Electronic Theses and Dissertations (Masters)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37931
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Item Emergency Department Turnover Intention: Are Job Satisfaction and Burnout Really the Main Culprits?(University of the Witwatersrand, Johannesburg, 2022-11) Jonker, Yvonne Denise; Motara, Feroza; Moolla, MuhammedBackground: Patient presentations to emergency departments (ED) keep increasing. High staff turnover is detrimental to the healthcare worker (HCW), the organisation and the patient. While high levels of burnout (BO) and low levels of job satisfaction (JS) lead to a higher intention to leave (ItL), there are other factors affecting the ItL that need to be evaluated. Objective: To determine the levels of BO, JS and ItL, including when, where and why HCWs want to leave in order to find ways to reduce staff turnover. Methods: This was a prospective observational cross-sectional study conducted in two tertiary-level EDs in Johannesburg, South Africa namely Chris Hani Baragwanath Academic Hospital (CHBAH) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Doctors and nurses were invited to complete self-administered questionnaires between 24 November 2020 and 24 March 2021. After analysis the results for doctors and nurses and the two units were compared in order to bring understanding to the different facets affecting staff turnover. Results: A total of 78 respondents (66% of doctors and 58% of nurses) completed questionnaires and were included for analysis. According to the Copenhagen Burnout Inventory 79% of CHBAH doctors, 62% of CHBAH nurses, 79% of CMJAH doctors and 84% of CMJAH nurses suffered from severe personal burnout, while 68% of CHBAH doctors, 62% of CHBAH nurses, 95% of CMJAH doctors and 68% of CMJAH nurses suffered from severe work-related BO and 42% for CHBAH doctors, 24% of CHBAH nurses, 47% of CMJAH doctors and 32% of CMJAH nurses had severe patient-related burnout. Doctors had significantly higher patient-related burnout (p=0.012). JS was average for all staff but nurses were significantly less satisfied (p=0.003). While 42% of staff intended to leave within a year, of which half wanted to leave as soon as possible, a total of 73 % wanted to leave within 5 years. CMJAH staff had higher levels of BO, lower levels of JS and higher levels of ItL. Higher levels of BO and lower levels of JS increased the ItL. The main reasons for leaving were career-related. Conclusion: Burnout levels were higher than similar populations before and during the Covid-19 pandemic, while job satisfaction levels were average. Although burnout and job satisfaction affected intention to leave, the main reasons for wanting to leave were career-related indicating that even when work conditions and burnout could be addressed successfully, the turnover of staff in tertiary level EDs may remain high.Item Histopathological Spectrum of Conjunctival Lesions at St John Eye Hospital(University of the Witwatersrand, Johannesburg, 2023-07) Mofokeng, Thabiso; Welsh, NicoleBackground: Various non-invasive modalities have been described in diagnosing conjunctival lesions but histology remains the gold standard. Shortages in ophthalmology services and pathology laboratories in non-urban areas is one of the main reasons for delayed presentation and appropriate treatment in sub-Saharan Africa. The purpose of this study is to determine the spectrum of histopathologic findings in conjunctival lesions from patients at St John Eye Hospital (SJEH). Materials and Methods: Data of patients who underwent conjunctival surgical biopsies was retrieved from the main theatre register of SJEH for a period of 3 years, starting from 1st November 2016 to 31st October 2019. This data was used to retrieve histology reports from National Health Laboratory Services (NHLS). Results: A total of 679 patient records were retrieved from the theatre register, only 585 histology reports from 584 patients could be analysed. There were 305 benign lesions with pterygia making up most of the benign lesions with a total of 249 (42.56%). A total of 174 premalignant lesions were recorded with severe ocular surface squamous neoplasia (OSSN) making up the bulk of premalignant lesions, 147/174(84.48%). Squamous cell carcinoma (SCC) was the main malignant lesion, 102 reported cases of a total 106 malignant lesions. The age ranged from 1 to 90 years with mean of 43.14 years. The patients were predominantly black, Caucasians constituted only 1%. The average age for SCC was 41.3 years, severe OSSN 43.6 and pterygia 46.3 years. Benign and premalignant lesions had a slightly higher predilection for females at 55.4% and 58.6% respectively. Males had a slightly higher predilection of malignancy at 54.7%. Conclusion: Pterygia are the most common excised benign conjunctival lesions and severe OSSN is the most common premalignant lesion excised at SJEH. SCC made up the bulk of conjunctival malignancies excised at SJEH. Pterygia, OSSN and SCC presents in a significantly younger age group when compared with reports from Europe, North and South America.Item Surgical aortopulmonary shunts - a thirty-seven year experience in a South African tertiary institution(University of the Witwatersrand, Johannesburg, 2019-11) Dladla-Mukansi, Nontobeko Charity; Cilliers, Antoinette; Mammen, Vijay; Vanderdonk, KathyIntroduction: The surgical aortopulmonary shunt is a valuable palliative procedure in the management of congenital heart diseases. There is a paucity of data regarding aortopulmonary shunts in the developing world, including South Africa. Objectives: The primary objective was to describe the demographic, clinical and echocardiographic characteristics of children between ages 0 and 14 years that underwent surgical aortopulmonary shunts. The secondary objectives were to describe trends in aortopulmonary shunt designs, outcomes in terms of morbidity and mortality, progression to definitive surgery and to assess patency of shunts. Material and Methods: A retrospective clinical audit of patient files who underwent an aortopulmonary shunt between 01 January 1980 to 30 December 2016 was undertaken at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg. The study period was divided into 3 stages and for descriptive purposes as follows: 1980-1991 refers to period 1, 1992-2003 refers to period 2 and 2004-2016 refers to period 3. Results: A total of 177 aortopulmonary shunts were done over the 37-year study period. Of these 177 patients, 165 (93.2%) patient files were available. Fifty-six percent of the patients included in the study were male. The majority of patients were from the Gauteng Province (76.8%). The four most common diagnoses across the entire study period were tricuspid atresia (26.0%), pulmonary atresia with VSD (23.7%), tetralogy of Fallot (23.2%) and complex cardiac lesions (16.9%), with no particular trend in the proportion of these diagnoses presenting across this study period. There was no statistical difference between period 1 and 2 (p-value a=0,328) and between period 1 and 3 (p-value b=0,548). The total number of all surgeries done over the entire study period was 2145, of which 8.3% were aortopulmonary shunts. Period 1 had the highest percentage [35 (10.9%)] of aortopulmonary shunts compared to the total number of surgeries performed. There was a decline in the number of aortopulmonary shunts performed over the study periods 1-3. With no statistical difference across periods as shown in table 1 with p-value a and b. Of the different types of aortopulmonary shunts, most patients [157 (88.7%)] had a modified Blalock-Taussig shunt (BTS). The remainder of the shunts included 3 (1.7%) classic BTS, 12 (6.8%) central shunts and 5 (2.8%) unknown BTS. The percentage of modified BTS done increased from 80% in period 1 to 87.3% in period 2 and to 95.2% in period 3. Period 1 had the most complications (28.6%) compared to 11.4% in period 2 and 19.1% in period 3. Sepsis as a complication following surgery increased over the study period from 2.9% in period 1 to 3.8% and 7.9% in periods 2 and 3 respectively. Early mortality was 17.1%, 26.6% and 25.4% from periods 1-3 respectively. Late mortality declined from 17.0% in period 1 to 11.4% and 0% in periods 2 and 3 respectively. Only 37 (20.9%) patients were documented to have further surgery after the initial aortopulmonary shunt. Across all three study periods, no blocked shunts were documented. Conclusions: This study describes the characteristics and outcomes of aortopulmonary shunts over a 37-year period in a tertiary care resource limited low to middle income country setting. The commonest cardiac lesions for which aortopulmonary shunts are performed are tricuspid atresia, pulmonary atresia with VSD, tetralogy of Fallot and other complex cyanotic cardiac lesions. The frequency of aortopulmonary shunts compared to total surgeries has corrective surgery for these cardiac lesions. The modified BTS is the most frequently performed aortopulmonary shunt used for palliative surgery in our setting, which is a similar trend in developed countries. The morbidity and mortality in this study is higher than developed countries, with sepsis being the most common complication. Attention to infection control practises need to be emphasized peri- and post-operatively in our hospitals.Item A retrospective study of the biochemical and radiological profile of children with genetic hypophosphatemic rickets and their response to conventional treatment(University of the Witwatersrand, Johannesburg, 2023-11) Isaac, Nikhila; Thandrayen, KebashniObjectives: Assessing the biochemical and radiological profile of children with genetic hypophosphatemic rickets and their response to conventional treatment. Design: Retrospective descriptive study. Setting: Metabolic Bone clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Subjects: