http://hdl.handle.net/10386/184 Wed, 22 May 2013 15:12:08 GMT 2013-05-22T15:12:08Z http://hdl.handle.net/10386/800 Title: An Audit of preoperative evaluation of general surgery patients at Dr George Mukhari Hospital (DGMH), Ga-Rankuwa Authors: Mokgwathi, Gaorutwe Thomas Abstract: ABSTRACT INTRODUCTION: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Poor documentation and record keeping on the preoperative evaluation (PEF) form is a big obstacle in attaining good practice and hence improving patient outcome following operative procedures. The aim of the study was to conduct an audit of the anaesthetic preoperative evaluation of general surgery patients at Dr George Mukhari hospital (DGMH), Garankuwa. METHODS: A sample size of 88 record files of general surgery patients who underwent elective surgery during 2008 at DGMH was analysed. The proportion of completeness of information recorded on the PEF used at DGMH was compared with a standardized PEF which uses the global quality index (GQI). RESULTS: Only 75 out of88 patients had PEF in their files. The Modified GQI scores for the sample of75 patients ranged between 33.3% and 100%. The mean Modified GQI score was 72.2 +/- SD 13.9%. The median was 73.3 %, while the lower quartile was 60% and the upper quartile was 80%. The GQI scores were low for the following criteria; 'preoperative diagnostic procedure' (46.7%), 'medications prescribed by surgeons' (46.7%), 'preoperative fasting status' (32%), and deficiency in 'patient's weight' (34.7%) and 'allergies' (34.7%) during the preoperative assessment. Only in 1.3% was the PEF filled completely in accordance with the Modified GQI score. CONCLUSION: The overall quality of the preoperative assessment was inadequate in a number of the ModifiedGQI scores criteria suggesting the need for improvement in preoperative assessment of patients by anaesthetists at this hospital to improve patient outcome. Description: Thesis (Anaesthesiology)) -- University of Limpopo, 2010. Fri, 01 Jan 2010 00:00:00 GMT http://hdl.handle.net/10386/800 2010-01-01T00:00:00Z http://hdl.handle.net/10386/545 Title: The characteristics of preoperative blood tests and their costs at Dr George Mukhari Hospital Authors: Nthwane, Keletso Adrinah Abstract: In surgical practice, preoperative testing involves a certain number of routine tests, among them chest X-rays, electrocardiography, urine analysis and blood tests. This study sought to characterize routine preoperative blood tests performed at DGMH. This was a descriptive cross-sectional prospective study of preoperative blood tests conducted at the Medical Laboratory of DGMH. Patient files and their laboratory reports of tests performed during a 2-month period were examined for the extraction and collation of data. Of the 246 patients’ records included in the analysis, there were 130 male and 116 female patients but the distribution differed based on the age, since in female patients, the majority of them were older than 40 years. The main findings were that the most commonly done tests at DGMH are hemoglobin, FBC electrolytes, creatinine, glucose and partial prothrombin test. The average number of tests per patient was 3 and their cost on average was R224 per patient. The results of these tests impacted on the management of patients in that 11.4% of elective surgeries were postponed. The tests that were associated with postponement were low values of HB. In conclusion, hemoglobin was the common laboratory test and the only one that had significant impact as it led to the postponement of planned surgical procedures. This test may be recommended for routine testing before surgical operations. Description: Thesis (M. Med.(Anaesthesiology))--University of Limpopo (Medunsa Campus), 2010. Fri, 01 Jan 2010 00:00:00 GMT http://hdl.handle.net/10386/545 2010-01-01T00:00:00Z http://hdl.handle.net/10386/415 Title: Incidence of hearing loss in young and elderly patients following spinal anaesthesia for cystoscopy Authors: Mpholo, Lebogang Thateng Abstract: Introduction: Multiple studies have described a variable incidence of transient hearing loss (hypoacousis) from 0.4% to 40% after subarachnoid block, especially in the low-frequencies range (125 – 500 Hz) (1, 2). The mechanism of transient hypoacousis is attributed to leakage of cerebrospinal fluid, which leads to a decrease in perilymph pressure within the cochlear. Hypothesis: The study hypothesis was based on an assumption that hearing loss is more frequent in young patients who undergo spinal anaesthesia in comparison with elderly patients. Objective: 1) To determine the incidence of hearing loss after spinal anaesthesia in the young versus elderly patients. Materials and Methods: Ninety-eight male patients (ASA 1 - 11) scheduled for cystoscopy under spinal anaesthesia were recruited for the study. Recruitment of patients for the study was age-dependent and was divided into two groups: One group (49 patients) had patients aged between 17 and 44 years (Group Y) and the other group had 49 patients aged between 45 and 77 years made up group two (GROUP E). Subarachnoid injection at L3-4 was performed using a standard 22-gauge Quincke spinal needle with patients in the sitting position and 2,5 ml to 3 ml of 0.5% isobaric bupivacaine was administered. Patients were evaluated on the day before spinal anaesthesia by pure tone audiometry at three different frequency sounds viz. 125 – 500 Hz (Low frequency), 500 – 2000 Hz (Speech frequency) and at 2000 – 4000 Hz (High frequency). This assessment was repeated 48 hours after the spinal block was given. Statistical Analysis: Analysis was descriptive providing information on the mean (or median) and standard deviation of the variables for each of the two groups. The results of the audiometry were analyzed using repeated measures analysis of variance and transformation to p-value. Differences in outcomes of the study between the two groups were recorded as being statistically significant if p-value is ≤ 0.05. Results: No patient from the two groups developed hearing loss either at low or high frequencies. However, there was a statistically significant improvement in audiometric results (p-value ranging from 0.0001 and 0.063) 48 hours post-surgery in the elderly group as compared with patients in the younger group. Conclusion: The study revealed no hearing loss post-spinal anaesthesia in both groups. It did, however, show that the elderly group have better hearing acuity at all three frequency levels of sound compared to the younger group after spinal anaesthesia. Description: Thesis ( M Med (Anaesthesiology)--University of Limpopo, 2011. Sat, 01 Jan 2011 00:00:00 GMT http://hdl.handle.net/10386/415 2011-01-01T00:00:00Z http://hdl.handle.net/10386/410 Title: Impact of preoperative chest X-rays on the surgery of patients at Dr George Mukhari Hospital Authors: Molefe, B. H. Abstract: The purpose of this study was to interrogate the clinical relevance and cost effectiveness of the routine preoperative chest X-rays at DGMH. It was conducted as a descriptive cross-sectional prospective study of radiographic films in the Radiology department. A review of patients’ files and chest X-rays performed during a 6-month period from January to June 2008. Data from 100 patients’ files were included in the analysis. The age of patients ranged from 45 to 84years, the median age was 57years. The majority of patients younger than 50years were female, while the majority of male patients were over 50years. From a total of 100 patients only 8%(8 patients) were deemed unfit and consequently postponed or cancelled for further investigation and optimization. The cost for performing one routine chest X-ray was estimated to be R393 manpower, time and film inclusive, the total costs for the 100 patients included in this study being R39300. This study has provided some evidence that the routine preoperative chest X-rays can help in uncovering some abnormalities that were not apparent on clinical examination, it has pointed out that the impact of these uncovered abnormalities is very minimal on the planned surgery and that the costs associated with doing routine pre-operative chest X-rays can be substantial. Description: Thesis(M. Med (Anaesthesiology)--University of Limpopo(Medunsa Campus), 2010. Fri, 01 Jan 2010 00:00:00 GMT http://hdl.handle.net/10386/410 2010-01-01T00:00:00Z