Magister Scientiae Dentium - MSc(Dent) / The aim of the study was to investigate and describe the incidence of Plasmablastic Lymphoma (PBL) diagnosed at the Divisions of Anatomical Pathology and Haematopathology at Tygerberg Hospital from 2005 to 2017, and to ascertain a possible correlation with HIV infection, by identifying the number of HIV positive and negative patients diagnosed with Plasmablastic Lymphoma. Method: This was a retrospective study using the case records of all newly diagnosed PBL patients from 2005 to 2017. Results: Fifty-seven cases of PBL were diagnosed from 2005-2017. The overall result shows an increasing incidence of PBL in the intended period with the maximum incidence occurring in 2017. Most of the cases, 40.4%, were diagnosed in the age range 40-49-years. Forty-five patients were HIV-positive (78.9%) with (P value 0.011) and the majority of the patients were males (66.7%).

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital. / AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

Thesis (MPA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The relevance of employment equity has been widely debated. This study is of the view that affirmative action is the core factor in realising compliance to and implementation of employment equity. The study was aimed at investigating why Tygerberg Hospital has not complied with the implementation of the Employment Equity Act (EEA) No 55 of 1998 specifically with regards to the field of Dietetics. Research questions have been formulated, relying on literature which includes guiding legislation and policies. Recruitment and selection processes applicable to the dietetic department were analysed and linked with the consulted literature. Role of transformation in transforming the institution was part of the study to ascertain the scope of transformation in managing diversity within Tygerberg Hospital. A combination of data collection tools was used in the study, including interviews and questionnaires to better understand the underlying reasons of non-compliance. The fundamental findings of the study showed that even though policies and legislation had been formulated, there are underlying issues to be addressed by the institution, such as language barriers and personal perceptions of the institution which could subsequently be improved through effective diversity management strategies. It is recommended that the institution will have to come up with a short-term, measurable plan to ensure compliance such as an institutional employment equity plan, appointment of a transformational officer who will focus on managing the institutional diversity management, and an internal capacity building unit to carry out institutional training and development as opposed to the current system. To ensure monitoring and evaluation compliance on employment equity, it is recommended that the responsibility be linked to the performance plan of the senior managers as well as the line manager of the dietetic department. By so doing failure to comply will result in a poor performance assessment outcome of the delegated authority, compliance enforced through departmental disciplinary procedures. / AFRIKAANSE OPSOMMING: Die toepaslikheid van billike indiensneming is al wyd gedebatteer. Hierdie studie is die mening toegedaan dat regstellende aksie die kern faktor is om nakoming van en die implementering van billike indiensneming te bereik. Die studie was daarop gemik om ondersoek in te stel waarom Tygerberg Hospitaal nie voldoen het aan die implementering van die Indiensneming Gelykheids Wet No 55 van 1998 nie, spesifiek met betrekking tot die veld van Dieetkunde. Vrae in die navorsing was geformuleer, gebasseer op literature wat rigtinggewende wetgewing en beleid insluit. Werwing en seleksie prosesse van toepassing in die Dieetkunde Departement was ontleed en gekoppel aan die toepaslike literatuur. Die rol van transformasie in die transformering van die inrigting het deel uitgemaak van die studie om die omvang van transformasie te bepaal, rakende die bestuur van diversiteit binne Tygerberg Hospitaal. ‘n Kombinasie van data versameling metodes was in die studie gebruik. Dit het onderhoude en vraelyste ingesluit om die onderliggende redes vir nie-nakoming te verstaan. Die fundamentele bevindinge van die studie het getoon dat ongeag die feit dat beleid en wetgewing geformuleer was, daar onderliggende aspekte was wat by die inrigting aangespreek moet word, soos taal-hindernisse en persoonlike persepsie oor die inrigting en wat gevolglik verbeter kan word by wyse van ‘n effektiewe uiteenlopende bestuursstrategie. Dit word aanbeveel dat die inrigting navore moet kom met ‘n kort-termyn en meetbare plan ter versekering van ‘n institusionele billikheidsindiensneming plan, die indiensneming van ‘n Transformasie Beampte wat sal fokus op bestuur van die inrigting se diversiteit en ‘n interne eenheid om die vermoë van die inrigting se opleiding en ontwikkeling uit te voer in teenstelling met die huidige sisteem. Om monitoring en evaluasie van billike indiensneming te verseker, word dit aanbeveel dat dié verantwoordelikheid gekoppel word aan die werkverrigtingsplan van Senior Bestuurders asook dié van Lynbestuurders van die Dieetkundige Departement. Mislukking om hieraan te voldoen sal lei tot ‘n swak werkverrigting evaluering resultaat van die aangewese outoriteit. Voldoening hieraan sal afgedwing moet word deur departementele dissiplinêre prosedures.