School of Clinical Medicine (ETDs)

Permanent URI for this community

https://hdl.handle.net/10539/37930

Browse

Browsing School of Clinical Medicine (ETDs) by SDG "SDG-17: Partnerships for the goals"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Assessing financial literacy amongst anaesthetists in an academic department
    (2024) Mohamed, Ayesha Noor
    Background: Financial literacy is an important skill that is used to navigate the complex financial landscape. According to studies done in South Africa, wealth, income, racial classification, age, geographical location and level of education affect financial literacy levels. Higher financial literacy is associated with greater wellness and less financial concerns. Studies done in other countries show that doctors have low financial literacy. The financial literacy of anaesthetists in South Africa is not known. Objectives: The aim of this study was to assess financial literacy among anaesthetists in the Wits Department of Anaesthesiology and to identify demographic factors that could predict differences in financial literacy. Methods: This was a cross-sectional, contextual and descriptive study using an anonymous, self administered questionnaire. The questionnaire was an adaptation of the original used in the South African Social Attitudes Survey and was scored similarly. A mean financial literacy score was calculated for each anaesthetist using four domain scores (financial knowledge, financial planning, financial control and product choice and awareness) and used to make comparisons between demographic categories. Results: A total of 184 anaesthetists from the Wits Department of Anaesthesiology were included. The mean financial literacy score (0-100 scale) was 72. With the exception of White anaesthetists scoring higher than Coloured anaesthetists (p= .049), no other demographic category showed significant differences. Gender, age, relationship status and years of employment did not inform any enduring trend with regards to mean financial literacy scores. The mean scores for the individual domains were 79 for financial control, 76 for financial planning, 51 for product choice and 82 for financial knowledge. Between the domains, the mean financial knowledge score was higher than the mean financial planning score (p =.011). The product choice score was found to be the lowest (p<.0005) Only 35% of anaesthetists are confident in buying financial products and services by themselves while 8.2% of anaesthetists are very confident in their retirement planning. Anaesthetists who held an unsuitable financial product in their portfolio accounted for 40%, while 36% of anaesthetists experienced regret regarding financial decisions. It was also found that younger, junior, Coloured and Black anaesthetists have poorer financial preparedness. Conclusion: Anaesthetists in the Wits Department of Anaesthesiology have high levels of overall financial literacy, however, do not display adequate preparedness in planning for a secure financial future. A mandatory structured financial literacy programme during university, specialisation and fellowship training is recommended.
  • Thumbnail Image
    Item
    Comparison of ultrasound and magnetic resonance Imaging findings in patients with suspected placenta accreta spectrum at Chris Hani Baragwanath Academic Hospital
    (2024)
    Background: Placenta accreta spectrum (PAS) is a serious condition that is increasing in prevalence with an increase in the caesarean section rate. This condition is associated with significant haemorrhage. Accurate diagnosis and adequate surgical planning are associated with favourable outcomes. Ultrasound and MRI are used in prenatal diagnosis of this condition. • Objectives: To compare ultrasound and MRI report findings with histopathology or surgical findings in patients with suspected PAS at Chris Hani Baragwanath Academic Hospital. To compare the diagnostic accuracy of PAS between the junior and senior (>5 years’ experience) radiologists’ MRI reports. Method: A retrospective comparison of 14 MRI and 18 ultrasound report findings of patients with suspected PAS were compared with histopathologic or surgical report findings. These imaging modalities' sensitivity, specificity, accuracy, true positive, true negative, false negative and false positive values were determined. The accuracy, sensitivity and specificity of MRI reports were determined based on radiologists’ experience. Results: Ultrasound correctly diagnosed PAS in 10/18(56%) of the patient reports. MRI correctly diagnosed PAS in 6/14(43%) of reports. Ultrasound reports had sensitivity and specificity of 90.9% and 28.6%, respectively, while MRI reports had sensitivity and specificity of 20% and 75%, respectively. The senior radiologists correctly diagnosed PAS in 3/7(42%) of reports, while junior radiologists correctly diagnosed PAS in 4/6(67.7%) of MRI reports. Conclusion: There was no statistically significant difference in the accuracy of Ultrasound and MRI in diagnosing PAS. There was no statistically significant difference in diagnosis of PAS between junior and senior radiologists
  • Thumbnail Image
    Item
    Efficacy of antero lateral thigh flap in head and neck reconstruction
    (2024) Machaka, Leah Mokgadi
