Delay in provision of breast cancer care in patients seen at a district hospital diagnostic breast unit in South AfricaNg'ang'a, Mukuhi January 2018 (has links)
Background: There is evidence to show that delays in breast cancer management are detrimental to patient outcome. The aim of this study was to determine time trends and causes of delay in a newly established diagnostic breast clinic based at a district hospital in South Africa. Method: All patients who presented to Mitchells Plain District Hospital Breast Clinic from January to December 2015 and had a diagnosis of breast cancer were included in this study. The intervals between the time she first noted her symptoms to initial contact with a health professional and delivery of definitive therapy was documented. Patient delay referred to the interval from when the patient first noted her symptoms to her initial contact with a health care provider. Provider delay referred to the interval between the first hospital visit and onset of therapy. Result: A total of 33 patients were enrolled in this study. The median overall total delay (time lapse between the moment the patient first noticed her symptoms to time definitive anti-cancer treatment was started) was 157days, (range 29 to 839 days). Median patient delay (time lapse between the moment the patient first noticed her symptoms and the visit to a health professional) was 56 days, (range 7 to 730 days). Median overall provider delay (time lapse between the patients' first encounter with a clinician to time definitive anti-cancer treatment was started) was 84 days, (range 22 to 338 days). Median Referral delay was 11 days (range 4 to 39 days). Median Diagnostic delay was 15 days (range 9 to 135 days) and median treatment delay was 45 days (range 5 to 246 days). Conclusion: The median overall total delay for patients diagnosed with breast cancer at Mitchells Plain District Hospital does not compares well with institutions in developed nations but it is similar to studies done in developing nations. The largest contributor to this delay was patient delay. The main contributors to provider delay was related to diagnosis (almost exclusively related to tissue diagnosis) and treatment (mainly patients who received surgery as their first definitive therapy).
Douie, Walter James Percival
Bibliography: leaves 61-75. / The optimal therapy for most patients with end stage renal disease is renal transplantation. This form of therapy results in improved quality of life, decreased medical expense, and perhaps a survival advantage for the recipient. Renal transplantation is however a complex form of therapy which may be associated with signiﬁcant complications. The most common allograft complication post transplantation is the development of delayed graft function with a reported incidence of between 23 to 34%. This is a costly complication requiring ongoing dialysis and prolonged hospitalization. It also has a signiﬁcant emotional impact on the patient and their family. Of greater concern though are the reports in the literature which associate delayed graft function with decreased graft survival. With current organ shortages organ donor criteria have been expanded to match the shortage. It is thus imperative that we should understand the mechanisms of graft damage which may result in delayed graft function. A better understanding of the relationship between delayed graft function and graft survival might signiﬁcantly impact on our practice in certain settings such as in the use of organs harvested from a marginal donor.
Includes bibliographical references (leaves 48-59). / This dissertation represents the culmination of work and research on the management of pancreatic fluid collections (PFCs) undertaken at Groote Schuur Hospital. The aim of the study was to review the management outcome, via different treatment modalities, of pancreatic fluid collections according to a locally derived classification. Patients with symptomatic and unresolved PFCs treated during a nine year period were reviewed, assessing clinical features and anatomical location determined using CT scanning. The classification system applied distinguishes PFCs according to the associated pancreatitis, being acute or chronic. This was based on definitions established at the Atlanta Symposium in 1992. The chronic pancreatitis related pseudocysts were further selected anatomically into intra or extra pancreatic.
Banderker, Mohammed Asif
The aim of this study is to identify factors associated with limb loss in patients with popliteal artery injuries. Retrospective chart review of a prospectively collected data base of all patients with popliteal artery injuries presenting to the Groote Schuur Hospital Trauma Centre from 01 January 1999 to 31 December 2008. Demographic data, mechanism of injury, hemodynamic status, limb status (viable, non-viable or ischaemic), special investigations, associated injuries, ischaemic time, surgical treatment and amputation rate were analysed.
