Electronic Theses and Dissertations (ETDs) - Items to be moved to 3. Electronic Theses and Dissertations (ETDs).
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
For queries relating to content and technical issues, please contact IR specialists via this email address : openscholarship.library@wits.ac.za, Tel: 011 717 4652 or 011 717 1954
Browse
11 results
Search Results
Item The learning styles and study behaviours of Anaesthetists in a postgraduate training programme(2017) Mahomed, SameerahThe Part I examination in anaesthesiology in South Africa has historically attracted a low average national pass rate of 50% or less. The medical and educational literature has shown that students’ approaches to learning, amongst other factors, may impact their educational and assessment outcomes. Therefore, the aim of this study was to describe the learning styles and study behaviours of anaesthetists in the postgraduate programme at Wits, particularly in the context of their preparation for the Part I examination. A prospective, cross-sectional, contextual, descriptive study was conducted amongst all anaesthetists who were on the Wits circuit, who had attempted the Part I examination from 2010 to 2015. A self-administered questionnaire was used for data collection. Measures were put in place to maintain confidentiality of the participants, as well as to ensure validity and reliability of the study. This study showed that anaesthetists at Wits were diverse in their approaches to learning, with average scores of 70% for deep learning, 67.8% for strategic learning and 60.8% for surface learning styles. Females were significantly more strategic than males (p=0.03) and those who had passed on first attempt at the Part I examination scored significantly higher on the “organised studying” sub-scale (p=0.048). This study further suggests that the anaesthetists may not necessarily be attuned to the requirements of adult learning when compared to their international counterparts in other disciplines. This may be a result of various academic and non-academic challenges cited by the anaesthetists in their experience with the Part I examination. In attempting to overcome these challenges, the anaesthetists had to adapt their study behaviours and develop effective coping mechanisms in order to be successful in the examination. This study further emphasises the need for constructive alignment within the adult educational system.Item Inter-rater variability between anaesthetists when classifying patients the american society of anesthesiologists physical status (ASA-PS) classification system(2018) Soni, Zaheera JalaluddinBackground Anaesthetists convey the physical state of patients by use of the American Society of Anaesthesiologists Physical Status classification system (ASA-PS). It is a simple, popular tool with many uses, but not without fault, where variation between anaesthetists when classifying patients exists. To date there is no South African study comparing inter-rater variability between anaesthetists particularly between junior and senior anaesthetists. Our study includes scenarios with patients with Human Immunodeficiency Virus (HIV). A „modifier‟ and it‟s level of acceptance is also proposed. Method A questionnaire comprising of two parts was distributed. The first part assessed demographics and attitude towards a proposed “modifier” and the second consisted of ten hypothetical case scenarios which were created to incorporate a wide variety of conditions including Human Immunodeficiency Virus (HIV). Results After receiving 134 of the 200 questionnaires distributed, 132 were analysed. There were 93 juniors and 39 seniors. A Cohen‟s kappa statistic over all the scenarios of 0.23 (fair agreement) was determined. In none of the scenarios was there complete agreement. In each case there was a majority viewpoint shared by both juniors and seniors except Scenario 2. Large ranges were found in scenarios which included pregnant, geriatric and emergency patients. Conclusion Results are in keeping with other studies. Inter-rater variability is prevalent despite guidelines being available. A simple modifier such as letter “G” denoting a gravid patient may be acceptableItem Use and fit of filtering facepiece respirators in a department of anaesthesiology(2018) Niemandt, MarthinetBackground: Reliable protection against nosocomial tuberculosis transmission in theatre depends on the appropriate use of filtering facepiece respirators (FFRs) with an N95 filter, as recommended by the Centers for Disease Control and Prevention. Aim: To describe anaesthetist compliance and comfort with the use of FFRs, followed by donning technique and fit tests outcomes. Design: Prospective, contextual, descriptive, two part study. Setting: Part 1 was done in a university affiliated department of anaesthesiology. Part 2 was a pilot study in the theatre complex of a 1200-bed tertiary-level academic hospital. Participants: Part 1 – anaesthetists in the department selected by convenience sampling (n=140). Part 2 – anaesthetists selected by stratified random sampling (10 male and 10 female). Methods: In Part 1 a self-administered questionnaire was distributed. In Part 2 the donning technique was directly observed, corrected, then followed by qualitative fit testing