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Item A tale of two sites: an audit of central nervous system metastases in two Johannesburg tertiary centres(2024) Molefe, MasechabaBackground: Literature reports the most common neoplasms of the CNS as metastases. Most studies are from the US and Europe with a paucity of data in the African setting. Objective: To provide information among patients with histologically confirmed CNS metastases treated at the neurosurgical units of the University of the Witwatersrand, namely at CHBAH and CMJAH. Methods: A retrospective record review of patients with histologically confirmed CNS metastases, presenting between 01 January 2015 and 31 December 2019 was conducted. The following data were collected and analysed: demographic, clinical, radiological and histopathological data. Results: 88 patients were included in the study. The frequencies of brain and spine metastases were 13% and 48% respectively compared to all other operated primary tumours. More females were prevalent at 51.7% in the brain metastases cohort, while males were more prevalent in the spine metastases cohort at 57.1%. In brain metastases patients the median age at presentation was 49 and for those with spine metastases the mean age was 47.1. The distribution for brain metastases was: 65% supratentorially; 20% infratentorially; 15% mixed. The distribution for spine metastases was: thoracic 32.1%; lumbosacral 28.5%; cervical 14.3%, mixed 25%. The most prevalent histopathologies for brain metastases were: lung 21.7%; breast 11.7%; melanoma 11.7%. The most prevalent histopathologies for spine metastases were lymphoma and plasma cell neoplasms each comprising 21.4%. Conclusion: More females presented with brain metastases and predominantly more males had spine metastases. There was a younger age of presentation compared to most studies conducted in Africa and globallyItem Admission hypothermia in very low birth weight newborns at Charlotte Maxeke Johannesburg Academic Hospital(2024) Mauree, Angidi PillayBackground: Hypothermia is associated with increased morbidity and mortality rates. Very low birth weight (VLBW) newborns are at an increased risk of hypothermia especially within the first few hours after delivery. Objectives: To determine the prevalence, associated risk factors, and outcomes of admission hypothermia in VLBW newborns, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a quaternary hospital in Johannesburg, South Africa. Methods: This was a retrospective descriptive study of all VLBW newborns born over a seven year period (from 1st January 2013 to 31st December 2019) at CMJAH. Comparisons between hypothermic and normothermic newborns as well as between moderately-to-severely hypothermic and mildly hypothermic newborns were done. Multivariate binary logistic regression with 95% confidence interval and a p-value of < 0.05 was used to identify variables which had a significant association. Results: Mean gestational age and birthweight of enrolled newborns was 28.9 ± 2.7 weeks and 1097 ± 250 g respectively. Prevalence of admission hypothermia was 61.5 % of which 54.3% was mild hypothermia, 43.9 % was moderate hypothermia and 1.8 % was severe hypothermia. VLBW newborns with hypothermia were more likely to have a birthweight < 1000 g [aOR 1.37 (1.12-1.68)] and less likely to be associated with early onset sepsis [aOR 0.51 (0.30-0.88)]. VLBW newborns with moderate to severe hypothermia were less likely than those with mild hypothermia to have received antenatal steroids [aOR 0.66 (0.48-0.89)]. There was no significant association of mortality in either VLBW newborns with hypothermia as compared to those with normothermia [aOR 0.95 (0.76-1.19), p value 0.67] or in VLBW newborns with moderate to severe hypothermia as compared to those with mild hypothermia [aOR 0.76 (0.46- 1.26), p value 0.29]. Conclusions: Prevalence of admission hypothermia in VLBW newborns is high and reinforces the need for thermoprotective measures in this population.Item An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital(2024) Gamede, NomdumisoBackground: Cancellation of elective surgery is one of the quality indicators of theatre operation worldwide. The cancellation of elective surgery in paediatric patients is a world-wide problem with the rates ranging from 0.21% to 44%. This study aimed to determine the rates and describe the reasons for cancellation of elective surgeries in paediatric patients at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: A retrospective study was conducted using theatre records from 01 January to 31 December 2019. The numbers and reasons for elective paediatric surgeries were reviewed. Data was collected using structured collection sheet and entered into Microsoft excel. Statistical Package for Social Sciences was also used to further analyse the data. Results were expressed as percentages in a graph and table forms. Results: In the year 2019, a total of 3399 elective paediatric procedures were scheduled in fourteen specialties at CHBAH. Of these, 634 (19%) were cancelled due to various reasons. The highest number of cases cancelled were from paediatric surgery and neonates (n=204, 31%), followed by ENT (n=99, 24%), burns (n=80, 20%) and paediatric orthopaedics (n=79, 16%). The lowest number of cancelled cases came from urology (n=3, 17%) and hands (n=3, 3%). The commonest reason for cancellation of elective surgery in paediatric patients at CHBAH was found to be time constraint (34%) followed by patients not arriving for surgery (16%). The reasons for cancellation in our study were mostly due to avoidable factors at 68% and non-avoidable at 32%. Conclusion: The rate of cancellation in our study was high but comparable to other African and South African studies. Majority of the causes for cancellation were avoidable.Item An audit of clinically triaged women at low risk for breast cancer presenting to the Helen