Dell, Angela June
18 February 2019
There is limited data with regard to the available paediatric surgical workforce in South Africa as well as their employment prospects upon completion of their specialisation training. These data are essential in developing a National Surgical Plan to address the burden of surgical disease as well as determining where resource allocation is needed. In addition, specialist paediatric surgeons who are unable to find suitable employment are more likely to emigrate, leading to further collapse of the surgical health care system. This aim of this study was to quantify and analyse the paediatric surgical workforce in South Africa as well as to determine their geographic and sector distribution. This research builds on previous research conducted in the field of general surgery and continues to grow the national database on surgical resource in South Africa. This study involved a quantitative descriptive analysis of all registered specialist as well as training paediatric surgeons in South Africa, and included their demographic data, the geographic location of their practice, as well as the sector in which they work. Quantitative data included their plans for public, private or dual practice once they have completed their specialization training. The results showed 2.6 paediatric surgeons per one million population under 14 years. More than half (69%) were male and the median age was 46.8 years. There were however, more female surgical registrars currently in training. The majority of the paediatric surgical practitioners were found in Gauteng (43%), followed by the Western Cape (26%) and Kwa-Zulu Natal (16%). The majority of specialists reportedly worked in the public sector (40.9%), however this number may have been over-reported as hours spent in public practice were not specified. Interprovincial differences as well as intersectoral differences were marked indicating geographic and socioeconomic maldistribution of paediatric surgeons. The public sector paediatric surgeon density (per million population under 14 years) was 2.4 which fell below the private sector paediatric surgeon density of 9.4. These numbers fell far below developed countries such as the United States, Germany and the Netherlands but the private sector density compared favourably with Ireland and Canada. Access to paediatric surgical care requires an adequate supply of experienced surgeons distributed over a wide geographical area. Additionally, paediatric surgeons require a wide range of ancillary support staff and hospital facilities. Without these resources, surgical access for the most vulnerable of populations is limited. Addressing the maldistribution of paediatric surgical workforce requires concerted efforts to expand existing training posts as well as equipping the remainder of level three hospitals to provide paediatric surgical training.
The use of topical sodium hypochlorite in the management of Pseudomonas aeruginosa burn wound infectionCoetzee, Emile January 2011 (has links)
The aim of the study is: 1. To undertake a meta-analysis of Pseudomonas aeruginosa burn wound infection. 2. To undertake a retrospective audit of Pseudomonas aeruginosa burn wound infection at the Red Cross War Memorial Children's Hospital. 3. To investigate the local effects of sodium hypochlorite solutions in Pseudomonas aeruginosa burn wound infection with regards to efficacy and toxicity.
19 February 2019
Background: There is an urgent clinical need for an alternative vascular graft, especially for smaller artery applications such as in below-knee and coronary artery bypass. Currently available synthetic grafts have unacceptably low patency rates, while autologous saphenous vein grafts are not feasible in one third of patients. Decellularised vascular grafts have been investigated as alternative conduits, but this chemical treatment results in degradation of the extracellular matrix. Chemical stabilization of elastin with penta-galloyl glucose (PGG) combined with collagen stabilisation during covalent heparinisation was previously investigated by our group in a small animal model and shown to be effective and safe. The current study describes their evaluation in a large animal (ovine) model. Methods: Porcine mammary arteries were harvested, decellularised according to an established protocol involving rinsing with sodium hydroxide, alcohol (ETOH), treatment with DNAse/RNAse enzymes, immersion in PGG and subsequently surface modified with covalently bound heparin. Samples of the grafts were also tested for radial and suture retention strength. The prepared grafts were implanted as interposition grafts into the carotid arteries of 6 sheep, using industry standard 6mm expanded polytetrafluoroethylene (ePTFE) on the contralateral side of each animal as control. In-situ patency was determined by ultrasound and angiography at two months, following which the grafts were explanted for macro- and microscopic analysis. Results: In-vitro evaluation: Grafts showed significant levels of bound heparin (14.56 mg/g vs 0.69mg/g in untreated tissue) and demonstrated similar mechanical properties to those of human carotid arteries. Survival: Five out of six sheep survived the full 2-month implant period, while the remaining animal developed sepsis shortly after implantation and was euthanized on day 4. Patency: None of the decellularised grafts were patent at explant, as assessed by ultrasound, angiography and macroscopic examination. Two of the five control (ePTFE) grafts were patent. Microscopic analysis: An inflammatory cell infiltrate with vascularised granulation tissue was found encasing the decellularised xenografts with little or no sign of endothelial cell infiltration. Signs of early occlusion, likely due to technical factors, was noted at the sites of anastomosis. Conclusion: Although demonstrating similar mechanical properties to human carotid arteries, and promising results in the small animal model, the stabilised decellularised vascular grafts failed to achieve endothelialisation or patency in this sheep carotid model. Significant calibre mismatch between the test graft and the native artery is thought to be the primary factor in the failure of these grafts, highlighting the potential difficulty in acquiring grafts of an appropriate size from animal sources.