with the single model and size FFR available. Results: Part 1 -Compliance with the use of the FFR was inadequate with a compliance score of 14.5 (SD 5.0) out of 25. FFRs are deemed to be uncomfortable (discomfort score of 9.9 (SD 4.0) out of 21.) Part 2 - Of the 20 anaesthetists, six (30%), five males and one female, passed the fit test. Conclusions: Compliance with FFR use was poor and anaesthetists at the research institution found the FFRs uncomfortable. FFR donning technique was observed to be lacking. Research with a larger study group is required. Poor fit test results were most likely due to the availability of only one size and model of FFR.Item Anaesthetists’ practice of awake fibreoptic intubation in adult patients(2018) Van Rooy, ElizabethBackground Awake fibreoptic intubation (FOI) remains the gold standard management of the anticipated difficult airway. An organised approach will ensure success and patient comfort. Training has to be rigorous to instil confidence. Exposure, practice and level of confidence of awake FOI in the Department of Anaesthesiology at the University of the Witwatersrand (Wits), is not known. Methods Anaesthetists were surveyed with an anonymous self-administered questionnaire. A total of 130 questionnaires were distributed at departmental academic meetings over five months and 126 (96.9%) questionnaires were returned. Results The majority (41.2%) had only performed one to five awake FOIs, 12.7% had performed 21 to 50, but 13.5% had never performed any. The majority were trained on asleep (39.8%) and awake (31.9%) patients. Only 20.4% had manikin, and 4.2% simulator training. While 58.7% had reasonable levels of confidence, 41.3% had low confidence. Midazolam (35.0%) and fentanyl (26.7%) were the most commonly used drugs for sedation followed by remifentanil (16.1%) and dexmedetomidine (12.2%). All topicalised the airway prior to awake FOI. Lignocaine 2% was the drug of choice (72.2%). Techniques included application of soaked swabs (23.4%), spray (22.8%), spray-as-you-go (18.7%), nebulisation (16.4%), gel or ointment (8.8%), transtracheal block (6.4%) and gargle (2.9%). Conclusion Anaesthetists in the Wits Department may not be adequately exposed to awake FOI and demonstrated a marked variability in sedation and topicalisation practices.Item Personality profile of anaesthetists in a Department of Anaesthesiology(2017) Segal, CraigBackground: Personality assessment has potential implications in anaesthesiology for recruitment into specialist programs, performance outcomes and identifying risk for burnout or psychological distress. The personality traits of anaesthetists can predispose them to occupational stress and burnout. Moreover, anaesthesiology is an inherently stressful workplace. Different researchers have found personality types to be prominent in subsets of doctors. The aim of this study was to describe the personality profile of the anaesthetists working in a department of Anaesthesiology. Methods: A descriptive, prospective, contextual study design was used. The Short Temperament-Character Inventory (TCI-140) is a self administered personality questionnaire and was used to describe the personality profile of anaesthetists. Results: Anaesthetists in the sample had low Novelty Seeking (median 25%), average Harm Avoidance (median 37%), average Reward Dependence (median 47%), high Persistence (median 70%), high Self Directness (median 87%), high Cooperativeness (median 73%) and average Self Transcendence (median 34%). Forty participants were classified as extreme temperament personality types. One participant was an immature personality type. Conclusions: : Male anaesthetists scored as low Harm Avoidance compared to average for female anaesthetists. There was no significant difference between anaesthetists of different ages. Senior anaesthetists scored low for Harm Avoidance and Self Transcendence compared to average for junior anaesthetists for those dimensions. The personality profile of anaesthetists in this sample is similar to other studies and reflects qualities required for the practice of anaesthesiology.Item The accuracy of anaesthetists in the depth of oral endotracheal tube placement in an academic hospital(2017) Campbell A, Ryan JonathanBackground: Endotracheal intubation is currently the proverbial “gold standard” for securing and protecting a patient’s airway. However, endotracheal tube (ETT) misplacement is a recognised complication of intubation and can result in significant patient morbidity and mortality. The aims of this study were to describe anaesthetists accuracy at placing oral ETTs to the correct depth, factors which influenced this accuracy and the methods used by anaesthetists to confirm correct ETT placement. Methods: A prospective, contextual, descriptive research design was used. The sample included 138 adult patients presenting for elective surgery requiring oral ETT insertion, and the anaesthetists intubating these patients. Recorded variables included patient age, gender, height, ETT position at the front upper incisors, ETT tip to carina distance and the methods used by anaesthetists to confirm correct ETT placement. Results: Only 45.7% of ETTs were accurately placed with 34.8% being too deep. There were significantly more deep ETT