Hypertension is the major cause of cardio-vascular diseases and contributes to 13.5% of premature deaths worldwide. With a 10–year risk to develop organ damages estimated at 30%, severe hypertension exposes even more patients to premature death. Severe hypertension is a type of hypertension with systolic blood pressure ≥ 180mmHg and/or diastolic blood pressure ≥ 110 mmHg that may present with or without symptoms/signs or target organ damages, and may be classified accordingly as asymptomatic (without symptoms/signs) severe hypertension, hypertension urgency (with symptoms/signs, no target organ damage) or hypertension emergency (with target organ damage). Hypertension urgency and hypertension emergency are considered hypertension crisis. This study aimed to establish the socio-demographic and clinical characteristics of the patients who presented with severe hypertension at the Emergency Departments of two private hospitals of the Netcare Management (Pty) Limited in Johannesburg during the period from the 1st of January 2010 to 30th April 2011. These patients presumably receive quality health care and may not be expected to develop severe hypertension. Therefore, this study would contribute to efforts to identify patients at risk and those who may benefit from preventive measures. The methodology of this study was a retrospective, transversal and comparative study. One thousand and forty-two patients were included in the study. All of these participants had a medical aid cover or were able to pay for medical consultation at a private hospital. Data were collected from an electronic database, the Medibank™, and from manual patients’ registers kept in each hospital’s Emergency Department. Severe hypertension was found among 1.7% of all patients who presented to the studied emergency departments. Only 817 patients were classified in the different subtypes of SH. Asymptomatic severe hypertension was the most common (83.4%) type of severe hypertension and hypertension emergency was the least common (4.8%). At Mulbarton Hospital, 50.2% of severe hypertension patients were male and at Linksfield Hospital, 60.3% were female. Male patients were younger than female patients. White patients and elderly were mostly affected by severe hypertension in the studied population. Systolic blood pressures were similar among the different races and genders. Black patients had higher diastolic blood pressure compared to white patients. White patients were older and may have had a tendency of isolated systolic hypertension. Overall, the most common symptoms/signs in hypertension urgency were chest pains (46.4%), headache (34.0%) and epistaxis (11.3%). The most common target organ damages in hypertension emergency were stroke (58.9%), left ventricular failure/congestive cardiac failure (28.2%) and seizures (12.8%). None of the studied characteristics could be claimed predictors of hypertension crisis. Also, there was no association between seasons and days of presentation and onset of severe hypertension in each hospitals. Further studies are required to include other factors that are known to affect the occurrence of severe hypertension, such as co-morbidities, smoking, alcohol intake and poor adherence to medication by known hypertensive patients. Also, risk factors contributing to the occurrence of SH among younger black patients need to be analysed.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Emergency Medicine. Johannesburg, 2012 / Introduction: Healthcare professionals working in the Emergency Medicine field are often required to function in difficult environments. Noise is one environmental factor that may adversely affect their performance. Objectives: To firstly determine if there is any difference in cognitive task performance required for clinical decision-making of healthcare professionals in a quiet compared to a noisy environment and secondly, to assess the subjective experience of participants with regards to performance in a noisy environment. Design: Prospective cross-over study. Setting: Three Academic Hospitals in Johannesburg. Participants: Forty one doctors exposed to emergency management of patients. Methods: A 30 minute examination consisting of six matched and pre-validated questions was conducted. Half of the questions were completed with exposure to ambient noise (range 40-45dB(A)) and the other half with exposure to pre-recorded background Emergency Department noise at 80-85dB(A). The questions were completed in alternating quiet and noise. Each question was scored out of 10 and the time taken to complete each question was recorded. Main Results: Overall mean test scores in quiet and noise were 18.7/30 and 19.4/30 (p=0.36) respectively, with overall time for test completion of 836s in quiet and 797s (p=0.005) in noise. While there was no statistically significant difference in task performance, 65% of the doctors found the noise distracting with 88% experiencing varying degrees of stress. Conclusions: This study showed no difference in cognitive performance in a quiet compared to a noisy environment. Deterioration in functionality might be seen with higher levels of noise and/or longer exposure.

Thesis (M.H.A.)--University of Michigan, 1969.

Thesis (D.P.H.)--University of Michigan, 1996.

Thesis (M.A.)--University of Michigan. / Also issued in print.

Thesis (M.A.)--University of Michigan. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.H.A.)--University of Michigan, 1969.

Thesis (D.P.H.)--University of Michigan, 1996.

Background: Studies have shown that healthcare workers in Emergency Units (EUs) are at a high risk of both physical and non-physical workplace violence. While several international studies have focused on the experience of workplace violence by Emergency Medicine (EM) specialist physicians, there is a paucity of data regarding that of EM physicians in training. Objectives: This study aimed to determine the amount of workplace violence (and the subtypes thereof) perpetrated against Western Cape EM registrars and consultants, and their perceived level of, and identified barriers to and facilitators of, job safety and satisfaction. Methods: This cross-sectional study relied upon responses to a survey, electronically disseminated over a 6-week period, in May/June 2018, amongst Western Cape public sector EM registrars and consultants. The primary outcome was the incidence of workplace violence experienced. The secondary outcomes were the sub-types of workplace violence perpetrated, as well as the perceived level of job safety and satisfaction, and identified barriers thereto and facilitators thereof. Results: In total, 66% of respondents had experienced at least one act of physical violence while working in Western Cape EUs, specifically by patients. Regarding non-physical violence, 90.6% of respondents had experienced at least one act of verbal harassment, 84.9% of verbal threat, and 45.3% of sexual harassment. The rates of both physical and non-physical workplace violence (especially sexual harassment), perpetrated by patients specifically, were found to be higher in female than in male respondents. Apart from acts of verbal harassment, which were perpetrated equally by patients and visitors, all other acts of physical and nonphysical workplace violence were perpetrated at a higher rate by patients than visitors. The rates of both physical and non-physical workplace violence, perpetrated by patients specifically, were found to be higher in EM consultants than in EM registrars. The factors most commonly indicated by respondents as contributory to workplace violence were patient and/or visitor alcohol use, drug use and psychiatric illness. Other factors commonly indicated were long waiting times and unmet expectations, and resultant patient and/or visitor frustration. Conclusion: Workplace violence against EM registrars and consultants is a significant problem in Western Cape EUs. The information gained during this study will be useful in improving safety and security policies at an EU (and hospital) level. It may even be applicable at a provincial (or national) level in changing legislation, in order to reduce, and ultimately prevent, workplace violence in the EU.

Thesis (M.H.A.)--University of Michigan, 1972.