Browsing by Author "Cupido, Clint"
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- ItemOpen AccessLife-threatening angio-oedema and death associated with the ACE inhibitor enalapril(2007) Cupido, Clint; Rayner, BrianAngiotensin-converting enzyme (ACE) inhibitors are widely used and effective drugs in the treatment of a broad range of cardiovascular and renal disorders. The recent death of a patient as a result of angio-oedema related to enalapril use prompted us to review all admission records of the intensive care units (ICUs) of Victoria, G F Jooste, New Somerset and Groote Schuur hospitals.
- ItemOpen AccessProfile and anticoagulation outcomes of patients on warfarin therapy in an urban hospital in Cape Town: a review of records of patients attending Victoria Hospital, Cape Town, South Africa(2016) Sonuga, Babatunde; Hellenberg, Derek; Cupido, ClintBackground: Warfarin is the most frequently used oral anticoagulant worldwide and it is the oral anticoagulant of choice in South Africa for reducing thrombosis - related morbidity and mortality. However, the safety and efficacy of warfarin therapy depends mainly on careful monitoring and maintenance of the international normalized ratio (INR) within an optimal therapeutic range. In the ACTIVE - W trial conducted across nine countries, South Africa had the poorest anticoagulation control with warfarin. This study showed that 86% of patients on warfarin therapy in the country have their mean time in therapeutic range below target. This was an indication of a very poor warfarin control in South Africa .The trial reported centre - specific differences within each country. It was however silent on these differences in South Africa. Aim: The aim of this study was to describe the profiles and the anticoagulation outcomes of patients on warfarin therapy in a major warfarin clinic in Western Cape Province of South Africa. Setting: Victoria Hospital - a district hospital in Cape Town, South Africa, which serves around one million people. Methods: A cross sectional review of clinical records of patients on warfarin therapy who attended the INR clinic from 01 January 2014 to 30 June 2014 was done. Data analysis was done with Stata to generate appropriate descriptive data and groups were compared using non - parametric tests. Results: Age range for male patients was between 29 - 85 years with median age of 62 years, while that of female patients was between 17 - 92 years with a median age of 66 years. Atrial fibrillation (AF) was the commonest indication for warfarin use in this study and hypertension was the commonest co-morbidity amongst these patients. Only 48.5% (66 patients) achieved target therapeutic range as of 01 July 2014, while 51.5% (70/136) of the patients were out of range. Patients who were non - alcohol users (88.9%) had better therapeutic control than those who consumed alcohol (9.6%). There was a significant association between alcohol consumption and poor anticoagulation outcomes (p value <0.022). Unlike alcohol use, there was no statistical relationship between smoking habit and target therapeutic range (P value = 0.198). The study also showed that anticoagulation outcomes were better among the older age groups, male patients and in those with atrial fibrillation. The prevalence of thrombotic events while on warfarin treatment was 2.2%, while prevalence of haemorrhagic events was 14%. Most of the patients with bleeding events were on concurrent use of warfarin and other medications with potential drug interactions. Conclusion: In this study, patients who achieved target therapeutic control were less than the acceptable 60%. Bleeding complications were more common among patients on concurrent use of warfarin with other medications such as NSAIDS and simvastatin. Therefore, it is of utmost importance for health professionals to take note of drug - drug or drug - disease interactions among patients on warfarin and to monitor INR levels more frequently in patients who have to unavoidably be on concurrent use of medications with possible major interactions with warfarin. Keywords: Oral anticoagulant, anticoagulation outcomes, therapeutic control, percentage INR within target therapeutic range (%ITTR).
- ItemOpen AccessQuality and extent of adherence on internal medicine discharge letters in a regional hospital in South Africa to prescribed guidelines. A retrospective audit(2019) Nya, Anthony; Ras, Tasleem; Cupido, ClintBackground: Hospital discharge letters are an essential part of good patient record keeping that ensures transmission of the healthcare information of a patient from the hospital of admission to the primary care practitioner. These letters were traditionally handwritten, but the medical ward in Victoria hospital Wynberg in adapting to current progress in clinical record keeping has transited from paper to the use of electronic discharge letters. Objectives: To audit the structure and contents of the electronic discharge summaries and find out to what extent they meet universally accepted criteria. Methodology: A retrospective clinical record audit of 60 patient records was conducted, spanning a period of 12 months (January-December) of 2018. Sequential sampling was used to select five folders from each months’ discharge records, making a total study sample of 60 patient records. A checklist of prescribed criteria was developed and used to collect data which was analysed descriptively. Ethical approval was obtained from University of Cape Towns’(UCT) Human Research Ethics Committee (HREC) and the Western Cape Government Provincial Research Committee. Electronic discharge letters compiled in the period 1 January- 31 December 2018 with corresponding folders found properly indexed in the medical records department were included in the sample, while discharge letters where the folders could not be found were excluded, as were the folders of patients who died during the hospital admission. Results: Nearly all clinical records contained biodata (100%), contact details (93%) and clinical details (93%). Only two-thirds of the folders contained information on other diagnoses(67%) and investigations matched clinical issues 63%.). The least compliant category was medication changes(53%), with just under half the folders containing this information. Conclusion: This study found that clinical records met 67% of the standards that define clinical and medico-legal compliance in the internal medicine ward in Victoria Hospital Wynberg. Several areas for future intervention were identified. A useful audit tool was also developed for ongoing quality improvement cycle.
- ItemOpen AccessThe utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two south African hospitals with a high HIV burden(2019-11-13) Raubenheimer, Peter J; Day, Cascia; Abdullah, Faried; Manning, Katherine; Cupido, Clint; Peter, JonnyAbstract Background Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa. Methods Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospective observational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic records. Results 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68–81%), specificity of 85% (83–88%), a positive predictive value of 56% (49–63%) and a negative predictive value of 93% (91–95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87–16.9, p < 0.001). Conclusions The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.