OpenUCT :: Browsing by Subject "surgery"

Browsing by Subject "surgery"

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Open Access
A descriptive study of the use of troponin I testing at a Cape Town district hospital
(2018) Gibson, Joshua Glynn; Malan, Jacques; Bruijns, Stevan
Introduction: Troponin I tests have been shown to be accurate and are relied upon to assist in making critical decisions regarding patient care in patients presenting with chest pain. The tests are expensive, however, and so their rational use becomes extremely important in a budget-constrained public health sector. The aim of this study was to describe how Troponin I tests are used throughout Victoria Hospital, by a range of requesting clinicians, working in different specialties. Methods A cross-sectional, prospective design was employed, using multiple data sources. We collected a consecutive sample over a three-month period from Victoria hospital’s Emergency Centre using a dedicated data collection tool connected to use of the point-of-care troponin I test. We supplemented this prospective sample with outcome data, using the hospital’s electronic admission record. Results Three hundred and sixteen patient entries were included in the final results. The majority of Troponin tests were negative (70%). Discharge directly from Emergency Centre was 10% in Troponin I positive patients, 37,5% in Equivocal Troponin patients, and 65% in Troponin negative patients. Furthermore, patients were twice as likely to be transferred to a tertiary facility if their Troponin was positive (24%), compared to equivocal (10.4%) or negative (12%). Discussion Chest pain was the most common presenting complaint, with Acute Coronary Syndrome being the most common working diagnosis. The clinical management of patients varied considerably when comparing their Troponin I result. Troponin I appears to be used as an effective rule-out tool in the decision-making pathway.
Open Access
A prospective, longitudinal, observational study to assess the health-related quality of life of patients with pancreatic ductal adenocarcinoma in the South African context
(2022) Kotze, Urda Karin; Jonas, Eduard; Krige, Jake
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive visceral malignancy originating from pancreatic duct cells. Despite advances in detection, diagnostic procedures and surgical and oncologic treatment, the overall prognosis remains dismal. GLOBOCAN 2020 ranks PDAC as the 7 th leading cause of all cancer deaths. There are no reliable statistics on the incidence of PDAC in South Africa. The National Cancer Registry South Africa of 2017 reports that PDAC accounts for 0.53% and 0.58% of all cancers in females and males respectively. However, this low incidence may be due to underreporting, as the diagnoses are based on positive histology which are performed on only a small proportion of PDAC patients reported by the National Health Laboratory Service (NHLS), only one of several laboratories in South Africa. The overall 5-year survival rate for all PDAC patients is reported to be less than 5%, and the overall median survival is 4-7 months from the time of diagnosis. Surgical resection offers the only chance of cure, but as few as 10% of patients are treated with curative intent with 5-year survival rates of 15-25%. A median survival of 2.8-5.7 months has been reported for patients with metastatic disease. Early symptoms of PDAC such as loss of appetite, weight loss and fatigue are vague and non-specific, which often leads to a delay in the diagnosis. Approximately 80% of patients who have PDAC involving the head of the pancreas present with painless jaundice. In those with advanced disease other digestive symptoms such as loss of weight, nausea and vomiting, bloating, altered bowel habits and backache are prominent. Because of the severity of symptoms, the small proportion of patients who are eligible for curative treatment, and the dismal overall survival, palliative treatment is an important component of the overall treatment of PDAC. In this respect information provided by health-related quality of life (HRQOL) assessments, which refer to the subjective experiences and perceptions of patients regarding their health, illness, and medical interventions, and how these affect their everyday life and functioning, are invaluable for planning and assessing the effect of palliative treatment. HRQOL assessment quantifies not only the actual symptoms but also the effect of the disease on a person in his or her totality. Many studies that report on HRQOL in PDAC are conducted in sponsored clinical trials and are guided by regulatory requirements. These studies typically include highly selected cohorts defined by strict inclusion and exclusion criteria, and results do not reflect HRQOL in the larger unselected patient population. Several nonclinical trial PDAC HRQOL studies have been done both in patients who underwent an operation and those who received palliative treatment. The prognostic value of HRQOL parameters have also been investigated. Very little data are available on the HRQOL of PDAC patients in low- and middle-income countries (LMICs), and to our knowledge no data have been published on the HRQOL of PDAC patients in South Africa. The