Utilisation of outpatient services at Red Cross War Memorial Children's Hospital, Cape Town

The demand for outpatient services continues to grow at Red Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department (OPD). In addition, we reviewed the RCCH Annual Reports for the period 1961 - 1988. Annual outpatient attendances have increased from around 42000 in 1957 to their highest level ever; nearly 350000 in 1988. This steady rise in outpatient attendance was stemmed during the 1970s by the expansion of health services in the greater Cape Town area, in particular the introduction ofday hospitals. In general, blacks are utilising the OPD as a primary community hospital for the treatment of infectious and environmentally induced diseases. In contrast, the white outpatient profile is more characteristic of a tertiary referral centre, with a higher proportion of specialist clinic attendances. The utilisation patterns for coloured children are intermediate. Analysis of the residential address of patients and their presenting diagnoses indicates an urgent demand for primary health care services in the most recently settled and poorest suburbs of Cape Town, many of which are remote from the hospital

The referral letter - a problem of communication

This cross-sectional ,descriptive study assesses the letters sent with referred patients to Red Cross War Memorial Children's Hospital, Cape Town, and makes appropriate recommendations. During the 6-month period 1 July - 31 December 1987, 9 288 letters were photocopied at the admissions offices of the hospital. A sample of the letters collected, systematically stratified to represent the available days during the study, was analysed. Detailed analysis of 1143 (12,3%) letters was undertaken. The private sector, i.e. general practitioners, was the largest referral agency, followed by communitybased day hospitals. The quality of information in referral letters was comparable to that found in other studies. The quality of letters influenced the writing of replies by hospital staff. There is a need to develop ways of improving communication between hospital staff and referral agents

Rectal ketamine and midazolam for premedication in pediatric dentistry

Rectally administered midazolam (0.30 mg/kg) and ketamine (5 mg/kg) were compared for preanesthetic medication in children undergoing dental extractions. Sixty patients between the ages 2 and 9 years were randomly allocated to three groups in this double-blind study. In one group of patients who received ketamine rectally, intravenous midazolam (0.05 mg/kg) also was administered immediately after induction of anesthesia. The results from this trial show that 30 minutes after rectal administration of the two drugs, good anxiolysis, sedation, and cooperation were obtained in most patients. Although midazolam appeared to be marginally more efficacious than ketamine in the majority of assessments made and seemed to have less adverse effects, no statistically significant differences could be shown. Ketamine showed a slight decrease and midazolam a slight increase in average blood pressures after premedication. These blood pressure differences were, however, considered to be of little clinical importance.Articl

Blood Pressure measurements - An evaluation of three digital devices

This study evaluated blood pressure (BP) measurements utilising three automatic blood pressure measuring devices. BPs of 36 healthy subjects taken with the AND Digital Blood Pressure Meter UA-731, auto-inflating, the AND Digital Blood Pressure Meter UA-701, manual inflating, and the AND Digital Blood Pressure Meter Memory + Printer UA-751, auto-inflating, were compared with measurements taken with the standard mercury sphygmomanometer. Devices UA-731 and UA-701 gave significantly higher systolic BP measurements than the manual method, while measurements taken with the UA-751 did not differ significantly from the manual method. Diastolic measurements using the electronic devices were lower than those determined using the manual method. Only measurements taken by device UA-751 were statistically significantly lower. This study showed that order effect in multiple determinations of BP has to be considered to interpret the data. Using electronic devices for home determination of BP can be very useful, if the patient is trained according to standardised procedures. The same argument holds for epidemiological surveys. A very helpful attribute for epidemiological surveys is that the operator does not have to be a medically trained person, which keeps costs down.Revie

Risk of invasive cancer of the cervix in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen oral contraceptives (South Africa)

Background: Cervical cancer is caused by specific types of the human papilloma virus (HPV), but not all infected women develop cancer. It has been hypothesized that hormonal contraceptives may potentiate the oncogenicity of HPV infection. Methods: In a case-control study of colored and black women in the Western Cape Province, South Africa, 524 incident cases of clinically evident invasive cervical cancer (stages 1b-1V) were compared with 1541 controls, and with a subgroup of 254 HPV-positive controls. Findings: For injectable progestogen contraceptives (95% of which were depot medroxyprogesterone acetate) the overall relative risk, adjusted for confounding, was 1.0 (95% confidence interval 0.8-1.3); for combined estrogen/progestogen oral contraceptives the corresponding estimate was 0.8 (0.7-1.1). When the data were divided into categories of duration of use extending to ≥15 years, or according to age, ethnic group, or recency of use, there was no consistent evidence of an increased risk. The findings were unchanged when the cases were compared with the HPV-positive controls. Interpretation: The present findings suggest that neither injectable progestogen-only nor combined estrogen/progestogen oral contraceptives increase the risk of clinically evident invasive cancer of the cervix.Articl