3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An analysis of fifth year Paediatric teaching(1987) Skapinker, ReneeMuch teaching in paediatrics is done at the patient's bedside. The clinical ward round should integrate all the pertinent features of the case. A prospective study was undertaken at the Johannesburg Hospital to evaluate such teaching. Twenty-two fifth year medical students and ten paediatric consultants were studied during the students1 first exposure to clinical paediatrics. Analysis of the teaching showed that there were significant differences between ideal objectives set by the Department, what was actually taught during the clinical ward round and what students perceived as having been taught. Futhermore, consultants defined more objectives for the teaching session when this was done prior to the tutorial than after the tutorial. The correlation between objectives considered taught by consultants and those perceived by students as having been taught, was poorer when consultants defined their teaching objectives before the tutorials compared with when consultants defined their objectives after the tutorials. These findings indicate unrealistic expectations in terms of what tutors are able to cover in a ward round when the objectives are pre-defined. Further analysis of the data revealed a bias towards objectives which were inappropriate for students with limited clinical experience.Item Retrospective and prospective case review of chronic inflammatory demyelinating polyradiculoneuropathy at the Johannesburg Hospital(2009-05-04T13:49:19Z) Anderson, David GrahamBackground: Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is an immune mediated neuropathy with variable presentation ranging from symmetrical paralysis to a variety of focal manifestations progressing slowly or in a fluctuating pattern. There is no information about the condition in Africa. Method: A Prospective case series of CIDP patients defined according to the criteria of Saperstein. Patients were recruited from the Johannesburg Hospital, South Africa, over a 2-year period. Results: 26 patients were identified. The male to female ratio was 1: 2 with an average age of 41 years. 10 patients were HIV positive. All were black females. There were no differences clinically between the HIV positive and HIV negative groups. The CSF proteins level was raised in only 42% of patients. Conclusion: The patients seen by us at the Johannesburg hospital have a younger age of onset and a female predominance. HIV was identified in 40% of our patients.Item An analysis of reasons for exclusion of potential live kidney donors(2009-03-23T07:34:50Z) Levy, Cecil StevenItem An assessment of the Remunerative Work Outside Public Sector Policy at the Johannesburg Hospital(2008-10-13T13:40:51Z) Khan, FarzanaGood infrastructure and equitable distribution of resources are critical factors in securing equal health care access to all. Poverty, food production and distribution, water, sanitation, housing, environmental protection and education all impact on health (Lee and Mills, 1983). Despite the multi-dimensional determinants of health and healthcare, one of the most noticeable challenges facing the health care system is that of human resources. Health care systems cannot function optimally without sufficient levels and adequate distribution of health care personnel. Brain drain in South Africa is one of the critical areas of concern according to the Health Minister (Poggenpoel, 2004). Recruitment and retention of health care workers within public health institutions is still one of the most critical challenges facing South Africa. Poor working conditions; limited consumable resources and mismanagement of facilities aggravate the problem of shortage of skilled health care personnel. Limited private practice (LPP) is seen as one of the many mechanisms to retain health care personnel. Limited Private Practice or moonlighting allows for government or state employees to perform private duties within certain time parameters. LPP is common in many developing countries, including South Africa. This study focuses on the health professionals engaging in limited private practice in South Africa. Remunerative Work Outside Public Sector (RWOPS) is potentially an alternative term used for LPP in South Africa. The study focuses on the evolutionary process of the RWOPS policy and explores the attitudes and perceptions of the health professionals and management at the Johannesburg Hospital with regards to the RWOPS policy. Policy documents, press releases, international studies and official documents collected through searches on the world-wide-web have provided the bases for the evolutionary process of the study. The perception and attitudes were determined through a selfadministered structured questionnaire. Participants were randomly selected from a list obtained from the Johannesburg Hospital Human Resource personnel. Some participants were selected using snowball sampling. A total of forty two questionnaires were handed out to the respective participants with feedback from thirty five participants. The questionnaire compromised of closed and open ended questions. The sample population consisted of the following participants: · Nursing personnel (these included nurses at all levels, professional nurses, senior nurses, chief nurses as well as representatives from DENOSA) · Doctors (all levels registrars, senior registrars, Head Of Department’s, consultants and reps from SAMA) · Management (the CEO and some human resource personnel responsible for processing the RWOPS applications) · Allied Health Professionals (all levels of physiotherapists, occupational therapists, pharmacists and the speech and hearing therapists) The results are presented graphically. The data was thematically analyzed allowing the researcher to identify the role of the key actors in the implementation process. The Walt and Gilson (1994) model was used to analyze and assess the RWOPS policy. A pilot study was conducted to determine if the validity and reliability of the questionnaire in determining the role, attitudes and perceptions of these key actors with regards to the RWOPS policy. The pilot study was included in the actual sample population. Management n=2; doctors n=11; nurses n=15 and allied health n=7 were the total number of respondents. Most individuals felt that a shortage of human resource was the most critical challenge. Most participants are not familiar with the RWOPS policy even though seventy seven percent of the participants answered yes to being familiar with the policy. The expectation from many participants was for them to receive substantial financial incentives through the policy. This relates the lack of knowledge on the policy terms. Participants also felt that certain professions and individuals benefited the most from the RWOPS resulting in animosity amongst health care workers at the Johannesburg Hospital. The questionnaires indicated that there was minimal input from all the relevant key actors. This lack of consultation with all relevant actors or perhaps a miscommunication amongst the relevant players may have contributed to the abuse of this policy.Item Knowledge and practices of doctors and nurses about management of health care waste at Johannesburg Hospital in the Gauteng Province, South Africa(2008-08-29T12:33:32Z) Ramokate, TuduetsoABSTRACT Introduction: The Gauteng Province in South Africa is home to four large hospitals which generate enormous amounts of waste. However, no formal study has been done to asses the magnitude of this problem. Health care waste falls under a cluster of waste which is regarded as hazardous due to its composition and therefore ability to transmit disease. It has become an important type of waste mainly because of its ability to transmit HIV/AIDS, Hepatitis B and C among other infectious diseases. This study attempted to address the knowledge and practices of doctors and nurses, which are just some of the factors which influence health care waste management. Aims: The main aim of this study was to evaluate the current knowledge and practices of doctors and nurses regarding the management of health care waste. Methods: This was a descriptive cross sectional study. A self administered questionnaire was used to collect the data. A total sample of 128 doctors and nurses was drawn from the Johannesburg Hospital, an academic hospital in the Gauteng Province. Results: Although there was overall lack of awareness about the existence of the international, national, provincial and local documents (Act, Regulation, Manual, Code of Practice and Policies) regulating heath care waste management, the majority of the respondents (84%) knew about the existence of the Johannesburg Hospital’s policy on waste management. Generally, knowledge of nursing staff was significantly higher than that of doctors. Although some good practices such as use of gloves were reported, there is generally a lack of knowledge about key documents regulating health care waste, particularly among the doctors. Conclusion: This study was the first of its kind to be done at the Hospital. As the Hospital policy is more accepted and accessible to the health professionals than the other documents investigated in this study, it should be updated regularly to incorporate new changes. The Hospital should not only make that policy document more easily accessible and visible but also strive to reach doctors with training in health care waste management. Continuous monitoring and evaluation is also necessary to ensure that policies and procedures are followed.