Browsing by Author "Isaacs, Sedick"

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    Adult tonsillectomy - are long waiting lists putting patients at risk?
    (Health and Medical Publishing Group, 2006) Mulwafu, Wakisa; Fagan, Johannes J; Isaacs, Sedick
    There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more, only 55 were contactable. This low yield (15.7%) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy), it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis
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    Amiodarone-induced thyroid dysfunction
    (2005) Ross, Ian Louis; Marshall, David; Okreglicki, Andrzej; Isaacs, Sedick; Levitt, Naomi Sharlene
    Background. Little is known about the frequency of thyroid dysfunction (TD) associated with amiodarone therapy in southern Africa. Objectives. To determine the incidence of TD in a cohort of patients initiated on amiodarone therapy at a cardiac clinic in Cape Town, South Africa, believed to be an iodine-replete area. Patients. Pharmacy records were used to obtain the names of patients who received amiodarone between November 1999 and December 2002. Results. The sample size was 194, but data analysis was limited to the 163 patients for whom there were complete data. The mean age ± standard deviation (SD) was 59.0 ± 15.0 years (range 22 - 89 years). There were 67 female and 96 male patients. The indications for amiodarone therapy were supraventricular tachycardias (N = 102, 62.6%), ventricular tachycardia (N = 55, 33.7%), and prophylaxis against tachycardias (N = 3, 1.8%). The indication was uncertain in 3 patients (1.8%). The median duration of amiodarone treatment was 679.0 days (quartile deviation (QD) 1 172 days, range 3 - 6 425 days) in the whole cohort. The median duration of amiodarone therapy until new TD was 943 days (QD 1 185 days), significantly longer than in patients who remained euthyroid (547 days, QD 1 135 days) (P = 0.05). There were 45 new TD cases (27.6%): 11 patients (6.7%) were thyrotoxic, 1(0.6%) transient thyrotoxicosis, 1 (0.6%) subclinical hyperthyroidism, 13 (8.0%) had subclinical hypothyroidism, 12 (7.4%) hypothyroidism and 7 (4.3%) had minor changes in thyroid function. Conclusions. We found a high incidence of new-onset TD, similar to the highest rates reported internationally. Local factors responsible for this need to be investigated.
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    Factors associated with the successful implementation of computerised hospital information systems in South Africa
    (2009) Hanmer, Lyn Avril; Dewald, J; Isaacs, Sedick
    A conceptual model of Computerised Hospital Information System (CHIS) use was developed and refined, in order to improve understanding of factors associated with successful CHIS implementation in level 1 and level 2 public sector hospitals in two South African provinces. The study drew on models of information system (IS) success, insights from the HIS evaluation literature and studies of risk factors associated with the implementation of clinical information systems (CISs), in order to synthesise relevant results. A multi method approach was used to investigate the complex study environment. Pilot case studies were conducted in three level 2 hospitals in Province 1, in order to understand the use of CHISs in these environments. The major output of this phase was the initial conceptual model of CHIS use, which identified seven factors associated with successful CHIS implementation. In the second phase of the study, a further case study was conducted at a fourth level 2 hospital in Province 1, and interviews were conducted with three South African CHIS experts. An extended conceptual model of CHIS use was developed on the basis of the data from this phase. In the third and final phase of the study, a survey of CHIS use was conducted in more than thirty level 1 and level 2 hospitals, in two provinces, using one of three CHISs, in order to validate the conceptual model developed in the previous study phase. The results of the case study informed the refinement of the conceptual model to create the revised conceptual model of CHIS use. The conceptual model of CHIS use is a major output of this study. The survey results confirmed that the factors of the conceptual model are associated with CHIS success in level 1 and level 2 hospitals in the study provinces, and supported most of the relationships between the factors in the model. The study provides unique insights into the CHIS implementations in rather poorly resourced environments, thereby contributing to a growing literature on health information system development, implementation and use in developing areas from the perspective of information system success modelling, health information system evaluation, and a developing country context.
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    Overt hypoadrenalism is uncommon in patients with stage 3 and 4 bronchogenic carcinoma
    (Health & Medical Publishing Group, 2003) Ross, Ian L; Marais, Suzaan; Raubenheimer, Peter; Abratt, Raymond; Isaacs, Sedick; Soule, Steven
    Introduction. Lung cancer is the leading cause of cancer mortality in most countries. The adrenal glands are common sites of metastatic lung cancer as approximately 40% of subjects with stage 4 bronchogenic carcinoma have adrenal metastases. The prevalence of biochemical hypoadrenalism is, however, remarkably poorly documented. Objectives. Our study aimed to determine the prevalence of primary hypoadrenalism, as defined by a subnormal cortisol response to the 250 µg adrenocorticotrophic hormone (ACTH) stimulation test, in patients with stage 3 and 4 lung cancer. Methods. Thirty patients with stage 3 and 4 bronchogenic carcinoma were prospectively recruited from the bronchus clinic. Demographic data and electrolytes were recorded and each patient had a 250 µg ACTH stimulation test to determine the prevalence of overt adrenal insufficiency, defined as a +30 minute cortisol of less than 550 nmol/l. Results. The median age and quartile deviation was 62 (10) years and the median basal cortisol was 429.5 (321) nmol/l. The median peak cortisol was 828.5 (342) nmol/l (range 536 - 1 675 nmol/l). Twenty-eight patients (93.3%) had an appropriate rise of cortisol to greater than 550 nmol/l following 250 µg ACTH stimulation. Two patients (6.7%) had mild primary adrenal failure with a peak cortisol between 500 and 550 nmol/l associated with a raised plasma ACTH concentration (131.4 and 10.5 pmol/l, normal 2.2 - 10 pmol/l). Twenty-eight patients (92.9%) were normonatraemic, while the two hyponatraemic patients had biochemical evidence of the syndrome of inappropriate antidiuretic hormone secretion. Conclusion. In conclusion, despite evidence that the adrenal glands of patients with disseminated bronchogenic carcinoma are frequently affected by metastatic disease, biochemical evidence of clinically significant hypoadrenalism is relatively uncommon and is not accurately predicted by electrolyte abnormalities.
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