Research

Researcher: Dr Grant Laing

Designation: Sub-specialist Trauma surgeon

Study: The Construction, Implementation and Evaluation of Surgical Electronic Medical Record Systems within the Pietermaritzburg Metropolitan Hospital Complex. A Means of Implementing Clinical Governance to Audit and Improve the Quality of Local Services

Summary: The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry.

Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured.

The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths.

The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care.

 

Researcher: Dr Grant Laing

Designation: Sub-specialist Trauma surgeon

Study: A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre

Summary: The selective non-operative management (SNOM) of penetrating abdominal trauma (PAT) is well established in our environment. As a quality-improvement initiative, we aimed to re-evaluate patient outcomes with PAT. This follows the application of new imaging and diagnostic modalities using protocolised management algorithms.

A prospectively maintained digital registry was retrospectively interrogated and all patients with PAT treated by our service from January 2012 to March 2013 were included in this study.

A total of 325 patients sustained PAT during the fourteen-month study period. This included 238 SWs, 80 GSWs and 7 impalement injuries. 11 patients had eviscerated bowel, and 12 had eviscerated omentum. A total of 123 patients (38%) were selected for a trial of SNOM. This included 103 SWs, 15 GSWs and 5 impalement injuries. Emergency laparotomy was performed on 182 patients (115 SWs, 65 GSWs and 2 impalement injuries) and 21 patients with left sided thoraco-abdominal SWs underwent definitive diagnostic laparoscopy (DL). SNOM was successful in 122 cases (99%) and unsuccessful in one case (1%). In the laparotomy group 161 (88%) patients underwent a therapeutic procedure, in 12 cases (7%) the laparotomy was non-therapeutic and in 9 cases (5%) the laparotomy was negative. In the laparoscopy group (24), two patients required conversion for colonic injuries and one for equipment failure. Seven (33.3%) laparoscopies were therapeutic with the identification and intra-corporeal repair of seven left hemi-diaphragm injuries.

We have improved our results with the SNOM of PAT and have also managed to safely and successfully extend the role of SNOM to abdominal GSWs. We have selectively adopted newer modalities such as laparoscopy to assess stable patients with left thoraco-abdominal SWs and abdominal CT scan for the SNOM of abdominal GSWs.

 

Researcher: Dr Grant Laing

Designation: Sub-specialist Trauma surgeon

Study: A paediatric case of AAST grade IV duodenal injury with application of damage control surgery

Summary: Isolated severe blunt duodenal injuries are rare. We present an American Association for the Surgery of Trauma grade IV duodenal injury in a paediatric patient. The strategic use of damage control surgical principles, involving an initial abbreviated laparotomy followed by a delayed reconstruction, resulted in a successful outcome.

 

Researcher: Dr Grant Laing

Designation: Sub-specialist Trauma surgeon

Study: Haemobilia following blunt liver injury

Summary: Blunt liver trauma is commonly managed by non-operative measures. We report a case of an American Association for the Surgery of Trauma grade III liver injury and its complications, successfully managed by a combination of minimally invasive interventions.

 

Researcher: Dr Grant Laing

Designation: Sub-specialist Trauma surgeon

Study: Case Report - AAST grade III pancreatic injury following blunt abdominal trauma

Summary: Isolated pancreatic trauma with major pancreatic duct disruption is a rare finding; it can present with equivocal clinical signs. Serum amylase levels and diagnostic contrast-enhanced computed tomography can facilitate the diagnostic process.

 

Researcher: Dr Colile Dlamini

Designation: Student

Study: Developing a Clinical Education Model for the Integration of Theory and Practice in Swaziland

Summary: The research is the result of the theory-practice gap that exists in nursing education in Swaziland and from the lack of an informative framework to guide clinical facilitation and supervision.

The study is beneficial to nursing education and practice in Swaziland and perhaps also for a wider area. Having used a collaborative approach increased stakeholder buy in and the probability of them adopting the academic model.

 

 

Researcher: Dr Kingsley Ngosa

Designation: Student

Study: The risk of pulmonary tuberculosis in underground miners exposed to silica dust in Zambia's copper mines.

Summary: the study sought to determine the risk of pulmonary tuberculosis (PTB) among in-service underground mineworkers in Zambian copper mines.

The overall aim of the study was to determine the risk of PTB among underground miners exposed to silica dust in Zambia’s copper mines, with the specific objectives of establishing the levels of silica dust at various work sites, determining the prevalence of PTB and investigating the relationship between PTB and cumulative exposure to the dust.

The cross sectional study reviewed 360 in-service miners’ medical records and silica exposure data at the Occupational Health, Safety and Research Bureau (OHSRB) in Kitwe. The period reviewed was between 1 January 2005 to 31 December 2010.

The results of the study indicated that after adjusting for age, gender and smoking habits, miners in a high cumulative silica dust category had a 6.3 fold greater risk of developing PTB than those in low cumulative silica dust category. Further, miners who smoked tobacco had a 4.5 fold greater risk of developing PTB than non-smokers.


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