aim of this research was to assess HRQOL in a South African PDAC patient cohort presenting at a major hepato-pancreato-biliary (HPB) academic referral centre, and to determine the possible clinical applications of HRQOL outcomes in the management of these patients, treated with either curative or palliative intent. The European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30 and EORTC-QLQ-PAN26 instruments were used in a longitudinal design study to allow for comparisons with baseline (BL) reports at regular intervals, thereby identifying statistically significant and clinically meaningful changes that may have occurred over time. As in previous publications, a high mortality and decreasing compliance over time in both the curative intended and palliative cohorts were noted. In contrast to patients who underwent an operation in whom the functional and symptom scales and scores fluctuated notably between time points, the same remained relatively stable in the patients who received palliative treatment. Some interesting observations regarding the possible prognostic value of HRQOL outcomes in the respective treatment groups need to be further investigated in larger patient cohorts. Some of the lessons learnt in this study from a LMIC, may be of value in planning subsequent tumour-related HRQOL studies in LMICs, regardless of tumour type.
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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.
Open Access
Development of a model to address the content, process and communication aspects of emergency centre handover
(2021) Makkink, Andrew William; Bruijns, Stevan Raynier; Stein Christopher Alexander
Introduction: The emergency centre forms the first formal interaction between the prehospital and inhospital phases of the patient care continuum. There are several variables that have the potential to affect handover efficacy. Poor handover has been associated with an increase in sentient events and a risk to patient safety. This thesis aimed to investigate the perceptions of the practice of patient handover between prehospital emergency care providers and the emergency centre. This information was used to generate a model that addresses identified aspects of the emergency centre handover, namely content, process, and communication. Methods: The methodology followed a sequential, explanatory, mixed-methods design. Data were collected from prehospital emergency care personnel (PECP) and emergency centre personnel (ECP) in the Johannesburg area of South Africa. Study One and Study Two formed the quantitative and qualitative data collection phases respectively. Study One formed the quantitative component of the study using a survey that utilised a crosssectional, convenience design. Questionnaires were compiled de novo using data sourced from a search of major databases and were pilot tested prior to distribution. Questionnaires contained a mix of Likert-type, forced binary and open-ended questions. Questionnaires were distributed using a purposive, convenience strategy where potential participants were approached at their place of work. Data were analysed descriptively and reported on. The responses to the open-ended questions were used to compile the interview schedule used in Study Two. Study Two formed the qualitative approach of the thesis and used a qualitative descriptive design. Questions for Study Two were compiled using the results of the coding, analysis and interpretation of the responses to the open-ended questions from the paper-based questionnaire. Data were collected from 15 PECP and 15 ECP using face-to-face, semi structured interviews. Participants were approached using a purposive strategy and, where consent was obtained, were interviewed in a location that was conveniently available and afforded an adequate amount of privacy. Interviews were transcribed and then analysed using Computer-Assisted Qualitative Data Analysis Software Atlas.ti. Data were read and reread, coded and analysed to identify categories and themes that were then reported. A code-recode strategy ensured trustworthiness. Results: Handover content variables were ranked according to the perceived level of importance by prehospital emergency care and ECP. Physiological variables dominated the ten most important variables for both PECP and ECP. Handover quality was perceived by both PECP and ECP as requiring improvement. Less than half of both PECP and ECP had been exposed to formal handover training. Mnemonic knowledge was generally poor, and the most familiar mnemonic used by PECP was unfamiliar to the ECP. The same was true for the mnemonic most familiar to the ECP. Process factors that had the potential to affect the efficacy of emergency centre handover included repetition of information and having to hand over multiple times. The busyness of the emergency centre and the noisy environment associated with it were linked to compromised patient privacy and a distractive environment in which to hand over. Understaffing and overworked staff were identified as barriers to an effective handover process and contributors to some of the identified issues related to poor emergency centre handover. There were several communication factors identified by both PECP