation in whole rat brain homogenate induced by Fe(II)-EDTA/H2O2 and ascorbate (Fenton system). However, DA and 6-OHDA increase protein oxidation in rat brain homogenate, which is further increased in the presence of the Fenton system. In addition to this, the incubation of rat brain homogenate with DA or 6-OHDA is also accompanied by a significant reduction in the total GSH content of the homogenate. The exogenous administration of LD and/or SEL was found to have no detrimental effects on striatal lipids, proteins or total GSH levels. Systemic LD administration actually had a neuroprotective effect in the striatum by inhibiting iron (II) induced lipid peroxidation. Inorganic studies, including electrochemistry and the ferrozine assay show that DA and 6-OHDA are able to release iron from ferritin, as iron (II), and that DA can bind iron (III), a fact that may easily impede the availability of this metal ion for participation in the Fenton reaction. The binding of iron (III) by DA appears to discard the involvement of the Fenton reaction in the increased production of hydroxyl radicals induced by the addition of DA to mixtures containing Fe(II)-EDTA and hydrogen peroxide. 6-OHDA did not form a metal-ligand complex with iron (II) or iron (III). In addition to the antioxidant activity and MAO-B inhibitory activity of SEL, the iron binding studies show that SEL has weak iron (II) chelating activity and that it can also form complexes with iron (III). This may therefore be another mechanism involved in the neuroprotective action of SEL. The results of the pineal indole metabolism study show that the systemic administration of SEL increases the production of N-acetylserotonin (NAS) by the pineal gland. NAS has been demonstrated to be a potent antioxidant in the brain and protects against 6-OHDA induced toxicity. The results of this study show that DA displays antioxidant properties in relation to lipid eroxidation and exhibits pro-oxidant properties by causing an increase in the production of hydroxyl radicals and superoxide anions, as well as protein oxidation and a loss of total GSH content. Despite the toxic effects of DA in vitro, the treatment of rats with exogenous LD does not cause oxidative stress or oxidative damage. The results also show that LD and SEL have some neuroprotective properties which make these agents useful in the treatment of PD.
- Full Text:
- Date Issued: 2008
- Authors: Scheepers, Mark Wesley
- Date: 2008
- Subjects: Parkinson's disease , Nervous system -- Degeneration -- Treatment , Neurotoxic agents , Neuroanatomy , Oxidative stress , Pharmacology , Dopamine , Selegiline , Dopaminergic neurons
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3789 , http://hdl.handle.net/10962/d1003267 , Parkinson's disease , Nervous system -- Degeneration -- Treatment , Neurotoxic agents , Neuroanatomy , Oxidative stress , Pharmacology , Dopamine , Selegiline , Dopaminergic neurons
- Description: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a profound loss of dopaminergic neurons from the substantia nigra (SN). Among the many pathogenic mechanisms thought to be responsible for the demise of these cells, dopamine (DA)-dependent oxidative stress and oxidative damage has taken center stage due to extensive experimental evidence showing that DA-derived reactive oxygen species (ROS) and oxidized DA metabolites are toxic to SN neurons. Despite its being the most efficacious drug for symptom reversal in PD, there is concern that levodopa (LD) may contribute to the neuronal degeneration and progression of PD by enhancing DA concentrations and turnover in surviving dopaminergic neurons. The present study investigates the potential neurotoxic and neuroprotective effects of DA in vitro. These effects are compared to the toxicity and neuroprotective effects observed in the rat striatum after the administration of LD and selegiline (SEL), both of which increase striatal DA levels. The effects of exogenous LD and/or SEL administration on both the oxidative stress caused by increased striatal iron (II) levels and its consequences have also been investigated. 