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Now showing 1 - 5 of 19

Recent Submissions

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The Use of Computational Fluid Dynamics for Assessing FlowInduced Acoustics to Diagnose Lung Conditions
Khanyisani Mhlangano Makhanya; S Connell; Muaaz Bhamjee; Neil Martinson
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Voiding cystourethrography in the renal pre-transplantation workup: an essential investigation?
(University of the Witwatersrand, Johannesburg, 2022-10) Sofianos, Zelia; Rajkumar, Leisha; Lucas, Susan
INTRODUCTION: Due to resource constraints in the South African public healthcare sector, patients with End-Stage Renal Disease (ESRD) are eligible for renal replacement therapy only if they are also found to be eligible for renal transplant. AIM: The aim of this study is to document Voiding Cystourethrogram (VCUG) findings in potential renal transplant candidates to assess the contribution of the VCUG as a standard investigation in the renal transplant workup. METHODS: Of the patients who underwent VCUG in Klerksdorp/Tshepong Hospital Complex (North West province, South Africa) from 1 January 2019 to 31 March 2020, 85 patients were included in the study and their VCUG findings retrospectively analysed. RESULTS: The mean age was 40.0 years (range 21-62 years), with males constituting 57.7% of patients and females 42.3%. Lower urinary tract abnormalities were identified in 24.7% of patients, some of whom had more than one abnormality. Of the total abnormalities, VUR (vesicoureteral reflux) accounted for 15.3%, bladder diverticula for 5.9%, urethral strictures for 3.5% and a significant post-void residual volume for 4.7%. No comorbidities were found to have a statistically significant association with the presence of VCUG abnormalities. CONCLUSIONS: To ensure that patients with End-Stage Renal Disease are adequately prepared for renal dialysis and potential renal transplant, and that their comorbidities and lower urinary tract are optimised should abnormalities be identified on VCUG, the VCUG remains an essential investigation in the renal transplant workup.
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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, Muhammed
Background: 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.
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Adopting sustainable innovations for remote access to TB and HIV care in South Africa
M Galvin; Denise Evans; Aneesa Moolla; Lezanie Coetzee; Vongani Maluleke; Patricia Leshabana; Jacqueline Miot
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Analysis of Orthopaedic Injuries in Polytrauma Patients at Charlotte Maxeke Johannesburg Academic Hospital
(University of the Witwatersrand, Johannesburg, 2022) Laney, Wezley; Naicker, Dharshen; Milner, Brenda
Background: Traumatic injuries represent a significant burden globally, accounting for ten percent of the global burden of disease. In South Africa we commonly see patients who have sustained major trauma, often with multiple injuries. This significant burden of trauma necessitates the demand for rapid diagnostic assessment of injuries for appropriate therapeutic intervention. A whole body computed tomography (CT pan scan) allows for a rapid multisystem injury diagnosis of trauma patients. There is a scarcity of literature evaluating the extent of orthopaedic injuries in polytrauma patients. Study Aim: The aim of the study was to evaluate the local epidemiology of orthopaedic injuries in polytrauma patients who have undergone a CT pan scan. Methods: A retrospective, observational analysis, based at Charlotte Maxeke Johannesburg Academic Hospital, was done of polytrauma patients who underwent a CT pan scan, during a 2-year period from 01/01/2018 – 31/12/2019. A database was compiled by accessing the picture archiving and communication system for CT reports. The qualitative data was reported using frequencies and percentages. Categorical variables were analysed using the Chi-squared test (or Fisher’s exact test). Results: Over the two-year study period a total of 296 polytrauma patients had a reported CT pan scan performed. Of these, 85% were male and 15% were female with a median age of 33 years. The most common mechanism of injury was motor vehicle accidents (33.1%). The prevalence of orthopaedic injuries in polytrauma patients was 53.3%. A total of 1012 injuries were found. One hundred and ninety-six (196) spinal fractures were detected; a total of 137 pelvic/sacral fractures, 101 long bone fractures with 75% lower limbs and 25% were upper limb fractures. The most common non-orthopaedic injury sustained was a chest injury. The most common combination of orthopaedic and non-orthopaedic injuries identified in the study was a chest injury with an associated pelvic/sacral fracture secondary to a PVA. Interpersonal and intentional injuries were significantly associated with a higher risk of thoracic spine fractures (RR 1.8, CI 1.1-2.9). Road traffic accidents were significantly associated with a higher risk of scapular/clavicular fractures (RR 2.0, CI 1.2-3.5) and a higher risk of tibial/fibula fractures (RR 3.5, CI 1.2-10.3) Conclusion: The majority of polytrauma patients seen at CMJAH were young males, who sustained injuries during road traffic accidents. Fractures accounted for 94% of all orthopaedic injuries. The most common orthopaedic injury detected in our cohort, overall, was a spinal fracture, most commonly involving the cervical spine. A patient involved in a road traffic accident is 3.5 times more likely to sustain a tibia/fibular fracture as opposed to any other fracture. The most common non-orthopaedic injury sustained was a chest injury. Importantly, 1 in 4 of these patients sustained an associated cervical spine injury and 1 in 3 a pelvic injury, similarly with head injuries. The most common combination of injuries is a chest injury with an associated pelvic/sacral fracture secondary to a pedestrian vehicle accident. The findings highlight the significant burden of orthopaedic injuries in polytrauma patients. In addition, the findings of this study, highlight injury patterns that should be anticipated in polytrauma patients.