Browsing by Author "Coetzee, Johan F."

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    Burnout among rural hospital doctors in the Western Cape : comparison with previous South African studies
    (AOSIS, 2018-05) Liebenberg, Andrew R.; Coetzee, Johan F.; Conradie, Hofmeyr H.; Coetzee, Johan F.
    Background: Burnout among doctors negatively affects health systems and, ultimately, patient care. Aim: To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies. Setting: Rural district hospitals. Methods: During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands. Results: Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants.Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey;however, the score for personal accomplishment (PA) was greater. EE and PA scores were similar to that of a study of junior doctors working in the Red Cross Children’s Hospital;however, EE was smaller. Conclusion: This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.
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    Comparison of hemoglobin measurements by 3 point-of-care devices with standard laboratory values and reliability regarding decisions for blood transfusion
    (Lippincott, Williams & Wilkins, 2020-08) Johnson, Marianne; Marwick, Peter C.; Coetzee, Johan F.
    BACKGROUND: We compared the accuracy of 3 point-of-care testing (POCT) devices with central laboratory measurements and the extent to which between-method disagreements could influence decisions to transfuse blood. METHODS: Hemoglobin concentrations [Hb] were measured in 58 adult patients undergoing cardiothoracic surgery using 2 Ilex GEM Premier 3500 blood gas analyzers (BG_A and BG_B) and a HemoCue Hb-201+ device (HemoCue). Measurements were compared with our central laboratory’s Siemens Advia 2120 flow cytometry system (laboratory [Hb] [Lab[Hb]]), regarded as the gold standard. We considered that between-method [Hb] differences exceeding 10% in the [Hb] range 6–10 g/dL would likely erroneously influence erythrocyte transfusion decisions. RESULTS: The 70 Lab[Hb] measurements ranged from 5.8 to 16.7 g/dL, of which 25 (36%) were <10.0 g/dL. Measurements by all 4 devices numbered 57. Mean POCT measurements did not differ significantly (P > .99). Results of the Bland–Altman analyses revealed statistically significant bias, with predominant underestimations by all 3 POCTs predominating. HemoCue upper and lower limits of agreement (LOA) were narrower, and the 95% confidence intervals (95% CIs) of the LOAs did not overlap with those of BG_A and BG_B. Similarly, a narrow mountain plot demonstrated greater precision for the HemoCue. Comparing BG_A with BG_B revealed no bias and narrow LOA. Error grid analysis within the [Hb] range 6–10 g/dL revealed that 5.3% of HemoCue measurements were beyond the permissible 10.0% error zone in contrast to 19.0% and 16.0% of the blood gas measurements. Possible inappropriate transfusion decisions based on POCT values generally erred toward unnecessary transfusions. Calculations of Cohen κ statistic indicated better chance-corrected agreement between HemoCue and Lab[Hb] regarding erythrocyte transfusions than the blood gas analyzers. CONCLUSIONS: All 3 POCT devices underestimated the Lab[Hb] and cannot be used interchangeably with standard laboratory measurements. BG_A and BG_B can be considered to be acceptably interchangeable with each other. Whereas the HemoCue had little bias and good precision, the blood gas analyzers revealed large bias and poor precision. We conclude that the tested HemoCue provides more reliable measurements, especially within the critical 6–10 g/dL range, with reduced potential for transfusion errors. Decisions regarding erythrocyte transfusions should also be considered in the light of clinical findings.
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    A comparison of induction of anaesthesia using two different propofol preparations
    (Southern African Journal of Anaesthesia and Analgesia, 2008) Terblanche, Nico; Coetzee, Johan F.
    Background: Investigators have reported inter-patient variability with regard to propofol dosage for induction of anesthesia, since early dose finding studies. With the arrival of generic formulations of propofol, questions have arisen regarding further variability in dose requirements. Various studies have confirmed that generic propofol preparations are pharmacokinetically and pharmacodynamically equivalent to Diprivan®. Nevertheless a number of practitioners are under the impression that certain generic propofol preparations require greater doses for induction of anaesthesia than does Diprivan®. Methods: 20 female patients of ASA status I-II, between the ages of 18-55 years, scheduled for routine surgery were randomly allocated to two groups to undergo induction of anaesthesia using two different propofol formulations; Diprivan® and Propofol 1% Fresenius®. Either preparation was administered using a target-controlled infusion of propofol (STEL-TCI) targeting the plasma (central) compartment at a concentration of 6 μg.ml-1, employing the pharmacokinetic parameters of Marsh et al. A processed EEG (bispectral index) was continuously recorded. Loss of consciousness (LOC) was regarded as the moment at which the patient could not keep her eyes open and was confirmed by the absence of an eyelash reflex. At this point propofol administration was discontinued and data were recorded for a further two minutes, before administering an appropriate opioid and/or nitrous oxide/volatile agent and/or muscle relaxant to maintain anaesthesia. Time to LOC after start of propofol administration, and the dose of propofol administered during induction were annotated. Results: There were no demographic differences between the groups. There were no differences between the groups with regard to the mean dose for LOC, time to LOC and to the mean BIS values obtained at the following stages: awake, at LOC, at 1 and 2 minutes after LOC as well as the lowest recorded value. Conclusions: Our results confirm that the two propofol formulations that we studied, are pharmacologically equivalent with regard to induction of anaesthesia. Other mechanisms can explain the variability in clinical response to bolus administration of propofol. The most important is the recirculatory or “front-end” kinetics of propofol in which cardiac output plays a major role, as well as the rate of drug administration. Emulsion degradation can also influence dose-response and in this regard it should be noted that the addition of foreign substances such as lignocaine, can result in rapid deterioration of the soyabean emulsion.
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    What keeps health professionals working in rural district hospitals in South Africa?
    (AOSIS Publishing, 2015-06) Jenkins, Louis S.; Gunst, Colette; Blitz, Julia; Coetzee, Johan F.
    Background: The theme of the 2014 Southern African Rural Health Conference was ‘Building resilience in facing rural realities’. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. Conference workshop: The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, ‘What is it that keeps you going to work every day?’ Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Results: Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Conclusion: Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported.