A view of paediatric outcomes research

No Abstract. South African Medical Journal Vol. 95(10) 2005: 785-78

Private-sector caesarean sections in perspective

No Abstract

Is registrarship a different experience for women?

Objective. To detennine differences between male and female registrars in their subjective perceptions and experience of a paediatrics registrar training programme.Design. Cross-sectional survey.Setting. University-affiliated teaching hospitals.Participants. Thirty-nine paediatrics registrars.Results. Of the 39 respondents, 18 (46%) were women. Men were older than women (30A v. 29.1 years, p = 0.049). There were no gender differences in the number of hours worked per week (65.7 v. 67.8 hours, P = 0.384) or participation in the training programme. Success rates in postgraduate paediatrics examinations were also similar for the two groups (85% v. 76%, P = 0.486). Male registrars were more likely to have 'moonlighted' (43% v. 6%, P =0.011). FIfty-nine per cent of female registrars believed that they had been disadvantaged in their careers because of their gender, 28% felt that more was expected of a woman registrar and 22% of the female trainees claimed to have been subjected to sexual harassment. The majority (82%) of women registrars contemplated taking time off from practising clinical paediatrics in the Mure (postregistrarship), mainly for child-bearing purposes. Female respondents criticised both the academic department and the hospital authorities for discriminatory practices, such as the awarding of home loans to men and women who were breadwinners only. The findings suggest that women registrars do feel disadvantaged and discriminated against, and highlight the need for flexible, creative programmes that recognise the needs and aspirations of female registrars and, indeed, all women in academic medicine

A review of selection criteria used by medical scheme advisers to approve or deny procedures with a cosmetic component

Objective. To review and apply statistical tests to the selection criteria used by two medical advisers to approve or deny applications for three common cosmetic or reconstructive procedures within a large group of medical schemes.Design. A retrospective descriptive study which applied multiple regression analysis, frequency analysis, comparison of means and simple correlations to the data sets for three procedures.Setting. Administrative records from the clinical files of medical advisers and the administrator's claims database.Subjects. Data were reviewed for 1 143 members who, between January and December 1996, submitted applications for breast reduction, excimer laser refractive surgery, or otoplasty.Main outcome measures. The primary outcome measure was the statistical relationship between medical advisers' selection criteria and final decision. In addition, the financial implications of these cosmetic/reconstructive procedures were assessed.Results. For the three procedures reviewed there was a statistically significant relationship behveen 5 of 13 preoperative criteria requested and the medical advisers' opinion. Excimer laser surgery was generally approved on the basis of the refractive error (myopia> -3.00; astigmatism > -1.5 dioptres); otoplasty was generally approved for children aged :≤ 12.years; and breast reduction was usually covered for women with a sternal-nipple distance > 29.0 cm and with a cup size ≥ DD. The other data submitted were similarly distributed between the approved and denied groups.Conclusions. Review of medical advisers' decisions is important in an era of protocols, guidelines and 'standard operating procedures'. Selection criteria for approval of applications for medically necesssary cosmetic/reconstructive surgery must be reviewed and revised to provide a reliable, reproducible and statistically valid process

Screening for abdominal aortic aneurysm - a pilot study in six medical schemes

No Abstract

Analysis of paediatric prescribing profiles in two health-funding systems

No Abstract

The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study

<p>Abstract</p> <p>Background</p> <p>Corrective bracing for adolescent idiopathic scoliosis (AIS) has favourable outcomes when patients are compliant. However, bracing may be a stressful and traumatic experience and compliance with a bracing protocol is likely to be dependent upon patients' physical, emotional and social wellbeing. The Brace Questionnaire (BrQ), a recently-developed, condition-specific tool to measure quality of life (QOL) has enabled clinicians to study relationships between QOL and compliance.</p> <p>Methods</p> <p>The BrQ was administered to 31 AIS patients after a minimum of 1 year of wearing a brace. Subjects were 13–16 year old South African girls with Cobb angles of 25–40 degrees. Participants were divided into two groups according to their level of compliance with the bracing protocol. Brace Questionnaire sub- and total scores were compared between the two groups using the t-test for comparison of means.</p> <p>Results</p> <p>Twenty participants were classified as compliant and 11 as non-compliant. Mean total BrQ scores (expressed as a percentage) were 83.7 for the compliant group and 64.4 for the non-compliant group (p < 0.001), and on analysis of the 8 domains that make up the BrQ, the compliant group scored significantly higher in the 6 domains that measured vitality and social, emotional and physical functioning.</p> <p>Conclusion</p> <p>Poor compliance with a brace protocol is associated with poorer QOL, with non-compliant patients lacking vitality and functioning poorly physically, emotionally and socially. Quality of life for adolescents with idiopathic scoliosis may relate more to psychosocial coping mechanisms than to physical deformity and its consequences. It is important to establish whether remedial programmes are capable of addressing personal, group and family issues, improving QOL and promoting compliance.</p