Browsing by Author "Klopper, Juan"

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    A retrospective audit of the outcomes of the Fellow Of College Of Surgeons (FCS) (General Surgery) Final Examinations
    (2018) Kahn, Miriam; Kahn, Delawir; Navsaria, Pradeep H; Klopper, Juan
    Background and aim: An audit of the Fellowship of the College of Surgeons FCS (SA) Final Examination results has not been previously performed. The purpose of this study was to review and determine any predictors of outcome. Methods: The results of the FCS (SA) Final Examinations from October 2005, to and including, October 2014, were retrieved from the College of Medicine of South Africa database. The current format of the examinations consists of: two written essay question papers, an OSCE, two clinical cases and two vivas. These were retrospectively reviewed and analyzed. Predictors of failure or success were determined. Analysis was performed using IPython for scientific computing. Assumptions for the normal distribution of numerical values were made based on the Kolmogorov-Smirnov test and quantile-quantile plots. Normally distributed variables were analyzed by parametric tests. In all other cases nonparametric tests were employed. An alpha value of 0.05 was chosen to indicate statistical significance, using a confidence level of 95%. Results: During the 10-year study period, 472 candidates attempted the examinations. A total of 388 (82,2%) candidates were successful in the written component of the examination and were subsequently invited to participate in the oral/clinical component of the examinations. 9 Overall, 296 (62,7%) of candidates passed and 176 (37,3%) failed. A total of 19 candidates achieved less than 50% for both papers, yet still managed an average of more than 45%. A total of 15 (79%) of these candidates went on to fail the examination. There were 51 candidates who were invited to the oral examinations despite an average of less than 50% in the two papers, and 34 (67%) failed the overall examination. Similarly, 126 candidates were invited having failed one of the two papers of which 81 (64.3%) ultimately failed. A total of 49 candidates failed the OSCE, 82% of these candidates failed overall. There was strong correlation between paper one and paper two (r = 0.56, p-value < 0.01), oral one and oral two (r = 0.41, p-value < 0.01) and case one and case two (r = 0.38, p-value < 0.01). Similar correlations were seen between the averages of the papers versus the orals (r = 0.52, p-value < 0.01), the papers versus the cases (r = 0.5, p-value < 0.01) and the papers versus the OSCE (r = 0.54, p-vale < 0.01). Conclusion: The written papers are the main determinant of invitation to the second part of the examination. Candidates with marginal scores in the written component had an overall failure rate of 67%. Failing one paper and passing the other, resulted in an overall failure rate 64,3%. Failing the OSCE resulted in an overall 82% failure rate. With the high failure rate of candidates with marginal scores and with the inter-examination variability of the papers, it might be prudent to revisit both the process of invitation selection and the decision to continue with the long-form for the written component.
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    A01 The Esophagus - Embryology
    (2014-09-12) Klopper, Juan
    This video is the first in a series of surgical study videos focusing on managing acute care surgical conditions. This particular video focuses on the embryology of the oesophagus. This resource is useful for junior medical students who are developing their anatomical knowledge.
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    Anatomy of the oesophagus for medical students and young doctors
    (2013) Klopper, Juan
    In this second video in the series of the management of acute conditions in surgery for medical students and young doctors we take a look at the anatomy of the oesophagus. Anatomy of the oesophagus for senior medical students preparing for their clinical exams and young doctors facing patients with acute conditions of the oesophagus.
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    Anatomy of the oesophagus for senior medical students preparing for their clinical exams and young doctors facing patients with acute conditions of the oesophagus
    (2013) Klopper, Juan
    Lecture series in acute care surgery. Managing acute care surgical conditions.
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    An audit of the workload of an acute surgery unit in a tertiary academic hospital before and after the closure of a referring community hospital
    (2015) Moodie, Quintin Keith; Klopper, Juan; Kahn, Delawir
    Aim: An audit of the workload of an Acute Care Surgery Unit in a Tertiary Academic Hospital and an assessment of the impact on this Unit by the closure of a busy Community Hospital. Background: The primary mission of the Acute Care Surgery service is to provide timely surgical assessment, operative and/or non-operative management of the acutely ill non-trauma surgical patient. Both locally and internationally, fewer surgeons are perusing general practice, opting instead for subspecialty training, with no or only minimal time spent in emergency surgical care. This is demonstrated for example by evidence that some colorectal surgeons refer diseases of the appendix to the general surgeon, reflecting the narrow point of care that is being practiced in certain fields of surgery. In many cases acute care surgery has been described as a multidisciplinary approach involving Emergency and Trauma Surgery, and Critical Care Medicine.(1-3) In South Africa the rules and regulation by the Health Professions Council stipulates the requirement of training and qualifying as a General Surgeon, before pursuing Fellowship training in a field of subspeciality. As treatment paradigms shift and surgical emergency disease management evolves, we need properly trained surgeons that are willing to pursue the optimal emergency care (surgical or non-operative) for specific conditions in patients presenting with these acute surgical emergencies.(2,4) Groote Schuur Hospital (GSH) is privileged in its provision of an Acute Care Surgical Unit (ACSU) that functions in a tertiary environment and is affiliated with the University of Cape Town (UCT), the leading ranked University on the African Continent. The ACSU in GSH has 28 dedicated beds, and functions as a secondary and tertiary level General Surgery Unit excluding all acute trauma care. Provision is also made for the management of primary level surgical diseases. A neighboring surgical referral hospital, GF Jooste Hospital (GFJH), has 90 dedicated surgery beds. It is a Community Hospital, which caters for primary and secondary level diseases. Acute care is also given to tertiary level trauma and emergency surgical diseases. The unit at GFJH will be closing to allow for a reconstruction of the building, and thus the patient population will require access to alternate facilities whilst awaiting the reopening. A subset of these patient will have to be accommodated at GSH.