Children less than 18 years, attending the Metabolic Bone clinic from 1st January 2006 to April 2020, with genetic hypophosphatemic rickets, commenced on conventional treatment. Results: Seventy patients met the inclusion criteria. Majority of patients were black South African (n=54 (77%)). Positive family history seen in 32 (46%) patients. The patients were short statured with a mean height for age z score (HAZ) of - 3.4 ± 1.79. The mean calcium, phosphate, alkaline phosphatase, parathyroid hormone levels and median Thacher score was 2.3 ± 0.16 mmol/L, 0.84 ± 0.19 mmol/L, 776.6 ± 531 IU/L, 7.15 ± 4.8 pmol/L and 8 (4-8) respectively. Improvement on last follow up on treatment was seen in ALP (776 ±531 vs 525±232; p <0.001) and Thacher scores (8 (4-8) vs 2 (1-3.5); p =0.01) after 5 years, but no change in phosphate or HAZ. Conclusion: Conventional therapy for treatment of hypophosphatemic rickets is not associated with an improvement in HAZ despite an improvement in radiology and ALP. Adherence is a major challenge for the majority of patients.Item An audit of early complications after endonasal transsphenoidal resection of pituitary adenomas at Chris Hani Baragwanath Academic Hospital: a 5 year review of record(University of the Witwatersrand, Johannesburg, 2023-10) Mohale, Masedi Selby; Ouma, John R.Background: Endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas is a common procedure done at Chris Hani Baragwanath Academic Hospital (CHBAH) due to a significant number of patients requiring the procedure at the institution. Post-transsphenoidal tumour resection complications may not be common but if unrecognised, they may result in significant morbidity and even mortality and hence it is of paramount importance to evaluate factors that may predict the occurrence of these various complications so as to improve vigilance and be able to monitor and manage them appropriately to avoid disastrous outcomes following EETS. However, there is no study has ever been conducted to clinically audit early complications associated with EETS at CHBAH. Even though literature suggests that complications associated EETS are not common. It is with outmost importance that they are monitored and managed appropriately as some of them may lead to chronic disability or death. Aim of the study: The aim of the study is to evaluate early complications following endoscopic endonasal transsphenoidal surgery of pituitary adenoma. Methodology: The study is a retrospective research study which evaluated early complications following EETS of PA at CHBAH. Also, investigated in this study was the factors that are associated with the occurrence of the complications, including the clinical outcomes following EETS. The study was a clinical audit that collected and analysed data from the medical records. Data was collected from medical records of patients with PAs who have undergone EETS’s from January 2016 until December 2020. CHBAH does an average of four EETS’s every month. A period of five years is defined as a suitable criterion for a clinical audit, and it is a reasonable period for a pool of study participants. The determination of sample size was performed in consultation with a biostatistician who recommended an estimated sample size of one hundred twenty (120). Descriptive analysis of all statistical data was analysed using Statistical Package for the Social Sciences (SPSS) version 24 (SPSS inc., Chicago, IL, USA). Results: The sociodemographic characteristics indicated that the majority of the study participants in non-functional PA group were males while the majority of the study participants in the functional pituitary adenoma group were females. The observation that there were more males than females in the non-functional pituitary adenoma group was expected, and the findings of the current study are in agreement with other several research studies. Also, the observation that there were more females in the functional pituitary adenoma group was not unexpected. These findings were also not surprising and were also in agreement with other previous studies. In bivariate analysis, study participants whose age were 20 - 40 years, and ages above 40 years were found be associated with the likelihood of occurrence of early complications of EETS of PA, including study participants whose tumour extensions were suprasella and parasella. These findings were not unexpected considering that prevalence of early complications vary depending on several factors, such as the size and location of the tumour, the experience and skill of the surgeon, and the patient's overall health status. Conclusion: The result of the current study confirms the notion that early complication of EETS of PA are rare.Item An audit of anaesthetic charts at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2022-04) Nkadimeng, Lebohang Matau; Gilliland, Lizil; Nel, Dorinka; Mashinini, MduduziBackground: The anaesthetic