misplacements in females (p=0.0231), and patients with deep ETT placement were significantly shorter than those with accurate ETT placement (p<0.05). The number of methods used by anaesthetists to confirm correct ETT placement did not influence accuracy (p=0.4014). Neither the 21/23 cm nor the 20/22 cm methods were shown to improve the accuracy of ETT placements. Endotracheal tube distance measured at the front upper incisors was weakly correlated to the ETT distance measured above the carina in female patients but not in males. Conclusion: Endotracheal tube misplacement is a frequent event in the intraoperative period, and potential risk factors identified included female gender and extremes of height. Endotracheal tube placement should be individualized. Airway ultrasound is a point of care test that could potentially help confirm correct ETT placement.Item The perceptions and effects of sleep deprivation in anaesthetists(2016) Sanders, Megan AdelBackground: Sleep deprivation is known to have multiple pathophysiological, psychological and cognitive effects. The effects of sleep deprivation on anaesthetists have been recognised both within and outside of the workplace. Guidelines and strategies have been proposed to counteract some of the effects of sleep deprivation. This study investigated the perceived effects of sleep deprivation amongst anaesthetists. Method: A prospective, contextual, descriptive research design was followed for the study. Anaesthetists completed a questionnaire regarding perceptions and effects of sleep deprivation and the Epworth Sleepiness Scale (ESS). Results: A mean longest time spent without sleep due to work schedule of 31 (SD 9.1) hours. The mean score from the ESS was 11.5 (SD 4.4), indicating mild sleepiness. Sixty-one (57%) anaesthetists reported insufficient sleep due to work schedule 1 to 2 nights per week and the majority reported perceptions of the effects of sleep deprivation at work in the 1 to 2 times per week category. Sixtytwo (57.9%) anaesthetists have dozed off in theatre during the day and 85 (79.4%) have dozed off in theatre on a night call with varying degrees of regularity. Fifty-two (48.6%) anaesthetists perceived making mistakes related to sleepiness and 74 (69.2%) making mistakes unrelated to sleepiness. Due to sleepiness, 44 (41.1%) anaesthetists reported a percutaneous injury, 101 (94.4%) anaesthetists admitted to feeling at risk of a motor vehicle accident and 99 (92.5%) anaesthetists missed social or family activities because of sleepiness. Strategies to reduce sleepiness were assessed. Eighty-seven (81.3%) anaesthetists consumed at least one caffeinated beverage per day. Conclusion: Anaesthetists reported perceptions of inadequate sleep and the subsequent effects. The mean score from the ESS indicated a mild sleepiness level. Few anaesthetists used strategies to reduce the effects of sleep deprivation.Item An audit of syringe labelling practices of anaesthetists at four academic hospitals(2016) Tshabalala, Mologadi PrideBackground Drug administration errors have seen a marked rise in the medical fraternity. In anaesthesia these are expected to be higher as for any anaesthetic given, multiple drugs are administered. Although many risk factors have been identified as causes of medication errors, in anaesthesia in particular, syringe labelling has been identified as an easily preventable source of medication error. Methodology The aim of this study was to audit the syringe labelling practices of anaesthetists in four academic hospitals affiliated to the University of the Witwatersrand. The research design used to conduct the study was a prospective, contextual and descriptive one. The study population was all syringes prepared for anaesthesia during the course of the data collection days at the four academic hospitals. A consecutive convenience sampling method was used to collect the data Results A total of 279 syringes were included in the study. Of the 279 syringes, 242 (87%) were labelled. Six (2%) of the 242 labels were colour coded. A total of 37 (13%) syringes had no labelling at all. All labelled syringes had the name of the medication present, either in full or abbreviated. Two hundred and nine (86%) of the labelled syringes had the dose and/or concentration of the medication. Fifteen (6%) of syringes had date, 6(2%) had time. A total of six (2%) syringes had a signature of the person who prepared the drug and one (0.4%) had a signature of the person that checked the drug. The majority 193 (69%) of syringes had only two out of the six required labelling items. Conclusion This study revealed that syringe labelling practices of anaesthetists in the four academic hospitals associated with Wits did not meet the recommended standards. It is recommended that a standard operating procedure for syringe labelling be introduced as studies have shown that syringe labelling is an easy way of preventing and/or reducing medication error.Item Vitamin D levels of anaesthetists in the department of anaesthesiology at the University of the Witwatersrand(2016) Kelly, Eugene HamertonBackground and Objective There has been a recent resurgence of interest in vitamin D and its far-reaching effects in physiology and pathophysiology. Theatre personnel, and all indoor workers, should