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Pietermaritzburg, South Africa

Kong V.,University of KwaZulu - Natal | Aldous C.,University of KwaZulu - Natal | Handley J.,Edendale Hospital | Clarke D.,University of KwaZulu - Natal
Annals of the Royal College of Surgeons of England | Year: 2013

INTRODUCTION Appendicitis in the developing world is a cause of significant preventable morbidity. This prospective study from a regional hospital in South Africa constructs a robust cost model that demonstrates the cost effectiveness of an efficient curative surgical service in a primary healthcare-orientated system. METHODS A prospective audit of all patients with acute appendicitis admitted to Edendale Hospital was undertaken from September 2010 to September 2011. A microcosting approach was used to construct a cost model based on the estimated cost of operative and perioperative interventions together with the associated hospital stay. For cost analysis, patients were divided into the following cohorts: uncomplicated appendicitis, complicated appendicitis with localised intra-abdominal sepsis, complicated appendicitis with generalised intra-abdominal sepsis, with and without intensive care unit admission. RESULTS Two hundred patients were operated on for acute appendicitis. Of these, 36% (71/200) had uncomplicated appendicitis and 57% (114/200) had perforation. Pathologies other than appendicitis were present in 8% (15/200) and these patients were excluded. Of the perforated appendices, 45% (51/114) had intra-abdominal contamination that was localised while 55% (63/114) generalised sepsis. The mean cost for each patient was: 6,578 ZAR (£566) for uncomplicated appendicitis; 14,791 ZAR (£1,272) for perforation with localised intra-abdominal sepsis and 34,773 ZAR (£2,990) for perforation with generalised intra-abdominal sepsis without intensive care admission. With intensive care admission it was 77,816 ZAR (£6,692). The total cost of managing acute appendicitis was 4,272,871 ZAR (£367,467). Almost 90% of this total cost was owing to advanced disease with abdominal sepsis and therefore potentially preventable. CONCLUSIONS Early uncomplicated appendicitis treated appropriately carries little morbidity and is relatively inexpensive to treat. As the pathology progresses, the cost rises exponentially. An efficient curative surgical service must be regarded as a cost effective component of a primary healthcare orientated system. Source


Hansen M.,University of San Francisco | Oosthuizen G.,Edendale Hospital | Windsor J.,University of Auckland | Doherty I.,University of Auckland | And 2 more authors.
Journal of Medical Internet Research | Year: 2011

Background: Designing and delivering evidence-based medical practice for students requires careful consideration from medical science educators. Social Web (Web 2.0) applications are a part of today's educational technology milieu; however, empirical research is lacking to support the impact of interactive Web 2.0 mobile applications on medical educational outcomes. Objectives: The aim of our study was to determine whether instructional videos provided by iPod regarding female and male urinary catheter insertion would increase students' confidence levels and enhance skill competencies. Methods: We conducted a prospective study with medical trainee intern (TI) participants: 10 control participants (no technological intervention) and 11 intervention participants (video iPods). Before taking part in a skills course, they completed a questionnaire regarding previous exposure to male and female urinary catheterization and their level of confidence in performing the skills. Directly following the questionnaire, medical faculty provided a 40-minute skills demonstration in the Advanced Clinical Skills Centre (ACSC) laboratory at the University of Auckland, New Zealand. All participants practiced the skills following the demonstrations and were immediately evaluated by the same faculty using an assessment rubric. Following the clinical skill evaluation, participants completed a postcourse questionnaire regarding skill confidence levels. At the end of the skills course, the intervention group were provided video iPods and viewed a male and a female urinary catheterization video during the next 3 consecutive months. The control group did not receive educational technology interventions during the 3-month period. At the end of 3 months, participants completed a follow-up questionnaire and a clinical assessment of urinary catheterization skills at the ACSC lab. Results: The results indicate a decline in skill competency over time among the control group for both male and female catheterizations, whereas the competency level was stable among the experimental group for both procedures. Interaction results for competency scores indicate a significant level by group and time (P= .03) and procedure and group (P= .02). The experimental group's confidence level for performing the female catheterization procedure differed significantly over time (P < .001). Furthermore, confidence scores in performing female catheterizations increased for both groups over time. However, the confidence levels for both groups in performing the male catheterization decreased over time. Conclusions: Video iPods offer a novel pedagogical approach to enhance medical students' medical skill competencies and self-confidence levels. The outcomes illustrate a need for further investigation in order to generalize to the medical school population. © Margaret Hansen. Source


Pillay S.,Edendale Hospital | Aldous C.,University of KwaZulu - Natal
South African Medical Journal | Year: 2016

Globally diabetes mellitus (DM) and its complications are placing an enormous burden on individual patients and countries alike. South Africa is a developing country already under enormous pressure from communicable diseases such as HIV and tuberculosis. Added to this is DM, which serves to fuel the interactions between communicable and non-communicable diseases. Data from KwaZulu-Natal Province(KZN) have demonstrated that the majority of patients with DM in the public healthcare sector are diagnosed and started on treatment at their local resource-limited healthcare clinics. This article describes introduction of a multifaceted approach to the management of DM in a resource-limited clinic at Edendale Hospital, Pietermaritzburg, KZN. Strategies like this may help provide a blueprint for other resource limited healthcare facilities in developing countries. © 2016, South African Medical Association. All rights reserved. Source


Grey B.,Edendale Hospital | Grey B.,University of KwaZulu - Natal | Rodseth R.N.,University of KwaZulu - Natal | Muckart D.J.J.,Level 1 Trauma Unit and Trauma Intensive Care | Muckart D.J.J.,University of KwaZulu - Natal
Injury | Year: 2013

Introduction: In polytrauma patients with an injury severity score (ISS) > 16, early long bone and pelvic fracture fixation within 24 h after injury has been shown to be beneficial. In contrast, surgery in the presence of subclinical hypoperfusion (SCH), defined as normal vital signs with a serum lactate ≥ 2.5 mmol/L may be detrimental. This study aimed to investigate the effect of fracture fixation in polytrauma patients with SCH. Methods: We undertook a database review extracting 88 polytrauma patients with a new injury severity score (NISS) > 16 with significant long bone or pelvic fractures (extremity NISS ≥ 9) who underwent surgical fracture stabilisation within 48 h of injury. In the group of patients with normal vital signs (mean arterial pressure ≥ 60 mmHg and heart rate ≤ 110 beats/min) we compared outcomes between those with a normal preoperative lactate (<2.5 mmol/L) and those with a raised lactate (≥2.5 mmol/L). Results: Of the 36 patients with normal preoperative vital signs, 17 had normal lactates (control group) and 19 abnormal lactates (SCH group). There were no significant differences in the method of fixation or theatre time between the groups. The SCH group required more inotropic support in the first 24 h post surgery (p = 0.02) and had higher sequential organ failure assessment (SOFA) scores on day 3 (p = 0.003). Although not reaching mathematical significance those with SCH required on average 10 days longer on mechanical ventilation. Conclusion: Early fracture fixation in patients with SCH as defined by normal vital signs and a lactate ≥ 2.5 mmol/L is associated with significant postoperative morbidity. Consideration should be given to delaying surgery in this cohort. © 2012 Elsevier Ltd. All rights reserved. Source


Pillay S.,Edendale Hospital | Aldous C.,University of KwaZulu - Natal
South African Medical Journal | Year: 2016

Background. Diabetes mellitus (DM), together with its devastating complications, has a huge impact on both the patients it affects and the global economy as a whole. The economies of developing countries are already under threat from communicable diseases. More needs to be done to stem the tide of non-communicable diseases like DM. In order for us to develop new strategies to tackle this dread disease we need to obtain and analyse as many data as possible from the geographical area where we work. Objective. To describe the burden of DM in the public sector of the province of KwaZulu-Natal (KZN), South Africa (SA). Method. Data on the number of diabetes visits, DM patients that were initiated on treatment, defaulters and DM-related amputations were accessed from the Department of Health records for the period 2010 - 2014 inclusive. Results. There was a decline in the number of patients initiated on treatment per 100 000 population from 2010 to 2014 inclusive (265.9 v. 197.5 v. 200.7 v. 133.4 v. 148.7). Defaulter rates for 2013 compared with 2014 were 3.31% v. 1.75%, respectively and amputation rates were 0.09% v. 0.05% for 2013 and 2014, respectively. There was a strong proportional relationship observed between the number of defaulters and number of diabetes-related amputations (r=0.801; p=0.000) (Pearson correlation). A notable percentage of DM patients ranging between 63% and 80% were commenced on pharmacological therapy at their local clinics rather than at hospitals in the province. Conclusion. Strategies directed towards detection and treatment of DM, together with decreasing defaulter rates and thereby decreasing diabetes-related amputations, need to be addressed urgently. The majority of patients were initiated on therapy at the clinic level. This emphasises the need to strengthen our clinics in terms of resources, staffing, and nursing and clinician education, as this is where diabetes control begins. Although this study was based solely in KZN, the second most populous province in SA, it probably reflects the current situation regarding DM in other provinces of SA as well. © 2016, South African Medical Association. All rights reserved. Source

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