Browsing by Author "Von Pressentin, Klaus"

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    Open Access
    District Level Hospital Diabetic Patients Referred to Intermediate Care: A Descriptive Analysis
    (2023) Jansen, Rosa; Von Pressentin, Klaus
    Background Diabetes mellitus contributes considerably to morbidity and mortality. By analysing a South African cohort with diabetes-related adverse outcomes, the researchers felt that reviewing their past primary care may reveal contributing factors resulting in these outcomes. Methods A retrospective cohort design was used. Data from an existing district-level hospital database of referrals to intermediate care were analysed, focusing on diabetic adult patients referred between 1 November 2020 and 31 August 2021. Additional data were collected on the standard of primary care, investigations performed on admission and patient demise within 12 months of the research window. Results The cohort comprised 188 patients. The mean age was 64.4 years, 113 (60.1%) were female, and 98.1% had low socioeconomic status. The majority were admitted with strokes 130 (69.2%) and 139 (73.9%) were referred for intense short-term rehabilitation. A quarter of patients were newly diagnosed diabetics at admission. Of known diabetics, 44 (30.8%) had no HbA1c in the preceding two years. ACE-inhibitors were not prescribed adequately, and insulin initiation was delayed. Accessible data 12 months post review window revealed that 53 (28.2%) had demised and of those, 29 (54.7%) had demised within a month of initial admission. Conclusion Diabetic screening and management in primary care need improvement. It appears that guidelines were not followed adequately and potentially may have contributed to the outcomes experienced by this cohort, as well as subsequent costs to the health system. Contribution The authors recommend that barriers to following primary care diabetes guidelines be explored further in future research.
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    Open Access
    Exploring the importance, meaning and experience of hope for adult patients with advanced cancer and their family caregivers in KwaZulu-Natal
    (2023) Cox, Colleen; Von Pressentin, Klaus
    Background: The importance of hope for patients with cancer and other life-threatening illness has been widely reported in international literature. Hope enhances patients' quality of life and facilitates coping. Towards end-of-life, hope is typically directed at “being” rather than at “doing”, and at preparing for a peaceful death. Patients and their families reportedly look to healthcare professionals to give them hope. In South African palliative care settings, patients describe their need for psychosocial and spiritual care and for their hope to be upheld. There is however not a clear understanding of what hope means in the South African healthcare setting, particularly around issues such as “hope for a cure” and “false hope”. Also, while several hope-fostering interventions have been validated internationally, the benefits of such interventions in South Africa are unknown. Aim: The study aimed to describe the importance, meaning and experience of hope for adult patients with advanced cancer and their family caregivers in KwaZulu-Natal (KZN). Method: Two study sites in KZN were chosen, a state hospital oncology unit and a hospice. The study followed a qualitative descriptive cross-sectional design, involving in-depth analysis of semistructured interviews with patients with advanced cancer and their family caregivers. Each patient and their family caregiver were managed as a dyad. Questions around the importance, meaning and experience of hope were explored. Data collection continued via purposive sampling until data adequacy was achieved. Data were coded and analysed thematically. Data were also analysed in the context of the clinical, socio-economic and cultural contexts of the patients and their caregivers. Results: The study sample included 11 patients and 11 family caregivers. Purposive sampling achieved variance in most clinical and socio-economic factors. Identified limitations of the study however included the lack of young adults in the study sample, and that each study participant had a religious affiliation, either Christian, African Ancestral, Hindu or Muslim. Despite wider screening, there were no atheist or agnostic participants. There was unanimous affirmation from all patients and caregivers that hope was important to them, particularly in the face of a cancer diagnosis or caregiving role. Thematic analysis of the meaning of hope revealed a strong correlation with spirituality, human connection and support, and physical and psychological comfort. Hope was also associated with psychological fortitude, having a goal and purpose, and living well while being ready to die. The study demonstrated the tension of oscillating between hoping for a cure and accepting a poor prognosis. As with meaning, the hope experience was strongly influenced by spirituality, human