Joseph Mammography Unit, Johannesburg(2024) Naidu, Lavandhra R.BACKGROUND: The Helen Joseph Hospital (HJH) Breast Clinic utilises a clinical triage system to stratify patients based on their risk of breast cancer into high, medium, or low risk profiles. This allows for timeous imaging and subsequent management of those patients at increased risk for breast cancer. OBJECTIVES: The primary objective was to determine the cancer detection rate (CDR). The secondary objective was to correlate biopsy results with the Breast Imaging – Reporting and Data System (BI-RADS) risk-assessment. METHODS: A retrospective audit of the patients at low risk for breast cancer who were referred to the Breast Imaging Unit (BIU) in 2019 at HJH. Patients were clinically assessed as low risk based on a triage form (Figure 4) and were identified using the imaging files stored in the BIU. Results were recorded on Microsoft Excel and calculated as per the American College of Radiology guidelines. RESULTS: The total population sample consisted of 398 patients. Two patients were characterised as BI-RADS 4 and underwent breast biopsies. One patient was diagnosed with histologically proven breast cancer. The CDR was 2.51% and the most representative age group was the 60 to 69 years one. The most common BI-RADS breast density assessment was group B while the most common BI-RADS risk assessment was category 2. CONCLUSION: Amongst the low-risk population, both the CDR and spectrum of disease was comparable that of a screening population. This may be due to the use of a triage system prior to imaging, as well as an increase in clinical awareness of breast cancer within a tertiary institution.Item An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital breast imaging unit(2021) Christofides, Nicholas ChristopherBackground: Benign breast pathology is a common presenting complaintand its assessment is important to characterize so as to not miss malignant pathology. At Helen Joseph Hospital (HJH) patients are triaged at the Breast Clinic according to the clinical suspicion of benign versus malignant disease. The patients are assigned a colourlabel based on their clinical presentation. This triage system affects waiting times between clinical examination and mammography appointments. This study aims to assess the association between clinical examination and the radiological and pathological findings of disorders deemed clinically benign and to ascertain the spectrum of benign breast disorders encountered at HJH. Method: A retrospective study of imaging results of patients at HJH presenting as clinically benign breast disorders from January –June 2018 was conducted. Assessed BIRADS score was noted and if core biopsies were performed, their results and patient demographics were documented. Results: Of the 1263 clinically benign patients presenting from January -June 2018 the radiological assessment was: BIRADS 1: 158 (12.5%), BIRADS 2: 685 (54.2%), BIRADS 3: 292 (23.1%), BIRADS 4a: 54 (4.3%), BIRADS 4b: 29 (2.3 %), BIRADS 4c: 21 (1.7%), BIRADS 5: 24 (1.9%). There were 133 biopsies (including 8 BIRADS 3 patients), with 46 (3.6%) confirmed malignancies. The combined specificity of mammography and ultrasound was 65.52 % (54.56% -75.39%) and combined sensitivity 91.30% (79.21% –97.58%). Conclusion: There is a vast spectrum of benign conditions presenting in this population group with only 3.6% confirmed malignancies, confirming an accurate triage system utilised at the breast clinic. Radiological imaging is highly sensitive but less specific emphasising the triad of clinical, radiological and histological assessment as the gold standard with regard to diagnosis of breast disease.Item An audit of the practice of red packed cell transfusion in neonatal surgery in an academic hospital(2024) Govender, KushalBackground: Neonates undergoing surgery are at greater risk of requiring red packed cells transfusion. Pediatric transfusion practices vary widely between countries and institutions, especially in the management of neonates. Aims: The aim of this study was to describe the practice of intraoperative red packed cells transfusion primarily, and blood products and fluid transfusion secondarily in neonates presenting for surgery. Methods A retrospective contextual and descriptive study was conducted at Chris Hani Baragwanath Academic Hospital. A total of 1077 anesthetic records of neonates who underwent surgery from 1 January 2015 to 31 December 2019 were reviewed. Descriptive and inferential statistics were used to analyze the data. Results: Three hundred and twenty seven (30%) neonates received intraoperative red packed cells transfusion. The median (IQR) volume of red packed cells, fresh frozen plasma, platelets and clear fluid administered was 15 (10 - 21.8) ml/kg, 12.3 (10 - 23.5) ml/kg, 13.6 (10 - 20.5) ml/kg and 19 (9.1 - 28.8) ml/kg respectively. Very low weight, low preoperative hemoglobin, long total anesthetic time, emergency surgery and major surgery were independently associated with blood product transfusion. Post-conceptional age, low and very low weight, blood product transfusion and major surgery were independently associated with the composite adverse outcomes. 