School of Clinical Medicine (ETDs)

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Browsing School of Clinical Medicine (ETDs) by SDG "SDG-8: Decent work and economic growth"

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    A Multicenter Retrospective audit on the treatment modalities of sternal sepsis: A 10-year review
    (University of the Witwatersrand, Johannesburg, 2024) Phalafala, Refilwe Palesa Mokgadi; Ndobe, Elias; Fru, Pascaline
    Background: Mediastinitis is a life-threatening complication, of a septic sternal wound. The key treatment is for early radical debridement and adequate reconstruction. The aim of this study was to perform a comparative review of the management modalities undertaken on patients with sternal sepsis from 2007–2017 at one public and two private surgical practices in Johannesburg, South Africa. Methodology: The study was a retrospective series of 120 chronologically selected patients from three hospital units (40 from each unit): The Cardiothoracic Unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH - public) and two private plastic surgery practices within Netcare Milpark Hospital (NMH). The patients were categorized into three groups: 1) Vacuum-Assisted Closure (VAC), 2) VAC and reconstruction (muscle flaps or alloplastic material) and 3) reconstruction alone (muscle flaps or alloplastic material). Results: Of the120 patients, the median age, was 58yrs (19yrs – 89yrs). Hypertension was the most common comorbidity. Patients in NMH were more likely to undergo VAC dressing for a shorter period. Patients in NMH were more likely to be reconstructed with a flap (44%, n=35/78), of which the bilateral pectoralis major flaps (19%, n=43) was more frequent. Out of the 120 patients, 61% had one debridement and VAC therapy as a temporizing modality prior to reconstruction. CMJAH had a higher mean length of hospital stay of 41 days and re-do operations 27% (n=11/40) compared to NMH which had a mean hospital stay of 31 days and a re-do operations of 16% (n= 13/78). Plastic surgeons were more likely to be involved in initial debridement’s in NMH 96% (n=32/33) compared to CMJAH with 3% (n= 1/33). Conclusion: NMH, private hospital, demonstrated to have statistically significant better outcomes with a shorter hospital stay compared to its counterpart CMJAH, public hospital, with regards to management of sternal sepsis. NMH, showed a shorter VAC dressing period to be an effective temporizing modality, however the most efficient management of, sternal sepsis, would be to involve a plastic surgeon early on for radical and fewer number of debridements, and early reconstruction. The bilateral pectoralis major flap was the option of choice in this study. The incidence of sternal sepsis from both hospitals was in keeping with international rates.
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    Anaesthetic nurses’ knowledge and skills in perioperative airway management at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2024) Dold, Matthew
    Background: Airway management in the peri-operative period carries specific inherent risks, and the benefit of assistance by a skilled anaesthetic nurse cannot be over-stated. The aim of this study was to assess the theoretical and clinical knowledge regarding perioperative airway management in anaesthetic nurses at Chris Hani Baragwanath Academic Hospital (CHBAH). Method: A quantitative, contextual, cross-sectional and descriptive survey was performed by means of a self-administered anonymous questionnaire using convenience sampling. The questionnaire assessed identification of airway equipment, knowledge of the cleaning, maintenance and use of equipment and clinically applicable insight into perioperative airway procedures and emergencies. It’s adequacy and validity were ensured by means of the Angoff standard setting method. Data was analysed in consultation with a biostatistician. Results: A total of 68 nurses took part in the study. By distribution of rank, 78% (n=53) enrolled nurses, 19% (n=13) professional nurses and 3% (n=2) nursing assistants. The incidence of prior airway training was 41% (n=28). The overall mean questionnaire score was 69,8% (SD: 9.6%) with a range of 45% - 97%. Only 19% (n=13) of nurses achieved adequate overall scores. Years of experience was positively associated with overall mean scores (p=0.0009) and adequacy of knowledge (OR 1.28, p=0.004). Airway training showed a small increase mean scores (mean difference=4.63%, p=0.049). There were no statistically significant associations between adequate knowledge and age, prior airway training and nurse qualification. Conclusion: This study found that the theoretical and clinical knowledge of perioperative airway management of many anaesthetic nurses at CHBAH is inadequate. Knowledge adequacy improved with increasing experience but not with current forms of formal training. This may be attributed to the low frequency of training as well as the type of training methods currently employed; both of which should be addressed to improve anaesthetic nurse competence and ultimately patient perioperative safety