and ECP that negatively affected handover efficacy. Verbal, non-verbal and paraverbal cues were identified as having he potential to act as facilitators of or barriers to effective emergency centre handover. Listening skills were identified as a barrier to effective handover by both PECP and ECP. Interprofessional communication and relationships were identified as important for effective emergency centre handover. Using the data, a novel model was developed using an iterative process. The model proposes solutions to some of the content, process and communication problems that were identified in this thesis. The model sees handover as comprising of five phases of information flow and unlike many previous models, recognises the bidirectional nature of communication within the handover process. Conclusion: Emergency centre handover between PECP and ECP needs improvement. The novel model proposed in this thesis divides handover into phases, each of which has identified factors that have the potential to act as facilitators of or barriers to effective handover. The model has potential to be implemented in emergency centre handover environments and may also have relevance in other patient handover environments.
Open Access
Factors influencing the development of transplantation in Africa
(2019) Gool, Ferhana; Muller, Elmi
Background Access to dialysis and transplantation in Africa is very limited. The challenges vary in different countries across the continent from legislative, to political, to financial. Aim To assess factors influencing the development of organ donation and transplantation in the African context. Methods A structured interview was held with African delegates attending the 25th Southern African Transplantation Society Congress and Global Alliance for Transplantation Workshop in Durban from the 28th July to 2nd of August 2013. Data from workshop working group presentations for each African country were additionally analysed. Results 30 delegates from 10 African countries (Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Rwanda, Tunisia, Sudan and Zambia) participated in the working groups. Twenty-eight questionnaires were completed. The burden of disease and challenges were large and varied. With marked disparity between countries where kidney transplantation is paid for entirely out-of-pocket—such as Ghana, Kenya, and Nigeria (kidney transplant rates in 2012 of 0.1, 1.4 and 0.1 per million population respectively)—and countries where costs are covered by the government or by insurance schemes—such as Sudan and Tunisia (kidney transplant rates of 5.3, and11.5 per million population, respectively). For most countries, the cost of immunosuppressive drugs and the ability to perform adequate matching of donors and recipients were the main infrastructure concerns. Five countries (Cameroon, Nigeria, Ghana, Ethiopia, Zambia) did not have legislation governing organ transplantation. Conclusion There is need for major political transform which will to ensure that African populations achieve access to transplantation. This would allow international collaboration and willing local clinicians a framework within which to develop sustainable transplant systems.
Open Access
Foley catheter balloon tamponade for penetrating neck injuries at Groote Schuur hospital: an update
(2020) Scriba, Matthias Frank; Navsaria, Pradeep
Introduction Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is an effective, readily available and easy-to-use technique. This study aims to audit the technique and highlight current investigative and management strategies. Methods All adult patients (18 years and older) with PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were included. Data was captured from an approved electronic registry and analysed. Analysed parameters included demographics, major injuries, imaging, management and outcomes. Results Over the study period a total of 628 patients with PNI were managed at GSH, in which 95 patients (15.2%) FCBT was utilised. The majority were men (98%) with an average age was 27.9 years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH (1.1% prehospital, 45.3% at clinic level and 34.7% at district hospital level). Computerised tomography (CT) angiography was used in 92.6% of patients, while 8 patients (8.4%) required formal angiography. Of these, 2 were purely diagnostic and 6 were performed for definitive endovascular management. A total of 34 arterial injuries (19 major and 15 minor) were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate at haemorrhage control. Thirteen (13.7%) patients requried open neck surgery. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48-72 hours post injury. Only two of these had bleeding on catheter removal. Fifteen patients required ICU admission. A total of 36 separate morbidities were documented in 28 patients (29.5%). There were 4 deaths (4.2% mortality rate), with only one of these attributable to uncontrolled haemorrhage from the neck wound. Conclusion This large series shows the current use of FCBT for PNI. It highlights ease of use, high rates of success at haemorrhage control (97%) and good outcomes with the technique. Venous injuries and minor arterial injuries can be managed with this technique definitively.