be cognisant of vitamin D deficiency as a real occupational hazard. Vitamin D deficiency is a global problem that has been studied extensively in colder climates and even been found in warmer climates. No research was identified among medical personnel in South Africa. The primary objective of this study was to describe serum 25-hydroxyvitamin D (25(OH)D) levels of anaesthetists. The secondary objective was to describe and compare factors influencing vitamin D levels in anaesthetists who are vitamin D insufficient to those who are not. These factors included: ethnicity, gender, body mass index (BMI), multivitamin use, calcium or vitamin D supplementation, sun exposure, vitamin D intake from diet alone, vitamin D intake from diet and supplementation and calcium intake (dairy). Methods Data was collected over a period of one month, in winter (mid-July to mid-August 2013). On the morning of sample collection anaesthetists agreeing to participate signed the informed consent (Appendix 2), prior to enrolment in the study. The anaesthetists then completed the questionnaire (Appendix 5). The following data was obtained from the questionnaire: age, gender, ethnic group, dietary supplementation, sun exposure, sunscreen use, BMI and diet. Each participant had 5 ml of blood collected in a standardised manner into a purple top ethylenediaminetetraacetic acid blood specimen tube. The processing of samples was done by qualified laboratory personnel using standard chemical pathology equipment and procedures. High Performance Liquid Chromatography was performed to determine 25(OH)D levels using a Shimadzu® Nexera X2 Ultra performance liquid chromatography system with a photodiode array detector (Shimadzu®, Japan). Results The median 25(OH)D was 43.8 nmol/l (IQR 26-76), with 51 of 89 (57.30 %) anaesthetists being vitamin D insufficient. There was a statistically significant association between ethnicity and vitamin D status (p<0.001). Twenty-one (80.77 %) Indian anaesthetists and 14 (70.00 %) black anaesthetists were vitamin D insufficient, as compared to only 10 (28.57%) white anaesthetists. There was no significant association between the other secondary objectives-gender (p=0.60), sun exposure (p = 0.93), vitamin D intake from diet alone (p= 0.07), vitamin D intake from diet and supplementation (p=0.05) and calcium intake (p=0.55) and vitamin D status. There was no significant difference between BMI and vitamin D status. When a comparison was made between the two groups of BMI <25 and BMI ≥25, using a Mann-Whitney test the two-tailed P value was 0.6791. There was a significant association between multivitamin use (p=0.01) and vitamin D status. Conclusion Vitamin D should no longer be a forgotten vitamin. The insufficient vitamin D levels of anaesthetist in this study, puts them at risk for pathology far beyond bone health. Adequate vitamin D levels should be seen as essential, rather than optional, even in “sunny” climates.Item Anaesthetic nurses knowledge of commonly used drugs in four academic hospitals(2016-10-17) Ngwenya, Makhosazana BusisiweLack of pharmacology knowledge among nurses can result in adverse events and medical errors which can have serious consequences for the patient. The South African Society of Anaesthesiologists (SASA) states that a trained anaesthetic assistant is necessary for the safe and efficient conduct of anaesthesia. Literature worldwide have shown that pharmacology knowledge of nurses is lacking. Knowledge of anaesthetic drugs used in theatre by anaesthetic nurses in the four academic hospitals affiliated to the University of the Witwatersrand is not known. The aim was of this study was to describe the knowledge of anaesthetic nurses working in four public academic hospitals in Johannesburg regarding selected drugs commonly administered during anaesthesia. The primary objectives of the study were to describe the knowledge of anaesthetic nurses regarding five drugs commonly administered during anaesthesia and to describe the sources used by nurses to obtain knowledge of drugs. The secondary objectives were to correlate the level of knowledge with years of nursing experience and to compare the level of knowledge with the nurse’s qualification. The study was descriptive, prospective and contextual.Thirty-six nurses took part in the study. A self administred questionnaire, with a demographic and knowledge section, was used to collect data. It was found that anaesthetic nurses had inadequate knowledge as only 36% of the participants passed, achieving a score of ≥ 80%.The most common source of knowledge was obtained from clinical experience.A weak negative correlation was found between the level of knowledge and years of anaesthetic experience (r=-0.1850). There was no statistical significance between level of knowledge and nursing qualification (p=0.999). It is of importance to note that the questionnaire was simple and practical, and if a more standardised questionnaire was used then an even lower pass rate would have been obtained. The study revealed that anaesthetic nurses lack adequate knowledge and are essentially functioning outside their scope of practice. The study highlights the need for an intervention to improve pharmacology knowledge of anaesthetic nurses in the Department of Anaesthesiology.