3 Conclusions: Intraoperative blood product transfusion occurred up to three times more frequently in our study than in comparative studies. Weight-based dosing of red packed cells, blood products and clear fluids were in keeping with current recommendations. Further prospective cohort studies are recommended to inform an institution specific patient blood management program.Item Assessment of the management of inpatient hyperglycaemia by physicians and intensivists in South African hospitals(2024) Hewson, Peter Llewellyn BlanshardBackground Hyperglycaemia is highly prevalent in patients admitted to hospital and is associated with prolonged hospital stay, increased costs, morbidity and mortality. As there is currently limited local data on the management of hyperglycaemia, this study aimed to investigate physician practices in the management of inpatient hyperglycaemia in South African hospitals Methods: A survey investigated the practices of 154 physicians in general medical wards and intensive care units (ICUs) in the state and private sectors. To validate these responses, an audit of 100 general medical and 111 ICU patient files was performed at three major Johannesburg academic hospitals. Patients with inpatient hyperglycaemia related to diabetes mellitus (DM) or hospital-associated factors were included, while patients admitted with diabetic emergencies were excluded. Results: In the general medical wards, oral hypoglycaemic agents (OHAs) were used in the majority of survey respondents (94.5%) and audited files (64%). In the ICU, OHAs were used by 34.9% of survey respondents and 14.4% of audited patient files. Of the OHAs, metformin use was most frequently reported (93.8% in the survey) and used (64% in the audit) agent in the general medical wards, followed by sulfonylureas (SUs) (75.8% in the survey and 5% in the audit). In the critical care setting, the survey demonstrated frequent use of metformin followed by dipeptidyl peptidase-4 inhibitors (DPP4-i), while the audit showed that metformin and SU use was 14.4% and 0.9% respectively. Surveyed clinicians in general medical wards report most frequently using the basal insulin plus sliding scale insulin (SSI) regimen (36.6%), while the audit showed that SSI alone (36%) or premix insulin-based regimens (34%) are used most often. In the critical care setting, more surveyed clinicians reported using an insulin infusion (34.9%) compared to other insulin regimens, while the audit demonstrated that the majority of patients (59.5%) were managed with SSI alone. Four-to-six hourly glycaemic monitoring was noted as the standard of care in both surveys and audits. While the majority of clinicians reported daily review of their glycaemic management (91.7% and 87.3% of participants in the general medical wards and ICU, respectively), the audit revealed that this was noted in just 34% and 3.6% of participants in the general medical wards and ICU, respectively. Conclusion: Both the survey and audit demonstrated significant discrepancies from current clinical guidelines. This highlights a significant impact on patient care, in particular, as OHAs have not been recommended for use in the ICU setting, one in every three critical care patients may be exposed to potential complications as a result of the use of such agents. The findings of this study suggest further investigations regarding inpatient hyperglycaemia practices as well as implementation of education and in-hospital protocols are needed in the South Africa healthcare context in order to improve clinical outcomes.Item The authority of the United Nations Security Council to waive the personal immunity of heads of States in the context of international crimes(2019) Memela, SinethembaIn 1998, the Rome Statute of the International Criminal Court (ICC) was adopted with the aim of ending impunity for perpetrators of international crimes. Under Article 13(b) of the Rome Statute, if the United Nations Security Council (UNSC) refers a situation to the ICC while acting under Chapter VII of the UN Charter, the ICC is entitled to exercise jurisdiction over the territory and nationals of the relevant State that. In some cases, the referred State is neither a party to the Rome Statute nor has consented to its jurisdiction, and implicated senior officials of the state enjoy immunity. In terms of Article 27 of the Rome Statute, immunity does not bar the ICC from exercising jurisdiction. However, customary international law has historically afforded immunity to senior State officials, such as Heads of State, from prosecution. This dichotomy has been a challenge in international criminal law; specifically, the question of balancing the competing objectives of ending impunity for international crimes while maintaining stable relations and respecting the sovereignty of States by respecting customary international law rules on immunity. This challenge has been compounded by the question of the implication of a UNSC referral, of a non-State party to the Rome Statute, to the ICC on the immunity of implicated senior state officials of that State. Accordingly, this study is primarily concerned with whether, and the extent to which, the UNSC can waive the immunity enjoyed by senior state officials of UN Member States, particularly Head of State immunity, when it refers a situation to the ICC using its Chapter VII powers in the UN Charter. Before dealing with the above, the study analyses the concept of immunity, specifically personal immunity, in international law and the obligations of States to respect such immunity, taking into consideration their obligations under the Rome Statute as applicable.Item Automatic exchange of tax information and the right to privacy: a South African constitutional analysis(2021) Mia, Aisha BibiBroad-based automatic exchanges of information are increasingly viewed as the norm in global tax practice. The mass transmission of large amounts of personal and financial data creates informational risks and implicates the privacy rights of impacted data subjects. This investigation considers the interaction between broad-based automatic exchanges of information –specifically the Common Reporting Standard (CRS) and FATCA– and the right to privacy contained in section 14 of the South African Constitution. To date there has not been any authoritative legal precedent on this area and the available academic literature is also limited. Applying a doctrinal research method and drawing on the approach employed by the Constitutional Court when adjudicating Bill of Rights matters; a synthesis and analysis of various written sources was undertaken. The sources