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    Lecture series on thyroid disease
    (2013) Klopper, Juan
    A lecture series of 30 videos on diseases of the thyroid. The series spans both medical and surgical interests in thyroid pathology. This series of video lectures gives the senior medical student a thorough and integrated perspective on diseases of the thyroid, both from a medical and surgical perspective. It aims to arm you with all the knowledge you need when confronted by a patient with complaints suggestive of a thyroid origin.
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    Percutaneous cholecystostomy placement in cases non-responsive or otherwise non-operable acute cholecystitis: a retrospective descriptive and outcomes analysis
    (2020) Gandhi, Karan; Klopper, Juan; Kloppers Jacobus
    Purpose of the Study: The primary aim of this research is to demonstrate the safety and efficacy, or lack thereof, of percutaneous cholecystostomy placement as a management option in patients with acute cholecystitis (AC), not suitable for cholecystectomy and not responding to best medical management. The secondary aim of this research is to investigate the feasibility and complexities of interval cholecystectomy in this cohort of patients, with respect to the conversion rate to open, operating time and performing a subtotal cholecystectomy. Background: Acute cholecystitis is a complication of cholelithiasis (gallstones) and one of the most common admission diagnoses in Acute Care Surgery Units. The standard of care, according to the Tokyo Guidelines (1-4), for the management of acute cholecystitis, includes the immediate use of empiric antimicrobial drugs and index-admission laparoscopic cholecystectomy. A (>72 hour) delay between the onset of symptoms and presentation and initiation of medical care, as well as high operative risk patients are the two main reasons for diversion from this protocol of care. In the case of delay, the guidelines suggest the use of interval (six week) cholecystectomy as appropriate care. Index admission cholecystectomy in the setting of delayed presentation has been associated with increased morbidity. As inflammation of the gallbladder progresses, the tissues become more oedematous, with anatomic distortion and therefore increased difficulty in identifying important structural landmarks during LC. This difficulty increases the risk of operative complications, including bleeding and common bile duct injury, the most feared complication of LC. In addition to this distortion, adjacent surrounding organs may be involved in this inflammatory complex, thereby also being placed at risk of injury during dissection. In such circumstances, alternative methods of controlling disease progression may be necessary. 7 According to the Tokyo guidelines (1-4), AC can be classified into three grades of severity, namely mild (grade I), moderate (grade II) and severe (grade III). The grading system takes into account clinical and laboratory parameters, with organ dysfunction representing more advanced disease. Percutaneous cholecystostomy tube placement has been described as a method to achieve sepsis control in patients with severe AC, in which case LC may not be safe, owing to operative and high anaesthetic risk. The use of percutaneous cholecystostomy is well established in critically ill patients with acalculous cholecystitis and its safety and efficacy have been reported in many studies (5-11). Early LC has recently been shown to reduce the rate of major complications as compared to PC, even in high risk patients (15) The management of one subset of patients with acute cholecystitis remains unclear. This group comprises those with delayed presentation, in whom index-admission surgery is not advised, but who subsequently do not respond to best medical therapy. They have traditionally undergone urgent cholecystectomy but suffer higher rates of both morbidity and mortality (12- 14). In the current setting, patients often present with a delay since the onset of symptoms, rendering index-admission cholecystectomy unsafe. This problem is exacerbated by the lack of urgent operating theatre time, often with more urgent cases taking preference, thus delaying operative care beyond what is deemed safe by the Tokyo guidelines. The vast majority of patients are managed by interval cholecystectomy, leaving only the mentioned unresponsive subset. Recent reports have established the safety of the use of percutaneous cholecystostomy tube placement in patient groups that include this subset (severe sepsis, septic shock, local gallbladder rupture, progressive intolerant pain and persistent fever) (5-11).
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    Topics in general surgery: a video series by Dr Juan Klopper
    (2013) Klopper, Juan
    This resource is a collection of Surgery videos created by Dr Juan Klopper. It contains presentations on topics in General Surgery created by Dr Klopper, Registrars and Medical Officers. This is a study resource that aims to assist candidates sitting the South African College of Medicine exam for Surgery. It contains teaching videos and journal articles which cover important and relevant topics for the examinations.
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    Why OER ?
    (2013) Mitchell, Veronica; Klopper, Juan
    This video resource is a valuable contribution to promoting Open Educational Resources (OER) for educators to understand how teaching material can be produced and shared. Dr Juan Klopper's willingness to share his expertise and passion with the wider world is an example of good practice where knowledge is for the public good. This video can be an inspiration to other educators to open up their classrooms and to be a producer of OER. In addition it encourages students to realize the flexibility gained from a flipped classroom approach to learning. Dr Klopper's popular website with YouTube teaching tutorials in Surgery, Mathematics and Physics and video edits has been viewed by over 160,000 people worldwide (August 2013).