    Background: Head and neck defects commonly from excision of cancer, require complex reconstruction. Our reconstructive goals are aimed at achieving safety, form and function. Escalation to the highest option on the ladder of reconstruction is obligatory. With the discovery of free anterolateral thigh flaps our reconstructive goals could be attained. Antero lateral thigh flap offered more to the reconstructive options than what it was initially described as. Antero lateral thigh flap not only gained popularity but also became the workhorse flap in head and neck reconstruction. Research has been done all over the world on the application of Antero lateral thigh flap but nothing is reported from South Africa. The aim of the study was to determine the efficacy of antero lateral thigh flap in head and neck reconstruction in plastic surgery department at Charlotte Maxeke Johannesburg Academic Hospital. Methodology: A retrospective medical record review was conducted at Charlotte Maxeke Johannesburg Academic Hospital which included all adult patients reconstructed with antero lateral thigh flap. Theatre and ward registration were used to identify the patients during the five-year period from 01 January 2014 – 31 December 2018. The number of patients with head and neck cancer during this period totalled 80, of which 33 met the study inclusion criteria: Adults with head and neck cancer reconstructed with antero lateral thigh flap. Main Outcome Measures – Flap survival, recipient and donor complications and length of hospital stay. Results: The study comprised 33 patients who had undergone a wide local excision, with/without neck dissection and reconstructed with antero lateral thigh flap. The mean age of the patients was 55.89 +/- 12.77 years. Most participants were male (n=24: 72.73%), female (n=9:27.27%), smokers (n=18: 56.25%) and 25 (78.13%) had SCC diagnosis, there were 15 (44.12%) patients with comorbidities and the average duration of the operation was 10.12+/- 2.65 hours. The most frequent anatomical site was the oral cavity (n=15: 50%). Maximum ICU stay was 2 days (n=31.93: 94%), The median hospital stay was 38 days with an interquartile range of 34-44 days. Post operation complications were experienced by 7 patients – recipient site complication (n=3,9%) and donor site complication (n=4, 12%), with a total flap survival of 94%. Conclusion: Our experience has given us the confidence to use this flap in a variety of head and neck defects. The antero lateral thigh flap is highly versatile, has a high survival rate and a low complication rate. Antero lateral thigh flap has found a permanent and highly valued place in head and neck reconstruction.
  • Thumbnail Image
    Item
    Electrocardiographic features and characteristics of pericardial disease in children
    (2024) Coopoo, Kevanya
    Introduction: There is little information regarding the aetiology, diagnosis and outcomes of pericardial disease in children on the African continent. The diagnosis is made easy using echocardiography, but it is not always available in a resource limited setting. The electrocardiogram (ECG) is an inexpensive and easily available tool that can be used to detect pericardial disease, but little data is available regarding its use in children. This study reports the characteristics of pericardial disease in children and their ECG features in a South African periurban setting. Methods: This retrospective descriptive study was conducted at a tertiary level hospital in Johannesburg, South Africa. The paediatric cardiology database was searched to identify all children with pericardial effusions from 1st January 1993 to 30th April 2019. Only patients that needed procedures or surgical intervention were selected for the study cohort, as it was expected that they would have ECGs available as part of their pre-procedure assessments. Available ECGs were collected and analysed for abnormalities. Other data such as age at presentation, sex, Human Immunodeficiency Virus (HIV) status, tuberculosis (TB) status, medications, pericardial fluid characteristics, details of pericardial surgical intervention and clinical outcome was also sourced from patient records and analysed. Basic descriptive statistics, such as percentages and frequencies was used for data interpretation. Results: Over the 26-year period, 724 cases of echo-proven PEs were identified. There were 79 patients who underwent interventions, which comprised the study cohort. Seventy-eight percent were over 5 years of age and the majority had large pericardial effusions. Infectious causes predominated, of which TB was the most common (60%). Forty-five percent were documented as HIV positive. The most common procedure performed was the insertion of a pericardial drain. Fifty-four percent of patients had resolution on follow-up, 4% had disease recurrence, 14% of the cohort died and 24% had unknown outcomes. The predominant ECG features in the 25 ECGs that were legible were those of sub-acute or chronic pericarditis, showing abnormal T-waves in 96% and sinus tachycardia in 80%. Other abnormalities were: decreased chest lead QRS voltages (52%), PR segment depression (48%) and decreased limb lead QRS voltage (40%), Less common findings were electrical alternans (28%), ST segment elevation (12%) and ‘Spodick’s sign’ (8%). Conclusions: The study showed that infectious causes, in particular TB, are the predominant causes of paediatric pericardial disease in South Africa. The majority of children, however, had complete resolution of their pericardial disease despite the need for invasive interventions. Although few ECGs were located and legible, all showed abnormalities with the majority displaying features of sub-acute or chronic pericarditis, suggesting that most children undergoing invasive treatment have later stages of pericardial disease. The few ECGs that were available for interpretation constitute a notable study limitation, but provide a basis for future studies on ECG changes in children with pericardial disease.