consulted include: legislation, South African case law, international law, treaty instruments, foreign case law, policy papers and academic literature. This study finds that the CRS exchange of taxpayer information is aimed at reducing global tax evasion and is reciprocal in nature. Additionally, the exchanges take place within a robust privacy framework. Accordingly, the CRS is constitutionally valid, with only limited opportunity to further enhance constitutional consonance. Contrastingly, the FATCA data exchanges are de facto unilateral. They cannot therefore be linked to any legitimate objective to improve tax compliance and revenues in South Africa. In this regard the investigation concludes that FATCA fails to pass constitutional muster.Item Balancing legality and certainty: the Oudekraal principles and their development(2020) Mahlangu, SiyabongaThis thesis is a study of the Oudekraal principles and their development. In Oudekraal Estates (Pty) Ltd v City of Cape Town 2004 (6) SA 222 (SCA), the Supreme Court of Appeal fundamentally transformed the approach of South African law to the anomaly that an unlawful administrative act may have legal consequences. The court rejected past explanations for this phenomenon, such as the presumption of validity, the distinction between voidness and voidability, the theory of legal relativity and, where the courts have declined to set aside unlawful acts on grounds such as delay, judicial pragmatism. Instead, the court developed a principled approach by which it sought to strike a careful balance between the competing rule-of-law values of legality and certainty. Four principles emanating from this seminal judgment are identified in the thesis. These are that an unlawful act may have legal effect for so long as it has not been set aside; that the legal effect depends on whether the validity of an originating act is a precondition for the validity of the subsequent act; that an unlawful act which compels a person to do or not to do something must be valid, and a person affected by it is entitled to challenge its invalidity collaterally; and that the court reviewing an unlawful act has discretion to refuse the remedy of setting aside even if a ground of review has been established. The thesis investigates how the courts since Oudekraal have interpreted, applied and developed these four principles. It concludes that there is an interplay between the various principles. In this interplay the Constitutional Court has recently tended to emphasise the value of legality over that of certainty, resulting in a lack of clarity as to what it means for an unlawful act to have legal effect prior to its being set asideItem Capacity development of service delivery structures and programmes in Bojanala Platinum District Municipality(2021) Mphahlele, MatukuBojanala Platinum District Municipality (BPDM), in the North West Province is a centre of the extractive economy in South Africa. The BPDM experiences challenges in relation to delivering quality public services. In this context, this thesis examines capacity development of service delivery structures and programmes of the local municipalities, in the BPDM, that is, Kgetlengrivier, Rustenburg, Madibeng, Moses Kotane and Moretele. In addition, the study explores the ways in which they can be overcome for enhanced service delivery. The BPDM is embedded in an extractive economy and experiences challenges of the largely heterogeneous and mobile population that results in high influx of labour migrants, socio-economic inequality, and unemployment that impact heavily on the municipal capacity to deliver services (Van Wyk, 2012; Alexander, Sinwell, Lekgowa, Mmope & Xezwi, 2012). Accordingly, the Mineral Petroleum Resource Development Act 28 of 2002 (MPRDA) unpacks legislative prescripts on what structures mining companies have to establish, how to monitor and report on collaborative Social and Labour Plans (SLPs) in conjunction with municipal Integrated Development Plans (IDPs) for enhancement of service delivery. Thus, the study also examines the nature of structures and programmes, facilitators and inhibitors of skills development initiatives and how mining companies as local partners facilitate or impede improvement in delivering municipal services to the community. Within the context of local government capacity development, this study develops a theoretical framing incorporating scholarship on human capital, performance improvement and collaborative participatory governance perspectives. This framing is premised on the scholarly evidence that capacity development is an enabler of service delivery, influenced by skills development, municipal performance improvement and collaborative participation. ii )To generate perspectives in relation to capacity development of service delivery structures and programmes, a qualitative case study approach, using interviews is adopted. Semi-structured interviews were undertaken with senior managers in the municipalities and the respective, locally based mining company. In addition to semi-structured interviews, documentary analysis and the descriptive statistics were employed. The study’s research questions examine the structures and programmes for enhancing capacity development in relation to service delivery. In addition, the study hones in on how local partners facilitate or hinder improvement in providing municipal services and how local municipalities better utilise their capacity development resources, including partnership with mining companies in relation to service delivery. This case study reveals that there are difficulties with respect to capacity development associated with skills retention, organisational relations and socio-political capacity building. The study concludes that political abandonment, poor communication and stakeholder engagements aggravate weakened inter-municipal co-operation and inadequate utilisation of