Proefschrift--Amsterdam.

Proefschrift--Amsterdam.

MPH (Hospital Management), Faculty of Health Sciences, University of the Witwatersrand

No description available.

Magister Administrationis - MAdmin / Nursing is a vital part of the health care delivery system, but managers of health care facilities worldwide are increasingly asked to “do more with less”. Nurses are under increasing work pressure and this often manifests in stress and conflict at work and possible absenteeism. Very few researchers have focused on the patterns of absenteeism among different demographics, length of service and occupational strata. The main question this research seeks to answer is: what is the extent and costs of absenteeism amongst nurses and do seniority, length of service and demographic factors matter at Groote Schuur hospital (GSH). Confined to a period of two years, 2012 to 2013, this study draws on a data set of about 1,635 nurses in order to provide a more accurate analysis of sick leave trends showing occupational levels, gender, age, and race. Nurses at GSH are predominantly female and almost 55% of the workforce is classified as “Coloured”. African nurses in general are younger than the Coloured, White and Indian nurses. The research shows that the nurses in age category 60-66 in fact have a better attendance record; but the data shows there is no overall correlation between years of service and absenteeism. The study suggests that contrary to assumed views, absenteeism is well managed at GSH.

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. *e primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups (p ≤ 0.05). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%; p = 0.33) or relapse status (8.1% versus 10.3%; p = 0.22) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group (p = 0.11), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0]; p = 0.001). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes.

Magister Chirurgiae Dentium - MChD / Mandibular fractures are common facial injuries, occurring twice as frequently as fractures of the bones of the midface. Only the nasal bones are fractured more often as the result of trauma to the face (Olson eta/ 1982; Theriorletal 1987; Shepherd et al 1988; Dodson et al 1990; Lownie et al 1996). In many oral and maxillofacial units, the treatment of fractures of the mandible form the major proportion of the services rendered. Internationally it is accepted that there are two methods of treatment for fractures of the mandible, namely, closed and open reduction. Closed reductions are performed in dentate patients either under local or general anaesthesia. This method entails the placement of eyelet wires between or around teeth in both arches and then placing the patient into intermaxillary fixation. This is the method of choice when treating an undisplaced fracture of the mandible.

Background: Despite advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in acute hospital settings. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, current practice must be understood. Aim: To evaluate pain assessment and management of patients in two surgical wards at Groote Schuur Hospital. Setting: Groote Schuur Hospital is a government-funded tertiary academic institution within the Western Cape Province of South Africa. The patients at this hospital are generally from the low-income strata and live in resource-poor communities. Methods: A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward at Groote Schuur Hospital in June 2015 were targeted for review. Medical folders not available or with missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan. Results: 168 folders were available for review. Nearly half of the patients had no documented pain assessment. When pain assessment was conducted, the verbal rating scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge and experience of the practitioner and were not evidence-based. Conclusion: Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings of studies referenced in this text. Health professionals need to be empowered to manage pain adequately. An assessment tool, which integrates the biopsychosocial factors that influence the pain experience, should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.

The advent of intravenous thrombolytic agents has revolutiontzed the management of patients with acute myocardial infarction and has dramatically altered the morbidity and mortality associated with this condition. The aims of this study in patients presenting with acute myocardial infarction and treated with thrombolytic agents are: 1. To evaluate the efficacy of thrombolytic agents used at Groote Schuur Hospital in terms of (a) patency of the infarct related artery; ( b) short and long-term mortality. 2. To assess the feasibility and safety of combining intravenous beta-adrenergic blockade with intravenous thrombolytic therapy in patients presenting with acute nyocardial infarction. 3. To assess the need for coronary angiography in all patients treated with thrombolytic agents for acute myocardial infarction. 4. To assess the effect on mortality of offering coronary angioplasty or coronary artery bypass grafting only to those patients manifesting spontaneous or inducible ischaemia post infarction.

Doctor of Philosophy / Anindilyakwa is the language spoken by over 1,000 Warnindilyakwa Aborigines on Groote Eylandt, Northern Territory. In the Australian language families, it is placed in the Groote Eylandt Family (Oates 1970:15) or the Andilyaugwan Family (Wurm 1972:117). As Yallop (1982:40) reports, Anindilyakwa and Nunggubuyu "are similiar in grammar and possibly share the distinction of being the most gramatically complex Australian languages. They are diverse in basic vocabularly, however, and are therefore allocated to separate families".