Browsing by Subject "outcomes"

Now showing 1 - 7 of 7
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    Audit of outcomes of endoscopic cholesteatoma ear surgery
    (2019) Diale, Ndivhuwo; Harris, Tashneem
    Background: Endoscopic ear surgery has gained acceptance as a complementary tool to microscopic ear surgery, but perhaps not so much as an instrument for exclusive use.With this approach becoming popular, there is scarce data on cholesteatoma recidivism and hearing outcomes, when exclusively used. Objectives: Auditing outcomes of endoscopic ear surgery for the surgical management of cholesteatoma in the Groote Schuur hospital (above13 year age group) and the Red Cross War Memorial Children’s hospital (below 13 year age group) , with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques for cholesteatoma resection, namely, exclusive endoscopic (EES), microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques. Methods: A retrospective chart review was conducted at our two tertiary academic referral hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital and Groote Schuur Hospital from January 2012 to December 2016. Results: A total of 128 cholesteatoma ear surgeries were done; 110 patients were above the age of 13 years and 18 patients were below the age of 13 years. Eight Red Cross patients underwent EES, 7 had CWU, 2 had CWD and 1 had a combined technique. Overall recidivism rate in this population was 33% (6/18), of which 2 were approached exclusively endoscopically, 2 underwent a microscopic CWU, 1 had a CWD and 1 had combined endoscopic-microscopic approach. The mean postoperative hearing in this group was 40dB compared to a preoperative mean of 50,3 decibels (dB). In the Groote Schuur group, 23 underwent an exclusive endoscopic approach; 42 had a CWU, 40 had a CWD and 5 had a combined endoscopic-microscopic approach. Overall recidivism rate for the above 13 year old group was 17% (19/110). Of those, 7 were from the endoscopic group, 8 from the CWU group, 1 from CWD group and 3 from the combined technique group. Mean postoperative hearing was 47,4dB compared to a preoperative hearing of 48,4dB. Conclusions: The CWD technique demonstrated superior outcomes in both the above and below 13 year age groups. In the above 13 year old group, the EES approach had the same recurrence rate as CWU. While paediatric cholesteatomas have much higher recidivism rates compared to adults, our below 13 year old group was too small to conclude any statistical significant differences between the different approaches, and therefore, further studies are required in this age group. Management of cholesteatoma requires a highly individualized approach that takes into account anatomic, clinical and social factors to determine the most appropriate surgical treatment paradigm
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    Clinical Outcomes Associated with Speech, Language and Swallowing Difficulties Post-Stroke – A Prospective Cohort Study
    (2022) Kaylor, Stephanie Anne; Singh, Shajila
    Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.
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    Environmental health recommendations for Multidrug-Resistant Tuberculosis in low- and middle-income countries: a systematic review
    (2022) Nel, Amy; Rother, Hanna-Andrea; Miller, Mary E
    Despite efforts towards the management and prevention of Tuberculosis (TB) having shown some success, Multidrug-Resistant Tuberculosis (MDR-TB) may potentially compromise these endeavours. MDR-TB has the potential to become the most dominant form of TB in low- and middle-income countries (LMICs). The impact of environmental health factors on the optimization of health of MDR-TB infected individuals, as well as on the prevention of transmission to household contacts, is not well documented. Current Sustainable Development Goals (SDGs) aim to achieve inclusivity, sustainability and resilience, not only through economic and social changes, but also through environmental targets in order to achieve optimal health and well-being for all. However, without appropriate acknowledgment of the environment's influence on outcomes during TB treatment, these targets are potentially unattainable. Establishing the recommendations of environmental health risk factors for individuals living at home with MDR-TB will have important policy implications as well as assist in decision making for those affected with MDR-TB in LMICs, such as South Africa. This systematic review, therefore, sought to identify the environmental health factors in LMICs that affect treatment outcomes for individuals living at home with MDR-TB, to optimize their health during completion of their treatment regimen and prevent transmission to household contacts. Part A outlines the current literature