Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 153-169).

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine. Johannesburg, 2018. / Objectives Present on arrival infection is a common indication for admission in surgical patients initially managed at primary care level. We aimed to describe the demographic and disease profile of patients with infection requiring surgical management, describe determinants of patients’ health seeking behaviour and identify barriers to care. Methods A prospective descriptive questionnaire based study was conducted at Edenvale General Hospital between February 2014 and October 2016. Minors were excluded. Results Eighty nine patients participated. Abscesses (26%, 23/89), diabetic foot (22%, 20/89), and cellulitis (16%, 14/89) were the largest categories of infection necessitating admission. The majority of patients were South African (88%, 78/89), Black African (82%, 73/89), males (58%, 52/89), without medical aid (99%, 88/89), who were not formally employed (58%, 52/89), were from poor households (74%, 73/89), inhabited some form of formal housing (90%, 80/89), were in charge of decisions regarding personal health (80%, 71/89), and first sought help at the primary care level (71%, 62/89). Delay from onset of symptoms to presentation was noted in 69% (61/89) of patients, and delay from presentation to referral to specialist care in 46% (41/89) of patients. Age, race, history of diabetes, and main source of monthly income were significant variables in delayed presentation (p<0.05), and age and level of care on first contact in delayed referral (p<0.05). The most common reason for delay to presentation (84%, 51/61) and referral (61%, 25/41) was patients’ own belief that the problem would get better spontaneously. Conclusions Patients’ socio-economic status, past medical history, demographics, level of first contact with the health care system, and perceptions of their own health contributed to delays in seeking and receiving care. Barriers to care may be addressed by improvements targeting issues of availability, accessibility, acceptability and affordability of health care services. / E.K. 2019

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (doctoral)--Københavns universitet.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesia Johannesburg, April 2013 / BACKGROUND: Once lauded as one of the most valuable interventions across all fields of contemporary medicine, perioperative beta blockade (PBB) is a practice that has come under intense scrutiny. Publication of the PeriOperative ISchemic Evaluation (POISE) study forced a modification of recommendations for PBB in consensus guidelines. Practice in South Africa has not been previously reported. OBJECTIVES: The primary objective of this study was to describe current intended practice, with respect to PBB, in patients undergoing major vascular surgery at South African specialist training facilities. Secondary objectives were describing participant satisfaction with current strategy, reporting suggested modifications to clinician responsibilities in the future, and identifying potential barriers to the intervention. METHOD: One anaesthesiologist and one vascular surgeon from each of the seven recognised training facilities for vascular surgery in South Africa were included in a partially selective observational survey. Data was generated by the use of a semi-structured questionnaire specifically developed to address the objectives of the study. RESULTS: The POISE study results and updated international consensus guidelines had not prompted a change in approach at most facilities. There was inconsistency in methods of risk stratification, treatment implementation, titration practices, and the timing of withdrawal of medication. Anaesthesiologist and vascular surgeon opinion on current intended practice correlated poorly. Opinions correlated least well at facilities where both clinicians claimed responsibility for PBB, implying that communication may be a problem. Similarities, where they did occur, were in keeping with recommendations that are widely supported in the literature. Less than half of the participants were satisfied with current practice. The involvement of the anaesthesiologists in the perioperative management of vascular surgery patients was less than reported in other countries. The participants supported a major role for anaesthesiologists in the future, and a move towards multidisciplinary involvement in policy development and patient management. The need for appropriate monitoring was identified as one of many important barriers. CONCLUSIONS: This study describes current intended practice at South African training facilities for vascular surgery. The variable practice across the country; the poor correlation of participant responses; widespread dissatisfaction with current strategy; suggested changes to clinician responsibilities; and the identification of multiple barriers to the implementation of strategy, highlight the need for review at all facilities. Further research is needed, since the optimal strategy for reducing risk in patients undergoing vascular surgery remains elusive.