resources. These challenges undermine cost-effective, efficient and effective implementation of capacity development of service delivery structures and programmes, underpinned by skills development and organisational learning. This study, suggests that socio-political resilience and administrative synergy are key enablers in the enhancement of service delivery. The thesis contributes to the body knowledge about the distinctive nature of the interface between learning and skills development, underscoring key enablers of improved capacity development of service delivery structures and programmes.Item Clinical spectrum and outcomes of idiopathic inflammatory myopathies at Chris Hani Baragwanath Academic Hospital(2024) Birch, Candice TatumBackground: Idiopathic inflammatory myopathies (IIM) are rare diseases for which there is a paucity of data in Africa. We undertook a retrospective records review of clinical and laboratory features of patients with IIM attending a tertiary service in Gauteng, South Africa. Patients and methods: Case records of patients seen between January 1990 and December 2019 and fulfilling the Bohan and Peter criteria for IIM were reviewed for demographics, clinical features, special investigations and drug therapy. Results: Of 94 patients included in the study, 65 (69,1%) had dermatomyositis (DM) and 29 (30,9%) had polymyositis (PM). Overall, the mean (SD) age at presentation and disease duration were 41,5 (13,6) and 5,9 (6,2) years, respectively. 88 (93,6%) were Black Africans. The most common cutaneous features in DM patients were Gottron’s lesions (72,3%) and abnormal cuticular overgrowth (67,7%). Dysphagia was the most common extra-muscular feature (31,9%), more so in PM than DM (p=0,02). Creatine kinase, total leucocyte count and CRP were similarly higher in PM than DM patients (p=0,006, 0,002, 0,01, respectively). Anti-nuclear and anti-Jo-1 antibodies were positive in 62,2% and 20,4% of patients tested, respectively, the latter significantly more in PM than DM patients (OR=5.1, p=0,03) and more likely to be positive with ILD (p=0,001). Corticosteroids were prescribed in all patients, 89,4% had additional immunosuppressive drugs and 6,4% required intensive/high care. Malignancies occurred in three patients, all of whom had DM. There were seven known deaths. Conclusion: The present study provides further insights into the spectrum of clinical features of IIM, especially cutaneous features of DM, anti-Jo-1 antibodies and associated ILD, in a cohort of predominantly black African patients.Item Colonisation with ESKAPE organisms and Candida auris among primary caregivers and healthcare workers in a neonatal unit at a public sector tertiary South African hospital(2024) Rees, NickiBackground: Nosocomial neonatal infection remains a significant cause of mortality and morbidity, particularly in the high care and intensive care settings. Among implicated pathogens ESKAPE- C organisms are considered particularly worrisome due to their virulence, ability to gain resistance and propensity to affect multiple sites. Transmission to neonates is postulated to occur through contact with colonised adults. Objective: This study aims to describe the prevalence of colonisation of both primary caregivers and healthcare workers in contact with admitted neonates. As a secondary objective this study aims to identify the most common resistance patterns in ESKAPE-C organisms isolated from primary caregivers and healthcare workers in a neonatal unit. The overall aim of the study is to provide insight into how best to prevent hospital acquired infections in this group. Methods: This cross-sectional prevalence study describes colonisation of healthcare workers (HCW) and primary caregivers in a neonatal unit in a tertiary South African hospital. Over one week in August 2021, twenty-five primary caregivers and twenty-nine healthcare workers submitted specimens which were processed for the identification of ESKAPE-C organisms. Susceptibility was performed on identified organisms. Results: Of the healthcare worker participants 13,8% (4/29) were shown to be colonised with one or more ESKAPE-C pathogen, while 52% (13/25) of primary caregivers were shown to be colonised with one or more ESKAPE-C pathogens. Of the S. aureus organisms isolated 28,6% were MRSA, of the A. baumannii organisms isolated 66.7% were XDR and of the Enterobacteriaceae isolated 60% were ESBL producing. No CRE or VRE organisms were isolated in this study. Conclusion: This study demonstrates that the prevalence of colonisation of healthcare workers and primary caregivers is significant and reinforces the need for stringent infection prevention and control strategies to prevent transmission to vulnerable neonates.Item Comorbidities in a cohort of privately insured South Africans with systemic lupus erythematosus(2024) Ntumba, Mbombo Henriette NganduBackground: Comorbidities in systemic lupus erythematosus (SLE) impact negatively health related quality of life and life expectancy. We undertook a retrospective study of the burden of comorbidities in privately insured South Africans with SLE. Methods: Data review of patients insured with Discovery Health Medical Scheme (DHMS), ≥16years at diagnosis, ≥6months follow-up and diagnosed with SLE based on ICD 10 codes. Demographics, drug therapy and comorbidities listed in the Charlson Comorbidity Index (CCI) and other comorbidities occurring commonly in SLE patients were documented. Results: Of 520 patients with SLE ICD 10 codes, only 207 met the other inclusion/exclusion criteria for data analysis. Most were women (90.8%), median (IQR) age and follow-up duration of 39 (30.3-53.0) and 6.1 (3.7-8.1) years, respectively. All patients had at least one comorbidity, the most frequent CCI comorbidities being pulmonary disease (30.9%), congestive heart failure (CHF) (15%) and renal disease (14.5%). Common CCI comorbidities were hypertension (53.1%), mood and anxiety disorders (46.9%), infections (urinary tract infections (UTI) (37.7%) and pneumonia (33.8%)). Independent predictors of 1) CHF were renal disease (OR=855), dyslipidaemia (OR=15.3) and male gender (OR=43.0); 2) hypertension were age at diagnosis (OR=1.03), type 2 diabetes (OR=4.45) and renal disease (OR=4.34); and 3) mood and anxiety disorders were female gender (OR=3.98), cerebrovascular accident (OR=3.18), UTI (OR=2.39) and chloroquine use (OR=1.94). Conclusion: Comorbidities in this cohort of privately insured South Africans with SLE were common, with all patients having at least one comorbidity. Hypertension, infections and mood and anxiety disorders were the leading comorbidities.Item Compliance of medical practitioners with diabetic treatment guidelines at Dr Yusuf Dadoo Hospital, West Rand Health District Gauteng(2024) Ohanson, N.J.Background: Diabetes (DM) is a common chronic condition. The prevalence is increasing globally and has become a common health care problem associated with multiple complications. Guidelines have been formulated to standardise care among people living with DM, with aim of optimising patient care and thus minimising the complications. Aim: The aim of this study was to assess how well health care practitioners in Dr Yusuf Dadoo Hospital complied with the most recent diabetic treatment guideline, SEMDSA 2017. Setting: This study was conducted in the out-patient department of Dr Yusuf Dadoo hospital in the Westrand Health district of Gauteng. Methods: A retrospective cross-sectional review of patient record living with diabetes was done. Three hundred and twenty-three Record of patients seen from August 2019 to December 2019 were reviewed and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017. Results: Files were audited in 4 main categories. Comorbidities, Examinations. Investigations, presence of complications. In terms of monitoring parameters, only 40(12.4%) had HbA1c assessed 6monthly, with annual creatinine assessed in 179(55.4%) and lipogram 154(47.7%) of patients. More than 70% of patients had uncontrolled glycaemia. More than 70% of patients had uncontrolled glycaemia. The most frequently documented target organ screening/examinations were foot related at 8.7% (28) and all of them had established complications. Only 2 people were screened for erectile dysfunction. Conclusion: Adherence to DM treatment guidelines was found to be poor. Monitoring and control parameters were infrequently done as per guideline recommendation. The resultant effect are poor glycaemic control and therefore numerous complications. The study site and thus the West rand needs targeted strategies to improve medical practitioner adherence to guidelines including adequate interpretation of results, timely intervention, when necessary, as a way to improve DM care and thus minimise the risk of complications amongst patients in the districtItem A critical analysis of the legal framework relating to cybercrime in Uganda(2021) Adesuyi, DaramolaThis dissertation examines the legal framework relating to cybercrime in Uganda and its effect on the enforcement of its terms. Investigating this issue is crucial in the wake of the rise in global interconnectivity as a result of the relative advances in technology, which challenge the application of the old standard of classification and investigation of traditional crimes. Unlike the advanced nations, the current laws regulating criminal conduct in most developing nations today are ill-equipped to cope with these emerging cybercrimes. Therefore, this dissertation argues that Uganda’s extant legal framework is manifestly inadequate to protect individuals from the threats resulting from cybercrime effectively. This view is held based on an analysis of the major procedural challenges and issues in Uganda today and a review of the current legal regime. This dissertation contends that, contrary to the common belief, merely enacting legislation, which is a ‘cut and paste’ of foreign cyber laws, does not automatically resolve issues related to cybercrimes in Uganda. Furthermore, the dissertation argues that useful lessons can be obtained from an effective legal regime based on insights from the Council of Europe Convention on Cybercrime, and South Africa. Similarly, other pragmatic ways of effective protection against cybercrime in Uganda are suggested to improve awareness and scholarship, strengthen law enforcement agencies and the judiciary, and improve cooperation with international and regional cybercrime regimesItem Enhancing access to justice in Kenya through clinical legal education(2021) Kotonya, Anne; Du Plessis, RietteThis thesis examines the endeavours of university law clinics towards enhancing access to justice in Kenya. It isolates the social justice function of clinics in countries with a pressing access to justice need as that of serving the indigent and orienting lawyers towards social justice in society. In exploring the interface between access to justice and legal education, it analyses the legal frameworks, distribution, structures, settings and projects of university law clinics in Kenya in relation to literature on clinical legal education (CLE). The thesis centres on the social justice mission of CLE as a way of aligning legal education with the country’s transformative constitutional framework. In this way, it capitalises on the clinics to foster transformative legal education. The thesis makes an original contribution to knowledge when it addresses the research gap on clinical legal education in Kenya and presents empirical data on the current forms of clinical programs in law schools in the country. It incorporates the voices of clinicians and student leaders and presents the challenges they encounter in their attempt to use clinics to enhance access to justice for indigent persons. The emphasis on social justice as well as the comparison with South