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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.
Open Access
Long term mortality after lower extremity amputation in South Africa
(2019) Husein, Salah; Chu, Kathryn
Introduction: Long-term mortality after lower extremity amputation is not well reported in low- and middleincome countries. The primary aim of this study was to report 30-day and one-year mortality after lower extremity amputation in South Africa. The secondary objective was to report risk factors for one-year mortality. Methods: This was a retrospective cohort study of patients undergoing lower extremity amputations at New Somerset Hospital from October 1, 2015, to October 31, 2016. A medical record review was undertaken to identify co-morbidities, operation details, and perioperative mortality rate. Outcome status was defined as alive, dead, or lost to follow-up. Outcomes at 30 days and one year were reported. Results: There were 152 patients; 90 (59%) males and the median age (interquartile range, IQR) was 60 (54-67) years. At 30 days, 102 patients were traced and 12 (12%) were dead. At one year, 86 (57%) were traced and 37 (43%) were dead. Conclusion: At this South African hospital, 43% of patients undergoing lower extremity amputations were dead after one year. In resource-constrained settings, mortality data are necessary when considering resource allocation for lower extremity amputations and essential surgical care packages.
Open Access
Surgical management of stress incontinence in women: The role of the family practitioner. Part 2: Surgical procedures and their sequelae
(South African Academy of Family Physicians, 2005) Rienhardt, G; De Jong, P
The surgical management of stress incontinence in women should encompass a combined approach by the family practitioner and the specialist. This review, in two parts, discusses the place of the family practitioner in this process. The continence mechanism, pre-operative counselling, appropriate surgical procedures, post-operative complications and aftercare are all discussed, to enable the family practitioner to provide adequate support to the patient.
Open Access
Surgical trainee supervision during non-trauma emergency laparotomy in Rwanda and South Africa
(2021) Pohl, Linda M; Chu, Kathryn
Objective: The primary objective was to describe the level of surgical trainee autonomy during non-trauma emergency laparotomy (NTEL) operations in Rwanda and South Africa. The secondary objective was to identify potential associations between trainee autonomy, and patient mortality and reoperation. Design, Setting, and Participants: This was a prospective, observational study of NTEL operations at three teaching hospitals in South Africa and Rwanda over a oneyear period from September 1, 2017 – August 31, 2018. A total of 543 operations on adults over the age of 18 years who underwent NTEL performed by the acute care and general surgery services were included. Results: surgical trainees led three quarters of NTEL operations, and of these, 72% were performed autonomously in Rwanda and South Africa. Trainees were less likely to perform the operations autonomously for patients who were: age ≥ 60 years, had ASA classification ≥ III, had cancer or TB. Notably, trainee autonomy was not significantly associated with reoperation or mortality. Conclusions: trainees were able to gain autonomous surgical experience without impacting mortality or reoperation outcomes, while still providing surgical support in a high-demand setting. More in-depth studies to understand the association of high trainee autonomy with surgical competency and patient safety is needed.
