Browsing by Author "Isaacs, Abdul Aziz"

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    An audit of geriatric stroke rehabilitation services at a post-acute hospital (Booth Memorial) in urban Cape Town, South Africa
    (2009) Ras, Tasleem; Isaacs, Abdul Aziz; Schweitzer, Beverley
    Booth Memorial Hospital (BMH), situated at the foot of Table Mountain in urban Cape Town, South Africa, is an NGO-run hospital in a Public- Private Partnership with the Western Cape Department of Health. The essential service being offered is sub-acute health care, with state hospitals referring patients needing terminal, rehabilitation or convalescent care for a variety of illnesses. Post-acute stroke rehabilitation forms an integral part of the general service being offered by BMH. This dovetails with the state-run rehabilitation hospital in the sense that younger patients able to undergo intense rehabilitation are sent to the state-run hospital, while BMH generally cares for those patients who may not be able to withstand the rigours of an intense rehabilitation program. In our setting, this means that most of the patients seen at BMH for post-stroke rehabilitation are elderly. The elderly patient who has suffered a stroke is vulnerable in many respects. The most obvious vulnerability refers to the physical, emotional and psychological derangements that follow strokes in this age group. In addition, due to rampant poverty prevalent in the community we serve, social and economic factors place this group of patients at an even greater disadvantage. It is an imperative for social survival and an acceptable quality of life that this group of patients retain as much of their independence and empowerment after the stroke as is possible. The current situation of overflowing old-age homes, increasing prevalence of elder abuse and neglect, and the deficiency of community structures to care for the elderly compel health care providers to ensure that a post-stroke rehabilitation service operates with maximal efficiency, given the paucity of resources endemic in our health system. The above factors provided an impetus for this study. A need arose to assess the quality of the stroke rehabilitation services at BMH, as the starting point to what is hoped will be a continuous Quality Improvement Cycle. An additional factor compelling the examination of the quality of service being offered is that the Geriatric population is underserved in the present health system, competing for scarce resources with other vulnerable groups such as children, Cancer patients, and people living with HIV/AIDS. By focussing on a service that is almost exclusively aimed at the elderly, we hope to be able to advocate for greater resource allocation to this age group, given that receiving good health care is essential to the quality of life of the ageing population. This assessment of the current services looked at the Structure, Process of care and Clinical Outcomes of stroke rehabilitation services being given to patients over the age of 65 years. The findings were evaluated against internationally accepted norms of post-acute stroke care, and are presented in this study.
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    Implementing and evaluating a weight reduction program for diabetic patients at a primary health care facility in the Western Cape
    (2016) Razack, Adil; Isaacs, Abdul Aziz
    Background: Diabetes is now the most common non-communicable disease globally and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, self-management of diabetes and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for DM states that carbohydrates should make up 45-60% of the total nutritional intake and that low carbohydrate or high protein diets offer no long term success over healthy eating plans. Recent studies suggest that there may be merit in using low carbohydrate diets in diabetic patients. Aim and Objectives: The study aimed to implement and evaluate a program for weight loss in Diabetes Mellitus type 2 patients by comparing a Low carbohydrate diet to the conventional low fat diet. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded in both groups. Methods: The study design was that of a two group randomised parallel design, with one group following a low fat diet and the other a low carbohydrate diet. Both groups received advice on exercise and behaviour change. Clinical parameters were recorded at week 0 (baseline) and week 12 of the program. Patients were invited to participate in the study using leaflets, posters and via staff. A total of 10 patients per group were identified and followed. Results: Significant reductions were seen in weight loss and Hba1c in the Low Carbohydrate diet group which was not evident in the Low fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low Carbohydrate diets are effective in promoting weight loss and glucose control in diabetic patients. More research is recommended to assess patient's experience of following a low carbohydrate diet. Recommendations include training staff at facilities in our Sub-District on understanding and implementing Low Carbohydrate diets.
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    A quality improvement cycle for acute bronchospasm in primary health care: Mitchell's Plain Community Health Centre, Cape Town
    (2015) Marimuthu, Sarojini; Isaacs, Abdul Aziz
    Asthma affects over 300 million people worldwide and is the sixth highest cause of morbidity and mortality in South Africa. Mitchell’s Plain is a large suburb in Cape Town, with a population of approximately 320 000 people. A previous study in 2006 indicated that 15.7% of patients that presented to Mitchell’s Plain Community Health Care casualty were for an acute exacerbation of asthma and 7.8% of total deaths were from acute asthma. There was generally poor adherence to the national guidelines with respect to the management of an acute asthma exacerbation. Aim and Objectives: This study aimed to assess and improve the quality of management of acute bronchospasm at Mitchell’s Plain CHC. Objectives included assessing the current management, comparing it to the national guidelines and implementing strategies to improve care. Method: The study methodology was that of an audit cycle. Eligible patients were identified from the casualty admissions register. A total of 351 patients’ records were reviewed and compared to criteria based on the national guidelines. The initial findings were presented to the casualty staff that critically reflected; planned and implemented change. Intervention strategies involved raising awareness about the asthma guidelines, the audit tool and the South African Triage Score. A re-audit was performed after 6 months.