connection and support, and physical and psychological comfort. The role of overcoming previous adversity as a source of hope for most participants was an unexpected finding. Almost all participants expressed a preference for truthful communication regarding their diagnosis or prognosis and described how hope assisted them to cope with bad news and to reach acceptance. Participants described how doctors and nurses can give hope to patients and families. Conclusion: The study confirmed the importance of hope in assisting patients with cancer and their family caregivers to cope and to live well in the face of life-threatening illness. Interventions including H - human connection and support, O - (reflections on) overcoming previous adversity, P - physical and psychological comfort, and E - existential or spiritual support, are expected to enhance hope for patients with cancer and their family caregivers in the South African setting. Further research to validate hope-fostering interventions in South Africa is recommended
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    Exploring the perceived impact of a leadership training module on clinical family medicine practice: a qualitative study
    (2025) Dladla, Samantha; Ras, Tasleem; Von Pressentin, Klaus
    Background: Family physicians are the senior clinicians responsible for clinical governance in the District Health System. Their training programmes must prepare them for the leadership roles they are expected to fulfil. At the University of Cape Town, family medicine registrars enrolled in a four-year Masters of Medicine (MMed) degree complete a four-month Leadership and Governance module during their third year of study. This module consists of seminars, a leadership profile, and critical reflection sessions. While the immediate feedback is useful, the relevance of this module to the actual work of these family physicians is not known. This study aimed to understand how the postgraduate L&G module at UCT helped prepare qualified family physicians working in the Western Cape Province public sector for their leadership role. Methods: Ten graduates were purposively sampled for online semi-structured interviews, which were recorded, transcribed, and analysed using the framework method. Data were analysed deductively and assigned to the relevant theme. Where coded data did not fit into these themes, a new theme was generated if the data was sufficiently cohesive. Results: The following themes were identified : key leadership qualities and fit for purpose training. Two additional themes were generated: early experiences of the FP as clinical leaders and Resources used by FPs. Conclusion: This qualitative study explored recently qualified family physician consultants perceptions on their leadership training. Four key themes emerged that describe their leadership journeys, highlighting aspects of the current training that could be strengthened. Future research should explore workplace-based leadership training models, the impact of leadership role-modelling, and provide ongoing evaluation of fit for purpose training programmes.
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    Post-vasectomy semen analysis: Follow-up of patients at three Cape Town Metropole facilities.
    (2023) Le Roux, Michael; Von Pressentin, Klaus
    Background: Vasectomies are generally considered an underutilised method of contraception worldwide. Our study was aimed at determining patient adherence to the post-vasectomy follow-up plans and whether the procedures were done successfully by the different categories of surgeons at three facilities in the Cape Town Metropole. Methods: We conducted a retrospective chart review of patient folders at three study sites. The sites included were Wesfleur Hospital, Heideveld CDC and Mitchell's Plain CHC. The sociodemographic data and procedure information were extracted from theatre records and patient folders. We retrieved the results of the post-vasectomy semen analysis (PVSA) from the Reproductive Medicine Unit at Groote Schuur Hospital. Results: Our study population included 270 patients who had vasectomies from September 2016 to July 2021. Only 122 (45.2%) PVSA results from those patients that adhered to the follow-up protocol were retrievable, of which 115 (94.2%) showed that the procedure was successfully done. This is below the global estimated success rate of 99%. Conclusion: Missing data from the patient records influenced the results significantly. It was thus not possible to achieve our study objectives fully. A data collection instrument was developed and standardised stationery, already in use at some of the sites, was implemented to provide more complete datasets for future audits. Contribution: The study identified flaws in record-keeping practices at the three study sites. The implementation of the stationery and the data collection instrument may assist future research and quality improvement projects, by tracking procedural success and patient adherence to post-vasectomy semen analyses.