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Biomedical subjects

I T Hay

Publications and source records attributed to I T Hay.

At least 19 recordsLinked to original sources
PubMed2005

The versatility of progress testing assessed in an international context: a start for benchmarking global standardization?

Sharing and collaboration relating to progress testing already takes place on a national level and allows for quality control and comparisons of the participating institutions. This study explores the possibilities of international sharing of the progress test after correction for cultural bias and translation problems. Three progress tests were reviewed and administered to 3043 Pretoria and 3001 Maastricht medical students. In total, 16% of the items were potentially biased and removed from the test items administered to the Pretoria students (9% due to translation problems; 7% due to cultural differences). Of the three clusters (basic, clinical and social sciences) the social sciences contained most bias (32%), basic sciences least (11%). The differences that were found, comparing the student results of both schools, seem a reflection of the deliberate accentuations that both curricula pursue. The results suggest that the progress test methodology provides a versatile instrument that can be used to assess medical schools across the world. Sharing of test material is a viable strategy and test outcomes are interesting and can be used in international quality control.

Benchmarking↗
PubMed1997

Medical problem-solving: a five stage approach in primary medical care.

A methodology for a five stage or pentagonal problem-based approach to solve individual or family health-related problems is described. The model can be applied in health worker learning, student teaching or problem solving in the real world of the patient and his/ her family within the context of community health. The model stresses interdisciplinary co-operation, the consideration of ethical factors in each case, and a logical transition from individual patient care to community diagnosis and intervention. The model is applicable to any disease process, all levels of care, all levels of intervention and all clinical disciplines.

Community Medicine↗
PubMed1997

Bacterial meningitis in children at Kalafong Hospital, 1990-1995.

OBJECTIVES: To determine the bacteriological profile, morbidity, mortality and factors which contributed to the outcome. DESIGN: Retrospective descriptive. SETTING: Kalafong Hospital, Pretoria. SUBJECTS: Children older than 1 month and younger than 13 years admitted between January 1990 and December 1995 with culture-proven bacterial meningitis. MAIN OUTCOME MEASURES: Causative bacteria, antibiotic sensitivity, age, clinical features and short-term morbidity and mortality. RESULTS: Sixty-one patients had culture-proven bacterial meningitis. In 57% Haemophilus influenzae, in 33% Streptococcus pneumoniae and in 1.6% (1 patient) Neisseria meningitidis were cultured (5 patients yielded other organisms). Some H. influenzae cultures showed resistance to cefotaxime and ampicillin and some S. pneumoniae cultures to penicillin. The mean age of all patients was 18 months. Twenty-three per cent of the patients had consulted between 1 and 5 health workers and were then self-referred. Fever, cough and vomiting were the most common complaints. On examination, fever and pneumonia were the most common findings apart from neurological system involvement. Twelve patients (20%) died and 46% were discharged with obvious neurological complications. Morbidity and mortality were the highest for S. pneumoniae meningitis. Bad prognostic features were delayed referral, S. pneumoniae meningitis, convulsions and abnormal neurological signs on admission. CONCLUSION: H. influenzae was the most common cause of childhood bacterial meningitis at Kalafong Hospital, with N. meningitidis meningitis being very rare. Morbidity and mortality were very high, compared with outcome in developed countries. Delayed referral seems to be an important factor in predicting an adverse outcome.

Age Factors↗
PubMed1996

A primary health care approach to an outbreak of cutaneous larva migrans.

Primary health care (PHC) has been defined by the World Health Organisation as essential health care made universally accessible to community members, with their full participation, at a cost affordable to the community. PHC could therefore be used in the prevention and treatment of zoonotic diseases in humans, as such diseases are more prevalent in disadvantaged communities. The successful use of PHC principles in the treatment and control of cutaneous larva migrans in children in a semi-rural, low-income community is discussed in this paper. Constraints to implementation of PHC principles were identified as resistance from health care professionals, lack of interdepartmental cooperation and bureaucratic delays. It is concluded that PHC principles can be used successfully for the prevention and treatment of specific zoonoses provided that an aetiological diagnosis is made and the epidemiology of the condition understood. The results also confirmed the relevance of the veterinarian in the control of zoonotic diseases as part of the PHC team.

Ancylostoma↗
PubMed1996

An investigation of the relative morbidity of zoonoses in paediatric patients admitted to Ga-Rankuwa Hospital.

Human-animal interaction is regarded as a positive factor in child development, yet fears have been expressed about the risk of zoonotic diseases. A literature review of zoonotic diseases indicated that it was difficult to judge the relative importance of zoonoses in a population by using incidence or prevalence, as these were not available for all the zoonoses which could occur in children and the data which were available were not comparative. Therefore, in order to investigate the relative importance of zoonoses as a cause of disease in children, relative morbidities were calculated from available medical records from the Department of Paedatrics and Child Health at Ga-Rankuwa Hospital. Diagnoses made were listed and ranked. The relative morbidities of zoonotic diseases were found to be very low. It was concluded that this may have been partially due to the tendency for symptomatic rather than aetiological diagnoses to be made by clinicians, as several of the symptomatic diagnoses made (such as respiratory disease and gastroenteritis) could have had a zoonotic aetiology.

Animals↗
PubMed1994

Paraffin ingestion--the problem.

Paraffin ingestion is the commonest cause of accidental childhood poisoning in South Africa. Children from the lower socio-economic group are affected most. They drink paraffin in the summer months from bottles or intermediate containers, mistaking it for water or cold-drink. The children are predominantly male with a mean age of 24 months. The clinical picture is one of respiratory distress with a hospital case fatality rate of 0.74%. The use of paraffin as a source of household energy in South Africa is on the increase. Based on a modernisation index it would seem that this trend will continue into the next century. It can therefore be expected that the number of cases of paraffin ingestion will steadily increase if no active steps are taken to address the problem. Prevention should entail a wide spectrum of measures, the basis of which should be a child-resistant container. An effective durable, low-cost child-resistant container which is easy to pour from should be made available by petroleum companies and/or entrepreneurs and distributed through their network. This should be combined with health education on the danger of paraffin. Health care workers and administrators should be made more aware of the problem and become involved in health education and prevention. Further research should be undertaken on the effect a change in the colour of paraffin and the use of child-resistant caps would have on the incidence of paraffin ingestion in South Africa.

Accidents, Home↗
PubMed1994

The impact of child-resistant containers on the incidence of paraffin (kerosene) ingestion in children.

The commonest cause of accidental poisoning in the South African black paediatric population is paraffin ingestion. In this intervention study a specifically designed child-resistant container (CRC) was introduced to evaluate whether its use would decrease the incidence of paraffin ingestion. CRCs were distributed to 20,000 households in the study area (Gelukspan district). No CRCs were distributed in the control area (Lehurutshe district). Health education about paraffin poisoning prevention was given in both the control and the study areas. The monthly incidence rates of paraffin ingestion were monitored during the 14-month intervention period after the distribution and were compared with the pre-intervention incidence rates in the study and control areas. The main finding was that the incidence of paraffin ingestion dropped by 47% in the study area during the intervention period. The circumstances surrounding the cases of paraffin ingestion that still occurred in the study and control areas were investigated by means of a questionnaire. We recommend that paraffin be sold in CRCs, and suggestions are made for improving health education to prevent paraffin poisoning.

Accidents, Home↗
PubMed1991

Diagnosis-related groups--application in a paediatric department.

The Diagnosis-Related Groups (DRG) system is used in the USA to classify patients on the basis of diagnosis into medically meaningful groups. The system was developed for evaluation of resource utilisation for peer review purposes. It has become better known through being utilised by Medicare, the medical insurance system for the poor in the USA, for prospective determination and payment of patient's hospitalisation costs. A pilot study to compare the costs of hospital care in a sample of the paediatric patient population at Ga-Rankuwa Hospital with the DRG weightings was undertaken to assess its application locally. A poor correlation was found. The costing studies conducted for this purpose were also used to compare resource use between units in the Department of Paediatrics, and substantial unexplained variations were found. It is concluded that the weightings used in the US DRG system cannot be directly applied to the patients at Ga-Rankuwa Hospital for billing purposes. The DRG principle, however, is feasible and has important management benefits; it is recommended that locally determined DRG weightings be developed, and that other hospitals explore their use in peer review of resource management, costing and pricing.

Diagnosis-Related Groups↗
PubMed1990

Schistosomiasis of the spinal cord--underdiagnosed in South Africa?

Schistosomiasis is endemic in many areas of South Africa, particularly the northern and eastern Transvaal. At Ga-Rankuwa Hospital in the northern Transvaal, 30 km north-west of Pretoria, spinal cord disease is common. In a substantial proportion of these cases no obvious cause for the condition can be found. In an attempt to draw attention to schistosomiasis as a possibly underdiagnosed cause of spinal cord disease, 3 cases of schistosomiasis of the spinal cord seen over a period of 3 years are reported. These 3 patients had histological evidence of spinal schistosomiasis. Because myelography of the spinal cord is often non-contributory in schistosomal involvement, it is suggested that patients with 'myelopathy of unknown origin' who come from an endemic area be given a therapeutic trial of praziquantel, especially if the serological findings are positive for schistosomiasis and the lower cord is involved.

Adolescent↗
PubMed1989

Comparison of the sodium contents of six commonly recommended oral rehydration solutions.

The sodium contents of six differently prepared oral rehydration solutions (ORS) were measured. A total of 452 solutions were prepared in our gastro-enteritis unit. The finger-pinch-and-cup method produced sodium values that were too high and too variable. The most acceptable sodium level was achieved using half a 5 ml medicine teaspoon or 1 level common household teaspoon of salt in 1 litre of water. Half a commonly available household teaspoon of salt caused sodium levels to be low but still acceptable and safe. We recommend that half a teaspoon of salt in 1 litre of water be used when preparing an ORS.

Fluid Therapy↗
PubMed1989

Age and admission weight as predictors of mortality in gastro-enteritis.

The age and weight of 2,095 children admitted to the Ga-Rankuwa Hospital outpatient rehydration unit were analysed with regard to death as an outcome. Age was not a good predictor of death as an outcome. Weight, expressed as a percentage of expected weight for age, was a good predictor of death and should be utilised as an important inpatient admission criterion.

Age Factors↗
PubMed1988

Breast-feeding practices in a private maternity hospital.

An interview questionnaire study of 51 breast-feeding mothers was conducted to assess the stated policy of breast-feeding promotion in a private maternity hospital. A mean period of 20.6 hours elapsed after delivery before initiation of breast-feeding, and 39.9 hours elapsed before rooming-in took place. At least 47.1% of babies received prelacteal feeds, 94.1% were routinely test-weighed, and 56.9% received complementary feeds. A patient-administered questionnaire is proposed to provide hospital management and attendant medical practitioners with essential feedback that could assist them to close the gap between policy and practice.

Breast Feeding↗
PubMed1986

Hospital information systems--a need to re-evaluate the roles of management.

Hospital information systems are now entering a third generation, not only as regards new technology but more significantly with regard to the role of those involved in their design and implementation. This new emphasis requires a re-evaluation of the roles of the designer and user. In the design of a hospital information system, its unique nature--relating central management to a number of independent clinical specialties--must be recognized. One way to achieve this is the establishment of a minimum basic data set dictated by the specific needs of top management interacting with independent clinical subsystems.

Hospital Administrators↗