available for such a topic as well as methodology used within the systematic search and analysis of included articles. Prominent environmental health exposure variables of interest that have previously been identified as having a significant role in TB transmission or influencing the well-being of infected individuals, were identified within the literature. These included air pollution, nutrition, migration, urbanization, smoking, alcohol, other substance use and housing. Outcomes of interest included optimization of health and prevention of MDR-TB transmission to household contacts. The article (part B) represents the results from the systematic search as well as the application to current policy recommendations. After screening and reviewing the full text of potential articles for inclusion (N = 87), only thirteen articles were eligible for inclusion into the final sample. All included studies were primary observational studies, examining the relationship between MDRTB and the pre-defined exposures and outcomes in populations ≥13 years of age. Environmental risk factors for household transmission of MDR-TB potentially included malnutrition but showed no significant relationship with overcrowding. There was disagreement as to whether smoking was as a significant predictor of mortality but findings did indicate that smoking did have a negative impact on sputum culture conversion among patients receiving treatment. Other substance use was found to have a significant role in the default of treatment. The use of alcohol was associated with poor treatment outcomes, default of treatment and lack of sputum culture conversion. In terms of household conditions, an association was found between substandard housing conditions and treatment default. Formal housing was associated with a decline in treatment default but a residential address change was associated with defaulting treatment. The results of the review presented contradictory results regarding the risk of mortality and underweight/overweight BMI estimates. The review potentially highlighted vulnerable population groups including gender groups, children and HIV positive individuals. Therefore, this systematic review highlighted the potential relationship between environmental risk factors and optimising the health of individuals on treatment for MDR-TB, as well as the role that promoting environmental health may play in preventing the transmission to household contacts. In conclusion, environmental risk factors should be incorporated into local health system strategies and global policy. This includes WHO targets in TB prevention efforts, as well as in action areas for the attainment of relevant SDGs (e.g. SDG 3 and SDG 5), to address the burden of MDR-TB and decrease MDR-TB transmission in LMICs, effectively and sustainably.
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    Forefoot deformity surgical reconstruction outcomes in people living with rheumatoid arthritis in South Africa
    (2021) Mukabeta, Takura Darlington Maumbe; McCollum, Graham
    Introduction: Involvement of the forefoot is common among patients with Rheumatoid Arthritis. It results in severe deformities with significant disabilities. Aim: The aim of this study was to compare and assess in patients with Rheumatoid Arthritis in a South African population the outcomes of severe forefoot deformity reconstruction surgery in the short- to medium-term and in particular focusing on radiological, clinical, and functional outcomes. Patients and Methods: A retrospective review of 19 patients who received reconstructive forefoot surgery for forefoot deformities resulting from Rheumatoid Arthritis was undertaken. They all underwent Modified Hoffman Surgical Reconstruction (first MTPJ fusion and lesser toe resection arthroplasty). The patient records between 2013 and 2016 were reviewed. Pre-operative and post-operative outcome scores were collected. Final postoperative radiographs were analyzed. Patients completed Short Form 36 and AOFAS forefoot scores. Post-operative scores were collected 6 months post-op. Results: There were 19 patients in the study with a minimum 6 months follow up. Of the 19 patients 17 (89.5%) were females and 2 (10.5%) males. The mean age was 54.9 ± 9.6 years (range: 34 – 69 years). Most patient outcomes (SF36, AOS alignment, VAS Pain percentage, and VAS Disability percentage) significantly improved with a p value < 0.05, when comparing the pre-operative versus post-operative variable scores. However, only AOS Alignments showed no significant difference between pre-operative and post-operative scores (p>0.05). Conclusion: Reconstructive forefoot surgery with the Modified Hoffman Surgical Reconstruction provides marked radiological correction, with significant improvements in the quality of life of the cohort of patients.