6-Hydroxydopamine (6-OHDA) is a potent neurotoxin used to mimic dopaminergic degeneration in animal models of PD. The formation of 6-OHDA in vivo could destroy central dopaminergic nerve terminals and enhance the progression of PD. Inorganic studies using high performance liquid chromatography with electrochemical detection (HPLC-ECD) show that hydroxyl radicals can react with DA to form 6-OHDA in vitro. SEL results in a significant decrease in the formation of 6-OHDA in vitro, probably as a result of its antioxidant properties. However, the exogenous administration of LD, with or without SEL, either does not lead to the formation of striatal 6-OHDA in vivo or produces concentrations below the detection limit of the assay. This is despite the fact that striatal DA levels in these rats are significantly elevated (two-fold) compared to the control group. The auto-oxidation and monoamine oxidase (MAO)-mediated metabolism of DA causes an increase in the production of superoxide anions in whole rat brain homogenate in vitro. In addition to this, DA is able to enhance the production of hydroxyl radicals by Fenton chemistry (Fe(III)-EDTA/H2O2) in a cell free environment. Treatment with systemic LD elevates the production of striatal superoxide anions, but does not lead to a detectable increase in striatal hydroxyl radical production in vivo. The co-adminstration of SEL with LD is able to prevent the LD induced rise in striatal superoxide levels. It has been found that the presence of DA or 6-OHDA is able to reduce lipid peroxidation in whole rat brain homogenate induced by Fe(II)-EDTA/H2O2 and ascorbate (Fenton system). However, DA and 6-OHDA increase protein oxidation in rat brain homogenate, which is further increased in the presence of the Fenton system. In addition to this, the incubation of rat brain homogenate with DA or 6-OHDA is also accompanied by a significant reduction in the total GSH content of the homogenate. The exogenous administration of LD and/or SEL was found to have no detrimental effects on striatal lipids, proteins or total GSH levels. Systemic LD administration actually had a neuroprotective effect in the striatum by inhibiting iron (II) induced lipid peroxidation. Inorganic studies, including electrochemistry and the ferrozine assay show that DA and 6-OHDA are able to release iron from ferritin, as iron (II), and that DA can bind iron (III), a fact that may easily impede the availability of this metal ion for participation in the Fenton reaction. The binding of iron (III) by DA appears to discard the involvement of the Fenton reaction in the increased production of hydroxyl radicals induced by the addition of DA to mixtures containing Fe(II)-EDTA and hydrogen peroxide. 6-OHDA did not form a metal-ligand complex with iron (II) or iron (III). In addition to the antioxidant activity and MAO-B inhibitory activity of SEL, the iron binding studies show that SEL has weak iron (II) chelating activity and that it can also form complexes with iron (III). This may therefore be another mechanism involved in the neuroprotective action of SEL. The results of the pineal indole metabolism study show that the systemic administration of SEL increases the production of N-acetylserotonin (NAS) by the pineal gland. NAS has been demonstrated to be a potent antioxidant in the brain and protects against 6-OHDA induced toxicity. The results of this study show that DA displays antioxidant properties in relation to lipid eroxidation and exhibits pro-oxidant properties by causing an increase in the production of hydroxyl radicals and superoxide anions, as well as protein oxidation and a loss of total GSH content. Despite the toxic effects of DA in vitro, the treatment of rats with exogenous LD does not cause oxidative stress or oxidative damage. The results also show that LD and SEL have some neuroprotective properties which make these agents useful in the treatment of PD.
- Full Text:
- Date Issued: 2008
Utilising new technology to enable sustainable chemical and drug manufacturing in Africa
- Authors: Watts, Paul
- Subjects: Drug development , Pharmacology , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21000 , vital:29426
- Description: Over the last few decades organic chemists have developed highly sophisticated chemical reactions to prepare very complex molecules. The pharmaceutical industry uses the methodology that academics develop within research programmes to manufacture drugs to treat a plethora of medical conditions. When unwell, all citizens expect treatment, however it needs to be remembered that the pharmaceutical industry is a business in order to make a profit for its shareholders, and consequently only rich nations can afford access to the most modern treatments available.
- Full Text:
- Authors: Watts, Paul
- Subjects: Drug development , Pharmacology , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21000 , vital:29426
- Description: Over the last few decades organic chemists have developed highly sophisticated chemical reactions to prepare very complex molecules. The pharmaceutical industry uses the methodology that academics develop within research programmes to manufacture drugs to treat a plethora of medical conditions. When unwell, all citizens expect treatment, however it needs to be remembered that the pharmaceutical industry is a business in order to make a profit for its shareholders, and consequently only rich nations can afford access to the most modern treatments available.
- Full Text:
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