Female general surgeons: current status, perceptions and challenges in South Africa. A pilot study at a single academic complexRoodt, Liana January 2016 (has links)
Background: Today, the majority of medical graduates in South Africa and internationally, are female. Current literature suggests that the surgical workforce does not reflect this gender integration. This trend, as well as a decrease in the popularity of general surgery as career choice, has been investigated internationally. It is postulated that gender plays a significant role in specialty choice. In the midst of the gender debate, there are also generational shifts in preferences around work and lifestyle that need to be considered. Paucity of data about these trends from the African continent exists. Aim: The aim of this study was to determine the gender, generational and discipline-specific factors that are currently impacting on general surgery as a career and specialty choice by administering questionnaires to undergraduate students, surgical trainees and consultant surgeons. The questionnaires were designed to determine the: 1. "Status" of female general surgeons as opposed to male general surgeons. 2. "Perceptions" about female general surgeons opposed to male general surgeons. 3. "Challenges" faced by general surgeons, both male and female. Methods: An institutionally validated, self-administered questionnaire was used to gather data on the current status, perceptions and challenges pertaining to general surgeons, male and female, at the University of Cape Town. The questionnaires were distributed to a group of final-year medical students, and to current surgical registrars and surgical consultants in the department of surgery, and were analysed with a particular focus on gender. Results: The response rate from the surgical department was 67.8%: 29 (51%) respondents were consultant surgeons (six female and 23 male), and 28 were surgical registrars (11 female and 17 male). Of the 114 students invited, 59 (51.7%) completed the survey: 18 male and 41 female. Status: The small numbers made it difficult to comment on the status of female surgeons within the discipline. However, the average age of female surgical consultants were six years younger than male consultants (39 vs. 45). Two female consultants were the head of a firm, none has been on the editorial board of a peer-reviewed journal, nor has acted as postgraduate research supervisors, but their average number of publications is almost equivalent to those of the male consultants. Perceptions: A statistically significant proportion of registrars (p = 0.03; six [35%] female and 16 [40%] male) felt that women had an advantage when applying for a surgical training post. A total of 19 (33%) felt that there are too many female surgical registrars; only two (3.5%) felt there are too few. Nine (32%) registrars felt that more female surgeons complicate the departmental routine - male participants were statically more likely to consider a female presence disruptive (p = 0.02). Fourteen (50%) registrars, 13 (45%) consultants and 36 (61%) students think men are better suited for a career in general surgery, but the majority across all groups considers female surgeons just as technically competent as male surgeons. A minority of registrars (5/28: 18%) and consultants (4/29: 13.7%) perceive female surgeons to portray a lot of masculine qualities, while 24 (40.6%) students think female surgeons are more assertive, aggressive and decisive than women in other specialties. Challenges: Poor work-life balance, the effect their surgical career has on their family and personal relationships, together with meeting research and academic demands, were identified as major challenges across both genders in the consultant and registrar groups. The majority of students, both male - 13 (72%), and female - 28 (68%), indicated that perceived lifestyle during training will deter them from choosing a career in general surgery. Nineteen (46.3%) female and six (33%) male students are deterred by the influence a surgical career may have on their personal relationships. Conclusion: This pilot study moves the gender conversation in surgery beyond balancing numbers. More women in surgery does not necessarily translate into better integration - in our survey, men are still considered better suited for a career in general surgery. Women are considered disruptive to the discipline and are perceived to face more challenges in carving out a successful career in general V surgery. There are, however, challenges that increasingly affect both genders. As the number of women in the surgical workforce rise, it will be imperative to distinguish what challenges are discipline rather than gender-related. Addressing gender as well as generational challenges may enable the discipline to draw the best candidates and restore general surgery to its position as a popular career choice.
Navsaria, Pradeep H
Includes bibliographical references. / Distal rectal washout and presacral drainage appear to have little or no influence on the morbidity and mortality in patients with low-energy trauma to the rectum. The ever-increasing popularity and obvious advantages of minimal access surgery have prompted surgeons to apply its use to a variety of surgical diseases, including trauma-related conditions. This study retrospectively reviews and examines the safety and efficacy of laparoscopy and the formation of a diverting sigmoid loop colostomy through an abdominal wall trephine, in a limited number of carefully selected patients with isolated extra-peritoneal rectal injuries. The patient is thus spared a major laparotomy wound. The value of distal rectal washout and presacral drainage in such injuries is also examined.
Hydrogels have successfully proved themselves useful for drug delivery applications and several delivery routes have been developed over the years. The particular interest in this work was to design, synthesise and evaluate in situ forming drug eluting hydrogels, which have the potential to ameliorate the healing of cardiovascular diseases.
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