Open Access
The surgical management and prevention of laparoscopic cholecystectomy associated bile duct injuries
(2020) Lindemann, Jessica Danielle; Jonas, Eduard; Strasberg Steven
Laparoscopic cholecystectomy (LC) is considered the gold standard in the surgical management of gallstone disease and is one of the most commonly performed general surgery operations worldwide. Bile duct injury (BDI) in LC remains a feared complication as it is associated with significant morbidity, prolonged hospital stay, increased costs, and reduced quality of life for patients, as well as the risk of litigation for the injuring surgeon. The initial incidence of BDI after the introduction of LC was reported to be between 0.4 and 0.8%, which was higher than the estimated 0.2% reported during the open cholecystectomy era. However, recent reports from the United States and Europe suggest a return to open cholecystectomy rates. Despite being a frequently performed operation in both the private and public health sectors in South Africa, there is a paucity of data on the incidence of BDI. In the only study to date reporting the frequency of BDI in South Africa, a single centre incidence of 1.2% was documented over an 18-month period, which is significantly higher than previous reports. No data have been published on the implications of BDI for patients treated within the South African healthcare system. This thesis describes the surgical management of BDI at an academic referral centre over a thirty-year period. Potential factors influencing treatment and patient outcome after BDI are investigated. These include the influence of geographic distance from referral centre on the timing of referral and repair, and subsequent long-term patient outcomes. The influence of dual healthcare sectors (public vs. private) on access to diagnostic and interventional modalities, and eventual outcome is also investigated, and the evolution in the management of BDIs over the three studied decades is documented. Factors associated with loss of patency following surgical repair of LC-BDIs are also determined. Based on the findings of this detailed review of the management and outcomes of LC-BDIs, a treatment algorithm for management in resource-constrained environments is proposed. Establishing the optimal management of LC-BDIs in a developing country healthcare setting is important but does not address the source of the problem. In an effort to make LC-BDI a near-never event, a standardized method of performing, documenting and monitoring the quality of LC was developed and implemented for all LCs performed in the Cape Metro West health district. Prospective data collection is scheduled to continue to the end of 2020; however, an interim analysis is presented. A previously published scoring system for assessing quality of the critical view of safety achieved during LC, a critical component of a safe LC, is applied and validated in a large cohort of LC patients. A prospective database was created for data capture along with a Standard Operating Procedure, both designed with the goal of expanding the intervention and database nationally. The studies reported in this thesis make a substantial contribution to the literature and will have a beneficial impact on patient care in two important ways. Firstly, the management of BDI in South Africa is described and a treatment algorithm for resource-constrained environments is proposed, based on local experience. Secondly, a change of practice was implemented and a LC database was established with the possibility of expanding the effort to the national level. Locally, the change in practice has thus far resulted in identification of areas of improvement to limit BDI and increased knowledge about the appropriate steps to take to avoid causing a LC-BDI.
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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.
Open Access
Upper gastrointestinal bleed: a comparative outcomes study of pre and post implementation of management guidelines in the acute care surgery unit, Groote Schuur Hospital
(2019) Aborkis, Ismail; Rayamajhi, Shreya; Thomson, Sandie
Background: Upper gastrointestinal bleeding (UGIT) is a common presentation to hospital and can result in a significant morbidity, mortality and hospital costs. Consensus guidelines are present from various international expert bodies regarding the management of these patients and compliance with these guidelines is variable and is dependent on rigorous implementation and continuous audits. Aim: The primary aim of this study is to evaluate complaints to three aspects of management of UGITB (time of endoscopy ,use of dual endotherapy and haemoglubin trigger for transfusion) at Acute Care Surgery Unit, at Groote Schuur Hospital. Methods: This is a comparative study between a retrospective control group and a prospective cohort post implementation of a quality improvement program (QIP). Results: This study included 109 patients, 51 in the control and 58 in the QIP group. The two groups were statistically comparable in terms of demographics, clinical presentation, referral pattern and endoscopy finding. Over 80% in both groups had their endoscopy within 24 hours (Control 83.7%, QIP 81.6%). Time to endoscopy was not statistically significantly different between the Control and QIP groups for low and high-risk patients ((suspected varices or Modified Glasgow-Blatchford Score (MBS) >10)). However, when both groups are combined, patients with an MBS of >10 or more had a statistically shorter 'Time to scope’ by 8 hours than those with a score < 10 (p=0.02).
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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).

Browsing by Subject "surgery"

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