Preventable deaths presenting to a level 1 trauma centre in South Africa : a panel study

Includes bibliographical references.The aim of our study was to identify areas for quality improvement in regards to preventable trauma deaths at Groote Schuur Hospital Trauma Centre (GSHTC)

An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review

It is widely assumed in the literature that large thyroid goitres pose a significant risk to the airway perioperatively. They are of concern to anaesthetists because of anticipated difficulty relating to intubation, ventilation and post-thyroidectomy tracheomalacia. They are of concern to surgeons because of the anticipated risk of difficult dissection and increased risk of surgical complications including haemorrhage, laryngeal nerve injury and tracheomalacia. Objectives: To analyse the folders of patients who have undergone anaesthesia and surgery for large, nonmalignant goitre, to assess the impact of large goiters on perioperative and postoperative management. An attempt will also be made to identify possible predictive markers/ patient characteristics associated with difficult intubation. Design: A retrospective folder review Setting: Groote Schuur Hospital Participants: All patients who had thyroidectomies performed at Groote Schuur Hospital between Jan 2010 and June 2016 for large, non-malignant goitres. Measurements and main results: Of the patients who underwent a thyroidectomy procedure at Groote Schuur Hospital between Jan 2010 and June 2016, 196 were identified as having non-malignant goitre and size in one dimension of greater than fifty millimeters. There were seven documented difficult intubations and only one case of failed intubation. This case was subsequently put onto cardiopulmonary bypass and intubated successfully using a rigid fibreoptic bronchoscope. Of the one hundred and nighty-six cases, four were intubated using a fibreoptic bronchoscope, eight with a videolaryngoscope, and six cases, a bougie. All other patients underwent uneventful tracheal intubation via direct laryngoscopy. All glands were removed via a collar incision with no requirement to proceed to sternotomy. There was only one patient requiring blood intraoperatively and only four reported cases of postoperative haematomas. There were no instances of tracheomalacia. Two patients suffered long term recurrent laryngeal nerve injury with voice changes. Conclusion: The data shows that, in patients with large, benign goitre undergoing thyroidectomy, airway difficulties at intubation and surgical and anaesthetic complications postextubation are rare. Intravenous induction and direct laryngoscopy is a safe technique in appropriately experienced hands

A Retrospective Analysis of Referrals to Consultation-Liaison Psychiatry over a Five-Year Period in a Tertiary Hospital in South Africa

Objective: The aim of this study was to review referrals to the consultation-liaison psychiatric service at Groote Schuur Hospital including the number of referrals, demographic details of referred patients, medical and psychiatric diagnoses, management and outcome over a five-year-period. It was anticipated that referrals had increased on an annual basis. Method: The study was observational and was conducted at Groote Schuur Hospital in Cape Town, South Africa. All inpatients referred to consultation-liaison psychiatry (CLP) during the study period were included. The study information was gathered via data capture sheets that are completed for patients referred to the division. Results: A total of 1978 patients were referred to CLP and analysed in the study. Most referrals occurred in 2018 (n=499; 25.2%). The majority of referrals came from the division of internal medicine (n=607; 30.7%), and the main reasons for referral were unspecified (n=402; 20.3%), suicide/risk assessment (n=333; 16.8%), and other symptoms of mental illness (n=264; 13.3%). The most frequent immediate management included medication initiation or adjustment (n=793; 40.1%), and supportive counselling/psychoeducation (n=511; 25.8%). Conclusion: Referral numbers to the division have increased during the study period as hypothesized. As expected, most referrals came from the internal medicine division. The results from this study highlight the importance of the consultation-liaison service at Groote Schuur Hospital

Violence against women : a prospective study of women presenting to a South African trauma centre

Background - Violence against Women is a major public health issue, and it is universally under reported. Objective - To conduct an injury surveillance of severe or life threatening violent acts against women, to determine the demographics of the injured women and to identify the nature of the perpetrators. Methods - A standardized structured questionnaire administered in an interview conducted on female patients admitted to the Trauma Centre at Groote Schuur Hospital as a result of interpersonal violence. Age, level of education, employment status, housing and substance abuse was recorded

Upper gastrointestinal bleed: a comparative outcomes study of pre and post implementation of management guidelines in the acute care surgery unit, Groote Schuur Hospital

Background: Upper gastrointestinal bleeding (UGIT) is a common presentation to hospital and can result in a significant morbidity, mortality and hospital costs. Consensus guidelines are present from various international expert bodies regarding the management of these patients and compliance with these guidelines is variable and is dependent on rigorous implementation and continuous audits. Aim: The primary aim of this study is to evaluate complaints to three aspects of management of UGITB (time of endoscopy ,use of dual endotherapy and haemoglubin trigger for transfusion) at Acute Care Surgery Unit, at Groote Schuur Hospital. Methods: This is a comparative study between a retrospective control group and a prospective cohort post implementation of a quality improvement program (QIP). Results: This study included 109 patients, 51 in the control and 58 in the QIP group. The two groups were statistically comparable in terms of demographics, clinical presentation, referral pattern and endoscopy finding. Over 80% in both groups had their endoscopy within 24 hours (Control 83.7%, QIP 81.6%). Time to endoscopy was not statistically significantly different between the Control and QIP groups for low and high-risk patients ((suspected varices or Modified Glasgow-Blatchford Score (MBS) >10)). However, when both groups are combined, patients with an MBS of >10 or more had a statistically shorter 'Time to scope’ by 8 hours than those with a score < 10 (p=0.02)

Primary health eye care knowledge among general practitioners working in the Cape Town Metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly, and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions, including a self-assessment section, was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2% was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2%). The mean test score was 52.5% (standard deviation [SD]: 22.2). The mean self-rating was 51.9% (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9% of them would attend such courses. Also, 82% of GPs felt that primary care doctors, not optometrists, should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems, presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Quadruple valve replacement in a patient with severe rheumatic heart disease

We present a patient with rheumatic heart disease involving all the heart valves. An intraoperative transoesophageal echocardiography confirmed severe mitral stenosis, severe aortic regurgitation, severe tricuspid regurgitation and stenosis, and severe pulmonary stenosis. The patient underwent successful quadruple valve replacement during a single operation at the Groote Schuur Hospital, Cape Town, South Africa