Africa’s original clinics differentiates this thesis from the growing body of literature that centres on the pedagogical aspects of CLE. The thesis applies grounded theory, a vigorous qualitative research method to guide the collection and analysis of data. The theoretical explanation of the factors that enhance and those that resist the role of clinics in enhancing access to justice is grounded in data which was collected from purposively selected law schools. The data, obtained inductively from the interviews and focus group discussions, is also used to develop a theoretical explanation of the use of university law clinics to enhance access to justice in a transformative constitutional context. The thesis establishes a nexus between legal education and transformative constitutionalism as well as between CLE and transformative legal education. It begins by demonstrating the absence of a suitable framework for investigating the factors that resist or enhance clinics’ contribution to access to justice in a transformative constitutional setting. The thesis then locates clinics in Kenya in the context of the development of the legal profession, legal education and the constitutional history of the country. It develops a legal and institutional framework made up of a transformative constitution and legislation governing legal education, the legal profession and national legal aid schemes. Chapter three proceeds to apply this framework to Kenya and finds a legal framework based on strong constitutional foundations that in certain instances is also fragmented, inconsistent and marred by gaps. The exploration of the CLE experiences in the country is presented in chapter four. These find the curriculum, law students, academic staff and the place of clinic in the university as central to determining the form and structure of CLE in the respective institutions. The forms of clinics are reflective of the broad definitions of CLE that include Street Law and skills courses. They provide evidence of clinics that are skewed towards the social justice mission of CLE. The data also yields aspects of clinics that influence their role in access to justice. The thesis finds that clinical practice in Kenyan universities takes the form of both curriculum-based and extracurricular clinics, with the latter bearing a strong social justice orientation and the former a pedagogical one. The focus of CLE is inclined towards social justice, while its pedagogical mission remains underutilised. The thesis analyses factors that undermine the promotion of access to justice through CLE in Kenya. Identifying shortfalls in clinical practice in the country, it deduces that the clinical practices are indeed CLE but at its nascent stages. The findings are in harmony with literature that considers the twin missions of CLE as inseparable orientations that are not mutually exclusive. They show the Constitution of Kenya 2010 and legal aid legislation as providing further impetus for CLE beyond their original goals at inception. However, this impetus is not reciprocated by the policy and legal framework for legal education. In considering the dysfunction of the legal profession as the dominant institution in providing access to justice, the thesis deliberates on university law clinics as an institutional bypass for the provision of access to justice for the indigent in the country. It proposes university law clinics as the theory of change for the legal profession. The thesis makes suggestions for future research on the understanding that further steps need to be taken in Kenya to optimise both social justice and pedagogy that are the twin missions of clinical practiceItem Evaluation of medical interns’ knowledge and confidence in orthopaedic surgery at the University of the Witwatersrand's academic hospital complex in Johannesburg, South Africa(2024) Terreblanche, Michael HarlandBackground Junior doctors’ knowledge and confidence in the assessment and treatment of musculoskeletal disorders and injuries has previously been shown to be limited, both locally and internationally. This has far-reaching consequences, not least of which is sub-optimal patient care. The aim of this study was to evaluate the effectiveness of current undergraduate orthopaedic training in South Africa. Materials and methods Medical interns rotating through the orthopaedic departments of three academic hospitals in Johannesburg, South Africa were surveyed, using a validated questionnaire consisting of twenty-five questions, to assess their knowledge of orthopaedic surgery. Furthermore, they were asked to rate their self-perceived confidence levels relating to various aspects of the care of individuals with musculoskeletal problems using a 5-point Likert scale. The future career interest of the interns was also recorded. Results Seventy-eight completed questionnaires were included in this study for analysis. Ninety six percent (96%) of the medical interns in this study failed to achieve basic cognitive competency concerning knowledge of orthopaedic surgery. Three out of seventy-eight medical interns in this study achieved basic theoretical competency in orthopaedic surgery. The interns’ mean score in the 25-question examination was 40.7% (SD 13.4%) with a range of 17 – 69%. Ninety two percent (92.3%) of participants reported that they were either confident or highly confident in orthopaedic surgery. Future career choice had no influence on the knowledge of orthopaedic surgery. Conclusion The effectiveness of South African undergraduate training of orthopaedic surgery is deficient. Recent South African medical graduates’ knowledge of orthopaedic surgery is inadequate, with a mean score of 40.7% in the Freedman and Bernstein questionnaire, and only 3.8% of interns achieving theoretical competency. The graduates demonstrated inappropriate confidence in orthopaedic surgery with only 7.7% acknowledging a lack of