Browsing by Subject "Effectiveness"

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    Open Access
    Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital
    (2019) Isah, Ahmed Rufai; Kotze, Tessa
    Aim: The aims of this audit were: To determine the proportion of hyperthyroid patients receiving I-131 therapy in whom treatment with a single fixed dose was successful, as defined by the achievement of euthyroidism or hypothyroidism 6-months after the therapy; To identify patients in whom treatment was not successful and a second dose needed; And, if possible, to establish the factors associated with treatment failure. Methods: A single observer reviewed the records of all patients who received I-131 therapy for hyperthyroidism between 23rd April 2010 and 23rd November 2017 in conjunction with their pre and post treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc-99m sodium pertechnetate thyroid scans were also retrieved and reprocessed. Results: The records of 409 patients treated between April 2010 and November 2017 were retrieved. 223 (63%) patients were referred by the endocrine clinic at Groote Schuur hospital (GSH. Of the 409 patients, 56 (14%) patients that were excluded because their post therapy records were not available for analysis. Majority of our patients were females 310 (88%). Patients between the ages of 15 and 45 years are more likely to present with Grave’s disease while those aged more than 45 years presented with toxic multinodular gland (p=0.000). Patients that presented between the ages of 15 and 45 years are more likely to have moderately increased pretreatment FT4 (12-51 mmol/L) (p=0.002). We administered a radioiodine therapy dose of 456.6±54.8 MBq (Mean ± SD) to these 409 patients. Among the 353 patients, with complete records, 314(89%) achieved cure at some stage after receiving one dose of RAI; 239(76%) achieving cure ≤ 6 months of therapy and 75(24%) patients after 6 months. In our audit the patients who failed to achieve cure following the first RAI therapy appeared to be younger (median(interquartile range) age 39(16), p= 0.03), have severe hyperthyroidism as demonstrated by higher pre-treatment FT4 (median(interquartile range) 27 pmol/L(30.6), p= 0.05) and high pertechnetate uptake (median(interquartile range) uptake 9.9%(14), p= 0.002) on thyroid scintigraphy. CONCLUSION Our audit showed RAI therapy was found to be successful in 68% of patients at 6 month and 89% at a year. A second therapy with radioactive iodine would be indicated in 32% of patients, as these patients have not achieved cure at 6 months. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Due to major deficiencies in referral, record keeping and follow up, other factors responsible for treatment were not be able to be evaluated. Based on these findings, suggested areas for further research are: should patients with severe hyperthyroidism be considered for pretreatment with antithyroid medication prior to RAI; would a one year follow up after radioiodine therapy be considered before second RAI. Now that the deficiencies in our current practice have been identified and suggestions put forward to address these deficiencies, a follow up audit would be needed.
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    Open Access
    Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study
    (2020-01-20) Kokota, Demoubly; Lund, Crick; Ahrens, Jennifer; Breuer, Erica; Gilfillan, Sheila
    Abstract Background There has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers’ knowledge, confidence, attitudes and detection rate of major mental disorders in Mulanje, Malawi. Method The study used a quasi-experimental method (single cohort pre- and post-measures) with an interrupted time-series design. A 2 day mhGAP training was delivered to 43 primary healthcare workers (PHWs) working in 18 primary care clinics serving the entire population of Mulanje, Malawi (population 684,107). Modules covered were psychosis, moderate-severe depression, and alcohol & substance use disorders. The PHWs completed pre and post-tests to assess knowledge, confidence and attitudes. Number of diagnosed cases was obtained from clinic registers for 5 months prior to and 7 months following training. Data was analyzed using mean scores, t-test, one-way analysis of variance and linear regression. Results The mean knowledge score increased significantly from 11.8 (SD: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t (42) = 7.79, p < 0.01. Similarly, mean knowledge score was significantly higher 6 months post training at 13.9 (SD: 2.52) compared to before; t (42) = 4.57, p < 0.01. The mean confidence score also increased significantly from 39.9 (SD: 7.68) before training to 49.6 (SD: 06.14) immediately after training; t (84) = 8.43, p < 0.01. It was also significantly higher 6 months post training 46.8, (SD: 6.03) compared to before; t (84) = 6.60, p < 0.01. One-way analysis of variance showed no significant difference in mean scores on all four components of the scale used to measure attitudes. A significant positive change in the trend in mental health service utilization after the intervention was demonstrated using a segmented linear regression (β = 2.43 (95% CI 1.02; 3.83) as compared to before (β = − 0.22 (95% CI − 2.67; 2.23) and immediately after (β = 1.63 (95% CI − 7.31; 10.57). Conclusion The findings of this study add to the growing evidence for policy makers of the effectiveness of mhGAP training and supervision in a resource-constrained country.
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    Open Access
    The LIFE TRIAD of emergency general surgery
    (2022-07-25) Coccolini, Federico; Sartelli, Massimo; Kluger, Yoram; Osipov, Aleksei; Cui, Yunfeng; Beka, Solomon G; Kirkpatrick, Andrew; Sall, Ibrahima; Moore, Ernest E; Biffl, Walter L; Litvin, Andrey; Pisano, Michele; Magnone, Stefano; Picetti, Edoardo; de Angelis, Nicola; Stahel, Philip; Ansaloni, Luca; Tan, Edward; Abu-Zidan, Fikri; Ceresoli, Marco; Hecker, Andreas; Chiara, Osvaldo; Sganga, Gabriele; Khokha, Vladimir; di Saverio, Salomone; Sakakushev, Boris; Campanelli, Giampiero; Fraga, Gustavo; Wani, Imtiaz; Broek, Richard t.; Cicuttin, Enrico; Cremonini, Camilla; Tartaglia, Dario; Soreide, Kjetil; Galante, Joseph; de Moya, Marc; Koike, Kaoru; De Simone, Belinda; Balogh, Zsolt; Amico, Francesco; Shelat, Vishal; Pikoulis, Emmanouil; Di Carlo, Isidoro; Bonavina, Luigi; Leppaniemi, Ari; Marzi, Ingo; Ivatury, Rao; Khan, Jim; Maier, Ronald V.; Hardcastle, Timothy C.; Isik, Arda; Podda, Mauro; Tolonen, Matti; Rasa, Kemal; Navsaria, Pradeep H.; Demetrashvili, Zaza; Tarasconi, Antonio; Carcoforo, Paolo; Sibilla, Maria G.; Baiocchi, Gian L.; Pararas, Nikolaos; Weber, Dieter; Chiarugi, Massimo; Catena, Fausto
    Emergency General Surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital by general emergency surgeons and other specialists. It is the most diffused surgical discipline in the world. To live and grow strong EGS necessitates three fundamental parts: emergency and elective continuous surgical practice, evidence generation through clinical registries and data accrual, and indications and guidelines production: the LIFE TRIAD.