Includes abstract. / Includes bibliographical references. / The purpose of this study was to describe the outcomes of patients with severe traumatic brain injury managed by emergency care providers in the Cape Town Metropole.

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. The prediction of outcome in severe burns is important to aid in clinical decision making, improve scarce resource allocation and allow comparisons between different burn units. Age, burn size and the presence of inhalational injury have been determined to be the most important factors in predicting mortality. There is little published data on the outcome of severe burns in the Southern African region. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerberg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20 to 40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. A stepwise logistic regression analysis was done on the derivation cohort where age, gender, TBSA% and presence of inhalational injury were identified as significant for predicting death. A mortality prediction model is presented which was internally validated on the validation cohort. An easy to use EXCEL calculator was created to estimate the probability of death. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burn injuries within the Southern African region. Further interventions are needed to tackle this serious public health issue. A mortality prediction model is proposed for use in the burn unit, but needs external validation before being adopted into clinical practice. Further research is needed to improve data capturing in the burn unit.

Background & Objectives: Major incidents occur commonly in Uganda, but little is known about either local hazards which risk causing major incidents, or health system preparedness for such events. Understanding risk and current preparedness is the first step in improving response. Methods: We undertook a cross - sectional study across four teaching hospitals in Kampala (Mulago National Referral Hospital, Nsambya Hospital, Mengo Hospital and Lubaga Hospital). A local geographic area Hazard Vulnerability Analysis (HVA) f or each site was combined with a key informant questionnaire and standardized facility checklist within the hospitals. Data collected included status of major incident committees, operational major incident plans and facility major incident operation centres, bed capacity, equipment and supplies and staffing. The HVA assessed the human impact, impact on property and on business of the hazards as well as measures for mitigation (preparedness, internal response and external response) in place at the hospitals. Results: Only one of the four hospitals was found to have had an operational major incident plan. The designated coordinator for major incidents across all facilities was mostly a general surgeon; no funds were specifically allocated for planning .All hospitals have procedures for triage, resuscitation, stabilization and treatment. None of the facilities had officially designated a major incident committee. All the facilities had sufficient supplies for daily use but none had specifically stock piled any reserves for major incidents. All hospitals were staffed by at least a medical officer, clinical officers, nurses and a specialist with procedures for mobilizing extra staff s for major incidents. Some staffs had received some emergency care training in courses namely basic life support, advanced trauma life support, primary trauma care and emergency triage and treatment but no team had received training in major incident response. Only one hospital carried out annual simulation exercises. Incidents involving human hazards specifically bomb threats, road crash mass casualty incidents, civil disorder and epidemics posed the highest risk to all four hospitals and yet preparation and response measures were inadequate. Conclusion: Hospitals in Kampala face a wide range of hazards and frequent major incidents but despite this they remain under - prepared to respond. Large gaps were identified in as far as staffing, equipment and infrastructure.

Includes bibliographical references (leaves 59-66). / This study examines the outcomes of a group of low-risk patients with uncertain diagnosis, who were seen at a rural health facility. A stress ECG was performed on the patients within 24 hours of the onset of pain, with those with negative tests subsequently being discharged.

Includes bibliographical references (leaves 45-50).

Includes abstract. / Includes bibliographical references (leaves 42-55). / The aim of my study is to directly compare the patient’s perceptions of care received in the emergency department to that of the attending physician’s. The aim is to give us better insight into how the patient experiences their care, with a view to improving the level of care offered. The study elucidates the emphasis a patient places on aspects of their care such as empathy, communication, waiting times, etc. The study was conducted at GF Jooste Emergency Department over a period of eight weeks. Patients voluntarily, and with full anonymity, filled in a short questionnaire. The attending physician did the same. Questionnaires were collected and data fed into a database, analyzed and the results interpreted.

Background: The measurement of, and reporting on clinical outcomes, is an integral part of clinical governance but no consensus has been reached about which measures to use and the validity thereof. Objective: To compare an administrative predictive model (Hospital Standardised Mortality Ratio [HSMR]) with a physiological predictive model (APACHE ®IV) to determine the correlation in the predicted risk adjusted mortality rates. To determine whether stratifying the patients into low (<10%), medium (<50%) or high (>80%) risk bands will lead to more accurate comparisons. Design: Prospective cohort study Setting: 63 critical care units in 34 private acute care facilities across South Africa Methods: Both HSMR and APACHE ®IV are calculated routinely in all participating facilities and the research study will use the data generated. An additional audit process will be implemented to determine and ensure the integrity of the data. Ethics: The healthcare facilities have standard processes in place to ensure confidentiality and the statistician analysing the data is employed by the healthcare group and bound to a confidentiality agreement. Ethics approval has also been obtained by the University of Cape Town ethic committee before the approval of the research proposal.

Includes bibliographical references / Includes abstract. / The evidence suggests an association between HIV, TB and DVT. There are no studies of this link in the Southern African setting, where the incidence of both of these conditions (HIV and TB) is high. We therefore undertook a study to define the incidence of HIV and TB in patients with confirmed DVT in this setting. The aim of this study is to describe the incidence of HIV, TB and the more commonly accepted risk factors in patients with confirmed DVT in a South African public hospital.

Includes bibliographical references. / The aim of this study is to determine whether routine blood cultures performed in a secondary level hospital Emergency Centre affect the choice of antibiotic used in treating patients with bacterial infections. A secondary aim is to determine if staff in the EC are aware of correct procedures for drawing blood cultures, and whether their practice reflects this. This will be a retrospective analysis of all blood cultures done in GF Jooste hospital over a 12 month period (1 April 2008 - 31 March 2009). The EC sees approximately 45 000 patients per year, and approximately 300 blood cultures are performed every month. Inclusion criteria: Age 18 or greater; Blood culture performed by EC staff in EC; Recorded blood culture result by laboratory; Patient in hospital when results received. The data will be analysed and presented as simple descriptive statistics.

Includes abstract. / Includes bibliographical references (leaves 35-37). / Patients with COPD presenting to the Emergency Unit with acute hypercapnic respiratory failure often require invasive mechanical ventilation and subsequent admission to the intensive care unit (ICU). These patients are at an increased risk of prolonged and complicated ventilation and often experience weaning difficulties. In addition, the impact of a previous episode of pulmonary tuberculosis that might have resulted in structural lung disease on the duration of mechanical ventilation in such patients has not previously been evaluated. Methods: All patients with COPD admitted to the Respiratory ICU at Tygerberg academic hospital from the 01st January 2004 until 31st December 2007 requiring intubation and invasive mechanical ventilation for acute hypercapnic respiratory failure were included in the study.