confidence. Interns’ future career interest was not found to have a significant association with knowledge of orthopaedic surgery. This study suggests that, in South Africa, orthopaedic undergraduate training needs reform.Item Evaluation of outcomes in patients with pancreatic cancer and Human Immunodeficiency Virus at Chris Hani Baragwanath Academic Hospital and the Donald Gordon Medical Centre, Johannesburg(2024) Wing, Jessica RobertaBackground: Cancers which are not associated with Acquired Immune Deficiency Syndrome (AIDS) are increasing in incidence and mortality in the HIV-positive population. Pancreatic cancer (PC) is projected to be the second most common cause of cancer-related death by 2030. No literature exists on patients with PC and concomitant human immunodeficiency virus (HIV) infection in South Africa (SA), which has the highest number of HIV-positive people in the world. Objectives: To compare the demographics, stage, histological grade of disease, and survival outcomes of HIV-positive compared to HIV-negative patients diagnosed with PC. Methods: Records of patients diagnosed with PC were collected from Chris Hani Baragwanath Academic Hospital (CHBAH) and the Wits Donald Gordon Medical Centre (DGMC) from the 1 st of January 2013 to the 31st of December 2018. A total of 240 patients’ records were obtained. Demographic, clinical, and survival data were collected. Results: There were predominantly black Africans (64.6%) and males (54.6%) in the study. Although overall survival between the HIV-positive and negative patients did not differ (p=0.051), the median time of survival from presentation was significantly shorter in the HIV-positive compared to the HIV-negative patients (2.1 months; IQR 1.2-6.0 vs. 4.7 months; IQR 1.6-13.0; p=0.017). The HIV-positive cohort presented at a significantly younger age compared to the negative cohort (54.6; ±9.6 vs 62.4; ±11.1; p=0.0001) and at a more advanced stage of disease (72.2% vs. 43.1%; p=0.017). No difference was found between the histological grade of PC in both cohorts (p=0.298). The median survival time for HIV-positive patients on therapy at presentation was significantly longer compared to patients who were not (3.0; IQR 1.3-7.8 vs 1.1 months; IQR 0.9-1.9; p=0.037). Overall survival in patients who underwent pancreaticoduodenectomy at Wits DGMC was shown to be higher compared CHBAH V (41.7% vs. 12.5%; p=0.049). The majority of the patients presented with regionally advanced (30.6%) and metastatic (50.3%) disease. Conclusion: This is the first study in SA to provide insight into the clinical disease profile and survival outcomes of HIV-positive patients diagnosed with PC. This study has shown that HIV-infected patients with PC have a specific disease profile. Therefore, testing for HIV infection should be included in the management of all patients with PC, a higher index of suspicion for cancer should be maintained in younger HIV-positive patients and initiation of Antiretroviral treatment (ART) must be timeous.Item Examining The Use of Evaluative Evidence in Decision- Making Within Catholic Faith-Based Organisations(University of the Witswatersrand, Johannesburg, 2023) Ebong, Fotoh Paul; Masvaure, StevenCatholic Faith-Based Organisations are critical in contributing to social betterment through various development initiatives(Camilleri & Winkworth, 2004). The use of evaluations conducted in these organisations to enhance learning, programme improvement and eventually social betterment through informed decision-making is the concern of this research. Literature on the use of evaluations underlines the fact that evaluations are aimed at providing relevant information to various stakeholders for their decision-making and improvement of the evaluand as well as assessing their merits and worth (Alkin, 1975; Maloney, 2017a; Patton, 2012; Stufflebeam, 2001a). As a widely researched phenomenon, the use of evaluation has been identified by various authors to include instrumental use, conceptual use, process use, and symbolic use (Alkin & Christie, 2004; Johnson et al., 2009). The need to make evaluations useful has, therefore, been the driving force behind the development of the different approaches to evaluation, evaluation principles and standards, as well as the creation of various voluntary associations to sustain and promote the professionalism of the field (Stufflebeam, 2004). Even though Catholic faith-based organisations conduct evaluations, little is documented about the extent to which these evaluations were used in decision-making processes, if any, and what role the evaluation characteristic factors, organisational and human factors play in influencing use. To investigate the extent to which these organisations use these evaluations and the extent to which evaluation distinct variables play a role in enhancing use, a mixed method was undertaken to gather quantitative and qualitative data from 43 respondents who were selected purposefully among the eligible organisations for the study. A questionnaire was administered online, followed by key informant interviews. The findings show that most organisations make use of evaluations to inform practice. Still, since the evaluations are commissioned mainly by the funders, the willingness of these organisations to take the initiative of conducting their evaluations is less evident. To some, carrying out evaluations is merely to comply with the funding requirements rather than seeking evidence based upon which informed decisions can be made. Therefore, I recommend that Catholic faith-based organisations institutionalise monitoring and evaluation units within their organisations to strengthen their internal capacity to generate and use evidence in decision-making. This would equally build evidence-use awareness and establish a culture of evaluative thinking in organisational practices.
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