Participatory development of a minimum dataset for the Khayelitsha district

Background. Traditional 'data-led' information systems have created excessive amounts of poor-quality and poorly utilised data. The Health Information Systems Pilot Project (HISPP), a Western Cape project that started in 1996, initiated a process in one of its three pilot sites to model an alternative approach to developing a district health information system.Objective. To develop a minimum dataset for Khayelitsha as part of an action-led district health and management information system in a participatory 'bottom-up' process.Method, The HISPP, in conjunction with health workers in the proposed Khayelitsha district, developed a minimum dataset through a process of defining local goals, targets and indicators. This dataset was integrated with data requirements at regional and provincial levels,Results. A minimum dataset was produced that defined all the data needed according to the frequency of reporting and the level at which it was required.Conclusion, The HISPP has demonstrated an alternative model for defining health information needs at district level. This participatory process has enabled health workers to appraise their own information needs critically and has encouraged local use of information for planning and action

Conditional linearizability criteria for a system of third-order ordinary differential equations

We provide linearizability criteria for a class of systems of third-order ordinary differential equations (ODEs) that is cubically semi-linear in the first derivative, by differentiating a system of second-order quadratically semi-linear ODEs and using the original system to replace the second derivative. The procedure developed splits into two cases, those where the coefficients are constant and those where they are variables. Both cases are discussed and examples given

A point symmetry based method for transforming ODEs with three-dimensional symmetry algebras to their canonical forms

We provide an algorithmic approach to the construction of point transformations for scalar ordinary differential equations that admit three-dimensional symmetry algebras which lead to their respective canonical forms

Decreasing Medical Complications for Total Knee Arthroplasty: Effect of Critical Pathways on Outcomes

BACKGROUND: Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. METHODS: We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. RESULTS: Two hundred ninety five hospitals (73%) responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (± 5.8). After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication compared to patients in hospitals without pathways (OR 0.68, 95% CI 0.50-0.92). Patients managed on a critical pathway had an average length of stay 0.5 days (95% CI 0.3-0.6) shorter than patients not managed on a pathway. CONCLUSION: Medicare patients undergoing total knee replacement surgery in hospitals that used critical pathways had fewer postoperative complications than patients in hospitals without pathways, even after adjusting for patient and hospital related factors. This study has helped to establish that critical pathway use is associated with lower rates of postoperative mortality and complications following total knee replacement after adjusting for measured variables

An analysis of acute admissions to a general hospital psychiatric unit

Rapid turnover of patients in a general hospital psychiatric unit demands stabilization and discharge as soon as possible. It is likely that patients are being prematurely discharged because of this pressure.Aim: The study sought to analyse admissions to an acute psychiatric unit with a view to determining the demographic distribution of the patients, duration of stay, and patterns of substance abuse with specific emphasis on patients discharged within seven days of admission.Method: One hundred and thirty five consecutive patients, 18 years and older, who were admitted to the unit during a three-month period were included in the study. The data was obtained from a questionnaire, completed by the doctor on discharge.Results: Nearly 40% of the patients were discharged within seven days of admission. Most of the patients were youthful, substance abusing males with a past psychiatric history of either an Axis I or a co-morbid Axis II disorder, and had defaulted on their regular follow up.Conclusion: The profile of the short stay admissions suggests that our concerns regarding premature discharge are unjustified.Keywords: Acute admissions, Psychiatric, General hospitalSouth African Psychiatry Review - November 200

Epidemiological profile of patients utilizing dental public health services in the eThekwini and uMgungundlovu districts of KwaZulu-Natal province, South Africa