chart is an important component of a patient’s health record in the perioperative period. Studies have shown that anaesthetic charts are often incomplete. The adequacy of chart completion in the anaesthetic department at Chris Hani Baragwanath Academic Hospital (CHBAH) has never been quantified. An audit was done, and the charts were assessed for adequacy of completion. Methods: A retrospective audit of anaesthetic charts was done for the year 2019. Using a peer reviewed checklist adapted from the Australian and New Zealand College of Anaesthetists (ANZCA) and the South African Society of Anaesthesiologists (SASA) guidelines, a sample of 333 charts was audited to assess adequacy of completion. To eliminate sampling bias, a stratified sampling method was used. Results: Completeness was defined as a chart scoring 100%. None of the charts scored 100%. The overall median score of the charts was 77%. Charts were subdivided into three groups. Charts scoring between 75-99% (n=212), 50-74% (n=121) and charts less than 50% complete (n=0). Patient category (adult versus paediatrics), time of shift (day versus night) and type of anaesthetic were audited and compared as factors that could affect chart completeness. The only factor that had a statistically significant difference in chart completeness was the patient category, where adult chart completion scored higher compared to paediatric charts with a p-value <0.0074. Conclusion: In conclusion the charts audited scored higher than previous audits done both locally and internationally. Some important aspects of the charts were poorly documented. Ongoing audits and training on chart completion can potentially improve the adequacy of completion and should be part of the academic program. Better documentation has the potential to improve perioperative patient care and mitigate medicolegal risks.Item Retrospective audit of the appropriate use criteria for ventilation/perfusion imaging in pulmonary embolism in a South African population cohort(University of the Witwatersrand, Johannesburg, 2023-09) Sibindlana, Amanda Patiswa; Vangu, Mboyo-Di-Tamba; Malan, Nico; Momodu, JaleelatBackground: Venous thromboembolism (VTE) is blood clot formation comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). Stasis, endothelial dysfunction and hypercoagulability place an individual at increased risk for developing DVT. VQ scans are crucial to determine the appropriate treatment in patients. The use of VQ scans is addressed in several clinical scenarios, including pregnancy, renal failure, contrast allergy, haemodynamic instability and abnormal chest X-ray findings. Aim: This study assessed the appropriateness of VQ scan requests received by the nuclear medicine departments at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: The appropriateness of referrals and VQ scintigraphy in patients with suspected PE at CMJAH and CHBAH nuclear medicine clinical departments was determined. A retrospective audit was done on the request forms of patients referred for VQ scintigraphy to a diagnose pulmonary embolism over five years from 01 January 2015 to 31 December 2019. The clinical information in the request forms was compared to the appropriate use criteria (AUC) to determine the level of appropriateness and categorised as appropriate, maybe appropriate and rarely appropriate. Statistical software (STATA) was used for data analysis. T-tests were used for continuous variables, and Pearson’s chi-squared tests were used for dichotomous data. A p-value of <0.05 was considered statistically significant. Results: A total of 1167 records were reviewed, and fewer than 50% of the referrals were found to be appropriate overall. There were 440 records that fitted the relevant criteria, 580 were rarely appropriate, and 149 maybe appropriate. The median age of individuals referred was 45 years. Most records were for females, with 321 (73%) falling into the appropriate category. There were 72 (13%) confirmed pregnancies and 17 (24%) were appropriate for a VQ scan. The average D-dimer concentration for these patients was 2.15 mg/L. The average D-dimer concentration was the highest in patients where referrals for VQ scans were considered as maybe appropriate (2.6 mg/L; 1.18 – 6.7) compared to an average D-dimer concentration of 2.5 mg/L (1.35 – 6.78) in patients appropriately referred for VQ scans and 0.68 mg/L (0.41 – 1.51) for patients inappropriately referred for VQ scans. Some patients were still referred for VQ scans to exclude the possibility of PE. Conclusion: The criteria used for referrals in our clinical setting were found insufficient due to the inefficient system and criteria used to refer patients in our clinical setting. This may result from a lack of required information and standardisation of the assessments with which clinicians judge the patient’s risk for PE/VTE. This was the case even in a largely female cohort with many concurrent risk factors.