Browsing by Author "Levitt, N S"

Now showing 1 - 9 of 9
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    Barriers to initiating insulin therapy for patients with poorly controlled type 2 diabetes mellitus on maximum dose of oral agents in public sector primary health care centres in Cape Town, South Africa
    (2002) Haque, Monirul; Navsa, Mariam; Levitt, N S
    Most patients with type 2 diabetes in Cape Town are attending at primary care community health centers (CHCS) and have unsatisfactory glycaemic control. Insulin therapy is indicated in patients with type 2 diabetes, with inadequate metabolic control on maximum oral therapy. Insulin can be initiated in these CHCs.
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    Carotid artery intima-media thickness measurement in subjects with type 2 diabetes in Cape Town, South Africa
    (2007) Isiavwe, Afokoghene Rita; Levitt, N S
    The aim of this study is to test the hypothesis that, for similar durations of diagnosed diatetes (DM); black South Africans have less atherosclerosis as measured by Carotid Intima Media Thickness (CIMT) than non-black South Africans.
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    Development and application of diabetes care (Type 2) indicators at primary level in the Cape Town metropole region
    (2006) Mutsago, Bernard; Levitt, N S
    Since many of the diabetic complications can be prevented by good management, healthcare delivery ought to be of the highest quality possible. Therefore, continuous assessment and improvement of quality of care is important in order to give people with diabetes the care they deserve. This study aimed to develop a multi-faceted, indicator-based audit tool to evaluate the structural, process and outcome dimensions of quality of care for Type 2 diabetes at primary level in Cape Town metropole region.
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    Hyperglycaemic crisis in the Eastern Cape province of South Africa: High mortality and association of hyperosmolar ketoacidosis with a new diagnosis of diabetes
    (2010) Ekpebegh, C O; Longo-Mbenza, B; Akinrinmade, A; Blanco-Blanco, E; Badri, Motasim; Levitt, N S
    Objectives. To describe the frequencies, presenting characteristics (demographic, clinical and biochemical) and outcomes (duration of admission and mortality rates) for various types of hyperglycaemic crisis. Methods. Retrospective review of medical records of patients with hyperglycaemic crisis admitted to Nelson Mandela Academic Hospital, Mthatha, E Cape, from 1 January 2008 to 31 December 2009. Outcome measures were duration of admission and mortality. Results. Data were available for 269 admissions (response rate 81.0%), 169 females and 100 males. Admissions for hyperglycaemia (HG, N=119), and non-hyperosmolar diabetic ketoacidosis (NHDKA, N=97) were more frequent than those for hyperosmolar hyperglycaemic state (HHS, N=29) and hyperosmolar diabetic ketoacidosis (HDKA, N=24). Duration of admission was similar in all groups. Mortality was high in all groups, but was higher in patients with HDKA (37.5%, risk ratio (RR) 3.88, 95% confidence interval (CI) 1.41 - 10.67, p=0.009), HHS (31.0%, RR 2.91, 95% CI 1.09 - 7.75, p=0.033) and HG (19.5%, RR 1.56, 95% CI 0.75 - 3.21, p=0.236) than in those with NHDKA (13.4%). HDKA (62.5%) was associated with new-onset diabetes more often than NHDKA (27.8%), HHS (44.8%) or HG (17.6%) (p<0.0001). An altered level of consciousness was more frequent in HDKA than NHDKA admissions (RR 5.71, 95% CI 1.90 – 17.17, p=0.002).
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    Hyperglycaemic emergency admissions to a secondary level hospital in South Africa – an unnecessary financial burden
    (2007) Pepper, D J; Levitt, N S; Cleary, S; Burch, V C
    Background and objectives. Diabetes affects approximately 1 million South Africans. Hospital admissions, the largest single item of diabetes expenditure, are often precipitated by hyperglycaemic emergencies. A recent survey of a 200- bed hospital, serving approximately 1.3 million Cape Town residents, showed that hyperglycaemic emergencies comprised 25.6% of high-care unit admissions. A study was undertaken to determine the reasons for, and financial cost of, these admissions. Methods. All hyperglycaemic admissions during a 2-month period (1 September - 31 October 2005) were surveyed prospectively. Admissions were classified using the American Diabetes Association classification of hyperglycaemic emergencies. Demographic data, and the reason for, duration of and primary outcome of admission, were recorded. The following costs per admission were calculated using public sector pricing: (i) total costs; (ii) patient-specific costs; (iii) no patient- specific costs; and (iv) capital costs. Results. Sepsis (36%), non-compliance with therapy (32%) and a new diagnosis of diabetes (11%) were the predominant reasons for admission of 53 hyperglycaemic emergency cases. Mean duration of hospital stay was 4 days, with an in-hospital mortality of 7.5%. Mean cost per admission was R5 309. Clinical staff (25.8%), capital (25.6%) and overhead (34%) costs comprised 85.4% of expenditure. Discussion and recommendations. Hyperglycaemic admissions, costing more than R5 300 per patient, represent a health burden that has remained unchanged over the past 20 years. Urgently required primary care preventive strategies include early diagnosis of diabetes, timely identification and treatment of precipitating causes, specifically sepsis, and education to improve compliance.