INTRODUCTION: Oral conditions such as dental caries, periodontal diseases, tooth loss and trauma affect millions of people globally. These conditions can be prevented when detected early, thereby avoiding adverse outcomes. The prevalence of oral conditions has been reported in most provinces. However, there is a paucity of data in KwaZulu-Natal. AIM AND OBJECTIVE: This study aimed to determine the prevalence of oral conditions at public health facilities in two health districts in KwaZulu-Natal, South Africa. MATERIALS AND METHODS: A cross-sectional analytical study design was used to determine the nature of oral conditions treated in dental facilities in the eThekwini and uMgungundlovu districts, in KwaZulu-Natal. The study was conducted over a 5-month period (November 2018 - April 2019). After clinicians examined the patients they entered the data in the patients clinical records and selected information (routine medical history questions as well as 16 possible diagnosis codes) were entered into a data extraction template. The data were analyzed using statistical software SPSS. RESULTS: Dental caries was the most prevalent oral condition at 66.4% followed by periodontal disease at 11.7%, trauma at 7.3% and lastly tooth loss at 5.9% CONCLUSION: These findings contribute to knowledge on the prevalence of these oral conditions found in the province

Are central hospitals ready for National Health Insurance? ICD coding quality from an electronic patient discharge record for clinicians

Background. South Africa (SA)’s planned National Health Insurance reforms require the use of International Statistical Classification of Diseases (ICD) codes for hospitals to purchase services from the proposed National Health Authority. However, compliance with coding at public hospitals in the Western Cape Province has been challenging. A computer application was developed to aid clinicians in integrating ICD coding into the patient hospital discharge process.Objectives. To evaluate the quality of ICD codes captured using the application and predictors thereof in a single hospital department.Methods. After 6 months, the quality of ICD codes was determined by comparing ICD code descriptors with medical concepts in a random sample of original patient records selected over a 6-week period. Patient and personnel characteristics influencing quality of coding, derived from a theoretical framework, were collected.Results. Of 223 patient records, 45.3% (95% confidence interval (CI) 38.8 - 51.9) had complete ICD codes. Primary ICD code accuracy was 74.0% (95% CI 67.8 - 79.5). Patient characteristics such as female gender, younger age group and fewer comorbidities, as well as seniority of clinician rank, were significantly associated with ICD coding being complete on adjusted analysis.Conclusions. The results of this study describe ICD coding quality at a central hospital in SA supported by a computer application and the factors influencing this. More interventions are required to achieve reliable coding data, such as additional ICD coding validation tools, training and oversight of junior clinicians

A unification in the theory of linearization of second order nonlinear ordinary differential equations

In this letter, we introduce a new generalized linearizing transformation (GLT) for second order nonlinear ordinary differential equations (SNODEs). The well known invertible point (IPT) and non-point transformations (NPT) can be derived as sub-cases of the GLT. A wider class of nonlinear ODEs that cannot be linearized through NPT and IPT can be linearized by this GLT. We also illustrate how to construct GLTs and to identify the form of the linearizable equations and propose a procedure to derive the general solution from this GLT for the SNODEs. We demonstrate the theory with two examples which are of contemporary interest.Comment: 8 page

Risky behaviour and psychosocial correlates in adolescents – is there a link with tuberculosis?

Objective: Reasons for the increase in incidence of Tuberculosis (TB) in late adolescence are poorly understood. One hypothesis is that psychological and behavioural variables associated with adolescence may increase risk of developing TB. The study aimed to determine whether psychosocial and behavioural variables affect incidence of TB disease in adolescents. Methods: A casecontrol study design was used in adolescents who were participants in a TB epidemiological study. Cases were adolescents diagnosed with TB disease. Approximately half of the controls had no TB disease but a positive TST indicative of latent TB. Half had neither TB disease nor latent TB. A self-administered questionnaire was completed by participants. The questionnaire consisted of a combination of standardised psychosocial instruments. Results: Of 292 participants, 62 were cases, 112 had latent TB and 118 neither TB disease nor latent TB. There were no significant differences in instrument scores between cases and controls. There was a trend for certain adverse life events to be more common in the TB-disease group. Conclusion: In adolescents, a trend for association between TB incidence and psychosocial and behavioural variables was not statistically significant. Given the trend, research with larger samples, and more comprehensive assessment of the relationship between stressors and TB, is warranted.Keywords: Tuberculosis; Adolescents; Self-injurious behaviour; Psychosocial factor