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    Strengthening leadership through networking: a mixed method evaluation of a core component of the Emerging African Leaders Programme (EALP)
    (2021) Muneesamy, Loganaden; Goodman, Suki
    In line with its mission to promote public leadership in Africa, the UCT Nelson Mandela School of Public Governance (NMSPG) implements the Emerging African Leaders Programme (EALP). With the use of an intensive two-week residential workshop in Cape Town, integral coaching and an EALP alumni network, the programme endeavours to enhance the leadership capacity of emerging African leaders. The purpose of the EALP alumni network is to keep EALP alumni connected, enable them to have an ongoing dialogue and facilitate collaborations with the ultimate objective of making a contribution to addressing Africa's wicked challenges. A mixed method formative outcome evaluation of the networking component of the EALP was conducted. Data was collected by means of a document review, an online survey, semi-structured interviews and focus group discussions involving the main stakeholders. The findings showed that the EALP alumni network had created, albeit in a suboptimal resource-constrained context, positive outcomes at individual, network, organisational and policy-making levels. The network helped to increase the self-confidence, connectivity, networking ability, networking, problem-solving and decision making capacity, learning, social capital and career prospects of EALP alumni. Furthermore, most of the EALP alumni expressed above average trust and commitment in the EALP alumni network, and, opined that efforts were made to ensure effective inclusion of all network members. On the other hand, on average, EALP alumni, were generally connected and interacted with others within their respective cohort, with mutual support and exchange of information and other resources only occasionally taking place among them. Of the sample, fifty percent of the EALP alumni experienced network cohesion. On average, EALP alumni, reported that it was easy to collaborate on the network but they had developed few productive collaborations with others. Slightly more than half of EALP alumni were satisfied with the management of the EALP alumni network and one fifth of them had fully internalised the network goal. Some positive outcomes were also noted at organisational and policy-making levels. With a view to strengthening the EALP alumni network, ensuring its sustainability and improving its effectiveness, the following recommendations have been made: formulation of a strategy and plans for the network, introduction of a monitoring, evaluation and learning system, formalisation of the network, appointment of a dedicated network manager to engage and support EALP alumni, and ongoing capacity-building.
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    Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa
    (BioMed Central Ltd, 2012) Nglazi, Mweete; Kranzer, Katharina; Holele, Pearl; Kaplan, Richard; Mark, Daniella; Jaspan, Heather; Lawn, Stephen; Wood, Robin; Bekker, Linda-Gail
    BACKGROUND: Very few data are available on treatment outcomes of adolescents living with HIV infection (whether perinatally acquired or sexually acquired) in sub-Saharan Africa. The present study therefore compared the treatment outcomes in adolescents with those of young adults at a public sector community-based ART programme in Cape Town, South Africa. METHODS: Treatment outcomes of adolescents (9-19 years) were compared with those of young adults (20-28 years), enrolled in a prospective cohort between September 2002 and June 2009. Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders. The treatment outcomes were mortality, loss to follow-up (LTFU), immunological response, virological suppression and virological failure. RESULTS: 883 patients, including 65 adolescents (47 perinatally infected and 17 sexually infected) and 818 young adults, received ART. There was no difference in median baseline CD4 cell count between adolescents and young adults (133.5 vs 116 cells/muL; p = 0.31). Overall mortality rates in adolescents and young adults were 1.2 (0.3-4.8) and 3.1 (2.4-3.9) deaths per 100 person-years, respectively. Adolescents had lower rates of virological suppression (< 400 copies/mL) at 48 weeks (27.3% vs 63.1%; p < 0.001). Despite this, however, the median change in CD4 count from baseline at 48 weeks of ART was significantly greater for adolescents than young adults (373 vs 187 cells/muL; p = 0.0001). Treatment failure rates were 8.2 (4.6-14.4) and 5.0 (4.1-6.1) per 100 person-years in the two groups. In multivariate analyses, there was no significant difference in LTFU and mortality between age groups but increased risk in virological failure [AHR 2.06 (95% CI 1.11-3.81; p = 0.002)] in adolescents. CONCLUSIONS: Despite lower virological suppression rates and higher rates of virological failure, immunological responses were nevertheless greater in adolescents than young adults whereas rates of mortality and LTFU were similar. Further studies to determine the reasons for poorer virological outcomes are needed.
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    Twelve-year mortality in adults initiating antiretroviral therapy in South Africa
    (2017) Egger, Matthias; Davies, Mary-Ann; Boulle, Andrew
    Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa.