Pietermaritzburg, South Africa
Pietermaritzburg, South Africa

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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.


Background: In many Sub-Saharan African countries, first-line therapy for HIV may include a nucleoside reverse transcriptase inhibitor (NRTI). Longterm NRTI use is associated with symptomatic hyperlactataemia due to inhibition of mitochondrialDNApolymerase g, a potentially fatal complication. Objective: The purpose of the study was to evaluate the factors associated with inhospital fatality for HIV inpatients prescribed NRTIs long term who presented with symptomatic hyperlactataemia. Methods: We performed a retrospective cohort study at a 900-bed university hospital in South Africa over 4 years (2005-2008).We included HIV inpatients prescribed NRTIs long term who presented with symptomatic hyperlactataemia (long-term NRTI use; lactate >4.0 mmol/L; absence of infectious source; symptoms requiring admission). Data included demographics, medical history, NRTI duration, blood pressure, symptom duration and relevant laboratory data. Results: Of 79 patients who met inclusion criteria (mean age 38.2 ± 10.5 years, 97% female) there were 46 fatalities (58%). Factors significantly associated with fatality were presence of diabetes mellitus (p = 0.04), lactate ≥10 mmol/L (p = 0.003), pH <7.2 (p = 0.002), creatinine ≥200 mmol/L (p= 0.03) and altered mental status (p = 0.03). Conclusions: In this study, NRTI-related symptomatic hyperlactataemia occurred predominantly in females. Mortality was associated with severely elevated lactate (≥10 mmol/L), the degree of acidosis, elevated creatinine, history of diabetes and altered mental status on presentation. © 2011 Adis Data Information BV. All rights reserved.


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.


Drain P.K.,Harvard University | Hyle E.P.,Harvard University | Noubary F.,Harvard University | Noubary F.,Institute for Clinical Research and Health Policy Studies | And 7 more authors.
The Lancet Infectious Diseases | Year: 2014

The aim of diagnostic point-of-care testing is to minimise the time to obtain a test result, thereby allowing clinicians and patients to make a quick clinical decision. Because point-of-care tests are used in resource-limited settings, the benefits need to outweigh the costs. To optimise point-of-care testing in resource-limited settings, diagnostic tests need rigorous assessments focused on relevant clinical outcomes and operational costs, which differ from assessments of conventional diagnostic tests. We reviewed published studies on point-of-care testing in resource-limited settings, and found no clearly defined metric for the clinical usefulness of point-of-care testing. Therefore, we propose a framework for the assessment of point-of-care tests, and suggest and define the term test efficacy to describe the ability of a diagnostic test to support a clinical decision within its operational context. We also propose revised criteria for an ideal diagnostic point-of-care test in resource-limited settings. Through systematic assessments, comparisons between centralised testing and novel point-of-care technologies can be more formalised, and health officials can better establish which point-of-care technologies represent valuable additions to their clinical programmes. © 2014 Elsevier Ltd.


Fiandeiro D.,Edendale Hospital | Govindsamy J.,Edendale Hospital | Maharaj R.C.,King Dinizulu Hospital
South African Medical Journal | Year: 2015

Background. Early cooling with 10 - 20 minutes of cool running water up to 3 hours after a burn has a direct impact on the depth of the burn and therefore on the clinical outcome of the injury. An assessment of the early cooling of burns is essential to improve this aspect of burns management. Objectives. To assess the rates and adequacy of prehospital cooling received by patients with severe burns before presentation to the Emergency Department (ED) at Edendale Hospital, Pietermaritzburg, South Africa. Patients with inadequate prehospital cooling who presented to the ED within 3 hours were also identified. Methods. A retrospective review of the burns database for all the patients with severe burns admitted from the ED at Edendale Hospital from September 2012 to August 2013 was undertaken. Demographic details, characteristics and timing of the burns, and presentation were correlated with burn cooling. Results. Ninety patients were admitted with severe burns. None received sufficient cooling of their burns, 25.6% received cooling of inadequate duration, and 32.3% arrived at the ED within 3 hours after the burn with either inadequate or no cooling. The median time to presentation to the ED after the burn was 260 minutes. Conclusion. Appropriate cooling of severe burns presenting to Edendale Hospital is inadequate. Education of the community and prehospital healthcare workers about the importance of early appropriate cooling of severe burns is required. Many patients would benefit from cooling of their burns in the ED, and facilities should be provided for this vital function. © 2015, South African Medical Association. All rights reserved.


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.


Parkinson F.,Edendale Hospital | Kent S.,Ngwelezane Hospital | Aldous C.,University of KwaZulu - Natal | Oosthuizen G.,Edendale Hospital | Clarke D.,Edendale Hospital
South African Medical Journal | Year: 2013

Background. Globally, 90% of road traffic crash (RTC) deaths occur in low- and middle-income countries. Objective. To document the mortality and morbidity associated with RTCs managed at a busy regional hospital in South Africa and investigate potentially preventable factors associated with RTCs. Methods. This was a prospective study of all patients presenting to Edendale Hospital following a RTC over a 10-week period from late 2011 to early 2012. All fatalities recorded at the police mortuary for the same period were included. Medical records were reviewed and all admitted patients were interviewed about the circumstances of the accident. We calculated an injury pyramid to compare our data with European data. Results. A total of 305 patients were seen over the study period, 100 required admission and there were 45 deaths due to RTCs in the area. Of the patients admitted, 41 were pedestrians involved in pedestrian vehicle crashes (PVCs) and 59 motor vehicle occupants involved in motor vehicle crashes (MVCs). The majority (n=58) of crashes involved a private vehicle. Only 17% of MVC patients were wearing a seatbelt and 8 were allegedly under the influence of alcohol. On average, RTC patients spent 19 days in hospital and 62 patients required at least 1 operation. According to our injury pyramid, the number of severe and fatal injuries was higher than in Europe. Conclusion. Our results demonstrate a high incidence of RTCs associated with a high injury score and significant morbidity. Most crashes were associated with a number of high-risk behaviours.


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.


Parkinson F.,Edendale Hospital | Parkinson F.,University of KwaZulu - Natal | Kent S.J.W.,Ngwelezane Hospital | Aldous C.,University of KwaZulu - Natal | And 3 more authors.
Injury | Year: 2014

Background Road traffic crashes are responsible for a vast amount of death and disability in developing countries. This study uses a bottom up, micro-costing approach to determine the cost of road traffic related crashes in South Africa. Methods Using the data from one hundred consecutive RTC related admissions to a regional hospital in South Africa we performed a bottom up costing study. To calculate costs patients were reviewed every 48 h and all interventions were recorded for each individual patient. Prices of interventions were obtained from hospital pricelists. A total cost was calculated on an individual basis. Results The total cost of in-patient care for these patients was US $6,98,850. Upper limb injuries were the most expensive, and the total cost increased with the number of body regions injured. The biggest expenditure was on ward overheads ($2,81,681). Ninety operations were performed - the total cost of theatre time was $1,48,230 and the cost of orthopaedic implants was $1,26,487. Conclusion The cost of care of a RTC victim is significant. In light of the high numbers of RTC victims admitted over the course of the year this is a significant cost burden for a regional hospital to bear. This cost must be taken into account when allocating hospital budgets. © 2013 Elsevier Ltd. All rights reserved.


Kong V.,Edendale Hospital
Indian journal of medical ethics | Year: 2012

Patients with extensive burns injuries are often given a poor prognosis. Those who survive after an initial early resuscitation phase often require extensive operative and critical care input, a prolonged hospital stay, and associated significant complications. The overwhelmingly high volume of patients already using the resource-stricken burns care service places extreme pressure on clinicians in respect of decisions they make about who should and should not be resuscitated. In this paper, we present the case of a young woman who sustained significant burn injuries, and discuss the ethical dilemmas encountered during the subsequent management of her care.

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