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    Improving the annual review of diabetic patients in primary care: an appreciative inquiry in the Cape Town District Health Services
    (2008) Mash, R; Levitt, N S; Van Vuuren, U; Martell, R
    Background: Diabetes in a common chronic disease in the Cape Town District Health Services and yet an audit of diabetic care demonstrated serious deficiencies in the quality of care. The Metro District Health Services (MDHS) decided to focus on improving the annual review of the diabetic patient. The MDHS provides primary care to the uninsured population of Cape Town through a network of 45 Community Health Centres (CHC). Methods: An appreciative inquiry was established amongst the staff responsible for diabetic care at the 15 CHCs that had newly appointed facility managers. The inquiry completed three cycles of action-reflection over a period of one year and included training in clinical skills as requested by the participants. At the end of the inquiry a consensus was reached on the learning of the group. Results: This consensus was expressed in the form of 11 key themes. CHCs that reported success with improving the annual review formed chronic care teams that met regularly to discuss their goals, roles and to plan improvements. These teams developed more structured and systematic approaches to care, which included the creation of special clubs, attention to the steps in patient flow and methods of summarising and accessing key information. These teams also appointed specific champions who would not rotate to other duties and who would provide continuity of leadership and organisation. These teams also supported continuity of relationships, clinical management and organisation of care. Teams involved the community and local non-profit organisations, particularly in the establishment of support groups that could disseminate medications and build health literacy and self-efficacy. Some teams emphasised the need to also care for the carers and to not just focus on workload and output indicators. More successful CHCs also grappled with balancing of the workload, quality of care and waiting times in a way that improved all three in an upward spiral. Patient satisfaction, staff satisfaction and clinical outcomes were seen as interlinked' There was a need to plan methods for empowering patients and build self-efficacy through a variety of facility- and community-based as well as individual- and group-orientated initiatives. Training in clinical skills was requested for foot and eye screening. Feedback was given to the MDHS on the need to improve referral pathways and access to preventative services such as dieticians, podiatrists and vascular surgery. Finally, the inquiry process itself together with the annual audit supported organisational learning and change at the facility level. Conclusion: Improving the annual review has more to do with the organisation of care than gaps in knowledge or skills that can be addressed through training. While such gaps do exist, as shown by the training around foot screening, the main focus was on issues of leadership, teamwork, systematic organisation, continuity, staff satisfaction, motivation and the balancing of quality care provided, quantity of care demanded and queuing required. The appreciative inquiry (Al) process supported decentralised organisational learning and, while key themes were shared, the specific solutions were localised.
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    Non-invasive management of organic impotence
    (1995) Kaplan, F J; Levitt, N S; Stevens, P J; Phillips, C
    OBJECTIVE: To establish the efficacy of a vacuum device (ErecAid) in the management of organic impotence. DESIGN: Cohort study; questionnaire before and after a 6-month study period. SETTING: Groote Schuur Hospital, Cape Town. PARTICIPANTS: A total of 19 men with organic impotence, 8 diabetic and 11 with previous pelvic surgery or radiotherapy. INTERVENTION: Vacuum device (ErecAid, Osbon Medical Systems). OUTCOME MEASURE: Efficacy of ErecAid. RESULTS: Six of 8 diabetics and 6 of 11 non-diabetics reported successful intercourse, while 16 of the participants would recommend the device to others. Some difficulty with the device was experienced by 11 and only 9 described an increase in self-esteem. CONCLUSION: Although some difficulties may be experienced in the use of the ErecAid, it clearly has a role to play in the management of patients with organic impotence, who ideally should be able to select their preferred form of therapy.
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    Retrospective analysis of pregnancies at the Grootte Schuur Hospital : a comparison of pregnancy outcomes in pre-gestational and gestational diabetes
    (2006) Ekpebegh, Chukwuma Ogbonna; Levitt, N S
    Although the treatment of gestational impaired glucose tolerance (GIGT) has been shown to be beneficial, the cost implications in treating GIGT in resource constrained economies needs examination. Thus this study assessed: (i) pregnancy outcomes in pre-gesational types 1 and 2 diabetes (DM) with particular emphasis on the modality of therapy for pregnant women with type 2 DM, (ii) pregnancy outcomes in subjects with gestational diabetes (GDM) and the effect of stratification by fasting plasma glucose (FPG) and 2 hour oral glucose tolerance test (OGTT) plasma glucose values, and (iii) the effect of OGLAs on pregnancy outcomes in GDM.
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    Thyroid dysfunction in the elderly
    (1997) Muller, GMM; Levitt, N S; Louw, SJ
    The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary.